The UK Royal College of Physicians has released a report concluding  that e-cigarettes are "much safer" that smoking and aid quitting, " smokers could be reassured and encouraged to use them as an aid to quit".  It also stated that concerns that e-cigarettes are a gateway to smoking have not been demonstrated and that e-cigarettes should be part of a comprehensive tobacco control strategy.

E-cigarettes have been controversial since they become widely available from 2007. An e-cigarette is a device that looks like a cigarette and contain solutions typically containing nicotine that are heated electronically by the device to make a vapour ( hence the term vaping)The first were not produced by cigarette companies, but the cigarette companies have become involved heavily in the business of promoting and selling e-cigarette and vaping products.  

Despite being promoted as a significant tool for smoking reduction, there has been  only small reductions in smoking rates in the UK, USA and Australia since their introduction. The harm-reduction benefit for individual smokers switching to e-cigarettes is not supported by evidence, which has demonstrated that  more dual use smoking happens as a result of adding e-cigarettes . A recent systematic review and meta- analysis published by The Lancet, concluded that e-cigarettes are associated with significantly less quitting amongst smokers than other techniques used. Similar results have been found by the Cochrane database. In studies of the best method for quitting, abrupt quitting works better than gradual reduction of cigarettes. Addiction in other areas is not best managed by moving people to other equally addictive substances.

The authors also ignore the enormous uptake of e-cigarettes by young people who would not otherwise smoke or be exposed to nicotine. The report states  that UK data does not show substantial youth uptake, however data from the US National Tobacco Survey shows  that current e-cigarette use among high school students has increased from 1,5% in 2011 to 16% in 2015 to become the most common tobacco /.nicotine product used in this group.  Fashionable behaviour  travels with social media to other countries and it is naive to assume otherwise. 

As the devices become more efficient at delivering high doses of nicotine rapidly, the risk for regular use and addiction in children will increase. . 

The argument that nicotine causes little if any harm also must be contested, The International Agency for Research on Cancer has noted that the potential for nicotine to cause DNA damage exists , with growing concern from the agency of a link to lung cancer. Electronic cigarettes are not currently prescribed  in most countries and have a very small evidence base from which to draw conclusions regarding safety.  The report states  that current evidence is weak, but e-cigarettes are unlikely to be harmless and long term use is likely to be  associated with increased risk of chronic obstructive pulmonary disease, lung cancer, possible cardiovascular disease and some long term conditions associated with smoking. Toxicologists have recently challenged the  claim that the risk from  e-cigarette use is unlikely to exceed 5% of the harm from smoking tobacco, users may be repeatedly exposing themselves to contaminants and by-products and carcinogenic chemicals as yet not detected or studied.

While e-cigarettes deliver lower levels of carcinogens than conventional cigarettes, they deliver the same or more ultrafine particles than cigarettes. A study published in Chest on April 11 demonstrated smoking one e-cigarette impacts the functioning of arteries as much as smoking a conventional cigarette in smokers and non-smokers. The conclusion of the study was that even if e-cigarettes have no cancer risk associated, the heart, non-cancer lung disease  and vascular disease caused could be as dangerous as conventional cigarettes and is much higher than the 5% estimate popularized by Public Health England and the Royal College of Physicians in England and e-cigarette enthusiasts in the USA.

Internationally academics remain concerned about the promotion of e-cigarettes  because of the weak evidence base for their use in smoking reduction outcomes and the high risk to children. The Tobacco Industry is heavily involved in the promotion and sales of e-cigarettes, to support a business model with a shrinking market is a very unlikely successful business plan to adopt for the Industry well known for complicated selling and marketing strategies. They openly state their core business will remain in tobacco sales. Their products still target children. The global market for e-cigarettes is now estimated as over US $6 billion

Cigarette smoking is the leading preventable cause of death in the world, estimated to kill 6 million people per year. Most adult smokers took their first puff as an adolescent and most wish they had never started, considering it to be one of the worst decisions they have ever made. The average 40 year old smoker who started in his teenage years has made more than 20 attempts at quitting. Some research has suggested that using e-cigarettes are as effective as other smoking cessation approaches, but the research is limited and major health organisations and medical organisations currently do not support their use. The British College of Physicians is the only one to support the use of e-cigarettes as a harm-minimisation strategy.

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