The pulse oximeter most commonly used to measure blood oxygen levels on the Apple Watch fails to accurately record blood oxygen levels for people with black and brown skin.
A new class action lawsuit claims that the blood oxygen sensor on the Apple Watch is not calibrated to take into account darker skin tones, worsening the documented bias of blood sensing technology that regularly fails to accurately measure blood oxygen levels for Black and Brown individuals. According to court documents, the lawsuit was filed on December 24 in the Manhattan federal court on behalf of Alex Morales, a New York resident who purchased an Apple Watch between 2020 and 2021. Apple has 21 days from the date of the summons to respond.
Pulse oximeters, which use light to measure oxygen saturation, have been around since the 1970s. While you may already be familiar with finger pulse oximeters, which resemble a paper clip attached to the finger, smartphones and smartwatches also use simpler light-based oximeters. However, the inherent biases shown by finger pulse oximeters on darker skin tones have been recognized in the medical community since the beginning. According to an August status article, researchers are working to develop oxygen readers that consistently work on darker skin tones.
Since Series 6, the Blood Oxygen feature has been a standard feature on Apple Watches. The company claims to compensate for "natural variations in the skin" with four groups of LED lights on the back of the watch. The measurement is "not intended for medical use and is only designed for fitness and general health purposes," according to Apple. While the lawsuit does not explicitly state that Morales or other users are using Apple Watches to collect accurate medical data, it does claim that Apple has failed to "recognize the general failure of pulse oximetry about people of color." According to the lawsuit, researchers have "confirmed the clinical significance of racial bias in pulse oximetry using patient records taken both during and before the pandemic.
Various research has shown that minorities and other marginalized groups have been disproportionately affected during the worst months of the COVID pandemic. A letter published in The New England Journal of Medicine two years ago noted that devices intended to monitor blood oxygen levels using pulse oximetry consistently fail to accurately measure when Black patients enter hypoxemic states when their blood oxygen levels drop below normal.
"The real-world significance of this bias was not addressed until the midpoint of the coronavirus pandemic, which coincided with a greater awareness of the structural racism present in many aspects of society," the lawsuit says.
Users previously complained in 2015 that dark tattoos interfered with device sensors, according to AppleInsider. The Apple Blood Oxygen app page mentions that tattoos can block the light from sensors, but does not mention skin color.
Although the lawsuit does not mention specific users who received inaccurate results from the Apple blood sensor. The lawsuit also cites a study published in the open-access Digital Health journal that claims Apple's oxygen sensors are comparable to most medical-grade oximetry devices, but the study "failed to recognize the general failure of pulse oximetry about people of color," according to the lawsuit.
Apple is not unfamiliar with class action lawsuits for its various products, but this is the latest of many examples of what happens when companies fill "everything" devices with technology, including technology that has been proven to be racially biased. You don't have to look far either, as companies like Google recently explicitly marketed the camera capabilities of their Pixel. Apple has stated that it is working to improve the rendering of dark skin tones with AI, even with its latest iPhone 14 and IOS 16.
Even though the lawsuit still needs to be certified as a class, it welcomes plaintiffs from New York as well as North Dakota, Wyoming, Idaho, Alaska, Iowa, Mississippi, Arkansas, North Carolina, and Utah.
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