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In this issue of JAMA, Lisa M. Schwartz, MD, MS, and Steven Woloshin, MD, publish a Special Communication on medical marketing in the United States,1 a topic that affects every physician and patient, and virtually every for-profit entity (and many not-for-profit organizations) involved with the US health care system. This article is a unique contribution and represents a comprehensive, rigorous, and insightful report on the ubiquitous, multifaceted, multitargeted, and well-financed phenomenon of medical marketing.
JAMA publishes only a handful of Special Communication articles each year. For example, JAMA published 2 in 20172,3 and 6 in 2018.4-9
Potential authors often ask what makes a good Special Communication. Special Communication articles focus on topics of broad interest to medicine and the health care community and are authoritative, scholarly, in-depth examinations of important and timely issues. Some Special Communication articles, for example the report by Marston and colleagues,10 collate and summarize a vast amount of information (theirs on antibiotic resistance), whereas others, such as the report by Papanicolas and colleagues,7 present original data (eg, health care costs in the United States compared with those of other countries). The reports are rigorous and data driven and are not intended to represent long thought pieces or to focus on more narrow topics (such as a Viewpoint or Editorial may do).
The ideas for most Special Communication articles (not including those such as major guidelines, for example, the new Physical Activity Guidelines for Americans4 or guidelines for scientific reporting8,9) usually originate after discussion of potential topics among the editors of JAMA. Once a suitable topic is selected, we evaluate the literature and seek advice to identify potential expert authors. Discussions with potential authors ordinarily involve development of the conceptual framework for the article, creation and review of an outline and often draft figures and tables, and establishment of an editorial timetable for the manuscript. These articles often take 6 to 12 months to complete. During the process we personally communicate with the authors, may periodically have additional discussions about article content, orchestrate peer review and seek review and consultation as necessary, and work closely with the authors during the revision and final editing processes. A great deal of effort is focused on clarity of presentation and effective use of figures and tables to highlight key findings.
The report by Schwartz and Woloshin1 on medical marketing in this issue epitomizes the expectations for Special Communication articles in JAMA. The topic is broad, interesting, and important; the article is rich in data and detail; and the content analysis is scholarly and authoritative. This article is particularly representative of our process of developing a Special Communication report and bringing it to fruition.
Advertising for medical products, services, and organizations is highly prevalent in the United States, making the topic suitable for consideration as a Special Communication. The amount and types of medical advertising in the United States have increased and evolved substantially, with an growing emphasis on direct-to-consumer advertising. For instance, during prime-time television programs or sporting events, it is not unusual to view multiple advertisements for various medications. During one televised sporting event, 2 drug commercials ran consecutively, one for a drug to help individuals fall sleep, followed by one for another drug to help individuals stay awake. Current medical marketing also involves more disease awareness campaigns, and more marketing not only by commercial care entities, but also by hospitals and some academic medical centers. In conversations with numerous physicians, it is clear that very few physicians are supportive of direct-to-consumer advertising, and the United States remains only 1 of a few countries that permit such advertising.
Identifying Drs Schwartz and Woloshin as potential authors was easy: they are world-renowned experts and acknowledged leaders in the field of health communications. After a brief discussion about pursuing the topic of medical marketing as a Special Communication, they accepted, and following an exchange of an outline and draft tables and figures they began their work. Periodic discussions followed, as they formulated the approach to the article, sought and obtained the necessary data from multiple sources, and synthesized and collated the information they obtained into a cogent and comprehensive article.
Their article in this issue of JAMA documents the evolution of the marketing of prescription drugs, disease awareness campaigns, health services, and laboratory tests over a 20-year period, from 1997 to 2016. Among the key findings are that
From 1997 to 2016, spending on medical marketing of drugs, disease awareness, health services, and laboratory testing nearly doubled, increasing from $17.7 billion to $29.9 billion.
Marketing to physicians and other health care professionals by pharmaceutical companies accounted for most promotional spending and increased from $15.6 billion in 1997 to $20.3 billion in 2016.
Marketing to health professionals included $5.6 billion for prescriber detailing and $979 million of direct physician payments (eg, speaking fees, meals)
The most rapid increase in medical marketing was in direct-to-consumer advertising: from $2.1 billion (11.9%) of total spending in 1997 to $9.6 billion (32.0%) of total spending in 2016.
Direct-to-consumer prescription drug advertising increased from $1.3 billion for 79 000 advertisements in 1997 to $6 billion for 4.6 million advertisements in 2016, with a shift toward advertising high-cost biologics and cancer immunotherapies, while direct-to-consumer advertising for health services increased from $542 million to $2.9 billion.
Advertising in journals declined substantially, from approximately $744 million to $119 million.
Regulation by the FDA Office of Prescription Promotion remained quite limited, despite an increase in submissions of materials to review, from 34 182 to 97 252; the number of violation letters declined from 156 to 11.
The Special Communication by Schwartz and Woloshin is rich in data and requires a careful reading of both the text and figures and tables to appreciate not only the scope and multifaceted nature of medical marketing, but also the related consequences and regulation of medical marketing in the United States. This report should serve to raise awareness about the extent of, investment in, and potential influence of medical marketing and will serve as a valuable benchmark for years to come.
Corresponding Author: Howard Bauchner, MD (firstname.lastname@example.org).
Conflict of Interest Disclosures: None reported.
Bauchner H, Fontanarosa PB. Medical Marketing in the United States—A Truly Special Communication. JAMA. 2019;321(1):42–43. doi:10.1001/jama.2018.20505
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