We’ve had magic bullets (q.v.) and holy grails (q.v.). Last autumn, another unobtainable appeared on The BMJ’s news pages: “Is Hunt’s plan to expand medical student numbers more than a party conference pipe dream?”
Pipe dream (sometimes hyphenated) originated in the US in the late 19th century, meaning (OED) a fantastic or impracticable notion or plan, compared to a dream produced by smoking opium; a ‘castle in the air’. I had not realised the connection with opium; I’d just envisaged a chap sitting by the fire wreathed in tobacco smoke, idly dreaming the day away. There are 98 pipe dreams in PubMed®, almost all in titles and many in the form ‘Reality or pipe dream?’ It’s a good metaphor for a title. “Breast cancer vaccines: promise for the future or pipe dream?” could be simply, ‘Are breast cancer vaccines possible?’, but pipe dream enlivens it even though using pipe dream is only asking, ‘Is it likely?’; ‘Is it possible?’ Given the origin of the metaphor, I especially liked “Opioid receptors: pipe dreams realized”, an article headed by a quote from Keats: “…a drowsy numbness pains my sense, as though of hemlock I had drunk, or emptied some dull opiate to the drains”. It wouldn’t harm if all medical authors had to find literary quotations to head their articles; it might tempt them to read good writing.
Sixty of the pipe dream articles have no available abstract. So there is an article in the Journal of Thoracic and Cardiovascular Surgery titled “Reality or singular pipe dream”, and another in Natural Materials titled “Material witness: pipe dreams”, but there are no clues to the dreamer or the dream. The sassily named journal Positively Aware has an article from 1998 titled just Pipe dreams, and that does have an abstract, which is, in its entirety, “A chart is presented listing new compounds that will become available to fight HIV. The chart lists compounds according to when they are expected to be available, their classification, the drug’s significance, and the manufacturer. Contact information is provided for some of the manufacturers.”
On a scale of impossibility, a castle in the air is higher than a pipe dream. An early use was by the French essayist, Michel de Montaigne (1533-92), who wrote, provocatively, “all religion is but a castle in the air”. A pipe dream may come true, but a castle in the air really is impossible. Likening a treatment or outcome to one is to condemn it and there are few castles in PubMed, although as none of the articles has an abstract I don’t know what is being condemned.
Ivory tower is a biblical expression, used from the 19th century to denote academic disdain for everyday practical matters. When describing something as a pipe dream, the writer smiles condescendingly; as a castle in the air, the writer dismisses knowingly; but, describing something as an ivory tower, the writer must take care not to sneer.
Neville Goodman is a retired consultant anaesthetist and a writer. He is co-author of a book on medical English.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that my only competing interest is my co-authorship of a book about medical English.