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Health professionals and their patients have every reason to feel confused. One week the WHO issues a position paper calling for strict regulations on electronic nicotine delivery systems (ENDS), more commonly referred to as electronic cigarettes, including restrictions on marketing and a ban on using them in enclosed public spaces.1 The next week, a group of scientists attracts widespread media attention, with headlines claiming that these products could save 50 000 lives in the UK,2 although this figure appears nowhere in the corresponding paper.3 What is one to make of these conflicting messages?
Before reviewing the evidence, some context is necessary. For several decades the tobacco industry, which has been rapidly increasing its share of the market for ENDS sold in the UK,4 has actively sought to create confusion. It did this very successfully when it sought to block bans on smoking in public places, engaging in a massive campaign of deception.5 It sought to portray second-hand smoke as harmless, even though its own research showed that sidestream smoke was even more toxic than directly inhaled smoke.6 It also promoted the idea that a ban would hit the takings of bars and restaurants, even though it had funded the only research to show such an effect.7 As one of its leading scientists claimed, in discussions with lawyers advising on the tobacco industry's strategy, ‘he could bring a healthy scepticism to … some of the claims being made about environmental tobacco smoke’.6 The industry has also been very good at displacing attention from more important issues, and it is noteworthy that, since the apparent controversy about ENDS has erupted, there has been virtually no media coverage of the UK government's failure to take forward its commitment on standardised packaging, another area where industry funded …
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