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Just about every segment of the medical community is piling on the pharmaceutical industry these days, accusing drug makers of deceiving the public, manipulating doctors and putting profits before patients.

As more voices have called for change, new guidelines for how drug makers and doctors should interact are coming from both industries, and doctors say some abuses of the past have ended. But the industries' dealings remain fraught with potential conflict because the sectors depend on each other so much — medicine on drug makers' research dollars and drug makers on the credibility that researchers give them.

"The influence that the pharmaceutical companies, the for-profits, are having on every aspect of medicine . . . is so blatant now, you'd have to be deaf, blind and dumb not to see it," said Dr. Catherine DeAngelis, Journal of the American Medical Association editor and a longtime industry critic. "We have just allowed them to take over, and it's our fault, the whole medical community."

DeAngelis said industry influence includes swaying doctors and medical students to their brands with gifts; funding research at top teaching hospitals but keeping control of the studies and results; failing to disclose study authors' conflicts of interest; and even taking over the continuing medical education system for doctors by running courses on new treatments.

Already, top journals are listing study authors' conflicts of interest, and dozens of medical schools and medical specialty societies are barring gifts to doctors and limiting their other financial ties to industry. Some schools bar professors from being paid as drug-company speakers. And one expert noted that drug makers have stopped giving cash prizes to medical students for presenting favorable research on their drugs at conferences.

Still, no one is suggesting anything as drastic as cutting off industry funding for academic research on new drugs. Those billions help pay lab and other expenses at virtually all U.S. teaching hospitals, medical schools and affiliated practices, while giving the drugs' developers the cachet of having big-name academic researchers running their studies.

The industry's trade group, in an apparent response, in July revised its 2002 "Code on Interactions With Health-Care Professionals" to ban giving out pens, mugs and other non-educational gifts, taking doctors to restaurants and giving them tickets for shows or sports events. Bringing meals to their offices and donating anatomical models and textbooks will still be allowed when the code takes effect in January.

"America's pharmaceutical companies devote many years and billions of dollars to researching and developing lifesaving medicines," and help drive progress and economic growth, said Diane Bieri, general counsel for the Pharmaceutical Research and Manufacturers of America. "We will always face criticism, and at times deserve it, but our companies remain committed to listening to and learning from parties with divergent points of views."

David Rothman, president of the Institute on Medicine as a Profession, said about one-fourth of U.S. medical schools now have policies on industry gifts "that really pass muster." Some bar sales reps from giving doctors drug samples — but allow donations to a central supply office — and don't let them wander their halls to speak to doctors.

"You're not being bribed; you're being gifted," doctors may think, but industry freebies influence prescribing patterns, Rothman said.

At the University of Pittsburgh School of Medicine, pharmaceutical reps since February have had to get a perfect score on an online training program about its rules to get appointments.

Some reps have been warned about infractions, but none has been banned, said Dr. Barbara Barnes, head of industry relations.

In June, the Association of American Medical Colleges put out guidelines that bar drug makers from paying for continuing medical education sessions on specific topics but allow donations to a central fund.

Sen. Charles Grassley, an Iowa Republican and a frequent industry critic, is sponsoring a bill to require drug makers to report all payments to doctors — from buying meals to flying them to conferences at resorts.

Doctors say there's more to be done, but they see an impact.

Dr. Marc Siegel, an internist and associate professor at New York University School of Medicine, said the school has fewer drug-maker-sponsored events, and he no longer gets offers of baseball tickets or paid junkets as a consultant at a doctors' meeting — things he turned down anyway. He said some colleagues no longer let drug sales reps in their offices, but he does.

"I don't mind — I like my staff to get a free lunch," Siegel said. "I don't think it influences one iota what I prescribe."