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Short abstract:

This paper shows that there has been wide variation in how researchers have studied the impacts of skin tone on pulse oximeter accuracy, which has not only contributed to debate in this area but also contributed to the construction of race in and through biomedicine.

Long abstract:

Pulse oximeters are small devices commonly used in clinical contexts to assess patients’ blood oxygen levels. Developed in the early 1970s, finger pulse oximeters work by shining light through the fingertip to establish the oxygen content of arterial blood. Because of the way pulse oximeters use light to determine blood oxygen levels, the scientists who developed these devices assumed that measurements were not affected by factors such as subcutaneous fat, skin thickness, or skin tone. However, by the late-1980s, these assumptions were questioned, especially those related to skin tone. Dozens of studies were carried out by investigators across the United States and elsewhere which showed that finger pulse oximeters modestly overestimated the blood oxygen levels of patients with darker skin tones, an important finding that has implications for medical care. Over the past few years, and because of the COVID-19 pandemic, the accuracy of pulse oximeters has attracted renewed attention, with several leading scientists arguing that the flaws in the devices are an example of systemic racism in healthcare. This paper analyzes the science on which claims about pulse oximeter accuracy, particularly with respect to skin tone, are based. We show that there has been wide variation in how researchers have studied the impacts of skin tone on pulse oximeter accuracy, which has not only contributed to debate in this area but also contributed to the construction of race in and through biomedicine.