Hookworms Make Us Human: The Microbiome, Eco‐immunology, and a Probiotic Turn in Western Health Care

Abstract

Historians of science have identified an ecological turn underway in immunology, driven by the mapping of the human microbiome and wider environmentalist anxieties. A figure is emerging of the human as a holobiont, composed of microbes and threatened by both microbial excess and microbial absence. Antimicrobial approaches to germ warfare are being supplemented by probiotic approaches to restoring microbial life. This article examines the political ecology of this probiotic turn in Western health care. It focuses on Necator americanus-a species of human hookworm-and its relations with immunologists. The analysis moves from a history of human disentanglement from hookworm, to contemporary anxieties about their absence. It examines the reintroduction of worms for helminthic therapy and explores emerging trajectories for probiotic health care involving the synthesis, modification, and/or restoration of worms and their salutary ecologies. The conclusion differentiates these trajectories and identifies an emerging model of "post-paleo" microbiopolitics. This article is protected by copyright. All rights reserved.

Air care: an ‘aerography’ of breath, buildings and bugs in the cystic fibrosis clinic

“…As we suggest above, air is even becoming enfolded in a material discourse of atmospheric ‘rewilding’ not dissimilar to that happening in other contexts of ‘going probiotic’ (Lorimer 2019), dovetailing with mounting concerns around the bio‐depletion of both the body and the built environment, reflected in attempts to mitigate resistance through restorative bio‐diversifying interventions. The rigid spherological boundaries of the built environment are in this way being called into question.…”

Abundance in the Anthropocene

“…Like bed bugs, hookworms have a long, co-evolutionary history with humans, perhaps dating back 12,000 years (or longer) (Cox, 2002; Palmer, 2009). Medical historians, anthropologists and others have explored aspects of this history (Couacaud, 2014; Ettling, 1981/2014; Palmer, 2009), but, most notably, geographer Jamie Lorimer (2016, 2017a, 2017b, 2018) has charted human–hookworm relations from ancient times to present day. Lorimer (2017a, 2018) traces human–hookworm entanglement, disentanglement and re-entanglement through three transitions: a period of sudden infection intensity and increasing scientific and medical attention in the nineteenth century; a separation (in some regions) in the twentieth century onwards; and increasing contemporary attempts to restore hookworms as a key part of the human microbiome.…”

“…Medical historians, anthropologists and others have explored aspects of this history (Couacaud, 2014; Ettling, 1981/2014; Palmer, 2009), but, most notably, geographer Jamie Lorimer (2016, 2017a, 2017b, 2018) has charted human–hookworm relations from ancient times to present day. Lorimer (2017a, 2018) traces human–hookworm entanglement, disentanglement and re-entanglement through three transitions: a period of sudden infection intensity and increasing scientific and medical attention in the nineteenth century; a separation (in some regions) in the twentieth century onwards; and increasing contemporary attempts to restore hookworms as a key part of the human microbiome. These periods are shaped by and echoed in three figures of the hookworm – the parasite, ghost and mutualist (Lorimer, 2017a) – across which the hookworm emerges as ambivalent: in different situations the worms can become pathological through excessive presence and total absence, whilst in moderation they are potentially beneficial.…”

“…Until the second half of the nineteenth century, hookworm infection had been more or less present in people of tropical and warm temperate regions (including in Europe and North America) without significant attention or concern on the part of ‘Western’ medical science (Lorimer, 2018; Palmer, 2009). However, the political-ecological intensities of colonial capitalism in India, Africa, the Americas and Australia created conditions for hookworms to become parasitic: colonial mines, railroad beds, reserves and plantations were hotspots for hookworm disease due to high-density populations of displaced, poorly nourished people living with poor sanitation and suitable soil (Lorimer, 2018). This led to frequent re-infection and excessively high wormloads: hookworm infection tipped over into hookworm disease (Palmer, 2009).…”

Making the microbiome public: Participatory experiments with DNA sequencing in domestic kitchens

“…Microbiologists and immunologists have linked microbial dysbiosis to a wide range of health, hygiene and lifestyle practices. Their investigations pick up on, and are arguably co‐produced alongside, concerns with the risks posed by excessively antibiotic ways of managing microbial life (Lorimer, ). A “hygiene hypothesis” explaining increases in allergy was proposed in the late 1980s (Strachan, ).…”