 Thank you, professors, Lira and Shun. It is my honor to introduce Dr. Sarah Hull to lead our next question and answer session. Dr. Hull has worked at the NIH since 1999 and is currently on detail with the NIH Tribal Health Research Office to support the development of policies, procedures, and training to enhance the ethical conduct of tribal research. In addition, Dr. Hull holds joint appointments as the director of the Bioethics Corps of the NHGRI, this chair of the NIH Intramural IRB that is a faculty member in the Department of Bioethics. Over to you, Dr. Hull. Good morning. Thank you so much, Chris. And thank you, professors Lira and Shun, for your excellent presentations. The work that you've done to characterize these cases is so important in answering questions of how could this happen? How did this happen? But I also, I really appreciated how both of your presentations engaged both with stories of resistance and dissent, stories that I was a little less familiar with, but also they engaged with the enduring legacy, the modern-day relevance of how we apply these claims that were used to support eugenic policies and so many social spheres and structures and aspects of modern-day life. And a lot of the questions that we've been receiving from participants engaged with how we can better, how we learn the lessons of history, how do we apply these lessons to what we're seeing today? Both some applications, it seemed just really overtly problematic and offensive, but even by those who are working in well-intentioned ways to do socially valuable work, work that many of my genetics colleagues do on a daily basis. So if I could, I'd like to begin with one of the questions that engages a little bit with the past and then bring us into some of the modern-day contexts that our participants have pointed out in the discussion. There was a question about the role of medical professionals in implementing eugenic policies and a recognition, and you both spoke about social workers and physicians and nurses and others who are medical professionals. And the attendee would like to ask if you can engage a little more deeply with what you know about how medical professionals justified their work, especially in light of ethics codes that existed at the time and how this supported for them or justified for them their willingness to engage in eugenic policies. Can I start out by thanking the organizers, the participants and the audience for this really amazing conference? I have been blown away both yesterday and today by the discussion and the questions and the presentations. This is really fabulous and so important. I can speak a little bit to North Carolina, although I will preface what I say by noting that not much is known about the way in which medical professionals who were directly involved in eugenic sterilization responded to it. So the way that it worked in North Carolina is that if the eugenics board authorized a sterilization, it was assigned to a particular hospital to a particular surgeon and the surgeon did the sterilization as part of his, they were all men, a caseload of the day. And I'm actually not clear in how far the surgeons knew the details about the fact that the person that they were sterilizing at a particular time was somebody whose sterilization had been authorized by the state. I do know that there was some tussle between the eugenics board and members of, I think it was the Duke University medical staff, particularly residents in the 1960s who did not want to participate. And I suspect what, I don't know the outcome of that because I do know from the sources that Duke university physicians and surgeons were regularly involved in sterilizations, but I suspect if the board encountered physicians who were unwilling to participate, they just moved to a different surgeon. And I also have to say, I mean, yes, I mean, to a certain extent we can talk about the moral and ethical requirements of medical staff, but physicians and surgeons during that time were often very conservative. And in fact, many of them actually supportive of sterilizing those people who became the center of eugenics board attention so far so that there were many physicians and surgeons who just sterilized, especially women on their own accord without getting state authorization. And those are sterilizations we don't really know anything about because there is no record left. So I would not assume that they were constitutionally critical of this. I think it is likely that it was fairly easy to find people who supported the program and who also felt that the people who came to the attention of the eugenics board were actually good candidates for sterilization. Yeah, I'll add that in California and I agree with what Dr. Showne said that physicians and nurses were not kind of like a tool of eugenics. They were part of the eugenics movement very often. And so they didn't see this at or many of them didn't see this as contradictory to any kind of moral or ethical professional guidelines. They saw this many of them as kind of a humanitarian practice that through a very paternalistic view that these are people that are incompetent and this is what's best for them and this is what's best for society, right? It's in California and in North Carolina and in many other states, a public health department was involved in eugenics sterilization. The Supreme Court case that legitimizes eugenics sterilization in the 1920s, but Vibel in part does so through a public health reasoning, right? That this is a public health measure. And so this is seen as in line with the professional goals. I'll also say that's not to say that there weren't nurses and physicians that dissented, there were and in my research, I did come across a number of letters from physicians and nurses who were very alarmed by this practice, right? I'll also say in California and another one of in the other institution that I didn't talk about in this presentation, Sonoma, the director of the institution was a physician, Brad Butler, who performed many of the sterilizations himself and so I wouldn't position physicians and nurses as separate from this program and this policy. They were embedded and it was often a professionalizing opportunity that many of them made their careers off of this practice, especially in California. I would also add just to remind people, right, that the first thing that I did to remind people, right, that most of these practices took place during a time when there wasn't effective birth control and when abortion was illegal. And so far as physicians had humanitarian concerns where they felt they were really helping clients, I would say to some extent, those were heartfelt concerns because there weren't many alternatives for people to control their reproduction if this is what they wanted to do. And I think the fact that many of the people who were sterilized, I mean, in North Carolina, I know this in particularly had many, many children, I think speaks to that further. And I think the other thing that we can notice that the point at which both social workers but also medical professionals became increasingly skeptical of the petitions that came to the North Carolina eugenics board was the point at which the pill becomes available and at which the IUD becomes available. And that is the point at which eugenic board members turn around and basically say to social workers who submit petitions, well, show us that you have tried these forms of birth control for these clients and that they don't work before we're willing. So I think there is a link between what was accessible in terms of controlling reproduction and the excitement and enthusiasm with which people approach eugenic sterilization. Thank you. There's been a really, I think, important and nice connection between the presentations from yesterday into today. And one of the themes that comes out is the use of language and descriptors as a way to undergird the scientific basis of these policies. And so now I'd like to ask you if you can help us consider the present day context. One of the questions that's gotten upvoted and I think really nicely characterizes this issue about learning from our mistakes from the past. Sometimes in the throes of a situation, the mistake is not apparent. There were and are works being done in the hopes of improving something. So today, how do we, how do geneticists and other researchers collect information about characteristics like skin color? We talked about hair texture yesterday, variation in intellectual ability and cognition in such a manner that achieves the important health related goals of some of that work without offending, without harming and without repeating past mistakes. Do you have any advice to that attendee and others who are asking similar questions about how they can think about this in their work today? I think part of it is about being very clear and deliberate about why certain data and information is being collected and the usefulness of that data and information. And so I'm just, I'm kind of finishing up the semester of seminar on race medicine and society and we talked a lot about the use of race in medical studies for example and the way that race and racial categories are used very uncritically, right? Without an understanding of what race is socially and politically and that unintentionally perhaps reasserts the notion that race is kind of an essential biological category, right? And so, and I think the corrective for that is going, you know, being very clear about the reason why we're collecting these, this information and this data and what we believe the meaning and purpose of this information is. And I think that is a start, right? And I think it's less about offending people and more about being conscious of the way that this information skin color, hair texture has been used to make connections that are socially based and not biologically based and are not as useful as we think, right? So, you know, people will say like it's important to collect racial information because we need to know ancestry, but actually race, we know that race is not a very useful or accurate data point for ancestry. So I think that's part of it. I think Professor Lira is right on, I mean, I would almost counsel anybody who feels that they're interested and that it's important to collect and do research on racial differences to go and read Dorothy Roberts' work where she really kind of takes apart the incredible appeal that this research has, but the, you know, the fact that, that racial difference is socially constructed and that it doesn't really, that I think what we need to do is we need to change the paradigm in which we think about the research question that are going to lead us in the future. And then I think the other thing to realize is, but this is not an excuse to researchers, but to realize that researchers are not policy makers. So I think we also have to be really careful to differentiate between research results and how those are taken up by policy makers to then go and design the harmful policies. Thank you. Really excellent answers to those questions. A number of our participants have drawn out examples of language and discourse around COVID vaccination and both in the public policy and jurisprudence sphere sentencing as well as more generally in just the public discourse. And a lot of these characterizations judge populations related to their intelligence and their willingness to be vaccinated or assumptions about the likelihood that they will be vaccinated. So to sort of synthesize some of those questions, do you see these kinds of attitudes as potentially signaling the promotion of eugenics based on things like intelligence or compliance? I think that there is a connection there. I would have to think more about whether it's signaling eugenics. I think it's certainly troubling the line of thinking can lead to dismissiveness of people's genuine concerns. And a longer history of mistrust that often gets conflated with kind of just hard line anti-vax. I think there's a lot of conflation going on between an anti-vax movement and mistrust of vaccines and social policies and public health that is grounded in real histories. And so I think kind of like dismissing folks as unintelligent or as deserving to be excluded from healthcare or deserving to just die off is certainly troubling and can offer just an easy dismissal without having to grapple with real reasons why some people might be cautious in questioning. I don't know that I have anything to add. I think partly because I don't really understand the question. I do think that the skepticism over vaccine is more a political question and the way in which COVID in particular has been politicized in this country and the kind of increasing skepticism towards science. Then I mean, I don't really see the relationship to eugenics, I'm really sorry. A lot of questions are coming in rapidly and not all of them have had a chance to be upvoted. But I'm wondering if you could talk a little bit about your views on standardized surveys and tests that are used today. There's a number here that analogize current academic testing to tests that were used to support eugenic policies. And oops, the question did get upvoted and I lost it. But will these modern day, is there a risk that modern day behavior surveys will lead to eugenic policies? And are there concerns in the area of how race-based data are used in that realm? Well, I think, I mean, we should recognize that standardized testing is an outgrowth of IQ testing and that whole history. And I think that there are similar, I mean, research on standardized testing, for example, in high schools shows that, there are serious biases in the testing and they lead to inequality in outcomes. And so I think there is a clear line there and there are questions about the usefulness. I think given COVID, people are now a lot of universities, for example, are suspending their reliance on these tests and kind of rethinking how useful they are and really determining people's ability to succeed in college, for example. But I think there is a clear line there between the history of intelligence testing and contemporary standardized tests. Yeah, I think going along with the notion that we can test and identify students who will not be able to benefit from education, right? That was one of the prime issues and prime topics that we can see in the kind of more popular eugenic literature. There have been a number of comments, both yesterday and today and multiple speakers who have really drawn out the importance of understanding the perspectives of those who were the victims of eugenic policies, those who were sterilized. And we know certainly from the discussion of compensation that there are still living survivors today. Are you aware of research that's been done that really looks at how they're doing at what their life experience has been and the impact of having been subjected to these policies? And if so, could you share what you know about that with us? I have to say that I don't know of any such research, but I also have to say that if it exists, I don't know that I would know, partly because it's a totally different field. So I'm sorry, I can't answer that. You know, the survivors of... So California's sterilization program largely ended by the early 1950s. So there aren't very many living survivors. You know, our lab has estimated a couple of hundred. And so for that period, the studies that I know that exist on folks that were sterilized in Pacific colony in particular were conducted by actually an anthropologist, Robert Edgerton, who did follow-up interviews with people that were institutionalized in Pacific colony. There is one article in particular where he talks about where he's looking at their reactions to sterilization. And many of them were, of course, very negative, you know, many of them. Some of them didn't even know that they had been sterilized. Many of them talk about not understanding why it had been done to them, talking about interfering with future romantic relationships because they either didn't want to be involved with someone that they wouldn't be able to have children with or the person that they were involved with that wanted to have children. Many of them experienced, of course, emotional trauma, some of them also physical trauma because the operation was performed poorly. And so, you know, that is a set of experiences that he documents later on when we, you know, have the sterilizations that occurred in the 60s and 70s. We have a couple documentaries, for example, the Nomaz-Bibidz documentary, which features women who were sterilized at the USC County Hospital in Los Angeles. They talk about very similar things, right, that they interfered with their marriage, that it caused them long-term emotional harm, trauma. And so, I think there are echoes of that throughout various periods of sterilization abuse. And I'm not sure that there are, like, longitudinal studies or official studies, but there's certainly evidence in films and in different sources that point to the impacts of sterilization. Yeah, if I can add to that very briefly. Certainly the survivors who have spoken out in public who are survivors of the North Carolina sterilization program have expressed exactly what Professor Lira just described. So being very traumatized and basically feeling that they had no control over their lives, feeling devastated by the fact that they couldn't have their own children, difficult, romantic relationships and so on. I think to get back to the question of specific research, I mean, I think one of the issues that makes such research difficult, if not impossible, is that the identity of sterilization victims unless they come out and speak out in public and self-identify continues to be protected. So it's not that anybody who's interested in the topic can just go access a database, identify those who have been sterilized and then send them a questionnaire or conduct interviews. So the only way we know about them is because they have come forward and have talked about, or because journalists and documentary filmmakers have found them and they were willing to talk to them. There's a documentary about the compensation program in North Carolina that interviewed a number of sterilization victims in which the victims are also very evocative about their lives. Great, thank you. Professor Lyra, I was really struck by some of the evidence and information you shared about the characterization of Mexican Indian residents and the ways in which they were both counted and characterized. We have a question that builds on that related to current day immigration policies and their relationship to eugenics policies. And this participant is particularly interested in both African and South American nations and policies concerning immigration to the United States. Can I invite you to expand on that theme of it either from the evidence you learned in your historical research or how you see that playing out today? Sure, and I'm understanding correctly the question. I think concerns around immigration were certainly informed the racialization of Mexican origin youth who were committed to Pacific colony. And I want to reiterate too, that ideas about the defectiveness or the unfitness of Mexican origin youth build on already existing racial stereotypes of Mexicans in California that are grounded in these concerns over immigration and this seemingly problematic population in California in the state. And so I think that in these ideas about Mexican youth as Mexican origin boys as criminal is something that exists since before eugenics, right? And of young Mexican women as hypersexual and sexually deviant also exists before eugenics. And eugenics, what eugenics really does is make it scientific, right? A legitimate idea. And I think these ideas continue in contemporary notion, contemporary nativist ideas and kind of anti-immigrant rhetoric. And we see this particularly, I see a very clear parallel here, particularly around, you know, these concerns over unaccompanied youth migrants kind of flooding the border and coming across the border, right? And a lot of, you know, if we recall, for example, in 2006, when there was kind of this wave of unaccompanied minors, concerns revolved around public health risks and criminality, right? That these were gang members that were coming to the United States, right? And so there are very similar discourses that eugenics winds up legitimizing and that, again, I wouldn't, I can't say that it's eugenics again, but it's the same type of argument, right? That these racialized immigrant groups are a public health risk, that they're a social risk, right? They're socially deviant in that, just by coming here, they're bringing all of these problems. Thanks, we're getting very close to the end of our time, but I'm going to try to squeeze in one additional question about gender. There's a question that for me is really provocative, which was whether women ever served on eugenics boards? And it really, I mean, you both spoke about the relationships between race and disability and gender and the interrelationship of these constructs, but how did that play out on the side of the professionals? And do you have any observations about the relevance of gender in that space? I mean, I think women were as much eugenicists as men. So the eugenics board in North Carolina was for most of its duration, really run by Ellen Winston, who was the director of the Department of Public Welfare and most of the social workers who submitted sterilization petitions were women because it was a women's profession. So yes, very much so. Yeah, I'll say, you know, in my research, certainly like the institutional superintendents were often male, but the kind of other professional folks that were really invested in kind of supporting Pacific colony were largely women. So a lot of women's clubs took up this kind of humanitarian effort of building this institution to like address the social problem. It became part of their kind of organizing in their own, you know, formation of their own civic identity and identity as kind of like capable, active social women. Right. And so we have them building kind of an identity of white able-bodied women who deserve the right to vote who deserve the right to serve on judges because actually the law that passed, that established Pacific colony was passed at the same time with support of the women's group at the same time as a law that allowed women to serve as judges on the court or as participants in legal processes. So there's a very clear connection there and women were very much active, especially in Pacific colony and kind of establishing the institution and also supporting leader efforts. Well, unfortunately, we've come to the end of our time and maybe borrowed a little bit from folks lunch break, but I just want to thank you both so much for both of your presentations, the work that you do and for engaging with these really challenging questions. I can tell there's going to be spillover into these later discussions we have today and hopefully far into the future. And I apologize to all of those whose excellent questions we didn't get to in this moment, but we are tracking them and we will continue to engage with them. So I think now, Chris, do I turn this back over to you? Yes. Thank you, Sarah. Thank you again, Professor Shun and Lyra for this fascinating and impactful and meaningful discussion. We will be on break until 1pm Eastern time for lunch. Thank you very much and we will see you in the afternoon.