Medical Nihilism – Jacob Stegenga .pdf

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Medical Nihilism
Jacob Stegenga

Presented by Matthieu VERRY

Medical Nihilism – Jacob Stegenga
In this book Jacob Stegenga defends the thesis of medical nihilism, the nihilism is in general
defines by the author as "some particular kind of value, abstract good, or form of meaning in
life exists". In this book we are interested in medical nihilism which can be defined as
skepticism towards the effectiveness of medical interventions. This idea can be understood as
the near impossibility of justifying one's confidence in the effectiveness of medical
interventions. Stegenga's first argument is that most of historical medical interventions have
failed. In other words, the prior probability of a treatment being effective is low. The second
argument is that it is difficult, perhaps even impossible, to make an antidote which targets a
specific cause of a disease and which is being effective in eliminating the cause of the disease,
without causing too much side effects. These are, as the chemist Paul Ehrlich says, magic
bullets, and Stegenga brings the example of the insulin to illustrate this idea. However, these
kinds of treatments seem to be rare, and we tend to treat symptoms at the expense of the
disease in general. The third argument is that there is a probability that the medical operation
will not succeed. The placebo sometimes has the same quality as a drug, particularly in the
psychiatric field. The final argument is that, because of the institutional framework in which
medical evidence is produced and communicated, there are biases in favour of positive
evidence, regardless of a treatment’s actual effectiveness. Indeed, regarding the example of
randomized controlled trials and meta-analyses, Stegenga points out that researchers are
biased when designing their trials and when they interpret the results. In other words:
randomized controlled trials and meta-analyses are malleable. Moreover, since medical
journals tend to publish more positive results, researchers are more prone to falsify results and
tend to ignore negative evidence.
With the coronavirus crisis, it is easier to hold Stegenga's thesis now. Thus, as we saw during
the pandemic crisis, regulators are the first to be affected by nihilism. This is because these
institutions are guided by men and not science and men makes mistakes. So, in my opinion, I
am not convinced by these arguments. I think that science has many flaws, but it gives hope to
patients. Even if medical science does not explain everything and will never explain
everything, it allows to give ways of thinking to help peoples. I think science gives hope,
which is very important. So, even if many of the arguments given by Stegenga are
understandable, I think that a patient always wants to understand the reason for his illness and
medical science allows to shed some light on the unknown.


What impressed me most about this book is that Stegenga's arguments for medical nihilism
are not at all anti-scientific. He gives his opinion on science, picking up on the flaws in
science to make his point. The depth of this book is not to destroy science but to make it more
"scientific". It is in this idea that Stegenga neither rejects nor denies the scientific method. He
simply argues that the best protocols are not always followed, that they are not perfect, and
that when they are followed, the resulting evidence does not support effectiveness. These very
well constructed arguments do not advocate an anti-scientific alternative to medical science. I
also find it courageous of the author to write in favour of nihilism in 2018, when science takes
precedence over everything.
Nihilism has only increased in recent years (especially since the coronavirus outbreak) after it
became clear that science too is limited. I think it would be interesting to protect medical
science, i.e. to give it a path where it is in its domain. In other words, science must remain in
its field. So, I think that relaxing the definition of diseases, as the phenomenon of creating
new disorders called "disease-mongering" is going, is not a good idea because it creates a
society composed of patients (who are actually healthy) treated by people calling themselves
medical doctors. In effect, it increases the number of people who are ill, creating a society that
is victimized and unaware of how lucky they are to be healthy. Moreover, medical science is
nowadays everywhere and is often chemical, so that a sick person does not even understand
what they are treating. Perhaps a solution would be to return to a medical system that is
healthier and closer to the patient by being more educational. In addition, a return to more
traditional and nonchemically extracted medicines could be a way to explore for science.


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