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Varenicline binds with high affinity and selectivity at the 42 neuronal nicotinic acetylcholine receptors, where it acts as a partial agonist, a compound that has both agonist activity, with lower intrinsic efficacy than nicotine, and antagonist activities in the presence of nicotine

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That would involve taking a group of say 6,000 people, selecting 3,000 at random and forcing them to smoke for 5 years, while forcing the other 3,000 not to smoke for 5 years, and then comparing the incidence of lung cancer in the two groups, says Donald Gillies, an emeritus professor of philosophy of science and mathematics at University College London