Table 4 Answers to open-ended question (Q28) on what practices could indicate abusive practices

Labor exploitation (11):

Long hours. Smaller budgets for developing countries than for HICs countries. Work hours. Exploitation of vulnerable (poor) workers. Selfish interests dominating community interests. Suspending trials prematurely when first-world quotas are met, inconveniencing patients (ethics dumping). Poor work and safety conditions. Work schedules. Prolonged studies. Lack of social security. Substandard work conditions (facilities and schedules).

Unequal wages (10 mentions):

Payment for the same work done is disproportionately lower in the LMICs.

Patient abuse (10 mentions):

Not informing patients of the benefits. Treating patients as means instead of ends. No travel or meals expenses for patients. Not giving patients enough information. Inadequate (long, unclear) informed consent. Inadequate comprehension of informed consents. Patients left unprotected when the trial ends. Utilizing patients for financial gain. Not enough time for patients to understand the informed consent. Patients not being able to afford the medication after the end of the trial. Poor economic compensation for participants.

Researchers (7 mentions):

Pressure to fulfill enrollment quotas. Researchers selected because of the volume, not the quality, of their work, compromising trial safety and the integrity of results. Inappropriate recruitment, falsifying information. Privileging the protocol over safety. Fabricating information. Researchers lacking knowledge necessary for the study. Lack of participation in publishing.

Sponsors (3 mentions):

Testing medications whose use is restricted in their country of origin (ethics dumping). Failure to report results. Failure to comply with regulations. Providing incomplete drug information, not disclosing adverse effects (ethics dumping).