Why did I bring asceticism in? It definitely draws from Max Weber’s analytics. Weber took up Marx’s work and said that he’d removed the particularity of capitalism by making it explainable by a political economy; instead, he said, let’s look at the cultural forms that comprise capitalism. Similarly, the anthropology of “biosociality” or “life itself” can come across as “pure,” as if the market and some idea of the “biological” are what determine the biosciences; this risks reproducing the very rationality and cleanness of the biosciences. The asceticism I am studying is not an extension of a rational political economy—it has other cultural roots. It is not simply that the subject must be compliant. It is an ethical responsibility to want to take in these biomedical forms. People should come to desire to be compliant. With the chronic diseases, there is an ethics to it: the idea that the patient is not taking care of him or herself but, echoing Foucault, that technologies of the self are technologies of the family. People owe it to their children and they owe it to the state to take care of themselves. But genetics has a way of removing the moral framework from the study of the disease.

There is an amazing cleanness to the transfer of the languages of diagnosis between the U.S. and the Caribbean, and there is a huge amount of literature on the kinds of patients produced in the compliance framework. There’s a reason to go into the ascetic patient more thoroughly. The genetics part of this is interesting, since it seems to circumvent the social, erasing the possibility of recognizing the impact of social conditions. Genetics racializes and categorizes, but your work brings the social back in. Since genetics can establish who is pre-diabetic (who has to be compliant before they even have the disease), it treats a social future.

Weber developed his understandings of secularism relative to specific places and traditions. What we know about global health is in large part based on the choices we’ve made to do research. Are there some places in the world that for one reason or another are more often apt to be the subjects of research? Are there places that are convenient for certain sorts of things? Denmark is popular because they have meticulously recorded studies. What is Barbados’ draw? It’s poverty? That people might be bribable? That they can’t say no? Does that make them ascetic or just poor?

Why research in Barbados? They are poor, but they can also be made to stand in for African Americans. Researchers get to deal with “African-Americans” without dealing with the “hostility” of urban African-American communities in the U.S. And why Barbados within the Caribbean? The country has a highly viable public health system and the government works to attract the research.

What is interesting about Barbados is that it is one of a series of places that has used the genomics revolution to sell itself to the market. If one goes back to Weber, one cannot really talk about ethics without looking at his sociological arguments about organization and the disciplining of the churches, for example. By particularizing ethics that way, one can make it do much more work comparatively.

From a Weberian point of view, you are actually talking about a capitalist subject that was formerly a Protestant. Would there be anything to be gained ethnographically by sticking to the religious connotations of ascetism?

Pentecostalism is exploding across the world. Fifty percent of those coming into clinics in Mozambique attend Pentecostal churches. AIDS is still seen as a sign of being a sinner, but adhering to treatment becomes a moral duty. You might think about looking at real, actual religious adherents.

What is the nature of the clinical interaction versus how Barbados is setting itself up as a client of U.S. patrons? There are multiple levels of paternalism here. How far down does it go? What is made of obese children? What happens to the parents who are being held responsible for those children?

On the issue of compliance and some of its legal consequences. According to health systems economist Uwe Reinhardt, conservative policy-makers are picking up on this idea of holding people responsible for obesity. As they bring the risk of disease upon themselves, these patients should also pay more for their treatment. In this framework, the patient is compliant but the patient is also more liable.

I would like to hear more about the racialization of metabolic syndromes. How does the correlation between excess behavior and race square with other places (like Poland) with a lot of metabolic disorder drug trials going on? One could argue that excess is everywhere and that it does not need to have a final resting place in ethnicity or race. Why do some metabolics get the genetic label and others don’t? Also, it may be convenient for the researchers to not face their neighbors in Baltimore and to go to Barbados instead, but how does that enterprise find validation as “good science”?