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Because of their arguably extreme nature, and the fact that regulatory agencies did eventually intervene, these cases could all too easily be brushed aside as the exceptional dirty laundry in an otherwise clean research environment. The rather limited analysis and discussion of finder''s fees in the literature (6) may both reflect and reinforce the unwarranted belief that finder''s fees are rare and adequately dealt with under existing professional and research ethics codes and policies. Offers of finder''s fees ranging between $2,000 and $5,000 per subject are now regarded as "common" in the United States. (7) The lack of similar reports in other countries could give the impression that finder''s fees raise troubling issues only in the United States. This is not the case. We have heard personal testimony from various sources in Canada indicating that many Canadian physicians and other health-care workers receive up to several thousands of dollars for enrolling patients in, or referring them to, clinical trials. Direct evidence of this practice is unfortunately hard to obtain. Those involved have no interest in drawing attention to their activities, and their colleagues are understandably reluctant to speak out.

These are Quality Practices, a set of easy-to-use, online workbooks written to educate the consumer about best practices, and My Quality Coach, an electronic approach to helping employees better understand their condition and manage their care.The Midwest Business Group on Health is a Chicago-based not-for-profit coalition of more than 90 members from an 11-state area. MBGH, which was founded in 1980, provides leadership and knowledge to employers working together to continuously improve the quality and cost-effectiveness of health services. A copy of the Dr. Data project report, "How We Choose Doctors - What Is and What Could Be" is downloadable from the reports section of the MBGH website - http://www.mbgh.org

Over the past 5 years, a series of articles in leading American newspapers has revealed the extent to which the conduct of clinical trials may be affected by inducements offered by corporate research sponsors and accepted by some unscrupulous physicians. (1) The cases described were disturbing. They involved physicians engaged in excessive "enrollment activities" in exchange for money. Some of these physicians perpetrated fraud, falsifying their recruitment records in order to increase their profits. Others ignored exclusion criteria designed to ensure the safety of subjects and the validity of research results, referring their patients to research investigating treatments for conditions from which they did not suffer. (2) One of the articles reports that physicians focusing exclusively on commercial research regularly divulge annual incomes upwards of $1,000,000 with profits in excess of $300,000. Two physicians accumulated well over $10,000,000 through clinical trials activities in less than a decade. (3) Another article reported the role of finder''s fees and payments to parents in increasing the enrollment of children in medical research in the United States from 16,000 in 1997 to 45,000 in 2001. (4) It also highlighted the fact that subjects may be exposed to serious harm through referrals by zealous and inexperienced physicians, drawn to recruitment activity by offers of up to $5,000 per patient referred. Finally, several other "disturbing recruitment practices" were reported by the U.S. Department of Health and Human Services'' Office of Inspector General in its report on subject recruitment practices. These include many cases of patients being harassed for participation; a nursing home resident being told to participate in research or leave the home; and a subject who died and was later found not to have met the inclusion criteria for the study. (5)

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