{"id":43866,"date":"2019-01-14T16:52:07","date_gmt":"2019-01-14T15:52:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43866"},"modified":"2019-01-14T16:52:07","modified_gmt":"2019-01-14T15:52:07","slug":"peter-brindley-but-why-are-we-here","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/14\/peter-brindley-but-why-are-we-here\/","title":{"rendered":"Peter Brindley: But why are we here? \u00a0\u00a0"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Spend enough time in a medical job and you\u2019ll face unexpected and existential questions. The most curious may even come from your own family. Several Christmases ago I faced a doozey: \u201cDaddy, why are we here?\u201d I tossed back an excessively world weary reply: \u201cbecause the microbes need us, darling\u201d before resuming an indulgent post-prandial nap. Later, I apologized profusely, and substituted that old chestnut about \u201cleaving the planet better than when you arrived.\u201d Turns out my original answer was right: it\u2019s a bug\u2019s life, after all.<\/span><\/p>\n<p><span style=\"font-weight: 400\">All hail author Ed Yong, and his remarkable book, <em>I Contain Multitudes: The Microbes Within us and a Grander View of Life<\/em>. [1] This was my holiday read and is one to pick up in 2019. Yong offers a one-stop shop for anyone needing to understand the micro-biome, micro-genome, and micro-virome. Turns out that this is everyone plying the biomedical trade, or inhabiting a body. The intriguing title is from a Walt Whitman poem arguing that it is our complexities and contradictions that make us who we are. [2]<\/span><\/p>\n<p><span style=\"font-weight: 400\">It\u2019s never a bad idea to be reminded of one\u2019s own unimportance. For me \u201cembracing\u201d my microbiome has, hyperbole aside, changed the way I look at life. It is now easier to accept that I am both nothing special and something extraordinary. Because I am festooned with bugs I am never truly alone or truly independent. I love the idea that each of us is not just a person, but rather a zoo with an ecosystem. Because human cells make up less than half our body, I need to understand my \u201cother self,\u201d and even reconsider what &#8220;self&#8221; means. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Sure, the simplistic \u201cus versus them\u201d <\/span><span style=\"font-weight: 400\">germ-theory helped to develop antibiotics, antivirals, and vaccines. However, the inability to understand interdependence has also spawned pan-resistant bugs. We need to dial down the <\/span><span style=\"font-weight: 400\">microbiological blitzkrieg and aseptic genocide<\/span><span style=\"font-weight: 400\">. As in many areas of life, it\u2019s time to get along. <\/span><span style=\"font-weight: 400\">Our microbiome is less a &#8220;villain&#8221; in need of destruction, and more a &#8220;roommate&#8221; in need of accommodation. We are stuck together and take turns providing for the other. It\u2019s mutually-assured-survival as much as mutually-assured-destruction.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite all the \u201cfreewill\u201d mantra, Yong points out how we humans are even prompted when and what to eat by our buggy cohabitants. We eat to keep them happy, and, in turn, they keep us safe. When we die we no longer feed them and so they eat us. They clean up the mess, and so continues the circle of life. <\/span><span style=\"font-weight: 400\">O<\/span><span style=\"font-weight: 400\">ur immune system kills invaders, but is also a tenancy agreement between human and microbe. If balance is symbiosis then the loss of balance is dysbiosis\u2026though you can call it disease. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Yong proffers evidence for why asthma, obesity, rheumatoid arthritis, colitis, even depression and autism, can be understood in terms more familiar to ecologists than doctors. Accordingly, the future of medicine invites terms more familiar to park rangers than bomber pilots. The glorious act of falling in love is no less wonderous even if the microbes create and sense the pheromones. Childbirth is still wonderful beyond words even though vaginal birth and breast feeding deliver essential bugs not just babies. Don\u2019t get me started on kissing though: yuck.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Hominid history is fleeting next to the four billion years that microbes\u2014<\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacteria\"><span style=\"font-weight: 400\">bacteria<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/Archaea\"><span style=\"font-weight: 400\">archea<\/span><\/a><span style=\"font-weight: 400\">\u00a0and single-celled\u00a0<\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/Eukaryote\"><span style=\"font-weight: 400\">eukaryotes\u2014<\/span><\/a><span style=\"font-weight: 400\">have ruled the roost. Multi-celled animals emerged so recently that we had to find accommodation on a planet where every niche was crammed. Humans are here because we cooperated, bodily and genetically. This includes the blessed-union that created our mitochondria. [3] Embracing our contractual obligations\u2014rather than fighting tooth and nail\u2014could be the next medical revolution.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We first met our microbiologic neighbours 200 years ago via microscope. This coincided with religion teaching that we were the &#8220;chosen ones&#8221; and Darwin arguing that life is a zero-sum &#8220;struggle.&#8221; We still over-label microbes (and anything we don\u2019t understand) as pathogens, rather than mutualists or symbiotes. Even the term colonizer is unjustified: microbes were here long before us. As for why I and my feral children are here, I am not equipped to answer, but am lucky beyond-measure or merit. Accordingly, for 2019, my resolution is to be guided more by my microbe-filled gut.<\/span><\/p>\n<p><em><strong>Peter Brindley<\/strong>, professor in the department of critical care medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. He is on Twitter\u00a0<a href=\"https:\/\/twitter.com\/docpgb?lang=en\">@docpgb<\/a><\/em><\/p>\n<p><i><\/i><em><span style=\"font-weight: 400\"><strong>Competing interests:<\/strong> None declared.\u00a0<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Spend enough time in a medical job and you\u2019ll face unexpected and existential questions. The most curious may even come from your own family. Several Christmases ago I faced a [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/14\/peter-brindley-but-why-are-we-here\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":43867,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18895],"tags":[],"class_list":["post-43866","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-peter-brindley"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Peter Brindley: But why are we here? \u00a0\u00a0 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/14\/peter-brindley-but-why-are-we-here\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Peter Brindley: But why are we here? \u00a0\u00a0 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Spend enough time in a medical job and you\u2019ll face unexpected and existential questions. 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