now published in RACP


Electronic cigarettes in physician practice
Colin P. Mendelsohn School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia

"Ethical considerations
Medical practitioners have a duty of care to provide the best possible management at each patient encounter. Withholding a legitimate treatment option that could prevent a life-threatening illness is a breach of that obligation.
A policy that specifically allows the widespread sale and use of nicotine in its most lethal delivery system yet denies access to a far safer alternative is hard to justify on ethical grounds.
Government interventions to restrict the rights and behaviour of individuals are not justified in the absence of evidence of material harm to others.

Electronic cigarettes are a valid alternative for smokers who have been unable to quit using the available first-line therapies. Evidence for effectiveness is growing andthe scientific consensus is that they are substantially less harmful than smoking. Although more research isneeded, there is now sufficient empirical evidence and real-world experience to consider their use as a legitimate tobacco harm reduction tool.

Practice points
E-cigarettes are battery-powered devices that heat aliquid solution into an aerosol for inhalation and simulate the act of smoking.
E-cigarettes are used almost exclusively by smokers to quit smoking or reduce the harm from tobacco.
There is growing evidence for the effectiveness of e-cigarettes as a quitting aid from population studies, longitudinal studies and randomised controlled trials.
The scientific consensus is that e-cigarettes are substantially less harmful than smoking.
Almost all the harm from smoking is from the tar, carbon monoxide and other toxic chemicals caused by burning tobacco.
These harmful and potentially harmful chemicals are mostly absent from, or present in substantially lower amounts in, e-cigarette vapour.
While young people may experiment with e-cigarettes, regular sustained use by never-smokers is very rare and there is very little evidence in support of their role as a gateway product to smoking."

I just cut and pasted some of it for those with limited internet so there could be some mistakes