Mycins v Microbes Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues by Martin J. Blaser (2014) Holt New York, USA

Dr. martin blaser was classically trained in infectious-disease medicine and spent his early career “fighting the good fight” against germs, first as a resident at the University of Colorado and then as the Salmonella surveillance officer with the Centers for Disease Control and Prevention's Epidemic Intelligence Service before he moved on to academic appointments at Vanderbilt University and New York University's Langone Medical Center. But, somewhere along this path, he strayed from the position of most of his peers, who considered microbes solely as pathogens, and grew to recognize that some microbes were beneficial and, in fact, essential to human health. Blaser's intellectual odyssey also serves as the framework for this book, which makes for a very effective narrative style to convey the typical twists and turns that is scientific research. As a founding publisher of the Bellevue Literary Review (New York, USA; http://blr.med.nyu.edu/), the founder of the Virtual Museum of Bacteria (http://www.bacteriamuseum.org), as well as the author of many publications in lay literature, the author has had a life-long passion for communicating the importance and impact of microbiology and biomedical science to the public. In this book, he has now taken on the formidable task of educating the public about the dangers of antibiotics.

THE DEVELOPING MICROBIOME

His main hypothesis—that antibiotic use in the modern era may be causing an unintended but potentially irreversible effect on global human health, with a particular impact on children—is systematically developed through 16 chapters and an Epilogue. Throughout the book, he regularly draws from historical lessons in medical science to emphasize his points. The first five chapters lay the foundation for the remainder of the book and serve as a primer by describing what infectious and autoimmune diseases are, the significance and role of microorganisms on earth and in humans, how infectious diseases develop and spread, and the history of antibiotic development. Chapter Six is the first to outline the dangers of antibiotic overuse, noting the increase in antibiotic resistance among common infectious agents and also the lack of development of any new classes of antibiotics that could take the place of antibiotics to which microbes have already developed resistance. Chapter Seven continues the focus on the development of antibiotic resistance, but this time, in livestock and poultry, as a result of the decades-old practice of giving subtherapeutic doses of antibiotics to fatten them up for market. Furthermore, Blaser highlights the direct exposure to antibiotics that we regularly receive in our food as a result of this practice. Chapter Eight begins to address the potential impacts of antibiotics to the human microbiome. The author begins by describing how microbes are passed down from mother to child, the natural history of the human microbiome. During pregnancy, the make-up of the mother's vaginal microbial community changes so that a prime inoculum of beneficial microbes can be passed onto the infant. As the infant passes through the birth canal, the baby is coated with the microbes in this soup, which begin to colonize all exposed surfaces immediately. Also, on aspiration, the gut begins to become colonized. Successive waves of microbial colonization events continue in the child, stimulated by mother's milk, changes in diet and exposure to microbes from other members of the family, until at about age 3, the child's microbiome stabilizes and become very adult like in composition. With this backdrop in the natural history of the microbiome as reference, Blaser then goes on to highlight the postulated impact of antibiotics early in life and on the developing microbiome.

HELICOBACTER PYLORI: FRIEND AND FOE

The next five chapters form the heart of this book. This is where Blaser describes the series of experiments that his lab and other colleagues in the field carried out over the last three decades on a particular infectious agent, H. pylori, and how these early studies led him to begin thinking differently about this microbe's role in human health and disease and then how this microbe grew to become the poster child for Blaser for all microbes essential for human health. One can sometimes detect the almost quixotic zeal with which Blaser pursued his new line of thinking about H. pylori. It is also a complicated story and so, takes some time to tell. H. pylori is generally held to be a pathogen, usually thought to be responsible for ulcers and stomach cancer. As a consequence, people were routinely given antibiotics to get rid of H. pylori. In developed countries (i.e, westernized countries), ulcers were now under control, but gastric esophageal reflux disease, Barrett's esophagus, and esophageal adenocarcinoma were all increasing in incidence at an alarming rate. With the use of epidemiological data, Blaser hypothesized that H. pylori may, in fact, also play a protective role in humans by stimulating a low level of inflammation in the stomach and so, preventing colonization by opportunistic pathogens. A decrease in ulcers but an increase in these other diseases may be a result of the loss of our H. pylori. Blaser proposed that H. pylori, rather than just being a pathogen, may also be an essential member of the endogenous microflora (as they were known at the time) having coevolved with the human to provide a protective role against pathogens. This hypothesis was not well received at the time it was proposed (an understatement if ever there was one), but he went further. He went on to examine epidemiological data to look for broader relationships between changes in the endogenous microflora and “westernized world” diseases and went on to propose that the loss of many microbes, as a result of primarily antibiotic use but also other modern practices, such as caesarean birth and formula feeding, may be responsible for the rise in modern diseases in developed countries, such as type II diabetes, obesity, celiac disease, and other autoimmune diseases and allergies. The final chapter provides some possible solutions to antibiotic exposure for all to ponder, such as more considered use of antibiotics by parents and pediatricians, government programs to reduce or eliminate unnecessary antibiotic use and exposure and public education, as in this book, to instruct us all about the power and danger of antibiotics.

THE PUBLIC AND THE MICROBIOME

Since the release of this book, some social media sites and science bloggers have commented about the amount and kinds of press that has come out around this book and whether the author may be misinterpreting studies, which only show correlation and not causation, to press his point. Dr. Blaser has certainly made excellent use of all of the outlets available to him—National Public Radio, The New York Times, CNN, The Daily Show, Wired magazine, among others. Whether you think he has hyped the connections between the human microbiome, so-called “First World” diseases and antibiotic use or you think he is using his bully pulpit to simply raise the visibility of this topic is your decision. I feel those of us who interact with the public on scientific topics often struggle to strike the right balance between communicating sometimes arcane experimental results, while emphasizing their larger significance. It is important to point out that unlike many social media commentaries, he has provided a rich Notes Appendix with citations to the primary literature, so critical readers can evaluate for themselves if they would come to the same conclusions as he has. For many years, the scientific community and government agencies have been calling out the dangers of antibiotic resistance. Now, there is potentially an even greater consequence to human health from antibiotic use than the rise of antibiotic resistance. Many of us bemoan the lack of understanding of science and medicine by the general public. Martin Blaser has made the communication of medicine to the general public his life's work when so few among us have been willing to do so. I would recommend you share this book with your next-door neighbor, your cousin, or your mother and then invite them for coffee and conversation. The engaging style of this book makes it easy for anyone without formal scientific training to learn what the issues are, and so, open the door to learn more.