Index
The Laws of Medicine: Field Notes from an Uncertain Science (Mukherjee, Siddhartha)
The only way to break the deadly monotony was to read. In the medieval story, a prisoner is sent to jail with just one book, but discovers a cosmos of a thousand books in that single volume.
if you had a hammer, as the saying goes, then everything looks like a nail.)
Sciences have laws—statements of truth based on repeated experimental observations that describe some universal or generalizable attributes of nature.
law distills a relationship between observable phenomena that remains true across multiple circumstances and multiple conditions. Laws are rules that nature must live by. There are fewer laws in chemistry. Biology is the most lawless of the three basic sciences: there are few rules to begin with, and even fewer rules that are universal.
Every diagnostic challenge in medicine can be imagined as a probability game.
a test can only be interpreted sanely in the context of prior probabilities.
This is the way we intuit the world, Bayes argued. There is no absolute knowledge; there is only conditional knowledge. History repeats itself—and so do statistical patterns. The past is the best guide to the future.
Every outlier represents an opportunity to refine our understanding of illness.
“Inliers” allow us to create rules—but “outliers” act as portals to understand deeper laws.
Karl Popper proposed a crucial criterion for distinguishing a scientific system from an unscientific one. The fundamental feature of a scientific system, Popper argued, is not that its propositions are verifiable, but that its propositions are falsifiable—i.e., every theory carries an inherent possibility of proving it false. A theory or proposition can only be judged “scientific” if it carries within it a prediction or observation that will prove it false. Theories that fail to generate such “falsifiable” conjectures are not scientific
The human genome has about twenty-four thousand genes in total.
Every science suffers from human biases. Even as we train massive machines to collect, store, and manipulate data for us, humans are the final observers, interpreters, and arbiters of that data. In medicine, the biases are particularly acute for two reasons. The first is hope: we want our medicines to work.
“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.” The pivotal word in this scathing description is know. The discipline of medicine concerns the manipulation of knowledge under uncertainty.