Medical Nihilism

Medical nihilism is the view that we should have little confidence in the effectiveness of medical interventions. This book argues that medical nihilism is a compelling view of modern medicine. If we consider the frequency of failed medical interventions, the extent of misleading evidence in medical research, the thin theoretical basis of many interventions, and the malleability of empirical methods in medicine, and if we employ our best inductive framework, then our confidence in the effectiveness of medical interventions ought to be low. Part I articulates theoretical and conceptual groundwork, in which Jacob Stegenga offers a defence of a hybrid theory of disease, which forms the basis of a novel account of effectiveness, and applies this to pharmacological science and to issues such as medicalization. Part II critically examines details of medical research. Even the very best methods in medical research, such as randomized trials and meta-analyses, are malleable and suffer from various biases. Methods of measuring the effectiveness of medical interventions systematically overestimate benefits and underestimate harms. Part III summarizes the arguments for medical nihilism and what this position entails for medical research and practice. To evaluate medical nihilism with care, Stegenga states the argument in formal terms. Medical nihilism suggests that medical research must be modified, that clinical practice should be less aggressive in its therapeutic approaches, and that regulatory standards should be enhanced.

Jacob Stegenga is a Lecturer in the Department of History and Philosophy of Science at the University of Cambridge. He received a Ph.D. from the University of California San Diego, and he has held fellowships at the University of Toronto and the Institute of Advanced Study at Durham University. His research focuses on philosophy of science, including methodological problems of medical research, conceptual questions in evolutionary biology, and fundamental topics in reasoning and rationality. His research employs empirical findings, analysis, and formal methods to establish normative conclusions about science.

1. Introduction
Part I. Concepts
2. Effectiveness of Medical Interventions
3. Effectiveness and Medicalization
4. Magic Bullets
Part II. Methods
5. Down with the Hierarchies
6. Malleability of Meta-Analysis
7. Assessing Medical Evidence
8. Measuring Effectiveness
9. Hollow Hunt for Harms
Part III. Evidence and Values
10. Bias and Fraud
11. Medical Nihilism
12. Conclusion
Appendix 1. Bayes' Theorem and Screening
Appendix 2. Measurement Scales
Appendix 3. Epistemic Proof of Superiority of RD over RR
Appendix 4. Decision-Theoretic Proof of Superiority of RD over RR
Appendix 5. Modeling the Measurement of Effectiveness