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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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Sara_Nesheiwat
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This film appeals to the viewers from an emotional aspect. The documentary follows a family and is told from the father's perspective, a student from Wisconsin. It shows a first person experience of what it was like to deal with this situation and the climate and magnitude of the situation in Liberia. The documentary isn't scientific or statistics heavy. Rather it has testimony from natives of the area and footage of bodies and the lack of hospital effectiveness and government protocol. The stories and narratives from locals is what really captures the attention of viewers and accurately portrays the hardships faced. There were a few parts at the end where numbers of those infected were mentioned, yet the the narrator's account of what occurred as well as other local's stories is what really drives home the point of anguish and despair seen during those hard times in Africa. 

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Sara_Nesheiwat
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"Although violence directly affecting health service delivery in complex security environments has received a great deal of media attention, there is very little publically available research, particu- larly peer-reviewed, original research."  

"Overall, it is important to understand the perspectives of per- petrators in order to find solutions that enable effective delivery of health services "

"Key challenges in addressing violence affecting health service delivery in complex security environments include a lack of health- specific, accessible and comparable, gender-disaggregated data and sufficient data on perpetrator motives. "

"According to workshop participants, in some cases the lack of gender-disaggregated data may be partly due to attempts to protect the confidentiality of victims. "

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Sara_Nesheiwat

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Sara_Nesheiwat
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As mentioned, this site offers data on long term health afflictions of those exposed to 9/11. Yet the site also offers information about the participants in the registry. How they were selected, how many people are entered in the registry and where their exact locations were during the attacks. On top of providing data on the participants, the site also offers information on funding, as well as access to annual reports addressing the health impacts of 9/11. The site also gives access to those that the registry works with and collaborates with. The history behind the registry and the attacks are also provided. Sources for all data and a full bibliography is also available along with information about legal aspects of the health and compensation act, enrollee's confidentiality and thousands of other resources. 

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Sara_Nesheiwat
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I researched the current law and statues on immigration and health care/illness in other countries aside from France. I wanted to be able to understand how France's policies compared to our own, as well as America's policies versus other countries. I also researched the immigration protocols in France, both going and coming. Along with this, I also wanted to learn more about their current healthcare system, what they can offer, how advanced they are and compare it to America, to help put it into context. I also wanted to research how their health system works, as well as any protocols they follow in terms of public health. 

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Sara_Nesheiwat
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The main focus of this article was on chronic disaster syndrome, or the psychological and physiological effects generated by the disruptions caused by a disaster, or specifically in this article, Hurricane Katrina. The effects of long term stress related to loss of family, shelter, community and jobs are analyzed. In this article individual suffering based off chronic trauma and long term displacement, disaster capitalism tied to social welfare and the ways the displacement function within the disaster capitalism are discussed in this article.  

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Sara_Nesheiwat
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The authors are Emily Goldmann and Sandro Galea. Emily Goldmann is a PhD, MPH, and assistant research professor of global public health at the College of Global Public Health at NYU. Her work focuses on social and environmental determinants of mental health consequences of health events such as strokes. She has an interest in epidemiology and she studied economics and Mandarin as an undergraduate at Columbia University and got her Masters and PhD in epidemiology from University of Michigan.

Sandor Galea is an MD, MPH and DrPHD. He is the Dean at Boston University School of Public Health. He has worked at the University of Michigan and New York Academy of Medicine. His works centers around the social production of health of urban populations and he focuses on the causes of brain disorders. Both very public health oriented.