Financial advisers who sell you insurance or mortgages are required by the rules to tell you how much commission they will earn as a result of your custom. But doctors who ask patients under their care to take part in a clinical trial are under no obligation to reveal how much they might earn as a result of their patients agreeing to take part in the trial. Can this be right?
Of course, the situation is not quite as simple as this. Selling insurance, one could argue, is not the same as inviting a patient to take part in a clinical trial. If the doctor was not reimbursed generously for his time then important clinical research would just not get done.1 The doctor can be trusted to put the best interests of the patient above personal gain, and therefore telling potential trial subjects how much the doctor will be paid is unnecessary. Do these arguments stand up to closer scrutiny? Or has the practice and scale of payments reached a point where it has become harmful to the conduct of good research?
Randomised clinical trials, often sponsored by pharmaceutical companies with a valid commercial as much as a genuinely scientific interest, are the only reliable way to generate good quality evidence of efficacy.2 Clinicians ideally should be in equipoise about the treatments being tested,3 and patients should give voluntary consent based on full disclosure of relevant information.4 The practice of paying doctors to recruit patients under their care, and not disclosing this pecuniary interest, corrupts both these ideals.
- Doctors are often paid to recruit patients to clinical trials sponsored by pharmaceutical companies
- Such payments are not at present disclosed to potential trial patients as part of the process of gaining consent
- Patients believe that such payments are wrong and that they have a right to be told about them
- Such non-disclosure is potentially unethical and damages efforts to involve patients more fully in clinical trials.