BMJ Signals Success

Posted 17th May 2019 by Dave Cross
The British Medical Journal (BMJ) is more used to carrying pieces penned by Martin McKee that attack vaping. This month, it prints a piece by the National Institute for Health Research (NIHR), highlighting the importance of a recent study led by Peter Hajek.

NIHR Signals is a route for the latest important health research evidence to reach key decision makers and clinicians within the NHS. It says it, “provides decision makers in the NHS, public health and social care with the latest important research from the NIHR and other health research organisations.”

Signals explains to readers why the study was needed, what the researchers did, what the study found, how this relates to current guidelines and what the implications are of the findings. They are accompanied by commentary from experts in their field, researchers and those working in practice.

In the article published in the BMJ, Rob Cook (Economist Intelligence Unit), Peter Davidson (Wessex Institute) and Rosie Martin (Economist Intelligence Unit) write about a study by Hajek P, Phillips-Waller A, Przulj D, et al.

Why was the study needed?

In 2016, 15.5% of adults smoked yet, although vaping is considered to be much less harmful than smoking, controversy exists over its effectiveness in smoking cessation (efficacy).

Vape Club

They write: “This new study is the first sizeable, long term trial comparing modern refillable e-cigarettes with nicotine replacement therapy (NRT) within the context of existing NHS stop smoking services, where only about 10% of smokers manage to quit with standard care. The trial offers the best evidence yet available about the effectiveness of e-cigarettes combined with behavioural support for smoking cessation.”

What did it find?

  • Eighteen per cent of participants randomised to receive e-cigarettes reported themselves to be abstinent from smoking after 12 months, backed up by negative carbon monoxide breath tests. Of these people, 80% were still using e-cigarettes. In total, 39.5% of e-cigarette users were still using them after 12 months
  • The chances of having stopped smoking were 83% higher for people who used e-cigarettes compared with NRT
  • There were no serious adverse events related to either NRT use or e-cigarette use

The trio concluded: “The finding that e-cigarettes are substantially more effective than NRT products, even when used with expert support, signals a potential shift towards provision of e-cigarettes as part of NHS stop smoking services.”

“This would require training of stop smoking service staff. Potential for purchase of e-cigarettes by services would need to be considered. This publication did not include a cost comparison, but reports that the 2016 cost to the trial of an e-cigarette starter pack was £30.25, compared with £120 for a three-month supply of a single NRT product. This suggests that e-cigarettes might be a good economic choice, as well as more clinically effective, compared with NRT.”


  • “A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy” by Hajek, Phillips-Waller, Przulj et al – [link]
  • “E-cigarettes helped more smokers quit than nicotine replacement therapy” by Cook, Davidson and Martin – [link]

 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker