HOW CAN DIGITAL TECHNOLOGIES IMPACT DIVERSITY AND INCLUSION IN 2022 AND BEYOND?
By Jhonatan Bringas Dimitriades, MD
Access to health care has always been a right to the elites in many regions, it also has impacted the development of technologies, medications and beyond. This predilection for certain populations (due to accessibility or lower risks in follow-ups and adherence), developments have been centralized specific phenotypic populations, one example of the consequences of this, is the SpO2 issues in pigmented patients during the COVID-19 pandemic.
When we discuss development of medical technologies (such as devices of Digital Health solutions), biotechnologies or pharmaceuticals, we always talk about Clinical Trials, safety, pharmacovigilance and regulatory procedures. These processes and activities have been created to ensure that these developments are safe for usage and consumption by human beings (more specifically because these human beings are patients in need of medical interventions during illnesses).
All these measurements that are in place have made modern medicine a successful endeavour that has proven to prolong life expectancy worldwide (In 1950, life expectancy was 35–55 years and in 2021 it was 72–83 years).
Although these measurements have given tremendous results, they have always needed special conditions to be implemented, such as research centers, correct patient recruitment, patient adherence during Clinical Trials and patient literacy.
Some of these conditions, although necessary in the past, are the origin of a limitation that related to access and diversity. This came to light in many studies, such as the study by the Penn State University’s Cancer Institute, which unveiled that only 11% of patients in Clinical Trials are other than White and Male.
The problem of Clinical Research and development models based on this specific phenotype is not only a representation issue, it carries an even deeper constraint, the risk of Medical inefficacy or adverse effect due to specific phenotypic-related medical implications. Implications that won’t be perceived during Clinical Trials and that will cause potentially severe complications if unnoticed.
A crucial example would be the creation and further implementation of PPG in SpO2 measurement in medical practice. This development was achieved using specific phenotypic populations that included a limited number of pigmented patients. The result: SpO2 inaccuracies in dark-skinned individuals have risked the lives of many patients during the COVID-19 pandemic. Link: https://pubs.asahq.org/anesthesiology/article/102/4/715/7364/Effects-of-Skin-Pigmentat ion-on-Pulse-Oximeter
To enable more democratized and diverse/equal populations in Clinical Trials (for med-tech, pharmaceutical or biotech developments or for academic research purposes), new technologies are being developed, technologies that allow patients to be recruited online, to assist to medical consultations and to be Remote Monitored from their homes while participating in a Clinical Trial, eliminating the limitation of location or distance to the research center. Decreasing the risk of loss to follow-up and allowing more diverse, gender equal, ethnicity equal populations. These technologies enable a new type of Clinical Trial, the Decentralized Clinical Trials.
The development of new Digital solutions for Decentralized Clinical trials focuses on allowing patients to participate in the entirety of the Clinical Trial from a remote location.
Let’s create an example of inclusion related to Digital developments in Clinical Trials: In the case of participants of a clinical trial in Perú, for instance, the potential clinical trial would be able to enroll patients of the 6 ethnical groups of the countries: White, Mestizo, Amerindian (which in its own has more than 15 sub-ethnicities), Black, Nikkei and Tusan. A correct and diverse research design would replicate the distribution of these ethnicities in the country (If the research is only country based) or would distribute according to global representation.
More developments continue to happen in the Clinical Trial and academic research world, more discoveries and creations implicate more attention to the ethnic and gender related connotations, it is the responsibility of us, the technology developers to bring this diversity to the table, so we build for everyone.
