Doctoral Dissertation Grant: An Ethnography of Chronic Disease Risk and Pre-Diabetes

这个项目研究风险是如何成为生物医学干预的对象的。它将探索生物医学风险实践和话语如何改变当代社会生活。为了阐明这些过程，研究人员将研究城市环境中的糖尿病前期现象。糖尿病前期是一个新的、迅速扩大的诊断类别。这个术语的使用说明了监测和管理血液中葡萄糖的新方法。它正在创造一个介于疾病和健康之间的广泛且不断增长的高危人群。该项目将探讨关于风险的论述和风险规避的必要性。它将引起临床医生、医生、患者、家庭成员和卫生保健政策制定者的兴趣。糖尿病前期？诊断正在成为个人健康状况的标志，与2型糖尿病一样，它也正在成为国家危机的象征。为了在此背景下分析糖尿病前期诊断，研究人员将在城市社区进行为期12个月的人种学田野调查。该项目将以四个研究问题为指导：(1)糖尿病前期是如何作为一个正式的诊断类别被产生、争论和巩固的？(2)糖尿病前期是如何被临床医生和接受预诊断的个人沟通、理解和采取行动的？(3)糖尿病前期人群的幽灵是如何动员起来的政治和文化舞台？以及(4)糖尿病前期病例如何促进我们对风险作为一种社会现象的理解？为了回答这些问题，调查人员将与糖尿病专家、医疗保健提供者、政府和卫生系统官员、健康活动家以及患者及其家人进行面谈。此外，它还将在三个初级保健诊所、针对糖尿病前期患者的教育计划以及科学会议上进行广泛的参与者观察。这些发现将有助于解决预防医学的兴起、相关生物标志物的监测以及将风险状态转换为诊断类别的学术问题。

This project examines how risk is made into an object of biomedical intervention. It will explore how biomedical risk practices and discourses are transforming contemporary social life. To illuminate these processes, the investigators will study the phenomenon of pre-diabetes in an urban environment. Pre-diabetes is a new and rapidly expanding diagnostic category. The use of the term speaks to new methods of surveillance and management of glucose in the bloodstream. It is creating a wide and growing at risk population that is situated between ill and healthy. The project will explore discourses of risk and the imperative of risk avoidance. It will be of interest to clinicians, physicians, patients, family members and health care policy makers. The ?pre-diabetes? diagnosis is becoming a marker of individual health-status that is also emerging, alongside type 2 diabetes, as a symbol of national crisis. To analyze the pre-diabetes diagnosis in this context, the investigators will undertake 12 months of ethnographic fieldwork in an urban community. The project will be guided by four research questions: (1) How has pre-diabetes been produced, contested, and consolidated as a formal diagnostic category? (2) How is pre-diabetes communicated, understood, and acted upon both by clinicians and the individuals who receive this prediagnosis? (3) How is the specter of the pre-diabetic population mobilized political and cultural arenas? and (4) How does the case of pre-diabetes advance our understanding of risk as a social phenomenon? To answer these questions the investigators will conduct interviews with diabetes experts, healthcare providers, government and health system officials, health activists, and patients and their families. In addition it will conduct extended participant observation in three primary care clinics, in an educational program directed at pre-diabetics, and at scientific conferences. Findings will contribute to scholarship addressing the rise of preventive medicine, the associated surveillance of biomarkers, and the conversion of risk states into diagnostic categories.