Participation in a clinical trial must be purely voluntary, competent, and informed, with consent understood and uninfluenced by other considerations, as stated in the 1947 Nuremburg Code.26 But in actual practice, this seldom occurs, particularly if no alternative treatment is available. The decisions of patients, especially those who are impoverished, are often influenced by the economic context and system of medical coverage and care.27 The economic incentives and the possibility of obtaining continuous and personalized medical care, which would be otherwise unavailable, make informed consent difficult.28 In certain countries, financial incentives for participating in a clinical trial may be more than a potential study subject’s regular wages. Consequently, ethical considerations arise with respect to remuneration of the study subjects, the investigators, or both. Compensation for participation in a study has many potential consequences in poorer countries because it creates an incentive that may minimize consideration of the risks and disadvantages of participating. Hence, economic incentive must not be the sole reason for the patient’s participation in the clinical trial. There should not be any monetary payment to the patient except to cover the expenses incurred by his or her participation. Similarly, payment to the investigators and their institutions should be transparent and should be commensurate with the costs of performing the study.