Richard Smith: The Case for Medical Nihilism and “Gentle Medicine”


From The BMJ Opinion: Most practising doctors are instinctive medical nihilists, argues Richard Smith.

richard_smith_2014Jacob Stegenga, a philosopher of science in Cambridge, has written a closely argued and empirically supported book in which he argues the case for medical nihilism by which he means that our confidence in the effectiveness of medical interventions should be low. My belief is that many doctors, particularly senior ones, are instinctively nihilists but most patients are not.

Medical Nihilism is one of the latest in a long history of arguments doubting the effectiveness of medicine. Stegenga briefly summaries that history, starting with Heraclitus (the way that doctors torture their patients is “just as bad as the diseases they claim to cure”), passing through Oliver Wendell Holmes (“If the whole materia medica, as now used, could be sunk to the bottom of the sea it would be all the better for mankind—and all the worse for the fishes”) to Ivan Illich (“modern medicine is a negation of health . . . it makes more people sick than it heals”). In the same week that Stegenga’s book was launched the doctor and journalist James Le Fanu launched Too Many Pills, a book in which he argues that doctors are prescribing too many pills and endangering health (more of that in another blog) and The BMJ made the case for overcoming overuse of medicine. Something is up.

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  1. Wouldn’t it be great if this “philosopher” could make the connection, and realize that psychiatry and mental health interventions are not medicine at all. Despite lip service to the ineffectiveness of anti-depressants, and the dubious nature of depression, he doesn’t really go there. The point I am making here is that if much medicine is actually medicalization, and nowhere is this clearer than in the world of so-called “mental health”, calling things that aren’t actually medical medical, of course, doctors should be nihilists regarding this kind of fraud. Medical doctors should not be making people physically “sick” by presuming to “heal” or “cure” them when they aren’t physically ill in the first place. Calling those who don’t medical nihilists doesn’t entirely do it for me. How about medical fraud nihilists instead? Conceptually and ethically, there’s this blurred line that is just too blurred for comfort. Maybe he could also then replace “gentle medicine” with “honest medicine”.

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