Iranian family being asked to participate in a clinical trial

WHO/ TDR / Crump

Clinical trials in developing countries are often surrounded by concerns that poorly educated people with little access to treatment might feel undue pressure to participate.

Writing in The Lancet, Ezekiel Emanuel and colleagues argue that inducements offered to encourage participation in trials are only unreasonable when they are strong enough to persuade people to put their welfare at risk.

Incentives are part of "everyday life", say the authors, pointing out that people are often encouraged to move to a new job by offers of better pay or more holiday time.

They argue that just because a trial offers benefits does not mean it is unduly persuading participants to take part. Researchers should focus instead on ensuring trials meet ethical standards, they add.

In an accompanying article in The Lancet, Robyn Martin says the issue is not as simple as having a trial signed off by an ethics review committee. If participants are offered a treatment they have no other way of receiving, they have no real choice but to take part.

Even the most rigorous process of informed consent or the most vigilant review board cannot filter out all undue inducement, says Martin.

Ultimately, he concludes, even approval from an ethics committee should not remove researchers' duty to consider whether a trial induces people to take part out of desperation rather than altruism.

Link to full article by Emanuel and colleagues in The Lancet*

Link to full article by Martin in The Lancet*

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