Last week I looked at Jonathan Khan’s Race in a Bottle. I briefly mentioned Michael Montoya’s work Making the Mexican Diabetic: Race, Science, and the Genetics of Inequality. I recommend this book as it is a powerful piece that explores the politics and ethics of the diabetic research process. The racialization of disease in medical research is dangerous. Medicine is traditionally regarded as an objective institution, one which is logical, rational, and truth-seeking. Monotoya shows how research into type 2 diabetes, a disease which disproportionally affects certain ethnic groups, results not only in the commodification of a human body, but in the creation of a group ethnic identity. Using Mary Douglas’s phrase of “Purity and Danger,” Montoya highlights the danger in the “purity” often associated with medicine and genetic research, showing how pressures for powerful data (data which is intended to reflect a certain definition of truth) create the need for a commodification of Mexicana/o bodies.
Mexican-Americans from southern Texas, who are the primary “lab rats” in Montoya’s work, are in an almost paradoxical state. On the one hand, they are singled out as a group (Mexican Americans) for the high rate of type 2 diabetes in their community. On the other, this identity encompasses and requires a level of admixture, or “the percentage of genetic material derived from each branch of a person’s ancestral line” (Monotoya, 2011: 91). Purity here, is a purity of mixture. In an almost arbitrary fashion, the purity of admixture is “presumed to be a 31 percent blend of American Indian, 64 percent blend of European, and 5 percent blend of “other” (Monotoya, 2011: 94). Medicine and genetic research is a field to heavily reliant on precision, on purity. There is a need for the create of a “pure” category for what it means to be a Mexican-American. Moreover, while race in the biological sense is considered a “dead” concept by many, it is constructed here in the most fundamentally biological way; through DNA. There very much remains, as described by Duana Fullwiley, a “biologistical construction of race” (Monotoya, 2011: 95). Admixture, used in this sense to categorize and subjectify, “ideologically upholds social relations of inequality” (Monotoya, 2011: 99). The ethnic identity of Mexican-Americans is constructed around a disease and a history of disposition and subjectification. Indeed, “the Mexicana/o population’s “race” is itself a necessary part of the exchangeability of their samples” (Monotoya, 2011: 151). Diabetes is no longer just a disease, it is an adjective defining a community and a means for profit. Monotoya mentions Rabinow’s suggestion to look “at science as a cultural construct that can be used to imagine something new or make sense of something old” (Monotoya, 2011: 126). As we have seen in this class, traditional definitions of terms that initially seem familiar are often narrow. Science and its link to objectivity may be an illusion, or only a part of a larger picture. Montoya shows how science, and specifically scientific research, becomes a commercial market one of labor and exploitation.
It is important to understand how genetic research represents a labor market for several reasons. Labor is necessary for the production of knowledge and our society is, in some ways, defined by “the wholesale fetishization of things exchanged for other things” (Monotoya, 2011: 147). However, as Montoya points out, this exchange within the context of diabetes research is off-balanced. In general, “the donation of biological samples is fraught with concerns about exploitation, most notably that informed consent and an equitable exchange occur between donor and recipient” (Monotoya, 2011: 145). It becomes clear that this exchange is not equitable, furthering inequalities among groups. While participants may receive free transportation, a meal, and referrals to appropriate medical personnel if necessary, the researchers who gain the immense power of data get hundreds of thousands of dollars in research grants and access to vast commercial and pharmaceutical market. Part of the reason this imbalance occurs so naturally is due to the changing meaning and value placed on the blood participants donate. For participants, blood samples are relatively meaningless in terms of economic profit. If anything giving a blood sample could be seen as a potential economic loss; a positive diagnosis for type 2 diabetes means a new system of care and lifestyle. For the researchers who take this blood, diagnosing type 2 diabetes is the most basic step. The research conducted later is far more lucrative. Monotoya mentions Garcia Canclini in this regard with the following “the meanings of an object as it moves between producer, consumer, and broker make tracing the social course of an object ideal for understanding “the matter in which capitalist development redefines identity as it combines various forms of production and representation” (Monotoya, 2011: 144). Diabetes and the blood samples necessary for its research turns DNA into a currency. As Monotoya explains “ the disease no longer is the point, but rather the excess, the fantasy of getting rich quick, as the ultimate foil for social dis-ease” (Monotoya, 2011: 154).
The structure and signification of the Mexican-American identity depends heavily upon the decisions of scientific researchers and marketeers. The dangerous use of rationalizations that Foucault mentions in his piece “The Subject and Power” is employed here by scientists and marketeers to “circulate representations of human variation” and to explain “the use of bioethnically conscripted groups of people” (Monotoya, 2011: 177). At the fundamental level, a scientific research project that “traffics in biologically, socially, and historically crafted data” causes “the meanings of social inequality to take the form of individual pathology, which invites new forms of genetic surveillance and predetermines the hegemony of biological solutions for a chronic sociological dis-ease” (Monotoya, 2011: 177). This hegemony is also determined by the biological differences found by researchers, differences which are “based on social differences found between groups of people” (Monotoya, 2011: 177). I think the greatest danger of all is exactly this: that socially constructed differences and social constructions of race, things which are all intensely subjective, are used to create and explain supposedly objective and scientific data.
Montoya hints to a much larger issue; one that extends outside the realm of genetic research. It is this: social and individual perceptions dictate the discourse surrounding illness, diagnosis, prognosis, and treatment options. Stigma, stereotypes, and assumptions determine the quality of care one receives not only in the medical field, but more generally in society. More specifically, “social categories get mapped onto emergent scientific knowledge” (Monotoya, 2011: 176). In the case of Mexican-Americans a social history of displacement, subjectification, and disrespect has more easily allowed a body identified by certain ethnic markers to be “configured as a commodity” (Monotoya, 2011: 145). Monotoya argues for a closer look at the why and how of the social relations that live under racial statistics and taxonomies; such an examination may very well reveal “burdens of racial discrimination, of poverty, and of inequity” (Monotoya, 2011: 178).