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E-cigarettes: A Moral Quandary

By Expert Author: Julia Jackson

With sales expected to boom in the next year, e-cigarettes are the subject of much debate. Data for their safety and efficacy are desperately needed, and from a public health perspective, many questions remain unanswered.

Results of a trial published in The Lancet on Sept 7 showed that e-cigarettes might be as effective as patches to help with smoking cessation at 6 months. Although the study was underpowered to draw definite conclusions, it showed encouraging results in terms of adverse events and smoking reduction. How should the medical community interpret these findings? Although e-cigarettes might reduce harms compared with traditional cigarettes, appropriate regulation of safety and product consistency is essential. Marketing also needs to be monitored to ensure that the easy availability of e-cigarettes does not encourage people to start smoking.

Indeed, the US Centers for Disease Control and Prevention reported that the percentage of middle and high school students who used e-cigarettes had more than doubled between 2011 and 2012 in the USA, and one in five middle school children who reported using e-cigarettes had never smoked conventional cigarettes.

As a result of safety fears, the EU and the UK are planning to regulate e-cigarettes as they would a medicine. On the one hand, excessive regulation could marginalise e-cigarettes in favour of conventional cigarettes. On the other hand, deficient regulation might contribute to the expansion of the e-cigarette market—in which tobacco companies have a substantial stake—potentially renormalising smoking habits and negating years of intense anti-tobacco campaigning.

Amid disagreements between public health experts, and uncertainty about the long-term efficacy and safety of e-cigarettes, should we stand back and wait for robust results before adopting a formal public health stance? Harm reduction should be our guiding principle, but the prospect of colluding with one of the industries most devastating to health presents a moral quandary that needs to be addressed through strong public and professional engagement.

Article Credit: www.thelancet.com

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