The PNAS study by Alsan and colleagues, an observational analysis of Veterans Health Administration electronic health records, demonstrates that pulse oximeter overestimation of oxygen saturation in Black patients directly reduces rates of subsequent clinical interventions compared with white patients sharing identical device readings. This large-scale EHR review (sample size in the tens of thousands) avoids selection bias inherent in prior paired pulse-ox/arterial blood gas studies by conditioning solely on the initial noninvasive reading. Unlike randomized trials, however, residual confounding from unmeasured comorbidities remains possible, and no conflicts of interest were disclosed. Earlier work, such as the 2020 NEJM letter by Sjoding et al. (observational, n=1,333 paired measurements), first quantified the 1.5–3 percentage point overestimation in darker skin but stopped short of tracing downstream care decisions. A 2021 FDA safety communication further acknowledged calibration on predominantly light-skinned populations yet stopped at device labeling updates without mandating redesign. Mainstream coverage frames these findings as isolated technical glitches; the deeper pattern reveals how melanin-dependent light absorption, fixed since the 1970s device architecture, propagates through automated alerts and clinician thresholds to widen racial gaps in supplemental oxygen, ICU transfer, and mortality. Emerging green-light reflectance prototypes show promise in small feasibility studies but lack large-scale validation. Until regulatory standards require melanin-adjusted performance metrics, Black patients will continue to experience systematically delayed care.