Pills used to come in brown bottles. Prescriptions were written in an indecipherable scrawl by doctors who would brook no dissent from uppity patients. Those days are gone forever.

Led by US consumer activism and a growing interest in health, and fuelled by a relaxation in regulations and increased access to the internet, medicines are beginning to resemble other consumer products.

Certainly there will always be differences. New, powerful drugs will continue to be screened by trained physicians. People will never purchase chemotherapy medicines on impulse at the supermarket checkout. But these days, as never before, drugs are created, branded and promoted with the consumers (including the prescribing physician) very much in mind.

Global launches are becoming increasingly possible as regulation between the US, Europe and Japan gradually harmonises (see Japan section).

Companies spend increasing amounts of time and money developing a global brand name and a consistent message that can be delivered (with minor tweaks) anywhere in the world.

As health professionals train abroad, medical practice is becoming more universal, creating a more tight-knit global community of experts whose opinions cascade down to lower levels of the healthcare system. Patients, too, are tapping into this body of knowledge and are gaining a greater say in their own treatment.

"The internet and direct-to-consumer advertising is increasing the power of patients," says David Baker, head of European life sciences at Computer Science's Corporation, a consultancy.

"We are no longer in an age where an ill-informed patient goes to see a doctor for advice. More often than not the patient is already well informed before they go through the surgery door."

"We know that 66 per cent of patients that ask the doctor for a particular product get it," says Thomas Ebeling, the former Pepsi executive who has become head of pharmaceuticals at Novartis, the Swiss drugs group.

"Time is money. If the patient wants a product and it's indicated [licensed for that condition] and it's a good product, then why should the doctor start a discussion."

The traditional push is being complemented by pull and the industry has responded to the possibilities. In first six months of 2000, according to IMS health, drug companies invested $1.3bn in direct to consumer advertising, the same as in the whole of 1998.

According to Cap Gemini, the consultancy, DTC now accounts for 16 per cent of total promotional spend in the healthcare industry. In terms of TV advertising, medicines come third only to cars and retail products.

Such advertising is largely a US phenomenon following a relaxation in regulations in 1997, a change currently under review.

But in Europe, where direct advertising of branded prescription products is banned, companies have not given up the chance of creating consumer pull.

They do so through internet sites, which can be viewed from anywhere in the world. (Warnings that information is intended for US audiences only tend to be in small type.) They also promote the use of their medicines through disease awareness campaigns, such as that of Pharmacia in the UK urging patients to seek treatment for urinary incontinence. Pharmacia, naturally enough, has the leading medicine in this field.

Industry observers believe, as pressure for patient information increases, regulations will gradually relax, allowing companies to forge closer relationships with the public.

When Mr Ebeling joined Novartis from the soft drinks industry, what struck him most were the similarities. "The same rules of differentiating your product, making sure you promote with the right message in the right media to the right people is really the same," he says.

"What's different is the product, which is more complicated. But the principles of marketing and sales are the same."

Bayer is proof positive of the value of brands. Criticised for lack of innovation in recent years, the company has been able to compete simply by milking its tried and trusted products.

Adalat, a heart medicine, reached record sales last year of more than E1bn in spite of the fact that the 25-year-old medicine has long lost its patent. While that has meant the death of other medicines, Bayer has done a superb job at extending the drug's uses and geographical spread.

Among Bayer's best-selling medicines is a brand as familiar as Coke or Pepsi. The brand, of course, is aspirin, a drug that has just completed its one-hundredth anniversary.