A study published online this week by the journal Tobacco Control casts further doubt on the effectiveness of "nicotine replacement therapy" (NRT) as a method of quitting smoking. The researchers followed 787 Massachusetts smokers who had recently quit, interviewing them three times over about four years. At each stage, the subjects who used nicotine gum and patches, with or without professional counseling, were just as likely as the others to have started smoking again. It's possible that smokers who were strongly attached to the habit were especially likely to use nicotine replacement, which might partially explain these dismal results. But they are in line with other research on the subject, which generally finds modest benefits at best from NRT. The fact that an FDA-approved, officially favored method of quitting seems to barely work at all underlines the stupidity of government resistance to alternatives such as snus and electronic cigarettes. One reason NRT performs so poorly may be that it is designed and presented as a short-term medication to wean smokers off cigarettes rather than a long-term alternative that avoids all the health risks associated with inhaling tobacco smoke. Snus and e-cigarettes both show promise in that regard, and if public health officials truly were interested in reducing smoking-related morbidity and mortality they would let smokers choose the harm-reduction methods that work best for them instead of puritanically insisting on a goal of complete abstinence.