Medical Nihilism by Stegenga, Jacob -- Read -- Imperial Library of Trantor

Index

Cover page Halftitle page Title page Copyright page Dedication page Contents Acknowledgments Parlance 1. Introduction

1.1 Medical Nihilism 1.2 Our Present Confidence 1.3 Brief History of Medical Nihilism 1.4 Evidence-Based Medicine 1.5 The Key Arguments 1.6 The Master Argument 1.7 After Nihilism

Part I: Concepts

2. Effectiveness of Medical Interventions

2.1 Effectiveness and Disease 2.2 Naturalism 2.3 Normativism 2.4 Hybridism 2.5 Eliminativism 2.6 Conclusion

3. Effectiveness and Medicalization

3.1 Introduction 3.2 Levels of Effectiveness 3.3 Scope Requirements for Effectiveness 3.4 An Ill for Every Pill 3.5 Overdiagnosis and Overtreatment 3.6 Targeting the Normative 3.7 Objections

4. Magic Bullets

4.1 Introduction 4.2 Magic Bullets 4.3 Medicine without Magic 4.4 Non-Specificity 4.5 Complexity 4.6 Conclusion

Part II: Methods

5. Down with the Hierarchies

5.1 Evidence Hierarchies 5.2 Evidence Users Employ Evidence Tokens 5.3 Different Hypothesis Types, Different Hierarchies 5.4 Assessing and Amalgamating Evidence 5.5 Trouble at the Top 5.6 Abandoning Hierarchies 5.7 Discussion

6. Malleability of Meta-Analysis

6.1 Meta-Analysis 6.2 Constraint and Objectivity 6.3 Failure of Constraint 6.4 Meta-Analysis is Malleable 6.5 The Hill Strategy 6.6 Conclusion

7. Assessing Medical Evidence

7.1 Quality Assessment Tools 7.2 Inter-Rater Reliability 7.3 Inter-Tool Reliability 7.4 Underdetermination of Evidential Significance 7.5 Conclusion

8. Measuring Effectiveness

8.1 Introduction 8.2 Instruments 8.3 Measures 8.4 Extrapolation 8.5 Measurement in Regulation 8.6 Conclusion

9. Hollow Hunt for Harms

9.1 Introduction 9.2 Operationalizing Harm 9.3 First-in-Human, Never Seen Again 9.4 Clinical Trials and the Abuse of Power 9.5 Jump Now, Look Later (but Don’t Look Hard) 9.6 Secrecy of Data 9.7 Conclusion

Part III: Evidence and Values

10. Bias and Fraud

10.1 Introduction 10.2 Varieties of Bias 10.3 Publication Bias 10.4 Fraud 10.5 Conflicts of Interest 10.6 Formalizing Bias 10.7 Discussion

11. Medical Nihilism

11.1 Introduction 11.2 Rejected Medical Interventions 11.3 Medicine’s Darkest Secret 11.4 Master Argument 11.5 Objections 11.6 Conclusion

12. Conclusion

12.1 Gentle Medicine 12.2 Tweaking Methodological Details 12.3 Rethinking Research Priorities 12.4 Regulation and Inductive Risk 12.5 Revolutionizing Medical Research 12.6 The Art of Medicine and the Love of Humanity

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 References General Index Index of Drugs