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>> GOOD AFTERNOON, THANK
YOU FOR

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JOINING US FOR TODAY'S OSHRP

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SESSION, TITLED CARE:  A MODEL

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FOR THE INTERNATIONAL

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CLASSIFICATION IMRAIGZ OF

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CULTURAL HUMILITY INTO HUMAN

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SUBJECTS RESEARCH.

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WE'RE FORTUNATE TO HAVE AS OUR

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GUEST SPEAKER SANA LOU, FROM

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CASE WESTERN SCHOOL OF MEDICINE

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IN CLEVELAND, OHIO.

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DR. LOUE HOLDS SECONDARY DEGREES

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IN QUANTITATIVE SCIENCES AS WELL

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AS UNIVERSITY SCHOOL OF SOCIAL

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WORK.

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SHE HAS A LAW DEGREE, Ph.D. IN

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EPIDEMIOLOGY, AND A Ph.D. IN

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MEDICAL ANTHROPOLOGY, AS WELL AS

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SEPARATE MASTERS DEGREES IN

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SOCIAL WORK, PUBLIC EDUCATION,

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PUBLIC HEALTH, THEOLOGY AND

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HISTORY.

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DR. LOUE SERVED AS THE INAUGURAL

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SCHOOL FOR DEVELOPMENT AND

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FACULTY DIVERSITY FROM 2012 TO

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2020.

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THE GEOGRAF IRK LOCATIONS WHERE

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SHE HAS CONDUCTED RESEARCH ARE

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QUITE BROAD INCLUDING LAOS,

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RUSSIA, ROMANIA,

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[INDISCERNIBLE], AND UGANDA.

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SHE AS ENGAGED IN AUDUNIONS

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ISSUES ON ETHICAL RESEARCH,

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PROFESSIONAL DEVELOPMENT AND

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DIVERSITY IN CANADA, CHILE,

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COLUMBIA, [INDISCERNIBLE],

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MEXICO, ROMANIA, RUSSIA, SPAIN,

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SWITZERLAND, KATIKASTAN, AND

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VIETNAM.

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FOR MORE THAN 20 YEARS DR. LOU E

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HAS MENTORS GRADUATE STUDENTS

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POST DOCTORAL FELLOWS AND

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FACULTY.

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HER RESEARCH IN BOTH DOMESTIC

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AND INTERNATIONAL CONTEXT HAS

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FOCUSED ON HIV RISK AND

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PREVENTION, SEVERE MENTAL

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ILLNESS, FAMILY VIOLENCE AND

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RESEARCH ETHICS.

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HER CURRENT RESEARCH ADDRESSES

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THE INTERPLAY BETWEEN RELIGIOUS,

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SOCIETY, BIOETHICS AND THE

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INTEGRATION OF HUMILITY IN

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CLINICAL CARE AND RESEARCH

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SETTINGS AND PAST AND CURRENT

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FORMULESS OF NUGENICS.

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HE HAS AUTHORED MORE THAN 30

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WORKS AND CO-AUTHORED MORE THAN

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130 PEER REVIEWED ARTICLES.

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TODAY'S PRESENTATION WILL BE

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ARCHIVED IN THE PAST EVENTS

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SECTION OF THE NIH VIDEOCAST

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SITE, A LINK TO THE VIDEOCAST AS

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WELL AS THE SLIDES FROM THE

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SESSION WILL ALSO BE POSTED ON

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THE OHSRP WEBSITE APPROXIMATELY

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1-2 WEEKS AFTER THE SESSION. 

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IN THE PRESENTATIONA AFCHIVE

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SECTION, AND TRAINING PAGE,

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THROUGHOUT THE SESSION, WE

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ENCOURAGE RUERS TO SUBMIT

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QUESTIONS BY CLICKING ON THE BOX

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BELOW THE VIDEO TIELTSED LIVE

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FEEDBACK LINK AND DR. LOUE AND

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HAPPY TO RESPOND TO THOSE

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QUESTIONS IN REALTIME.

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WE ALSO WILL HAVE A Q&A AT
THE

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END BUT DO GO AHEAD AND FEEL

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FREE TO POST YOUR QUESTIONS

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DURING THE PRESENTATION.

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SO THANK YOU FOR YOINING US

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DR. LOUE, PLEASE  GO AHEAD AND

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GET US STARTED.

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>> THANK YOU SO MUCH AND
IT'S

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WONDERFUL TO BE HERE WITH

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EVERYONE AND THANK YOU FOR THE

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INVITATION.

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THIS IS QUITE AN HONOR.

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I'M HOPING THAT MY SCREENS

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ADVANCE AS THEY ARE SUPPOSED TO,

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IF THEY DON'T, PLEASE LET ME

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KNOW AND I WILL SEE WHAT I CAN

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DO HERE.

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>> LOOKS GOOD.

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>> GREAT.

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THANK YOU.

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WHY UOF --JUST A QUICK REMINDERT

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CONTENT COPYRIGHT, COPYRIGHT

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APPLIES.

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YOU HAVE MY BIO, AND I HAVE NO

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RELEVANT PROFESSIONAL PERSONAL

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OR FINANCIAL RELATIONSHIPS TO

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DISCLOSE, SO JUST A RECAP OF OUR

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LEARNING 

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LEARNING OBJECTIVES, THE FIRST

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IS TO DISTINGUISH BETWEEN

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CULTURAL COMPETENCE AND CULTURAL

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HUMILITY SO WE'RE ALL ON THE

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SAME PAGE, EXPLAIN HOW CULTURAL

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HUMILITY CAN BE INTEGRATED INTO

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HUMAN SUBJEKS RESEARCH AND MY

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PREFERENCE IS TO REFER TO HUMAN

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PARTICIPANT RESEARCH RATHER THAN

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HUMAN SUBJECTS AND AS PART OF

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THAT I WILL GO THROUGH A COUPLE

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OF EXAMPLES THAT ARE SORT OF A

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LOOK BACK AT HOW THINGS MIGHT

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HAVE BEEN DIFFERENT IN

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PARTICULAR RESEARCH STUDIES IF

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CULTURAL HUMILITY HAD BEEN

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INTEGRATED AND THEN IDENTIFY

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STRATEGIES FOR THE INDIVIDUAL TO

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DEVELOP CULTURAL HUMILITY AND TO

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APPLY CULTURAL HUMILITY IN THE

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RESEARCH CONTEXT.

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SO THIS IS GOING TO BE OUR

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ROADMAP FOR TODAY, WE WILL TART

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WITH CULTURAL COMPETENCE,

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CULTURAL HUMILITY, TALK A LITTLE

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BIT ABOUT CULTURAL HUMILITY IN

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THE CLINICAL CONTEXT, LOOK AT

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CARE, THAT THE MODEL THAT I'M

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PROPOSING AND THE RESEARCH

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CONTEXT FOLLOWED BY A FEW

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EXAMPLES AND THEN LOOK AT HOW

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CULTURAL HUMILITY CAN BE

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INTEGRATED INTO THE ETHICS

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REVIEW OF PROPOSED PROTOCOLS.

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SO IF WE LOOK AT CULTURAL

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COMPETENCE AND HOW IT WAS

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ORIGINALLY CONCEIVED AND WHAT IT

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ATTEMPTS TO DO FOR US, WE'RE

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SUPPOSED TO BE ABLE TO DEVELOP A

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KNOWLEDGE BASE ABOUT DIFFERENT

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GROUPS THAT ARE--AND THIS

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KNOWLEDGE IS EXTENSIVELY BASED

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ON IDENTIFIABLE OR IDENTIFIED

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CHARACTERISTICS OR QUALITIES OF

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INDIVIDUALS IN GROUPS.

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THE FACT THAT IT TALKS ABOUT

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COMPETENCE SUGGESTS THAT IF WE

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ACQUIRE CERTAIN BODIES OF

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KNOWLEDGE, WE WILL BE ABLE TO

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MONITOR OUR OWN EXPLICIT BIASES

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AND BEHAVIORS, AND THAT WE WILL

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ACHIEVE SOME LEVEL OF MASTERY.

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HOWEVER, WHEN WE ACTUALLY LOOK

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AT THE UNDERLYING ASSUMPTIONS OF

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CULTURAL COMPETENCE PARTICULARLY

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IN MULTICULTURAL SOCIETIES, WE

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FIND THAT THE GOALS ARE NOT

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REALLY ACHIEVED.

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FIRST VERY OFTEN CULTURAL

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COMPETENCE ASSUMES THAT AN

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INABILITY TO WORK CROSS

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CULTURALLY OR TO WORK IN A WAY

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THAT IS PRODUCTIVE WITH OTHER

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INDIVIDUALS IS THE RESULT OF

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CULTURAL INCOMPETENCE IS A LACK

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OF KNOWLEDGE AND THAT IF WE JUST

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PROVIDE INDIVIDUALS WITH

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KNOWLEDGE, THAT THEIR ATTITUDES

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AND BEHAVIORS WILL SOMEHOW BE

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TRANSFORMED.

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IT SAYS IF WE ARE SAYING, WELL,

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IF WE GIVE THEM SO MUCH

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KNOWLEDGE, THEY ARE EMPTY

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VESSELS AND ANYTHING THAT THEY

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MAY HAVE THOUGHT BEFORE, WILL

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JUST SORT OF FALL OUT OF THIS

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VESSEL AND WILL BE REPLACED WITH

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THIS NEW KNOWLEDGE.

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IT ALSO SUGGESTS THAT MASTERY OF

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A CULTURE OF ANY CULTURE IS

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POSSIBLE AND I WOULD PROPOSE

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THAT MASTERY OF ANY CULTURE IS

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IMPOSSIBLE BECAUSE CULTURE IS

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NOT STATIC, IT CHANGES.

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AND WHEN WE TALK ABOUT

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UNDERSTANDING A CULTURE BASED ON

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CERTAIN CHARACTERISTICS, WE'RE

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ASSUMING THAT THOSE

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CHARACTERISTICS ARE REALLY

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STATIC OVERTIME.

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IT ASSUMES THAT MINORITY AND

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MAJORITY GROUPS EVOLVE AND

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TRANSFORM AT THE SAME RATES OF

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SPEED.

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IT ALSO LEADS--BUT THE RESEARCH

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HAS SHOWN IS THAT IT ACTUALLY

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LEADS TO THE REINFORCE AM OF

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STEREOTYPES, SO RATHER THAN

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DISSIPATING THEM, IT TENDS TO

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REINFORCE THEM AND IF CULTURAL

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COMPETENCE ALSO ASSUMES THAT THE

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LACK OF CONFIDENCE IS REALLY AN

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ISSUE ONLY BETWEEN WHITES,

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PEOPLE WHO ARE IDENTIFIED AS

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WHITE, AND PEOPLE WHO ARE

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IDENTIFIED AS NONWHITE OR

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SOMEHOW MINORITIZED AND WE KNOW

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THIS IS NOT ACCURATE.

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ONE OF THE OTHER MAJOR ISSUES,

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WITH THE IDEA OF CULTURAL

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COMPETENCE IS THAT IT SUGGESTS

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THAT WE FOCUS ON 1 SPECIFIC

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CHARACTERISTIC AT A TIME, SO, IF

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A PERSON WALKS INTO OUR OFFICE

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AS A POTENTIAL RESEARCH

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PARTICIPANT, WE FOCUS ON THEM AS

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A MALE, AS A FEMALE AS A MEMBER

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OF A PARTICULAR ETHNIC OR RACIAL

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GROUP RIGHT, BUT NOT AS AN

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INTEGRATED WHOLE PERSON. 

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IT ALSO ASSUMES THAT HOW WE

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IDENTIFY AN INDIVIDUAL, HOW WE

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PERCEIVE THEM IS HOW THEY

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SELF-IDENTIFY.

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THAT SELF-IDENTIFICATION AND

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IESHES DENTIFICATION BY OTHERS

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IS CONGRUENT AND WE KNOW THIS IS

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NOT ALWAYS THE CASE.

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SO IF WE LOOK AT CULTURAL

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HUMILITY, WE SEE THAT IT'S

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REALLY QUITE DIFFERENT AND THIS

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IS A CONCEPT THAT WAS DEVELOPED

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INITIALLY BY [INDISCERNIBLE] IN

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THE CONTEXT OF MEDICINE EMPLOY

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SO THE BASIC AYOU SUSMGZ -

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-ASSUMPTION IS THAT IN

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EACH AND EVERY INTERACTION THERE

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IS SOMETHING WE DON'T

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UNDERSTAND.

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ONE OF THE EXAMPLES I VERY OFTEN

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USE WITH CLINICAL RESEARCHERS

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AND CLINICIANS IS YOU KNOW YOU

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WALK BO A ROOM, PARTICULARLY

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WITH CLINICIANS, AND THE PATIENT

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HAS ASKED FOR AN APPOINTMENT FOR

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A PARTICULAR ISSUE AND YOU

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ASSUME THAT BASED ON THE MEDICAL

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RECORD IS WHAT THE PATIENT SAID

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THEY NEEDED THAT YOU HAVE ALL OF

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THE INFORMATION THAT YOU NEED,

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WHEN IN FACT IT'S NOT TRUE,

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RIGHT, IF THE CLINICIAN IS GOING

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TO PRESCRIBE A CERTAIN

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METRICSICATION, DOES THE PATIENT

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HAVE INSURANCE, DOES THE PATIENT

260
00:09:42,633 --> 00:09:44,401
HAVE ACCESS TO THE MEDICATION

261
00:09:44,401 --> 00:09:45,569
OUTSIDE OF INSURANCE, DOES THE

262
00:09:45,569 --> 00:09:47,337
PATIENT HAVE A REFRIGERATOR IN

263
00:09:47,337 --> 00:09:48,972
WHICH TO REFRIGEERATE IT, RIGHT?

264
00:09:48,972 --> 00:09:51,008
SO THERE ARE ALL KINDS OF ISSUES

265
00:09:51,008 --> 00:09:54,645
SURROUNDING WHAT SEEMS TO BE A

266
00:09:54,645 --> 00:09:55,913
VERY SIMPLE ASSUMPTION.

267
00:09:55,913 --> 00:09:57,714
IT ASKS THAT WE FOCUS ON OUR

268
00:09:57,714 --> 00:10:00,284
DEVELOPMENT OF OUR CRITICAL

269
00:10:00,284 --> 00:10:01,785
CONSCIOUSNESS TO CHANGE OUR

270
00:10:01,785 --> 00:10:04,388
ATTITUDE AND THIS REQUIRES IN

271
00:10:04,388 --> 00:10:07,925
TURN THAT WE BE WILLING TO

272
00:10:07,925 --> 00:10:10,861
COMMIT TO LIFE LONG REFLECTION

273
00:10:10,861 --> 00:10:11,295
AND SELF-CRITIQUE.

274
00:10:11,295 --> 00:10:14,131
SO WHAT DID I DO WELL IN THIS

275
00:10:14,131 --> 00:10:14,431
INTERACTION?

276
00:10:14,431 --> 00:10:16,700
WHAT DID I NOT DO WELL?

277
00:10:16,700 --> 00:10:18,168
WHAT ASSUMPTIONS DID I MAKE THAT

278
00:10:18,168 --> 00:10:22,506
I SHOULDN'T HAVE MADE THAT

279
00:10:22,506 --> 00:10:23,040
WERE--THAT MAYBE I DIDN'T

280
00:10:23,040 --> 00:10:24,942
REALIZE I WAS MAKING.

281
00:10:24,942 --> 00:10:27,010
IT REQUIRES ACTIVE ENIMAIJMENT

282
00:10:27,010 --> 00:10:29,513
WITH THE OTHER INDIVIDUAL OR

283
00:10:29,513 --> 00:10:31,014
INDIVIDUALS OR COMMUNITIES AND

284
00:10:31,014 --> 00:10:33,417
IT REQUIRES AN EXERCISE OF

285
00:10:33,417 --> 00:10:37,054
HUMILITY AND BY EXERCISING

286
00:10:37,054 --> 00:10:38,822
HUMILITY WE'RE REALLY HELPING TO

287
00:10:38,822 --> 00:10:40,457
CHANGE THE POWER BALANCE BECAUSE

288
00:10:40,457 --> 00:10:41,492
WE'RE RECOGNIZING THAT THE

289
00:10:41,492 --> 00:10:44,027
PEOPLE WITH WHOM WE'RE

290
00:10:44,027 --> 00:10:45,429
INTERACTING THE COMMUNITIES WITH

291
00:10:45,429 --> 00:10:46,930
WHICH WE'RE INTERACTING ARE THE

292
00:10:46,930 --> 00:10:50,767
HOLDERS OF THE KNOWLEDGE THAT WE

293
00:10:50,767 --> 00:10:54,404
WOULD LIKE AND WITHOUT THEIR

294
00:10:54,404 --> 00:10:56,573
PARTICIPATION, WE CAN'T DO OUR

295
00:10:56,573 --> 00:10:57,674
RESEARCH.

296
00:10:57,674 --> 00:11:00,177
SO CULTURAL HUMILITY RECOGNIZES

297
00:11:00,177 --> 00:11:03,380
THAT CULTURE CHANGES OVER TIME,

298
00:11:03,380 --> 00:11:05,449
THAT IT CHANGES AT DIFFERENT

299
00:11:05,449 --> 00:11:06,817
RATES DEPENDING ON WHETHER IT'S

300
00:11:06,817 --> 00:11:08,785
AT THE INDIVIDUAL LEVEL, THE

301
00:11:08,785 --> 00:11:11,655
FAMILY LEVEL, THE GROUP LEVEL,

302
00:11:11,655 --> 00:11:16,527
THE SOCIETAL LEVEL AND THAT A

303
00:11:16,527 --> 00:11:18,028
SUCCESSFUL OUTCOME REQUIRES

304
00:11:18,028 --> 00:11:19,196
REQUIRES INTERACTION AND BALANCE

305
00:11:19,196 --> 00:11:22,399
BETWEEN INDIVIDUALS, GROUPS AND

306
00:11:22,399 --> 00:11:22,966
THE LARGER SOCIETY.

307
00:11:22,966 --> 00:11:27,337
SO IF WE LOOK AT THE KEY

308
00:11:27,337 --> 00:11:28,639
ELEMENTS, CULTURAL HUMILITY

309
00:11:28,639 --> 00:11:30,440
REQUIRES ACTIVE LISTENING AND

310
00:11:30,440 --> 00:11:32,843
THIS IS LISTENING NOT ONLY TO

311
00:11:32,843 --> 00:11:35,913
THE WORDS THAT SOMEONE IS

312
00:11:35,913 --> 00:11:39,750
SAYING, BUT ALSO ATTENDING TO

313
00:11:39,750 --> 00:11:41,685
BODY LANGUAGE TO FACIAL

314
00:11:41,685 --> 00:11:45,589
EXPRESSIONS, BOTH THEIRS AND OUR

315
00:11:45,589 --> 00:11:46,023
OWN.

316
00:11:46,023 --> 00:11:47,424
COLLABORATION WITH THE OTHER

317
00:11:47,424 --> 00:11:50,194
PERSON, WITH THE PERSPECTIVE

318
00:11:50,194 --> 00:11:51,862
PARTICIPANT, WITH PARTICIPANT

319
00:11:51,862 --> 00:11:55,199
REPRESENTATIVES, WITH COMMUNITY

320
00:11:55,199 --> 00:11:56,767
MEMBERS, CONSIDERATION OF THE

321
00:11:56,767 --> 00:11:58,135
PERSPECTIVES THAT ARE BROUGHT TO

322
00:11:58,135 --> 00:12:04,741
THE TABLE BY OTHER INDIVIDUALS.

323
00:12:04,741 --> 00:12:05,509
FLEXIBILITY OF NEGOTIATION.

324
00:12:05,509 --> 00:12:08,045
I VERY OFTEN SAY, YOU KNOW THERE

325
00:12:08,045 --> 00:12:15,352
CAN BE A SPECTRUM OF POSSIBILITY

326
00:12:15,352 --> 00:12:17,988
AND WHAT WE DECIDE ON MAY NOT BE

327
00:12:17,988 --> 00:12:19,957
OPTIMAL BUT IT MAY FALL WITHIN

328
00:12:19,957 --> 00:12:22,893
THE RANGE OF WHAT IS APPROPRIATE

329
00:12:22,893 --> 00:12:25,128
AND ACCEPTABLE THAT WORKS FOR

330
00:12:25,128 --> 00:12:29,733
EVERYONE WHO IS CONCERNED WITH A

331
00:12:29,733 --> 00:12:30,901
PARTICULAR RESEARCH PROJECT OR

332
00:12:30,901 --> 00:12:31,168
PROTOCOL.

333
00:12:31,168 --> 00:12:33,136
IT REQUIRES THAT WE INTERROGATE

334
00:12:33,136 --> 00:12:37,941
OUR OWN BIASES AND ASSUMPTIONS,

335
00:12:37,941 --> 00:12:40,210
ENGAGE IN SELF-EVALUATION, MAKE

336
00:12:40,210 --> 00:12:43,213
EFFORTS TO EXPAND OUR OWN

337
00:12:43,213 --> 00:12:44,581
SELF-AWARENESS AND AGAIN, THIS

338
00:12:44,581 --> 00:12:51,788
IS A LIFE LONG PROCESS.

339
00:12:51,788 --> 00:12:53,991
SO WHEN WE COMPARE THAT AGAIN TO

340
00:12:53,991 --> 00:12:55,659
CULTURAL COMPETENCE, WE SEE

341
00:12:55,659 --> 00:12:57,594
CULTURAL COMPETENCE ASSUMES A

342
00:12:57,594 --> 00:12:59,930
FINITE AND POINT WHILE CULTURAL

343
00:12:59,930 --> 00:13:02,266
HUMILITY FOCUSES ON PROCESS

344
00:13:02,266 --> 00:13:03,834
RATHER THAN CONTENT.

345
00:13:03,834 --> 00:13:07,004
LEARNING WITHIN THE CONTEXT OF

346
00:13:07,004 --> 00:13:08,872
CULTURAL COMPETENCE VERY OFTEN

347
00:13:08,872 --> 00:13:12,409
TENDS TO BE INFORMATIVE, WHEREAS

348
00:13:12,409 --> 00:13:15,612
CULTURAL HUMILITY IS REALLY

349
00:13:15,612 --> 00:13:16,680
TRANSFORMATIVE, I LIKE TO SAY

350
00:13:16,680 --> 00:13:19,883
THAT IF I AM TRULY ENIMAIJED IN

351
00:13:19,883 --> 00:13:23,320
ACTIVE LISTENING OF ANOTHER

352
00:13:23,320 --> 00:13:23,987
INDIVIDUAL, AND ATTENDING TO

353
00:13:23,987 --> 00:13:27,124
THEM AS A FULL PERSON, THAT

354
00:13:27,124 --> 00:13:28,392
INTERACTION IMPACTS NOT ONLY

355
00:13:28,392 --> 00:13:31,561
THEM, BUT IT CHANGES ME BECAUSE

356
00:13:31,561 --> 00:13:32,963
I LEARN SOMETHING ABOUT MYSELF

357
00:13:32,963 --> 00:13:37,534
AND ABOUT THE OTHER INDIVIDUAL

358
00:13:37,534 --> 00:13:39,436
WHEREAS CULTURAL COMPETENCE MAY

359
00:13:39,436 --> 00:13:45,042
LEAD TO  INCREASED STEREOTYPING

360
00:13:45,042 --> 00:13:47,110
THE IDEA BEHIND CULTURAL

361
00:13:47,110 --> 00:13:48,912
HUMILITY IS THAT WE ENTER INTO A

362
00:13:48,912 --> 00:13:50,480
PARTICULAR INTERACTION WITH A

363
00:13:50,480 --> 00:13:54,117
SENSE OF HUMILITY AND NOT WITH

364
00:13:54,117 --> 00:13:57,621
THE IDEA THAT PEOPLE HOLD

365
00:13:57,621 --> 00:13:58,121
CERTAIN CHARACTERISTICS.

366
00:13:58,121 --> 00:14:01,325
NOW IN THE CLINICAL CONTEXT, A

367
00:14:01,325 --> 00:14:03,760
NUMBER OF DIFFERENT MODELS HAVE

368
00:14:03,760 --> 00:14:04,227
BEEN PROPOSED.

369
00:14:04,227 --> 00:14:06,663
THE FIRST THAT I'LL GO THROUGH,

370
00:14:06,663 --> 00:14:08,999
JUST VERY BRIEFLY, THESE MODELS,

371
00:14:08,999 --> 00:14:12,703
IS THE 5 Rs, WHICH IS

372
00:14:12,703 --> 00:14:17,774
REFLECTION, RESPECT, REGARD,

373
00:14:17,774 --> 00:14:19,443
RELEVANCE AND RESILIENCY, QIAN

374
00:14:19,443 --> 00:14:21,812
WHICH TRANSLATES INTO THE

375
00:14:21,812 --> 00:14:23,213
HUMBLENESS IN CHINESE WAS

376
00:14:23,213 --> 00:14:25,048
DEVELOPED BY CLINICIANS

377
00:14:25,048 --> 00:14:26,983
SPECIFICALLY FOR THOSE

378
00:14:26,983 --> 00:14:29,119
INTERACTIONS THAT INVOLVE

379
00:14:29,119 --> 00:14:34,424
INDIVIDUALS WITH A BACKGROUND

380
00:14:34,424 --> 00:14:37,494
WHO CLAIM CHINESE ETHNICITY AND

381
00:14:37,494 --> 00:14:39,830
THE ELEMENTS OF QIAN INCLUDE

382
00:14:39,830 --> 00:14:40,430
SELF-QUESTIONS AND CRITIQUE

383
00:14:40,430 --> 00:14:45,669
WHICH YOU CAN SEE IS ANALOGOUS

384
00:14:45,669 --> 00:14:47,838
TO CULTURAL HUMILITY,

385
00:14:47,838 --> 00:14:52,376
BI-DIRECTIONAL CULTURAL

386
00:14:52,376 --> 00:14:54,778
EMERSION, MUTUAL ACTIVE

387
00:14:54,778 --> 00:14:56,713
LISTENING AND FLEXIBLE

388
00:14:56,713 --> 00:14:57,080
NEGOTIATION.

389
00:14:57,080 --> 00:15:02,486
ORCHA WAS DEVELOPED IN THE WORK

390
00:15:02,486 --> 00:15:05,689
OF CLINICAL SOCIALNESS TO

391
00:15:05,689 --> 00:15:06,523
PRACTICE.

392
00:15:06,523 --> 00:15:10,227
ORCA IS OPENNESS, RESPECT,

393
00:15:10,227 --> 00:15:12,028
CURIOSITY AND ACCOUNTABILITY.

394
00:15:12,028 --> 00:15:14,898
SO THE CARE MODEL ASSUMES THAT

395
00:15:14,898 --> 00:15:17,434
WE CAN EPITHELIAL GREAT CULTURAL

396
00:15:17,434 --> 00:15:19,136
HUMILITY INTO THE RESEARCH

397
00:15:19,136 --> 00:15:21,438
ENDEAVOR, AND THIS INCLUDES 4

398
00:15:21,438 --> 00:15:26,610
ELEMENTS THAT MAKE UP CARE,

399
00:15:26,610 --> 00:15:27,544
CURIOSITY, ATTENTIVENESS,

400
00:15:27,544 --> 00:15:30,981
RESPECT AND RESPONSIVENESS AND

401
00:15:30,981 --> 00:15:31,281
EMBODIMENT.

402
00:15:31,281 --> 00:15:32,983
SO IF WE THINK OF CURIOSITY,

403
00:15:32,983 --> 00:15:36,319
THIS IS SOMETHING THAT'S REALLY

404
00:15:36,319 --> 00:15:39,189
INTEGRAL TO SCIENCE, RIGHT?

405
00:15:39,189 --> 00:15:40,724
WE--WE WONDER WHY THINGS HAPPEN,

406
00:15:40,724 --> 00:15:44,060
WE ARE CONSTANTLY QUESTIONING,

407
00:15:44,060 --> 00:15:46,229
WE ARE TESTING HYPOTHESIS TO SEE

408
00:15:46,229 --> 00:15:47,731
WHETHER THEY HOLD UP, WHETHER

409
00:15:47,731 --> 00:15:49,566
THEY DON'T HOLD UP.

410
00:15:49,566 --> 00:15:52,502
WE RECOGNIZE THAT NO MATTER HOW

411
00:15:52,502 --> 00:15:55,272
MUCH WE KNOW, SOMETHING REMAINS

412
00:15:55,272 --> 00:15:59,643
UNKNOWN AND WE ARE ABLE,

413
00:15:59,643 --> 00:16:01,611
HOPEFULLY TO ACKNOWLEDGE

414
00:16:01,611 --> 00:16:04,347
AMBIGUITY AND NUANCE SO WE BRING

415
00:16:04,347 --> 00:16:06,082
THIS CURIOSITY TO RESEARCH AS A

416
00:16:06,082 --> 00:16:11,321
PART OF THE SCIENTIFIC ENDEAVOR.

417
00:16:11,321 --> 00:16:12,289
ATTENDIVENESS HAS BEEN DEFINED

418
00:16:12,289 --> 00:16:14,624
AS THE STATE OF BEING ARK WAKE,

419
00:16:14,624 --> 00:16:16,626
ALERT AND ACTIVELY PAYING

420
00:16:16,626 --> 00:16:17,527
ATTENTION TO STIMULUS.

421
00:16:17,527 --> 00:16:20,730
SO AGAIN, THIS GOES TO ACTIVE

422
00:16:20,730 --> 00:16:21,164
LISTENING.

423
00:16:21,164 --> 00:16:23,300
THE QUALITY OF LISTENING OR

424
00:16:23,300 --> 00:16:31,174
WATCHING CAREFULLY, AND WITH

425
00:16:31,174 --> 00:16:31,441
INTEREST.

426
00:16:31,441 --> 00:16:33,610
SIMONE WALE WHO IS A FRENCH

427
00:16:33,610 --> 00:16:34,578
PHILOSOPHER SAID THAT INTENTION

428
00:16:34,578 --> 00:16:37,714
IS THE RAREST AND PUREST FORM OF

429
00:16:37,714 --> 00:16:40,450
GENEROSITY BECAUSE YOU'RE REALLY

430
00:16:40,450 --> 00:16:43,053
DEVOTING YOUR ENTIRE ATTENTION

431
00:16:43,053 --> 00:16:44,254
TO THE PERSON AND YOUR

432
00:16:44,254 --> 00:16:45,655
INTERACTION WITH THE PERSON OR

433
00:16:45,655 --> 00:16:47,724
THE COMMUNITY OR PERSONS, AND

434
00:16:47,724 --> 00:16:50,160
THIS SPACE THAT'S CREATED

435
00:16:50,160 --> 00:16:50,861
BETWEEN YOU.

436
00:16:50,861 --> 00:16:55,332
IT REQUIRES THAT WE FOCUS ON

437
00:16:55,332 --> 00:16:55,765
MULTIPLE DIMENSIONS,

438
00:16:55,765 --> 00:16:57,400
SIMULTANEOUSLY BUT ON THE WHOLE

439
00:16:57,400 --> 00:16:58,568
AT THE SAME TIME.

440
00:16:58,568 --> 00:17:00,670
AND AGAIN, THE ACTIVE LISTENING

441
00:17:00,670 --> 00:17:06,776
IS THROUGH BOTH VERBAL AND

442
00:17:06,776 --> 00:17:07,277
NONVERBAL BEHAVIORS.

443
00:17:07,277 --> 00:17:14,651
THE QUALITY OF RESPECT, I

444
00:17:14,651 --> 00:17:20,357
BELIEVE COMES FROM

445
00:17:20,357 --> 00:17:22,726
BOOBER'S--BUBER IN I-THOU, AND

446
00:17:22,726 --> 00:17:24,461
HE SAID I-IT IS WHEN WE ADDRESS

447
00:17:24,461 --> 00:17:26,930
AN INDIVIDUAL AS IF THEY ARE AN

448
00:17:26,930 --> 00:17:30,400
OBJECT WHEREAS WHEN WE ADDRESS

449
00:17:30,400 --> 00:17:32,736
THEM AS I-THOU, WE ENIMAIJ WITH

450
00:17:32,736 --> 00:17:33,203
THEM AS EQUALS.

451
00:17:33,203 --> 00:17:36,373
AND THIS IS WHY I PREFER TO

452
00:17:36,373 --> 00:17:38,441
REFER TO RESEARCH PARTICIPANTS

453
00:17:38,441 --> 00:17:40,210
AS OPPOSE TO RESEARCH

454
00:17:40,210 --> 00:17:41,478
SUBRECYCLINGS BECAUSE A SUBJECT

455
00:17:41,478 --> 00:17:43,680
TO ME IMPLIES THAT IT'S SOMEONE

456
00:17:43,680 --> 00:17:49,152
WHO IS BEING ACTED UPON RATHER

457
00:17:49,152 --> 00:17:51,321
THAN PARTICIPATING WITH.

458
00:17:51,321 --> 00:17:55,325
BUBER SAID UNLIKE THE RELEVANT

459
00:17:55,325 --> 00:17:58,762
EXPERIENCE, THE I-YOU IS

460
00:17:58,762 --> 00:18:00,196
MEDIATED, NOTHING CONCEPTUALLY

461
00:18:00,196 --> 00:18:02,232
INTERVENES BETWEEN THE I AND U,

462
00:18:02,232 --> 00:18:04,067
NO PRIOR KNOWLEDGE, NO IMAGINE

463
00:18:04,067 --> 00:18:07,571
AND MEMORY ITSELF IS CHANGED AS

464
00:18:07,571 --> 00:18:09,739
IT PLUNGES FROM

465
00:18:09,739 --> 00:18:12,475
PARTICULARULARRITY TO WHOLENESS,

466
00:18:12,475 --> 00:18:14,678
NO PURPOSE INTERVENES BETWEEN I

467
00:18:14,678 --> 00:18:15,545
AND YOU.

468
00:18:15,545 --> 00:18:18,548
NO GREED AND NO ANTICIPATION AND

469
00:18:18,548 --> 00:18:21,151
LONGING ITSELF IS CHANGED AS IT

470
00:18:21,151 --> 00:18:24,120
PLUNGES FROM THE DREAM INTO

471
00:18:24,120 --> 00:18:24,487
APPEARANCE.

472
00:18:24,487 --> 00:18:26,489
EVERY MEANS IS AN OBSTACLE, ONLY

473
00:18:26,489 --> 00:18:29,593
WHERE ALL MEANS HAVE

474
00:18:29,593 --> 00:18:34,664
DISINTEGRATED TRUE ENCOUNTER

475
00:18:34,664 --> 00:18:36,099
OCCURS.

476
00:18:36,099 --> 00:18:40,003
NOW, HERMAN CONE THE PHILOSOPHER

477
00:18:40,003 --> 00:18:40,971
EMBELLISHED THIS IDEA AND HE

478
00:18:40,971 --> 00:18:43,039
SAID THAT WHEN WE ACTUALLY

479
00:18:43,039 --> 00:18:46,242
ENGAGE WITH THE OTHER, IT'S NOT

480
00:18:46,242 --> 00:18:47,444
AS [INDISCERNIBLE] WHICH MEANS A

481
00:18:47,444 --> 00:18:50,747
MAN NEXT TO ME, BUT AS A

482
00:18:50,747 --> 00:18:54,017
[INDISCERNIBLE] WHICH MEANS A

483
00:18:54,017 --> 00:18:54,818
MAN WITH ME.

484
00:18:54,818 --> 00:18:57,787
AND SHE SUGGEST THAD IT IS AN

485
00:18:57,787 --> 00:19:01,091
ETHICAL ACTION WHICH TURNS THE

486
00:19:01,091 --> 00:19:03,727
OTHER MAN INTO THOU, THE

487
00:19:03,727 --> 00:19:05,462
[INDISCERNIBLE], THE EFFECTIVE

488
00:19:05,462 --> 00:19:07,530
ACTION FOR ELIMINATING HIS

489
00:19:07,530 --> 00:19:08,932
SUFFERING.

490
00:19:08,932 --> 00:19:12,202
IN THIS CORRELATION, MAN

491
00:19:12,202 --> 00:19:15,171
CONSTITUTES THE OTHER I-THOU,

492
00:19:15,171 --> 00:19:17,474
BUT AT THE SAME TIME

493
00:19:17,474 --> 00:19:18,308
CONCONSTITUTES HIMSELF AS THOU

494
00:19:18,308 --> 00:19:19,075
FOR THE OTHER.

495
00:19:19,075 --> 00:19:21,378
THE COMPASSION IS NOT A

496
00:19:21,378 --> 00:19:22,946
REFLEXIVE FEELING OF A

497
00:19:22,946 --> 00:19:24,280
CONSITUTED EKING O WHO BY MEANS

498
00:19:24,280 --> 00:19:29,252
OF REDUCTION OF THE OTHER 2

499
00:19:29,252 --> 00:19:31,655
HIMSELF RETURNS TO HIMSELF BUT

500
00:19:31,655 --> 00:19:32,722
IT IS ETHICAL ACTION WHILE

501
00:19:32,722 --> 00:19:36,393
TAKING UP THE SUFFERING OTHER AS

502
00:19:36,393 --> 00:19:37,661
[INDISCERNIBLE] CONSTITUTES HEMS

503
00:19:37,661 --> 00:19:42,198
AT THE SAME TIME IN CORRELATION.

504
00:19:42,198 --> 00:19:45,168
SO AGAIN IT'S LISTENING TO

505
00:19:45,168 --> 00:19:46,803
UNDERSTAND THE OTHER, TO ENGAGE

506
00:19:46,803 --> 00:19:50,006
WITH THE OTHER RATHER THAN

507
00:19:50,006 --> 00:19:51,975
WAITING, THINKING ABOUT HOW TO

508
00:19:51,975 --> 00:19:55,745
RESPOND WITHOUT ACTUALLY

509
00:19:55,745 --> 00:19:56,212
LISTENING.

510
00:19:56,212 --> 00:19:59,516
RESPONSIVENESS IS GROUNDED IN

511
00:19:59,516 --> 00:20:01,051
ONGOING SHIFTING CONFLUENCE AND

512
00:20:01,051 --> 00:20:01,584
KNOWLEDGE.

513
00:20:01,584 --> 00:20:03,153
SO AGAIN, IT'S AWARENESS OF

514
00:20:03,153 --> 00:20:05,288
OURSELVES, OF OUR TRIGGERS,

515
00:20:05,288 --> 00:20:07,657
ESSENTIALLY THE BAGGANCE THAT WE

516
00:20:07,657 --> 00:20:10,360
BRING TO EVERY INTERACTION.

517
00:20:10,360 --> 00:20:13,596
IT CHALLENGES US TO RESPOND IN

518
00:20:13,596 --> 00:20:16,566
SITUATIONS RATHER THAN REACTING

519
00:20:16,566 --> 00:20:18,668
REFLEXIVELY AND IT REQUIRES THAT

520
00:20:18,668 --> 00:20:20,637
WE BE ATTUNED TO OURSELVES, TO

521
00:20:20,637 --> 00:20:22,806
THE OTHER AND TO AGAIN, THE

522
00:20:22,806 --> 00:20:26,910
SPACE THAT'S CREATED BETWEEN US.

523
00:20:26,910 --> 00:20:31,047
EMBODIMENT AGAIN REFERS TO

524
00:20:31,047 --> 00:20:31,848
ATTUNEMENT.

525
00:20:31,848 --> 00:20:33,283
AND IT'S INHERENTLY RELATIONAL

526
00:20:33,283 --> 00:20:35,785
BECAUSE IT INVOLVES THE

527
00:20:35,785 --> 00:20:36,886
RELATIONSHIPS BETWEEN PERSONS

528
00:20:36,886 --> 00:20:39,422
AND BETWEEN THE PERSONS AND

529
00:20:39,422 --> 00:20:40,323
THEIR ENVIRONMENTS.

530
00:20:40,323 --> 00:20:42,926
WE KNOW FROM RESEARCH THAT OUR

531
00:20:42,926 --> 00:20:45,295
NEURAL SYSTEMS REACT AND

532
00:20:45,295 --> 00:20:47,897
RECREATE WHAT OTHERS DO AND

533
00:20:47,897 --> 00:20:48,098
FEEL.

534
00:20:48,098 --> 00:20:51,367
SO WE BECOME MIRRORS FOR THE

535
00:20:51,367 --> 00:20:53,103
OTHERS AND THE OTHER BECOMES A

536
00:20:53,103 --> 00:20:55,438
MIRROR FOR US, AND IT REQUIRES

537
00:20:55,438 --> 00:20:59,375
AN INTUITIVE UNDERSTANDING OF

538
00:20:59,375 --> 00:20:59,642
OTHERS.

539
00:20:59,642 --> 00:21:01,911
IT REQUIRES CLOSE ATTENTION TO

540
00:21:01,911 --> 00:21:07,117
OUR OWN BODIES AND IN INDIVIDUAL

541
00:21:07,117 --> 00:21:07,417
ASSESSMENT.

542
00:21:07,417 --> 00:21:10,286
SO IF WHAT I AM DOING CONGRUENT

543
00:21:10,286 --> 00:21:13,189
WITH WHAT I'M FEELING AND IF I'M

544
00:21:13,189 --> 00:21:15,225
NOT, WHERE--WHERE IS THE LACK OF

545
00:21:15,225 --> 00:21:17,794
CONGRUENCE, WHAT IS HAPPENING

546
00:21:17,794 --> 00:21:18,495
HERE.

547
00:21:18,495 --> 00:21:24,534
AND WHAT RESEARCH HAS FOUND IS

548
00:21:24,534 --> 00:21:27,804
THAT WHERE THE FEELING AND

549
00:21:27,804 --> 00:21:29,539
BEHAVIORS ARE CONGRUENT, AND

550
00:21:29,539 --> 00:21:31,608
THERE'S AN UNDERSTANDING OF THAT

551
00:21:31,608 --> 00:21:32,642
CONGREEN CELLS ENSEL,

552
00:21:32,642 --> 00:21:35,245
INDIVIDUALS TEND TO HAVE HIGHER

553
00:21:35,245 --> 00:21:37,380
LEVELS OF EMPATHY WITH OTHER

554
00:21:37,380 --> 00:21:37,680
INDIVIDUALS.

555
00:21:37,680 --> 00:21:40,517
THERE HAVE BEEN A NUMBER OF

556
00:21:40,517 --> 00:21:41,451
DIFFERENT PRACTICES AND

557
00:21:41,451 --> 00:21:42,952
INTERVENTIONS THAT HAVE BEEN

558
00:21:42,952 --> 00:21:45,221
PROPOSED TO HELP INDIVIDUALS

559
00:21:45,221 --> 00:21:49,993
DEVELOP THIS SENSE OF

560
00:21:49,993 --> 00:21:58,301
EMBODIMENT, 1 IS PUPPETRY

561
00:21:58,301 --> 00:21:59,235
PEDAGOAJY WHERE THEY WILL

562
00:21:59,235 --> 00:22:01,104
ATTEMPT TO HAVE A PUPPET MOVE IN

563
00:22:01,104 --> 00:22:02,572
A OTHER THAN WAY AND UNDERSTAND

564
00:22:02,572 --> 00:22:03,907
THEIR OWN LACK OF CONTROL OVER

565
00:22:03,907 --> 00:22:05,008
THAT SITUATION.

566
00:22:05,008 --> 00:22:06,543
DRAMA AND THEN VIRTUAL REALITY

567
00:22:06,543 --> 00:22:11,314
TRAINING WHICH IS BECOMING MUCH

568
00:22:11,314 --> 00:22:12,115
MORE COMMON.

569
00:22:12,115 --> 00:22:14,984
SO I HAVE A MANTRA I'M BEEN

570
00:22:14,984 --> 00:22:18,321
USING FOR AT LEAST 30 YEARS THAT

571
00:22:18,321 --> 00:22:22,192
HELPS ME TO REMEMBER ABOUT

572
00:22:22,192 --> 00:22:24,494
CULTURAL HUMILITY AND IT'S

573
00:22:24,494 --> 00:22:25,695
SCRIPT, STAY CENTERED, REMAIN IN

574
00:22:25,695 --> 00:22:27,564
BALANCE, AND THE IDEA IS IF I'M

575
00:22:27,564 --> 00:22:30,133
NOT CENTERED IN MYSELF, THEN I

576
00:22:30,133 --> 00:22:32,068
CAN'T ACTIVELY ENGAGE WITH

577
00:22:32,068 --> 00:22:32,402
SOMEONE ELSE.

578
00:22:32,402 --> 00:22:37,473
IF I AM CARING OVER MY FEELINGS,

579
00:22:37,473 --> 00:22:39,876
MY THOUGHTS, SOME DISTRESS OR

580
00:22:39,876 --> 00:22:40,577
HAPPINESS WITH ANOTHER

581
00:22:40,577 --> 00:22:44,414
INTERACTION THAT I HAD

582
00:22:44,414 --> 00:22:46,282
PREVIOUSLY, I AM BRINGING

583
00:22:46,282 --> 00:22:48,418
WHENEVER THAT IS GOOD, BAD OR

584
00:22:48,418 --> 00:22:51,054
INDIFFERENT INTO A SPACE WITH

585
00:22:51,054 --> 00:22:53,556
INTERACTIONS WITH ANOTHER

586
00:22:53,556 --> 00:22:54,357
INDIVIDUAL, ANOTHER COMMUNITY,

587
00:22:54,357 --> 00:22:54,924
ANOTHER GROUP.

588
00:22:54,924 --> 00:22:59,262
SO I'M NOT CENTERED IN ACTIVELY

589
00:22:59,262 --> 00:23:02,432
ENGAGED, ACTIVELY LISTENING WITH

590
00:23:02,432 --> 00:23:03,633
THEM.

591
00:23:03,633 --> 00:23:04,300
I'M NOT COMPARTMENTALIZING.

592
00:23:04,300 --> 00:23:07,170
SO THE IDEA IS TO REALLY AT A

593
00:23:07,170 --> 00:23:08,838
CENTERED AND THIS HELPS ME TO

594
00:23:08,838 --> 00:23:15,545
RESPOND TO SITUATIONS RATHER

595
00:23:15,545 --> 00:23:16,312
THAN REFLEXIVELY REACTING EMPLOY

596
00:23:16,312 --> 00:23:17,680
SO I WOULD LIKE TO TALK A LITTLE

597
00:23:17,680 --> 00:23:22,785
BIT ABOUT A COUPLE OF RESEARCH

598
00:23:22,785 --> 00:23:24,520
STUDIES THAT DON'T DISPLAY

599
00:23:24,520 --> 00:23:27,724
CULTURAL HUMILITY AND SORT OF

600
00:23:27,724 --> 00:23:30,193
HYPOTHESIS WHAT MIGHT HAVE

601
00:23:30,193 --> 00:23:31,461
HAPPENED DIFFERENTLY IF IN FACT

602
00:23:31,461 --> 00:23:34,097
THE RESEARCH TEAM HAD DISPLAYED

603
00:23:34,097 --> 00:23:34,731
CULTURAL HUMILITY.

604
00:23:34,731 --> 00:23:37,500
BEFORE I GO ON TO THE EXAMPLES,

605
00:23:37,500 --> 00:23:39,469
I WOULD LIKE TO ASK PEG IF THERE

606
00:23:39,469 --> 00:23:41,004
ARE ANY QUESTIONS THAT FOLKS

607
00:23:41,004 --> 00:23:43,973
MIGHT LIKE TO HAVE ANSWERED.

608
00:23:43,973 --> 00:23:46,075
>> WE DON'T HAVE ANY
QUESTIONS

609
00:23:46,075 --> 00:23:46,676
YET.

610
00:23:46,676 --> 00:23:47,243
>> OKAY, THANK YOU.

611
00:23:47,243 --> 00:23:48,745
>> AS I MENTIONED EARLIER
FOR

612
00:23:48,745 --> 00:23:50,079
THOSE THAT MIGHT HAVE JOINED

613
00:23:50,079 --> 00:23:51,814
LATE, WE'RE HAPPY TO TAKE

614
00:23:51,814 --> 00:23:52,882
QUESTIONS THROUGHOUT THE

615
00:23:52,882 --> 00:23:53,816
PRESENTATION, SO FEEL FREE TO

616
00:23:53,816 --> 00:23:55,351
CLICK ON THE LINK BELOW THE

617
00:23:55,351 --> 00:23:56,753
VIDEO WHERE IT SAYS LIVE

618
00:23:56,753 --> 00:23:57,887
FEEDBACK AND SEND YOUR QUESTIONS

619
00:23:57,887 --> 00:23:59,989
ALONG NOW IF YOU WOULD LIKE.

620
00:23:59,989 --> 00:24:04,928
>> GREAT, THANK YOU SO
MUCH.

621
00:24:04,928 --> 00:24:07,230
SO THE CAMBODIAN PREEXPOSURE

622
00:24:07,230 --> 00:24:08,398
PROPHYLAXIS TRIAL WAS DESIGNED

623
00:24:08,398 --> 00:24:12,702
TO TEST THE SAFETY AND EFFICACY

624
00:24:12,702 --> 00:24:20,143
OF ANTIRETROVIRAL DRUG

625
00:24:20,143 --> 00:24:21,311
TENOFOFVIV, DISOPROXIL FUMARATE

626
00:24:21,311 --> 00:24:21,778
TO PREVENT HIV.

627
00:24:21,778 --> 00:24:24,147
AND THIS WAS GOING TO BE DONE IN

628
00:24:24,147 --> 00:24:25,081
CAMBODIA AND IT WAS ANYTHING TO

629
00:24:25,081 --> 00:24:28,017
TRY TO ANSWER THE QUESTION OF

630
00:24:28,017 --> 00:24:30,987
WHETHER 1 PILL A DAY WAS SAFE

631
00:24:30,987 --> 00:24:32,922
FOR HIV NEGATIVE PEOPLE AND

632
00:24:32,922 --> 00:24:36,125
WHETHER IT WOULD PREVENT HIV.

633
00:24:36,125 --> 00:24:38,428
IT WAS THE FIRST LARGE SCALE

634
00:24:38,428 --> 00:24:41,197
CLINICAL TRIAL FOR THIS IN

635
00:24:41,197 --> 00:24:45,168
CAMBODIA, IT BEGAN IN 2003.

636
00:24:45,168 --> 00:24:46,936
IT WAS ALSO THE FIRST PREP TRIAL

637
00:24:46,936 --> 00:24:51,607
TO BE CANCELED AS EARLY AS 2004.

638
00:24:51,607 --> 00:24:54,043
NOW IN 2053 OTHER PREP TRIALS

639
00:24:54,043 --> 00:24:57,246
WERE CANCELED FOR OTHER ISSUES,

640
00:24:57,246 --> 00:25:02,952
IN  CAMEROON IT WAS LACK OF

641
00:25:02,952 --> 00:25:05,154
PARTICIPANT EDUCATION, IN MALAWI

642
00:25:05,154 --> 00:25:08,224
AND NIGERIA, THERE WERE CONCERNS

643
00:25:08,224 --> 00:25:11,527
REGARDING THE INTEGRITY OF LAB

644
00:25:11,527 --> 00:25:12,528
PROCEDURES AND THE AVAILABILITY

645
00:25:12,528 --> 00:25:15,098
OF THE DRUGOT OPEN MARKET.

646
00:25:15,098 --> 00:25:17,567
BUT IN CAMBODIA, THE TRIAL WAS

647
00:25:17,567 --> 00:25:21,904
CANCELED AS A RESULT OF A

648
00:25:21,904 --> 00:25:23,072
PARTICULAR CONTROVERSY.

649
00:25:23,072 --> 00:25:26,275
SO THE RESEARCH TEAM HAD GONE

650
00:25:26,275 --> 00:25:27,810
THROUGH THEIR IRBs, THEY HAD

651
00:25:27,810 --> 00:25:31,914
HAD THE PROTOCOL REVIEWED BY

652
00:25:31,914 --> 00:25:34,517
NIH, AND THEY HAD ADHERED TO THE

653
00:25:34,517 --> 00:25:35,651
ETHICAL PRINCIPLES IN THE

654
00:25:35,651 --> 00:25:38,454
CONTEXT OF THEIR PROTOCOL, THE

655
00:25:38,454 --> 00:25:39,856
INFORMED CONSENT FORMS AND

656
00:25:39,856 --> 00:25:42,492
THESE, THE RIGHTS THAT WERE

657
00:25:42,492 --> 00:25:44,527
EMBODIED IN THESE DOCUMENTS IN

658
00:25:44,527 --> 00:25:45,828
THE INFORMED CONSENT PROCEDURE,

659
00:25:45,828 --> 00:25:48,698
WERE THE RIGHTS THAT WERE

660
00:25:48,698 --> 00:25:57,473
CONCEIVED OF AS BEING UNIVERSAL.

661
00:25:57,473 --> 00:26:00,243
HOWEVER, THE FOLKS IN CAMBODIA

662
00:26:00,243 --> 00:26:01,310
WHICH INCLUDED THE SEX WORKERS

663
00:26:01,310 --> 00:26:02,712
WHO WERE GOING TO BE

664
00:26:02,712 --> 00:26:04,013
PARTICIPANTS IN THE TRIAL WERE

665
00:26:04,013 --> 00:26:08,051
FOCUSED ON WHAT WERE CALLED POST

666
00:26:08,051 --> 00:26:09,185
COLOWNIAL BIOETHICS, THE IDEA

667
00:26:09,185 --> 00:26:11,654
THAT RATHER THAN HAVING

668
00:26:11,654 --> 00:26:13,089
SOMETHING DONE TOO THEM THEY

669
00:26:13,089 --> 00:26:15,691
SHOULD BE ACTIVE PARTICIPANTS

670
00:26:15,691 --> 00:26:18,428
AND ENGAGE AS EQUALS IN THE

671
00:26:18,428 --> 00:26:20,963
FORMULATION OF THE RESEARCH, THE

672
00:26:20,963 --> 00:26:23,666
INTERPRETATION OF THE RESEARCH,

673
00:26:23,666 --> 00:26:25,201
AND THE QUEPING THE

674
00:26:25,201 --> 00:26:35,244
UNDERSTANDING OF RISKS AND

675
00:26:35,244 --> 00:26:35,711
BENEFITS.

676
00:26:35,711 --> 00:26:38,214
SO THE SEX WORKERS AND VARIOUS

677
00:26:38,214 --> 00:26:42,752
AGENCIES IN CAMBODIA FOCUSED ON

678
00:26:42,752 --> 00:26:44,620
UNBENEFITS BETWEEN THE

679
00:26:44,620 --> 00:26:45,988
RESEARCHERS, COLLABORATORS AND

680
00:26:45,988 --> 00:26:46,722
THE COMMUNITY.

681
00:26:46,722 --> 00:26:48,024
PARTICULARLY FROM THE

682
00:26:48,024 --> 00:26:48,591
PARTICIPANT COMMUNITY

683
00:26:48,591 --> 00:26:49,125
PERSPECTIVE WAS THIS WAS

684
00:26:49,125 --> 00:26:50,827
SOMETHING THAT WAS GOING TO BE

685
00:26:50,827 --> 00:26:52,929
DONE TO THEM RATHER THAN HAVING

686
00:26:52,929 --> 00:26:54,997
ENGAGED WITH THEM FROM THE

687
00:26:54,997 --> 00:26:55,565
BEGINNING.

688
00:26:55,565 --> 00:27:01,137
SO THE TRIAL WAS CONCEIVED OF AS

689
00:27:01,137 --> 00:27:02,071
BINARY.

690
00:27:02,071 --> 00:27:03,606
FOREIGN INVESTIGATORS ACTING

691
00:27:03,606 --> 00:27:06,476
UPON CAMBODIAN SEX WORKERS AND

692
00:27:06,476 --> 00:27:11,013
THE CAMBODIAN COLLABORATORS WERE

693
00:27:11,013 --> 00:27:11,948
LARGELY UNSEEN.

694
00:27:11,948 --> 00:27:14,350
SO THE IMPLICATION FOR THE

695
00:27:14,350 --> 00:27:16,752
COMMUNITIES AND FOR SOME OF THE

696
00:27:16,752 --> 00:27:18,855
CAMBODIAN AGENCIES WAS THAT THE

697
00:27:18,855 --> 00:27:21,023
CAMBODIANS WERE GOING TO BE

698
00:27:21,023 --> 00:27:26,062
EXPLOITED FOR THE BENEFIT OF

699
00:27:26,062 --> 00:27:26,429
NONCAMBODDIANS.

700
00:27:26,429 --> 00:27:29,465
SO THE QUESTION BECOMES, WOULD

701
00:27:29,465 --> 00:27:30,433
CULTURAL HUMILITY MADE A DRVES

702
00:27:30,433 --> 00:27:32,535
IN SO WE DON'T KNOW, THERE ARE

703
00:27:32,535 --> 00:27:34,403
MANY THINGS WE DON'T KNOW ABOUT

704
00:27:34,403 --> 00:27:35,705
THIS PARTICULAR STUDY AND THE

705
00:27:35,705 --> 00:27:38,107
CONTEXT IN WHICH IT OCCURRED.

706
00:27:38,107 --> 00:27:40,743
SO WE DON'T KNOW FOR INSTANCE

707
00:27:40,743 --> 00:27:42,812
WHETHER THE RESEARCHER, THAT THE

708
00:27:42,812 --> 00:27:45,181
PI OR MEMBERS OF THE RESEARCH

709
00:27:45,181 --> 00:27:49,051
TEAM WENT INTO THIS STUDY WITH

710
00:27:49,051 --> 00:27:51,120
SOME UNDERLYING ASSUMPTIONS OR

711
00:27:51,120 --> 00:27:54,123
BIASES ABOUT SEX WORKERS, ABOUT

712
00:27:54,123 --> 00:27:57,193
CAMBODIAN SEX WORKERS IN

713
00:27:57,193 --> 00:28:00,630
PARTICULAR OR ABOUT CAMBODIANS

714
00:28:00,630 --> 00:28:01,697
GENERALLY, AND WHAT THOSE

715
00:28:01,697 --> 00:28:02,498
PRECONCEPTIONS MIGHT HAVE BEEN

716
00:28:02,498 --> 00:28:04,934
AND HOW THEY MIGHT HAVE

717
00:28:04,934 --> 00:28:08,104
INFLUENCED THE DEVELOPMENT OF

718
00:28:08,104 --> 00:28:09,605
THE PROTOCOL.

719
00:28:09,605 --> 00:28:11,240
THE WOMEN'S AIENDA FOR CHANGE

720
00:28:11,240 --> 00:28:16,679
HAD REFUSED TO SIGN THE 2003

721
00:28:16,679 --> 00:28:17,513
ANTIPROSTITUTION PLEDGE THAT HAD

722
00:28:17,513 --> 00:28:19,048
BEEN REQUIRED BY THE U.S.

723
00:28:19,048 --> 00:28:21,517
GOVERNMENT TO RECEIVE FUNDS

724
00:28:21,517 --> 00:28:22,919
UNDER THE PRESIDENT'S EMERGENCY

725
00:28:22,919 --> 00:28:24,654
PLAN FOR AIDS RELIEVE.

726
00:28:24,654 --> 00:28:27,857
AND WE DON'T KNOW TO WHAT EXTENT

727
00:28:27,857 --> 00:28:31,827
THIS MAY HAVE PLAYED A ROLE IN

728
00:28:31,827 --> 00:28:33,663
THE EXCHANGES OR LACK THEREOF

729
00:28:33,663 --> 00:28:35,398
BETWEEN THE INVESTIGATORS AND

730
00:28:35,398 --> 00:28:38,601
THE SEX WORKER COMMUNITY.

731
00:28:38,601 --> 00:28:40,369
WOULD IT HAVE MADE A DIFFERENCE

732
00:28:40,369 --> 00:28:43,406
IF THERE HAD BEEN INCREASED

733
00:28:43,406 --> 00:28:44,207
COLLABORATION AND ENGAGEMENT

734
00:28:44,207 --> 00:28:47,276
FROM THE VERY BEGINNING, EVEN

735
00:28:47,276 --> 00:28:53,583
BEFORE THE PROTOCOL HAD BEEN

736
00:28:53,583 --> 00:28:55,518
DEVELOPED, WITH CAMBODIAN

737
00:28:55,518 --> 00:28:57,853
AGENCIES, WITH CAMBODIAN NG

738
00:28:57,853 --> 00:28:58,788
Os, WITH THE COMMUNITY.

739
00:28:58,788 --> 00:29:01,557
ONE OF THE MAJOR COMPLAINTS THAT

740
00:29:01,557 --> 00:29:04,427
CAME FROM THE CAMBODIAN SEX

741
00:29:04,427 --> 00:29:07,630
WORKERS AND SOME NG Os WAS

742
00:29:07,630 --> 00:29:09,232
THAT THE INVESTIGATOR LACKED AN

743
00:29:09,232 --> 00:29:13,302
UNDERSTANDING OF THE LOCAL

744
00:29:13,302 --> 00:29:13,869
CONTEXT.

745
00:29:13,869 --> 00:29:15,738
SO THERE WAS NO SAFETY NET

746
00:29:15,738 --> 00:29:18,274
FOOTWORK SEX WORKERS, RIGHT?

747
00:29:18,274 --> 00:29:19,542
THEY DON'T HAVE HEALTH

748
00:29:19,542 --> 00:29:21,677
INSURANCE, THEY DON'T ARE LIFE

749
00:29:21,677 --> 00:29:24,513
INSURANCE, AND IF THERE WAS AN

750
00:29:24,513 --> 00:29:26,682
ADVERSE RESPONSE TO THE

751
00:29:26,682 --> 00:29:28,651
ADMINISTRATION OF THIS

752
00:29:28,651 --> 00:29:29,819
PARTICULAR DRUG, AND THEY WERE

753
00:29:29,819 --> 00:29:32,021
NO LONGER ABLE TO WORK BECAUSE

754
00:29:32,021 --> 00:29:35,891
OF SOME RESULTING DISABILITY,

755
00:29:35,891 --> 00:29:37,193
WHETHER IT WAS PERMANENT OR

756
00:29:37,193 --> 00:29:38,261
TEMPORARY, HOW WERE THEY GOING

757
00:29:38,261 --> 00:29:41,097
TO SUPPORT THEIR FAMILIES.

758
00:29:41,097 --> 00:29:45,601
WHERE WAS THE SAFETY NET AND

759
00:29:45,601 --> 00:29:48,137
THEY FELT QUITE VIGOROUSLY THAT

760
00:29:48,137 --> 00:29:49,405
THE INVESTIGATORS SHOULD HAVE

761
00:29:49,405 --> 00:29:52,608
PROVIED A SAFETY NET.

762
00:29:52,608 --> 00:29:54,043
THE HISTORY OF COLONIALISM,

763
00:29:54,043 --> 00:29:56,112
AGAIN, THE SENSE OF BEING ACTED

764
00:29:56,112 --> 00:29:59,915
UPON FOR THE BENEFIT OF OTHERS.

765
00:29:59,915 --> 00:30:02,752
WERE THEY GOING HAVE ACCESS TO

766
00:30:02,752 --> 00:30:05,688
THE DRUG AFTER THE CLOSE OF THE

767
00:30:05,688 --> 00:30:07,556
TRIAL AND FOR HOW LONG WOULD

768
00:30:07,556 --> 00:30:09,792
THEY HAVE ACCESS TO THE DRUG AND

769
00:30:09,792 --> 00:30:17,933
WHAT THE SEX WORKERS WHO ENGAGED

770
00:30:17,933 --> 00:30:19,001
ULTIMATELY, READ THE PROTOCOL

771
00:30:19,001 --> 00:30:22,571
AND WANTED THE STUDY TO BE

772
00:30:22,571 --> 00:30:25,174
DISCONTINUED, FELT THAT IN FACT

773
00:30:25,174 --> 00:30:27,677
THE INVESTIGATORS HAD COME TO

774
00:30:27,677 --> 00:30:29,645
THIS CONTEXT WITH THE

775
00:30:29,645 --> 00:30:32,748
ASSUMPTIONS THAT ALL SEX WORKERS

776
00:30:32,748 --> 00:30:34,984
WERE VICTIMS, THAT THEY WERE ALL

777
00:30:34,984 --> 00:30:37,720
VICTIMS OF HUMAN TRAFFICKING,

778
00:30:37,720 --> 00:30:39,588
AND NEEDED RESCUE WHEN IN FACT

779
00:30:39,588 --> 00:30:41,757
SOME SAID, YOU KNOW WE'RE IN

780
00:30:41,757 --> 00:30:43,025
THIS PROFESSION BY CHOICE

781
00:30:43,025 --> 00:30:46,095
BECAUSE WE'VE LOOKED AT ALL OF

782
00:30:46,095 --> 00:30:48,798
OUR OPTIONS FOR ECONOMIC

783
00:30:48,798 --> 00:30:50,166
SUSTENANCE AND THIS IS WHAT IS

784
00:30:50,166 --> 00:30:55,338
GOING TO WORK THE BEST FOR US

785
00:30:55,338 --> 00:30:58,107
AND OUR FAMILIES.

786
00:30:58,107 --> 00:31:00,176
SO ANOTHER TRIAL INVOLVED THE

787
00:31:00,176 --> 00:31:04,080
UNIVERSITY OF MINNESOTA AND THIS

788
00:31:04,080 --> 00:31:11,220
WAS A DOUBLE BLIND RANDOMIZED

789
00:31:11,220 --> 00:31:16,225
CLINICAL TRIAL TO COMPARE

790
00:31:16,225 --> 00:31:20,496
QUETIAPINE AND OLANZAPINE AND

791
00:31:20,496 --> 00:31:23,666
RISPERIDONE, FOR FIRST EPISODE

792
00:31:23,666 --> 00:31:26,235
SCHIZOPHRENIA AND DAN MARKING

793
00:31:26,235 --> 00:31:28,437
SON WAS A 26 YEAR-OLD MALE WHO

794
00:31:28,437 --> 00:31:30,506
WAS EXPERIENCING HIS FIRST

795
00:31:30,506 --> 00:31:31,674
PSYCHOTIC BREAK, HIS MOTHER WAS

796
00:31:31,674 --> 00:31:33,676
VERY CONCERNED ABOUT HIM, SHE

797
00:31:33,676 --> 00:31:35,311
REFERRED HIM TO THE POLICE WHO

798
00:31:35,311 --> 00:31:39,448
BROUGHT HIM IN, HE WAS

799
00:31:39,448 --> 00:31:41,484
INVOLUNTARILY HOSPITALIZED, THE

800
00:31:41,484 --> 00:31:43,686
COURT APPOINTED A PSYCHOLOGIST

801
00:31:43,686 --> 00:31:47,523
TO   PERFORM AN EVALUATION OF

802
00:31:47,523 --> 00:31:50,192
MARKING SON AND THE COURT

803
00:31:50,192 --> 00:31:51,026
APPOINTED PSYCHOLOGIST CONCLUDED

804
00:31:51,026 --> 00:31:53,996
THAT HE WAS SUFFERING FROM A

805
00:31:53,996 --> 00:31:56,866
GROSS IMPAIRMENT OF YMENT AND

806
00:31:56,866 --> 00:31:58,701
BEHAVIOR, CAPACITY TO RECOGNIZE

807
00:31:58,701 --> 00:32:04,306
REALITY AND CAPACITY TO REASON

808
00:32:04,306 --> 00:32:06,075
OR UNDERSTAND.

809
00:32:06,075 --> 00:32:07,143
THE COURT APPOINTED--THE COURT

810
00:32:07,143 --> 00:32:09,779
SAID TO MARKING SON, YOU CAN GO

811
00:32:09,779 --> 00:32:13,315
FOR PSYCHIATRIC CARE AND WILL

812
00:32:13,315 --> 00:32:14,917
NOT BE INVOLUNTARILY

813
00:32:14,917 --> 00:32:15,951
HOSPITALIZE, HOWEVER, IF YOU

814
00:32:15,951 --> 00:32:18,921
DON'T FOLLOW THE DIRECTIVES OF

815
00:32:18,921 --> 00:32:25,227
YOUR PSYCHIATRIST, YOU WILL BE

816
00:32:25,227 --> 00:32:26,996
INVOLUNTARILY INSTITUTIONALIZED.

817
00:32:26,996 --> 00:32:28,731
STEPHEN OLSON WAS A PSYCHIATRIST

818
00:32:28,731 --> 00:32:29,999
WITH THE UNIVERSITY OF MIN MEN

819
00:32:29,999 --> 00:32:33,702
AND HE BECAME MARKING SON'S

820
00:32:33,702 --> 00:32:34,570
PSYCHIATRIST OF RECORD.

821
00:32:34,570 --> 00:32:37,573
HE WAS ALSO THE PRINCIPLE

822
00:32:37,573 --> 00:32:41,143
INVESTIGATOR OF THIS RANDOMIZED

823
00:32:41,143 --> 00:32:41,744
CLINICAL TRIAL.

824
00:32:41,744 --> 00:32:46,449
MARKING SON SIGNED AN INFORMED

825
00:32:46,449 --> 00:32:48,684
CONSENT FORM THAT INDICATED HIS

826
00:32:48,684 --> 00:32:49,952
INFORMED CONSENT TO PARTICIPATE

827
00:32:49,952 --> 00:32:54,123
IN THIS TRIAL WHICH MARKING SON

828
00:32:54,123 --> 00:32:55,291
AS HIS PSYCHIATRIST RECOMMENDED

829
00:32:55,291 --> 00:32:56,926
AND AGAIN REMEMBER THAT MACKING

830
00:32:56,926 --> 00:33:00,596
SON IS ALSO THE PI OF THIS STUDY

831
00:33:00,596 --> 00:33:02,865
AND IS RECEIVING A PORTION OF

832
00:33:02,865 --> 00:33:04,099
HIS SALARY THROUGH THE FUND

833
00:33:04,099 --> 00:33:08,070
THAGOREAN IS BEING CONTRIBUTED

834
00:33:08,070 --> 00:33:09,572
BY THIS STUDY.

835
00:33:09,572 --> 00:33:10,739
SO MARKINGSON WAS TOLD BY THE

836
00:33:10,739 --> 00:33:13,275
COURT THAT HE WOULD BE

837
00:33:13,275 --> 00:33:14,777
INVOLUNTARILY COMMITTED IF HE

838
00:33:14,777 --> 00:33:17,913
FAILED TO FOLLOW HIS

839
00:33:17,913 --> 00:33:19,515
PSYCHIATRIST REGIMEN.

840
00:33:19,515 --> 00:33:23,619
DURING THE COURSE OF

841
00:33:23,619 --> 00:33:24,320
MARKINGSON'S TREATMENT WITH

842
00:33:24,320 --> 00:33:26,222
DR. OLSON AND AS A PARTICIPANT

843
00:33:26,222 --> 00:33:28,190
IN THIS STUDY, HE WAS

844
00:33:28,190 --> 00:33:30,392
TRANSFERRED TO A HALFWAY HOUSE.

845
00:33:30,392 --> 00:33:32,828
HIS MOTHER NOTICED THAT HIS

846
00:33:32,828 --> 00:33:34,697
CONDITION WAS ACTUALLY

847
00:33:34,697 --> 00:33:37,833
DETERIORATING RATHER THAN

848
00:33:37,833 --> 00:33:40,035
IMPROVING AND STAFF IN THE

849
00:33:40,035 --> 00:33:42,304
HALFWAY HOUSE INDICATED AS WELL

850
00:33:42,304 --> 00:33:45,941
THAT HE WAS DETERIORATING, THE

851
00:33:45,941 --> 00:33:47,910
MOTHER CONTACTED THE STUDY TEAM

852
00:33:47,910 --> 00:33:49,612
AND CONTACTED UNIVERSITY

853
00:33:49,612 --> 00:33:51,947
OFFICIALS WHO WERE ESSENTIALLY

854
00:33:51,947 --> 00:33:53,282
NONRESPONSIVE TO HER CONCERNS

855
00:33:53,282 --> 00:33:55,751
AND SAID WHAT DO YOU EXPECT US

856
00:33:55,751 --> 00:33:58,654
TO DO ABOUT THIS?

857
00:33:58,654 --> 00:34:02,191
MARKINGSON COMMITTED SUICIDE IN

858
00:34:02,191 --> 00:34:05,861
2004 BY DECAPITATING HIMSELF IN

859
00:34:05,861 --> 00:34:07,863
HIS BATH TUB.

860
00:34:07,863 --> 00:34:09,598
AN AUTOPSIES FOUND THE ONLY DRUG

861
00:34:09,598 --> 00:34:11,233
IN HIS STUDY WAS THE STUDY DRUG

862
00:34:11,233 --> 00:34:13,269
TO WHICH HE HAD BEEN RANDOMIZED

863
00:34:13,269 --> 00:34:16,305
AND IN A LATER AUDIT BY

864
00:34:16,305 --> 00:34:17,406
MINNESOTA STATE WHICH WAS

865
00:34:17,406 --> 00:34:22,344
CONCLUDED QUITE A NUMBER OF

866
00:34:22,344 --> 00:34:23,779
YEARS AFTER MACKINGSON'S SUICIDE

867
00:34:23,779 --> 00:34:26,982
FOUND DEFICIENCIES IN THE IRB

868
00:34:26,982 --> 00:34:28,183
REVIEW, AND A CLEAR CONFLICT OF

869
00:34:28,183 --> 00:34:33,489
INTEREST ON THE PART OF THE

870
00:34:33,489 --> 00:34:33,822
PSYCHIATRIST.

871
00:34:33,822 --> 00:34:36,292
SO WE CAN ASK FOR INITANCE HOW

872
00:34:36,292 --> 00:34:38,227
MIGHT CULTURAL HUMILITY HAVE

873
00:34:38,227 --> 00:34:42,731
MADE A DIFFERENCE IN SO I WOULD

874
00:34:42,731 --> 00:34:44,500
PROPOSE THAT THE PSYCHIATRIST IN

875
00:34:44,500 --> 00:34:46,936
THIS CASE, STEPHEN OLSON WAS NOT

876
00:34:46,936 --> 00:34:49,572
ACTIVELY LISTENING TO THE

877
00:34:49,572 --> 00:34:50,940
RESEARCH PARTICIPANT, THAT OTHER

878
00:34:50,940 --> 00:34:55,077
MEMBERS OF THE STUDY TEAM WERE

879
00:34:55,077 --> 00:34:57,713
NOT ACTIVELY ENGAGED, THAT THERE

880
00:34:57,713 --> 00:35:02,418
WAS NO CURIOSITY ABOUT HOW THE

881
00:35:02,418 --> 00:35:04,720
PARTICULAR INDIVIDUALS WAS

882
00:35:04,720 --> 00:35:06,055
PROGRESSING OR NOT IN THE COURSE

883
00:35:06,055 --> 00:35:08,390
OF THE STUDY AND THAT RATHER IT

884
00:35:08,390 --> 00:35:10,259
WAS A QUESTION OF WAITING FOR

885
00:35:10,259 --> 00:35:11,660
THE STUDY OUTCOME AND SEEING

886
00:35:11,660 --> 00:35:15,664
WHAT HAPPENED AT THE END.

887
00:35:15,664 --> 00:35:20,235
SO IF WE LOOK AT HOW

888
00:35:20,235 --> 00:35:22,037
INSTITUTIONAL REVIEW BORDS,

889
00:35:22,037 --> 00:35:24,640
ETHICS, REVIEW COMMITTEES, MIGHT

890
00:35:24,640 --> 00:35:27,409
REVIEW FOR CULTURAL HUMILITY IN

891
00:35:27,409 --> 00:35:30,813
THE CONTEXT OF REVIEWING

892
00:35:30,813 --> 00:35:32,982
SCIENTIFIC PROTOCOLS, HOW AND TO

893
00:35:32,982 --> 00:35:34,984
WHAT EXTENT HAS THE RESEARCH

894
00:35:34,984 --> 00:35:37,019
TEAM FAMILIARIZED ITSELF WITH

895
00:35:37,019 --> 00:35:38,520
THE CONTEXT IN WHICH THE STUDY

896
00:35:38,520 --> 00:35:40,456
IS GOING TO OCCUR.

897
00:35:40,456 --> 00:35:43,225
SO THIS GOES TO THE SOCIAL

898
00:35:43,225 --> 00:35:45,995
CONTEXT, THE ECONOMIC CONTEXT,

899
00:35:45,995 --> 00:35:46,929
THE HISTORICAL CONTEXT, SO WE

900
00:35:46,929 --> 00:35:51,800
CAN SEE FOR INSTANCE WITH THE

901
00:35:51,800 --> 00:35:52,968
PREP TRIAL THAT THE

902
00:35:52,968 --> 00:35:55,471
INVESTIGATORS SEEMED NOT TO

903
00:35:55,471 --> 00:35:57,539
UNDERSTAND OR HAVE KNOWLEDGE OF

904
00:35:57,539 --> 00:36:00,376
THE HISTORICAL CONTEXT AND THE

905
00:36:00,376 --> 00:36:02,077
ECONOMIC CONTEXT FOR THE SEX

906
00:36:02,077 --> 00:36:02,311
WORKERS.

907
00:36:02,311 --> 00:36:08,784
IF WE LOOK AT THE MARKINGSON

908
00:36:08,784 --> 00:36:10,085
MARKINGSON'S PARTICIPATION IN

909
00:36:10,085 --> 00:36:11,453
THE RANDOMIZED DRUG TRIAL, IT'S

910
00:36:11,453 --> 00:36:16,425
NOT CLEAR THAT THE INVESTIGATORS

911
00:36:16,425 --> 00:36:18,894
UNDERSTOOD THESE SOCIAL CONTEXT

912
00:36:18,894 --> 00:36:21,463
IN WHICH THE INDIVIDUALS WHO ARE

913
00:36:21,463 --> 00:36:25,668
ENROLLED IN THE STUDY WERE

914
00:36:25,668 --> 00:36:26,235
FUNCTIONING OR NOT.

915
00:36:26,235 --> 00:36:30,606
HOW AND TO WHAT EXTENT DO THE

916
00:36:30,606 --> 00:36:32,107
RESEARCH PROCEDURES FACILITATE

917
00:36:32,107 --> 00:36:34,009
TEAM MEMBERS, BIASES AND VALUES

918
00:36:34,009 --> 00:36:36,779
AND THEIR IMPACT ON THE RESEARCH

919
00:36:36,779 --> 00:36:37,346
PARTICIPANTS.

920
00:36:37,346 --> 00:36:40,082
AND I WOULD SUGGEST HERE THAT IN

921
00:36:40,082 --> 00:36:43,185
BOTH OF THE EXAMPLES I PROVIDED,

922
00:36:43,185 --> 00:36:45,120
THERE WAS NO EXAMINATION EITHER

923
00:36:45,120 --> 00:36:48,991
ON AN INDIVIDUAL BASIS OR ON A

924
00:36:48,991 --> 00:36:51,093
GROUP LEVEL BASIS, OF TEAM

925
00:36:51,093 --> 00:36:53,495
MEMBERS BIASES AND VALUES.

926
00:36:53,495 --> 00:36:55,998
THAT PEOPLE DID NOT QUERY

927
00:36:55,998 --> 00:36:59,968
THEMSELVES OR EACH OTHER AS TO

928
00:36:59,968 --> 00:37:01,637
THEIR ASSUMPTIONS GOING INTO A

929
00:37:01,637 --> 00:37:04,707
STUDY INVOLVING SEX WORKERS, A

930
00:37:04,707 --> 00:37:07,910
STUDY INVOLVING A SOUTHEAST

931
00:37:07,910 --> 00:37:10,846
ASIAN CULTURE, THAT THEY DIDN'T

932
00:37:10,846 --> 00:37:12,648
QUESTION OR EVEN RECOGNIZE

933
00:37:12,648 --> 00:37:14,783
PERHAPS THEIR BIASES WITH

934
00:37:14,783 --> 00:37:16,819
RESPECT TO INDIVIDUALS SUFFERING

935
00:37:16,819 --> 00:37:19,822
FROM A SEVERE MENTAL ILLNESS AND

936
00:37:19,822 --> 00:37:21,356
MAYBE THERE WAS AN ASSUMPTION

937
00:37:21,356 --> 00:37:27,029
THAT THESE WERE INDIVIDUALS TO

938
00:37:27,029 --> 00:37:29,765
BE ACTED UPON.

939
00:37:29,765 --> 00:37:30,966
REVIEWING FOR ATTENTIVENESS,

940
00:37:30,966 --> 00:37:32,935
AGAIN WHAT STEREOTYPES OR

941
00:37:32,935 --> 00:37:34,703
ASSUMPTIONS ABOUT THE STUDY SITE

942
00:37:34,703 --> 00:37:37,639
OR PARTICIPANTS DO RESEARCHERS

943
00:37:37,639 --> 00:37:37,840
BRING.

944
00:37:37,840 --> 00:37:41,009
HOW HAVE THE INDIVIDUALS WHO

945
00:37:41,009 --> 00:37:44,546
WILL BE INTERACTING WITH THE

946
00:37:44,546 --> 00:37:46,248
PARTICIPANTS BEEN TRAINED IN

947
00:37:46,248 --> 00:37:49,351
THEIR IRPT ACTION, HOW HAD THEY

948
00:37:49,351 --> 00:37:51,687
BEEN TRAINED TO ANALYZE DATA,

949
00:37:51,687 --> 00:37:58,260
ARE THEY LOOKING FOR ALTERNATIVE

950
00:37:58,260 --> 00:37:59,228
EXPLANATIONS FOR WHAT THEY'RE

951
00:37:59,228 --> 00:38:03,232
SEEING IN THE DATA, WHETHER IT'S

952
00:38:03,232 --> 00:38:04,500
QUANTITATIVE, QUALITATIVE OR

953
00:38:04,500 --> 00:38:05,334
MIXED METHODOLOGIES.

954
00:38:05,334 --> 00:38:07,569
HOW MIGHT THEIR ASSUMPTIONS

955
00:38:07,569 --> 00:38:08,537
IMPACT THEIR DATA INTERPRETATION

956
00:38:08,537 --> 00:38:09,538
AND ARE THEY ENGAGING

957
00:38:09,538 --> 00:38:12,875
INDIVIDUALS IN THE TARGET

958
00:38:12,875 --> 00:38:16,078
COMMUNITY IN ASSISTING THEM TO

959
00:38:16,078 --> 00:38:21,016
UNDERSTAND BETTER THE OUTCOMES

960
00:38:21,016 --> 00:38:22,618
OF THEIR DATA COLLECTION

961
00:38:22,618 --> 00:38:24,920
REVIEWING FOR RESPECT AND

962
00:38:24,920 --> 00:38:26,421
RESPONSIVENESS, HOW LONG HAS

963
00:38:26,421 --> 00:38:28,490
THIS PARTICULAR RESEARCH TEAM

964
00:38:28,490 --> 00:38:30,659
BEEN ENGAGED WITH THIS

965
00:38:30,659 --> 00:38:30,926
COMMUNITY.

966
00:38:30,926 --> 00:38:32,995
I'M SURE MANY OF US ARE FAMILIAR

967
00:38:32,995 --> 00:38:36,965
WITH THE TERM HELICOPTER

968
00:38:36,965 --> 00:38:39,134
RESEARCH, WHERE RESEARCHERS

969
00:38:39,134 --> 00:38:41,670
THRIE IN, DO RESEARCH TAKE

970
00:38:41,670 --> 00:38:43,405
WHATEVER SAMPLES OR DATA THEYA

971
00:38:43,405 --> 00:38:44,706
HAVE GARNERED AND NEVER SEE THE

972
00:38:44,706 --> 00:38:45,974
COMMUNITY AGAIN AND HAVE NEVER

973
00:38:45,974 --> 00:38:49,278
SEEN THE COMMUNITY BEFORE THAT.

974
00:38:49,278 --> 00:38:51,046
SO WHAT MECHANISMS HAVE BEEN IN

975
00:38:51,046 --> 00:38:54,116
PLACE TO REALLY BUILD A

976
00:38:54,116 --> 00:38:56,351
RELATIONSHIP. 

977
00:38:56,351 --> 00:38:58,086
TO REDUCE THE POWER IMBALANCE

978
00:38:58,086 --> 00:38:59,955
BETWEEN THE COMMUNITY AND THE

979
00:38:59,955 --> 00:39:01,890
RESEARCHERS, SO THAT IT'S CLEAR

980
00:39:01,890 --> 00:39:03,625
THAT EACH IS BEING GIVEN AN

981
00:39:03,625 --> 00:39:07,763
OPPORTUNITY TO LEARN FROM THE

982
00:39:07,763 --> 00:39:08,564
OTHER.

983
00:39:08,564 --> 00:39:10,666
ARE THERE RESEARCH PROTECTIONS

984
00:39:10,666 --> 00:39:14,269
AND LEVEL OF PARTICIPANT

985
00:39:14,269 --> 00:39:17,940
REMUNERATION RESPONSIVE TO

986
00:39:17,940 --> 00:39:19,007
PARTICIPANTS CONCERNS, AGAIN

987
00:39:19,007 --> 00:39:21,210
WITHIN THE CONTEXT OF FEDERAL

988
00:39:21,210 --> 00:39:22,244
REGULATIONS AND INTERNATIONAL

989
00:39:22,244 --> 00:39:23,345
GUIDELINES AND THIS AGAIN

990
00:39:23,345 --> 00:39:25,514
REQUIRES AN UNDERSTANDING OF THE

991
00:39:25,514 --> 00:39:26,782
ECONOMIC CONTEXT IN WHICH THE

992
00:39:26,782 --> 00:39:31,220
RESEARCH IS BEING CONDUCTED AND

993
00:39:31,220 --> 00:39:33,589
ARE REPRESENTATIVES OF THE

994
00:39:33,589 --> 00:39:35,691
COMMUNITY BEING ENGAGED FOR

995
00:39:35,691 --> 00:39:36,191
THEIR INPUT.

996
00:39:36,191 --> 00:39:37,993
DO THEY HAVE A SEAT AT THE

997
00:39:37,993 --> 00:39:39,795
TABLE, BOTH IN THE DEVELOPMENT

998
00:39:39,795 --> 00:39:43,131
OF THE PROTOCOL AND THE

999
00:39:43,131 --> 00:39:46,368
ANALYSIS, AND INTERPRETATION OF

1000
00:39:46,368 --> 00:39:48,070
THE DATA.

1001
00:39:48,070 --> 00:39:50,806
SO REVIEWING FOR EMBODIMENT,

1002
00:39:50,806 --> 00:39:53,242
HAVE THE RESEARCHERS CONSIDERED

1003
00:39:53,242 --> 00:39:54,376
THE IMPLICATIONS FOR

1004
00:39:54,376 --> 00:39:56,111
PARTICIPANTS BECAUSE OF THEIR

1005
00:39:56,111 --> 00:39:59,514
CONTACT WITH TEAM MEMBERS, WILL

1006
00:39:59,514 --> 00:40:04,286
THERE BE SOCIAL OR POLITICAL

1007
00:40:04,286 --> 00:40:04,987
REPERCUSSIONS TO THE

1008
00:40:04,987 --> 00:40:06,388
PARTICIPANTS AND I CAN GIVE YOU

1009
00:40:06,388 --> 00:40:09,157
AN EXAMPLE FROM MY OWN RESEARCH

1010
00:40:09,157 --> 00:40:14,263
WHERE I WAS DOING HIV RELATED

1011
00:40:14,263 --> 00:40:16,832
RESEARCH IN LAOS IN THE MID1990S

1012
00:40:16,832 --> 00:40:21,436
AND THIS WAS REALLY LOOKING AT

1013
00:40:21,436 --> 00:40:24,139
THE HIV PREVALENCE AMONG

1014
00:40:24,139 --> 00:40:26,942
PREGNANT WOMEN AND WOMEN WERE

1015
00:40:26,942 --> 00:40:29,845
BEING RECRUITED FROM SOME GYN

1016
00:40:29,845 --> 00:40:30,078
CLINICS.

1017
00:40:30,078 --> 00:40:32,247
THE WOMEN WERE WILLING TO

1018
00:40:32,247 --> 00:40:33,982
PARTICIPATE IN THIS STUDY, BUT

1019
00:40:33,982 --> 00:40:38,820
THEY WERE VERY CONCERNED THAT

1020
00:40:38,820 --> 00:40:41,924
SOMEBODY MIGHT FIND OUT THAT

1021
00:40:41,924 --> 00:40:43,625
THEY HAD PARTICIPATED AND THAT

1022
00:40:43,625 --> 00:40:45,294
THERE WOULD BE POLITICAL

1023
00:40:45,294 --> 00:40:54,036
REPERCUSSIONS, THAT IF THE

1024
00:40:54,036 --> 00:40:56,772
GOVERNMENT REGIME CHANGES, THAT

1025
00:40:56,772 --> 00:40:59,741
THEY WOULD SUFFER AS A RESULT

1026
00:40:59,741 --> 00:41:01,710
BECAUSE ANY CONTACT WITH

1027
00:41:01,710 --> 00:41:03,045
FOREIGNERS LED TO REPERCUSSIONS.

1028
00:41:03,045 --> 00:41:06,415
SO THEY SIGNED THE CONSEBT FORM

1029
00:41:06,415 --> 00:41:08,183
AND WE HAD TO NEGOTIATE AN

1030
00:41:08,183 --> 00:41:08,917
AGREEMENT WITH THE MINISTRY OF

1031
00:41:08,917 --> 00:41:10,986
HEALTH THAT ALL TAPE RECORDINGS

1032
00:41:10,986 --> 00:41:11,787
OF THE INTERVIEWS WHICH

1033
00:41:11,787 --> 00:41:14,589
OBVIOUSLY THEN HAD TO BE

1034
00:41:14,589 --> 00:41:18,126
TRANSCRIBED INTO ENGLISH, BUT

1035
00:41:18,126 --> 00:41:20,395
ALL RECORDINGS WOULD BE TAKEN

1036
00:41:20,395 --> 00:41:24,032
OUT OF THE COUNTRY BECAUSE THE

1037
00:41:24,032 --> 00:41:26,935
WOMEN WERE CONCERNED IF SOMEONE

1038
00:41:26,935 --> 00:41:29,104
RECOGNIZED THEIR VOICE THEY

1039
00:41:29,104 --> 00:41:35,010
WOULD SUFFER REPERCUSSIONS UP TO

1040
00:41:35,010 --> 00:41:37,079
AND INCLUDING IMPRISONMENT HAVE

1041
00:41:37,079 --> 00:41:38,046
THE RESEARCHERS DEVELOPED

1042
00:41:38,046 --> 00:41:39,348
ADEQUATE MEASURES TO PROTECT THE

1043
00:41:39,348 --> 00:41:41,316
IDENTITY AND AGAIN THIS REQUIRES

1044
00:41:41,316 --> 00:41:42,718
MORE THAN A SUPERFICIAL

1045
00:41:42,718 --> 00:41:44,486
UNDERSTANDING OF THE POLITICAL

1046
00:41:44,486 --> 00:41:49,391
CONTEXT, THE SOCIAL CONTEXT, THE

1047
00:41:49,391 --> 00:41:52,027
ECONOMIC CONTEXT, AND HAVE

1048
00:41:52,027 --> 00:41:53,895
MEMBERS DESIGNED THE STUDY IN A

1049
00:41:53,895 --> 00:41:56,898
WAY THAT IS SENSITIVE TO LOCAL

1050
00:41:56,898 --> 00:41:58,700
CUSTOMS RELATING TO PERSONAL

1051
00:41:58,700 --> 00:42:03,438
SPACE AND INTERPERSONAL

1052
00:42:03,438 --> 00:42:03,772
COMMUNICATION.

1053
00:42:03,772 --> 00:42:06,541
A COLLEAGUE OF MINE AND I

1054
00:42:06,541 --> 00:42:08,577
PUBLISHED, HAD PUBLISHED A

1055
00:42:08,577 --> 00:42:14,383
MANUSCRIPT AT THE END OF 2023,

1056
00:42:14,383 --> 00:42:20,989
THAT'S TITLED CARE, CURIOSITY

1057
00:42:20,989 --> 00:42:24,893
ATTENTIVENESS, RESPECT AND

1058
00:42:24,893 --> 00:42:26,661
RESPONSIVENESS AND EMBODIMENT

1059
00:42:26,661 --> 00:42:28,497
MODEL, OPERATIONALIZING CULTURAL

1060
00:42:28,497 --> 00:42:29,831
HUMILITY AND CONDUCT OF CLINICAL

1061
00:42:29,831 --> 00:42:33,535
WERE, AND THIS WENT INTO HOW WE

1062
00:42:33,535 --> 00:42:35,604
DRAW ON BUBER AND CONE FOR OUR

1063
00:42:35,604 --> 00:42:36,104
BASIC PRINCIPLES.

1064
00:42:36,104 --> 00:42:38,507
I WOULD LIKE TO ACKNOWLEDGE

1065
00:42:38,507 --> 00:42:40,642
TIMOTHY NICHOLAS MY CO AUTHOR ON

1066
00:42:40,642 --> 00:42:46,048
THAT PAPER AND ANDREA DRAGIN WHO

1067
00:42:46,048 --> 00:42:48,216
PRESENTED A SIMILAR PRESENTATION

1068
00:42:48,216 --> 00:42:49,351
AT LAST YEAR'S PREMIER

1069
00:42:49,351 --> 00:42:49,651
CONFERENCE.

1070
00:42:49,651 --> 00:42:53,288
I WOULD LIKE TO THANK YOU AGAIN

1071
00:42:53,288 --> 00:42:55,490
FOR THE INVITATION TO PRESENT TO

1072
00:42:55,490 --> 00:42:55,891
YOU.

1073
00:42:55,891 --> 00:42:57,826
IT'S REALLY QUITE AN HONOR AND I

1074
00:42:57,826 --> 00:42:58,927
WOULD BE HAPPY TO TAKE ANY

1075
00:42:58,927 --> 00:43:07,803
QUESTIONS THAT YOU MAY HAVE.

1076
00:43:07,803 --> 00:43:09,404
OKAY, PLEASE GO AHEAD AND PUT

1077
00:43:09,404 --> 00:43:11,840
YOUR QUESTIONS IN THE LIVE

1078
00:43:11,840 --> 00:43:12,207
FEEDBACK LINK.

1079
00:43:12,207 --> 00:43:16,311
ONE QUESTION I HAVE IS HAVE YOU

1080
00:43:16,311 --> 00:43:19,081
HAD EXPERIENCE AND HOW ARE

1081
00:43:19,081 --> 00:43:21,850
IRBs SUPPOSED TO DETERMINE IF

1082
00:43:21,850 --> 00:43:23,552
THE RESEARCHERS HAVEN'T

1083
00:43:23,552 --> 00:43:24,419
ADEQUATELY CONSIDERED THESE

1084
00:43:24,419 --> 00:43:30,759
VARIOUS ASPECTS OF CULTURAL

1085
00:43:30,759 --> 00:43:32,260
HUMILITY, PRIOR TO THE REVIEW

1086
00:43:32,260 --> 00:43:34,229
THEY'RE DOING, WHETHER IT'S DONE

1087
00:43:34,229 --> 00:43:36,198
THOROUGHLY ENOUGH, HAVE A LOOKED

1088
00:43:36,198 --> 00:43:38,033
AT EVERYTHING, IT'S A BIG

1089
00:43:38,033 --> 00:43:39,734
UNDERTAKING TO DO BUT THEN FOR

1090
00:43:39,734 --> 00:43:42,137
THE IRB TO ASSESS IT'S BEEN DONE

1091
00:43:42,137 --> 00:43:42,437
ADEQUATELY.

1092
00:43:42,437 --> 00:43:43,271
HOW SHOULD THAT HAPPEN IN.

1093
00:43:43,271 --> 00:43:45,140
>> SO 1 OF THE THINGS I

1094
00:43:45,140 --> 00:43:47,175
THINK--THAT'S A GREAT QUESTION: 

1095
00:43:47,175 --> 00:43:51,446
ONE OF THE THINGS THAT REVIEW

1096
00:43:51,446 --> 00:43:52,681
COMMITTEES CAN DO PARTICULARLY

1097
00:43:52,681 --> 00:43:53,548
WHEN IT'S A RESEARCHER WHO

1098
00:43:53,548 --> 00:43:54,983
CLEARLY DOES NOT HAVE A TRACK

1099
00:43:54,983 --> 00:43:58,620
RECORD OF WORKING WITH A

1100
00:43:58,620 --> 00:43:59,654
PARTICULAR COMMUNITY, THEY CAN

1101
00:43:59,654 --> 00:44:02,124
ENGAGE WHAT COULD BEING CALLED A

1102
00:44:02,124 --> 00:44:04,092
CULTURAL EXPERT, SON SM WHO WHO

1103
00:44:04,092 --> 00:44:05,660
IS FAMILIAR WITH THAT PARTICULAR

1104
00:44:05,660 --> 00:44:08,230
COMMUNITY WHO HAS WORKED IN THE

1105
00:44:08,230 --> 00:44:09,664
PARTICULAR COMMUNITY, AND HAS A

1106
00:44:09,664 --> 00:44:13,468
RECORD OF ENGAGEMENT WITH THE

1107
00:44:13,468 --> 00:44:14,102
COMMUNITY.

1108
00:44:14,102 --> 00:44:17,472
SO FOR INSTANCE A RESEARCHER WHO

1109
00:44:17,472 --> 00:44:21,243
MAY WANT TO LOOK AT PEOPLE'S

1110
00:44:21,243 --> 00:44:22,978
ATTITUDES TOWARDS THEIR

1111
00:44:22,978 --> 00:44:27,516
GOVERNMENTS IN THE CONTEXT OF

1112
00:44:27,516 --> 00:44:31,052
HUMAN RIGHTS, AND IS ASKING THIS

1113
00:44:31,052 --> 00:44:32,387
OF INDIVIDUALS WHO ARE THROUGH A

1114
00:44:32,387 --> 00:44:37,125
SURVEY OF INDIVIDUALS WHO ARE

1115
00:44:37,125 --> 00:44:40,829
LOCATED IN COUNTRIES THAT HAVE

1116
00:44:40,829 --> 00:44:42,164
VERY STRINGENT SURVEILLANCE

1117
00:44:42,164 --> 00:44:43,231
SYSTEMS, FOR INSTANCE OVER

1118
00:44:43,231 --> 00:44:46,635
SOCIAL MEDIA, IT WOULD BE

1119
00:44:46,635 --> 00:44:47,702
IMPORTANT TO ENGAGE SOMEONE WHO

1120
00:44:47,702 --> 00:44:50,005
IS QUITE FAMILIAR WITH THAT

1121
00:44:50,005 --> 00:44:53,008
POLITICAL SYSTEM, WITH THE KINDS

1122
00:44:53,008 --> 00:44:55,177
OF REPERCUSSIONS THAT SOMEONE

1123
00:44:55,177 --> 00:44:57,245
MIGHT MIGHT FACE IF THEY WERE TO

1124
00:44:57,245 --> 00:44:59,681
ANSWER PARTICULAR KINDS OF

1125
00:44:59,681 --> 00:44:59,948
QUESTIONS.

1126
00:44:59,948 --> 00:45:02,751
SO COULD THE QUESTIONS BE

1127
00:45:02,751 --> 00:45:03,451
REFRAMED.

1128
00:45:03,451 --> 00:45:05,921
IS THAT A COUNTRY WHERE IT WOULD

1129
00:45:05,921 --> 00:45:07,189
NOT BE ADVISABLE TO DO THIS

1130
00:45:07,189 --> 00:45:08,890
PARTICULAR RESEARCH AT THIS

1131
00:45:08,890 --> 00:45:09,658
PARTICULAR TIME.

1132
00:45:09,658 --> 00:45:12,194
DOESN'T MEAN IT CAN'T BE DONE

1133
00:45:12,194 --> 00:45:14,129
FOR ALL TIME BUT AT THIS

1134
00:45:14,129 --> 00:45:14,829
PARTICULAR TIME GIVEN A

1135
00:45:14,829 --> 00:45:18,099
PARTICULAR ANY OF THAL

1136
00:45:18,099 --> 00:45:18,466
ADMINISTRATION.

1137
00:45:18,466 --> 00:45:23,238
SO THAT WOULD BE 1 WAY OF

1138
00:45:23,238 --> 00:45:27,108
POSSIBLY FOCUSING ON CULTURAL

1139
00:45:27,108 --> 00:45:27,576
HUMILITY.

1140
00:45:27,576 --> 00:45:30,679
WE SEE FOR INITANCE THAT THE

1141
00:45:30,679 --> 00:45:32,414
FEDERAL REGULATIONS REQUIRE FOR

1142
00:45:32,414 --> 00:45:34,349
INSTANCE A PRISONER

1143
00:45:34,349 --> 00:45:35,417
REPRESENTATIVE FOR PRISON

1144
00:45:35,417 --> 00:45:36,218
RESEARCH, RIGHT?

1145
00:45:36,218 --> 00:45:37,786
AND THIS AGAIN GOES TO THE--I

1146
00:45:37,786 --> 00:45:40,188
THINK IT'S AN EXAMPLE OF HOW

1147
00:45:40,188 --> 00:45:42,157
CULTURAL HUMILITY CAN BE

1148
00:45:42,157 --> 00:45:44,092
INTEGRATED INTO THE REVIEW

1149
00:45:44,092 --> 00:45:45,293
PROCESS, WHERE SOMEONE WHO HAS

1150
00:45:45,293 --> 00:45:49,297
WORKED IN THAT CONTEXT, WHO IS

1151
00:45:49,297 --> 00:45:51,633
FAMILIAR WITH THAT PARTICULAR

1152
00:45:51,633 --> 00:45:53,635
CONTEXT IN A TODAY THAT I DID A

1153
00:45:53,635 --> 00:45:57,639
NUMBER OF YEARS AGO, THAT LOOKED

1154
00:45:57,639 --> 00:46:03,111
AT THE CO OCCURRENCE OF HIV RISK

1155
00:46:03,111 --> 00:46:04,713
AMONG SELF-IDENTIFIED PUERTO

1156
00:46:04,713 --> 00:46:07,816
RICAN AND MEXICAN WOMEN WITH

1157
00:46:07,816 --> 00:46:09,117
DIAGNOSIS OF SCHIZOPHRENIA,

1158
00:46:09,117 --> 00:46:11,653
BIPOLAR DISORDER OR MAJOR

1159
00:46:11,653 --> 00:46:11,987
DEPRESSION.

1160
00:46:11,987 --> 00:46:15,190
WE HAD A COMMUNITY ADVISORY

1161
00:46:15,190 --> 00:46:16,758
BOARD THAT CONSISTED OF--THAT

1162
00:46:16,758 --> 00:46:20,195
INCLUDED WHAT WE CALL

1163
00:46:20,195 --> 00:46:20,795
PARTICIPANT REPRESENTATIVES.

1164
00:46:20,795 --> 00:46:21,863
SO THESE WERE INDIVIDUAL WHO IS

1165
00:46:21,863 --> 00:46:23,365
MIGHT HAVE LIKED TO PARTICIPATE

1166
00:46:23,365 --> 00:46:26,034
IN THIS STUDY THAT WERE

1167
00:46:26,034 --> 00:46:28,003
OTHERWISE ELIGIBLE BUT PERHAPS

1168
00:46:28,003 --> 00:46:30,538
THEIR AGE WAS OUTSIDE OF THE AGE

1169
00:46:30,538 --> 00:46:32,173
RANGE TAKEN--THEY WE HAD

1170
00:46:32,173 --> 00:46:35,043
DELINEATED FOR THE STUDY.

1171
00:46:35,043 --> 00:46:38,346
SO THAT COMMUNITY ADVISE REBOARD

1172
00:46:38,346 --> 00:46:41,516
INCLUDED FOR INSTANCE, SEX

1173
00:46:41,516 --> 00:46:44,586
WORKERS, PARTICIPANT

1174
00:46:44,586 --> 00:46:48,423
REPRESENTATIVES, DRUG DEALERS,

1175
00:46:48,423 --> 00:46:50,558
POLICE OFFICERS, INDIVIDUALS

1176
00:46:50,558 --> 00:46:51,393
FROM SOCIAL SERVICE ENTITIES

1177
00:46:51,393 --> 00:46:52,594
THAT WORKED WITH THE COMMUNITIES

1178
00:46:52,594 --> 00:46:54,396
FROM WHICH WE WOULD BE

1179
00:46:54,396 --> 00:46:56,031
RECRUITING.

1180
00:46:56,031 --> 00:47:01,936
SO THE IDEA WAS THAT YOU TRY TO

1181
00:47:01,936 --> 00:47:02,971
GET REPRESENTATION FROM, WITH

1182
00:47:02,971 --> 00:47:04,906
PEOPLE WHO CAN ADDRESS AT LEAST

1183
00:47:04,906 --> 00:47:06,908
SOME OF THE DIMENSIONS OF WHAT

1184
00:47:06,908 --> 00:47:08,376
IS HAPPENING IN THIS STUDY

1185
00:47:08,376 --> 00:47:09,711
BECAUSE NO 1 CAN ADDRESS

1186
00:47:09,711 --> 00:47:10,011
EVERYTHING.

1187
00:47:10,011 --> 00:47:12,447
I DON'T KNOW IF THAT HELPS, AND

1188
00:47:12,447 --> 00:47:15,784
THEN FOR THE IRB TO LOOK AT THE

1189
00:47:15,784 --> 00:47:19,387
COMPOSITION OF THAT COMMUNITY

1190
00:47:19,387 --> 00:47:19,888
ADVISORY BOARD.

1191
00:47:19,888 --> 00:47:23,625
>> AND REQUIRE SOMETHING
LIKE

1192
00:47:23,625 --> 00:47:25,327
THAT POTENTIALLY--

1193
00:47:25,327 --> 00:47:25,860
>> POTENTIALLY, RIGHT.

1194
00:47:25,860 --> 00:47:27,862
>> AND DO YOU USE ADHOC

1195
00:47:27,862 --> 00:47:28,830
REVIEWERS THAT ARE A LOST

1196
00:47:28,830 --> 00:47:29,998
EXPERIENCE IN THAT AREA AT ALL

1197
00:47:29,998 --> 00:47:34,369
IN NEXT ?

1198
00:47:34,369 --> 00:47:36,271
>> I CAN'T SPEAK FOR ALL
IRBs,

1199
00:47:36,271 --> 00:47:40,742
BUT I CAN SAY CASE WESTERN

1200
00:47:40,742 --> 00:47:41,343
IRB DOES.

1201
00:47:41,343 --> 00:47:43,878
WE HAVE CULTURAL REVIEWERS, WE

1202
00:47:43,878 --> 00:47:45,814
HAVE ADHOC MEMBERS THAT WE BRING

1203
00:47:45,814 --> 00:47:48,216
IN FOR SPECIFIC PROTOCOLS WHERE

1204
00:47:48,216 --> 00:47:53,088
WE FEEL THAT WE DON'T HAVE STAFF

1205
00:47:53,088 --> 00:47:54,022
COMPETENCE, SUFFICIENT EXPERTISE

1206
00:47:54,022 --> 00:47:59,461
ON THE BOARD AS IT IS

1207
00:47:59,461 --> 00:47:59,761
CONSITUTED.

1208
00:47:59,761 --> 00:48:00,762
AND DO HAVE YOU ANY PARTICULAR

1209
00:48:00,762 --> 00:48:03,198
TOOLS THAT YOU USE TO SORT OF

1210
00:48:03,198 --> 00:48:08,770
FRAME THESE QUESTIONS AS PART OF

1211
00:48:08,770 --> 00:48:09,871
APPLICATIONS OR THAT IDENTIFY

1212
00:48:09,871 --> 00:48:11,439
PARTICULAR PROTOCOLS WHERE THIS

1213
00:48:11,439 --> 00:48:14,342
IS GOING TO BE A BIGGER CONCERN

1214
00:48:14,342 --> 00:48:17,212
THAN MAYBE OTHERS SO THAT THE

1215
00:48:17,212 --> 00:48:18,146
INVESTIGATORS KNOW SORT OF RIGHT

1216
00:48:18,146 --> 00:48:20,315
OFF THE BAT THAT THIS IS GOING

1217
00:48:20,315 --> 00:48:26,955
TO BE AN EXPECTATION.

1218
00:48:26,955 --> 00:48:29,724
>> OUR TEMPLATES DO ASK
THAT

1219
00:48:29,724 --> 00:48:32,360
INVESTIGATORS CONSIDER ALL RISKS

1220
00:48:32,360 --> 00:48:33,461
AND BENEFITS.

1221
00:48:33,461 --> 00:48:35,263
AND IT'S CLEAR IN THE

1222
00:48:35,263 --> 00:48:36,765
INSTRUCTIONS, IN THE GUIDANCE

1223
00:48:36,765 --> 00:48:39,501
THAT WE PROVIDE TO INVESTIGATORS

1224
00:48:39,501 --> 00:48:42,370
AT LEAST AT THIS UNIVERSITY THAT

1225
00:48:42,370 --> 00:48:44,139
IT'S NOT GOING TO BE ACCEPTABLE

1226
00:48:44,139 --> 00:48:45,673
TO SAY WELL, THERE ARE NO RISKS

1227
00:48:45,673 --> 00:48:47,308
OR THE RIIVES ARE MINIMAL AND

1228
00:48:47,308 --> 00:48:49,644
THEN, SORT OF GO ON FROM THERE

1229
00:48:49,644 --> 00:48:51,212
WITHOUT CLARIFYING WHAT THEY

1230
00:48:51,212 --> 00:48:53,948
ARE. 

1231
00:48:53,948 --> 00:48:55,650
AND SO THE RISK--THEIR

1232
00:48:55,650 --> 00:48:56,885
EVALUATION OF RISK SHOULD

1233
00:48:56,885 --> 00:48:58,153
RESPOND DIRECTLY TO WHAT IS

1234
00:48:58,153 --> 00:49:00,922
HAPPENING IN THE PROTOCOL IN THE

1235
00:49:00,922 --> 00:49:04,626
CONTEXT IN WHICH THE PROT COLIS

1236
00:49:04,626 --> 00:49:07,295
BEING--IS PROPOSED TO BE

1237
00:49:07,295 --> 00:49:07,562
CONDUCTED.

1238
00:49:07,562 --> 00:49:11,466
ONE OF THE THINGS THAT WE ALSO

1239
00:49:11,466 --> 00:49:17,939
DO TO TRY TO MAXIMIZE THE

1240
00:49:17,939 --> 00:49:18,540
LIKELIHOOD THAT PARTICIPANTS

1241
00:49:18,540 --> 00:49:20,275
WILL UNDERSTAND WHAT IS BEING

1242
00:49:20,275 --> 00:49:27,081
ASKED OF THEM IS WE REQUIRE THAT

1243
00:49:27,081 --> 00:49:29,584
RESEARCHERS PROVIDE 4-5

1244
00:49:29,584 --> 00:49:30,385
QUESTIONS OF EVERY PERSPECTIVE

1245
00:49:30,385 --> 00:49:33,388
PARTICIPANT ABOUT THE STUDY.

1246
00:49:33,388 --> 00:49:34,756
AND THE PARTICIPANT MUST BE ABLE

1247
00:49:34,756 --> 00:49:37,992
TO ANSWER A MINIMUM OF 3 OF THEM

1248
00:49:37,992 --> 00:49:38,293
ACCURATELY.

1249
00:49:38,293 --> 00:49:41,496
AND IF THEY DON'T, THEY ARE NOT

1250
00:49:41,496 --> 00:49:45,033
ADEQUATELY INFORMED TO CONSENT.

1251
00:49:45,033 --> 00:49:48,536
AND AGAIN, THAT ALSO HELPS

1252
00:49:48,536 --> 00:49:50,138
HOPEFULLY, THE INVESTIGATOR TO

1253
00:49:50,138 --> 00:49:53,007
REFLECT ON HOW THEY ARE

1254
00:49:53,007 --> 00:49:55,276
EXPLAINING THE PARTICULAR TODAY

1255
00:49:55,276 --> 00:49:57,412
TO PARTICIPANTS, PARTICULARLY

1256
00:49:57,412 --> 00:50:00,748
WHERE THERE ARE--IT'S NOT SORT

1257
00:50:00,748 --> 00:50:03,017
OF A 1-OFF, RIGHT?

1258
00:50:03,017 --> 00:50:04,252
WHERE 1 PARTICIPANT DOESN'T

1259
00:50:04,252 --> 00:50:05,720
UNDERSTAND, BUT THERE ARE

1260
00:50:05,720 --> 00:50:06,654
MULTIPLE PARTICIPANTS WHO ARE

1261
00:50:06,654 --> 00:50:07,722
NOT ABLE TO ANSWER THESE

1262
00:50:07,722 --> 00:50:08,923
QUESTION ANDS THOSE QUESTIONS

1263
00:50:08,923 --> 00:50:11,726
ARE SPECIFICALLY REVIEWED IN THE

1264
00:50:11,726 --> 00:50:15,196
CONTEXT OF IRB REVIEW.

1265
00:50:15,196 --> 00:50:17,532
NSOUNDS LIKE AN EXCELLENT IDEA.

1266
00:50:17,532 --> 00:50:20,168
LET'S SEE HERE, DO YOU EVER GET

1267
00:50:20,168 --> 00:50:22,237
PUSH BACK FROM INVESTIGATORS

1268
00:50:22,237 --> 00:50:23,204
THAT BASICALLY ARE IMPLYING THAT

1269
00:50:23,204 --> 00:50:26,241
THIS IS JUST A WAY TO PROLONG OR

1270
00:50:26,241 --> 00:50:28,843
DELAY THEIR APPROVAL TO GET THE

1271
00:50:28,843 --> 00:50:30,845
RESEARCH STARTED?

1272
00:50:30,845 --> 00:50:31,646
>> ABSOLUTELY.

1273
00:50:31,646 --> 00:50:37,051
AND THAT'S A VERY COMMON

1274
00:50:37,051 --> 00:50:37,285
CONCERN.

1275
00:50:37,285 --> 00:50:38,820
AND I THINK THERE ARE A COUPLE

1276
00:50:38,820 --> 00:50:40,321
WAYS WE ADDRESS THAT DEPENDING

1277
00:50:40,321 --> 00:50:42,757
ON HOW THE QUESTION IS RAISED

1278
00:50:42,757 --> 00:50:46,528
AND THE NATURE OF THE STUDY.

1279
00:50:46,528 --> 00:50:48,296
SO, 1 POTENTIAL ANSWER IS TO

1280
00:50:48,296 --> 00:50:50,131
SIMPLY SAY, WELL, LOOK WHAT

1281
00:50:50,131 --> 00:50:53,635
HAPPENED TO THESE PARTICULAR

1282
00:50:53,635 --> 00:50:56,938
STUDIES WHERE IT APPEARS THAT

1283
00:50:56,938 --> 00:50:57,539
INDIVIDUALS DIDN'T REALLY

1284
00:50:57,539 --> 00:50:59,407
UNDERSTAND THE CONTEXT IN WHICH

1285
00:50:59,407 --> 00:51:04,746
THEY WERE CONDUCTING THIS STUDY 

1286
00:51:04,746 --> 00:51:05,513
SOMETIMES THAT WORKS.

1287
00:51:05,513 --> 00:51:07,649
SOMETIMES WHAT WE SAY IS, WELL,

1288
00:51:07,649 --> 00:51:10,184
IT'S PROBABLY FASTER FOR YOU TO

1289
00:51:10,184 --> 00:51:13,121
DO THIS, THAN TO ARGUE BACK AND

1290
00:51:13,121 --> 00:51:15,857
FORTH WITH THE BOARD BECAUSE

1291
00:51:15,857 --> 00:51:18,593
WE'RE NOT GOING TO REALLY

1292
00:51:18,593 --> 00:51:21,229
APPROVE IT UNTIL WE SEE IN SOME

1293
00:51:21,229 --> 00:51:22,697
MOVEMENT HERE AND OUR PRIMARY

1294
00:51:22,697 --> 00:51:25,667
JOB, WE'RE NOT TRYING TO

1295
00:51:25,667 --> 00:51:26,834
OBSTRUCT YOUR RESEARCH, BUT OUR

1296
00:51:26,834 --> 00:51:29,170
PRIMARY JOB IS TO PROTECT THE

1297
00:51:29,170 --> 00:51:29,737
PARTICIPANTS.

1298
00:51:29,737 --> 00:51:33,975
SO WE NEED TO SEED SOME MOVEMENT

1299
00:51:33,975 --> 00:51:35,243
TOWARDS PROVIDING MORE

1300
00:51:35,243 --> 00:51:36,277
PROTECTION, MORE UNDERSTANDING

1301
00:51:36,277 --> 00:51:41,549
OF HOW THAT PROTECTION CAN BE

1302
00:51:41,549 --> 00:51:41,816
PROVIDED.

1303
00:51:41,816 --> 00:51:43,318
AND THAT USUALLY WORKS.

1304
00:51:43,318 --> 00:51:46,354
>> I'M SURE THERE'S
OCCASIONS

1305
00:51:46,354 --> 00:51:48,022
WHERE IF SOMEBODY IS VERY NEW TO

1306
00:51:48,022 --> 00:51:49,624
THAT AREA OF RESEARCH, WHERE

1307
00:51:49,624 --> 00:51:52,827
THEY MIGHT BE SOMEWHAT LOFULT IN

1308
00:51:52,827 --> 00:51:54,796
TERMS OF WELL, YOU KNOW WHAT IS

1309
00:51:54,796 --> 00:51:56,164
IT YOU WANT ME TO DO?

1310
00:51:56,164 --> 00:51:59,667
AND THERE MAY BE AN EDUCATIONAL

1311
00:51:59,667 --> 00:52:01,736
COMPONENT PART TO TRY AND

1312
00:52:01,736 --> 00:52:03,071
CLEARLY ARTICULATE WHAT IT IS

1313
00:52:03,071 --> 00:52:04,672
YOU'RE TALKING ABOUT.

1314
00:52:04,672 --> 00:52:05,440
>> ABSOLUTELY.

1315
00:52:05,440 --> 00:52:07,575
AND I THINK OUR IRB STAFF IS

1316
00:52:07,575 --> 00:52:09,310
WONDERFUL ABOUT THAT BECAUSE

1317
00:52:09,310 --> 00:52:10,478
THEY WILL SIT IS DOWN WITH

1318
00:52:10,478 --> 00:52:11,045
SOMEONE.

1319
00:52:11,045 --> 00:52:13,047
I MEAN IF THEY SEE THAT THERE

1320
00:52:13,047 --> 00:52:15,683
ARE THESE KINDS OF ISSUES BEFORE

1321
00:52:15,683 --> 00:52:18,019
SENDING IT OUT FOR WHAT IT'S

1322
00:52:18,019 --> 00:52:19,187
SUBMITTED, BEFORE SENDING IT OUT

1323
00:52:19,187 --> 00:52:21,222
TO REVIEWER OR TO THE FULL

1324
00:52:21,222 --> 00:52:22,457
BOARD, THEY WILL SIT WITH THE

1325
00:52:22,457 --> 00:52:23,224
INDIVIDUAL AND SAY, YOU KNOW

1326
00:52:23,224 --> 00:52:25,193
THESE ARE THE GAPS THAT WE'RE

1327
00:52:25,193 --> 00:52:25,927
SEEING, THESE ARE LIKELY GOING

1328
00:52:25,927 --> 00:52:28,529
TO BE THE ISSUES, THAT COME UP

1329
00:52:28,529 --> 00:52:31,499
WITH OUR REVIEWERS, WITH OUR

1330
00:52:31,499 --> 00:52:33,901
FULL BOARD, YOU KNOW WHETHER

1331
00:52:33,901 --> 00:52:35,937
IT'S EXPEDITED OR NOT EXPEDITED,

1332
00:52:35,937 --> 00:52:37,672
I WOULD SUGGIEST YOU MIGHT WANT

1333
00:52:37,672 --> 00:52:40,241
TO THINK ABOUT XYZ, SO IT

1334
00:52:40,241 --> 00:52:43,144
BECOMES AN EDUCATIONAL EXCHANGE

1335
00:52:43,144 --> 00:52:48,182
AND HOPEFULLY THAT HELPS TO

1336
00:52:48,182 --> 00:52:52,320
OFFSET WHAT MIGHT OTHERWISE BE

1337
00:52:52,320 --> 00:52:53,087
AN ENORMOUS DELAY.

1338
00:52:53,087 --> 00:52:54,122
NDO YOU EVER HAVE SITUATIONS

1339
00:52:54,122 --> 00:52:55,823
WHERE YOU HAVE RESEARCHERS THAT

1340
00:52:55,823 --> 00:52:58,126
ARE VERY EXPERIENCED AND DO THIS

1341
00:52:58,126 --> 00:53:00,428
VERY, VERY WELL AND THEN YOU

1342
00:53:00,428 --> 00:53:03,498
HAVE A NEW INVESTIGATOR TO THAT

1343
00:53:03,498 --> 00:53:03,731
AREA.

1344
00:53:03,731 --> 00:53:08,169
IS THERE USUALLY WILLINGNESS FOR

1345
00:53:08,169 --> 00:53:09,237
THAT EXPERIENCED PERSON TO OR

1346
00:53:09,237 --> 00:53:10,905
ARE THEY MORE OR LESS CLOSED OFF

1347
00:53:10,905 --> 00:53:13,341
IN TERMS OF THIS IS HOW I DO MY

1348
00:53:13,341 --> 00:53:15,643
RESEARCH RATHER THAN SHARING, IN

1349
00:53:15,643 --> 00:53:16,544
THIS PARTICULAR CULTURE OR

1350
00:53:16,544 --> 00:53:18,179
COUNTRY, THESE ARE THE ISSUES

1351
00:53:18,179 --> 00:53:19,681
THAT WE FACE ALL THE TIME AND

1352
00:53:19,681 --> 00:53:21,382
YOU WOULD BE WELL ADVISED TO

1353
00:53:21,382 --> 00:53:23,518
LOOK AT THIS, THIS, AND THIS AND

1354
00:53:23,518 --> 00:53:25,887
ARE THEY MORE SILOED?

1355
00:53:25,887 --> 00:53:31,292
>> I WOULD SAY THAT MOST
WHO

1356
00:53:31,292 --> 00:53:32,293
HAVE DEVELOPED THAT EXPERTISE

1357
00:53:32,293 --> 00:53:34,562
ARE WILLING TO SHARE.

1358
00:53:34,562 --> 00:53:37,265
I THINK THE DIFFICULTIES ARE NOT

1359
00:53:37,265 --> 00:53:39,200
SO MUCH WITH JUNIOR

1360
00:53:39,200 --> 00:53:40,835
INVESTIGATORS WHO ARE TRYING TO

1361
00:53:40,835 --> 00:53:42,470
SORT OF UNDERSTAND THE

1362
00:53:42,470 --> 00:53:44,839
PARAMETERS OF WHAT'S EXPECTED,

1363
00:53:44,839 --> 00:53:47,008
BUT MAYBE WITH MORE SENIOR

1364
00:53:47,008 --> 00:53:48,209
INVESTIGATORS WHO SAY, YOU KNOW

1365
00:53:48,209 --> 00:53:50,511
I'VE BEEN DOING IT THIS WAY FOR

1366
00:53:50,511 --> 00:53:52,246
30 YEARS, AND I DON'T THINK I

1367
00:53:52,246 --> 00:53:59,454
NEED TO CHANGE NOW.

1368
00:53:59,454 --> 00:54:00,321
IT'S MINORITY INVESTIGATORS BUT

1369
00:54:00,321 --> 00:54:02,724
I THINK WE FIND AT LEAST IN MY

1370
00:54:02,724 --> 00:54:04,859
EXPERIENCE THAT THE PUSH BACK

1371
00:54:04,859 --> 00:54:07,161
TENDS TO COME FROM FROM SENIOR

1372
00:54:07,161 --> 00:54:12,934
INVESTIGATORS AS OPPOSE TO

1373
00:54:12,934 --> 00:54:13,401
JUNIOR INVESTIGATORS.

1374
00:54:13,401 --> 00:54:14,736
>> AND AGAIN, I THINK
POINTING

1375
00:54:14,736 --> 00:54:16,437
OUT THE EXAMPLES AS YOU HAVE AS

1376
00:54:16,437 --> 00:54:18,439
TO WHAT CAN GO WRONG AND DO YOU

1377
00:54:18,439 --> 00:54:21,976
REALLY WANT TO GO DOWN THIS

1378
00:54:21,976 --> 00:54:23,244
PATHWAY AND HAVE IT END THIS WAY

1379
00:54:23,244 --> 00:54:25,012
WHEN HAVE YOU THIS FABULOUS IDEA

1380
00:54:25,012 --> 00:54:26,180
OR YOU'RE VERY EXCITED ABOUT

1381
00:54:26,180 --> 00:54:31,586
WHAT YOU'RE GOING TO BE DOING

1382
00:54:31,586 --> 00:54:32,587
BUT YOU REALLY HAVEN'T THOUGHT

1383
00:54:32,587 --> 00:54:34,255
IT THROUGH.

1384
00:54:34,255 --> 00:54:34,689
NEXACTLY.

1385
00:54:34,689 --> 00:54:37,358
>> NOT AS A THREAT BUT AS
A REAL

1386
00:54:37,358 --> 00:54:38,526
CONCERN FOR THEIR SUCCESS.

1387
00:54:38,526 --> 00:54:39,961
>> YEAH, YOU WANT PEOPLE
TO

1388
00:54:39,961 --> 00:54:41,028
SUCCEED WITH THEIR RESEARCH,

1389
00:54:41,028 --> 00:54:41,229
RIGHT?

1390
00:54:41,229 --> 00:54:42,997
YOU DON'T WANT TO HAVE TO COME

1391
00:54:42,997 --> 00:54:50,238
BACK AS AN IRB AND SAY, YOU KNOW

1392
00:54:50,238 --> 00:54:51,506
THIS ISN'T WORKING AND WE'RE

1393
00:54:51,506 --> 00:54:53,708
GOING TO SHUT YOUR RESEARCH DOWN

1394
00:54:53,708 --> 00:54:56,244
BECAUSE THE PARTICIPANTS ARE AT

1395
00:54:56,244 --> 00:55:00,581
TOO GREAT OF RISK GIVEN XYZ, AND

1396
00:55:00,581 --> 00:55:01,549
THAT HAPPENS UNFORTUNATELY.

1397
00:55:01,549 --> 00:55:03,151
NTHIS IS A LITTLE BIT OF A

1398
00:55:03,151 --> 00:55:06,154
DIFFERENT TOPIC BUT AS YOU KNOW

1399
00:55:06,154 --> 00:55:07,989
IRBs RESPOND TO COMPLAINTS

1400
00:55:07,989 --> 00:55:09,190
FROM PARTICIPANTS WE HAVE TO

1401
00:55:09,190 --> 00:55:11,626
HAVE A MECHANISM FOR DOING THAT,

1402
00:55:11,626 --> 00:55:16,397
DO YOU EVER GET DIRECT

1403
00:55:16,397 --> 00:55:17,098
COMPLAINTS FROM PARTICIPANTS

1404
00:55:17,098 --> 00:55:19,500
WITH THESE TYPES OF SITUATIONS

1405
00:55:19,500 --> 00:55:21,435
WHERE THE CULTURE OF HUMILITY IS

1406
00:55:21,435 --> 00:55:23,471
COMPLETELY MISSING ON THE PART

1407
00:55:23,471 --> 00:55:23,838
OF INVESTIGATOR?

1408
00:55:23,838 --> 00:55:26,607
OR IS IT MORE THE END RESULT,

1409
00:55:26,607 --> 00:55:29,010
YOU SEE THAT THE RESEARCH NOTED

1410
00:55:29,010 --> 00:55:30,311
THERE WAS A PROBLEM AND YOU CAN

1411
00:55:30,311 --> 00:55:33,080
AM TO LEARN THAT WAS THE

1412
00:55:33,080 --> 00:55:33,548
PROBLEM.

1413
00:55:33,548 --> 00:55:34,982
I'M JUST CURIOUS DO THE

1414
00:55:34,982 --> 00:55:38,286
PARTICIPANTS ARE SPEAK UP AND

1415
00:55:38,286 --> 00:55:38,686
COMMUNICATE THAT?

1416
00:55:38,686 --> 00:55:41,489
>> SO I WOULD SAY I'VE
SEEN

1417
00:55:41,489 --> 00:55:42,857
COMPLAINTS IF PARTICIPANTS BUT

1418
00:55:42,857 --> 00:55:51,465
WE HAVE ALSO GOTTEN COMPLAINTS

1419
00:55:51,465 --> 00:55:53,734
PRACTICES OTHER IRBs.

1420
00:55:53,734 --> 00:55:56,470
THAT INVESTIGATORS WERE NOT--THE

1421
00:55:56,470 --> 00:55:57,572
BEHAVIOR OF INVESTIGATORS WAS

1422
00:55:57,572 --> 00:56:01,642
NOT WHAT THEY WOULD HAVE LIKED

1423
00:56:01,642 --> 00:56:03,678
EMPLOY AND DO--DO MANY OR MOST

1424
00:56:03,678 --> 00:56:07,515
OF THESE GET SOME SORT OF

1425
00:56:07,515 --> 00:56:08,149
IN-COUNTRY ETHICS COMMITTEE

1426
00:56:08,149 --> 00:56:11,953
REVIEW AS WELL. 

1427
00:56:11,953 --> 00:56:12,286
NYES.

1428
00:56:12,286 --> 00:56:13,621
>> OKAY, SO THAT MIGHT
ALSO BE A

1429
00:56:13,621 --> 00:56:17,425
WAY WHERE THE LOCAL CONTEXT CAN

1430
00:56:17,425 --> 00:56:18,059
BE BETTER APPRECIATED.

1431
00:56:18,059 --> 00:56:21,162
THEY WOULD BE THINKING ABOUT

1432
00:56:21,162 --> 00:56:22,697
THOSE ISSUES AND HOPEFULLY MORE

1433
00:56:22,697 --> 00:56:25,233
OR LESS BUILDING THAT INTO THEIR

1434
00:56:25,233 --> 00:56:26,167
REVIEW PROCESS.

1435
00:56:26,167 --> 00:56:26,868
>> YES.

1436
00:56:26,868 --> 00:56:28,569
>> SO THAT EVEN THOUGH
YOUR IRB

1437
00:56:28,569 --> 00:56:32,273
MAY NOT BE AN EXPERT IN CULTURAL

1438
00:56:32,273 --> 00:56:34,675
ISSUES WITH THE COMMUNITY, THAT

1439
00:56:34,675 --> 00:56:39,914
LOCAL ETHICS COMMITTEE SHOULD

1440
00:56:39,914 --> 00:56:40,848
HAVE THAT EXPERTISE AND THAT'S

1441
00:56:40,848 --> 00:56:45,553
WHERE WE GET THE COMPLAINTS FROM

1442
00:56:45,553 --> 00:56:46,220
THE LOCAL IRB.

1443
00:56:46,220 --> 00:56:47,755
>> WELL GOOD THAT THEY
SHARE

1444
00:56:47,755 --> 00:56:50,291
THAT WITH YOU IN THE INTEREST OF

1445
00:56:50,291 --> 00:56:53,561
PARTICIPANT SAFETY AND RESPECT.

1446
00:56:53,561 --> 00:56:54,195
>> ABSOLUTELY.

1447
00:56:54,195 --> 00:56:54,495
ABSOLUTELY.

1448
00:56:54,495 --> 00:56:56,430
>> I DON'T THINK WE HAVE
ANY

1449
00:56:56,430 --> 00:56:58,132
OTHER QUESTIONS, IF ANYTHING

1450
00:56:58,132 --> 00:56:59,400
COMES IN, I WILL FORWARD THAT TO

1451
00:56:59,400 --> 00:57:02,737
YOU IF THAT'S OKAY?

1452
00:57:02,737 --> 00:57:05,239
>> THAT WOULD BE FINE,
THANK

1453
00:57:05,239 --> 00:57:05,406
YOU.

1454
00:57:05,406 --> 00:57:06,674
>> THIS HAS BEEN SUPER,
SUPER

1455
00:57:06,674 --> 00:57:08,976
INTERESTING AS YOU KNOW WE DO A

1456
00:57:08,976 --> 00:57:12,146
WIDE VARIETY OF RESEARCH AND THE

1457
00:57:12,146 --> 00:57:12,980
NIH INTRAMURAL RESEARCH PROGRAM

1458
00:57:12,980 --> 00:57:14,482
AND CERTAINLY A LOT OF

1459
00:57:14,482 --> 00:57:18,986
INTERNATIONAL RESEARCH SO I

1460
00:57:18,986 --> 00:57:20,321
THINK THAT'S BEEN A VERY TIMELY

1461
00:57:20,321 --> 00:57:22,256
TOPIC AND WE ARE VERY

1462
00:57:22,256 --> 00:57:23,557
APPRECIATIVE OF YOU TAKING TIME

1463
00:57:23,557 --> 00:57:25,259
TO PRESENT TO US TODAY, SO THANK

1464
00:57:25,259 --> 00:57:25,927
YOU SO MUCH.

1465
00:57:25,927 --> 00:57:28,029
>> WELL, THANK YOU IT HAS
BEEN

1466
00:57:28,029 --> 00:57:28,629
QUITE AN HONOR.

1467
00:57:28,629 --> 00:57:29,997
THANK YOU.

1468
00:57:29,997 --> 00:57:31,098
>> HAVE A WONDERFUL DAY

1469
00:57:31,098 --> 00:57:33,334
EVERYBODY. 

1470
00:57:33,334 --> 00:57:43,577
>> BYE-BYE.

1471
01:46:28,233 --> 01:46:30,902
VERSUS STUDYING THE IMMUNE

1472
01:46:30,902 --> 01:46:31,836
RESPONSE, TRANSLATABILITY TO

1473
01:46:31,836 --> 01:46:32,971
HUMANS AS WELL.

1474
01:46:32,971 --> 01:46:37,008
WE'LL DISCUSS IN MORE DETAIL IN

1475
01:46:37,008 --> 01:46:38,042
SESSION 4 TOMORROW.

1476
01:46:38,042 --> 01:46:40,612
SO I'D LIKE TO THANK EVERYBODY

1477
01:46:40,612 --> 01:46:43,248
WHO GAVE WONDERFUL TALKS TODAY

1478
01:46:43,248 --> 01:46:45,984
AND FOR VERY ENGAGING PANEL

1479
01:46:45,984 --> 01:46:47,085
DISCUSSIONS, VERY MUCH

1480
01:46:47,085 --> 01:46:48,386
APPRECIATE EVERYBODY

1481
01:46:48,386 --> 01:46:48,720
PARTICIPATING.

1482
01:46:48,720 --> 01:46:51,589
FOR THOSE STAYING AT THE HOTEL,

1483
01:46:51,589 --> 01:46:55,426
THE BUS WILL BE HERE AT 4:45 BUT

1484
01:46:55,426 --> 01:46:56,427
WON'T LEAVE UNTIL 5:00 P.M. TO

1485
01:46:56,427 --> 01:46:59,831
TAKE YOU BACK TO THE HOTEL.

1486
01:46:59,831 --> 01:47:00,632
THAT'S THE ONLY PLACE THE

1487
01:47:00,632 --> 01:47:01,866
SHUTTLE WILL DROP YOU AT.

1488
01:47:01,866 --> 01:47:04,769
WE DO HAVE AN OPTIONAL DINNER

1489
01:47:04,769 --> 01:47:08,006
THIS EVENING, HAPPY HOUR/DINNER

1490
01:47:08,006 --> 01:47:09,073
AT 6:30.

1491
01:47:09,073 --> 01:47:10,275
AT PINSTRIPES, IN THE PIKE AND

1492
01:47:10,275 --> 01:47:11,075
ROSE NEIGHBORHOOD.

1493
01:47:11,075 --> 01:47:13,378
IF YOU'RE ABLE TO JOIN US,

1494
01:47:13,378 --> 01:47:15,847
PLEASE DO, AROUND 6:30.

1495
01:47:15,847 --> 01:47:18,583
WE WOULD BE HAPPY TO HAVE

1496
01:47:18,583 --> 01:47:21,619
FURTHER DISCUSSION WITH

1497
01:47:21,619 --> 01:47:21,886
EVERYBODY.

1498
01:47:21,886 --> 01:47:24,188
OR REALLY JUST ENJOY BEING WITH

1499
01:47:24,188 --> 01:47:25,857
EACH OTHER SOCIALLY.

1500
01:47:25,857 --> 01:47:26,691
WITH THAT WE'LL ADJOURN FOR

1501
01:47:26,691 --> 01:47:31,195
TODAY AND THEN WE'LL SEE

1502
01:47:31,195 --> 01:47:31,629
EVERYBODY TOMORROW.

1503
01:47:31,629 --> 01:47:34,299
[END OF PROGRAM]

1504
01:47:34,299 --> 01:47:41,973
 

1505
01:47:41,973 --> 01:47:52,016