Genetics of Nicotine Addiction - Examining Ethics and Policy
PI: Barbara Koenig, Ph.D.
CO-INVESTIGATORS: Judy Illes, Ph.D., Tom Raffin, M.D., Robert Malenka, Mildred
Cho, Ph.D.
PROJECT DATES: start 9/30/02
FUNDER: National Institutes of Health
Studies are currently underway to examine the genetic factors contributing to smoking, including starting to smoke, nicotine dependence and inability to quit. New molecular genetics approaches to substance dependence are using advances in science to illustrate drug-induced alterations in the human brain. By providing a better understanding of the biological mechanisms and brain impacts of nicotine addiction, this unfolding body of genetic research is expected to fuel developments in pharmacogenetics (the effort to target drugs according to individual or group predisposition), to create new genetic tests, and ultimately, to provide the basis for innovative strategies for smoking cessation and preventive interventions.
Although genetic research on smoking behaviors and nicotine addiction is still in its infancy, it is likely to induce fundamental changes in our views of smoking, which in turn will have significant impacts on existing and future policies to reduce tobacco use. Even before any practical applications are developed, the identification of genetic variations associated with nicotine dependence will contribute to the emergence of a "genetic understanding of smoking," that may cast additional stigma on smoking and smokers or, if understood in an overly simplistic and deterministic way, shift responsibility for addiction away from the cigarette (and the tobacco industry) and onto individuals' genetic make-up. Crucial issues will also arise if genetic tests are developed. Who should be considered at high risk, and thus be tested, for what may be a "genetic susceptibility to nicotine addiction?" How can genetic research findings, and eventual testing, best be integrated with current medical and public health efforts to reduce smoking prevalence? Given the central importance of brain functioning in the development of nicotine addiction and other addictive behaviors, new drugs that will ensue from developments in pharmacogenetics of nicotine addiction may include psychotropic drugs (those which directly affect the brain). Should we use pharmacological manipulation of the brain to further reduce the prevalence of smoking?
Clearly, evolving genetic research findings raise important ethical, social and policy issues that require further investigation through a combination of descriptive, empirical research (characterizing what "is") and normative analysis (examining what "ought" to be). Very limited research exists on the impact of molecular genetics approaches to complex traits such as smoking that have both biological and behavioral components. Previous research in ethics and genetics policy has focused more on the impact of genetic testing for single-gene disorders, such as cystic fibrosis, or for hereditary forms of cancers. Given the novelty of genetic research on common and rare genetic variations associated with complex disorders and behaviors, and the variety of potential applications - from pharmacogenetics, to genetic testing and work on how genes work in the brain - previous studies provide a limited perspective from which to anticipate key ethical, social and policy implications.
The goal of the project is to provide policy makers with a clear understanding of the potential impacts and limitations of this research, assure that genetic research findings will integrate harmoniously in current public health measures to reduce tobacco use, and contribute to a responsible and sensitive use of genetic research findings on addic-tive behaviors in future formulations of tobacco control policy. To this end, the project will:
- assess the state of scien-tific knowledge about the genetic basis of smoking behaviors and susceptibility to nicotine addiction,
- anticipate and characterize clinical and preventive health applications based on this knowledge, and
- examine the emergence of a genetic understanding of smoking among key stakeholders in tobacco control. Based on results from this empirical in-vestigation, and in consultation with an Advisory Board composed of renowned ethics and policy experts, the proposed project will lay the groundwork for normative analysis that will seek to
- delineate and evaluate the foreseeable impact of genetic explanations on existing smoking control policies, such as public health strategies and treatment programs, and,
- identify and analyze key ethical, legal and social consequences of a genetic understanding of smoking behaviors.
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