Apart from the benefactors and beneficiaries, few will anymore try and defend the way drug companies wine and dine our doctors. There is a mountain of evidence showing that when doctors accept “food, flattery and friendship” offered by drug reps, prescribing habits are distorted.

That means we are recommended the latest most expensive drugs when we may not need them, draining the public purse and causing a public health catastrophe of untold unnecessary side effects. Around the globe the public debate is finally moving away from what’s wrong with the duchessing of doctors, to what on earth we can do about it.

The first strategy is to let the profession and the industry solve the problem in some version of self-regulation, but we’d all die waiting for that to happen. When Swiss giant Roche was caught out taking specialists to $200-a-head “educational” dinners at the Sydney Opera House, the first to defend the gluttony was the Australian Medical Association. When the consumer watchdog issued new rules forcing drug companies to disclose all such “educational” events, the drug industry took them to court. Sadly for industry, it lost, resoundingly.

The next strategy is mandatory disclosure. This means governments step in and force either drug companies, doctors, or both, to publicly disclose all financial ties between them — whether its branded pens or free trips around the world. Australia already has an early version of mandatory disclosure, in the new ACCC rules that force drug companies to disclose all “educational” dinners.

A key weakness is that doctors who attend don’t have to be named. Perhaps more importantly, there are many forms of entanglement not covered by these new rules. Similarly in the United States, several states, including Vermont and Minnesota, have tried to force disclosure, with limited success.

As I’ve written in today’s issue of a new Canadian medical journal, Open Medicine, the next step is disentanglement, and it’s urgently needed. The ties between doctors and drug companies fundamentally compromise public trust in the profession and constitute a costly threat to public health.

Drugs can be life-saving but drug company marketing strategies can be poisonous. It’s time for policy-makers to creatively design incentives for doctors to get out of bed with drug companies, while simultaneously punishing those who persist with keeping their snouts in the trough.

Tomorrow – how the pharmaceutical industry keeps journalists cashed up too.