Book Report

Book Summary: The Laws of Medicine

The Laws of Medicine: Field Notes from an uncertain scientist by Siddhartha Mukherjee

Dr.  Mukherjee is a cancer physician who was being interviewed in a podcast I heard recently. He has written some very notable books, and while I wait for the two most recent Kindle versions in the library, I picked up this short 70-page Ted Talk book. It makes for an excellent approach to looking at how medicine approaches interventions in human health.

In the first few pages he quotes a Doctor who trained surgical residents: “It’s easy to make perfect decisions with perfect information. Medicine asks you to make perfect decisions wiht imperfect information.”

I think that sets a much-needed tone in the arena of medical interventions. If you come across someone, patient or provider, that is convinced beyond a reasonable doubt of exactly what the ailment is and precisely the single best way to fix it – pause. Medicine is extremely humbling, even beyond the challenge we have gathering relevant information, is that many (if not most) conditions are multi-factorial.

Law One: A strong intuition is much more powerful than a weak test

This picks up on the thought above of so much of illness being multi-factorial. , gave an example of a patient he had done everything for in a textbook fashion, but still wasn’t making progress. Then by a chance observation, he saw this patient talking to a patient in the medical facility lobby that was an IV drug user who had HIV. With this new context, he ran a confirming test and got an AIDS diagnosis. He didn’t do anything out of protocol, but it was this chance moment that caused his intuition to look deeper.

I have experienced this a few times. Looking through some of the Success Stories, sometimes it is an obeservation of something outside the presenting symptoms that can be factored into the precipitating cause. Mold tends to be a big one, and stress likely one  of the most impactful.

Law Two: “Normals” teach us rules; “outliers” teach us laws.

The takeaway from this law is that there is much to learn from the exceptions to the proverbial rule. Taking the time to understand why someone doesn’t succeed in a trial where most due is, something he pointed out, is overlooked. An example used was one patient who responded amazingly well to a new bladder cancer drug. Instead of casting her an outlier, an analysis of the cancer genetics was performed and they found a gene that will signal when this drug will work and when it won’t.

Law Three: For every perfect experiment, there is a perfect human bias.

This one really stood out to me. Bias has to be acknowledged and discussed to bring proper context to all presentations. I have logged a few obvious examples of this in the FAKE HEALTH NEWS tagged articles of the blog. But even more subtle than that is the filtering of info through all of our established lenses.  One example from the book was people who were diagnosed with cancer mis-remembered their diet in terms of being high-fat (assuming it is bad and must have contributed) when it had no excess fat upon analysis. He writes that randomizied trials are helpful, but that the power of these trials are dependent on imposed limits and this is the very thing that makes them limited. Even if done perfectly how it can be generalized to broader populations is questionable. I think  this piece ties into Law Two; generalized takeaways tend to leave off what can be learned from outliers.

The other thought that came to mind on Law Three was that bias is not inherently bad. We all hae experiences that shape our outlook. Understanding these is important, and then accepting others positions to broaden your own can be very helpful in the contiued drive to learn more. Specifically for me, Dr. Mukherjee declares in this book that cancer is a genetic disease. He is an expert, I am not, but my experience chronicled a bit on these pages (more to be added) says these genetic abnormalities stem from a metabolic disruption. That being said, I plan to read his works and follow what he is working on as he is a thoughtful writer who has been on the frontlines trying to find solutions. He has much to share, and the fact that he comes to a different conclusion than mine can only help paint a full picture.

I enjoyed this short read and believe it will be something to look back on periodically to put a proper perspective on various findings and discussions in the medical field.

This Book Report collection is meant to provide some of the best take-home points from the health and science genre I read. I will continue to go thru my notes of the 160+ and counting (as of January 2019) Kindle books I have on file. To view ALL the notes I saved on this one AND many others without a Book Report post yet, THAT IS ALSO SEARCHABLE, please click here.


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