1
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Despax J, Lacharité C, Bouteyre E. Adoptees' experiences of using direct-to-consumer genetic testing and determinants of this use: A mixed study in Quebec. J Genet Couns 2024. [PMID: 39175135 DOI: 10.1002/jgc4.1963] [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: 11/16/2023] [Revised: 07/01/2024] [Accepted: 08/11/2024] [Indexed: 08/24/2024]
Abstract
Adoptees' use of direct-to-consumer genetic testing (DTC-GT) is known to raise both ethical and emotional issues, and it can also challenge their identity. The objective of the present study was to describe the experiences of DTC-GT use among adoptees living in Quebec and to better understand the benefits and disadvantages of use. We adopted a mixed method approach whereby a questionnaire comprising standardized scales was administered to 143 adoptees who had used genetic testing and 40 adoptees who had not. Semi-structured interviews were performed with five respondents from the DTC-GT use group. The quantitative and qualitative data were analyzed and integrated together using the Pillar Integration Process. The results highlighted familial reunion as the primary motivation for the use of DTC-GT among responding adoptees. Reported challenges included needing help with results interpretation, as well as the need for autonomy in the ownership of the results. Participants describe not being particularly concerned by potential ethical issues, describing the benefits of the tests as more important than possible disadvantages. Overall, participants had a good experience of using DTC-GT, and users were less anxious. Various factors associated with the use and experience of use were highlighted (age, psychological distress, community membership, etc.). The results from this study provide much-needed information about adoptees' needs regarding DTC-GT, highlight key risk factors, and introduces best practice recommendations so that adoptees are properly informed and supported when pursuing DTC-GT.
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Affiliation(s)
- Johanna Despax
- Centre d'Etudes Interdisciplinaires sur le Développement de l'Enfant et de la Famille (CEIDEF), Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Carl Lacharité
- Centre d'Etudes Interdisciplinaires sur le Développement de l'Enfant et de la Famille (CEIDEF), Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Evelyne Bouteyre
- EA 3278, Laboratory LPCPP, Aix-Marseille University, Aix-en-Provence, France
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2
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Harris AR, McGivern P, Gilbert F, Van Bergen N. Defining Biomarkers in Stem Cell-Derived Tissue Constructs for Drug and Disease Screening. Adv Healthc Mater 2024:e2401433. [PMID: 38741544 DOI: 10.1002/adhm.202401433] [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: 04/18/2024] [Revised: 04/24/2024] [Indexed: 05/16/2024]
Abstract
The development of stem cell-derived tissue constructs (SCTCs) for clinical applications, including regenerative medicine, drug and disease screening offers significant hope for detecting and treating intractable disorders. SCTCs display a variety of biomarkers that can be used to understand biological mechanisms, assess drug interactions, and predict disease. Although SCTCs can be derived from patients and share the same genetic make-up, they are nevertheless distinct from human patients in many significant ways, which can undermine the clinical significance of measurements in SCTCs. This study defines biomarkers, how they apply to SCTCs, and clarifies specific ethical issues associated with the use of SCTCs for drug and disease screening.
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Affiliation(s)
- Alexander R Harris
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Patrick McGivern
- School of Humanities and Social Inquiry, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Frederic Gilbert
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
| | - Nicole Van Bergen
- Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, 3002, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3002, Australia
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3
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Bruins D, Onstwedder SM, Cornel MC, Ausems MGEM, van Mil MHW, Rigter T. Information Provision Regarding Health-Related Direct-to-Consumer Genetic Testing for Dutch Consumers: An in-Depth Content Analysis of Sellers' Websites. Genes (Basel) 2024; 15:517. [PMID: 38674451 PMCID: PMC11049909 DOI: 10.3390/genes15040517] [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: 03/04/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Previous studies have suggested that information offered by sellers of health-related direct-to-consumer genetic tests (DTC-GTs) is often incomplete, unbalanced, or too difficult to understand. The extent to which this is the case for sellers accessible to Dutch consumers has not previously been studied. Methods and Goals: The present study aimed to assess the completeness, balance, readability, and findability of informational content on a selection of websites from several health-related DTC-GT sellers accessible to Dutch consumers. An in-depth content analysis was performed based on a recently published checklist outlining key items for policy guidance regarding DTC-GT services. Results: The information provided by sellers did not equally cover all aspects relevant to health-related DTC-GT service provision. The provided information was slightly unbalanced, with benefits of health-related DTC-GT usage being overemphasized compared to its risks and limitations. The readability of the provided information was low, on average requiring college education for proper understanding. A findability analysis showed that information concerning all themes is overall relatively evenly distributed across analyzed sellers' websites. Conclusions: Information provision by assessed health-related DTC-GT sellers is suboptimal regarding completeness, balance, and readability. To better empower potential consumers to make an informed decision regarding health-related DTC-GT usage, we advocate industry-wide enhancement of information provision.
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Affiliation(s)
- Danny Bruins
- Section Community Genetics, Department of Human Genetics, Amsterdam Public Health Research Institute, Personalized Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (D.B.)
| | - Suzanne M. Onstwedder
- Section Community Genetics, Department of Human Genetics, Amsterdam Public Health Research Institute, Personalized Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (D.B.)
- Center for Health Protection, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands
| | - Martina C. Cornel
- Section Community Genetics, Department of Human Genetics, Amsterdam Public Health Research Institute, Personalized Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (D.B.)
| | - Margreet G. E. M. Ausems
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Marc H. W. van Mil
- Center of Education and Training, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Tessel Rigter
- Section Community Genetics, Department of Human Genetics, Amsterdam Public Health Research Institute, Personalized Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (D.B.)
- Center for Health Protection, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands
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4
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Abitbol A, Lee NM, VanDyke MS, Meneses C, Wallace K. The Role of Human Voice in Direct-To-Consumer Health Communication. HEALTH COMMUNICATION 2024:1-7. [PMID: 38591185 DOI: 10.1080/10410236.2024.2338669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Despite overall positive perceptions, many customers distrust direct-to-consumer genetic testing companies in regard to privacy and aftercare. Prior research suggests companies can assuage mistrust by personalizing communication when discussing sensitive health information. This content analysis of customer e-mails (N = 338) investigates the purpose, personalization, and use of the human voice strategy by direct-to-consumer genetic testing companies to gain trust. Results reveal that companies rarely use human voice when communicating with customers, most of the information provided is promotional, and they invite dialogue less over time. Theoretical and practical implications are provided.
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Affiliation(s)
- Alan Abitbol
- Department of Communication, University of Dayton
| | - Nicole M Lee
- School of Social and Behavioral Sciences, Arizona State University
| | - Matthew S VanDyke
- Department of Advertising & Public Relations, The University of Alabama
| | | | - Kaylynne Wallace
- School of Social and Behavioral Sciences, Arizona State University
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5
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Hsieh E, Morrissey BS, Chiareli IA. The Landscape of Direct-To-Consumer Genetic Testing in Reproductive Health Contexts: An Analytical Framework of Stakeholders and Their Competing Motivations. HEALTH COMMUNICATION 2024:1-14. [PMID: 38317624 DOI: 10.1080/10410236.2024.2312607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
We propose a theoretical framework that identifies (a) the different categories of stakeholders and (b) the normative values that drive their attitudes toward direct-to-consumer genetic testing, with an emphasis on the reproductive health contexts. We conducted a literature search using varied combinations of search terms, including direct-to-consumer genetic testing, decision-making, reproductive health, and policy. Using a grounded theory approach to existing literature and in combination with a narrative review, we present a systematic framework of five categories of stakeholders (i.e., genome-driven stakeholders, industry-driven stakeholders, history-driven stakeholders, value-driven stakeholders, and social justice-driven stakeholders) that shape the public's discourse. Moving beyond the dialectical ethics that have governed the public discourse, we also identify the normative values and interests that motivate different stakeholders' attitudes and decision-making through theoretical sampling under the grounded theory. We investigate the competing and conflicting values within the same category of stakeholders. For example, despite being industry-driven stakeholders, medical professionals' attitudes are driven by concerns about standards of care; in contrast, health insurance companies' concerns are centered on profit. We further explore the tensions between these stakeholders that impact their strategic alliances and pose challenges to the practices of direct-to-consumer genetic testing. Finally, we examine how these stakeholders and their corresponding values may shape future development and policies of direct-to-consumer genetic testing in the context of reproductive health.
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Affiliation(s)
- Elaine Hsieh
- Department of Communication Studies, University of Minnesota-Twin Cities
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6
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McCoy MS, Allen AL, Kopp K, Mello MM, Patil DJ, Ossorio P, Joffe S, Emanuel EJ. Ethical Responsibilities for Companies That Process Personal Data. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:11-23. [PMID: 37262312 DOI: 10.1080/15265161.2023.2209535] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It has become increasingly difficult for individuals to exercise meaningful control over the personal data they disclose to companies or to understand and track the ways in which that data is exchanged and used. These developments have led to an emerging consensus that existing privacy and data protection laws offer individuals insufficient protections against harms stemming from current data practices. However, an effective and ethically justified way forward remains elusive. To inform policy in this area, we propose the Ethical Data Practices framework. The framework outlines six principles relevant to the collection and use of personal data-minimizing harm, fairly distributing benefits and burdens, respecting autonomy, transparency, accountability, and inclusion-and translates these principles into action-guiding practical imperatives for companies that process personal data. In addition to informing policy, the practical imperatives can be voluntarily adopted by companies to promote ethical data practices.
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Affiliation(s)
| | | | | | | | - D J Patil
- Belfer Center, Harvard Kennedy School
| | - Pilar Ossorio
- University of Wisconsin School of Law, Morgridge Institute for Research
| | - Steven Joffe
- Perelman School of Medicine, University of Pennsylvania
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7
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Richards JL, Knight SJ. Parents' Perspectives on Secondary Genetic Ancestry Findings in Pediatric Genomic Medicine. Clin Ther 2023; 45:719-728. [PMID: 37573223 PMCID: PMC11182349 DOI: 10.1016/j.clinthera.2023.06.001] [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: 02/22/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE With advances in genome sequencing technologies, large-scale genome-wide sequencing has advanced our understanding of disease risk and etiology and contributes to the rapidly expanding genomic health services in pediatric settings. Because it is possible to return ancestry estimates following clinical genomic sequencing, it is important to understand the interest in ancestry results among families who may have the option of receiving these results. METHODS We conducted 26 semi-structured qualitative telephone interviews of parents with children/newborns with likely genetic conditions from two studies of clinical genome sequencing. Using a purposive sampling approach, we selected parents from the SouthSeq cohort, Clinical Sequencing Evidence-Generating Research (CSER Phase 2) project active in Alabama, Mississippi, and Louisiana, or an earlier Clinical Sequencing Exploratory Research (CSER Phase 1) initiative based in the same region. Our interviews focused on parental knowledge about, attitudes on, interest in, and preferences for receiving genetic ancestry results following clinical genome sequencing in the neonatal intensive care unit or in pediatric clinics. FINDINGS Overall, parents prioritized clinical results or results that would help guide the diagnosis and treatment of their child, but they were also interested in any genetic result, including genetic ancestry, that potentially could enhance the meaning of information on disease risk, prevention and screening guidance, or family planning. While parents thought that ancestry results would help them learn about themselves and their heritage, the had concerns over the privacy, security, and accuracy of genetic ancestry information, although parents indicated that they had greater trust in ancestry findings provided as part of clinical care compared with those offered commercially. Parents also wanted ancestry results to be returned in a timely manner by knowledgeable staff, with kid-friendly materials and online tools available to aid, as needed, in the understanding of their results. IMPLICATIONS Taken together, our results highlight that despite being in high-stress situations, such as having a newborn in the neonatal intensive care unit, parents were interested in receiving genetic ancestry results along with their clinically relevant findings.
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Affiliation(s)
- Jaimie L Richards
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara J Knight
- Department of Internal Medicine, Division of Epidemiology, University of Utah, School of Medicine, Salt Lake City, Utah, USA; Informatics, Decision-Enhancement, and Analytical Sciences Center of Innovation, Salt Lake City VA Healthcare System, Salt Lake City, Utah, USA.
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8
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Direct-to-consumer genetic testing in the news: a descriptive analysis. J Community Genet 2023; 14:63-69. [PMID: 36239910 PMCID: PMC9947208 DOI: 10.1007/s12687-022-00613-z] [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: 08/06/2022] [Accepted: 10/04/2022] [Indexed: 10/17/2022] Open
Abstract
Direct-to-consumer genetic testing (DTC GT) diagnostic tools do not entail referral through a healthcare provider and are used by consumers to screen for genetic health risk, pharmacogenomics, and predisposition to certain diseases and to learn more about ancestry. The purpose of this study was to describe the content of DTC DNA online news articles - specifically to characterize how rising concerns related to consumer privacy, medical advancements, and bioethics are covered in online news as access to these testing kits continues to grow. One hundred news articles identified on Google News using the search term "direct to consumer DNA testing" were coded for pre-determined content categories. Only 34.0% of news articles were created by healthcare professionals. Only 10.0% of online news articles mentioned testing confidentiality and privacy protection. Articles that mentioned > 5 commercial DTC DNA products more often discussed how DTC DNA testing provides personalized information about health and link to family disease risk and other traits (85.7% vs. 61.1%, p = 0.02), can lead to the location of family members or ancestors (78.6% vs. 55.63%, p = 0.03), and that the testing results housed in DNA databases can be utilized by law enforcement to track suspects or their relatives (32.1% vs. 9.7%, p = 0.01). Articles that mentioned ≤ 5 commercial DTC DNA products failed to mention that there exists a potential for data breaches (75.0% vs. 53.6%, p = 0.04). Online news articles should adequately inform consumers regarding the benefits and risks of DTC GT tests to facilitate informed decision-making.
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9
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Samlali K, Thornbury M, Venter A. Community-led risk analysis of direct-to-consumer whole-genome sequencing. Biochem Cell Biol 2022; 100:499-509. [PMID: 35939839 DOI: 10.1139/bcb-2021-0506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Direct-to-consumer (DTC) genetic testing is cheaper and more accessible than ever before; however, the intention to combine, reuse, and resell this genetic information as powerful data sets is generally hidden from the consumer. This financial gain is creating a competitive DTC market, reducing the price of whole-genome sequencing (WGS) to under 300 USD. Entering this transition from single-nucleotide polymorphism-based DTC testing to WGS DTC testing, individuals looking for access to their whole-genomic information face new privacy and security risks. Differences between WGS and other methods of consumer genetic tests are left unexplored by regulation, leading to the application of legal data anonymization methods on whole-genome data, and questionable consent methods. Large representative genomic data sets are important for research and improve the standard of medicine and personalized care. However, these data can also be used by market players, law enforcement, and governments for surveillance, population analyses, marketing purposes, and discrimination. Here, we present a summary of the state of WGS DTC genetic testing and its current regulation, through a community-based lens to expose dual-use risks in consumer-facing biotechnologies.
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Affiliation(s)
- Kenza Samlali
- BricoBio Community Biology Lab, Montréal, QC, Canada.,Centre for Applied Synthetic Biology, Concordia University, Montréal, QC, Canada.,Department of Electrical and Computer Engineering, Concordia University, Montréal, QC, Canada
| | - Mackenzie Thornbury
- BricoBio Community Biology Lab, Montréal, QC, Canada.,Centre for Applied Synthetic Biology, Concordia University, Montréal, QC, Canada.,Department of Biology, Concordia University, Montréal, QC, Canada
| | - Andrei Venter
- BricoBio Community Biology Lab, Montréal, QC, Canada
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10
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Gooden A, Thaldar DW. Direct-to-Consumer Genetic Testing in South Africa: Stumbling Over the First Legal Hurdle? POTCHEFSTROOM ELECTRONIC LAW JOURNAL 2022; 25:10.17159/1727-3781/2022/v25i0a11764. [PMID: 37383487 PMCID: PMC10306243 DOI: 10.17159/1727-3781/2022/v25i0a11764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Despite the growing popularity of direct-to-consumer genetic testing, there is minimal South African literature on the topic. The limited available research suggests that direct-to-consumer genetic testing is unregulated. However, we suggest that direct-to-consumer genetic testing is indeed regulated, and unusually so. The first step in the process - the collection of a saliva sample by consumers themselves - is unlawful on a plain reading of the National Health Act 61 of 2003 and the Regulations Relating to the Use of Human Biological Material. This is because these statutes require that certain healthcare professionals must remove saliva for genetic testing. Yet, on closer analysis, such an apparent ban on the self-collection of saliva is neither aligned with a purposive interpretation of the relevant legislation, nor would it survive constitutional scrutiny - as it impedes an individual's autonomy. It is concluded that, contrary to a plain reading of the relevant statutes, individuals can lawfully collect their own saliva for direct-to-consumer genetic testing. To provide legal clarity we recommend that the relevant provisions of the National Health Act 61 of 2003 and Regulations Relating to the Use of Human Biological the Material be amended to allow individuals to collect their own saliva samples.
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Affiliation(s)
- Amy Gooden
- University of KwaZulu-Natal South Africa
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11
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Oleksyk TK, Wolfsberger WW, Schubelka K, Mangul S, O'Brien SJ. The Pioneer Advantage: Filling the blank spots on the map of genome diversity in Europe. Gigascience 2022; 11:6695081. [PMID: 36085557 PMCID: PMC9463063 DOI: 10.1093/gigascience/giac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Documenting genome diversity is important for the local biomedical communities and instrumental in developing precision and personalized medicine. Currently, tens of thousands of whole-genome sequences from Europe are publicly available, but most of these represent populations of developed countries of Europe. The uneven distribution of the available data is further impaired by the lack of data sharing. Recent whole-genome studies in Eastern Europe, one in Ukraine and one in Russia, demonstrated that local genome diversity and population structure from Eastern Europe historically had not been fully represented. An unexpected wealth of genomic variation uncovered in these studies was not so much a consequence of high variation within their population, but rather due to the "pioneer advantage." We discovered more variants because we were the first to prospect in the Eastern European genome pool. This simple comparison underscores the importance of removing the remaining geographic genome deserts from the rest of the world map of the human genome diversity.
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Affiliation(s)
- Taras K Oleksyk
- Uzhhorod National University, Uzhhorod, 88000, Ukraine.,Oakland University, Department of Biological Sciences, Rochester, 48309 MI 48309-4479, USA
| | - Walter W Wolfsberger
- Oakland University, Department of Biological Sciences, Rochester, 48309 MI 48309-4479, USA
| | - Khrystyna Schubelka
- Oakland University, Department of Biological Sciences, Rochester, 48309 MI 48309-4479, USA
| | - Serghei Mangul
- University of Southern California, USC School of Pharmacy, Los Angeles, CA 90089, USA
| | - Stephen J O'Brien
- Nova Southeastern University, Halmos College of Natural Sciences and Oceanography, Fort Lauderdale, FL 33314, USA
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12
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Koplin JJ, Skeggs J, Gyngell C. Ethics of Buying DNA. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:395-406. [PMID: 35854191 PMCID: PMC9463216 DOI: 10.1007/s11673-022-10192-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 08/13/2021] [Indexed: 06/15/2023]
Abstract
DNA databases have significant commercial value. Direct-to-consumer genetic testing companies have built databanks using samples and information voluntarily provided by customers. As the price of genetic analysis falls, there is growing interest in building such databases by paying individuals for their DNA and personal data. This paper maps the ethical issues associated with private companies paying for DNA. We outline the benefits of building better genomic databases and describe possible concerns about crowding out, undue inducement, exploitation, and commodification. While certain objections deserve more empirical and philosophical investigation, we argue that none currently provide decisive reasons against using financial incentives to secure DNA samples.
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Affiliation(s)
- Julian J Koplin
- Melbourne Law School, University of Melbourne, 185 Pelham St, Carlton, VIC, 3053, Australia.
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Jack Skeggs
- Monash University, Melbourne, VIC, Australia
| | - Christopher Gyngell
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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13
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Cernat A, Bashir NS, Ungar WJ. Considerations for developing regulations for direct-to-consumer genetic testing: a scoping review using the 3-I framework. J Community Genet 2022; 13:155-170. [PMID: 35171498 PMCID: PMC8941003 DOI: 10.1007/s12687-022-00582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Direct-to-consumer (DTC) genetic testing exists largely outside of any regulatory schemes, and studies providing a comprehensive overview of the ethical, social, legal, and technological considerations for regulating these types of technologies are lacking. This paper uses the 3-I framework for policy analysis to analyze the ideas, interests, and institutions relevant to policy development for DTC genetic testing in North America and internationally. A scoping review was conducted. Citation databases were searched for papers addressing the ethical, social, legal, and technological implications of DTC genetic testing; stakeholder perspectives on and experiences with DTC genetic testing; or the effect of such testing on the healthcare system. Ninety-nine publications, organizational reports, governmental documents, or pieces of legislation were included. The ideas included are autonomy, informed decision making, privacy, and clinical validity and utility. The interests discussed are those of the public and healthcare providers. The institutions included are regulatory organizations such as the Food and Drug Administration in the United States, laws governing the implementation or delivery of genetic testing in general, and legislation created to protect against genetic discrimination. This analysis clarifies the ethical, social, legal, and technological issues of DTC genetic testing regulation. This information can be used by policy makers to develop or strengthen regulations for DTC genetic testing such as requiring an assessment of the clinical validity of tests before they become publicly available, controlling how tests are marketed, and stipulating requirements for healthcare provider involvement and informed consent.
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Affiliation(s)
- Alexandra Cernat
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Naazish S Bashir
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
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14
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Wan Z, Hazel JW, Clayton EW, Vorobeychik Y, Kantarcioglu M, Malin BA. Sociotechnical safeguards for genomic data privacy. Nat Rev Genet 2022; 23:429-445. [PMID: 35246669 PMCID: PMC8896074 DOI: 10.1038/s41576-022-00455-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 12/21/2022]
Abstract
Recent developments in a variety of sectors, including health care, research and the direct-to-consumer industry, have led to a dramatic increase in the amount of genomic data that are collected, used and shared. This state of affairs raises new and challenging concerns for personal privacy, both legally and technically. This Review appraises existing and emerging threats to genomic data privacy and discusses how well current legal frameworks and technical safeguards mitigate these concerns. It concludes with a discussion of remaining and emerging challenges and illustrates possible solutions that can balance protecting privacy and realizing the benefits that result from the sharing of genetic information. In this Review, the authors describe technical and legal protection mechanisms for mitigating vulnerabilities in genomic data privacy. They also discuss how these protections are dependent on the context of data use such as in research, health care, direct-to-consumer testing or forensic investigations.
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Affiliation(s)
- Zhiyu Wan
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Computer Science, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James W Hazel
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Ellen Wright Clayton
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA.,Vanderbilt University Law School, Nashville, TN, USA
| | - Yevgeniy Vorobeychik
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Murat Kantarcioglu
- Department of Computer Science, University of Texas at Dallas, Richardson, TX, USA
| | - Bradley A Malin
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Computer Science, Vanderbilt University, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
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15
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Alsaffar MM, Hasan M, McStay GP, Sedky M. Digital DNA lifecycle security and privacy: an overview. Brief Bioinform 2022; 23:6518049. [PMID: 35106557 DOI: 10.1093/bib/bbab607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/14/2022] Open
Abstract
DNA sequencing technologies have advanced significantly in the last few years leading to advancements in biomedical research which has improved personalised medicine and the discovery of new treatments for diseases. Sequencing technology advancement has also reduced the cost of DNA sequencing, which has led to the rise of direct-to-consumer (DTC) sequencing, e.g. 23andme.com, ancestry.co.uk, etc. In the meantime, concerns have emerged over privacy and security in collecting, handling, analysing and sharing DNA and genomic data. DNA data are unique and can be used to identify individuals. Moreover, those data provide information on people's current disease status and disposition, e.g. mental health or susceptibility for developing cancer. DNA privacy violation does not only affect the owner but also affects their close consanguinity due to its hereditary nature. This article introduces and defines the term 'digital DNA life cycle' and presents an overview of privacy and security threats and their mitigation techniques for predigital DNA and throughout the digital DNA life cycle. It covers DNA sequencing hardware, software and DNA sequence pipeline in addition to common privacy attacks and their countermeasures when DNA digital data are stored, queried or shared. Likewise, the article examines DTC genomic sequencing privacy and security.
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Affiliation(s)
- Muhalb M Alsaffar
- Department of Computing, AI and Robotics, School of Digital, Technologies and Arts, Staffordshire University, College Road, ST4 2DE, Staffordshire, United Kingdom
| | | | - Gavin P McStay
- Department of Biological Sciences, School of Health, Science and Wellbeing, Staffordshire University, College Road, Stoke-on-Trent, Staffordshire, ST4 2DE, United Kingdom
| | - Mohamed Sedky
- Department of Computing, AI and Robotics, School of Digital, Technologies and Arts, Staffordshire University, College Road, ST4 2DE, Staffordshire, United Kingdom
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16
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Huang J, Liang ZS, Pallotti S, Ranson JM, Llewellyn DJ, Zheng ZJ, King DA, Zhou Q, Zheng H, Napolioni V. PAGEANT: personal access to genome and analysis of natural traits. Nucleic Acids Res 2021; 50:e39. [PMID: 34928375 PMCID: PMC9023285 DOI: 10.1093/nar/gkab1245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022] Open
Abstract
GWASs have identified numerous genetic variants associated with a wide variety of diseases, yet despite the wide availability of genetic testing the insights that would enhance the interpretability of these results are not widely available to members of the public. As a proof of concept and demonstration of technological feasibility, we developed PAGEANT (Personal Access to Genome & Analysis of Natural Traits), usable through Graphical User Interface or command line-based version, aiming to serve as a protocol and prototype that guides the overarching design of genetic reporting tools. PAGEANT is structured across five core modules, summarized by five Qs: (i) quality assurance of the genetic data; (ii) qualitative assessment of genetic characteristics; (iii) quantitative assessment of health risk susceptibility based on polygenic risk scores and population reference; (iv) query of third-party variant databases (e.g. ClinVAR and PharmGKB) and (v) quick Response code of genetic variants of interest. Literature review was conducted to compare PAGEANT with academic and industry tools. For 2504 genomes made publicly available through the 1000 Genomes Project, we derived their genomic characteristics for a suite of qualitative and quantitative traits. One exemplary trait is susceptibility to COVID-19, based on the most up-to-date scientific findings reported.
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Affiliation(s)
- Jie Huang
- Department of Global Health, Peking University School of Public Health, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China.,National Institute of Health Data Science at Peking University, Beijing, China
| | - Zhi-Sheng Liang
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Stefano Pallotti
- Genetics and Animal Breeding Group, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Janice M Ranson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, UK.,Alan Turing Institute, London, UK
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Daniel A King
- Northwell Health Cancer Institute and Feinstein Institutes for Research, Lake Success, NY, USA
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, Shenzhen, China
| | - Houfeng Zheng
- Diseases & Population (DaP) Geninfo Lab., School of Life Sciences, Westlake University, Hangzhou, China
| | - Valerio Napolioni
- Genomic and Molecular Epidemiology (GAME)Lab., School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
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17
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de Groot NF, van Beers BC, Meynen G. Commercial DNA tests and police investigations: a broad bioethical perspective. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2021-107568. [PMID: 34509983 PMCID: PMC8639940 DOI: 10.1136/medethics-2021-107568] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
Over 30 million people worldwide have taken a commercial at-home DNA test, because they were interested in their genetic ancestry, disease predisposition or inherited traits. Yet, these consumer DNA data are also increasingly used for a very different purpose: to identify suspects in criminal investigations. By matching a suspect's DNA with DNA from a suspect's distant relatives who have taken a commercial at-home DNA test, law enforcement can zero in on a perpetrator. Such forensic use of consumer DNA data has been performed in over 200 criminal investigations. However, this practice of so-called investigative genetic genealogy (IGG) raises ethical concerns. In this paper, we aim to broaden the bioethical analysis on IGG by showing the limitations of an individual-based model. We discuss two concerns central in the debate: privacy and informed consent. However, we argue that IGG raises pressing ethical concerns that extend beyond these individual-focused issues. The very nature of the genetic information entails that relatives may also be affected by the individual customer's choices. In this respect, we explore to what extent the ethical approach in the biomedical genetic context on consent and consequences for relatives can be helpful for the debate on IGG. We argue that an individual-based model has significant limitations in an IGG context. The ethical debate is further complicated by the international, transgenerational and commercial nature of IGG. We conclude that IGG should not only be approached as an individual but also-and perhaps primarily-as a collective issue.
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Affiliation(s)
- Nina F de Groot
- Philosophy, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Britta C van Beers
- Legal Theory and Legal History, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerben Meynen
- Philosophy, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, The Netherlands
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18
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Rockwern B, Johnson D, Snyder Sulmasy L. Health Information Privacy, Protection, and Use in the Expanding Digital Health Ecosystem: A Position Paper of the American College of Physicians. Ann Intern Med 2021; 174:994-998. [PMID: 33900797 DOI: 10.7326/m20-7639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Technologic advancements and the evolving digital health landscape have offered innovative solutions to several of our health care system's issues as well as increased the number of digital interactions and type of personal health information that is generated and collected, both within and outside of traditional health care. This American College of Physicians' position paper discusses the state of privacy legislation and regulations, highlights existing gaps in health information privacy protections, and outlines policy principles and recommendations for the development of health information privacy and security protections that are comprehensive, transparent, understandable, adaptable, and enforceable. The principles and recommendations aim to improve on the privacy framework in which physicians have practiced for decades and expand similar privacy guardrails to entities not currently governed by privacy laws and regulations. The expanded privacy framework should protect personal health information from unauthorized, discriminatory, deceptive, or harmful uses and align with the principles of medical ethics, respect individual rights, and support the culture of trust necessary to maintain and improve care delivery.
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Affiliation(s)
| | - Dejaih Johnson
- American College of Physicians, Washington, DC (B.R., D.J.)
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19
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Aleman KM, Chipman M, Peck JL, Hughes AK, Murphey C. Direct to consumer genetic and genomic testing with associated implications for advanced nursing practice. J Am Assoc Nurse Pract 2021; 34:381-388. [PMID: 34107502 DOI: 10.1097/jxx.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Direct-to-consumer genetic and genomic testing (DTCGT) has paved the way for consumers to gain information about their genetic makeup. Consumers may seek DTCGT to estimate ethnic background, identify genetic relations, or obtain raw DNA information that can be used for other purposes, such as testing for paternity and identifying genetically linked illnesses. Despite robust progress in genetic and genomic testing, most people have a low exposure threshold to DTCGT. Patient consumers may unnecessarily experience anxiety if they do not have a health care provider (HCP) to consult and review their results. Presently, there is a knowledge gap in how accurately HCPs can interpret and communicate genetic test results to patients compared with genetic specialists who may be inaccessible to underserved populations. Genetic and genomic information is rapidly progressing in health care and can identify patients at increased risk for certain diseases and improve patient care and outcomes. Appropriate use of genetic and genomic testing and knowing the limitations and difficulties of current testing available are integral to the success of HCPs in using these results in health promotion and improving quality of life. Health care providers should be aware of DTCGT recommendations and implications for patients, be prepared to counsel patients who present with testing results in hand, seeking advisement, and be competent in determining the need for further diagnostic testing or referral to a specialist genetic counselor.
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Affiliation(s)
| | | | - Jessica L Peck
- National Association of Pediatric Nurse Practitioners, New York, New York
- Baylor University, Waco, Texas
| | - Ashley K Hughes
- Department of Veterans Affairs, Home Based Primary Care, Temple, Texas
| | - Christina Murphey
- College of Nursing and Health Sciences, Texas A&M University-Corpus Christi, Corpus Christi, Texas
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20
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Tafazoli A, Guggilla RK, Kamel-Koleti Z, Miltyk W. Strategies to Improve the Clinical Outcomes for Direct-to-Consumer Pharmacogenomic Tests. Genes (Basel) 2021; 12:361. [PMID: 33802585 PMCID: PMC7999840 DOI: 10.3390/genes12030361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 12/27/2022] Open
Abstract
Direct-to-consumer genetic tests (DTC-GT) have become a bridge between marketing and traditional healthcare services. After earning FDA endorsement for such facilities, several fast-developing companies started to compete in the related area. Pharmacogenomic (PGx) tests have been introduced as potentially one of the main medical services of such companies. Most of the individuals will be interested in finding out about the phenotypic consequences of their genetic variants and molecular risk factors against diverse medicines they take or will take later. Direct-to-consumer pharmacogenomic tests (DTC-PT) is still in its young age, however it is expected to expand rapidly through the industry in the future. The result of PGx tests could be considered as the main road toward the implementation of personalized and precision medicine in the clinic. This narrative critical review study provides a descriptive overview on DTC-GT, then focuses on DTC-PT, and also introduces and suggests the potential approaches for improving the clinical related outcomes of such tests on healthcare systems.
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Affiliation(s)
- Alireza Tafazoli
- Department of Analysis and Bioanalysis of Medicines, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Rama Krishna Guggilla
- Department of Population Medicine and Civilization Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, 15-269 Bialystok, Poland;
| | - Zahra Kamel-Koleti
- Department of Pathology and Medical Laboratory, Shohada Hospital, Mazandaran University of Medical Sciences, Behshahr 4851613185, Iran;
| | - Wojciech Miltyk
- Department of Analysis and Bioanalysis of Medicines, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland;
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21
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Mladucky J, Baty B, Botkin J, Anderson R. Secondary Data Usage in Direct-to-Consumer Genetic Testing: To What Extent Are Customers Aware and Concerned? Public Health Genomics 2021; 24:199-206. [PMID: 33640892 DOI: 10.1159/000512660] [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: 06/24/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Customer data from direct-to-consumer genetic testing (DTC GT) are often used for secondary purposes beyond providing the customer with test results. OBJECTIVE The goals of this study were to determine customer knowledge of secondary uses of data, to understand their perception of risks associated with these uses, and to determine the extent of customer concerns about privacy. METHODS Twenty DTC GT customers were interviewed about their experiences. The semi-structured interviews were transcribed, coded, and analyzed for common themes. RESULTS Most participants were aware of some secondary uses of data. All participants felt that data usage for research was acceptable, but acceptability for non-research purposes varied across participants. The majority of participants were aware of the existence of a privacy policy, but few read the majority of the privacy statement. When previously unconsidered uses of data were discussed, some participants expressed concern over privacy protections for their data. CONCLUSION When exposed to new information on secondary uses of data, customers express concerns and a desire to improve consent with transparency, more opt-out options, improved readability, and more information on future uses and potential risks from direct-to-consumer companies. Effective ways to improve readership about the secondary use, risk of use, and protection of customer data should be investigated and the findings implemented by DTC companies to protect public trust in these practices.
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Affiliation(s)
- Janessa Mladucky
- University of Utah Graduate Program in Genetic Counseling, Salt Lake City, Utah, USA,
| | - Bonnie Baty
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jeffrey Botkin
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca Anderson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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22
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Oliver KH, Higgs S, Clayton J. The End of Genetic Privacy in the Blade Runner Canon. JOURNAL OF LITERATURE AND SCIENCE 2021; 14:108-124. [PMID: 36506249 PMCID: PMC9731365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Kendra H. Oliver
- Departments of Pharmacology and Communication of Science and Technology, Vanderbilt University
| | | | - Jay Clayton
- Departments of English, Cinema and Media Arts, and Communication of Science and Technology, Vanderbilt University
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23
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Tanisawa K, Wang G, Seto J, Verdouka I, Twycross-Lewis R, Karanikolou A, Tanaka M, Borjesson M, Di Luigi L, Dohi M, Wolfarth B, Swart J, Bilzon JLJ, Badtieva V, Papadopoulou T, Casasco M, Geistlinger M, Bachl N, Pigozzi F, Pitsiladis Y. Sport and exercise genomics: the FIMS 2019 consensus statement update. Br J Sports Med 2020; 54:969-975. [PMID: 32201388 PMCID: PMC7418627 DOI: 10.1136/bjsports-2019-101532] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
Rapid advances in technologies in the field of genomics such as high throughput DNA sequencing, big data processing by machine learning algorithms and gene-editing techniques are expected to make precision medicine and gene-therapy a greater reality. However, this development will raise many important new issues, including ethical, moral, social and privacy issues. The field of exercise genomics has also advanced by incorporating these innovative technologies. There is therefore an urgent need for guiding references for sport and exercise genomics to allow the necessary advancements in this field of sport and exercise medicine, while protecting athletes from any invasion of privacy and misuse of their genomic information. Here, we update a previous consensus and develop a guiding reference for sport and exercise genomics based on a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis. This SWOT analysis and the developed guiding reference highlight the need for scientists/clinicians to be well-versed in ethics and data protection policy to advance sport and exercise genomics without compromising the privacy of athletes and the efforts of international sports federations. Conducting research based on the present guiding reference will mitigate to a great extent the risks brought about by inappropriate use of genomic information and allow further development of sport and exercise genomics in accordance with best ethical standards and international data protection principles and policies. This guiding reference should regularly be updated on the basis of new information emerging from the area of sport and exercise medicine as well as from the developments and challenges in genomics of health and disease in general in order to best protect the athletes, patients and all other relevant stakeholders.
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Affiliation(s)
- Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Guan Wang
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Jane Seto
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Ioanna Verdouka
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Richard Twycross-Lewis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Antonia Karanikolou
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Masashi Tanaka
- Department for Health and Longevity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Mats Borjesson
- Department of Neuroscience and Physiology, Center for Health and Performance, Goteborg University, Göteborg, Sweden
- Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
| | - Luigi Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Michiko Dohi
- Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Bernd Wolfarth
- Department of Sport Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - Jeroen Swart
- UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
| | | | - Victoriya Badtieva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
- Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- British Association of Sport and Exercise Medicine, Doncaster, UK
| | | | - Michael Geistlinger
- Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Salzburg, Austria
| | - Norbert Bachl
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Fabio Pigozzi
- Sport Medicine Unit, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Yannis Pitsiladis
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
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24
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Abstract
Although the explosive growth of direct-to-consumer (DTC) genetic testing has moderated, a substantial number of patients are choosing to undergo genetic testing outside the purview of their regular healthcare providers. Further, many industry leaders have been expanding reports to cover many more genes, as well as partnering with employers and others to expand access. This review addresses continuing concerns about DTC genetic testing quality, psychosocial impact, integration with medical practice, effects on the healthcare system, and privacy, as well as emerging concerns about third-party interpretation services and non-health-related uses such as investigative genetic genealogy. It concludes with an examination of two possible futures for DTC genetic testing: merger with traditional modes of healthcare delivery or continuation as a parallel system for patient-driven generation of health-relevant information. Each possibility is associated with distinctive questions related to value and risk.
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Affiliation(s)
- Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA; , ,
| | - Christi J Guerrini
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA; , ,
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA; , ,
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25
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Bonomi L, Huang Y, Ohno-Machado L. Privacy challenges and research opportunities for genomic data sharing. Nat Genet 2020; 52:646-654. [PMID: 32601475 PMCID: PMC7761157 DOI: 10.1038/s41588-020-0651-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
The sharing of genomic data holds great promise in advancing precision medicine and providing personalized treatments and other types of interventions. However, these opportunities come with privacy concerns, and data misuse could potentially lead to privacy infringement for individuals and their blood relatives. With the rapid growth and increased availability of genomic datasets, understanding the current genome privacy landscape and identifying the challenges in developing effective privacy-protecting solutions are imperative. In this work, we provide an overview of major privacy threats identified by the research community and examine the privacy challenges in the context of emerging direct-to-consumer genetic-testing applications. We additionally present general privacy-protection techniques for genomic data sharing and their potential applications in direct-to-consumer genomic testing and forensic analyses. Finally, we discuss limitations in current privacy-protection methods, highlight possible mitigation strategies and suggest future research opportunities for advancing genomic data sharing.
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Affiliation(s)
- Luca Bonomi
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA.
| | - Yingxiang Huang
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| | - Lucila Ohno-Machado
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
- Division of Health Services Research & Development, VA San Diego Healthcare System, San Diego, La Jolla, CA, USA
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26
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Abstract
PURPOSE OF REVIEW Advances in personal genomics have made predictive genetic testing increasingly popular. The purpose of this review is to examine and summarize recent literature regarding the ethical concerns and considerations surrounding genetic testing for Alzheimer's disease. RECENT FINDINGS Four basic bioethical principles can be applied in the context of genetic testing: autonomy, nonmaleficence, beneficence and justice. The concepts of clinical validity, clinical utility and personal utility are also necessary for the ethical deliberation of genetic testing for Alzheimer's disease. Ethical considerations can differ among three distinct settings present in the literature: research, clinical and direct-to-consumer services. Studies have found that the negative psychosocial impact of genetic test results on the individual is limited, but emphasize the importance of pre/posttesting genetic counselling. SUMMARY The literature should ideally inform policy-making around genetic testing. There exists an urgent need for regulation, particularly in the direct-to-consumer (DTC) market, since interest for testing in this context is rapidly growing. Standardized protocols for disclosure should be developed, and there is a need to find ways to meet the growing need for genetic counselling. Importantly, comprehensive, evidence-based regulation requires that research be conducted in different contexts with more diverse participants.
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27
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Hoxhaj I, Stojanovic J, Sassano M, Acampora A, Boccia S. A review of the legislation of direct-to-consumer genetic testing in EU member states. Eur J Med Genet 2020; 63:103841. [PMID: 31923586 DOI: 10.1016/j.ejmg.2020.103841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/24/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Ilda Hoxhaj
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Jovana Stojanovic
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Health, Kinesiology, and Applied Physiology (HKAP), Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec, H4B 1R6, Canada; Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, 5400, Boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada
| | - Michele Sassano
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Acampora
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefania Boccia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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28
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Savard J, Hickerton C, Metcalfe SA, Gaff C, Middleton A, Newson AJ. From Expectations to Experiences: Consumer Autonomy and Choice in Personal Genomic Testing. AJOB Empir Bioeth 2020; 11:63-76. [PMID: 31885332 PMCID: PMC7048070 DOI: 10.1080/23294515.2019.1701583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Personal genomic testing (PGT) offers individuals genetic information about relationships, wellness, sporting ability, and health. PGT is increasingly accessible online, including in emerging markets such as Australia. Little is known about what consumers expect from these tests and whether their reflections on testing resonate with bioethics concepts such as autonomy.Methods: We report findings from focus groups and semi-structured interviews that explored attitudes to and experiences of PGT. Focus group participants had little experience with PGT, while interview participants had undergone testing. Recordings were transcribed and analyzed using thematic analysis. Findings were critically interpreted with reference to bioethics scholarship on autonomy.Results: Fifty-six members of the public participated in seven focus groups, and 40 individuals were interviewed separately. Both groups valued the choice of PGT, and believed that it could motivate relevant actions. Focus group themes centered on the perceived value of choices, knowledge enabling action and knowledge about the self. Interview themes suggest that participants reflexively engage with their PGT information to make meaning, and that some appreciate its shortcomings. Critical interpretation of findings shows that while consumers of PGT are able to exercise a degree of autonomy in choosing, they may not be able to achieve a substantive conceptualization of autonomy, one that promotes alignment with higher-order desires.Conclusions: PGT consumers can critically reason about testing. However, they may uncritically accept test results, may not appreciate drawbacks of increased choice, or may overestimate the potential for information to motivate behavioral change. While consumers appear to be capable of substantive autonomy, they do so without ongoing support from companies. PGT companies promote a problematic ("default") account of autonomy, reliant on empowerment rhetoric. This leaves consumers vulnerable to making decisions inconsistent with their higher-order desires. As PGT expands, claims about its power and value need to be carefully drawn.
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Affiliation(s)
- Jacqueline Savard
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
| | - Chriselle Hickerton
- Genetics Education and Health Research, Murdoch Children’s Research Institute, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sylvia A. Metcalfe
- Genetics Education and Health Research, Murdoch Children’s Research Institute, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Clara Gaff
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute of Medical Research, Victoria, Australia
| | - Anna Middleton
- Society and Ethics Research, Wellcome Genome Campus Society and Ethics Research Group, Hinxton, Cambridge, United Kingdom
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Ainsley J. Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
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Physician Experience with Direct-To-Consumer Genetic Testing in Kaiser Permanente. J Pers Med 2019; 9:jpm9040047. [PMID: 31683813 PMCID: PMC6963876 DOI: 10.3390/jpm9040047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 02/08/2023] Open
Abstract
Health systems and physicians nationwide aspire to consistently and reliably apply genetic and genomic information to guide disease prevention, management, and treatment. However, clinical information, including genetics/genomics data from within and outside of the care delivery system, is expanding rapidly. Between November 2017 and April 2018, we surveyed 1502 Permanente Medical Group primary care and specialist physicians to assess the degree to which direct-to-consumer genetic test results were being presented to physicians and identify genetics educational needs among physicians (response rate 15%). Adjusted logistic regression (according to respondent characteristics) was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing responses within groups. Results showed 35% and 12% of respondents reported receiving at least one direct-to-consumer health risk genetic result (DTC-health risk) or direct-to-consumer pharmacogenomic test result (DTC-PGx), respectively, from a patient in the past year. Of those receiving at least one test result, 40% (DTC-health risk) and 39% (DTC-PGx) of physicians reported 1+ referral(s); 78% (DTC-health risk) and 42% (DTC-PGx) of referrals were to clinical genetics. In total, 85% of physicians would spend ≥2 h/year on genetics/genomics education.
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Chinen J, Lawrence M, Dorsey M, Kobrynski LJ. Practical approach to genetic testing for primary immunodeficiencies. Ann Allergy Asthma Immunol 2019; 123:433-439. [PMID: 31472268 DOI: 10.1016/j.anai.2019.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Javier Chinen
- Department of Pediatrics, Allergy and Immunology Section, Baylor College of Medicine, Houston, Texas, Texas Children's Hospital, The Woodlands, Texas
| | - Monica Lawrence
- Department of Medicine, Division of Asthma, Allergy & Immunology University of Virginia, Charlottesville, Virginia
| | - Morna Dorsey
- Department of Pediatrics, Division of Allergy, Immunology and Blood and Marrow Transplant, University of California, San Francisco, California
| | - Lisa J Kobrynski
- Department of Pediatrics, Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis, Sleep, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
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Pruebas genéticas de venta directa a los consumidores. Perspectiva de la Comisión de Ética de la Asociación Española de Genética Humana. Med Clin (Barc) 2019; 153:35-40. [DOI: 10.1016/j.medcli.2019.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/24/2022]
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Hendricks-Sturrup RM, Lu CY. Direct-to-Consumer Genetic Testing Data Privacy: Key Concerns and Recommendations Based on Consumer Perspectives. J Pers Med 2019; 9:jpm9020025. [PMID: 31075859 PMCID: PMC6616921 DOI: 10.3390/jpm9020025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 11/30/2022] Open
Abstract
Direct-to-consumer genetic testing (DTC-GT) companies are engaging health consumers in unprecedented ways and leveraging the genetic information they collect to further engage health companies. This has produced controversy about DTC-GT consumer expectations, standards, and perceptions of privacy. In this commentary, we highlight recent events involving DTC-GT companies and controversy about privacy that followed those events and discuss recent studies that have explored DTC-GT consumer concerns about privacy. We discuss DTC-GT company standards of upholding consumer privacy and the general accessibility of DTC-GT company terms of use agreements and privacy policies that are written at reading levels above that of many consumers. We conclude that broader discussions and more research are needed to identify DTC-GT consumer concerns about and expectations of privacy. We anticipate that our recommendations will advance discussions on consumer privacy expectations and protections in an era of increasing engagement in DTC-GT.
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Affiliation(s)
- Rachele M Hendricks-Sturrup
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02215, USA.
| | - Christine Y Lu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02215, USA.
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34
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Blell M, Hunter MA. Direct-to-Consumer Genetic Testing's Red Herring: "Genetic Ancestry" and Personalized Medicine. Front Med (Lausanne) 2019; 6:48. [PMID: 30984759 PMCID: PMC6449432 DOI: 10.3389/fmed.2019.00048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/21/2019] [Indexed: 12/30/2022] Open
Abstract
The growth in the direct-to-consumer genetic testing industry poses a number of challenges for healthcare practice, among a number of other areas of concern. Several companies providing this service send their customers reports including information variously referred to as genetic ethnicity, genetic heritage, biogeographic ancestry, and genetic ancestry. In this article, we argue that such information should not be used in healthcare consultations or to assess health risks. Far from representing a move toward personalized medicine, use of this information poses risks both to patients as individuals and to racialized ethnic groups because of the way it misrepresents human genetic diversity.
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Affiliation(s)
- Mwenza Blell
- Policy, Ethics and Life Sciences Research Centre, School of Geography, Politics and Sociology, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - M A Hunter
- Department of Philosophy, Logic, and Scientific Method, Centre for Philosophy of Natural and Social Science (CPNSS), The London School of Economics and Political Science, London, United Kingdom.,Philosophy Department, University of California, Davis, Davis, CA, United States
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Mackey TK, Kuo TT, Gummadi B, Clauson KA, Church G, Grishin D, Obbad K, Barkovich R, Palombini M. 'Fit-for-purpose?' - challenges and opportunities for applications of blockchain technology in the future of healthcare. BMC Med 2019; 17:68. [PMID: 30914045 PMCID: PMC6436239 DOI: 10.1186/s12916-019-1296-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 12/16/2022] Open
Abstract
Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.
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Affiliation(s)
- Tim K. Mackey
- Department of Anesthesiology and Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, San Diego, CA USA
- Department of Healthcare Policy, Technology and Research, University of California, San Diego – Extension, San Diego, CA USA
- Global Health Policy Institute, San Diego, CA USA
- BlockLAB, San Diego Supercomputer Center, La Jolla, CA USA
| | - Tsung-Ting Kuo
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA USA
| | - Basker Gummadi
- Bayer Corporation, 100 Bayer Boulevard, Whippany, NJ 07981 USA
| | - Kevin A. Clauson
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy & Health Sciences, Nashville, TN USA
| | - George Church
- Department of Genetics, Harvard Medical School, Boston, MA USA
- Nebula Genomics, Inc., San Francisco, CA USA
| | - Dennis Grishin
- Department of Genetics, Harvard Medical School, Boston, MA USA
- Nebula Genomics, Inc., San Francisco, CA USA
| | - Kamal Obbad
- Nebula Genomics, Inc., San Francisco, CA USA
| | - Robert Barkovich
- Productive Consulting, Mountain View, CA USA
- Health Linkages Inc., Mountain View, CA USA
| | - Maria Palombini
- IEEE Standards Association, 445 Hoes Lane, Piscataway, NJ 08854 USA
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36
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Schaper M, Wöhlke S, Schicktanz S. "I would rather have it done by a doctor"-laypeople's perceptions of direct-to-consumer genetic testing (DTC GT) and its ethical implications. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:31-40. [PMID: 29705970 DOI: 10.1007/s11019-018-9837-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Direct-to-consumer genetic testing (DTC GT) has been available for several years now, with varying degrees of regulation across different countries. Despite a restrictive legal framework it is possible for consumers to order genetic tests from companies located in other countries. However, German laypeople's awareness and perceptions of DTC GT services is still unexplored. We conducted seven focus groups (participants n = 43) with German laypeople to explore their perceptions of and attitudes towards commercial genetic testing and its ethical implications. Participants were critical towards DTC GT. Criticism was directed at health-related, predictive testing, while lifestyle tests were accepted and even welcomed to some extent. Participants expressed strong reservations regarding commercial provision of genetic diagnostics and expressed a lack of trust in respective companies. They preferred non-commercial distribution within the public healthcare system. Participants also expressed high expectations of physicians' abilities to interpret information obtained via DTC GT companies and provide counseling. Legal restrictions on commercial distribution of genetic tests were opposed, with participants arguing that it should be available to consumers. DTC GT companies are not perceived as trustworthy when compared to the public healthcare system and its professional ethical standards and practices. Laypeople rated general consumer autonomy higher than their own concerns, thus recommending against strong legal regulation. We conclude that medicine's trustworthiness may be negatively affected if commercial provision is not visibly opposed by the medical professions, while DTC GT companies may gain in trustworthiness if they adapt to standards and practices upheld in medicine.
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Affiliation(s)
- Manuel Schaper
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
| | - Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany
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37
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Du L, Becher SI. Genetic and Genomic Consultation: Are We Ready for Direct-to-Consumer Telegenetics? Front Genet 2018; 9:550. [PMID: 30559758 PMCID: PMC6287034 DOI: 10.3389/fgene.2018.00550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/29/2018] [Indexed: 12/23/2022] Open
Abstract
Telegenetics, the application of telemedicine in the context of genetic services, is a growing market. One of the recent developments in this field is the use of direct-to-consumer (DTC) marketing to promote and advertise genetic and genomic consultant services to consumers. Using Google.com, we identified providers that promote their telegenetics services online. By analyzing their websites, we identify and examine key points regarding DTC telegenetics: how are telegenetics services portrayed, how is informed consent obtained, and what protections are offered to clients' personal health information? We found that the portrayal of a wide range of telegenetics services on providers' websites is extremely positive. The risks associated with the implementation of telegenetics were rarely mentioned. Consent forms were often unavailable and did not cover all of the relevant information. The measures for protecting clients' personal health information by telegenetics providers were found to be generally inadequate and weak. We concluded that DTC telegenetics may increase patients' access to genetic counseling with affordable costs. However, before further developing DTC telegenetics, more research and regulatory improvements are required to guarantee truthful advertising, ensure informed consent, secure personal health data sharing, and warrant adequate privacy protection.
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Affiliation(s)
- Li Du
- Faculty of Law, University of Macau, Macau, China
| | - Shmuel I. Becher
- School of Accounting and Commercial Law, Victoria University of Wellington, Wellington, New Zealand
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38
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Schaper M, Schicktanz S. Medicine, market and communication: ethical considerations in regard to persuasive communication in direct-to-consumer genetic testing services. BMC Med Ethics 2018; 19:56. [PMID: 29871685 PMCID: PMC5989449 DOI: 10.1186/s12910-018-0292-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/16/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Commercial genetic testing offered over the internet, known as direct-to-consumer genetic testing (DTC GT), currently is under ethical attack. A common critique aims at the limited validation of the tests as well as the risk of psycho-social stress or adaption of incorrect behavior by users triggered by misleading health information. Here, we examine in detail the specific role of advertising communication of DTC GT companies from a medical ethical perspective. Our argumentative analysis departs from the starting point that DTC GT operates at the intersection of two different contexts: medicine on the one hand and the market on the other. Both fields differ strongly with regard to their standards of communication practices and the underlying normative assumptions regarding autonomy and responsibility. METHODS Following a short review of the ethical contexts of medical and commercial communication, we provide case examples for persuasive messages of DTC GT websites and briefly analyze their design with a multi-modal approach to illustrate some of their problematic implications. RESULTS We observe three main aspects in DTC GT advertising communication: (1) the use of material suggesting medical professional legitimacy as a trust-establishing tool, (2) the suggestion of empowerment as a benefit of using DTC GT services and (3) the narrative of responsibility as a persuasive appeal to a moral self-conception. CONCLUSIONS While strengthening and respecting the autonomy of a patient is the focus in medical communication, specifically genetic counselling, persuasive communication is the normal mode in marketing of consumer goods, presuming an autonomous, rational, independent consumer. This creates tension in the context of DTC GT regarding the expectation and normative assessment of communication strategies. Our analysis can even the ground for a better understanding of ethical problems associated with intersections of medical and commercial communication and point to perspectives of analysis of DTC GT advertising.
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Affiliation(s)
- Manuel Schaper
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073 Göttingen, Germany
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Abstract
Privacy is commonly regarded as a regulatory requirement achieved via technical and organizational management practices. Those working in the field of informatics often play a role in privacy preservation as a result of their expertise in information technology, workflow analysis, implementation science, or related skills. Viewing privacy from the perspective of patients whose protected health information is at risk broadens the considerations to include the perceived duality of privacy; the existence of privacy within a context unique to each patient; the competing needs inherent within privacy management; the need for particular consideration when data are shared; and the need for patients to control health information in a global setting. With precision medicine, artificial intelligence, and other treatment innovations on the horizon, health care professionals need to think more broadly about how to preserve privacy in a health care environment driven by data sharing. Patient-reported privacy preferences, privacy portability, and greater transparency around privacy-preserving functionalities are potential strategies for ensuring that privacy regulations are met and privacy is preserved.
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Tiller J, Lacaze P. Regulation of Internet-based Genetic Testing: Challenges for Australia and Other Jurisdictions. Front Public Health 2018; 6:24. [PMID: 29497607 PMCID: PMC5818403 DOI: 10.3389/fpubh.2018.00024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/23/2018] [Indexed: 12/21/2022] Open
Abstract
The Internet currently enables unprecedented ease of access for direct-to-consumer (DTC) genetic testing, with saliva collection kits posted directly to consumer homes from anywhere in the world. This poses new challenges for local jurisdictions in regulating genetic testing, traditionally a tightly-regulated industry. Some Internet-based genetic tests have the capacity to cause significant confusion or harm to consumers who are unaware of the risks or potential variability in quality. The emergence of some online products of questionable content, unsupported by adequate scientific evidence, is a cause for concern. Proliferation of such products in the absence of regulation has the potential to damage public trust in accredited and established clinical genetic testing during a critical period of evidence generation for genomics. Here, we explore the challenges arising from the emergence of Internet-based DTC genetic testing. In particular, there are challenges in regulating unaccredited or potentially harmful Internet-based DTC genetic testing products. In Australia, challenges exist for the Therapeutic Goods Administration, which oversees regulation of the genetic testing sector. Concerns and challenges faced in Australia are likely to reflect those of other comparable non-US jurisdictions. Here, we summarize current Australian regulation, highlight concerns, and offer recommendations on how Australia and other comparable jurisdictions might be more proactive in addressing this emerging public health issue.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Starkweather AR, Coleman B, Barcelona de Mendoza V, Fu MR, Menzies V, O'Keefe M, Williams JK. Strengthen federal regulation of laboratory-developed and direct-to-consumer genetic testing. Nurs Outlook 2017; 66:101-104. [PMID: 29331443 DOI: 10.1016/j.outlook.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Mei R Fu
- Genomic Nursing & Health Care Expert Panel
| | | | | | - Janet K Williams
- Genomic Nursing & Health Care Expert Panel; Bioethics Expert Panel
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Niemiec E, Kalokairinou L, Howard HC. Current ethical and legal issues in health-related direct-to-consumer genetic testing. Per Med 2017; 14:433-445. [PMID: 29754566 DOI: 10.2217/pme-2017-0029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A variety of health-related genetic testing is currently advertized directly to consumers. This article provides a timely overview of direct-to-consumer genetic testing (DTC GT) and salient ethical issues, as well as an analysis of the impact of the recently adopted regulation on in vitro diagnostic medical devices on DTC GT. DTC GT companies currently employ new testing approaches, report on a wide spectrum of conditions and target new groups of consumers. Such activities raise ethical issues including the questionable analytic and clinical validity of tests, the adequacy of informed consent, potentially misleading advertizing, testing in children, research uses and commercialization of genomic data. The recently adopted regulation on in vitro diagnostic medical devices may limit the offers of predisposition DTC GT in the EU market.
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Affiliation(s)
- Emilia Niemiec
- Interdepartmental Centre for Research in the History, Philosophy, and Sociology of Law and in Computer Science and Law, University of Bologna, 40121 Bologna, Italy.,Department of Law, University of Turin, 10153 Turin, Italy.,Centre for Ethics & Law in the Life Sciences, Institute of Philosophy, Leibniz University Hannover, D 30159 Hannover, Germany
| | - Louiza Kalokairinou
- Centre for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, 3000 Leuven, Belgium
| | - Heidi Carmen Howard
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, SE-751 22 Uppsala, Sweden
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Haeusermann T, Greshake B, Blasimme A, Irdam D, Richards M, Vayena E. Open sharing of genomic data: Who does it and why? PLoS One 2017; 12:e0177158. [PMID: 28486511 PMCID: PMC5423632 DOI: 10.1371/journal.pone.0177158] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/24/2017] [Indexed: 01/12/2023] Open
Abstract
We explored the characteristics and motivations of people who, having obtained their genetic or genomic data from Direct-To-Consumer genetic testing (DTC-GT) companies, voluntarily decide to share them on the publicly accessible web platform openSNP. The study is the first attempt to describe open data sharing activities undertaken by individuals without institutional oversight. In the paper we provide a detailed overview of the distribution of the demographic characteristics and motivations of people engaged in genetic or genomic open data sharing. The geographical distribution of the respondents showed the USA as dominant. There was no significant gender divide, the age distribution was broad, educational background varied and respondents with and without children were equally represented. Health, even though prominent, was not the respondents' primary or only motivation to be tested. As to their motivations to openly share their data, 86.05% indicated wanting to learn about themselves as relevant, followed by contributing to the advancement of medical research (80.30%), improving the predictability of genetic testing (76.02%) and considering it fun to explore genotype and phenotype data (75.51%). Whereas most respondents were well aware of the privacy risks of their involvement in open genetic data sharing and considered the possibility of direct, personal repercussions troubling, they estimated the risk of this happening to be negligible. Our findings highlight the diversity of DTC-GT consumers who decide to openly share their data. Instead of focusing exclusively on health-related aspects of genetic testing and data sharing, our study emphasizes the importance of taking into account benefits and risks that stretch beyond the health spectrum. Our results thus lend further support to the call for a broader and multi-faceted conceptualization of genomic utility.
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Affiliation(s)
- Tobias Haeusermann
- Health Ethics and Policy Lab, Epidemiology, Biostatistics & Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Bastian Greshake
- Department for Applied Bioinformatics, Institute for Cell Biology and Neuroscience, Goethe University, Frankfurt am Main, Germany
| | - Alessandro Blasimme
- Health Ethics and Policy Lab, Epidemiology, Biostatistics & Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Darja Irdam
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Martin Richards
- Centre for Family Research, Department of Psychology. University of Cambridge, Cambridge, United Kingdom
| | - Effy Vayena
- Health Ethics and Policy Lab, Epidemiology, Biostatistics & Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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Transparency of genetic testing services for 'health, wellness and lifestyle': analysis of online prepurchase information for UK consumers. Eur J Hum Genet 2017; 25:908-917. [PMID: 28703222 DOI: 10.1038/ejhg.2017.75] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/04/2017] [Accepted: 04/05/2017] [Indexed: 12/29/2022] Open
Abstract
The declining cost of DNA sequencing has been accompanied by a proliferation of companies selling 'direct-to-consumer genetic testing' (DTC-GT) services. Many of these are marketed online as tools for enabling citizens to make more informed decisions about their health, wellness and lifestyle. We assessed the 'information for consumers' provided by these companies at the prepurchase stage, which could influence initial decisions to part with money, data or tissue samples. A scoping exercise revealed 65 DTC-GT companies advertising their services online to consumers in the United Kingdom, of which 15 met our inclusion criteria. We benchmarked their consumer information against the good practice principles developed by the UK Human Genetics Commission (HGC). No provider complied with all the HGC principles and overall levels of compliance varied considerably. Although consent for testing was discussed by all but one company, information about data reuse for research or other purposes was often sparse and consent options limited or unclear. Most did not provide supplementary support services to help users better understand or cope with the implications of test results. We provide recommendations for updating the preconsumer transparency aspects of the HGC guidelines to ensure their fitness-for-purpose in this rapidly changing market. We also recommend improving coordination between relevant governance bodies to ensure minimum standards of transparency, quality and accountability. Although DTC-GT has many potential benefits, close partnership between consumers, industry and government, along with interdisciplinary science input, are essential to ensure that these innovations are used ethically and responsibly.
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