The authors admit this in the paper. They write: "This is a cross-sectional study, which only allows us to identify associations, not causal relationships."

In fact, in a by Flouris et al., the investigators found that real cigarettes, but not the fake ones, had a significant detrimental effect on pulmonary function, measured by spirometry. This study documents that while active smoking has immediate, clinically meaningful effects in reducing lung function, electronic cigarettes do not.

It is clear from the overall evidence that electronic cigarettes are not as risky as tobacco cigarettes in terms of acute effects on lung function. On this issue, Dr. Glantz's comment is simply wrong.

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