Intended for healthcare professionals


Evidence about electronic cigarettes: a foundation built on rock or sand?

BMJ 2015; 351 doi: (Published 15 September 2015) Cite this as: BMJ 2015;351:h4863
  1. Martin McKee, professor of European public health1,
  2. Simon Capewell, professor of clinical epidemiology2
  1. 1London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  2. 2Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
  1. Correspondence to: M McKee martin.mckee{at}

Public Health England recently endorsed the use of e-cigarettes as an aid to quitting smoking. Martin McKee and Simon Capewell question the evidence on safety and efficacy underpinning the recommendations

Those responsible for safeguarding the health of the public must often tackle complex and controversial issues. Public Health England (PHE) has been courageous in entering the debate on the role of electronic cigarettes in tobacco control. In a new report it concludes that e-cigarettes are much safer than conventional cigarettes,1 and one of its author is quoted as describing them as a potential “game changer” in tobacco control.2 Media coverage suggests that the debate is now over, with a BBC correspondent describing the evidence as “unequivocal.”2 However, although British organisations such as the Royal College of Physicians of London3 and ASH UK,4 have endorsed some of the report’s conclusions, albeit with caveats, many others have come to the opposite opinion. These include the British Medical Association, the UK Faculty of Public Health, the US Centers for Disease Control and Prevention, the American Lung Association, the World Health Organization,5 the European Commission,6 and other leading international health bodies.7 The available evidence about e-cigarettes suggests that the debate is far from over and questions remain about their benefits and harms.

Defining the role of e-cigarettes

Fundamental divisions seem to exist between those engaged in this debate. Supporters of e-cigarettes focus narrowly on existing smokers, comparing the devices’ effects with those of smoking conventional cigarettes. As well as being an aid to quitting, e-cigarettes are seen as having a role for people who do not want to quit, offering a safer substitute for some of the cigarettes they would otherwise smoke.

Meanwhile, those on the other side of the debate express concern about uptake of e-cigarettes among people, especially children …

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