In one patient out of every ten, digoxin doesn’t work. Its downfall is a gut bacterium called Eggerthella lenta, which converts the drug into an inactive and medically useless form. Only some strains of E. lenta do this. In 2013, Peter Turnbaugh showed that just two of the bacterium’s genes distinguish the problematic drug-deactivating strains from the neutral ones.46 He thinks that doctors might be able to use the presence of these genes to guide their treatments. If they are absent from a patient’s microbiome, fine – give them digoxin. If they are there, the patient needs to eat a lot of
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