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Aggarwal A, Han L, Lewis D, Costigan J, Hubbard A, Taylor J, Rigg A, Purushotham A, van der Meulen J. Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population-based study. Cancer 2024; 130:1221-1233. [PMID: 38186226 DOI: 10.1002/cncr.35153] [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: 08/08/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND This national study investigated hospital quality and patient factors associated with treatment location for breast cancer surgery. METHODS By using linked administrative data sets from the English National Health Service, the authors identified all women diagnosed between January 2, 2016, and December 31, 2018, who underwent breast-conserving surgery (BCS) or a mastectomy with or without immediate breast reconstruction. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regressions were used to estimate the impact of travel time, hospital quality, and patient characteristics. RESULTS 22,622 Of 69,153 patients undergoing BCS, 22,622 (32.7%) bypassed their nearest hospital; and, of 23,536 patients undergoing mastectomy, 7179 (30.5%) bypassed their nearest hospital. Women who were younger, without comorbidities, or from rural areas were more likely to travel to more distant hospitals (p < .05). Patients undergoing BCS (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.36-2.50) or mastectomy (OR, 1.52; 95% CI, 1.14-2.02) were more likely to be treated at specialist breast reconstruction centers despite not undergoing the procedure. Patients receiving mastectomy and immediate breast reconstruction were more likely to travel to hospitals employing surgeons who had a media reputation (OR, 2.41; 95% CI, 1.28-4.52). Patients undergoing BCS were less likely to travel to hospitals with shorter surgical waiting times (OR, 0.65; 95% CI, 0.46-0.92). The authors did not observe a significant impact for research activity, hospital quality rating, breast re-excision rates, or the status as a multidisciplinary cancer center. CONCLUSIONS Patient choice policies may drive inequalities in the health care system without improving patient outcomes.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Oncology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Lu Han
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Lewis
- UK Department for Environment, Food, and Rural Affairs, Agriculture Ministry of the United Kingdom, London, UK
| | | | - Alison Hubbard
- Patient and Public Involvement Representative, Liverpool, UK
| | | | - Anne Rigg
- Department of Oncology, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Arnie Purushotham
- Department of Breast Surgery, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Horton R, Boyle L, Weller S, Lucassen A. Glowing gels and pipettes aplenty: how do commercial stock image banks portray genetic tests? Eur J Hum Genet 2024; 32:456-460. [PMID: 38066171 PMCID: PMC10999410 DOI: 10.1038/s41431-023-01508-4] [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: 06/09/2023] [Revised: 11/02/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024] Open
Abstract
News stories and patient-facing material about genetic tests are often illustrated by images, but the content of such images and the messages they propagate are rarely scrutinised. Stock image banks were searched to identify a hundred images relating to genetic tests and analysed using a multimodal critical discourse approach, aiming to identify what the images featured, how they were composed, and what they communicated about genetic testing. We found that images tended to focus on technical aspects of sample processing (for example, pipetting) and drew on older technologies (for example slab gel electrophoresis) when representing data arising from genetic tests. Composition choices like focussing images around pipette tips, or emphasising colour or brightness of electrophoretic bands, represented genetic testing as precise, unambiguous and illuminating. Only 7% of images featured a person having a genetic test, and only one image alluded to communication of genetic results. Current popular visual representations of genetic testing rarely highlight the possibility of uncertain or non-diagnostic outcomes, and may contribute to high public expectations of informativeness and certainty from such tests.
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Affiliation(s)
- Rachel Horton
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Leah Boyle
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Susie Weller
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK
| | - Anneke Lucassen
- Clinical Ethics, Law and Society Group, University of Oxford, Oxford, UK.
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK.
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Liu M, Fan X, Ma S. A Linguistic Analysis of News Coverage of E-Healthcare in China with a Heterogeneous Graphical Model. ENTROPY (BASEL, SWITZERLAND) 2022; 24:1557. [PMID: 36359647 PMCID: PMC9689216 DOI: 10.3390/e24111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
E-healthcare has been envisaged as a major component of the infrastructure of modern healthcare, and has been developing rapidly in China. For healthcare, news media can play an important role in raising public interest and utilization of a particular service and complicating (and, perhaps clouding) debate on public health policy issues. We conducted a linguistic analysis of news reports from January 2015 to June 2021 related to E-healthcare in mainland China, using a heterogeneous graphical modeling approach. This approach can simultaneously cluster the datasets and estimate the conditional dependence relationships of keywords. It was found that there were eight phases of media coverage. The focuses and main topics of media coverage were extracted based on the network hub and module detection. The temporal patterns of media reports were found to be mostly consistent with the policy trend. Specifically, in the policy embryonic period (2015-2016), two phases were obtained, industry management was the main topic, and policy and regulation were the focuses of media coverage. In the policy development period (2017-2019), four phases were discovered. All the four main topics, namely industry development, health care, financial market, and industry management, were present. In 2017 Q3-2017 Q4, the major focuses of media coverage included social security, healthcare and reform, and others. In 2018 Q1, industry regulation and finance became the focuses. In the policy outbreak period (2020-), two phases were discovered. Financial market and industry management were the main topics. Medical insurance and healthcare for the elderly became the focuses. This analysis can offer insights into how the media responds to public policy for E-healthcare, which can be valuable for the government, public health practitioners, health care industry investors, and others.
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Affiliation(s)
- Mengque Liu
- School of Journalism and New Media, Xi’an Jiaotong University, No.28 Xianning West Road, Xi’an 710049, China
| | - Xinyan Fan
- Center for Applied Statistics, School of Statistics, Renmin University of China, 59 Zhongguancun Street, Haidian District, Beijing 100872, China
| | - Shuangge Ma
- Department of Biostatistics, Yale University, 60 College Street, New Haven, CT 06520, USA
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4
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Petrova D, Cruz M, Sánchez MJ. BRCA1/2 testing for genetic susceptibility to cancer after 25 years: A scoping review and a primer on ethical implications. Breast 2022; 61:66-76. [PMID: 34920368 PMCID: PMC8686063 DOI: 10.1016/j.breast.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mutations in the genes called BRCA1 and BRCA2 are associated with significantly elevated lifetime risk of developing breast and ovarian cancer. This year marks 25 years since genetic tests for BRCA1/2 mutations became available to the public. Currently, comprehensive guidelines exist regarding BRCA1/2 testing and preventive measures in mutation carriers. As such, BRCA1/2 testing represents a precedent not only in genetic testing and management of genetic cancer risk, but also in bioethics. The goal of the current research was to offer a review and an ethical primer of the main ethical challenges related to BRCA testing. METHOD A systematic scoping review was undertaken following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Four databases were searched and 18 articles that met the inclusion criteria were synthetized narratively into a conceptual map. RESULTS Ethical discussions revolved around the BRCA1/2 gene discovery, how tests are distributed for clinical use, the choice to undergo testing, unresolved issues in receiving and disclosing test results, reproductive decision-making, and culture-specific ethics. Several unique properties of the latest developments in testing circumstances (e.g., incorporation of BRCA1/2 testing in multi-gene or whole genome sequence panels and tests sold directly to consumers) significantly raised the complexity of ethical debates. CONCLUSIONS Multidisciplinary ethical discussion is necessary to guide not only individual decision making but also societal practices and medical guidelines in light of the new technologies available and the latest results regarding psychological, social, and health outcomes in cancer previvors and survivors affected by BRCA mutations.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Maite Cruz
- Escuela Andaluza de Salud Pública, Granada, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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5
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Zimmermann BM, Shaw DM, Elger B, Koné I. The use of heuristics in genetic testing decision-making: A qualitative interview study. PLoS One 2021; 16:e0260597. [PMID: 34847204 PMCID: PMC8631642 DOI: 10.1371/journal.pone.0260597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Decision-making concerning predictive genetic testing for hereditary cancer syndromes is inherently complex. This study aims to investigate what kind of complexities adults undergoing genetic counseling in Switzerland experience, how they deal with them, and what heuristics they use during the decision-making process. METHODS Semi-structured qualitative interviews with eighteen Swiss adults seeking genetic counseling for hereditary cancer syndrome genetic testing and two counseling physicians were conducted and analyzed using a grounded theory approach. RESULTS Counselees stated that once they were aware of their eligibility for genetic testing they perceived an inevitable necessity to make a decision in a context of uncertainties. Some counselees perceived this decision as simple, others as very complex. High emotional involvement increased perceived complexity. We observed six heuristics that counselees used to facilitate their decision: Anticipating the test result; Focusing on consequences; Dealing with information; Interpreting disease risk; Using external guidance; and (Re-)Considering the general uncertainty of life. LIMITATIONS Our findings are limited to the context of predictive genetic testing for hereditary cancer syndromes. This qualitative study does not allow extrapolation of the relative frequency of which heuristics occur. CONCLUSIONS The use of heuristics is an inherent part of decision-making, particularly in the complex context of genetic testing for inherited cancer predisposition. However, some heuristics increase the risk of misinterpretation or exaggerated external influences. This may negatively impact informed decision-making. Thus, this study illustrates the importance of genetic counselors and medical professionals being aware of these heuristics and the individual manner in which they might be applied in the context of genetic testing decision-making. Findings may offer practical support to achieve this, as they inductively focus on the counselees' perspective.
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Affiliation(s)
- Bettina Maria Zimmermann
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - David Martin Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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6
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Paget SP, Campbell L, Blaxland A, Lewis J, Morrow AM, Wimalasundera N. 'Life-changing surgery': English-language news media representation of selective dorsal rhizotomy. Child Care Health Dev 2021; 47:844-850. [PMID: 34251700 DOI: 10.1111/cch.12894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 01/26/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) is a neurosurgical intervention to reduce spasticity in children with cerebral palsy. Parents researching SDR for their child may be influenced by framing of SDR in news media articles they read. This study examined framing of SDR in English-language news media. METHODS Content analysis of English-language news media articles including the search term 'rhizotomy' in the Factiva database published July 2015 to July 2018 in online or print form in Canada, New Zealand, Australia, United States of America and the United Kingdom. RESULTS One hundred and eighty-six articles were identified describing 91 different children (45 male), almost all with cerebral palsy, median age 4 years old. One hundred and twenty-six articles were written prior to surgery; in many articles, SDR surgery involved travel overseas and/or fundraising. SDR was described universally in positive terms with little discussion of risks. Content of articles variably included the specialized nature of SDR, parental frustration with their local health system and their hope for positive outcomes. There was geographical variation in both numbers of articles and content. CONCLUSIONS SDR is a common focus in cerebral palsy news media articles in some countries. Framing in these articles supports SDR as a beneficial and specialized procedure and may lead families to believe they need to work outside their local health systems. As news media are likely an important influence on families' attitudes to SDR, clinicians should be aware of this influence.
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Affiliation(s)
- Simon Paul Paget
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lani Campbell
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anneliese Blaxland
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jennifer Lewis
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Angela Mary Morrow
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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7
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Pagnaer T, Siermann M, Borry P, Tšuiko O. Polygenic risk scoring of human embryos: a qualitative study of media coverage. BMC Med Ethics 2021; 22:125. [PMID: 34537037 PMCID: PMC8449454 DOI: 10.1186/s12910-021-00694-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Current preimplantation genetic testing (PGT) technologies enable embryo genotyping across the whole genome. This has led to the development of polygenic risk scoring of human embryos (PGT-P). Recent implementation of PGT-P, including screening for intelligence, has been extensively covered by media reports, raising major controversy. Considering the increasing demand for assisted reproduction, we evaluated how information about PGT-P is communicated in press media and explored the diversity of ethical themes present in the public debate. METHODS LexisNexis Academic database and Google News were searched to identify articles about polygenic embryo screening. This led to 535 news articles. 59 original articles met the inclusion criteria. Inductive content analysis was used to analyse these articles. RESULTS 8.8% of articles gave embryo polygenic scoring a positive portrayal, while 36.8% expressed a negative attitude. 54.4% were neutral, mostly highlighting limited practical value of the technology in in vitro fertilization settings. We identified five main ethical themes that are also present in academic literature and the broader debate on reproductive technologies: a slippery slope towards designer babies, well-being of the child and parents, impact on society, deliberate choice and societal readiness. CONCLUSIONS Implementation of embryo polygenic profiling engenders a need for specific recommendations. Current media analysis discloses important ethical themes to consider when creating future guidelines for PGT-P.
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Affiliation(s)
- Tiny Pagnaer
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Maria Siermann
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Olga Tšuiko
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, Centre for Human Genetics, KU Leuven, Leuven, Belgium
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8
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Dar-Nimrod I, Kuntzman R, MacNevin G, Lynch K, Woods M, Morandini J. Genetic essentialism: The mediating role of essentialist biases on the relationship between genetic knowledge and the interpretations of genetic information. Eur J Med Genet 2020; 64:104119. [PMID: 33285312 DOI: 10.1016/j.ejmg.2020.104119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/15/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Genetic research, via the mainstream media, presents the public with novel, profound findings almost on a daily basis. However, it is not clear how much laypeople understand these presentations and how they integrate such new findings into their knowledge base. Genetic knowledge (GK), existing causal beliefs, and genetic essentialist tendencies (GET) have been implicated in such processes; the current study assesses the relationships between these elements and how brief presentations of media releases of scientific findings about genetics are consumed and affect the readers. METHODS An Australian national survey of GK, GET, and existing causal beliefs about health phenomena (heart disease and obesity) was conducted. Participants were also exposed to news headlines that offered genetic and non-genetic partial explanations of the same health phenomena and reported their evaluations of these headlines, as well as the effects of the headlines on their personal understanding of the health phenomena. RESULTS GK was negatively-associated with GET. Whereas GK did not directly predict the evaluation and effects of the genetic headlines, GET did. GK predicted the effects of the headlines indirectly via GET and via GET and existing causal beliefs. CONCLUSION GET seem to predict unwarranted effects of exposure to news headlines about genetic science, whereas GK seems to indirectly mitigate the same unwarranted effects.
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Affiliation(s)
- Ilan Dar-Nimrod
- School of Psychology, University of Sydney, Australia; The Charles Perkins Centre, University of Sydney, Australia.
| | - Ruth Kuntzman
- School of Psychology, University of Sydney, Australia
| | | | - Kate Lynch
- The Charles Perkins Centre, University of Sydney, Australia; Department of Philosophy, University of Sydney, Australia
| | - Marlon Woods
- School of Psychology, University of Sydney, Australia
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Du L, Lin S, Kamenova K. Framing Ethical Concerns and Attitudes towards Human Gene Patents in the Chinese Press. Asian Bioeth Rev 2020; 12:307-323. [PMID: 33717340 PMCID: PMC7747419 DOI: 10.1007/s41649-020-00136-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022] Open
Abstract
This study examines the representations of human gene patents in Chinese newspapers. We conducted a qualitative content analysis of news articles published between 2006 and 2017 to identify the major themes in media coverage, ethical considerations, perceptions of risks and benefits, and attitudes towards the patentability of human genes. The results show that two key ethical concerns were expressed by journalists: (1) that it is morally wrong to own or patent human genes and (2) that gene patents could potentially impede patients' access to healthcare services. Nonetheless, the press coverage has tended to be largely favorable (57.8%), rather than opposed (17.8%) to human gene patenting. There were no normative claims that human genes should not be patentable in China, which indicates a generally positive attitude towards patentability in media discourse. Most articles that expressed criticism toward gene patenting discussed challenges in other countries, with significant attention given to the United States Supreme Court's ruling in the Myriad case that invalidated Myriad Genetics' patents on the BRCA1 and BRCA2 genes. Overall, the newspapers were uncritical of the Chinese gene patenting regime. News reporting on the issue was highly suggestive of a strong pro-commercialization stance, although some discussions emphasized potential risks over benefits. Our analysis highlights the need for balanced media reporting on human gene patents in China and a top-down approach to engage the public in substantive discussions on the ethical and societal implications of the existing patent regime.
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Affiliation(s)
- Li Du
- Faculty of Law, University of Macau, Taipa, Macau SAR
| | - Sijie Lin
- Faculty of Law, University of Macau, Taipa, Macau SAR
- C&C Lawyers & Notaries, Macau, Macau SAR
| | - Kalina Kamenova
- Canadian Institute for Genomics and Society, Toronto, Ontario Canada
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10
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Hamilton JG, Genoff Garzon M, Shah IH, Cadet K, Shuk E, Westerman JS, Hay JL, Offit K, Robson ME. Illustrating Cancer Risk: Patient Risk Communication Preferences and Interest regarding a Novel BRCA1/2 Genetic Risk Modifier Test. Public Health Genomics 2020; 23:6-19. [PMID: 32191943 DOI: 10.1159/000505854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/10/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Genetic risk modifier testing (GRMT), an emerging form of genetic testing based on common single nucleotide polymorphisms and polygenic risk scores, has the potential to refine estimates of BRCA1/2 mutation carriers' breast cancer risks. However, for women to benefit from GRMT, effective approaches for communicating this novel risk information are needed. OBJECTIVE To evaluate patient preferences regarding risk communication materials for GRMT. METHODS We developed four separate presentations (panel of genes, icon array, verbal risk estimate, graphical risk estimate) of hypothetical GRMT results, each using varying risk communication strategies to convey different information elements including number of risk modifier variants present, variant prevalence among BRCA1/2 carriers, and implications and uncertainties of test results for cancer risk. Thirty BRCA1/2 carriers evaluated these materials (randomized to low, moderate, or high breast cancer risk versions). Qualitative and quantitative data were obtained through in-person interviews. RESULTS Across risk versions, participants preferred the presentation of the graphical risk estimate, often in combination with the verbal risk estimate. Interest in GRMT was high; 76.7% of participants wanted their own GRMT. Participants valued the potential for GRMT to clarify their cancer susceptibility and provide actionable information. Many (65.5%) anticipated that GRMT would make risk management decisions easier. CONCLUSIONS Women with BRCA1/2 mutations could be highly receptive to GRMT, and the minimal amount of necessary information to be included in result risk communication materials includes graphical and verbal estimates of future cancer risk. Findings will inform clinical translation of GRMT in a manner consistent with patients' preferences.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA, .,Department of Psychiatry, Weill Cornell Medical College, Cornell University, New York, New York, USA, .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA,
| | - Margaux Genoff Garzon
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ibrahim H Shah
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kechna Cadet
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elyse Shuk
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joy S Westerman
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA.,Program in Cell Biology and Genetics, Sloan Kettering Institute, New York, New York, USA
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
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11
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Finnegan A. Effects of a sister's death in childbirth on reproductive behaviors: Difference-in-difference analyses using sisterhood mortality data from Indonesia. Soc Sci Med 2020; 250:112795. [PMID: 32145482 DOI: 10.1016/j.socscimed.2020.112795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/08/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
RATIONALE Risk of maternal mortality increases rapidly during the intrapartum period making skilled care at delivery an effective intervention to reduce the risk of maternal death. Demand generation for skilled care typically focuses on institutional channels; however, much less attention has been paid to whether what women may learn through their social networks can potentially influence their choice of delivery care. OBJECTIVE The objective of this study was to analyze whether a sister's death in childbirth has the potential to improve delivery care choices for women who experience this event. METHODS This study uses retrospective reports of sister deaths - either in childbirth or from some other cause - reported in the sisterhood moratlity module from five waves of the Indonesia Demographic and Health Surveys (IDHS) spanning 1989 to 2012. A cross-sectional, difference-in-difference strategy compares delivery care behavior of women before and after losing a sister in childbirth to women before and after losing a sister of reproductive age from some other cause in an intent-to-treat framework. RESULTS Women are less likely to give birth at home after losing a sister in childbirth relative to women who lose a sister from some other cause. Losing a sister in childbirth may trigger behaviors that help usher women of lower socioeconomic status into formal delivery care. CONCLUSION This study extends the literature on health behavior change through social networks to improve delivery care. Public health campaigns should consider social networks when designing messages around maternal mortality in order to help women at risk of maternal mortality make decisions that reduce their risk of and ultimately avoid maternal death.
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Affiliation(s)
- Amy Finnegan
- Duke Global Health Institute (DGHI), 310 Trent Drive Durham, NC, 27710, United States; IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC 27517, United States.
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12
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Abstract
Governments and financial institutions in several jurisdictions are planning or implementing nonmedical/'forced' switches by cutting drug coverage for reference biologics and funding only less expensive biosimilars. Switches raise numerous ethical and legal challenges, as the drugs are framed as not being identical and, despite strong evidence for noninferiority of some biosimilars, there is controversy over whether switching can sometimes lead to adverse events. Canadian law generally requires physicians to give precedence to their patients' best interests over social interests such as cost containment. The primacy of patients' interests is also clearly reflected in professional policies and codes of ethics. Moreover, physicians are obligated to disclose everything a reasonable person in the patient's position would want to know when obtaining informed consent for treatment, including addressing not only scientific information but also relevant social controversy about nonmedical switches. Under Canadian law, physicians may be obligated to tell patients about the ability to access unfunded biologics, even if patients lack the resources to obtain them. In sum, while there is no inherent right to funding for reference biologics in Canada, physicians in some circumstances may have a legal obligation as fiduciaries to advocate on behalf of patients to remain on a reference biologic. At a minimum, the controversy surrounding switching will necessitate, as part of the consent process, a robust and thorough disclosure of relevant risks, benefits and reasonable alternatives.
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Affiliation(s)
- Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
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13
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Marcon AR, Allan D, Barber M, Murdoch B, Caulfield T. Portrayal of umbilical cord blood research in the North American popular press: promise or hype? Regen Med 2020; 15:1228-1237. [PMID: 32101099 DOI: 10.2217/rme-2019-0149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: This study examined how umbilical cord blood (UCB) use was portrayed in the English language North American popular press. Methods: Directed content analysis was conducted on 400 articles from 2007 to 2017 containing 'cord blood,' published by the most read Canadian and American news sources. Results: A total of 86.3% of the articles detailed UCB treatments and therapies, the majority of which align with clinical evidence. Some articles portrayed speculative/experimental therapies as efficacious. Public and private banking initiatives received substantial attention, and were portrayed diversely. Promotional narrative messaging was evident around private banking. Conclusion: Findings demonstrate the need for continual monitoring of the media portrayals of UCB as stem cell and transplantation research develops and as clinics continue to operate.
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Affiliation(s)
- Alessandro R Marcon
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada, T6G 2H5
| | - David Allan
- Ottawa Hospital Research Institute, Canadian Blood Services, University of Ottawa, Ottawa ON, Canada, K1Y 4E9
| | - Morgan Barber
- University of Alberta, Faculty of Law, Edmonton, AB, Canada, T6G 2H5
| | - Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada, T6G 2H5
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada, T6G 2H5
- School of Public Health, University of Alberta, Edmonton, AB, Canada, T6G 1C9
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Zimmermann B, Elger B, Shaw D. Media Coverage of Ethical Issues in Predictive Genetic Testing: A Qualitative Analysis. AJOB Empir Bioeth 2019; 10:250-264. [PMID: 31596686 DOI: 10.1080/23294515.2019.1670275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Predictive genetic testing (PGT) raises many ethical issues and is of increasing interest to the general population. Mass media, especially newspapers, are the public's main source of information on this topic. Methods: We conducted a content analysis of British newspaper reporting, assessing which ethical issues were mentioned. The analysis was qualitative with semi-quantitative aspects. All articles about PGT published in The Guardian and the Daily Telegraph from 2011 to 2016 were included. Results: Most ethical issues discussed in the scientific and ethical literature are implicitly or explicitly covered in newspapers, but there was no discussion of incidental findings and the possibility of false reassurance of a negative test result was mentioned only once. There are also important gaps regarding the multidimensional nature and complexity of many issues. The Guardian mentioned ethical issues more frequently than the Daily Telegraph. Most ethical issues were portrayed as first-person narratives. Conclusions: Ethical issues concern potential test users and society more than scientific background knowledge about such tests; therefore, more efforts should be taken to address these complex issues in a manner that is comprehensible for the lay public.
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Affiliation(s)
- Bettina Zimmermann
- Institute for Biomedical Ethics, University of Basel , Basel , Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel , Basel , Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel , Basel , Switzerland
- Care and Public Health Research Institute, Maastricht University , Maastricht , the Netherlands
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15
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Al-Hussaini M, Ammar K, Kasasbeh N, Sultan H, Al-Omari A. Global celebrities' effect on health awareness among Jordanians: A study using the case of Angelina Jolie. J Genet Couns 2019; 28:1021-1028. [PMID: 31386265 DOI: 10.1002/jgc4.1154] [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: 01/22/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 11/07/2022]
Abstract
Celebrities' health decisions have long been associated with heightened awareness and health trend changes. This is the first study conducted in an Arab population investigating the impact of international celebrity news on local communities using the case of Angelia Jolie's (AJ) prophylactic mastectomy and oophorectomy surgeries. The objective was to measure the effect of publicized medical information on cancer genetic testing knowledge, attitudes, and practices (KAP). This is a cross-sectional study using a semi-structured, self-administered questionnaire for clinic visitors at the King Hussein Cancer Center (KHCC). We had predominantly female (n = 262, 66.3%) and healthy participants (n = 248, 66.5%). Approximately 80.7% (n = 330) recognized AJ, the actress, and of these, 71% (n = 232) were aware of her recent diagnosis and prophylactic surgeries. Males reported a higher knowledge score (p < .001). However, females had more initiative to seek information (18.3% vs. 10.1%; p = .04). People aware of Angelina's prophylactic procedures were inclined to seek information regarding cancer genetics (20.8% vs. 9.6% p = .003). Breast and ovarian cancer patients were more likely than other cancer patients to encourage family members to undergo prophylactic surgery in case of BRCA1/2 mutations (39.2% vs. 17.1% p = .03). Ninety-three percent of the sample lacked knowledge regarding the availability of cancer genetic testing in Jordan. Results highlight a clear effect of celebrity medical news on our population, as well as openness to consider genetic testing as an early detection tool for women with a family history of breast and/or ovarian cancer. Generalization of these results to the population of Jordan requires further studies.
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Affiliation(s)
- Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan.,Office of Human Research Protection Program (HRPP), King Hussein Cancer Center, Amman, Jordan
| | - Khawlah Ammar
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Nour Kasasbeh
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Hala Sultan
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Amal Al-Omari
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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16
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Zimmermann BM, Aebi N, Kolb S, Shaw D, Elger BS. Content, evaluations and influences in newspaper coverage of predictive genetic testing: A comparative media content analysis from the United Kingdom and Switzerland. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2019; 28:256-274. [PMID: 30583711 DOI: 10.1177/0963662518816014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Predictive genetic testing often entails challenging decisions about preventive measures and uncertain health-related risk predictions. Because of its increasing availability, it is important to assess how to debate it publicly. Newspaper content analysis represents a common and reliable way to investigate public discourse retrospectively. We thus quantitatively compare broadsheet newspaper coverage about predictive genetic testing in the United Kingdom and Switzerland during the period of 2011-2016 regarding content, evaluations, stakeholder influence, and trigger events. British coverage was more extensive and positive and included more personal stories. Swiss coverage had more focus on political issues. Angelina Jolie's announcement about her double mastectomy was the most important coverage trigger. Researchers were the most frequently cited stakeholder group, but stakeholders from government and civil society were also represented. Our results thus reflect a movement toward a more active public engagement with predictive genetic testing. The findings help to improve and enrich public engagement regarding predictive genetic testing.
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Affiliation(s)
| | - Noah Aebi
- Institute for Biomedical Ethics, University of Basel, Switzerland
| | - Steffen Kolb
- HTW Berlin-University of Applied Sciences, Germany
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Switzerland; Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Switzerland; Center for Legal Medicine, University of Geneva, Switzerland
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17
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Allen CG, Andersen B, Khoury MJ, Roberts MC. Current Social Media Conversations about Genetics and Genomics in Health: A Twitter-Based Analysis. Public Health Genomics 2018; 21:93-99. [PMID: 30466105 DOI: 10.1159/000494381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The growing availability of genomic information to the public may spur discussion about genetics and genomics on social media. Sites, including Twitter, provide a unique space for the public to access and discuss health information. The objective of this study was to better understand how social media users are sharing information about genetics and genomics in health and healthcare and what information is most commonly discussed among Twitter users. METHODS We obtained tweets with specific genetics- and genomics-related keywords from Crimson Hexagon. We used Boolean logic to collect tweets containing chosen keywords within the timeframe of October 1, 2016, to October 1, 2017. Features of the software were used to identify salient themes in conversation, conduct an emergent content analysis, and gather key demographic information. RESULTS We obtained 347,196 tweets from our search. There was a monthly average volume of 28,432 tweets. The five categories of tweets included: genetic disorders/disease (45.3%), health (15.6%), genomics (8%), and genetic testing (7.3%). Top influencers in the conversation included news outlets and universities. CONCLUSIONS This content analysis provides insight about the types of conversation related to genomics and health. Conversations about genomics are occurring on Twitter, and they frequently emphasize rare genetic diseases and genetic disorders. These discussions tend to be driven by key influencers who primarily include news media outlets. Further understanding of the discussions related to genomics and health in social media may offer insight about topics of importance to the public.
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Affiliation(s)
- Caitlin G Allen
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA,
| | - Brittany Andersen
- Division of Emerging Media Studies, Boston University, Boston, Massachusetts, USA
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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18
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Vasconcellos-Silva PR, Sormunen T, Craftman ÅG. Evolution of accesses to information on breast cancer and screening on the Brazilian National Cancer Institute website: an exploratory study. CIENCIA & SAUDE COLETIVA 2018; 23:1303-1312. [PMID: 29694575 DOI: 10.1590/1413-81232018234.14082016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/09/2016] [Indexed: 11/22/2022] Open
Abstract
Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA's website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.
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19
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Marcon AR, Bieber M, Caulfield T. Representing a "revolution": how the popular press has portrayed personalized medicine. Genet Med 2018; 20:950-956. [PMID: 29300377 DOI: 10.1038/gim.2017.217] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/26/2017] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This study investigated the portrayal of "personalized" and "precision" medicine (PM) in North American news over the past decade. Content analysis of print and online news was conducted to determine how PM has been defined and to identify the frames used to discuss PM, including associated topics, benefits, and concerns. METHODS A data set was built using the FACTIVA database, searching for popular North American publications with the terms "personalized (personalised) medicine" and/or "precision medicine" from 1 January 2005 to 15 March 2016. The final set of publications totaled 774. RESULTS PM is almost exclusively defined as related to genetics and is often part of a story related to cancer. The PM story is overwhelmingly one of highlighting (potential) benefits and optimism, especially in shorter publications, and ones where PM is not the main focus. This promotional PM discourse has remained fairly consistent over the past decade. CONCLUSION The numerous concerns associated with PM have received little attention over the past decade, especially in articles more likely to be encountered by a more general audience. This promotion of PM serves as an example of the science hyping that takes place in science reportage and may have implications for consumers, public expectations, and related health policy.
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Affiliation(s)
- Alessandro R Marcon
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Bieber
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada. .,Faculty of Law and School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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20
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Baum E, Domaradzki J. Chapter 13 Geneticization and Bioethics: Ethical Dilemmas in Genetic Counselling. THE ETHICS OF REPRODUCTIVE GENETICS 2018:189-204. [DOI: https:/doi.org/10.1007/978-3-319-60684-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
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21
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Meisel SF, Fraser LSM, Side L, Gessler S, Hann KEJ, Wardle J, Lanceley A. Anticipated health behaviour changes and perceived control in response to disclosure of genetic risk of breast and ovarian cancer: a quantitative survey study among women in the UK. BMJ Open 2017; 7:e017675. [PMID: 29275340 PMCID: PMC5770899 DOI: 10.1136/bmjopen-2017-017675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Genetic risk assessment for breast cancer and ovarian cancer (BCOC) is expected to make major inroads into mainstream clinical practice. It is important to evaluate the potential impact on women ahead of its implementation in order to maximise health benefits, as predictive genetic testing without adequate support could lead to adverse psychological and behavioural responses to risk disclosure. OBJECTIVE To examine anticipated health behaviour changes and perceived control to disclosure of genetic risk for BCOC and establish demographic and person-specific correlates of adverse anticipated responses in a population-based sample of women. DESIGN Cross-sectional quantitative survey study carried out by the UK Office for National Statistics in January and March 2014. SETTING Face-to-face computer-assisted interviews conducted by trained researchers in participants' homes. PARTICIPANTS 837 women randomly chosen from households across the UK identified from the Royal Mail's Postcode Address File. OUTCOME MEASURES Anticipated health behaviour change and perceived control to disclosure of BCOC risk. RESULTS In response to a genetic test result, most women (72%) indicated 'I would try harder to have a healthy lifestyle', and over half (55%) felt 'it would give me more control over my life'. These associations were independent of demographic factors or perceived risk of BCOC in Bonferroni-corrected multivariate analyses. However, a minority of women (14%) felt 'it isn't worth making lifestyle changes' and that 'I would feel less free to make choices in my life' (16%) in response to BCOC risk disclosure. The former belief was more likely to be held by women who were educated below university degree level (P<0.001) after adjusting for other demographic and person-specific correlates. CONCLUSION These findings indicate that women in the UK largely anticipate that they would engage in positive health behaviour changes in response to BCOC risk disclosure.
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Affiliation(s)
- Susanne F Meisel
- Dept of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Lucy Side
- Clinical Genetics, University Hospital Southampton NHS Trust, Southampton, UK
| | - Sue Gessler
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
- Gynaecological Cancer Centre, University College London Hospitals (UCLH), London, UK
| | - Katie E J Hann
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
| | - Jane Wardle
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anne Lanceley
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
- Gynaecological Cancer Centre, University College London Hospitals (UCLH), London, UK
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22
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Menendez JA, Folguera-Blasco N, Cuyàs E, Fernández-Arroyo S, Joven J, Alarcón T. Accelerated geroncogenesis in hereditary breast-ovarian cancer syndrome. Oncotarget 2017; 7:11959-71. [PMID: 26943589 PMCID: PMC4914261 DOI: 10.18632/oncotarget.7867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/21/2016] [Indexed: 12/21/2022] Open
Abstract
The geroncogenesis hypothesis postulates that the decline in metabolic cellular health that occurs naturally with aging drives a "field effect" predisposing normal tissues for cancer development. We propose that mutations in the cancer susceptibility genes BRCA1/2 might trigger "accelerated geroncogenesis" in breast and ovarian epithelia. By speeding up the rate at which the metabolic threshold becomes "permissive" with survival and expansion of genomically unstable pre-tumoral epithelial cells, BRCA haploinsufficiency-driven metabolic reprogramming would operate as a bona fide oncogenic event enabling malignant transformation and tumor formation in BRCA carriers. The metabolic facet of BRCA1 one-hit might involve tissue-specific alterations in acetyl-CoA, α-ketoglutarate, NAD+, FAD, or S-adenosylmethionine, critical factors for de/methylation or de/acetylation dynamics in the nuclear epigenome. This in turn might induce faulty epigenetic reprogramming at the "install phase" that directs cell-specific differentiation of breast/ovarian epithelial cells, which can ultimately determine the penetrance of BRCA defects during developmental windows of susceptibility. This model offers a framework to study whether metabolic drugs that prevent or revert metabolic reprogramming induced by BRCA haploinsufficiency might displace the "geroncogenic risk" of BRCA carriers to the age typical for those without the mutation. The identification of the key nodes that directly communicate changes in cellular metabolism to the chromatin in BRCA haploinsufficient cells may allow the epigenetic targeting of genomic instability using exclusively metabolic means. The validation of accelerated geroncogenesis as an inherited "one-hit" metabolic "field effect" might offer new strategies to therapeutically revisit the apparently irreversible genetic-hereditary fate of women with hereditary breast-ovarian cancer syndrome.
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Affiliation(s)
- Javier A Menendez
- ProCURE (Program Against Cancer Therapeutic Resistance), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Catalonia, Spain.,Molecular Oncology Group, Girona Biomedical Research Institute (IDIBGI), Salt, Catalonia, Spain
| | - Núria Folguera-Blasco
- Computational and Mathematical Biology Research Group, Centre de Recerca Matemàtica (CRM), Barcelona, Spain
| | - Elisabet Cuyàs
- ProCURE (Program Against Cancer Therapeutic Resistance), Metabolism and Cancer Group, Catalan Institute of Oncology, Girona, Catalonia, Spain.,Molecular Oncology Group, Girona Biomedical Research Institute (IDIBGI), Salt, Catalonia, Spain
| | - Salvador Fernández-Arroyo
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Campus of International Excellence Southern Catalonia, Reus, Spain
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Campus of International Excellence Southern Catalonia, Reus, Spain
| | - Tomás Alarcón
- Computational and Mathematical Biology Research Group, Centre de Recerca Matemàtica (CRM), Barcelona, Spain.,Institució Catalana d'Estudis i Recerca Avançats (ICREA), Barcelona, Spain.,Departament de Matemàtiques, Universitat Autònoma de Barcelona, Barcelona, Spain.,Barcelona Graduate School of Mathematics (BGSMath), Barcelona, Spain
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23
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Okur V, Chung WK. The impact of hereditary cancer gene panels on clinical care and lessons learned. Cold Spring Harb Mol Case Stud 2017; 3:mcs.a002154. [PMID: 29162654 PMCID: PMC5701305 DOI: 10.1101/mcs.a002154] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mutations in hereditary cancer syndromes account for a modest fraction of all cancers; however, identifying patients with these germline mutations offers tremendous health benefits to both patients and their family members. There are about 60 genes that confer a high lifetime risk of specific cancers, and this information can be used to tailor prevention, surveillance, and treatment. With advances in next-generation sequencing technologies and the elimination of gene patents for evaluating genetic information, we are now able to analyze multiple genes simultaneously, leading to the widespread clinical use of gene panels for germline cancer testing. Over the last 4 years since these panels were introduced, we have learned about the diagnostic yield of testing, the expanded phenotypes of the patients with mutations, and the clinical utility of genetic testing in patients with cancer and/or without cancer but with a family history of cancer. We have also experienced challenges including the large number of variants of unknown significance (VUSs), identification of somatic mutations and need to differentiate these from germline mutations, technical issues with particular genes and mutations, insurance coverage and reimbursement issues, lack of access to data, and lack of clinical management guidelines for newer and, especially, moderate and low-penetrance genes. The lessons learned from cancer genetic testing panels are applicable to other clinical areas as well and highlight the problems to be solved as we advance genomic medicine.
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Affiliation(s)
- Volkan Okur
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York 10032, USA
| | - Wendy K Chung
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York 10032, USA; .,Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA
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Vicari S. Twitter and Non-Elites: Interpreting Power Dynamics in the Life Story of the (#)BRCA Twitter Stream. SOCIAL MEDIA + SOCIETY 2017; 3:2056305117733224. [PMID: 29278246 PMCID: PMC5731555 DOI: 10.1177/2056305117733224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In May 2013 and March 2015, actress Angelina Jolie wrote in the New York Times about her choice to undergo preventive surgery. In her two op-eds, she explained that - as a carrier of the BRCA1 gene mutation - preventive surgery was the best way to lower her heightened risk of developing breast and ovarian cancer. By applying a digital methods approach to BRCA-related tweets from 2013 and 2015, before, during, and after the exposure of Jolie's story, this study maps and interprets Twitter discursive dynamics at two time points of the BRCA Twitter stream. Findings show an evolution in curation and framing dynamics occurring between 2013 and 2015, with individual patient advocates replacing advocacy organizations as top curators of BRCA content and coming to prominence as providers of specialist illness narratives. These results suggest that between 2013 and 2015, Twitter went from functioning primarily as an organization-centered news reporting mechanism, to working as a crowdsourced specialist awareness system. This article advances a twofold contribution. First, it points at Twitter's fluid functionality for an issue public and suggests that by looking at the life story-rather than at a single time point-of an issue-based Twitter stream, we can track the evolution of power roles underlying discursive practices and better interpret the emergence of non-elite actors in the public arena. Second, the study provides evidence of the rise of activist cultures that rely on fluid, non-elite, collective, and individual social media engagement.
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25
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Rachul C, Rasko JEJ, Caulfield T. Implicit hype? Representations of platelet rich plasma in the news media. PLoS One 2017; 12:e0182496. [PMID: 28792974 PMCID: PMC5549909 DOI: 10.1371/journal.pone.0182496] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/19/2017] [Indexed: 01/08/2023] Open
Abstract
Platelet Rich Plasma (PRP) has gained popularity in recent years for treating sports-related injuries and the news media frequently reports on elite athletes’ and celebrities’ use of PRP. We conducted a content analysis of newspaper coverage of PRP in Australia, Canada, Ireland, New Zealand, United Kingdom, and the United States. Findings show that news media coverage of PRP appears most frequently in sports-related stories, and in relation to elite athletes use of PRP. PRP injections are largely portrayed as a routine treatment for sports-related injuries and newspaper articles rarely discuss the limitations or efficacy of PRP. We argue that while news media coverage of PRP exhibits very few common hallmarks of hype, its portrayal as a routine treatment used by elite athletes and celebrities creates an implicit hype. This implicit hype can contribute to public misunderstandings of the efficacy of PRP.
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Affiliation(s)
- Christen Rachul
- Office of Educational and Faculty Development, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John E. J. Rasko
- Gene & Stem Cell Therapy Program, Centenary Institute, University of Sydney, Camperdown, Australia
- Sydney Medical School, University of Sydney, Camperdown, Australia
- Cell and Molecular Therapies, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Timothy Caulfield
- Health Law Institute, and Faculty of Law and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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26
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Meisel SF, Rahman B, Side L, Fraser L, Gessler S, Lanceley A, Wardle J. Genetic testing and personalized ovarian cancer screening: a survey of public attitudes. BMC WOMENS HEALTH 2016; 16:46. [PMID: 27460568 PMCID: PMC4962369 DOI: 10.1186/s12905-016-0325-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/19/2016] [Indexed: 01/22/2023]
Abstract
Background Advances in genetic technologies are expected to make population-wide genetic testing feasible. This could provide a basis for risk stratified cancer screening; but acceptability in the target populations has not been explored. Methods We assessed attitudes to risk-stratified ovarian cancer (OC) screening based on prior genetic risk assessment using a survey design. Home-based interviews were carried out by the UK Office of National Statistics in a population-based sample of 1095 women aged 18–74. Demographic and personal correlates of attitudes to risk-stratified OC screening based on prior genetic risk assessment were determined using univariate analyses and adjusted logistic regression models. Results Full data on the key analytic questions were available for 829 respondents (mean age 46 years; 27 % ‘university educated’; 93 % ‘White’). Relatively few respondents felt they were at ‘higher’ or ‘much higher’ risk of OC than other women of their age group (7.4 %, n = 61). Most women (85 %) said they would ‘probably’ or ‘definitely’ take up OC genetic testing; which increased to 88 % if the test also informed about breast cancer risk. Almost all women (92 %) thought they would ‘probably’ or ‘definitely’ participate in risk-stratified OC screening. In multivariate logistic regression models, university level education was associated with lower anticipated uptake of genetic testing (p = 0.009), but with more positive attitudes toward risk-stratified screening (p <0.001). Perceived risk was not significantly associated with any of the outcome variables. Conclusions These findings give confidence in taking forward research on integration of novel genomic technologies into mainstream healthcare.
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Affiliation(s)
- Susanne F Meisel
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Belinda Rahman
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Lucy Side
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Lindsay Fraser
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Sue Gessler
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Anne Lanceley
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, Gower Street, London, WC1E 6BT, UK
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Abrams LR, Koehly LM, Hooker GW, Paquin RS, Capella JN, McBride CM. Media Exposure and Genetic Literacy Skills to Evaluate Angelina Jolie's Decision for Prophylactic Mastectomy. Public Health Genomics 2016; 19:282-9. [PMID: 27427958 DOI: 10.1159/000447944] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 06/23/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine public preparedness to evaluate and respond to Angelina Jolie's well-publicized decision to have a prophylactic mastectomy. METHODS A consumer panel (n = 1,008) completed an online survey in November 2013, reporting exposure to Jolie's story, confidence applying genomic knowledge to evaluate her decision, and ability to interpret provided genetic risk information (genetic literacy skills). Linear and logistic regressions tested mediating/moderating models of these factors in association with opinions regarding mastectomies. RESULTS Confidence with genomics was associated with increased genetic literacy skills and increased media exposure, with a significant interaction between the two. Confidence was also associated with favoring mastectomies for women with BRCA mutations, mediating the relationship with media exposure. Respondents were more likely to form opinions about mastectomies if they had high genetic literacy skills. CONCLUSION These findings suggest that having higher genetic literacy skills may increase the public's ability to form opinions about clinical applications of genomic discovery. However, repeated media exposure to high-profile stories may artificially inflate confidence among those with low genetic literacy.
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Affiliation(s)
- Leah R Abrams
- University of Michigan School of Public Health, Ann Arbor, Mich., USA
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Rachul C, Toews M, Caulfield T. Controversies with Kalydeco: Newspaper coverage in Canada and the United States of the cystic fibrosis "wonder drug". J Cyst Fibros 2016; 15:624-9. [PMID: 27150823 DOI: 10.1016/j.jcf.2016.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/15/2016] [Accepted: 03/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The cystic fibrosis drug, Kalydeco, has attracted attention both for its effectiveness in particular CF patients and its substantial price tag. An analysis of newspaper portrayals of Kalydeco provides an opportunity to examine how policy issues associated with rare diseases and orphan drugs are being represented in the popular press. METHODS We conducted a content analysis of 203 newspaper articles in Canada and the U.S. that mention Kalydeco. Articles were analyzed for their main frame, discussion of Kalydeco, including issues of drug development, patient access, and reimbursement, and overall tone. RESULTS In Canadian newspaper coverage, 77.4% of articles were framed as human interest stories featuring individual patients seeking public funding for Kalydeco, yet only 7.5% mentioned any budgetary limitations in doing so. In contrast, U.S. newspaper coverage was framed as a financial/economic story in 43.1% of articles and a medical/scientific story in 27.8%. CONCLUSIONS Newspaper coverage varied significantly between Canada, where Kalydeco is predominantly a story about increasing patient access through full government funding, and the U.S., where Kalydeco is largely a financial story about the economic impact of Kalydeco. The difference in coverage may be due to differences in public funding between the healthcare systems of these two countries.
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Affiliation(s)
- Christen Rachul
- School of Linguistics and Language Studies, Carleton University, Paterson Hall 236, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada.
| | - Maeghan Toews
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB T6G 0H5, Canada.
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB T6G 0H5, Canada.
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Sabel MS, Cin SD. Trends in Media Reports of Celebrities’ Breast Cancer Treatment Decisions. Ann Surg Oncol 2016; 23:2795-801. [DOI: 10.1245/s10434-016-5202-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Indexed: 01/11/2023]
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Du L, Rachul C, Guo Z, Caulfield T. Gordie Howe's "Miraculous Treatment": Case Study of Twitter Users' Reactions to a Sport Celebrity's Stem Cell Treatment. JMIR Public Health Surveill 2016; 2:e8. [PMID: 27227162 PMCID: PMC4869214 DOI: 10.2196/publichealth.5264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/20/2015] [Accepted: 01/04/2016] [Indexed: 01/24/2023] Open
Abstract
Background Former Detroit Red Wing Gordie Howe received stem cell (SC) treatment in Mexico in December 2014 for a stroke he suffered in October 2014. The news about his positive response to the SC treatment prompted discussion on social networks like Twitter. Objective This study aims to provide information about discussions that took place on Twitter regarding Howe’s SC treatment and SC treatment in general. In particular, this study examines whether tweets portrayed a positive or negative attitude towards Howe’s SC treatment, whether or not tweets mention that the treatment is unproven, and whether the tweets mention risks associated with the SC treatment. Methods This is an infodemiology study, harnessing big data published on the Internet for public health research and analysis of public engagement. A corpus of 2783 tweets about Howe’s SC treatment was compiled using a program that collected English-language tweets from December 19, 2014 at 00:00 to February 7, 2015 at 00:00. A content analysis of the corpus was conducted using a coding framework developed through a two-stage process. Results 78.87% (2195/2783) of tweets mentioned improvements to Howe’s health. Only one tweet explicitly mentioned that Howe’s SC treatment was unproven, and 3 tweets warned that direct-to-consumer SC treatments lacked scientific evidence. In addition, 10.31% (287/2783) of tweets mentioned challenges with SC treatment that have been raised by scientists and researchers, and 3.70% (103/2783) of tweets either defined Howe as a “stem cell tourist” or claimed that his treatment was part of “stem cell tourism”. In general, 71.79% (1998/2783) of tweets portrayed a positive attitude towards Howe’s SC treatment. Conclusions Our study found the responses to Howe’s treatment on Twitter to be overwhelmingly positive. There was far less attention paid to the lack of scientific evidence regarding the efficacy of the treatment. Unbalanced and uncritical discussion on Twitter regarding SC treatments is another example of inaccurate representations of SC treatments that may create unrealistic expectations that will facilitate the market for unproven stem cell therapies.
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Affiliation(s)
- Li Du
- Health Law Institute Faculty of Law University of Alberta Edmonton, AB Canada
| | - Christen Rachul
- School of Linguistics and Language Studies Carleton University Ottawa, ON Canada
| | - Zhaochen Guo
- Department of Computing Science University of Alberta Edmonton, AB Canada
| | - Timothy Caulfield
- Health Law Institute, Law Centre, University of Alberta Edmonton, AB Canada
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Speck RM, Neuman MD, Resnick KS, Mellers BA, Fleisher LA. Anticipated regret in shared decision-making: a randomized experimental study. Perioper Med (Lond) 2016; 5:5. [PMID: 26941952 PMCID: PMC4776353 DOI: 10.1186/s13741-016-0031-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/17/2016] [Indexed: 11/12/2022] Open
Abstract
Background Explicit consideration of anticipated regret is not part of the standard shared decision-making protocols. This pilot study aimed to compare decisions about a hypothetical surgery for breast cancer and examined whether regret is a consideration in treatment decisions. Methods In this randomized experimental study, 184 healthy female volunteers were randomized to receive a standard decision aid (control) or one with information on post-surgical regret (experimental). The main outcome measures were the proportion of subjects choosing lumpectomy vs. mastectomy and the proportion reporting that regret played a role in the decision made. We hypothesized that a greater proportion of the experimental group (regret-incorporated decision aid) would make a surgical treatment preference that favored the less regret-inducing option and that they would be more likely to consider regret in their decision-making process as compared to the control group. Results A significantly greater proportion of the experimental group subjects reported regret played a role in their decision-making process compared to the control counterparts (78 vs. 65 %; p = 0.039). Recipients of the regret-incorporated experimental decision aid had a threefold increased odds of choosing the less regret-inducing surgery (OR = 2.97; 95 % CI = 1.25, 7.09; p value = 0.014). Conclusions In this hypothetical context, the incorporation of regret in a decision aid for preference-sensitive surgery impacted decision-making. This finding suggests that keying in on anticipated regret may be an important element of shared decision-making strategies. Our results make a strong argument for applying this design and pursuing further research in a surgical patient population. Trial registration Clinicaltrials.gov, NCT02563808. Electronic supplementary material The online version of this article (doi:10.1186/s13741-016-0031-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca M Speck
- Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA ; Evidera, 1417 4th Ave., Suite 510, Seattle, WA 98101 USA
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA
| | - Kimberly S Resnick
- Department of Psychiatry, University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104 USA
| | - Barbara A Mellers
- Department of Psychology, Department of Marketing, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104 USA
| | - Lee A Fleisher
- Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA
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Dodd RH, Marlow LAV, Forster AS, Waller J. Print and online newspaper coverage of the link between HPV and oral cancer in the UK: a mixed-methods study. BMJ Open 2016; 6:e008740. [PMID: 26920439 PMCID: PMC4769401 DOI: 10.1136/bmjopen-2015-008740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 12/17/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The role of human papillomavirus (HPV) in some oral cancers has been reported in the news press, though little is known about the content of these articles. This study aimed to examine how frequently the link between HPV and oral cancer has been reported in the news press and to examine the content of these articles. DESIGN UK media articles were searched for articles relating to oral cancer and HPV in the database NexisUK. Of 854 articles identified by the initial search, 112 were eligible for inclusion (2002-2014) and content analysis was used to determine the main themes discussed. RESULTS Themes included actor Michael Douglas' claim that his throat cancer was caused by HPV, the riskiness of oral sex, health information (including HPV as a cause of oral cancer) and the need to vaccinate boys against HPV. Many articles also referred to the link between HPV and cervical cancer and the increasing incidence of HPV-related oral cancer. The largest peak in articles occurred when Michael Douglas discussed his cancer (June 2013). Facts about HPV and references to research were provided in some articles. CONCLUSIONS The link between HPV and oral cancer and the transmission of HPV via oral sex was regularly discussed, yet coverage often lacked detailed health information. This could increase awareness of the link between oral sex and HPV risk, but may also lead to public concern about oral sex as a sexual behaviour.
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Affiliation(s)
- Rachael H Dodd
- Department of Epidemiology & Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Laura A V Marlow
- Department of Epidemiology & Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Alice S Forster
- Department of Epidemiology & Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Jo Waller
- Department of Epidemiology & Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
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McGannon KR, Berry TR, Rodgers WM, Spence JC. Breast cancer representations in Canadian news media: a critical discourse analysis of meanings and the implications for identity. QUALITATIVE RESEARCH IN PSYCHOLOGY 2016. [DOI: 10.1080/14780887.2016.1145774] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kosenko KA, Binder AR, Hurley R. Celebrity Influence and Identification: A Test of the Angelina Effect. JOURNAL OF HEALTH COMMUNICATION 2016; 21:318-326. [PMID: 26192626 DOI: 10.1080/10810730.2015.1064498] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Angelina Jolie's announcement that she is a BRCA1 carrier and has had a prophylactic bilateral mastectomy was met with widespread support as well as speculation about its possible impact on the public. These speculations were the subject of a Time magazine cover story titled "The Angelina Effect" (Kluger et al., 2013 ). Although there is anecdotal evidence to support this hypothesized Angelina effect, empirical tests are lacking. To explore possible links between Angelina's announcement and public health, we surveyed 356 adults immediately after the announcement. Guided by a model of celebrity influence, the survey assessed participants' demographics and health history, identification and parasocial interaction with Jolie, and genetic testing intentions. Results supported the model's predictions and provided preliminary evidence of an Angelina effect.
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Affiliation(s)
- Kami A Kosenko
- a Department of Communication , North Carolina State University , Raleigh , North Carolina , USA
| | - Andrew R Binder
- a Department of Communication , North Carolina State University , Raleigh , North Carolina , USA
| | - Ryan Hurley
- a Department of Communication , North Carolina State University , Raleigh , North Carolina , USA
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Dean M. Celebrity Health Announcements and Online Health Information Seeking: An Analysis of Angelina Jolie's Preventative Health Decision. HEALTH COMMUNICATION 2015; 31:752-761. [PMID: 26574936 DOI: 10.1080/10410236.2014.995866] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
On May 14, 2013, Angelina Jolie disclosed she carries BRCA1, which means she has an 87% risk of developing breast cancer during her lifetime. Jolie decided to undergo a preventative bilateral mastectomy (PBM), reducing her risk to 5%. The purpose of this study was to analyze the type of information individuals are exposed to when using the Internet to search health information regarding Jolie's decision. Qualitative content analysis revealed four main themes--information about genetics, information about a PBM, information about health care, and information about Jolie's gender identity. Broadly, the identified websites mention Jolie's high risk for developing cancer due to the genetic mutation BRCA1, describe a PBM occasionally noting reasons why she had this surgery and providing alternatives to the surgery, discuss issues related to health care services, costs, and insurances about Jolie's health decision, and portray Jolie as a sexual icon, a partner to Brad Pitt, a mother of six children, and an inspirational humanitarian. The websites also depict Jolie's health decision in positive, negative, and/or both ways. Discussion centers on how this actress' health decision impacts the public.
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Affiliation(s)
- Marleah Dean
- a Department of Communication , University of South Florida
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Lebo PB, Quehenberger F, Kamolz LP, Lumenta DB. The Angelina effect revisited: Exploring a media-related impact on public awareness. Cancer 2015; 121:3959-64. [PMID: 26414603 DOI: 10.1002/cncr.29461] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/12/2015] [Accepted: 04/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2013, Angelina Jolie's double mastectomy and publication of her personal treatment choice for BRCA1 positivity generated considerable media attention. To the authors' knowledge, the current study is the first prospective survey conducted among the general public to measure a quantifiable media-related effect on public awareness. METHODS The authors analyzed the changes in the general public's awareness of reconstructive options in breast cancer among 2 female population-matched cohorts aged 18 to 65 years (1000 participants in each cohort) before (March 2013; poll 1) and after (June 2013; poll 2) the announcement of Ms. Jolie's mastectomy in May 2013. RESULTS There was an observed increase in public awareness: significantly more women from poll 2 were aware of reconstructive breast surgery being possible after breast cancer-related mastectomy, notably with regard to autologous tissue and single-stage reconstructions. Approximately 20% of the women in poll 2 (205 women) indicated that media coverage regarding Ms. Jolie affected their interest in breast cancer. A question that was exclusive to poll 2 revealed a preference for autologous (66.2%) versus implant-based (8.2%) reconstructions, with the remainder indicating no preference (25.6%). None of the stratification variables were found to be associated with the above findings. CONCLUSIONS To the best of the authors' knowledge, this is the first prospective study to demonstrate a statistically significant impact of a celebrity announcement on public awareness regarding breast cancer treatment. The results underscore the importance of a media-related impact for professionals in the health care sector, which can serve as a tipping point for raising awareness and improving knowledge concerning a specific disease among the general public.
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Affiliation(s)
- Patricia Beatrice Lebo
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Franz Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - David Benjamin Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Next-generation sequencing for hereditary breast and gynecologic cancer risk assessment. Curr Opin Obstet Gynecol 2015; 27:23-33. [PMID: 25502425 DOI: 10.1097/gco.0000000000000141] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW To summarize advances in next-generation sequencing and their application to breast and gynecologic cancer risk assessment. RECENT FINDINGS Next-generation sequencing panels of 6-112 cancer-associated genes are increasingly used in patient care. Studies report a 4-16% prevalence of mutations other than BRCA1/2 among patients who meet evidence-based practice guidelines for BRCA1/2 testing, with a high rate (15-88%) of uninterpretable variants of uncertain significance. Despite uncertainty about results interpretation and communication, there is early evidence of a benefit from multiple-gene sequencing panels for appropriately selected patients. SUMMARY Multiple-gene sequencing panels appear highly promising for the assessment of breast and gynecologic cancer risk, and they may usefully be administered in the context of cancer genetics expertise and/or clinical research protocols.
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Rachul C, Caulfield T. The media and access issues: content analysis of Canadian newspaper coverage of health policy decisions. Orphanet J Rare Dis 2015; 10:102. [PMID: 26303029 PMCID: PMC4548449 DOI: 10.1186/s13023-015-0320-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/10/2015] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have demonstrated how the media has an influence on policy decisions and healthcare coverage. Studies of Canadian media have shown that news coverage often emphasizes and hypes certain aspects of high profile health debates. We hypothesized that in Canadian media coverage of access to healthcare issues about therapies and technologies including for rare diseases, the media would be largely sympathetic towards patients, thus adding to public debate that largely favors increased access to healthcare—even in the face of equivocal evidence regarding efficacy. Methods In order to test this hypothesis, we conducted a content analysis of 530 news articles about access to health therapies and technologies from 15 major Canadian newspapers over a 10-year period. Articles were analyzed for the perspectives presented in the articles and the types of reasons or arguments presented either for or against the particular access issue portrayed in the news articles. Results We found that news media coverage was largely sympathetic towards increasing healthcare funding and ease of access to healthcare (77.4 %). Rare diseases and orphan drugs were the most common issues raised (22.6 %). Patients perspectives were often highlighted in articles (42.3 %). 96.8 % of articles discussed why access to healthcare needs to increase, and discussion that questioned increased access was only included in 33.6 % articles. Conclusion We found that news media favors a patient access ethos, which may contribute to a difficult policy-making environment.
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Affiliation(s)
- Christen Rachul
- School of Linguistics and Language Studies, Carleton University, Paterson Hall 236, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, Office 468, Edmonton, AB, T6G 2H5, Canada.
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Carroll B, Freeman B. 'The secret shame': a content analysis of online news reporting of a celebrity admitting smoking while pregnant. Health Promot J Austr 2015; 26:4-9. [PMID: 25774973 DOI: 10.1071/he14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/02/2014] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED Around one in 10 Australian women report that they smoke while pregnant, and this may be a significant underestimation. In 2013, Australian celebrity Chrissie Swan announced publicly that she had been smoking during her pregnancy, generating substantial media coverage. This study sought to identify the main themes in the reporting of the 'Swan pregnant and admitting smoking' story by online news media. METHODS Between 6 February 2013 and 18 February 2013 inclusively, a content analysis was conducted of Australian online news items using the keywords: 'Chrissie Swan smoking', and 'Chrissie Swan pregnant and smoking'. News items were coded for nine themes. RESULTS A total of 124 items were identified. The most frequent themes were: 'celebrity story' (90.32%) and 'societal judgement of pregnant smokers' (69.35%). Less than one-half (45.97%) of the news items included 'quitting is hard' content and only 29.03% of the news items included 'smoking and health' content. Specific quit-referral content was found in only 13.71% of the news items. CONCLUSIONS There was a missed opportunity to promote positive, non-judgemental smoking and pregnancy messages and health information that support pregnant women to quit smoking. SO WHAT?: Health promotion strategies are needed to build capacity in advocacy to promote positive health messages and counter societal judgement of pregnant smokers. Formative research into the use of celebrities and other influential women to promote positive empowering messages should be carried out and incorporated in future health promotion campaigns to improve pregnant women's ability to quit smoking.
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Affiliation(s)
- Beverley Carroll
- School of Public Health, Sydney Medical School, University of Sydney, c/o 226a, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia
| | - Becky Freeman
- School of Public Health, Sydney Medical School, University of Sydney, c/o 226a, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia
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Gordie Howe’s Stem Cell ‘Miracle’: A Qualitative Analysis of News Coverage and Readers’ Comments in Newspapers and Sports Websites. Stem Cell Rev Rep 2015; 11:667-75. [DOI: 10.1007/s12015-015-9606-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hoffman SJ, Tan C. Biological, psychological and social processes that explain celebrities' influence on patients' health-related behaviors. ACTA ACUST UNITED AC 2015; 73:3. [PMID: 25973193 PMCID: PMC4429495 DOI: 10.1186/2049-3258-73-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/30/2014] [Indexed: 12/31/2022]
Abstract
Background Celebrities can have substantial influence as medical advisors. However, their impact on public health is equivocal: depending on the advice’s validity and applicability, celebrity engagements can benefit or hinder efforts to educate patients on evidence-based practices and improve their health literacy. This meta-narrative analysis synthesizes multiple disciplinary insights explaining the influence celebrities have on people’s health-related behaviors. Methods Systematic searches of electronic databases BusinessSource Complete, Communication & Mass Media Complete, Humanities Abstracts, ProQuest Political Science, PsycINFO, PubMed, and Sociology Abstracts were conducted. Retrieved articles were used to inform a conceptual analysis of the possible processes accounting for the substantial influence celebrities may have as medical advisors. Results Fourteen mechanisms of celebrity influence were identified. According to the economics literature, celebrities distinguish endorsed items from competitors and can catalyze herd behavior. Marketing studies tell us that celebrities’ characteristics are transferred to endorsed products, and that the most successful celebrity advisors are those viewed as credible, a perception they can create with their success. Neuroscience research supports these explanations, finding that celebrity endorsements activate brain regions involved in making positive associations, building trust and encoding memories. The psychology literature tells us that celebrity advice conditions people to react positively toward it. People are also inclined to follow celebrities if the advice matches their self-conceptions or if not following it would generate cognitive dissonance. Sociology explains how celebrities’ advice spreads through social networks, how their influence is a manifestation of people’s desire to acquire celebrities’ social capital, and how they affect the ways people acquire and interpret health information. Conclusion There are clear and deeply rooted biological, psychological and social processes that explain how celebrities influence people’s health behaviors. With a better understanding of this phenomenon, medical professionals can work to ensure that it is harnessed for good rather than abused for harm. Physicians can discuss with their patients the validity of celebrity advice and share more credible sources of health information. Public health practitioners can debunk celebrities offering unsubstantiated advice or receiving inappropriate financial compensation, and should collaborate with well-meaning celebrities, leveraging their influence to disseminate medical practices of demonstrated benefit. Electronic supplementary material The online version of this article (doi:10.1186/2049-3258-73-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven J Hoffman
- Faculty of Law, University of Ottawa, Ottawa, Canada ; Department of Clinical Epidemiology & Biostatistics and McMaster Health Forum, McMaster University, Hamilton, Canada ; Department of Global Health & Population, Harvard School of Public Health, Boston, MA USA
| | - Charlie Tan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
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Caulfield T, Clark MI, McCormack JP, Rachul C, Field CJ. Representations of the health value of vitamin D supplementation in newspapers: media content analysis. BMJ Open 2014; 4:e006395. [PMID: 25552612 PMCID: PMC4281532 DOI: 10.1136/bmjopen-2014-006395] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To examine the nature of media coverage of vitamin D in relation to its role in health and the need for supplements. DESIGN Media content analysis. SETTING Print articles from elite newspapers in the UK, the USA and Canada. PARTICIPANTS 294 print newspaper articles appearing over 5 years (2009-2014). RESULTS Newspaper coverage of vitamin D generally supported supplementation. The most common framing of vitamin D in print articles was "adequate vitamin D is necessary for good health." Articles also framed vitamin D as difficult to obtain from food supply and framed vitamin D deficiency as a widespread concern. In discussions of supplementation, 80% articles suggested supplementation is or may be necessary for the general population, yet almost none of the articles discussed the potential harms of vitamin D supplementation in any detail. Print articles named 40 different health conditions in relationship to vitamin D. The most commonly cited conditions included bone health, cancer and cardiovascular health. Although print articles referred to a wide range of scholarly research on vitamin D with varying degrees of endorsement for supplementation, a general tone of support for vitamin D supplementation in media coverage persisted. CONCLUSIONS Newspaper articles conveyed overall support for vitamin D supplementation. News articles linked vitamin D to a wide range of health conditions for which there is no conclusive scientific evidence. Media coverage downplayed the limitations of existing science and overlooked any potential risks associated with supplementation.
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - Marianne I Clark
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - James P McCormack
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christen Rachul
- School of Linguistics and Language Studies, Carleton University, Ottawa, Ontario, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Juthe RH, Zaharchuk A, Wang C. Celebrity disclosures and information seeking: the case of Angelina Jolie. Genet Med 2014; 17:545-53. [PMID: 25341112 PMCID: PMC4408206 DOI: 10.1038/gim.2014.141] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/02/2014] [Indexed: 11/25/2022] Open
Abstract
Purpose On May 14, 2013, actress Angelina Jolie disclosed that she had a BRCA1 mutation and underwent a prophylactic bilateral mastectomy. This study documents the impact of her disclosure on information-seeking behavior, specifically regarding online genetics and risk reduction resources available from the National Cancer Institute (NCI). Methods Using Adobe Analytics, daily page views for 11 resources were tracked from April 23, 2013 through June 25, 2013. Usage data were also obtained for four resources over a 2-year period (2012–2013). Source of referral by which viewers located a specific resource was also examined. Results There was a dramatic and immediate increase in traffic to NCI’s online resources. The Preventive Mastectomy fact sheet received 69,225 page views on May 14, representing a 795-fold increase compared with the previous Tuesday. A fivefold increase in page views was observed for the PDQ®Genetics of Breast and Ovarian Cancer summary in the same timeframe. A substantial increase from 0% to 49% was seen in referrals from news outlets to four resources from May 7 to May 14. Conclusion Celebrity disclosures can dramatically influence online information-seeking behaviors. Efforts to capitalize on these disclosures to ensure easy access to accurate information are warranted.
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Affiliation(s)
- Robin H Juthe
- Office of Communications and Education, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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The communication of the radiation risk from CT in relation to its clinical benefit in the era of personalized medicine: part 2: benefits versus risk of CT. Pediatr Radiol 2014; 44 Suppl 3:525-33. [PMID: 25304716 DOI: 10.1007/s00247-014-3087-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/06/2014] [Accepted: 06/12/2014] [Indexed: 01/19/2023]
Abstract
In order to personalize the communication of the CT risk, we need to describe the risk in the context of the clinical benefit of CT, which will generally be much higher, provided a CT scan has a well-established clinical indication. However as pediatric radiologists we should be careful not to overstate the benefit of CT, being aware that medico-legal pressures and the realities of health care economics have led to overutilization of the technology. And even though we should not use previously accumulated radiation dose to a child as an argument against conducting a clinically indicated scan (the "sunk-cost" bias), we should consider patients' radiation history in the diagnostic decision process. As a contribution to future public health, it makes more sense to look for non-radiating alternatives to CT in the much larger group of basically healthy children who are receiving occasional scans for widely prevalent conditions such as appendicitis and trauma than to attempt lowering CT use in the smaller group of patients with chronic conditions with a limited life expectancy. When communicating the CT risk with individual patients and their parents, we should acknowledge and address their concerns within the framework of informed decision-making. When appropriate, we may express the individual radiation risk, based on estimates of summated absorbed organ dose, as an order of magnitude rather than as an absolute number, and compare this with the much larger natural cancer incidence over a child's lifetime, and with other risks in medicine and daily life. We should anticipate that many patients cannot make informed decisions on their own in this complex matter, and we should offer our guidance while maintaining respect for patient autonomy. Proper documentation of the informed decision process is important for future reference. In concert with our referring physicians, pediatric radiologists are well-equipped to tackle the complexities associated with the communication of CT risk, a task that often falls upon us, and by becoming more involved in the diagnostic decision process we can add value to the health care system.
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Lewis C, Choudhury M, Chitty LS. ‘Hope for safe prenatal gene tests’. A content analysis of how the UK press media are reporting advances in non-invasive prenatal testing. Prenat Diagn 2014; 35:420-7. [DOI: 10.1002/pd.4488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Celine Lewis
- Clinical and Molecular Genetics; UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Mahrufa Choudhury
- Clinical and Molecular Genetics; UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Lyn S. Chitty
- Clinical and Molecular Genetics; UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
- Fetal Medicine Unit; University College London Hospitals NHS Foundation Trust; London UK
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Aggarwal A, Batura R, Sullivan R. The media and cancer: education or entertainment? An ethnographic study of European cancer journalists. Ecancermedicalscience 2014; 8:423. [PMID: 24834118 PMCID: PMC3998657 DOI: 10.3332/ecancer.2014.423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 12/31/2022] Open
Abstract
The media plays a vital role in informing the public about new developments in cancer research and influencing cancer policy. This is no easy task, in view of the myriad of trials and wonder drugs that purport to be the 'magic bullet'. However, misrepresentation can have profound consequences. In this qualitative study, we sought to understand the interaction between the media and cancer through the perspective of European science journalists by defining their attitudes towards current cancer research and challenges faced when reporting science news. A total of 67 respondents took part in this online survey, which was distributed by the European CanCer Organisation (ECCO) to all its media contacts between June and September 2013. Fifty-three per cent had over 20 years experience in reporting science news stories. The respondents utilised a number of media formats, including newsprint, online services, and radio. Fifty per cent ranked public interest as the greatest influence on their selection of cancer research topics, followed by topicality. Respondents were conscious of being fed ambiguous and exaggerated results from trials by the research community. Sixty-five per cent of respondents would appreciate access to a forum of experts willing to provide comment on new research findings. Seventy per cent highlighted the importance of prompt responses from scientists and researchers during correspondence, and the need to have advance warning of new developments (49%). To conclude - coverage of cancer related issues and scientific advances require greater collaboration between the press and cancer healthcare community to provide both credibility and accountability for the health information disseminated. Key areas include a more precise definition of the research context and differentiation of absolute and relative risks, as well as individual and population risks and an informed discussion about the realities and limitations of cancer care and research.
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Affiliation(s)
- Ajay Aggarwal
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, Guy's NHS Foundation Trust Campus & Kings College London, Department of Research Oncology, Bermondsey Wing, London SE1 9RT, UK ; Guys & St Thomas' NHS Trust, Department of Clinical Oncology, London SE1 7EH, UK ; Kings College London, London SE1 9RT, UK
| | - Rekha Batura
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, Guy's NHS Foundation Trust Campus & Kings College London, Department of Research Oncology, Bermondsey Wing, London SE1 9RT, UK ; Kings College London, London SE1 9RT, UK
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, Guy's NHS Foundation Trust Campus & Kings College London, Department of Research Oncology, Bermondsey Wing, London SE1 9RT, UK ; Kings College London, London SE1 9RT, UK
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