Published: McDonald, D 2013, Book review: The electronic cigarette, an alternative to tobacco? by J-F Etter, Drug and Alcohol Review, vol. 32, no. 6, pp. 635-6. The electronic cigarette, an alternative to tobacco? JEAN- FRANOIS ETTER n.p.: CreateSpace Independent Publishing Platform, 2013 ISBN 978-1481061889 Price US$5.48 (paperback), US$2.99 (e-book) For decades Australian drug policy has run two things in parallel: with respect to all drugs but one, our approach has been to prevent or minimise the use of drugs, and to minimise the harms experienced by people who use drugs and by other people affected by that drug use. For one drug onlynicotinewe have taken a different approach: people should be either dependent tobacco smokers or totally tobacco abstinence. In this approach, nicotine replacement therapy can be used for brief periods, but only as a smoking cessation aid, not as a maintenance intervention. Does this sound ridiculous? Many believe it is. But tobacco harm reduction is now creeping onto the agenda, a set of strategies that sits between dependent tobacco consumption and total abstinence from nicotine. Etters book about electronic cigarettes (e-cigarettes) is the best contribution we have to date to inform at least part of this third way. The book is highly accessible. It is self-published (through Amazon), brief (119 pages in length), clearly-written, and sold online at a modest price. It has ten short chapters, with the text adequately, though not overwhelmingly, referenced. The author starts with the (correct) assumption that many readers will not know much about e-cigarettes, so the first two chapters get us au fait in this area. He then discusses Why do people use e-cigarettes? Subsequent chapters deal with the safety and toxicity of these products, what we know about the toxicity and addictive properties of nicotine, and the nicotine withdrawal syndrome. He then answers (in the affirmative) the question Can e-cigarettes help smokers to quit or cut down? and spells out a range of legal, political, economic and social considerations. The final chapter comprises five sets of recommendations, one each for would-be users, current users, health professionals, policymakers and regulatory agencies, and researchers. Useful appendices are included that are aimed at assisting current and former tobacco smokers to quit or avoid relapse. The key message that this reader gains from Etters book is found in his section on Recommendations for policy makers (page 74):

How well e-cigarettes are regulated and taxed will have a decisive impact on the number of users, the number of smokers who quit, and the number of people who die from smoking-related diseases. From a legislative perspective, it is necessary to assess whether the benefits of e-cigarettes outweigh their drawbacks in comparison with tobacco.

One of the authors best achievement is his careful identification of what we do not know about e-cigarettes with respect to patterns of use, the beneficial and detrimental consequences of use, and the optimal policy settings to manage this innovation. This has implications for a range of stakeholders. Etters book is timely. Millions of people are using e-cigarettes. Addiction professionals, policy makers and therapeutic product regulators need to learn about this phenomenon and what the science tells us about it. This makes the book a must read, particularly for people who have, until now, had closed minds about the possibility of tobacco harm reduction.