For the first time at an APA annual meeting, I had pangs of guilt. As a psychiatrist who has been attending these meetings for the past 20 years, I have always held a certain disdain for pharmaceutical company attempts to entice me to use their products. After all, the medications I pick for my patients are based on my review of the literature and my clinical experience, not what some drug rep or company exhibit says I should do. I won’t even allow the treatment staff at the inpatient unit where I am medical director to use pens or pads that are covered with drug company emblems.

In the past, a drug company exhibit would consist of some colorful posters accompanied by a cheerful company associate and a free pen. As the companies became more aggressive in their attempts to influence our prescribing practices, they began giving away more valuable gifts. Coffee mugs, notebooks, luggage tags, tote bags, calculators, umbrellas, tape players, watches, clocks, disposable cameras, and even massages are gifts that have been given in exchange for listening to sales pitches, and I’ve watched my peers fill huge, logo-covered plastic bags with their loot.

This picture would engender a sense of disgust and self-righteousness; I would never lower my self to that level—although in the past I have looked longingly at the golf umbrellas. The purple brains are O.K.; they are for the kids.

For the past several years technology has created some awesome "learning" experiences. Computer stations with teaching programs are actually quite useful. Case vignettes and graphics that showed receptor-site action for the medication in question are quite impressive. Perhaps the most incredible exhibits are the virtual-reality machines that put you inside the brain. Getting to know your patients’ psyche was never like this. I think pharmaceutical sponsorship of these educational activities is good.

Industry-supported symposia have long been part of APA’s annual meetings. It can be argued that these activities have educational value and are not direct inducements to using certain products. At first, they were small sessions that came with a soda and some snacks. Now they have developed into full-fledged mealtime affairs. Take your pick—breakfast, lunch, or dinner. Dinner symposia are very attractive. What could be better than having a prime rib entrée with all the fixings and your favorite wine? I have seen my peers bring their entire families just for the meal. Moreover, the speakers are the best available, from such places as the National Institute of Mental Health and Harvard.

To add to the symposia’s learning caché, taking notes is a thing of the past. Beautiful wire-bound monographs "sponsored by (fill in the blank)" of all the presenters’ Powerpoint slides are handed out, at least to those wise enough to arrive early. I must admit that some of the most informative educational experiences I have had came from these symposia.

Well, I guess receiving a good meal isn’t too unethical. It’s educational. It was just like getting pizza from the drug reps when they sponsored journal club during residency. This year, however, I set out onto a more slippery slope: attendance at drug company–sponsored activities with no educational components. As I went to the House of Blues with a colleague while in Chicago, I wondered, Is this the life of a member of Congress? Like a little devil sitting on my right shoulder, she said, "Don’t worry about it. This is not going to change the way you prescribe." And after a few drinks at the open bar, listening to the visceral and sexually charged performances of the blues great Buddy Guy, I wasn’t worrying about anything.

My denial finally crumbled at Wrigley Field. It wasn’t the free tickets and transportation that were bothersome; it was the cold, hard cash. My friend and I received $90 in "Cubs cash." Now why would we need $90 at a baseball game? We had already gotten free tickets. What really hit home for me was when I used a $10 "Cubs cash bill" and was given change in good old green U.S. currency. So now I was being given cold hard cash to use the company’s products. What else could the money be for? The company wouldn’t give me money to use someone else’s product! Free food, free lectures, and free entertainment is one thing. Free money is another.

What the hell was I doing? Well, after five years of individual psychotherapy and three years of psychoanalysis, I think I might have to go back on the couch.