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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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ciera.williams

This study examined the risk of acquiring Ebola Virus Disease (EVD) by healthcare workers in the setting of general hospitals and isolation units. By looking retrospectively at the Ebola Outbreak in Sierra Leone, the relative levels of risk to healthcare workers were computed and compared. The reasoning for these levels was also examined through interviews of surviving workers and the families/associates/colleagues of the deceased workers. The interviews reviewed common actions (and lack there of) for affected workers. This revealed certain themes that should be visited when reveising/creating hospital infection prevention and control policies.

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ciera.williams
Annotation of

The film provided general facts about MSF and the conditions in Lieria and the Congo, but no detailed medical statisitics. There wasn't any comparison of the issues in this mission versus those on other missions. The film could have included more on the factors that contribute to the diseases themselves, rather than the barriers to treating them. The film also needed more on the exact amounts of supplies that were given relative to what one would have in a clinic elsewhere. 

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ciera.williams

In the aftermath of the hurricane, numerous issues arose for the evacuated citizens of New Orleans.First, the immediate affects of lack of access were apparent, such as lack of schooling, pharmacies, and employment. Then psychological affects appeared as people were told they couldn't return home, even if they were minimally damaged. The combined affects of the physical and mental conditions, combined with the lack of physicians and psychiatrists, led to a massive instability in the people. 

The government further exacerbated this instability by providing limited resources and shelter for victims. More exactly, the resources and shelter were unevenly distributed to the victims, favoring white mid- to upper-class citizens. The funds that otherwise should have gone to essential care facilities and housing, were unseen by the people. Promises of finanicial aid were never fulfilled, and no legislation (such as that in the wake of 9/11) was passed to support victims.

This leads to the creation of "disaster capitalsim" in which private companies benefit from the disaster and state-of-emergency, raising prices and suspending insurance policies. Poor government oversight of the private sector created deficiencies and health crises. 

The article concludes by suggesting the response to Katrina be examined to prevent the same mistakes from occuring in the future. However, there is a lack of optimism, as the system of response is ingrained into American Society. 

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ciera.williams

The article explores the effects of society, politics, and science on the diagnosis/treatment of medical conditions in the wake of Chernobyl's nuclear disaster. The article looks into the complex development of a system of compensation and benefits for victims of the disaster, and how people became dependent on the system for their basic needs.