Free NRT by mail an intent-to-treat defeat
Zawertailo, Selby and colleagues conclusion that free replacement nicotine (NRT) by mail is effective is deeply disturbing. While the study's free abstract portrays free NRT by mail as a resounding success (21.4% smoking cessation at 6 months versus 11.6% for no-intervention), it neglects mention that under intent-to-treat analysis that there was zero benefit over no-intervention (an average of 8.7 percent 30-day point prevalence at 6 months for both mailed NRT and control).
All evidence presented in the 2008 Guideline Update relied exclusively upon intent-to-treat data. Here, the rates shared in the abstract ignore 2,746 six-month follow-ups where participants were successfully reached by phone. Why? Because they either hung-up or refused interview. It's a number greater than the 2,601 actually interviewed. Do happy, thankful and successful quitters normally hang-up after previously agreeing to follow-up?
A number of recent population studies have found NRT totally ineffective (Ferguson 2005, Doran 2006, Hartman NCI 2006, Pierce 2012, Alpert 2012 and Coleman 2012). The prospect of a billion smoking related deaths before century's end, now is not the time for creative quitting definitions which ignore disappointed or disgruntled participants.
John R. Polito, JD
 Zawertailo L, Dragonetti R, Bondy SJ, Victor JC and Selby P, Reach and effectiveness of mailed nicotine replacement therapy for smokers: 6-month outcomes in a naturalistic exploratory study. Tob Control. doi:10.1136/tobaccocontrol-2011-050303
Conflict of Interest:
Pro bono director of a cold turkey quitting forum.