Glenn Reynolds links a Reuters report of a new study, which he calls "MORE POTENTIALLY MONEY-SAVING NEWS FROM THE WORLD OF HEALTHCARE RESEARCH."

How true. Although cost-cutting is not specifically mentioned in this research report, a new meme is inescapable: save money by eliminating hope.

The Reuters headline makes a sweeping claim which I don't think is supported by the study at all:

U-M Research Shows Chronically Ill Patients Might Be Happier if They Give Up Hope

Study shows that colostomy patients who believed their condition was irreversible reported better quality of life than those with faith that they would be cured

ANN ARBOR, Mich., Nov. 2 /PRNewswire-USNewswire/ -- Holding on to hope may not make patients happier as they deal with chronic illness or diseases, according to a new study by University of Michigan Health System researchers.

"Hope is an important part of happiness," said Peter A. Ubel, M.D., director of the U-M Center for Behavioral and Decision Sciences in Medicine and one of the authors of the happily hopeless study, "but there's a dark side of hope. Sometimes, if hope makes people put off getting on with their life, it can get in the way of happiness."

The results showed that people do not adapt well to situations if they are believed to be short-term. Ubel and his co-authors -- both from U-M and Carnegie Mellon University -- studied patients who had new colostomies: their colons were removed and they had to have bowel movements in a pouch that lies
outside their body.

At the time they received their colostomy, some patients were told that the colostomy was reversible -- that they would undergo a second operation to reconnect their bowels after several months. Others were told that the colostomy was permanent and that they would never have normal bowel function again. The second group -- the one without hope -- reported being happier over the next six months than those with reversible colostomies.

"We think they were happier because they got on with their lives. They realized the cards they were dealt, and recognized that they had no choice but to play with those cards," says Ubel, who is also a professor in the Department of Internal Medicine.

"The other group was waiting for their colostomy to be reversed," he added. "They contrasted their current life with the life they hoped to lead, and didn't make the best of their current situation."

It is not hope that is at issue here, but certainty of outcome. People who are waiting for another operation which will restore them to normal are of course not going to devote a lot of time adjusting to the difficulty of using a colostomy bag, not will they be resigned to it. It's like the difference between temporary blindness and permanent blindness. If a patient were told after eye surgery that he was now temporarily blind, but in six months his vision would be restored by another operation, it would be pointless for him to get a seeing eye dog, learn braille, and spend the six months practicing navigation with a white cane, wouldn't it? Obviously, someone who really was permanently blind would devote his all to doing these things, because he would have a new life as a blind person. Surely, no one would argue that the permanently blind are better off than than the temporarily blind, would they?

The same would probably hold true with two groups of amputees who had lost a leg, with one group being told the leg was gone for good and the other being told about a new treatment that would grow a new, genetically-identical leg from the patient's stem cells, but that it would take six months to grow and another operation to attach. Which patient would be doing better with the crutches and the artificial leg in six months?

And if you were told by your doctor that you could not drive for six months, you'd probably be more miserable during that six months of not driving than if you had your license permanently yanked for medical reasons. The latter would mean you'd do a more thorough job of adjusting to no more driving.

What I would like to know is how is any of this is a lesson in hope. I see the problem as involving certainty.

The important thing is the time period:

The second group -- the one without hope -- reported being happier over the next six months than those with reversible colostomies.

What's surprising to me is that anyone would be surprised by this. It's common sense, and I don't think it should have required a study.

Considering the obvious limitations of the study, the implications of the headline become almost sinister.

Again,

U-M Research Shows Chronically Ill Patients Might Be Happier if They Give Up Hope

How did this "research" show that in any way? I would not consider colostomy patients chronically ill once they have recovered from the surgery, and certainly those who later have normal bowel function restored are not. And since when does learning to live with a handicap (which a permanent colostomy certainly is) constitute "giving up hope"? Couldn't it be argued that it's the opposite? What worries me is the clear attempt to extrapolate from colostomy patients to much more serious and terminal conditions, when these things are not the same at all. But the authors go further than that -- even analogizing to death:

Loewenstein said these results also may explain why people who lose a spouse to death often recover better emotionally over time than those who get divorced.

"If your husband or wife dies, you have closure. There aren't any lingering possibilities for reconciliation," Loewenstein said.

The authors also fault doctors for being optimistic:

Ubel said health professionals find it easier to deliver optimistic news to patients even when they believe the prognosis is unfavorable, justifying it by assuming that holding on to hope was better for the patient.

Said Loewenstein: "It may be easier for a doctor to deliver a hopeful message
to a patient, even when there isn't much objective reason for hope, but it may
not be best for the patient."

"Hopeful messages may not be in the best interests of the patient and may interfere with the patient's emotional adaptation," Ubel says. "I don't think we should take hope away. But I think we have to be careful about building up people's hope so much that they put off living their lives."

How supremely condescending.

Who the hell gets to decide such things?

And what's next? Helping patients "get on with their deaths"? No doubt studies would show that people who have resigned themselves to death are happier than people struggling to live.

(I guess I should be glad they don't apply this "happier without hope" meme to politics or they might want to make elections illegal.)

UPDATE: Study author George Loewenstein is Sigmund Freud's great grandson, and a professor of Economics.

Hmmm...

I'm glad I didn't know that when I wrote this post. I might have been less dismissive.

(Not that there's anything rational about that!)