Blood Sugar: Racial Pharmacology and Food Justice in Black America by Anthony Ryan Hatch (review)

First defined in 1956, metabolic syndrome is the confluence of high blood pressure, high cholesterol, high blood sugar, and excess weight. When present simultaneously these signs indicate the potential for serious health complications. Metabolic syndrome is a highly profitable niche for drug companies, a source of anxiety for public health advocates and doctors, and, as Anthony Ryan Hatch deftly shows, a site of racial meaning-making in the United States. In Blood Sugar he offers a brief, informative history of metabolic syndrome together with a critique of the racializing processes at work in contemporary biomedical and pharmaceutical research and regulation.

Hatch frames anxieties about metabolic health within a history of race and corporate-government collaboration, criticizing the multiple ways that research and drug production for metabolic syndrome embed inferences about race. He offers a discursive analysis of scientists’ and regulators’ work, reading medical studies, corporate documents, and government reports, among other materials. To build his argument, Hatch draws on critical race theory and theories from science and technology studies, cogently distilling complicated concepts, including Michel Foucault’s biopower, Michael Omi and Howard Winant’s racial formation, and Bruno Latour’s technoscience. Some terminology will be familiar to readers, and Hatch juxtaposes ideas effectively to show that racial power operates through biomedical knowledge production. The clear exposition of theory also makes the book suitable for introductory courses in medical humanities or science and technology studies.

The author offers a compelling description of the process by which population-level studies of metabolic health reify racial categories. Rather than sharpening our ability to reduce health disparities between racial groups, researchers increasingly employ a “form of essentialism [which] positions race and ethnicity as heritable genetic structures that govern metabolic processes” (p. 71). This amounts to a new form of scientific racism when some researchers assert—without sound methodological basis—that race is an “immutable, fixed, biological, and genetic feature of bodies” (p. 111).

This is particularly problematic because racial categories that are used as variables in population studies are “often statistically associated with undesirable health outcomes, and in this context race is often interpreted as an individual-level risk factor” (p. 31). Race does not “cause” individuals to develop metabolic syndrome, regardless of the statistical correlation between race and elevated biomarkers at the population level. Yet this elision is precisely what Hatch detects in biomedical and pharmaceutical study. Researchers wittingly and unwittingly conceptualize “race as a causal and genetic concept” in their studies of metabolic syndrome (p. 62). Inferences drawn from population studies applied in the clinical setting can thus be obnoxious (at best) and discriminatory (at worst).

In chapter 5, Hatch focuses on metabolic health, nutrition science, and modern agro-food systems. This chapter is the least well-developed, though he makes the important point that rather than blaming individuals for eating too much sugar, we ought to demand accountability from food corporations and the government. They do too little to assure equitable access to healthy food, instead promoting foods that are cheap but unhealthy.

The problems are real, the risks are real, and Hatch does not deny that there are genuine concerns among researchers and practitioners hoping to improve our metabolic health. He affirms that the “knowledge of blood sugar made available through biotechnology is life-saving information” (p. x). Diagnosed with type 1 diabetes himself more than two decades ago, Hatch interweaves his own experience with the “politics of metabolism,” including the intensive self-surveillance, cyborg-like use of medication pumps, and close attention to diet.

The assertion that new metabolic technologies and practices can be lifesaving reveals a crucial conundrum. On the one hand, researchers have worked hard to show that there are persistent racial disparities in health outcomes resulting from social stratification. Likewise, what we know now about metabolism has improved (and enabled) life for many people. But it remains difficult to diagnose racial disparities and develop new treatments without creating...