The Polarization Over E-cigarettes

Two distinct camps have emerged in the discourse on e-cigarettes. One emphasizes “precaution” to prevent plausible risks to public health, while the other focuses on “harm reduction” and advocates for risk-proportionate regulation on the basis of what available evidence suggests is likely to be true (epistemic probabilism). This chapter explores the discord between these competing perspectives. The conceptual origins of harm reduction and the precautionary principle are introduced and precedents are discussed. The drivers of polarization, including different goals, priorities, and interpretations of the data, and the legacy of tobacco industry malfeasance are explored. Misinformation, reporting bias, and publication bias are described as both consequences of polarization and creators of feedback loops perpetuating confusion about e-cigarettes, leading to poor decision-making by smokers and government agencies. The chapter closes by discussing how polarization in the debate on e-cigarettes has parallels in other areas of the broader public discourse.