Sure, there's an element of sleaze involved when doctors accept trips to Italy, Mets tickets and the like in exchange for the winked-at promise that they'll prescribe a pharmaco's drug. After all, it gets ugly when an industry spends as much as $13,000 per person in what amount to bribes. But as it turns out, the payoffs aren't as destructive as they seem. It's flattery, chumminess and admiring attention from the industry that really corrode a doctor's judgment, argues Dr. Kent Sepkowitz. Column