The Laws of Medicine

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In The Laws of Medicine Siddhartha Mukherjee uses his skills in writing and storytelling to elaborate on medical realities learned from invaluable education and experience. Mukherjee 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 modern history of medicine from the cure-all treatments of the 1800’s to a more careful observance of the Hippocratic oath in the 1900’s. Mukherjee pays homage to William Osler (commonly referred to as the “Father of Modern Medicine”), and Lewis Thomas’s The Youngest Science: Notes of a Medicine Watcher. Mukherjee 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. 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 in the 21st century, bias is the prey of physicians. Mukherjee reflects on the role of physicians to hunt bias, including their own bias, while using imperfect information to help patients make better 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 uncertainty within medicine. 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 each worthy of in-depth study. 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 to be Mukherjee’s most concise and easy read. Mukherjee’s 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

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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. Should memorials to rebels and slave owners be maintained? 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 I told colleagues I could “…understand both sides…” and didn’t want to condone “…censoring history…”. “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 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 114 years after W. E. B. Du Bois published The Souls of Black Folk and 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…
  • around 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 event 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 systemic social hierarchies reinforced by 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 direct or indirect effects on the present, regret for the racially motivated decisions of the past would benefit current societal relationships. A sense of “white guilt” is not something people need to be ashamed of. Feelings of remorse for generational transgressions do not necessitate self-hatred or despise for one’s own skin color. Descendants of slavers and people who benefited from slavery have the right to feel guilty for the sins their ancestors committed, condoned, and/or tolerated.  This guilt is not something to fear or be ashamed of but something to act on. Shame can often feel like self-loathing, but guilt can feel more like catalyst for positive change. “White guilt” can simply be a lesson from history and a motivation for creating or maintaining more just societies. In that context, “white guilt” is not holding oneself individually responsible for the crimes of another individual. Rather, it is an individual confession of past crimes that are relevant due to their direct or indirect effects on the present. One could argue that as living creatures, mammals, or in the very least as human beings, we are all one human family, and any society interested in social justice, human rights, and general civility will take on a communal responsibility to never repeat the sin of slavery.

Furthermore, 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 can actually 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 need not be constantly avoided but rather should be 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 different from one’s own may feel odd to some (especially if one grew up learning that such a feeling should feel odd), but it should not feel wrong simply for sake of appearance or for avoidance of surface-level judgments. If such feelings and affections spark a romantic relationship, people can find solace in the long history of many joyful couples who have ignored skin color as a deal-breaker for their romantic relationships.

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, these monuments are cold giants that use size and art to vainly seek to make up for whatever piece of humanity that was 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, and/or hope.  History has afforded us 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 and democratically removed from a place of honor or, disrespectfully, torn down.