“This kind of reminds me of Mr. Burns from The Simpsons, during that episode where he has somehow managed to contract every single disease known to man, but remains alive because each of his symptoms cancel each other out; they operate in equilibrium relative to each other,” Dr. Rob Sargis retorts, an emergent grin illuminating his face. As he transitions to his next slide, Dr. Sargis, an endocrinologist at the University of Chicago’s Pritzker School of Medicine, turns to his captive audience. His presentation (a summary of a paper he co-authored about environmental toxins’ direct effects on genes and gene expressions linked to the development of type-II diabetes), given on May 23rd at the Quadrangle Club as part of the Frizzell Family Memorial Lecture series, touched on the intersection of endocrine health, social justice, and ecological balance as informants of policy—a vital intersection that explains “big picture” origins of societal circumstance but far too often goes neglected in favor of rigid reductionism into individual components or disparate, hyper-specific, and incompatible analyses from different disciplinary perspectives. In a way, this intersection functions much like the curious physiology of “invincible” Mr. Burns: the lines along which it exists dynamically combine to both sculpt and sustain systemic realities—problematic realities, which enable the propagation of inequality through vicious, hard-to-break cycles of privilege and oppression—but largely universal ones, whose rising economic, medical, and humanitarian costs necessitate immediate, intelligent, and intersectoral action.
“This,” Dr. Sargis continues, pointing to a color-coded map of the United States, “displays information from the literature my lab and I have compiled about communities across the country who have most heavily been exposed to arsenic.” He pauses, then asks, “What do you notice about the where these communities are located and what they have in common?” Within a minute, several brave audience members collectively eke out a complete, correct response—namely, that the population areas at highest risk of arsenic poisoning lie in post-industrial, socioeconomically depressed neighborhoods and towns, among them the poorest regions of Chicago’s Southeast Side and, more broadly, the Calumet. “It’s a wonder that under a century ago, arsenic-containing products were marketed to women as beautifying creams and concealers,” Dr. Sargis remarks, as old magazine ads juxtaposed with horrifying images of skin lesions induced by arsenic poisoning flash across the projection screen.
“Moving on. This is the chemical structure of tolylfluanid, a compound commonly found in industry-grade pesticides. In mouse trials, its ingestion has been linked strongly to type-II diabetic phenotypes, such as abnormal insulin levels, changed metabolic rates, and obesity.” Asked about how valid these findings are for policymaking purposes, given that they exist not in isolation but in combination with other public health risk factors prevalent where these findings are most applicable (e.g., food deserts, where harmful dietary habits are common due to lack of access to fresh, healthy foods; isolated zones suffering from high crime rates, where working class individuals and families have little time or safe space to exercise; and other environmental pollutants or contaminants), Dr. Sargis returns to intersectionality: “Diabetes is more than just a medical issue; it’s a social justice issue. That’s why I’m so passionate about researching it.” Making a quick point about how even the best of models, methods, designs, and techniques are unable to account for every real-world situation, he emphasizes the need to maximally capitalize on available data and incorporate elements of research into analyses, plans, and implementation strategies only as discrete building blocks of larger systems—as some of many means to an end, not as ends in and of themselves. Essentially, this need denotes the crux of his arguments and fundamentally motivates his paradigms and approaches.
While Dr. Sargis presents findings that seem alarmingly and discouragingly bleak, hope is far from lost. There still exist numerous workable and cost-effective solutions that could prove revolutionary in reversing some of the troublesome trends revealed. For instance, relatively recent research on selenoproteins, which when activated by the trace element selenium (introduced into body systems via ingestion) counteract the mechanistic action of arsenic, suggest that fortifying the diets of heavily-affected areas’ residents with selenium might very well mitigate the most serious symptoms of arsenic poisoning. Coupled with other sensible (and community-motivated) policy interventions addressing sociological, political, and economic realms of inequality, the case for environmental justice in endocrinology—though comparatively new—is sound, innovative and practical. Moreover, it (re)orients the field of medicine back toward its Hippocratic ideal: that of a rigorous science simultaneously rooted in the noble art of the personal. And perhaps, if enough contemporary practitioners embrace this ideal, along with the lesson Mr. Burns from The Simpsons imparts (rather solidly—all things considered—if unintentionally) about intersectionality, global society can begin to tackle the paradoxes of its own progress.
The Paradox of Progress: Environmental Disruption of Metabolism and the Diabetes Epidemic
Brian A. Neel, Robert M. Sargis
(Diabetes Jul 2011, 60 (7) 1838-1848; DOI: 10.2337/db11-0153)
Paradox of Progress: Environmental Origins of Diabetes
Sargis, Robert M., M.D.
(2016 Frizzell Family Memorial Lecture. The University of Chicago Quadrangle Club, Chicago, IL. 23 May 2016. Lecture.)