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W F Bynum is impressed by a book about the role of chance in medical innovation
It is no news that science is messy. Louis Pasteur said it most famously: “Chance favours the prepared mind.” His compatriot the physiologist Claude Bernard chipped in with: “Experimental ideas are often born by chance.” The Nobel prize winner Peter Medawar probably argued it most subtly, when he wrote a paper, cheeky but serious, announcing that the scientific paper is a fraud. Medawar wasn't a whistleblower; he merely analysed, in his inimitable style, the fact that scientific papers routinely present the route to their results through a series of logical experiments, correct deductions, and obvious conclusions.
In practice, things rarely go as expected. Abortive experiments are abandoned, and results are tidied up to be presented in their strongest form. This is normal experimental practice, although it took someone of Medawar's stature to make it public quite so blatantly.
It is significant that Morton Meyers draws his examples from major medical innovations and can usually draw on the authors of those discoveries to confess that something went wrong or that they found results they were not looking for. It is easy to confess that things were not all that neat when the result has won the researcher fame (and, often, fortune).
The phenomenon of serendipity in science and medicine is well known, but Meyers has collected a particularly well populated group of such discoveries and presented them in a chatty, readable fashion. In four sections he exposes the role of chance in the discovery of antibiotics, anticancer drugs, cardiovascular innovations, and psychopharmacology. The familiar examples are all here: Fleming's exposed petri dish leading ultimately to penicillin; Waksman's work with soil bacteria that turned up streptomycin; the road from nitrogen mustard gas to cancer chemotherapy or from spoiled clover to coumarin.
Meyers has also scoured the literature and uncovered some less well known examples. Nearly all of the physical treatments in psychiatry seem to have been stumbled on. Short chapters detail the centrality of chance in the introduction of fever therapy for treating general paralysis of the insane, chemically and electrically induced shock, lobotomy, lithium, chlorpromazine, mephenesin, monoamine-oxidase inhibitors, tricyclic antidepressants, fluoxetine, chlordiazepoxide, diazepam, disulfiram, and LSD. In each case someone noticed something unexpected in the laboratory or clinic and was able to develop the observation further—or at least publish the paper that allowed others to do so.
Meyers has a good eye for detail and anecdote, and the book is an excellent read. To his credit he unfolds his story within a reasonably sophisticated philosophy of discovery. We are treated to the role of “normal” and “revolutionary” science, as developed by Thomas Kuhn. Meyers is appropriately critical of Richard Nixon's “war on cancer” approach to biomedical research. This, he points out, has led to boring, mundane science that is inefficient and unlikely to give value for money. The routine screening of possible compounds occasionally throws up a useful discovery, but in Meyers' account such discoveries are often as likely to be in a completely different field, needing the prepared, creative scientist to notice the novelty. One gets the impression that Meyers is no great fan of the medical paper with 50 or more authors. Creativity, not teamwork, is the hero of this monograph.
Occasionally Meyers exaggerates the role of serendipity. For instance, Julius Wagner-Jauregg, who won a Nobel prize for his work on malaria infection as treatment for general paralysis of the insane, knew, as did many psychiatrists of the 1910s, that there were many reports of psychotic patients improving after a bout of fever. His creativity, such as it was, lay in devising a controlled way of giving patients a high temperature with vivax malaria, which could then be treated with quinine. The other psychiatric intervention that led to a Nobel prize, lobotomy, did have a touch of serendipity about its introduction, but Meyers curiously suggests that its subsequent widespread use was mostly the result of demand from patients and that doctors were dubious about its virtues. The reality was much messier.
Indeed, the messiness of modern drug discovery and marketing gets fairly short shrift in this account. Meyers is more likely to tell us how many Americans are taking anticoagulants, antidepressants, or tranquillisers, or what the first billion dollar cancer drug was than about side effects, inappropriate prescribing, or dubious claims by drug companies. When we do get such information it is presented in the blandest of terms, quite unlike the tone when Meyers describes original observations.
His cosy blandness is partially redeemed in his last chapter, when he castigates the pernicious lobbying and direct advertising strategies of modern drug companies in the United States. Even here Meyers blames but two of the three guilty parties: companies, for their direct advertising to the general public of expensive add-on drugs that have no benefit; and patients, for responding to such advertising and demanding the drugs from their doctors. But doctors, too, have a responsibility, notwithstanding Meyers' cogent criticisms of the US style medical marketplace.
Meyers exposes the role of chance in the discovery of antibiotics, anticancer drugs, cardiovascular innovations, and psychopharmacology
Happy Accidents: Serendipity in Modern Medical Breakthroughs
Morton A Meyers
Arcade Publishing, $29.95, pp 408
ISBN 978 1 55970 819 7