Contextualising the microbiota-gut-brain axis in history and culture.

Abstract

This special edition on humanistic approaches to the microbiota–gut–brain axis was inspired by two symposia organised by literary scholar Dr Manon Mathias at the University of Aberdeen in 2017 and at the University of Glasgow in 2018, both involving the participation of medical historian Dr Alison M. Moore and gastroenterological researcher Dr Jørgen Valeur, with all the contributors to this special edition having spoken at one or other symposium. Mathias and Moore are among the rare cohort of humanities scholars who approach past literary, cultural and medical concepts with the aim of contextualising current medical models and research findings, while Valeur is among the even rarer cohort of medical researchers and clinicians to see inherent value in humanistic understandings of health. It is the shared premise of all three editors that historical and cultural perspectives enrich the current understanding of microbial ecology, and the science of microbe–host interactions. One reason it should interest all medical researchers and clinicians to read the articles in a special edition such as this, is to consider what is truly novel in current scientific models and what may be inherited from past medical concepts. Such earlier concepts may help or hinder current science, but without researchers knowing anything about them, it is most likely that their influence will not be helpful. As the American enteric nervous system researcher Michael D. Gershon noted in his 1998 book on the Second Brain, ‘hubris for scientists comes from inadequate knowledge and appreciation of the past’ [1]. Indeed, failures to see what is truly new in the treatment of gastroenterological disorders can be found throughout the scientific record. The history of faecal microbial transplant (FMT) is a case in point: though often claimed as a ‘new’ therapy [2], it has existed in the form of oral administration in European medical traditions since Ancient Greece, featured in severalmajorworks ofmedical description of the sixteenth and seventeenth centuries [3], and has been used in Chinese medical traditions since the Don-jin dynasty (4 century CE) [4]. Rectal delivery of FMT was used by the American doctor I.O. Wilson in 1910, following the identification of changes in faecal bacterial composition among patients with functional bowel disorders [5]. Thus, FMT is anything but ‘new’ and its historical and trans-cultural ubiquity may indeed lend support to the emergent scientific model of the gut microbiome as an essential organ of the human body, composed of organisms that have co-evolved with our own cells such that they are to some extent ‘us’. This indeed is the very argument that FMT researcher Alexander Khoruts has made for why this therapy for Clostridium difficile should be seen not as a ‘drug’ but as a ‘transplant’ [6]. Themounting evidence for commensal and symbiotic intestinal microbes lends itself to this interpretation, and is consistent with the acceptance of the microbial origin of our cellular mitochondria [7]. It is not hard to see then why new research on the gut microbiome should fascinate scholars in the humanities since it touches upon the very question of what it means to be human – indeed the core concern of these disciplines. Humanities scholars are richly imaginatively endowed, as both Bencard &Whiteley’s and Lucas’ creative endeavours in exhibiting and narrativising medical research on the microbiota–gut–brain axis demonstrate. They are also particularly trained in critical and contextual ways of reading concepts, a skill-set generallymissing from science degrees, as Moore herself was surprised to discover when studying biomedical sciences at an Australian university between 2010 and 2013. A 2018 article involving two biomedical researchers, Katarzyna Hooks and Jan Peter Konsman, with the philosopher of microbiology Maureen O’Malley, offering a critical evaluation of microbiota–gut–brain research, is an excellent case in point [8]. The authors, while acknowledging the importance of microbiota–gut–brain axis research for understanding brain function and behaviour, show that there are frequent weaknesses in study design and conceptual modelling in the field, as well as in public communication, with pre-emptive hyperbole too often capturing popular health movements. But we might do well to remember also that medical research does not only filter out into popular cultural imaginaries, but is indeed situated within specific cultural and historical contexts. Our special edition is precisely about some of the earlier medical concepts that have helped to prime medical researchers toward posing questions about the brain by turning to the gut, and about how current medical research on the microbiota–gut–brain axis can be responsibly publicly disseminated. The paper that engages in most depth with the question of scientific dissemination and public engagement is Bencard&Whiteley’s piece on the ‘Mind theGut’ exhibition at the Medical Museion, Copenhagen. This exhibition was the result of intense reflection involving a range of academic researchers, artists and curators, and the article reveals the importance of this extended dialogue MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2019, VOL. 30, 1546267 https://doi.org/10.1080/16512235.2019.1546267