Consumer Health Digest #19-03
Your Weekly Update of News and Reviews
January 20, 2019
Consumer Health Digest is a free weekly e-mail newsletter edited by William M. London, Ed.D., M.P.H., with help from Stephen Barrett, M.D. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making. Its primary focus is on health, but occasionally it includes non-health scams and practical tips.
Twenty years of US medical marketing reviewed. JAMA has published a comprehensive analysis of consumer advertising, professional marketing, state and federal regulatory actions, peer-reviewed medical journals, business journals, and news media from 1997 through 2016. [Schwartz L, Woloshin S. Medical marketing in the United States, 1997-2016. JAMA 321:80-96, 2019] The findings include:
- 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. The 2016 figure 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 (DTC) advertising: from $2.1 billion (11.9%) of total spending in 1997 to $9.6 billion (32.0%) of total spending in 2016.
- DTC 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.
- DTC advertising for health services increased from $542 million to $2.9 billion.
- 103 financial settlements between drug companies and federal and state governments totaled more than $11 billion in fines for off-label or deceptive marketing practices.
- 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 to review, from 34 182 to 97 252, the number of violation letters declined from 156 to 11.
- The FTC has never acted against a misleading laboratory test promotion.
- Many hospitals market "executive physicals" that involve 1- to 2-day examinations with unproven advanced imaging.
- People have been found to falsely believe in drug benefits based on information from disease awareness campaigns.
- Drug, device, and technology companies have made substantial donations to patient advocacy groups and work with television scriptwriters to create disease-related story lines without disclosing the collaboration.
- The Joint Commission, which accredits health-care organizations, does not consider advertising during its review processes.
An accompanying editorial says the analysis is "a unique contribution and represents a comprehensive, rigorous, and insightful report on the ubiquitous, multifaceted, multitargeted, and well-financed phenomenon of medical marketing." [Bauchner H, Fontanarosa PB. Medical marketing in the United States—a truly special communication. JAMA 321(1):42-43, 2019] Another commentary about the investigation concluded:
Patients' trust in physicians puts them in a position to help mitigate the harms of DTC advertising. However, trust in physicians and health care institutions may be at stake if medical marketing by practitioners, health care organizations, and manufacturers of health care products continues to increase unchecked. [Ortiz SE. Rosenthal MB. Medical marketing, trust, and the patient-physician relationship. JAMA. 321(1):40-41, 2019]
Evidence still lacking for facilitated communication. A systematic review of the scientific literature published since 2014 has concluded that there still is no evidence that facilitated communication is valid. In the FC process, a so-called "facilitator" supports the hand or arm of a nonverbal, disabled person who points to letters, pictures, or objects on a keyboard or communication board. It is clear, however, that the messages originate with the facilitator, not the patients. The researchers concluded: (a) there are still no studies that demonstrate that individuals with communication disabilities are the authors of the messages generated using FC, and (b) substantial peer-reviewed literature is critical of FC and warns against its use. [Hemsley B and others. Systematic review of facilitated communication 2014–2018 finds no new evidence that messages delivered using facilitated communication are authored by the person with disability. Autism & Developmental Language Impairments 3:1-8, 2018] On January 10, 2019, despite requests from critics to cancel the event, the National Down Syndrome Society broadcast a Webinar that promoted FC. [Vyse S. National Down Syndrome Society promotes communication pseudoscience. Skeptical Inquirer. January 16, 2019]
This page was posted on January 20, 2019.