Department of Anthropology, History, and Social Medicine University of California, San Francisco, USA.
Med Anthropol Q. 2012 Sep;26(3):338-60. doi: 10.1111/j.1548-1387.2012.01222.x.
Since the U.S. National Institutes of Health (NIH) Revitalization Act of 1993, researchers with federal funding have been required to include "minorities and women" in their clinical trials, and inclusion in research has come to be seen as an important strategy for reducing health disparities. On the basis of ethnographic research in oncology clinics in an academic medical center and a public hospital over a period of two years, this article examines how the NIH inclusion mandate is playing out in the context of oncology clinical trials. We argue that although individual patients are recruited to particular trials by individual providers, recruitment processes are shaped by the structural inequities in the U.S. health care system that create differential access to medical facilities with different and unequal research infrastructures. Given the heterogeneity of clinical trials, research infrastructures, and the U.S. health care system, the meanings of inclusion in research are multiple, and inclusion by itself does not ensure equity.
自 1993 年美国国立卫生研究院（NIH）复兴法案以来，获得联邦资金资助的研究人员被要求将“少数族裔和妇女”纳入临床试验，并且将其纳入研究已经被视为减少健康差异的重要策略。本文基于在学术医疗中心和公立医院的肿瘤学临床诊所进行的民族志研究，在为期两年的时间里，探讨了 NIH 纳入指令在肿瘤学临床试验中的实施情况。我们认为，尽管个别提供者通过个别患者招募到特定的试验中，但招募过程受到美国医疗保健系统中结构性不平等的影响，这种不平等导致了不同和不平等的研究基础设施的医疗设施的获取机会存在差异。鉴于临床试验、研究基础设施和美国医疗保健系统的多样性，研究中纳入的意义是多方面的，而且纳入本身并不能确保公平。
