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Nassim Nicolás Taleb (Flaneur)
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."
From Happy Accidents: Serendipity in Modern Medical Breakthroughs, by Morton Meyers, a book that just came out. It is a MUST read. Please go buy it. Read it twice, not once. Although the author does not take my drastic "stochastic tinkering" approach, he provides all kind of empirical evidence for the role of design. He does not directly discuss the narrative fallacy(q.v.) and the retrospective distortion (q.v.) but he certainly allows us to rewrite the history of medicine.
We did not realize that cures for cancer had been coming from other brands of research. You search for noncancer drugs and find something you were not looking for (and vice versa). But the interesting constant:
a- The discoverer is almost always treated like an idiot by his colleagues. Meyers describes the vicious side effect of "peer reviewing".
b- Often people see the result but cannot connect the dots (researchers are autistic in their own way).
c- 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. The establishment kept asking him "where is your M.D., monsieur". Luckily Pasteur had too much confidence to be deterred.
d- Many of the results are initially discovered by an academic researchers who neglects the consequences because it is not his job --he has a script to follow. Or he cannot connect the dots because he is a nerd. Meyers uses Darwin as the ultimate model: the independent gentleman scholar who does not need anyone and can follow a lead when he sees it.
e- It seems to me that discoverers are nonnerds.
Now it is depressing to see the works of the late Roy Porter, a man with remarkable curiosity and a refined intellect, who wrote many charming books on the history of medicine. Does the narrative fallacy cancels everything he did? I hope not. We urgently need to rewrite the history of medicine without the ex post explanations. Meyers started the process: he provides data for modern medicine since, say, Pasteur. I am more interested in the genesis of the field before the Galenic nerdification.
An entertaining and accessible look at the role of serendipity in major medical and scientific breakthroughs of the twentieth century explains how chance and lucky accidents led to the discovery of such medical advances as penicillin, chemotherapy drugs, X-rays, Valium, the Pap smear, and Viagra.