The Missing Step in the Scientific Method

MEET THE ADVOCATE

How Thomas Valley, MD, MS, advocates for change based on his pulse oximetry research

By Andrea Brown
March 21, 2026 | VOLUME 4, ISSUE 1

For Thomas Valley, MD, MS, advocacy didn鈥檛 begin in a policy meeting or on Capitol Hill. It started at the bedside鈥攚ith a number he trusted.

Like many clinicians, Dr. Valley relied on pulse oximeters every day to assess his patients鈥� oxygen levels. The small device clipped to a finger offered what seemed like an objective truth. But over time, a troubling realization emerged: that number might not be telling the whole story.

Thomas Valley, MD, MS
Associate Professor, University of Colorado Anschutz School of Medicine

鈥淲e鈥檝e become accustomed to just believing it,鈥� Dr. Valley said. 鈥淲e follow it with blind faith.鈥�

That trust began to unravel as Dr. Valley and his colleagues investigated pulse oximeter accuracy and discovered a critical flaw鈥攐ne that disproportionately affected patients with darker skin. Their research helped demonstrate that these devices can overestimate oxygen levels in Black patients, potentially delaying necessary care.

What was perhaps even more alarming, however, was not just the finding itself but how long it had been overlooked.

鈥淭his problem had actually been recognized nearly 30 years before our study was published,鈥� he said. 鈥淎nd yet it hadn鈥檛 been integrated into routine care.鈥�

That realization marked a turning point for Dr. Valley.

“This problem had actually been recognized nearly 30 years before our study was published, and yet it hadn鈥檛 been integrated into routine care.”

When research isn鈥檛 enough

Initially, his solution was what many researchers would consider standard: Publish the findings and share them with the medical community. But as he reflected on the broader implications, it became clear that publication alone was insufficient.

鈥淲e can publish these papers that are incredibly important鈥攎atters of life and death鈥攁nd still not see a change in practice,鈥� he said.

That realization was reinforced by his own experience at the bedside. Looking back, Dr. Valley recalled caring for patients who said they felt short of breath or unwell, even when their pulse oximeter readings appeared normal.

In those moments, he trusted the data. 鈥淚 hear you, but everything looks good,鈥� he would tell them鈥攐nly later questioning whether those numbers had been misleading.

That gap between evidence and implementation highlighted a deeper issue within the health care system and revealed a new role for clinicians.

鈥淚 started to recognize that research by itself is limited,鈥� Dr. Valley said. 鈥淭here is a need for researchers to also be advocates.鈥�

“We can publish these papers that are incredibly important鈥攎atters of life and death鈥攁nd still not see a change in practice.”

Is there a better way?

Dr. Valley said he believes that clinicians are uniquely positioned to drive meaningful change because they experience problems in real time.

鈥淲e have this opportunity that most people don鈥檛鈥攖o see the problems at the bedside and feel those problems ourselves,鈥� he said.

Yet, in the fast-paced clinical environment, those obstacles are often managed in the moment rather than addressed in a more encompassing manner.

鈥淎 lot of times, we try to work around [these problems],鈥� he said. 鈥淲e figure out how to get through them to take care of our patients rather than asking how to remove them entirely.鈥�

Advocacy begins by resisting that instinct, Dr. Valley said. It starts when you pause to examine recurring frustrations and ask a simple but powerful question: Is there a better way?

That shift鈥攆rom working around problems to interrogating them鈥攚as not automatic. It required stepping back and recognizing patterns in everyday frustrations rather than dismissing them as part of the job.

Many of his research efforts, including his work on pulse oximetry, stem from exactly that mindset: identifying pain points in patient care and pursuing solutions that extend beyond individual encounters.

“Research by itself is limited. There is a need for researchers to also be advocates.”

Learning on the job

Despite its importance, advocacy is not something most clinicians are formally prepared for.

鈥淲e spend a lot of time learning how to practice medicine and how to be researchers,鈥� Dr. Valley said, 鈥渂ut [we spend] very little time learning how to advocate.鈥� As a result, many clinicians interested in advocacy must navigate unfamiliar territory, often without a clear road map.

鈥淭here鈥檚 no great training that says, 鈥楾hese are the steps you should take,鈥欌€� he said. 鈥淚t鈥檚 very much learning on the job.鈥�

Mentorship can play a critical role, but systemic barriers remain. Without structured pathways or dedicated time, advocacy work can be difficult to prioritize alongside clinical and research responsibilities.

Dr. Valley credits mentors who were strong advocates themselves with helping shape his approach, even as he navigated the space largely without formal training. At the same time, he stressed that many clinicians who could make meaningful contributions in this space may never do so, not because of a lack of interest but because they lack the time, structure, or guidance to get started.

Still, Dr. Valley emphasized that the stakes are too high to ignore.

鈥淐hange can be slow,鈥� he said. 鈥淏ut I don鈥檛 think that鈥檚 a good enough response when patients鈥� lives are at risk.鈥�

“We spend a lot of time learning how to practice medicine and how to be researchers but very little time learning how to advocate.”

Why accurate pulse oximetry matters

For the pulmonary, critical care, and sleep medicine community, pulse oximeter inaccuracy is more than a technical concern; it is a patient safety issue with implications for health equity.

Clinicians rely on these devices to make critical decisions, from hospital admissions to oxygen therapy. When those readings are misleading, the consequences can be severe.

Dr. Valley recalled moments in his own practice that now feel unsettling in hindsight鈥攖imes when patients reported symptoms that didn鈥檛 align with their readings.

鈥淚 remember patients saying they felt short of breath, and I鈥檇 say, 鈥業 hear you, but everything looks good,鈥欌€� he said. 鈥淣ow I think about where those numbers came from and whether they were misleading me.鈥�

The experience underscores a broader lesson: Even widely trusted tools have limitations, and clinicians must remain critical and curious in their use.

“Change can be slow. But I don鈥檛 think that鈥檚 a good enough response when patients鈥� lives are at risk.”

Scaling advocacy beyond the bedside

For clinicians interested in advocacy, Dr. Valley offers a reassuring perspective: The foundation already exists.

鈥淲e are natural advocates,鈥� he said. 鈥淭hat鈥檚 what we do at the bedside.鈥�

The challenge鈥攁nd the opportunity鈥攊s to extend that mindset beyond individual patients.

鈥淚nstead of just fixing a problem for one patient at a time, we should ask: Are there opportunities to scale this? Can we work together to create change at a larger level?鈥�

In the case of pulse oximetry, that has meant engaging with regulatory agencies, raising awareness across the medical community, and pushing for improved device standards.

Dr. Valley and his colleagues began by publishing their findings and bringing attention to the issue, then they worked to ensure the data reached the right audiences. Their efforts have contributed to increased awareness and have helped prompt engagement from organizations such as the US Food and Drug Administration, though progress has been uneven.

鈥淲e鈥檝e had varying degrees of success,鈥� he said, noting that while some institutions have responded, discernible change at a systemwide level takes time.

There is growing recognition of the problem and momentum toward better standards, but reliable solutions are not yet fully in place. Clinicians are left navigating this uncertainty in real time, balancing the benefits of pulse oximetry with a clearer understanding of its limitations.

鈥淚鈥檓 still taking care of patients in the ICU, and I still don鈥檛 really know what to do about pulse oximeters,鈥� he admitted.

“We are natural advocates. That鈥檚 what we do at the bedside.”

The problems worth solving

If there is one takeaway from Dr. Valley鈥檚 journey, it is that advocacy does not look the same for everyone. It begins with attention鈥攑aying close enough attention to recognize when something isn鈥檛 working鈥攁nd the willingness to act.

鈥淭he key is to think about the things that bug you when you鈥檙e taking care of patients,鈥� he said. 鈥淭hose are often the problems worth solving.鈥�

From there, the path to advocacy may not be straightforward. But as Dr. Valley鈥檚 work demonstrates, it is essential.

“Are there opportunities to scale this? Can we work together to create change at a larger level?”

No stranger to this battle

For years, 糖心原创 has spoken out regarding the need to address inaccuracies in pulse oximetry.

In 2024, Aaron Baugh, MD, presented a prerecorded statement on behalf of 糖心原创 to the Anesthesiology and Respiratory Therapy Devices Panel of the FDA Medical Devices Advisory Committee.

鈥淲e have an interesting emergent situation where the best hypothesized explanation scientifically of what鈥檚 happening [with incorrect pulse oximetry readings] diverges from the public’s understanding of what鈥檚 going on鈥攅specially with this misidentification around one racial ethnic group,鈥� Dr. Baugh said. 鈥淚n such a circumstance, I would argue it’s our obligation to resolve both of those questions simultaneously.鈥�

Eric Gartman, MD, FCCP, also spoke on behalf of 糖心原创 at a meeting of the same advisory panel in 2022. 鈥淲hat I would advocate鈥攁nd what I think we should advocate for鈥攊s the calibration cohort for pulse oximetry needs to be done in the population that it鈥檚 going to be used in, not in an artificial ‘normal’ population,鈥� Dr. Gartman said.

Trials for determining the efficacy of pulse oximeters should span diverse skin tones, diverse lung disease, and levels of illness, he continued. Realistically, those are the patients in which clinicians are most concerned about oxygen levels, but that鈥檚 not the population that these devices are being tested in, he said. 鈥淲e wouldn鈥檛 tolerate that for a medicine, so I鈥檓 not sure we should tolerate that for a device either.鈥�

Dr. Gartman鈥檚 testimony followed letters to the FDA in 2022 and 2021, which stated the clear racial health disparity that must be addressed and urged the FDA to encourage consumer-grade pulse oximeter manufacturers to participate in corrective efforts.

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