Over the half century since the link with cancer was established, smoking is well down among almost all classes and age groups – young women being the worrying exception – but more needs to be done to help us kick the habit. Given the vast human suffering and sheer cost to the NHS of tobacco use, every assistance in reducing the toll should be embraced. If e-cigarettes can help smokers quit more effectively than nicotine patches and gum, as the latest surveys suggest, then the authorities should encourage their use; in extreme cases e-cigarettes might even be prescribed by a GP.
There seems little downside. It is unlikely that adolescents will start smoking through the acceptance of e-cigarettes – just as patches and gum did not prove to be much of a “gateway” to smoking cigarettes: e-cigarettes, it is safe to say, do not possess even the superficial air of sophistication that conventional cigarettes do. Nor do these bizarre little devices “normalise” smoking in the way critics fear. Even if they did, they would still be better than conventional smoking – and that is really the choice for too many unfortunate addicts.
Pragmatism is the ally of public health. In an imperfect world, but one where the effects of smoking comprise a large threat to the health of the nation, we should act on the balance of probabilities – which is that e-cigarettes cut smoking. Like health education, the ban in pubs and high taxation, e-cigarettes are part of the answer.