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Mamudu HM, Nwabueze CA, Yang JS, Mackey TK, Ahuja M, Smith A, Weierbach FM, McNabb M, Minnick C, Jones A. Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community. Prev Med Rep 2022; 29:101953. [PMID: 36161107 PMCID: PMC9501989 DOI: 10.1016/j.pmedr.2022.101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022] Open
Abstract
Social media use to discuss ENDS among youth in distressed areas is understudied. Nearly 1 in 3 and 1 in 8 of youth were ever and current ENDS users, respectively. Nearly 1 in 5 of the youth reported using social media to talk about ENDS. Social media increased current and ever ENDS use by 4 and 3 times, respectively. Social media engagement may lead to ENDS uptake among youth in distressed areas.
Electronic nicotine delivery systems (ENDS) are the most used tobacco products among middle and high schoolers in the United States (U.S.). Familial relations and access play a major role in uptake among adolescents; yet the role of social media in this phenomenon in the context of communities impacted by tobacco-related health disparities is understudied. In Spring 2019, data were collected from adolescents in 8th and 9th grades in a school located in a rural distressed county in Tennessee to assess social media’s role in ENDS uptake. Descriptive and multivariable statistical analyses were performed to delineate factors associated with ENDS use. Of a total of 399 respondents, 12.5 % reported current ENDS use and 22.1 % indicated having ever discussed ENDS on social media. Closed messaging platforms (Snapchat) and video platforms (Facebook/Instagram/You Tube) were the most reported form of social media used (8.31 % and 8.31 % respectively). Social media use was positively associated with both ever ENDS use (odds ratio [OR] = 2.9) and current ENDS use (OR = 3.98). Parental advice against ENDS use was positively associated with ever ENDS use. In conclusion, social media use was positively associated with both ever and current ENDS use, and Snapchat was the most popular platform among this population of students. The results indicate that youth social media engagement may lead to exposure that can influence ENDS uptake. Future studies are needed to further examine these associations among distressed communities.
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Affiliation(s)
- H M Mamudu
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - C A Nwabueze
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
| | - J S Yang
- Department of Public Health, California State University, Fullerton, KHS 161 A, 800 N. State College Blvd, Fullerton, CA, 92831, USA
| | - T K Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
| | - M Ahuja
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - A Smith
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - F M Weierbach
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Nursing, East Tennessee State University, Johnson City, TN, USA
| | - M McNabb
- Northeast Regional Office of Tennessee Department of Health, Johnson City, TN, USA
| | - C Minnick
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson, City, TN, USA
- College of Public Health, East Tennessee State University, Johnson, City, TN, USA
| | - A Jones
- Department of Sociology & Department of Epidemiology, Milken School Institute of Public Health, The George Washington University, Washington, DC, USA
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Cuomo RE, Mackey TK. Examining the association between international migration and colorectal cancer among multiple ancestry groups in the United States. Ethn Health 2022; 27:275-283. [PMID: 31679393 DOI: 10.1080/13557858.2019.1685652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/08/2019] [Indexed: 06/10/2023]
Abstract
Objectives: Prior research has not adequately examined the relationship between international migration and colorectal cancer (CRC) by cultural regions in the US. The purpose of this exploratory study was to determine how annual CRC incidence varied with US annual international migrant inflow in ten different regions, corresponding to dominant ancestry group.Design: County-level international migrant inflow and dominant ancestry type were obtained from the American Community Survey, and age-adjusted CRC incidence was obtained from the National Cancer Institute. A linear regression model was tested for each ancestry region to assess the relationship between migrant inflow and CRC incidence.Results: Higher international migrant inflow was associated with lower CRC incidence among counties where the dominant ancestry group was African American (p = 0.0207), British (p = 0.0212), Hispanic (p = 0.0001), and Native American (p = 0.0056).Conclusions: These findings suggest that US residents in certain ancestry groups are at higher risk for CRC.
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Affiliation(s)
| | - T K Mackey
- Global Health Policy Institute, San Diego, CA, USA
- Department of Anesthesiology, School of Medicine, University of California, San Diego, San Diego, CA, USA
- Division of Global Public Health, School of Medicine, University of California, San Diego, San Diego, CA, USA
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Purushothaman VL, Cuomo RE, Garland CF, Mackey TK. Could age increase the strength of inverse association between ultraviolet B exposure and colorectal cancer? BMC Public Health 2021; 21:1238. [PMID: 34218809 PMCID: PMC8256562 DOI: 10.1186/s12889-021-11089-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/18/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vitamin D has been identified as a potential protective factor in the development of colorectal cancer (CRC). We expect to see a stronger association of ultraviolet B (UVB) exposure and CRC crude rates with increasing age since chronic vitamin D deficiency leads to sustained molecular changes that increase cancer risk. The DINOMIT (disjunction, initiation, natural selection, overgrowth, metastasis, involution, and transition) model postulates various stages of cancer development due to vitamin D deficiency and the associated latency period. The purpose of this study is to examine this age-dependent inverse relationship globally. METHODS In this ecological study, a series of linear and polynomial regression tests were performed between country-specific UVB estimates adjusted for cloud cover and crude incidence rates of CRC for different age groups. Multiple linear regression was used to investigate the association between crude incidence rates of colorectal cancer and UVB estimate adjusting for urbanization, skin pigmentation, smoking, animal consumption, per capita GDP, and life expectancy. Statistical analysis was followed by geospatial visualization by producing choropleth maps. RESULTS The inverse relationship between UVB exposure and CRC crude rates was stronger in older age groups at the country level. Quadratic curve fitting was preferred, and these models were statistically significant for all age groups. The inverse association between crude incidence rates of CRC and UVB exposure was statistically significant for age groups above 45 years, after controlling for covariates. CONCLUSION The age-dependent inverse association between UVB exposure and incidence of colorectal cancer exhibits a greater effect size among older age groups in global analyses. Studying the effect of chronic vitamin D deficiency on colorectal cancer etiology will help in understanding the necessity for population-wide screening programs for vitamin D deficiency, especially in regions with inadequate UVB exposure. Further studies are required to assess the need for adequate public health programs such as selective supplementation and food fortification.
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Affiliation(s)
- Vidya Lakshmi Purushothaman
- Department of Anesthesiology, University of California, San Diego, USA
- Global Health Policy Institute, San Diego, USA
| | - Raphael E Cuomo
- Department of Anesthesiology, University of California, San Diego, USA
- Global Health Policy Institute, San Diego, USA
- Division of Extended Studies, University of California, San Diego, USA
| | - Cedric F Garland
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Timothy K Mackey
- Department of Anesthesiology, University of California, San Diego, USA.
- Global Health Policy Institute, San Diego, USA.
- Division of Extended Studies, University of California, San Diego, USA.
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Nali MC, Purushothaman V, Xu Q, Cuomo RE, Mackey TK. Characterizing and assessing compliance of online vendors to the state of Massachusetts ENDS product sales ban. Tob Induc Dis 2021; 19:05. [PMID: 33488322 PMCID: PMC7816198 DOI: 10.18332/tid/131199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Recent reports of lung injury associated with Electronic Nicotine Delivery System (ENDS) products precipitated by increasing vaping prevalence and interest in flavors among adolescents has led to policies that restrict the sale, distribution, and accessibility of ENDS products. This study assessed compliance of online ENDS vendors to the Massachusetts temporary sales ban. METHODS The study involved structured web surveillance for online ENDS vendors using keyword searches on Google search engine (October to November 2019.) Once vendors were identified, we conducted simulated online purchases, defined as placing an order for an ENDS product by putting it in the website shopping cart without finalizing payment. Simulated purchases and content analysis of websites was conducted to determine compliance characteristics. Fisher’s exact test was used to identify associations between compliance and website characteristics such as location and age verification requirements. RESULTS Simulated online purchases from 50 identified ENDS vendors yielded 72% (n=36) stores that were non-compliant and allowed placement of ENDS product orders, without restrictions, to a Massachusetts address. The remaining 14 websites had processes in place to prevent orders from buyers located in Massachusetts. Other characteristics of interest, including use of age verification, location data, and web registrar/registrant data were collected and reported. CONCLUSIONS The September 2019 Massachusetts executive order was a comprehensive ban on selling ENDS products both online and offline. However, our study found that close to three-fourths of the vendors appeared to be non-compliant, indicating that implementation and enforcement are ongoing challenges for future tobacco control efforts on the internet. Policymaking needs to be specifically tailored to address the unique challenges of online environments, particularly in the context of identifying non-compliant sites, ensuring age verification, and addressing non-US sellers.
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Affiliation(s)
- Matthew C Nali
- Global Health Policy Institute, San Diego, United States.,Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, United States
| | - Vidya Purushothaman
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, United States.,Master's Program in Public Health, University of California San Diego School of Medicine, San Diego, United States
| | - Qing Xu
- Global Health Policy Institute, San Diego, United States.,Department of Healthcare Research and Policy, University of California San Diego - Extension, San Diego, United States
| | - Raphael E Cuomo
- Global Health Policy Institute, San Diego, United States.,Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, United States.,Department of Healthcare Research and Policy, University of California San Diego - Extension, San Diego, United States
| | - Timothy K Mackey
- Global Health Policy Institute, San Diego, United States.,Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, United States.,Department of Healthcare Research and Policy, University of California San Diego - Extension, San Diego, United States.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, United States
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Cuomo RE, Purushothaman V, Li J, Cai M, Mackey TK. Sub-national longitudinal and geospatial analysis of COVID-19 tweets. PLoS One 2020; 15:e0241330. [PMID: 33112922 PMCID: PMC7592735 DOI: 10.1371/journal.pone.0241330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives According to current reporting, the number of active coronavirus disease 2019 (COVID-19) infections is not evenly distributed, both spatially and temporally. Reported COVID-19 infections may not have properly conveyed the full extent of attention to the pandemic. Furthermore, infection metrics are unlikely to illustrate the full scope of negative consequences of the pandemic and its associated risk to communities. Methods In an effort to better understand the impacts of COVID-19, we concurrently assessed the geospatial and longitudinal distributions of Twitter messages about COVID-19 which were posted between March 3rd and April 13th and compared these results with the number of confirmed cases reported for sub-national levels of the United States. Geospatial hot spot analysis was also conducted to detect geographic areas that might be at elevated risk of spread based on both volume of tweets and number of reported cases. Results Statistically significant aberrations of high numbers of tweets were detected in approximately one-third of US states, most of which had relatively high proportions of rural inhabitants. Geospatial trends toward becoming hotspots for tweets related to COVID-19 were observed for specific rural states in the United States. Discussion Population-adjusted results indicate that rural areas in the U.S. may not have engaged with the COVID-19 topic until later stages of an outbreak. Future studies should explore how this dynamic can inform future outbreak communication and health promotion.
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Affiliation(s)
- Raphael E. Cuomo
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, California, United States of America
- Global Health Policy Institute, San Diego, California, United States of America
- * E-mail:
| | - Vidya Purushothaman
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, California, United States of America
- Global Health Policy Institute, San Diego, California, United States of America
- Masters Program in Public Health, Department of Family Medicine and Public Health, University of California, San Diego, California, United States of America
| | - Jiawei Li
- Global Health Policy Institute, San Diego, California, United States of America
- Department of Healthcare Research and Policy, University of California, San Diego, California, United States of America
| | - Mingxiang Cai
- Department of Healthcare Research and Policy, University of California, San Diego, California, United States of America
| | - Timothy K. Mackey
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, California, United States of America
- Global Health Policy Institute, San Diego, California, United States of America
- Department of Healthcare Research and Policy, University of California, San Diego, California, United States of America
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Yang JS, Mamudu HM, Mackey TK. Governing Noncommunicable Diseases Through Political Rationality and Technologies of Government: A Discourse Analysis. Int J Environ Res Public Health 2020; 17:ijerph17124413. [PMID: 32575474 PMCID: PMC7345866 DOI: 10.3390/ijerph17124413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Abstract
In the last two decades, global action to address noncommunicable diseases (NCDs) has accelerated, but policy adoption and implementation at the national level has been inadequate. This analysis examines the role of rationalities of governing, or governmentality, in national-level adoption of global recommendations. Critical discourse analysis was conducted using 49 formal institutional and organizational documents obtained through snowball sampling methodology. Text were coded using a framework of five forms of governmentality and analyzed to describe the order of discourse which has emerged within the global NCD policy domain. The dominant political rationality used to frame NCDs is rooted in risk governmentality. Recommendations for tobacco control and prevention of harmful alcohol use rely on a governmentality of police mixed with discipline. The promotion of physical activity relies heavily on disciplinary governmentality, and the prevention of unhealthy diet mixed disciplinary measures, discipline, and neoliberal governmentalities. To translate global NCD prevention and control strategies to national action, acceptability for the political rationalities embodied in policy options must be nurtured as new norms, procedures, and institutions appropriate to the political rationalities of specific interventions are developed.
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Affiliation(s)
- Joshua S. Yang
- Department of Public Health, California State University, Fullerton, KHS 161 A, 800 N. State College Blvd, Fullerton, CA 92831, USA
- Correspondence:
| | - Hadii M. Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA;
| | - Timothy K. Mackey
- Department of Anesthesiology and Division of Global Public Health, San Diego School of Medicine, University of California, San Diego, CA 92037, USA;
- Global Health Policy Institute, San Diego, CA 92130, USA
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Liang BA, Mackey TK, Lovett KM. Reply to Stanback et al.'s “Suspect Online Sellers and Contraceptive Access”. Contraception 2013; 88:583. [DOI: 10.1016/j.contraception.2013.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/30/2013] [Indexed: 11/16/2022]
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Abstract
OBJECTIVES Unsupervised online direct-to-consumer (DTC) access to medical services has rapidly expanded to medical screening tests, which have not been critically evaluated for their evidence basis. The objective of this study is to identify the scope of online-advertised DTC screening tests, outline the evidence for use of available DTC testing and suggest regulatory reform to address the relevant issues. METHODS An observational study of website advertisements, testing services and counselling/follow-up services for DTC testing was conducted. Data were collected from websites between 4 April and 1 June 2011. Each website was assessed for tests offered, advertised indications and availability of counselling/follow-up services. Advertised testing indications were compared with US Preventive Services Task Force recommendations and/or specialty guidelines and categorized as Supported, Against, Insufficient Evidence or No Guidance. RESULTS Of 20 companies identified as offering DTC screening tests, 95% (19/20) do not clearly offer pretest counselling, post-test counselling and/or test follow-up. One hundred and twenty-seven different tests were identified. Only 19/127 (15%) could be Supported for screening in a target group selected for testing; 38/127 (30%) were given recommendations to avoid use in specific target group(s) selected for testing ('Against recommendations'); 29/127 (23%) had Insufficient Evidence of value, and for 64/127 (50%) No Guidance could be given. Only 4/127 (3%) tests were Supported for general screening use. CONCLUSIONS Virtually all identified medical tests advertised and offered DTC are not recommended for use in screening by evidence-based guidelines. Limited oversight may lead to inaccurate self-diagnosis, treatment and wasted health resources.
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Affiliation(s)
- Kimberly M Lovett
- Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.
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Abstract
The online, direct-to-consumer (DTC) medical marketplace is proliferating more rapidly than regulation is evolving to ensure proper patient safety and public health controls. Along with this growing body of unrestrained medical testing and pharmaceuticals offered DTC online, most types of insulin and insulin administration products may now be purchased without prescriptions or physician guidance. Given the relatively significant risks of insulin use, the abuse potential, the high prevalence of diabetes mellitus, and the rising population of uninsured and underinsured, it is imperative to reform the online DTC medical marketplace to ensure that patient safety and public health are protected.
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Mackey TK, Liang BA, Lovett KM. Waking Up to the Risks of Online Direct-to-Consumer Advertising of Sleep Apnea Screening Tests. J Clin Sleep Med 2012; 8:5-6. [DOI: 10.5664/jcsm.1644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Timothy K. Mackey
- Institute of Health Law Studies, California Western School of Law
- Joint Doctoral Program in Global Health, University of California, San Diego-San Diego State University
| | - Bryan A. Liang
- Institute of Health Law Studies, California Western School of Law
- San Diego Center for Patient Safety, University of California, San Diego School of Medicine
- Department of Anesthesiology, University of California, San Diego School of Medicine
| | - Kimberly M. Lovett
- Institute of Health Law Studies, California Western School of Law
- San Diego Center for Patient Safety, University of California, San Diego School of Medicine
- Kaiser Permanente
- Department of Family and Preventive Medicine, University of California, San Diego School of Medicine
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Liang BA, Mackey TK. Prevalence and Global Health implications of social media in direct-to-consumer drug advertising. J Med Internet Res 2011; 13:e64. [PMID: 21880574 PMCID: PMC3222189 DOI: 10.2196/jmir.1775] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/09/2011] [Accepted: 05/09/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Direct-to-consumer advertising (DTCA), linked to inappropriate medication use and higher health care expenditures, is the fastest growing form of pharmaceutical marketing. DTCA is legal only in the United States and New Zealand. However, the advent of online interactive social media "Web 2.0" technologies-that is, eDTCA 2.0-may circumvent DTCA legal proscriptions. OBJECTIVE The purpose of this study was to assess the prevalence of DTCA of leading pharmaceutical company presence and drug product marketing in online interactive social media technologies (eDTCA 2.0). METHODS We conducted a descriptive study of the prevalence of eDTCA 2.0 marketing in the top 10 global pharmaceutical corporations and 10 highest grossing drugs of 2009. RESULTS All pharmaceutical companies reviewed (10/10, 100%) have a presence in eDTCA 2.0 on Facebook, Twitter/Friendster, sponsored blogs, and really simple syndication (RSS) feeds. In addition, 80% (8/10) have dedicated YouTube channels, and 80% (8/10) developed health care communication-related mobile applications. For reviewed drugs, 90% (9/10) have dedicated websites, 70% (7/10) have dedicated Facebook pages, 90% (9/10) have health communications-related Twitter and Friendster traffic, and 80% (8/10) have DTCA television advertisements on YouTube. We also found 90% (9/10) of these drugs had a non-corporate eDTCA 2.0 marketing presence by illegal online drug sellers. CONCLUSION Pharmaceutical companies use eDTCA 2.0 to market themselves and their top-selling drugs. eDTCA 2.0 is also used by illicit online drug sellers. Regulators worldwide must take into account the current eDTCA 2.0 presence when attempting to reach policy and safety goals.
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Affiliation(s)
- Bryan A Liang
- Department of Anesthesiology, San Diego Center for Patient Safety, San Diego School of Medicine, University of California, San Diego, CA, USA
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Affiliation(s)
- Timothy K Mackey
- Institute of Health Law Studies, California Western School of Law, USA
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