It may have been too good to last. After an upswing in pharma's global reputation in 2015, its standing among patient groups has swung the other way—again. Only 38% of patient groups said the industry had either an “excellent” or “good” reputation, down from almost 45% last year.

In fact, after last year’s peak, pharma scores dropped across all the measurements in PatientView's annual survey, including innovation, transparency, pricing, ethical marketing and high-quality, useful products.

The good news—if it can be called that—is that pharma wasn’t alone. Almost all of the other healthcare segments PatientView explores in the survey, from biotech to insurers, also dropped in their esteem. The only exception was not-for-profit insurers.

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Blame President Donald Trump for playing a role, what with his very public criticisms of pharma "getting away with murder" and his vows to bring down drug prices. Then there's the ongoing pricing debate, which kicked into high gear when then-CEO of Turing Pharmaceuticals, Martin Shkreli, hiked the price of an old med, Daraprim, by 6,000% in 2015.

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But another part of the reason for the overall declines may be that, as patient groups become a more important part of the healthcare conversation and infrastructure, they feel more confident speaking their minds. Their increased standing may give them a firmer foundation for criticizing pharma and the rest of the healthcare business, said Alex Wyke, founder and CEO of PatientView.

“I often say to look at what happened with feminism, what happened with civil rights, what happened with the environment and how that affected the world, then you’re getting a flavor of what’s happening in the healthcare world with patients and patient groups,” she said, referring to the fact that gains in these various movements led to criticism.

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Wyke also pointed to the current political climate and the pricing debate, particularly in the U.S.

“I think Trump probably had a part,” Wyke said. “Something that also started happening in 2015 was that we started getting more comments along the lines of ‘What’s the point of you inventing a drug when we can’t get access to it because of pricing?’ So I think that innovation and pricing are getting more interlinked.”

In fact, patient groups' opinions on pharma's pricing took a dive in the survey. The industry's rating for fair pricing dropped to just 11% in the excellent or good column, down from 15% last year. Another large drop was in ethical marketing, where 25% of patient groups said pharma was doing a good job keeping its marketing on the up-and-up, down from 36% last year.

As the pricing debate continues to rage, pharma and biotech's leading trade groups are touting their commitments to science, innovation and improving patients lives in broad—and expensive—image campaigns. Pfizer has mounted its own image-boosting campaign, highlighting the long journey new drugs take from early lab work to patients' medicine cabinets.