From sample to society

A newborn baby is brought to the laboratory for urgent bilirubin testing. The request form states “query jaundice,” but the sample arrives later than expected. On the postnatal ward, the usual visual cues – yellowing of the skin and sclerae – were far less apparent because the baby had dark brown skin. By the time the condition was recognised, bilirubin levels had risen to a point where urgent phototherapy was required to prevent severe complications.

For the laboratory team processing that sample, the numbers told the full story. But the delay between symptom onset and sample arrival was a direct consequence of a bias embedded in clinical teaching: jaundice is often described, illustrated and taught using examples of light skin. Without training and resources that reflect the full spectrum of skin tones, the risk of delayed recognition and, therefore, delayed laboratory investigation remains high.

This is not an isolated case. Across pathology disciplines, from haematology to microbiology, our teaching materials, diagnostic criteria and even our so-called “normal” ranges are often built on data and perspectives rooted in a narrow historical context. These legacies, shaped by the colonial history of science and medicine, still influence how we train, how we research and, ultimately, how we care for patients.

When we talk about decolonising the curriculum, we are not talking about erasing history or discarding scientific achievements from the West. Rather, we are expanding the lens: recognising the contributions of scientists from across the globe, questioning inherited assumptions and ensuring our science reflects the diversity of the people it serves. For biomedical scientists, this is not just an academic exercise. It is about accuracy, equity and patient safety. As our patient populations become ever more diverse, and as global health challenges demand truly international collaboration, decolonisation is emerging as a professional imperative. By embedding a broader, more inclusive perspective in our curricula and our practice, we strengthen the foundations of biomedical science making them more representative, more resilient and, ultimately, more effective.

Historical legacy

The example used at the beginning of this piece is not simply a modern oversight. It reflects deeper structural issues in how medicine has developed. Many of the tools, thresholds and “normal” values we rely on today were shaped during periods when medical research was overwhelmingly Eurocentric, often conducted in colonial contexts where the priorities, ethics and populations studied did not reflect the global community we now serve.

In the era of European colonial rule and empire-building, medical science expanded rapidly but not always equitably. Research in colonised territories frequently focused on protecting colonial economies rather than improving health outcomes for local populations. Diseases such as malaria, yellow fever, and sleeping sickness were studied intensively because they threatened colonial administration, while other pressing local health concerns were neglected. Data gathered in these settings was often applied without accounting for genetic, environmental, or cultural differences, embedding bias into what became “universal” medical knowledge.

Diseases were studied that threatened colonial administration, while other pressing local health concerns were neglected

In laboratory medicine, reference ranges, diagnostic criteria and even equipment design were often based on studies involving white, male, European or North American populations. Pulse oximeters, validated primarily in lighter-skinned individuals, have been shown to overestimate oxygen saturation in patients with darker skin, a disparity with clear clinical consequences. Similarly, certain rare blood group phenotypes, more common in people of African descent, have been under-recognised in transfusion science, increasing the risk of mismatched transfusions.

These are not just historical footnotes. They are the foundations upon which modern laboratory science still rests and without critical scrutiny, they continue to shape our results and influence patient care.

Why this matters

In the laboratory, it is easy to see our work as objective and data-driven, insulated from social or historical bias. Yet the datasets we analyse, the algorithms we apply and the interpretive frameworks we use are products of human decision-making. Those decisions, about what to measure, which populations to study and how to interpret results, have often been shaped by historical limitations.

Today’s UK population is more diverse than ever, with more than 15% identifying as Black, Asian, or from another minority ethnic background. Migration, global travel and climate change are altering the epidemiology of disease. This means our reference intervals, diagnostic cut-offs and case studies must be fit for purpose across a wide spectrum of genetic backgrounds, physiological profiles and environmental exposures.

Examples abound. Misinterpreting microcytosis as iron deficiency without considering thalassaemia trait can lead to unnecessary investigations. The long-standing ethnicity adjustment in estimated glomerular filtration rate (eGFR) calculations, based on flawed assumptions about muscle mass, has now been removed after evidence showed it could mask kidney disease in Black patients. Certain infections still labelled as “tropical” are increasingly seen in temperate regions, yet their case studies often remain locked in outdated geographical framing.

From a regulatory perspective, both the Health and Care Professions Council Standards of Proficiency and the IBMS curriculum require us to practise in ways that are inclusive, equitable, and responsive to diverse populations. Decolonisation is not an optional extra – it is a means of meeting professional standards more completely and effectively.

Decolonisation is a means of meeting professional standards more completely and effectively

Decolonisation in the curriculum

Decolonising the biomedical science curriculum begins with recognising that the way we teach and assess knowledge reflects the perspectives and historical contexts of those who shaped it. By widening that lens, we can better prepare future biomedical scientists to work with accuracy, sensitivity and scientific rigour in a global healthcare environment.

The first step is to critically review what we currently teach. Whose data underpins our “normal” values? Do our examples reflect the diversity of the patients we serve? Are disease patterns presented as fixed, or do we acknowledge that they change with shifting environmental and social conditions?

This process is not about discarding established science, but about placing it in context. Reference intervals can be taught alongside an explanation of how they were derived and when they may need reinterpretation. Outdated geographical labels for disease can be replaced with ecological or epidemiological framing that reflects present-day realities. Conditions more common in certain populations can be embedded into core teaching of their relevant systems, rather than treated as peripheral.

A decolonised curriculum also gives space to the global history of biomedical science. Many concepts we take for granted, from pulmonary circulation to antiseptic principles, have been documented in different forms by scientists and physicians across Africa, Asia, and the Middle East, often centuries before their “rediscovery” in Europe. This phenomenon has not been confined to the Global South – within Europe, contributions from minority and marginalised groups, such as the Welsh, Bretons, Jews and others whose languages and cultures were historically suppressed, have likewise been overlooked or absorbed into dominant narratives without due recognition. Acknowledging these diverse origins not only corrects the historical record but also reinforces that science is, and always has been, a global and culturally rich endeavour.

Practical steps for educators and practitioners

Turning the principles of decolonisation into everyday practice requires deliberate, sustained action. It is not about overhauling the curriculum or laboratory protocols overnight, but about making incremental, thoughtful changes that cumulatively shift the culture of our profession.

A useful starting point is auditing existing teaching materials and laboratory resources for representation and relevance. For example, a haematology lecture might present iron deficiency anaemia and sickle cell disease as entirely separate topics, with only the former integrated into the main anaemia teaching. By embedding sickle cell and thalassaemia alongside iron deficiency as core causes of anaemia, students see these conditions as part of routine UK laboratory practice, not rare “special topics”. Microbiology case studies might show only light-skinned patients with visible rashes – including images across a range of skin tones can help avoid the diagnostic blind spots that have been well documented.

Another practical measure is to teach the origins and limitations of reference intervals alongside the values themselves. For example, when discussing serum creatinine and eGFR, explaining that ethnicity-based adjustments were historically introduced based on limited assumptions about muscle mass (and have now been phased out in

UK practice) demonstrates how science evolves in response to evidence and equity concerns. In clinical chemistry, this approach might also mean reviewing how vitamin D deficiency is defined, taking into account variations in baseline levels among different ethnic groups.

Collaboration enriches these efforts. Inviting colleagues with expertise in global health, epidemiology, or health inequalities to contribute to lectures or continuing professional development sessions can provide students and practitioners with broader context. For example, a joint seminar between a biomedical scientist and a public health specialist on tuberculosis could explore both the laboratory diagnostics and the social determinants influencing its incidence in migrant populations.

Within the laboratory itself, decolonisation can influence quality assurance and workflow decisions. For instance, in transfusion science, recognising that certain rare blood group phenotypes (such as U-negative or Rh variants) are more prevalent in people of African descent should prompt active donor recruitment strategies and targeted antibody screening protocols. In microbiology, shifting away from the term “tropical disease” in standard operating procedures (SOPs) to terminology that reflects pathogen ecology and transmission better reflects current realities.

Finally, engaging with the wider professional community helps embed these changes across the sector. Writing up a case study for the British Journal of Biomedical Science, presenting at an IBMS branch meeting, or developing a CPD module on inclusive diagnostics are all ways to share best practice. Even small steps, such as updating one lecture or adapting a single SOP, can set a precedent that encourages others to reflect and act.

Challenges, misconceptions and resistance

The word decolonisation can carry baggage. Some hear it and imagine a rejection of Western science, or a politically driven rewriting of history. In biomedical science, it is neither. It is about enhancing the quality and applicability of our evidence base by addressing gaps and questioning inherited assumptions.

Another misconception is that our discipline, being data-driven, is inherently objective. But data is collected and interpreted by people, and those people work within cultural, historical and institutional contexts. Recognising where bias has entered our knowledge systems is not undermining science – it is practising it more rigorously.

Recognising where bias has entered our knowledge systems is not undermining science – it is practising it more rigorously

Concerns about workload or lack of expertise are also common. In reality, meaningful change often starts with small adjustments: reframing a single case study, adding a discussion about dataset origins, or including more representative patient images in teaching resources. These incremental steps are manageable, but collectively they can shift professional norms.

Conclusion

Decolonising the biomedical science curriculum is not about rewriting the past, it is about practising our science with greater accuracy, fairness and global relevance. The historical legacies that shaped our discipline continue to influence the datasets we trust, the parameters we use, and the assumptions we make. By recognising and addressing them, we move closer to a form of biomedical science that truly reflects the diversity of the patients we serve.

A laboratory result is only as reliable as the data, methods and interpretive frameworks behind it. Expanding those frameworks to include a wider range of populations, conditions and perspectives strengthens our science and safeguards patient safety. This work is not separate from our professional duties – it is integral to them.

Every biomedical scientist can take part, whether by revisiting teaching materials, questioning the origins of reference intervals, or sharing inclusive case studies. Small, deliberate steps can lead to significant, lasting change. In the “hidden” world of the laboratory, where decisions quietly shape patient care, embedding decolonisation into our thinking and practice ensures those decisions rest on the most accurate, relevant and equitable science possible. That is not just good professional practice, it is good science.

Dr Dylan Jones is a Lecturer in Biomedical Sciences (Haematology and Human Physiology) at North Wales Medical School