Meagher Karen M, Watson Sara, Suh Gina A, Virk Abinash
Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA.
Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA.
J Pers Med. 2022 Aug 12;12(8):1308. doi: 10.3390/jpm12081308.
The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the "right drug, at the right dose, at the right time." Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub "precision stewardship." However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for "the ELSI of precision stewardship." In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.
精准健康时代可能会减少并应对抗菌药物耐药性（AMR）。我们的管理和精准努力共享术语，力求实现“在正确的时间，使用正确的药物，给予正确的剂量”。目前，快速诊断检测、系统发育监测和实时疫情应对只是我们称之为“精准管理”的分子技术进步的几个例子。然而，AMR的因果因素涵盖从分子层面到全球卫生政策层面。与AMR科学的跨部门性质相呼应，探讨AMR的伦理、法律和社会影响（ELSI）的研究跨越了学术领域。随着AMR的兴起，人们越发意识到其道德和社会意义，因此需要一个平行的研究领域。在本文中，我们对这一领域进行差距分析，即提出一个“精准管理的ELSI”议程。在第一部分，我们讨论了美国数十年来在ELSI研究方面的国家投资所取得的成果，这些研究关注人类遗传学的进展。在下一部分，我们概述了与AMR相关的不同ELSI主题。精准管理的ELSI议程的独特性为未来建立管理团队的合作提供了新机会。
