Thursday, September 3, 2009

Logical Fallacies in Defense of Conflict of Interest: Innocent, or Deliberate?

Roy Poses' post "Again, Defending Conflicts of Interest with Logical Fallacies" and a similar piece by Dr. Howard Brody over at Hooked: Ethics, Medicine, and Pharma were written by them with no foreknowledge by me of their planning, writing, or posting. I state this up front, because I have a very important observation to add after reading them.

The name of the subject of those posts, Dr. Larry Hirsch, seemed immediately familiar to me, for good reason:

Dr Hirsch was an employee at Merck & Co from 1988-2006 and managed the Medical Communications Department [at VP level - ed.] for clinical research publications from late 2001 to mid-2006.

He was VP of Clinical Drug Development, Clinical Trial Registration and Publication, as per his LinkedIn bio.

I was Director of Published [i.e., scientific] Information Resources and of The Merck Index of Chemicals, Drugs and Biologicals in Merck Research Labs from mid 2000-late 2003.

The name stood out due to my recollections of meetings I attended with Dr. Hirsch. The topic was whether, and how, Merck clinical trials results should be made available to the public. Being knowledgeable in electronic health records and biomedical information management, my input was sought.

I am, as is Dr. Poses, quite sensitive to logical fallacies. In my case, this sensitivity arises from early medical mentorship under the aegis of Dr. Victor P. Satinsky, cardiovascular surgeon, inventor (of the Satinsky clamp and other heart surgery-enabling devices) and polymath, and leader of the Hahnemann Medical College and Hospital's NSF-funded summer science programs.

Dr. Satinsky stressed "critical thinking ... always ... or your patient's dead" to his students; most still probably recall those words, repeated time and again. He would cut down poor arguments and logical fallacy directly and even confrontationally when he encountered them.

I recall Dr. Hirsch making reasonable arguments about the issues in publicizing clinical trials data, both pro and con, and even more importantly I left the meetings with a sense that such matters were in able hands. Dr. Hirsh was well able to synthesize information such as I presented and make rational arguments in response. I did not sense a fool in any way, shape or form.

Hence, my surprise and disappointment in the logical fallacies observed and defined by Dr. Poses and Dr. Brody in Dr. Hirsch's Mayo Clinic Proceedings article regarding the effects of conflict of interest.

This raises a number of questions:

  • Have Dr. Hirsch's personal feelings simply clouded his judgment over the conflict of interest issue, resulting in a somewhat hysterical tone and logical swiss cheese, the holes as catalogued by Drs. Poses and Brody?
  • Alternatively, are the logical fallacies deliberate and purposeful, as is done in propaganda written to confuse the audience and steer them erroneously towards a point of view that is not in their own best interests? (Such behaviors, of course, depend on an elitist belief that the audience - in this case, physicians, regulators and the public - lacks abilities to detect such flaws, or put more bluntly, as Dr. Satinsky might have said, is stupid and gullible.)
  • Although this is less likely, there's been enough ghostwriting going on in this industry that the following question must be asked: who, exactly, wrote the Mayo Proceedings article in question? Could it have been, or could there have been contributions from, an unattributed "communications specialist", i.e., a non-scientist skilled in political spin while less skilled in logical argumentation?
  • Are the reviewers and editors of the Mayo Clinic Proceedings able to critically review submitted pieces and themselves perform the analysis that Dr. Poses has performed? As a peer reviewer for scientific publications myself, I would likely have opined that such a piece was unsuitable for publication in its present form due to its flaws in reasoning.

I do not opine on the answers to these questions, but I do feel great disappointment that they even need to be asked. Dr. Satinsky, one of many medical giants of the past, must be rolling in his grave.

-- SS

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