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Medical Nihilism


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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

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. His research employs empirical findings, analysis, and formal methods to establish normative conclusions about science.


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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