Intended for healthcare professionals

Head To Head

Should we recommend e-cigarettes to help smokers quit?

BMJ 2018; 361 doi: (Published 25 April 2018) Cite this as: BMJ 2018;361:k1759

Re: Should we recommend e-cigarettes to help smokers quit?

Simon Chapman points out that the NICE does not include e-cigarettes under the section of their guidance entitled ‘Evidence based stop smoking interventions’.

Firstly, e-cigarettes are consumer products which many people find help them to stop smoking, rather than a ‘stop smoking intervention’.

Secondly, NICE, quite rightly, requires very high standards of evidence when making top line recommendations for a product or intervention, typically reviews of RCTs. At the time the guideline was written there were only two RCTs which fitted the criteria and both were conducted using e-cigarette products which are now outdated and obsolete.

Because the consumer e-cigarette market in the UK consists of a range of hugely varied products and is constantly innovating, it is unlikely that NICE will ever be able to simply recommend e-cigarettes generically as an ‘evidence based stop smoking intervention’.

However, where there is sufficient lower grade evidence or expert testimony that a particular course of action or intervention is effective, NICE are able to make weaker recommendations or offer advice, as they did for e-cigarettes in their latest guidance.

Relevant though not competing interest:

I am a vaper, the Chair of the UK charity New Nicotine Alliance, and I served in a personal capacity on the NICE Public Health Advisory Committee which recently updated the guidance on smoking cessation.

Competing interests: No competing interests

28 April 2018
Sarah Jakes
Chair of the Board of Trustees
New Nicotine Alliance (UK)