In a new and interesting book entitled Medical Nihilism (2018), Jacob Stegenga attempts to convince us that modern medical therapies are less effective than we think. Given the heterogeneity of hypotheses in medicine and the evidence for or against them, I argue that such a decontextualised critique cannot be made unless substantially weakened. Instead, I put forward an alternative, more nuanced and defensible epistemic view of medicine. According to this view, evaluating medical evidence requires analysis of both the methods of research e.g. randomised controlled trial (RCT), and context-specific information. This is because the way a trial (even an RCT) is conducted e.g. the population recruited and how it is intervened on, will vary and will have significant effects on the likelihood of a positive outcome. Moreover, the relationship between the positive outcome of a trial and the actual effectiveness of an intervention (the trial validity) will depend on these context specific factors. I argue for this position against nihilism by showing how each of Stegenga's individual claims about medical trials (trials are biased in favour of positive outcomes etc) can be questioned by taking the context into consideration.

中文翻译：

---

医学虚无主义：去上下文化的医学批评的局限性。

在一本有趣的新书《医学虚无主义》（2018年）中，雅各布·斯特根加（Jacob Stegenga）试图说服我们现代医学疗法远没有我们想象的有效。考虑到医学假说的异质性以及支持或反对医学假说的证据，我认为，除非充分削弱，否则就无法进行这种去上下文化的批评。相反，我提出了一种替代性的，更细微和可辩护的医学认识论。根据这种观点，评估医学证据需要分析研究方法，例如随机对照试验（RCT）和特定于上下文的信息。这是因为进行试验（甚至是随机对照试验）的方式（例如，招募的人群及其干预方式）将有所不同，并且会对阳性结果的可能性产生重大影响。此外，试验的积极结果与干预措施的实际有效性（试验有效性）之间的关系将取决于这些具体情况。我通过展示如何考虑到上下文来质疑Stegenga关于医学试验的个人主张（审判偏向于积极成果等），以此反对虚无主义。