Medical Nihilism

Medical Nihilism

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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. 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.
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Product details

  • Paperback | 248 pages
  • 157 x 233 x 14mm | 386g
  • Oxford, United Kingdom
  • English
  • 0198747209
  • 9780198747208
  • 407,329

Table of contents

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
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Review quote

Ultimately, medical nihilism is an important topic in healthcare today, and the present book is a significant addition to that topic, which deserves wide readership and engagement. * James A. Marcum, Theoretical Medicine and Bioethics * A much needed call to temper our enthusiasm about the enterprise of medical therapy. * Mathew Mercuri, Metapsychology Online Reviews * This book is philosophy with a bite. Should we trust medicine? Stegenga shows there is much to be sceptical of. This is a scary thesis, all the more so because Stegenga's arguments are persuasive and his accounts of the empirical facts seem fair and well balanced. The underlying problem that the book tackles in medicine how to distinguish compelling science from chaff is not only at the heart of philosophy of science but at the heart of every science. Here Stegenga
shows how we can address this problem in a particular scientific context by understanding the fine details of research. This is first-rate philosophy applied to one of our most important sciences. * Nancy Cartwright, University of California San Diego & Durham University * Jacob Stegenga's book is timely as it arrives when many doctors feel medicine is in crisis. We have become unsure what medicine is for and have over-reached ourselves; and despite the appearance of evidence-based medicine 20 years ago there is deep anxiety now about the quality and completeness of the evidence that underpins medicine. The best doctors, I believe, have always been medical nihilists, aware that many new interventions are oversold, but the depth and
scope of this book can help doctors move beyond their present crisis. * Richard Smith, Former Chief Editor, BMJ *
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About Jacob Stegenga

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.
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Rating details

62 ratings
4.02 out of 5 stars
5 32% (20)
4 45% (28)
3 15% (9)
2 8% (5)
1 0% (0)
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