Previously, I have posted blogs about the implicit biases of doctors in treating patients. A recent article in the Science and Technology section of The Economist entitled “Fatal Truths” (April 10, 2021) at p.71-72 notes that this implicit bias also exists in medical devices and treatments.
As we are all aware, at the height of the pandemic, due to the scarcity of available hospital beds, only the sickest were admitted. To determine who qualified, doctors measured a patient’s blood-oxygen level by using a pulse oximeter which clips onto a fingertip like a clothes pin. Unfortunately, these devices do not work as well on dark skinned persons as white persons. They often recorded the former as being healthier than they, in fact, were and so were denied admission to a hospital when in reality that was where they should have been.
Why? It has to do with the technology involved. Pulse oximeters “…work by passing two beams of light, one red and one infrared, through the tissue of the finger they are clipped to and then calculating the amount of each that is absorbed…” (Id. at 71-72). Thus, they must be calibrated to take into account the lightness or darkness of the skin since “…[d]ark skin will clearly absorb more of the incident light than white skin, thus weakening the signal ….” (Id. at 72). Consequently, a false result will be given; those with darker skin will appear healthier than they really are.
As if this bias alone is not enough, the article then discusses how a medical algorithm “…used on more than 100m Americans a year to allocate scarce resources to those with the greatest need” creates bias against black patients. (Id.) The algorithm looks at previous medical spending of a patient; because the black patient typically spends less on medical care than the white patient, the algorithm “decides” that his/her current medical needs are not as great as those of a white patient. As a result, the white patient is given priority over the black patient in assessing current medical needs and expenses. (Id.)
And, last not but not least, is the bias against women. A 2013 study showed that women had a 29% higher risk of a hip implant failing with three years of hip replacement surgery than men. A 2019 study found that women were twice as likely to experience complications within three months from the implantation of a cardiac device such as a pacemaker.
Why? Many of these medical devices are tested only on white males. They are not tested on non-white persons or persons of color. For example, women tend to be smaller than men such that the size of the device will matter. This is especially true with oxygen oximeters: “…if the device is too large, light from the room can interfere with the reading–and women tend to have smaller fingers.” (Id.)
And while in 1993, Congress directed the National Institutes of Health to be more diverse in its testing populations, today- non-white people and women are still underrepresented. As of 2019, women made up less than 30% of the participants in a study and blacks made up no more than 10% in studies. (Id.)
So, while much focus has been directed at eliminating implicit bias in everyday life, this article clearly shows that we must also seek to eliminate it in medical testing and technology.
… Just something to think about!
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