Spreading it around: money for researcher and research participants

There is a consensus that inducements for participants in research studies are ethically permitted as long as they are not "undue." The subject of inducements for investigators has not been ethically analyzed. This essay outlines the three models for compensation suggested by Dickert and Grady--market model, reimbursement model and wage-payment model--and argues that this analysis can be fruitfully applied to remuneration for investigators. Currently, investigators are compensated according to the market model, resulting in undue inducement. Investigators should be compensated according to the wage-payment model, as skilled workers, at the rate an internist earns per hour. The wage-payment model avoids undue inducement, but compensates investigators, particularly non-academic investigators who are not salaried, for their time and effort. However, additional safeguards must be erected: investigators must demonstrate research competency for the studies they are to manage; they must understand research ethics; all investigators must be routinely audited; and subjects must be informed of all remuneration that investigators receive.