Jacob Stegenga: Medical nihilism
“For many medical interventions,” Jacob Stegenga declares, “the best evidence available today suggests that they are barely effective, if at all” (p. 171). This is certainly a bold claim, and it captures what the author means by the book’s title. In other words, medical nihilism is the position that we should have little (if any) faith or confidence in the effectiveness of contemporary medical interventions—whether drugs or devices. The reason is that there is a great deal of “malleability”—the author’s favorite word for the notion of variability—not only in the design and execution of clinical studies but also in the evidence obtained from such studies, as well as its analysis and interpretation. Stegenga formalizes a master argument in Bayesian terms to support and explicate medical nihilism, which I elaborate on later. Importantly, medical nihilism is not a skeptical position toward specific medical interventions but rather a general existential stance or angst toward the...
- 1.Angell, Marcia. 2004. The truth about the drug companies: How they deceive us and what to do about it. New York: Random House.Google Scholar
- 2.Li, Jie Jack. 2014. Blockbuster drugs: The rise and decline of the pharmaceutical industry. New York: Oxford University Press.Google Scholar
- 3.Carr, Teresa. 2017. Too many meds? America’s love affair with prescription medication. Consumer Reports. https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication. Accessed August 8, 2018.
- 5.PhRMA. 2017. Do not go gentle. #GOBOLDLY. https://www.phrma.org/video/do-not-go-gentle-goboldly. Accessed August 8, 2018.
- 6.Mukherjee, Sy. 2017. Inside big pharma’s epic multimillion dollar PR campaign to save its reputation. Fortune Magazine. http://fortune.com/2017/01/24/phrma-go-boldly-pr-campaign. Accessed August 8, 2018.
- 7.Hood, Leroy E. 2017. P4 medicine and the democratization of health care. NEJM Catalyst. https://catalyst.nejm.org/p4-medicine-democratization-health. Accessed August 8, 2018.
- 8.Sagner, Michael, Amy McNeil, Pekka Puska, Charles Auffray, Nathan D. Price, Leroy Hood, Carl J. Lavie, et al. 2017. The P4 health spectrum—A predictive, preventive, personalized and participatory continuum for promoting healthspan. Progress in Cardiovascular Diseases 59: 506–521.CrossRefGoogle Scholar