Patient advocacy is part of a healthy democratic society, and grassroots organizations are of course welcome to accept donations and to advocate. However, when such organizations are financed by a for-profit industry, they should not be allowed in the public square to represent industry messages as if they were independently derived grassroots opinion. Just as drug packaging must be labelled to identify its active ingredient, the same principle should apply to drug-related advocacy.

   In the USA, corporations enjoy rights to free speech comparable to individuals, but they do not have a right to purchase deceptive speech. For example, the Federal Trade Commission has sued companies for purchasing positive online reviews of their products from third parties. First, to protect consumers, the Uniform Deceptive Trade Practice Act should be modernized to define astroturfing as a deceptive business practice and to mandate disclosure of material connections between “grassroots” groups that endorse a company’s products and the company in question. Second, because astroturfing can also represent a form of fraud against investors by conveying that a company’s products are more popular with the public than they are in reality, the Securities and Exchange Commission should exercise its authority to require full disclosure in annual corporate filings of all funding of advocacy groups in which corporations engage.

   Legislative bodies and advisory boards at all levels of government should also discourage astroturfing in hearings by adopting a public disclosure norm. Specifically, immediately after witnesses are sworn in and are therefore legally required to tell the truth, the committee chair could direct that each witness publicly state whether they or their organization have any financial connections to the industry whose products and practices are the subject of the hearing. 

   Journalism has responsibilities in this area as well because mass media is one of the most common routes through which astroturf groups disseminate pro-industry messages. Journalists who consider quoting members of putatively grassroots advocacy organizations should adopt as standard practice asking whether the organization is funded by the industry and including that information in any reported coverage of the organization.