Thursday, February 14, 2008

The Professor's Straw Man Free Lunch for Physicians Argument

According to a Wikipedia entry: "A straw man argument is an informal fallacy based on misrepresentation of an opponent's position. To 'set up a straw man' or 'set up a straw man argument' is to create a position that is easy to refute and attribute that position to the opponent. "

Defenders of drug industry marketing practices often use this technique to counteract opponents' arguments against certain pharma marketing practices.

Such is the case of Emory University Professor Paul H. Rubin's argument that "there's nothing wrong with letting drug reps schmooze with doctors," and specifically nothing wrong with sales reps providing free lunches to doctors (see his article in Forbes: "A Free Lunch").

Professor Rubin previously was Chief Advertising Economist at the Federal Trade Commission and Chief Economist at the U.S. Consumer Product Safety Commission and he currently "consult(s) for the drug industry from time to time, most recently for Pfizer."

The professor is in good company -- ie, the legion of former government officials once employed by regulatory agencies whose mission is to protect consumers who are now in "academia," PR agencies, or non-profit centers working full-time or part-time for the drug industry. The smart asses over at Drug Wonks are among this group.

They all employ the same kind of straw man rhetorical technique.

It's easy to win an argument that "free" lunches provided to physicians cannot possibly be harmful, whereas it is harder to refute the fact that expensive new drugs are often not the best option for improving outcomes.

Professor Rubin puts down a study regarding gifts to physicians by using the proof-by-lack-of-evidence-to-the-contrary card: "there was no evidence of harm to patients caused by doctors and drug reps breaking bread."

Of course there isn't! Most drugs do help patients rather than harm them -- even if they are prescribed to the wrong patients, drugs are not likely to hurt them in any "measurable" way. When was the last time you checked into a hospital because Lipitor caused leg cramps? Either you lived with it or you stopped taking the drug. There's no outcome that can be measured here -- except that you and your insurance company wasted money.

As a counter-argument, Rubin cites a study by another professor -- Frank Lichtenberg of Columbia University -- who receives funds from Merck and Pfizer and consults for Barr Laboratories (plus law firms and/or PR agencies that probably represent the drug industry). That study purports to proves that today's more expense drugs improve outcomes (at least as far as saving hospitalization costs are concerned.)

Professor Rubin claims that busy doctors do not have time to read medical journals and "a meal with a pharmaceutical salesperson is a time-efficient way for a busy doctor to learn about new drugs..."

As if doctors could not have quiet lunches by themselves in their offices in front of their computers and learn about new drugs from a myriad of sources -- including their colleagues on social networking sites like Sermo.

Rubin claims that because manufacturers of generics do not promote those drugs, "it might be difficult for the physician to learn about generics at all."

Thus, professor Rubin's position can be boiled down to this: without pharmaceutical marketing -- including free lunches -- doctors would be dumbasses and patients would suffer worse outcomes.

Rubin also says that "the life expectancy of Americans is at its highest level ever and will continue to increase." What he doesn't say, however, is that US life expectancy is lower than in many other countries where pharmaceutical marketing to consumers is not legal and where physicians prescribe drugs from strict one-payer formularies (see, for example, "Do New Drugs Prolong Lives?").

Rubin also does not mention that Heart Disease May Be Rising in U.S., Ending 30 Years of Decline. Perhaps all these new Rx drugs Americans are taking may be contributing to this rise? You might recall the results from Vioxx and Zetia clinical trials that showed increased CV problems.

The report I just cited states:
"Heart disease fell from 1981 to 1995, when it leveled off, and may have risen since 2000, said an article in today's issue of the Archives of Internal Medicine."
Of course, doctors don't have time to read this journal, so they'll have to depend on pharma sales reps to tell them all about this. Oh yeah! That'll happen!

It's interesting that direct to consumer advertising of drugs really became significant in the US at about the same time that heart disease leveled off and began to rise! Coincidence? You tell me.

4 comments:

  1. Anonymous12:12 PM

    You're dead on! They also fail to mention that the most heavily marketed docs are specialists such as psychiatrists. These docs are only prescribing a handful of drugs over 95% + of the time. If the doctor can't take the time to keep up on the few drugs he prescribes daily, please retire, buy one less mercedes for your kids or ask one of the medically trained nurses to fill you in as opposed to that cute business grad.

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  2. coelentrate7:18 AM

    "Thus, professor Rubin's position can be boiled down to this:without pharmaceutical marketing -- including free lunches -- doctors would be dumbasses and patients would suffer worse outcomes."

    The strawman argument phallacy includes misrepresentation of of the opponent by exaggeration. You are just as guilty of making a strawman argument, if not worse.

    Just sayin'

    ReplyDelete
  3. Ha, ha! You caught me!

    ReplyDelete
  4. coelentrate3:54 AM

    I agree with you though

    ReplyDelete

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