The gala was glitzy but the vibe was uneasy.

Just nine weeks after UnitedHealthcare CEO Brian Thompson was murdered on a weekday morning on a busy street, the luminaries of the health care and public opinion industries made a brave return to Midtown Manhattan. Just seven blocks over and five blocks up from where the shell casings hit the sidewalk, they gathered for gaiety in a glitzy ballroom.

The occasion was the 2025 PRWeek Healthcare Awards, a celebration of the sector that crafts the public’s perception of pharmaceutical companies, hospitals, health care insurers and care providers—through advertising, lobbying, corporate outreach, and so much more. Cocktail attire, please.

It had not been the best year ever. There was, obviously, the public relations disaster of Thompson’s murder. There was also the looming specter of an antagonistic new health secretary installed by Donald Trump. Corporate profits for insurance giants were high, sure, but not the highest. Drugmakers’ stock prices had been flagging.

Not to say there weren’t standouts. Eli Lilly, the country’s largest pharmaceutical company, reported $45 billion in revenue in 2024, a 32 percent increase over last year. The company’s net income was up 102 percent since last year. Their profit margin leaped from 15 to 24 percent. Also, the company, along with strategic communications firm Porter Novelli, was shortlisted for an award: Best in Media Relations, for the launch of Kisunla, a new drug for Alzheimer’s that costs patients $32,000 per year.

The insurance giant Cigna, on the other hand, had seen its net profit drop from more than $5 billion in 2023 to just $3.4 billion this year. But it, and its in-house team, were up for an award, too, in the category of Best in Mental Health and Well-Being, for a holistic health survey referred to as the company’s new “Vitality Index.” (The findings were not altogether rosy: “Americans report downward shifts in physical, emotional and financial dimensions of health,” it stated. But also, “optimism is increasing.”)

UnitedHealth, meanwhile, brought in a record $400.3 billion in revenue in 2024, and notched a best-ever adjusted profit of over $25 billion, but incurred a lot of costs dealing with cyberattacks, which brought down the final haul. And then, as we all know, someone—maybe a random twentysomething gunman with back pain, allegedly—offed the company’s CEO and then escaped the city without hassle, and a huge percentage of America said, Well, he’s got a point. So that was really bad, especially as far as relating to the public goes. UnitedHealth was not nominated for an award. No one from the company appeared to be at the event.

I arrived at Gustavino’s, the tony East Side venue, midway through the 6 p.m. cocktail hour. There were no menacing bodymen, no armed guards. “I looked for that, too,” said John Digles, of Ascent Strategy Group, nominated for Outstanding Agency Professional. “At J.P. Morgan in San Francisco”—that’s the J.P. Morgan Healthcare Conference, held in January, the largest and most consequential health care gathering of the year, whose title sponsor should tell you a thing or two about the priorities of the health care industry—“there was heavy security.” This time they didn’t even check ID. “Would you like champagne?” I was asked right upon entry. Why, yes, I would.

Public relations—advertising, communications, crisis response—is an essential part of the American health care industry. Americans pay by far the most for health care of any country, have the most expensive prescription drugs, and, for all that, still have the worst health outcomes among high-income countries. When you’re wringing billions of dollars in profits out of the sickly, you’ve got to put some money into massaging public opinion. That’s just smart business.

Per the awards’ own event page: “Healthcare is an essential part of the PR economy, making up around 35 percent of large agency revenues. It spans pharmaceuticals, hospital systems, public health, medical devices, care providers, health technology, digital health and health equity.” Of all the different types of PR—and there are many—health care is one of the “biggest, most dynamic, innovative and important.” It provides “inspiration everyone can learn from.”

In other words, the PR industry needs the health care industry. And the health care industry needs good PR.

In 2023, according to one Harris Poll survey, more than 70 percent of U.S. adults reported feeling that the health care system was failing to meet their needs in at least one way. Health care spending has continued its expensive skyward climb: In 2000, total health expenditures in America reached $1.4 trillion; by 2023 that amount had more than tripled to $4.9 trillion, easily outrunning inflation. (In 1970 it was $74 billion.) There are the age-old indignities of premiums and copays and costs seemingly all going up all the time. And then there are the endless new pain points for Americans—the rejected claims, the surprise billing, the groveling for coverage in the face of capricious, error-plagued, and rejection-heavy A.I algorithms.

It’s perhaps no coincidence that a 2021 study by AHIP, a health industry trade organization, found that 7 of the 10 biggest pharma companies spend more on advertising, marketing, and sales than they do on research and development. And here I was, swilling cocktails with the people who make it happen.

At a table near the bar, I spoke with Heather Schwanke, a marketing professional in client management. “Was it that nearby?” she responded, when I asked if she was concerned about returning to the place of the CEO hit. “I was leaving a Starbucks this morning and I was like, I hope it’s not this one.” I asked her what she thought the general mood of the industry was. “It’s a tricky time,” she told me.

It’s not just because of the killing and the subsequent lionization of Luigi Mangione, the man charged with—not convicted of!—having done it. Robert F. Kennedy Jr., who was recently confirmed as secretary of Health and Human Services, is not just hostile to the health industry, but has pledged to banish big pharma from television advertising. Despite the fact that he is a conspiracy theorist, swollen with bad ideas, this particular stance—that big pharma shouldn’t advertise—could be good for consumers. According to the New York Times, pharma firms tend to make five times as much in sales as they spend on those commercials. But research has also found that the majority of the most advertised drugs between 2015 and 2021 offered little to no medical benefit compared to existing treatments.

A person could maybe argue that it’s good for Americans to know what drugs are available and on the market. But the United States and New Zealand are the only countries of the 193 recognized by the U.N. that have not functionally made drug advertisements illegal. Pharmaceutical ads tend to overstate benefits and downplay side effects and costs, encouraging vulnerable people to diagnose themselves and ask their doctors for pricey, sometimes unnecessary meds. In general, companies actually spend more money on advertising drugs that are less effective in clinical studies; according to recent research from Johns Hopkins, published in the Journal of the American Medical Association, for every 1.5 percent increase in ad spending, there’s a 10 percent increase in sales. In laymen’s terms: The advertising works selling some drugs that don’t. Meanwhile, what few regulations exist are now being gamed by telehealth startups who hawk their meds online. It’s happening in everything from ADHD medication to psoriasis treatment, all of which can lead to overprescription, which is great for profits but not so great for health outcomes.

Already, Schwanke told me, firms like hers were scrambling to provide guidance and reassurance to their clients about ways to circumvent possible future restrictions on advertising, including relying more on “broadcast news stories.” If RFK Jr. was successful in his quest to banish pharma ads on TV, “that would be a huge change,” she told me. “But we can still get the message out for your drug.”

A sharply dressed queue of people lined up for red-carpet photos in front of a step-and-repeat banner emblazoned with logos of corporate sponsors. Guests snacked on canapés and hors d’oeuvres before proceeding upstairs for the main course. A battalion of waiters fanned out with salads and filled glasses with wine. The awards were announced while we dined.

“This year’s entrants meet the moment and create real change, giving a voice to those who need a platform,” boomed the program’s emcee from the lectern. “You are setting the bar for what health care communications can achieve.”

Genentech, owned by Roche, the world’s sixth-largest pharma company, kicked things off with a big win in “Best Content.” The standout campaign, produced by the advertising firm Syneos Health, was a feel-good musical combatting ableism called Most Likely Not To, which had cast actors with spinal muscular atrophy in a comedy-slash-romance centered on a high school reunion. The story focuses on the long-thwarted love connection between a nondisabled male actor and the wheelchair-using female lead. In the end, they kiss. Song and dance ensue and Genentech sells a treatment for spinal muscular atrophy.

Allegra, owned by pharma giant Sanofi, and Edelman, the world’s largest independent PR firm, picked up the A.I. award, for a campaign called Allegra Airways. Artificial intelligence was used to test air quality in the area of Allegra takers in real time: If the air was thick with wildfire smoke, smog, or pollen where an Allegra user lived, there would be responsive price drop, a “dynamic coupon mechanism,” a not-so-distant cousin of “surge pricing.” (Allegra for all in our dystopian wasteland!) There was even a web-browser component, accessible on mobile, that could help Allegra users chart a path through streets with the cleanest air.

The main course came. (I had an eggplant-heavy vegetarian special). AstraZeneca won an award for Best in Corporate. The anti-ableism musical won again, this time for Best in Media Relations.

Cigna, the biggest and best-represented health insurer at the event, did not take home the award for Best in Mental Health for its “Vitality Index,” even though that campaign had been paired with a million-dollar donation to certain Y locations, for teen and young adult programming—and not a moment too soon: According to the index, “Gen Z adults continue to report the lowest levels of vitality, driven by poor mental health and stress about finances, and 83 percent report experiencing negative impacts of social media.”

Instead, the honor went to Bristol Myers Squibb, which won for a campaign for the company’s new schizophrenia drug, featuring the actor Taye Diggs. In the ad, he engages in a little carpentry while talking with his real sister, who has been diagnosed with schizophrenia. A clip of Diggs appearing on NBC News, in promotion of that promotion, was shown at the awards ceremony. “We need to change the conversation, because so many people see things on television that aren’t necessarily true,” he intoned gravely.

Colorful stage lights flashed on the terracotta tiles of Gustavino’s vaulted ceilings. At my table, there was some grousing about the dinner, which was, if we’re being honest, not very good.

Sanofi won an award for Best Public Affairs, for an ad campaign on Type 1 diabetes. Just two years ago, the company shelled out $3 billion to acquire a firm that specializes in Type 1 diabetes treatment, and a few months later found itself in federal court facing allegations it was acting as a “multifaceted monopolization scheme” to keep insulin prices high. It also faced scrutiny from the Federal Trade Commission. This year’s PR effort—don’t call it a comeback!—featured Usher and NFL insider Adam Schefter traipsing around Capitol Hill and making a visit to the White House.

The anti-ableism musical got another award. “It really was a great show,” the woman seated next to me whispered.

Digles, of Ascent, was seated at my table; the Outstanding Agency Professional nominees were announced, and his headshot flashed on the projector screen, but he did not win. “There’s a shift in public relations,” he told me, when I asked what he thought about this challenging moment for the industry. “For health care, the shift in public opinion is significant. The trust factor is significantly different. We have to pass that test. Public trust has plummeted. Our business has to be more aggressive in addressing that. We have to go on podcasts like Rogan.”

“The horrible thing that happened with UnitedHealthcare,” he said, “painful as it is for us as a business, it’s so important to listen and learn.” That the public had turned against the sector so resolutely that alleged gunman Luigi Mangione still had a fandom of supporters camping out overnight just for a glimpse of his shackled, sockless ankles—that his legal defense fund runneth over with donations, that the general discontentment with American health care seemed to have, in an instant, crossed over into white-hot violent rage. “It sucks,” said Digles.

A gelatinous dessert was disseminated. Some bolted for the door; others made a beeline for the open bar.

I inched over to the Cigna table to chat. Here, I figured I would find the most poignant thoughts on the Luigi Problem; UnitedHealthcare is Cigna’s peer and largest direct competitor, and was already off to a terrible 2025: Two weeks later the Department of Justice announced it was investigating the firm’s billing practices. I sat down next to three women and two men who had lingered at the table. I introduced myself and asked if, given all that had happened—and all that was to come, plus the location of the night’s events—they felt afraid.

“Yeah, it’s serious,” one of them said.

“I would direct you to ‘Let’s Make it Better’ on our website,” one said.

“No comment,” said a third.