1
|
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.
Collapse
Affiliation(s)
- Amy Gooden
- University of KwaZulu-Natal South Africa
| | | |
Collapse
|
2
|
Huang J, Liang ZS, Pallotti S, Ranson JM, Llewellyn DJ, Zheng ZJ, King DA, Zhou Q, Zheng H, Napolioni V. PAGEANT: personal access to genome and analysis of natural traits. Nucleic Acids Res 2021; 50:e39. [PMID: 34928375 PMCID: PMC9023285 DOI: 10.1093/nar/gkab1245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022] Open
Abstract
GWASs have identified numerous genetic variants associated with a wide variety of diseases, yet despite the wide availability of genetic testing the insights that would enhance the interpretability of these results are not widely available to members of the public. As a proof of concept and demonstration of technological feasibility, we developed PAGEANT (Personal Access to Genome & Analysis of Natural Traits), usable through Graphical User Interface or command line-based version, aiming to serve as a protocol and prototype that guides the overarching design of genetic reporting tools. PAGEANT is structured across five core modules, summarized by five Qs: (i) quality assurance of the genetic data; (ii) qualitative assessment of genetic characteristics; (iii) quantitative assessment of health risk susceptibility based on polygenic risk scores and population reference; (iv) query of third-party variant databases (e.g. ClinVAR and PharmGKB) and (v) quick Response code of genetic variants of interest. Literature review was conducted to compare PAGEANT with academic and industry tools. For 2504 genomes made publicly available through the 1000 Genomes Project, we derived their genomic characteristics for a suite of qualitative and quantitative traits. One exemplary trait is susceptibility to COVID-19, based on the most up-to-date scientific findings reported.
Collapse
Affiliation(s)
- Jie Huang
- Department of Global Health, Peking University School of Public Health, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China.,National Institute of Health Data Science at Peking University, Beijing, China
| | - Zhi-Sheng Liang
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Stefano Pallotti
- Genetics and Animal Breeding Group, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Janice M Ranson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, UK.,Alan Turing Institute, London, UK
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Daniel A King
- Northwell Health Cancer Institute and Feinstein Institutes for Research, Lake Success, NY, USA
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, Shenzhen, China
| | - Houfeng Zheng
- Diseases & Population (DaP) Geninfo Lab., School of Life Sciences, Westlake University, Hangzhou, China
| | - Valerio Napolioni
- Genomic and Molecular Epidemiology (GAME)Lab., School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Horne J, Gilliland J, O'Connor C, Seabrook J, Madill J. Enhanced long-term dietary change and adherence in a nutrigenomics-guided lifestyle intervention compared to a population-based (GLB/DPP) lifestyle intervention for weight management: results from the NOW randomised controlled trial. BMJ Nutr Prev Health 2020; 3:49-59. [PMID: 33235971 PMCID: PMC7664486 DOI: 10.1136/bmjnph-2020-000073] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 01/30/2023] Open
Abstract
Background Adherence to nutritional guidelines for chronic disease prevention and management remains a challenge in clinical practice. Innovative strategies are needed to help optimise dietary behaviour change. Objective The objective of this study was to determine if a nutrigenomics-guided lifestyle intervention programme could be used to motivate greater dietary adherence and change in dietary intake short-term, moderate-term and long-term compared to the gold-standard population-based weight management intervention (Group Lifestyle Balance (GLB)/Diabetes Prevention Programme (DPP)). Design The Nutrigenomics, Overweight/Obesity, and Weight Management (NOW) randomised controlled trial is a pragmatic, parallel-group, superiority clinical trial (n=140), which was conducted at the East Elgin Family Health Team (EEFHT). GLB weight management groups were prerandomised 1:1 to receive either the standard GLB programme or a modified GLB+nutrigenomics (GLB+NGx) programme. Three 24-hour recalls were collected at baseline, 3, 6 and 12 months using the validated multiple pass method. Research assistants collecting the three 24-hour recalls were blinded to the participants’ group assignments. Statistical analyses included split plot analyses of variance (ANOVAs), two-way ANOVAs, binary logistic regression, χ2 and Fisher’s exact tests. Using the Theory of Planned Behaviour as guidance, key confounding factors of behaviour change were considered in the analyses. This study was registered with clinicaltrials.gov (NCT03015012). Results Only the GLB+NGx group significantly reduced their total fat intake from baseline to 12-month follow-up (from 36.0%±4.8% kcal to 30.2%±8.7% kcal, p=0.02). Long-term dietary adherence to total fat and saturated fat guidelines was also significantly (p<0.05) greater in the GLB+NGx group compared to the standard GLB group. Conclusions Weight management interventions guided by nutrigenomics can motivate long-term improvements in dietary fat intake above and beyond gold-standard population-based interventions.
Collapse
Affiliation(s)
- Justine Horne
- East Elgin Family Health Team, Aylmer, Ontario, Canada.,Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Jason Gilliland
- Department of Paediatrics, Western University, London, Ontario, Canada.,School of Health Studies, Western University, London, Ontario, Canada.,Department of Geography, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Colleen O'Connor
- Lawson Health Research Institute, London, Ontario, Canada.,School of Food and Nutritional Sciences, Brescia University College (Western University), London, Ontario, Canada
| | - Jamie Seabrook
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,School of Food and Nutritional Sciences, Brescia University College (Western University), London, Ontario, Canada
| | - Janet Madill
- Lawson Health Research Institute, London, Ontario, Canada.,School of Food and Nutritional Sciences, Brescia University College (Western University), London, Ontario, Canada
| |
Collapse
|
5
|
Hoxhaj I, Stojanovic J, Sassano M, Acampora A, Boccia S. A review of the legislation of direct-to-consumer genetic testing in EU member states. Eur J Med Genet 2020; 63:103841. [PMID: 31923586 DOI: 10.1016/j.ejmg.2020.103841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/24/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Ilda Hoxhaj
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Jovana Stojanovic
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Health, Kinesiology, and Applied Physiology (HKAP), Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec, H4B 1R6, Canada; Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, 5400, Boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada
| | - Michele Sassano
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Acampora
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefania Boccia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| |
Collapse
|
6
|
Dong Y, Branscum P. What Motivates Individuals to Get Obesity Related Direct-To-Consumer Genetic Tests? A Reasoned Action Approach. AMERICAN JOURNAL OF HEALTH EDUCATION 2019. [DOI: 10.1080/19325037.2019.1663379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
7
|
A Scientific Perspective of Personalised Gene-Based Dietary Recommendations for Weight Management. Nutrients 2019; 11:nu11030617. [PMID: 30875721 PMCID: PMC6471589 DOI: 10.3390/nu11030617] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 01/06/2023] Open
Abstract
Various studies showed that a "one size fits all" dietary recommendation for weight management is questionable. For this reason, the focus increasingly falls on personalised nutrition. Although there is no precise and uniform definition of personalised nutrition, the inclusion of genetic variants for personalised dietary recommendations is more and more favoured, whereas scientific evidence for gene-based dietary recommendations is rather limited. The purpose of this article is to provide a science-based viewpoint on gene-based personalised nutrition and weight management. Most of the studies showed no clinical evidence for gene-based personalised nutrition. The Food4Me study, e.g., investigated four different groups of personalised dietary recommendations based on dietary guidelines, and physiological, clinical, or genetic parameters, and resulted in no difference in weight loss between the levels of personalisation. Furthermore, genetic direct-to-consumer (DTC) tests are widely spread by companies. Scientific organisations clearly point out that, to date, genetic DTC tests are without scientific evidence. To date, gene-based personalised nutrition is not yet applicable for the treatment of obesity. Nevertheless, personalised dietary recommendations on the genetic landscape of a person are an innovative and promising approach for the prevention and treatment of obesity. In the future, human intervention studies are necessary to prove the clinical evidence of gene-based dietary recommendations.
Collapse
|
8
|
Schaper M, Wöhlke S, Schicktanz S. "I would rather have it done by a doctor"-laypeople's perceptions of direct-to-consumer genetic testing (DTC GT) and its ethical implications. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:31-40. [PMID: 29705970 DOI: 10.1007/s11019-018-9837-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Direct-to-consumer genetic testing (DTC GT) has been available for several years now, with varying degrees of regulation across different countries. Despite a restrictive legal framework it is possible for consumers to order genetic tests from companies located in other countries. However, German laypeople's awareness and perceptions of DTC GT services is still unexplored. We conducted seven focus groups (participants n = 43) with German laypeople to explore their perceptions of and attitudes towards commercial genetic testing and its ethical implications. Participants were critical towards DTC GT. Criticism was directed at health-related, predictive testing, while lifestyle tests were accepted and even welcomed to some extent. Participants expressed strong reservations regarding commercial provision of genetic diagnostics and expressed a lack of trust in respective companies. They preferred non-commercial distribution within the public healthcare system. Participants also expressed high expectations of physicians' abilities to interpret information obtained via DTC GT companies and provide counseling. Legal restrictions on commercial distribution of genetic tests were opposed, with participants arguing that it should be available to consumers. DTC GT companies are not perceived as trustworthy when compared to the public healthcare system and its professional ethical standards and practices. Laypeople rated general consumer autonomy higher than their own concerns, thus recommending against strong legal regulation. We conclude that medicine's trustworthiness may be negatively affected if commercial provision is not visibly opposed by the medical professions, while DTC GT companies may gain in trustworthiness if they adapt to standards and practices upheld in medicine.
Collapse
Affiliation(s)
- Manuel Schaper
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
| | - Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany
| |
Collapse
|
9
|
Stewart KFJ, Kokole D, Wesselius A, Schols AMWJ, Zeegers MP, de Vries H, van Osch LADM. Factors Associated with Acceptability, Consideration and Intention of Uptake of Direct-To-Consumer Genetic Testing: A Survey Study. Public Health Genomics 2018; 21:45-52. [PMID: 30359983 DOI: 10.1159/000492960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With interest in personalised health care growing, so is interest in personal genetic testing. This is now offered direct-to-consumer, thereby referred to as direct-to-consumer genetic testing (DTC-GT). Criticisms have been expressed on whether a truly informed decision to undergo testing is made with regard to these services. In order to provide relevant information to achieve this, knowing the characteristics of the expected user population is helpful. Therefore, the aim of this study is to identify characteristics of individuals who (1) find the concept of DTC-GT acceptable and (2) consider undergoing DTC-GT in the distant or near future. METHODS This cross-sectional study investigated factors associated with acceptability, consideration and intention in the Dutch general population. Studied variables included awareness, principles and how-to knowledge, attitude, innovativeness, and multiple demographic characteristics. Generalised linear models were applied to identify associated variables. RESULTS Full data was obtained for 836 respondents. Of those, 18.3% found DTC-GT somewhat or totally acceptable, whereas 12.6% considered and 5.5% intended to undergo DTC-GT in the distant or near future. Acceptability was greater with lower principles knowledge, and consideration and intention with lower how-to knowledge. A more positive attitude and greater innovativeness were associated with an increase in all 3 outcomes. CONCLUSION Informed decision making may be hampered as individuals with lower how-to knowledge were found to be more interested in pursuing testing. The identified characteristics can be used in development and distribution of public and personalized information, in order to help consumers make a truly informed decision.
Collapse
Affiliation(s)
- Kelly F J Stewart
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The .,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The
| | - Daša Kokole
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Maurice P Zeegers
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
10
|
Abstract
Jose Ordovas and colleagues consider that nutrition interventions tailored to individual characteristics and behaviours have promise but more work is needed before they can deliver
Collapse
Affiliation(s)
- Jose M Ordovas
- JM-USDA-HNRCA at Tufts University, Boston, MA, USA
- Centro Nacional Investigaciones Cardiovasculares, Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Lynnette R Ferguson
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| |
Collapse
|
11
|
Schaper M, Schicktanz S. Medicine, market and communication: ethical considerations in regard to persuasive communication in direct-to-consumer genetic testing services. BMC Med Ethics 2018; 19:56. [PMID: 29871685 PMCID: PMC5989449 DOI: 10.1186/s12910-018-0292-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/16/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Commercial genetic testing offered over the internet, known as direct-to-consumer genetic testing (DTC GT), currently is under ethical attack. A common critique aims at the limited validation of the tests as well as the risk of psycho-social stress or adaption of incorrect behavior by users triggered by misleading health information. Here, we examine in detail the specific role of advertising communication of DTC GT companies from a medical ethical perspective. Our argumentative analysis departs from the starting point that DTC GT operates at the intersection of two different contexts: medicine on the one hand and the market on the other. Both fields differ strongly with regard to their standards of communication practices and the underlying normative assumptions regarding autonomy and responsibility. METHODS Following a short review of the ethical contexts of medical and commercial communication, we provide case examples for persuasive messages of DTC GT websites and briefly analyze their design with a multi-modal approach to illustrate some of their problematic implications. RESULTS We observe three main aspects in DTC GT advertising communication: (1) the use of material suggesting medical professional legitimacy as a trust-establishing tool, (2) the suggestion of empowerment as a benefit of using DTC GT services and (3) the narrative of responsibility as a persuasive appeal to a moral self-conception. CONCLUSIONS While strengthening and respecting the autonomy of a patient is the focus in medical communication, specifically genetic counselling, persuasive communication is the normal mode in marketing of consumer goods, presuming an autonomous, rational, independent consumer. This creates tension in the context of DTC GT regarding the expectation and normative assessment of communication strategies. Our analysis can even the ground for a better understanding of ethical problems associated with intersections of medical and commercial communication and point to perspectives of analysis of DTC GT advertising.
Collapse
Affiliation(s)
- Manuel Schaper
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany
| |
Collapse
|
12
|
Vlahovich N, Hughes DC, Griffiths LR, Wang G, Pitsiladis YP, Pigozzi F, Bachl N, Eynon N. Genetic testing for exercise prescription and injury prevention: AIS-Athlome consortium-FIMS joint statement. BMC Genomics 2017; 18:818. [PMID: 29143596 PMCID: PMC5688405 DOI: 10.1186/s12864-017-4185-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There has been considerable growth in basic knowledge and understanding of how genes are influencing response to exercise training and predisposition to injuries and chronic diseases. On the basis of this knowledge, clinical genetic tests may in the future allow the personalisation and optimisation of physical activity, thus providing an avenue for increased efficiency of exercise prescription for health and disease. RESULTS This review provides an overview of the current status of genetic testing for the purposes of exercise prescription and injury prevention. As such there are a variety of potential uses for genetic testing, including identification of risks associated with participation in sport and understanding individual response to particular types of exercise. However, there are many challenges remaining before genetic testing has evidence-based practical applications; including adoption of international standards for genomics research, as well as resistance against the agendas driven by direct-to-consumer genetic testing companies. Here we propose a way forward to develop an evidence-based approach to support genetic testing for exercise prescription and injury prevention. CONCLUSION Based on current knowledge, there is no current clinical application for genetic testing in the area of exercise prescription and injury prevention, however the necessary steps are outlined for the development of evidence-based clinical applications involving genetic testing.
Collapse
Affiliation(s)
- Nicole Vlahovich
- Australian Institute of Sport (AIS), Australian Sports Commission, Canberra, Australia
| | - David C Hughes
- Australian Institute of Sport (AIS), Australian Sports Commission, Canberra, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Guan Wang
- Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Eastbourne, UK
| | - Yannis P Pitsiladis
- Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Eastbourne, UK
- Department of Movement Human and Health Sciences University of Rome "Foro Italico", Rome, Italy
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Fabio Pigozzi
- Department of Movement Human and Health Sciences University of Rome "Foro Italico", Rome, Italy
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Nobert Bachl
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports and Exercise Physiology, Centre for Sports Science and University Sports of the University of Vienna, Vienna, Austria
| | - Nir Eynon
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
| |
Collapse
|
13
|
Factors determining the integration of nutritional genomics into clinical practice by registered dietitians. Trends Food Sci Technol 2017. [DOI: 10.1016/j.tifs.2016.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
14
|
Gray SW, Gollust SE, Carere DA, Chen CA, Cronin A, Kalia SS, Rana HQ, Ruffin MT, Wang C, Roberts JS, Green RC. Personal Genomic Testing for Cancer Risk: Results From the Impact of Personal Genomics Study. J Clin Oncol 2016; 35:636-644. [PMID: 27937091 DOI: 10.1200/jco.2016.67.1503] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Significant concerns exist regarding the potential for unwarranted behavior changes and the overuse of health care resources in response to direct-to-consumer personal genomic testing (PGT). However, little is known about customers' behaviors after PGT. Methods Longitudinal surveys were given to new customers of 23andMe (Mountain View, CA) and Pathway Genomics (San Diego, CA). Survey data were linked to individual-level PGT results through a secure data transfer process. Results Of the 1,042 customers who completed baseline and 6-month surveys (response rate, 71.2%), 762 had complete cancer-related data and were analyzed. Most customers reported that learning about their genetic risk of cancers was a motivation for testing (colorectal, 88%; prostate, 95%; breast, 94%). No customers tested positive for pathogenic mutations in highly penetrant cancer susceptibility genes. A minority of individuals received elevated single nucleotide polymorphism-based PGT cancer risk estimates (colorectal, 24%; prostate, 24%; breast, 12%). At 6 months, customers who received elevated PGT cancer risk estimates were not significantly more likely to change their diet, exercise, or advanced planning behaviors or engage in cancer screening, compared with individuals at average or reduced risk. Men who received elevated PGT prostate cancer risk estimates changed their vitamin and supplement use more than those at average or reduced risk (22% v 7.6%, respectively; adjusted odds ratio, 3.41; 95% CI, 1.44 to 8.18). Predictors of 6-month behavior include baseline behavior (exercise, vitamin or supplement use, and screening), worse health status (diet and vitamin or supplement use), and older age (advanced planning, screening). Conclusion Most adults receiving elevated direct-to-consumer PGT single nucleotide polymorphism-based cancer risk estimates did not significantly change their diet, exercise, advanced care planning, or cancer screening behaviors.
Collapse
Affiliation(s)
- Stacy W Gray
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sarah E Gollust
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Deanna Alexis Carere
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Clara A Chen
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Angel Cronin
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sarah S Kalia
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Huma Q Rana
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Mack T Ruffin
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Catharine Wang
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - J Scott Roberts
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| | - Robert C Green
- Stacy W. Gray, City of Hope National Medical Center, Duarte, CA; Sarah E. Gollust, University of Minnesota School of Public Health, Minneapolis, MN; Deanna Alexis Carere, McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Clara A. Chen and Catharine Wang, Boston University School of Public Health; Angel Cronin and Huma Q. Rana, Dana-Farber Cancer Institute; Sarah S. Kalia and Robert C. Green, Brigham and Women's Hospital; Huma Q. Rana and Robert C. Green, Harvard Medical School; Robert C. Green, Partners Healthcare Personalized Medicine, Boston, MA; Mack T. Ruffin IV, University of Michigan School of Medicine; and J. Scott Roberts, University of Michigan School of Public Health, Ann Arbor, MI
| |
Collapse
|
15
|
Hurlimann T, Robitaille J, Vohl MC, Godard B. Ethical considerations in the implementation of nutrigenetics/nutrigenomics. Per Med 2016; 14:75-83. [PMID: 29749825 DOI: 10.2217/pme-2016-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Awareness of ethical issues that may be raised by the implementation of nutrigenetic/nutrigenomic (NGx) testing and personalized nutrition, at an individual or a public health level, is crucial to ensure the latter's sound and effective implementation. NGx tests that are currently offered or developed have different natures and scopes. We provide an example of NGx testing on the MTHFR gene to illustrate the current challenges when it comes to grasp the meaning of the results of such testing. In addition, NGx testing is developed within an evolving landscape of new genomic technologies and occurs at a time when public health policies mainly focus on preventive and predictive healthcare, with an emphasis on increased individual responsibility. The ethical issues raised by such a context and the genetic nature of NGx testing both should be carefully evaluated.
Collapse
Affiliation(s)
- Thierry Hurlimann
- Public Health Research Institute - University of Montreal (IRSPUM), PO Box 6128, Station Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Julie Robitaille
- Institute of Nutrition & Functional Foods (INAF) & School of Nutrition, Université Laval, 2440 Hochelaga Blvd, Room 2729-N, Quebec City, QC, Canada
| | - Marie-Claude Vohl
- Institute of Nutrition & Functional Foods (INAF) & School of Nutrition, Université Laval, 2440 Hochelaga Blvd, Room 2729-N, Quebec City, QC, Canada
| | - Béatrice Godard
- Public Health Research Institute - University of Montreal (IRSPUM), PO Box 6128, Station Centre-ville, Montreal, QC, H3C 3J7, Canada
| |
Collapse
|
16
|
Li SX, Ye Z, Whelan K, Truby H. The effect of communicating the genetic risk of cardiometabolic disorders on motivation and actual engagement in preventative lifestyle modification and clinical outcome: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr 2016; 116:924-34. [PMID: 27405704 PMCID: PMC4983776 DOI: 10.1017/s0007114516002488] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/30/2016] [Accepted: 05/19/2016] [Indexed: 11/06/2022]
Abstract
Genetic risk prediction of chronic conditions including obesity, diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest. We aimed to understand whether the latter is indeed true by conducting a systematic review and meta-analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification. We included all randomised controlled trials (RCT) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease, without restrictions on age, duration of intervention or language. We conducted random-effects meta-analyses for perceived motivation for behaviour change and clinical changes (weight loss) and a narrative analysis for other outcomes. Within the thirteen studies reviewed, five were vignette studies (hypothetical RCT) and seven were clinical RCT. There was no consistent effect of genetic risk on actual motivation for weight loss, perceived motivation for dietary change (control v. genetic risk group standardised mean difference (smd) -0·15; 95 % CI -1·03, 0·73, P=0·74) or actual change in dietary behaviour. Similar results were observed for actual weight loss (control v. high genetic risk SMD 0·29 kg; 95 % CI -0·74, 1·31, P=0·58). This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults. Of thirteen studies, eight were at high or unclear risk of bias. Additional larger-scale, high-quality clinical RCT are warranted.
Collapse
Affiliation(s)
- Sherly X. Li
- Medical Research Council Epidemiology Unit, University
of Cambridge, Cambridge CB2 0QQ,
UK
| | - Zheng Ye
- Medical Research Council Epidemiology Unit, University
of Cambridge, Cambridge CB2 0QQ,
UK
| | - Kevin Whelan
- Diabetes and Nutritional Sciences Division, King’s
College London, London SE1 9NH, UK
| | - Helen Truby
- Department of Nutrition & Dietetics, Monash
University, Level 1, 264 Ferntree Gully
Road, Notting Hill, VIC 3168,
Australia
| |
Collapse
|
17
|
Bishop C, Strong K, Dimmock D. Choices of incidental findings of individuals undergoing genome wide sequencing, a single center's experience. Clin Genet 2016; 91:137-140. [DOI: 10.1111/cge.12829] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 01/17/2023]
Affiliation(s)
- C.L Bishop
- Division of Genetics, Department of Pediatrics; Medical College of Wisconsin; Milwaukee WI USA
- Human and Molecular Genetics Center; Medical College of Wisconsin; Milwaukee WI USA
| | - K.A Strong
- Human and Molecular Genetics Center; Medical College of Wisconsin; Milwaukee WI USA
- Program in Genomics and Ethics, Bioethics and Medical Humanities; Medical College of Wisconsin; Milwaukee WI USA
| | - D.P Dimmock
- Division of Genetics, Department of Pediatrics; Medical College of Wisconsin; Milwaukee WI USA
- Human and Molecular Genetics Center; Medical College of Wisconsin; Milwaukee WI USA
| |
Collapse
|
18
|
Bouchard-Mercier A, Desroches S, Robitaille J, Vohl MC. Factors Associated with the Intention of Registered Dietitians to Discuss Nutrigenetics with their Patients/Clients. CAN J DIET PRACT RES 2016; 77:163-169. [PMID: 27182816 DOI: 10.3148/cjdpr-2016-005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The objective of this study was to investigate factors affecting the intention of Registered Dietitians (RDs) to discuss nutrigenetics with their patients/clients. METHODS A survey based on the theory of planned behaviour (TPB; attitude, subjective norm, and perceived behavioural control) was developed and sent by email to RD members of the Ordre professionnel des diététistes du Québec. Multiple regression analyses were performed to examine the determinants of intention and behaviour. RESULTS A total of 141 RDs completed the questionnaire (5.8% response rate). On a scale from -2 to 2 (from strongly disagree to strongly agree), the intention of discussing nutrigenetics with patients/clients was neutral (mean of -0.07 ± 0.92). The TPB construct of attitude was the most strongly associated with intention (β = 0.66, P < 0.0001) followed by perceived behavioural control (β = 0.33, P < 0.0001) and subjective norm (β = 0.21, P = 0.03). Finally, 13 out of 141 RDs (~9%) actually practiced the behaviour, which was to have discussed nutrigenetics with their patients/clients in the last 3 months. Only perceived behavioural control contributed to explain the behaviour (β = 0.17, P < 0.0001). CONCLUSIONS Main determinants of the intention of RDs to discuss nutrigenetics with their patients/clients were determined. This knowledge will help inform the design of future educational content about nutrigenetics.
Collapse
Affiliation(s)
- Annie Bouchard-Mercier
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
| | - Sophie Desroches
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
| | - Julie Robitaille
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
| | - Marie-Claude Vohl
- a Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec, QC.,b Department of Food Science and Nutrition, Laval University, Quebec, QC
| |
Collapse
|
19
|
Covolo L, Rubinelli S, Ceretti E, Gelatti U. Internet-Based Direct-to-Consumer Genetic Testing: A Systematic Review. J Med Internet Res 2015; 17:e279. [PMID: 26677835 PMCID: PMC4704942 DOI: 10.2196/jmir.4378] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 12/26/2022] Open
Abstract
Background Direct-to-consumer genetic tests (DTC-GT) are easily purchased through the Internet, independent of a physician referral or approval for testing, allowing the retrieval of genetic information outside the clinical context. There is a broad debate about the testing validity, their impact on individuals, and what people know and perceive about them. Objective The aim of this review was to collect evidence on DTC-GT from a comprehensive perspective that unravels the complexity of the phenomenon. Methods A systematic search was carried out through PubMed, Web of Knowledge, and Embase, in addition to Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist with the key term “Direct-to-consumer genetic test.” Results In the final sample, 118 articles were identified. Articles were summarized in five categories according to their focus on (1) knowledge of, attitude toward use of, and perception of DTC-GT (n=37), (2) the impact of genetic risk information on users (n=37), (3) the opinion of health professionals (n=20), (4) the content of websites selling DTC-GT (n=16), and (5) the scientific evidence and clinical utility of the tests (n=14). Most of the articles analyzed the attitude, knowledge, and perception of DTC-GT, highlighting an interest in using DTC-GT, along with the need for a health care professional to help interpret the results. The articles investigating the content analysis of the websites selling these tests are in agreement that the information provided by the companies about genetic testing is not completely comprehensive for the consumer. Given that risk information can modify consumers’ health behavior, there are surprisingly few studies carried out on actual consumers and they do not confirm the overall concerns on the possible impact of DTC-GT. Data from studies that investigate the quality of the tests offered confirm that they are not informative, have little predictive power, and do not measure genetic risk appropriately. Conclusions The impact of DTC-GT on consumers’ health perceptions and behaviors is an emerging concern. However, negative effects on consumers or health benefits have yet to be observed. Nevertheless, since the online market of DTC-GT is expected to grow, it is important to remain aware of a possible impact.
Collapse
Affiliation(s)
- Loredana Covolo
- Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy, Brescia, Italy.
| | | | | | | |
Collapse
|
20
|
Rafiq M, Ianuale C, Ricciardi W, Boccia S. Direct-to-consumer genetic testing: a systematic review of european guidelines, recommendations, and position statements. Genet Test Mol Biomarkers 2015; 19:535-47. [PMID: 26313927 DOI: 10.1089/gtmb.2015.0051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Personalized healthcare is expected to yield promising results, with a paradigm shift toward more personalization in the practice of medicine. This emerging field has wide-ranging implications for all the stakeholders. Commercial tests in the form of multiplex genetic profiles are currently being provided to consumers, without the physicians' consultation, through the Internet, referred to as direct-to-consumer genetic tests (DTC GT). OBJECTIVES The objective was to review all the existing European guidelines on DTC GT, and its associated interventions, to list all the supposed benefits and harms, issues and concerns, and recommendations. METHODS We conducted a systematic review of position statements, policies, guidelines, and recommendations, produced by professional organizations or other relevant bodies for use of DTC GT in Europe. RESULTS Seventeen documents met the inclusion criteria, which were subjected to thematic analysis, and the texts were coded for statements related to use of DTC GT. DISCUSSION AND CONCLUSIONS Professional societies and associations are currently more suggestive of potential disadvantages of DTC GT, recommending improved genetic literacy of both populations and health professionals, and implementation research on the genetic tests to integrate public health genomics into healthcare systems.
Collapse
Affiliation(s)
- Muhammad Rafiq
- 1 Medical Management Center (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet , Stockholm, Sweden .,2 SDA Bocconi School of Management , Milan, Italy
| | - Carolina Ianuale
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Ricciardi
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
21
|
McBride CM, Abrams LR, Koehly LM. Using a Historical Lens to Envision the Next Generation of Genomic Translation Research. Public Health Genomics 2015; 18:272-82. [PMID: 26226840 DOI: 10.1159/000435832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past 20 years have witnessed successive and exponential advances in genomic discovery and technology, with a broad scientific imperative pushing for continual advancements. The most consistent critique of these advances is that they have vastly outpaced translation of new knowledge into improvements in public health and medicine. METHODS We employ a historical and epistemological analysis to characterize how prevailing scientific meta-narratives have shaped the pace and priorities of research applying genomics to health promotion. We use four 'pivotal events' - the genetic characterization of Down syndrome, the launch of the Human Genome Research Project, the discovery of BRCA1, and the emergence of direct-to- consumer genetic testing - to illustrate how these scientific meta-narratives have inhibited genomic translation research. RESULTS The notion that discovery should precede translation research has over-focused translation research on the latest genetic testing platform. The idea that genetic-related research has an exceptional potential for public harm has encouraged research on worst case scenarios. The perceived competition between genetics and social determinants of health has discouraged a unified research agenda to move genomic translation forward. CONCLUSION We make a case for creating new scientific meta-narratives in which discovery and translation research agendas are envisioned as an interdependent enterprise.
Collapse
|
22
|
Awareness, attitudes and perspectives of direct-to-consumer genetic testing in Greece: a survey of potential consumers. J Hum Genet 2015; 60:515-23. [DOI: 10.1038/jhg.2015.58] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 04/30/2015] [Indexed: 12/28/2022]
|
23
|
Bishop JP, Halburnt SB, Akkari PA, Sundseth S, Grossman I. Roadmap to Drug Development Enabled by Pharmacogenetics. ADVANCES IN PREDICTIVE, PREVENTIVE AND PERSONALISED MEDICINE 2015. [DOI: 10.1007/978-3-319-15344-5_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
24
|
Kechagia S, Mai Y, Vidalis T, Patrinos GP, Vayena E. Personal Genomics in Greece: An Overview of Available Direct-to-Consumer Genomic Services and the Relevant Legal Framework. Public Health Genomics 2014; 17:299-305. [DOI: 10.1159/000366175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
25
|
Strong KA, Zusevics KL, Bick D, Veith R. Views of primary care providers regarding the return of genome sequencing incidental findings. Clin Genet 2014; 86:461-8. [PMID: 24673592 DOI: 10.1111/cge.12390] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/13/2014] [Accepted: 03/25/2014] [Indexed: 01/18/2023]
Abstract
Sequencing of the entire exome or genome is increasingly used in clinical practice. Debate continues, however, regarding which incidental findings (IFs) should be returned and who should be involved in those decisions. Previous empirical research regarding stakeholder attitudes to the return of IFs has primarily involved genetics professionals; non-genetics health professionals have not been widely surveyed. Given this, a survey regarding return of IFs was administered at the Best Practices in Pediatrics Conference following an educational presentation on genetics terminology and genetic condition examples. A total of 258 participants completed the survey. Of particular note, respondents who were positively disposed to sequencing did not always report wanting to learn about IFs, even if actionable. This is noteworthy given recent American College of Medical Genetics and Genomics guidelines recommending particular actionable IF be returned 'without reference to patient preference'. This study's findings are important because they provide insight regarding the attitudes to the return of genome sequencing results for an important professional group, primary care providers. Ultimately, as likely gatekeepers to referrals for this technology, their opinions about the test will be key to its successful deployment.
Collapse
Affiliation(s)
- K A Strong
- Program in Genomics and Ethics, Center for Bioethics and Medical Humanities, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA; Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | |
Collapse
|
26
|
Steele FR, Gold L. DTC-and-Me: Patient, Provider, Proteins and Regulators. J Pers Med 2014; 4:79-87. [PMID: 25562144 PMCID: PMC4251405 DOI: 10.3390/jpm4010079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/16/2022] Open
Abstract
The yet-unrealized potential for more "personalized" Direct-to-Consumer (DTC) tests to fundamentally alter the practice and economics of healthcare is undeniable. However, there are also many challenges to be met, including the herculean task of ensuring that the information provided by such tests is scientifically sound and, ideally, medically actionable. We consider recent events in DTC testing and suggest a "thought experiment" of an approach that could ultimately meet the needs of patients, providers and regulatory authorities.
Collapse
Affiliation(s)
- Fintan R Steele
- SomaLogic Inc., 2945 Wilderness Pl., Boulder, CO 80301, USA.
| | - Larry Gold
- SomaLogic Inc., 2945 Wilderness Pl., Boulder, CO 80301, USA.
| |
Collapse
|
27
|
Camp KM, Trujillo E. Position of the Academy of Nutrition and Dietetics: nutritional genomics. J Acad Nutr Diet 2014; 114:299-312. [PMID: 24439821 DOI: 10.1016/j.jand.2013.12.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Indexed: 01/28/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that nutritional genomics provides insight into how diet and genotype interactions affect phenotype. The practical application of nutritional genomics for complex chronic disease is an emerging science and the use of nutrigenetic testing to provide dietary advice is not ready for routine dietetics practice. Registered dietitian nutritionists need basic competency in genetics as a foundation for understanding nutritional genomics; proficiency requires advanced knowledge and skills. Unlike single-gene defects in which a mutation in a single gene results in a specific disorder, most chronic diseases, such as cardiovascular disease, diabetes, and cancer are multigenetic and multifactorial and therefore genetic mutations are only partially predictive of disease risk. Family history, biochemical parameters, and the presence of risk factors in individuals are relevant tools for personalizing dietary interventions. Direct-to-consumer genetic testing is not closely regulated in the United States and may not be accompanied by access to health care practitioners. Applying nutritional genomics in clinical practice through the use of genetic testing requires that registered dietitian nutritionists understand, interpret, and communicate complex test results in which the actual risk of developing a disease may not be known. The practical application of nutritional genomics in dietetics practice will require an evidence-based approach to validate that personalized recommendations result in health benefits to individuals and do not cause harm.
Collapse
|
28
|
Anderson AE, Flores KG, Boonyasiriwat W, Gammon A, Kohlmann W, Birmingham WC, Schwartz MD, Samadder J, Boucher K, Kinney AY. Interest and informational preferences regarding genomic testing for modest increases in colorectal cancer risk. Public Health Genomics 2014; 17:48-60. [PMID: 24435063 DOI: 10.1159/000356567] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS This study explored the interest in genomic testing for modest changes in colorectal cancer risk and preferences for receiving genomic risk communications among individuals with intermediate disease risk due to a family history of colorectal cancer. METHODS Surveys were conducted on 272 men and women at intermediate risk for colorectal cancer enrolled in a randomized trial comparing a remote personalized risk communication intervention (TeleCARE) aimed at promoting colonoscopy to a generic print control condition. Guided by Leventhal's Common Sense Model of Self-Regulation, we examined demographic and psychosocial factors possibly associated with interest in SNP testing. Descriptive statistics and logistic regression models were used to identify factors associated with interest in SNP testing and preferences for receiving genomic risk communications. RESULTS Three-fourths of participants expressed interest in SNP testing for colorectal cancer risk. Testing interest did not markedly change across behavior modifier scenarios. Participants preferred to receive genomic risk communications from a variety of sources: printed materials (69.5%), oncologists (54.8%), primary-care physicians (58.4%), and the web (58.1%). Overall, persons who were unmarried (p = 0.029), younger (p = 0.003) and with greater cancer-related fear (p = 0.019) were more likely to express interest in predictive genomic testing for colorectal cancer risk. In a stratified analysis, cancer-related fear was associated with the interest in predictive genomic testing in the intervention group (p = 0.017), but not the control group. CONCLUSIONS Individuals with intermediate familial risk for colorectal cancer are highly interested in genomic testing for modest increases in disease risk, specifically unmarried persons, younger age groups and those with greater cancer fear.
Collapse
Affiliation(s)
- A E Anderson
- Huntsman Cancer Institute, University of Utah, Utah, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Hurlimann T, Menuz V, Graham J, Robitaille J, Vohl MC, Godard B. Risks of nutrigenomics and nutrigenetics? What the scientists say. GENES AND NUTRITION 2013; 9:370. [PMID: 24293399 DOI: 10.1007/s12263-013-0370-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/18/2013] [Indexed: 01/12/2023]
Abstract
Nutrigenomics and nutrigenetics (hereafter NGx) have stimulated expectations for beneficial applications in public health and individuals. Yet, the potential achievability of such promise is not without socioethical considerations that challenge NGx implementation. This paper focuses on the opinions of NGx researchers about potential risks raised by NGx. The results of an online survey show that these researchers (n = 126) are fairly confident about the potential benefits of NGx, and that most downplay its potential risks. Researchers in this field do not believe that NGx will reconfigure foods as medication or transform the conception of eating into a health hazard. The majority think that NGx will produce no added burden on individuals to get tested or to remain compliant with NGx recommendations, nor that NGx will threaten individual autonomy in daily food choice. The majority of researchers do not think that NGx will lead to discrimination against and/or stigmatization of people who do not comply with NGx dietary recommendations. Despite this optimism among NGx researchers, we suggest that key risk factors raised by the socioethical context in which NGx applications will be implemented need to be considered.
Collapse
Affiliation(s)
- T Hurlimann
- Department of Social and Preventive Medicine, Bioethics Programmes, School of Public Health (ESPUM), University of Montreal, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada
| | | | | | | | | | | |
Collapse
|
30
|
Su P. Direct-to-consumer genetic testing: a comprehensive view. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2013; 86:359-65. [PMID: 24058310 PMCID: PMC3767220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Direct-to-consumer (DTC) genetic testing refers to testing sold directly to consumers via the Internet, television, or other marketing venues without involving health care professionals. As the recent Supreme Court ruling eliminated the patentability of human genes, this rapidly evolving segment in the laboratory testing industry is starting to attract increasing scrutiny by government, scientists, consumers, and other interested parties. This article provides a panoramic view of the DTC genetic testing industry, including reasons for seeking DTC testing services, benefits and concerns associated with the industry, and potential development and prospects of this relatively new market under the current regulatory environment.
Collapse
|