Most people trust in effectiveness of modern medicine, but is this trust misguided? In his thought-provoking book Medical Nihilism, Dr. Jacob Stegenga rigorously argues that we ought to have little confidence in modern medicine.
TLDR:
Quite nicely, Jacob summarizes his master argument in a clever mathematical formula leveraging Bayes Rule. Define \(H\) as the truth of whether a drug is effective or not and \(E\) as evidence either supporting or refuting this effectiveness. Using this he concludes that the chance a pharmaceutical drug is effective is low given the evidence, i.e. \(P(H|E)\) is small, and therefore we ought to have little confidence in modern medicine. Let’s break down each piece below and dive a little deeper:
\[ P(H|E) = \frac{P(E|H)\cdot P(H)}{P(E)} \]
P(H) is low
due to the dearth of magic bullets; thin theoretical basis for many interventions; covered in Part I of book.
P(E|H) is low
due to the ubiquity of small effect sizes; based on this there is little empirical reason to believe modern medicine is effective; touched on in Part II.
P(E) is high
due to the financial inclinations of pharmaceutical companies to exploit the malleability of research methods to bring their drug to market; methodological and societal bent toward favorable evidence; this is the key focus of the book and is covered extensively in Part II and some of Part III.
Therefore P(H|E) is low
Given that both of the numerators are small and the denominator is large, Jacob concludes that the probability that a drug is effective given available evidence is small, i.e. \(P(H=1|E) <<<P(H=0|E)\). Consequently, we ought to have little confidence in the effectiveness of novel medical interventions, even in light of supporting evidence.
Core of Jacob’s argument
As intriguing and clever as his multifaceted argument is, it is ultimately misguided. In this post I’ll pick apart his argument at face-value before I dive into a deeper critique of his real argument. After this I’ll propose a more constructive and realistic framework for evaluating drugs on a case-by-case basis before concluding this post.
“We should have little confidence in the effectiveness of medical interventions.” - Jacob Stegenga
This is what Jacob said, and his argument is carefully poised to defend this general statement above. Effectiveness of medical interventions is made relative
Most modern pharmaceutical drugs are ineffective.
This is what Jacob wanted to say, and ultimately explains why he titled his book Medical Nihilism, why he blanketed his critique on novel drugs with the ambiguous term medical interventions, and why he is dead-set against pharmaceutical companies for researching, producing, and marketing drugs. What motivates a person to unreasonably compare on an entire industry to its greatest triumphs?
Should we spit on the food industry because not all meals are Michelin-starred masterpieces (effectiveness)? And… another example pointing to purposeful deceit
Unknowingly nor not, his argument is motivated by a misguided anti-pharma sentiment; a sentiment enjoying great popularity in our button-pushing, instant-gratification culture. To show where he errs, let’s look at some of his stronger more central points and show why even these crumble under scrutiny.
The Life Sciences are one of the few major industries whose business model lives and breathes by discovery. - generics while generally not effective, bring down the price of drugs and may have less side-effects. They give options to a patient.