Talk:Health effects of electronic cigarettes/Archive 3

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Archive 1 Archive 2 Archive 3 Archive 4

RFC: Are medical statements such as those from the World Lung Foundation reliable for medical content?

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.
Clear policy-based consensus that such statements are (a) reliable and (b) appropriate for inclusion. Guy (Help!) 08:50, 17 April 2015 (UTC)

The dispute revolves around material from the World Lung Foundation which was removed in this diff and mterial from the World Medical Association was removed in this diff.

The text from the WLF in our article was "The World Lung Foundation stated that "Researchers find that many e-cigarettes contain toxins, contaminants and carcinogens that conflict with the industry’s portrayal of its products as purer, healthier alternatives. They also find considerable variations in the amount of nicotine delivered by different brands. None of this information is made available to consumers so they really don’t know what they are ingesting, or how much."; cited to this statement released by the WLF.

The text from the WMA in our article was "In October 2012, the World Medical Association stated, "Manufacturers and marketers of e-cigarettes often claim that use of their products is a safe alternative to smoking, particularly since they do not produce carcinogenic smoke. However, no studies have been conducted to determine that the vapor is not carcinogenic, and there are other potential risks associated with these devices: Appeal to children, especially when flavors like strawberry or chocolate are added to the cartridges."; cited to this statement released by the WMA.

Should these statements be included in the article? Yobol (talk) 20:44, 19 February 2015 (UTC)

Positions

  • Include statements. Both statements are reliably sourced to WP:MEDRS compliant sourcing, specifically position statements by medical organizations. Arguments for their removal including assertions that tertiary sources cannot be used on Wikipedia fly in the face of WP:MEDRS which explicitly allows for the use of tertiary sources including medical textbooks. While I would agree that these are not the most ideal MEDRS sources, neither of these statements appear at all controversial in content, and the sourcing is adequate for the purpose. I should also note that it has been argue above that there is a "consensus" that only review articles can be used as sources here. I will note that this declaration of a consensus appears to have been made up whole cloth out of thin air, and no evidence whatsoever of any such consensus has been produced. Yobol (talk) 20:44, 19 February 2015 (UTC)
  • Use secondary review WP:MEDRS sources instead. Position statements are interesting and valuable to decipher the level of consensus or policy on a specific issue, but they are not medically relevant sources. For that there are secondary sources. Position statements are by their very nature tertiary, and thus per WP:MEDRS (and WP:RS) we should use the underlying secondary sources instead. And we should use the best secondary review WP:MEDRS compliant sources available. For position statements there is a specific article Positions of medical organizations regarding electronic cigarettes. --Kim D. Petersen 20:52, 19 February 2015 (UTC)
KimDabelsteinPetersen, you deleted a number of sources including reviews.[1][2][3][4][5][6][7][8] So what is your explanation for also deleting the secondary reviews you state should be used instead?[9] QuackGuru (talk) 17:47, 9 March 2015 (UTC)
First, you have no idea whether these statements are secondary or tertiary, as you do not know what data or studies the sources base their statements on. Second, even if they were tertiary sources, however, tertiary sources are not disallowed by WP:RS, WP:MEDRS or any other policy or guideline on Wikipedia. Removing them repeatedly merely on the basis that they are tertiary sources does not comply with any Wikipedia guideline or policy. Yobol (talk) 20:57, 19 February 2015 (UTC)
If it is not tertiary - then they are then primary... which doesn't make it better. Once more: We should use the best secondary review WP:MEDRS compliant papers. If the information in a position statement cannot be found in the secondary review literature - then there really is a problem with using position statements - because then they are purely politically based. There is a specific article for position statements. --Kim D. Petersen 21:02, 19 February 2015 (UTC)
They clearly are not primary as they are using the underlying medical literature as a source (either the primary or secondary literature), making those statements at least secondary in nature. You are trying to make up your own rules on what is allowable per MEDRS. These are position statements by medical organizations and therefore MEDRS compliant. We don't have additional rules that they have to be corroborated by a published review article, and we certainly do not have a restriction to only review articles in MEDRS. Please stop making up your own rules. Yobol (talk) 21:07, 19 February 2015 (UTC)
Are you truly trying to say that we cannot decipher or "know what data or studies the sources base their statements on"?? And then you still want to use it? Erh? Don't you see a problem here? I would assume that they get their positions from the secondary literature, and not just make up stuff that isn't in the medical literature already. --Kim D. Petersen 21:04, 19 February 2015 (UTC)
They could also be basing it off the primary medical literature, making the statements a secondary source. Yobol (talk) 21:07, 19 February 2015 (UTC)
Then we should be able to decipher what secondary sources they are based upon. Position statements are less reliable than secondary review articles under all circumstances. If they are purely based upon primary material, then they even less reliable than secondary review papers. So use: Secondary review material instead - just as consensus has been on electronic cigarette articles all of the time. --Kim D. Petersen 21:18, 19 February 2015 (UTC)
There is no such consensus, and repeatedly declaring such a consensus exists does not make it so. Yobol (talk) 21:20, 19 February 2015 (UTC)
There most certainly has been such a consensus - no matter how much you argue against it. But consensus can of course change, but please consider the consequences. So far everything has been based upon secondary review material from highranking MedLine indexed journals - are we throwing that requirement away? --Kim D. Petersen 21:28, 19 February 2015 (UTC)
If such a consensus exists, that the only sources allowable for medical content is published review articles, please point out the talk page section or RfC which establishes it. We use MEDRS compliant sourcing for medical content, which includes statements by medical organizations. Yobol (talk) 21:31, 19 February 2015 (UTC)
  • Use secondary review WP:MEDRS sources Formal policy statements that are review quality can also be used. Because formal scientific reports are mentioned on WP:MEDRS which says " formal scientific reports, which can be the equal of the best reviews published in medical journals". The World Lung Foundation souse that is cited as an example is a Press release (clearly marked as one in the yellow bar at the top as a Press Release) and not a source that should be relied on for medical claims.AlbinoFerret 21:08, 19 February 2015 (UTC)
WP:MEDRS does not have a restriction to only using published journal article reviews. Yobol (talk) 21:09, 19 February 2015 (UTC)
Press releases are not appropriate for medical claims. AlbinoFerret 21:11, 19 February 2015 (UTC)
Where you see a press release, I see a position statement adopted by the general assembly of the organization. Yobol (talk) 21:16, 19 February 2015 (UTC)
This [10] is a press-release. And it is one of the sources that you argue for in the above. --Kim D. Petersen 21:22, 19 February 2015 (UTC)
There is also no language in that press release saying this was "adopted by the general assembly of the organization". AlbinoFerret 16:50, 20 February 2015 (UTC)
  • These are eligible sources here (add: so include them) per WP:MEDRS and our general policy on reliability and weight. Alexbrn talk|contribs|COI 21:09, 19 February 2015 (UTC)
Eligible certainly. But less useful, and carrying significantly less weight than secondary review literature, which has so far been the consensus position as the threshold for material on electronic cigarette articles. --Kim D. Petersen 21:20, 19 February 2015 (UTC)
You keep saying there is a "consensus" that only review articles are allowed to be used as medical sources. Please point me to the thread or RfC which established such a consensus. Absent this, please stop making up your own "consensus". Thanks. Yobol (talk) 21:24, 19 February 2015 (UTC)
Sigh! Reliable secondary review WP:MEDRS compliant papers, in high quality MedLine indexed journals has so far been the consensus. Can you tell me what is wrong about that previous consensus? Don't you think that we should use the very best material available per WP:MEDRS? --Kim D. Petersen 21:33, 19 February 2015 (UTC)
@KimDabelsteinPetersen: Actually no, there are many circumstances in which the position statements of major bodies (NHS, NICE, ACS, WHO) offer the strongest source - or at the very least one which should not be omitted. Alexbrn talk|contribs|COI 21:25, 19 February 2015 (UTC)
That is why we have a whole article Positions of medical organizations regarding electronic cigarettes based upon these sources, and summarize them at Electronic cigarette. Can you tell me why reliable secondary review material isn't enough here? --Kim D. Petersen 21:31, 19 February 2015 (UTC)
Where is the talk page section or RfC which establishes that only published review articles can be used? Yobol (talk) 21:32, 19 February 2015 (UTC)

The question of whether there is a local "consensus" to eliminate position papers as sources for this article is irrelevant, because there is a broader consensus across all of Wikipedia that these are ideal sources for this type of content. Have you taken a look at WP:RS recently? It states unambiguously that

Ideal sources for biomedical assertions include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally reputable expert bodies.

WP:RS

The statement is repeated in WP:MEDRS

Ideal sources for such content includes literature reviews or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies.

WP:RS

These guidelines reflect broad consensus from editors across all of Wikipedia. You cannot create a local exception just because you don't like what "ideal sources" stay about these devices. If you want to change this, you have to get consensus to change both WP:RS and WP:MEDRS. I doubt very much you will be successful. Formerly 98 (talk) 21:33, 19 February 2015 (UTC)

Cherry picking from WP:MEDRS and WP:RS now? Are you truly saying that WP policy is that we should prefer tertiary sources over secondary, or that position statements are the equivalent of reviews? Have you btw. read WP:Tertiary, WP:CON or WP:WEIGHT recently? --Kim D. Petersen 21:36, 19 February 2015 (UTC)
I have no idea what you are referring to by "cherrypicking". The term is usually used to refer to picking out a single article that favors a certain POV out of a set of many that express a different opinion. There is only one WP:MEDRS and only one WP:RS and both clearly and unambiguously prohibit this sort of exclusion of ideal sources. I'm sorry you don't like what these sources say. I suggest you find a different strategy for trying to exclude them, as this one will not survive review even if successful locally. Formerly 98 (talk) 01:21, 20 February 2015 (UTC)
Im surprised you want to included press releases. AlbinoFerret 01:29, 20 February 2015 (UTC)
To clarify, that press release links to another from the CDC saying almost the same thing! essentially intended to promote awareness of a paper published the same day, 20 Aug 2014: "Intentions to Smoke Cigarettes Among Never-Smoking US Middle and High School Electronic Cigarette Users: National Youth Tobacco Survey, 2011-2013" PMID 25143298. That (large primary) paper compares to "E-cigarette prevalence and correlates of use among adolescents versus adults: a review and comparison", PMID 24680203. That too indicates that youth using e-cigarettes (compared to never-using them) are more likely to later try conventional cigarettes, though the precise details and wording vary.LeadSongDog come howl! 03:59, 23 February 2015 (UTC)
So we have press releases to promote primary sources? By the way the Chapman review is already in the main e-cig article. AlbinoFerret 04:30, 23 February 2015 (UTC)
Just abit about tertiary sources:

Policy: Reliable tertiary sources can be helpful in providing broad summaries of topics that involve many primary and secondary sources, and may be helpful in evaluating due weight, especially when primary or secondary sources contradict each other. Some tertiary sources are more reliable than others, and within any given tertiary source, some articles may be more reliable than others.

WP:Tertiary

WP:MEDRS#Definitions might also give a hint here. WP:MEDRS compliant secondary review papers are the best sources we can use. So why would we choose lesser sources? --Kim D. Petersen 21:40, 19 February 2015 (UTC)
Seems to me that for some editors it is not enough with the material that they can find in the best available sources per WP:MEDRS and thus want to WP:COATRACK material that belongs in Positions of medical organizations regarding electronic cigarettes into this article. Tertiary sources, position statements, policy statements etc. are lesser sources than review material! --Kim D. Petersen 21:43, 19 February 2015 (UTC)\
You can also look at Other sources on the WP:MEDRS wich directly addresses press releases. AlbinoFerret 03:11, 26 February 2015 (UTC)
Kim and Albino, what part of "Ideal sources for such content includes... medical guidelines or position statements from nationally or internationally recognised expert bodies", repeated in both WP:RS and WP:MEDRS is hard to understand? Formerly 98 (talk) 15:17, 26 February 2015 (UTC)
Whats hard to understand is why you want to include press releases. You also seem to be ignoring Other sources on the WP:MEDRS and completly ignoring "The reliability of these sources range from formal scientific reports, which can be the equal of the best reviews published in medical journals, through public guides and service announcements, which have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature." WP:MEDORG. Press releases are not even spoken of, and in no way are these formal policy statements. This is an example of a formal policy statement that was published in a peer reviewed journal, its in the article as we discuss this. What is trying to be included is lower quality material, fine for the Position page, so it is included, but not to make medical claims on this page. AlbinoFerret 16:55, 26 February 2015 (UTC)
You are against including formal policy statements too. You tried to delete it. See https://en.wikipedia.org/w/index.php?title=Safety_of_electronic_cigarettes&diff=642107506&oldid=642095256 If it is fine for the Position page then it should be fine for this page too because the Position page also includes medical claims. Even a service announcement may be used. Where does MEDRS say press releases from reputable organisations are unreliable? It appears you are making up your own rules for this e-cig page to exclude any source that is not a review. QuackGuru (talk) 17:44, 26 February 2015 (UTC)
You are making another misstatement that has been clairified before, yet you continue in the faulty premise. The source has COI, addressed in the source. Not only did some of the authors recieve funding from the pharmicutuical industry, they sit on the boards of dirctors for pharmicutical companies. It wasnt removed because its a formal policy statement as the next edits prove diff. I recommend you stop characterising peoples edits falsely as its a clear violation of AGF and may be, and is by me, considered a personal attack. AlbinoFerret 18:04, 26 February 2015 (UTC)
You wrote above "This is an example of a formal policy statement that was published in a peer reviewed journal, its in the article as we discuss this."[11]
Yet you deleted this source. https://en.wikipedia.org/w/index.php?title=Safety_of_electronic_cigarettes&diff=642107506&oldid=642095256
Brandon, T. H.; Goniewicz, M. L.; Hanna, N. H.; Hatsukami, D. K.; Herbst, R. S.; Hobin, J. A.; Ostroff, J. S.; Shields, P. G.; Toll, B. A.; Tyne, C. A.; Viswanath, K.; Warren, G. W. (2015). "Electronic Nicotine Delivery Systems: A Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology". Clinical Cancer Research. doi:10.1158/1078-0432.CCR-14-2544. ISSN 1078-0432.
The next edits shows there is a problem the with context you added. For example, "I don't think it's original research, but it sure seems over-the-top. Perhaps a better description than WP:OR would be WP:UNDUE, or WP:FRINGE (in emphasis), perhaps WP:POINTy, WP:EDITORIALIZING, WP:ALLEGED, or trying to WP:RIGHTGREATWRONGS, using a WP:PRIMARYSOURCE to sneak in an editor's POV rather than simply reporting what well-accepted reliable sources say." according to BarrelProof. See Talk:Safety_of_electronic_cigarettes/Archive_1#Original_research_2. So why do you want to ignore MEDRS and use only secondary reviews when MEDRS allows reviews, statements from respected organisations, and medical textbooks? Claiming that only reviews are allowed is disruptive. QuackGuru (talk) 19:38, 26 February 2015 (UTC)
Your rehashing of the same edit will receive the same response. I really dont care if BarrelProof, like you have applied the wrong reasons for the edit. They are clearly shown in further edits, but you dont look at them, because it doesnt fit with your preconceived rationalizations. The source had, and still has has COI issues including the authors sitting on the board of directors of pharmaceutical companies. BarrelProof questioned if the COI was OR, but it isnt because the COI is clearly laid out in the source itself. Your question is misleading and a lie, I have never said formal policy statements by the groups listed in WP:MEDORG cant be used. You want to include press releases which are not even mentioned in the section you keep referring to.AlbinoFerret 22:30, 26 February 2015 (UTC)
You are clearly against including any statement that is not a formal policy statement from an organisation against MEDRS. You are also against including this source and this review you deleted. So why should there be different rules for this e-cig page? QuackGuru (talk) 23:04, 26 February 2015 (UTC)
You are clearly trying to use press releases against WP:MEDRS.So why should there be different rules for this e-cig page? AlbinoFerret 23:28, 26 February 2015 (UTC)
The statement from the World Lung Foundation organization is reliable. The World Lung Foundation stated "A recent study indicated that e-cigarette vapor causes changes at the cellular level in a similar way as traditional cigarettes. As the WHO points out, e-cigarette vapour is not just water vapour as the e-cigarette industry likes to claim..." That indicates the statement by World Lung Foundation is also a secondary source because it reviewed the evidence. I previously explained you deleted other sources that are also reliable. This includes this source and this review among others.[12] So why did you delete a number of sources including reviews against MEDRS? QuackGuru (talk) 23:39, 26 February 2015 (UTC)
Reliability does not guarantee inclusion. AlbinoFerret 04:02, 27 February 2015 (UTC)
So the sources are all reliable and you have not given a specific reason to exclude them. QuackGuru (talk) 04:04, 27 February 2015 (UTC)
I am not going to go into specifics of edits with you in this RFC, because it does no good, its round in circles and right back to "they are reliable" when reasons are given. AlbinoFerret 04:08, 27 February 2015 (UTC)
You confirmed the sources are reliable[13] yet you refuse to explain what is wrong with including relevant information about safety.[14] You are not collaborating. QuackGuru (talk) 04:15, 27 February 2015 (UTC)
I have discussed this with you to no end, you dont seem to get it, or dont want to hear it. This entire RFC has the position laid out. There are numerous sections on the talk pages on this. Collaboration is a two way street. You dont discuss edits, no discussions on mammoth edit you tried recently, nothing. AlbinoFerret 04:21, 27 February 2015 (UTC)
You have not given a reason to exclude reliable sources. Claiming "Reliability does not guarantee inclusion." without any specific reason is not a valid reason.[15] The statements from the organisations and the text from the reviews are about the safety of e-cigs. Why are you not explaining a specific reason to exclude reliable sources relevant to the topic? Do you understand that claiming "Reliability does not guarantee inclusion."[16] is not a good reason to exclude pertinent information? QuackGuru (talk) 04:34, 27 February 2015 (UTC)
Thanks for proving my point. Even after additional discussions, you circle back to the beginning. If you havent seen the reasons, it isnt because they are not there. I suggest you reread archive 2, and at this point silence on my part does not mean consensus WP:SILENCE. AlbinoFerret 15:09, 28 February 2015 (UTC)
In reaching consensus we all may learn something: Wikipedia only works when editors collaborate to form a consensus. Discussion is as important in the editing process as editing itself. While participation is not a requirement at the talk page, refusing participation can be perceived as a refusal to collaborate, and is not conducive to consensus-building. You are continuing to refuse to explain your deletion of a number of position statements from reputable organisations and a number of reviews. Again, claiming that "Reliability does not guarantee inclusion."[17] is not a specific reason to exclude pertinent information. Do you understand? QuackGuru (talk) 21:15, 28 February 2015 (UTC)
  • Use high quality reviews, positions statements from respected organizations, and major medical textbooks This is what WP:MEDRS says. All three have their place and attempts to exclude any of them are not appropriate. Doc James (talk · contribs · email) 21:43, 19 February 2015 (UTC)
No one is talking about excluding. The article Positions of medical organizations regarding electronic cigarettes is for this kind of material, and this article is medical information from high quality reviews and major medical textbooks. All of which gets summarized in Electronic cigarette, of which both articles are subarticles. All of it has its place, and this is not the place for policy or position statements, this is about the underlying secondary review class material. --Kim D. Petersen 21:47, 19 February 2015 (UTC)
  • Use review articles and meta-analyses: While there is a case for the inclusion of statements by medical organizations, these should only be sourced to authoritative institutions that issue health guidelines regularly, such as the U.S. National Institutes of Health, the U.K. National Health Service, or the World Health Organization. I don't think the statements of the World Lung Foundation or the World Medical Association are considered to be authoritative, and, as far as I know, none of them issue medical guidelines on a regular basis. The World Lung Foundation, in particular, appears to be a relatively new society founded in 2004 and may be of questionable notability (and reliability). Anyone can issues health statements, but not all are widely recognized and even fewer are considered to be authoritative. -A1candidate 21:56, 19 February 2015 (UTC)
    • A1candidate also deleted a number of sources including review articles.[18][19] So what is the explanation for the blanket reverts? A1candidate, are you going to continue make blanket reverts including deleting a number of reviews? QuackGuru (talk) 17:47, 9 March 2015 (UTC)
  • Reliable per WP:MEDRS. I'm not going to wade into this further for now due to lack of time aside from saying that press releases are plenty fine for policy statements by organizations like this. That's often how reputable medical organizations make their positions known. Press releases are not ok though for trying to assert scientific fact, and that's where you bring in review articles instead. That's a relatively clear distinction that seems like it's being missed here. Whether the source is secondary, tertiary, etc. is irrelevant in this conversation, partly seen in our [Tertiary source] article that describes when there can be ambiguity between the two as well. Instead, we look for reviews and statements from reputable medical organizations regardless of what degree of source we call them. Above, A1candidate may have a case from a WP:WEIGHT perspective on how noteworthy the organization actually is, but at my first glance it seems adequate. Kingofaces43 (talk) 22:28, 19 February 2015 (UTC)
Thats why we have the Positions of medical organizations regarding electronic cigarettes page. For those types of statements. This page is a medical page for medical facts. The sources are on the Positions page, but they want to bring them here for medical claims. AlbinoFerret 22:34, 19 February 2015 (UTC)
Looks like a problem with a WP:POVFORK in having that article. The two really should be the same. However, this RfC is about whether the source in question is reliable in this article on the safety of e-cigs. It seems to have a decent fit here regardless of what's going on at other articles. If an article is going to be titled safety of e-cigs, then you're going to need to discuss relevant medical organizations perspectives in that article. This article doesn't even have a section summarizing the organization statement page (which is the norm with daughter articles), so it's looking like there is some undue weight in the omission of summarizing the medical organizations. That's mainly why I'm not seeing a legitimate reason not to include it. Kingofaces43 (talk) 22:56, 19 February 2015 (UTC)
The two pages were originally under the Health effects section, It was not my choice to split them off instead of the section itself. It was Doc James who split them like this, at the same time. AlbinoFerret 23:01, 19 February 2015 (UTC)
  • COMMENT Claims that "position statements from nationally or internationally reputable expert bodies" are not "secondary sources" per WP:MEDRS are completely and literally incorrect per Wikipedia:Identifying_reliable_sources_(medicine)#Definitions which has already been quoted above. Importantly Policies and guidelines cannot be changed locally. What is a MEDRS-acceptable secondary source, is one, be it here or there. Now, someone ~could~ argue that one or both of World Lung Foundation or the World Medical Association are not "nationally or internationally reputable expert bodies". That would be a reasonable argument under WP's policies and guidelines. I have never heard of the World Lung Foundation and based on a quick look wouldn't object to a decision that they are not major. I had never heard of World Medical Association but once I looked into it, it is clear that this is the UN of national medical associations (AMA is a member). This is definitely authoritative. Jytdog (talk) 00:26, 20 February 2015 (UTC)
The WMA might be fairly well-known, but their website says that they're mainly involved in the following non-clinical stuff:
  • Ethics
  • Human Rights
  • Public Health
  • Health Systems
  • Advocacy
  • Campaigns
In fact, I can't find anything on their website that suggests they issue regular medical guidelines, and I doubt this is the case since the WHO has always been the one doing most of it. In any case, the WMA's list of Topics in advocacy includes "Tobacco control" as one of their goals. Are their statements regarding E-cigarettes scientifically neutral? Probably not. -A1candidate 01:11, 20 February 2015 (UTC)
Sources are not required to be "neutral", we as Wikipedia editors are. Also, if the only reliable medical sources are those who take no position about the obvious detrimental health effects of tobacco smoking, I suspect we will find it very hard to find any sources to use at all. Yobol (talk) 03:10, 20 February 2015 (UTC)
If there are detrimental health effects of e-cigarettes, they would be mentioned in review articles. Otherwise, there are none. -A1candidate 03:24, 20 February 2015 (UTC)
I think we're cross talking. You mentioned "tobacco control" advocacy as a sign that a source is not "neutral"; my comment is that almost any relevant medical source recognizes that tobacco is detrimental to the health of individuals and would advocate for cessation of tobacco use. To find a source that says tobacco is good for you or not harmful would be a sign of an unreliable medical source. Yobol (talk) 04:00, 20 February 2015 (UTC)
Prevention of patient's tobacco consumption is what most medical organizations aim for. Advocacy for tabacco control is what the WMA does. -A1candidate 04:11, 20 February 2015 (UTC)
Controlling tobacco use is what every responsible medical organization does. I'm afraid we'll have to agree to disagree that advocating people stop smoking is somehow a disqualifying feature of a medical source. Yobol (talk) 04:19, 20 February 2015 (UTC)
That's only because you fail to understand two types of advocacy - Political advocacy, which is what the WMA does, and making clinical recommendations, which is what most medical organizations do. -A1candidate 04:24, 20 February 2015 (UTC)
Oh yes, very political. Cough. Yobol (talk) 04:35, 20 February 2015 (UTC)
  • Include, in segregated section There should be a section with a summary of significant statements, but kept apart from the purely medical sections. We all know research is scrambling to catch up with the growth of e-cigs, and is as yet unable to say anything about the long-term effects, so such statements are more significant here than for many long-established issues (like tobacco use for example). Johnbod (talk) 16:41, 20 February 2015 (UTC)
  • The statements are absolutely relevant. The sources are reliable and no evidence to the contrary has been provided. The argument for excluding them are we must use reviews for e-cig articles. On the contrary, positions of organizations are also reliable. QuackGuru (talk) 23:12, 24 February 2015 (UTC)
  • Include statements Agree with Doc James. Cloudjpk (talk) 23:17, 24 February 2015 (UTC)
  • Include statements Per Doc James. The statements are pertinent to the section. Jim1138 (talk) 23:57, 24 February 2015 (UTC)
  • Comment: Please await the results of the RfC before starting to use this material, otherwise we are not respecting the processes of wikipedia. Status Quo before the RfC was that the material was not included, and to base even more material on this, is premature. --Kim D. Petersen 10:04, 25 February 2015 (UTC)
  • Include statements per Doc James Formerly 98 (talk) 15:33, 25 February 2015 (UTC)
  • Use secondary reviews If this viewpoint is significant enough then we should have no problems backing it up with secondary reviews that actually systematically analyse the studies that the quotes refer to.Levelledout (talk) 14:38, 26 February 2015 (UTC)
  • Include statements This RfC is a farce, these are major reputable organizations, and whether or not they should be included is a non-question. They are absolutely reputable as per WP:MEDRS. -- CFCF 🍌 (email) 16:59, 27 February 2015 (UTC)
What does "respectable" have to do with the issue at hand? They are very reliable for the context of Positions of medical organizations regarding electronic cigarettes. But here they are used in a context where we should use secondary MEDRS reviews, which are the most reliable sources for this kind of information. It seems though that editors either do not want to use secondary reviews, or alternatively want to double the effect of secondary sources, by duplicating it from tertiary ones,. --Kim D. Petersen 22:51, 27 February 2015 (UTC)
Your concerns are not reflected in the policy. There is nothing in it about context, and we are using position statements by major reputable bodies because they hold strong weight. We do not use them to "double the effect" of a statement, but rather in order to provide proper facts as interpreted by the most influential and authoritative organizations in the world. This entire discussion is merely disruptive and detracts from any possibility of actually improving this article and wastes time that could be spent on other articles. The RfC should be closed as per WP:SNOWBALL. -- CFCF 🍌 (email) 23:03, 27 February 2015 (UTC)
There is no policy that states that just because something is reliable that it then must be included. In fact editing is the process of sorting out what sources should and shouldn't be used, and what weight is attached to them. In this case there is significantly more weight put on secondary MEDRS reviews, which also are the most reliable of MEDRS sources - sources in the category of position statements are tertiary material for medical and safety information, and thus should per WP:MEDRS be used to find secondary sources, not as sources themselves. Why use less reliable material, that only repeats what we can already find in more reliable material? Can you answer me that? --Kim D. Petersen 23:39, 27 February 2015 (UTC)
Health professionals consider the statements of major health bodies as inherently the most reliable, and so does Wikipedia. Data that contradicts the statements is valuable but it should be stated as carrying less weight, not more. -- CFCF 🍌 (email) 10:47, 28 February 2015 (UTC)
Oh well if you say that's true then it must be. Of course. Levelledout (talk) 00:02, 1 March 2015 (UTC)
Of course. And can we move forward now? Cloudjpk (talk) 18:50, 27 February 2015 (UTC)
If you think it's such a farce then you should get it struck out at AN, no point in keep complaining about it here.Levelledout (talk) 22:24, 27 February 2015 (UTC)
  • Reference statements but don't necessarily quote them in full. There are so many statements that have been and will be released on the topic from medical associations that I'd rather keep the text of them at Positions of medical organizations regarding electronic cigarettes. I suggest summarizing the main points of important statements. For example, "In October 2012, the World Medical Association issued a position statement criticizing the lack of proof that e-cigarettes are not carcinogenic, and the appeal of flavored products to children." Andrew327 13:07, 4 March 2015 (UTC)
  • Include statements per Doc James and others. [And if I may, I'd like to note that there seems to have been (at least in the past) on these articles about e-cigs an effort by some editor(s) to POV them in favor of the business interests of e-cig manufacturers -- yet another reason to make sure that Wikipedia is including all the relevant position-statements from relevant respected reliable organizations.] The fact that there are currently a few articles on e-cigs and/or their safety on wiki does not mean that relevant information should be excluded from any of those articles if it applies to the subject matter of the article's title. Softlavender (talk) 06:54, 5 March 2015 (UTC)
  • Include It looks like the organization is wholly legitimate and trusted, and Wikipedia policy guidelines suggest that such entities be utilized as legitimate references and citations. Damotclese (talk) 18:30, 26 March 2015 (UTC)

Discussion on positions

There never was a consensus to use only using reviews for medical claims on e-cig pages. We don't have different rules for e-cig pages. There is a long standing WP:CON to include other sources including WHO, the US Food and Drug Administration, and the World Lung Foundation. See Electronic_cigarette#Position_of_medical_organizations. Also see Electronic_cigarette#Harm_reduction for other sources such as the Centers for Disease Control and Prevention (CDC) that are not reviews. Claiming that only reviews can be used for medical claims runs against WP:MEDORG. This RfC has apparently turned into WP:SNOW. User:AlbinoFerret also deleted other sources including a formal policy statement. After User:AlbinoFerret could not delete the reliable source you then added context that was inappropriate.[20][21][22] The inappropriate content smacked WP:POINT. See Talk:Safety_of_electronic_cigarettes/Archive_1#Original_research_2. User:AlbinoFerret, User:KimDabelsteinPetersen, and User:Levelledout appeared to be against using the formal policy statement written in a peer-reviewed journal for medical claims. See Talk:Electronic_cigarette/Archive_21#Policy_Statement_from_the_American_Association_for_Cancer_Research_and_the_American_Society_of_Clinical_Oncology. User:AlbinoFerret last edit to the safety page deleted even more sources including a number of reviews. So what is your reason to make a full revert back to an old version while deleting a number of sources including reviews? User:AlbinoFerret, you were asked "Are there issues with the sources or the summary of said sources?" So far you have not specifically explained which new sources are a concern to justify your blanket revert. See Talk:Safety_of_electronic_cigarettes#Removal_of_mammoth_edit.

Let's review according to the start of this page: https://en.wikipedia.org/w/index.php?title=Safety_of_electronic_cigarettes&oldid=634900625 See WHO: https://en.wikipedia.org/w/index.php?title=Safety_of_electronic_cigarettes&oldid=634900625#cite_ref-WHOPosition2014_8-0 See US Food and Drug Administration (FDA): https://en.wikipedia.org/w/index.php?title=Safety_of_electronic_cigarettes&oldid=634900625#cite_ref-FDA_nitrosamines_13-0 See The UK National Health Service https://en.wikipedia.org/w/index.php?title=Safety_of_electronic_cigarettes&oldid=634900625#cite_ref-nhs_17-0 These sources are not reviews or formal policy statements written in a peer-reviewed journal but they are reliable according to WP:MEDORG. This confirms that there is a long standing WP:CON to include other reliable sources rather than just reviews or formal policy statements. QuackGuru (talk) 17:03, 9 March 2015 (UTC)

The World Lung Foundation, in particular, appears to be a relatively new society founded in 2004 and may be of questionable notability (and reliability). Anyone can issue health statements, but not all are widely recognized and even fewer are considered to be authoritative. -A1candidate 21:44, 13 March 2015 (UTC)
Founded in 2004 about ten years ago does not mean it is questionable. Where in WP:MEDORG supports your argument that a source founded about 10 years ago may be unreliable? QuackGuru (talk) 22:13, 13 March 2015 (UTC)
It is found in the phrase "reputable major medical and scientific bodies". -A1candidate 22:38, 13 March 2015 (UTC)
It is a reputable organisation according to the Global Health Workforce Alliance. QuackGuru (talk) 22:44, 13 March 2015 (UTC)
Reputable for providing "assistance to governments and non-government organizations", but not reputable for issuing medical guidelines. -A1candidate 22:51, 13 March 2015 (UTC)
Since the World Lung Foundation is a reputable organisation it is reliable for the medical claims.QuackGuru (talk) 23:01, 13 March 2015 (UTC)
Which part of this article indicates that it is reliable or reputable? -A1candidate 23:03, 13 March 2015 (UTC)
Here is another ref. "WLF is one of five coordinating partners of the Bloomberg Initiative to Reduce Tobacco Use, which focuses on low and middle income countries, where more than two-thirds of the world’s smokers live."[23] QuackGuru (talk) 23:19, 13 March 2015 (UTC)
What you've just showed me is a job offer in a WordPress blog. Can I consider that an indicator of reliability or notability? No. -A1candidate 23:25, 13 March 2015 (UTC)
We are not using a WordPress blog. We are using a statement made by the World Lung Foundation that has a good reputation to help prevent and manage lung disease. QuackGuru (talk) 23:29, 13 March 2015 (UTC)
Being a member of the GHWA simply means that the WLF does a lot of good work in developing countries. It does not automatically make it an authoritative organization for medical guidelines. -A1candidate 23:34, 13 March 2015 (UTC)
Since they do a lot of good work in developing countries regarding tobacco control it makes them an expert on the topic. See "Essentially e-cigarette companies are selling nicotine addiction," said Dr. Neil Schluger, chief scientific officer for the World Lung Foundation, which advocates for tobacco control."[24] QuackGuru (talk) 17:43, 14 March 2015 (UTC)
No. Reliability does not depend on the amount of good work one does. -A1candidate 20:02, 14 March 2015 (UTC)
They do a lot of good work around the world on the topic of tobacco control, which makes them a major organisation.[25][26] QuackGuru (talk) 20:40, 14 March 2015 (UTC)
Where do these sources indicate that it is a major organization? -A1candidate 22:29, 14 March 2015 (UTC)
The American Cancer Society and World Lung Foundation jointly released the The Tobacco Atlas, third edition, which is currently available worldwide in several languages.[27] That is as major as it gets on tobacco control. QuackGuru (talk) 23:55, 14 March 2015 (UTC)
Tobacco control is more of a sociopolitical than a biomedical issue. -A1candidate 08:10, 15 March 2015 (UTC)
The website and 2012 financial statements are informative. It has about 30 staff and income/spend in the $20 miilions annually, mostly grants in and out. It was founded mainly for efforts in mid and low income countries on TB, but then got a big slug of Bloomberg & Gates Foundation money for tobacco control. I'm not sure that does make it "major" in terms of policy statements. But they have a particular interest in the 3rd world, which most statement-making bodies don't, so perhaps they are. Certainly they are WP notable. Johnbod (talk) 13:10, 15 March 2015 (UTC)
What I'm interested to know is whether they issue medical guidelines on a regular basis, particular those related to pulmonary health in general, just like what the American Heart Association does for cardiology topics. Their financial standing and sources of income are of less importance here. -A1candidate 13:22, 15 March 2015 (UTC)
I doubt it. Sources of income are always very important in these circumstances. Johnbod (talk) 13:58, 15 March 2015 (UTC)
What about a staff size of 30? Consensus statements like these often involve at least 10 to 15 healthcare experts. -A1candidate 17:57, 15 March 2015 (UTC)
Who normally will all, or nearly all, have other jobs elsewhere. Johnbod (talk) 18:43, 15 March 2015 (UTC)
So which medical experts are associated with the WLF - a supposedly major and reputable medical organization? -A1candidate 18:49, 15 March 2015 (UTC)
I don't know, Mr District Attorney. Why don't you look at their website & try to find out? Johnbod (talk) 20:25, 15 March 2015 (UTC)
Because I've looked and found none so far. At least none are listed on their staff page. -A1candidate 20:43, 15 March 2015 (UTC)
No, they wouldn't be - nor would the AHA statement's authors be staff there. I don't disagree with your point here btw, but medical guidelines covering treatment are a somewhat different thing. Johnbod (talk) 11:06, 18 March 2015 (UTC)
You wanted global and I gave you the World Lung Foundation and the World Medical Association. Thanks for your suggestion. QuackGuru (talk) 07:05, 18 March 2015 (UTC)
None of these institutions issue medical guidelines on a regular basis. How about the World Wildlife Fund instead?. -A1candidate 08:51, 18 March 2015 (UTC)
Do you have a source for World Wildlife Fund? QuackGuru (talk) 00:29, 12 April 2015 (UTC)
The above discussion is preserved as an archive of the debate. Please do not modify it. No further edits should be made to this discussion.

Schraufnage not a MEDLINE journal

The recent addition[28] does not originate from a MEDLINE indexed journal[29], and seems to be tangent to the article. Nicotine should be handled in its own article, and only summarized here where relevant and pointed out by reviews. --Kim D. Petersen 06:51, 3 April 2015 (UTC)

Electronic Cigarettes: Vulnerability of Youth.
Schraufnagel DE.
Pediatr Allergy Immunol Pulmonol. 2015 Mar 1;28(1):2-6. Review.
PMID: 25830075
See https://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed_reviews&from_uid=25830075 QuackGuru (talk) 06:55, 3 April 2015 (UTC)
Doesn't change that it isn't a MEDLINE journal[30] - does it? --Kim D. Petersen 06:59, 3 April 2015 (UTC)
It is still a reliable source according to WP:MEDRS. QuackGuru (talk) 07:01, 3 April 2015 (UTC)
Quote from WP:MEDRS:
An integral part of finding high quality sources is avoiding articles from journals without a reputation for fact-checking and accuracy. A red flag that a journal article is probably not reliable for health claims might be publication by a publisher that has a reputation for exhibiting "predatory" behavior, which includes questionable business practices and/or peer-review processes that raise concerns about the reliability of their journal articles. (See "References" section below for examples of such publishers.[16][17]) Other indications that a biomedical journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE,[18] or its content being outside the journal's normal scope (for instance, an article on the efficacy of a new cancer treatment in a psychiatric journal or the surgical techniques for hip replacement in a urology journal). Determining the reliability of any individual journal article may also take into account whether the article has garnered significant positive citations in sources of undisputed reliability, suggesting wider acceptance in the medical literature despite any red flags suggested here.
We have had this discussion several times earlier, and general consensus was to rely on MEDLINE journals. --Kim D. Petersen 07:04, 3 April 2015 (UTC)
Where was the discussion several times earlier for a "general consensus" to use only certain types of journals?
I think the source is reliable for the mundane claim. See the link for more information on the source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269219/ QuackGuru (talk) 07:16, 3 April 2015 (UTC)
It's not MEDLINE indexed but it's peer reviewed, collected in NLM, provided online by NIH, and indexed/abstracted in: PubMed Central; Current Contents/Clinical Medicine; Science Citation Index Expanded; Biological Abstracts; BIOSIS Previews; Journal Citation Reports/Science Edition; International Pharmaceutical Abstracts; EMBASE/Excerpta Medica; Scopus; CAB Abstracts; Global Health; CINAHL database as per publisher Cloudjpk (talk) 19:20, 9 April 2015 (UTC)
It's one of a number of journals where selected cites are included in PubMed. This is one of those so included. The paper clearly meets WP:MEDRS. Guy (Help!) 10:59, 17 April 2015 (UTC)
KDP, I do't think the claim that nicotine has an impact on practically every tissue in the body is that controversial so even if this source isn't perfect it's more than good enough. The second half of your objection I do agree with. I think that paragraph needs quite a bit of rewording, both for the dodgy english and the lack of idea flow in it.
Something like the below as a first dab at the spoon (this should really be directly followed by a paragraph on PG and VG info).

The long term impact of the main constituents in the vapor is not fully understood.[71] Nicotine exposure risks causing addiction and other adverse events[13] including high blood pressure[66], abnormal heart rhythms[66], low estrogen[66] and early menopause[66]. In May 2014, Cancer Research UK stated that there were, "preliminary results that suggest that e-cigarettes promote tumour growth in human cells."[71] In Adolescents, nicotine use may damage brain development, including areas connected with higher cognitive function.[58] The health effects of nicotine in infants and children are unclear.[58] In August 2014 the American Heart Association released a policy statement which noted that "e-cigarettes could fuel and promote nicotine addiction, especially in children, and their acceptance has the potential to renormalize smoking behavior."[56]

SPACKlick (talk) 11:23, 17 April 2015 (UTC)

I cleaned up the section. QuackGuru (talk) 22:58, 17 April 2015 (UTC)
Quack, please use DISCUSSION before this kind of wholesale edit. There's no rush for these edits in sections where the content is accurate and the issue is how it's presented. Your opinion on presentation is just one of many. Given this article is contentious a little caution would be prudent.SPACKlick (talk) 01:19, 18 April 2015 (UTC)
I disagree with deleting the other sentences in the same paragraph if that is part of the proposal. I disagree with putting together different sentences from different sources together into one sentence because different sources say different things. QuackGuru (talk) 03:41, 18 April 2015 (UTC)
@SPACKlick:, that paragraph reads very well to me as a statement of the current reservations of professional bodies over e-cigs. I'd support its inclusion if nobody can provide a good counter-argument. Guy (Help!) 08:30, 18 April 2015 (UTC)
  • Without meaning to provide comment on anything other than QG's specific edit (since I was asked to do so): I don't see it as a too outlandish change to make without first establishing consensus. To me at least, QG's version is likely to be more readable to the average reader. It can certainly be improved further, and it wouldn't be a bad idea to do so through collaboratively on this talk page or even a draft subpage, but I do not view QG's edit here as a violation of the sanctions. Kevin Gorman (talk) 05:14, 19 April 2015 (UTC)

Are sources now considered to be flawed to be removed?

Case in point https://en.wikipedia.org/wiki/Safety_of_electronic_cigarettes#cite_note-Bekki2014-19 This study has been proven to be flawed in it's methodology, reviews by Dr Farsalinos here and here show that the conditions of the testing were in no way indicative of actual use. In short the devices were not used as intended and were in fact used at settings far beyond what the components would normally operate at.

Similar studies have also been found to produce flawed results that are in no way indicative of actual use. One recent study by Jensen et al. has been critised as being flawed for the same reason as the study referenced in the first line.

Edit: In addition to the first reference mentioned above there is this ( full text ) reference in which the authors seem to be confused about the difference between a liquid aerosol and particulate matter from combustion suggesting that the so called particulates could be as damaging as that of tobacco smoke. Further he references the Schober et al study upon which their assumption is based, this study has since been found to be flawed here (PDF)

Lancer2K (talk) 02:10, 21 April 2015 (UTC)

Hi Lancer2K, ecigarette-research.com and .org are the personal self-published blog websites of Dr. Farsalinos, who describes himself here as someone who "clearly supports that electronic cigarettes should be used as smoking substitutes, by smokers unwilling or unable to quit smoking with currently approved medications." This is absolutely fine, and it his prerogative to have that opinion and publish his opinions on his own websites. But per Wikipedia policy WP:SELFPUBLISH and guideline like WP:MEDASSESS such sources are generally not acceptable and are considered lowest-tier quality. Of the other sources you'd listed
You should take a look at WP:MEDRS and how it emphasizes what the best-quality evidence sourcing is, which are generally recent secondary sources like reviews and meta-analyses published in high-quality, authoritative journals in their areas of expertise. Zad68 19:40, 23 April 2015 (UTC)
Hello Zad68 Thanks for that, the reason I posted the links to Dr. Farsalinos site was the examination and explanation of the flaws of the study I mentioned, he explained it far better than I could. I was not suggesting that editorial responses be used as sources for the article it self but rather as contributary evidence that the cited sources may not be as sturdy as we would wish. Lancer2K (talk) 22:25, 23 April 2015 (UTC)

Propylene Oxide

Propylene glycol degrades at sustained temperatures in excess of 500c. Whereas e-cigarette coils are at worst only about 300c and operate for a brief period. Perhaps more pertinently, the vapor at approximately 1mm from the coil of a cartomizer has been measured to be about 56c. So the propylene oxide thing is just one of the dozens of highly suspect items in this article.

And no i am not citing sources, you people hash it out yourselves i'm just pointing out that your credibility here is nearing the ridiculously low standards of your reputation for credibility.

This article is an incomprehensible he-said/she-said mess. That is all.

71.221.67.253 (talk) 09:21, 24 April 2015 (UTC)joe

Dripping

Ignoring the fact that nobody who does it would refer to it as "the dripping method" rather simply as "dripping" can someone quote the actual wording of the conclusion that it produces formaldehyde? It would surprise me if this conclusion was as cut and dry as that but I don't have access to the full paper. Source SPACKlick (talk) 14:29, 2 June 2015 (UTC)

"Increased voltages increased toxin levels, including carcinogenic carbonyl compounds such as formaldehyde and acetaldehyde.37 A popular new method of EC use, known as ‘‘dripping’’ (eg, EC liquid is dripped directly onto the device-heating element), creates combustion reactions enough to produce these toxins.38"[31] These toxins is referring to the carbonyl compounds such as formaldehyde and acetaldehyde. QuackGuru (talk) 18:00, 2 June 2015 (UTC)
I'm wondering if there is more in the source to make some sense b/c technically seen there is no difference other than that instead of having a tank constantly supplying liquid to soak the wicking material attached to the coil, the same is done manually by the user when "dripping". You could compare it to a motorcycle lacking a gas tank and refilling the carburetor by hand. Voltage/wattage depends on the resistance of the coil thus those variable devices which can be adjusted to match the coil in use. "Dripping" or tank, it will overheat if one is cranking it up, like oil in a frying pan reaching its smoking point.
Point is, the claim made would apply to "dripping" just as much as to tank systems. Can we get some more clarification out of this citation?--TMCk (talk) 18:46, 2 June 2015 (UTC)
The only mention of a tank system I found was "Another recent study suggested that only 1% reported using nonnicotine liquid, and most were using a reusable tank system.25"[32] The source did not mention anything else about the "dripping". I think the same can be said for tank systems using higher voltage. Please read Safety_of_electronic_cigarettes#Propylene_glycol_and_other_chemicals: Devices using higher voltages can produce carcinogens including formaldehyde at levels found in cigarette smoke.[74]" QuackGuru (talk) 19:20, 2 June 2015 (UTC)
Thanks for checking. Seems like we're stuck with technically wrong information unless more in depth sources are found. BTW, your last sentence basically just repeated what I wrote above. + I don't trust wikipedia and if I don't have access to the source it's meaningless to me anyways ;) --TMCk (talk) 19:26, 2 June 2015 (UTC)
It is known that thermal degradation can lead to the release of toxins. Here is an article about "dripping". QuackGuru (talk) 21:52, 2 June 2015 (UTC)
Yes, QG, it is and was common knowledge even before e-cigs came out. Every material exposed at or above their "thermal degradation" temperature will release matter, often in toxic form for humans [So zombies are good ;) ]. If e-cigs are cranked up too high by the user or maybe by the manufacturer on preset units they are not exempt from basic laws of physic. I don't even need a source for that b/c I also know that the earth is not flat. But it would be nice if the source(s) we use would give more detail about it, I.e. providing data information on equipment used as a starter. Also providing a rough "smoking point" like for cooking oils would be nice to get some perspective. The list is endless and since you have free access to all those med sources, could you look out for such information and post it here? I certainly would be very interested in such as a reader, not just as editor. Thanks.--TMCk (talk) 22:45, 2 June 2015 (UTC)
"The heating element in the e-cigarette causes the incidental generation of carbonyl compounds in e-cigarette smoke mist.30,58"[33]
Ref 30 is Kosmider L, Sobczak A, Fik M, et al. Carbonyl Compounds in Electronic Cigarette Vapors-Effects of Nicotine Solvent and Battery Output Voltage. Nicotine Tob Res. May 15 2014.
Ref 58 is Uchiyama S, Ohta K, Inaba Y, Kunugita N. Determination of carbonyl compounds generated from the E-cigarette using coupled silica cartridges impregnated with hydroquinone and 2,4-dinitrophenylhydrazine, followed by high-performance liquid chromatography. Anal Sci.2013;29(12):1219-1222.
I don't think any review go into such details. But there could be primary studies out there. The issues is obviously the heating element.
For now I added "The liquid is heated to a temperature of 55°C to create an aerosolized vapor." to the Construction page. QuackGuru (talk) 01:44, 3 June 2015 (UTC)

Thanks. Better than nothing and a start.--TMCk (talk) 02:12, 3 June 2015 (UTC)

I could not verify the claim for the word wick

The source said "Increased voltages increased toxin levels, including carcinogenic carbonyl compounds such as formaldehyde and acetaldehyde.37 A popular new method of EC use, known as ‘‘dripping’’ (eg, EC liquid is dripped directly onto the device-heating element), creates combustion reactions enough to produce these toxins.38"[34]

See diff. QuackGuru (talk) 18:01, 4 June 2015 (UTC)

Proposed Merge (List of chemicals in e-cigarette vapour)

I would like to propose that List of chemicals in the aerosol of electronic cigarettes is merged into this article as a low detail list, as the detail of the various components will be discussed here if relevant. SPACKlick (talk) 08:40, 23 June 2015 (UTC)

  • Oppose Wikipedia has space for all kinds of information. If the information were merged here then it would probably be judged as WP:UNDUE, because that is why this content is in a new article anyway. As you say, "the detail of the various components will be discussed here if relevant", but I expect that it is not relevant for inclusion here. If everyone felt strongly that this material should be presented here then I would support the move. I cannot support a merge with intention to delete. I might support a merge of the content if the other article were WP:AfD'd. Overall I had hoped that the forking of various aspects of e-cigarette articles would allow more people to go into more detail about nuances which are too detailed for main articles. Forks like this one, I hope, will relieve tension and bring compromise. Blue Rasberry (talk) 18:27, 23 June 2015 (UTC)
  • Oppose. This article is about safety. The chemicals in e-cigarette vapour is specifically about the chemicals that have been found in the vapour. It would be too much detail to list or include all the chemicals found in the vapour in this article. QuackGuru (talk) 18:35, 23 June 2015 (UTC)
  • Oppose In general we do not merge lists and articles in this manner. The list has potential for expansion, while the article by necessity needs to cull certain facts. I don't feel the list has a place in the article. Including a subsection may be relevant, but that would require a new proposal and the benefit over listing the chemicals in the prose isn't immediately obvious. -- CFCF 🍌 (email) 19:07, 23 June 2015 (UTC)
@CFCF: The "list" is not really a list. You may want to check the articles before giving your !vote :) --Kim D. Petersen 19:27, 23 June 2015 (UTC)
  • Delete instead there is currently (afaict) no information in the List that isn't already contained within this article. So unless major changes happen, the list should be deleted. --Kim D. Petersen 19:18, 23 June 2015 (UTC)
  • Oppose Agree with CFCF Cloudjpk (talk) 20:06, 23 June 2015 (UTC)
Parroting what comes out of your town makes little sense if you're not addressing the mistake made, or does it?--TMCk (talk) 21:03, 23 June 2015 (UTC)
Including nanoparticles is not repetitive. I noticed editors are deleting sourced text from the list. See another diff. QuackGuru (talk) 21:09, 23 June 2015 (UTC)
Did you hit the wrong thread or do you really believe it makes any sense here what-so-ever? Banana!--TMCk (talk) 21:13, 23 June 2015 (UTC)
  • Oppose: These are different kinds of articles. This one is an article on medical effects, the other (which is not a list and no longer has "list" in the title) is an article on chemistry.  — SMcCandlish ☺ ☏ ¢ ≽ʌⱷ҅ᴥⱷʌ≼  18:14, 10 July 2015 (UTC)

Discussion

Editors have not decided if the page should be a bare list or should have context. See Talk:List_of_chemicals_in_the_aerosol_of_electronic_cigarettes#Requested_move_19_June_2015. QuackGuru (talk) 19:15, 23 June 2015 (UTC)

They have now. It is not a list any longer.  — SMcCandlish ☺ ☏ ¢ ≽ʌⱷ҅ᴥⱷʌ≼  18:15, 10 July 2015 (UTC)
Yep. I'm surprised how many different things can be found in the aerosol. QuackGuru (talk) 18:18, 10 July 2015 (UTC)

Arbitration committee discussion

(Notice cross posted to: Electronic cigarette, Safety of electronic cigarettes, Legal status of electronic cigarettes, Positions of medical organizations regarding electronic cigarettes, Electronic cigarette aerosol, Cloud-chasing & vape shop. Please focus any discussion on the main page

There is an ArbCom case pending related to this family of topics. SPACKlick (talk) 11:36, 31 July 2015 (UTC)

Delete Useless, Meaningless Sentence in the 1st Paragraph

Another found that products approved by the US Food and Drug Administration (FDA), such as nicotine inhalers, are probably a safer means to supply nicotine than e-cigarettes.[9]

link redirects to an article that has nothing to do with nicotine inhalers.2605:6000:6942:F00:BC00:C3C:2EBC:91A3 (talk) 04:49, 12 August 2015 (UTC)

I redirected it to the correct page. QuackGuru (talk) 08:40, 12 August 2015 (UTC)

Search for review in the future

https://www.ncbi.nlm.nih.gov/pubmed/26324250 Nicotine delivery via some e-cigarettes with a high concentration of nicotine in the e-liquid could exceed that of a traditional cigarette. QuackGuru (talk) 00:22, 4 September 2015 (UTC)

No doubt, but this is not very significant. Subjects were given a pre-determined puffing regimen to follow over 60 minutes. But plenty of cigarette smokers smoke more than one cigarette per hour. Both smokers and vapers determine their own pace of delivery. Johnbod (talk) 01:47, 4 September 2015 (UTC)
The nicotine level in some e-liquids are extremely high which in turn caused elevated levels of nicotine in the blood exceeding that of a traditional cigarette. In the future a review could mention this. A review (and editors) will determine if this is significant. QuackGuru (talk) 15:52, 4 September 2015 (UTC)

Yes Quack, a review could mention it. The point being made is that it would be surprising if a good review put much weight on it because it didn't consider realistic conditions. It's already well documented that smokers (and a little for e-cigarette users) vary their intake against the strength in ad-lib usage. SPACKlick (talk) 16:13, 4 September 2015 (UTC)

To my surprise and the surprise of the researchers the level of nicotine was well off the charts in some e-cigarettes because the level of nicotine in some e-liquids were at very high levels. It was impossible to achieve the levels of nicotine in the blood from a traditional cigarette under the same protocols given. It is irrelevant that smokers (or e-cigarette users) vary their intake. It is about the higher level of nicotine delivery from the e-cigarettes with which no rationale was given by the tobacco companies. It looks like they are spiking the e-liquid with abnormally high levels of nicotine. The point being made is that it is uncertain the reason for this. QuackGuru (talk) 16:40, 4 September 2015 (UTC)
Yes, 36 mg/ml is an abnormally high level - I don't think I've ever seen it offered (24 is normally the highest on sale, and in the UK & I think the rest of EU 20 will be the legal maximum when the EU Tobacco Directive comes into force). When it is labelled as such to call it "spiked" is flaky POV. In the UK at least (see PHE report) tobacco companies are not the manufacturers or sellers of e-liquid. There are very limited conclusions to be drawn from comparison with a single cigarette - a heavy smoker may smoke 40+ per day, & so would be smoking several in an hour. No doubt good reviews will not miss these points. Johnbod (talk) 18:32, 4 September 2015 (UTC)
I'm aware of heavy smokers who started at 36mg/ml, but they tend to quickly reduce the levels (my suspicion is in part that you take in less nicotine when you're new to the device and using it like a cigarette but that's purely informed speculation) The point being QG that if you gave a smoker an excess of nicorette gum they'd have a blood spike. If you chain smoke strong cigarettes you can get to levels of 50ng/ml as is well known Being able to increase blood nicotine levels is one thing but it being a risk is only a thing if it happens ad lib without intention, turns out it doesn't people stop vaping when the have a blood nicotine of 10-50ng/ml and similarly smokers stop smoking (or inhale less on a cigarette) when their blood nicotine reaches their satisfaction point. The researchers conclude that the reason for these strong dose abilities is uncertain without asking manufacturers and users why it exists. Ask them and they'll tell you. Some people need high dose nicotine to be satisfied in some situations. SPACKlick (talk) 22:38, 4 September 2015 (UTC)
I think regulations will cap off the levels allowed in the e-liquid. If that is the case then some users may not be able to get enough nicotine from e-cigarettes compared to traditional cigarettes. QuackGuru (talk) 23:47, 4 September 2015 (UTC)
Yep, you commonly see European vapers, after the TPD passed, talking about stockpiling sufficient strong nicotine base to keep homemaking their juice at strengths they want. 24mg/ml is a very common strength that'll be banned by it. SPACKlick (talk) 01:03, 5 September 2015 (UTC)
From 24 to 20 is not a great jump (20 is not currently normally sold, here anyway), & I've never seen over 24 offered. They'll just have to puff more often (or chew nicotine gum at the same time etc). Dual users might be affected I suppose. Johnbod (talk) 03:15, 5 September 2015 (UTC)

Archiving

The archiving of all talk pages on this subject has been has been far too sudden, and naturally looks suspicious in the middle of an Arbcom case. One of the pages had fewer than 2,000 bytes turned into an archive! Blanking the page is not normal on WP. Please ask on the talk page before archiving again, QG, since you behaviour has been far from the WP norm. Clearing out the page just encourages people to raise the same issues again and again. Johnbod (talk) 03:37, 10 September 2015 (UTC)

Duplication using a non-MEDRS source

This change uses a source that is not a review. The text is also very similar to other information. QuackGuru (talk) 04:00, 19 October 2015 (UTC)

No, the header you gave this section is correct, its not just similar, its a duplication. Removal was correct QG. AlbinoFerret 18:35, 19 October 2015 (UTC)
Although it is very similar, the specific wording is not identical to other information. QuackGuru (talk) 18:48, 19 October 2015 (UTC)
Have you even read the source that was given? You'd be surprised what not to find.--TMCk (talk) 18:59, 19 October 2015 (UTC)

Duplication

Most of the text is duplication. QuackGuru (talk) 02:24, 21 November 2015 (UTC)

I do not understand what you are suggesting be done. Are you suggesting something? Mystery Wolff (talk) 13:55, 21 November 2015 (UTC)
It does not appear to be duplication, please point out what it duplicates that is already in the article. AlbinoFerret 19:01, 21 November 2015 (UTC)
I removed the other text that was duplication. See my edit. Now it is no longer duplication. QuackGuru (talk) 19:04, 21 November 2015 (UTC)
Unless you point out what the duplication is it will be replaced. You cant just remove cited claims. AlbinoFerret 19:08, 21 November 2015 (UTC)
I did not delete the text you added that was not duplication. I moved it to where there was information about the same subject. The same text that was duplication was removed. It is still in the article the text that is not duplication. See this section.
You added this text. "While e-cigarettes with higher voltage batteries can produce carcinogens including formaldehyde at levels found in cigarette smoke,[87] reduced voltage e-cigarettes produce vapor with levels of formaldehyde and acetaldehyde roughly 13 and 807-fold less than indicated in cigarette smoke.[15] A 2015 review found vaping e-cigarettes at a high voltage (5.0V) may generate formaldehyde-forming chemicals at a greater level than smoking, which has been determined to be a lifetime cancer risk of about 5 to 15 times greater than smoking;[84] the underlying research had used a "puffing machine".[88] Another small study with people using similar devices and settings found that the users could not use the devices because of "dry-puffs" at the high settings, which according to the 2015 Public Health England report "poses no danger to either experienced or novice vapers, because dry puffs are aversive and are avoided rather than inhaled" and "At normal settings, there was no or negligible formaldehyde release."[88] They concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes."[88]"[35]
This is the current text. "While e-cigarettes with higher voltages can produce carcinogens including formaldehyde at levels found in cigarette smoke,[88] reduced voltages (e.g. 3.0 volts[10]) produce vapor with levels of formaldehyde and acetaldehyde roughly 13 and 807-fold less than indicated in cigarette smoke.[12] A 2015 review found vaping e-cigarettes at a high voltage (5.0V) may generate formaldehyde-forming chemicals at a greater level than smoking, which has been determined to be a lifetime cancer risk of about 5 to 15 times greater than smoking;[10] the underlying research had used a "puffing machine".[13] Another small study with people using similar devices and settings found that the users could not use the devices because of "dry-puffs" at the high settings, which according to the 2015 Public Health England report "poses no danger to either experienced or novice vapers, because dry puffs are aversive and are avoided rather than inhaled" and "At normal settings, there was no or negligible formaldehyde release."[13] They concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes."[13]"
Only the duplication was removed. QuackGuru (talk) 19:36, 21 November 2015 (UTC)

I noticed there is an issue with the wording in the lede. "The long term safety of Electronic Cigarettes[1][2] [3] is unknown". is duplication and the three refs do not verify the claim. The refs are disorganized and the lede does not mention "dry puffing". QuackGuru (talk) 01:19, 24 November 2015 (UTC)

Citing Absence of Data, as evidence

Material in this page is using the absence of data, as evidence of conclusions written by editors and not supported by the citations given. This simple should not be done. A lot of entries need to be updated. Anyone have thoughts on this? Mystery Wolff (talk) 14:03, 21 November 2015 (UTC)

You'll have to be (much) more specific. The absence of data is always mentioned by all sources, whatever view they take, and is at least evidence of uncertainty, which is the predominant element in scientific views on this topic. Johnbod (talk) 01:49, 22 November 2015 (UTC)
If the current available options for citation are junk science, that does no mean they need to be folded into this Wiki. There is ample confusion and lack of information available for citation out in the WWW. Evidence of uncertainty is well established by the absence of well cited sources. Again, "there is no evidence of harm" is not a proper citation to CONCLUDE there is no harm. And Visa Versa. Mystery Wolff (talk) 06:00, 22 November 2015 (UTC)
Specific quotes of passages you are complaining about please. Johnbod (talk) 11:32, 22 November 2015 (UTC)

The plan

This page is bad. It is jumbled and reads horribly. So the plan is:

  • 1. Start by adding some subsections and grouping claims in specific topics.
  • 2. Identify if information is more suitable for Electronic cigarette aerosol.
  • 3. Add summery of Electronic cigarette aerosol to make it a daughter page of this one.
  • 4. Once that is done, copy editing for readability and flow.

If anyone has any suggestions or wants to help, leave a comment. AlbinoFerret 00:07, 30 November 2015 (UTC)

This is one of the places where we should explain the different views of the balance between harm reduction arguments and clinical uncertainty which underly all the current controversies. Johnbod (talk) 03:11, 30 November 2015 (UTC)
I agree, right now I dont plan to make any real changes to whats presented. I am still in organizing. There is just way to much that was all jumbled up. There is also a fair amount of duplication, especially in the adverse effects. I plan on taking it slow. I think a good chunk can go to aerosol like the particles and perhaps the bystanders stuff. AlbinoFerret 03:28, 30 November 2015 (UTC)
Johnbod I have done the top most section under the lede, what do you think for a start? AlbinoFerret 18:19, 30 November 2015 (UTC)
The Carcinogenicity section has 2 claims that date to 2009. The TSNA's have been found since and there are other sources that can be used. The diethylene glycol claim from 2009 was for one cartridge and has never been found again. I wondering if these claims should be in the article because of age and newer sources available or not found since. I also question the ammount of nicotine information in the article. Wikipedia already has a nicotine article and I think some, not all, of whats in this one should be removed and some kind of link to Nicotine used. AlbinoFerret 22:03, 30 November 2015 (UTC)

Well the plan isnt going off as planned. I have made a run through the article up to particles first hand. Some of the sections have had a second go through as claims are moved from below. One area of concern is that in the lung function and particles sections I had to go to the sources as the wording was strange. In doing so I ran into OR and/or misrepresenting the sources. A more detailed look at each claim will need to be done on a subsequent run through the article. AlbinoFerret 04:38, 3 December 2015 (UTC)

Ok, I am pretty much done with Aerosol, only two sections left and they are small and dont look that bad. AlbinoFerret 03:46, 6 December 2015 (UTC)

Possible Copyvios

I noticed that the wordings of a couple of statements in the Aerosol section are very similar to their source, Grana2014.

  • Source: In summary, the particle size distribution and number of particles delivered by e-cigarettes are similar to those of conventional cigarettes, with most particles in the ultrafine range (modes, ≈100–200 nm).
  • Article: a 2014 review found that the particle size distribution and sum of particles emitted by e-cigarettes are like traditional cigarettes, with the majority of particles in the ultrafine range (modes, ≈100–200).
  • Source: These metal nanoparticles can deposit into alveolar sacs in the lungs, potentially causing local respiratory toxicity and entering the bloodstream.
  • Article: Metal nanoparticles can deposit in the lung's alveolar sacs, potentially leading to local respiratory toxicity.

Is it necessary to reword them? P Walford (talk) 15:50, 14 December 2015 (UTC)

I will if you dont want to. Copyvios are serious problems. AlbinoFerret 16:44, 14 December 2015 (UTC)
 Done It might be useful to mention that the number of metal nanoparticles is very small. P Walford (talk) 17:33, 15 December 2015 (UTC)
I have noticed that a lot of the claims I have had to look up to rewrite have either left out important info, left out mitigating information, or were written from the abstract. I think it may be wise to go through every claim and double check that they are complete and not based on the abstract but the body. AlbinoFerret 21:43, 15 December 2015 (UTC)

Dubious

"Commonly reported adverse effects from e-cigarette use include upper respiratory tract irritation, dry cough, dryness of the mucus membrane, nose bleeding, release of cytokines and pro-inflammatory mediators, allergic air way inflammation, reduced levels of exhaled nitric oxide, headache, dizziness, nervousness, insomnia, sleeplessness, nausea, vomiting, dry mouth, tongue sores, black tongue, gum bleeding, gingivitis, gastric burning, constipation, palpitation, chest pain, eye irritation, eye redness, eye dryness, may result in eye damage, altered bronchial gene expression, chance of lung cancer, shortness of breath, and shivering."

This sentence in Adverse effects is cited to 5 sources. One is paywalled, and I can't access it. Three others do not support it. It appears to come from the first cited source, [36]. The list includes observations in mice, observations of cells in vitro, and "may result in" and "chance of" statements. I removed these misleading parts. The statement is still problematic because of the word "commonly". I added a tag. P Walford (talk) 14:24, 16 December 2015 (UTC)

The last few were done to combine the multiple adverse effects statements that duplicated what was in that list. Perhaps adding them in a note would be better and explain that they mention some of the adverse effects listed. Im going to remove commonly. Some of those are not common. The source also contadicts itself on this, it lumps them all in a table that says frequent, then in the body says things like this "In addition, e smoking can cause, headache, sleepiness, sleeplessness, dizziness, gingivitis and black tongue." That doesnt say common to me. AlbinoFerret 14:28, 16 December 2015 (UTC)
Thanks, I removed the tag. I don't know why this source is used for anything. Better ones are available. P Walford (talk) 14:42, 16 December 2015 (UTC)
Because it has that list is my guess, I didnt add it. The editor who did is topic banned at this time. AlbinoFerret 14:56, 16 December 2015 (UTC)
I grouped the other references in a note. AlbinoFerret 18:49, 16 December 2015 (UTC)
There are still problems with this sentence. Dryness of the mucus [sic] membrane, eye irritation, and eye dryness are cited to this article, which in turn cites studies of the use of glycol and glycerol in theatrical settings, and as such are not reported adverse effects of EC use. Eye redness is cited to the same source, but I couldn’t find it there. Insomnia is cited to the Farsalinos survey, which doesn’t mention it. Interestingly Farsalinos does list sleepiness, something Meo & al Asiri didn’t mention. Gastric burning and constipation aren't cited to anything. I didn’t see shortness of breath and shivering in the source they cited.
There are enough errors and inaccuracies in this source to remove the entire sentence. If there’s a need for an exhaustive list of reported adverse effects, I suggest starting again with the other sources cited in the note. Furthermore, the other sentence cited to Meo & al Asiri, “Nicotine may result in neuroplasticity variations in the brain”, should be removed. Even if it’s deemed to be a reliable source for this content and to have sufficient weight, its place is the Nicotine article. P Walford (talk) 17:21, 20 December 2015 (UTC)
When its discussing chemicals that we know are in the liquid, I think it would be better to keep them. Those effects that are incorrectly attributed to other sources that dont mention them is a red flag. But I think we need more input before any removal is done. Perhaps a post on the main articles talk page mentioning this section would be a good idea. AlbinoFerret 18:00, 20 December 2015 (UTC)
It needs sorting out, and ideally sorting known side effects from nicotine in any form ("dizziness, nervousness, insomnia, sleeplessness, nausea, vomiting" I suppose) from those specific to e-cigs. What is the difference between insomnia and sleeplessness anyway? Johnbod (talk) 05:36, 21 December 2015 (UTC)

VA study

An interesting new primary in-vitro study shows cytotoxicity and genotoxicity with or without nicotine:

  • Yu V, Rahimy M, Korrapati A, Xuan Y, Zou AE, Krishnan AR, Tsui T, Aguilera JA, Advani S, Crotty Alexander LE, Brumund KT, Wang-Rodriguez J, Ongkeko WM (January 2016). "Electronic cigarettes induce DNA strand breaks and cell death independently of nicotine in cell lines". Oral Oncol. 52: 58–65. doi:10.1016/j.oraloncology.2015.10.018. PMID 26547127. {{cite journal}}: Unknown parameter |laysource= ignored (help)

It probably can't be used at this stage, but it's bound to show up in secondary sources soon. LeadSongDog come howl! 18:15, 30 December 2015 (UTC)

Is this the same case?

In the Poisoning section:

"In the United States, a child died after ingesting liquid nicotine in 2014, and another in Israel in 2013.[1] In December 2014, a one-year-old child in Fort Plain, New York died after an accidental ingestion of nicotine liquid.[2]"

References

  1. ^ Biyani, S; Derkay, CS (28 April 2015). "E-cigarettes: Considerations for the otolaryngologist". International journal of pediatric otorhinolaryngology. 79: 1180–3. doi:10.1016/j.ijporl.2015.04.032. PMID 25998217.
  2. ^ Mohney, Gillian, "First Child's Death From Liquid Nicotine Reported as 'Vaping' Gains Popularity", ABC News, December 12, 2014.

Is the US child in the first sentence and the child in the second sentence the same child? I can't access the first source. — Preceding unsigned comment added by P Walford (talk • contribs) 15:00, 9 January 2016‎ (UTC)

While I dont have access to the first, the review is dated in 2015, and the news report is from 2014. Since the 2015 review says one child died in the US in 2014, odds are its the same. Even if its not, we should not be using a popular press source for this type of claim. It is a biomedical claim to attribute a death to something. AlbinoFerret 15:34, 9 January 2016 (UTC)
While technically it doesn't say the death was caused by nicotine poisoning, the implication is present. As far as I know, medical confirmation of the cause of death was never made public. This newspaper article says it was "the first child in the country to die from accidentally swallowing the toxic ingredient in electronic cigarettes, according to the American Academy of Pediatrics." Considering the event occurred in December, the two sentences appear to refer to the same child. The second should be removed. Btw, the PHE report said the incident in Israel is an unconfirmed newspaper report.
Agreed, we could keep the reference and just move it to the remaining claim as additional support.AlbinoFerret 18:56, 10 January 2016 (UTC)

Cinnamaldehyde

"Cinnamaldehyde has been documented as a highly cytotoxic material in cinnamon-flavored refill solutions."

"Cinnamaldehyde has been specifically identified as a highly cytotoxic substance in cinnamon-flavored refill fluids."

"A recent study evaluated in more detail the cytotoxic potential of eight cinnamon-flavored EC liquids in human embryonic stem cells and human pulmonary fibroblasts [Behar et al. 2014]. The authors found that the flavoring substance predominantly present was cinnamaldehyde, which is approved for food use. They observed significant cytotoxic effects, mostly on stem cells but also on fibroblasts, with cytotoxicity associated with the amount of cinnamaldehyde present in the liquid. However, major methodological issues arose from this study. Once again, cytotoxicity was just restricted to EC liquids and not to their vapors. Moreover, the authors mentioned that the amount of cinnamaldehyde differed between liquids by up to 100 times, and this raises the suspicion of testing concentrated flavor rather than refills. By searching the internet and contacting manufacturers, based on the names of samples and suppliers mentioned in the manuscript, it was found that at least four of their samples were not refills but concentrated flavors. Surprisingly, the levels of cinnamaldehyde found to be cytotoxic were about 400 times lower than those currently approved for use [Environmental Protection Agency, 2000]."

  • Don't know what to do with this. P Walford (talk) 13:31, 9 February 2016 (UTC)
Looks like bad methodology, not sure if this should remain as it calls into question the reliability of the information. If it stays more information on the methodology should be added. AlbinoFerret 13:56, 9 February 2016 (UTC)
We have contradictory secondary sources and no clear reason to disregard either. Your own interpretation of the evidence does not come into it, so we should simply present both sides. CFCF 💌 📧 23:18, 9 February 2016 (UTC)
This is all test tube evidence - in a cancer article we wouldn't allow this for supposed carcinogens. Johnbod (talk) 23:59, 9 February 2016 (UTC)
WP:MEDRS discounts the use of single in vitro studies as primary sources for statements, and this is secondary sourced material. As long as we are clear that this is in vitro there is nothing that speaks against including it—and including any controversy surrounding it. CFCF 💌 📧 00:06, 10 February 2016 (UTC)
No personal opinions involved, Farsalinos and Polosa clearly describe bad methodology. Including adding in pure flavourings to what was tested, not eliquid. If it stays this bad methodology will have to be added. AlbinoFerret 01:17, 10 February 2016 (UTC)
  • Looking at this from a high level - the Farsalinos nor Polosa paper is a really transparent advocacy piece for e-cigs as smoking cessation devices. Last line: "Due to their unique characteristics, ECs represent a historical opportunity to save millions of lives and significantly reduce the burden of smoking-related diseases worldwide." They take pains to discount every study that may give caution. So hm, advocate much? On this specific issue, neither is a toxicologist so it is unclear what the basis for their critique is. When I work on controversial issues and find a clearly biased paper like this, I don't bring it to the table. The originally cited review by Ebbert is an uncritical narrative review in the tox section, just citing the primary sources and summarizing what they say. When I find reviews like this, I generally don't use them for those parts, because there was actually no review. (this is especially true about tox stuff) About Johnbod's remark - yes, solid tox work involves animal studies, for sure. Where I end up is - delete the detail b/c it is not "accepted knowledge" yet - namely, delete "Cinnamaldehyde has been documented as a highly cytotoxic material in vitro and has been found to be present in certain cinnamon-flavored refill solutions.[1] A study has demonstrated that a balsamic flavored e-cigarette with no nicotine is capable of triggering a proinflammatory cytokine release in lung epithelial cells and keratinocytes.[31]" If there is ever a review done using standards/methods of toxicology (in deciding what research papers to even consider, looking at whether the research took into account routes of exposure, dose/response, use of an appropriate animal model, etc) that will be an awesome source for this kind of detail. The rest of the paragraph seems OK to me. Jytdog (talk) 02:07, 10 February 2016 (UTC)
Now that is a personal opinion reading into a review. If problems are detected and they are from a reliable source we as editors cant read between the lines. Yet papers from a known activist are let into the articles.....AlbinoFerret 03:28, 10 February 2016 (UTC)
I offered a suggestion about what to do about conflicting sources, neither of which is very good. What is yours. Jytdog (talk) 04:21, 10 February 2016 (UTC)

Awilley—I looked up the source and the content was almost to close to the source, bordering on COPYVIO, so no need to add a dubious tag. I've rewritten it for clarity, if you have trouble accessing sources feel free to send me an e-mail. CFCF 💌 📧 23:15, 9 February 2016 (UTC) 

Thanks for looking that up, and thanks to the others above who did the legwork researching this. I was in a hurry when I made the request and couldn't find a link to the paper in the citation. From reading the abstract it sounds like this was a primary research article that doesn't have terribly clear implications. If other groups pick up on it, replicate the results, and find effects in lung cells instead of stem cells, I could definitely see citing a secondary review of those studies. As it is, I find myself tending to agree with Johnbod and Jytdog's comments above. ~Awilley (talk) 05:38, 10 February 2016 (UTC)

How toxic is it?

"The e-liquid has a low level of toxicity, and contamination with various chemicals has been identified in the product.[1]" has been changed to "The e-liquid itself is highly toxic if it swallowed or spilled on skin[2][3][4] and poison control centers track poisoning events.[5]"

References

  1. ^ Cite error: The named reference Bertholon2013 was invoked but never defined (see the help page).
  2. ^ Durmowicz, E. L. (2014). "The impact of electronic cigarettes on the paediatric population". Tobacco Control. 23 (Supplement 2): ii41–ii46. doi:10.1136/tobaccocontrol-2013-051468. ISSN 0964-4563. PMID 24732163.
  3. ^ Cite error: The named reference Crowley2015 was invoked but never defined (see the help page).
  4. ^ Cite error: The named reference Brandon2015 was invoked but never defined (see the help page).
  5. ^ Cite error: The named reference OrrAsal2014 was invoked but never defined (see the help page).

While it appears that "a low level" is not supported by Bertholon et al., it also appears that "highly toxic" isn't supported by the cited sources.

  • Durmowicz: "Although serious nicotine poisoning due to traditional cigarettes is relatively rare, the high concentrations of nicotine in the e-liquids (eg, e-liquids with concentrations up to 100 mg/mL are available) may pose greater risk of nicotine toxicity following inhalation, ingestion or dermal exposure."
  • Crowley: I can't find anything that supports this.
  • Brandon et al.:Nicotine is a known potentially lethal toxin, and poisoning related to ENDS can occur by ingestion, inhalation, or absorption through the skin or eyes." Later in the same paragraph: "...the concentrated nicotine in ENDS solutions can be toxic if it is inadvertently ingested or absorbed through the skin."

P Walford (talk) 14:30, 10 February 2016 (UTC)

Yes we have an adequate article on nicotine poisoning, which should be linked. Johnbod (talk) 15:04, 10 February 2016 (UTC)
The reason that the literature is ambiguous on this point (toxicity of nicotine), is because no one really knows. The Surgeon General(2015) chapter on nicotine[37] notes that the commonly accepted figure of 50-60mg has unknown origins, and is uncertain. Mayer(2014) traced back that the commonly held figure of 50-60mg as extremely dubious in origins as well, and that the correct figure is very likely much higher[38]. The sources that describe it as very toxic use the 50-60mg figure, and those that consider it low in toxicity use a higher figure. So in summary: We can't really make a call, and if we go into it, we must present both sides.. --Kim D. Petersen 16:27, 10 February 2016 (UTC)
The conclusions even taking the lower number are unclear as to the size of bottle and eliquid as can be proven by simple math. A 10mg bottle of eliquid at 3mg nicotine would be 30mg, well below even the lower numbers. Also 100mg is liquid base for DYI liquid. AlbinoFerret 16:54, 10 February 2016 (UTC)


The report concluded that "There is insufficient data to conclude that nicotine causes or contributes to cancer in humans, but there is evidence showing possible oral, esophageal, or pancreatic cancer risks".[28] Is this "academic" talk? Doesn't cause or contribute but possible risk. Insufficient data but we have evidence. Wow - we do and we don't. We probably need more tax money to research this!2601:181:8000:D6D0:D429:9928:9E4C:3F44 (talk) 23:19, 5 May 2016 (UTC)

nicotine

Should there be more of a distinction between nicotine and merely flavored vapors? Benjamin (talk) 07:22, 28 September 2016 (UTC)

Overly negative tone

"The safety of electronic cigarettes is uncertain" does not accurately summarize the data and studies on the subject to an ordinary / lay reader. Electronic cigarettes are significantly safer than smoking for users and bystanders. Due to the articles popularly (#1 result for e cigarette safety) I would urge page owners to chose language (especially in the introduction) that reflects this. An excellent plain-english resource on the subject is available here: [1]

References

  1. ^ McNeill, A; Brose, LS; Calder, R; Hitchman, SC; Hajek, P; McRobbie, H (August 2015). "E-cigarettes: an evidence update A report commissioned by Public Health England" (PDF). UK: Public Health England.

— Preceding unsigned comment added by Billyoffland (talk • contribs) 21:03, 9 July 2017 (UTC)

This is a very old conversation here. The article makes it clear that e-cigs are safer than cigs (e-cigs vs cigs). But the absolute risk of them (e-cigs vs nothing) is a different matter, and is not well understood. Jytdog (talk) 21:14, 9 July 2017 (UTC)
The page is overly positive. Wait until the review comes out in this page that people who wrote the Public Health England report have connections to the tobacco industry. Then it won't be so positive anymore. I hope no editor deletes the Public Health England report when the facts are revealed. The safety of electronic cigarettes is uncertain, according to WP:MEDRS compliant sources. Billyoffland, I formatted the source for you and for others read what a report looks like that was written (by who) in the UK. QuackGuru (talk) 21:29, 9 July 2017 (UTC)
It does not make it clear in the introduction. At all. Hardly more so throughout. The overall tone shows clear Expectation bias. Writers have assumed knowledge and are writing to support that. This is a popular article on a subject effecting public health. It needs to be approached with this in mind.— Preceding unsigned comment added by Billyoffland (talk • contribs) 21:33, 9 July 2017 (UTC)
I have excess to over 50 million PDF files. What would you like me to do? QuackGuru (talk) 21:37, 9 July 2017 (UTC)

With regard to the "Public Health England report have connections to the tobacco industry" 1 out of 185 references was to "Nutt, D.J., et al., Estimating the harms of nicotine-containing products using the MCDA approach." 1 person on that panel worked for an e cigarette company. As an aside, another person on that panel worked for a smoking cessation company. 50 million PDFs? I am uncertain as to your meaning. — Preceding unsigned comment added by Billyoffland (talk • contribs) 21:42, 9 July 2017 (UTC)

It is not well known that authors of Public Health England report have ties to the tobacco industry, yet you seem to know about the report in detail. I have access to over 50 million articles in PDF file format. That's what I meant. Unless you have a proposal or suggestion we're done here. QuackGuru (talk) 21:51, 9 July 2017 (UTC)

Introduction Length

It should be noted that the introduction paragraph of the article is too long for the word count of the article, please move (into the body of the article) or reword sections of the introduction.

Article length Lead length
Fewer than 15,000 characters One or two paragraphs
15,000–30,000 characters Two or three paragraphs
More than 30,000 characters Three or four paragraphs

AwiarN (talk) 15:48, 28 November 2017 (UTC)

reverted QG's dry-puff unverified tag

This quote from McNeill(2015) [the reference given] verifies it - page 77:

The EC was puffed by the puffing machine at a higher power and longer puff duration than vapers normally use. It is therefore possible that the e-liquid was overheated to the extent that it was releasing novel thermal degradation chemicals. Such overheating can happen during vaping when the e-liquid level is low or the power too high for a given EC coil or puff duration. Vapers call this phenomenon ‘dry puff’ and it is instantly detected due to a distinctive harsh and acrid taste (it is detected by vapers, but not by puffing machines) [139]. This poses no danger to either experienced or novice vapers, because dry puffs are aversive and are avoided rather than inhaled.

Thus i reverted it[39]--Kim D. Petersen 17:13, 4 December 2017 (UTC)

If the verification failed tag was for the other name "dry hit", then i suggest that we add this from Farsalinos' blog (he did the research that is referred to in McNeill)[40] which refers to both usages "dry puff" and "dry hit" --Kim D. Petersen 17:18, 4 December 2017 (UTC)
I did not tag dry puff. The source does not verify or "dry hit" on page 77 or any other page. I oppose using the blog. QuackGuru (talk) 00:26, 5 December 2017 (UTC)

Conference source

The tags were deleted from a source that fails WP:MEDRS. QuackGuru (talk) 23:10, 25 May 2018 (UTC)

Agreed, the source is non-MEDRS compliant, and it is a primary source. As a conference paper it is probably not even peer-reviewed. So remove is recommended. --Kim D. Petersen 22:21, 28 May 2018 (UTC)

The citation fails MEDRS. Hence, the tag added. QuackGuru (talk) 19:34, 1 June 2018 (UTC)

Excessive discussion about Formaldehyde in lead, that is unbalanced wrt WEIGHT.

This section:

Normal usage of e-cigarettes,[1] and reduced voltage (3.0 V[2]) devices generate very low levels of formaldehyde.[3] Later-generation e-cigarettes used with higher power may generate equal or higher levels of formaldehyde than compared to smoking.[4][failed verification][Notes 1] A 2015 review found that these levels were the result of overheating under test conditions that bear little resemblance to common usage.[5] A 2015 Public Health England (PHE) report found that high levels of formaldehyde only occurred in overheated "dry-puffing".[6] Users detect the "dry puff" or "dry hit" and avoid it, and they concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes."[7] However, e-cigarette users may "learn" to overcome the unpleasant taste due to elevated aldehyde formation, when the nicotine craving is high enough.[8] E-cigarette users who use devices that contain nicotine are exposed to its potentially harmful effects.[2] Nicotine is associated with cardiovascular disease, potential birth defects, and poisoning.[9] In vitro studies of nicotine have associated it with cancer, but carcinogenicity has not been demonstrated in vivo.[9] There is inadequate research to demonstrate that nicotine is associated with cancer in humans.[10] The risk is probably low from the inhalation of propylene glycol and glycerin.[11] No information is available on the long-term effects of the inhalation of flavors.[12]


This material should be weaved into the formaldehyde section of the article, where not all of it is present. And we should probably summarize the formaldehyde issue somewhat like this:

Formaldehyde is found in the aerosol but usually at a order of magnitude 1-3 fold lower than regular cigarettes[4]. Under some scenarios it is generated at levels higher than cigarettes[4], and there is some controversy over the real world likelihood of this happening[13].

At the moment it is dominating the lead, and is given excessive WP:WEIGHT. --Kim D. Petersen 13:45, 31 July 2018 (UTC)edited to add the references that QG is stating as missing in discussion below --Kim D. Petersen 00:03, 1 August 2018 (UTC)

It was claimed the content FV. Verification was provided. Then a different tag was added. Other reviews verify similar content. For example, see "Running at a higher power (temperature) not only increases nicotine delivery, but also increases the amount of formaldehyde and other aldehydes that are naturally produced by heating up propylene glycol or vegetable glycerin and other toxins produced in the e-cigarette aerosol."[41] The content stating "A 2015 review found that these levels..." is a SYN violation. The undue weight is the content that is a SYN violation. The proposal on the talk page is unsourced. No sources were presented for "Formaldehyde is found in the aerosol but usually at a order of magnitude 1-3 fold lower than regular cigarettes. Under some scenarios it is generated at levels higher than cigarettes, and there is some controversy over the real world likelihood of this happening."[42] The lead is currently too short, and is not giving enough WP:WEIGHT for 4 paragraphs. QuackGuru (talk) 18:13, 31 July 2018 (UTC)
My argument as stated is not that formaldehyde shouldn't be discussed in the article. Just that it is presented with undue weight (which is not the same as WP:SYN!) and to a detail level that doesn't fit the WP:LEDE. It is not even a summary of the subsection in the article that discusses this!
As for the 1-3 fold - how about you look at the review that we are quoting here. It states this. This is the start of the discussion, not the end, nor was the proposed summary of the section stated as anything other than a proposal that is 100% verifiable via the sources that we already have on formaldehyde. Have you read up on it? My summary is very fair, very balanced and does fit with the preponderence of reviews existing in the literature about this subject. --Kim D. Petersen 23:53, 31 July 2018 (UTC)
Formaldehyde is found in the aerosol but usually at a order of magnitude 1-3 fold lower than regular cigarettes[4]. Where does it state this in the 2015 review? The source mentions formaldehyde twice. I could not find where it states this in the sources used.
Under some scenarios it is generated at levels higher than cigarettes[4], This is misleading and inaccurate. It does not explain what are the scenarios this happens. The current wording "Later-generation e-cigarettes used with higher power may generate equal or higher levels of formaldehyde than compared to smoking." is far more accurate and it is sourced.
and there is some controversy over the real world likelihood of this happening[13]. Where does the source mention there is a "controversy"? Both sources do not appear to verify the claim. It would help to find and read the sources first rather than make a proposal that is unsourced and then add sources for each claim later to try to verify each claim. You stated "And we should probably summarize the formaldehyde issue somewhat like this:"[43] The proposal is not a summary of the body. QuackGuru (talk) 00:48, 1 August 2018 (UTC)
Lets take them in order:
  • With regards to the 1-3 fold, in the source it is stated that Carcinogen levels were 9 to 450 times lower. Formaldehyde is one of these - and thus it is somewhere between a magnitude 1-3 fold lower (allowed calculation per WP:CALC). But we can take it from another reference, since this figure is stated in all reviews that give the magnitude of formaldehyde under regular usage. I'm agnostic as to which review we use.
  • With regards to "controversy", we can use whatever word you want: disagreement/discussion/not settled .... The fact is that this particular issue is argued by the sources - e-cig positive reviews dismiss the issue, and e-cig negative reviews do the opposite => controversy.
As for your statement that the sentence isn't a summary of the body, you will have to be more specific, since as far as i can see, it is a comprehensive neutral summary of the content in both the section in the body, and of the material that is in the lede. --Kim D. Petersen 19:14, 1 August 2018 (UTC)
See "Carcinogen levels were 9 to 450 times lower than those in conventional tobacco products."[44] That's for carcinogen levels in general not specifically for formaldehyde. For formaldehyde it made a very different claim. It was not lower in general. It can be higher. The review found "a more recent study utilizing the newer "tank-style" systems with higher voltage batteries reported that these e-cigarettes might expose users to equal or even greater levels of carcinogenic formaldehyde than in tobacco smoke."[45] Specifically for carcinogens there already is content in the lede. See "The vapor have been found to contain flavors, propylene glycol, glycerin, nicotine, tiny amounts of toxicants, carcinogens, heavy metals, and metal nanoparticles, and other substances.[5][25]"
With regards to "controversy", you made a specific proposal but the source does not support the claim.
The part about Under some scenarios... is very vague. The current wording tells the reader the specific scenarios.
None of the sentences you proposed summarise the body and there are still problems with each sentence being proposed. QuackGuru (talk) 20:02, 1 August 2018 (UTC)
I'm sorry. But what are you saying here? That formaldehyde is above 9 times lower for normal conditions? Per the source? Where do you read that? --Kim D. Petersen 20:15, 1 August 2018 (UTC)
I did not say or imply that the formaldehyde is above 9 times lower for normal conditions.
Source said "Carcinogen levels were 9 to 450 times lower than those in conventional tobacco products."[46] The source did not make a specific claim for the levels being 9 to 450 for formaldehyde. The source did make a claim for the levels of carcinogens in general. For formaldehyde the source arrived at a different conclusion. The body says "The majority of e-cigarettes evaluated included carcinogenic tobacco-specific nitrosamines (TSNAs); heavy metals such as cadmium, nickel, and lead; and the carcinogen toluene.[30] However, in comparison to traditional cigarette smoke, the toxic substance levels identified in e-cigarette vapor were 9- to 450-fold less.[30]" That's not specifically about formaldehyde. The proposal is not a summary of formaldehyde and the wording is unclear and misleading. QuackGuru (talk) 20:31, 1 August 2018 (UTC)

I propose to remove the undue weight tag. The sentence is most relevant and is well sourced. Deleting the sentence that indicates later-generation e-cigarettes may pose a risk of inhaling higher levels of formaldehyde than compared to smoking would not be summarising the issue. It would be hiding the issue. It was not a single study. It was a review making the claim. Other reviews make similar claims. The lede would be very unbalanced based on the current literature on this topic to remove that sentence. The next sentence stating "A 2015 review found that these levels...". is essentially duplication. It is very similar to "A 2015 Public Health England (PHE) report found that high levels of formaldehyde only occurred in overheated "dry-puffing".[20] Users detect the "dry puff" or "dry hit" and avoid it, and they concluded that "There is no indication that EC users are exposed to dangerous levels of aldehydes."[21] " The lede is also too short and can be expanded to summarize each issue concisely. QuackGuru (talk) 14:32, 2 August 2018 (UTC)

You seem to be of the mistaken opinion that i object to a deep dive into the formaldehyde issue, i'm not. It just doesn't belong in the lede, where it is WP:UNDUE. Try coming up with a summary of the section in the article, and weaving into that section the material that isn't there already. But the major point is: There is too much formaldehyde debate in the lede, we need a short summary of 1 to 3 sentences. --Kim D. Petersen 03:38, 3 August 2018 (UTC)
You did not specifically oppose my proposal to remove the tag to the most relevant content about formaldehyde in the lede and you did not specifically oppose my proposal to remove the sentence that is essentially duplication. Your proposal is different than mine. You want to overall shorten it. For now I want to trim it by deleting duplication and removing the inline tag to the most relevant sentence. I strongly oppose to deleting or tagging the most relevant sentence about formaldehyde. What material in the lede isn't already in the body? QuackGuru (talk) 15:40, 3 August 2018 (UTC)
Let me be clear then: As long as the formaldehyde section in the lede is longer than 2-3 sentences. The lede is providing WP:UNDUE weight to this issue. Because it is presented out of proportion with its significance in the literature. Simple as that. --Kim D. Petersen 00:07, 4 August 2018 (UTC)
What is the explanation for tagging the most relevant sentence about the issue? That sentence is not WP:UNDUE weight. If you want to tag a sentence it would be the sentence that is essentially duplication. QuackGuru (talk) 02:02, 4 August 2018 (UTC)
The rationale is given in the text attached to the tag. Basically the sentence was cherry-picked from the review, it was specifically tagged in the paper as being an "outside" result from a single paper. But if you are more comfortable with it, i could tag the lede instead, which is, i agree with you, would be much more correct. --Kim D. Petersen 12:42, 4 August 2018 (UTC)
The sentence was not cherry-picked from the review. You proposed content using the same source. The review found that higher voltage e-cigarettes can produce equal or higher levels of formaldehyde than smoking. That's appropriate to include in the lede. The review found "a more recent study utilizing the newer "tank-style" systems with higher voltage batteries reported that these e-cigarettes might expose users to equal or even greater levels of carcinogenic formaldehyde than in tobacco smoke."[47] Your proposal "Under some scenarios it is generated at levels higher than cigarettes[4]," is using the same source and attempted to summarise the same sentence. That proposal was vague and unclear. The current wording is far more accurate. What sentence from the same review did you summarise for "Under some scenarios it is generated at levels higher than cigarettes[4],"? QuackGuru (talk) 16:55, 4 August 2018 (UTC)
When the authors of the review state "a more recent study...", then you as a wikipedia editor should know that this is not a solid conclusion, and that you cannot just elevate it to the same level as other conclusions in reviews. When you non the less do it, then that is cherry picking. --Kim D. Petersen 17:38, 5 August 2018 (UTC)
We don't need to cite a review that cited multiple studies to reach a specific conclusion. Other reviews make similar conclusions including the review you cited. Other sources in the article cite the same 2015 study.
I asked you a specific question for the content you sumamrised. See What sentence from the same review did you summarise for "Under some scenarios it is generated at levels higher than cigarettes[4],"? QuackGuru (talk) 20:20, 5 August 2018 (UTC)

Lets retry - propose an alternative

Since my proposal for a short summary of formaldehyde in the lede is not acceptable to some editors, and as a stated above it was only a proposal, then please suggest an alternative text, that is roughly 2-3 sentences long, and which summarizes the issue. The lede is significantly bloated, so we need to summarize each issue succinctly. --Kim D. Petersen 20:19, 1 August 2018 (UTC)


References

  1. ^ Wilder 2016, p. 82.
  2. ^ a b Cite error: The named reference Cheng2014 was invoked but never defined (see the help page).
  3. ^ Cite error: The named reference Bekki2014 was invoked but never defined (see the help page).
  4. ^ a b c Orellana-Barrios, Menfil A.; Payne, Drew; Mulkey, Zachary; Nugent, Kenneth (2015). "Electronic cigarettes-a narrative review for clinicians". The American Journal of Medicine. 128: 674–81. doi:10.1016/j.amjmed.2015.01.033. ISSN 0002-9343. PMID 25731134.
  5. ^ Polosa, R; Campagna, D; Caponnetto, P (September 2015). "What to advise to respiratory patients intending to use electronic cigarettes". Discovery medicine. 20 (109): 155–61. PMID 26463097.
  6. ^ McNeill 2015, p. 77.
  7. ^ McNeill 2015, p. 77-78.
  8. ^ Cite error: The named reference Rowell2015 was invoked but never defined (see the help page).
  9. ^ a b Cite error: The named reference Jerry2015 was invoked but never defined (see the help page).
  10. ^ Cite error: The named reference SGUS2014 was invoked but never defined (see the help page).
  11. ^ Cite error: The named reference Hajek2014 was invoked but never defined (see the help page).
  12. ^ Cite error: The named reference Bertholon2013 was invoked but never defined (see the help page).
  13. ^ Abrams, David B.; Glasser, Allison M.; Pearson, Jennifer L.; Villanti, Andrea C.; Collins, Lauren K.; Niaura, Raymond S. (2018). "Health Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives". Annual Review of Public. 39: 193–213. doi:10.1146/annurev-publhealth-040617-013849. PMID 29323611.


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