Medical nihilism
This book defends medical nihilism, which is the view that we should have little confidence in the effectiveness of medical interventions. If we consider the frequency of failed medical interventions, the extent of misleading evidence in medical research, the thin theoretical basis of many intervent...
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| Format: | eBook Book |
| Language: | English |
| Published: |
Oxford
Oxford University Press
2018
Oxford University Press, Incorporated |
| Edition: | 1 |
| Subjects: | |
| ISBN: | 9780198747048, 0198747047, 0198747209, 9780198747208 |
| Online Access: | Get full text |
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Table of Contents:
- 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 -- 10.2.1 Confirmation bias -- 10.2.2 Design bias -- 10.2.3 Analysis 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 -- 11.5.1 The 'merely empirical' objection -- 11.5.2 The 'medicine is awesome' objection -- 11.5.3 The regulation objection -- 11.5.4 The peer review objection -- 11.5.5 Anti-science? -- 11.5.6 Game-changers -- 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
- Cover -- Medical Nihilism -- Copyright -- Dedication -- 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 -- 1.5.1 Targeting diseases with magic bullets -- 1.5.2 Malleability of contemporary research methods -- 1.5.3 Harms, bias and fraud -- 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 -- 6.4.1 Choice of primary evidence -- 6.4.2 Choice of outcome measure -- 6.4.3 Choice of quality assessment tool -- 6.4.4 Choice of averaging technique -- 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