Drug makers and other healthcare companies spent almost $30 billion in a single year to influence the medical choices made by Americans and steer them toward treatments that were newer, vastly more expensive and sometimes riskier than their tried-and-true alternatives, new research shows. The 2016 expenditures paid for TV commercials, sponsorships of patients' groups, promotional meetings for doctors, free drug samples and perks for prescribers. The amount represents a 70% increase since 1997, when drug companies began making direct appeals to American consumers. The study ... offers the most comprehensive accounting of healthcare marketing efforts to date. It traces broad shifts in the media and regulatory environment in which health companies operate, as well as the drugs and services " including erectile dysfunction pills, DNA testing kits and robotic surgery services " they are keen to sell. While lawmakers and regulators have tried to counter the impact of healthcare marketing in recent years, the reforms have had little effect on an industry that accounts for nearly 18% of the country's gross domestic product. The drug industry has increasingly turned to a more indirect approach in its marketing: sponsoring disease-awareness campaigns. Such campaigns, in which a company sponsors ads that do not name a particular medication, rose from 44 in 1997 to 401 in 2016, with an attendant spending increase from $177 million to $430 million.