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Pima Indians are American Indians; their ancestors were one the first groups to come to America, over 30,000 years ago. The modern day Pima Indians live in the Gila River Indian Community, in southern Arizona, where they have lived for over 2,000 years. History shows that a variety of health research studies has used Pima Indians, mainly because they have exhibited high prevalence levels of obesity and diabetes. They are also ready to volunteer and cooperate, another reason that has helped researchers make significant breakthroughs in health studies (Busatta, 2011). For instance, their input was especially significant in studies surrounding obesity; diabetes; kidney complications, among other studies, and the findings have enabled medical practitioners to establish the causes of these diseases, and the way they can be treated or controlled (National Institute of Diabetes and Digestive and Kidney Diseases, 1996).
Primarily, researchers attribute the success they have achieved by using Pima Indians to understand the causes and treatment of diabetes, obesity, cardiovascular diseases, and kidney complications because of high exposure of the group is to these diseases. The second reason is that Pima Indians have maintained their heritage, as they have continued to occupy the land of their ancestors and married from within the community. This status has been helpful to researchers because they are able to trace the causes of the investigated diseases through generations. Moreover, research studies take extremely long durations; thus, it is desirable to sample subjects who do not migrate much because they are easy to monitor. In addition, Pima Indians are a kind community, which drives them to volunteer themselves to be used as subjects in a variety of researches that end up being useful to humankind. For these among other reasons, researchers continue to refer to Pima Indians as pathfinders for health. A pathfinder is the first person who discovers something in any field.
Although there is voluminous supply of the contributions that Pima Indians have made towards understanding some aspects of human health, it is necessary to conduct a research study to find out their role as the pathfinders in medical research. Therefore, the research question is: why are the Pima Indians pathfinders in health research? In this context, the thesis statement will read: Pima Indians can be acclaimed for being pathfinders in health research because of volumes of information that highlight their contributions towards health research breakthroughs. Moreover, the purpose of this paper is to present information that will aid readers in understanding why researchers refer to the Pima Indians as pathfinders for health.
Justification Why Pima Indians Are Referred To As Pathfinders For Health
The chief reason why the Pima Indians have become active subjects in the research leading to controlling, preventing and treating obesity, kidney diseases, and diabetes is because the community has experienced a significant shift in nutrition and dietary habits (Sugarman, 1989). The reasons for the drastic shift are an early shift from their traditional economic activities such as farming, hunting, and gathering to a cash economy in 20th century. This led families to seek for formal employment, and consequently, there was less homegrown produce, and more processed foods (Halpern, 2007). Additionally, there are a growing number of poor populations, who rely on government commodity programs, which consume primarily processed foods that have high carbohydrates content, are low in fiber, vitamins, among other essential nutrients. In addition, the shift from an active lifestyle in farming and hunting to a sedentary one reduced their level of physical activity; therefore, increasing the risk of getting overweight and other risk factors. A comparison study between the Pima from Arizona and those from Mexico also concluded that the environment plays a significant role in the development of diabetes and obesity because the Pimas of Arizona are less active in comparison to those from Mexico; therefore, it explains why prevalence of diseases is higher among those from Arizona than among the Mexican. Furthermore, a study conducted by the National Institute of Diabetes and Digestive and Kidney Diseases on the Pima revealed that genetics contribute to excessive weight because thrifty genes store fat, converting into energy when the body is starving (2009). The Pima community was desirable subjects for this study because they experienced extremes, famine, and bounty, so their bodies developed a thrifty gene storing the fat to keep the body from starving. Unfortunately, since their lifestyle has changed, they no longer need the thrifty gene for famine periods, so all the fat that the gene stores in preparation for starvation has ended up being harmful to their health leading to diseases that result from high cholesterol (National Institute of Diabetes and Digestive and Kidney Diseases, 2009).
The National Institute of Diabetes and Digestive and Kidney Diseases owe much of its progress in treating and controlling diabetes to the Native American Indians. This group of people has participated in research on the effects of obesity on diabetes for over thirty years. The Pima community has been cooperating with medical practitioners since 1965, and this arrangement has made some remarkable contributions in the diabetes study (Kayaer & Yildirim, 2003). Doctors are now confident that there is the correlation between obesity and diabetes, as they have been conducting systematic tests on the Pima who visit the NIH clinic in the Hu Hu Kam Hospital because the community has given them the consent to use their genes for the study (Busatta, 2011). The conclusion that National Institute of Diabetes and Digestive and Kidney Diseases has drawn from the study: people with obesity complications have a high risk factor of developing diabetes. Researchers have observed that about 50% of adult Pima Indians have diabetes complications, and about 95% of the diabetic population is overweight (Stefan et al., 2003). The research on diabetic conducted on this group revealed that prior to becoming obese subjects tend to have a lower metabolic rate than people weighing the same, and a combination of a high fat diet with low metabolic rate leads to obesity (Steyn et al., 2004). Moreover, researchers have used the two groups of Pima Indians to justify that diabetes may not be a genetic disease (Broxmeyer, 2005). Investigators studied the Pima of Arizona and those of Mexico, and concluded that the latter exhibited lower risk factors of developing diabetes, albeit they have the genes attributed to Type-2 diabetes. Essentially, only 1 out of 15 Mexican Pima develop diabetes. Therefore, researchers conclude that genetics do not have a considerable impact in the development of obesity and Type 2 diabetes because if they did, then the Pima from Mexico would have high prevalent levels of diabetes too.
Researches have used the American Pima to develop ways to control and treat kidney diseases. Studies depict that, for every 1 case of kidney failure among the general US population, there are 20 such case among the American Pima, which is extremely alarming. More research among the American Pima revealed that high blood pressure, microalbuminuria, family history of kidney disease, high blood sugar, or serious diabetes are some of the risk factors for kidney disease of diabetes. It is also evident that a person who has had diabetes for a long time is likely to develop complications such as high blood pressure and kidney problems (National Institute of Diabetes and Digestive and Kidney Diseases, 2009). Medical practitioners further deduced that reducing the impact of these risk factors would be effective in preventing or mitigating development of kidney disease. In addition, they obtained a sample of Pima Indians and found that the kidneys in both Type 1 and Type 2 diabetes patients filter blood faster, and the high pressure destroys the filters of the kidney; thus, allowing protein-leakage into the urine. After conducting several studies on the Pima, medical practitioners believe that they have found the means to control and prevent kidney disease of diabetes, and they have embarked on clinical trials using an ACE inhibitor with the same group of people to test its effectiveness. In the meantime, there is sufficient evidence to say that exercising regularly, eating a healthy diet, and maintaining a healthy weight can prevent kidney disease of diabetes across all populations.
Pima Indians have also shown high prevalence rate for Tuberculosis, which investigators attribute to the high rate of diabetes among this group. They found that diabetic Pima Indians had five times more chances of contracting TB than other Americans (Broxmeyer, 2005). Further research conducted on the Pima also revealed that TB patients were likely to develop diabetes. Other populations of non-Pima descent in America later revealed similar findings. Following the established relationship between TB and diabetes, medical practitioners have found that specific mycobacterial and tuberculosis proteins are responsible for hyperglycemia and diabetes although the test has not been conducted on human beings. Moreover, some researchers have linked tuberculosis with Type 2 diabetes because patients with TB have insulin deficiency and high blood sugar. However, more studies ought to be conducted because there is evidence that some patients contracted TB before diabetes, but it is not clear which of the two precedes the other.
Medical practitioners have used a sample of Pima Indians to understand what causes Diabetic Eye Disease (retinopathy), though their efforts have not been successful. However, they argue that there is a connection of the disease with diabetes since long-term diabetes sometimes causes the blood vessels in the retina to weaken and breakdown causing poor vision or in extreme cases, blindness. Studies show that maintaining normal blood pressure and blood sugar, and regular checkups are the key ways of addressing this potential problem. The NIH Clinic in the Gila River Indian Community avails the eye exams that residents should take to prevent blindness, and these efforts have proved fruitful in combating the disease (Roubideaux, 2004). It is also proof that regular eye examinations can detect early signs of retinopathy, which is treatable because majorities of the patients who have sought treatment in the initial stages have recovered.
The Pima community has also been helpful in understanding gingivitis and periodontal diseases that are common in diabetics. Study shows that Type 2 diabetics who have a periodontal condition are highly likely to die from cardiovascular and kidney complications. For example, a study conducted by Dr. Knowler sampled 549 respondents from the Pima community aged 45 and over and were diabetic. About 60% of them exhibited periodontal conditions, and a significant number had lost their teeth, not to mention that others had bone conditions. The researcher monitored the sample for 10 years, and found that, after the duration, 172 respondents had died of natural causes; 23 of them were natural deaths, although the respondents suffered from severe gum disease, and 15 of them died, but they also had mild periodontal conditions. This study also revealed the correlation between diabetes and heart disease because about 15 deaths were as a result of diabetic nephropathy and heart disease (Medimise, 2011). Inevitably, diabetics should maintain the highest level of oral health possible, more so if they are prone to develop periodontal conditions or gingivitis. Research has shown that periodontal disease causes inflammation of blood vessels, and over time leads to heart and kidney damage.
Despite the high prevalence rates of obesity, diabetes, and kidney complications among the Pima Indians, they have low prevalence rates of heart disease, contrary to the rest of American population, which is intriguing to note. Studies conducted on this group have indicated that they have low levels of serum cholesterol, which explains why they are not heavily predisposed to heart disease. A study conducted by Savage, Hamman, and Bartha (2001) revealed that among a sample of Pima Indians aged 40 and above, only 5% suffered from heart disease, which is lower than the 8.1% among the Tecumseh. Another study compared the cholesterol levels between the Pima Indians and the US Caucasians, and found similar results indicating that the former group had lower cholesterol levels and incidences of coronary disease than the latter.
A study tested the effect of renal replacement therapy (RRT) among the Pima Indians, between 1965 and 1998. On realizing the high prevalence rate of diabetes, medical practitioners introduced RRT on a trial basis among the group in the 1970s and 1980s. The researchers observed that Ischemic heart disease was the root of numerous deaths among the diabetic population during this time (Pavkov, Sievers, Knowler, Bennett & Nelson, 2004). They also observed that the longer one had diabetes, the higher his or her risk of dying from diabetic complications such as kidney failure, which increased significantly within a 30-year period. In addition, the investigators found that RRT is effective in curtailing diabetes related complications; therefore, it prolonged the lives of a majority of those living with diabetes.
More studies revealed that physiological factors such as glomerular hyper filtration have a key impact in the development of diabetic nephropathy. Glomerular hyper filtration among the Pima Indians reveals that it occurs when an individual develops impaired glucose tolerance. Interestingly, the Pima Indians sample has not reported an increase in renal size during hyper filtration, even though other populations have reported this. Moreover, the research established that patients with macroalbuminuria rapidly develop high levels of hypertension, proteinuria, and a glomerular filtration rate (GFR) (Lemley, 2008). According to the sample, investigators found that over 50% of patients with excess proteinuria reach the end-stage in about ten years, and that albuminuria development takes place years after the diabetic renal injury has evolved. Other factors are structural aspects, citing that diabetic nephropathy occur when there is continuous accumulation of the extracellular matrix material including the glomerular basement membrane (GBM) and the mesangium. A study conducted by Pagtalunan et al., and cited by Lemley (2008), showed that there are equal volume fractions of mesangium and GBM widths in Pima Indians who are diabetic. Generally, non-diabetic Pima Indians have exhibited higher glomerular infiltration than the diabetic ones. In addition, it is clear that considerable structural lesions are evident overt GFR depression; therefore, these developments are the causes of the continuous and irreversible loss of GFR, which leads to advanced diabetic nephropathy.
The Pima Indians played a significant role in medical research, for over three decades, since they have helped medical practitioners understand the causes, treatment, and preventive measures with respect to disease such as diabetes, kidney failures, periodontal diseases obesity and high blood pressure, among others. Researchers chose to use this unique group for studies because they observed there were high levels of diabetes and obesity among these people unlike the rest of the American population. It was also reasonable to study their genetic composition, in a bid to establish if genetics have correlations with diabetes and obesity because this community did not intermarry; therefore, their genetic composition remained unchanged. In addition, these people do not migrate much; hence, it is easy to monitor their progress especially in long-term research. Lastly, the Pima Indians are kind people, and they felt there was a need to participate in the researches because they will benefit the people.
Studies show that even though genetics may cause diabetes to some extent, it is also possible that genetics do not contribute a significant effect in the development of Type 2 diabetes. This can be argued to be true because studies have used two Pima samples, one from Arizona and the other from Mexico. The results showed that the Mexican Pima has lower diabetes prevalence levels compared to Arizona counterparts, despite the similarity in their genetic composition. This study revealed that environmental factors including diet and level of physical activity have a significant impact on the development of diabetes since the Mexican Pima, who are physically active, exhibited lower prevalence levels of diabetes than their Arizona cousins who lead a sedentary lifestyle, not to mention that they have poor eating habits.
Interestingly, the Pima had shown low prevalence levels of heart disease because research conducted on these subjects indicated low serum cholesterol presence in comparison with the rest of the American population. It is a fact that high serum cholesterol is responsible for causing heart disease. However, studies have highlighted serious predisposition of these people to develop diabetes, obesity, and kidney disease. In these studies, investigators found that diabetes is a precursor to multiple diseases among them tuberculosis; kidney failure; gingivitis; periodontal disease; hypertension; heart disease; diabetic eye disease, and many others which stem from these diseases. However, there is no sufficient information pertaining to the relationship between tuberculosis and diabetes; therefore, it is not clear which disease precedes the other. For that reason, further research should be done in order to make reliable inferences.
In order to prevent diabetes, investigators recommend one to engage in regular physical exercise, eat proper diets full of fiber, and avoid smoking. They cite that managing one’s behavior will help in mitigating the possibilities of developing diabetes and other diseases that come because of being diabetic. In addition, investigators recommend proper and regular checkups that can help in detecting conditions in their early stages; thus, increasing the probability of preventing full-blown conditions that may be difficult to treat.
In conclusion, the statement that posits that the Pima Indians are pathfinders for health can be argued to be true based on the supporting literature provided in this paper. They have been key facilitators in the breakthroughs that medical research has made with regard to diabetes and associated diseases. This community deserves the acclamation because it accepted that there was a diabetes epidemic in the community, and it allowed and entrusted its people to the medical researchers, not only for their own benefit, but also for the entire humanity. In exchange, the community has the information and resources it requires to contain, treat, and prevent diabetes and other diseases that have been prying on the Pima Indians. The Pima Indians community has undoubtedly been of immense help to the medical practitioners and patients of diabetes, kidney diseases, among other diseases mentioned in this paper.