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Appreciate this deep dive. Worth adding that there is a detectable bit of extra mortality and morbidity with fingertip pulse oximeters when testing darker-skinned folks. The devices usually face the same issue as smartwatches. This interferes with timely treatment for acute and chronic symptoms of COVID and other conditions which cause lowered blood oxygen concentrations.

Supposedly the tech was out there to solve it, but it was expensive enough that medtech manufacturers hadn’t ever bothered making compatible devices at a scale to serve most patients or consumers.

Tldr: this specific issue is more physics than racism. Plus there's more!

I presume op knows this, but others may want to look up WEIRD as an acronym.

It's actually both simpler and more complex than that, and it's less of an underrepresentation issue. It's not that that isn't an issue. Repesentation is just less of the cause of the problem in this context than you think.

It's also very much not explicit discrimination. The people who do this type of work are overwhelmingly anti racist. There's also plenty of dark skinned people amongst them. Most engineers are white males and Asians. That's an issue as well, but for another time.

First of all, they don't mention that this only applies to optical imaging. CT, ultrasound, MR, PET, etc. are not affected by skin tone (that's an ultrasound in the image, btw).

There are representation issues in medical testing. Not just purely racial ones as well. For example, most psychological studies are done with white women of college age. That's because the only people they can get to participate in such studies are psychology students who are overwhelmingly white women. Then there's the issue that you can't really experiment on children at all. That's WEIRD.

These are all well known and studied issues. They just don't have easy solutions.

The problem here isn't mostly representation. It's physics.

In order to image someone optically, you need to reflect light (or have something that emits light). Dark skin absorbs more and reflects less light than light skin. That is the purpose of dark skin.

No matter what we do, or how hard we try, optical imaging will never work as well on dark skinned people as light skinned people.

There's way more issues, too.

You can't just collect people based on skin color. Medical testing is extremely sensitive and difficult. You can't pay people too much. You can't pay people too little. Like the psychology issue, there are plenty of studies that are conducted on strange populations.

My brain is in several publicly available databases and papers and such. I get rooked into it because colleagues need subjects when I was in grad school. These studies are full of two kinds of people, grad students in the sciences, professors, their children, and people for whom a trivial amount of money is worth their time. That's not a cross section, and it's not really solvable.

You're correct that, in principle, you could collect people on quantitative skin color metrics for optical imaging. Other issues need a more complex understanding of race.

Now what is race? People say it's a social construct, but that's not scientifically correct. Race is a collection of phenotypes that helped our ancestors survive. It can be quantified. At the very least, genetically.

That's scientific racism. That's what the Nazis did. Granted, it's being done for anti racist purposes, but still, it's ugly.

So, I want to conduct a study that's DEI. How do I know I have proper representation? The terms Asian, black, Latino, and white are so huge and diverse that they are useless for this purpose.

What do I do?

Anyway, I could go on, but I'll stop after one last thing. The FDA is considering making DEI mandatory. That won't really solve the problem, though.

Edit: typos