Risk, judgment and fairness in research incentives.

Emanuel and Miller argue that “by themselves the payment and profit status of [TeGenero] do not make the [TGN1412] trail ethically suspect” (2007, 76). I think that they are right to argue that there is nothing necessarily incriminating about for-profit companies conducting medical research, but that this conclusion is irrelevant to the moral status of incentives in the TeGenero trial. Not only do Emanuel and Miller miss the point of the objection that pecuniary incentives distort judgment, but they also employ too strong a standard to establish that there is nothing ethically suspect. On the first issue, Emmanuel and Miller (2007) suggest that monetary inducements do not distort judgment in a morally problematic way because monetary incentives are a matter of course for almost all professions in which risks are involved. But not all incentives are equivalent. Suppose two hypothetical incentive structures by which I might be paid for participation in a medical trial: