Monday, 21 April 2014

Serendipity, chance and the anatomy of discovery in Happy Accidents

From The Week of April 6th, 2014

Serendipity is a constant throughout our lives. Whether it is the tragedy narrowly avoided or the good news received at just the right moment, its unexpected gifts and arrows have the power to delight, to terrify and to change our world. For who hasn't had the course of their existence altered by a moment unlooked for, a circumstance not considered? But for all of serendipity's capacity to change our moods and our lives, is it not, on some level, merely a means by which to explain the strange oddities that chance sometimes throws up? Is it not an evocation of some external force to explain a lack of vision? The absence of the mental clarity to consider all that lies before us? Whatever its implications, it lies at the heart of this fascinating history of medicine from Mr. Mayers.

Of all the industries that have been redefined over the last two centuries, few have experienced more change, and more advancement, than medicine. As late as the 19th century, doctors were little more than priests when it came to their capacity to heal. They had a handful of steadfast remedies with which they could attempt to mend the broken, but their knowledge of the human body was about as poor as their comprehension of the world around them. Germs and diseases had yet to be discovered, let alone studied. And curatives were often as poisonous to the patient as the affliction. Comprehension of the world and all its forces was so poor that, even when radiation was discovered at the turn of the 20th century, it was thought to be beneficial, even therapeutic. It wasn't until cancers began to erupt from these applications that the true cost of playing with such fundamental forces was revealed. Ignorance, creating assumptions, creating dogmas, until those dogmas were shattered in the face of hard truths.

But as dark as the 19th century may have been for medicine, the 20th was a revolution. Where prior centuries had been a wasteland of discovery and understanding, treatments for cancer, Tuberculosis, bacterial infection, heart attacks and high blood pressure all became widespread. Even the mysteries of the brain were, to some degree, conquered with drugs that successfully fought numerous strains of mental illness. In les than a hundred years, the doctor's toolbox expanded from prayer and good fortune to hundreds of possible remedies for any of a host of formerly lethal conditions. But just how did these magnificent discoveries eventuate? Were humans suddenly smarter, more intuitive, more understanding of the human form and its connection to the broader world, or were there other forces at play?

A persuasive argument for the virtues of screwing up, Happy Accidents is an engaging adventure through the slap-dash, serendipitous world of medicine and the discoveries that have shaped its last hundred years. Morton Mayers, himself a medical doctor, divides his chronicle up into sections, each of which sheds light upon the fundamental workings of the heart, the cell,the circulatory system, the blood and even the brain. His intent is not so much to give his readers a refresher on high-school biology, though he does this admirably, as to illuminate the anatomy of the breakthroughs, the circumstances that surrounded the key insights that not only pulled back the curtain on the innerworkings of these systems, but that lead to revolutionary cures that have restored life to the terminal and sanity to the doomed. In each case, from antibiotics to antipsychotics, from Lipitor to Lithium, he exposes a startlingly clear pattern of ignorance that was dispelled by happenstance, leading to awareness and, finally, to solutions.

Underpinning Mr. Mayers' work here is the understanding that humans invariably operate based on a collection of assumptions that become, in their certainty, unhelpfully dogmatic. X should not work on Y because of Z. But of course, truths are only true until they are proven false. The sun revolved around the Earth until it didn't. The Earth was 6,000 years old until it wasn't. Emotions stemmed from the heart until they didn't. Certainty; giving way to puzzlement in the face of contradictions; forcing the forging of newer, better certainties; starting the process all over again until perhaps something like knowledge is possessed. However, given the discomfort of living in constant doubt, we like certainty. We cling to it and we are damned by it. For it blinds us to the discoveries, the connections, that would be obvious to us if we were willing to try everything rather than being dismissive out of hand and waiting for random chance to drop fortunate outcomes into our laps.

But as wonderfully as the author constructs this argument, and as much knowledge as he drops on the reader during its repeated demonstration, his proscriptions for its rectification seem inadequate. Mr. Mayers levels an accusatory finger at everyone, from big pharma to big government, to explain why this age of rapid discovery has slowed, why fewer treatments than ever are being discovered. And perhaps he is right to blame these forces interfering with good research. However, Happy Accidents is nothing if not a book about the narrow mindedness of humanity, of how we have to practically be smashed over the head with a gong before we see what's before us. And so crediting serendipity for the golden age of medicine and then blaming institutions for its end seems, at best, inconsistent and, at worst, blind to the possibility that we have plucked all the low-hanging fruit. We have made most, if not all, of the simple discoveries that it's possible for chance to gift to us, that what remains are more systemic discoveries that will require open minds and collaborative efforts to achieve.

Happy Accidents is a dense and deeply rewarding adventure through the human body and the men and women who reduced it from mysterious phenomenon to a highly complex machine that we've gone a long way to explaining. For this knowledge alone, a must read. For those intrigued by happenstance and randomness, no disappointment will be found within these pages. But for those looking for solutions to the intriguing problems posed here, the answers will have to be sought out elsewhere. (4/5 Stars)

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