IBS: post modern medical nemesis.
The history of medicine over the last 100 years has been nothing short of miraculous. The diseases that used to kill millions: smallpox, tuberculosis, typhoid, typhus, cholera, pneumonia have all but disappeared. Doctors have effective treatments for heart failure, diabetes, renal failure, liver failure, colitis, coeliac disease, and many other life threatening conditions. They can prevent heart attacks and strokes, treat Parkinson’s Disease and arrest the course of many different cancers. People are living far longer; eighty is the new sixty. We have come a long way and might be forgiven for thinking that human disease will soon become a historical curiosity, a thing of the past.
Yet the recent Long Term Conditions Compendium of Information, published by Department of Health in 2012 reported that as many as one in five new consultations in primary care, 7% of all prescriptions, 25% of outpatient care, 8% of inpatient bed days and 5% of A&E attendances are for illnesses can neither diagnose or treat effectively. It is estimated that the NHS spends £3 billion a year on medically unexplained illnesses. For people with medically unexplained symptoms, contacts with primary care physicians may be at least 50% greater than in the general population and they may also have 33% more secondary care consultations. Obesity, food intolerance, Chronic Fatigue Syndrome, Depression, Fibromyalgia, backache, headache, insomnia, arthritis and of course, the Irritable Bowel Syndrome, are so much more common that they used to be. They are ‘the illnesses that doctors cannot cure’. Modern medicine has failed to keep up with the long trudge of poorly explained illnesses; the 30% of the population that are chronically sick with these conditions usually have several overlapping diagnoses. So what is going on? Is it all in the mind? Is it our lifestyle? Does the combination of a restricted diet, stress and frequent use of antibiotics deplete the beneficial bacteria that make up 90% of the cells in our body? Are these societal ills; the effects of poverty and deprivation and a lack of any real influence on those who control our lives? Is it all the above and more? In previous posts, I have suggested that there is not a specific or even a dominant pathological factor in IBS. Immunological hyper-reactivity, disturbances in intestinal motility and sensitivity, changes in the populations of bacteria in the colon, perturbation along the brain gut axis, emotional stress, a leaky gut may all be involved either as causes or effects. The result is a colon that is ‘reset’ to a more sensitive state.
Nevertheless, medical philosophy has remained stuck in heady days of the last century, when research opened up possibilities for the eradication of infectious disease and suppression of many other known illnesses. It is a case of a pill for every ill – make a definitive diagnosis, apply a specific treatment and receive thanks from a grateful patient. But despite the high regard that society bestows upon it, medical research is an inexact science, replete with flaws and fallacies. A specific technological approach does not work for most ‘illness’, yet people are conditioned to expect it and doctors trained to deliver it. We urgently need to change the paradigm for unexplained or ‘functional’ illness, while retaining the technological miracles for those diseases we can treat.
Illness is an expression of who we are; an amalgam of the forces that have shaped us; our inheritance, upbringing, our physical and social environment, our diet and life style and the things that have happened to us. How can we hope to convey all of that to our doctor in an eight minute appointment? These days, few patients are known by the doctors they see in their modern group practices. So all doctors can do for somebody that do not know with an illness that they cannot understand is to screen for what it is not, write another prescription, put them on a diet or refer them on. The outcome is frustration, a feeling of disempowerment and the risk of more illness from ill considered treatments. So are doctors the best people to manage illnesses like IBS? Are dietitians? It is perhaps a revealing statistic that despite the successes of medical research in finding specific treatments, more and more people are seeking help not from the NHS but from complementary therapists in private practice. At least complementary therapists have to time to listen and understand the influences on a person’s life and can work out with their client what might be the best way forward.
This may sound a bit depressing, but the best person to help us overcome your IBS is you. You are the expert. Only you know what has happened to you and the way it has affected you, but you need help to bring it back to mind, put it into context and find the way that is right for you. Recent surveys indicate that people want to be more involved in decisions about their own health care. Increasingly, the role of the health care professional in a sick society is to provide the information, advice, encouragement, insight and support to help you help yourself better.
People who are ill often say how powerless they feel. The irony is that all too often, health care professionals with the best intentions can remove the little power they have by imposing an inappropriate drug or dietary regimen that does not conform to their patients’ real needs. A more empowering approach is for GPs to work together with their patients to facilitate our own resources and guide them to the right course of management for them. The best treatment is often the one they can both believe in.
The IBS Network’s IBS Self Care Programme attempts to provide all the information and advice you might possibly need to manage your own IBS: diagnosis, diet, medications, stress management, complementary therapies as well as specific data on constipation, diarrhoea, pain and bloating and where to seek further help. But managing your IBS is not just about information, it is also about self regulation and confidence. Now you may be lucky and meet somebody who loves you enough to soothe, stimulate, give you confidence, make you feel safe and bring out the best in you, but it is a sad fact that about 40% of people live alone ‘often with just their Facebook and the television for company’. This is nearer 60% in people over 70. Loneliness is probably the largest cause of illness in our society.
So how can we regulate our own psychology and physiology? In the last twenty years, the concept that has captured the imagination of patients and health care professionals is ‘Mindfulness’, an application of age-old Buddhist philosophy. Mindfulness is not just a matter of sitting in a darkened room with josticks and thinking beautiful thoughts. It is more about living in the ‘here and now’ instead of the ‘there and then’. Too much of our time is spent regretting the past or worrying about the future. Mindfulness is about engagement and focus, activity and creativity, novelty, variety, relaxed attention and routines. It might be thought of as ‘getting in the zone’ and ‘engaging with the essence of life. There are many routes to mindfulness. How fulfilling it is to immerse yourself in something you enjoy doing, like for example, writing or drawing, or jogging, swimming, or even cooking or helping your children or grandchildren focus on something that captures their interest.
Mindfulness is healing; it takes you away from the frustrations and worries of life, soothes the pain and discomfort and quietens the inner turmoil. Allocating sufficient time for rest and focused activity allows you to see the situations that upset you in context by bringing them back to mind. It helps you get back in control of your body reactions and gives you hope and health confidence. No matter what is wrong with you, what illness you may have, these very basic aspects of healthy living will make you feel better. Make it a vital component of your life and as you begin to feel better, let go, don’t take yourself too seriously. Maintain, if you can, a healthy sense of the ridiculous. Laughter can be the best medicine.
This article is based on a talk I gave last night to ‘Skeptics in the Pub’ in Sheffield. The audience consisted of about 50 people from all walks of life who meet monthly to focus and discuss ‘what it’s all about’. .
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