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To date, work on health democracy has never dealt with relationships between patient associations and the pharmaceutical industry. The emergence of a genuine health citizenship depends, however, to a great extent on the quality of such a relationship. This communication, which is based on a survey of 1742 patient associations and 270 French-pharmaceutical companies, conducted by BVA upon request of the Ethics Commitee of the French association of pharmaceutical companies (CODEEM) highlights the significance of the ethical issues. Beyond the financial issue, the relationship between patient associations and pharmaceutical companies raises the issue of associations governance, and reveals the limits of "association expertise" but also a high expectations for effective partnerships.