Taking the Plunge

Tip Strip

Remember:

• Read the main text first, ignoring the gaps, to get a general understanding of its subject matter and organization.
• Read the text around each gap carefully. Look at the whole paragraph, before and after the gap.
• Read paragraphs A – H. Check for topic and language links with the paragraphs in the base text.
• Highlight words that refer to people and places.
• Highlight time references; this will help you to follow the development of the argument.
• Re-read the completed text to be sure it makes sense.

Question 1: Which option picks up on the scenario described in the first paragraph?

Question 4: Which option picks up on the idea of risk mentioned before the gap and introduces the idea of employment developed after the gap?

Question 7: At the end of the text, the writer is stating his own opinion about the issue. In which option is this indicated?

Paying people to take part in clinical trials is frowned upon. But in a world of risks and rewards, what’s the problem, asks Julian Savulescu

Consider the following scenario. Researchers from an Australian biotech company want to enlist a family with a rare genetic mutation for a study into genetic illness. They strongly believe that they can identify one of the genes involved in the disease in this family, and if they do, the company stands to make a large amount of money. The researchers aim to persuade the family to take part in the study by offering each member $10,000. All they would have to do is give some saliva samples.

Such standards are rigorously enforced. But there is another way of looking at it. Pharmaceuticals and biotech companies carry out trials because they hope eventually to make substantial profits from the results. The researchers also benefit financially and through the advancement of their careers. Meanwhile, the participants in a trial barely benefit at all. Indeed, they could be said to be exploited in the interests of industry and biomedicine.

Now compare the trial mentioned above with a real example in which a patient is invited to take part in a study into genetic predisposition to glaucoma, a disease of the eye which can cause a person to gradually lose their sight. If she agrees, the patient will have access to a new genetic test for glaucoma that is not available outside the study. The cost of this test is a few hundred dollars.

The issue becomes most acute when applied to high-risk research. Ethics committees argue that in these cases money may make people go against their ‘better judgement’ and take risks that they would not ordinarily take. However, not paying volunteers who take part in high-risk research makes an even greater mockery of the system.

In many cases such as this, the financial reward is the only thing that makes it worthwhile for a volunteer to take the risk. But why should that bother ethics committees? We make such decisions every day. Do we always make them against our better judgement?

Similarly, an unemployed man sees an advertisement for a construction worker’s job. At the interview, the employer tells him the job involves working on high scaffolding and that the risk of dying on the site is between 1 in 2000 and 1 in 5000 higher per year than working at ground level. In compensation for this he will receive an extra $10,000 a year. He takes the job.

Why should they be treated as a special case? Life is all about taking considered risks. If $10,000 is the going rate for taking on a 1 in 2000 increased risk of dying then researchers should be allowed to offer volunteers the going rate. Competent rational people are quite able to weigh up the risks and benefits for themselves. I have never understood the suggestion that offering money restricts people’s freedom to choose.

It seems to me we should allow people to take measured risks for the chance to improve the quality of their lives or their children’s lives or for anything else they value. We should allow them to make that choice in any field.

A For example, a researcher wishes to recruit healthy, unemployed men at a local labour exchange for a study into the effects of new anti-hypertensive medications. The volunteers would have to wear a device to measure pressure in the heart. This can cause life-threatening complications, although the risk of death is 1 in 2000 and is clearly stated on the consent form, yet all the researcher can offer the volunteers is a mere $100 for their trouble.

B In many countries today such a scenario is inconceivable. Researchers are not allowed to offer significant sums of money to participants in a medical trial, even for low-risk experiments. Offering money is considered ‘undue inducement’ that could interfere with a volunteer’s judgement on whether to take part, and turn the relationship between scientist and subject into a commercial, unethical one.

C Benefits in kind like this are permissible, and many volunteers receive them. They are not considered undue inducements, yet money is. This is paternalistic and nonsensical. It would be far more respectful to volunteers if researchers could offer them the choice.

D Could you say that either situation resulted in unsound judgements? In both cases they are effectively being paid for taking on a greater risk. There appears nothing objectionable in their decisions, yet participants in medical trials are not even allowed to make the choice.

E The crucial things are to ensure that the risk involved is reasonable compared with the benefits it will offer the participant and society, and that the participants are fully informed and give their consent freely. If the risks balance the benefits – for example if the right study is likely to save the lives of patients in the future – and the participants know all the risks and are free to make their choice, then what does it matter how much they are paid?

F Consider a couple with two young children who are contemplating buying a new car. They find one for $30,000 but if they spend an extra $10,000, they could get one with significantly better safety features such as air bags and an anti-lock braking system. The safer car has been shown to reduce the risk of death by 1 in 2000 a year. But the couple decide to buy a cheaper car and spend the extra $10,000 on a family holiday instead.

G One such ethics committee in Australia nearly rejected a proposal to pay a particular group of people the equivalent of just 10 US dollars for completing an anonymous questionnaire about their behaviour for a study on the spread of hepatitis C.

H If this is the case, surely it is only fair that they share in the rewards? Publicly funded research is perhaps more complicated, as participants may be acting in the public interest. But my main argument applies equally to commercial and non-commercial trials: researchers should be allowed to pay volunteers, and to pay them well, even for high-risk research.

Дата добавления: 2014-11-16