Clinical Ecology—Transforming 21st-Century Medicine with Planetary Health in Mind

Four decades ago, several health movements were sprouting in isolation. In 1980, the environmental group Friends of the Earth expanded the World Health Organization definition of health, reminding citizenry that, “health is a state of complete physical, mental, social and ecological well-being and not merely the absence of disease—personal health involves planetary health”. At the same time, a small group of medical clinicians were voicing the concept of “clinical ecology”—that is, a perspective that sees illness, especially chronic illness, as a response to the total lived experience and the surroundings in which “exposures” accumulate. In parallel, other groups advanced the concept of holistic medicine. In 1977, the progressive physician-scientist Jonas Salk stated that “we are entering into a new Epoch in which holistic medicine will be the dominant model”. However, only recently have the primary messages of these mostly isolated movements merged into a unified interdisciplinary discourse. The grand, interconnected challenges of our time—an epidemic of non-communicable diseases, global socioeconomic inequalities, biodiversity losses, climate change, disconnect from the natural environment—demands that all of medicine be viewed from an ecological perspective. Aided by advances in ‘omics’ technology, it is increasingly clear that each person maintains complex, biologically-relevant microbial ecosystems, and those ecosystems are, in turn, a product of the lived experiences within larger social, political, and economic ecosystems. Recognizing that 21st-century medicine is, in fact, clinical ecology can help clear an additional path as we attempt to exit the Anthropocene.

Biodiversity, the Human Microbiome and Mental Health: Moving toward a New Clinical Ecology for the 21st Century?

Advances in research concerning the brain-related influences of the microbiome have been paradigm shifting, although at an early stage, clinical research involving beneficial microbes lends credence to the notion that the microbiome may be an important target in supporting mental health (defined here along the continuum between quality of life and the criteria for specific disorders). Through metagenomics, proteomics, metabolomics, and systems biology, a new emphasis to personalized medicine is on the horizon. Humans can now be viewed as multispecies organisms operating within an ecological theatre; it is important that clinicians increasingly see their patients in this context. Historically marginalized ecological aspects of health are destined to become an important consideration in the new frontiers of practicing medicine with the microbiome in mind. Emerging evidence indicates that macrobiodiversity in the external environment can influence mental well-being. Local biodiversity may also drive differences in human-associated microbiota; microbial diversity as a product of external biodiversity may have far-reaching effects on immune function and mood. With a focus on the microbiome as it pertains to mental health, we define environmental “grey space” and emphasize a new frontier involving bio-eco-psychological medicine. Within this concept the ecological terrain can link dysbiotic lifestyles and biodiversity on the grand scale to the local human-associated microbial ecosystems that might otherwise seem far removed from one another.

Computerized Neuropsychological Assessment in Aging: Testing Efficacy and Clinical Ecology of Different Interfaces

Digital technologies have opened new opportunities for psychological testing, allowing new computerized testing tools to be developed and/or paper and pencil testing tools to be translated to new computerized devices. The question that rises is whether these implementations may introduce some technology-specific effects to be considered in neuropsychological evaluations. Two core aspects have been investigated in this work: the efficacy of tests and the clinical ecology of their administration (the ability to measure real-world test performance), specifically (1) the testing efficacy of a computerized test when response to stimuli is measured using a touch-screen compared to a conventional mouse-control response device; (2) the testing efficacy of a computerized test with respect to different input modalities (visual versus verbal); and (3) the ecology of two computerized assessment modalities (touch-screen and mouse-control), including preference measurements of participants. Our results suggest that (1) touch-screen devices are suitable for administering experimental tasks requiring precise timings for detection, (2) intrinsic nature of neuropsychological tests should always be respected in terms of stimuli presentation when translated to new digitalized environment, and (3) touch-screen devices result in ecological instruments being proposed for the computerized administration of neuropsychological tests with a high level of preference from elderly people.

Guest commentary: The human microbiome and the promise of clinical ecology

Metagenomics, the application of high-throughput sequencing to nucleic acids extracted directly from environmental samples, made its debut in 2004 through two high-profile papers in Science (Sargasso Sea) and Nature (acid mine drainage). A key strength of the approach is the ability to circumvent the well-known cultivation bottleneck and lay bare the genetic blueprints of ecologically important members of the microbial community, many of which cannot be easily obtained in culture.

Ecoepidemiology

The origins, definitions, and usage of the term "ecoepidemiology" wind their way through the scientific literature of ecology and medicine. This study sought to determine if "ecoepidemiology" has been granted a common meaning in these disciplines or if the meanings have diverged or if new phrases have been proposed. "Ecoepidemiology" appears in the French literature of medicine — as the name for the geographic variable in epidemiologic studies — about ten years before it appears in English-language articles on ecology. In the English literature, a few scientists writing about ecological monitoring and assessment adopted the term because they needed a word or phrase to emphasize research methods common both to ecology and to epidemiology in human medicine. After the term "clinical ecology" was rejected in the medical literature, it was offered as an alternative to "ecoepidemiology". "Clinical ecology" can be defined as "the branch of ecology that studies the condition of ecosystems to document change in status and trends". A more logical term than "ecoepidemiology", "clinical ecology" keeps the literature about ecosystem health grouped by subject in libraries and bibliographic databases with ecology instead of improperly assigned to collections of information on human health and medicine. "Ecoepidemiology", however, seems to be more prevalent in the literature of the environmental and ecological sciences.