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THE LAWS OF MEDICINE

Field notes from an uncertain science.

by Siddhartha Mukherjee ‧ RELEASE DATE: Oct. 13, 2015

A splendid exploration of how medicine might be transformed.

Oncologist and Pulitzer Prize winner Mukherjee (Medicine/Columbia Univ.; The Emperor of All Maladies: A Biography of Cancer , 2010) skillfully dives into the hidden side of medicine in this elaboration of the author’s 18-minute TED talk.

Easily consumed in a single sitting, this brief book concisely explains the author’s reasoning of why and how medicine asks its practitioners “to make perfect decisions with imperfect information.” The author builds a solid foundation demonstrating the genesis of his concept of establishing laws for the practice of medicine. Cogently moving through books that influenced his thinking and the effects of his medical training and numerous practical experiences with patients, Mukherjee guides readers through his thought process on establishing the laws. The author admits beginning slowly but then spending much of his time during medical school with his “odd preoccupation” researching laws governing his chosen profession. Mukherjee stumbled upon the first law, dealing with intuition, by chance. Another law, regarding issues of medical testing, was refined by his analysis of how data, which doesn’t fit accepted models of disease, such as “single patient anecdotes,” can point to new methods for interpreting test results. The author deftly examines the diverse personalities and subjects that have influenced his thinking (e.g., 16th-century Danish astronomer Tycho Brahe and early-20th-century physician and scientist Lewis Thomas, author of  The Youngest Science ); the positive effect of the 20th-century philosophy on therapeutic nihilism; and the utility of the magical laws embraced by the novice witch Hermione Granger of Harry Potter fame. This mininarrative, packed with complex ideas translated into easily accessible language and an engaging style, leaves the readers time to ponder the author’s ideas at greater length, and the result is a fascinating and illuminating trek through a beautiful mind.

Pub Date: Oct. 13, 2015

ISBN: 978-1-4767-8484-7

Page Count: 120

Publisher: TED/Simon & Schuster

Review Posted Online: Aug. 5, 2015

Kirkus Reviews Issue: Aug. 15, 2015

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WHEN BREATH BECOMES AIR

by Paul Kalanithi ‧ RELEASE DATE: Jan. 19, 2016

A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...

A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.

Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”

Pub Date: Jan. 19, 2016

ISBN: 978-0-8129-8840-6

Page Count: 248

Publisher: Random House

Review Posted Online: Sept. 29, 2015

Kirkus Reviews Issue: Oct. 15, 2015

GENERAL BIOGRAPHY & MEMOIR | GENERAL CURRENT EVENTS & SOCIAL ISSUES | BIOGRAPHY & MEMOIR | CURRENT EVENTS & SOCIAL ISSUES

GOOD ECONOMICS FOR HARD TIMES

by Abhijit V. Banerjee & Esther Duflo ‧ RELEASE DATE: Nov. 12, 2019

Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.

“Quality of life means more than just consumption”: Two MIT economists urge that a smarter, more politically aware economics be brought to bear on social issues.

It’s no secret, write Banerjee and Duflo (co-authors: Poor Economics: A Radical Rethinking of the Way To Fight Global Poverty , 2011), that “we seem to have fallen on hard times.” Immigration, trade, inequality, and taxation problems present themselves daily, and they seem to be intractable. Economics can be put to use in figuring out these big-issue questions. Data can be adduced, for example, to answer the question of whether immigration tends to suppress wages. The answer: “There is no evidence low-skilled migration to rich countries drives wage and employment down for the natives.” In fact, it opens up opportunities for those natives by freeing them to look for better work. The problem becomes thornier when it comes to the matter of free trade; as the authors observe, “left-behind people live in left-behind places,” which explains why regional poverty descended on Appalachia when so many manufacturing jobs left for China in the age of globalism, leaving behind not just left-behind people but also people ripe for exploitation by nationalist politicians. The authors add, interestingly, that the same thing occurred in parts of Germany, Spain, and Norway that fell victim to the “China shock.” In what they call a “slightly technical aside,” they build a case for addressing trade issues not with trade wars but with consumption taxes: “It makes no sense to ask agricultural workers to lose their jobs just so steelworkers can keep theirs, which is what tariffs accomplish.” Policymakers might want to consider such counsel, especially when it is coupled with the observation that free trade benefits workers in poor countries but punishes workers in rich ones.

Pub Date: Nov. 12, 2019

ISBN: 978-1-61039-950-0

Page Count: 432

Publisher: PublicAffairs

Review Posted Online: Aug. 28, 2019

Kirkus Reviews Issue: Sept. 15, 2019

GENERAL CURRENT EVENTS & SOCIAL ISSUES | GENERAL BUSINESS | CURRENT EVENTS & SOCIAL ISSUES | BUSINESS | PUBLIC POLICY | ISSUES & CONTROVERSIES | ECONOMICS

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Review: Pulitzer Prize Winner Siddhartha Mukherjee’s Laws of Medicine

The Laws of Medicine: Field Notes from an Uncertain Science by Dr. Siddhartha Mukherjee

We’ve been trained—from childhood—to trust our doctors; some patients trust their doctors absolutely. For many, it can be unnerving to hear a doctor discuss what he or she doesn’t know—and admitting that what we do know about medicine is a tiny speck in the vast universe of what has yet to be discovered.

It’s strangely refreshing, then, to hear a doctor address this fundamental truth about medicine so directly and reassure us that the human element of navigating the unknown might be the most valuable resource we have in medicine, the so-called “youngest science.”

To develop tools that would help him reconcile the known and the unknown, Mukherjee (the Pulitzer Prize-winning author of The Emperor of All Maladies ) formulated three laws of medicine, “laws of uncertainty, imprecision and incompleteness,” he writes. “These are laws of imperfection.”

His first law tells us that “A strong intuition is much more powerful than a weak test.” To illustrate this principle, he tells the story of a 56-year-old man, a resident of Boston’s tony Beacon Hill neighborhood, who was complaining of fatigue and weight loss. An endless battery of tests turned up nothing. But Mukherjee’s chance glimpse of the man in the hospital lobby led him to a hunch that eventually uncovered the man’s malady. Mukerjee saw the man conversing with a former patient whom the doctor had treated for side effects from drug use. Soon after, Mukerjee found the answer: the man with the mystery condition was a heroin user and he had contracted AIDS. Without Mukerjee’s hunch, there’s no telling how long his patient’s illness would have gone undetected.

Mukerjee’s second law tells the reader that “‘Normals’ teach us rules; ‘outliers’ teach us laws.” For example, when doctors notice that patients with some neurological diseases, such as Parkinson’s, have a reduced risk of cancer it “represents an opportunity to refine our understanding of illness,” Mukherjee writes. “Pieces of data that do not fit our current models of illness have become especially important, not only because we are reassessing the nature of our knowledge, but also because we are generating more such pieces of data every day.”

The solution Mukherjee argues, isn’t eliminating biases, but acknowledging them. “The simplest way to tackle the bias problem is to confront it head-on and incorporate it into the very definition of medicine,” he writes. “The greatest clinicians that I know seem to have a sixth sense for bias . . . They understand the importance of data and trials and randomized studies, but are thoughtful enough to resist their seductions.

“Human decision-making, and particularly, decision-making in the face of uncertain, inaccurate and imperfect information, remains absolutely vital to the life of medicine,” writes Mukherjee. “There is no way around it.”

So to what degree should we trust our doctors? When making that decision, patients must remember that doctors are blending the titanic amount of raw data that medicine has accumulated over the generations with their inherent humanity and human ability. “The discipline of medicine concerns the manipulation of knowledge under uncertainty,” Mukherjee writes. “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 him—and you have a discipline that is still learning to reconcile pure knowledge with real knowledge.

“The ‘youngest science’ is also the most human science,” Mukherjee writes. “It might well be the most beautiful and fragile thing that we do.”

Michael Ruscoe

Michael Ruscoe is a writer, teacher, and musician living in Southern Connecticut. He is the author of the novel, "From the Stray Cat Files: You’ll Do Anything," the anthology, "Baseball: A Treasury of Art and Literature," and numerous educational texts. An instructor at Southern Connecticut State University, Ruscoe is also lead singer and songwriter for the indie band Save the Androids! In his spare time he earns karma for his next life by ardently following the New York Mets. The proud father of two children, Ruscoe also cares for and supports a pair of goldfish, who, in all honesty, are not very good conversationalists.

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TED Book: The Laws of Medicine

What he writes is important, and he does so in an elegant, engaging fashion. This is a moving, deeply humane book. — Los Angeles Review of Books

The Laws of Medicine: Field Notes From an Uncertain Science

by Siddhartha Mukherjee 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. Buy now

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About the book

Over a decade ago, when Siddhartha Mukherjee was a young, exhausted, 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? In The Laws of Medicine Dr. Mukherjee investigates the most perplexing and illuminating cases of his career that ultimately led him to identify three principles that govern modern medicine.

Brimming with historical details, personal stories and modern medical breakthroughs, The Laws of Medicine is a fascinating glimpse into the struggles and Eureka! moments that doctors experience but people outside of the medical profession rarely see.

Provocative and humane, The Laws of Medicine is a field-guide for every profession that confronts uncertainty and wonder. Ultimately, this book lays the groundwork for a new way of understanding, not just medicine, but the world around us.

The 'laws of medicine' are really laws of uncertainty, imprecision, and incompleteness. They apply equally to all disciplines of knowledge where these forces come into play. They are laws of imperfection.

Press and reviews

Read the Los Angeles Review of Books' review

A great interview with Siddhartha on The Diane Rehm Show : Listen

About the author

Siddhartha Mukherjee is a cancer physician and researcher. He is the author of 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 University Medical Center. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. He has published articles in Nature, The New England Journal of Medicine , Cell , and The New York Times . He lives in New York with his wife and daughters.

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Book Review: The Laws of Medicine by Siddhartha Mukherjee

A cogent, forward-looking piece that highlights some of the most salient themes overarching the field of Medicine.

Title : The Laws of Medicine: Field Notes from an Uncertain Science Author : Siddhartha Mukherjee Genre : Nonfiction Originally published : 8 October 2015 Finished reading : 15 August 2019 Links : Get this book on Amazon

Do not be put off by the title. It is not a didactic, academic-paper-style book—far from it.

Through anecdotes and allusions to historical experiments and medical cases, Mukherjee artfully derives three ‘laws’ that govern the field of Medicine. Unlike his Pulitzer Prize-winning The Emperor of All Maladies , you can easily finish this short volume in just one sitting.

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.

Even though I had not yet commenced any form of medical training, I found myself identifying deeply with Mukherjee’s propositions. They will likely take on even more profound meaning when coupled with personal experience.

On the whole, The Laws of Medicine showed me the dynamism, fluidity and uncertainty of Medicine as a discipline . Not only is Medicine ever-evolving with the latest advances and therefore never static over time, there are and always will be outliers and anomalies that cannot be easily characterised nor categorised.

The complexity of the human body and the sophisticated workings of the various biological systems that govern it insinuate that when part of such an intricate system is rendered dysfunctional, the consequences can be multifarious—and the underlying cause, at times, elusive.

Mukherjee’s cogitations on the nature of Medicine reflect substantial clinical experience and professional expertise. Yet they also reveal his propensity for deeper thought and reflection. Such rumination transformed into succinct prose arguably transcends the study of science and is steeped deep in the realm of the humanities.

This is not to say that Medicine is not based on the strong foundations of science. But pure, hard science alone would not have led Mukherjee to ponder, to question, to experience and to synthesise. It would have been woefully inadequate; it would never have culminated in this book.

Reading it was for me a potent reminder that Medicine is a fundamentally human endeavour . In Medicine, the human element is indispensable—perhaps even core to this ‘science’. For ultimately, doctors are treating patients—people—striving to alleviate their suffering and enabling wellbeing. As Mukherjee concludes,

The “youngest science” is also the most human science. It might well be the most beautiful and fragile thing that we do.

This thought-provoking book is a must-read for both current and prospective medical students.

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The Laws of Medicine: Field Notes from an Uncertain Science Hardcover – Oct. 13 2015

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• Part of series TED
• Print length 96 pages
• Language English
• Publisher Simon & Schuster/ TED
• Publication date Oct. 13 2015
• Dimensions 12.7 x 1.78 x 17.78 cm
• ISBN-10 1476784841
• ISBN-13 978-1476784847
• See all details

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• Publisher ‏ : ‎ Simon & Schuster/ TED; 1st edition (Oct. 13 2015)
• Language ‏ : ‎ English
• Hardcover ‏ : ‎ 96 pages
• ISBN-10 ‏ : ‎ 1476784841
• ISBN-13 ‏ : ‎ 978-1476784847
• Item weight ‏ : ‎ 1.05 kg
• Dimensions ‏ : ‎ 12.7 x 1.78 x 17.78 cm
• #30 in Medical Ethics & Legal Issues
• #30 in Physician & Patient Medical Ethics
• #33 in Physician & Patient Diagnosis

About the author

Siddhartha mukherjee.

Siddhartha Mukherjee is a cancer physician and researcher. He is an assistant professor of medicine at Columbia University and a staff cancer physician at the CU/NYU Presbytarian Hospital. A former Rhodes scholar, he graduated from Stanford University, University of Oxford (where he received a PhD studying cancer-causing viruses) and from Harvard Medical School. His laboratory focuses on discovering new cancer drugs using innovative biological methods. Mukherjee trained in cancer medicine at the Dana Farber Cancer Institute of Harvard Medical School and was on the staff at the Massachusetts General Hospital. He has published articles and commentary in such journals as Nature, New England Journal of Medicine, Neuron and the Journal of Clinical Investigation and in publications such as the New York Times and the New Republic. His work was nominated for Best American Science Writing, 2000 (edited by James Gleick). He lives in Boston and New York with his wife, Sarah Sze, an artist, and with his daughter, Leela.

His author website is www.siddharthamukherjee.me

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• Lifelong Learning in Clinical Excellence

Navigating the Uncertain: A Book Review of “The Laws of Medicine”

Siddhartha Mukherjee, MD, provides a framework to reconcile the uncertainties we constantly experience in our practice of medicine in his book, "The Laws of Medicine."

Lifelong Learning in Clinical Excellence | June 18, 2019 | 2 min read

By sam kant, md, johns hopkins university school of medicine.

Great books provide avenues to comprehend the sensory and cognitive overload that we’re often subjected to. I’ve frequently turned to “The Laws of Medicine, “ by Siddhartha Mukherjee , MD, for treading this path.

During residency, the author was looking for ways to reconcile the uncertainties he constantly experienced in the practice of medicine, and was inspired by a collection of essays by Lewis Thomas, “The Youngest Science,”   and the foundations were laid for the laws he discusses in his own book.

One of Mukherjee’s main points is that even though medicine is considered a science, it lacks laws that other fields of science possess. The author tracks the arc of medicine, and then weaves together interesting clinical encounters that have shaped scientific breakthroughs with ones that have personally influenced him, to conceive his three laws.

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

Our differential diagnoses have varying degrees of probability associated with them. We employ tests to push one of these differentials into the realm of certainty. However, many of these tests are imperfect. Prior knowledge (or intuition) helps us interpret these tests better and influences these diagnostic probabilities. A classic example is the prostate specific antigen (PSA) test. Interpret it without context and it will lead us down the path of a multitude of unnecessary investigations. But add more elements such as family history, risk factors, genetics, or a change of PSA value over time into the mix, and its ability to adjudicate further investigation increases.

Law Two – “Normals” teach us rules; “Outliers” teach us laws .

The author illuminates examples ranging from astronomy to autism to show that even though we can establish patterns from studying the vast majority, it’s the outliers that have the potential the upend these patterns. Just like an analysis of a dramatic responder in a trial employing everolimus for advanced bladder cancer paved the way for understanding genetic influences on the dreaded condition.

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

The very fact that human beings are part of research, whether designing it or by being a subject, is a harbinger for bias. The main endeavor of studies is generalization; however, much research falls short – women are historically underrepresented in randomized trials, as are female mice in laboratory studies.

We constantly seek a blueprint to understand the various nuances of medicine and can feel disorientated in the absence of the same. These laws can be that initial map to aid that pursuit for both the fledgling and the established practitioner.

My search for the laws was not an attempt to codify or reduce the discipline into grand universals. Rather, I imagined them as guiding rules . . . ~ Siddhartha Mukherjee, MD

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The Laws of Medicine: Field Notes from an Uncertain Science (TED Books)

Description.

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.

About the Author

Siddhartha Mukherjee is the author of The Song of the Cell, The Gene: An Intimate History,  a #1  New York Times  bestseller;  The Emperor of All Maladies: A Biography of Cancer , winner of the 2011 Pulitzer Prize in general nonfiction; and  The Laws of Medicine . He is the editor of Best Science Writing 2013 . Mukherjee is an associate professor of medicine at Columbia University and a cancer physician and researcher. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. In 2023, he was elected as a new member of the National Academy of Medicine. He has published articles in many journals, including  Nature ,  The New England Journal of Medicine ,  Cell , The New York Times Magazine , and The New Yorker . He lives in New York with his wife and daughters. Visit his website at: SiddharthaMukherjee.com.

Praise for The Laws of Medicine: Field Notes from an Uncertain Science (TED Books)

"This mininarrative, packed with complex ideas translated into easily accessible language and an engaging style, leaves the readers time to ponder the author's ideas at greater length, and the result is a fascinating and illuminating trek through a beautiful mind. A splendid exploration of how medicine might be transformed." — Kirkus (starred) "The prose is lovely, often witty, always clear.... a fast and informative read." — Booklist “What he writes is important, and he does so in an elegant,engaging fashion. This is a moving, deeply humane book.” – Los Angeles Review of Books

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The Laws of Medicine

Field notes from an uncertain science.

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About The Book

About the author.

Siddhartha Mukherjee is the author of The Song of the Cell , The Gene: An Intimate History, a #1 New York Times bestseller; The Emperor of All Maladies: A Biography of Cancer , winner of the 2011 Pulitzer Prize in general nonfiction; and The Laws of Medicine . He is the editor of Best Science Writing 2013 . Mukherjee is an associate professor of medicine at Columbia University and a cancer physician and researcher. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. In 2023, he was elected as a new member of the National Academy of Medicine. He has published articles in many journals, including Nature , The New England Journal of Medicine , Cell , The New York Times Magazine , and The New Yorker . He lives in New York with his wife and daughters. Visit his website at: SiddharthaMukherjee.com.

Product Details

• Publisher: Simon & Schuster/TED (October 13, 2015)
• Length: 96 pages
• ISBN13: 9781476784847

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Raves and Reviews

"This mininarrative, packed with complex ideas translated into easily accessible language and an engaging style, leaves the readers time to ponder the author's ideas at greater length, and the result is a fascinating and illuminating trek through a beautiful mind. A splendid exploration of how medicine might be transformed."

– Kirkus (starred)

"The prose is lovely, often witty, always clear.... a fast and informative read."

“What he writes is important, and he does so in an elegant,engaging fashion. This is a moving, deeply humane book.” – Los Angeles Review of Books

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Book summary and reviews of The Laws of Medicine by Siddhartha Mukherjee

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The Laws of Medicine

Field Notes from an Uncertain Science (TED Books)

by Siddhartha Mukherjee

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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.

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"Starred Review. This mininarrative, packed with complex ideas...A splendid exploration of how medicine might be transformed." - Kirkus "The prose is lovely, often witty, always clear...a fast and informative read." - Booklist

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Siddhartha Mukherjee Author Biography

Siddhartha Mukherjee is the author of The Emperor of All Maladies: A Biography of Cancer and The Gene: An Intimate History , winner of the 2011 Pulitzer Prize in general nonfiction, and The Laws of Medicine . He is the editor of Best Science Writing 2013 . Mukherjee is an assistant professor of medicine at Columbia University and a cancer physician and researcher. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. He has published articles in Nature, The New England Journal of Medicine, The New York Times, and Cell. He lives in New York with his wife and daughters.

Name Pronunciation Siddhartha Mukherjee: sih-DART-uh MOO-ker-jee

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The Laws of Medicine: Field Notes from an Uncertain Science

Siddhartha mukherjee. s&s/ted, $16.99 (96p) isbn 978-1-4767-8484-7.

Reviewed on: 01/04/2016

Genre: Nonfiction

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• ISBN-10 1476784841
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• Publisher ‏ : ‎ Simon & Schuster/ TED; 1st edition (13 October 2015)
• Language ‏ : ‎ English
• Hardcover ‏ : ‎ 96 pages
• ISBN-10 ‏ : ‎ 1476784841
• ISBN-13 ‏ : ‎ 978-1476784847
• Item Weight ‏ : ‎ 1 kg 50 g
• Dimensions ‏ : ‎ 12.7 x 1.78 x 17.78 cm
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About the author

Siddhartha mukherjee.

Siddhartha Mukherjee is a cancer physician and researcher. He is an assistant professor of medicine at Columbia University and a staff cancer physician at the CU/NYU Presbytarian Hospital. A former Rhodes scholar, he graduated from Stanford University, University of Oxford (where he received a PhD studying cancer-causing viruses) and from Harvard Medical School. His laboratory focuses on discovering new cancer drugs using innovative biological methods. Mukherjee trained in cancer medicine at the Dana Farber Cancer Institute of Harvard Medical School and was on the staff at the Massachusetts General Hospital. He has published articles and commentary in such journals as Nature, New England Journal of Medicine, Neuron and the Journal of Clinical Investigation and in publications such as the New York Times and the New Republic. His work was nominated for Best American Science Writing, 2000 (edited by James Gleick). He lives in Boston and New York with his wife, Sarah Sze, an artist, and with his daughter, Leela.

His author website is www.siddharthamukherjee.me

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How medicine always defies lawgivers

The Laws of Medicine is an arresting title for a very small book. 1 It follows the author Siddharta Mukherjee’s The Emperor of All Maladies, 2 an equally arresting title for a very large book. Both are a delight to read and adopt a similar style. Real clinical stories are turned into parables and aphorisms that illustrate various aspects of real clinical medicine. In that way they not only resonate with clinicians but, more importantly, offer a wide readership the opportunity to understand and share in the deep issues of how medicine advances and how medical decisions are made.

Anyone who tries to lay down laws for medicine is bound to be accused of hubris. But there is a gentle irony in Mukherjee’s title, which he immediately subverts with the subtitle “Field Notes from an Uncertain Science.” At the end of the book he explicitly throws off the cloak of the lawgiver to reveal the real oncology teacher offering three challenging assertions for his new residents to chew over. He happily concedes that lots of similar “laws” could be devised. The essays on the three laws included in the book follow the great tradition begun by Montaigne and Bacon and exemplified in post-war British medicine by Richard Asher 3 and Peter Medawar. 4 The laws all address the central paradox that “medicine asks you to make perfect …

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The Laws of Medicine

Field notes from an uncertain science.

LIST PRICE $16.99

Free shipping when you spend $40. Terms apply.

Buy from Other Retailers

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Table of Contents

• Rave and Reviews

About The Book

About the author.

Siddhartha Mukherjee is the author of The Song of the Cell , The Gene: An Intimate History, a #1 New York Times bestseller; The Emperor of All Maladies: A Biography of Cancer , winner of the 2011 Pulitzer Prize in general nonfiction; and The Laws of Medicine . He is the editor of Best Science Writing 2013 . Mukherjee is an associate professor of medicine at Columbia University and a cancer physician and researcher. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. In 2023, he was elected as a new member of the National Academy of Medicine. He has published articles in many journals, including Nature , The New England Journal of Medicine , Cell , The New York Times Magazine , and The New Yorker . He lives in New York with his wife and daughters. Visit his website at: SiddharthaMukherjee.com.

Product Details

• Publisher: Simon & Schuster/TED (October 13, 2015)
• Length: 96 pages
• ISBN13: 9781476784847

Raves and Reviews

"This mininarrative, packed with complex ideas translated into easily accessible language and an engaging style, leaves the readers time to ponder the author's ideas at greater length, and the result is a fascinating and illuminating trek through a beautiful mind. A splendid exploration of how medicine might be transformed."

– Kirkus (starred)

"The prose is lovely, often witty, always clear.... a fast and informative read."

“What he writes is important, and he does so in an elegant,engaging fashion. This is a moving, deeply humane book.” – Los Angeles Review of Books

Awards and Honors

• Paradies Lagardere Non-Fiction Airlines Pick

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• Book Cover Image (jpg): The Laws of Medicine Hardcover 9781476784847

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The Resilience of Natural Law

Legal positivists view natural law as both fruitless and pernicious, but without it legal theory makes little sense.

At its inception in seventeenth-century England, our liberal order held that law must be humble. Brutal political conflict had proved that we are incapable of knowing basic moral and social truths. With fundamental disagreement inescapable, law must defer to skepticism and relativism. Humble law would provide just enough stability to leave people free to safely craft their own truths, identities, and manners of life. In the framing of Sean Coyle, since liberalism doubts that there are “any true principles of right conduct that are rationally discoverable,” the ambition of natural law jurisprudence to codify universally known moral truths smacks of vain authoritarianism.

Natural law is at odds with the liberal spirit that established our law schools and, laments Sean Coyle, “has contributed to the dismissal of natural law theory as an antiquated relic of no relevance to modern times.” Even though natural law theory dominated Western legal education from the twelfth through to the end of the eighteenth century, academic publishing today seldom features natural law in its handbooks of law and legal theory. 

Professor of Jurisprudence at the University of Birmingham, England, Coyle’s book Natural Law and Modern Society is a large and detailed inquiry into the resilience, cogency, and scope of natural law theory. A rich and careful work, Coyle’s is a technical study in the philosophy of law. Coming in three parts, Natural Law and Modern Society first shows that natural law theory bests legal positivism, the principal theory of law in higher education today. The second section shows the cogency of tying morality to legal justice, and the third demonstrates the range of natural law in adjudicating knotty jurisprudential questions, such as whether natural rights are the same as human rights.

Throughout, the natural law tradition is represented by the Catholic Italian friar Thomas Aquinas (c. 1225–74), the Spanish Jesuit Francisco Suarez (1548–1617), and the Dutch Protestant Hugo Grotius (1583–1645). By no means are these theorists identical and Coyle sometimes plays one off against another. However, they represent, he believes, a tradition of powerful and live jurisprudential concepts.

Most law school education is built on a foundation of legal positivism. Legal positivists argue that the effort by natural law thinkers to lodge law in morals is both fruitless and pernicious: our knowledge is too limited, and the attempt must make a casualty of tolerance. Coyle counters that classic works of legal positivism show there is no escape from natural law reasoning. 

Natural law jurisprudence dates to Aquinas, but as Coyle points out, Thomas relies on a eudaemonist philosophy built upon the ancients and their idea that persons ultimately act for “the end for the sake of which all other ends are sought (in Aristotle’s definition), or as the good composed of all other goods (as in Plato’s).” Combining and amending Aristotle and Plato, Aquinas posits that the end is the loving personal Logos. As Aquinas explains, this makes the cosmos a rational community: “The whole community of the universe is governed by Divine Reason.” Human nature, says Aquinas, “has a share of the Eternal Reason, whereby it has a natural inclination to its proper act and end.” By contrast, and typical of modern deflationary accounts of meaning and reality, legal positivism atomizes, resting its defence of liberty, as Coyle puts it, on the “belief that each person invents their own end.”

Natural law, relays Coyle, relies on the proposition that “reason does not impose order upon human nature but discovers an order that is already present.” Per this order, natural law reflection identifies a pattern of human goods without which persons cannot flourish. Natural law theory proves its resilience because legal positivism backs into these human goods.

Coyle ably shows that prominent legal positivists assume such natural goods. They cannot explain legal phenomena otherwise. For example, the Austrian Hans Kelsen (1881–1973) reasons that violators of the law are punished with a “depravation of possessions—life, health, freedom or property.” It is quite clear that these are the human goods of eudaemonist reasoning. The English H. L. A. Hart fares no better. Certainly alert to the problem, he argues that the end of human striving is survival. However, he proposes that “all living are described as healthy or unhealthy depending upon their progress towards or away from their optimal condition.” Hart speaks of human vulnerability, for example, but one is then compelled to ask what is the character of woundedness? The only possible answer is that human goods are lost in our being wounded. Coyle insists: “This signals his agreement with Aristotle that the nature of a thing is determined according to a mature and flourishing condition of a thing, not the condition in which it is merely in potentia or in decay.” 

What then are the basics of this theory of “objective human ends”?

Core Morality

The natural law tradition argues that human beings are always set inside an order of desires. Coyle quotes Aquinas: “The natural law is promulgated precisely in that God instilled it in us, in the form of natural knowledge [i.e. inclinations].” The addition in brackets is made by Coyle. Rightly, I think, he takes Aquinas to argue that our inclinations are a natural knowledge of morals. That is, they make evident to us human goods. An illustration of the cogency of this idea is Adam Smith’s plausible belief that language had its origin in the human need to settle on words for housing, clothing, and nourishment.

This natural knowledge of the good is refined by our rational nature into precepts of law. The inclinations shine a light on objects that are good for us and in this light reason frames, Coyle explains, “the relevant range of precepts of natural law [that] include being at peace with others, creation of and participation in mutual forbearances, defence of the weak against the violence of the strong, suppression of criminality, and so forth.”

This work of rational desire is “the law’s rationality,” argues the natural law tradition. Coyle observes something more: “But Aquinas in fact sets out a hierarchy among the primary precepts of natural law, ranging from the most fundamental (protection of life) to those which call out to human excellences (sociability, peace, intellectual relationship to God).” This helps explain why liberalism is averse to the core morality idea of natural law theory. Even if liberal theory could concede we have a natural moral orientation set by desire, the idea that desire shapes up in a hierarchical order cannot be borne. It is for this reason that Hobbes pointedly minimizes our appetites to violent self-interest.

Natural law theory defends the idea of a core morality, but it also gives great latitude to lawmakers in crafting reason-based laws.

Aquinas says that “natural law is something appointed by reason” and Coyle is quick to observe that “the demands of natural law are immanent demands.” For this reason, Coyle argues that natural law jurisprudence is not a branch of philosophical theology, and nor is it a branch of political theory. Core morality is not up for political negotiation. It is the measure by which one can assess the justice of human-made law (positive law). In a nice formulation, Coyle drives home the point that per natural law, “ethics is the starting point for all inquiry into law and politics: the human goods that the law protects must first be identified and illuminated.”

We can only attain the ends to which we are prompted by our inclinations by having “the good of a stable legal order.” This brings us to the tricky problem of the common good. “For certain general aspects of common good are an intrinsic part of the individual’s good.” An example is due process. What institutional order expresses this common good?

Human Rights

Following Aquinas, Coyle argues that law must be directed to the common good, lest it become a mere façade of law. The common good is neither the utilitarian idea of the “greater number” nor an organicist lockstep but a social friendship that secures “the benefit of the whole community including the individual.” It assumes establishment. Coyle cites Suarez’s interesting examples of open meadows, churches, and magistracies composing establishment. We can add much to the list, but the important point is that establishment is an enabling communal background, “the whole edifice of rules and conditions that make individual choice possible.” 

Natural law “establishment” is necessarily a complex phenomenon, since the common good has elements of both external and internal peace. Both international law and criminal law would be included in the larger phenomenon. Our sociability demands concord amongst citizens, and so natural law establishment also includes contract and administrative law, monitoring prosperity and just distribution. As a measure of the order of desire, natural law is of wide scope; its jurisprudence frames all the principal areas of law. However, not all elements of our legal establishment are equally rooted in reason. An example is the difference in standing between natural and human rights. 

A quiet partner in this book is Catholic Social Thought (CST), that body of moral and legal reflection primarily developed by popes. The Catholic Church is the global institution that frames its public discourse—addressed to “all people of good will”—in terms of natural law theory. Papal documents speak liberally of human rights, but during the pontificate of St. John Paul II, epic diplomatic battles raged as the Clinton administration sought to  write into UN documents abortion as a human right—an issue still very much with us. What continuity is there between core morality and human rights?

Coyle is fond of a phrase from  Gaudium et spes . This 1965 Vatican II document warns that there are “forgotten and unacknowledged rights” belonging to the poor and needy. Human rights are positive law, written into treaty documents by Commissioners—in the first place by Eleanor Roosevelt. In 1948, the philosophical foundation of the new category of rights was said to be work for another day. Insofar as human rights are linked to our being, and not mere historical creations, they are in fact natural rights, contends Coyle. For example, the human right of family is based upon the natural right of parents to be stewards of their children, and evidence of the natural heft of that right is the high burden placed on the state before lawful child removal.

Positive law is a welcome and necessary part of legal establishment. However, the measure of human-made law is “the law’s rationality,” the work of rational desire. Being alert to this measure is basic to the work of jurists and policymakers lest they transgress natural justice. A too-casual orchestration of human rights is likely to trammel the poor and needy, who are not represented in the corridors of power where human rights documents are drafted. Alertness to the institutional character of legal establishment is critical if we are to heed the warning of St. Augustine’s libido dominandi or Adam Smith’s “conspiracy of the merchants.” Indeed, Coyle flags the “ideology of human rights,” cautioning that human rights proliferation is the work of a caste, the global legal literati. It is part of the scope of natural law to monitor the drafting of laws by the state and its analogs.

Growing Relevance

Natural Law and Modern Society is 450 pages of close argumentation. The argumentation will be recognizable to those familiar with the analytical tradition of philosophy. It makes a good companion piece to James Carey’s Natural Reason and Natural Law ,  a fine work placing Thomas alongside Strauss and Heidegger. Sadly, this volume is a shocking price ($145). I do not know why. The pages are not sewn but glued. Other academic presses put out hardbacks with even more pages for $35.

Besides resilience, cogency, and scope, natural law’s theoretical relevance is more obvious with our changing world order. Natural law theory defends the idea of a core morality, but it also gives great latitude to lawmakers in crafting reason-based laws. It is ideally positioned to articulate and justify a universal but limited set of objective moral truths to which all legal systems must defer, while also tolerating not only varied laws and procedures, but various political regimes. Natural law takes the liberty of human law seriously. For this reason, legal orders informed by natural law jurisprudence have always been humble. With world order becoming polycentric natural law theory stands fair to see a revival. 

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