Saturday, September 27, 2014

Review of Happy Accidents: Serendipity in Modern Medical Breakthroughs by Morton A. Meyers

Our friend Taleb strongly recommended reading Happy Accidents: Serendipity in Modern Medical Breakthroughs by SUNY radiologist Morton Meyers:

"[A] 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.'"
The point of Meyers' book is that almost none of the dozens of most important medical breakthroughs over the past century or so, especially in pharmaceuticals, would have been found by the current medical research system. Huge projects with NIH or other government funding are not what led to breakthrough discoveries. Physicians and scientists tinkering with accidental (serendipitous) discoveries is what has led to breakthroughs. Taleb sees a pattern in the researchers' stories:
  • The discoverer is almost always treated like an idiot by his colleagues. Meyers describes the vicious side effect of "peer reviewing".
  • Often people see the result but cannot connect the dots (researchers are autistic in their own way).
  • 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.
  • Many of the results are initially discovered by an academic researchers who neglects the consequences because it is not his job.
Besides the National Cancer Institute that Taleb mentioned in his review, China is a good example of the failure of top-down research and over-organization. As was discussed in our review of The Party, the Chinese "elite consumes all of the potentially productive capital that innovators might otherwise use to create additional capital. So China's list of inventions is paltry."

The other key insight from the book, which is sort of tangential to his thesis, is that medical discoveries are incredibly slow to be put into practice. Ignaz Semmelweis discovered in 1847 that medical students in Vienna were killing women with puerperal fever by conducting autopsies and then examining patients without washing their hands. Doctors were offended and it took decades for them to finally wash their hands.

There are some things I've read over the past several years that still aren't widely known. For example, while cholesterol levels too high may be bad, the optimal cholesterol is not zero, and it is higher than people think. There is a U-shaped curve where high cholesterol has the well-known cardiovascular effects, but low cholesterol leads to depression and suicide.

Another interesting one is that lithium levels in municipal drinking water are inversely associated with suicide. Note that lithium for mania is one of the breakthroughs in Meyers' book, and he writes that "another factor contributing to slow development of lithium therapy was the lack of commercial interest by pharmaceutical companies in this inexpensive, unpatentable mineral."

I wonder if there are all kinds of mineral deficiencies in the population, because there's something similar occurring with magnesium. This recent paper says that there is "more than sufficient evidence to implicate inadequate dietary magnesium as the main cause of treatment resistant depression, and that physicians should prescribe magnesium for treatment resistant depression". See also this Evolutionary Psychiatry post where she says that the Mg case studies remind her of "old fashioned papers, such as [the] one by John Cade about the use of lithium in mania."

She says that "there is a woeful lack of well-designed, decent-sized randomized controlled trials of various psychiatric disorders and magnesium supplementation." This is because there is no vig for anyone in increasing dietary Mg, and in fact it would torpedo the sales of the big pharma lucrative antidepressants if it works as advocates suspect it does.

I give this a 3/5 in that I wouldn't need to reread it again, but I agree 100% with Meyers' thesis.

1 comment:

James said...


You may enjoy Plague Time by Paul Ewald, which covers similar territory:

The book's message is that infections diseases have evolved in response to better sanitation and that the medical establishment has missed/ignored the implications of this. Ewald mentions Semmelweis and his struggle for acceptance early in the book.