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Eyal N. Research ethics and public trust in vaccines: the case of COVID-19 challenge trials. JOURNAL OF MEDICAL ETHICS 2024; 50:278-284. [PMID: 35595525 PMCID: PMC9157325 DOI: 10.1136/medethics-2021-108086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
Despite their clearly demonstrated safety and effectiveness, approved vaccines against COVID-19 are commonly mistrusted. Nations should find and implement effective ways to boost vaccine confidence. But the implications for ethical vaccine development are less straightforward than some have assumed. Opponents of COVID-19 vaccine challenge trials, in particular, made speculative or empirically implausible warnings on this matter, some of which, if applied consistently, would have ruled out most COVID-19 vaccine trials and many non-pharmaceutical responses.
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Affiliation(s)
- Nir Eyal
- Center for Population-Level Bioethics, Department of Philosophy (SAS) and Department of HBSP (SPH), Rutgers University, New Brunswick, New Jersey, USA
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Anderson EE. Balancing Protection and Inclusion by Including More Non-Scientist and Nonaffiliated Members on IRBs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:116-118. [PMID: 37220382 DOI: 10.1080/15265161.2023.2201215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Roberts LW, Kim JP, Rostami M, Kasun M, Kim B. Self-reported influences on willingness to receive COVID-19 vaccines among physically ill, mentally ill, and healthy individuals. J Psychiatr Res 2022; 155:501-510. [PMID: 36191518 PMCID: PMC9491855 DOI: 10.1016/j.jpsychires.2022.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Individuals with mental and physical disorders have been disproportionately affected by adverse health outcomes due to the COVID-19 pandemic, and yet vaccine hesitancy persists despite clear evidence of health benefits. Therefore, our study explored factors influencing willingness to receive a COVID-19 vaccine. METHODS Individuals with mental illness (n = 332), physical illness (n = 331), and no health issues (n = 328) were recruited via Amazon Mechanical Turk. Participants rated willingness to obtain a fully approved COVID-19 vaccine or a vaccine approved only for experimental/emergency use and influences in six domains upon their views. We examined differences by health status. RESULTS Participants across groups were moderately willing to receive a COVID-19 vaccine. Perceived risk was negatively associated with willingness. Participants differentiated between vaccine risk by approval stage and were less willing to receive an experimental vaccine. Individuals with mental illness rated risk of both vaccines similarly to healthy individuals. Individuals with physical illness expressed less willingness to receive an experimental vaccine. Domain influences differently affected willingness by health status as well as by vaccine approval status. CONCLUSIONS Our findings are reassuring regarding the ability of people with mental disorders to appreciate risk in medical decision-making and the ability of people of varied health backgrounds to distinguish between the benefits and risks of clinical care and research, refuting the prevailing notions of psychiatric exceptionalism and therapeutic misconception. Our findings shine a light on potential paths forward to support vaccine acceptance.
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Affiliation(s)
- Laura Weiss Roberts
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Palo Alto, CA, USA.
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Kim JP, Tsungmey T, Rostami M, Mondal S, Kasun M, Roberts LW. Factors Influencing Perceived Helpfulness and Participation in Innovative Research: A Pilot Study of Individuals with and without Mood Symptoms. ETHICS & BEHAVIOR 2022; 32:601-617. [PMID: 36200069 PMCID: PMC9528999 DOI: 10.1080/10508422.2021.1957678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Little is known about how individuals with and without mood disorders perceive the inherent risks and helpfulness of participating in innovative psychiatric research, or about the factors that influence their willingness to participate. We conducted an online survey with 80 individuals (self-reported mood disorder [n = 25], self-reported good health [n = 55]) recruited via MTurk. We assessed respondents' perceptions of risk and helpfulness in study vignettes associated with two innovative research projects (intravenous ketamine therapy and wearable devices), as well as their willingness to participate in these projects. Respondents with and without mood disorders perceived risk similarly across projects. Respondents with no mood disorders viewed both projects as more helpful to society than to research volunteers, while respondents with mood disorders viewed the projects as equally helpful to volunteers and society. Individuals with mood disorders perceived ketamine research, and the two projects on average, as more helpful to research volunteers than did individuals without mood disorders. Our findings add to a limited empirical literature on the perspectives of volunteers in innovative psychiatric research.
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Kim JP, Ryan K, Tsungmey T, Kasun M, Roberts WA, Dunn LB, Roberts LW. Perceived protectiveness of research safeguards and influences on willingness to participate in research: A novel MTurk pilot study. J Psychiatr Res 2021; 138:200-206. [PMID: 33865169 PMCID: PMC8513533 DOI: 10.1016/j.jpsychires.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/27/2022]
Abstract
Little is known about how individuals with mood disorders view the protectiveness of research safeguards, and whether their views affect their willingness to participate in psychiatric research. We conducted an online survey with 80 individuals (self-reported mood disorder [n = 25], self-reported good health [n = 55]) recruited via MTurk. We assessed respondents' perceptions of the protectiveness of five common research safeguards, as well as their willingness to participate in research that incorporates each safeguard. Perceived protectiveness was strongly related to willingness to participate in research for four of the safeguards. Our findings add to a limited literature on the motivations and perspectives of key stakeholders in psychiatric research.
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Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, 94304, USA.
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Tenzin Tsungmey
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Max Kasun
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Willa A. Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura B. Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
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Kim JP, Rostami M, Roberts LW. Attitudes of Mothers Regarding Willingness to Enroll Their Children in Research. J Empir Res Hum Res Ethics 2020; 15:452-464. [PMID: 32552481 DOI: 10.1177/1556264620927583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed mothers' perspectives regarding research involvement by their children, factors that might affect perceptions of research risks, and attitudes regarding willingness to enroll children in research. Participants completed a survey on Amazon Mechanical Turk. Mothers were less inclined to enroll children in research involving procedures posing higher risk (regression coefficient = -0.51). Mothers without mental health issues with children without health issues were more sensitive to risk than mothers without mental health issues with children with health issues (estimated difference = 0.49). Mothers with mental health issues were more willing than mothers without mental health issues to enroll children in research (regression coefficient = -0.90). Among mothers with mental health issues, having a child with a health issue was associated with increased willingness to enroll in research, compared with having children without health issues (estimated difference = 0.65).
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Affiliation(s)
- Jane Paik Kim
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maryam Rostami
- Stanford University School of Medicine, Palo Alto, CA, USA
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Sullivan K, Mtande T, Jaffe E, Rosenberg N, Zimba C, Hoffman I, Little M, Faden R, Lyerly AD. Views among Malawian women about joining HIV prevention clinical trials when pregnant. AIDS Res Ther 2020; 17:27. [PMID: 32460804 PMCID: PMC7251879 DOI: 10.1186/s12981-020-00271-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pressing need to expand the biomedical HIV prevention evidence base during pregnancy is now increasingly recognized. Women's views regarding participation in such trials and initiating PrEP while pregnant are critical to inform evolving policy and best practices aimed at responsibly expanding evidence-based access for this population. METHODS We conducted 35 semi-structured interviews with reproductive-aged women in Malawi in the local language, Chichewa. Participants were HIV-negative and purposively sampled to capture a range of experience with research during pregnancy. Women's perspectives on enrolling in three hypothetical HIV prevention trial vignettes while pregnant were explored, testing: (1) oral PrEP (Truvada) (2) a vaginal ring (dapivirine), and (3) a randomized trial comparing the two. The vignettes were read aloud to participants and a simple visual was provided. Interviews were audio-recorded, transcribed, translated, and coded using NVivo 11. Thematic analysis informed the analytic approach. RESULTS A majority of women accepted participation in all trials. Women's views on research participation varied largely based on their assessment of whether participation or nonparticipation would best protect their own health and that of their offspring. Women interested in participating described power dynamics with their partner as fueling their HIV exposure concerns and highlighted health benefits of participation-principally, HIV protection and access to testing/treatment and ancillary care, and perceived potential risks of the vignettes as low. Women who were uninterested in participating highlighted potential maternal and fetal health risks of the trial, challenges of justifying prevention use to their partner, and raised some modality-specific concerns. Women also described ways their social networks, sense of altruism and adherence requirements would influence participation decisions. CONCLUSIONS The majority of participants conveyed strong interest in participating in biomedical HIV prevention research during pregnancy, largely motivated by a desire to protect themselves and their offspring. Our results are consistent with other studies that found high acceptance of HIV prevention products during pregnancy, and support the current direction of HIV research policies and practices that are increasingly aimed at protecting the health of pregnant women and their offspring through responsible research, rather than defaulting to their exclusion.
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Affiliation(s)
- Kristen Sullivan
- Center for Bioethics and Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Campus Box 7240, Chapel Hill, NC, 27599, USA.
| | - Tiwonge Mtande
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Elana Jaffe
- Center for Bioethics and Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Campus Box 7240, Chapel Hill, NC, 27599, USA
| | - Nora Rosenberg
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Chifundo Zimba
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Irving Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Maggie Little
- The Kennedy Institute of Ethics, Georgetown University, 3700 O Street Northwest, Washington, DC, 20057, USA
| | - Ruth Faden
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Anne Drapkin Lyerly
- Center for Bioethics and Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Campus Box 7240, Chapel Hill, NC, 27599, USA
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Tsungmey T, Kim JP, Dunn LB, Ryan K, Lane-McKinley K, Roberts LW. Negative association of perceived risk and willingness to participate in innovative psychiatric research protocols. J Psychiatr Res 2020; 122:9-16. [PMID: 31891880 PMCID: PMC7243412 DOI: 10.1016/j.jpsychires.2019.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
Psychiatric researchers grapple with concerns that individuals with mental illness may be less likely to appreciate risks of research participation, particularly compared to people not suffering from mental illness. Therefore, empirical studies that directly compare the perspectives of such individuals are needed. In addition, it is important to evaluate perspectives regarding varied types of research protocols, particularly as innovative psychiatric research protocols emerge. In this pilot study, respondents with a mood disorder (n = 25) as well as respondents without a mood disorder (n = 55) were recruited using Amazon's Mechanical Turk (MTurk) platform. These respondents were surveyed regarding four psychiatric research projects (i.e., experimental medication [pill form]; non-invasive magnetic brain stimulation; experimental medication [intravenous infusion]; and implantation of a device in the brain). Regardless of health status, respondents rated the four research protocols as somewhat to highly risky. The brain-device implant protocol was seen as the most risky, while the magnetic brain stimulation project was viewed as "somewhat risky". Respondents, on average and regardless of health status, rated their willingness at or below "somewhat willing." Respondents were least willing to participate in the brain-device implant protocol, whereas they were "somewhat willing" to participate in the magnetic brain stimulation protocol. Trust in medical research was negatively associated with perceived risk of research protocols. Perceived risk was negatively associated with willingness to participate, even when adjusting for potential confounders, suggesting that attunement to risk crosses diagnostic, gender, and ethnic categories, and is more salient to research decision-making than trust in medical research and dispositional optimism. The findings of this study may offer reassurance about the underlying decision-making processes of individuals considering participation in innovative neuroscience studies.
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Affiliation(s)
- Tenzin Tsungmey
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717.
| | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Kyle Lane-McKinley
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
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Fisher JA, Monahan T, Walker RL. Picking and Choosing Among Phase I Trials : A Qualitative Examination of How Healthy Volunteers Understand Study Risks. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:535-549. [PMID: 31713712 PMCID: PMC6938537 DOI: 10.1007/s11673-019-09946-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
This article empirically examines how healthy volunteers evaluate and make sense of the risks of phase I clinical drug trials. This is an ethically important topic because healthy volunteers are exposed to risk but can gain no medical benefit from their trial participation. Based on in-depth qualitative interviews with 178 healthy volunteers enrolled in various clinical trials, we found that participants focus on myriad characteristics of clinical trials when assessing risk and making enrolment decisions. These factors include the short-term and long-term effects; required medical procedures; the type of trial, including its design, therapeutic area of investigation, and dosage of the drug; the amount of compensation; and trust in the research clinic. In making determinations about the study risks, participants rely on information provided during the consent process, their own and others' experiences in clinical trials, and comparisons among studies. Our findings indicate that the informed consent process succeeds in communicating well about certain types of risk information while simultaneously creating lacunae that are problematically filled by participants through their collective experiences and assumptions about risk. We discuss the ethical implications of these findings and make recommendations for improving the consent process in healthy volunteer trials.
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Affiliation(s)
- Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, CB 7240, Chapel Hill, NC 27599-7240 USA
| | - Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, CB 3285, Chapel Hill, NC 27599-3285 USA
| | - Rebecca L. Walker
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, CB 7240, Chapel Hill, NC 27599-7240 USA
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Fisher JA, McManus L, Wood MM, Cottingham MD, Kalbaugh JM, Monahan T, Walker RL. Healthy Volunteers' Perceptions of the Benefits of Their Participation in Phase I Clinical Trials. J Empir Res Hum Res Ethics 2018; 13:494-510. [PMID: 30296882 PMCID: PMC6235676 DOI: 10.1177/1556264618804962] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Other than the financial motivations for enrolling in Phase I trials, research on how healthy volunteers perceive the benefits of their trial participation is scant. Using qualitative interviews conducted with 178 U.S. healthy volunteers enrolled in Phase I trials, we investigated how participants described the benefits of their study involvement, including, but not limited to, the financial compensation, and we analyzed how these perceptions varied based on participants' sociodemographic characteristics and clinical trial history. We found that participants detailed economic, societal, and noneconomic personal benefits. We also found differences in participants' perceived benefits based on gender, age, ethnicity, educational attainment, employment status, and number of clinical trials completed. Our study indicates that many healthy volunteers believe they gain more than just the financial compensation when they accept the risks of Phase I participation.
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Affiliation(s)
| | - Lisa McManus
- University of North Carolina at Chapel Hill (USA)
- North Carolina State University (USA)
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Fisher JA, McManus L, Cottingham MD, Kalbaugh JM, Wood MM, Monahan T, Walker RL. Healthy volunteers' perceptions of risk in US Phase I clinical trials: A mixed-methods study. PLoS Med 2018; 15:e1002698. [PMID: 30457992 PMCID: PMC6245523 DOI: 10.1371/journal.pmed.1002698] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/22/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is limited research on healthy volunteers' perceptions of the risks of Phase I clinical trials. In order to contribute empirically to long-standing ethical concerns about healthy volunteers' involvement in drug development, it is crucial to assess how these participants understand trial risks. The objectives of this study were to investigate (1) participants' views of the overall risks of Phase I trials, (2) their views of the risk of personally being harmed in a trial, and (3) how risk perceptions vary across participants' clinical trial history and sociodemographic characteristics. METHODS AND FINDINGS We qualitatively and quantitatively analyzed semi-structured interviews conducted with 178 healthy volunteers who had participated in a diverse range of Phase I trials in the United States. Participants had collective experience in a reported 1,948 Phase I trials (mean = 10.9; median = 5), and they were interviewed as part of a longitudinal study of healthy volunteers' risk perceptions, their trial enrollment decisions, and their routine health behaviors. Participants' qualitative responses were coded, analyzed, and subsequently quantified in order to assess correlations between their risk perceptions and demographics, such as their race/ethnicity, gender, age, educational attainment, employment status, and household income. We found that healthy volunteers often viewed the overall risks of Phase I trials differently than their own personal risk of harm. The majority of our participants thought that Phase I trials were medium, high, or extremely high risk (118 of 178), but most nonetheless felt that they were personally safe from harm (97 of 178). We also found that healthy volunteers in their first year of clinical trial participation, racial and ethnic minority participants, and Hispanic participants tended to view the overall trial risks as high (respectively, Jonckheere-Terpstra, -2.433, p = 0.015; Fisher exact test, p = 0.016; Fisher exact test, p = 0.008), but these groups did not differ in regard to their perceptions of personal risk of harm (respectively, chi-squared, 3.578, p = 0.059; chi-squared, 0.845, p = 0.358; chi-squared, 1.667, p = 0.197). The main limitation of our study comes from quantitatively aggregating data from in-depth interviews, which required the research team to interpret participants' nonstandardized risk narratives. CONCLUSIONS Our study demonstrates that healthy volunteers are generally aware of and reflective about Phase I trial risks. The discrepancy in healthy volunteers' views of overall and personal risk sheds light on why healthy volunteers might continue to enroll in clinical trials, even when they view trials on the whole as risky.
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Affiliation(s)
- Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lisa McManus
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Sociology and Anthropology, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Marci D. Cottingham
- Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands
| | - Julianne M. Kalbaugh
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Megan M. Wood
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Rebecca L. Walker
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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