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The e-cigarette issue is one of the most difficult ethical and professional dilemmas faced by pharmacy in years. It's the same for regulators, leadership organisations and the wider public health community.

Many pharmacists remain deeply sceptical about the safety, quality and effectiveness of these unlicensed devices (with some justification), as well as the safety of long-term nicotine use (unknown). Not that 2.1 million vapers give a jot about any of this. They just don't want their access restricted to products that they believe passionately work for them.

In an area where hard evidence is lacking, the research being carried out by ASH, Professor Robert West and others is vitally important. Some of the early findings will certainly give pharmacists pause for thought. For instance, e-cigarette use in a quit attempt appears to improve the chances of success compared with using no aid or a licensed nicotine product bought from a store.

Pharmacy Voice's Rob Darracott has described e-cigarette users as a mass movement, but it is one that, for a variety of reasons, many of them perfectly valid, the profession has failed to engage with in any meaningful way. Yet now there are indications that NHS stop smoking services are beginning to factor in e-cigarette use in their advice rather than risk clients relapsing back into smoking tobacco.

So the key question is €“ does pharmacy have to somehow reach an accommodation with itself over e-cigarettes or possibly risk being marginalised to the point of irrelevance in a key area of public health?

Richard Thomas, editor

email: richard.thomas@1530.com