In the absence of any monitoring mechanism, the nexus has been growing like never before.
A smart senator thought of making a small beginning in tackling the unhealthy trend. His starting point was the requirement for academic researchers in most universities to disclose such payments.
So Charles E. Grassley,a Republican from Iowa wrote letters to a few universities to understand how well such a reporting system actually works.
On the Senate floor, Grassley said last week that he encountered several problems at the first step itself.
First, universities do not verify the information filed by their professors, so "the only person who knows if the reported income is accurate and complete is the doctor who is receiving the money."
Also, the universities generally keep this information secret from patients, who have no way of knowing whether their doctor is on a drug maker's payroll, he said.
"So if there is a doctor getting thousands of dollars from a drug company payments that might be affecting his or her objectivity the only people outside the pharmaceutical industry who will probably ever know about this are the people at that very university," he said.
Grassley also said that he had asked how much the Cincinnati University child psychiatrist Dr. Melissa DelBell made from AstraZeneca, the London-based drug giant that manufactures the antipsychotic Seroquel.
Dr. DelBello's studies of Seroquel in children have helped to fuel the widespread pediatric use of antipsychotic medicines. Those studies were inconclusive, but she has described them as demonstrating that Seroquel is effective in some children.
The term antipsychotic is applied to a group of drugs used to treat psychosis Common conditions with which antipsychotics might be used include schizophrenia, mania and delusional disorder, alhough antipsychotics might be used to counter psychosis associated with a wide range of other diagnoses.
Atypical antipsychotics are second-generation medicines designed to cause fewer neurological complications than conventional antipsychotics. They include aripiprazole (sold as Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).
Asked in a past newspaper interview how much she was paid by AstraZeneca to help market Seroquel, she had said, "Trust me, I don't make very much."
But her disclosure forms at the University of Cincinnati show she received $100,000 from AstraZeneca in 2003 and $80,000 in 2004. Dr. DelBello consults for seven other drug makers as well.
Richard Puff, a university spokesman, said he did not know how much Dr. DelBello made in combined payments from all eight drug makers. Asked if the institution did anything to verify its professors' financial disclosures, he replied, "We do trust our faculty when they're making these disclosures."
The state government of the state of Vermont disclosed in June last that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state's Medicaid program.
Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.
The number most likely represents a small fraction of drug makers' total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.
"For the fourth year in a row, our analysis shows that there is a great deal of money being spent in our small state on marketing pharmaceutical products," said William H. Sorrell, the Vermont attorney general.
Endocrinologists received the second largest amount, according to the Vermont analysis, earning an average of $33,730. Since the state identified the specialties of only the top 100 earners, these averages represent the money earned by only some of the state's specialists. There were 11 psychiatrists and 5 endocrinologists in that top group of 100.
As in Vermont, psychiatrists earned on aggregate the most in Minnesota, with payments ranging from $51 to $689,000.
Both the doctor and the drug maker are happy. But what about the patient is the question.
So a registry is considered a way out. Minnesota, Vermont and Maine already have similar registries, and other states are considering them. Now several senators are proposing a federal registry.
The drug industry opposes such registries, saying they would discourage doctors from receiving needed education. John Bentivoglio, a lawyer in Washington who represents drug makers, said the registries would be a burden for the companies and might be misinterpreted.
"One of the concerns is that these payments are seen as bribes," Mr. Bentivoglio said. "That's not the case. The vast majority are lawful payments for services."
But Senator Grassley said he would propose that drug makers make public any payments made to doctors who bill the federal Medicare and Medicaid programs, which would include nearly all doctors.
Noting that voters can easily look up the contributions made to elected officials, he asked, "Shouldn't we hold doctors to similar standards?"