Do Heavy Smokers Need a Higher Replacement Dose of Nicotine to Quit?

To the Editor.  —In the context of previous research that supports the idea that heavy smokers are more likely to quit with higher levels of nicotine replacement,¹ the trial by Dr Jorenby and colleagues,² which concluded that "2 patches are no better than 1," was quite surprising. We believe that a careful inspection of the study actually supports the argument that heavy smokers do better with 2 nicotine patches than with 1.When viewed from the perspective of health care practitioners who typically use minimal behavioral counseling, the primary research question should be "With this heavy smoker who wants to quit, should I prescribe 1 or 2 nicotine patches?" If this was the primary research question, then the study by Jorenby et al was a positive study at 4 weeks comparing 44 mg/d to 22 mg/d in both heavy and light smokers (76% vs 49% for participants smoking