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I situate my research at the crossroads of history, philosophy, sociology and anthropology of science. In the past, I have focused on epigenetics, environmental research, empirical bioethics and environmental justice, within and outside the academia, as you can read here, or here. Now I am focusing on antibiotic resistance, and I use it as a lens to interpret the contradictions of the last century derived by industrial production, environmental degradation and biomedical cultures.

What interests me is the (at that time) new epistemic discourse that since the Forties has been produced to explain morphological changes of organisms produce when they experience new environmental conditions or perturbations. Through an important experiment at the base of the so-called concept of genetic assimilation, Conrad H. Waddington showed that a thermic shock can produce changes in wings’ veins of fruit flies, changes that can eventually be inherited across generations, without the environmental trigger that caused them.

This focus on production and (genetic) storage of biological differences elicited by the environment is nowadays coupled with the knowledge produced through microbiome research that explains the phenotypic patterns that recur across generations.

In a thought-provoking twist, with microbiome research, the focus shifts from production and inheritance of biological differences to production and inheritance of biological similarities. Microbiome research shows that some phenotypic patterns are allowed by ecological communities of microorganisms composing all animals. Bacteria allow the development and functioning of our bodies within an epistemic framework that is now key to understand biology. The network of vessels composing mammals’ stomach is formed through cellular differentiation and expression of genes coordinated by bacteria. The same is true for our immune system that is coordinated by gut bacteria. Food, which is an important aspect of our lives also impacts on this microecology and mediates between our biological functions and functioning of means of production whose parts dedicated to food production have immense importance for our biology and our internal and external ecologies. Antibiotic resistance is one of the crossroads where culture, biology, history and the Anthropocene meet. Indeed, Antibiotic resistance shows that means of production of our societies have an even more widespread, deep and allegedly unexpected impact on the biology of animals and plants. The microorganism can indeed adapt to resist the selective toxicity of antibiotics. Moreover, bacteria can transfer their genetic code horizontally, by touch, so that we can acquire antibiotic resistance by eating food that functions as a vector, by hosting lice on our heads and many other contacts. Bacteria that are resistant to antibiotics that have been used as growth factors in animal husbandry and to prevent diseases in livestock and aquaculture, spread in natural ecosystems and can be found in wild species. Rivers and estuarine waters are places hosting antibiotic resistance.

Searching on PubMed (the search engine for biomedical literature) titles of articles containing the terms ‘antimicrobial’ and ‘Louisiana’ I retrieved just one twelve-years-old article. No results with terms such as 'Mississippi' or 'New Orleans'. The authors collected and analysed Oysters from both waters of Louisiana Gulf and in restaurants and food retailers in Baton Rouge. In most of the samples gathered, scientists recognised the presence of bacteria (Vibrio parahaemolyticus and Vibrio vulnificus) resistant to specific antimicrobials. Food production is indeed the first factor in terms of the quantity of antibiotics used. This use and related antibiotic resistance impact all the living beings present in a specific area, and can easily travel around the globe through many channels. As Littman & Viens have highlighted, a sustainable future is a future without antibiotics as “there may be no truly sustainable way of using antibiotics in the long-run, as microorganisms have shown to be almost infinitely adaptable since the first introduction of antibiotics” (Littman & Viens 2015). But in the meanwhile, we need to use them and antibiotic resistance is a phenomenon that can be better studied through environmental research, by analysing wild species and emissions nearby livestock, for instance.

The study that I retrieved focuses on Oysters. But what about antibiotic resistance conveyed through food that is consumed by the most?

What about exposures of communities that are living in highly polluted areas?

And what is the additive value on antibiotic resistance for individuals who experience the presence of industrial pollutants and that live in areas where cancer epidemics are registered?

In this respect, there is a strategy to cope with the issue of antibiotic resistance promoted by the Center for Disease Control and Prevention. The document doesn’t mention any action to monitor and regulate the production and usage of antibiotics in livestock. Nevertheless, the CDC wants to scrutinise, through genome sequencing, “Listeria, Salmonella, Campylobacter, and E. coli and uploads sequence data into PulseNet for nationwide monitoring of outbreaks and trends.” Moreover, the document reports that “In Fiscal Year 2019, Louisiana will begin simultaneously monitoring these isolates for resistance genes. When outbreaks are detected, local CDC-supported epidemiologists investigate the cases to stop spread.”

The questions that I would like to ask (to local ppl, activists, researchers, practitioners..) are:

What could be the epidemiologic characteristics (socioeconomic status, gender, residence..) of the populations more vulnerable to antibiotic resistance?

What is the additive role of antibiotic resistance for people living in highly polluted areas?

What is the impact of antibiotic resistance for people and patients living in areas where cancer incidence is high?

And on the long run I am interested in imagining possible strategies to not only living with the problem but also to tackle the problem itself, which means to develop strategies to answer the questions:

Why antibiotic resistance, which is known since a century, it’s a problem on the rise?

What is the role and interest of capitalism, in terms of profit-making of corporations, knowledge production and environmental degradation, in not being able to resolve antibiotic resistance?

What can be strategies of local communities to tackle the problem and to promote environmental justice in terms of alliances with ecologists, doctors, epidemiologists and other activists?

"Over the past 10 years, MSF has provided medical care to approximately almost 118,000 victims of sexual violence. Integrating related care into MSF general assistance to populations affected by crisis and conflicts has presented a considerable institutional struggle and continues to be a challenge. Tensions regarding the role of MSF in the care to victims of sexual violence and when facing the multiple challenges inherent in dealing with this crime persist. An overview of MSF experience and related reflection aims to share with the reader on one hand the complexity of the issue, and on the other hand the need to continue fighting for the provision of adequate medical care for victims of sexual violence, which after all and despite the limits, is feasible."

MSF is stricken by the intensely difficult task of helping with sexual violence. Not only do they have to deal with supporting the 118,000 people physically, but they help emotionally as well. Another aspect which contributes to the problem is the vast differences in gender equality throughout the world.  

Hailey-Means’ mental and physical health quickly deteriorated. Her treatment by guards and the intolerable conditions in solitary confinement — complete isolation, extreme temperatures, polluted air, the stink of the landfill — led Candie to try to take her own life.

What they’re calling for instead is a divestment from mass incarceration, along with an end to bail, and an investment in health care, living wage jobs, and mental health treatment that would lead to safer communities.

Google scholars had this article referenced 52 times. Many of these articles are in refernce to major disasters and the recovery of those areas from said disasters.

The article illustrates with the use of statistics of the health care system and their diagnostic method that while the program was created with good intentions, it has become apparent that in order to receive the financial assistance necessary, they need to seek assistance from influential advocacy groups.

The Waiting Room, a documentary film addressing the conversation about health care reform and equal access to care, goes through the lives of those in the emergency room of a hospital. It addresses the problem that some families have no other choice, but to visit the ER, since they do not have a PCP (Primary Care Provider) or insurance.  Additional unforeseen cases, such as trauma, arrests, and individuals that have very urgent needs only naturally make the wait longer. 

The bibliography suggests multiple essays from the MSF showing that it is mostly focusesed on the MSF view. Not to say that this is bad.

The program's purpose is reaffirm the importance that, along with good clinical skills, practicioners of all levels should be able to practice with the ability to listen to a patient's social background, not just have an objective view.

The article has a very diverse bibliography with multiple references from the International Atomic Energy Agency. If you can learn anything, it's that Schmid pulls information from reliable sources. 

1. The study in Baltimore showed that with a reduction in the influence of socio-economic factors in patients receiving health care services. The studies showed that with their increased awareness and effort the socioeconomic disparities largely vanished. Unfortunately this is also underscored by the emergence of HIV which is resistant to multiple drugs. 

2. The use of the PIH model in Haiti was shown to have positive results there, so much so that it was adapted in Rwanda. The greater challenges faced by this group is water quality and gender inequality.

3. Another way the argument is supported is by discussing the ways that clinicians can help to intervene in structural violence.