MONEY IS THE MEDIUM OF THE MESSAGE.

• Author: Singleton, Marilyn M.
• Position: MEDICINE & HEALTH

More than 50 years ago, Prof. Marshall McLuhan posited that the medium is the message. Now, it seems that money is the medium of the message.

Medical Marketing and Media magazine recently published its Health Influencer 50, a "list of professionals across the health care spectrum." It says that these "influencers" made their impact by innovative thinking and "patient-centric" strategies. As expected, the ever-present Google, Facebook, Twitter, and several medical marketers amply were represented. Disturbingly, five of the top 11 influencers were pharmaceutical companies. The sole physician on the list (at No. 12) was Food and Drug Administration Commissioner Scott Gottlieb.

Only three of the named organizations actually were involved in the delivery of medical care: Dignity Health, the fifth largest health system in the nation; Ascension, the largest nonprofit health system in the U.S.; and the Cleveland Clinic.

One troublesome "patient-centric" strategy is the ubiquitous brazen direct-to-consumer pharmaceutical ad. One crafty example is an "informational" or public service-type announcement persuading the viewer to get vaccinated against pneumococcal pneumonia. Ummm. Was the ad sponsored by a health plan? Medicare? The American Academy of Family Physicians? No, the sponsor (credited in very small print) was Pfizer, the vaccine's manufacturer.

Apparently, the influence of many of these entities extends to Congress. The 2017 lobbying expenses of Medical Marketing Magazine's No. 1 "influencer," GlaxoSmithKline, totaled $3,070,000. The other influencers' lobbying costs: No. 2 Gilead Sciences ($2,650,000); No. 4 Allergan ($2,380,000); No. 8 Johnson & Johnson ($3,160,000); No. 10 Pfizer ($8,510,000); and No. 11 Bayer ($7,050,000). Overall, the pharmaceutical manufacturing industry hired more than 800 lobbyists to the tune of $132,405,742.

The mega health insurer Blue Cross/Blue Shield's vice president of Strategic Communications made the list at No. 39. If the criterion were lobbying, Blue Cross/Blue Shield had a leg up with $14,173,960 in related costs--more than triple that of the next health insurer that employs lobbyists.

Then again, perhaps Blue Cross/Blue Shield was rewarded for navigating its way out of the financial depths of ObamaCare's essential benefit mandates. Of the 35 Blue Cross/Blue Shield companies, 23 reported a collective $1,900,000,000 decline in earnings for the first nine months of 2015, and 16 reported net losses because...