From farm to pharmacy: An ecological model for medicine


Farmacology, Daphne Miller’s new book, is an ambitious attempt to weave together a holistic approach to food production and a similar, often overlapping approach to medicine. She is especially well qualified for the task. A highly trained physician, Dr. Miller decided to eschew a fulltime academic career for a general practice in San Francisco’s Mission District that she combines with a writing career and an unorthodox investigation into the relationship between what people eat and how well they thrive. In her latest book she recounts what she learned from visits to seven innovative farms across the country.
Some of her visits focus on the production of a specific product—cattle, eggs, wine, -aromatic herbs—while others have a more complex purpose. In order to develop her holistic approach to agriculture and its lessons for innovative health care, she begins her explorations at the Kentucky homestead of Wendell Barry, a leading proponent of sustainable farming. One of the lessons she learns from him is embodied in a quote he repeats from Alexander Pope, “You must always consult the genius of the place.” Barry continues: “What does nature require you to do here? What will nature help you do here?”
Her travels also take her to a group of abandoned city lots in the Bronx that have been converted into mini-farms. There she witnesses the beneficial effects of pesticide-free, locally grown fruits and vegetables in what were previously “urban deserts.” She explores how these activities and the farmers markets that sell the produce not only improve the health of individual growers and consumers, but also improve crime rates, economic activity and other vital aspects of poverty-stricken neighborhoods.
If it seems like more than enough to describe what she sees in her travels, in most chapters she links her observations to her general practice. She selects patients who are suffering from debilitating conditions and applies principles she has learned at one or more of the agricultural sites. She also applies her findings to various personal problems.
She is not content to rely solely -on anecdotal accounts. Wherever possible she cites scientific data that corroborate her reports, and in a number of cases she interviews researchers at their laboratories, from Stanford University all the way to Munich.
Dr. Miller has a disarmingly autobiographical style, and reveals many personal details. Her idealistic American parents left an Israeli kibbutz after she was conceived because, as they explained, they didn’t want “a communal baby.” Soon after, her parents returned to graduate school in the United States and bought a rundown farm where they lived intermittently between Peace Corps stints in Morocco, Afghanistan and Tunisia.
Dr. Miller has this to say about her parents, who now live in West Marin but still combine international travel with their academic careers: “My mother and father were wonderful parents… but terrible farmers.” In spite of this opinion Dr. Miller traces her interest in the benefits of farming to her early years.
The author offers many other personal touches, such as a confession that she feared drinking the fresh raw milk offered to her at one of the farms she visited. “Dairy… expands my gut with such speed and intensity that I am left with little choice but to remove myself from polite company and find someplace private (and preferably soundproof) to spend the rest of the evening.” She reports that drinking milk fresh from a cow did not produce the same results. Other personal revelations are less embarrassing, but, taken together, they make her story more enjoyable, and the reader is more inclined to believe what she has to say.
Dr. Miller’s core discovery in the book is that “… the carbon, nitrogen, and every mineral and vitamin that is a building block in our bodies is derived from the soil… we are not simply nourished by the soil, we are of the soil.”
She offers five “ahas,” or surprising insights derived from her farm visits that apply both to farming and medicine. In the first, “Feed the soil, not the plant,” she learns it is the farm itself that is the subject of attention. Translating this into medical practice, she rejects “reductionist medicine” that seeks to isolate a single disease or disorder. Physicians are trained to narrow down a patient’s complaints to one or two issues and attempt to “cure” them. Dr. Miller says this may work in treating conditions like appendicitis, but, for the most part, that it is important to identify social, nutritional, emotional and other factors that may contribute to illness and distress.
Her second realization is that eco-farmers are not anti-chemical or anti-innovation. What is important to them—and to Dr. Miller—is that “where these ecologist farmers rely on technology, it is not to disrupt nature’s design, but rather to preserve or restore what nature has given them.”   Adapting the phrase “integrated pest management,” she calls her new medical strategy “integrated patient management.”
In another aha she identifies three “vital signs” of resilient farm ecology: diversity (variability), synergy and redundancy. For Dr. Miller synergy means there is no single strategy or technique that any eco-farmer uses, “the whole being greater than the sum of the parts.” She explains redundancy as repeated patterns within each organism and the whole ecosystem. Redundancy is “a sign of a system’s resilience. In the event of a failure, one part can provide a backup or become a substitute for another.”
In traditional medicine, by contrast, research and treatments are based on predictability, linearity and isolation—in other words, on a reductionist approach that attempts to find a specific phenomenon that is cause an illness. Her approach involves looking at all aspects of functioning and how they can be transformed to reflect diversity, synergy and redundancy.
Her last two insights have to do with the cadre of physicians who are exploring new, integrative approaches to their profession. Although they may not think of themselves in this manner, she calls them medical ecologists. She concludes that “by thinking like farmer ecologists, we can all make profound and lasting changes in our own health and our lives.” She offers a series of suggestions about ways to begin thinking ecologically.
Dr. Miller does not buy all of the new approaches being adopted by physicians, farmers or the general public. For instance, she points out a dozen deficiencies in what consumers get when they buy certified organic food, starting with the lack of a guarantee that the food is freshly picked from a local farm. As far as medical treatment is concerned, she has this to say:

For health providers, a test promises something definitive to tell a suffering patient; for patients, it offers what is often a long-sought explanation for bothersome symptoms; for nutraceutical and pharmaceutical companies, tests provide opportunities to sell new products, and for hospitals (and doctors), there’s revenue to be gained not only from the test itself, but from a surgery or procedure that may follow. It’s easy to see that the medical industry, like the farming industry, has a big stake in creating an enthusiastic market for all this sampling.

But there are even worse problems in mass food production. The same week Farmacology was published, newspapers reported that President Obama is poised to sign regulations that would reduce Food and Drug Administration oversight and expose workers, inspectors and the public to toxic, bacteria-killing chemicals being used to neutralize contaminants in chicken carcasses as they are prepared for sale by speeding up processing. News reports included stories of increasing illnesses and possible deaths of inspectors and plant workers from exposure to these chemicals. There have been no FDA studies of the impacts on consumers, and the agency is relying on information provided by the industry.
Given the growing hazards of food processing and the increasing reliance on medications that can have debilitating side effects, Dr. Miller’s book offers a useful philosophical framework, as well as many practical recommendations to improve nutrition and understand its role in holistic healthcare.

Daphne Miller will be in conversation with cheese-maker, sheep rancher and former science writer Marcia Barinaga at 7:30 p.m. Saturday, June 15 at Toby’s Feed Barn, in Point Reyes Station. $15 tickets available at Sponsored by Point Reyes Books and the Marin Agricultural Land Trust.