Institutional review boards (IRBs) are often faced with the question of whether research participants should or must be compensated, and how much. In the medical ethics community there is often a presumption that there are ethical reasons not to offer participants too much compensation. This is a very different intuition from the more general notion (embodied e.g. in minimum wage laws) that there are ethical reasons not to offer too little compensation.
I'm one of 64 signers of an open letter about this...
Abadie, R. et al. (2025) ‘Pursuing Fair and Just Compensation for Research Participants: An Open Letter to the Research Ethics Community’, The American Journal of Bioethics, pp. 1–5. doi: 10.1080/15265161.2025.2506328.
"We, the 64 undersigned, from fields including philosophy, law, medicine, policy, public health, patient advocacy, and research ethics, offer this open letter to highlight the growing recognition of the pitfalls of excessive concern over payment to research participants. Experts in the field of research oversight, including institutional review boards/research ethics committees (IRB/RECs), now recognize that for adult participants capable of providing their own informed consent, instances of monetary undue influence are generally quite rare, underpayment is far more common and ethically concerning than overpayment, and that lowering payments threatens justice and fairness without providing substantive protection for participants.
...
"Absent strong evidence that monetary payment will lead to undue influence, it is likely that more harm than good is done by lowering compensation levels for a given study. Research participation generates immense social value, and generous compensation can reflect this value and serve as an important sign of respect and appreciation for participants (Fernandez Lynch et al. Citation2021).
...
"Concern over undue influence through monetary compensation, while well intended, receives outsized attention, even at the expense of other ethical issues. Ultimately, there must be very strong rationale when suggesting such limits for an otherwise approved study, and attempts to limit payment based on the potential for undue influence should be scrutinized especially closely. IRBs/RECs should still keep in mind the amount of time required and burden on participants to ensure at least a minimum standard of compensation is met. At times, they should even require sponsors or investigators to increase compensation amounts when what they are proposing is insufficient. It is high time that the default question shift from “is this payment too much?” to “is this enough?” in clinical trials."
Signed by:
Roberto Abadie Assistant Professor, University of Wisconsin-Madison Department of Kinesiology
Adam L. Anderson Associate Professor of Medicine, Washington University in St. Louis
Emily E. Anderson Professor of Bioethics, Loyola University Stritch School of Medicine
Andrew Berman Professor of Medicine, Rutgers New Jersey Medical School
Barbara Bierer Professor of Medicine, Harvard Medical School, and Faculty Director, MRCT Center
François Bompart Member, INSERM Ethics Committee (France)
Brandon Brown Professor of Medicine, University of California, Riverside, School of Medicine
Arthur Caplan Head, Division of Medical Ethics, NYU Grossman School of Medicine
Carolyn Riley Chapman Lead Investigator/Faculty, Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard
Coalition for Clinical Trial Equity
Alexandra Collins Assistant Professor of Community Health, Tufts University
Marci Cottingham Associate Professor of Sociology, Kenyon College
Stephanie Solomon Cargill Associate Professor of Research Ethics, Albany Medical College
Arlene M. Davis Professor of Social Medicine, UNC School of Medicine
David DeGrazia Elton Professor of Philosophy, George Washington University
David Diemert Professor of Medicine, George Washington University
Anna Durbin Professor, Johns Hopkins Bloomberg School of Public Health
Jake Earl Adjunct Lecturer in Philosophy, Georgetown University
Jake D. Eberts Member of the Board of Directors, 1Day Sooner
Gunnar Esiason Head of Patient Engagement & Patient-Centered Innovation, RA Ventures
James A. Feldman Professor of Emergency Medicine, Boston University School of Medicine
Holly Fernandez Lynch Associate Professor of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine
Susan S. Fish Professor, Boston University Chobanian & Avedisian School of Medicine
Celia B. Fisher Marie Ward Doty Endowed University Chair in Ethics and Professor of Psychology
Jill A. Fisher Professor of Social Medicine, UNC Center for Bioethics
Allison Foss Executive Director, Myasthenia Gravis Association
Foundation for Sarcoidosis Research
Luke Gelinas Senior IRB Chair Director, Advarra
Kevin Griffith Assistant Professor of Health Policy, Vanderbilt University
Marielle Gross Founder/ceo, de-bi, co; Faculty, Johns Hopkins Berman Institute of Bioethics
Scott D. Halpern John M. Eisenberg Professor in Medicine, University of Pennsylvania
Logan Harper ILD & Sarcoidosis Center, Cleveland Clinic, Assistant Professor of Medicine, CCLCM/CWRU School of Medicine
David A. Heagerty Associate Director, University of Pennsylvania IRB
Kristin Hermann Executive Vice President, Strategic Accounts, Scout
W. Ennis James Associate Professor of Medicine and Sarcoidosis Program Director, Medical University of South Carolina
Steven Joffe Art and Ilene Penn Professor and Chair of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine
Nancy M. P. King Emeritus Professor, Wake Forest University School of Medicine
Stephanie A. Kraft Assistant Professor, Geisinger College of Health Sciences
Walter K. Kraft Professor, Thomas Jefferson University
Benjamin Krohmal Assistant Professor, Georgetown University School of Medicine
Emily A. Largent Associate Professor of Medical Ethics, University of Pennsylvania Perelman School of Medicine
Anne Drapkin Lyerly Professor of Social Medicine, University of North Carolina at Chapel Hill
Lazarex Cancer Foundation
Dylan Matthews Senior Correspondent, Vox
Lindsay McNair Principal Consultant, Equipoise Consulting
Josh Morrison President, 1Day Sooner
Joseph Millum Senior Lecturer, University of St Andrews
Torin Monahan Professor, University of North Carolina at Chapel Hill
Axel Ockenfels Professor of Economics at the University of Cologne and Director at the Max Planck Institute for Research on Collective Goods in Bonn
Joshua Osowicki Infectious diseases physician and Team Leader, Murdoch Children’s Research Institute, Melbourne, Australia
Leah Pierson MD/PhD candidate, Harvard Medical School; Cohost of the Bio(un)ethical podcast
Jessica Propps Caregiver Advocate, Foundation for Sarcoidosis Research
Jeanne M. Regnante Principal, Patient 3i, LLC
David B. Resnik Bioethicist
Donald Richardson Cardiovascular Disease Fellow, Cedars-Sinai Medical Center
Alvin Roth Craig and Susan McCaw Professor of Economics, Stanford University
Julian Savulescu Professor of Medical Ethics, National University of Singapore
Scout Clinical
Peter H. S. Sporn Professor of Medicine, Northwestern University Feinberg School of Medicine
Kawsar Talaat Associate Professor, Johns Hopkins Bloomberg School of Public Health
Rebecca L. Walker Professor of Philosophy and of Social Medicine, University of North Carolina at Chapel Hill
Margaret Waltz Research Associate, University of North Carolina at Chapel Hill
Kathryn Washington Sarcoidosis patient advocate
Sarah A. White Executive Director, The Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard
Megan M. Wood Assistant Professor of Communication and Media, Ohio Northern University
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