Powerlessness and impotence

“Powerlessness and impotence” by Mark Palfreyman

The coronavirus pandemic has shone a light on the abilities and limitations of medics and scientists alike.


When medics have an existential crisis, they look to science. And when scientists have an existential crisis, they look to medicine.

The paradox of medicine is that despite offering its practitioners real power and the opportunity to literally save people’s lives, it can also – over time – breed a peculiar sense of powerlessness: no matter how many people you patch up, they keep coming. No matter how good your drugs, your equipment, and your coworkers are – and as we’re discovering during the coronavirus pandemic, in certain circumstances even those things can be in short supply – your ability to influence events is limited to one patient at a time.

We also shouldn’t forget that even this ability is a surprisingly recent acquisition for the profession. The late Lewis Thomas’ autobiography (“The Youngest Science”) provides one of the most vivid depictions of the pre-antibiotic era, when a doctor’s role was basically limited to diagnosis and some palliative gestures. When medics are criticised they are often portrayed as “playing god”, but these are young gods whose influence can only be exerted at the individual level.

And right now, we’re seeing the limits of that influence. A lot. Healthcare systems overwhelmed, shortages of ventilators, doctors forced into decisions about who gets treatment and who doesn’t, all against a drumbeat of ongoing and unrelenting mortality. A mortality that includes the healthcare workers themselves (over 100 have died in Italy alone) – the young gods are not immortal either.

When that sense of powerlessness sets in, medics in the grip of an existential crisis often look with envy on the scientists who, set apart from the coughing and the rasping and the dying, can offer an ultimate cure. A new drug, a new vaccine, a new treatment, a new insight, a new understanding. Something that addresses the big picture, that can offer hope not just to one patient, but to all patients simultaneously.

It’s an ironic predicament, because the overwhelming feeling for many scientists right now is one of profound impotence. Scientists are acutely aware that it’s the medics literally putting their bodies on the line and making a difference when emergencies strike.

This feeling of uselessness is especially acute for those in the biological sciences, who work close to medicine and whose work is often funded by medical research councils. For those confined to home and looking after kids, it’s especially galling. There’s a global biomedical emergency and the scientists are left doing childcare instead of healthcare.

There have, of course, been efforts to mobilise. Scientists, in their thousands, have volunteered through various institutional or crowd-sourced initiatives to donate protective equipment, assist with diagnostic tests, and those with relevant specialisations have started churning out paper after paper on the molecular biology, pathology, and epidemiology of the coronavirus.

The degree of possible mobilisation has varied from country to country, however. In the UK, prominent academics such as Matthew Freeman (University of Oxford) have repeatedly appealed for the university workforce to be mobilised in the diagnostic effort, but their overtures have been largely rebuffed by central government.

One notable fact is that science’s practical outputs – the focus of the medics’ envy – are strictly for the future, and often the far future. A vaccine is probably 6 months off (and even that would be record-breaking in its speed), and validated drugs not much less than that. Science’s allure is its ability to focus on the big picture instead of the individual patient, but its promise inevitably lies further off in the distance. It takes time.

This apparent inability to save lives or make a difference in the here and now makes scientists look at medics (those same stressed, traumatised, exhausted medics) with a sense of admiration and envy. The scientists’ existential crisis is that their ability to make an immediate difference is very limited, and the mobilisation to do something, anything, to be of help is an indirect acknowledgement of that relative impotence.

Science is driven by curiosity about the natural world. Many scientists do want to help society, and in the biological sciences, this translates into a motivation to study diseases. Getting insight into a disease and thereby into its fundamental mechanisms may lead to treatment (“identify possible drug targets” is a mantra in grant applications). But science remains detached. No matter what you do, you’re unlikely to ever see a vaccine or drug hit the market in your professional lifetime, especially if you’re working in basic research. Medicine offers the possibility of making a real difference immediately. This is the empowering thing about medicine.

Medicine is driven by a desire to help and heal people. But as noted already, medics’ point of action is always focused on the individual patient, while scientific research offers a glimmer of hope for an ultimate cure. This is the empowering thing about science.

Scientists and medics are often portrayed or perceived as two tribes. The stereotypical medic (at the extreme) doesn’t worry about understanding how or why something works, so long as it’s effective and thereby assists the patient. The stereotypical scientist (at the extreme) is consumed by the need to know how and why something works, even if it is of little or no practical value.

The fact that the members of those two tribes persistently envy the other in their moments of existential crisis reveals something important. It’s natural that we often only see the shortcomings of our chosen profession, but the fact that the practitioners of these two careers so neatly envy each other shows that the two pursuits are in fact highly complementary. Both are important: in the here and now, and in the future.



Artwork this week is from Mark Palfreyman. He writes, “Not all who wander are lost, but most are. I’m one of those. I started my life in France playing with worms, after college in Colorado decided to try it again. I moved to Utah and did a PhD. Then I found some fruit flies in Vienna and played with them. Now I’m taking a step sideways as a duck might step sideways à l’orange; or, maybe more likely, as a coq steps sideways au vin. What I’m currently doing, I know not.

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