Melbourne Documentary Film Festival 2023: The Invisible Extinction | Interview

A rich, necessary and skillfully crafted documentary, The Invisible Extinction is the fruit of Steven Lawrence and Sarah Schenck’s meticulous work, and a must-watch.

Up to one third, or even half of the prescribed antiobiotics in the United States are useless. After experiencing the heavy risks associated with the prescription of antibiotics, Sarah Schenck and Steven Lawrence joined forces to embark on a fruitful research and filmmaking journey. The result is The Invisible Extinction, eye-opening must watc, currently playing at the 8th Melbourne Documentary Film Festival, which we are delighted to cover as media partner.

We had the honour of speaking with the filmmakers behind the outstanding The Invisible Extinction, which premiered at CPH:DOX in 2022.

Film Fest Report: What pushed you to embark on this journey?

Sarah Schenck: One in every thirteen children in the USA have food allergies, some of them deadly. Two of those kids are mine.

My youngest child nearly died when she was three. This was a shock because, as a baby, she ate everything; she had no allergies. Then she contracted strep throat and took two rounds of antibiotics in one year. A few months later, after eating a pecan cookie, I watched her face go scarlet and her lips swell as her airways shut down. We got her to the ER in the nick of time.

The first thing I did when we got her home was to seek answers.

Steven Lawrence: My own health problems motivated me to work on The Invisible Extinction. In the 1990s I was given multiple rounds of antibiotics for what my doctors thought was a persistent parasitic infection picked up making films in Russia and Central Asia. As treatment progressed, instead of getting better I developed debilitating gut, allergy and autoimmune problems that made life very hard for over a decade and continue to affect me. I searched for answers, but back then no one knew that nuking the gut with antibiotics could not only damage intestinal health but derail the immune system. The term “gut microbiome” was not even in use and didn’t enter the scientific conversation until the early 2000s. So, when by chance I met Sarah Schenck at a dinner in 2014 and she told me she was working on a doc about the microbiome and looking for a collaborator, I decided I must help. By then I understood that what had hurt me – medically unnecessary use of antibiotics – was happening to tens of millions of people worldwide. I wanted to put my many years of documentary experience behind a film that would be a wake-up call about the importance of our gut microbiome to our health.

Film Fest Report: How have you met the characters of the film? And how did you build a safe space for some of them to talk to you about very intimate experiences?

Sarah Schenck: After my daughter’s scary experience, I spent late nights and early mornings at the NY public library diving into the vast research examining he sudden, shocking rise in severe food allergies just in the last two decades. Some of the most compelling research was by Dr. Martin Blaser, then at NYU, who tied the rise in food allergies to the loss of our ancient microbes, primarily from the overuse of antibiotics.

My life’s mission is to translate scientific concepts into accessible stories for regular people – so I began shooting a film. I tracked down Dr. Blaser and found that he had a rare gift: he could convey complex scientific ideas in engagingly simple terms. His wife, Venezuelan microbiologist Maria Gloria Dominguez-Bello was equally brilliant and charismatic. I’d found the fulcrum of the film in this duo.

Marty and Gloria were both naturally gifted communicators which was evident to me from the first time we spoke; over the years we worked together they gave us access to many intimate moments together – they trusted us and we trusted them.

Steven Lawrence: I met Gloria and Marty through Sarah, who had found and interviewed them before we decided to collaborate. We all had a long dinner in April 2015 and after that they fully committed to being the focus of the film, including access to their personal lives. With them there were never any barriers – they trusted us and because they’re used to being public figures, they weren’t intimidated by the camera or crew. They just fully embraced the filmmaking process, and we all became friends.

It would take too long to tell the stories of how we found the other subjects,  but especially for the American patient stories, we did a lot of outreach – through social media, doctors, and even a couple of casting directors – and interviewed many people before deciding on Theresa and Cam.

With each of the subjects other than Gloria and Marty the comfort level varied a bit, but I think what made it easy for them all is that they understood how committed Sarah and I were to the film, and that our personal experience was motivating us. For example, in the food allergy story, Cam’s parents knew that Sarah’s daughters also have life-threatening food allergies, so that it made it easier for them to relate to her and feel comfortable. For the most part we were blessed with both scientists and patients who were highly motivated to have their stories told, so there wasn’t the challenge documentary filmmakers often face of building trust and openness over time, though of course the work became more relaxed the more we filmed with each of them.

I’d say the biggest challenge for us was finding a way to work intimately with our Chinese subjects in the autism story, and in this we were very fortunate in finding Yimin Zhuang, who goes by Fanfan, as our location producer-director. We had learned about autism researcher Dr. You Xin when Marty and Gloria visited her Beijing clinic, which they documented at our request with their iPhones – footage we used in the film. With Xin and her hospital’s cooperation we decided to follow two autistic children undergoing treatment, but we didn’t have the money to make multiple trips to China.

Fanfan was enthusiastic and had the right experience doing verité work and quickly built a trusting relationship with Ningning’s family and the family of another child, a girl in Szechuan province named Yinyi, whose story is not in the film. We supervised long-distance, but as Americans who don’t speak Mandarin I don’t think we could have bonded with the children and their families as Fanfan did. And we must also praise DP Tian Li, for his beautiful and sensitive cinematography.

We also remotely supervised the filming of Marty & Gloria’s trip to Shanghai and Shenzhen, which was done by another exceptional Chinese filmmaker, Long Miaoyuan, who was producer-director-DP. And we had an Israeli field producer, Hagar Alroey, who was fantastic at being our surrogate for some shoots when we couldn’t be in Israel.

Oscar Noya Alarcon, who is the medical doctor for Gloria’s research team in Venezuela, played a similar role for the Amazon filming. Again, we didn’t have the money to go – it would have cost over $35,000 just for two people! Oscar had done some video and photo documentation of previous research trips to the remote Amazon. I met with him in NY and spent a few hours explaining the kinds of shots and moments we needed, but we did not realize how cinematically talented he was until we saw the material a month or so later. Using a GoPro and filming in his spare moments, he did superb work, and his knowledge of village life, and his rapport with the villagers, made it possible for him to be in the right place at the right time.

Documentary filmmakers almost always want to be present for every shoot, but over many years and film projects, I’ve learned that sometimes working with collaborators remotely is not only cost-efficient, but a better choice, especially when there are significant cultural or language barriers.

Film Fest Report: For how long have you filmed? And has research on microbiome and antibiotics evolved during this time?

Sarah Schenck: For 11 years! I shot the first modern-day fecal transplant over a decade ago, with my friend and fellow filmmaker Margaret Sclafani – as well as our initial shooting with Marty and Gloria. It was still very very difficult to get any funding for a science film, even after Steven, who is an experienced doc film fundraiser, came on board. It took years, and our deep gratitude goes to Neil and Anna Rasmussen, who were our first significant funders.

The research has exploded during this time, watch our film to find out some of the ways this work is being done all over the world.

Steven Lawrence: Sarah did some preliminary filming before I got involved, including what is probably the first video documentation of a fecal transplant. Hats off to her for that shoot! We used some of the fecal transplant footage in the final edit, but everything else was shot between December 2015 and January 2021, with just some pickup shots needed to finish.

Microbiome research and studies on the impact of antibiotics evolved over the course of filming, but not enough to make any of the core information and ideas in the film outdated. The studies that have emerged since we finished provide further proof that overuse of antibiotics, especially in young children, is a factor in the diseases we mention in the film. There are recent studies about the connection between our microbes and Alzheimer’s, Parkinson’s, autism, heart disease, and depression among other illnesses, and there’s evidence that optimizing the microbiome can improve the efficacy of some cancer treatments. As Marty and Gloria say in the film, we’re in the early days of a scientific revolution.

Film Fest Report: How did you manage to craft such a fluid and accessible film about a complex topic? And can you comment on the choice and aesthetics of the very well executed animated scenes?

Steven Lawrence: Gloria and Marty are the heart of the film and the key to its accessibility because the first 20 minutes focuses on them, the “invisible extinction” of our ancestral microbiome, and the work they’re doing to save it. They’re warm relatable, eloquent, dedicated to their mission, and in love. Putting them front and center was always our intention, but soon after filming began we decided to add three patient stories so viewers would understand the experience of people coping with, and trying to overcome, some of the illnesses Marty calls our “modern plagues.” Finding the right patients, and the scientists and doctors helping them took several months of research.

Ultimately, the trick was to find the right balance between character-driven storytelling and delivery of key scientific ideas and information for a general audience and making the flow back and forth feel seamless. Test screenings were critical to this process. Many of them were done virtually because we were editing during the Covid pandemic – and the feedback we got led us to drop some stories and characters, and prune some of the science. Our editor Russ Greene helped guide us every step of the way. He’s one of the best.

There was also a certain amount of luck involved, which is almost always the case with documentaries. When Gloria and Marty were invited to give lectures in China, we decided we had to document the trip, and that opened the door to meeting Dr. You Xin and filming the autism story.

The animated sequences were produced once we were close to picture lock. Our biggest challenge was to create what we call the “microbeverse” – our gut microbiome. Working with Blue Spill, an exceptional London-based design and animation studio, we selected specific microbes for them to use as models and scripted the sequences. We wanted the microbeverse to be vibrant, inviting, and magical, which I think we achieved thanks to the artistry and stamina of the Blue Spill team led by Anthony Brownmoore.

The microbiota vault sequence was a special challenge, because at the last minute the Swiss Army told us we couldn’t film inside the bunker Gloria and Manuel were inspecting, so we had to animate the space and imagine what it would look like when converted into a modern “Noah’s Ark” for the human microbiome. Fortunately, we were able to record audio of the bunker inspection, so we had that as a guide.

Too often the contributions of sound designers and composers are not acknowledged so we want to give kudos to these members of our team. Paul Vîtolinš did a brilliant job creating the sonic world of the microbeverse, giving the microbes distinctive voices. And composer Hahn Rowe delivered a gorgeous, nuanced score, that perfectly supports  the magic of the microbeverse and the struggles and heroism of our scientists and patients. He played all the instruments himself. Like our editor, he’s one of the best.

Sarah Schenck: We benefited from the excellent advice of iconic film editor Walter Murch who said, with a complex scientific subject, we should be prepared to do MANY more test screenings with audiences to find out what was working and what wasn’t. We did over a dozen test screenings – and we are VERY GRATEFUL to the friends, colleagues, students, and random strangers who participated in these critical feedback sessions! Blue Spill was able to create an infinitely beautiful microbial world that looked very different from the way everyone else has been representing microbes. Through extensive conversations, and honing his initial vision, Anthony Brownmoore captured the magical journey of a baby through the birth canal, and this first encounter with microbes. We benefitted from additional high-impact graphic and animation contributions from fellow New Yorker Steven LaMorte. Our gifted editor Russ Greene was our key creative collaborator in seamlessly weaving together these characters – patients and researchers – as well as sharing the scientific tidbits so that they invite the viewer into the conversation.

Film Fest Report: What are your hopes and expectations from screening the film around the world? Do you wish to raise awareness among the general public? Or lead to political measures?

Sarah Schenck: I hope our film lets other individuals and families facing these challenges know that they aren’t alone. “The Invisible Extinction” shines a light on the work of innovative researchers, and in an era in which humanity needs a better understanding of medical progress and shortcomings, it elevates scientific discourse for all of us.

On the political front, here are 3 goals:

1) A medical education campaign to physicians and med students showcasing the importance of NOT prescribing antibiotics when they are not clearly medically indicated (as you glean from our film — ⅓ to ½ of all prescriptions in the USA are USELESS, i.e. prescribed for illnesses that WON’T respond to antibiotics — so you’re doing harm with no potential benefit). And regular folks can always ask their doctors when they’re prescribed antibiotics if they are necessary or if it would be okay to wait another day or two and see if the illness resolves itself as it often does.

2) A citizen action campaign to share with women that C-sections are critical medical procedures to use also only when medically indicated — it would be wonderful to see the end of the ‘elective’ C-section.

3) Get antibiotics out of our food supply (and monitor to make sure it’s enforced) — we are losing our precious antibiotics for cheap meat!

On the research front: I’d like to see a focus on developing better, quicker diagnostics – so it would be less likely you’d end up with an unnecessary antibiotic prescription.  And it would be great to see the development of narrow-spectrum antibiotics that can target a specific illness without carpet-bombing our “good microbes” at the same time. Maybe this has to do with developing new delivery mechanisms as well, for example, an ear drop for an ear infection instead of systemic amoxicillin, or a skin patch or suppository for a localized infection – UTIs are another common reason antibiotics are prescribed. We have a lot of room for improvement! The resurgence of phage therapy for new infection treatment options is another exciting field of research.

Steven Lawrence: We want viewers to come away from the film with an awareness that the microbes that live inside us are critical to our well-being, and that we risk further health problems if we continue to degrade them through certain practices, like medically unnecessary use of antibiotics and elective C-section births, too much processed food, and exposure to chemicals. And that disruption of our gut microbes is especially problematic in childhood when the immune system is developing. But we also want to make sure that people understand that the film is not against antibiotics. They are miracle drugs and have saved untold numbers of lives. Following Marty and Gloria’s leads, our film simply argues for their judicious use and the development of new ones to avoid the increasing possibility of a superbug pandemic.

The larger frame for the film is that the loss of our internal biodiversity – 50% in the last 50 years – parallels what’s happening on a planetary basis – animal species disappearing in unprecedented numbers, our rainforests being decimated, etc. It’s not surprising that we’ve unintentionally damaged our inner ecology as much as the outer world, but I think viewers will be shocked to learn that it seems to be happening even faster than climate change, as Marty Blaser says in our film.

We hope The Invisible Extinction will be a conversation starter and encourage dialogue between people and their doctors, and especially between parents and pediatricians who still often recommend antibiotics for problems like ear infections when it’s possible in many cases to wait and few days and see if they’re needed. And we also hope the film will help accelerate the creation of the Microbiota Vault, Gloria’s critical initiative for helping to preserve our vanishing ancestral microbes. See the film to learn more about it.

Make sure to catch The Invisible Extinction at Melbourne Documentary Film Festival 2023, running online on July 1st-31st, 2023 and in theaters on July 21st-30th. Book your screening here.