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51 chapter three Our Genes ­Don’t Match Your Culture Japa­nese Narratives about the Origins of Type 2 Diabetes Theories of medicalization and biomedicalization have generated new perspectives on the pro­ cesses transforming biomedicine and expanding its domain beyond illness to health itself. Although most empirical work engaging with the biomedicalization framework is still U.S.-­ based, biomedicalization scholars have always argued that medicalization and biomedicalization are not merely North American phenomena. Rather, “­ these transformations of medical care and of life itself are, of course, increasingly exported and (re)modeled as well as being produced elsewhere . . .” (Clarke et al. 2010: 32). This chapter examines medicalization and biomedicalization in their “transnational travels” by analyzing the construction of the type 2 diabetes epidemic in con­temporary Japan. I use grounded theory to situate and model the ways in which risk for diabetes is explained by Japa­ nese health professionals, patients, and other lay participants during interviews. In the pro­ cess, I draw connections between differences in the biomedicalized production of risk for diabetes in Japan and broader social patterns that provide the raw material from which risk is conceived and constructed. Like the United States, Japan is among the world’s most affluent socie­ties, and the dominant approach to health care and maintenance is technologically advanced biomedicine. The Japa­ nese and American medical communities share similar empirical, often reductionist, approaches to the production and adjudication of best practices in medicine. And de­ cades of exchange programs, fellowships, and cooperation agreements between Japa­ nese and American universities have brought generations of Japa­ nese physicians to American medical centers on a temporary basis. However, ­ these similarities have limits. As Shobita Parthasarathy (2012) demonstrates in her work on BRCA testing in Britain and the United States, we should not assume that shared emphasis on empirical medicine ­will necessarily lead to identical conclusions about best practices; the influence of national context on practice can be profound. As an example of techno­ scientific biomedicine outside the West, Japan has much to contribute to North American scholars’ expanding understanding of biomedicalization. 52 Chapter Three As I argued in Chapter 1, biomedicalization has progressed in Japan along several of the dimensions articulated by ­others (see Clarke et al. 2003, 2010). The focus on health has intensified, and states of pre-­illness or potential illness have been demarcated, denormalized, and increasingly managed through biomedical intervention. This is particularly true of diabetes: in Japan, it is common for patients to be diagnosed and managed for impaired glucose tolerance (IGT) years before they develop type 2 diabetes. Second, the intensifying emphasis on surveillance and risk, particularly for age-­ related changes, puts Japan at the forefront of global biomedicalization. Most laypeople are able to articulate surprisingly detailed risk profiles for chronic disease and turn to biomedicine not only to diagnose and treat ­these diseases, but as the authoritative source for insight into the lifestyle that ­will prevent them and maintain normality. Fi­ nally, the production of risk is a key feature of biomedicalization in both the United States and Japan, yet it is constituted differently in the two countries. As a consequence, the implied moral imperative to manage that risk is also constructed differently—­ shaping how ­people with diabetes are assessed by their health care providers and peers. The public health narrative casting the increase in type 2 diabetes and IGT as an epidemic—­ and an epidemic with a clear source—is part of this production of risk. The interviews analyzed in this chapter document the construction of the type 2 diabetes “epidemic” by laypeople, diabetes patients, and biomedical health professionals. Interview participants cast Japan’s diabetes epidemic as a morality tale about the nature of Japa­ nese identity, mirroring a trope that stretches back at least as far as Japan’s modernization period. In stark contrast to the American diabetes epidemic narrative explicated in the previous chapter, this narrative emphasizes the particularity of diabetes risk to the Japa­nese body in con­temporary, globalized Japan. In the following sections, interview respondents respond to questions about how diabetes came to be an epidemic in Japan. Many use culture as an explanatory device. The idea that Japa­ nese culture is essentially unique has long been rejected by most social scientists and theorists. However, this theme is pervasive in popu­ lar discourse. Explanation and belief are not the same ­ thing. The fact that a narrative is pervasive does not mean it is in earnest . Pervasiveness is impor­ tant, though, ­ because it indicates the...


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