Good Bug/Bad Bug: Reflections on Immunology Research in Modern America F.R. Lendacki Science & Medicine This summer concludes my first year as a full-time grad student in epidemiology. As Kate Winslet in Contagion and anyone else who has ever studied in this field knows, epi often starts with a healthy overview of both chronic and infectious disease topics. Infectious disease epi answered all my most pressing questions: why is seasonal flu so different from pandemic? Why can oysters make you sick? Should we be horrified that aedes aegypti mosquitoes are evolving to survive everywhere?* WHAT WAS THE DEAL WITH EBOLA? Then came the vaccination pitch: Immunizations are one of the ten greatest public health achievements of the 20th century, and have enabled the control or eradication of smallpox, polio, measles, rubella, tetanus, diphtheria, Flu B . . . sold. Sign me up to be one of those crazy “vaccine champions,” full of feels toward “those” moms who refuse to play nice and get their kids their shots. Spring brought my chronic disease class, in which, while acknowledging the importance of immunizations, my teacher first posed to us that ever-present question of medical ethics: “Yes, we can — but should we?” We now have the technology to inoculate ourselves with some of history’s greatest killers, antibodies swimming inside us for decades or lifetimes, but at what cost? What if, in trying to shield them from everything under the Sun, we are actually leaving American kids’ little bodies in a constant date of hyper-self-defense? Increasingly, we are realizing the unintended immunological consequences of re-immunizing, over-sanitizing . . . . My pliable little graduate brain. Full of feelings and questions, I applied for a summer internship with vaccine researchers at the Marshfield Clinic, and I GOT IT. Here I am in pastoral central Wisconsin, working in HPV vaccine research — we’re talking a virus (infectious!) that causes cancer (chronic!) — pretty wild, right? The Marshfield Clinic Research Foundation also houses the National Farm Medicine Center, and they are doing some fascinating work. They have been finding that kids who grow up having a blast outside with animals tend to have fewer issues with asthma and markedly stronger immune systems than us pansy suburbanites. Recalling a childhood of being lulled to sleep by an air purifier, allergic to pollen, baseball season and happiness generally, I may be bitter — but more than that, I’m intrigued. How do you feel about this idea that there is such a thing as “too clean” — that modern America, as with anything and everything, is completely overdoing it with the shots and the gel and the bleaching? The real kicker, for me, has been learning about the advent of probiotic cleaning products. In other words, “Paying money to spray germs back onto surfaces.” The idea is that filling a space with “good bugs” will crowd out the bad, and help restore order to our vulnerable microbiomes. Overuse of harsh cleaners and antibiotics, as we have been learning, has equated to atom-bombing our internal and external microenvironments. Left behind are sterile wastelands, patrolled only by MRSA** and other mutant pathogens evolved to survive us all. So I ask again — how far is too far? In googling “probiotic cleaners,” I found a host of trendy articles — improve your wellness by “spray-conditioning” your air! A lady in a pristine white t-shirt faces her open bedroom windows, curtains billowing with fresh air and the promise of well-being, thanks to the cotton-scented probiotic army she has just misted everywhere. This is what it has come to: in our increased ability/desire to fight disease and achieve our modern metric of clean, we have gotten too good. We now have to spend more money to restore what we’ve taken away. What if, along what we think is this linear trajectory of medical achievement, we are actually inching up just one peak of some freaky sinusoid of disease progression? As we conquer one cycle of diseases, a brand new one is coming to light (chronic inflammation, asthma, superbugs) — but what comes after this? Does this not make your head spin, even a little? It should. We are not that far off from having a “microbial” hand rub right next to the “antimicrobial” one that currently exists in hospitals, airports, and diaper bags everywhere. Cleaning the bad and then trying to replace the good — will this become the new shampoo and conditioner? I am not writing with the intent or capacity to answer these questions. I only hope you are slightly more interested in “all this antimicrobial resistance stuff” and “the hygiene hypothesis” than when you started reading this rant. Decades from now, when we hoverbot over to Walgreen’s (2080 edition) to scoop up bottles of oral fecal supplements, I hope you will smile, and think about this commentary. Because then, out of desperation, we will literally will be turning our shit into gold. *YES **Methicillin-resistant Staphylococcus aureus Featured image courtesy of Flickr.