BMA Calls for Wide Review into Racial Bias in Healthcare

Peter Russell

November 22, 2021

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 were equally effective regardless of a patient's ethnicity.

England's Health Secretary Sajid Javid commissioned the review after research showed that pulse oximeters could 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 the inquiry should go further and investigate racial bias in other areas, including medical training.

Tackling Health Disparities

The Department of Health and Social Care (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 would be launched "shortly," with initial findings expected in late January 2022

The DHSC acknowledged that while current UK regulations set out clear expectations, they did not currently include provisions to ensure that medical devices were equally effective regardless of demographic factors, such as ethnicity.

A letter  published in The New England Journal of Medicine last year suggested that Black patients could have almost three times the frequency of occult  hypoxemia as White patients because it was 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 could lead to delays in receiving medical care and inadequate supplemental oxygen therapy being provided in

hospital settings.

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, according to an April 2021 paper in The Lancet.

Poorer Health Outcomes 'Unacceptable'

Writing in The Times on Sunday, 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.

Meanwhile, Mr Javid said he was working with his US counterpart, Xavier Beccerra, 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 needed 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 socio-economic 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 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."

Disclosure: Peter Russell has disclosed no relevant financial relationships.

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