The Laws of Medicine: Field Notes from an Uncertain Science

Mukherjee, an oncologist and Pulitzer Prize winner for The Emperor of All Maladies, brilliantly observes the practice of medicine from a wide angle, offering his perspective on three crucial elements: intuition, statistical outliers, and human bias. He recounts his medical education, both formally and informally, as he delves into the practical lessons he has learned. For example, now that it's possible to cheaply collect reams of genetic data on every patient, understanding those patients who lie outside the parameters of "normalcy" becomes essential. Previously, the one patient responding to an otherwise failed drug was dismissed as an "exceptional responder" and the drug shelved. But now that patient's genes can be sequenced to see mutations for possible drug targeting. Mukherjee advises viewing medicines and surgical procedures "not as therapeutic interventions but as investigational probes." Still, as successes multiply, so do biases. One hospital's new doctors were stunned by a drug's anecdotally high response rate, only to discover that the real rate was only 15%. Hospital staff had given new doctors good responders, afraid they couldn't handle poor ones. The lesson is repeated throughout: bias is fought with solid data and the instincts that grow with experience. Mukherjee has established himself as new medicine's philosopher/poet and has produced a brief, accessible book for patients and practitioners alike. (Apr.)