Jacob Stegenga on Medical Nihilism

Medical Nihilism

Jacob Stegenga introduces the concept of medical nihilism, a profound skepticism about the effectiveness of modern medical interventions. He argues that many treatments fail to achieve their intended goals or come with significant negative side effects, challenging the common perception of medical advancements. Stegenga notes that while trials have improved in detecting benefits, they reveal smaller effect sizes, suggesting that the perceived effectiveness of drugs is often overstated 1.

We ought to have low confidence in the effectiveness of medical interventions.

--- Jacob Stegenga

This skepticism extends to the belief that modern medicine is significantly more effective than past practices, despite historical failures like bloodletting 2.

   

FDA's Leniency

Stegenga criticizes the FDA's drug approval process, arguing that it is too lenient and allows drugs with negative benefit-harm profiles to enter the market. He highlights that the evidential standards required for approval are too low, often based on minimal positive results from randomized control trials 3. This leniency contrasts with the argument that the FDA is too slow, which he refutes by pointing out the lack of a pipeline of life-saving drugs being delayed 4.

The evidential standards are far too low. They're far too easy to get a drug which has a negative benefit harm profile approved.

--- Jacob Stegenga

Stegenga suggests that a stricter regulatory standard could prevent harmful drugs from reaching consumers.

   

Side Effects

The discussion on side effects reveals how modern medical practices often underestimate the harms of interventions. Stegenga points out that clinical trials frequently exclude populations like the elderly, leading to an underestimation of side effects once drugs are widely used 5. He argues that the majority of evidence on drug harms emerges post-approval, often based on anecdotal reports rather than rigorous trials 6.

Trials are systematically underestimating the harm profile of medical interventions.

--- Jacob Stegenga

This oversight results in a skewed perception of safety, where the true risks of drugs are not fully appreciated until after they are on the market 7.