13 highlights
-
Are fingertip pulse oximeters racist? The question might strike you as absurd. But according to a study published in December 2020 and widely reported in the media, these devices significantly overestimate the level of blood oxygen in Black patients in real-world conditions, meaning that Black people might have to be sicker than white people before they qualify for treatment.
-
In a detailed analysis published in August 2020, the anthropologist Amy Moran-Thomas tells the story of these devices, from their initial calibration with mainly light-skinned test subjects to the largely ignored laboratory studies, dating back to 2005, showing their racial biases.
-
Consider instead the racial bias of an automatic soap dispenser that activates more readily for lighter skin.
-
That pulse oximeters don’t work as well for darker-skinned patients might not have been intentional, but it is by no means accidental. It can be traced to a long history of similar biases in light-based technologies, from film emulsifiers to soap dispensers to wearable fitness trackers.
-
But here’s a more subtle downstream effect: the purportedly objective data provided by the device could be used to cast doubt on patients’ own claims about how sick they are.
-
Dermatological photos that help physicians identify ‘COVID toes’ were initially limited to light-skinned patients, despite greater prevalence of the disease in Black and brown communities.
-
N95 respirator masks, worn by healthcare workers, must be fit-tested for safety, and research has shown that fit pass rates are especially low among female and Asian workers.
-
All of us think and act with the objects that we have. As the philosopher John Haugeland put it in 1993, the mind is ‘intimately embodied and intimately embedded in its world’.
-
When a group of individuals is biased in a similar way, a pattern of cognition and action becomes socially sticky. That’s how a biased pulse oximeter makes it more likely that medical providers, as a group, will undertreat patients who are racialised as Black.1
-
The truth is more complicated. Our minds are embodied and embedded in the world, including the social and physical worlds. If you feel short of breath, but the oximeter on your fingertip says your lungs are working perfectly fine, you might actually feel a little better, because you think with the machine.
-
What’s more, the micro-inequalities built into individual oppressive things are bound to accumulate into significant, and often nearly inescapable, harms. The philosopher Katrina Hutchison, examining gender biases in artificial hips and other implantable devices, deems this a type of ‘moral aggregation problem’.
-
We don’t know whether biased pulse oximeters do more harm than good for darker-skinned patients; we know only that their propensity to harm appears to be inequitably distributed.2
- Any attempt to fix the problems of pulse oximeters should take the saga of race-based corrections in a test for kidney function as both a model and a cautionary tale. The eGFR blood test plays a role in deciding who gets listed for a kidney transplant. Like a pulse oximeter, it generates data used in life-and-death decisions. Initially, a race-based mathematical correction in these tests was intended to make the results as accurate for Black patients as for white patients. But the correction itself might be causing an underestimation of how sick Black kidney patients are, not to mention reinforcing scientifically dubious ideas about biological racial differences.