A big chunk of that $20B is on high cost ads to the general public, which doesn’t occur in many other parts of the world. It’s a backwards system when a patient is told to ask their doctor for a prescription to a medication by the company that manufactures said medication.
No, that $20 billion is ONLY for doctor marketing. There's an additional $10 billion on top of that spent on patient advertising/marketing.
edit: There's a whole industry around providing pharma companies better tools to influence doctors. I believe the industry name for this part of pharma companies is Medical Affairs so feel free to google the tooling being offered.
Yes, one of the few culture shocks when I lived in America was pharmaceutical advertising to the public. Another was constant political advertising on TV.
It is also a source of culture shock for Americans like me who visit friends and relatives that watch television. I mean, I watch netflix, but haven't ever had a cable subscription, and while I have a digital antena, I pretty much never use it. Visiting a home where the TV is on constantly is shocking, with all the ads and the viewpoints presented. It really shows how much the media fracturing is helping drive the political divide in the country too. I can't really imagine having those messages constantly pounded into my head.
