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Three Black and disabled folx (a non-binary person in a power wheelchair, a femme leaning against a wall, and a non-binary person standing with a cane) engaged in conversation. All three are outdoors and in front of a building with two large windows.

BY Leo Hynett

Healthcare

Medical Device Bias May Have Led to Avoidable COVID-19 Deaths

Sajid Javid states BAME patients may have died unnecessarily during the pandemic due to medical device bias. From oximeters to face masks, medical devices and protective equipment are not delivering equal results.

NOVEMBER 22  2021

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Some medical devices may be performing better on white patients than people of colour, the health secretary has warned. These comments come as Sajid Javid has also announced the launch of a review into systemic racism and bias in medical devices, examining why people of colour and women have worse health outcomes.

‘It is easy to look at a machine and assume that everyone’s getting the same experience’, Sajid Javid wrote in The Sunday Times. ‘But technologies are created and developed by people, and so bias, however inadvertent, can be an issue here too.’

Devices such as oximeters are primarily designed and tested on caucasians, resulting in devices that do a better job of providing accurate readings on white skin.

Inaccuracy and inequality

Research suggests that oximeters – blood oxygen monitors that are clipped on the end of a finger – ‘can overstate the level of oxygen in the blood of people from ethnic minorities.’ Oximeters work by sending infrared light into capillaries, but skin pigmentation may affect how this light is absorbed, thus affecting their accuracy on darker skin.

It has been suggested that this could be one of the many reasons behind the unequal impact of COVID-19 on BAME people. Over the course of the pandemic, some people who were deemed “not sick enough” to be treated for COVID-19 in hospitals were sent home with oximeters to keep an eye on potential deterioration. In light of the disparities in the devices’ effectiveness, this could have had a significant negative impact on BAME people with COVID-19.

Back in March, reports were already beginning to emerge that there was a growing body of evidence suggesting that they could be providing BAME patients with ‘seriously misleading’ results. A review by the independent NHS Race and Health Observatory ‘stressed the need to ensure healthcare equipment and devices are culturally competent and sensitive, whilst not contributing to the array of current and historic health inequalities.’

This has huge potential health implications not only amidst the pandemic but also for people with conditions such as Sickle Cell Disease (which mostly affects BAME people) where drops in blood oxygen can be extremely serious. People with conditions such as SCD regularly rely on blood oxygen monitoring as a health indicator both in and out of clinical settings, relying on readings to determine whether they need to seek medical help and, if they do, how much oxygen they need to be given. As such, it is vital that these technologies are improved so that they can accurately inform and support the people who rely on them.

‘The pandemic has brought this issue to the fore, but the issue of bias within medical devices has been ducked for far too long. Although we have very high standards for these technologies in this country – and people should keep coming forward for the treatment they need – we urgently need to know more about the bias in these devices, and what impact it is having on the frontline.’

The issue highlighted by this disparity in oximeter readings runs much deeper. Systemic inequalities permeate many aspects of healthcare, from medications and procedures to textbooks and health AI. A lot of these are created in majority-white countries and based on majority-white needs and experiences, resulting in systems that are primarily geared towards the needs of white bodies. Filtering face piece (FFP) masks, for example, must fit properly in order to offer full protection, but research has shown they do not fit as well on people from some ethnic backgrounds. Their design was created with white facial characteristics as the default, inadvertently resulting in poorer protection for those outside of that.

It would seem that all healthcare is not created – nor provided – equally.

Understanding and overcoming the biases that are currently entrenched in the health system will not be an easy task, but it is great to see the Health Secretary taking tangible steps towards doing so. An upcoming review will examine where systematic bias and risk exists within existing approved devices, from oximeters to MRI machines. Initial findings are expected in January 2022.

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