Author's Commentary on "An Impoverished Student"

Offering financial incentives to increase participation in clinical studies raises a series of ethical issues. For example, participation should be on a voluntary basis, inspired by the desire to help, and not for the money. In addition, when financial incentives are offered, there is a tendency to recruit from vulnerable groups such as the poor, students, intravenous drug users, alcoholics, etc. It is more likely that these marginalized people will lie about their lifestyle in order to qualify to participate and receive money.

In this case, the volunteer was using an herbal remedy, and he did not disclose that information. If the incentive is great enough, it is even more likely that candidates who are users of illegal narcotics will try to qualify. How will the interviewers guarantee that they can exclude drug users, who are unlikely to admit to drug use during the interview process?

Given these considerations, one can also question the scientific validity of such a study. Clinical investigators must be aware that by offering financial incentives they are recruiting from a population that is not representative of the general population. Therefore, the results are biased. Despite this fact, it is quite common to pay clinical study participants.

In addition, these issues raise the question of how to go about proper screening of candidates for clinical trials. It is essential to design screens in order to minimize the likelihood that a situation such as the one described in this case study occurs. It is evident that the investigators must be extremely rigorous in their questioning of potential participants, especially if they are offering cash incentives. If they fail to screen properly, are they committing the ethical equivalent of scientific fraud?

In this case, financial desperation drove the graduate student to take risks with his own health in order to pay for his studies. One may question what obligations universities have to graduate students to continue funding through the studentsÀ careers. In addition, there is a seeming discrimination, which most universities display in providing more assistantships for students in the natural sciences than students in the social sciences and humanities.