Cutting Through the Smoke, continued

Call it the genetics of smoking. “Our goal is to obtain a more complete understanding of the role of specific genetic factors and bio-behavioral mechanisms that promote tobacco use,” the center’s mission statement explains, “in order to apply this knowledge to prevention, treatment, and reduction of harmful tobacco exposure.”

The Penn/Georgetown TTURC is actually one of seven such academic research centers around the country devoted to studying various aspects of tobacco use and nicotine addiction. As its name suggests, it crosses disciplines with wild abandon, delving into psychology, genetics, neuroscience, medicine, epidemiology, communications, and public policy. Lerman herself has appointments in the Abramson Cancer Center (where she’s associate director of the Cancer Control and Population Science program), the Department of Psychiatry, and the Annenberg School for Communication (where she holds the Mary Whiton Calkins Chair, which she herself named in honor of the first female president of the American Psychological Association and the American Philosophical Association).

Though the center has been at Penn for less than two years—ever since Lerman arrived from Georgetown, bringing her grants and many of her colleagues with her—the TTURC is already a major player. It has a full-time staff of some 35, and $10 million in federal grants from the National Cancer Institute (NCI) and the National Institute on Drug Abuse (NIDA)—not to mention some $400,000 from the Robert Wood Johnson Foundation to study the public-policy and communications pieces of the tobacco puzzle.

For those of us who aren’t accustomed to federal largesse, that seems an awful lot of money. But tobacco is no ordinary research subject. Consider these facts—some of which may be depressingly familiar—from TTURC’s Website:

Some 43.5 million adults in the United States—23.3 percent of the adult population—smoke cigarettes.
Nearly one in every five deaths in the U.S. is a result of smoking, making it the leading preventable cause of death.
More than 440,000 deaths in the U.S. are attributable to tobacco use each year—more than those caused by AIDS, alcohol, motor-vehicle accidents, homicides, drugs, and suicides combined.
The annual cost of smoking-related health care is $75.5 billion.
Roughly 3,000 Americans die each year because of exposure to secondhand smoke, and more than 1,000 infants die because their mothers smoked during pregnancy.

Some might argue that cigarette addiction is really a matter of weakness (users), greed (sellers/producers), and venality (Congress and everyone else who conspire to keep it legal). But the story, and the science, are a lot more complicated than that.

“I’ve always had the desire to do work that was cancer-related,” Lerman is saying. “Most people in their lives know people or have people close to them who have died of cancer. In my case it was my aunt, who I was very close to.”

Her first deep interest in psychology was the mind-body connection—specifically the “impact of the mind or stress on physical illness.” She was a graduate student at USC in the late 1970s and early ’80s, when the field of behavioral medicine was getting underway, and her dissertation was on Type A Behavior Pattern—“Nothing that relates to me personally at all,” she deadpans. She doesn’t act like the Central Casting kind of Type A—too calm, and her sense of humor is too quietly subversive—but along the way she garnered the Society of Behavioral Medicine New Investigator Award (1989) and the American Psychological Association Award for Outstanding Contributions to Health Psychology (1995), and they tend not to give those things to navel-gazers.

She got hooked on cancer genetics while working in Fox Chase Cancer Center’s behavioral-research crew. “My initial work was on the psychological aspects of genetic testing—understanding how all this exciting research coming out of the human-genome project was actually going to impact on people’s lives, where people want to know their genetic futures,” she says. “How would they react to the information psychologically? Would they change their behavior?”

That, in turn, led to a deep interest “in the question of whether we could characterize the genetic underpinnings of different behaviors that relate to cancer,” she says. “And, of course, one of the most important cancer-risk behaviors is tobacco use.”

About seven years ago, by then at Georgetown, she and some colleagues at the National Cancer Institute began a series of studies to look for specific genetic effects on smoking behavior. That, she says, “provided the foundation for submitting the TTURC grant.”

One study examined the effects of giving smokers relevant information about their genetic susceptibility to lung cancer—to see “whether we could overcome a sense of invulnerability and motivate them to quit smoking,” she explains. “We discovered that we did motivate them a great deal by giving them biological feedback. However, despite a really high level of motivation and many quit-attempts, most people in the study were not able to quit smoking.

“That’s where I became more interested in the problem of addiction,” she adds. “Because it’s not just a matter of wanting to quit, knowing cigarettes are bad for you and that quitting will prevent cancer and other diseases—that’s not enough. There’s got to be some real core biology.”

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