Earlier this month, thought leaders in technology assembled for a public event on “diversity in STEM,” underscoring the importance of a talented, diverse workforce across science, technology, engineering, and math (STEM) fields. But they overlooked a critical element: STEM is literally a matter of life and death.
Indeed, that same day, a panel of the U.S. Food and Drug Administration met virtually and discussed how pulse oximeters, a fingertip device that estimates blood oxygen levels, must be improved because of “ongoing concerns that pulse oximeters may be less accurate in individuals with darker skin pigmentations,” as acknowledged in a statement issued days later.
In the panel of the Anesthesiology and Respiratory Therapy Devices Panel of the Medical Devices Advisory, Dr. Jeff Shuren, director of the FDA’s Center for Devices and Radiological Health, spoke about a “potential bias,” in pulse oximeters “due to skin pigmentation, potentially putting patients with darker skin pigmentation at risk in delays in treatment and worse patient outcomes.”
He called the concerns an issue of “great public health importance.”
In other words certain innovations work fine for White people, but Black and Brown men, women and children may actually be endangered by inaccurate readings.
Take for example, the growing recognition that racism is deeply embedded in clinical algorithms that clinicians use in assessing everything from kidney functions to determining pain thresholds. One of the leading drivers of reform is a Black physician, Dr. Michelle Morse, who is now deputy commissioner and chief medical officer at the New York City Department of Health, and leading a Coalition to End Racism in Clinical Algorithm.
It’s clear that racism in medicine contributes to the larger issue of inequities in communities of color and the social determinants of health, which dimmish the quality of life for many Black families, sending men, women and children to premature deaths.
“The travesty of life expectancies varying by 20 -30 years based on zip codes a few miles apart is inexcusable,” says Dr. Eric Griggs, Assistant VP of Community Medicine for Access Health Louisiana. “The umbrella of equitable health includes access to healthcare, digital literacy, food security, safety, health education, health literacy and overall health stability of the communities in which we live… all communities have a right to live their healthiest lives…ALL communities…everywhere. “
With medical technology and innovations, the stakes go beyond race. Not long ago, because women were historically excluded from car manufacturing design and test processes, female seat-belted drivers had a 47% higher chance of injury than male belted drivers in similar crashes. This sobering statistic is a result of women being excluded from both the car manufacturing design and test processes. Back in 2014, Apple’s iOS team launched a health app that excluded women’s menstruation cycles.
I’ve watched the debate over pulse oximeters unfold over the last two years, as an educator, former mechanical engineer professor and founder of STEM Global Action, a nonprofit based in New Orleans, LA., dedicated to advancing youth from low-income, low resource communities in STEM. In December 2020 during the midst of the Covid pandemic, physicians at the University of Michigan Medical School first raised concerns about oximeters with a letter to the editor to The New England Journal of Medicine, headlined, “Racial Bias in Pulse Oximetry Measurement.”
“Oxygen is among the most frequently administered medical therapies, with a level that is commonly adjusted according to the reading on a pulse oximeter that measures patients’ oxygen saturation,” the Michigan physicians wrote. “Questions about pulse oximeter technology have been raised, given its original development in populations that were not racially diverse…in two large cohorts, Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients. Given the widespread use of pulse oximetry for medical decision making, these findings have some major implications, especially during the current coronavirus disease (Covid-19) pandemic. Our results suggest that reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia.”
Two years later, the experts are still talking about this problem, and not doing enough about it, and other applications, that are biased against Black & Brown people.
At SGA, we have an answer.
With hands-on activities, SGA affiliates bring STEM activities to communities in Ne
w Orleans and throughout the country. Our K-12 students learn coding, Newton laws, higher-level mathematics, robotics, and other STEM fundamentals. There is a clear path to eliminating racial inequities throughout medicine and science: getting more students of color into the jobs and careers that design and evaluate health devices, practices and standards.
Our formula works. With SGA partners from the private sector and academia, we host “STEM Saturday” events around the country that engage Black & Brown children in a broad range of STEM activities, building their interest in STEM, creating a pipeline to STEM careers, and using young professionals and college interns to serve as mentors. It is so important that our children see people like them as doctors, scientists and engineers.
In the last three weeks alone, we hosted a STEM Saturday in New Orleans where, in partnership with Ochsner Health System, our event helped children learn about their heart and circulatory system. More than 150 K-12 students dissected sheep hearts, were exposed to technology with model hearts being printed on a 3-D printer, experienced the inside of the heart and circulatory system through virtual reality and left with their own mechanical heart that they built. Professionals from Ochsner worked with students along with more than 75 medical students from Tulane University and LSU, as well as undergraduates from local colleges. The same Heart STEM Saturday event was hosted in Gulfport, MS engaging over 150 K-12 students, parents and volunteers
But our initiatives, and other like them, face a growing problem. There is a dire need to scale them, but a shocking “lack of diversity” and inclusion exists in funding the innovations that will shape the future.
Over the last two years, CARES Act funding has allowed thousands of young students to participate in STEM programs. But our concern is that not enough of this funding goes to organizations like our SGA affiliates and community-based nonprofits, which have developed successful ways to engage children from under-resourced communities in STEM. One must experience the joy and wonderment at our STEM events to grasp their impact. Instead, the overwhelming amount of funding goes to white-led entities that may have good intentions, but lack the experience in shaping programs that work.
Why does improving representation in STEM matter? It matters because women and people of color can help find solutions for the inequities and biases expressed – and hopefully eliminate them in scientific research and healthcare.
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