Alicia M. Alexander is a second-semester senior at Grinnell College. She studied Psychology with a focus in Neuroscience. Outside of her coursework, she enjoys going on adventures, listening to vinyl records, and snuggling with her personable cat Waffles.
Americans have become increasingly more wary of pharmaceuticals, the pharmaceutical industry, and relationships between pharmaceutical companies and doctors. While dubious marketing practices continue to result in marketing settlements, more and more investigative journalist books, such as Jacky Law’s Big Pharma, are hitting the market to expose the pharmaceutical industry’s influence on health care. As direct-to-consumer (DTC) advertising continues to shape the public’s perceptions of health, illness, and cures, these ethically questionable promotions signify the re-emergence of yesterday’s patent medicine peddlers.
While there are many definitions of “quacks,” this analysis is specifically geared towards marketing behavior  for promoter profit rather than public good. Quacks are people who define normal life-problems using medical terms in order to create a market where consumers will purchase the advertised product, or cure, in the hopes of regaining health. It is important to clarify here that medications are not bad in and of themselves. Rather, it is the presentation of such medications for profit under examination here. Clearly drugs such as insulin, vaccines, antibiotics, and antihistamines (just to name a few) have saved millions of lives since their discovery, and are undeniable medical advancements.
The object of interest, therefore, is the direct-to-consumer advertising of drugs as cures for problems that are not inherently medical. Because such advertising techniques are critical in shaping the public’s perception of health and illness, as well as the relationship between doctor and patient, there are several ethical considerations that accompany DTC marketing. However, big pharma has seemingly ignored these in the interest of company profit. These are all too familiar characteristics of quacks that have been plaguing America for centuries.
Quackery was introduced to Colonial America through English Nostrum imports during the 18th century . Originally, simple ads containing the name of the imported goods were listed in newspapers. The real advertisement took place directly towards product consumers as removable, elaborate labels wrapped around distinctively packaged bottles. As the American Revolution erupted, trade became more restricted, imports were greatly reduced, and the distinctive bottles were re-filled with American counterparts. Though British imports were resumed after the war, imports were noticeably more expensive than local remedies. Whereas there was no incentive for elaborate newspaper advertisements before the war, as proceeds would mainly support over-seas producers, postwar marketing changing to promotional pamphlets and medicine shows signified American interest in profit.
Rooted in theatrical performance , quacks appealed to potential consumers by catering to folk beliefs, attracting crowds through singing, and re-assuring people that the products would cure their ills. These were salesmen of the most charming variety, who boosted their legitimacy by using medical terminology in order to describe everyday problems. Their advertisements produced most of the income for newspapers by the early 19th century. With the advent and boom of radio in the early 20th century, companies could continue to strengthen their marketing relationship with the media using DTCs. This relationship was profitable to both parties involved. “In 1934, radio grossed $72,887,000 in advertising, more than 80% of which went to the advertising of drugs, foods, and other convenience items” . When adjusted for inflation, today that would be $1,242,515,861.48.
After media statements such as, “the quickest way to a woman’s lips is in her ears”  had quickly proven to be true, the Standards of Practice for Radio Broadcasters of the United States of America issued a regulation for radio advertisements in 1937. Prior to this point, the 1906 Pure Food and Drug Act attempted to promote public safety by requiring manufacturers to list the active ingredients on their labels. While this act brought ingredients into awareness, it did not regulate advertising. The new radio regulation meant that broadcasters could only report the name of the program sponsor rather than their DTC advertisements. By 1938, Congress was beginning to define what drugs could be used and who could administer them. The Federal Food, Drug, and Cosmetic Act of 1938 brought safety to the forefront of marketing regulations by requiring proof of product safety prior to advertising; it was followed by drug limitations.
The period between 1951 and 1970 was marked by increasing legislation for drug safety, restriction, and drug information provided to consumers. Drug advertising had been directed towards physicians in journals rather than directly at consumers. Then Reagan took office, and the 1980s began the shift from “the golden age of doctoring” to an “increasingly buyer-driven system” . With a change in the wealth perspective, pharmaceutical companies – as well as other big industries – embraced the concept and benefits of fortune. Patents, intended to be a financial incentive for pharmacological research , became a method of accruing profit rather than better pharmaceuticals as companies teamed up with tax-payer-funded university research departments. The Hatch-Waxman Act in 1984 [see page 25] extended patent life from an average of 8 years in 1980 to an average of 12 years by 1993. Subsequent Acts throughout the 1990s increased the average patent life to almost 16 years, assuring an increase in a company’s revenue.
Because pharmaceutical companies – assuming they are funding their own research – gain financial expenditures back once the drugs are patented and approved for marketing, patent expiration is a revenue killer. Once generic drugs are able to be marketed and sold, developer profit is greatly decreased. For example, Zantac sales decreased by 90% within four years of the generic release [see p. 245]. Three components, then, contribute to product sales. First, brand name recognition becomes important for continued selling, because patients as consumers will recognize the brand and request it from their physician. Second, DTC advertising is a way to familiarize patients with that name. Finally, marketing drugs for multipurpose use keeps them on the market.
The need for marketing regulations in the 1930s illustrates the power of advertising on consumer demand. Setting those regulations aside in the late 20th century, The Food and Drug Administration Modernization Act (FDAMA) increased the previously reigned in freedom of advertising to promote medication . As patient consumers are bombarded with advertisements about drugs that are framed around everyday situations with suggestions of possible medical explanations, these non-medical moments become illnesses to be treated with the marketed product. In comparison to America’s past several centuries, the advertisements today now that regulations are no longer as strict as they were in the 20th century are frighteningly similar to the advertisements of proclaimed cure-alls. It’s time for the public to inquire and the government to reflect on medicine’s historical contexts.
- Porter, Roy. Health for sale: quackery in England, 1660-1850. Manchester [England: Manchester University Press ;, 1989.
- Young, James Harvey. The medical messiahs; a social history of health quackery in twentieth-century America.. Princeton, N.J.: Princeton University Press, 1967.
- Anderson, Ann. Snake oil, hustlers and hambones: the American medicine show. Jefferson: McFarland & Co., 2004.
- Fowler, Gene, and Bill Crawford. Border radio. Austin, Tex.: Texas Monthly Press, 1987.
- Conrad, Peter. The medicalization of society: on the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press, 2007.
- Brekke, Kurt R., and Odd Rune Straume. “Pharmaceutical Patents: Incentives for Research and Development or Marketing?” Southern Economic Journal 76, no. 2 (2009): 351-374.