LAUSR

www.thelancet.com Vol 392 August 11, 2018 473 The National Academies of Sciences, Engineering, and Medicine finds substantial evidence that electronic cigarette (EC) use increases the risk of ever using combustible tobacco cigarettes in youth and young adults, and moderate evidence that EC use increases the frequency and intensity of subsequent smoking of combustible tobacco cigarettes. In disputing this, Newton and colleagues state that regular use (at least once per week) of ECs by young people remains largely confined to those who have previously smoked in the UK and USA. This is correctly cited, but the study answers the wrong question— it provides no information on the question of whether occasional or regular EC use preceded smoking. The only other reference is a critique of the 2016 US Surgeon General’s Report in an open access journal written by authors with a known position on ECs and major conflicts of interest, an opinion piece that provides no original data. In the Public Health England evidence review, the authors criticise those who seek publicity but do not accurately represent articles or who rely on posters or presentations at conferences when no peer-reviewed article exists to be taken as defin itive findings. However, the authors refer themselves to numerous conference presentations and several unpublished papers or papers being reviewed, and 19 references, mostly favourable to their arguments, are unpublished or published after the cutoff of Aug 18, 2017, for the peer-reviewed literature review. By contrast, data published in the same extended period showing adverse effects, such as rapid loss of lung function with 2 years of EC use, seem unworthy of attention. In crucial aspects, this Comment and the Public Health England report are below the standard required to inform public decision making, and those who are forming a judgment would be wise to look to the National Meanwhile, a congressionally mandated review by the National Aca demies of Sciences, Engineer ing, and Medicine of more than 800 peerreviewed scientific studies on the health effects of ECs on adol escents concluded that “There is sub stantial evidence that e-cigarette use by youth and young adults increases their risk of ever using conventional cigarettes”. Therefore, the National Academies of Sciences, Engineering, and Medicine’s recommendation should be appropriately reflected in future paediatric clinical guidelines for EC use to prevent a future global tobacco epidemic.