The amount of money spent on medical marketing in the United States has dramatically grown from 1997 through 2016, according to data from a study published in JAMA.1 The increase in direct-to-consumer (DTC) spending was partially attributed to the “shift toward advertising high-cost biologics and cancer immunotherapies.”

Study researchers reviewed several areas of medical marketing between 1997 and 2016, including the marketing of prescription drugs, disease-awareness campaigns, health services, and laboratory tests. They also reviewed action taken by the US FDA during that time period, such as fines and financial settlements.

Spending on medical marketing increased from $17.7 billion in 1997 to $29.9 billion in 2016. The most dramatic increase in spending was for direct-to-consumer (DTC) advertising, which was $2.1 billion of total spending (11.9%) in 1997 and $9.6 billion (32.0%) in 2016. An editorial accompanying the study described this as the “most striking” pattern of change in medical marketing to be identified by the study authors.2

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Spending on DTC prescription drug advertising rose from $1.3 billion to $6 billion, the study authors wrote. The number of advertisements also increased from 79,000 in 1997 to 4.6 million in 2016.

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This increase in DTC advertising by manufacturers “increases the need for clinicians to help patients understand product claims, medical need, cost, and nonmedical alternatives,” wrote the authors of the editorial.2 “Evidence that physicians have been either misled or otherwise persuaded to act based on fraudulent pharmaceutical marketing in recent decades, however, suggests that professionals may need further education or support to serve as the arbiter of deceptive marketing.”

Even though medical marketing for DTC advertising for drugs and health services increased substantially during the study period, pharmaceutical marketing to health professionals still accounted for the most spending, “and remains high even with new policies to limit industry influence,” the authors of the main study wrote. “Despite the increase in marketing over 20 years, regulatory oversight remains limited.”1

Spending on DTC advertising for health services rose from $542 million to $2.9 billion; spending on DTC advertising for laboratory tests rose from $75.4 million to $82.6 million; spending on marketing to health care professionals by pharmaceutical companies rose from $15.6 billion to $20.3 billion.

Companies submitted an increasing number of consumer and professional drug promotional materials to the FDA (34,182 in 1997 vs 97,252 in 2016). Meanwhile, the FDA sent a decreasing number of violation letters for misleading drug marketing (156 in 1997 vs 11 in 2016).

Some critics pointed out that once one accounts for inflation, the difference between the marketing spend by pharmaceutical companies from 1997 to 2016 is not as dramatic as it may appear. And, although marketing for prescription drugs and disease-awareness campaigns increased 60% during this period, total US drug spending increased as well — by 180%. This means that in actuality, drug marketing as a proportion of total US drug spending decreased from 14.7% to 8.2% during this period.


  1. Schwartz LM and Woloshin S. Medical marketing in the United States, 1997-2016. JAMA. 2019;321(1):80-96.
  2. Ortiz SE and Rosenthal MB. Medical marketing, trust, and the patient-physician relationship. JAMA. 2019;321(1):40-41.