There are multiple reasons that healthcare spending in the U.S. is twice the per capita average of other wealthy countries – one of which is that Americans spend more on pills than anyone else. Our spending on prescription pharmaceuticals is 67% higher than second-place Germany and roughly double the average of the 38 OECD countries.

And it is no coincidence that not a single country in Europe or Asia allows drug companies to advertise pharmaceutical medications directly to consumers (DTC). In the U.S., however, DTC ads for medications that require a doctor’s prescription comprise about 15% of all television advertising spots.

There are numerous possible explanations. Maybe Novo Nordisk

buys a bunch of Super Bowl ads to make doctors aware of Ozempic. Some people theorize that prescription drugs ads are a way for pharmaceutical companies to curry favor with network news departments. But the simplest explanation is probably the most likely: drug companies want patients to tell their physicians what drugs they need.

The perverse irony is that the prescription medications most heavily advertised directly to consumers tend to offer minimal-to-no therapeutic benefit relative to existing alternatives. Instead, drug ads are most likely to feature high-revenue, patent-protected drugs for chronic conditions. That is, the products most likely to produce the longest-lasting, most profitable revenue streams.

In the past five years, pharmaceutical company spending on ads for prescription medications has more than doubled, compared to a 45% increase in research and development spending. The ten largest pharmaceutical companies spend about $14 billion a year on DTC ads and marketing, or twice the U.S. government research funding for the National Cancer Institute.

My general philosophy is that people are responsible for themselves, or at least should be. If advertisers can simultaneously convince me to purchase Doritos potato chips and Ozempic, that’s on me. But the drug portion of that freedom equation is more complicated than the snack food – and not just because connection between the buyers and payors of those products are so different. If the argument in favor of DTC advertising for pharmaceuticals is that it allows consumers/patients to make more informed healthcare decisions, then why require prescriptions? Shouldn’t consumers be able to make their own choices about which diabetes or antidepressant pills to buy?

But if not, because these choices are inherently complex or easily manipulated, then maybe we should admit that drug advertising isn’t really about patient education. It’s about persuasion and demand generation – no different than a beer commercial.

And we should also admit that this relentless push to generate consumer demand is one of the many reasons Americans spend more on healthcare than anyone else.

David Moon is president of Moon Capital Management. A version of this piece originally appeared in the USA TODAY NETWORK.