Talk:Electronic cigarette/Archive 29

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Youth vaping images

To expand: 5 out of 16 pictures are on the subject of youth vaping. With WP:WEIGHT in mind, this is disturbing. And now a push for an image that indicates that e-cigarettes are associated with illegal drug usage? Hmmm. The CDC's view is also rather overrepresented in the images, considering that the US view and (as an example) the UK view is, if not directly opposite, then certainly not in agreement, i would consider that something to fix as well. --Kim D. Petersen 16:49, 27 January 2016 (UTC)

The reason we use CDC content to such an extent is because of their licensing practice, that is to say beyond the face that their positions holds very much weight. Their most recent position also concerns young and e-cigarettes, and making up less than 30% of the articles images is not undue burden. Neither do 5 out of 16 images have to do with use among youth, that is a miscategorization. CFCF 💌 📧 16:58, 27 January 2016 (UTC) 

(edit conflict)Lets count the images then[1], since you seem to think that it is a miscategorization:

• image 1-3 not about youth
• image 4 "showing teens using e-cigarettes are more likely to start smoking tobacco"
• image 5 "may appeal especially to younger users"
• image 6 "may appeal to younger users"
• image 7 "middle and highschool students"
• image 8 "Ads and Youth which concerned marketing towards adolescents"
• image 9-13 not about youth
• image 14 "Youths are exposed to e-cigarette advertisements..."
• image 15 not about youth.

You are correct - i miscounted. There are 6 images out of 15 that are about youth, which is 40% of all images. An even higher percentage than i counted. Lets talk about WP:WEIGHT again? --Kim D. Petersen 17:12, 27 January 2016 (UTC)

Way to many images on one subject. AlbinoFerret 17:21, 27 January 2016 (UTC)

Agree, too many images on the same subject. The images currently in the article create a POV problem.

Total number of images = 16

Images (including captions) of:

• positive content about ecigs = 0
• neutral content about ecigs = 8
• negative content about ecigs = 8
• negative content about ecigs cited to US government-funded sources = 8

There are problems with some of the individual images and their captions, but that's probably the subject of a different discussion. P Walford (talk) 15:19, 3 February 2016 (UTC)

The images are factual and represent the literature well, with poignant captions and a good representation of common topics. The literature discusses use among adolescents to an extensive degree, and this is represented in the article, the CDC focuses on young potential users — as do traditional anti-smoking campaigns. The point is neither to shine a negative nor a positive light on electronic cigarettes, but to have factual images with well supported captions. CFCF 💌 📧 19:26, 3 February 2016 (UTC)

Factual does not mean NPOV. You do know that don't you? Please refer to WP:UNDUE for a good read. What we need is not an article that presents a negative, positive or neutral view.... but an article that presents the information gathered from secondary sources in proportion to the prominence in the reliable secondary literature on the topic. --Kim D. Petersen 21:00, 3 February 2016 (UTC)

• re "factual images with well supported captions":

• "National Institute on Drug Abuse director Nora Volkow discussing a National Institutes of Health-funded study showing teens using e-cigarettes are more likely to start smoking tobacco." Dr. Volkow mentions a study, but nowhere in the article or the source is a link or even a title of the study provided. Thus, as it stands, it's a primary source. Dr. Volkow said, "..that's actually what they seem to have found", which sounds less definitive than the caption.

• "There are concerns that colorful electronic cigarettes may appeal especially to younger users." This is cited to a dead link. I can't find this point in the archived version.

• "Candy, fruit and coffee flavored e-liquid may appeal to younger users of electronic cigarettes." It has been mentioned already that it's cited to primary sources.

• "2014 Centers for Disease Control (CDC) press release concerning e-cigarettes." It's not a press release, it's a marketing image in a press release. The fact that it's an estimate needs to be mentioned. How many middle and high school students were there in the US? "Had used e-cigarettes" is not accurate as it is based on ever-use figures. "Had used an e-cigarette" would be more accurate, but unfortunately the CDC didn't use those words.

• "The United States Centers for Disease Control and Prevention released a 2016 report titled E-cigarette Ads and Youth which concerned marketing towards adolescents." The only thing this image has to do with marketing towards adolescents is the fact that it's a CDC image marketing towards adolescents. The image says "continued tobacco product use among youth". Yes, the CDC consider ecigs to be tobacco products, but this is not a consensus view of the reliable sources. "Youth" and "adolescents" need to be defined.

• "Adolescents are exposed to electronic cigarette marketing in a number of ways, many of which are not available to traditional cigarettes." Again, "youth" and "adolescents" need to be defined. If it's desirable to include an image in the Marketing section, perhaps an example of marketing would be better, maybe the 2012 advert that merits four sentences in the second paragraph? It's an even better idea to stay away from marketing images entirely, regardless of their sources. P Walford (talk) 15:32, 4 February 2016 (UTC)

Your comments are both inaccurate and disruptive.

• The video is released by the CDC and can be said to show their position, it is both a primary source and its inclusion is supported by MEDRS because it is released by the CDC as a health information body.
• Please clarify which link this is, the sources were all fine less than a week ago. I will be able to provide the source for inspection if you are unable to find it.
  Edit: archived version
• There are multiple citations backing that statement, none of the ones in the article are primary.
• If you disagree with the CDCs analysis you should take it up with them.
• This is an informative image released by the CDC, and I strongly disagree that youth or adolescents need to be defined seeing as the CDC does not see the need to do so. CFCF 💌 📧 16:43, 4 February 2016 (UTC)

The observations look accurate for the most part to me. Please WP:FOC. The video is a primary source and not a formal position statement. I think we should stay away from sources that have been removed by the creators because one reason it may have been removed is errors in the source. I think we need to move off of primary sources, they seem to be piling up. Press releases really need to go, yet another primary source. Youth and adolescents appear to be the same group from various dictionary searches. AlbinoFerret 17:55, 4 February 2016 (UTC)

The observations are not accurate, despite the fact that you believe so. The video is not a primary source, it does not present original research, and even if it were it is a position of the CDC. As for the NACCHO source, there is nothing to indicate that it has been retracted, websites are restructured continuously and it does impact its credibility. I find it entertaining that you suggest press releases should be removed from sources while advocating strongly for the inclusion of the NHS Smokefree Electronic cigarettes site as well as the Press release – E-cigarettes: an emerging public health consensus used for the statement "In a 2015 joint statement, Public Health England and twelve other UK medical bodies concluded "e-cigarettes are significantly less harmful than smoking." Youth and adolescents are pretty similar groups, and the terms are often used interchangeably — mostly for variation. CFCF 💌 📧 18:59, 4 February 2016 (UTC)

The NHS Smokefree Electronic cigarettes site, is just that a site, not a press release. As for E-cigarettes: an emerging public health consensus, I direct your attention to the subtitle "Joint statement on e-cigarettes by Public Health England and other UK public health organisations." The Joint statement was released to the press. But it is a position statement. As for the video on the CDC website. From the source itself, my bold "NIDA Director Dr. Nora Volkow discusses NIH-funded study which shows possible link between teens use of e-cigarettes and initiation of tobacco use.". It is a discussion of a primary source by a member of the same group that funded it. This is not a position statement. Its not setting forth their position, its a discussion about a study that was funded by the NIH which she is a part of. The caption is also inaccurate as the source says its a "possible link" where the caption states it as a fact. AlbinoFerret 19:54, 4 February 2016 (UTC)

Ingredients, additives and adulterants

What are we trying to say here? If it's an ingredient, it isn't an adulterant in my book. Tobacco extract is presumably for flavour, and ? cannabis left over from production runs of cannabis e-juice on insufficiently cleaned equipment. What are the sources saying? Johnbod (talk) 13:03, 31 January 2016 (UTC)

Adulterant was a direct quote from the second source and concerns what is not expressly declared on the list of ingredients. It was changed to additives by Doc James, but this isn't entirely correct — though I can't think of any other simple synonym for adulterant. CFCF 💌 📧 19:18, 3 February 2016 (UTC)

I think adulterants are a type of additive. But either way. Doc James (talk · contribs · email) 19:27, 3 February 2016 (UTC)

Maybe undeclared additives would work?CFCF 💌 📧 19:33, 3 February 2016 (UTC)

Keeping "adulterant" and removing "ingredient" is fine The latter strongly implies it is in the "recipe". Johnbod (talk) 20:52, 4 February 2016 (UTC)

I restored adulterant as per the source wording (CC-BY). CFCF 💌 📧 23:13, 4 February 2016 (UTC)

The lone source on cannabis is Giroud C. Copied from above "The main source for this has an impact factor of 2 for 2015, its highest ever. The Giroud C source is also cited by a whopping 3 other sources, one a survey." The other source, Pisinger, doesnt mention cannabis or marijuana. AlbinoFerret 18:47, 3 February 2016 (UTC)

Oops, I just removed the wikilink as an "easter egg" before I saw this section. Putting cannabis in it sounds like Lacing (drugs), but I'm not sure if saying e-cigs are sometimes "laced with cannabis or tobacco extracts" is representative of the sources cited. ~Awilley (talk) 21:34, 4 February 2016 (UTC)

No, definitely not. It concerns specific e-liquids which contain cannabis or cannabinoids. See the source. CFCF 💌 📧 23:10, 4 February 2016 (UTC)

Awilley—do the last edits help? CFCF 💌 📧 23:18, 4 February 2016 (UTC)

I don't much care what word is used as long as it adequately represents the source. If you want a layman's opinion, I don't think I've ever seen the word "adulterant" before today, though I didn't have trouble figuring out its meaning either. In my opinion, if "adulterant" is a subset of "additive", and "additive" is also acceptable per the source, then I guess I'd have a preference for "additive" as being more accessible to the reader. (Something along the lines of WP:JARGON) My main concern was WP:EGG—saying "additive" and linking to "adulteress." (kidding) ~Awilley (talk) 05:28, 5 February 2016 (UTC)

Term "NRT" used without definition

The "Smoking Cessation" section frequently uses the term "NRT", without defining it. I'm guessing that this is an acronym for "Nicotine Replacement Therapy", but I'm not sure, and I think many readers of the article wouldn't be either. Could someone who knows for certain what it means please put the full term at the location of first usage? ie: Nicotine Replacement Therapy ("NRT"). Marcus erronius (talk) 01:31, 8 February 2016 (UTC)

Done; there was a disguised link in para 2 of the lead. I don't think we should tak of "NRTs" myself - "NRT products" is better. Johnbod (talk) 03:41, 8 February 2016 (UTC)

POV: Opinion articles used to counter secondary reviews?

I find this edit[2] disturbing. Since it directly breaks with WP:MEDRS and WP:POV. From WP:MEDREV:

Primary sources should not be cited with intent of "debunking", contradicting, or countering any conclusions made by secondary sources. Synthesis of published material advancing a position is original research, and Wikipedia is not a venue for open research. Controversies or uncertainties in medicine should be supported by reliable secondary sources describing the varying viewpoints. Primary sources should not be aggregated or presented without context in order to undermine proportionate representation of opinion in a field. If material can be supported by either primary or secondary sources – the secondary sources should be used. Primary sources may be presented together with secondary sources.

Here an anonymous editorial (opinion => primary source) is being used in exactly this way. --Kim D. Petersen 15:06, 27 January 2016 (UTC)

I was wonding if the reference name ":0", which looks rather like an emoticon, is used here as WP:POINT? Particularly since it bears no relevance to the reference, if so, then it is really troubling. --Kim D. Petersen 15:10, 27 January 2016 (UTC)

The :0 is added automatically when using visual editor to add references. It then continues with :1, :2, :3, etc. CFCF 💌 📧 15:21, 27 January 2016 (UTC)

Unique but ugly. (The first author's last name followed by year would be less cryptic.) Boghog (talk) 09:39, 6 February 2016 (UTC)

This is the position statement of an authoritative medical organization — namely The Lancet. It is attributed to the journal itself, it is not a primary source and does not present any original results. CFCF 💌 📧 15:22, 27 January 2016 (UTC)

The edits were removed by AlbinoFerret in this edit [3] which is very faulty. CFCF 💌 📧 15:25, 27 January 2016 (UTC)

I can imagine the uproar if someone other than a wikiproject medicine editor inserted an editorial to counter a MEDRS source. AlbinoFerret 15:33, 27 January 2016 (UTC)

No, the Lancet editorial is not a position statement, otherwise it would have been tagged as such. It is simply an anonymous editorial. So Yes, it is a primary source - and opinion to boot. Apologies for misunderstanding the visual editor inserts. Nb: Please do not outdent at level 1, it disturbs the ability to follow and reply to threads in text (see Help:Using_talk_pages#Indentation). --Kim D. Petersen 15:29, 27 January 2016 (UTC)

Btw. Editorials are even within the less restrictive bounds of WP:RS, as opposed to WP:MEDRS, always considered opinion, and thus not usable for general content, and can in no way be considered secondary! That you believe that it should be otherwise within MEDRS is disturbing. --Kim D. Petersen 15:37, 27 January 2016 (UTC)

There is an enormous difference between an "anonymous editorial" and one which the journal body puts its own name behind. The position of the article is endorsed by the Lancet, and is also one which is shared with numerous other sources. CFCF 💌 📧 15:42, 27 January 2016 (UTC)

An editorial (which is a primary source and not MEDRS) is not a good source to counter a MEDRS source. AlbinoFerret 15:46, 27 January 2016 (UTC)

Also note that the Lancet Editorial Board is not anonymous, you have at least twenty people standing behind the position at [4]. It is recognized as one of the most prestigious journals in the world and as such its positions hold much weight, enough that this statement illicited first page news around the world:

• Wired – E-cigarettes 'safer than tobacco' study faces Lancet criticism
• Wall Street Journal – U.K. Government Agency’s E-Cigarettes Report Based on ‘Flimsy’ Evidence, the Lancet Says

Neither does it counter the source, but the criticism should be included in the article, seeing as it comes from a high profile respected source.CFCF 💌 📧 15:52, 27 January 2016 (UTC)

Doesn't change the fact that editorials are opinion and primary sources. Do please read WP:MEDRS#Biomedical_journals(first paragraph) where it makes it very clear that such material is to be avoided. WP:MEDASSESS has two nice images that show you where editorials are placed within the ranking of level of evidence. Your insistance at trying to get opinion in as equivalent to reviews is disturbing. And your reliance here on Wired and the Wall Street Journal to "vet" the opinion is even more disturbing. Newspapers go for the controversy - not for the evidence! As any wikipedia science/medical editor should know. --Kim D. Petersen 16:01, 27 January 2016 (UTC)

I am sure CFCF knows about the ranking images, he had a hand in placing them there. AlbinoFerret 16:08, 27 January 2016 (UTC)

I know. Which makes this discussion even more disturbing with regards to POV. --Kim D. Petersen 16:40, 27 January 2016 (UTC)

What is clear is that The Lancets position is permitted by WP:MEDRS, it is accordingly on the top of those pyramids (which I created). CFCF 💌 📧 16:52, 27 January 2016 (UTC)

No, The Lancets editorial (not position) is not permitted by WP:MEDRS. Position statements are a specific category of statements - that are always marked as such. They are formal, and from medical bodies - not journals. --Kim D. Petersen 17:01, 27 January 2016 (UTC)

• The stances being taken here are tendentious. The editorial in the Lancet is by the editorial board; it is not your common editorial signed by Dr Ima GeniusWIthaStrongOpinion, and the Lancet has a lot of prestige in the UK, where of course the report is generated. It deserves to be in the article. No, it of course is not of equal with weight with PHS itself per MEDRS but it serves as a significant remark on what the stronger MEDRS source says. I will bring this to WT:MED and post it there to get more feedback. It would be useful to get actual feedback there, so please do not carry the acrimonious and transparently partisan backbiting above there, or everyone will vomit and ignore the post, and there will be no useful feedback. It will be up in a moment. Jytdog (talk) 06:53, 6 February 2016 (UTC)

  How is it "tendentious" to state that A) The Lancet editorial is a WP:MEDRS primary source and B) The PHE report is a WP:MEDRS secondary source. And C) We cannot use a primary source to debunk a secondary source per WP:MEDPRI? --Kim D. Petersen 09:31, 6 February 2016 (UTC)

<squeeze>t is clear how you are applying the definition of "editorial" in MEDRS to this specific editorial, and the logic that follows from that application is also clear. You don't need to keep repeating it. Jytdog (talk) 15:58, 6 February 2016 (UTC)

The editorial board did not publish original research findings in this editorial and hence it cannot be considered primary. The editorial board reviewed the reviews hence it should be considered tertiary. Furthermore this a very reliable tertiary source and per WP:PSTS can be used to comment on conflicting secondary sources. Boghog (talk) 09:50, 6 February 2016 (UTC)

We should not be using editorials to counter MEDRS secondary sources. We have been over this topic before. There are no conflicting MEDRS secondary sources that I know of, otherwise they would have been added instead of an editorial. AlbinoFerret 14:07, 6 February 2016 (UTC)

@AlbinoFerret: I was not a party to the previous discussion. What MEDRS says is that we should not use primary sources to debunk secondary sources. We have already established that the editorial is not a primary source. The editorial is a secondary/tertiary source that is highly respected. Surely you will agree that MEDRS demands that we must cite this source. Right? Boghog (talk) 20:16, 6 February 2016 (UTC)

It is the definition of TENDENTIOUS to keep repeating yourself. Everybody understands your perspective. Please stop repeating it already. It is clear that we have an impasse on this. Jytdog (talk) 15:45, 6 February 2016 (UTC)

@Boghog, After doing a little looking I dont think this editorial fits the definition of a tertiary source which are described as textbooks and encyclopedias. Its a opinion piece from an unknown author. Per the core policy WP:RS editorial commentary, analysis and opinion pieces are primary sources. AlbinoFerret 18:53, 7 February 2016 (UTC)

• I just closed the thread I opened since Kimmy could not restrain himself from entering the conversation to push his POV - what he wrote there clarified nothing, as everybody at WT:MED knows exactly what I meant by "statement by major health authority". Everybody in WP is sick of you guys. You don't seem to understand that. Am thinking about what the appropriate DR forum for this is, now that Kimmy tanked the most appropriate one. Jytdog (talk) 15:06, 6 February 2016 (UTC)

• OK, here is my thought, and is what I should have done before posting at WT:MED. Kimmy and Albino, would you please frame the question that you would like the folks at WT:MED to respond to? And if we can agree on the question, will you and CFCF and other participants here, please agree to stay out of the ensuing discussion so that we can get actual feedback? I will stay out of it too. Jytdog (talk) 15:48, 6 February 2016 (UTC)

The key point here seems to be "Can an editorial in the lancet be used as an RS to contradict the conclusions of a secondary source?". However all of this can be avoided if both sides will bend a little towards reasonability. It's fair to say the lancet editorial is not alone in its criticisms of the PHE Report so why not include the note that the PHE's verdict is not universally acknowledged (or similar words to say it's not the only accepted mainstream scientific view) citing the Lancet as an example of that. For instance

Public Health England report stated that e-cigarettes are estimated to be 95% less harmful than smoking, although the basis for that figure is not universally accepted.

References

SPACKlick (talk) 16:57, 6 February 2016 (UTC)

I find this a reasonable compromise, considering that we seem to be split on this issue. I do think that this opens a can of worms with regards to critiques of secondary sources - but we'll have to cross that bridge when we reach it. [Wouldn't surprise me if there is an editorial in a journal about the new Glantz paper ... and then] --Kim D. Petersen 08:06, 8 February 2016 (UTC)

That is a useful move toward the middle and was the focus of the Lancet's editorial board's statement. The conclusion went farther however: "Tobacco is the largest single cause of preventable deaths in England—e-cigarettes may have a part to play to curb tobacco use. But the reliance by PHE on work that the authors themselves accept is methodologically weak, and which is made all the more perilous by the declared conflicts of interest surrounding its funding, raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency's peer review process. PHE claims that it protects and improves the nation's health and wellbeing. To do so, it needs to rely on the highest quality evidence. On this occasion, it has fallen short of its mission." (source is here, for handiness).

Instead of the content being insert where it was, I think adding something like the following, after a description of the PHE statement is given, something like. "The editorial board of The Lancet responded to the PHE report, criticizing the claim that e-cigarettes are estimated to be 95% less harmful than smoking, which was emphasized in the PHE's press releases, and questioning the conclusions of the report." and provide the quotation above in the reference. This gives the greatest WEIGHT to the PHE report but gives a significant dissent a voice, but with appropriately lesser WEIGHT. Jytdog (talk) 19:35, 6 February 2016 (UTC)

I disagree, Jytdogs suggested edit creates a false balance giving "a significant dissent a voice" to a much lower weighted source. I will have to think on SPACKlick's suggestion a little, but it looks like it might be a possible compromise. AlbinoFerret 20:08, 6 February 2016 (UTC)

• shall we tee up various versions of proposed content, or tee up the underlying question to use for DR? I am fine with either, and have proposed one of each. Let's move forward with some DR process to resolve the impasse. Jytdog (talk) 21:00, 6 February 2016 (UTC)

The source is reliable, a tertiary source. As to weight, WP:PSTS says tertiary sources are themselves "helpful in evaluating due weight, especially when primary or secondary sources contradict each other" which is the case here. Cloudjpk (talk) 18:26, 7 February 2016 (UTC)

Insertion of image dealing with illegal drugs

CFCF inserted an image without discussing it.[5] The top image is an electronic cigarette. The bottom one contains images of illegal substances and devices used to inhale them which are not e-cigs. AlbinoFerret 15:30, 27 January 2016 (UTC)

The source PMID 26308021 makes it entirely clear that these are electronic cigarettes, it is even in the caption of the image. That they can be used for other things has no impact on whether they are ecigs or not. This article overlooked the use of cannabis in electronic cigarettes, something which is covered heavily in the literature. CFCF 💌 📧 15:39, 27 January 2016 (UTC) 

No, an electronic cigarette and a Vaporizer (inhalation device) are very different things, you should move them to that page if you feel they belong on WP. E-cigs are one type of vaporiser, but not all vaporisers are e-cigs. AlbinoFerret 15:44, 27 January 2016 (UTC)

I prefer to follow the statement from the review article that I linked above instead of your personal definition. It clearly states (not only from its title E-Cigarettes: A Review of New Trends in Cannabis Use.) in the first sentence:

The emergence of electronic cigarettes (e-cigs) has given cannabis smokers a new method of inhaling cannabinoids.

CFCF 💌 📧 15:59, 27 January 2016 (UTC)

It is disturbing, that when looking upon the article and only taking in the pictures, then we get a different view of what the article is about, than when reading the article. --Kim D. Petersen 15:55, 27 January 2016 (UTC)

I agree with Albino here. The Giroud paper uses a definition of e-cigarettes that is significantly different from the norm. The majority of those devices are vaporisers and not e-cigarettes. SPACKlick (talk) 16:01, 27 January 2016 (UTC)

I agree, its a very fringe view. AlbinoFerret 16:06, 27 January 2016 (UTC)

No it isn't. It is a view shared by a number of sources, among others:

• PMID 26347431 – High School Students' Use of Electronic Cigarettes to Vaporize Cannabis.
• Healthline – Teens Using E-Cigarette Devices to Smoke Marijuana
• PMID 24680203 – E-cigarette prevalence and correlates of use among adolescents versus adults: a review and comparison.

You can not chose terminology according to your personal preference, this is in established sources, you have yet to provide sources that make the clear distinction, or that say how e-cigs can not be used with cannabis or cannabinoids. CFCF 💌 📧 16:50, 27 January 2016 (UTC)

The healthline link uses the same definition used on this page and that the rest of the world uses, that e-cigarettes vaporize liquid using a heating element. Items which vaporise solids, which have been used for cannabis inhillation long before e-cigarettes were invented are a different thing both in terms of engineering and health effects. The third link (Chapman paper) also uses that definition. It is atypical use to refer to vaporisers as e-cigarettes. SPACKlick (talk) 17:04, 27 January 2016 (UTC)

Portion cropped out

Original image

SPACKlick, they are categorized as ecigs as per the source, which also takes up the difference between traditional vaporizers and e-cigs used for cannabis/cannabinoid e-liquid.
Would you be more comfortable using the image: File:Ijerph ecig variants.jpg which has that section cropped out?

Neither as it still includes non e-cig hardware. AlbinoFerret 18:37, 27 January 2016 (UTC)

That is your interpretation, not that of the source which starts off a rather lengthy caption with:

Some models of e-cigs for vaping [...]

See: Figure 2

CFCF 💌 📧 18:44, 27 January 2016 (UTC)

The image contained ileagal substances before you edited it, and it now contains hardware for those substances.AlbinoFerret

The hardware isn't different because it is used for something else – the article makes that clear. Check the citation which I've already linked multiple times. CFCF 💌 📧 21:49, 27 January 2016 (UTC)

Actually what the image illustrates is that the hardware is different. Of the 6 devices boxed, only #2 and #6 are e-cigs - the others have different atomizers for dry-herb and gel. While they may look similar, they aren't.--Kim D. Petersen 22:04, 27 January 2016 (UTC)

No surprise because the source that the image comes from makes the same distinction. AlbinoFerret 18:25, 3 February 2016 (UTC)

Non consensus edit

CFCF has added more illegal drug usage to the article against consensus above that shows it does not belong in this article.[6] AlbinoFerret 18:33, 27 January 2016 (UTC)

The added content is properly sourced to both drugabuse.gov as well as a secondary sourced review article.

• DrugFacts: Electronic Cigarettes (e-Cigarettes) on drugabuse.gov
• PMID 26308021 E-Cigarettes: A Review of New Trends in Cannabis Use.

The discussion you speak of concerns the use of a specific image. CFCF 💌 📧 18:47, 27 January 2016 (UTC)

It is off topic and against consensus above. AlbinoFerret 18:50, 27 January 2016 (UTC)

What is the prevalence of such usage? How much is this covered in the secondary literature? How do you justify the WP:WEIGHT put on this - with a new section and only two sources, where only one is a WP:MEDRS review? From the last many discussions it rather seems like you are on a path of advocacy against, rather than an NPOV description of, ecigs. --Kim D. Petersen 20:40, 27 January 2016 (UTC)

I have found no data on prevalence, but the topic is available in the literature, a quick PubMed search will find you articles with ["electronic cigarette" AND cannabis] [7].

Outside of the medical literature there are a number of sources concerning the topic:

• More teens are using e-cigarettes for marijuana, police say – crime statistics, MEDRS not applicable in this sense
• YaleNews – E-cigs work well with pot too, teenagers find
• Drugfree.org – E-Cigarettes Being Used to Vaporize Marijuana
• Medscape – High School Students Using e-Cigarettes to Vape Cannabis (we use this source for other claims in the article)
• etc. I don't think I have to labor the point.

Neither would I categorize 2,360 bytes out of 136,969 as undue weight, making up less than 2% of the article. CFCF 💌 📧 21:17, 27 January 2016 (UTC)

So in other words: 1 (one) review - and 7 primary sources listed on PubMed. And a lot of newspaper articles, where sensationalism is in the main seat. Do you really consider that enough to merit a whole section and the WP:WEIGHT here? [had you btw. looked at the review, it noted that prevalence even amongst marihuana users is infrequent. (very small sample size though)] --Kim D. Petersen 21:39, 27 January 2016 (UTC)

Yes, the prevalence is low, but it also takes up less than 2 % of the article. These sources are sufficient, we could potentially expand the section with the police reports. The fact that the National Institute on Drug Abuse (NIDA) singles it out in its report on electronic cigarettes would on its own be enough. I created the new section because it doesn't really fit anywhere else. CFCF 💌 📧 21:45, 27 January 2016 (UTC) 

It is a non notable subtopic at the moment, which might at the most, elicit one or two sentences of mention based upon that one review. Just because it exists doesn't mean it belongs on Wikipedia, see WP:IINFO. Also seems to be more relevant to the safety article. --Kim D. Petersen 21:54, 27 January 2016 (UTC)--Kim D. Petersen 21:54, 27 January 2016 (UTC) [2% of an article where other more relevant stuff is left out, or delegated to subarticles - is actually quite a lot. And you seem to believe that it even needs its own subsection! --Kim D. Petersen 21:58, 27 January 2016 (UTC)]

The main source for this has an impact factor of 2 for 2015, its highest ever. The Giroud C source is also cited by a whopping 3 other sources, one a survey. The other source, Pisinger, doesnt mention cannabis or marijuana. AlbinoFerret 18:45, 3 February 2016 (UTC)

It is completely unreasonable to say that this belongs only under safety, there is no rationale whatsoever for that. There are a number of sources supporting this, two of which are in the article now, including the NIDA-page. Seeing as this is a legal issue beyond beyond the purely medical aspects, we can expand with non-MEDRS sources as well.
The Medscape – Medscape article would also be an acceptable source to expand/support the section. CFCF 💌 📧 19:31, 3 February 2016 (UTC)

The question is how many sources, compared to the number of sources that talk about e-cigs using nicotine? So far you have 3 or 4 vs hundreds. Very WP:UNDUE As for expanding sources, I dont think so when you are talking about a dangerous illegal drug. AlbinoFerret 22:44, 3 February 2016 (UTC)

(edit conflict)CFCF i'm not sure why you would really argue this? Cannabis and e-cigarettes is (at the moment at least) a fringe concept, as acknowledged in the very source (Giroud) that you cite, and that fringe is within the cannabis user milieu, not the e-cigarette one. So why put this much emphasis on it here? WP:DUE weight, as i mentioned above would be to mention it in passing with one or two sentences at the most. But the place where it makes the most sense is in the safety article - because it is related to safety. --Kim D. Petersen 22:58, 3 February 2016 (UTC)

I have so far not found anything that says it is fringe. That it is rare does not make it non-notable, certainly not when so many non-medical sources discuss it. It is common enough that it is taught in medical schools, so that doctors should know about the concerns. Certainly there are aspects of this that belong under safety as well as here, but with limited time I have not been able to expand the content in that article, you may feel free to.

As it is both rare and distinctly different from other uses having a separate subheader is far better than to split the content under the existing headings — were the phenomenon is mention in one section and the health effects in another, this muddles up the other sections and might give the impression that it is more common that it actually is if we repeat it in every section. CFCF 💌 📧 16:49, 4 February 2016 (UTC)

Per WP:FRINGE "We use the term fringe theory in a very broad sense to describe an idea that departs significantly from the prevailing views or mainstream views in its particular field." The overwhelming view of sources is that e-cigs are used to vape nicotine. This source departs from that and suggests that they are used for other substances calling them "e-cigs" when few other sources if any do. A perfect description of a fringe source. AlbinoFerret 18:00, 4 February 2016 (UTC)

You have under no circumstance explained how it amounts to being fringe. Far from it— we have established its presence in the CDCs/NIDA information pages, in the medical literature and abundant sources in the non-medical literature. Being rare or not common is not the same thing as fringe, and though it is evident you want to discredit the sources—that is not sufficient. Show some refutations instead of continually repeating yourself. CFCF 💌 📧 18:57, 7 February 2016 (UTC)

Consensus for change of image

Is this image a good example of an "odd" ecig?

CFCF changed the image of the Construction section here.[8] The image is of an older device from 2013, around the date of the image. Its a unusual design that has to my knowledge never been copied and is no longer available. Few things if any from 2013 are in the fast paced development of the e-cig. This image replaces one (discussed above) that replaced the common cigalike broken into components. Does this image help the reader understand construction of ecigs? Is it an improvement to the article? I would say no and one of the component images should take its place. AlbinoFerret 19:28, 7 February 2016 (UTC)

This image does not replace anything? The age of the device is completely irrelevant as it is its characteristic shape that is what is on display — and the fact that ecigs come in very many different shapes and sizes. And the device is actually still manufactured, so I don't at all see your point. Similar oddly-shaped devices exist today and it is better to show one weird device than to show none because each individual specimen is rare. This is nit-picky bordering on inane. CFCF 💌 📧 19:46, 7 February 2016 (UTC) 

What source shows this device is still being made? What source shows similar devices being made today? AlbinoFerret 20:07, 7 February 2016 (UTC)

It's still on innokin's product website. It's not a bad example of an odd design. Shame we can't point to some of the mods out there like these SPACKlick (talk) 21:07, 7 February 2016 (UTC)

Yes, its on the Inokin website, but its been discontinued. Cant find the article I remember reading long ago but this site tells the tale.[9] It was a faulty design and Inokin pulled them because of button issues. At one point they were even giving people refunds if they returned them. I do agree its a shame we cant use some of those you linked to SPACKlick. But is it an improvement to replace an image of them broken down to show components with an assembled image? If the device was more broken down it wouldnt be an issue. I also wouldnt have a problem showing it in another area. But it doesnt seem to fit what the section is about. AlbinoFerret 21:25, 7 February 2016 (UTC)

I don't know where else it could belong. Neither can I see any reason not to include another image as well. This article is still text-dense when compared to the amount of images. CFCF 💌 📧 22:32, 7 February 2016 (UTC)

The Construction section is small, more than two images is to much, and the Coolfire 2 (the current model is the Coolfire 4) just isnt the best for helping the reader understand Construction, which should be the main focus of the images in that section. AlbinoFerret 18:07, 8 February 2016 (UTC)

What is the rationale for using this image? I agree with the above that it's an obsolete and rather obscure device. Certainly doesn't represent a typical e-cigarette or mod. Is it for shock value? --Kim D. Petersen 07:47, 8 February 2016 (UTC)

ciga-like internals

I recently found this image which shows the internals of cigalikes. Maybe this could be included, it's higher quality than what was in the article a couple of weeks ago. CFCF 💌 📧 23:07, 7 February 2016 (UTC)

That would fit better with Construction. AlbinoFerret 01:00, 8 February 2016 (UTC)

Diacetyl - toxicology section added to main article. Consensus on moving it to Safety

CFCF has added a section to the page dealing with Diacetyl. This is a toxicology section and IMHO belongs on safety instead of adding it here to a summery section. Opinions? AlbinoFerret 01:23, 8 February 2016 (UTC)

I strongly disagree, this information is florating in the popular press and while this does not give indication to the strength of the information it says a whole deal about its relevance to the main article.

• Wired
• Motherboard
• Washington Post
• National Law Review

The source of the commotion is a new research paper (yes primary, so I chose not to include it) from Harvard claiming: Diacetyl was found in "39 of the 51 flavors tested" [10]

This is not only important as health information for anyone considering buying such e-liquids, but due to recent events also important as a source of proper information in a sea of misinformation, where there are claims that all flavorings are poisonous or even than all ecigs may cause bronchiolitis obliterans. CFCF 💌 📧 06:56, 8 February 2016 (UTC)

• Clearly belongs in the Safety of electronic cigarettes article. And if the material is sufficiently important/pertinent to be summarized from that article, then it should be in that summary. With regards to CFCF's commentary above: You seem to think that Wikipedia should be used to debunk or support what is in the current news-cycle. In other words use Wikipedia as journalism, which is a no go. And finally: Newsmedia coverage does not lead WP:WEIGHT to a MED topic... we are all aware of how wrong media gets medical and science issues - right? --Kim D. Petersen 07:25, 8 February 2016 (UTC)

The above sources have no impact on the weight of the content currently in the article, but they impact its relevance and give an idea about how many readers will come here to inquire about it. It is exactly as you say "we are all aware of how wrong media gets medical and science issues" — but, this is a reason why we should present the facts, instead of leaving to popular speculation. Hiding important and relevant content in sub-articles isn't helpful, and we shouldn't pretend that these get any significant readership (the reason I don't spend any of my limited time working on them), but by all means copy the content there as well. CFCF 💌 📧 21:31, 8 February 2016 (UTC) 

• Doesn't belong anywhere in WP yet, until it is discussed in a secondary source. Jytdog (talk) 07:55, 8 February 2016 (UTC) (striking, I apologize for not having read the actual introduced content Jytdog (talk) 01:10, 9 February 2016 (UTC))

Jytdog It is discussed in secondary sources, the added text is only from secondary sources. This was only justification for it being included in the main article, not in the safety article. CFCF 💌 📧 09:26, 8 February 2016 (UTC)

One of the sources in the article isnt on e-cigs. Its about Diacetyl and popcorn flavourings. AlbinoFerret 11:54, 8 February 2016 (UTC)

Yes, and that source is used to add context that this was how the discovery was made that aerosolized exposure may lead to lung disease. It is absolutely relevant to the section and does not add anything that could amount to synthesis of sources. CFCF 💌 📧 21:31, 8 February 2016 (UTC)

Thats mixing apples and oranges. There is no source that links the type of exposure in a industrial popcorn factory to the exposure in e-cigs. AlbinoFerret 00:15, 9 February 2016 (UTC)

Actually, the first source in the section, the one you cited ([11]) does. — page 4
Actually the very sentence above the one you cited

Some ENDS solutions contain harmful flavoring molecules, diacetyl and acetyl propionyl, used to add a buttery taste to the vapor and are known to cause bronchiolitis obliterans. These chemicals have been demonstrated to be present in higher concentrations in ENDS than is recommended by the National Institute of Occupational Safety and Health [33].

CFCF 💌 📧 00:35, 9 February 2016 (UTC)

Content in question

Flavorings

Diacetyl is commonly found at lower levels in e-cigarettes than in traditional cigarettes. Certain flavorings may contain harmful substances such as diacetyl and acetyl-propionyl which give a buttery taste. Diacetyl has previously been connected to bronchiolitis obliterans when breathed in as an aerosol by popcorn manufacturers, known then as Popcorn lung. A 2015 review urged for specific regulation of diacetyl and acetyl-propionyl in e-liquid, which are safe when ingested but harmful when inhaled. Both diacetyl and acetyl-propionyl have been found in concentrations beyond those recommended by the US National Institute for Occupational Safety and Health.

A 2015 class-action lawsuit is pending in Orange County over claims connecting the specific e-liquid flavorings containing diacetyl and acetyl propionyl and incidences of the lung disease bronchiolitis obliterans.

References

To clarify this is the added text, it is not related to the above popular press and primary sources. As you can see — this is all sourced to secondary sources, all of which are MEDRS-compliant or unrelated to medicine. CFCF 💌 📧 21:36, 8 February 2016 (UTC)

The first paragraph of that content is fine WP content. My apologies again for my earlier sloppy reaction. With regard to the second paragraph, I have a strong preference to not discuss ongoing litigation until it is resolved, unless the litigation itself causes big changes (in this case, if companies stopped using it because of the litigation, per reliable sources. I'll address the WEIGHT question - whether this belongs here - in a moment, when I read some more. Jytdog (talk) 01:13, 9 February 2016 (UTC)

In a main article like this, which has spawned sub-articles, I am a firm believer that content should be added first to the relevant spun-off articles, evaluated as to whether it is important enough to make the lead of that article, and if it does, modify the lead of that article, and only then added to the main article. That is all per WP:SUMMARY and WP:SPLIT. I have removed the content from this article and have added it to the body of the safety article and blended it in this series of diffs. I did remove the litigation information. I think we will need more information on how prevalent diacetyl is in e-cig liquids in order to decide if it rises to the importance of making the lead of that article; there is not enough information in hand to decide that right now. Jytdog (talk) 01:40, 9 February 2016 (UTC)

I agree with all that. Johnbod (talk) 09:49, 9 February 2016 (UTC)

A note

I made a few changes to the article (mostly Lead section) today. Most of it was stylistic, merging sentences, rephrasing, moving stuff around, but I hope people will review them for any unintentional errors I might have made. ~Awilley (talk) 21:27, 4 February 2016 (UTC)

Thank you, most of the changes look good. Is there a reason the phrase "but reduced voltage e-cigarettes produce very low levels of formaldehyde" was removed? P Walford (talk) 16:19, 5 February 2016 (UTC)

Thanks for your feedback. On the voltage phrase, I was trying to make it more accessible to normal readers and take out redundancy. So instead of talking about high and low "voltage", which might alienate some readers ("what's a voltage and how do I reduce it?") I put it in terms of high and low "power". The sentence "Using later-generation e-cigarettes on high power can generate more formaldehyde than tobacco does" implies that using them at low power doesn't. It's not necessary IMO to follow that up with "but using e-cigarettes on normal power doesn't generate very much formaldehyde." You can add it back if you want. ~Awilley (talk) 18:25, 5 February 2016 (UTC)

Voltage is more specific than power since higher power may also be caused by an increase in current. Sizeofint (talk) 02:42, 13 February 2016 (UTC)

The increase in voltage is accompanied by an increase in current. The Resistance is fixed, the device can increase the voltage (sometimes displayed as wattage increase but it's the same step up voltage process). It's a power increase and the mechanism usually used is voltage change. That said as here is an interdevice comparison you can have power changes for other reasons and strictly wattage is more closely related to the formaldehyde issue, most directly it's coil temperature. SPACKlick (talk) 02:49, 13 February 2016 (UTC)

@Doc James: Regarding this I did a quick search of the archives and found a lot of RfCs, but I couldn't find the one you're talking about. I don't doubt your word, but would you mind pointing me to this particular one?

On whether Health is more notable than History, I would say that the latter is more important for an encyclopedia, but I can understand why you, in particular, would disagree with that. In any case, I don't think "notable" is a good criteria for determining order. That should be done logically, preferably chronologically, with the reader in mind. To me it makes sense to start with the general introduction, then talk about the history, and then talk about safety, health, cultural impact, etc. I realize all articles will do it differently, but I looked up the most closely related article I could think of (cigarette) and it fits that pattern fairly well.

Last point: If you think that Healthy/Safety is indeed the most important thing, you should be trying to end the Lead section with the paragraph on health/safety, since that's the last thing most visitors will read. See our article on serial position effect for why that might be a good thing. ~Awilley (talk) 04:47, 6 February 2016 (UTC)

It is normal in health-related articles to put History much lower than on many other types, and I think this is absolutely correct. Few readers of pancreatic cancer will be very interested in the history, I suspect. Putting history generally first is a WP tradition, but one I think we overuse, especially when the section is long. Cigarette should probably change too - at present the "Health effects" section begins at (on my m/c) the 16th screen down, which is downright bizarre, but at least that story is no secret. Certainly we should not use that as a model here - I think a very different crowd edits there. I think the RFC the Doc refers to was a general one at the MED project,not specific to this article. Johnbod (talk) 05:53, 6 February 2016 (UTC)

@Awilley There have been a few RFC's on page order. Archive 16, Never closed and archive 17 no consensus and archive 22 no consensus, I may have missed the one DJ is referring to. The topic keeps coming up every so often. I wonder if a list somewhere near the top of all the RFC's this page has had would be helpful to avoid this kind of thing in the future. AlbinoFerret 06:29, 6 February 2016 (UTC)

Thanks Albino for providing the links. The order has been controversial. Doc James (talk · contribs · email) 15:13, 6 February 2016 (UTC)

Good heavens, let's not start that up again. There are more significant improvements that can be made without starting another RfC to change something as mundane as the section order. ~Awilley (talk) 17:03, 6 February 2016 (UTC)

effect on immune system genes

I just came across this--leaving it here for other people to possibly decide to use.

• http://arstechnica.com/science/2016/02/e-cigs-shut-down-hundreds-of-immune-system-genes-regular-cigs-dont/

173.228.123.101 (talk) 19:20, 13 February 2016 (UTC)

Yu et. al.

I have seen several stories in the national press in the UK covering Yu et. al.: [12]. Since this is from November 2015 I presume it has already been discussed, which archive should I look in please? Guy (Help!) 11:18, 15 February 2016 (UTC)

For clarity the article is doi:10.1016/j.oraloncology.2015.10.018 (the link did not work for me)—but no, it has not been discussed. We stick almost entirely to secondary sources for these articles, and while that source is without question very interesting, it is so in the same way that Ars Technica – E-cigs shut down hundreds of immune system genes—regular cigs don’t is interesting—the evidence is only preliminary and it is better if Wikipedians are removed from trying to interpret it. CFCF 💌 📧 12:22, 15 February 2016 (UTC)

Agreed. We stick to secondary sources entirely. --Kim D. Petersen 15:02, 15 February 2016 (UTC)

Also agree, we do not lack for secondary sources in this article. Its best that we stick to secondary sources. AlbinoFerret 20:06, 15 February 2016 (UTC)

Glanze Redux

Just listened to an interesting 5 mins or so feature on Glanze's recent paper (see above) on today's More or Less (radio programme), a BBC radio programme covering statistics etc. Some of you should be able to pick it up online from the website linked at the article, starts about 5 mins in. Linda Bauld, Ann McNeill, Peter Hajek (co-author of the Cochrane Review - "grossly misleading" he says), Robert West ("mashed together very different studies") - all saying the paper should not have been published, as did an un-named person who peer-reviewed it for the Lancet sub-journal. Glanze & the editor unrepentent. Johnbod (talk) 16:52, 5 February 2016 (UTC)

That's what you get when you mix activism with science. I'm sure it will be straightened out in coming reviews.--TMCk (talk) 18:11, 5 February 2016 (UTC)

Well from a WP stance, as i mentioned earlier[13] its simple: The Glantz paper is a secondary WP:MEDRS review, thus reliable and can be used. The More or Less program is interesting - but cannot really be used. If the paper is flawed then we as WP editors must wait until it gets resolved in the peer-reviewed press. --Kim D. Petersen 09:39, 6 February 2016 (UTC)

Well, the American Legacy Foundation (currently Truth Initiative), which is the largest anti-smoking organisation in the USA, has publicized a systematic review ("The findings were compiled from an in-progress comprehensive systematic review of all published scientific literature on e-cigarettes conducted via a PubMed search through February 19, 2015") which criticizes a pre-published version of Glantz's meta-analysis. Can their findings be reflected in WP?GreyZig 14:37, 16 February 2016 (UTC) — Preceding unsigned comment added by Zvi Zig (talk • contribs)

Cochrane evidence on cessation should be labeled "moderate"

The article referred to Cochrane, saying "There is tentative evidence that they can help people quit smoking."

However, the evidence that they can help can people quit is moderate according to the cited Cochrane review. In the table titled "Summary of Findings for the Main Comparison", footnotes 3 and 4 clarify that the GRADE rating was downgraded from 'moderate' (relevant to statistical quality) to 'low' for the randomization against placebo, due to the fact that the e-cigarettes in one trial delivered nicotine poorly, meaning the effect size likely underestimates efficacy.

As a binary outcome measure, the evidence that e-cigarettes can help smokers quit is moderate according to Cochrane.— Preceding unsigned comment added by Zvi Zig (talk • contribs) 09:42, 3 March 2016 (UTC)

Source says the confidence level is "low" for a number of reasons. Seems tentative to me. Yobol (talk) 13:18, 3 March 2016 (UTC)

Yobol, you apparently did not read what I wrote above. The GRADE rating had been downgraded from 'moderate' to 'low' because the device in one trial delivered nicotine poorly compared to devices currently on the market, meaning the effect size may be underestimated.Zvi Zig (talk)

Right, the authors say that their confidence is "low" in the effect, which is a another way of saying "tentative". I have no idea where, from the source, you are getting the word "moderate". Yobol (talk) 14:09, 3 March 2016 (UTC)

The word "moderate" is in the table "Summary of Findings for the Main Comparison". It describes the systematic approach to grading evidence.

Footnotes 3 and 4 in the table relate to the randomization of EC against placebo, they read:

• Downgraded one level due to indirectness. The electronic cigarette used in Bullen 2013 was not very effective at delivering nicotine
• Downgraded one level due to imprecision. Only two included studies, small number of events (<300) in each arm Zvi Zig (talk • contribs)

That table describes all of the studies as being of "low" or "very low" quality. I do not see any evidence in the source to support the change you propose to "moderate". Yobol (talk) 15:48, 3 March 2016 (UTC)

Zvi Zig it seems that the argument you are making, is a) from the footnote, it seems that the efficacy was underestimated because the device delivered nicotine poorly b) so the evidence is stronger than it appears; c) so we should say it "moderate" not "low" - is that an accurate description of your argument? Jytdog (talk) 16:22, 3 March 2016 (UTC)

Thanks, Jytdog. Let me clarify. The footnotes quoted above are Cochrane's explanations for the assigned GRADE rating.

On statistical quality, the results are 'moderate'. However, because of poor nicotine delivery, the results (RR 2.29) may have been underestimated and thus the GRADE rating had been downgraded to 'low'.

So, if the question is what's our confidence in the RR, then the correct answer is 'low'. However, if the question is what's our confidence that e-cigarettes can help cessation, then the correct answer is 'moderate'. Zvi Zig (talk • contribs)

Except nowhere in the actual source does it say that the evidence for smoking cessation is "moderate", so we can't say that it is. Yobol (talk) 21:46, 3 March 2016 (UTC)

The systematic rating system is fairly explicit. At the very least, there's no justification for describing the evidence that e-cigarettes help cessation as tentative. Zvi Zig (talk • contribs)

The source explicitly states that their confidence is low as to the effect, and the source does not explicitly state anywhere that the evidence is "moderate". Time to drop the WP:STICK, your version is not supported by the source. Yobol (talk) 22:46, 3 March 2016 (UTC)

To reiterate:

1. The source is explicit that rating was downgraded from 'moderate' due to poor nicotine delivery (in Table titled, "Summary of Findings for the Main Comparison").
2. Regardless of whether the word 'moderate' is considered explicit, or not, the 'low' rating reflects the finding that the effect size may have been underestimated.
3. Being that the the 'low' rating actually reflects the possible underestimation of the effect size, it is inappropriate to use it to support describing the evidence for efficacy as "tentative". Zvi Zig (talk • contribs)

Those points just prove it further – tentative is pretty much the only accurate summation. CFCF 💌 📧 23:21, 3 March 2016 (UTC)

CFCF, you are apparently not differentiating between the effect size, to which the risk of underestimation relates, and the question of whether e-cigarettes are effective. Zvi Zig (talk • contribs)

Thanks for confirming above. I see what you mean, but this is going beyond summarizing what the source says and analyzing it, and coming up with your own new finding. This goes beyond summarizing the source, and is the kind of thing that WP:OR disallows. I would say the same thing if you were downgrading the conclusion. Jytdog (talk) 18:50, 4 March 2016 (UTC)

Thanks, Jytdog. Let me clarify please...

Cochrane's 'low' score is the basis of Wikipedia's assertion, "There is tentative evidence that they can help people quit smoking". However, the 'low' grade was assigned to the effect estimate, not to the (binary) positive outcome. Cochrane specifically states, "These GRADE ratings reflect low levels of confidence in the effect estimates".

I think that the other editors here want to extend the 'low' confidence grade from the effect estimate to the binary positive outcome. This is absurd; the 'low' score stems from the suspicion that the effect estimate is underestimated. Zvi Zig (talk • contribs)

C&EN Cover Story

The C&EN Cover Story Boom In E-Cigarettes Sparks Calls For Regulation might useful for updating the article. --Leyo 11:15, 7 March 2016 (UTC)

Why all the refs in the lead?

The lead section of a Wikipedia article is supposed to summarize the article's contents, so inline citations (which make it look like the material was added to the lead first) should be kept to a minimum. And yet somehow this article's lead has over forty!? Also, the lead is enormous... just saying...

Hijiri 88 (聖やや) 09:58, 22 February 2016 (UTC)

Most leads on medical articles are referenced, and should be. Most leads are also much too short, and this is a long article on a complex topic. The lead now has 5 paras, one more than WP:LEAD suggests, but personally I think that's ok. Johnbod (talk) 12:45, 22 February 2016 (UTC)

Can you cite tge PAG that says "Most leads on medical articles should be referenced"? This seems counter-intuitive to me. The body should be thoroughly referenced, but the lead should comprise a summary of the body. It should be based on the content of the article itself, not on external reliable sources. Hijiri 88 (聖やや) 13:58, 22 February 2016 (UTC)

Can you provide a PAG that says that the lede should not be referenced? AlbinoFerret 14:08, 22 February 2016 (UTC)

WP:LEDE states that ”[t]he lead serves as ... a summary of [the article's] most important contents”. It does say that the lead's contents should be verifiable (a given), but this in my experience more usually interpreted as meaning that the lead should summarize the sourced contents of the article body. The only things it says need citations are contentious statements. The enormous number of citations in this article's lead (some of them not cited anywhere else in the article!) implies it was composed independently of the rest of the article, which would be a clear violation of the project norm. Hijiri 88 (聖やや) 22:59, 22 February 2016 (UTC)

I take that as a no, you do not have a PAG that says the lede should not be referenced. AlbinoFerret 23:16, 22 February 2016 (UTC)

The relevant section is WP:LEADCITE, which doesn't prohibit going overboard with cites (that's left to editorial judgement). Common practice is to avoid citation clutter in the lead as, per MOS:INTRO, it is "a concise version of the article" meant to "briefly summarize the most important points covered in an article" (where the cites are mandatory and thus redundant in the lead). Cites in the lead interfere with its readability, particularly when they are numerous. This lead is a particularly ugly example, but I won't comment on whether it's justified. Curly Turkey 🍁 ¡gobble! 23:46, 22 February 2016 (UTC)

@AlbinoFerret: So let's get this straight: I post an OP comment accurately summarizing the PAG that says that leads should summarize body contents, and another user shows up and makes a bizarre claim that articles on medical topics usually have more sources in the lead than other articles. This "PAG" does not appear anywhere on-wiki. When I ask the user to quote the PAG, you show up and dodge the question, insisting that I quote the PAG that I already quoted. I do this, and then you promptly ignore the PAG that I quoted at you. But still no Wikipedia PAG has been provided that says "Most leads on medical articles should be referenced". MOS:MED actually says the opposite: Adding sources to the lead is a reasonable practice but not required as long as the text in question is supported in the body of the article. So why are there some sources cited in the lead that aren't cited in the body? Does the material they support in the lead not appear in the body? If so, that is an explicit violation of the core principle of WP:LEDE that The lead should ... summarize the body of the article with appropriate weight.. Hijiri 88 (聖やや) 04:49, 23 February 2016 (UTC)

To say, as I did, "Most leads on medical articles are referenced" will only seem a "bizarre claim" to someone who has never looked at any of our developed medical articles. Johnbod (talk) 13:55, 23 February 2016 (UTC)

There are statements in the lead that aren't cited in the body? That's a straight-up violation. Are you sure they weren't in today's addition (the one that added a fifth paragraph) that has since been reverted? Curly Turkey 🍁 ¡gobble! 05:06, 23 February 2016 (UTC)

I can respond to Hijiri88 by stating that no PAG supports this either way, and LEADCITE allows for a fully cited lede. That medical articles normally have fully cited ledes doesn't mean any PAG requires them to have citations, but that the community of editors has come to realize that it is very helpful—it may at some point be added to a PAG, but for now that hasn't been done as it is not required. WP:MEDRS gives an indication as to why medical statements are sensitive, not only because of their impact on lives, but also because of the controversy surrounding any single statement.

Now, this may be going to in depth for this discussion, but most of our readers (especially on medical articles) do not read past the lede, and having sources present there is very useful for that group. (I will not provide data for this here, but it exists). Also worthy of notice is how certain editors and even IPs will tag any statement without a directly visible source in medical articles with a {{cn}}-tag, regardless if it is in the lede or in the body.

So, lets move this discussion from the unproductive to the productive. We identified that the prior 5-paragraph lede had 6 citations for a single statement – which is CITATIONOVERKILL – and normally a sign of dubious statements. I can not see any similar issues with the current content — does anyone else? CFCF 💌 📧 07:28, 23 February 2016 (UTC)

There are statements in the lead that are cited to sources that are only cited once, in the lead. Admittedly, on a brief inspection the one I found was attached to a sentence that also cited two other sources, which means either that it is redundant or that the sentence includes information taken from all three sources, and some of that information does not appear in the body of the article. I don't have a serious problem with a fully-cited lead (though I think it is ugly and gives the wrong impression, and would never do it myself -- this attitude is not required by PAG, but it is encouraged), but unique citations in the lead are definitely a problem, as they are either redundant and give the wrong impression, or they are being used to include information in the lead that does not appear in the article proper. A slightly more thorough examination revealed that there are at present three such sources (currently numbered 15, 29 and 37); of these, only the last is not accompanied by other citations, and appears to be used to support the statement that "In the United States e-cigarettes are used by a significant percentage of ... adults". ("e-cigarettes are used by a significant percentage of youth" is attributed to another source that is used in the following section for "up to 13% of American high school students had used them at least once in the last month", but this difference in wording is not really a problem.) I don't have time to read the entire article at the moment, much less the tens of thousands of words of talk page archives, but has this sentence in the lead been discussed? Does it accurately and duly summarize some point that is made in the article? Summarizing "3.4% of American adults" as "significant" seems dubious... Hijiri 88 (聖やや) 08:12, 23 February 2016 (UTC)

The more controversial an article subject is, the more citations you will see in the lede. That follows per WP:V. If someone could question the statement, then it must be cited. --Kim D. Petersen 21:47, 22 February 2016 (UTC)

The more controversial an article subject is, the more citations you will see in the lede—not true. Richard Nixon (a Featured Article) is the subject of considerable controversy, yet there isn't a cite in his entire lengthy lead (even, surprisingly, for the statement "he is historically ranked as among the worst U.S. presidents"). Citations are allowed in the lead for particularly contentious individual statements, but never are they required in the lead, as any statement in the lead must be in the body, where it must be cited. Curly Turkey 🍁 ¡gobble! 23:50, 22 February 2016 (UTC)

• I tend to agree with the OP that the Lead does have a case of WP:Citation overkill. The 1st sentence of paragraph 2 has 6 citations! As a side note, I'm not sure when it grew a 5th paragraph. It only had 4 the last time I checked. ~Awilley (talk) 01:32, 23 February 2016 (UTC)

This poorly constructed and undiscussed edit inserted the 5th paragraph just a few hours ago: https://en.wikipedia.org/w/index.php?title=Electronic_cigarette&diff=706352255&oldid=706329637 CFCF 💌 📧 01:45, 23 February 2016 (UTC)

(edit conflict)Pinging User:Zvi Zig who seems to have added the 5th paragraph just today [14] ~Awilley (talk) 01:46, 23 February 2016 (UTC)

Have restored it to 4 paragraphs. Refs in the lead are fine. Doc James (talk · contribs · email) 02:31, 23 February 2016 (UTC)

Sorry I've not known the 4 paragraph lede rule...

Unfortunately, my edits have been reverted by talk. The concerns that I tried addressing in my reverted edit were...

1. The opening lede statement on health asserting all-embracing uncertainty is redundant vague. The direct statements on health risks and cessation, convey their respective degrees of certainty.

2. As a review by Cancer Research UK states, that "there is a consensus that e-cigarettes are almost certainly much safer than tobacco smoking". A wide range of sources concur on this point, as I have referenced in my edit which talk reverted. The phrase, "e-cigarettes are probably safer", doesn't reflect this point.

3. 95% less harmful estimate by Public Health England and others should be reflected in the lede -- "safer" is not quantified. The Pisinger review conclusion that "no firm conclusions can be reached..." should also be reflected, for balance. ZviZig/GreyZig 12:03, 23 February 2016 (UTC)

You are missing the numerous less than positive reports, it has taken time to find the balance that now exists between positive and negative sources. CFCF 💌 📧 13:41, 23 February 2016 (UTC)

• I've started Wikipedia_talk:WikiProject_Medicine#.22Adding_sources_to_the_lead_is_a_reasonable_practice_but_not_required_as_long_as_the_text_in_question_is_supported_in_the_body_of_the_article.22 - if we don't have a "PAG" (?!) explicitly stating what we normally do in medical articles, then we should. Johnbod (talk) 14:57, 23 February 2016 (UTC)

The original premise in this discussion is flawed. Our manual of style gives this guidance on the lead: "The lead serves as an introduction to the article and a summary of its most important contents." and "It should identify the topic, establish context, explain why the topic is notable, and summarize the most important points, including any prominent controversies." (my emphases), which is not the same as assuming that it must be solely a summary of the rest of the article and nothing else. Not every topic can be properly introduced through sources that already exist in the rest of the article, and that may be especially true of articles dealing with controversial topics. It is perfectly reasonable for a source that gives a broad introduction to a topic to be a good choice for referencing part of the lead, and yet not be sufficiently detailed to act as a good choice as a citation within a complex discussion later in the article, where more specialised sources are more appropriate. These sort of judgements belong to discussion in individual articles and it is necessary to seek a consensus in these cases. Apart from direct quotations, there's no rule that dictates whether citations appear in the lead or not; nor is there a rule that proscribes the use of a citation in the lead that does not appear elsewhere. --RexxS (talk) 18:53, 23 February 2016 (UTC)

You're not seriously suggesting the lead can be loaded up with information not in the body, are you? Curly Turkey 🍁 ¡gobble! 23:12, 23 February 2016 (UTC)

Are you seriously suggesting that the lead must only contain information in the body? I've linked the PAG pages that show how you have failed to understand that the lead performs more functions than just summary of the body. You are simply wrong when making false claims like "any statement in the lead must be in the body" - which is patent nonsense. The balance between the functions of introduction, establishing notability, providing context, and summarising the body is a matter for consensus between editors at the article, not by dictat from a non-existent policy. --RexxS (talk) 23:47, 24 February 2016 (UTC)

I'm seriously suggesting that serious justification is required for anything in the lead not appearing in the body. How do you justify keeping such information out of the body if it's important enough to be in the lead? How does that not violate WP:WEIGHT, for one instance? Curly Turkey 🍁 ¡gobble! 02:06, 25 February 2016 (UTC)

• Hijiri88 - please read WP:CITELEAD. It says that if anything in the lead is challenged, editors should provide in-line citations. You may not be aware that almost every line of this article has been fought over; there is nothing that hasn't been challenged. Because of that, I hope you can see that it is completely appropriate to have citations in the lead. In my view, the lead is probably about the right length as this is a long article. It could possibly be condensed more but doing so will probably be very costly in terms of volunteer time to negotiate that. There is nothing alarming in the lead that I can see, and nothing to really argue about. This has nothing to do with MEDMOS - that is a red herring. It is plain old WP:LEAD at work here. Jytdog (talk) 19:52, 23 February 2016 (UTC)

I am indeed aware of the controversy surrounding the article. I even discussed it with Curly Turkey some time ago, and the latter user pointed out how much more controversial this article apparently is on Wikipedia than, say, the State of Palestine. It frankly baffles me. But this article's lead currently appears to contain information not found in the body, or at best a dubious summary of what's in the body (3.4% became ”a significant percentage”, which is WP:WEASEL at best). This can happen as a good faith mistake when the lead is independently of the body, rather than based directly on the body. Any time the lead cites sources not cited in the body it should be a cause for concern. Hijiri 88 (聖やや) 06:05, 24 February 2016 (UTC)

I agree that nothing should be in the lead that is not the body. Why not try to just fix it (as conservatively as you can!!) and see how that goes? I would suggest that you understand what is driving the dispute before you get involved so that you don't walk into propeller blades. I'll drop a note on your talk page. Jytdog (talk) 08:35, 24 February 2016 (UTC)

Break

There is general agreement that Lead sections can have citations (nobody has argued otherwise) and that this particular Lead section should have citations. The problem that seems to be getting ignored in some of the arguments above is that this Lead section has too many citations. For instance, we have the following completely uncontroversial sentence with 4 (!) citations.

The e-liquids used in e-cigarettes usually contains a mix of propylene glycol, glycerin, nicotine, and flavorings.^{[17][19][23][24]}

There is also this beast with 7 citations:

The vapor can contain small amounts of toxins, including traces of heavy metals detected at levels permissible in inhalation medicines,^[16][27][6] and some potentially harmful chemicals not found in tobacco smoke^[28] at levels permissible by workplace safety standards.^[27][29][30]

I think the best way forward would be for somebody to judiciously prune some of these citations so we have no more than about 1-2 per sentence, and certainly no more than 1 per clause. If we find long sentences like my second example that can't be sourced to 1-2 sources it might be a good reason to break them up or look for possible WP:SYNTH. I could do this, but I don't know the literature as well as most of you regulars here so it would take me 5x as long. Volunteers? ~Awilley (talk) 19:46, 24 February 2016 (UTC)

That may be possible, but some sentences have been combined and the citations moved to the end. In that case it may be necessary to keep them. But the main components of ejuice is probably non controversial. AlbinoFerret 20:52, 24 February 2016 (UTC)

You don't need to remove cites; you can bundle them. That still leaves the issue of material in the lead that's not in the body, though. Curly Turkey 🍁 ¡gobble! 21:19, 24 February 2016 (UTC)

I now removed some extra references relevant to the sentence I edited on heavy metals. I also left only most authoritative sources in the sentence on e-juice (Cochrane and AACR reviews).GreyZig 21:46, 24 February 2016 (UTC)

Bundling is a good idea, but I'm not sure if it's compatible with the current reference system of naming the references and re-using them in the article. Reference 6 (Grana 2014) is currently being cited in 26 different sentences throughout the article. Bundling all the instances of multiple citations could lead to a lot of redundancy. Another option might be to convert the references using {{Harvard citation}} with short citations that link to the full citations in a References section, but that's a lot of work. ~Awilley (talk) 22:33, 24 February 2016 (UTC)

Well, if someone wants to do it, it would save a lot of headaches in the long run and make the article more pleasant to read. Still, that leaves the issue of material in the lead that's not in the body. Curly Turkey 🍁 ¡gobble! 22:59, 24 February 2016 (UTC)

I think that bundling is the way to go, but we need to check the citations for redundancy, there are quite a few that are essentially saying the same, do not directly support the statement, or just point to an article/publication that "talks about the subject".

Once example of redundancy

Non-smokers who use e-cigarettes risk becoming addicted to nicotine,[21] a chemical with a range of harmful effects.[22]

Both of the citations tend to support the first part of the sentence; but none of them (specially 22) support/talk the second part (harmfull effects of nicotine). While there is a full article devoted to the second part which in my opinion is better to link. Marianol (talk) 16:54, 10 March 2016 (UTC)

Repeating that there is material in the lede that doesn't exist in the body is all good—but you haven't actually presented anything that argues for this. Like RexxS says — we don't necessarily need the same sources, but for the lede to be a summary of the article's major points. The only substantive argument in this entire mass of verbiage is that 3.4% of the adult American population isn't significant — but since that includes nearly 10 million people it damn well is significant. Now I'm going to paraphrase Jytdog (though somewhat less elegantly) and ask you and Hijiri 88 to either come with constructive suggestions or stop wasting everyone's time on petty semantics and nit-picky interpretation of policy. CFCF 💌 📧 23:05, 24 February 2016 (UTC)

I'm not going to make assumptions and insult your level of education and/or choice of major like you did to me below, but "the American population "and "American adults" are radically different numbers. If what you are saying is that when the article body says "adults (as opposed to youths)" it should say "population" and the relevant line in the body is already misquoting the source, then the problem is even worse than I thought, and adults aren't mentioned anywhere in the body so whether 3.4% is significant would be a moot point. Hijiri 88 (聖やや) 04:43, 25 February 2016 (UTC)

Sorry. The above was a response to my misreading of CFCF's comment. I tend to say "American adult population" rather than "adult American population", and because I was reading the code as a diff rather than the actual text, with screen size and everything. Basically I messed up. It still doesn't justify him calling me "the troll", insulting my intelligence and level of education, and generally taking a dismissive and hypocritical attitude toward my presence on this page -- over an hour earlier than I made the above mistake. But an error is an error, and I apologize for making this one. Hijiri 88 (聖やや) 08:02, 26 February 2016 (UTC)

It looks like the 3.4% number comes from 2011. Later in the body we have the statement that "In the US, as of 2014, 12.6% of adults have used an e-cigarette at least once and about 3.7% are still using them." The source that is being used to say "significant percentage" in the Lead is a 2015 Reuters poll that says "About 10 percent of U.S. adults now vape, according to the online Reuters/Ipsos poll of 5,679 Americans conducted between May 19 and June 4. That's almost four times higher than a U.S. government estimate that 2.6 percent of adults used e-cigarettes in 2013." I think it would be best if we treated the Reuters article like a "primary" source and used numbers from secondary sources analyzing lots of polls. ~Awilley (talk) 16:35, 25 February 2016 (UTC)

Primary and secondary sources are not the concern. We should not be giving information in the lead that contradicts that in the body, even if both are reliably sourced. If the 3.4% figure in the body is out of date, the body should be updated first and then the lead should be edited to summarize what is in the body. The lead should never have been sourced independently of the body. Hijiri 88 (聖やや) 23:00, 25 February 2016 (UTC)

but you haven't actually presented anything that argues for this—you're right, but my point was that the issue was raised but hadn't been addressed. If there isn't material in the lead that isn't in the body, then somebody should say so.

but since that includes nearly 10 million people it damn well is significant—you have an empirical measure of "significant"? Curly Turkey 🍁 ¡gobble! 23:24, 24 February 2016 (UTC)

On that note, I'm still trying to find the place in the body that says "a significant percentage of American adults"... Hijiri 88 (聖やや) 01:37, 25 February 2016 (UTC)

So you're arguing that we should consider random musings of unengaged individuals? If you aren't going to take an effort to understand the underlying issues I am going to ignore you from now on, and I suggest others do so as well—per WP:Don't feed the troll(s). As for having "an empirical measure" of significant I suggest you brush up on what linguistics is, and why words are by definition intangible. CFCF 💌 📧 03:17, 25 February 2016 (UTC)

You've put on display more levels of ignorance with this statement than I have the energy to deal with. Curly Turkey 🍁 ¡gobble! 03:58, 25 February 2016 (UTC)

I find it incredibly ironic that at least two users have advised me that by posting on this page I am stepping into a minefield, but several users are also apparently criticizing me for not directly implementing my proposals without getting talk page consensus first. Actually Jytdog's was not so much a criticism as a friendly suggestion that I make a move that might get me in trouble in the short run. The last week has taught me to be slow to listen to the well-intentioned advice of friends -- I almost got blocked for it. I'd much rather follow my gut and discuss on the talk page first.

How is my pointing out that the lead of this article contains information not given in the article body, sourced to references not cited in the article body, and that this is a violation of Wikipedia standards, a "random musing of an unengaged individual"?

Hijiri 88 (聖やや) 04:25, 25 February 2016 (UTC)

1) Making one or two conservative fixes and then asking on talk, how was that, or 2) offering concrete proposals on talk for discussion, are much more productive ways to move things forward. i hope you didn't think i was advising you to go hog wild. :) Jytdog (talk) 04:29, 25 February 2016 (UTC)

Well, we can see what a minefield this is—Hijiri hasn't actually made any edits to the article, nor has he volunteered to, but he's already been templated and called a troll. Curly Turkey 🍁 ¡gobble! 04:35, 25 February 2016 (UTC)

(edit conflict) That's explained in detail at WP:OWN. Curly Turkey 🍁 ¡gobble! 04:30, 25 February 2016 (UTC)

ay caramba. providing a new editor to the discussion with formal notice of DS is not "templating", it is good process, and required for the DS to function. Curly Turkey. (which reminds me that I should make sure you have been notified) And I meant what I said - if you review these talk pages they are full of long, long, general conversations. On controversial topics it is way more productive to talk simply and clearly about concrete content. Make a conservative change and ask for reactions, or propose conservative changes. That's all. Now really, what do you want to change in the content, Curly Turkey? Concretely, please. Jytdog (talk) 23:13, 25 February 2016 (UTC)

Jytdog: the comment wasn't in response to the templating, but to the "random musings of unengaged individuals" horseshit—the "you're not an expert so fuck off" horseshit. If you look closely at the indenting of my comment, you'll see I wasn't intending to respond to you. Curly Turkey 🍁 ¡gobble! 00:31, 26 February 2016 (UTC)

Oh I see; sorry i missed that. elbows do get thrown on this article, more than anyone would like. i'm sorry about that. Jytdog (talk) 00:32, 26 February 2016 (UTC)

Lead

Doc James -- I think you're making a mild error of judgment on this article. You keep removing paragraph breaks in the lead, and I don't think that's well advised. It's true that WP:LEAD says there should be four paragraphs in the lead. This is not the same as four blocks of text, and what you're actually making is blocks of text that consist of several different paragraphs all jammed together.

A paragraph is a thematically related series of ideas which develop a particular subject. A block of text is the area between two line breaks. Do you see the difference?—S Marshall T/C 12:42, 10 March 2016 (UTC)

Social and cultural aspects are one theme. Health and safety is another theme. The paragraphs are broad themes. Doc James (talk · contribs · email) 17:39, 10 March 2016 (UTC)

Rightly or wrongly, on WP paragraph = block of text. Johnbod (talk) 17:52, 10 March 2016 (UTC)

• So just to confirm ---- the fourth block of text, which begins with the history and geography, goes on to discuss user numbers in Western democracies, and then takes a little side-trek into reasons for use and dual use with tobacco cigs before talking about law and regulation, and then finishes off with brand numbers ---- you don't feel that's incoherent and confusing at all?—S Marshall T/C 19:10, 10 March 2016 (UTC)

Stating the journal statements are from

Have reverted this edit [15] which added "according to the American Journal of Respiratory and Critical Care Medicine in 2014"

If we begin stating which journal and which year all our content comes from this page will turn into a disaster. Adding the quote from the paper for the second bit. Doc James (talk · contribs · email) 04:47, 6 March 2016 (UTC)

Fair enough. I'm willing to compromise on that one, but as I stated in the edit summary, the year is also needed to give the statement a point of reference. Instead of ignoring my comments and simply reverting (as you did twice), it would be more helpful to drop me a line on my talk page or discuss it here first.

That wasn't the only edit you reverted, by the way. On two occasions, you also restored the statement, "Trying e-cigarettes was common among less educated people.", and this last time you changed "common" to "more common" including the quote from the source in an attempt to address my concern. However, I still disagree that this provides any real value to the article. First of all, the source does not state it is "more common" in the "less educated". It simply points out that it is common, and that's it. Without providing a direct comparison to the "more educated", the statement falls flat of providing any real value to the article and context it was provided in. I propose we remove it. --GoneIn60 (talk) 16:37, 6 March 2016 (UTC)

• Agree, it doesn't provide any real value. The Use section currently repeats many factoids originating from small surveys. With often geographically limited and frequently outdated results, they have been used, either by review authors or Wikipedia editors, to make broad conclusions about ecig users that they don't necessarily support. In this example, the source cited a 2010 US survey of 249 ever-users. Another source used elsewhere in the article said, "Compared with nonsmokers, EC users tend to be younger, better educated, and of higher income class" (from another limited survey). P Walford (talk) 21:03, 6 March 2016 (UTC)

@Doc James: The case to remove some of the content you restored has been made. Care to comment at this point? --GoneIn60 (talk) 10:45, 10 March 2016 (UTC)

With respect to adding the year. I am fine with that. Doc James (talk · contribs · email) 17:36, 10 March 2016 (UTC)

The primary issue deals with the removal of the statement quoted above. If you still oppose its removal, please explain your position in detail, taking into account the arguments supporting its removal. --GoneIn60 (talk) 00:50, 11 March 2016 (UTC)

Outdated reference inappropriately restored

I had deleted the statement, "There is little data about their health effects", which references a paper authored mid-2013. Using statements about research quantity from a time when the overwhelming majority of today's research was unavailable is inappropriate.

A Pubmed search on e-cig terms shows that only a fraction of today's research had been available at the time.

My deletion had been reverted [[16]] by Yobol who explained, while there is clearly more data, there is still little high quality safety data regarding e-cigarettes, especially long term.

This does not justify restoring the irrelevant source; whatever one's views on today's data quality, this certainly not supported by a mid-2013 estimate on data quantity.

References

- Zvi Zig 11:34, 11 March 2016 (UTC)

Positions of health authorities

I have reverted this set of changes, as they distort the position of regulatory authorities. If you read the WHO statement, it is pretty hostile to current e-cigs - the known risks, the unknown risks, especially the lack of regulation. yes there is the one line that says "the use of appropriately regulated ENDS may have a role to play in supporting attempts to quit." but even there, it is not current ENDS, but rather "appropriately regulated" ENDS, which do not exist, as the report makes clear. So I reverted. Happy to discuss. Jytdog (talk) 14:43, 11 March 2016 (UTC)

Jytdog, you are right with regards to the WHO report. This was an embarrassing terrible mistake on my part.Zvi Zig (talk • contribs 11:08, 13 March 2016 (UTC)

:). no problem, thanks for being gracious. Jytdog (talk) 18:31, 13 March 2016 (UTC)

Section ordering

Not sure what TracyMcClark is talking about here with regard to "Blind revert"? The ordering of this article has been talked to death:

• 2015-05 Talk:Electronic_cigarette/Archive_24#Section_ordering (which has review of the extensive past discussions and links to them.

P Walford's change in this dif was too bold per the DS as I noted when I reverted in this dif. This is not something people should just be messing with, without prior discussion. Jytdog (talk) 20:38, 13 March 2016 (UTC)

The order of the sections has been an ongoing issue and the order has been stable for a long time, the result of a consensus discussion, carried out by an uninvolved admin. If the sections are reordered it should be the result of a discussion/RFC. Be aware that the last two or so RFC's ended as no consensus. This probably has more to do with the nature of the device. It is not a medical device and making the page in a medical order or something close is not likely to reach consensus. AlbinoFerret 20:41, 13 March 2016 (UTC)

(ec) - Jytdog: Have you again not paid attention? The longstanding order was first changed yesterday w/o any further discussion.--TMCk (talk) 20:45, 13 March 2016 (UTC)

Agreed P Walford's edit simply restored the long standing page order. AlbinoFerret 20:47, 13 March 2016 (UTC)

• Re "This is not something people should just be messing with, without prior discussion": I agree with you, and that is why, as others have pointed out, I restored the long-standing order. P Walford (talk) 14:38, 14 March 2016 (UTC)

Cancer Safety

The primary causing cancer suspects from chewing tobacco, second hand smoke, and smoking are not present in detectable levels in e-cigs: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555263/ . All the references to politicized organizations in this article do not carry as much weight with me as this one scientific study. Someone with more interest and stamina may be able to include it. There's not even a mention of NNK, NNN, or even TSNA's in general (the cancer-causing agents in smoking). Ywaz (talk) 09:52, 20 March 2016 (UTC)

American Legacy Foundation

this edit is not OK. American Legacy Foundation is not a major health authority, and their study cannot be used to overthrow the existing published reviews and the most recent statements of major health authorities. I reverted. Jytdog (talk) 01:15, 21 March 2016 (UTC)

truthinitiative.org is not a reputable publisher. We would want something that is pubmed indexed at least or from a major medical organization. Doc James (talk · contribs · email) 01:15, 21 March 2016 (UTC)

It is a major medical organization. In fact, it is the largest tobacco-control organization in United States, with a prestigious research department. Why would you want to censor this information from Wikipedia?Zvi Zig (talk • contribs 01:42, 21 March 2016 (UTC)

Was that systematic review published in a journal? Or just done inhouse? Often charities publish in reputable medical journals.

Anyway looking at it further I am undecided.Doc James (talk · contribs · email) 03:14, 21 March 2016 (UTC)

Wow I followed the link to our article on that organization and it was crappy. I looked into them further and do not see the evidence that they are what we generally consider a "major health organization." Jytdog (talk) 05:04, 21 March 2016 (UTC)

Doc James, it is not published in a journal. The New York Times interviewed their researchers quite a few times when publishing on tobacco research. So, decide how you want to classify them.Zvi Zig (talk • contribs 14:26, 21 March 2016 (UTC)

Yes if not published in the peer reviewed literature and as there are lots of other sources on this topic probably best to use them. Doc James (talk · contribs · email) 17:46, 21 March 2016 (UTC)

Reviving conversation relating to characterizing Cochrane's results as tentative

I would like to revive a conversation. I feel that I was misunderstood/I was not clear. I would appreciate a user with experience in statistics can be pinged.

The Cochrane Review is quoted, "There is tentative evidence that they can help people quit smoking." The word tentative comes from Cochrane's 'low' GRADE of confidence level in the effect estimate. As I showed, Cochrane is clear that they downgraded their confidence grade from 'moderate' to 'low' because one of the devices delivered nicotine poorly, meaning the effect size may be an underestimate.

Now, Cochrane is explicit that the the 'low' grade is not related to negating the null hypothesis. They write, "These GRADE ratings reflect low levels of confidence in the effect estimates".

Bottom line, there is no support for use of the word tentative in relation to reporting these results as a "yes or no" outcome.

Now, I am not arguing that we infer that the effect size was indeed underestimated, this would certainly be WP:OR.Zvi Zig (talk • contribs 15:57, 24 March 2016 (UTC)

I read the previous discussion and listened to your comments above. I also read the author's conclusions here, which clearly state, "The quality of the evidence overall is low because it is based on only a small number of studies." Therefore, it is clear that the use of the adjective tentative is justified and supported by the source. --GoneIn60 (talk) 17:06, 24 March 2016 (UTC)

Thanks, GoneIn60. Good point. The external summary is actually different than what is stated in the paper, but nothing can be done about that.Zvi Zig (talk • contribs 20:56, 24 March 2016 (UTC)

External links modified

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Nicotine Addiction

Nicotine addiction outside of tobacco has been disputed recently. A quote: "Perhaps most surprising is that, in studies by Boyd and others, nicotine has not caused addiction or withdrawal when used to treat disease. These findings fly in the face of nicotine’s reputation as one of the most addictive substances known, but it’s a reputation built on myth. Tobacco may well be as addictive as heroin, as some have claimed. But as scientists know, getting mice or other animals hooked on nicotine alone is dauntingly difficult. As a 2007 paper in the journal Neuropharmacology put it: “Tobacco use has one of the highest rates of addiction of any abused drug.” Paradoxically it’s almost impossible to get laboratory animals hooked on pure nicotine, though it has a mildly pleasant effect. "<src>http://discovermagazine.com/2014/march/13-nicotine-fix</src>

Perhaps this section needs to be a little more balanced? Gbaughma (talk) 03:46, 8 April 2016 (UTC)

See. The difference between nicotine "when used to treat disease" and "when used recreationally" is the dose and route of administration - both of those strongly affect the development of an addiction. Seppi333 (Insert 2¢) 04:21, 8 April 2016 (UTC)

References

I agree with Seppi333. This doesn't belong in the article. It would be OR b/c it's not related to e-cigarettes. It's even harder to predictably self-regulate nicotine delivery with an E-cigarette than a regular cigarette.[17][18] Actually, that should be in the article if it isn't already. PermStrump(talk) 04:48, 8 April 2016 (UTC)

Coming from someone who smokes an e-cig on a daily basis, I can guarantee you that I'm addicted to nicotine, and would absolutely go through withdrawals if I quit. (72.196.216.21 (talk) 18:45, 17 April 2016 (UTC))

Vapour disappears in seconds

Does anyone have access to the paper this article is referring to? SPACKlick (talk) 12:30, 21 April 2016 (UTC)

GA Review

This review is transcluded from Talk:Electronic cigarette/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: David Eppstein (talk · contribs) 05:48, 28 April 2016 (UTC)

Edit warring on this contentious subject has continued both before and since the nomination, with the most recent battles involving at least five editors (Permstrump and CFCF on one side, Zvi Zig, Outofsinc, and Jytdog on the other), five reverts one way or the other of the same material in the last couple of days, and three more of the same material within the review period. This looks like a clear quick fail under criterion #4, "The article is not stable due to edit warring on the page". —David Eppstein (talk) 05:48, 28 April 2016 (UTC)

Removal of adequate source

This edit [19] removed what is a fully adequate review article from the article, see pubmed-link. The edit-summary identified it as polemic, but it is a clear summary of the facts in this paper — which is not considered particularly controversial. I will restore this because the rationale for removal was quite faulty, and does not take into account the articles status as a review under WP:MEDRS. Carl Fredik 💌 📧 22:59, 19 April 2016 (UTC) 

The article is published in the Frontiers in Public Health explicitly as a "Perceptive Article". The historical fact regarding the tobacco industry is uncontroversial, but its relevance and implied parallel to e-cigarette safety is certainly polemical. It is appropriate for a Perceptive Article, but not for Wikipedia.

References

- Zvi Zig (talk • contribs 02:32, 20 April 2016 (UTC)

It's a secondary source that reviews the literature and considers how policy options might be informed by the scientific evidence and the historical record. It's relevant, WP:MEDRS, and improves the page. Cloudjpk (talk) 19:44, 20 April 2016 (UTC)

Firstly, Perspective Articles are not on the same level as review articles which are meant to be neutral. Secondly, both the factual content and the relevance of this statement do not reflect a NPOV. Consider the statement placed in the sentence in question:

Early studies funded by the tobacco industry on the effects of cigarette smoking where also inconclusive, and proponents of the precautionary principle have urged for more independent funding to assess the risks of e-cigarette use. (emphasis added)

To consider this sentence taken out of a labeled Perspective Article a neutral point of view fit for the 2nd sentence on the safety of e-cigarettes is outrageous!

1. Non-industry researchers and public health advocates support e-cigarette, the comparison wrong and offensive.
2. Unlike with regards to early smoking research, there's widespread agreement on both sides of the public health debate that e-cigarettes are likely much safer than smoking, but not risk free.
3. Lastly, the application of the precautionary principle is uncontroversial with regards to early studies on smoking, but there is considerable debate regarding its application to areas relating to harm-reduction, where precaution may have unintended consequences. Zvi Zig (talk • contribs 21:46, 22 April 2016 (UTC)

Of course you're right but pretty much all of the more competent editors were pov-pushed out by exhaustion so you're stuck with what is left. Late to the party so to say.--TMCk (talk) 23:44, 22 April 2016 (UTC)

You're both missing the issue. It doesn't matter if the statement or source itself is neutral, but that it is from a prominent WP:MEDRS-aligned source - and is also a review article. That it is a perspective article doesn't come into it, and WP:NPOV requires us to always show both sides of the coin. Carl Fredik 💌 📧 11:14, 27 April 2016 (UTC)

• i am on the fence over this. There are two issues, the source and the content that has been generated from it.

Source: Frontiers Media is a borderline predatory publisher, so kind of iffy. In my own editing, i steer clear of journals they publish. I don't delete them when other people add them, but I steer clear of them. Iffy.

Content. There are two pieces to this - discussion of precautionary principle, and the tobacco industry analogy.

* I think it is very reasonable and even important to discuss the precautionary principle in this article, as a key reason why some folks are trying to slow down the growth of e-cig use. The lack of discussion is a significant gap in the article. Using this source to support some content about the application of the PP to e-cigs, I would support.

* i am not a big fan of ... uncareful analogizing to the actual history of bad publishing by the tobacco industry. I could see the relevance if preclinical studies of e-cigs and vapor that have been published were overwhelmingly funded by the e-cig industry but as far as i know they haven't been; as far as I know they have been independently funded. Is anyone aware of a reliable source that discusses funding of the research that has been published to date, to show that the application of the tobacco industry is relevant? Like I said, it is my impression that they haven't been. The analogy is also kind of inflammatory in this context, where at least some e-cig advocates are motivated by the public health concern of harm reduction and getting people away from smoking. So I think this part of the content should go.

So i would support content focused on the PP, leaving the tobacco industry out, based on this source. Jytdog (talk) 18:48, 27 April 2016 (UTC)

Frontiers Media is not a predatory publisher as far as I'm aware — would you please point to where you got that info? As for the ecig industry funding a sizable portion (not clear if it is the majority) of research — it is detailed in the precise article we are discussing — and has been discussed in other sources as well, such as the BMJ which did a feature on ecig industry ties to researchers.

It is possible that the content from this source could be expanded, because there is much more on the precautionary principle and ecigs in it, but both of the points set forth here are relevant — there are similarities to early tobacco-research; and there is opposition because of the skewed source of funding. Carl Fredik 💌 📧 21:26, 27 April 2016 (UTC) 

I didn't say they are a predatory publisher, i said they are borderline. I linked to our article on them on purpose; you can read it and read the sources there. I searched this article for content about research funding before I wrote, and didn't see anything. Where is that? thx Jytdog (talk) 00:15, 28 April 2016 (UTC)

Overemphasis on Grana/LingBenowitz

On coming back to this article after a period of absence and reading it with fresh eyes, the thing that strikes me most about it is how many citations there are to Grana/Benowitz, and how few there are to other sources of similar reliability (e.g. Rahman). In fact, Grana/Benowitz receives more than twice as many citations as the Cochrane Review, and in my view this is clearly inappropriate. Grana/Benowitz is not a low-quality source, but it is among the most anti-e-cigarette of the high-quality ones, and the overemphasis on it is detrimental to the article's balance.

Experience tells me that attempting to replace sentences that draw on Grana/Benowitz with sentences drawn from Cochrane or Rahman is likely to be controversial, because those sources are somewhat more pro-vaping than Grana/Benowitz is. So I thought I'd begin by seeing if there is consensus that the article is unbalanced in favour of Grana/Benowitz at the moment.—S Marshall T/C 17:15, 3 May 2016 (UTC)

• Silence is the weakest form of consensus. I will wait another few days and if there is no response I will begin to replace some of the sentences sourced to Grana/Benowitz with sentences sourced to Cochrane.—S Marshall T/C 15:32, 6 May 2016 (UTC)

I agree Grana Benowitz is an overused source. I've sort of lost track of more modern sources. Grana Ling is only used 3 times

• The health and lifestyle appeal may also encourage young non-smokers to use e-cigarettes, as they may perceive that trying e-cigarettes is less risky and more socially appealing. This may decrease negative beliefs or concerns about nicotine addiction.
• Candy, fruit and coffee flavored e-liquid may appeal to younger users of electronic cigarettes
• Easily circumvented age verification at company websites enables young people to access and be exposed to marketing for e-cigarettes.

Whereas Benowitz is used over 20 times

• E-cigarettes are probably safer for users and bystanders than smoking tobacco. (2 other sources)
• No serious adverse effects from e-cigarettes have been reported in trials.[6] Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing.
• E-cigarettes create a vapor made of ultrafine particles
• However, chemicals may exceed the more stringent safety limits that apply to the public
• A majority of e-cigarette users still smoke tobacco, leading to concerns that dual use can "delay or deter quitting".
• E-cigarette users mostly keep smoking traditional cigarettes.
• Some young people who have tried an e-cigarette have never smoked tobacco, so ECs can be a starting point for nicotine use
• Others use them to circumvent smoke-free laws and policies, or to cut back on cigarette smoking.
• There is considerable variability between vaporizers and in quality of their liquid ingredients and thus the contents of the aerosol delivered to the user. (2 other sources)
• Less serious adverse effects from e-cigarette use include throat and mouth inflammation, vomiting, nausea, and cough.
• fires caused by vaporizer malfunction,
• E-cigarette vapor contains fewer toxic substances
• E-cigarettes create vapor that consists of ultrafine particles, with the majority of particles in the ultrafine range
• The vapor has been found to contain flavors, propylene glycol, glycerin, nicotine, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other chemicals. (1 Other Source)
• significant numbers of teenagers who have never smoked tobacco have experimented with e-cigarettes.
• A 2014 review stated that tobacco and e-cigarette companies interact with consumers for their policy agenda.
• The companies use websites, social media, and marketing to get consumers involved in opposing bills that include e-cigarettes in smoke-free laws
• The same review said this is similar to tobacco industry activity going back to the 1980s
• These approaches were used in Europe to minimize the EU Tobacco Product Directive in October 2013.
• The legal status of e-cigarettes is currently pending in many countries.
• Some countries such Brazil, Singapore, the Seychelles, and Uruguay have banned e-cigarettes.
• A 2014 review said, "the e-cigarette companies have been rapidly expanding using aggressive marketing messages similar to those used to promote cigarettes in the 1950s and 1960s."
• While advertising of tobacco products is banned in most countries, television and radio e-cigarette advertising in some countries may be indirectly encouraging traditional cigarette smoking.
• There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some claiming to want to cooperate in "harm reduction"

am I looking at the wrong sources? I've no objection to any updates or improvements to any of these SPACKlick (talk) 16:20, 6 May 2016 (UTC)

• Sorry, yes, you're correct: Grana/Benowitz is overused, not Grana/Ling.—S Marshall T/C 16:23, 6 May 2016 (UTC)

I don't see anything particular pro or contra in that content. The Grana/Benowitz review is two years old and there are more recent ones so updating makes sense as the natural course of things. Jytdog (talk) 17:29, 6 May 2016 (UTC)

I disagree the source is overused. It's a major review and covers the area broadly. Cloudjpk (talk) 18:57, 6 May 2016 (UTC)

• This is absolutely absurd and has been discussed many times over and over again. The content should be restored. Carl Fredik 💌 📧 21:23, 6 May 2016 (UTC)

Calm your boots, no content has been removed. The discussion was whether it was worth updating any of it. For instance, there may well be a newer or more rounded source for "some countries have banned it" If one was found, no worries on updating the page. If one isn't found Grana stays. As I said above. There's nothing there that seems massivley controversial, my personal feelings on the uncontextualised use of "ultrafine particles" in a non-academic work aside, but there are things in there that could well be better explained in some of the more recent reviews. SPACKlick (talk) 21:36, 6 May 2016 (UTC)

Removing wikilink to the safety article makes no sense

I reverted this. There is no NPOV issue linking to the safety article. Jytdog (talk) 12:54, 20 May 2016 (UTC)

Thanks, I agree.Zvi Zig (talk • contribs 13:10, 20 May 2016 (UTC)

Adverse events

There's a sentence in the lead that currently says, "No serious adverse effects from e-cigarettes have been reported in trials" (PMID 25515689). I think it's misleading because what the source actually says is,

The ECLAT trial (Caponnetto 2013a) found no difference in frequency of AEs at 3- or 12-month follow-up between the three groups... Of the people available for 6-month follow-up in the ASCEND trial (Bullen 2013) 44.4% of participants in the nicotine EC arm reported any AEs, compared with 44.7% and 45.6% in the patch and placebo EC arms respectively. Differences were not statistically significant... None of the RCTs or cohort studies reported any serious adverse events (SAEs) that were considered to be plausibly related to EC use. One RCT provided data on the proportion of participants experiencing any adverse events. Although the proportion of participants in the study arms experiencing adverse events was similar, the confidence intervals are wide (ECs vs placebo EC RR 0.97, 95% CI 0.71 to 1.34; ECs vs patch RR 0.99, 95% CI 0.81 to 1.22). The other RCT reported no statistically significant difference in the frequency of AEs at three- or 12-month follow-up between the EC and placebo EC groups, and showed that in all groups the frequency of AEs (with the exception of throat irritation) decreased significantly over time.

That doesn't mean there were NO adverse events. It means there were the same amount of adverse events as with the patch and other smoking cessation produts. I'm having trouble coming up with a succinct way to word it though. Any suggestions? —PermStrump(talk) 14:56, 22 May 2016 (UTC)

SPACKlick, you reverted my edit here, but it's clearly WP:SYNTH by putting those 2 sentences back to back: "No serious adverse effects from e-cigarettes have been reported in trials. (PMID 25515689) Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing (PMC4018182)." That second source actually reads, "Major injuries and illness have resulted from e-cigarette use, including explosions and fires. Less serious adverse events include throat and mouth irritation, cough, nausea, and vomiting." And the first source doesn't say there weren't any adverse effects, just that the AEs weren't any worse than the adverse effects for the patch, etc. (see above). —PermStrump(talk) 15:31, 22 May 2016 (UTC)

You may want to read up on what constitutes an Adverse effect.--TMCk (talk) 16:27, 22 May 2016 (UTC)

I believe an argument could be made for changing the word "Less" to "non" or some other modifier, to avoid it appearing to the reader unfamiliar with the common usage of such terms that the two sentences are a comparison, however the second sentence should make it clear that these are adverse events of lesser severity. Additionally any modification to the lede should also be made in the main section which these sentences are lifted from. SPACKlick (talk) 16:35, 22 May 2016 (UTC)

Sigh! Maybe we should just quote "None of the RCTs or cohort studies reported any serious adverse events (SAEs) that were considered to be plausibly related to EC use." rather than indulge in this endless quibbling. Johnbod (talk) 16:38, 22 May 2016 (UTC)

That would be a delightful change in content and approach.--TMCk (talk) 16:43, 22 May 2016 (UTC)

We should use the same source for both sentences instead of picking the more positive sounding phrasing from each one. These are the most succinctly worded options that give the full context:

1. PMID 25515689: "The included studies did not identify any serious adverse effects associated with short- to medium-term (up to two years) use of ECs. The most commonly reported adverse effects were irritation of the mouth and throat."

2. PMC4018182: "Major injuries and illness have resulted from e-cigarette use, including explosions and fires. Less serious adverse events include throat and mouth irritation, cough, nausea, and vomiting."

—PermStrump(talk) 00:42, 23 May 2016 (UTC)

The first of those two isn't bad. I don't think it's better than the current phrasing. SPACKlick (talk) 16:09, 24 May 2016 (UTC)

Primary sources

We do not need primary sources. We can support text with secondary sources. Therefore reverted this.[20] Doc James (talk · contribs · email) 12:09, 27 May 2016 (UTC)

Why are we trying to use https://www.ncbi.nlm.nih.gov/pubmed/23467656 Doc James (talk · contribs · email) 12:10, 27 May 2016 (UTC)

Cannavaping

Just came across PMID 27228348, a review article on this, which isn't cited here. Happy to send it to any one who can't it so we can discuss including it. Jytdog (talk) 19:47, 27 May 2016 (UTC) (redacted per below Jytdog (talk) 21:27, 27 May 2016 (UTC))

Doesn't seem like a review? I'd like to read it though, since (so far) i've considered cannabis vaping incompatible with the methodologies used in e-cigs, mainly because cannabinol (afaik)is non-soluable in e-liquid, and thus you'd have to either use gel- or dry-herb vaporizer, which while similar, isn't the same as the vaporization method used in e-cigarettes. --Kim D. Petersen 20:26, 27 May 2016 (UTC)

It is not classified yet but it came up in a pubmed search for reviews I was doing for something else. It turns out to be open access and their website was down earlier today. It is back up now and the article is here - it is not a review. PMID 26308021 is for sure a review that discusses this; it is an MDPI journal so not one I would use, so there is nothing to do here for now. Jytdog (talk) 21:27, 27 May 2016 (UTC)

"Long term effects unknown"

WHO states:

"It is unknown if the increased exposure to toxicants and particles in exhaled aerosol will lead to an increased risk of disease and death among bystanders as does the exposure to tobacco smoke"[21] 2014

CDC says:

"Insufficient data are available to accurately predict the risk associated with use of e-cigarettes or secondhand exposure to the particulate aerosols and gases they emit. Nonetheless, the FDA and others have noted that e-cigarette cartridges and aerosols may contain harmful chemicals and substances such as diethylene glycol, nicotine, formaldehyde, acetaldehyde, toxic metals, and others" [22] 2015

NIH says:

"There are currently no accepted measures to confirm their purity or safety, and the long-term health consequence of e-cigarette use remain unknown." [23] 2016

Review in Circulation:

"Long-term biological effects are unknown at this time because e-cigarettes have not been in widespread use long enough for assessment." "Because there are no long-term safety studies of e-cigarette use, patients should be urged to set a quit date for their e-cigarette use and not plan to use it indefinitely" [24] 2014 Will add. Doc James (talk · contribs · email) 10:56, 29 May 2016 (UTC)

Couple of quick comments (i'm on the way out): It is not the CDC above - but NIOSH. WHO and the Circulation review are tightly bound (essentially the same), since the Circulation review is the scientific basis for the WHO report. NIH doesn't reach review level.

Finally, if we are doing a comparison/aggregation, then we need the other comprehensive reports from NHE and the RCP as well as other reviews in. --Kim D. Petersen 13:12, 29 May 2016 (UTC)

Just for the record, accuracy and precision do not mean the same thing in statistical sense; hence, neither do the adjacent statements.
Accuracy is a measure of the closeness of a parameter's estimator to its true population value (called the "reference value" in this image); unbiased estimators are accurate by definition and have an expected value that is equal the true population parameter value.
Precision is analogous to statistical power - higher power=higher precision=smaller estimator error bounds (i.e., smaller confidence intervals).
Seppi333 (Insert 2¢) 01:37, 30 May 2016 (UTC)

Lack of direct knowledge on long-term effects does not mean long-term effects are simply "unknown". We certainly have an idea about long-term effects (at least according to some). In fact, some major medical organizations have even given numerical estimates for them. This is precisely why organizations from the CDC's NIOSH (link) to the Royal College of Physicians (link) use modifiers like "accurately" or "precise" in describing knowledge limitations on long-term effects.

- CDC's NIOSH says

Insufficient data are available to 'accurately' predict the risk associated with use of e-cigarettes" (emphasis mine)

- The Royal College of Physicians says

it is not possible to quantify the long-term health risks associated with e-cigarettes 'precisely'. (emphasis mine)

We do not have direct or precise knowledge of tomorrow's weather, but that doesn't mean it's toally unknown.

These should be reflected in the article, please. Zvi Zig (talk • contribs 19:52, 29 May 2016 (UTC)

Zvi please tell me what are the effects in on human lungs of chronic inhalation of vaporized propylene glycol over a period of say 5 years? Jytdog (talk) 20:16, 29 May 2016 (UTC)

It has been estimated to be <5% the harm of smoking, which also gives you a reference point for absolute risk. There's evidence relating to propylene glycol safety from long term inhalation studies on rats, monkeys, dogs and humans (PMID 20265820)(PMID 21683116)(link)(link) Zvi Zig (talk • contribs 00:14, 30 May 2016 (UTC)

There is a difference between knowing nothing, and knowing something. The envelope of uncertainty is not all encompassing. Thus while it can't be said with certainty (nothing can), there are several million users who have been exposed to "chronic inhalation...", and so far no major adverse effects have been found, that are distinguishable from with post-smoking effects. There are always unknowns - but there are also bounds (the uncertainty envelope) within which the unknowns/uncertainties are located.

What can be said is, that while the exact effect is unknown, the severity/extent of these is likely to be very small (see for instance the RCP report 5.3.3.6) "However, the absolute magnitude of any risk attributable to e-cigarette use is likely to be very small in absolute terms,". (referring to the total long term risk-profile). --Kim D. Petersen 20:33, 29 May 2016 (UTC)

And of course the rather famous "Although it is not possible to quantify the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure." (RCP p. 84, as well as PHE) - which is an expression of uncertainty, but also a description of the risk envelope. --Kim D. Petersen 20:36, 29 May 2016 (UTC)

And yes, beating the dead horse; the comparison to cigarettes is half the story. Please stop bringing that up. The absolute (compared to not vaping and not smoking) long term effects of e-cigs and things it involves, like chronic inhalation of vaporized propylene glycol, are unknown. The exposure to vaporized PG in particular is unprecedented - this is not something people were ever chronically exposed to before, and we don't know what the effects will be. Could be nothing, could be the next asbestos. We don't know. Jytdog (talk) 21:23, 29 May 2016 (UTC)

Nope, it is not a dead horse. That is what the literature compares the risk to, and thus it is what we as editors have to go by. And since this is a product that is overwhelmingly only used by smokers or former smokers it is the pertinent comparison. And unless i'm not mistaken, the risks of tobacco smoking is not unknown - so the <5% is quantifiable. You may not like it, but it is.

Your "Could be nothing, could be the next asbestos" is simply WP:OR and in direct contradiction to the literature - since tobacco smoke and asbestos are comparable risk factors (asbestos is (iirc) worse). Your POV is showing - sorry. --Kim D. Petersen 22:09, 29 May 2016 (UTC)

No, I am just trying to express what the best sources say in plain language, here on the Talk page. The entire NIOSH source says "we don't know" in as many ways as are possible Jytdog (talk) 22:22, 29 May 2016 (UTC)

Since when is that what "the best sources" say? What makes you say that NIOSH is better than RCP? And once again you are confusing unknown with uncertain. NIOSH is quantifying the potential risk factors, not quantifying risk [Ins: its not even attempting to --Kim D. Petersen 23:12, 29 May 2016 (UTC)]. <5% relative risk to cigarettes is not incompatible with saying that the risk is uncertain. It could be 0.1% or 4.9% - which is a huge uncertainty envelope, and which can account for a lot of "we don't know the absolute risk" statements. --Kim D. Petersen 23:07, 29 May 2016 (UTC)

• All the serious sources say the same thing. Even the RCP which is very concerned about harm reduction says "As with all new products, however, longterm or rare adverse effects will remain uncertain until e-cigarettes have been in widespread use for several decades". This is not a controversial thing. Jytdog (talk) 01:17, 30 May 2016 (UTC)

  So the whole <5% in the RCP, as well as their endorsement of e-cigs as a stop-product is simply BS? Or have you chosen not to understand that there is a difference between knowing absolutely and assessing risk? Again your POV is showing. --Kim D. Petersen 06:23, 30 May 2016 (UTC)

We already say in the next sentence "There is general agreement that they are likely less hazardous than tobacco cigarettes." Doc James (talk · contribs · email) 07:14, 30 May 2016 (UTC)

Jytdog, "uncertain" is not "unknown". No one is arguing that we can exclude any quantity of unknown adverse effects. However, to assert blanket ignorance in the opening statement is biased and misleading. Furthermore, my proposal is very reasonable: the precise long-term health effects are unknown.

Doc, lets stay on subject. The opening statement is in contradiction with WP:NPOV, (if accurate according by any authoritative POV). Adding the word precise is reasonable, and should make the phrase more accurate by all accounts. Zvi Zig (talk • contribs 09:59, 30 May 2016 (UTC)

We disagree I guess. We could have a RfC if you wish. Doc James (talk · contribs · email) 12:23, 30 May 2016 (UTC)

Explosions - sourcing and weight

Per WP:MEDRS we go with review articles over popular press. Therefore reverted this edit.[25] Doc James (talk · contribs · email) 07:01, 25 May 2016 (UTC)

• Yeah, the reason why I think you're mistaken there is that in this case the review article cites the popular press as its source. I'd prefer to discuss this at WP:RS/N rather than on this talk page, unless anyone objects?—S Marshall T/C 07:34, 25 May 2016 (UTC)

  Is this a lead-worthy material at all? Electronic devices tend to blow on occasion, and few isolated incidents in many years hardly deserve so serious risk to earn a prominent placement in this article, per WP:DUE. Surely needs a mention in #Safety section, of course, but there it has been devoted only 2-3 sentences. No such user (talk) 10:50, 25 May 2016 (UTC)

  I think here is a good place to discuss as any.Doc James (talk · contribs · email) 11:56, 25 May 2016 (UTC)

While I'm not sure MED:RS applies to the safety of an electronic system I agree that here tertiary sources are better sources than popular press. people blow up lithium batteries all the time in various devices. How common it is and what level of damage these batteries cause for e-cigarettes is better reported as an aggregate than by pointing to individual cases. Also I see no reason not to discuss here.SPACKlick (talk) 12:51, 25 May 2016 (UTC)

• With all due respect, this is why I'd prefer to discuss this on a board frequented by editors with an interest in discussing the comparative reliability of sources and without a pre-determined position on electronic cigarettes. I'll repeat the significant part of what I'm saying: The review is based on the popular press articles I cited. Where the review discusses "major injuries", it cites these two popular press articles as its own sources. Read. Comprehend. Think. Respond.—S Marshall T/C 16:33, 25 May 2016 (UTC)
• What about posting something on RS/N with a link here asking for comments? I think the tertiary source is best per WP:TERTIARY. I also think it's DUE because the review article thought it was important to talk about in the sentence before mentioning the other adverse events. I could see more of an argument for including the more detailed descriptions from the popular press in the body, but in the lead I think it's a little TMI. —PermStrump(talk) 17:20, 25 May 2016 (UTC)
• It clearly doesn't belong in the lead, Permstrump. Since I last read the article, someone has decided to add to the lede an alleged risk of major injuries, explosions and fires arising from e-cigarette use. This is sourced to this article, "Grana/Berkowitz", which at first glance appears to be a credible review by serious academics. But when you read that article and check where it gets its information from, it cites references #76 (which, when you check it, is this popular press article about major injuries caused to an un-named person who was not available for comment) and #77 (which, when you check it, is this popular press article in which a woman from southeast Atlanta claims that an e-cigarette scorched her couch and burned a hole in her rug, but nobody was actually hurt). The tertiary source makes these allegations about explosions and fires seem more credible than they actually are, because it's couched in stilted scholarly language and includes lots of little references. But the "explosions and fires" is all built on the foundations of these two popular press sources. Note please that MEDRS does not apply to this claim. This is not a medical claim. It's a claim about explosion and fire risk relating to a mechanical device, and nobody with their head screwed on thinks e-cigarettes are therapeutic devices, so there's nothing medical about it at all. We need to remove it from the lead completely, and the first step is to be honest about where these claims about explosions and fires really come from.—S Marshall T/C 19:17, 25 May 2016 (UTC)

There is a pretty evident confusion here about what a tertiary source is. A tertiary source is not the third in a line of citations to mention a topic, but a specific type of source. This review is not a tertiary source, but a secondary source, and summarizes anecdotal evidence in a satisfactory way for the type of source that it is. Including the original text is acceptable for the article, and the subject is definitely worthy of mention in the lede, at least in the short way that it currently is. I do not agree with Permstump that we should use popular press mentions to elaborate in the body. Carl Fredik 💌 📧 19:29, 25 May 2016 (UTC)

• There's "pretty evident confusion" about how to evaluate the reliability of a source, which is why I think this belongs on RS/N.—S Marshall T/C 19:49, 25 May 2016 (UTC)

Actually, when you read WP:MEDASSESS (last paragraph, a part of MEDRS): evaluating the reliability of sources when considering whether to include them or not is not our job as Wikipedians - we should only evaluate the reliability of source-type, and this is a review article by prominent academics. No doubt about it, no reason to waste time at RS/N, seeing as the result is pretty much pre-determined. Carl Fredik 💌 📧 21:45, 25 May 2016 (UTC)

Per WP:ALLPRIMARY, "many high-quality sources contain both primary and secondary material". In this specific situation, the secondary source being cited here would be secondary for the medical claims within that it discusses and analyzes. However, it would only be primary for other claims such as this one dealing with "explosions and fires". It is simply reporting what has been reported in other primary sources and does not analyze or interpret that data. In addition, this specific subject matter is not necessarily limited to coverage within the medical field, and may actually receive better coverage in another that specializes in scientific analysis of electronic devices like e-cigarettes. So let's not make the blanket claim that every topic discussed in the article is going to be constrained to the MED:RS guideline; that may be true for a majority of the article, but as this discussion shows, that won't always be the case. Medical or not, WP:CONTEXTMATTERS allows us to always evaluate the reliability of a source depending on the context in which it is being used to support a specific claim. So while we shouldn't reject a high-quality study based on personal observations of its methodology (per WP:MEDASSESS), it is well within the WP:RS guideline to scrutinize context. If some sort of working consensus cannot be obtained in this discussion, I would recommend bringing this up at RS/N to get the opinions of uninvolved editors. It's usually the next best step before seeking dispute resolution.

The other point raised here is that we may be giving this undue weight in the lead. I think it's significant enough to appear there with adequate coverage in the body, but right now, it appears that the adequate coverage is lacking. If this is covered in another article, then it shouldn't have this much prominence in this article's lead. If the coverage just needs to be expanded in this article, then per WP:LEADFOLLOWSBODY we should wait for that to happen before adding anything to the lead. --GoneIn60 (talk) 09:37, 26 May 2016 (UTC)

Suggestion: S Marshall's edit is not really fixing things; it's substituting one primary citation for two other primary citations. Really what we need here is a true secondary citation, one that analyzes and quantifies the significance of "explosions and fires". The fact that these occurrences have been reported tells us nothing about how often they occur and what kind of impact they have on the public, industry, etc. – this additional insight would then likely make a good case for it to be mentioned in the lead. --GoneIn60 (talk) 09:49, 26 May 2016 (UTC)

Sigh, it is not primary either —in that it provides analysis that is independent of the original sources. This has nothing to do with the nature of the science governing the claims — it is not secondary for medical claims, and primary for other sciences. It is secondary in that is combines, analyzes and summarizes the primary sources in a way that is independent of the primary sources. Beyond that it is also a quality review article that passes under WP:MEDRS, while not a requirement for statements in the physical sciences, it definitely does not detract from its reliability — and in this case where analysis of the damage to health is present it is required for use on Wikipedia. Carl Fredik 💌 📧 10:12, 26 May 2016 (UTC)

How does it "combine, analyze and summarize" the primary sources? The only statement I see is:

"Major injuries and illness have resulted from e-cigarette use, including explosions and fires."

There is no analysis given. It is simply reporting that these events have occurred and offers no additional insight beyond that. Also, let's not lose sight of the fact that there is the issue pertaining to its appearance in the lead. --GoneIn60 (talk) 11:28, 26 May 2016 (UTC)

As medical information it is most certainly primary. Analysis of two cases reported in the popular press does not a medical review make.

Lets take an analogy: assume that you write a paper that combines and analyses various statements/happenings reported on the internet. Would that be a primary or secondary source?

And the answer to that is: It would be a primary source - since it combines and collates data, and draws a unique conclusion from it. Therefore this particular information _is_ primary. --Kim D. Petersen 11:49, 26 May 2016 (UTC)

- No, just no. This discussion isn't going anywhere, take it to RS/N for all you like, but you're wasting your time. Carl Fredik 💌 📧 11:52, 26 May 2016 (UTC)

Not sure what your fascination is with outdenting all the time, but it is distracting and makes it seem you like the emphasis to be placed on your response every time. Please refrain from doing so until necessary (like when the number of indentations nears or exceeds 10). You made a claim that this source is secondary, but you have not yet shown where the opinion or analysis is in the statement quoted above. RS/N may very well be necessary, but at the moment, it appears you are in the minority and there's still a chance to form a consensus. The WP:DUE "lead" issue still needs attention, and it was suggested that there are likely better sources analyzing the risk surrounding explosions and fires (regardless if the one in question could possibly be considered secondary). GoneIn60 (talk) 12:01, 26 May 2016 (UTC) → Updated: --GoneIn60 (talk) 22:05, 26 May 2016 (UTC)

• Just a note - we don't peer review reviews, and this is what S Marshall is doing. This argument about the sources used by a source is not a valid argument in Wikipedia. See WP:MEDASSESS. Jytdog (talk) 22:37, 26 May 2016 (UTC)
• Why would we care what WP:MEDASSESS says? This is not in any sense a medical claim. Physicians have no special expertise in assessing the risk of fire or explosions. In fact this is a standard encyclopaedic judgment to make. We have several decent sources about safety of electronic cigarettes but they don't agree. One (1) of those sources claims there's a risk of major injury from fires and explosions, and cites popular press articles as its source. The other sources don't mention it. On the strength of that one (1) source, the risk of fire and explosions receives a prominent mention in the lede. This is a good decision because _____________?—S Marshall T/C 22:48, 26 May 2016 (UTC)

I wouldn't even say it addresses "risk". I quoted the exact line above. It just says major injuries and illness have occurred, not how often or how likely. Without quantifying the significance of this statement, I don't see how it's really relevant here, except to say the same thing that primary sources have reported on. --GoneIn60 (talk) 22:57, 26 May 2016 (UTC)

That is because with the data that exists it is not possible to say how often or how likely such cases are — that doesn't somehow make it into a primary source. It analyzes and summarizes — and inclusion in the review is also to be considered. This is a review article — as apparent by its review-tag on Pubmed and is an ideal source per MEDRS. I really don't see what you are getting at? No matter your take on the nature of the statement, it is more reliable than the popular press. Carl Fredik 💌 📧 23:16, 26 May 2016 (UTC)

Just to be clear, I'm not advocating the same position as S Marshall. It is not my intention to replace this source with other primary sources necessarily. What I am saying, is that the statement holds no real significance to the article. Saying that major injuries have occurred is just an observation. Someone reading that will wonder "how many" and "how likely". It could represent two occurrences (the smallest form of the plural), or it could represent a hundred. But without quantification and actual analysis, this statement tells us very little and certainly doesn't belong in the lead. There has to be a better source out there for this information, whether that be primary, secondary, or tertiary. You keep saying it has analyzed the data, but I think you and I must have very different views of what that means exactly. Here's one definition:

"to examine carefully and in detail so as to identify causes, key factors, possible results, etc." (source)

Does it seem like the quoted statement from that review source is identifying causes, key factors or examining anything for that matter in detail? Doesn't seem like it to me. Combine this problem with the absence of any real value the statement adds to the article, and now the issue is two-fold. --GoneIn60 (talk) 23:39, 26 May 2016 (UTC)

PHE's review also discusses explosions, concluding that, "It seems likely that the risk of fire and electrical fault is similar to other domestic electrical products, indicating that EC should be subject to the same guidelines and safety mechanisms." It summarizes, "There is a risk of fire from the electrical elements of EC and a risk of poisoning from ingestion of e-liquids. These risks appear to be comparable to similar electrical goods and potentially poisonous household substances." (link)

Zvi Zig (talk • contribs 00:02, 27 May 2016 (UTC)

Thanks for that Zvi Zig. That source further questions the significance of the observation made by the Grana/Berkowitz source, showing how incomplete and vague that statement really was. I would support some form of inclusion of the information provided by the PHE review into the body of the article, which should have a direct impact of what appears in the lead. --GoneIn60 (talk) 09:20, 27 May 2016 (UTC)

Safety is a health issue. I don't see how you argue it is not. Jytdog (talk) 23:00, 26 May 2016 (UTC)

Mechanical safety is most certainly not normally a health issue. Which is why its usually handled by engineers and not medical professionals. --Kim D. Petersen 20:40, 27 May 2016 (UTC)

After commenting at RSN just to add here - safety is a health issue only so much as the outcomes impact on health. It is assuredly not a medical issue. You dont trust a doctor to tell you how likely your electrical goods are to explode, and you dont trust an electrical engineer to tell you how likely your liver is to fail. Risk assessement for mechanical failure is not a medical issue as doctors lack the training and experience to correctly predict the risk involved (from mechanical failure). Comment on the risk to the human body *should* it fail yes, but not the likelyhood of it doing so. There is also bias in that a doctor will undoubtedly see the worst cases in their personal experience, the working perfectly fine cases wont ever cross their path. If a doctor says 'this device is risky to use, I have had 15 people with burns in the last year', without qualification that 25-30 million people were using it perfectly fine, its undue to suggest, even by implication, that an electrical product is dangerous. Only in death does duty end (talk) 08:23, 28 May 2016 (UTC)

I saw this in my watchlist: WP:RS/N#Major injuries caused by electronic cigarette use, but hadn't seen it mentioned here, so I wanted to make sure other people were aware. —PermStrump(talk) 04:21, 27 May 2016 (UTC)

Believe it or not, MEDR applies because having your faced melted by a faulty or poorly designed ecig is a "practice" with "health effects", which means it is "biomedical information". It seems a stretch to me, but that's my best guess at what this is all about, absent any deeper explanation from Doc James. Hard to see how better sources can't be found, or how policy would ever say to ignore how this paper obviously isn't a systematic review of fire and explosion reporting at all. In my experience, the fire risk does prevent smokers from converting to vaping, smokers who have already failed to quit using other methods. If the fire risk of quality assured ecigs used properly has been found to be comparable to other devices, then they deserve to know. Just like they deserve not to be misled into thinking this paper was reporting fires seen in trials, as is inferred by the grammar of the whole paragraph now. CrezT (talk) 22:23, 27 May 2016 (UTC)

• Indeed. Predictably, the discussion at RSN is tending to agree that this isn't subject to MEDASSESS and it's UNDUE to include it in the lead. It's also revealed a source from people who're actual experts at assessing fire and explosion risk which is here. The conclusion we're reaching is to remove everything about fires and explosions that's sourced to Grana/Berkowitz, remove the offending misinformation from the lead, and add to the body text a paragraph about the fire and explosion risk caused by misusing lithium-based rechargeable batteries.—S Marshall T/C 07:46, 28 May 2016 (UTC)

Your statements are extremely wrong — in that they seem to express the idea that fire protection services are the best at assessing risk to health by certain types of exposure. They are not the ones treating the burns, assessing the severity of the explosion upon the human body — your entire argument is severely deluded. Carl Fredik 💌 📧 11:26, 28 May 2016 (UTC)

Doctors have no professional competence w.r.t. assessing and minimising the risk of fire and explosion arising from the faulty design or incorrect use of ecigs. That's a basic fact, one which professionals wouldn't even attempt to dispute, not even doctors. CrezT (talk) 14:46, 28 May 2016 (UTC)

They most certainly have competence to assess risk of injury in case of fire and in case of explosion. Additionally it is not a question whether doctors have this competence, but whether we are required to apply MEDRS on cases concerning epidemiology — and that is very clear if you choose to read WP:MEDRS & WP:BIOMEDICAL. That does not mean that they are the only ones able to reliably assess the risk — but that MEDRS applies. A paper released by USFA-FEMA is similarly MEDRS-compliant — whether doctors wrote it is irrelevant. Carl Fredik 💌 📧 10:48, 29 May 2016 (UTC)

That is a freaking great source - a major authority. Is anybody not happy with this source? We can stop right here on the source question and determine what to do with it contentwise. Jytdog (talk) 08:39, 28 May 2016 (UTC)

Additional sources

I think the statement can be strengthened, here are some additional WP:MEDRS (and otherwise WP:RS) sources:

• [26] United States Fire Administration report on Electronic cigarettes which details explosions and injuries
• [27] Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review
• … to be expanded

Carl Fredik 💌 📧 10:18, 28 May 2016 (UTC)

Have you actually looked at the FEMA document? From the keypoints:

• There were 2.5 mio users in 2014
• There have been 25 incidents from 2009-2014

So the risk is extremely low, and so small that it is hard to derive a statistical meaning from it - or am i missing something? And that should be in the lead??? --Kim D. Petersen 12:32, 28 May 2016 (UTC)

And WP:MEDASSESS would discount the second as low-quality (its basically a case-report) --Kim D. Petersen 12:34, 28 May 2016 (UTC)

1) Yeah, the risk is low — the source also explains that there may a be a significant degree of underreporting.

2) No, it is a systemic review. If you're confused about that I suggest you check out our articles on Literature review and Systematic review, and the clause on source types at WP:MEDRS.

Carl Fredik 💌 📧 12:39, 28 May 2016 (UTC)

On your #2 - has MED really gone so bad that people think that a description of 3 cases/incidents can be called a systemic review? Really? Incidentally. From what information, do you derive that it should be a systemic review. [Did you btw. also notice, while you were checking whether it was a review or not, that it is not from a medline indexed journal?] --Kim D. Petersen 13:01, 28 May 2016 (UTC)

Just a note: Have you noticed that the PDF version[28] is headlined by "Interesting Case Series" - does that mean "systematic review" to you? --Kim D. Petersen 13:05, 28 May 2016 (UTC)

(edit conflict)Hmmm, seems to me that you've linked to the wrong article? Correct? You really meant this: [29]? But that source mentions very little on this topic. --Kim D. Petersen 13:11, 28 May 2016 (UTC)

Linked the wrong article, fixed.Carl Fredik 💌 📧 13:08, 28 May 2016 (UTC) 

• In accordance with the consensus at RSN, the statement about electronic cigarette use causing major injuries should be removed from the lead. Now we have a proper source I think it's not UNDUE scaremongering to include a statement about the risk of serious injury from fires and explosions, arising from using the wrong equipment to recharge the lithium-ion batteries, in the body text.—S Marshall T/C 15:20, 28 May 2016 (UTC)

I don't follow your conclusion that consensus reflects such a wish. So far the discussion here has been both more broad and between more individuals. Carl Fredik 💌 📧 16:12, 28 May 2016 (UTC)

• This talk page is dysfunctional. So far here, people have tried to contend: (1) that physicians rather than firefighters are the right people to assess the explosion risk posed by electromechanical devices; (2) that I'm not permitted to dispute the reliability of a source; and (3) that it's reasonable to say in the lede that e-cigs pose a risk of major injury to users. These contentions are preposterous, and merit no weight.—S Marshall T/C 16:29, 28 May 2016 (UTC)

1). No, but they are far better posed to assess the risk and degree of injury upon explosion

2). No one is saying that — what they're saying is that you are wrong and that your arguments don't make sense and are not founded on sound reasoning. This is an ad hominem attack at the editors on this page — not usually a good way to press your view.

3). These risks are brought up in a number of major reviews on electronic cigarettes, and have prompted investigation by the USFA — this indicates that there are concerns to be had.

Carl Fredik 💌 📧 10:44, 29 May 2016 (UTC)

• This talk page is dysfunctional, though. The basic fact is this: Right now the lede of the article contains an unqualified contention that electronic cigarette use poses a risk of major injuries. You Doc James, and Jytdog are colluding to retain that contention in its unqualified form. The contention is directly attributed via inline citation to a source which, I've plainly shown, is itself based on popular press articles. I think you, Doc James, and Jytdog are displaying questionable editorial judgment by persisting in this, and it's not unreasonable of me to say so. I found the discussion on RSN, to the extent that it consists of editors without an established position on electronic cigarettes, realistic, intelligent, sensible and productive.

  You're right to say that physicians are experts in assessing the degree of injury, but you're wrong to say they're experts in assessing risk of fire and explosion. That's not part of a physician's training and I see your repeated contentions in this respect as very strange. I don't see how it's compatible with your apparent endorsement of the FEMA source I found.

  The reality is that (1) in the US, electronic cigarettes are not subject to any compulsory product safety checking regime, and (2) electronic cigarettes contain a lithium-ion battery which poses a small but non-zero risk of exploding, particularly if recharged at the wrong voltage. These explosions are rare, but can lead to, and have led to, serious injuries.

  At the moment, the lede of the article says: No serious adverse effects from e-cigarettes have been reported in trials. Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing. Major injuries related to explosions and fires were also reported. This is obviously stupid and self-contradictory. Major injuries are obviously serious adverse effects.

  It's also blatant scaremongering. About a dozen Americans have been injured by electronic cigarettes. In the last decade, 416 Americans were injured by yo-yo balls. In 290 of those cases the cord became wrapped around someone's neck, posing a clear threat of strangulation. More than 15,400 Americans were injured by falling televisions, 279 of them fatally. More than 66,000 Americans a year are injured by trampolines, and since 1990 there have been 4 fatalities. Unaccountably, the Wikipedia articles on these lethal deathtraps fail to contain prominent warnings in the lede about these risks, but never fear! At least our e-cigarette article is doing its moral duty.

  Sarcasm aside: Explain to me how the warning in the lede isn't WP:UNDUE scaremongering bullshit?—S Marshall T/C 00:44, 30 May 2016 (UTC)

Changed it to:

Cases of major injuries and property damage related to explosions and fires have also been reported.

Done, that should clarify that it hasn't been reported in trials — can we drop this discussion? Carl Fredik 💌 📧 12:46, 30 May 2016 (UTC)

No not really. Its still ridiculous to have any mention of it at all. You might as well put in the lead for the article 'Cars' that they explode. The risk factor is so tiny as to be a non-problem. Only in death does duty end (talk) 14:44, 30 May 2016 (UTC)

Let me clarify this, failure rate is based on the number of uses, not the % per population. If a device is used 100 times and explodes once, thats a very low failure rate, but at least mentionable. If a device is used by 2.5 million people for 5 years for 5 - 10 times a day (and thats a conservative estimate for smokers), and there are 25 incidents, even taking into account non-reports, that is so low as to be statistically meaningless (in 2014 alone that would be using an average of 7 times a day over 6387500000 uses.) My kettle has a higher failure rate than that. Only in death does duty end (talk) 14:50, 30 May 2016 (UTC)

You would be correct in your kettle comparison[30] - they cause rather a lot of mayhem ;) --Kim D. Petersen 19:02, 30 May 2016 (UTC)

• I'm going to differ from OID in that I don't think it's ridiculous to mention it. I only think it's undue to mention it in the lede. Having a sentence in the body text would be reasonable, and it certainly belongs in safety of electronic cigarettes. If CFCF won't back down on this we might need to go to RFC.—S Marshall T/C 21:58, 30 May 2016 (UTC)

An RfC is unnecessary at this point. The consensus is overwhelmingly in favor of removing it from the lead, which appears to be the major concern. Additional discussion may still be needed to find the best neutral phrasing in the body, but it seems like we're making progress on that front as well. --GoneIn60 (talk) 02:37, 31 May 2016 (UTC)

I agree there's enough sourcing on it to warrant mention in the body. Would be great if we could find sourcing on the rate of fires/explosions across types of devices because some seem anecdotally more risky than others. It's clearly not something that needs to be in an already unwieldy lead. SPACKlick (talk) 23:03, 30 May 2016 (UTC)

• The FEMA source says the explosions strongly tend to come from vape pens and other small devices that don't come with their own rechargers, after an electrically illiterate user has plugged them into something with unregulated voltage.—S Marshall T/C 07:30, 31 May 2016 (UTC)

Contextualizing adverse events

The reason I added the line about "major injuries" the other day in the first place was in reference to this part of the lead:

"No serious adverse effects from e-cigarettes have been reported in trials. (PMID 25515689) Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing (PMC4018182)."

I feel that those 2 sentences alone are WP:SYNTH and cherrypicking overly positive wording from 2 different sources. And the first sentence in particular misrepresents what the source was actually saying (see also #Adverse events thread above). First I tried to neutralize the tone with this edit, which was reverted. Then I tried new wording to contextualize those statements so that they'd more accurately reflect their sources and was reverted again. The "major injuries" line was my 3rd attempt to add more context from the sources to resolve the WP:OR and misrepresentation of the sources. Personally, I'd probably be fine with any of those 3 edits, but I feel strongly that the former wording is inappropriate and needed to be adjusted. The most important part is clarifying/contextualizing the claim that "NO serious adverse events were reported", because the first source actually says that no serious adverse events were reported exclusively to e-cigarettes, meaning of the 1-2 studies that reported AEs, participants reported the same serious adverse events with e-cigarettes as they did for traditional cigarettes and the patch, which is very different from zero serious adverse events. As an aside, it should also be clarified that none of the studies looked at longterm AEs. —PermStrump(talk) 17:07, 28 May 2016 (UTC)

Actually, IMHO the best solution might be to only use this one sentence in the lead: In trials, the most commonly reported adverse events have been throat and mouth inflammation, vomiting, nausea, and coughing. This takes out the judgment/subjectivity of the word "serious" and lets readers evaluate the seriousness of the risk for themselves based on the most commonly reported AEs. —PermStrump(talk) 17:11, 28 May 2016 (UTC)

• I haven't commented on the substance here, but only on the sourcing. So about the content. Two things; the content should mention that these explosions are exceedingly rare, result from device malfunction or user error (using the wrong charger), and that there is no product testing required - those are all supported by the FEMA source. Secondly, in my view mentioning this in the LEAD is UNDUE. We do report major adverse events in articles about medical devices and drugs but this is exceedingly rare and the FEMA report mentions only 2 burns out of zillions of uses. Jytdog (talk) 18:57, 30 May 2016 (UTC)

Ten reasons the uncertainty statement needs to go

I sincerely hope other Wikipedia volunteers are willing to engage on this issue, and are not put off by my ramblings above. Accordingly, I hereby present my definitive case for why the line "The benefits and the health risks of e-cigarettes are uncertain" needs to go. I invite all interested volunteers to give it careful consideration and a meaningful and thorough response.

1. It is factually wrong. Nicotine addiction, accidental ingestion, and short term effects, are just three areas where the health risks of ecigs are very much known. Other risks are also extremely quantifiable, such as the issues surrounding batteries etc, and indeed that is precisely why regulations have been drawn up, acting on those certainties.

2. It goes against established professional writing practice in this field. The BBC link I gave above is a summary piece covering all the controversies surrounding ecig risks to date, and yet it does not include a similarly broad statement. Just like Wikipedia, the BBC's mission is to inform readers without much working knowledge of a topic. Unlike Wikipedia, the BBC has a reputation for giving unbiased information about controversial topics. Absent other reasons, it must be Wikipedia, not the BBC, who have erred here.

3. It is misleading. Outside the factual inaccuracies detailed already, the potential to mislead also arises in this assumption that readers coming to this line are naturally in the mindset of thinking that it applies to all potential and actual uses of ecigs, and indeed to third parties. Everything indicates this is not the case (not least the facts found later in the article about the history and usage of ecigs), and most readers coming afresh to the article would be operating on the assumption the line refers to smokers who vape as an alternative to smoking. The potential for confusion, even if that is just temporary until they receive clarification from later text, would be eliminated entirely if the sentence was simply not there. Assuming the alternative mitigation, providing some basic facts and figures about known usage prior to the blanket statement, would not be acceptable, as I suspect it would not.

4. It is redundant. It has been argued that its various vague meanings are acceptable because it is clarified in the text that immediately follows it. And yet it is precisely because they are there, that the reader would be oblivious to the line not even being there. I cannot think of a single way that any reader would be missing out if the statement was removed, but if it were, many readers would benefit, particularly those who perhaps don't read the whole introduction, or who are presented with a small snippet of the article which cuts it off after just a few lines, as happens a lot with technology these days.

5. It is not supported. I have been told above that Wikipedia is a tertiary source, and if readers have doubts about its claims or want to know how they originate, they can always substantiate them by looking at the underlying source. Looking at the three given in the article to support this sentence however, they are all quite clearly medical papers, written by and meant to be read by medical professionals. If the statement can be supported, then why not pick a more accessible but equally authoritative publisher, like the BBC? These medical sources are meant to be read by people who are perfectly capable of recognising and discounting the obvious issues with vague statements like this, either through common professional knowledge or because they already know from the paper what the intended context is. That is not the case here, the statement is presented and the only context given is the title and first paragraph. Context is provided after, sure, but since those statements do not come from the same papers, any suggestion that one is meant to relate to the other for the purposes of substantiation is misleading. Explaining what one paper might mean by referring to another paper is what a secondary source does, not a tertiary source like an encyclopedia.

6. It is dated. Its basic factual errors aside, and ignoring the fact short term risks do not stay unknown for long, it was obviously true once that people really had no idea of the risks, they really were "uncertain" in the dictionary definition sense. But day by day, that becomes an increasingly unsupportable position - the science is at the stage now where politicians are so confident of what they do know regarding the risks, they are issuing regulations to specify what makes a safe ecig. As this process moves forward, it only makes the statement more misleading, as readers surely wonder whether it is referring to regulated or unregulated vaping, or both. That adds another layer of doubt about its intended meaning, onto an already over-broad statement.

7. It is needlessly scaremongering. Undoubtedly the intended meaning of "uncertain" in this line is the dictionary definition - lacking in certainty. Professional writers, particularly those writing for the general public, would however fully recognise that most readers will interpret the word with negative connotations, particularly when it appears alongside "health risks" - the public is well attuned to the fact smoking has no benefits and its proponents had a long history of deliberately covering up health risks. This is another area where people need to be mindful of the difference between pieces written for medics and pieces by the likes of the BBC - scientists have no need to be reminded what "uncertain" does and does not mean.

8. It evidently violates Wikipedia's own summary style. As I understand it, the introduction serves as the summary of everything else in the article, and yet it has been argued that the sentence serves as a summary of what is also included in the introduction, namely the lines that come after it. Unless someone can clarify how I have misunderstood this aspect of Wikipedia style, I can only conclude it does not comply - either the rest of the text that follows it is misplaced or redundant, or the summary of the summary is redundant.

9. It is inconsistent with other Wikipedia articles. Take a look at the article on fracking, it also does not contain a similarly broad statement, even though that too is a subject with a multi-faceted health risk controversy. In an attempt to find other Wikipedia articles with this sort of vague sentence construct to determine if this was just a one off, a Google search of the terms uncertain health risks on the Wikipedia domain actually revealed no other subject specific articles except ecigs - all other results being generic articles about risk or medicine, and interestingly, the article for manufactured controversy.

10. It's the right thing to do, if the goal is presenting accurate, unbiased and informative articles to readers who have concerns over the risks of ecigs.

CrezT (talk) 16:28, 24 May 2016 (UTC)

tl/dr but basically no. none of that is based on WIkipedia's policies and guidelines. Jytdog (talk) 17:01, 24 May 2016 (UTC)

None of it? Is that a claim you think will stand up to even the most basic of scrutiny? In light of your previous advice about proper conduct, I ask you to reflect on the accuracy of this comment, and how it could be perceived. I was not the person who started issuing advice about proper conduct, that was yourself above, but as it is now out there and I am apparently beholden to it, I am not going to be shy about ensuring this is a level playing field. CrezT (talk) 19:30, 24 May 2016 (UTC)

Yes none of it. Which is not surprising, as you are new here. The content policies are WP:NPOV, V, WP:OR, and WP:NOT; relevant guidelines are WP:RS and WP:LEAD which is part of WP:MOS. Another guideline is WP:TPG and counter to what they advise, you just threw up a wall of text with your opinions, which aren't based on the policies and guidelines. We discuss article content based on the policies and guidelines, and it is best to be concise. Jytdog (talk) 19:46, 24 May 2016 (UTC)

My mention of style appears to follow LEAD, which is no surprise, as I was working from what was told to me about your own rules. Same goes for the tertiary issues, which is from OR it seems. My mentions of accuracy, misleading, etc, all seem to have support in neutrality and verification, as expected. At this point, after just this quick look, since nothing I said would go against what any reponsible encyclopedia for the general public would do, I am confident my only mistake is urging WP to emulate the standards of the BBC, which may very well not be a rule here, but I suspect that might not be the devastating blow to my argument you're trying to portray it as. Now, if your only issue is that I have not quoted specific lines of your rules, I can certainly try to accommodatre you, but it won't lessen my view that you are not taking my comments in the way TPG advises. CrezT (talk) 20:21, 24 May 2016 (UTC)

Please thread your comments by indenting them, per the TPG. And you are editing Wikipedia; every time you edit you agree to follow the policies and guidelines, per the Terms of Use - they are our rules and that includes you. Thanks.

The sentence summarizes the body, per WP:LEAD; the lead is redundant on purpose. Neutrality is defined by what all the reliable sources say, per WP:NPOV and this is what reliable sources say. Jytdog (talk) 20:58, 24 May 2016 (UTC)

Jytdog, you aren't being helpful here. Rather than giving a WP:ALPHABETSOUP and quite WP:BITEy dismissals, I'd rather see an argument on the merits of inclusion of the disputed sentence. Yes, CrezT wasn't concise, but that is not in itself a reason to dismiss all of his arguments. See my reply to Johnbod below. P.S. I'd appreciate if you wouldn't template me with the Arbcom notice, I'm well aware of it. I have this article on my watchlist, and have made some minor edits, but I don't intend to deep-delve into it. I only reacted to the increasing level of unhelpful sniping all-around. No such user (talk) 08:27, 25 May 2016 (UTC)

We don't just make things up here based on what people like or based on their opinions. I am not being snarky. Editing WIkipedia is nothing like writing a blog; content is governed by policies and guidelines that take some time to learn and understand. As a Wikipedia editor you are obligated to learn and follow them, and to be guided by the sources, the policies and guidelines, and to have your judgement informed by them when you are editing. Jytdog (talk) 15:33, 25 May 2016 (UTC)

Please try and find some way of making your comments relevant to what anyone else here has said or done, or at the very least make sure other people here know exactly what words or actions you are basing these comments on. If you do not, it will have to be assumed this behaviour is intentional, designed as much to annoy other participants as it is to delay proper discussion of the issue at hand, the disputed sentence. See also related earlier reply below. CrezT (talk) 18:17, 25 May 2016 (UTC)

I'll reply at your talk page; this is far afield from discussing content. Jytdog (talk) 22:09, 25 May 2016 (UTC)

Your message was just more of the same, yet another claim I have not understood some part of Wikipedia's rules, again without a shred of detail about which rule I have supposedly not followed. Indeed, these repeated unsolicited and unwarranted pieces of advice are wearing thin, so I expect them to cease. If you cannot control this urge to teach me, find a suitable intermediary, one with better understanding of how communicate effectively. On that score, again, you are subject to the same rules I am. Discussing content is not the mere act of saying words that vaguely or partially relate to it, they do actually need to relate to the truth and address what others have said, in proportionate detail, if you hope to remain in compliance. There is no get out clause for anyone here just because they're volunteers, that much is obvious from the rules I have read many times now - no compliance, no right to object to the proposed change. CrezT (talk) 01:31, 26 May 2016 (UTC)

Please do then base your comments on the sources, policies, and guidelines. Thanks. Jytdog (talk) 02:04, 26 May 2016 (UTC)

The rules that condemn behavour like this you mean? After everything that has been said, you can't have genuinely thought that you carrying on down this road would be received well, so what is it, if not a very basic and very obvious case of trolling? CrezT (talk) 04:22, 26 May 2016 (UTC)

What I am saying is that the current sentence is well supported by the sources and by the policies, and guidelines and you have not provided any basis in sources, policies, or guidelines why it isn't. Jytdog (talk) 04:27, 26 May 2016 (UTC)

It's obvious that is what you want to say, the issue is the complete lack of effort you have put into proving it is remotely true. It's blind assertion on your part, with others expected to work what it means and how it can be proven by fitting it to the facts and policy. But it does not fit. I've given a very detailed case why it is not correct, covering every part of your objection, not that it has more than two basic components. Yet you have avoided addressing it in detail throughout, instead preferring to stick with these vague, evasive and repetitive responses, despite specific requests for you to stop this TPG non compliant behaviour. As just one example, it is Wikipedia policy not to mislead readers with factually incorrect information. The sentence asserts the risks and benefits are uncertain, but I have given three examples of risks that are known, risks which you and others have been arguing must be within the intended scope of the sentence for it to retain the meaning you wish it to convey, i.e. to every possible device, use and timeframe, plus risk to third parties. This inconvenient truth is just one of a number of points you have not responded to, presumably because you cannot without undermining your own vague objections. This is why your opinion shall not count here when considering the consensus view, and that is straight out of the relevant Wikipedia rule - I checked and double checked, just to be sure. CrezT (talk) 13:55, 26 May 2016 (UTC)

Maybe it would help if you would draft a completion of: "The benefits and the health risks of e-cigarettes are now clearly known. They are: ..." Best of luck! Johnbod (talk) 17:34, 24 May 2016 (UTC)

I can help you by pointing out, as I learned from TPG, that deliberate misrepresentation is against Wikipedia's rules of proper conduct, even if intended as sarcasm (I hope it was, but it is not an easy thing to convey in text). As it happens, it would help if the statement was qualified with a bracket - ("except the risks that are known"). Are you suggesting that as a compromise solution? CrezT (talk) 19:30, 24 May 2016 (UTC)

Please, let's not go into the fallacy of the excluded middle territory. From a reader's viewpoint, I tend to agree with CrezT about the utter lack of informational value in said sentence (aka bullshit#In the philosophy of truth and rhetoric). Going forward, I think it should be replaced with a better summary from a newer source, along the lines of The benefits and the health risks of e-cigarettes are subject to extensive research. There is evidence that it has less/more X, Y and Z compared to regular cigarettes, and that it helps/does not help quitting. However, it poses risks of... Of course, all of that with a backing by the RS and consensus. But someone with more knowledge than myself should propose a wording first, I agree. No such user (talk) 08:27, 25 May 2016 (UTC)

I could get on board with substituting "subject to extensive research" or something similar in place of "unknown". I think the opposition here has clearly shown that since some risks and benefits are known, they can't all be unknown, and therefore a change in this phrasing is warranted. I'm not sure we need to spend all this effort to agree on that much, and hopefully it won't take another week of bickering to agree on what to change it to. Let's knock this out and move on. --GoneIn60 (talk) 10:12, 25 May 2016 (UTC)

Jytdog, the rules apply to you, so per TPG your replies need to stop containing obvious lies (my ten points have multiple crossovers with Wikipedia policy and guidance - deny it a third time if you want, it's still going to be false), deliberate misrepresentions of my arguments (you will not find in my ten points any statement that says the redundancy of the line is wrt to the main article, that is clearly not my issue), lacking in comprehensiveness (you'd have barely scratched the surface of my whole argument with these two points even if they were right), and in general being so vague as to be useless for the purposes of sensible discussion (reliable sources state some risks are known, so your last point is either patent nonsense, another deliberate lie, or a vacuous proforma statement you trot out regularly without any regard to the debate at hand). @others, it is clear this issue won't move forward until Jtydog and Johnbod improve their conduct. We're well past the point that this could simply be down to any kind of miscommunication or genuine disagreement about how to interpret the same facts. CrezT (talk) 13:42, 25 May 2016 (UTC)

CrezT What do you think is wrong with saying it's uncertain. Every review says it's uncertain and more time and research is needed for certainty. We know that x,y,z aren't in the vapour but we don't know exactly what the constituents of the vapour do over time with the level of exposure from e-cigarettes. SPACKlick (talk) 13:53, 25 May 2016 (UTC)

I gave ten reasons above. The very fact you had to explain what it means here in quite specific terms shows the issue - what reason do readers have to know that is what it means? Why would they conclude it only refers to vapour ingredients, or long term effects? And nicotine is an ingredient, so are the risks really uncertain there? I think not. It is vague to the point of misleading. More importantly, if it wasn't there, is that information lost? If not, why not - perhaps because the sentence is redundant to the more specific lines that follow it? (I am not referring to the main article, but what comes directly after it.) CrezT (talk) 14:07, 25 May 2016 (UTC)

Noting here for the record these two edits. [31][32], which have markedly changed the disputed wording. No need for anyone else to be confused by this dysfunctional talk page (and yes, I am making this same identical note in three related sections, and that is intentional). CrezT (talk) 18:22, 2 June 2016 (UTC)

adding content only to the lead

Zvi, would you please stop adding content/sources only to the lead? Per WP:LEAD, the lead summarizes the body. Things need to go there first, and then we update the lead if it rises to that. Thanks. Jytdog (talk) 01:08, 27 May 2016 (UTC)

Will move to body.Zvi Zig (talk • contribs 01:11, 27 May 2016 (UTC)

The introduction is too long. It's a small article all on its own, created from an assorted and disparate collection of sentences written in a process far removed from any idea you start by looking at the main article and summarise its main points. As a topical example, it currently claims fires and explosions have been reported [in trials]. The much disputed uncertainty sentence is not a summary, it's a verbatim copy of one found in the harm reduction section, yet presented and defended in the lead as if it refers to all risks. People making a conscious effort to summarise the main article simply wouldn't make such glaring and obvious mistakes. People constructing a mini-article from sources they want people to read first, before they can get better information from any of the rest of the page, would. Any suggestion this article currently complies with LEAD is as much a fiction as this idea all risks and benefits are still uncertain. CrezT (talk) 20:26, 27 May 2016 (UTC)

Yes, the lede is too long — but no it does not claim that fire has been reported in trials. Carl Fredik 💌 📧 10:53, 29 May 2016 (UTC)

It appears you figured out how it did, and just a day later. [33]. You really should note stuff like this for the benefit of others, if I hadn't seen it I would have wasted a few minutes explaining how it did, which is nonetheless completely moot now anyway as the entire line has gone. I completely echo the sentiments above about dysfunctional talk pages, that has been my experience throughout. CrezT (talk) 18:30, 2 June 2016 (UTC)

Elephants in the room

The user inhales the vapor,[2] which is called vaping.[4]. Congratulations to the author of this "sentence", supported by no less than two references to reliable sources, and to all who permitted this abomination of English syntax to stand in the second sentence of a major article. The whole lead section sounds as if written by a 3rd-grader. I'm removing this abomination of an article and its dysfunctional talk page from my watchlist, and I regret getting myself involved. Keep on doing a lousy job. No such user (talk) 21:21, 5 June 2016 (UTC)

The uncertainty statement is not supported by the three papers provided

With nothing else to do while the stonewalling is in full flow above, I just looked in detail at the abstracts of the three medical sources used to support this uncertainty sentence.

https://www.ncbi.nlm.nih.gov/pubmed/25572196

Counseling patients on the use of electronic cigarettes.

Electronic cigarettes (e-cigarettes) have substantially increased in popularity. Clear evidence about the safety of e-cigarettes is lacking, and laboratory experiments and case reports suggest these products may be associated with potential adverse health consequences. The effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch combined with minimal behavioral support. Although a role for e-cigarettes in the treatment of tobacco dependence may emerge in the future, the potential risk of e-cigarettes outweighs their known benefit as a recommended tobacco treatment strategy by clinicians. Patients should be counseled on the known efficacy and potential risks of e-cigarettes.

https://www.ncbi.nlm.nih.gov/pubmed/26389730

Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement.

DESCRIPTION:

Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on counseling and interventions to prevent tobacco use and tobacco-related disease in adults, including pregnant women.

https://www.ncbi.nlm.nih.gov/pubmed/24898072

Electronic nicotine delivery systems ("e-cigarettes"): review of safety and smoking cessation efficacy.

BACKGROUND AND OBJECTIVES:

Cigarette smoking is common among cancer patients and is associated with negative outcomes. Electronic nicotine delivery systems ("e-cigarettes") are rapidly growing in popularity and use, but there is limited information on their safety or effectiveness in helping individuals quit smoking.

Clearly these sources are not supporting the statement in the way its defenders have argued it should be read, i.e. with reference to the risks and benefits of all ecig users - smokers trying to quit, smokers not trying to quit and people who have never smoked, as well as to third parties. Other sources need to be found, ones which match the intended scope of the sentence. If not, it has to go. That is unambiguous Wikipedia policy. CrezT (talk) 16:53, 27 May 2016 (UTC)

Noting here for the record these two edits. [34][35], which have markedly changed the disputed wording. No need for anyone else to be confused by this dysfunctional talk page (and yes, I am making this same identical note in three related sections, and that is intentional). CrezT (talk) 18:22, 2 June 2016 (UTC)

Doc James has now restored the disputed sentence, [36], claiming not to see consensus. That's.....interesting, as I can't see where anyone has even bothered to reply in this section, which was very pertinent to his briefly stated opinion, or address in detail any of the other issues. Seeing is believing, or not as the case may be. CrezT (talk) 05:58, 7 June 2016 (UTC)