Dive Brief:

• Spending on most methods of medical marketing grew in the past two decades, but direct-to-consumer advertisements increased the fastest, a comprehensive analysis published Tuesday in JAMA found.
• Total spending on marketing for prescription drugs, disease awareness campaigns, health services and laboratory tests by the health industry totaled $29.9 billion in 2016, up 60% from $17.7 billion in 1997. 
• Spending on DTC ads more than tripled in that time frame, growing in importance to account for roughly one-third of all medical marketing at nearly $10 billion in 2016.

Dive Insight:

These figures help quantify how much value pharma has found in DTC advertising, which also explains industry vitriol over a Trump administration proposal to require drugmakers disclose list prices in TV prescription drug ads.

The analysis also broke down DTC spending by therapeutic area. Leading the way in ad spend for 2016 were drugs for diabetes ($725 million in U.S. spending), dermatology ($605 million) and pain ($542 million).

The three therapeutic categories that decreased since 1997 were drugs for allergies, cholesterol and osteoporosis — all areas where blockbuster drugs lost patent protection or became over-the-counter medicines over those two decades, such as statins and antihistamines.

Pharma companies also spent more on disease awareness campaigns, the report found, going up from $177 million to $430 million in annual spend. These ads are unbranded and promote a disease without mentioning a specific drug.

Promotional spending targeting healthcare professionals didn't increase as aggressively as DTC ads, but still rose to make up roughly two-thirds of total medical marketing.

Of the approximately $20 billion spent on this category in 2016, about $13.5 billion was for free samples, $5.6 billion went to prescriber detailing and slightly less than $1 billion on direct payments to physicians on expenses like speaking fees and meals.

While nearly all tracked categories went up, spending on medical journal ads dropped from $744 million to $119 million in 2016.

On the regulatory side, the study found companies submitted nearly triple the number of materials to the Food and Drug Administration, but the number of issued marketing violation letters issued went in the reverse direction. There were 156 such letters in 1997 and 11 in 2016. 

That downward trend in warning letters has continued, BioPharma Dive previously reported, with one senior FDA official citing legal concerns over the First Amendment. After issuing a record-low five letters in 2017, the office wound up sending seven such letters last year.

"Companies might be producing better materials but it is also possible that FDA reviewers may be overwhelmed by the massive increase in promotional submissions," the JAMA authors wrote.

In a related editorial, health policy professors Selena Ortiz of Penn State and Meredith Rosenthal of Harvard expanded on the rocky history of DTC marketing for prescription medications, which is only allowed in the U.S. and New Zealand.

Previously, they wrote, the American Medical Association and American Hospital Association banned their members from advertising over concerns it would tarnish the integrity and trust in their institutions. Those bans have since been lifted, and medical marketing has prospered.

The professors warned trust in physicians and healthcare institutions is at risk if similar increases in advertising continue unchecked.