New York has it in for biased algorithms

The ideas and innovators shaping health care

Nov 28, 2022 View in browser   By Grace Scullion , Ben Leonard , Carmen Paun and Ruth Reader TECH MAZE Black patients who've had caesarean sections are told more often than white patients that they have to do the same for subsequent pregnancies. | AP Artificial intelligence offers hope for improving diagnoses and care. But health care experts worry the algorithms that drive it could also amplify bias and exacerbate care disparities. New York City is trying to prevent that from happening with its Coalition to End Racism in Clinical Algorithms. The coalition highlighted three highly used algorithms with racial biases in a recent report: — A calculation for measuring kidney function that presumes Black individuals have increased muscle mass relative to others, leading to delays in clinically important care, such as timely access to nephrology specialists and evaluation for kidney transplantation — A formula for assessing lung health that uses 19th-century research that suggests Black people have lower lung capacity than white people — A scoring index for determining whether a person can have a vaginal  birth after a cesarean section that gives Black and Hispanic patients a 5 to 15 percent lower success rate Over the last year, 11 health systems have committed to ending the use of at least one of the three algorithms featured in the report. Michelle Morse, who leads the coalition, said its goal is to educate providers on the bias and update their systems "so that providers are no longer using the racist version of the algorithm, but are using a new version that will help us actually end racial inequities instead of solidifying them and normalizing them." She told Ruth that she's creating a space where providers can talk about their barriers and successes: "That created an opportunity for a lot of saved work and efficiency." What's next: The coalition plans to work with professional medical societies, like the American Society of Nephrology, as well as the National Institutes of Health, to identify racially biased algorithms and remove them from health care.   POLITICO APP USERS: UPGRADE YOUR APP BY DECEMBER 19! We recently upgraded the POLITICO app with a fresh look and improved features for easier access to POLITICO's scoops and groundbreaking reporting. Starting December 19, users will no longer have access to the previous version of the app. Update your app today to stay on top of essential political news, insights, and analysis from the best journalists in the business. UPDATE iOS APP – UPDATE ANDROID APP .     WELCOME TO FUTURE PULSE Bass Harbor Head Light, Acadia National Park | Shawn Zeller This is where we explore the ideas and innovators shaping health care.  There's good news on monkeypox in the U.S.: After peaking in August at more than 450 cases a day, the latest CDC data says that the seven-day average had declined to 13 cases per day on Nov. 16. Share news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Grace Scullion at gscullion@politico.com.  Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, POLITICO labor reporter Nick Niedzwiadek joins Katherine Ellen Foley to discuss the HHS' classification of long Covid as a disability, which opens up protections and accommodations that extend into the workplace. They explore what that means both to patients who seek to be productive workers and to their employers. Listen to today's Pulse Check podcast WASHINGTON WATCH Senators return to Washington today, while representatives are back tomorrow. | Getty Images Congress returns to Washington this week with just 20 legislative days on its calendar to finish fiscal 2023 appropriations and a defense bill. As a result, health care interests are ramping up their lobbying to convince lawmakers to extend eased Medicare telehealth rules that allow patients to virtually visit doctors from their homes. AARP, the American Heart Association, the Arthritis Foundation, the Asthma and Allergy Foundation of America and the Eating Disorders Coalition for Research, Policy & Action confirmed their advocates are engaged on the issue. They have cause for optimism: In July, the House passed an extension through 2024 on a 416-12 vote. Cause for concern: The Senate hasn't acted, and some proponents of an extension worry the Congressional Budget Office will deem one expensive. That could slow or stop the process if lawmakers think they'll need to offset new spending with budget cuts or tax increases. Congress is also more likely to act when faced with a deadline. And the Medicare rules' expiration, five months after the end of the Covid-19 public health emergency, is still a ways off. The emergency is slated to end in January, but HHS has signaled that it will be extended.   TUNE IN TO THE PULSE CHECK PODCAST: Keep your finger on the pulse of the biggest stories in health care by listening to our daily Pulse Check podcast. POLITICO's must-listen briefing decodes healthcare policy and politics, and delivers reality checks from health professionals on the front lines. SUBSCRIBE NOW AND START LISTENING .     DANGER ZONE Boxes of the measles, mumps and rubella virus vaccine. | AP Photo/Damian Dovarganes 128,000 The number of children who died of measles last year Measles is an imminent global threat as vaccination rates have dropped to the lowest levels since 2008 due to the Covid-19 pandemic, the World Health Organization and the Centers for Disease Control and Prevention are warning. A record high of nearly 40 million children missed a measles vaccine dose last year, putting them at risk for one of the world's most contagious diseases that can be deadly for kids. Some 9 million children were infected in 2021, according to the agencies' global report. Nearly two dozen countries recorded major outbreaks. In the U.S., an outbreak in Ohio sickened 24 unvaccinated children this month, most under 2 years old. In India, an outbreak killed a dozen children this year. The WHO and CDC blame: — The drop in vaccine coverage — Inadequate measles surveillance — Increased vaccine hesitancy stemming from controversies over Covid vaccination Background: Vaccination of at least 95 percent of children with two doses is needed to prevent the virus from spreading. Globally, 81 percent of children received their first dose and 71 percent got their second shot in 2021, the lowest uptake rate in more than a decade. The countries in which the most children missed first shots last year were Nigeria, at 3.1 million, and India, 2.5 million.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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