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5 cast as ‘quit or die’ – this new value proposition fits between the two. It is likely to be successful, because it requires less effort to reduce the harm – i.e. it does not require complete nicotine cessation. Expert views suggest a health risk of at least 95% or 20 times lower than smoking. In advice to a UK parliamentary hearing, leading UK smoking cessation experts; Professor Robert West of University College London, Professor Peter Hajek of Queen Mary University of London, Profesor Ann McNeill, of Kings College London, Dr Jamie Brown of University College London and Deborah Arnott, the Director of Action on Smoking and Health, put the relative risk in perspective 7 From analysis of the constituents of e-cigarette vapour, e-cigarette use from popular brands can be expected to be at least 20 times safer (and probably considerably more so) than smoking tobacco cigarettes in terms of long-term health risks Professor John Britton, Chair of the Royal College of Physicians Tobacco Group and Director of the UK Centre for Centre for Tobacco and Alcohol Studies, and his colleague Ilze Bogdanovica give a similar if unquantified message in an assessment for the government agency Public Health England 8: Overall however the hazards associated with use of products [e-cigarettes] currently on the market is likely to be extremely low, and certainly much lower than smoking. Robert West & Jamie Brown, in an editorial for the British Journal of General Practice 9, point out that we know enough to make reasonable judgements about e-cigarette risk relative to smoking. Some reviews have bizarrely concluded that we do not know whether e-cigarette use is safer than smoking, ignoring the fact that the vapour contains nothing like the concentrations of carcinogens and toxins as cigarette smoke. In fact, toxin concentrations are almost all well below 1/20th that of cigarette smoke. Professor Peter Hajek, reinforces the 95% reduction in risk, in an interview for News-Medical 10 Electronic cigarettes are estimated to be at least 95% safer than cigarettes and they appeal to smokers who cannot or do not want to stop smoking, but who want to reduce the risks smoking poses to their health. 2.3 Do e-cigarettes help people to quit smoking? An assessment of the trials undertaken at the end of 2014 for the Cochrane Library concludes 11 Combined results from two studies, involving over 600 people, showed that using an EC containing nicotine increased the chances of stopping smoking long-term compared to using an EC without nicotine. Using an EC with nicotine also helped more smokers reduce the amount they smoked by at least half compared to using an EC without nicotine. The most comprehensive study so far of ‘real world’ use of e-cigarettes showed 12 7 West R et al Briefing: Electronic cigarettes what we know so far. Presented to UK All-Party Parliamentary Group on Pharmacy: 10th June 2014 [link] 8 Britton J, Bogdanovica I. Electronic cigarettes: A report commissioned by Public Health England. May 2014 [link] 9 West R, Brown J. Electronic cigarettes: fact and faction. Br J Gen Pract 2014; 64: 442–3.[link] 10 News-Medical, Electronic cigarettes and smoking cessation: an interview with Professor Peter Hajek, 5 Feb 2015 [link] 11 McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD010216. [link] 12 Brown J, Beard E, Kotz D, Michie S, and West R (2014) Real-world effectiveness of e-cigarettes when used to aid