The New Precision Stewards?

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.

Keywords: antimicrobial drug resistance; antimicrobial stewardship; biomedical ethics; biomedical research; environment and public health; microbial genetics.

Grants and funding

The research to prepare this manuscript was partly supported by the Mayo Clinic Center for Individualized Medicine. The sponsor had no role in the writing of the report or the decision to submit the article for publication.