Final Project: Diabetes

In the United States, almost 1 in 10 people have diabetes. This is a disease associated with a person’s inability to properly regulate and use the glucose in their blood, and the long term health problems that result from consistently high blood sugar. Type I and Type II have comparable symptoms, but differ in the biochemical cause of insulin malfunctioning. Type I, for example, typically starts at a young age and is a result of the patient’s immune system attacking the cells responsible for insulin production. Because of this, Type I diabetics usually have to inject insulin, whereas Type II diabetics do produce insulin, but it is either in inadequate amounts or it is ineffective. Type II diabetes is treated with medication and lifestyle changes, but not usually insulin injections. [7] The prevalence of this disease depends greatly on many non-biological factors, and choosing a treatment without taking these into account is unwise. Because diabetes varies greatly, in both the type of people it commonly effects, and the treatment option that works best for each person, assessing it from different anthropological perspectives can give us valuable insight into its contributing factors and how to manage them.

Race is a huge factor in risk for developing diabetes, in fact, according to the National Diabetes Education Program, half of all black women, Hispanic women and Hispanic men will eventually develop Type II diabetes. Furthermore, Native Americans are twice as likely to have diabetes as non-Hispanic whites. This doesn’t necessarily illustrate a biological link between race and diabetes risk, because it is important to account for the oppression and poverty often associated with being non-white. Ann McElroy does point an important biological explanation for diabetes, however, citing the harsher conditions humans evolved to survive under thousands of years ago. She explains how a “thrifty metabolism” would increase odds of survival because food supply was inconsistent, but in modern times it is often linked to obesity and diabetes.[6]

Because this is a chronic disease whose treatment is carried out largely by the patient, it is important to build trust and understanding between doctor and patient. People in different cultures find relief from different forms of healing, and incorporating elements of their healing with biomedical ones can be critical to a patient receiving the care he needs. Patricia Brown tells us of a particularly delicate situation in California in regards to Hmong refugees and respecting their beliefs about medicine. In order to treat patients and respect their beliefs, and Shaman program was brought to life, and according to Dr. John Paik-Tesch, it has “built trust both ways,” between the doctor and the Hmong. Shamans use different rituals to help patients with diseases like diabetes, and because the Shaman has a basic understanding of biomedicine, he can also facilitate communication between the doctor and patient, a relationship that is critical to the patient receiving the best treatment option. [1]

For those who cope with diabetes, especially Type I, managing the disease requires constant attention and careful diet choices. The illness narrative part, therefore, can be a significant part of how a patient copes with their disease on a daily basis.[8] 11-year-old Anna Mclean walks us through a day in her life, with a remarkably positive attitude, explaining how she experiences and copes with the disease in different situations, what having the disease is generally like, and how she brought meaning to her diabetes by spreading awareness and encouraging support of the Juvenile Diabetes Research Foundation. [2] I would argue that, like any other chronic disease, knowing and sharing stories with other diabetics is a significant part of how a patient deals with their disease. Talking about other people’s coping strategies, sharing recipes and suggestions can help a patient feel more comfortable with their disease and give them greater confidence in their ability to deal with it. In the words of Dr. Jim McDiarmid, “social support and beliefs affect a patient’s ability to rebound from illness”[1]

As we know, diabetes is a disease the patient is largely responsible for managing, and because of this it is critical the patient understand the nature of their disease, the medications and other strategies they can use to deal with it, and how/when to administer treatment. This repertoire of knowledge is part of what might qualify diabetics as expert patients, and has the potential to make the patient believe they know better than their doctor,[9] especially if a celebrity, like Paula Deen, is telling them so. This is because “their wealth and status afford them access to the best medical expertise and care and as a result, consumers place particular value on their healthcare decisions.”[4] Doctors and their patients should be wary of this, however, because celebrities seldom fully understand their disease and they are usually paid off by pharmaceutical companies to promote certain drugs. [4] It is certainly true that the post-industrial trends like mass production and consumer capitalism have influenced how we understand health today, and therefore how we understand illness and treatment, so we must also take these into account when choosing a treatment plan. [9]

The Explanatory Models Approach could be an appropriate way to deal with diabetes as a medical professional, and it provides a platform for doctors to openly communicate with their patient  while “setting their expert knowledge alongside (not over and above) the patient’s own explanation and viewpoint.” [5]The 6 “mini-ethnography” steps outlined by Kleinman and Benson each touch on different non-medical factors that tell us important information about the patient’s background, beliefs, experiences, and lifestyle, and are therefore crucial to choosing a treatment that works for both the patient and doctor. Though these 6 steps address different aspects of a person’s identity, they share a clear theme of assessing what a patient values, whether it be their beliefs, cultural practices, or their day-to-day life, knowing these things can help find the best course of action. Or, in other words, “If we were to reduce the six steps of culturally informed care to one activity that even the busiest clinician should be able to find time to do, it would be to routinely ask patients what matters most to them in the experience of illness and treatment.”[5]

With a disease like diabetes, biomedical knowledge barely scratches the surface of useful information, and it is critical that we use anthropological approaches when trying to understand the true nature of the disease and why it impacts who it does. In each approach, value is placed primarily on the individual patient’s experience, beliefs, and comfort in communicating openly with clinicians and peers. Because the essence of all of these are addressed in the 6-step Explanatory Model, I would be most inclined to employ it. To be frank, a clinician who fails to use at least part of this Model to help a diabetes patient is being irresponsible and disrespectful. This is because diabetes and the appropriate treatment are closely tied to factors addressed in said model. Overall, diabetes is a disease we can learn a lot about by learning about its patients and how they live their life. Because the patient is responsible for their own wellbeing, it is critical we provide them with a treatment they feel comfortable using or else they may refrain from doing so. In order to figure out the treatment they are comfortable with, however, it is clear that biomedical knowledge is less helpful than the knowledge revealed through anthropological approaches.

[1] Brown, Patricia Leigh. “A Doctor for Disease, a Shaman for the Soul.” The New York Times. September 19, 2009. Accessed August 18, 2016. http://www.nytimes.com/2009/09/20/us/20shaman.html?_r=3.

[2] Christimclean1313. “A Day Living with Diabetes.” YouTube. July 22, 2010. Accessed August 18, 2016. https://www.youtube.com/watch?v=AVUOIr8Etow.

[3]”How Diabetes Affects Minority Groups.” National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/-/media/Files/Diabetes/Diabetes-in-Minority-Groups_Infographic_508.pdf?la=en.

[4]Karim, Tazin. “The Commodification of Celebrity Health.” Anthropologies. March 25, 2013. Accessed August 18, 2016. http://www.anthropologiesproject.org/2013/03/the-commodification-of-celebrity-health.html.

 

[5]Kleinman, Arthur, and Peter Benson. “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It.” PLoS Med PLoS Medicine 3, no. 10 (October 24, 2006). doi:10.1371/journal.pmed.0030294.

 

 

[6]Mcelroy, Ann. “Evolutionary and Ecological Perspectives.” Encyclopedia of Medical Anthropology, 2004, 31-37. doi:10.1007/0-387-29905-x_4.

 

[7]”Types of Diabetes | NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases. February 2014. Accessed August 18, 2016. https://www.niddk.nih.gov/health-information/diabetes/types.

 

 

[8] “Week 4: Lecture 2.” ANP 204 Introduction to Medical Anthropology. 2012. Accessed August 18, 2016. http://anthropology.msu.edu/anp204-us16/lecture-videos/week-4-lecture-2/.

 

[9]“Week 5: Lecture 2.” ANP 204 Introduction to Medical Anthropology. 2012. Accessed August 18, 2016. http://anthropology.msu.edu/anp204-us16/lecture-videos/week-5-lecture-2/.

 

 

 

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