Marisa de Andrade, 4 March 2009

I don't have a problem with people keeping their skeletons safely stored in their closets, as long as they aren't responsible for my wellbeing. Like doctors.

When I have one of my very frequent headaches, I pop a pill trusting that it will kill my throbbing skull. I place an enormous amount of faith in a little plastic capsule.

Scientists have run tests to ensure the drug is safe and effective. Regulators have stamped it with their licensing seal of approval. Doctors have prescribed it with confidence that it will make me better. Or at least make me feel better.

But what happens when there is a breakdown in the process of professional conduct? What if a bit of data goes missing, gets misrepresented or selectively reported and a dubious drug gets branded as a wonder pill? My doctor gets taken out for lunch by a pharmaceutical rep, who wins him over with a four-course meal and six bottles of wine? The government gets a hefty handout from pharmaceutical giants, just because they can? That is when disclosure becomes a necessity.

Here is how the road to revelation has gone so far. In 2004, Lilly became the first company to voluntarily make public its clinical trials – research studies testing how well new medicines work in people.

At the same time, GlaxoSmithKline (GSK) was in the midst of a PR nightmare – accused of withholding negative data on its popular antidepressant Seroxat, a charge the drug company denied. To make things better, GSK unveiled plans for a full online clinical trial register for all sponsored trials, something it claimed to have planned all along.

This would ensure any research assigning humans to evaluate the effects on health outcomes would be open for inspection, making for a more transparent system.

But just how open is this disclosure? The GSK policy relates to clinical trial data and its commitment is to all its trials. But Dr Yoon Loke, senior lecturer in clinical pharmacology at the University of East Anglia, points out: "There is no clear stipulation on putting down the list of report authors, nor is there any good way of policing it, as there aren't any sanctions that can be applied."

We have to trust that self- regulation works, just as we need to believe our doctors aren't influenced by business-class transatlantic flights and five-star hotels courtesy of drug companies.

Is this possible? Self-confessed reformed "pharma junkie" Dr Des Spence, from No Free Lunch UK, isn't convinced. He is determined to change the NHS hospitality culture as penance for his previous life as a Scottish doctor entertained at the expense of drug giants. He's not sure if the pharmaceuticals' move to reveal dealings with doctors goes far enough.

"I suppose the devil is in the detail," he says. "To what level are they going to be disclosing their payments? Have they said it's going to be money in-kind for wining and dining? There's supposed to be a register with hospitals in Scotland for registering gifts and hospitality, but Freedom of Information Act requests to hospitals have shown this isn't happening."

Dr Spence also wonders why US companies Pfizer, GSK, Lilly and Merck have announced plans to declare such payments, ahead of new laws forcing them to do so. "Is this an attempt to move before they're pushed? I don't want to be cynical, it looks like damage limitation," he adds.

Lilly has volunteered to reveal all payments of more than $500 (£350) to doctors in an online database it plans to launch as early as the second half of this year. It is likely to include the doctor's name or other identifying information and why the payment was made, for instance for consultancy services or a speaking engagement. Lilly plans to expand the registry to include payments for travel, entertainment and gifts by 2011.

But what's happening this side of the Atlantic? Spence says: "The sums of money are on a different scale in the US. There, you are talking donations of hundreds of thousands of dollars. Here, it is a much smaller scale. Doctors might get consulting fees up to £10,000 for working for companies."

The No Free Lunch UK website (www.nofreelunch-uk.org) has some glorious confessions from doctors, pharmacists, nurses and journalists who have been treated, for example, to cancan and flamenco dancers, wine, fireworks and live music at a Diabetics conference hosted by a drug company.

Even if pharmaceutical companies in the UK decide on a watered-down system of disclosure, this won't go far enough unless the medical profession ends its silence and acknowledges it has a problem. Dr Spence wants to take things even one step further: "I personally think doctors shouldn't have contact with pharma reps at all. If they do, there should be full disclosure so patients can make the decision," he says.

• Marisa de Andrade is a journalist and broadcaster, completing a PhD in sociology at Strathclyde University on the communication strategies of pharmaceutical companies.

This article first appeared in The Scotsman