Tending the Body’s Microbial Garden

I don’t usually find medical research interesting - but throw some ecology in there and I am all for it.

For a century, doctors have waged war against bacteria, using antibiotics as their weapons. But that relationship is changing as scientists become more familiar with the 100 trillion microbes that call us home — collectively known as the microbiome.

“I would like to lose the language of warfare,” said Julie Segre, a senior investigator at the National Human Genome Research Institute. “It does a disservice to all the bacteria that have co-evolved with us and are maintaining the health of our bodies.”

This new approach to health is known as medical ecology. Rather than conducting indiscriminate slaughter, Dr. Segre and like-minded scientists want to be microbial wildlife managers.

No one wants to abandon antibiotics outright. But by nurturing the invisible ecosystem in and on our bodies, doctors may be able to find other ways to fight infectious diseases, and with less harmful side effects. Tending the microbiome may also help in the treatment of disorders that may not seem to have anything to do with bacteria, including obesity and diabetes.

Antibiotics kill off harmful bacteria, but broad-spectrum forms can kill off many desirable species, too. Dr. Fischbach likens antibiotics to herbicides sprayed on a garden. The herbicide kills the unwanted plants, but also kills off the tomatoes and the roses. The gardener assumes that the tomatoes and roses will grow back on their own.

In fact, there’s no guarantee the microbial ecosystem will automatically return to normal. “It’s one of those assumptions we make today that will seem silly in retrospect,” Dr. Fischbach said. Indeed, some bacteria are adapted for invading and establishing themselves in disrupted ecosystems. A species called Clostridium difficile will sometimes invade a person’s gut after a course of antibiotics. From 2000 to 2009, the number of hospitalized patients in the United States found to have C. difficile more than doubled, to 336,600 from 139,000. Once established, the antibiotic-resistant C. difficile can be hard to eradicate.

Dr. Fischbach cautions that it may take a while to figure out how to manipulate the microbiome to make people healthy.

And it may take even longer to persuade doctors to think like ecologists.

“The physicians I know really like things that are clear and crisp,” Dr. Fischbach said. “But like any ecosystem, the microbiome is not the kind of place to find simple answers.”

It’s really a great thing that these researchers are trying to work with the human microbiome instead of against it. What do you think, is this the next horizon for medicine? Will our current antibiotic regime be seen as antiquated and backwards 50 years from now?