Several people have asked me what I thought of the just-published paper E-Cigarettes in Historical Context—Innovation, Risk, and Regulation by Michael Pesko, Jamie Hartmann-Boyce, Rachel Fung and Neal Benowitz.
Like other similar papers published by some of these people, the Pesko paper relies on the 7 year old 2018 National Academies of Science, Engineering and Medicine report to conclude that ecigs are much safer than cigarettes. It was prepared well before almost all of the current evidence that ecigs are nearly as bad as cigs, dual use is worse than smoking was published and that, as consumer products, e-cigarettes do not help smokers quit. So, the NASEM report, which was a reasonable summary of the evidence when it was written, is badly out-of-date.
Indeed, today there are about 6 times as many peer reviewed papers on e-cigs as when the NASEM report was written.
I am confident that Pesko and his coauthors are well aware that this much larger literature exists and simply ignored it because the current evidence does not support their position that e-cigs are good for public health. Very disappointing.
In contrast, here is what two recent comprehensive reviews based on all the available evidence at the time concluded:
- 2024 WHO Call to Action (associated technical note): ”to date, the commercialization (sale, importation, distribution, or manufacture) of e-cigarettes as consumer products has not been proven to have had a net benefit for public health. Instead, alarming evidence on their adverse population health effects is mounting. … The WHO both supports countries who have prohibited the import and sale of e-cigarettes and provides detailed evidence-based guidance for those who allow sale of e-cigarettes.”
- 2025 International Pediatric Association: “In contrast to early hopes and assumptions, e-cigarettes are not an effective harm reduction strategy for adults and pose a serious risk to nicotine-naive youth. There are effective policies to counter this threat that have been and need to be increasingly implemented.”
These current conclusions – particularly the fact that ecigs don’t reduce harm for adults – is what should form the basis for current public health and clinical advice and policy making.
Stanton Glantz blog 
Thanks. I saw that yesterday. I noticed in the COI disclosures that Pesko lists the Kentucky Institute for the Study of Free Enterprise. That is funded by the Global Action to End Smoking.
How much does the industry pay these guys? And I do not understand Benowitz at all. Two of those folks are economists, but Benowitz is a physician, who allegedly takes care of patients.
Conflict of Interest Disclosures: Dr Pesko reported grants from the National Institutes of Health during the conduct of the study; grants from National Institutes of Health, grants from Food and Drug Administration, grants from American Cancer Society, personal fees from Health Canada, personal fees from University of Kentucky’s Institute for the Study of Free Enterprise, and personal fees from Joseph Saveri Law Firm for expert witness testimony on harms resulting from alleged Altria-Juul antitrust violations outside the submitted work; and Dr. Pesko is an officer of the Tobacco Online Policy Seminar, is a member of the Board of Scientific Counselors for the National Center for Health Statistics in the United States, and is a member of the Canadian Scientific Advisory Board on Vaping Products. Dr Hartmann-Boyce reported research funding from government sources and charitable foundations which relate to the topic of this article (e-cigarettes). Dr Benowitz reported Consultant to Achieve Life Sciences, Qnovia and Lilly, companies that are developing new smoking cessation medications; expert testimony in litigation against tobacco companies. No other disclosures were reported.
Sent from my iPad Joel S. Dunnington MD, FACR,
Retired Professor of Diagnostic Radiology
UT MD Anderson Cancer Center
281-387-6770, jsdunnington@outlook.com
1036 Monterra Ln., Timnath, CO 80547
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Yes, the selective quoting is notable. Entire bodies of evidence are ignored. Out-of-date sources blithely cited as if they were still relevant.
Also notable: it never mentions the history of filters, lite, and low-tar. A glaring omission in a paper that purports to provide historical context on tobacco and technology. That history shows that any “technology” the industry is OK with ends up protecting industry profits, not public health.
Selective on the science, selective on the history, and it’s pretty clear why.
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