Dear Editor: The position article by Reynales-Shigematsu and colleagues¹1. Reynales-Shigematsu LM, Barrientos-Gutiérez I, Zavala-Arciniega L, Arillo-Santillán E. Nuevos productos de tabaco, una amenaza para el control de tabaco y la salud pública en México. Salud Publica Mex. 2018;60(5):598-604. https:// doi.org/10.21149/9682
https://doi.org/10.21149/9682... on the public health impact in Mexico of combustion-free electronic nicotine delivery systems (ENDS) fails to present a balanced overview of the risk-benefit ratio of these new technologies, grossly misrepresents the existing evidence, and ignores the broad consensus that these products are much less harmful than cigarettes.²2. Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016 [cited October 7, 2018]. Available from: Available from: http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0
http://www.rcplondon.ac.uk/projects/outp... ^,33. McNeill A, Brose LS, Calder R, Bauld L, Robson D. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England, 2018 [cited October 7, 2018]. Available from: Available from: https://www.gov.uk/government/ publications/e-cigarettes-and-heated-tobaccoproducts-evidence-review
https://www.gov.uk/government/ publicati... ^,44. National Academies of Sciences, Engineering and Medicine. Public health consequences of e-cigarettes. Washington DC: The National Academies Press, 2018. https://doi.org/10.17226/24952
https://doi.org/10.17226/24952...

The work cited by the authors (references 8-21) on exposure risks from e-cigarette aerosol emissions report misleading results that do not reflect normal conditions of use.5 The authors claim that trial of e-cigarettes is propitiating tobacco initiation among Mexican adolescents, citing a longitudinal cohort study on Mexican high school students (reference 31) which actually disproves this claim, as it reported that the association between e-cigarette trial at baseline and past 30 day smoking at follow-up was not even statistically significant.⁵5. Polosa R, Urso S, Farsalinos KE. Response to “New tobacco products, a threat for tobacco control and public health of Mexico” [internet]. Greece; c2015-2016 [updated 2019 Apr 26; cited 2018 Oct 7]. E-cigarrete research [about 7 screens]. Available from: Available from: http://www.ecigarette-research.org/research/index.php/ whats-new/2019/269-mexico-ecig
http://www.ecigarette-research.org/resea... The authors dismiss the utility of ecigarettes in smoking cessation, but their cited references do not support this claim.5 Further, a recent high quality randomized controlled trial⁶6 . Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers-Smith K, Bisal N, et al. A randomized trial of e-cigarettes versus nicotine replacement therapy. N Engl J Med. 2019;380:629-37. https:// doi.org/10.1056/NEJMoa1808779
https://doi.org/10.1056/NEJMoa1808779... has shown e-cigarettes to be twice as effective in smoking cessation compared to nicotine replacement therapies. A detailed critique of the position article is available.⁵5. Polosa R, Urso S, Farsalinos KE. Response to “New tobacco products, a threat for tobacco control and public health of Mexico” [internet]. Greece; c2015-2016 [updated 2019 Apr 26; cited 2018 Oct 7]. E-cigarrete research [about 7 screens]. Available from: Available from: http://www.ecigarette-research.org/research/index.php/ whats-new/2019/269-mexico-ecig
http://www.ecigarette-research.org/resea...

Following the authors, ENDS can only be part of a harm reduction strategy for Mexico if they immediately promote total smoking abstinence, as well as complete absence of dual usage and recruitment of non-smokers.⁷7. Norma Oficial Mexicana NOM-028-SSA2-2009 Para la prevención, tratamiento y control de las adicciones. México: Conadic, 2009 [cited October 7, 2018]. Available from: Available from: http://www.conadic. salud.gob.mx/pdfs/norma_oficial_nom.pd
http://www.conadic. salud.gob.mx/pdfs/no... However, these are maximalist and unrealistic conditions that no new harm reduction product can fulfill. A more realistic approach to harm reduction yields concrete benefits: the recreational usage of e-cigarettes, endorsed by health institutions in the United Kingdom under a consistent Tobacco Control strategy, has contributed to a significant decay of smoking prevalence with negligible usage by non-smokers of all ages.²2. Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016 [cited October 7, 2018]. Available from: Available from: http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0
http://www.rcplondon.ac.uk/projects/outp... ^,33. McNeill A, Brose LS, Calder R, Bauld L, Robson D. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England, 2018 [cited October 7, 2018]. Available from: Available from: https://www.gov.uk/government/ publications/e-cigarettes-and-heated-tobaccoproducts-evidence-review
https://www.gov.uk/government/ publicati...

By presenting ENDS as a threat to public health (consequently recommending their regulation as combustible tobacco products), Reynales- Shigematsu and colleagues are depriving 15 million Mexican smokers of key information on a plausible harm reduction alternative that can vastly improve their health. As an unintended consequence, this misinformation will keep them smoking.

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