I shall begin with my conclusion: the major product implication of alternative treatment goals is the maintenance of flexibility. We need to develop a variety of pharmacotherapeutic options to allow individualised treatment, both for the particular smoker and for a particular treatment goal.

I refer to flexibility here over a number of different dimensions, which I refer to as corollaries of flexibility. The table shows these major areas of concern. The first and obviously most important of those corollaries of flexibility or dimensions of concern, is the pharmacotherapeutic agent, per se.

The figure shows cigarettes as well as the currently available, and perhaps soon to be available, nicotine replacement medications along a continuum of those that are the shortest acting and most rapid to reach their peak to those that are of longest duration and reach their peak the slowest. The first line indicates the dosage form; the second line shows the number of dosage units (cigarettes, sprays, pieces, systems) used per day; the third line is the approximate time to reach peak concentration; and the last line indicates approximate duration of significant plasma levels of nicotine.

Of course, there are also several other important variables along this continuum, including the total administered dose, the degree of active patient participation, or the degree to which the medication is passive, as well as the side effect profile. Active participation by the patient is indicated to some degree by the frequency of administration. Those dosage forms on the left side of the continuum, requiring most frequent administration, involve the most active patient participation, while those requiring less frequent dosing, often referred to as passive medications, appear on the right side. Transdermal nicotine replacement, with only one daily dose, is currently the form requiring the least patient participation.

The total administered dose per …