The call of Shalowitz et al for action regarding interactions with industry is a commendable beacon.

We applaud the clarity: Interactions are “strongly discouraged” (see Table ) because, of course, industry’s aim is “to influence (prescribers) behavior” and “transparency by itself is not a sufficient solution.” However, industry continues to argue that it “plays a valid and important role in the provision of medical education …” and that “medical representatives can be a useful resource for healthcare professionals …” despite evidence to the contrary. In addition, mere disclosure of conflicts of interests does not make them disappear. We should avoid euphemisms such as “social events and industry symposia” when they are actually “sham events to increase prescribing.”

Their analysis of data available with the Physician Payments Sunshine Act is revealing when they highlight that 765 gyneco-oncologists accepted research-unrelated payments totaling $1,957,004 in 2014 (mean value $2500 each), 48 receiving >$10,000. This way of portraying the data contrasts with other reports that minimize the problem, for example when pediatric authors summarize company-reported data as a “median individual payment” of $14 “commonly for meals” and “median total pay per general pediatrician” of $89. Previous approaches have mischaracterized the problem and seem to ignore the fact that cheap meals are linked with attendance to speeches by highly paid key opinion leaders.

Shalowitz et al rightly stressed the profession’s responsibility to self-regulate but transparency has a serious drawback if it is seen as the goal, rather than a means to an end. Merely making high undue payments to key opinion leaders visible without acting could have adverse consequences for the profession; yielding lower levels of overall cooperation, interconnectedness, and wealth.

We think that regulators and the administration must regulate marketing in this sector by banning the use of brand names. Insurance or Medicare reimbursement should only be made for the active ingredient of prescriptions using international nonproprietary (generic) names.