Each institution that receives federal support for research on humans is required to create an institutional review board. All proposed clinical research, regardless of the source of support, should be approved by the local institutional review board to assure that the research plans are reasonable and that research participants are adequately protected. Although this formal system of review is designed to protect research participants, the premise on which all ethical research is based is mutual trust and respect between research participants and researchers. This premise requires that physician-investigators involved in designing or carrying out research have primary concern for the potential participants in these investigations. Although the responsibility for assuring reasonable protection of human research participants resides with the investigators and the local institutional review board, the medical profession as a whole also has responsibilities.
Clinical investigation is fraught with opportunities for conflicts to arise.
Physicians should avoid situations in which they are rewarded for particular outcomes. Physician-investigators may find themselves in dual roles with respect to patients who are also research participants. The health and welfare of the patient must always be the physician's primary consideration. If the risks of the research become too great or if continued participation cannot be justified, the physician must be willing to advise the patient to withdraw. Giving finder's fees to individual physicians for referring patients to a research project generates an unethical conflict of interest.