The ends aren’t supposed to justify the means, and people shouldn’t be unnecessarily risked for the sake of medical progress. But if paying patients to risk themselves would accelerate progress, is it okay?

That dilemma is raised in a solution proposed by two University of Chicago health policy experts to a paradox of drug development: If moderately effective drugs are already available, patients will have little reason to volunteer for tests of drugs that could be better, but might not work at all.

The policy experts, Anup Malani and Tomas Philipson, illustrate the paradox with data from the early days of HAART, the anti-HIV drug cocktail that hit the market in 1996. Compared to existing drug regimens, HAART was genuinely revolutionary, and has allowed many people to live with the virus for decades rather than years. But HAART still has limitations: Not everyone responds, the side effects can be vicious, and it’s a delay rather than a cure.

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