Chapter 1: The Role of Chance in Medical Discoveries

In the realm of medicine, the influence of chance can be profound, often leading to unexpected breakthroughs. While scientific inquiry provides a framework for understanding complex medical conditions, there are times when fate takes the reins.

Many refer to these occurrences as luck, serendipity, or even destiny. Regardless of the label, these "accidental" discoveries have significantly contributed to advancements in medical diagnoses and treatments. A personal experience involving my wife’s sudden vision loss illustrates this phenomenon well.

Before delving into her story, let's reflect on other significant medical breakthroughs. For instance, Alexander Fleming's unintentional discovery of penicillin marked the inception of antibiotics. Similarly, a Danish research team investigating malaria prevention in pregnant women stumbled upon a potential cancer treatment. Additionally, the creation of the implantable heart pacemaker and the first blood thinner, warfarin, exemplify how chance can lead to transformative innovations.

My wife suffers from a hereditary eye condition known as granular corneal dystrophy, specifically Type 2 or Avellino dystrophy, named after the small town in Italy where it originated. This condition leads to plaque formation in the cornea, generally not affecting vision until later in life, often requiring a corneal transplant—though the results can be temporary and fraught with complications.

After my wife had cataract surgery in 2017, she unexpectedly experienced nearly complete blindness by 2019. Multiple specialists attributed this to her corneal dystrophy, and despite undergoing a laser procedure at a prestigious university eye center, her vision did not improve.

It wasn't until her cataract surgeon discovered that scar tissue behind her lens was the true culprit that things changed. A quick, painless YAG laser procedure resolved the issue, restoring her sight almost immediately. In my Medium post, I detail her journey and the common oversights made by medical professionals.

Currently, her vision is deteriorating again due to the progression of her corneal dystrophy. To manage this, her specialist has recommended hard contact lenses. During a recent visit, after the assistant fitted her with the lenses, my wife’s vision surprisingly worsened. We both speculated that the wrong prescription had been used.

While waiting to see the optometrist, she randomly retrieved her +3.25 diopter reading glasses from her bag and put them on. To her delight, she exclaimed, "I can see! I can read the words on the television, and everyone’s face is so clear!"

The entire waiting room turned to look at her. I asked her to read the words on the screen, and she did so flawlessly. I was astonished, pondering how this was even possible.

After her examination, the optometrist explained that while the prescription was indeed incorrect, this isn't unusual with irregular corneal surfaces. It may take a few attempts to find the right fit. Her reading glasses corrected the long-distance prescription, leading to this unexpected improvement.

This incident can be seen as a stroke of luck, karma, or coincidence, depending on one’s beliefs. My wife remains uncertain about why she instinctively reached for her reading glasses. It’s likely that even the eye doctor did not foresee this outcome.

Throughout my years in medical practice, I have witnessed similar occurrences too frequently to dismiss them. Some might attribute this to karma or the universe conspiring to assist us. My wife strongly believed the contact lenses would work, and when they didn't, perhaps an unseen force guided her and her doctor to the solution.

A deeply religious person may see this as a miracle stemming from profound faith. My wife, a devout Catholic, had even prayed for assistance with her declining eyesight, a fact she only recently shared with me.

Conversely, skeptics might view this as mere coincidence, one of countless random events in the universe. Their perspective often confines them to the laws of nature and science when assessing causes and effects. This raises an intriguing question: can one be both a doctor or scientist and maintain a belief in miracles? I believe it is entirely possible.

Doctors, despite their training, cannot predict every outcome. If they could, I would have retired long ago, having accurately forecasted the next lottery numbers. Instead, we analyze patterns and risks associated with complex diseases, making educated guesses and recommendations, but absolute predictions can be misleading.

I recall a patient named Natalie, who was in her early 90s when I first met her. She suffered from congestive heart failure due to a leaky valve. Though medications helped to an extent, the underlying issue was mechanical, necessitating a valve replacement. Despite this, she declined surgery due to other health concerns. As expected, her heart condition worsened, and medical studies predicted she had a limited lifespan. Yet, she astonished us all by living to 106! Every six months, she would visit, greeting me with a smile and asking, "Are you surprised to see me?" To which I would honestly reply, "Yes." Natalie's longevity was not a result of any special care on my part but rather sheer luck.

I have a strong faith in the scientific method, though I remain cautious about anecdotal evidence. High-quality scientific studies are essential for discerning cause and effect in medicine. Ideally, these studies should be prospective, double-blind, randomized, and crossover in design. However, the recent pandemic and the missteps of government policies have led me to question some of these beliefs.

Yet, I have witnessed enough unexpected outcomes to retain my faith that a higher power may be at work alongside us. Thus, faith, spirituality, and science can coexist harmoniously.

Dr. Barron Lerner discusses how luck plays a role in medicine, noting that many physicians are hesitant to acknowledge its impact. The prevailing notion is that luck contradicts the scientific foundation of medicine, leading many to believe that the two cannot coexist. I argue otherwise, as doctors make mistakes, lack complete knowledge, and cannot predict every outcome. To think otherwise is a form of arrogance.

In conclusion, I recall advice from a former partner after a challenging coronary stent procedure. When I commended him on the successful outcome, he remarked, “Sometimes it’s better to be lucky than good.”

I am a retired MD with a passion for culture, medicine, health, sports, and food. Stay informed about my writings by subscribing for updates.