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Feature Christmas 2009: Years Like This

Will it all go wrong? Sod’s law and medicine

BMJ 2009; 339 doi: (Published 14 December 2009) Cite this as: BMJ 2009;339:b5299
  1. Tony Hope, professor of medical ethics and honorary consultant psychiatrist1,
  2. Dominic Wilkinson, Oxford Nuffield medical research fellow 12
  1. 1Ethox Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF
  2. 2Oxford Uehiro Centre for Practical Ethics, Department of Philosophy, University of Oxford, Oxford OX1 1PT
  1. Corresponding author: T Hope tony.hope{at}

    Modern medicine has failed to take account of one of history’s most fundamental rules and the lessons of a neglected 16th century philosopher

    Iudico potere essere vero che la fortuna sia arbitra della metà delle azioni nostre, ma che etiam lei ne lasci governare l’altra metà, o presso, a noi. [I believe that it is probably the case that fortune controls half of what we do, but she allows the other half to be controlled by ourselves.] Niccolò Machiavelli, 1513 (published 1532).1

    Modern medicine attempts to exert control over outcomes. It is the intellectual descendant of Machiavelli. But are such attempts to manipulate and minimise chance futile, do they risk making the worst outcome more likely? Such questions were anticipated and debated five centuries ago by a contemporary of Machiavelli, now largely forgotten, the Italian philosopher Girolamo Di Sod.

    Girolamo Di Sod

    Di Sod was born in Florence to a poor aristocratic family, towards the end of the 15th century. He was almost certainly in correspondence with Machiavelli before the age of 20.2 With Machiavelli’s support, he was invited to take part in the literary gatherings at the Oricellari Gardens, where he engaged with some of the finest political thinkers of the age.

    Although none of Di Sod’s works has survived, descriptions by other members of Orti Oricellari suggest that he was both brilliant and eccentric. He studied with the Franciscan Luca Pacioli who had, a decade earlier, written the first printed work to discuss probability.3 However, Di Sod quickly transcended his teacher in his efforts to quantify and control the element of chance. One of Di Sod’s most distinctive views related to the conservation of personal fortune—episodes of fortune must be balanced by episodes of misfortune. He developed a pathological fear of gambling, convinced that good luck in such …

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