The Politics of Metabolism: The Metabolic Syndrome and the Reproduction of Race and Racism

Abstract

Biomedical researchers, government agencies, and the pharmaceutical industry increasingly use the term metabolic syndrome to define the observed co-occurrence of the major biological risk markers for heart disease, type II diabetes, and stroke. The metabolic syndrome is a new feature in what I call the politics of metabolism, or the discourses, social processes, and institutional relationships that governs the metabolism of individuals and groups. The emergence of the metabolic syndrome reflects a growing network of scientific, state, and corporate actors and institutions that are invested in studying, regulating, and profiting from control over metabolism. Drawing on insights from critical race theory, science and technology studies, and Foucauldian studies of biopower, I analyze the metabolic syndrome as a new discourse about metabolism that continually draws upon racial meanings to construct individual and group differences in different kinds of metabolic risk.

The metabolic syndrome not only constitutes a new way of constructing, studying, and treating metabolic health problems, it also constitutes an emerging site for the production of racial meanings. Researchers use race in metabolic syndrome research and to study, prescribe, and label prescription drugs that may be related to the metabolic syndrome. I investigate the use of race and the metabolic syndrome in biomedical research on prescription drugs and African Americans. I develop the metaphor of killer applications to examine how prescription drugs operate in the politics of metabolism. A killer application is a superior technology that combines human and non-human elements that structure bodily practices in a wide range of social, commercial, and scientific contexts--prescription drugs have become the new killer applications in biomedicine. I argue that the search for killer applications has transformed the ways that pharmaceutical corporations study prescription drugs, metabolism, and race. I compare how drug researchers use race and the metabolic syndrome to study antipsychotics and statins in African Americans, how physicians' race-based diagnoses of schizophrenia and high cholesterol structure the prescribing patterns of antipsychotics and statins, and how scientists' assumptions about the genetic basis of racial differences in drug metabolism structure the debate about racebased drug therapies.