Of patients over 65 years old who survived coronary bypass surgery, a

The flaw with D here is that the patients were fully informed but of what ..?? were they informed that surgery would beneficial to them ? But was the surgery needed for them ? Hence D does not do job properly or as better as E.

This is a difficult question, but the correct answer choice is clearly E.

Consider the following analogy, perhaps not the best one but I hope it will be good enough to make the point.

A dealer sells second-hand cars. Last year 75% of the cars didn't present any problems after the sale, whereas the other 25% presented several problems a few months after the sale. Clearly in that 25% percent of the cars sold, the dealer was more interested in making profit that in the security of the people who bought the cars.

Which of the following, if true, most seriously undermines the argument?

-- the dealer didn't know whether the cars had any problems prior to the sale.
-- the dealer equally informed all the customers about the risks of buying a second-hand car.

In this example, I know is not exactly the same, the correct answer choice is clearly the first one. The dealer here could know that the cars were in bad condition, and still convinced the people to buy the cars.

What makes option D incorrect?

If you read closely the stimulus is says

Thus it appears that for one in four such patients, the doctors who advised them to undergo this surgery, with its attendant risks and expense.

IMO the stimulus already acknowledges for the information given, so the doctors could haven given the same information but recommended patients undergo to the coronary bypass surgery even if the doctors knew that the patients would not benefit.

Choice D - Patients were aware of the consequences of the surgery before hand and still opted to undergo the operation -> Doctors less culpable.
Doctors' motive might have been practice/fee but ultimate decision making power was with the patients.

Choice E - Before surgery patients were medically indistinguishable but we do not know if doctors were forthright in conveying surgery associated risks to them -> Doctors may or may not be culpable.

Experts help plz.

puto,

Let's start with the conclusion: "it appears that for one in four such patients, the doctors who advised them to undergo this surgery, with its attendant risks and expense, were more interested in an opportunity to practice their skills and in their fee than in helping the patient." This implies that the doctors knew that the surgery would probably not help those patients but advised them to undergo the surgery regardless (in order to practice their skills and collect the fee). Thus, the argument would be undermined by any evidence that the doctors thought that those patients were no less likely to benefit from surgery than the other 75% of patients.

Does D undermine the argument? Not necessarily... this does not tell us whether the doctors knew in advance that the group of 25% would probably not benefit from surgery. In fact, if the doctors informed those patients of the risks but failed to tell those patients that they would probably not be helped by the surgery, then this would in fact strengthen the argument.

If there is no way for the doctors to distinguish between the two groups, then they have no idea whether one group is more or less likely to benefit from the surgery. Since the argument rests on the assumption that the doctors knew that the surgery would probably not help those patients (the one in four who did not benefit), choice E undermines the argument.

D - > Specifically addresses the focus group [patients over 65 years] whereas E does not.

Also, argument says: "The doctors who advised them to undergo this surgery, with its attendant risks and expense"->
Does this statement not imply that risk of 'not helping the patient' was informed to the patient !?

Option E -> Again this option talks about patients in general not about the group in contention.

Since there is no way for Doctors to medically distinguish they have more incentive to recommend surgery to patients as any complication arising later could be attributed to lack of sufficient information.

The possibility that the surgery does not help the patient is not a risk. A risk is something that exposes the patient to danger or harm. Not being helped by the surgery isn't a positive outcome, but by itself this doesn't imply any danger to the patient. For example, imagine a new back surgery that is only 25% effective (ie only helps 25% of patients) but has absolutely no risks (no possible dangers); surely, most people with back pain would be willing to try it, even though the odds of success are low (there are no risks, so why not?).

Choice D states that the patients in the focus group were AS FULLY INFORMED as the others. That means both groups understood the risks. But this does not rule out the possibility that the doctors KNEW that some of those patients were less likely to have successful outcomes and withheld that information from those patients.

The argument accuses the doctors of recommending the surgery to those in the focus group despite knowing that the surgery was unlikely to help those patients. If the patients in the focus group were medically indistinguishable, there would be no way for the doctors to make that distinction (ie as far as the doctors knew, ALL patients recommended for surgery were equally likely to have successful results). Lets say that out of 100 patients, 75 had successful surgeries. If the doctors knew in advance that the other 25 were unlikely to have successful surgeries but still recommended the surgery, this would support the argument. But if all 100 were medically indistinguishable, the doctors cannot be guilty of the alleged behavior; perhaps the surgery simply has a 75% success rate and there is no way to know in advance who is more or less likely to have a successful outcome.

The conclusion: the doctors who recommended the surgery were doing so for selfish reasons (a chance to hone their skills/a chance to make $)
The premise: 25% of the patients undergoing the operation did not benefit.

The argument is asserting that the doctors, in some cases, knew that a patient was a bad candidate for the surgery, but recommended the procedure anyway. (Imagine a doctor evaluating a patient, thinking to herself, "yikes, there's no way this procedure will work," and then doing it anyway for the money.)

If we want to undermine that claim, we want to show that the doctors were not consciously thinking that some of these patients would make poor candidates for the procedure.

D is irrelevant. We're assessing the knowledge/motivation of the doctors, not of the patients.

E: If it were impossible to tell the difference between the patients who would benefit and those who wouldn't, then doctors couldn't possibly have been thinking to themselves that some of the patients were poor candidates for the procedure, as they looked just like the ones that benefited. So the scenario above, where the doctor is thinking to herself "bad candidate, but let's make some money!" is no longer plausible. E is the answer.

Moreover, The conclusion here is the last sentence: the doctors were more interested in practicing their skills and making money than in helping the 1 in 4 patients who did not benefit from the surgery. This assumes without providing justification that there's no other reason that doctors would perform the surgery on people who did not benefit from it. However, E weakens the argument by explaining that there was no way to know who would or wouldn't benefit from the surgery; prior to the surgery, all of the patients seemed the same, so until they actually operated and saw the outcome, the doctors had no idea which patients would see good results and which ones wouldn't. Therefore, they weren't necessarily trying to practice their skills and make money on the 25% that didn't see good results. They might have really been trying to help everyone, and 25% of the time, they just failed for some reason.

Just wanted to note that the question says "undermines."

"undermines" = weakens argument

"underlies" = basis for argument, supports

Good to watch out for those two very close-looking words!

E is the best answer choice here.

GMATNinja & GMATNinjaTwo, Could you help to explain why (D) is incorrect and (E) is correct? I could not understand the meaning of (medically indistinguishable). Does it mean the patients who did not benefit = the patients who did benefit?

We are told that 25% of patients do not benefit from the surgery. The author thus concludes that "the doctors who advised them to undergo this surgery, with its attendant risks and expense, were more interested in an opportunity to practice their skills and in their fee than in helping the patient." In order to reach such a conclusion, we have to assume that the doctors somehow knew in advance that those patients were less likely to benefit from surgery.


Imagine that the doctors did in fact know in advance that 25% of the patients were unlikely to benefit from the surgery. Even if the doctors fully explained the risks to ALL patients, if the doctors did not inform the 25% that they were less likely to benefit from surgery, then the author's accusation could still be valid.


Yes, "medically indistinguishable" implies that the doctors could not tell the difference between the patients who would benefit and the patients who would not benefit. If that were the case, then the doctors could not be guilty of knowingly performing the surgery on patients who were less likely to benefit from surgery. This undermines the author's argument, so choice (E) is the best answer.

Couldnt eliminate C option, any inputs?

The author concludes that the doctors who advised the 25% of patients “were more interested in an opportunity to practice their skills and in their fee than in helping the patient.” The author reaches this conclusion on the basis of the fact that the 25% did not benefit from the surgery. In other words, simply because the 25% did not benefit from their surgeries, the advising doctors had ulterior motives.

With that in mind, here’s (C):


(C) indicates that most patients who underwent surgery did so because they were advised that it would reduce the risk of future heart attacks. But we don’t actually know whether the doctors advising those patients were genuine and telling the truth or merely promising benefits to sell a surgery. It’s possible that they were genuine, and the surgery simply failed to benefit the patients. But it’s equally possible that the doctors promised the hope of a reduced risk of future heart attacks simply in order to practice their skills and receive a fee.

For that reason, (C) neither weakens nor strengthens the argument, and we can eliminate it.

I hope that helps!

In option C - The fact that the patients couldnt see the benefit now but the doctors recommended them surgery to prevent future heart attacks. Hence, doctors didnt do the surgery for the fees or to practise skills? GMATNinja @VeritasKarishma
Please explain why option C is wrong?

Take another look at the exact wording of (C):

There are two issues with this answer choice.

First, we know from the passage that "only 75 percent [of patients] benefited from the surgery." There's no time cap on this information -- perhaps they benefitted immediately, or perhaps the surgery prevented a heart attack years down the road.

We're not interested in the doctors' motivations for doing the surgery on these patients (who DID benefit) -- we're interested in the doctors' motivations for operating on the OTHER 25% of patients. Why did doctors operate on this smaller subset of patients? (C) doesn't give us any insight into that question.

Another issue with (C) is that it talks about how doctors convinced patients to get the surgery. But remember that the author doesn't particularly trust these doctors -- he/she thinks that they "were more interested in an opportunity to practice their skills and in their fee[/b] than in helping the patient."

So even if a doctor tells a patient that the surgery will provide a benefit, that doesn't mean that it actually WILL provide that benefit. It's unlikely that a doctor would tell a patient, "Look, this surgery isn't going to benefit you but I'd really like to practice/collect a fee."

Overall, (C) doesn't undermine the argument that doctors are nefariously doing this surgery on patients who won't benefit.

Compare that with (E):

(E) says that there is no way of knowing which patients are going to benefit from the surgery. So the doctors isn't sitting there with the knowledge that a certain patient won't benefit, and then deciding to do the surgery anyway in order to practice/collect a fee. This completely undermines the author's argument.

(E) is the correct answer.

I hope that helps!

Hello from the GMAT Club VerbalBot!

Thanks to another GMAT Club member, I have just discovered this valuable topic, yet it had no discussion for over a year. I am now bumping it up - doing my job. I think you may find it valuable (esp those replies with Kudos).

Want to see all other topics I dig out? Follow me (click follow button on profile). You will receive a summary of all topics I bump in your profile area as well as via email.