A few weeks ago, Amy Moran-Thomas and 20 students in her class 21A.311 (The Social Lives of Medical Objects) were gathered around a glucose meter, a jar of test strips, and various spare medical parts in the MIT Museum seminar room, talking about how to make them work better.
The class had just heard a presentation from the president of the Belize Diabetes Association in Dangriga, Norma Flores, a nurse whose hospital had recently received a huge shipment of insulin that, although durable in theory, seemed to have spoiled in a heat wave. Flores and the students discussed whether scientists could develop temperature-stable insulin and design repairable glucose meters and other technologies for hospitals worldwide.
“Whenever people keep saying they are concerned about an issue, but the medical literature doesn’t describe it yet, there is a key question about what’s happening,” says Moran-Thomas. “Ethnography can help us learn about it.”
For Moran-Thomas, an MIT anthropologist, that class session was a way of connecting people and ideas that are too often overlooked. Flores was a central figure in Moran-Thomas’ 2019 book, “Traveling with Sugar: Chronicles of a Global Epidemic,” about diabetes in Belize and the failures of medical technology designed to treat it. (At the end of class, Flores surprised Moran-Thomas with a framed commendation from the Belize Diabetes Association for their nearly 20 years of work together.)
That approach informs all of Moran-Thomas’ work. Currently she is co-leading a group working on a project called the “Sugar Atlas,” mapping the social and economic dimensions of diabetes in the Caribbean, in tandem with scholars Nicole Charles of the University of Toronto and Tonya Haynes of the University of West Indies. Moran-Thomas has also spent more than a decade following the case of notorious medical experiments that took place in Guatemala in the 1940s, the subject of a recent paper she published with Susan Reverby of Wellesley College.
Closer to home, Moran-Thomas is working on a book about how energy extraction affects chronic conditions and mental health in her native Pennsylvania, at a time of increasing hospital closures. As part of this research, she has been working with MIT seismologist William Frank to develop low-cost sensors that people can use to measure the impact of industrial activity on their home neighborhoods. The research team was recently awarded a grant by the MIT Human Insight Collaborative (MITHIC) for the work. And with another MITHIC grant, Moran-Thomas and several colleagues are working to create a new “Health and Society” educational program at MIT.
“A through line in my work is the question about how to put people at the center of health and medicine,” says Moran-Thomas, an associate professor in MIT’s anthropology program. “Because that’s not how it feels to most people in the world. Care technologies that work for everybody, and health technologies in relation to chronic disease, connect all these different projects.”
The work Moran-Thomas may be best known for occurred in 2020, during the Covid-19 pandemic, when her research recovered an array of neglected clinical studies showing that oximeters functioned differently depending on the skin color of patients. After she published a piece about it in the Boston Review, further hospital studies by physicians who found the essay confirmed a pattern of disproportionately inaccurate readings, leading to subsequent efforts to improve the technology — all steming from her careful, patient-centric approach.
“What anthropology has to offer the world, and other knowledge systems, is the insights of people that might be missing from many accounts, and highlighting these stories that are getting left out,” Moran-Thomas says. “Those are not footnotes, but the central thing to follow. And those histories are also alive in the material world around us.”
Thinking across medical and climate technologies
After growing up in Pennsylvania, Moran-Thomas majored in literature while earning her BA from American University. She decided to pursue ethnographic research as a graduate student, and entered Princeton University’s program in anthropology, earning an MA in 2008 and her PhD in 2012. After postdoc stints at Princeton and Brown University, Moran-Thomas joined the MIT faculty in 2015.
At Princeton, Moran-Thomas’ dissertation research examined the diabetes epidemic in Belize, forming the basis of her first book, “Traveling with Sugar,” whose title is an expression in Belize for living with diabetes. As she chronicles in the book, plantation-era changes that undermined indigenous agriculture, among other things, contributed to a local economy that made diets sugar-heavy, while medical technologies are often unreliable or ill-suited to local conditions. The book also traces breakdowns in care technologies, such as prosthetic limbs (often sought after diabetes-linked amputations), glucose meters, hyperbaric chambers, insulin supply chains, dialysis machines, and pain management technologies.
“Traveling with Sugar” also develops a critique that has become a theme of Moran-Thomas’ work: that society often shifts the blame for illness onto patients while minimizing the larger-scale factors affecting everyday health.
“There can be this focus on exclusively prevention without care, the implicit assumption that patients need to act differently,” Moran-Thomas says. “Blame falls on individuals and families instead of a focus on other questions. Why are these technologies always breaking down? How are they designed, and by whom, for whom? What role is history playing in the present? And how are people trying to remake those structures?”
Those issues are highlighted in Moran-Thomas’ ongoing project, “Sugar Atlas: Counter-Mapping Diabetes from the Caribbean,” which is backed by a two-year Digital Justice Seed Grant from the American Council of Learned Societies. Whereas international organizations tend to lump North America and the Caribbean together when tracking diabetes, this project zooms in on specific aspects of the disease and its historical and structural contributors in the Caribbean, such as the distance people must travel to buy vegetables, their proximity to insulin supplies, and the ways climate change is affecting sea life and fishing practices.
“We’re trying to create a community platform offering a different vision of these conditions,” Moran-Thomas says of the effort to map otherwise unrecorded aspects of the global diabetes epidemic, while tracing mutual aid networks and people’s “arts of care” in the present.
Better design for common devices
Following her research in Belize, where glucose meters were prone to breaking, Moran-Thomas began taking a more active focus on the design of medical technology. At MIT, she began co-teaching a course with tech innovator Jose Gomez-Marquez, 21A.311 (The Social Lives of Medical Objects). The idea was to get students to think about device design that could lead to more durable, fixable, and equitable products.
In turn, Moran-Thomas’ interest in devices led her to question the pulse oximeter readings she started seeing first-hand during the Covid-19 pandemic. Pulse oximeters measure oxygen saturation levels in patients and are a part of even routine appointment check-ins. They work visually, casting beams of light to measure the color of hemoglobin, which varies depending on how much oxygen it contains.
After firsthand encounters with the sensors led to more research, Moran-Thomas learned that some medical professionals had lingering, unanswered questions about pulse oximeters and they way they were calibrated. After she published her essay in the Boston Review, arguing for more data collection, medical researchers examined the issue more closely, finding that patients with darker skin were about three times more likely to have erroneous blood-oxygen readings than patients with lighter skin. Ultimately, an FDA panel recommended changes to the devices.
“A lot of my work has been learning about health and medicine technologies from the perspectives of patients, families, and nurses, rather than beginning with engineers and doctors,” Moran-Thomas says. “Those two projects, about blood sugar and blood oxygen, were about the shortcomings of those devices and how they could be improved. Those are perspectives I can highlight in hopes others will pick up on them and make other kinds of designs and policies possible.”
Moran-Thomas’ interest in device design has continued with her current book project, about the chronic health effects of energy production in Pennsylvania. She has worked with MIT seismologist William Frank, of the Department of Earth, Atmospheric and Planetary Sciences, to construct an inexpensive meter people can use to measure shaking in their homes caused by industrial activities. (After colleagues in western Pennsylvania reached out with seismic concerns, Moran-Thomas first got the idea to contact Frank after reading about his work in MIT News, incidentally).
The effort is also inspired by guidance from community leaders based at the Center for Coalfield Justice in western Pennsylvania. The research team has received a MITHIC Connectivity grant for their project, “Seismic Collaboratory: Rural Health, Missing Science, and Communicating the Chronic Impacts of Extraction.”
“I’ve met people who have been told by their doctors they must have vertigo, while they thought the walls of their house were really shaking,” Moran-Thomas says. “In a case like that, the device you need is not in the clinic, it’s a monitor at home.”
The book, overall, will examine the effects of energy production on chronic disease and mental health issues in Pennsylvania, something exacerbated by more hospitals being shuttered in the state.
Moran-Thomas is simultaneously working with several co-investigators to create the “Health and Society” educational program at MIT, including Katharina Ribbeck, Erica James, Aleshia Carlsen-Bryan, and Dina Asfaha. Their work was recently awarded an Education Innovation Seed Grant from MITHIC.
From small devices to large-scale changes in health care systems, from the U.S. to other regions, Moran-Thomas remains focused on a core set of issues about how to improve and broaden health care — and lessen the need for it in the first place.
“Thinking across scales is something that’s really useful about anthropology,” Moran-Thomas says. “Even one medical device is a tiny piece of a bigger infrastructure. In order to study that technology or device or sensor, you have to understand the bigger infrastructure it’s attached to, and that there are people involved in all parts of it.”
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