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Call to improve transparent communication in direct-to-consumer test marketing
  1. Emma Grundtvig Gram1,2,
  2. Helen Macdonald2,3,
  3. Barnett Kramer2,
  4. Steven Woloshin2,4
  5. on behalf of the Preventing Overdiagnosis Scientific Committee
    1. 1Centre and Research Unit for General Practice, University of Copenhagen Department of Public Health, Copenhagen, Denmark
    2. 2Lisa Schwartz Foundation for Truth in Medicine, Norwich, VT, Vermont, USA
    3. 3BMJ, London, UK
    4. 4Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth University, Lebanon, New Hampshire, USA
    1. Correspondence to Emma Grundtvig Gram, Centre and Research Unit for General Practice, University of Copenhagen Department of Public Health, Copenhagen, Denmark; emma.gram{at}

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    All tests ‘(…) do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.’ Muir Gray and Angela Raffle.1

    Medical tests are widely and increasingly marketed directly to consumers via traditional and social media.2 Such tests may diagnose disease, detect biochemical or hormonal imbalances, or characterise physiological states. Tests come in different forms including self-diagnosis questionnaires, home testing kits, blood tests, as well as tests consumers can request in healthcare settings with or without a doctor’s involvement. Examples include tests for vitamin deficiency, thyroid function, cancer, mental health conditions, and sexually transmitted infections. The complexity of these tests varies substantially. Some direct-to-consumer testing may involve a degree of clinical input, for example, a computed tomography (CT) performed for lung cancer screening while other tests can be performed with minimal to no involvement of clinicians, for example, Human Papilloma Virus (HPV) self-testing. The premise of such tests marketed directly to the public or consumers, is that they enhance individual autonomy and help people make better personal health decisions to improve their health or well-being. Tests performed in healthcare settings may have undergone more stringent validation than home tests; however, all direct-to-consumer tests inevitably lead to harm, and their benefits are often not documented in many such settings.

    To decide whether to use any tests directly marketed to them, …

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    • X @EmmaGrundtvig, @drhelmac

    • Collaborators Preventing Overdiagnosis Scientific Committee: Brooke Nickel, Carl Henegan, John Brodersen, Karsten Juhl Jørgensen, Kirsten McCaffery, Minna Johansson, Thomas Kühlein.

    • Contributors This piece was written by the four authors based on discussions within the Preventing Overdiagnosis Scientific Committeee. Committee members contributed intellectually to the manuscript revision. The four authors contributed equally to writing and editing this piece.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests All authors are members of the scientific steering committee of the Preventing Overdiagnosis conference for which BMJ is a media partner.

    • Provenance and peer review Not commissioned; internally peer reviewed.