You may not know it, but you’re likely working for Big Pharma. And you have been since the 1980s.

That was when drug companies decided to begin direct-to-consumer (DTC) advertising. Until then pharmaceutical companies had limited themselves to advertising to the medical community. There was no law that prevented them from taking their message to the streets. It was just the common practice.

Since the ’80s we have been increasingly bombarded with ads for drugs that are supposed to cure or “help alleviate” certain conditions, from the well-known ones such as diabetes to the obscure ones such as Peyronie’s disease. And since that time, ordinary people with no medical education – like you and me – have been shilling for Big Pharma.

The drugs ads all exhort you to “ask your doctor if Drug X is right for you.” Sounds simple enough. What it means, though, is that you, the consumer, are advertising the drug to your physician. In 2017, drug companies spent over $6.1 billion on DTC drug ads and you can bet that they are receiving much more than that in sales, or they wouldn’t do it.

There are FDA regulations that say that the advertising must not be false or misleading. That’s why you see in magazines one page of a smiling family, the name of a drug, and perhaps a slogan. The other page is black and white and features at least three columns of tiny type that no one ever reads, even if their eyesight is good enough. It’s the reason that the voice-over announcer on TV ads recites the list of possible side effects, which many consumers joke are worse than the disease.

One result is that consumers may pressure their doctors to prescribe the newest, most expensive drugs, even if the medication isn’t right for the patient’s condition. In the Journal of Clinical Oncology, oncology nurse practitioners were surveyed on the topic. A full 94% said a patient had requested an advertised drug; in 74% of cases, the request was for an inappropriate drug. And 43% felt pressured to prescribe the inappropriate drug.

But can’t medical people ignore the patients’ inappropriate requests? Maybe. But at least half of patients’ requested drugs are then prescribed. Patients don’t like being told that a drug is too expensive, or not thoroughly tested, or that there are other, older drugs and treatments that work just fine. Americans want the newest, the best, and the most expensive, whether it be sportscars or drugs.

You may notice that ads for brand-name drugs pop up and then hold on for a few years. Then you rarely see them again. Drug companies don’t make as much money when generic drugs become available, so they scale back the advertising. It’s much more profitable to tweak the formula and come out with a newer, even better version of the more expensive drug that consumers can sell to their doctors.

Don’t think that DTC advertising brings health care costs down, either. First, there’s that $6.1 billion dollars in advertising that must be recouped. A study reported in the Archives of Internal Medicine that the cost of Plavix increased due to the need to recoup the high costs of DTC drug advertising.  So did the Medicaid funds spent for Plavix in pharmacies.

Brand-name drugs, the only kinds you see advertised, cost more than the equivalent, just-as-good generics. If you have insurance, the company may have to pay Big Pharma more for the designer drugs, and you can bet the costs are passed along to you in the form of higher premiums.

And insurance companies have lists of drugs they will and won’t pay for, called formularies. If the drug you requested and the doctor prescribed isn’t on the right list, you’re stuck with accepting a different drug or paying exorbitant costs for the shiny new one that caught your eye while you were watching Game of Thrones or the Today Show.

Drug companies used to send employees known as drug reps to doctors’ offices and convention, often spreading dollars, free samples, and certain perks around to influence the sale of their drugs. Now they’ve got a whole new sales force – the American people.

A more thorough discussion of the situation can be found at https://prescriptiondrugs.procon.org/.