US drug companies have decided to take their wares directly to the people.

Increasingly, the big conglomerates are advertising their prescription drugs direct to the consumer.

In the past these advertisement were limited to the pages of medical journals. But while direct advertising in the US has been legal since 1983, recently it has become more widespread. Today a consumer can see advertisements for prescription only drugs Viagra is a good example on buses, subway trains, in magazines and newspapers and on television. It has been estimated that US pharmaceutical industry spends in the region of a billion dollars a year in direct consumer advertising.

While these advertisements are supposed to refer patients to their doctors for more information and should not encourage self diagnosis or treatment, often this is not the case. Speaking at a symposium sponsored by the American Medical Writers Association, Susan Hershberg Adelman, a paediatric surgeon of the University of Michigan and a trustee of the American Medical Association, people "see advertisements for stimulants, tranquillisers, antidepressants, hypertension drugs, all available from foreign [Internet] sites. They self diagnose, order the medication from an Internet site and take it. God only knows what happens to these people."

Drug manufacturers, not surprisingly, see advertising as a good thing. They argue that it is a way to drive health costs down, and promote greater awareness of treatment options among consumers. But according to Adelman, the likely end result of such advertising may end up costing the drug companies dearly. Because there is no longer a "learned intermediary" in the form of a doctor advising on drug use, drug companies could be risking hefty law suits if they fail to inform consumers clearly of the risks and benefits of their products (BMJ, 1999; 319: 805).