A disrupted future?

The tobacco industry worldwide has annual revenues of hundreds of billions of dollars, and annual smoking-associated death rates in the millions. Electronic cigarettes designed as a less harmful alternative to traditional tobacco products allow users to inhale nicotine, without consuming the products of burning tobacco, thus significantly lowering health risks. These and similar innovative solutions have a potentially disruptive impact on existing markets. Both newcomers and established cigarette firms have been active around these alternatives. However, the health implications of such products are still poorly studied and seemingly ambiguous. Moreover, there is an increasing number of reports on mass diseases associated with vaping. As a result, most countries and international institutions, including the World Health Organization, have adopted negative attitudes towards electronic cigarettes.Do e-cigarettes represent a Trojan Horse that will undermine tobacco control efforts - or are they an effective way to wean users away from cigarettes thus opening the way towards better future? This paper outlines estimates of the future health impacts of cigarette and e-cigarette use, and considers the broader issues surrounding this potentially disruptive innovation. It points to areas requiring further research and suggests how Foresight studies might address the topic.