Paper short abstract:

The objective is to contribute new insights on the intra- and inter-professional responses to, and dynamics within, an emerging jurisdiction of the medical profession, related to not only individual patients’ health problems but also global health problems such as antimicrobial resistance (AMR).

Paper long abstract:

This paper examines how professional medical practices govern and control current prescription of antibiotics in Danish primary care and how notions of 'good doctoring' may be relevant for understanding the handling and care of patients. Focus is on changing jurisdictions (Abbott 2005), normative registers of health care practices and transformative capacities of diseases in clinical settings (Mol 2009; Mol and Law 2004). Drawing on qualitative in-depth interviews with general practitioners (GPs) and abductive analysis (Tavory & Timmermans 2014), we explore professional practices of 'prudent use' of antibiotics. It is examined how GPs maintain a professional etiquette to distance themselves from the potential controversial case management (Armstrong & Ogden 2006) and how they manage dilemmas in clinical practice if and when decisions about antibiotic prescriptions cannot be based on facts about molecular conditions. By four trajectories (daily care; guidelines and 'wait and see' prescriptions; non-medical factors; attitudes towards professional engagements with antibiotic usage) the theoretical view of the intertwined nature of social and technical dimensions is followed. It is argued that jurisdictions are not purely made up of 'social stuff' such as identities, issues of control and authority but also by the normative conflicts that unfold around how a disease and the actual treatment with antibiotics matters between professional occupations, patients, standards, codes, measurement and techniques. Intra- and inter-professional responses to, and dynamics within, an emerging jurisdiction of the medical profession are demonstrated in relation to not only individual patients' health problems but also global health problems such as antimicrobial resistance.

Paper short abstract:

This paper explores the co-production of knowledge on Antimicrobial Resistance between the media and the public in the United Kingdom. The aim is to better understand the ‘scientific’ knowledge uptake by the media and the public and how to deal with public controversies and public learning

Paper long abstract:

Both 'scientific' and 'non-scientific' literature present different versions on factors that contribute to the definition of Antimicrobial Resistance (AMR). Not only is AMR an issue of scientific complexity and conflicting interests, it is also an issue of uncertainty, in which risk perceptions of various actors are affected by different truth claims on what makes AMR. This paper explores the present media discourse and the publics 'scientific' understanding of AMR in the UK. A document analysis study has been performed by the researcher on the construction of AMR in UK media sources (newspapers, online newspapers and twitter) published between 2012-2015. By using a discourse analysis of written documents, the first part of this study analysed how the debate on AMR by the media was framed, whose definitions got communicated and which stakeholders were blamed. The second part analysed online comments of the public on these media sources to gain knowledge on how the public constructs AMR and what events covered in the media affected the publics sense of reassurance and thrust. These insights can be used to study uncertainties and controversies concerning AMR beyond the established factors and 'scientific facts' on AMR listed by the official actors, which provides new lines of research. The discussion on AMR is an ongoing process reducible neither to parliamentary politics, biomedical science, media or the public. This paper will serve as a point of departure to further explore how these multiple ontological realities of AMR are produced, how they co-exist and how interfere with each other.

Paper short abstract:

The paper focuses on public health initiatives to reduce antibiotic use among different publics, exploring the ways such initiatives work on people’s attachment to or desire for medication, and the possible contradictions in encouragement to value antibiotics and to avoid them.

Paper long abstract:

Public health concerns about antimicrobial-resistant bacteria have led to efforts to engage different publics with antibiotic stewardship - practices for conserving the current stock of antibiotics and reducing the growth of resistance by ending 'inappropriate use'. This paper critically examines a range of strategies through which stewardship initiatives try to work on users' attachments to antibiotics as an effective health technology. Drawing attention to the ways in which different human sciences (marketing, psychology, economics) are invoked to frame versions of the antibiotic user or subject, the paper will also explore the object politics of antimicrobial resistance, considering how viruses and bacteria are produced as manageable or mundane threats, while antibiotics may be re-imagined or made as ineffective and even dangerous. In many ways the stewardship initiatives examined here reprise familiar problems from public health, for example with the relationship between knowledge and action, or individual and social responses to risk, however they also struggle with the possible contradictions contained in encouragement to value antibiotics and to avoid them. The paper thus seeks to contribute to STS discussion of the issue of antimicrobial resistance, public health responses and understandings of public engagement.

Paper short abstract:

What could we learn by following antimicrobials as objects that might not otherwise be considered in the core knowledge-collectives emerging around antimicrobial resistance (AMR)? Social scientists can help make collective sense of the challenge of AMR by anticipating potential future controversies.

Paper long abstract:

Antimicrobial resistance (AMR) is increasingly described as a grand social challenge and social scientists are called upon to apply their particular skills to help societies figure out how to address it. At one level, the rise of AMR can be understood as a natural outcome of micro-organisms evolving resistance to various antimicrobial agents that humans have used to inhibit or destroy them. But a central part of this narrative is the role of human behaviour in squandering a precious technology through patterns of systemic misuse. Assuming that social scientists are willing to engage in the task allocated to them of understanding behaviour, how far and how deep could we go in this enterprise? We might stick with the problem of AMR as it has been defined by the dominant knowledge-collective as one associated with antibiotic use, transmission of antibiotic-resistant bacteria and their clinical implications. Or, we might also follow lines of inquiry that are emerging at some distance from this core collective, examining the unruly relationship between clinical antibiotics and a broader variety of antimicrobial agents within multiple environments of concern. We might even discover domains of antibiotic and other antimicrobial use (current and future) that are yet to be subjected to much scrutiny. Building on the concept of anticipation which has so far been applied mainly to emerging technologies, I explore the implications of attempts to follow antimicrobial objects for the future of AMR as a social-material challenge.

Paper short abstract:

The paper aims to investigate conflicting enactments of the bacterium Streptococcus group A and risk in a medical debate on the national guidelines for management of throat infection in Sweden. It is argued that these conflicting enactments draw on different microbiopolitics, which makes the conflict endure.

Paper long abstract:

In the autumn of 2013 a number of articles, warning for the spread of a "flesh-eating" "murder bacterium" were to be found in the Swedish newspapers. One article stated: "a lethal flesh-eating bacterium is currently spreading with an alarming speed in northern Stockholm".

While the flesh-eating bacterium seems as a caricature of the evil germ, a more positive approach towards bacteria has won ground over the last decades, both in news media and science. For example Ingram (2007) argues that we need to positively embrace the relationship between human and bacteria. In the STS-field the relation between microbes and human beings has been used to rethink the boundaries of the (human) organism, as well as the human position and place in the world and ecosystem.

In this paper the bacterium streptococcus group A takes the title role. This is the bacterium the alarming news described above - the flesh eating murder bacterium - but it is also the bacterium that causes mundane infections like bacterial tonsillitis (strep throat). This paper aims to investigate conflicting enactments of the bacterium Streptococcus group A and risk in a medical debate on the national guidelines for management of throat infection in Sweden. It is argued in the paper that these conflicting enactments draw on different understandings of the relations between the human and the microbial world - different microbiopolitics (Paxon 2008) - and that this is what makes the conflict endure.

Paper short abstract:

Drawing on ethnographic data of a transnational microbiome study and contributing to debates within medical anthropology and decolonial studies, this paper examines how human microbiome science is individualising bodies and personalising medicine, producing innovation and reproducing inequalities.

Paper long abstract:

The human microbiome has been described by scientists and popular science literature alike as "our second genome", that is, as a primary "source of genetic diversity" (Grice and Segre, 2012). From a social sciences angle, the microbiome destabilises and deconstructs ontologies and epistemologies of the body as a singular entity in which microbes are antithetical to human life and wellbeing. Yet ethnographic research into what we might call a 'biosocial' (Ingold and Palsson, 2013; Meloni, 2014) understanding of multispecies ecologies remains limited. A contemporary example of a microbiome research in the Peruvian and Brazilian Amazon exploring lifestyle and socio-cultural values in relation to health and disease illuminates the ways in which the production of knowledge and the choice and assemblage of biotechnologies is shaping bodies. Against the medical anthropologists Margaret Lock's and Vinh-Kim Nguyen's (2010) view of biomedicine and biotechnologies as knowledge-practices of bodily standardisation, we argue that microbiome research signal towards the individualisation of bodies in (Western) clinical practice. Contrasting a classical biopolitical tool such as the Body Mass Index (BMI) with individual microbial profiling for the development of personalised probiotics, we sustain that while the passage from standardisation to individualisation of bodies does not have a consolidating meaning, it is nevertheless an indicative move in contemporary biomedicine. Examining the tensions between inequalities and innovation associated with the individualisation of microbiome clinical practice (predominantly in Northern regions), this paper will then consider the ways in which the social sciences and humanities might reconfigure the 'biosocial' character of microbiome science.

Paper short abstract:

Yeast has been our domesticated servant for millennia, but how might we be differently entangled with a radically re-engineered synthetic yeast genome?

Paper long abstract:

Yeast is perhaps one of our oldest companion species, and because of its essential contribution to the production of wine, bread and beer it has been our domesticated servant for millennia. It is also crucial to much industrial biotechnology, and is an important model organism for genetics. In this presentation I examine an on-going attempt to re-design and re-imagine the genome of the yeast species Saccharomyces cerevisiae, by drawing on interviews and lab ethnography.

This large-scale 'Saccharomyces cerevisiae 2.0' project involves constructing a 'neochromosome', and building in the ability to evolve the yeast on demand. The research promises applications like biofuels and better beer, but a central aim is to make a genome that can further biological understanding.

Questions arise about whether this re-design will result in the production of a new species. While the researchers on the project feel that the changes they are making to the genome are 'aggressive', they have been surprised at the tolerance of the yeast. Its 'yeastiness' is maintained.

This idea of 'yeastiness' is my starting point to explore questions about what it means to be entangled with a synthetic, instrumentalized version of this familiar organism, and to ask what, if anything, it can tell us about the engineering of 'life'.