Although the use of water pipes is rare outside of China, the present study nonetheless provides some important lessons for those living in western countries. The findings by She et al4 highlight how little we know about safety when it comes to alternative smoking devices and, furthermore, how inadequate current public health regulations are in combating the potential harm related to these devices. For instance, in the United States, there is an epidemic of hookah smoking and, most importantly, e-cigarette smoking. Despite valiant efforts to ban cigarette smoke in public locations like restaurants and bars in recent years, little legislation exists to ban these forms of smoking. Hookah smoking, related to water-pipe smoking, is associated with higher rates of COPD and lung cancer than conventional cigarette smoking,5 yet it is allowed to continue unabated in 90% of the American cities that have enacted cigarette smoking bans.6 The laxity surrounding the hookah flies in the face of clear and compelling scientific evidence that hookah smoke carries four times as many polycyclic aromatic hydrocarbons and aldehydes as cigarette smoke.7 Similarly, tough advertising policies that restrict tobacco companies have yet to be applied to the e-cigarette industry, which alone spent $20.8 million on advertising in 2012 (a number that has since grown considerably)8 and whose sales now top $1.7 billion, with the fastest growth among young students.9 In spite of the dearth of evidence regarding their safety, the allowance of television advertising for e-cigarettes with glamorous and beautiful Hollywood stars and the frequent (and potentially misleading) message of harm reduction in online e-cigarette advertisements10 pose a serious challenge for public health advocates today. There are no long-term studies evaluating the risk of COPD, lung cancer, and cardiovascular disease from smoking e-cigarettes. In the meantime, there are credible reports that e-cigarettes produce inconsistent amounts of nicotine in products inaccurately labeled by manufacturers,11 not to mention heavy metals,12 silicate particles,12 and diethylene glycol.11 The argument that e-cigarettes may help cigarette smokers to quit is, at this time, simply not established enough in the scientific literature13 to permit unregulated sales and advertising.