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Feature Tobacco

Why e-cigarettes are dividing the public health community

BMJ 2015; 350 doi: (Published 24 June 2015) Cite this as: BMJ 2015;350:h3317

Rapid Response:

Re: Why e-cigarettes are dividing the public health community

We welcome the article by Gornall as we think it will promote much needed debate about a very important public health concern.(1) However, many of the issues covered are not new. Over 30 years ago, Taylor published a seminal book which provided a comprehensive insight into the world of public health politics.(2) The Smoke Ring discusses the ring of political and economic interests surrounding the tobacco industry, and for those who are unsure about the goals and tactics of certain multinational companies, it is certainly worth reading.

Tobacco companies have tremendous financial and political powers and, despite the overwhelming medical evidence against traditional cigarettes, companies are still able to sell their products. Moreover, certain markets are expanding. Two of the world’s largest tobacco companies are based in the UK and a sign of their success is that they are both listed in the FTSE 100 Index.(3) Both companies continue to perform strongly and are confident about their future performances, especially as markets are growing in lower income countries where there is tremendous potential for profit.(4,5)

It is still crucial to reiterate that tobacco smoking is the largest single preventable cause of ill health and death.(6) In the UK the reduction in smoking should be seen as one of the great public health success stories. However, it is important that this achievement is not reversed.

E-cigarettes are increasingly popular, and in the UK we have already seen the establishment of high-street vendors and local and national advertisements, thus potentially contributing to the perceived normalisation of this activity. The widespread use of e-cigarettes has the potential to act as a gateway to traditional cigarettes, and they could also be used to promote traditional cigarettes both here in the UK and in lower income countries.

We are not in favour of e-cigarettes being extensively advertised or promoted, as the widespread use of e-cigarettes has not been demonstrated to be conducive to health. We think that their use and sale should be restricted only to circumstances where there is evidence for their effectiveness.

The Institute of Health Promotion and Education has a position statement on e-cigarettes with five clear recommendations.(7)
1. E-cigarettes should be seen as a part of the armoury of devices intended to wean smokers away from cigarettes, and nothing more.
2. E-cigarettes should not be promoted to non-tobacco users.
3. More research is needed into the efficacy of e-cigarettes.
4. There needs to be further debate about the use of e-cigarettes in public places (including workplaces).
5. Careful monitoring of the promotion and use of e-cigarettes is needed.

1) Gornall J. Why e-cigarettes are dividing the public health community. BMJ 2015;350:h3317.

2) Taylor P. Smoke Ring: The Politics of Tobacco. London: Bodley Head Ltd, 1984.

3) FTSE Group. FTSE All-Share Index Ranking (unofficial guide) As at close on Wed, 24 June 2015 [viewed 27 June 2015]. Available from:

4) British American Tobacco. Annual Report 2014. Delivering today. Investing in Tomorrow. London: British American Tobacco, 2014. [viewed 26 June 2015]. Available from:$FILE/medMD9UWNLR.pdf?openelement

5) Imperial Tobacco Group. A Stronger Business. Annual Report and Accounts 2014. Bristol: Imperial Tobacco Group PLC, 2014. [viewed 26 June 2015]. Available from:

6) World Health Organisation. Tobacco Free Initiative. Why tobacco is a public health priority. [viewed 26 June 2015]. Available from:

7) Institute of Health Promotion and Education. IHPE Position Statement: Electronic Cigarettes [viewed 26 June 2015]. Available from:

Competing interests: No competing interests

28 June 2015
Michael Craig Watson,
Associate Professor in Public Health.
Dr Mark Forshaw (President, Institute of Health Promotion and Education. Subject Leader in Health & Applied Psychology, Natural Sciences and Psychology, Liverpool John Moores University).
University of Nottingham, Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA