“I think that we largely use this idealized notion of humans as coming with a fixed, uniform biological profile… but the copious evidence for human adaptation at the biological level to different diets, behaviors, and ecologies needs to be considered more seriously.”

– Damián Blasi

Big-picture thinking has always challenged humans; perhaps that accounts for our obsession with space travel—that, and our desire to run away from ourselves. Biomedical thinking is especially problematic for late moderns; we like our Bernoulli-based bit-by-bit thinking, the yes/no, either/or decision that is quick ’n’ easy. Like much late modern food, it isn’t very nourishing; it doesn’t get us anywhere worth going. It creates a human-generated virtual reality that is as comforting as it is dangerous because it appeals to the subconscious ego.

One way to compensate for the narrowness that comes with simple thinking is to pay attention to context—one of the key tenets of the emerging paradigm. We may not like to be aware that we do not control reality or even know what to pay attention to, but if we make a point of paying attention to the background and then adding the foreground, and relax our reliance on symbols, we prepare ourselves to notice real things, to allow chance to favor our minds with the unexpected. The contextual biography seems to have emerged in the ‘80s (based on the books on my shelf). It is time for medicine to catch up.

The pre-eminence of laboratory technology makes this a challenge. A case in point: in vitro studies of the microbiome. To me, that’s like an in vitro study of the autonomic nervous system, which is impossible so we ignore it as much as possible to the point that we don’t notice it in patients with comprehensive neurotoxicity. The upside is that microbiomes are so disordered and so long-ignored that any information may lead to an advance. But in vitro studies will mean little until they at least try to emulate the real context. This would mean adding in vivo poisons to in vitro studies of all aspects of nutrition.