Geoff: Technological innovations
are reshaping the U.S. Health
care system, transforming
medical science and treatment.
A new report finds that a number
of software programs used in
hospitals across the country are
powered by algorithms with
racial biases which can cause
physicians to misdiagnose
medical conditions or delay
critical treatment.
Joining us now is Dr. Jayne
Morgan, a cardiologist with the
south eastern life sciences
association.
Her work has posters -- focused
extensively on health equity
issues.
Among the biased information
these hospitals are using is a
kidney function calculation
which presumes that lack
patients have more muscle mass
that can cause delays in care.
There is a long health formula
using 19th-century research
suggesting black patients have a
lower lung capacity.
There's a scoring index
determining if a person can have
a virginal birth after a
c-section that gives nonwhite
patients a lower success rate.
How do biased data points like
these affect treatment?
>> You hit the nail on the head.
What you're talking about with
the kidney function is something
called estimated glomerular
filtration rate.
It's what we use to do an
assessment of your kidney
function and that's incredibly
important because that number
can determine whether or not you
are eligible for a transplant.
When you should be referred to
specialty care.
Which meditations -- medications
you should be on and when you
should start them.
It can make your kidney function
appear better than it really is
and therefore delay needed and
specialty care that you may need
to have.
We see that as well with lung
capacity when we look at
spirometry.
A lot of those calculations are
built into the software.
Physicians are even unaware that
race calculation is being used
in the software.
When we look at lung capacity.
And that is incredibly important
as we are in the middle of this
covid search.
And people certainly can have
pulmonary issues.
We want to make certain that
everybody gets the absolute best
care.
Geoff: Help us understand where
this information comes from.
Clinical trials have
historically contributed to this
problem because they don't tend
to have enough people of color
involved in them.
>> Certainly there is some
historical context to that.
We know things that were done in
the name of research and I say
that in quotation marks, from
50-150 years ago often began
with false premises and then
that was carried on.
If we look at lung capacity, one
of the justifications that was
used is that body proportions
are different in the black race
in the white race.
And therefore they put this race
factor in that decreases your
lung capacity automatically for
a specific race.
While we recognize the
individual proportions may be
different, things also can be
related to occupational and
social determinants of health
and all proportions are not
certainly race-based.
If those calculations are going
to be done, they need to be done
on an individual basis, not
using race as a proxy in these
formulations and this software.
Geoff: The bias can extend
beyond treatment into medical
devices.
>> Pulse oximeters are put on
your finger to give hospitals
and physicians an indication of
what the percent of oxygen is in
your body.
B UT often times can be used T
triage you with regard to
whether or not you need to be
seen immediately or transferred
to the icu, whether you should
be given supplemental oxygen or
even intubated.
What we know is that the greater
the amount of melanin in your
skin, it artificially impairs
the reading of the pulse
oximeters.
So you can appear if you have
darker skin or more melanin to
have a higher oxygen level then
you really do and therefore you
are triaged to lower levels of
care when in fact your medical
condition may be more critical
than that pulse oximeters
indicates.
The reason we have that problem
is pulse oximeters were created
in the early 70's and in those
clinical trials, they were not
inclusive of people of color.
We see that as well with the
infrared thermometers we see.
Certainly during covid people
were using them during
screening.
You place them in front of
someone's forehead to get a
measure of what is there
temperature.
And again, we can see that
different amounts of melanin in
the skin can certainly impair
what the thermometer actually
reads.
So we've got to begin to make
certain that we not only use
these clinical tools as
physicians, but demand and
request that these tools be
validated on all peoples of
color.
Because therefore when
physicians are using them, they
can inadvertently make decisions
and errors based on readings
from software and clinical
trials that were not inclusive.
Geoff: Dr. Jayne Morgan, thanks
for your time and insights.