Categories
· Health/Science
· Secondhand Smoke
· Letter
· Ethnic Issues
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Vol. 288 No. 24, December 25, 2002
Jump to full article: Journal of the American Medical Association (JAMA), 2002-12-25
Intro: 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. . .
Although they may seem surprising, the results of Drs Pierce and Gilpin1 are actually consistent with the few published controlled "minimal intervention" efficacy studies of the nicotine patch. . . .
As a rural family physician with a large population of African American patients, who disproportionately experience greater smoking-attributable morbidity and mortality,1 I am constantly searching for ways to reduce health disparities associated with smoking. I agree with Drs Pierce and Gilpin2 that prescription benefit support of pharmaceutical cessation aids reduces the cost disincentives for their use. Many of my patients have such coverage. However, the most important factor in use of smoking cessation aids in African American and Hispanic patients in rural areas is access to information.
There is not even a daily newspaper in my county. Thus, patients' primary source of information (other than television) is print media with advertisements that specifically target increasing smoking in their ethnic groups. These magazines and monthly papers continue to have disproportionately large amounts of ads with images that glorify smoking. This leaves the physician with a profound responsibility to educate patients about the dangers of smoking.
I am the only African American family physician in my county and there is one Hispanic family physician. Many minority patients tell me that no health care provider has ever addressed the issue of smoking cessation with them, yet studies have shown that more than 80% of African American smokers desire to give up smoking. . .
Drs Pierce and Gilpin1 state: "Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers." This is a strong assertion that has the potential to significantly damage public confidence in NRT. In fact, this conclusion is much stronger than can be justified by the study results. The findings are derived from self-reported data on past cessation attempts from cross-sectional surveys in a single state. We believe that it is premature to draw inferences from this research. . . .
In Reply: Dr Franzon and colleagues note that meta-analyses of randomized trials estimate the efficacy of NRT as doubling the rate of long-term successful cessation.1, 2 Our data and that of others,3 however, suggest that its long-term effectiveness in the general population is less promising. . . .
Both Franzon et al and Stead et al feel that our conclusions are much stronger than the data justify. They worry that these findings will damage public confidence in NRT. We would hope that our results point to the need for research into how NRT can be made more effective in the general population. We agree with Silagy et al2 that "Falsely raising the expectations of smokers who purchase these products 'over-the-counter' without at least providing minimal support and an adequate explanation of the limitations of using NRT may be counterproductive in the long term."
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