Racial biases in medical training, research, and technology
Dr. Neil Singh, author of the recent article 'Decolonizing Dermatology,' discusses the inherent risk of viewing type I as the default skin colour (600 words, 3.5 minutes)
Racial biases in medical training and research run deeper than some may think, according to Dr. Neil Singh, a primary care physician based in Brighton, UK. It is not as simple as textbooks and research papers that do not include darker skin types; these biases are built into the technology that is used to capture photos and the algorithms that will power software used to train the next generation of dermatologists. Dr. Singh explained his views in a recent article published by The Guardian newspaper. During an interview with Skin Spectrum Weekly, Dr. Singh spoke about the article, “Decolonizing Dermatology: why black and brown skin need better treatment”, and discussed the dangers of medical professionals viewing white as the default skin colour.
Dr. Singh described his thought process while writing the article.
“There was this particular case, which I mentioned in the article, where I was left feeling undereducated and stumped by my ignorance,” he said.
He said that while there are plenty of doctors, including himself, who do not know enough about the inherent biases in medical training, textbooks and research, he wanted to also communicate the issue to a broader public.
“I saw this topic as something that bridged those worlds,” Dr. Singh said. “I hope there is something [in the article] for so-called experts, but generally it was for a much broader audience, for people who would not have thought about skin and the sort of non-deliberate, but structural violence of racism in medicine.”
In response to Dr. Singh’s article, an international group of five dermatologists penned a rebuttal, also published online by The Guardian newspaper. In their response, the group pointed to textbooks and conferences that specifically focus on a wide spectrum of skin types saying: “While we acknowledge that further work needs to be done to ensure that the diverse spectrum of human phenotypes and genotypes are encompassed in our specialty, it is also important that the tremendous amount of work that has already been done in relation to this issue is not neglected.
In his article, Dr. Singh acknowledges a history of activism and discusses the history of dermatologists of colour who have set up specialist clinics and written dedicated textbooks on the topic. But he also said that medical schools and medical programs might have a hard time adequately addressing these issues quickly.
“There are some things that medical schools can do, although they are slightly limited,” he said. “I say limited because until all the textbooks that they use and the websites and the repositories have inclusive pictures until the cameras used to take pictures of rashes are also not biased, there is a limited amount that we can do,” said Dr. Singh.
What can be done includes putting students and doctors in contact with a diverse array of examples of how a rash is presented in all kinds of skin, not necessarily just dark Black skin, but all shades.
“That is good because generally and subconsciously, it de-centres whiteness, but also—from a concrete medical perspective—it takes a patient who would have been misunderstood and misdiagnosed and allows doctors who see those images to make the right call and serve them better.”
As Dr. Singh mentioned, he sees the issue as much deeper than just including more photos in textbooks. Cameras and other medical technology have been built with the inherent biases of the builders, he said.
“Film that we have been using and the standards that we use were never meant to pick up dark skin accurately.”
Other medical devices such as pulse oximeters are limited in their ability to properly work on darker skin types too, he said. On darker skin, oxygen levels can be overestimated by as much as 7 per cent, he said.
“That is huge, it is enough to make a difference between somebody being hospitalized or not, or in the case of Covid, having a tube put down their throat or not.”
The issue can’t be addressed quickly enough, although he feels that a tipping point has been met.
“It might just simply be that the proportion of medical students who have skin of colour is growing,” he said. “I think in five years’ time this will be much better, but it is such a deeply-rooted issue that it is going to be tough,” said Dr. Singh.
The takeaway: Though initiatives have been launched to account for the lack of medical training and research inclusive of all skin types, technology such as cameras and software algorithms may be designed with inherent biases toward lighter skin.
What can the dermatology therapeutics industry do to effectively support the values of diversity & inclusiveness? Please click below to provide your opinions:
FROM THE LITERATURE ON RACIAL BIAS IN RESEARCH
Representations of race and skin tone in medical textbook imagery
In an analysis of 4,146 images from several medical textbooks, researchers found a disproportional amount of imagery of skin of colour compared to population demographics in the U.S. Investigators also found a complete lack of images of dark skin tone for some cancers common in people with skin of colour.
Absence of images of skin of colour in publications of COVID‐19 skin manifestations
In conducting a systematic literature review of research articles on Covid-19-related skin manifestations published between Dec. 31, 2019, and May 3, 2020, researchers found that 92 per cent of images depicted skin types I-III, only 6 per cent of images depicted patients with skin type IV and there were no images of skin types V or VI.
Racial disparities in melanoma survival
A large study of 96,953 patients found evidence that though cutaneous melanoma affects people with white skin at a higher rate, survival rates for people with non-white skin were much lower.
VIDEO: Canadian and American medical associations release statements on racial injustice
AT THE INTERSECTION OF SKIN & SOCIETY
In a recent article published by Allure (Aug. 14, 2020), dermatologists, experts, and patients describe their experiences treating and living with vitiligo. Brands such as Sports Illustrated, CoverGirl, and Barbie have all recently featured models with the skin condition, which is described as often misunderstood. Symptoms, causes, and treatments are also discussed. Read the full article here.
THIS WEEK
September is Acne Awareness Month
Wednesday, Sept. 9-Sept. 12 Association for Academic Psychiatry (AAP) Annual Meeting 2020
Thursday, Sept. 10-12 Canadian Association of Paediatric Surgeons (CAPS) 2020 Annual Meeting
Something to think about during the week ahead:
NEXT WEEK
A presentation by Dr. Marissa Joseph on how skin ageing differs among races. Subscribe to Skin Spectrum Weekly and have each issue sent directly to your phone or inbox.
Don’t forget to register now for the Skin Spectrum Summit 2020 Webinar Series, beginning October 1, 2020. Sign up here