Consumption (56 page)

And as we deracinate ourselves, sadness settles over us. We lose the nourishment that roots provide us. We replace that nourishment with other satisfactions: mobility and movement, anonymity and freedom. These are all very satisfying things, which is why people pay a steep price to obtain them. But
roots remain necessary—no matter how thin and chemically enriched the substrate of one’s growth.

I travelled to the Pacific Islands at the end of my career in Rankin Inlet, to visit friends I had known in the Arctic. The account of their migration is an interesting one, but not my subject here—I will confine myself to the following: they both sought escape from what had become too familiar.

One of them was the priest I lived alongside, if not precisely with, all those years on the tundra. The other was a young man who I delivered in the Arctic; he sailed south from Rankin Inlet on a sailboat that had overwintered on Marble Island, off the coast near there. They arrived on Hiva Oa independently and when the priest learned of the other’s existence, he sought the younger man out and visited him, then wrote me a letter telling me this news. Never close when they lived beside Hudson Bay, on this warmer ocean, the priest eats supper with the young man and his wife every other Saturday night.

When I went to dinner at the young man’s house, the local doctor was also a guest, a Parisian woman who told me about the way diabetes was sweeping the islands, diabetes and gout and vascular disease and
crises cardiaques
(a phrase that captures the urgency of the moment nicely), and how none of these had existed twenty years earlier. She could not have been more than thirty, and spoke with the sort of fervour I was capable of at that age. The wind off the sea moved through the little house and my friend’s baby cried briefly in her crib, settling when her mother tucked a sheet over her. It seemed both utterly dissimilar to and exactly like the Arctic.

My young friend told me that he would remain in this place, that here he was able to accept change, because he was less a part of it. He had given up on the traditions of the Inuit, and although doing so had wounded him, he could bear the loss if he was not constantly confronted with it. Here he dealt with the place as it was—he did not agonize over what it had been. The priest, also at supper that night, listened and did not comment. The man’s wife had heard this from him already—I could tell from the way her nodding anticipated his words—and when he was done, she told us stories of the islands, of the way
her people had died when the French came. The Marquesans, the most dominant of all the Polynesian cultures, had wilted like cut stems at contact. The Marquesans were one hundred thousand when European boats first visited them. Now they are ten thousand.

These were melancholy tales, and when the priest and I walked back to the rectory to sleep, we did not speak.

What I thought about was whether anyone knows with any certainty whether people in other times were more sad or more happy than they are now. I think that this much is true: when they were sad, they were sad about the relentless death of their children, the failure of the crops and the hunt, the appearance of blood in the sputum of their wife. These were the daily facts of their lives. Probably all parents, no matter how inured, are eviscerated by the passing of a child, so the people of earlier times were likely very sad—and often. But I think they were less likely to be sad about nothing, in the way we are. Which is the state that words like
anomie
try to describe, which psychiatrists endeavour to treat with their serotonin-receptor antagonists. It is the state that poisons us and our ambitions, leading us to immobility.

And then I was at the door of the guest-house I had been lent. I said goodnight to my friend the priest and I watched him amble his way down the moonlit path to the main residence. I thought how odd it was, that the process that leads us to static motionlessness begins as a response to too-rapid change. In the palm trees all around, the wind roared.

sweet blood

When I first came to the Arctic I was told by the other doctors I worked with how different medicine was here. There was rabies in the foxes and every year we gave vaccinations to trappers who were unwary; bear and dog maulings were common; there was still endemic tuberculosis; and “seal finger,” an infection acquired while skinning seals that involved an unusual bacterium unresponsive to conventional antibiotics. The Inuit also smoked heavily, and had since the whalers from New England started coming a hundred years ago and paid the Inuit hunters for being crew with tobacco. That completed an interesting circle of exchange of that little weed: Indians to Caucasians (Kablunauks up here, meaning “hairy eyebrows and bellies,” as a tribute to New Englanders’ hirsutism) to Inuit. And so we treated emphysema and lung cancer, just as in the south.

But there was no diabetes, except among Kablunauks, and almost no heart disease or stroke. This, in a people who, until twenty years ago, confined their diets almost exclusively to animal fat and protein, except when they ate the stomach contents of the caribou and muskoxen. (Which sufficed to prevent scurvy, but surely could not have been their favourite part of the day.) Almost all their calories were animal fat. For years the Rankin Inlet Clinic kept bottles of clot-dissolving thrombolytics on its shelves to treat heart attacks and yet the drug was never given.

The absence of vascular disease in this part of the Arctic is an astonishing thing for a physician trained in the south. Working here is like walking off a noisy city street into a silent cathedral. Vascular disease kills a hundred
million people every year. The worldwide toll from banal and familiar heart attacks and strokes exceeds that of wars and malnutrition and AIDS by a factor of eight. Fifty-five per cent of us will die of atherosclerosis, hardening of the arteries, in one or another of its manifestations: the strokes and heart attacks mentioned above, but also peripheral vascular disease and blood clots, and atherosclerotic kidney disease and abdominal aortic aneurysms. This affects every single one of us. The minority who do not succumb to vascular disease directly avoid it only by dying of malignancies and pneumonias first. Every old person who grew up among automobiles and plate glass has this disease. But none of the Inuit do.

Our blood vessels tighten into wiry strictures; our limbs grow progressively cooler and die in blackened gangrenous agony, just as our hearts and our minds do when the lumina of those blood vessels finally occlude completely. And yet we are inured to it, understand it to be “normal,” an essential expression of who we are and what we must endure, like consumption was in another age. Living in the south, it is an easy mistake, to think that vascular disease is the unavoidable conclusion of a life spent on this earth. Then one comes to the Arctic and immediately wonders why it is so noisy outside.

The thrifty gene is a concept that describes the changes seen among hunting-gathering peoples as they are acculturated. It exists both as an idea and as a sequence of nucleic acids; the genetic trait is common to most of the indigenous peoples of North and South America, and to most Pacific Islanders as well. It represents an evolutionary response to the problem of recurrent famine, altering the way fat tissue and the brain communicate with each other, prompting people to eat aggressively whenever food is available and to avidly store those calories as fat. Clearly, heading into famine with an extra fifteen pounds under the belt is a helpful thing, and the Darwinian pressure in favour of such a trait must have been significant on the islands of the South Pacific and in the Indian settlements in the taiga of the North American Subarctic.

But what was an adaptive trait in a traditional setting has become profoundly maladaptive in the era of unlimited cheap calories. All through the tropical Pacific, and the native settlements of North and South America, obesity, and the consequent diabetes and vascular disease, is exploding in prevalence. These are peoples who were devastated by European diseases; tuberculosis, smallpox, and influenza all killed millions in waves of epidemics that swept through these places over the last five hundred years. But the worst thing that ever came from the contact between traditional and European cultures is turning out to be Spam. And Cheez Doodles. And Cherry Coke. All available in little stores on tropical islands and Indian reservations and small Arctic communities for a bit of money and no physical effort at all.

These are bodies designed to anticipate extraordinary stressors in the coming rainy season or freezing winter. These are bodies prepared for the need to work to the point of muscle-shaking exhaustion on a few hundred calories of chewed sinew or dried taro root. The problem of limiting caloric intake is not one that has previously arisen. For millennia upon millennia, there was no such problem as too much food.

Until the late 1970s, diabetes was still uncommon among the indigenous peoples of the Subarctic, the Cree and Dene of Northern Ontario, Quebec, Manitoba, and Saskatchewan. Research efforts were undertaken to understand why the Cree, for instance, seemed relatively immune to diabetes. Then the disease appeared like a pall in the desperate reservations in the taiga. Now, half of adults in some reserves are diabetic. The dialysis population doubles every three years. The immunity proved relative indeed.

There are two types of diabetes. Type I, sometimes called juvenile onset diabetes, though it need not develop in childhood, consists of a failure of the pancreas to secrete adequate amounts of insulin, usually as a consequence of an assault by the body’s own immune system. This used to be by far the most common type of diabetes, and was the type that Banting and Best addressed by administering insulin derived from pig and cattle pancreases. It is not
related to obesity, is not really preventable, and its incidence has changed relatively little over the last century.

Ninety per cent of diabetics today, in every developed society, have type II diabetes. This disease is not really a variant of the other but a distinctly different circumstance, as different as obesity is from anorexia. It ought to have a different name. Here, the pancreas is initially healthy, and produces insulin as it should, but the insulin receptors in fat and muscle cells are resistant, numb, to its effect. The body is dependent on the activation of such receptors to be able to take sugar up from the bloodstream and metabolize it into energy, or store it as fat. When it can’t do this, the sugar levels in the blood rise, the pancreas senses the elevated glucose levels, and so pumps out more than normal amounts of insulin. By pumping out steadily increasing quantities of insulin, it is able, for a time, to overcome the increasingly benumbed insulin receptors and to maintain appropriate levels of sugar in the blood.

But, like the heart that pumps for years against too-high blood pressure and then dilates and fails, eventually the pancreas becomes overburdened and is no longer able to secrete enough insulin to maintain normal blood glucose. Indeed, when the pancreas fails, it often ceases to be capable of secreting even a normal quantity of insulin into the blood. The problem in the late stage of type II diabetes is insufficient insulin combined with insulin resistance. The body is hit from both sides of the equation, like a bushfire in drought—there is the problem and there is the absence of what you need to solve it.

Eight per cent of North Americans have diabetes as it has been traditionally recognized—by elevated blood sugar levels. Five times as many have insulin resistance—the metabolic syndrome. Essentially every obese hypertensive is insulin-resistant and, today, the majority of American adults are overweight. The prevalence of diabetes is increasing logarithmically—as is obesity and insulin resistance, its precursor states.

It is an appalling and demeaning illness; ulcers develop in the cold and unoxygenated feet and progress steadily, rotting off limbs—modern-day leprosy. Diabetes is the most common cause of amputations anywhere it is prevalent. The high concentration of sugar in the blood paralyzes the white blood cells and infections of every sort arise: bladder infections and yeast
infections and, especially, awful, stinking skin infections caused by fungi and bacteria and anything at all that wants to eat sickened sweet flesh. The odour of a person with long-time poorly controlled diabetes is like rotten milk. The ability of too-sweet blood to cause blindness and the swelling malaise of kidney failure comes as no surprise to anyone who understands the disease’s character. Diabetes is the commonest cause of these indignities anywhere people are fat.