Should you trust modern medicine?
A general belief in progress has led the majority to trust 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.
Jacob’s stance is summarized by his master argument, which is captured in a clever, mathematical formula leveraging Bayes Rule. If we define \(H\) as the truth of whether a drug is effective or not, then \(H = \{ 0, 1 \}\). Similarly we can define \(E\) as the evidence either supporting or refuting the effectiveness of the drug, then \(E = \{ 0, 1 \}\). He comes to this conclusion above by critically dissecting the three components on the right of the equal sign below, which are defined as follows:
\[ P(H|E) = \frac{P(E|H)\cdot P(H)}{P(E)} \]
P(H): low due to the dearth of magic bullets; thin theoretical basis for many interventions; covered in Part I of book.
P(E|H): 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): 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.
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.
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.
Critiquing the critic
“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
Deeper counterarguments
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.