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AMA J Ethics. 2020 Feb 1;22(2):E82-92. doi: 10.1001/amajethics.2020.82.

How Should Physicians in Low- and Middle-Income Countries Regard Electronic Nicotine Delivery Systems to Facilitate Smoking Cessation?

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A professor emeritus of epidemiology and biostatistics at the San Diego State University School of Public Health, and previously served as assistant surgeon general and deputy assistant secretary for health in the US Department of Health and Human Services.
A doctoral student in public health and policy at the London School of Hygiene and Tropical Medicine and entered specialty training in August 2016 as a public health specialty registrar and a National Institute for Health Research Academic Clinical Fellow.


Electronic nicotine delivery systems (ENDS) have been widely referred to as "safer," "healthier," and more "effective" smoking cessation aids, but little evidence supports such claims. New concerns about pulmonary injuries associated with ENDS suggest reasons for concern about these products' health risks and potential for nicotine addiction. Nevertheless, multinational tobacco companies heavily market ENDS to retain customers with nicotine addiction, and global progress against tobacco use might slow as a result. The tobacco industry has managed to divide the tobacco control community by offering hope of harm reduction without actual evidence of ENDS' effectiveness or long-term safety. Low- and middle-income countries need this evidence to assess ENDS' value in mitigating tobacco use.

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