Happy Accidents: Serendipity in Major Medical Breakthroughs in the Twentieth Century by Morton A. Meyers

the mucosal cells undergo a particular reactive transformation, changes that predispose them to cancer. Gastric cancer is second only to lung cancer as a cause of cancer death worldwide, killing hundreds of thousands of people each year. It is particularly prevalent in Asia and many developing countries. In the United States it is only the ninth most common.
    People with H. pylori gastritis over decades have a risk of developing gastric cancer that is up to six times greater than among people without this infection, but the malignancy actually develops in only a tiny percentage. David Forman of the Imperial Cancer Research Fund in England had originally thought that Marshall's claim for various stomach diseases, including cancer, was a “totally crazy hypothesis.” Now, along with others, he is a convert to the fact that H. pylori infection is a major factor in gastric cancer and in ulcers. By 1993 a status report in Gastroenterology could proclaim: “It would have been unimaginable that such seemingly diverse diseases as gastritis, gastric ulcer, duodenal ulcer, and… gastric carcinoma would all be different manifestations of an infection with a bacterium. The unimaginable has happened.” 17
    M ARSHALL 's O DYSSEY
    Marshall's odyssey illustrates several characteristics that are typical of revolutions in medical science. Earlier observers had seen bacteria in the stomach but their importance was simply not recognized. The inability of these observers to connect the dots meant that opportunities for a major breakthrough were lost. After examination of random samples from limited segments of the stomach derived in a blind fashion, the bacteria were declared a mere contaminant in 1954 by a respected gastroenterologist and therefore of no particular interest. His premature conclusion slammed the door on further investigation. The development of the new technology known as fiberoptic endoscopy was necessary to allow Warren to inspect targeted samples for pathologic changes and thereby serendipitously observe the plentiful coloniesof spiral bacteria deep in the mucus layer. Yet gastroenterologists remained uninterested.
    Marshall was a youthful maverick, not bound by traditional theory and not professionally invested in a widely held set of beliefs. There is such a thing as being too much of an insider. Marshall viewed the problem with fresh eyes and was not constrained by the requirement to obtain approval or funding for his pursuits. It is also noteworthy that his work was accomplished not at a high-powered academic ivory tower with teams of investigators but instead far from the prestigious research centers in the Western Hemisphere.
    The delay in acceptance of Marshall's revolutionary hypothesis reflects the tenacity with which long-held concepts are maintained. Vested interests—intellectual, financial, commercial, status—keep these entrenched. Dogmatic believers find themselves under siege by a new set of explanations. The stage is set, in the scholarly phrase of the historian of science Thomas Kuhn, for “incommensurable competing paradigms where proponents live in different worlds.” 18
    Given the confluence of multiple factors, are certain discoveries inevitable? Some think so. One investigator in the field was of this opinion: “Somebody was going to find the bacterium sooner or later. But the fact is he (Marshall) did find it. And he wrote it up and he pushed it.” 19
    In 2005 Marshall and Warren were awarded the Nobel Prize for Physiology or Medicine. No further proof was needed to disclaim the tongue-in-cheek charge by some that Western Australia is “the wrong end of the wrong place.”

Part II
    The Smell of Garlic
Launches the War on Cancer
It leaves the impression that all shots can be called from a national headquarters; that all, or nearly all, of the really important ideas are already in hand…. It fails to allow for the surprises which must surely lie ahead if we are really going to gain an