Jacob Stegenga: Medical nihilism
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“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...
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