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"Antibiotic Resistance in Louisiana"

fdabramo

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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Sara.Till

 Often considered a "social disease" HIV/AIDS can be linked to certain social groups and subsequent behaviors within these groups. Taking this a step further, poor prognosis in treatment can be linked to social stratification. In the early 90's in Baltimore, a study was performed that linked race to reception of timely medical intervention. Modifications to the programs, such as removing insurance status as a determining factor for care, drastically reduced racially-biased outcomes. In the Rwandan campaign, Partners in Health instituted proximal care to rural regions-- the areas where care was most significantly lacking. This, in turn, can greatly mitigate the effects of social violence. Moreover, structural interventions (such as changing the accepted and prescribed practices of international bodies) can greatly reduce the effects of disease within a population. This includes such things as when and how drugs are administered, who is receiving medications, and changing conventional practices proven to enhance the spread of disease. 

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Sara.Till

The article primarily argues that, although there are interventions and steps in place, "biosecurity" is not currently a viable or stable entity. The four main areas stated in this article (emerging infectious disease, bioterrorism, cutting-edge life sciences, and food safety) are not formerly understood or controlled enough to make a feasible and honest plan that ensures safety. While steps can be taken and measures used, the dynamic nature of these fields and the human condition prevents us from establishing a truly flawless safety net at this time. One only has to look at the re-emergence of previously extinct diseases such as measles, the prevalence of pertussis, or the assertion of chemotherapy's deadliness  to see we do not have a full handle on any of these fields.

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Sara.Till

Dr Knowles examines three historical structural disasters: the burning of the Capital Building (1814), the Hague Street boiler explosion (1850), and the Chicago Iroquois Theater fire (1903). The Capital Building burning (henceforth noted as CBB), and the subsequent investigation by engineer Benjamin Latrobe provided numerous insights into the disaster. These are discussed, but Dr. Knowles pays particular attention to the major scrutiny endured by Latrobe. As a major player during the planning and building of the Capital Building, the CBB was painted as his failure (despite indications otherwise). More than anything, the report highlights Latrobe's inability to prevent and evaluate disaster; although an employee directly of the president and senate, he was powerless to enact change. Similarly, the Hague street boiler seemed to be fraught with issues. Yet, those who came to present in the ensuing investigation had no true standing to alter future events. It  again follows this pattern of disaster, difficult investigation, and minimal substantial response by those in power. The Iroquois Theater Fire investigation seemed to finally deviate from this norm. Multiple fire experts, engineers, and public officials involved themselves in the case. However, ultimately, the investigation's findings were not put to use. Some advances occurred, yet so many other technical progressions were ignored.

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Sara.Till

This article primarily focuses on a French law instituted in 1997 allowing for the acceptance of immigrant residents on the basis of illness. This landmark law deviated from the typical methodologies of achieving residency-- most often through work or familial/marital ties. The article examines this "humanitarian reason" for immigrant inclusion, discussing the historical progression to its creation and how it can be implemented. The article also discusses how and why this criteria came to be-- how the bodily capability of an immigrant could suddenly ascend to such a high level of regard.

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Sara.Till

This article undertakes reviewing the current approaches to handling mental health in the wake of disasters. It particularly focuses of the current methodologies of research utilized, past methodologies/findings, and how these effect today's approaches to treatment of mental disorders during emergency response. The article begins by discussing the major psychopathology found in populations effected by disasters, including mood disorders such as PTSD and MDD. Other disorders, such as substance abuse and outside symptomologies, are also discussed-- but these first two seem to be the major players addressed here. The work then describes how current comorbidities exist, and how these manifest as pre-disaster risk factors (for example, female disaster survivors are generally more likely to have adverse psychological outcomes, such as PTSD or MDD). Other factors include age, socioeconomic status, and basal trait-level anxiety/depressive symptoms. The report also speaks to during disaster and post-disaster factors as well, as these both have been shown to indicate increased likelihood of developing mental health disorders from a disaster event. Finally, the report delves into current interventions utilized during all three of these time periods (pre, peri, and post), and how these may amplify or diminish the mental health effects of a disaster event. Unfortunately, the paper gives very general guidelines, such as discouraging building in vulnerable locations or testing responses in communities even before disasters occur. For post-disaster preventative measures, however, the report included several key notations-- including implementation of stress debriefings for disaster survivors, and usage of PFA (psychological first aid) to prevent adverse mental health outcomes. 

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Sara.Till

The documentary follows Ensingmer during his searches for information and during the government hearing regarding the water contamination. This includes multiple interviews with former residents of the base, including former marines who are currently undergoing treatment for cancer and other illnesses caused by VOM's. The film mainly includes input from these residents; while it does provide some information through texts during pauses in the film, it does not provide exact numerical data, and mostly provides emotional appeals. The film also follow those effected as they attempt to collect information about all of those exposed to the contaminated water, including a spreadsheet of former male residents diagnosed with breast cancer.