Purpose -The purpose of this paper is to assess the state of the art in social media and pharmaceutical marketing through empirical analysis of online consumer conversations. Proliferation of social media has significantly changed traditional one-way, marketing-controlled communications. Balance of power has shifted to consumers, who use social networking sites, blogs and forums to obtain extensive brand and product information, often from each other. This prompts companies towards more intimate, transparent and constant two-way consumer engagement. Pharmaceutical marketing and direct to consumer advertising (DTCA) are not immune to this pervasive, disruptive cultural/technological phenomenon, which poses particular challenges given regulatory, legal and ethical constraints on their marketing. Design/methodology/approach -This research uses "netnographic" data collection of online conversations occurring in social media and develops an explanatory framework using grounded theory analytical methods. Findings -This research shows that significantly impactful and pervasive bonding among consumers, bloggers and unofficial "experts" about pharmaceutical offerings is widespread, and occurs regardless (and perhaps in spite of) pharmaceutical companies' involvement. Originality/value -Considering the structure and nature of online consumer bonding, a way forward is proposed for pharmaceutical companies to implement social media strategies as part of their pharmaceutical marketing and DTCA efforts through an intermediary and interactive online presence arising from disease and health care education.