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Recorded on 9th June 2022. Speakers: Paige Patchin, SPRC // James Doucet-Battle, Uni of California // Alya Harding, Elinor Gibbs and Liz Kombate, SPRC MA students
Paige Patchin: Welcome back to the SPRC podcast. My name is Paige Patchin and I’m delighted to welcome James Doucet-Battle here to join us to talk about his amazing book, Sweetness in the Blood: Race, Risk and Type 2 Diabetes, which came out in 2021. James is a medical anthropologist, working in the Sociology department at University of California Santa Cruz. He writes that Sweetness in the Blood tries to challenge arguments claiming that collecting and filtering data according to racial categories offer the best approach to understanding, managing and curing Type 2 Diabetes. So, I wonder, James, if you could just say more about that statement or that claim, that project, as a way of introducing the book and giving a short summary of it, to get us going.
James Doucet-Battle: Well, the book began originally as an examination of Type 2 Diabetes among diagnosed African Americans. I wanted to understand how this imagined community, to bring in Anderson, interacted with the biomedical message around Type 2 Diabetes: the technologies, the forms of discipline that are required in order to manage one’s diabetes. I talk about these imagined categories to try to emphasise the dynamism of them, in ways that trouble boundaries, and in this respect, Paul Gilroy’s work was really influential in asking us to move beyond mere phenotype to look at practices, to look at the ways in which different environmental and cultural environments, landscapes, create different types of bodies, particularly in relationship to power and to history and to capital.
So, in doing this, I wanted to challenge notions or claims that tend to continually equate race with biology; and in so doing, I wanted to delink race from risk in order to tell a more holistic, anthropological story, if I may, about the ways in which environment, culture, practices and capital intersect in creating metabolic bodies that are the products of these particular histories and forms of capital circulation and demands.
If you notice in the introduction, this began as a family story, this began quite autobiographically. And I wanted to bring this conversation into a wider space that troubled nationalistic boundaries and narratives around what it means to be Black, what it means to be African American. I wanted to expand the notion or the geographical imagination of what the Caribbean is to include southern Louisiana as part of this sugar industrial complex that Sidney Mintz talked about in his classic work, Sweetness and Power, which my book is largely inspired by, by the way. And I wanted to bring these ideas together to argue for a contingent environmental risk and not a determined racialized risk for Type 2 Diabetes, which was the focus of the book.
Paige: Thank you. So, in my excitement, I forgot to mention that this is the first episode of the podcast that we have some students joining us. So, today we have Liz Kombate, Alya Harding and Elinor Gibbs, who are joining us for the conversation and they’re from the first cohort of the SPRC’s MA programme in Race, Ethnicity and Postcolonial Studies. I wonder if one of them could follow up the question with what James just opened up.
Alya Harding: Hi James, Alya here. Very nice to meet you, virtually. My follow up question, I think you’ve already answered it, but it was around what was your inspiration for the book? You spoke about your focus on delinking race from risk and about bringing this conversation into a wider space. So, in wanting to bring those conversations of Type 2 Diabetes into this wider space, what did you imagine it would look like and has it met your expectations? Has it opened new conversations?
James: Great question. Well, one thing I found in doing this work is that ethnographies are time specific. They are ethnographic snapshots that quickly become historiography over time. What I wanted to do in the book was to try to keep pace with the rapid changes in diabetes science which were rapidly moving into the area of genomics and genomic risk, and that is what I discuss in the fourth and fifth chapters of the book, that moment in which genomic estimations of risk began to change the ways in which we looked at metabolic risk. And I bring in the case of Henrietta Lacks and the HeLa cells, to talk about the ways in which mitochondrial DNA and the mapping of the genome and epigenome of the HeLa cell opened these new conversations and brought notions of risk further back into ancestral time, pre-racial - pre-racial in a way that seems to invariable get reinterpreted through a racial lens and the ways in which the science is going on, and how the recruitment of African descent bodies had figured not only in biomedical research but the ways in which sub-Saharan African diversity promises to expand these recruitments and these investigations as well.
So, what we have are groups like H3Africa and others who are doing work on the continent, in league with people at my university, who are working on a pan-genome project, of this race to re-map Africa, in a way, genomically and people are furiously trying to collect samples of sub-Saharan African DNA to build reference libraries, to sharpen this technology of predicting risk, for example, not only for Type 2 Diabetes but for other diseases and other illnesses as well.
That is leading to my next project, which we could talk about later, but for now, yes, that is what I was really, really trying to do. I was trying to bring the conversation, first I wanted to bring it out of the nation state, out of the bio-political nation state and the narratives that the nation state has about differentially categorising bodies. I mentioned in the book about the ways in which the Black British population is viewed vis-à-vis the South Asian population in the UK around Type 2 Diabetes risk. I have colleagues who are doing work on prostate cancer among Black British men and the ways in which the BMA has different criteria for evaluating that risk compared to the ways in which that risk is estimated and assessed in the United States, as far as what is actionable, and at what age to begin testing.
So, this book tries to bring all of these things together. It tries to bring the history of the Black Atlantic off the plantation and into the research laboratory, to examine the ways in which race is continually being redefined and how science and technology continue to misinform these distinctions between race and ethnicity.
Paige: Elinor, do you want to follow up on that?
Elinor Gibbs: Hi, I’m Elinor. It’s really nice to meet you. I was really struck by, as you mentioned earlier, the autobiographical elements of the book, I think especially the moment where you discuss getting the diabetes test yourself. That really stood out to me. So, I was wondering how you write yourself into your books and to what level you have that balance between academia and autobiography?
James: Great question and I have quite a few colleagues who I look up to who maintain that autobiography should be kept out of your work; that’s another thing. But in terms of my book, what I wanted to do was begin with the personal and open it up to the general and then refocus it into the specific. I wanted to deal with the autobiographical elements, to set up the narrative, the larger conversation. I wanted to do that in the introduction and then just kind of weave it into chapter one, and then from there, engage in a full-on foray into the topic at hand. And there is so much experience with sugar and history and capital and diabetes in my family and in other families, in this nexus between the Caribbean and southern Louisiana in terms of sugarcane cultivation; to my mind, in my opinion, the not sufficiently discussed connections between Haiti and Louisiana and the rest of the Caribbean.
Julia Scott’s book, A Common Wind, if you haven’t read it, I would highly recommend it. This was a dissertation that was turned into a book that examines the ways in which the Haitian revolution and narratives and discourses around it and about were circumvented, censored, abridged in ways that prevented the full message, the full import of the Haitian revolution from being more widely disseminated in the United States, and similar forces were at work in Louisiana as well.
So, I wanted to try to tell a different story. I wanted to tell a story that, according to, say, Saidiya Hartman, I wanted to tell a story that was largely absent from the archive. The work itself, I must say, from an autobiographical standpoint, it began with my grandmother and, in a sense, there is this link between my grandmother and Henrietta Lacks as part of a particular type of history, a history born in the era of a post-slavery, Jim Crow environment, in which labour and health and race and gender conspired to create the conditions, not only for the racial category being established but for our understandings of what Type 2 Diabetes is, beginning with the family and then expanding that conversation to the wider society and its more global import.
Paige: In starting the story in Louisiana and in developing Sidney Mintz’s work on the Caribbean, you make a point of noting that when you say African American, you mean this in a hemispheric sense and not a nationalist sense, and that’s one of the main things I took away from the book. So, I wonder if you could just say a bit more about that and its significance to the wider study of the idea of race and how race works today?
James: Well, when I’m in the Caribbean, when I’m working in the Caribbean, I’m always reminded, 'we’re Americans too'. The term African American is a term that Jesse Jackson pushed for in the 1980s. Before then we were Black Americans. Before then we were negro Americans and colored and so it changed and for a certain period in the 19th century, we were even called Ethiopians, at least until the Battle of Adwa when the Ethiopians defeated the Italians and somehow that went out of use.
So, I wanted to delink, and I think genomic science will probably in the next few decades make stronger connections to the hemispheric forms of genomic relationality that exists among the diasporic population, irrespective of nationality; not only in terms of African diaspora but in terms of those European and other ancestors who we may all be related to, to some degree. I wanted to have a conversation about an illness which is global, pandemic, if not syndemic, to use Singer’s term, and in so doing, create a parallel dialogue that also removes the bio-political boundaries that author and police and survey many of the conversations, many of the discourses around what Type 2 Diabetes means within any particular nation state.
Now that we know, for example, in Great Britain, Great Britain reached its obesity tipping point in the late 1990s, the United States in the late 1980s. Japan has reached its tipping point, not in terms of obesity but in terms of sugar consumption. Around 90lbs per person per year is what the average America consumes at least, and Japan reached that in the mid-2000s, I believe. So, we’re looking at a global epidemic that requires a global understanding of an illness that cannot be simply confined to or addressed in bio-political nationalist terms or through bio-political racial categories that have been created arbitrarily in response to and as a justification of inequality and hierarchization in society.
Paige: Liz, do you want to jump in?
Liz Kombate: Lovely to meet you, James. Turning to something else that’s also global, it’s almost impossible to talk about health-related literature in 2022 without talking about Covid 19. So, turning our discussion to the pandemic, we’ve seen a resurgence of medical discourse talking about the idea of biological race which, as you’ve mentioned, is something you strongly refute throughout the book and how different ‘races’ have been impacted by the virus differently. My first question is, how do you think your book has added to the discourse about biological race? And secondly, leading on from that, how do you feel that the release of your book during the pandemic has impacted how audiences might have received your work?
James: Interestingly enough, one of the interesting outcomes of the book has been enquiries from the media for interviews to talk about vaccine refusal in the African American community, not about Type 2 Diabetes specifically. Type 2 Diabetes in these conversations is usually referred to tangentially in terms of co-morbidities or pre-existing conditions that exacerbate peoples’ responses to Covid. Actually, it was just announced that, out of the nearly one million deaths due to Covid 19 in the United States, 400,000 of those deaths could be connected or could be attributed to individuals with Type 2 Diabetes.
So, we know that Type 2 Diabetes - due to the amount of hyperglycaemia that Type 2 diabetics tend to have and the insulin resistance that they also possess - that they tend to be more susceptible to infections of various sorts and it appears that Covid 19 is one of them. So, fully 40% of the fatalities due to Covid 19 in the United States have occurred in and with people with Type 2 Diabetes. That’s an amazing, amazing statistic.
Paige: One thing that we’ve seen in the UK a lot is, the second that we went into lockdown in March 2020, it was the search for biological predisposition to Covid 19 to getting seriously ill or dying from it, and specifically the search for a racial origin to the different disparities in outcomes really. Do you see the link between Covid and diabetes as kind of another iteration of this search for biological reasons for disparities in health outcomes?
James: Wonderful question and a timely one. What I found is this, and you may have been following this as well, at the beginning of the pandemic, there was a lot of rushed publication in 2020. A lot of people were publishing things prematurely before we truly knew what the pandemic was all about, and one of the narratives that were circulated, or one of the questions that were circulated, was why aren’t sub-Saharan Africans contracting Covid as quickly as everyone else? You may remember that. Upon further investigation, it’s now been argued that there are different factors. We know that in Western industrialised countries, there was high mortality due to Covid in nursing homes, but in sub-Saharan Africa most of the elderly stay with their families. They’re not crowded spatially into these areas where you have large numbers or critical mass of elderly people with low immunity and other issues that predispose them more readily to contracting the virus. The other thing is the lack of public health intelligence on the ground, to actually screen and find out whether or not people are contracting Covid. And then the third argument was that people in sub-Saharan Africa, due to repeated infections, due to malaria and other things, have learned over time, their bodies have learned to effectively fight off other forms of viral infections that may assail the body or the community.
But the spatial analysis also uncovered that this did not hold true in South Africa where, due to the history of Apartheid and the creation of segregated, high population density communities, impoverished communities, Covid 19 was spreading rapidly. So, the spatial analysis lends well to understanding how Covid affected under-served populations, marginalised populations, spatially segregated and neglected populations who live in areas with poor medical access, and I know that this isn't an argument that applies to all countries, to all bio-political systems. You have the NHS, we have the for-profit medical system here which is a completely different animal, or beast is perhaps a better term, and we have people who don’t have health insurance or if they do, it’s government sponsored. And we also have people who actually do not trust, and I talk about the issue of trust in the book, where the legacy of Tuskegee and other things that have gone indefensibly wrong continue to linger in the minds of many in the community, and I’ve seen this in my family, I’ve seen this, even though we’re all vaccinated now, but in the community that I grew up in in New York.
I’ve seen this happen to other people and to a family that got tired of the lockdowns and the ‘shelter in place’ in last Spring, they decided to throw a family gathering and they put it on YouTube, 40 people in the kitchen, no one wearing masks, everyone having a great time. Within a week, three of the siblings were dead and the only sibling that survived was the one who stayed home to take care of their spouse who had a pre-existing condition. So, no one was vaccinated and one of the people who was at that party, a member of that family had actually been hired to be a DJ at my mother and my aunt’s birthday party last year, and that created a little bit of a kerfuffle in the family, but somehow that got worked out.
So, from a community perspective, the ways in which history and space and these legacies of medical malpractice, the way they affect the ways in which people reach out for medical care, for medical assistance, for treatment, continues to reverberate through the pandemic and perhaps even more loudly than before.
Paige: On the topic of differences between the US healthcare system and the NHS here, but also some similarities as well, I know Elinor you had a connection to draw.
Elinor: So, recently I’ve been reading about gestational politics and so I was wondering what your opinions are in relation to your work? I had a little look to educate myself about gestation diabetes and on the NHS website, they have a list of increased risks, one of which says your body mass index is above 30 and another one says you are of South Asian, Black, African, Caribbean or Middle Eastern origin, even if you were born in the UK. So, I was wondering how this sort of politics of gestation diabetes relates to your work, especially in terms of how pregnant peoples’ bodies are controlled and how this maybe fits in your wider discussion of diabetes?
James: Excellent question. Although I don’t engage the question of gestational diabetes in relationship to race and gender in the book, I think that it is an important topic to examine. One thing we know is that BMI indices, first of all, matter very little in terms of South Asian and East Asian populations. You can be extremely slim, you can have a low amount of abdominal fat or adipose tissue and you can still have high risk for Type 2 Diabetes if you’re East Asian or South Asian. For African descent people, the BMI indices are rarely realistic and rarely do they make sense, particularly for Black women if we’re talking about gestational diabetes. But the question is, is it due to race or is it due to culture? Is it due to social economics status and access to healthy fresh food? These are larger questions, and this is where hopefully you will forge a closer, more influential relationship between the social sciences and the epidemiologists and those working in public health who realise that they need qualitative work. They need qualitative researchers to help them understand the social field, but they don’t quite know what to do with us.
On the other hand, they’re the ones who are bringing in all the funding. They have the leverage, they have the final say, they have the institutional heft in order to drive policy and make recommendations. So, this is where I think people trained in the social sciences and the humanistic and the medical social sciences, women, diverse groups of scholars and researchers, will need to continue to push to get their expertise included and their bioethical and other concerns listened to and taken seriously in actionable ways, in order to drive changes in these policies which, in a sense, are more descriptive than they are explanatory. They don’t really tell you why. They just tell you who. And I discuss this a bit in the book where I look at how the diabetes websites in the UK, they tend to portray the South Asian population, whereas here they tend to portray the African American and the Latinx populations as being the high-risk groups. What’s the difference? Is it culture? Is it the amount of tea that one group is drinking compared to the other? Do we know? Or is it just because there’s something that we can ascribe to a racial cause that is inherent to these bodies that we can say helps to drive an increased amount of risk around Type 2 Diabetes?
In terms of gestational diabetes, I think more work needs to be done, perhaps your work will engage this, about the ways in which these people are looked at. What is the gaze upon these particular groups, upon Black British women, around South Asian women in the UK and others? And what are the ways in which they live, the ways in which they eat? What are their social economic statuses? Is there something that we can learn - I deal with this in the book - about this tension between the diabetes educators and the community health workers, and I don’t know quite what the equivalents are in the UK, but if you want to conduct this fieldwork, I would strongly suggest teasing out those tensions between those community workers, who I say have the ears on the ground, versus those who have the eyes on the science.
I think your question points towards this dichotomy of understanding, this dichotomy of knowledge and expertise and in some respects, the struggle for authority and expertise around these conversations, around what truly constitutes risk and what does risk look like? Or does that risk actually have a face at all? Are we looking at something that is more environmentally contingent, as I argue in the book, than something that is racially contingent?
Paige: Alya, the topic of gestation, I think, links up with your work as well, so do you want to follow up with a question?
Alya: Building on the conversation that we’ve been having on race and gender, you highlight specifically in chapter five, the relationship between race, gender and ancestry, as well as the research gaze on the Black female body. I was wondering how feminism influences your work, or does it influence your work? We’d be interested to hear more on that.
James: Would you really like to hear more of that? When I came into graduate school, I told myself I’m not going to work on race. I want to be able to sleep at night. I want to be able to be a member of my own community without objectifying them in order to study them. Then I decided on this diabetes project and it quickly became one in which, to quote Omi and Winant, it became a racial project. I found myself being drawn into this literature, as Elinor also alluded to, these conversations, these claims equating race and risk and Type 2 Diabetes, James Neil’s work and the ways in which it got subsequently racialized. How did these things happen? How did Native Americans become the poster children for Type 2 Diabetes? I’d like to recommend Arleen Marcia Tuchman’s book, Diabetes, excellent book; it’s a historiography of Type 2 Diabetes over the last 120 years, which began in America largely as a conversation around Jewish immigrant risk - no one really talks about that anymore. So, how different groups successively came under the biomedical gaze and were attributed as having somehow some exceptional or inherent forms of Type 2 Diabetes risk that needed to be looked at through a racial or an ethnic lens.
So, after realising that I could not avoid discussing gender in my work, along comes the mapping of Henrietta Lacks’ HeLa cell. First of all the release of her book, which I teach, or the book by Rebecca Schlott, which I teach, as well as a book by a British filmmaker, Adam Curtis, he made a documentary called The Way of All Flesh in, I think, 1999/2000, which is one of the most complete and prescient treatments of the Henrietta Lacks story that has been told and it was recorded at a time when quite a few of Henrietta Lacks’ children were still alive. So, once the Henrietta Lacks book came out and the whole story about her family, the contrasts between the bio-scientific wealth that the HeLa cell has generated over the last 70 years, versus the increasing forms of poverty and objection that her descendants continue to live in, the story of her being born in a former slave quarters of a tobacco plantation, developing or contracting repeated infections and being treated in a segregated ward of a hospital, and then having her HeLa cells taken, which were not against any bioethical regulations at that time.
Suffice to say, this is a long way of answering your question, due to bioethical protocols that are now in place today, we would never have known about Henrietta Lacks. Her data would have been de-identified and we would not know anything about her or her life. From a historical standpoint, from a social scientific standpoint, it was a moment that could not be repeated today. So, in 2013, when the genome and epigenome of the HeLa cell got mapped by the German researchers, I found myself drawn into a discussion of gender. I was blindsided. I found myself having to dive deeply into Black feminist scholarship. I’d read Morrison, I’d read Hartman, I’d read Spillers, I’d read Holloway, but I had to dive even more deeply. I had to read Toni Morrison, I had to read Octavia Butler. I had to bring in all of these different voices that were telling stories that were not extant in the scholarly literature about Black women, the reproduction of power, the gift exchange from a racial and gendered perspective, the notion of the Black matriarch and the absence of political power, and economic resources. What do these languages, what do these conversations, what do these terms actually mean and can we empty them of whatever content they had? Or can we expose them as being void of content? These ongoing languages of matriarchy, which social scientists have adopted uncritically. The Moynihan Report in the United States used the term quite liberally and incorrectly, even though the Moynihan Report was signed off by some of the most prominent African American sociologists of the time.
I had to deal with this because this matriarchal language was now being ascribed to Henrietta Lacks and to HeLa and how could that be used, conscionably and appropriately, given the status, not only of her family but the ways in which HeLa cells continue to be used around the world. And you can do a Google search on HeLa cells and you’ll find dozens of companies that are selling them, various types. You can even buy HeLa cell jewellery online, modelled after the actual cells themselves. So, there’s been a huge industry, not only in HeLa, but the family is attempting to capitalise from their mother’s story as well, by going on tours, by organising their own yearly symposium and so on and so forth.
So, I found myself, through this investigation of gender, being able to then subsequently and consequently argue that we cannot understand race without first understanding gender. That is one realisation. That is one conclusion that I never in my wildest dreams entertained going into graduate school, at least a conversation that I thought that I would be able to contribute to and participate in.
The decreasing costs of sequencing a genome in 2011 made all of this possible and here I am writing up my dissertation, thinking I’m going to graduate in 2011, and then this event occurs and, I walked across the stage in 2011 but I realised I had more writing to do and that is where, at what point in your thesis or in your dissertation, do you realise, fully and finally, what your intervention is? You can spend years thinking about what your intervention is, but that moment made it abundantly clear to me what this book had to say, not only in terms of contextualising the past and past understandings of Type 2 Diabetes and race and gender, but also signalling what that might mean for the future, and that is where my second project comes in.
Paige: Well, I have to ask then, what’s the next project?
James: The next project is entitled Laboratory Life and Social Death: The Problem of Diversity in Science and Society. So, I’m bringing in Latour, I'm bringing in Patterson and Hartman, to try to examine this seemingly contradictory push to collect more sub-Saharan African diversity by scientists, versus ethno-nationalist impulses in the global north against diversity itself. And I want to counterpose these two against each other, to try to understand exactly what does diversity mean in different spaces? What does it mean in the bio-political space? What does it mean in the bio-economic space? What does it mean in the nationalist space?
We have our own movements in the United States, you have the National Front and others in the UK. We have Marine Le Pen and others in Continental Europe. We have anti-immigrant sentiment even in the developing world, of course, but the difference between, I think, Continental Europe and the UK and the United States, is that in the United States we are just awash in firearms and it creates a completely different scenario here, in terms of what that might mean in terms of pushback, in terms of refusal, around an enforced re-definition of what it means to be an American, specifically within a hierarchical context in which history seeks to reproduce itself through notions of who belongs and who doesn’t? Who belongs unconditionally and who belongs contingently? So, that is my next project and that project would not have occurred if not for the developments, the events that made chapter five of this book possible.
Paige: That’s great, James. Thank you so much for joining us today. Thank you to Liz, Alya and Elinor as well, and we look forward to joining you next time.
James: Thank you all and I look forward to it. Thanks for the invitation.