Patients for Affordable Drugs has released a new report examining the financial levers and tactics used by Big Pharma to influence patient advocacy groups in America.

The complex matrix of money and influence built by drug industry over decades extends deeply into organizations that represent patients or claim to represent patients, creating conflicts of interest and constraints on even the most respected groups when it comes to critical drug pricing reforms.

The startling report outlines the financial and organizational relationship between major advocacy groups and some of the largest drug companies in the world.

Among a sample of 15 influential U.S. national patient organizations, all took contributions from Big Pharma. In addition, all but one of the organizations failed to disclose the full extent of their funding from the pharmaceutical industry. On top of that, 12 out of the 15 groups have a representative from the pharmaceutical industry on their board.

For example, the report found that the American Cancer Society fails to disclose how much revenue it receives from the pharmaceutical industry. The group refuses to back policy provisions that would allow Medicare to negotiate lower drug prices, and at least three of the 22 members of the Society’s board of directors are drug company executives

The report may explain why patient advocacy groups have been largely mute in the battle to reduce prescription drug costs in the U.S. – the highest in the world.