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Letters: W K Al-Delaimy, E A Gilpin, and J P Pierce When California smokers use nicotine replacement therapy, most are trying to quit smoking Tob Control 2005; 14: 359-a-360-a [Full text] [PDF]

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Is NRT loosing its efficacy?

John R Hughes   (2 November 2005)

Is NRT loosing its efficacy? 2 November 2005
John R Hughes, Physician University of Vermont, USA Send letter to journal: Re: Is NRT loosing its efficacy? john.hughes{at}uvm.edu John R Hughes	The recent article by Al-Delaimy et al (TC 14:359) makes two conclusions. The first is that use of over-the-counter (OTC) nicotine replacement therapy (NRT) for reasons other than smoking cessation is uncommon. This result is consistent with several other studies not cited in this letter (Nic Tobacco Research 6:79; Nicotine Safety and Toxicity (N Benowitz, ed) p 147). The second conclusion is that "some smokers may be questionning the efficacy of NRT for quitting." This conclusion is based on the observation that among those who had ever used NRT, many had not used it in their last quit attempt. This is not a necessary deduction from this observation. For example, assume a) we have a treatment that is proven effective but is effective in a minority of patients, b) that patients have a chronic relapsing disorder that requires several treatment episodes and c) most patients are reluctant to use any treatment that has failed in the past. Under these conditions, all effective treatments will be unlikely to be used in the last treatment episode. For example, I would wager that most smokers who used behavioral therapy for smoking cessation did not use behavioral therapy on their last attempt. Concluding that this data means that patients are "questionning the efficacy" suggests that over time the treatment is loosing its efficacy. This is not a necessary deduction from the above observation. If so, then we would have to conclude that all treatments effective in a minority of patients are loosing efficacy over time.