Newswise — Reproductive rights, abortion laws, vaccine trials, and misinformation about whether COVID afffects fertility—these are some of the hot topics in the news that also relate to Natali Valdez’s research. Below, Valdez, assistant professor of women’s and gender studies at Wellesley, answers questions about her new book, Weighing the Future: Race, Science, and Pregnancy Trials in the Postgenomic Era, pregnancy trials, and the ways we can make science and research more equitable.
E.B. Bartels: What inspired you to write Weighing the Future?
Natali Valdez: 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.
To explore my interests, I completed two years’ worth of coursework in child maternal health and epidemiology at UC-Berkeley and UC-Irvine. I learned about pregnancy trials and made connections to scientists and principal investigators who designed these trials. After three years, I was finally granted access to ethnographically study these ongoing clinical trials in the United States and the United Kingdom.
Bartels: Could you explain a bit about the history of clinical trials that include pregnant people?
Valdez: Pregnant people have been framed as a “vulnerable population” and restricted from participating in clinical trials, specifically drug trials, since the mid-20th century.
In the 1950s, a drug called thalidomide was tested only on male rats and deemed safe for human consumption in Europe. This drug was marketed to pregnant people in Europe as an antinausea medication and thousands consumed it, which caused children to be born with malformed limbs. However, the director of the FDA at the time said that the drug needed further testing, so it was not allowed to be marketed to pregnant populations in the U.S. The “thalidomide trials” resulted in the restriction of pregnant people from pharmaceutical drug trials. Only in the last few years has the National Institutes of Health reevaluated this policy because many pregnant populations need to know which kinds of medicine they can take while pregnant.
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.
Bartels: What was something unexpected that you learned over the course of your research?
Valdez: 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.
Bartels: In the book you discuss the ways clinical trials fall short when they don’t consider issues participants of color and lower-income participants often face (like housing instability, difficulty accessing prenatal care, and the disproportionate rates of premature birth and maternal and infant mortality among Black women). Ideally, how would you like to see research change?
Valdez: I make some recommendations, but the overarching theme is to reevaluate how we design clinical trials in a way that considers issues of equity––not merely diversity. Equity attends to issues of power and access in specific manners. For instance, attending to issues of power would require reframing who has the authority to design clinical trials. Why not include diverse participants at the design stage, not just for recruitment? If a trial is designing a pregnancy intervention, why not include pregnant populations to help design interventions that they deem necessary for their health? In this way, trials can both advance science and address the health needs of vulnerable populations.
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.
Bartels: What advice do you have for people entering the field of anthropology? How can they work to change the way we approach research trials?
Valdez: In my courses, I incorporate feminist and critical race approaches to understanding social inequalities, systemic racism, and power dynamics. All of these are vital to changing what tools, data, and methods we value in scientific knowledge production. I recommend that all students interested in making change take courses across the humanities and social sciences to broaden their scope and approach to science and technology. Doing so can facilitate reimagining how we define current health problems and solutions.
Bartels: What was the most challenging part of the researching and writing process?
Valdez: 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.
Bartels: And what part was the most rewarding?
Valdez: 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.
Bartels: The topics of pregnancy, abortion, and adoption have been in the news since the restrictive Texas abortion law went into effect and with the Supreme Court now taking up the case. How do your book and your research connect to current events?
Valdez: Drawing on feminist theories, my book provides a way to understand reductive approaches to complex health issues. This approach is also vital for understanding complex issues of reproductive and population health crises. For instance, through a critical lens, we can understand the tremendous resources that were poured into crafting the Texas abortion law. This points to a deeper concern around how resources, expertise, and authority are wielded toward singular, specific issues and not broader, urgent, public crises.
Bartels: What do you hope readers will take away from your book?
Valdez: I hope readers will understand the value of examining medicine, health, and science from a critical race and feminist lens. Doing so can significantly improve current methods, tools, and interventions in evidence-based medicine.
To hear more from Valdez, visit her website, natalivaldez.com, to find the schedule of her upcoming presentations.