A Nation Under the Influence

: The $7 Billion Persuasion Machine. (No. 82)

For most of the 1980s, I maintained a strict boycott of Pepsi products. My reasoning was straightforward: their primary spokesman was Michael Jackson, and I simply detested him. Not even the infamous 1984 production mishap—where a pyrotechnic error literally set Jackson’s hair on fire—could soften my stance or entice me to try the drink. My stubbornness only wavered in the 1990s after I moved to North Carolina. Here, I discovered that soda preference wasn’t just about celebrity endorsements; it was a matter of deep-seated geographic identity. Pepsi was “invented” in New Bern, so it is the beverage of choice for many North Carolinians.

While a distaste for a pop star or a sense of regional loyalty might seem like arbitrary reasons to choose a soft drink, they are as logical as any other factor in brand preference. As consumers, we are relentlessly bombarded by advertising logic that borders on the surreal. We have just emerged from a holiday season where marketing departments expected us to believe that mentally stable, middle-class couples routinely surprise each other with $90,000 SUVs adorned with giant red bows. Even more bizarre are the commercials featuring parents meticulously inspecting their children’s rear ends to ensure they aren’t suffering from the “substandard” toilet paper found outside the home.

These excesses in consumerism, however, pale in comparison to pharmaceutical ads. Drug companies now run over $7 billion in television ads annually, with the top ten spenders alone shelling out nearly $3 billion last year to dominate the airwaves. It is impossible to watch any movie or sports event without being absolutely drowned in ads claiming to relieve everything from tardive dyskinesia to toenail fungus.

When I was a college business student in the 1980s, the Holy Grail of marketing jobs was pharmaceutical sales rep. These jobs paid well, featured great work environments, and offered lavish perks like company cars and clothing allowances. Basically, the role of these reps was to visit doctors’ offices—often bearing gifts, food, and educational materials, along with samples—and advise staff on new drugs and applications. While the travel could be stressful, they were clearly a cut above most other outside sales positions. I have to believe that direct-to-consumer (DTC) pharmaceutical advertising has taken some of the luster from those jobs.

Until 1997, consumer advertising by pharmaceutical companies was highly restricted. The belief was that flooding the marketplace with ads that the non-medical public could not fully understand would create a confused consumer who would then pressure doctors to prescribe medicines that may or may not be appropriate for their specific situation.

That original fear has since manifested into a bizarre cultural reality. Today, the patient is no longer just a seeker of healing; they are a shopper of brands. Drug company ads rely less on fact-based education and more on catchy jingles and choreographed dance routines. We have transitioned from a “doctor-knows-best” model to one where patients arrive at clinics with a “shopping list” curated by prime-time commercial breaks. When a typical 30-second spot for a drug costs upwards of $200 million in annual airtime, the goal isn’t just to inform—it is to create a demand that didn’t exist before the commercial aired.

This “consumerism gone wild” has turned the exam room into a negotiation table. Studies show that physicians are nearly seventeen times more likely to prescribe a specific drug if a patient asks for it by name, even when the doctor feels a cheaper or more lifestyle-based intervention would be more effective. We see this most clearly in the “medicalization” of the human experience—where normal life experiences like shyness, restless sleep, or age-related thinning hair are rebranded as clinical pathologies requiring a lifelong subscription to a pill.

The result is a feedback loop: billions are spent to convince us we are unwell, leading us to demand expensive solutions, which in turn fund even larger marketing budgets. In this environment, the “Holy Grail” marketing job of the past has fundamentally changed. The sales rep no longer needs to convince the doctor; the television has already convinced the patient.