For Better or Worse
By Amy Willis
How many medical treatments have you endured that may have been ineffective- or even done you more harm than good? How often are the negative side effects of medical intervention greater than the benefit they provide? In this episode, EconTalk host Russ Roberts may have met his skeptical- er, nihilist- match. Philosopher Jacob Stegenga joins Russ to talk about his new book, Medical Nihilism.
As you might guess, Stegenga is very skeptical about the efficacy of medical interventions, particularly pharmaceuticals. (Though he also tells a fascinating story about his own torn ACL toward the end of the conversation…) Stegenga argues that there are very few “magic bullets” in medicine. This does not, he asserts, make him purely anti intervention.
1- What characterizes a medical “magic bullet,” according to Stegenga? He and Roberts stress it’s not that drugs that aren’t magic bullets are useless… Why do most interventions fail to become magic bullets? How can we get more and more magic bullets in the future?
2- Why does Stegenga argue that we should be most skeptical of first-person reports of a drug’s efficacy? (Hint: You might want to revisit this episode with Gary Greenberg for part of the answer. You might also want to look at this episode with Eric Topol for a slightly different perspective…)
3- The conversation takes up side effects of medical intervention, and Roberts notes that Stegenga’s book has relatively little discussion of cancer. What are the forces that cause us to underestimate the harm of intervention and overestimate the benefits, according to Stegenga? How do you think Steven Horwitz would reply to Stegenga?
4- “… there’s an inverse correlation between trial quality and measured effect size in the trial.” What does this mean, and what does it suggest about the possibility of detecting harms? Does this constitute a “principled argument” for medical nihilism, as Stegenga suggests?
5- Stegenga states, “… this argument from economists that the FDA standard is killing people–doesn’t carry much weight… I think you could go even further and say the economists’ standard would kill orders of magnitude more people, because more harmful drugs would get through the regulatory standard. Thereby killing a lot of people.” Is the FDA- too lenient? How does this compare with Charles Hooper’s perspective in this Econlib article?