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SECTION EIGHT

Public health and medicine

It seems almost inevitable that people will take good enough medicine for their ailments: medicine–taking seems to be a human trait, even when much of it is ineffectual. While there's life there's hope.

I was born in the opening years of the Age of Antibiotics which has changed, for a time, the effectiveness of medication, at least for infectious illness. Even so, all extensions of any population's lifespan through reductions in infant mortality and adult morbidity are achieved by Public Health measures, not by medication.⁹⁶ Does this make all medication little more than palliative? If that were so, there would be little point to books on health that feature medication unless the sanitary measures we take for granted and the clean water we can drink from our taps are also in place.⁹⁷ As this claims to be a book on health, I had better answer the charge right away that many of its suggestions cannot be compared with the clean air and water we are used to and so will be irrelevant to health outcomes at the population level.

First, I would say that my idea of Poise aspires to a life with less illness rather than an extension of life, and second, that the Health Measures rightly sought by policy makers and the statistics generated do not fully take into account personal, social and cultural subjectivities. It is assumed that developed nations like ours with increasing lifespans are uniform in our responses to health and medicine.⁹⁸ The book you are reading makes no such assumptions, and also resists a simple tale of two approaches: conventional and alternative, where for “and” one might read “versus”. Anthropologists examine the social variation in belief in populations in what is known today (but for how much longer?) as the developing world and take account of the richness and subtlety they find there, the better to advise policy makers. In our so–called developed world, the metrics tell us that we have no need for variation of belief, let alone subtlety, because health is a commodity and that it is assured by “health providers”. Field workers in the Developing World are trained against the risks of patronising their clients, but doctors and nurses in our Health Industry take no such precautions despite a cloying piousness towards the rights and needs of the patient which amount almost to veneration. This approach seems to me an inevitable consequence of the sycophancy that advertisers deploy to beguile their customers. It may also be a reaction against the peremptory, even harsh, approach displayed by pre–NHS medics. In spite of the prevalence of sycophancy towards the sick, it is a veneer that barely sticks to the surface: if you want to experience rudeness and arbitrariness that would not be tolerated in any other non–criminal sphere, visit a doctor's surgery.

At the population level, public health measures and social policy towards women and babies and the early lives of the disadvantaged are of inestimable importance compared to the medicating doctor (or herbalist) but, in the management of personal health, an individual physician can better help the individual patient achieve greater poise by guidance to the six nurtures and by nudging the terrain with medicinal plants. Of the six, exercise provides probably the greatest long-term benefits at the least cost yet inactivity can begin very early in industrialised societies and can be sustained in a way that was not really possible even in my early lifetime. I am so lucky to have walked and cycled most places most days and so have felt able to ignore the cultural call to competitive and punishing endurance sports with all their potential for damage.⁹⁹

If our propensity for certain types of disease is a probabilistic function of our genome, it can be reduced epigenetically by the six nurtures and further by the daily intake of spice and culinary plants as aids to medicine, and of course the avoidance of those known but culturally permitted harms.

The medical theoretician

In the end, Freud decided, as Galen, Paracelsus and Hahnemann all decided, how things were. As I said in the preface, I have developed my ideas by experience not by experiment. Although Galen experimented, his experiments served to confirm his preconceptions and were made to fit in with humoral theory.¹⁰⁰ He, in common with the other theoreticians mentioned above, was an autocrat who brooked no opposition. The triumph of being right may have been at the expense of his patients. As lacking in experimental support as the theories in this book may be, I would welcome dissent and hope to be shown the deficiencies in my own self–criticism.

All these medical theoreticians were extremely touchy individuals, as were Newton and Hooke and many of the great mathematicians and scientists of the modern era.¹⁰¹ But they have left palpable, testable ideas which are capable of precise and recordable manipulation, whereas theoreticians of medicine have left monuments to their own opinion. Surely (best to get one's own criticism in first) we opinionated theoreticians are obsolete in an age of scientific verification? For my own part (and I retract any elision of this work with illustrious forebears), I am only interested in conversation: to impose is to invalidate. I can only hope that a few of these ideas may be of practical benefit or at least open some questions in the minds of herbal practitioners and challenge some assumptions as I hope to be challenged in turn. To call someone an “armchair…” is the current term for dismissing the amateur pontificator and distinguishing him (usually him) from the professional. Well, at least my ideas have come from sitting for some decades in a professional armchair and the “natural” of the medicine I practise comes from woods, hedgerows and waysides.

Alternative medicine

Nietzsche claimed that there were no facts, only interpretations. In medicine, one could say that there are no alternative facts, only alternative interpretations. As biology possesses fewer facts than physics, and as medicine is skewed by cultural assumptions, the tendency to speculation is somewhat normative. In this book, the Mindedness Hypotheses attempt to show that no useful demarcation line can be drawn that could separate the psyche and the production of culture from the biosphere. By extension, the nuclear and mitochondrial genomes are repositories not actors: they may set certain bounds, but it is life itself, the bios interacting with the physical world, that liberates or constrains our potential.

In spite of the opening sentence to this passage, closer examination displays quite a scarcity of facts. One useful criterion might be the facts you choose to live by. It is one thing to doubt the validity of the scientific method and yet to live by technologies that depend upon its application, but then you would have to exclude hypocrisy from your guiding principles. Human argumentation relies upon corralling “facts” to a point of view. When it comes to medicine, although the call for evidence is often a bid for prestige and power, nonetheless, our responsibility to the well-being and safety of our patients requires us to be clear about our ideas and what we take to be facts.

Just as priests can get in the way of the religious impulse, so the will of physicians can obstruct healing whether you are a herbalist or a doctor or both. We are mediators of effects but are only actors upon a stage. Good medical ethical practice may require Apollonian austerity and control but equally needs to channel the Dionysian impulse to achieve a result that is a good and empathic performance. The manner and circumstances in which patients present themselves occupy a huge range, but each lives in the one human sphere and should not be placed in compartments. People need allies; won't that do for your ambition?

Traditional medicine

The final cutting of the strand between Traditional and Modern Medicine occurred in Britain in about 1948. The first European divergences began, of course, at the start of the early modern period or, if you wish to cite Paracelsus, the very end of the medieval period. In my view, he sowed the seed of both allopathic and homeopathic medicine, with their emphasis on single substances. Both of these diverge in principle from herbal medicine.¹⁰²

As for the classical tradition, both in China and Europe, a distinction was made between the medical treatment of aristocrats and peasants. Galen, for all his acceptance of Hippocratic ideas of temperament, was a surgeon and physiologist, modern in his sense of clinical observation, and used plants as nothing more than useful available agents, supplementing food plants. He experienced epidemics of the plague and all the squalor of the Roman metropolis. Besides, being an astute psychiatrist, he was also an erudite philosopher while the herbalist, if known at all, would have been seen as an uneducated tradesman (see footnote 9 in Section 2). Apart from the influence of the Roman hegemony on Christianity and the subsequent influence in turn of Christianity on medicine, an important reason that Galen's unified approach survived for so long in the West was that no one, save Avicenna and the Islamic physicians of Andalusia, replaced it with some other coherent corpus of knowledge.¹⁰³

Medicine in India, China and Europe was always learnèd and effectively aristocratic; it never espoused folk medicine even if much was borrowed from it; we cannot know, for this very absence of attribution except for occasional mythic tales. At least that is the case for theoretical medicine; surgery, by contrast, was a craft and performed by craftsmen.¹⁰⁴ Even in our lifetime, the publication of Mrs Grieve's A Modern Herbal depended for its success on upper class society women like Hilda Leyel. The premises of the Society of Herbalists in London's Mayfair, just off fashionable Berkeley Square, had nothing of the demotic. On my first visit there, when I tried to speak to a herbalist to find out how I might become one, I was treated with haughty disdain.