Geisinger Health, the major health care system of central and northeastern Pennsylvania, recently joined Abington Memorial Hospital, the World Health Organization and other tobacco-conscience health care organizations by announcing that it will screen prospective employees for nicotine before hiring—those whose urine tests positive for nicotine will not be hired. Along with smoke-free air policies, cigarette taxes, and graphic warning labels, pre-employment nicotine screenings are yet another arrow in the public health quiver of efforts aimed at getting people not to smoke.
Given that we’re so serious about cracking down on smoking, one might wonder if we should consider a more efficient approach—one that completely stops people from smoking in the first place. This is the goal of NicVAX—a conjugate vaccine being developed to prevent and treat nicotine addiction.
According to Nabi Biopharmaceuticals, the company developing NicVAX with aid from a $4.1 million National Institute on Drug Abuse grant, the vaccine is intended to work by getting the body’s immune system to produce antibodies, which bind to molecules of nicotine in the blood stream, which in turn block the nicotine reaching the brain and prevent the release of feel-good chemicals, like dopamine, which make cigarettes addictive. If it works as intended, NicVAX will prevent smoking and help people quit by making the experience less pleasurable—not an outright adverse experience as Antabuse (Disulfiram) does with alcohol.
While NicVAX may not see FDA approval and widespread use in clinical settings anytime soon (the vaccine recently performed no better than placebo in two phase III clinical trials), one can’t help but speculate about the philosophical and public health and ethical implications of such an approach to smoking prevention.
What could a nicotine vaccine mean for the public’s health? Well, according to the CDC, smoking is responsible for 88,600 deaths annually and $193 billion in economic losses ($96 billion in direct health care costs and $97 billion in lost productivity). So there’s that. Locally, it is estimated that over a quarter of adults in Philadelphia smoke cigarettes. Philadelphia also wears the yellow, nicotine-stained crown of having the highest rate of highest rate of youth smoking among comparable big cities. From a strictly public health perspective, a nicotine vaccine would be a good thing.
So what about the more thorny philosophical issues? Is there precedent for this sort of intervention? People take all sorts of drugs to prevent the undesired effects of certain behaviors (birth control, for example), but there are far fewer medical technologies designed to prevent the behavior itself—let alone one as enduring and invasive as a vaccine. Even as a self-proclaimed advocate of public health, I must say that there is something somewhat unsettling and Orwellian about the idea of being vaccinated against a socially undesirable behavior.
But then again, a nicotine vaccine would be completely voluntary (initially, at least …). In theory, the vaccine wouldn’t constrain people’s free will, but rather empower them by taking the elements of physical addiction out of the equation—leveling the playing field so that rational decisions can be made. Nevertheless, it’s not beyond the realm of possibility that, if proven safe and effective, a nicotine vaccine could become compulsory given the enormous health, social, and economic benefits it would yield for society.
What do you think? Would a voluntary nicotine vaccine be a worthy 21st century addition to the public health armamentarium of efforts aimed at reducing smoking rates? Or would it be just an example of the private sector developing new technologies that serve to supplant one’s free will in exchange for shareholder profits?
And would it represent the beginning of a slippery slope toward a mandate? (If so, would that be a good or bad thing?) Post a comment below.
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