Professor Natali Valdez at the Intersection of Medicine, Racism, and Feminism
生殖权利、堕胎法、疫苗试验，以及关于新冠病毒是否影响生育能力的错误信息，这些都是新闻中与生育有关的一些热门话题娜塔莉·瓦尔迪兹’s research. Below, Valdez, assistant professor of women’s and gender studies at Wellesley, answers questions about her new book,权衡未来：后基因组时代的种族、科学和妊娠试验, pregnancy trials, and the ways we can make science and research more equitable.
E.B.巴特尔斯:What inspired you to writeWeighing the Future?
娜塔莉·瓦尔迪兹:This whole research project unfolded in a surprising way. I had originally set out to examine metabolic illnesses, such as diabetes and obesity, among Mexican populations in the U.S. and Mexico. However, a few different experiences shifted my focus toward the design and implementation of lifestyle interventions that target metabolic illnesses. Specifically, I became more interested in who designs the interventions, and how they are implemented.
为了探索我的兴趣，我在加州大学伯克利分校和加州大学欧文分校完成了为期两年的儿童孕产妇健康和流行病学课程。我了解了妊娠试验，并与设计这些试验的科学家和主要研究人员建立了联系。三年后，我终于获准在美国和英国对这些正在进行的临床试验进行民族志研究。
巴特尔斯:Could you explain a bit about the history of clinical trials that include pregnant people?
瓦尔迪兹:Pregnant people have been framed as a “vulnerable population” and restricted from participating in clinical trials, specifically drug trials, since the mid-20th century.
20世纪50年代，一种名为沙利度胺的药物仅在雄性大鼠身上进行了试验，并被认为在欧洲人类食用是安全的。这种药物在欧洲作为一种抗麻醉药销售给孕妇，数千人食用，导致儿童出生时四肢畸形。然而，当时美国食品和药物管理局局长表示，该药物需要进一步测试，因此不允许在美国向怀孕人群销售。由于“沙利度胺试验”，孕妇不能参加药物试验。直到最近几年，美国国立卫生研究院才重新评估了这项政策，因为许多孕妇需要知道他们在怀孕期间可以服用哪些药物。
Distinctly, the trials that I study are not drug trials, but behavioral or lifestyle trials that test interventions of diet and exercise on pregnant populations. These trials are deemed safe for pregnant populations, and thus were allowed to recruit thousands of pregnant people
我之所以成为人类学家，是因为我相信人种学方法是理解社会最紧迫问题的关键。
娜塔莉·瓦尔迪兹, assistant professor of women’s and gender studies
巴特尔斯：在你的研究过程中，你学到了什么意想不到的东西？
瓦尔迪兹:I was surprised to learn how similar data could be used to inform distinct maternal health policies in the United States and United Kingdom. In addition, it was surprising to learn first-hand how challenging it is to recruit diverse pregnant populations for clinical trials in different health care environments. Since I worked at the U.S. trial as a staff member, I was in charge of recruiting and delivering the intervention to clinical trial participants. This unique form of participant observation gave me great insight into why and how pregnancy trials are designed and implemented.
巴特尔斯在这本书中，你讨论了临床试验在不考虑肤色和低收入者经常面临的问题时（如房屋不稳定，难以接受产前护理，以及黑人妇女早产和母婴死亡率不成比例）的问题。理想情况下，你希望看到研究如何变化？
瓦尔迪兹：我提出了一些建议，但总体主题是重新评估我们如何以一种考虑公平问题的方式设计临床试验——而不仅仅是多样性问题。衡平法以特定的方式处理权力和准入问题。例如，处理权力问题需要重新界定谁有权设计临床试验。为什么不在设计阶段包括不同的参与者，而不仅仅是为了招聘？如果一项试验正在设计怀孕干预措施，为什么不让怀孕人群参与进来，以帮助设计他们认为对健康必要的干预措施？通过这种方式，试验既可以促进科学发展，也可以满足弱势群体的健康需求。
Who we imagine as a clinical trial participant is often misrepresented and misunderstood. That is, the blanket statement that there is not enough racial diversity in clinical trials is both accurate and misleading. While there aren’t enough “racial minorities” in phase 2 or 3 clinical trials, African American and Latinx populations may be overrepresented in phase 1 clinical trials—the riskiest phase of clinical trials. In addition, nongovernmental trials often recruit healthy Black and Latinx men from job fairs for formerly imprisoned people. Participating in risky phase 1 drug trials is one of the few well-paying employment options for people who are transitioning out of prison. This points to the issue of equity and power, not diversity and inclusion.
Importantly, focusing too much on diversity and inclusion via proxies of race/ethnicity classifications often distracts from effective or precise characterizations of “diversity” needed in science that directly address racist disparities in health, and not just racial difference. To effectively address the country’s most urgent public health concerns, evidence-based medicine can and must do better. A key step in improving the impact of clinical trials is to broaden our understanding of diversity and reframe efforts towards issues of equity.
巴特尔斯:What advice do you have for people entering the field of anthropology? How can they work to change the way we approach research trials?
瓦尔迪兹：在我的课程中，我采用了女权主义和批判种族主义的方法来理解社会不平等、系统性种族主义和权力动态。所有这些对于改变我们在科学知识生产中重视的工具、数据和方法至关重要。我建议所有对变革感兴趣的学生学习人文和社会科学课程，以拓宽他们在科学和技术方面的范围和方法。这样做有助于重新想象我们如何定义当前的健康问题和解决方案。
巴特尔斯:What was the most challenging part of the researching and writing process?
瓦尔迪兹:Gaining access to study ongoing trials in the U.S. and U.K. This process took three years, and three Institutional Review Board approvals across two countries.
巴特尔斯:And what part was the most rewarding?
瓦尔迪兹:Doing the fieldwork! I became an anthropologist because I believe in ethnographic methods as a key to understanding society’s most pressing issues. So completing about two years of fieldwork was the highlight of my doctoral career. Now that the book is out, I look forward to hearing about how others receive this work.
巴特尔斯：自从德克萨斯州限制性堕胎法生效以来，怀孕、堕胎和领养的话题一直在新闻中出现，最高法院正在审理此案。你的书和研究是如何与时事联系在一起的？
瓦尔迪兹：根据女权主义理论，我的书提供了一种理解复杂健康问题的简化方法。这种方法对于理解生殖和人口健康危机的复杂问题也至关重要。例如，通过批判性的视角，我们可以理解为制定德克萨斯州堕胎法投入的巨大资源。这表明了人们对如何将资源、专业知识和权威运用于单一的具体问题，而不是更广泛、紧急的公共危机的更深层次的担忧。
巴特尔斯：你希望读者从你的书中得到什么？
瓦尔迪兹：我希望读者能从一个批判性的种族和女权主义者的角度理解审视医学、健康和科学的价值。这样做可以显著改善循证医学的现有方法、工具和干预措施。
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To hear more from Valdez, visit her website,纳塔利瓦德兹。通用域名格式，以查找她即将进行的演示的时间表。
