Blood Sugar: Racial Pharmacology and Food Justice in Black America by Anthony Ryan Hatch
Blood Sugar is a highly readable account of the emergence and import of “metabolic syndrome,” a biomedical category of risk designed to capture the dangers of stroke, heart disease, and diabetes posed by the combination of potentially pathological characteristics: high blood pressure, high blood sugar, abnormal cholesterol, and high waist circumference. Metabolic syndrome provides a fascinating window into contemporary racialized biomedical conceptualizations of risk, and Blood Sugar is the first sustained sociological analysis of it. [End Page 145]
The book explores the “politics of metabolism,” which author Anthony Ryan Hatch defines as “the ideas, social practices, and institutional relationships that govern the metabolic health of individuals and groups” (p. 7). These operate across a range of scales, from “government health-research institutions, pharmaceutical corporations, and professional medical associations” to “biochemicals, DNA, and prescription drugs” (p. 7). Hatch’s evidence is drawn mainly from published medical journals, complemented by reflections on his own experiences and broader observations. One of the most distinctive features of the book is that Hatch weaves macroscopic and microscopic technoscientific accounts together with his own embodied experience as an African American man who has been living with diabetes since 1992. The analysis of all of these registers is theoretically informed, drawing on critical race theory, biomedicalization, and Foucauldian biopower.
Hatch’s analysis is guided by three questions (p. 11). The first concerns the intellectual history of metabolic syndrome: “How did metabolic syndrome emerge as a new discourse in the politics of metabolism?” (p. 11). This is rendered as a Foucauldian genealogy rather than a progressive history. It includes fascinating stories of early statistically driven categories of risk, such as French physician Jean Vague’s 1940s elaboration of the notion of “index of maculine differentiation” and its attendant “android obesity” as a metacategory of risk for both heart disease and diabetes (pp. 46–48), and American physician Gerald Reaven’s 1988 coining of a metacategory of risk driven by insulin insensitivity, the melodramatically named “Syndrome X” (pp. 52–55).
Hatch’s second question is fundamentally epistemological: “How are current conceptions and meanings of race constructed through the science of metabolic syndrome?” (p. 11). This scientific racial construction comes to the fore in an incisive chapter provocatively titled “The Scientific Racism of Metabolism” (pp. 61–75). Hatch explores such issues as the problem of defining “ethnicity” as a “cause” of metabolic problems (p. 61). This component complements other recent scholarship in race and medicine that has explored other specific physiological and disease states, such as lung capacity, cancer, schizophrenia, and heart disease.
Hatch’s third question extends his analysis beyond the spheres of scientific medicine: “What are the implications of this emerging relationship between metabolic syndrome and race for understanding the construction of racial meanings and the reproduction of racism within the politics of metabolism?” (p. 11). This becomes a route into discussing the broader issues of “food justice in Black America,” promised in the book’s subtitle. Hatch discusses both the brutal origin of African Americans’ relationship with sugar, since sugar was an important cash crop in slave economies (p. 100), and the context of the contemporary relationships between race, social class, transnational food corporations, and neoliberal capitalism (p. 106). This leads to some of the book’s most interesting synthetic analysis, across questions of food and pharmaceuticals: “the economic interests of agricultural and pharmaceutical corporations operate in our very bodies and shape the politics of metabolism in ways that go beyond posing food and drugs as disconnected political issues” (p. 107). [End Page 146]
The book closes with “prescriptions,” including calls for a “boycott of all foods that require laboratories, scientists, and factories for their mass production,” and a call to “become . . . better educated about the potential benefits and real dangers of all pharmaceuticals compared to nonpharmaceutical forms of healing and wellness” (p. 119). Hatch argues that this should not be reduced to policing individual-level food choices, however, and that “we need to scrutinize and criticize the systems of choices for food and healing presented to us through the politics of metabolism” (p. 120). These are not altogether satisfying solutions for the deeply entrenched problems that the book has described, but perhaps that’s fitting. Blood Sugar will be of interest to scholars across academic fields and even to nonscholarly readers, but there will be no easy answers.