E-cigarettes have become a dirty word in many countries, amid claims they encourage non-smokers to take up the habit - and make an unpalatable experience attractive to young people.
But at a meeting of leading medical experts in Washington DC this week, professional opinion seems clear: legalise but regulate them, promote them to hardened smokers, and hammer conventional cigarettes with high taxes.
Many countries, including the UAE and New Zealand, which have banned e-cigarettes and related devices, are likely to be watching closely.
The primary case study is the UK and at the E-Cigarette Summit in Georgetown, praise was heaped upon Public Health England by experts for its decision to officially promote to help smokers quit.
What is known is that e-cigarettes and similar devices are less harmful than smoking, and existing research to support that has been enough for the UK to change its stance and support their use as a quitting aid.
“The fastest decline in tobacco use in the UK took place shortly after e-cigarettes came onto the market,” said Deborah Arnott, chief executive of Action on Smoking and Health UK (ASH).
“Our tobacco control plan aims to have a smoke-free generation by 2022, reducing adult smoking from 15.5 per cent to 12 per cent, and in young people from 8 per cent to just 3 per cent.
“E-cigarette use has remained stable in the UK since 2013, and e-cigarette use by non-smokers remains very low.
“There needs to be a comprehensive strategy towards smoking as a whole before authorities can consider the endorsement of e-cigarettes.”
In the UAE, where the sale of e-cigarette devices is not allowed, data from the global Tobacco Atlas Report found more than 2,900 people died from smoking-related illness in 2016.
Lost productivity and heathcare costs due to smoking also cost the country $569 million (Dh2.09 billion), according to the report.
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Of those victims, figures show the vast majority – 2,718 – were men, but 265 women also died as a result of smoking tobacco.
Whilst the EU sets a broader framework for tobacco control, through advertising directives and taxes to set minimum standards on product regulations, the UK has gone further.
It is leading the continent on a tobacco control scorecard that assesses industry controls and restrictions.
In 2007, smoking rates in the UK were at the European average of 33 per cent. They have fallen to around 17 per cent today.
Sweden is the only other country in Europe to come close to that level of reducing smoking.
Local advertising on billboards and the point of sale for e-cigarettes is allowed in the UK, but ads have to meet standards, with new products notified six months in advance.
Health warnings must be attached to devices, and adults buying e-cigarettes and related paraphernalia on behalf of children or young people can be prosecuted.
New guidance on e-cigarettes across Europe is yet to be published, and that is leading to some confusion in the market.
“E-cigarette use has remained stable in the UK since 2013, and e-cigarette use by non-smokers remains very low,” said Ms Arnott.
“Innovative technologies that reduce harm should be permitted and encouraged, and the National Institute for Clinical Excellence is offering the latest public health guidance to support harm reduction.”
Up to January 2018, 2,927 e-cigarettes and 30,831 e-liquids were published in a list of approved devices in the UK.
A public reporting system for side effects and safety concerns has logged just 39 minor reports.
A PHE report published in 2018 said there were no circumstances where it would be beneficial to carry on smoking instead of using e-cigarettes.
The report on e-cigarettes and heat-not-burn devices said while there was limited evidence the devices may aid smoking cessation, they had encouraged tens of thousands of additional quitters in England.
Professor Ann McNeill, professor of tobacco addiction at the UK Centre for Tobacco and Alcohol Studies, said UK surveys had provided no evidence that e-cigarettes were leading people to take up smoking.
“We recognise that education and training is required to be able to offer the best advice on using e-cigarettes to help smokers quit,” she said.
“Switching completely from smoking to vaping conveys substantial health benefits.
“Sixty per cent of smokers in Britain have tried e-cigarettes, we need to know 40 per cent are yet to try them to help them quit smoking.”
Despite the shift in professional opinion, some medics, including in the UAE, remain unconvinced, saying more time and data is needed to before the full impact on an e-cigarette smoker's health is known.
"People think e-cigarettes are harmless but we know they are chemicals so there will be problems with them in future," said Dr Mohamed Maki Shalal, head of ER at Canadian Specialist Hospital in Dubai, speaking to The National last year.