In his book, Making the Mexican Diabetic: Race, Science, and the Genetics of Inequality, Michael Montoya argues that there is nothing Mexican about being diabetic, despite soaring rates of type 2 diabetes among Mexican Americans. In fact, Montoya says, high rates of diabetes can be found among disenfranchised people around the world, whether Aboriginal, Appalachian or Native American.
Evidence suggests the illness is the result of generations of oppression, poor diets resulting from dislocation, poverty and trauma, Montoya says. The solution is better food options, health care, parks, livable wages, and affordable housing.
But the solution, as many scientists see it, continues to lie in a quest for a gene or genes carried by Mexican-Americans that cause type 2 diabetes. Montoya spent a year and a half with researchers on a quest for the still-elusive diabetes gene, leading him to ask, “Are we serious about disease or do we want patents and profits?”
I interviewed Montoya in June; excerpts of our discussion appear below in an edited form:
Q: Who exactly did you study?
A: I spoke with scientists, clinicians, and field workers who were taking blood samples on the U.S. Mexican border. I hung out with them on field sites, in laboratories, went with them collecting blood samples, followed scientists who were giving presentations, teaching classes, giving lectures. I interviewed them and asked them questions.
Q: Did you station yourself at the border?
A: No. I followed the blood sample. The story I’m hoping to tell is what happens to the blood sample when it gets taken, processed, shipped to a lab, converted to a data set, emailed to collaborators around the world, converted into a finding, promoted as a publication, talked about in conferences, cited as a finding… it all starts with someone like Mr. Lopez in the grapefruit fields on the border.
Q: Why do you take issue with the term “Mexican diabetic“?
A: The labels that you use presume a causal relationship. If you say Mexican diabetic, you’re using it not as descriptive term but as if there’s a relationship between Mexico and diabetes. What I’m trying to show is the relationship isn’t between Mexicans and diabetes. I’m trying to explain why scientists might think there is. Mexican refers to a nation. There’s nothing about the nation of Mexico that is diabetic.
Q: Is it racist to try to isolate a gene among a single racial or ethnic group?
A: There’s an entire history of thinking of human beings and human variation as proof of essential difference. It begins with the colonial and pre-colonial contact…when people were engaging with people that seemed so different from them and figuring how to justify slavery…or forced relocation of Mexican Americans, for example. If you track the historical moments and accompanying rhetoric, race has to do with, “these people are not like us.” Scientists are a product of society like we all are….That’s all that’s happening here. Scientists have been taken up in their moment.
Q: What’s your explanation of the epidemic if type 2 diabetes among Mexican-Americans?
A: That has to do with the life circumstances of the diabetics today and those of their ancestors. If you look at the global rates of diabetes, the groups with highest rates, like off the charts, are Mexican-Americans, Asian-Pacific Islanders, native Americans, Aboriginal peoples, southeast Asians, white Appalachians. These groups don’t share a language, they don’t share particular genetic markers for diabetes. They don’t share culture, food, lifestyle, religion or geographies. What each of these groups share is multiple generations of radical life hardship and trauma.
Q: So it’s about history rather than genetics?
A: Historical epidemiology shows that illness rates follow the patterns of history.
Q: But don’t environmental factors lead to genetic patterns?
A: The genetic part is about exposure and stress. If you severely stress people they won’t regulate their blood sugar very well. Children living in fear in neighborhoods, violence in the home or on the streets, living in a society that has turned it back on working people — all these have a burdening effect on the human organism.
Q: Is all genetic research in diabetes futile?
A: It’s not that there is not a genetic contribution to disease and wellness. There is. But there is no genetic contribution that would make you think of diabetes as a Mexican genetic condition. They have looked and looked, at hundreds of studies, maybe by now thousands, to find first of all a gene for diabetes or a set of genes for diabetes that can be attributable to an ethnic group. Together, all these studies can explain about 1-3% of global prevalence rates.
Q: Why are scientists overlooking the obvious question of environment and history?
A: They’re not overlooking the obvious, but it is not their question. Their question is what are the genes? The best scientists on the planet have been looking for this for decades and they have nothing to show for it except… they have long career trajectories, amazing computational capacities, patents galore, professional apparatuses, employment for people in labs around the world. Lots of scientific accolades but in terms of finding genetic contribution for type 2 diabetes, no. That’s what I’m trying to explain. If they were asking the right question, they might get to the answer quicker.
Q: What’s right question?
A: I think it’s why do all these global populations who have come from different places and cultures share high rates of diabetes? If you’re interested in solutions, the questions you need to ask are what are the conditions that lead to ill health?
Q: What are the newest locations in which high diabetes rates are emerging?
A: In Mexico, India and China…. There are 100 million in China alone due to rapid urbanization, industrialization and suffering in rural areas. It’s the same pattern around the globe. People are being forced into new ways of thinking, eating and surviving in urban areas, working in shops and factories. That’s where diabetes is coming from, these radical disruptions and trauma. Being forced to go from rural village to a new place — these changes in your life are stressful, and once you’re there trying to eek out a living, it’s extremely stressful.
Q: What are other explanations for diabetes in high concentrations?
A: In natural experiments, such as the Dutch famine but also in lab experiments involving mammals, when you starve a mother who is pregnant, her offspring have diabetes for seven generations, even if the animal is fed normally afterward… Why? This is called epigenetic or developmental origins. It’s a hypothesis that what happens in embryonic development is carried on. If the ova is coded for starvation conditions, it can be passed on for generations.
Q: What differences in diabetes rates exist between Mexicans in Mexico and immigrants and their families living here?
A: Look at the Tohono O’odham (Pima) people; half were in Mexico and half in the U.S. Their livelihood here was based on a complicated irrigation system that was dammed up to slake the thirst of development in Arizona, to build the Hoover Dam. They developed very high rates of diabetes. On the Mexican side, only recently have diabetes rates risen.
Q: Back to scientists, what fuels them to continue their gene hunt?
A: There is an entire scientific industry, the diabetes enterprise, that has been built up over decades, which supports the collective imaginary about why we are sick. That imaginary says we are sick because of something inside us alone or something we do or we do alone. Or maybe it’s our group or our people, sometimes our biology or culture. Well, I’m quite convinced by the evidence that view is a cultural assumption and that the world that we have created is why we’re sick and subject to complex chronic illnesses.
Q: Are there incentives from the drug industry to find a genetic explanation?
A: I’m quite convinced the search for patents and discovery are connected…. There is an incentive for scientists to find genetic connections. Some profit individually, and there are a lot of biology start ups. When it comes to race, many are profiting from the idea that race is biological.
— Amy DePaul
Photo, Uwe Hermann