When reformers look for ways to slash the ever-higher costs of American medical care, one line item should leap from television screens, print pages, and radio broadcasts: How does the nation benefit from medical enterprises spending $30 billion annually in a growing avalanche of marketing and advertising — and why can’t this be stopped or subjected to tougher regulation?
Two physician-scientists at The Center for Medicine in the Media at the Dartmouth Institute for Health Policy and Clinical Practice have published on the JAMA Network their new research, showing that:
[M]edical marketing expanded substantially [between 1997 and 2016], and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.
Steven Woloshin, co-director of the center and a co-author the study with Dr. Lisa M. Schwartz, told the independent, nonpartisan Kaiser Health News Service, that medical huckstering comes at a cost to consumers, saying, “Marketing drives more testing. It drives more treatments. It’s a big part of why health care is so expensive, because it’s the fancy, high-tech stuff things that get marketed.”
As KHN’s Liz Szabo wrote of the research findings by Schwarz and Woloshin:
Advertising doesn’t just persuade people to pick one brand over another. … Sophisticated campaigns make people worry about diseases they don’t have and ask for drugs or exams they don’t need. Consumer advocates say that taxpayers pay the real price, as seductive ads persuade doctors and patients alike to order pricey tests and brand-name pills.
Diana Zuckerman, president of the National Center for Health Research, a nonprofit that provides medical information to consumers, told Szabo that, as advertising and marketing push demand for medical services and drugs skyward, insurers hike health coverage costs accordingly. Further, taxpayers foot these bills through Medicare and Medicaid. Zuckerman told Szabo: “These ads can be amazingly persuasive, and they can exploit desperate patients and family members.”
Meantime, Big Pharma keeps showering doctors and hospitals with freebies: food, drinks, tchotchkes, trips, conferences, and speaker fees. All these “little” items added up in 2016 to almost $20 billion in spending, which other researchers have documented, has a corrupting influence on how doctors practice — whether “buying” their prescription pad for the cost of a pizza, prompting them to rely on costly drugs and medical devices, or even in abetting the opioid crisis.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, effective, and excellent medical care. This is truer as medical costs soar — notably for prescription drugs — and the complexity and uncertainty of treatments rises. The torrent of medical marketing, advertising, hype, and bunk has gone far past unacceptable. Cable TV channels have become one disease-, drug-, or medical device-commercial after another. It’s impossible to pick up most any publication without getting hit in the face with an ad for a drug or medical treatment.
A West Coast colleague notes that viewers weary of watching playoff NFL games could barely turn the channel in Los Angeles, the nation’s No. 2 broadcast market, without hitting hours of sponsored, testimonial programming for dubious stem-cell therapies — which also are subjects of full-page print ads or even topics for whole publication sections.
Schwartz and Woloshin, throughout a readable academic work, pound home in area after area that the federal Food and Drug Administration and the Federal Trade Commission have become inert, impotent, and ineffectual in protecting Americans from spurious spending for the hype of dubious medical services, drugs, and devices. Contrast this, for example, to the rest of the world, where, for example, direct-to-patient advertising for prescription drugs is banned (except in New Zealand).
Yes, America has and needs robust free speech and commercial activity. But over-screening, over-diagnosis, and over-treatment have become an epidemic of wasteful medical spending that may amount to hundreds of billions of dollars annually — and slashing medical advertising and marketing, turning the spigot on a key source of the kerosene for this raging cost burn would be a wise start, even if only to extinguish the abundant and damaging bunk flooding the market.