Therapeutic nihilism

In the 19th century, there was a lack of confidence in the remedies of the day. Oliver Wendell Holmes said, "...if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be so much the better for mankind – and all the worse for the fishes."

Therapeutic nihilism is the belief or philosophical stance that medical or therapeutic interventions are often ineffective and may even cause more harm than good. Adherents to this view argue that it is impossible to meaningfully cure individuals or societies of their ills through treatment alone and advocate for a more restrained or skeptical approach to medical intervention.

Historical Perspective

The roots of therapeutic nihilism can be traced back to the writings of Michel de Montaigne, a 16th-century French philosopher, who in his 1580 Essais, criticized the effectiveness of medicine and advocated for the natural healing power of the body. Montaigne questioned the utility of physicians and argued that many supposed remedies were more harmful than the conditions they sought to treat.

Therapeutic nihilism gained significant traction in the early 19th century, particularly in France during the 1820s and 1830s, as many physicians began to doubt the efficacy of the prevailing medical practices, such as bloodletting, emetics, and purging. These practices, which were based on humoral theory, often failed to improve patient outcomes and sometimes worsened them.

Decline in Popularity

The rise of modern medicine and the discovery of effective treatments led to the decline of therapeutic nihilism as a dominant medical ideology. With the development of antibiotics, vaccines, anesthesia, and evidence-based medicine, physicians began to demonstrate measurable success in curing or managing diseases. These scientific advancements diminished the appeal of therapeutic nihilism and reinforced confidence in the medical profession.

Contemporary Revival

While therapeutic nihilism is no longer mainstream in medical circles, a modern version of the philosophy has been explored by contemporary scholars. Notably, Jacob Stegenga, a philosopher of science at the University of Cambridge, has defended a form of therapeutic nihilism in his book Medical Nihilism. He argues that due to systematic biases in clinical trials, publication bias, commercial interests, and the modest effect sizes of many pharmaceutical interventions, we should adopt a more cautious and skeptical stance toward many forms of medical treatment.

Stegenga’s perspective does not call for the abandonment of medicine but rather supports a minimalist and evidence-sensitive approach that emphasizes preventive care, lifestyle interventions, and public health measures over aggressive pharmaceutical or surgical solutions.

Philosophical and Ethical Implications

Therapeutic nihilism intersects with debates in bioethics, philosophy of medicine, and healthcare policy. It challenges assumptions about the role of the physician, the goals of medicine, and the nature of healing. Proponents argue that over-medicalization can lead to unnecessary harm, iatrogenesis, and resource misallocation, while critics warn that excessive skepticism may erode trust in effective medical care and delay necessary treatment.

See also

• Evidence-based medicine
• Medical skepticism
• Overdiagnosis
• Iatrogenesis
• Philosophy of medicine
• Placebo effect
• Jacob Stegenga

Further reading

• Stegenga, J. (2018). Medical Nihilism. Oxford University Press.
• Montaigne, M. de (1580). Essais.

External links

• Stanford Encyclopedia of Philosophy – Philosophy of Medicine
• Oxford University Press – Medical Nihilism