Text: Béatrice Schaad
Photo: Patrick Dutoit

Promises can be toxic

He’s on his bed, already partially paralysed. Simply putting on a jumper requires a formidable effort, and he needs help.

He’s on his bed, already partially paralysed. Simply putting on a jumper requires a formidable effort, and he needs help. His wife is usually graciously willing to assist, but that day their baby is screaming in another room and she’s left her husband to deal with it. The jumper is halfway on, his head not even through the neck. Stephen Hawking sat there for several minutes, a prisoner of his clothing. He searched for a glimmer of light through the holes in the knitting. Then the question that would take up his entire life dawned on him, in a split second. Is a black hole the origin of the universe?

The history of research is full of wonderful anecdotes recounting how researchers have turned sometimes totally ordinary situations into intuition. These flashes of insight have always been the driving force of scientific advancement.

However, what has changed is that scientists used to test their hypotheses secretly in their laboratory before reporting them publicly. Today, intuition and communication take place almost simultaneously. We announce what will come of research before even seeing the results. The chickens were counted long ago, but the eggs haven’t yet been laid. When the internet was still in its early stages back in 1994, didn’t Al Gore promise an unprecedented extension of human freedom?

Admittedly, promises contain part utopia, part momentum. They express the end goal of creators, the people who want to change reality as it is. They inspire concrete economic and political choices. And all this is essential when it comes to persevering in the face of the harsh and sluggish world of research.

But in medicine, promises can also be toxic. They are sometimes motivated by growing economic pressure to protect one’s ideas from the competition and can instil empty expectations and bitter disappointment in patients. This is what the authors of an upcoming book call “the poison of false hope”.

Equally detrimental is early communication, all that noise upstream about what researchers hope to achieve. It fuels the idea that medicine is all-powerful and no disease can resist it. It wipes out any powerlessness or limitation. This communication pits patients – with their high expectations sustained by these promises – against healthcare professionals, who are utterly incapable of satisfying everyone. In short, promises institutionalise frustration and therefore conflict.