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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?

The claims are supported by personal interviews/surveys by the author as well as external data from the state and other sources and studies. 

The way that countries and the world address nuclear emergencies is addressed in this article. Currently there is no central international response resources or authority. Because of the rarity of nuclear catastrophic nuclear emergencies, there are few pockets of professionals with field experience with dealing with these types of emergencies. Japan greatly lacked the assistance of these people during this disaster. These things all contribute to a less optimal emergency response. By addressing these issues the quality of response to nuclear emergencies can be greatly increased.

Dr. Kramer refers to various people in various medical cases but redacts their names.

The Journal of the American Medical Association and the medical community as a whole embraced “evidence based medicine” back in the 90s and claimed that individual case stories were inferior, antiquated, and a thing of the past.

Oxford University press and the New England Journal of Medicine started writing case reports embracing stories.

    The article: “Structural Violence and Clinical Medicine” was written by Paul E Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. Paul Farmer is an anthropologist and physician who works professionally as a humanitarian healthcare worker in impoverished nations, physician at Brigham and Women’s Hospital Division of Social Medicine and Health Inequalities, Professor at Harvard University, and cofounder of Partners In Health. Bruce Nizeye is a Director of the Program on Social and Economic Rights. Sara Stulac is a Director of Pediatric Programs at Inshuti Mu Buzima, in Rwanda, and Partners In Health’s deputy chief medical officer. Salmaan Keshavjee is also a physician at Brigham and Women’s Hospital, an instructor at Harvard’s Department of Medicine, and a specialist at Partners In Health on tuberculosis.

                It is important to understand the work of Partners in Health (PIH) is to assist underdeveloped countries build high quality healthcare systems, when talking about the authors’ work.

1) “‘A confusion between humanitarianism and politics–two fundamentally different orders of activity – can only lead to a mutual weakening of both”.

2) “Approaching gender-based violence as a medical or health issue alters how violence is both approached and understood; that is, rather than understanding gender violence in the context of gendered relations of power, or as part of larger histories and expressions of inequality which are inseparable from histories of class or race or colonialism, this type of medicalisation transforms gender-based violence into an emergency illness, requiring immediate intervention.”

3) “Sexual violence elicited a particular form of moral outrage in the MSF report and debate; and the question was how to justify the willingness to condemn the perpetrators in cases of rape more than with other forms of violence or torture. Should women be !C 2011 Blackwell Publishing Ltd. Medicalising and Politicising Sexual Violence 259 treated as special categories of victim, who need more protection? Furthermore, are they the only ones recognised as subject to rape? Should sex and sexual violence be seen as crimes apart, or should they be equivalent to any type of harm or injury in times of war? What is the nature of gender-based violence, and how do we qualify the particular vulnerabilities to it?”

Andrew Lakoff is an Associate Professor of Sociology and Communication at the University of Southern California, Department of Sociology. His disciplines are: Social Theory, Medical Anthropology, and Cultural Anthropology.

Stephen Collier holds a Ph.D in Sociocultural Anthropology at the University of California Berkeley, Department of Department of Sociology. His disciplines are Social Policy, Social Theory, Social Theory, Foucault, and Neoliberalism. He was also Chair and Associate Professor at The New School, Department of International Affairs from 2003-2015.

Although they are not directly involved in emergency response, Stephen and Andrew have written extensively on the social aspects of medicine, especially in disaster scenarios. 

I felt that the extend interview time of Emmanuel Urey’s family in the US did not further any real understanding of the issue and was just an appeal to the viewer’s emotion.

The Iroquois Theater Fire, the destruction of US Capitol Building, and the Hague Street boiler explosion are used as historical examples to support the arguments made in the article as well as the findings of a steel expert who investigated the collapse of the towers.