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LETTERS: Manfred Neuberger Article skips over weaknesses of nicotine replacement BMJ 2007; 335: 112-a [Full text]

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Response to Neuberger

Paul Aveyard, Robert West   (20 July 2007)

Response to Neuberger 20 July 2007
Paul Aveyard, NIHR Career Scientist Department of Primary Care, University of Birmingham, Birmingham B15 2TT, UK, Robert West Send response to journal: Re: Response to Neuberger	Neuberger questions our conclusions on the Allen Carr Easyway. 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. We believe the literature is insufficient to show whether NRT is completely safe and there is still insufficient evidence of its efficacy in pregnancy to confidently recommend it. However, based on clear evidence of its efficacy in non-pregnant populations(1), and based on clinical reasoning that a lower dose of nicotine from NRT(2) is safer than a higher dose with additional toxins from cigarettes, there should be a presumption of use in pregnancy. The UK drug regulatory authority also concluded this. 1. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Nicotine replacement therapy for smoking cessation Cochrane Database of Systematic Reviews: Reviews 2004 Issue 3 John Wiley & Sons, Ltd Chichester, UK DOI: 10 1002/14651858 CD000146 pub2 2004;(3). 2. Benowitz NL. Pharmacology of Nicotine: Addiction and Therapeutics. Annu Rev Pharmacol Toxicol 1996; 36(1):597-613. Competing interests: These are the same as in our original article