Carnegie Mellon University’s Alex John London and George Loewenstein joined Cynthia Cryder, assistant professor of marketing at the Olin Business School at Washington University in St. Louis, and Kevin G. Volpp of the University of Pennsylvania School of Medicine and the Wharton School to investigate how payment levels affect the anticipation of risk for the estimated 15 million Americans recruited annually to take part in clinical trials.
George Loewenstein, the Herbert A. Simon Professor of Economics and Psychology, says the findings contradict some of the common guidelines used for establishing participation incentives. “Most organizations that do research prohibit participation payments that substantially exceed compensation for time and expenses,” he said. “The fear is that people will be overly tempted by high payments to take excessive risks. Our research challenges this convention. It suggests that people assume that studies that don’t pay much aren’t risky.”
The research team conducted three experiments to measure people’s interest in participating in potentially risky research studies, their perception of the risk associated with those studies and how payment amounts affected their interest and perceptions. In two of the studies, respondents believed that they were actually being recruited for a study, and the researchers looked at the extent to which they navigated the Web site to learn about the study’s risks. Those offered higher payments for participating, spent more time learning about risks and ultimately concluded that the study posed greater risks to them than those that offered lower payments.
Participants for the experiments included a nationwide sample recruited by a link on a newspaper Web site and a sample from a lower-middle class neighborhood in Pittsburgh.
“Contrary to the assumption that high payments are excessively tempting, our research suggests that they alert subjects to potential risk,” explained Loewenstein. “An added bonus of high payments is that it is ethically sensible for people to be adequately compensated when they do, in fact, incur risks.”
The authors of the study believe their findings should contribute to the debate over research participation incentives and informed consent. According to Cryder, the study’s lead author and a former graduate student at Carnegie Mellon, “The way potential human subjects interpret payment, risk and information about clinical trials has to be considered when setting guidelines for research compensation.”
Additionally, the findings do more than just point out flaws in the current standard. “Our research suggests that it might be possible to use payments in ways that enhance, rather than undermine, the informed consent process,” said London, associate professor of philosophy and director of Carnegie Mellon’s Center for the Advancement of Applied Ethics and Political Philosophy. “This is a surprising finding because it suggests a way of thinking about study payments that differs from frameworks that focus primarily on compensation or speeding study recruitment.”