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HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2025 47 410 McGinnis, J. M., Stuckhardt, L., Saunders, R., & Smith, M. (Eds.). (2013). Best care at lower cost: the path to continuously learning health care in America. Institute of Medicine. 411 Martin CB, Hales CM, Gu Q, Ogden CL. (2019) Prescription drug use in the United States, 2015–2016. NCHS Data Brief, no 334. Hyattsville, MD: National Center for Health Statistics. 412 Piper, B. J., Ogden, C. L., Simoyan, O. M., Chung, W., & Kim, M. Caggiano, J. F., Nichols, S. D., & McCall, K. L. (2018). Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLOS ONE PloS one , 13(11), e0206100. 413 Centers for Disease Control and Prevention. (2024, November 19). Data and statistics on ADHD. https://www.cdc.gov/adhd/data/[ ] (https://beta.cdc.gov/adhd/data/ index.html). 414 Chua, K. P., Volerman, A., Zhang, J., Hua, J., & Conti, R. M. (2024). 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Risk factors for low adherence to methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder. scientific reports, 11(1), 1707. • Half of Continuing Medical Education courses in the U.S. are funded by the pharmaceutical industry. 500 Studies find sponsored courses profoundly impact physician behavior, increasing prescribing of the sponsor’s drug; 501 industry studies show the return on investment for this averages $3.56 for every dollar spent. 502 • Industry donations to the CDC Foundation are believed to influence federal public health campaigns, highlighting “awareness” of selected child conditions to justify more diagnosis and drug use. 503 The CDC foundation openly advertises that “you can advance CDC’s work on a specific health threat by supporting a CDC foundation program” and have “the ability to target investments where most needed.” 504 Such conflicts of interest may have influenced CDC work, related to hepatitis C screening and chronic kidney dis- ease, as noted in a BMJ investigation. 505 • Clinical guidelines written by respected professional societies and organizations provide a particularly powerful and potentially amplified influence target for industry. Studies suggests there is considerable funding and effort in this direction, with notable con- sequences. Examples include: • Studies have found the majority of clinical guideline panelists in the US have financial ties to pharmaceutical or device companies. 506 • TheAmerican DiabetesAssociation’s (ADA) type 2 diabetes guideline, with 94% of authors reporting conflicts, recommends aggres- sive glucose control through drugs; research indicates this may often worsen outcomes. 507 • TheADAguideline also recommends treating “prediabetes”with drugs despite limited evidence of long-term benefits, 508 consistent with marketing of “conditions” like pre- hypertension and pre-hyperlipidemia. • The majority of the panelists who composed the DSM-5 were found to have conflicts of interest 509 and their recommendations loosened criteria for ADHD and bipolar disorder, driving a 40-fold increase in diagnoses in children 1994-2003, 510 with a rise in prescriptions for antipsychotics and stimulants. 511 • Pharmaceutical companies have settled with U.S. government, including for major settlements of $430 million, 512 $2.2 billion, 513 and $3 billion. 514 4. Influencing Media, Disincentivizing Public Criticism The corporate capture of media, primarily through lavish advertising campaigns that are uniquely targeted to American consumers (no other developed country allows direct advertising of drugs to consumers, other than New Zealand where such advertising is heavily regulated and federally controlled) 515 confers a notable level of reliance on the industry by those that benefit financially. While in the U.S. the pharmaceutical industry has the First Amendment right to have these advertisements, studies suggest that they have a strong influ- ence on those who view them, potentially increasing inappropriate prescriptions. In 2023, drug companies spent over $5 billion on television advertisements. 516 While many more studies exist on drugs used by adults, 517 518 519 520 two specific studies the impact of Direct to Consumer (DTC) advertising on children are broadly illustrative of the problem is also highly concerning: • Direct to Consumer (DTC) DTC advertising for ADHD drugs in children were found have been suggested to use vague symptom lists including typical childhood behaviors ; the ads led , potentially leading parents to overestimateADHD prevalence and to request ADHD drugs inappropriately. 521 • Similarly, DTC advertising for antidepressants is believed to encourage greater use of psychotropic medications in teenagers were found to employ vague symptom lists that overlap with typical adolescent behaviors; this was also associated with inappropriate parental requests for antidepressants adolescents, including antianxiety, antipsychotic, and antidepressant classes . 522