Public Health England (PHE), the UK governmental body the equivalent to the U.S. Centers for Disease Control and Prevention (CDC), says that its review of the evidence has found that e-cigarettes are 95 percent less harmful to health than combustible cigarettes and they should be recommended for smoking cessation and harm reduction.

This is the opposite stance taken by anti-smoking activists who have morphed into anti-nicotine activists, and demand that cigarette smokers engage in "abstinence only" when it comes to nicotine, an approach that works with almost nothing. 

While there is scant evidence of how successful e-cigarettes are for smoking cessation, that is irrelevant, since it is illegal to market them as smoking cessation tools. What gets left out of the comparisons is that nothing works very well; gums and patches are also ineffective, but what has been effective is having a myriad of choices. If each tool is only 10 percent effective, but there are multiple ways to quit, it covers 40 percent of more of smokers.

Yet instead of embracing anything that will lead to fewer lung cancers, e-cigarettes have been linked to adverse tobacco health risks. In a new "Perspective" in the New England Journal of Medicine, researchers from Columbia University's Mailman School of Public Health draw on the history of harm reduction in the UK and U.S., comparing the UK's conclusion in 1926 that drug addiction was an illness that should be treated by physicians with safe drug practices to the very different U.S. stance of refusing drugs to addicts as a treatment practice.

Comparisons like these led the researchers to the question: Do electronic cigarettes work against reducing tobacco smoking or offer the possibility of minimizing harm for those who just cannot quit tobacco cigarettes? 

Criticisms of Public Health England
were in full force. In "E-cigarettes: Public Health England's evidence-based confusion," the editors of The Lancet focused on the methodological limits of one of the many studies on which the review had relied. They concluded, "PHE claims that it protects and improves the nation's health and well-being.... On this occasion, it has fallen short of its mission." In The British Medical Journal, critics claimed that PHE had failed to meet the most basic evidentiary standard of public health policy. 

In the U.S., opinion is more uniform - everyone simply denounces e-cigarettes, and the CDC warns that they may be associated with health risks, even if they can't find any yet.

The debate won't end soon and e-cigarette proponents have to share some of the blame. They have begun to argue that they should be used for recreation and to rail against even sensible regulations related to kids and safety. That makes it difficult to have reliable data on who uses them and why.