Cytisine is a naturally occurring plant alkaloid that acts as a partial agonist at the nicotinic acetylcholine receptor, and has been sold in Eastern Europe as an inexpensive smoking-cessation aid for 50 years but is unavailable elsewhere. An editorial notes the study shows that cytisine is at least equivalent to nicotine-replacement therapy (NRT), since both were used in real-world practice, but further trials will be needed to determine whether it is truly superior to NRT, and how it compares with other first-line pharmacotherapies. The author expresses disappointment that in US and Western Europe there is now no direct pathway through the regulatory and pharmaceutical market structure for a potentially useful drug with cytisine's unconventional history; and the solution will require creative collaboration among a range of stakeholders.