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You have full access to this open access article. This article sets out to investigate the marketing of image and performance enhancing drugs IPEDs on the social media platforms Facebook and Instagram. Techniques identified include athlete sponsorship, the sharing of bodybuilding fitspiration content, self-objectification, posting images showcasing transformation photos and customer feedback, and seasonal sales and promotions. Analysis encompasses the centrality of product branding, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study. Finally, conclusions relating to the implications of these findings to scholarship, policy, and regulation are offered. The use and supply of image and performance enhancing drugs IPEDs has come under sustained scholarly scrutiny over the last decade Evans-Brown et al. HEDN identify the most common muscle drugs as anabolic androgenic steroids AAS and human growth hormone hGH as well as highlighting the polypharmacy undertaken by most muscle drug users with, amongst other types of enhancers, weight-loss drugs like clenbuterol and human chorionic gonadotropin HCG consumed alongside the muscle-drugs themselves. Anabolic androgenic steroids are a class of drugs that include the male hormone testosterone, or a synthetic derivative of it, that are commonly employed to bolster muscular performance and strength, improve athletic ability, and achieve a lean muscular appearance Christiansen PCT describes taking drugs and supplements to mitigate or reverse negative side effects of AAS and restore natural hormone levels in the body Christiansen et al. Turning to the IPED market, although scholarship has long noted its peer-reliant, culturally embedded nature Coomber et al. Importantly, this is not to say that traditional offline markets have ceased to exist. Instead, the UK IPED marketplace can be conceptualised as a dual space, wherein hardcore fitness networks provide culturally embedded users with readymade supply chains Coomber et al. Importantly however, this is not to say that overlap does not exist between these two aspects of the market and, as will be discussed in this paper, the online often bleeds into the offline as well as offline norms and cultures manifesting in online spaces Gibbs and Hall Analysis will encompass the centrality of product branding, the inherent distrust of social media sales, the importance of building a trustworthy brand online, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study in order to enhance knowledge of this rapidly evolving online marketplace. The market for image and performance enhancing drugs has undergone seismic changes in the last two decades and, as has been alluded to above, its partial digitisation has created something of a dual space of commerce Gibbs, Forthcoming. Before presenting an overview of the supply-side of the market however, it is worth considering the production of IPEDs. Underground labs can be defined as illicit operations where IPEDs, most commonly anabolics androgenic steroids, are produced from these imported powders outside of registered pharmaceutical manufacture. These operations vary in scale from minor set-ups with minimal expertise, to large-scale production staffed by highly specialised but illicitly operating staff capable of producing a wide range of enhancement drugs beyond just AAS see Gibbs Forthcoming , for an overview of the UK UGL market. The public health challenges of such production are widely reported, encompassing product dosing, hygiene, and contamination Llewellyn and Tober ; Coomber et al. Analogous substances like post-cycle therapy drugs and human growth hormone, on the other hand, are generally produced in licit pharmaceutical laboratories in jurisdictions with more lax regulations and subsequently imported or removed from domestic pharmaceutical supply chains by illicit actors Fink et al. As has been alluded to above, empirical evidence indicates that the bulk of IPED transactions occur between peers operating within sporting or fitness-related contexts van de Ven and Mulrooney ; Sagoe et al. Coomber et al. However, Coomber and Moyle critique the concept of social supply on account of its dismissal of the fundamentally economic nature of drug transactions. Firstly, a raft of literature points to a professionalisation of the IPED market. Fincoeur et al. This is supported by Salinas et al. Secondly, changes in the global accessibility of IPEDs have occurred due to the rise of online selling. This includes users sourcing products online as self-prescribed testosterone replacement therapy TRT Dunn et al. Scholarly research into social media drug supply, although still relatively scant, has grown substantially in recent years see Moyle et al. Examining the social media market for cannabis, cocaine, and prescription medications, Demant et al. Further, the researchers identified that the Facebook groups through which sellers advertised their products tended to be open to the public and therefore sellers were, on the whole, overt about their enterprise. Further, Shukman notes that, on Instagram, sellers employ hashtags including anabolic and performanceenhancement to increase the searchability of their marketing posts, therefore allowing consumers to simply search for their desired product in much the same way as conventional e-commerce sites. It is this context that foregrounds this paper and, in the absence of any substantial prior research explicitly addressing the marketing of IPEDs on Facebook and Instagram for a recent exception, see Cox et al. Alongside an understanding of the contemporary IPED market, it is also crucial to explore the licit health and fitness industry and its digitised advertising apparatus in order to contextualise the IPED marketing strategies that will be set out below. More presciently, the various lockdowns and limitations on physical space accelerated the already burgeoning online fitness market Nyenhuis et al. This typically involves users documenting their workouts alongside motivational quotations and training advice. Given the above outline of the partial digitisation of the IPED market, this article sets out to explore the marketing strategies employed by IPED sellers on social media platforms, and any potential synergies or replication between the licit and illicit economy. Therefore, given that the same fundamental injunction to turn a profit binds the licit and illicit economy, it stands to reason that social media IPED suppliers share some of these methods in their selling efforts. The year-long mixed methods study — conducted between and —encompassed online and offline ethnographic observation, which saw the author train alongside participants around five times a week, conduct twenty-eight semi-structured interviews with gym users and those involved in the consumption and supply of IPEDs, undertake digital ethnography on Facebook and Instagram, and conduct online interviews with IPED suppliers. Data variously took the form of interview transcripts, pages of digital ethnographic screenshots, and offline fieldnotes. These were then thematically analysed. Participants were initially recruited using purposive sampling on social media, followed by a snowball approach. Pseudonyms were assigned to anonymise their identities, and the names of IPED brands as well as any identifiable information in the dataset were redacted as is demonstrated in the various pictorial data presented below. Finally, unlike Demant et al. First, underground laboratory representatives — who supply most prevalently on Facebook—sell exclusively on behalf of the UGL they are affiliated with, acting to promote a specific brand. In reward, they are offered commission for their sales. Certain brands opt to be more visible than others on social media and, over the course of the fieldwork, the underground lab representatives most frequently encountered were mainly from Phoenix Labs, Energise, Victory Labs, and KSI. Their modus operandi generally involves creating private Facebook groups through which to advertise their products and offer advice and guidance see Gibbs, Forthcoming. Further, unlike the actors that Hall and Antonopoulos identified in the illicit medicines trade, UGL representatives tend to be British as a result of the domestic nature of the underground lab economy and, unlike most recreational drug sellers on social media, they are open about their identity within the groups that they operate. Unlike UGL representatives, independent IPED resellers may carry various different UGL brands and different medicinal products and therefore do not necessarily represent a specific producer. With that said, most of these suppliers appear to have long-standing relationships with certain online pharmacies or underground labs and although not exclusively stock and advertise their products. For this reason, their nationality is unclear from their profiles. However, following numerous interactions with such sellers, data collected in this project suggests that most operate from nations like China, Pakistan, Turkey, and Ukraine see Hall and Antonopoulos Table 1. Interaction is then typically transferred to an encrypted messaging service like WhatsApp, Kik, or Wikr see Moyle et al. Important to note however is that this seller typology is certainly not comprehensive, and some actors might move between these categorisations or indeed overlap the two. With this in mind, echoing Christiansen et al. Therefore, the two categories of social media seller ought to be viewed as an approximation of two market positions observed within the broader research project, which may be refined following further study. Echoing the often eye-catching branded presentation of ecstasy and other drugs like LSD then Duterte et al. This sentiment can be extended from UGLs to independent IPED resellers who, given the inherently untrustworthiness of illicit drugs markets Tzanetakis et al. The notion of branding and self-presentation by illicit drug dealers on social media has recently been addressed by Bakken , who analysed illicit drug supplier Facebook profiles in Scandinavia to shed light on how individuals who sold cannabis, ecstasy, and other controlled substances, use their profiles to enhance their business. Their research uncovered a suite of differing approaches to username brand creation from illicit drug sellers, including sleek professional presentations, plagiarising real-life brands and characters, and explicit controlled drug references. Therefore, this article aims to track the adaptations and crossovers with these tactics found on the Facebook and Instagram IPED markets in order to add to the existing literature. A further consideration, however, is the illicit nature of the products on offer and therefore the underlying awareness of law enforcement. This is documented by Lusthaus in his exploration of trust in cybercrime networks. Unlike the licit economy, where digital marketing teams unproblematically seek maximal exposure Pauwels and Dans , illicit online actors must not be overly explicit in their customer soliciting, especially on surface web platforms Bancroft et al. This is addressed by Bakken and Harder in their comparison of licit and illicit cannabis markets on social media. They found that illicit actors, in countries where cannabis is not legalised, opted not to use images or showed only blurry, functional content rather than any market gloss, and were business-like and impersonal in nature. However, the wider IPED market is generally poorly regulated and is certainly not a high priority for law enforcement Gibbs et al. As such, sellers might exhibit riskier marketing behaviours compared to their more heavily regulated counterparts in recreational drug supply. Finally, Bakken notes the lack of a formalised feedback system on social media sites compared with dark web and surface web forum illicit drug supply Hardy and Norgaard ; Turnock a , which is particularly challenging given that online markets require democratised customer review systems in place of relationships and social capital Tzanetakis et al. As such, the strategies to maximise customer rapport and establish credibility presented below are of paramount importance to this market. This will be followed by a discussion focussing on the overlaps between the licit and illicit ergogenic aids industries, the affordances of the social media platforms under study, and the implications for those regulating the IPED market. The first means by which underground labs build brand recognition and establish trust is the use of sponsored athletes. As such, UGL representatives are aware of the sanctity of creating promotional networks that can vouch for their trustworthiness. It should be noted here that sponsored athletes are distinct from UGL representatives as, whilst both of these actors operate on behalf of their underground labs, brand ambassadors are not involved in the actual sale of illicit products and instead function to offer advice, guidance, and promotion. Therefore, underground labs select influential figures in the fitness community and renumerate them for showing public affiliation to the lab. Then obviously in turn my clients use the brand. The latter of these categories is epitomised by Carl, an amateur forty-six-year-old bodybuilder from Wales, who held a number of UGL sponsorships, including Phoenix, during the data collection period. Most brand ambassadors appear to be approached by their sponsors. This is particularly true of participants with a high degree of influence in the IPED community like Rob, who incredulously recounted his experiences of being solicited by Phoenix:. Phoenix sent me fifty vials of their gear for no apparent reason whatsoever. This highly public advertising, operationalised by various UGLs see Figs. Whilst the inclusion of brand names in public posts may appear reckless, unlike general drug hashtags like buysteroidsUK, underground lab brand names require a degree of cultural embeddedness to access. Publicly available hashtagging appears to be more prevalent in amateur brand ambassadors, compared to IFBB Pros or other elite athletes. Despite his unexceptional following however, Carl compensated for his limited reach with his trust-building potential. Echoing licit fitness influencers then, Carl functions as a guarantor of quality and legitimacy as his bodily progression is testament to his successful IPED use, facilitated by the UGL. Therefore, by acting as the public face of the lab, brand ambassadors afford the operation a heightened level of cultural embeddedness, attempting to replicate the offline models of social supply van de Ven and Koenraadt ; van de Ven and Mulrooney in that sales are based on tailored, holistic consultation rather than faceless online interaction see Gibbs et al. Whilst such tactics can be interpreted as a mere profit maximisation exercise, this is perhaps a reductive reading. Having since moved away from Phoenix Labs, Carl represented Inception, a smaller British UGL, at the close of the data collection period, Footnote 3 and was keen to portray their genuine, well-intentioned marketing approach:. Less pressure, if you want to buy you can buy but a lot of advice is offered, free advice. UGL Inception demonstrate a responsible vending approach Van Hout and Bingham , encouraging their sponsored athletes to offer free advice around nutrition, training and safe IPED use. Alongside overt brand affiliation signifiers like hashtagging, UGLs also utilise brand ambassadors in a more subtle, community-embedded manner. As demonstrated, although social media was used to recruit Sam initially, the bulk of his referrals occurred offline in the gym setting. Thus, capitalising both upon the gradual normalisation of IPED use in the gym and the burgeoning social media market Richardson et al. Then you need to tag us in every post that you have. Having no legally binding contract in place, his relationship with the UGL was entirely based upon trust, which is problematic given the power differential at play Beckert and Wehinger Carl faced an ultimatum to either risk prosecution or be cut adrift, which ultimately led to him working with Inception in a more advisory role. During a follow-up interview with Sam, questioning turned to his sponsorship with Phoenix and whether the arrangement was still in place:. Have you made many referrals? So anyway, I have ended up just going through \[a local supplier\] instead. Phoenix appeared to have been negatively affected by the fall in demand that occurred over the nationwide lockdown see Gibbs ; Zoob Carter et al. Underground labs also employ the more insidious tactic of creating fake profiles and constructing fictitious conversations in order to subversively market their operations. This strategy was summed up by Rob, as he laid out a hypothetical marketing plan that he would follow if he were to set up a lab:. Not even direct marketing, very very subversive, you know? UGLs can exploit the relative anonymity of social media platforms Schlesinger et al. Such deceptive practices echo the challenges of fake customer reviews on licit e-commerce sites like Amazon and the concerted research and resources that have been mobilised to detect and regulate them see Paul and Nikolaev ; Salminen et al. Here, we can see that attempts at building trust and kinship are entirely curated Bakken Therefore, this underhand marketing technique provides what appears to be organic electronic word of mouth marketing eWOM Phua and Ahn to unknowing social media users. Ultimately, the use of deception illustrates just how muddy the waters of the social media IPED market are, and the need for vigilance from the consuming population. The first tactic mobilised by social media resellers involves echoing common tropes of bodybuilding fitspiration, wherein motivational content that mirrors the vernacular and sentiment of hardcore fitness culture is posted on their social media profile, in order to appear more proximate to their customer base. An example of this behaviour is demonstrated in Fig. This post functions on several levels. However, the utilisation of fitspiration-style content may also function to stimulate a sense of bodily lack and self-awareness in the prospective consumer, leaving them more susceptible to purchasing IPEDs. This is again reflected in Fig. Though this self-presentation could be construed as genuine, it seems likely that the posts are primarily a means of maximising customer engagement and, ultimately, sales. The ploy can be understood in relation to the inherent challenge of being perceived as legitimate and building trust with prospective consumers online as, given the technologically mediated interactions that the sellers rely upon, they must construct enough cultural capital in their posts to convince consumers of their trustworthiness Koenraadt Perhaps the most striking means by which IPED sellers position themselves alongside their customer base is a utilisation of their own bodily transformations. In doing this, it appears that the reseller is aware of the inherent mistrust in online sellers and is therefore attempting to emulate the tropes of social, community-based supply van de Ven and Koenraadt It appears that this seller all but disregards the threat of the regulatory authorities Gibbs et al. However, given the similarity of the licit and illicit ergogenic aids markets online, it is unsurprising that this practice has bled from PTs and other fitness professionals into the illicit IPED market. This is one of the most striking similarities between the online IPED marketplace and behaviours exhibited by many personal trainers as, without the captions attributing the purported transformations to IPEDs, these could be mistaken for those of legitimate fitness professionals Hockin-Boyers et al. However, as has been widely documented, images mediated through social media may have been doctored and filtered Bell ; Leaver et al. More troublingly, due to the lack of regulation, the legitimacy of the images in Figs. This speaks to the lowered barriers of entry to IPED supply brought about by online trade and how this lack of cultural capital can be exploited by sellers. Despite this fakery, the production of transformation images allows the seller to simultaneously advertise their products and dispel the distrust within the marketplace. Though the physiques in Fig. The penultimate utilisation of social media platforms by online suppliers is the sharing of customer feedback in an effort to prove the legitimacy of their operation. This is exemplified by Instagram supplier muscledelivery Fig. The story acts as a guide to prospective customers, as the seller instructs the viewer to privately message the account with a specific emoji to order. This alludes to the lack of official protocol in the social media IPED market as, unlike online pharmacy websites, the customer may not be aware of the norms of social media market interaction given its relative infancy Demant et al. The role of technology in facilitating the instantaneous mass dissemination of content is also evident here as, unlike traditional offline sellers, muscledelivery is able to reach all of their followers with one simple marketing message, rather than soliciting individual users. As demonstrated in Figs. Finally, Fig. Bakken and Harder discuss this in relation to licit market female cannabis influencer behaviour. They contend that a gendered showcasing of their cannabis products, including deliberate lighting and positioning, sells the lifestyle of the substances to their followers. Though not gender-specific and far from aesthetic, arguably seller Cyber Steroids deliberately employs this humorous — perhaps even kitsch — presentation to stand out in the congested market and create an element of uniqueness to their brand. This was variously manifested as athlete sponsorship, an emphasis on cultural proximity through bodybuilding fitspiration and self-objectification, electronic word of mouth advertising, and the display of complimentary customer feedback. Indeed, it is not always clear whether tactics like sharing bodybuilding fitspiration and posting supposedly self-curated bodily content truly aim to build kinship, or instead simply intend to bolster the likelihood of sales. Though these two aims are certainly not mutually exclusive, this work draws slightly more dour conclusions about the implementation of such tactics compared to van de Ven and Koenraadt This is further echoed in the diverse landscape of athlete sponsorship. On one hand, brand ambassadors like Carl, in his work for Inception, are able to offer knowledgeable best practice and other guidance see Gibbs et al. However, what remains, despite these questions about intent and authenticity, is a commitment to building a coherent brand that can be recognised and trusted by the consumer. Finally, although the wider research project identified social media resellers as less inclined to reveal their identity compared to UGL representatives, the above strategies broadly challenge the awareness of the transparency paradox discussed by Tzanetakis et al. Hall navigates this development of digital prosumption expertly in relation to the wider lifestyle drug online market. She contends that the lines between producers and consumers have blurred considerably, going some way to explaining this bold marketing strategy. The reason for this openness compared to other illicit markets, it can be argued, is the relative under-policing of IPED supply and the lowly position that substances like anabolic steroids occupy in law enforcement priorities Gibbs et al. This is a potentially prescient finding in relation to policy and policing and adds texture to discussions about trust and branding. This is certainly true of the social media IPED market, as a number of practices have been shown to have transcended the legal mainstream economy to have become embedded in the practices of UGL representatives and social media resellers. Principal amongst these is the deployment of sponsored athletes by UGLs, actors who employ calibrated amateurism Abidin and aspects of anabolics coaching Gibbs et al. This should not come as a surprise given that the ultimate aim of the IPED suppliers, just like any commercial actor, is to accrue capital, and social media has become a prime site through which to sell a host of licit and illicit products Fuchs The numerous points of convergence, therefore, simply represent the most effective means of online branding and marketing for a commodity that is a low priority for law enforcement. However, certain cultural aspects also account for the coherence of the techniques under study. As was detailed in Section ' The digitised health and fitness industry '. Therefore, these social media marketing practices, it can be argued, would not have come to fruition without two symbiotic elements. First, the digital fitness culture prosumed by prospective customers, and second, the existing highly effective practices of licit commerce. To first address the former of these, a fundamental capitalist logic undergirds the replication of mainstream marketing tactics in the social media IPED market. Facebook and Instagram, by design, lend themselves to the perpetuation of capital and the stimulation of consumer desire both as spaces of commerce for example, in-app purchasing and advertisement particularly the monetisation of self-representation afforded to social media influencers van Driel and Dumitrica As is argued above, the digitisation of fitness is symbiotic with the burgeoning licit and illicit social media ergogenic aids market, and therefore Facebook and Instagram allow non-culturally embedded sellers Fincoeur et al. However, whilst social media platforms have proven to be fruitful avenues for the supply of IPEDs and other illicit substances Demant et al. True to the current literature on the inherent distrust in online illicit drugs markets, analysis uncovered multiple elements of deception by social media IPED sellers which, ironically, potentially functioned to undermine attempts to establish a trustworthy brand. Therefore, whilst social media platforms may be potent marketing tools for the seller, the customer perhaps does not benefit from this development. This has potentially negative consequences for the safety of users and the regulation of the market. This work has set out to interrogate the means by which IPED suppliers utilise the social media platforms Facebook and Instagram to build a coherent brand and market their products. Set against the context of the partial digitisation of the IPED market Turnock a ; Gibbs Forthcoming and the burgeoning centrality of the online in the health and fitness industry, data from a year-long connective ethnography has been analysed to first establish a typology of social media IPED sellers, before showcasing a number of techniques employed by each. Sellers can be crudely placed into two categories: UGL representatives and social media resellers. UGL representatives, who sell on behalf of specific IPED producers, have been shown to mobilise athlete sponsorship and the creation of fake profiles and deception in order to build a strong brand and maximise their sales. As has been discussed, several themes underpinned these techniques. Secondly, obvious parallels and points of transcendence have been noted between the licit health and fitness industry and the social media IPED market. Finally, the suitability and affordances of Facebook and Instagram in facilitating the marketing of IPEDs are striking. Although the platforms somewhat stimulate the inherent distrust of social media illicit drug supply through their susceptibility to deception, the same capitalistic features cultivated by the sites to facilitate licit trade ultimately serve the illicit economy equally as well. This invites further investigation into the in-built suitability of social media platforms to illicit substance marketing, and raises concerning questions as to the regulation of illegal activity on the sites. Ultimately, this article has addressed the lacuna in scholarship around the online marketing of IPEDs, building upon the work of Mackey and Nayyar and van de Ven and Koenraadt to present novel and prescient data that can inform scholarly understanding of illicit drugs markets, policy, and regulation. 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Sociol Health Illness 33 5 — Yar M Crime, media and the will-to-representation: Reconsidering relationships in the new media age. Crime Media Cult 8 3 — Internet Res. Front Psych — Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Nick Gibbs. Approval was obtained from the ethics committee of the Northumbria University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Gibbs, N. Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram. Trends Organ Crim Download citation. Accepted : 23 February Published : 28 March Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Trends in Organized Crime Aims and scope Submit manuscript. Download PDF. Abstract This article sets out to investigate the marketing of image and performance enhancing drugs IPEDs on the social media platforms Facebook and Instagram. Fit for life: A content analysis of fitness tracker brands use of Facebook in social media marketing Article 15 September Use our pre-submission checklist Avoid common mistakes on your manuscript. Introduction The use and supply of image and performance enhancing drugs IPEDs has come under sustained scholarly scrutiny over the last decade Evans-Brown et al. The IPED market The market for image and performance enhancing drugs has undergone seismic changes in the last two decades and, as has been alluded to above, its partial digitisation has created something of a dual space of commerce Gibbs, Forthcoming. The digitised health and fitness industry Alongside an understanding of the contemporary IPED market, it is also crucial to explore the licit health and fitness industry and its digitised advertising apparatus in order to contextualise the IPED marketing strategies that will be set out below. Table 1 Captures the main characteristics of these seller types Full size table. Underground laboratory marketing strategies Athlete sponsorship The first means by which underground labs build brand recognition and establish trust is the use of sponsored athletes. N: Do you get any sort of financial discount for doing that? Full size image. Conclusion This work has set out to interrogate the means by which IPED suppliers utilise the social media platforms Facebook and Instagram to build a coherent brand and market their products. Data Availability The data that support the findings of this study are available on request from the corresponding author, Dr Nick Gibbs. Penguin, Harmondsworth Google Scholar Greenway CW, Price C A qualitative study of the motivations for anabolic-androgenic steroid use: The role of muscle dysmorphia and self-esteem in long-term users. Bristol: Policy Press Gibbs N. J Subst Abus 20 4 — Google Scholar Koenraadt R The illicit medicines trade from within: An analysis of the demand and supply sides of the illicit market for lifestyle medicines. Bristol University Press, Bristol Mackey TK, Nayyar G Digital danger: a review of the global public health, patient safety and cybersecurity threats posed by illicit online pharmacies. Ann Epidemiol 24 5 — Article Google Scholar Salinas M, Floodgate W, Ralphs R Polydrug use and polydrug markets amongst image and performance enhancing drug users: Implications for harm reduction interventions and drug policy. Front Psych — Google Scholar Download references. Funding No funds, grants, or other support was received. Informed consent Informed consent was obtained from all individual participants included in the study. Conflicts of interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. About this article. Cite this article Gibbs, N. Copy to clipboard. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

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