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More On Paid Clinical Trials

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Paid clinic trials are gaining more and more popularity among healthy volunteers.

Paid clinical trials are used in different medical contexts. Context is defined primarily by treatment modality rather than medical specialty because it is the nature of the therapy that relates most directly to clinical trial design. The specific contexts discussed are drugs, devices, surgery, complementary and alternative medicine (CAM), and prevention. The intent is not to fragment the principles that underlie trials but to illustrate common themes in these diverse areas. It is helpful to understand how the setting has an impact on the design, ethics, interpretation, and frequency of studies performed.

Statistical principles of experimental design are very reliable, flexible, and broad, having been of service to agriculture, industrial quality control, reliability testing, and medicine. Trials have been used for decades to develop and test interventions in nearly all areas of medicine and public health. Trials seem to be most actively employed in cancer, cardiovascular disease, and AIDS. These areas share a need to evaluate new drugs, drug combinations, devices, surgery, other treatment modalities, and diagnostics. However, trial methods can also be used to assess treatment algorithms as compared with specific agents, making them applicable to a wide array of therapeutic and prevention questions.

Despite extensive use, paid clinical trials have not diffused evenly into all medical disciplines or contexts. The heterogeneous application of trial methodology can be partly explained by two general factors: demands by practitioners and patients, and key external pressures. Demands by practitioners and patients are different in various specialties and diseases, affecting the perceived necessity and acceptance of clinical trials. For example, the training of practitioners in some disciplines may not cultivate a reliance or insistence on clinical trials as rigorous evaluation tools. Also patients may place inconsistent demands on different therapies or those administered at different points in the progression of disease. A good example is treatment for cancer. Soon after diagnosis most patients demand cutting-edge and safe therapies. If the disease progresses, the same patients may turn to alternative therapies that appear safe but are marginally effective or completely unproven, without the same demands for demonstrated efficacy. This illustrates that patients’ risk-benefit assessments change as a disease advances. Different contexts and areas of medicine also experience distinct key external pressures. These influences arise from regulation, the pace of therapeutic development—which itself may depend on scientific developments in other fields, chance, and the economics of care. There are different kinds of pain clinical trials available for healthy individuals.

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