Diabetes: A History of Race and Disease by Arleen Marcia Tuchman (review).

Abstract

Reviewed by: Diabetes: A History of Race and Disease by Arleen Marcia Tuchman James Doucet-Battle Arleen Marcia Tuchman. Diabetes: A History of Race and Disease. New Haven, Conn: Yale University Press, 2020. xvii + 288 pp. Ill. $32.50 (978-0-300-22899-1). In Diabetes: A History of Race and Disease, Arleen Marcia Tuchman presents a comprehensive and engaging account of the ways diabetes has been viewed through racial and ethnic lenses over the last one hundred and fifty years. Tuchman traces how Jewish, African American, Native American, and LatinX categorized groups emerged successively in both the scientific and public imagination as differentially embodied carriers of inherited Type 2 risk. The book conducts a sweeping [End Page 459] interrogation of not only the putative racial and ethnic categories, but also of the nosology of diabetes diagnostic categories as well. In this way, Tuchman offers a persuasive narrative of the tortuous journey to knowledge about diabetes, a journey muddled historically and contemporaneously by the insidious racialization of both science and society. Tuchman charts the history of diabetes science as embedded within the history of racial science. From the late nineteenth century, imagined populations of diabetes risk were grouped racially, fueled by theories of social evolution and civilizational hierarchy. Such attitudes fed directly into eugenicist claims that diabetics had “defective genes,” and that therefore “insulin was harming the race by allowing individuals with defective genes to reproduce” (p. 54). Tuchman deftly contrasts ethnoracial notions of diabetes risk with an examination of how whiteness has served as an index of normative citizenship and a moral economy of care. While some high-risk and diagnosed whites were adjudged to be “defective” genetically, Tuchman illustrates how minoritized populations became seen as reservoirs of diabetes risk. Eugenicist assertions of risk attributed to defective genes in feeble-minded whites were presumed to exist, tout court, in non-whites. Diabetes makes vital connections between the ways ethnoracial groups and communities have been imagined1 and the public health approaches, medical practices, and clinical research efforts targeting these stratified populations. Throughout the book, Tuchman counterposes the seemingly endurable influence of racial thinking, with strident but furtive arguments linking environmental and social determinants of health in ascribing diabetes risk. The root of the debate about diabetes centers on whether the illness is due to either environmental or innate biological factors, and if the “innate” could be linked to race. Regarding the former, racial biology was seen to work in apposition, depending on the rankings of different groups within evolutionary social and civilizational hierarchies. For example, haphazardly categorized white and Jewish sub-populations were viewed as having acutely sensitive physical constitutions that made them more susceptible to diabetes risk. On the other hand, Native and African American groups were deemed brutish, savage, and incapable of abstract thought. Occupying a somewhat liminal position, some argued (and continue to do so) that degrees of Native American/Indigenous admixture among LatinX groups elevate Type 2 risk. Tuchman weaves a counter-narrative that contrasts and pushes against putative theories linking race and biology. The narrative presents a spatial history of nonwhite immigration, African enslavement, LatinX subordination, and Native American dispossession that illustrates the social construction of racial biologies and the political economy of power that misrecognizes the affective drivers of cardiometabolic risk in rural/urban, reservation, ghetto, and barrio environments. In this analysis, Tuchman explicates James Neel’s argument for an environmental, and not racial, contingency for Type 2 diabetes risk.2 [End Page 460] In addition to its rich historiography, Diabetes: A History of Race and Disease brings relevant appeal to scholars and students in a wide interdisciplinary range of audiences. Those in public health would benefit from examining the ways demographic change legitimated forms of surveillance based on race and ethnicity, often fed by misinformed theories of Type 2 diabetes risk rooted in perennial iterations of scientific racism. In connection, the book also calls clinical researchers and physicians to rethink putative assumptions that situate Type 2 risk differentially within racially encoded communities and bodies. Scholars in both the history of science as well as science and (technology) society studies will find the book a generative work that links science as history with...