title: An alternative point of view: getting by with less: what's wrong with perfection?
abstract: OBJECTIVE
  Predictions 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.
  
  
  METHODS
  A 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?
  
  
  RESULTS
  Serendipity 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.
  
  
  CONCLUSIONS
  Ideal 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.
authors: Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA. mnunnall@dacc.uchicago.edu
authors: Mark E
authors: ME
authors: Nunnally
mesh_terms: D020811:Biomedical Technology / Q000639:trends; D003422:Critical Care / Q000379:methods* / Q000639:trends; D016638:Critical Illness / Q000628:therapy; D005544:Forecasting; D006801:Humans; D009102:Multiple Organ Failure / Q000628:therapy*; D035703:Therapies, Investigational / Q000639:trends