Socializing the Gut in Probiotics Experimentation: Calibrating Microbiota and Science Policy

DOIhttp://doi.org/10.1002/wmh3.325
AuthorDavid R. Gruber,Jason Kalin
Date01 December 2019
Published date01 December 2019
357
doi: 10.1002/wmh3.325
© 2019 Policy Studies Organization
Socializing the Gut in Probiotics Experimentation:
Calibrating Microbiota and Science Policy
David R. Gruber and Jason Kalin
Prebiotic and probiotic products continue to experience strong consumer growth while gastro-
enterological researchers work behind the scenes to understand the effects of specific bacterial strains
on study participantsfeelings of mindbody healthfulness. Correlations are achieved through the use
of psychometric questionnaires, which aim to measure affect states like stress, anxiety, and depression.
In this paper, we turn to qualitative textual analysis to examine two commonly employed psycho-
metric questionnaires (HAMD and HADS)used in studies of the same probiotic formulation. We
show how concepts of social deviance and norms of behavior (e.g., sleep patterns, social life, and work
productivity)inform such questionnaires, thus inserting normative ethical imperatives into clinical
findings. After demonstrating several key disjunctions across these questionnaires, we develop rec-
ommendations for gastroenterological researchers. In particular, we recommend that researchers give
more focused attention to aligning psychometric questionnaires and more carefully enact their
qualitative assessment requirements. In like manner, we recommend that ethical reviewers and science
policy reviewers consider how psychometric questionnaires embed social assumptions into clinical
trials, which can affect determinations of healthfulness.
KEY WORDS: gut, science policy, psychometric questions
In her book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and
Our Illusion of Control, the medical and science writer Barbara Ehrenreich (2018)
notes, In the healthconscious mindset that has prevailed among the worldsaf-
fluent people for about four decades now, health is indistinguishable from virtue,
tasty foods are sinfully delicious,while healthful foods may taste good enough to
be advertised as guiltfree’” (chap. 1). Indeed, as her title suggests, the current
epidemic of wellnessis propelled by the search for controlboth the individuals
control of her mind and body, or mindbody,and the social control of what it
means to have and to be a healthy mindbody. Nothingweight, body shape, diet,
exercise, thoughts, and emotionsshould be out of ones control. Those who lapse
in their healthful living, Ehrenreich observes, must repent by performing fasts,
purges, cleanses, and detoxes to regain control over their mindbody. Clean eating
becomes a moral imperative; selfdiscipline and selfcontrol feel like virtues.
The consumer market both creates and adapts to the demands for/of virtuous
eating, touting the health benefits of functional foods, superfoods, and prebiotics
and probiotics. In particular, prebiotic and probiotic products have experienced
strong growth in recent years (de Simone, 2019). Fermented foods, like yogurt,
kombucha, and kimchi; various cheeses reported to contain healthful bacteria; and
supplements in the form of herbs, powders, and pills have skyrocketed in popu-
larity (Shaikh, 2018). Yet, as Ed Yong (2016), a popular science journalist, explains
in summarizing recent probiotics research, Even the most concentrated probiotics
contain just a few hundred billion bacteria but the gut already holds a least a
hundredfold more(p. 222). Furthermore, the bacteria most common in yogurt and
other fermented foodsLactobacillus and Bifidobacteriumhave been shown to
neither colonize the volunteersguts nor change the composition of their micro-
biomes(p. 22). Though these bacteria may not have colonized our guts, they have
colonized our mindbody. We eat them as if they are good for us, and perhaps, we
feel in control in doing so. Probiotics, whatever effect they have on the gut, are
another means of trying to shape the mindbody and live a good life.
Thinking probiotics as a quick consumer resolution to various bothersome
states may envision the mindbody as a cohesive whole wanting mutuality, as a
kind of smoothrunning machine in which each part obediently performs its
tasks for the benefit of the common good(Ehrenreich, 2018, Introduction).In
contrast, Ehrenreich argues that the mindbody is at best a confederation of parts
cells, tissues, even thought patternsthat may seek to advance their own
agendas, whether or not they are destructive of the whole(Introduction).She
presents this confederation of partsas a dystopian view of the bodynot as a
wellordered machine, but as a site of ongoing conflict at the cellular level, which
ends, at least in all the cases we know of, in death(Introduction).Yong(2016),
too, notes that one microbe in the gut is lifeenhancing, the same microbe in the
bloodstream is lifethreatening: It all comes down to context(p. 81).Inthis
view, microbiota and probiotics may be pharmakonbothacureandadisease,the
path to the good life and the road to ruin.
The field of the rhetoric of health and medicine seeks to understand how
scientific advances are contextualized and how their promotion and discussion
stages them to be used in specific ways. Scholars study, for example, how particular
findings, such as mirror neuronsfrom the neurosciences, have been repeatedly
interpreted as simulation mechanisms, despite multiple other options; in this case,
the elegant mirror metaphor as well as existing sociocultural discourses about
mirroring in human development add persuasive power to the simulation inter-
pretation, which, in turn, makes mirror neurons easier to incorporate into other
fields (see Gruber, 2014, 2016). Thus, from a rhetoric scholars point of view, the
study of a scientific phenomenon is necessarily intertwined with biological, mate-
rial, and social spheres: The feelings of bodies, the practices of institutions, and the
social discussions that are happening, including in documentation, are seen as co
forming and, often, mutually validating. In this way, rhetoric of health and med-
icine takes an ecological approach to analyze how a particular phenomenon arises
within materialsemiotic arrangementsfor instance, how something like Activias
Daily Gut Challenge might have been viably advanced and, accordingly, how the
good lifeor the road to ruinmight be presumed.
Following this approach when examining the materialsemiotic arrangements
of probiotics experimentation, we previously proposed the term gut rhetorics to
358 World Medical & Health Policy, 11:4

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