Steven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth Institute

Marketers Spend At Least Six Times FDA Budget on Promotion of Medical Services Interview with:
Steven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth InstituteSteven Woloshin, MD, MS
Co-director of the Center for Medicine and Media
The Dartmouth Institute What is the background for this study? What are the main findings? What influence does medical marketing have on medical care and drug prices?

Response: There are published studies looking at promotional spending mostly for drugs (DTC and professional).  This paper is unique because it is such a broad look including not just drugs but also marketing of disease (in “awareness campaigns”), health services and laboratory tests.

What is new here is the size and scope of marketing.  For context, $29.9 billion spent on promoting prescription drugs, disease awareness campaigns, health services, and laboratory tests corresponds approximately to $1000 per American.    For context, FDA’s total budget is around $5 billion – and NIH’s total budget is about $30 billion.

This figure is up from $17.7 billion in 1997, with the most rapid increase in DTC promotion of prescription drugs and health services.   Pharmaceutical marketing to professionals (detailing visits and samples) accounted for most spending and remained high despite policies to limit industry influence.

$30 billion is of an underestimate (egg, we did not include monies spent on professional marketing (detailing) of laboratory tests, health services or devices, the value of drug coupons/discounts/rebates, company marketing budgets, lobbying or campaign contributions).

Further it is just the tip of the iceberg – marketing works so promotional spending is an important driver of why medical care is so expensive:  it leads to more – and more expensive – tests and treatments. What should readers take away from your report?

 Response: Medical marketing increased substantially from 1997 through
2016, especially DTC advertising for prescription drugs and health services.
Pharmaceutical marketing to health professionals accounted for most spending and remains high even with new policies to limit industry influence. Despite the increase in marketing over 20 years, regulatory oversight remains limited. What recommendations do you have for future research as a result of this work?

Response: We need more research on what goes on in detailing visits, better metrics for impact of marketing (ie, dollars are problematic with shift to less expensive digital media) and more focus on and regulation of awareness campaigns.


Unrelated disclosures:

  • I was cofounder of Informulary, Inc, a company that provided data on the benefits, harms, and uncertainties of prescription drugs. The company has ceased operations and never took industry money.
  • I received personal fees from Ross Feller Case, LLP for serving as a medical expert in testosterone litigation (for plaintiffs).


Schwartz LM, Woloshin S. Medical Marketing in the United States, 1997-2016. JAMA. 2019;321(1):80–96. doi:10.1001/jama.2018.19320

[wysija_form id=”3″]



The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Last Updated on January 9, 2019 by Marie Benz MD FAAD