Antonuccio raises a number of interesting and thoughtful points in his letter. These issues, as he implies, are not only relevant in terms of interpreting our work, but, indeed, in interpreting virtually all of the smoking cessation studies published in the medical literature, particularly those using a nicotine reduction medication, eg, nicotine polacrilex, nicotine patch, nicotine nasal spray, or nicotine vapor inhaler.
First, in our view, it is appropriate to compare active vs placebo treatment conditions at the same time points from target quit day (TQD) onward. As has been clearly documented over the past 30 years, nicotine is not responsible for the overwhelming majority of the morbidity and mortality produced by tobacco smoke.1 There is no evidence that either nicotine or its metabolites are carcinogens or co-carcinogens.1 Rather, the vast majority of cigarette-produced illnesses are created from the other 4000 compounds in tobacco smoke.1 Thus, from
Sachs DPL, Säwe U, Leischow SJ. Will the Nicotine Patch Really Stick?-Reply. Arch Intern Med. 1994;154(8):927–930. doi:10.1001/archinte.1994.00420080133017