Social-Cultural Approaches to Microbial Life in an Era of Antimicrobial Resistance

我们生活在一个新出现的传染病、多重耐药感染以及合成生物学等新的科学领域和实践正在打破关于我们如何思考和接触微生物生命形式的长期假设的时代。特别是，抗菌素耐药性是当代许多健康挑战之一，它正在揭开现代医学和现代生活的想当然(Hutchinson，2016)。据预测，到2050年，耐药性感染的速度不断增加，每年可能导致多达1000万人死亡(O‘Neill，2016)。抗生素耐药性通常被认为是科学或技术术语(Smith，2015)。但ABR既是一个技术和生物问题，也是一个社会和文化问题。20世纪70年代，社会学家Tanya Stiver指出了患者压力和开处方的文化规范如何影响全科医生诊所的抗生素使用和健康结果(Stiver，2007)。最近，人类学家和社会学家已经超越了全科医生诊所，研究了医疗文化在医院环境中塑造ABR的作用，以及在低收入国家推动ABR的社会文化动态(参见Broom等人，2016；Roess等人，2015)。这一奖学金的目的是在我的博士和博士后研究期间所获得的知识和经验的基础上，对这一当代生物社会复杂和变化时刻的社会层面进行概念性的描述，并制定一项方法论议程。作为这一奖学金的一部分，我将追踪当代生物社会时刻的变化轮廓。我将阐明社会创新如何以及为什么重要。解决ABR的主要方法往往侧重于技术解决方案，包括新的和更好的药物以及改进的诊断方法。但这种方法没有认识到，技术创新总是在社会背景下发挥作用。例如，我们开始看到，诊断测试--旨在导致更好的诊断和更明智地使用抗生素的关键技术工具--正在与不同的护理模式和社会压力交织在一起，这种方式促进了它们的过度使用，并且可以复合而不是帮助应对ABR挑战(Ledingham等人，2018年)。通过开发一份面向科学的报告，我还将概述如何利用不同的社会科学方法来应对ABR挑战。仍然有一种倾向，即将社会科学定位为主要关注获取信仰和社会观点。但信仰和意见很少能无缝地转化为实践。这是因为，当信仰和意见遇到社会和文化规范和背景的厚度时，它们是不同的。这是一个积极的工作方案，在整个研究金过程中，我将与研究最终用户和不同的利益攸关方接触，包括世卫组织欧洲和致力于应对ABR挑战的科学家。我将组织一次日活动，将来自SWDTP以及非学术机构的科学家和社会科学家聚集在一起，以探索社会科学家和科学家如何在ABR挑战中以试验性和新的方式合作和合作。

We live in a moment where newly emerging infectious diseases, multi-drug resistant infections and new scientific fields and practices such as synthetic biology are unravelling long held assumptions about how we think about and engage with microbial life forms. Antibacterial resistance in particular, is one of a number of contemporary health challenges which is unravelling the taken-for-grantedness of modern medicine and modern life (Hutchinson, 2016). By 2050 it is predicted that increasing rates of drug reistant infections may contribute to as many as 10 million deaths per year (O'Neill, 2016).Antibacterial resistance is often thought of in scientific or technical terms (Smith, 2015). But ABR is as much of a social and cultural issue as it is a technical and biological one. In the 1970s the sociologist Tanya Stivers pointed to the ways in which patient pressure and cultural norms of prescribing shape antibiotic use and health outcomes in the GP clinic (Stivers, 2007). More recently, anthropologists and sociologists have moved beyond the GP clinic and have examined the role of medical culture in shaping ABR in hospital settings and the social-cultural dynamics that drive ABR in low income countries (cf Broom et al, 2016; Roess et al, 2015). The aim of this fellowship is to build upon the knowledge and isnights that I have gained during my PhD and postdoctoral research and to develop of a conceptual account of, as well as a methodological agenda for engaging with, the social dimensions of this contemporary moment of biosocial complexity and change.As part of this fellowship I will trace the shifting contours of the contemporary biosocial moment. I will map out how and why social innovation matters. Predominating approaches to tackling ABR often focus on technological solutions including new and better drugs as well as improved diagnostics. But this approach fails to recognise that technical innovations are always put to work in a social contexts. We are beginning to see, for example, that diagnostic tests - key technological tools designed to result in better diagnosis and the more judicious use of antibiotics - are intersecting with different care models and social pressures in ways which facilitate their overuse and which can compound, rather than help to tackle, the ABR challenge (Ledingham et al, 2018).Through the development of a science-facing report I will also outline how different social science methods can be brought to bear on the ABR challenge. There is still a tendency to position social science as being primarily concerned with accessing beliefs and social opinions. But beliefs and opinions are rarely translated seamlessly into practice. This is because beliefs and opinions are diffracted as they encounter the thickness of social and cultural norms and contexts.This is an engaged programme of work and throughout the course of the fellowship I will engage with research end users and diverse stakeholders including WHO Europe and scientists working to address the challenge of ABR. I will organise a day event drawing together scientists and social scientists from across the SWDTP as well as non-academic bodies in order to explore how social scientsts and scientists might work together and collaborate in experimental and new ways on the challenge of ABR.