Bacteria on display—can we, and should we? Artistically exploring the ethics of public engagement with science in microbiology

Just out in the latest issue of FEMS Microbiology Letters is a small commentary by myself and Artist Anna Dumitriu, describing our experience of collaborating on Microbiology/Art public engagement pieces. We focus on the ethical issues involved in displaying bacteria publicly, how to address the risks involved, and projects that can open up wider debates around the ethics of new technologies, namely the Trust me I’m an Artist collaboration.

Can we display bacteria from poop? If we do, how can we minimise the risk? And who gets a say in whether we should or not?

The shiny full published version can be found: at  https://academic.oup.com/femsle/article/365/11/fny101/4983122#116947251

Accepted manuscript for those who don’t have access to paywall can be downloaded here: FEMSLE_accepted_manuscript

Figures:

Figure 1: The MRSA Quilt The quilting squares were added to Methicillin-resistant Staphylococcus aureus cultures on chromogenic agar. Standard antibiotic susceptibility testing equipment was used to create the patterns, together with other known antimicrobial pigments and dyes. The whole work was autoclaved prior to display. It serves as a tactile, aesthetic ‘conversation piece’, as microbiological techniques are described to explain how the effects are achieved. More information on this piece and more can be found at http://www.normalflora.co.uk

Figure 2: Sequence Dress The dress was created using material impregnated and patterned using Staphylococcus aureus culture on chromogenic agar. DNA from Staphylococcus aureus cultured from Dumitriu’s body was sequenced using an Illumina Miseq, and the light output from the flow cells captured and mapped digitally onto a dress. The DNA sequence was projected behind. The piece has been exhibited internationally, and serves to highlight new technologies in the field of Microbiology. http://www.normalflora.co.uk

This is a pre-copyedited, author-produced version of an article accepted for publication in FEMS  Micro Letters following peer review. The version of record [Nicola J Fawcett, Anna Dumitriu; Bacteria on display—can we, and should we? Artistically exploring the ethics of public engagement with science in microbiology] is available online at: https://academic.oup.com/femsle/article/365/11/fny101/4983122#116947251 .

‘Gut Flora’ features

Science as Art brochure

Summary

https://www.ukri.org/news/impact-and-breadth-of-uk-china-collaboration-on-show-at-china-launch-of-uk-research-and-innovation/

https://lsc.org/explore/exhibitions/microbes-rule

Peppa Pig and Primary Care Services:Improved Version

This great Christmas BMJ article considers whether portrayal of general practice in Peppa Pig raises patient expectation and encourages inappropriate use of primary care services.

In the spirit of the article, I would like to suggest an improved Peppa Pig episode that could be used to convey more realistic expectations, encourage safe self-management and use primary care services more effectively .

Previously : Case study 2: George catches a cold (quoted in the article) 

Parents call Dr Brown Bear on a Saturday regarding an 18 month old piglet with a 2 minute history of coryzal symptoms after playing outside without his rain hat.

Dr Brown Bear telephone triages and makes an urgent home visit.

After examining the throat, he diagnoses an upper respiratory tract infection and advises bed rest and warm milk. Symptoms resolve within 12 hours.

New : George catches a cold (more realistic suggestion ) 

George Pig has a fever and is grumpy as hell. Mummy Pig knows the score from previous experience. She checks the NHS website just to be sure, and notes George has none of the concerning signs that would suggest she needs to seek further medical advice.

She goes to the local pharmacy and has a constructive conversation with the pharmacist, and is given some pink medicine for George Pig. She goes home and attempts to syringe some pink medicine into George Pig’s mouth until roughly equal quantities of medicine have gone into George, on the carpet and in Mummy Pig’s face.  George Pig is eventually only placated by bottle and daddy’s smartphone, and doesn’t want to sleep for more than 20 minutes at a time unless he is in Mummy Pig’s arms and being rocked.

Great articles on antibiotic use in animals

Scientific American: How Drug-Resistant Bacteria Travel from the Farm to Your Table https://www.scientificamerican.com/article/how-drug-resistant-bacteria-travel-from-the-farm-to-your-table/

The Atlantic: Apocalypse Pig: The Last Antibiotic Begins to Fail http://phenomena.nationalgeographic.com/2015/11/21/mcr-gene-colistin/

Bloomberg: Indian Poultry Farms Are Breeding Drug-Resistant Superbugs https://www.bloomberg.com/news/articles/2017-07-20/poultry-farms-in-india-resemble-superbug-reservoirs-study-finds

 

 

The cautionary tale of the phage cocktails

A lovely little case report has just come out in AAC, about a patient with pretty terminal multidrug-resistant Acinetobacter baumanii infection being treated with a cocktail of bacteria-destroying phages.

I like to hear little radio reports from planet phage every now and then, as I do get asked  about them quite a lot when talking antibiotic apocalypses.

It’s well worth a read for those who want a quick insight, as it’s like a microcosm of the phage therapy world all in one patient – all the hopes, limitations, concerns, all in a very nicely written article.

Clever science? tick. Phages being inactivated by the patient’s own body? tick. Development of resistance by the bacteria? tick.  But also… possible clinical effect in someone with few options, and an excellent discussion about synergy between phages and antibiotics, Which I think boils down to ‘if you hit it with enough things simultaneously it goes down eventually’.

Antibiotic Resistance explained using Game of Thrones

Someone on twitter suggested that if we described the threat of antibiotic resistance in terms of Game of Thrones, it might be easier to grab attention and understand. I mean, it’s all in the news about how resistant superbugs are going to kill us all…

So here we go: (Massive spoilers for GoT warning)

White Walkers = near-unkillable superbugs

So for a long time, bad guys could be killed with sharp, pointy things, and heavy, smashy things. Like bacteria can be killed with antibiotics.  Only some people/things/bugs have managed to change and can no longer be killed by sharpness or smashing or even the strongest antibiotics. This is bad. Modern life sort of depends on us being able to kill things that want to kill us. If we can’t, it’s a bit of a game over, really.

But right now, they seem like they’re a long way away, and they only affect wildlings/ other people you don’t really care about but read about in the Daily Mail.

Reading the Path of Antibiotic Decline in Bacterial DNA

“It is hard not to feel a sense of awe of the ingenuity of the bacterial machine in surviving human intervention, as you see it revealed in DNA sequencing; findings that are beautiful in their science, and often deeply concerning in their potential consequences.”

How Whole Genome Sequencing technology is helping us understand and respond to antimicrobial resistance – our article for Angle Journal is available here:

https://anglejournal.com/article/2016-04-reading-bacterial-dna-how-whole-genome-sequencing-technology-is-helping-us-understand-and-respond-to-antimicrobial-resis/

Antibiotics and resistance – there is a problem, but it’s not my fault!

When I talk to my hospital colleagues, and my patients,  about antibiotics, overuse, and resistance, there is certainly no lack of awareness. Unprompted I frequently get told exactly what the problem is.

There’s one answer I rarely get.

“I’m probably part of the problem, and I am changing what I am doing, to do my bit”.

—–

Is this reflected in what is said online? 

Probiotics -seeds of change, or unnecessary chimpanzees?

AKA What I say when people ask me about Yakult.

“Probiotics -what do you think of them?” 

I get asked this quite a lot, when I talk about antibiotics, gut bacteria, and our own microbial community, or ‘microbiome’,  in general.

So first up, let’s just say, I love Microbiomes. I think the whole area is fascinating, I’m lucky enough to work in the area,  and I firmly believe a better understanding will transform how we see health, and how we treat our patients.

I think…we’re not quite there yet.

As I’ve heard it described many times, Microbiome science is generally still in the ‘cataloguing’ stage. We’ve just been given the tools for the first time to go and explore these incredibly complex ecosystems, previously hidden from our eyes. And we’re going into Amazon rainforest, Appalachian plains, and snowy mountains, and we’re cataloguing and counting everything we find there.  It’s a wonderfully exciting time.

We’re finding that some people have incredibly diverse guts, full of  rarely-seen species – (Amazon rainforest guts) – and others maybe have guts more like Siberian tundra – more sparse, fewer different species (that we can see).

Some scientists are finding they can correlate the presence of certain species with health conditions. You might say guts of patients with diabetes are less likely to contain oak trees, or guts of obese patients have far more monkeys than ants, compared to those of normal bodyweight.   Great.  This is all interesting stuff.

What can we do with this, and how does it relate to probiotics? 

The wild garden of the gut bacteria

This is an entry for the  American Society of Microbiology Agar Art competition, and yes, it’s created using poop! Or more correctly, bacteria from poop.

You can see more of the agar art at:

http://www.facebook.com/media/set/?set=a.10154367491515200.1073741836.62453295199&type=3

Update: We’ve now got a full gallery of  our art at http://modmedmicro.nsms.ox.ac.uk/art-from-the-gut/

Photography is by Chris Wood, of Oxford Medical Illustration, whose awesome work is all over this blog. The images are photographed over a lightbox, to bring out the colors and transparency of the agar.

 

 

There’s a lot more behind it than I could fit into 200 words! So I  so here’s the longer description.

What’s the science behind this? 

We often talk about bacteria as harmful things. Images in the media, advertising, even Doctors and Scientists, portray a healthy, desirable world as one free of bacteria- sterile, washed and scrubbed clean.  It’s becoming increasingly clear that this isn’t true. Recent advances in scientific research have enabled us to study bacteria in new ways, helping us realise that we wouldn’t be able to survive in this world without bacteria – we live together, and often help one another.  One of the most important places this happens is in our partnership with the bacteria in the gut. We provide them with food and habitat. They, in return, help protect us from harmful bacteria, help regulate the immune system so it fights infections but doesn’t get over-reactive (which may stimulate auto-immune diseases), and also affect our metabolism, or hormones, even possibly our mood…

Some people have compared the bacteria that live in our gut to a ‘garden’ – a healthy gut is one that is populated with many different types of bacteria, living together – in this setting, bacteria are desirable and beautiful.  Some bacteria are almost always beneficial, some are harmless, and some can be harmful. They all interact with one another, forming an ecosystem- they compete for nutrients, interact and communicate with one another.  But much like a garden, some types of bacteria can get out of control and cause damage if the careful balance between human and bacterial community is disrupted. For instance, previously harmless gut bacteria can sometimes escape the gut and enter our bloodstream if our immune system isn’t working well, or if our gut wall is damaged. Perhaps, rather than partnership, we should consider the relationship between our bacteria as a mutually-beneficial truce, occasionally broken by both sides when circumstances change.

You can see the techniques used here:

Thanks to That’s Oxford TV!

What’s going on in the images?