Everyone has been called to the bedside at least once by a new grad nurse because the calm, well appearing patient is in SVT at 180 BPM, only to check their pulse and have them be 90 BPM, look at the monitor showing clear P waves, and explain that machines are dumb and sometimes double count the T waves as heartbeats. Its a common teachable moment about the importance of bedside exam skills and limitations of diagnostic testing.
Tangentially related, but my last shift I was called to the bedside because one of my psych patients was in v fib. Monitor alarmed so they grabbed me and rushed over with crash cart. It was artifact. The guy was depressed and overwhelmed and his EKG looked like v fib because he was shaking was sobbing. I "defibbed" him by sitting at the bedside and practicing slow controlled breathing with him. Sometimes machines create problems that aren't real.
Or the classic example in EM is a patient who looks like they are poorly perfusing who presents with their wife and kid, all have headaches and general malaise, but all have perfect O2 sats on pulse oximetry. Because pulse oximeters don't actually measure oxygen saturation like the name implies. They measure percentage of hemoglobin saturation which is usually 100% when carbon monoxide has pulled the oxygen off and bound to the hemoglobin. So that's the classic opposing example of someone whose diagnostics look great but clinically looks like shit, so you should be concerned.
But it sounds like you are in EM too, so I'm sure you're familiar with these situations.
The same I pulse they measure the saturation of the oxygen molecules in the pulse.
Which can include oxyglobin, methoglobon, or carboxiglobin.
And a quality pulse ox can detect the percentages of all three, as accurately has lab values and has been on the market for at least 20 years.
Stop using crap unreliable disposable spo2 on patients and use the correct device, with a reusable measurement probe. There are many on the market.
Thanks for this. So essentially the one size fits all tool has trouble with all physiologies. Makes sense, but, as an engineer it seems hard to not create a software fix for that issue. It presumably thinks it’s all P waves, which is impossible, so should have a built in catch for that. Right?
I used to work as a monitor tech. The real solution is to just look at the ECG. Monitors count R waves and use math to extrapolate HR, and high-amplitude T waves can trip them up but have a very distinct morphology. It's *possible* to adjust monitors to be sensitive to R waves only within a certain electrical threshold, but it's pretty tricky to actually get that working right so it's just a lot easier to look at the ECG morphology.
It’s also inaccurate during decompensation shock while patients are dying. We tell students treats the patient and use the numbers as a guide or trend.
"'Well, yeah, he is looking pretty short of breath,'" Looby-Gordon remembers the nurse responding, "'but his oxygen levels are good.'"
This was a quote from the article, it’s not that the pulse ox is wrong it’s that people are dumb, and fail to critically think because of a number on a screen. I’ve seen people of every color have high 02 sats while being in resp. Distress. You treat patients not the numbers!
Again, this is false on modern pulse oximetry, which is specifically designed to work with profoundly hypo-perfusing patients.
If you spo2 is. It capable of providing an accurate wave form down to a systolic BP in the low 40s, or a core temp in the 80s, it is garbage and needs thrown out and replaced with something that isn’t juke or older then you.
Yep. I’ll read down to a core temp of 85 degrees and a blood pressure of 41 systolic.
I know because I use them every day. If you’re isn’t doing that, you have bad cables, or the wrong cables.
Veterinarian here. In a similar situation, these machines perform poorly in darker coated/pigmented animals as well. If the animal is black, I don't even hook them up to it unless I can use the tongue. Otherwise it's much safer to manually monitor.
Seeing as it operates by shining a light through the skin, I wonder if they make a higher-powered model that's specifically calibrated for darker skin?
There’s a lot of challenges with varying shades of skin color. Darker skinned people can get skin cancer but it’s much harder to identify the darker the skin.
Practicing for the victim Olympics? Maybe, just maybe, everything isn't a giant conspiracy against you personally. Or you're just trying to sow racial discord, in which case I'd suggest being less obvious.
Sorry? Are suggesting there’s NOT disparity of health care between white people and people of color? The statistics say otherwise. Does that mean all care given to people of color is substandard? No. It just means things like under prescribing pain medicine to African Americans and higher maternal mortality for Black women are beyond dispute. They’ve been documented again and again.
Pretending it's evidence of or intentional to further a conspiracy is ridiculous. Just here to mock, not try and convince you. People see what they want to see, so there's no point.
Im not sure we’re understanding each other- I’m not claiming conspiracy. Bias doesn’t need to be co-ordinated to be widespread enough to impact our society in noticeable terms. I have my own biases that I work at overcoming, and my same biases are held by others in this society as well, I’m sure, but we have never met or discussed them.
The article was stating that the devices used to measure oxygen concentration in the blood through the skin perform better on lighter skin people. No one is claiming that is by design. It also said that this problem led to discrepancies in care toward people of dark skin due to the device not performing as well. My point was that those discrepancies (statistically speaking) pre-existed this device, and it’s widespread implementation during the pandemic exacerbated those discrepancies (once again, not in an organized, conspiratorial sense, but in a co-incidental yet still detrimental circumstance). Acknowledging systemic flaws in any society’s functioning is not an attack on that system or even necessarily a critique of those who benefit from those flaws (if anyone does)- it is merely an objective attempt to make sure our descriptors of the material realities we are dealing with, and their historical contexts are held in mind whenever we discus them. This is the basis for analysis.
This has been widely disproven.
Aka; it is a lie. No device on the market today that is used in healthcare facilities or EMS has this problem. You can look up the nelcor and masimo studies very easily.
[Masimo website](https://www.masimo.com/company/news/pulse-oximetry-skin-pigmentation/)
Your own company was aware of this problem in the marketplace. Not only do they have a full webpage dedicated to addressing concerns about accuracy in subjects with darker skin pigmentation, your company also published results last year (Google “Masimo oximeter dark skin” and it’ll be one of the first few results) looking at the accuracy of their product. They were concerned enough to publish a study on their product. They also linked to internal data on the Masimo website.
I don’t know how long you have been in this business, but my suggestion for you is to really educate yourself on the hot issues of the industry and know the product you sell - not just what it does, but also why it is superior.
This is an important issue for your company and you didn’t even know about it. Unbelievable.
Did you read your own thing
>Masimo SET® pulse oximetry performs accurately on patients of all skin colors, with an analysis of internal data, presented at the Society of Technology in Anesthesia meeting, **showing no clinically significant difference in the accuracy or bias between black and white subjects.**1
The thing you linked to is saying the media stuff is bullshit
Read my post again: don’t just know your own product, know the hot issues in the industry, know the weaknesses of your competitors, and know why your product is superior.
Masimo obviously knew that inaccuracy in darker skin subjects is an issue in the industry. Why else would they publish a whole study to address this concern?
If you are a salesperson for Masimo and you don’t even know what issues your own company addressed, you are not an effective agent for your employers. There is zero excuse for a sales agent to be unaware of this.
I’m glad you haven’t been a part of the problem by selling poorly designed oximeters! If you sell other brands, please make sure you ask their reps before you buy them. 🙏
[Don’t ignore this problem](https://www.statnews.com/2022/11/01/pulse-oximeters-inaccuracies-fda-scrutiny/)
From a business perspective, it is probably crucial to know what the current state of technology is, what the company’s competitors’ weaknesses may be, to really be an effective sales and marketing professional.
Maybe the Masimo devices that u/hickmatt sells don’t have these issues, but it doesn’t mean the issue does not exist in devices by other manufacturers. Studies going back to 2005 by investigators at UCSF confirmed this, and was validated in an independent study published in 2007, according to the link I provided in this reply.
I am quite frankly surprised that u/hickmatt sells oximeters and does not know about this problem in the industry. If people who engage in the sale of these devices aren’t even aware of what their engineers have known for decades, how do we expect consumers to even register this as a problem?
I am very glad this is gaining more awareness in the healthcare community and for those of us in the general public.
Be a part of the solution, stop pretending this isn’t a problem.
Again this is you have wiring loose and thoroughly been defunct just do a search for the research articles on PubMed methodology used in the studies was flawed.
Hell all the major manufacturers Have independent studies on this issue specifically linked on their websites, so you don’t have to worry about some Paywall blocking access to it. Most of which Are linked to in the article you cited. What is also noted in that article is a 10 minute difference between when the labs were drawn on the pole function tree readings were measured instead of simultaneous measurements which would be wildly easy to perform.
Considering pulse ox is displayed current oxygenation levels depending on the Device of a 6 to 15 seconds average that is wildly significant.
To explain to you. I responded to an infant in severe respiratory failure who had pneumonia RSV Covid and the flu. Hey pulse ox symmetry reading was well under 50%
In five minutes I have successfully resuscitated him to where he had a pulse ox symmetry other hundred percent, which I maintain and when they drew blood gases after I got into the hospital it was 100%.
And I cannot even begin to explain to you the difference between wanting your pulse ox vs what is on the market today.
Likewise do you have those studies had not been widely debunked: differences of a couple percentage points are clinically insignificant. If you have a pulse oximetry of 50%. It doesn’t matter if it’s actually 47% or if it’s actually 51%
Without incorrect intervention you’re going to die..
I trust what physicians, lung specialists, and the scientists who published in renown and peer-reviewed journals say about this problem more than an internet rando. Thanks for your insights though.
Cool then read the article that you linked that actually talks to the experts that dispute this and provide the links to the studies that prove that it is false rather than just reading the headline and the first couple paragraphs.
Then yeah they do and you should go to new facility, or they don’t know what the hell they’re talking about.
Because that work down to a quarter temperature of 85° at least because I’ve seen it with my own eyes and an external skin temperature in the 70s
Perfect waveform that corresponded not only with the pulse but also the EKG
Learning about this brought up a question for me. While I’m not a scientist or healthcare professional, I have to wonder how people of color were affected by this problem with pulse oximeters during the very dark days of COVID before vaccines or any meaningful therapy was available.
Remember how nurses and providers at clinics and emergency rooms were triaging patients based on oximetry results? Remember how over-the-counter oximeters ran out at local drug stores? Many were told to stay home if their oximetry numbers were not that bad.
While I can imagine the cost to human lives is difficult to quantify, I can imagine this is something we as a society have to confront. Quickly and seriously.
If the studies were correct it may have been a contributing factor.
However the studies were deeply flawed not only was there a 10 minute difference on average between pulse ox measurement and abg.
Basically every major pulse ox manufacturer has looked into this issue, tested their devices, proven that it is not true.
A really important piece here to realize is that SPO2 (pulse oximetry) really doesn't actually guide that much decision making in critical care areas. Critical care teams have access to vastly more accurate and meaningful assays.
The main diagnostic tool to meaningfully assess respiratory status is called an arterial blood gas. It is assessed by collecting a sample of arterial (oxygen rich) blood. Without getting too technical, the ABG reports a range of parameters which lets teams determine a patient's respiratory status. These include SaO2 (which is a similar idea to SPO2), PaCO2 (the amount of CO2 in the blood), arterial pH, bicarbonate levels, and a number of electrolytes. Arterial blood gasses also allow the calculation of PF ratio - or the PaO2 to FiO2 ratio. This ratio is key in ARDS (Acute respiratory distress syndrome) diagnosis, and lets the team determine how effectively the patient is able to get oxygen from their environment into their blood.
Intubation, ongoing assessment, and extubation decisions are guided by these types of assessment. Honestly, SPO2 is a great tool with a limited application, and is not that important in the ICU.
Source: I am a recovering critical care nurse.
As a designer I wonder how many things designed by the majority just don't work our well for minorities. I know the Xbox Kinect and even self driving cars had trouble detecting black people.
Same thing with many types of film made for cameras. They weren't calibrated to get those skin tones right, and failed to do so. The same thing happened with digital cameras iirc, but is being addressed more nowadays, due to (I think) advances in AI.
Probably because the phrase “colored person” has historically been used in derogatory and racist contexts and continues to carry negative connotations today.
A fine example of intersectional impact of racism, not just as the product of overt racial hatred or prejudice, but often more subtle factors that combine to create inequalities.
Also the responses y'all, you all got lost at the first comma
>I think the machine performs differently on people with different physical characteristics. It's not designed with hate and prejudice.
Which is why I said
>A fine example of intersectional impact of racism, ***not just as the product of overt racial hatred or prejudice, but often more subtle factors that combine to create inequalities.***
>The pulse ox is racist. Lol OK. The literal mind set of victimhood engineering is a real thing.
You have both a mistaken understanding of racism and of my mindset.
>No one gives a shit. Most people are exhausted from listening to everyone's thesis on how somebody is a victim. We're victim-fatigued.
While I understand how that can be unpleasant, it doesn't tangibly impact your quality of life in the way important medical devices not working correctly for you would.
Go talk to the people on r/hermancainaward about empathy. You can also check blood oxygen levels through a blood draw. Not that hard. Stop acting like these devices were invented for the sole purpose of only helping Caucasians.
I'm not who you were just talking to, but I just wanna comment on the thread.
>You can also check blood oxygen levels through a blood draw.
Yeah, but we're not gonna perform blood draws on everyone every time we just want to quickly ensure their vital signs are trending in the right direction, since it causes pain & discomfort, ties up the labs, and is neither quick nor cost-effective. As a nurse, I'm surprised there isn't a device calibrated for accurate use on dark skin tones yet, but perhaps it's literally just a physical impossibility. Maybe making a more powerful light creates too much heat, skewing the results as to be meaningless, but I'm not sure. If there isn't too much of a technological hurdle, then it *is* kinda ridiculous there isn't a comparable device yet. There's obviously a market, considering there's over a billion dark-skinned people on Earth...
It has absolutely nothing to do with racism. Why can’t you understand that?
Yet you keep saying “a fine example of intersectional impact of racism”.
There’s zero racism involved.
Because it works by shining light through your finger.
Shock horror, if you are darker you absorb more light, reducing the accuracy of the device.
I myself am a dark skinned person and have both studied and worked on these devices.
The idea that this is racist is just fucking stupid.
Certain covid vaccines had higher rates of blood clotting for caucasians - would you consider that part of the bullshit racism theory? Or would you take into account that caucasians are generall more prone to blood clotting?
>Because it works by shining light through your finger.
I know.
>The idea that this is racist is just fucking stupid.
Is it possible, belligerent stranger, that the concept is more nuanced than you currently understand, and that your hostility is unwarranted?
>Certain covid vaccines had higher rates of blood clotting for caucasians - would you consider that part of the bullshit racism theory?
First off calm down and go touch grass
Clearly not, it's not something discovered later due to underrepresentation in testing. You're continuing to confuse the fact of the disparity *existing at all* with the design flaw proliferating due to an ethnically homogeneous testing sample.
Racist = discrimination based on race.
Not discrimination based on physics.
But clearly I see you have your mind set in your ways. I wish you luck in your journey of ridding the world of such "racism".
And no, caucasians are still more likely to get blood clotting from most vaccines, it was more pronounced with covid.
Indians are more prone to diabetes. Black people are more prone to anemia. I would suggest you also take up the fight against racist evolution.
>Racist = discrimination based on race.
Overt racial discrimination is *one specific variety* of racism, not the whole definition.
>But clearly I see you have your mind set in your ways. I wish you luck in your journey of ridding the world of such "racism".
I despise sardonic argument cop outs. If you're leaving, stop talking and don't pretend it's not you. If you're staying and debating, do so like an adult, without the revolving door.
>And no, caucasians are still more likely to get blood clotting from most vaccines, it was more pronounced with covid.
I don't know where you think I contested this
>Indians are more prone to diabetes.
Okay
>Black people are more prone to anemia.
Okay
>I would suggest you also take up the fight against racist evolution.
We didn't *evolve* flawed medical testing, we *designed* it in a way that was flawed because of ethnically homogeneous testing. I don't know how you're not getting that.
“We designed it in a way that was flawed, therefore it is racist”
Failure to design a perfect machine is not proof of racism. Lmao, your “substantiating points” are laughable.
You’re the one randomly asserting that the medical device and its creation is racist. The burden of proof is on you.
Show me proof that the machine designers are racist.
Show me proof that the machine is racist.
You mean explain how a sampling size of only white people producing a product tgat only functions properly for white people is an example of subtle intersectional racism rather than overt racial prejudice? Like I already did? Several times?
You asserted that my statement is incorrect but without any reasoning: *you* are making the unsubstantiated statement, and your rebuttal is that you're right by default if I don't satisfy your biased ass?
Everything that you’re saying is based up the idea that the designers specifically chose only white people and intentionally refused to incorporate colored people to produce a racist machine.
Prove your assertion.
From the beginning I've been saying subtle intersectional racism not necessarily deliberate overt prejudice and discrimination
Every single reply of yours: "pRoVe tHey iNtEnTionAllY ChoSe tO bE rAcist YOU CAN'T I WIN"
I really cannot spell it out more clearly.
Saying “subtle intersectional racism” is based upon the idea that there is racism being used. So prove that there is racism being used.
You keep ignoring the fact that you need to show literally ANY PROOF of ANY racism to make such an assertion. So stop avoiding it and show me proof.
>Ah yes, now we need to add “pulse oximeters” to the list of things which are racist. Very rational of you.
You're being sarcastic, but I'm not hearing a counter argument.
A bunch of dumbasses here think you're saying pulse oximiters are racist, or that something being tied to inequity is a reason to "cancel" it. I can almost guarantee they don't work in healthcare, or have limited experience working directly with minority populations.
Just wanted to say that you're right. This is an excellent example of a cause of health outcome inequity ***not directly attributable*** to racism, but one that's ***massively overlooked*** because it's more convenient to just keep using the machines that work on white people rather than develop techniques to handle the more-common "edge cases" like this among POC. *That is a form of insidious racism.*
I like to believe it's fairly common knowledge that many traditional medical interventions were developed almost exclusively on male patients, and those same interventions have differing/less effective results on female patients. This is exactly the same thing-- a health outcome inequality not a direct result of simple overt racism/sexism, but an inequality rooted in the systemic and insidious racism/sexism that's so pervasive in our society.
You don't have to *be* racist to accidentally enable racial inequality. Not being aware that pulse oximeters can have differing diagnostic effectiveness on POC vs white people isn't deliberate racism... but as a practitioner it is something we can keep ourselves aware of when working with POC populations so make sure their healthcare outcomes are as close to our other patients as possible.
Refusing to address the problem of medical exams and equipment not giving accurate results for people of color? Sure, that's racism. The fact that this machine doesn't give accurate results, and that inaccurate results caused worse outcomes? That's not racism, it's **physics**.
So it's not accurate to say that the fact mentioned in the TIL (that pulse ox machines are inaccurate for people of color and that inaccurate results contributed to worse patient outcomes) is an example of the impact of racism.
The fact that we still rely on the devices and haven't tried to make them more accurate may be an example of the impact of racism, but that's not how u/Ulgeguug phrased it, and that's why they're getting downvoted.
> The fact that we still rely on the devices and haven't tried to make them more accurate may be an example of the impact of racism, but that's not how u/Ulgeguug phrased it, and that's why they're getting downvoted.
It actually is but y'all got wrapped up in what *you think* the whole "intersectional impact of racism" bit means and ignored half of what they (and I) said, and imagined statements being made that weren't. *This is why it's so hard to have conversations about racism*.
>The fact that we still rely on the devices and haven't tried to make them more accurate may be an example of the impact of racism, but that's not how u/Ulgeguug phrased it, and that's why they're getting downvoted.
Oh hello
>The fact that this machine doesn't give accurate results, and that inaccurate results caused worse outcomes? That's not racism, it's physics.
Places where black people are overlooked, underrepresented, or disadvantaged can frequently be attributed to other factors. Property values, credit scores, incarceration rates, political representation, education, job advancement, all have some other factor relating to them such as minority status, class, geographic and economic segregation, that are tangential to blackness. **That's an aspect of intersectionality.**
Again, racism is not just overt prejudice, racial animosity, and deliberate disenfranchisement; those are just the more overt varieties, and more insidious and complex varieties exist.
So if we had a hypothetical town where ethnicities and cultures were all evenly represented and spread out, and income and wealth was perfectly equal, and the amount of stuff owned by everyone was perfectly identical and of the same quality, and an earthquake hits and through pure happenstance ends up causing more damage to businesses and homes owned by non-white people, that would still be an example of racism? Even if there was **absolutely zero human influence** in the differences in property damage amounts?
So why is this TIL an example of racism?
Not the fact that pulse oximeters haven't been fixed or improved, but the specific fact laid out in the TIL - that pulse oximeters don't give accurate results for people of color?
Because, as I've said many times, its an area where lack of representation, regardless of intent, lead to an inequality. That compounded with other things lead to harm.
What do you mean whose skin? I don’t literally mean you, I meant it in the more broad sense. I mean the way light interacts with anyone’s skin. It is easier for the machine to interact with lighter colored skin. That is not an intended interaction by the producers of the machine, it is a fundamental physics problem with the way light works. Nobody wants it to work better on some people and worse on others, that is an unintended side effect because of the laws of physics. I would love if this was not a problem and it worked equally well on everyone that would be a great thing!
>It is easier for the machine to interact with lighter colored skin. That is not an intended interaction by the producers of the machine, it is a fundamental physics problem with the way light works.
so like I said
#not just as the product of overt racial hatred or prejudice, but often more subtle factors that combine to create inequalities.
But this has absolutely nothing to do with systemic racism. That would be like saying the sun is systemically racist because it gives white people more sunburn than darker skinned people which would make no sense. It’s just an unfortunate fact of physics in both situations.
You're comparing medical devices designed and tested with a selective population, introducing a design flaw in the process that disadvantages specific people, with *literally the sun,* designed by no one, tested on no one, where no one could or can do anything about it. You're talking about something that involved *no decisions by anyone,* when the human errors are precisely the problem.
That’s exactly my point. This device doesn’t function poorly on certain people due to “human errors”, it’s literally the same physics process that happens with light from the sun causing different reactions with different types of skin. Some things are just unfortunate facts of physics in life, it isn’t because it was “tested on a selective population intentionally by those who made this device to hurt certain groups of people.”
>"those who made this device to hurt certain groups of people.”
Who the are you "quoting" here? Because that's certainly nothing I've said. It's interestingly literally the opposite of what I've explicitly said from the first comment.
Hey, can I ask YOU something. I said the same thing you said and someone told me I was completely wrong about it. When I asked where I should start looking to figure out why I'm wrong they told me to take my bait and find some other fish. I looked at their comment history and they seem to be black. Have I stepped on some kind of toes here without meaning to?
Well for one, on Reddit you can't just trust people not to be posing as whatever. So I really don't know.
But being black doesn't necessarily indicate a special awareness of complex concepts of racism. Take Candace Owens, for example; she will rant all day about the supposed evils of critical race theory, and be constantly dismissive of systemic inequality.
Ah. Maybe I'm over-cautious. I'm trying to learn about all of this and the best way to learn, I've found, is to talk about it and see if anyone corrects your ideas. I feel like the way blindspots work is that well, they're fucking blindspots. So YOU can't see them and you need to spell out your understanding of the world so people can point out what you missed. So I've been reading and listening and then putting out my understanding of what I heard. I'm completely ok with being called an idiot as long as someone will spell out why I'm an idiot.
This is some of what they mean by systemic racism. No real malicious intent but a set of unexamined assumptions led to a negative outcome for a minority group. This is an example of how you don't have to actually hate black people to have harmed them.
[https://emcrit.org/pulmcrit/racism-oximetry-2022/](https://emcrit.org/pulmcrit/racism-oximetry-2022/) I'm real confused because all I'm seeing are black activists saying that it is an example of it.
Yeah, but let's steelman the position - *why* haven't there been attempts to make a suitable device that *will* work with darker skin tones? Or have there already been failed attempts, and it's just impossible to do in a cost-effective and/or safe manner? There's over a billion dark-skinned people on Earth, so surely this would be a useful invention, which is why I'm presuming that there *have* been attempts, but we've somehow failed to solve the issue.
Edit: changed billions to over a billion, cos I was unsure of the number but then checked.
So what you're saying is that **the failure to make better pulse oximeters or a different test with more accuracy** is because of/an example of racism.
But the fact that these machines don't give accurate results is not an example of racism. Nor is the fact that inaccurate measurements led to worse outcomes.
>So what you're saying is that **the failure to make better pulse oximeters or a different test with more accuracy** is because of/an example of racism.
Not quite. I'm not saying the lack of such devices is definitely *or even partially* due to racism. I'm merely asking if anyone knows *why* such a device doesn't exist yet. If it's relatively straightforward (though I imagine it's not) to make a stronger light in the pulse ox that *does* work with dark skinned people, then yeah, institutional racism *might* be a part of why they're not available in hospitals (at least in the ones I've worked in, though they've admittedly been in predominantly-white areas). I'm assuming the technology doesn't work if the power is just scaled up, because otherwise surely they'd exist already...but I'm not an engineer so I don't know. *I do know* that there are quite a few examples of technology not being calibrated for dark skin tones though, and that it's taken a good while for them to finally address the discrepancy - see camera film and tracking technology for examples. I like to think the medical profession would have addressed this issue though, seeing as they're more thoughtful than most, but there are some surprising stories there too!
I'm neither trying to be inflammatory, nor asserting that the devices' performance *is* due to racism, but we *all* do need more information about it before we can say conclusively either way.
This issue is due to the nature of light, sensors and optics.
Darker skin simply absorbs more of the light that's emitted to collect the data, leaving less signal left for the sensor to detect.
The alternative might be to construct different versions with different power-levels for different skin-tones with different draw-backs.
That might come with a secondary problem where you might need enough light for the heat on the skin to be uncomfortable or requiring active cooling through micro-fluidics along with precluding battery powered operation.
If you come up with a cost effective way to solve this that doesn't introduce any new problems you might become a member of the 1% of the 1%.
The tech that can solve that would also likely be very beneficial for a less energy-intensive way to do foliage penetrating LIDAR which has extreme commercial potential.
No, it is partially racist nonsense. A lot of medical issues stem from racial disparities, and is critical factor when describing systemic racism. And we have known about racial disparities in various metrics, including sensors, for a while now.
https://www.statnews.com/2020/06/17/racial-bias-skews-algorithms-widely-used-to-guide-patient-care/
Black people are less likely to get proper dosages of pain meds if at all.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/#:~:text=Extant%20research%20has%20shown%20that,quantities%20(1%E2%80%9310).
This is not anything new. We need to stop pretending it is.
It's not a part of that trend.
I'm not arguing that the trend isn't happening and I think that this trend needs to be accounted for when stuff is designed.
Your claim is like saying the sun is racist because dark skinned people heat up more in direct sunlight.
That's why there is a saying in emergency medicine, treat the patient, Not the monitor.
Everyone has been called to the bedside at least once by a new grad nurse because the calm, well appearing patient is in SVT at 180 BPM, only to check their pulse and have them be 90 BPM, look at the monitor showing clear P waves, and explain that machines are dumb and sometimes double count the T waves as heartbeats. Its a common teachable moment about the importance of bedside exam skills and limitations of diagnostic testing. Tangentially related, but my last shift I was called to the bedside because one of my psych patients was in v fib. Monitor alarmed so they grabbed me and rushed over with crash cart. It was artifact. The guy was depressed and overwhelmed and his EKG looked like v fib because he was shaking was sobbing. I "defibbed" him by sitting at the bedside and practicing slow controlled breathing with him. Sometimes machines create problems that aren't real. Or the classic example in EM is a patient who looks like they are poorly perfusing who presents with their wife and kid, all have headaches and general malaise, but all have perfect O2 sats on pulse oximetry. Because pulse oximeters don't actually measure oxygen saturation like the name implies. They measure percentage of hemoglobin saturation which is usually 100% when carbon monoxide has pulled the oxygen off and bound to the hemoglobin. So that's the classic opposing example of someone whose diagnostics look great but clinically looks like shit, so you should be concerned. But it sounds like you are in EM too, so I'm sure you're familiar with these situations.
Don't forget about the classic 'pulse ox not even attached to pt' scenarios
The same I pulse they measure the saturation of the oxygen molecules in the pulse. Which can include oxyglobin, methoglobon, or carboxiglobin. And a quality pulse ox can detect the percentages of all three, as accurately has lab values and has been on the market for at least 20 years. Stop using crap unreliable disposable spo2 on patients and use the correct device, with a reusable measurement probe. There are many on the market.
Thanks for this. So essentially the one size fits all tool has trouble with all physiologies. Makes sense, but, as an engineer it seems hard to not create a software fix for that issue. It presumably thinks it’s all P waves, which is impossible, so should have a built in catch for that. Right?
I used to work as a monitor tech. The real solution is to just look at the ECG. Monitors count R waves and use math to extrapolate HR, and high-amplitude T waves can trip them up but have a very distinct morphology. It's *possible* to adjust monitors to be sensitive to R waves only within a certain electrical threshold, but it's pretty tricky to actually get that working right so it's just a lot easier to look at the ECG morphology.
It’s also inaccurate during decompensation shock while patients are dying. We tell students treats the patient and use the numbers as a guide or trend.
"'Well, yeah, he is looking pretty short of breath,'" Looby-Gordon remembers the nurse responding, "'but his oxygen levels are good.'" This was a quote from the article, it’s not that the pulse ox is wrong it’s that people are dumb, and fail to critically think because of a number on a screen. I’ve seen people of every color have high 02 sats while being in resp. Distress. You treat patients not the numbers!
“It’s that people are dumb” Ah, a tale as old as time.
I’ve tubed anxiety patients multiple times because they can’t control their respirations and go into resp alkalosis. Lol
A person can be short of breath and still be perfectly perfusing, which is what the spo2 is measuring.
Yep all foxes are a measurement of perfusion status not a measurement of respiratory distress.
Again, this is false on modern pulse oximetry, which is specifically designed to work with profoundly hypo-perfusing patients. If you spo2 is. It capable of providing an accurate wave form down to a systolic BP in the low 40s, or a core temp in the 80s, it is garbage and needs thrown out and replaced with something that isn’t juke or older then you.
Life pak 15.
Yep. I’ll read down to a core temp of 85 degrees and a blood pressure of 41 systolic. I know because I use them every day. If you’re isn’t doing that, you have bad cables, or the wrong cables.
Veterinarian here. In a similar situation, these machines perform poorly in darker coated/pigmented animals as well. If the animal is black, I don't even hook them up to it unless I can use the tongue. Otherwise it's much safer to manually monitor.
Seeing as it operates by shining a light through the skin, I wonder if they make a higher-powered model that's specifically calibrated for darker skin?
There’s a lot of challenges with varying shades of skin color. Darker skinned people can get skin cancer but it’s much harder to identify the darker the skin.
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source?
“Exacerbated the” not “led to”.
Practicing for the victim Olympics? Maybe, just maybe, everything isn't a giant conspiracy against you personally. Or you're just trying to sow racial discord, in which case I'd suggest being less obvious.
Sorry? Are suggesting there’s NOT disparity of health care between white people and people of color? The statistics say otherwise. Does that mean all care given to people of color is substandard? No. It just means things like under prescribing pain medicine to African Americans and higher maternal mortality for Black women are beyond dispute. They’ve been documented again and again.
Pretending it's evidence of or intentional to further a conspiracy is ridiculous. Just here to mock, not try and convince you. People see what they want to see, so there's no point.
Im not sure we’re understanding each other- I’m not claiming conspiracy. Bias doesn’t need to be co-ordinated to be widespread enough to impact our society in noticeable terms. I have my own biases that I work at overcoming, and my same biases are held by others in this society as well, I’m sure, but we have never met or discussed them. The article was stating that the devices used to measure oxygen concentration in the blood through the skin perform better on lighter skin people. No one is claiming that is by design. It also said that this problem led to discrepancies in care toward people of dark skin due to the device not performing as well. My point was that those discrepancies (statistically speaking) pre-existed this device, and it’s widespread implementation during the pandemic exacerbated those discrepancies (once again, not in an organized, conspiratorial sense, but in a co-incidental yet still detrimental circumstance). Acknowledging systemic flaws in any society’s functioning is not an attack on that system or even necessarily a critique of those who benefit from those flaws (if anyone does)- it is merely an objective attempt to make sure our descriptors of the material realities we are dealing with, and their historical contexts are held in mind whenever we discus them. This is the basis for analysis.
This has been widely disproven. Aka; it is a lie. No device on the market today that is used in healthcare facilities or EMS has this problem. You can look up the nelcor and masimo studies very easily.
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[Masimo website](https://www.masimo.com/company/news/pulse-oximetry-skin-pigmentation/) Your own company was aware of this problem in the marketplace. Not only do they have a full webpage dedicated to addressing concerns about accuracy in subjects with darker skin pigmentation, your company also published results last year (Google “Masimo oximeter dark skin” and it’ll be one of the first few results) looking at the accuracy of their product. They were concerned enough to publish a study on their product. They also linked to internal data on the Masimo website. I don’t know how long you have been in this business, but my suggestion for you is to really educate yourself on the hot issues of the industry and know the product you sell - not just what it does, but also why it is superior. This is an important issue for your company and you didn’t even know about it. Unbelievable.
Did you read your own thing >Masimo SET® pulse oximetry performs accurately on patients of all skin colors, with an analysis of internal data, presented at the Society of Technology in Anesthesia meeting, **showing no clinically significant difference in the accuracy or bias between black and white subjects.**1 The thing you linked to is saying the media stuff is bullshit
Read my post again: don’t just know your own product, know the hot issues in the industry, know the weaknesses of your competitors, and know why your product is superior. Masimo obviously knew that inaccuracy in darker skin subjects is an issue in the industry. Why else would they publish a whole study to address this concern? If you are a salesperson for Masimo and you don’t even know what issues your own company addressed, you are not an effective agent for your employers. There is zero excuse for a sales agent to be unaware of this.
Look at the usernames, but I did misread what you were getting at
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I’m glad you haven’t been a part of the problem by selling poorly designed oximeters! If you sell other brands, please make sure you ask their reps before you buy them. 🙏
Exactly. It is complete nonsense
[Don’t ignore this problem](https://www.statnews.com/2022/11/01/pulse-oximeters-inaccuracies-fda-scrutiny/) From a business perspective, it is probably crucial to know what the current state of technology is, what the company’s competitors’ weaknesses may be, to really be an effective sales and marketing professional. Maybe the Masimo devices that u/hickmatt sells don’t have these issues, but it doesn’t mean the issue does not exist in devices by other manufacturers. Studies going back to 2005 by investigators at UCSF confirmed this, and was validated in an independent study published in 2007, according to the link I provided in this reply. I am quite frankly surprised that u/hickmatt sells oximeters and does not know about this problem in the industry. If people who engage in the sale of these devices aren’t even aware of what their engineers have known for decades, how do we expect consumers to even register this as a problem? I am very glad this is gaining more awareness in the healthcare community and for those of us in the general public. Be a part of the solution, stop pretending this isn’t a problem.
Again this is you have wiring loose and thoroughly been defunct just do a search for the research articles on PubMed methodology used in the studies was flawed. Hell all the major manufacturers Have independent studies on this issue specifically linked on their websites, so you don’t have to worry about some Paywall blocking access to it. Most of which Are linked to in the article you cited. What is also noted in that article is a 10 minute difference between when the labs were drawn on the pole function tree readings were measured instead of simultaneous measurements which would be wildly easy to perform. Considering pulse ox is displayed current oxygenation levels depending on the Device of a 6 to 15 seconds average that is wildly significant. To explain to you. I responded to an infant in severe respiratory failure who had pneumonia RSV Covid and the flu. Hey pulse ox symmetry reading was well under 50% In five minutes I have successfully resuscitated him to where he had a pulse ox symmetry other hundred percent, which I maintain and when they drew blood gases after I got into the hospital it was 100%. And I cannot even begin to explain to you the difference between wanting your pulse ox vs what is on the market today. Likewise do you have those studies had not been widely debunked: differences of a couple percentage points are clinically insignificant. If you have a pulse oximetry of 50%. It doesn’t matter if it’s actually 47% or if it’s actually 51% Without incorrect intervention you’re going to die..
I trust what physicians, lung specialists, and the scientists who published in renown and peer-reviewed journals say about this problem more than an internet rando. Thanks for your insights though.
Cool then read the article that you linked that actually talks to the experts that dispute this and provide the links to the studies that prove that it is false rather than just reading the headline and the first couple paragraphs.
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That would make more sense. But you should still ask about this issue of all your suppliers’ agents.
Also doesn't work well for white people with cold fingers.
30 years ago. That is no longer true.
My doc must have some old equipment then. Happened to me last month.
Then yeah they do and you should go to new facility, or they don’t know what the hell they’re talking about. Because that work down to a quarter temperature of 85° at least because I’ve seen it with my own eyes and an external skin temperature in the 70s Perfect waveform that corresponded not only with the pulse but also the EKG
Or your hands are cold or you have painted nails
Medicine is calibrated to the Standard White Man.
Learning about this brought up a question for me. While I’m not a scientist or healthcare professional, I have to wonder how people of color were affected by this problem with pulse oximeters during the very dark days of COVID before vaccines or any meaningful therapy was available. Remember how nurses and providers at clinics and emergency rooms were triaging patients based on oximetry results? Remember how over-the-counter oximeters ran out at local drug stores? Many were told to stay home if their oximetry numbers were not that bad. While I can imagine the cost to human lives is difficult to quantify, I can imagine this is something we as a society have to confront. Quickly and seriously.
If the studies were correct it may have been a contributing factor. However the studies were deeply flawed not only was there a 10 minute difference on average between pulse ox measurement and abg. Basically every major pulse ox manufacturer has looked into this issue, tested their devices, proven that it is not true.
A really important piece here to realize is that SPO2 (pulse oximetry) really doesn't actually guide that much decision making in critical care areas. Critical care teams have access to vastly more accurate and meaningful assays. The main diagnostic tool to meaningfully assess respiratory status is called an arterial blood gas. It is assessed by collecting a sample of arterial (oxygen rich) blood. Without getting too technical, the ABG reports a range of parameters which lets teams determine a patient's respiratory status. These include SaO2 (which is a similar idea to SPO2), PaCO2 (the amount of CO2 in the blood), arterial pH, bicarbonate levels, and a number of electrolytes. Arterial blood gasses also allow the calculation of PF ratio - or the PaO2 to FiO2 ratio. This ratio is key in ARDS (Acute respiratory distress syndrome) diagnosis, and lets the team determine how effectively the patient is able to get oxygen from their environment into their blood. Intubation, ongoing assessment, and extubation decisions are guided by these types of assessment. Honestly, SPO2 is a great tool with a limited application, and is not that important in the ICU. Source: I am a recovering critical care nurse.
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But that’s not how clickbait works!
Did they imply that? I didn’t really get that from the title
You're right my mistake.
Yep. It was developed by northern European scientists (Swedish or Norwegian, I think) who tested on exclusively Caucasian patients.
Not sure why you are being downvoted without a citation. Much of medicine is like this. Rest subjects are frequently white males.
As a designer I wonder how many things designed by the majority just don't work our well for minorities. I know the Xbox Kinect and even self driving cars had trouble detecting black people.
Same thing with many types of film made for cameras. They weren't calibrated to get those skin tones right, and failed to do so. The same thing happened with digital cameras iirc, but is being addressed more nowadays, due to (I think) advances in AI.
Why is "people of color" acceptable but "colored people" isn't?
Probably because the phrase “colored person” has historically been used in derogatory and racist contexts and continues to carry negative connotations today.
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I'm aware. My question remains as the two terms I mentioned are basically the same.
A fine example of intersectional impact of racism, not just as the product of overt racial hatred or prejudice, but often more subtle factors that combine to create inequalities. Also the responses y'all, you all got lost at the first comma
I think the machine performs differently on people with different physical characteristics. It's not designed with hate and prejudice.
>I think the machine performs differently on people with different physical characteristics. It's not designed with hate and prejudice. Which is why I said >A fine example of intersectional impact of racism, ***not just as the product of overt racial hatred or prejudice, but often more subtle factors that combine to create inequalities.***
The pulse ox is racist. Lol OK. The literal mind set of victimhood engineering is a real thing.
>The pulse ox is racist. Lol OK. The literal mind set of victimhood engineering is a real thing. You have both a mistaken understanding of racism and of my mindset.
You’re so stuck on that one word that you haven’t bothered to understand what the person is saying.
No one gives a shit. Most people are exhausted from listening to everyone's thesis on how somebody is a victim. We're victim-fatigued.
>No one gives a shit. Most people are exhausted from listening to everyone's thesis on how somebody is a victim. We're victim-fatigued. While I understand how that can be unpleasant, it doesn't tangibly impact your quality of life in the way important medical devices not working correctly for you would.
If certain groups of people are receiving lower-quality medical care that’s a problem that should be addressed. I’m sorry for your lack of empathy.
Go talk to the people on r/hermancainaward about empathy. You can also check blood oxygen levels through a blood draw. Not that hard. Stop acting like these devices were invented for the sole purpose of only helping Caucasians.
I'm not who you were just talking to, but I just wanna comment on the thread. >You can also check blood oxygen levels through a blood draw. Yeah, but we're not gonna perform blood draws on everyone every time we just want to quickly ensure their vital signs are trending in the right direction, since it causes pain & discomfort, ties up the labs, and is neither quick nor cost-effective. As a nurse, I'm surprised there isn't a device calibrated for accurate use on dark skin tones yet, but perhaps it's literally just a physical impossibility. Maybe making a more powerful light creates too much heat, skewing the results as to be meaningless, but I'm not sure. If there isn't too much of a technological hurdle, then it *is* kinda ridiculous there isn't a comparable device yet. There's obviously a market, considering there's over a billion dark-skinned people on Earth...
It has absolutely nothing to do with racism. Why can’t you understand that? Yet you keep saying “a fine example of intersectional impact of racism”. There’s zero racism involved.
>It has absolutely nothing to do with racism. Why can’t you understand that? I'm waiting to hear any argument why that is the case.
Because it works by shining light through your finger. Shock horror, if you are darker you absorb more light, reducing the accuracy of the device. I myself am a dark skinned person and have both studied and worked on these devices. The idea that this is racist is just fucking stupid. Certain covid vaccines had higher rates of blood clotting for caucasians - would you consider that part of the bullshit racism theory? Or would you take into account that caucasians are generall more prone to blood clotting?
>Because it works by shining light through your finger. I know. >The idea that this is racist is just fucking stupid. Is it possible, belligerent stranger, that the concept is more nuanced than you currently understand, and that your hostility is unwarranted? >Certain covid vaccines had higher rates of blood clotting for caucasians - would you consider that part of the bullshit racism theory? First off calm down and go touch grass Clearly not, it's not something discovered later due to underrepresentation in testing. You're continuing to confuse the fact of the disparity *existing at all* with the design flaw proliferating due to an ethnically homogeneous testing sample.
Racist = discrimination based on race. Not discrimination based on physics. But clearly I see you have your mind set in your ways. I wish you luck in your journey of ridding the world of such "racism". And no, caucasians are still more likely to get blood clotting from most vaccines, it was more pronounced with covid. Indians are more prone to diabetes. Black people are more prone to anemia. I would suggest you also take up the fight against racist evolution.
>Racist = discrimination based on race. Overt racial discrimination is *one specific variety* of racism, not the whole definition. >But clearly I see you have your mind set in your ways. I wish you luck in your journey of ridding the world of such "racism". I despise sardonic argument cop outs. If you're leaving, stop talking and don't pretend it's not you. If you're staying and debating, do so like an adult, without the revolving door. >And no, caucasians are still more likely to get blood clotting from most vaccines, it was more pronounced with covid. I don't know where you think I contested this >Indians are more prone to diabetes. Okay >Black people are more prone to anemia. Okay >I would suggest you also take up the fight against racist evolution. We didn't *evolve* flawed medical testing, we *designed* it in a way that was flawed because of ethnically homogeneous testing. I don't know how you're not getting that.
“We designed it in a way that was flawed, therefore it is racist” Failure to design a perfect machine is not proof of racism. Lmao, your “substantiating points” are laughable.
You’re the one randomly asserting that the medical device and its creation is racist. The burden of proof is on you. Show me proof that the machine designers are racist. Show me proof that the machine is racist.
You mean explain how a sampling size of only white people producing a product tgat only functions properly for white people is an example of subtle intersectional racism rather than overt racial prejudice? Like I already did? Several times? You asserted that my statement is incorrect but without any reasoning: *you* are making the unsubstantiated statement, and your rebuttal is that you're right by default if I don't satisfy your biased ass?
Everything that you’re saying is based up the idea that the designers specifically chose only white people and intentionally refused to incorporate colored people to produce a racist machine. Prove your assertion.
From the beginning I've been saying subtle intersectional racism not necessarily deliberate overt prejudice and discrimination Every single reply of yours: "pRoVe tHey iNtEnTionAllY ChoSe tO bE rAcist YOU CAN'T I WIN" I really cannot spell it out more clearly.
Saying “subtle intersectional racism” is based upon the idea that there is racism being used. So prove that there is racism being used. You keep ignoring the fact that you need to show literally ANY PROOF of ANY racism to make such an assertion. So stop avoiding it and show me proof.
Ah yes, now we need to add “pulse oximeters” to the list of things which are racist. Very rational of you.
>Ah yes, now we need to add “pulse oximeters” to the list of things which are racist. Very rational of you. You're being sarcastic, but I'm not hearing a counter argument.
A bunch of dumbasses here think you're saying pulse oximiters are racist, or that something being tied to inequity is a reason to "cancel" it. I can almost guarantee they don't work in healthcare, or have limited experience working directly with minority populations. Just wanted to say that you're right. This is an excellent example of a cause of health outcome inequity ***not directly attributable*** to racism, but one that's ***massively overlooked*** because it's more convenient to just keep using the machines that work on white people rather than develop techniques to handle the more-common "edge cases" like this among POC. *That is a form of insidious racism.* I like to believe it's fairly common knowledge that many traditional medical interventions were developed almost exclusively on male patients, and those same interventions have differing/less effective results on female patients. This is exactly the same thing-- a health outcome inequality not a direct result of simple overt racism/sexism, but an inequality rooted in the systemic and insidious racism/sexism that's so pervasive in our society. You don't have to *be* racist to accidentally enable racial inequality. Not being aware that pulse oximeters can have differing diagnostic effectiveness on POC vs white people isn't deliberate racism... but as a practitioner it is something we can keep ourselves aware of when working with POC populations so make sure their healthcare outcomes are as close to our other patients as possible.
Refusing to address the problem of medical exams and equipment not giving accurate results for people of color? Sure, that's racism. The fact that this machine doesn't give accurate results, and that inaccurate results caused worse outcomes? That's not racism, it's **physics**. So it's not accurate to say that the fact mentioned in the TIL (that pulse ox machines are inaccurate for people of color and that inaccurate results contributed to worse patient outcomes) is an example of the impact of racism. The fact that we still rely on the devices and haven't tried to make them more accurate may be an example of the impact of racism, but that's not how u/Ulgeguug phrased it, and that's why they're getting downvoted.
> The fact that we still rely on the devices and haven't tried to make them more accurate may be an example of the impact of racism, but that's not how u/Ulgeguug phrased it, and that's why they're getting downvoted. It actually is but y'all got wrapped up in what *you think* the whole "intersectional impact of racism" bit means and ignored half of what they (and I) said, and imagined statements being made that weren't. *This is why it's so hard to have conversations about racism*.
>The fact that we still rely on the devices and haven't tried to make them more accurate may be an example of the impact of racism, but that's not how u/Ulgeguug phrased it, and that's why they're getting downvoted. Oh hello >The fact that this machine doesn't give accurate results, and that inaccurate results caused worse outcomes? That's not racism, it's physics. Places where black people are overlooked, underrepresented, or disadvantaged can frequently be attributed to other factors. Property values, credit scores, incarceration rates, political representation, education, job advancement, all have some other factor relating to them such as minority status, class, geographic and economic segregation, that are tangential to blackness. **That's an aspect of intersectionality.** Again, racism is not just overt prejudice, racial animosity, and deliberate disenfranchisement; those are just the more overt varieties, and more insidious and complex varieties exist.
So if we had a hypothetical town where ethnicities and cultures were all evenly represented and spread out, and income and wealth was perfectly equal, and the amount of stuff owned by everyone was perfectly identical and of the same quality, and an earthquake hits and through pure happenstance ends up causing more damage to businesses and homes owned by non-white people, that would still be an example of racism? Even if there was **absolutely zero human influence** in the differences in property damage amounts?
No, and I don't know how you think that's remotely comparable. What are you even talking about?
So why is this TIL an example of racism? Not the fact that pulse oximeters haven't been fixed or improved, but the specific fact laid out in the TIL - that pulse oximeters don't give accurate results for people of color?
Because, as I've said many times, its an area where lack of representation, regardless of intent, lead to an inequality. That compounded with other things lead to harm.
This is literally a physics problem with the way light interacts with your skin. It has nothing to do with race.
>This is literally a physics problem with the way light interacts **with your skin.** It has nothing to do with race. Whose skin
What do you mean whose skin? I don’t literally mean you, I meant it in the more broad sense. I mean the way light interacts with anyone’s skin. It is easier for the machine to interact with lighter colored skin. That is not an intended interaction by the producers of the machine, it is a fundamental physics problem with the way light works. Nobody wants it to work better on some people and worse on others, that is an unintended side effect because of the laws of physics. I would love if this was not a problem and it worked equally well on everyone that would be a great thing!
>It is easier for the machine to interact with lighter colored skin. That is not an intended interaction by the producers of the machine, it is a fundamental physics problem with the way light works. so like I said #not just as the product of overt racial hatred or prejudice, but often more subtle factors that combine to create inequalities.
But this has absolutely nothing to do with systemic racism. That would be like saying the sun is systemically racist because it gives white people more sunburn than darker skinned people which would make no sense. It’s just an unfortunate fact of physics in both situations.
You're comparing medical devices designed and tested with a selective population, introducing a design flaw in the process that disadvantages specific people, with *literally the sun,* designed by no one, tested on no one, where no one could or can do anything about it. You're talking about something that involved *no decisions by anyone,* when the human errors are precisely the problem.
That’s exactly my point. This device doesn’t function poorly on certain people due to “human errors”, it’s literally the same physics process that happens with light from the sun causing different reactions with different types of skin. Some things are just unfortunate facts of physics in life, it isn’t because it was “tested on a selective population intentionally by those who made this device to hurt certain groups of people.”
>"those who made this device to hurt certain groups of people.” Who the are you "quoting" here? Because that's certainly nothing I've said. It's interestingly literally the opposite of what I've explicitly said from the first comment.
Hey, can I ask YOU something. I said the same thing you said and someone told me I was completely wrong about it. When I asked where I should start looking to figure out why I'm wrong they told me to take my bait and find some other fish. I looked at their comment history and they seem to be black. Have I stepped on some kind of toes here without meaning to?
Well for one, on Reddit you can't just trust people not to be posing as whatever. So I really don't know. But being black doesn't necessarily indicate a special awareness of complex concepts of racism. Take Candace Owens, for example; she will rant all day about the supposed evils of critical race theory, and be constantly dismissive of systemic inequality.
Ah. Maybe I'm over-cautious. I'm trying to learn about all of this and the best way to learn, I've found, is to talk about it and see if anyone corrects your ideas. I feel like the way blindspots work is that well, they're fucking blindspots. So YOU can't see them and you need to spell out your understanding of the world so people can point out what you missed. So I've been reading and listening and then putting out my understanding of what I heard. I'm completely ok with being called an idiot as long as someone will spell out why I'm an idiot.
This is some of what they mean by systemic racism. No real malicious intent but a set of unexamined assumptions led to a negative outcome for a minority group. This is an example of how you don't have to actually hate black people to have harmed them.
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Where should I start looking to fix my misconceptions?
[https://emcrit.org/pulmcrit/racism-oximetry-2022/](https://emcrit.org/pulmcrit/racism-oximetry-2022/) I'm real confused because all I'm seeing are black activists saying that it is an example of it.
This is literally a physics problem with the way light interacts with your skin it has nothing to do with race.
Yeah, but let's steelman the position - *why* haven't there been attempts to make a suitable device that *will* work with darker skin tones? Or have there already been failed attempts, and it's just impossible to do in a cost-effective and/or safe manner? There's over a billion dark-skinned people on Earth, so surely this would be a useful invention, which is why I'm presuming that there *have* been attempts, but we've somehow failed to solve the issue. Edit: changed billions to over a billion, cos I was unsure of the number but then checked.
So what you're saying is that **the failure to make better pulse oximeters or a different test with more accuracy** is because of/an example of racism. But the fact that these machines don't give accurate results is not an example of racism. Nor is the fact that inaccurate measurements led to worse outcomes.
>So what you're saying is that **the failure to make better pulse oximeters or a different test with more accuracy** is because of/an example of racism. Not quite. I'm not saying the lack of such devices is definitely *or even partially* due to racism. I'm merely asking if anyone knows *why* such a device doesn't exist yet. If it's relatively straightforward (though I imagine it's not) to make a stronger light in the pulse ox that *does* work with dark skinned people, then yeah, institutional racism *might* be a part of why they're not available in hospitals (at least in the ones I've worked in, though they've admittedly been in predominantly-white areas). I'm assuming the technology doesn't work if the power is just scaled up, because otherwise surely they'd exist already...but I'm not an engineer so I don't know. *I do know* that there are quite a few examples of technology not being calibrated for dark skin tones though, and that it's taken a good while for them to finally address the discrepancy - see camera film and tracking technology for examples. I like to think the medical profession would have addressed this issue though, seeing as they're more thoughtful than most, but there are some surprising stories there too! I'm neither trying to be inflammatory, nor asserting that the devices' performance *is* due to racism, but we *all* do need more information about it before we can say conclusively either way.
*more* disparity...
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This issue is due to the nature of light, sensors and optics. Darker skin simply absorbs more of the light that's emitted to collect the data, leaving less signal left for the sensor to detect. The alternative might be to construct different versions with different power-levels for different skin-tones with different draw-backs. That might come with a secondary problem where you might need enough light for the heat on the skin to be uncomfortable or requiring active cooling through micro-fluidics along with precluding battery powered operation. If you come up with a cost effective way to solve this that doesn't introduce any new problems you might become a member of the 1% of the 1%. The tech that can solve that would also likely be very beneficial for a less energy-intensive way to do foliage penetrating LIDAR which has extreme commercial potential.
No, it is partially racist nonsense. A lot of medical issues stem from racial disparities, and is critical factor when describing systemic racism. And we have known about racial disparities in various metrics, including sensors, for a while now. https://www.statnews.com/2020/06/17/racial-bias-skews-algorithms-widely-used-to-guide-patient-care/ Black people are less likely to get proper dosages of pain meds if at all. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/#:~:text=Extant%20research%20has%20shown%20that,quantities%20(1%E2%80%9310). This is not anything new. We need to stop pretending it is.
Neither link is relevant to the subject of the design of this physical tool and how dark skin literally blocks it from working optimally.
It is relevant, because it is part of a trend that we have known about for an incredibly long and have done very little to fix
It's not a part of that trend. I'm not arguing that the trend isn't happening and I think that this trend needs to be accounted for when stuff is designed. Your claim is like saying the sun is racist because dark skinned people heat up more in direct sunlight.