Dr. Luther Bartelt and Dr. Heather Henderson, members of the Institute for Global Health and Infectious Diseases were interviewed as recipients of a new Seed Funding Program in the College of Arts and Science’s Office of Research and Innovation. They are working on the project “Fishy Remedies: A Mixed-Methods Study of Self-Medication with Fish Antibiotics, Socioeconomic Inequality, and Medical Mistrust in Rural North Carolina.” This is an interdisciplinary study investigating the under recognized practice of self-medication with over-the-counter fish antibiotics in southern North Carolina, which has raised urgent concerns about unregulated drug use and high rates of antimicrobial resistance. Through ethnographic research and chemical analysis, the project aims to inform effective, community-based approaches to antimicrobial stewardship and address gaps in current public health strategies.
“Only recently have there been efforts to understand how, for example, socioeconomic inequalities can actually weaken antibiotic stewardship for already disadvantaged populations,” Chua explained.
“Through a people-centered approach, we want to appreciate the resourceful agency of people who might be excluded from the health care system because of the cost or inaccessibility of health care, or perhaps because of medical mistrust, while documenting the disparities that may severely limit their choices.”
— Jocelyn Chua
Chua and Bartelt wanted to explore the use of these products through both anthropological and pharmaceutical lenses — an approach that didn’t lend itself well to funding mechanisms targeted to either discipline. They teamed up with Brandie Ehrmann, director of the Mass Spectrometry Core Laboratory in the chemistry department, and Heather H. Henderson, an assistant professor of infectious diseases in the UNC School of Medicine, to apply for the seed grant. Bartelt saw the grant as a perfect opportunity to kickstart their project.
“Chemical analyses and ethnographic, qualitative research methods don’t typically mix,” he said. “The opportunity to bring them together was very attractive.”
The qualitative part of the project, assisted by undergraduate researcher Erin Collins, will involve focus groups and interviews with North Carolina residents who have used aquarium fish antibiotics in the past five years. From this research, Chua hopes to better understand how and why they’re seeking out these drugs.
“Through a people-centered approach, we want to appreciate the resourceful agency of people who might be excluded from the health care system because of the cost or inaccessibility of health care, or perhaps because of medical mistrust, while documenting the disparities that may severely limit their choices,” Chua said.
From the chemistry side, the team wants to explore what these fish antibiotics consist of. Since they are not regulated by the U.S. Food and Drug Administration, their quality and composition may vary. Using state-of-the-art chemical analysis equipment, Bartelt, Ehrmann and colleagues intend to determine what active ingredients are in these products, how much there is and what inactive ingredients may be mixed in. This may help individuals choosing to use these products make a more informed decision regarding the potential risks and benefits.
Chua and Bartelt are grateful to the College for supporting early-stage, exploratory projects like theirs that may spur more multifaceted approaches to deepen the discussion around antibiotic use.
“The kinds of questions we’re asking aren’t typically addressed within antibiotic stewardship efforts,” Chua said. “We feel they’re important to developing community-relevant, context-specific solutions to address both antimicrobial resistance and the problem of equitable access to safe medications.”
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