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Viewpoint | Scientific Discovery and the Future of Medicine

The Human Microbiome and the Future Practice of Medicine

David A. Relman, MD1,2
[+] Author Affiliations
1Departments of Medicine and of Microbiology and Immunology, Stanford University, Stanford, California
2Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMA. 2015;314(11):1127-1128. doi:10.1001/jama.2015.10700.
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This Viewpoint describes early observations about the human microbiota and what research might tell us about the benefits and vulnerabilities of an individual’s microbial ecosystem.

All animals coexist in intimate, dependent relationships with microbes. Humans are no exception. Host-associated microbes, like nearly all others on this planet, form communities in which the overall composition, structure, and function are explained by ecological processes and environmental factors. Evidence of coadaptation and mutual benefit are key features of these symbioses between hosts and their microbial communities, or microbiotas.1 The human microbiota is a fundamental component of what it means to be human.

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Microbial Biogeography and Community Stability in the Human Body

Left, Each zone is distinguished by a distinct microbial community composition and function.4 Right, A stable state, depicted as a depression in the landscape, may be associated with health or disease. The position of the ball indicates the current state of the ecosystem. For a given individual, the landscape topology reflects host genetics, immune status, lifestyle, prior exposures to drugs, chemicals, and pathogens, and microbiota composition. With time, the topology may change, for example, as a result of immune system impairment—prompting a shift to a different state.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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