A commentary in the May American Journal of Public Health calls for adding the “informal and non-advertising forms of drug promotion to a strengthened regulatory portfolio.”

The article’s authors assert that despite the attention focused on DTC of prescription drugs, which has ballooned up to $4.2 billion as of 2005, non-advertising forms of promotion are also extensive, with consumers constantly being exposed to, “celebrity endorsements, ‘astro-turfing’ (planned and industry-funded‘grassroots’ disease awareness programs), friendly (or for-hire) science writers, and the like.”

And the situation has been similar for decades, say Jeremy Greene of the Harvard department of the history of science and David Herzberg of the University of Buffalo.

For example, in the 1920s some pharmas ran ad campaigns in popular magazines lauding the quality of pharmaceuticals without mentioning a product. In the 1950s, note the authors, Roche put ads in copies of Time that were mailed to doctors. In the 1950s and 1960s there was “an energetic exploration of non-advertising marketing through newsreels, article placements, event planning, and other domains of public relations,” they state.