As Medical Marketing Soars, Is Regulation Needed?
TUESDAY, Jan. 8, 2019 (Pharmacist's Briefing) -- Turn on prime-time TV and you'll likely see a pitch for arthritis or impotence pills, and maybe a cancer center. Advertisers spent nearly $10 billion marketing prescription drugs and medical services to the American public in 2016 -- five times what they doled out 20 years earlier, a new study finds.
Experts said the results raise questions about the influence of advertising over how Americans see their health and make health-care decisions.
The study analyzed trends in "medical marketing" between 1997 and 2016, looking at TV and digital advertising, social media and more.
Medical marketing includes ads directed to consumers: Many are for prescription drugs, but others tout treatments, tests and various services offered by hospitals, clinics and other health providers. It also includes marketing to doctors by drug companies and lab test manufacturers.
In 2016, the study found, those advertisers spent almost $30 billion marketing to professionals and the public. That was up two-thirds from 1997, when the figure stood at $17.7 billion.
And while companies still devote more money to courting providers, spending on consumer ads rose at a much greater rate -- from $2.1 billion in 1997, to $9.6 billion in 2016. The findings were published Jan. 8 in the Journal of the American Medical Association.
"It's an impressive amount of money -- and it's because companies know it works," said study co-author Dr. Steven Woloshin, a professor at the Dartmouth Institute for Health Policy and Clinical Practice.
The problem, said Woloshin, is that by nature, ads tell consumers that the product is "good." Prescription drug ads mention side effects -- in a quick voiceover in a TV commercial, for instance -- but they do not quantify the benefits versus risks.
"People don't realize that even though a drug is approved by the [U.S.] Food and Drug Administration, it may only be marginally effective," Woloshin said.
Nor do ads mention the alternatives for treating a particular condition -- which may be cheaper or drug-free, he noted.
"That's not to say that marketing is always bad," Woloshin pointed out.
It may help lift the "stigma" attached to conditions like HIV or depression, he said, or help people get appropriate tests or treatments.
There's a flip side, though: overdiagnosis and overtreatment.
Woloshin mentioned a study where researchers had actors go to primary care doctors portraying symptoms of either major depression or adjustment disorder. Some specifically asked for an antidepressant, citing something they'd seen on TV.
The result: People who asked for medication were more likely to get it, even when they did not report depression symptoms.
"Marketing can have benefits, but also harms," Woloshin said. "That's why we need strong regulation."
However, the study found little evidence that regulation has kept pace with the explosion in marketing. According to Woloshin, the FDA has taken some action in recent years -- to curtail marketing of unapproved genetic tests that promise to reveal your risks of developing various diseases.
But the public might be surprised by how little regulatory oversight there is, said Meredith Rosenthal, a professor of health economics at the Harvard School of Public Health.
"Don't assume an ad has been reviewed and blessed by the FDA," said Rosenthal, co-author of an editorial published with the study.
The FDA can act when an ad's content violates law, she noted. But it does not put a stamp of approval on every ad.
In theory, Rosenthal said, doctors are the "bulwark," steering patients away from inappropriate treatments, even if they demand them. But, she noted, doctors are targeted by marketers, too, or may advertise services themselves.
Plus, Woloshin said, even when doctors try to convince patients that lifestyle changes, for example, are a better option, they can end up fighting a losing battle.
For now, he and Rosenthal suggested the public regard medical ads with a healthy dose of skepticism.
That includes "disease awareness campaigns," which are often funded by drug companies, Woloshin said.
Again, Woloshin said, that kind of marketing can have benefits, but also harms when campaigns try to expand a disease definition and "medicalize" normal experience. He cited "low testosterone" as one example.
"Some people say we should ban [medical marketing]," Woloshin said. "But that's not going to happen, because of the First Amendment. What we need is stronger regulation."
The U.S. Food and Drug Administration has a guide for consumers on prescription drug advertising.