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

• DOI: http://doi.org/10.1002/wmh3.325
• Date: 01 December 2019
• Published date: 01 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 participants’feelings of mind‐body 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 (HAM‐D 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 health‐conscious mindset that has prevailed among the world’saf-

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 ‘guilt‐free’” (chap. 1). Indeed, as her title suggests, the current

“epidemic of wellness”is propelled by the search for control—both the individual’s

control of her mind and body, or “mindbody,”and the social control of what it

means to have and to be a healthy mindbody. Nothing—weight, body shape, diet,

exercise, thoughts, and emotions—should be out of one’s 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; self‐discipline and self‐control 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 foods—Lactobacillus and Bifidobacterium—have been shown to

“neither colonize the volunteers’guts 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 “smooth‐running 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 patterns—that may seek to advance their own

agendas, whether or not they are destructive of the whole”(“Introduction”).She

presents this “confederation of parts”as a “dystopian view of the body—not as a

well‐ordered 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 life‐enhancing, the same microbe in the

bloodstream is life‐threatening: “It all comes down to context”(p. 81).Inthis

view, microbiota and probiotics may be pharmakon—bothacureandadisease,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 neurons”from 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 scholar’s 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 material‐semiotic arrangements—for instance, how something like Activia’s

Daily Gut Challenge might have been viably advanced and, accordingly, how “the

good life”or “the road to ruin”might be presumed.

Following this approach when examining the material‐semiotic arrangements

of probiotics experimentation, we previously proposed the term gut rhetorics to

358 World Medical & Health Policy, 11:4