Medical Marketing in the United States, 1997-2016

• Published in: JAMA : the journal of the American Medical Association 2019-01, Vol.321 (1), p.80-96
• Main Authors: Schwartz, Lisa M, Woloshin, Steven
• Format: Article
• Language: English
• Subjects: Addictions; Advertising; Advertising - economics; Advertising - trends; Business law; Cancer; Cancer immunotherapy; Clinical Laboratory Techniques; Clinics; Companies; Data; Dental materials; Direct-to-Consumer Advertising - legislation & jurisprudence; Direct-to-Consumer Advertising - trends; Drug Industry - economics; Drug Industry - ethics; Drugs; Expenditures; False advertising; Federal agencies; Genetic screening; Genetic testing; Gift Giving; Government programs; Government Regulation; Health care; Health care industry; Health Knowledge, Attitudes, Practice; Health Services; Hospitals; Immunotherapy; Laboratory tests; Legal services; Litigation; Market shares; Marketing; Marketing of Health Services - economics; Marketing of Health Services - legislation & jurisprudence; Marketing of Health Services - trends; Meals; Medicaid; Medical personnel; Medicare; Mental disorders; Mental health; Mental health services; News media; Payments; Pharmaceutical industry; Pharmaceuticals; Prescription Drugs; Professionals; Public finance; Regulation; Regulatory agencies; Safety regulations; Sales promotions; State government; Television; United States; United States Federal Trade Commission; United States Food and Drug Administration
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2018.19320

IMPORTANCE: Manufacturers, companies, and health care professionals and organizations use an array of promotional activities to sell and increase market share of their products and services. These activities seek to shape public and clinician beliefs about laboratory testing, the benefits and harms of prescription drugs, and some disease definitions. OBJECTIVE: To review the marketing of prescription drugs, disease awareness campaigns, health services, and laboratory tests and the related consequences and regulation in the United States over a 20-year period (1997-2016). EVIDENCE: Analysis (1997-2016) of consumer advertising (Kantar Media data for spending and number of ads); professional marketing (IQVIA Institute for Human Data Science, Open Payments Data [Centers for Medicare & Medicaid Services]); regulations and legal actions of the US Food and Drug Administration (FDA), Federal Trade Commission (FTC), state attorneys general, and US Department of Justice; and searches (1975-2018) of peer-reviewed medical literature (PubMed), business journals (Business Source Ultimate), and news media (Lexis Nexis) for articles about expenditures, content, and consequences and regulation of consumer and professional medical marketing. Spending is reported in 2016 dollars. FINDINGS: From 1997 through 2016, spending on medical marketing of drugs, disease awareness campaigns, health services, and laboratory testing increased from $17.7 to $29.9 billion. The most rapid increase was in direct-to-consumer (DTC) advertising, which increased from $2.1 billion (11.9%) of total spending in 1997 to $9.6 billion (32.0%) of total spending in 2016. DTC prescription drug advertising increased from $1.3 billion (79 000 ads) to $6 billion (4.6 million ads [including 663 000 TV commercials]), with a shift toward advertising high-cost biologics and cancer immunotherapies. Pharmaceutical companies increased DTC marketing about diseases treated by their drugs with increases in disease awareness campaigns from 44 to 401 and in spending from $177 million to $430 million. DTC advertising for health services increased from $542 million to $2.9 billion, with the largest spending increases by hospitals, dental centers, cancer centers, mental health and addiction clinics, and medical services (eg, home health). DTC spending on advertising for laboratory tests (such as genetic testing) increased from $75.4 million to $82.6 million, although the number of ads increased more substantially (from 14