E-cigarettes are getting a bad rap in society. But as unhealthy as they may be, they may have a positive place in society.

Nicotine delivery systems. That’s the gotcha moment in The Insider, a based-on-a-true-story exposé on the deceptions of Big Tobacco. When 60 Minutes producer Lowell Bergman (as played by Al Pacino) hears whistleblower Jeffrey Wigand (Russell Crowe) refer to the industry view of cigarettes as “nicotine delivery systems,” you can see on his face that he knows he’s reached the promised land of investigative journalism. Nicotine is known to be a highly addictive cancer-causing agent, and Big Tobacco was manufacturing and marketing cigarettes with the sole intent of profiting by delivering nicotine into the bloodstreams of consumers, hooking them so that the profit stream does not relent. Gotcha.

At first glance, then, a recent recommendation by Public Health England (or PHE, the rough equivalent to the Centers for Disease Control (CDC) in the United States) concerning electronic cigarettes—technically known as electronic nicotine delivery systems (ENDS)—may seem odd. Rather than pushing for a ban, PHE is not only encouraging legislators to make e-cigarettes available by way of a prescription, but also for employers—and even hospitals—to provide areas where people can vape.

It’s not as crazy as it sounds when you look at “E-cigarettes: an evidence update”, an independent 2015 study commissioned by PHE. Among their key findings: e-cigarettes are 95 percent safer than regular cigarettes, few people who have never smoked cigarettes begin using e-cigarettes, and e-cigarettes can be an effective tool for quitting smoking entirely.

That study, though, is not without criticism. For example, The Lancet, one of the world’s most respected medical journals, called the PHE-commissioned study “the opinions of a small group of individuals with no prespecified expertise in tobacco control” who based their conclusions on an “extraordinarily flimsy foundation.”

Yet despite such searing criticism, something The Lancet does not assert is that PHE was necessarily wrong in any of their assertions or recommendations. “Tobacco is the largest single cause of preventable deaths in England,” they wrote, “[and] e-cigarettes may have a part to play to curb tobacco use.”

One of the problems is that there are still many unknowns pertaining to e-cigarettes; and because of the way our systems of justice and commerce work, the pace of e-cigarettes distribution has far outstripped the pace of research. As discussed in Scientific American in 2014, when e-cigarettes entered the U.S. market in 2007, the Food & Drug Administration (FDA) intended to regulate them under the theory that they are drug-delivery devices (defined as “intended to affect the structure or any function of the body). Although that seems like a no-brainer considering that e-cigarettes are, after all, electronic nicotine delivery systems, in 2010 a federal appeals court ruled that the FDA was not authorized to do so—partly because of a 2000 court ruling in which the FDA was deemed not to have the authority to regulate cigarettes themselves.

If you’re confused, sorry, but it only gets worse. Even though that 2000 ruling was overridden with the passage of the Family Smoking Prevention and Tobacco Control Act of 2009 (commonly known as “the Tobacco Act”), the 2010 court ruling asserted that the FDA cannot regulate tobacco products as drug-delivery systems unless such products are “marketed for therapeutic purposes.” In other words, as long as tobacco companies ignore the possibility that e-cigarettes may be a means to stop smoking and instead promote only on their “recreational” use (a term that makes giving yourself lung cancer sound like playing frisbee on the beach), the FDA cannot regulate the e-cigarette the way they do nicotine patches.

This may demonstrate the basic wisdom behind PHE’s recommendation. There are still many unknowns concerning the use of e-cigarettes, such as whether propylene glycol, a main ingredient in e-cigarette cartridges, is harmful when inhaled. But considering that sales of e-cigarettes have not been impeded by these unknowns, might it be wise to heed PHE’s recommendation and treat e-cigarettes as the lesser of two evils—not unlike the way methadone is used to help wean addicts off of heroin—rather than a recreational product?

That is certainly the FDA’s desire. Between August 2016 and February 2017 the FDA amended and clarified its existing rules concerning tobacco products, pushing the limits of its authority to regulate all tobacco products to the extent of the limits imposed upon it by the above-referenced court decisions. Included in that shift is the recognition of the role e-cigarette may be able to play in weaning people off of cigarettes. “The FDA recognizes that some tobacco products have the potential to be less harmful than others,” the FDA says. “[…] If certain products, such as e-cigarettes, have reduced toxicity compared to conventional cigarettes; encourage current smokers to switch completely; and/or are not widely used by youth, they may have the potential to reduce disease and death.”

But in light of current evidence, it’s questionable whether that “if” is legitimate. For example, in July of last year University of California at San Diego researchers published results of a 15-year study of over 160,000 Americans, concluding that “[t]he substantial increase in e-cigarette use among US adult smokers [between 2001 and 2015] was associated with a statistically significant increase in the smoking cessation rate at the population level.”

Electronic cigarettes certainly merit more study. But considering the promise they show as a means to help cigarette smokers break an indisputably life-threatening habit, Public Health England’s suggested approach may be a point the way to overall harm reduction, even if e-cigarettes are in themselves unhealthy.

About the Author:

Except for a four-month sojourn in Comoros (a small island nation near the northwest of Madagascar), Greggory Moore has lived his entire life in Southern California. Currently he resides in Long Beach, CA, where he engages in a variety of activities, including playing in the band MOVE, performing as a member of RIOTstage, and, of course, writing.

His work has appeared in the Los Angeles Times, OC Weekly, Daily Kos, the Long Beach Post, Random Lengths News, The District Weekly, GreaterLongBeach.com, and a variety of academic and literary journals. HIs first novel, The Use of Regret, was published in 2011, and he is currently at work on his follow-up. For more information: greggorymoore.com