Knowledge

Research shows that knowledge about ‘appropriate’ antimicrobial use does not equate to following recommendations in practice for clinicians or patients (Chandler et al 2008; Kamat 2006). Nonetheless, when the global community begins to address an emerging health crisis such as AMR, we start from assessment of knowledge and awareness raising activities (Chandler et al 2015; Yoder 1997). What other ways are there to think about and to come to ‘know’ about AMR and antimicrobial use? And why do we so often start with individual cognition?

Social scientists – like natural scientists – want to push the boundaries of knowledge, asking questions about taken-for-granted concepts and truth claims to demonstrate that what often appears as static, singular and fixed, is typically contingent and dynamic. For example, for antibiotics this might involve asking what constitutes and defines the ‘rational’, ‘irrational’, or ‘prudent’ use of antibiotics in different settings? And asking who gets to define these concepts? Thus, rather than starting with questions about human behaviour in antimicrobial use, we may think more widely about our reliance on antimicrobials on a societal level. This also necessarily requires reflection on scientific practices, policy guidelines, legal frameworks and regulations that AMR unfolds and exists within. Here, science, technologies and policies are studied as processes that contribute to defining, organising and acting on the world in particular ways. To do so, involves paying close attention to how a problem is framed, for example the language and metaphors used (e.g. war) may mirror wider societal concerns (i.e. migration) and can reveal what is at stake for whom. This is exemplified in Brown & Nettleton’s article.

Policy-guidelines and scientific studies often attribute the rise in AMR to individual behaviour of doctors, patients, drug sellers and their customers. This makes sense within behaviour models that locate individual human action at the centre. However, how well these models map on to the materialities of microbial, genetic and antimicrobial ecosystems is unclear. One approach to understanding how we have ended up with particular models of biology is tracing a social history of biology, locating dominant narratives in wider context. For example, we learn in Roberto Esposito’s (2011) Immunitas how entwined our visions of microbial life are with our political histories in Europe, and how this has shaped what we have seen as possible anti-microbial measures. Another approach is to delve further into the details of processes through which AMR has written a biology of history as Hannah Landeker has done, depicting how for example mass consumer culture, differences in access and regulation of antimicrobials, and neoliberal market politics have all been inscribed into the biology of AMR. These examples demonstrate how the careful analysis of the context of the co-construction of science and policy of AMR can open up new spaces for knowledge production.

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