Dear Editor
:
The position article by
Reynales-Shigematsu and collea
–
gues
1
on the public health impact in
Mexico of combustion-free electronic
nicotine delivery systems (ENDS)
fails to present a balanced overview
of the risk-benefit ratio of these new
technologies, grossly misrepresents
the existing evidence, and ignores
the broad consensus that these pro
–
ducts are much less harmful than
cigarettes.
2-4
The work cited by the authors
(references 8-21) on exposure risks
from e-cigarette aerosol emissions
report misleading results that do not
reflect normal conditions of use.
5
The
authors claim that trial of e-cigarettes
is propitiating tobacco initiation
among Mexican adolescents, citing a
longitudinal cohort study on Mexican
high school students (reference 31)
which actually disproves this claim,
as it reported that the association
between e-cigarette trial at baseline
and past 30 day smoking at follow-up
was not even statistically significant.
5
The authors dismiss the utility of e-
cigarettes in smoking cessation, but
their cited references
do not support
this claim.
5
Further, a recent high
quality randomized controlled trial
6
has shown e-cigarettes to be twice
as effective in smoking cessation
compared to nicotine replacement
therapies. A detailed critique of the
position article is available.
5
Following the authors, ENDS
can only be part of a harm reduction
strategy for Mexico if they imme
–
diately promote total smoking abs
–
tinence, as well as complete absence
of dual usage and recruitment of
non-smokers.
7
However, these are
maximalist and unrealistic conditions
that no new harm reduction product
can fulfill. A more realistic approach
to harm reduction yields concrete
benefits: the recreational usage of
e-cigarettes, endorsed by health insti
–
tutions in the United Kingdom under
a consistent Tobacco Control strate
–
gy, has contributed to a significant
decay of smoking prevalence with
negligible usage by non-smokers of
all ages.
2,3
By presenting ENDS as a threat
to public health (consequently re
–
commending their regulation as
combustible tobacco products), Rey
–
nales-Shigematsu and colleagues
are
depriving 15 million Mexican smokers
of key information on a plausible
harm reduction alternative that can
vastly improve their health. As an
unintended consequence, this misin
–
formation will keep them smoking.
