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Your comments are both inaccurate and disruptive.
The observations are not accurate, despite the fact that you believe so. The video is not a primary source, it does not present original research, and even if it were it is a position of the CDC. As for the NACCHO source, there is nothing to indicate that it has been retracted, websites are restructured continuously and it does impact its credibility. I find it entertaining that you suggest press releases should be removed from sources while advocating strongly for the inclusion of the NHS Smokefree Electronic cigarettes site as well as the Press release – E-cigarettes: an emerging public health consensus used for the statement "In a 2015 joint statement, Public Health England and twelve other UK medical bodies concluded "e-cigarettes are significantly less harmful than smoking." Youth and adolescents are pretty similar groups, and the terms are often used interchangeably — mostly for variation. CFCF 💌 📧 18:59, 4 February 2016 (UTC)
What are we trying to say here? If it's an ingredient, it isn't an adulterant in my book. Tobacco extract is presumably for flavour, and ? cannabis left over from production runs of cannabis e-juice on insufficiently cleaned equipment. What are the sources saying? Johnbod ( talk) 13:03, 31 January 2016 (UTC)
The "Smoking Cessation" section frequently uses the term "NRT", without defining it. I'm guessing that this is an acronym for "Nicotine Replacement Therapy", but I'm not sure, and I think many readers of the article wouldn't be either. Could someone who knows for certain what it means please put the full term at the location of first usage? ie: Nicotine Replacement Therapy ("NRT"). Marcus erronius ( talk) 01:31, 8 February 2016 (UTC)
I find this edit [2] disturbing. Since it directly breaks with WP:MEDRS and WP:POV. From WP:MEDREV:
Here an anonymous editorial (opinion => primary source) is being used in exactly this way. -- Kim D. Petersen 15:06, 27 January 2016 (UTC)
Also note that the Lancet Editorial Board is not anonymous, you have at least twenty people standing behind the position at [4]. It is recognized as one of the most prestigious journals in the world and as such its positions hold much weight, enough that this statement illicited first page news around the world:
Neither does it counter the source, but the criticism should be included in the article, seeing as it comes from a high profile respected source. CFCF 💌 📧 15:52, 27 January 2016 (UTC)
The key point here seems to be "Can an editorial in the lancet be used as an RS to contradict the conclusions of a secondary source?". However all of this can be avoided if both sides will bend a little towards reasonability. It's fair to say the lancet editorial is not alone in its criticisms of the PHE Report so why not include the note that the PHE's verdict is not universally acknowledged (or similar words to say it's not the only accepted mainstream scientific view) citing the Lancet as an example of that. For instance
Public Health England report stated that e-cigarettes are estimated to be 95% less harmful than smoking, [1] although the basis for that figure is not universally accepted. [2]
References
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SPACKlick ( talk) 16:57, 6 February 2016 (UTC)
CFCF inserted an image without discussing it. [5] The top image is an electronic cigarette. The bottom one contains images of illegal substances and devices used to inhale them which are not e-cigs. AlbinoFerret 15:30, 27 January 2016 (UTC)
The emergence of electronic cigarettes (e-cigs) has given cannabis smokers a new method of inhaling cannabinoids.
SPACKlick, they are categorized as ecigs as per the source, which also takes up the difference between traditional vaporizers and e-cigs used for cannabis/cannabinoid e-liquid.
Would you be more comfortable using the image:
File:Ijerph ecig variants.jpg which has that section cropped out?
Some models of e-cigs for vaping [...]
CFCF has added more illegal drug usage to the article against consensus above that shows it does not belong in this article. [6] AlbinoFerret 18:33, 27 January 2016 (UTC)
It is completely unreasonable to say that this belongs only under safety, there is no rationale whatsoever for that. There are a number of sources supporting this, two of which are in the article now, including the NIDA-page. Seeing as this is a legal issue beyond beyond the purely medical aspects, we can expand with non-MEDRS sources as well.
The
Medscape – Medscape article would also be an acceptable source to expand/support the section.
CFCF
💌
📧 19:31, 3 February 2016 (UTC)
CFCF changed the image of the Construction section here. [8] The image is of an older device from 2013, around the date of the image. Its a unusual design that has to my knowledge never been copied and is no longer available. Few things if any from 2013 are in the fast paced development of the e-cig. This image replaces one (discussed above) that replaced the common cigalike broken into components. Does this image help the reader understand construction of ecigs? Is it an improvement to the article? I would say no and one of the component images should take its place. AlbinoFerret 19:28, 7 February 2016 (UTC)
I recently found this image which shows the internals of cigalikes. Maybe this could be included, it's higher quality than what was in the article a couple of weeks ago. CFCF 💌 📧 23:07, 7 February 2016 (UTC)
CFCF has added a section to the page dealing with Diacetyl. This is a toxicology section and IMHO belongs on safety instead of adding it here to a summery section. Opinions? AlbinoFerret 01:23, 8 February 2016 (UTC)
Actually, the first source in the section, the one you cited (
[11]) does. — page 4
Actually the very sentence above the one you cited
Some ENDS solutions contain harmful flavoring molecules, diacetyl and acetyl propionyl, used to add a buttery taste to the vapor and are known to cause bronchiolitis obliterans. These chemicals have been demonstrated to be present in higher concentrations in ENDS than is recommended by the National Institute of Occupational Safety and Health [33].
CFCF 💌 📧 00:35, 9 February 2016 (UTC)
Flavorings
Diacetyl is commonly found at lower levels in e-cigarettes than in traditional cigarettes. [1] Certain flavorings may contain harmful substances such as diacetyl and acetyl-propionyl which give a buttery taste. [1] Diacetyl has previously been connected to bronchiolitis obliterans when breathed in as an aerosol by popcorn manufacturers, known then as Popcorn lung. [1] [2] [3] A 2015 review urged for specific regulation of diacetyl and acetyl-propionyl in e-liquid, which are safe when ingested but harmful when inhaled. [4] Both diacetyl and acetyl-propionyl have been found in concentrations beyond those recommended by the US National Institute for Occupational Safety and Health. [1]
A 2015 class-action lawsuit is pending in Orange County over claims connecting the specific e-liquid flavorings containing diacetyl and acetyl propionyl and incidences of the lung disease bronchiolitis obliterans. [5]
References
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To clarify this is the added text, it is not related to the above popular press and primary sources. As you can see — this is all sourced to secondary sources, all of which are MEDRS-compliant or unrelated to medicine. CFCF 💌 📧 21:36, 8 February 2016 (UTC)
I made a few changes to the article (mostly Lead section) today. Most of it was stylistic, merging sentences, rephrasing, moving stuff around, but I hope people will review them for any unintentional errors I might have made. ~ Awilley ( talk) 21:27, 4 February 2016 (UTC)
On whether Health is more notable than History, I would say that the latter is more important for an encyclopedia, but I can understand why you, in particular, would disagree with that. In any case, I don't think "notable" is a good criteria for determining order. That should be done logically, preferably chronologically, with the reader in mind. To me it makes sense to start with the general introduction, then talk about the history, and then talk about safety, health, cultural impact, etc. I realize all articles will do it differently, but I looked up the most closely related article I could think of ( cigarette) and it fits that pattern fairly well.
Last point: If you think that Healthy/Safety is indeed the most important thing, you should be trying to end the Lead section with the paragraph on health/safety, since that's the last thing most visitors will read. See our article on serial position effect for why that might be a good thing. ~ Awilley ( talk) 04:47, 6 February 2016 (UTC)
I just came across this--leaving it here for other people to possibly decide to use.
173.228.123.101 ( talk) 19:20, 13 February 2016 (UTC)
I have seen several stories in the national press in the UK covering Yu et. al.: [12]. Since this is from November 2015 I presume it has already been discussed, which archive should I look in please? Guy ( Help!) 11:18, 15 February 2016 (UTC)
Just listened to an interesting 5 mins or so feature on Glanze's recent paper (see above) on today's More or Less (radio programme), a BBC radio programme covering statistics etc. Some of you should be able to pick it up online from the website linked at the article, starts about 5 mins in. Linda Bauld, Ann McNeill, Peter Hajek (co-author of the Cochrane Review - "grossly misleading" he says), Robert West ("mashed together very different studies") - all saying the paper should not have been published, as did an un-named person who peer-reviewed it for the Lancet sub-journal. Glanze & the editor unrepentent. Johnbod ( talk) 16:52, 5 February 2016 (UTC)
The article referred to Cochrane, saying "There is tentative evidence that they can help people quit smoking."
However, the evidence that they can help can people quit is moderate according to the cited Cochrane review. In the table titled "Summary of Findings for the Main Comparison", footnotes 3 and 4 clarify that the GRADE rating was downgraded from 'moderate' (relevant to statistical quality) to 'low' for the randomization against placebo, due to the fact that the e-cigarettes in one trial delivered nicotine poorly, meaning the effect size likely underestimates efficacy.
As a binary outcome measure, the evidence that e-cigarettes can help smokers quit is moderate according to Cochrane.— Preceding unsigned comment added by Zvi Zig ( talk • contribs) 09:42, 3 March 2016 (UTC)
Thanks for confirming above. I see what you mean, but this is going beyond summarizing what the source says and analyzing it, and coming up with your own new finding. This goes beyond summarizing the source, and is the kind of thing that WP:OR disallows. I would say the same thing if you were downgrading the conclusion. Jytdog ( talk) 18:50, 4 March 2016 (UTC)
The C&EN Cover Story Boom In E-Cigarettes Sparks Calls For Regulation might useful for updating the article. -- Leyo 11:15, 7 March 2016 (UTC)
The lead section of a Wikipedia article is supposed to summarize the article's contents, so inline citations (which make it look like the material was added to the lead first) should be kept to a minimum. And yet somehow this article's lead has over forty!? Also, the lead is enormous... just saying...
Hijiri 88 ( 聖 やや) 09:58, 22 February 2016 (UTC)
The original premise in this discussion is flawed. Our manual of style gives this guidance on the lead: "The lead serves as an introduction to the article and a summary of its most important contents."
and "It should identify the topic, establish context, explain why the topic is notable, and summarize the most important points, including any prominent controversies."
(my emphases), which is not the same as assuming that it must be solely a summary of the rest of the article and nothing else. Not every topic can be properly introduced through sources that already exist in the rest of the article, and that may be especially true of articles dealing with controversial topics. It is perfectly reasonable for a source that gives a broad introduction to a topic to be a good choice for referencing part of the lead, and yet not be sufficiently detailed to act as a good choice as a citation within a complex discussion later in the article, where more specialised sources are more appropriate. These sort of judgements belong to discussion in individual articles and it is necessary to seek a consensus in these cases. Apart from direct quotations, there's no rule that dictates whether citations appear in the lead or not; nor is there a rule that proscribes the use of a citation in the lead that does not appear elsewhere. --
RexxS (
talk) 18:53, 23 February 2016 (UTC)
"any statement in the lead must be in the body"- which is patent nonsense. The balance between the functions of introduction, establishing notability, providing context, and summarising the body is a matter for consensus between editors at the article, not by dictat from a non-existent policy. -- RexxS ( talk) 23:47, 24 February 2016 (UTC)
There is general agreement that Lead sections can have citations (nobody has argued otherwise) and that this particular Lead section should have citations. The problem that seems to be getting ignored in some of the arguments above is that this Lead section has too many citations. For instance, we have the following completely uncontroversial sentence with 4 (!) citations.
The e-liquids used in e-cigarettes usually contains a mix of propylene glycol, glycerin, nicotine, and flavorings.[17][19][23][24]
There is also this beast with 7 citations:
The vapor can contain small amounts of toxins, including traces of heavy metals detected at levels permissible in inhalation medicines,[16][27][6] and some potentially harmful chemicals not found in tobacco smoke[28] at levels permissible by workplace safety standards.[27][29][30]
I think the best way forward would be for somebody to judiciously prune some of these citations so we have no more than about 1-2 per sentence, and certainly no more than 1 per clause. If we find long sentences like my second example that can't be sourced to 1-2 sources it might be a good reason to break them up or look for possible WP:SYNTH. I could do this, but I don't know the literature as well as most of you regulars here so it would take me 5x as long. Volunteers? ~ Awilley ( talk) 19:46, 24 February 2016 (UTC)
Once example of redundancy
Non-smokers who use e-cigarettes risk becoming addicted to nicotine,[21] a chemical with a range of harmful effects.[22]
Both of the citations tend to support the first part of the sentence; but none of them (specially 22) support/talk the second part (harmfull effects of nicotine). While there is a full article devoted to the second part which in my opinion is better to link. Marianol ( talk) 16:54, 10 March 2016 (UTC)
Doc James -- I think you're making a mild error of judgment on this article. You keep removing paragraph breaks in the lead, and I don't think that's well advised. It's true that WP:LEAD says there should be four paragraphs in the lead. This is not the same as four blocks of text, and what you're actually making is blocks of text that consist of several different paragraphs all jammed together.
A paragraph is a thematically related series of ideas which develop a particular subject. A block of text is the area between two line breaks. Do you see the difference?— S Marshall T/ C 12:42, 10 March 2016 (UTC)
Have reverted this edit [15] which added "according to the American Journal of Respiratory and Critical Care Medicine in 2014"
If we begin stating which journal and which year all our content comes from this page will turn into a disaster. Adding the quote from the paper for the second bit. Doc James ( talk · contribs · email) 04:47, 6 March 2016 (UTC)
I had deleted the statement, "There is little data about their health effects", which references a paper authored mid-2013. Using statements about research quantity from a time when the overwhelming majority of today's research was unavailable is inappropriate.
A Pubmed search on e-cig terms shows that only a fraction of today's research had been available at the time. [1]
My deletion had been reverted [ [16]] by Yobol who explained, while there is clearly more data, there is still little high quality safety data regarding e-cigarettes, especially long term.
This does not justify restoring the irrelevant source; whatever one's views on today's data quality, this certainly not supported by a mid-2013 estimate on data quantity.
References
- Zvi Zig 11:34, 11 March 2016 (UTC)
I have reverted this set of changes, as they distort the position of regulatory authorities. If you read the WHO statement, it is pretty hostile to current e-cigs - the known risks, the unknown risks, especially the lack of regulation. yes there is the one line that says "the use of appropriately regulated ENDS may have a role to play in supporting attempts to quit." but even there, it is not current ENDS, but rather "appropriately regulated" ENDS, which do not exist, as the report makes clear. So I reverted. Happy to discuss. Jytdog ( talk) 14:43, 11 March 2016 (UTC)
Not sure what TracyMcClark is talking about here with regard to "Blind revert"? The ordering of this article has been talked to death:
P Walford's change in this dif was too bold per the DS as I noted when I reverted in this dif. This is not something people should just be messing with, without prior discussion. Jytdog ( talk) 20:38, 13 March 2016 (UTC)
The primary causing cancer suspects from chewing tobacco, second hand smoke, and smoking are not present in detectable levels in e-cigs: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555263/ . All the references to politicized organizations in this article do not carry as much weight with me as this one scientific study. Someone with more interest and stamina may be able to include it. There's not even a mention of NNK, NNN, or even TSNA's in general (the cancer-causing agents in smoking). Ywaz ( talk) 09:52, 20 March 2016 (UTC)
this edit is not OK. American Legacy Foundation is not a major health authority, and their study cannot be used to overthrow the existing published reviews and the most recent statements of major health authorities. I reverted. Jytdog ( talk) 01:15, 21 March 2016 (UTC)
I would like to revive a conversation. I feel that I was misunderstood/I was not clear. I would appreciate a user with experience in statistics can be pinged.
The Cochrane Review is quoted, "There is tentative evidence that they can help people quit smoking." The word tentative comes from Cochrane's 'low' GRADE of confidence level in the effect estimate. As I showed, Cochrane is clear that they downgraded their confidence grade from 'moderate' to 'low' because one of the devices delivered nicotine poorly, meaning the effect size may be an underestimate.
Now, Cochrane is explicit that the the 'low' grade is not related to negating the null hypothesis. They write, "These GRADE ratings reflect low levels of confidence in the effect estimates".
Bottom line, there is no support for use of the word tentative in relation to reporting these results as a "yes or no" outcome.
Now, I am not arguing that we infer that the effect size was indeed underestimated, this would certainly be WP:OR. Zvi Zig ( talk • contribs 15:57, 24 March 2016 (UTC)
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Cheers.— cyberbot II Talk to my owner:Online 19:56, 28 March 2016 (UTC)
Nicotine addiction outside of tobacco has been disputed recently. A quote: "Perhaps most surprising is that, in studies by Boyd and others, nicotine has not caused addiction or withdrawal when used to treat disease. These findings fly in the face of nicotine’s reputation as one of the most addictive substances known, but it’s a reputation built on myth. Tobacco may well be as addictive as heroin, as some have claimed. But as scientists know, getting mice or other animals hooked on nicotine alone is dauntingly difficult. As a 2007 paper in the journal Neuropharmacology put it: “Tobacco use has one of the highest rates of addiction of any abused drug.” Paradoxically it’s almost impossible to get laboratory animals hooked on pure nicotine, though it has a mildly pleasant effect. "<src> http://discovermagazine.com/2014/march/13-nicotine-fix</src>
Perhaps this section needs to be a little more balanced? Gbaughma ( talk) 03:46, 8 April 2016 (UTC)
when used to treat disease" and "when used recreationally" is the dose and route of administration - both of those strongly affect the development of an addiction. Seppi333 ( Insert 2¢) 04:21, 8 April 2016 (UTC)
References
In general, drugs that are less addictive in humans (such as marijuana) are not as likely to be self-administered by animals, and drugs that are not addictive in humans are not reinforcing in or self-administered by animals. Nicotine appears to represent an exception to this rule; although it does not strongly reinforce drug-seeking behavior in animals, it produces strong addiction in some humans. ... Nicotine is the main psychoactive ingredient of tobacco and is responsible for the stimulant effects, reinforcement, dependence, and addiction that result from tobacco use. Cigarette smoking rapidly delivers pulses of nicotine into the bloodstream. Nicotine differs from cocaine and opiates in that it is powerfully reinforcing in the absence of subjective euphoria.
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Does anyone have access to the paper this article is referring to? SPACKlick ( talk) 12:30, 21 April 2016 (UTC)
GA toolbox |
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Reviewing |
Reviewer: David Eppstein ( talk · contribs) 05:48, 28 April 2016 (UTC)
Edit warring on this contentious subject has continued both before and since the nomination, with the most recent battles involving at least five editors (Permstrump and CFCF on one side, Zvi Zig, Outofsinc, and Jytdog on the other), five reverts one way or the other of the same material in the last couple of days, and three more of the same material within the review period. This looks like a clear quick fail under criterion #4, "The article is not stable due to edit warring on the page". — David Eppstein ( talk) 05:48, 28 April 2016 (UTC)
This edit [19] removed what is a fully adequate review article from the article, see pubmed-link. The edit-summary identified it as polemic, but it is a clear summary of the facts in this paper — which is not considered particularly controversial. I will restore this because the rationale for removal was quite faulty, and does not take into account the articles status as a review under WP:MEDRS. Carl Fredik 💌 📧 22:59, 19 April 2016 (UTC)
Early studies funded by the tobacco industry on the effects of cigarette smoking where also inconclusive, and proponents of the precautionary principle have urged for more independent funding to assess the risks of e-cigarette use. (emphasis added)
You're both missing the issue. It doesn't matter if the statement or source itself is neutral, but that it is from a prominent WP:MEDRS-aligned source - and is also a review article. That it is a perspective article doesn't come into it, and WP:NPOV requires us to always show both sides of the coin. Carl Fredik 💌 📧 11:14, 27 April 2016 (UTC)
So i would support content focused on the PP, leaving the tobacco industry out, based on this source. Jytdog ( talk) 18:48, 27 April 2016 (UTC)
On coming back to this article after a period of absence and reading it with fresh eyes, the thing that strikes me most about it is how many citations there are to Grana/Benowitz, and how few there are to other sources of similar reliability (e.g. Rahman). In fact, Grana/Benowitz receives more than twice as many citations as the Cochrane Review, and in my view this is clearly inappropriate. Grana/Benowitz is not a low-quality source, but it is among the most anti-e-cigarette of the high-quality ones, and the overemphasis on it is detrimental to the article's balance.
Experience tells me that attempting to replace sentences that draw on Grana/Benowitz with sentences drawn from Cochrane or Rahman is likely to be controversial, because those sources are somewhat more pro-vaping than Grana/Benowitz is. So I thought I'd begin by seeing if there is consensus that the article is unbalanced in favour of Grana/Benowitz at the moment.— S Marshall T/ C 17:15, 3 May 2016 (UTC)
The health and lifestyle appeal may also encourage young non-smokers to use e-cigarettes, as they may perceive that trying e-cigarettes is less risky and more socially appealing. This may decrease negative beliefs or concerns about nicotine addiction.
Candy, fruit and coffee flavored e-liquid may appeal to younger users of electronic cigarettes
Easily circumvented age verification at company websites enables young people to access and be exposed to marketing for e-cigarettes.
E-cigarettes are probably safer for users and bystanders than smoking tobacco.(2 other sources)
No serious adverse effects from e-cigarettes have been reported in trials.[6] Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing.
E-cigarettes create a vapor made of ultrafine particles
However, chemicals may exceed the more stringent safety limits that apply to the public
A majority of e-cigarette users still smoke tobacco, leading to concerns that dual use can "delay or deter quitting".
E-cigarette users mostly keep smoking traditional cigarettes.
Some young people who have tried an e-cigarette have never smoked tobacco, so ECs can be a starting point for nicotine use
Others use them to circumvent smoke-free laws and policies, or to cut back on cigarette smoking.
There is considerable variability between vaporizers and in quality of their liquid ingredients and thus the contents of the aerosol delivered to the user.(2 other sources)
Less serious adverse effects from e-cigarette use include throat and mouth inflammation, vomiting, nausea, and cough.
fires caused by vaporizer malfunction,
E-cigarette vapor contains fewer toxic substances
E-cigarettes create vapor that consists of ultrafine particles, with the majority of particles in the ultrafine range
The vapor has been found to contain flavors, propylene glycol, glycerin, nicotine, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other chemicals.(1 Other Source)
significant numbers of teenagers who have never smoked tobacco have experimented with e-cigarettes.
A 2014 review stated that tobacco and e-cigarette companies interact with consumers for their policy agenda.
The companies use websites, social media, and marketing to get consumers involved in opposing bills that include e-cigarettes in smoke-free laws
The same review said this is similar to tobacco industry activity going back to the 1980s
These approaches were used in Europe to minimize the EU Tobacco Product Directive in October 2013.
The legal status of e-cigarettes is currently pending in many countries.
Some countries such Brazil, Singapore, the Seychelles, and Uruguay have banned e-cigarettes.
A 2014 review said, "the e-cigarette companies have been rapidly expanding using aggressive marketing messages similar to those used to promote cigarettes in the 1950s and 1960s."
While advertising of tobacco products is banned in most countries, television and radio e-cigarette advertising in some countries may be indirectly encouraging traditional cigarette smoking.
There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some claiming to want to cooperate in "harm reduction"
I reverted this. There is no NPOV issue linking to the safety article. Jytdog ( talk) 12:54, 20 May 2016 (UTC)
There's a sentence in the lead that currently says, "No serious adverse effects from e-cigarettes have been reported in trials
" (
PMID
25515689). I think it's misleading because what the source actually says is,
The ECLAT trial (Caponnetto 2013a) found no difference in frequency of AEs at 3- or 12-month follow-up between the three groups... Of the people available for 6-month follow-up in the ASCEND trial (Bullen 2013) 44.4% of participants in the nicotine EC arm reported any AEs, compared with 44.7% and 45.6% in the patch and placebo EC arms respectively. Differences were not statistically significant... None of the RCTs or cohort studies reported any serious adverse events (SAEs) that were considered to be plausibly related to EC use. One RCT provided data on the proportion of participants experiencing any adverse events. Although the proportion of participants in the study arms experiencing adverse events was similar, the confidence intervals are wide (ECs vs placebo EC RR 0.97, 95% CI 0.71 to 1.34; ECs vs patch RR 0.99, 95% CI 0.81 to 1.22). The other RCT reported no statistically significant difference in the frequency of AEs at three- or 12-month follow-up between the EC and placebo EC groups, and showed that in all groups the frequency of AEs (with the exception of throat irritation) decreased significantly over time.
That doesn't mean there were NO adverse events. It means there were the same amount of adverse events as with the patch and other smoking cessation produts. I'm having trouble coming up with a succinct way to word it though. Any suggestions? —PermStrump (talk) 14:56, 22 May 2016 (UTC)
No serious adverse effects from e-cigarettes have been reported in trials. ( PMID 25515689) Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing ( PMC4018182)." That second source actually reads, "Major injuries and illness have resulted from e-cigarette use, including explosions and fires. Less serious adverse events include throat and mouth irritation, cough, nausea, and vomiting." And the first source doesn't say there weren't any adverse effects, just that the AEs weren't any worse than the adverse effects for the patch, etc. (see above). —PermStrump (talk) 15:31, 22 May 2016 (UTC)
We do not need primary sources. We can support text with secondary sources. Therefore reverted this. [20] Doc James ( talk · contribs · email) 12:09, 27 May 2016 (UTC)
Just came across
PMID
27228348, a review article on this, which isn't cited here. Happy to send it to any one who can't it so we can discuss including it.
Jytdog (
talk) 19:47, 27 May 2016 (UTC) (redacted per below
Jytdog (
talk) 21:27, 27 May 2016 (UTC))
WHO states:
"It is unknown if the increased exposure to toxicants and particles in exhaled aerosol will lead to an increased risk of disease and death among bystanders as does the exposure to tobacco smoke" [21] 2014
CDC says:
"Insufficient data are available to accurately predict the risk associated with use of e-cigarettes or secondhand exposure to the particulate aerosols and gases they emit. Nonetheless, the FDA and others have noted that e-cigarette cartridges and aerosols may contain harmful chemicals and substances such as diethylene glycol, nicotine, formaldehyde, acetaldehyde, toxic metals, and others" [22] 2015
NIH says:
"There are currently no accepted measures to confirm their purity or safety, and the long-term health consequence of e-cigarette use remain unknown." [23] 2016
Review in Circulation:
"Long-term biological effects are unknown at this time because e-cigarettes have not been in widespread use long enough for assessment." "Because there are no long-term safety studies of e-cigarette use, patients should be urged to set a quit date for their e-cigarette use and not plan to use it indefinitely" [24] 2014 Will add. Doc James ( talk · contribs · email) 10:56, 29 May 2016 (UTC)
Lack of direct knowledge on long-term effects does not mean long-term effects are simply "unknown". We certainly have an idea about long-term effects (at least according to some). In fact, some major medical organizations have even given numerical estimates for them. This is precisely why organizations from the CDC's NIOSH ( link) to the Royal College of Physicians ( link) use modifiers like "accurately" or "precise" in describing knowledge limitations on long-term effects.
- CDC's NIOSH says
Insufficient data are available to 'accurately' predict the risk associated with use of e-cigarettes" (emphasis mine)
- The Royal College of Physicians says
it is not possible to quantify the long-term health risks associated with e-cigarettes 'precisely'. (emphasis mine)
We do not have direct or precise knowledge of tomorrow's weather, but that doesn't mean it's toally unknown.
These should be reflected in the article, please. Zvi Zig ( talk • contribs 19:52, 29 May 2016 (UTC)
Per WP:MEDRS we go with review articles over popular press. Therefore reverted this edit. [25] Doc James ( talk · contribs · email) 07:01, 25 May 2016 (UTC)
There is a pretty evident confusion here about what a tertiary source is. A tertiary source is not the third in a line of citations to mention a topic, but a specific type of source. This review is not a tertiary source, but a secondary source, and summarizes anecdotal evidence in a satisfactory way for the type of source that it is. Including the original text is acceptable for the article, and the subject is definitely worthy of mention in the lede, at least in the short way that it currently is. I do not agree with Permstump that we should use popular press mentions to elaborate in the body. Carl Fredik 💌 📧 19:29, 25 May 2016 (UTC)
Major injuries and illness have resulted from e-cigarette use, including explosions and fires."
- No, just no. This discussion isn't going anywhere, take it to RS/N for all you like, but you're wasting your time. Carl Fredik 💌 📧 11:52, 26 May 2016 (UTC)
to examine carefully and in detail so as to identify causes, key factors, possible results, etc." ( source)
I saw this in my watchlist: WP:RS/N#Major injuries caused by electronic cigarette use, but hadn't seen it mentioned here, so I wanted to make sure other people were aware. —PermStrump (talk) 04:21, 27 May 2016 (UTC)
Believe it or not, MEDR applies because having your faced melted by a faulty or poorly designed ecig is a "practice" with "health effects", which means it is "biomedical information". It seems a stretch to me, but that's my best guess at what this is all about, absent any deeper explanation from Doc James. Hard to see how better sources can't be found, or how policy would ever say to ignore how this paper obviously isn't a systematic review of fire and explosion reporting at all. In my experience, the fire risk does prevent smokers from converting to vaping, smokers who have already failed to quit using other methods. If the fire risk of quality assured ecigs used properly has been found to be comparable to other devices, then they deserve to know. Just like they deserve not to be misled into thinking this paper was reporting fires seen in trials, as is inferred by the grammar of the whole paragraph now. CrezT ( talk) 22:23, 27 May 2016 (UTC)
I think the statement can be strengthened, here are some additional WP:MEDRS (and otherwise WP:RS) sources:
Carl Fredik 💌 📧 10:18, 28 May 2016 (UTC)
You're right to say that physicians are experts in assessing the degree of injury, but you're wrong to say they're experts in assessing risk of fire and explosion. That's not part of a physician's training and I see your repeated contentions in this respect as very strange. I don't see how it's compatible with your apparent endorsement of the FEMA source I found.
The reality is that (1) in the US, electronic cigarettes are not subject to any compulsory product safety checking regime, and (2) electronic cigarettes contain a lithium-ion battery which poses a small but non-zero risk of exploding, particularly if recharged at the wrong voltage. These explosions are rare, but can lead to, and have led to, serious injuries.
At the moment, the lede of the article says: No serious adverse effects from e-cigarettes have been reported in trials. Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing. Major injuries related to explosions and fires were also reported.
This is obviously stupid and self-contradictory. Major injuries are obviously serious adverse effects.
It's also blatant scaremongering. About a dozen Americans have been injured by electronic cigarettes. In the last decade, 416 Americans were injured by yo-yo balls. In 290 of those cases the cord became wrapped around someone's neck, posing a clear threat of strangulation. More than 15,400 Americans were injured by falling televisions, 279 of them fatally. More than 66,000 Americans a year are injured by trampolines, and since 1990 there have been 4 fatalities. Unaccountably, the Wikipedia articles on these lethal deathtraps fail to contain prominent warnings in the lede about these risks, but never fear! At least our e-cigarette article is doing its moral duty.
Sarcasm aside: Explain to me how the warning in the lede isn't WP:UNDUE scaremongering bullshit?— S Marshall T/ C 00:44, 30 May 2016 (UTC)
Cases of major injuries and property damage related to explosions and fires have also been reported.
The reason I added the line about "major injuries" the other day in the first place was in reference to this part of the lead:
No serious adverse effects from e-cigarettes have been reported in trials. ( PMID 25515689) Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing ( PMC4018182)."
I feel that those 2 sentences alone are WP:SYNTH and cherrypicking overly positive wording from 2 different sources. And the first sentence in particular misrepresents what the source was actually saying (see also #Adverse events thread above). First I tried to neutralize the tone with this edit, which was reverted. Then I tried new wording to contextualize those statements so that they'd more accurately reflect their sources and was reverted again. The "major injuries" line was my 3rd attempt to add more context from the sources to resolve the WP:OR and misrepresentation of the sources. Personally, I'd probably be fine with any of those 3 edits, but I feel strongly that the former wording is inappropriate and needed to be adjusted. The most important part is clarifying/contextualizing the claim that "NO serious adverse events were reported", because the first source actually says that no serious adverse events were reported exclusively to e-cigarettes, meaning of the 1-2 studies that reported AEs, participants reported the same serious adverse events with e-cigarettes as they did for traditional cigarettes and the patch, which is very different from zero serious adverse events. As an aside, it should also be clarified that none of the studies looked at longterm AEs. —PermStrump (talk) 17:07, 28 May 2016 (UTC)
In trials, the most commonly reported adverse events have been throat and mouth inflammation, vomiting, nausea, and coughing.This takes out the judgment/subjectivity of the word "serious" and lets readers evaluate the seriousness of the risk for themselves based on the most commonly reported AEs. —PermStrump (talk) 17:11, 28 May 2016 (UTC)
I sincerely hope other Wikipedia volunteers are willing to engage on this issue, and are not put off by my ramblings above. Accordingly, I hereby present my definitive case for why the line "The benefits and the health risks of e-cigarettes are uncertain" needs to go. I invite all interested volunteers to give it careful consideration and a meaningful and thorough response.
1. It is factually wrong. Nicotine addiction, accidental ingestion, and short term effects, are just three areas where the health risks of ecigs are very much known. Other risks are also extremely quantifiable, such as the issues surrounding batteries etc, and indeed that is precisely why regulations have been drawn up, acting on those certainties.
2. It goes against established professional writing practice in this field. The BBC link I gave above is a summary piece covering all the controversies surrounding ecig risks to date, and yet it does not include a similarly broad statement. Just like Wikipedia, the BBC's mission is to inform readers without much working knowledge of a topic. Unlike Wikipedia, the BBC has a reputation for giving unbiased information about controversial topics. Absent other reasons, it must be Wikipedia, not the BBC, who have erred here.
3. It is misleading. Outside the factual inaccuracies detailed already, the potential to mislead also arises in this assumption that readers coming to this line are naturally in the mindset of thinking that it applies to all potential and actual uses of ecigs, and indeed to third parties. Everything indicates this is not the case (not least the facts found later in the article about the history and usage of ecigs), and most readers coming afresh to the article would be operating on the assumption the line refers to smokers who vape as an alternative to smoking. The potential for confusion, even if that is just temporary until they receive clarification from later text, would be eliminated entirely if the sentence was simply not there. Assuming the alternative mitigation, providing some basic facts and figures about known usage prior to the blanket statement, would not be acceptable, as I suspect it would not.
4. It is redundant. It has been argued that its various vague meanings are acceptable because it is clarified in the text that immediately follows it. And yet it is precisely because they are there, that the reader would be oblivious to the line not even being there. I cannot think of a single way that any reader would be missing out if the statement was removed, but if it were, many readers would benefit, particularly those who perhaps don't read the whole introduction, or who are presented with a small snippet of the article which cuts it off after just a few lines, as happens a lot with technology these days.
5. It is not supported. I have been told above that Wikipedia is a tertiary source, and if readers have doubts about its claims or want to know how they originate, they can always substantiate them by looking at the underlying source. Looking at the three given in the article to support this sentence however, they are all quite clearly medical papers, written by and meant to be read by medical professionals. If the statement can be supported, then why not pick a more accessible but equally authoritative publisher, like the BBC? These medical sources are meant to be read by people who are perfectly capable of recognising and discounting the obvious issues with vague statements like this, either through common professional knowledge or because they already know from the paper what the intended context is. That is not the case here, the statement is presented and the only context given is the title and first paragraph. Context is provided after, sure, but since those statements do not come from the same papers, any suggestion that one is meant to relate to the other for the purposes of substantiation is misleading. Explaining what one paper might mean by referring to another paper is what a secondary source does, not a tertiary source like an encyclopedia.
6. It is dated. Its basic factual errors aside, and ignoring the fact short term risks do not stay unknown for long, it was obviously true once that people really had no idea of the risks, they really were "uncertain" in the dictionary definition sense. But day by day, that becomes an increasingly unsupportable position - the science is at the stage now where politicians are so confident of what they do know regarding the risks, they are issuing regulations to specify what makes a safe ecig. As this process moves forward, it only makes the statement more misleading, as readers surely wonder whether it is referring to regulated or unregulated vaping, or both. That adds another layer of doubt about its intended meaning, onto an already over-broad statement.
7. It is needlessly scaremongering. Undoubtedly the intended meaning of "uncertain" in this line is the dictionary definition - lacking in certainty. Professional writers, particularly those writing for the general public, would however fully recognise that most readers will interpret the word with negative connotations, particularly when it appears alongside "health risks" - the public is well attuned to the fact smoking has no benefits and its proponents had a long history of deliberately covering up health risks. This is another area where people need to be mindful of the difference between pieces written for medics and pieces by the likes of the BBC - scientists have no need to be reminded what "uncertain" does and does not mean.
8. It evidently violates Wikipedia's own summary style. As I understand it, the introduction serves as the summary of everything else in the article, and yet it has been argued that the sentence serves as a summary of what is also included in the introduction, namely the lines that come after it. Unless someone can clarify how I have misunderstood this aspect of Wikipedia style, I can only conclude it does not comply - either the rest of the text that follows it is misplaced or redundant, or the summary of the summary is redundant.
9. It is inconsistent with other Wikipedia articles. Take a look at the article on fracking, it also does not contain a similarly broad statement, even though that too is a subject with a multi-faceted health risk controversy. In an attempt to find other Wikipedia articles with this sort of vague sentence construct to determine if this was just a one off, a Google search of the terms uncertain health risks on the Wikipedia domain actually revealed no other subject specific articles except ecigs - all other results being generic articles about risk or medicine, and interestingly, the article for manufactured controversy.
10. It's the right thing to do, if the goal is presenting accurate, unbiased and informative articles to readers who have concerns over the risks of ecigs.
CrezT ( talk) 16:28, 24 May 2016 (UTC)
None of it? Is that a claim you think will stand up to even the most basic of scrutiny? In light of your previous advice about proper conduct, I ask you to reflect on the accuracy of this comment, and how it could be perceived. I was not the person who started issuing advice about proper conduct, that was yourself above, but as it is now out there and I am apparently beholden to it, I am not going to be shy about ensuring this is a level playing field. CrezT ( talk) 19:30, 24 May 2016 (UTC)
Maybe it would help if you would draft a completion of: "The benefits and the health risks of e-cigarettes are now clearly known. They are: ..." Best of luck! Johnbod ( talk) 17:34, 24 May 2016 (UTC)
Jytdog, the rules apply to you, so per TPG your replies need to stop containing obvious lies (my ten points have multiple crossovers with Wikipedia policy and guidance - deny it a third time if you want, it's still going to be false), deliberate misrepresentions of my arguments (you will not find in my ten points any statement that says the redundancy of the line is wrt to the main article, that is clearly not my issue), lacking in comprehensiveness (you'd have barely scratched the surface of my whole argument with these two points even if they were right), and in general being so vague as to be useless for the purposes of sensible discussion (reliable sources state some risks are known, so your last point is either patent nonsense, another deliberate lie, or a vacuous proforma statement you trot out regularly without any regard to the debate at hand). @others, it is clear this issue won't move forward until Jtydog and Johnbod improve their conduct. We're well past the point that this could simply be down to any kind of miscommunication or genuine disagreement about how to interpret the same facts. CrezT ( talk) 13:42, 25 May 2016 (UTC)
Noting here for the record these two edits. [31] [32], which have markedly changed the disputed wording. No need for anyone else to be confused by this dysfunctional talk page (and yes, I am making this same identical note in three related sections, and that is intentional). CrezT ( talk) 18:22, 2 June 2016 (UTC)
Zvi, would you please stop adding content/sources only to the lead? Per WP:LEAD, the lead summarizes the body. Things need to go there first, and then we update the lead if it rises to that. Thanks. Jytdog ( talk) 01:08, 27 May 2016 (UTC)
The introduction is too long. It's a small article all on its own, created from an assorted and disparate collection of sentences written in a process far removed from any idea you start by looking at the main article and summarise its main points. As a topical example, it currently claims fires and explosions have been reported [in trials]. The much disputed uncertainty sentence is not a summary, it's a verbatim copy of one found in the harm reduction section, yet presented and defended in the lead as if it refers to all risks. People making a conscious effort to summarise the main article simply wouldn't make such glaring and obvious mistakes. People constructing a mini-article from sources they want people to read first, before they can get better information from any of the rest of the page, would. Any suggestion this article currently complies with LEAD is as much a fiction as this idea all risks and benefits are still uncertain. CrezT ( talk) 20:26, 27 May 2016 (UTC)
The user inhales the vapor,[2] which is called vaping.[4]
. Congratulations to the author of this "sentence", supported by no less than two references to reliable sources, and to all who permitted this abomination of English syntax to stand in the second sentence of a major article. The whole lead section sounds as if written by a 3rd-grader. I'm removing this abomination of an article and its dysfunctional talk page from my watchlist, and I regret getting myself involved. Keep on doing a lousy job.
No such user (
talk) 21:21, 5 June 2016 (UTC)
With nothing else to do while the stonewalling is in full flow above, I just looked in detail at the abstracts of the three medical sources used to support this uncertainty sentence.
https://www.ncbi.nlm.nih.gov/pubmed/25572196
Counseling patients on the use of electronic cigarettes.
Electronic cigarettes (e-cigarettes) have substantially increased in popularity. Clear evidence about the safety of e-cigarettes is lacking, and laboratory experiments and case reports suggest these products may be associated with potential adverse health consequences. The effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch combined with minimal behavioral support. Although a role for e-cigarettes in the treatment of tobacco dependence may emerge in the future, the potential risk of e-cigarettes outweighs their known benefit as a recommended tobacco treatment strategy by clinicians. Patients should be counseled on the known efficacy and potential risks of e-cigarettes.
https://www.ncbi.nlm.nih.gov/pubmed/26389730
Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement.
DESCRIPTION:
Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on counseling and interventions to prevent tobacco use and tobacco-related disease in adults, including pregnant women.
https://www.ncbi.nlm.nih.gov/pubmed/24898072
Electronic nicotine delivery systems ("e-cigarettes"): review of safety and smoking cessation efficacy.
BACKGROUND AND OBJECTIVES:
Cigarette smoking is common among cancer patients and is associated with negative outcomes. Electronic nicotine delivery systems ("e-cigarettes") are rapidly growing in popularity and use, but there is limited information on their safety or effectiveness in helping individuals quit smoking.
Clearly these sources are not supporting the statement in the way its defenders have argued it should be read, i.e. with reference to the risks and benefits of all ecig users - smokers trying to quit, smokers not trying to quit and people who have never smoked, as well as to third parties. Other sources need to be found, ones which match the intended scope of the sentence. If not, it has to go. That is unambiguous Wikipedia policy. CrezT ( talk) 16:53, 27 May 2016 (UTC)
Noting here for the record these two edits. [34] [35], which have markedly changed the disputed wording. No need for anyone else to be confused by this dysfunctional talk page (and yes, I am making this same identical note in three related sections, and that is intentional). CrezT ( talk) 18:22, 2 June 2016 (UTC)
Doc James has now restored the disputed sentence, [36], claiming not to see consensus. That's.....interesting, as I can't see where anyone has even bothered to reply in this section, which was very pertinent to his briefly stated opinion, or address in detail any of the other issues. Seeing is believing, or not as the case may be. CrezT ( talk) 05:58, 7 June 2016 (UTC)
This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 25 | ← | Archive 27 | Archive 28 | Archive 29 | Archive 30 | Archive 31 | Archive 32 |
Your comments are both inaccurate and disruptive.
The observations are not accurate, despite the fact that you believe so. The video is not a primary source, it does not present original research, and even if it were it is a position of the CDC. As for the NACCHO source, there is nothing to indicate that it has been retracted, websites are restructured continuously and it does impact its credibility. I find it entertaining that you suggest press releases should be removed from sources while advocating strongly for the inclusion of the NHS Smokefree Electronic cigarettes site as well as the Press release – E-cigarettes: an emerging public health consensus used for the statement "In a 2015 joint statement, Public Health England and twelve other UK medical bodies concluded "e-cigarettes are significantly less harmful than smoking." Youth and adolescents are pretty similar groups, and the terms are often used interchangeably — mostly for variation. CFCF 💌 📧 18:59, 4 February 2016 (UTC)
What are we trying to say here? If it's an ingredient, it isn't an adulterant in my book. Tobacco extract is presumably for flavour, and ? cannabis left over from production runs of cannabis e-juice on insufficiently cleaned equipment. What are the sources saying? Johnbod ( talk) 13:03, 31 January 2016 (UTC)
The "Smoking Cessation" section frequently uses the term "NRT", without defining it. I'm guessing that this is an acronym for "Nicotine Replacement Therapy", but I'm not sure, and I think many readers of the article wouldn't be either. Could someone who knows for certain what it means please put the full term at the location of first usage? ie: Nicotine Replacement Therapy ("NRT"). Marcus erronius ( talk) 01:31, 8 February 2016 (UTC)
I find this edit [2] disturbing. Since it directly breaks with WP:MEDRS and WP:POV. From WP:MEDREV:
Here an anonymous editorial (opinion => primary source) is being used in exactly this way. -- Kim D. Petersen 15:06, 27 January 2016 (UTC)
Also note that the Lancet Editorial Board is not anonymous, you have at least twenty people standing behind the position at [4]. It is recognized as one of the most prestigious journals in the world and as such its positions hold much weight, enough that this statement illicited first page news around the world:
Neither does it counter the source, but the criticism should be included in the article, seeing as it comes from a high profile respected source. CFCF 💌 📧 15:52, 27 January 2016 (UTC)
The key point here seems to be "Can an editorial in the lancet be used as an RS to contradict the conclusions of a secondary source?". However all of this can be avoided if both sides will bend a little towards reasonability. It's fair to say the lancet editorial is not alone in its criticisms of the PHE Report so why not include the note that the PHE's verdict is not universally acknowledged (or similar words to say it's not the only accepted mainstream scientific view) citing the Lancet as an example of that. For instance
Public Health England report stated that e-cigarettes are estimated to be 95% less harmful than smoking, [1] although the basis for that figure is not universally accepted. [2]
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SPACKlick ( talk) 16:57, 6 February 2016 (UTC)
CFCF inserted an image without discussing it. [5] The top image is an electronic cigarette. The bottom one contains images of illegal substances and devices used to inhale them which are not e-cigs. AlbinoFerret 15:30, 27 January 2016 (UTC)
The emergence of electronic cigarettes (e-cigs) has given cannabis smokers a new method of inhaling cannabinoids.
SPACKlick, they are categorized as ecigs as per the source, which also takes up the difference between traditional vaporizers and e-cigs used for cannabis/cannabinoid e-liquid.
Would you be more comfortable using the image:
File:Ijerph ecig variants.jpg which has that section cropped out?
Some models of e-cigs for vaping [...]
CFCF has added more illegal drug usage to the article against consensus above that shows it does not belong in this article. [6] AlbinoFerret 18:33, 27 January 2016 (UTC)
It is completely unreasonable to say that this belongs only under safety, there is no rationale whatsoever for that. There are a number of sources supporting this, two of which are in the article now, including the NIDA-page. Seeing as this is a legal issue beyond beyond the purely medical aspects, we can expand with non-MEDRS sources as well.
The
Medscape – Medscape article would also be an acceptable source to expand/support the section.
CFCF
💌
📧 19:31, 3 February 2016 (UTC)
CFCF changed the image of the Construction section here. [8] The image is of an older device from 2013, around the date of the image. Its a unusual design that has to my knowledge never been copied and is no longer available. Few things if any from 2013 are in the fast paced development of the e-cig. This image replaces one (discussed above) that replaced the common cigalike broken into components. Does this image help the reader understand construction of ecigs? Is it an improvement to the article? I would say no and one of the component images should take its place. AlbinoFerret 19:28, 7 February 2016 (UTC)
I recently found this image which shows the internals of cigalikes. Maybe this could be included, it's higher quality than what was in the article a couple of weeks ago. CFCF 💌 📧 23:07, 7 February 2016 (UTC)
CFCF has added a section to the page dealing with Diacetyl. This is a toxicology section and IMHO belongs on safety instead of adding it here to a summery section. Opinions? AlbinoFerret 01:23, 8 February 2016 (UTC)
Actually, the first source in the section, the one you cited (
[11]) does. — page 4
Actually the very sentence above the one you cited
Some ENDS solutions contain harmful flavoring molecules, diacetyl and acetyl propionyl, used to add a buttery taste to the vapor and are known to cause bronchiolitis obliterans. These chemicals have been demonstrated to be present in higher concentrations in ENDS than is recommended by the National Institute of Occupational Safety and Health [33].
CFCF 💌 📧 00:35, 9 February 2016 (UTC)
Flavorings
Diacetyl is commonly found at lower levels in e-cigarettes than in traditional cigarettes. [1] Certain flavorings may contain harmful substances such as diacetyl and acetyl-propionyl which give a buttery taste. [1] Diacetyl has previously been connected to bronchiolitis obliterans when breathed in as an aerosol by popcorn manufacturers, known then as Popcorn lung. [1] [2] [3] A 2015 review urged for specific regulation of diacetyl and acetyl-propionyl in e-liquid, which are safe when ingested but harmful when inhaled. [4] Both diacetyl and acetyl-propionyl have been found in concentrations beyond those recommended by the US National Institute for Occupational Safety and Health. [1]
A 2015 class-action lawsuit is pending in Orange County over claims connecting the specific e-liquid flavorings containing diacetyl and acetyl propionyl and incidences of the lung disease bronchiolitis obliterans. [5]
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To clarify this is the added text, it is not related to the above popular press and primary sources. As you can see — this is all sourced to secondary sources, all of which are MEDRS-compliant or unrelated to medicine. CFCF 💌 📧 21:36, 8 February 2016 (UTC)
I made a few changes to the article (mostly Lead section) today. Most of it was stylistic, merging sentences, rephrasing, moving stuff around, but I hope people will review them for any unintentional errors I might have made. ~ Awilley ( talk) 21:27, 4 February 2016 (UTC)
On whether Health is more notable than History, I would say that the latter is more important for an encyclopedia, but I can understand why you, in particular, would disagree with that. In any case, I don't think "notable" is a good criteria for determining order. That should be done logically, preferably chronologically, with the reader in mind. To me it makes sense to start with the general introduction, then talk about the history, and then talk about safety, health, cultural impact, etc. I realize all articles will do it differently, but I looked up the most closely related article I could think of ( cigarette) and it fits that pattern fairly well.
Last point: If you think that Healthy/Safety is indeed the most important thing, you should be trying to end the Lead section with the paragraph on health/safety, since that's the last thing most visitors will read. See our article on serial position effect for why that might be a good thing. ~ Awilley ( talk) 04:47, 6 February 2016 (UTC)
I just came across this--leaving it here for other people to possibly decide to use.
173.228.123.101 ( talk) 19:20, 13 February 2016 (UTC)
I have seen several stories in the national press in the UK covering Yu et. al.: [12]. Since this is from November 2015 I presume it has already been discussed, which archive should I look in please? Guy ( Help!) 11:18, 15 February 2016 (UTC)
Just listened to an interesting 5 mins or so feature on Glanze's recent paper (see above) on today's More or Less (radio programme), a BBC radio programme covering statistics etc. Some of you should be able to pick it up online from the website linked at the article, starts about 5 mins in. Linda Bauld, Ann McNeill, Peter Hajek (co-author of the Cochrane Review - "grossly misleading" he says), Robert West ("mashed together very different studies") - all saying the paper should not have been published, as did an un-named person who peer-reviewed it for the Lancet sub-journal. Glanze & the editor unrepentent. Johnbod ( talk) 16:52, 5 February 2016 (UTC)
The article referred to Cochrane, saying "There is tentative evidence that they can help people quit smoking."
However, the evidence that they can help can people quit is moderate according to the cited Cochrane review. In the table titled "Summary of Findings for the Main Comparison", footnotes 3 and 4 clarify that the GRADE rating was downgraded from 'moderate' (relevant to statistical quality) to 'low' for the randomization against placebo, due to the fact that the e-cigarettes in one trial delivered nicotine poorly, meaning the effect size likely underestimates efficacy.
As a binary outcome measure, the evidence that e-cigarettes can help smokers quit is moderate according to Cochrane.— Preceding unsigned comment added by Zvi Zig ( talk • contribs) 09:42, 3 March 2016 (UTC)
Thanks for confirming above. I see what you mean, but this is going beyond summarizing what the source says and analyzing it, and coming up with your own new finding. This goes beyond summarizing the source, and is the kind of thing that WP:OR disallows. I would say the same thing if you were downgrading the conclusion. Jytdog ( talk) 18:50, 4 March 2016 (UTC)
The C&EN Cover Story Boom In E-Cigarettes Sparks Calls For Regulation might useful for updating the article. -- Leyo 11:15, 7 March 2016 (UTC)
The lead section of a Wikipedia article is supposed to summarize the article's contents, so inline citations (which make it look like the material was added to the lead first) should be kept to a minimum. And yet somehow this article's lead has over forty!? Also, the lead is enormous... just saying...
Hijiri 88 ( 聖 やや) 09:58, 22 February 2016 (UTC)
The original premise in this discussion is flawed. Our manual of style gives this guidance on the lead: "The lead serves as an introduction to the article and a summary of its most important contents."
and "It should identify the topic, establish context, explain why the topic is notable, and summarize the most important points, including any prominent controversies."
(my emphases), which is not the same as assuming that it must be solely a summary of the rest of the article and nothing else. Not every topic can be properly introduced through sources that already exist in the rest of the article, and that may be especially true of articles dealing with controversial topics. It is perfectly reasonable for a source that gives a broad introduction to a topic to be a good choice for referencing part of the lead, and yet not be sufficiently detailed to act as a good choice as a citation within a complex discussion later in the article, where more specialised sources are more appropriate. These sort of judgements belong to discussion in individual articles and it is necessary to seek a consensus in these cases. Apart from direct quotations, there's no rule that dictates whether citations appear in the lead or not; nor is there a rule that proscribes the use of a citation in the lead that does not appear elsewhere. --
RexxS (
talk) 18:53, 23 February 2016 (UTC)
"any statement in the lead must be in the body"- which is patent nonsense. The balance between the functions of introduction, establishing notability, providing context, and summarising the body is a matter for consensus between editors at the article, not by dictat from a non-existent policy. -- RexxS ( talk) 23:47, 24 February 2016 (UTC)
There is general agreement that Lead sections can have citations (nobody has argued otherwise) and that this particular Lead section should have citations. The problem that seems to be getting ignored in some of the arguments above is that this Lead section has too many citations. For instance, we have the following completely uncontroversial sentence with 4 (!) citations.
The e-liquids used in e-cigarettes usually contains a mix of propylene glycol, glycerin, nicotine, and flavorings.[17][19][23][24]
There is also this beast with 7 citations:
The vapor can contain small amounts of toxins, including traces of heavy metals detected at levels permissible in inhalation medicines,[16][27][6] and some potentially harmful chemicals not found in tobacco smoke[28] at levels permissible by workplace safety standards.[27][29][30]
I think the best way forward would be for somebody to judiciously prune some of these citations so we have no more than about 1-2 per sentence, and certainly no more than 1 per clause. If we find long sentences like my second example that can't be sourced to 1-2 sources it might be a good reason to break them up or look for possible WP:SYNTH. I could do this, but I don't know the literature as well as most of you regulars here so it would take me 5x as long. Volunteers? ~ Awilley ( talk) 19:46, 24 February 2016 (UTC)
Once example of redundancy
Non-smokers who use e-cigarettes risk becoming addicted to nicotine,[21] a chemical with a range of harmful effects.[22]
Both of the citations tend to support the first part of the sentence; but none of them (specially 22) support/talk the second part (harmfull effects of nicotine). While there is a full article devoted to the second part which in my opinion is better to link. Marianol ( talk) 16:54, 10 March 2016 (UTC)
Doc James -- I think you're making a mild error of judgment on this article. You keep removing paragraph breaks in the lead, and I don't think that's well advised. It's true that WP:LEAD says there should be four paragraphs in the lead. This is not the same as four blocks of text, and what you're actually making is blocks of text that consist of several different paragraphs all jammed together.
A paragraph is a thematically related series of ideas which develop a particular subject. A block of text is the area between two line breaks. Do you see the difference?— S Marshall T/ C 12:42, 10 March 2016 (UTC)
Have reverted this edit [15] which added "according to the American Journal of Respiratory and Critical Care Medicine in 2014"
If we begin stating which journal and which year all our content comes from this page will turn into a disaster. Adding the quote from the paper for the second bit. Doc James ( talk · contribs · email) 04:47, 6 March 2016 (UTC)
I had deleted the statement, "There is little data about their health effects", which references a paper authored mid-2013. Using statements about research quantity from a time when the overwhelming majority of today's research was unavailable is inappropriate.
A Pubmed search on e-cig terms shows that only a fraction of today's research had been available at the time. [1]
My deletion had been reverted [ [16]] by Yobol who explained, while there is clearly more data, there is still little high quality safety data regarding e-cigarettes, especially long term.
This does not justify restoring the irrelevant source; whatever one's views on today's data quality, this certainly not supported by a mid-2013 estimate on data quantity.
References
- Zvi Zig 11:34, 11 March 2016 (UTC)
I have reverted this set of changes, as they distort the position of regulatory authorities. If you read the WHO statement, it is pretty hostile to current e-cigs - the known risks, the unknown risks, especially the lack of regulation. yes there is the one line that says "the use of appropriately regulated ENDS may have a role to play in supporting attempts to quit." but even there, it is not current ENDS, but rather "appropriately regulated" ENDS, which do not exist, as the report makes clear. So I reverted. Happy to discuss. Jytdog ( talk) 14:43, 11 March 2016 (UTC)
Not sure what TracyMcClark is talking about here with regard to "Blind revert"? The ordering of this article has been talked to death:
P Walford's change in this dif was too bold per the DS as I noted when I reverted in this dif. This is not something people should just be messing with, without prior discussion. Jytdog ( talk) 20:38, 13 March 2016 (UTC)
The primary causing cancer suspects from chewing tobacco, second hand smoke, and smoking are not present in detectable levels in e-cigs: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555263/ . All the references to politicized organizations in this article do not carry as much weight with me as this one scientific study. Someone with more interest and stamina may be able to include it. There's not even a mention of NNK, NNN, or even TSNA's in general (the cancer-causing agents in smoking). Ywaz ( talk) 09:52, 20 March 2016 (UTC)
this edit is not OK. American Legacy Foundation is not a major health authority, and their study cannot be used to overthrow the existing published reviews and the most recent statements of major health authorities. I reverted. Jytdog ( talk) 01:15, 21 March 2016 (UTC)
I would like to revive a conversation. I feel that I was misunderstood/I was not clear. I would appreciate a user with experience in statistics can be pinged.
The Cochrane Review is quoted, "There is tentative evidence that they can help people quit smoking." The word tentative comes from Cochrane's 'low' GRADE of confidence level in the effect estimate. As I showed, Cochrane is clear that they downgraded their confidence grade from 'moderate' to 'low' because one of the devices delivered nicotine poorly, meaning the effect size may be an underestimate.
Now, Cochrane is explicit that the the 'low' grade is not related to negating the null hypothesis. They write, "These GRADE ratings reflect low levels of confidence in the effect estimates".
Bottom line, there is no support for use of the word tentative in relation to reporting these results as a "yes or no" outcome.
Now, I am not arguing that we infer that the effect size was indeed underestimated, this would certainly be WP:OR. Zvi Zig ( talk • contribs 15:57, 24 March 2016 (UTC)
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Nicotine addiction outside of tobacco has been disputed recently. A quote: "Perhaps most surprising is that, in studies by Boyd and others, nicotine has not caused addiction or withdrawal when used to treat disease. These findings fly in the face of nicotine’s reputation as one of the most addictive substances known, but it’s a reputation built on myth. Tobacco may well be as addictive as heroin, as some have claimed. But as scientists know, getting mice or other animals hooked on nicotine alone is dauntingly difficult. As a 2007 paper in the journal Neuropharmacology put it: “Tobacco use has one of the highest rates of addiction of any abused drug.” Paradoxically it’s almost impossible to get laboratory animals hooked on pure nicotine, though it has a mildly pleasant effect. "<src> http://discovermagazine.com/2014/march/13-nicotine-fix</src>
Perhaps this section needs to be a little more balanced? Gbaughma ( talk) 03:46, 8 April 2016 (UTC)
when used to treat disease" and "when used recreationally" is the dose and route of administration - both of those strongly affect the development of an addiction. Seppi333 ( Insert 2¢) 04:21, 8 April 2016 (UTC)
References
In general, drugs that are less addictive in humans (such as marijuana) are not as likely to be self-administered by animals, and drugs that are not addictive in humans are not reinforcing in or self-administered by animals. Nicotine appears to represent an exception to this rule; although it does not strongly reinforce drug-seeking behavior in animals, it produces strong addiction in some humans. ... Nicotine is the main psychoactive ingredient of tobacco and is responsible for the stimulant effects, reinforcement, dependence, and addiction that result from tobacco use. Cigarette smoking rapidly delivers pulses of nicotine into the bloodstream. Nicotine differs from cocaine and opiates in that it is powerfully reinforcing in the absence of subjective euphoria.
{{
cite book}}
: CS1 maint: multiple names: authors list (
link)
Does anyone have access to the paper this article is referring to? SPACKlick ( talk) 12:30, 21 April 2016 (UTC)
GA toolbox |
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Reviewing |
Reviewer: David Eppstein ( talk · contribs) 05:48, 28 April 2016 (UTC)
Edit warring on this contentious subject has continued both before and since the nomination, with the most recent battles involving at least five editors (Permstrump and CFCF on one side, Zvi Zig, Outofsinc, and Jytdog on the other), five reverts one way or the other of the same material in the last couple of days, and three more of the same material within the review period. This looks like a clear quick fail under criterion #4, "The article is not stable due to edit warring on the page". — David Eppstein ( talk) 05:48, 28 April 2016 (UTC)
This edit [19] removed what is a fully adequate review article from the article, see pubmed-link. The edit-summary identified it as polemic, but it is a clear summary of the facts in this paper — which is not considered particularly controversial. I will restore this because the rationale for removal was quite faulty, and does not take into account the articles status as a review under WP:MEDRS. Carl Fredik 💌 📧 22:59, 19 April 2016 (UTC)
Early studies funded by the tobacco industry on the effects of cigarette smoking where also inconclusive, and proponents of the precautionary principle have urged for more independent funding to assess the risks of e-cigarette use. (emphasis added)
You're both missing the issue. It doesn't matter if the statement or source itself is neutral, but that it is from a prominent WP:MEDRS-aligned source - and is also a review article. That it is a perspective article doesn't come into it, and WP:NPOV requires us to always show both sides of the coin. Carl Fredik 💌 📧 11:14, 27 April 2016 (UTC)
So i would support content focused on the PP, leaving the tobacco industry out, based on this source. Jytdog ( talk) 18:48, 27 April 2016 (UTC)
On coming back to this article after a period of absence and reading it with fresh eyes, the thing that strikes me most about it is how many citations there are to Grana/Benowitz, and how few there are to other sources of similar reliability (e.g. Rahman). In fact, Grana/Benowitz receives more than twice as many citations as the Cochrane Review, and in my view this is clearly inappropriate. Grana/Benowitz is not a low-quality source, but it is among the most anti-e-cigarette of the high-quality ones, and the overemphasis on it is detrimental to the article's balance.
Experience tells me that attempting to replace sentences that draw on Grana/Benowitz with sentences drawn from Cochrane or Rahman is likely to be controversial, because those sources are somewhat more pro-vaping than Grana/Benowitz is. So I thought I'd begin by seeing if there is consensus that the article is unbalanced in favour of Grana/Benowitz at the moment.— S Marshall T/ C 17:15, 3 May 2016 (UTC)
The health and lifestyle appeal may also encourage young non-smokers to use e-cigarettes, as they may perceive that trying e-cigarettes is less risky and more socially appealing. This may decrease negative beliefs or concerns about nicotine addiction.
Candy, fruit and coffee flavored e-liquid may appeal to younger users of electronic cigarettes
Easily circumvented age verification at company websites enables young people to access and be exposed to marketing for e-cigarettes.
E-cigarettes are probably safer for users and bystanders than smoking tobacco.(2 other sources)
No serious adverse effects from e-cigarettes have been reported in trials.[6] Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing.
E-cigarettes create a vapor made of ultrafine particles
However, chemicals may exceed the more stringent safety limits that apply to the public
A majority of e-cigarette users still smoke tobacco, leading to concerns that dual use can "delay or deter quitting".
E-cigarette users mostly keep smoking traditional cigarettes.
Some young people who have tried an e-cigarette have never smoked tobacco, so ECs can be a starting point for nicotine use
Others use them to circumvent smoke-free laws and policies, or to cut back on cigarette smoking.
There is considerable variability between vaporizers and in quality of their liquid ingredients and thus the contents of the aerosol delivered to the user.(2 other sources)
Less serious adverse effects from e-cigarette use include throat and mouth inflammation, vomiting, nausea, and cough.
fires caused by vaporizer malfunction,
E-cigarette vapor contains fewer toxic substances
E-cigarettes create vapor that consists of ultrafine particles, with the majority of particles in the ultrafine range
The vapor has been found to contain flavors, propylene glycol, glycerin, nicotine, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other chemicals.(1 Other Source)
significant numbers of teenagers who have never smoked tobacco have experimented with e-cigarettes.
A 2014 review stated that tobacco and e-cigarette companies interact with consumers for their policy agenda.
The companies use websites, social media, and marketing to get consumers involved in opposing bills that include e-cigarettes in smoke-free laws
The same review said this is similar to tobacco industry activity going back to the 1980s
These approaches were used in Europe to minimize the EU Tobacco Product Directive in October 2013.
The legal status of e-cigarettes is currently pending in many countries.
Some countries such Brazil, Singapore, the Seychelles, and Uruguay have banned e-cigarettes.
A 2014 review said, "the e-cigarette companies have been rapidly expanding using aggressive marketing messages similar to those used to promote cigarettes in the 1950s and 1960s."
While advertising of tobacco products is banned in most countries, television and radio e-cigarette advertising in some countries may be indirectly encouraging traditional cigarette smoking.
There is no evidence that the cigarette brands are selling e-cigarettes as part of a plan to phase out traditional cigarettes, despite some claiming to want to cooperate in "harm reduction"
I reverted this. There is no NPOV issue linking to the safety article. Jytdog ( talk) 12:54, 20 May 2016 (UTC)
There's a sentence in the lead that currently says, "No serious adverse effects from e-cigarettes have been reported in trials
" (
PMID
25515689). I think it's misleading because what the source actually says is,
The ECLAT trial (Caponnetto 2013a) found no difference in frequency of AEs at 3- or 12-month follow-up between the three groups... Of the people available for 6-month follow-up in the ASCEND trial (Bullen 2013) 44.4% of participants in the nicotine EC arm reported any AEs, compared with 44.7% and 45.6% in the patch and placebo EC arms respectively. Differences were not statistically significant... None of the RCTs or cohort studies reported any serious adverse events (SAEs) that were considered to be plausibly related to EC use. One RCT provided data on the proportion of participants experiencing any adverse events. Although the proportion of participants in the study arms experiencing adverse events was similar, the confidence intervals are wide (ECs vs placebo EC RR 0.97, 95% CI 0.71 to 1.34; ECs vs patch RR 0.99, 95% CI 0.81 to 1.22). The other RCT reported no statistically significant difference in the frequency of AEs at three- or 12-month follow-up between the EC and placebo EC groups, and showed that in all groups the frequency of AEs (with the exception of throat irritation) decreased significantly over time.
That doesn't mean there were NO adverse events. It means there were the same amount of adverse events as with the patch and other smoking cessation produts. I'm having trouble coming up with a succinct way to word it though. Any suggestions? —PermStrump (talk) 14:56, 22 May 2016 (UTC)
No serious adverse effects from e-cigarettes have been reported in trials. ( PMID 25515689) Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing ( PMC4018182)." That second source actually reads, "Major injuries and illness have resulted from e-cigarette use, including explosions and fires. Less serious adverse events include throat and mouth irritation, cough, nausea, and vomiting." And the first source doesn't say there weren't any adverse effects, just that the AEs weren't any worse than the adverse effects for the patch, etc. (see above). —PermStrump (talk) 15:31, 22 May 2016 (UTC)
We do not need primary sources. We can support text with secondary sources. Therefore reverted this. [20] Doc James ( talk · contribs · email) 12:09, 27 May 2016 (UTC)
Just came across
PMID
27228348, a review article on this, which isn't cited here. Happy to send it to any one who can't it so we can discuss including it.
Jytdog (
talk) 19:47, 27 May 2016 (UTC) (redacted per below
Jytdog (
talk) 21:27, 27 May 2016 (UTC))
WHO states:
"It is unknown if the increased exposure to toxicants and particles in exhaled aerosol will lead to an increased risk of disease and death among bystanders as does the exposure to tobacco smoke" [21] 2014
CDC says:
"Insufficient data are available to accurately predict the risk associated with use of e-cigarettes or secondhand exposure to the particulate aerosols and gases they emit. Nonetheless, the FDA and others have noted that e-cigarette cartridges and aerosols may contain harmful chemicals and substances such as diethylene glycol, nicotine, formaldehyde, acetaldehyde, toxic metals, and others" [22] 2015
NIH says:
"There are currently no accepted measures to confirm their purity or safety, and the long-term health consequence of e-cigarette use remain unknown." [23] 2016
Review in Circulation:
"Long-term biological effects are unknown at this time because e-cigarettes have not been in widespread use long enough for assessment." "Because there are no long-term safety studies of e-cigarette use, patients should be urged to set a quit date for their e-cigarette use and not plan to use it indefinitely" [24] 2014 Will add. Doc James ( talk · contribs · email) 10:56, 29 May 2016 (UTC)
Lack of direct knowledge on long-term effects does not mean long-term effects are simply "unknown". We certainly have an idea about long-term effects (at least according to some). In fact, some major medical organizations have even given numerical estimates for them. This is precisely why organizations from the CDC's NIOSH ( link) to the Royal College of Physicians ( link) use modifiers like "accurately" or "precise" in describing knowledge limitations on long-term effects.
- CDC's NIOSH says
Insufficient data are available to 'accurately' predict the risk associated with use of e-cigarettes" (emphasis mine)
- The Royal College of Physicians says
it is not possible to quantify the long-term health risks associated with e-cigarettes 'precisely'. (emphasis mine)
We do not have direct or precise knowledge of tomorrow's weather, but that doesn't mean it's toally unknown.
These should be reflected in the article, please. Zvi Zig ( talk • contribs 19:52, 29 May 2016 (UTC)
Per WP:MEDRS we go with review articles over popular press. Therefore reverted this edit. [25] Doc James ( talk · contribs · email) 07:01, 25 May 2016 (UTC)
There is a pretty evident confusion here about what a tertiary source is. A tertiary source is not the third in a line of citations to mention a topic, but a specific type of source. This review is not a tertiary source, but a secondary source, and summarizes anecdotal evidence in a satisfactory way for the type of source that it is. Including the original text is acceptable for the article, and the subject is definitely worthy of mention in the lede, at least in the short way that it currently is. I do not agree with Permstump that we should use popular press mentions to elaborate in the body. Carl Fredik 💌 📧 19:29, 25 May 2016 (UTC)
Major injuries and illness have resulted from e-cigarette use, including explosions and fires."
- No, just no. This discussion isn't going anywhere, take it to RS/N for all you like, but you're wasting your time. Carl Fredik 💌 📧 11:52, 26 May 2016 (UTC)
to examine carefully and in detail so as to identify causes, key factors, possible results, etc." ( source)
I saw this in my watchlist: WP:RS/N#Major injuries caused by electronic cigarette use, but hadn't seen it mentioned here, so I wanted to make sure other people were aware. —PermStrump (talk) 04:21, 27 May 2016 (UTC)
Believe it or not, MEDR applies because having your faced melted by a faulty or poorly designed ecig is a "practice" with "health effects", which means it is "biomedical information". It seems a stretch to me, but that's my best guess at what this is all about, absent any deeper explanation from Doc James. Hard to see how better sources can't be found, or how policy would ever say to ignore how this paper obviously isn't a systematic review of fire and explosion reporting at all. In my experience, the fire risk does prevent smokers from converting to vaping, smokers who have already failed to quit using other methods. If the fire risk of quality assured ecigs used properly has been found to be comparable to other devices, then they deserve to know. Just like they deserve not to be misled into thinking this paper was reporting fires seen in trials, as is inferred by the grammar of the whole paragraph now. CrezT ( talk) 22:23, 27 May 2016 (UTC)
I think the statement can be strengthened, here are some additional WP:MEDRS (and otherwise WP:RS) sources:
Carl Fredik 💌 📧 10:18, 28 May 2016 (UTC)
You're right to say that physicians are experts in assessing the degree of injury, but you're wrong to say they're experts in assessing risk of fire and explosion. That's not part of a physician's training and I see your repeated contentions in this respect as very strange. I don't see how it's compatible with your apparent endorsement of the FEMA source I found.
The reality is that (1) in the US, electronic cigarettes are not subject to any compulsory product safety checking regime, and (2) electronic cigarettes contain a lithium-ion battery which poses a small but non-zero risk of exploding, particularly if recharged at the wrong voltage. These explosions are rare, but can lead to, and have led to, serious injuries.
At the moment, the lede of the article says: No serious adverse effects from e-cigarettes have been reported in trials. Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing. Major injuries related to explosions and fires were also reported.
This is obviously stupid and self-contradictory. Major injuries are obviously serious adverse effects.
It's also blatant scaremongering. About a dozen Americans have been injured by electronic cigarettes. In the last decade, 416 Americans were injured by yo-yo balls. In 290 of those cases the cord became wrapped around someone's neck, posing a clear threat of strangulation. More than 15,400 Americans were injured by falling televisions, 279 of them fatally. More than 66,000 Americans a year are injured by trampolines, and since 1990 there have been 4 fatalities. Unaccountably, the Wikipedia articles on these lethal deathtraps fail to contain prominent warnings in the lede about these risks, but never fear! At least our e-cigarette article is doing its moral duty.
Sarcasm aside: Explain to me how the warning in the lede isn't WP:UNDUE scaremongering bullshit?— S Marshall T/ C 00:44, 30 May 2016 (UTC)
Cases of major injuries and property damage related to explosions and fires have also been reported.
The reason I added the line about "major injuries" the other day in the first place was in reference to this part of the lead:
No serious adverse effects from e-cigarettes have been reported in trials. ( PMID 25515689) Less serious adverse effects include throat and mouth inflammation, vomiting, nausea, and coughing ( PMC4018182)."
I feel that those 2 sentences alone are WP:SYNTH and cherrypicking overly positive wording from 2 different sources. And the first sentence in particular misrepresents what the source was actually saying (see also #Adverse events thread above). First I tried to neutralize the tone with this edit, which was reverted. Then I tried new wording to contextualize those statements so that they'd more accurately reflect their sources and was reverted again. The "major injuries" line was my 3rd attempt to add more context from the sources to resolve the WP:OR and misrepresentation of the sources. Personally, I'd probably be fine with any of those 3 edits, but I feel strongly that the former wording is inappropriate and needed to be adjusted. The most important part is clarifying/contextualizing the claim that "NO serious adverse events were reported", because the first source actually says that no serious adverse events were reported exclusively to e-cigarettes, meaning of the 1-2 studies that reported AEs, participants reported the same serious adverse events with e-cigarettes as they did for traditional cigarettes and the patch, which is very different from zero serious adverse events. As an aside, it should also be clarified that none of the studies looked at longterm AEs. —PermStrump (talk) 17:07, 28 May 2016 (UTC)
In trials, the most commonly reported adverse events have been throat and mouth inflammation, vomiting, nausea, and coughing.This takes out the judgment/subjectivity of the word "serious" and lets readers evaluate the seriousness of the risk for themselves based on the most commonly reported AEs. —PermStrump (talk) 17:11, 28 May 2016 (UTC)
I sincerely hope other Wikipedia volunteers are willing to engage on this issue, and are not put off by my ramblings above. Accordingly, I hereby present my definitive case for why the line "The benefits and the health risks of e-cigarettes are uncertain" needs to go. I invite all interested volunteers to give it careful consideration and a meaningful and thorough response.
1. It is factually wrong. Nicotine addiction, accidental ingestion, and short term effects, are just three areas where the health risks of ecigs are very much known. Other risks are also extremely quantifiable, such as the issues surrounding batteries etc, and indeed that is precisely why regulations have been drawn up, acting on those certainties.
2. It goes against established professional writing practice in this field. The BBC link I gave above is a summary piece covering all the controversies surrounding ecig risks to date, and yet it does not include a similarly broad statement. Just like Wikipedia, the BBC's mission is to inform readers without much working knowledge of a topic. Unlike Wikipedia, the BBC has a reputation for giving unbiased information about controversial topics. Absent other reasons, it must be Wikipedia, not the BBC, who have erred here.
3. It is misleading. Outside the factual inaccuracies detailed already, the potential to mislead also arises in this assumption that readers coming to this line are naturally in the mindset of thinking that it applies to all potential and actual uses of ecigs, and indeed to third parties. Everything indicates this is not the case (not least the facts found later in the article about the history and usage of ecigs), and most readers coming afresh to the article would be operating on the assumption the line refers to smokers who vape as an alternative to smoking. The potential for confusion, even if that is just temporary until they receive clarification from later text, would be eliminated entirely if the sentence was simply not there. Assuming the alternative mitigation, providing some basic facts and figures about known usage prior to the blanket statement, would not be acceptable, as I suspect it would not.
4. It is redundant. It has been argued that its various vague meanings are acceptable because it is clarified in the text that immediately follows it. And yet it is precisely because they are there, that the reader would be oblivious to the line not even being there. I cannot think of a single way that any reader would be missing out if the statement was removed, but if it were, many readers would benefit, particularly those who perhaps don't read the whole introduction, or who are presented with a small snippet of the article which cuts it off after just a few lines, as happens a lot with technology these days.
5. It is not supported. I have been told above that Wikipedia is a tertiary source, and if readers have doubts about its claims or want to know how they originate, they can always substantiate them by looking at the underlying source. Looking at the three given in the article to support this sentence however, they are all quite clearly medical papers, written by and meant to be read by medical professionals. If the statement can be supported, then why not pick a more accessible but equally authoritative publisher, like the BBC? These medical sources are meant to be read by people who are perfectly capable of recognising and discounting the obvious issues with vague statements like this, either through common professional knowledge or because they already know from the paper what the intended context is. That is not the case here, the statement is presented and the only context given is the title and first paragraph. Context is provided after, sure, but since those statements do not come from the same papers, any suggestion that one is meant to relate to the other for the purposes of substantiation is misleading. Explaining what one paper might mean by referring to another paper is what a secondary source does, not a tertiary source like an encyclopedia.
6. It is dated. Its basic factual errors aside, and ignoring the fact short term risks do not stay unknown for long, it was obviously true once that people really had no idea of the risks, they really were "uncertain" in the dictionary definition sense. But day by day, that becomes an increasingly unsupportable position - the science is at the stage now where politicians are so confident of what they do know regarding the risks, they are issuing regulations to specify what makes a safe ecig. As this process moves forward, it only makes the statement more misleading, as readers surely wonder whether it is referring to regulated or unregulated vaping, or both. That adds another layer of doubt about its intended meaning, onto an already over-broad statement.
7. It is needlessly scaremongering. Undoubtedly the intended meaning of "uncertain" in this line is the dictionary definition - lacking in certainty. Professional writers, particularly those writing for the general public, would however fully recognise that most readers will interpret the word with negative connotations, particularly when it appears alongside "health risks" - the public is well attuned to the fact smoking has no benefits and its proponents had a long history of deliberately covering up health risks. This is another area where people need to be mindful of the difference between pieces written for medics and pieces by the likes of the BBC - scientists have no need to be reminded what "uncertain" does and does not mean.
8. It evidently violates Wikipedia's own summary style. As I understand it, the introduction serves as the summary of everything else in the article, and yet it has been argued that the sentence serves as a summary of what is also included in the introduction, namely the lines that come after it. Unless someone can clarify how I have misunderstood this aspect of Wikipedia style, I can only conclude it does not comply - either the rest of the text that follows it is misplaced or redundant, or the summary of the summary is redundant.
9. It is inconsistent with other Wikipedia articles. Take a look at the article on fracking, it also does not contain a similarly broad statement, even though that too is a subject with a multi-faceted health risk controversy. In an attempt to find other Wikipedia articles with this sort of vague sentence construct to determine if this was just a one off, a Google search of the terms uncertain health risks on the Wikipedia domain actually revealed no other subject specific articles except ecigs - all other results being generic articles about risk or medicine, and interestingly, the article for manufactured controversy.
10. It's the right thing to do, if the goal is presenting accurate, unbiased and informative articles to readers who have concerns over the risks of ecigs.
CrezT ( talk) 16:28, 24 May 2016 (UTC)
None of it? Is that a claim you think will stand up to even the most basic of scrutiny? In light of your previous advice about proper conduct, I ask you to reflect on the accuracy of this comment, and how it could be perceived. I was not the person who started issuing advice about proper conduct, that was yourself above, but as it is now out there and I am apparently beholden to it, I am not going to be shy about ensuring this is a level playing field. CrezT ( talk) 19:30, 24 May 2016 (UTC)
Maybe it would help if you would draft a completion of: "The benefits and the health risks of e-cigarettes are now clearly known. They are: ..." Best of luck! Johnbod ( talk) 17:34, 24 May 2016 (UTC)
Jytdog, the rules apply to you, so per TPG your replies need to stop containing obvious lies (my ten points have multiple crossovers with Wikipedia policy and guidance - deny it a third time if you want, it's still going to be false), deliberate misrepresentions of my arguments (you will not find in my ten points any statement that says the redundancy of the line is wrt to the main article, that is clearly not my issue), lacking in comprehensiveness (you'd have barely scratched the surface of my whole argument with these two points even if they were right), and in general being so vague as to be useless for the purposes of sensible discussion (reliable sources state some risks are known, so your last point is either patent nonsense, another deliberate lie, or a vacuous proforma statement you trot out regularly without any regard to the debate at hand). @others, it is clear this issue won't move forward until Jtydog and Johnbod improve their conduct. We're well past the point that this could simply be down to any kind of miscommunication or genuine disagreement about how to interpret the same facts. CrezT ( talk) 13:42, 25 May 2016 (UTC)
Noting here for the record these two edits. [31] [32], which have markedly changed the disputed wording. No need for anyone else to be confused by this dysfunctional talk page (and yes, I am making this same identical note in three related sections, and that is intentional). CrezT ( talk) 18:22, 2 June 2016 (UTC)
Zvi, would you please stop adding content/sources only to the lead? Per WP:LEAD, the lead summarizes the body. Things need to go there first, and then we update the lead if it rises to that. Thanks. Jytdog ( talk) 01:08, 27 May 2016 (UTC)
The introduction is too long. It's a small article all on its own, created from an assorted and disparate collection of sentences written in a process far removed from any idea you start by looking at the main article and summarise its main points. As a topical example, it currently claims fires and explosions have been reported [in trials]. The much disputed uncertainty sentence is not a summary, it's a verbatim copy of one found in the harm reduction section, yet presented and defended in the lead as if it refers to all risks. People making a conscious effort to summarise the main article simply wouldn't make such glaring and obvious mistakes. People constructing a mini-article from sources they want people to read first, before they can get better information from any of the rest of the page, would. Any suggestion this article currently complies with LEAD is as much a fiction as this idea all risks and benefits are still uncertain. CrezT ( talk) 20:26, 27 May 2016 (UTC)
The user inhales the vapor,[2] which is called vaping.[4]
. Congratulations to the author of this "sentence", supported by no less than two references to reliable sources, and to all who permitted this abomination of English syntax to stand in the second sentence of a major article. The whole lead section sounds as if written by a 3rd-grader. I'm removing this abomination of an article and its dysfunctional talk page from my watchlist, and I regret getting myself involved. Keep on doing a lousy job.
No such user (
talk) 21:21, 5 June 2016 (UTC)
With nothing else to do while the stonewalling is in full flow above, I just looked in detail at the abstracts of the three medical sources used to support this uncertainty sentence.
https://www.ncbi.nlm.nih.gov/pubmed/25572196
Counseling patients on the use of electronic cigarettes.
Electronic cigarettes (e-cigarettes) have substantially increased in popularity. Clear evidence about the safety of e-cigarettes is lacking, and laboratory experiments and case reports suggest these products may be associated with potential adverse health consequences. The effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch combined with minimal behavioral support. Although a role for e-cigarettes in the treatment of tobacco dependence may emerge in the future, the potential risk of e-cigarettes outweighs their known benefit as a recommended tobacco treatment strategy by clinicians. Patients should be counseled on the known efficacy and potential risks of e-cigarettes.
https://www.ncbi.nlm.nih.gov/pubmed/26389730
Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement.
DESCRIPTION:
Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on counseling and interventions to prevent tobacco use and tobacco-related disease in adults, including pregnant women.
https://www.ncbi.nlm.nih.gov/pubmed/24898072
Electronic nicotine delivery systems ("e-cigarettes"): review of safety and smoking cessation efficacy.
BACKGROUND AND OBJECTIVES:
Cigarette smoking is common among cancer patients and is associated with negative outcomes. Electronic nicotine delivery systems ("e-cigarettes") are rapidly growing in popularity and use, but there is limited information on their safety or effectiveness in helping individuals quit smoking.
Clearly these sources are not supporting the statement in the way its defenders have argued it should be read, i.e. with reference to the risks and benefits of all ecig users - smokers trying to quit, smokers not trying to quit and people who have never smoked, as well as to third parties. Other sources need to be found, ones which match the intended scope of the sentence. If not, it has to go. That is unambiguous Wikipedia policy. CrezT ( talk) 16:53, 27 May 2016 (UTC)
Noting here for the record these two edits. [34] [35], which have markedly changed the disputed wording. No need for anyone else to be confused by this dysfunctional talk page (and yes, I am making this same identical note in three related sections, and that is intentional). CrezT ( talk) 18:22, 2 June 2016 (UTC)
Doc James has now restored the disputed sentence, [36], claiming not to see consensus. That's.....interesting, as I can't see where anyone has even bothered to reply in this section, which was very pertinent to his briefly stated opinion, or address in detail any of the other issues. Seeing is believing, or not as the case may be. CrezT ( talk) 05:58, 7 June 2016 (UTC)