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Shih P, Sandberg S, Balla J, Basok BI, Brady JJ, Croal B, De Vos N, Karlsson M, Kedars P, Ozben T, Pijanovic M, Plebani M, Orth M. Direct-to-consumer testing as consumer initiated testing: compromises to the testing process and opportunities for quality improvement. Clin Chem Lab Med 2024; 0:cclm-2024-0876. [PMID: 39141796 DOI: 10.1515/cclm-2024-0876] [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: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024]
Abstract
Direct-to-consumer testing (DTCT) refers to commercial laboratory tests initiated by laypersons without the involvement of healthcare professionals. As this market grows in size and variety of products, a clear definition of DTCT to ground the conceptualization of their harms and benefits is needed. We describe how three different modalities of DTCT (home self-testing, self-sampled tests, and direct access tests) present caveats to the traditional testing process ('brain-to-brain loop'), and how this might differ between medical vs. non-medical laboratories. We make recommendations for ways to improve quality and reduce errors with respect to DTCT. The potential benefits and harms of DTCT will invariably depend on the context and situation of individual consumers and the types of tests involved. Importantly, implications for both consumers and the healthcare system should be considered, such as the effects on improving health outcomes and reducing unnecessary testing and use of clinical resources. 'Consumer initiation' must be a central defining characteristic of DTCT, to clearly demarcate the key drawbacks as well as opportunities of this type of testing from a laboratory specialists' perspective. The concept of 'consumer initiated testing' should also help define DTCT regulation, and provide a locus of efforts to support consumers as the main decision-makers in the purchasing and conducting of these tests in the absence of clinician gatekeeping.
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Affiliation(s)
- Patti Shih
- Australian Centre for Health Engagement Evidence and Values, School of Health & Society, 8691 University of Wollongong , Wollongong, Australia
| | - Sverre Sandberg
- Noklus, Bergen, Norway
- Department of Public Global Health and Primary Care, University of Bergen, Bergen, Norway
- Noklus, The Norwegian Organization for Quality Improvement of Laboratory Examinations, Haraldsplass Diakonale Sykehus AS, Bergen, Norway
- Department of Public Global Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Jan Balla
- Klinicka biochemia a imunochemia, Analyticko-diagnosticke laboratorium, Kovacska, Presov, Slovakia
| | - Banu Isbilen Basok
- Faculty of Medicine, University of Health Sciences Izmir, Izmir, Türkiye
| | - Jennifer J Brady
- Department of Clinical Biochemistry, Children's Health Ireland at Temple St, Dublin 1, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Bernard Croal
- Aberdeen Royal Infirmary, NHS Grampian-Clinical Biochemistry, Aberdeen, Aberdeen, UK
| | - Nathalie De Vos
- LHUB-ULB Clinical Chemistry, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mathias Karlsson
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Piret Kedars
- Central Laboratory, East Tallinn Central Hospital, Tallinn, Harjumaa, Estonia
| | - Tomris Ozben
- Department of Clinical Biochemistry, Medical Faculty, Akdeniz University, Antalya, Türkiye
- Faculty of Medicine and Surgery, Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Mario Plebani
- Dipartimento di Medicina di Laboratorio, Universita di Padova, Azienda Ospedaliera di Padova, Padova, Italy
| | - Matthias Orth
- Institut für Laboratoriumsmedizin, Vinzenz von Paul Kliniken gGmbH, Stuttgart, Baden-Württemberg, Germany
- Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany
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Shih P, Ding P, Carter SM, Stanaway F, Horvath AR, Langguth D, Saad M, St John A, Bell K. Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility. BMJ Open 2023; 13:e074205. [PMID: 38151277 PMCID: PMC10759116 DOI: 10.1136/bmjopen-2023-074205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES The objective of this study is to map the range and variety of direct-to-consumer (DTC) tests advertised online in Australia and analyse their potential clinical utility and implications for medical overuse. DESIGN Systematic online search of DTC test products in Google and Google Shopping. DTC test advertisements data were collected and analysed to develop a typology of potential clinical utility of the tests at population level, assessing their potential benefits and harms using available evidence, informed by concepts of medical overuse. RESULTS We identified 484 DTC tests (103 unique products), ranging from $A12.99 to $A1947 in cost (mean $A197.83; median $A148.50). Using our typology, we assigned the tests into one of four categories: tests with potential clinical utility (10.7%); tests with limited clinical utility (30.6%); non-evidence-based commercial 'health checks' (41.9%); and tests whose methods and/or target conditions are not recognised by the general medical community (16.7%). Of the products identified, 56% did not state that they offered pretest or post-test consultation, and 51% did not report analytical performance of the test or laboratory accreditation. CONCLUSIONS This first-in-Australia study shows most DTC tests sold online have low potential clinical utility, with healthy consumers constituting the main target market. Harms may be caused by overdiagnosis, high rates of false positives and treatment decisions led by non-evidence-based tests, as well as financial costs of unnecessary and inappropriate testing. Regulatory mechanisms should demand a higher standard of evidence of clinical utility and efficacy for DTC tests. Better transparency and reporting of health outcomes, and the development of decision-support resources for consumers are needed.
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Affiliation(s)
- Patti Shih
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline Ding
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stacy M Carter
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Fiona Stanaway
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrea R Horvath
- NSW Health Pathology, Sydney, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
| | - Daman Langguth
- Sullivan Nicolaides Pathology, Wesley Hospital, Brisbane, Queensland, Australia
| | - Mirette Saad
- Australian Clinical Labs, Victorian Central Laboratory Headquarters, Clayton, Victoria, Australia
| | | | - Katy Bell
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Filipoiu DC, Bungau SG, Endres L, Negru PA, Bungau AF, Pasca B, Radu AF, Tarce AG, Bogdan MA, Behl T, Nechifor AC, Hassan SSU, Tit DM. Characterization of the Toxicological Impact of Heavy Metals on Human Health in Conjunction with Modern Analytical Methods. TOXICS 2022; 10:toxics10120716. [PMID: 36548549 PMCID: PMC9785207 DOI: 10.3390/toxics10120716] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 05/13/2023]
Abstract
Increased environmental pollution, urbanization, and a wide variety of anthropogenic activities have led to the release of toxic pollutants into the environment, including heavy metals (HMs). It has been found that increasing concentrations of HMs lead to toxicity, mineral imbalances, and serious diseases, which are occurring more and more frequently. Therefore, testing has become imperative to detect these deficiencies in a timely manner. The detection of traces of HMs, especially toxic ones, in human tissues, various biological fluids, or hair is a complex, high-precision analysis that enables early diagnosis, addressing people under constant stress or exposed to a toxic environment; the test also targets people who have died in suspicious circumstances. Tissue mineral analysis (TMA) determines the concentration of toxic minerals/metals at the intracellular level and can therefore determine correlations between measured concentrations and imbalances in the body. Framing the already-published information on the topic, this review aimed to explore the toxicity of HMs to human health, the harmful effects of their accumulation, the advantages vs. the disadvantages of choosing different biological fluids/tissues/organs necessary for the quantitative measurement of HM in the human body, as well as the choice of the optimal method, correlated with the purpose of the analysis.
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Affiliation(s)
- Dana Claudia Filipoiu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073 Oradea, Romania
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073 Oradea, Romania
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
- Correspondence: (S.G.B.); (L.E.)
| | - Laura Endres
- Department of Psycho-neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
- Correspondence: (S.G.B.); (L.E.)
| | - Paul Andrei Negru
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073 Oradea, Romania
| | - Alexa Florina Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073 Oradea, Romania
| | - Bianca Pasca
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Andrei-Flavius Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073 Oradea, Romania
| | - Alexandra Georgiana Tarce
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Mihaela Alexandra Bogdan
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Tapan Behl
- Department of Pharmacology, School of Health Sciences & Technology (SoHST), University of Petroleum and Energy Studies, Bidholi 248007, India
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, 011061 Bucharest, Romania
| | - Syed Shams ul Hassan
- Shanghai Key Laboratory for Molecular Engineering of Chiral Drugs, School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Delia Mirela Tit
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073 Oradea, Romania
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
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Wong AWY, White HEG, Plant A, Shipman AR, Shipman KE. Issues surrounding consumer-bought food-allergy testing. Clin Exp Dermatol 2021; 47:547-552. [PMID: 34655248 DOI: 10.1111/ced.14978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergy is increasingly reported by patients and members of the public, and there is evidence that the prevalence is increasing. Not all diagnoses have been made by clinicians, as direct-to-consumer (DTC) allergy tests are widely available online. AIM To determine if DTC allergy tests are processed in accredited laboratories and utilize validated methods, while providing an overview of the DTC allergy tests available. METHODS Internet searches using 'allergy test kit' and 'intolerance test' were performed to identify DTC food-allergy tests. Each company was contacted to enquire if they had ISO15189 accreditation, what methods of testing they used and what was the extent of individual clinical input used to guide the test requested or result interpretation. RESULTS In total, 24 online companies providing DTC food-allergy testing were identified, of which 22 were contactable. One laboratory had ISO15189 accreditation, which was also the only laboratory using clinically recognized specific IgE testing and had a clinician involved in the process. Other laboratories used bioresonance or IgG and involved a nutritionist at most. CONCLUSION Online DTC food-allergy tests are largely misleading to the consumer and provided by unaccredited laboratories using controversial methodology. The dermatologist must politely discount these results and assess the role of food allergy in a patient's skin disease on the merit of clinical history, supported by specific IgE testing as appropriate.
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Affiliation(s)
- A W Y Wong
- Department of Dermatology, Portsmouth Hospital, Portsmouth, UK
| | - H E G White
- Department of Dermatology, Portsmouth Hospital, Portsmouth, UK
| | - A Plant
- Department of Dermatology, Portsmouth Hospital, Portsmouth, UK
| | - A R Shipman
- Department of Dermatology, Portsmouth Hospital, Portsmouth, UK
| | - K E Shipman
- Department of Clinical Biochemistry, Worthing Hospital, Worthing, UK
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Hoet P, Haufroid V, Lison D. Heavy metal chelation tests: the misleading and hazardous promise. Arch Toxicol 2020; 94:2893-2896. [DOI: 10.1007/s00204-020-02847-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
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