The genetics of nicotine addiction liability: ethical and social policy implications
Article first published online: 9 JAN 2008
© 2008 The Authors
Volume 103, Issue 3, pages 350–359, March 2008
How to Cite
Hall, W. D., Gartner, C. E. and Carter, A. (2008), The genetics of nicotine addiction liability: ethical and social policy implications. Addiction, 103: 350–359. doi: 10.1111/j.1360-0443.2007.02070.x
- Issue published online: 9 JAN 2008
- Article first published online: 9 JAN 2008
- Submitted 3 May 2007; initial review completed 26 June 2007; final version accepted 12 September 2007
- Ethical implications;
- genetic screening;
- nicotine dependence
Aim To assess the promise and risks of technological applications of genetic research on liability to develop nicotine dependence.
Methods We reviewed (i) the evidence on the genetics of nicotine dependence; (ii) the technical feasibility of using genetic information to reduce smoking uptake and increase cessation; and (iii) policy and ethical issues raised by the uses of genetic information on addiction liability.
Results (i) Despite evidence from twin studies that genes contribute to addiction susceptibility, research to date has not identified commonly occurring alleles that are strongly predictive of developing nicotine addiction. Nicotine addiction is likely to involve multiple alleles of small effect that interact with each other and with the environment. (ii) Population screening for susceptibility alleles is unlikely to be effective or cost-effective. Tailoring of smoking cessation treatments with genetic information is more plausible but results to date have been disappointing. Population health strategies such as increased taxation and reduced opportunities to smoke are more efficient in reducing cigarette smoking. Tobacco harm reduction policies applied to populations may also play a role in reducing tobacco-related harm. (iii) Future uses of genomic information on addiction risk will need to assess the risks of medicalising addiction (e.g. pessimism about capacity to quit) and community concerns about genetic privacy.
Conclusions Nicotine genomics is a very new and underdeveloped field. On the evidence to date, its advocates would be wise to avoid extravagant claims about its preventive applications.