How luck leads to medical breakthroughs

Serendipity in Modern Medical Breakthroughs

By Morton Meyers

Arcade. 408 pp. $27.96

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If you've ever read a paper in a medical journal, you know that such are not exactly the most interesting documents in the world. They're typically dull, jargon-laden, and put forth the idea that the results reported, even if groundbreaking, were something researchers knew would happen all along.

Morton Meyers disagrees. Well, he agrees that the tone of these papers is about as exciting as the color beige. But he argues, quite convincingly, that the biggest breakthroughs in medical history weren't discoveries found on a preordained track but the blessings of "the muse of serendipity."

"The heroes of the stories told in this book," he writes, "are not scientists who merely plodded rationally from point A to point B, but rather those who came upon X in the course of looking for Y, and saw its potential usefulness, in some cases to a field other than their own."

Consider some of the most groundbreaking, and lifesaving, medical discoveries that were Eureka moments - the X found on the path toward Y: X-rays, penicillin, chemotherapy drugs, and treatments for syphilis, schizophrenia, depression, lymphoma, leukemia, tuberculosis, ulcers and erectile dysfunction. These medical breakthroughs were all found by people looking for something else, usually by people Meyers calls "mavericks" - scientists, doctors, researchers and sometimes even amateurs not at the center of their respective fields of study.

Take ulcers. Doctors long believed they were caused by stress and diet. When Barry Marshall, along with J. Robin Warren, put forth - based on sound evidence found by mistake - that he believed ulcers were caused by bacteria, he was called a "madman." Marshall had to make himself sick by drinking the bacteria to prove he was right.

Meyers sets out to make telling these stories the anti-medical paper, injecting information about these mavericks' lives. But the pacing doesn't always flow, with three- and four-page chapters wedged in between longer passages. Meyers is at his best when he takes his time in telling of greater discoveries - his section on penicillin is brilliant and witty. But the shorter snippets, even if the discoveries found within were important, seem tacked on, and they interrupt the narrative.

Meyers also takes an abrupt turn at the book's conclusion. Through most of Happy Accidents, the tone is light and almost funny, but Meyers then makes a vicious attack - not entirely without merit - on the current state of medical research and the pharmaceutical industry. He argues that the way research is funded (with the National Institutes of Health providing grants, thereby making scientists dependent on them for their livelihoods) stifles the creative side in research.

"In the past," he opines, "the real advances in medicine have often come not from research specifically directed against a target but rather from discoveries made in fields other than the one being studied. . . . When scientists were allowed to pursue whatever they found, serendipitous discovery flourished. Today, targeted research is pretty much all there is." In other words, instead of unexpectedly finding an answer and looking for the question, researchers are told what questions to ask - lasering their focus and blinding them to what could be breakthrough discoveries.

Meyers also points out that the pharmaceutical industry, which spends $4.2 billion a year in direct-to-consumer advertising (those "ask your doctor" commercials), isn't helping. Instead of investing in finding new drugs for conditions that need treating, it instead focuses on "me too" and lifestyle drugs, making slight variations of ones that already exist and still work. "Instead of looking for truly innovative medicines to succeed those slated to lose patent production, the industry focuses most of its research efforts on developing and producing drugs that are either minor variations or outright duplicates of drugs already on the market," Meyers writes. "Of the ten top-selling drugs in the world, half offer almost no benefit over drugs marketed previously." When the patent on AstraZeneca's Prilosec, which is used to treat heartburn, was set to expire, the company "simply extracted the active half of its molecule," and patented that as a separate invention - Nexium, which was the most advertised drug in 2006.

The environment for more "happy accidents" looks grim, at least in the United States. Meyers points to the work being done at the Howard Hughes Medical Institute's Janelia Farm Research Center in Virginia, which allows scientists to follow what they believe is worth following.

But these efforts are small compared to the big machine that is both the National Institutes of Health and big pharma. Maybe if research at Janelia starts producing more worthwhile treatments and cures than NIH-supported and big pharma research, the medical community will wake up to how important that muse of serendipity is. As Meyers points out, between 1996 and 2005, the number of new FDA-approved drugs dropped, from 53 to 20. As research has become more organized (and pricey), less has been accomplished. That is a rather sad accident.