These Gifts Are Bad for Our Health

· Improve data quality. More than half of the "name-identified data" in Vermont contained only a last name and amount of gift.

"Do-not-call" lists that are made public could provide broad recognition and encouragement for physicians who rebuff drug reps. No Free Lunch, an organization that advocates a complete ban on promotional gifts, also collects commitments to spurn industry gifts. Already, more than 250 physicians have taken the pledge.

Littenberg says, "Taking anything from drug companies violates a trust. They shouldn't be allowed to offer [gifts], and we shouldn't be allowed to accept them, and it's appalling it's even an issue. It would be like Consumer Reports taking money from the washing machine manufacturers."

While people have criticized the pharmaceutical industry for promoting less-than-desirable drugs, the fact is that for every dangerous or inappropriate drug prescribed, there is a prescribing physician -- one who may have been unduly or unconsciously influenced by these quiet billions in gifts. Physicians should serve as patients' trusted intermediaries, but that trust must be built on openness; the public has a right to know about potential biases. Public disclosure may not stop the distorting influence of money in medicine, but it should be the first step.

Author's e-mail:stephen.cha@yale.edu

Stephen Cha is an internist and a Robert Wood Johnson clinical scholar at Yale University School of Medicine.