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Happy Accidents: Serendipity in Modern Medical Breakthroughs

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Let me preface my remarks by mentioning that I am a practicing radiologist and I also serve as Editor in Chief for the American Journal of Roentgenology (AJR), a scholarly, scientific journal that has been in existence for more than 100 years.

In 1995, an article titled "Science, Creativity, and Serendipity" by Morton A. Meyers was published in the AJR [1]. This was the Glen W. Hartman Lecture of the Society of Gastrointestinal Radiologists of that year. The AJR's Editor at that time, Robert Berk, believed it to be one of the most outstanding papers published during his tenure and commented that "Residents will be fortunate to have this information at the beginning of their careers" (M. A. Meyers, personal communication). Fortunately for us, Dr. Meyers has maintained a continuing interest in the role of serendipity as it applies to major medical breakthroughs, and he published a book on this very topic in March 2007, titled "Happy Accidents: Serendipity in Modern Medical Breakthroughs--When Scientists Find What They're NOT Looking For" [2].

It was my good fortune recently to pick up Dr. Meyers' book and casually begin to leaf through it. To my astonishment, almost everything important in medicine that has developed over the past two centuries came about, to a large extent, through pure serendipity. The book is divided into four parts. Let me list them here in order so you can appreciate Dr. Meyers' approach to this topic:
Part I: The Dawn of a New Era: Infectious Diseases and Antibiotics, the Miracle Drugs
Part II: The Smell of Garlic Launches the War on Cancer
Part III: A Quivering Quartz String Penetrates the Mystery of the Heart
Part IV: The Flaw Lies in the Chemistry, Not the Character: Mood-Stabilizing Drugs, Antidepressants, and Other Psychotropics

Dr. Meyers draws some conclusions at the end of the book that are extremely thought provoking and left me wondering about the current system that exists at the National Institutes of Health (NIH) for supporting research and funding specific programs. What is most enjoyable about this compelling book is that Dr. Meyers writes this story with exceptional literary skill and without bogging down into highly technical jargon. While this book will be absolutely fascinating to everyone in the medical field, it can be equally appreciated and enjoyed by the interested layperson as well.

Over the years, I have heard a few of the stories to which Dr. Meyers alludes, but never in their entirety and never appreciating how purely serendipitous was the outcome of a particular diverted research project. The author reflects on his own personal experiences during his distinguished career as an abdominal radiologist. Let me quote directly from Dr. Meyers' Preface, page xii: "Most people have had at least one experience in which an unintentional action or inadvertent observation, or perhaps even simple neglect, led to a happy outcome--to something they could not, or would not, have been able to accomplish even if they had tried."

Quoting further from the Preface, page xiii: "This is the essence of serendipity. Although the term has become popularized to serve as the synonym for almost any pleasant surprise, it actually refers to searching for something but stumbling upon an unexpected finding of even greater value--or, less commonly, finding what one is looking for in an unexpected way...But serendipity is not a chance event alone. It is a process in which a chance event is seized upon by a creative person who chooses to pay attention to the event, unravel its mystery, and find a proper application for it."

In the Introduction of the book, page 6, Meyers reflects on "accidents and sagacity." "Sagacity--defined as penetrating intelligence, keen perception, and sound judgment--is essential to serendipity. The men and women who seized on lucky accidents that happened to them are anything but mindless. In fact, their minds typically had special qualities that enabled them to break out of established paradigms, imagine new possibilities, and see that they had found a solution, often to some problem other than the one they were working on. Accidental discoveries would be nothing without keen, creative minds knowing what to do with them." As stated by Louis Pasteur and quoted by the author, "In the field of observation, chance favors only the prepared mind."

In reading this book, I learned of the very common and recurring theme that the discoverers of major breakthroughs were often reluctant to reveal the chance events that led to their ultimate breakthrough. The true story of what actually occurred often did not surface until late in the investigator's career, sometimes during a Nobel Laureate's acceptance speech. By revealing to us the critical role that chance plays in four major fields of medical advances, infectious disease, cancer, heart disease, and mental illness, Dr. Meyers raises important fundamental questions about how the nation's research dollars are currently spent. In his concluding remarks, he emphasizes the need to foster rather than stifle creativity and for the funders of research not to be so rigid and proscriptive in the way research studies are conducted and research dollars allocated.

For those of you who are involved with medical students and physicians during the formative years of their training, I urge you to obtain this book, read it, and absorb the message, and incorporate it into your views of how creative research should be stimulated and supported. This remarkable book by a fellow abdominal imager will change the way you think as well as provide you with a wonderful reading experience.

[...]

When I first started this book, I considered it nothing more than a bunch of fun anecdotes about medical discoveries. About two-thirds of the way through I realized that Meyers is making a serious point about how science really progresses. Huge projects are much less likely to make breathrough discoveries than scientists piddling around with whatever interests them. Some relatively minor changes in the way science is funded and organized could make a big difference in the return on research dollars. My own experience as a chemist in the pharmaceutical industry and as a patent attorney tends to support Meyers.

I am not so sure that Meyers has hit the nail on the head when it comes to science education. I agree that science is presently taught very poorly. However, I think part of the problem is the numerous educational reforms that have been put in place over the years, with little or no evidence that they work. The result is that many bright kids today leave school not only uninspired, but without a solid understanding of the subject. I would like to see more research on the actual education received by noted scientists--also better quality of educational research in general.

[...]

The Birth Stochastic Science: Rewriting the History of Medicine
Controlled experiment can easily show absence of design in medical research: you compare the results of top-down directed research to randomly generated discoveries. Well, the U.S. government provides us with the perfect experiment for that: the National Cancer Institute that came out of the Nixon "war on cancer" in the early 1970s.
"Despite the Herculean effort and enormous expense, only a few drugs for the treatment of cancer were found through NCI's centrally directed, targeted program. Over a twenty-year period of screening more than 144,000 plant extracts, representing about 15,000 species, not a single plant-based anticancer drug reached approved status. This failure stands in stark contrast to the discovery in the late 1950s of a major group of plant-derived cancer drugs, the Vinca Alcaloids -a discovery that came about by chance, not through directed research."
From Happy Accidents: Serendipity in Modern Medical Breakthroughs, by Morton Meyers, a book that just came out. It is a MUST read. Please go buy it. Read it twice, not once. Although the author does not take my drastic "stochastic tinkering" approach, he provides all kind of empirical evidence for the role of design. He does not directly discuss the narrative fallacy(q.v.) and the retrospective distortion (q.v.) but he certainly allows us to rewrite the history of medicine.
We did not realize that cures for cancer had been coming from other brands of research. You search for noncancer drugs and find something you were not looking for (and vice versa). But the interesting constant:
a- The discoverer is almost always treated like an idiot by his colleagues. Meyers describes the vicious side effect of "peer reviewing".
b- Often people see the result but cannot connect the dots (researchers are autistic in their own way).
c- The members of the guild gives the researcher a hard time for not coming from their union. Pasteur was a chemist not a doctor/biologist. The establishment kept asking him "where is your M.D., monsieur". Luckily Pasteur had too much confidence to be deterred.
d- Many of the results are initially discovered by an academic researchers who neglects the consequences because it is not his job --he has a script to follow. Or he cannot connect the dots because he is a nerd. Meyers uses Darwin as the ultimate model: the independent gentleman scholar who does not need anyone and can follow a lead when he sees it.
e- It seems to me that discoverers are nonnerds.
Now it is depressing to see the works of the late Roy Porter, a man with remarkable curiosity and a refined intellect, who wrote many charming books on the history of medicine. Does the narrative fallacy cancels everything he did? I hope not. We urgently need to rewrite the history of medicine without the ex post explanations. Meyers started the process: he provides data for modern medicine since, say, Pasteur. I am more interested in the genesis of the field before the Galenic nerdification.

Much like The Three Princes of Serendip from the old Persian fairy tale about three men who were on a mission but they always found something that was irrelevant but which they ultimately needed in reality, the author of Happy Accidents provides an excellent account of how serendipity has played such a vital role in revolutionary medical discoveries. However, let it be said that though luck played its part, "Chance only favors the prepared mind" - Louis Pasteur. Subsequently the author provides us with the discoveries of many prepared minds and divides the book up into four basic parts:

Part 1: Infectious Disease and Antibiotics
Part 2: War on Cancer
Part 3: The Mystery of the Heart
Part 4: Mood-Stabilizing Drugs & Other Psychotropics

Whether from the fabulous mold of Penicillin, or Australian guinea pigs for Lithium treatments, or to the worst Allied shipping disaster since Pearl Harbor for Nitrogen Mustards for the treatments for lymphomas, chance and unexpected results played its part in all of these, and more, in the history of medical discoveries.

Of all the money spent by Big Government medical research, this compilation of how discovery actually works should give one pause next time we hear the words "War on Whatever" as this money and research, in general, usually goes down a rat hole. In addition and as a cautionary concern, once big money starts its steamroller effect, it usually pushes creativity sadly out of the picture as one gets "your" idea or research is not what we are pursuing at this time.

All in, the book is recommended as there are thirty-nine (39) accounts of many discoveries which are entertaining and enlightening on the unexpected, creative, and prepared mind process.

HAPPY ACCIDENTS: SERENDIPITY IN MODERN MEDICAL BREAKTHROUGHS tells of happy accidental discoveries in the world of science, documenting events and also providing insights into how these accidents came to be realized as beneficial. It's this perspective which makes HAPPY ACCIDENTS a highly recommended pick not just for general interest lending libraries, but for college-level collections strong in health science. Learning to recognize and assess unexpected and accidental results for their possible lessons and benefits is key to any researcher's success: the author draws on both personal experience and research and interviews with winners of the Nobel Prize in Medicine and other awards to document this process of discovery.

By "Accident" I found the book. I have been talking about it ever since all over the country in step 1,2,3 class. This is a INDISPENSIBLE idea for EVERY student laboring over what seems to be "Boring" stuff in Med school. How fantastic!

Imagine that EVERY day, there are potential lines of discovery emerging from the world to YOUR mind and eyes, but only a person with drive, curiosity and passion will take the time to investigate.

How many things described in this book (lithium, anti-psychotic medications, chemotherapy, prednisone, vincristine, Helicobacter pylori as the cause of ulcers, etc,) would have been missed?

I have been meaning to contact the publisher and Mort Meyers to distribute to all my classes in Medicine and Physiology at Kaplan.

I found the book inspirational and critically important. I would place it with Steven Pinker's book "The Better Angels of Our Nature: The Decline of Violence in History and Its Causes" (2011) in terms of importance for the mind and the uplift of the civilization.
Conrad Fischer, MD
Associate Professor of Physiology, Pharmacology and Medicine,
Touro College of Medicine
Chairman of Medicine
Kaplan Medical

I ordered this for a friend for Christmas who is in the drug testing industry. He loved it and even though he hasn't finished it, said it was a great book and right up his alley.

Morton A. Meyers makes these stories of scientific discovery come alive. This brief history of medicine kept me on the edge of my seat like a mystery novel.

Viagra, Lipitor, antidepressants, chemotherapy drugs, penicillin and other antibiotics - all were discovered by accident, according to Meyers. Similarly, the Pap smear and cathertization of the heart arteries. "Happy Accidents" goes on to provide a number of examples of how this occurred, including new uses for aspirin, advances in ulcer treatment, thalidomine, etc.

Bottom Line: "Happy Accidents" provides researchers with a structure to help encourage beneficial serendipitous thinking.

Morton Meyers book, "Happy Accidents: Serendipity in Modern Medical Breakthroughs" is a thorough and well-written account of a diverse collection of medical events and discoveries in the applied science field of medicine. It is unclear if this was the author's intent or not, but most of the individual doctors, researchers, and scientists cited and discussed are Jewish. The role of Jewish intellectuals in fields as diverse as physics and psychiatry is well-documented. However, Dr. Morton misses few opportunities to celebrate Jewish achievements, culture, education, and history which are only tangentially-related to his main narrative about the role of chance in discovery. A few more examples from other cultures would have provided this balance, e.g. case studies from the African, Islamic and Oriental medical annals and establishment. Expanding the coverage of serendipity's role in research beyond medicine might have achieved this balance, since other fields of applied and pure science might also reveal a thought process different from that of Jewish doctors and scientists who have come from a culture with its roots in Jewish mysticism and its present-day manifestations of assimilation, economic prosperity and political influence.