Editorials Christmas 2015

Siddharta Mukherjee’s three laws of medicine

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6708 (Published 14 December 2015) Cite this as: BMJ 2015;351:h6708
  1. Richard Lehman, senior advisory fellow
  1. 1UK Cochrane Centre, Oxford OX2 7LG, UK
  1. edgar.lehman{at}btopenworld.com

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 Asher3 and Peter Medawar.4 The laws all address the central paradox that “medicine asks you to make perfect …

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