We all know by now that the good old days of medicine—before consumer advertising and obscene marketing budgets—will never be back. Dollar-driven medical messaging is a fact of life in the new millennium, and as long as everyone in the equation (phy­sician, supplier and pa­tient) understands that, I believe we can manage. Not to say reforms aren't needed.

Today, we have association guidelines from device makers and drug manufacturers. And yet we have national headlines such as those raised in a whistle-blower lawsuit last month alleging that medical-device maker Medtronic Inc. improperly paid millions of dollars to more than a dozen doctors around the United States, prompting them to perform un­ne­ces­sary spinal surgeries and otherwise affecting their judgment.

Today, we have codes of conduct from medical societies. And yet we have more headlines made by articles such as that in the January 25 Journal of the Am­­erican Medical Association decrying the practices of free gifts, consulting relationships and other practices that have become standard in modern medicine in this country.

The authors of the JAMA article warn, "More stringent regulation is necessary, including the elimination or mod­ification of common practices re­lated to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts."

Whether the medical establishment on its own can ever succeed in reining in the ex­cesses associated with medical marketing is questionable. It may not be the Wild West out there, but it's not a stretch to imagine that more strin­gent government regulation may be in the offing.

I don't pretend to have a solution to this, but there is one thing I'd like to see. There is one party in the equation that is being kept in the dark: the patient. Most pa­tients, to be honest, are probably just as happy to be in the dark on this, but for those few who might be interested, let's get it out in the open. If you're consulting, on a speaker's bureau, receiving re­search support, or any financial support from a medical supplier, let's hear it. This is in­formation you routinely share with your colleagues any time you present at a meeting or publish an article. Not, in other words, any violation of your privacy. You don't have to hang it up next to your sheepskin. If you hand out any "welcome to the practice" material to patients, slip your standard financial disclosure in there. If medicine as a whole adopted the practice, it would not only add to more open atmosphere around this issue, it might just make further regulation unnecessary.