Mistrust in Medical Oximeters
Dr. Noha Aboelata is a family doctor and CEO of Roots Community Health in Oakland, California. She recently faced a patient care dilemma. Her patient, a 60-year-old African American man with emphysema, showed normal oxygen saturation levels. Yet, her instincts told her otherwise. A laboratory test confirmed her suspicion; contrary to the reading on the oximeter, her patient required supplemental oxygen at home.
Racial Bias Evident in Oxygen Level Readings
In December 2020, she came across an article in the New England Journal of Medicine that caught her attention. The article reported that pulse oximeters were three times more likely to miss dangerously low blood oxygen levels in Black patients compared to white patients. These findings set off alarm bells, especially as Black Americans were dying from COVID at a higher rate, and hospitals were fighting to find beds and oxygen for those who needed it.
The report exposed one of the most glaring examples of institutional racism in American health care. It revealed a potential flaw in a device doctors across the U.S. had placed trust in, sparking anger and frustration among the medical community.
Push for Corrective Measures
State prosecutors and U.S senators have since urged the Food and Drug Administration (FDA) to take steps to eradicate racial disparity in pulse oximeters readings. Officials recognize this has caused delays in treatments and unfavorable outcomes in health care. Furthermore, it has raised concerns about the reliability of AI tools used in hospitals, which rely heavily on data from such devices.
Dr. Aboelata’s clinic has responded by suing creators and merchants of oximeters. They demand these devices are either withdrawn or labeled with safety warnings. Many of their patients depend on oxygen services at home. For Medicare to cover these services, accurate information is paramount.
The Role and Necessity of Oximeters
Eliminating these devices isn’t an option, as oximeters are essential for treating heart and lung diseases, sleep apnea, and other conditions. Since the 1990s, these handy finger clips have largely replaced arterial blood gas readings. Despite their recent criticism, pulse oximeters will sell an estimated $3 billion worth of devices this year, used in hospitals, clinics, and senior living residences alike. Amid the pandemic, hundreds of thousands of Americans purchased these devices for personal use at home.
Necessity of Improved Oximeters
Despite the high demand, there are calls for better performing devices. The focus is on designing oximeters that give accurate readings for all patients, irrespective of their skin pigmentation. Efforts from the FDA may create conditions for correct functioning devices in healthy adults with darker skin but may not solve low perfusion concerns. Having better devices is not just a matter of accuracy; it can avert critical health consequences and possibly save lives.
Addressing Accuracy and Affordability
The solution is not straightforward. More accurate devices carry high price tags, costing $6,000 or more, posing another challenge to patient access. With higher precision oximeters comes reduced patient access due to high costs. While the FDA may not be able to please everyone, they are committed to ensuring greater diversity in the development and testing of such devices before they hit the market. Higher standards are long overdue, but the potential adverse effects of the oximeters’ readings cannot be quickly assessed since these errors often make up just part of a string of related incidents.
A Call for A More Inclusive Future
Amid the issues news about the limitations of certain brands of oximeters has brought to the forefront, health providers and patients agree that the solution is working with less inaccurate devices. This will foster improved healthcare delivery, reducing the instances of overlooked patients and enhancing outcomes, especially for people of dark skin tones. Accessibility to these improved devices, however, remains a hurdle to be addressed. Nevertheless, the call for improved and more inclusive healthcare devices remains loud and clear.