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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?

The policy addresses the "vulnerable" population of EMS personnel who are underprepared or not accompanied by law enforcement officers.

Funding appears to come from the university, along with the Ministry of Education, Culture, Sports, Science and Technology. 

This has been referenced in a number of articles involving similar topics. 

This was a retrospective study. While not the most accurate and well supported way to conduct a study, due to the effects of recall bias, it was really the only way to gain the data that was presented in the report. There isn't really anything new about the style of research. 

The policy definitely provides a good amount of suport for a large amount of people affected. However, certain populations are left out of this. The large number of transiet persons, as well as non-resident people, in New York City is enourmous. These people were surely affected by the attacks, but are not included in the policy. This is, of course, understandable, as tracking the presence of these people's is nearly impossible nearly 10 years after the attacks. Regardless, it is a flaw in the policy. 

I was unable to find the number of currently active field missions for MSF, but I found information on the process of working for MSF. Each year they send about 2500 international aid workers (not just doctors) to many countries. These people are put alongside locally hired medical personnel to complete the missions. The process for becoming a volunteer is a bit long, with lots of requirements. Candidates need experience in their discipline, experience in management/ teaching, language skills, and previous experience in a humanitarian environment. From the film, it didn't seem that all the doctors had this experience, namely Davinder. MSF also likes that candidates have profficieny in French.

While looking at the FAQs on the US website, I found an interesting portion regarding care facilities and missions in Gaza, the West Bank, and Jerusalem. The MSF has a section defending their care in that area, but it is posed in the form of questions like "Why are you taking sides? You seem biased" or "Why are you getting involved in this but choose to stay neutral in other conflicts around the world?" It just strikes me as strangely unprofessional to have it phrased that way. The answers also seem very defensive in a reactionary manner. I just honestly thought it could have been phrased better or not included at all. It is information that maybe a few people might find useful, but would be better placed in a press release or answered by a recruiter.

I also learned that, interestingly enough, 90 percent of the medical professionals are local rather than international. They are trained by the international staff so as to provide a continuity of care. The film didn't really portray that fact, and made it seem like the clinic would have nearly no staff once the international doctors left.

They interviewed and used outside interviews of the people affected by the disaster. They also used other articles, research, and media to support the story and their beliefs. 

The main point is that their was water contamination on a military base that caused cancer in several people, including servicemen and their children. The government/military covered it up and this led to a bit of a scandal.