Industry influence still threatens the integrity of healthcare and harms patients “To influence physicians from the bottom up” reads an internal company document published in the late 1990s from the drug manufacturer Parke-Davis.1 This memo, outlining the company’s business strategies for a section of its market, became public through litigation around off-label drug promotion. Among the company’s key promotional strategies was “to solidify Parke-Davis’s role in the resident’s mind as he/she evolves into a practising physician.”1 Over two decades later, drug and medical device industries globally continue to target clinicians early in their careers, including during periods of training, to cultivate long term, reciprocal relationships through payments, free meals, and sponsored education. Researchers recently examined payments to cardiology fellows in the United States before and after graduation, finding that 73% of cardiology fellows received payments in the year before graduation, j