This paper identifies research priorities in evaluating the ways in which “genomic medicine”—the use of genetic information to prevent and treat disease—may reduce tobacco-related harm by: (1) assisting more smokers to quit; (2) preventing non-smokers from beginning to smoke tobacco; and (3) reducing the harm caused by tobacco smoking. The method proposed to achieve the first aim is “pharmacogenetics”, the use of genetic information to optimise the selection of smoking-cessation programmes by screening smokers for polymorphisms that predict responses to different methods of smoking cessation. This method competes with the development of more effective forms of smoking cessation that involve vaccinating smokers against the effects of nicotine and using new pharmaceuticals (such as cannabinoid antagonists and nicotine agonists). The second and third aims are more speculative. They include: screening the population for genetic susceptibility to nicotine dependence and intervening (eg, by vaccinating children and adolescents against the effects of nicotine) to prevent smoking uptake, and screening the population for genetic susceptibility to tobacco-related diseases. A framework is described for future research on these policy options. This includes: epidemiological modelling and economic evaluation to specify the conditions under which these strategies are cost-effective; and social psychological research into the effect of providing genetic information on smokers’ preparedness to quit, and the general views of the public on tobacco smoking.
- DRD2, dopamine D2 receptor
- NRT, nicotine replacement therapy
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Funding: This work was funded by start-up funding for the Office of Public Policy and Ethics provided by the Institute for Molecular Bioscience, University of Queensland, and an Australian National Health and Medical Research Council project grant on the future of tobacco control.
Competing interests: None declared.
An earlier version of this paper was presented to the Australian Tobacco Conference, Sydney, 24 November 2005.