"In the past, Jews may have suffered disproportionately from diabetes, and today statistically significant studies show that the rate of diabetes is higher among American Indians, African Americans, and Hispanic Americans than among whites as a whole. The critical question is: how have those rates been explained?" (xvii).
on the difficulties of having a disability in the US: "The fears and concerns... articulated, while clearly a response to losses in their own and their loved ones' physical abilities, were also shaped by the cultural and political meaning of dependence. In a society that went beyond merely idealizing rugged individualism to making 'independence' a key qualification for adulthood and thus, by implication, for citizenship, becoming dependent carried a heavy burden" (48).
"In the years following insulin's discovery, individuals with diabetes struggled to understand the meaning of this new drug in their lives. There can be no question that it gave me any of them the miracle of a longer, fuller life, allowing them to contemplate a future beyond the average of three years post-diagnosis for those with the acute form, and six years for those with the milder form. It also raised new questions about the nature of diabetes, its effect on one's ability to be a 'productive' member of society, and its relationship to other conditions widely viewed as 'disabilities'" (49).
"Kellyl Miller, a black mathematician educated at Harvard University and Johns Hopkins University, issued an immediate rebuttal [to the idea that the "black race was on the road to extinction" due to "the race traits and tendencies" of black people]... He... argued that high morbidity and mortality rates had nothing to do with innate racial traits and everything to do with social factors. The genius of his approach was to turn to studies of London's poor, which revealed health problems similar to those of black people in the United States. Class, not race, he argued, best explained excessive mortality" (75).
"...medical researchers and physicians read African Americans' low rate of diabetes as biological 'evidence' that they lacked the sensibilities and sensitivities that made a race like the Jews so prone to the disease. Similar to other scientific studies that alleged to offer proof of the inferiority of the "African race" and its descendants, medical writings often presented black people as occupying a step lower on the evolutionary ladder than whites, which meant they were considered less developed neurologically. 'The higher the organization, the higher the physiological development, the higher the nervous system, the greater the sensation,' asserted a physician at the meeting of the Saint Louis Medical Society in 1884, adding that is why black people, who had 'less brain' and a 'less developed' nervous system, did not suffer from 'a great number of diseases' that affected whites.' .... 'Nervous system strain, intense application to business, mental shock and worry have frequently served to plan an important role, at least in precipitating the phenomena of the disease [diabetes] or aggravating it. The negro race is to a very great degree free from these influences. The average individual is happy-go-lucky, living from hand to mouth and from day to day, without great responsibilities and without great ambitions which carry with them great cares...'" (75-76).
"African Americans and Jews were constructed as polar opposites: one primitive, the other civilized; one carefree, the other high-strung; one simple-minded, the other intellectually astute. In this way, the diabetes literature produced, legitimized, and proliferated two sharply drawn, differentiated stereotypes and put the two groups at cross-purposes" (76).
Later higher rates of diabetes were recognized, and especially once studies realized that there was a self-reporting bias.
M. C. Guthrie, the chief medical director of the Bureau of Indian Affairs said "'ignorance, prejudice and superstition'...led Indians to seek the help of 'so-called medicine men and other charlatans,' rather than taking advantage of 'trained personnel.' To Guthrie, this was the mark of a primitive people,' a characterization with which few would have disagreed at the time.
"But what did 'primitive' signify in this context? Guthrie's comment alluded to one meaning: the direct antithesis of Enlightenment ideals of rationality, science, and hygiene, each of which symbolized the ability to control nature" (108).
Geneticist James Neel described Native Americans as "'one of the last great resources for the study of primitive man, one of the last opportunities to attempt to fathom the nature of the forces to which man was responding during the course of human evolution.'
"...he and other scientists were imagining them as frozen in time at an earlier stage of human history.... Of course, in theory, Neel and other human geneticists could have viewed 'primitive' populations as simply having different gene frequencies than less 'primitive' populations--perhaps as the result of becoming reproductively isolated at some point in time--but the claim that one population represented an early stage in another population's evolutionary development reintroduced not only the notion of stasis, but also of racial hierarchy. Native Americans, they were implying, did not have different gene frequencies because their paths diverged from that of whites; they had different gene frequencies because they had not changed, while whites had. Put differently, they were less evolved" (119).
"The narrative that Neel ended up constructing could have been lifted almost entirely from early twentieth-century explanations for why Native Americans had succumbed disproportionately to tuberculosis. Once again, underlying structural inequalities were ignored and the bodies of primitive peoples were imagined as being forced to deal quickly with changes to which more civilized populations had had ample time to adapt" (132).
Other geneticists developed observations that "are consistent with Neel's hypothesis that diabetes results from the introduction of a steady food supply to people who have evolved a 'thrifty genotype'" (134).
