This is potentially a very bad thing. Like many doctors, Clifford Dacso, a vice chair at Baylor College of Medicine, worries that direct-to-consumer advertising will cause patients to ask for medicines they don't need. But he also thinks ads could play an important role. "We have words of art in medicine that are innately deceptive," Dacso says. If our words can be translated into images that are understandable and it creates a more open market for information, people can make better decisions."

Right now, that's not happening. Prescription drug ads underperform those for over-the-counter drugs, which are made and marketed by the same firms. An ad for Celebrex, the painkiller sold by Pfizer (nyse: PFE - news - people ), was the top-ranked prescription drug ad by IAG's metrics in 2002. But it came in ninth place when prescription drugs, over-the-counter drugs and herbal supplements were mixed together. Ads for Immodium, the diarrhea treatment sold by Johnson & Johnson (nyse: JNJ - news - people ), and Excedrin, a mixture of acetaminophen, aspirin and caffeine sold by Bristol-Myers Squibb (nyse: BMY - news - people ), were etched more deeply in consumers' minds.

An obvious caveat springs up here. Celebrex had 2002 sales of nearly $3 billion, whereas Excedrin and Immodium didn't even merit line items in the earnings reports of Bristol and J&J. But that is because a 200-milligram capsule of Celebrex costs $2.50, while an extra-strength Excedrin pill costs 90 cents. One patient on Celebrex is worth three on Excedrin. Even so, there's a lot more besides direct-to-consumer advertising driving Celebrex sales.

 

Take these numbers, culled from a report by pharmaceutical consulting firm Arxcel. In 2001, the drug industry spent $2.6 billion on direct-to-consumer advertising (that includes magazine and other advertisements as well as television), 8% more than in 2000. That might seem like a lot, but drug firms spent nearly twice as much visiting doctors, and nearly four times as much--a walloping $10.5 billion--on free samples of medicines. Direct-to-consumer advertising was 14% of the promotional pie--significant, but not overwhelming.

Some doctors defend the $10.5 billion worth of freebees as a good thing, because they allow patients to "test drive" new medicines before paying for them. "The drug companies are doing it because the assumption is the drug will work and I'll write a big ole prescription for it," says Baylor's Dacso. "They're dead-on right." Right or wrong, prescription drug advertisements are not the most powerful driver of drug sales.

In fact, it is possible that some of the greatest success stories of direct-to-consumer advertising are overblown. Claritin, the non-sedating antihistamine from Schering-Plough (nyse: SGP - news - people ), is often credited with starting off the direct-to-consumer marketing craze in the pharmaceutical industry. But Claritin was filling a huge void in the market. Other non-sedating antihistamines then being sold, such as J&J's Hismanal, had just been shown to cause potentially deadly heart side effects. Even without a push to consumers, doctors might have flocked to write prescriptions for Claritin.

It's impossible to know. Likewise, it is not clear why prescription drug ads perform so dismally. One obvious answer is regulation. All that fine print included on TV ads for prescription products certainly makes it more difficult for companies to be convincing. Stacker 2, the reputed herbal "fat burner" sold by privately held NVE Pharmaceuticals, can tell its story however it wants, big pharmaceutical companies face restrictions. Another factor: Prescription drug ads are a relatively new phenomenon, and drug firms still have a lot to learn about making them.

 

There are glaring exceptions. For one, Viagra, Pfizer's pill for erectile dysfunction, has significant brand recognition, and viewers tend to remember ads for it. So far this year, an advertisement for Viagra being shown this year has been trumping most of the O-T-C ads. In the ad, "Bob" goes to a party and is asked if he cut his hair or got a new shirt. In reality, he finally asked his doctor about Viagra.

Even in that success story, there is a necessary caveat. Viagra's $1.7 billion in annual sales are up only $300 million since 1999. The impotence pill has proven very difficult to sell. Soon, Pfizer will have to share the market with two competing pills. The ads may be helping, but they're certainly not driving Viagra to mega-blockbuster status.

The world might be a better place if drug companies could tell their stories more clearly. The unfortunate side-effect of the FDA's regulation of drug ad claims is that companies wind up saying very little at all. They should instead be encouraged to take swipes at each other in an active debate. Baylor's Dacso even thinks this might provide part of the solution to skyrocketing drug costs.

"If we recognize that there are five drugs that treat the same illness the same way," Dacso says, "they're commodities." It is about time the advertising world treated them as such.