Stegenga on Medical Nihilism

How good is modern medicine? Almost everyone loves to hate it, but routinely for the wrong reasons. We are used to hearing criticism of medicine mostly from cranks and quacks, and about 90% of it is just in service of selling their bullshit “alternatives.” In the post-pandemic US, medicine and medical science are now also on the front lines of the American culture war on science and expertise.

Imagine criticizing medicine for the right reasons. What a surprisingly rare and refreshing idea! I’d like to strongly recommend this extremely skeptical, high-quality take on the state of art and science of medicine, from the podcast EconTalk, interviewing Jacob Stegenga.

Stegenga is harsh but absolutely fair, criticizing medicine without being anti-scientific. He gives credit to medicine where due, but only where due, and argues persuasively that we should have little confidence in the effectiveness of medical interventions, and a lot of caution about their harms. He proposes that we need a lot more “gentle medicine” that errs on the side of less intervention.

I think this is the kind of criticism medicine actually needs. There’s a fantastic book, and a short British Medical Journal editorial about it. Listening to Stegenga talk about it himself on a podcast is another good introduction to the book.