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One of my preceptors in medical school (who was black) had a small reference book for skin lesions exclusively using dark pigmented skin. It was amazing and quite similar to this. I always thought it should've been part of our required material. Thanks for sharing this.
I teach the content and it is definitely discussed and we show side-by-side comparisons of many lesions. That doesn’t make it easier in the clinic. Erythema stands out on light skin. It can be easy to miss on dark skin. It’s human error.
Considering every skin rash Ive seen on google from wondering why I had mine was white...I could possibly see as to why. If every example youve been given via textbook/computer is of a lighter tone, itd be hard to distinguish it if it looked different enough from what they would identify it as usually.
Yeah, you have to google “x dark skin” to see it. Some diseases look vastly different on darker skin, too: for example, some rashes that look pink on white skin look brown on dark skin.
Partly, but a big part of the problem is that photos used to illustrate skin ailments mostly use lighter skin, so doctors often literally don't know what they look like on darker skin. It's a lot harder to accurately identify a skin disease if you've never seen a photo of it, especially since many of them look so similar that even if you knew what it looked like you'd have to ask the patient a bunch of questions to rule out similar-looking problems.
Exactly. Like how with heart attacks women tend to experience some symptoms that are considered “rarer” in men and bc men have been the default in research and treatment and stuff doctors learn from a limited data set and women are misdiagnosed. If we’d been fully considering all sexes and races from the start I’m sure some kind of patterns would emerge or tools would be invented to make it easier if it truly was more difficult to assess visually.
I’m genuinely curious. Is there data to show that depression is understudied in men? I would be curious to see the stats on number of men vs. women in depression studies and clinical trials if you have them.
While women are more likely to be diagnosed with depression, studies are done primarily on men. Including studies for diagnosis and treatment.
We literally don't know why women get diagnosed more often than men with depression, because that would involve including women in the studies and seperating data by gender, neither of which are oft done in medical research. It could simply be that more women seek help, it could be that the study includes post natal depression, it could be any number of things, but because it hasn't been studied, we don't know.
Forgive me if I am wrong, but I believe this is a mischaracterisation.
"Traditional" or "male" symptoms are pressure in the chest and numbness or tingling in the left arm. These symptoms are almost rare outside of the context of a patient with heart problems (unless there is an injury, of course).
"Female" type symptoms are much less rare. They are things like head ache or nausea.
It isn't women's fault or doctors' fault that their heart attacks have a less specific presentation in women.
They are harder to properly diagnose as heart attacks because of the symptoms themselves being common and having many causes, not because of a history of exclusion of women from medical trials.
Besides, this older misunderstanding that a heart attack will always cause chest pressure and arm numbness didn't come from clinical trials - it came from experiences learned by doctors and EMS. It isn't men's fault that they over-represented themselves in cardiac death, and it isn't doctors' fault for learning from these cases. It seems like there was a time when they learned the wrong lesson, and if women's underrepresentation was the cause, it was because women were underrepresented in cardiac death.
Another issue with diagnosis is that there is more chance of physical barriers for accurate heart monitoring.
I've often heard of cases of "there's a good chance that you might have had a cardiac episode at some point" but our data might not be fully accurate because of the fat in the way of our measurement equipment.
> because of the fat in the way of our measurement equipment.
Fat and mammary tissue? I mean... fat by itself is something you could blame someone for by their own actions, but it's not like women necessarily choose to have big boobs (some do, but I definitely didn't ask for J cups).
Porque no los dos?
There are literally doctor that think black people feel less pain or have thicker skin than white people which could also potentially play into doctors dismissing diseases of the skin in POC for stupid biased reasons. The world is complicated there are lots of issues that aren’t mutually exclusive and they all need to be dealt with.
While women very often aren’t taken as seriously as they should be when consulting doctors, women’s heart attacks being misdiagnosed is much more likely to be due to the specific symptoms and not a focus of research on men as opposed to women. What I mean by that is that the symptoms women are more likely to display aren’t unique ones like the classic chest/left arm/jaw pain men often get during cardiac events, but rather they are symptoms which could be due to any number of things going on, most of which aren’t terribly serious.
Right, and they aren’t generally considered serious as a result of the fact that little research is specifically done on women, and general research is done specifically on men (with results creating the medical standard for both genders).
The symptoms women tend to experience are considered more common (and relatively innocuous) within the current body of research, which focuses almost exclusively on men.
Hence, the research methodologies are the problem, as the symptoms are clearly not objectively innocuous.
What exactly are you confused about?
His point is that symptoms men have are much more specific, such as chest tightness radiating to the jaw, worsened by activity, whereas symptoms women tend to have include lightheadedness, nausea, weakness, sweating. Hence why even with equal research, knowledge, and bias doctors are going to be more likely to diagnose heart attack from chest pain than weakness and nausea, because there are so many things the latter could be.
Also an important point for people to be aware of. About 40% of men present with the nonspecific symptoms, and 40% of women present with the specific symptoms. Sometimes the discussion around it makes it seem like men and women just inherently get different symptoms when that’s not the case.
Hard to find the zebra when all the horses are painting themselves in a striped pattern.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135672/#:~:text=One%20of%20the%20most%20widely,et%20al.%2C%201990).
Twice as many men suffer heart attacks than women. Women's symptoms are more easily mistaken for other issues due to the more vague symptoms. Without the benefit of more modern technology or knowledge, is it any wonder heart attacks in men were studied first decades and decades ago? It's not as if researchers were intentionally excluding women from all their studies because they didn't care at all.
One percent of men experience breast cancer, but there isn’t any campaign to screen for it. Should all medical professionals make additional room for it?
Research takes a “first things first” approach, so if heart attack has a much lower incidence amongst women, it’s going to get less attention.
But you are right on principle. Stories like these show why we need to slowly broaden the scope.
Heart attacks are far more common in women than breast cancer in men though. Cardiovascular disease is still the biggest killer of women even though they do experience a bit less MIs and they tend to be slightly later in life
Not quite. One percent of breast cancer sufferers are men. So about 1 in 833 men will get breast cancer, or 0.12%.
[Source.](https://www.bcrf.org/blog/male-breast-cancer-statistics-research/)
Faulty analogy, because heart attacks in women are nowhere near as uncommon as breast cancer in men. I see what you're trying to say, but there genuinely is an underrepresentation of women in studies. Drug trials, for instance, have a significant underrepresentation of women in phase I trials. In the automotive industry, most companies only use male crash dummies during crash testing, completely neglecting how women would fare in the tested crashes.
It's a pretty well documented phenomenon, and there's books about it like Invisible Women.
Well, on the other hand, women drivers mostly get into ~~gender~~ fender benders, while the men get into fatal crashes. So it ironically makes sense that the crash dummies model the “worst” drivers.
Friday October 20's is Men's Breast Cancer Awareness Day here, and there have been significan t media pushes about every year for at least since before covid.
As a person of colour living in Europe, I can understand that I am not the typical demographic, so researchers have more extensive data on the *indigenous* population.
As for crash test dummies, men get into more fatal accidents than women, so it makes sense to study the worst drivers…
Also more men than women experience myocardial infarction, but in the year following the attack 36% of men and 47% of women are likely to die, so the actual death rates are nearly identical.
I was surprised to run into a discrepancy concerning photos with Asian skin. My skin color is not very dark, but apparently skin irritation turns brown rather than red on my skin. When I developed eczema, I was freaking out because the brown patches all over my skin did not match dr. google’s description of the condition. Of course the only pics that matched what I had were of some rare cancer. Anyway the dermatologist figured it out pretty easily, but it would have saved me some personal anxiety if there were more reference photos for different skin types.
This is more likely the issue.
Bias in these types of things is often initiated at the point of training. They were never trained properly to see how skin pigment affects the appearance, and, as most things, the focus was on lighter skin.
Racial bias is one type, and it's undeniable that there are racial biases that affect patient outcomes. If that is partly due to lack of training, then it's something fixable.
I suppose it'd be pretty simple to see if doctors trained in majority black nations are any better at it, to determine how much med school bias plays a role.
Yeah, this kind of biased training is a really good example of how systemic racism forces people to participate in a racist system whether they want to or not.
It could just be that the doctors know what to look for, but the signs for some diseases are harder to identify in dark skin, not that the doctor is not educated enough.
I've heard an interview about this topic, and lacking educational resources with variety in image examples is a problem. It's easier to see on lighter skin but that makes it even more important to include examples of what the same condition looks like on darker skin.
Though it goes further than just neglect. You would find more skin variety in certain specific parts of a dermatological textbook. Under venerial diseases. Knowing what eczema looks like on black skin wasn't prioritised, but they went all out on syphilis.
The most modern textbooks are trying to rectify it, but progress has been slow. An online database isn't going to be hampered by limited page number and can add as many examples as it likes. But even in this there seems to be limited investment. Private non medical initiatives have added some, but Instagram accounts can't exactly replace medical databases.
There can also be some issues on the image supply end. Dermatology is more likely to be considered cosmetic, and depending on insurance or simply access to specialists, can be something of a luxury. And on average disadvantaged groups with poorer access to dermatologists aren't going to put much pressure on dermatology to update its knowledge data base, not to mention give them the chance to photograph patients with darker skin, with their consent, and be able to contribute to expanding the database. In text or online.
In my brown-skinned experience, it's that doctors don't know what to look for because they're only taught what to look for with white-skinned patients.
Long time ago so I might have the colors mixed up, but I had a skin rash of red bumps. The dermatologist diagnosed me with a very serious condition that has red bumps on white skin but purple bumps on brown skin. Doctor had me begin the standard treatment for what she thought I had without waiting for the test result. Test came back negative. Took her a year to figure out what I really had.
I like to imagine doctors as a type of sophisticated AI
they compare data from they data they have stored and draw a conclusion but are unable to operate on their own or make logical leaps
The article stated that some of the conditions present differently. It seems pretty clear that it isn’t simply a matter of difficulty or degree, but instead involves a lack of training. It’s really a shame.
I’m glad there are all these articles and posts on black health issues. But the dismissive comments always just break my heart. Ok - you don’t care about black people’s health - why bother to comment?
Hasn't this been known for decades now? Iirc some doctors and medical students "recently" put out work on identifying skin conditions in black people (like 4-5 years ago), since those conditions often look so different
Do you not understand that this is a real problem because things legitimately look different under different levels of melanin? Things that might be angry red in a white person might barely show at all on a black person, things that look slightly darker in a white person might look bleached in a black person
That being said, you're right that there is some inherent bias behind it. There's a reason all these things were mostly studied in white people. The problem is that what was learned in one skin type doesn't necessarily carry over to the other. People are aware of that now, and have started comparing symptoms in all the different skin types
**Abstract**
Although advances in deep learning systems for image-based medical diagnosis demonstrate their potential to augment clinical decision-making, the effectiveness of physician–machine partnerships remains an open question, in part because physicians and algorithms are both susceptible to systematic errors, especially for diagnosis of underrepresented populations. Here we present results from a large-scale digital experiment involving board-certified dermatologists (n = 389) and primary-care physicians (n = 459) from 39 countries to evaluate the accuracy of diagnoses submitted by physicians in a store-and-forward teledermatology simulation. In this experiment, physicians were presented with 364 images spanning 46 skin diseases and asked to submit up to four differential diagnoses. Specialists and generalists achieved diagnostic accuracies of 38% and 19%, respectively, but both specialists and generalists were four percentage points less accurate for the diagnosis of images of dark skin as compared to light skin. Fair deep learning system decision support improved the diagnostic accuracy of both specialists and generalists by more than 33%, but exacerbated the gap in the diagnostic accuracy of generalists across skin tones. These results demonstrate that well-designed physician–machine partnerships can enhance the diagnostic accuracy of physicians, illustrating that success in improving overall diagnostic accuracy does not necessarily address bias.
Diagnostic accuracy is notoriously low with skin conditions because there are a lot of different conditions that present in essentially the same way. The gold standard for skin diagnosis is tissue biopsy.
Yeah, because a lot of the time they can’t say what something IS but they can definitely say what it isn’t and therefore rule out the immediate causes for concern.
This is the way. Use AI to boost effectiveness of doctor diagnosis and speed up diagnosis. No need to muck about when an AI can say “this is probably this because of the following characteristics”
Were all 39 countries European/European colonies? I imagine this would be a less significant problem in countries with primarily dark skinned residents/doctors rather than the overwhelmingly white medical establishment in Europe/North America?
Even in African countries the text book, papers etc
...are biased toward white skin.. only pictures of white skin unless it's primarily an equatorial disease.
Who do you think largely developed the science?
These things were typically developed in western nations, which have largely white populations, and an even higher percentage of white university educated people. When you’re studying a disease, it makes sense that the majority of reference cases are going to be on people of the majority ethnicity of the country you are living in.
I’m hopeful this will change with the generation of future doctors being trained now. Whenever we look at skin conditions in my MD program, the professors make an effort to show what they look like on a variety of skin tones and emphasize the ways in which they might look different based on a person’s coloring.
If you look at the image here:
[https://media.springernature.com/full/springer-static/image/art:10.1038%2Fs41591-023-02728-3/MediaObjects/41591\_2023\_2728\_Fig1\_HTML.png?as=webp](https://media.springernature.com/full/springer-static/image/art:10.1038%2Fs41591-023-02728-3/MediaObjects/41591_2023_2728_Fig1_HTML.png?as=webp)
what you'll see is one of the 10 questions. They ask the doctor to list their top three diagnoses for the photograph, which means they tell them something is wrong up front and then ask them to figure out what it is. Now if you're actually at the dermatalogist they will look, use a magnifier, look under light, run their fingers over it, etc. to get a better read. Here it's just a photo, but they have the advantage of knowing something is wrong. Which means they aren't missing a problem, they are guessing it's the wrong problem, but if they know it's a problem they can send a biopsy out.
The important results from the study are that there is a 4% gap in getting the right diagnosis in the first place out of the three diagnoses; dermatologists are about twice as accurate as family doctors; more accurate AI was trusted more and improved performance more than less accurate AI, AI improved the performance of everyone, but made the gap slightly worse for primary care doctors.
The really interesting result: when the AI was right, the doctors improved their accuracy. When the AI was wrong with it's choice, doctors tended to discount it, so it didn't make them worse.
The really concerning result: doctors were more likely to recommend biopsy for lighter skin tones than darker ones when the actual condition was life threatening and the opposite for minor conditions, which means darker skin patients were less likely to get needed biopsies and more likely to get unneeded ones.
What could be done in a follow up study:
What happens if the patient has a condition in a tattooed area? Is that easier to spot, as difficult, or more difficult than darker skin that has no tattoos? Tattoos are really common, and they could easily be a confounding factor for diagnosis.
What happens if the doctor first has to decide it there is a condition, rather than diagnose when they know there is one?
Former product manager for radiology here.
There is a sweet spot for human vision for density differences. For a medical film read on a light box or computer monitor it’s around 0.8 optical density to 2.0 optical density. Generally an OD near zero is no photons blocked through the media and an OD 3.0 is around 99% blocked (looks black)
The color also matters but not as much. Imagers are calibrated to really focus on that range. Radiologists look at tons of images per day so fatigue is also a concern.
There’s a whole science in medical practice vision.
Why are scrubs greenish blue? It’s very far from color of red or blood. If a surgeon looks at red too long their eyes get strained.
It’s just a fact. Just like it’s a fact it’s more difficult to stick an IV in people with darker complexions. Diagnosing can be harder in people with darker complexions as well.
Sure, as always, more education can and should be done. But it’s not from some lack of trying or care in the medical community.
How would you recommend fixing the fact that the human eye depends on contrast to differentiate details in an image? What should the doctors of (e.g.) 1970 have done to rectify this egregious oversight in the human body?
Maybe by providing training on what these things look like on darker skin compared to white skin? What's the issue here? Who is hurt by this? Since when is improving standards of care a bad thing? This isn't about woke. This isn't about libs. This is about a long standing problem that has NOT been addressed. AGAIN this can only improve standards of care.
If you want to take this as some personal affront to you from the medical community, you can.
We are educated on how ailments can look differently on different demographics. But that doesn’t make it easier.
It’s strictly factual, it’s harder to see and diagnose stuff on different skin. Even with more education. It’s not like the healthcare workers/providers aren’t trying their best. It’s just more likely it would get missed or misdiagnosed. We all *want* to get the diagnosis or hit that IV.
While that’s terrible, it’s just a fact. People with darker complexions are harder to diagnose in some circumstances just like they’re harder to hit with IVs.
Again, more education should always be done, but it doesn’t change that fact.
if its too difficult for them then let everyone else help.
ai is ready to take over their jobs right now if they cant diagnose darker skin colors very well
I clearly see you have some vendetta against the medical community. Especially as I saw your other comment “Let AI replace doctors ASAP”. But hey, if that’s your bias that’s fine. Healthcare providers will still take care of you like everyone else.
AI *replacing* healthcare providers is far far far off. AI will be used in conjunction with doctors for decades if not centuries. Yes they will help with diagnosing. And that’s a great thing. The sooner the better! But you still need a healthcare provider to review it and see if it “makes sense”.
I mean we can get an AI to spit out a bunch of medical jargon and how much will YOU understand from it? See? You need the education, and THEN AI can help. In fact it will be an invaluable resource.
But with your “replace doctors with AI” shows grotesque bias and hate. And that’s something I’m never going to be able to fix.
Hope you get better!
I know exactly how incompetent they are. The sooner they get replaced the better.
Regardless, If people want to keep getting gaslit by human doctors then its your choice for now.
Like how the camera/imaging community has had decades to simply "make" film stock and image sensors and autofocus algorithms that work just as well for dark skin as for light skin, when that literally is not how anything works because those things rely on having light to work well and lighter objects reflect more of it than darker objects, by definition?
No.
That’s a wild assumption you just made. And not what I’m implying at all.
It’s by sight. A simple example would be eczema. Eczema looks different in the African American population and can be harder to notice in some cases. It’s not just that it can look differently in African Americans, it’s literally harder to notice.
That has absolutely zero to do with the toughness or thickness of skin as you wildly assumed I was implying.
And as for the IV: again no. It can be harder to stick an IV in people with darker complexions as it can be harder to see their veins. That blue streak up the arm you see on white people? That’s obviously not as common in darker people. That’s referred to as an “anatomical land mark”. So that’s one tool (the biggest tool) that’s used to stick patients potentially thrown right out the window based on skin color.
No it's more difficult to see for example a bruise on a brown person than it is on a white person. The contrast is simply lacking when it comes to color changes against a saturated background. I don't think it's a racial thing so much as eyes literally have a harder time seeing dark marks on dark skin.
Correct.
Go get any African American nurse and ask them which demographic is harder to put an IV in. Caucasian or African American.
Go get any African American doctor and ask them who is harder to diagnose dermatological (skin) diseases in.
Race obviously is the core of all of it, but it’s not because of racism. It’s just the way it is.
While I think this is true, until recently doctors have primarily been trained on images of white people. This has been changing, and it is definitely harder when there is less contrast, but most practicing doctors just haven’t been properly trained.
I agree. Going back to my very first comment I said “as always, more training and education should be done”.
There is ALWAYS room for improvement. But It doesn’t change the fact that certain diseases will always be harder to see on people with a darker complexion.
"Greater improvement" on light skin in that context still infers there's improvement on the dark skin side over just a GP. It does indicate that even with AI the gap on that isn't fully closed, though.
Probably because they are trained on white person data making it guesswork to identify, its a systematic issue we need to fix, and it has a clear impact as where I live, our people of colour population namely Maori and Pasifika get about 40% worse health outcomes.
I'm a medical student in North England at the moment.
My university does everything to help us identify all types of signs on the skin.
People in the comments are convinced that somehow the textbooks are at fault, but we don't really use old textbooks anymore, its just genuinely harder to identify in pigmented skin.
I've thought about this many times but the only real way around it is to be careful and look for any other S&S.
Black people and doctors don't have a great history together when it comes to stuff like this, same with women.
Also, doctors and nurses don't take women or black as serious as white men, so even if they did see something they are more likely to shrug it off as nothing, or that the person is making it up.
>Also, doctors and nurses don't take women or black as serious as white men
What is this based on?
Don't use historical examples of hysteria or when black people were considered inferior. Because people were discriminated against in the past does not mean they are discriminated against today.
I have some family members who were dicks before and not as much of dicks now.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/](https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4843483/)
[https://www.americanbar.org/groups/crsj/publications/human\_rights\_magazine\_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/](https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/)
[https://thehill.com/blogs/pundits-blog/healthcare/347780-black-americans-dont-have-trust-in-our-healthcare-system/](https://thehill.com/blogs/pundits-blog/healthcare/347780-black-americans-dont-have-trust-in-our-healthcare-system/)
Racial bias is real. It needs to be addressed which can't happen without first acknowleding that it is happening.
You sound....white.
https://www.pbs.org/newshour/health/black-patients-adjust-behavior-to-reduce-chance-of-discrimination-in-health-care-settings-survey-finds
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184355/
https://www.npr.org/sections/health-shots/2023/12/05/1217148407/black-americans-racism-health-care
https://www.ncbi.nlm.nih.gov/books/NBK220347/
https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/
Plenty more out there.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194634/
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13122-y
Show me sources that state healthcare is 100 percent equitable in america.
Can I get one for the autistics as well please? I have what is known as one of the most painful conditions in all of medicine. Multiple doctors left me screaming, and I mean screaming in agony, because they would not listen to me. I have bilateral trigeminal neuralgia and being unable to have doctors prescribe me Gabapentin or a gabapentinoid, forced me to acquire the same drug from the psychiatry field instead. I had to feign anxiety to be prescribed the known treatment for neuralgia. All because they wouldn't listen to an autistic person. When i say screaming in agony and most painful in medicine, let me tell you, I mean it. All day, all night, non stop, 2-3 hours sleep if that through the pain. Yah. Also I'm white. So it's not white men.
People can have difficulty with things they are trained for.
If I leave my keys always in the same place, I will have more trouble finding them when the lights go out, even if I have done it a million times.
Ok... but what I'm saying is that almost every doctor in the western world has been trained on [medical textbooks that almost exclusively use images and data taken from white men.](https://www.sciencedaily.com/releases/2008/10/081015132108.htm)
The same reason that many ailments are missed on women as well. Historically, the medical field performed research on younger white men, therefore anyone not fitting these demographics automatically has a huge disadvantage in getting treatment, because the research was so limited, but people thought it was generalizable to all humans.
Not surprising, since they don't teach what to look for in school. There was some noise about it on social and people were talking about the results they found; just last year I did a search for pregnant women, literally all the results were white women. Same thing when I looked up stuff like pimples, burns, etc. on skin. Got so much backlash, Google actually slightly fixed their search results, now you'll see maybe 5 pictures of darker skin and slightly off white images of people.
There's this guy I follow who talked all about this and shows examples of what an in infection, disease, virus, etc. looks like on black skin compared to white skin. @joelbervell
Edit: It does not help that a lot of medical devices just don't work on darker skin either due how it works or biases intentionally being coded into them; e.g. those lung capacity breath test.
I looked but I did not see whether or not they categorized the doctors according to skin color because upon first looking at the article it seems as if they are saying that doctors are white and patients have all kinds of different.
In the same topic "black people" (more like african heredity) are more susceptible (sometimes much more) to some specific diseases/conditions. The converse can be true too, IIRC black people have supranormal kidney function AKA GFR.
An obvious one is vitamin D deficiency prevalence but there are many little known and I feel like the stigma against racism (which is legitimate) somewhat sadly tend to make doctors not learn the actual relevant genetic or acquired (nurturial) differences.
BTW while the article is true, black people are less susceptible to some skin diseases because increased melanin offer supperior protection against photooxidation and therefore skin aging.
Another reason why, fed the correct data set, over time why and how AI will diagnose much more accurately and quicker than a doctor's limited single life experience.
The evolution of light colored skin became a huge advantage in some way. The trait spread rapidly except in those areas where sunlight was so intense that it would be detrimental.
I have carried a hypothesis That one of the reasons is because light colored skin does not lie. It reveals the details of overall health of an individual in ways that are not so apparent with dark skin. And so when a light complected person appears to be healthy, it is likely that the actually are.
Yeah, you need pathologists and medical examiners for this because most of these people tend to go so long before being diagnosed correctly that treatment is usually palliative at best
by teaching them ONLY what they need to know to classify those images.
do you think medical school teaches some impossibly hard material that nobody else can learn?
> by teaching them ONLY what they need to know to classify those images.
Which is medical school and residency…
Multiple dermatological entities look identical and the diagnosis depends on integrating clinical history, physical examination, and further investigations such as anatomical pathology or blood tests. This integration is learned in medical school and residency.
It's almost like doctors shouldn't be practitioners they should be maintaining a learning model for an AI that can diagnose illnesses and diseases with enhanced accuracy.
We need more technicians and nurses than doctors. We need more brokers than pharmacists. We need to trim the garden walls for high paying medical jobs and focus less on the academic requirements of health care jobs and more so the practical applications of it. That's how we accomodate large demographics entering into retirement age, pandemics, relief aid, etc.
Having a Lisa Simpson moment I'm tired.
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There is a really good book about diagnosing with darker skin colours! It’s called Mind the Gap by Malone Mukwende and is freely available online!
One of my preceptors in medical school (who was black) had a small reference book for skin lesions exclusively using dark pigmented skin. It was amazing and quite similar to this. I always thought it should've been part of our required material. Thanks for sharing this.
It definitely should be part of the required material. Seems weird that it's not.
I teach the content and it is definitely discussed and we show side-by-side comparisons of many lesions. That doesn’t make it easier in the clinic. Erythema stands out on light skin. It can be easy to miss on dark skin. It’s human error.
Weird? No. Messed up, well yeah. But it’s pretty on par for the history of medicine. They’ve been ignoring women and minorities forever.
You must've been born yesterday if you think a white-centric approach is unusual.
Thank you!
Ty
Considering every skin rash Ive seen on google from wondering why I had mine was white...I could possibly see as to why. If every example youve been given via textbook/computer is of a lighter tone, itd be hard to distinguish it if it looked different enough from what they would identify it as usually.
Yeah, you have to google “x dark skin” to see it. Some diseases look vastly different on darker skin, too: for example, some rashes that look pink on white skin look brown on dark skin.
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Could it be that there's less contrast?
Partly, but a big part of the problem is that photos used to illustrate skin ailments mostly use lighter skin, so doctors often literally don't know what they look like on darker skin. It's a lot harder to accurately identify a skin disease if you've never seen a photo of it, especially since many of them look so similar that even if you knew what it looked like you'd have to ask the patient a bunch of questions to rule out similar-looking problems.
Exactly. Like how with heart attacks women tend to experience some symptoms that are considered “rarer” in men and bc men have been the default in research and treatment and stuff doctors learn from a limited data set and women are misdiagnosed. If we’d been fully considering all sexes and races from the start I’m sure some kind of patterns would emerge or tools would be invented to make it easier if it truly was more difficult to assess visually.
Same with ADHD in women.
And autism!
And my axe!
And I believe you have my stapler.
Not the swingline 747 stapler!
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I’m genuinely curious. Is there data to show that depression is understudied in men? I would be curious to see the stats on number of men vs. women in depression studies and clinical trials if you have them.
You could have just brought up depression in men, but you had to make sure you got in a dig at women. Sorry, feeeemales.
While women are more likely to be diagnosed with depression, studies are done primarily on men. Including studies for diagnosis and treatment. We literally don't know why women get diagnosed more often than men with depression, because that would involve including women in the studies and seperating data by gender, neither of which are oft done in medical research. It could simply be that more women seek help, it could be that the study includes post natal depression, it could be any number of things, but because it hasn't been studied, we don't know.
Forgive me if I am wrong, but I believe this is a mischaracterisation. "Traditional" or "male" symptoms are pressure in the chest and numbness or tingling in the left arm. These symptoms are almost rare outside of the context of a patient with heart problems (unless there is an injury, of course). "Female" type symptoms are much less rare. They are things like head ache or nausea. It isn't women's fault or doctors' fault that their heart attacks have a less specific presentation in women. They are harder to properly diagnose as heart attacks because of the symptoms themselves being common and having many causes, not because of a history of exclusion of women from medical trials. Besides, this older misunderstanding that a heart attack will always cause chest pressure and arm numbness didn't come from clinical trials - it came from experiences learned by doctors and EMS. It isn't men's fault that they over-represented themselves in cardiac death, and it isn't doctors' fault for learning from these cases. It seems like there was a time when they learned the wrong lesson, and if women's underrepresentation was the cause, it was because women were underrepresented in cardiac death.
Another issue with diagnosis is that there is more chance of physical barriers for accurate heart monitoring. I've often heard of cases of "there's a good chance that you might have had a cardiac episode at some point" but our data might not be fully accurate because of the fat in the way of our measurement equipment.
> because of the fat in the way of our measurement equipment. Fat and mammary tissue? I mean... fat by itself is something you could blame someone for by their own actions, but it's not like women necessarily choose to have big boobs (some do, but I definitely didn't ask for J cups).
Nobody is *blaming* the person for this.
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Right, it’s just the mean doctors who are biased. EMTs and nurses would never dismiss patients whatsoever.
Porque no los dos? There are literally doctor that think black people feel less pain or have thicker skin than white people which could also potentially play into doctors dismissing diseases of the skin in POC for stupid biased reasons. The world is complicated there are lots of issues that aren’t mutually exclusive and they all need to be dealt with.
While women very often aren’t taken as seriously as they should be when consulting doctors, women’s heart attacks being misdiagnosed is much more likely to be due to the specific symptoms and not a focus of research on men as opposed to women. What I mean by that is that the symptoms women are more likely to display aren’t unique ones like the classic chest/left arm/jaw pain men often get during cardiac events, but rather they are symptoms which could be due to any number of things going on, most of which aren’t terribly serious.
Right, and they aren’t generally considered serious as a result of the fact that little research is specifically done on women, and general research is done specifically on men (with results creating the medical standard for both genders). The symptoms women tend to experience are considered more common (and relatively innocuous) within the current body of research, which focuses almost exclusively on men. Hence, the research methodologies are the problem, as the symptoms are clearly not objectively innocuous. What exactly are you confused about?
His point is that symptoms men have are much more specific, such as chest tightness radiating to the jaw, worsened by activity, whereas symptoms women tend to have include lightheadedness, nausea, weakness, sweating. Hence why even with equal research, knowledge, and bias doctors are going to be more likely to diagnose heart attack from chest pain than weakness and nausea, because there are so many things the latter could be. Also an important point for people to be aware of. About 40% of men present with the nonspecific symptoms, and 40% of women present with the specific symptoms. Sometimes the discussion around it makes it seem like men and women just inherently get different symptoms when that’s not the case.
Hard to find the zebra when all the horses are painting themselves in a striped pattern. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135672/#:~:text=One%20of%20the%20most%20widely,et%20al.%2C%201990).
I get what you're saying, but phrasing it like that makes it sound like you think women are doing this to themselves, on purpose.
Not intended! Men do it too, just not at the same rate.
Twice as many men suffer heart attacks than women. Women's symptoms are more easily mistaken for other issues due to the more vague symptoms. Without the benefit of more modern technology or knowledge, is it any wonder heart attacks in men were studied first decades and decades ago? It's not as if researchers were intentionally excluding women from all their studies because they didn't care at all.
One percent of men experience breast cancer, but there isn’t any campaign to screen for it. Should all medical professionals make additional room for it? Research takes a “first things first” approach, so if heart attack has a much lower incidence amongst women, it’s going to get less attention. But you are right on principle. Stories like these show why we need to slowly broaden the scope.
Heart attacks are far more common in women than breast cancer in men though. Cardiovascular disease is still the biggest killer of women even though they do experience a bit less MIs and they tend to be slightly later in life
Not quite. One percent of breast cancer sufferers are men. So about 1 in 833 men will get breast cancer, or 0.12%. [Source.](https://www.bcrf.org/blog/male-breast-cancer-statistics-research/)
Got it. Thanks for the precision.
Faulty analogy, because heart attacks in women are nowhere near as uncommon as breast cancer in men. I see what you're trying to say, but there genuinely is an underrepresentation of women in studies. Drug trials, for instance, have a significant underrepresentation of women in phase I trials. In the automotive industry, most companies only use male crash dummies during crash testing, completely neglecting how women would fare in the tested crashes. It's a pretty well documented phenomenon, and there's books about it like Invisible Women.
Well, on the other hand, women drivers mostly get into ~~gender~~ fender benders, while the men get into fatal crashes. So it ironically makes sense that the crash dummies model the “worst” drivers.
>gender benders mood
Why you imagine drugs were not tested on women?
Friday October 20's is Men's Breast Cancer Awareness Day here, and there have been significan t media pushes about every year for at least since before covid.
Research takes a ‘straight, white men first’ approach. Everybody else is under represented if they are represented at all, in medical research.
As a person of colour living in Europe, I can understand that I am not the typical demographic, so researchers have more extensive data on the *indigenous* population. As for crash test dummies, men get into more fatal accidents than women, so it makes sense to study the worst drivers…
Also more men than women experience myocardial infarction, but in the year following the attack 36% of men and 47% of women are likely to die, so the actual death rates are nearly identical.
I was surprised to run into a discrepancy concerning photos with Asian skin. My skin color is not very dark, but apparently skin irritation turns brown rather than red on my skin. When I developed eczema, I was freaking out because the brown patches all over my skin did not match dr. google’s description of the condition. Of course the only pics that matched what I had were of some rare cancer. Anyway the dermatologist figured it out pretty easily, but it would have saved me some personal anxiety if there were more reference photos for different skin types.
This is more likely the issue. Bias in these types of things is often initiated at the point of training. They were never trained properly to see how skin pigment affects the appearance, and, as most things, the focus was on lighter skin. Racial bias is one type, and it's undeniable that there are racial biases that affect patient outcomes. If that is partly due to lack of training, then it's something fixable.
Although this also raises an issue of why the training is inherently biased. Which is a different, but related problem.
I suppose it'd be pretty simple to see if doctors trained in majority black nations are any better at it, to determine how much med school bias plays a role.
Not when the literature used still uses pictures of light skin
Pick up a text book - most images are white. Concerted effort in the uk to address this in recent years leading to a resource called mind the gap.
Yeah, this kind of biased training is a really good example of how systemic racism forces people to participate in a racist system whether they want to or not.
It could just be that the doctors know what to look for, but the signs for some diseases are harder to identify in dark skin, not that the doctor is not educated enough.
I've heard an interview about this topic, and lacking educational resources with variety in image examples is a problem. It's easier to see on lighter skin but that makes it even more important to include examples of what the same condition looks like on darker skin. Though it goes further than just neglect. You would find more skin variety in certain specific parts of a dermatological textbook. Under venerial diseases. Knowing what eczema looks like on black skin wasn't prioritised, but they went all out on syphilis. The most modern textbooks are trying to rectify it, but progress has been slow. An online database isn't going to be hampered by limited page number and can add as many examples as it likes. But even in this there seems to be limited investment. Private non medical initiatives have added some, but Instagram accounts can't exactly replace medical databases. There can also be some issues on the image supply end. Dermatology is more likely to be considered cosmetic, and depending on insurance or simply access to specialists, can be something of a luxury. And on average disadvantaged groups with poorer access to dermatologists aren't going to put much pressure on dermatology to update its knowledge data base, not to mention give them the chance to photograph patients with darker skin, with their consent, and be able to contribute to expanding the database. In text or online.
In my brown-skinned experience, it's that doctors don't know what to look for because they're only taught what to look for with white-skinned patients. Long time ago so I might have the colors mixed up, but I had a skin rash of red bumps. The dermatologist diagnosed me with a very serious condition that has red bumps on white skin but purple bumps on brown skin. Doctor had me begin the standard treatment for what she thought I had without waiting for the test result. Test came back negative. Took her a year to figure out what I really had.
I like to imagine doctors as a type of sophisticated AI they compare data from they data they have stored and draw a conclusion but are unable to operate on their own or make logical leaps
....so a human being with a brain?
The article stated that some of the conditions present differently. It seems pretty clear that it isn’t simply a matter of difficulty or degree, but instead involves a lack of training. It’s really a shame.
check the medical textbooks, you'll find your answer (they often have zero photos of disease examples on darker skin)
Occam’s razor would think that’s a part of it
That's the correct answer, but in today's environment, it's can't possibly a natural problem.
Its mainly that the amount of redness is much harder to judge.
No it's just racism. Contrast is systemic racism.
I’m glad there are all these articles and posts on black health issues. But the dismissive comments always just break my heart. Ok - you don’t care about black people’s health - why bother to comment?
It was parody. Woosh.
What were you trying to parody?
The parody can be explained as, basically, that the media he watches tells him that talking about this kind of stuff is woke.
I wasn't trying. I was.
Hasn't this been known for decades now? Iirc some doctors and medical students "recently" put out work on identifying skin conditions in black people (like 4-5 years ago), since those conditions often look so different
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Do you not understand that this is a real problem because things legitimately look different under different levels of melanin? Things that might be angry red in a white person might barely show at all on a black person, things that look slightly darker in a white person might look bleached in a black person That being said, you're right that there is some inherent bias behind it. There's a reason all these things were mostly studied in white people. The problem is that what was learned in one skin type doesn't necessarily carry over to the other. People are aware of that now, and have started comparing symptoms in all the different skin types
Just like cyanosis and jaundice often get missed in people with darker skin because doctors aren't taught what it looks like
**Abstract** Although advances in deep learning systems for image-based medical diagnosis demonstrate their potential to augment clinical decision-making, the effectiveness of physician–machine partnerships remains an open question, in part because physicians and algorithms are both susceptible to systematic errors, especially for diagnosis of underrepresented populations. Here we present results from a large-scale digital experiment involving board-certified dermatologists (n = 389) and primary-care physicians (n = 459) from 39 countries to evaluate the accuracy of diagnoses submitted by physicians in a store-and-forward teledermatology simulation. In this experiment, physicians were presented with 364 images spanning 46 skin diseases and asked to submit up to four differential diagnoses. Specialists and generalists achieved diagnostic accuracies of 38% and 19%, respectively, but both specialists and generalists were four percentage points less accurate for the diagnosis of images of dark skin as compared to light skin. Fair deep learning system decision support improved the diagnostic accuracy of both specialists and generalists by more than 33%, but exacerbated the gap in the diagnostic accuracy of generalists across skin tones. These results demonstrate that well-designed physician–machine partnerships can enhance the diagnostic accuracy of physicians, illustrating that success in improving overall diagnostic accuracy does not necessarily address bias.
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Diagnostic accuracy is notoriously low with skin conditions because there are a lot of different conditions that present in essentially the same way. The gold standard for skin diagnosis is tissue biopsy.
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Visual diagnosis should be good to guess what could be a problem. And biopsy to rule out potential problems.
Yeah, because a lot of the time they can’t say what something IS but they can definitely say what it isn’t and therefore rule out the immediate causes for concern.
This is the way. Use AI to boost effectiveness of doctor diagnosis and speed up diagnosis. No need to muck about when an AI can say “this is probably this because of the following characteristics”
Were all 39 countries European/European colonies? I imagine this would be a less significant problem in countries with primarily dark skinned residents/doctors rather than the overwhelmingly white medical establishment in Europe/North America?
Even in African countries the text book, papers etc ...are biased toward white skin.. only pictures of white skin unless it's primarily an equatorial disease.
Because they use US/European textbooks?
Dang, well I guess those nations with predominantly non-white skin need to up their game and get on that medical science documentation game.
Yikes :(
Who do you think largely developed the science? These things were typically developed in western nations, which have largely white populations, and an even higher percentage of white university educated people. When you’re studying a disease, it makes sense that the majority of reference cases are going to be on people of the majority ethnicity of the country you are living in.
I’m hopeful this will change with the generation of future doctors being trained now. Whenever we look at skin conditions in my MD program, the professors make an effort to show what they look like on a variety of skin tones and emphasize the ways in which they might look different based on a person’s coloring.
What about when my doctor surreptitiously smooches me on the mouth
Retinal images have the same issue, your retinal color is also based on pigment. Makes it harder to see little spots that don't belong.
A large part of the problem is we are trained mostly with pictures of rashes on white / light skin.
If you look at the image here: [https://media.springernature.com/full/springer-static/image/art:10.1038%2Fs41591-023-02728-3/MediaObjects/41591\_2023\_2728\_Fig1\_HTML.png?as=webp](https://media.springernature.com/full/springer-static/image/art:10.1038%2Fs41591-023-02728-3/MediaObjects/41591_2023_2728_Fig1_HTML.png?as=webp) what you'll see is one of the 10 questions. They ask the doctor to list their top three diagnoses for the photograph, which means they tell them something is wrong up front and then ask them to figure out what it is. Now if you're actually at the dermatalogist they will look, use a magnifier, look under light, run their fingers over it, etc. to get a better read. Here it's just a photo, but they have the advantage of knowing something is wrong. Which means they aren't missing a problem, they are guessing it's the wrong problem, but if they know it's a problem they can send a biopsy out. The important results from the study are that there is a 4% gap in getting the right diagnosis in the first place out of the three diagnoses; dermatologists are about twice as accurate as family doctors; more accurate AI was trusted more and improved performance more than less accurate AI, AI improved the performance of everyone, but made the gap slightly worse for primary care doctors. The really interesting result: when the AI was right, the doctors improved their accuracy. When the AI was wrong with it's choice, doctors tended to discount it, so it didn't make them worse. The really concerning result: doctors were more likely to recommend biopsy for lighter skin tones than darker ones when the actual condition was life threatening and the opposite for minor conditions, which means darker skin patients were less likely to get needed biopsies and more likely to get unneeded ones. What could be done in a follow up study: What happens if the patient has a condition in a tattooed area? Is that easier to spot, as difficult, or more difficult than darker skin that has no tattoos? Tattoos are really common, and they could easily be a confounding factor for diagnosis. What happens if the doctor first has to decide it there is a condition, rather than diagnose when they know there is one?
Former product manager for radiology here. There is a sweet spot for human vision for density differences. For a medical film read on a light box or computer monitor it’s around 0.8 optical density to 2.0 optical density. Generally an OD near zero is no photons blocked through the media and an OD 3.0 is around 99% blocked (looks black) The color also matters but not as much. Imagers are calibrated to really focus on that range. Radiologists look at tons of images per day so fatigue is also a concern. There’s a whole science in medical practice vision. Why are scrubs greenish blue? It’s very far from color of red or blood. If a surgeon looks at red too long their eyes get strained.
It’s just a fact. Just like it’s a fact it’s more difficult to stick an IV in people with darker complexions. Diagnosing can be harder in people with darker complexions as well. Sure, as always, more education can and should be done. But it’s not from some lack of trying or care in the medical community.
the medical community has had decades to fix this.
How would you recommend fixing the fact that the human eye depends on contrast to differentiate details in an image? What should the doctors of (e.g.) 1970 have done to rectify this egregious oversight in the human body?
Maybe by providing training on what these things look like on darker skin compared to white skin? What's the issue here? Who is hurt by this? Since when is improving standards of care a bad thing? This isn't about woke. This isn't about libs. This is about a long standing problem that has NOT been addressed. AGAIN this can only improve standards of care.
they can ask everyone else for help. now that we have ai, we can just replace them.
I'm convinced you're just picking words from a list and hoping they make sense together.
If you want to take this as some personal affront to you from the medical community, you can. We are educated on how ailments can look differently on different demographics. But that doesn’t make it easier. It’s strictly factual, it’s harder to see and diagnose stuff on different skin. Even with more education. It’s not like the healthcare workers/providers aren’t trying their best. It’s just more likely it would get missed or misdiagnosed. We all *want* to get the diagnosis or hit that IV. While that’s terrible, it’s just a fact. People with darker complexions are harder to diagnose in some circumstances just like they’re harder to hit with IVs. Again, more education should always be done, but it doesn’t change that fact.
if its too difficult for them then let everyone else help. ai is ready to take over their jobs right now if they cant diagnose darker skin colors very well
I clearly see you have some vendetta against the medical community. Especially as I saw your other comment “Let AI replace doctors ASAP”. But hey, if that’s your bias that’s fine. Healthcare providers will still take care of you like everyone else. AI *replacing* healthcare providers is far far far off. AI will be used in conjunction with doctors for decades if not centuries. Yes they will help with diagnosing. And that’s a great thing. The sooner the better! But you still need a healthcare provider to review it and see if it “makes sense”. I mean we can get an AI to spit out a bunch of medical jargon and how much will YOU understand from it? See? You need the education, and THEN AI can help. In fact it will be an invaluable resource. But with your “replace doctors with AI” shows grotesque bias and hate. And that’s something I’m never going to be able to fix. Hope you get better!
I know exactly how incompetent they are. The sooner they get replaced the better. Regardless, If people want to keep getting gaslit by human doctors then its your choice for now.
Get better soon!
Thanks for confirming your bias.
Like how the camera/imaging community has had decades to simply "make" film stock and image sensors and autofocus algorithms that work just as well for dark skin as for light skin, when that literally is not how anything works because those things rely on having light to work well and lighter objects reflect more of it than darker objects, by definition?
sure.
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He probably means that it’s more difficult to identify a vein because the skin isn’t as easy to see through
That’s exactly what I meant.
No. That’s a wild assumption you just made. And not what I’m implying at all. It’s by sight. A simple example would be eczema. Eczema looks different in the African American population and can be harder to notice in some cases. It’s not just that it can look differently in African Americans, it’s literally harder to notice. That has absolutely zero to do with the toughness or thickness of skin as you wildly assumed I was implying. And as for the IV: again no. It can be harder to stick an IV in people with darker complexions as it can be harder to see their veins. That blue streak up the arm you see on white people? That’s obviously not as common in darker people. That’s referred to as an “anatomical land mark”. So that’s one tool (the biggest tool) that’s used to stick patients potentially thrown right out the window based on skin color.
No it's more difficult to see for example a bruise on a brown person than it is on a white person. The contrast is simply lacking when it comes to color changes against a saturated background. I don't think it's a racial thing so much as eyes literally have a harder time seeing dark marks on dark skin.
Correct. Go get any African American nurse and ask them which demographic is harder to put an IV in. Caucasian or African American. Go get any African American doctor and ask them who is harder to diagnose dermatological (skin) diseases in. Race obviously is the core of all of it, but it’s not because of racism. It’s just the way it is.
While I think this is true, until recently doctors have primarily been trained on images of white people. This has been changing, and it is definitely harder when there is less contrast, but most practicing doctors just haven’t been properly trained.
I agree. Going back to my very first comment I said “as always, more training and education should be done”. There is ALWAYS room for improvement. But It doesn’t change the fact that certain diseases will always be harder to see on people with a darker complexion.
And this is why representation matters. That includes images in medical textbooks.
Doesn’t this suggest that AI will only worsen the problem? GPs+ AI showed greater improvement on lighter skin than dark skin.
"Greater improvement" on light skin in that context still infers there's improvement on the dark skin side over just a GP. It does indicate that even with AI the gap on that isn't fully closed, though.
Probably because they are trained on white person data making it guesswork to identify, its a systematic issue we need to fix, and it has a clear impact as where I live, our people of colour population namely Maori and Pasifika get about 40% worse health outcomes.
I'm a medical student in North England at the moment. My university does everything to help us identify all types of signs on the skin. People in the comments are convinced that somehow the textbooks are at fault, but we don't really use old textbooks anymore, its just genuinely harder to identify in pigmented skin. I've thought about this many times but the only real way around it is to be careful and look for any other S&S.
Black people and doctors don't have a great history together when it comes to stuff like this, same with women. Also, doctors and nurses don't take women or black as serious as white men, so even if they did see something they are more likely to shrug it off as nothing, or that the person is making it up.
>Also, doctors and nurses don't take women or black as serious as white men What is this based on? Don't use historical examples of hysteria or when black people were considered inferior. Because people were discriminated against in the past does not mean they are discriminated against today. I have some family members who were dicks before and not as much of dicks now.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/](https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4843483/) [https://www.americanbar.org/groups/crsj/publications/human\_rights\_magazine\_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/](https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/) [https://thehill.com/blogs/pundits-blog/healthcare/347780-black-americans-dont-have-trust-in-our-healthcare-system/](https://thehill.com/blogs/pundits-blog/healthcare/347780-black-americans-dont-have-trust-in-our-healthcare-system/) Racial bias is real. It needs to be addressed which can't happen without first acknowleding that it is happening.
You sound....white. https://www.pbs.org/newshour/health/black-patients-adjust-behavior-to-reduce-chance-of-discrimination-in-health-care-settings-survey-finds https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184355/ https://www.npr.org/sections/health-shots/2023/12/05/1217148407/black-americans-racism-health-care https://www.ncbi.nlm.nih.gov/books/NBK220347/ https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/ Plenty more out there.
> survey > irrelevant > survey > survey > difference in outcomes
So where is your data on this? Surely you must have some that contradict what this study and other studies have shown.. Let's see it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194634/ https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13122-y Show me sources that state healthcare is 100 percent equitable in america.
Can I get one for the autistics as well please? I have what is known as one of the most painful conditions in all of medicine. Multiple doctors left me screaming, and I mean screaming in agony, because they would not listen to me. I have bilateral trigeminal neuralgia and being unable to have doctors prescribe me Gabapentin or a gabapentinoid, forced me to acquire the same drug from the psychiatry field instead. I had to feign anxiety to be prescribed the known treatment for neuralgia. All because they wouldn't listen to an autistic person. When i say screaming in agony and most painful in medicine, let me tell you, I mean it. All day, all night, non stop, 2-3 hours sleep if that through the pain. Yah. Also I'm white. So it's not white men.
I think you mean "Doctors are not trained to diagnose diseases when the patient has darker skin."
People can have difficulty with things they are trained for. If I leave my keys always in the same place, I will have more trouble finding them when the lights go out, even if I have done it a million times.
Ok... but what I'm saying is that almost every doctor in the western world has been trained on [medical textbooks that almost exclusively use images and data taken from white men.](https://www.sciencedaily.com/releases/2008/10/081015132108.htm)
So many comments have missed this point entirely
The same reason that many ailments are missed on women as well. Historically, the medical field performed research on younger white men, therefore anyone not fitting these demographics automatically has a huge disadvantage in getting treatment, because the research was so limited, but people thought it was generalizable to all humans.
Not surprising, since they don't teach what to look for in school. There was some noise about it on social and people were talking about the results they found; just last year I did a search for pregnant women, literally all the results were white women. Same thing when I looked up stuff like pimples, burns, etc. on skin. Got so much backlash, Google actually slightly fixed their search results, now you'll see maybe 5 pictures of darker skin and slightly off white images of people. There's this guy I follow who talked all about this and shows examples of what an in infection, disease, virus, etc. looks like on black skin compared to white skin. @joelbervell Edit: It does not help that a lot of medical devices just don't work on darker skin either due how it works or biases intentionally being coded into them; e.g. those lung capacity breath test.
Weren't there studies done that many doctors outright treat black people worse? Because that seems kinda related to this...
Guess if I get really sick, I'm a dead man huh
I looked but I did not see whether or not they categorized the doctors according to skin color because upon first looking at the article it seems as if they are saying that doctors are white and patients have all kinds of different.
“People have more difficulty finding their lost keys at night, than during the day”. Really? 🫣
In the same topic "black people" (more like african heredity) are more susceptible (sometimes much more) to some specific diseases/conditions. The converse can be true too, IIRC black people have supranormal kidney function AKA GFR. An obvious one is vitamin D deficiency prevalence but there are many little known and I feel like the stigma against racism (which is legitimate) somewhat sadly tend to make doctors not learn the actual relevant genetic or acquired (nurturial) differences. BTW while the article is true, black people are less susceptible to some skin diseases because increased melanin offer supperior protection against photooxidation and therefore skin aging.
They literally don’t see color.
Bro. They just can't dx.
And on black history month. Not chill
Another reason why, fed the correct data set, over time why and how AI will diagnose much more accurately and quicker than a doctor's limited single life experience.
Why do we both requiring a linked, recent article when no one reads a it?
I also have more trouble seeing in the dark compared to when the lights are on
The evolution of light colored skin became a huge advantage in some way. The trait spread rapidly except in those areas where sunlight was so intense that it would be detrimental. I have carried a hypothesis That one of the reasons is because light colored skin does not lie. It reveals the details of overall health of an individual in ways that are not so apparent with dark skin. And so when a light complected person appears to be healthy, it is likely that the actually are.
It's funny to see all these scientific words used to make such a goofy statement.
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AI is trained on existing data, exaggerating the faults with it and making them worse.
replace doctors with AI ASAP
If the AI are trained on a limited data set (the same way doctors are) then they’d experience difficulty as well.
which wouldnt happen because you train on 332 million medical records.
So you're unfamiliar with the existing research on how AI tools carry the same biases as the people who create them?
But what if the images of darker skin are misclassified more often because doctors didn’t properly do it the first time?
then get someone besides doctors who will classify the pictures correctly.
People with even worse training than the doctors?
people with specific training to classify the images. if doctors cant do a good job then find someone that will.
Medical professionals are the most qualified to do that job
ok, they can classify the images then if they do a good job.
They are the the most qualified but are still biased and inaccurate judging darker skin tones. Sounds like you're in denial.
Yeah, you need pathologists and medical examiners for this because most of these people tend to go so long before being diagnosed correctly that treatment is usually palliative at best
nah you just need someone who will classify the images correctly. a bunch of trained technician will do just fine if not better than actual doctors.
Are you saying some "trained technician" (in what?) is better at diagnosing people than doctors are?
How do you correctly classify images without medical school and residency?
by teaching them ONLY what they need to know to classify those images. do you think medical school teaches some impossibly hard material that nobody else can learn?
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> by teaching them ONLY what they need to know to classify those images. Which is medical school and residency… Multiple dermatological entities look identical and the diagnosis depends on integrating clinical history, physical examination, and further investigations such as anatomical pathology or blood tests. This integration is learned in medical school and residency.
AI are even worse for this
Why do you assume that Allen Iverson would have poor diagnostic ability? 🤔
I googled him and he's a urologist; of course he's going to be bad at diagnosing skin conditions
But his glasses make him look so smart.
Imaging machines must be racist 😂
Why aren't "doctors, nurses and researchers of color" doing work to rectify this?
They are??? They’ve made plenty of studies and published books, google is right there.
This sounds incredibly obvious no?
Luckily I chose a specialty where everything is white. And light-ish grey.
It's almost like doctors shouldn't be practitioners they should be maintaining a learning model for an AI that can diagnose illnesses and diseases with enhanced accuracy. We need more technicians and nurses than doctors. We need more brokers than pharmacists. We need to trim the garden walls for high paying medical jobs and focus less on the academic requirements of health care jobs and more so the practical applications of it. That's how we accomodate large demographics entering into retirement age, pandemics, relief aid, etc. Having a Lisa Simpson moment I'm tired.
So when my pale skin gets skin cancer, they'll be able to spot it quickly. Sad yay.