Participants: Jessica, Johnny, Jordan, and Justin
In their 2006 paper (abstract here) Schulz et al. studied two genetically similar groups of Pima Indians, one living in southern Arizona and the other in a relatively inaccessible area of the nearby Mexican Sierra Madre mountains. At a rate of 40.8% of the women and 34.2% of the men, the US group has the highest known incidence of diabetes in the world--the diagnosed disease rate among the women over 55 years of age exceeds 80%.
Before this study the diabetes rate in the Mexican Pima group was unknown. Tests in a research clinic revealed overall rates of 5.6% among the men and 8.5% in the women. A brief examination of the paper's Table 1 raises questions of survival biasing in the data. (Are the Mexican Pima incidence numbers so low because fewer people who develop the disease survived to be counted?) Survivor bias likely has some effect on the data, but it cannot account for the qualitative difference in the prevalence rates. Other markers such as impaired glucose tolerance (which would not affect survival) reveal significant differences in disease risk between the US and Mexican Pima groups.
How does this affect us as prospective health professionals?
In our discussion, no one was surprised by the paper's assertion that habits of exercise and nutrition were critical factors determining diabetes risk. So why is this paper valuable? It speaks to the power changes in personal habits in prevention of the disease. When a patient is told "this disease is hereditary", there is a risk that they will understand the disease to be inevitable. Fatalism surrounding disease contraction and course can cause serious problems in because it erodes patients' willingness to comply with a therapy. Survival rates do, after all, tend to zero over long enough periods.
In groups with a high incidence of a disease, there is a risk that individuals will be socialized to accept a preventable illness as "something that happens to us". Some Native American communities in the Southwest have come to expect that the disease will run a certain course: on the heels of a diagnosis early in life will come peripheral nerve problems, then eye problems and loss of fertility, then amputation and dialysis, finally followed by death. Schulz et al. provides a different narrative. You, the patient can do something about this, because a family history of diabetes puts you at risk of developing diabetes but doesn't ensure that you're going to get it. If you already have it, you can still do something for your children and grandchildren. They don't have to come down with this thing too.
How does this affect us as prospective health professionals?
In our discussion, no one was surprised by the paper's assertion that habits of exercise and nutrition were critical factors determining diabetes risk. So why is this paper valuable? It speaks to the power changes in personal habits in prevention of the disease. When a patient is told "this disease is hereditary", there is a risk that they will understand the disease to be inevitable. Fatalism surrounding disease contraction and course can cause serious problems in because it erodes patients' willingness to comply with a therapy. Survival rates do, after all, tend to zero over long enough periods.
In groups with a high incidence of a disease, there is a risk that individuals will be socialized to accept a preventable illness as "something that happens to us". Some Native American communities in the Southwest have come to expect that the disease will run a certain course: on the heels of a diagnosis early in life will come peripheral nerve problems, then eye problems and loss of fertility, then amputation and dialysis, finally followed by death. Schulz et al. provides a different narrative. You, the patient can do something about this, because a family history of diabetes puts you at risk of developing diabetes but doesn't ensure that you're going to get it. If you already have it, you can still do something for your children and grandchildren. They don't have to come down with this thing too.
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