I have come to the conclusion that our pediatricians, allergists ...

It's not as simple as bribery. There are studies that indicate that Singulair is a beneficial treatment. There is a lot of data that despite the avalanche of asthma treatments in the past twenty years, the rate of asthma-related mortality is unchanged. Doctors go to seminars and continuing education units where they are presented the results of these studies and suggested protocols for treating their patients with asthma.

Many of the current recomemndations are founded on the idea that asthmatics should not rely on their rescue inhaler alone, that if they are using it more than twice a week, they should be on a maintenance medication. I do not know the foundation for these reccomendations - but there are posters in every allergist's office that I've been to, to that effect.

So a good doctor needs to put the patient on a maintenance medicine. That's the message from many sources. The choices are inhaled steroids or singulair.

If the doctor fails to prescribe a maintenance medication for someone who is having more than two asthma attacks per week, that doctor is not practicing medicine that is "consistent with current practice". And therefore - vulnerable to disciplinary action from overseeing HMOs. There's the chance of a lawsuit, but the real pressure comes from the HMOs, which seem to believe that by prescribing a maintenance medication, their costs will be reduced. The HMOs pay the doctors.

"Big Pharm" understands these concepts and leverages them. Big Pharm can influence the HMOs who can then pressure the doctors, more discreetly and more effectively than the drug reps can.

I am not disputing the claim that drug reps are a negative influence on doctors - they're just not the only one.

My own doctor has signs clearly indicating that drug reps are not to leave any sort of gift, and I have been there when a nurse is firmly dismissing a drug rep bearing a box of chocolates, while she clearly states, "We are interested in information and samples only. Please leave."

I'm not saying ALL doctors. Maybe yours is one of the "few exceptions". Lucky you. The majority is exactly as I previously posted.