Back in 1981 Ira, a journalist who had been suffering from arthritis of the hips for many years, saw the first television ad for a pharmaceutical. At the time Ira, who is now my patient, had no inkling that he was witness to the inception of an insidious process that in twenty years' time would threaten to undermine the fabric of medical discourse between doctor and patient. This first ad glamorized Motrin, one of the original arthritis drugs, and Ira became one of many who asked his physician at the time, Dr. Peter Berczeller, to prescribe it.

"When I was in practice, these ads weren't really in vogue yet," says Dr. Berczeller, retired professor of medicine at New York University. "But I was worried that they would remove the doctor as a filter, an essential provider of information. Prescribing drugs was intended to be a medical function, not a capitalistic stratagem. It's wrong for us to be pressured to prescribe by a patient dazzled by a slick ad."

It's not only wrong, it's unnecessarily inflating medical costs. In February the New England Journal of Medicine published a study showing that direct-to-consumer advertising was 16 percent of drug promotion spending. At the same time the National Institute for Health Care Management released a study showing that 2001 drug costs were up 17.1 percent from the year before, with most of the increases in four heavily advertised categories: arthritis, cholesterol, depression and allergy.

The Kaiser Family Foundation has demonstrated an association between consumer advertising expenditures and drugs that are growing the fastest. Pfizer has practically monopolized the cholesterol market over the past few years by heavily promoting Lipitor to the public as the drug to lower cholesterol and somehow bring about a healthier lifestyle. The result is a $3-billion-a-year drug. This advertising strategy is now being copied by an even more expensive drug, Zocor (Merck), which is less potent at the same dose. Meanwhile, another drug that may have fewer side effects, Pravachol (Bristol-Myers Squibb), is overlooked.

In 1983 the Food and Drug Administration, sensing a controversy, requested a voluntary moratorium on all drug ads until it could determine its position. This moratorium was lifted in 1985. At first, drug companies were hamstrung by the need for an extensive summary of side effects whenever brand names were mentioned. Many manufacturers tried to get around this by resorting to ads that increased consumer awareness of target medical conditions without mentioning brand names. The few drug ads on television that did mention specific products included a prohibitively long trailer of side effects. In 1996 an ad for Depo-Provera, a gynecological medicine, ran almost three minutes and contained almost two minutes of warnings.

But in 1997 the FDA issued a series of limited guidelines that essentially allowed TV ads with only a brief mention of side effects. The drug companies refer to this as "liberation day." The FDA now receives approximately 32,000 notifications of pending product advertisements a year, but generally deals with these over the telephone or with brief correspondences within an eight-week period before the ad is to appear. The actual ad is not seen prior to its appearance on television or in print, and the FDA almost never demands a correction or issues a reprimand. Bob Ehrlich, chairman of Rx Insight, a company that advises drug companies on direct-to-consumer advertising, administers a yearly survey course to drug representatives. He admits, "Like it or not, direct-to-consumer advertising has come to symbolize a drug industry hungry for sales and profits at a time when drug access and affordability are key social and political issues."

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