美国国家公共电台 NPR Diagnostic Gaps: Skin Comes In Many Shades And So Do Rashes（在线收听）

DAVID GREENE, HOST:

All right. So if you go to a dermatologist with, say, a rash, chances are the doctor's going to want to take a look, right? So much of diagnosing skin conditions comes down to what the doctor sees. But as Deena Prichep reports, some are raising concerns about whether doctors are getting the whole picture in their training.

ELLEN BUCHANEN WEISS: Can you show Mama how to blow bubbles? No? (Laughter).

DEENA PRICHEP, BYLINE: Like a lot of new parents, Ellen Buchanen Weiss is pretty into her kid.

WEISS: We adopted him when he was 11 days old. He is gentle, sweet, hilarious, on the go all day. (Laughter).

PRICHEP: And like a lot of new parents, Buchanen Weiss had all sorts of questions during that blurry first year, like after her son's 12-month vaccinations, when he broke out in a rash.

WEISS: I'm trying to figure out, would I be paranoid if I went to the doctor at this point? Is that a reasonable thing to do? So I started Googling it.

PRICHEP: We're talking image searches. Also looking at pages from the Mayo Clinic, CDC. But her son has brown skin.

WEISS: And it became immediately clear to me that the vast majority of even common skin conditions are on white skin. You have to scroll down, like, 80 pictures to find a single one on brown skin.

LYNN MCKINLEY-GRANT: It's not surprising, but it is concerning. Very concerning.

PRICHEP: Dr. Lynn McKinley-Grant is a dermatology professor at Howard University and president of the Skin of Color Society. She knows there's a gap, and not just on the Internet.

MCKINLEY-GRANT: Often in medical schools, they have limited pictures of diseases in skin of people of color.

PRICHEP: And that's a big problem. Medical school is a lot of pattern recognition, especially when it comes to dermatology. You see picture after picture to encode them into your brain. And if you don't see pictures of different skin types, you may not be able to diagnose them. Take rashes.

MCKINLEY-GRANT: You'll hear a term called erythema.

PRICHEP: Erythema, the official medical term, from the Greek word for red. But rashes don't always look red on dark skin. They can look kind of purple or barely show up at all.

MCKINLEY-GRANT: So I've had patients who have said they go in and they tell the doctor that they have redness, and the doctor can't see it. They're like, well, there's nothing there, you know, just put some lotion on and go home.

PRICHEP: McKinley-Grant says schools are making an effort to diversify training materials. But they've still got a ways to go, and this problem could get even worse. Dr. Roxana Daneshjou is a dermatology resident at Stanford. For her Ph.D., she's looking at artificial intelligence.

ROXANA DANESHJOU: If we don't fix the biases that we have in health care before we jump to training a computer to do it, we're just going to actually perpetuate those biases.

PRICHEP: The computer learns the same way students do. Daneshjou and her team feed in image after image to create a tool that can help doctors recognize patterns. And when there aren't images of darker skin, the algorithm, like a doctor, won't be as good at diagnosing people of color, whether that's an allergic reaction or a Lyme disease rash or skin cancer.

DANESHJOU: Addressing bias and improving diversity are not tangential issues. They are actually central to providing equitable health care.

PRICHEP: So how do you get more diverse images? There are resources, especially for doctors and medical students. But people have to seek them out. And sometimes they don't even realize what's missing. For Ellen Buchanen Weiss, who couldn't find pictures that looked like her son, the answer was right on her phone.

WEISS: I thought to myself, well, you know, I could just open an Instagram account.

PRICHEP: Buchanen Weiss launched Brown Skin Matters in August, posting pictures of skin conditions on people of color. And in just a few months, she got over 7,000 followers.

WEISS: I expected moms to want this resource, but I've been surprised at how much of the attention has been from medical professionals.

PRICHEP: All of the dermatologists we spoke with stressed that this is not a substitute for a medical exam. But it is a resource, and it's helping raise awareness of the problem, which is one of the first steps to making sure that the picture of the future looks a little different. For NPR News, I'm Deena Prichep.

(SOUNDBITE OF SONG, "BROWN SKIN")

INDIA.ARIE: (Singing) Brown skin. You know I love...