Talk:Electronic cigarette/Archive 8

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Another Cessation Study That Has Been Added

See [diff]. The New York Times has been used as the source which obviously does not really conform with WP:MEDRS, the article is I believe based on this press release in the peer-reviewed Addiction journal: [[1]] The study is not actually published until tomorrow (midnight tonight UK time, which is a couple of hours away). It is not a systematic review but it has been peer-reviewed and renowned UK organisations like University College London and Cancer Research are involved. It also seemingly directly addresses the issue of e-cigarettes and smoking cessation in an area where data in general is lacking at present. Although 6000 people took part, I'm not sure of the quality of the methodology of the study, maybe others can comment here and more will obviously become apparent when its published. The question is should we wait for this to be reviewed or should we keep it? — Preceding unsigned comment added by Levelledout (talk • contribs) 21:17, 20 May 2014 (UTC)

Consensus so far has been not to use non-WP:MEDRS sources (and non-reviews) for information such as this. NYT is certainly not a valid source for this. --Kim D. Petersen 21:59, 20 May 2014 (UTC)

What do you mean it is not reliable? This is not an article about Medicine, and the article is not attempting to diagnose or treat a disease. Cwobeel (talk) 22:09, 20 May 2014 (UTC)

The survey and the results are medical data - NYT is not a reliable source for interpreting science. It is a reliable source for many other things though. --Kim D. Petersen 22:12, 20 May 2014 (UTC)

Yes we need high quality secondary sources and position statements of major organizations. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:59, 20 May 2014 (UTC)

That is a very narrow interpretation of policies, and I respectfully disagree with your assessments. Cwobeel (talk) 00:09, 21 May 2014 (UTC)

There certainly are some narrow interpretations going on here, such as the utterly baseless claim that to be WP:MEDRS a source has to be PubMed-indexed, but in this case it's reasonable to ask for a better source. Like this one.--FergusM1970^{Let's play Freckles} 00:29, 21 May 2014 (UTC)

I think it would be better to follow WP:CON and wait until a consensus has developed on this matter rather than descend into a mini-edit war after almost every post. Levelledout (talk) 00:52, 21 May 2014 (UTC)

The NYT article, and the primary journal article are not WP:MEDRS compliant. When this study is reviewed and placed in context by a MEDRS compliant secondary source like a review article, we can include said information. Yobol (talk) 01:16, 21 May 2014 (UTC)

My previous post was not a complaint that it had been removed, it was a complaint that the information had been reverted back and forth 4 times in the last 24 hours. — Preceding unsigned comment added by Levelledout (talk • contribs) 01:23, 21 May 2014 (UTC)

This approach to argue for WP:MEDRS is totally stupid. This is a survey reported in reliable secondary sources, not an assertion of a cure or a medicine. Cwobeel (talk) 02:29, 21 May 2014 (UTC)

The problem is that you have come to the determination that the NYT is a reliable source for medical claims. It is not. Yobol (talk) 03:31, 21 May 2014 (UTC)

I've asked several times for someone to show me where MEDRS says primary sources can't be used. Zip. Yes, I know it says they can't be used to rebut secondary sources, but MEDRS does not say they can't be used at all.--FergusM1970^{Let's play Freckles} 03:57, 21 May 2014 (UTC)

You should stop asking. Everyone knows primary sources are generally not acceptable. Claiming "MEDRS does not say they can't be used at all" is not the point. We got plenty of good sources. QuackGuru (talk) 04:09, 21 May 2014 (UTC)

Exactly, the issue is that primary sources are allowed, but they are generally considered worse as they are less reliable than secondary sources. Therefore they should only be used when there is a lack of secondary sources concerning a topic, and in this case there is no lack. Any perceived lack due to secondary sources only pointing in one direction should be telling for the stance of the medical community at large. CFCF (talk · contribs · email) 09:12, 21 May 2014 (UTC)

But the secondary sources aren't all pointing in one direction. I know that's the accepted version here, where WHO FAQs are counted as secondary sources and the Smoking Toolkit Survey isn't, but the evidence is in fact quite conclusive that e-cigs are not an obstacle to smoking cessation. Even Glantz seems to acknowledge this; his latest utterance is very revealing.--FergusM1970^{Let's play Freckles} 12:46, 21 May 2014 (UTC)

I quote from the WP e-cigarette article, "The review found no studies that directly measured the effectiveness of electronic cigarettes in smoking cessation". Levelledout (talk) 10:16, 21 May 2014 (UTC)

I'm sure there have been several. The Bullen study, for example, or the Italian one. They consistently find that e-cigs - even cigalikes - are at least as effective as licensed NRT.--FergusM1970^{Let's play Freckles} 15:08, 21 May 2014 (UTC)

Well the review from my previous quote was published in 2011 so that information may be outdated to some extent. My point was as much intended to illustrate the fact that there is a lack of systematic reviews using direct studies on cessation. So other than position statements which echo this decent primary sources are (mainly) all we have. In fact we already have several primary sources in the article's cessation section.Levelledout (talk) 18:34, 21 May 2014 (UTC)

Well here is the study anyway which has now been published: [[2]]Levelledout (talk) 18:34, 21 May 2014 (UTC)

I fail to understand the arguments made here. This study is a survey, not a medical treatment or a quack, or any other medicine-related study. So why are folks here referring to WP:MEDRS???? Enlighten me, please. Cwobeel (talk) 22:14, 21 May 2014 (UTC)

Since the survey you are referring to, is published in a peer-reviewed medical journal, it is classified as science. And as such a summary from a non-science source wouldn't be reliable, regardless of the general reliability of the non-science source, thus the requirement for WP:MEDRS on such info. Newspapers and other such media are generally very poor at summarizing science and interpreting the results. Other than that, the information is interesting, and hopefully will be covered in a review within a short while, and thus end up being written about here. --Kim D. Petersen 22:36, 21 May 2014 (UTC)

So the policy you are then invoking is WP:PRIMARY? I am still confused, sorry. Cwobeel (talk) 22:41, 21 May 2014 (UTC)

Why we can't quote directly from a peer-reviewed article? Cwobeel (talk) 22:42, 21 May 2014 (UTC)

Per WP:SCHOLARSHIP: Many Wikipedia articles rely on scholarly material. When available, academic and peer-reviewed publications, scholarly monographs, and textbooks are usually the most reliable sources. Cwobeel (talk) 22:44, 21 May 2014 (UTC)

You can use the peer-reviewed paper as a source. What you can't do is use a newspaper article about the peer-reviewed paper.--FergusM1970^{Let's play Freckles} 14:46, 22 May 2014 (UTC)

OMG, all this discussion for just saying that the NYT article can't be used, but the peer reviewed article can? This is nuts. Cwobeel (talk) 16:57, 22 May 2014 (UTC)

According to this edit we can't use the peer-reviewed article. User:FergusM1970, you should not delete the peer-reviewed source. QuackGuru (talk) 18:28, 22 May 2014 (UTC)

Regardless of whether removal of the information was right or wrong in this particular case, it must be admitted that WP:CON and WP:NPOV were not adhered to in the first place. WP:CON was not followed due to editing (adding information) during a dispute before a consensus had been reached (same as the FDA information). WP:NPOV, well that one is obvious to a greater extent but included:

• Opinions were stated as facts in Wikipedia's voice
• Judgemental, biased language was used, e.g. "to evade smoke-free laws"
• No attempt was made to indicate the relative prominence of opposing views

Levelledout (talk) 22:42, 22 May 2014 (UTC)

CON was not followed and this was the result. Questioning reliable sources again is not productive. QuackGuru (talk) 23:04, 22 May 2014 (UTC)

I have no intention of commenting on slurs on other editors. However, I politely ask you to consider why these policies might not be being implemented and to respond as they are very important policies, NPOV for example is a "core policy". I am not trying to get into an argument, I am simply trying to improve the article and to do that it is pretty much vital that we are all agreed on following these policies.Levelledout (talk) 00:06, 23 May 2014 (UTC)

Speaking as the implementor of that block, it was a special circumstance that reflected a long standing issue not fully relevant to this conversation. However, that does not mean that your position is incorrect. Levelledout, rather than arguing about whether procedure was followed, can you concisely state what your objections are with the current state of the article? Thanks, NW (Talk) 03:21, 23 May 2014 (UTC)

I think the fact that edits were being made during disputes ([here] for example where an edit was made which disregarded both the FDA and the Circulation Study disputes) is an important issue to raise and sort out and I still think that there is a case to answer.

However, on the separate issue yes I am quite prepared to clearly define all of my general present objections to the article. Unfortunately I don't have time to right now but I will do this when I get this chance, possibly in a new section as it would probably be more appropriate there.Levelledout (talk) 13:23, 23 May 2014 (UTC)

Two new reports by Public Health England on E-cigarettes.

• Britton, John; Bogdanovica, Ilze (May 15, 2014), Electronic cigarettes - A report commissioned by Public Health England (PDF), Public Health England {{citation}}: Cite has empty unknown parameter: |1= (help)
• Bauld, Linda; Angus, Kathryn; de Andrade, Marisa (May 15, 2014), E-cigarette uptake and marketing - A report commissioned by Public Health England (PDF), Public Health England

--Kim D. Petersen 23:37, 24 May 2014 (UTC)

Press release page[3] --Kim D. Petersen 23:38, 24 May 2014 (UTC)

NPOV Edits

Hello, I have made some edits to the lead to try to improve on NPOV. I was going to provide a long list of everything that I thought could be improved with the article but I thought it would just be easier to go ahead and start making some changes to see if people agreed that they were suitable. I have not added any new sources here, just done some rewording, removed a couple of things and moved/copied a couple of others around. It's pretty much all listed below anyway.

My main problems with the content of the article are that opinions are commonly stated as facts, the prominence of opposing views of often not represented and on a minority of occasions content is simply plain biased and partial. All of that obviously comes under the umbrella of WP:NPOV.

If you have a problem with any of what has been done below please reply so we can discuss the issue.

• "They carry a risk of nicotine addiction *to non-smokers*".

Changed (added "to non-smokers") to reflect obvious reality and the actual findings of the study.

• "There are concerns that these products should be adequately regulated, mainly to protect users, while avoiding unintended consequences caused by excessive or inappropriate regulation."

Removed because, in order to reflect the actual conclusions of the study, I would have to change this to something like: "One study stated that the products should be adequately regulated but that this should be done on the basis of an "enabling framework" This would have represented a minority opinion within the medical/academic establishment too prominently, particularly in the lead of the article.

• "while some young people who have never smoked cigarettes have tried electronic cigarettes at least once."

Removed because the scenario is so inevitable that it is statistically meaningless. Of course at least one young person in the world somewhere who has never smoked a cigarette has used an electronic cigarette at least once, at least one young person somewhere in the world who has never smoked a cigarette has used every single other drug in existence at least once and done everything else you could possibly imagine. It doesn't add anything to the article, it just creates a vague impression that there is a problem with e-cigarettes and non-smoking young people, which is not proven, particularly internationally.

• "One study found that frequency of use has increased with up to 10% of American high school students having ever used electronic cigarettes as of 2012 and around 3.4% of American adults as of 2011."

Removed because they are tabloid statistics, that is the highest, most exaggerated ("ever use"), most shocking (children involved) statistics have been selected. Replaced with an opinion from the same study and an opposing opinion from ASH UK. — Preceding unsigned comment added by Levelledout (talk • contribs) 14:31, 24 May 2014 (UTC)

A review article is not a tabloid [4] Thus reverted. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:48, 24 May 2014 (UTC)

Frequency of use is correlated in that text with ever-use - that is tabloid usage of statistics. What are your comments on the other changes? And how do you propose solving the perceived POV problem? Reverting back didn't resolve that - did it? --Kim D. Petersen 16:31, 24 May 2014 (UTC)

• If someone is already a smoker, they can maintain their addition by using e-cigs thus "to non-smokers" is not really needed. You are correct that the WHO ref didn't support it entirely thus added another ref which supports in those already smoking.
• This [5] is a 2014 review article and is not just the conclusions of "One study"
• There are primary sources that state it is fairly frequent. This second source sees it as notable enough to mention thus there is no concern with us doing the same. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:53, 24 May 2014 (UTC)

• When stating "risk of addiction" then it begs the question "to whom" and "by what". This is not written for medical professionals.
• So read that as "one review stated" - we have several reviews here, who do not agree with each other.
• Of course there is a concern, particularly because other reviews state that it isn't a concern for instance the Saitta et al(2014) that you mention in your second bullet. I quote "Regulatory authorities have expressed concern about e-cigarette use by youngsters or by never smokers, with e-cigarettes becoming a gateway to smoking or becoming a new form of addiction. However, such concerns are unsubstantiated by existing data that e-cigarette use by youngsters is virtually nonexistent unless they are smokers [Centers for Disease Control and Prevention, 2013; Dockrell et al. 2013; Camengaa et al. 2014] and in fact the use of e-cigarettes may serve as a gateway ‘out’ of smoking [Polosa and Caponnetto, 2013a]." add to this that the British large scale population study finds no statistically significant usage amongst non-smokers (including adolecents)

What you aren't doing here is addressing the weight of the literature which we have to do when writing in an WP:NPOV manner. Reviews aren't agreeing - thus there is a significant discordance amongst scholars on some of these issues (for instance usage amongst youth, and the "gateway idea"), and we can't just use whatever fact we find in a review as being gospel. --Kim D. Petersen 17:23, 24 May 2014 (UTC)

Let me summerize my comment into: Having a secondary sources stating something does not mean that you can uncritically add that information, a secondary source is only the first tier for making content available for use, you still have to address the weight of the literature, and balance between views based on that. --Kim D. Petersen 18:19, 24 May 2014 (UTC)

Doc James, please explain why you felt it necessary to revert the whole edit without keeping any of it? You could also have discussed the situation here first to seek a compromise but you didn't. To be honest you seem to miss the whole point that I am trying to improve the NPOV of the article, you seem more interested in justifying a certain POV instead of engaging in this discussion, I hope I am wrong.

• With regards to the contents, yes the usage statistics were selected in and presented in a tabloid manner which is why they were removed. If we are going to put those statistics there, then why choose those ones from the Usage Statistics section and not the ones that say "among non-smokers under 18, 1% reported having tried e-cigarettes "once or twice," 0% reported continuing use, and 0% intended to try them in the future" (which of course would be equally biased as your proposal)?

• "A risk of nicotine addiction" is not the same thing as "maintaining a nicotine addiction which already exists" and this should be made clear if we are the slightest bit interested in presenting the article in an impartial way.

• With regards to the review article, great if you found a valid source, I have no problem with that. Now you found a source, how about we represent the opposing minority point of view as of WP:NPOV in the original source somewhere in the article which states:

‘there is place for regulation, but it should be to create an “enabling framework” for these new, much less risky, alternatives to smoking to enter the market in a way that gives consumers confidence in switching from smoking’

• I propose we revert back to my edit eventually with whatever compromises are necessary because I think the revert by Doc James was unjustified.Levelledout (talk) 18:21, 24 May 2014 (UTC)

per WP:BRD let us finish the discussion first. You were bold, Doc James reverted, and now we'll discuss it for a bit :) --Kim D. Petersen 18:28, 24 May 2014 (UTC)

We state "They carry a risk of nicotine addiction" to what is obviously "nicotine". Have clarified to "They carry a risk of nicotine addiction in those who do not already smoke,[11] and possibly continue addition in those who already smoke." Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:29, 24 May 2014 (UTC)

(edit conflict)*"Who do not already smoke"? That would indicate that you believe that vaping is smoking. Should be rewritten - non-smokers is significantly more clear.

• Do they really carry such an "addition"? What refs are you using for that. (for instance the Saitta et al(2014) states that such concerns seem to be unfounded). What is the weight?
• Do we have such concerns mentioned in the lede on other nicotine replacement products? Why not? Iirc the Cochrane review states that such is a concern for NRTs. Is it because they are medical products?

-- Kim D. Petersen 19:42, 24 May 2014 (UTC) — Preceding unsigned comment added by Levelledout (talk • contribs)

I have tried a compromise, now changed to

• "There is also a possible risk of continued addiction to nicotine in people who substitute tobacco for electronic cigarettes."

I have also removed (again)

• while some young people who have never smoked cigarettes have tried electronic cigarettes at least once.

If anybody thinks that this should still be in there please clearly justify why. I have given my reasons at the top of this section and nobody has countered them.

The only thing I have a major problem with now is the usage statistics which are still substantially biased IMO. I really don't think we can justify keeping them in there unless we include some other ones that illustrate an alternative POV. Even if you don't agree with all of the other points raised about them, these are US statistics if I'm not mistaken and Wikipedia is not supposed to give special focus to one country. In the UK, completely different conclusions have been reached.

I also think we need to include something positive about e-cigarettes in the paragraph we have been editing because there is nothing in there whatsoever, only neutral and negative opinions. Something along the lines of "e-cigarettes are considered likely to be safer than tobacco according to SO&SO", backed up with a valid source of course. Anyone got any objections to that? — Preceding unsigned comment added by Levelledout (talk • contribs) 20:34, 24 May 2014 (UTC)

This "among non-smokers under 18, 1% reported having tried e-cigarettes "once or twice," 0% reported continuing use, and 0% intended to try them in the future" (which of course would be equally biased as your proposal)?" is from a primary source. Should really be removed from the article but definately should not be in the lead. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:32, 24 May 2014 (UTC)

I do not see that in the lede, but in the usage statistics section. And it is a secondary source from a major British health organization (ASH). --Kim D. Petersen 19:49, 24 May 2014 (UTC)

The proposal seems to be to put it in the lead and it is a single survey done by ASH. It is not published in a journal. And major, I'm not so sure. This article does comment on it though [6] Am happy to see it continue to be used as it is. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:59, 24 May 2014 (UTC)

Lots of statements and data from health organizations are used within the article, which have not been published in a journal. You, yourself, even added such a non-journal organization citation in the lede today.[7]. --Kim D. Petersen 22:44, 24 May 2014 (UTC)

It was not a serious proposal and if you re-read my original comment I'm sure you'll realise that. What I said was done to illustrate how biased it appears now with just comment about 10% of American children having ever picked up an e-cigarette possibly once in their entire lifetime.Levelledout (talk) 20:42, 24 May 2014 (UTC)

Joining a lengthy conversation late in the game, but wasn't sure if this new review in the Journal of Psychiatric Research had been noted yet. The CDC hates these things, as does the American Heart Association, the American Cancer Society, The American Association of Pediatrics, the American Society for Clinical Oncology and the World Health Organization. I apologize for joining the conversation late, especially if the above has already been discussed, but who is on the other side of this issue such that we should not present these as an overall negative for public health as the mainstream position? Best Formerly 98 (talk) 20:48, 24 May 2014 (UTC)

Yep, there seems to be a rather huge divide between a puritan and a harm reduction approach to the subject at hand. Much of which seems to divide the European and US approaches to the topic. (albeit not entirely - both have their proponents on each side of the pond) --Kim D. Petersen 21:06, 24 May 2014 (UTC) [Sorry bit of a hurry here - saw the question late. Read the recent reviews by (Grana et al(2014)) and compare to (Saitta et al(2014)) which kinda shows the two different stances towards the same data. --Kim D. Petersen 21:10, 24 May 2014 (UTC)

Thanks I'll look at the reviews. But I think its a lot more complicated than simply writing the folks onthe other side of the issue off as "puritans" and proclaiming those who agree with you as "harm reducers". Formerly 98 (talk) 22:45, 24 May 2014 (UTC)

I think you misunderstand me. I do not write them off by naming these two approaches - i was using the description that Prof. Robert J. West[8] was recently using in an interview. Neither of those two approaches are inherently right or wrong, they are simply different views upon the same. Call them paradigms if you will :) --Kim D. Petersen 22:52, 24 May 2014 (UTC) - as an example of how the harm-reduction approach is gaining in the UK, there is a new report (May 2014) for Public Health England that illustrates this (and describes them)[9]. --Kim D. Petersen 23:28, 24 May 2014 (UTC)

Well Kim, whoever came up with that nomenclature, its seems like an obvious attempt to trivialize the views of those on one side of the issue by defining them as choosing outmoded scruples over real life benefits. I don't think its use will help faciltitate communication Formerly 98 (talk) 02:27, 25 May 2014 (UTC)

Well what a surprise, QuackGuru has done another one of their covert edits where he has reverted my compromise entirely without even bothering to mention it anywhere. And added a bunch of POV material for good measure of course Levelledout (talk) 00:51, 25 May 2014 (UTC)

I disagree with your changes because your changes were not an improvement. QuackGuru (talk) 01:25, 25 May 2014 (UTC)

Could you please argue your disagreements, instead of assert, and edit-war them? --Kim D. Petersen 01:44, 25 May 2014 (UTC)

"I disagree with your changes because your changes were not an improvement" is the anti-thesis of an argument. Unfortunately you have to provide actual reasons, simply saying "I don't like it" is meaningless.Levelledout (talk) 02:35, 25 May 2014 (UTC)

Please explain how this is NPOV.

Could someone explain to me how this edit by User:QuackGuru represents a WP:NPOV representation of the literature?

Although the evidence is limited, research points to high levels of dual use of e-cigarettes with traditional cigarettes, no proven cessation assistance, and a rapid increase in youth initiation with e-cigarettes.

This is based on the very recent Grana(May 2014) review, but considering that another recent review Saitta(march 2014) has this to say (i've ignored dual use in the below):

• No proven cessation assistance:

  Today, a growing body of scientific studies on e-cigarettes and liquids supports the efficacy and safety of these products. Even smokers who do not want to quit may do so when introduced to e-cigarettes [Polosa et al. 2011, 2013] and the overall level of risk is much lower than cigarette smoking, with no chemicals raising serious health concerns in e-liquids [Cahn and Siegel, 2011; Goniewicz et al. 2013]. In the most comprehensive systematic review of chemical studies to date, Burstyn concluded that there is no evidence that ‘vaping’, that is neologism, coined to indicate the act of vaporizing the liquid contained in e-cigarettes, produces inhalable exposures to contaminants of aerosol that would warrant health concerns [Burstyn, 2013]. However, chronic inhalation data in humans are needed before any definite conclusions are made.

• Youth initiation:

  Regulatory authorities have expressed concern about e-cigarette use by youngsters or by never smokers, with e-cigarettes becoming a gateway to smoking or becoming a new form of addiction. However, such concerns are unsubstantiated by existing data that e-cigarette use by youngsters is virtually nonexistent unless they are smokers [Centers for Disease Control and Prevention, 2013; Dockrell et al. 2013; Camengaa et al. 2014] and in fact the use of e-cigarettes may serve as a gateway ‘out’ of smoking [Polosa and Caponnetto, 2013a].

How can we then use Wikipedia's voice to state the first as fact? Does WP:MEDRS negate WP:NPOV and WP:WEIGHT? (representing views appropriately and balanced according to their prevalence in reliable secondary sources)? This is only one of my problems with recent edits. --Kim D. Petersen 20:19, 25 May 2014 (UTC)

(edit conflict):As a further comment: This seems to be symptomatic here, that editors consider a WP:MEDRS review to be gospel, and that they can indiscriminately use what is written within such, without considering what the WP:MEDRS literature en masse is saying. --Kim D. Petersen 20:27, 25 May 2014 (UTC)

We are not asserting it as fact because there is a qualifier: "Although the evidence is limited,...". QuackGuru (talk) 20:26, 25 May 2014 (UTC)

That does not explain how you can use this as if it is fact, and not consider the rest of the literature on the topic. This is one view stated as fact. --Kim D. Petersen 20:28, 25 May 2014 (UTC)

If the qualifier was removed then you would have an argument. The text clearly stated the evidence is limited. QuackGuru (talk) 20:36, 25 May 2014 (UTC)

The text including the qualifier is written in Wikipedia's voice, as if fact. And as my above quotes show, neither the text without, nor with the qualifier is undisputed fact. --Kim D. Petersen 20:43, 25 May 2014 (UTC)

You haven't shown there is a dispute that the "evidence is limited". QuackGuru (talk) 20:50, 25 May 2014 (UTC)

I'm sorry? The sentence is composed of more than the first few words. Even if we agree on "the evidence is limited" - there are several other claims/assessments made in that sentence that are not supported by a weighted neutral reading of the literature. --Kim D. Petersen 20:55, 25 May 2014 (UTC)

The source indicates "the evidence is limited" and no evidence to the contrary has been presented. You haven't shown that the text is not supported by a weighted neutral reading of the literature. QuackGuru (talk) 06:18, 26 May 2014 (UTC)

Legal status of electronic cigarettes

Because the article has grown significantly I found it of value to split the legal section into a new list-class article. It is possible we ought mention a little more than I left here, but I think this is an improvement which adds to the overall readability of the article. CFCF (talk · contribs · email) 14:48, 27 May 2014 (UTC)

This is getting too POV. We are now claiming E-cigs are as dangerous as cigs.

These new edits[10], now have our article state that:

Electronic cigarettes are generally perceived erroneously as less hazardous than traditional cigarettes, when their health risk is similar.[16]

Considering that the reference given is O'Connor(2012)[11] which specifically states:

The limited data available suggest that the products are not likely to approach the health hazards of cigarettes (page 6)

I'm flabbergasted - truly flabbergasted. --Kim D. Petersen 18:56, 27 May 2014 (UTC)

Kim you are correct, the content isn't supported by the source cited. The source cited is making that comment about "Smoked forms of tobacco" and not e-cigs. QuackGuru it appears in this edit, the content provided isn't supported by the source. It looks like you're summarizing the intro paragraphs of the source, which is talking about smoked tobacco products, not e-cigs. Can you please double-check and correct as necessary. Zad68 19:06, 27 May 2014 (UTC)

I checked it again and made the corrections. QuackGuru (talk) 19:25, 27 May 2014 (UTC)

And why do you now start to talk about smokeless tobacco in the article? It is not even within the topic area. Snus and e-cigs have nothing except nicotine in common. What was wrong with the old sentence? " Electronic cigarettes should have fewer toxic effects than traditional cigarettes," which is supported by just about every review out there (including Grana)? And which was removed with the text "Mass original research." --Kim D. Petersen 19:31, 27 May 2014 (UTC)

I moved the text to smokeless tobacco. The old sentence was replaced with the new sentence: Limited evidence suggests e-cigarettes are safer than real cigarettes, and possibly as safe as other nicotine replacement products.[12] QuackGuru (talk) 19:45, 27 May 2014 (UTC)

POV tag

I've tagged the article with POV now. There are several unresolved threads relating content already here on the talk-page, and still more content is added to the article that relies on a single review. The changes to the lede, relating to this, such as a sentence such as:

The e-cigarette aerosol delivers nicotine, ultrafine particles, other toxic chemicals, and carcinogens.[1] There is a poor relationship between labeled and existing nicotine content, as well as differing levels of other chemicals and toxicants in the e-liquid and aerosol.[1]

Is putting significant weight on something that i haven't seen other reviews do, and seem to indicate that some editors simply want to describe this topic as negatively as possible. --Kim D. Petersen 13:11, 26 May 2014 (UTC)

There is no issue if the question hasn't even been raised. I see your discussion above, where I fail to see an argument. You can't just say "I don't like this sentence" and tag an entire article NPOV. What is the issue here? CFCF (talk · contribs · email) 13:35, 26 May 2014 (UTC)

Please do not remove the tag while there are active discussions about the neutrality of the article. The tag is there to attract editors with different viewpoints to edit or give additional insight. --Kim D. Petersen 14:56, 26 May 2014 (UTC)

I agree that the neutrality of the article is seriously compromised, I have personally highlighted my reasons for one paragraph of the article alone in the section "NPOV Edits above". Since all of my original changes have been reverted, this is still relevant.

What I have said in the NPOV Edits section is relevant to the rest of the article, also the Grana study has been grossly overused to push a particular POV and, for example, simply sticking "despite the fact that evidence is limited" in front of a very partisan statement does not mean it has been presented in an impartial way. I may add some more to this argument later.

Levelledout (talk) 15:25, 26 May 2014 (UTC)

I'll just add that I mainly listed my actual objections regarding neutrality near the end of the "Another Cessation Study Has Been Added" section.Levelledout (talk) 15:37, 26 May 2014 (UTC)

Unfortunately, more highly contentious material continues to be added to the article, presented as absolute fact such as:

• "The e-cigarette aerosol contains nicotine, ultrafine particles, other toxic chemicals, and carcinogens"

Other content has questionable relevance and is simply being used to push a POV, again presented in a highly opinionated manner stated as fact:

• "A disproportionate use of flavored traditional tobacco products are used by youth and initiators, and flavored cigarettes except menthol have been banned in the U.S."

Yet further material has been added in a partisan, highly opinionated manner:

• "The e-cigarette brands have been rapidly expanding using aggressive marketing campaigns similar to those used to popularize cigarettes in the 1950s and 1960s."

And this has crept in somewhere along the line for good measure:

• "There is a poor relationship between labeled and existing nicotine content, as well as differing levels of other chemicals and toxicants in the e-liquid and aerosol."

There are in fact 26, yes 26, separate references to the Grana study in the article.Levelledout (talk) 17:48, 26 May 2014 (UTC)

An article wide POV tag is not justified. The purpose of the tag is to attract editors with a variety of viewpoints and we have that already. There is no indication that all sections of the article have POV problems, which is what an article wide tag indicates. There is a relatively minor disagreement over weight. The article wide tag should be removed. Zad68 17:55, 26 May 2014 (UTC)

Since it is quite apparent that there isn't a lot of editors discussing the various issues here on talk - then an influx is needed. As far as i can tell, we have a few independent editors, and the rest are all from the WP:MED project, which not in itself is bad, but also means that they come with a certain POV attached, and a lack of knowledge about the topic itself. --Kim D. Petersen 18:16, 26 May 2014 (UTC)

And the trouble is spread all over the article at this moment. And it involves the lede as well, that makes it not a point-problem, but a systematic one. --Kim D. Petersen 18:21, 26 May 2014 (UTC)

To illustrate: Since i added the tag, and described my problems with relying on a single review, 7 new additions to the article, in 5 different sections, citing this review has been added[12] without any discussion (or apparent critical reading of what other reviews say). --Kim D. Petersen 18:35, 26 May 2014 (UTC)

The tag has to go. No legitimate reason has been given to keep the tag. QuackGuru (talk) 18:05, 26 May 2014 (UTC)

I'm aware that you can't see the problems, which is one of the problems. The reliance on ONE source alone in your edits, is one major POV problem here - we need a balanced approach taking all reliable sources into account, and determining the individual merit and weight of each issue from the sources. --Kim D. Petersen 18:19, 26 May 2014 (UTC)

And there we go - another revert of the tag[13] without even marking it up as a revert. Sigh. Not going to try to edit-war it, it simply confirms the POV problems to me, and indicates WP:OWN problems on top. --Kim D. Petersen 18:54, 26 May 2014 (UTC)

All these amendments in connection to _one_ (biased) paper, which says exactly the opposite of a large majority of published papers -> This article does need the POV-Tag for sure! --Merlin 1971 (talk) 19:11, 26 May 2014 (UTC)

I think this dispute should be escalated, it is a ridiculous situation, most of us have no control or say over the article whatsoever. I personally do not have the experience to escalate the dispute, hopefully someone else does. I am quite prepared to help in anyway I can.Levelledout (talk) 20:35, 26 May 2014 (UTC)

Did not realise POV tag had been reinserted. I retract my previous comment regarding escalation for now but reserve it for immediate future use should the POV tag yet again be edit-warred out of the article.Levelledout (talk) 21:02, 26 May 2014 (UTC)

POV tag is absolutely justified. Claims like: "The e-cigarette aerosol delivers nicotine, ultrafine particles, other toxic chemicals, and carcinogens." are written in a incendiary fashion that only presents half truths. The source clearly sates that "The levels of toxicants in the aerosol were 1 to 2 orders of magnitude lower than in cigarette smoke but higher than with a nicotine inhaler". Just stating that e-cigs deliver crap without saying how much of the said crap is being delivered is biased. — Preceding unsigned comment added by 184.70.5.58 (talk) 04:58, 27 May 2014 (UTC)

Then this could easily be changed, we don't need an article wide-tag for that. CFCF (talk · contribs · email) 06:52, 27 May 2014 (UTC)

Since the problems raised so far are all over the article, the problem is systematic, and not a point-problem. What is it that is so scary about attracting more editors to take a look at the problem? Please adhere to what the tag states "Please do not remove this message until the dispute is resolved.", and check WP:NPOVD so that we can get on. --Kim D. Petersen 13:18, 27 May 2014 (UTC)

Looking at this from the outside, I'd offer the following commnents:

• Electronic cigarettes are almost certainly better for you than smoking, and almost certainly worse for you than using nothing at all. So the harm reduction issue comes down to how large these differences are and whether e-cigs are used by significant number of people to reduce or eliminate their smoking habit, vs being used as a recreational drug or introducing people to smoking. For all the back and forth, it really looks like they are too new for these things to be known with certainty. Instead of trying to split hairs based on limited evidence, the article should probably just acknowledge this uncertainty.
• About half of this article consists of bulleted lists of the legal status of e-cigs in various countries and local jurisdictions around the world. What is this, some kind of a vote? This needs to be condensed, its nothing more than a POV battleground.
• The "Construction" section reads a little bit like an advertisement. This level of detail seems to me to be of interest only to someone who is getting ready to go shopping. I'd suggest cutting it back to a level that is more appropriate to an article aimed at a general audience rather than aficianados.

Just my 2 cents Formerly 98 (talk) 13:40, 27 May 2014 (UTC)

Agree allmost entirely with your 1st point, and to a large degree with your 2nd, not as much on your 3rd, since this really is an article about e-cigarettes, with the medicine/health part as an important part... ie. depends on who you are writing for. E-cigs cannot be described that simple, there are too many terms/variables on the construction. --Kim D. Petersen 14:27, 27 May 2014 (UTC)

I agree completely with the statements, but I don't really see how the article does anything but present the fact that there is limited evidence. As for the second suggestion, I went ahead and implemented it at once. CFCF (talk · contribs · email) 14:50, 27 May 2014 (UTC)

Use the Wikipedia DR pathways to address specific issues instead of article-wide tagging

Despite the words used, those arguing for the article-wide POV tag appear to be trying to tag the article with a "badge of shame" rather than respect Wikipedia processes and content guidelines. The call for "Do not remove the tag until consensus is achieved!" is most often a ruse, because naturally what happens is those arguing keep arguing to ensure the tag stays until their preferred version is achieved, regardless of whether their preferred version is actually what Wikipedia content guidelines call for. Instead, use the normal dispute resolution pathways such as an RFC, NPOVN, RSN, DR, etc. These pathways usually have a limited lifespan with an outcome that can be adjudicated as either finding consensus for or not finding consensus for a specific change. Once the pathway has be exercised, the discussion can be closed and put behind us so that the article remiains stable. Zad68 15:31, 27 May 2014 (UTC)

No, i'm not trying to tag it for a "badge of shame", i'm trying to get more editors to look at these issues. The POV tag can be silently removed if the discussions peter out, or the problems are resolved. And i'm not calling for an "until consensus is achieved", and i don't believe anyone else does so either, that is a strawman. RFC's, NPOVN, RSN are for point-issues not for systemic problems, and it is my contension that the problems at the moment are systemic. --Kim D. Petersen 15:38, 27 May 2014 (UTC)

Additionally, you may want to look at WP:AGF, since your comment is lacking this. --Kim D. Petersen 15:42, 27 May 2014 (UTC)

Kim, pick the lowest-hanging fruit--the most glaringly obvious specific issue with the article. Frame it in the form of a specific change: "I propose where the article says X, it should say Y, because of Z." Start an RFC or NPOVN or RSN or DN discussion, your choice. After that's started, please drop a note here. Also notify WP:MED as appropriate. That's the way to actually start seeing whether there's support from a wide variety of experienced editors for your proposed changes. Zad68 15:46, 27 May 2014 (UTC)

I propose that we take each usage of the Grana2014 review, and look at whether the wording used is balanced compared to the other WP:MEDRS reviews that we have. In the last 3 days, this reference has gone from not being used, to dominating the article, in every section. And not even that, it has been used, in almost every instance, as if it was uncontested fact, where every other usage of reviews have been prefixed with "a <year> review found that".

This is a rather systemic problem in the article at the moment. --Kim D. Petersen 15:52, 27 May 2014 (UTC)

Are the issues you perceive with the use of this review just in the section Health, or do you also perceive issues with the few uses of this review in the non-Health sections too? Can you pick one use of this review, the most obviously incorrect one, and make a concrete suggestion based on it? Zad68 16:01, 27 May 2014 (UTC)

The usage is problematic in almost all sections, as i mentioned several times above. Perhaps you should look at the discussions that are located above this tag one - because almost all address such problems. --Kim D. Petersen 16:04, 27 May 2014 (UTC)

This is the last comment/suggestion I'll make here and then it will be up to you to show if your focus is on using the WP DR pathways to drive a particular issue to conclusion or if your interest is just general tagging: Pick one issue, frame it as a change request from X to Y because of Z, start the appropriate process. When it concludes, the change proposal either will find support or it won't, but it will be closed. Then move on to the next one. Zad68 16:09, 27 May 2014 (UTC)

first problem - second usage of Grana2014

(edit conflict)Lets go for the second usage of Grana2014 in the lede:

"The e-cigarette aerosol delivers nicotine, ultrafine particles, other toxic chemicals, and carcinogens.[1]"

Is that even correct? Is that really all what is the default constituents of the aerosol (ie. for e-cigs generally), and does it really contain this much toxic chemicals and carcinogens that it can be stated this clearly and prominently? Do other reviews make such a focus? And if this is really the case, then why are other reviews stating that there is uncertainty as to the dangers? Removal would be my recommendation here. --Kim D. Petersen 16:13, 27 May 2014 (UTC)

Quote from the Saitta2014 review: "the overall level of risk is much lower than cigarette smoking, with no chemicals raising serious health concerns in e-liquids [Cahn and Siegel, 2011; Goniewicz et al. 2013]" to compare with. --Kim D. Petersen 16:22, 27 May 2014 (UTC)

In comparing the relative strengths of the sources, I see that Grana 2014 is published in the well-respected, AHA-affiliated, MEDLINE-indexed journal Circulation and the article is specifically reviewing the health effects and safety of e-Cigs. In contrast the Saitta review is published in a Sage journal that is not MEDLINE-indexed. Off the top I'd expect that Grana should be given significantly more weight. I see you are the only one specifically arguing for giving equal validity to Saitta. Either accept that consensus is against you here, or try one of the DR boards I mentioned. Zad68 16:59, 27 May 2014 (UTC)

Sigh! First of all, congratulations on asserting consensus without considering other input. I'm using Saitta only because it is just as recent a review as Grana (which btw. is PMID: 24821826 [PubMed - in process]), and have at no point stated that it should be given equal weight. i cannot recall any other review being as affirmative as Grana. But i will check.

Can you please quote me the section in Grana that supports that sentence, in light of the questions i asked? --Kim D. Petersen 17:52, 27 May 2014 (UTC)

I apologize for responding without a specific change proposal from you. Still waiting for your specific change proposal so that we can eliminate the possibility of misunderstanding exactly what change you're proposing. Zad68 17:57, 27 May 2014 (UTC)

Wait, you DID have a proposal: Remove the use of Grana 2014 here entirely, correct? Your suggestion is to fix the weight problem by removing Grana 2014 entirely? Zad68 17:59, 27 May 2014 (UTC)

Have you found the location in Grana2014 that supports the sentence? Here is btw. a few quotes from Grana (search for toxic or ultrafine):

• Given these uncertainties, it is not clear whether the ultrafine particles delivered by e-cigarettes have health effects and toxicity similar to the ambient fine particles generated by conventional cigarette smoke or secondhand smoke.(Grana et al)
• Tests on e-cigarettes show much lower levels of most toxicants, but not particles, than conventional cigarettes. The thresholds for human toxicity of potential toxicants in e-cigarette vapor are not known(Grana et al)
• However, subjects should be informed that, although e-cigarette aerosol is likely to be much less toxic than cigarette smoking, the products are unregulated(Grana et al) --Kim D. Petersen 18:27, 27 May 2014 (UTC)

Since apparently the Saitta review is not usable here - because it is not in a MEDLINE journal - lets go to the Caponnetto(2013) review for much the same:

Electronic cigarettes use the process of vaporisation rather than combustion and the low operating temperature of the atomiser (about 50-60°C; approx. 5-10% of the temperature of a lit cigarette) suggests that these products as a class are unlikely to emit cigarette toxicants in their mist [25].

This in a section about toxicology that doesn't raise any such concerns as the lede sentence makes. --Kim D. Petersen 22:00, 27 May 2014 (UTC)

Continuing from Caponnetto:

The data noted above suggests that electronic cigarettes are safer than tobacco cigarettes [28] and comparable in terms of tobacco-specific nitrosamines (TSNAs) levels to conventional nicotine replacement products [37].

as well as

In fact, this tool appears to be much safer than traditional cigarettes and comparable in toxicity to conventional nicotine replacement products [28].

So where does the weight on this come from? --Kim D. Petersen 22:02, 27 May 2014 (UTC)

continuing usage of Grana2014 in lede

When considering that WP:LEAD states that:

The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points—including any prominent controversies.[1] The notability of the article's subject is usually established in the first few sentences. The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources. Apart from trivial basic facts, significant information should not appear in the lead if it is not covered in the remainder of the article.

Does anyone consider this, from the first paragraph of the lede to be balanced, or a summary of the salient points in the article body? Personally i must say that it reads like an Inductive fallacy:

There is a poor relationship between labeled and existing nicotine content, as well as differing levels of other chemicals and toxicants in the e-liquid and aerosol.[1] Various e-liquid flavors include tobacco, menthol, coffee, fruit, candy, and alcohol flavors, as well as odd flavors like cola and Belgian waffle.[1] A disproportionate use of flavored traditional tobacco products are used by youth and initiators, and flavored cigarettes except menthol have been banned in the U.S.[1]

After the Inductive fallacy of implying that flavours are there to induce youths to vape... and the implications that since menthol is banned in smokes, it should also be in vaping, we haven't even left the first paragraph of the lede. --Kim D. Petersen 16:49, 27 May 2014 (UTC)

Kim would you please make a specific suggestion to improve the wording here? Zad68 17:50, 27 May 2014 (UTC)

Considering your assertions of consensus where none is evident above - i can't really see the use. Lets take the above first, and let you demonstrate that there actually is a consensus on that sentence, and that it is even supported by the actual review. --Kim D. Petersen 17:55, 27 May 2014 (UTC)

If you're finding communication difficult here on the Talk page consider starting a DR discussion. Zad68 18:04, 27 May 2014 (UTC)

No, i'm finding the point-approach to a systemic problem to be rather silly. And i also find that it seems that a lot people here are entirely unfamiliar with the literature as a whole, and thus cannot see that relying on a single review/secondary source is detrimental to the overall picture. --Kim D. Petersen 22:14, 27 May 2014 (UTC)

Report of Prof. Dr. Britton

I have to stress that explicit: Public Health England commissioned a background paper on e-cigarettes from Professor Dr. John Britton (Professor of Epidemiology, Director of the UK Centre for Tobacco Control Studies, School of Community Health Sciences, Division of Epidemiology and Public Health) an huge expert on tobacco and tobacco control leviathan who had published dozens of scientific papers, reviews and studys. THIS is real science - Read it and compare it to the review of Gana, N. Benowitz and Glantz. At least the WP-Article has to present both papers in contrast - with emphasis on the review of Britton, because his paper is backed by major reviews and studys!--Merlin 1971 (talk) 17:07, 28 May 2014 (UTC)

As several of us have pointed out above, the massive reliance on the Grana paper is a problem. There are several papers that provide differing views, such as the Caponnetto(2013), Saitta(2014), ... and the National Health England report as well. Also (imho) the focus being taken from the Grana review is significantly slanted by a negative selection of disassociated parts in that review. --Kim D. Petersen 17:43, 28 May)

original reasearch

The Grana review says this: Goniewicz et al41 analyzed the aerosol from 12 brands of e-cigarettes, a conventional cigarette, and a nicotine inhaler for toxic and carcinogenic compounds. "The levels of toxicants in the aerosol were 1 to 2 ORDERS OF MAGNITUDE LOWER THAN IN CIGARETTE SMOKE but higher than with a nicotine inhaler ". 1 to 2 order of magnitude lower than in cigarette smoke = 10 to 100 times lower than traditional cigarettes. Why the Original Research tag? 64.66.22.160 (talk) 19:21, 28 May 2014 (UTC)

User:QuackGuru apparently doesn't want to answer that. I asked much the same question on his talkpage[14], specifically because he, himself, had added the 1 to 2 orders of magnitude, no more than 24 hours earlier.... the answer was to "cleanup"[15]. I'm still curious though. --Kim D. Petersen 19:38, 28 May 2014 (UTC)

Goniewicz et al(2013) [the primary source that Grana(2014) cites] is more specific with 9-450 times lower, the orders of magnitude language is from Grana(2014)... Saitta(2014) also notes "All testing of vapour to date has found no evidence that exhaled vapour produces exposures to contaminants that would warrant health concerns by the standards that are used to ensure safety of workplaces [Cahn and Siegel, 2011; Goniewicz et al. 2013]." which seems interesting in this context. --Kim D. Petersen 19:48, 28 May 2014 (UTC)

The e-cigarette aerosol contains nicotine, ultrafine particles, other toxic chemicals, carcinogens, and metal nanoparticles.[1]

The low level details are in the body. Where does the source say metal nanoparticles were 10 to 100 times lower than traditional cigarettes?

The article says: The aerosol was also found to contain other metals, such as nickel, 2 to 100 times greater than detected in Marlboro cigarette smoke.[1] 10 to 100 times lower than traditional cigarettes is a broad statement that is misleading. QuackGuru (talk) 19:53, 28 May 2014 (UTC)

Nb. the amount of Nickel found in e-cigs was roughly the same as found in the licenced NRT inhalator (also noted in Grana(2014)) --Kim D. Petersen 20:09, 28 May 2014 (UTC)

Your addition of the sentence that the aerosol contains these elements is more likely based on original research, it is certainly not a summary of the body of our article - nor does it follow from a reading of other relevant WP:MEDRS reviews that such a focus can be put on toxins and carcinogens. I would remind you that i've asked several times (above) for the sentence in Grana(2014) that supports that assertion.

If we take the WP:WEIGHT of all WP:MEDRS sources, then they all state that (paraphrased): "Much less dangerous that cigs, comparable to other NRT's in substances measured for". So the focus taken in the sentence you quote is very much WP:POV (ie. not representing fairly, proportionately, and, as far as possible, without bias, all of the significant views that have been published by reliable sources on a topic) --Kim D. Petersen 20:04, 28 May 2014 (UTC)

You have ignored my comment and the source does say it... "still contains nicotine, ultrafine particles, other toxic chemicals, and carcinogens." QuackGuru (talk) 20:14, 28 May 2014 (UTC)

Since i commented on your comment User:QuackGuru, it is rather impossible for me to have ignored it - isn't it? There are 3 instances of usage of "still" in the Grana(2014) paper - none of which is followed by "contains nicotine" - would you like to try again? And you still haven't addressed the WP:WEIGHT issue. --Kim D. Petersen 20:18, 28 May 2014 (UTC)

The section under "What Is Known About E-Cigarettes?" says "still contains nicotine, ultrafine particles, other toxic chemicals, and carcinogens."[16] QuackGuru (talk) 20:25, 28 May 2014 (UTC)

(edit conflict)User:QuackGuru are you aware that the link you just provided isn't to the review? And that it isn't the paper cited in our article? The one you link to is PMID:24821830[17] the one in our reference list is PMID:24821826[18]. The latter is the review, the former is not. How many such mistakes have you made? --Kim D. Petersen 20:32, 28 May 2014 (UTC)

Some text was deleted from the lede and body. Do you have a specific proposal? You can edit the article too. QuackGuru (talk) 01:37, 29 May 2014 (UTC)

Anyways.. I am planning on doing a whole bunch of deleting in the intro section later when I get home. As stated earlier, the intro of this article is now ridiculously long and littered with crap that belongs in the health section (if they even belong there at all)209.91.107.161 (talk) 20:27, 28 May 2014 (UTC)

Image

A logged-in account and an IP added similar text unrelated to the image. QuackGuru (talk) 08:41, 28 May 2014 (UTC)

The image is unrelated to the section in which it appears in the first place. The trivial fact that some people use e cigs to circumvent smoke free laws does not warrant a huge image as if it a huge deal. I would remove it entirely. — Preceding unsigned comment added by 184.70.5.58 (talk) 14:22, 28 May 2014 (UTC)

(edit conflict)Here are 3 questions User:QuackGuru:

• Why is the text unrelated?
• Why would your text be more related?
• Which has more WP:WEIGHT in the section: A) Smoking cessation B) Circumvention of smoke-free areas? (does B in fact have more than 1 sentence?)

--Kim D. Petersen 14:28, 28 May 2014 (UTC)

I think the serious question to ask is why was the relevant image deleted from the appropriate section. QuackGuru (talk) 04:41, 29 May 2014 (UTC)

Since i cannot see anything that has ever remotely looked like a consensus for that image, the amount of edit-warring on whether it should or shouldn't be there, i don't think it is that great of a loss. I personally can't see the value of it. --Kim D. Petersen 05:25, 29 May 2014 (UTC)

According to the edit summary the image was misplaced: "removal of the image that is irrelevant in the smoking cessation section." Can you think of which section would be a better fit for the image? QuackGuru (talk) 05:48, 29 May 2014 (UTC)

Yet more POV problems .. 1/3 of youth who use e-cigarettes never touched a cigarette...

Our article states:

Although the majority of youth using e-cigarettes are dual users, one third of young people who used an e-cigarette have never tried a traditional cigarette, indicating that some young people are initiating use of the addictive drug nicotine through e-cigarettes.(Grana(2014))

This should have alarmbells chiming by everyone who has read the literature on this subject, and who've seen for instance the National Health England report or the new Brown et al(2014) paper about British usage of e-cigarettes. So i digged, this is cited to the Grana(2014) review, where it is stated in the Policy recommendation section without citation, but User:QuackGuru apparently took it[19] from the prevalence section in the paper, and here it says:

The Utah Department of Health found that 32% of ever e-cigarette users reported that they had never smoked conventional cigarettes.34

So we are stating a Utah finding as global fact in our article at the moment...

Even more curiously, if we dig further is that ref 34 in the Grana paper is a blog posting[20] by Stantz (co-author), which points to a Health Status Update[21] by the Utah Health Department. Which says:

PNA data also show that 31.7% percent of students who reported ever using e-cigarettes say they have never tried conventional cigarettes. This raises concerns that electronic cigarettes could serve as a gateway drug for conventional cigarettes.

So now we have:

• A regional health statistic becomes cited as global fact.
• ever-use of e-cigs, becomes usage.

And people are wondering why singular reliance on Grana(2014), and stating its findings as fact, is so problematic. --Kim D. Petersen 22:02, 28 May 2014 (UTC)

Read under Prevalence: "Although dual use with cigarettes is high, some youth experimenting with e-cigarettes have never tried a tobacco cigarette, which indicates that some youth are initiating use of nicotine, an addictive drug, with e-cigarettes." "Similarly, in 2011 in Korea, 15% of students in grades 7 through 12 who had ever used e-cigarettes had never smoked a cigarette.10" Here is the full text. QuackGuru (talk) 22:24, 28 May 2014 (UTC)

Did i question "some X went to e-cigs without smoking first"? Nope! I questioned the rather encompassing claim now in our article that 1/3 of youth go to e-cigs without touching cigs first. And that is not supported by your quote. 15% is not 33%. You still do not see a problem? --Kim D. Petersen 22:29, 28 May 2014 (UTC) -- interestingly btw. the Korean study[22] is published by ..... Grana & Glantz (+ first author Lee). So they cite themselves for that factoid. --Kim D. Petersen 22:39, 28 May 2014 (UTC)

This is (very!) weird, because other scientists (and tobacco controller) has discovered completely different data. Example:

Prof. Dr. Dautzenberg: "The President of the French Office for the Prevention of smoking was the first to worry about the incentive effect of the e-cigarette there two years ago. According to the survey, many young people have taken to the new device: in 2014, over 90% of smokers had puffed on an e-cigarette, as well as 23% of non-smokers. In one year, experimenting with e-cigarettes which from 12 years has doubled and is at its height for 16-17 year olds: with 53% having held one in their hands. By comparison, the number of students lighting a cigarette once out of school has reduced significantly: 20% of 12-15 year olds smoked in 2011, it is now 11.2%. Same dynamic in high school, where 33.5% of students smoked in 2014, against 42.9% in 2011."

Action on Smoking and Health UK: "The anti-tobacco charity Ash (Action on Smoking and Health) says the number of e-cigarette users has tripled from 700,000 in 2012. Nearly two-thirds of users are smokers and the other third are ex-smokers, Ash says, while use of the devices among non-smokers is negligible, at only 0.1%.

The "Grana paper" is cherrypicking (and misinterpretating) appropriate single datasets to justify biased conclusions.--Merlin 1971 (talk) 22:47, 28 May 2014 (UTC)

It was an accidental mistake. QuackGuru (talk) 22:48, 28 May 2014 (UTC)

Regarding the "Korean Study" by Lee, Grana, Glantz it is important to read the whole thing, because there is a _funny passage_ in it: "Because the [survey] used cross-sectional data, the directionality of our findings cannot be established." In other words: It cannot be determined whether users of e-cigarettes were less likely to succeed in quitting, or whether youth who had trouble quitting were more likely to try e-cigarettes.--Merlin 1971 (talk) 22:58, 28 May 2014 (UTC)

I'm reading that study - and i can't figure out where the 15% comes from btw. --Kim D. Petersen 23:02, 28 May 2014 (UTC)

There is another accidental mistake that you haven't addressed yet, in the above thread[23] --Kim D. Petersen 23:02, 28 May 2014 (UTC)

Please edit the article or make a specific proposal? I think the text improved. What do you think about my edit? QuackGuru (talk) 01:39, 29 May 2014 (UTC)

Still have a problem with: "The majority of e-cigarette users continue to smoke traditional cigarettes. Although the majority of youth using e-cigarettes are dual users, some youth who used an e-cigarette have never tried a traditional cigarette, indicating that some youth are initiating use of the addictive drug nicotine through e-cigarettes." because the sources of the Grana-Study did not backup that "this is indicating that some youth are initiating use of the addictive drug nicotine through e-cigarettes"! The sourcedata is cross-sectional data - you can't present this as a fact (certainly not because of the other studys!) This had to be presented in contrast with the other data!--Merlin 1971 (talk) 18:21, 29 May 2014 (UTC)

Deleted statement "youth initiating" because it is not backed up neither by source within in the Grana-Review nor other studys recently published.--Merlin 1971 (talk) 21:00, 29 May 2014 (UTC)

The lede should summarise the body

Usage statistics

The lede should have a summary of the usage statics.

The lede should have four paragraphs not split into 5. See WP:LEADLENGTH. QuackGuru (talk) 04:31, 29 May 2014 (UTC)

If you want it to have no more than 4 paragraphs.... Then we have to remove more stuff from there. Changing the subject in the middle of a paragraph makes it hard to read. As the paragraph article of wikipedia defines it "A paragraph (..)is a self-contained unit of a discourse in writing dealing with a particular point or idea."TheNorlo (talk) 06:23, 29 May 2014 (UTC)

And as I told you on my IP [24] page: Do I think the lead should have a summary of usage and statistic? Sure... But not a verbatim cherry picked excerpt of the said section.TheNorlo (talk) 06:27, 29 May 2014 (UTC)

@QuackGuru - WP:LEADLENGTH says: "The appropriate length of the lead section depends on the total length of the article. As a general guideline—but not absolute rule—the lead should usually be no longer than four paragraphs."--Merlin 1971 (talk) 14:11, 29 May 2014 (UTC)

I have restored the statistics and kept the article at 4 paragraphs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:47, 29 May 2014 (UTC)

I maintain that there is to much information in the intro for it to be restricted to 4 paragraphs. The 4th paragraph talks about the invention of the electronic cigarette and their world wide regulation. It should therefore be split in 2 to isolate these two different and unrelated subject. I find it very disjointed and hard to read as it stands. I don't want the intro to be as paragraph heavy as the article on lingustics but I see no reason why 5 paragraphs wouldn't be justified.TheNorlo (talk) 15:51, 29 May 2014 (UTC)

The lede is too short for 5 paragraphs. QuackGuru (talk) 16:02, 29 May 2014 (UTC)

I disagreeTheNorlo (talk) 18:33, 29 May 2014 (UTC)

Recommendation is 4 paragraphs at WP:LEAD. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:50, 30 May 2014 (UTC)

Trivial POV in secondary source bugs me.

The Liquid section says: as well as odd flavors like cola and Belgian waffle.

I don't care if it comes from a secondary source, describing a flavor as odd is a POV, especially when a quick internet search yield thousands of results for the said odd flavors, seems like pretty standard flavors to me.TheNorlo (talk) 17:45, 30 May 2014 (UTC)

Feel free to remove "odd" Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:09, 30 May 2014 (UTC)

Rise of E-Cig use and fall of tobacco use

@DocJames: I'm a little bit confused... You've changend my contribution in that way, that only the rise of E-Cig use is left over. You have written yesterday: "One also needs to look at if they decrease cig usage or increase cig use in society as a whole." So: Why do you delete a contribution, that is dealing precisely with that topic?--Merlin 1971 (talk) 18:47, 30 May 2014 (UTC)

This is a primary source and should not be used at all. Is there a better source that covers this? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:35, 30 May 2014 (UTC)

But: You've edited it anyway, in that way that you've deleted the fall of tobacco use and the rise of E-Cig use is left over? I have no better source than this press release ATM. So what can we do about this? Deleting the "In France many young people have tried e-cigarettes: in 2014, over 90% of smokers had puffed on an e-cigarette, as well as 23% of non-smokers." or complement it by the fall in tobacco use? --Merlin 1971 (talk) 20:04, 30 May 2014 (UTC)

This article is about e-cigs not traditional cigs. Trying to imply the increase in e-cigs has lead to the decline in regular cigs such as adding "By comparison, the number of students lighting a cigarette once out of school has reduced significantly: 20% of 12-15 year olds smoked in 2011, it is now 11.2%. Same dynamic in high school, where 33.5% of students smoked in 2014, against 42.9% in 2011." We would need a much better source for this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:11, 30 May 2014 (UTC)

Ok... I've deleted the sentence according the french press release.--Merlin 1971 (talk) 20:24, 30 May 2014 (UTC)

Thanks Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:46, 30 May 2014 (UTC)

Proposal for lead summary sentence on health risk

Can i get consensus discussion going, on putting this sentence into the lead as a summary of the various reviews that we have? As far as i can tell, all of our recent reviews and other reports are supportive of this sentence:

While there is still limited research, and considerable uncertainty, and little knowledge about long-term effects, a growing body of research indicates that the health risks of e-cigarettes are significantly lower than regular cigarettes, and probably on par with licensed Nicotine replacement therapies

Suggestions for word-changes or caveats will be appreciated, since i'm not a particularly good word-smith, my forte lies in research, and fact-checking. I am aware that the NRT comparison is somewhat tentative, but both Grana and Caponnetto refers to it and summarizes the results.

Summarizing these assessments in recent reviews and reports:

Caponnetto et al(2013)

In fact, this tool appears to be much safer than traditional cigarettes and comparable in toxicity to conventional nicotine replacement products [28].

Saitta et al(2014)

Products that deliver nicotine without the smoke carry no more than 1% of the health risks of smoking[Phillips et al. 2006] and Today, a growing body of scientific studies on e-cigarettes and liquids supports the efficacy and safety of these products. Even smokers who do not want to quit may do so when introduced to e-cigarettes [Polosa et al. 2011, 2013] and the overall level of risk is much lower than cigarette smoking, with no chemicals raising serious health concerns in e-liquids [Cahn and Siegel, 2011; Goniewicz et al. 2013]. In the most comprehensive systematic review of chemical studies to date, Burstyn concluded that there is no evidence that ‘vaping’, that is neologism, coined to indicate the act of vaporizingthe liquid contained in e-cigarettes, produces inhalable exposures to contaminants of aerosol that would warrant health concerns [Burstyn, 2013]. However, chronic inhalation data in humans are needed before any definite conclusions are made.

Grana et al(2014)

However, subjects should be informed that, although e-cigarette aerosol is likely to be much less toxic than cigarette smoking, the products are unregulated. and The levels of toxicants in the aerosol were 1 to 2 orders of magnitude lower than in cigarette smoke but higher than with a nicotine inhaler (Table 1).

National Health England(2014)

Overall however the hazards associated with use of products currently on the market is likely to be extremely low, and certainly much lower than smoking.

(references used):

If i entirely read the reviews wrongly, cherry picked or otherwise been on the wrong track - feel free to correct :) Going to be out most of the day, so i can't answer questions before tonight. --Kim D. Petersen 06:25, 29 May 2014 (UTC)

It is always a red flag to use so many references at the end of a sentence. I would never do that. All the references do not verify the same text. QuackGuru (talk) 06:29, 29 May 2014 (UTC)

Isin't this the definition of a "summary"? I don't see a problem with it especially since this subject is controversial within the literature, there is no bible on this subject. TheNorlo (talk) 06:35, 29 May 2014 (UTC)

Different sources don't verify the same text. The text should summarise existing text in the body. QuackGuru (talk) 06:42, 29 May 2014 (UTC)

Imho this would be better:

A growing body of research indicates that the health risks of e-cigarettes are significantly lower than regular cigarettes, and probably on par with licensed Nicotine replacement therapies There is limited research and little knowledge about long-term effects.

It is not a red flag to use so many references at the end of a sentence, because this sentence summarizes the existing science (in a appropriate, fact-based way). BTW: Argueing about the fact that, e-cigs have only been on the market since 2007 and "we just don’t know the long-term damage they may be doing to people’s health" is is just a convenient way of getting around the fact that e-cigarettes are, by all conventional measures, harmless. E-cigarettes contain none of the tar or other toxins (within the magnitude) that make conventional cigarettes bad for one’s health. The mayority of reviews and studys reflect this simple fact.--Merlin 1971 (talk) 11:39, 29 May 2014 (UTC)

The above is to complicated in its wording and does not take into account the WHO position. We could have "While the benefits and risks of electronic cigarette use are uncertain [ref to WHO] some research indicates that the health risks are likely lower than regular cigarettes and similar to nicotine replacement therapy" Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:37, 29 May 2014 (UTC)

I am happy to go with Doc James's version. It's accurate and neutrally worded. The wording could perhaps be tweaked to be a bit more descriptive with regard to "some research", but apart from that I think its good.Levelledout (talk) 15:19, 29 May 2014 (UTC)

Yes indeed. The wording could perhaps be tweaked a bit more ("likely lower" is not correct - it is "lower"!), but besides that, i can live with the wording.--Merlin 1971 (talk) 21:00, 29 May 2014 (UTC)

Theoretically it should be lower. But since the device was only invented several years ago there are no decades-long epidemiological studies that allow us to be certain.

Levelledout (talk) 21:56, 29 May 2014 (UTC)

As pointed out above: This is just a convenient way of getting around the fact that e-cigarettes are, by all conventional measures, harmless. E-cigarettes contain none of the tar or other toxins (within the magnitude) that make conventional cigarettes bad for one’s health. The mayority of reviews and studys reflect this simple fact. Even the Grana-Study states: "Although it is reasonable to assume that, if existing smokers switched completely from conventional cigarettes (with no other changes in use patterns) to e-cigarettes, there would be a lower disease burden caused by nicotine addiction". There is not one study out there, that states "ECigs will result in the same health hazards like tobacco cigarettes". "Likely" is wrong - it should be "highly probable" or "most likely" if not a simple "While the benefits and risks of electronic cigarette use are uncertain [ref to WHO] recent research indicates that the health risks are lower than regular cigarettes and similar to nicotine replacement therapy". Anyone who says otherwise is ignoring the simple fact that ecigs are not producing the nearly 10.000 Chemical Components of Tobacco and Tobacco Smoke.--Merlin 1971 (talk) 22:52, 29 May 2014 (UTC)

I personally have no objections changing it from "some research" to "recent research" if it is indeed the case that the majority of research that supports that conclusion. However, we obviously do need to reach a consensus over this and I'm not sure that one word is vastly important if it is going to prevent us from reaching it with other editors.

You are correct that e-cigarettes do not contain the large amount of toxic chemicals that tobacco does and therefore likely to be safer than tobacco. However it is not proven that they do not contain any toxic chemicals whatsoever themselves. Most food flavourings for instance have not been tested on humans for inhalation because we have never inhaled them before e-cigarettes were invented. Even the likes of Farsalinos, who are supportive of e-cigarettes, [say this] and urge caution.Levelledout (talk) 23:49, 29 May 2014 (UTC)

There is no clear evidence that they are definitely less risky than cigs and this is clearly wrong "by all conventional measures, harmless." Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:45, 30 May 2014 (UTC)

Currently our text now says Some research indicates that the health risks are likely lower than regular cigarettes, fine, but this is actually a far more conservative description, than a fair and unbiased summary of the literature would give us, isn't it?

• much safer than traditional cigarettes (Caponnetto)
• no more than 1% of the health risks of smoking; overall level of risk is much lower than cigarette smoking (Saitta)
• likely to be much less toxic (Grana)
• likely to be extremely low, and certainly much lower than smoking (NHE)

So an NPOV description would be "much lower" correct?

Secondly why do we say "some" (a classic weasel word)? Are there any reviews to indicate otherwise? I would like to have someone cite any recent review or report that states that there is indications in the research that e-cigs might be even close to the risk levels of cigarettes. Please? We are supposed to present fairly, proportionately, and, as far as possible, without bias, all of the significant views that have been published by reliable sources on a topic.(WP:NPOV), and not let our own credulity (or incredulity) influence us. --Kim D. Petersen 06:06, 30 May 2014 (UTC)

• Outsider Comment from MONGO....just wanted to say that if it is narrowed down to disagreements over whether we use the term likely lower instead of lower then it may be preferable to simply provide a direct quote from the sources so there is zero ambiguity as to what they say. Of course all quotes should immediately be followed by a reference.--MONGO 11:41, 30 May 2014 (UTC)

The thing is we also need to balance with the sources such as this 2013 World Health Organization document "The safety of ENDS has not been scientifically demonstrated." I am happy with likely much lower. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:07, 30 May 2014 (UTC)

BTW: "The safety of parachutes and mobile phones has not been scientifically demonstrated". ;) We have to balance the sources - Yes! The majority of sources (and common sense) indicates that the health risks from e-cigs are lower than regular cigarettes - there is no room for an "likely". Even a "safety has not been scientifically demonstrated" is not in contradiction to "lower"!--Merlin 1971 (talk) 12:21, 30 May 2014 (UTC)

@Doc James: Did you have read this letter? Have a look at the signatories - In my view, these are among the most credible experts in the field of tobacco control and tobacco dependence.--Merlin 1971 (talk) 12:30, 30 May 2014 (UTC)

The safety of e-cigs are not just with respect to their use in a single individual. One also needs to look at if they decrease cig usage or increase cig use in society as a whole. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:49, 30 May 2014 (UTC)

Which research is the WHO statement/FAQ based upon? Is there a report? Can i get a citation-list? Will i be able to fact check it? Or is it simply "take our word for it!"? --Kim D. Petersen 18:36, 30 May 2014 (UTC)

You could email them. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:44, 30 May 2014 (UTC)

Not really Doc James, what i am referring to is that a position paper without any form of justification is worth nothing. WHO also acts as an advocacy and policy agency. And we need the actual research/science here.... And the WHO usually does give refs, for instance on DDT and Breastfeeding... So please either cite actual research that supports an alternate view, or let the WP:WEIGHT of actual science reviews speak. --Kim D. Petersen 22:47, 30 May 2014 (UTC)

Alternatively if no review papers are found to support the WHO FAQ, then we must consider it a minority view, and present it as such, according to WP:NPOV. --Kim D. Petersen 22:53, 30 May 2014 (UTC)

Reading it again. As we have "some" we do not really need "likely" so have removed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:17, 30 May 2014 (UTC)

Thank you - that is (likely) much better ;) BTW: Your opinion "e-cigs are not just with respect to their use in a single individual. One also needs to look at if they decrease cig usage or increase cig use in society as a whole." is a personal one, isn't it? Just asking, because the majority of people will read the sentence "Some research indicates that the health risks are much lower than regular cigarettes and similar to nicotine replacement therapy." only with respect to their use in a single individual, not for all mankind! And another question: Did you read this? Just because the french survery states that " the number of students lighting a cigarette once out of school has reduced significantly: 20% of 12-15 year olds smoked in 2011, it is now 11.2%. Same dynamic in high school, where 33.5% of students smoked in 2014, against 42.9% in 2011.". Besides that: Imho a consensus has been reached by reference to that sentence!--Merlin 1971 (talk) 14:45, 30 May 2014 (UTC)

Yes it is popular press. We need to use secondary sources. WP:MEDRS state that we should not use the popular press for medical content. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:10, 30 May 2014 (UTC)

Next sentence: "They carry a risk of nicotine addiction in those who do not already smoke" - There is no such thing as "nicotine addiction" classified in this world! The WHO classifies in ICD: F.17 - Mental and behavioural disorders due to use of tobacco and DSM-5 Highlights states a "tobacco use disorder" and "tobacco abuse". Prof. Fagerström, inventor of the "Fagerström Test for Nicotine Dependence" has recently changed its name to "Fagerström Test for Cigarette Dependence" because "it has been found that, although nicotine is the most important addictive component of tobacco smoke, it is probably not the only substance involved in the development of tobacco dependence." There is no mental illness called "nicotine dependence"! BTW: The source for that sentence isn't backup any "nicotine addiction". The WHO states (correctly): "In the form of tobacco products, nicotine is an addictive chemical..." I will remove that!--Merlin 1971 (talk) 15:10, 30 May 2014 (UTC)

The WHO source mentions addiction. We could change it to "addition to nicotine" Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:08, 30 May 2014 (UTC)

Veto! The WHO source does not mention addiction to nicotine! It`s addiction to tobacco! Show me one case of nicotine addiction or a scientific paper about nicotine addiction in scopus.com! Only one! You'll not able to find something like that. All of the papers are related to "nicotine in tobacco"! It's not without reason the WHO mention "In the form of tobacco products". Your change is designing a brand-new form of addiction and the existing sentence is not backed up by it's source!--Merlin 1971 (talk) 17:11, 30 May 2014 (UTC)

"Veto"? Not sure what meaning that carries in this context.

The WHO is recognized as an authoritative reliable secondary source here. The source says " In addition, use of these products -when they contain nicotine- can pose a risk for nicotine poisoning (i.e. if a child of 30 Kilos of weight swallows the contents of a nicotine cartridge of 24 mg this could cause acute nicotine poisoning that most likely would cause its death) and a risk for addiction to nonsmokers of tobacco products." The article currently summarizes the source accurately. That's really all there is to it. The rest of your arguing here is pure original research and so not applicable. Zad68 17:21, 30 May 2014 (UTC)

Erh, No. The WHO is consider a scientific body that can put out statements that we consider secondary sources, no more or no less valid than other seconday sources. We do not consider them authoritative. The WHO could be considered such, if they did research on the topic, or were tasked with compiling consensus material on the topic (such as like the IPCC does within the climate change field). But as for themselves... nope, they are a scientific body just like every other scientific body. --Kim D. Petersen 23:32, 30 May 2014 (UTC)

"a risk for addiction to nonsmokers of tobacco products" is not "risk of nicotine addiction"! The classificationsystem of the WHO states "F.17 - Mental and behavioural disorders due to use of tobacco" There is no "Mental and behavioural disorders due to use of nicotine". This is not OR - These are the facts iaw WHO!--Merlin 1971 (talk) 17:42, 30 May 2014 (UTC)

Rereading the sentence from the WHO and its context in the document as a whole, I don't see how the WHO could be understood to be talking about anything other nicotine addiction there. I have no idea why you're brining up "F.17" as it's not mentioned in the source cited at all. Please avoid WP:SYNTH. Zad68 17:51, 30 May 2014 (UTC)

Are you kidding me? :) F.17 is "tobacco addiction" and is cleary mentioned in the cited source. On the other hand there is no "nictine addcition" cited in the source. "Nicotine addcition / addcition to nicotine" is constructed/interpreted out of the source. WP is up to interpret sources? (BTW: The source for both is the WHO - So, there is imho no case of WP:SYNTH) --Merlin 1971 (talk) 18:08, 30 May 2014 (UTC)

SUre we can change it to tobacco addiction. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:12, 30 May 2014 (UTC)

How about this: "They carry a risk of acting as a gateway to cigarettesmoke in those who do not already smoke,[4] and possibly continue addiction in those who already smoke"?--Merlin 1971 (talk) 18:25, 30 May 2014 (UTC)

Supports current text better than the above. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:48, 30 May 2014 (UTC)

Ah... I see you've allready changed it, before it is cleared here... Interesting!--Merlin 1971 (talk) 18:53, 30 May 2014 (UTC)

Your concern was "nicotine addiction". You wanted it more like the WHO paper. So I made it so. I can switch it back if you wish to nicotine addiction. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:55, 30 May 2014 (UTC)

I can live with the existing sentence - I'm only surprised, that you changed it before a consensus was reached at the talk-page. Isn't this the normal behaviour in WP for everyone or is it more like "Everyone's equal, but some are more equal than others"? BTW: English is (obviously) not my mother tongue... Are you "Threatening" with an revert? If you do - it is not very kind.--Merlin 1971 (talk) 19:17, 30 May 2014 (UTC)

You wished it more similar to the WHO site. I changed it. I did not see this edit as a big deal. I did not threaten to revert it. I was simply saying that if you want to return it to what it was before and have more discussion first I have no problem with that either. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:34, 30 May 2014 (UTC)

Thank you for your statement and clarification.--Merlin 1971 (talk) 20:04, 30 May 2014 (UTC)

I think the word tobacco should be removed, the source does not state that e-cigarettes cause tobacco addiction.Levelledout (talk) 20:51, 30 May 2014 (UTC)

Levelledout is right - The source does not state that e-cigarettes cause a "nicotine addiction" either! I think, this would be better to reflect the source: "According to the WHO, e-cigarettes carry a risk of addiction in those who do not already smoke...."--Merlin 1971 (talk) 21:43, 30 May 2014 (UTC)

I have no particular objections to your version Merlin, other than it would seem difficult to fit it into the rest of the sentence as two different sources are used in the same sentence. I've just removed the "tobacco" word for now, feel free to change it to your version if you wish.Levelledout (talk) 03:03, 31 May 2014 (UTC)

So looking at the "expert doctor" letter, I note that the first page contains an emeritus professor of dentistry, and adjunct professor, and an "consultant" who has written papers sponsored by the "E-Cigarettes Research Advocates group". A great PR effort, but all it proves is that there are at least 100 people in the world with advanced degrees who think this is a good idea. Formerly 98 (talk) 23:23, 30 May 2014 (UTC)

Petitions and letters are not reliable sources, but please bear in mind that these are WP:BLP's. --Kim D. Petersen 23:43, 30 May 2014 (UTC)

ordering of section, variability of cartridge ingredients

Hi all I just read this article and was surprised. One of the biggest concerns the FDA and other authorities have with with e-cigs is the variability (and customizability) of the liquids used, and the variability in the vaporizers, which makes a big difference in what, and how much of what, is delivered to the user. Any general statements about safety or health are impossible to make because of this. Authorities are worried about risk of what might be delivered to users - there can be no general concrete concerns at this point about safety. In my mind, the details of what e-cigs actually are - the section on Construction - should come before the section on health & safety... for the reason said above. You can't have a sensible discussion of health and safety w/out a clear understanding of what you are talking about. Once that is done, the lead should be changed accordingly. The sources we already have say all this - it is just not stated clearly in the article. I am going to boldly make these changes, and wanted to put a note here for discussion as well. Jytdog (talk) 18:05, 1 June 2014 (UTC)

Yes, they are variable.. but despite this reliable sources state that with all likelihood that they are significantly safer than cigarettes (see above discussion named Talk:Electronic cigarette#Proposal for lead summary sentence on health risk). Mind you that this doesn't mean that they are safe - but instead that the comparative risk is significantly lower. So it is not impossible to make such statements. --Kim D. Petersen 18:27, 1 June 2014 (UTC)

I am sorry you are missing the point. If you don't know what it is a given cartridge, you cannot make claims about safety. I am not talking only about nicotine. Please show me any MEDRS source that does not mention the problems of a) unknown ingredients; b) variability in ingredients; c) variabilty in what is delivered to the user. I will show you three that discuss it explicitly. O'Connor: "However, significant concerns exist with the purity of ingredients employed, device functionality and quality control, the ease with which devices can be modified by users, and the general lack of oversight in manufacturing or marketing," FDA: "The agency is concerned that:...the products may contain ingredients that are known to be toxic to humans; because clinical studies about the safety and efficacy of these products for their intended use have not been submitted to FDA, consumers currently have no way of knowing 1) whether e-cigarettes are safe for their intended use, or 2) about what types or concentrations of potentially harmful chemicals or what dose of nicotine they are inhaling when they use these products." Grana: "Health claims and claims of efficacy for quitting smoking are unsupported by the scientific evidence to date....As of late 2013, there was wide variability in e-cigarette product engineering, including varying nicotine concentrations in the solution used to generate the nicotine aerosol (also called e-liquid), varying volumes of solution in the product, different carrier compounds (most commonly propylene glycol with or without glycerol [glycerin]), a wide range of additives and flavors, and battery voltage. Quality control is variable,16 and users can modify many of the products, including using them to deliver other drugs such as marijuana.17,18 These engineering differences result in variability in how e-cigarettes heat and convert the nicotine solution to an aerosol and consequently the levels of nicotine and other chemicals delivered to users and the air pollution generated by the exhaled aerosol....subjects should be informed that, although e-cigarette aerosol is likely to be much less toxic than cigarette smoking, the products are unregulated, contain toxic chemicals, and have not been proven as cessation devices. " (emphasis added). Jytdog (talk) 18:38, 1 June 2014 (UTC)

When stating that ingredients are unknown this is a statement, that is only somewhat true. E-juice is ~80% PG/VG or PEG400, the rest is nicotine (optional), flavouring (probably unknown). The FDA made a preliminary analysis in the early days of e-cigs, and haven't (afaik) checked since. You are confusing a lot of stuff here... by conflating construction/nicotine content/flavouring unknowns/efficacy etc. Slow down please :) To address one of your concerns - it has been generally found that e-cigarettes deliver less nicotine than expected. --Kim D. Petersen 19:50, 1 June 2014 (UTC)

I agree with your changes regarding the moving of sections but I have removed the additional Grana citation from the article due to the ongoing dispute in the talk section above.Levelledout (talk) 18:41, 1 June 2014 (UTC)

It has been restored, I do not see at all why you removed it. CFCF (talk · contribs · email) 19:08, 1 June 2014 (UTC)

Well you should not have restored it with respect to WP:CON as there is quite clearly an ongoing dispute about whether there are too many Grana citations in the article.Levelledout (talk) 19:16, 1 June 2014 (UTC)

Well you can't arbitrarily remove one of the statements just because there is a general discussion. CFCF (talk · contribs · email) 19:24, 1 June 2014 (UTC)

When did WP:BRD lose validity? --Kim D. Petersen 19:52, 1 June 2014 (UTC)

I'm done doing what i said above. Jytdog (talk) 21:10, 1 June 2014 (UTC)

Primary ingredients:

Caponnetto(2013) states:

Complete toxicology characterisation of the elements contained in electronic cigarettes’ liquid and vapour using gas chromatography mass spectrometry (GC-MS) is accumulating quickly and shows that their primary components are propylene glycol (PG), water, nicotine and glycerine[24].

Grana(2014) states:

typically made up of propylene glycol or glycerol (glycerin), nicotine, and flavoring agents

Saitta(2014) states:

designed to vaporize a liquid solution of propylene glycol or vegetable glycerine which also contains water and flavourings and may or may not contain nicotine.

NHE(2014):

produces vapour by heating a solution of nicotine, usually in propylene glycol or glycerine, held in a (often refillable) cartridge in the device

Odum(2014):

vaporize a solution containing nicotine and propylene glycol in a refillable cartridge

Palazzolo(2013):

The ingredients found in e-cigarette cartridges and solutions are relatively few, and for the most part non-toxic and non-carcinogenic, especially in the low quantities delivered. They include nicotine, propyleneglycol, glycerin, and tobacco flavoring (4, 48)

Our sentence is (was):

Liquid for producing vapor in electronic cigarettes, commonly known as e-juice or e-liquid, is a solution of propylene glycol (PG), vegetable glycerin (VG), and/or polyethylene glycol 400 (PEG400) mixed with concentrated flavors; and optionally, a variable concentration of nicotine.

Which matches the above references pretty well, except for the PEG400, which was typically used in the beginnings of e-cigs, and which can still be found (albeit rarely).

I'm quite willing to remove PEG400 because of lack in refs (although it would be wrong), but could we please stop trying to add a "commonly" in this statement, since it is not something that any ref is saying. --Kim D. Petersen 20:17, 1 June 2014 (UTC)

Kim, the quotes you brought say "usually" and "typically" and "commonly"! How can you object to "commonly" being in the article? Jytdog (talk) 20:29, 1 June 2014 (UTC)

Notice the Caponnetto review - which refers to chromatograph data on this. It says "usually" or "typically" that because the proportions of PG/VG is not set in stone. If you had a food-labelling of e-liquid, then all of them would have: (PG and/or VG and/or PEG400),water,flavoring,nicotine as the ingredience list. Those btw. are usually marked on the bottle, since vapers are interested in the relative proportion of PG to VG, because it is those that carry flavor and deliver the vapor. Personally i vape a 80:20 solution of PG to VG, usually at 80-90% with 10-20% flavoring (which is usually also in a PG/VG solution)

Any uncertainties here exist in the flavorings, nicotine concentration or in the purity of the PG/VG. --Kim D. Petersen 20:37, 1 June 2014 (UTC)

Additionally when you refer to TSNA's and metals below in your stricken text (which i tried to reply to three times - but edit-conflicted on), then they've only been found in trace amounts - and thus cannot be main ingredients. --Kim D. Petersen 20:40, 1 June 2014 (UTC)

This is bizarre. Again, the sources 'you brought say say "usually" and "typically" and "commonly". You have removed very well supported content, supported by references that you brought. I don't see what leg you have to stand on.... I will put the "commonly" back and hope you will drop this. Jytdog (talk) 20:55, 1 June 2014 (UTC)

I also note that the lead says "usually" as well. This is really a strange argument. Jytdog (talk) 20:59, 1 June 2014 (UTC)

Give me an example of an ingredient that comprises more than 20% of any e-liquid that isn't PG/VG/water or PEG-400. Just one. You seem to have read all the reviews, since you cite them - so you must be able to do so - right? (Hint: you can't because there isn't such an ingredient. Flavoring is the uncertain part - none of the others are)--Kim D. Petersen 21:19, 1 June 2014 (UTC)i was tempted to write 10% but didn't since some flavourings do not note what their solvent is (typically PG or VG though) --Kim D. Petersen 21:19, 1 June 2014 (UTC)

Hi Kim. I really don't understand. You are ignoring what I am writing. Of course I cannot bring a source that says anything definitive about the ingredients. Neither can you. Ingredients are not disclosed and are customizable, which is why the sources you brought say "usually" and "typically" and "commonly". And again, the lead already said "usually." I don't get what you are arguing about. What is at stake for you here? Jytdog (talk)

Except of course that i can, and have. I've given citations for everything that i've said, except for my personal comments. All sources say that the main ingredients are: propylene-glycol, glycerin, nicotine and flavoring. I'll up you one more from Palazzolo(2013), which contains a section entitled "Chemical analysis of e-cigarette cartridges, solutions and mist":

The ingredients found in e-cigarette cartridges and solutions are relatively few, and for the most part non-toxic and non-carcinogenic, especially in the low quantities delivered. They include nicotine, propylene glycol, glycerin, and tobacco flavoring (4, 48). Propylene glycol, an FDA-approved solvent used in foods, a vehicle for intravenous diazepam, and as the major ingredient found in e-cigarette fluids, makes up about 90% of the solution (Palazzolo(2013))

Now that one is pretty clear. Same with Caponnetto(2013). I'm curious as to why you believe that this is uncertain? And i'm also curious, now that i've read Palazzolo in depth how you came to give it as a reference to this[25] --Kim D. Petersen 21:46, 1 June 2014 (UTC)

Key word in Palazzo is "include." he doesn't say "are limited to" are "always". "include". And again, you brought three sources that say "usually". I have written that three times already, please respond . Jytdog (talk) 21:53, 1 June 2014 (UTC)

The major ingredients are not uncertain User:Jytdog, the relative proportion of the major ingredients are - some e-liquids are only PG (no VG), and some are VG (no PG) ... but regardless, the ingredients are always (PG,VG,PEG400), water, flavour and nicotine. There is no doubt on that, and no reliable source exibits any such. --Kim D. Petersen 22:01, 1 June 2014 (UTC)

For you to write this, that I haven't brought sources, is infuriating. I have written three times, now four, that the sources you brought support "usually" and you have not responded yet. You are showing some real issues with WP:ADVOCACY and WP:TENDENTIOUS editing here. I urge you to consider that. Jytdog (talk) 21:57, 1 June 2014 (UTC)

The sources are there in plain site as Jytdog says, to simply refute what they say is an ineffective strategy. CFCF (talk · contribs · email) 22:01, 1 June 2014 (UTC)

So what other ingredient is there CFCF? Please expand - and please do so with a WP:MEDRS. --Kim D. Petersen 22:03, 1 June 2014 (UTC)

I really don't like repeating the point, but to paraphrase Jytdog: To not admit there may be others is WP:OR, as "include" is a very general term, and is very far from "only includes". We could present it by writing: "may include other substances", but whether we use may/sometimes/can is nitpicking and stops us from actually improving the article. CFCF (talk · contribs · email) 22:10, 1 June 2014 (UTC)

We can't invent uncertainty either CFCF. The sources are pretty much clear on all of the main ingredients, and to imply that there may be others is ... well ... WP:OR. You and Jytdog would like to read the "typically" and other wordings as being an open slot to insert uncertainty into, but not when we have this many reliable sources that mention the same ingredients, and with most of them not exhibiting uncertainty about it. --Kim D. Petersen 22:15, 1 June 2014 (UTC)

Kim, YOUR OWN SOURCES SAY "USUALLY/COMMONLY/TYPICALLY" AND YOU REFUSE TO EVEN ACKNOWLEDGE IT ALTHOUGH THIS IS NOW THE FIFTH TIME I HAVE WRITTEN THIS. You are a nightmare editor. I can't believe you are fighting over this. Please read WP:TENDENTIOUS and reflect on your behavior in this discussion. Jytdog (talk) 22:47, 1 June 2014 (UTC)

No, User:Jytdog, despite your yelling with caps, i do not refuse to acknowledge it. I'm saying that a statement such as (typically contains ingredient A or ingredient B) when there are solutions containing (Ingredient A - 20%; Ingredient B - 80%) is correct. But does not imply that suddenly Ingredient C can "pop up" and be part of such a solution. Let me be clear: All e-juices contain (PG,VG,PEG-400),water,flavoring and nicotine - and nothing more. The reason i did a parenthesis there is because those 3 can be mixed in various proportions, but no extra ingredient exists.

And considering that the most in-depth WP:MEDRS that we have, with regards to the chemical composition of the liquids (Caponnetto, Palazzolo) do not such exhibit uncertainty, it is not really problematic. I also notice that none of the reviews mention any Ingredient X that might be added to the composition. --Kim D. Petersen 23:03, 1 June 2014 (UTC) [btw. only Grana contains "typically" none of the others are uncertain]. --Kim D. Petersen 23:05, 1 June 2014 (UTC)

regulation

This morning I updated the body of the main Legal status of electronic cigarettes article with the regulations passed by the EU in Feb, then updated the lead of that article with that and and the proposed regs by the FDA published in April, then updated the body of this article as per WP:SUMMARY. As per everything I wrote above, the main concern of regulators has been variability and lack of QC of liquids and devices and therefore the variability of the contents of the resulting vapor when any given user vapes, and lack of disclosure of ingredients. The regs also address tamper/child proofing of liquids to deal with the risk of nicotine poisoning. Now I am done with what I wanted to do. Jytdog (talk) 13:35, 2 June 2014 (UTC)

After an initial, rough, review: The article has gained in readability and transparency! Thank you!--Merlin 1971 (talk) 17:07, 2 June 2014 (UTC)

glad you are pleased... thanks for noting it! Jytdog (talk) 21:10, 2 June 2014 (UTC)

Grana Review WP:WEIGHT

At present there are 31 separate citations of this study in the article. The next most popular references have 5 citations. Either Grana is over six times more important than any other source in the whole article or there is a WP:WEIGHT problem.

Unless anybody can justify with respect to WP:WEIGHT why this study is so much more important than all of the others, then I think we should address this problem and reduce the amount of weight given to Grana accordingly.Levelledout (talk) 03:26, 31 May 2014 (UTC)

Well it would appear that nobody is able to provide the aforementioned justification. However since there have been no other replies, my specific proposal is that the weight given to Grana should immediately be scaled back to something similar to the next most popular reference. It is quite clear that the Grana study has been grossly overused and this would seem the fairest and easiest way to remedy the situation promptly.

Presently the next most popular reference after Grana is Saitta which has 7 citations and is given 4 and a bit sentences of article space. I propose we should keep the following Grana citations based on the fact that they seem the most informative or significant:

• "Solutions usually contain a mixture of propylene glycol, glycerin, nicotine, and flavorings,"

• "The majority of users who tried e-cigarette, continue to smoke traditional cigarettes." (presently in lead and smoking cessation)"

• "E-cigarette devices are predominately manufactured in China."

(presently in lead and history, we could remove from lead and leave in history)

• "Long-term biological effects are currently unknown since e-cigarettes haven't been in widespread use long enough for evaluation."

• "adverse events included throat and mouth inflammation, cough, nausea, and vomiting."

• "The levels of toxic and carcinogenic compounds in the aerosol were found to be 1 to 2 orders of magnitude smaller than in cigarette smoke but greater compared to a nicotine inhaler."

• There is a ridiculously long piece about metals found in e-cigarettes under safety. I think we can summarise this with "Grana noted that one study found heavy metals in e-liquids and e-cigarette vapor."

Even that is still a bit more space than given to Saitta. All other citations to Grana should obviously be deleted. Opinions please?Levelledout (talk) 15:49, 1 June 2014 (UTC)

High quality review article published in a high impact very well respected journal. Thus not a serious issue. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:07, 1 June 2014 (UTC)

Of course there is an issue, if other high quality reviews have different takes... and they do. WP:WEIGHT hasn't suddenly been invalidated. --Kim D. Petersen 16:41, 1 June 2014 (UTC)

Question to you Doc James though, with regards to the Grana review[26], how long does it usually take for such a paper to be pubmed indexed? The Grana review is still "[PubMed - in process]" and hasn't been tagged as a review, in fact it doesn't even turn up in searches for "electronic cigarettes" (or "e-cigarettes") on Pubmed. --Kim D. Petersen 16:49, 1 June 2014 (UTC)

Yes it is a serious issue Doc James, WP:NPOV is an important policy. Furthermore you have not demonstrated how Grana alone, represents almost the absolute dominating majority view and how every other source in the entire article represents a tiny minority. As of WP:WEIGHT this is required in order to justify the status quo. The fact that it is a decent source (like many other sources that we have) does not by any means automatically equate to this.Levelledout (talk) 17:27, 1 June 2014 (UTC)

I'd rather see more usage of the Caponnetto review since that one has a better "pedigree" than the Saitto one. (MEDLINE wise). The National Health England report should get more focus as well. --Kim D. Petersen 16:44, 1 June 2014 (UTC)

Sorry DocJames, but: The Grana-Study is not a "High quality review article"! It is a advocating review about the e-cigarette, published in a (well respected) journal wich is specialized in cardiovascular health! Don't you see the failure? And: The huge amount of citations of this study in the article is wrong! We have to weight the studys!--Merlin 1971 (talk) 17:16, 1 June 2014 (UTC)

I don't see your point, cardiovascular health is a very relevant and important field, why would this be in any view a failure? CFCF (talk · contribs · email) 19:04, 1 June 2014 (UTC)

Count the sentences related to "cardiovascular health" in the Grana-Review. When this is done, pls tell me what kind of scientific reviewers are related to an journal specialized in cardiovascular health?--Merlin 1971 (talk) 19:57, 1 June 2014 (UTC)

Yes it does seem that there are far more suitable journals for e-cigarette research, drug safety journals seem to be a common one.Levelledout (talk) 17:32, 1 June 2014 (UTC)

i find this a little bizarre. Grana is not an advocate: he she begrudgingly allows that e-cigs may be OK for people who are trying to quit smoking as a last resort (he she doesn't mention doctors discussing them with anyone else), but is very clear that there are lots of risks. MEDRS drives us to use the most recent reviews that become available, and in a fast moving field like this, recent reviews that pick up and synthesize primary studies are very valuable. When the next solid review comes out, you can bet that it will get the most weight and the weight given to Grana will drop accordingly, and this will continue to evolve as the field evolves, and will settle when the field settles in a few years. This is entirely normal in health related articles in Wikipedia. Jytdog (talk) 18:48, 1 June 2014 (UTC)(corrected assumption that Grana is male. thanks for pointing it out. Jytdog (talk) 23:08, 2 June 2014 (UTC))

He? Rachel Grana is part of the Center for Tobacco Control at the UCSF and is working with Stanton Glantz. She is a tobacco control advocate.--Merlin 1971 (talk) 19:57, 1 June 2014 (UTC)

I am busted as a sexist. thanks for the correction. oy. Jytdog (talk) 23:06, 2 June 2014 (UTC)

So you are proposing that Grana should be given multiple times more weight than, for example, Saitta because Grana was published a few weeks later? How does this make Grana the large majority view and Saitta the small minority?Levelledout (talk) 19:11, 1 June 2014 (UTC)

We have to weight the points against eachother and also the fact that Grana touches on several themes that aren't discussed in Saita. Therefore it is quite reasonable that it is cited more times without being given undue weight. CFCF (talk · contribs · email) 19:28, 1 June 2014 (UTC)

But those points are addressed in Caponnetto(2013), in NHE(2014) and in other reviews. Grana is not the end-all,be-all reference. Grana must be taken into account, but it is only one reference out of several, and the WP:WEIGHT given to it currently is significantly out of proportion. --Kim D. Petersen 19:55, 1 June 2014 (UTC)

i just took out a bunch of Grana refs - the Health section was overcited and overdetailed on the variability issue Jytdog (talk) 20:18, 1 June 2014 (UTC)

Nielsen Holdings and Bonnie Hergoz

I am reinstating The neilsen paragraph with a few modification. I do not believe that it is trivial since it shows that second generation products are now a substantial part of the e-cig market. I believe this is relevant in usage and statistics since the big corp cig-a-like market is loosing ground to smaller players.TheNorlo (talk) 08:31, 3 June 2014 (UTC)

Ordering of sections

I agreed with the re ordering of the sections. I think that the construction section belong on top of the article since the article is called "electronic cigarette" and not "health effects of electronic cigarette". I am not the only one who agreed with the changes so I am wondering why it was reverted?TheNorlo (talk) 18:18, 2 June 2014 (UTC)

The reason that doc james gave, was that he was following WP:MEDMOS, where the use is put first, and then details of the device or drug come later. It is arguable whether we should follow that here. I too think it is more useful in this case to put the device and liquid information first, and I kind of struggle (as even regulators do) with whether we should consider e-cigs as medical device at all and thus whether we should apply the MEDMOS framework (MEDRS for sure, applies to health claims). But I can live with this either way and don't care enough to argue about it. The key thing I wanted was that the whole thing hang together - that variability in device and liquids is explained in those sections, and the effect of that variability on our ability to make general statements about health is explained too. The overall order doesn't matter so much to me. Jytdog (talk) 18:37, 2 June 2014 (UTC)

We use the same format for alt med treatment as well caffeine. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:54, 2 June 2014 (UTC)

Unlike Caffeine and tobacco cigarettes, e-cigs are not a substance that someone ingests. It is an apparatus, much more comparable to syringes than caffeine. TheNorlo (talk) 19:12, 2 June 2014 (UTC)

from a regulatory standpoint, e-cigs would be considered a drug-device combination (if they were regulated medically). Which is why I have emphasized variability in the vaporizers (device) as well as in the liquids ("drug"). In any case, in the syringe article (a medical device subject to MEDMOS) you will notice that the body opens with a discussion of how syringes are used. (not explicit in the sectioning, but definitely there, content wise). Jytdog (talk) 19:19, 2 June 2014 (UTC)

As far as I know, it's (nearly)impossible to regulate e-cigs as a drug-device or e-liquid as a drug in the USA or the EU!
USA: Judge Leon has written to following in his "Memorandum Opinion" regarding the case "distributors Smoking Everywhere and NJOY vs FDA":

"The “intended use” of a product is determined by “the objective intent of the persons legally responsible” for labeling the product."

and

"Since Smoking Everywhere and NJOY both state that their product is not for smoking cessation and encourages continued recreational nicotine use, then electronic cigarettes cannot be considered drug /device combinations according to the law."

EU: The Directive 2001/83/EC (Community code relating to medicinal products for human use) states a similar meaning when it comes to the "definition of a Medicinal product". As far as no e-cig company states "this product will heal something" or someone find a disease which is healed by e-liquid - e-cigs will not be a "medicinal or medical product" and therefore no drug-device.--Merlin 1971 (talk) 20:20, 2 June 2014 (UTC)

please note that I used the subjunctive, "would be" and carefully said "if" they were...  :) I most carefully did not say "are" or "will be." I mentined the drug/device combination only b/c TheNorlo seemed to be arguing that we should organize the article as we would for a medical device (a syringe). It wasn't my goal to open a conversation or debate about the regulatory status. Whatever the regulatory status is or will be - which is far from being worked out - out there in the RL, in here in Wikipedia, which is its own special world, we treat anything health related under WP:MEDRS and WP:MEDMOS. There are zillions of reasons for this, but the biggest ones are that we have tons of tinfoil hat people trying to shove crazy health related things into WP, and those claims need to discussed under the rubric of science... which comes down to "medical science". That is why in his brief note, doc james said that that alt med articles are organized as per MEDMOS as well. there are clearly lots of health claims around e-cigarettes and MEDMOS provides a useful framework to organize all the information. One needs some kind of framework! Jytdog (talk) 20:52, 2 June 2014 (UTC)

I have realized the subjunctive :) - My comment was only meant to be a complement (didn't want to start a debate on this particular matter, too!)--Merlin 1971 (talk) 21:15, 2 June 2014 (UTC)

Thought it worth noting that WP:MEDMOS, if it even applies here, is quite clear that the ordering of sections may be varied per article, particularly if it helps the article develop concepts.

Electronic cigarettes are obviously not a form of pseudoscience. They are not a drug (e.g. caffeine) or a drug delivery device (e.g. syringe) although their individual components could be referred to as such. They are also officially recreational devices only. Either way I think the article certainly makes a lot more logical sense with the concept of an electronic cigarette developed first and then safety and other information to follow.Levelledout (talk) 21:34, 2 June 2014 (UTC)

I also noticed that yes the caffeine article does follow WP:MEDMOS, but the nicotine article doesn't.Levelledout (talk) 21:41, 2 June 2014 (UTC)

the nicotine article is a mess that i have started to fix (see the history for how it was a week or so ago). Still needs lots of work, and i will probably fit into MEDMOS to give it appropriate structure as I finished cleaning it up. Bad model to pick (although I see why you reached for it) Jytdog (talk) 22:25, 2 June 2014 (UTC)

also nobody is saying e-cigs are alt med. doc james just cited that (and i cited him) to show that articles that are not medicine, but that have lots of discussion about health, are organized and managed under "medical"-y things in WP. Jytdog (talk) 22:49, 2 June 2014 (UTC)

I did not say that anybody said that. I was simply demonstrating how e-cigarettes elude and transcend the categories or types of articles that other editors had mentioned.Levelledout (talk) 23:11, 2 June 2014 (UTC)

i hear you on that! Jytdog (talk) 00:21, 3 June 2014 (UTC)

I didn't brought up the syringe to have this article treated like a medical device, sorry for the misunderstanding, what I should of said is this; e-cigs are more comparable to a coffee maker than to caffeine. That being said I understand that advocates as well as critics of e-cigs more often than not make health claim about the product. Although I think that having the construction section above the health section makes more sense, I understand why some people disagree. Trying to find RS about the technical aspect of the vast world of personal vaporizers is extremely difficult, whereas finding info pertaining to health implications is very easy. This fact suggests to me that people in general are very interested about the health effect of the said product but not so much about the tech behind it. Status quo is find with me for now. Of course that could change as more research comes in.TheNorlo (talk) 07:42, 3 June 2014 (UTC)

great! Jytdog (talk) 19:42, 3 June 2014 (UTC)