Happy Accidents: Serendipity in Modern Medical Breakthroughs by Morton A. Meyers, M.D.

Happy Accidents: Serendipity in Modern Medical Breakthroughs - When Scientists Find What They're NOT Looking For
by Morton A. Meyers, M.D.
Copyright 2007
Arcade Publishing (nonfiction)
320 pages

What led you to pick up this book? Ah, yes, another one of those impulse library check-outs. The cover's a bit of a grabber, isn't it? I picked the book up, flipped through it and thought it sounded fascinating.

Summarize the plot but don't give away the ending. It's nonfiction, so there's no plot and the ending is a conclusion that emphasizes our current medical situation, as the book is written in the Introduction/Body/Conclusion format. Happy Accidents begins with a rather heavy-handed introduction explaining why serendipity has played such an important role in medical discovery and how important it is not only for such unexpected "accidents" to occur, but also how crucial that some knowledgeable person has the wisdom to observe the mistake and take note of it, as well as the ability to creatively utilize a mistake for its potential.

He quotes Winston Churchill while discussing how only a creative mind can "convert a stumbling block into a stepping-stone": Men occasionally stumble across the truth, but most of them pick themselves up and hurry off as if nothing happened.

Morton adds the following:

[Introduction: p. 21] Relatively few investigators have spontaneously acknowledged the contribution of chance and accident to their discoveries. Scientific papers in the main do not accurately reflect the way the work was actually done. Researchers generally present their observations, data, and conclusions in a dry passive voice that perpetuates the notion that discoveries are the natural outcome of deliberate search. The result, in the words of Peter Medwar, winner of a Nobel Prize for his pioneering work in immunology, is to "conceal and misrepresent" the working reality.Virtually without exception, scientific literature imposes a post facto logic on the sequence of reasoning and discovery.

The book then focuses on the recent (meaning, I'd guess, primarily the last 200 years) history of medical discoveries, with focus on those that had a serendipitous element - and almost all of the really meaningful discoveries in the last couple of hundred years were based on some sort of accidental happening. There's an excellent conclusion, followed by brief acknowledgments and then copious notes (about 40 pages or so), a bibliography, and an index. It is a very thorough book but the history is written with flair and is surprisingly entertaining.

What did you like most about the book? The body of the book is very well written and orderly, divided into sections on particular interconnected discoveries (Part I, for example, examines discoveries for treatment of infectious diseases, antibiotics, and miracle drugs; Part III on the understanding of the heart, its electrical properties, circulation, blood-thinning, etc.). The book is written with enthusiastic detail without usually going too far over the layman's head (that's me) and scientists are described much like characters in a novel - how they looked, their habits, whether or not they were respected, their determination and how they responded to rejection. There are a lot of interesting tidbits, like this blurb about Paul Erlich, who discovered the cure for syphilis:

Nazi Gratitude: When the Nazis came to power in 1933, they confiscated all books about Ehrlich and burned them in an attempt to expunge his name from German history. In 1938 his widow and family fled to the United States.

What did you think of the main character? There's obviously no main character, so let me just say that I think the author of this book - who has collected stories of medical serendipity as a hobby, for many years - has an agenda that is for the benefit of all humans and the repetition in his introduction is, therefore, worth forgiving. He proposes a return to unstructured experimentation that allows scientists to explore pathways that unexpectedly open up as they appear (rather than staying within strict experimental guidelines). He lays out the history in an entertaining manner. There were some moments that he lost me, but I learned to skim the medical detail that was beyond my understanding (fortunately, there's very little of that); and, he states his case with intelligence and strength without sounding either whiny or condescending.

Share some quotes from the book.

During the time that penicillin was a new drug but in dramatically short supply:

[p. 74] Events now took on the character of an Eric Ambler thriller. Florey was determined to keep penicillin from the Germans. When a German invasion of the British Isles under Hitler's Operation Sea Lion seemed likely, the Oxford team smeared the lining of their clothes with the penicillin mold in the hope that spores of the precious discovery could be smuggled to safety.

One of those little "tidbits" separated in gray-highlighted boxes:

Slightly Crackers: Later, reflecting on his discovery of what would be identified as H. pylori in the stomach, Warren commented: "It was something that came out of the blue. I happened to be there at the right time, because of the improvements in gastroenterology in the seventies . . . Anyone who said there were bacteria in the stomach was thought to be slightly crackers."

In case you're wondering, Warren and his cohort, Barry Marshall - who shared a Nobel prize for the discovery that ulcers are caused by bacteria, rather than stress and poor diet (thus leading to treatment with antibiotics and prevention of stomach cancer) - are Australian. Warren is from Adelaide and Marshall from a remote area in Western Australia. Hence the "slightly crackers" comment. I loved that.

About the pharmaceutical industry's misleading marketing about new discoveries and the dramatic drop in new drugs that effect health (as opposed to lifestyle - most "new" drugs are actually not even new, but reformulations that can be mere molecules apart in difference and are created in order to obtain a new patent and market for huge profits):

[Conclusion: p. 308] Since the mid-1980s, the industry has shown a striking decline in innovation and productivity, even while its profits have soared. The number of new drugs approved by the Food and Drug Administration (FDA) fell especially sharply in the ten-year period from 1996 to 2005, from 53 in 1996 to only 20 in 2005, despite record-high research spending by the industry, averaging more than $38 billion a year during that time.

Why did the industry have so few major breakthroughs in such a free-spending period? Because it has progressively shifted the core of its business away from the unpredictable and increasingly expensive task of creating drugs and toward the steadier business of marketing them. Most drug makers now spend twice as much marketing medicines as they do researching them. They compensate for dramatically diminished productivity and loss of patent protection by raising prices, maneuvering to extend patents, engaging in direct-to-consumer advertising, and developing and marketing more and more "me-too" and lifestyle drugs that do not enhance health and longevity. Hope has been largely replaced by hype.

Share a favorite scene from the book: I really enjoyed the sections describing the discovery of H. pylori and its significance. Of particular interest is the tale of how Marshall sickened himself with the bacteria in order to fulfill the necessary third causation required for proof of a discovery: "the pure culture must be shown to induce the disease experimentally." The caption for this section: Physician, Heal Thyself (But First Make Thyself Sick).

In general: A fascinating book that I hope will lead to positive changes including a return to the old-fashioned method of investigation in which scientists and research physicians accidentally leave cultures on benches or allow them to be speckled with airborne particles, thereby leading to the startling discoveries that save lives. There was only one brief paragraph or two that I strongly disagreed with and that was a comment about the safety of drugs in the Prozac family. Nuh-uh. I disagree. I'm friends with the mother of one of the "anecdotal cases" that led to the warning label stating that certain mood-enhancing drugs can cause dangerous mental changes (suicidal tendencies, violence).

He encourages funding of open-ended studies that don't limit medical researchers to a narrow path and I strongly agree with that. I also agree that the "peer review" process is severely self-limiting and leads to a narrow-minded approach to scientific publication.

4.5/5 - Excellent! I can only take off half a point for the occasional over-my-head bits that could very likely cause a lot of people to put the book down. The pharmaceutical industry's role in diminishing new discoveries is recent, but huge, and it would be great if every doctor in the United States would read this book and get noisy. The rest of us know we have something huge to fight, anyway, when it comes to drug companies. Highly recommended, but do be aware that some parts can get a little too technical. It's not as dry as most books of its type; really, it's quite entertaining.

Coming up: Wahoo! Wednesday. I remember, today! But, I have yet another busy day ahead of me, so please be patient.

Currently no references to: Pl*yb*y models in this blog. I was getting a ridiculous number of hits that involved searches for the author of Angels of a Lower Flight, sans clothing. Dudes, there are no nudes. Unless you count the critters, and they have fur or very excellent scales, etc. I have removed the author's name from all previous blog entries, but the review of her book remains because I think it's a story that needs to be read. Also, the word Pl*b*y looks just like that.

Hey, that Gaiman dude is not so bad: Okay, I'm still of the opinion that the stories in M is for Magic are, for the most part, not for children - either too adult thematically or with too many details that only an adult can fully understand. But, he does have a knack for giving the ordinary a magical spin. I'm about halfway and today is the due date for the book, so either I'll need to bury myself in it during swim practice or I must recheck. It's short. I'll try the digging-in option.

Gotta go. Wahoos may be a late-evening activity. Best to all and happy reading!