Everyone seems so scared of the word government regulation when it comes to health care. Why? In part, this is because those against regulations (everyone making money off health care) make sure to scare laypeople into equating such action with socialism. Fear of concept is not a good argument against regulating monopolies that are bankrupting millions of Americans. Pretty sure most Americans would be happy to have limitations placed on drug companies if that meant they could afford their medications. Others are concerned that once the government becomes more involved, access will be limited. Valid concern—the government has not proven itself to be the most effective and efficient agency. However, this unfortunate concern regarding access is already a reality. Wait times and delays in care already exist, given the shortage of doctors. And that’s just exacerbated the farther you get from a metropolitan area. The government has legitimate responsibilities that can’t be replaced by private entities—the latter are motivated by profit and not the general welfare of its society. Keep in mind, there are many services the government provides that do not generate profit—profit is not the point of government.
We’ve regulated health care with limits before; the ACA implemented many regulations with the intent of reducing ballooning profit and decreasing costs to consumers. The intent behind the ACA was noble and on point: forbidding insurance agencies from using pre-existing conditions to exclude coverage and allowing young adults to stay on their parents’ insurance are two great examples. The implementation and reality of the ACA missed a lot of marks as insurance and drug companies created workarounds to defang the original intent of the law. What’s needed is major limitations and even moratoriums. But that’s highly unlikely to happen when our government is controlled by money—not good intentions—and our politicians are corrupted by greed and re-election—not the general welfare of their constituents. When a company is making hand-over-fist money, it isn’t just going to give that up without some sort of legal regulation. Only the government has the authority to enact laws that can rein in some of the outlandish profit being made by those in health care—at the expense of Americans and their health. That means our congresspersons should lead the way. Sadly, it seems, most are too busy following the money.
Let’s start there: Ban political contributions by for-profit drug companies. Such money should go towards lowering the costs of drugs, not lining politicians’ pockets. Surprisingly, though, the most recent contributions aren’t as impressive as one would think. Big pharma PAC contributions were less than $1 million per company in 2024. Not surprisingly, they contribute on both sides of the aisle, giving to Republicans and Democrats. When politicians get sizeable donations from a company, you have to imagine that it influences what laws they support and how they vote. Drug companies don’t need more influence than the average consumer.
Actually, drug companies are spending way more on consumers—ads to consumers. While doctors need to learn about new drugs that are more effective or with fewer side effects than the ones we learned about in medical school, the average layperson does not. In 1997, pharmaceutical companies spent $15.6 billion on advertising to physicians (sending paid representatives to doctors’ offices to talk about a drug, free samples, or compensating physicians for giving talks about the drug). That amount increased to $20.6 billion in 2016. During that same time period, pharmaceutical companies increased spending directed towards laypersons from $1.6 billion to $6 billion. This often successfully convinces patients—not doctors—of the benefit of their drug—without any unbiased or counter information. One obvious downside: I have to spend 20 minutes of my patient’s visit convincing them why they don’t actually need the drug they saw on TV. And this is not to say that the patient couldn’t benefit from a drug they’ve heard about on TV. But I can honestly say that I’ve never learned about a new drug that has been scientifically proven beneficial for me to prescribe to a patient from any patient directly. Not to mention, patients are usually happy to get further education and viewpoints, but not every physician has the time to have that discussion. Without taking the time to educate, the patient walks away feeling unheard and frustrated. That, or the patient just finds a new physician to give them what they wanted in the first place. It’s hard for a doctor to refuse the care for which a patient is asking. It’s way easier to just write the prescription than to spend 20 minutes educating the patient. God forbid the “satisfaction scores” that patients give doctors go down—the same scores that may be tied to compensation and/or job stability in an employed situation. Such a scenario perpetuates the cycle of bad medicine.
Why do we allow drug companies to advertise directly to consumers? The average person has not studied pharmacology, various types of medical trials, or the comparative pricing of similar drugs. Having such a background is important to be able to determine if it’s a good drug and if that drug is right for a particular individual. Without that knowledge, it comes down to having the best salesperson, the best jingle, or the most catchy commercial. None of that truly helps the patient. Yet, big pharma spends billions on advertising annually. In 2022, advertising for the top 10 drugs cost companies between $111.8 million and $315.8 million dollars per drug for national TV ads. Think of how much cheaper the drug would be if they eliminated spending on TV ads. Or how much more research could be done? It’s been shown that drug companies spent more than 19 times on marketing than they did on R&D.
After an SNL skit made fun of a super bowl ad back in 2016 for a medication to help constipation—especially constipation after taking narcotics, Ford Vox said it best: “This skit is savvy satire that portrays the medicalization and commercialization of a “street drug” and that seemingly absurd scenario speaks to the underlying truth that a haywire medical system ruled by corporate greed, bad regulations, and complacent doctors actually generated this problem in the first place. SNL also lampooned our increasingly absurd prescription drug ads, which are so pervasively out of control that Super Bowl audiences were treated to a cutesy ad for opioid-induced constipation. Think about that –a pharmaceutical company spent millions advertising a drug that treats the side effects of another overprescribed drug, to the world’s most general audience.”
Just this month, Hims & Hers released a controversial Super Bowl commercial that had many arguing that they didn’t list the possible side effects of their medications. Guess what? They don’t have to. They are not selling an FDA-approved medication, so they don’t have to follow the same regulations and rigorous testing that the rest of the drug companies and their drugs do. And does the layperson have any idea of that difference? I venture to say no. And some congresspersons are trying to take action; Democratic Sen. Dick Durbin of Illinois and Republican Sen. Roger Marshall of Kansas sent a letter to the FDA asking the agency to take action: “To the extent this falls within a regulatory loophole for the FDA’s authorities, we plan to soon introduce bipartisan legislation to close this gap, so that patients are not deceived by advertisements that glaringly omit critical safety and side effect information.” On many things, physicians question Robert F. Kennedy’s ideas. On this point, I agree completely: Just ban the ads in the first place … problem solved.
While no governmental limitations have been put on what drug companies can contribute to political campaigns or spend on national advertising, the ACA did put limits on what drug companies could spend on doctors. Most physicians (94 percent) have some type of relationship with the pharmaceutical industry. Such relationships involved receiving food in the workplace (83 percent), receiving drug samples (78 percent), etc. The ACA said that what drug companies spent on doctors had to be educational. So they couldn’t spend money on pens with their drug or company logo and pass them out to doctors anymore. They couldn’t pay for doctors’ meals at a fancy restaurant or send them to a weekend conference—or could they? This is where the workarounds come into play. Drug companies can still take doctors to dinner as long as there is that educational speaker—and that’s usually a doctor they pay to give a presentation. This often ends up being a nice dinner for office staff (with or without the doctor attending) who don’t necessarily care about or even listen to the educational presentation. Everyone loves a free meal—or to be able to provide your staff with a fancy dinner. But rewarding staff at the expense of the drug company is part of the problem. By rewarding our staff with drug company money, doctors are complacent. Unfortunately, we know the drug companies can afford to do this more than we can. So we acquiesce. However, having the drug company pay for my staff’s meals is not going to improve the health of my patients. Therefore, it’s a waste of drug company money—which adds up to as much as $2.2 billion per year.
Not to say that relationships between physicians and industry don’t have positive effects on patient care. Certain drugs wouldn’t exist if physicians didn’t enroll patients in manufacturers’ clinical trials and provide companies with advice on drug development. Even attending an industry-sponsored dinner may result in physicians prescribing beneficial drugs for their patients. But, “there is no reason why an educational activity needs to be accompanied by an expensive meal or a trip to a tropical resort,” as Eric G. Campbell, PhD said. Ultimately, those expenses get pushed back onto the consumer.
In addition, it’s a slippery slope of quid pro quo when it comes to doctors benefiting from drug company handouts. It might even be subconscious on the part of physicians. This also plays out with free samples. Drug companies aren’t giving out samples to help patients; they do it because it influences prescription writing and maximizes profits. I can make the argument that free samples are great! They allow a patient to try an expensive medication before committing to purchasing it. If it doesn’t help them, they aren’t out anything. However, if it does, they often can’t afford to keep taking it when I prescribe it. So, we haven’t helped anyone. Often, physicians feel free samples help the neediest patients, but this notion hasn’t proven true. In fact, wealthy or insured Americans are more likely to receive free drug samples than poor or uninsured Americans. And all those samples come at a cost. In 2012, drug companies gave out $5.7 billion worth of free samples. These billions are adding up.
As mentioned, the ACA limited what drug companies could spend on doctors. Meanwhile, there are no limits on what drug companies can spend on their CEOs. CEO salary is just part of their overall annual pay/total compensation. Salaries are impressive enough, but total compensation can be staggering. In 2022, the top 10 pharmaceutical company CEOs made $28 million/year or more, with the highest paid getting more than $124.9 million, thanks to stock option awards worth the majority of that. For 2023, the top 10 Big Pharma executives’ compensation ranged from $20.3 million to $28.4 million—the latter was a 116 percent increase from 2022 for Johnson & Johnson’s Joaquin Duato.
And not to say these executives aren’t leading vital and life-changing companies. They are. But I argue that doctors are leading vital and life-saving practices as well, while getting paid less each year for it. America is one of the leaders, if not the leader, in the global drug industry. American drug companies pay for more of the research and studies regarding drugs than other countries. But most of the time, there’s a huge payback when they produce, paten,t and then market a successful drug—with the exclusive rights to that drug for at least 10 years. But it’s all still about the money; the drug companies can’t deny that. They spend billions more dollars on executive compensation, dividends, and stock buyouts than they spend on research and development. In 2022, J&J spent $17.8 billion on stock buybacks, dividends, and executive compensation and just $14.6 billion on R&D. That same year, Bristol Myers Squibb spent $12.7 billion on stock buybacks, dividends, and executive compensation and only $9.5 billion on R&D. When 9.2 million adults (8.2 percent) reported not taking medications as prescribed due to cost, I think it’s reasonable to enact percentage reductions, compensation caps, or some other cost-containment formulary for the heads of drug companies. They aren’t going to do it on their own.
As I’ve stated before, health care is not a standard market. We can’t rely on the laws of supply and demand, nor can we trust corporate America to curb profits in order to provide affordable and adequate health care. We still have arguably the best health care in the world, but the average American, even with insurance, often can’t access it. Or patients go bankrupt when they do. For all these reasons, the system needs some major overhauling. Drug companies have to be a part of this change:
Banning political donations by drug companies saves hundreds of thousands of dollars and removes improper influence. Banning ads to laypersons and banning free drug samples saves literally billions of dollars as well as eliminating safety concerns. Finally, limiting drug company CEO compensation just seems fair. Who is honestly going to argue against that?
Alisa Berger is a urologist.
