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Momin MM, Wray NR, Lee SH. R2ROC: an efficient method of comparing two or more correlated AUC from out-of-sample prediction using polygenic scores. Hum Genet 2024; 143:1193-1205. [PMID: 38902498 DOI: 10.1007/s00439-024-02682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/29/2024] [Indexed: 06/22/2024]
Abstract
Polygenic risk scores (PRSs) enable early prediction of disease risk. Evaluating PRS performance for binary traits commonly relies on the area under the receiver operating characteristic curve (AUC). However, the widely used DeLong's method for comparative significance tests suffer from limitations, including computational time and the lack of a one-to-one mapping between test statistics based on AUC and R 2 . To overcome these limitations, we propose a novel approach that leverages the Delta method to derive the variance and covariance of AUC values, enabling a comprehensive and efficient comparative significance test. Our approach offers notable advantages over DeLong's method, including reduced computation time (up to 150-fold), making it suitable for large-scale analyses and ideal for integration into machine learning frameworks. Furthermore, our method allows for a direct one-to-one mapping between AUC and R 2 values for comparative significance tests, providing enhanced insights into the relationship between these measures and facilitating their interpretation. We validated our proposed approach through simulations and applied it to real data comparing PRSs for diabetes and coronary artery disease (CAD) prediction in a cohort of 28,880 European individuals. The PRSs were derived using genome-wide association study summary statistics from two distinct sources. Our approach enabled a comprehensive and informative comparison of the PRSs, shedding light on their respective predictive abilities for diabetes and CAD. This advancement contributes to the assessment of genetic risk factors and personalized disease prediction, supporting better healthcare decision-making.
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Affiliation(s)
- Md Moksedul Momin
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, 5000, Australia.
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia.
- Department of Genetics and Animal Breeding, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University (CVASU), Khulshi, Chattogram, 4225, Bangladesh.
- South Australian Health and Medical Research Institute (SAHMRI), University of South Australia, Adelaide, SA, 5000, Australia.
| | - Naomi R Wray
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, OX3 7JX, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - S Hong Lee
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, 5000, Australia.
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia.
- South Australian Health and Medical Research Institute (SAHMRI), University of South Australia, Adelaide, SA, 5000, Australia.
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2
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Katz SJ, Abrahamse P, Furgal A, Hodan R, Tocco RS, Ward KC, Hamilton AS, Wallner LP, Kurian AW. Genetic Counseling, Testing, and Family Communication Into Survivorship After Diagnosis of Breast Cancer. J Clin Oncol 2024; 42:3123-3129. [PMID: 39008790 PMCID: PMC11377164 DOI: 10.1200/jco.24.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/01/2024] [Accepted: 05/14/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE To examine receipt of genetic testing and communication with relatives about results into survivorship after diagnosis of breast cancer. METHODS Women age 20-79 years diagnosed with early-stage breast cancer in 2014-2015 and reported to the Georgia and Los Angeles County SEER registries were surveyed approximately 7 months and 6 years after diagnosis (n = 1,412). We asked about genetic counseling, testing, and communication with relatives about results. We categorized women into indications for testing on the basis of clinical guidelines at the time of diagnosis and at the time of the follow-up survey (FUPs). RESULTS A total of 47.4% had indications for genetic testing at any time: 28.0% at baseline and an additional 19.4% at the time of the FUPs (only); 71.9% (95% CI, 67.4 to 76.4) of those with a baseline indication reported genetic testing versus 53.3% (95% CI, 47.3 to 59.2) with an indication at FUPs only and 35.0% (95% CI, 31.6 to 38.4) with no indication (P < .001). There were no significant racial or ethnic differences in receipt of testing, controlling for age and clinical indications (P = .239); results for genetic counseling were similar. Only 3.4% of survivors had direct-to-consumer genetic testing (DTCt) for cancer. Testers who reported a pathogenic variant (n = 62) were much more likely to have talked to most or all their first-degree adult relatives about genetic testing than those with a variant of unknown significance (n = 49) or a negative finding (n = 419): 62.7% versus 38.8% and 38.0%, respectively (P < .001). CONCLUSION Many women with indications for genetic counseling and testing into survivorship do not receive it. But those tested reach out to family members on the basis of the clinical relevance of their results. Very few patients obtained DTCt, which suggests that these tests do not substitute for clinical testing in breast cancer survivors.
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Affiliation(s)
- Steven J Katz
- Department of Medicine, University of Michigan, Ann Arbor, MI
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Paul Abrahamse
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Allison Furgal
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Rachel Hodan
- Cancer Genetics, Stanford Health Care, Stanford, CA
| | - Rachel S Tocco
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GE
| | - Ann S Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lauren P Wallner
- Department of Medicine, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Allison W Kurian
- Department of Medicine, Stanford University, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
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Barlevy D, Juengst E, Kahn J, Moreno J, Lambert L, Charo A, Chneiweiss H, Farooque M, Guston DH, Hyun I, Knoepfler PS, Selin C, Wilbanks R, Zaghlula M, Scott CT. Governing with public engagement: an anticipatory approach to human genome editing. SCIENCE & PUBLIC POLICY 2024; 51:680-691. [PMID: 39035203 PMCID: PMC11258878 DOI: 10.1093/scipol/scae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/21/2024] [Indexed: 07/23/2024]
Abstract
In response to calls for public engagement on human genome editing (HGE), which intensified after the 2018 He Jiankui scandal that resulted in the implantation of genetically modified embryos, we detail an anticipatory approach to the governance of HGE. By soliciting multidisciplinary experts' input on the drivers and uncertainties of HGE development, we developed a set of plausible future scenarios to ascertain publics values-specifically, their hopes and concerns regarding the novel technology and its applications. In turn, we gathered a subset of multidisciplinary experts to propose governance recommendations for HGE that incorporate identified publics' values. These recommendations include: (1) continued participatory public engagement; (2) international harmonization and transparency of multiple governance levers such as professional and scientific societies, funders, and regulators; and (3) development of a formal whistleblower framework.
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Affiliation(s)
- Dorit Barlevy
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, United States
| | - Eric Juengst
- Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Jonathan Moreno
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Lauren Lambert
- College of Global Futures, Arizona State University, Tempe, AZ 85287, United States
| | - Alta Charo
- Law School, University of Wisconsin–Madison, Madison, WI 53706, United States
| | - Hervé Chneiweiss
- Neuroscience, Institute of Biology Paris Seine, CNRS UMR8246, INSERM U1130, Sorbonne Université, Paris 75252, France
| | - Mahmud Farooque
- Consortium for Science, Policy & Outcomes, Arizona State University, Washington, DC 20006, United States
- School for the Future of Innovation in Society, Arizona State University, Tempe, AZ 85281, United States
| | - David H Guston
- School for the Future of Innovation in Society, Arizona State University, Tempe, AZ 85281, United States
- Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Tempe, AZ 85287, United States
| | - Insoo Hyun
- Museum of Science, Boston, MA 02114, United States
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, United States
| | - Paul S Knoepfler
- Department of Cell Biology & Human Anatomy, UC Davis School of Medicine, Davis, CA 95616, United States
| | - Cynthia Selin
- School for the Future of Innovation in Society, Arizona State University, Tempe, AZ 85281, United States
- School of Sustainability, Arizona State University, Tempe, AZ 85281, United States
| | - Rebecca Wilbanks
- University Writing Program, Johns Hopkins University, Baltimore, MD 21218, United States
| | - Manar Zaghlula
- Innovative Genomics Institute, University of California, Berkeley, CA 97404, United States
| | - Christopher Thomas Scott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, United States
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Willard L, Uhlmann W, Prince AER, Blasco D, Pal S, Roberts JS. The Genetic Information Nondiscrimination Act and workplace genetic testing: Knowledge and perceptions of employed adults in the United States. J Genet Couns 2024. [PMID: 39037108 DOI: 10.1002/jgc4.1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
Workplace wellness programs are an emerging avenue for health-related genetic testing, with some large employers now offering such testing to employees. Employees' knowledge and concerns regarding genetic discrimination may impact their decision-making about and uptake of workplace genetic testing (wGT). This study describes employed adults' objective knowledge of the Genetic Information Nondiscrimination Act (GINA) and evaluates how this knowledge correlates with attitudes and beliefs regarding wGT. Analyses utilized data from a large, national web-based survey of employed adults (N = 2000; mean age = 43 years; 51% female; 55.2% college educated). Overall, most respondents (57.3%) said they were unaware of any laws protecting against genetic discrimination. Specifically, 62.6% indicated they were not at all familiar with GINA. The primary study outcome was respondents' score on a 13-item measure assessing knowledge of basic facts about GINA. Participants had low overall GINA knowledge (M = 4.6/13 items correct (35%), SD = 2.9), with employees often presuming GINA offers greater legal protections than it does (e.g., 45.3% erroneously endorsed that GINA protected against discrimination in life insurance). Logistic regression analyses assessed associations between GINA knowledge and employees' demographic characteristics, prior experience with genetic testing, and attitudes regarding wGT. Variables significantly associated with GINA knowledge included higher interest in wGT (aOR = 1.45; 95% CI: 1.20, 1.77), self-reported familiarity with GINA (aOR = 2.02; 95% CI: 1.64, 2.50), and favorable attitudes toward wGT (aOR = 1.92; 95% CI: 1.52, 2.44). Results indicate public knowledge of GINA remains low over 15 years after its passage. These findings highlight the need for employee education on GINA before participating in wGT, as well as broader public education on GINA's legal protections and limitations. Genetic counselors lead GINA education efforts in clinical and public settings and can play a pivotal role in ongoing public education initiatives about GINA.
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Affiliation(s)
- Lindsay Willard
- Department of Human Genetics, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Wendy Uhlmann
- Department of Human Genetics, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Drew Blasco
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Subhamoy Pal
- Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, Michigan, USA
| | - J Scott Roberts
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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5
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Onstwedder SM, Jansen ME, Cornel MC, Rigter T. Policy Guidance for Direct-to-Consumer Genetic Testing Services: Framework Development Study. J Med Internet Res 2024; 26:e47389. [PMID: 39018558 PMCID: PMC11292153 DOI: 10.2196/47389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/10/2023] [Accepted: 05/09/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND The online offer of commercial genetic tests, also called direct-to-consumer genetic tests (DTC-GTs), enables citizens to gain insight into their health and disease risk based on their genetic profiles. DTC-GT offers often consist of a combination of services or aspects, including advertisements, information, DNA analysis, and medical or lifestyle advice. The risks and benefits of DTC-GT services have been debated and studied extensively, but instruments that assess DTC-GT services and aid policy are lacking. This leads to uncertainty among policy makers, law enforcers, and regulators on how to ensure and balance both public safety and autonomy and about the responsibilities these 3 parties have toward the public. OBJECTIVE This study aimed to develop a framework that outlines aspects of DTC-GTs that lead to policy issues and to help provide policy guidance regarding DTC-GT services. METHODS We performed 3 steps: (1) an integrative literature review to identify risks and benefits of DTC-GT services for consumers and society in Embase and Medline (January 2014-June 2022), (2) structuring benefits and risks in different steps of the consumer journey, and (3) development of a checklist for policy guidance. RESULTS Potential risks and benefits of DTC-GT services were mapped from 134 papers and structured into 6 phases. In summary, these phases were called the consumer journey: (1) exposure, (2) pretest information, (3) DNA analysis, (4) data management, (5) posttest information, and (6) individual and societal impact. The checklist for evaluation of DTC-GT services consisted of 8 themes, covering 38 items that may raise policy issues in DTC-GT services. The themes included the following aspects: general service content, validity and quality assurance, potential data and privacy risks, scientific evidence and robustness, and quality of the provided information. CONCLUSIONS Both the consumer journey and the checklist break the DTC-GT offer down into key aspects that may impact and compromise individual and public health, safety, and autonomy. This framework helps policy makers, regulators, and law enforcers develop methods to interpret, assess, and act in the DTC-GT service market.
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Affiliation(s)
- Suzanne Maria Onstwedder
- Department of Public Health Genomics and Screening, Centre for Health Protection, Dutch National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Section Community Genetics, Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Personalized Medicine Programme, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marleen Elizabeth Jansen
- Department of Public Health Genomics and Screening, Centre for Health Protection, Dutch National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Section Community Genetics, Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Personalized Medicine Programme, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Martina Cornelia Cornel
- Section Community Genetics, Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Personalized Medicine Programme, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Tessel Rigter
- Department of Public Health Genomics and Screening, Centre for Health Protection, Dutch National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Section Community Genetics, Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Personalized Medicine Programme, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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6
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Sun Y, Zhao X, Fan X, Wang M, Li C, Liu Y, Wu P, Yan Q, Sun L. Assessing the impact of sequencing platforms and analytical pipelines on whole-exome sequencing. Front Genet 2024; 15:1334075. [PMID: 38818042 PMCID: PMC11137314 DOI: 10.3389/fgene.2024.1334075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- Yanping Sun
- GeneMind Biosciences Company Limited, Shenzhen, China
| | - Xiaochao Zhao
- GeneMind Biosciences Company Limited, Shenzhen, China
| | - Xue Fan
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Miao Wang
- GeneMind Biosciences Company Limited, Shenzhen, China
| | - Chaoyang Li
- GeneMind Biosciences Company Limited, Shenzhen, China
| | - Yongfeng Liu
- GeneMind Biosciences Company Limited, Shenzhen, China
| | - Ping Wu
- GeneMind Biosciences Company Limited, Shenzhen, China
| | - Qin Yan
- GeneMind Biosciences Company Limited, Shenzhen, China
| | - Lei Sun
- GeneMind Biosciences Company Limited, Shenzhen, China
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Rodriguez NJ, Furniss CS, Yurgelun MB, Ukaegbu C, Constantinou PE, Fortes I, Caruso A, Schwartz AN, Stopfer JE, Underhill-Blazey M, Kenner B, Nelson SH, Okumura S, Zhou AY, Coffin TB, Uno H, Horiguchi M, Ocean AJ, McAllister F, Lowy AM, Klein AP, Madlensky L, Petersen GM, Garber JE, Lippman SM, Goggins MG, Maitra A, Syngal S. A Randomized Trial of Two Remote Health Care Delivery Models on the Uptake of Genetic Testing and Impact on Patient-Reported Psychological Outcomes in Families With Pancreatic Cancer: The Genetic Education, Risk Assessment, and Testing (GENERATE) Study. Gastroenterology 2024; 166:872-885.e2. [PMID: 38320723 PMCID: PMC11034726 DOI: 10.1053/j.gastro.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND & AIMS Genetic testing uptake for cancer susceptibility in family members of patients with cancer is suboptimal. Among relatives of patients with pancreatic ductal adenocarcinoma (PDAC), The GENetic Education, Risk Assessment, and TEsting (GENERATE) study evaluated 2 online genetic education/testing delivery models and their impact on patient-reported psychological outcomes. METHODS Eligible participants had ≥1 first-degree relative with PDAC, or ≥1 first-/second-degree relative with PDAC with a known pathogenic germline variant in 1 of 13 PDAC predisposition genes. Participants were randomized by family, between May 8, 2019, and June 1, 2021. Arm 1 participants underwent a remote interactive telemedicine session and online genetic education. Arm 2 participants were offered online genetic education only. All participants were offered germline testing. The primary outcome was genetic testing uptake, compared by permutation tests and mixed-effects logistic regression models. We hypothesized that Arm 1 participants would have a higher genetic testing uptake than Arm 2. Validated surveys were administered to assess patient-reported anxiety, depression, and cancer worry at baseline and 3 months postintervention. RESULTS A total of 424 families were randomized, including 601 participants (n = 296 Arm 1; n = 305 Arm 2), 90% of whom completed genetic testing (Arm 1 [87%]; Arm 2 [93%], P = .014). Arm 1 participants were significantly less likely to complete genetic testing compared with Arm 2 participants (adjusted ratio [Arm1/Arm2] 0.90, 95% confidence interval 0.78-0.98). Among participants who completed patient-reported psychological outcomes questionnaires (Arm 1 [n = 194]; Arm 2 [n = 206]), the intervention did not affect mean anxiety, depression, or cancer worry scores. CONCLUSIONS Remote genetic education and testing can be a successful and complementary option for delivering genetics care. (Clinicaltrials.gov, number NCT03762590).
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Affiliation(s)
- Nicolette J Rodriguez
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - C Sloane Furniss
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Chinedu Ukaegbu
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Pamela E Constantinou
- Sheikh Ahmed Center for Pancreatic Cancer Research, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | - Scott H Nelson
- Pancreatic Cancer Action Network Volunteer, Patient Advocate, and Pancreatic Cancer Survivor
| | | | | | - Tara B Coffin
- WIRB-Copernicus Group Institutional Review Board, Puyallup, Washington
| | - Hajime Uno
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Miki Horiguchi
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Florencia McAllister
- Sheikh Ahmed Center for Pancreatic Cancer Research, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Andrew M Lowy
- Moores Cancer Center, UC San Diego, San Diego, California
| | - Alison P Klein
- Johns Hopkins University, Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland
| | - Lisa Madlensky
- Moores Cancer Center, UC San Diego, San Diego, California
| | | | - Judy E Garber
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael G Goggins
- Johns Hopkins University, Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland
| | - Anirban Maitra
- Sheikh Ahmed Center for Pancreatic Cancer Research, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sapna Syngal
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
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8
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Nagappan A, Kalokairinou L, Wexler A. Ethical issues in direct-to-consumer healthcare: A scoping review. PLOS DIGITAL HEALTH 2024; 3:e0000452. [PMID: 38349902 PMCID: PMC10863864 DOI: 10.1371/journal.pdig.0000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
An increasing number of health products and services are being offered on a direct-to-consumer (DTC) basis. To date, however, scholarship on DTC healthcare products and services has largely proceeded in a domain-specific fashion, with discussions of relevant ethical challenges occurring within specific medical specialties. The present study therefore aimed to provide a scoping review of ethical issues raised in the academic literature across types of DTC healthcare products and services. A systematic search for relevant publications between 2011-2021 was conducted on PubMed and Google Scholar using iteratively developed search terms. The final sample included 86 publications that discussed ethical issues related to DTC healthcare products and services. All publications were coded for ethical issues mentioned, primary DTC product or service discussed, type of study, year of publication, and geographical context. We found that the types of DTC healthcare products and services mentioned in our sample spanned six categories: neurotechnology (34%), testing (20%), in-person services (17%), digital health tools (14%), telemedicine (13%), and physical interventions (2%). Ethical arguments in favor of DTC healthcare included improved access (e.g., financial, geographical; 31%), increased autonomy (29%), and enhanced convenience (16%). Commonly raised ethical concerns included insufficient regulation (72%), questionable efficacy and quality (70%), safety and physical harms (66%), misleading advertising claims (56%), and privacy (34%). Other frequently occurring ethical concerns pertained to financial costs, targeting vulnerable groups, informed consent, and potential burdens on healthcare providers, the healthcare system, and society. Our findings offer insights into the cross-cutting ethical issues associated with DTC healthcare and underscore the need for increased interdisciplinary communication to address the challenges they raise.
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Affiliation(s)
- Ashwini Nagappan
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California, United States of America
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, United States of America
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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9
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Haley CE, Zawati MH. Direct-to-Consumer Genetic Tests and Canadian Genetic Counselors: A Pilot Exploration of Professional Roles in Response to Novel Biotechnologies. Genes (Basel) 2024; 15:156. [PMID: 38397146 PMCID: PMC10888315 DOI: 10.3390/genes15020156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/14/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
The role of genetic counselors is evolving in response to health-related direct-to-consumer genetic tests (DTC-GT). While there is consensus in the literature that pre- and post-DTC-GT genetic counseling would benefit consumers, genetic counselors have reservations about DTC-GTs, and there is a paucity of research on providing DTC-GT counseling. This pilot quantitative survey is the first study to examine Canadian genetic counselors' views on DTC-GTs and how this disruptive biotechnology affects their role, and consumer informed consent and privacy. Canadian genetic counselors are cognizant of the harm to informed consent and privacy associated with DTC-GT, but are hesitant to engage directly, wary of misusing clinical time and resources. However, counselors are open to producing educational materials on DTC-GTs and collaborating with other stakeholders and the DTC-GT industry to support consumers. In this study, practical considerations for DTC-GT counseling sessions are discussed, including the unique needs of DTC-GT patients and the challenges posed by DTC-GTs to the genetic counseling duty to inform. This research benefits genetic counselors and physicians by examining how best to utilize genetic counselors' skills in the DTC-GT context, to minimize burdens on the healthcare system and support DTC-GT consumers.
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Affiliation(s)
| | - Ma’n H. Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada;
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10
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Kirby HG, Rehm HL, Hull LE. An Environmental Scan of Consumer-Initiated Germline Genetic Testing for Health Risks. Mayo Clin Proc 2023; 98:1529-1543. [PMID: 37632486 PMCID: PMC10593045 DOI: 10.1016/j.mayocp.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 08/28/2023]
Abstract
As patient access to laboratory testing outside the clinic grows, health care providers can expect to confront increasing questions about the utility and interpretation of consumer-initiated genetic testing for health risks. We sought to characterize the marketplace diversity of consumer-initiated germline genetic testing options. An environmental scan was conducted to identify germline genetic testing companies that offer testing for at least one diagnosable health condition and are available for purchase by consumers in the US market without a visit to one's health care provider. We limited our scope to tests available between October 1, 2019, and September 30, 2021. We characterized variability in the content and processes used by 21 companies offering 74 distinct test products that met our inclusion and exclusion criteria. A minority (8 of 21 companies) offered tests that assessed the presence of at least 1 US Centers for Disease Control and Prevention Tier 1 condition for which detection can impact an individual's clinical care and for which evidence-based guidelines for detection and management exist.
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Affiliation(s)
| | - Heidi L Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Leland E Hull
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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Oni-Orisan A, Tuteja S, Hoffecker G, Smith DM, Castrichini M, Crews KR, Murphy WA, Nguyen NHK, Huang Y, Lteif C, Friede KA, Tantisira K, Aminkeng F, Voora D, Cavallari LH, Whirl-Carrillo M, Duarte JD, Luzum JA. An Introductory Tutorial on Cardiovascular Pharmacogenetics for Healthcare Providers. Clin Pharmacol Ther 2023; 114:275-287. [PMID: 37303270 PMCID: PMC10406163 DOI: 10.1002/cpt.2957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
Pharmacogenetics can improve clinical outcomes by reducing adverse drug effects and enhancing therapeutic efficacy for commonly used drugs that treat a wide range of cardiovascular diseases. One of the major barriers to the clinical implementation of cardiovascular pharmacogenetics is limited education on this field for current healthcare providers and students. The abundance of pharmacogenetic literature underscores its promise, but it can also be challenging to learn such a wealth of information. Moreover, current clinical recommendations for cardiovascular pharmacogenetics can be confusing because they are outdated, incomplete, or inconsistent. A myriad of misconceptions about the promise and feasibility of cardiovascular pharmacogenetics among healthcare providers also has halted clinical implementation. Therefore, the main goal of this tutorial is to provide introductory education on the use of cardiovascular pharmacogenetics in clinical practice. The target audience is any healthcare provider (or student) with patients that use or have indications for cardiovascular drugs. This tutorial is organized into the following 6 steps: (1) understand basic concepts in pharmacogenetics; (2) gain foundational knowledge of cardiovascular pharmacogenetics; (3) learn the different organizations that release cardiovascular pharmacogenetic guidelines and recommendations; (4) know the current cardiovascular drugs/drug classes to focus on clinically and the supporting evidence; (5) discuss an example patient case of cardiovascular pharmacogenetics; and (6) develop an appreciation for emerging areas in cardiovascular pharmacogenetics. Ultimately, improved education among healthcare providers on cardiovascular pharmacogenetics will lead to a greater understanding for its potential in improving outcomes for a leading cause of morbidity and mortality.
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Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Sony Tuteja
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Glenda Hoffecker
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D. Max Smith
- MedStar Health, Columbia, Maryland, USA
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Matteo Castrichini
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristine R. Crews
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - William A. Murphy
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nam H. K. Nguyen
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Yimei Huang
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Christelle Lteif
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin A. Friede
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kelan Tantisira
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Folefac Aminkeng
- Departments of Medicine and Biomedical Informatics (DBMI), Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
- Centre for Precision Health (CPH), National University Health System (NUHS), Singapore City, Singapore
| | - Deepak Voora
- Precision Medicine Program, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Julio D. Duarte
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Jasmine A. Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
- Center for Individualized and Genomic Medicine Research, Henry Ford Health System, Detroit, Michigan, USA
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12
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Wodoslawsky S, Fatunbi J, Mercier R, Braverman AM. Sperm donor attitudes and experiences with direct-to-consumer genetic testing. F S Rep 2023; 4:36-42. [PMID: 36959965 PMCID: PMC10028474 DOI: 10.1016/j.xfre.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 03/12/2023] Open
Abstract
Objective To identify factors influencing sperm donor willingness to participate in direct-to-consumer genetic testing, comfort with sharing genetically identifiable data in commercial genetic testing databases, and likelihood to donate sperm again. Design Cross-sectional online anonymous survey. Setting Multicenter, 2 large American sperm banks from July 1, 2020 to July10, 2021. Patients Sperm donors from 1980 to 2020. Interventions None. Main outcome measures Associations between donor demographic characteristics, donation history, and attitudes toward direct-to-consumer genetic testing. Results A total of 396 donors completed the survey. Most donations (61.5%) occurred from 2010 to 2020, and 34.3% were nonidentified donations. Nonidentified donors were less comfortable with their genetic data being shared than open-identity donors (25.4% vs. 43.8%) and were less likely than open-identity donors to donate sperm again (43.3% vs. 72.1%). Donors who donated after the inception of direct-to-consumer genetic testing in 2007 were less likely to participate in commercial genetic testing than those who donated before 2007 (25.8% vs. 37.1%). Most donors (87.4%) have disclosed their donation(s) to current partners, but fewer have disclosed them to their families (56.6%) or children (30.5%). Of the donors who had been contacted by donor-conceived persons, 79.5% were identified via direct-to-consumer genetic testing. Overall, 61.1% of donors would donate again regardless of direct-to-consumer genetic testing. Conclusions Direct-to-consumer genetic testing is playing a dynamic role in sperm donor identification, but donors seem willing to donate again. Implication counseling regarding future linkage and contact from donor-conceived persons needs to be standardized for potential donors before donation.
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Affiliation(s)
- Sascha Wodoslawsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joy Fatunbi
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrea Mechanick Braverman
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Reprint requests: Andrea Mechanick Braverman, Ph.D., Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 833 Chestnut Street, Mezzanine, Philadelphia, Pennsylvania 19004.
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13
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Morstead T, DeLongis A. Searching for secrets, searching for self: Childhood adversity, self-concept clarity, and the motivation to uncover family secrets through direct-to-consumer genetic testing. J Genet Couns 2023. [PMID: 36734314 DOI: 10.1002/jgc4.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
Direct-to-consumer (DTC) genetic tests have become an attractive product for those hoping to gain insight into their health, ancestry, and biological relatedness. In some cases, test results are unexpected, and lead to the revelation of previously undisclosed family secrets. A subset of individuals may pursue testing explicitly for this purpose; however, the psychosocial processes underlying this motivation remain unexamined. Grounded in the literature on family secrecy, trauma, and the development of self-concept, we tested a hypothesized mediation model to provide insight into this motivation among a sample of 433 individuals in pursuit of DTC genetic testing. In line with the documented association between maladaptive family communication patterns and trauma exposure in childhood, we found that exposure to adverse childhood experiences was associated with the motivation to pursue DTC genetic testing for the purpose of uncovering family secrets. We also found evidence of an indirect effect through reduced self-concept clarity. These findings suggest that impaired identity formation processes may have played a role in transmitting the effect. Furthermore, the findings highlight a novel way in which family histories may contribute to DTC genetic testing motivations. Future examination of these and other psychosocial phenomena that contribute to DTC genetic testing will be crucial to consider as the tests become increasingly accessible, and as the information they can provide becomes increasingly comprehensive. Findings from this line of research could help to identify for whom and under what conditions DTC genetic testing benefits well-being, and the conditions under which the act of testing and receipt of results could have adverse psychosocial effects. These insights will be of interest to genetic counselors working in the field of DTC genetic testing, and those working with individuals and families affected by unexpected test results.
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Affiliation(s)
- Talia Morstead
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anita DeLongis
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
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14
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Offit K, Sharkey CM, Green D, Wu X, Trottier M, Hamilton JG, Walsh MF, Dandiker S, Belhadj S, Lipkin SM, Sugrañes TA, Caggana M, Stadler ZK. Regulation of Laboratory-Developed Tests in Preventive Oncology: Emerging Needs and Opportunities. J Clin Oncol 2023; 41:11-21. [PMID: 35944238 PMCID: PMC10409443 DOI: 10.1200/jco.22.00995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/19/2022] [Accepted: 06/27/2022] [Indexed: 12/27/2022] Open
Abstract
Cancer predictive or diagnostic assays, offered as Laboratory-Developed Tests (LDTs), have been subject to regulatory authority and enforcement discretion by the US Food and Drug Administration. Many LDTs enter the market without US Food and Drug Administration or any regulatory review. The Centers for Medicare & Medicaid Services under the Clinical Laboratory Improvement Amendments focuses on analytic performance, but has limited oversight of the quality or utility of LDTs, including whether patients have been harmed as a result of their use. Increasingly, LDTs for cancer risk or early detection have been marketed directly to consumers, with many LDT developers depicting these tests, requested by patients but ordered by personal or company-associated physicians, as procedures falling under the practice of medicine. This patchwork of regulation and enforcement uncertainty regarding LDTs and public concerns about accuracy of tests given emergency authorization during the COVID-19 pandemic led to the Verifying Accurate Leading-edge IVCT (in vitro clinical test) Development Act of 2021. This pending federal legislation represents an opportunity to harmonize regulatory policies and address growing concerns over quality, utility, and safety of LDTs for cancer genomics, including tests marketed directly to consumers. We review here questions regarding the potential benefits and harms of some cancer-related LDTs for cancer risk and presymptomatic molecular diagnosis, increasingly marketed to oncologists or directly to the worried well. We offer specific proposals to strengthen oversight of the accuracy and clinical utility of cancer genetic testing to ensure public safety.
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Affiliation(s)
- Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Dina Green
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Xiaohan Wu
- The University of California, Berkeley School of Law, Berkeley, CA
| | - Magan Trottier
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jada G. Hamilton
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Michael F. Walsh
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sita Dandiker
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sami Belhadj
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Michele Caggana
- Wadsworth Center, New York State Department of Health, Albany, NY
| | - Zsofia K. Stadler
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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15
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Kiflen M, Le A, Mao S, Lali R, Narula S, Xie F, Paré G. Cost-Effectiveness of Polygenic Risk Scores to Guide Statin Therapy for Cardiovascular Disease Prevention. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003423. [PMID: 35904973 DOI: 10.1161/circgen.121.003423] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atherosclerotic cardiovascular diseases (CVDs) are leading causes of death despite effective therapies and result in unnecessary morbidity and mortality throughout the world. We aimed to investigate the cost-effectiveness of polygenic risk scores (PRS) to guide statin therapy for Canadians with intermediate CVD risk and model its economic outlook. METHODS This cost-utility analysis was conducted using UK Biobank prospective cohort study participants, with recruitment from 2006 to 2010, and at least 10 years of follow-up. We included nonrelated white British-descent participants (n=96 116) at intermediate CVD risk with no prior lipid lowering medication or statin-indicated conditions. A coronary artery disease PRS was used to inform decision to use statins. The effects of statin therapy with and without PRS, as well as CVD events were modelled to determine the incremental cost-effectiveness ratio from a Canadian public health care perspective. We discounted future costs and quality-adjusted life-years by 1.5% annually. RESULTS The optimal economic strategy was when intermediate risk individuals with a PRS in the top 70% are eligible for statins while the lowest 1% are excluded. Base-case analysis at a genotyping cost of $70 produced an incremental cost-effectiveness ratio of $172 906 (143 685 USD) per quality-adjusted life-year. In the probabilistic sensitivity analysis, the intervention has approximately a 50% probability of being cost-effective at $179 100 (148 749 USD) per quality-adjusted life-year. At a $0 genotyping cost, representing individuals with existing genotyping information, PRS-guided strategies dominated standard care when 12% of the lowest PRS individuals were withheld from statins. With improved PRS predictive performance and lower genotyping costs, the incremental cost-effectiveness ratio demonstrates possible cost-effectiveness under thresholds of $150 000 and possibly $50 000 per quality-adjusted life-year. CONCLUSIONS This study suggests that using PRS alongside existing guidelines might be cost-effective for CVD. Stronger predictiveness combined with decreased cost of PRS could further improve cost-effectiveness, providing an economic basis for its inclusion into clinical care.
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Affiliation(s)
- Michel Kiflen
- Department of Medicine, University of Toronto, Toronto (M.K.).,Population Health Research Institute (M.K., A.L., S.M., R.L., S.N., G.P.), McMaster University, Hamilton, Ontario, Canada
| | - Ann Le
- Population Health Research Institute (M.K., A.L., S.M., R.L., S.N., G.P.), McMaster University, Hamilton, Ontario, Canada.,Department of Medical Sciences (A.L.), McMaster University, Hamilton, Ontario, Canada
| | - Shihong Mao
- Population Health Research Institute (M.K., A.L., S.M., R.L., S.N., G.P.), McMaster University, Hamilton, Ontario, Canada
| | - Ricky Lali
- Population Health Research Institute (M.K., A.L., S.M., R.L., S.N., G.P.), McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact (R.L., S.N., F.X., G.P.), McMaster University, Hamilton, Ontario, Canada
| | - Sukrit Narula
- Population Health Research Institute (M.K., A.L., S.M., R.L., S.N., G.P.), McMaster University, Hamilton, Ontario, Canada.,Department of Internal Medicine, Yale University, New Haven, CT (S.N.)
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact (R.L., S.N., F.X., G.P.), McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Paré
- Population Health Research Institute (M.K., A.L., S.M., R.L., S.N., G.P.), McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact (R.L., S.N., F.X., G.P.), McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine (G.P.), McMaster University, Hamilton, Ontario, Canada.,Thrombosis & Atherosclerosis Research Institute (G.P.), McMaster University, Hamilton, Ontario, Canada.,McMaster University, Hamilton, Ontario, Canada (G.P.)
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16
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Calderon-Casellas C, Lacson JCA, Forgas SM, Doyle SH, Del Rio J, Feliciano AR, Kim Y, Roetzheim RG, Sutton SK, Vadaparampil ST, Soto-Torres B, Kanetsky PA. Assessment of skin cancer precision prevention materials among Hispanics in Florida and Puerto Rico. PATIENT EDUCATION AND COUNSELING 2022; 105:3143-3150. [PMID: 35778318 DOI: 10.1016/j.pec.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess Hispanic participants' ratings of intervention materials and examine differences by language preference. METHODS Participants on a skin cancer prevention trial were randomized to receive generic (n = 457) or precision prevention materials conveying average (n = 195) or higher genetic risk (n = 268) based on MC1R genotype. Three months after receiving either English or Spanish language prevention materials, participants reported amount read, believability and clarity of materials, and intention to change preventive behavior. RESULTS Participants reported high levels on all four outcomes, but the precision prevention groups noted lower clarity than the generic group (p = 3.2 ×10-6). Participants preferring Spanish provided consistently higher scores than those preferring English. Among English-preferring participants, those in the precision prevention groups scored lower on all measures than those in the generic group. CONCLUSIONS Skin cancer prevention materials were well-received by Hispanic participants. Higher scores among participants preferring Spanish may indicate acquiescence bias, or that translated prevention materials met their linguistic needs. Participants in the precision prevention groups with English language preference may have challenges in the uptake of genetic risk results. PRACTICE IMPLICATIONS Availability of Spanish materials may have facilitated higher scores. Additional strategies should be explored to optimize participants' believability and clarity of precision prevention materials.
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Affiliation(s)
| | - John Charles A Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Stephanie M Forgas
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Scarlet H Doyle
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jocelyn Del Rio
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan T Vadaparampil
- Department of Health and Behavioral Outcomes, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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17
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Gooden A, Thaldar DW. Direct-to-Consumer Genetic Testing in South Africa: Stumbling Over the First Legal Hurdle? POTCHEFSTROOM ELECTRONIC LAW JOURNAL 2022; 25:10.17159/1727-3781/2022/v25i0a11764. [PMID: 37383487 PMCID: PMC10306243 DOI: 10.17159/1727-3781/2022/v25i0a11764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Despite the growing popularity of direct-to-consumer genetic testing, there is minimal South African literature on the topic. The limited available research suggests that direct-to-consumer genetic testing is unregulated. However, we suggest that direct-to-consumer genetic testing is indeed regulated, and unusually so. The first step in the process - the collection of a saliva sample by consumers themselves - is unlawful on a plain reading of the National Health Act 61 of 2003 and the Regulations Relating to the Use of Human Biological Material. This is because these statutes require that certain healthcare professionals must remove saliva for genetic testing. Yet, on closer analysis, such an apparent ban on the self-collection of saliva is neither aligned with a purposive interpretation of the relevant legislation, nor would it survive constitutional scrutiny - as it impedes an individual's autonomy. It is concluded that, contrary to a plain reading of the relevant statutes, individuals can lawfully collect their own saliva for direct-to-consumer genetic testing. To provide legal clarity we recommend that the relevant provisions of the National Health Act 61 of 2003 and Regulations Relating to the Use of Human Biological the Material be amended to allow individuals to collect their own saliva samples.
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Affiliation(s)
- Amy Gooden
- University of KwaZulu-Natal South Africa
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18
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Koplin JJ, Skeggs J, Gyngell C. Ethics of Buying DNA. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:395-406. [PMID: 35854191 PMCID: PMC9463216 DOI: 10.1007/s11673-022-10192-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 08/13/2021] [Indexed: 06/15/2023]
Abstract
DNA databases have significant commercial value. Direct-to-consumer genetic testing companies have built databanks using samples and information voluntarily provided by customers. As the price of genetic analysis falls, there is growing interest in building such databases by paying individuals for their DNA and personal data. This paper maps the ethical issues associated with private companies paying for DNA. We outline the benefits of building better genomic databases and describe possible concerns about crowding out, undue inducement, exploitation, and commodification. While certain objections deserve more empirical and philosophical investigation, we argue that none currently provide decisive reasons against using financial incentives to secure DNA samples.
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Affiliation(s)
- Julian J Koplin
- Melbourne Law School, University of Melbourne, 185 Pelham St, Carlton, VIC, 3053, Australia.
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Jack Skeggs
- Monash University, Melbourne, VIC, Australia
| | - Christopher Gyngell
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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19
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O'Sullivan JW, Raghavan S, Marquez-Luna C, Luzum JA, Damrauer SM, Ashley EA, O'Donnell CJ, Willer CJ, Natarajan P. Polygenic Risk Scores for Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e93-e118. [PMID: 35862132 PMCID: PMC9847481 DOI: 10.1161/cir.0000000000001077] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cardiovascular disease is the leading contributor to years lost due to disability or premature death among adults. Current efforts focus on risk prediction and risk factor mitigation' which have been recognized for the past half-century. However, despite advances, risk prediction remains imprecise with persistently high rates of incident cardiovascular disease. Genetic characterization has been proposed as an approach to enable earlier and potentially tailored prevention. Rare mendelian pathogenic variants predisposing to cardiometabolic conditions have long been known to contribute to disease risk in some families. However, twin and familial aggregation studies imply that diverse cardiovascular conditions are heritable in the general population. Significant technological and methodological advances since the Human Genome Project are facilitating population-based comprehensive genetic profiling at decreasing costs. Genome-wide association studies from such endeavors continue to elucidate causal mechanisms for cardiovascular diseases. Systematic cataloging for cardiovascular risk alleles also enabled the development of polygenic risk scores. Genetic profiling is becoming widespread in large-scale research, including in health care-associated biobanks, randomized controlled trials, and direct-to-consumer profiling in tens of millions of people. Thus, individuals and their physicians are increasingly presented with polygenic risk scores for cardiovascular conditions in clinical encounters. In this scientific statement, we review the contemporary science, clinical considerations, and future challenges for polygenic risk scores for cardiovascular diseases. We selected 5 cardiometabolic diseases (coronary artery disease, hypercholesterolemia, type 2 diabetes, atrial fibrillation, and venous thromboembolic disease) and response to drug therapy and offer provisional guidance to health care professionals, researchers, policymakers, and patients.
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20
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Toussaint PA, Renner M, Lins S, Thiebes S, Sunyaev A. Direct-to-Consumer Genetic Testing on Social Media: Topic Modeling and Sentiment Analysis of YouTube Users' Comments. JMIR INFODEMIOLOGY 2022; 2:e38749. [PMID: 37113449 PMCID: PMC10014090 DOI: 10.2196/38749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/15/2022] [Accepted: 08/18/2022] [Indexed: 04/29/2023]
Abstract
Background With direct-to-consumer (DTC) genetic testing enabling self-responsible access to novel information on ancestry, traits, or health, consumers often turn to social media for assistance and discussion. YouTube, the largest social media platform for videos, offers an abundance of DTC genetic testing-related videos. Nevertheless, user discourse in the comments sections of these videos is largely unexplored. Objective This study aims to address the lack of knowledge concerning user discourse in the comments sections of DTC genetic testing-related videos on YouTube by exploring topics discussed and users' attitudes toward these videos. Methods We employed a 3-step research approach. First, we collected metadata and comments of the 248 most viewed DTC genetic testing-related videos on YouTube. Second, we conducted topic modeling using word frequency analysis, bigram analysis, and structural topic modeling to identify topics discussed in the comments sections of those videos. Finally, we employed Bing (binary), National Research Council Canada (NRC) emotion, and 9-level sentiment analysis to identify users' attitudes toward these DTC genetic testing-related videos, as expressed in their comments. Results We collected 84,082 comments from the 248 most viewed DTC genetic testing-related YouTube videos. With topic modeling, we identified 6 prevailing topics on (1) general genetic testing, (2) ancestry testing, (3) relationship testing, (4) health and trait testing, (5) ethical concerns, and (6) YouTube video reaction. Further, our sentiment analysis indicates strong positive emotions (anticipation, joy, surprise, and trust) and a neutral-to-positive attitude toward DTC genetic testing-related videos. Conclusions With this study, we demonstrate how to identify users' attitudes on DTC genetic testing by examining topics and opinions based on YouTube video comments. Shedding light on user discourse on social media, our findings suggest that users are highly interested in DTC genetic testing and related social media content. Nonetheless, with this novel market constantly evolving, service providers, content providers, or regulatory authorities may still need to adapt their services to users' interests and desires.
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Affiliation(s)
- Philipp A Toussaint
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
- HIDSS4Health - Helmholtz Information and Data Science School for Health Karlsruhe/Heidelberg Germany
| | - Maximilian Renner
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
| | - Sebastian Lins
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
| | - Scott Thiebes
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
| | - Ali Sunyaev
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
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21
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Arcila ME, Snow AN, Akkari YMN, Chabot-Richards D, Pancholi P, Tafe LJ. Molecular Pathology Education: A Suggested Framework for Primary Care Resident Training in Genomic Medicine: A Report of the Association for Molecular Pathology Training and Education Committee. J Mol Diagn 2022; 24:430-441. [PMID: 35304347 DOI: 10.1016/j.jmoldx.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/17/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
Developments in genomics are profoundly influencing medical practice. With increasing use of genetic and genomic testing across every aspect of the health care continuum, patients and their families are increasingly turning to primary care physicians (PCPs) for discussion and advice regarding tests, implications, and results. Yet, with the rapid growth of information, technology, and applications, PCPs are finding it challenging to fill the gaps in knowledge and support the growing needs of their patients. A critical component in expanding PCP genomic literacy lies in the education of physicians in training and in practice. Although a framework for developing physician competencies in genomics has already been developed, the Association for Molecular Pathology is uniquely situated to actively utilize the skills of its members to engage and support PCPs in this effort. This report provides an overview and a suggested basic teaching framework, which can be used by molecular professionals in their individual institutions as a starting point for educational outreach.
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Affiliation(s)
- Maria E Arcila
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony N Snow
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Yassmine M N Akkari
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Cytogenetics and Molecular Pathology, Legacy Health, Portland, Oregon
| | - Devon Chabot-Richards
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Preeti Pancholi
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura J Tafe
- Molecular Genetic Pathology Primary Care Curriculum Task Force of the Training and Education Committee, Association for Molecular Pathology, Rockville, Maryland; Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
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22
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Lee J, Kwon KH. Development of customized inner beauty products and customized cosmetics apps according to the use of NRF2 through DTC genetic testing after the COVID‐19 pandemic. J Cosmet Dermatol 2022; 21:2288-2297. [PMID: 35466548 PMCID: PMC9115250 DOI: 10.1111/jocd.14467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 04/02/2022] [Accepted: 09/08/2021] [Indexed: 10/26/2022]
Affiliation(s)
- Jinkyung Lee
- Division of Beauty Arts Care Department of Practical Arts Graduate School of Culture and Arts Dongguk University Seoul Republic of Korea
- Daily Beauty Unit Amorepacific Co. Seoul Republic of Korea
| | - Ki Han Kwon
- College of General Education Kookmin University Seoul Republic of Korea
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Anderson HD, Thant TM, Kao DP, Crooks KR, Mendola N, Aquilante CL. Pharmacogenetic testing among patients with depression in a US managed care population. Clin Transl Sci 2022; 15:1644-1653. [PMID: 35385214 PMCID: PMC9283740 DOI: 10.1111/cts.13279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022] Open
Abstract
Actionable drug–gene pairs relevant to depression treatment include CYP2D6 and CYP2C19 with specific antidepressants. While clinical use of pharmacogenetic testing is growing, little is known about pharmacogenetic testing for depression treatment in managed care. We determined the incidence of single‐gene CYP2D6 and CYP2C19 testing following a new depression episode among US managed care patients, and described characteristics and antidepressant use of patients receiving tests. We used paid medical and pharmacy claims for patients from commercial health plans in the US. For adult patients with a new depression episode from January 1, 2013 to June 30, 2018, we identified covered claims for single‐gene CYP2D6 and CYP2C19 pharmacogenetic tests and antidepressant fills. Fewer than 1% (n = 1795) of the depressed cohort (n = 438,534) received a single‐gene CYP2D6 or CYP2C19 test through their insurance within 365 days of their earliest depression episode. The percentage of patients who received a test nearly tripled from 0.2% in 2013 to 0.5% in 2014 before plateauing at 0.4% from 2014 to 2017. Among the patients who received a single‐gene CYP2D6 or CYP2C19 test and filled an antidepressant within 365 days of their depression diagnosis, up to 30% may have had their initial antidepressant informed by the test result. Our findings describe the use of antidepressants before and after pharmacogenetic testing, which is clinically relevant as pharmacogenomic testing becomes more common in clinical practice. Our study also emphasizes the need for procedure and billing codes that capture multiple‐gene panel tests to be more widely implemented in administrative databases.
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Affiliation(s)
- Heather D Anderson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Thida M Thant
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David P Kao
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kristy R Crooks
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas Mendola
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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Hull LE, Natarajan P. Self-rated family health history knowledge among All of Us program participants. Genet Med 2022; 24:955-961. [PMID: 35058155 PMCID: PMC8995381 DOI: 10.1016/j.gim.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Disparities in access to genetics services are well-documented. Family health history is routinely used to determine whether patients should be screened for heritable conditions. We sought to explore variation in levels of self-rated family health history knowledge as a possible contributer to this disparity. METHODS We performed a cross-sectional analysis of survey data from the All of Us Research Program. We compared the characteristics of participants who reported "None," "Some", and "A lot" of family health history knowledge using multinomial logistic regression. RESULTS Self-rated family health history data were available for 116,799 participants. A minority of survey participants (37%) endorsed "A lot" of knowledge about their family health history (n = 43,661). Most participants (60%) endorsed "Some" family health history knowledge (n = 69,914) and 3% (n = 3224) endorsed "None." In adjusted analyses, those who indicated "Some" family health history knowledge or "None" were more likely to be assigned male sex at birth, identify as possible gender and sexual minorities, have a self-reported race other than White, have a lower household annual income (<$25,000), or report lower educational attainment ( CONCLUSION Family health history knowledge may be limited, especially among traditionally underserved populations.
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Affiliation(s)
- Leland E Hull
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
| | - Pradeep Natarajan
- Department of Medicine, Harvard Medical School, Boston, MA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA; Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA.
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Potential Pitfalls of Reproductive Direct-to-Consumer Testing. F S Rep 2022; 3:3-7. [PMID: 35386504 PMCID: PMC8978065 DOI: 10.1016/j.xfre.2022.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/22/2022] Open
Abstract
The availability of direct-to-consumer (DTC) testing has dramatically increased over the past 2 decades, particularly those targeted at reproduction and fertility. Several ethical concerns exist with regard to DTC tests, including the lack of governmental regulation and consumer protection, standardized laboratory methodology, and clinical validity and actionability. Physicians must familiarize themselves with the pitfalls of DTC tests to best aid patients in interpreting DTC test results and guide them toward evidence-based treatment plans.
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Toussaint PA, Thiebes S, Schmidt-Kraepelin M, Sunyaev A. Perceived fairness of direct-to-consumer genetic testing business models. ELECTRONIC MARKETS 2022; 32:1621-1638. [PMID: 35874303 PMCID: PMC9294841 DOI: 10.1007/s12525-022-00571-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/29/2022] [Indexed: 05/14/2023]
Abstract
UNLABELLED Although consumers and experts often express concerns regarding the questionable business practices of direct-to-consumer (DTC) genetic testing services (e.g., reselling of consumers' genetic data), the DTC genetic testing market keeps expanding rapidly. We employ retail fairness as our theoretical lens to address this seeming paradox and conduct a discrete choice experiment with 16 attributes to better understand consumers' fairness perceptions of DTC genetic testing business models. Our results suggest that, while consumers perceive privacy-preserving DTC genetic testing services fairer, price is the main driver for fairness perception. We contribute to research on consumer perceptions of DTC genetic testing by investigating consumer preferences of DTC genetic testing business models and respective attributes. Further, this research contributes to knowledge about disruptive business models in healthcare and retail fairness by contextualizing the concept of retail fairness in the DTC genetic testing market. We also demonstrate how to utilize discrete choice experiments to elicit perceived fairness. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12525-022-00571-x.
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Affiliation(s)
- Philipp A. Toussaint
- Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstr. 89, 76133 Karlsruhe, Germany
| | - Scott Thiebes
- Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstr. 89, 76133 Karlsruhe, Germany
| | - Manuel Schmidt-Kraepelin
- Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstr. 89, 76133 Karlsruhe, Germany
| | - Ali Sunyaev
- Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstr. 89, 76133 Karlsruhe, Germany
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27
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Kilbride MK, Bradbury AR. Evaluating Web-Based Direct-to-Consumer Genetic Tests for Cancer Susceptibility. JCO Precis Oncol 2022; 4:1900317. [PMID: 34970636 DOI: 10.1200/po.19.00317] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Recent years have seen direct-to-consumer (DTC) genetic testing for cancer susceptibility change dramatically. For one, a new model now dominates the market where tests are advertised to consumers but ordered by physicians. For another, many of today's tests are distinguished from earlier DTC offerings for cancer susceptibility by their scope and potential clinical significance. This review provides a comprehensive overview of available DTC genetic tests for cancer susceptibility and identifies aspects of the DTC testing process that could affect consumers' ability to make informed decisions about testing and understand their results. METHODS First, we provide an overview of each DTC genetic test for cancer susceptibility that includes information about cost; who orders it; whether variants of uncertain significance are returned; availability of genetic counseling; intended users; management of variant reclassifications; whether it is characterized as diagnostic, actionable, and clinically valid; molecular technique used; and Clinical Laboratory Improvement Amendments/College of American Pathologists status. Second, we identify six aspects of the testing process that could affect consumers' ability to make informed decisions about testing and interpret their results: How companies use certain terms (eg, medical grade or clinical grade); how companies use consumers' health information during the ordering process; the extent of genetic counseling provided by companies; companies' procedures for returning results; the role of company-provided ordering physicians; and companies' procedures for communicating variant reclassifications. RESULTS On the basis of our review of companies' Web sites, we believe that consumers would benefit from more information about these aspects of testing. CONCLUSION Providing this information would help consumers make informed decisions about whether to use a particular DTC genetic testing service and, should they choose to pursue testing, understand the implications and limitations of their results.
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Affiliation(s)
- Madison K Kilbride
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Angela R Bradbury
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Medicine, Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Lee GY, Han SN. Direct-to-Consumer Genetic Testing in Korea: Current Status and Significance in Clinical Nutrition. Clin Nutr Res 2021; 10:279-291. [PMID: 34796133 PMCID: PMC8575646 DOI: 10.7762/cnr.2021.10.4.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022] Open
Abstract
Direct-to-consumer genetic testing (DTC-GT) provides a means for consumers to gain insights into their genetic background and how it relates to their health without the involvement of medical institutions. In Korea, DTC-GT was introduced in 2016 in accordance with the legislation on Paragraph (3) 2 of Article 50 of the Bioethics and Safety Act. Only 12 genetic test items involving 46 genes were approved at first, but the approved items were expanded to 70 in November 2020. However, the genetic test items of DTC-GT services in Korea are still restricted to the wellness area, and access to disease risk related information is only permitted to medical institutions. Further, studies revealing the relationship between genotype differences and responses to nutrients, food components, or nutritional status are increasing, and this association appears to be robust for some genes. This strong association between genetic variations and nutrition suggests that DTC-GT can be used as an important tool by clinical nutritionists to gain insights into an individual's genetic susceptibilities and provide guidance on nutritional counseling and meal planning based on the patient's genetic information. This review summarized the history and current status of DTC-GT and investigated the relationship between genetic variations with associated phenotypic traits to clarify further the importance of DTC-GT in the field of clinical nutrition.
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Affiliation(s)
- Ga Young Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul 08826, Korea
| | - Sung Nim Han
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul 08826, Korea.,Research Institute of Human Ecology, Seoul National University, Seoul 08826, Korea
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29
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Bowden TL, Letourneau-Freiberg LR, Kandasamy B, Sanyoura M, Tian P, Harris AG, Bell GI, Philipson LH, Naylor RN, Greeley SAW. Insight on Diagnosis and Treatment From Over a Decade of Research Through the University of Chicago Monogenic Diabetes Registry. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:735548. [PMID: 36330312 PMCID: PMC9629510 DOI: 10.3389/fcdhc.2021.735548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/12/2021] [Indexed: 06/16/2023]
Abstract
Monogenic diabetes is a category of diabetes mellitus caused by a single gene mutation or chromosomal abnormality, usually sub-classified as either neonatal diabetes or maturity-onset diabetes of the young (MODY). Although monogenic diabetes affects up to 3.5% of all patients with diabetes diagnosed before age 30, misdiagnosis and/or improper treatment occurs frequently. The University of Chicago Monogenic Diabetes Registry, established in 2008, offers insight into the diagnosis, treatment, and natural history of individuals known or suspected to have monogenic diabetes. Those interested in participating in the Registry begin by completing a secure web-based registration form found on our website (http://monogenicdiabetes.uchicago.edu/registry/). Participants are then screened for eligibility and consented either by phone, video call, or in person. Relevant medical and family history is collected at baseline and then annually via surveys through our secure Research Electronic Data Capture (REDCap) database. The University of Chicago Monogenic Diabetes Registry has enrolled over 3800 participants from over 2000 families. Participants represent all 50 states and more than 20 different countries. To date, over 1100 participants have a known genetic cause of diabetes. While many Registry participants reported being referred through their diabetes care provider (54%), a large portion also learned about the Registry through web searching (24%), friends/family (18%), or other sources (13%). Around two-thirds of those with a known genetic cause had research-based genetic testing completed rather than clinical testing due to insurance coverage difficulties. Of those who were found to have monogenic diabetes, significant delays in diagnosis were identified, which highlights the need for increased access to clinical genetic testing covered by insurance companies specifically within the United States. Among genes that cause a MODY phenotype, GCK mutations were the most common (59%) followed by HNF1A mutations (28%), while mutations in KCNJ11 were the most common among genes that cause neonatal diabetes (35%) followed by INS (16%). Over the last decade, improvements in data collection for the University of Chicago Monogenic Diabetes Registry have resulted in increased knowledge of the natural history of monogenic diabetes, as well as a better understanding of the most effective treatments. The University of Chicago Monogenic Diabetes Registry serves as a valuable resource that will continue to provide evidence to support improved clinical care and patient outcomes in monogenic diabetes.
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Affiliation(s)
- Tiana L. Bowden
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Lisa R. Letourneau-Freiberg
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Balamurugan Kandasamy
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - May Sanyoura
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Persephone Tian
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Anastasia G. Harris
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Graeme I. Bell
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Louis H. Philipson
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Rochelle N. Naylor
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, The University of Chicago, Chicago, IL, United States
| | - Siri Atma W. Greeley
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, IL, United States
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, The University of Chicago, Chicago, IL, United States
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Cheung NYC, Fung JLF, Ng YNC, Wong WHS, Chung CCY, Mak CCY, Chung BHY. Perception of personalized medicine, pharmacogenomics, and genetic testing among undergraduates in Hong Kong. Hum Genomics 2021; 15:54. [PMID: 34407885 PMCID: PMC8371796 DOI: 10.1186/s40246-021-00353-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The global development and advancement of genomic medicine in the recent decade has accelerated the implementation of personalized medicine (PM) and pharmacogenomics (PGx) into clinical practice, while catalyzing the emergence of genetic testing (GT) with relevant ethical, legal, and social implications (ELSI). RESULTS The perception of university undergraduates with regards to PM and PGx was investigated, and 80% of undergraduates valued PM as a promising healthcare model with 66% indicating awareness of personal genome testing companies. When asked about the curriculum design towards PM and PGx, compared to undergraduates in non-medically related curriculum, those studying in medically related curriculum had an adjusted 7.2 odds of perceiving that their curriculum was well-designed for learning PGx (95% CI 3.6-14.6) and a 3.7 odds of perceiving that PGx was important in their study (95% CI 2.0-6.8). Despite this, only 16% of medically related curriculum undergraduates would consider embarking on future education on PM. When asked about their perceptions on GT, 60% rated their genetic knowledge as "School Biology" level or below while 76% would consider undergoing a genetic test. As for ELSI, 75% of undergraduates perceived that they were aware of ethical issues of GT in general, particularly on "Patient Privacy" (80%) and "Data Confidentiality" (68%). Undergraduates were also asked about their perceived reaction upon receiving an unfavorable result from GT, and over half of the participants perceived that they would feel "helpless or pessimistic" (56%), "inadequate or different" (59%), and "disadvantaged at job seeking" (59%), while older undergraduates had an adjusted 2.0 odds of holding the latter opinion (95% CI 1.1-3.5), compared to younger undergraduates. CONCLUSION Hong Kong undergraduates showed a high awareness of PM but insufficient genetic knowledge and low interest in pursuing a career towards PM. They were generally aware of ethical issues of GT and especially concerned about patient privacy and data confidentiality. There was a predominance of pessimistic views towards unfavorable testing results. This study calls for the attention to evaluate education and talent development on genomics, and update existing legal frameworks on genetic testing in Hong Kong.
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Affiliation(s)
- Nicholas Yan Chai Cheung
- Bachelor of Medicine and Bachelor of Surgery Program, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Jasmine Lee Fong Fung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Yvette Nga Chung Ng
- Bachelor of Medicine and Bachelor of Surgery Program, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Wilfred Hing Sang Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Claudia Ching Yan Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.
| | - Christopher Chun Yu Mak
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.
| | - Brian Hon Yin Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, SAR, China.
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, SAR, China.
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Lekstutiene J, Holm S, Gefenas E. Biobanks and Individual Health Related Findings: from an Obstacle to an Incentive. SCIENCE AND ENGINEERING ETHICS 2021; 27:55. [PMID: 34379215 PMCID: PMC8526456 DOI: 10.1007/s11948-021-00330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
Despite the benefits biobanks are expected to bring, there have recently been concerns raised that the public and private non-profit biobanks still prevailing in Europe often fail to reach their initial objectives due to a variety of reasons, including a shortage of funding and insufficient utilization of collections. The necessity to find new ways to manage biobanks has been clearly recognized and one way to do this is to follow the success of some commercial direct-to-consumer genetic testing (DTC GT) companies in the biobanking field. This paper is focused on a double role the return of individual health related findings (IHRF) detected through the biobanking activities can play in the management of biobanks. These findings can be seen as an untapped opportunity to offer health related information to biobank participants. At the same time, the IHRF policy can also serve as an additional tool that can improve biobanking governance. This paper aims to consider diverse IHRF approaches as well as to explore some key ethical concerns related to them. In particular, it reveals how different accounts of personal autonomy shape consent policies related to IHRF and emphasizes ethical controversies related to the commercial DTC GT initiatives as well as some non-profit biobanks.
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Affiliation(s)
- Jurate Lekstutiene
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio 21, 03101, Vilnius, Lithuania.
| | - Søren Holm
- Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK
- Center of Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eugenijus Gefenas
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio 21, 03101, Vilnius, Lithuania
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Galior KD, Baumann NA. Challenges with At-home and Mail-in Direct-to-Consumer Testing: Preanalytical Error, Reporting Results, and Result Interpretation. Clin Lab Med 2021; 40:25-36. [PMID: 32008637 DOI: 10.1016/j.cll.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Companies that offer direct-to-consumer (DTC) testing on specimens such as saliva, blood, or urine, allow consumers to order laboratory tests without the involvement of a health care provider. This approach allows individuals to have direct access to their own laboratory results, interpret them, and make decisions regarding their health care. However, as with conventional clinical laboratory testing, there are factors that will impact the accuracy of DTC test results and limitations that consumers need to be aware of. This article focuses on challenges with DTC testing specifically related to preanalytical errors, result reporting, and result interpretation.
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Affiliation(s)
- Kornelia D Galior
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave Madison, WI 53792, USA
| | - Nikola A Baumann
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Hilton 3-70, Rochester, MN 55905, USA.
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Galbraith LN, Preys CL, Rehm HL, Scheuner MT, Hajek C, Green RC, Christensen KD. Primary care providers' responses to unsolicited Lynch syndrome secondary findings of varying clinical significance. Genet Med 2021; 23:1977-1983. [PMID: 34113000 PMCID: PMC8487923 DOI: 10.1038/s41436-021-01225-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: How primary care providers (PCPs) respond to genomic secondary findings (SFs) of varying clinical significance (pathogenic, uncertain significance (VUS), or benign) is unknown. Methods: We randomized 148 American Academy of Family Physicians members to review three reports with varying significance for Lynch syndrome. Participants provided open-ended responses about the follow-up they would address and organized the SF reports and five other topics in the order they would prioritize responding to them (1=highest priority, 6=lowest priority). Results: PCPs suggested referrals more often for pathogenic variants or VUSs than benign variants (72% vs 16%, p<0.001). PCPs were also more likely to address further workup, like a colonoscopy or EGD, in response to pathogenic variants or VUSs than benign variants (43% vs 4%, p<0.001). The likelihoods of addressing referrals or further workup were similar when PCPs reviewed pathogenic variants and VUSs (both p>0.46). SF reports were prioritized highest for pathogenic variants (2.7 for pathogenic variants, 3.6 for VUSs, 4.3 for benign variants, all p≤0.014). Conclusions: Results suggest that while PCPs appreciated the differences in clinical significance, disclosure of VUSs as SFs would substantially increase downstream health care utilization.
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Affiliation(s)
- Lauren N Galbraith
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Charlene L Preys
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Heidi L Rehm
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Maren T Scheuner
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Division of Medical Genetics, Department of Pediatrics, and Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Catherine Hajek
- Sanford Health Imagenetics, Sioux Falls, SD, USA.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Ariadne Labs, Boston, MA, USA
| | - Kurt D Christensen
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA. .,Broad Institute of Harvard and MIT, Cambridge, MA, USA. .,Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
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34
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Magavern EF, Kaski JC, Turner RM, Janmohamed A, Borry P, Pirmohamed M. The Interface of Therapeutics and Genomics in Cardiovascular Medicine. Cardiovasc Drugs Ther 2021; 35:663-676. [PMID: 33528719 PMCID: PMC7851637 DOI: 10.1007/s10557-021-07149-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
Pharmacogenomics has a burgeoning role in cardiovascular medicine, from warfarin dosing to antiplatelet choice, with recent developments in sequencing bringing the promise of personalised medicine ever closer to the bedside. Further scientific evidence, real-world clinical trials, and economic modelling are needed to fully realise this potential. Additionally, tools such as polygenic risk scores, and results from Mendelian randomisation analyses, are only in the early stages of clinical translation and merit further investigation. Genetically targeted rational drug design has a strong evidence base and, due to the nature of genetic data, academia, direct-to-consumer companies, healthcare systems, and industry may meet in an unprecedented manner. Data sharing navigation may prove problematic. The present manuscript addresses these issues and concludes a need for further guidance to be provided to prescribers by professional bodies to aid in the consideration of such complexities and guide translation of scientific knowledge to personalised clinical action, thereby striving to improve patient care. Additionally, technologic infrastructure equipped to handle such large complex data must be adapted to pharmacogenomics and made user friendly for prescribers and patients alike.
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Affiliation(s)
- E F Magavern
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - J C Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - R M Turner
- The Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Janmohamed
- Department of Clinical Pharmacology, St George's, University of London, London, UK
| | - P Borry
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Leuven Institute for Human Genetics and Society, Leuven, Belgium
| | - M Pirmohamed
- The Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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35
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Gammal RS, Smith DM, Wiisanen KW, Cusimano JM, Pettit RS, Stephens JW, Walko CM, Yang RH, Dunnenberger HM. The pharmacist's responsibility to ensure appropriate use of direct‐to‐consumer genetic testing. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - D. Max Smith
- American College of Clinical Pharmacy Lenexa Kansas USA
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36
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Eklund SE. Perioperative evaluation of direct-to-consumer genetic testing results. Paediatr Anaesth 2021; 31:619-620. [PMID: 33844374 DOI: 10.1111/pan.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Susan E Eklund
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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37
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Pygmalion in the genes? On the potentially negative impacts of polygenic scores for educational attainment. SOCIAL PSYCHOLOGY OF EDUCATION 2021. [DOI: 10.1007/s11218-021-09632-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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38
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Pavarini G, Hamdi L, Lorimer J, Singh I. Young people's moral attitudes and motivations towards direct-to-consumer genetic testing for inherited risk of Alzheimer disease. Eur J Med Genet 2021; 64:104180. [PMID: 33781925 PMCID: PMC8192412 DOI: 10.1016/j.ejmg.2021.104180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 02/13/2021] [Accepted: 02/20/2021] [Indexed: 11/18/2022]
Abstract
Purpose Since the U.S. Food and Drug Administration approved sales of genetic tests for late-onset Alzheimer's disease (LOAD) risk, a heated debate has arisen over whether these tests should indeed be offered online and direct-to-consumer (DTC). As this debate progresses, it is important to understand the ethical perspectives and motivations of young people, who are a key target group for DTC services. Methods Thirty-one grandchildren of people with LOAD, aged 16–26, were interviewed about their moral attitudes and motivations with regards to DTC genetic testing for LOAD. Results Even though most participants claimed that people should have the right to access these services, they also expressed concerns about potential distress in response to learning about risk, particularly for minors. About a third were interested in testing, primarily to gain self-knowledge regarding one's health; however, face-to-face services were vastly preferred over the online option. Conclusion While DTC genetic companies often market their services as a “fun consumer product”, DTC testing for LOAD was largely understood as a serious health screening procedure and a vulnerable moment in the lives of young people in Alzheimer's families. This points to the importance of appropriate standards of information and support to young people pre- and post-testing.
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Affiliation(s)
- Gabriela Pavarini
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Ethics and Humanities, University of Oxford, UK
| | - Lamis Hamdi
- Department of Psychiatry, University of Oxford, UK.
| | - Jessica Lorimer
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Ethics and Humanities, University of Oxford, UK
| | - Ilina Singh
- Department of Psychiatry, University of Oxford, UK; Wellcome Centre for Ethics and Humanities, University of Oxford, UK
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39
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Amendola LM, Golden-Grant K, Scollon S. Scaling Genetic Counseling in the Genomics Era. Annu Rev Genomics Hum Genet 2021; 22:339-355. [PMID: 33722076 DOI: 10.1146/annurev-genom-110320-121752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The development of massively parallel sequencing-based genomic sequencing tests has increased genetic test availability and access. The field and practice of genetic counseling have adapted in response to this paradigm-shifting technology and the subsequent transition to practicing genomic medicine. While the key elements defining genetic counseling remain relevant, genetic counseling service delivery models and practice settings have evolved. Genetic counselors are addressing the challenges of direct-to-consumer and consumer-driven genetic testing, and genetic counseling training programs are responding to the ongoing increased demand for genetic counseling services across a broadening range of contexts. The need to diversify both the patient and participant groups with access to genetic information, as well as the field of genetic counseling, is at the forefront of research and training program initiatives. Genetic counselors are key stakeholders in the genomics era, and their contributions are essential to effectively and equitably deliver precision medicine.
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Affiliation(s)
- Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, Seattle, Washington 98195, USA; ,
| | - Katie Golden-Grant
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, Seattle, Washington 98195, USA; ,
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA;
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40
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Christensen KD, Bell M, Zawatsky CLB, Galbraith LN, Green RC, Hutchinson AM, Jamal L, LeBlanc JL, Leonhard JR, Moore M, Mullineaux L, Petry N, Platt DM, Shaaban S, Schultz A, Tucker BD, Van Heukelom J, Wheeler E, Zoltick ES, Hajek C. Precision Population Medicine in Primary Care: The Sanford Chip Experience. Front Genet 2021; 12:626845. [PMID: 33777099 PMCID: PMC7994529 DOI: 10.3389/fgene.2021.626845] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/11/2021] [Indexed: 01/10/2023] Open
Abstract
Genetic testing has the potential to revolutionize primary care, but few health systems have developed the infrastructure to support precision population medicine applications or attempted to evaluate its impact on patient and provider outcomes. In 2018, Sanford Health, the nation's largest rural nonprofit health care system, began offering genetic testing to its primary care patients. To date, more than 11,000 patients have participated in the Sanford Chip Program, over 90% of whom have been identified with at least one informative pharmacogenomic variant, and about 1.5% of whom have been identified with a medically actionable predisposition for disease. This manuscript describes the rationale for offering the Sanford Chip, the programs and infrastructure implemented to support it, and evolving plans for research to evaluate its real-world impact.
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Affiliation(s)
- Kurt D Christensen
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States.,Department of Population Medicine, Harvard Medical School, Boston, MA, United States.,Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Megan Bell
- Sanford Health Imagenetics, Sioux Falls, SD, United States
| | - Carrie L B Zawatsky
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Ariadne Labs, Boston, MA, United States
| | - Lauren N Galbraith
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Robert C Green
- Broad Institute of MIT and Harvard, Cambridge, MA, United States.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Ariadne Labs, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Leila Jamal
- National Cancer Institute, Bethesda, MD, United States.,Department of Bioethics, National Institutes of Health, Bethesda, MD, United States
| | - Jessica L LeBlanc
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | | | - Michelle Moore
- Sanford Health Imagenetics, Sioux Falls, SD, United States
| | - Lisa Mullineaux
- Mayo Clinic Genomics Laboratory, Rochester, MN, United States
| | - Natasha Petry
- Sanford Health Imagenetics, Fargo, ND, United States.,Department of Pharmacy Practice, North Dakota State University, Fargo, ND, United States
| | - Dylan M Platt
- Sanford Health Imagenetics, Sioux Falls, SD, United States
| | - Sherin Shaaban
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States.,ARUP Laboratories, Salt Lake City, UT, United States
| | - April Schultz
- Sanford Health Imagenetics, Sioux Falls, SD, United States.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | | | - Joel Van Heukelom
- Sanford Health Imagenetics, Sioux Falls, SD, United States.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | | | - Emilie S Zoltick
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Catherine Hajek
- Sanford Health Imagenetics, Sioux Falls, SD, United States.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
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41
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Tafazoli A, Guggilla RK, Kamel-Koleti Z, Miltyk W. Strategies to Improve the Clinical Outcomes for Direct-to-Consumer Pharmacogenomic Tests. Genes (Basel) 2021; 12:361. [PMID: 33802585 PMCID: PMC7999840 DOI: 10.3390/genes12030361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 12/27/2022] Open
Abstract
Direct-to-consumer genetic tests (DTC-GT) have become a bridge between marketing and traditional healthcare services. After earning FDA endorsement for such facilities, several fast-developing companies started to compete in the related area. Pharmacogenomic (PGx) tests have been introduced as potentially one of the main medical services of such companies. Most of the individuals will be interested in finding out about the phenotypic consequences of their genetic variants and molecular risk factors against diverse medicines they take or will take later. Direct-to-consumer pharmacogenomic tests (DTC-PT) is still in its young age, however it is expected to expand rapidly through the industry in the future. The result of PGx tests could be considered as the main road toward the implementation of personalized and precision medicine in the clinic. This narrative critical review study provides a descriptive overview on DTC-GT, then focuses on DTC-PT, and also introduces and suggests the potential approaches for improving the clinical related outcomes of such tests on healthcare systems.
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Affiliation(s)
- Alireza Tafazoli
- Department of Analysis and Bioanalysis of Medicines, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Rama Krishna Guggilla
- Department of Population Medicine and Civilization Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, 15-269 Bialystok, Poland;
| | - Zahra Kamel-Koleti
- Department of Pathology and Medical Laboratory, Shohada Hospital, Mazandaran University of Medical Sciences, Behshahr 4851613185, Iran;
| | - Wojciech Miltyk
- Department of Analysis and Bioanalysis of Medicines, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland;
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42
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Koop AH, Ghoz HM, Stancampiano FF, Nordelo K, Palmer WC. A survey of lifestyle habits, physician counseling, and direct-to consumer genetic testing in patients with hereditary hemochromatosis. Clin Res Hepatol Gastroenterol 2021; 45:101658. [PMID: 33676066 DOI: 10.1016/j.clinre.2021.101658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/22/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES The goal of this study was to assess lifestyle habits and physician counseling of patients with hereditary hemochromatosis (HH), and determine the prevalence of direct-to-consumer (DTC) genetic testing. MATERIALS AND METHODS A 52-question survey was created to collect information on lifestyle habits and physician counseling among patients with HH, and the use of DTC genetic testing of patients referred to a clinic for evaluation of HH. A multivariate logistic regression model was applied to identify predictors of DTC genetic testing use. RESULTS The survey was e-mailed to 379 patients, of which 101 responded (26.6%). Among patients with HH, 37% reported alcohol use more than once weekly and 50% reported red meat consumption. The use of a vitamin C supplement was reported by 38.9% of participants. Among patients with living children and siblings, physicians failed to recommend HH screening 15.3% and 21.2% of the time respectively. Thirty-one patients reported DTC genetic testing, of which 46.7% (14/31) reported their DTC genetic test screened for HH. Six (19%) of those patients were prompted to see a specialist in HH based on the results. CONCLUSIONS Among patients with HH, lifestyle habits that may impact iron stores are common, but not all receive appropriate counseling. Direct-to-consumer genetic testing is common, and physicians should be aware of its limitations when patients seek further evaluation for HH based on their test results.
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Affiliation(s)
- Andree H Koop
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, United States.
| | - Hassan M Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, United States.
| | - Fernando F Stancampiano
- Division of Community Internal Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, United States.
| | - Katie Nordelo
- Clinical Research Internship Study Program, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, United States.
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, United States.
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Hsieh V, Braid T, Gordon E, Hercher L. Direct-to-consumer genetic testing companies tell their customers to 'see a genetic counselor'. How do genetic counselors feel about direct-to-consumer genetic testing? J Genet Couns 2021; 30:191-197. [PMID: 32706156 DOI: 10.1002/jgc4.1310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022]
Abstract
Professional societies, the FDA, and many direct-to-consumer genetic testing (DTC-GT) companies have highlighted the value of counseling from a medical professional with genetics expertise in order to enhance the value and minimize the risks associated with DTC-GT. However, there is limited information available identifying genetic counselors' own views on DTC-GT, their willingness to counsel consumers based on DTC-GT results, and their experiences to date seeing DTC-GT consumers in a clinical setting. We surveyed genetic counselors accessed through mailing lists associated with the National Society of Genetic Counselors (NSGC) and the American Board of Genetic Counseling (ABGC). Response rate was estimated to be 12.2% (n = 482). A majority of all respondents (56.4%, n = 263) described themselves as feeling negatively or very negatively toward DTC-GT; only 6.9% (n = 32) described themselves as feeling positively or very positively. While 90.9% of respondents (n = 398) believed that DTC-GT would be improved with the involvement of genetic counselors, only 31.2% agreed or strongly agreed that they are comfortable providing counseling to DTC-GT consumers (n = 142). Clinical counseling of DTC-GT consumers is not routine but it is also not uncommon; 40.1% of all respondents (n = 189) have seen at least one consumer in clinic for the sole purpose of reviewing DTC-GT results. The results of our study suggest that most respondents would be more accepting of DTC-GT if genetic counseling was a part of the process, but the majority of counselors do not feel comfortable providing this service.
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Affiliation(s)
- Vicky Hsieh
- Department of OB/GYN, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Tamara Braid
- High-Risk Cancer Genetics Program, Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Erynn Gordon
- VP Clinical Operations, Genome Medical, Inc, San Francisco, California, USA
| | - Laura Hercher
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, New York, USA
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Gray JS, Campbell MJ. Challenges and Opportunities of Genomic Approaches in Therapeutics Development. Methods Mol Biol 2021; 2194:107-126. [PMID: 32926364 DOI: 10.1007/978-1-0716-0849-4_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The magnitude of all therapeutic responses is significantly determined by genome structure, variation, and functional interactions. This determination occurs at many levels which are discussed in the current review. Well-established examples of structural variation between individuals are known to dictate an individual's response to numerous drugs, as clearly illustrated by warfarin. The exponential rate of genomic-based interrogation is coupled with an expanding repertoire of genomic technologies and applications. This is leading to an ever more sophisticated appreciation of how structural variation, regulation of transcription and genomic structure, both individually and collectively, define cell therapeutic responses.
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Affiliation(s)
- Jaimie S Gray
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Moray J Campbell
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH, USA.
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45
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Basch CH, Hillyer GC, Wahrman MZ, Garcia P, Basch CE. DNA testing information on YouTube: Inadequate advice can mislead and harm the public. J Genet Couns 2020; 30:785-792. [PMID: 33382174 DOI: 10.1002/jgc4.1375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 01/07/2023]
Abstract
Direct-to-consumer (DTC) DNA (i.e., genetic) testing has become very popular, with close to 30 million Americans having used these services. The 100 most widely viewed DNA YouTube testing videos were analyzed to determine whether they are providing adequate information for consumers. The top 100 videos had more than 300 million cumulative views, showing the popularity and reach of the information source. While many videos addressed the specimen collection process, family roots and ancestry, and the prospect of uncovering unexpected information about family or health leading to possible distress, almost none of the videos addressed accuracy or confidentiality issues, which are major issues of DNA testing. It is recommended that further information on those issues be made readily available, and more vigilant oversight by regulatory agencies be implemented. Such oversight should include monitoring what information is and is not readily provided by each company, and the veracity of information being communicated to existing and prospective consumers. We also recommend that for medical issues, clinical genetic testing, along with genetic counseling by genetic counselors, be the method of choice.
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Affiliation(s)
- Corey H Basch
- Department of Public Health, William Paterson University, Wayne, NJ, USA
| | - Grace C Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University NY, New York, NY, USA
| | - Miryam Z Wahrman
- Department of Biology, William Paterson University, Wayne, NJ, USA
| | - Philip Garcia
- Department of Public Health, William Paterson University, Wayne, NJ, USA
| | - Charles E Basch
- Health and Behavior Studies, Teachers College, Columbia University NY, New York, NY, USA
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46
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Hercher L. Pondering the future of genetic counseling: An adolescent field comes of age. J Genet Couns 2020; 30:61-69. [PMID: 33377588 DOI: 10.1002/jgc4.1370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Laura Hercher
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, Bronxville, NY, USA
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47
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Raccor BS, Thompson DK, Thomas C, Hill AK, Shields K, Alcala-Williams I, Cartrette T, Fasinu P, Al-Achi A. Assessment and clinical utility of pharmacogenomics by healthcare practitioners in North Carolina. Pharmacogenomics 2020; 22:13-25. [PMID: 33356552 DOI: 10.2217/pgs-2020-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Perceived knowledge, use and perceptions of pharmacogenomics (PGx) testing were assessed among healthcare practitioners in North Carolina. Materials & methods: A validated survey was distributed to various healthcare professionals and analyzed for differences among the groups. Results: The majority of the 744 survey respondents acknowledged the perceived benefits of PGx testing, but indicated either never or rarely using it. A substantial percentage of practitioners reported educational experiences but the majority had received no training. Among groups reporting using PGx testing, barriers to implementation were cost and insufficient training. Conclusion: The perceived cost of PGx testing and insufficiency or lack of training are major contributing factors to the infrequent use of PGx testing by healthcare providers in North Carolina.
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Affiliation(s)
- Brianne S Raccor
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA.,College of Arts & Sciences, Trinity Washington University, 125 Michigan Ave NE, Washington, DC 20017, USA
| | - Dorothea K Thompson
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA
| | - Chantley Thomas
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA
| | - Amber K Hill
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA
| | - Kaitlin Shields
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA
| | - Isabel Alcala-Williams
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA
| | - Tristyn Cartrette
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA.,Southeastern Regional Medical Center, 300 W 27th St, Lumberton, NC 28358, USA
| | - Pius Fasinu
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA
| | - Antoine Al-Achi
- College of Pharmacy & Health Sciences, Campbell University, Post Office Box 1090, Buies Creek, NC 27506, USA
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Mullins VA, Bresette W, Johnstone L, Hallmark B, Chilton FH. Genomics in Personalized Nutrition: Can You "Eat for Your Genes"? Nutrients 2020; 12:E3118. [PMID: 33065985 PMCID: PMC7599709 DOI: 10.3390/nu12103118] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
Genome-wide single nucleotide polymorphism (SNP) data are now quickly and inexpensively acquired, raising the prospect of creating personalized dietary recommendations based on an individual's genetic variability at multiple SNPs. However, relatively little is known about most specific gene-diet interactions, and many molecular and clinical phenotypes of interest (e.g., body mass index [BMI]) involve multiple genes. In this review, we discuss direct to consumer genetic testing (DTC-GT) and the current potential for precision nutrition based on an individual's genetic data. We review important issues such as dietary exposure and genetic architecture addressing the concepts of penetrance, pleiotropy, epistasis, polygenicity, and epigenetics. More specifically, we discuss how they complicate using genotypic data to predict phenotypes as well as response to dietary interventions. Then, several examples (including caffeine sensitivity, alcohol dependence, non-alcoholic fatty liver disease, obesity/appetite, cardiovascular, Alzheimer's disease, folate metabolism, long-chain fatty acid biosynthesis, and vitamin D metabolism) are provided illustrating how genotypic information could be used to inform nutritional recommendations. We conclude by examining ethical considerations and practical applications for using genetic information to inform dietary choices and the future role genetics may play in adopting changes beyond population-wide healthy eating guidelines.
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Affiliation(s)
- Veronica A. Mullins
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85719, USA; (V.A.M.); (W.B.)
| | - William Bresette
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85719, USA; (V.A.M.); (W.B.)
| | - Laurel Johnstone
- The BIO5 Institute, University of Arizona, Tucson, AZ 85719, USA; (L.J.); (B.H.)
| | - Brian Hallmark
- The BIO5 Institute, University of Arizona, Tucson, AZ 85719, USA; (L.J.); (B.H.)
| | - Floyd H. Chilton
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85719, USA; (V.A.M.); (W.B.)
- The BIO5 Institute, University of Arizona, Tucson, AZ 85719, USA; (L.J.); (B.H.)
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Yin Z, Song L, Clayton EW, Malin BA. Health and kinship matter: Learning about direct-to-consumer genetic testing user experiences via online discussions. PLoS One 2020; 15:e0238644. [PMID: 32898148 PMCID: PMC7478842 DOI: 10.1371/journal.pone.0238644] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022] Open
Abstract
Background Millions of people have undergone direct-to-consumer genetic testing (DTC-GT), but little is known about individuals' motivations and experiences (e.g., discussion topics and emotions after obtaining the test results) in engaging with DTC-GT services. Previous studies either involved only a small number of DTC-GT consumers or were based on hypothetical scenarios. Objective Our study aimed to fill this gap by investigating online discussions about DTC-GT that developed naturally among tens of thousands of social media users. Methods We focused on the posts that were published in the r/23andme and r/AncestryDNA subreddits, which correspond to the two companies with the largest number of consumers in the DTC-GT market. We applied computational methods to infer and examine the topics discussed, temporal trends in posting rates and themes (e.g., aggregation of related topics), and emotions expressed in these online forums. Results We collected 157,000 posts published by 16,500 Reddit users between 2013 and 2019. We found that the posting rates increased sharply after popular promotional events (e.g., each Amazon Prime Day and Black Friday) and most posts were inquiries into, or status updates about, testing progress. The inferred themes of Ancestral Origin and Kinship/Feelings were the two most frequently discussed, while discussions about the Health Risks theme focused primarily on submitting DTC-GT raw data to third parties for interpretation. The Kinship/Feelings theme exhibited the largest range of emotional response. A qualitative review of the posts with extreme emotions showed that some people became excited because they found their biological parents or other kin, while others became upset because they unexpectedly found that their parents or other kin were not biologically related to them. Conclusion This research demonstrates that online social media platforms can serve as a rich resource for characterizing actual DTC-GT experiences. The findings suggest that DTC-GT consumers' purchasing behaviors are associated with societal events and that future investigations should consider how DTC-GT challenges our understanding of kinship structure and function, genomic privacy, and the interpretation of health risks.
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Affiliation(s)
- Zhijun Yin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, United States of America.,Center for Genetic Privacy & Identity in Community Settings, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Lijun Song
- Center for Genetic Privacy & Identity in Community Settings, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.,Department of Sociology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Ellen W Clayton
- Center for Genetic Privacy & Identity in Community Settings, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.,Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, United States of America.,Center for Genetic Privacy & Identity in Community Settings, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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50
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Burcat K, Cowles K, Irwin J, Martin C. Unraveling the Mystery of Genetics Information for Consumers: Information Professionals and Genetic Health Literacy. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1792171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kiri Burcat
- Data & Evaluation Coordinator, Network of the National Library of Medicine, Southeastern/Atlantic Region, Health Sciences and Human Services Library, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Kelsey Cowles
- Academic Coordinator, Network of the National Library of Medicine, Middle Atlantic Region, University of Pittsburgh, Health Sciences Library System, Pittsburgh, Pennsylvania, USA
| | - Jarrod Irwin
- Consumer Health Coordinator, Network of the National Library of Medicine, Southeastern/Atlantic Region, Health Sciences and Human Services Library, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Carolyn Martin
- Consumer Health Coordinator, Network of the National Library of Medicine, Pacific Northwest Region, University of Washington Health Sciences Library, Seattle, Washington, USA
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