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This book argues that if we consider the ubiquity of small effect sizes in medicine, the extent of misleading evidence in medical research, the thin theoretical basis of many interventions, and the malleability of empirical methods, and if we employ our best inductive framework, then our confidence in medical interventions ought to be low.
List 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
About the author
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.
Summary
Medical nihilism is the view that we should have little confidence in the effectiveness of medical interventions. Jacob Stegenga argues persuasively that this is how we should see modern medicine, and suggests that medical research must be modified, clinical practice should be less aggressive, and regulatory standards should be enhanced.
Additional text
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.
Report
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
