American Society for Microbiology

A s a discipline, nephrology is burdened by commonly held but incorrect perceptions.Unfortunately, these myths can make nephrology less appealing as a career option for medical students, residents, and future researchers and scientists; decrease how health systems value the specialty; and make it more difficult for ASN to advocate on behalf of the more than 850 million people worldwide living with kidney diseases.Identifying the most insidious myths, presenting evidence to prove these misconceptions false, and providing a more realistic explanation will help change how nephrology and nephrologists are viewed.In Meditations, Roman emperor Marcus Aurelius expressed the Stoic perspective, "All things fade and quickly turn to myth: quickly too utter oblivion drowns them" (1).Rather than accept misperceptions that threaten the field, ASN and the rest of the kidney community must continue to strive to present facts and truth.Myth: Nephrologists earn among the lowest compensation of all internal medicine specialties.No one contends that nephrologists are compensated fairly.In most cases, nephrologists work harder-and longer hours, especially when considering the "windshield time" required to drive between dialysis units or transplant outreach clinics-to generate a reasonable wage.Additionally, payors fail to differentiate among the different types of nephrologists."Nephrology is cognitive and procedural, has a primary care component focused on identifying patients and slowing progression of kidney diseases, and includes the need to manage comorbidities," ASN Past President Anupam Agarwal, MD, FASN, and I observed in 2020 (2)."Nephrologists also provide 24-hour coverage-often for dialysis services for [patients who are critically ill]-an important service to health systems."Among the 13 internal medicine specialties, nephrology ranks sixth for average compensation (3).Physician work relative value units (wRVUs), accounting for the time, effort and technical skill, judgment and mental energy, and stress to provide a service (2), are misvalued and unfairly favor procedure-based specialties (4).Unfortunately, wRVUs do not reflect changes in technology, which have vastly increased the efficiency of many procedures, thus allowing some physicians to generate more RVUs per hour than specialties requiring actual face time with complex patients, such as in nephrology (4).

The 2024 International Union of Microbiological Societies Congress was held in Florence, the city of Renaissance. The theme was to increase the awareness of the power of microbial life, recognizing that it can lead the transformation towards a sustainable planet. The meeting gathered over 1400 experts from more than 90 countries and focused on the transformative potential of microbiology in addressing global challenges and aligning microbial science with the Sustainable Development Goals. Six roundtable discussions explored the pivotal role of microbiology in mitigating climate change, preparing for pandemics, producing sustainable energy, promoting a One Health approach, understanding microbiome dynamics, and developing data infrastructure. The discussions revealed that microbes are still overlooked agents in sustainable solutions. Expert panellists at the roundtables discussed microbial innovations in hydrogen and biofuel production, conversion of greenhouse gases, biomanufacturing, and soil restoration, the role of microbiome in immune health, the importance of cross-kingdom interactions, and the integration of food, environmental, and microbiomes under the One Health framework. Panels stressed the need for equitable access to vaccines, diagnostics, and data sharing, especially in the face of antimicrobial resistance. The importance of global collaboration, data repositories, and regulatory alignment, was repeatedly emphasized. The congress invited calls for the formation of an international microbiology coalition, need for interdisciplinary partnerships, increased investment in microbial technologies, updating of regulatory frameworks, and integration of microbiome science into public health and environmental policy. Microorganisms are the oldest architects of nature, able to build a sustainable future for the planet.

The climate crisis is one of the greatest challenges of our time, yet the role of microorganisms remains underrecognized in climate science and policy. Microbes are highly sensitive to environmental change and regulate essential biogeochemical processes, while also offering solutions for reducing emissions, restoring ecosystems, and enhancing resilience. Microbiology societies from five continents recently convened in Washington, DC, for the inaugural Global Strategy Meeting on Microbes and Climate Change. The gathering launched a global alliance to position microbial science as a pillar of climate action and identified four priorities: building a coalition, embedding microbes in climate frameworks, transforming communication, and advancing real-world demonstration projects. This initiative marks the beginning of coordinated global action to harness microbial life for climate solutions.

The field of microbial ecology, evolution, and biodiversity (EEB) is at the leading edge of understanding how microbes shape our biosphere and influence the well-being of humankind and Earth. To that end, EEB is developing new transdisciplinary tools to analyze these ecologically critical, complex microbial communities. The American Society for Microbiology's Council on Microbial Sciences hosted a virtual retreat in 2023 to discuss the trajectory of EEB both within the Society and microbiology writ large. The retreat emphasized the interconnectedness of microbes and their outsized global influence on environmental and host health. The maximal potential impact of EEB will not be achieved without contributions from disparate fields that unite diverse technologies and data sets. In turn, this level of transdisciplinary efforts requires actively encouraging "broad" research, spanning inclusive global collaborations that incorporate both scientists and the public. Together, the American Society for Microbiology and EEB are poised to lead a paradigm shift that will result in a new era of collaboration, innovation, and societal relevance for microbiology.

This paper is a call to action. By publishing concurrently across journals like an emergency bulletin, we are not merely making a plea for awareness about climate change. Instead, we are demanding immediate, tangible steps that harness the power of microbiology and the expertise of researchers and policymakers to safeguard the planet for future generations.