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Tailoring Smoking Cessation Treatment by Genotype: Implications for Ethics and Clinical Practice

As PI of a 5-year grant from the Robert Wood Johnson Foundation, Dr. Shields led a transdisciplinary effort examining clinical, ethical, and social implications of integrating genetically-tailored smoking cessation treatment into primary care practice.  As one of four research projects of the Georgetown Transdisciplinary Tobacco Use Research Center, the goal of this project was to conduct policy analyses, focus groups, and a national survey of primary care physicians to identify challenges associated with translating emerging genetics research on smoking into improved smoking cessation treatment.  This project included convening a national ethics research consortium, conducting various ethical analyses, and conducting qualitative and survey research.  The attitudes of primary care physicians and smokers toward genetic-based treatments for smoking cessation were evaluated through focus groups and a national survey.  This project also included the development of The Georgetown Ethics Research Consortium on Smoking and Genetics, a national transdisciplinary research group that conducted ethical and policy analyses related to individualized smoking treatment. 

Recent advances in nicotine dependence treatment are promising.  Inherited differences in nicotine clearance rates have been associated with smoking behavior and cessation rates, with a genetically-informed biomarker (the nicotine metabolite ratio, NMR) identified as promising tool to match patients with the pharmacotherapy that will most likely work to help them quit.  An international, prospective trial is now underway to validate the efficacy of the NMR to tailor individual smokers to pharmacotherapy, raising expectations that personalized smoking treatment may soon become widely available.

Related Publications

  • Lerman C., Patterson F., Shields A.E. Genetic basis of substance use and dependence: implications for prevention in high-risk youth. In: Romer D., ed. Reducing Adolescent Risk: Toward an Integrated Approach. Thousand Oaks, CA: Sage Publications; 2003:149-164.

  • Shields A.E., Lerman C., Sullivan P.  Translating emerging research on the genetics of smoking into clinical practice: ethical and social considerations. Nicotine and Tobacco Research. 2004; 6(4): 675-688.

  • Shields A.E., Blumenthal D., Weiss K.B., Comstock C.B., Currivan D., Lerman C. Barriers to translating emerging genetic research on smoking into clinical practice: perspectives of primary care physicians. Journal of General Internal Medicine. 2005; 20(2):131-138. PMID: 15836545.

  • Munafo M.R., Lerman C., Niaura R., Shields A.E., Swan G.E. Smoking cessation treatment: Pharmacogenetic assessment. Current Opinion in Molecular Therapeutics. 2005; 7:202-208. PMID: 15977416.

  • Munafo M.R., Shields A.E., Berrettini W.H., Patterson F., Lerman C. Pharmacogenetics and nicotine addiction treatment. Pharmacogenomics. 2005; 6(3):211-223. PMID: 16013953.

  • Schnoll R.A., Rukstalis M., Wileyto P., Shields A.E. Smoking cessation treatment by primary care physicians: An update and call for training. American Journal of Preventive Medicine. 2006; Sep; 31(3):233-9. PMID: 16905034.

  • Park E., Kleimann S., Pelan J., Shields A.E. Anticipating clinical integration of genetically-tailored tobacco dependence treatment: Perspectives of primary care physicians. Nicotine and Tobacco Research. 2007; 9(2) 271-279. PMID: 17365758.

  • Lerman C., Shields A.E., Munafo M. Pharmacogenetic approaches to the treatment of nicotine dependence. In: George T.P., ed. Medication Treatments for Nicotine Dependence. Boca Raton, FL: CRC Press; 2007:263-274.

  • Levy D.E., Youatt E.J., Shields A.E. Primary Care Physicians’ Concerns about Offering a Genetic Test to Tailor Smoking Cessation Treatment. Genetics in Medicine. 2007; 9(12):842-849. PMID: 18091434.

  • Phillips J., Siegel S.J., Shields A.E., Patterson F, Gould TJ, Strasser AA, Ray R, Pinto A, Audrain-McGovern J., Rukstalis M., Perkins K.A., Blendy J.A., Lerman C. Translating Basic Science to Improve Pharmacotherapy for Nicotine Dependence. Nicotine and Tobacco Research. 2007; 9 Suppl 4:S583-S598. PMID: 18067034.

  • Shields A.E., Lerman C. Anticipating clinical integration of pharmacogenetic treatment strategies for addiction: are primary care physicians ready? Clinical Pharmacology Therapeutics. 2008; Apr; 83(4):635-9. PMID: 18323859.

  • Shields A.E., Burke W., Levy D.E. Differential use of available genetic tests among primary care physicians in the United States: Results of a national survey. Genetics in Medicine. 2008; Jun; 10(6): 404-414. PMID: 18496223.

  • Shields A.E., Levy D.E., Blumenthal D., Currivan D., McGinn-Shapiro M., Weiss K.B., Yucel R., Lerman C. Primary Care Physicians’ Willingness to Offer a New Genetic Test to Tailor Smoking Treatment, According to Test Characteristics. Nicotine and Tobacco Research. 2008; Jun; 10(6):1037-1045. PMID: 18584467.

  • Schnoll R.A., Shields, A.E. Physician Barriers to Incorporating Pharmacogenetic Treatment Strategies for Nicotine Dependence into Clinical Practice. Clinical Pharmacology & Therapeutics. 2011; Mar; 89(3): 345-7. PMID: 21326262.

  • Shields A.E. Anticipating Pharmacogenomic Treatment Strategies for Addiction: Ethical Considerations. Addiction Science and Clinical Practice. (In press.)

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