SRNT Newsletter Vol. 4 No. 4 December 1998
The Future of Funding
Despite the confusion of revived tobacco litigation and settlements, new grant review strategies, and worldwide economic queasiness, several new U.S. funding initiatives may warrant researchers’ optimism
Janet Brigham, Ph.D.
SRNT Newsletter Editor
It’s hard to imagine, unless you’ve been there.
Some in our ranks live on a perilous edge, poised between success and disaster. We submit multiple grant applications and proposals each year, attempting to build a purposeful career while our livelihood hinges on the decisions—dare we say whims?—of grant reviewers and other decision-makers.
Those who are starting a career can find that, even with the help of well-known and well-funded mentors, the struggle to secure funding can vacillate between being daunting and being nearly impossible. For instance, grant reviewers might demand more preliminary data, yet without initial funding, there is no way to attain such data.
Even grant mechanisms that fund research into preliminary questions can be difficult to transition into a long-range plan. By the time the data are gathered and analyzed, the researcher has had to find other sources of support. For any grant or proposal, the time lag for securing funding can extend out several years, as proposals are submitted, resubmitted, and resubmitted again before being funded, if they are funded at all.
A proposal that was innovative in its first incarnation can become stale and outdated before it can be reviewed again. Sometimes, applicants’ necessary responses to reviewers’ critiques lead away from innovation and relevance—and from being funded.
And amid this relative chaos, the demand for new, useful research is pressing. Despite the need for answers to critical questions, it can be surprisingly difficult for a researcher simply to set out to study an area of interest. Many hurdles stand in the way, some of them seemingly insurmountable.
An additional strain on researchers has come from the recent shifts in scoring routines used by the National Institutes of Health. Prior to this year, grant applications were scored on a 1-5 scale (1=outstanding), with applications that rated worse than a score of 5 not receiving scores. Now, only applications in a range of 1-2.5 receive a numeric score and can be funded.
This leaves authors of unscored proposals with no way to know whether their application is close to the cutoff and should be revised and resubmitted, or whether it has little potential for ever being funded. Additionally, proposals above the scorable range generally are not discussed by an entire study section of reviewers, thus providing the applicants with responses from perhaps only two reviewers and depriving them of the benefit of discussion by the larger review group.
This practice is potentially problematic in situations in which staff and reviewers are unaware of the limitations of their own lack of experience or expertise in the topics they are reviewing. Full study section discussion might illuminate such shortfalls. Over the last year, study section meetings typically have started with a discussion of the latest wrinkles and twists in scoring. Submitters of proposals generally are unaware of these procedural shifts, both subtle and dramatic, which can affect whether applications are scored and funded. Applicants know only the many hours of work that went into the proposal, and the need for securing funding to establish or maintain a career track, or even to stay employed.
The same angst is felt throughout much of the scientific community, and it hits some professions worse than it hits behavioral and medical research. When comet Hale-Bopp lit the skies, unemployed astronomer Alan Hale used his sudden (and, he suspected, brief) fame to focus attention on scientists’ struggles for funding. He gathered "horror stories" from other scientists and presented this information to policymakers and information disseminators.
Those in nicotine and tobacco research have been alternately encouraged and discouraged by the continually changing fortunes of funding agencies; by settlements between the U.S. government, states, and tobacco companies; and by uncertainties in other sources of funding, such as money set aside by states and federal agencies.
One example of the Flubber-like quality of allocated funding is in the state of California’s Tobacco-Related Disease Research and Prevention Program, which received only $11.7 million (U.S.) of the $26 million expected. The headline the group wrote to describe its funding situation told the story: "TRDRP’s Budget Roller Coaster Continues."
Changes at NIH
Adding to the uncertainty are changes within NIH, which has a new Center for Scientific Review (CSR), restructured in October 1997 from the Division of Research Grants. Prior to this development, proposals submitted to NIH commonly were reviewed by study sections within a given institute, such as the National Institute on Drug Abuse. (Some applications, such as those for Small Business Innovation Research grants, already were reviewed by cross-institute panels.) Now most NIH grants will be reviewed through the centralized process.
CSR now has 19 Initial Review Groups (IRGs), each with responsibility for a scientific area. Those most likely to be examining nicotine and tobacco proposals include the IRGs for Biobehavioral and Social Sciences; Brain Disorders and Clinical Neuroscience; Health Promotion and Disease Prevention; Integrative, Functional and Cognitive Neuroscience; and Molecular, Cellular, and Developmental Neuroscience.
Under each IRG group are a number of study sections, whose members review proposals on specific topics. For example, the Health Promotion and Disease Prevention IRG includes six study sections that examine aspects of the epidemiology, prevention, and control of human disease. These include three on Alcohol and Toxicology, two on Epidemiology and Disease Control, and one on Nursing.
Information about the CSR process, staffing, deadlines, and study section rosters is available through the CSR’s Web site, www.csr.nih.gov.
Triggering New Opportunities?
Also on the horizon are research funding initiatives that could "alter the way tobacco control research has been traditionally conducted," according to the National Cancer Institute (an NIH institute).
An infusion of U.S. government allocations is anticipated to combine with new research funds from tobacco settlement money. These expectations stem from recommendations from the National Cancer Institute's (NCI) Tobacco Research Implementation Group (TRIG), which has recommended nine research opportunities that need immediate implementation. The National Cancer Institute released its Tobacco Research Implementation Plan in October—the institute’s first attempt at a comprehensive listing of where the research community needs to focus new research efforts.
Several SRNT members were prominent on the planning committee, and SRNT contributed its input to the plan as well. The nine areas of emphasis are biobehavioral research on initiation, progression, and cessation; tailoring of cessation interventions to special populations; effectiveness of community interventions; dissemination of proven prevention and treatment interventions; policy research; biomarkers of tobacco exposure and early carcinogenesis; genetic susceptibility to tobacco-related cancers; surveillance to monitor use and effectiveness of interventions; and tobacco research centers.
"SRNT is exploring ways to use this excellent plan as a springboard," according to John Hughes of the SRNT Policy Committee. Potentially, the efforts could involve other NIH and non-NIH agencies (e.g., the U.S. Food and Drug Administration, Environmental Protection Agency, and others) in contributing to a national research plan that could be used to track the adequacy of NIH efforts on tobacco and nicotine research.
NCI is attempting to implement the recommendations soon, beginning with two major research initiatives that will be funded at $142 million over five years. These initiatives are as follows:
These are the other seven research opportunities identified by TRIG:
And the Settlements Mean...?
Possible settlements between state and national governments and the tobacco industry hover. Will there be money for research and, if so, what kind? Who will administer it? How will it be administered? Will the attorneys receive more money than the research community?
No one knows.
Researchers once priming to compete for a fat pot of settlement money have now retreated to more typical support-seeking activities, such as writing grant applications.
And as holy writ asserts, the rain will continue to fall equally on the just and the unjust.
Changes, Challenges Come Just in Time
Jack E. Henningfield, Ph.D.
SRNT President, 1998-1999
The World Health Organization has designated tobacco, along with malaria, as a priority area for focus in the coming years, because both areas are among the major emerging challenges to global health. Along with many individual countries, organizations such as the European Community are also rising to meet the challenge with policies appropriate to the scope of the problem and the nature of dependency. A common theme expressed by policy developers in both governmental and nongovernmental organizations is a strong desire to base their actions on science and research.
This is where SRNT can be especially useful. Our efforts to foster science that is of the highest possible degree of excellence and relevance to public health may be our most important contribution to reducing tobacco-caused disease. Our annual meeting is and our new journal also are major contributions. In addition, our newsletter and Web site offer forums for information exchange. More is coming.
We are now also well on our way on a course to strengthen the management of our organization. The Society has signed a contract with Thomas Miller Associates of Madison, Wisconsin, to assume management responsibilities until May of 1999. Thomas Miller Associates (TMA) was selected by the Society of Behavioral Medicine earlier this year to manage their organization. Over the next several months, we will be completing our formal review and selection process for a permanent management service. (TMA has applied and will be considered on a highly competitive basis.) We expect our 1999 meeting to be run more smoothly than past meetings, and we are confident that many crucial services to members will be enhanced.
TMA has employed Sarah Evans, formerly of Phoenix (SRNT’s prior management organization), to manage SRNT matters. The Board of Directors was pleased with this action, since Ms. Evans has garnered respect from those who have worked with her. It has thus been a busy year for SRNT, but our volunteer members have made substantial strides toward developing an organizational infra- structure that will effectively position tobacco and nicotine science to meet the challenges of the 21st Century.
The SRNT Policy Committee has joined with a consortium of professional organizations in proposing that tobacco research be a funding priority. The consortium has submitted recommendations to Dr. Richard Klausner, director of the National Cancer Institute.
The consortium’s Ad Hoc Committee on Tobacco and Nicotine Research proposed that NCI make tobacco control research an Extraordinary Scientific Opportunity for Investment for the 2001 Bypass Budget. The committee is a consortium formed by the Society for Research on Nicotine and Tobacco, the American Psychological Association, the National Center for Tobacco-Free Kids, the College on Problems of Drug Dependence, the American Psychiatric Association, and the Society of Behavioral Medicine.
The recommendation statement included the following explanation:
"Tobacco use is the number one preventable cause of cancer and is involved in 30% of all cancer deaths. We have seen an extraordinary amount of tobacco control activity in the last few years. NCI has been a leader in funding research that resulted in the development and implementation of effective tobacco control policies and programs,...
"The settlements of Medicaid litigation by the states will generate hundreds of millions of dollars from the tobacco industry. States that have already settled their lawsuits— Minnesota, Florida, Texas— have earmarked some of the money they received for public health interventions to decrease tobacco use. Those who join the large settlement recently negotiated will undoubtedly follow suit, given society’s high priority for tobacco control.
"Behavioral and social scientists and tobacco control practitioners understand that the effectiveness of these efforts depends on continued research....The general public and our elected officials also place great value on evidence-based policies and programs. Most believe public health interventions to decrease tobacco use will continue to be a high priority for our society.
"We believe tobacco control research should be on NCI’s list of Extraordinary Scientific Opportunities for several reasons. First, NCI has recently released its Tobacco Research Implementation Plan. We are very impressed with this plan not only due to its content but also because it is the first time an NIH institute clearly stepped up to the plate with a comprehensive plan for all areas of tobacco research. That document clearly describes recent developments and breakthroughs in tobacco/nicotine research which we will not repeat here. However, without increased funding, NCI can accomplish only a few of the pressing needs outlined in that plan.
"Second, we noted that NCI’s current four areas of Extraordinary Opportunities all concern biomedical research to the exclusion of behavioral aspects of cancer control. We believe it is time for NCI to signal the cancer community and NIH its commitment to behavioral and prevention research."
Suzanne L. Tyas, Ph.D.
Centre on Aging, University of Manitoba
(Editor's Note: Reference numbers are in parentheses; these are in superscript in the printed version of this article..)
As populations age, diseases related to aging affect more people and represent a source of growing concern. The prevalence of Alzheimer’s disease (AD), a major cause of dementia, rises exponentially with increasing age. (1) AD is a neurodegenerative disorder characterized by progressive cognitive impairment and decreased life expectancy. (2) Aside from personal costs, AD represents a major economic burden on health care and social services. (3,4)
Both genetic (5,6) and environmental (7-8) factors have been implicated in the development of AD, suggesting that AD may be multifactorial in origin. The cause of AD remains unknown, however, and there is no cure or effective treatment.
Smoking is one of the environmental factors that have been suggested to influence the risk of developing AD. (9) This report provides an overview of the rationale and epidemiologic evidence for an association between smoking and AD. Elucidation of such an association may advance research on the cause of AD and provide a theoretical basis for treatment of AD; nicotine-based interventions have already been considered. (10)
Why Smoking and AD?
A protective effect of smoking on AD is biologically plausible. (9) Cholinergic system deficits, characterized by reduced levels of acetylcholine and nicotinic receptors, are found in AD. (11) Nicotine increases acetylcholine release, elevates the number of nicotinic receptors, and improves attention and information processing. (12) Smokers, because of their exposure to nicotine, may have a less severe cholinergic deficit and thereby be protected from AD or may experience delayed onset of the disease. Other potential mechanisms have also been proposed. (9)
Epidemiologic Studies
Possible biological mechanisms became of particular interest when some epidemiologic studies reported a reduced risk of AD among smokers. Despite plausible mechanisms, however, the epidemiologic evidence does not unequivocally support a protective effect of smoking on AD. Epidemiologic studies on the association of smoking and AD are summarized in Table 1. Results are inconsistent, with most studies finding no significant relationship. A statistically significant protective effect of smoking on AD has been observed in some studies, (3-15) particularly in earlier reports. Some of these studies, however, can be criticized; for example, Ferini-Strambi and colleagues (13) conducted only bivariate analyses and thus did not consider other factors that differ between smokers and nonsmokers and that might also be related to AD (e.g., age and education). More recent reports have provided results consistent with no association between smoking and AD or, in some studies, even an increased risk of AD among smokers.
Because many methodological limitations apply particularly to case-control studies, evidence from cohort studies is generally given more weight. The results of cohort studies are inconsistent, with smoking reported to be a risk factor, a protective factor, or not significantly associated with AD. (16-21) Katzman and colleagues (17) noted that individuals with AD were less likely to have been smokers; statistical tests were not reported, but Lee (22) used their data to calculate a significantly decreased relative risk (RR) of 0.24 (95% confidence interval CI=0.11-0.53). A statistically nonsignificant protective effect of smoking was found in some studies. (16,20) Letenneur and colleagues (19) observed a significantly reduced risk until analyses were adjusted for age, sex, occupation, and education. Mayeux and Tang (18) found a significant protective effect of smoking in a case-control study, but noted a nonsignificant increased risk in their adjunct cohort study. A recent study (21) reported that smokers were at greater risk of AD (RR=2.3; 95% CI=1.3-4.1).
Lack of statistical power has been suggested to explain the preponderance of statistically nonsignificant results in case-control studies. Meta-analyses examining eleven (23,24) and nineteen (22) studies of risk factors for AD found a statistically significant inverse association between smoking and AD. The eight studies included in the EURODEM collaborative reanalysis of case-control studies (23, 24) had all originally reported a nonsignificant association between smoking and AD. The pooled analysis produced an odds ratio (OR) of 0.78 (95% CI=0.62-0.98), indicating a significantly reduced risk of AD among smokers. A significant inverse dose-response relationship was found in four studies with relevant data: the risk of AD decreased with increasing number of pack-years of smoking. The meta-analysis by Lee (22) included nineteen, primarily case-control, studies on AD and smoking. Lee reported that, of the nineteen studies analyzed, four found a statistically significant protective effect and eleven a nonsignificant decreased risk of AD among smokers. For the fifteen studies for which information on ORs and CIs was available, the combined OR reflected a significant protective effect of smoking on AD (OR= 0.68, 95% CI=0.58-0.79).
Although meta-analyses have increased power to detect significant associations, they are limited by the flaws of their constituent individual studies. Thus, the significant inverse relationship between smoking and AD reported in the meta-analyses needs to be interpreted in the light of the limitations of these earlier studies. Case-control studies published after the meta-analyses have reported mixed results, with both statistically significant and nonsignificant associations noted between smoking and AD.
There is evidence, however, that the variable results may be due to differences in subject characteristics. A significant protective effect of smoking found in one study was shown to disappear when appropriate confounders (age, education, hypertension) were controlled in the analyses. (25) A cohort study (19) also found that a significantly reduced risk of AD among smokers became nonsignificant after confounding variables were considered. These results indicate that an association with AD was not due to smoking itself, but rather to differences in other variables; failure to adjust for these confounding variables in other studies may have led to inconsistent results of the effects of smoking on AD, with different findings simply reflecting different subject characteristics across studies. (25)
Another measure of subject heterogeneity, genetic risk, may also be involved in the association of smoking and AD and may explain some of the apparent inconsistency in results. Where there were significant protective effects noted, it was usually for specific subgroups of subjects, such as those grouped by family history of dementia (25, 26) or apolipoprotein E (ApoE) allele status, (27) a genetic marker for AD. Further research is required to clarify the interaction between genetic factors and smoking in the development of AD. Because smokers are more likely than nonsmokers to die before developing AD, a protective association between smoking and AD has been attributed to selective mortality. (28, 29) Higher mortality of smokers compared with nonsmokers would create an apparent lower risk of AD among smokers if those smokers who died were more likely to have developed AD. Although some researchers have argued against such an explanation, (27, 30) the possibility that a protective effect of smoking could be attributable to survival bias cannot yet be dismissed.
Conclusions
Although it is biologically plausible that smoking increases the risk of AD, epidemiologic studies have not unequivocally supported this hypothesis. Earlier studies on smoking and AD, including two meta-analyses, are consistent with a reduced risk of AD among smokers. More recent studies suggest that smoking is not a significant protective factor for all subjects combined, but that there may be such an association within particular genetic risk subgroups. Differences between smokers and nonsmokers that are not controlled in analyses may explain the inconsistent results reported. Further research will be needed before the true association between smoking and AD is fully understood.
Suzanne Tyas, Ph.D., is associated with the Centre on Aging, 338 Isbister Bldg., University of Manitoba, Winipeg, Manitoba, Canada R3T 2N2; telephone (204) 474-6547; fax (204) 474-7576; email Suzanne_Tyas@umanitoba.ca.
References
1. Rocca, W. A., Hofman, A., Brayne, C., Breteler, M. M. B., Clarke, M., Copeland, J. R. M., Dartigues, J.-F., Engedal, K., Hagnell, O., Heeren, T. J., Jonker, C., Lindesay, J., Lobo, A., Mann, A. H., Mölsä, P. K., Morgan, K., O'Connor, D. W., da Silva Droux, A., Sulkava, R., Kay, D. W. K., & Amaducci, L. (1991). Frequency and distribution of Alzheimer’s disease in Europe: a collaborative study of 1980-1990 prevalence findings. Annals of Neurology, 30, 381-90.
2. Terry, R. D., Katzman, R., & Bick, K. L. (Eds.) (1994). Alzheimer Disease. New York: Raven Press.
3. Ernst, R. L., & Hay, J. W. (1994). The U.S. economic and social costs of Alzheimer’s disease revisited. American Journal of Public Health, 84, 1261-1264.
4. Østbye, T., & Crosse, E. (1994). Net economic costs of dementia in Canada. Canadian Medical Association Journal, 151, 1457-1464.
5. Lendon, C. L., Ashall, F., & Goate, A. M. (1997). Exploring the etiology of Alzheimer disease using molecular genetics. The Journal of the American Medical Association, 227, 825-31.
6. Slooter, A. J. C., & van Duijn, C. M. (1997). Genetic epidemiology of Alzheimer disease. Epidemiologic Reviews, 19, 107-119.
7. Breteler, M. M. B., Claus, J. J., van Duijn, C. M., Launer, L. J., & Hofman, A. (1992). Epidemiology of Alzheimer’s disease. Epidemiologic Reviews, 14, 59-82.
8. Katzman, R., & Kawas, C. (1994). The epidemiology of dementia and Alzheimer disease. In R. D. Terry, R. Katzman, & K. L. Bick (Eds.), Alzheimer disease. New York: Raven Press 1994: pp. 105-122.
9. Tyas, S. L. (1996). Are tobacco and alcohol use related to Alzheimer’s disease? A critical assessment of the evidence and its implications. Addiction Biology, 1, 37-54.
10. Newhouse, P. A., Potter, A., & Levin, E. D. (1997). Nicotinic system involvement in Alzheimer’s and Parkinson’s diseases. Drugs and Aging, 11, 206-228.
11. Nordberg, A. (1992). Biological markers and the cholinergic hypothesis in Alzheimer’s disease. Acta Neurologica Scandinavica Supplementum, 139, 54-58.
12. Kellar, K. J., & Wonnacott, S. (1990). Nicotinic cholinergic receptors in Alzheimer’s disease. In S. Wonnacott, M. A. H. Russell, & I. P. Stolerman (Eds.), Nicotine psychopharmacology: molecular, cellular, and behavioral aspects. Oxford: Oxford University Press, pp. 341-373.
13. Ferini-Strambi, L., Smirne, S., Garancini, P., Pinto, P., & Franceschi, M. (1990). Clinical and epidemiological aspects of Alzheimer’s disease with presenile onset: A case control study. Neuroepidemiology, 9, 39-49.
14. van Duijn, C. M., & Hofman, A. (1991). Relation between nicotine intake and Alzheimer’s disease. British Medical Journal, 302, 1491-1494.
15. Brenner, D. E., Kukull, W. A., van Belle, G., Bowen, J. D., McCormick, W. C., Teri, L., & Larson, E. B. (1993). Relationship between cigarette smoking and Alzheimer’s disease in a population-based case-control study. Neurology, 43, 293-300.
16. Hebert, L. E., Scherr, P. A., Beckett, L. A., Funkenstein, H. H., Albert, M. S., Chown, M. J., & Evans, D. A. (1992). Relation of smoking and alcohol consumption to incident Alzheimer’s disease. American Journal of Epidemiology, 135, 347-355.
17. Katzman, R., Aronson, M., Fuld, P., Kawas, C., Brown, T., Morgenstern, H., Frishman, W., Gidez, L., Eder, H., & Ooi, W. L. (1989). Development of dementing illnesses in an 80-year-old volunteer cohort. Annals of Neurology, 25, 317-324.
18. Mayeux, R., & Tang, M.-X. Smoking and Alzheimer’s disease. American Journal of Epidemiology, 138, 645. 19. Letenneur, L., Dartigues, J.-F., Commenges, D., Barberger-Gateau, P., Tessier, J.-F., & Orgogozo, J.-M. (1994). Tobacco consumption and cognitive impairment in elderly people: A population-based study. Annals of Epidemiology, 4, 449-454.
20. Yoshitake, T., Kiyohara, Y., Kato, I., Ohmura, T., Iwamoto, H., Nakayama, K., Ohmori, S., Nomiyama, K., Kawano, H., Ueda, K., Sueishi, K., Tsuneyoshi, M., & Fujishima, M. (1995). Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: The Hisayama study. Neurology, 45, 1161-1168.
21. Ott, A., Slooter, A. J. C., Hofman, A., van Harskamp, F., Witteman, J. C. M., Van Broeckhoven, C., van Duijn, C. M., & Breteler, M. M. B. (1998). Smoking and risk of dementia and Alzheimer’s disease in a population-based cohort study: The Rotterdam study. Lancet, 351, 1840-1843.
22. Lee, P. N. (1994). Smoking and Alzheimer’s disease: A review of the epidemiological evidence. Neuroepidemiology, 13, 131-144.
23. Graves, A. B., van Duijn, C., Chandra, V., Fratiglioni, L., Heyman, A., Jorm, A. F., Kokmen, E., Kondo, K., Mortimer, J. A., Rocca, W. A., Shalat, S. L., Soininen, H., & Hofman, A. (1991). Alcohol and tobacco consumption as risk factors for Alzheimer's disease: A collaborative re-analysis of case-control studies. International Journal of Epidemiology, 20 (Suppl. 2), S48-S57.
24. van Duijn, C. M., & Hofman A. (1992). Risk factors for Alzheimer's disease: The EURODEM collaborative re-analysis of case-control studies. Neuroepidemiology, 11 (Suppl. 1), 106-113.
25. Tyas, S. L. (1998). Are tobacco and alcohol use related to Alzheimer’s disease? Results from three Canadian data sets. Unpublished doctoral dissertation, The University of Western Ontario, London, Ontario, Canada.
26. Salib, E., & Hillier, V. (1997). A case-control study of smoking and Alzheimer’s disease. International Journal of Geriatric Psychiatry, 12, 295-300.
27. van Duijn, C. M., Havekes, L. M., Van Broeckhoven, C., de Knijff, P., & Hofman, A. (1995). Apolipoprotein E genotype and association between smoking and early onset Alzheimer’s disease. British Medical Journal, 310, 627-631.
28. Riggs, J. E. (1993). Smoking and Alzheimer’s disease: Protective effect or differential survival bias? Lancet, 342, 793-794.
29. Graves, A. B., & Mortimer, J. A. (1994). Does smoking reduce the risks of Parkinson’s and Alzheimer’s diseases? Journal of Smoking-Related Disorders, 5(Suppl. 1), 79-90.
30. Plassman, B. L., Helms, M. J., Welsh, K. A., Saunders, A. M., & Breitner, J. C. S. (1995). Smoking, Alzheimer's disease, and confounding with genes. Lancet, 345, 387.
Member Directory Available at www.srnt.org
If you have access to the Web, you now have access to SRNT’s latest membership information. A recent addition to the ever-growing SRNT Web site is a searchable directory of SRNT members. This enhancement is the result of work by Richard Brown of Brown University, and SRNT Web site Webmaster Michelle Ricci.
The directory is searchable by name (first, last, or both), state, and country. This feature allows users to locate other SRNT members in their locality. Eventually, the listings will also be searchable by interest area, once interest-area designations have been revised and members’ interest areas have been categorized.
Those not wanting their contact information (name, affiliation, telephone, address) listed on the Web site should contact Rick Brown at (401) 455-6254, email Richard_Brown@brown.edu.
‘Lone Ranger’ Ed Lichtenstein Reflects:
Many Lessons Learned during a Career
Raine Riggs
University of Vermont
The 1964 report to the U.S. Surgeon General was a major turning point in Ed Lichtenstein’s career. Until then, Lichtenstein’s training was strongly psychoanalytically oriented and "intraindividually focused." As a graduate student at the University of Michigan, he was a teaching assistant in a Rorschach class and for a dissertation study tested psychoanalytic hypotheses about free association.
He received a Ph.D. in clinical psychology in 1961 and began shifting his interests toward behavior therapy. Lichtenstein decided to switch his focus from the neuroses to more readily measurable outcomes. He was looking for a target behavior that was "more socially significant than a snake phobia" when the 1964 report came out. Despite the fact that he had "no clue" about the pharmacology of nicotine, Lichtenstein decided to try developing smoking cessation treatments for smokers.
That was the beginning of a long and productive career. Since then, Lichtenstein has authored more than 100 articles on smoking and co-authored a self-help smoking cessation book. Lichtenstein is currently working at the Oregon Research Institute in Eugene, Oregon. ORI is a private, nonprofit behavioral research institution that employs mostly psychologists.
Lichtenstein describes himself as a "recovering clinical psychologist" and his current work as public or population health intervention research. He designs and implements smoking cessation interventions at the population level, most commonly in healthcare settings.
When asked to describe the pros and cons of research in this area, he readily says that the most difficult aspect of this type of research is that it takes a long time. On average, it takes from three to five years to see results. He also says that it can be difficult to gain entry into healthcare settings. And even when he is able to gain entry, there is tremendous variability in the settings he studies, which can make it difficult to design effective interventions or to generalize results.
On a more positive note, Lichtenstein finds the work challenging and interesting. This type of research reaches whole populations of smokers, rather than self-selected samples. Also, Lichtenstein finds matching effective cessation programs with healthcare settings very "reinforcing."
Lichtenstein names his dissertation adviser, Ed Bordin, as one of the most influential shapers of his career. Bordin was the person who "got me interested in behavior change." He also credits Michael Russell, with whom Lichtenstein studied while on a sabbatical in 1973-74. Russell taught him about the importance of nicotine in smoking behavior. Finally, Lichtenstein credits Russell Glasgow with facilitating his move to a public health perspective. The two have collaborated for the past 20 years.
Lichtenstein says that his most "fun" research project was the Community Intervention Trial (COMMIT), a public health cessation intervention for smokers. COMMIT began in 1986 and was published in 1995. While he admits that the results were modest, Lichtenstein believes that the trial was important because it supplied strong data on some of the limitations of a public health approach to smoking cessation.
Overall, Lichtenstein says that the last 10 to 12 years of his career have been the most interesting. "Trying to develop a brief, sustainable behavioral intervention for healthcare settings has been a real challenge," he says.
Lichtenstein sees the future of nicotine and tobacco research as going in several directions. He points out that tobacco research is becoming well funded and will likely continue to be so. Additionally, he expects that pharmaceutical companies will provide a "stream of new drug treatments." However, he suspects that pharmaceutical cessation interventions will suffer because of the gap between efficacy trials and effectiveness trials. Products that are capable of helping people quit smoking in controlled trials also need examination in uncontrolled, real-world settings.
Furthermore, Lichtenstein foresees a shift toward a policy perspective for prevention and treatment, with research focusing on barriers to implementation. Examples of barriers include determining whether clinicians should be paid for administering smoking cessation treatments, convincing clinicians and managed-care payers to implement new interventions and policies, and challenging the idea that prevention is not a part of the medical paradigm.
Lichtenstein also predicts an increase in the use of quasi-experimental designs to enable researchers to examine components of successful smoking control programs. Research will also increase in the areas of program evaluation, intervention for children and youth at the individual and societal levels, and the use of technology for smoking cessation, he predicts. Specifically, researchers will begin to utilize information technologies, such as television, video, and the Internet, to bring cessation treatments and prevention programs to larger audiences.
Researchers will strive to combine pharmacotherapy, behavioral/coping skills training, and motivational change to create optimal brief interventions, according to Lichtenstein. Currently, "we tend to emphasize one or another."
On the one hand, Lichtenstein sees a continuous demand for new pharmacological treatments. On the other hand, he thinks that researchers should continue to develop drug-free interventions. He believes that cessation takes much more than pharmacotherapy. It is important to note that many smokers are able to quit smoking without pharmacotherapy.
"Half of ever-smokers are ex-smokers, and a great majority of them stopped without drug treatment," he says. "However, there will always be a demand for some new drug."
On a more personal note, Lichtenstein says that he sees himself in the "twilight of a research career." At this point, most of his work is collaborative. He plans to continue working in healthcare settings, focusing his efforts on integrating cessation treatments into standard care.
Currently, he and his colleagues are developing an Internet cessation program involving a free, interactive Web site. Ultimately, the research team plans to conduct a randomized trial, comparing the interactive Web site with currently available smoking-related Web sites, which are static. The trial will last four years. If it is successful, the interactive Web site will be made available to the general public, bringing a viable cessation treatment to a large audience.
Reflecting on the past 37 years of his career, Lichtenstein provides several pieces of advice for young investigators. First, he advises young researchers to diversify their skills more than he has. He says that researchers can diversify across substances or within nicotine research. "Be more than just a tobacco researcher. Develop skills and a track record in other areas as well," he says. "Learn to conduct clinical trials as well as laboratory studies, for example."
Lichtenstein also feels that it is increasingly important to collaborate. He advises young researchers to choose an institution where others are doing related research. He thinks it is more important to complete postdoctoral training and to work under a senior investigator than it was when he began his career.
"I was a lone ranger. I was the only tobacco researcher in my department when I first started," says Lichtenstein. "Now, you need a biostatistician. You need other substance abuse researchers and behavior change people around. Fortunately, I had some great graduate students and then wonderful colleagues at ORI."
Lichtenstein’s final advice to veteran and new researchers is to keep working. "Our knowledge is incomplete, and the smoking problem still remains our greatest public health challenge."
Nicotine Safety and Toxicity:
Take a Good Look, Then Keep This Book Handy
Nicotine Safety and Toxicity. Neal Benowitz, Ed. New York: Oxford University Press, 1998. ISBN 0195114965, 203 pp., $55.00 U.S.
John Marriott, Ph.D.
SRNT members will soon be receiving a copy of a new book that reviews nicotine’s safety and toxicity. Before retiring it to the reference shelf for permanent residence, it would be worthwhile to spend a little time getting acquainted with this modest-size volume and reviewing its contents.
Members who have attended recent meetings of the Society will recognize that the book originated with a meeting on this topic held by the Society in late 1996. Contributors at the meeting and to the book include scientists and physicians from academia, industry, and the Food and Drug Administration, many of whose names would be familiar to most Society members. The compilation of papers was edited by former SRNT President Neal Benowitz, M.D., of the University of California, San Francisco.
Overviews of the results from this meeting have been presented at several subsequent forums. However, the book offers methodological details, data, and references that cannot be fully appreciated in a meeting presentation.
Benowitz has organized the book into five main topics—cardiovascular disease, cancer, reproduction, behavioral toxicity, and a miscellaneous category—followed by a succinct summary chapter providing guidance on the main risk/benefit formulations reached by the authors and meeting participants for each of the areas covered. While focusing primarily on nicotine toxicity, there are also chapters on tobacco-specific nitrosamines, nicotine metabolites, cigarette smoke, and snuff.
The entire volume, including the index, is just a little over 200 pages, with the 18 chapters averaging around 10 pages each. The index has useful notations indicating references to tables and figures.
Reading the contributions in this volume, you come away with the clear message that nicotine is not the evil actor that years of research have found tobacco to be. While nicotine, like any drug, has some negative effects—most notably, causing addiction to tobacco—it is the relative safety of nicotine, even in patients with significant disease, that is most impressive. Sadly, nicotine too often takes the rap for tobacco in the public’s eyes, so that even therapeutic uses of nicotine are negatively impacted by the perception of nicotine as the toxic substance associated with tobacco use.
This volume should help clear the air in public policy discussions, in regulatory reviews, and in clinical decision-making regarding the health risks of using nicotine to treat tobacco dependence and possibly other disorders. It will also inform the emerging debate on possible long-term use of nicotine by those who cannot or desire not to remain tobacco-free (or nicotine-free?). The message is clear: Nicotine is always safer than tobacco. Now we need to decide whether it will also become as easily available and, potentially, as widely used as tobacco.
John G. Marriott, Ph.D. can be contacted at 4592 West 100 North, Ogden, Utah 84404; (801) 731-7225, email jgmarriott@aol.com.
Nicotine Safety and Toxicity is being mailed to all SRNT members. Additional copies can be purchased or ordered through local bookstores, online booksellers, and the publisher’s Web site, www.oup-usa.org.
Thomas L. Petty, M.D., Chairman
National Lung Health Education Program
The National Lung Health Education Program (NLHEP), a new healthcare initiative, is aimed at early identification and intervention in COPD and related disorders.
The scientific basis for NLHEP is the Lung Health Study, where it was shown that patients with airflow obstruction have accelerated losses in airflow (as judged by FEV1) if they keep smoking, but a slight improvement in airflow with only a minor decline over five years in those who succeeded in stopping smoking throughout the program. Sadly, only 22% of patients who received a special program in smoking cessation quit, compared with 5% assigned to usual care.
The premature losses of lung function herald the onset of symptomatic stages of COPD and are associated with an astonishing incidence of lung cancer, which is 2% to 5%, depending upon the age of the patient and the severity of airflow obstruction. Thus, a major challenge for nicotine addiction research is evident.
Answers to these questions could offer foundations for new therapeutic strategies for primary care physicians who are on the frontline in treating patients with early stages of COPD.
We badly need to offer the primary care physician new tools for smoking cessation. We need new pharmacological strategies to be able to stem the progress of the most rapidly growing health problem in the United States today.
The battle cry of the NLHEP is "Test Your Lungs, Know Your Numbers!" NLHEP aims to put spirometers in the hands of all primary care physicians for early identification and intervention. Today, industry has answered the call for accurate handheld spirometers. These devices are user-friendly, which will allow for widespread use in doctors' offices, at the workplace, and in smoking cessation clinics.
Preliminary studies indicate that even smokers with normal pulmonary function tests (PFTs) can be motivated to quit. Smokers with abnormal PFTs must be especially counseled that continued smoking will lead to further lung damage.
Nicotine researchers can play a major role in studying the impact of pulmonary function knowledge on smokers’ motivation to quit. Emphysema is the most destructive and dreaded component of the COPD spectrum. In this era of "spin," maybe we should consider the notion that NLHEP really means: Nicotine Limits the Health of Emphysema Patients!
The Lung Health Education Program can be contacted at 1850 High St., Denver, CO (USA), telephone (303) 839-6817, fax (303) 832-5137.
FURTHER READING
Petty, T. L. (1997). Do your patients at risk know their ‘lung number’? A new national strategy for COPD. The Journal of Respiratory Diseases, 18, 365-369.
Petty, T. L., Weinmann, G. G. (1997). Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease. The Journal of the American Medical Association, 277, 246-253.
Future Events
SECOND EUROPEAN CONFERENCE ON TOBACCO OR HEALTH, "Smoke Free 21st Century Conference," 23-27 February 1999, Gran Canaria Island. Information at: www.rcanaria.es/tobacco99.org .
SRNT FIFTH ANNUAL MEETING, 5-7March 1999, at the Sheraton Hotel, San Diego, California. Held in conjunction with the 20th Annual Meeting of the Society of Behavioral Medicine. Late-submission poster deadline is 8 February 1999. (See additional information in News and Other Offerings, below.)
WORKSHOP ON STATE-OF-THE-ART SMOKING CESSATION INTERVENTIONS, 11-12 March 1999, University Place Conference Center, Indianapolis, Indiana. Sponsored by the Indiana University schools of Medicine and Dentistry and the Indiana University Nicotine Dependence Program. For more information, telephone (317) 274-8353 or (800) 622-4989.
90TH ANNUAL SCIENTIFIC MEETING OF THE AMERICAN ASSOCIATION FOR CANCER RESEARCH, 10-14 April 1999, Philadelphia, Pennsylvania. Topics include cancer prevention. Contact AACR, fax (215) 440-9313, email aacr@aacr.org.
11TH WORLD CONFERENCE ON TOBACCO OR HEALTH, 6-10 August 2000, Chicago, Illinois. Theme "Tobacco: the growing epidemic." Contact American Cancer Society, Atlanta, Georgia, fax (404) 325-2217.
ANNUAL MEETING POSTERS. The late-submission Rapid Communications poster deadline
for the Fifth Annual SRNT Annual Meeting is 8 February 1999. Contact Joy Schmitz [jschmitz.utmsinwm@msi66.msi.uth.tm.edu
(713) 500-2867 phone (713) 500-2849 fax] regarding submission. Electronic submission is preferred.
NEW MANAGEMENT TEAM IN PLACE. Look at the bottom left corner of page 2 of the newsletter, and you’ll notice a new name. Thomas Miller Associates has been selected as interim manager of SRNT’s organization. The Society also will be accepting competitive bids for a long-term management arrangement. Sarah Evans, who has assisted with SRNT management in the past, will be SRNT Executive Director on the TMA team. A column by SRNT President Jack Henningfield in this issue explains the transition.
UPDATE YOURSELF. Members whose contact information has changed during the last two years should fill out and return the yellow postcard enclosed with this newsletter. Please use the card to notify SRNT of any change in name, address, work location, telephone number, fax number, or email address. Note that postage is required for mailing. Any member who is not certain that SRNT has the most current information should fill out and mail the card.
MORE TO COME. The First International Meeting of SRNT was "a smashing success," according to those who attended. More than 300 scientists attended the meeting in Copenhagen in August and participated in eight symposia, plenary lectures, and more than 70 poster presentations. As the Society’s non-United States membership rises, plans are under way for another European SRNT meeting and SRNT satellite symposia.
YOU ARE NEEDED. Want to volunteer? SRNT needs you! John Hughes and E. D. Glover are organizing offers to help on SRNT committees. Look over the list of committees on the last page of the newsletter. If you have an interest in volunteering, please e-mail Hughes at john.hughes@uvm.edu. If you have volunteered in the past and not yet been assigned, please restate your interest. Hughes and Glover apologize for any volunteers whose offers have been overlooked, and promise to contact all who are willing to contribute time, thought, and effort.
Officers and Committees
President
Jack E. Henningfield (1998-1999)
Past President
Maxine L. Stitzer (1997-1998)
President-Elect
Dorothy Hatsukami (1999-2000)
Secretary-Treasurer
Harry A. Lando (1996-1999)
Member-Delegates
Murray E. Jarvik (1995-1998)
Allan C. Collins (1996-1999)
Karl O. Fagerström (1997-2000)
Judith Ockene (1999-2002)
COUNCIL CHAIRS
Membership and Development
Scott J. Leischow (1997-2000)
Program, Public Information, and Training
Stephen J. Heishman (1997-2000)
Publications, Communications
Ovide F. Pomerleau (1997-2001)
Scientific Liaison, Public Policy
Neil E. Grunberg (1996-1999)
STANDING COMMITTEES
Finance
Ray Niaura (1998-2001)
Long-Range Planning
Neal L. Benowitz (1998-1999)
Nominations
Martin J. Jarvis (1997-2000)
COMMITTEES UNDER COUNCIL JURISDICTION
Development
Mitchell A. Nides
Education/Training
Tom J. Payne
Journal Editor
Gary E. Swan
Membership
Lisa Brauer
Liaison
Neil E. Grunberg
Newsletter
Janet Brigham
Program
Joy M. Schmitz
Public Policy
John R. Hughes
Research Support
Kenneth J. Kellar
AD HOC COMMITTEE
Operations/Oversight
Maxine Stitzer, chair
Jack Henningfield
Ray Niaura
Harry Lando
John Hughes
Ovide Pomerleau
CORPORATE SPONSORS
Glaxo Wellcome
Pharmacia & Upjohn
Ortho-McNeil Pharmaceutical
PICS
SmithKline Beecham
Publishing Information
SRNT Newsletter
Published quarterly by the
Society for Research on Nicotine and Tobacco
EDITOR
Janet Brigham, Ph.D.
Center for Health Sciences
SRI International
333 Ravenswood Ave.
Menlo Park, CA 94025 USA
Phone: (650) 859-2797
Fax: (650) 859-5099
E-mail: jzb@unix.sri.com
ASSISTANT EDITOR
Raine L. Riggs
University of Vermont
rriggs@zoo.uvm.edu
CONTRIBUTING EDITORS
International News
Robert West, Ph.D.
sgjt600@sghms.ac.uk
Peter Hajek, Ph.D.
p.hajek@mds.qmw.ac.uk
Biobehavioral Research
Kenneth J. Kellar, Ph.D.
kellark@gunet.georgetown.edu
Clinical Research
Ray Niaura, Ph.D.
raymond.niaura@brown.edu
Public Health Research
Linda Pederson, Ph.D.
lindap@mindspring.com
SRNT CENTRAL OFFICE
7611 Elmwood Ave.
Middleton, WI 53562 USA
608-836-3787 (phone)
608-831-5485 (fax)
e-mail: srnt1@aol.com
Executive Director
Sarah Evans
SRNT WEB SITE
www.srnt.org