Incentives shape outcomes. Science is shaped by hidden economic and political forces that distort what seems to be true. Decentralized Science may alleviate problems around funding, conducting, and sharing research. The resulting swell in knowledge — if we make DeSci happen — would be nothing less than a second scientific revolution.

This three part series describes systems to augment existing scientific practices. These incentives structures are made practical by distributed networks, more commonly known as blockchains.

This first part focuses on incentivizing participation in clinical trials.

Decentralized Clinical Trials

Definition

For decades, decentralized trials have referred to experiments that are conducted without a singular clinic site. Perhaps a federation of clinic sites located across multiple geographic regions administered the treatment and collected blood samples. Alternatively, participants might be mailed a biological compound, and their responses would be collected by mail or phone.

Decentralized trials need not have a ‘blockchain’ component, but the right incentives might drive consistency and adherence, which are typically challenging relative to traditional clinical trials.

Problem

In all human research, participants drop out. Perhaps they move; perhaps they grow bored and then simply forget. Perhaps they have a negative reaction to the treatment, but do not want to seem “mean”, and rather than reporting the adverse event, they simply stop showing up or responding to the clinicians.

This problem is even worse in ‘decentralized trials’.

In decentralized trials, there is often less of a human connection to the clinical staff. Participants tend to have less ‘skin in the game’. They may be eager to receive the treatment for ‘free’, but are often not very motivated to actually supply results to the researchers.

This drives costs up, and creates added difficulty for estimating how many participants will be needed for the study to have statistical significance.

Solution A: Escrow

When a participant signs up (and is deemed eligible to participate in a trial) they must then put some currency into an ‘escrow’ account before they receive the treatment.

Upon the study’s conclusion, if the participant is found to have submitted their data, they receive their currency held in escrow back.

An added twist: adherent participants receive a cut of the drop outs’ currency; making participation in the study profitable.

*This solution is ideal for ‘low risk’ trials, in which dropping out is more likely to be driven by inattention rather than adverse events. *

Caveat: Participants are motivated to submit ANY data, and not necessarily true data. Consequently, it is important that participants have a way to ‘exit’ the study and still receive their escrow back; perhaps by having a call with a researcher. There must be SOME friction to leave the trial, but not enough that they would rather submit fake data than lose their currency held in escrow.

Solution B: Tokens

Upon completion of the trial, participants that were satisfactorily adherent receive a share of tokens. These tokens represent equity or royalties for future commercialization of the treatment.

This solution is more ethical for ‘high risk’ trials, in which participants may experience harmful effects.

Caveat: Bad actors may seek to make multiple accounts, or coordinate between participants, to supply fake data. This conspiracy may, for instance, inflate the treatment’s effect. Such actors would likely sell their tokens at the first chance, potentially wrecking the project’s chance of ever making it to market. Anti-sybil and reputation mechanisms will likely alleviate this risk.

Conclusion

Decentralized trials are one of the solutions for the ‘valley of death’ facing new biomedical therapies. By adding ‘crypto incentives’ to decentralized trials, participation and adherence can be increased, allowing more therapies to be validated.

Calls to Action

Interested in participating in a decentralized clinical trial, or finding other biohackers? Fill out this brief survey to join the community.

Are you a researcher yourself? Consider adding one of these incentives to an upcoming study; potentially as an added condition to document their effect on adherence.

Are you also building in DeSci? Let’s coordinate on implementing these mechanisms into emerging platforms, like POAP or DeSci Labs.

Email address: contact@researchcollective.io

Twitter: ResearchDAO