I found myself in front of a group of medical residents earlier this week to give a talk on conflicts of interest in medicine. The session, part of course offered residents at George Washington University Hospital in the District of Columbia, took place at the headquarters of the Pharmaceutical Research and Manufacturers Association. Two others, including a PhRMA representative, sat on the panel.

One of the residents pushed back against the idea that small gifts or fees influence physician behavior. After pointing out the well-studied principle that even small gifts create a sense of mutual obligation, I found myself saying, "Look, you are going to have to decide 'who's your daddy' as you move along your career. Is it going to be your patient, or the providers of the tools in the medicine bag that you bring to that patient? If you can live with public exposure of your accepting gifts and fees from the pharmaceutical and medical device and imaging industries, then go for it. But in a few years, this information will all be known, not just to you and the few people attending your seminars, but to your patients, to your employers and to the government."

We're seeing that play out already with the limited disclosures now being posted on the Internet. Eli Lilly was the first company out of the box. Pfizer, the industry behemoth, will begin making similar disclosures next year courtesy of the "corporate integrity agreement" that accompanied the $2.3 billion settlement for the company's alleged illegal off-label marketing of Bextra and other drugs. And should health care reform pass, all physicians and medical school personnel who take payments from industry will be in the same boat because both the House and Senate bills contain versions of the Physician Payments Sunshine Act, which requires universal disclosure.

Journalists are already having a minor field day with the limited disclosures to date. Today's New York Times analyzes the Lilly disclosures and discovered that an adjunct professor of psychiatry at Stanford named Manor V. Waikar earned nearly $75,000 last year giving talks for the company to other medical professionals. Lilly's best selling drugs for psychiatric conditions include Cymbalta and Zyprexa.

Waikar gave 51 talks last year to earn that $75,000. That's one a week, week after week, all year at $1,500 a pop. Think about it. Same slides, same talk. Just show up for two hours and the check is in the mail. Do that for three companies and you're earning over $200,000 annually. And you were wondering how the man earns a living on an adjunct faculty's salary.

Stanford, for its part, distanced itself from Dr. Waikar's extracurricular activities. Its full-time faculty are prohibited from serving on industry speakers' bureaus, a spokesman said. But this is a distinction without a difference. What's really for sale here is Stanford's credibility. I could have given those talks.

Indeed, I no longer prepare for my conflicts of interest talks to medical residents. I just show up. Same set of slides. Same talk.

The only difference is that no one writes a check.