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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?

• Chernobyl was an unexpected disaster, however several more nuclear disasters have occurred since then. I looked into the safeguards that were changed after Chernobyl and if those had any part in mitigating other nuclear meltdowns. After the explosions several countries and international groups developed nuclear policies that attempted to prevent critical system failures as occurred during the test that caused the reactor to overheat, but many countries refused to adopt additional safeguards that may prevent future disasters.
• The article described the various zones put into place to keep people away from the most radioactive areas around Chernobyl, I looked into the zones used and the determining factors in determining the sizes of each zone. The initial response determined a zone of 30km around the site, however as scientific understanding of radiation improved the zone was extended to 2600km. This shows the importance of an informed response to prevent further damage after a disaster.

Finally, I researched the effects of low dose radiation poisoning to better understand the medical care needed by those affected. Even low exposure doses can cause lasting damage to organs, or cause cancer and blood related illnesses through the effect of radiation on bone marrow. Those exposed would need frequent medical exams and treatment for the entirety of their lives.

The report was published by United Nations Publication in 2014.

• Throughout the article it became apparent that the individuals being interviewed were rarely prescribed medication and in some cases did not take their medication. I researched the effectiveness of epilepsy medication and severity of not treating seizures in order to better understand that specific illness.
• The article was written using data collected in 1988. Since medical knowledge has changed dramatically since then I decided to look into the current medical situation in Turkey. Although it is challenging to find unbiased opinions it appears that even with advances in medical science, cultural traditions remain an integral part in dealing with illness in many places and needs to be understood when dealing with patients who have those beliefs.
• A majority of the patients interviewed attribute their seizures to a traumatic moment in their past, as I was unaware that epilepsy could be triggered in such a way I looked into the causes of epilepsy. In many cases the cause cannot be identified, however there is significant evidence for epileptic fits being caused by post-traumatic stress as well as neurological trauma and even cardiac issues.

The article focused on treatment and prevention of diseases affecting communities, however I was interested in the initial causes of these epidemics in places that were originally free of disease. I read an article “The Tipping Point” published in the New York Times that explained multiple social theories as to how epidemics begin, using Baltimore as a case study.

I looked into the stated mission and some of the work done by the Partners in Health, as they are a group that responds to epidemics. It was interesting to see that they focus not on immediate emergency response but instead on creating lasting infrastructure to gradually stop epidemics, as well as educating locals on how to react to future emergencies of the same nature.

The article mentions that clinicians are not trained to see social issues as they are so commonplace in everyday life as to become invisible, I felt that was a limited mindset and read an article written by Doctors for America. The article showed that while it is true that comparatively little time is spent on social issues during a doctor’s education, clinicians dealing directly with patients clearly recognize social conditions effecting health. The article suggests that the lack of attention on those issues in the medical field is not due to ignorance but rather the lack of an existing system through which individual doctors can report their experiences and work towards a solution.

Emergency response is addressed in terms of post-incident humanitarian aid, dealing with how to identify and help victims of sexual violence without politicizing their situations to the point of forcing them to relive their trauma or making them feel separated from other people receiving aid.

The article referenced many other papers that focus on the modern health threats due to scientific advancement, the spread of disease in modern society, and on the current approach to health prevention and the response to epidemics. This suggests that the paper was a culmination of ideas that did not include new research or data.

There are seven authors on this project, all of whom are connected to research institutes or universities. The project was primarily written by individuals associated with the Stockholm International Peace Research Institute, which has a good reputation.

The argument is mainly supported by historical examples of structural failures and the subsequent investigations. The post incident investigation tactics, or lack thereof, discussed support the argument that disasters require an existing structure for authority and procedure. The 1814 Burning of the Capitol Building is an example of an unrestricted investigation that had a successful ending, the building was reconstructed. The 1850 Hauge St. Explosion shows how a joint investigative team without proper distribution of expertise and responsibility leads to an incomplete investigation.  Finally, the 1903 Iroquois Theater Fire is an example of a modern investigation process that utilized available knowledge and resources effectively.

This policy has significant implications as to the future of EMS and fire response, if it became common to carry firearms while on duty. While there are safety benefits, and EMS personnel in Bethel Township say they are also more confident knowing they could defend themselves, it is important to recognize that police have extensive training and protocols on when and how to safely use their firearms. Police should still respond to EMS calls if there is any suspicion that the scene may be unsafe. Additionally, the knowledge that calling an ambulance also means calling several people who may be armed could negatively affect the public opinion of EMS. EMS is here to help the public, and for this to be successful those in need have to feel safe calling 911.