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Happy Accidents: Serendipity in Major Medical Breakthroughs in the Twentieth Century Paperback – September 1, 2011
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“Well-researched and well-documented . . . . Provides much food for thought.” (New England Journal of Medicine)
“Original and highly enjoyable.” (Robert Fuchgott, Nobel Laureate in Medicine)
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I read "The Microbe Hunters" years ago and, like most others, had assumed medical knowledge had progressed in logical steps, that massive research programs were the solution to intractable medical problems and that research activities and funding were based on the likelihood of successful outcomes. Wow was I wrong!
Subsequent to reading "Happy Accidents..." I found that others were already aware of the problem and are quite disgruntled with everything that is and isn't happening in medicine and medical research.
"Smokescreens" was one description I heard, citing the example that follows: Patient A develops cancer at 53 and it is discovered at age 57 and he dies at 58. Patient B develops the same cancer at 53 but it was discovered at age 55 and dies at 58. Patient B is statically attributed with with two years of additional lifespan when all that actually happened was being diagnosed two years earlier. (The example assumes everything is identical which, of course, they never are.) It is shocking to realize progress in treatment is actually only progress in diagnostics!
The casual misuse of antibiotics portends a disaster in the making as microbes develop immunity to the wonder drugs of the 20th century. With many staph type infections and the flesh eating bacteria there if often only a single course of treatment that remains effective. Should that treatment be breached nothing remains to prevent the mass epidemics prevalent prior to the 1950s.
Read this book! But a copy, anonymously if necessary, for your doctor. Get one for your congressman and senator since government funding supports so much medical research. But take action. The life you save might well be your own!
But the stories of early discoveries are all rather interesting. Some not as history may have been explained to you.
A naval battle in World War II might seem an odd setting for a story on cancer research. Lt. Col. Stewart Alexander, a medical officer stationed at the port of Bari, noted the acrid smell of garlic following an aerial bombardment by the Nazis and suspected chemical weapons. Sailors who survived the bombing by swimming in the bay water - contaminated with diluted chemicals - did not appear “shocked” as had victims of mustard gas in World War I, but would go on to die at a higher rate. Myers delineates how a line of research on the effects of mustard compounds - initiating from Alexander’s reports - found that lymphoid tissues were particularly sensitive and then led to a class of compounds being developed as a therapy for lymphoma cancer. Their development was an early benchmark for modern clinical cancer research.
Another chapter in the book illustrates how an idea can be ahead of its time. Judah Folkman had picked up an idea from the 1940s that cancer cells send an “angiogenic” signal to recruit new blood vessels to deliver nutrients. Folkman’s lab identified the angiogenic protein VEGF and inhibitors of tumor angiogenesis, but it took decades for the cancer research field to take notice. At a conference in 1987, the cancer researcher Noelle Bouck had not been intending to attend Folkman’s talk (she was resting her feet in the back of the room when he went to the podium) but after seeing his results, said to herself “This guy’s really onto something!”. She decided to switch her research focus to angiogenesis, and her efforts along with Folkman and other colleagues led to the identification of angiostatin and endostatin. Today, to complement traditional cancer therapies, doctors can slow cancer growth by inhibiting angiogenesis with drugs such as Avastin.
Myers describes many more episodes that illustrate how research in a seemingly disparate field led to advances in understanding cancer. Ethnobotany of tea made from Jamaican Periwinkle led to the identification of vinblastine. Studies on bacteria being exposed to electric fields led to cisplatin. A veterinarian studying the reproductive system of dogs discovered a role for sex hormones in cancer progression. Most of the chapters work well, but a few don’t quite fit the serendipity narrative. Nevertheless, his writing is inspiring and accessible for the scientist, physician and lay reader alike, as he recounts the steps from a curious observation to development of a therapeutic molecule.
More importantly, in a time when big-science initiatives seem to be announced every few months, Myers makes the persuasive argument that medical research needs to account for the possibility that the next breakthrough may very well come from outside of these targeted, goal-oriented programs. This has been once again brought to light since the publishing of the book, when CRISPR-CAS technology burst onto the scene. This exciting and potentially powerful technology to edit genomes of cells, tissues and organisms has its roots in the somewhat obscure host-pathogen dynamics between bacteria and viruses. It is highly unlikely that a large-scale research initiative to build gene-editing tools would generate something as elegant as CRISPR-CAS. In addition to funding the “War On ______” (fill in the disease), it would be wise to allocate funding for a broad range of creative, novel, and even weird science in diverse fields. Policy makers would do well to learn about the history of medical advances and mis-steps, and putting this book in their hands would be a start.