Friday, March 20, 2015

"Put that kid out in the dirt ..." (17 April 2014)

It would have been some time in the mid-ish 1940s, perhaps 1947 or so, when I was a small child and — my mother's story went — she took me to a pediatrician who told her "Put that kid out in the dirt and get him around more kids."

            The pediatrician was concerned that my mother was keeping me too clean and sanitized and that I wasn't contracting childhood diseases in childhood and, well, just seemed unnaturally clean.

            The pediatrician had solid experience and evidence for the importance of getting childhood diseases in childhood — a human male, especially, doesn't want mumps in adulthood — but the rest was mostly prejudice, reinforced a little from what was becoming a real science of immunology. Still, that advice stemmed mostly from literal prejudice, in a morally neutral sense: he had judged before a lot of evidence was in that there was just something, well, unhealthy about keeping kids too sanitized, deodorized, and antiseptic.

            I went on to participate in grammar-school football and played line until the other kids outgrew me too much for me to block; but I did play football in robust Chicago wind and rain and mud, and there was no danger then or later that I'd ever be crazy clean.

            I went further on to take 18 hours of Microbiology in college and work three summers doing Micro, more or less. Among the lessons I was taught was, "Bacteria are ubiquitous, pretty much everywhere on Earth except deep in an active volcano or in the bloodstream of a healthy mammal"; and I learned that the human mouth is, bacteriologically speaking, filthy. At least I got more growth plating out a swab from the mouth of a healthy person — me, for a "normal" every few days — than I got plating out a squashed fly.

            And beyond that I read at a fairly young age Mary Douglas's great book Purity and Danger (1966) and figured out that many US customs rationalized as hygiene — and sometimes useful for hygiene — had more to do with purity and a kind of ritual/social cleanliness than anything very scientific.

            So I've been fascinated even more than usual the last year or so with stories reaching the lay media on the American crazy-clean concern with skin sanitizers and antibiotics and high-tech birthing of babies and gloves of latex or plastic on the hands of people not performing surgery or CSI work. I've been fascinated with increasingly insistent suggestions that in some areas of hygiene in a broad sense we have gone overboard and moved from diminishing returns to "counter-productive" to, in public health terms, self-defeating.

            We didn't have the term "microbiome" when I was preparing to enter the Microbiology biz or working on a project in gastroenterology, but we were well aware of the importance of gut bacteria and other gut microorganisms, and it was standard folklore that if one took antibiotics, one should eat real yogurt, the kind with what I learned to call "active cultures."

            (I learned to call them that the first time I asked the counter-guy at a frozen yogurt place if there were living bacteria in their product, and he said "No! Of Course Not!", and I told him that was too bad 'cause this frozen yogurt stuff looked good but I was taking an antibiotic and I wanted to send some "friendlies" down into my gut to take up niches — I didn't say "niches" to him — that might otherwise be filled by organisms I really, really didn't want to play host to. He got his boss, who told me to ask about "active cultures" and served me up some in a concoction I can't call healthful — not with the caramel topping and other crap I loaded it up with — but one I really enjoyed.)

            It's way too early for definitive statements, but it feels right to me that "food allergies, asthma, celiac disease[,] and intestinal disorders like Crohn's disease have been on the rise," and obesity to boot, and that part of the reason for the increase would be America's overkill of the microorganisms that share our environment and bodies (NPR 14Ap14).

            That old pediatrician back in the 1940s prejudged the issue, but his "instincts" were right and his advice good. My primary-care physician in the 1980s had more data to go on — if still nothing definitive — but he was right to comment that "a lot of Americans shower and bathe too much" and advise me that aging skin shouldn't have a lot of soap and hot water run over it seven days a week (not even in the American Midwest, where water falls right out of the sky).

            Do vote for bond issues for sewers and sanitation and clean water. Do get your inoculations and definitely get your kids shot up for preventable diseases. But lay off a little on the hand-sanitizers, showers, and surgical procedures — as in C-sections here — that aren't absolutely necessary. And definitely throw children out of the house fairly frequently and point them toward a bunch of other little germ-bearers looking for dirt to play in.

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