How Medicine Discriminates: Do many devices and treatments work less well for non-whites and women?
Last year New England Journal of Medicine published a report in which it observed more than 10,000 patients throughout America, suggesting that pulse oximeter used overestimated blood-oxygen saturation more frequently in black people than white.
Healthy human beings have an oxygen saturation of 92–96%. In this report, some patients who registered that level according to the pulse oximeter had a true saturation of less than 88%. For Black people, that happened 12% of the time- three times the rate at which it occurred for white participants. Therefore, according to Dr Michael Sjoding of the University of Michigan, the study leader, this difference would also be a difference between admitting to a hospital and being sent home. Why?
At the peak of covid 19 in the U.S., hospitals needed to triage patients- only the sickest were admitted, and others were sent home. One device was used to measure the severity of an individual illness was his blood-oxygen level. The employed device was pulse oximeters. You clip the device onto a finger and have a result. As a consequence, chances are that some patients who needed hospital treatments were denied treatment.
Dr Michael Sjoding report is just a tiny picture. Problems due to oximeters goes back to 1999. Despite that, they are still being used. In America only non-white people have been disproportionately affected by covid 19, and according to CDC, Hispanics and blacks were likely to die from the infection.
There are countless reasons to dispute but one device cannot take all the blame. However, medical technologies must be free from all the bias, but unfortunately, it isn’t. Experts say that it is because devices are designed by white men and tested on white men, so it works best on them. But couldn’t this be lethal consequences for the world population who are not white?
Pulse oximeter invented in the 1970s and introduced in the 1980s for commercial use is a classic case study. It works by passing two-beam lights, one red and infrared, through the tissue of the finger when clipped and then calculate. Darker skin will clearly absorb more of the incident light than white skin, weakening the signal. Therefore, the result may be biased.
Despite its history, oximeters are still widely used in hospitals. Even well before covid 19, doctors in hospitals used oximeters to decide whether to admit a patient in hospitals or not. Moreover, it became so popular that American Lung Association asked healthy people not to order oximeters.
Another scandal came to my knowledge in 2020 when a medical algorithm was used on more than 100m Americans a year to allot scarce resources to those with vital needs. In regards to this, a study published in 2019 stated that this particular software gave white people priority black one’s. Why? Because it used people previous medical spendings as a proxy for their current medical needs. Since black people in America spend less on medical care, they tend to have fewer previous experiences than white patients with similar medical requirements. Although the firm that created this algorithm has now quickly taken this into consideration and is currently working, researchers can counter this issue.
Not Only Race But Gender As Well
Women are also on the side of disadvantages when it comes to medical treatments. Procedures like hip implants and heart surgery are more likely to fail in women than men. The journal of the American Medical Association published a study in 2013, which found that women in four American regions had a 29% higher chance of failing their hip implants within three years of hip replacement operation. Another study published in 2019 stated that women are more likely to experience co plications from implantable cardiac devices such as peacemakers within 90 days of implantation. In both cases, the device failed to understand the physical difference between the body of men and women.
What’s the Solution?
One way to eliminate these problems is to have a diverse range of individuals. In theory, this is already supposed to happen. However, non-white and women are still underrepresented. According to Lori Abrams, Executive Director, Patient Advocacy & Diversity, WCG, sponsors could partner with organisations to create centres of excellence at smaller community hospitals with large populations of ethnic/racial minority physicians and patients. This would create clinical trial education and referral programs for physicians not interested in becoming investigators.
Such strategies to support human variation would be cherished for medical devices. Whether medical technology and organisations will meet the demand remains to be seen.
