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"Antibiotic Resistance in Louisiana"

fdabramo
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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?

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joerene.aviles
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1. In this sense, gender-based violence makes it clear that the suffering body – while purportedly universal – requires certain political, historical and cultural attributes to render it visible and worthy of care.

2. It seems that humanitarianism, as universalism, both erases and depends on difference; on the one hand, it manages difference, declawing it so that it doesn’t tear apart the humanitarian kit, made to fit and rehabilitate everyone into a basic bare-bones humanity.

3. In this sense, bringing gender-based violence into the humanitarian mission has inadvertently opened up a space for confrontation with politically significant forms of difference and inequality in their real and rabid forms.

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joerene.aviles
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Bruze Nizeye and Sara Stulac both work with Partners in Health (founded by Paul Farmer) while Salmaan Keshavjee is a physician and researcher whose expertise is in multi-drug resistant tuberculosis and global health. Farmer's and Keshavjee's anthropological research in particular is important to emergency response because it would allow for improved preparation of treatment to those communities. Their work in seeing the social causes of health epidemics would also allow for better prevention of disasters. 

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joerene.aviles
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1. Multi-drug resistant HIV and impact to treatments and research

2. Rudolph Virchow and his work in public health

3. "In the two rural districts of Rwanda in which the PIH model was introduced in May 2005, an estimated 60 percent of inhabitants are refugees, returning exiles, or recent settlers; not a single physician was present to serve 350,000 people." -looked up how this came to be; was there any healthcare available to them at all?

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joerene.aviles

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joerene.aviles
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The author is Didier Fassin, a French sociologist and anthropologist who was trained as a physician in internal medicine. He developed the field of critical moral anthropology and currently does research on punishment, asylum, and inequality. This research looks at the social and political forces that affect public health trends, so is not directly involved in emergency response.

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joerene.aviles
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The stakeholders are Dr. Atul Gawande, other healthcare professionals, and the patients with terminal illnesses. They have to decide what the patient's priorities are, treatment options, and basically how much time and quality of life patients are willing to trade for extended years to live. Is the treatment making the patient worse or better? Doctors have to put themselves in a position of vulnerability by personally getting to know their patients, and deal with the guilt and blame if their treatments aren't successful or what they had said to the patient's family.