A modeling study by Sara Kalkhoran and Stanton A. Glantz published in the Oct. 1, 2015 edition of JAMA Internal Medicine can reasonably be interpreted as demonstrating the possibility that promoting e-cigarette sales for smoking cessation in the United States has the potential for substantial public-health benefits. But the authors posit that net benefit is far from guaranteed, given uncertainties about the risk posed by e-cigarettes, compared to tobacco cigarettes, and the potential for teens to be recruited to nicotine addiction.

The data presented make the case that the impact of e-cigarettes on current smokers is almost entirely beneficial. The magnitude of the benefit depends on the reduction in risk offered by s-cigarettes. On the other hand, their model shows only harm to non-smoking teens. The magnitude of this harm is presented as proportional both to the harm posed by nicotine to the developing teen brain and to the potential for teens addicted to e-cigarettes to transition to tobacco cigarettes.

If, however, the balance of potential benefits and harms in the United States is similar to the balance articulated by British public health experts – and reflected by some American investigators, including myself – substantial public-health benefits will be assured.

Given the potential benefit of adding a tobacco-harm-reduction component to current tobacco-control programming, perhaps the time has come for American public-health authorities to consider actively what steps could be taken to capture these potential benefits, while minimizing, if not nearly totally eliminating, the potential harms.

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