Clinical trials as an industry and an employer of labour

Abstract

To produce drugs, clinical trials depend upon the labour of volunteer participants. For ethical reasons, participants are described as volunteers because to position them otherwise could be considered undue inducement. By using a labour market perspective, we argue that clinical trial participants may be understood as workers. Ethical guidelines argue that remuneration for ‘work done’ by participants in research may result in coercion: research participants will feel obliged to remain in a research trial despite any discomfort and distress simply because of remunerations received. However, we suggest that monetary benefits – in the form of wages – for research participants are no more coercive than the existing and accepted level of inducement. In our commentary, we review clinical trial conduct as it has evolved over the past two decades, the changing investments in this multi-million dollar industry, the ways in which beneficiaries and benefits are conceptualized and how these framings fall short. While it is acknowledged that framing research participants as labourers through the payment of wages has the potential to entrench inequities, we argue that it opens space to consider ways to link global health to the economic empowerment of individuals. Recognizing volunteers not as participants but as ‘workers’ has the capacity to widen the discourses on bioethics as a relevant and powerful counterweight to the injustices of the world today.