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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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erin_tuttle

Data collected from a study done in Baltimore in the 1990’s, including statistics and observations is used to support the main argument. The methods used in Haiti and Rwanda as well as the results from implementing those methods are also used as examples for the claim that social conditions greatly impact disease susceptibility.

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erin_tuttle

“There is no such thing as being “too secure.” Living with risk, by contrast, acknowledges a more complex calculus. It requires new forms of political and ethical reasoning that take into account questions that are often only implicit in discussions of biosecurity interventions.” (Lakoff 28)

“On the one hand, they examine the different political and normative frameworks through which the problem of biosecurity is approached: national defense, public health, and humanitarianism, for example. On the other hand, they examine the styles of reasoning through which uncertain threats to health are transformed into risks that can be known and acted upon” (Lakoff 12)

“These initiatives build on a growing perception among diverse actors—life scientists and public health officials, policymakers and security analysts—that new biological threats challenge existing ways of understanding and managing collective health and security. From the vantage point of such actors, the global scale of these threats crosses and confounds the boundaries of existing regulatory jurisdictions. Moreover, their pathogenicity and mutability pushes the limits of current technical capacities to detect and treat disease” (Lakoff 8)

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erin_tuttle

The family followed during most of the film was able to get several members out of Liberia during the Ebola crisis, I was under the impression that travel across the border of affected nations was prohibited. The CDC webpage was able to confirm that travel bans were imposed to and from Guinea, Liberia, and Sierra Leone during the Ebola crisis. Travel to and from these places was only permitted for health officials and aid worked, and required a 21 day quarantine upon returning to the US. However, several cases in surrounding countries were reported and it is known that people would first travel to a different country before attempting to fly to the United States.

I was also interested in how health care workers and emergency responders kept themselves safe while working with such a dangerous virus, the CDC webpage was also able to clarify the PPE used when dealing with suspected or confirmed cases of Ebola, including gloves, gowns, respiratory protection and boots. Protocols also exist for training responders in the proper methods of donning and doffing PPE to protect themselves.

As a portion of the film focused on the public outrage concerning the quarantine, I read an article “Encouraging Compliance with Quarantine: A Proposal to Provide Job Security an Income Replacement” by Mark A. Rothstein which explains in greater detail the effectiveness but also challenges posed by a quarantine, and how this directly effects the infected and uninfected individuals inside.

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erin_tuttle
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This policy was created in response to attacks against non-police first responders, the effort to enable the responders to carry firearms was in part motivated by a 911 call where the caller faked a medical emergency and then took the firefighters hostage when they arrived. He later stated that he had chosen a medical emergency because he knew they wouldn’t be armed. This, and other incidents, began to affect patient care as paramedics no longer felt safe entering buildings without police.

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erin_tuttle

The article mentioned a database the Times was using to track the location of firefighters throughout the incident, I looked at that system. It is not publicly available but was interesting in that it entirely depended on the news footage, personal videos and eyewitness accounts.

The article mentioned helicopters were being considered for rooftop evacuation, which surprised me due to the smoke. I looked into the visibility in the airspace directly surrounding the World Trade Center, while the smoke was so severe as to be captured by the International Space Station the wind did clear the smoke sufficiently for a clear line of sight between the helicopters and portions of the towers.

The firefighters were climbing the stairs, and reportedly would take hours to reach the top. The article also mentioned several groups of resting firefighters, so I researched the weight each firefighter would have been carrying which added up to 45 pounds of gear and at least an additional 20-30 pounds of tools.

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erin_tuttle
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The technical aspects of the site are quite complex, as the system has over 1,000 active data sites to compile in addition to the reports and reviews stored. The data collection software is the main function that the software supports as it relieves the users from needing their own data bank to work off of.  The publication functions are also supported by the storage system of the app allowing all users to access all publications.