In one form or another, this set of reviews has social issues as an underlying theme. Society and justice are on everybody’s mind. Technology may be neutral, but how it is used can have enormous social consequences.
-Marc Ringel, MD
This article is not about the sort of computation-intensive system that I usually include in my article reviews. I’ve chosen it because of the stark clarity with which this simple calculation of kidney function, adjusted for race, demonstrates how the human assumptions that are embedded in “neutral” calculations can have huge negative consequences, no matter how well intentioned. This report demonstrates that, based on an adjustment of normal values for kidney function based on race, resulted in 700 black people out of 57,000 patients with kidney disease being classified with less severe renal failure than people of other races. This led to the unfair exclusion 64 black patients from transplant waiting lists.
Is it any surprise that, when it comes to telehealth, as in most everything else in American healthcare, women, people of color, the old and the poor have lesser access.
How about some good news from the Feds for a change? The Federal Communications Commission reported last year that the “digital divide” between rural and urban access to broadband internet access, defined as at least 25/3 mbps (download/upload), narrowed significantly. Between 2016 and 2019, the number of rural Americans without broadband access fell by, 46%, 14.5 million. And the number with access to higher speed broadband (250/25 mbps) increased 268%.
Speaking about people who are sometimes discriminated against, or at least not appreciated as they should be within the medical hierarchy, let me put in a word for nurses. The authors of this study, published last year in the Journal of Medical Internet Research, attached sensor badges to ICU personnel in order to generate a sociogram of who spent face-to-face time with whom, and how much. What they found should not surprise anybody who has ever worked in a healthcare setting. Nurses are at the center of things while, to quote the abstract, “doctors remain at the periphery.”
Physicians, like other high-profile people in our country, are plenty likely to be targets of social media tormentors. 43% of 464 doctors reported having been victimized by some sort of virtual harassment. Messages ranged from verbal abuse to doxing to death threats. Not surprisingly, female doctors were more than twice as likely as men to have been harassed online, with a large dose of that being sexual harassment. Antivaxers accounted for a significant portion of the offensive messages.