Jacob Stegenga: Medical Nihilism and Gentle Medicine

In a thesis he calls medical nihilism, Dr. Jacob Stegenga argues that society’s confidence in the effectiveness of medical interventions ought to be low. Stegenga points to bias and malleability in medical research, the ubiquity of tiny effect sizes from the best studies, and the thin theoretical basis of many interventions. After describing the arguments for this position, he will discuss what medical nihilism entails for clinical practice, medical research, and regulation. As an alternative, Stegenga suggests that “gentle medicine” is a better course -- that is, a less aggressive clinical practice. He says the aims and priorities of medical research should be reconfigured and that regulatory standards should be strengthened. This lecture was recorded on Wednesday, October 30, 2019. 00:00 - [Introduction] 07:35 - [Medical nihilism] 12:55 - [Evidence and confidence] 17:10 - [Biased research] 24:30 - [Small effect sizes] 29:20 - [Few magic bullets] 35:45 - [Most important medical discoveries since 1840] 38:15 - [Objections to medical nihilism and presentation of gentle medicine] 48:25 - [Q and A] ABOUT JACOB STEGENGA Dr. Jacob Stegenga is a reader in the Department of History and Philosophy of Science at the University of Cambridge in the United Kingdom. Stegenga earned his PhD from the University of California San Diego and taught in the United States and Canada before joining Cambridge. Stegenga’s area of research include the methodological problems of medical research, conceptual questions in biology, and fundamental topics in reasoning and rationality. His research employs empirical findings, analysis, and formal methods to establish prescriptive conclusions about science. Stegenga is the author of Medical Nihilism and Care and Cure: An Introduction to Philosophy of Medicine and he is currently writing a book on the sciences of sexual desire. ABOUT THE CENTER The Center for Values in Medicine, Science, and Technology’s mission is to understand, evaluate, and improve the ethical and cultural influences on and implications of medicine, science, and technology. This mission is driven by several key ideas: Innovation led by the heart as well as the head. Science that is ethically and socially responsible. Medicine practiced with compassion and wisdom. Social and cultural change informed by the best science and technology. Using creativity, knowledge, and intelligence to make the world a better place in which to live.