The pharmaceutical industry is motivated by profit and it is the quest for ever larger sales and profits that determines how the industry promotes its products. The author analyzes the methods that drug companies use in marketing their drugs to doctors and consumers, and the consequences in terms of costs and health. Some of the drugs advertised are valuable; others are irrational mixtures, useless or dangerous and should not be on the market. Even for products of proven worth, the companies have a double standard when it comes to promoting them in the Third World. The International Federation of Pharmaceutical Manufacturers Associations does have a Code of Marketing Practice, but major weaknesses in the code render it almost impotent in regulating promotion. When consumers and health care professionals question the tactics of the industry, the response is usually to attack the credibility of the critics rather than to deal with the issues that they raise. Physicians and consumers are strongly influenced by pharmaceutical promotion, with all too predictable results: Doctors prescribe irrationally and consumers develop grossly distorted ideas about the value of modern medications. Reforms to promotional practices are possible, but may be beyond the resources of Third World countries. Achieving these reforms will require the efforts of Third World countries, progressive elements in the pharmaceutical industry, consumer and professional groups and some form of organized international support.