When I ask Jack Gilbert about the future of medicine, he tells me what he recommends to his graduate students before they head into surgery, “When you go to cut someone open, you don’t just have one patient on the gurney. You have 40 trillion patients, and you have to think of how your actions are going to affect them.”
Those trillions of patients are microorganisms, communities of bacteria, viruses, fungi, and in some unhappy cases—pathogens. But they’re not all free riders. A growing body of research is making the case that the microscopic creatures in our gut, ears, mouth, and on our skin—together called our microbiome—play an essential role in our wellbeing. And Gilbert, faculty director of the Microbiome Center at the University of Chicago, and his team are at the cutting edge of this research.
Gilbert chatted with Nautilus from Chicago about the microbiome revolution, what a future trip to your doctor might look like, how our microbiome can make us fat (or thin), and the advice he presents to parents in his new book Dirt is Good.
You’ve said there is a revolution happening in medicine. What is it?
For the last hundred years, doctors have tried to remove all sources of dangerous pathogens: Making sure that our apron is clean, our hands are clean, the air is clean. Then we pump [the patient] full of antibiotics with the understanding that we’ve then killed off all the bacteria, and therefore there is no chance that the patient can get infected. And when the patient does get infected, one of those two things must have failed. And we blame ourselves.
We will have the ability to tweak elements of their life and microbiome in order to treat them before there’s a problem.
Well, this [approach] stresses the bacteria in the body, and allows the body to almost select for organisms that are more prone to attacking it. So, instead of curing the patient and removing the dangerous sources, we’re actually creating an environment inside the patient that selects for organisms that are dangerous.
So, the paradigm shift is looking at medicine not only from the perspective of the patient, but from the perspective of the microbial environment inside the patient. In many instances, the next 10 years are probably going to be the golden age of discovery for the applications of clinical science in our field.
What will a visit to the doctor be like in 10 years?
Imagine you have a routine mammogram and there’s a lump. They will refer you to an oncologist who will sequence the genome of your cancer and your microbiome. You’ll plug this information into our machine learning algorithms, and determine the most appropriate personalized strategy for you to respond to therapy. Maybe the doctor will find that you’re missing certain microbes, which would make a given therapy most effective. So we also give you a biological probiotic to enhance the activity of your therapeutic…