Talk:Nicotine replacement therapy

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 September 2019 and 13 December 2019. Further details are available on the course page. Student editor(s): Letony331, Kchun, Wu.Marilyn, Joanna.sy.choi. Peer reviewers: Nataliealsalek, Cqdang.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 05:17, 17 January 2022 (UTC)

Criticism

Does anyone else think the "criticism" section doesn't really belong, as at no point does it mention any real criticism of NRT? Not to mention it has no citations and is poorly written. Chocobomastr (talk) 21:42, 3 May 2010 (UTC)

As it stands now (feb 11 2011), it sort of deteriorates into an opinion piece. The last two paragraphs are argumentative and un-sourced. 83.251.88.13 (talk) 14:29, 11 February 2011 (UTC)

DAP> I agree the criticism appears highly biased. IMO, the issue is not whether NRT increases long-term abstinence (whoever claimed it did?), but whether it makes initial quitting faster/easier/more successful. Like almost any other addiction, long-term abstinence depends on other factors, not chemical replacement (e.g. motivation, peer support, CBT/counseling, replacement activities such as exercise, etc. etc.). D Anthony Patriarche (talk) 23:57, 25 April 2012 (UTC)

Nicotine Replacement

Taking nicotine increases the endorphins in the body. That's what a smoker really craves, endorphins. Why replace the nicotine, if what the smoker really wants are the endorphins? Exercise is a great way to create endorphins in the body. When withdrawal symptoms from nicotine get strong, taking a long, fast walk will ease withdrawal symptoms tremendously. Moreover, exercise is a free treatment, unlike nicotine replacement. In any case, why replace nicotine at all when endorphins are the ultimate goal of the therapy? Years ago, I knew a doctor in Baltimore who gave endorphin replacement therapy by injecting endorphins.

No its nicotine that smokers get addicted to, exercise is not addictive.203.94.54.14 (talk) 03:23, 6 October 2008 (UTC)

Yea, this is total BSUntilzero (talk) 19:54, 9 July 2009 (UTC)

Taking nicotine increases the endorphins in the body! that is why smoking is so nice. The nicotin signals to the brain to release endorphines. Doing excercise releases endorphines which can lessen the withdrawel effects of abstinace for a smooker! —Preceding unsigned comment added by 194.255.48.12 (talk) 18:11, 22 September 2010 (UTC)

The talk page is for discussion of ways to improve the article. Not for scientific debate. Please find a more appropriate forum for this. Apophenian Alchemy (talk) 15:31, 9 July 2011 (UTC)

Withdrawal and reenforcing addiction

I tried to put the following into the nicotine patch article, but it was removed within minutes:

Nicotine is a relatively easy drug to quit. As far as I know, not one person has ever died from nicotine withdrawal. Moreover, nicotine dependency is short-lived. Nicotine is completely out of the body in 48 hours. At that point, physical cravings cease. Anyone who can go 48 hours without a cigarette stands a really good chance of quitting. Nicotine is highly addictive, however. Any small amount, even from second-hand smoke, will immediately reenforce nicotine addiction - resetting the clock back to 48 hours. The nicotine patch will guarantee that the addiction clock is reset back to 48 hours every time it is used. Logic might suggest that one cannot end nicotine addiction by taking nicotine. Unlike heroine or alcohol withdrawal, you cannot die from smoking cessation. Therefore, a step-down program would appear to be unnecessary, and fails as a quitting aid in a great many cases.

Perhaps the best method to fight cravings is exercise which causes the body to produce its own endorphins. These endorphins in turn negate many of the effects of withdrawal.

It seems likely that the cigarette industry would love to convince everyone that it is impossible to quit smoking. That way, people would not ever try to quit. Short of this, the next best thing would be to convince everyone that it is very difficult to quit smoking. Then people will give-up trying more easily.

How can this information be included in the article? Or is this article monitored by the advertising agencies and public relations firms for the patch sellers and the cigarette companies?

This was probably removed because it is poorly written, reads like a personal rant, has absolutely no cited references for any of the 'factual' claims made by the author, and is, as far as I know and have read, riddled with inaccuracies. For instance, it is well known that death from heroin withdrawal is *extremely* rare, and those that do typically have serious underlying health problems which are simply exacerbated by the strain of acute withdrawal. This is an encyclopedia for better or worse, not a blog. You can't simply state something without any cited references to back it up.Untilzero (talk) 19:52, 9 July 2009 (UTC)

You also mustn't talk in the first person. The only place for "I" in wiki is in quotes. —Preceding unsigned comment added by 87.194.35.228 (talk) 21:23, 6 December 2009 (UTC)

Nicotine is the most addictive substance know to science [1]. So, you're wrong, that's why it was removed. Chocobomastr (talk) 21:39, 3 May 2010 (UTC)

Content moved from Tobacco smoking

I just moved a ton of content here from the Tobacco smoking article. I didn't write it - heck, I barely read it - and I don't know anything about NRT so I don't feel qualified to try and edit it. So, here you go, do with as you will.

Note on Edit 6.09.06 This could be an important resource for many smokers looking for help to quit. I've tried to stress the advantages of using NRT, it is an important weapon in the war against tobacco, many people find it useful in quitting. It is crucially, clinically proven to double your chance of quitting successfully.

Usefullness of NRT

This linkpage has some interesting links that challenge the efficacy of NRT. For example this JAMA article on the effectiveness of over the counter sales and this discussion on some flaws in the blinding of the NRT clinical studies (cf. links). -- user unknown

I suggest the 'clinically proven' part be left out of the article until it really has been prov Beck 08:26, 21 October 2006 (UTC)

Interesting links I'm sure. Interesting in that they are hosted by a smoking cessation group that is opposed to any but "cold turkey" cessation methods. After a brief perusal of the "linkpage" (actually a polemic against pharmacological and NRT therapies), and discovering that many statistics quoted were not normalized for the populations considered - rendering them meaningless -- and that what references were there were often misrepresented, or even simply links to further opinions from the owners of the website, I gave up. Apparently this commenter's "link page" is nothing but more mularkey from whyquit.com. Even if the page didn't have numerous POV problems, the talk page is for suggestions or discussions of ways to improve the article. If you think any of the links belong in or attached to the article, you are as welcome as anyone to make the appropriate edits. Deprived of their POV context, I don't see where they would fit. Apophenian Alchemy (talk) 18:34, 9 July 2011 (UTC)

near self-contradictory text

icotine is the addictive drug in tobacco products, and some research indicates that it may be a carcinogenic substance. While studies have shown that many of the constituents of tobacco smoke are carcinogenic, they fail to produce any evidence that nicotine itself is a carcinogen.

The first sentence says research may indicate nicotene is carcinogenic, the second that research does not "prove" nicotene carcinogenic. These sentences are not mutually contradictory only in the strictest sense.

I replace the text with: Nicotine is the addictive drug in tobacco products. According to the research consensus, many of the constituents of tobacco smoke are carcinogenic. That nicotene itself is a carcinogen, on the other hand, remains disputed. 68.148.160.10 (talk) 20:38, 29 August 2009 (UTC)

Accuracy of section "Cost" in Criticism (was: Outdated? Thoughts on expense)

I was wondering about something in the article that may be outdated by recent fluctuations in price of both cigarettes and nicotine replacement therapy. The article mentions that NRT is more expensive than cigarettes, which was undeniably true several years ago, but that may no longer be the case. I realize that the cost of said items will vary from location to location (particularly within the U.S., given individual states' taxation on cigarettes) and that it's not a sourced statement to begin with in the strictest sense, but I think that mentioning the relative cost of NRT to smoking is extremely useful to readers and definitely has a place in the article.

In short, I was extremely surprised earlier this year to note that the "nicotine gum" was significantly less expensive than the equivalent amount of cigarettes needed by a heavy smoker over the same time frame. Additionally, the high- and low-dose versions of each NRT generally retail at the same price (meaning that the light or moderate smoker could obtain the highest dose possible, at the same cost, and modify their usage of the NRT to further cut expenses). I'd understand if the 'modification' thing is too WP:OR to go into the article, but I think what is already there should be updated to reflect the decreasing cost of NRT vs. the increasing costs of cigarettes (presumably due to public health concerns). I brought this to the discussion page rather than just adding it myself because I'm not sure if what I've observed is typical in other areas. I'm also not sure if my calculations are relying too heavily on the fact that I smoke like a freight train transporting chimneys. Thoughts, anyone? *Vendetta* _{(whois talk edits)} 06:13, 13 November 2010 (UTC)

The price quoted for a script is incorrect also, the article refer to British NHS, but the cost of a script is not uniform across all the home nations, for instance the cost of s script is cheaper in Scotland I think it is £3 and will be free from April 2011, I believe that they are free also in Wales.

Yakacm (talk) 12:35, 25 January 2011 (UTC)

Besides the fact that the section violates WP:OR, even as written it doesn't make sense. According to the U.S. Dept of Health and Human Services (http://oas.samhsa.gov/2k3/cigs/cigs.htm) the average smoker 26 years and older smokes an average of 15 cigarettes per day. Using the figures given in the article section, that amounts to an average cost of £26 for 7 days of cigarettes, versus "up to £20" for NRT. The only way to make the figures validate the criticism is if you assume young smokers (who typically smoke less) or smokers that smoke less than the average. Sections which appear to be representative but are not should have such biases noted. And again, as noted, local conditions vary, but my experience as a U.S. resident has been that NRT has never been more costly than an equivalent periods supply of cigarettes (though granted my 20/day average is apparently above average). I guess my question has to be, is this a reasonable "criticism" of NRT or not -- especially with such speculations as "that people may become addicted to the NRT product and turn back to tobacco products to save money," without which the entire section self-destructs (I know of no research demonstrating this to be a prominent concern, but I'm always willing to be corrected. <insert sound of crickets chirping>). All told, this section looks like another hit piece of the anti-NRT, "cold turkey only" smoking cessation activists, and likely should simply be removed. Peeking at the next section, "Exempted populations", which talks about everything BUT exempted populations -- instead focusing on suggested differences between "real world" results and clinical research claims -- it's clear that the same kind of nonsensical anti-NRT mayhem is at work. *sigh* Time for an NPOV template. Apophenian Alchemy (talk) 16:41, 9 July 2011 (UTC)

A pack of 20 Lambert and Butler costs £7 - £7.50 depending on the shop. At an average of 15 per day, that's 105 per week. The strongest Nicorette patches are 21mg of nicotine over 24 hours. This equates to over 20 cigarettes per day. If we can assume that the average smoker spends £38.10 per week on fags and a presciption for 2 weeks worth of patches at the standard UK National Health Service prescription rate (which may not be indicative of rates in other countries), than it is A LOT cheaper than smoking. If the cost of a second prescription for a 1mg nicotine mouth spray is also included once per month, then it is also cheaper. I appreciate that all I've said is OR, but giving up smoking is VERY hard (more OR, it is backed up in many sources that I can't be bothered to cite right now) and misinformation is always wrong. I know that Wikipedia does not give medical advice, but smokers deserve to know that quitting (in the UK anyway) is cheaper than they think. Blackmetalgrandad (talk) 22:16, 17 November 2011 (UTC)

The article states "The British NHS provides help in the form of prescriptions, reducing the cost to £7.40 per script, and if several products are included on one script then the price will drop well below that of actual cigarettes." This isn't true. The cost on NHS prescription is per-item not per-script. That said, a 30 day supply of NRT will count as one item regardless of how many packets it is made up of as long as the packets are all the same. It's also important to keep in mind most GPs / health centres will either run a cessation clinic or be able to refer smokers to a local one. Cessation clinics will issue vouchers for up to 12 weeks worth of free NRT regardless of the wealth or otherwise of the smoker.92.40.254.237 (talk) 15:55, 13 January 2012 (UTC)

== Where I live (British Columbia, Canada) NRT is definitely much cheaper than smoking; we have high taxes on tobacco products. Assuming an average cigarette delivers 1 mg nicotine, a pack-a-day habit costs about $60/week for a total of 140 mg nicotine. Medium-strength nicotine lozenges cost about $40 for 108*2 mg nicotine, which works out to $26/week for the nicotine equivalent to a pack-a-day, while 4 mg lozenges at a very slightly higher price per 108-pack deliver 140 mg nicotine for about $14. Nicorette® NRT cartridge inhalers are rated at 4 mg, but actually contain 10 mg nicotine, and can be reused to deliver about 8 mg total; 42 cartridges at a similar cost to 108 lozenges work out to $16-32/week depending on how efficiently they are used. Pipe tobacco & cigars are more expensive per gram of tobacco, so the saving is even greater. Government programs are available to supply some forms of NRT for free.

What this all comes down to is that the relative cost of smoking and NRT depends so much on where you live, what you smoke, and what type of NRT you use, that IMHO this whole section is meaningless and should be deleted, or at least replaced by a simple statement that "NRT tends to be somewhat cheaper than the equivalent smoking, but this is highly dependent on jurisdiction and individual practice". And if that didn't get tagged as a "weasel statement" by the editors, I'd eat my cigar butt. D Anthony Patriarche (talk) 04:13, 18 July 2012 (UTC)

Criticism Ineffectiveness section removed

The section labeled "Ineffectiveness" under Criticisms has been removed. It consisted largely of a rant about possible toxic effects of nicotine, unrelated to whether NRT is an effective therapy for smoking cessation or not. (And even the few facts it stated are disputable. As noted on another tobacco related talk page, the research relating nicotine to cancer is at best suggestive, and the authors of it recommend "further research". The link between MAOI compounds is also rather speculative: the rant says it's a "fact" that tobacco addiction is the result of both nicotine and MAOI substances in tobacco smoke, the abstract of the referenced source for this claim states, "However, the molecular mechanisms underlying tobacco dependence are still not completely understood. Nicotine's action on nicotinic acetylcholine receptors, and the downstream release of dopamine, is believed to be the major pathway underlying tobacco dependence. However there is mounting evidence indicating that non-nicotinic components of tobacco smoke also play a role by inhibiting monoamine oxidase (MAO) and subsequently altering neurotransmitter levels." Mounting evidence that MAOI's may play a role do not amount to a fact that it is the combination which results in addiction. Beyond those two false statements, the only other relevant statement is that NRT efficacy is "controversial" (which could mean anything, and is unsourced). I've been making my way around the smoking cessation circuit of articles at wikipedia this morning, and many appear to be infected by the non-NPOV of "cold turkey only" smoking cessation advocates; I have no particular inclination to clean up the mess, from whomever, but this pointless and mislabeled rant was my limit, and it had to go. It had basically nothing to do with its title, and was little more than a scare piece to discourage use of NRT therapies. If the effectiveness of NRTs is disputed in the professional community, and can be appropriately source and explained in a NPOV way, by all means, do so. The existing section I removed did not. Apophenian Alchemy (talk) 15:59, 9 July 2011 (UTC)

Alternative and non-FDA approved smoking cessation products

I'd like to see if someone could include a section on non-fda approved cessation products (e-cigarettes and vaping) which, while not having had government studies conducted, have apparently offered outstanding success rates. Also, nicotine inhalers have been ignored. Simply because a product or technique is not FDA approved does not mean that it is ineffective. There is also some indications of successful smoking cessation due to diet changes, acupuncture, acupressure, and a plethora of herbal remedies (of varying effectiveness.) The important part seems to be that while many of the methods mentioned seldom have effectiveness ratings above that of 'cold turkey', e-cigarettes and nicotine inhalers appear to offer a much-higher than cold turkey rate of smoking cessation, and e-cigs in particular are cost effective. — Preceding unsigned comment added by 67.2.9.41 (talk) 20:06, 10 September 2011 (UTC)

Article currently seems highly biased to me

The articles on nicotine and tobacco are much better examples of an attempt to be thorough and unbiased.

This article contains little of the information someone would look for -- for example, a longer discussion of delivery methods, a history of NRT (I believe gum was introduced in the 80s by prescription), a longer discussion of public health efforts to encourage NRT (New York City will give you a coupon for free nicotine replacement products), and above all, a more balanced discussion of the pros and cons of NRT.

As someone (like Mark Twain) who has quit smoking many times, with and without NRT, I have done a lot of research on quitting smoking. The current article reads very much like it was written by one of the stop smoking support groups, such as whyquit.com, that have a strong ideological objection to using NRT. I don't have any issue with those who feel it is better to stop "cold turkey", but it is important to realize that there are very strong POV feelings about whether you should or should not use NRT to quit smoking -- and to my mind, this article reflects a particular POV.

In short, editors should be aware that there is controversy and guard against it. They should also be aware that NRT is endorsed by many health officials. That endorsement is legitimately subject to criticism, but this *entire* article as it currently stands only represents that criticism -- quite imbalanced. Most of the article is contained under the heading "Criticism", which alone indicates clear bias. I would also ask those editors who believe that NRT is unhelpful to cessation efforts, or harmful, to at least allow a balanced explanation of the various POVs. No one trusts a clearly biased article, so you hurt your own cause. Let smokers make up their own minds on how to quit. (And I truly challenge you to find anyone who says that using NRT is even remotely as harmful as continuing to smoke.) StrangeAttractor (talk) 01:13, 11 October 2012 (UTC)

Contribution from a medical student

Hello! I am a fourth year UCSF medical student enrolled in the Expanding WikiProject Medicine course. The goal of this course is to introduce health professional students to the WikiProject Medicine in an effort to improve the quality of existing content. I am excited to begin editing articles and contributing to this open source resource used by so many people worldwide.

I have selected the Nicotine replacement therapy article to contribute to. This is an article that is listed as "high importance" by WikiProject Medicine and is in the "start" phase. This article has had 2540 views in the last 30 days. I feel this is a great opportunity to provide quality evidence-based information to those looking to learn more about nicotine replacement treatment options.

Please feel free to leave me comments and feedback as I work over the next month. JKSinghMD (talk) 22:03, 28 October 2014 (UTC)

Jksingh2014 Great idea. On Pubmed, when searching for reviews with "Tobacco Use Cessation Products"[MAJR] you get a number of excellent sources that can be of help in expanding this. MeSH doesn't have a separate header for NRT, so you will also find data for bupropion and varenicline; this may be relevant if it compared with NRT as a smoking cessation tool. JFW | T@lk 21:16, 29 October 2014 (UTC)

Edits from UCSF Pharmacy Student

Hi All! I am adding edits on the page to include use in populations that need special consideration (including pregnant women and those under the age of 18). Please let me know what you think of the edits. Thank you!

Yendu (talk) 02:02, 3 November 2014 (UTC)

Hi Yendu! Thanks for helping out with this page. I went through and reorganized the article a bit. Would you be interested in writing out the side effects portion of the page? Remember to keep the language simple for a broad audience and cite your resources. I will do the effectiveness portion. Thanks! JKSinghMD (talk) 21:57, 4 November 2014 (UTC)

Hello Jksingh2014! I can definitely help write the side effects. After I upload the side effects, do you think the precautions such as pregnancy and CV population would best fit under your future "Safety" category? Thank you! Yendu (talk) 08:41, 17 November 2014 (UTC)

Update from Med Student 11/4/14

Hello all! I have reorganized the article in what I believe to be a simple, logical way. I have not adjusted the content majorly thus far, I mainly just reorganized. This is the outline I am envisioning:

   Introduction/Lead paragraph: Quick overview of NRT in simple, easy-to-read language
   Mechanism: Explanation of how NRT options work
   Side effects: Known side effects of NRT options
   Effectiveness: Evidence behind effectiveness or non-effectiveness of NRT options     
        compared to alternatives (placebo, pharmacologic treatments including buproprion  
        and varenicline)
   Safety of NRT
   Economics: Cost-effectiveness of NRT
   “Exempted populations”: I didn’t write this bit. It feels out of place. I will need to do some 
              more reading on this. 
    Global Health: This is a reference to WHO’s list of essential medicines. It is not absolutely 
              necessary to this article, but provides an interesting factoid. 

What do you all think? The next step is to add appropriate content to the sections. JKSinghMD (talk) 22:31, 4 November 2014 (UTC)

too old?

"The claims for high efficacy and cost-effectiveness of NRT have not been substantiated in real-world effectiveness studies. Pierce and Gilpin (2002) stated their conclusion as follows: “Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation” (p. 1260)."

- no refs after 2006, one appears wrong/dead. Bauld et al (2009) more recent, & appears to contradict. Also the statement is vague and subjective; NRT works for many but not enough. Thoughts? Johnbod (talk) 11:34, 20 November 2015 (UTC)

medically-approved

These products are over the counter in many areas of the world. Thus medical approval is not needed. Nor is medical advice. Doc James (talk · contribs · email) 04:21, 25 December 2015 (UTC)

Really? Nor is "medical advice"? That seems like a very strange directive for taking a powerfully addictive pharmocological agent, regardless of whether it's OTC or not. (And I say that as someone who believes NRT should be OTC, and has no philosophical objection to being addicted to nicotine, or indeed anything, if addiction is the only consideration.) Nonetheless, as medical professional who contributes here frequently and enthusiastically, you truly don't think using nicotine ever warrants a consultation with one's physician? No need to disclose, or consult, or worry about conflict with other medications or conditions? I had no idea that nicotine was as safe and worry-free as H20, and frankly feel sincerely relieved, since I have been using nicotine for decades. I'll no longer mention to the physicians treating me. Thanks. StrangeAttractor (talk) 05:58, 17 September 2016 (UTC)

Use of multiple forms

Ref says "Evidence suggests that combinations of nicotine replacement therapy may be more effective than using a single formulation"

I guess the question is how do we want to summarize this? Doc James (talk · contribs · email) 04:26, 25 December 2015 (UTC)

CP133 2019 Group 27 Proposed Edits

Joanna - Instead of listing the side effects like that in the introduction/side effects sections, it might be more informative to make a table, list the common s/e of all NRTs, and individualize for each product. Readers who are looking for specific side effects for the products they are using might be able to easily locate their product this way. Add precaution section to warn the readers about who shouldn’t be taking NRT (other than pregnant population and adolescents) “Pregnancy,” “ Youth,” “Cardiovascular conditions” sections should be in a different section, maybe “special population,” not under side effects.

Katherine - The introduction section mentions the price of patches/gum based on a source from 2015. We can update this to more current prices if applicable. The medical uses section cites sources that seem like they may be old. We can utilize PubMed to find more current resources if any are available to update this section of the article. The economics section mentions the price of patches, gum, and lozenges. We can update this section with prices of each of the different formulations.

Marilyn - Under Mechanisms of Action, describe in more detail the science behind how it reduces cravings d/t nicotine addiction (eg. stimulation of neural nicotinic acetylcholine receptors (NAChRs) in the ventral tegmental area of the brain → release of dopamine in the nucleus accumbens → reduction in nicotine withdrawal symptoms in regular smokers who abstain from smoking; source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003586/). Under Formulations, add more detailed description of each NRT formulation, including advantages/disadvantages, dosing (move Dosing from Medical Uses section to each individual formulation’s subsection).. Also, can include newer forms of NRT, such as Nicotine Preloading, True Pulmonary Inhaler, and Nicotine Vaccines under the Society and Culture section.

Tony - Under the subtitle “Dosing” subtitle, I would include tables to show how each formulation should be recommended to patients (i.e. time to first cigarette, etc.). I would like to add more/update images for the formulations so that the general public has an idea of available products. I would also add a note about the availability of NRT over the counter at pharmacies. I would also like to expand on costs in the “Economics” section to give people an idea of how much treatment would cost them. I would also like to add a subtitle “Contraindications” to show people who CAN’T use it. Letony331 (talk) 00:03, 15 October 2019 (UTC)

/* CP133 2019 Group 26 Peer Review Edits */

This article did a great job informing readers about nicotine replacement therapy (NRT), its purpose, who could use it, the price and availability. The writers did an excellent job by adding more depth to the article such as adding more information about generic availability and signs/symptoms of nicotine overdose. Their edits significantly improved the quality of the article. It encompasses a well-rounded explanation of NRT basics, without imposing too much upon personal views and biases. There is certain wording that I would recommend changing such as utilizing the word "should" and replacing this word with "could" in "Medical Uses" section. By telling readers that NRT should be used for those who are heavy nicotine users, the particular sentence might convey a more one-sided view of NRT without addressing other forms of therapy that could additionally benefit individually who are severe nicotine addicts. Overall, the writers did a great job reflecting a neutral point of view regarding NRT.AllisonLee 2019 (talk) 20:32, 2 November 2019 (UTC)Allison Lee

Peer Edit 2: review sources: Group 27 did a wonderful job improving this article and informing readers about NRTs. These improvements included adding a table of AWPs of products and dosing information based on nicotine use. Although I understand that the group worked on specific sections, it is important to look at the article as a whole. With regards to references, the first reference is reflected as [2], not [1], so that’s an easy fix. In addition, just looking at the references section, the formatting of 3 citations (marked in red) needs to be adjusted. Sixty references were used in this article which is pretty impressive. It is hard for me to go through every single reference and assess the statement attributed to them. I will only focus on some references used by the group 27. Most of these references were credible and easily accessible by the public such as the American Cancer Society and smokefree.gov. In addition, another great reference utilized was Lexicomp; however, this reference requires paid subscription which makes it difficult to access by the public. Overall, this article is very informative. Well done group 27! Nataliealsalek (talk) 21:06, 5 November 2019 (UTC)

Peer Edit 3: I found this Wikipedia page consumer friendly and will be particularly helpful for those who are interested in starting nicotine replacement therapy due to the inclusion of the tables and images that displayed the different NRT formulations. The tables were easy to follow as they were organized by different formulations of NRT and also how to dose it. I believe that the group has achieved its overall goals for improvement in their individual sections. However, there could be more organization of the article to sort the topics into appropriate headers and subtitles. For example, I think that formulations and dosing would not fall under “Society and culture” and perhaps could go under the “Medical uses” header instead. I did not find any instances of copyviolation or plagiarism and the citations were all appropriately sourced. Cqdang (talk) 23:42, 6 November 2019 (UTC) Carolyn Dang

Peer Review Edit 4: (Part 1) I think group 27 has been able to significantly improve this article. They have improved several sections of the article including those regarding the mechanism of the action of NRT, side effects of NRT, and signs and symptoms of overdose by NRT. They have also improved the article by correcting some grammatical and vocabulary errors and they have added new sections to the article such as NRT in special populations. Additionally, they have added some information to the previous tables, and they have made new tables that help readers understand the content more easily. I think group 27 has set very high goals for improving this article. As a result, they might have not been able to achieve all these goals (for example, they do not have a table for side effects of each individual NRT formulation), but they have achieved most of their goals for the improvement of the article. (Part 2, formatting review) I think group 27’s edits are consistent with Wikipedia’s manual of style. The style and formatting of the sections that they have added/edited is consistent with the style and formatting of the rest of the article. This includes section headings, organization of the overall article and within each section, use of simple English language that is easy to understand by non-healthcare professionals regardless of the type/variety of English language that they know, and correct use of abbreviations. The only section that I recommend group 27 to modify is the tables in the sections under “Society and culture”. I think the location of the tables within this section is not consistent. Therefore, I think it will be nice if they can improve the consistency and appearance of this part of the article as well. Anisa Shoghi (talk) 10:44, 7 November 2019 (UTC)

Contradiction

We have two statements that contradict each other

The efficacy for each of the formulations (lozenges, nasal spray, gum, and transdermal patch) to aid in smoking cessation is equal.

Each formulation varies in its level of effectiveness and rate of absorption and is more effective when combined with concomitant behavioral therapy, such as cessation counseling. Wadgave U, Nagesh L (July 2016). "Nicotine Replacement Therapy: An Overview". International Journal of Health Sciences. 10 (3): 425–35. PMC 5003586. PMID 27610066. This second one is from a source with an impact factor of less than one https://www.researchgate.net/journal/0924-2287_International_journal_of_health_sciences

The first is better. The second should be removed when it contradicts other sources and ideally replaced with a better source. Doc James (talk · contribs · email) 16:09, 21 November 2019 (UTC)

References

Effect on blood pressure

Some OR with a statistical sample of 1 ;-) leads me to suspect that large doses of nicotine, as delivered by NRT, especially sprays, may lead to a much greater elevation in diastolic BP than systolic. This can have serious medical consequences. A quick Google didn't turn anything up. Does anyone have info on this? --D Anthony Patriarche, BSc (talk) 09:38, 2 October 2020 (UTC)

BTW I missed the joke here: "Some OR with a statistical sample of 1 ;-)" }:-) .It's well known that nicotine in the blood (from any source) affect the corronaries (heart), which is more or as important as the BP. I'll look into it. Actually the statement in the article that "NRT does not seem to cause HA " is vague in the referenced medpub. Also interested in objectives of NRT: from statistical of sample of 10's It seems to me quiting is as likely outcome as NR(indefinite)Use NRU. In which case it's more important the circulatory effects and other (?) Artemon ge (talk) 01:53, 8 January 2021 (UTC)

"Pack" is not a very useful measure

In the table under dosing, instead of giving a number of cigarettes for "heavy" smoking, it says, "1 or more pack of cigarettes daily."

Even if "a pack" is geographically consistent or some form of known measure among smokers, it does not convey any information to someone who has never smoked or handled a pack of cigarettes!

Perhaps someone could add a number? Indeed, possibly other things in that table would be improved by numbers, too?

FloweringOctopus (talk) 13:23, 17 November 2023 (UTC)

No - Pack-year is the accepted measure of smoking in the field, used in vast amounts of scientific literature. A pack of course = 20 cigs. It's not perfect - "king-size", "lights" etc, but it's the best we have. What "numbers" would you want anyway. 1 pack-year = 365 x 20 = 7,300 cigs. Is that any more informative? Johnbod (talk) 16:23, 17 November 2023 (UTC)

As mentioned previously, it is a standard scientific term in this case. But to add, think of it this way - if you are asking someone how much they smoke, which number do you think will be more reliable, "how many cigarettes" they've smoked this month, or "how many packs" they've smoked? It's an easier concept for people to think about, and thus it makes data collected (and reported) in this way more reliable. Just-a-can-of-beans (talk) 21:05, 1 January 2024 (UTC)