"Modern Medicine Is a Scam" Is Not the Same as Medical Nihilism

 There's a serious philosophical argument going around that we should trust medical treatments less than we do. There's also a much louder, much lazier claim that medicine is a scam. People increasingly treat these as the same idea, wearing different volumes. They are not the same idea, and conflating them lets the weaker one borrow credibility it hasn't earned.

The serious version has a name: medical nihilism, developed most rigorously by philosopher of science Jacob Stegenga. His argument is not that medicine doesn't work. It's that our methods for finding out whether it works are weaker than we like to admit. Clinical trials can be designed, analysed, and published in ways that favour a positive result. The same data, run through different statistical choices, can support different conclusions. And most interventions we test, given how complicated human biology is, were never likely to have large effects in the first place. Put those together and Stegenga's conclusion follows: for most treatments, we should hold our confidence a notch lower than the evidence appears to license.

Notice what this argument is about. It's about the reliability of evidence — trial design, statistical bias, publication incentives. It is, in its own way, an act of good faith toward medicine: it assumes researchers are genuinely trying to find the truth and asks whether their tools are good enough to reach it. You can accept every word of it and still take your antibiotics.

"Modern medicine is a scam" is a different accusation altogether. It isn't a claim about weak evidence — it's a claim about bad intent. It says doctors, or drug companies, or the whole institution, know their treatments don't work and sell them anyway. That's not scepticism about evidence; it's an allegation of fraud, and it needs a different kind of proof — proof of deception, not proof of uncertainty. Rarely does anyone making the claim supply it.

The tell is what happens to real evidence in each hand. A nihilist looks at a reversed medical practice or an industry-funded trial and concludes: we should have been more careful, and we should be more careful going forward. A scam-theorist looks at the same case and concludes: this proves the whole system is rotten. One is calibration. The other is a leap dressed up as an inference — asserting a sweeping, unfalsifiable verdict on the strength of a single, often true, data point.

There's a useful test here, and it cuts both ways. Ask of any confident claim — including the confident dismissal — what would have to be true for it to be wrong, and whether anyone bothered to check. Genuine scepticism survives that question by staying proportionate: doubting exactly as much as the evidence warrants, no more. "It's all a scam" fails the moment you ask it, because there is no finding that would ever be allowed to count against it.

Healthy scepticism about medicine is not the enemy of trusting it. Cynicism dressed as scepticism is.