With Irreverence and Humor, Ed Yong Gives 'Voice to the Voiceless'

Covering Science for The Atlantic

Eric J. Topol, MD: Hello. I am Eric Topol. I am editor-in-chief of Medscape. I am really privileged today to have Ed Yong with me, who is The Atlantic magazine's science journalist and one of my favorite science journalists in the world. Ed is going to tell us not only about the work he does, but also about his new book that has just come out, which has been an immense success, and what it's like to cover some of the most interesting aspects of biomedical science. Ed, welcome.

Ed Yong, MPhil: Thank you for having me.

Dr Topol: You went to Cambridge and got your baccalaureate and master's degree in zoology?

Mr Yong: Yes, I got an undergraduate degree in zoology with a splash of molecular biology.

Dr Topol: From National Geographic, where you had an interesting blog, you went very recently to The Atlantic—is that right?

Mr Yong: I have been a science writer for just over 10 years now. I have been at The Atlantic for the past year and a half. I was the first—and for some time the only—staff science writer they had. The Atlantic is a very long, august publication. It has covered health and technology for a long while, and they recently decided to grow a new emphasis on science coverage, too, which is where I came in.

Dr Topol: They have such strength in other areas. In fact, The Atlantic has had some conferences in this forum. They had The Atlantic meets The Pacific, with James Fallows, Corby Kummer, and many other journalists there. It's great that you are going to continue to bolster some of the science coverage. Do you get to write anything you want?

Mr Yong: Yes, roughly. I pitch all of my story ideas, and The Atlantic has a wonderful culture whereby they recruit people who they know are good and then give them free rein to be the journalists they want to be, with all of the editorial and institutional support that they can provide. I write about what I want to write and cover all sorts of topics, from genomics to microbiology, animal behavior, and, increasingly, science policy—the whole works.

Giving a Voice to the Voiceless

Dr Topol: How do you pick a topic? So many things come out every week; how do you zoom in and say, this is the one?

Mr Yong: The first criterion, and really the only one that truly matters, is whether I am interested in something or not—whether it makes me excited enough to want to write about it—because I can then convey that excitement to audiences. I care a lot about stories. I am trying to move away from just writing about the week's big new Nature paper or the Science paper of the week.

I'm interested in stories that show the process of science. I want to talk about the way people do science, the lives of scientists, and, increasingly, how science is engaging with the realm of politics and policy, and to tell the stories of patients. I like to think of journalism as giving voice to the voiceless, and that could be underrepresented groups or things that literally have no voice, like endangered species, ecosystems, or microbes.

Dr Topol: When we first met, I asked you if you could talk to a patient of mine who was essentially voiceless but who had diagnosed herself with a very complicated group of multiple rare diseases. You did it, but it wasn't easy, right?

Mr Yong: It was hard. When you are telling people's stories, you want to make sure that it's scientifically rigorous as well as very respectful of what people have gone through. But these are the stories that I love telling. They are a way of humanizing science and getting away from the idea that science coverage is just a stream of discoveries, or breakthroughs, or whatever. It's so much more than that. It's a process of knowing the world and a very important part of the world around us.

Dr Topol: Because of your background, do you have a natural propensity for the microbiome and zoology?

Mr Yong: I have always been a fan of zoology. I was the kid who went to zoos and watched the David Attenborough documentaries, but my interests are pretty broad. I didn't study microbiology when I was at university. I like to say that I write about everything that is, or was once, alive.

I started writing about microbiology quite early on when I became a science writer, and it's been a continuing fascination since then. I think it's because microbes are almost the ultimate underdogs. We can't see them; we tend to fear them, and if we don't fear them, we ignore them.

They have incredible stories to tell, as well. It turns out that they are core players in our stories. Rather than things that just kill us, or which are signs of dirt or disease, they are crucially important and they are part of us.

This grander view of ourselves as ecosystems, as worlds in our own right, is a deeply subversive and really fascinating way of understanding ourselves.

This grander view of ourselves as ecosystems, as worlds in our own right, is a deeply subversive and really fascinating way of understanding ourselves. That is why I wanted to write the book. My contention is that if we don't understand the relationships with microbes that share our bodies, we don't really properly understand our own biology.

Our Hidden Natural History

Dr Topol: With 10 years of journalism, you did at some point commit to writing a book. The topic couldn't be hotter, of course.

Mr Yong: It couldn't. Actually, I steered away from it for that reason. I feel like the human microbiome field has a lot of interesting stories within it, but it is also a growing field that is suffering from the problems of any young field—like human genetics had in its early days—a lot of hype and exaggeration.

I felt that a book that focused solely on that would be too preliminary. There has been so much work on animal microbiomes in general—the microbiomes of squid and aphids and deep sea worms and mosquitoes, and all of this stuff—that when I realized that I had actually been covering that for a very long time and that I could tell those stories in tandem and use the stories from animal microbiomes to inform and draw parallels with the work in humans, that's when I thought, "This is a book." It's not going to be a diet book or a health book or a self-help book; it's going to be a natural history book that focuses on the hidden natural history that people don't know about.

Dr Topol: [I Contain Multitudes] is an extraordinary book. When I read it, I thought, "This is clearly going to be a New York Times bestseller," and that was before it had come out. It is really quite exceptional. I knew it was going to be good because I watched your TED Talk. This was a couple of years ago. Tell us what that was about.

Mr Yong: It was on mind-controlling parasites.

Dr Topol: Yes. It was ideal to see that translated into a book with so much more depth and breadth. What kind of impact do you think the book has had on you and the field?

Mr Yong: I went into the book thinking that I really wanted it to be accessible and interesting to the general public—to people who just about know what bacteria are and not a lot beyond that. They get that bacteria are small things, but I wanted to open their eyes to this new way of seeing the world, of seeing themselves, and all of the other life that they were familiar with. I also wanted the book to be useful to the field because the field is going through such a tumultuous—almost a teething—period.

It's a time when it's very useful to have a synthesis of what's happening and how to think about the microbiome in this deeper ecological way—not just as a means of improving our health, but as a more fundamental way of looking at biology. From the comments and the reviews I've had, I feel that those goals have been realized. I've had a lot of positive feedback, from both the mainstream and the scientific press.

It's very gratifying when you get good reviews in the New York Times but also from Science. It has certainly—and this is really the reason why I wrote the book in the first place—helped to crystallize my own thoughts on the field. Being able to delve into it for a year and a half and interview all of the best people, and understand it on a historical as well as a conceptual level, you couldn't ask for a better opportunity. I feel like it has influenced my own reporting on this since.

Accessibility Through Irreverence and Humor

Dr Topol: You have differentiated yourself among so many fine journalists as being a particularly great explainer, and you add lots of humor, like you did in the book. But it's also spread throughout all of your pieces. How do you do that? How do you get down to the nuts and bolts, to make it fun and not only inject humor but bring it down to a level that everybody can grab onto?

Mr Yong: It sort of plays to the way I am built. I am naturally quite irreverent. I am somewhat disrespectful of authority and established power structures, and it helps when you are trying to explain something in a very easy-to-understand way—an accessible way. The idea that science should be a little bit stuffy, and very formal, is very against the way I think.

Dr Topol: You just undressed it all.

Mr Yong: Yes, and that's the type of communication and the type of reading that I like, that I engage with, and that drove my fascination for the natural world when I was a kid. Being able to peel back a lot of the formality that surrounds this field, and actually talk to people in a very natural way, as if you were in a bar or just chatting across a dinner table, is really important.

Dr Topol: That's a great lesson for people who like to write. In fact, you even got the award from the National Academy of Sciences for such an extraordinary communication—another congratulatory point there.

The microbiome has been a subject in medicine of tremendous hype and it has been linked with virtually every disease of mankind, from autism to irritable bowel syndrome. How are we going to pierce through all of this overhype?

Mr Yong: It's hard. It's a problem because a lot of the studies that draw links between the human microbiome and all of these various diseases and disorders are small. They are correlative studies done in animal models. They don't necessarily say whether the microbes are responsible for the disease or a consequence thereof. We don't know whether the microbes are initiating or exacerbating the condition.

Irritable bowel syndrome, like a lot of other conditions, has been on the increase recently. Is that to do with changes in the microbiome? The field is very good at finding statistically significant defects but not a lot of actually significant defects, at the moment. These are teething problems that happen in any young field. Human genetics went through exactly the same thing in its early stages, with small correlative studies that found a lot of compelling associations, some of which turned out to be false positives.

We'll get there as the field progresses. We have gone from a point where microbiology was entirely dominated by the study of infectious diseases to a greater understanding of host-microbe relationships and the importance of benign and beneficial microbes living within us. We'll get there, but the field is also becoming increasingly introspective about this problem. I have heard this discussed a lot, and there will still be small, weak studies out there, but I get the sense of change and movement in the right direction.

You showed with emojis the way a fecal transplant works.

Dr Topol: I like your optimism, and you've certainly dissected some of the key problems. Earlier [at the Future of Genomic Medicine conference] you showed with emojis the way a fecal transplant works. Only you would think of an emoji, and you got roaring applause. How do you come up with this stuff?

Mr Yong: I want it to be fun, and the thing about fecal transplants is—I have learned this the hard way—you literally cannot talk about them without people wanting to make jokes anyway, because it is such a weird idea. The problem with writing about fecal transplants is that you make puns even if you try to not make puns. You might as well go all-in, with people wearing badges saying, "I gave a shit." To be serious for a bit, the thing about fecal transplants that I think is really interesting is that they have been so powerful for treating C diff, but they were ignored for a very long time and are now getting traction in the medical establishment.

They are a very good example of the old axiom that there is no such thing as alternative medicine. If it works, it just becomes medicine. That is what is happening here. You have this thing that sounds so medieval and weird, and yet, because people have actually tested it in rigorous clinical studies and because the evidence base has built up, it's now the subject of serious investigation and it's something that doctors are taking very seriously. The FDA is looking at how to regulate fecal transplants. It's a really good case study of the power of solid evidence to make a change in how we practice medicine.

Holding the Powerful Accountable

Dr Topol: It's actually startling, the profound impact that it has had, and now the question is whether it can be extended to other conditions and be simulated without the undesirable aspects. You also have made some good points about probiotics, which have all sorts of false claims and are being taken widely. Are there any data to support the use of probiotics?

Mr Yong: They seem to be good for things like infectious diarrhea—for example, C diff. They have been linked to so many fairly nebulous claims, like boosting digestion or helping your immunity, to very specific claims about everything from inflammatory bowel disease, colds, and flu. There the evidence is far more mixed and less convincing. The general principle of trying to add beneficial bacteria to your body to improve your health is a theoretically sound one, but we need to get much more savvy about which taxa we use and how we go about doing that. It's not like taking a vitamin supplement. It's much more complicated than that. These are living, evolving organisms. They eat things; they have ecological niches. We need to get more subtle and more informed about how we go about designing probiotic therapies. We just need a higher caliber of evidence.

Dr Topol: One of the things you need to do, obviously, is track the flood of information that comes out on a daily basis. I know you through Twitter. You show up a lot on Twitter—you have a large following. How do you use Twitter and why do you use it?

Mr Yong: I use it for lots of different reasons. I use it to promote my own work and to share it with other people. I actually use it as a way of finding stories. I follow a lot of scientists and I listen to their conversations. I find that it's a very good way of getting a lay of the land in fields in a way that is quite similar to going to conferences. Rather than just seeing a field like the microbiome in terms of the papers that are being pushed out, if you look at the debates that are going on on Twitter, you get a better sense of where the controversies lie, what people are excited about, which papers people think are good, and which papers people think are bad.

It's a really good way of keeping on top of the areas that I am interested in. It's been a great way of finding sources, and scientists, like yourself, who share interesting things, who I know I can go to for comments. And it's been a good way of socializing with the science journalism community too. It's a very thriving group of people.

Dr Topol: I learn a lot every day from it. You moved recently from the UK to DC, within the past year or so.

Mr Yong: Formally within the past month. I heard that you guys love immigrants, so I thought I would come over.

Dr Topol: That brings me to my last question. Because I follow you on Twitter, I don't get to see nearly enough, but I can get into your mind. You are tweeting a fair amount about political turmoil, and I learn from that too. My question is, do all of the problems that are happening in this country with the current administration and immigration—every day it's something else—distract you from what you want to do, what you'd like to do?

Mr Yong: It actually gives me a new focus—one of several. I'm not going to stop writing about basic science, genetics, and microbiology, but I have done a lot more science-policy stories recently, and this is a time when journalism is more important than ever. It's a vital component in preserving democracy, in shining a light on stories that are not being told, and on holding the powerful accountable.

As the new administration rolls in, journalism will continue to be incredibly important. I've written stories about threats to the nature of expertise itself, and about regulatory changes that will make it harder for scientific evidence to be effectively used in policy. I've written speculative pieces about how the new administration will be able to cope with, for example, a pandemic, like the Ebola outbreak. How will that play out given what we've seen and given the track record of the people currently in power?

That's important for people to understand. The immigration ban happened literally hours after my flight landed. Science and politics are not disparate things. Science is done by scientists, and scientists have political opinions and are profoundly impacted by political decisions.

After that happened, I wrote a piece detailing how the immigration ban affects scientists, how it affects people from those seven targeted countries, and how a lot of America's great science comes from people with Iranian backgrounds, for example. I have written the stories about how scientists are engaging with policy, how many of them, like Michael Eisen, are considering running for office.

I have interviewed scientists who have successfully run for office in places like Canada. So I do not see this as a distraction. I think it's arguably some of the most important work that I do now. It's a privilege and an honor to be able to do that that kind of reporting at someplace like The Atlantic, which prizes it. It values it so much. There is a real fire and energy in the news room at the moment.

The Atlantic was founded a long time ago as an organ of emancipation. We were championing civil rights from the very start, and being part of that institution and being able to give voice to how science is being affected in the current administration feels like a tremendous honor at the moment.

Dr Topol: I had not even thought of connecting the dots with the long heritage that The Atlantic has brought us, in terms of covering these topics. Are you going to be working on another book?

Mr Yong: Not right now. I have no particular ideas, although I will say that on this particular question, I have a track record of being full of shit. I specifically said that I wasn't going to do a book to the man who is now my agent, literally weeks before I sent him my book proposal. I'm telling you now that I don't have a second book idea and it is true, but it may also be not true in days or weeks. Who can say?

Dr Topol: At the young age of 35, I know you have all kinds of stuff ahead of you and I wouldn't be surprised if there are multiple books. I want to thank you for being such an extraordinary journalist and for teaching us all the time with your writing. Not only do you get into the hot topics, but you do it in a way that just makes it eminently readable and enjoyable. Thank you for all of your hard effort.

Thank you for tuning in to this conversation with Ed Yong and for all of your support of Medscape.

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