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How science is preparing for antibiotic resistance

Antibiotic resistance: thinking about humans in the environment

Agnès Vernet, Science journalist
On March 16th, 2022 |
3 mins reading time
3
Antibiotic resistance: thinking about humans in the environment
Léonie Varobieff 1
Léonie Varobieff
PhD candidate in philosophy at ANSES and CNRS
Key takeaways
  • Antibiotic resistance raises questions about our relationship with health care, our perceptions of disease, and the position of humans within the community of living beings.
  • When the production of penicillin was industrialised in the 1940s, the use of antibiotics became widespread.
  • However, scientists have known since the discovery of antibiotics that unreasonable use and misuse ultimately threaten their effectiveness.
  • The WHO is now warning of the risk of a post-antibiotic era in which doctors would lack effective molecules.

It may seem sur­pris­ing that phi­los­o­phy is inter­est­ed in antibi­ot­ic resis­tance. How­ev­er, this pub­lic health prob­lem ques­tions our rela­tion­ship with health­care, our rep­re­sen­ta­tions of dis­ease, and the posi­tion of humans with­in the com­mu­ni­ty of liv­ing beings. Mirac­u­lous in terms of effec­tive­ness, we must nev­er­the­less start by recall­ing that antibi­otics are only one ther­a­peu­tic option among oth­ers. Although less spec­tac­u­lar, these oth­er options should not be overlooked.

A political history

In Europe and North Amer­i­ca, approach­es such as sani­tis­ing oint­ments or phages were aban­doned. The lat­ter, which uses dead­ly virus­es against tar­get­ed bac­te­ria, was a par­tic­u­lar­ly devel­oped tech­nique in the Sovi­et world. Its com­plex pre­scrip­tion and par­tic­u­lar logis­tics do not in them­selves explain why it was aban­doned in favour of antibi­otics. The polit­i­cal con­text at the time and the Cold War must also be considered.

The speci­fici­ties of our West­ern cul­ture com­bined with the eco­nom­ic inter­ests of the time favoured the devel­op­ment of antibi­otics. When peni­cillin pro­duc­tion was indus­tri­alised in the 1940s1, mod­ern med­i­cine was hap­py to be able to offer a stan­dard­ised prod­uct that could cure an infec­tion with­in days. The inci­dence of infec­tion-relat­ed deaths fell and antibi­ot­ic use became widespread.

Indus­tri­alised coun­tries have mas­sive­ly export­ed this stan­dard­ised ther­a­py to low-income coun­tries to treat infec­tious dis­eases. Very quick­ly, how­ev­er, coun­ter­feit or under-dosed drugs appeared on the mar­ket, con­tribut­ing to the emer­gence of resistance.

Look­ing beyond eco­nom­ic prof­it, it is our way of under­stand­ing bac­te­ria and our vul­ner­a­bil­i­ties that antibi­ot­ic resis­tance calls into ques­tion. Sci­en­tists have known since the dis­cov­ery of antibi­otics that their unrea­son­able use and mis­use ulti­mate­ly threat­en their effec­tive­ness. How­ev­er, they have been, and some­times still are, admin­is­tered pre­ven­tive­ly to avoid sec­ondary infec­tion, even in patients with­out risk fac­tors, or mas­sive­ly in live­stock until the ear­ly 2000s in Europe2.

Human and vet­eri­nary med­i­cine has long prac­tised, with­out tak­ing into account its envi­ron­ment, even its imme­di­ate envi­ron­ment, neglect­ing the equi­lib­ri­um of the micro-organ­isms (path­o­gen­ic or not) with which we cohab­it. The philoso­pher of biol­o­gy Thomas Pradeu ques­tions these bound­aries between “self” and “non-self’3. Are these terms appro­pri­ate when the pres­ence of these microbes is essen­tial for our survival?

Nev­er­the­less, the vocab­u­lary in the field is vio­lent, using a war­like lex­i­cal that evokes infec­tious agents. Med­i­cine and hygien­ism “fight-against” rather than “deal-with” bac­te­ria, so advo­cat­ing their erad­i­ca­tion in the col­lec­tive con­scious­ness. These rep­re­sen­ta­tions hin­der our curios­i­ty about liv­ing things and our propen­si­ty to seek bal­anced rela­tion­ships in biodiversity.

Facing the crisis

WHO warns of the risk of a post-antibi­ot­ic era, in which doc­tors would lack effec­tive mol­e­cules. The cri­sis is seri­ous, even though it was fore­see­able, even antic­i­pat­ed. « Why have we been blind to it » is the first ques­tion that need to be answered when con­sid­er­ing the phenomenon.

This cog­ni­tive dis­so­ci­a­tion is not unre­lat­ed to our mech­a­nis­tic con­cep­tion inher­it­ed from Carte­sian phi­los­o­phy. When René Descartes depict­ed human­i­ty as being rad­i­cal­ly sep­a­rat­ed from the rest of the liv­ing world in the ear­ly 17th cen­tu­ry, he estab­lished that the pur­pose of acquir­ing knowl­edge is to mas­ter nature, pre­cise­ly for the sake of human health, « which is undoubt­ed­ly the first good and the foun­da­tion of all the oth­er goods of this life« 4.

Although this think­ing has been con­stant­ly chal­lenged by research in ecol­o­gy and biol­o­gy, it remains cen­tral to when it comes to train­ing doc­tors and vet­eri­nar­i­ans. With­out belit­tling it, it does, nev­er­the­less, favour a type of care ori­ent­ed towards “tech­nique” rather than “rela­tion­ship”.

The social sci­ences have shown, how­ev­er, that depend­ing on whether a per­son­’s beliefs are ori­ent­ed towards sci­ence, con­spir­a­cy the­o­ries or scep­ti­cism, his or her behav­iour in rela­tion to antibi­ot­ic pre­scrip­tions will change.

Antibi­ot­ic resis­tance thus rais­es eth­i­cal ques­tions, and prac­ti­tion­ers will have rethink their role as care­givers beyond their tech­ni­cal role as “heal­ers”. It also calls into ques­tion the cur­rent­ly unbal­anced doc­tor-patient rela­tion­ship and encour­ages co-con­struc­tion of care, even in the choice of pre­scrip­tions5.

A car­er is not a car­er if he does not feel cared for by the per­son being cared for, as the psy­chi­a­trist Jean Oury ele­gant­ly put it. Thus, when we expect doc­tors or vet­eri­nar­i­ans to “edu­cate” their patients or clients so that they do not undu­ly demand antibi­otics or use them bet­ter, we mis­un­der­stand what is at stake.

Rebuild­ing our rela­tion­ship with care would there­fore undoubt­ed­ly open the way to more pro­found and last­ing changes in behav­iour than man­age­ment approach­es are capa­ble of doing. Approach­es that are cur­rent­ly being adopt­ed both by insti­tu­tions and by many experts are the best way to respond to the antibi­ot­ic-resis­tance health sit­u­a­tion. More inclu­sive approach­es, such as « One Health« 6 are among the most inter­est­ing soci­etal approach­es to invest in, pro­vid­ed that they go beyond mere win­dow-dress­ing to build a real col­lec­tive philo­soph­i­cal investment.

1André Frogerais, Les orig­ines de la fab­ri­ca­tion des antibi­o­tiques en France, 2015. ⟨hal-01100810v4⟩)
2Les antibi­o­tiques util­isés comme fac­teur de crois­sance n’ont été inter­dits en Europe qu’à par­tir de 2006.
3Edgar­do D. Carosel­la, Thomas Pradeu, L’I­den­tité, la part de l’autre Immunolo­gie et philoso­phie, Odile Jacob Ed., Sci­ences Coll., Paris, 2010.
4René Descartes, Dis­cours de la méth­ode, (1637), Gal­li­mard Flam­mar­i­on, Coll. Philoso­phie, Paris, 2016.
5Pas­cale Molin­ier, Patri­cia Paper­man, San­dra Laugi­er, Sous la dir. Qu’est-ce que le Care ? Souci des autres, sen­si­bil­ité, respon­s­abil­ité, Pay­ot Essais, Paris, 2021.
6https://​www​.poly​tech​nique​-insights​.com/​d​o​s​s​i​e​r​s​/​s​o​c​i​e​t​e​/​a​l​i​m​e​n​t​a​t​i​o​n​-​m​a​l​a​d​i​e​s​-​b​i​o​d​i​v​e​r​s​i​t​e​-​n​o​t​r​e​-​r​a​p​p​o​r​t​-​a​u​x​-​a​n​i​m​a​u​x​-​d​o​i​t​-​i​l​-​e​v​o​l​u​e​r​/​l​e​s​-​z​o​o​n​o​s​e​s​-​m​a​l​a​d​i​e​s​-​p​a​s​s​a​n​t​-​d​e​-​l​a​n​i​m​a​l​-​a​-​l​h​o​m​m​e​-​o​n​t​-​t​r​i​p​l​e​-​d​e​p​u​i​s​-​u​n​-​s​i​ecle/