Health Care Renewal's original goal was to open discussion of US health care dysfunction. We originally focused on issues discussed in my 2003 article (Poses RM. A cautionary tale: the dysfunction of American health care. Eur J Int Med 2003; 14(2): 123-130. Link here). These included ill-informed, incompetent, self-interested, conflicted or even corrupt leadership; and attacks on the scientific basis of medicine. We soon found out that bad health leadership and attacks on science were facilitated by deceptive marketing, public relations, propaganda, and disinformation. Furthermore, we then realized that logical fallacies were important tools used by deceptive marketers, propagandists, and disinformationists.
Introduction: Logical Fallacies
To help understand logical fallacies, we used two main sources. One was the Nizkor project, a Holocaust educational resource, which contained a guide to logical fallacies (available here and here). The impetus for publishing this guide was to counter the use of logical fallacies to push the agenda of holocaust deniers. Another was Logically Fallacious, a book by Bo Bennett PhD, and its accompanying website.
Logically Fallacious defines logical fallacies thus:
Criteria for Logical Fallacies:
It must be an error in reasoning not a factual error.
It must be commonly applied to an argument either in the form of the argument or in the interpretation of the argument.
It must be deceptive in that it often fools the average adult.Therefore, we will define a logical fallacy as a concept within argumentation that commonly leads to an error in reasoning due to the deceptive nature of its presentation. Logical fallacies can comprise fallacious arguments that contain one or more non-factual errors in their form or deceptive arguments that often lead to fallacious reasoning in their evaluation.
Our first semi-formal discussion of logical fallacies appeared in 2008. Its focus was how logical fallacies were used to support public relations/ propaganda about health care policy in support of the interests of pharmaceutical corporations. I confess it was rather personal. The blog and I had come under written attack by a blogger who worked for a non-profit that was funded by and associated with the pharmaceutical industry. The attacks featured "creative use of multiple logical fallacies." My post attempted to analyze some examples.
Logical Fallacies in Health Care and Public Health
Since 2008 we published multiple posts about logical fallacies often featuring vivid examples. Logical fallacies were: used to obfuscate the role of an academic medical center in giving apparently preferential treatment to members of Japanese organized crime (Yakuza) (look here); justify conflicts of interest affecting clinical researchers (look here, ); justify huge compensation given to managers of non-profit hospital systems (look here); justify a federal prosecutor who pursued unethical practices by health care corporations exiting the revolving door to become a defense attorney for such corporations (look here); justify a renowned academic medical center going into the contract research business (look here); and justify use of a poor clinical research practice, an active run-in period before a randomized controlled trial (look here).
Then things got much wilder during the Trump years. Early on, Trump and his enablers became known for a steady stream of propaganda and disinformation, often employing logical fallacies, and sometimes to support his health care or health policy ideas. For example, by 2019, the Washington Post documented Trump's voluminous uses of the appeal to common belief fallacy to justify, among other things, his attacks on the Democrats health care agenda as a "disaster," and his boasts about a reform of the US Veterans Administration, reforms that actually preceded his time in office.
Then we heard about an unusual viral disease in China that quickly morphed into the COVID-19 pandemic. Logical fallacies became a powerful tool for generating the onslaught of propaganda and disinformation about the pandemic. The propaganda and disinformation came so fast and the pandemic situation was so unstable that I had trouble keeping up with it, other than documenting it on my Twitter feed. However, once again logical fallacies were used by the disinformationists, eg, to justify decreases in coronavirus testing (look here); and to justify attacks against pandemic mitigation measures, such as mask wearing (look here).
So now seems like a good time to catalog some of the logical fallacies that have most frequently or vividly been used in a health care or public health context to support deceptive marketing, propaganda, and disinformation to sell products and services, justify management behavior or misbehavior, or further leaders' self-interest. The catalog is organized by the usual names of the cognitive fallacy arranged alphabetically. Examples from the archive of Health Care Renewal of each fallacy will be provided. Some will be from our early days, when logical fallacies were often used to support aspects of pharmaceutical/ biotechnology/ device company marketing and public relations practices, and to support public relations practices by hospital management and related groups. Some will be more recent, and reflect the new (ab)normal, their widespread usage to generate propaganda and disinformation about the COVID-19 pandemic
There are several sub-types of the ad hominem fallacy. In particular, the circumstantial version is defined:
Suggesting that the person who is making the argument is biased or predisposed to take a particular stance, and therefore, the argument is necessarily invalid.
Example: Richard Epstein, a prominent market fundamentalist law professor, attacked critics of conflicts of interest affecting pharmaceutical marketing as those who "often treat the phrase 'market forces' as though it embodies the worst things in life," that is, as anti-capitalists (look here).
Example: A physician decrying proposed restrictions on conflicts of interest in medicine called for leaders to "resist the temptation to join the separation witch hunt." The implication is that people calling for more restrictions are witch hunters, that is embarking on a totally unreasonable and dangerous ideological crusade (look here).
[Witch from The Lost King of Oz, Ruth Plunky Thompson, 1925]
Note that a person may be biased towards a certain point of view, and that bias could affect that person's arguments, but not necessarily.
The ad hominem tu quoque fallacy is defined:
Claiming the argument is flawed by pointing out that the one making the argument is not acting consistently with the claims of the argument.
Example: Since I worked on a project for and thus was paid as a consultant by Merck in 1997-9, it was implied my criticism of a pharmaceutical company in 2008 was hypocritical and therefore invalid (look here).
Note that one's actions in one case do not necessarily affect one's arguments in another.
Appeal to Authority
The appeal to authority is defined:
Insisting that a claim is true simply because a valid authority or expert on the issue said it was true, without any other supporting evidence offered.
Example: An author tried to dismiss concerns about conflicts of interest affecting medical societies because physicians are so virtuous and responsible that conflicts could not possibly affect them (look here)
Note that an authority may be more likely to make a valid argument, but there is no guarantee that all arguments made by an authority are valid.
Appeal to Common Belief
The appeal to common belief is defined:
When the claim that most or many people in general or of a particular group accept a belief as true is presented as evidence for the claim.
Example: President Trump claimed that everyone knew that the Democratic health care policies were a "disaster," and that his reforms of the VA were extremely significant (although they were actually enacted during the previous administration (see the Washington Post in 2019).
Just because many people believe something does not make it true.
Appeal to Common Practice
The appeal to common practice has the following structure:
X is a common action.
Therefore, X is correct/moral/justified/reasonable etc
Example: An author tried to dismiss concerns about conflicts of interest affecting physicians, particularly research physicians by saying publication bias "has been reported for more than 2 decades," implying that because it is common, worry is uncalled for (look here).
Example: The CEO of a renowned academic medical center, formerly a high paid biotechnology executive, defended its venture into the contract research business by saying ""universities need to recognize this is how things are," and "the old way of doing things doesn't really work anymore." (Look here)
Just because some people do something does not mean what they do is justified, or based on truth.
Appeal to Fear
There are many kinds of appeals to emotion, generally defined as.
the general category of many fallacies that use emotion in place of reason in order to attempt to win the argument. It is a type of manipulation used in place of valid logic.
The appeal to fear is one sub-type. It is defined:
When fear, not based on evidence or reason, is being used as the primary motivator to get others to accept an idea, proposition, or conclusion.
Example: A physician decrying proposed restrictions on conflicts of interest in medicine warned that "Those institutions that choose such inquisitional approaches will be blighted and suffer competitive disadvantages." The use of the emotionally charged word "blighted," in the absence of a clear argument that the blight would necessarily occur, made this an appeal to emotion, particularly fear (look here).
Just because something is feared does not make it more likely.
Appeal to False Authority
This is related to the appeal to authority, above. The appeal to false authority is defined:
Using an alleged authority as evidence in your argument when the authority is not really an authority on the facts relevant to the argument.
Example: The CEO of a state hospital association justified the huge compensation given to local hospital system CEOs by quoting "management expert Peter Drucker" who asserted that hospital management is particularly difficult. Note that she provided no evidence that Mr Drucker has any special expertise about health care (look here).
Just because someone is said to be an expert in a particular field does not mean that person is an expert. Just because a person is an expert does not make an argument based on that person's opinions right.
Appeal to Ignorance
This is also known as argument from ignorance. Its definition is:
The assumption of a conclusion or fact based primarily on lack of evidence to the contrary. Usually best described by, 'absence of evidence is not evidence of absence.'
Newer Example: President Trump called for a decrease in coronavirus testing apparently because he believes that diagnosing fewer cases would mean less actual disease: "Here's the bad part ... when you do testing to that extent, you're going to find more people; you're going to find more cases. So I said to my people, slow the testing down please." (look here and here).
Newer Example: Governor Kristi Noem of South Dakota also claimed that there were more cases of coronavirus, and hence more hospitalizations for coronavirus in her state than other states because the state was testing at a higher rate (look here). Thus she and the president seemed to equate diagnosis with disease, and were arguing that if there is less evidence of disease, there must be less actual disease.
Failure to see or detect something does not mean it does not exist.
The definition of the slippery slope is:
When a relatively insignificant first event is suggested to lead to a more significant event, which in turn leads to a more significant event, and so on, until some ultimate, significant event is reached, where the connection of each event is not only unwarranted but with each step it becomes more and more improbable.
Example: Richard Epstein, a prominent market fundamentalist law professor, attacked proposals of new restrictions on conflicts of interest affecting pharmaceutical marketing as leading to the prohibition of "the collaborative efforts that have long characterized standard practices [in research]." Yet none of the proposals he mentioned would have directly affected collaboration per se (look here).
Although things may appear to occur in sequence, a chain of causation may not be inevitable.
The definition of special pleading is:
a fallacy in which a person applies standards, principles, rules, etc. to others while taking herself (or those she has a special interest in) to be exempt, without providing adequate justification for the exemption.
Example: An author attacked the credibility of a published critique of conflicts of interest affecting research sponsored by a particular drug company by saying that critique's authors had failed to completely disclose their alleged conflicts. They were consultants to attorneys for plaintiffs who had sued the company. Yet the author did not completely disclose his own conflicts in his article attacking the critiques, suggesting that he believed other people should have to fully disclose conflicts of interest, but he was exempt (look here).
[Scarecrow from Dorothy and the Wizard of Oz, L Frank Baum, 1908]
when a person simply ignores a person's actual position and substitutes a distorted, exaggerated or misrepresented version of that position.
Example: Because I had criticized manipulation and suppression of clinical research about particular drugs (SSRIs, Avandia, Vytorin), my critic implied "I suggested 'people should stop taking SSRIs, Avandia, and Vytorin.' He then added 'now I guess this should also apply to Zocor.'" However, I had stated no such thing. (Look here)
Newer Example: A state Republican Chairman argued against pandemic mitigation members saying "We can’t live in a world where there’s never again a live, in-person concert or convention or gathering" No one had credibly argued that pandemic mitigation meant that no such things would ever happen. (look here).
Other Logical Fallacies Used to Support Propaganda or Disinformation
There are many other logical fallacies. Some that have been used frequently lately by disinformationists in the political arena include:
- the abusive ad hominem fallacy: "Attacking the person making the argument, rather than the argument itself, when the attack on the person is completely irrelevant to the argument the person is making;"
- cherry picking: "When only select evidence is presented in order to persuade the audience to accept a position, and evidence that would go against the position is withheld.
-the false dilemma: "When only two choices are presented yet more exist, or a spectrum of possible choices exists between two extremes. False dilemmas are usually characterized by “either this or that” language"
- the red herring fallacy: "Attempting to redirect the argument to another issue to which the person doing the redirecting can better respond"
Perusal of Logically Fallacious and the Nizkor project, as well as a number of other good sources, will reveal a catalog of fallacies and errors of reasoning, most of which are being used in contemporary political and sometimes specifically health care and public health related propaganda and disinformation.
Summary- Propaganda, Disinformation, and Logical Fallacies
As we noted recently, the coronavirus pandemic has been accompanied by a pandemic of
disinformation, sometimes called the "infodemic." In the US, while it
would have seemed unthinkable up to 5 years ago, the biggest source of
disinformation has been President Donald Trump (look here). Although Trump is now out of office, the barrage of coronavirus disinformation has continued apparently unabated, propagated by Trump's supporters (look here), foreign powers, eg, Russia (look here), and various anonymous internet-based trolls, bots, etc. The infodemic has likely had a major role in amplifying the pandemic by discouraging peoples' cooperation with pandemic control measures, and now generating vaccine hesitancy. The result has likely been considerable morbidity and death.
If we hope to reduce suffering and death from the pandemic, we will need to confront the propaganda and disinformation that is driving it.
Propaganda and disinformation operate through multiple mechanisms, including various forms of deception including manipulation and suppression of evidence; generation of specious arguments, including via the use of logical fallacies; and appeals to emotion and manipulation of human psychology. Better understanding of logical fallacies will help us better counter propaganda and disinformation.