Academic Medicine Deploys a Logical Fallacy to Avoid Disclosing Inconvenient Truths
Healthcare Renewal
by Dr. Roy Poses
September 14, 2011
We recently discussed a simultaneous retreat from aggressive regulation and enforcement applied to big health care corporations by US government agencies. Now a story published by Bloomberg [currently available without a subscription here on PharmaGossip] showed that the push for less disclosure of relationships with industry that generated conflicts of interest for academic medicine came not from industry, but from … academic medicine:
The lobby for Harvard University and other research institutions drove the Obama administration to weaken draft rules for scientists to disclose potential conflicts of interest, according to U.S. records and watchdog groups.In particular,
Universities objected to draft rules in a letter to NIH and in meetings with officials at the White House Office of Management and Budget, approver of the final version, said Carrie Wolinetz, associate vice president for federal relations at the Association of American Universities that represents 61 research universities.Also,
The letter was co-signed with the Association of American Medical Colleges, American Council on Education and Association of Public and Land-Grant Universities.The one example of the universities’ reasoning to justify their objections to greater disclosure of conflicts of interest was striking.
Wolinetz’s organization wrote in the letter that ‘there is a paucity of evidence that the disclosure and management of financial conflicts of interest affect objectivity and integrity.’
Needless to say, the Academic Institutions’ anti-reform stance and lobbying efforts were motivated by something as far from the primary charges of academia as possible – an egregious decision of the first order. Dr. Poses correctly identifies the logic in their argument as fallacious:
So the academic institutions’ argument seems to be a variant on the false dilemma logical fallacy. If the only alternative to doing nothing about conflicts of interest is disclosure, and if disclosure is really a poor solution to the problem, than perhaps doing nothing makes sense. However, if disclosure is just a necessary first step, as the IOM asserted, then it is a first step that should be taken in preparation for other steps to come. Note that the academic institutions’ argument also seems to be a version of what has been called the Nirvana fallacy, or the perfect is the enemy of the good fallacy. That is, if what one can do does not result in Nirvana, then one should do nothing.
Of course Poses is right – their objections are absurd. He concludes:
So we have come this far. Universities are ostensibly about finding and disseminating the truth. Yet universities’ academic medical subsidiaries now deploy illogic to avoid revealing particular truths that they find uncomfortable, and which might raise questions about relationships with industry that are increasingly lucrative. Universities seem now willing to jettison their mission to make more money. True health care reform would require academic medicine to put its mission ahead of its revenues.
It seems to me that there are two questions left unanswered. First, why did academia oppose this reform? Poses believes that they’re afraid of losing the Pharmaceutical Industry that has essentially been supporting academic medicine – certainly academic psychiatry – and as an aside, medical education. In a financial time like today’s, it’s unlikely that the government or the benevolent community would fill the gap were industry to be driven from the halls of ivy. The academy would undoubtedly shrink dramatically. As much as I hate their decision, I expect that the people charged with financing medical schools are keenly aware of the depth of their dependency on industry.
The second question is, given the lobbying efforts of the Medical Colleges, why did the Office of Management and Budget and the NIH give in to the lobbying efforts? It can’t be that they believe the silly arguments so deftly exposed by Dr. Poses. Did they bow to the power of the lobby? Were they convinced that they would be hurting the universities? Are they as corrupted as the people making the arguments? I hate to say it, but I expect that the latter is closest to the truth.
The DSM-III wasn’t the only thing that happened in 1980. Ronald Reagan was elected President and ushered in a wave of conservatism that continues to hold us in its grip. Without discussing all the thousands of ways that affects us, the meme of "privatization" has pervaded our political and economic life, fundamentally changing America. I think that "privatization" which puts medicine, academic and otherwise, into the free-wheeling capitalist economy, makes decisions like this one inevitable. Right now, Academic Medicine is just a business. The endless assault on Social Security, Medicare, Research Budgets, Training Grants, etc. are extensions of this same trend. So as much as I abhor what’s happening, I am skeptical that we’ll see any relief until the national priorities are driven by something that is more rational than simply the profit margins of industry. They’ve already taken us close to collapse, but still refuse to yield an inch. Medicine is just a barometer, not a special case…
One of your best posts, Mickey.
It is tragic what’s happening to academia, isn’t it? More and more, colleges are run like corporations. They’re slashing “unnecessary” things like library budgets and career counseling, and pumping up all the stuff that brings in the yahoo crowd but adds nothing to the quality of education: glossy brochures, new athletic arenas, new equipment for sports teams, and cushy dining halls and dorms. It’s corporate mentality in the raw: aggressively market to the lowest common denominator, which is increasingly the majority of Americans today.
It’s all calibrated to “justify” the outrageous rise in tuition, which is enabled by a securitized loan situation that is eerily similar to the mortgage crisis. End result: more and more students graduate with six-figure student loan debt (non-dischargeable in bankruptcy!) with a degree that is based on dumbed-down standards in the worst economy since the Depression. Hooray.
*If you are interested in learning more about the corporatization of higher ed and the student loan fiasco, read the link at the end of this post. It’s the single best article on this fine mess that I’ve read.
Your points about Reagan and the rise of privatization are well-taken. However, I would point out to you that what Reagan initiated and what we have now is far from a free market. Reagan began the sad tradition of openly courting Wall Street into the White House when he appointed Donald Regan — the CEO of Merrill Lynch! — as Treasury Secretary. This set the stage for Wall Street to directly lobby Washington for its own deregulatory interests so they could reap eye-bugging short-term profits in exchange for the financial ruin of regular Americans like you and me.
Now, this is NOT the way capitalism works. This is crony capitalism. Wall Street lobbies Washington for deregulatory goodies in exchange for their campaign donations. Look at Obama’s list of campaign contributors. They’re all there: Goldman Sachs, Citigroup, JP Morgan, you name it. These banks contributed because they know where their bread’s buttered. And they knew that when the meltdown hit, they’d be bailed out because it would be political suicide if Washington let them fail. If this were a truly free market system, a business would fail if it screwed up (and the banks screwed up royally) and new banks would eventually arise from the vacuum and if they were well-run, they would survive and increase the health of the economy. They wouldn’t get this artificial government-sponsored life-support that we have now, which produces zombie banks.
All of this is an unholy intervention of government and politics into capitalism, and it needs to stop. Privitization itself isn’t necessarily the problem; government interference and quid-pro-quo corruption IS. Just look at the Solyndra debacle. I rest my case.
And you can bet the elite colleges are embedded in Washington too. The once-president of Harvard, Larry Summers, was also once the Treasury Secretary!
It all stinks to high heaven, and I don’t think that privitization and free-market economics, when they are practiced as they SHOULD be practiced, are necessarily to blame.
PS: I love the nirvana fallacy! I see that all the time when I prod mainstream psychiatrists about reform in psychiatry and the FDA. They always throw out the straw-man, “Well, no system is perfect” as if I ever expected we’d have a perfect system. The reasoning behind such statements is obvious: it’s not that they and the rest of psychiatry (and the FDA) can’t change and take steps for reform, it’s that they WON’T, because they benefit so handsomely from the status quo. It is deeply sad.
LINK: http://nplusonemag.com/bad-education