blog 02 Nov 2017
– Clare Chandler – London School of Hygiene and Tropical Medicine

‘How do we get patients to stop demanding antibiotics?’ is a question I have frequently been asked. Not only by journalists trying to get a handle on this latest hot topic, but also by other scientists and policy makers. Taking this question seriously has started several lines of action.

First, it has prompted primary research into the realities of antimicrobial usage, which has quickly shifted from the concept of patient demand to societal requirement. Patients infrequently directly demand antibiotics. In what ways have societies developed materially, economically, even morally, in conjunction with antimicrobials, such that these medicines are needed for the fabric of life to continue? We explore these questions in our empirical research projects AMIS Thailand and AMIS Uganda.

Second, this question prompts reflective practice into the reasons we formulate the problem of AMR around patient misuse of medicines. This follows in the path of other public health programmes that have isolated patient ‘lifestyle factors’ as solutions despite knowledge of societal drivers of diseases such as obesity. And it follows a long-standing discourse of ‘rational drug use’ whereby a ‘right case, right drug, right duration’ ideology can be applied. Science, however, continues to surprise us and AMR is surrounded by scientific uncertainties, including the significance for resistance of short doses of antibiotics taken before a patient feels better. How can truly interdisciplinary research be undertaken to understand the best courses of action, with least negative reaction, to address AMR?

 

Third, these questions pose another: don’t we already have some of these answers? Reviewing social literature revealed that indeed there is substantial social theory that can be applied to thinking about AMR. Such theory can catalyse innovative thinking and help move beyond existing models that constrain our understanding of AMR and potential solutions. This is being demonstrated by the range of strong social research currently being undertaken across the globe. However, much of the relevant literature is in books or not easily found online, and can be intimidating for those without a first degree in the social sciences, it seemed important to make this literature more visible and legible to a broad range of researchers and decision makers. It also seemed useful to profile high quality ongoing social research on AMR in order to draw connections and anticipate outputs. And so, the AMIS Hub online resource was born. Through the website, we connect readers with ‘Essential Reading’ , which we summarise to illustrate relevance to AMR; we help to frame these in terms of bodies of work through our ‘Themes’ ; and we provide connections with the ‘People ’ doing the latest social science in AMR in an exciting range of projects around the world.

Today as our new AMIS Hub website goes live, I am thrilled that this idea has come into being. I hope we generate new connections both conceptually and collegiately, and push beyond traditional boundaries and framings to address this important issue for the health of humans, animals, and our globe.

As this is our first commentary, and there has been a huge effort getting to today, I would like to note my gratitude to the whole AMIS programme team – in Thailand, Uganda and London , especially Bianca D’Souza, Laurie Denyer-Willis and Pat Ng who have done all the hard work in getting this live, and to our photographers in Thailand and Uganda whose photos make the site so captivating. Thank you!