Book review: happy accidents
Authors: Sanjay A Pai
Journal: Journal of the Royal Society of Medicine (2008)

Serendipity, as most physicians know, is the term coined in a letter by Horace Walpole in 1754, wherein he referred to three princes of Serendip (the Persian name for Sri Lanka) who made unusual discoveries by chance. The phrase was popularized by Walter Cannon much later. Scientists have often benefited from serendipitous observations, with the best-known example in medicine being the discovery of penicillin by Alexander Fleming. There is a large body of literature, mainly in journals, on serendipity in medicine.

Morton Meyers, a radiologist, with an interest in serendipity and history of medicine, has put together a book detailing numerous examples. I, too, have a special interest in the subject and have written on it – though I cannot claim to have made any discoveries, serendipitously or otherwise! – but was pleasantly surprised to learn of so many examples of which I was not aware. There are four separate sections, with articles on infectious disease and pharmacology, cancer, cardiology and psychiatry. The usual suspects are covered, including the discovery of penicillin as an antibiotic and the beginnings of cancer chemotherapy due to an observation of leucopoenia in survivors of a bombing attack during World War II, when mustard gas was released into the atmosphere. However, we also learn about the role that serendipity has played in the discovery of aspirin’s efficacy as an agent against colon cancer, cisplatin as an antineoplastic, the acid fast stain for tuberculosis and thalidomide as an anti-angiogenesis drug, among others.

Many anecdotes, not all of which are related to serendipity, come to light. Wilhelm Einthoven, the discoverer of the ECG, was an honourable man in addition to being a great researcher. After receiving the Nobel Prize in 1924, he tried to track down his assistant to give him a share of the prize money. On learning that his assistant had passed away but that his sisters were living in poverty, Einthoven gave them half of the money. On the other hand, von Behring, the winner of the 1901 Nobel Prize, did not acknowledge the contributions of Paul Ehrlich, a fact that is not well known to many – including Wikipedia.

My only concern is that a few of the anecdotes would at best be bordering on serendipity. The use of thalidomide for blocking angiogenesis was indeed a direct offshoot of another observation, the unfortunate one of seal limbs in babies – yet to my mind, this does not qualify as classic serendipity. Nor, for that matter, does the discovery of salvarsan for the treatment of syphilis by Paul Ehrlich. While there was indeed some luck involved, the fact is that Ehrich was working specifically on a chemotherapeutic agent against the bacterium that causes syphilis (the actual story is too long to be recounted here). Luck forms an important part of any research venture, but to ascribe everything to serendipity is overkill.

What message does the book carry, beyond informing and entertaining the reader? It is obvious to anyone reading this book that structured, linear-thinking research is not always successful. Luck favours those who investigate every curious, apparently irrelevant observation. Meyers suggests that the referees who sit on committees and give grants to evidence-based medicine take a fresh look at their beliefs and accommodate creative, unbiased thinking. To this end, he has interviewed numerous historians and researchers, including Nobel laureates, who have admitted that luck played a major role in their discovery. Meyers states, quite correctly, that maverick, outside-the-box thinking is unlikely to be accepted by peers who think within the accepted paradigms. Pharmaceutical research, too, he believes, suffers from the same problem of not taking risks. Meyers explains what factors make ‘lucky’ scientists tick and believes that it is essential for educators to emphasize the importance of original thinking in science.