• Paediatrics
• Respiratory Medicine
• Emergency Care

Everyone is familiar with the devastating effects of smoking, which impacts especially on low-income families. In the 20th century, the global tobacco industry employed diverse marketing tactics, often targeting specific groups, including children and young people (CYP). Tactics included strategic media advertising, sponsorship (including major sporting events) and product placements in films. Shamefully, physicians were also on their advertising payroll. Regulations on advertising, taxation, restrictions on public use and change in societal opinion have significantly reduced tobacco use and improved health outcomes.

However, the industry has struck back with e-cigarettes. Especially in England, we have been repeatedly told that they are the key to ending dependence on tobacco and are 95% safer than cigarettes. There is certainly plenty of scope for harm reduction, but are e-cigarettes the answer? The European Respiratory Society (ERS) decisively rejects this.1 Also, harm reduction should extend to the whole community, not just smokers. CYP are increasingly being harmed as a result of current marketing.2 Worryingly, one in six vapes confiscated from schoolchildren are laced with the street drug Spice. Doubtless, the tobacco industry would self-righteously say this is nothing to do with them, but they cannot escape responsibility for the results of their devices getting into children’s hands. Surprisingly, the Royal College of Physicians has issued a document on harm reduction without apparently involving any respiratory paediatrician.3 Here we highlight the recent duplicitous behaviour of the tobacco industry, emerging studies that are increasing safety concerns, new guidance from the …