Economic Behavior and Informed ConsentEconomic Behavior and Informed Consent

To the Editor: Drs Dunn and Gordon¹ suggest that economic principles are the driving force behind an individual’s decision to participate in research. They contend that an individual weighs perceived gains (financial compensation, access to health care, altruistic gratification) and costs as the deciding factor for eventual participation. However, this cost-benefit model fails to address the effects of cross-cultural differences on research participation and health care.² Family, for example, is not a factor in the economic model; however, in some cultures (eg, Chinese Confucian) the family plays an integral role in a family-patient-physician relationship for medical decision making,³ which may minimize individual preference in the decision to become involved as a research participant. Furthermore, patient trust, especially in minority populations, can be affected by the researcher’s sex and race,⁴ so that it is possible that the characteristics of the researcher obtaining informed consent may unintentionally skew participation. Moreover, certain societies (eg, agrarian) place higher value on community responsibility over individuality, resulting in individuals who are not medically “self-determining”⁵ ; this may alter the involvement of a person from these groups.

Economics certainly play a central role when obtaining informed consent and can skew research demographics as described by Dunn and Gordon. However, with increased ease of global transportation and a constant influx of immigrants to the United States, we must consider the culture of potential research participants. Coupling economic incentive with cross-cultural understanding may improve the ability of informed consent to protect the rights of patients, as well as enhance recruitment in research without unintentionally altering demographics.