Intended for healthcare professionals


All creatures great and small

BMJ 2019; 365 doi: (Published 03 June 2019) Cite this as: BMJ 2019;365:l2385
  1. Aaron Bernstein, hospitalist, co-director12
  1. 1Division of General Pediatrics, Boston Children’s Hospital, USA
  2. 2Center for Climate, Health, and the Global Environment, Harvard TH Chan School of Public Health, USA
  1. aaron_bernstein{at}

Biodiversity is critical to human health

A recent report from the United Nations forecasting the pending loss of one million or more species from the planet seems an unlikely topic for a medical journal.1 After all, what does this loss of life, as tragic as it is, have to do with the daily practice of medicine? As it turns out, almost everything.


Around 65% of all new small molecule drugs licensed by the US Food and Drug Administration between 1981 and 2014 owe their existence to the molecular peculiarities harboured within life on earth.2 For some groups of therapeutics, such as chemotherapeutics and antimicrobials, our dependence on biodiversity is even greater. Of the 14 major classes of antibiotics, 10 would not exist if they hadn’t been given to us by an assortment of fungi and bacteria. Antivirals and antiparasitics are no different. Many, if not most, are directly or indirectly based on natural products, and some come from exotic creatures, such as the sea sponges that live in highly endangered coral reef habitats.23 Given …

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