When Linda Oyesiku was a child, she stripped her knee in the school playground. The school nurse cleaned her and covered the wound with a peach-stained bandage. On Oyesiku's dark skin, the bandage was left out, so Oyesiku was colored with a brown marker. Years later, Oyesiku, now a medical student at Miller University School of Medicine, needed to hide a wound on her face after being operated on. Well aware that it was unlikely that the surgeon’s office had a brown sales band on hand, he came prepared with his own box. Those episodes left her wondering: Why were those bandages no longer available?
The ubiquity of peach-colored or “meat” bandages provides an absolute reminder that medicine remains focused on white patients, says Oyesiku, who calls for brown bandages to become mainstream. Brown bandages would symbolize that patients of color no longer represent “deviations from the norm,” he writes in an October commentary in Pediatric Dermatology.
Peach-dyed sales, invented by the pharmaceutical company Johnson & Johnson in the 1920s, have been the bearer of the banner for a century. Normalizing peach as the default meat color has had a knock-on effect: the nicotine and contraceptive adhesive patches that have appeared on the market are also nuanced peach, Oyesiku reports. Over the past few decades, smaller companies have introduced bandages for multiple skin tones, but they are still harder to get than peach-toned ones.
The problem is deeper than a bandage, Oyesiku says. The treatment of whiteness as a default in medicine contributes to the distrust of blacks and other minority groups by medical professionals (SN: 4/10/20) and has led to bias in machine learning programs that US hospitals use to prioritize patient care (SN : 10 / 24/19).
The field of dermatology represents an obvious starting point for the dismantling of structural racism in medicine, says dermatologist Jules Lipoff of the University of Pennsylvania. “Dermatology is racist only insofar as it is all medicine and all society. But because we are on the surface, that racism is easier to recognize. "
Consider "COVID toes." This disease, a symptom of COVID-19 infection, is characterized by swollen and discolored toes and occasionally toes. When researchers reviewed 130 images of skin conditions associated with COVID-19, they found that almost all of the images represented people with white skin. Because COVID-19 has disproportionately impacted black communities in the United States and the United Kingdom, photos representing this population are crucial for proper diagnosis and care, researchers report in the September 2020 British Journal of Dermatology.
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This shortage of medical imaging for dark skin is pervasive. Only 4.5 percent of images in common medical textbooks represent dark skin, Lipoff and colleagues reported in the Jan. 1 issue of the American Academy of Dermatology.
At least when it comes to bandages, change can be underway. Last June, in response to civil rights protests, Johnson & Johnson pledged to launch bandages for multiple skin tones. It remains to be seen whether health care providers and stores routinely store those sales.
Brown sales will not solve racism in dermatology, let alone medicine as a whole, but its presence would symbolize that everyone’s flesh color matters, Oyesiku says. “Inclusion in dermatology and medicine (is) much deeper than a Band-Aid. But small things like this are a gateway to … other changes. "