Free NRT by mail an intent-to-treat defeat

John R. Polito, Nicotine Cessation Educator,
April 27, 2012

Zawertailo, Selby and colleagues conclusion that free replacement nicotine (NRT) by mail is effective is deeply disturbing.[1] 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

[1] 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.

Conflict of Interest

None declared