Chapter 41 Quiz
Twenty-two items. Multiple choice and short answer. The answer key is collapsed at the bottom —
attempt the whole thing before opening it.
1. Genericization refers to:
- A. the process by which a drug's patent expires and generic manufacturers enter
- B. the process by which a brand name comes to be used as the common noun for a whole category
- C. the regulatory requirement that a drug be assigned an international nonproprietary name
- D. the substitution of a generic drug for a branded one at the pharmacy
2. Which of the following pairs contain the same active molecule?
- A. Ozempic and Mounjaro
- B. Wegovy and Zepbound
- C. Ozempic and Wegovy
- D. Rybelsus and Zepbound
3. Short answer. §41.1 describes a five-rung ladder. Name the rung at which the word stops
identifying a molecule, and the rung at which it stops identifying a drug.
4. According to §41.2, a formulary is organized by:
- A. molecule
- B. manufacturer
- C. product and indication
- D. therapeutic class
5. True or false: the clinical observation that substantial weight loss reduces facial fat is
specific to GLP-1 receptor agonists.
6. Short answer. Name the four harms §41.2 attributes to genericization.
7. The claim "GLP-1 receptor agonist use can be identified in an individual by looking at their
face" is rated:
- A. ✅ Strong clinical evidence
- B. ⚠️ Promising but preliminary
- C. ❌ Hype outpaces evidence
- D. 🔬 Frontier
8. In a diagnostic accuracy study, the reference standard is:
- A. the test being evaluated
- B. the independent method that establishes the truth
- C. the threshold above which a result counts as positive
- D. the minimum sensitivity a test must achieve to be useful
9. Short answer. §41.3 argues that the reference standard is the step that "kills the project"
outside a research setting. Why?
10. A visual test correctly flags 80% of users and correctly clears 80% of non-users, applied to a
population in which 10% are users. Of 100 people, roughly how many flags are raised, and how many are
correct?
- A. 8 flags, 8 correct
- B. 18 flags, 8 correct
- C. 26 flags, 8 correct
- D. 26 flags, 18 correct
11. The claim "public figures have an ethical obligation to disclose" receives:
- A. ❌, because no evidence supports it
- B. 🔬, because it is too early to say
- C. ⚠️, because it is partly supported
- D. NOT RATED, because it is not an empirical claim
12. Short answer. §41.4 declines to impose a disclosure duty but draws one distinction it says
does fall in the book's lane. State it.
13. Which of the following is not given in §41.4 as an argument against a disclosure
obligation?
- A. medical privacy is a default, not a reward
- B. the demand is applied selectively and unequally
- C. disclosure invites the abuse it is meant to prevent
- D. disclosure would reduce demand for the drugs
14. In §41.5, the decisive objection to speculating about an individual's drug use is that it is:
- A. unkind
- B. unfalsifiable
- C. illegal in most jurisdictions
- D. statistically unlikely to be correct
15. Short answer. Why does the chapter present the epistemic objection as more useful than the
moral one, even though it does not claim it is more important?
16. According to §41.6, a joke differs from every higher rung of the compression ladder because
it loses:
- A. the qualifiers
- B. the effect size
- C. the claim itself
- D. the population
17. Short answer. Define social fact as §41.6 uses the term, and give the example the chapter
gives.
18. "It's a joke" functions in argument as:
- A. a concession that the claim was false
- B. a defense against evaluation, which protects the premise from inspection
- C. a request for the listener to supply evidence
- D. an admission that the speaker holds no position
19. Which of these does §41.7 credit the culture with producing?
- A. making a stigmatized condition discussable
- B. transferring the idea that appetite is a regulated signal into general understanding
- C. surfacing access and cost as public political questions
- D. all of the above
20. Short answer. The claim "public attention has increased appropriate access" is rated ⚠️. Give
the single strongest reason the chapter offers for not rating it higher.
21. §41.8 describes harms that flow from cultural framing rather than pharmacology. Which of the
following is not one of them?
- A. shortage effects falling on people using the drug for its approved indication
- B. coverage arguments becoming harder because the drugs are coded as cosmetic
- C. an increased rate of gastrointestinal adverse effects
- D. people being asked to justify an approved prescription in ordinary social settings
22. Short answer. List the five practices in §41.9, and state which one the chapter grounds in
epistemics rather than courtesy.
Answer key
**1. B.** Genericization is a linguistic process: a brand name becomes the common noun for its
category. It is unrelated to patent expiry (A), to nonproprietary naming (C), or to pharmacy
substitution (D) — though all four get confused with one another, which is itself a small illustration
of the chapter's point.
**2. C.** Ozempic and Wegovy both contain semaglutide, in products with different supplied doses,
different devices, and different approved indications. Rybelsus is the third semaglutide product.
Mounjaro and Zepbound both contain tirzepatide.
**3.** The word stops identifying a **molecule** at rung 3 (CATEGORY), where the brand is applied to
other drugs in the class. It stops identifying a **drug** at rung 5 (METAPHOR), where "the Ozempic of
X" refers to any startlingly effective intervention in an unrelated domain.
**4. C.** Product and indication. This is why "is Ozempic covered?" is not an answerable question, and
why the brand-name shorthand has financial consequences rather than merely aesthetic ones.
**5. False.** Facial volume loss follows substantial weight reduction by *any* mechanism — dieting,
bariatric surgery, illness — because it reflects loss of facial fat compartments. Rate and magnitude
matter; mechanism does not. See Chapter 8 §8.8.
**6.** (i) Patients cannot say what they are taking; (ii) prescribers field requests for the wrong
product; (iii) coverage conversations become confused because payers decide by product and indication;
(iv) the brand name becomes a container for things that are not the drug, including compounded and
gray-market preparations.
**7. C — ❌.** Note what the rating covers. The *physiology* (weight loss reduces facial fat) is well
supported. The *inferential* claim (a face identifies a prescription) is unsupported: no reference
standard, no published sensitivity or specificity, many alternative causes, and a base-rate problem
that defeats even a good test.
**8. B.** The reference standard is the independent method establishing the truth against which the
index test (A) is judged. Thresholds (C) and performance requirements (D) are separate elements.
**9.** Because establishing the truth requires verified prescription or dispensing records, or
confirmed disclosure — which is exactly the information that speculation exists to substitute for. You
cannot validate the guess without the disclosure the guess is standing in for.
**10. C.** Ten users, of whom 8 are flagged. Ninety non-users, of whom 20% — that is, 18 — are wrongly
flagged. Twenty-six flags total, 8 correct. Most positive judgments are wrong even though the test is
"80% accurate," because the condition is uncommon. (These numbers are invented for the demonstration
and correspond to no data.)
**11. D — NOT RATED.** The rating system measures the state of evidence for a claim about the world.
"Ought" claims have no population, no endpoint, and no study that could settle them. Rating it ❌ would
be a category error: it would assert that evidence fails to support it, when evidence is not the
relevant instrument.
**12.** Silence and misattribution are not the same act. A person who says nothing has made no claim,
and there is nothing to evaluate. A person who *attributes their results to a cause that was not the
cause* has made an efficacy claim, which is subject to the same evaluation as any other.
**13. D.** The chapter makes no claim about disclosure affecting demand. The other three are its
stated arguments, along with "there is no stopping rule" and "nobody owes an explanation for their own
body."
**14. B — unfalsifiable.** It is also unkind, but unkindness is a moral objection, and the chapter's
point is that the epistemic objection does more work.
**15.** Because it does not require the reader to share any value. Someone who thinks public figures
are fair game must still concede that no available observation would settle the question — so the
argument transfers to an audience the moral argument cannot reach. "More useful," not "more
important."
**16. C — the claim itself.** Every rung loses qualifiers; the joke is the only rung that also loses
the assertion. Nothing is stated, so nothing can be checked, and yet a premise has been transmitted
and confirmed by laughter.
**17.** A social fact is something that is true because a group treats it as true, independent of any
external measurement. The chapter's example: "this drug is everywhere" can be a social fact while the
actual prevalence remains unknown to everyone asserting it — including the person who made the joke.
**18. B.** The correct response to "is that actually true?" is socially fixed as "it's a joke," which
means the premise enters the audience without ever being submitted for inspection. The format
immunizes its own payload.
**19. D — all of the above.** §41.7 also credits public attention with contributing to coverage
changes (hedged) and, ironically, with creating the occasion to correct the molecule-versus-brand
confusion it caused.
**20.** Confounding with shortage. The same attention that plausibly improved access for some drove
demand that contributed to supply constraints, reducing access for others — and drove a parallel
unregulated market. The net effect is not cleanly quantified and may be positive for one population
and negative for another simultaneously.
**21. C.** Gastrointestinal adverse effects are pharmacological, not cultural. The other three are
second-order effects of how the drugs are talked about.
**22.** (i) Use generic names; (ii) distinguish the drug from the indication; (iii) decline to
speculate about individuals; (iv) notice when a joke is doing a claim's work; (v) ask how we would
know. **The third** is grounded in epistemics rather than courtesy — you decline not because it is
rude but because no available observation would make you right.