Neville Goodman’s Metaphor Watch: Holy Grail

neville_goodmanThe Holy Grail (COD) is the cup or platter used by Christ at the Last Supper, and in which St Joseph of Arimathea received Christ’s blood. As such, it is a metaphor for anything that is eagerly sought after. There is much in medicine that is eagerly sought after—not least, magic bullets (qv)—and there are nearly 900 Holy Grails in PubMed®, over 500 of them in article titles.

There are another nearly 200 Grails that omit the holy, but that number is misleading: GRAIL is an acronym for a computer programme in gene mapping (gene recognition and analysis internet link) and for an astrophysical project (gravity recovery and interior laboratory). It also stands for GALEN representation and integration language. GALEN is generalised architecture for languages, encyclopaedias, and nomenclatures in medicine.

The GALEN project is an EU funded project that “aims to develop language independent concept representation systems as the foundations for the next generation of multilingual coding systems.” I think I know what that means, but writing instead “aims to develop coding for medical terms which is independent of language” untangles the frightful noun cluster of “language independent concept representation systems.” The untangling shows “as the foundations for the next generation of multilingual coding systems” to be tautologous. I wish them luck, but wonder how many steps it takes to change GALEN into BABEL.

PubMed’s® first Holy Grail appeared in 1979, in the Lancet. Titled imaginatively, “In search of the Holy Grail,” there is no abstract. ScienceDirect wanted $36 for access. In these days of open access journals, even for current research, how can any scientific organisation justify a paywall to just a couple of pages of almost certainly out of date opinion from 35 years ago? When Holy Grail is part of a title, most of the articles either have a secondary title—”In search of the Holy Grail: folate-targeted nanoparticles for cancer therapy“—or the phrase is incorporated: “The quest toward the Holy Grail of mechanical circulatory support.”

And these two titles illustrate how unimaginative Holy Grail is as a metaphor. The metaphor should enliven but, like magic bullet, it adds nothing. If we were to develop targeted nanoparticles, they might enable better cancer therapy, but there are all sorts of ways in which they might fail. Even if they did enable better therapy, would they mean cancer would always be curable? Would it mean the winding up of cancer research as unnecessary? Because that, surely, is what a Holy Grail is all about. The Holy Grail grants eternal life to those who drink from it, not just another year or two with a number of side effects. Yes, “Prevention and cure of diabetes is the Holy Grail but remain elusive due to lack of detailed understanding of the metabolic, genetic, and immunological causes that underpin diabetes,” but that is a confession of ignorance better introduced by, “We are unlikely to prevent or cure diabetes until . . . ,” and that is a truism.

Let’s leave the Holy Grail to Monty Python and Indiana Jones (who illustrated the supreme importance of choosing the right grail to drink from), and realise that writing about the Holy Grail says no more than, “It would be nice if . . . ”

Neville Goodman is a retired consultant anaesthetist and a writer, and 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.