I mean, the counties that are majority
Black have three times the rate of infections,
six times the rate of death.
Something is going on here.
--information out from the White House last night on which
coronavirus patients are suffering the worst outcomes.
A small medical device can help patients monitor those oxygen
levels at home.
They talk about the blue collar, white collar divide here.
What works for some may not work for others.
And those are usually the ones who participate the least.
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After you recognize that skin color could affect
these values, then you kind of feel a little dumb
that you didn't think about it before.
At the University of Michigan, our patient demographics
are historically about 80% white, about 10% Black.
In that early COVID pandemic, that demographic just flipped.
We were routinely placing these catheters in people's arteries
so that we could check their arterial blood frequently.
There was a mismatch between someone's pulse oximeter values
and the blood we were getting from their artery.
And what a pulse oximeter is, is a device
that measures how much light is transmitted
across your fingertip.
And so by measuring how much light comes across,
we can say, OK, this person has 98% of their blood
that's oxygenated because without it, we
would have to sample someone's arterial blood
to know what their oxygen level is.
And we use this technology so frequently
that we depend on it.
The care that we provide depends on the quality
of the data we receive.
But some parts of data that we use
all the time, whether it's your vital signs, heart
rate, your blood pressure, and nowadays
your oxygen saturation, is considered
kind of a gold standard piece of data that we use and just
believe.
At first, we thought it was maybe just a COVID problem,
right?
We thought, hey, there's something unique about COVID
where it's causing this mismatch.
It was the fact that we were taking care of, suddenly,
so many Black patients.
And they were having this mismatch.
There have been a handful of studies
that have demonstrated clear harm to Black patients
as a result of inaccuracies in pulse oximeters.
Black patients had higher risk of death
due to these pulse oximeters.
So as science technology studies people
call it, a sociotechnical system of the society
that you're using it in-- who's building it?
Who's using it on whom?
Then you can see much more clearly how this kind of thing
can amplify societal inequities and not fix them.
We're at a pivotal moment.
We have an opportunity to correct the wrongs that
have already been made in the first several decades
of technology's innovation.
And if left unchecked, we will continue to, I think,
exacerbate inequality, lead to increased polarization.
And the technology creation and the products and the ideas
will be concentrated only among a select few, which
will not serve our entire global population.
One in three medical students believes that Black patients
experience less pain or experience pain differently,
even today.
There's this baseline assumption that there
are these huge differences between different racial and
ethnic groups.
And a lot of times, it's like modern medicine
looks to try to quantify them instead
of asking the real question, which is, do they even exist.
Increasingly, we're recognizing that a lot
of the tools we use every day are
rooted in data that are both very old and very racist.
The regulatory approval of pulse oximeters,
more than likely, the individuals
who they were tested on, healthy subjects,
were predominantly white men.
So right now, through FDA--
the Food and Drug Administration,
is the body that handles regulation
of these medical devices that use AI.
And they suggest doing tests of racial and ethnic bias
but do not require it as part of the clearance or approval
process for these devices.
There are many possible different definitions
of discrimination or unfairness.
Some of them conflict with each other.
The first one I always ask is, is
one group experiencing a positive outcome
at a higher or lower rate than another group?
If certain people aren't allowed to ask certain questions
in their research and in their development of tech,
tech can't be objective and can't be unbiased as a result.
We need to make sure that when these devices come out,
that they are regulated in some way,
in a correct way that takes into account a diverse group
of people.
We need to start from the root.
And we need to think about the funding and the reason,
the motivation that we're creating this thing for, right?
We don't know what we don't know.
And it requires a lot of light bulbs
to go off to be able to root out all of these problems
from medicine.
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