When science is used to sell hope

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Why, as a clinical physicist-audiologist, I dare to be assertive about treatment promises that are greater than their substantiation

Sometimes I notice that I am more assertive than others.

That happened again during a conversation with colleagues about new developments in tinnitus care. About products and treatments that are presented as innovative, promising, or scientifically substantiated. Lenire is an example of that for me.

I noticed that I reacted emotionally to that. Not because I don't want nuance. Not because I am against science. On the contrary. Precisely because I consider science, patient care, and clinical responsibility too important to keep talking carefully around the subject.

I am a clinical physicist-audiologist. I have been seeing patients with tinnitus, hyperacusis, and sound sensitivity for more than twenty-five years. Not just a few dozen. Not a nice research group in a controlled setting. But thousands of people. People who are afraid. People who are seeking hope. People who have sometimes already tried everything. People who do not just hear a sound, but can become trapped in attention, control, fear, avoidance, and exhaustion.

From that clinical perspective, I sometimes dare to be more assertive than a scientist can be in an article.

The patient is not on a graph.

In science, you have to phrase things carefully. I understand that. Researchers talk about probabilities, limitations, control groups, effect sizes, and follow-up research. That is good. That is part of science.

But something else happens in the consulting room.

There is no average patient sitting there.

There is a person sitting there.

A person who reads on the internet that there is a new treatment. A device. A combination of sound and stimulation. A promise that the brain can be retrained. A suggestion that there is finally something that can reduce tinnitus.

And that is exactly where my concern begins.

Because the patient does not always read the nuance. The patient reads hope.

And hope is beautiful.

But false hope is dangerous.

Not because people will only lose money. That is bad enough. But because people might end up back in the battle. Starting to measure again. Starting to check again. Starting to look for reduction again. Starting to think again: if this doesn't work, then maybe there is something wrong with me.

That is not neutral.

That can exacerbate symptoms.

Why I say: this doesn't work

When I say that Lenire doesn't work for me, I don't mean that no one will ever experience temporary improvement. Of course, there will be people who say they have benefited. That happens with almost every intervention that combines expectation, attention, ritual, guidance, and hope.

But that is exactly the point.

The fact that something has an effect does not mean that the specific mechanism works.

When someone invests a lot of time, money, and attention in a treatment, expectations always arise. Focus emerges. Meaning emerges. Hope emerges. Sometimes there is temporary relief. Sometimes there is a change in how someone experiences their symptoms. That is human. That is powerful. But that does not mean that the device does what it promises.

We, as professionals, must remain vigilant about that.

Because tinnitus is not a simple linear problem. It is not: there is a sound, we counter it with a stimulus, and then the problem disappears. That is not how the brain works. That is not how attention works. That is not how anxiety works. That is not how the attribution of meaning works.

Tinnitus is about hearing, the brain, and the human being.

On perception, interpretation, threat, control, avoidance, sleep, stress, burden, attention, and living space.

In my opinion, anyone who reduces tinnitus to a technical problem that can be solved with a technical device misses the point.

The example of the powerband

We have seen this before.

Years ago, there was the powerband. A wristband that was supposed to improve balance, strength, and energy. People took a test. Without the band, they were pushed off balance. With the band, they stood more firmly. It seemed convincing. You could see it happening. People *felt* the difference.

But it wasn't in the tape.

It lay in expectation, suggestion, attention, and the way the test was conducted.

The body reacts to meaning. To context. To belief. To the relationship between the person doing the testing and the person being tested. That does not make the effect feel fake. People can genuinely experience something. But the explanation is incorrect.

And that is exactly the danger.

An experience is sold as proof.

A feeling of improvement is presented as effect.

A ritual acquires the status of a treatment.

The placebo effect is no detail

Sometimes, the placebo effect is almost dismissed as a minor detail. As if it were a disturbing factor that you simply need to filter out. But with tinnitus, the placebo is no footnote.

It is extremely important.

Tinnitus is particularly sensitive to attention, expectation, reassurance, anxiety reduction, and a change in meaning. If someone feels taken seriously, receives an explanation, experiences hope, and actively takes action, the experience of tinnitus can change. We know that.

But then we have to be honest about what is changing.

Does the sound change by itself?

Or does the relationship to the sound change?

Is the brain really being reset by a specific device?

Or does the threat temporarily decrease because someone thinks they finally have something in their hands?

That distinction is crucial.

Because if we do not make that distinction, we will confuse placebo effects with specific treatment effects. In that case, a human psychological mechanism is used to give a product medical weight.

And then science becomes vulnerable.

We at WC-Eend recommend WC-Eend.

That is why I sometimes have to think of an old Dutch commercial for a toilet-cleaning brand called WC-Eend.

Its slogan became famous in the Netherlands:

“We at WC-Eend recommend WC-Eend.”

For Dutch people, everyone immediately understands what this means. It has become a shorthand for a party with a commercial interest presenting itself as an objective authority on the very product it is trying to sell.

In English, you might say:

“The company selling the solution also happens to be the one telling us that the solution works.”

Of course, reality is more subtle. Of course, there are researchers who sincerely want to know if something works. Of course, there are scientists who try to measure with integrity. But the commercial world understands very well how scientific language works.

A graph inspires confidence. A publication confers status. A white coat confers authority. A study conveys the feeling: this is serious. And that is precisely where we need to be careful.

For science can be used to investigate whether something works. But science can also be employed to give a product credibility. In that case, the order is reversed. One no longer starts with a clinical problem and an open research question, but with a product that needs a market.

That is where my unease lies. Not with science. But with science as a marketing tool.

In the past, science often began with practice.

Many important insights in medicine have arisen because people looked closely. Doctors, practitioners, and researchers saw patterns in patients. They noticed something. They formulated a hypothesis. Then they proceeded to test it.

Practice was not inferior to science. Practice was often its beginning.

Even now, we must not dismiss clinical experience as “just an opinion.” Of course, experience is not the same as proof. But experience is not insignificant either. Certainly not when you see thousands of patients for years and recognize the same mechanisms time and again.

As a clinician, you sometimes see early on where something is wrong.

You can see when a treatment helps people live more freely.

But you also see when a treatment actually traps people further in control, hope, disappointment, and a focus on symptoms.

The latter is my major concern regarding treatments that present tinnitus as something that can be reduced with a device.

My assertiveness does not stem from hardness.

I notice that my assertiveness sometimes clashes.

When consulting with colleagues, it can feel as though I am standing in opposition to nuance. As if I am going too fast. As if I am being too emotional.

But my certainty does not stem from hardness.

My certainty stems from concern.

I picture the patients. The young people who no longer dare to sleep. The elderly who are desperately seeking silence. The people who have already spent thousands of euros. The people who say: “I had hoped so much that this would help.” The people who, after the next failed treatment, are not only disappointed in the product, but also in themselves.

That is where my emotion lies.

I do not want us as professionals, however unintentionally, to contribute to a fog in which patients believe there is a proven effective solution.

Nuance is important. But nuance must not become fog.

What I do expect, then

I do not expect that we will immediately reject every new development.

Research is allowed. Innovation is allowed. Curiosity is allowed. In fact, we need it.

But the bar must be set high.

Especially for vulnerable patient groups. Especially with tinnitus. Especially when commercial parties sell hope to people who are sometimes desperate.

Then we, as audiological centers, practitioners, and scientists, may be clear.

Not: “Maybe it helps, maybe not, time will tell.”

But rather:

At this moment, there are major caveats. We must be extremely cautious about suggesting that this is an effective treatment. And we must clearly explain to patients that improvement in the experience of tinnitus is different from evidence for a specific mechanism of action of a device.

That is not negativity. That is protection.

The world upside down

What touches me is that sometimes it feels like the world is turned upside down.

Not first spending years understanding what tinnitus is from clinical practice. Not first looking at the complexity of hearing, the brain, and the human being. Not first investigating how anxiety, attention, and avoidance play a role.

But developing a product, building a scientific layer around it, and then saying: look, there is research.

And in the meantime, patients are drawn into a story of technological hope.

I cannot look at that neutrally. I have seen too many people for that. I know too well how fragile hope is.

When research itself becomes hope

Today I received another email from someone with severe tinnitus.

Complaints for years. Already tried treatment. Still searching.

First to a center that talks a lot about neuromodulation. Then to deep brain stimulation. Then to a possible new study.

Not with the question of how he can better cope with his tinnitus.

Not with the question of how he can make his life bigger again.

But with the question:

Can you help me get to participate in that study?

Not because anyone is naive. But because suffering makes people search.

That is precisely where my concern lies.

For a patient, examination is rarely just examination. It becomes hope. A door. Maybe the next chance. Maybe finally the button.

But tinnitus is not a switch.

Tinnitus is hearing, brain, and human. Attention, threat, sleep, stress, control, meaning, and life balance.

When we reduce that complex whole to a single device, a single intervention, or a single promising study, we make the story too small.

And then hope can become a waiting room again.

Waiting for the next study. The next treatment. The next breakthrough.

Meanwhile, life stands still.

Therefore, we as professionals must be clear.

Research is important.

But research must not become a place where people park their lives.

Finally

Perhaps it will turn out someday that I was too assertive. That is allowed. Science may correct me.

But until then, I feel a professional responsibility to be clear.

Not because I want to be right. Not because I am against innovation. Not because I distrust science.

But because I believe that science should not be misused to sell hope. And because I believe that real tinnitus care begins with honesty. With explanation. With understanding the brain. With restoring trust. With making room for life, despite the sound.

Perhaps my language sounds harsh. But soft healers make deep wounds. When a technological ritual is presented as a medical treatment while the substantiation is insufficient, caution is not always mildness. Sometimes caution becomes complicit in confusion.

Sometimes, as a clinician, you have to dare to say:

This is not correct.

Not later. Not only when the next study confirms it. But now.

Because today's patient is not helped by tomorrow's nuance.

I am writing this text in a personal capacity, based on my clinical experience as a clinical physicist-audiologist. My criticism is not directed at individual patients, researchers, or practitioners, but at the way in which technological treatment claims for tinnitus can be presented and received.