I took my daughter to the general practice the other day. She has a swelling knee that looks infected. We waited a short time and then we were called in. The doctor examined it and confirmed our fears. He then shifted to offer a prescription. And did something I’ve never seen before but completely appreciated! He noted that the computer said she had a serious egg allergy. This was something from a very long time ago and is definitely not true for her. In discussion with us we agreed it should come off and he removed it from the medical record.
This is the first time I have seen this happen in practice. I thought he managed it beautifully.
As someone from the National Institute of Health and Care Excellence told me at their conference in 2010 penicillin allergy has become a major issue for anyone still battling antimicrobial resistance in the National Health Service. Hopefully it’s happening in many more places all over the country, as many of these ‘allergies’ are not valid. In a letter to Clinical Medicine, published last week, leading AMR specialists called for this to happen much more often. They noted that it has recently been shown that in low risk patients a direct oral challenge is usually safe. Having those allergies on your record might mean you did not take penicillin when you needed it, which is terms of antimicrobial resistance is often disastrous, leading to more use of ‘last ditch’ antibiotics.
Moving back to social science theory, the story about the food or drug that you might be allergic to, is a story about the human relationship with an object. An allergy is often conceived of as a bad thing, but in practice it’s the relationship not the thing that is bad. As Mol reminds us, technologies can be read as a text. So an antibiotic may be both a good and a bad relationship depending on the people taking it, their circumstances, and the specific drug. Mol writing in talks about a ‘politics of what’ replacing the ‘politics of who’ that she associates with Foucault’s work. Her more recent ethnographic work of eating shows that nutritional advice can work hard to avoid critical confrontation, and accept the possibility of ‘situated knowledge’. They hope to support such efforts which are perhaps the public health equivalent of clinical sensitivity, to ‘strengthen and sharpen the theoretical creativity of our informants and help their insights to travel beyond their daily practices’ (p306). For example, they note that while the Zimbabwean bush pump waters a community, other products and practices are designed to support the individual, such as personal water filters.
This is a great example of a product meaning different things to different people. As Mol observes in her work with De Laet on the Zimbabwean bush pump, a pump aligns with a community. Other products, like filtration straws, are tailored to the individual. And of course this takes us back to antibiotics, which may create allergies in some, but be perfectly safe for others.
About the author: Catherine Will is Reader in the Sociology of Science and Technology (Sociology and Criminology) in the School of Law, Politics and Sociology at the University of Sussex.