In the midst of charges that much of medicine, and psychiatry in particular, is too aligned with drug companies, a revised pharma industry code was drafted and will take effect January 2009.

Although the industry is acting as if newly articulated principles (which replace a seven-year old set) will satisfy critics, some of the recommendations are modest at best: no more baseball tickets, don't expect pencils, but keeping (modest) meals in the service of education seems okay. Except for minor changes, the new guidelines appear to codify the existing relationship while asking for disclosure as if that were a ritual purification.

Physicians who have no stomach for the offerings have been calling for reform for the past decade. Now this issue is gaining visibility and traction, partly because politicians find the extraordinary fees, and the lack of transparency, outrageous. The American Medical Student Association, which has been in front of the pack, noted the pharmaceutical industry recognized "gifts do not belong in the health care system." Still Dr. Brian Hurley, AMSA’s national president, was disappointed in the actual guidelines. "The updates are clearly inadequate,” he said.

It's hard to imagine what will be changed except, of course, the claim that something is different. The guidelines are available in pdf.