Name: Medical Nihilism
ISBN: 9780198747048

Medical Nihilism

• A highly controversial argument for a sceptical view about the effectiveness of modern medicine • Draws on interdisciplinary research and grounds the arguments in medical examples • Accessible to readers from any academic background Medical nihilism is the view that we should have little confidence in the effectiveness of medical interventions. This volume 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.

What Hacker News says

avsteeleAug 2022

For non-experimental, non hard science, and based on the replicability studies of the last few years, and the things we have already known for a long time: I feel pretty comfortable with a prior probability of a paper's result being true positive at ~50%. For experimental, hard science, papers I still have a high belief, maybe 90%.

After this I use the following heuristics:

- => Lower belief

+ => higher belief

effects multiply, of course, but each is few %.

++ => sufficient details present that I think I can attempt to replicate without contacting authors (this is rare)

+ => code used is available in public repository (subset of above)

+ => published in med-to-high ranking journal

--- => published in obscure journal

-- => socially desirable outcome

+++ => socially undesirable outcome

-- => non-US, non-EU university or nat. lab

+ => national lab

I mostly read papers in my field (exp. physics), of course. But I began reading a bit more in medical and psyche a few years ago. My views are influenced by books like "Medical Nihilism", and "Science Fictions". Reading COVID papers was also caused me to revise my prior-probabilities downward.

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__blockcipher__Aug 2021

> Aerosols are composed of droplets

This is backwards. Aerosols are smaller than droplets. You can’t be composed of something bigger than yourself.

Aerosol essentially means it doesn’t fall to the ground like a saliva droplet does.

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The “natural experiment” you linked is a great example of why RCTs are so important (particularly for anything you’re proposing mandating). Saying “after masking was adopted cases went down” isn’t proof because if you look at the non-mask areas, cases also went down during the period.

—

I’m on mobile so can’t dig up the quote but I’d really recommend reading Medical Nihilism by Stegenga. You seem to have a backwards view of evidentiary standards. That is to say, most findings are false (Ionnidis has a famous paper on this too). That’s why RCTs and the like are so incredibly important.

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avsteeleMay 2019

Related, Recommended:

https://www.amazon.com/Medical-Nihilism-Jacob-Stegenga/dp/01...

You can listen to a recent EconTalk podcast for a one hour summary of the book.

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ZhuanXiaApr 2019

Pharmaceutical research is very broken. It is startling how ineffective all but a few drugs are. Medical Nihilism by Jacob Stegenga is a great book on the topic.

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mlinksvaApr 2019

The week before that was even more incisive http://www.econtalk.org/jacob-stegenga-on-medical-nihilism/

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taconJan 2022

>Psychostimulants for ADHD are universally associated with better outcomes

When someone in the medical field starts talking about universal outcomes in relation to biological entities, my spidey sense goes crazy. As Eric Hoffer so eloquently put it, "We can be absolutely certain only about things we do not understand."[0] The pharmaceutical industry has strong incentives to emphasize benefits and downplay harm from drugs, especially in the long term effects[1]. That is assuming that the drugs are actually manufactured correctly[2]. And even drugs manufactured correctly can decay on the shelf into carcinogens at a million times the safe limit, and (almost) no one bothers to check[3]. I once sat through a doctor going through how to use the ADHD meds, and my head started to hurt. How to take one type before sleep so it kicks in just as the kid wakes up for school, but another works faster or slower, and on and on. And all of this from doctors (and medical students) who can tell you everything about how great drugs are but spend close to zero time learning about the uses of exercise in improving health outcomes[4].

[0] https://www.brainyquote.com/quotes/eric_hoffer_142924

[1] https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/

[2] https://peterattiamd.com/katherineeban/

[3] https://peterattiamd.com/davidlight/

[4] https://www.exerciseismedicine.org/

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