Are e-cigarettes giving tobacco companies the means to appear benign while actually “killing people softly” or are the alternatives offering the best chance of reducing harm from cigarette smoking? Doctors are bitterly divided over the question.

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Glamorizing cigarette smoking or saving lives?

An article in The BMJ reports from both sides of the debate. Simon Capewell, professor of public health and policy at the Institute of Psychology, Health and Society at the UK’s University of Liverpool, tells the journal he is suspicious of big tobacco.

Prof. Capewell argues that if the big tobacco companies were genuinely concerned about the disease and the harm they caused, “they would cease production – end of discussion. They would go into e-cigarette production 100%.”

Instead, tobacco companies are cynically acting to worm their ways into public bodies, pretending to be part of the solution and deflecting attention away from the harm they do, argue such public health experts.

The argument against e-cigarettes also says they help to glamorize and renormalize smoking. But such an idea is given a strongly-worded dismissal by one organization that has previously been an arch-enemy of the tobacco companies but now appears alongside them at conferences.

Deborah Arnott, chief executive of the UK charity Action on Smoking and Health (ASH), says:

There are people in the public health community who are obsessed by e-cigarettes. This idea that it renormalizes smoking is absolute bullshit. There is no evidence so far that it is a gateway into smoking for young people.”

Arnott asks: “Do you want the tobacco industry to carry on making cigarettes which are highly addictive and kill when used as intended, or do you want them to move to a product which is much nearer licensed nicotine replacement therapy and is unlikely to kill anyone?”

But the opposition remains. Public health experts against such positions include 129 who warned the World Health Organization and other public bodies not to “buy into the tobacco industry’s well-documented strategy of presenting itself as a partner.”

The article in The BMJ characterizes the debate as divided broadly between two types of doctor – public health experts looking at the population effects, and supposedly “idealist” about the issue, and doctors in practise who have a more “pragmatic” view of potential benefits for individuals.

While the debate rages, the reality of smoking versus vaping plays out.

A report from the Centers for Disease Control and Prevention and the Food and Drug Administration’s Center for Tobacco Products revealed that the use of electronic cigarettes tripled among middle and high school students between 2013 and 2014.

The news of the findings means that the use of e-cigarettes among this population has exceeded use of all other tobacco products – including conventional cigarettes.

Much of the opposition to the developments is a result of the involvement of tobacco companies, the report in The BMJ says.

“When they first came on the market, 5 or 6 years ago, there was a positive openness and curiosity” about electronic cigarettes, says Karl Fagerström, a Swedish clinical psychologist and a founder of the Society for Research on Nicotine and Tobacco. But after the cigarette industry became involved, the attitude changed from suspicion to opposition, he adds.