Brown, N., Buse, C., Martin, D., Nettleton, S., and Lewis, A. (2020) Findings Report January 2020 – Pathways, Practices and Architectures: Containing Antimicrobial Resistance in the Cystic Fibrosis Clinic (PARC). York: University of York. 48772_Final Report PARC_v5 (3)
Brown, N., Buse, C., Lewis, A., Martin, D., & Nettleton, S. (2019). Interim Key Findings Summary October 2019 – Pathways, Practices and Architectures: Containing Antimicrobial Resistance in the Cystic Fibrosis Clinic (PARC). York: University of York. 47292_InterimFindings_v6 (3)
Brown, N., Buse, C., Lewis, A., Martin, D., & Nettleton, S. (2019). Pathways, practices and architectures: Containing antimicrobial resistance in the cystic fibrosis clinic. Health. https://doi.org/10.1177/1363459319866894
Abstract: Antimicrobial resistance and the adaptation of microbial life to antibiotics are recognised as a major healthcare challenge. Whereas most social science engagement with antimicrobial resistance has focussed on aspects of ‘behaviour’ (prescribing, antibiotic usage, patient ‘compliance’, etc.), this article instead explores antimicrobial resistance in the context of building design and healthcare architecture, focussing on the layout, design and ritual practices of three cystic fibrosis outpatient clinics. Cystic fibrosis is a life-threatening multi-system genetic condition, often characterised by frequent respiratory infections and antibiotic treatment. Preventing antimicrobial resistance and cross-infection in cystic fibrosis increasingly depends on the spatiotemporal isolation of both people and pathogens. Our research aims to bring to the fore the role of the built environment exploring how containment and segregation are varyingly performed in interaction with material design, focussing on three core themes. These include, first, aspects of flow, movement and the spatiotemporal choreography of cystic fibrosis care. Second, the management of waiting and the materiality of the waiting room is a recurrent concern in our fieldwork. Finally, we take up the question of air, the intangibility of airborne risks and their material mitigation in the cystic fibrosis clinic.
Brown, Nik (2018) ‘The “biotic politics” of buildings – a SATSU research agenda‘, EASST Review 37(2) (https://goo.gl/FKWH2f).
Excerpt: There’s a hospital in Skane, just outside Malmo Sweden. Some of you might know its distinctive spherical, doughnut shape. It’s one of a ‘new generation’ of hospitals commissioned and built for what’s described as the ‘post-antibiotic’ era. Its cylindrical ring-like shape is a little like that of an organic orbicular cell. Historically many hospitals have been modelled on a different kind of body. The cruciform or crucified shape. Limbs radiating from a central torso or spine. Or they have ‘wings’ that fan out from the body of the building. That’s why most hospitals have these improbably long central corridors, with wards and departments stretching out from the building’s central spine, or trunk.
Brown, Nik and Sarah Nettleton (2018, in press) ‘Economic imaginaries of the Antibiosis: Between “economies of resistance” and the “resistance of economies”’. In: Hinchliffe, S., Chandler, C., Chuengsatiansup, K. & Lambert, H. (eds) Anti-biosis? Interdisciplinary Approaches to Microbe-Human Relations (London: Palgrave Communications – Nature, 4).
Abstract: This paper seeks reports on the way economic principles, formulae and discourse inform biological research on antimicrobial resistance (AMR) in the life sciences. AMR, it can be argued, has become the basis for performing certain forms of ‘economic imaginary’. Economic imaginaries are ways of projecting and materially restructuring economic and political orders through motifs, metaphors, images and practices. The paper contributes to critical social science and humanities research on the socio-economic underpinning of biological discourse. The performance of economy in this context can be seen to follow two key trajectories. The first trajectory, discussed at length in this paper, might be described as ‘economies of resistance’. Here the language of market economics structures and frames microbiological explanations of bacterial resistance. This can be illustrated through, for example, biological theories of ‘genetic capitalism’ where capitalism itself is seen to furnish microbial life with modes of economic behaviour and conduct. ‘Economies of resistance’ are evidence of the naturalisation of socioeconomic structures in expert understandings of AMR. The methodological basis of this paper lies in a historical genealogical investigation into the use of economic and market principles in contemporary microbiology. The paper reports on a corpus of published academic sources identified through the use of keywords, terms, expressions and metaphors linked to market economics. Search terms included, but were not limited to: ‘trade-off’, ‘investment’, ‘market/s’, ‘investment’, ‘competition’, ‘cooperation’, ‘economy’, ‘capital/ism’, ‘socialist/ism’, etc. ‘Economies of resistance’ complements a second distinct trajectory that can be seen to flow in the opposite direction from biology to economic politics (the ‘resistance of economies’). Here, economic imaginaries of microbial life are redeployed in large-scale debates about the nature of economic life, about the future of the welfare state, industrial strategy, and about the politics of migration and race, etc. ‘Economies of resistance’ and the ‘resistance of economies’ are not unrelated but, instead, they are mutually constituting dynamics in the coproduction of AMR. In attempting to better understand this co-production, the paper draws upon literatures on the biopolitics of immunity in political philosophy and Science and Technology Studies (STS).
Brown, Nik (2017) ‘Anatomospheres: a ‘respiratory politics’ of buildings and breath‘, Discover Society DS/47 (https://goo.gl/AVvzqV).
Excerpt: I’m sat with a clinician. She’s a lung infection specialist. We’re talking windows. Whatever clinic I go to, the conversation always returns to the windows. Windows that don’t open. Windows that can’t be closed, or let in a draft. Windows that need replacing, or windows that were better before being replaced. The irony isn’t lost on me. A respiratory specialist talking about the breath of the building. The breeze coming in. The hospital air moving out. In and out. Inhalation and exhalation. The clinic gasping for breath. All a reminder of the window’s early meaning, vindauga, the ‘wind-eyes’ of the building.
Brown, Nik and Sarah Nettleton (2017) ‘Bugs in the Blog: Immunitary moralism and Anti-Microbial Resistance (AMR)‘, Social Theory and Health 15(3): pp. 302-322 (https://doi.org/10.1057/s41285-017-0030-9).
Abstract: This paper examines social theoretical literatures on immunity in the context of contemporary biopolitical debates about antibiotics and antimicrobial resistance (AMR). An exploration of contributions to the online forum ‘Mumsnet’ about antibiotic use and AMR serves as an empirical anchorage to these literatures. Five themes emerge from these data: ‘temporal constraints and technological fixes’, ‘restorative bodies’, ‘spatial othering’, ‘moral accountabilities’ and ‘domestic immunitary environments’. We offer the concept ‘immunitary moralism’ to capture the way antibiotics prompt moral reflection on immunity, biopolitical citizenship, bodily integrity and communal probity. We reveal how the moral politics of blame and immunitary othering are present in online debates about AMR, and explore the way these registers resonate with writings in biopolitical philosophy on the ascendency of immunitary individualism and tensions between community and immunity (communitas and immunitas).
Brown, Nik and Sarah Nettleton (2017) ‘”There is worse to come:” The biopolitics of traumatism in Antimicrobial Resistance (AMR)‘, The Sociological Review 65(3): pp. 493-508 (https://doi.org/10.1111/1467-954X.12446).
Abstract: This paper reflects on the different futures and imaginaries constructed through the politics and policy of antimicrobial resistance (AMR). We examine the role of catastrophism, trauma and notions of ‘resistance’ expressed at different moments in the development of the AMR debate. The paper focuses on a number of imaginaries in the politics of AMR, particularly a characterisation of Britain as the ‘sick man of Europe’ or the ‘British disease’ and, more recently, the catastrophist prospect of a ‘return to the dark ages of medicine’. We draw upon recent writing in biopolitical philosophy on immunity and autoimmunity, particularly in the work of Derrida and Sloterdijk, to interrogate immunitary politics of AMR at the intersections of the human and the microbial.