title: Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest.
abstract: Patient advocacy organizations (PAOs) are influential health care stakeholders that provide direct counseling and education for patients, engage in policy advocacy, and shape research agendas. Many PAOs report having financial relationships with for-profit industry, yet little is known about the nature of these relationships.
  
  
  
  To describe the nature of industry funding and partnerships between PAOs and for-profit companies in the United States.
  
  
  
  A survey was conducted from September 1, 2013, to June 30, 2014, of a nationally representative random sample of 439 PAO leaders, representing 5.6% of 7865 PAOs identified in the United States. Survey questions addressed the nature of their activities, their financial relationships with industry, and the perceived effectiveness of their conflict of interest policies.
  
  
  
  Amount and sources of revenue as well as organizational experiences with and policies regarding financial conflict of interest.
  
  
  
  Of the 439 surveys mailed to PAO leaders, 289 (65.8%) were returned with at least 80% of the questions answered. The PAOs varied widely in terms of size, funding, activities, and disease focus. The median total revenue among responding organizations was $299 140 (interquartile range, $70 000-$1 200 000). A total of 165 of 245 PAOs (67.3%) reported receiving industry funding, with 19 of 160 PAOs (11.9%) receiving more than half of their funding from industry. Among the subset of PAOs that received industry funding, the median amount was $50 000 (interquartile range, $15 000-$200 000); the median proportion of industry support derived from the pharmaceutical, device, and/or biotechnology sectors was 45% (interquartile range, 0%-100%). A total of 220 of 269 respondents (81.8%) indicated that conflicts of interest are very or moderately relevant to PAOs, and 94 of 171 (55.0%) believed that their organizations' conflict of interest policies were very good. A total of 22 of 285 PAO leaders (7.7%) perceived pressure to conform their positions to the interests of corporate donors.
  
  
  
  Patient advocacy organizations engage in wide-ranging health activities. Although most PAOs receive modest funding from industry, a minority receive substantial industry support, raising added concerns about independence. Many respondents report a need to improve their conflict of interest policies to help maintain public trust.
authors.affiliation: Office of Patient Experience, Department of Bioethics, Cleveland Clinic, Cleveland, Ohio2Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Susannah L
authors.initials: SL
authors.lastname: Rose
authors.affiliation: Harris School of Public Policy, University of Chicago, Chicago, Illinois.
authors.forename: Janelle
authors.initials: J
authors.lastname: Highland
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Karafa
authors.affiliation: Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Steven
authors.initials: S
authors.lastname: Joffe
mesh_terms: D001709:Biotechnology / Q000191:economics; D016265:Conflict of Interest / Q000191:economics*; D004345:Drug Industry / Q000191:economics; D004864:Equipment and Supplies / Q000191:economics; D005376:Financial Management; D061889:Healthcare Financing / Q000941:ethics*; D006801:Humans; D010344:Patient Advocacy / Q000191:economics / Q000941:ethics; D011050:Policy Making; D011635:Public Health Administration / Q000191:economics / Q000941:ethics; D014481:United States