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.