Calls for a full appraisal of racial bias in the health service follow a Government review into whether medical devices are equally effective regardless of ethnicity

ICU bed

The British Medical Association (BMA) has called for a wide-ranging appraisal of racial bias throughout the health system after the Government ordered a review to look into whether medical devices are equally effective regardless of a patient’s ethnicity.

England’s Health Secretary Sajid Javid commissioned the review after research showed that pulse oximeters can be less accurate when used on people with darker skin. He said that racial bias in a medical instrument cannot be acceptable at any level’.

However, the BMA said that the inquiry should go further and investigate racial bias in other areas, including medical training.

Tackling health disparities 

The DHSC has promised:

  • an independent review to examine potential bias in items like oxygen measuring devices, and the impact on patients from different ethnic groups
  • to drive forward new international standards to improve healthcare and tackle disparities
  • that a rapid review will be launched ‘shortly’, with initial findings expected in late January 2022.

The DHSC acknowledged that, although current UK regulations set out clear expectations, they do not at present include provisions to ensure that medical devices are equally effective regardless of demographic factors, such as ethnicity.

letter published in the New England Journal of Medicine last year suggested that Black patients may have almost three times the frequency of occult hypoxemia as White patients because the condition is not detected as often by pulse oximetry.

A March 2021 report published by the NHS Race and Health Observatory warned that inaccuracies in pulse oximeter readings can lead to delays in receiving medical care and inadequate supplemental oxygen therapy being provided in hospital settings.

According to an April 2021 paper published in The Lancet, an analysis of data from Public Health England suggested that mortality from COVID-19 among people from minority ethnic groups was two to four times greater than among the White population in England.

Poorer health outcomes ‘unacceptable’ 

Writing in The Times on 20 November 2021, Mr Javid said: ‘At the height of the COVID peak last winter, Black, Asian, and other minority ethnic groups made up 28% of critical-care admissions in England—about double their representation in the population as a whole.’

He added that: ‘One of the founding principles of our NHS is equality, and the possibility that a bias—even an inadvertent one—could lead to a poorer health outcome is totally unacceptable.’

The review will look at all medical devices.

Mr Javid also said that he is working with his US counterpart, Xavier Becerra, on agreeing an international standard for devices used in healthcare.

Call for review of racial bias in medical training 

Responding to the announcement of a review, Dr Chaand Nagpaul, BMA Chair of Council, said: ‘There needs to be a requirement that all research and development of medical devices is based on testing them on people of different ethnicities before production.’

The issue of racial bias in medical education also needs to be addressed, he said. ‘For example, dermatology training is based on showing images of skin conditions only on white skins when they can appear very differently on darker skins. Clinical trials and research often do not have diverse cohorts, which can result in drugs that do not work as well on other ethnicities.’

‘These unacceptable disparities result in health inequalities, which when combined with a range of other socioeconomic factors, severely disadvantage large numbers of people in our community.’

The NHS Race and Health Observatory welcomed the review of medical devices. Its director, Dr Habib Naqvi, said that it had ‘commissioned work to look into other ethnic health inequalities around data and maternal outcomes’, and had ‘recently announced focused work looking into inequalities in sickle cell disease’.

This article originally appeared on Medscape, part of the Medscape Professional Network.

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