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While critics have called unsuccessfully for limits on gifts and payments to doctors for decades, several events have changed the terrain in recent years.

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Maine, Minnesota, Vermont, West Virginia sitt the District of Columbia have enacted laws requiring drug and medical device manufacturers to publicly report payments and gifts to doctors that relate to marketing. The reports revealed that some doctors were making tens of thousands of dollars annually working with companies whose drugs they promoted and prescribed.

This year, researchers reported that Merck, which makes the painkiller Vioxx, wrote overly positive journal articles about the controversial drug and then paid scientists who had little or no involvement with the research to become official "authors. Using cutting-edge tests that can reveal brain activity as it changes from second to second, scientists have shown that even small gifts can alter our choices.

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Friedlander, director of the Baylor University neuroscience department, which has done much of the new work. Your brain controls you.

Catherine D. Also last month, the Association of American Medical Colleges, the trade group for all academic medical institutions, released a report on industry funding that called for tighter restrictions on doctor-industry relationships. The proposal will be voted on this spring.

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He notes that some doctors earn hundreds of thousands geore dollars a year simply by giving speeches at industry events. Korn and most other critics emphasize that they don't want a complete break with drug and device makers.

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They say the private sector can provide legitimate scientific and financial input to researchers and practitioners. But they say the situation has spun out of control. Some institutions have set limits.

Inthe University of Pennsylvania and Stanford University prohibited doctors from accepting industry gifts of any size - including cat samples - geoge at private-practice, off-campus clinics. Both set tight controls on continuing medical education courses, often sponsored by pharmaceutical companies to promote specific drugs. The Johns Hopkins University and the University of Maryland allow doctors and researchers to accept gifts that have "educational value" and to earn money for company-sponsored speeches.

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Officials at both schools say the policies are under discussion and might be tightened in response to the new AAMC guidelines. Congress is also interested. The Senate Committee on Aging has held three hearings on the issue, and last fall, Sens.

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