Does the medieval notion of the human body as a microcosm of the wider Cosmos – in which is played out an eternal battle between good and evil – still influence our thinking?
Keith S. Taber wants to tell you a story
Are you sitting comfortably?
Good, then I will begin.
Once upon a time there was an evil microbe. The evil microbe wanted to harm a human being called Catherine, and found ways for his vast army of troops to enter Catherine's body and damage her tissues.
Luckily, unbeknown to the evil microbe, Catherine was prepared to deal with invaders – she had a well-organised defence force staffed by a variety of large battalions, including some units of specialist troops equipped with the latest anti-microbe weapons.
There were many skirmishes, and then a series of fierce battles in various strategic locations – and some of these battles raged for days and days, with heavy losses on both sides. No prisoners were taken alive. Many of Catherine's troops died, but knowing they had sacrificed themselves for the higher cause of her well-being.
But, in the end, all of the evil microbe's remaining troops were repelled and the war was won by the plucky defenders. There was much rejoicing among the victorious army. The defence ministry made good records of the campaign to be referred to in case of any future invasions, and the surviving soldiers would long tell their stories of ferocious battles and the bravery of their fallen comrades in defeating the wicked intruders.
Catherine recovered her health, and lived happily ever after.
There is a myth, indeed, perhaps even a fairy story, that is commonly told about microbial disease and immunity. Disease micro-organisms are 'invaders' and immune cells are 'defenders' and they engage in something akin to warfare. This is figurative language, but has become so commonly used in science discourse that we might be excused for forgetting this is just a stylistic feature of science communication – and so slip into habitually thinking in the terms that disease actually is a war between invading microbes and the patient's immune system.
Immunity is often presented through a narrative based around a fight between opposed sentient agents. (Images by Clker-Free-Vector-Images and OpenClipart-Vectors from Pixabay.)
Actually this is an analogy: the immune response to infection is in some ways analogous to a war (but as with any analogy, only in some ways, not others). As long as we keep in mind this is an analogy, then it can be a useful trope for talking and thinking about infectious disease. But, if we lose sight of this and treat such descriptions as scientific accounts, then there is a danger: the myth undermines core biological principles, such that the analogy only works if we treat biological entities in ways that are contrary to a basic commitment of modern science.
In this article I am going to discuss a particular, extensive, use of the disease-as-war myth in a popular science book (Carver, 2017), and consider both the value, and risks, of adopting such a biological fairy-tale.
Your immune system comprises a vast army of brave and selfless soldiers seeking to protect you from intruders looking to do you harm: an immune response is a microcosm of the universal fight between good and evil?
A myth is a story that has broad cultural currency and offers meaning to a social group, usually involving supernatural entities (demons, superhuman heroes, figures with powerful magic), but which is not literally true.
Carver's account of the immune system
I recently read 'Immune: How your body defends and protects you' (henceforth, 'Immune') by Catherine Carver. Now this is clearly a book that falls in the genre 'popular science'. That is, it has been written for a general audience, and is not meant as a book for experts, or a textbook to support formal study. The publishers, Bloomsbury, appropriately describe Carver as a 'seasoned science communicator'. (Appropriately, as metaphorical dining features strongly in the book as well.)
Carver uses a lot of contractions ("aren't", "couldn't", "doesn't", "don't", "isn't", "it's", "there's", "they're", "we've", "what's", "who'd", "wouldn't", "you'd") to make her writing seem informal, and she seems to make a special effort to use metaphor and simile and to offer readers vivid scenes they can visualise. She offers memorable, and often humorous, images to readers. A few examples offer an impression of this:
- "…the skin cells…migrate through the four layers of the epidermis, changing their appearance like tiny chameleons…"
- "Parietal cells dotted around the surface of the stomach are equipped with proton pumps, which are like tiny merry-go-rounds for ions."
- "a process called 'opsonisation' make consuming the bacterial more appealing to neutrophils, much like sprinkling tiny chocolate chips on a bacterial cookie."
- "The Kupffer cells hang around like spiders on the walls of the blood vessels…"
In places I wondered if sometimes Carver pushed this too far, and the figurative comparisons might start to obscure the underlying core text…
"…the neutrophil…defines cool. It's the James Dean of the immune system; it lives fast, dies young and looks good in sunglasses."
Carver, 2017, p.7
"The magnificence of the placenta is that it's like the most efficient fast-food joint in the world combined with a communications platform that makes social media seem like a blind carrier pigeon, and a security system so sophisticated that James Bond would sell his own granny to the Russians just to get to play with it for five minutes."
Carver, 2017, p.113
When meeting phrases such as these I found myself thinking about the metaphors rather than what they represented. My over-literal (okay, pedantic) mind was struggling somewhat to make sense of a neutrophil in (albeit, metaphoric) sunglasses, and I was not really sure that James Bond would ever sell out to the Russians (treachery being one of the few major character faults he does not seem to be afflicted by) or be too bothered about playing with a security system (his key drives seem focused elsewhere)…
…but then this is a book about a very complex subject being presented for an audience that could not be assumed to have anything beyond the most general vague prior knowledge of the immune system. As any teacher knows, the learner's prior knowledge is critical in their making sense of teaching, and so offering a technically correct account in formal language would be pointless if the learner (or, here, reader) is not equipped to engage at that level.
'Immune' is a fascinating and entertaining read, and covers so much detailed ground that I suspect many people reading this book would would not have stuck with something drier that avoided a heavy use of figurative language. Even though I am (as a former school science teacher *) probably not in the core intended audience for the book, I still found it very informative – with much I had not come across before. Carver is a natural sciences graduate from Cambridge, and a medical doctor, so she is well placed to write about this topic.
Catherine Carver's account of the immune system is written to engage a popular readership and draws heavily on the disease-as-war analogy.
My intention here is not to offer a detailed review or critique of the book, but to explore its use of metaphors, and especially the common disease-as-war theme (Carver draws on this extensively as a main organising theme for the book, so it offers an excellent exemplar of this trope) – and discuss the role of the figurative language in science communication, and its potential for subtly misleading readers about some basic scientific notions.
The analogy
The central analogy of 'Immune' is clear in an early passage, where Carver tells us about the neutrophil,
"…this cell can capture bubonic plague in a web of its own DNA, spew out enzymes to digest anthrax and die in a kamikaze blaze of microbe-massacring glory. The neutrophil is a key soldier in an eternal war between our bodies and the legions of bacteria, viruses, fungi and parasites that surround us. From having sex to cleaning the kitchen sink, everything we do exposes us to millions of potential invaders. Yet we are safe. Most of the time these invaders' attempts are thwarted. This is because the human body is like an exceedingly well-fortified castle, defended by billions of soldiers. Some live for less than a day, others remember battles for years, but all are essential for protecting us. This is the hidden army that we all have inside of us…"
Carver, 2017, p.7
Phew – there is already a lot going on there. In terms of the war analogy:
- We are in a perpetual war with (certain types) of microbes and other organisms
- The enemy is legion (i.e., has vast armies)
- These enemies will invade us
- The body is like a well-protected fort
- We have a vast army to defend us
- There will be battles between forces from the two sides
- Some of our soldiers carry out suicide (kamikaze) missions
- Our defenders will massacre microbes
- We (usually) win the battles – our defences keep us safe
Some of these specific examples can be considered as metaphors or similes in they own right when they stand alone, but collectively they fit under an all-encompassing analogy of disease-as-war.
Read about analogies in science
Read about metaphors in science
But this is just an opening salvo, so to speak. Reading on, one finds many more references to the 'war' (see Boxes 1 and 2 below).
The 'combatants' and their features are described in such terms as army, arsenals, assassins, band of rebels, booby-traps, border guards, border patrol force, commanders, defenders, fighting force, grand high inquisitors, hardened survivor, invaders, lines of defence, muscled henchman, ninjas, soldiers, terminators, trigger-happy, warriors, and weapons.
Disease and immune processes and related events are described in terms such as alliance, armoury, assassination campaign, assault, assault courses, attack, battlefield, bashing, battles, boot camp, border control, calling up soldiers, chemical warfare, cloaking device, craft bespoke weaponry, decimated, dirty bomb, disables docking stations, double-pronged attack, exploding, expose to a severe threat, fight back, fighting on fronts, friendly fire, go on the rampage, hand grenades, heat-seeking missiles, hold the fort, hostile welcome, instant assault , kamikaze, killer payload, massacring, patrolling forces, pulling a pin on a grenade, R & R [military slang for 'rest and recuperation'], reinforcing, security fence, self-destruct, shore up defences, slaughters/slaughtering, smoke signals, standing down, suicidal missions, Swiss army knife, taking on a vast army on its home turf, throwing dynamite, time bomb, toxic cloud, training camp, training ground, trip the self-destruct switch, Trojan horse, victories, war, and wipe out the invader.
Microbes and cells as agents
A feature of the analogue is that war is something undertaken by armies of soldiers, that are considered as having some level of agency. The solder is issued with orders, but carries them out by autonomous decision-making informed by training as well as by conscience (a soldier should refuse to obey an illegal order, such as to deliberately kill civilians or enemy combatants who have surrendered). Soldiers know why they are fighting, and usually buy into at least the immediate objectives of the current engagement (objectives which generally offer a more favourable outcome for them than for the enemy soldiers). A soldier, then, has objectives to be achieved working towards a shared overall aim; purposes that (are considered to) justify the actions taken; and indeed takes deliberate actions intended to bring out preferred outcomes. Sometimes soldiers may make choices they know increase risks to themselves if they consider this is justified for the higher 'good'. These are moral judgements and actions in the sense of being informed by ethical values.
An extensive range of terminology related to conflict is used to describe aspects of disease and the immune response to infection. (Image sources: iXimus [virus], OpenClipart-Vectors [cell], Tumisu [solders in 'Raising the Flag on Iwo Jima'-like poses], from Pixabay.)
Now, I would argue that none of this applies to either disease organisms nor components of a human immune system. Neither a bacterium nor an immune cell know they are in a war; neither have personal, individual or shared, objectives; and neither make deliberate choices about actions to take in the hope they will lead to particular outcomes. No cell knowingly puts itself at risk because it feels a sacrifice is justified for the benefit of its 'comrades' or the organism it is part of.
So, all of this might be considered part of what is called the 'negative analogy', that is, where the analogy breaks down because the target system (disease processes and immune responses) no longer maps onto the analogue (a war). Perhaps this should be very obvious to anyone reading about the immune system? At least, perhaps scientists might assume this would be very obvious to anyone reading about the immune system?
Now, if we are considering the comparison that an immune response is something like a nation's defence forces defending its borders against invaders, we could simply note that this is just a comparison but one where the armies of each side are like complex robotic automatons pre-programmed to carry out certain actions when detecting certain indicators: rather than being like actual soldiers who can think for themselves, and have strategic goals, and can rationally choose actions intended to bring about desired outcomes and avoid undesired ones. (A recent television advertising campaign video looking to recruit for the British Army made an explicit claim that the modern, high-tech, Army could not make do with robots, and needed real autonomous people on the battlefield.)
However, an account that relies too heavily on the analogy might be in danger of adopting language which is highly suggestive that these armies of microbes and immune cells are indeed like human soldiers. I think Carver's book offers a good deal of such language. Some of this language has already been cited.
Immune cells do not commit kamikaze
Consider a neutrophil that might die in a kamikaze blaze of microbe-massacring glory. Kamikaze refers to the actions of Japanese pilots who flew their planes into enemy warships because they believed that, although they would surely die and their planes be lost, this could ensure severe damage to a more valuable enemy resource – where the loss of their own lives was justified by allowing them to remain at the plane's controls until the collision to seek to do maximum damage. Whatever we think of war in general, or the Kamikazi tactics in particular, the use of this term alludes to complex, deliberate, human behaviour.
Immune cells do not carry out massacres
And the use of the term massacre is also loaded. It does not simply mean to kill, or even to kill extensively. For example, the Jallianwala Bagh massacre, or Amritsar massacre, is called a massacre because (British) soldiers with guns deliberately fired at, with intent to kill or seriously injure, a crowd of unarmed Indians who were in their own country, peacefully protesting about British imperial policies. The British commanders acted to ensure the protesters could not easily escape the location before ordering soldiers to fire, and shooting continued despite the crowd trying to flee and escape the gunfire. Less people died in the Peterloo Massacre (1819) but it is historically noteworthy because it represented British troops deliberately attacking British demonstrators seeking political reform, not in some far away 'corner of Empire', but in Manchester.
Amritsar occurred a little over a century ago (before modern, post-Nurenmberg, notions of the legality of military action and the responsibility of soldiers to not always follow orders blindly), but there are plenty of more recent examples where the term 'massacre' is used, such as the violent clearing of protesters in Tiananmen Square in 1989 and the Bogside 'Bloody Sunday' massacre in 1972 (referenced in the title of the U2 song, 'Sunday Bloody Sunday'). In these examples there is seen to be an unnecessary and excessive use of force against people who are not equipped to fight back, and who are not shown mercy when they wish to avoid or leave the confrontation.
'Monument in Memory of Chinese from Tiananmen in Wrocław, Poland' commemorating the massacre of 4th June 1989 when (at least) hundreds were killed in Beijing after sections of the People's Liberation Army were ordered to clear protesters from public places (Masur, Public domain, via Wikimedia Commons)
The term massacre loses its meaning without this sense of being an excessively immoral act – and surely can only apply to an action carried out by 'moral agents' – agents who deliberately act when they should be aware the action cannot be morally justified, and where they can reasonably see the likely outcomes. (Of course, it is more complicated that this, in particular as a soldier has orders as well as a conscience – but that only makes the automatic responses of immune cells towards pathogens even less deserving of being called a massacre.)
The term moral agent does not mean someone who necessarily behaves morally, but rather someone who is able to behave morally (or immorally) because they can make informed judgements about what is right and wrong – they can consider the likely consequence of their actions in terms of a system of values. An occupied building that collapses does harm to people, but cannot be held morally responsible for its 'behaviour' in the way a concentration camp guard or a sniper can be. A fox that takes a farmer's chickens has no conception of farming, or livestock, or ownership, or of the chickens as sentient beings that will experience the episode from a different perspective, but just acts instinctively to access food. Microbes and cells are like the building or the fox, not the guard or the sniper, in this respect.
Moreover, in the analogue, the massacred are also moral agents: human beings, with families, and aspirations for their futures, and the potential for making unique contributions to society… I am not convinced that bacteria or microbes are the kinds of entities that can be massacred.
Anthropomorphic references
Carver then writes about the immune system, or its various components, as well as various microbes and other pathogenic organisms, as though they are sentient, deliberative agents acting in the world with purposes. After all, wars are a purely human phenomenon.1 Wars involve people: people with human desires, motives, feelings, emotions, cunning, bravery (or not), aims and motivations.
Anthropomorphism is describing non-human entities as if they are people. Anthropomorphism is a common trope in science teaching (and science communication) but learners may come to adopt anthropomorphic explanations (e.g., the atom wants…) as if they are scientific accounts (Taber & Watts, 1996).
Bacteria, body cells and the like are not these kinds of entities, but can be described figuratively as though they are. Consider how,
"Some bacteria are wise to this and use iron depletion as an indicator that they are inside an animal. Other bacteria have developed their own powerful iron-binding molecules called 'siderophores' which are designed to snatch the iron from the jaws of lactoferrin. Perhaps an even smarter strategy is just to opt out of the iron wars altogether…
…tear lipocalin, whose neat structure includes a pocket for binding a multitude of molecules. This clever pocket allows tear lipocalin to bind the bacterial siderophores…neutralising the bacterium's ability to steal iron from us…"
Carver, 2017, pp.20-21
Of course, bacteria are only 'wise' metaphorically, and they only 'develop' and 'design' molecules metaphorically, and they only adopt 'smarter strategies' or can 'opt out' of activities metaphorically – and as long as the reader appreciates this is all figurative language it is unproblematic. But, when faced with multiple, and sometimes extended, passages seeming to imply wise and clever bacteria developing tools and strategies, could the reader lose sight of this (and, if so, does that matter?)
If bacteria are not really clever, nor are pockets (or 'pockets' – surely this is a metaphor, as actual pockets are designed features not evolved ones). Stealing is the deliberate taking of something one knows is owned by someone else. Bacteria may acquire iron from us, but (like the fox) they do not steal as they have no notion of ownership and property rights, nor indeed, I suggest, any awareness that those environments from which they acquire the iron are considered by them[our]selves as 'us'.
That is, there is an asymmetrical relationship here: humans may be aware of the bacteria we interact with (although this has been so only very recently in historical terms) but it would be stretching credibility to think the bacteria have any awareness – even assuming they have ANY awareness in the way we usually use the term – of us as discrete organisms. So, the sense in which they "use iron depletion as an indicator that they are inside an animal" cannot encompass a deliberate use of an indicator, nor any inference they are inside an animal. There is simply a purely automatic, evolved, process that responds to environmental cues.
I have referred in other articles posted here to examples of such anthropromorphic language in public discourse being presented apparently in the form of explanations: e.g.,
"viruses might actually try to…hide…the microbes did not just accept defeat"
My focus here is Catherine Carver's book, but it is worth bearing in mind that even respectable scientific journals sometimes publish work describing viruses in such terms as 'smart', 'nasty', 'sneaky' – and, especially it seems, 'clever' (see 'So who's not a clever little virus then?'). So, Carver is by no means an outlier or maverick in using these devices.
'Immune' is embellished throughout with this kind of language – language that suggests that parasites, microbes, body cells, or sometimes even molecules:
- act as agents that are aware of their roles and/or purposes;
- do things deliberately to meet objectives;
- have preferences and tastes.
The problem is, that although this is all metaphorical, as humans we readily interpret information in terms of our own experiences, so a scientific reading of a figurative text may requires us to consciously interrogate the metaphors and re-interpret the language. Historians of chemistry will be well aware of the challenge from trying to make sense of alchemical texts which were often deliberately obscured by describing substances and processes in metaphoric language (such as when the green lion covers the Sun). Science communicators who adopt extensive metaphors would do well to keep in mind that they can obscure as well as clarify.
For example, Carver writes:
"…the key to a game of hide and seek is elementary: pick the best hiding place. In the human body, the best places to hide are those where the seekers (the immune system) find it hard to travel. This makes the brain a very smart place for a parasite to hide."
Carver, 2017, p.132
'There is a strong narrative here ("the eternal game of hide and seek [parasites] play with us")- most of us are familiar with the childhood game of hide and seek, and we can readily imagine microbes or parasites hiding out from the immune cells seeking them. This makes sense, because of course, natural selection has led to an immune system that has components which are distributed through the body in such a way that they are likely to encounter any disease vectors present – as this increases fitness for the creature with such a system – and natural selection has also led to the selection of such vectors that tend to lodge in places less accessible to the immune cells – as this increase fitness of the organism that we2 consider a disease organism. Thus evolution has often been described, metaphorically, as an arms race.
But this is not really a game (which implies deliberate play – parasites can not know they are playing a game); and the disease vectors do not have any conception of hiding places, and so do not pick where to go accordingly, or using any other criterion; the immune cells are not knowingly seeking anything, and do not experience it being harder to get to some places than others (they are just less likely to end up in some places for purely naturalistic reasons).
So, a parasite that ends up in the brain certainly may be less accessible to the immune system, but is not deliberately hiding there – and so is no more 'smart' to end up there than boulders that congregate at the bottom of a mountainside because they think it is a good place to avoid being sent rolling by gravity (and perhaps having decided it would be too difficult to ascend to the top of the mountain).4
It is not difficult to de-construct a text in the way I have done above for the hide-and-seek comparison- if a reader thinks this is useful, and consequently continually pauses to do so. Yet, one of the strengths of a narrative is that it drives the reader forward through a compelling account, drawing on familiar schemata (e.g., hide and seek; dining; setting up home…) that the reader readily brings to mind to scaffold meaning-making.
Another familiar (to humans) schema is choosing from available options:
"…the neutrophil's killer skills come to the fore…It only has to ask one question: which super skills should be deployed for the problem at hand?"
Carver, 2017, p.27
So, it seems this type of immune cell has 'skills', and can pose itself (and answer) the question of which skills will be most useful in particular circumstances (perhaps just like a commando trained to deal with unexpected scenarios that may arise on a mission into enemy-held territory?) Again, of course, this is all figurative, but I wonder just how aware most readers are of this as they read.
Carver's account of Kupffer cells makes them seem sentient,
"The Kupffer cells hang around like spiders on the walls of the blood vessels waiting to catch any red blood cells which have passed their best before date (typically 120 days). Once caught, the red blood cell is consumed whole by the Klupffer cell, which sets about dismantling the haemoglobin inside its tasty morsel."
Carver, 2017, p.27
Kupffer cells surely do not 'hang around' or 'wait' in anything more than a metaphorical sense. If 'catching' old red blood cells is a harmless metaphor, describing them as tasty morsels suggests something about the Kupffer cells (they have appetites that discriminate tastes – more on that theme below) that makes them much more like people than cells.
Another striking passage suggests,
"Some signals are proactive, for example when cells periscope from their surface a receptor called ULBP (UL16-binding protein). Any NK cell that finds itself shaking hands with a ULBP receptor knows it has found a stressed-out cell. The same is true if the NK cell extends its receptors to the cell only to find it omits parts of the secret-handshake expected from a normal cell. Normal, healthy cells display a range of receptors on their surface which tell the world 'I'm one of us, everything is good'. Touching these receptors placates NK cells, inhibiting their killer ways. Stressed, infected cells display fewer of these normal receptors on their surface and in the absence of their calming presence the trigger-happy NK cells attack."
Carver, 2017, p.27
That cells can 'attack' pathogens is surely now a dead metaphor and part of the accepted lexicon of the topic. But cells are clearly only figuratively telling the world everything is good – as 'telling' surely refers to a deliberate act. The hand-shaking, including the Masonic secret variety (n.b., a secret implies an epistemic agent capable of of knowing the secret), is clearly meant metaphorically – the cell does not 'know' what the handshake means, at least in the way we know things.
If the notion of a cell being stressed is also a dead metaphor (that is 'stressed' is effectively a technical term here {"the concept of stress has profitably been been exported from physics to psychology and sociology" Bunge, 2017/1998}), a stressed-out cell seems more human – perhaps so much so that we might be subtly persuaded that the cell can actually be placated and calmed? The point is not that some figurative language is used: rather, the onslaught (oops, it is contagious) of figurative language gives the reader little time to reflect on how to understand the constant barrage of metaphors…
"…it takes a bit of time for the B cells to craft a specific antibody in large quantities. However the newly minted anti-pollen antibodies are causing mischief even if we can't see evidence of it yet. They travel round the body and latch on to immune cells called masts anywhere they can find them. This process means the person is now 'sensitised' to the pollen and the primed mast cells lie in wait throughout the body…"
Carver, 2017, pp.183-184
…so, collectively the language can be insidious – cells can 'craft' antibodies (in effect, complex molecules) which can cause mischief, and find mast cells which lie in wait for their prey.
Sometimes the metaphors seemed to stretch even figurative meaning. A dying cell will apparently 'set its affairs in order'. In humans terms, this usually relates to someone ensuring financial papers are up to date and sorted so that the executors will be able to readily manage the estate: but I was not entirely sure what this metaphor was intended to imply in the case of a cell.
Animistic language
Even a simple statement such as "First the neutrophil flattens itself"(p.28) whilst not implying a conscious process makes the neutrophil the active agent rather than a complex entity subject to internal mechanisms beyond its deliberate control. 3
So, why write
"Finally, the cell contracts itself tightly before exploding like a party popper that releases deadly NETs [neutrophil extracellular traps] instead of streamers."
Carver, 2017, p.27
rather than just "…the cell contracts tightly…"? I suspect because this offers a strong narrative (one of active moral agents engaged in an existential face-off) that is more compelling for readers.
Neutrophils are said to 'gush' and to 'race', but sometimes to be slowed down to a 'roll' when they can be brought to a stop ("stopping them in their tracks" if rolling beings have tracks?). But on other occasions they 'crawl'. Surely crawling is a rather specific means of locomotion normally associated with particular anatomy. Typically, babies crawl (but so might soldiers when under fire in a combat zone?)
There are many other examples of phrases that can be read as anthropomorphic, or at least animistic, and the overall effect is surely insidious on the naive reader. I do not mean 'naive' here to be condescending: I refer to any reader who is not so informed about the subject matter sufficiently to already understand disease and immunity as natural processes, that occur purely through physical and chemical causes and effects, and that have through evolution become part of the patterns of activity in organisms embedded in their ecological surroundings. A process such as infection or an immune response may look clever, and strategic, and carefully planned, but even when very complex, is automatic and takes place without any forethought, intentions, emotional charge or conscious awareness on the part of the microbes and body cells involved.
There are plenty of other examples in 'Immune' of phrasing that I think can easily be read as referring to agents that have some awareness of their roles/aims/preferences, and act accordingly. And by 'can easily be read', I suspect for many lay readers (i.e., the target readership) this means this will be their 'natural' (default) way of interpreting the text.
So (see Box 3 , below), microbes, cells, molecules and parasites variously are in relationships, boast, can beckon and be beckoned, can be crafty, can be egalitarian, can be guilty, can be ready to do things, can be spurred on, can be told things, can be treacherous, can be unaware (which implies, sometimes they are aware), can dance choreographed, can deserve blame, can find things appealing, can have plans, can mind their own business, can pay attention, can spot things, can take an interest, can wheedle (persuade), congregate, craft things, dare to do things, do things unwittingly, find things, get encouraged, go on quests, gush, have aims, have friends, have goals, have jobs, have roles, have skills, have strategies, have talents, have techniques, insinuate themselves, know things, like things, look at things, look out for things, play, outwit, race, seek things, smuggle things, toy with us, and try to do things.
Microbes moving in
One specific recurring anthropomorphic feature of Carver's descriptions of the various pathogens and the harmless microbes which are found on and in us, is related to finding somewhere to live – to setting up a home. Again, this is clearly metaphorical, a microbe may end up being located somewhere in the body, but has no notion, or feeling, of being at home. Yet the schema of home – finding a home, setting up home, being at home, feeling at home – is both familiar and, likely, emotionally charged, and so supports a narrative that fits with our life-experiences.
A squatter among pathogen society? Images by Peter H (photograph) and Clker-Free-Vector-Images (superimposed virus) from Pixabay
Viruses and bacteria are compared in terms of their travel habits (in relation to which, "The human hookworm…[has] got quite an unpleasant commute to work…"),
"…viruses are the squatters of pathogen society. Unlike bacteria, which tend to carry their own internal baggage for all their disease-making needs, viruses pack light. They hold only the genes they need to gain illegal entry to our cells and then instruct our cells' machinery to achieve the virus's aims. The cell provides a very happy home for the virus, and also gives it cover from the immune system."
Carver, 2017, p.35
These pathogens apparently form a society (where there is a distinction between what is and what is not legal 5) and individually have needs and aims. A virus not only lives in a home, but can be happy there. Again, such language does have a sensible meaning (if we stop to reflect on just what the metaphors can sensibly mean), but it is a metaphorical meaning and so should not be taken literally.
The analogy is however developed,
"…the human microbiota is the collective name for the 100 trillion micro-organisms that have made us their real estate. From the tip of your tongue to the skin you sit on, they have set up home in every intimate nook and cranny of our body…The prime real estate for these microbes, the Manhattan or Mayfair equivalent inside you and me, is the large intestine or colon. If you had a Lonely Planet or Rough Guide to your gut, the colon would have an entry something like this: 'The colon is a must-see multi-cultural melting-pot, where up to one thousand species of bacteria mingle and dine together every second of every day. In this truly 24/7 subterranean city, Enterococci rub shoulders with Clostridia; Bacteroides luxuriate in their oxygen-depleted surroundings and Bifidobacteria banquet on a sumptuous all-you-can-eat poo buffet. It's the microbe's place to see, and be seen'. ….[antibiotic's] potential to kill off vast swathes of the normal gut flora. This creates an open-plan living space for a hardy bacterium called Clostridium difficile. This so-called superbug (also known as C. diff) is able to survive the initial antibiotic onslaught and then rapidly multiplies in its newly vacated palace."
Carver, 2017, p.76-78
This metaphor is reflected in a number of contexts in Immune. So, the account includes (see Box 4, below) break ins, camps, communities, homes, lounging, palaces, penthouses, playgrounds, preferred places to live, real estate, residents, shops, squatters, suburban cul-de-sacs, and tenants .
What is for dinner?
The extracts presented above also demonstrate another recurring notion, that microbes and body cells experience 'eating' much like we do ('tasty morsel', 'dine together', 'banquet…buffet'). There are many other such illusions in 'Immune'.
We could explain human eating preferences and habits in purely mechanistic terms of chemistry, physics and biology – but most of us would think this would miss an important level of analysis (as if what people can tell us about what they think and feel about their favourite foods and their eating habits is irrelevant to their food consumption) and would be very reductive. Yet, when considering a single cell, such as a Kupffer cell, surely a mechanistic account in terms of chemistry, physics and biology is not reductionist, but exhaustive. Anything more is (as Einstein suggested about the aether) superfluous.
One favoured dining location is the skin:
"The Demodex dine on sebum (the waxy secretion we make to help waterproof our skin), as well as occasionally munching on our skin cells and even some unlucky commensal bacteria like Propionibacterium acnes…like many of us, P. acnes is a lipophile, which is to say it adores consuming fat. The sebum on our skin is like a layer of buttery, greasy goodness that has P. acnes smacking its lips. However, when P. acnes turns up to dine it has some seriously bad table manners, which can include dribbling chemicals all over our faces…[non-human] animal sebum lacks the triglyceride fats that P. acnes [2 ital] loves to picnic on."
Carver, 2017, pp.81-82
p.82
It is hopefully redundant, by this point, for me to point out that Propionibacterium acnes does not adore anything – neither preferred foodstuffs nor picnics – but has simply evolved to have a nutritional 'regime' that matches its habitat. Whilst this extract immediately offers a multi-course menu of metaphors, it is supplemented by a series of other semantic snacks. So 'Immune' also includes references to buffet carts, chocolate chips, cookies, devouring, easy meals, gobbling up, making food appetising, making food tastier, munching, a penchant for parma ham and rare steak, soft-boiled eggs, tasty treats and yummy desserts.
Can you have too much of a metaphorical good thing?
I am glad I bought 'Immune'. I enjoyed reading it, and learnt from it. But perhaps a more pertinent question is whether I would recommend it to a non-scientist* interested in learning something about immunity and the immune system. Probably, yes, but with reservations.
Is this because I am some kind of scientific purist (as well as a self-acknowledged pedant)? I would argue not: if only because I am well aware that my own understanding of many scientific topics is shallow and rests upon over-simplifications, and in some cases depends upon descriptive accounts of what strictly need to be appreciated in formal mathematical terms. I do not occupy sufficiently high ground to mock the novice learner's need for images and figures of speech to make sense of unfamiliar scientific ideas. As a teacher (and author) I draw on figurative language to help make the unfamiliar become familiar and the abstract seem concrete. But, as I pointed out above, figurative language can sometimes help reveal (to help make the unfamiliar, familiar); but can also sometimes obscure, a scientific account.
I have here before made a distinction between the general public making sense of science communication in subjective and objective terms. Objective understanding might be considered acquiring a creditable account (that would get good marks in an examination, for example). But perhaps that is an unfair test of a popular science book: perhaps a subjective making-sense, where the reader's curiosity is satisfied – because 'yes, I see, that makes sense to me' – is more pertinent. Carver has not written 'Immune' as a text book, and if readers come away thinking they have a much better grasp of the immune system (and I suspect most 'naive' readers certainly would think that) then it is a successful popular science book.
My reservation here is that we know many learners find it difficult to appreciate that cornerstone of modern biology, natural selection (e.g., Taber, 2017), and instead understand the living world in much more teleological terms – that biological processes meet ends – occur to achieve aims – and do so through structures which have been designed with certain functions in mind.
So, microbes, parasites, cells, and antibodies, which are described as though they are sentient and deliberate actors – indeed moral agents seeking strategic goals, and often being influenced by their personal aesthetic tastes – may help immunity seem to make sense, but perhaps by reinforcing misunderstandings of key foundational principles of biology.
In this, Catherine Carver is just one representative of a widespread tendency to describe the living world in such figurative terms. Indeed, I might suggest that Carver's framing of the immune system as a defence force facing hostile invaders makes 'Immune' a main-stream, conventional, text in that it reflects language widely used in public science discourse, and sometimes even found in technical articles in the primary literature.
A myth is a story that has broad cultural currency and offers meaning to a social group, usually involving supernatural entities (demons, superhuman heroes, figures with powerful magic – perhaps microbial aesthetes and sentient cells?), but which is not literally true. e.g., Your immune system comprises a vast army of brave and selfless soldiers seeking to protect you from intruders looking to do you harm: an immune response is a microcosm of the universal fight between good and evil?
My question, then, is not whether Carver was ill-advised to write 'Immune' in the way she has, but whether it is time to more generally reconsider the widespread use of the mythical 'war' analogy in talking about immunity and disease.
Notes
1 Even if, for example, some interactions between groups of ants from different nests {e.g., see 'Ant colony raids a rival nest | Natural World – Empire of the Desert Ants – BBC'} look just as violent as anything from human history, their 'battles' are surely not planned as part of some deliberate ongoing campaign of hostilities.
2 The bacteria infecting us, if they could conceptualise the situation (which they cannot), would have no more reason to consider themselves a disease, than humans who 'infected' an orchard and consumed all the fruit would consider themselves a disease. Microbes are not evil for damaging us, they are just being microbes.
3 If my rock analogy seems silly, it is because we immediately realise that rocks are just not the kind of entities that behave deliberately in the world. The same is true of microbes and body cells -they are just not the kind of entities that behave deliberately in the world, and as long as this is recognised such metaphorical language is harmless. But I am not sure that is so immediately obvious to readers in these cases.
4 Such an issue can arise with descriptions about people as well. If I want to share a joke with a friend I may wink. If a fly comes close to my eye I may blink. Potentially these two actions may seem indistinguishable to an observer. However, the first is a voluntary action, but in the second case the 'I' that blinks is not me the conscious entity that ascribes itself self-hood, but an autonomous and involuntary subsystem! In a sense a person winks, but has blinking done to her.
5 If entry to our cells was 'illegal' in the sense of being contrary to natural laws/laws of nature, it would not occur.
* A note on being a scientist. Any research scientists reading this might scoff at my characterisation of the readers of popular science books as being non-scientists with the implied suggestion that I, by comparison, should count as a scientist. I have never undertaken research in the natural sciences, and, although I have published in research journals, my work in science education would be considered as social science – which in the Anglophile world does not usually count as being considered 'science' per se. However, in the UK, the Science Council recognises science educators as professional scientists. Learned societies such as the Royal Society of Chemistry and the Institute of Physics will admit teachers of these subjects as professional members, and even Fellows once their contributions are considered sufficient. This potentially allows registration as a Chartered Scientist. Of course, the science teacher does not engage in the frontiers of a scientific research field in the way a research scientist does, however the science teacher requires not only a much broader knowledge of science, but also a specialist professional expertise that enables the teacher to interrogate and process scientific knowledge into a form suitable for teaching. This acknowledges the highly specialised nature of teaching as an expert professional activity which goes far beyond the notion of teaching as a craft that can be readily picked up (as sometimes suggested by politicians).
Work cited
- Bunge, M. (2017/1998). Philosophy of Science. Volume 1: From problem to theory. Routledge. (1967)
- Carver, C. (2017). Immune. How your body defends and protects you. Bloomsbury Sigma.
- Taber, K. S. (2017). Representing evolution in science education: The challenge of teaching about natural selection. In B. Akpan (Ed.), Science Education: A Global Perspective (pp. 71-96). Switzerland: Springer International Publishing.
[Download chapter] - Taber, K. S. and Watts, M. (1996) The secret life of the chemical bond: students' anthropomorphic and animistic references to bonding, International Journal of Science Education, 18 (5), pp.557-568. [Download here.]
| "neutrophil is a key soldier" "the human body is like an exceedingly well-fortified castle, defended by billions of soldiers" "…the incredible arsenal that lives within us…" "the hidden army" "…our adaptive assassins, our T and B cells" "The innate system is the first line of defence…" skin: "…an exquisite barrier that keeps unwanted invaders out." "…your airways are exceedingly well booby-trapped passages lined with goblet cells, which secrete a fine later of mucus to trap dirt and bacteria." "Initially it was seen as a simple soldier with a basic skills set …Now we know it is a crafty assassin with a murderous array of killing techniques." "…ninja skill of neutrophils…", "ninja neutrophils" "macrophages are stationed at strategic sites…what an important outpost the liver is for the immune system" "NK cells [have] killer ways" "trigger-happy NK cells" "Ever neat assassins, NK cells" "vicious immune cells" compared to "a pack of really hungry Rottweilers" interleukins are "pro-inflammatory little fire-starters" "neutrophils, macrophages and other immune system soldiers" "T cells…activate their invader-destroying skills." "…a weapon with a name worthy of a Bond villain's invention: the Membrane Attack Complex" "miniature mercenaries" "a system whose raise d'etre is to destroy foreign invaders" "everything we do exposes us to millions of potential invaders." "…all invaders need an entry point…" "these tiny sneaks [e.g., E. coli]" "the dark-arts of pus-producing bacteria…" Neisseria meningitidis: "this particular invader" "foreign invaders" "an aggressive border patrol" 'Tregs are the prefects of the immune system…" "…the parasite larva has more in common with a time bomb…" "T cells…are the grand high inquisitors of the immune system, spotting and destroying infected cells and even cancer…these assassins" "imagining you have to make a Mr Potato Head army, and you know that the more variety in your vegetable warriors the better" "this process is about …making a mutant army." "they form a fighting force that rivals Marvel Comic's Fantasic Four" "each antibody molecule released as a single soldier" "The pancreas … acts as the commander-in-chief when its comes to controlling blood sugar levels." "our tiny but deadly defenders" "cells in the spleen with a specialised killer-skill" "wears a mask that conceals its killer features from its would-be assassins" "the microbiological mass murderers…the serial killers" "PA [protective antigen] is the muscled henchman" "the murderous cast of immune cells and messengers…this awe-inspiring army" "a microscopic army, capable of seeking out and destroying bacteria" "the terminators are targeted killers" "weaponised E. coli |
| "a kamikaze blaze of microbe-massacring glory" "an eternal war between our bodies and the legions of bacteria, viruses, fungi and parasites that surround us" "these invaders' attempts are thwarted" "battles" "all my innate defences would essentially hold the fort and in many instances this first line would be enough to wipe out the invader before the adaptive system gets a chance to craft bespoke weaponry." "the tears we shed [are] a form of chemical warfare." "…allowing the neutrophils to migrate through the blood vessel and into the battlefield of the tissue beyond" "the cell contracts itself tightly before exploding" "their friendly fire contributed to the death of the victim." "spewing microbe-dissolving chemicals into the surround tissue. This allows the neutrophil to damage many microbes at once, a bit like fishing by throwing dynamite into the water." "NK [natural killer] cells target the microbes that have made it inside our cells." "NK cells attack" "…the initial hole-poking assault…" "all part of the NK cell's plan to kill the cell." "…they trip the cell's self-destruct switch" "expose a cell to a severe, but not quite lethal threat…transform the cell into a hardened survivor" immune cells have an "ability to go on the rampage" "call up … immune system soldiers to mount a response" "leukaemia … has decimated a type of white blood cells called T cells" "it behaves like a Trojan horse [as in the siege of the City of Troy]" "telling our soldier cells to kick back and take some R & R" "the smoke signals of infection" "…like a showing of tiny hand grenades on the surrounding cells." "the donor cells would be vastly outnumbered and it would be like a band of rebels taking on a vast army on its home turf" "the recipient's own immune system is in a weakened state and unable to fight back" "…the antibodies …are therefore able to give a hostile welcome to alpha-gal-wearing malaria parasites." "…our gut bacteria effectively provide a training ground for the immune system – a boot camp led by billions of bacteria which teaches us to develop an arsenal of antibodies to tackle common foreign invader fingerprints…" "fighting on certain fronts" "edgy alliance" "shore up the intestinal defences by reinforcing the tight junctions which link the gut cells together" "our gut's security fence" "a self-cell that should be defended, not attacked" "this mouse-shaped Trojan horse" "the scanning eyes of the immune system" "a form of border control, policing" "…the bacteria-bashing brilliance…" "…the IgA effectively blocks and disables the invaders' docking stations…" "B cells and their multi-class antibody armoury have the ability to launch a tailored assassination campaign against almost anything" "the exquisitely tailored assassination of bacteria, viruses and anything else that dares enter the body" "One of the seminal victories in our war on bugs" "Some bacteria have a sugar-based cloaking device" "…tripped by the pollen attaching to the IgE-primed mast cells and, like pulling a pin on a grenade, causing them to unleash their allergy-inducing chemicals." "The almost instant assault of the immediate phase reaction occurs within minutes as the dirty bomb-like explosion of the mast cell fill the local area with a variety of rapidly acting chemicals." "..the battle against infectious diseases." "teaching the patrolling forces of the immune system to stand down if the cell they're interrogating is a healthy cell that belong to the body. It's a bit like a border patrol force wandering through the body and checking passports" "like a training camp for the newly created border guards". "ordering those that react incorrectly to self-destruct" "These bacteria have a sugar-based polysaccharide outer shell, which acts like a cloaking device" "the [oncolytic] viruses have a Swiss army knife selection of killer techniques" "This approach slaughters these foot soldiers of our immune system…" "they [macrophages] have picked up a time bomb" "antibodies that act like heat-seeking missiles" "Kadcyla …has a double-pronged attack." "we are setting up easy antibiotic assault courses all over the place" "His suicidal minions were engineered to seek out a pneumonia-causing bacterium by the name of Pseudomonas aeruginosa and explode in its presence releasing a toxic cloud of a Pseudomonas-slaughtering chemical called pyocin." "it could secrete its killer payload" "stimulate the little terminators to produce and release their chemical warfare." |
| "The macrophage's … job as a first responder…" " osteoclasts and osteoblasts" are "Carver refers to "the bony equivalent of yin and yang…osteoblasts are the builders in this relationship" (said to be "toiling") …osteoclast, whose role is the constant gardener of our bones" "…a white blood cell called the regulatory T cell, or 'Treg' to its friends…" "…this biological barcode lets the T cell know that it's looking at a self-cell …" "…the ball of cells that makes up the new embryo finishes bumbling along the fallopian tube and finds a spot in the uterus to burrow into…" "By using this mouse-shaped Trojan horse the parasite gets itself delivered directly into the cat's gut, which is where Toxoplasma likes to get it on for the sexual reproduction stage of its lifecycle." "It's as if the trypanosome has a bag of hats that it can whip out and use to play dressing-up to outwit the immune system." "proteins… help smuggle the ApoL1 into the parasite" "Some parasites have a partner in crime…" "the chosen strategy of the roundworm Wuchereria bancrofti…uses a bacterium to help cloak itself from the immune system." "the work of a master of disguise…precisely what Wuchereria bancrofti is." "…its bacterial side-kick" "parasites that act as puppet masters for our white blood cells and direct our immune response down a losing strategy" "parasites with sartorial skills that craft themselves a human suit made from scavenged proteins" "parasites toy with us" "B cells have one last technique" "Chemical messengers beckon these B cells" "what AID [activation induced deaminase] seeks to mess with" "Each class [of antibody] has its own modus operandi for attacking microbes" "in terms of skills, IgG can activate the complement cascade" "…one of its [IgA] key killer skills is to block any wannabe invaders from making their way inside us." "the helper T cell and the cytotoxic T cell, which take different approaches to achieve the same aim: the exquisitely tailored assassination of bacteria, viruses and anything else that dares enter the body." "B cells, cytoxic T cells and macrophages in their quest to kill invaders" "T cells interact with their quarry" "add a frisson of encouragement to the T cell, spurring it on to activation." "the brutally egalitarian smallpox" "Polio is another virus that knows all about image problems." "the guilty allergen" "IgE and mast cells are to blame for this severe reaction [anaphylaxis]" "…The T regulatory cells identify and suppress immune cells with an unhealthy interest in normal cells." "the skills of a type of virus well versed in the dark arts of integrating into human DNA" "The spleen is a multi-talented organ" "to get rid of the crafty, cloaked bacteria" "Even once cells are able to grow despite the chemical melting pot they're stewing in telling them to cease and desist…" "It is believed that tumour cells bobbing about in the bloodstream try to evade the immune system by coating themselves in platelets…" "the cancer's ability to adorn itself" "They [oncolytic viruses] work by …drawing the attention of the immune system" "when the replicating virus is finally ready to pop its little incubator open" "…anthrax, which lurks in the alveoli awaiting its cellular carriage: our macrophages…" "The macrophages are doing what they ought … Completely unaware that they have picked up a time bomb…" "the microbial thwarting talents of interferons" "…your mAbs will do the legwork for you, incessantly scouring the body for their target destination like tiny, demented postal workers without a good union." "One of the tumour techniques is to give any enquiring T cells a 'these aren't the cells you're looking for' handshake that sends them on their way in a deactivated state, unaware they have let the cancer cells off the hook. Checkpoint inhibitor mAbs bind to the T cell and prevent the deactivating handshake from happening. This leaves the T cell alert and able to recognise and destroy the cancer cells." "A third neutrophil strategy…" "all part of the NK cell's plan to kill the cell." "…a majestic dance of immune cells and messengers, carefully choreographed…" "So my immune system's bag of tricks might not currently include a smallpox solution, but if I were to contract the disease my adaptive immune response would try its hardest to create one to kill the virus before it killed me." "Thus earwax can catch, kill and kick out the multitude of microbes that wheedle their way into out ears…" "Up to 200 million neutrophils gush out of our bone marrow and into the blood stream every day. They race around the blood on the look-out for evidence of infection." "a process called 'opsonisation' make consuming the bacterial more appealing to neutrophils" "the same siren call of inflammation and infection that beckoned the neutrophils." "…a set of varied and diverse circumstances can prompt multiple macrophages to congregate together and, like a massive Transformer, self-assemble into one magnificent giant cell boasting multiple nuclei." "The cell responds to the initial hole-poking assault by trying to repair itself…At the same time that it pulls in the perforin holes, the cell unwittingly pulls in a family of protein-eating granzymes…" "the gigantosome is more than just a pinched-off hole-riddled piece of membrane; its creation was all part of the NK cell's plan to kill the cell." caspases in cells "play an epic game of tag" Arachidonic acid: "Normally it just minds its own business" "The interferon molecule insinuates itself into the local area" "The chemokines …their ability to beckon a colourful array of cells to a particular location…they can call up neutrophils, macrophages and other immune system soldiers to mount a response to injury and infection…" "chemicals that can tell these cells where to go and what to do. These crafty chemicals…" "…the triad of goals of the complement system…" "It's the T cell's job to spot infected or abnormal cells." "Microbes aren't easy bedfellows" "…the 'lean' microbes won out over the 'obese' ones." "IgD is the most enigmatic of all the immunoglobins" "the parasite larva …treacherous" |
| "Bifidobacterium infantis, a normal resident of the healthy infant gut" "trillions of microbes that make us their home" "…a much more diverse community of inner residents…" "Entamoeba … just happened to prefer to live in a multicultural colon." "…the mouth had the least stable community, like the microbial equivalent of transient squatters, while the vagina was the quiet suburban cul-de-sac of the map, with a fairly fixed mix of residents." "that's where they [Mycobacteria] set up home" "Neisseria meningitidis "sets up shop inside our cells…it breaks in…" "…Heliocobacter pylori (a.k.a H. pylori), a bacterium that makes its home in the sticky mucus that lines the stomach. While the mucus gives H. pylori some protection from the gastric acid, it also employed a bit of clever chemistry to make its home a touch more comfortable." Dracunculus medinensis will "seek out a mate, turning the abdominal wall into their sexual playground." "…plenty of creepy crawlies have been known to to call the human brain home, lounging among our delicate little grey cells…" the tapeworm Spirometra erinaceieuropaei : "…this particular tenant ensconced in their grey matter." "the worm…wriggled up through his body to reach its cranial penthouse where it could enjoy the luxury of a very special hiding spot." "There are flatworms, roundworms hookworms, whipworms, fleas and ticks, lice and amoeba. They're all queuing up to get a room at the palace of parasites" Clostridium tetani "can often set up camp in soil", "About 75 million people worldwide are thought to carry the dwarf tapeworm in their small intestine, where it lives a fairly innocuous life and causes its host few if any symptoms." "Though it may not seem like it, our nostrils are prime real estate and rival bacteria fight each other for resources, a fight which includes chemical warfare." "…we'll meet the creepy critters that like to call us home and the ways our immune system tries to show them the door." |
| "an all-you-can-eat oligosaccharide buffet for B. infantis [Bifidobacterium infantis]" "…complement's ability to make these bacteria seem tastier to our macrophages…" "Mycobacteria… actually want to be gobbled up by our macrophages…" "sprinkling C3b on the surface of bacteria makes them much more appetising to microbe-munching cells" macrophages 'devour' the remains of dead cells "…Salmonella, which likes a soft-boiled egg, and Toxoplasma gondii, which shares my penchant for parma ham and rare steak." Dracunculus medinensis "looks like an easy meal for a peckish water flea. Sadly for the water flea the parasite larva has more in common with a time bomb than a tasty snack ever should, and the treacherous morsel spends the next 14 days inside the flea…" "…flagging a microbe as munchable for macrophages…" "IgG …can mark targets as munchable. Thus any bacterium, virus or parasite coated in IgG finds itself the yummiest dessert on the buffet cart and every hungry macrophage rushes to get itself a tasty treat." "…from our brain to our bones, we are riddled with munching macrophages…" opsonisation: "much like sprinkling tiny chocolate chips on a bacterial cookie" "Demodex dine on sebum…as well as occasionally munching on our skin cells" "P. acnes is a lipophile, which is to say it adores consuming fat. The sebum on our skin is like a layer of buttery, greasy goodness that has P. acnes smacking its lips." "when "P. acnes turns up to dine it has some seriously bad table manners" " P. acnes loves to picnic." |
