The HOPE Clinic In May 1999 York Times published a series about abuses resulting from drug companies paying private practice doctors to refer patients as experimental subjects (Eichenwald & Kolata, 1999a, 1999b). The series provided intriguing history of economic events and policy decisions that created this situation. According to Eichenwald and Kolata (1999a), it began in early 1990s, with managed care providers pressuring drug companies to reduce price of their products and drug companies, in turn, strategizing to compensate for lost revenues by expanding their product line. Reforms at FDA accelerated process of bringing new drugs to market, but more experimental subjects were needed to test new drugs. Drug companies began to solicit private practice doctors as researchers, reasoning that they would have easier access to subjects than academic researchers. Anyone with MD degree is technically qualified to conduct research. Certain private practice doctors, who were meanwhile losin g income as a result of managed care payment cutbacks, greeted these incentives--as much as $1,000 per patient-- with enthusiasm. The number of private doctors involved in drug studies increased 300 percent (4,307 to 11,662) between 1990 and 1997. This practice of payment per subject led to numerous abuses, endangering patients and jeopardizing validity of research findings (Eichenwald & Kolata, 1999a). As a clinical social worker, I assumed such matters fell outside scope of my practice. Then I received a form letter announcing opening of a new psychiatric clinic for adolescents in a nearby city. Although I teach full-time at a school of social work, I also maintain a small clinical practice working mostly with adolescents, which was how my name came to be on mailing list. As social workers we have ethical duty to discourage, prevent, report, expose, and correct what we perceive as unethical conduct (NASW, 2000, p. 18, section 2.1la). However, because Commentary column in Social Work is not intended for investigative reporting but rather for discussions of current professional issues, I refer to as HOPE clinic. The letter I received bore imprimatur of a prestigious England medical school; let us call it New England College of Medicine. The clinic, according to letter, was an exciting new, investigational program offering assessment and treatment for teenagers who be at risk for developing mental illness. The letter claimed that HOPE clinic was the first initiative in this country to study prevention of serious mental illness. A vague reference was made to international data that suggested a psychosis could be delayed or prevented through early identification and intervention, although no specific studies were cited. The remainder of letter included a symptom list to help identify which clients might be appropriate for treatment and offer of $400 to be paid to recipient of letter for every client referred and accepted into study. Although no specific intervention was described in letter, accompanying brochure mentioned a newly approved drug. A clinic representative, contacted by phone, identified drug in question as Zyprexia, and explained that treatment would consist in every case of one year of psychodynamic therapy in conjunction with either Zyprexia or a placebo, randomly assigned. Although clinic representative would neither confirm nor deny that was a drug trial, he did say that one of funders of clinic, and perhaps sole funder of clinic, was Eli Lilly and Company, manufacturer of Zyprexia. Nowhere was this acknowledged in any of literature I received. According to a fact sheet published by NAMI (the National Alliance for Mentally Ill), Zyprexia is one of new atypical antipsychotic medications. …