by Emily A. Largent and Alan Wertheimer, PhD
How do institutional review board (IRB) members and human research protections professionals think about the relationship between payment, coercion, and undue influence?
This is a topic of obvious interest to the research community: Researchers routinely offer payment to prospective research participants as an incentive to enroll or as compensation for their participation in research. IRBs are, in turn, asked to review these payments for their ethical implications. Yet, there is little systematic data about attitudes toward payment in general, and specifically, when IRB members consider payment coercion or undue influence.
To address these questions, in 2010, we surveyed randomly selected PRIM&R members who had previously self-identified as interested in IRBs and human subjects research. Our complete results have recently been published in IRB: Ethics and Human Research.
Here, we’ll highlight three of our findings:
- We found persistent ethical concern about the effect of offering payment to research subjects. Sixty-one percent of respondents reported feeling somewhat, moderately, or very concerned that payment of any amount might influence a participant’s decisions or behaviors regarding research participation.
- Virtually all respondents agreed that an offer of payment constitutes undue influence if it “distorts a subject’s ability to perceive accurately the risks and benefits of research.” However, a surprising 80% also judged that the offer of payment constitutes undue influence simply because it motivates someone to do something they otherwise would not.
Although more than 90% of respondents agreed with a definition of coercion tied to threat of harm, a substantial majority also agreed that research participants are coerced when an offer of payment—not a threat of harm—gets them to participate when they otherwise would not or when they feel they have no alternative but to participate.
There was, however, notable divergence between how individuals viewed the meaning of coercion and undue influence in the abstract and how they applied these concepts to the concrete scenarios included in the survey.
- The majority of respondents expressed acceptance of payment as reimbursement for expenses or as compensation for time, effort, and incon¬venience—regardless of the study population. By contrast, fewer respondents accepted payment as an incentive to participate (about half) or as compensation for risk (about one-third).
Although survey respondents endorsed limiting the amount of payment offered to research participants, the connection between attitudes toward payment and actual IRB practices is unclear. Not only is further research needed, but we also believe that policy guidance and educational efforts should clarify the concepts of coercion and undue inducement. We would love to see PRIM&R’s leadership and members continue engaging in these important conversations.
Stay tuned for a forthcoming blog post in which we will argue that some of our findings reflect misconceptions about coercion and undue inducement!