Canadian doctors admit earning thousands in trial recruitment feesBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b951 (Published 06 March 2009) Cite this as: BMJ 2009;338:b951
Several Canadian doctor have admitted, on condition of anonymity, that they earn tens of thousands of dollars each year by recruiting patients for clinical trials.
The doctors made the revelation in the current issue of the journal of the Canadian Medical Association (CMAJ doi:10.1503/cmaj.090131). The news article, part of a series on clinical trials that CMAJ will run throughout 2009, says that many doctors are increasingly concerned about the pressure to commercialise research, raising potential conflicts of interest and, for some, ethical quandaries about receiving such money.
One doctor admitted that he was paid as much as $C2000 (£1100; €1240; $1560) from a drug company for each patient whom he persuaded to participate in a clinical trial of a cancer drug.
The article also draws attention to the trend for drug companies to look overseas for trial participants. In India, some patients sign consent forms that they cannot read or are enrolled in trials without their knowledge. There will be about two million patients in clinical trials in India by 2010, it says.
It quotes Jeff Blackmer, executive director of the Canadian Medical Association’s office of ethics, as saying: “When pharmaceutical firms, which fund the majority of clinical trials in Canada, chase physicians to recruit patients, the doctors often have questions about what they are being asked to do.
“Those queries typically come from doctors in community settings. Is participation ethical? Is the sponsor offering too much money? Should the physician agree to sign a nondisclosure form? Physicians who engage in clinical research must juggle an array of issues—patients’ expectations, trial transparency, disclosure of results, scientific validity, trial merits, patient risks, and, of course, financial opportunities contained therein.”
Canada’s three research fund granting bodies recently released a new draft of their ethical guidelines for research involving humans (www.pre.ethics.gc.ca/eng/policy-politique/initiatives/draft-preliminaire/). It includes a new section on financial conflicts of interest. It instructs research ethics boards within universities to scrutinise clinical trial budgets for “unreasonable payments and undue inducements,” such as finders’ fees for referring patients.
The University of Toronto’s Faculty of Medicine prohibits the offer or acceptance of finders’ and completion fees, while the College of Physicians and Surgeons of Ontario has a policy governing conflicts of interest and recruitment of patients into clinical trials, under which non-compliance with its provisions may constitute professional misconduct (http://cpso.on.ca/policies/default.aspx?ID=1536).
However, such ideas have not yet gained traction in the wider research community, says the CMAJ article, so that oversight is “at best sporadic.”
Muhammad Mamdani, director of the applied health research centre at the Li Ka Shing Knowledge Institute of St Michael’s Hospital in Toronto, says that issues of remuneration of doctors and involvement in clinical trials in Canada are mostly governed by guidelines, “and a lot of guidelines are not very proscriptive.”
“There is too much room to play,” he said.
Cite this as: BMJ 2009;338:b951