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DEI and Technology: Something You May Have Missed But Should Think About Richard E. Burney, MD
Equity across all parts of society is a hot topic these days, with equity in health care front and center in the debate, which rages because no one has the answer on how to correct our current problems. I recently ran across an article by Shobita Parthasarathy, University of Michigan Professor of Public Policy and director of the Science, Technology, and Public Policy Program at U of M that I found innovative and worth your attention. The article appears in the Winter 2022 issue of Issues in Science and Technology, a publication of the National Academies of Sciences, Engineering, and Medicine (v. XXXVIII, No. 2, pp30-36)
In her essay, Dr. Parthasarathy posits that “today’s health innovation system doesn’t’ benefit everyone equally. To change it we need to think differently about expertise, innovation, and systems for ensuring access to crucial technologies.” In other words, there is implicit bias in our research endeavors that are reflected in machine learning algorithms and other technologies that unless recognized and corrected will serve only to perpetuate the current inequities. If you look up her bibliography, you will see that she knows whereof
she speaks.
If you think for a moment about most of the innovations in medical care, you will recognize that they are in diagnostic tools, devices, medicines, and treatments that are increasingly sophisticated and increasingly expensive, so much so that they are inaccessible or unaffordable for many. Why is this so? Because our system of rewarding innovation focuses on “scientific and economic output.” Innovations related to health care are accompanied by innovations that enable their equitable application. Drug company patents enable monopolies that can charge exorbitant prices, even though the drug may have been developed with government money.
I didn’t know this, but the Bayh-Dole Act of 1980, which allows universities to commercialize inventions developed with federal support through patents and licensure, also enables those federal agencies to “march in” and inter- vene if those patents and licenses are not serving the public interest. This has never happened. As a result, innovation and health care equity remain disconnected.
It is easier to focus on molecules than on social dispari- ties. Consider asthma, which is increasing in incidence in
urban environments. Government sponsored research has focused on genetic and biologic mechanisms to the exclusion of environmental and socioeconomic causes. Focus on the latter does not lead to commercializable products, such as drugs.
You may have read about research done by a U of M surgical resident, Dr. Valeria Valbuena, who pointed out that the most commonly used pulse oximeter is inaccu- rate in patients with darker skin. How this came about is explained by Dr. Parthasarathy as an example of bias inherent in the marketplace. In its original research on pulse oximetry, Hewlett-Packard tested its device on patients with a variety of skin tones to assure accuracy, but then decided to abandon this area of biotech. A new biotech firm patented a device that was tested only on light-skinned individuals, and once patented and ap- proved by the FDA rejected requests for information regarding accuracy in others. The FDA, with its narrow focus on safety and efficacy rather than on utility across populations, did not object. Neither did the Patent and Trademark Office, which as a matter of policy determines only whether the new technology is an “invention” under the law. (I have to question the FDA’s focus on efficacy because I know of innumerable presumably safe but useless or even dangerous devices that have been approved under lax regulations.)
The Bottom Line
The bottom line is that little consideration of the public interest or equity is found in the current policies guiding development of innovative new technologies in health care. Dr. Parthasarathy goes on to describe examples of public participation in health care policy, including the Healthy Flint Research Coordinating Center, which vets research proposals related to the Flint Water Crisis to be sure they take community concerns into account.
I found Dr. Parthasarathy’s essay eye-opening and provocative. You can find it easily on-line at issues.org where you can also find many other interesting and informative articles on matters of public interest published quarterly by the National Academies of Sciences, En•gi- neering, and Medicine and Arizona State University.
Volume 74 • Number 1 Washtenaw County Medical Society BULLETIN 27