Pharmaceutical drug promotion practices are found to have potentially controversial ethical standards. They may compromise on patient's wellbeing especially when it inordinately affects the clinical care and patient's interests by influencing the prescribing behavior of physicians. There is no proper system to keep a watch on the drug marketing and promotion strategies by the pharmaceuticals in Pakistan. A cross sectional study using a specially designed questionnaire and convenience sampling was conducted in Karachi for 6 months targeting prescribers and medical sales representative (MSRs). A total of 600 MSRs and prescribers consented to participate. 66% of MSRs highlighted that prescribers follow ethical prescribing but only (58%) seek evidence base behind promoted drug. This was contradictory to prescribers' response to same, which was 87%. Only (10%) of prescribers acknowledged demanding expensive gifts such as laptops, ACs, furniture and renovation of the clinic which was about 40% according to MSRs. This study offered intricate insights into the MSR and physicians interactions. It highlighted various aspects of these relationships from both MSRs' and prescribers' point of view. Although majority of the physicians negated the notion of expecting expensive favors from the sales representatives, responses by MSRs suggest that anticipation of gifts and incentives exists on part of the physicians. This has the potential to indulge in unethical promotion and irrational prescribing on part of MSRs and prescribers respectively that may further contribute to untoward patient outcomes such as increased treatment costs and adverse drug reactions.