The Trump administration’s attacks on diversity, equity and inclusion programs threaten to derail efforts to fix racial disparities associated with pulse oximeters — just as the federal government was finally making headway on the matter.
“We are very concerned,” said Dr. Michael Lipnick, an anesthesiologist at the University of California, San Francisco, whose work is dedicated to resolving how pulse oximeters perform on a variety of skin tones. “We’ve been trying to figure out where the money is going to come from next.”
Eighty percent of Lipnick’s research funding has typically come from federal health agencies, such as the Food and Drug Administration and the U.S. Agency for International Development (USAID).
The future of that money is now in question. Just hours after he was sworn in for a second term last week, President Donald Trump issued an executive order banning DEI initiatives. While that order primarily focused on ways in which employees are hired, there is concern about spillover into pulse oximeter studies intended to expand the number of participants with darker skin tones.
That is, how can researchers seek out people of color to fill gaps in research while adhering to new directives to stop focusing on race?
Recent directives to halt scientific communications from federal health agencies have frustrated federal health scientists seeking clarity on whether they’d be able to continue research. A request for comment from the Department of Health and Human Services, which oversees all federal health agencies, was not immediately answered.
“I have spent probably 25 hours in the last week talking with my colleagues as we try to understand what these poorly written, obviously immoral and probably unlawful orders will actually mean,” said Dr. Theodore Iwashyna, a critical care physician and professor at the Johns Hopkins Bloomberg School of Public Health.
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Iwashyna co-authored an influential 2020 study showing how pulse oximeters don’t work as intended in Black patients.
He described the anti-DEI initiatives as “an attack on the scientists who are most likely to do work to ensure pulse oximeters work better for everyone.”
Pulse oximeters are commonly used during routine checkups, seeking out oxygen-rich blood by shining a light through the fingertip. That light, however, also absorbs skin pigment. The more pigment a person has, the healthier they seem to be, often leading to faulty pulse oximeter readings in people with darker skin.
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While the racial disparities of pulse oximeters have been known for decades, in-depth research into the disparities reignited during the Covid pandemic.
The FDA appears to be focused on finalizing guidelines for pulse oximeter manufacturers to address the issue. Earlier this month, the FDA issued draft guidance for manufacturers to drastically expand the skin tone varieties when testing their devices and demonstrate how they work equally for all skin pigments.
Not all research on racial disparities of pulse oximeters is threatened. Dr. Andrew Goodwin at the Medical University of South Carolina is leading a massive effort to analyze possible racial differences in pulse oximetry readings in hospitalized patients.
Goodwin’s work is expected to continue because it’s secured private funding from one of the biggest pulse oximeter manufacturers, Masimo.
His research team has recruited nearly 200 patients so far. “We have a really robust distribution across skin pigment thus far in our preliminary data set,” Goodwin said. Results aren’t expected for several more years.
The future of Lipnick’s research, however, is unclear, even as he’s moved his family from San Francisco to Kampala, Uganda, to set up a pulse oximetry lab to explore how pulse oximeters work on darker skin tones.
His team has just begun applying for new federal funding.
“Right now, we’re broke,” he said. “Everybody at the intersection of health equity is like, ‘What is about to happen?’”
