We need an environmentalism for the human gut.
I realized this when I read a single phrase from the Center for Disease Control report that's getting so much attention right now: "poor antimicrobial stewardship." With those three words, I felt I was glimpsing a new worldview. In the future, the environment inside the human body is going to require just as much care, thought, and protection as the environment outside. Otherwise -- like the environment outside -- it will kill us.
In case it hasn't been trending on your social media, the take-home from the report is that drug-resistant diseases are multiplying and growing stronger. We are approaching "a post-antibiotic era," a world where a bug from the playground, a dinner plate, or a hospital visit can invade your body and sicken you beyond any medical help. These "superbugs" are the products of lightning-fast evolution under conditions of intensive, and often sloppy, antibiotic use. The superbugs are the survivors, the ones that have withstood onslaught after onslaught of antibiotics and survived to reproduce.
This is just as scary as it seems. It is easy to forget that we live in an unprecedented situation. For us, dying young, or mysteriously, is a catastrophe and a tragedy. For every other human population, it has been business as usual. Only the strong and lucky made it to old age. You expected to see people fall away: any infection, any scrape or congestion, could be the one that took them. Mastering those cruel and arbitrary fates is one of the great ways that technology has humanized the world. A post-antibiotic era would be a world dehumanized again.
So, back to antimicrobial stewardship. What the CDC report means is that people are using antibiotics in stupid ways that help the superbugs evolve. Hospitals use too many antibiotics, and aren't careful enough about how they use them. Maybe even worse is the agricultural use. Livestock producers manage to keep animals alive until slaughter in crowded, filthy conditions only by pumping them full of antibiotics until slaughter. When you buy a hamburger, you might as well be contributing your dollars to biological warfare research -- aimed at us.
There's some venality here, but there's also a lot of ignorance. The ecological complexity of the microbe world -- the world of guts (human and animal), soil, and every other substance that houses life -- is basically invisible to most people, most of the time. It's out of sight and out of mind, and that puts it totally outside anyone's circle of responsibility. If it helps them to do their jobs -- raising meat or processing sick kids -- people will drop some antibiotics into those ecosystems without thinking about what happens to them next. It's as if anything that went into the body -- a human or another mammal's body -- fell into a black hole.
That is exactly how people used to think about what they dumped into rivers, winds, and soil. It's how they thought about sewage, industrial waste, and smokestack emissions. You put it out of sight, and it went away. The age of political ecology, of modern environmentalism, began when people realized that everything they threw away was coming back, because everything -- winds, waters, soil -- is connected, and it all connects back to the human body. We discovered the big, interdependent world outside us, we called it the environment, we started trying to take responsibility for it (if only to save ourselves), and environmentalism was born. Now it makes sense to talk about environmental stewardship; in fact, it's almost banal. But that's only because people learned to see the world outside themselves as one complexly linked whole, a beautiful thing but also dangerous, and requiring stewardship and care.
Now we need to do the same thing for the inner world. It won't be enough to think of hospitals as processing sick people, anymore than it's enough to think of factories as producing chemicals and tires. We have to think of what they put into the ecosystem. The same goes for factory farms -- and we have to decide that those are just too harmful to the inner environment, as we did about the worst forms of pollution in the outside environment. We'll have to look at all the institutions that shape the inner ecology -- the ones that administer antibiotics, the ones that manage soil, the ones that shape kids' diets -- as potential polluters, the way the first environmental generation had to look anew at every player in the economy.
The optics may not be as pretty as NASA's earth photograph, which helped so many people envision the planet as a single, delicate organism; but with any luck we will learn to think of the world inside as precious, fragile, and essential to our survival and flourishing. That will help microbial stewardship to become real, as surely as recognizing the interdependent world outside helped inspire people to save it, and themselves.
Modern environmentalism began in a sense of crisis, with Rachel Carson's Silent Spring. But from the beginning, ecology was also a positive ideal of health, an integrated relation between a good way of life for humans and a flourishing natural world. That's part of why environmentalism is inspiring as well as scary, and why so many environmentally minded people these days are doing positive things like working on local food systems and renewable energy sources.
Microbial stewardship, too, has a positive side. All the new, popular, and uncertain science about the importance of gut ecologies to health is the non-catastrophic version of a post-antibiotic world -- a world where we learn to work with, not just against, healthy communities in the ecology inside us all.
To do that, though, we will have to stay alive and healthy in the first place. And that will require environmentalism for the ecology of the gut.
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