No free lunch

It is no secret that drug companies operate in a world of high risks and potentially high gains. Recouping large investments made in new drug research and development and maximizing corporate profits depend on persuading the medical community to prescribe as much of specific medications as possible That persuasion takes many forms, including funding research, sponsoring educational events, and providing a variety of promotional gifts to physicians. The ubiquity and expense of these efforts raise difficult ethical quest Lions for physicians and the public. Paul Jung, an internist recently out of residency and Howard Brody, a veteran medical educator, explore the vulnerabilities of physicians to the blandishments of drug promotion. Jung is concerned about physicians' hunger, real and metaphorical, and Brody about a sense of entitlement that tends to drop physicians' guard to potential intellectual compromises. Frank Davidoff, editor emeritus of the Annals of Internal Medicine, recounts his experience struggling with the conflicts of interest inherent in manuscripts submitted by authors whose research was sponsored by drug firms. Commenting on the articles from the perspective of the industry, Bert Spilker, a senior vice-president of the Pharmaceutical Research and Manufacturers of America, explains the valuable role that drug representatives can play in educating physicians about new drugs and, in turn, improving treatment for patients.