Veterinary prescription of antibiotics between medical and economic practices
The problem of antimicrobial resistance has been put up on worldwide political agendas over the last ten years. This has encouraged the implementation of various strategies to reduce the use of antibiotics in livestock farming. Government plans and policies, labels and specifications from the agri-food industry and “best practice” guidelines from the veterinary profession are now increasingly being drawn up to regulate the conditions of use, prescription and sale of antibiotics for animals. In Europe, these dynamics seem to be bearing fruit since antibiotic use has been reduced by 34% since 2011 (EMA, 2020).
This movement also goes hand in hand with profound changes in the veterinary profession (Fortané, 2019, 2020). Indeed, while antibiotics have historically been a central technology in veterinary practices and knowledge in terms of animal health management (Kirchhelle, 2020), drastically (and rapidly) reducing their use requires the development of new ways of working, from the understanding of animals and their diseases to the labour and economic organisation of veterinary businesses. This is what this article proposes to analyse in the French case, on the basis of an ongoing research on veterinarians in different sectors. By the time the manuscript is submitted, some fifty semi-directive interviews will have been conducted with farm animal veterinarians, covering their animal health management practices (particularly diagnosis and prescription), their relations with livestock farmers, their working conditions and employment status, and the economic and contractual dimensions of their professional activity. The article proposes to discuss the following findings.
Firstly, there is a development of new approaches to animal health, which is certainly reinforced by the movement to reduce the use of antibiotics but which is also based on independent professional dynamics. Antibiotics are a central tool in the clinical knowledge of veterinarians: the disease is analyzed "at the bedside" of the animal, by identifying the symptoms that make it possible to establish a diagnosis and initiate treatment. However, for many years now, other approaches have been developed and articulated with the "classic" clinic in such a way that veterinary expertise in animal health is now plural: biological analyses, epidemiological data, zootechnical knowledge and even " alternative " conceptions of health (including ecological/ecosystemic approaches) ).
It is therefore important to describe in detail how this multiple knowledge is put into practice on a daily basis, and what is the place of antibiotics according to the different "configurations of expertise". This will allow us to establish a praxeology of veterinary reasoning and to see how this can vary according to context: in the pig and poultry industries, for example, preventive approaches are much more developed than in the dairy industry (where there are many more veterinarians). Documenting this praxeology will enable us to finely grasp how the production and prescription of preventive and/or 'alternative' medicines call for new veterinary skills and areas of specialisation (implementation of self-vaccination, formulation and testing of phytotherapeutic products, etc.).
Secondly, there have been significant changes in the supply of veterinary services. As veterinary expertise becomes more diverse, the professional and economic models on which it is based are also changing. While the sale of antibiotics was for a long time the main, if not the only, source of income for veterinarians, the latter must now diversify their remuneration and learn to value the variety of their expertise. Special attention to the economic dimensions of veterinary activity will therefore lead us to consider the heterogeneity of veterinary business models and the ways in which veterinarians are remunerated.
It is therefore important to show how veterinary businesses are changing in terms of labour organisation and financial structure. Indeed, we now observe in France a concentration of veterinary businesses through the development of holding companies (usually called “networks of practices”) in order to pool certain resources and offer more services or goods on the animal health market (e.g. audits on biosecurity, training for livestock farmers or the sale of hygiene and nutrition products). This vast movement is corollary to the decline in the use of antibiotics but is developing at different paces and in different ways depending on the sector and region.
Finally, the article will discuss the link between these two sets of results: to what extent is the evolution of veterinary practices and knowledge linked to changes in professional and economic models? What does the decline in the use of antibiotics mean in concrete terms at these different levels? Medical anthropology and the sociology of the professions provide food for thought. First of all, a professional jurisdiction is also a market (Abbott, 1988). Knowledge is therefore a service that acquires an economic value in a system of market relations between veterinary businesses, farmers, cooperatives and agri-food industries. Furthermore, medicines have a 'social life' (White et al., 2003) which means that their uses are linked to their conditions of production, distribution and circulation, which implies paying attention to the concrete modalities of their purchase and sale by veterinarians. In the end, antibiotic use could clearly be conceived both as a medical and an economic practice and this is only by considering these two intertwined dimensions that we could fully analyse the place and role of pharmaceuticals in veterinary medicine.