The Research Subject as Entrepreneur

In her paper "Money for Research Participation: Does It Jeopardize Informed Consent?" Christine Grady (2001) advocates the payment of research subjects, arguing that if certain conditions are met, then payment does not jeopardize informed consent. One of these conditions is that the amount of money offered for research participation be "more or less comparable to that available through similar unskilled moneymaking opportunities in the relevant community." Grady and coauthor Neal Dickert elaborate on this idea in a recent article in which they examine three models for cash payments to subjects: market model, wage-payment model, and reimbursement model. They reject both the market and reimbursement models and argue for the acceptance of the wage-payment model (Dickert and Grady 1999). This model gives research subjects an hourly wage based, not on the market value ofresearch subjects, but on that of other unskilled laborers.

Other commentators consider important questions related to the voluntariness of consent when subjects are paid and the injustice in the preferential enrollment of the poor in studies that pay subjects (Dresser 2001; Sears 2001). We consider a different moral question. Accepting Grady's analysis, how might we address moral concerns related to the research subject as entrepreneur? A case is effective in provoking moral intuitions about entrepreneurial research subjects. Robert Rodriguez, the Mexican-American filmmaker, funded his critically acclaimed feature film El Mariachi, a smartly directed story of a machine-gun toting minstrel, entirely through his participation in clinical research. Interviewed about his research experience on America Online, Mr. Rodriguez said "Yeah, I was in a research hospital called Pharmaco back in Austin, Texas. I was in there for a month testing a cholesterol-lowering drug. And I wrote the entire screenplay in the last three weeks that I was there" (Robert Rodriguez on America Online 1995). He was paid $7,000 as a research subject. El Mariachi was the lowest-budget major-studio movie ever made, grossing thousands of times its production cost (Rodriguez, 2000).

While this story makes us uncomfortable on a gut level, translating this concern into reasoned objections based on Grady's analysis is difficult. Once we have accepted that being a research subject is a job for which one may be paid, it seems difficult to find moral fault with the possibility of subjects-for-hire who might "exploit" the system for their own financial benefit. Indeed, Rodriguez's hourly wage as a research subject, $9.71 ($7,000 for 720 hours of work), is roughly equivalent to the $10/hr wage cited by Dickert and Grady as "just below the 1998 total national average for nonfarm production workers" (1999). Since Rodriguez was paid an hourly wage in line with that of unskilled laborers, he was paid in accordance with Dickert and Grady's model. We can conclude, assuming all additional conditions were met, that Mr. Rodriguez's entrepreneurial behavior is not only ethically permissible, but a perfect example of how "rather than an undue inducement, money to reimburse research participants for their expenses and compensate them in some way for their time and effort may be a demonstration of respect and appreciation for these generous individuals" (Grady, 2001).

Mr. Rodriguez's choice to earn the production budget for his film through research participation is, therefore, morally indistinguishable from the other lines of legitimate employment—whether as a construction worker, short-order cook, or telephone marketer—he may have sought. Our only recourse, then, is to view the ethics of research participation through the same moral lens used to articulate just working conditions for all persons in unskilled jobs. Indeed, this requirement follows from the principle of justice, cited by Dickert and Grady, which demands that "similar people be treated similarly" (1999).

Looking at the case through the lens of just working conditions raises unexpected moral questions about clinical research studies that pay subjects. Did Rodriguez receive compensation commensurate with the market value of his contribution? As Thompson notes, "wages and market considerations are inextricably joined. Employers pay...