Nihilism is a well-known phenomenon of attitude among the mass population with extreme skepticism believing that nothing in the world has a material existence or value. It is oftentimes associated with extreme symptoms or signs of pessimism and a radical skepticism that condemns existence. Nihilism plans in naught hold no fidelity and have no purpose other than momentum to destruct.
Nihilism became identified in Russia with a loosely organized revolutionary crusade in C.1860–1917, which rejected the authority of the state, church, and family. In his piece of writing, anarchist leader Mikhael Bakunin (1814–1876) is also identified with nihilism as he at one time said, “Let us put our trust in the eternal spirit which destroys and annihilates because is the unsearchable and eternally creative source of all life — the passion for destruction is also a creative passion!” Nihilistic beliefs are among which we can recall the historical ones such as political, existential, moral, foundation, etc. The existential or the intellection that nothing is real has historically been considered the most famous and purportedly dangerous form of nihilism is the motivation of analysis within the realism of immanent expression of minds.
Latterly, I came across an interesting blog about medical nihilism. My immediate presumptuousness was that the idea of medical nihilism is a new school of view, but on contrary after reading it I found it to be otherwise. Disconfirming a mental attitude to medicine is an ancient trait. Today, we can often read about it on vaccination- besides, it has varied over the past century. Medical nihilism is the sentiment of having little trust in the officiousness of medical interventions. The concept argues the compelling opinion of faulty modern medicine.
In a recent book, Medical Nihilism, published by Oxford University Press, Jacob Stegenga delivers a modern-day critique of medicine to its present applications. The author radically claims, the bulk of current interventions do not serve as they should, as current practices subject the patients to greater extent harm than good. He maintains we should not believe in medical interceding and solely reckon on them sparingly. In his writing, Stegenga argues, physicians are a persona of the problem, and that the significant fiscal profit blinds them to the wellbeing of their patients.
As we continue through this article, I destined to elaborate and comment on critiques of what I find relevant to my discourse; yet before that, we need to understand the concept of independent drivers of pessimism or nihilistic posture.
In general, for somebody to constitute a nihilist, he or she must manifest certain symptoms of pessimism towards one or more elements of an object, action, or idea. Intelligibly, some may collegiate pessimism to an experience with which a particular subject may have personally encountered, or it may be the outcome of the repeated vulnerability to people’s comments who lecture about their dis-confirming experiences. Pessimism can cost the outcome of the untoward beliefs people get in their lives.
One mode of coping with pessimism is to reinstate one’s belief structure. For the sake of contention, let’s apply the presently ongoing dilemma around vaccination, the anti-vaxxer movement, and cholesterol-lowering drugs. The anti-Vaxxer trend and recent legislative retort movement have been around for over a century. The trust of the public has been fluctuating over immunization merely counterbalanced by the arm twisting efforts of the legislatures in a try to urge public wellness without any strive to regain public trust, or recent across the board push back against the publicized health hazard associated with statin cholesterol-lowering agents. We can doubtlessly feel the healthcare pessimism in its modern shapes and forms within our sociopolitical environs.
The dichroic impingement
Skepticism about the practice of medicine, also referred to as therapeutic nihilism has been around patients and physicians since the 1800s as Oliver Wendell Holmes, dean of the Harvard Medical School, wrote one time “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.” Such cynicism partly faded with the advent of science and technology in the fields of anesthesia, antiseptic surgical techniques, vaccines, and evidence-based medicine, more so on antibiotics and insulin therapy. Stegenga called these latter progresses “magic bullets,” a deed according to him manufactured by physician and chemist Paul Ehrlich meant to refer to therapeutic interventions that target the disease selectively without the possibility of adverse reactions. But, as we know, such belief is still realistically out of the scope of 21st-century medical science.
Historically, Researchers have tried hard to fabricate those magic bullets, but as of today, such an accomplishment remains a fantasy. It must be the universally accepted conviction that virtually every treatment carries its own particular adverse reaction. The notion of being expecting, ability, and comprehending that there must be a secret sauce in existence; itself is a matter of major controversy. My personal conviction is that the effective human psyche functions by differentiating between skepticism and realism. The school of thought is- most diseases like cancer, heart disease, Parkinson’s, Alzheimer’s, arthritis, schizophrenia, and bipolar disorder, have no cures or dependable treatments of which the most available medications are effective and most have harmful side effects is coherent, as every physician and expert in the medical domain can convey, for diseases and health circumstances, no established cures and for some no optimal treatment choice, Moreover side effects that can be potentially harmful. It should never be the subject of misconceptions besides the fact that we must not equate treatment to the cure, side effects to the actual outcome by merely leaving out the concept of risk and benefit ratio.
In medical language treatment and cure are entirely different phenomena and are crucial to independently weigh the risks against the benefits of a particular treatment in each patient during every clinic encounter. In the interim, we need to always heron in mind our Hippocratic Oath as “Cure, sometimes, treat often, comfort always”
As common sense implies, as health improves healthcare costs will parallel go to shrivel. Besides, sociopolitical and economic influencers would inadvertently bear upon the quality of care. Such influences are further pronounced within the population health framework. In his book, Stegenga emphasizes, we need to resort to treatments much less often by referring to the Hippocrates quote, “to do nothing is also a good remedy.”
In accord, I trust advising a secular to seek to a lesser extent treatment resembles to demand an illiterate to compose poetry. The province of the physician is to evaluate every patient’s problem before determining if he or she is the right candidate for the right treatment if at all on their relationship. Hippocratic medicine is a personalized overture to the art of healing, as Population health by the adapted modus operandi of modern medicine relies upon is a cookie-cutter approach.
Too often than not, population health makes the system insensitive to the individual Patient commits and physician reign. As adopted in the 20th-century welfare states, resulted as complex political mechanisms for converting economic growth into enhanced population health. Since, it has worked well by the merit of the patient’s limited access to information, limited expectations, and passive stance based on limited knowledge. Today, the latter factors have been averted. Millennials expect more, better, and to a greater extent the efficient system of healthcare deliverance. Something, the population health model is unable to cede. It seems inequitable to brush aside the progress we have made in medical science for system nonstarter due to an alternate band of course; Or, by allowing ourselves to plan nihilistic attitude through dormant attentiveness.
Preconception and Pliability
Realistically, as tenacious as the human race continues through the journey of phylogeny, science and technology will never be perfect at any given point in time. That as well accounts for Medical research which has its own tipping points toward a positive outcome, with regard to clinical trials. I can concord with the writer, as every researcher fancy a positive outcome. Patients are desperate to be cured and never wish to be the ones receiving the placebo intervention.
Medical Journals are too selective in publishing artic of studies that correspond utterly within their editorial guidelines and to a greater extent than journals and mass media to publicize it, the public read and concur. According to Steganga, Researchers can arrive at grants, aura, and incumbency by showing that treatment works. Not long ago I wrote a story under the title “Data Science, Medicine; Tactics vs. Strategy: the commencement of unclaimed domain” within, I elaborated how overtime tactical scientific solutions were intentionally replaced by strategic quick fixes that merely focused on maximizing financial gain, corporate empowerment and how new entities started making strategic shortcuts to dominate the ever manifesting competitive market. To put more weight on the validity of Staging’s analysis is the concept of standardization and overemphasized biased protocols applied in research and development that has kindled corporate pivoting from tactics to strategy.
Over-reliance on standard operating procedures with minimal or no accountability along with poor transparency of its origin is the major corrupting factor of medical science. Such a significant flaw, yet a consequential issue, is by far another example of alienation of the medical community from the personalized healthcare system. It overlooks the fact that Medicine is the science of indefinite variance and respecting individual humane values is the virtue for a better upshot. The values which dictate the standard ought to be appropriated individually.
The liberal executions of faulty protocols in medicine are the resemblance of the obscure shackles in the modern terms of slavery, benefiting the masters of descriptive medicine practiced by non-clinicians. Likewise, the notion of biased research applies to any industry including pharmaceutical and biomedical professions. Under the tactical vs strategic planning and execution of protocols, biomedical firms and their contribution as a sponsor to the bulk of the research contend the “conflicts of interest abound” in medical research.
Randomized controlled trials are the gold standard for modern-day medical research. It functions as the down player of bias, by randomly assigning two groups of participants, one receiving the actual treatment and the other the inert placebo. In the study researchers and subjects are blinded by not knowing who is receiving the active medication. According to Stegenga, scientists must make judgment calls as they design, put in place, and interpret trials. Randomized controlled trials are thus far less stringent, objective and are subject to pliability and manipulation, thus prejudice. The same would be true for meta-analysis or interpretation of gathered data from the trials. He postulates, this plasticity explains why the results of different trials vary widely, and why industry-sponsored research is far more to present benefits than independent investigations.
The malleable nature of double-blind randomized cross-over studies is mainly related to partiality in the protocol design, meta-analytics, and clinical guidelines. Hence, is manipulated and slackly validated without significant hindrance with the actual trial operation.
I do not necessarily concede with the criticism- More rigorous studies show fewer benefits even though not entirely paradoxical. Even so, the efficacy of a given treatment irrespective of its adverse effects is commonly determined at the earlier stages of five phases of the clinical trials. The idea of researchers being eager to get positive results by engaging in a formulation of hypotheses and data manipulation to support them after a study is carried out or in other words, cherry-picking, to allow researchers to attribute significance to what may be the random correlation is possible but less at the advanced phases. Stegenga as well believes, Meta-analysis by the Cochrane Collaboration, (a group of independent researchers with high standards of evidence) is less to report positive findings than meta-analysis by other groups. On the disturbing implication of these studies, he says, “better research methods in medicine lead to lower estimates of effectiveness.”
In general, the rigor of research on medical treatments is reciprocally proportional to the benefits it finds. There exists invariably an immanent element to any clinical trial and analysis. One must relentlessly keep in mind that sizing and position of the point of reference are of utmost significance when assessing the quality of a study. In contrast to contemporary hypothetically driven sociopolitical propagation, quality and value are the two fundamentally subjective phenomena. Henceforth, a strictly focused, point of reference will naturally yield a lower value. In other words “better research” should ideally be rephrased as “stringent research.”
Drugs and Food and Drug Administration (FDA)
Drug’s harmful effects are under-reported, as Stegenga states the FDA has close ties to the healthcare industry. It plays a discriminatory Role by setting the compliance thresholds low in approving the prescription medication. He also quotes a senior FDA epidemiologist denouncing that the agency “consistently overrated the benefits of the drugs it approved and rejected, downplayed, or ignored the safety problems.”
I must concur with the author’s view. Too, F.D.A’s pragmatic position has continually mirrored as “you may sell snake oil to the public, as long as no direct harm reported on a large-scale and diligently pay your administrative levies. Traditionally if a government envisioned intervening in a market, it would by implementing levels of regulations through mandates, inspection, tariffs, or licensing. He further points to “Dubious disorders” including restless leg syndrome, erectile dysfunction, premenstrual dysphoric disorder, halitosis, male balding, attention deficit hyperactivity disorder, osteoporosis, and social anxiety disorder. He criticizes FDA for approving flibanserin for “female sexual dysfunction” per lobbying efforts of a patient-advocacy group, who also accused the FDA of “gender bias” because it had “approved drugs for erectile dysfunction but had not yet approved a drug for the female sexual wish.” He called it “Even the Score.” believes, the lobbying was organized and funded by the manufacturer of flibanserin. Today as the big data industry joins the government’s list of interests, undoubtedly are subject to inspection and usage by the corporate entities, including the governments.
FDA’s position has always been controversial. Historically the agency’s attitude has not been to entertain clinical judgment or its efficacy; instead, its obligation is to make sure the safety of a particular drug or medical device. But at times their scope tends to extend to unrelated territories for an alternate mission. one such exercise is their recent approach to adult stem cell therapy and regenerative medicine. Physicians, pharmaceuticals, and disease mongering Healthcare providers engage in “disease-mongering.”, as Stegenga faults physicians and drug companies for expanding their markets by creating new disorders and making otherwise normal variations of the common conditions. Seem like a disease. The source strongly believes physicians voluntarily discovering disorders in new populations for financial gain in the diagnosis of mental illness. Accusing physicians guilty of disease mongering is an unjust argument even though the majority of physicians have taken passively coming on some issues. Still, by no means, it substantiates their active participation in creating false diseases. That perhaps true for the pharmaceutical industry- certainly not, physicians, as are not benefited in any means by creating illusive disorders. Corporate entities surely enjoy re-branding an existing drug about to go generic by opening a new channel for an added revenue stream which can be rendered possible by creating a new disease or equal disorder for the opposite gender.
About mental disorders, I must emphasize — what Stegenga referring to implies the expansion of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). But as of today if I am not mistaking psychiatric diseases have not been major profiting tools for physicians. Expansion of DSM-5 is at least partially related to social and behavioral factors pressing the medical community to emphasize more in categorizing certain profiles of behaviors as symptoms of a new diagnosis or sub-variant of an existing disorder including attention deficit hyperactivity disorder (ADHD) and autism.
Clinical Tests and Clinical Screening Procedures
Screening doesn’t save lives. Although he focuses on treatments, Stegenga disparages tests, as well. A staple of preventive care is that screening asymptomatic people for disease leads to earlier diagnosis and better outcomes. Screening can lead to “false positive diagnoses, over-diagnosis, and over-treatment. Thus, every physician would hold they would care for the patient, not the test results. And once we indiscriminately get in the habit of ordering tests then we do more harm. Regrettably, such vogue has been propagated by the advent of corporate monopoly, technocracy, and population healthcare, where the value of physicians is being downplayed by the virtue of technology that can supersede human skills.
Stegenga views most screening tests despite being disease-specific methods and seems reasonable; it might unduly favor the test by erroneously excluding deaths resulting from the disease treatment. He believes some researchers have argued tests should be evaluated by counting all deaths, no matter what the designated cause, in screened and unscreened groups. Once again, I concur with the technicalities of statistics and signs of the screening test, screening is another test and its indiscriminate utility not will fail to show its feasibility but too may potentially subject the patients to the unnecessary diagnostic worktop, thus untoward complications.
In conclusion, the author expects major benefits in mortality from screening to be guardedly tempered, Where I project is not the mortality but also the morbidly that must be accountable. For Grandness benefits of Quality of life would outweigh the mortality if one lives longer but incapacitated.
Modern medicine is overrated
Modern medicine is getting excessive recognition for boosting average lifespan spans, as Stegenga claims. He cites evidence compiled by scholar Thomas McKeown in the 1970s that increased longevity results less from vaccines, antibiotics, and other medical advances than from improved standards of living, nutrition, water treatment, and sanitation. And physicians violate the Hippocratic Oath for the 2013 study which estimated more than 400,000 “preventable hospital-caused deaths” occur in the U.S. yearly, and as many as 8 million patients endure major impairment.
Concept of Gentle Medicine and Medical Conservatism
“Medical nihilism” signifies the frustrated reaction of the citizens. Some call for “gentle medicine,” as a preventative measure to less emphasis on cures and more on care, like pain management, which indeed is what authentic medicine all about. Some physicians who espouse reductions in treatment call themselves “medical conservatives, but in realism, no medical conservatism exists. Following the Norms of personalized medicine, every patient deserves to receive the “right medicine”.
Conservative medicine is the passive-aggressive medical practice attuned by a physician against the excessive unsubstantiated regulations, mandates, and sociopolitical ascendance. Something independent physicians have been experiencing with today’s healthcare system causing burnout and desperation. For instance, if a physician senses a large risk of regulatory surveillance for prescribing opioids and feel criteria for disciplinary action is ill-defined, then he or she will stop prescribing opioid.
Is Stegenga a Technocrat?
My apprehension is from Staging’s attitude towards medical science and research and his radical over-reliance on technological comparison or decision-making selected on the footing of specialized knowledge and performance he may bear technocratic belief. Even though, he struggles not to politicize his judgment.
What is wrong with the picture?
Medical nihilism is indiscriminate to the variability of medical science. It tends to pull a blind eye over the persona of physicians and consumers by putting most of the inculpation on them- where in reality most of the Blame should be directed at the dis-functional system, politics, and corruption. We all can accept medicine has limitations, but we also react inadvertently to its substantiality, and yes! Indeed, personalized medicine is the way to ameliorate health and cut down costs.
The conception of nihilism along with its extreme identifiers of pessimism is the Gordian knot of the attitude thriving on reference to build on personal experiences throughout one’s lifespan. One can find infinite possibilities of nihilism with the unlimited focus of negativism, the medical nihilism among the most significant.
The writer of the book “medical nihilism” has touched on an important issue. It threatens the sovereignty of medicine and what the physicians stand up for. Simultaneously, the drive of the skepticism around healthcare is a complex one. Stegenga in his publication seems to have touched on issues, but missed out on one major theme; that is about flaws of sociopolitical and healthcare delivery systems. Technology has advanced, the standard of living has globally improved, access to information and access to knowledge base has progressed dramatically over the past decades, but we are still struggling with the means by which we can get the correct treatment and give the best tending to the patients. Healthcare has turned into a political dilemma.
People hear, read, and experience the constant negativism over the media. Corporate systems are disrupting the healthcare industry by the substance of delivering one-size-fits-all medical care switching the patient care from personal experience into a robotic arrangement that instead of caring for one person at a time, tries to cure applied science-driven test results validated on the majority, ineffectual to the minority and increase adverse effects on all. Patient and physician experiences are munificently communicated over societal media.
All mentioned are the grounds for the exploitation of medical pessimism more so among those with limited knowledge of what the practice of medicine entails. We see too many holes within today’s healthcare system, but the major problem is the outdated policies, protocols, and politics of healthcare. Physicians are indeed as guilty as the rest of the players in the industry but not the way is being elucidated by Stegenga.
To avert nihilism patients need to take charge of their care, given the self-reliance of selecting their options. To meet such a goal is a motive for independent physician empowerment. Insulation of corporate entities along with universal Transparency and validated accountability is fundamental to assure physician-patient collaborative participation.
"Medical nihilism is the symptom of a bad system, not the pre-indicant of overrated medical science."