This article takes a critical view of the application of marketing theory and concepts, particularly exchange and the marketing mix, to social marketing situations. It draws upon my experience of using traditional concepts and models in the training of health professionals, in addition to the literature. Conceptually and practically there are problems in understanding and applying concepts such as exchange, value, and the 4Ps. The use of behavioral change models adds complexity to the setting and measurement of goals and it can be difficult to identify and sell the benefits of these changes in a similar way to commercial product marketing. Commercial marketing itself is changing with the growth of relationship marketing, interactive communications, and the critical impact of branding. It is argued that social marketing theory and practice needs reconsidering in the light of these developments. There are also important ethical considerations when attempting to introduce marketing concepts and language to health professionals. Following a detailed analysis of the nature of exchange in social marketing, my article considers each of the 4Ps in turn before drawing conclusions and raising questions and issues for further discussion.