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"Antibiotic Resistance in Louisiana"

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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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After finished the program, the students will be award with diploma that is recognized by Haiti government and most of the international rehabilitation organizations. And Handicap International is working with Ministry for Health and Population to let this program gaining more recognitions.

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The final edited version has published via Annual Reviews of Public Health.

“The Annual Review of Public Health, in publication since 1980, covers significant developments in the field of Public Health, including key developments in epidemiology and biostatistics, environmental and occupational health, issues related to social environment and behavior, health services, and public health practice.” [http://www.annualreviews.org/journal/publhealth]

The journal can help the health professionals by exploring not only contents in the sub-sections of Public Health but further more explore other detailed topics with other journal sections such as Medicine, Nutrition etc.

“The mission of Annual Reviews is to provide systematic, periodic examinations of scholarly advances in a number of fields of science through critical authoritative reviews. The comprehensive critical review not only summarizes a topic but also roots out errors of fact or concept and provokes discussion that will lead to new research activity. The critical review is an essential part of the scientific method.” [http://www.annualreviews.org/page/about/our-mission-and-our-founder]

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  1. With the lack of medical centers, there is a lot of cost to invest into the help to these countries. But the main reason is the occurrence of war and instable activities.

“In 2015, MSF provided humanitarian assistance in 69 countries.

Around 54 per cent of activities were carried out in settings of instability. Some 57 per cent of programs were in Africa…MSF spent 1,283 million euros: 82 per cent was spent on humanitarian activities…” [http://www.msf.org/en/article/msf-international-activity-report-2015]

2. There is an urgently need of HIV/TB doctors in the field. [http://www.msf.org/en/work-msf/working-in-the-field]

“MSF provided care for 333,900 people living with HIV/AIDS and antiretroviral treatment for 240,100 people in 2015.” With the lack of appropriate medical educations, many people do not know they have infected with HIV. [MSF international_activity_report_2015_en_2nd_ed.pdf]

3. Close of Programs

“When a violent situation has stabilized sufficiently, and access to health services improves, MSF will close its program.”

“When local or national authorities and organizations have the capacity and motivation to restore and develop a medical system that meets the urgent needs of the population, MSF will withdraw.”

“MSF will close a program when a medical emergency ends.”

[http://www.msf.org/en/msf-activities]

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Cloud9 is built to serve as a bridge between the patients and the physicians (or similar organizations) to communicate on the issue that they are facing. This app has especially designed for improving mental healthcare for existing and unserved populations. It has engaged both parties with interactive/innovative features to profile and serve the patients. The ultimate aim for Cloud9 is to provide an affordable/approachable access to mental healthcare, along with reduce stigma surrounding mental disorders.