Quitting Smoking: Nicotine vs Placebo Gum

To the Editor.—  Hughes et al¹ add another well-designed randomized study to the literature on smoking cessation. However, the authors' conclusions about the ineffectiveness of nicotine gum with brief physician counseling need further discussion. First, their sample size had inadequate power to detect a 10% difference in quit rates. They attempt to justify their sample size by commenting that a lower quit rate would not be "clinically significant," given that physician advice alone results in a 5% quit rate. This statement coupled with the results of their survey—that the majority of primary care physicians would not use a medicine if it would only result in a 5% increase in quit rates—highlight the crux of the problem with smoking cessation. One of the major reasons physicians do not counsel smokers, either with or without nicotine gum, is that it is their perception that quit rates of 5% to 10% are