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The Laws of Medicine: Field Notes from an Uncertain Science
Essential, required reading for doctors and patients alike: A Pulitzer Prize-winning author and one of the world’s premiere cancer researchers reveals an urgent philosophy on the little-known principles that govern medicine—and how understanding these principles can empower us all.
Over a decade ago, when Siddhartha Mukherjee was a young, exhausted, and isolated medical resident, he discovered a book that would forever change the way he understood the medical profession. The book, The Youngest Science, forced Dr. Mukherjee to ask himself an urgent, fundamental question: Is medicine a “science”? Sciences must have laws—statements of truth based on repeated experiments that describe some universal attribute of nature. But does medicine have laws like other sciences?
Dr. Mukherjee has spent his career pondering this question—a question that would ultimately produce some of most serious thinking he would do around the tenets of his discipline—culminating in The Laws of Medicine. In this important treatise, he investigates the most perplexing and illuminating cases of his career that ultimately led him to identify the three key principles that govern medicine.
Brimming with fascinating historical details and modern medical wonders, this important book is a fascinating glimpse into the struggles and Eureka! moments that people outside of the medical profession rarely see. Written with Dr. Mukherjee’s signature eloquence and passionate prose, The Laws of Medicine is a critical read, not just for those in the medical profession, but for everyone who is moved to better understand how their health and well-being is being treated. Ultimately, this book lays the groundwork for a new way of understanding medicine, now and into the future.
Over a decade ago, when Siddhartha Mukherjee was a young, exhausted, and isolated medical resident, he discovered a book that would forever change the way he understood the medical profession. The book, The Youngest Science, forced Dr. Mukherjee to ask himself an urgent, fundamental question: Is medicine a “science”? Sciences must have laws—statements of truth based on repeated experiments that describe some universal attribute of nature. But does medicine have laws like other sciences?
Dr. Mukherjee has spent his career pondering this question—a question that would ultimately produce some of most serious thinking he would do around the tenets of his discipline—culminating in The Laws of Medicine. In this important treatise, he investigates the most perplexing and illuminating cases of his career that ultimately led him to identify the three key principles that govern medicine.
Brimming with fascinating historical details and modern medical wonders, this important book is a fascinating glimpse into the struggles and Eureka! moments that people outside of the medical profession rarely see. Written with Dr. Mukherjee’s signature eloquence and passionate prose, The Laws of Medicine is a critical read, not just for those in the medical profession, but for everyone who is moved to better understand how their health and well-being is being treated. Ultimately, this book lays the groundwork for a new way of understanding medicine, now and into the future.
70 pages, Hardcover
First published September 1, 2015
About the author
Siddhartha Mukherjee
32 books5,346 followersSiddhartha Mukherjee (Bengali: সিদ্ধার্থ মুখার্জী) is a cancer physician and researcher. He is an assistant professor of medicine at Columbia University and a staff cancer physician at Columbia University Medical Center. A Rhodes scholar, he graduated from Stanford University, University of Oxford, Harvard Medical School. He has published articles in Nature, The New England Journal of Medicine, The New York Times, and The New Republic. He lives in New York with his wife and daughters.
His book The Emperor of All Maladies: A Biography of Cancer won the 2011 Pulitzer Prize for General Non-Fiction.
His book The Emperor of All Maladies: A Biography of Cancer won the 2011 Pulitzer Prize for General Non-Fiction.
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Displaying 1 - 30 of 495 reviews
February 6, 2017
This is a very short book, but deep. It makes you reflect on the practice of medicine and how it might affect you if you had to make decisions for yourself or another. The first law of medicine, according to the author is “A strong intuition is much more powerful than a weak test.” Or, what you think you are seeing is more likely the case than what the computer spits out if you've been doing all the wrong tests or don't know the true circumstances.
Mukherjee uses as an example a man, a conventional banker-type, whose sickness he cannot diagnose no matter what test he orders. Then he sees him not in a patient context but chatting to a known heroin addict, and thinks maybe he too is a heroin addict and tests for AIDS, which the man has.
The second law is "Normals’ teach us rules; ‘outliers’ teach us laws.” That is, pay attention to the one person for who has a different story, a different treatment works for them, or they are the ones to beat the odds. It is their studying their differences that furthers medical knowledge.
The third law, “For every medical experiment, there is a perfect human bias," is a warning that we see what we want to see. That no matter how well tests are designed, double blind for instance, there is always the possibility of confirmation bias in their interpretation.
Which rather neatly brings it round to the first law and taking into consideration the second law: take a good history, get to know your patient well, and use your experience and intuition to interpret or even dismiss the results of tests when forming a diagnosis and treatment.
This is a short book, or a long lecture. It's as if the brilliance of his The Emperor of All Maladies: A Biography of Cancer has been tempered with the practicality and brevity in writing of Atul Gawande (also a doctor) and produced a philosophical book that will have you thinking long after the few hours it took to read.
Mukherjee uses as an example a man, a conventional banker-type, whose sickness he cannot diagnose no matter what test he orders. Then he sees him not in a patient context but chatting to a known heroin addict, and thinks maybe he too is a heroin addict and tests for AIDS, which the man has.
The second law is "Normals’ teach us rules; ‘outliers’ teach us laws.” That is, pay attention to the one person for who has a different story, a different treatment works for them, or they are the ones to beat the odds. It is their studying their differences that furthers medical knowledge.
The third law, “For every medical experiment, there is a perfect human bias," is a warning that we see what we want to see. That no matter how well tests are designed, double blind for instance, there is always the possibility of confirmation bias in their interpretation.
Which rather neatly brings it round to the first law and taking into consideration the second law: take a good history, get to know your patient well, and use your experience and intuition to interpret or even dismiss the results of tests when forming a diagnosis and treatment.
This is a short book, or a long lecture. It's as if the brilliance of his The Emperor of All Maladies: A Biography of Cancer has been tempered with the practicality and brevity in writing of Atul Gawande (also a doctor) and produced a philosophical book that will have you thinking long after the few hours it took to read.
October 30, 2015
How does the saying go? Sometimes big things come in little packages. Which certainly proved true with this book. A TED talk on medicine by the noted cancer physician. Unfortunately I have had more than my fair share of dealing with the medical profession, so I always have an interest in books such as this. Learned much about the tests that are ordered, how doctors make their decisions, drug trials and what they actually mean. Some interesting cases were presented in an easy to understand format. A very good if short read.
January 2, 2020
The encomiums are copious concerning creations by Oncologist/Pulitzer Prize winner Siddhartha Mukherjee. Having read his “Emperor of All Maladies: A Biography of Cancer” to “The Laws of Medicine: Field Notes from an Uncertain Science.” Both teach us law one: “A strong intuition is much more powerful than a weak test.”
Though not as involved or page heavy as previous works; this TED talks book helps us understand the reality that confronts all physicians having to make faultless decisions from imperfect information. Mukherjee documents his time in medical school (1995) and his mentors (Astronomer Tycho Brahe, Physician Lewis Thomas) that guide him.
“Law three for every perfect medical experiment, there is a perfect human bias. Why do some cancers carry similarities?...Humans are the final arbiters and interpreters of the medicine.”
---Siddhartha Mukherjee, MD
The Laws of Medicine: Field Notes from an Uncertain Science is a depiction of the uncertainties in medicine. He lauds about how hope is both beautiful/dangerous (especially when traces of tumor are left behind). The three laws are discussed, and Ovid comes to mind with “dolor hic tibi proderit olim.” This book is “Mukherjee light.”
Though not as involved or page heavy as previous works; this TED talks book helps us understand the reality that confronts all physicians having to make faultless decisions from imperfect information. Mukherjee documents his time in medical school (1995) and his mentors (Astronomer Tycho Brahe, Physician Lewis Thomas) that guide him.
“Law three for every perfect medical experiment, there is a perfect human bias. Why do some cancers carry similarities?...Humans are the final arbiters and interpreters of the medicine.”
---Siddhartha Mukherjee, MD
The Laws of Medicine: Field Notes from an Uncertain Science is a depiction of the uncertainties in medicine. He lauds about how hope is both beautiful/dangerous (especially when traces of tumor are left behind). The three laws are discussed, and Ovid comes to mind with “dolor hic tibi proderit olim.” This book is “Mukherjee light.”
October 23, 2015
Law One: A strong intuition is much more powerful than a weak test.
Law Two: "Normals" teach us rules; "outliers" teach us laws.
Law Three: For every perfect medical experiment, there is a perfect human bias.
Well, interesting, sort of. I would have probably really liked this in the early days of medical school. Each 'law' is illustrated with a few examples that give the reader a peek into his medical world. You know, the sort of godly laying-of-the-hands-and-the-noble-art-of-medicine world. Not the mucky real world of indifference, greed,and incompetence all jostling and wrestling hard with the grunting idealists pulling out all the stops and trying their darndest to save this life, because dammit we all deserve that, don't we?
Still, it is a lovely little book, physically. It would be a perfect gift for a new med student or newly minted doctor.
Law Two: "Normals" teach us rules; "outliers" teach us laws.
Law Three: For every perfect medical experiment, there is a perfect human bias.
Well, interesting, sort of. I would have probably really liked this in the early days of medical school. Each 'law' is illustrated with a few examples that give the reader a peek into his medical world. You know, the sort of godly laying-of-the-hands-and-the-noble-art-of-medicine world. Not the mucky real world of indifference, greed,and incompetence all jostling and wrestling hard with the grunting idealists pulling out all the stops and trying their darndest to save this life, because dammit we all deserve that, don't we?
Still, it is a lovely little book, physically. It would be a perfect gift for a new med student or newly minted doctor.
June 23, 2020
I liked this for the short read it was, and for the interesting cases included.
There's not a lot this book tries to prove; there's nothing that it's arguing about. It isn't a thesis to explain how medicine should be fundamental science among the crowed three. Nor is it a historical rendition on the birth of medicine.
What this book does do is give a little more insight into the world of medicine. And change the way you perceive the vital science. (See what I did there....it's a little weak, I'm sorry)
I think having more experience with the medical field can definitely allow you to connect better with the book because otherwise the content and lessons can ring a little dry. I'm going to partition my review with the three lessons that he included because I thought that if anyone was only slightly interested those lessons would be the only thing I recommend reading.
A strong intuition is much more powerful than a weak test
I'll admit I got confused with the first lesson, there was some math that was going on and for the life of me I could not figure out how I was supposed to use integration to get the uncertainty percent that Mukherjee was. So like any good math student, I took his word as law. Nevertheless, I think Mukherjee did a really good job of embedded cases into the flow of his 'argument'. His analysis that followed was just long enough that I would read the next case before I started to zone out. (A common theme I experience with a lot of non-fictional reads)
"Normals" teach us rules; "outliers" teach us laws.
I think one of the strong points of this book was that it was short. Mukherjee has clearly enough books before, to realize that you don't write a lot to get your point across. And the three laws that I'm outlining in this review (which I partially want to save somewhere for personal reference) make up the entire book. There isn't much else that Mukherjee goes into. So the short length is adequate.
For every perfect medical experiment, there is a perfect human bias
I think the writing style, which was obviously informative was very nice. It didn't sound bland, but at the same time didn't fictionalize the cases. It was a good balance.
Overall, I can't say that I'd recommend this, but it is definitely worth a read if you're curious about medicine.
There's not a lot this book tries to prove; there's nothing that it's arguing about. It isn't a thesis to explain how medicine should be fundamental science among the crowed three. Nor is it a historical rendition on the birth of medicine.
What this book does do is give a little more insight into the world of medicine. And change the way you perceive the vital science. (See what I did there....it's a little weak, I'm sorry)
I think having more experience with the medical field can definitely allow you to connect better with the book because otherwise the content and lessons can ring a little dry. I'm going to partition my review with the three lessons that he included because I thought that if anyone was only slightly interested those lessons would be the only thing I recommend reading.
A strong intuition is much more powerful than a weak test
I'll admit I got confused with the first lesson, there was some math that was going on and for the life of me I could not figure out how I was supposed to use integration to get the uncertainty percent that Mukherjee was. So like any good math student, I took his word as law. Nevertheless, I think Mukherjee did a really good job of embedded cases into the flow of his 'argument'. His analysis that followed was just long enough that I would read the next case before I started to zone out. (A common theme I experience with a lot of non-fictional reads)
"Normals" teach us rules; "outliers" teach us laws.
I think one of the strong points of this book was that it was short. Mukherjee has clearly enough books before, to realize that you don't write a lot to get your point across. And the three laws that I'm outlining in this review (which I partially want to save somewhere for personal reference) make up the entire book. There isn't much else that Mukherjee goes into. So the short length is adequate.
For every perfect medical experiment, there is a perfect human bias
I think the writing style, which was obviously informative was very nice. It didn't sound bland, but at the same time didn't fictionalize the cases. It was a good balance.
Overall, I can't say that I'd recommend this, but it is definitely worth a read if you're curious about medicine.
October 14, 2015
This is a very short book and makes for a quick and easy read. It gives color and light to the concept of priors in Bayes theorem. And also reviews a bit more about Bayesian reasoning. The author points out why outliers are more important than inliers in current medicine and are the future of medical theories.
So, we have two very important concepts being put forward in crystal clear language: Bayesian reasoning and "outliers" as the perfect ones to study when crafting a law of medicine. The analogies are very good and creatively used.
The book may be used by students who are having trouble conceptualizing sensitivity and specificity and the concept of "prior". But that should actually be very few students. Statistics is now a required course. And it is included on the MCAT. And this book while clear and easy reading is not deep. There are no problems to work out and there are no numerical fleshed out examples. This will be most useful to the layperson looking for the future of medical thinking or an older physician who doesn't totally know what the term "prior" means. But for the physician to fully understand it, they will need to put in more time and listen to in depth lectures or take a new course in probability theory.
To be current the physician will also need to go into more detail in probability theory and obtain a rudimentary understanding of Markov Decision Processes and similar concepts.
So, we have two very important concepts being put forward in crystal clear language: Bayesian reasoning and "outliers" as the perfect ones to study when crafting a law of medicine. The analogies are very good and creatively used.
The book may be used by students who are having trouble conceptualizing sensitivity and specificity and the concept of "prior". But that should actually be very few students. Statistics is now a required course. And it is included on the MCAT. And this book while clear and easy reading is not deep. There are no problems to work out and there are no numerical fleshed out examples. This will be most useful to the layperson looking for the future of medical thinking or an older physician who doesn't totally know what the term "prior" means. But for the physician to fully understand it, they will need to put in more time and listen to in depth lectures or take a new course in probability theory.
To be current the physician will also need to go into more detail in probability theory and obtain a rudimentary understanding of Markov Decision Processes and similar concepts.
May 28, 2022
The first book I read by Siddhartha Mukherjee was "Emperor of All Maladies"; the second, "Gene: An Intimate History". Both are sizeable tomes, well worth the time spent but weighty. This slim little volume is, in some ways, its opposite. That is because here Mukherjee is not attempting to lay out a vast amount of data and history, but rather, a few short "laws" of medicine:
A strong intuition is much more powerful than a weak test.
"Normals" teach us rules; "outliers" teach us laws.
For every perfect medical experiment, there is a perfect medical bias.
Each of them, of course, like the three laws of motion that Newton developed, are not easily understood by just reading them; you need to see them applied to problems first in order to truly understand them. Mukherjee does this, along with giving us a bit of his motivation for trying to develop such "laws" at all.
The core, hard truth at the basis of all of this, is that in medicine, we usually don't know what we are doing. Mukherjee quotes Voltaire, who wrote that "Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing". There are some parts of medicine in which things have improved since Voltaire's time, but enormous swathes in which it has not, or not by much. The way in which our immune system leads to autoimmune disorders or allergies, the causes and solutions for back problems, most kinds of cancer or heart disease, they are all still largely treated with more intuition, ritual, and tradition than science, because they are so complex that medical science is mostly at this point only able to generate more questions.
Given all this, the only justifiable response for a medical doctor would be to say, "we don't know, I can't help you", and yet we demand that they must try, and sometimes even we try to demand that they must know. The men and women who choose to go into a field in which they will most often have to guess at the answer to a riddle on which another human's life depends, are necessarily biased in the direction of intensely disliking to admit when they do not know what to do. We are fortunate to have at least a very few as adept as Mukherjee to write the truth for us, if we dare to read it. His "laws" of medicine also have a great deal to tell the rest of us, about everything else in life which we cannot understand, and yet must grapple with.
A strong intuition is much more powerful than a weak test.
"Normals" teach us rules; "outliers" teach us laws.
For every perfect medical experiment, there is a perfect medical bias.
Each of them, of course, like the three laws of motion that Newton developed, are not easily understood by just reading them; you need to see them applied to problems first in order to truly understand them. Mukherjee does this, along with giving us a bit of his motivation for trying to develop such "laws" at all.
The core, hard truth at the basis of all of this, is that in medicine, we usually don't know what we are doing. Mukherjee quotes Voltaire, who wrote that "Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing". There are some parts of medicine in which things have improved since Voltaire's time, but enormous swathes in which it has not, or not by much. The way in which our immune system leads to autoimmune disorders or allergies, the causes and solutions for back problems, most kinds of cancer or heart disease, they are all still largely treated with more intuition, ritual, and tradition than science, because they are so complex that medical science is mostly at this point only able to generate more questions.
Given all this, the only justifiable response for a medical doctor would be to say, "we don't know, I can't help you", and yet we demand that they must try, and sometimes even we try to demand that they must know. The men and women who choose to go into a field in which they will most often have to guess at the answer to a riddle on which another human's life depends, are necessarily biased in the direction of intensely disliking to admit when they do not know what to do. We are fortunate to have at least a very few as adept as Mukherjee to write the truth for us, if we dare to read it. His "laws" of medicine also have a great deal to tell the rest of us, about everything else in life which we cannot understand, and yet must grapple with.
May 8, 2020
«Якщо монета двадцять разів поспіль упала орлом, це говорить про майбутні шанси більше, ніж будь-яка абстрактна формула. Якщо ви не використовуєте попередньо зібраної інформації, ви неодмінно зробите хибне припущення про майбутнє.»
Маленька книжечка, якій вдалося мене здивувати, і яка є глибшою, ніж здається на перший погляд.
Ще в юному віці автор задумався над тим, що якщо медицина – це наука, то вона має мати ті закони, на які вона спирається, як і інші науки. Але які вони, ті закони? Автор видалив для себе такі:
1) Глибока інтуїція значно потужніша за легковажно проведений аналіз
Чому симптоми і реакції, оточення і спосіб життя важливіші за результати лабораторного тесту для встановлення діагнозу? Як працює правило «щоб дізнатися правильну відповідь, треба знати правильну відповідь»?
2) «Норми» навчають нас правил, а «винятки» навчають законів
Автор розмірковує над тим, як винятки з п��авил допомагають виявити хибність початкових припущень та недоліки в підходах і чому науковці не мають права списувати такі випадки на статистичні похибки. Як за допомогою похибок виявили справжню природу аутизму та чому саме вони можуть допомогти подолати рак?
3) На кожен бездоганний медичний експеримент припадає бездоганна людська похибка
Усі науки потерпають від людського фактора, але саме людські рішення, прийняті на основі неточних чи непевних даних, є абсолютно необхідними для розвитку медицини.
Книжка, до якої я буду повертатися. Автор, якого однозначно читатиму ще.
P.S. Виявляється, Видавництво Жупанського перекладало його книгу «Імператор усіх хвороб» ще у 2013 році. Все, мені треба))
Маленька книжечка, якій вдалося мене здивувати, і яка є глибшою, ніж здається на перший погляд.
Ще в юному віці автор задумався над тим, що якщо медицина – це наука, то вона має мати ті закони, на які вона спирається, як і інші науки. Але які вони, ті закони? Автор видалив для себе такі:
1) Глибока інтуїція значно потужніша за легковажно проведений аналіз
Чому симптоми і реакції, оточення і спосіб життя важливіші за результати лабораторного тесту для встановлення діагнозу? Як працює правило «щоб дізнатися правильну відповідь, треба знати правильну відповідь»?
2) «Норми» навчають нас правил, а «винятки» навчають законів
Автор розмірковує над тим, як винятки з п��авил допомагають виявити хибність початкових припущень та недоліки в підходах і чому науковці не мають права списувати такі випадки на статистичні похибки. Як за допомогою похибок виявили справжню природу аутизму та чому саме вони можуть допомогти подолати рак?
3) На кожен бездоганний медичний експеримент припадає бездоганна людська похибка
Усі науки потерпають від людського фактора, але саме людські рішення, прийняті на основі неточних чи непевних даних, є абсолютно необхідними для розвитку медицини.
Книжка, до якої я буду повертатися. Автор, якого однозначно читатиму ще.
P.S. Виявляється, Видавництво Жупанського перекладало його книгу «Імператор усіх хвороб» ще у 2013 році. Все, мені треба))
January 25, 2023
Most of my life has been a happy concurrence of magic and mundane, medicine and mischief. I am honoured to be part of the generation that read Harry Potter as very young children and continued to wait for our letter to Hogwarts even as colleges De-mentor-ed us and we became Muggled into pursuing careers or families.
So, you can imagine how I felt when I randomly bought a copy of Dr Siddhartha Mukherjee's brilliant 'The Laws of Medicine: Field Notes From An Uncertain Science' and there it was right after the fly leaf:
“Are you planning to follow a career in Magical Laws, Miss Granger?” asked Scrimgeour. “No, I'm not,” retorted Hermoine. “I'm hoping to do some good in the world!”
Not once before had a book so definitively welcomed me into it's embrace-- I was home. I was the antisocial bookworm who became a doctor, the childhood Harry Potter geek who people now trusted with their lives. And far from telling me that I was an oddball misfit, this book reassured me-- I was home. I was home.
People who have ever been at a crossroad in their life will know what I mean-- you're stumbling along through a fog, your friends are long gone, your life and career aren't where you thought it would be and suddenly-- sunlight! The fog lifts and you are given a moment of clarity that puts everything into perspective. It's not all doom and gloom, you realize. Sometimes, life can be about sunshine and ice-cream.
After my one year house-job and my father's death, I felt swamped under this fear that I wasn't good enough to be a doctor, that somehow I was an imposter amidst far, far more brilliant and compassionate healers. Life felt like a horrible prison sentence of more code blues and organ failures and young deaths. I abandoned my love cold-turkey, I left Medicine for make-up and clothes and cooking and raising my baby. There's, of course, nothing wrong with that and looking back, I realize that everyone I loved gave me that freedom to be whoever, trusting me to find my way back. After all, once you've drilled into a patient's skull, no perfect korma or winged liner could ever come close to that.
Dr Mukherjee's premise for the book is a familiar one for anyone fresh out of med school and into the abyss of clinical wards-- you have all this information yet remarkably little wisdom. You're swamped beneath the burden of what you know and the vast difference between knowing and doing. You can reel off the cranial nerves, the side effects of beta blockers but can you understand the circumstances of the patient who's suffering from a debilitating brain tumour or the patient who is simply unable to afford your beautiful beta blockers?
'Only connect'. E.M. Forrester may well have been telling that to our generation of physicians, overburdened as we are with information and data and not enough empathy.
Dr Mukherjee's book was a welcome return to everything that I had loved about medicine-- he took my by the hand and led me back one step at a time. Reading his book, I realized that to face the unknown, is to defeat it. On the other side of what you fear is... you. Only you. Unafraid.
His own clinical training in Oncology and love of reading led him to devise the three laws that form the heart of this slim volume. They are the unworded laws that all physicians imbibe in our immersion into the turbulent waters of clinical practice but Dr Mukherjee illustrates them with examples and historical context, from Star Trek to Kepler to Karl Popper, that gives you a new-found respect for all the accumulated wisdom of medicine that I, for one, totally took for granted.
It's easy to forget that medicine is called the Youngest Science for a reason-- it is constantly evolving, constantly faced with new challenges. But Dr Mukherjee's laws promise to keep you from getting lost in the quagmire and focusing instead on what makes medicine the 'most human science'.
I hope that some day every graduating student from my college would get a copy of this little book along with their degree. Dr Mukherjee's inimitable style and narrative voice will keep you hooked for weeks and months beyond your first encounter with him.
As for me, returning to a home you thought you'd abandoned is never easy but if JK taught me one thing it was that home is always there to welcome you back. Wish me luck :)
Fav Lines:
I spoke to no one, or, at least, I have no memory of speaking to anyone (I ran through a park by night, and through friends by day). “Illness reminds you that spontaneity, too, is a human right,” a patient once told me. Part of the horror of hospitals is that everything happens on time: medicines arrive on schedule; the sheets are changed on schedule; the doctors round at set times; even urine is collected in a graduated pouch on a timer. Those who tend the ill also experience some of this erasure of spontaneity. Looking back, I realize that I lived for a year, perhaps two, like a clockwork human, moving from one subroutine to the next. Days folded into identical days, all set to the same rhythm. By the end of my first month, even “flex” had turned into reflex.
The only way to break that monotony was to read.
So, you can imagine how I felt when I randomly bought a copy of Dr Siddhartha Mukherjee's brilliant 'The Laws of Medicine: Field Notes From An Uncertain Science' and there it was right after the fly leaf:
“Are you planning to follow a career in Magical Laws, Miss Granger?” asked Scrimgeour. “No, I'm not,” retorted Hermoine. “I'm hoping to do some good in the world!”
Not once before had a book so definitively welcomed me into it's embrace-- I was home. I was the antisocial bookworm who became a doctor, the childhood Harry Potter geek who people now trusted with their lives. And far from telling me that I was an oddball misfit, this book reassured me-- I was home. I was home.
People who have ever been at a crossroad in their life will know what I mean-- you're stumbling along through a fog, your friends are long gone, your life and career aren't where you thought it would be and suddenly-- sunlight! The fog lifts and you are given a moment of clarity that puts everything into perspective. It's not all doom and gloom, you realize. Sometimes, life can be about sunshine and ice-cream.
After my one year house-job and my father's death, I felt swamped under this fear that I wasn't good enough to be a doctor, that somehow I was an imposter amidst far, far more brilliant and compassionate healers. Life felt like a horrible prison sentence of more code blues and organ failures and young deaths. I abandoned my love cold-turkey, I left Medicine for make-up and clothes and cooking and raising my baby. There's, of course, nothing wrong with that and looking back, I realize that everyone I loved gave me that freedom to be whoever, trusting me to find my way back. After all, once you've drilled into a patient's skull, no perfect korma or winged liner could ever come close to that.
Dr Mukherjee's premise for the book is a familiar one for anyone fresh out of med school and into the abyss of clinical wards-- you have all this information yet remarkably little wisdom. You're swamped beneath the burden of what you know and the vast difference between knowing and doing. You can reel off the cranial nerves, the side effects of beta blockers but can you understand the circumstances of the patient who's suffering from a debilitating brain tumour or the patient who is simply unable to afford your beautiful beta blockers?
'Only connect'. E.M. Forrester may well have been telling that to our generation of physicians, overburdened as we are with information and data and not enough empathy.
Dr Mukherjee's book was a welcome return to everything that I had loved about medicine-- he took my by the hand and led me back one step at a time. Reading his book, I realized that to face the unknown, is to defeat it. On the other side of what you fear is... you. Only you. Unafraid.
His own clinical training in Oncology and love of reading led him to devise the three laws that form the heart of this slim volume. They are the unworded laws that all physicians imbibe in our immersion into the turbulent waters of clinical practice but Dr Mukherjee illustrates them with examples and historical context, from Star Trek to Kepler to Karl Popper, that gives you a new-found respect for all the accumulated wisdom of medicine that I, for one, totally took for granted.
It's easy to forget that medicine is called the Youngest Science for a reason-- it is constantly evolving, constantly faced with new challenges. But Dr Mukherjee's laws promise to keep you from getting lost in the quagmire and focusing instead on what makes medicine the 'most human science'.
I hope that some day every graduating student from my college would get a copy of this little book along with their degree. Dr Mukherjee's inimitable style and narrative voice will keep you hooked for weeks and months beyond your first encounter with him.
As for me, returning to a home you thought you'd abandoned is never easy but if JK taught me one thing it was that home is always there to welcome you back. Wish me luck :)
Fav Lines:
I spoke to no one, or, at least, I have no memory of speaking to anyone (I ran through a park by night, and through friends by day). “Illness reminds you that spontaneity, too, is a human right,” a patient once told me. Part of the horror of hospitals is that everything happens on time: medicines arrive on schedule; the sheets are changed on schedule; the doctors round at set times; even urine is collected in a graduated pouch on a timer. Those who tend the ill also experience some of this erasure of spontaneity. Looking back, I realize that I lived for a year, perhaps two, like a clockwork human, moving from one subroutine to the next. Days folded into identical days, all set to the same rhythm. By the end of my first month, even “flex” had turned into reflex.
The only way to break that monotony was to read.
December 4, 2018
Please let Mukherjee develop this into a full size book! In this extremely short book, Mukherjee offered a much needed perspective in medicine. It seems to me that when considering this and other recent books from MDs (e.g. Lisa Sanders' Every Patient Tells a Story) who focus on the issue of the difficulty of properly diagnosing a patient, a pattern is forming. Doctors, at least the ones authoring the books I have been reading, are no longer as interested in seeming mysterious or godlike. I like this trend (is it too early to call it a trend?) in which doctors write memoirs that highlight how much they don’t know, how unsure they are so much of the time, and describe their learning process that is not always smooth. It really engenders a feeling of teamwork between a doctor and patient who are trying their best to trudge through the mud of diagnosis together.
Mukherjee laid out a simple argument for why and how essential changes need to be made to help doctors become more effective diagnosticians.:
Time and financial resources are finite. Any doctor not using Bayesian methods to diagnose a patient is wasting everyone’s time playing a guessing game. Success rates of test results (false positive) vary for the same test, depending upon whether doctors have successfully understood how to use probability to home in on the best candidates for each test. When probability based selection is practiced, test accuracy increases, sometimes making a useless test (50% success rate of correct diagnosis) into a useful test that can provide a reasonable diagnosis.
Using Bayesian methods, doctors can and should get better at running the right tests, homing in on difficult to understand illness, and even know when to treat and when not to treat an illness. His point about treating of not treating was also covered quite brilliantly in his book Emperor of All Maladies. For example, need to give the right amount of radiation because more is not better. More might not be more effective at riding the body of cancer. Less might do as well and more might lead to cancer down the line. In Emperor of All Maladies, he also looked at breast cancer testing and efficacy. Eyeopening. I am pretty sure that is what he was referencing in this book.
Mukherjee laid out a simple argument for why and how essential changes need to be made to help doctors become more effective diagnosticians.:
Time and financial resources are finite. Any doctor not using Bayesian methods to diagnose a patient is wasting everyone’s time playing a guessing game. Success rates of test results (false positive) vary for the same test, depending upon whether doctors have successfully understood how to use probability to home in on the best candidates for each test. When probability based selection is practiced, test accuracy increases, sometimes making a useless test (50% success rate of correct diagnosis) into a useful test that can provide a reasonable diagnosis.
Using Bayesian methods, doctors can and should get better at running the right tests, homing in on difficult to understand illness, and even know when to treat and when not to treat an illness. His point about treating of not treating was also covered quite brilliantly in his book Emperor of All Maladies. For example, need to give the right amount of radiation because more is not better. More might not be more effective at riding the body of cancer. Less might do as well and more might lead to cancer down the line. In Emperor of All Maladies, he also looked at breast cancer testing and efficacy. Eyeopening. I am pretty sure that is what he was referencing in this book.
July 14, 2017
Some professions are passions, more than bread and butter. To cordon and define them by law or a set of rules is no easy task. Medicine is one among them and like Siddhartha Mukherjee says it is the most beautiful and fragile of all. Diagnostics and treatment rely greatly on accuracy and consistency but we always need to be intuitive because the outlier always gives us a chance for research, not to forget like any other people in this world we are prone to bias. These are some laws which he writes about giving us interesting anecdotes and trivia. As doctors we study a lot of textbooks of varied subjects and sizes, I must say that none of them have provided me the wisdom and perspective this seventy page book has in one morning.
October 30, 2021
Interesting and short book bit I'm not sure how I feel about the rating. I think the writing and knowledge is worth a 4 stars but as someone who doesn't know much about !medicine and such it didn't show enough about the topic as I had hoped. But still a very interesting little book
July 2, 2016
The Spaces Between the Facts
Siddhartha Mukherjee is not only a prominent cancer specialist, he is also the author of the beautifully written (but long) The Emperor of All Maladies: A Biography of Cancer. In this very short book he tries to distill the essential features of medicine that make it a science. The result is about more than medicine, it is an insight into how all of science works, using medicine as a metaphor that is familiar to the reader.
A doctor is expected to make perfect decisions based on imperfect information. Medicine is distinctive in that we patients are not interested in averages, we want to know what is going to happen to us. Such certainty is impossible. The task of the doctor is to make the best use of the information available.
We are gently led into an understanding of Bayesian probability. It seems obvious that if you might be sick we should run a bunch of tests and use the results. Ah, but he tells us that “a test can only be interpreted sanely in the context of prior probabilities,” meaning you need to have some idea of the answer before you can ask the question. The problem is that tests are never perfect - they can say patients have the condition when they do not, called a false positive. This can lead to unnecessary stressful and expensive treatment.
We are taken through a scenario where an AIDS test on random patients results in 95% of the test results being wrong, even though the test is 99% accurate. When the same test is given to high risk patients, 95% of the results are correct. How can this be? Think of giving the test when no one has AIDS - all the positive results will be wrong, no matter how good the test. If there are more people who actually have the disease, there will be fewer false results. As he puts it, a test is “a machine that modifies probabilities.” If the probability starts very low, it will not change much, and little will be learned. The lesson is that there is no substitute for understanding the patient. Similarly, scientists need to understand what they are looking for; they don’t do a bunch of random experiments and hope new knowledge pops out.
Tycho Brahe was an astronomer whose careful observations confirmed that the planets have circular orbits around the sun. Except for Mars. He handed that problem to his assistant, Johannes Kepler, who then discovered that the orbits are really elliptical. The point is that wisdom does not come from the “inliers”, those observations that fit the model, it comes from understanding what drives the outliers. The practice of medicine is full of outliers, which are traditionally ignored. Mukherjee gives us some examples of how we are starting to learn new things by paying attention to, and trying to explain, those outliers.
Medicine tries to learn by observing patients, preferably in controlled clinical trials. Unfortunately simply being in a clinical trial changes the attitude of the patient, which can affect the outcome. [I forgive Mukherjee for incorrectly associating this with the Heisenberg Uncertainty Principle.] Asking patients to remember their behaviour or the progress of their condition is also problematic. He concludes “the greatest clinicians I know see to have a sixth sense for biases. They understand when bits of scattered knowledge apply, and more important, do not apply to their patients. What doctors really hunt is bias.”
So there we have it. Tests are not enough, we have to understand what we are testing. Confirming rules is not enough, we need to understand why there are outliers. And good procedure is not enough, we are often misled by confirmation bias. In the end, facts are not enough. The truth is found in the spaces between the facts.
Siddhartha Mukherjee is not only a prominent cancer specialist, he is also the author of the beautifully written (but long) The Emperor of All Maladies: A Biography of Cancer. In this very short book he tries to distill the essential features of medicine that make it a science. The result is about more than medicine, it is an insight into how all of science works, using medicine as a metaphor that is familiar to the reader.
A doctor is expected to make perfect decisions based on imperfect information. Medicine is distinctive in that we patients are not interested in averages, we want to know what is going to happen to us. Such certainty is impossible. The task of the doctor is to make the best use of the information available.
We are gently led into an understanding of Bayesian probability. It seems obvious that if you might be sick we should run a bunch of tests and use the results. Ah, but he tells us that “a test can only be interpreted sanely in the context of prior probabilities,” meaning you need to have some idea of the answer before you can ask the question. The problem is that tests are never perfect - they can say patients have the condition when they do not, called a false positive. This can lead to unnecessary stressful and expensive treatment.
We are taken through a scenario where an AIDS test on random patients results in 95% of the test results being wrong, even though the test is 99% accurate. When the same test is given to high risk patients, 95% of the results are correct. How can this be? Think of giving the test when no one has AIDS - all the positive results will be wrong, no matter how good the test. If there are more people who actually have the disease, there will be fewer false results. As he puts it, a test is “a machine that modifies probabilities.” If the probability starts very low, it will not change much, and little will be learned. The lesson is that there is no substitute for understanding the patient. Similarly, scientists need to understand what they are looking for; they don’t do a bunch of random experiments and hope new knowledge pops out.
Tycho Brahe was an astronomer whose careful observations confirmed that the planets have circular orbits around the sun. Except for Mars. He handed that problem to his assistant, Johannes Kepler, who then discovered that the orbits are really elliptical. The point is that wisdom does not come from the “inliers”, those observations that fit the model, it comes from understanding what drives the outliers. The practice of medicine is full of outliers, which are traditionally ignored. Mukherjee gives us some examples of how we are starting to learn new things by paying attention to, and trying to explain, those outliers.
Medicine tries to learn by observing patients, preferably in controlled clinical trials. Unfortunately simply being in a clinical trial changes the attitude of the patient, which can affect the outcome. [I forgive Mukherjee for incorrectly associating this with the Heisenberg Uncertainty Principle.] Asking patients to remember their behaviour or the progress of their condition is also problematic. He concludes “the greatest clinicians I know see to have a sixth sense for biases. They understand when bits of scattered knowledge apply, and more important, do not apply to their patients. What doctors really hunt is bias.”
So there we have it. Tests are not enough, we have to understand what we are testing. Confirming rules is not enough, we need to understand why there are outliers. And good procedure is not enough, we are often misled by confirmation bias. In the end, facts are not enough. The truth is found in the spaces between the facts.
May 19, 2022
Huge fan of Mukherjee's other books, and this one contains similar, but equally fascinating information. The more I read memoirs from doctors and physicians, the more my image of them as these infallible geniuses that can cure everything is starting to erode in favor of something I feel is more realistic and grounded. Make no mistake, many of them ARE geniuses, however, in their ability to draw solutions and explanations with imperfect information and tools, and not in their ability to answer every question.
August 12, 2016
Siddhartha Mukherjee is a wonderful teacher and a truly great science writer. I recently became a fan as I started to get halfway through his masterpiece book The Emperor of All Maladies.
I'm still yet to finish that one and I've already bought Gene - An Intimate History and I've already flown through the significantly thinner The Laws of Medicine.
A cancer physician and researcher, Dr. Mukherjee straddles academia, clinical work and research in a way only America makes possible for people and it's truly wonderful to read this and his other book where he simplifies and electrifies theories and tests that seemed unnaturally dense and dull when read from textbooks authored by preeminent experts in the field.
I remember being particularly intimidated by biostatistics! In this book, Mukherjee teaches us about the likelihood ratio and positive predictive value of tests with such stunning ease that my jaw dropped while reading that page and the waitress in the coffee shop I was reading in came up to ask me if I was well!
Dr. Mukherjee tells us about three laws of medicine here that anyone who's worked in the field for atleast a couple of years will agree with - intuition is a powerful tool, and biases are a powerful hindrance and that exceptions to the rule tell us ever so much about the rule itself!
There's a book within this book called The Youngest Science written by a mid-twentieth century physician who truly lived in exciting times which was probably the only book the otherwise well-read Mukherjee read for one whole year as a trainee in medicine.
I remember that being my situation also in my first year of MD when the only book I finished reading was The Making of a Psychiatrist!
I am too fond of this author, his writing and its themes to be truly objective. But trust me, reading him is pretty damn mind-blowing! Try!
I'm still yet to finish that one and I've already bought Gene - An Intimate History and I've already flown through the significantly thinner The Laws of Medicine.
A cancer physician and researcher, Dr. Mukherjee straddles academia, clinical work and research in a way only America makes possible for people and it's truly wonderful to read this and his other book where he simplifies and electrifies theories and tests that seemed unnaturally dense and dull when read from textbooks authored by preeminent experts in the field.
I remember being particularly intimidated by biostatistics! In this book, Mukherjee teaches us about the likelihood ratio and positive predictive value of tests with such stunning ease that my jaw dropped while reading that page and the waitress in the coffee shop I was reading in came up to ask me if I was well!
Dr. Mukherjee tells us about three laws of medicine here that anyone who's worked in the field for atleast a couple of years will agree with - intuition is a powerful tool, and biases are a powerful hindrance and that exceptions to the rule tell us ever so much about the rule itself!
There's a book within this book called The Youngest Science written by a mid-twentieth century physician who truly lived in exciting times which was probably the only book the otherwise well-read Mukherjee read for one whole year as a trainee in medicine.
I remember that being my situation also in my first year of MD when the only book I finished reading was The Making of a Psychiatrist!
I am too fond of this author, his writing and its themes to be truly objective. But trust me, reading him is pretty damn mind-blowing! Try!
December 5, 2018
Siddhartha Mukherjee and me happen to have a common friend – Thomas Bayes, to whom the book is dedicated. Bringing Bayesian thinking in the world of medicine can make a huge difference there. The author starts with quite an astonishing eye-opening of how the present medicine operates and why there are still so many problems, despite the modern technology and deep theoretical basis.
Part of the problem, as the author points out, lies in the fact that as the tools are getting better and better, the doctors are taking on more and more challenging deceases. So this race will probably continue forever. Despite that, no matter on what level the doctors are attempting to treat their patients, having a Bayesian approach in these matters would allow them to diagnose individual patients with a higher precision and increase the overall effectiveness of the medical management system and optimise the utilisation of the limited resources.
These important points and perspectives are excellently presented in the book. I just wanted it to be much longer. Siddhartha Mukherjee appears to be not only a prominent cancer expert, but he also writes very good and interestingly. I am looking forward to get some time for his book on genes.
Part of the problem, as the author points out, lies in the fact that as the tools are getting better and better, the doctors are taking on more and more challenging deceases. So this race will probably continue forever. Despite that, no matter on what level the doctors are attempting to treat their patients, having a Bayesian approach in these matters would allow them to diagnose individual patients with a higher precision and increase the overall effectiveness of the medical management system and optimise the utilisation of the limited resources.
These important points and perspectives are excellently presented in the book. I just wanted it to be much longer. Siddhartha Mukherjee appears to be not only a prominent cancer expert, but he also writes very good and interestingly. I am looking forward to get some time for his book on genes.
June 19, 2017
Short but jam packed.Mukherjee is a wonderful writer.There's Bayes theorem,astronomy to explain medical mysteries,Heisenberg theories.Lots of stuff!Anyone who thinks that doctors will be replaced by technology can relax.The human touch is irreplaceable."The medical revolution will not be algorithmized."
For the feminists he reports on bias."Women are notoriously underrepresented in randomized studies.In fact female mice are notoriously underrepresented in laboratory studies."
Years ago I read about the Charles Manson 'family' and specifically about one member who would give his children LSD and leave them in the forest to enjoy their 'experience'.I was appalled.Now from Mukherjee "Children with autism were treated with electrical shocks,with attachment therapies,with hallucinogenic drugs to "warm"them to the world and more.
When discussing the man called Carleton in Boston,it seems like an episode of 'House'.I learned so much from this slim book.I recommend it to the world.
For the feminists he reports on bias."Women are notoriously underrepresented in randomized studies.In fact female mice are notoriously underrepresented in laboratory studies."
Years ago I read about the Charles Manson 'family' and specifically about one member who would give his children LSD and leave them in the forest to enjoy their 'experience'.I was appalled.Now from Mukherjee "Children with autism were treated with electrical shocks,with attachment therapies,with hallucinogenic drugs to "warm"them to the world and more.
When discussing the man called Carleton in Boston,it seems like an episode of 'House'.I learned so much from this slim book.I recommend it to the world.
November 7, 2015
There is no doubt Mukherjee is an incredible writer. However, there were many times while reading this short book I wish it were a lot longer and more in depth. His description of Bayes' Theorem, and the entire book in general, was intended for the layperson. Overall, a good exposure to biases we all have while trying to make decisions in times of uncertainty, yet not enough to gain more than a superficial understanding.
June 7, 2020
"The laws of medicine" is a very interesting and introductory book of medicine by Siddhartha Mukherjee who is Pultizer Prize-winning author, a cancer specialist and well-known researcher. The author has listed his own deduced three laws i.e. priors. outliers, and biases in the uncertain world of medicine which helped him greatly during his tenure as medical student and physician to effectively perceive the diseases and correctly perform the treatment. Presented with a number of examples from history and personal experience, he has nicely explained the dramatic shift in the field of this "Youngest Science" and why these laws, written in a very articulate and descriptive manner, govern its modern change of course. In his own words, "the book is about information, imperfection, uncertainty, and the future of medicine."
Three Laws of Medicine
1. A strong intuition is much more powerful than a weak test.
2.“Normals” teach us rules; “outliers” teach us laws.
3. For every perfect medical experiment, there is a perfect human bias.
Why Should I Read the Book?
Well, you may think that the book is for the students of medicine particularly by reading the title but actually it is for EVERYONE. First, because it is written in a very generic form that anyone with basic knowledge of science, not medical science, can understand it. Secondly, the book builds an insight to evaluate our reasoning and practices we follow in everyday life related to health and recovery.
My Favourite Excerpts
If you can’t name it, you can’t cut it.
It’s easy to make perfect decisions with perfect information. Medicine asks you to make perfect decisions with imperfect information.
I wondered if the compulsive naming of parts, diseases, and chemical reactions—frenulum, otitis, glycolysis—was a mechanism invented by doctors to defend themselves against a largely unknowable sphere of knowledge.
Magical laws do not exist to perpetuate magic. They exist as tools to interpret the world.
If you had a hammer, as the saying goes, then everything looks like a nail.
A doctor’s job, Thomas once told an interviewer, was to make a diagnosis, make a prognosis, give support and care—and not to meddle.
Technological innovations do not define a science; they merely prove that medicine is scientific.
Every diagnostic challenge in medicine can be imagined as a probability game.
The fundamental feature of a scientific system, Karl Popper argued, is not that its propositions are verifiable, but that its propositions are falsifiable.
Looking at cancer before genome sequencing was looking at the known unknown. With genome sequencing at hand, it was like encountering the
unknown unknown.
The device used to measure the subject transforms the nature of the subject.
A randomized study might make particular conclusions about the effectiveness of medicine—but in truth, it has only judged that effectiveness in the subset of people who were randomized.
Big data is not the solution to the bias problem; it is merely a source of more subtle (or even bigger) biases.
Thomas imagined a future in which machines took care of sick people. Now we have better machines, but we are using them to take care of sicker people.
I hope you enjoy reading it!
Three Laws of Medicine
1. A strong intuition is much more powerful than a weak test.
2.“Normals” teach us rules; “outliers” teach us laws.
3. For every perfect medical experiment, there is a perfect human bias.
Why Should I Read the Book?
Well, you may think that the book is for the students of medicine particularly by reading the title but actually it is for EVERYONE. First, because it is written in a very generic form that anyone with basic knowledge of science, not medical science, can understand it. Secondly, the book builds an insight to evaluate our reasoning and practices we follow in everyday life related to health and recovery.
My Favourite Excerpts
If you can’t name it, you can’t cut it.
It’s easy to make perfect decisions with perfect information. Medicine asks you to make perfect decisions with imperfect information.
I wondered if the compulsive naming of parts, diseases, and chemical reactions—frenulum, otitis, glycolysis—was a mechanism invented by doctors to defend themselves against a largely unknowable sphere of knowledge.
Magical laws do not exist to perpetuate magic. They exist as tools to interpret the world.
If you had a hammer, as the saying goes, then everything looks like a nail.
A doctor’s job, Thomas once told an interviewer, was to make a diagnosis, make a prognosis, give support and care—and not to meddle.
Technological innovations do not define a science; they merely prove that medicine is scientific.
Every diagnostic challenge in medicine can be imagined as a probability game.
The fundamental feature of a scientific system, Karl Popper argued, is not that its propositions are verifiable, but that its propositions are falsifiable.
Looking at cancer before genome sequencing was looking at the known unknown. With genome sequencing at hand, it was like encountering the
unknown unknown.
The device used to measure the subject transforms the nature of the subject.
A randomized study might make particular conclusions about the effectiveness of medicine—but in truth, it has only judged that effectiveness in the subset of people who were randomized.
Big data is not the solution to the bias problem; it is merely a source of more subtle (or even bigger) biases.
Thomas imagined a future in which machines took care of sick people. Now we have better machines, but we are using them to take care of sicker people.
I hope you enjoy reading it!
January 7, 2021
This book satisfied the nerd inside me to the utmost levels I am giving it the full mark. I think this one is important to be read by everyone in the medical profession, it is difficult to find someone stating such laws in the face of everything known to humans despite their very importance.
Highly recommended!
“Doctors,” Voltaire wrote, “are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”
Highly recommended!
“Doctors,” Voltaire wrote, “are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”
April 28, 2018
The description of this book weirdly states that one of the laws Mukherjee proposes is that “Rumours are more important than tests.” That’s not what he suggests: instead, he’s talking about intuition and putting two and two together so that you use the right tests in the right circumstances, reducing the number of needless false positives. He gives an example of realising that one of his patients who didn’t fit the profile was actually a drug addict, leading to being able to use a test for AIDs to figure out what was wrong with him. But doing the test for AIDs makes no sense when there are no risk factors: what really made things come together in this case was a little bit of intuition.
I’m definitely a strong believer in the power of intuition as a diagnostic tool in general. You should always check when you can, of course! But from my vague medical knowledge as a doctor’s daughter and a reader, at seventeen years old, I once realised from something about the way his face looked that someone I knew a little had a serious heart problem. I described what I saw to my mother (the doctor!) and she agreed with my intuition. But when he went to the A&E, they didn’t admit him and didn’t operate. He had an aneurysm, and yes, he died. I wish I could give that moment of intuition and insight to the doctor who saw him in A&E; I’m pretty sure my mother will agree that that intuition, that ability to connect the faintest of dots, can turn an academically good doctor into a great one.
(Yes, Mum, I know. I should be a doctor, but I’m a little old to go through medical school now and maybe my intuition will serve me well in a microbiology lab, too.)
So that rule in particular struck a chord with me, and made reading this worth it just on its own. The other two laws Mukherjee mentions are interesting and important too, but that first one was what really got my interest.
Reviewed for The Bibliophibian.
I’m definitely a strong believer in the power of intuition as a diagnostic tool in general. You should always check when you can, of course! But from my vague medical knowledge as a doctor’s daughter and a reader, at seventeen years old, I once realised from something about the way his face looked that someone I knew a little had a serious heart problem. I described what I saw to my mother (the doctor!) and she agreed with my intuition. But when he went to the A&E, they didn’t admit him and didn’t operate. He had an aneurysm, and yes, he died. I wish I could give that moment of intuition and insight to the doctor who saw him in A&E; I’m pretty sure my mother will agree that that intuition, that ability to connect the faintest of dots, can turn an academically good doctor into a great one.
(Yes, Mum, I know. I should be a doctor, but I’m a little old to go through medical school now and maybe my intuition will serve me well in a microbiology lab, too.)
So that rule in particular struck a chord with me, and made reading this worth it just on its own. The other two laws Mukherjee mentions are interesting and important too, but that first one was what really got my interest.
Reviewed for The Bibliophibian.
February 1, 2019
"The Laws OF Medicine" by Siddhartha Mukherjee (acclaimed author of "The Emperor of all Maladeries" and "The Gene") is a short, engrossing, intellectually stimulating discussion that focuses on "medicine" as an uncertain science that despite all the technological advances still needs to rely on a one on one, doctor-patient, relationship to achieve a correct diagnosis and experimental certainty... There are simply too many variables in medicine to rely totally on technology to achieve accurate results. A patient's history, behavior, environment, and family history are just a few things that are important in treating a patient's illness and in running experimental trials that give you more perfect and correct result. Medicine, unlike physics, is an uncertain science and in order for it to continue to evolve it needs to look at all possible factors in treating patients and running important trials and not to rely solely on technology.
October 15, 2015
I pre-ordered the book because Siddhartha Mukherjee's Emperor of All Maladies is my all time favorite and the description of why there should be "laws" in medicine fascinated me.
The only disappointment I had was that the book is just 70 pages and I finished it in one reading.
I got at least one career idea and a lot of inspiring thoughts while going through them.
The only disappointment I had was that the book is just 70 pages and I finished it in one reading.
I got at least one career idea and a lot of inspiring thoughts while going through them.
November 21, 2018
Brilliant!!! Eloquent writing.. Will surely come back for a reread.
April 29, 2021
"It is easy to make decisions with perfect information. Medicine asks you to make perfect decisions with imperfect information."
Although short this is a great thought provoking read. Good things do come in small packages. ;)
I'm looking forward to reading Mukherjee's other books as I enjoyed his writing style. This book was engrossing and comprehensive even for someone like me who isn't in the medical field.
Although short this is a great thought provoking read. Good things do come in small packages. ;)
I'm looking forward to reading Mukherjee's other books as I enjoyed his writing style. This book was engrossing and comprehensive even for someone like me who isn't in the medical field.
February 4, 2017
The Laws of Medicine is a little book with a big impression. It highlights the conundrums of “laws” governing established medical science versus medical-science-in-progress. As a young intern, the author had grappled with bridging the tangible aspects of knowledge with intangible clinical wisdom. What is this X factor that would make him a better doctor?
Those thoughts formulated and crystallized into the titular subject. The three laws outlined are not general laws of medicine, rather, they are the personal tenets of the author, Siddhartha Murkherjee *, cancer physician, researcher, and awardee of the 2011 Pulitzer-winning Cancer: The Emperor of all Maladies. These self-guided principles have saved him from making egregious judgement errors in a field fraught with imperfections, and have guided him in diagnosing and treating complex cases.
In essence, these are laws applicable to any disciplines where certainty is limited by current knowledge, which is in turn limited by uncertainty. In their entirety,
Law One:
A strong intuition is much more powerful than a weak test.
Law Two:
“Normals” teach us rules; “outliers” teach us laws.
Law Three:
For every perfect medical experiment, there is a perfect human bias.
Filled with Murkherjee’s insightful and anecdotal observations, this book is imbued with the spirit of a lifelong learner. X = Y, until X does not equal Y, then what? Do we substitute X, or Y, or introduce a new variable Z? Or fractionalize X and invert Y? Think outside the box, implored Murkherjee.
He often looked at history as a basis for learning what we did not know, and what we still need to know. Medical science may have progressed in leaps and bounds, but until doctors become perfectly unbiased, perfectly intuitive and perfectly comprehensive, signposts are needed - like these laws - to guide the way.
Published in Oct 2015 following Murkherjee's presentation in Ted Talks, this is a nifty little book to keep handy in our bags, which is where my copy is. A quick, incisive, and thoughtful read, Murkerjee's three laws have held up well for him, and perhaps they might for us too.
[* Murkerjee's bio]
Those thoughts formulated and crystallized into the titular subject. The three laws outlined are not general laws of medicine, rather, they are the personal tenets of the author, Siddhartha Murkherjee *, cancer physician, researcher, and awardee of the 2011 Pulitzer-winning Cancer: The Emperor of all Maladies. These self-guided principles have saved him from making egregious judgement errors in a field fraught with imperfections, and have guided him in diagnosing and treating complex cases.
In essence, these are laws applicable to any disciplines where certainty is limited by current knowledge, which is in turn limited by uncertainty. In their entirety,
Law One:
A strong intuition is much more powerful than a weak test.
Law Two:
“Normals” teach us rules; “outliers” teach us laws.
Law Three:
For every perfect medical experiment, there is a perfect human bias.
Filled with Murkherjee’s insightful and anecdotal observations, this book is imbued with the spirit of a lifelong learner. X = Y, until X does not equal Y, then what? Do we substitute X, or Y, or introduce a new variable Z? Or fractionalize X and invert Y? Think outside the box, implored Murkherjee.
He often looked at history as a basis for learning what we did not know, and what we still need to know. Medical science may have progressed in leaps and bounds, but until doctors become perfectly unbiased, perfectly intuitive and perfectly comprehensive, signposts are needed - like these laws - to guide the way.
Published in Oct 2015 following Murkherjee's presentation in Ted Talks, this is a nifty little book to keep handy in our bags, which is where my copy is. A quick, incisive, and thoughtful read, Murkerjee's three laws have held up well for him, and perhaps they might for us too.
[* Murkerjee's bio]
September 25, 2015
I suspect that the vast majority of us know very little about how one becomes a doctor that hasn’t been informed by TV shows. We expect doctors to diagnose like Dr. House or care for us like Dr. Dorian or entertain us like Patch Adams. Anyone who’s gotten a whiff of medical school will be quick to correct our misperceptions, but there are only a few doctors who are bringing the mysterious inner workings of practicing medicine to light for the general public. Atul Gawande is one. The late Oliver Sacks was another. Siddhartha Mukherjee is a relative newcomer to this part of the literary world. His first book, The Emperor of All Maladies, won a Pulitzer in 2011. The Laws of Medicine is a less daunting book; Maladies clocks in at almost 600 pages. The Laws of Medicine runs to less than 100 pages, but it’s no less ambitious. I’d say that Mukherjee intends for his laws of medicine to become a quiet revolution in medicine.
Read the rest of my review at A Bookish Type. I received a free copy of this book from Edelweiss, in exchange for an honest review.
Read the rest of my review at A Bookish Type. I received a free copy of this book from Edelweiss, in exchange for an honest review.
November 10, 2016
I have learned so much more information from this man in the past couple of hours than I've ever come close to learn anything so useful in classroom lectures. What an unbelievable experience this man emits to the future of medicine. I seriously wish he was my professor!! What an exemplary genius!!!!
The study of medicine is grueling and challenging. It's an everyday discovery to come up with the laws explained in this little book!! This is a great reminder that everyone is different, just as in medicine, where treatment and diagnoses vary, but an error not promptly prevented can be of serious circumstances to the patient and spread out so much damage.
This has been an excellent and highly recommended read.
The study of medicine is grueling and challenging. It's an everyday discovery to come up with the laws explained in this little book!! This is a great reminder that everyone is different, just as in medicine, where treatment and diagnoses vary, but an error not promptly prevented can be of serious circumstances to the patient and spread out so much damage.
This has been an excellent and highly recommended read.
January 27, 2018
Interesting to read this while also reading Thinking, Fast and Slow. He talks about doctors using intuition and that being better than some screening tests with less than perfect sensitivity and specificity. Intuition is the fast thinking built on subconsciously stored information and connections from previous experiences. It's both scary and interesting to think about how much of medicine is an art and still far from a hard and fast science.
January 11, 2016
Siddhartha Mukherjee is an annoyingly accomplished human being, a world-class doctor and cancer researcher seemingly affiliated with all the planet's best universities, a man who apparently decided to become a Pulitzer Prize-winning author in his spare time. I suppose if anybody's allowed to publish some idle musings in a grandiosely-titled 50-page TED Talk pamphlet and call it a book, he is.
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