While most of the national tobacco control organizations are boasting about the amazing progress since the 1964 Surgeon General's report on smoking - progress that they claim has continued to this day - one veteran anti-smoking activist is challenging this dogma, arguing that in recent years, the tobacco control movement has squandered the opporunity to reduce smoking-related disease and death. Instead of continued progress, he says, the tobacco control movement has largely been co-opted by a bureaucracy of national organizations that seem more concerned about bolstering their funding streams than fighting the tobacco industry.

Here, they find a correlation between e-cigarette use and higher and more sustained levels of smoking. But because this is a cross-sectional study, they cannot determine which came first. In other words, what is the direction of the causal relationship? Does the e-cigarette use precede, and cause, the smoking? Or does the smoking precede, and cause, the e-cigarette use?

• The truth is that the study we relied upon did not measure the time course of electronic cigarette and cigarette use. Thus, it could not determine whether the kids who were using both cigarettes and electronic cigarettes had initiated with smoking or with electronic cigarettes.

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