The Holston Journal 2019

The Holston

Acknowledgements

Major funding for The Holston provided by: King University English Department King University Student Government Association (SGA) King University Student Affairs Special Thanks to: Dr. Erin M. Kingsley, Faculty Advisor for The Holston King University English Department If you are a student, alumnus, faculty, or staff member at King University and wish to submit to next year's edition of The Holston, please email your submission in a Word document to: theholston@king.edu.

The Holston appreciates your patronage for the arts and welcomes your tax-deductible donation. Please make checks payable to “King University” and write “The Holston” in the subject line. Send to: Attn: Dr. Erin Kingsley Assistant Professor of English and The Holston Faculty Advisor King University 1350 King College Road Bristol, TN 37620 © 2019, Department of English, King University

Table of Contents Editorial Staff ..................................................................................................................................................... pg. 4 Letter from the Editors ..................................................................................................................................... pg. 5 Courtney Harvey and Jenny Leighann Tudor Faculty Spotlight ................................................................................................................................................ pg. 6 Dr. Laura Ong Alumni Spotlight ............................................................................................................................................... pg. 8 Jeremiah Caleb “Direct-to-Consumer Genetic Testing Leads to Improved Knowledge in the Medical Field” ..................... pg. 10 Amanda Ignacz “Glow” and “Border” ......................................................................................................................................... pg. 14 Caleb Beverly “My Attempt,” “Umbrella,” “Sentry,” and “Consumption” ............................................................................. pg. 15 Fausto Crapiz “Adventure of Time” .......................................................................................................................................... pg. 17 Linda LeeAnn Cottle “Betrayal” ........................................................................................................................................................... pg. 17 Madeline Davis “God Takes the Stress Away” ............................................................................................................................ pg. 17 Alexia Autrey “Mother’s Love” ................................................................................................................................................. pg. 18 Chloe Harmon “The Soldier’s Shadow: Chapter One: The Hardest Night”............................................................................. pg. 19 Gabrielle Madison Dockery “Hidden Layers” and “Things” .......................................................................................................................... pg. 21 Clayton Blankenbeckler “What my mirror reflects”................................................................................................................................. pg. 23 Kiayana Roberts “Flicker” and “Forget Me Not” .......................................................................................................................... pg. 23 Devan Click “Danny’s Hell” ................................................................................................................................................... pg. 26 Wyatt Burleson “He Provides”..................................................................................................................................................... pg. 30 Nick Meredith “The Sweet Name” ............................................................................................................................................. pg. 30 Alexis Stafford “Beep Beep” and “Bristol” ................................................................................................................................. pg. 31 Ulysses Tani Houston “On October 22” ................................................................................................................................................ pg. 32 Randall Gilmore “Asleep” .............................................................................................................................................................. pg. 32 Lori C. Byington “Legend Says” and “Crimson”........................................................................................................................... pg. 33 Jordan Cunningham “Bricks peeling their skin” and “Salt or mustard?” ......................................................................................... pg. 41 Sasha Gardiner “Direct-to-Consumer Genetic Testing: 23andMe’s Business Model” ............................................................ pg. 43 Jacinda Harrison “Hidden” and “Forgotten”................................................................................................................................. pg. 49 Alina Cirstea

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Editorial Staff Editor-in-Chief:

Courtney Harvey Jenny Leighann Tudor

Faculty Advisor:

Dr. Erin Kingsley

Editorial Board Members:

Jordan Cunningham Devan Click Brittany Rivera Alaura Sporleder Abigail Keith

Publicity Assistant:

Linda LeeAnn Cottle

Cover Artist:

Gabrielle Madison Dockery

Faculty Board Members:

Prof. Lori Byington Dr. Kevin DeFord Dr. Kim Holloway Dr. Logan Love Dr. Jennifer Mongold Prof. Josh Rudd Prof. Joe Strickland Prof. Alaska Vance

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Letter from the Editors Dear Readers, This year marks the third annual publication of The Holston, and in terms of the logistics of the journal, many milestones have been hit this academic year. The entire team has worked tirelessly to promote the journal, leading to our highest total submission count to date. The higher volume of submissions received is reflected in the number of pieces chosen to be published in the journal this year. The increase in submissions is solely due to the hard work and dedication of our team, who spent hours working to encourage submissions. This edition of The Holston would not be what it is today without them; furthermore, it would not be what it is today without our faculty advisor, Dr. Erin Kingsley, whose dedication to getting the journal complete and whose gentle reminders and steady encouragement to keep things moving has truly made this journal possible.

As you read, we hope you reflect on the hard work of not only the staff in putting together this edition, but also the hard work and bravery of those who submitted. This journal is comprised of the work of students, faculty, and alumni of King University, and the boundless imagination exhibited here is praiseworthy. We hope that in this journal, there is something that everyone can latch onto and love, and we also hope it sparks intellectual curiosity and a desire to dig deeper into the topics presented here.

Lastly, reader, we thank you for your support of The Holston, and we hope that you will continue to follow us on our literary journey in the years ahead.

The Holston Editors-in-Chief, Courtney Harvey and Jenny Leighann Tudor

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Faculty Spotlight Dr. Laura Ong What is one of your most striking King-related memories?

My most striking memory of King will always be my on-campus interview in April of 2012. The memories of that day are some of my best AND worst, and that’s why I remember it so well. Academic faculty interviews are pretty intense, and generally include a teaching demonstration; a research presentation; multiple interviews with students, faculty, and administration; meals with various members of the academic community; and often a campus tour thrown into the mix.

The first challenge for us (because my husband, Han, was interviewing for another position in Biology at King, on the same day!) was getting to the interview. We were living in Arkansas then, with three children under the age of six, and Han’s parents also happened to be visiting us from Malaysia at that time. So a couple of days before the interviews, we loaded EVERYONE into the car and drove eleven hours to my parents’ house, which was an hour and a half away from Bristol. The next morning, Han and I drove up to King for the interviews.

It would be a real understatement to say that I was not at my best on interview day. Our youngest son Joseph was about eight weeks old, and I was still in the phase where I was nursing him about every three hours. I was worried it would make a bad impression if I brought him with me to the interview, and I was also scared to ask for breaks during the day to pump. So all day I waddled around campus in pain, stuffed into a new suit that I had ordered online, in heels that I felt were attractive yet sensible for an academic interview. However, those were the days when we had several gravel parking lots and an un-restored Oval, and my shoes were totally inappropriate for those conditions.

As I literally and figuratively tiptoed through the day, I kept thinking that I was not doing very well, and that I was capable of so much better, and that Han was probably killing it in his interview while I was struggling.

But thankfully I did well enough to be hired here. When I think back about my interview now, I am not proud of my public performance, but I admire my own internal grit and tenacity that day. I’m also so thankful that the faculty, students, and administration believed in me then and gave me a chance to work here.

One bright spot on that particular Wednesday was getting to go to chapel. That was one part of the day when I could somewhat relax and feel a little more invisible, and reflect on what kind of place King really was. That particular day was Holy Week chapel, with several choral pieces and faculty reading scripture. I already knew I wanted to work at King, but being in chapel that day really confirmed that desire in me. I wish all faculty interviews could include a chapel or convocation time, because it really shows off one of the most special things about King.

What have you learned during your time at King?

When I came here, I was already a decent classroom teacher, but I didn’t yet know how to do the other parts of a faculty job. The most important thing I’ve learned (and am still learning) is how to listen well.

There’s a misconception that quiet people must automatically be good listeners since they spend less time talking, but I’ve had to learn to really focus on what people are saying with their spoken words AND their body language AND what they are NOT choosing to say. I’ve also learned that sometimes people really The Ong family at First Presbyterian Church, need you to listen to them, and that just by listening Easter 2018 you are helping them in some way.

Another lesson I’ve learned is to use my strengths in an efficient way. When I first started at King, I felt I should participate in every possible opportunity that presented itself. I found that I liked being involved, but some

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types of involvement were more draining than others. When I reflected on why I was feeling that way, it was because I was trying to do things that didn’t align with my particular talents and strengths. Other colleagues might be great at those activities, but I don’t have to be fantastic at those same things. One example is traveling with students; I can do that (and have done so several times), but I find it stressful and it causes me to worry too much. So I have focused more time on advising, assessment, and working with new faculty.

Those are things I really enjoy and it’s easier for me to make an impact there.

In the classroom, I have made lots of progress on how to teach difficult concepts by figuring out what students already know about a subject and then building off of that existing knowledge. I think of new examples or analogies to The “Onglets” on Easter 2012, two days after Dr. relate to physiological processes and try to come up with Ong’s job interview at King activities that help students learn those principles. If you’ve been a student in my class and did a fun activity that helped you learn, I definitely developed that during my time at King. Likewise, if you remember a particularly hard or complicated exam question, I developed that at King, too! I really enjoy thinking of new ways for students to show me what they’ve learned and how their new knowledge relates to real-world scenarios they might encounter in their careers.

What is one word or phrase you would use to sum up your experience at King?

For me, that word would be “fulfilling.” It’s such a gift to use my teaching vocation in a faith community of students, friends, colleagues, and fellow church members, and I try to never take that for granted.

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Alumni Spotlight Jeremiah Caleb In the fall of 1998, while on a private tour of the King campus, I found myself drawn to a building on the oval. It was rather old and neglected. Yet something about the history and the character of the building called out to me. I knew little of who I was, or what my life calling would be. I soon learned that it was the Fine Arts Building, and it shaped my time as a student and laid out the foundation for my future as an artist.

At that time, the student body of King was merely around 600. Out of that, 10% were international students, which gave me a window into the world outside of my small town. I was embraced by a family of nurturing faculty and fellow students with a strong desire to make contributions to that world. Dr. McDonald, my English professor and academic advisor, was the first person to see the fire my eyes and recognize that my desire to tell stories through writing and performing was far more than a college hobby. He, along with Dr. Flannagan and other educators in my life, pushed me towards excellence.

It was at King that I first figured out that if I applied myself with nothing but my best, I could live out my dreams. At a small liberal arts college like King, one could literally try everything and gain experience in roles one would later have to compete for. King helped me discover my passion, a strong spirit to persevere, and a deep sense of faith and responsibility to uphold. Almost two decades later, I still regard my alma mater with pride and duty.

Following the passing of my father and my graduation from King in the spring of 2002, I made a bold choice in moving to New York City and embarking on the arduous artist journey. While King certainly equipped me for this, I had only just begun with my climb. Over the years, I’ve devoted hours upon hours to training in my craft. I’ve knocked on countless doors for opportunities. Sometimes I won, and other times the doors remained closed to me. I’ve allowed myself to love and get my heart broken. I’ve held on to my calling when the society from which I came or those closest to me felt that God was not in my industry or what I was doing. It did not matter because I knew, and I heard the voice of the creator in my soul loud and clear, rousing my creativity within me. I knew going into this that it would be hard, but I soon discovered that it was also often to be a very lonely road. Yet even when I look back on it all, I would not trade a moment, for it is the journey that continues to shape me and inspire my craft.

As a man in my 30s, I have defined success. It isn’t to be found on the red carpet, at award shows, or dining with celebrities. That is just a bonus that may or may not be awarded to one who perseveres. Success is waking up every morning and doing exactly what I yearned to do when I started off on this journey as a young graduate of King. I simply live the life of a professional by daily training my body to write, produce, and bring new projects into existence. With experience comes excellence, and with excellence comes fulfillment. My television and film accolades, my books, and my filmmaking are all results of sleepless nights and the courage to tap into my flaws and fears, and allow myself to be vulnerable for the purpose of creating art that might make a positive contribution to humanity.

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I currently live in Los Angeles with my lovely wife who supports me despite my artistic temperaments and my strange behaviors when I am diving into a new character. In addition to our busy careers, we run the Caleb Hope Foundation, an initiative which sponsors education for destitute children from the slums of India. Following the homecoming premiere of my film Coming Home at the Paramount Theater in Bristol last fall, my creative partner and I have been dreaming up ways to bring our filmmaking to East Tennessee and give back to the culture there. I continue to chase big dreams, but every now and then I look back and reflect on how far I’ve come. In fact, my latest biographical novel, In His Time, is based on that journey that began at King at the turn of the millennium.

Along with all the pranks and romances of my college life, one of my most distinct memories is standing among peers at the Memorial Chapel singing “How Great Thou Art” long before I understood how great the creator really was and how wonderful this life can be with its broken parts and its beautiful parts. It all began at King, which will always be to me a dream maker.

Jeremiah Caleb – Actor, Author, Activist www.jeremiahcaleb.com

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Amanda Ignacz is a senior Cell and Molecular Biology major with a Psychology minor. This piece was inspired by the ongoing debate on whether direct-to-consumer (DTC) genetic testing provides helpful information, or if the negative aspects that DTC genetic testing comes with outweighs the positive aspects.

Direct-to-Consumer Genetic Testing Leads to Improved Knowledge in the Medical Field Direct-to-consumer (DTC) genetic testing is an accessible, easy way to find out information about one’s genetic history. The reason for using DTC genetic testing varies, ranging from determining one’s ancestral history to medical implications such as genetic disease detection (Kalokairinou et al. 2014). The ease of access to genetic information has peaked an interest in the public, and the market for DTC genetic testing has begun to rapidly evolve and has grown in popularity. With the advancements in genetic testing availability, there has been attention called to the debate of whether DTC genetic testing is helpful or harmful. DTC genetic testing should be required for everyone to test for carriers of genetic disease and, therefore, to allow couples to decide if having children is a good option or to prepare couples for possible genetic diseases their children may carry.

DTC genetic tests are at-home tests that can be ordered either online or over the phone to provide the consumer with information about their genetic history (Kalokairinou et al. 2014). The test requires that the consumer complete a saliva swab kit, in which either a saliva sample or a cheek swab is administered (Kalokairinou et al. 2014). Then the sample is sent to a lab where DNA can be extracted from the saliva sample, and this DNA is analyzed for what is advertised by the specific company (Kalokairinous et al. 2014). DTC testing can be used for a range of options, which has expanded the consumer market for the tests. A few of the available applications of DTC genetic testing are for complex diseases; to see if one is a carrier of an X-linked disorder; for pharmacological purposes, including how drugs may affect a person; and ancestry tests (Kalokairinous et al. 2014).

The use of DTC genetic testing to identify specific genetically-inherited diseases is important in the medical field. This form of genetic testing is easily available through mail order, and can diagnose one as either having the disease or being a carrier of the disease. This DTC genetic testing differs from others, such as ancestry tests, in that it is recommended that a doctor is involved in the process to help the consumer interpret and understand the results (Kalokairinous et al. 2014). One company that produces DTC genetic tests for inheritable diseases is Counsyl (Counsyl). This company allows for the testing of parents or prospective parents to detect any diseases or conditions that could be passed on to their children (Counsyl). Counsyl also offers different types of DTC testing, including a blood draw and a saliva sample (Counsyl). This shows how diverse DTC genetic testing can be, and how the form the testing comes in differs as the complexity of what the test is evaluating increases. Many of the Counsyl DTC tests require a health professional to be involved in the ordering of the test, which ensures that there is a trained professional who will be able to offer emotional support to the couple and to help interpret the results of the test (Counsyl). The company even gives consumers the option to contact a genetic counselor, who can help the couple understand their results and what the results could mean for their potential children (Counsyl). This particular company not only exhibits the use of DTC genetic testing for inheritable, X-linked diseases, but they also exhibit proper patient care by following up with their consumers and providing options for further explanation and help from genetic counselors.

DTC genetic testing should be used to diagnose inheritable diseases in children, as well as in adult carriers, in order to allow individuals or couples to make more informed decisions about treatment or about the choice of having biological children. Studies have shown that DTC genetic testing could be a faster and more affordable alternate in testing for genetically inherited diseases (Bell et al. 2011). This could encourage more individuals to get tested for being a carrier of genetically inheritable diseases who otherwise would not have the money or healthcare to afford testing by a geneticist in a laboratory. If every child were to be tested for genetically inherited diseases earlier in life (i.e. right after birth), treatments could be administered to improve the quality and longevity of life.

Likewise, if every potential parent were to be tested as a carrier of genetically inheritable diseases, their decision to have their own biological children could be influenced or they could at least be more prepared for having a child with an inherited disease.

Along with being more affordable than other forms of genetic testing, DTC genetic testing can allow for individuals to make decisions about the future of their health. Once DTC genetic testing is done, it becomes the job of the consumer to take control of their own health and to take preventative measures if one is predisposed to passing on certain diseases (McGuire and Burke 2011). Once the results of a test are received, the consumer can either approach their results with a “fatalistic attitude” or take action to seek the proper treatment to improve their health or the health of their children (McGuire and Burke 2011). For example, if a couple were to discover that one of them is a carrier for a genetically inheritable diseases, it is the decision of the couple or the affected individual

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what to do with the results. This could give the couple time to either mentally prepare to potentially have a child with a genetic disease, or it could even lead a couple to find alternative options to having children non-biologically.

Having DTC genetic testing would also allow for earlier treatment to be given to children with genetically-inherited diseases which could help improve life quality and longevity.

While DTC genetic testing offers the possibility of great advancements in the field of medicine, there are some aspects of the genetic testing process that some people find off-putting, or even harmful. Some may argue that DTC genetic testing can cause a negative impact on emotional and mental health due to the strain of discovering one’s child has a genetic disease or due to the discovery that one could pass on a genetic disease to future children.

A study was conducted to look at how DTC genetic testing could affect consumers (Bloss et al. 2011). The study tested subjects’ eating habits, anxiety, and exercise behavior post-genetic testing (Bloss et al. 2011). The results of this study showed no significant change in the mentioned behaviors as a result of the DTC genetic testing, demonstrating that having DTC genetic testing would not have a negative effect on one’s mental health (Bloss et al.

2011). While it must be acknowledged that receiving inconclusive results could lead to increased anxiety (Roberts and Middleton 2018), there is no statistical evidence to support the claim that DTC genetic testing would negatively impact one’s mental health, meaning that DTC genetic testing is still safe to administer.

Another complaint against DTC genetic testing is that there is a problem with understanding and interpreting the results. However, if genetic testing were to be done, and the company someone purchased the test from does not include genetic counseling as part of their advertised test, one must have the initiative to actively seek medical help for interpreting the results themselves. In addition, some DTC genetic testing companies, such as Counsyl, do provide genetic counseling services in addition to the test itself. An important part of DTC genetic testing is that one should be knowledgeable and informed about the services involved in the test prior to purchasing it. Also, in the study conducted by Bloss et al., genetic counseling was offered to every subject, but only 10% of the 2,037 subjects used this counseling (Bloss et al. 2011). If a couple or individual is offered the choice of genetic counseling through companies that conduct DTC genetic testing, but do not choose to use this service, it is not the fault of the company if the individual has difficulty interpreting their results. Once results are given to an individual, even if genetic counseling is not offered by the company the DTC test is ordered from, it is up to the consumer to make the decision to seek further assistance with understanding the implications of their results. This issue could be resolved if all DTC genetic companies required their consumers to contact a genetic counselor, or at least provided that as an option once the DTC genetic test results were completed. If this were to be done, there would be less of a stigma surrounding the misinterpretation and confusion caused by genetic test results.

Taken together, both these positive and negative aspects surrounding DTC genetic testing can influence the experience consumers have with disease testing. One disease that can be diagnosed through DTC genetic testing is cystic fibrosis (CF). DTC gene screening is available to allow couples to detect if they are at a high, predictable risk of having a child with CF, and therefore allows the couples to make informed reproductive decisions (Holtkamp et al. 2018). Since CF is not tested for during pregnancy, DTC gene screening could be the only chance a couple has of diagnosing their child with CF prenatally (Holtkamp et al. 2018). A case study has been conducted to determine how useful consumers found DTC genetic testing in the detection of whether one is a CF carrier or not (Holtkamp et al. 2018). This study included 39 couples that were tested for CF, of which none were shown to be carriers, offering the relief to each couple that they would not have the chance of passing on a gene that could result in CF to future children (Holtkamp et al. 2018). Participants in this study regarded the use of DTC genetic testing as being readily available and easy to request (Holtkamp et al. 2018). One important reaction from the participants in this study is that participants were surprised that DTC genetic tests were not more commonly ordered and used (Holtkamp et al. 2018). One participant even tied this dearth of use to the lack of knowledge among the community that there is DTC genetic testing available to test if people are carriers of inheritable diseases (Holtkamp et al. 2018). Participants also noted that there was clear information provided on the website of the company used for DTC genetic testing, while there was still some confusion about what the results of the testing meant and who to contact if questions were to occur (Holtkamp et al. 2018). While the overall reaction to this study was positive, the areas where improvement is still needed in DTC genetic testing were highlighted by this study. It is important to note that while improvement is needed, the responses to DTC genetic testing for CF was overall positive, showing that despite the few drawbacks participants still showed support of DTC testing.

While DTC genetic testing is helpful in diagnosing a few genetic diseases, I am hopeful that this form of genetic testing can be applied to more genetically-inheritable diseases as science advances. By being able to diagnose a wider array of genetic diseases, treatments can begin earlier for affected individuals; parents of potentially affected individuals can prepare for what their child’s needs will be; and couples can even have the chance to evaluate the choice to have their own biological children.

While I have not had any experiences with DTC genetic testing specifically, members of my family have had genetic testing done in the past. When my brother was younger, doctors realized that his motor function was not as

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developed as it should have been for someone his age. He learned to crawl later than most babies, and, as a toddler, my parents and doctors noticed he would have trouble standing up. When my brother was six, my mother took him to a hospital to have genetic testing conducted. The testing was for deletion-type mutations within the gene that codes for dystrophin production. The results were sent to my family within twenty days of the test being conducted, telling my family that my brother had Duchenne muscular dystrophy (DMD) and that my mother was a carrier for this sex-linked disease. It was only after receiving my brother’s official diagnosis that doctors were able to create a course of treatment to slow the progression of my brother’s disease. My brother passed away at eighteen years old due to complications from DMD. If my brother were to have had the genetic testing done to diagnose his DMD earlier in life, doctors would have been able to begin treatments to slow the progression of his disease sooner. I believe that if treatment had begun earlier in his life, his muscles would have been stronger, and he would still be alive today. Early diagnosis is crucial to early treatment, and these early treatments can save lives, as well as improve the quality of life for those affected by different diseases. While the genetic testing my brother had done was not DTC, if the market for DTC genetic testing were to be expanded so access to DTC tests for more inheritable diseases, such as DMD, was easier, more people would be able to live longer and better-quality lives. If DTC tests for genetic diseases like my brother had were available, deaths like my brother’s could be prevented.

Knowing that my mother is a carrier, I also plan to have genetic testing done to determine whether I am a carrier for DMD as well. By doing this, I will be able to take control of my own health and my health-related decisions. While others may not have the same perspective, the results of genetic testing for me will influence my decision of whether to have children or not in the future. I would not want to face the loss of a child, and I do not think I could handle watching another family member become progressively weaker, lose their autonomy, and eventually die. Genetic testing for diseases, and eventually DTC genetic testing for a wider array of diseases, helps to prepare parents who are carriers for diseases for what to expect when/if they have offspring, and can even help to influence whether a couple wants to have children or not. My personal experience with genetic diseases and genetic testing have impacted my outlook on the genetic testing industry, and I think that the spread of DTC genetic testing, especially to test if people are carriers of genetic diseases, is not only a benefit to society, but a necessity.

While I believe DTC genetic testing is helpful to couples both expecting or contemplating having a child, there is room for improvements in the DTC genetic testing technology. Through technological advancements, the accuracy and understanding of genetic testing results can be better understood. As determined in a study, about 10% of the disease mutations within the gene database are incorrect, which could either lead to a false diagnosis or the lack of a diagnosis (Bell et al. 2011). This issue could be resolved if more genetic testing were to be done through DTC testing, and this database could grow, and the information about genes within it would be more accurate. If these databases were to be expanded and re-evaluated in the future, this would allow DTC genetic carrier testing to be done more easily and more accurately. As previously mentioned, DTC gene sequencing could be cheaper and faster than going to a lab and having a blood-draw test done (Bell et al. 2011). If DTC genetic testing were to be more widely implemented in the future, this could save couples and individuals both time and money in the wait for a genetic diagnosis, and in turn this could help provide earlier treatment or preparation for individuals that have genetic diseases or for carriers of genetic diseases. Also, if more medical professionals were to be trained in interpreting genetic testing results, there would be less controversy with regards to individuals not being able to understand their own test results. If a consumer were able to visit their primary care physician to ask questions and interpret their test results, genetic testing for inheritable diseases or for carriers of disease could be more widely used and would appeal more to the consumer industry.

In terms of the direction the DTC genetic testing industry is moving, I think that DTC testing for carriers should become more of a primary focus. A wider array of diseases can also be tested for as new DTC genetic tests are developed. I think, if the DTC genetic testing industry directed its attention away from ancestry testing, which is commonly for recreation, and more towards genetic disease diagnostic testing, lives would be saved, and the DTC genetic testing industry would be seen in a more positive light on the medical front.

While no scientific invention is perfect, there is undoubtable evidence that DTC genetic testing has made a lasting and powerful impact on today’s society. If DTC genetic testing were to be more widely used, the spread of inheritable diseases could be prevented, controlled, or treated. The medical implementations of DTC genetic testing could lead to earlier diagnosis of genetic diseases, and would allow for couples who are carriers for genetic diseases to make a more informed decision if they want to have children, and would allow for these couples to be more prepared for having a child/children with genetic disease(s). While there are some drawbacks to DTC genetic testing, as science develops the DTC genetic testing process and the industry develops, the benefits of this testing will become clearer. DTC genetic testing will not only make people more informed about genetic diseases, but it will also help to administer earlier treatments to those with genetic diseases, ultimately saving lives.

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Citations Bell CJ, Dinwiddie DL, Miller NA, Hateley SL, Ganusova EE, Mudge J, Langley RJ, Zhang L, Lee CC, Schilkey FD, et al. “Carrier testing for severe childhood recessive diseases by next-generation sequencing.” Science Translational Medicine 3.65 (2011): 65ra4.

Bloss CS, Schork NJ, Topol EJ. “Effect of direct-to-consumer genomewide profiling to assess disease risk.” New England Journal of Medicine (2011) 364: 524-534.

Counsyl. How it Works. South San Francisco (CA): Counsyl, Inc. Accessed 23 September 2018. http://www.counsyl.com/patient/how-it-works.

Holtkamp KCA, Henneman L, Gille JJP, Meijers-Heijboer H, Cornel MC, Lakeman P. “Direct-consumer carrier screening for cystic fibrosis via a hospital website: a 6-year evaluation.” Journal of Community Genetics (2018).

Kalokairinou L, Howard HC, Borry P. “Direct-to-consumer genetic testing.” eLS. (2014) Wiley, Chichester. https://doi.org/10.1002/9780470015902.a0025181.

Khoury MJ. “Direct to Consumer Genetic Testing: Think Before You Spit, 2017 Edition!” Atlanta (GA): Centers for Disease Control and Prevention.

2017.

Accessed 23 September 2018. https://blogs.cdc.gov/genomics/2017/04/18/direct-to-consumer-2.

McGuire AL, Burke W. “Health system implications of direct-to-consumer personal genome testing.” Public Health Genomics. 14.1 (2011): 53-58.

Roberts J, Middleton A. “Genetics in the 21st Century: Implications for patients, consumers and citizens” [version 2; referees: 4 approved]. F1000Research. (2018) 6: (2020).

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Caleb Beverly is a rising senior at King University. He will graduate in Fall 2019 with a degree in Digital Media Art and Design. As a photographer and videographer, he focuses on man-made spaces. Most of his work emphasizes human stories through the structures and images that people leave behind in their environment.

Glow

Border

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Fausto Crapiz is a senior who will be graduating in Spring 2019. During his time at King, he has pursued English and Digital Media, Art and Design (DMAD) with a focus on photography. His past saw him being homeschooled on an 80 acre farm outside of Knoxville, Tennessee. During this time, he was introduced to poetry through the works of classic poets and found modern inspiration through trap and folk music.

The concept for “My Attempt” was created as a direct response to the author’s struggles with depression and anxiety.

For Crapiz, writing is a form of therapy in the way that it allows self-expression and exploration. “Umbrella” is a poem about an individual who finds themselves “crushing” on a person they hardly know.

Crapiz’s favorite location and subject for shooting are abandoned buildings. These areas present technical challenges that test the photographer’s skills as well as a specific mood or aura that surrounds each location.

Deserted areas offer a phenomenal space to capture the spirit of a place that many individuals would not enter.

Night photography is another chance for a camera to capture photographs that border on the surreal.

My Attempt

Umbrella

The only thing that I could say is me Is a bruised reflection of nihilist philosophy Nothing reflected in a dirty mirror A room outlined by the smell of fear

I had an umbrella But don't anymore Because she smiled at me in A muggy classroom And sat down beside me Like she always did

All I know now is that I am weak I face that one fear and it makes me seek The quiet end: I say, “Fuck God’s will” Give me my end by Satan’s pill So that as I die my last thoughts will be Concerned with my lack of immortality A crime to some, but I say I don’t care I long for the dark, the dirt in my hair Crushing my fear just like the pills Swallow the happy ending that kills Into the dark; my last moments of pain I no longer can lose, as death I do gain.

It was raining And she had to leave To go through the weather to A workplace Where “those damn idiots” Told her what to do.

I did what I could Chivalry or an inflated ego And gave the girl I barely knew An umbrella So that only her feet would get wet On the way to her car.

But I forgot That I had no jacket So I stand there wet and wondering in The rain If she'll bring my umbrella back Or if she knows my name

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Sentry

Consumption

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Linda LeeAnn Cottle is a King University Sophomore and a Criminal Justice major. Her inspiration for this acrostic poem was the ancient Greek play Antigone.

Adventure of Time An adventure is Near.

Time is your friend but enemy as well, it’s Intriguing at times, but Goes by fast and never stops.

Once it starts, you Never know what’s in store until it’s the End.

Madeline Davis is currently a junior at King with hopes of graduating Fall 2019. Maddie’s major is Math with a double minor in Security and Intelligence along with Leadership. The inspiration for this acrostic poem came from reading Antigone in a class, and her resulting desire to put a modern spin on the classical piece.

Betrayal Knowing how Antigone mourned her brother Ruthless was the leader who felt no emotion toward her Emotion was for the weak not he Only to find in the end he killed his family by his tongue No one to love as no one loved him

Alexia Autrey is a Freshman at King University. She is planning to double major in Business and English. Alexia is also a member of the King University swim team, SAAC, and the National SAAC. Her inspiration for the piece was a rainy day and her love for God. God Takes the Stress Away As I sit watching the rain, God takes my worries away.

Eternal life and Everlasting love; For He is Lord of Heaven above.

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Chloe Harmon, a Digital Media Art and Design major, captured this photograph for her Digital Imaging class during the fall semester of her sophomore year. She is looking to actively advance her knowledge in photography and cinematography at King University. She desires to go directly into the workforce after college to further develop her experience with multi-media production.

Mother’s Love

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Gabrielle Madison “Grizzly Bear” Dockery is a freshman at King University, majoring in Theatre. This story came to her after reading books about soldiers, particularly from the lens of a soldier’s wife. Dockery noticed that hardly any authors focus on the sister’s or brother’s side of the story. This story is near to her heart, and she hopes to bring light to the subject of heartbreak that weighs on people after the deployment of a sibling.

The Soldier’s Shadow Chapter One: The Hardest Night Max stood in front of the window of his bedroom, looking out towards the fields where a storm was rolling in. He watched as the leaves flew around the house and yard, tossed about by the winds. One leaf in particular got caught in the window sill of Max’s bedroom window, and he studied it for a moment before turning back toward his room. There was nothing particularly special about his room; it was just a typical room for a teenage boy. Max looked over to his clock: it was 8:26 at night. He crossed the room, walking toward his suitcase and picking up clothes off his bed. As he rolled up a white shirt, the muscles in his arms rolled along with it. He had hair down to his shoulders that was the color of melted chocolate in the sun. Standing close to six feet tall, Max was muscle through and through.

Placing the shirt in a bag, he reached for a pair of blue jeans. He glanced over at the door which was opened wide to look out to the hallway and stairs. Looking back at the blue jeans he held, he began to roll them up, but he stopped halfway through. Slowly he placed them down on top of his bag as he looked over his right shoulder.

Breathing deeply, he walked over to the door, making the old wooden floor creak underneath his weight. He leaned against the door frame to look outside his door, seeing his little sister Nova wearing nothing but sleep shorts and one of his shirts curled up in a small ball on the floor.

He slid down the wall to sit beside Nova, watching and listening to her crying softly. Her dark red hair curled over her shoulders, covering most of her balled up body. His four-year-old sister was the only thing that made Max’s world go around; he believed the same about their mother as well, but not about his step-father, Rick. When he was eight years old, his father passed away from cancer. His mother met up with Nova’s father at a bar. Over time, he became a drunk and abusive person. To Max, that man was nothing but a total asshole. Hell, he didn’t even work; Max’s mother worked to pay all the bills.

“Why do you have to go?” Nova’s voice pulled Max out of his thoughts, and he softly pulled her into his lap.

“I signed up, Nova. I have to go.”

“But you’ll be leaving me.” Nova’s voice cracked as she hugged tight to Max’s chest, her tears wetting his shirt.

Max hugged her tightly, comforting her as best he could. “Nova, I am always with you in your heart.”

They stayed that way in silence for a moment before the sound of their mother’s voice rang through the house. “Max! Hurry up or you’ll miss the bus!”

The bus station that he had to be at was six hours away, so he had to leave tonight in order to make the bus.

It would leave at 6:30 in the morning to travel west to California for boot camp.

Nova tilted her head back to look into Max’s eyes. “I don’t want to be alone, bubba.”

Max gently brushed Nova’s hair back. “You will never be alone, you hear me? You have me always, no matter what.”

After she calmed down, the two of them got up and went back into Max’s room to finish packing his clothes together. Once everything was packed, Max zipped the bag up before picking it up and pulling it over his left shoulder.

Nova jumped up and raced to her room on the other end of the hallway, calling out, “I’ll be right back!”

Smiling at her, Max walked to the stairs to wait for her. Seconds later, Nova rushed out of her room with a teddy bear in her hands, holding it up.

“Take Teddy.”

Frowning, Max kneeled on his right knee. “You don’t want him?”

Shaking her head, Nova replied, “No, you take him. He will keep the bad dreams away.”

Swallowing and reaching out to take the old brown bear, Max said, “I’ll sleep with him every night.”

Nodding with her arms crossed, Nova said, “Good!”

Max laughed a little as he stood up. “Who’s going to sleep with you now if I take him?”

Nova paused for a moment, thinking. “Maybe Woody or Fluffy.”

Starting down the stairs with Nova following behind him, Max replied, “Fluffy would be good and soft.”

Jumping up on Max’s back, Nova responded, “Yup, like you!”

Laughing and turning his head a bit to look at Nova, Max said, “I’m no softy.”

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Nova planted a little kiss on Max’s cheek before saying, “Yes, you are! You’re my bubba, the softy.”

Smiling, Max turned his head back in front of him, thinking as he walked down the stairs. Nova was a smart and bright young girl. At just four years old, she knew and understood some things that some six-year-olds didn’t understand.

As he walked toward the living room, Max saw Rick sitting on the black leather chair watching football. Max watched as he turned up a drink of his sixth beer since five o’clock. Beside him, Max saw his mother in her night gown drinking beer with him while talking on the phone.

Looking up at him, Max’s mom said, “Oh, there you are. The bus leaves the station at 6:30 a.m. It’s six hours away, you’ve got to get going.”

Nodding while Nova slipped off his back, Max placed his bag on the floor and said, “I know. I just got done packing.”

Snorting, Rick said, “Sounds like you’re backing out.”

Glaring, Max responded, “No, I was talking with Nova before I left.”

Softly, his mother said, “Sweetie, he didn’t mean it.”

Max rolled his eyes. His mother always defended her husband, but she never once defended her children.

Don’t get him wrong, he did love his mom to death, but the way she acted was problematic nonetheless. Sometimes Max wished that his mother would run off with the asshole, leaving him and Nova behind.

Pushing the thoughts from his mind, Max picked the bag back up and took it outside to put in his truck. He had an old 1987 Ford F-150 that was blue with a white roof. His father had left it to him. Even though the vehicle was old, it worked great for him. Max opened the passenger door, making the metal crack a little, and he placed the bag in the seat. Nova stood behind him, watching as he set the bag down.

Turning back to see her, Max smiled. “It’s late, sis. You need to be in bed.”

Rubbing her hands together, Nova asked, “Can you read to me before you go?”

Smiling and nodding, Max replied, “I sure will, doll.”

Max placed his hand on Nova’s back, guiding her into the house. They walked through the living room, passing their parents. As they headed upstairs to her room, Max thought about how he’d always read a goodnight story to Nova every night before bed since she was two weeks old. He always read to her because their mother or her father would refuse to.

Max watched Nova climb into bed and grab a book off the shelf. Max sat down on the edge of the bed as Nova handed over the book. It was the one book she always wanted: The Little Engine That Could.

Max opened up the book as Nova leaned up against him. He started to read the story, acting out all the parts. By the time he was halfway through the book, Nova was asleep. He closed the book, setting it down on the floor for a moment so her could lay her head on her pillow and cover her up. She looked peaceful cuddled up in her blankets. Smiling, he picked the book up off the floor and placed it on her nightstand. He leaned down and gently kissed her forehead, brushing her hair back as a tear landed on her cheek.

Walking carefully so to not wake Nova up, Max headed out of the room, turning out the lights and closing the door gently behind him. He headed down the stairs and walked into the living room. He saw his stepfather sitting in his chair, laughing about something on TV. Max made a beeline straight for his stepfather, glaring at him as he grabbed him by the shirt. Tears threatened to fall from Max’s eyes as he made eye contact with his stepfather and said in a low deep voice, “If you lay one hand on her or do anything to her, I will kill you.” Max pushed his stepfather back into his chair and looked over to his mother, pointing to her and saying, “And you better protect her and act like her mother.”

Max turned and walked out of the house, his stepfather trailing just behind him.

“Now you listen here, you son of a bit—” Max turned and pointed at his stepfather, cutting him off. “I don’t care what you say. She is my world, and if I come back and she says you touched her or anything, I’ll kill you. Don’t for a second think I won’t.”

Getting in his truck, Max turned it on, making dust shout from the tailpipe. He backed up with the lights on, the fog in the fields around the house making it look brighter. He turned onto the road and slowly drove towards the bus stop where he would soon leave this godforsaken place. In doing so, he would leave his sweet little sister alone.

Hitting the steering wheel, Max cried out as the radio was on. He looked over at the little photo of Nova on the dash between the speed reader and the gas gauge. It was a picture of her on her third birthday, sitting in his lap as he leaned up against the hood of his truck. She was just smiling away.

He rubbed his fingers over the photo as he whispered, “I’ll be back, sissy. I promise.”

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Clay Blankenbeckler lives in Bristol, TN and attends school at King University. He works as a portrait and wedding photographer, and enjoys exploring darker and more conceptual imagery in his personal work. He is working on his major in Business Administration, and is expected to graduate in Spring 2020.

Hidden Layers

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Things

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Kiayana Roberts is a Sophomore attending King University. Kiayana is majoring in Criminal Justice with a minor in Psychology. Kiayana’s inspiration for this piece was the insecurities she has battled throughout her life thus far, and the strength it has taken to overcome them.

What my mirror reflects I have never seen myself the way everyone else has I stare at my reflection, reaching for something to admire, Drawing my hands back covered in cuts deeper than caves.

I don’t love myself I guess you can blame the countless times I’ve been rejected, or how I always made a better friend than a lover My insecurities cut like razor blades and these may just take my life away I don’t know how to love myself Guys treat me like I’m one of the girls that’s good for the night but anything more than that wouldn’t be right…

I don’t love myself but I do have standards No matter how many people want to part me like hair before it’s braided Don’t get it twisted I don’t love me but I’ll be damned if I let a man make love to me without being in love with me.

Devan Click is a Junior double-majoring in Business Administration and English Literature. She tends to wander off into the books she reads, and has a bad habit of working on too many craft projects at once. She plans on attending graduate school after her time at King University. Eventually, she wants to become a Development Editor – working on storylines with their authors to make something great.

“Forget Me Not” is a personal narrative of a day in her everyday life. The story isn’t a happy one by any means, but rather the product of her frustrations, fears, anguish, and heartache spilling out onto paper. This piece was very difficult to share because it is such a personal piece and it reveals a side of her personality that she doesn’t like to show to others. On the other hand, though, “Flicker” was just a poem that was submitted for an assignment. Through it was written for an assignment, it still holds a bit of Devan’s beliefs when it comes to life.

Flicker A small spark will go out if left without.

A flame will run wild if left unbridled.

A life without a spark, glows dim in the dark.

A vibrant light will devour the night.

Void is an existence without significance, An explosion is what you should expect if you live with excess.

Betwixt and between is the best route seen, A life of serene will paint the best scene.

A flicker will grow much quicker, Without raging like fire—that quickly turns into your pyre.

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Forget Me Not The acrid smell of waste greets me as I walk down the stairs. Although I’m prepared, the stench never gets any easier to tolerate. Closing the baby gate behind me, so that The Stranger cannot go up the stairs and fall again, I walk into the kitchen to see who’s awake. It’s 7am, so Mom will probably be in the garage already. Dad converted it into a “man cave” about 4 years ago. The space is riddled with Steelers memorabilia, old neon signs advertising different beers that dot the walls, and useless junk-filled boxes that clutter the remaining area in the two-car space.

There is never a car in here though. God forbid that Dad has no place to put his shit. He constantly claims that he’s selling the items online, but I’ve only ever seen packages arriving. It’s all just junk to me, so I have no interest— other than the fact that Dad is buying more than we can afford. I find Mom in her pea green swivel chair, coffee in hand, and playing Candy Crush on her tablet.

The mornings are a blessing for Mom and I. Dad is usually still asleep and The Stranger isn’t awake and active yet. I decide not to tell Mom about the smell just yet. She’s relaxing right now and trying to enjoy the quiet before the parade of therapists get here. Sitting on the beat-up, cream leather couch, I finally get a good look at Mom. She’s beyond exhausted and I can tell that her shoulder is hurting her again because she’s playing Candy Crush left handed, with her coffee on the end table. Mom usually balances the coffee in her left hand and plays with her right, but the pinched nerve in her right shoulder makes this difficult. I’ve told her for the past week now to go to a doctor, but all she says is that “we can’t afford it right now.”

All too soon, my Dad stumbles in, his stomach the size of a pregnant woman in her third trimester— expecting quadruples—and shakes his way to the high top coffee table behind us. I know that his Parkinson’s acts up in the morning, but today, the movements look forced. He’s faking it this early to get out of whatever Mom was going to ask him to get done. Which just leaves Mom and I to handle it all. Great – lazy ass.

Mom notices the time and reluctantly puts her tablet away and drains her remaining coffee. She’s going to wake up The Stranger now. I still don’t tell her about the smell. She needed the extra few minutes and The Stranger wasn’t going to go anywhere anyway. Besides, Mom expects this – it’s the daily routine for her. Every morning, despite the diaper, The Stranger manages to soil not only herself, but her bed as well. Mom gets her up, walks her to the bathroom, cleans her off, and leaves her at the kitchen table while she deals with the mess in the bedroom.

I sit with The Stranger across from me and try to keep her busy and to get her to stay at the table while Mom cleans. The Stranger stares vacantly at me and starts off with the same useless questioning. Just like she does every morning. It’s always the same.

“I haven’t seen you in a while. How are you? Do you know where that lady went? What am I doing here?

Have I done something wrong?”

Automatically, I reply, “I’m fine, Grandma. Mom is in your room cleaning up. We’re getting ready for breakfast. No, we are just waiting here.”

“What do you mean?”

“Nothing, Grandma. Breakfast will be ready soon.”

I would make The Stranger something myself, but I don’t know what she’s supposed to eat anymore.

Between attending school, working my ten-hour shifts, and staying up late to work on assignments, I’m lucky if I remember what day it is anymore.

The Alzheimer’s and dementia have basically taken my Grandma away and put some stranger in her body.

The Stranger isn’t even the same age. She’ll throw food, spit milk onto the table, and even throw her medicine on the floor. The Stranger constantly reminds me of a two-year-old throwing a temper tantrum. She’ll get agitated and act out, but ultimately goes back to what she was doing before – the original root of the tantrum forgotten. I told Mom that we needed to find a bib and high chair for Grandma. Luckily, she shares my sense of humor and I’m rewarded with a laugh. It feels like I haven’t heard that sound in months and I devour it like a hot dog placed in front of a starving man.

Mom shuffles by with the soiled blanket and bed pad. We learned after the first 3 days of The Stranger living with us that the messes in the morning were going to be a daily thing. The bed pad saves us from having to completely strip the bed and replace the sheets every day.

After breakfast, I finish the laundry. It’s Wednesday, so I don’t have work or school. Today just happens to be a rare day without any assignments due either. Mom then puts The Stranger in her now clean bed. We have a few hours now before we must wake her up again. The various Therapists come by around 12pm, so that gives us about two hours. Together, we straighten up the kitchen and put the dishes in the dishwasher. Putting away the milk, I notice that we’re in desperate need of a trip to the grocery store. Mom notices my stare and says that she already has a list made up for a grocery run. Now, the dilemma of who to send. This is the one thing that Dad will,

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miraculously, feel better for. However, we both know that if we send him, he’ll get a third of the list and a bunch of junk food. So, it’s a no-go. I’m not sure what Mom would prefer, so I make the offer.

“I can run to the store for you. Or, I can watch Grandma while you’re gone.”

I watch as this choice is debated in her eyes. On one hand, she can take her shackles off and leave the house.

Getting a much-needed break from The Stranger’s antics and Dad’s uselessness. Her eyes light up with the hope of escaping, but the light is snuffed out the next second.

“Can you go to the store for me? I have to stay here for when the Physical and Speech Therapists arrive.”

I suppress a sigh and go to get ready. I don’t know what I’m more disappointed about. Selfishly, I wanted to enjoy a day in my pajamas and relax. It is one of my rare days off after all. Although, that would mean putting up with The Stranger for a few hours. After the hour of repeated questioning in the morning, I have very little patience for the same questions being asked every five minutes again. On the other hand, though, I’m disappointed with Mom because I offered her a chance to escape her prison for a little while, but she rejected it. At this rate, she’ll be in worse shape than The Stranger – especially if she can’t rest and heal. Changing into actual clothes, and reluctantly putting up my fuzzy pjs, I head to the store, a cloud of bittersweet feelings swirling in my wake.

By the time I return, the Speech Therapist has already started working with The Stranger. This is one of the few times, though, that The Stranger isn’t asking the questions, the Therapist is.

“What color is a banana?” – Stranger replies “Red.” “What state do you live in?” – Stranger replies “Maryland.” She hasn’t lived in Maryland for eight years now.

“Who is this woman?” The Therapist is gesturing to my Mom. – Stranger replies “My nurse.” Mom hasn’t been called her name, Wanda, or been acknowledged as The Stranger’s daughter for a week now. The Alzheimer’s is progressing.

The Therapist then points to me and asks the same question. “I don’t know. Is she my nurse?” Grandma questions. I look to Mom and see that she is trying to fight back tears. She can’t cry because she has to be strong for The Stranger. I guess she feels that she must be strong for me too – even though I’m not sure why. Whatever the reason, it proves to me that I am her daughter – I can’t cry either. I have to pretend to be strong for Mom’s sake.

Even though I had dubbed her “The Stranger” a few months ago, the knife of being unknown to my Grandma still cuts deep. I watch as these days continuously play out almost exactly like the previous day. Like a terrible song stuck on repeat. Over and over. The same questions being asked, but never answered correctly. Alzheimer’s is a sick joke. The one with Alzheimer’s forgets everyone around them. Slowly regressing to the point that they cannot use silverware, control their bowels, and eventually forgetting to even function to stay alive. Those caring for the Alzheimer’s patient are forced to remember every excruciating detail of their suffering. They will never forget. The memories are seared into their brain for them to carry until they too either succumb to the same disease or until they release their dying breath.

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Wyatt Burleson is a junior, majoring in Biology and minoring in Mathematics at King University. This scene was written for a final exam question and was inspired by a scene in Dante’s Inferno. The scene in question is of Dante debating philosophy with those he considers the greatest writers of history, Virgil (Vernon), Sophocles (Sophie), and Augustine (August).

Danny’s Hell Characters: DANTE

A man who has been kicked out of his longtime home. He has been in a state of grief and frustration since.

VERNON

Dante’s best friend and averagely popular streamer. He’s determined to help out his friend.

SOPHIE

Friend of Dante and Vernon. Also an amateur student of law.

AUGUST

Employee of Dante’s former landlord. She deeply regrets what has happened.

Setting:

The characters all live in the transition state of rural town and urban city. There’s little to do except go to other towns and cities.

Time: It’s been cloudy ever since winter began. The people haven’t experienced a colder winter since two years ago in 2019.

ACT 1 SCENE 1 SETTING:

Sophie’s apartment is very homey, mainly due to years of Sophie’s constant desire to decorate.

She likes using green, orange, and brown in all her decor choices. From a glance through a kaleidoscope, one would be convinced they were looking at a forest at the turn of fall.

AT RISE:

Dante is staying at Sophie’s apartment for the moment. Vernon has come over to help him try to figure out how to solve Dante’s problem. August has called Dante to let him know she’s coming.

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DANTE (slowly banging his head against the cold window frame, muttering) This is hell… This is hell… This is hell…

VERNON (pulls out a chair) Sit down, Danny.

(DANTE sits in the chair.)

SOPHIE (walks into scene, counting money, and talking into her phone) Okay, and it’s how much? $15? Alright, thanks.

DANTE (to SOPHIE) Thanks for the pizza, Soph. Don’t need to do that.

SOPHIE (shrugs it off) You’d do the same, I hope.

(A knock sounds at the door. AUGUST emerges into the scene, dripping wet from the rain.)

AUGUST Hello, everyone.

DANTE, VERNON, SOPHIE Hey, August.

AUGUST (to DANTE) Dante, I’m so sorry. IDANTE (holds up a hand to stop AUGUST) It’s not your fault. Don’t need to apologize.

VERNON Your boss should apologize, though.

AUGUST (frowning at VERNON) Don’t start this again, Vernon.

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VERNON What? I’m just saying it’s old Boneface’s fault Danny doesn’t have a home anymore.

I’m just saying your dear old boss is a jackass who kicked the guy with the most service hours out of everyone in town out onto the streets. I’m just saying— SOPHIE Could you just shut up, Vernon?

(VERNON shuts up.)

AUGUST (to DANTE) Can’t you sue for your house? I mean, it sounds pretty unlawful.

SOPHIE Sadly, no. The law isn’t on his side here. Any action he takes to get his house back, no matter how morally sound, will be illegal. You can thank my jackass uncle for that.

VERNON I could get my viewers to help. Nothing like the angry masses to incite some change.

AUGUST Can’t your sponsor help, too? Augustus?

VERNON (thinks for a moment) Augie might be able to. He owes me a favor, after all.

AUGUST Good. I can get some help in the church, too. Maybe even at a couple of AA meetings, as well. Lord only knows how a good act like this can inspire redemption in people like me.

DANTE (stands up from the chair with enough force to knock it down) Shut up! (his friends are quiet) You don’t understand! I’ve lost everything! Not just my home! I’ve lost the people!

They’ve left! They moved out the moment I was kicked out! They’re gone! The people I struggled to help for so long are just gone!

(No one speaks for a moment. DANTE takes a deep breath and speaks low.)

I grew up thinking I had a destiny. I grew up thinking I could make things better. I was taught about how justice thrives in our world. How it saves the innocent, redeems the broken, and punishes the guilty. I was taught to serve others in my community. I was taught that by doing that, the world would be better, even if it’s slow. But now… all I see is Hell.

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AUGUST (waiting a moment before speaking) You’re right. I’ve seen that side of the world. I’ve lived it. I’ve been so close to death too many times because of it. I have a kid I barely know because of it. Yet here I am. Standing. Living. Happy.

DANTE That’s it?

SOPHIE August’s right. The world is a bad place, and it won’t get better easily. It will claim too many lives before it gets better. Before what is morally right overcomes what is legally right. Before the existence of a justice where no one is treated greater or lesser than their neighbor. But it’s worth it.

DANTE What kind of world is worth the death of even one life?

VERNON The world with two lives.

DANTE Not you, too…

VERNON Shut up and let me speak, Danny.

(DANTE shuts up) You’ve spent more time helping people than anyone I know, famous or not. You’ve already lived a good life by serving your community like that. You’ve got nothing more to prove. But if you quit because of this, if you let yourself lose without even trying to fight, then you’ve wasted your time. You don’t deserve to see your precious stars.

DANTE (stays silent a moment before speaking) Thank you.

BLACKOUT. END OF PLAY.

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Nick Meredith is a fifteen-year-old high school student who is duel-enrolling at King University. He is the third of seven children and has been homeless his entire life. The poem draws from three Psalms: 18, 23, and 27. Nick hopes to one day use his talents to serve the United States as a foreign diplomat.

He provides The Lord is my Shepherd; I, a sheep.

Wandering aimlessly, Waiting.

He cares for His flock.

The Lord is my Light and my Salvation; I, once lost in darkness.

But He came down.

And brought light into the world.

The Lord is my Rock; I, tossed in the river of life.

He will lead me to streams Of water, Of quiet, Of peace, And I will exalt Him.

Alexis Stafford is a Freshman softball player who loves to write simple, yet heartfelt poems. Alexis has had an interest in writing even since she was in the third grade. Writing has always been such a relief for her. Alexis aims to connect with her readers, pulling out emotions to keep them involved.

Alexis grew up in a Christian-based home and her religious views have only grown stronger since then. She believes that a relationship with God is the most important relationship to have, and King University helps this vision stay intact.

The Sweet Name Jesus— the sweet, beautiful name, the courageous name we praise. to the sound of worship, our hands selflessly raise.

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Ulysses Houston is a Junior at King University. He is a Digital Media and Design (DMAD) major planning to focus on photography.

Beep Beep

Bristol

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Randall Gilmore earned his BA from King in 1985 with a major in History; his MA from Milligan in 2000 in Education; and his Ed.S in 2007 from Lincoln Memorial University in Curriculum and Instruction and Educational Leadership. The inspiration for this piece came from former King professor Dr. Linda Coggin. A fun fact about Randall is that he has an insatiable sweet tooth!

On October 22 On October 22, 2018, I left a space open for her, knowing she would not sit there this time.

She always sat next to me.

Whether it was for Chapel or Convocation, and no matter which one of us arrived first, the other would always leave a space open.

Colleague. Confidante. Challenger.

Shortly upon her arrival at King, she took issue to a supposition that I had made and she was right.

With surgical precision, she often sliced away at my ideas and motives, sometimes inflicting pain, but always causing more careful reflection on my part.

And so, when Katherine Paterson spoke at King on October 22, it just seemed natural that I should save a seat for her, even though she is far away now, in Canada.

In The Bridge to Terabithia Paterson says, “Just close your eyes and keep your mind wide open.’’

That is what I did this day, with the empty space next to me on the pew seeming like a dark, cold chasm.

I closed my eyes and kept my mind wide open.

And I thought of my friend, no longer sitting in the space I left open for her.

Professor Lori C. Byington is an Assistant Professor of English at King University. She is a 1985 graduate of King College and earned her Master’s Degree from East Tennessee State University. Professor Byington wrote the poem “Asleep” after seeing and reflecting on the mountains and valleys that surround the winding roads on the drive from Bristol, TN to Beech Mountain, NC. Asleep The craggy visage shows old age Although wisps of gray cirrus try to cloud the obvious.

Morning dawns and the ancient sentry awakes To behold the sun’s splendor through slit eyes.

It has rained— Old one can smell the newness and the sodden.

The butte’s height allows full view of the other mountains— Friends in their early morning glory.

What shall the eminence see today?

What shall he witness as he stands—majestic, Unmoving but always keeping watch over his territory?

Once guarded by the Indians who called these mountains home The only saviors on this bleary day are the Almighty, The craggy slate hillside And his brothers—the Appalachians.

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Jordan Cunningham is a Junior at King University, majoring in English with a specialization in Creative Writing and minoring in History. She has a love for mythology and storytelling and found inspiration in both of those hobbies to create these pieces.

Legend Says Legend says there is a beast Who walks among men and never sleeps; Skin so pale and eyes so cold Bore endlessly into one's soul.

Legend says there is a monster Speed like wolves and voice of thunder; Changing shape in the shadows of night, But is man again in the morning light.

Legend says there is a creature Born at sea and swims ever deeper; Half fish, half man with an angelic voice Luring in sailors, both men and boys.

Legend says there is a thing With horns and hair and yet no wings; It dwells in caves in forest land And will devour any man.

Legend says there is a beast Who pollutes the air and destroys the trees; Tall and short, old and young, The only beast that can use its tongue.

For all the beasts and creatures of old, Only one story has not been told; The story of man and his wicked ways Destroying his planet and numbering our days.

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cRIMSON Characters: GRAHAM

A young man in his early 20s. GRAHAM often wears a worn-out hoodie and faded jeans with beat-up sneakers. He is the leader of a small group of Survivors.

CRIMSON

GRAHAM’s younger sister, roughly 18.

Nicknamed CRIM by her group. CRIM is the group’s scout. Recognizable by her red hoodie.

LYCAN

LYCAN is the leader of a group called the Wolves. He is in his late 20s and is often seen wearing dark gray clothes.

HADEN

Member of the Survivors. CRIMSON’s escort on scouting missions.

WOLF

Member of the Wolves.

Setting: Post-apocalyptic city ruins.

Time: Near future.

ACT 1 SCENE 1

Rundown warehouse.

SCENE 2

Convenience store.

SCENE 3

City ruins.

ACT 1 SCENE 1 SETTING:

A side room in a rundown warehouse.

AT RISE:

CRIMSON and GRAHAM are looking at a tattered map of the city hanging on the back wall of the stage behind them. The room is lit with a few lanterns and some overhead industrial lighting.

There is a table sitting center stage with medical supplies, weapons, and clothing sitting atop it.

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GRAHAM (pointing vaguely at one area of the map) We’ve already scavenged this area, here, right? So, what if we went further into the city? I know that it’s dangerous, but I don’t think it’s anything you can’t handle on your own.

CRIMSON (nodding, CRIMSON points to another area of the map.)

I’m willing to bet that the convenience store on 7th Avenue still has some supplies.

People won’t take what they can’t carry, so there might still be some medicine and food that wasn’t raided in the beginning.

GRAHAM That’s true. But if we send you out, you need to make a trip out of it. Grab as much as you can, if there’s anything to grab. There’s also a drug store on the corner of 7th just up from that, so you should definitely check that out if you’ve got time before the pickup.

CRIMSON (lightly scratches the side of her face) I think I can do that. The Wolves haven’t gotten close to 7th yet, so it shouldn’t be a problem. If it is, I’ll radio in and let you guys know. Did you make a list?

GRAHAM (pulls a folded piece of paper out of his back pocket and hands it to CRIMSON) Delia wanted me to tell you to grab candy if you saw, but that it wasn’t super important. She just wanted something for the kids when they’re not feeling well.

CRIMSON (opens paper and inspects it) Canned food, water, ammo, meds. Am I getting the duffle or the backpack? I won’t have room for anything big if I take the backpack.

GRAHAM Both if you can handle them. I don’t want you to have to leave anything behind if we can afford it. I’ll send Mathias with you if I need to.

CRIMSON (wrinkles nose) Don’t you dare send me anywhere with Mathias! I’ll leave his body in the streets for the Wolves to pick over.

GRAHAM (chuckles) Only joking, CRIM. (GRAHAM picks up a walkie-talkie from the table.)

It should still be on the right station. Just test it out before you leave to make sure.

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(GRAHAM hands CRIMSON the walkie.)

CRIMSON Will do. Who’s my escort?

GRAHAM I’ll probably send HADEN. You guys work well together. We need this run to go smoothly, so I don’t want to send you with someone you haven’t done a run with before.

CRIMSON Sounds good to me. HADEN’s light on his feet, good with a gun. I trust him.

GRAHAM You’d better.

(GRAHAM looks at CRIM, concern on his face.)

Just be careful out there, kiddo. Don’t want you to get hurt.

CRIMSON (smiles at GRAHAM) I’m always careful, GRAHAM. I wouldn’t be alive if I wasn't.

(GRAHAM ruffles CRIMSON’s hair and exits stage left. CRIM looks after him and there is a beat of silence.)

I’m always careful.

BLACK OUT. END OF SCENE.

SCENE 2 SETTING:

Aisles of a convenience store.

AT RISE:

CRIMSON enters from stage left. There are shelves forming a T-shape on the stage, with a shorter one running across the middle of the stage. On the shelves are cans of food and bottles of water, as well as a few bottles of medicine. CRIM is putting a bottle of water into her backpack.

CRIMSON I should have grabbed the duffle from HADEN before we split. Definitely would have been able to fit all this food, then.

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(From stage right, LYCAN and WOLF enter but do not see CRIMSON. She ducks down by the lower shelf and peeks over to watch the newcomers.

LYCAN (picking up a bottle of medicine from one of the shelves) Hope they have somethin’ for that nausea crap that’s goin’ around.

WOLF (shoving random items into his bag) Doesn’t matter. It’s medicine. If we have it, the Survivors don’t. Anything to keep them on their knees.

LYCAN (making a face) Wish we could get a moment of peace from them asshats. Damned Survivors. Always raidin’ all these builds before we can get to them. If we had enough people, I’d say we fight ‘em.

WOLF We can send a party people hunting.

LYCAN (shaking head) Nah, I don’t wanna risk none of ours if we don’t have to.

WOLF If you say so. You’re the boss.

(CRIMSON ducks back down and shifts, her foot knocking a can of food across the stage. LYCAN and WOLF watch it before turning in CRIMSON’s direction.)

LYCAN Well, well, well, what do we have here?

WOLF (darts around the lowered shelf and hauls CRIMSON to her feet) We caught ourselves a little spy.

CRIMSON (kicking and trying to claw at WOLF’s arms)

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CRIMSON (cont.) (shouting) Let me go! Let go of me!

LYCAN (chuckling darkly) Now why would we do that? We’ve got our hands on a bargaining chip.

CRIMSON (glaring angrily) I’m warning you.

LYCAN (cocky grin) I’m counting on it, sweetheart.

(WOLF drags CRIMSON offstage and LYCAN follows close behind.)

BLACK OUT. END OF SCENE.

SCENE 3 SETTING:

A ruined street of the city.

AT RISE:

On stage right, LYCAN and WOLF stand. CRIMSON is sitting on her knees with her hands bound behind her back. On stage left, GRAHAM and HADEN stand on guard. HADEN has a baseball bat.

There is rubble scattered across the stage. A bent and broken street lamp is seen in the background.

GRAHAM What do you want from us, LYCAN? LYCAN You know what I want, GRAHAM. You have supplies that my people need. We’re willin’ to make a trade. Your precious little sister for a hundred cans of food.

GRAHAM (shaking his head) We don’t have that much food and you know it.

LYCAN When the world went to shit, your people took the upper half of town. The better half of town. All the shops were up there and you’ve taken out anyone from my group who even gets close to your borders. We know you’ve got enough food to spare. If not, then make up for it in water and medical supplies.

HADEN (angry)

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HADEN (cont.)

We don’t have a lot of medicine either. Why do you think we were out scouting?

LYCAN (sneers) I wasn’t talkin’ to you.

GRAHAM Listen, Lycan, we’ll get you what you want, but only if you give us Crim.

LYCAN (whistling) No can do, Graham. She’s the only guarantee that I’ll get what I’m askin’ for.

CRIMSON I’m not worth it.

WOLF (shoving CRIMSON roughly) Shut up!

HADEN (moving into defensive position, angrily) Don’t touch her!

LYCAN (giving WOLF a warning look) We don’t want to hurt her, but we will if you don’t give us the supplies we’re askin’ for.

GRAHAM Can you give us a second to discuss this?

(LYCAN waves in a dismissive way. GRAHAM turns so that he and HADEN are turned away from the Wolves. To HADEN) Do you think you could take them both down in one go, or would we need to split them up?

HADEN I’d need them split up, at least for a couple seconds so I can get CRIMSON on her feet.

GRAHAM Alright. I’ll take LYCAN if you take the minion.

HADEN (nodding) Okay.

GRAHAM (turning back so that he and HADEN are facing the Wolves again) Okay. We’ll give you the food.

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LYCAN (grinning) See, it wasn’t that hard now, was it?

(LYCAN motions WOLF to get CRIMSON to her feet.)

GRAHAM Now! (HADEN charges across the stage and jabs WOLF in the gut with his bat.

WOLF falls, clutching his stomach. CRIMSON jumps away and LYCAN turns to grab her arm.

GRAHAM moves closer and prepares to grab CRIMSON. HADEN swings his elbow up, hitting LYCAN in the face and shoving CRIMSON toward GRAHAM. WOLF stands and drags LYCAN offstage. HADEN helps CRIMSON get the binds off.)

CRIMSON Took you two long enough. I thought they were going to bore me to death, giving me the history of the Wolves and telling me how powerful they were.

GRAHAM You’re okay, though, right? They didn’t hurt you?

HADEN (scoffs) Have you seen her? The girl’s indestructible.

CRIMSON (grinning) I’m fine, GRAHAM. Let’s go home before they come back looking for revenge.

GRAHAM (ruffling CRIMSON’s hair) Yeah, let’s go home.

(The three walk off stage right. GRAHAM has his arm around CRIMSON’s shoulders.)

BLACK OUT. END OF PLAY.

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Sasha Gardiner is in her freshman year studying Digital Media, Art and Design (DMAD) at King University.

Originally from a town on the outskirts of London, England, she started studying photography as one of her ‘A-Level’ subjects at the age of 16. Early in this course, she realized she had a passion for capturing photographs and documenting moments in time, particularly within the field of street photography.

In the two photos we have published, you can see two very different pieces of work: one quite abstract, focusing on the peeling of paint, and the other clearly showing the reflections and colors of the Coke bottle and surrounding objects. In the first image, Sasha took the idea from an argument between the difference between shape and form.

These two concepts can often be intertwined, and, in this composition, Sasha saw the rectangular shape contrasted by the form and texture within the peeling paint. For the second image, Sasha’s inspiration was to experiment with color. She wanted to create a 60’s-looking atmosphere purely based on the way that she used and captured color.

After graduating in 2022, she hopes to use the wide range of skills that the DMAD program has taught her in order to pursue a career photographing and working alongside musicians, whether that be producing candid tour photographs or forming album covers.

Bricks peeling their skin

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Salt or mustard?

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Jacinda Harrison is a current senior at King University and will graduate in May 2019. Born and raised in Bristol, VA, she is a biology major with plans to become a dentist. In addition to studying biology, she is an active member in the community: she frequently volunteers at Healing Hands Health Center and Rural Area Medical Clinic. Her inspiration for this piece was first sparked in a genetics class discussion. With the desire to communicate and better educate the public, she discusses what may become the new “Google of Health Care.” Jacinda’s piece focuses on the ethical, legal, and social issues that surround the direct-to-consumer genetic testing market.

Direct-to-Consumer Genetic Testing: 23andMe’s Business Model Introduction The company 23andMe is growing and consolidating the direct to consumer genetic testing industry, but their back-end business model is surrounded by social, legal, and ethical issues (Botkin 2015). 23andMe is the first and only direct-to-consumer (DTC) genetic testing company that has received market authorization from the US Food and Drug Administration (FDA). The company’s mission is to enable people to access, understand, and benefit from their own powerful genetic information. The genetic testing company offers $99 “Personal Genome Service” kits to consumers. Basically, 23andMe offers to unlock genetic secrets for a small fee and a swab of spit.

The company claims that the consumer’s genetic information has the potential to unlock ancestry, predict traits, and influence health. 23andMe uses a number of different algorithms to arrive at these results. The customer can choose to order health services, ancestry services, or both. The customer will receive a saliva collection kit and ship it back to the company. A month or two later, the consumer will log in to their account to find personalized information such as percentage of European ancestry, carrier status for Bloom syndrome, details about parental lines, traits for bitter taste, health risk for Parkinson’s disease, muscle composition, and DNA relatives. 23andMe keeps their algorithms somewhat secretive. However, it turns out that the company is just really good at spotting patterns (“DNA Genetic Testing and Analysis”).

Once the company receives the saliva sample, 23andMe’s lab extracts the DNA and “chunks” up the entire genome. Following, the company will take each little piece of DNA and compare it against a reference data set of genes. The algorithm will go through the entire list of data and spit out a probability for where that piece of DNA came from. The company will also look at gene variants associated with certain diseases and calculate the risk of developing the disease if the consumer has the variant. Although the underlying tools are valid, there are limits to quality of the reference data (“DNA Genetic Testing and Analysis”).

While the FDA concentrates on the question of whether 23andMe’s kits are a safe and effective medical device, it is failing to address the real issue: what the company should be allowed to do with the data it collects, what limits should be in place, and how this data is affecting patients and medical providers. The social, legal, and ethical issues in 23andMe’s DTC business model have been subject to special scrutiny for several reasons. First, genetic testing can provide predictive information about an individual’s future health status for some heritable conditions such as Parkinson’s disease (Botkin 2015). Professionals are concerned with the lack of interpretation of these results which leads to concerns about physiological well-being of the patient and the clinical value of DTC genetic testing (Thrush and McCaffrey 2010).

Second, although the FDA has oversight of what kind of health information 23andMe can provide, they do not oversee how the data from these tests are being used or managed (Hamzelou 2018). The company discloses information in their consent document stating that “23andMe aims to make and support scientific discoveries and publish those discoveries in scientific journals,” but the challenge is that people do not read it (“DNA Genetic Testing and Analysis”). The company is claiming to decode genetic information to better the lifestyle of the consumer, but they may be getting more information out of it than the customer (Hamzelou 2018). Third, genetic testing is becoming increasingly common, but when it comes to children, genetic testing is an ethical battle. Parents have to make medical decisions on behalf of their children’s “best interest,” which is often complex and controversial. As genetic testing becomes more accurate and its uses become more common, these social, legal, and ethical issues will become more familiar and challenging (Botkin 2015).

Social Issues As DTC genetic tests become more available, concerns have been raised about their usefulness in healthcare as well as misinterpretation of results, negative consequences, and accuracy of information (Caulfield and McGuire 2012). Proponents have argued that DTC testing will raise health awareness about genetic risks for various diseases and may motivate individuals to take action to lower their risk. However, this is based on the notion that the general public can accurately interpret the results disclosed through DTC genetic testing (Thrush and McCaffrey 2010).

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23andMe indirectly acknowledges that the consumer may need professional assistance to understand their results by suggesting a genetic counselor (“DNA Genetic Testing and Analysis”).

In 2012, a web-based survey was conducted to evaluate how individuals will react to online genetic risk profiles. The study presented hypothetical genetic risk profiles and surveyed individuals regarding health-seeking behaviors and anxiety. The results showed that, out of 319 participants, 63% anticipated making doctor’s appointments, 40% felt more worried or anxious, and 57% wanted to make lifestyle changes. This study demonstrated that individuals overestimated their ability to correctly interpret their DTC genetic testing results.

Based on these results, consumers of DTC testing companies, like 23andMe, may not fully comprehend the risk information that they receive, and may seek professionals to interpret results, thus increasing the pressure on an already overburdened healthcare system. Conversely, if individuals interpret their own test results, this could lead to negative consequences such as unnecessary anxiety, false reassurance, and unjustified medical changes (Bansback, et al. 2012).

In 2012, an internet-based study examined the perceptions and intentions of 319 individuals who were both actual and potential users of DTC genetic testing. The study showed that the main motivations for pursing genomic services were to discover the risk for disease (78%) and to improve health (78%) (Gollust, et al. 2012). 23andMe has a medical disclaimer on their website stating that the genetic tests are for educational and research purposes rather than a medical diagnosis. However, studies show that consumers’ primary reason for accessing these services is to gain health information and to improve health (Thrush and McCaffrey 2010). Critics also speculate that DTC genetic testing may have a greater effect on individual’s risk perception, psychological distress, and lifestyle changes (Roberts, et al. 2013).

23andMe’s consumers go through a step-by-step process to choose what information they want to receive.

For example, the company does not provide customers with immediate access to the Alzheimer’s disease results; instead, they are required to read through information about testing for the disease before the results are unlocked.

However, it is unclear whether online users read through the benefits, limitations, and risks to learn about test findings and decide whether they are emotionally stable enough to learn the results (Roberts, et al. 2013). For instance, a study reported on consumer outcomes from 32 high-risk individuals who had received breast and ovarian cancer positive results through 23andMe’s Personal Genome Service. Among the 32 participants, 75% did not remember that they had to “unlock” their test results, 48% experienced moderate anxiety, and the majority consulted their primary care physician. The study found that newfound awareness of a high-risk disease leads to individuals seeking medical advice due to their perception of genetic risk (Francke, et al. 2013).

Many primary care physicians express doubt not only about the integrity and utility of DTC genetic testing, but also their own ability to help patients accurately interpret results (Roberts, et al. 2013). For example, a survey was conducted on 382 North Carolina primary care physicians to examine educational needs regarding DTC genetic testing. Out of the 382 participants, 85% reported feeling unprepared to answer patient questions about DTC genetic test results and 61% were unaware of testing in the first place (Powell, et al. 2012). Unfortunately, the current DTC industry is not only confusing and intrusive to customers, but also for physicians who lack the proper education to advice, counsel and educate patients about their genetic testing results (Thrush and McCaffrey 2010). This leads to another big concern for the medical and scientific community, which is the quality and integrity of the test results.

In 2010, the FDA sent warning letters to 23andMe declaring tests to be “misleading and of little or no practical use” (Roberts, et al. 2013). 23andMe’s test accuracy is based on analytical validity or how adequately their scientific evidence can support the correlation between a genetic variant and a particular risk or disease. Currently, the FDA does not oversee clinical validity of DTC genetic testing. The laboratories that perform genetic testing must be certified under the Clinical Laboratory Improvement Amendments (CLIA) of 1988. However, the CLIA does not address results or claims made by the labs regarding the tests. Not only do 23andMe’s labs lack regulatory oversight, but their scientific evidence for gene-disease association is also insufficient (Hudson, et al. 2007).

The challenge lies in the fact that the vast majority of gene variants covered by 23andMe are of a low predictive value. For example, a positive genetic test for breast and ovarian cancer means that an individual has roughly a 50% to 85% chance of developing the cancer, which increases with family history. Thus, consumers must take into account genetic predisposition information to create an effective lifestyle change or proceed with preventative procedures (Caulfield 2010). Overall, consumers are at a significant risk for being lured into selecting tests with unproven benefits, obtaining results that can be misleading, and making decisions without a trained, knowledgeable doctor or genetic counselor (Hudson, et al. 2007).

Legal Issues The personal genome service, 23andMe, is not primarily intended to be medical device but rather a commercial enterprise to collect one of the largest privately-owned genetic databases in the world (Spector-Bagdady 2016). 23andMe’s consent documents acknowledge that once consumers part with their genetic information, there

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are no guarantees to privacy. The company’s consent document states, “We will use your information and share it with third parties for scientific research purposes” (“Privacy and Data Protection”). In the spirit of “improving the future of health care,” individuals easily give consent and sign away their rights, often without fully investigating the fine print. For instance, the company uses click wrap contracts to facilitate transactions with the customer. Click wrap contracts are online agreements that consumers can quickly scroll through and click a button such as “I agree” to sign it. Additionally, DTC contracts are long with complex, uncommon language that an ordinary individual would have difficulty understanding.

23andMe knows that consumers often skip through or misinterpret consent documents and capitalize on this. Conversely, consumers are handing over their genetic, health, and personal information to 23andMe and paying them for the privilege to resell it (Phillips 2006). The actual sale of the test kits to consumers is a leverage tactic to store large amounts of genetic data. For instance, 23andMe offers an inexpensive product to be accessible to the average person in order to acquire broader consumer data and then leverage that data to produce a profit.

Patrick Chung, a 23andMe board member, states that the company is the “Google of personalized health care,” which comes as no surprise considering that 23andMe is financially backed by Google cofounder Sergey Brin (Spector-Bagdady 2016). Although, 23andMe states that they will not share or sell genetic data to third parties without proper consent, consumers have heard this before when Google was founded.

When Google first launched, the privacy policy stated that users’ information would not be sold for advertisement, but a decade later, the company broke its promises and diluted the word “privacy.” Likewise, 23andMe has not proven that their promises of privacy are any more binding than Google (Seife 2013). For instance, 23andMe warns their consumers that “We are the ‘controller’ with respect to your Personal Information because we determine the means and purposes of processing your information when using our Services” (“Privacy and Data Protection”). The company explicitly states that they have control and ownership over the innermost contents of their consumers’ cells, which is a one-way portal for 23andMe to package and resell valuable genetic data (Seife 2013).

The Personal Genome Service has made a number of deals with pharmaceutical and biotech companies to sell genetic information for a wide variety of secondary purposes such as medical or scientific advances. This year, the world’s biggest pharmaceutical company, GlaxoSmithKline (GSK), purchased a 300-million-dollar stake in the DTC industry to gain access to 23andMe’s genetic database to discover new drug targets. GSK’s million-dollar investment gives insight on just how valuable genetic information really is (Molteni 2018). 23andMe’s growing database of genetic information is where the big profits lie. Aside from genetic information, the information that is also valuable is the personal details that accompany it.

23andMe sends out regular questionnaires to their customers and asks questions like, “How frizzy is your hair?” or “What can you taste?” (Hamzelou 2017). Susan Wojcicki, CEO of 23andMe, told a room full of researchers, “Anyone can go get genomes. What’s really hard is the phenotypic data” (Molteni 2018). 23andMe gathers powerful information from the questionnaires in order to correctly predict traits such as the development of a disease which depends on the relationship between genotype and phenotype. Consequently, the information consumers get back from their spit sample is just a small fraction of the total data collected over time. When consumers think about purchasing these tests, it is worth considering how their unique, valuable genetic information will be shared and used in research practices (Hamzelou 2017).

Ethical Issues DTC genetic tests are becoming increasingly popular due to their low cost and availability, but major organizations, such as The American Society of Human Genetics (ASHG), argue that society should be cautious about testing children. As genetically guided, personalized healthcare and popularity of inexpensive DTC genetic tests continue to grow, society is nearing a point in time where nearly everyone will take a genetic test at some point in their lives. In the future, that time could likely be childhood, when decisions and action plans about genetic testing are not made by the ones being tested but rather by their parents. This may not seem like a big deal, because parents already handle personal and medical decisions for their children. However, genetic testing in children is an ethical minefield (White, 2015).

In 2015, the ASHG released a new report that offered recommendations to parents that consider subjecting their children to genetic testing. The report addresses questions such as informed consent, parentage, and physiological effects. Children warrant special consideration, because they lack decision-making capabilities. Thus, parents are responsible for making decision about testing their children with the notion that it is for the child’s “best interest.” The ASHG states that the nature of interests for those who cannot speak for themselves is complex and controversial (Botkin, et al 2015). The report suggests that parents should wait and let their children decide for themselves when they are old enough. Parents may find it difficult to delay testing if they are high risk for a disease

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and want to know whether their child will inherit it (White 2015). However, experts are not convinced that this type of information would be useful to the child or the parent.

Risk information for a disease can mark children with an unwanted medical identity and their parents with unnecessary worry. For example, one could imagine the emotional impact of a child who had the gene for breast cancer or Alzheimer’s (White 2015). ASHG states that the results of DTC genetic testing could leave children to deal with unfair burdens that might have implications for the rest of their life (Botkin, et al 2015). Another point to consider is parentage, which the ASHG says could cause extensive harm to children. 23andMe has testimonies from their customers explaining how their ancestry service helped them find a biological parent or sibling they never knew they had (White 2015). For example, a young college student wrote a blog about his 23andMe experience titled, “With genetic testing, I gave my parents a divorce” (Doe 2014).

The college student gifted the Personal Genome Service to his parents, and the results showed that his father had a child from another relationship. Ultimately, these results tore the nuclear family apart, and his parents got a divorce. The student regrets clicking the inconspicuous close relative box and wishes it had a warning that said, “Check this box and FYI: people discover their parents aren't their parents, they have siblings they didn't know about. If you check this box, these are the things you'll find” (Doe 2014). The student talks to a counselor regularly due to the negative and physiological impacts 23andMe’s results had on his family (Doe 2014). This is just one example of how DTC genetic testing can impact children for the rest of their lives. 23andMe warns in its terms and services that, “you may learn information about yourself that you do not anticipate.” Parents should consider the ASHG guidelines which discourages genetic testing in children unless there is a justified medical relevance (White 2015).

Conclusion 23andMe’s front-end product is an inexpensive, personalized genetic test kit, but its back-end business model is raising a wide variety of social, legal and ethical issues (Spector-Bagdady 2016). DNA determines many aspects of a person, and DTC genetic companies are claiming that they can decode it. Through 23andMe, consumers can unlock their genetic secrets and learn about their ancestry or risk for a disease. These test sound like a bit of fun, but they have a serious side. More seriously, this newfound genetic information can be dangerous (Hamzelou 2017). In 2006, 23andMe harnessed the power of the internet with the motivation for potential profit and consumer interest in self-mediated healthcare by offering genetic testing services directly to the public. The arrival of DTC genetic testing has sparked alarm among healthcare providers, consumer advocates, and governmental bodies (Hogarth, et al. 2008).

The DTC industry is challenging existing regulation because it does neatly fit into any current legal category.

This is due to the fact that 23andMe is an online platform that supplies genetic testing via the internet for a wide variety of purposes, not all of which are medical (Phillips 2016). Critics have raised a number of concerns, such as quality of tests, accuracy of information, phycological risks of consumers and clinical implications. Advocates argue that DTC genetic testing empowers consumers to make healthy, independent medical and lifestyle decisions by educating consumers about their health risks and the steps they can make to reduce those risks. Although these are potential benefits of the DTC model, their argument requires that the risk information is accurate, that consumers can interpret their own results, and that personal information is protected.

Based on support provided, 23andMe should be more transparent about the accuracy of their tests and limitations of their computer algorithms used to estimate disease risk percentages. There needs to be agreed upon standards to which the company can validate the hundreds of variants used to make disease-risk associations. A vast majority of studies support that individuals have difficulty understanding complex numerical values and have a tendency to overrate the clinical benefits of these tests. Critics argue that, without medical context and qualified professionals, consumers are vulnerable to unnecessary anxiety, false reassurance, and unjustified medical changes.

It should also be noted that DTC testing could pose an additional social cost in an already scarce healthcare system if it leads to unnecessary doctor appointments, medical tests, and procedures (Hogarth, et al. 2008).

Additionally, advocates should realize that DTC testing needs to be governed by appropriate safe guards to protect the privacy of consumer genetic information (Hogarth, et al. 2008). 23andMe has front-end technology that makes genetic data accessible to the average person by offering their services at a lower price, which, in turn, helps them create a large, diverse genetic database to profit on. The company is upfront about their collaboration with pharmaceutical and biotech companies, but the fine print in their consent documents can be misleading to consumers. 23andMe’s DTC contracts need to be shorter, more interactive, and they need to use appropriate language for consumers to understand how their information is being used and shared. Likewise, 23andMe is much more than a medical device; it is expanding into the “Google of healthcare” where corporations can buy a portion of consumers’ genetic information to promote “scientific” discovery (Spector-Bagdady 2016).

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When the FDA evaluates 23andMe, they should not only consider consumers’ misunderstanding of information and policy, but also the misuse of the genetic database and the implications of the information generated (Spector-Bagdady 2016). However, establishing a clear oversight system is challenging due to the lack of existing protocol and the lack of agreement about the need for and type of regulation for DTC tests. In relationship to privacy challenges, informed consent and accountability issues have been raised by experts. Advocates like to argue that parents should have the right to know if their child is susceptible to inheriting a disease. In the future, it may be inevitable that genetic testing in children will be common. As of now, the ASHG has raised alarms against genetic testing in children, because children are young, and decisions that are made for them might have implications for the course of their lives (White 2015).

The DTC genetic testing industry has a long way to come before experts can be confident that genetic tests are reliable, meaningful, and understandable for children and adults. The ASHG believes that there is a means to an end. The ASHG argues that, “As genetic and genomic tests become more accurate and their use becomes more common, the ethical, legal, and psychosocial challenges will become more familiar and less worthy of statements of this sort.” Until then, experts believe that everyone should think twice before signing away their genetic information (White 2015). In the short term, it is desirable that 23andMe improve their reliability, website transparency, and contracts, develop a better platform for consumers to understand results, and acquire an industry code of conduct.

Currently, the DTC genetic testing industry continues to proliferate, while policies to ensure their quality and safety have lagged behind. In the long term, there should be industry-specific regulations, educational initiatives to help consumers and professionals understand results, and FDA control over privately-owned genetic databases (SpectorBagdady 2016).

Citations Bansback, Nick, et al. “The effect of direct-to-consumer genetic tests on anticipated affect and health-seeking behaviors: a pilot survey.” Genetic Testing and Molecular Biomarkers 16.10 (2012): 1165-1171.

Botkin, Jeffrey R., et al. “Points to consider: ethical, legal, and psychosocial implications of genetic testing in children and adolescents.” The American Journal of Human Genetics 97.1 (2015): 6-21.

Caulfield, Timothy, et al. “Direct‐to‐consumer genetic testing: good, bad or benign?” Clinical Genetics 77.2 (2010): 101-105.

Caulfield, Timothy, and Amy L. McGuire. “Direct-to-consumer genetic testing: perceptions, problems, and policy responses.” Annual Review of Medicine 63 (2012): 23-33.

“DNA Genetic Testing and Analysis.” 23andMe. https://www.23andme.com.

Doe, George. “With Genetic Testing, I Gave My Parents the Gift of Divorce.” Vox, 9 Sept. 2014, www.vox.com/2014/9/9/5975653/with-genetic-testing-i-gave-my-parents-the-gift-of-divorce-23andme.

Francke, Uta, et al. “Dealing with the unexpected: consumer responses to direct-access BRCA mutation testing.”

PeerJ 1 (2013): e8.

Gollust, Sarah E., et al. “Motivations and perceptions of early adopters of personalized genomics: perspectives from research participants.” Public Health Genomics 15.1 (2012): 22-30.

Hamzelou, Jessica. “DNA tests put your genes on sale.” New Scientist 3146 (2017): 22-23.

Hogarth, Stuart, Gail Javitt, and David Melzer. “The current landscape for direct-to-consumer genetic testing: legal, ethical, and policy issues.” Annu. Rev. Genomics Hum. Genet. 9 (2008): 161-182.

Hudson, Kathy, et al. “ASHG statement on direct-to-consumer genetic testing in the United States.” American Journal of Human Genetics 81.3 (2007): 635 Molteni, Megan. “23andMe's Pharma Deals Have Been the Plan All Along.” Wired, Conde Nast, 6 Aug. 2018, www.wired.com/story/23andme-glaxosmithkline-pharma-deal/.

Phillips, Andelka M. “Only a click away—DTC genetics for ancestry, health, love… and more: a view of the business and regulatory landscape.” Applied & Translational Genomics 8 (2016): 16-22.

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Powell, Karen P., et al. “Educational needs of primary care physicians regarding direct-to-consumer genetic testing.”

Journal of Genetic Counseling 21.3 (2012): 469-478.

“Privacy and Data Protection.” 23andMe. https://www.23andme.com/privacy/.

Roberts, J. Scott, and Jenny Ostergren. “Direct-to-consumer genetic testing and personal genomics services: a review of recent empirical studies.” Current Genetic Medicine Reports 1.3 (2013): 182-200.

Seife, Charles. “23andMe Is Terrifying, but Not for the Reasons the FDA Thinks.” Scientific American, 27 Nov. 2013, www.scientificamerican.com/article/23andme-is-terrifying-but-not-for-the-reasons-the-fda-thinks/.

Spector-Bagdady, Kayte. ““The Google of Healthcare”: enabling the privatization of genetic bio/databanking.”

Annals of Epidemiology 26.7 (2016): 515-519.

Thrush, Sharon A., and Ruth McCaffrey. “Direct-to-consumer genetic testing: what the nurse practitioner should know.” The Journal for Nurse Practitioners 6.4 (2010): 269-273.

White, Michael. “Why We Should Think Twice About Giving Genetic Tests to Our Kids.” Pacific Standard, 23 July 2015, www.psmag.com/social-justice/why-we-should-think-twice-before-giving-genetic-tests-to-kids.

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Alina Cirstea is a sophomore, majoring in Political Science and minoring in Digital Media, Art and Design (DMAD).

She has been taking photos since she was young, but has started to become more interested in it in the past couple semesters. Her inspiration for her art comes from how she is feeling, using writing and photos as an outlet. She posts poems and photography on her Instagram @pixbyalina.

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The Holston Vol. III Spring 2019

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