Twisted together like the snake and the staff, doctors and drug companies have become entangled in a web of interactions as controversial as they are ubiquitous (box). As national drug bills rise at rates that vastly exceed those of inflation (fig 1), this entanglement and the subsequent flows of money and influence are attracting increasing public and academic scrutiny.

SUE SHARPLES

Studies from several countries show that 80-95% of doctors regularly see drug company representatives despite evidence that their information is overly positive and prescribing habits are less appropriate as a result.1 2 Many doctors receive multiple gifts from drug companies every year, and most doctors deny their influence despite considerable evidence to the contrary.3 Industry interactions correlate with doctors' preferences for new products that hold no demonstrated advantage over existing ones, a decrease in the prescribing of generics, and a rise in both prescription expenditures and irrational and incautious prescribing, according to a recent analysis of the ethics of gift giving.4 The number of gifts that doctors receive correlates with beliefs that drug representatives have no impact on prescribing behaviour.3

Accepting meals and expenses for travel or accommodation for sponsored educational meetings is common despite evidence that this is associated with an increase in formulary requests for and prescribing of the sponsor's drug.2 3 Most doctors attend company sponsored events providing continuing medical education, 2 yet evidence shows that these preferentially high-light the sponsor's drug.3 Many professional societies rely heavily on industry sponsorship, …