Research on cash payments to promote health: Ethical concerns may be misplaced

March 27, 2012

It is fairly common for clinical research participants to receive payment for expenses such as travel and parking. What has raised ethical questions are payments or incentives given to encourage people to participate in research or to use a specific health intervention or care plan as part of the research.

In a paper published in , Carnegie Mellon University's Alex John London argues that when incentives are used to encourage people to engage in healthy activities from which they are likely to benefit, and with which they are already familiar, about the use of incentives may be misplaced.

"Current research ethics guidelines do not distinguish between giving a person money as an incentive to enroll in a research study and conducting a study to see if giving someone money as an incentive to stop smoking or to lose weight helps such people stop smoking or lose weight," said London, associate professor of philosophy within CMU's Dietrich College of Humanities and Social Sciences and director of the university's Center for Ethics and Policy.

Writing on behalf of the Ethics Working Group of the HIV Network, London and colleagues argue that ethical concerns that may be appropriate when considering incentives given to encourage participation in research may be out of place when considering incentives given to people to engage in healthy behavior.

"I know a lot of people who would like to quit smoking or lose some weight but who can't seem to stick to the relevant care plan," London said. "Researchers want to know if providing cash incentives for sticking with these plans will help people succeed. They also want to know if offering for early HIV testing or for seeking treatment after a positive test will improve patient care and help contain the spread of HIV. The only way to answer these questions is to study the use of such incentives in research."

London and his colleagues wrote, "Some common concerns about using incentives to increase participation in research, such as that attractive incentives will undermine participant autonomy, are misplaced when incentives are used to overcome economic obstacles or a lack of effective motivation, and when recipients are incentivized to engage in health-related behaviors or practices with which they are already familiar and which they regard as beneficial or worthwhile."

The authors recommend that Research Ethics Committees — the established bodies responsible for approving the ethical conduct of trials — should require researchers to provide an evidence-based rationale for predicting that the provision of an incentive will encourage the intended healthy behavior and not adversely affect the willingness of participants or community members to engage in that behavior.

"Research Ethics Committees should ensure, as far as possible, that the use of incentives to promote healthy behavior could be sustained in the context where research is conducted and would not represent an unreasonable use of scarce health resources," said London.

Explore further: It pays to be healthier: Targeted financial incentives for patients can lead to health behavior change

More information: London AJ, Borasky DA Jr, Bhan A, for the Ethics Working Group of the HIV Prevention Trials Network (2012) Improving Ethical Review of Research Involving Incentives for Health Promotion. PLoS Med 9(3): e1001193. doi:10.1371/journal.pmed.1001193

Related Stories

It pays to be healthier: Targeted financial incentives for patients can lead to health behavior change

November 21, 2011
Financial incentives work for doctors. Could they work for patients, too? Could they encourage them to change unhealthy behaviors and use preventive health services more? In some cases, yes, according to Dr. Marita Lynagh ...

Recommended for you

New tool demonstrates high cost of lack of sleep in the workplace

September 25, 2017
Sleep disorders and sleep deficiency are hidden costs that affect employers across America. Seventy percent of Americans admit that they routinely get insufficient sleep, and 30 percent of U.S. workers and 44 percent of night ...

Maternal diet could affect kids' brain reward circuitry

September 25, 2017
Researchers in France found that rats who ate a junk food diet during pregnancy had heavier pups that strongly preferred the taste of fat straight after weaning. While a balanced diet in childhood seemed to reduce the pups' ...

Breathing dirty air may harm kidneys, study finds

September 21, 2017
Outdoor air pollution has long been linked to major health conditions such as heart disease, stroke, cancer, asthma and chronic obstructive pulmonary disease. A new study now adds kidney disease to the list, according to ...

Excess dietary manganese promotes staph heart infection

September 21, 2017
Too much dietary manganese—an essential trace mineral found in leafy green vegetables, fruits and nuts—promotes infection of the heart by the bacterium Staphylococcus aureus ("staph").

Being active saves lives whether a gym workout, walking to work or washing the floor

September 21, 2017
Physical activity of any kind can prevent heart disease and death, says a large international study involving more than 130,000 people from 17 countries published this week in The Lancet.

Frequent blood donations safe for some, but not all

September 21, 2017
(HealthDay)—Some people may safely donate blood as often as every eight weeks—but that may not be a healthy choice for all, a new study suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.