Read Online The Laws of Medicine by Siddhartha Mukherjee - Free Book Online
Authors: Siddhartha Mukherjee
Ads: Link
human can possibly be,â one physician recalled. Her vital signs fluttered on a precipice. In a last-ditch maneuver, she was injected with the antiarthritis drug. As the doctors watched, bewildered, the fever reversed. The kidneys, lungs, blood, and the heart returned to normal function. By thenext morning, she awoke from her coma. One year later, she remains in remission, with no sign of cancer in her bone marrow.
Is the case over? Far from it. Should this girl be given chemotherapy now to âconsolidateâ her remissionâas conventional wisdom might suggestâor would the added chemotherapy kill the very cells in her immune system that are keeping her disease in check? We donât know because there are no priors. Is her response normal, or is she an outlier? We wonât know until we can build a model of the nature of her response and try to make all the available data fit it. How will we objectively judge this therapy in a clinical trial when no other comparable therapies for relapsed, refractory leukemia exist? Can such a trial ever be randomized?
This experimentâand hundreds of similar studies at the frontiers of medicineâsuggest that human decision making, and, particularly, decision making in the face of uncertain, inaccurate, and imperfect information, remains absolutely vital to the life of medicine. There is no way around it. âThe [political] revolution will not be tweeted,â wrote Malcolm Gladwell. Well, the medical revolution will not be algorithmized.
....
One last thought: there is no reason to believe that there are only three laws of medicine. My own laws are personal. They stood by me throughout my internship, residency, and fellowship. They saved me from the most egregious errors of judgment; they helped me diagnose and treat the most difficult of the cases that I encountered in my practice. Every year, I begin my teaching rounds at the hospital by explaining my version of the laws to the new medical residents. Each time I see a new patient in the wards or in the clinic, I remind myself of them.
Yet if there are other laws, I suspect that they will also concern the nature of information and uncertainty at their very core. âDoctors,â Voltaire wrote, âare 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.â The pivotal word in this scathing description is know . The discipline of medicine concerns the manipulation of knowledge under uncertainty. Abstract away the smell of rubbing alcohol and bleach; forget the adjustable beds and ward signs and the gleaming granite of hospital lobbies; erase, for a moment, the many corporeal indignities of a man in a blue cotton gown in a room or the doctor trying to heal himâand you have a discipline that is still learning to reconcile pure knowledge with real knowledge. The âyoungest scienceâ is also the most human science. It might well be the most beautiful and fragile thing that we do.
....
ACKNOWLEDGMENTS
Iâd like to thank Michelle Quint for her careful editing of the manuscript and her remarkable equanimity in guiding this book to its final form. June Cohen and Chris Anderson helped shape a very shapeless idea of âlawsâ into this book. I owe a special debt to Sarah Sze, Nell Breyer, Sujoy Bhattacharyya, Suman Shirokar, Gerald Fischbach, Brittany Rush, and Ashok Rai for their comments and criticisms and to Bill Helman for helping me understand some of the most important ideas about uncertainty and the future of technology.
ABOUT THE AUTHOR
PHOTO: BRET HARTMAN/TED
Siddhartha Mukherjee is a cancer physician and researcher. He is the author of The Laws of Medicine and The Emperor of All Maladies: A Biography of Cancer , winner of the 2011 Pulitzer Prize in general nonfiction. Mukherjee is an assistant professor of medicine at Columbia University and a staff cancer physician at Columbia
Is the case over? Far from it. Should this girl be given chemotherapy now to âconsolidateâ her remissionâas conventional wisdom might suggestâor would the added chemotherapy kill the very cells in her immune system that are keeping her disease in check? We donât know because there are no priors. Is her response normal, or is she an outlier? We wonât know until we can build a model of the nature of her response and try to make all the available data fit it. How will we objectively judge this therapy in a clinical trial when no other comparable therapies for relapsed, refractory leukemia exist? Can such a trial ever be randomized?
This experimentâand hundreds of similar studies at the frontiers of medicineâsuggest that human decision making, and, particularly, decision making in the face of uncertain, inaccurate, and imperfect information, remains absolutely vital to the life of medicine. There is no way around it. âThe [political] revolution will not be tweeted,â wrote Malcolm Gladwell. Well, the medical revolution will not be algorithmized.
....
One last thought: there is no reason to believe that there are only three laws of medicine. My own laws are personal. They stood by me throughout my internship, residency, and fellowship. They saved me from the most egregious errors of judgment; they helped me diagnose and treat the most difficult of the cases that I encountered in my practice. Every year, I begin my teaching rounds at the hospital by explaining my version of the laws to the new medical residents. Each time I see a new patient in the wards or in the clinic, I remind myself of them.
Yet if there are other laws, I suspect that they will also concern the nature of information and uncertainty at their very core. âDoctors,â Voltaire wrote, âare 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.â The pivotal word in this scathing description is know . The discipline of medicine concerns the manipulation of knowledge under uncertainty. Abstract away the smell of rubbing alcohol and bleach; forget the adjustable beds and ward signs and the gleaming granite of hospital lobbies; erase, for a moment, the many corporeal indignities of a man in a blue cotton gown in a room or the doctor trying to heal himâand you have a discipline that is still learning to reconcile pure knowledge with real knowledge. The âyoungest scienceâ is also the most human science. It might well be the most beautiful and fragile thing that we do.
....
ACKNOWLEDGMENTS
Iâd like to thank Michelle Quint for her careful editing of the manuscript and her remarkable equanimity in guiding this book to its final form. June Cohen and Chris Anderson helped shape a very shapeless idea of âlawsâ into this book. I owe a special debt to Sarah Sze, Nell Breyer, Sujoy Bhattacharyya, Suman Shirokar, Gerald Fischbach, Brittany Rush, and Ashok Rai for their comments and criticisms and to Bill Helman for helping me understand some of the most important ideas about uncertainty and the future of technology.
ABOUT THE AUTHOR
PHOTO: BRET HARTMAN/TED
Siddhartha Mukherjee is a cancer physician and researcher. He is the author of The Laws of Medicine and The Emperor of All Maladies: A Biography of Cancer , winner of the 2011 Pulitzer Prize in general nonfiction. Mukherjee is an assistant professor of medicine at Columbia University and a staff cancer physician at Columbia
Similar Books
