Though wearables such as the EKG-measuring Apple Watch have been widely promoted has having the ability to transform clinical trials and treatment, those features are still unavailable to large swaths of the population because they have not been optimized for users with darker skin.
A recent report from S&P Global Market Intelligence compiled many of the complaints about digital health tools' lack of representation: Heart rate-measuring sensors in wearables, for example, are often trained on a limited range of skin colors, so they may not work correctly for users with darker skin or wrist tattoos.
This disparity doesn't just limit everyday wearable usage, but also upholds the longstanding lack of representation in clinical trials. Stanford (Calif.) Medicine's Apple Heart Study utilizes the Apple Watch, which has been proven to have difficulty sensing heart rate in some darker-skinned users, and thus may exclude an entire section of the population from its findings, per the report.
Additionally, the Apple Watch 4, among the most expensive commercially available wearables, is one of only a handful of devices currently cleared for use in clinical trials. Its high cost may serve as yet another prohibiting factor in clinical trial representation.
Finally, beyond wearable technology, many of the artificial intelligence and machine learning algorithms now being used to streamline clinical trials have also been trained on a largely white, male and upper-middle-class dataset. Though perhaps unintentional, these biases must still be addressed before digital health tools can be touted as transforming clinical care for everyone.