An article published Monday online ahead of print in the journal Tobacco Control challenges the prevailing wisdom in the tobacco control movement by arguing that nicotine replacement therapy (NRT) is ineffective for smoking cessation and that therefore, public expenditures for NRT provision to smokers is a waste of resources.
See: Alpert HR, Connolly GN, Biener L. A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation. Tobacco Control 2012; doi:10.1136/tobaccocontrol-2011-050129.
According to the study press release from the Harvard School of Public Health (HSPH):
"In the prospective cohort study the researchers, including lead author Hillel Alpert, research scientist at HSPH, and co-author Lois Biener of the University of Massachusetts Boston's Center for Survey Research, followed 787 adult smokers in Massachusetts who had recently quit smoking. The participants were surveyed over three time periods: 2001-2002, 2003-2004, and 2005-2006. Participants were asked whether they had used a nicotine replacement therapy in the form of the nicotine patch (placed on the skin), nicotine gum, nicotine inhaler, or nasal spray to help them quit, and if so, what was the longest period of time they had used the product continuously. They also were asked if they had joined a quit-smoking program or received help from a doctor, counselor, or other professional.
The results showed that, for each time period, almost one-third of recent quitters reported to have relapsed. The researchers found no difference in relapse rate among those who used NRT for more than six weeks, with or without professional counseling. No difference in quitting success with use of NRT was found for either heavy or light smokers.
"This study shows that using NRT is no more effective in helping people stop smoking cigarettes in the long-term than trying to quit on one's own," Alpert said. He added that even though clinical trials (studies) have found NRT to be effective, the new findings demonstrate the importance of empirical studies regarding effectiveness when used in the general population.
Biener said that using public funds to provide NRT to the population at large is of questionable value, particularly when it reduces the amount of money available for smoking interventions shown in previous studies to be effective, such as media campaigns, promotion of no smoking policies, and tobacco price increases."
The Rest of the Story
This landmark study confirms a point that I have repeatedly argued here at The Rest of the Story: that population-based studies of the use of NRT in real-life situations do not support the results from clinical trials showing that NRT is effective for smoking cessation, at least not in the long-term.
This study provides important empirical evidence that over the long-term, population-based use of NRT in real-life situations - outside of the clinical trial setting where there is extensive counseling and other support provided - is not an effective treatment to aid smoking cessation. It does not appear to be any better than smokers attempting to quit unaided.
This does not mean that in individual patients, NRT is not effective and should not be considered. But it does mean that on a population basis, as a matter of public health policy, the role of NRT has been way over-rated.
I agree that with limited funding available, using those funds to provide NRT is of limited value. Instead, limited public funding for tobacco control should be used for proven programs such as smoking prevention media campaigns, which have been shown to reduce youth smoking by as much as 50%.