The suggestion to pay for individuals to engage in pro-health behaviors and the question if this idea is an effective, sustainable, as well as cost-efficient tool to promote individual and public health is a controversial issue.

This week’s PLoS Medicine reports on the view of an international team of researchers from the Philosophy Department and Center for Ethics and Policy at the Carnegie Mellon University in Pittsburgh, USA, who write:

“When incentives are used to encourage utilization of, or compliance with, established means of producing individual or public health benefits and when it is likely that recipients are already favorably disposed to these goals, then traditional concerns about the provision of incentives in research may be misplaced, and even misguided.”

Leading author Alex John London and his team examine the ethical issues that are raised when researchers aim to establish whether incentives, either in form of cash payments, gift cards, vouchers, prizes, or other material benefits, encourages people to start or adhere to health interventions, care plans, or activities that change their behavior.

At present, research ethics guidelines make no distinction between providing incentives for the purpose of increasing recruitment into research studies and using incentives as part of a health intervention whose efficacy is being evaluated in a study.

London and his team who write on behalf of the Ethics Working Group of the HIV Prevention Trials Network contest that:

“Some common concerns about using incentives to increase participation in research, such as, that attractive incentives will undermine participant autonomy, are misplaced when incentives are used to overcome economic obstacles or a lack of effective motivation, and when recipients are incentivized to engage in health-related behaviors or practices with which they are already familiar and which they regard as beneficial or worthwhile.”

According to the authors, Research Ethics Committees, i.e. established bodies that are responsible for approving the ethical conduct of trials, should require that researchers provide them with an evidence-based case, which predicts that providing an incentive will promote the intended health behavior and has no adverse effect on people’s preparedness to partake in the desired behavior.

They suggest that:

“Research Ethics Committees should ensure, as far as possible, that the use of incentives to promote healthy behavior could be sustained in the context where research is conducted and would not represent an unreasonable use of scarce health resources.”

Written by Grace Rattue