Measuring hospital quality: what physicians do? How patients fare? Or both?

many of these issues apply to most efficacy studies of pharmacological agents in the early stages of research on the product. Another major concern is not necessarily related to the methods or results of the published articles but rather is the potential reaction to these reports by the public. Whenever a new stop smoking agent is approved by the FDA (and to some degree this occurs with any new drug), there is often unbridled enthusiasm regarding the potential to solve the problems associated with smoking. Starting with the release of nicotine gum, each product that the FDA approved for smoking cessation has received considerable media attention , which likely reflects the public health issues associated with smoking and how many people desperately need and want help to quit. Now, with the recent FDA approval of varenicline, the first new non–nicotine-containing agent for smoking cessation approved in almost a decade, the attention directed toward this drug is likely to be just as great. It is important for clinicians to moderate some of the potential enthusiasm that is likely to occur as the result of the publication of these trials, FDA approval of the drug, and promotion by this manufacturer. On the one hand, these studies 1-3 demonstrate that varenicline is associated with higher smoking cessation rates than placebo and may produce better cessation rates than bupropion, a first-line– approved smoking cessation drug. Importantly, vareni-cline represents a third class of drug with probably a different mechanism of action than either nicotine replacement therapy or bupropion. On the other hand, varenicline definitely is not a panacea for smoking cessation. Many participants in these trials experienced adverse events, stopped taking their study medication before they should have, and discontinued participation in the studies. Importantly, the majority of participants in these 3 studies did not quit smoking even with varenicline. Clearly, quitting smoking, even with pharmacological and behavioral assistance, is extremely difficult. Patients currently cannot and probably never will simply be able to " take a pill " that will make them stop smoking. Smokers must want to stop smoking and must be willing to work hard to achieve the goal of smoking abstinence. Although much research needs to be conducted to establish the effectiveness of varenicline, stop smoking researchers and clinicians, as well as smokers wanting to quit smoking , now have another product available that appears to help increase the probability of smoking …