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A Doctor Finds Miracles in Medicine

The celebrated writer-physician Sherwin B. Nuland — a clinical professor of surgery at Yale, the author of nine previous books, the winner of the National Book Award — is a believer in miracles. Not the parting-of-the-Red-Sea kind of miracles that suspend physical laws, but phenomena and events that can’t be explained by current scientific knowledge, and perhaps never will be.

In “The Uncertain Art: Thoughts on a Life in Medicine,†a delightful, companionable collection of occasional articles almost all of which appeared in The American Scholar magazine, Dr. Nuland feels free to follow his interests where they lead him — into medical history, etymology, even art criticism. He writes about the joy of exercising, the grief of 9/11, the satisfaction of authorship, the pain of losing a cherished friend. But the most engaging and thought-provoking articles deal with subjects that are mysterious, unsettling.

These pieces can be enjoyed for the simple sci-fi pleasure of encountering the inexplicable. Dr. Nuland, however, has a larger purpose in mind: to undermine smug certainties about modern science. By emphasizing the extraordinary he seeks to challenge his profession’s often unreflective reliance on technology and restore the doctor-patient relationship, the touchy-feely human connection, to the center of medical practice.

Doctors, he insists, have to be more than technicians. They should be, first of all, humanists, intuitionists, appreciative of each patient’s individuality and particular situation, practitioners of a quirky, unpredictable, uncertain art. True healers understand this. “To become comfortable with uncertainty,†Dr. Nuland writes, “is one of the primary goals in the training of a physician.â€

And so he leads readers into “astonishing†realms where science provides no explanation. He travels to China to determine firsthand if acupuncture is an effective technique. After witnessing two operations and speaking to the president of the Shanghai Medical University, who himself had undergone two thyroid operations with acupuncture, Dr. Nuland comes away a believer — even though the procedure “has still not been explained in terms acceptable to most orthodox Western scientists using orthodox Western investigative methods.â€

Science as we know it has gone at least part of the way in understanding acupuncture: somehow the needles stimulate the brain to increase its production of analgesic endorphins. But why that happens is not clear, and Dr. Nuland is willing to take a leap into the unknown in search of an explanation: “Perhaps philosophies may be required beyond those that have been so successful since the scientific method became a major current of Western thought.â€

He says pretty much the same thing about electroshock therapy, undeniably effective in combating debilitating depression but also outside the boundaries of mainstream science. Doctors employ it because it works. But they don’t understand why it works. In an earlier book Dr. Nuland described his own experience with electroshock therapy during a prolonged battle with severe depression. “It is truly a modern miracle,†he writes here.

The spookiest chapter of “The Uncertain Art†is “Mind, Body and the Doctor†and concerns a “confusing nuisance,†the placebo effect. Ever since the time of Hippocrates and Galen, physicians have known about cases in which people recovered from serious illnesses simply because they had the will to recover, often for no more reason than a desire to please their doctor. This is a more common phenomenon than one might imagine.

“Every doctor has anecdotes about this kind of thing,†Dr. Nuland says. “I have a bagful.†He writes about patients with terminal diseases who survived “for a period beyond all expert predictions,†because they wanted to witness a child’s college graduation or to see a loved one for the last time; and he tells us that for years he has been monitoring the obituaries in his local newspaper: “Almost always, the number of deaths has shrunk dramatically before Christmas, rising precipitously when the holiday is past.†In one striking example of the mind-over-matter placebo effect, he twits the “all-too-rational biomedical establishment†by once again trotting out the word “miracle.â€

Other chapters of the book are more down to earth. “Robbing Graves†is an irresistibly entertaining history of how doctors used to go about obtaining cadavers for their experiments. There were laws against desecrating bodies, so researchers had to rely on an underworld of unsavory suppliers. Inevitably the more entrepreneurial took it upon themselves to increase the number of fresh corpses on their own, with the result that one of the most notorious of them contributed his name to an entry in the Oxford English Dictionary — “burke: kill (a person) to sell the body for dissection.â€

There’s much to be learned from these brief, erudite pieces. Why do we say “Gesundheit†or “bless you†after a person sneezes? Because, traditionally, it was thought that a sneeze expelled the soul from the body, requiring a prayer to recover it.

Some of the articles are less successful. Dr. Nuland’s comments on 9/11 don’t really add anything to the gazillions of words that have already been expended on the attacks. An essay on exercise is little more than an exercise in guilt-inducing finger pointing. But none of the chapters are more than a few pages long, and since there’s no extended argument to follow, a reader can skip around, or put the book down at any point and pick it up again later.

It’s ideal airport or bathroom reading. Dr. Nuland probably understood as much, which may be why he included a piece about bowel movements and regularity. What better place than the bathroom, after all, to learn that it was probably the ancient Egyptians who invented enemas?