Medical Marketing Spending Increases, While Regulation Stalls


Direct-to-consumer prescription drug advertising increased from $1.3 billion to $6 billion over the past 20 years, particularly for high-cost biologics and cancer immunotherapies.

Although medical marketing has increased dramatically from approximately $17.7 billion to $29.9 billion from 1997 to 2016, regulation of this area has not, according to researchers at the Dartmouth Institute for Health Policy & Clinical Practice.

According to the article, published in JAMA, 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% of total spending) in 2016. Researchers found the following evidence in their review of spending:

  • 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 high-cost biologics and cancer immunotherapies.
  • Disease awareness campaigns by pharmaceutical companies increased from 44 to 401 and spending on them increased 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 centers, and medical services, such as home health.
  • DTC spending on advertising for laboratory tests (such as genetic testing) increased from $75.4 million to $82.6 million. However, due to fewer expensive electronic media advertising, the number of ads increased more significantly from 14,100 to 255,300.
  • In 1997, DTC ad spending for lab testing was almost exclusively for pregnancy/fertility tests, HIV tests, and glucose monitors, whereas, by 2016, 64% of DTC ad spending was for genetic tests. AncestryDNA, the highest advertiser, spent $38 million in 2016.

Although marketing to health care professionals rose less rapidly than DTC advertising, promotional activities did increase in most areas. Marketing to health care professionals by drug companies accounted for most of the promotional spending, with an increase from $15.6 billion to $20.3 billion during this period. Other findings include:

  • Spending on product detailing, or face-to-face office and hospital visits by pharmaceutical company sales reps to professionals was similar in 1997 and 2016, at approximately $5 billion.
  • Spending on free drug samples increased from $8.9 billion in 1997 to $13.5 billion in 2016.
  • One of the few areas in which spending decreased was in medical journal advertising, which declined from $744 million in 1997 to $119 million in 2016.

Health care spending in the United States is the highest in the world: totaling $3.3 trillion (17.8% of total spending) in 2016. In order to capture market share and to expand the market, drug companies and health care organizations use a wide array of promotional activities, including TV and digital advertising, social media, disease awareness campaigns targeting consumers, and marketing to professionals through free drug samples or consulting payments.

The FDA’s Office of Prescription Drug Promotion (OPDP) is responsible for reviewing prescription drug advertising or other promotional materials for validity. However, when reviewing regulatory activity from 1997-2016, researchers found that the number of advertisements or materials submitted for FDA review increased from 34,182 to 97,252, yet FDA violation letters for misleading drug marketing decreased from 156 to 11.

Furthermore, although there have been 103 financial settlements between drug companies and federal and state governments since 1997 that resulted in more than $11 billion in fines for deceptive or off-label marketing practices, the Federal Trade Commission has acted against misleading marketing only in the case of a single for-profit cancer center.

The authors said these findings suggest that enacting better oversight of product detailing or adding tables that quantify the benefits and adverse effects of drugs to advertising could improve the quality of health information and cut back on overprescribing and unnecessary medical spending.


  • Lisa M. Schwartz, Steven Woloshin. Medical Marketing in the United States, 1997-2016. JAMA, 2019; 321 (1): 80 DOI: 10.1001/jama.2018.19320. Accessed August 8, 2019.

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