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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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Sara.Till

Dr. Knowles discusses the role and nature of investigations after disasters, particularly in regard to engineering and structural aspects. He primarily draws parallels between the delayed and botched engineering investigations after 9/11 and several similar historical disasters. Dr. Knowles contends these investigations can drastically effect how the public interprets disaster response; yet, it is often overlooked by officials until demanded by public outcry.

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Sara.Till

Didier Fassian is a french anthropologist and sociologist with extensive global field work. He currently teaches as a professor in the School of Social Science in the Institute for Advanced Study. Fassin, although trained as an internal medicine specialist, focuses the vast body of his publication and research focuses on the intersection of the State, justice, and humanitarianism.

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Sara.Till

Emily Goldmann, PhD, MPH: current assistant research professor at NYU College of Global Public Health, Dr. Goldmann researches environmental and social determinants of mental health conditions. Formerly employed by NYC department of Health and mental Hygiene in the Bureau of mental Health, Dr. Goldmann focused on surveillance of psychological distress, serious mental illness, and psychiatric hospitalization of New Yorkers following Hurricane Sandy.

Sandro Galea, MD, MPH : a canadian/american board-certified emergency physician, Dr. Galea is currently the Dean of BU School of Public Health and former Chair of the Department of Epidemiology of Columbia University's Mailman School of Global Public Health. His particular research includes social production of health within urban populations, and especially notes psychological and mental health disorder prevalence within vulnerable populations, including mood-anxiety disorders and substance abuse. He also has participated in multiple committees and boards analyzing effects of mass trauma in the wake of international conflicts and disasters such as Hurricane Katrina, Iraq/Afghani wars, 9/11, and sub-Saharan Africa  conflicts.

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Sara.Till

The film centers around Camp Lejuene, a Marine Corps base in Jacksonville, North Carolina. The camp experienced contaminated water from about 1957 to 1987; the wells contained 240-300 times the allowed amount of volatile organic materials. The film follows the struggles of individuals who lived in Camp Lejuene during this time to receive information, compensation, and recognition for what they experienced. While many individuals are interviewed and discussed, the film specifically focuses on Jerry Ensminger, a former Marine Corps Master Sgt. for almost 25 years. Ensminger lost his daughter, Janie, to pediatric leukemia while living on the base. He is one of many parents and former residents who were directly effected by the contaminated water. The VOM's in the water included TCE, PCE, and benzene, all known to cause cancer and childhood defects.  

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Sara.Till

1) Current criteria surrounding clinical depression: While most of us hold an idea of what depression is, physicians have been given the task of specifically categorizing this nuanced disease. Also called "major depression", clinical depression is the prolonged sensation of low mood during almost all times/activities. These sensations must be present for at least 2 weeks and be persistent across daily activity in order to be considered major depression

2) CBT: Cognitive behavioral therapy is the current widely used model for psychosocial intervention. It focuses on the patient developing coping strategies to aid in emotional regulation, curb unhelpful cognitive patterns, and seek personal solutions

3) Vignette: Never heard of this word before. The term originally referred to small, pleasing sketches, views, engravings, photographs, or illustrations. However, the term is used here to describe a story of patient care. The quick snap-shot is a far-cry from the typical encyclopedia given to health care providers about a patient; it acts as a small, short tale depiction of the scenario, the intervention used, and the outcome. 

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Sara.Till

Individuals who have been involved in a traumatic event are considered a vulnerable population, especially those who have been involved in something like a sexual assault. Those who have been victimized often have very little knowledge of the services available to them or the nuances of the systems with which them must interface. Thus, these individuals (after coming off a severe emotional and physical trauma), must then navigate a complex system that often feels biased towards the accused. This report summarizes their experiences and the shortcomings of this system. 

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Sara.Till

1) Fukushima's nuclear safe guards followed the current accepted nuclear regulations. In addition to having back-up generators and short-term batteries to support the reactors during power failure, ownership had extensive emergency plans for tsunamis. These were executed and creative solutions were utilized with necessary. This then begs the question as to how such a well-prepared facility experience massive devastation.

2) Japan is known to be a first-world nation constantly innovating and exploring new technology, with an advanced economy and high emphasis on education. Dr. Schmid refers to members of the Japanese government as "scientifically trained, technologically savvy elites." While Dr. Schmid acknowledges nuclear energy to still be a murku field, Japanese officials represent the individuals most capable of making informed, knowledgeable decisions about nuclear facilities. This only further emphasizes her assertion that a set, elite organization needs to be created to handle nuclear emergencies.

3) While several organizations exist to discuss nuclear power on an international level, there is no entity which serves as a governing body over nuclear facilities. Nuclear emergencies very quickly spread from single-nation disasters to international events. Although there are many internationally recognized policies and guidelines, there is no body to ensure these are followed. Moreover, no single nation or organization at the present time has the fiscal capabilities or specialized knowledge to aid during nuclear disasters. 

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Sara.Till

Currently, BSVAC survives on state and community funding. However, as recently as 2014 the agency was being funded by the Commander's pension and funds from re-mortgaging his home. At present time, BSVAC has also received a check from Councilman Cornegy for their timely, professional response to violent crimes involving police officers and for general service to the community. As it stands, BSVAC runs on a budget of approximately 250,000 per year, mostly through donations and legislative grants.