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To the Editor: Drs Pierce and Gilpin¹ conclude that nicotine replacement therapy (NRT) has not increased smoking cessation rates since it became available over-the-counter. We do not believe that the authors can draw such efficacy conclusions from this nonrandomized, noncontrolled study.

Pierce and Gilpin compared users of NRT vs nonusers, but these may be different populations. Smokers who cannot quit on their own may be more likely to use NRT and thus are likely to be more dependent than those who attempt to quit without it. Stratification for the number of cigarettes smoked cannot correct for this.

This study is also limited by retrospective self-reporting, which relies heavily on memory, and may be biased as smokers may be more likely to remember successful cessation attempts than short, unaided, and unsuccessful efforts. Furthermore, the authors did not obtain biochemical verification of abstinence. Finally, the authors suggest that NRT is not effective . . . [Full Text of this Article]

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