Author and family physician Dr. Daphne Miller has long suspected that human health and agriculture are connected—but most modern medical practices seem blind to their linkage. Her new book, Farmacology: What Innovative Family Farming Can Teach Us About Health and Healing, explores how that connection works. Here’s Daphne on how thinking more holistically about planetary and bodily ecosystems can change the way we understand both medicine and agriculture.
“I think we can blame our record-breaking drought,” I said to my patient S. She shot me a quizzical look, the kind you give when someone answers your question with a total non sequitur. Here she was, worried about her all-time worst eczema flare, and all I could offer her was a weather report? And yet S., who has suffered from eczema her entire life, has often told me that her condition is exacerbated by parched skin. So why would my comment about our parched landscape seem irrelevant?
I thought about this after S. had left my office, armed with prescriptions for a strong emollient and a steroid cream (to use sparingly on the worst spots) and a recommendation to exempt herself from water rationing and take long, hydrating baths while she prayed for rain.
Like S., most of us can easily see how environmental conditions might impact our lives in the form of relatively minor inconveniences (foiled travel plans) as well as catastrophes (destroyed homes and neighborhoods). But understanding how the ecology that surrounds us can directly affect the ecology within us is harder to grasp. We tend to think of our own cells as a closed system, impervious to everything that occurs outside, and science reinforces this notion since relatively little research is dedicated to bridging the two worlds.
I realized this as I began research for my most recent book, Farmacology. Asking the relatively simple question How is our health connected to the health of the soil? led me to discover how little we know about the links between our bodies and that brown substrate—soil—that feeds them. I found plenty of studies on the poisonous potential of toxins or virulent organisms in the soil, but when it comes to understanding how healthy soil microbes might communicate with the microbes within us, how metabolites in the soil might impact our metabolism, or how different farming systems might impact our internal system, I came up with very little. How can it be that the same great minds that are focused on mapping our entire micro-biome are dedicating such little effort to understanding how this inner ecology might interact with other ecologies?
Of course, the answer is that in science, as in most fields, we put a premium on specialization and reductionist solutions. There is little reward for interdisciplinary collaboration, or for making big-picture connections where the solutions are multilayered and less marketable.
And yet I do believe that things are slowly shifting. A new generation of scientists are looking up from their electron microscopes and beginning to ask ecosystem-spanning questions.
To test this trend, I logged into the PubMed medical search engine and typed in “atopic dermatitis” (also known as eczema) and “drought.” This netted zero articles, but I was not deterred. Pushing on, I replaced the term “drought” with “climate change.” Fourteen studies popped up on the screen. They were from obscure journals and most were not translated from the original German so I added ”environment” to the search. That was more promising, producing at least eighty studies. Of course, this is small potatoes compared to the 5,500 studies I retrieved from my “atopic dermatitis” and “drug” query. But still, this was an exciting repository of new information on a disease that plagues a large proportion of the U.S. population and, according to World Health Organization data, is increasing worldwide.
As I read through the studies produced by this final search, I discovered scientists (once again, mostly in Europe) who were asking sophisticated questions about eczema and trying to understand the web of interactions between genetics, immunological factors, and environmental factors like climate, pollen, UV exposure, and food sources. For example, they have discovered that contact with farm animals and farm soil, drinking unpasteurized milk, cohabitating with siblings, and living in a moderate climate are protective, while a Western diet, past antibiotic use, lack of exercise, a lack of diversity in surrounding plant flora, cat ownership, and extremes in weather can, in combination with certain genotypes, trigger the disease. Of course, there is much more to discover about the connection between our skin cells and the environment, but these insights are a good beginning.
Two weeks after S.’s visit to my office, the rains finally came. Almost overnight, the tan hills above my house in Berkeley turned a shamrock green. On day four of the new weather pattern, I called S. to see how she was doing. “Much better” was the answer. Like the hills, her improvement was almost instantaneous. She told me that a week earlier she had flown down to Los Angeles, and as she peered out the plane window at California’s cracked and barren Central Valley—a place typically bursting with our nation’s produce—she finally made the connection.
“I looked at that earth,” she said. “And it looked just like my eczema. It made me care a lot more about our drought.”
Daphne Miller is a professor of family medicine at the University of California, San Francisco. Her writing and teaching explore the boundary between biomedicine and the natural world. Farmacology is out now from William Morrow.