To a lay reader like me, the idea does indeed appear promising: a $250 one-time treatment to crowd out the bacteria that’s in my mouth now, producing lactic acid anytime I eat sugar, with an engineered variety that will not. (The process is a bit like “gene drive” proposals to outbreed disease-carrying mosquitoes with varieties that can’t harbor malaria or dengue or other diseases menacing to humans.) But it is nevertheless disorienting to find myself, reading about Lumina, in the position to decide, on my own, whether it’s worth it, or safe, to give a novel bacterium a permanent home in my microbiome (“once you use it, it’s in your mouth approximately forever,” Alexander writes). And to thereby undertake what is essentially an unproven and untested treatment without any traditional reassuring oversight. (As Ruxandra Teslo puts it, “most of the direct data comes from small studies in rats and well … most humans are not rats.”)
And yet this position is an increasingly common one, at least in certain corners of the internet, especially since Covid upended an awful lot about not just our lives and our health but also the structure of our epistemic faith. Suddenly, groceries weren’t safe, and then they were; parks weren’t, either, and then they were; masks didn’t work, and then they did, and then maybe they didn’t again. Early on, especially, guidance seemed to shift almost by the week, which emboldened certain people to try to sort it all out for themselves, while others languished in sometimes fearful confusion. In 2020, there were those who placed their pandemic bets on ivermectin and hydroxychloroquine, infamously, but also those hawking vitamin D as a Covid fix and those who didn’t want to wait for the conclusion of clinical trials and instead assembled their own versions of the Covid vaccines, administering them in the form of nasal sprays. The pandemic’s rise of at-home test kits was not just about Covid-19 — which, in fact, became widely available only after many months or regulatory and messaging obstacles — but also about Lyme disease, hormone levels, STIs, menopause, vitamin D, DNA sequencing, thyroid function and many other health indicators. By 2021, a majority of states had passed laws restricting public health authorities from taking actions against future pandemics. In the aftermath of the Covid emergency, the country’s biggest pharmaceutical and perhaps biomedical story has been the spectacular rise of Ozempic, which technically hasn’t even gotten F.D.A. approval for weight loss (though its semaglutide cousin Wegovy has).
Off-label use is nothing new, of course; some estimates suggest up to one-third of all prescriptions for common drugs in the United States may be written for purposes other than those originally intended. And skepticism about the American medical establishment didn’t begin with the pandemic, given decades of hostility toward the authorities like the F.D.A. and an even longer national infatuation with quick fixes, “secret knowledge” and quack cures. But in part because no one was happy with how the pandemic went, and because everyone wanted to believe it would have been easy to handle it better, it did help cultivate what my colleague Michelle Goldberg has called “a coalition of the distrustful” — an anarchic sort of D.I.Y. health and wellness counter-establishment, one that mixes disdain for much conventional wisdom with great faith in the ability of smart people on the internet to do better. “Substackism,” Max Read recently called it, on his own Substack.
“The anti-woke wellness corner of Substack is just one portion of a large and loose network of influencers, podcasters, gurus, scientists, pseudoscientists, quacks, dieticians and scammers,” Read wrote earlier this month. “What links all of these diverse content producers together is less a particular level (or absence) of scientific rigor or expertise (sometimes these guys are absolutely correct!) and more an outsider attitude — a mistrust of institutions.”
To most Americans, not just on the right, this all feels not just familiar but intuitive: that the apparent stumbles of our public health establishment through the past few years would produce distrustful backlash against elite authorities. And there were missteps and mistakes: early on, about testing kits and aerosol spread; in the middle of the pandemic about “natural immunity” and breakthrough infections; and in the post-emergency phase about the universal value of Paxlovid, for instance, which, one recent study suggests, may offer little to no clinical benefit for the fully vaccinated.