The picture above is of a pulse oximeter.
You may know that. If you have asthma, COPD, or other lung function issues or have spent any time in a hospital, there’s a good chance you’ve used one at some point.
And during the COVID pandemic, suffice to say that this little device was a life-saver for many: alerting them to dangerously low oxygen levels, necessitating a trip to the hospital for supplemental oxygen when they might otherwise not have realized they were that bad off.
Last week, the Washington Post ran a fascinating piece about the development of the oximeter. Therein, they traced its history from a clunky, expensive device for Air Force fighter pilots to what we have now — units so small that millions of people have one in their bedside drawer or medicine cabinet.
The problem, however, is that pulse oximeters aren’t as accurate for people with darker skin.
Specifically, persons of color are more likely to exhibit “occult hypoxemia.” In these cases, an oximeter will indicate that a user has normal oxygenation even though their actual level is dangerously low.
In one study conducted in Veteran’s Administration Hospitals, Black patients exhibited occult hypoxemia 25 percent more often than whites.
According to a second study, Black patients with low oxygenation levels were about 30 percent less likely than whites to be deemed eligible for supplemental oxygen. Latinos were nearly one-fourth less likely to be deemed in need of intervention.
And Black patients in two other studies were nearly three times as likely as whites to experience low oxygenation undetected by pulse oximetry.
Flawed readings can then directly contribute to less concrete medical intervention on behalf of patients.
Indeed, one study found that inaccurate oxygen readings for Black, Latino and Asian patients caused these patients to receive less supplemental oxygen than whites, despite needing it.
Such differential interventions can then lead to sustained injury and even death. There is little doubt that, in some cases, they have produced precisely this effect.
Interestingly, the racial bias of pulse oximeters isn’t a new discovery.
Its existence didn’t just come to the attention of the press due to some ultra-woke anti-racist sting operation.
It’s something about which those in the industry have known since the early days of the technology.
When Hewlett-Packard (HP) developed the first oximeters (which attached to the ear), they recognized that readings could be affected by skin pigmentation and other epidermal characteristics. As such, they designed their devices to account for those effects and adjust calibrations accordingly.
In other words, HP took the issue of racial equity seriously and recognized that a colorblind approach would do a disservice to millions of people.
But the HP oximeter was so large and expensive that it wasn’t practical for personal use — it was used in clinical or research capacities only — and the company ultimately abandoned it.
Unfortunately, future efforts at developing oximeters, beginning with Minolta’s initial fingertip device and extending through to current models from other companies, did not address the issue of racial disparities in oxygen readings.
The desire to quickly develop simple and practical devices took precedence over racial equity — or, in effect, accuracy for millions.
Then, over the years, most pulse oximeters were calibrated using light-skinned research and development subjects.
The result?
Racially-disparate readings have been baked into the practice of pulse oximetry.
Although some in the medical community know of the biases inherent to such devices — and might push for more in-depth testing of patient oxygen levels through a blood draw for patients of color — how many might not be informed and know to do this?
And how many persons of color using these devices at home may not realize that the oxygen reading they obtained, which seemed in the normal range, might be masking a more insidious problem?
For those still confused by the concept of systemic racism, this is a perfect example of what the term means.
Unlike interpersonal racism, driven by overt hostility or the internalization of racist stereotypes at a subconscious level, systemic racism is different.
It describes how norms embedded in institutional spaces can produce or replicate racial inequity and injury, even without hostile intent.
No one suggests that the developers of pulse oximeters deliberately set out to shortchange patients of color when it came to obtaining accurate readings of their oxygen levels.
But by using only white subjects to calibrate the technology and then opting not to account for the known discrepancies such a default would produce in their device’s readings, the makers of oximeters have perpetuated racial harm.
Their lack of intent doesn’t reduce the injury caused or potentially caused by their colorblindness.
While they may not be personally bigoted, their lack of concern about the racial biases built into their products suggests a nonchalance that rises to the level of conscious neglect.
They may not be motivated by racism in the old-school sense. But how wide is the gulf between hatred and indifference, anyway?
Not very wide, I would argue.
Certainly not wide enough to acquit those who remain on the latter side of the shore to pretend they aren’t cousins of those to whom they can wave on the opposite one.
So the next time you hear someone say that intent is not the point when it comes to understanding racism, know that this is what they mean.
Intent might matter when it comes to assessing a person’s core character.
But the impact of one’s actions is all that matters when assessing the injury they’ve caused.
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This post was previously published on Tim Wise’s blog.
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You may also like these posts on The Good Men Project:
Escape the Act Like a Man Box | What We Talk About When We Talk About Men | Why I Don’t Want to Talk About Race | The First Myth of the Patriarchy: The Acorn on the Pillow |
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Photo credit: iStock