One of my favourite programmes on the radio is Gardeners Question Time. I often listen to the wisdom of Pippa Greenwood, Bunny Guinness, Matthew Beardshaw, Bob Flowerdew and Anne Swithenbank while driving up north for a weekend in Ilkley. No, I am not a gardener. Time’s winged chariot does not stop for such diversions or excursions. Nevertheless, I see gardening as a metaphor for the lost arts of medicine, the notions that attracted me to the profession half a century ago.
Gardeners understand the importance of the context in which certain plants grow, the quality of soil, temperature, light, moisture. They know that every plant needs its own conditions to thrive. Plant it in a different environment, deprive it of light, give it too much nitrogen, overwater it, prune it too closely, and it will turn into a different plant. During a drought, certain trees may burst into flower in a desperate attempt to maintain the species and justify Richard Dawkins ideas of the selfishness of genes. Fail to dig in enough manure and growth will be stunted. As Professor Ottiline Leyser reported in a recent broadcast of The Life Scientific, plants are highly adaptive living creatures, that have a diverse intelligence mediated by auxins and other hormones that are released from the growing tips of roots and shoots and travel from cell to cell or though phloem vessels to affect the growth and differentiation of plant tissues. Plants defend themselves against attack by insects, communicate and cooperate with fungi, decide when it’s time to flower and when it’s best to retire and lie dormant underground awaiting the next growing season. For plants it’s all about economics, adaptability and the optimisation of resources. The gardener understands that and will facilitate plants’ health and growth.
Gardening is an art in the way that agriculture isn’t. Gardeners rely on intuition based on experience to optimise the conditions for their plants to thrive and to determine how to modify those when they don’t. Each plant is an individual in it’s own local environment. Take care of the environment and it will do well. Gardening is about recognising the needs of individual plants. Farmers have different priorities; these are also about economics, but the economics of the colony or monoculture. Farmers could never run a profitable business if they worried overmuch about diversity and the needs of individual plants. For most of them, it’s more about the science of controlling the environment by such expedients as spraying with herbicides or insecticides or genetic engineering, and ignoring what this might do to the other species in the field, though organic farming offers a more environmentally friendly approach.
So how far do metaphors of agriculture and gardening apply to the contemporary practice of medicine? The contemporary practice of medicine is a practical science based on general principles derived from evidence derived from controlled experiments, clinical trial, statistics and epidemiology. In that respect, it is more like the science of agriculture than the art of gardening. From the political perspective of a health manager, human populations are monocultures, packed together in towns and cities for mutual security and survival, but vulnerable to illness and injury, not only by infection but also through the stress of overcrowding. Their task, like that of the farm manager, is economic and concerned with the population at large rather than the needs of the individual. Health services impose solutions designed to achieve the most advantageous outcome for the greatest number of people. Guidelines and algorithms regulate management procedures that can be justified and defended when confronted with disapproval and complaint. Public health and hygiene, immunisation, health education, diet and lifestyle advice, antibiotics, nutritional supplements and perhaps statins have all contributed massively to the stability and productivity of the population as a whole, but are in essence, social engineering that ignores the needs of the individual. Occasionally this broad brush approach goes seriously wrong, as with antibiotic resistance, but in general it works for the population at large. How else could government attempt to run an efficient nationalised health service?
Most models of disease assume a single or at least a dominant pathogenic factor, such as an infection, a gene mutation, a toxin, a specific nutrient deficiency, but that is often not the case. Most illness, especially long term illness occurs because of a unique combination of interconnected genetic, lifestyle and environmental factors and can only be understood from the context of the individual and treated holistically. This personal approach is more suited to the philosophy of the gardener.
As I have discussed previously in this blog, IBS is an individual illness. There is no single cause or treatment. Instead, it seems that psychosocial factors interact with microbial, dietary and lifestyle components to produce a unique expression of illness that may require the ‘practical wisdom’ of the gardener rather than the algorithms of the clinical scientist to help the sick individual find resolution. The responsibility for management of IBS must be with the ill person; they are the only one who can appreciate the illness in context. This works best when guided by reliable sources of information and possibly therapists with the time and experience to listen and advise. Recovery from IBS is about personal growth, self development and the resilience to overcome adversity. Psychotherapies and complementary therapies offer that approach, but should be more holistic in nature, offering specific dietary and pharmacological advice alongside an understanding of the patient’s narrative and appropriate life guidance.
There are too many sources of information on IBS, not all of them reliable and many advertise a specific product. Forgive me for The IBS Network, but since I retired at the end of last year, I no longer have a vested interest. As the UK’s independent charity for IBS, The IBS Network offers reliable, professional advice on the nature, diagnosis and management of IBS, culled from a range of disciplines, together with telephone helpline and email response service. Do check it out.
Few people can afford a gardener, but everybody can learn to tend their plants with the help of Eric Robson and his team.