Drugmakers spent $5.4 billion last year on direct-to- consumer advertising in all media, said Nielsen Monitor-Plus. That's a fivefold increase in the decade since new U.S. rules allowed drugmakers to advertise their products more easily. New Zealand is the only other country that allows drug ads on television.

Lawmakers at a House subcommittee hearing in May said many drug ads minimize medicines' side effects and may encourage overuse of expensive products. Members of Congress, led by Representatives John Dingell and Bart Stupak, Michigan Democrats, have called for stricter regulations. The American Medical Association asked for a moratorium on ads for newly approved drugs until doctors are educated and U.S. regulators have signed off on the messages.

"Pharmaceutical companies should consider it a privilege to be allowed to air" direct-to-consumer ads, said Stupak, at the May hearing. "As with all privileges, there comes responsibility."

FDA's advice

Pfizer said its new ad includes suggestions made by the Food and Drug Administration, which has 24 employees responsible for making sure drug advertising accurately portrays risks and benefits. The FDA reviewed 20,000 pieces of direct-to-consumer advertising last year and took an average of five months to warn drugmakers that violated the rules, according to a Government Accountability Office report in May.

Erlendson said he won the commercial's starring role after his talent agency responded to the Pfizer ad agency's request for a heart-attack patient who was taking Lipitor. Before his heart attack a year ago, Erlendson knew he had high cholesterol and thought he could treat it by losing weight and watching his diet, he said.

"How many people like me are out there who really think they are doing things to prevent a heart attack and are ahead of the game, and how many end up having heart attacks and are lucky enough to survive?" Erlendson said.