Background to the debate: An important mechanism for protecting human research participants is the prior approval of a clinical study by a research ethics board, known in the United States as an institutional review board (IRB). Traditionally, IRBs have been run by volunteer committees of scientists and clinicians working in the academic medical centers where the studies they review are being carried out. However, for-profi t organizations are increasingly being hired to conduct ethics reviews. Proponents of for-profi t IRBs argue that these IRBs are just as capable as academic IRBs at providing high-quality ethics reviews. Critics argue that for-profi t IRBs have a confl ict of interest because they generate their income from clients who have a direct financial interest in obtaining approval.