Monday, February 09, 2009

The Straw Man of physician entitlement

Here’s a description of the Straw Man fallacy:

The Straw Man fallacy is committed when a person simply ignores a person's actual position and substitutes a distorted, exaggerated or misrepresented version of that position. This sort of "reasoning" has the following pattern:

Person A has position X.
Person B presents position Y (which is a distorted version of X).
Person B attacks position Y.
Therefore X is false/incorrect/flawed.

This sort of "reasoning" is fallacious because attacking a distorted version of a position simply does not constitute an attack on the position itself.

The Straw Man, a distorted and much weaker argument than the one actually put forth, is a convenient way to ridicule an opponent but fallacious none the less.

A common Straw Man in the debate about physician-industry relations is one erected by Dr. Billy Rubin and Dr. Daniel Carlat in their response to our recent Medscape Roundtable discussion on industry supported CME: “I’m a physician and that entitles me to nice things.” As Dr. Rubin put it:

I am a physician and that entitles me to nice things. Trinkets, such as free hors d'oeuvres at the cocktail hour following the day's professional meetings, fancy dinners on the tab of the local drug rep, tax-deductible trips to "educational conferences" in the Bahamas--all this is part of the trappings of the lifestyle of a doc. Such is the mentality that resists seeing the obvious conflict-of-interest in industry sponsorship of CME; the defense of the indefensible rests on an emotional response, not a rational one.

This is not new. It is a tired canard. Although this sense of “entitlement to nice things” is supposed to be widespread in our profession I have yet to see evidence that it exists to a significant degree, or that it is “the mentality that resists seeing the obvious conflict-of-interest in industry sponsorship of CME;”. Among the many counter arguments against the proposed ban on industry support I have yet to see the “entitlement” position advanced.

Of course, there is agreement on both sides of the debate on one entitlement, but it has nothing to do with nice things: physicians deserve high quality CME. Beyond that, where is the argument? Digression for personal disclosure: I am appreciative or CME meetings held at nice places but do not feel entitled to them. I will be disappointed if they disappear but I am quite grateful and content that I have received more than a square deal in my professional life. Really. Pharma’s support of such meetings helps reduce registration fees, but it provides no funding towards lodging, meals or any other “nice things.” My registration at meetings such as this is paid by my medical group, as are those lodging and transportation costs directly attributable to the educational program, and will be paid regardless of whether the activity remains accredited so long as I attest to the educational value.

So, is this attitude of entitlement pervasive among my colleagues? Where is the whining? If it really exists to the degree that Dr. Rubin and Dr. Carlat and others claim, it is, to say the least, a very troubling statement about our ethics. I decided to take a closer look at the responses to our Roundtable. They were overwhelmingly in favor of industry support. Some respondents bemoaned the high cost of non-supported CME. (High tuition fees are a significant expense to low salaried primary care docs, many of whom are on a tight budget struggling with practice overhead and educational debt. Some fairly inexpensive offerings do exist but the selection is limited. There are a few non-supported free offerings but they are limited in scope and some are of dubious origin). But among all the responses there was not one mention of nice perks or entitlement.

If Dr. Carlat, Dr. Rubin or other readers are aware of any published defense of Pharma supported CME that’s based on the premise of entitlement to nice things I hope they will cite it in the comments below.

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