Nagappan Ashwini, Kalokairinou Louiza, Wexler Anna
Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California, United States of America.
Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
PLOS Digit Health. 2024 Feb 13;3(2):e0000452. doi: 10.1371/journal.pdig.0000452. eCollection 2024 Feb.
An increasing number of health products and services are being offered on a direct-to-consumer (DTC) basis. To date, however, scholarship on DTC healthcare products and services has largely proceeded in a domain-specific fashion, with discussions of relevant ethical challenges occurring within specific medical specialties. The present study therefore aimed to provide a scoping review of ethical issues raised in the academic literature across types of DTC healthcare products and services. A systematic search for relevant publications between 2011-2021 was conducted on PubMed and Google Scholar using iteratively developed search terms. The final sample included 86 publications that discussed ethical issues related to DTC healthcare products and services. All publications were coded for ethical issues mentioned, primary DTC product or service discussed, type of study, year of publication, and geographical context. We found that the types of DTC healthcare products and services mentioned in our sample spanned six categories: neurotechnology (34%), testing (20%), in-person services (17%), digital health tools (14%), telemedicine (13%), and physical interventions (2%). Ethical arguments in favor of DTC healthcare included improved access (e.g., financial, geographical; 31%), increased autonomy (29%), and enhanced convenience (16%). Commonly raised ethical concerns included insufficient regulation (72%), questionable efficacy and quality (70%), safety and physical harms (66%), misleading advertising claims (56%), and privacy (34%). Other frequently occurring ethical concerns pertained to financial costs, targeting vulnerable groups, informed consent, and potential burdens on healthcare providers, the healthcare system, and society. Our findings offer insights into the cross-cutting ethical issues associated with DTC healthcare and underscore the need for increased interdisciplinary communication to address the challenges they raise.
越来越多的健康产品和服务以直接面向消费者（DTC）的方式提供。然而，迄今为止，关于DTC医疗保健产品和服务的学术研究主要是以特定领域的方式进行的，相关伦理挑战的讨论发生在特定的医学专业领域内。因此，本研究旨在对各类DTC医疗保健产品和服务的学术文献中提出的伦理问题进行范围界定审查。使用迭代开发的搜索词在PubMed和谷歌学术上对2011年至2021年期间的相关出版物进行了系统搜索。最终样本包括86篇讨论与DTC医疗保健产品和服务相关伦理问题的出版物。所有出版物都按照提及的伦理问题、讨论的主要DTC产品或服务、研究类型、出版年份和地理背景进行了编码。我们发现，样本中提到的DTC医疗保健产品和服务类型涵盖六个类别：神经技术（34%）、检测（2%）、面对面服务（17%）、数字健康工具（14%）、远程医疗（13%）和物理干预（2%）。支持DTC医疗保健的伦理观点包括改善可及性（如经济、地理方面；31%）、增强自主性（29%）和提高便利性（16%）。常见的伦理担忧包括监管不足（72%）、疗效和质量存疑（70%）、安全和身体伤害（66%）、误导性广告宣传（56%）以及隐私问题（34%）。其他经常出现的伦理担忧涉及经济成本、针对弱势群体、知情同意以及对医疗服务提供者、医疗系统和社会的潜在负担。我们的研究结果为与DTC医疗保健相关的跨领域伦理问题提供了见解，并强调需要加强跨学科交流以应对它们所带来的挑战。
