US health care is broken. Doctors know it, patients know it. It’s a big, profit driven business that does not have the best interest of the patient at heart. A January article in JAMA examines the change in medical marketing from 1997-2016, a good portion of my career. It’s worth a read. Thanks Family Physician, Dr. Cathy Morrow from Dartmouth, for bringing it to my attention. Here are some of the highlights. Medical marketing includes direct to consumer marketing (DTC) about drugs, diseases, lab tests and health care services including clinics, physician groups and hospitals. We see it everywhere: billboards, commercials, magazines, newspapers, and now social media.

--First professional marketing. I thought marketing to physicians died early in my career. I remember drug sponsored lunches during medical schools and residency with good food and lots of gifts. Then they disappeared due to new rules in the residency or hospital/clinic where I worked. But I guess not. Marketing to health professionals about pain led to the opioid crisis and has revealed the dark side of assessing everyone’s pain, or in medical-ease: “Pain as the fifth vital sign.” The wearing down of the joints that comes with use and age needed treatment. Every ache and pain needed to be assessed. The risks of opioids were minimalized. Manufactures paid over 5000 physicians, pharmacists and nurses to attend speaker trainings and sponsored more than 20,000 pain education programs. Opioid sales and deaths quadrupled from 2000 to 2015. Big money was spent to make big money, and now we have a big mess.   

--Selling drugs directly to patients. It’s not uncommon to have a patient come in and ask if drug X would help them, thanks to some advertisement they’ve seen. I didn’t realize that the only countries that permit direct prescription drug marketing to patients are the US and New Zealand. As a result patient requests increased, drug sales increased, despite lower cost alternatives. FDA attempts to add drug fact boxes to advertisement has not been mandated and hence not adapted.  

--Disease awareness campaigns are sneaky. They appear to educate patients about treatments for stigmatizing diseases like Parkinson’s or depression. It sounds like a worthy effort. However, it also medicalizes normal life processes and promises treatments or creates disease that needs treatment. DTC advertising about the “low testosterone of aging,” an off-label use of testosterone which is used to treat primary testosterone deficiency not the age related process, increased testosterone prescriptions. During the campaign, testosterone sales increased from $1.01 million (2009) and peaked at $2.7 billion (2013). Social media advertising has become the new Wild West. Studies show that unbranded web and Facebook pages that describe symptoms and not drugs such as https://www.lighterblue.com sponsored by Takeda Pharmaceuticals which sells mental health drugs (among others) were far more popular and read more widely than the most popular branded page, a page that sells a drug—the multiple sclerosis drug by Novartis.https://gilenya.com/c/ms-treatment/ask-for-gilenya  Compare one million views to 295,000. Stay tuned. We will hear more and this is an area ripe for regulation.  

--Health services advertising is all around us, but is about the high tech, high expense services that are not always evidence based. I am still frustrated by the screenings for stroke or osteoporosis with the quick tests for the general public. The use of these instruments for general screening is not proven and only causes worry and more expense to address patient concerns.  The first hit on my google search for stroke screening led to this: LIFELINE SCREENING

--Finally Lab tests. If social media is the new Wild West, I am not sure how to label the new genetic tests. Often genealogy testing is bundled with testing for genetic diseases. This arena is ripe for abuse and money making schemes. Only a few states are regulating direct access laboratory testing for patients. I am relieved to see that RI is one of them.

So here is another call to action. If you care about ournation’s health and health care stay informed and politically active. We cannotafford to spend precious money on marketing that does no benefit our health androbs education, infra-structure repair, etc.