Letters
Environmental health
Volume 197 - Issue 1

Nicotine replacement therapy: evidence from observational studies versus clinical trials

Author:  Johnson George

Med J Aust 2012; 197 (1): 28. || doi: 10.5694/mja12.10653
Published online: 2 July 2012
In reply: The response of Chapman to my article is not surprising, given his involvement in the Alpert article.1 The recommendations of Alpert and colleagues have already been criticised internationally, and debate on the effectiveness of pharmacological smoking cessation therapies is not new. Meta-analyses have shown 50% to 70% greater quit rates for nicotine replacement therapy (NRT) compared with placebo or in controls.2,3 Advocates of ...
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In reply: The response of Chapman to my article is not surprising, given his involvement in the Alpert article.1 The recommendations of Alpert and colleagues have already been criticised internationally, and debate on the effectiveness of pharmacological smoking cessation therapies is not new. Meta-analyses have shown 50% to 70% greater quit rates for nicotine replacement therapy (NRT) compared with placebo or in controls.2,3 Advocates of cold turkey cessation question the effectiveness of NRT in the “real world”, using data from population studies.1,4,5

Multiple attempts are often necessary before a smoker can successfully quit. Smokers with a history of failure to quit without support may find behavioural counselling and pharmacological aids to be useful in their quit attempts and in achieving long-term success.

The National Health and Medical Research Council recommendations for developers of guidelines place randomised controlled trials well above observational studies in the study validity hierarchy. The submission to list nicotine patches on the Pharmaceutical Benefits Scheme was made by a consortium of independent public health organisations. Advocates of unassisted smoking cessation should provide stronger evidence to convince policymakers and practitioners.

Author

  • Johnson George1
  • 1. Centre for Medicine Use and Safety, Monash University, Parkville, VIC.

Correspondence: Johnson.George@monash.edu

Competing interests

I am an investigator in the Give Up For Good clinical trial, evaluating a multidisciplinary smoking intervention initiated during hospital stay, funded by the Australian Research Council and an investigator-initiated research grant from Pfizer.

References

View this article on Wiley Online Library

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