Recently, GlaxoSmithKline (GSK) is in cynosure for its dubious promotional activities in Italy, and the pharmaceutical firms operating in Italy decided to limit their promotional activities until the government makes it clear as to just what type of methods are acceptable.

GlaxoSmithKline is accused to have offered cash and gifts from the company, including trips abroad and medical equipment to some 2,900 medical professionals since July 2002. Such offences are not totally strange and are often brooked in developing countries, with no patent regulations where the domestic firms are enshrined by the governments in an attempt to boost indigenous growth or self- sufficiency.

But, it's particularly incomprehensible to note such pharmaceutical shenanigans, in the world's largest economies like Italy, which is listed in the rich G7 countries, and in the world's largest drug firm, GSK. For sure, the marketing tricks taught in the business schools are not paying off for the drug firms, obliging the marketers to adopt egregious ministrations to doctors through medical representatives (reps).

Selling prescription drugs clearly needs more than a fine line of promotion. A formal powwow with medical middlemen (doctors) with plenty of samples, scientific and commercial information to leave behind, the trade is no longer going to get better for the drug companies. In most of the developed nations, even such simple activities relating to sampling and scientific information are increasingly scrutinised, and in some cases the informational material often requires a formal authorisation from the health ministry.

With an undue pressure from the doctors on the sales-rep call, which is an average of less than three minutes, and strict monitoring of marketing activities the drug companies are starting to think unconventionally to peddle their pill sales. More and more sales reps, call-centres for doctors and patients, E-detailing and other electronic gadgets, Websites, patient education material and television commercials that can turn patients into demanding specific brands are all deployed effectively.

Yet, the required influence and persuasion of the doctors to prescribe products to consumers falls short of drug companies' targets, leading the path to legalised bribery: Sponsoring the doctors to medical conferences at home and abroad or even to final of World Cup, and buying expensive gifts including computers and exercise contraptions.

Absurd to say, but in some cases pirated books, software and even pretty women! Indeed, if there is ever a raid on the pharmaceutical offices or depots, it will not be surprising to uncover a stack of electronic gadgetry. Under these circumstances, it's going to be difficult for any government to draw a fine line between product promotion and undue influence. Not just for Italy.

Although much of the existing conundrum is thought to be self-created by the drug industry due to a dearth of newer and significantly superior drugs, increased me-too products, industry mergers and co-promotional deals. At the same time, it's also not even-handed to lambaste the drug makes alone for any such undefined offences. A hairline difference between unethical and illegal promotional activities is exploited across all industries.

Lastly, it must be remembered that the briber and the bribed are equally guilty. As many reps confess, doctors too expect and demand drug companies for cash and material gifts, parley nasty deals. And, if the Italy's tax police have found some 2,900 medical professionals for receiving bribery form GSK in the form of cash and gifts or trips abroad, they are equally fraud. Why should there be a partisan regulation on limiting the promotional activities of GSK and et al? It takes two to tango.