The author of an ‘Observation’ article published in the British Medical Journal (BMJ) discusses a prospective cohort study conducted in the US, which evaluated the population effectiveness of nicotine replacement therapies (NRT) with or without professional counselling.  The New York Times carried a front page article on this research, with the message that “the nicotine gum and patches that millions of smokers use to help kick their habit have no lasting benefit and may backfire in some cases.”

The study included 787 adults in the US who had recently quit smoking, who were interviewed in three waves over a period of six years.  The baseline response rate was 46%; follow-up was completed with 56% of the designated cohort at wave 2 and 68% at wave 3.  Around a third of participants reported to have relapsed by the time of the subsequent interview, and the authors say that the odds of relapse were unaffected by the use of NRT for >6 weeks, either with or without professional counselling.    

The researchers concluded that their findings “raise serious questions regarding the population level effectiveness” of nicotine replacement and counselling. Further, they are concerned that “funding ineffective services that aim to change individual behaviour may be resulting in the loss of scarce resources from public health programmes” such as mass media campaigns, tobacco tax rises, and antismoking regulation.

The author of the BMJ article acknowledges the large amount of previous research that has shown NRT can help smokers to quit in the short-term and to stay off tobacco for up to 12 months.  They discuss how population-based studies can be useful when evaluating such interventions, but discuss flaws of the current study, including the following:

• The probability sample was 6739 adults but the study sample only 787; were the ultimate participants similar to the non-participants?

• Only one in five of the 787 participants used nicotine replacement to help them quit and only 30% relapsed – the analysis therefore centres on a small number of patients (around 50 relapsers who used nicotine replacement).

• Only a third of these reported using NRT for the recommended 8 weeks

• There is a possibility of recall bias (i.e. those seeking treatment are more likely to remember it than those making a more informal attempt to quit)

• People who quit on their own are different from those who need and seek help through counselling or medication (e.g. they may be less addicted or have more willpower)

The author considers there to be no doubt that NRT helps smokers quit and stay off tobacco products for at least one year in the clinical setting; however studies on effectiveness in the community setting are needed (including OTC use), as are longer-term data.  They comment that a combination of strategies) clinical, public health, regulatory, and legislative) are need to effectively fight tobacco use.