The Apple Watch's blood oxygen measurement might be guilty of racial bias

The Apple Watch is the latest consumer tech product to come under fire for perpetuating racial biases, representing one part of a wider tech industry issue that revolves around racist and sexist AIs and racially insensitive practices. 

A new class action lawsuit, filed Dec. 24 on behalf of a group of New York residents and Apple users, alleges that the wearable tech's blood oxygen measurement feature does not accurately account for differences in skin tones, providing inaccurate readings for users with darker skin and perpetuating a widespread racial bias in both health and medicine. 

The tool, known in the medical field as an oximeter or pulse oximeter, reads blood oxygen saturation levels by shining a light through the device wearer's skin. Then, using a series of red, green, and infrared LEDs and light sensors, the monitor can estimate the percentage of oxygen in a red blood cell.

But that measurement process has long been noted as an insufficient system, unless the sensors are intentionally adjusted and monitored for skin tone variation. In 2020, responding to the lifesaving need to accurately monitor pulse and oxygen levels of those contracting the COVID-19 virus, medical professionals (and even viral TikTok accounts) brought the issue to public attention and scientific scrutiny. In the last two years, this built-in racial bias has been continuously noted, with valid concern for those using these devices during at-home health monitoring. The lawsuit asserts that patient records show "'reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia.'"

Apple introduced its blood oxygen measurement in its Apple Watch Series 6 in September 2020, coinciding with a global increase in handheld pulse oximeter purchases that ballooned into a billion dollar market by 2021. The latest version of the watch now retails between $400 to $800, a "premium price" that, according to the lawsuit, is based on unique features like the blood oxygen tool. It argues that because these measurements allegedly don't work for every user, the sale of these watches equates to consumer fraud.

When the watch-based oximeter was first announced, the company unveiled it would also be using the tool as a data set for a study on COVID-19 and influenza detection, partnering with the Seattle Flu Study at the Brotman Baty Institute for Precision Medicine and the University of Washington School of Medicine. The study would use the new blood oxygen measurement along with the device's heart rate monitoring to study how similar tech tools could signal respiratory conditions.

The combined power of Apple's health tools have been a selling point for many iPhone and Apple Watch users inclined to combine all of their wellness needs into one digital hub, but not all of the iOS health features have slid into the Apple repertoire criticism-free. 

In 2019, unveiling the new legion of health tools for the Apple Watch Series 4, the company claimed it was pushing to be the "ultimate guardian of your health." Speaking to Mashable that year, medical experts warned users that the watch was simply a "cool tool" and not a medical device, expressing concern that the sheer amount of random data (which was offered with little medical interpretation) wouldn't be helpful for either user or doctor. It wasn't an FDA-approved device at the moment of its launch, either, but has since received clearance by the federal agency for certain features, such as its ECG (electrocardiogram) tool.

Later, in 2022, the newly introduced fertility tracking tool also prompted warnings from privacy experts who remain wary of companies monitoring reproductive health in the post-Roe era. 

With these layered concerns of privacy, invasive data tracking, and the claim of additional racial bias in Apple's health monitoring, the company may be losing some users' sense of safety and trust. But beyond this consumer/company dynamic, the Apple Watch's oximeter problems brighten the spotlight on a problem of racial supremacy ingrained in spaces many consider to be the most politically neutral, such as the medicine field and its data-surmising algorithms. That notice will hopefully prompt individuals to consider how entire industries, not just products, are designed with only one kind of person in mind — and that fact can often have life-threatening consequences.  

Apple has 21 days from the filing to respond to the class action summons.