The Laws of Medicine

In The Laws of Medicine Siddhartha Mukherjee uses his words and storytelling to elaborate on medical realities learned from invaluable education and experience.  Mukherjee is sets out to describe principles of medical practice, pointing out that practicing medicine is about knowing the strengths and weaknesses of knowledge gleaned from patients, tests, experiments, and one’s self, then making the best decision with that information. Mukherjee much more eloquently elaborates on that point, emphasizing his three “laws” or principles of medicine.

  • Before Mukherjee describes the three principles of his book, he sets them up in a forward. He wonders if medical jargon is partly subconsciously employed to escape unknowns. He briefly discusses the history of medicine from the cure-all treatments of the 1800’s to careful observance of the Hippocratic oath, using William Osler as an example. He mentions Lewis Thomas’s The Youngest Science: Notes of a Medicine Watcher. He is careful to differentiate the “laws” he is about to expose from more pure scientific laws such as those in Physics, Chemistry, and Biology.
  • Mukherjee explains that assessing a patient involves raising or lowering the probability of a diagnosis through interpreting test results in context. Mukherjee uses Thomas Bayes, an 18th century Philosopher and Clergyman, to illuminate the imperfect nature of tests.
  • Mukherjee continues his excellence use of relevant storytelling to explain how the unexplained abnormal results of tests or experiments are keys to better understanding of the whole. Hearkening back to history once more, Mukherjee uses Karl Popper’s The Logic of Scientific Discovery to point out that medical knowledge is scientific only when it carries a stipulation that can disprove it by new information or discovery.
  • Mukherjee adapts Heisenburg’s uncertainty principle to medicine to question how generalizable experiments are. He mentions that Paul de Kruif’s Microbe Hunters may have been apt in the early 20th century, but here in the 21st century bias is the prey of physicians. Mukherjee reflects on the role of physicians to hunt bias, including their own, while using imperfect information to help patients make the best decisions about their health.

In The Laws of Medicine, Mukherjee impresses a sense of understanding upon the reader through taking complex issues and breaking them down into manageable pieces of information. He doesn’t need to explain the science behind his examples to give the reader a little understanding of the big picture. Furthermore, bleeding through the pages are rich examples of medical history that incite an appreciation for great minds that have come before Mukherjee’s imparting knowledge for him to build upon.

Another theme of Mukherjee’s book is the uncertainties of the medical field. His comments on medical jargon and the imperfections of tests are humbling. Still a relatively young science, medicine continues to experience a boom in information and technology. These advancements may clarify some things while opening up new areas vast with questions.

Studies, companies, and patients all have opinions on medicine, and it seems correlations are often unexplained while being sold as causation to the public. Statistics, anatomy, physiology, epidemiology, pathology, advanced mathematics, history, etc. are subjects each worthy of in-depth study, but combine all of those subjects while adding many others and you will begin to understand the challenges of medicine. It’s edifying to see an author acknowledging the difficulties of his field while simplifying the principles within it.

With all the avenues with which information and opinion is accessed in today’s world, it is difficult to focus on what matters most. Focus is what Mukherjee encourages with his three laws of medicine. Sifting through a myriad of information to find relevance seems an ever-increasing challenge among today’s youth, whether or not they are interested in practicing medicine. With the precision of a great writer, Mukherjee illuminates invaluable principles learned through a wealth of experience. These principles help thin the overwhelming fog of information to be processed, and if put to use are likely to improve the work of those practicing medicine.

Mukherjee’s The Laws of Medicine is a short and worthy read for anyone interested in the practice of medicine. At less than 100 pages, The Laws of Medicine seems Mukherjee’s most concise and easy read as his other books, The Gene and The Emperor of All Maladies: A Biography of Cancer, are both over 500 pages. The Emperor of All Maladies: A Biography of Cancer was awarded the Pulitzer Prize for General Nonfiction in 2011, and Mukherjee has also written for NEJM, Cell, Nature, and The New York Times.

 

On Statues

Statue4

 

There are certainly some persons who deserve to be remembered more than others, but does anyone deserve a statue molded in their likeness? Should any man or woman be memorialized by a larger than life image?

First hearing by word of mouth of the controversy in Charlottesville, Virginia last Sunday, it was hard to be surprised. There have been many acts of terrorism in the news lately, and one more senseless act added to the numbness. Terrible, egregious, disgusting, inhuman, evil… these words may be accurate descriptors, but they often fall short of empathy and feeling. It’s one thing to describe an incident, and it’s another to live it.

Later that night after having some time to reflect on the incident, a discussion with a friend commenced over a game of pool. What motivated the event? Why now? Is our society in regression or experiencing growing pains?

Then came the discussions of this week. Historical figures were compared, and the differing perspectives on their memorials were illuminated. Oppressive or defensive? Worthless or worthy? Hate or heritage?

During another brief personal discussion came the words “…understand both sides…”. “Understand” was inaccurate, and “both sides” was a poor choice of words. Some emotion brewed in a friend’s face as he asked if a memorial to Hitler would be appropriate? The question was rhetorical, but thoughts comparing Confederate leaders to Nazi leaders immediately came to mind… Do these men deserve to be memorialized?

Is there enough goodness in those Southern soldiers that is worth remembering? Or, does the obvious and overwhelming evil that these soldiers died defending rule out a position of honor for their statues? Is felling a Confederate leader’s memorial ignoring history, or would destroying theses statues be an acknowledgment of past crimes? It’s clear that history often, if not always, remains up for interpretation.

Another reality is that honorable intentions do not right injustices. Every human seems more dynamic than people are willing to admit, and stereotypes or generalizations often cloud the complexity of a life. However, are there things that must not be condoned, even if done by a generally good man?

The most accurate interpretations of the integrity of the men who’s statues are being debated should be left up to those honest individuals willing to search historical records and primary sources for the facts. That is not the subject here. The more relevant issue seems to be one of putting the present into historical context.

The men memorialized by these statues lived through events that changed the course of history. The nation that was split in two reunited, but were wrongs righted? Were all hurts healed?

Roughly 8 years after the inauguration of President Obama…

  • nearly 50 years after the death of Dr. King…
  • approximately 70 years after Robinson first swung a major league bat…
  • around 116 years after Booker T. Washington published Up From Slavery
  • something like 154 years after the formation of the 54th Massachusetts Infantry…
  • 160 years since the Supreme Court’s decision on Dred Scott v. Sanford…
  • 184 years after the death of William Wilberforce and the subsequent abolition of slavery in the British Empire…
  • nearly 200 years since the birth of Frederick Douglass…
  • thereabouts 243 years after General George Washington halted the recruitment of black soldiers for service in the Continental Army…
  • 228 years after the publication of Olaudah Equiano’s autobiography…
  • give or take 398 years since the first Africans were enslaved on American soil in Jamestown…
  • more or less than 516 years after Saint-Domingue (Santo Domingo) became an international slave port…
  • and circa 525 years since Columbus planted the seeds of European colonialism in the Caribbean – what would prove to be a tragic omen for millions of indigenous people in Africa and the West…

…these American lands are still reeling over past sins – sins that cannot be made right.

While there is no way to right the wrongs of the past, there is hope in the present.

  • First, those who have ancestors that were responsible for the injustices of genocide, slavery, or other acts of racist oppression and/or those who have benefited from systematic social hierarchies resulting from a history of white-European colonialism, would do well to seek recognition of how evils of the past have influenced their current circumstances.
  • Besides an awareness of the history of these injustices and their effects on the present, regret for the racially motivated decisions of the past would benefit current societal relationships.
  • Third, “white-guilt” is not something to be ashamed of, in the sense that feelings of remorse for generational transgressions lead one to self-hatred. Rather, this guilt is something to act on.

There is no shame in discouraging voluntary segregation or prejudice, even if one’s blood-line may have systematically oppressed the ancestors of another ethnicity or people-group, and vice-versa.

  • Feeling fear of unknowns at the site of a dinner party crowd of different cultures or skin tones should incite an urge to join their company rather than remain in the comfortable circle of more predictable commonplace.
  • Discussions of injustice driven by petty things such as skin color, wealth, or greed should not be constantly avoided but addressed with humility, authenticity, and caution – especially regarding an experience a person could not understand unless she or he took on the appearance, heritage, environment, and event of the one who lived it.
  • Having affections for an individual of a skin color quite opposite from one’s own may feel odd at first, but it should not feel wrong simply for sake of appearance or avoidance of surface-level judgement.
  • Lastly, if such affections should turn romantic and result in a desire for marriage, know that color line was crossed long ago and is littered with the footprints of many joyful couples.

On statues, carved or modeled – molded or assembled, they are lifeless things meant to represent or honor something greater. What benefit do these motionless creations have to offer besides reminders of higher ideals and heroic deeds? At best, statues are but a caricature of the people they are meant to emulate. Far from the beating hearts and original minds of the persons they represent, statues are cold giants that use size and art to vainly seek to make up for humanity lost.

This humanity is not flawlessly set as sinner against saint or hero versus villain. As much as people aspire to glorious perfection, it has yet to be reached by any of the finite creatures that populate this planet. Rather, each memorial should be purposed to bring out the best of this human condition while acknowledging the truth of the times which the figure represents.

An effective memorial should not encourage people to wallow in its presence or rage against its existence but carry on with their lives, taking with them a memory that will spark to light part of what it means to be truly human. There has been far to much tragedy in this world already. While history must be remembered for what it was, humanity needs not to abide memorials that recall and breed division in the present.

Statues should be constructed to promote a sense of righteous resolve, connectedness, or hope.  History has afforded many examples of individuals and events, flawed, but resulting in courageously righteous action. Uplift that which will uplift. If statues fail to meet this criteria, history can continue to be honestly maintained while the figure is respectfully removed from a place of honor or, disrespectfully, torn down.

On Truth

OnTruth

On Truth, written by Harry G. Frankfurt who was a professor of Philosophy at Princeton University, is a book defending and elaborating on the concept of truth. The first thing Frankfurt does is dispose of the fallacy that truth does not exist as disproving  itself (i.e. saying truth does not exist would be an absolute truth). The second thing Frankfurt does is emphasize that he is not writing about what is true and what is not true, but about the vital concept of truth itself.

Frankfurt then examines the importance of truth within modern society and some of the ideologies surrounding the idea of truth. Frankfurt indirectly invites the reader to consider if a person’s idea of truth is determined by her or his experiences and environment. The author emphasizes the importance of truth in regards to being honest about one’s self and in regards to a healthily functioning society. He discusses Baruch Spinoza’s idea that people who love themselves and their lives tend to love truth because of the role truth plays in life.

In the second half of “On Truth”, Frankfurt seems to continue his consequentialist approach to truth as he describes the importance of a person accepting reality for what it is regardless of whether or not she or he agrees with it. Though he continues to elaborate on the necessity of truth in living a fulfilled life, Frankfurt’s dialogue brings some fundamental questions. Is it better to utilize truth for one’s own gain, for the gain of a group, or for the gain of society as a whole? Is it better to exercise delayed gratification or immediate gratification?

For example:

The issue of the growing national debt of the United States government is discussed with every election cycle, and this topic must influence decision making on the part of U.S. citizens. Is it better to allow the debt to continue increasing to bolster the U.S. economy now or should the U.S. government make severe budget cuts now to avoid long-term consequences? One could argue that both approaches can be motivated by a consequentialist perspective (i.e. one seeks to benefit people in the present and the other seeks to benefit people in the future), but which approach provides the most benefit for the greatest number of people?

When considering a consequentialist approach an important distinction must be made between what benefits the individual (or the individual’s group) and between what benefits the greatest number of people in society. Though these discussions will likely make decisions much more complicated, they should also serve to make decisions more intentional in beneficence or non-beneficence and more effective in reaching set goals. A gray reality of conflicting information and viewpoints beckons for reasoning on principle / truth rather than impulsive black and white decision making based on preset preferences / experiences and incomplete information.

Frankfurt’s realization of the variation / grayness of life is refreshing. At one point Frankfurt implies that a lie may have consequential utility in one situation while being a burden to society in another situation.

For example:

Comedians lie frequently about their experiences to create a more humorous punch line. This is one example of how manipulating the reality of a situation may be of benefit to a great number of people. Often jokes are dependent upon realizing the untrue nature of a statement, and such sarcasm may serve to mock a falsity and admire a truth.

If the example of comedians seems like a weak defense of the utility of a lie, the genocidal examples of a German lying to the Gestapo about the location of Jews or of a Rwandan lying about her or his ethnicity to avoid being a victim of mass slaughter should serve as a more potent example. Frankfurt makes his points effectively without use of such examples, and he goes on to illuminate why lies can be so uncomfortable, even when they have some consequential utility.

Lies keep the hearer from some reality. The full truth of a situation is shrouded. That aspect of a lie is always negative, regardless of the lie’s consequential utility. The nature of a lie is entertaining a thought or an idea that is false, and this serves to explain why lies should be naturally less popular than truths (i.e. the nature of reality causes lies to be self-defeating).

“On Truth” is a short, reflective read that provides a good defense of the overall utility and vital nature of absolute truth while acknowledging the existence of various situations in which complete, raw honesty about truth is unknown, undesirable, or not of the most immediate beneficence. Truth has a self-evident nature which always makes falsity somewhat undesirable even if an untruth is useful. Frankfurt’s approach entertains the complex nature of truth while upholding truth’s integrity, and when discussing and deliberating what is likely the most important concept in life, such a balanced and rational approach is a good thing.

 

 

 

 

Dreams from My Father: A Story of Race and Inheritance

 

 

President Barack Obama’s history may not be well-known to most people. Is he from Hawaii or Chicago? What is his connection to Kansas, Kenya, and Indonesia? Most interestingly, what life experiences shaped the 44th President of the United States?

Written after his graduation from Harvard Law school in 1991 and originally published in the summer of 1995 (months before his mother’s early death), Dreams from My Father is personal throughout and at times poetic as it exposes the man Barrack Obama Jr. was before coming into senatorial and presidential power. In Dreams from My Father, President Obama reflects on a variety of topics (e.g. racism, family, religion, politics, poverty, community, etc.) and personal experiences (e.g. growing up in Hawaii in the absence of his biological father and in Indonesia in the presence of his step-father, going to school in New York before working as a community organizer in Chicago, and journeying to Kenya to discover his paternal roots) that have helped to shape his life. Well-performed and well-paced, the audiobook may lose one’s attention during some in-detail recounts of personal history or genealogy, but for the most part the narrative is concise with multiple compelling statements that reveal the balanced and diplomatic prowess of the 44th President’s worldview.

Regardless of one’s political opinions, this autobiographical account from the 44th President and 2009 Nobel Peace Prize winner is well worth a listen for the historical context and provoking questions that it provides to the listener.