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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?

1. "But with every explosion that shook the Japanese plant it became clearer: there was nobody -- not in Japan, nor Russia, nor the United States -- who had the relevant know-how, equipment, or strategy to handle a nuclear disaster. No international nuclear emergency response group exists today." pg 194

2. "But in the interest of sustainable, socially legitimate solutions, arguably deisions about even the technical responses to disasters should not be left to scientists and engineers alone." pg 196

3. "While national and international disaster relief organizations have refined their response techniques over the past decades, nuclear emergency preparedness and response has hardly gained traction." pg 200

Per Bech - Danish Psychiatrist who provided the author with a story about a patient of his. He is an innovator in clinical psychometrics. 

Journal of the American Medical Association - in 1992 published an article about giving weight to the combination of doctor's experience and biological plausibility. 

Hellmuth Kaiser - a teacher to the author and taught him about fictional cases portrayed on stage. 

Oxford University Press - began publishing a journal devoted to case reports of patients. 

New England Jounrl of Medicine - opened an issue with a case history to highlight patient experience. 

Lone Lindberg - coauthor for Dr. Bech, point out that spontaneous recovery from depression late in life is rare

Leston Havens - psychoanalyst - uses an interesting approach with his patients

"The outside world's response to Haiti's continuing cholera epidemic offers a revealing window on this disheartening dynamic"

"The source [of cholera] is clear to public health experts: Cholera was brought to Haiti by Nepalese soldiers quartered in a United Nations peacekeeping camp that spilled its waste into a tributary of the Artibonite."

"The UN has, thus far, refused to acknowledge responsibility for the cholera catastrophe"

The author uses MSF essays and statistics. She also uses information from the WHO and other analysis frome xperts in the field to help frame her argument. 

The main focus of this film is highlighting the need for proper public health infrastructure as a way to contain the spread of disease. 

There are many people portrayed and mentioned in the film. They discuss issues within governments and insurance companies. They show patients without insurance struggling to get medication and care. As a result, they express issues with access to care and paying for hte care that they receive. They show doctors and the struggles they have with handling patients and those that come in with the ambulance. Nurses and other ER staff are shown as well. They show narratives of several patients in the waiting room and their experience once they do finally make it to a bed. All of these players have a lot of decisions to make, starting with the decision of the patient ot come to this public hospital (possibly because being turned away from others), and ending with a doctor's care and decision whether or not to release patients. 

Emergency response is discussed a lot in this paper with respect to a global level of care. They analyze the current protocols in place that would create a global response and investigate their effectiveness. The need for a more concrete protocol is discussed as most countries exhibit nationalism and self interest that would inhibit them from helping others. 

1. "At the same time, academic research is often communicated in a format that fails to address the critical policy issues facing aid organizations."
2. "Because reporting often focuses on the most serious attacks, such as kidnapping and fatalities, workshop participants stressed that incidents perceived to be less severe, such as threats and obstructions, are more likely to be underreported. For this reason it is important to better understand the impact of perceived threats."
3. "Workshop participants also noted examples of violence linked to situations where the medical treatment provided has not met patients’ expectations or was unsatisfactory in other ways."
4. "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, particularly peer-reviewed, original research. Only thirty-eight articles met the original search criteria outlined in the methods section, of which only eleven contained original research; a further citation search yielded another four original research articles. The remainder was comprised of review articles, commentaries, letters, or analysis based on secondary sources."

1. The Burning of the Capitol Building in 1814 is discussed. Knowles talks about how the burning was investigated by one of the key engineers of the building, Latrobe. He was allowed to investigate without any issues and was ultimately allowed to rebuild. Most Americans, however, viewed the burning as a failure of the military, not the engineer. 
2. The Hague Street Explosion of 1850, which was caused by an exploding boiler and resulted in mass casualties. Investigation and determination of responsibility was carried out by the Coroner's office and police. Media and news reporters also assisted in providing information to the public and attributed the explosion to an overheated boiler, as opposed to an engineering flaw. Jurors listened to expert witnesses in order to determine where the blame could be placed, which ultimately led to the disaster being blamed on all involved in the boiler and factory. 
3. The Iroquois Theater Fire in Chicago that happened in 1903 provides information regarding disaster investigation as well. The fire curtains, shields, and other technology meant to protect the theater from the spread of a fire did not work. Building inspectors came into the city after the disaster to investigate along with architects and other commissioners. It was found that the theater (along with many others in the city) had many building code violations, which called into question the integrity of the entire building code system in Chicago. One of the nation's foremost authorities on fireproof construction, Ripley Freeman, conducted an extensive investigation with financial support from an elite man in Chicago. This marked a new era in history of disaster investigation in the US.