BMJ  2007;335:222 (4 August), doi:10.1136/bmj.39289.672928.BE

Letters

Managing smoking cessation

Authors' reply to letter

Neuberger questions our conclusions on the Allen Carr Easyway.¹ As he points out, the observational data on abstinence rates are contradictory. This illustrates the difficulty of judging the efficacy of interventions without clinical trial data. Drug companies would not be permitted to make the claims of effectiveness made by Allen Carr Easyway without having funded independent clinical trials. Allen Carr Easyway should fund such trials.

Neuberger also suggests that we ignore evidence of the harm from nicotine replacement therapy (NRT) in pregnancy. The literature is insufficient to show whether NRT is completely safe and its efficacy in pregnancy to confidently recommend it. However, given clear evidence of its efficacy in non-pregnant populations and clinical reasoning that a lower dose of nicotine from NRT is safer than a higher dose with additional toxins from cigarettes,^{2 3} there should be a presumption of use in pregnancy. The UK drug regulatory authority also concluded this.

¹ Department of Primary Care, University of Birmingham, Birmingham B15 2TT, ² Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London WC1E 6BT

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Competing interests: These are the same as in the original article.⁴

References

1. Neuberger M. Article skips over weaknesses of nicotine replacement. BMJ 2007;335: doi:10.1136/bmj.39275.964514.BE[Free Full Text]
2. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004;3:CD000146 pub2.[Medline]
3. Benowitz NL. Pharmacology of nicotine: addiction and therapeutics. Annu Rev Pharmacol Toxicol 1996;36:597-613.[CrossRef][ISI][Medline]
4. Aveyard P, West R. Managing smoking cessation. BMJ 2007;335:37-41. (7 July.)[Free Full Text]

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Relevant Article

Managing smoking cessation

Paul Aveyard and Robert West
BMJ 2007 335: 37-41. [Extract] [Full Text] [PDF]