Retirement slammed Carole Jacko. Raising two grandchildren, she's too young for Medicare and too strapped to pay $600 a month for health insurance.
So when a trip to the emergency room ended with a diagnosis of diabetes, Jacko found a creative solution.
She became a medical guinea pig, offering herself to science in exchange for free medication, free doctor's visits and even a modest payment.
"It really covers costs," Jacko said. And the clinic staffers "are very good and professional. ... They keep a good eye on you."
With the economy careening and millions uninsured, some doctors and researchers believe the lure of volunteering for medical research is growing -- and so are potential ethical pitfalls.
"Sometimes desperation leads people to be poor shoppers," to gloss over risks or grasp at imagined benefits, said Kevin Weinfurt, a Duke University professor who focuses on medical decision-making and ethics.
No regulations limit how much a person can be paid to take part in medical research.
Payments are often modest, however, usually intended to cover gasoline, time or inconvenience. But the odd $25 here or $50 there can be dwarfed by the value of free medical care that would otherwise cost hundreds or thousands of dollars.
S. Elena MacLachlan, an Oakland nurse studying for her doctorate, is willing to undergo what might be a sham surgery for the chance to get a new type of weight-loss operation for free.
"I'm not in poverty. I have a good career. But my insurance doesn't cover it," she said, estimating a similar operation would cost her tens of thousands of dollars otherwise. "I thank God for this."
Researchers do not agree on how much money it takes to cross the line and exert "undue influence" or coercion to get someone to enroll in a study. That's something federal regulations do forbid.
"This is the most complicated issue in research ethics, and it's still an unsettled question," Weinfurt said.
It has lingered for more than 100 years, since an Army surgeon named Walter Reed paid volunteers at a Cuban outpost $100 in gold to risk being infected with yellow fever. The men got another $100 if they contracted the disease, payable to themselves -- or any designated survivor.
The dangers Carole Jacko runs are far less dramatic.
She is participating in a study aimed at evaluating how three different high blood pressure medications work together. The combination being studied is approved in Europe, but not by the U.S. Food and Drug Administration. Even so, U.S. doctors can and sometimes do prescribe the combination already -- but drug companies are not allowed to promote such "off label" uses.
Jacko signed a thick disclosure packet that detailed known side effects of each drug, including nausea, headaches and kidney problems. She was warned she would have to stop taking all medications during a "wash-out" period before the start of the study, leaving her high blood pressure temporarily uncontrolled.
That, she was told, carried a rare chance of a fatal or disabling stroke or heart attack.
"It really didn't scare me," she said, because she knew and trusted the medical assistants who saw her regularly.
E-mail Carrie Peyton Dahlberg of The Sacramento Bee at cpeytondahlberg(at)sacbee.com.
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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