Consumer Counseling

Does finance competence replace or supplement finance consulting? Described in this document we analyse the consumer's choice of giving pecuniary counsel in the shape of loan counseling on their loan and debts. Loan advisory services are an important part of the consumer lending industry for those who face difficulties with their debts.

By combining different instruments, we take into consideration the endogenous nature of an individual's finances in relation to education and the endogenous nature of education in relation to loan advice. The results show that loan advice is a substitute for finance competence. People with a better general education in finance are 60% less inclined to seek advice on loans.

The results suggest that loan advice provides a safe net for bad finance skills.

consumer and prospective consumer surveys

Editor:Springer National Society of Genetic Counselors, Inc. Published by Impact of gene testing on consumer attitudes to healthcare and fear: a consumer and prospective consumer questionnaire. The Journal of Genetic Counseling, 22 (5), p. 565-575. A number of businesses argue that they pose relatively high risk genes for various illnesses and thus promote good behavior. There was an on-line poll (n?=n?).

Interviewees consisted of people who had bought a DTC gene test and obtained their results (consumers, n =n ) and people who were either waiting for test results or considering buying a test (potential users, n =n ). They were asked whether their dietary habits or fears had altered since the results were known.

Respondents' actual behavior and fears of illnesses were surveyed and benchmarked. Consumer had significantly better values for behavior in terms of healthcare than prospective users (p =p .02), with no significant differences in fear of healthcare. On the basis of a self-report, this research indicates a correlation between the preservation of DTC gene test results and the increasing acceptance of good behavior among a small percentage of users, with more mixed results in terms of fear of wellbeing.

Limits to regulation of Internet-based genetic testing: Lawsuits against Australia and other jurisdictions

DTC (Direct-to-Consumer) gene testing is any test for the presence of a medicinal or non-medical characteristic in a test that allows the test results to be interpreted or communicated directly to a consumer and not through a healthcare provider. The DTC gene test is often called over the web without a doctor's reference outside the healthcare system.

Sampling sets can be sent directly to the consumer without the need for a doctor to be involved. DTC Internet-based gene targeting varies in terms of pricing, grade and gene contents metered, from "leisure" screening (1) to the provision of information on illness risks (2). On-line DTC gene screening is becoming increasingly popular due to various consumer reasons, many of which are not necessarily medicinal in character (2, 3).

A number of damage potentials and impacts of poorly managed Internet-based DTC test are well reported (4-6) and summarised in Figure 1. Procedures and results for accelerated and non-accredited gene test paths. Online-DTC gene test are usually performed without the need for gene counseling or clinical supervision.

A number of DTC test result users are now turning to general physicians or hospital genetics to help interpret or manage DTC gene results, a new set of issues for the healthcare profession (6, 7). Much of the on-line DTC gene testing comes from the US, where the Food and Drug Administration (FDA) has current issues in sustaining regulation (8).

On-line DTC assays that originate in the U.S. and are approved by the FDA do not necessarily receive country-specific approvals in non-US states. Many of these, however, are still available and reachable from any given Member State via the web, largely circumventing compliance with domestic inspection requirements in non-US States. A number of on-line DTC assays, if marketed in non-US locations, would violate applicable gene test policies.

Yet accessing them directly through a hosted on-line product platform poses a challenge to non-US regulators in implementing compliance with applicable laws for Internet-based consumer goods. It is unclear how individual countries such as Australia, the UK and Europe should deal with the regulatory and qualitative aspects of Internet-based gene tests (9-12). Immediate accessibility and immediate type of accessibility present new challenge.

Despite being challenging, many of these are not necessarily one-of-a-kind in the area of gene screening and are reflected in other sectors of government that have recently been disturbed by the development of a worldwide on-line market place, such as the Internet market for ethical medicines (13). There is a stringent system of regulations under the present Australia scheme for the enrolment and supply of screening services for humans provided by Australia enterprises (14-17).

In addition, labs performing gene tests must be approved for engineering competence by the National Association of Testing Authorities 18. This standard prescribes mandatory QC for gene tests in Australia. Adherence to these requirements, however, makes it difficult and relatively costly for Australia to offer low-cost DTC test service offerings in comparison to off-shore DTCs.

This type of off-shore company can connect to Australia's consumer via the web but is not regulated in Australia. It may be difficult for a consumer to distinguish between a locally certified product and a non-accredited product sold off-shore and sold on-line. Central to this is the failure of public health agencies such as the Therapeutic Goods Administration (TGA) to control gene tests and advertisements on the Web, which raises a variety of issues of concern to regulators, healthcare professionals and ethics, as outlined below and summarised in Table 1.

Furthermore, Australia's legislation expressly allows consumer exposure to non-accredited transatlantic test through an exempting self-import [(14) Reg 7.1 and Annex 4]. Refers to non-accredited on-line direct-to-consumer (DTC) gene test. While strict norms exist for gene test services carried out in Australia, the regulatory authorities have no authority to prohibit or control foreign accessibility or service levels of Internet-based DTC gene test services.

Faced with the challenge of general public gender illiteracy (19, 20), many users may not be conscious of the importance of on-line gene testing. Thus, the consumer is susceptible to on-line commerce by foreign businesses, especially for some of the most dubious items that are generally rejected by the academic and medicinal communities (10, 21).

Indications are that users of internet-based gene testing are progressively consulting general medical staff or clinic based genetics service providers to interpret the results (22). There is a danger of this increasing the pressure on established community healthcare systems, which are often financed by public funds with scarce natural resource. Financing extra service to meet a rising inflow of DTC users may not be sustained in Australia and other similar countries (23), especially where the results may be equivocal, unsafe or bewildering and are often found in people who do not have a real elevated level of illness exposure.

There is also room for damage (24) and/or insufficient health provision for those who need it, because some Internet-based DTC firms return significant genetically relevant information of medicinal and biological significance, such as variations in the BRCA gene, without receiving gene counselling or health assistance. In addition, users may find it difficult to distinguish between mainstream local accelerated trials (which meet high QC standards) and less expensive on-line choices that are not covered by the same EQ.

There is a danger of confusing the consumer and of undermining the long-standing effort of grassroots genetics service providers (25). DTC gene test buyers are more likely to be driven by inquisitiveness, pedigree or leisure motives than by medicinal considerations. They may, however, reveal serious medicinal hazard determinants, non-paternity or other unanticipated gene information during the test procedure without first considering the effects (5, 26).

Furthermore, some on-line utilities can now be used to analyse crude gene expression information from non-medical DTC testing (e.g. lineage tests) and to interpret clinical risks. That means individual persons can now on-line retrieve health hazard information from crude genetics without the need for regulatory, qualitative, or regulatory supervision after a parentage test.

That opens up the possibility of misinterpretation and the provision of truly medicinally significant information without informed approval, gene counseling or supervision (27). Genetics service that perform clinic tests in Australia comply with internationals rules on the proofs needed to corroborate medicinal hazard information before it is made available to the consumer (28).

Models have also been designed for the assessment of gene testing (29), but on-line DTC operators can make available consumer health information without meeting these proofs ( 30 ). Educational approval for Internet-based DTC devices is not in line with established genetics practice as most DTC organizations currently do not offer pre- or post-test gene counseling or health care services (10).

Several DTC assays provide information on genetically determined risks for incurable diseases before symptoms begin, such as the APOEe4 Alzheimer' s Virus 4 hazard aurel ( 31 ). Even though some trials have shown that such results can be used by at-risk persons to make advance plans (3), the immediate delivery of this information without having recourse to gene counselling or health supervision is generally not common practise in clinic and is seen by many as not ethical (32).

Press releases contain details of stories from people who suddenly obtained information about the risks of Alzheimer's through DTC tests and were in need as a consequence (33). Growing numbers of users sharing information about genes with on-line businesses also raise concern about the protection of personal information. A number of recent research projects have shown that many DTC on-line businesses do not comply fully with global standards on the use and protection of personal information (34), and consumers' expectation of personal information protection and the use of their own genes may be incompatible with business practice (35).

A lot of DTC on-line businesses keep sample material for later use, research included, with potentially equivocal consumer information about the use and storing of sample material (36). In addition, it has been proposed that on-line DTCs sell to third party users or provide research specimens for research without the prior notice or agreement of the consumer who provided the information for accessing their database of hereditary information (34, 35).

Faced with the increasing interest in gene tests, it is unavoidable that the consumer will keep looking for Internet-based DTCs. Also, the absence of local accreditation and the costs of local accreditation in some jurisdictions, particularly those with public financed healthcare schemes, may fuel increased demands for inexpensive, Internet-based DTC gene tests (37).

At present, there is no multinational organisation charged with the regulation of the DTC on-line markets. While the Global Alliance for Genomics and Health (38) develops genomics exchange standard, it has no authority to regulate it. Given the small amount of government funds available for trials in most jurisdictions, coupled with the growing need for trials, many people who are not eligible for government sponsored trials under the present guidance can look for alternatives to obtain gene information directly at low costs.

It is likely that if government does not take measures to educate the consumer about the risks of some on-line DTC gene test product or offer alternate test paths, the consumer will continue to have difficulties differentiating between high value (locally accredited) and low value (non-accredited) on-line product. A lot of users can opt for low-cost, low-quality screening and are therefore susceptible to many of the health, ethics and private concern.

Consideration must in Future be given to the approach of government or governmental healthcare providers that offer accessibility to generic, population-wide generic screenings for illness prophylaxis. It would offer an alternate test path to non-regulated Internet-based DTC tests accessible through the residential area. Unless there is a state-financed screen, it is likely that Australia and other jurisdictions ll keep ensuring that customers are interested in inexpensive, Internet-based gene tests, especially if their genomics expertise stays low.

Promoting information to the general public about DTC gene screening, as well as publishing alerts in celebrity and widely accessible publications on the risk of non-accredited on-line DTC gene screening. Provide official support to all locally or internationally operating businesses whose gene test meets or exceeds applicable locally accredited standard through an easy to recognise branded symbol so that the consumer can readily recognise current and authorised use.

Modify the existing rules so as not to penalise the introduction of non-accredited genetically modified test products into the Community. Ban the use of web advertisements for non-accredited off-shore testing and cooperate with foreign regulatory authorities on policies to regulate the promotion of and accessibility to on-line testing. Implementation of binding guidance prescribing the use of detection standards for the interpreting of gene testing prior to the reporting of results to the consumer.

View a proof-of-concept trial to test the feasibility of developing a cost-effective, publically financed, population-genomic young adult screener programme associated with the healthcare system, backed by educational support and focusing on providing evidence-based, useful disease information to those seeking it. Implementing these suggestions would involve a significant resource assignment by the federal authorities, both in terms of regulating on-line testing and in terms of establishing a healthcare system able to perform public genome testing, as well as scale the provision of gene counselling and other healthcare facilities.

Uncertainties remain about the prospective landscapes of gene tests in jurisdictions with robust healthcare regimes, such as Australia. A lot of individual will still search for DTC tests through the on-line marketing space, regardless of whether it is for leisure activities such as parentage tests, which have restricted damage potentials. More complex aspects have to be taken into account for the provision of information on medicinal risks.

Prospects for a nationwide genome screen in Australia to help identifying exploitable risks in adult consent could be taken into consideration. It could potentially allow early detection of an avoidable illness hazard, which, when associated with healthcare systems, could allow for tighter and more appropriate clinical, academic and moral supervision of the maintenance of the genome test streaming.

An investigation policy for investigating human and animal diseases would guarantee that those who are really at stake are properly pinpointed and that appropriate generic gene therapy is provided when needed. According to this approach, only wellestablished, viable genetics, backed by a set of clinically validated standards and a set of standards of good healthcare for avoidable diseases, are revealed (i.e. most individual patients do not receive results). Thus, the analysis of the genome results and following medicinal hazard evaluations can be improved.

This effort can discourage non-accredited DTC test product searches on-line for DTC test product risks and promote appropriate human resources for those at real risk. At the same time, it can also help to reduce the risks of DTC test product use. Prospects for generating populations by means of transgenic screenings in the context of a publicly funded healthcare system would call for a significant strengthening of Australia's existing clinic gene service, far beyond its present level.

Action in this regard must be taken as the consumer movement towards DTC tests will increase in the years to come. At present, the combination of the use of the Web and an increased interest in the genomic sciences is leading to unparalleled opportunities for gene testers. Increasingly, this will create new regulatory issues for test and interpreting service regulation by countries.

At JT, we provide advice to gene testers. Regulations for remedies (medical devices). MoU (Memorandum of Understanding) zwischen dem Commonwealth of Australia und der National Association of Testing Authorities, Australia, Australien. ACCE: a modelling procedure for the evaluation of newly developed gene test datas. Scientific foundation for the use of gene information to improve health and prevent disease.

Direct-to-Consumer Trent R. Genetics and the GP. MacKie R. warnings about shocking dementia disclosures from lineage DNA checks.