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Dr Hilary Tindle: Timelines and Advances in Precision Approaches to Smoking Cessation


Hilary Tindle, MD, MPH, associate professor of medicine at Vanderbilt University, discusses plans for implementing precision approaches to quitting smoking, as well as patient hesitations around such approaches.

Pilot work has informed the equitable implementation of precision approaches to smoking cessation in hopes of broadening their reach, said Hilary Tindle, MD, MPH, associate professor of medicine, Vanderbilt University.


What is the timeline for precision approaches for quitting smoking to be put in place? What still needs to be done?

These precision approaches are not currently part of standard of care. All that means is that insurance doesn't cover them. For example, most clinical setups, most health care systems do not have the infrastructure to lay them out as part of clinical care. What we need and what are ongoing right now are large, randomized trials that test a precision approach, such as using the nicotine metabolite ratio to decide which medicine should be started with to quit smoking. We need to test how good is that intervention, that precision approach relative to usual care? And those studies are ongoing at several universities, including Vanderbilt, where I am now.

It seems that African Americans have lower odds of endorsing this kind of approach, why is that?

In our pilot studies, asking patients and research participants, are you interested in these precision approaches? If a doctor ordered this blood test for you, would you take the test? And would you actually follow what the test said? For example, if you found that you were a faster metabolizer based on this blood test, would you use Chantix or varenicline medication instead of the patch, like what is proposed? And most people say yes, but there in our pilot work, there were 3 groups that tended to be less enthusiastic, not unenthusiastic, but just less enthusiastic.

Those were older people, so, for each year of age older, there was a little bit less enthusiasm to try precision approaches. People who said they had attained fewer years of education—so, high school as compared to college—people who had attained fewer years of education were a little less enthusiastic. And, people who are African American compared to Whites.

But I'm not discouraged by those results at all. In any new therapy, there's going to be a burden of proof on the investigators. And that's why I and my colleagues do the work that we do, because we need to produce the evidence base that's convincing and that shows people this really is a better way to quit smoking. We can increase the effectiveness of meds by tailoring them to your genetics, and we can possibly even reduce the side effects with these medications and have an overall better experience to quit smoking. The pilot work that we've done really informs how we implement precision approaches equitably so that they're acceptable to everyone, and so that they reach everyone.

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