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 Inequality

On Inequality is another short read from Philosopher Harry G. Frankfurt. Frankfurt immediately sets out to critique economic egalitarianism. He points out that the haves are not as much of a concern as the have-not’s (i.e. addressing the problems of society’s poorest is more of a concern than taking away from society’s richest), but he points out that the excesses of society’s richest are distasteful. Frankfurt points out that the inequality of political power that sometimes accompanies extravagant wealth is more of a concern than the wealth itself. Frankfurt advocates for the “doctrine of sufficiency”, emphasizing that although more economic and political equality may have a positive impact in many ways, the notion of societal equality as a fundamentally right moral principle is incorrect.

Frankfurt illuminates the dangers of comparison when he deals a deadly blow to the idea that it is right and fair for everyone to possess equal amounts of materials and goods. As an individual with differing ambitions, obligations, and requirements, it is silly think that one person’s fulfillment comes through having the same amount of wealth as the next person. All of this Frankfurt establishes within the first 12 pages.

Frankfurt then goes on to elaborate on some of the defenses of equality as a fundamentally right moral principle. He makes an argument about distribution of goods and utility thresholds when resources are scarce. His argument compellingly emphasizes that there are situations in which inequality is necessary for survival (i.e. the greatest benefit for the greatest number of people may not always result from equal distribution of goods if there are not enough goods for everyone to subsist on).

Though, resources are not globally scarce, even for the large population that this planet supports, resources are often scarce locally. In these situations populations must make decisions about the distribution of resources, and prioritizing the distribution of resources towards that which will provide the most efficient output seems to be common sense. With the technology and communication that modern society possesses, it is the hope that such local catastrophes may be adverted more and more, but Frankfurt’s point holds true – prioritizing equality in situations of scarcity is unlikely to produce the most utilitarian beneficence.

Besides the practical utility of goods, Frankfurt emphasizes that equality is not a fundamentally right moral principle in part because inequality does not prevent a person from being contented with his or her life (i.e. contentment is not dependent on having as much as the next person). This point again acknowledges the individuality of the person. Individuals do not want or desire the same things, but for some reason people often advocate for attainment of similar or equal resources thinking that will lead to fulfillment in life. It’s refreshing to realize that one person does not need the same things as the next person, and that one person may be significantly more contented having less than a discontented neighbor.

Frankfurt does not appear to be defending price gauging, lobbying, or other advantageous uses of resource or wealth distribution. Frankfurt states that rights, respect, consideration, and concern should be afforded to every person. On Inequality may be disturbing to some who misinterpret what Frankfurt is saying, but the book is ultimately a rational examination of the idea that economic equality is intrinsically the moral high ground.

On Inequality, like other small books that Frankfurt has written, provides a critical outlook on a subject that deserves more examination. Frankfurt provides an encouragingly detailed reflection on the concept of equal distribution of resources. His words are not idly written, chosen out of a reflexive feeling of defensiveness, or issued based on an immediate emotional response. Rather, Frankfurt provides a non-polarized assessment of a subject that receives far too many sound-bite responses. That is essentially what make Frankfurt’s books enjoyable to read.

 

On Truth

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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.

 

 

 

 

The Real Doctor Will See You Shortly

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The Real Doctor Will See You Shortly by Matt McCarthy is a book about the author’s first year as a resident after graduating from Harvard Medical School. The book is a raw story about the stressful ups and downs of life as a medical resident. Not all residents may feel the same kind of stress or sense the same kind of life-altering experiences that Doctor McCarthy reflects on in his book, but the experiences of residents must have a large impact on the courses of their futures as physicians. McCarthy’s book demonstrates how his experiences have impacted his career, and provides a valuable resource for students aspiring to a career in medicine.

The book opens with McCarthy exiting the world of academia for the work of residency. He travels from the cardiac care unit to a local outpatient clinic to the infectious disease service to the general medicine floor to intensive care unit during his residency at Columbia University Medical Center. He exchanges 2nd year resident mentors for which he has a constantly changing “scut” list of services to provide for patient care. He experiences triumphs and tragedies as he endeavors to survive his first year of residency.

McCarthy has authored other books, and his writing is not bland or above the level of the reader. He shares mnemonics like “ABC”, “VINDICATE”, “AEIOU”, and “NAVEL” to illustrate the rigors of remembering keys to good patient care, but he never expects the reader to take an interest in the academics of medicine. McCarthy writes for the sake of the story. He describes the emotions of patients and their caregivers, he illustrates the harsh physical realities of diseases and medical procedures, and he reflects on the good and bad things about life as a resident.

McCarthy also demonstrates a refreshing sense of humor and humanity. He makes corny jokes, illustrates some humorous situations that often arise in healthcare, and talks about the importance of periodically cutting loose from the serious nature of medical care. Healthcare professions can be a frustrating, and McCarthy’s humor provides welcome relief for the doctor and the reader.

The Real Doctor Will See You Shortly is a good read, especially if one is interested in working in the medical field. Working as a Medial Doctor is a very well-respected job for many reasons. The hard work and discipline that it takes to graduate from Medical School demonstrates a willingness to sacrifice time, energy, and wealth to achieve an admirable goal, and more importantly, providing quality patient care demonstrates a dedication to protecting the lives of others. As more readers delve into the pages of Dr. McCarthy’s telling first year, perhaps their confidence to sacrifice time, energy, and wealth for the sake of those who lack access to quality healthcare will grow as well. After all, it is not easy, becoming a doctor, but for the sake of others, it’s definitely worth it.

The Hungering Dark

 

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In The Hungering Dark, Buechner (1) Intentionally reads and reflects on the words of the Bible, (2) enters into a discussion of love that may catalyze some important philosophical questions (3) uses curious wording that may be referencing atheism and the theory of evolution, and (4) openly questions aspects of the Christian zeitgeist.

(1) It’s apparent from his detailed reflections on various verses that the man has spent a great deal of time reading the Bible.

  • The Gospels and select other passages may be most read among Christians today, but Buechner pulls verses from the books of Psalms, Daniel, Isaiah, Job, Genesis, and Songs of Solomon as well as the Gospels. He finds such depth in these verses that, when combined with other literature and his own experience, he is able to write down pages of thoughts inspired by a few sentences of scripture. He also differentiates Greek words for love without estranging his less studied readers.

(2) Buechner’s comparison and contrast of “eros” and “agape” love is enlightening for relational understanding, but it is also a good springboard for a conversation about the philosophy of morals.

  • In Chapter 9, “The Two Loves”, Buechner writes about love of in the context of human and divine relationship. He mentions that in relationships people are likely to get hurt and they are unlikely to predict when or where that hurt will occur. Whether romanticism or the illusion of foresight, individuals mostly fail to predict the inevitable pains of human relationships. As he goes on to talk of sacrificial love he intentionally or unintentionally may be pointing to what seems like a philosophical difference between many believers and unbelievers. Whatever religion one adheres to, there seem to be more faith-based statements among believers than among unbelievers. Believers usually profess to some beliefs that are hard to justify through a solely Consequentialist or Utilitarian thought process, but unbelievers may more easily justify their beliefs through a Utilitarian thought-process. When Buechner emphasizes the difficulties of predicting the onset of pain in romantic relationships his words parallel a problem of consequential ethics. Humanity has yet to discover a way to consistently and accurately predict the future. Buechner’s words help him to make his point that eros and agape are more similar than they are different, but in the process his words present a hard question to the idea that morality is solely a matter of consequence, especially for our finite species.

(3) Buechner seems to have given some serious reflection to the beliefs of atheism and perhaps, the theory of evolution.

  • In Chapter 7, “The Sign by the Highway”, Buechner writes poetically, not scientifically, about humanity’s ape-likeness. It’s unclear if he’s agreeing that humans are the distant cousins of apes, and that’s not the focus of his statement. Still, his choice of words may shift some readers towards thoughts of evolutionary biology.
  • In the first chapter, “The Face in the Sky”, Buechner aptly points out the lack of significance of the birth of Jesus to nonbelievers. However, nonbelievers may sharply disagree with Buechner’s later generalization that the manger scene must only be a source of sorrow for those who do not believe in the gospel. A disagreement from nonbelievers could be that life is sweeter and time more savory without the promise of an afterlife. Nonbelievers might also enjoy traditional aspects of religion (e.g. the nativity scene, hymns, or the teachings of Jesus) similarly to the way society enjoys Santa or the tooth fairy.
  • At the end of “The Sign by the Highway” Buechner echoes Pascal’s Wager. He also writes that it’s a good kind of amazing that people still believe in God. Ultimately, Buechner’s argument in “The Hungering Dark” is for belief in God, but Buechner seems to express some understanding of those who elect for the alternative.

(4) Though he argues for belief, Buechner openly questions many Christian attitudes.

  • In chapter 4, “A Sprig of Hope”, Buechner asserts that there is a tendency to treat more difficult parts of the Bible as fairy tales in order to cover for a judgment in those passages. Buechner is making the point that the stories of the Bible are often treated with a selective bias among believers, who may often pick and choose what stories to ignore, focus on, or tell with a certain sort of glaze or adornment. Interestingly, Buechner illustrates his point with mention of the Vietnam War which was still raging when the book was published. He goes on to illuminate the increased significance of some regularly sugar-coated Bible stories when these stories are read for what they are. Why would Christians try to sugar-coat scripture or God? In the end it may hurt more than help.

If this book was a river it would flow towards a cleft in a waterfall, on one side of the cleft would be intentional faith, hope for eternity, and pursuit of unconditional love and on the other side of the cleft would be strictly objective human reason, self-determination of meaning/purpose, and conditional love. There are other great themes in this book like connectedness in “Confusion of Face” & “Pontifex”, vocation & mission in “The Calling of Voices” & “The Killing of Time”, love in “The Two Loves” & “The Wedding at Cana”, joy in “The Monkey-God”, and hope in “The Rider”, but this book is mostly about questioning faith and keeping it. Regardless of one’s choice for or against faith and for people who have experienced or are experiencing this struggle, The Hungering Dark is still relevant and worth a read.