 Next up, we have Amna Rizvi Toner, a pharmacist by training, but also a PhD candidate in the Clinical Pharmacy Translational Science Program. Although her dissertation research focuses only on improving cancer care, she hopes to work toward improving healthcare for all. And so in her talk titled More than Skin Deep, Racism in Healthcare, she explores how healthcare disparities continue to persist despite widespread awareness. Racism is detrimental to the health of Americans, but the way in which it appears is not always obvious. The COVID-19 pandemic shed light on many examples of systemic racism, including previously unknown and seemingly innocuous sources of harm. Amna's talk will present one of these cases in detail alongside relevant political and historical context. But some interesting facts about Amna is that in 2022, she knocked on over 3,000 doors in the last election cycle to advocate for reproductive rights, and she also enjoys buying books she doesn't have time to read. Please join me in welcoming Amna. Thanks, Chloe. Okay. So let's go back to the end of the world. It's March 2020, and the world has come to a halt. Obviously, America has as well. Some of you Michiganders might recall receiving this public safety alert on your phone, where we were told to stay at home to prevent the spread of the COVID-19 virus. Stay home, stay safe, save lives. We were told this repeatedly. As the pandemic grew on and the cases surged, we stayed in isolation and watched horrifying news around the clock. We saw the rise in cases lead to the possible rationing of medical equipment and the actual rationing of medical equipment. We saw arguments about who should get this medical equipment that can save lives. And we kept seeing hospitalizations rise. They rose so much, both the hospitalizations and the deaths from COVID, that hospitals started to rely on refrigerated trucks to store the bodies. They had to run out of space. The city of Detroit had one of those hospitals that used refrigerated trucks as standing morgues. So I'm going to pause here for a second, a minute, and ask you all to imagine that you are a person of color. Some of us don't have to imagine very hard. You're a person of color who develops COVID symptoms. You have a fever. Your throat hurts so bad, you feel like it's on fire. Your chest is so tight, you can't breathe. You drive yourself to the ER. It's crowded. It's busy. There's a lot of people there. The nurse comes and hurriedly places a pulse oximeter on your finger. When the reading flashes, she noticeably relaxes, and she hurries on to the next patient who needs her care. But you're sitting there still confused, still breathless, wondering what to do. Someone tells you, it's OK. You're not an urgent case. Your blood oxygen level wasn't high enough to warrant more care. You can go home. You think, maybe I'm overreacting. Maybe it's all in my head. But you still can't breathe. So the next morning you wake up, your symptoms are worse. This time you have to call an ambulance. The ambulance comes, and in your case now is deemed urgent. You're admitted to the intensive care unit, where along with the pulse oximeter that looks at your blood oxygen level, they also draw a sample of blood to test more accurately what the oxygen level in your blood is, finding out that it's actually very low, while the pulse oximeter still shows that your value is high and you don't need urgent care. The doctors are puzzled. But they say, it's OK. You're here now. We can give you the care that you need. But that information would have been nice yesterday and potentially saved you a trip to the ICU. So what's going on? Why can't you breathe? Researchers at the University of Michigan found that black patients were three times more likely than white patients to have hidden levels of low oxygen in their blood when using pulse oximeters. Pulse oximeters, as I've mentioned, are these little devices that clip onto your finger. Some of you have probably used them before. And they display your blood oxygen level. However, the doctors finding this discrepancy noticed that when a more accurate test was taken, the elevated blood oxygen level showing that the patient was fine was actually incorrect and the patient needed urgent care. So why is this important? It's important because during the pandemic, during the worst times, they needed to use a way to prioritize patients. Well, if your blood oxygen level was high enough on this pulse oximeter, then you were fine. You could go home. You didn't need to be admitted. You didn't need supplemental oxygen or to be monitored further under the care of a doctor and a health care team. But the problem is for patients of color, their values were incorrect. They were being wrongly sent home. One of the researchers who published now, there's many studies that have been published talking about the death rates in patients of color due to this error. One of the researchers states that there's no doubt in her mind that patients were sent home to die from COVID-19 because of the pulse oximeter. So let's take a minute to back up and talk about how the pulse oximeter works. This clip has two lights that are shined through your finger and the amount of light that is absorbed by your blood shows how much oxygen is in it because oxygen is absorbed by a hemoglobin of protein in your blood. Well, guess what else absorbs the light? Melanin. And melanin is present in higher concentrations in people of color. So 1976, you might be wondering why we did not know about this problem before. Well, we did. 1976, scientists had noted that the machine needed to be calibrated to patients of color, people of color, in order to provide accurate results because melanin interferes with the absorption of the light. I'll do the math for you. 1976 was 44 years prior to 2020 and 48 years prior to today, 2024. So the question might not be, why was it not known? I think the question is, why was it not prioritized? Why did nothing change? Why did we not do anything to fix this problem before it became an even bigger problem in tragedy? So why? Well, one of the answers is systemic racism. Systemic racism encompasses many different levels of racism that can be institutional, interpersonal, internalized, and we'll make you read the table, but essentially systemic racism is present in medicine and in healthcare. It was present in the past and it's present today. As we see with this example with the pulse oximeter. Systemic racism, in fact, is so embedded in systems that it's often assumed to reflect the natural inevitable order of things. So I'd like to draw your attention to the red box there, January 18th, 2024, a little over a month ago. No progress has been made since all these research studies came out showing that this error, it's the error that continues to take place in hospitals and critical patients where nurses, physicians, different members of the healthcare team used that blood oxygen level to see how much care they need to provide, who they need to prioritize. Nothing has happened since. And now one of the physicians that was on the papers publishing about this problem is suing the developers of the device to see if we can get somewhere. But 2024. So I think there's really not much difference between the systemic racism that people of color experienced in the past from the systemic racism that they experienced today. But I hope we've seen enough. And I hope that the first step everyone would agree on is to be more aware and to listen. So thank you for being here today and listening. And I would like to leave you with this quote, racism is not an event. As we've seen from COVID-19, other examples that maybe are more popular in school classes, it's not an event. It's not a singular instant or act. It's plural, it happens over time, it's a process. So thank you for being here to take one step towards doing something to reverse the process. Thank you.