Anyone who has spent more than half an hour in a doctor's office has probably witnessed the parade of attractive, young professionals carrying brief cases checking in with the doctor's receptionist. The well-dressed visitors are not there to talk about a health problem, they are there to promote their employer's products - brand name, prescription drugs.

Pharmaceutical companies spent $18.5 billion courting doctors with sales reps bearing free samples, gifts, lunch invitations and more in 2002, according to IMS Health, an industry consulting company.

Many doctors report that daily, unscheduled visits by drug company sales reps are becoming a nuisance and interfering with their daily schedules with patients. But the interruptions are not likely to end soon with the intense competition to gain market share in the multibillion-dollar prescription drug market.

With billions of dollars in sales at stake, giant pharmaceutical companies have become very aggressive, and in some cases their efforts are going too far. Even in cases where the efforts are not deemed illegal, the practices of drug company's marketing efforts have been raising ethical questions.

The New York Times reported recently that a government probe into drug marketing practices has revealed that most of the largest drug makers, including Bristol-Myers, Squibb, Johnson & Johnson and Wyeth, have received subpoenas related to the investigation. The Times' article reports that a recent investigation revealed that many doctors received unsolicited checks from drugmaker Schering-Plough. The checks, ranging from $10,000 to several times that amount, came with no strings attached, other than a vague description of a "consulting" fee and an agreement to prescribe the company's medicines over competitors' products.

The newspaper article noted that the pharmaceutical drug market has in recent years exploded into a highly profitable $400 billion industry. The importance of market share is so critical that drug companies are now reported to spend twice as much money on marketing drugs as they do for research and development.

The army of sales reps on the road for drug companies is now estimated at close to 90,000 men and women, up from about 42,000 in 1996.

Marketing efforts include free samples, paid meals and other gifts - all in the hope that the doctor receiving the goodies will prescribe one drug over another, competitive product.

The issue is not simple. Doctors do need to be educated on the efficacy and side effects of the many new drugs being introduced. But studies published in professional journals and unbiased trials should trump cash or gift incentives from big pharmaceuticals and their platoons of drug reps.

A serious investigation into drug companies' marketing efforts is overdue. Some analysts also believe that scrutiny from the federal government into drug marketing practices and drug pricing will only increase as the new Medicare drug benefits take full effect in 2006 and the government is paying for up to half of all prescription medicine sold in the U.S.

Patients and taxpayers can only hope that federal investigations and multimillion-dollar fines will persuade drug manufacturers to change their marketing practices. Patients should not have to wonder if the drug prescribed by their doctor is the best medication for their condition - or the drug from the company offering the best financial incentive to the doctor.

- J.L.W.III