BOOKS ET AL.

2 MAY 2014 VOL 344 SCIENCE www.sciencemag.org 472

highways to relieve trafc congestion eases
things for a while but induces additional driv-
ing until the roads are again clogged. Fund-
ing agencies and research organizations
should make the changes that would gradu-
ally adjust the current excess supply of new
scientists to match demand and prevent new
funding from simply inducing expansion that
recreates excess supply. Only then could we
have a productive discussion about the ben-
ets of additional public funding.
References and Notes
1. S. Rosen, K. Murphy, J. Scheinkman, J. Polit. Econ. 102,
468 (1994).
2. Teitelbaum identies ve cycles. Denoted by what trig-
gered the initial boom, these are: the start of the Cold
War in the 1950s, Sputnik, the War on Cancer and Rea-
gan defense budget, the 1990s high-tech boom and Y2K
panic, and the Clinton-Bush doubling of the NIH budget.
3. www.nap.edu/openbook.php?record_id=11463.
4. www.nap.edu/openbook.php?record_id=12999.
5. http://dx.doi.org/10.1787/888932486659.
6. M. S. Teitelbaum, Science 321, 644645 (2008).
7. P. Stephan, How Economics Shapes Science (Harvard
Univ. Press, Cambridge, MA, 2012); reviewed in ( 10).
8. NIH, Biomedical research work-force working group
report (NIH, Bethesda, MD, 2012); http://acd.od.nih.
gov/biomedical_research_wgreport.pdf.
9. P. Stephan, The Endless Frontier: Reaping what Bush
sowed?, National Bureau of Economic Research Work-
ing Paper No. 19687 (2013).
10. M. Feldman, Science 335, 1171 (2012).
10.1126/science.1252696
The reviewer is at the Wellcome Trust Sanger Institute,
Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK.
E-mail: am24@sanger.ac.uk
M
ost people recognize that anti-
microbial drugs are becoming
increasingly ineffective, due to
the rise of antimicrobial resistance (AMR).
The incredible adaptability of microbes and
the strong and varied selection pressures to
which they are exposed compromise our abil-
ity to fight infections, and many common
procedures (from hip replacements to cancer
therapies) carry greater risks. This has been
highlighted in recent government reports
such as the UK Five Year Antimicrobial Resis-
tance Strategy 2013 to 2018 ( 1) and the U.S.
Centers for Disease Control and Preventions
Antibiotic Resistance Threats in the United
States, 2013 ( 2). With very few new drugs in
the pipeline, there is no doubt that the increas-
Antibiotics and
Collateral Damage
PUBLIC HEALTH
Alison E. Mather
ing resistance to antimicrobials poses a seri-
ous threat to human and animal health.
While AMR can be observed and mea-
sured on relatively short time scales, there
are other consequences to the use of antimi-
crobials and the less frequently considered
sanitizers and disinfectants. Their long-term
effects, at both individual and
population levels, have rarely
been addressed and are the
central themes in Martin Bla-
sers Missing Microbes. Blaser
(an infectious disease special-
ist at New York University) has
dedicated decades to investi-
gating how our use of antimi-
crobials over the past 70 years
or so relates to the phenomena
of obesity, food allergies, asthma, and heart-
burn, epidemics he refers to as our mod-
ern plagues. He argues that changes to our
microbiotathe collection of microbes in
our bodies, which helps us digest our food,
clot our blood, and protect us from invading
pathogensare responsible for many human
ills of the 21st century.
Blaser sets the scene by portraying the
complexity and diversity of microbial popu-
lations and their interactions within human
bodies. He has a particular and personal
interest in Helicobacter pylori, a bacterium
that for years has been associated with gastri-
tis and ulcers. Whereas the organism is often
portrayed as a villain, Blaser instead pro-
motes its dual nature, arguing that its absence
is associated with different disorders, an
example being gastroesophageal reux dis-
ease. Illustrating his points with a combina-
tion of data and personal anecdote, he walks
readers through the processes by which the
use of antimicrobials changes the nature and
composition of the resident microbial popu-
lations that have evolved with us and notes
how certain bacteria, such as H. pylori, are
disappearing. In doing so, Blaser argues that
we are interfering with our immune systems
and other key biological processes and thus
predisposing ourselves to these modern epi-
demics. In another example, he draws an
analogy between the frequent prescription
of antimicrobials in children (often for viral
infections on which they have no impact) and
the provision of antimicrobials for growth
promotion in food animals, inadvertently
fattening [our children] up.
As the author, to his credit, recognizes,
the strength of evidence for the association
between changing microbiota and these dis-
eases is, without doubt, variable. The dis-
eases are complex and multifactorial, and,
interesting though Blasers observations are,
for most of these illnesses a full understand-
ing of causal relationships lies some way off.
Importantly, he makes clear the critical dis-
tinction between association and causation,
and his explanations of ecological and epi-
demiological concepts are among the books
strong points. So too are his descriptions of
necessary but not sufficient
factors and the importance of
seeking other vantage points
from which to view ones data.
There can be little dis-
agreement with Blasers con-
cern that we are now facing
the doomsday scenario of an
antibiotic winter. In dis-
cussing that, he shifts from the
long-term, unintended conse-
quences of antimicrobial use and focuses
instead on the more immediate prospects of
untreatable resistant infections and human
populations, with their disrupted microbiota,
becoming more susceptible to pathogens.
Expressed in a style ranging from moder-
ate to strongly assertive, many of Blasers
views are contentious. However, new ideas
and fresh approaches are best generated from
intellectual sandpits and the tails of the dis-
tribution of opinions. Readable and challeng-
ing, Missing Microbes provides a stimulus
with which to probe existing dogma.
References
1. www.gov.uk/government/uploads/system/uploads/attach-
ment_data/le/244058/20130902_UK_5_year_AMR_
strategy.pdf.
2. www.cdc.gov/drugresistance/threat-report-2013/.
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10.1126/science.1252914
Missing Microbes
How the Overuse of
Antibiotics Is Fueling
Our Modern Plagues
by Martin J. Blaser
Holt, New York, 2014. 288 pp.
$28. ISBN 9780805098105.
Published by AAAS

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