So after reading ethicist Carl Elliott’s incisive and disturbing new book, “White Coat Black Hat: Adventures on the Dark Side of Medicine,” I asked him to inject some light into the darkness: What would he suggest to counteract the many pernicious ways that money influences the practice of medicine? He replied:
The Guinea Pigs
Well, the problem with paying research subjects is that you wind up exploiting poor people, who are often desperate enough to endure all kinds of risks and discomfort as long as they get a paycheck. I can see two options. One, you could just ban payment to research subjects, which might work, but you’d have to be vigilant about making sure that the pharmaceutical industry doesn’t simply find another exploitable population – for instance, in the developing world. Two, you could treat guinea-pigging like a job, and make sure that these subjects have all the protections of a decent job, like a fair wage, health insurance, compensation when they are injured, workplace inspections, the right to unionize, and so on – all the things that they are usually denied to them right now.