When the “nudge” goes too far: $1.6 million to support research on the ethics of recruiting research participants

In the late 1950s, market researchers inserted subliminal messages into movies, encouraging audiences to “eat popcorn” and “drink Coca-Cola.” It didn’t take long for the Federal Communications Commission and US courts to ban subliminal advertising – messages not consciously perceived by the eye but unconsciously retained – as unfair business practices and “contrary to the public interest”.

In modern parlance, these messages are often called nudges, but the problem is the same: is influencing a decision without the knowledge of the participant ethically questionable? In this context, an interdisciplinary team of researchers from Case Western Reserve University is examining how specific types of messages can unconsciously influence participation in research studies.

Professor Maxwell Mehlman
Maxwell Mehlman

“If you can’t use nudges to sell Coke, should you be able to use nudges to get people to participate in medical experiments?” said Maxwell Mehlman, the study’s co-principal investigator, emeritus university professor and Arthur E. Petersilge Professor of Law at Case Western Reserve School of Law.

Mehlman, who also co-directs the Law-Medicine Center, is part of a research team that recently received a four-year, $1.6 million grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (NIH). . The team plans to examine the ethical and legal concerns raised by the use of nudges – an approach rooted in behavioral economics, decision-making, behavioral policy and social psychology – to obtain consent from people participating in biomedical experiments.

“The nudge includes accepted public health practices such as counting calories on produce when not necessary, placing salad on the menu before entrees, and displaying graphic images on packages. of cigarettes,” Mehlman said. “But when we think about getting people into medical trials, it troubles me. It certainly raises a lot of questions.

Researchers will learn nudging techniques used to recruit participants, including the bias of questions asked and checklist items on consent forms, and how potential subjects perceive their use. Once the data has been collected and analyzed, they will share their findings and make policy recommendations.

Mehlman is joined in the research by co-principal investigator Kim Kaphingst at the University of Utah. Local contributors include Jessica Berg, co-dean of the CWRU School of Law; Aaron Goldenberg, Roselle Ponsaran, and Ben Schwan of the Department of Bioethics at the CWRU School of Medicine; and Eric Kodish of the Cleveland Clinic Children’s Department of Pediatric Hematology-Oncology.

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