602 journal of law, medicine & ethics The Journal of Law, Medicine & Ethics, 44 (2016): 602-613. © 2016 The Author(s) DOI: 10.1177/1073110516684803 1. Introduction The pharmaceutical industry devotes considerable resources to the promotion and marketing of its prod- ucts in order to support their market share while under patent protection. Pharmaceutical sales rep- resentatives’ (“sales reps”) visits, along with the free samples they distribute, are the largest promotional spending category. Pharmaceutical industry spending on promotion surpasses that for research, 1 and there is evidence that such marketing influences the quality, quantity, and cost of physician prescribing. 2 Given the industry’s wide-reach and capacity to influence physician prescribing, and by extension the health and safety of patients, governments around the world have sought to regulate pharmaceutical promo- tion. The rationale for developing a regulatory sys- tem for pharmaceutical promotion is to ensure that health professionals have access to accurate informa- tion concerning medicines’ safety and efficacy and an understanding of treatment guidelines to support them in making informed decisions concerning their use. While physicians believe that they are not influ- enced by promotion, evidence indicates that they are. 3 The asymmetry in the information on product safety and efficacy creates the potential for false claims by sponsors who may attempt to influence physicians to prescribe a product. 4 Sponsors do not always have the incentive to convey truthful information about their Regulating Information or Allowing Deception? Pharmaceutical Sales Visits in Canada, France, and the United States Roojin Habibi, Line Guénette, Joel Lexchin, Ellen Reynolds, Mary Wiktorowicz, and Barbara Mintzes Roojin Habibi, M.Sc., is a second-year law student in the French Common Law (J.D.) program at University of Ottawa. She received a bachelor’s degree in environmental and health studies from York University, an M.Sc. in Global Health from McMas- ter University and completed a research fellowship with Pharmaceutical Policy Research Collaboration. Line Guénette, Ph.D., is an Assistant Professor at Laval University, Quebec city, Quebec, Canada and a researcher with the Population Health and Optimal Health Practices Research Unit at the CHU de Québec Research Center. She received a bachelor degree in pharmacy (BPharm), an M.Sc. and a Ph.D. in pharmacoepidemiology also from Laval University. Her research interests revolve around drug utilization, determinants of rational drug utilization and interventions and policies to improve rational use by patients and healthcare professionals. Joel Lexchin, M.Sc., M.D., has been teaching health policy at York University for the past 14 years and working as an emergency physician at the University Health Network since 1988. He holds B.Sc., M.Sc., and M.D. degrees from the University of Toronto. He has authored or co-authored over 150 peer reviewed papers and on all aspects of pharmaceu- tical policy both in Canada and internationally. Ellen Reynolds, M.P.A., is Research Coordinator at the School of Population and Public Health, Faculty of Medicine, University of British Columbia. She received her Master’s in Public Administration from the University of Victoria in 2015. The focus of her research was on physicians’ experiences and attitudes towards interactions with pharmaceutical sales representatives. She has worked as a research coordinator with the University of British Columbia since 2008, and has worked extensively with women’s health organizations, including the Canadian Women’s Health Network and DES (diethylstilbestrol) Action Canada. Mary Wiktorowicz, Ph.D., is a Professor of Health Policy and Management, the Associate Dean Community and Global in the Faculty of Health, and the Interim Director, Dahdaleh Institute for Global Health, York University. She received her Ph.D. in Health Policy from the University of Toronto, Institute of Health Policy, Management and Evaluation. Her research involves developing frameworks to compare national and transnational governance models that guide the development of health policy to enhance our understanding of them. Her research is funded by the Canadian Institutes of Health Research and published in leading journals. Barbara Mintzes, Ph.D., is Senior Lecturer at the Charles Perkins Centre and the Faculty of Pharmacy at the University of Sydney and an Affiliate Associate Professor at the School of Population and Public Health at the University of British Columbia (UBC). She holds a Ph.D. in epidemiology from UBC. Her main area of re- search is in pharmaceutical policy, including the influence of drug promotion on prescribing and medicine use. She also carries out systematic reviews on the effectiveness and safety of drug treatments.