The pharmaceutical industry spends a significant amount of resources on marketing its products. According to one estimate, the top 50 companies in India alone spent Rs 5,340 crore in 2004 on drug promotion, spending 290% to 1,025% more on marketing than on research and development. The interactions between the pharmaceutical industry and the medical profession related to promotion of medicines have been described as an entanglement; 16 forms of this entanglement have been described, and they range from acceptance of gifts and sponsorship of lavishly organised continuing medical education events featuring industry-sponsored speakers, to industry-sponsored research. While physicians claim that they are not influenced by the promotional practices of the industry, there is compelling evidence that aggressive promotional efforts lead to irrational and incautious use of more expensive, newer medicines, and escalation of healthcare costs. The primary responsibility of physicians is to promote their patients` best interests, while the primary concern of the industry is to promote profitability. In the past few years, there has been increasing concern over the influence of the pharmaceutical industry over the practice of medicine, medical education and research, and guidelines of professional bodies strongly discourage physicians from accepting costly gifts, hospitality, trips and subsidies of any type from the industry. The WHO`s criteria for ethical medicinal promotion clearly prohibit industry from offering financial inducement and incentives. In India, where unethical drug promotion is a significant problem, the Medical Council of India`s code of conduct still does not address what constitutes appropriate, ethical and legal conduct in the interactions between professionals and their associations with the pharmaceutical industry.