Evidence map›Paper›PMID 38151277›Full record

ArticleBMJ open2023

Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility.

Patti Shih, Pauline Ding, Stacy M Carter, Fiona Stanaway, Andrea R Horvath, Daman Langguth, Mirette Saad, Andrew St John, Katy Bell

Abstract read
In one paragraph

Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Patti ShihSchool of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia pshih@uow.edu.au.ORCID 0000-0002-9628-7987
Pauline DingSchool of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia.
Stacy M CarterSchool of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia.
Fiona StanawaySchool of Public Health, University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0003-2104-3010
Andrea R HorvathNSW Health Pathology, Sydney, New South Wales, Australia.
Daman LangguthSullivan Nicolaides Pathology, Wesley Hospital, Brisbane, Queensland, Australia.
Mirette SaadAustralian Clinical Labs, Victorian Central Laboratory Headquarters, Clayton, Victoria, Australia.
Andrew St JohnDrajon Health, Toodyay, Western Australia, Australia.ORCID 0000-0001-7564-2823
Katy BellSchool of Public Health, University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-0137-3218

Funding

Medical Research Council
6 · The paper itself

Abstract

objectivesThe 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.

designSystematic 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.

resultsWe 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.

conclusionsThis 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.

Indexed as

AdvertisingGenetic TestingAustraliaHumansLaboratoriesReferral and Consultationdecision makinghealth services accessibilityhealth services administration & managementpathology

Identifiers

PMID38151277
PMCPMC10759116

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.