Chaos is evident in all aspects of life.  Weather forecasting is an exercise in probabilities because we can never be sure of the starting conditions.  We can’t factor in  all the variables.  This is why it is said that a butterfly flapping its wings in West Africa will result in a typhoon is south- east Asia.  It’s not meant to be taken literally, just a mathematical possibility to illustrate how small unconsidered variations can cause enormous effects.   

And take sport.  They said England had a good chance of winning The World Cup this year, but what went wrong?  Could a glance across the table by a teammate’s wife have set in train a sequence of events that unsettled the captain, led to a players revolt against the coach and culminated in a catastrophic collapse of confidence?

And what about politics, computing, and the stock market?  Somebody can’t sell his house in Wisconsin and we end up with a global recession.   Or the rail network.  The wrong leaves on the line in the Home Counties and business in the City of London slithers to a halt. Small variations can have massive effects.  A tiny wobble in the orbit of an asteroid could destroy all life on earth. 

And in medicine, a small change in environmental conditions, a particular event, can so easily bring about illness.   Perhaps a tune on the radio could revoke a memory that could upset the gut and result in an argument that ends a marriage.  With no chance at resolution the gut upset persists as unresolved IBS.   When scientists do trials of treatment, they try to hold all the conditions constant.  This is what is called a controlled study.   It relies on certain  assumptions about which factors are important.  Age and gender may be controlled,  diet might be in a few studies, emotional factors almost never and yet these may be crucial.  So they can never really control the outcome.  If they make the same measurements 100 times in the same patient and they will come up with a hundred different results.  So what do they do?  Employ a statistician to tell them an answer they might (or might not) be able to rely on!  But  they still might be ignoring certain crucial factors because they don’t think they count or they are impossible to control.  As Albert Einstein declared, ‘Not everything that counts can be counted.  And not everything that can be counted, counts.’  

Irritable Bowel Syndrome is an idiosyncratic disease.  It is more an expression of the personality, life experience and life style than those variables that can be easily measured.  Moreover it can’t be easily defined because there is no identifiable change in body structure or chemistry.  It is whatever doctors say it is.  No wonder treatment is so variable and so personal.  It’s an exercise in chaos; a bit of a lottery.  What works for one person may not necessarily work for another.  But you can cut down the variability by reading the self management programme and getting to know about your illness, yourself and with some guidance managing your own symptoms.

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1. Read NW (1999). Harnessing the patient’s powers of recovery: The role of the psychotherapies in the irritable bowel syndrome. In Baillieres Best Pract Res Clin Gastroenterol. series. (Ed. Houghton. L .A. and Whorwell P. J.) 13(3):473-87.
2. Read, N.W, (2000) Bridging the gap between mind and body: do cultural and psychoanalytical concepts of visceral disease have an explanation in contemporary neuroscience? In EA Mayer and CB Saper (Eds) The Biological Basis for Mind Body Interactions. Progress in Brain Research 122, pp 424-443.
3. Creed F, Guthrie E, Read NW, Thompson D, Ratcliffe J, Fernandez L, Palmer S, Rigby C, Tomenson B. (2000) A randomised trial comparing the cost effectiveness of psychotherapy and antidepressants for severe irritable bowel syndrome. J Psychosom Res 48 (3): 102
4. Read NW. Panacea or Placebo (2002). What Nutritional Supplements mean to users. In Ransley J, Donnelly J and Read NW. Food and Nutritional Supplements in Health and Disease. Heidelberg. Springer-Verlag.
5. Read N.W. (2000). Cerebral activation in Irritable Bowel Syndrome. Gastroenterology. 119 (5): 1420-1420.
6. Hobbis I, Turpin G and Read NW (2002). The Prevalence of Abuse Experiences in Sufferers of Functional Bowel Disease
7. Creed, F., Ratcliffe, J., Fernandes, L., Palmer, S., Rigby, C., Tomenson, B., Guthrie, E., Read, N., Thompson, D. (2005). Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders. Br J Psychiatry. 186: 507-515

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1. Read, N.W. (1987). Functional gastroenterological disorders. The Name’s the thing. Gut 28: 1-4.
2. Read, N.W. (1987). In: Irritable Bowel Syndrome. Scand. J. Gastroenterol. Supplement 130, pp.7-13.
3. Read, N.W. (1990) Functional gastrointestinal disorders: building castles in the air. Gastroenterology International 3 (4): 182-183.
4. Read NW. Enough is Enough! (A response to the debate ‘Do the Rome Criteria Stand Up’) Falk Symposium 1997. The Irritable Bowel Syndrome (2001). Chapter 90. Sleisenger and Fordtrans’s Gastrointestinal and Liver Disease, edition 7. Eds Mark Feldman, Lawrence Friedman and Marvin Sleisenger. Harcourt Health Sciences.

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1. Cann, P.A., Read, N.W., Brown, C., Hobson, N., Holdsworth, C.D. (1983) The Irritable Bowel Syndrome (IBS) relationship of disorders in the transit of a single solid meal to symptom patterns. Gut 24: 405-411.
2. Cann, P.A., Read, N.W., Cammack, I., Childs, H., Holden, S., Kashman, R., Longmore, I., Nix, S., Simms, N., Swallow, K., Weller, J. (1983) Psychological stress and the passage of a standard meal through the stomach and small intestine in man. Gut 24: 236-240.
3. Read, N.W., Al-Janabi, M.N., Cann, P.A. (1984) Breath hydrogen and the pathogenesis of pneumatosis coli. Gut 25: 839-845.
4. Read, N.W., Al Janabi, M.N., Bates, T.E., Barber, D.C. (1983) The effect of gastrointestinal intubation on the passage of a solid meal through the stomach and small intestine in humans. Gastroenterology 84: 1568-1572.
5. Holgate, A.M., Read, N.W. (1983) The relationship between small bowel transit time and absorption of a solid meal: influence of metoclopramide, magnesium sulfate and lactulose. Dig. Dis. & Sci. 28: 812-819.
6. Read, N.W., Al-Janabi, M.N., Barber, D.C. and Edwards, C.A. (1984) The relationship between post-prandial motor activity in the human small intestine and the gastrointestinal transit of food. Gastroenterology 86: 721-727.
7. Youle, M.S., Read, N.W. (1985) The effect of painless rectal distension on gastrointestinal transit of a solid meal. Dig. Dis. Sci. 29: 902-906.
8. Read, N.W., Bates, T.E., Al-Janabi, M.N. and Cann, P.A. (1985) The interpretation of the breath hydrogen profile after a solid meal containing unabsorbable carbohydrate. Gut 26: 834-842.
9. Read, N.W., Al-Janabi, M.N., Holgate, A.M. and Barber, D.C. (1986) Simultaneous measurement of gastric emptying, small bowel residence and colonic filling of a solid meal by the use of the gamma camera. Gut 27: 300-308.

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1. Read, N.W. The importance of gut feelings. J. Gastrointestinal Motility 1992; 4:79-81.
2. Prior, A., Read, N.W. Reduction of rectal sensitivity and postprandial motility by Granisetron, a 5HT3 antagonist, in patients with IBS. Alimentary Pharmacology Therap. 1993; 7: 175-180.
3. Bergin, A.J., Read, N.W. The effects of sleep deprivation on rectal sensitivity in healthy volunteers. Eur. J. Gastroenterol. Hepatol. 1993; 5(7): 527-532.
4. Read NW, Gwee KA.(1994) The importance of 5HT3 receptors in the gut. Alimentary Pharmacology and therapeutics. 62; l59-73.
5. Read N.W. (2000). Rectal Distension: From Sensation to Feeling. (Editorial). Gastroenterology 118 (5): 972-974.

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