I'd like to give my thanks to Drs. Paladine and Howard for stepping up to bat for our patients and our values in “Four Reasons Our Office Is Pharma-Free” (Opinion, March/April 2009). My office went pharma-free this year, and doing so has relieved the strain of pharma interruptions and their biases. One thing the article didn't mention is the potential for loss of revenue. Three or more drug rep visits could easily be replaced by one more patient visit per day, and that could bring in from $10,000 to $20,000 in revenue each year. At this time of declining reimbursement, how we spend our time matters more than ever.