When I lived in Philadelphia, I had an allergist who often gave me lung function tests to assess my asthma difficulties. test ever registered as normal, even when I was obviously sick, and in fact sometimes came out above average, which she said was strange for an asthmatic. I’ve always hated proving that I have a chronic illness and feel anxious whenever I have to go to the doctor for a flare-up, worried that I’ll be told it’s not that bad or that I’m fine. I put off medical care at times just to avoid suspicious looks from providers.

Spirometry measures how well a person’s lungs are working.

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A pulmonary function test, also called spirometry, measures how well a person’s lungs are working. By having the patient breathe into a device that records the amount and speed of air they breathe in and out, doctors can assess conditions such as asthma, chronic obstructive pulmonary disease (COPD), and other breathing problems.

For decades, lung health tests used different “normal” standards based on race, resulting in different treatments for black patients like me. As it turns out, these tests classify lung function differently for black and white people, often causing black patients to be underdiagnosed or undertreated.

White fists on the lungs of healthcare: new research

A breakthrough study by Diao and colleaguespublished this year in The New England Journal of Medicine, showed that race-adjusted gold standard equations for pulmonary function tests underestimate the severity of lung problems in black patients and overestimate the severity of lung problems in white patients, reinforcing health care disparities . These race-based calculations normalize low lung function for people of color, making them appear healthier than they are. In contrast, outcomes for white people are based on more sensitive classifications, leading to better access to care, support and benefits for people with disabilities.

For people of color, the estimated normal values ​​are adjusted to be about 10-15% lower than for people of color, which can cause health care providers to miss signs of lung diseases such as asthma, fibrosis cystic or COPD for people of color.

Eighteenth-Century Racism: Alive and Kicking

This race-based system was based on false notions that black people had naturally deficient lungs. Thomas Jefferson, in his 1785 Notes on the State of Virginia, described what he believed to be a difference in the lungs of enslaved people compared to white settlers, stating that the “difference in structure in the pulmonary apparatus” was a justification for slavery, arguing that forced labor would “vitalize the blood” of black slaves.

Jefferson’s claim was built upon by other researchers, including Samuel Cartwright, the physician who coined the term “drapetomania,” and John Hutchinson, an English scientist who invented the spirometer. By the early 20th century, the idea that there were racial differences in lung capacity was widely accepted as fact.

However, there is no legitimate physiological or genetic justification for why there would be innate racial differences in lung function, so this idea is scientifically unwarranted. Rather, it is a harmful and false medical stereotype that has led to incorrect clinical assessments that impact millions of people, including children (Non et al., 2023).

Black children suffer double the rate of asthma

About 4 million children in the US suffer from asthma. The percentage of black children with asthma is much higher than that of white children – more than 12% of black children in America have the disease, compared to 5.5% of white children. They also die at an astonishingly higher rate, with Black children 8 times more likely to perish from asthma.

In addition, struggling to breathe can be a cause of mental health problems such as depression and anxiety. Adolescents with asthma have a significantly increased risk of developing panic disorder (Wu et al., 2022), and a European study found that those with asthma were significantly more likely to suffer suicide suicidal ideation and attempts than those without—an association that persisted across age groups, even when controlling for demographics, socioeconomic status, mental health, smokingand stressful life events (Barker et al., 2015).

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Income disparities, access to care, and housing have all been implicated as reasons for this health disparity, but the impact of biased medical testing on disparities may be a bigger part of the problem than anyone realizes.

Blood oxygen miscalculated in black patients

It is not only historical notions that cause diagnostic problems. Racism it is systemic. As such, many times health care equipment is simply not designed with people of color in mind. For example, a recent study found that pulse oximeters systematically overestimate blood oxygenation levels in black patients compared to white patients (Sudat et al., 2023). Even though black patients’ blood oxygen was overestimated by just one percent, this translates into real differences in care—for example, this difference led to delays of more than four hours in receiving supplemental oxygen during COVID 19 pandemic.

We wonder if these devices were even tested on black people before they were shipped to doctor’s offices and hospitals. The study authors pointed out that differential pulse oximeter accuracy has the potential to exacerbate racial disparities for any condition, such as asthma, that relies on blood oxygenation to inform the clinic. decision making.

Racial bias in medical technology harms people of color

Originally intended to improve accuracy, race-based adjustments in spirometry have instead had detrimental effects on patients’ health, job opportunities, and financial stability. Experts are now calling for “race-neutral” tests to help end these injustices, stressing the need to change a system based on outdated and biased ideas. By justifying biased standards as medically necessary, the system perpetuated racist practices rooted in false beliefs of racial differences in lung function dating back to eighteenth-century assumptions. Diao’s study underscores the importance of overhauling medical practices and technologies that have disadvantaged black patients for decades.

Improving biased healthcare technology is not just a technical fix, but an urgent step toward justice and the elimination of fatal medical biases. There is a moral responsibility to eliminate unexamined racist practices to ensure fair and equal care for everyone. It is also a shocking reminder that when we are too quick to accept practices based on racial stereotypes, we are compromising the health and well-being of vulnerable people, including our children.