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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

The author is Adriana Petryna, a professor of Anthropology at the University of Pennsylvania. In addition to her work as at the University, Dr. Petryna has written several books and articles focusing on the effects of cultural and political forces on science and medicine. Other interests include social studies of science and technology, globalization of health, medical anthropology, and anthropological methods

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Sara.Till

This chapter from the work "Medicine, Rationality, and Experience: an anthropological perspective" seems to most frequently appear on websites for various Universities and Colleges. Moreover, the work as a whole seems to have been cited several times by subsequent reports further defining patient narration and medical relations.

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Sara.Till

Dr. Ticktin states in her introduction the report came about through both her personal experience with humanitarian efforts & sexual violence treatment and through supplemental studies. Her bibliography reflects this, and includes multiple studies/reports from humanitarian organizations. Additionally, she utilized multiple independent media sources discussing sexual violence in conflicts, the targeting of female populations, and humanitarian efforts within this realm. The bibliography also includes a multitude of research articles from various human rights journals and publications pertaining to female rights during conflicts.

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Sara.Till

This article was meant to highlight the gaps in data available for violence against health care/aid workers in unsecured areas. As such, a large portion of the methods segment is dedicated to discussing the difficulties in locating this data and any patterns in data gaps. The primary method of collection, it appears, was through an initial search for peer-reviewed work that transformed into an accumulation of accounts from media, documentary, and editorial reports. It should be noted that some data is available from various organizations, regarding their specific statistics; however, this mainly tends to focus on larger incidents, such as kidnappings and deaths (as mentioned in the paper). There is also some information available through Aid Workers Security Database, but shortcomings in this area are also heavily noted.

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Sara.Till

Several leaders from various New York State agencies convened to outline plans for this policy. This included Governor Andrew M Cuomo, State Health Commissioner Dr. Howard Zucker, State Police Superintendent Joseph D'Amico, Port Authority Executive Director Pat Foye, and representatives from health care centers and agencies around the state.

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Sara.Till

The article contains quotations attributed directly to the judge, so I would presume she was either present for the ruling or accessed the case brief. This would also be where Ms. Preston could obtain direct quotations from the plantiff's arguments. Additionally, the article includes statements from the EPA, public officials, and Senator Rodham Clinton; these would either be from official public releases or interviews by government personel. 

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Sara.Till

One of the co-founders and current director, Dr. Josiah Rich, began the foundation after realizing the possibilities of treating patients with difficult, life-long diseases in a closed environment. After receiving a 5-year grant in 2002, and inspiration from a recurring patient named Charles Long, Rich began providing basic health care to prisoners in Rhode Island-- specifically focusing on addiction treatments. The foundation began when Dr. Rich and colleague Scott Allen, MD, turned results from this grant into a full-fledged advocacy center. They built on the long-standing tradition of Brown's Warren Alpert Medical School to work in Rhode Island correctional facilities; the inmate population provided an ample source for teaching young physicians, as well as large population well-suited for long-term research studies. While it began as an 5-year study into addiction and incarceration, the Center for Prisoner Health and Human Rights, based in Miriam, has substance abuse rehabilitation clinics, treats HIV/AIDs patients, and studies/treats lifelong infectious diseases such as tuberculosis.