• Mark E Nunnally.
• Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA. mnunnall@dacc.uchicago.edu
• Crit. Care Med. 2010 Nov 1; 38 (11): 2247-9.

ObjectivePredictions about the future impact of technologic and process innovations inspire optimistic visions. Optimism and speculation require a counterweight. Because results often do not turn out as expected, anticipating failure is useful, and anticipating unintended consequences is visionary.MeasurementsA history of unfulfilled prognostications was explored with the intent of finding something essential to the complexities of medicine. Do missed predictions signal another side to innovation that also helps us uncover new information about our world?Main ResultsSerendipity is an important theme in medical innovation. There is no reason to think this will change. Things do not necessarily go as planned, but often the results are as important as the original prediction was supposed to be. It will not be clear where we end up until we get there.ConclusionsIdeal goals are useful but speculative and subjective. There in fact might be several ideals and contingency is important. The detours and incidental stops on the way to an ideal are more fruitful than the goal itself.

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