Missing Microbes

Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues by Martin J. Blaser
My rating: 5 of 5 stars

I love books like this.

Taken from the book jacket:

Martin Blaser "is the director of the Human Microbiome Program at NYU, served as the chair of medicine at NYU and as the president of the Infectious Diseases Society of America, and has had major advisory roles at the National Institutes of Health."

He has studied the bacterium H. pylori extensively. Linked to stomach ulcers, gastritis, and ultimately stomach cancer, this "stomach bug" is generally treated aggressively when found. Interestingly, Blaser and colleagues have established that while H. pylori can cause negative health outcomes in later life, it may also be protective against other diseases like asthma, esophageal adenocarcinoma, and possibly a whole host of other diseases earlier in life, a notion supported by research performed by Blaser and his cohorts. And, good or bad, it appears that H. pylori is slowly disappearing from the human microbiome.

Blaser's main point seems to be that humans have evolved as a complex ecosystem in which some inhabitants can be helpful at some turns and harmful at others. And thanks to relatively new changes like the invention of antibiotics, the increased incidence of C-section, and other changes to our environment, our microbiome may be undergoing a shift. It is possible, even likely, that this shift may be contributing to the increased incidence of diabetes, asthma, food allergies, and auto immune diseases...possibly others.

He acknowledges the importance of antibiotics, which save lives. Yet, he also points out that until now we did not know what the true cost of using them was/is. Assuming there was no downside to taking them, we may have been too indiscriminate and overly liberal when prescribing them, using them even if not absolutely necessary because we assumed they could only help and never hurt. But as we learn more about the role of microbes, whether they are good, bad, or possibly both, the more that assumption is looking to be false. In the end, like H. pylori, antibiotics could be both beneficial and harmful at the same time.

He also worries about antibiotics that are given to livestock, not to treat disease, but to fatten them up. He fears it will not only contribute to antibiotic resistant strains of harmful even deadly bacteria, but may also be exposing us to antibiotics indirectly through the foods we eat.

He also worries about the increasing prevalence of birth by C-section. It has been shown that babies born via C-section are missing certain microbes that appear critical for optimal health and development of the baby. And while the microbiomes of both groups eventually converge so that by age three there are no significant differences, the damage may already have been done. Again, he is not saying women should not have C-sections, just that we might not truly understand the long-term risks to the baby.

Bottom line: we are only now beginning to understand the immense impact the bugs living among us and even in us have. And as we learn more, we need to rethink standard practices to ensure that we aren't throwing out the baby with the bathwater, or worse, drowning the baby in the bathwater. We also need to take these bugs seriously and remember that they are older, and, at least from a evolutionary standpoint, wiser. They aren't simply going to go away. Good thing, too, since we need them probably more than they need us. And if we hope to avoid another massive plague thanks to a microscopic organism, we better start being smarter about how we use the antibiotics we currently have in addition to finding new ones. (He claims that the pharmaceutical companies have found many of the easy ones and aren't particularly motivated to find a cure for rogue bacteria like MRSA, simply because it isn't cost effective.)

Good book written with a lot of passion, yet not alarmist in its message.