The contrasting discourses in the marketing and medical literature on pharmaceutical marketing practices motivate this study. Of particular interest is detailing and related practices which involve deploying pharmaceutical sales representatives (PSRs) to interact with physicians often for providing product information and benefits (Manchanda and Chintagunta, 2004; Mizik and Jacobson, 2004). Acutely aware that a dominant effect of detailing on physician’s prescription choices is problematic, Gonul et al. (p. 90) summarize the marketing literature by noting that, “there are no reasons for public concern regarding the social implications of the reviewed personal selling practice employed by drug manufacturers because its effect is mostly informative.” By contrast, taking a combative and aversive view of PSRs, leading medical scholars and practitioners recommend strict sequestration of commercial interests of industry from the physician (Steinman, et al. 2006). Major medical centers including Yale, Harvard, Duke, Stanford, University of Pennsylvania, Henry Ford Health System, and UCLA have banned physicians from receiving monetary or non-monetary gifts, and PSRs from visiting patient care areas. Prestigious medical journals such as The British Medical Journal and Journal of American Medical Association, along with International Committee of Medical Journal Editors and World Association of Medical Editors, now require all authors to include an explicit disclosure of industry sponsored research and, in some cases, to conduct independent statistical analysis as a condition for publication (DeAngelis, 2006). Using public documents from a recent court case, I analyzed pharmaceutical industry’s marketing practices and their role in creating externalities that compromise trust and fiduciary responsibility governing physician-patient relationship. Results indicate that externalities are complicit in exploiting COI and undermining consumer welfare in medical markets. Our study contributes to the research into, and practice of pharmaceutical marketing practices for interacting with physicians in several ways. First, I develop a conceptual framework based on COI theory that has substantially informed the medical profession’s discourse but received minimal, if any, attention in the marketing literature (Moore, Cain, Loewenstein, & Bazerman, 2005). This framework posits an embedded view of physician exchanges that presents new insights that have heretofore remained unexplored in the marketing literature. Second, building on the COI framework, I outline an orchestration thesis that reliably represents the medical profession’s guiding approach for seeking and evaluating evidence relating to industry’s marketing practices. Unlike the marketing literature’s interest in examining the efficiency and effectiveness of different marketing instruments such as detailing and journal publishing, the orchestration thesis focuses on strategic intent that underlies all marketing instruments. As such, the orchestration thesis offers a competing perspective that challenges the evidence in the marketing literature. Third, using a novel approach based on systematic analysis of court documents, I examine the support, if any, for the orchestration thesis in a specific contextual setting. Finally, the current study builds the conceptual and empirical foundation to bridge the marketing and medical literatures. Such a bridge is critical in developing a common ground for reconciling disparate viewpoints and redirecting marketing practices.