Integrating Genetic Studies of Nicotine Addiction into Public Health Practice: Stakeholder Views on Challenges, Barriers and Opportunities

Abstract

Objective: Will emerging genetic research strengthen tobacco control programs? In this empirical study, we interview stakeholders in tobacco control to illuminate debates about the role of genomics in public health. Methods: The authors performed open-ended interviews with 86 stakeholders from 5 areas of tobacco control: basic scientists, clinicians, tobacco prevention specialists, health payers, and pharmaceutical industry employees. Interviews were qualitatively analyzed using standard techniques. Results: The central tension is between the hope that an expanding genomic knowledge base will improve prevention and smoking cessation therapies and the fear that genetic research might siphon resources away from traditional and proven public health programs. While showing strong support for traditional public health approaches to tobacco control, stakeholders recognize weaknesses, specifically the difficulty of countering the powerful voice of the tobacco industry when mounting public campaigns and the problem of individuals who are resistant to treatment and continue smoking. Conclusions: In order for genetic research to be effectively translated into efforts to minimize the harm of smoking-related disease, the views of key stakeholders must be voiced and disagreements reconciled. Effective translation requires honest evaluation of both the strengths and limitations of genetic approaches.

Challenges in Translational Research: The Views of Addiction Scientists

“…The data are from a large study exploring the geneticization - viewing diseases, conditions, and behaviors as being determined all or in part by genetic factors - of addiction. [21] , [22] , [23] , [24] The broader study captures the views of addiction patients as well as scientists' thoughts on the definition of addiction phenotypes and etiology. We examined scientist perspectives on the topic of translation because they are important stakeholders who possess a deep understanding of the science and its potential applications.…”

How Pharmaceutical Industry Employees Manage Competing Moral Commitments

“…To date, however, qualitative research has not shed much light on the values that drive industry employees. Instead, qualitative studies of the pharmaceutical industry have focused on industry employees' views about corporate social responsibility in general (Zaharia and Ghenghea [Mladin] 2011; Lee and Kohler 2010) and specific aspects of pharmaceutical strategy and policy such as facilitating and financing innovation (Biedenbach 2011), responding to new scientific paradigms (Dingel et al 2012), conducting strategic clinical trials (Eisenstein et al 2008), engaging with consumers (Hemminki, Toiviainen, and Vuorenkoski 2010), protecting intellectual property (Horikawa, Tsubouchi, and Kawakami 2009), regulating industry activities (Laeeque et al 2006), contending with globalisation (Wertheimer and Norris 2009), and facilitating good clinical practice (Wang et al 2010). …”

Public Health Genomics : translation of genomic research on smoking behaviour into evidence synthesis and guidelines for public health

“…Targeted interventions (in drugs, dose and duration) based on genomic factors can enhance smoking cessation through more precise and personalised interventions [34]. As smoking is a complex disorder, it is unlikely that only one gene will be sufficient to develop personalised interventions [35]. Moreover, the integration of genomebased information, i. e. genome-environmental interactions, into public health policies and practice needs strong evidence of causation, efficacy and cost-effectiveness [35].…”

“…As smoking is a complex disorder, it is unlikely that only one gene will be sufficient to develop personalised interventions [35]. Moreover, the integration of genomebased information, i. e. genome-environmental interactions, into public health policies and practice needs strong evidence of causation, efficacy and cost-effectiveness [35]. Clinical utility and clinical validity are, therefore, of high importance.…”