"The nicotine gum and patches that millions of smokers use to help kick their habit have no lasting benefit and may backfire in some cases according to the most rigorous longterm study to date of socalled nicotine replacement therapy. The study published Monday in the journal Tobacco Control included nearly  people trying to quit smoking over a period of several years and is likely to inflame a longrunning debate about the value of nicotine alternatives. In medical studies the products have proved effective making it easier for people to quit at least in the short term. Those earlier more encouraging findings were the basis for federal guidelines that recommended the products for smoking cessation. But in surveys smokers who have used the overthecounter products either as part of a program or on their own have reported little benefit. The new study followed one group of smokers to see whether nicotine replacement affected their odds of kicking the habit over time. It did not even if they also received counseling with the nicotine replacement. The market for nicotine replacement products has taken off in recent years rising to more than  million annually in  from  million in . The products were approved for overthecounter sale in  and many state Medicaid programs cover at least one of them.   We were hoping for a very different story said Dr. Gregory N. Connolly director of Harvards Center for Global Tobacco Control http and a coauthor of the study. I ran a treatment program for years and we invested millions in treatment services. Doctors who treat smokers said that the study findings were not unexpected given the haphazard way many smokers used the products. Patient compliance is a very big issue said Dr. Richard Hurt director of the Nicotine Dependence Center http at the Mayo Clinic who was not involved in the study. Dr. Hurt said products like nicotine gum and patches are absolutely essential but we use them in combinations and doses that match treatment to what the individual patient needs unlike smokers who are selftreating. The products have been controversial since at least  when researchers at the University of California San Diego reported from a large survey that they appeared to offer no benefit. The study did not follow people over time. A governmentappointed panel that included nicotine replacement as part of federal guidelines for treatment also came under fire because panel members had gotten payments from the product manufacturers. Some studies have questioned these treatments but the bulk of clinical trials have unequivocally endorsed them said Dr. Michael Fiore director of the University of Wisconsins Center for Tobacco Research and Intervention  http the chairman of the panel that wrote the guidelines. Dr. Fiore who has reported receiving payments from drug makers said that there are millions of smokers out there desperate to quit and it would be a tragedy if they felt because of one study that this option is ineffective. Top of Form Bottom of Form Top of Form In the new study conducted in Massachusetts the researchers followed a representative sample of  adults including  people who said at the start of the study that they had recently quit smoking. They interviewed the participants three times about once every two years during the s asking the smokers and quitters about their use of gum patches and other such products their periods of not smoking and their relapses. At each stage about onethird of the people trying to quit had relapsed the study found. The use of replacement products made no difference whether they were taken for the recommended twomonth period they usually were not or with the guidance of a cessation counselor. One subgroup heavy smokers defined as those who had their first cigarette within a halfhour of waking up who used replacement products without counseling was twice as likely to relapse as heavy smokers who did not use them. Our study essentially shows that what happens in the real world is very different from what happens in clinical trials said Hillel R. Alpert of Harvard a coauthor with Dr. Connolly and Lois Biener of the University of Massachusetts Boston. The researchers argue that while nicotine replacement appears to help people quit it is not enough to prevent relapse in the longer run. Motivation matters a lot so does a persons social environment the amount of support from friends and family and the rules enforced at the workplace. Media campaigns increased tobacco taxes and tightening of smoking laws have all had an effect as well."