Nevertheless, this does not stop the authors from drawing a conclusion. They conclude, despite their acknowledged inability to draw such a conclusion, that: "e-cigarette use is aggravating rather than ameliorating the tobacco epidemic among youths."

The rest of the story is that dual use is not necessarily a bad thing. In fact, it may for some be a gateway to smoking cessation.

In other words, the blatant flaw in this study is that it enrolled smokers who had already made quit attempts using e-cigarettes in the past. By definition, this resulted in a sample of smokers who were more resistant to quitting. One would expect to find lower quitting rates among this population of e-cigarette users.

This demonstrates just how contentious harm reduction debates are, especially in tobacco control. Both sides are acting on zealous idealism, with science playing very little role.

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