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

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.