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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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Savard J, Hickerton C, Tytherleigh R, Terrill B, Turbitt E, Newson AJ, Wilson B, Gray K, Gaff C, Middleton A, Stackpoole E, Metcalfe SA. Australians' views and experience of personal genomic testing: survey findings from the Genioz study. Eur J Hum Genet 2019; 27:711-720. [PMID: 30666046 PMCID: PMC6461785 DOI: 10.1038/s41431-018-0325-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/22/2018] [Accepted: 11/22/2018] [Indexed: 12/25/2022] Open
Abstract
Personal genomic tests (PGTs) for multiple purposes are marketed to ostensibly healthy people in Australia. These tests are generally marketed and purchased online commercially or can be ordered through a health professional. There has been minimal engagement with Australians about their interest in and experience with ordering a PGT. As part of a multistage, interdisciplinary project, an online survey (Stage 2 of the Genioz study) was available from May 2016 to May 2017. In total, 3253 respondents attempted the survey, with 2395 completed Australian responses from people with and without experience of having a PGT: 72% were female; 59% of the whole sample were undertaking/or had a university education; and, overall, age ranged from 18—over 80. A total of 571 respondents reported having had a genetic test, 373 of these classifiable as a PGT. A bivariate analysis suggests people who have undergone PGT in our sample were: women aged 25 and over; or in a high socioeconomic group, or have a personal or family diagnosis of a genetic condition (P ≤ 0.03). After a multivariate analysis, socioeconomic status and a genetic condition in the family were not of significance. The most common types of PGT reported were for carrier status and ancestry. Findings suggest greater awareness of, and an increasing demand for non-health related PGT in Australia. To support both consumers and health care professionals with understanding PGT results, there is a need for appropriate support and resources.
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Affiliation(s)
- Jacqueline Savard
- Deakin University, School of Medicine, Faculty of Health, Geelong, Victoria, Australia.,The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, NSW, 2006, Australia.,Garvan Institute of Medical Research, Sydney, Australia
| | - Chriselle Hickerton
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rigan Tytherleigh
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Bronwyn Terrill
- Garvan Institute of Medical Research, Sydney, Australia.,Genome.One, Sydney, Australia.,St. Vincent's Clinical School, University NSW, Sydney, Australia
| | - Erin Turbitt
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,National Human Genome Research Institute, Bethesda, MD, USA
| | - Ainsley J Newson
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, NSW, 2006, Australia.,Garvan Institute of Medical Research, Sydney, Australia
| | - Brenda Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Memorial Hospital, St John's, Newfoundland, Canada
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia
| | - Clara Gaff
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Elaine Stackpoole
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Genetic Services of Western Australia, Subiaco, WA, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
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Metcalfe SA, Hickerton C, Savard J, Terrill B, Turbitt E, Gaff C, Gray K, Middleton A, Wilson B, Newson AJ. Australians' views on personal genomic testing: focus group findings from the Genioz study. Eur J Hum Genet 2018; 26:1101-1112. [PMID: 29706641 PMCID: PMC6057916 DOI: 10.1038/s41431-018-0151-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 12/30/2022] Open
Abstract
Personal genomic testing provides healthy individuals with access to information about their genetic makeup for purposes including ancestry, paternity, sporting ability and health. Such tests are available commercially and globally, with accessibility expected to continue to grow, including in Australia; yet little is known of the views/expectations of Australians. Focus groups were conducted within a multi-stage, cross-disciplinary project (Genioz) to explore this. In mid-2015, 56 members of the public participated in seven focus groups, allocated into three age groups: 18–24, 25–49, and ≥50 years. Three researchers coded transcripts independently and generated themes. Awareness of personal genomic testing was low, but most could deduce what “personal genomics” might entail. Very few had heard of the term “direct-to-consumer” testing, which has implications for organisations developing information to support individuals in their decision-making. Participants’ understanding of genetics was varied and drawn from several sources. There were diverse perceptions of the relative influence of genetics and environment on health, mental health, behavior, talent, or personality. Views about having a personal genomic test were mixed, with greater interest in health-related tests if they believed there was a reason for doing so. However, many expressed scepticisms about the types of tests available, and how the information might be used; concerns were also raised about privacy and the potential for discrimination. These exploratory findings inform subsequent stages of the Genioz study, thereby contributing to strategies of supporting Australians to understand and make meaningful and well-considered decisions about the benefits, harms, and implications of personal genomic tests.
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Affiliation(s)
- Sylvia A Metcalfe
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia. .,Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Chriselle Hickerton
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jacqueline Savard
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Sydney, Australia
| | - Bronwyn Terrill
- Garvan Institute of Medical Research, Sydney, Australia.,Genome.One, Sydney, Australia.,St Vincent's Clinical School, University NSW, Sydney, Australia
| | - Erin Turbitt
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.,National Human Genome Research Institute, Bethesda, MD, USA
| | - Clara Gaff
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia
| | - Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Brenda Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Best M, Newson AJ, Meiser B, Juraskova I, Goldstein D, Tucker K, Ballinger ML, Hess D, Schlub TE, Biesecker B, Vines R, Vines K, Thomas D, Young MA, Savard J, Jacobs C, Butow P. The PiGeOn project: protocol of a longitudinal study examining psychosocial and ethical issues and outcomes in germline genomic sequencing for cancer. BMC Cancer 2018; 18:454. [PMID: 29685123 PMCID: PMC5914013 DOI: 10.1186/s12885-018-4366-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 04/12/2018] [Indexed: 12/23/2022] Open
Abstract
Background Advances in genomics offer promise for earlier detection or prevention of cancer, by personalisation of medical care tailored to an individual’s genomic risk status. However genome sequencing can generate an unprecedented volume of results for the patient to process with potential implications for their families and reproductive choices. This paper describes a protocol for a study (PiGeOn) that aims to explore how patients and their blood relatives experience germline genomic sequencing, to help guide the appropriate future implementation of genome sequencing into routine clinical practice. Methods We have designed a mixed-methods, prospective, cohort sub-study of a germline genomic sequencing study that targets adults with cancer suggestive of a genetic aetiology. One thousand probands and 2000 of their blood relatives will undergo germline genomic sequencing as part of the parent study in Sydney, Australia between 2016 and 2020. Test results are expected within12–15 months of recruitment. For the PiGeOn sub-study, participants will be invited to complete surveys at baseline, three months and twelve months after baseline using self-administered questionnaires, to assess the experience of long waits for results (despite being informed that results may not be returned) and expectations of receiving them. Subsets of both probands and blood relatives will be purposively sampled and invited to participate in three semi-structured qualitative interviews (at baseline and each follow-up) to triangulate the data. Ethical themes identified in the data will be used to inform critical revisions of normative ethical concepts or frameworks. Discussion This will be one of the first studies internationally to follow the psychosocial impact on probands and their blood relatives who undergo germline genome sequencing, over time. Study results will inform ongoing ethical debates on issues such as informed consent for genomic sequencing, and informing participants and their relatives of specific results. The study will also provide important outcome data concerning the psychological impact of prolonged waiting for germline genomic sequencing. These data are needed to ensure that when germline genomic sequencing is introduced into standard clinical settings, ethical concepts are embedded, and patients and their relatives are adequately prepared and supported during and after the testing process.
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Affiliation(s)
- Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse (C39Z), University of Sydney, Sydney, NSW, 2006, Australia. .,Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology (CeMPED - Psychology), University of Sydney, Sydney, NSW, 2006, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kathy Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, NSW, 2052, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Dominique Hess
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Barbara Biesecker
- National Human Genome Research, National Institutes of Health, 31 Center Drive, MSC 2073, Bethesda, MD, 20892, USA
| | - Richard Vines
- Rare Cancers, PO Box 440, Bowral, NSW, 2576, Australia
| | - Kate Vines
- Rare Cancers, PO Box 440, Bowral, NSW, 2576, Australia
| | - David Thomas
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Mary-Anne Young
- Genome One, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Jacqueline Savard
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Chris Jacobs
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse (C39Z), University of Sydney, Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology (CeMPED - Psychology), University of Sydney, Sydney, NSW, 2006, Australia
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Wong XY, Chong KJ, van Til JA, Wee HL. A qualitative study on Singaporean women's views towards breast cancer screening and Single Nucleotide Polymorphisms (SNPs) gene testing to guide personalised screening strategies. BMC Cancer 2017; 17:776. [PMID: 29162038 PMCID: PMC5697412 DOI: 10.1186/s12885-017-3781-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 11/13/2017] [Indexed: 12/17/2022] Open
Abstract
Background Breast cancer is the top cancer by incidence and mortality in Singaporean women. Mammography is by far its best screening tool, but current recommended age and interval may not yield the most benefit. Recent studies have demonstrated the potential of single nucleotide polymorphisms (SNPs) to improve discriminatory accuracy of breast cancer risk assessment models. This study was conducted to understand Singaporean women’s views towards breast cancer screening and SNPs gene testing to guide personalised screening strategies. Methods Focus group discussions were conducted among English-speaking women (n = 27) between 40 to 65 years old, both current and lapsed mammogram users. Women were divided into four groups based on age and mammogram usage. Discussions about breast cancer and screening experience, as well as perception and attitude towards SNPs gene testing were conducted by an experienced moderator. Women were also asked for factors that will influence their uptake of the test. Transcripts were analysed using thematic analysis to captured similarities and differences in views expressed. Results Barriers to repeat mammogram attendance include laziness to make appointment and painful and uncomfortable screening process. However, the underlying reason may be low perceived susceptibility to breast cancer. Facilitators to repeat mammogram attendance include ease of making appointment and timely reminders. Women were generally receptive towards SNPs gene testing, but required information on accuracy, cost, invasiveness, and side effects before they decide whether to go for it. Other factors include waiting time for results and frequency interval. On average, women gave a rating of 7.5 (range 5 to 10) when asked how likely they will go for the test. Conclusion Addressing concerns such as pain and discomfort during mammogram, providing timely reminders and debunking breast cancer myths can help to improve screening uptake. Women demonstrated a spectrum of responses towards a novel test like SNPs gene testing, but need more information to make an informed decision. Future public health education on predictive genetic testing should adequately address both benefits and risks. Findings from this study is used to inform a discrete choice experiment to empirically quantify women preferences and willingness-to-pay for SNPs gene testing. Electronic supplementary material The online version of this article (10.1186/s12885-017-3781-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xin Yi Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A Level 3, 18 Science Drive 4, Singapore, 117543, Republic of Singapore
| | - Kok Joon Chong
- Department of Planning and Development, Regional Health System Planning Office, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Janine A van Til
- Department of Health Technology & Services Research, School for Management & Governance, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Hwee Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A Level 3, 18 Science Drive 4, Singapore, 117543, Republic of Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Republic of Singapore.
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Abstract
One point of consensus in the otherwise very controversial discussion about the benefits and dangers of DTC genetics in the health domain is the lack of substantial clinical utility. At the same time, both the empirical and conceptual literature indicate that health-related DTC tests can have value and utility outside of the clinic. We argue that a broader and multi-faceted conceptualization of utility and value would enrich the ethical and social discussion of DTC testing in several ways: First, looking at ways in which DTC testing can have personal and social value for users – in the form of entertainment, learning, or a way to relate to others – can help to explain why people still take DTC tests, and will, further down the line, foster a more nuanced understanding of secondary and tertiary uses of DTC test results (which could very well unearth new ethical and regulatory challenges). Second, considering the economic value and broader utility of DTC testing foregrounds wider social and political aspects than have been dominant in the ethical and regulatory debates surrounding DTC genetics so far. These wider political aspects include the profound power asymmetries that characterize the collection and use of personal genetic data in many contexts.
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Affiliation(s)
- Mauro Turrini
- Centre for the Study of Techniques, Knowledge and Practices, University of Paris 1 "Panthéon Sorbonne", France
| | - Barbara Prainsack
- Department of Social Science, Health & Medicine, King's College London, United Kingdom
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Covolo L, Rubinelli S, Ceretti E, Gelatti U. Internet-Based Direct-to-Consumer Genetic Testing: A Systematic Review. J Med Internet Res 2015; 17:e279. [PMID: 26677835 PMCID: PMC4704942 DOI: 10.2196/jmir.4378] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 12/26/2022] Open
Abstract
Background Direct-to-consumer genetic tests (DTC-GT) are easily purchased through the Internet, independent of a physician referral or approval for testing, allowing the retrieval of genetic information outside the clinical context. There is a broad debate about the testing validity, their impact on individuals, and what people know and perceive about them. Objective The aim of this review was to collect evidence on DTC-GT from a comprehensive perspective that unravels the complexity of the phenomenon. Methods A systematic search was carried out through PubMed, Web of Knowledge, and Embase, in addition to Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist with the key term “Direct-to-consumer genetic test.” Results In the final sample, 118 articles were identified. Articles were summarized in five categories according to their focus on (1) knowledge of, attitude toward use of, and perception of DTC-GT (n=37), (2) the impact of genetic risk information on users (n=37), (3) the opinion of health professionals (n=20), (4) the content of websites selling DTC-GT (n=16), and (5) the scientific evidence and clinical utility of the tests (n=14). Most of the articles analyzed the attitude, knowledge, and perception of DTC-GT, highlighting an interest in using DTC-GT, along with the need for a health care professional to help interpret the results. The articles investigating the content analysis of the websites selling these tests are in agreement that the information provided by the companies about genetic testing is not completely comprehensive for the consumer. Given that risk information can modify consumers’ health behavior, there are surprisingly few studies carried out on actual consumers and they do not confirm the overall concerns on the possible impact of DTC-GT. Data from studies that investigate the quality of the tests offered confirm that they are not informative, have little predictive power, and do not measure genetic risk appropriately. Conclusions The impact of DTC-GT on consumers’ health perceptions and behaviors is an emerging concern. However, negative effects on consumers or health benefits have yet to be observed. Nevertheless, since the online market of DTC-GT is expected to grow, it is important to remain aware of a possible impact.
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Affiliation(s)
- Loredana Covolo
- Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy, Brescia, Italy.
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