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“Asset exchange”—interactions between patient groups and pharmaceutical industry: Australian qualitative study

BMJ 2019; 367 doi: (Published 12 December 2019) Cite this as: BMJ 2019;367:l6694

Commercial influence in health: from transparency to independence

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I’m more susceptible to drug company money than I’d like to be

  1. Lisa Parker, postdoctoral research fellow1,
  2. Alice Fabbri, postdoctoral research fellow1,
  3. Quinn Grundy, assistant professor2,
  4. Barbara Mintzes, associate professor1,
  5. Lisa Bero, professor1
  1. 1School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
  2. 2Faculty of Nursing, University of Toronto, Toronto, ON, Canada
  1. Correspondence to: L Parker lisa.parker{at}
  • Accepted 20 November 2019


Objective To understand and report on the nature of patient group interactions with the pharmaceutical industry from the perspective of patient group representatives by exploring the range of attitudes towards pharmaceutical industry sponsorship and how, why, and when interactions occur.

Design Empirical qualitative interview study informed by ethics theory.

Setting Australian patient groups.

Participants 27 participants from 23 Australian patient groups that represented diverse levels of financial engagement with the pharmaceutical industry. Groups were focused on general health consumer issues or disease specific topics, and had regional or national jurisdictions.

Analysis Analytic techniques were informed by grounded theory. Interview transcripts were coded into data driven categories. Findings were organised into new conceptual categories to describe and explain the data, and were supported by quotes.

Results A range of attitudes towards pharmaceutical industry sponsorship were identified that are presented as four different types of relationship between patient groups and the pharmaceutical industry. The dominant relationship type was of a successful business partnership, and participants described close working relationships with industry personnel. These participants acknowledged a potential for adverse industry influence, but expressed confidence in existing strategies for avoiding industry influence. Other participants described unsatisfactory or undeveloped relationships, and some participants (all from general health consumer groups) presented their groups’ missions as incompatible with the pharmaceutical industry because of fundamentally opposing interests. Participants reported that interactions between their patient group and pharmaceutical companies were more common when companies had new drugs of potential interest to group members. Patient groups that accepted industry funding engaged in exchanges of “assets” with companies. Groups received money, information, and advice in exchange for providing companies with marketing, relationship building opportunities with key opinion leaders, coordinated lobbying with companies about drug access and subsidy, assisting companies with clinical trial recruitment, and enhancing company credibility.

Conclusions An understanding of the range of views patient groups have about pharmaceutical company sponsorship will be useful for groups that seek to identify and manage any ethical concerns about these relationships. Patient groups that receive pharmaceutical industry money should anticipate they might be asked for specific assets in return. Selective industry funding of groups where active product marketing opportunities exist might skew the patient group sector’s activity towards pharmaceutical industry interests and allow industry to exert proxy influence over advocacy and subsequent health policy.


  • Contributors: LP designed the study, collected the data, participated in the analysis, and wrote the first and subsequent drafts of the manuscript. AF, QG, BM, and LB participated in the design and data analysis, and commented on all drafts, including reading and approving the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. LP is the guarantor.

  • Funding: No specific funding was received for this study. QG was supported by a postdoctoral fellowship from the Canadian Institutes of Health Research. AF was supported as a post-doctoral fellow by the National Health and Medical Research Council of Australia, project grant No 1122332.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; BM is a member of the European network of Health Action International (HAI-Europe) and acted as an expert witness on behalf of plaintiffs in a Canadian class action suit on cardiovascular risks of testosterone; the remaining authors declare no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by the University of Sydney Human Research Ethics Committee (project No 2017/758).

  • Data sharing: The database of publicly declared industry payments to patient groups is available at:

  • Transparency: The lead author (LP) affirms that the manuscript is an honest, accurate and transparent account of the study being reported.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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