Talk:Electronic cigarette

Possible side effect from some oil based flavourings

disclaimer: this is conjecture based on rapid development of various health issues within 2 years of trying a food additive flavoured ecig just couple times. I was 31 at the time of trying it with sedentary lifestyle. As I don't have exercise routine and am indoors as much as some hospitalized people, I breath very very casually so anything that would effect oxygen delivery in permanent way would be noticeable. I'd guesstimate there is 'good' odds that these issues would have developed anyway, I simply suspect the ecig lowered the oxygen intake ability during slow casual breathing just past a "tipping point" where as result there was acceleration in the onset of various health issues that may have been already on the way anyway due to lack of exercise etc and sitting on computer.

After trying ecig for only couple times, and not changing my daily routines in the following years I had a bunch of very subtle health issues develop that I have finally tracked down to the body regulating blood circulation to too low levels because of lack of oxygen. I would say that I was already "pre-compromised" due to sitting all day on computer so anything that would decrease the oxygen intake further was a tipping point. A bunch of mysterious issues developed with seemingly no connection because this lack of oxygen in circulation effects everything. Brittle nails, cold extremities, poor concentration - though because I also had some sort of stroke where I passed out about 1 year from trying the cig.

Economics section

We have: "In the US, big tobacco has a significant share of the e-cigarette market, and they are the major producers."

- I added the "in the US" as both sources are US-only, and for example the PHE report does not say this for the UK (which I think they would have done, if they knew it to be true). The first source is from CNN, the second from an open-access paper by an MD, who references it to "21. Legacy Tobacco Documents Library. Legacy Tobacco Documents Library. San Francisco, CA: University of California San Francisco Library", which is, let's say, a tad vague. We report elsewhere in the section that Nillson can't track sales of independent manufacturers selling to vape shops, so whereas big baccy's sales of (mostly) cigalikes via mainstream retail are apparently dropping in 2015 (WSJ etc), the situation of the independent sector is less clear. It's questionable whether information to support the second claim exists in the public sphere, though no doubt industry insiders have more info which they will treat as commercially confidential.

At the least we need better sources to support anything we say on this. Johnbod (talk) 16:05, 9 December 2015 (UTC)

Im taking a look for sources. This one [1] is ok but there isnt a lot of information, the nice thing is its from 2015. AlbinoFerret 16:23, 9 December 2015 (UTC)

• Yes, the economics section is another one that needs a lot of work. I suggest:- (1) Move and redirect the current content of Vape shop to Economics of electronic cigarettes; (2) Paste the text currently in Electronic cigarette#Economics into that article; and then (3) Rewrite this section of the proper e-cig article as a couple of concise and intelligible paragraphs.—S Marshall T/C 19:36, 9 December 2015 (UTC)

Sounds like a great plan. AlbinoFerret 20:07, 9 December 2015 (UTC)

Since the Afd proposal for Vape shop, which was pretty similar, has just been heavily defeated, you can't exactly do that. I don't know we have enough material for a proper sub-articles, & I think we need more than a couple of paras here. Johnbod (talk) 04:15, 10 December 2015 (UTC)

Per WP:DP and the subsection Deletion of articles if the page is kept "the page is kept and is again subject to normal editing, merging, or redirecting as appropriate." AlbinoFerret 05:58, 10 December 2015 (UTC)

Yes "as appropriate", which doesn't mean flouting a clear and recent community decision. Johnbod (talk) 18:07, 10 December 2015 (UTC)

Never said or intended to flout a community discussion. I just quoted it was subject to further editing, merger, and redirect. The community consensus is not to delete, not that it must stay in its present form, and nothing is planed to be deleted. But at this point we are no longer discussing deletion but merger. I am sure more discussions will need to happen. AlbinoFerret 18:13, 10 December 2015 (UTC)

• I'm disappointed to say this, but I think that the situation is that editors want to keep Quack's forks, stupid though I think that is. We can ask again in five months in the hope that consensus will have changed by then. In the meantime I do suggest we use the forks as containers for the most horribly-written parts of this article, and the obviously missing fork is Economics of electronic cigarettes. We're not proposing to delete the text of vape shop, nor to turn vape shop into a redlink.—S Marshall T/C 08:51, 10 December 2015 (UTC)

They aren't actually WP:FORKs at all, but regular sub-articles, diffused to keep this one manageable, which I'm surprised you don't support. It doesn't help to use the term, which has a specific meaning here. The work was mostly done by Quack, but as I recall there were discussions here agreeing the changes beforehand. They seem appropriate to me. Most of the detail is already in the sub-articles, as it should be, but if not some can be added there. At the moment I don't see we have enough on Economics of electronic cigarettes for a sub-article. A lot of the most basic information seems to be unavailable. Johnbod (talk) 18:07, 10 December 2015 (UTC)

Where in the articles can I find the summery and link to Vape shop showing where it was broken out? AlbinoFerret 18:14, 10 December 2015 (UTC)

• Well, Johnbod, my actual view is that a few well-chosen sub-articles would probably be a good idea but the easiest way to get there from here involves a little high explosive. I didn't say so during the deletion discussions because some of my fellow editors have an irritating way of saying "User thinks there should be an article with this title so just keep this one and adapt it" -- so I chose to present the case for completely deleting them.—S Marshall T/C 18:25, 10 December 2015 (UTC)

The sources in the Economics section are weak, and about half of the statements in it are outdated, dubious, or misleading. Some others aren’t very informative. If adequate sources don’t exist, material should be deleted. However, to do so aggravates a problem that already exists. The most reliable sources in this area (and Marketing too) are about the involvement of the tobacco industry because the efforts of some prohibitionists to emphasise it and the publicity campaigns of the companies are more likely to be reported in mainstream sources. Currently the role of the many small operations is downplayed in the article. Big tobacco sells mostly first generation devices, and there’s no mention of manufacturers of later generation devices. A reader could get the impression that tobacco companies dominate the market. It’s unclear, or perhaps doubtful, that this is the case. Unfortunately, I don’t have any suggestions for improvement. P Walford (talk) 15:04, 12 December 2015 (UTC)

• Yes, the financial media are well set up to report on large quoted companies selling to mainstream retailers, but very poorly set up to report on a bunch of rather tiny private businesses selling through the internet, small one-off specialist retailers and corner shops (UK term). Until it was removed this week (see a couple of sections back) our article did indeed flat-out say that "tobacco companies dominate the market". As I say there, I suspect nobody really knows whether this is the case in the US, where big baccy has placed the front line of its attempt to take over the sector - I think it is clear enough that it is not in the UK and Europe. Cigalikes can be treated as a cigarette-like product in terms of marketing and distribution, and use big baccy's existing skills, but later generation devices, with a one-off sale of kit followed by regular sales of e-juice that can come from any manufacturer, are very different. Maybe the car companies should have a go? Johnbod (talk) 15:35, 12 December 2015 (UTC)

The independents are an interesting phenomenon but likely, I think, to be short-lived given the spending power of the larger players who are setting up massive temples to vaping in the major retail malls. Guy (Help!) 22:47, 18 December 2015 (UTC)

in the US, you mean. But even there, I rather doubt that. Most vapers quickly move on from cigalikes to tanks, which is a market big baccy has shown little ability to penetrate (see above). Many if not most vapers have a strong loathing for the tobacco companies, who have a huge negative brand load to carry. No doubt the more successful independent tank players will eventually sell out, but they can probably count on their eventual sale price continuing to rise sharply for some years. Johnbod (talk) 23:43, 18 December 2015 (UTC)

Some of this dialogue could be useful to the Vape Shop ARTICLE. Vape shops could parallel many industries, which are not in the Big Tobacco paradigm, such as independent hamburger joints, vs MacDonald's.....or MicroBrewry vs Budweiser Mystery Wolff (talk) 00:31, 19 December 2015 (UTC)

I don't live in the US. The nearest vape-temple is at The Oracle, Reading. Guy (Help!) 00:43, 19 December 2015 (UTC)

If you're talking about the VIP store it's hardly a threat to the independents. The best e-cig VIP sell is a rebranded iStick 30. They're aiming squarely at beginners.--DaleCurrie (talk) 03:33, 19 December 2015 (UTC)

While checking sources used in the Economics section, I didn’t see a mention of anything resembling a “vape-temple”. So I looked for information about the one at The Oracle. It was opened last April, the fourth “blending boutique” VIP opened. Apparently they have plans to open them across the UK. As of October 27, there were ten of them. Most VIP retail outlets (between 100 and 200 of them) are small kiosks, like the one in the picture recently added to the Marketing section. It looks like the company intends to upgrade many of them to proper shops. The shop at The Oracle doesn’t look like a temple in pictures, but maybe the effect is different if when seeing it in person? Both VIP and their US-based parent company, Electronic Cigarettes International Group, say they’re independent. I’ve seen no evidence that they’re a big tobacco brand.

Re the Economics section: “and they are the major producers” should be removed. “A 2015 review said there are more than a hundred small e-cigarette businesses in the US, with about 70% of the market held by 10 businesses” should be removed. There’s enough evidence in reliable sources to show that these statements are inaccurate, and the sourcing standards used by Schraufnagel and Orellana-Barrios et al appear to be less rigorous than Wikipedia’s.

There’s more economics content in the History section. The last two paragraphs and the table in History should be moved to Economics, and the first two sentences of the second paragraph of Economics, “Tobacco manufacturers dismissed e-cigarettes as a fad at first; but the purchase of the US brand blu eCigs by US tobacco manufacturer Lorillard for $135 million in April 2012 signaled their entry into the market. "Big tobacco" companies have bought some e-cigarette businesses and greatly increased their marketing efforts”, should be moved (consigned?) to History. P Walford (talk) 14:33, 19 December 2015 (UTC)

The economics figures are quite frankly completely useless. The reason for this is that most of the market isn't monitored - and that goes for the US as well. The independent market is not only an interesting phenomenon, they are quite likely the majority of the market (and growing) - see this[2]. On top of that, figures for sales outside the US is almost impossible to get at, since no one is tracking them there.. --Kim D. Petersen 00:47, 20 December 2015 (UTC) [nb: not stating that the link is useful, i simply searched for Bonnie Herzog, who is (iirc) considered the go-to person for e-cigarette market analysis in the US - at least if you look at summaries of speeches from e-cig vendor conferences. But it does tell us something about the problems in analysing the market. --Kim D. Petersen 00:50, 20 December 2015 (UTC)]

At ECigIntelligence we have research-based estimates for the size of most major markets outside the U.S. - if any editor would like a particular one for the article please let me know. Also a great deal of data backing up the trend mentioned above, for the shift away from tobacco-company products in mainstream retail to specialist companies' products in vape stores - however, as mentioned, since nobody with the heft and reach of Nielsen tracks both those channels, the data is strongly suggestive rather than utterly conclusive - nobody is quite comparing apples with apples. Barnabypage (talk) 08:24, 22 December 2015 (UTC)

So, you have a dog in the fight. Funny how often that leads to supporting one extreme or another. Guy (Help!) 01:46, 24 December 2015 (UTC)

Not quite sure what you mean by that, but to clarify, I have no interest at all in the figures showing one thing or another. I'm just interest*ed* in knowing *what* they show! In any case, I think the picture is quite complex: there may be a trend toward vape stores and later-generation models but I certainly wouldn't say the Big Tobacco cigalike is dead, far from it. Barnabypage (talk) 23:31, 24 December 2015 (UTC)

Barnabypage, thank you. I presume you are saying that articles would be taken out from any paywalls, because linking to them as Cites I believe would require that. Much of the information about the industry economics is characterized by C-Store resources and Stock Analysts for the greater market share companies. However it leave a real gap because most items in Vape Shops do not have UPC codes, making them very hard to quantify. For items like Cigalikes many do have UPC codes, so while items like slowing growth is a consideration, I believe the numbers will show the overall size remains and is growing. Trying to quantify and characterize the refillable market here will likely be Original Research, either by declaration or by having two statistic put together to imply a correlation. If there were articles that aggregated public sourced information, I think it would be a great resource to improve this article. Thanks Mystery Wolff (talk) 13:25, 25 December 2015 (UTC)

Mystery Wolff, if there is specific data any editor wants to take a look at in connection with the Wikipedia article, I can temporarily liberate it from the paywall or provide it in some other form. Barnabypage (talk) 16:24, 1 January 2016 (UTC)

Just a small comment: There is no problem in citing paywalled content, as long as that content lives up to WP:RS (and of course WP:WEIGHT). --Kim D. Petersen 17:42, 25 December 2015 (UTC)--Kim D. Petersen 17:42, 25 December 2015 (UTC)

If it's behind a paywall, how can other editors look at it and confirm that information is well cited? Mystery Wolff (talk) 11:27, 26 December 2015 (UTC)

Its a problem, but its allowed WP:PAYWALL. That link is on WP:VER a core WP policy, it cant be overcome or ignored. AlbinoFerret 13:52, 26 December 2015 (UTC)

What part is a problem, and what are you trying convey by "That link is on WP:VER"? Mystery Wolff (talk) 09:34, 27 December 2015 (UTC)

We've been through this multiple times before, and if you want to verify content there are a multitude of places where you can request copies of articles: WT:MED, WP:RX, or simply by asking here. The easiest way may be to just send an e-mail --> CFCF 💌 📧 11:48, 27 December 2015 (UTC)

@Mystery Wolff WP:PAYWALL is a link to a section inside of the page WP:VER. AlbinoFerret 16:48, 27 December 2015 (UTC)

• Kim I agree with your comment, I was confused when it was said it "was a problem". There are procedures including https://en.wikipedia.org/wiki/Wikipedia:WikiProject_Resource_Exchange/Resource_Request, so the path of least resistance would be to have the articles in question to be moved out to a non-paywalled section of the site, by request, when possible. There is also the article on Vape Shops which could get more Economic information for the article.....but all of this is really shallow water because so little information is be pulled from a disorganized new industry, as it is just forming. Mystery Wolff (talk) 03:54, 29 December 2015 (UTC)

Mystery Wolff—Doing that without permission would be illegal, and I find it highly unlikely that we could convince major publishers to release content that is behind a paywall. CFCF 💌 📧 12:26, 29 December 2015 (UTC) 

CFCF, I am sure you misread what I was saying. I was talking about this process described here. https://en.wikipedia.org/wiki/Wikipedia:WikiProject_Resource_Exchange/Resource_Request And that sites commonly have sections which are both paywall and non-paywall, and that by request and agreement that could occur. My preference is always going to be to use resources and cites that anyone can open up. Many of the PubMed articles are only available in abstract form until the full paper is put out in the non-pay areas. Mystery Wolff (talk) 06:38, 30 December 2015 (UTC)

No, but you misunderstand the world of academic publishing. Only a very small minority of journals operate in that manner, most never release their content without a subscription. Getting releases of individual papers is really not feasible, with authors themselves not being able to do that once a license is already enacted. We here at Wikipedia use the best possible sources, regardless of their copyright status, otherwise we may end up misinterpreting the field or only showing a limited picture. CFCF 💌 📧 15:27, 30 December 2015 (UTC) 

The cigalike problem again

Again we have the cigalike problem. The economics section is almost completely about the sale of cigalikes and some of the claims make it sound like its about the market as a whole. I propose creating subsections dealing with the ciaglike market, and then one (or more if needed) on the rest of the market. Thoughts? AlbinoFerret 04:10, 24 December 2015 (UTC)

Probably best, if decent info on 2nd+ gen stuff can be found. Johnbod (talk) 16:28, 26 December 2015 (UTC)

There probably isnt much if any, but at least a cigalike section so readers know thats whats being discussed. AlbinoFerret 18:58, 26 December 2015 (UTC)

I split them up, one for Cigalikes and the other for other devices. but we have a similar issue in the Marketing section. It appears to be all cigalike information. AlbinoFerret 16:44, 27 December 2015 (UTC)

AlbinoFerret, I do think you should have read the feedback above, before splitting out a section. You don't have any data to support the Cigalike proposition you now split out. It is in fact Original Research at this point. As mentioned above, Vape Shops are not selling items with UPC codes, so their sales are harder to recognize. The refillable market includes Cigalikes, and it includes EGO refillables, which are also regarded as Cigalikes by some. You are trying to add a level of detail with which you don't have any supporting data. I am going to go ahead and remove the delineation of Cigalikes until are able to present some sort of sourced information. As it stands they way you have changed it, you are having a bunch of blended data that characterizes the entire market, being placed under "Cigalike" and that is not useful to the reader. Items VTM includes Cigalike as well. If the breakout is proper here, it would then stand to reason you would want an entire Article just on Cigalikes, and I don't believe you are proposing that? Mystery Wolff (talk) 03:17, 29 December 2015 (UTC)

The breakout is appropriate and your whole comment is WP:OR. Provide a source that says ego's are cigalikes. I selected manufacturers of cigalikes for the cigalike section, looking at each of the claims. Its organization, do you think every claim in Safety uses the word Safety? Do all of them use economics in that section?. Yes, thats the whole point of the cigalike problem, the whole article is mostly a cigalike problem and should be changed. The correct thing to do, is if you think something doesnt belong in one section is to move it, not revert the whole thing. AlbinoFerret 14:23, 29 December 2015 (UTC)

So thats 2 editors in favor on the talk page, SPACKlick edited and changed them back. Seems consensus is against you Mystery Wolff. AlbinoFerret 01:00, 30 December 2015 (UTC)

The sockpuppet editor who wrote in support and reverted, has been banned. I read Johnbod remarks as, he'll consider the change, IF (and that was an IF) 2nd Generation data and citations would support the breakout. Which then AlbinoFerret said there would not be any cites for that. Johnbod can certainly speak for himself, its how I read it.

All versions of Electronic Cigarettes are currently being sold and used, this article is covering all of them as currently being written. If AlbinoFerret is proposing to split the article, I will certainly want to read that. Regarding continuance of polling here, please see https://en.wikipedia.org/wiki/Wikipedia:POLL and please see https://en.wikipedia.org/wiki/Wikipedia:Consensus Thank you. Mystery Wolff (talk) 06:30, 30 December 2015 (UTC)

Yes, all generations are being sold but not every source uses data from every generation and not every company sells devices of every generation. A lot of existing research was conducted only on cigalikes which from later research on 2nd gen devices show a different effectiveness and profile of use and user. It is right to split them out where the sources are clear on which were used. I haven't double checked all the sources in Albino's change but if you find one which is referring to e-cigs in general in the igalike section feel free to fix it. SPACKlick (talk) 09:47, 30 December 2015 (UTC)

Eyes are needed on Electronic cigarette aerosol and e-liquid

Would editors please take a look at the article. AlbinoFerret 12:50, 30 December 2015 (UTC)

Can you be more specific? Mystery Wolff (talk) 23:48, 30 December 2015 (UTC)

No. This was a request that more editors look at the page. AlbinoFerret 23:49, 30 December 2015 (UTC)

Perhaps start a formal request for comment RFC. Right now, I see you are multiple reverting of edits I put in days ago. Canvassing will not be as effective as asking using the various WP processes in place. What specifically do you want to be looked at? If you are unwilling to begin a RFC (or other method of DS), let me know because I believe it will be in order. I am not comfortable with those reverts, in favor of retaining POV with poorly sourced and outdated materials. That combined with removal of multiple edits. There was a reason why I did each edit individually. I explained each one, and they were removed in a block without explanations of weight. Mystery Wolff (talk) 01:03, 31 December 2015 (UTC)

Asking for eyes on a sub article on the main articles page with a neutral post is not canvassing. All the editors on this page are already involved in the topic, and I did not selectively pick out editors who may share my views, but asked everyone. AlbinoFerret 02:05, 31 December 2015 (UTC)

First paragraph of the lede

In the recent past the construction page had a cleanup and c/e. Since the first paragraph of the lede is based on construction I propose this version with a better function description for the first paragraph of the lede.

An electronic cigarette[Notes 1] is a battery-powered vaporizer which simulates the feeling of smoking by vaporizing a liquid into an inhalable aerosol.[1] The primary parts that make up an e-cigarette are a mouthpiece, a cartridge (tank), a heating element/atomizer, a microprocessor, a battery, and possibly a LED light on the end.[2] An atomizer comprises a small heating element that vaporizes e-liquid and wicking material that draws liquid onto the coil.[3] When the user pushes a button.[4] or inhales a pressure sensor activates the heating element that atomizes the liquid solution;[5] The e-liquid reaches a temperature of roughly 100-250 °C within a chamber to create an aerosolized vapor.[6] The user inhales the aerosol, commonly called vapor, rather than cigarette smoke.[7] The aerosol provides a flavor and feel similar to tobacco smoking, but without tobacco.[1] Their use is commonly called "vaping".[4] The three main types of e-cigarettes are cigalikes, eGos, and MODs.[8] These devices are also categorized as first, second, third, and fourth generation devices.[9][10][11] Most are reusable but there are disposable versions of first generation devices also called cigalikes.[12] E-liquids usually contain propylene glycol, glycerin, nicotine, and flavorings.[13][14][15][16]

Edit 2/2/16 incorporated TMCk's suggestion. AlbinoFerret 16:12, 2 January 2016 (UTC)

The wording, claims, and references are already in the article. The full version with references can be found in this sandbox.User:AlbinoFerret/sandbox/ecig AlbinoFerret 22:42, 31 December 2015 (UTC)

This is not an improvement—not until sentence 7 does it actually explain the purpose—something that is in the current first sentence. CFCF 💌 📧 11:29, 2 January 2016 (UTC)

What it does , is shows how it works. Which is drastically missing in the lede. AlbinoFerret 13:26, 2 January 2016 (UTC)

Just add something like the following (bold):
An electronic cigarette is a battery-powered vaporizer which simulates the feeling of smoking by vaporizing a liquid into an aerosol to inhale.
Alternative: by transforming a liquid into an aerosol to inhale.
Note: Say what it does not what it doesn't (as in the current lede).--TMCk (talk) 14:37, 2 January 2016 (UTC)

Done, swapped a couple of words around, but its the same meaning. Removed the line further down that had the same info from the same source. AlbinoFerret 16:12, 2 January 2016 (UTC)

Don't you think this gives unnecessary detail in the lede for something that isn't essential to the topic? The construction is of secondary importance to the primary purpose. I find that the theme of the current lede is clearer. CFCF 💌 📧 10:39, 9 January 2016 (UTC)

The inserted information isnt construction its function. AlbinoFerret 14:05, 9 January 2016 (UTC)

Is this the text you intend to replace?

Electronic cigarettes are battery-powered vaporizers that simulate the feeling of smoking, but without tobacco. Their use is commonly called "vaping". The user activates the e-cigarette by taking a puff or pressing a button. Some look like traditional cigarettes, but they come in many variations. Most are reusable but there are also disposable versions called first generation cigalikes. There are also second, third, and fourth generation devices. Instead of cigarette smoke, the user inhales an aerosol, commonly called vapor. E-cigarettes typically have a heating element that atomizes a liquid solution known as e-liquid. E-liquids usually contain propylene glycol, glycerin, nicotine, and flavorings.

References

If it is, the current iteration is simply better and more precise in every way. CFCF 💌 📧 21:34, 11 January 2016 (UTC)

Smoking cessation

I present a partial restore from the archives:-

Current text

Proposed text

As of 2014, research on the safety and efficacy of e-cigarette use for smoking cessation is limited. E-cigarettes have not been subject to the type of efficacy testing as nicotine replacement products. The evidence suggests that e-cigarettes can supply nicotine at concentrations that are enough to substitute for traditional cigarettes. A 2014 Cochrane review found limited evidence of a benefit as a smoking cessation aid from a small number of studies, which included two randomized controlled trials (RCT). A third RCT in 2014 found that in smokers who were "not interested" in quitting, after eight weeks of e-cigarette use 34% of those who used e-cigarettes had quit smoking in comparison with 0% of users who did not use e-cigarettes, with considerable reductions in smoking found in the e-cigarette group. A 2014 UK cross-sectional population survey of smokers who tried to stop without professional assistance, found that those who used e-cigarettes were more likely to stop smoking than those who used nicotine replacement products. While there are some reports of improved smoking cessation, especially with intensive e-cigarette users, there are also several studies showing a decline in cessation in dual users. The US Preventive Services Task Force found there is not enough evidence to recommend e-cigarettes for quitting smoking in adults. A 2015 review found that e-cigarettes for quitting smoking were generally similar to a placebo. The same review concluded that while they may have a benefit for decreasing cigarette use in smokers, they have a limited benefit in quitting smoking. A 2014 review found e-cigarettes may have some potential for reducing smoking. A 2015 review found that vaping was not associated with successful quitting, but there are reports of quitting smoking or reduction. Since smoking reduction may just be dual use, smoking reduction may not be a positive public health result. A 2015 review found that e-cigarette users had 20% higher cessation rates than users of nicotine replacement products, which suggested that factors other than nicotine replacement products may contribute to quitting smoking. A 2014 review found limited evidence that e-cigarettes do not seem to improve cessation rates compared to regulated FDA nicotine replacement products. Two 2014 reviews found no evidence that e-cigarettes are more effective than existing nicotine replacement products for smoking cessation. A 2014 review found they may be as effective, but not more, compared to nicotine patches for short-term smoking cessation. However, a randomized trial found 29% of e-cigarette users maintained e-cigarette use at 6 months while 8% for patch users, indicating that vaping may continue after other quit methods. A 2014 review found that e-cigarettes have not been proven to be better than regulated medication for smoking cessation. A 2014 review found four experimental studies and six cohort studies that indicated that electronic cigarettes reduced the desire to smoke and withdrawal symptoms. This review also noted that two cohort studies found that electronic cigarettes led to a reduction in the number of cigarettes smoked per day. Nicotine-containing e-cigarettes were associated with greater effectiveness for quitting smoking than e-cigarettes without nicotine. A 2014 review concluded that the adverse public health effects resulting from the widespread use of e-cigarettes could be significant, in part due to the possibility that they could undermine smoking cessation. This review therefore stated for their use to be limited to smokers who are unwilling or unable to quit. A 2014 review found that personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes. However, e-cigarettes could have a broad adverse effect for a population by expanding initiation and lowering cessation of smoking. If e-cigarettes are used to quit smoking, they could reduce harm even more if the tobacco user quit using both. Any residual risk of vaping should be weighed against the risk of continuing or returning to smoking, taking account of the low success rate of currently-approved smoking cessation medications.

The available research on the safety and efficacy of e-cigarette use for smoking cessation is limited and the evidence is contradictory. Some medical authorities recommend that e-cigarettes have a role in smoking cessation, and others disagree. Views of e-cigarettes' role range from on the one hand Public Health England, who recommend that stop-smoking practitioners should:- (1) advise clients who want to quit to try e-cigarettes if they are not succeeding with conventional NRT; and (2) advise clients who cannot or do not want to quit to switch to e-cigarettes to reduce smoking-related disease to, on the other hand, 2015 reviews from the United States which conclude that e-cigarettes are not associated with positive health outcomes, not associated with quitting and are no more effective than a placebo at cutting down. Reviews in 2014 and 2015 found that e-cigarette users had 20% higher cessation rates than users of nicotine replacement products; that they were as effective as nicotine patches for quitting smoking over the short term; that they reduced withdrawal symptoms and mitigated the desire to smoke; and that personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes. However, e-cigarettes have not been subject to the same efficacy testing as nicotine replacement products. Several authorities take the view that there is not enough evidence to recommend e-cigarettes for quitting smoking in adults, and there are studies showing a decline in smoking cessation among dual users. A 2014 review found that e-cigarettes do not seem to improve cessation rates compared to regulated nicotine replacement products, and a trial found 29% of e-cigarette users were still vaping at 6 months, but only 8% of patch users still wore patches at 6 months.

I'm still hoping to make progress with this idea and would welcome additional commentary.—S Marshall T/C 21:38, 10 January 2016 (UTC)

It's a huge improvement over the current text. There are other changes I'd like to see, but I won't stand in the way of this one. P Walford (talk) 12:10, 11 January 2016 (UTC)

• I think this may be something like the 6th time I find myself repeating myself: we should not be mentioning PHE by name if we don't mention Cochrane or the WHO, both of which carry more authoritative opinions. Ping Doc James who commented on these proposed changes with similar concerns further up on the page. CFCF 💌 📧 13:05, 11 January 2016 (UTC)
• Looks good. AlbinoFerret 14:25, 11 January 2016 (UTC)

What about the concerns that it skews coverage and gives undue mention of a single positive report? This isn't an issue for you? May I remind you that you had issues with the text yourself [3]. CFCF 💌 📧 15:39, 11 January 2016 (UTC)

CFCF My concerns were to the first proposal that boiled it down to one paragraph, it has been expanded. AlbinoFerret 19:42, 11 January 2016 (UTC)

CFCF did indeed point this out in the past and I've failed to amend the proposed text in response to his concerns. I don't take those concerns seriously; the contention that the proposed text "skews coverage", or is unduly favourable to electronic cigarettes, is not one that I need to waste any of my time answering. But although it's silly, it's also easily countered without substantive changes, thus:-

Heading

Proposed text

The available research on the safety and efficacy of e-cigarette use for smoking cessation is limited and the evidence is contradictory. Some medical authorities recommend that e-cigarettes have a role in smoking cessation, and others disagree. Views of e-cigarettes' role range from on the one hand Public Health England, who recommend that stop-smoking practitioners should:- (1) advise people who want to quit to try e-cigarettes if they are not succeeding with conventional NRT; and (2) advise people who cannot or do not want to quit to switch to e-cigarettes to reduce smoking-related disease to, on the other hand, 2015 reviews from the United States which conclude that e-cigarettes are not associated with positive health outcomes, not associated with quitting and are no more effective than a placebo at cutting down. Reviews in 2014 and 2015 found that e-cigarette users had 20% higher cessation rates than users of nicotine replacement products. The Cochrane Collaboration concluded that they were as effective as nicotine patches for quitting smoking over the short term; that they reduced withdrawal symptoms and mitigated the desire to smoke; and that personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes. However, e-cigarettes have not been subject to the same efficacy testing as nicotine replacement products. Several authorities, including the World Health Organisation, take the view that there is not enough evidence to recommend e-cigarettes for quitting smoking in adults, and there are studies showing a decline in smoking cessation among dual users. A 2014 review found that e-cigarettes do not seem to improve cessation rates compared to regulated nicotine replacement products, and a trial found 29% of e-cigarette users were still vaping at 6 months, but only 8% of patch users still wore patches at 6 months.

The amendments are given in bold.—S Marshall T/C 19:07, 11 January 2016 (UTC)

— CFCF 💌 📧 19:52, 11 January 2016 (UTC)

• It isn't much use looking at these without the refs. I'm rather suspicious that some of the wording is sufficiently precise. Eg, are there really "2015 reviews from the United States which conclude that e-cigarettes are ... not associated with quitting", or not associated with better rates of quitting than other methods? Johnbod (talk) 20:38, 11 January 2016 (UTC)

Yes the pre Cochrane,and PHE staement sources from the US do argue that there are no sources that prove they help people quit. AlbinoFerret 21:28, 11 January 2016 (UTC)

Obviously there are sources that show ecigs as "associated with quitting" - not in itself a large claim. All the sources I can remember discuss how this "association" looks compared to conventional NRT, cold turkey, etc. What is "PHE staement sources from the US"? Johnbod (talk) 03:31, 13 January 2016 (UTC)

• I think "the pre Cochrane,and PHE statement sources from the US" should be parsed as:- "the pre-Cochrane and pre-PHE statement sources from the US".—S Marshall T/C 13:13, 13 January 2016 (UTC)

• Well, I didn't check that QuackGuru's claims were backed up by his sources. I simply assumed that he didn't go so far as to lie. If he did, then really, we need to nuke this whole article and start again from scratch.—S Marshall T/C 21:58, 11 January 2016 (UTC)

I seem to remember checking those sources, its basically a known unknown at the time the sources were written. It might be a good idea to add the sources now to final chacking can be done before inclusion as CFCF gave a thumbs up. AlbinoFerret 22:01, 11 January 2016 (UTC)

The WHO and Cochrane are more respected or at least more well known than PHE. So yes this version is an improvement over the prior version that was proposed. But what happpened to the USPSTF? Doc James (talk · contribs · email) 23:16, 11 January 2016 (UTC)

I think it represents a significant improvement and is clear. SPACKlick (talk) 11:41, 13 January 2016 (UTC)

• I think we've reached a rough consensus that this trimming is appropriate in principle, subject as always to a careful comparison of the detail with the sources.—S Marshall T/C 13:10, 13 January 2016 (UTC)

• Any discussion of smoking cessation and e-cigarettes that doesn't even mention dual use is missing a key point. Our sources find high levels of dual use, say that's a major part of what's happening in the real world. I suggest citing a source or two on this. Without it I think the trimming has cut meat along with the fat. Cloudjpk (talk) 18:53, 13 January 2016 (UTC)

Agree with that - it wasn't very well covered before either. Johnbod (talk) 19:07, 13 January 2016 (UTC)

Amazingly the PHE report also addresses dual use. The pages 26-29, and the summery on page 29 is quite interesting. AlbinoFerret 21:19, 13 January 2016 (UTC)

• This section is entitled smoking cessation, and someone who's dual-using is by definition not ceasing their smoking. I think that's why QuackGuru's text doesn't substantially mention it. (I'm not cutting any meat: it was never in this section in the first place.) There's clearly an appetite for discussing dual use, though, and I agree that in a well-written version of this article it would be discussed here. I propose that I draft a separate section entitled "smoking reduction" about dual use, to be placed immediately after the smoking cessation section, and begin a discussion about it here, once we have an agreed text for the smoking cessation part.—S Marshall T/C 22:38, 13 January 2016 (UTC)

PHE's point is that the many people who plan to "cut down cigarettes gradually" by dual use usually fail to do so; a complete switch is far more likely to be effective. Like so much in PHE, this is an old theme of the Smoking Toolkit surveys (http://www.smokinginengland.info/latest-statistics/ - latest update out this week I see). Johnbod (talk) 04:27, 14 January 2016 (UTC)

I think it should be added to this section rather than in a section of its own although it could likely stand to be a separate paragraph. We'd need to bear in mind that there are dual users who intend it, dual users who do it to reduce the number of cigarettes they smoke, those who intend to quit and fail and so continue dual using and those who successfully use dual use to quit, each of which is discussed, sometimes in combination, in different sources. 82.111.139.27 (talk) 13:13, 14 January 2016 (UTC) That was me SPACKlick (talk) 13:22, 14 January 2016 (UTC)

I'm fine with a separate section, linked from here. I'm fine with adding it here. I guess the relevance here is that dual use is not cessation and that e-cigarette use does not assume cessation. I guess the argument for its own section is high levels of dual use are a large part of the e-cigarette phenomenon. Cloudjpk (talk) 18:36, 14 January 2016 (UTC)

• I was surprised by the proposed content's description of the Cochrane review's findings of ECs being "as effective as nicotine patches for quitting smoking over the short term" - the flat definitiveness of that statement is not something I would think authors in the Cochrane group would say as the evidence is still so thin. And indeed, the review says: "There is evidence from one trial that ECs may lead to similar quit rates at six months as NRT, but the confidence interval is wide." That is very different. Jytdog (talk) 18:04, 14 January 2016 (UTC)

and what are the reviews discussed in this part again with a very flat statement of superiority to NRT? "Reviews in 2014 and 2015 found that e-cigarette users had 20% higher cessation rates than users of nicotine replacement products." Thanks Jytdog (talk) 18:21, 14 January 2016 (UTC)

• That's a small section of my proposed text taken out of context in such a way to make it look ridiculously extreme. Putting it back in the intended context, the first sentence of the proposed text reads: The available research on the safety and efficacy of e-cigarette use for smoking cessation is limited and the evidence is contradictory. I have said that front and centre, right at the start, and I do not think it is a good idea to repeat it in every paragraph afterwards.—S Marshall T/C 22:51, 14 January 2016 (UTC)

Thanks for replying, but I am not taking anything out of context. Any given source may or may not acknowledge the incompleteness of the picture currently, and the draft makes it seem like the Cochrane source is way more definitive than it is - which misrepresents it. Also what are the two sources I mentioned in the 2nd bullet? It is impossible to know if the sentence is accurate or not, without that information. Jytdog (talk) 23:25, 14 January 2016 (UTC)

• But, you see, that leads to the problem your buddy QuackGuru had, where he said the same thing again and again in every paragraph. That's exactly the problem that I'm trying to solve with this edit. I could address your concern by making the sentence read: Insofar as it is possible to draw conclusions based on the limited evidence available, the Cochrane Collaboration found... But it would be extremely poor editorial judgement to do that. It's true that my text misrepresents Cochrane in the mind of any reader who's forgotten how I began the first paragraph by the time they read the second sentence of the second one. But such a reader really does not have the capacity to understand this article in the first place.

  As for where the sources are --- I haven't checked them. I've simply assumed that despite QuackGuru's behavioural problems, he didn't go so far as to lie. I would suggest you read the source that QuackGuru gave when he made this claim (which is this one). If you do check the sources and find that QuackGuru lied, please do say so, as I will then have good grounds to propose that he's site-banned, and this article is nuked and restarted from scratch, which will make my life a great deal simpler. But I think he was telling the truth.—S Marshall T/C 20:35, 15 January 2016 (UTC)

i understand you are frustrated but we cannot discuss proposed content without sources. As for the problem you are describing about repeating things, here is my take on that. There are two ways to build a Wikipedia article. The normal way is to read what the relevant sources say, summarize them, and cite the sources. The other way, which often happens in highly contested articles like this one and is very sub-optimal, is to name the source in the actual content - to attribute in-text - and describe what that source says. We have gone down that route. if we are doing that, we have to accurately describe what each source says and we cannot elide. To do so misrepresents the source. If you want to simplify things, I would recommend proposing content that summarizes what the sources say and provide that, with the sources. Jytdog (talk) 20:46, 15 January 2016 (UTC)

The whole purpose of this section is get off of what we have been doing and move to a more summery style, your comments so far reflect keeping things as they are. This is just the start of that process, and other sections will follow. So to enforce how its been is not helpful. There is consensus so far that this article is not the best and written badly. Do you disagree with that? AlbinoFerret 21:14, 15 January 2016 (UTC)

There is "consensus so far that this article is not the best and written badly", but not that the way out of this involves reducing the length of sections by >50%, which generally I don't like. Johnbod (talk) 23:43, 15 January 2016 (UTC)

No, I am responding to the actual draft, which still says "a review published in 2014 says X". If a sentence says that, the sentence has to actually tell you what the attributed source said or else it misrepresents the attributed source. If the notion is to move away from in-text attribution that is great. The draft doesn't do that. Jytdog (talk) 22:48, 15 January 2016 (UTC)

• Did you check whether it does say that? I've linked the source QG used.—S Marshall T/C 23:24, 15 January 2016 (UTC)

again S Marshall what are the reviews you are mentioning in "Reviews in 2014 and 2015 found that e-cigarette users had 20% higher cessation rates than users of nicotine replacement products. " I am not being obtuse, I really don't know which ones you mean. Thanks. Jytdog (talk) 00:03, 16 January 2016 (UTC)

• I mean the source that QuackGuru has already placed in the article and linked to this statement when he made it. So as to help you find this source, I also linked it for you yesterday in the edit I made at 20:35. I will link it yet again: here. I don't think you're paying attention.—S Marshall T/C 16:57, 16 January 2016 (UTC)

Description of Cochrane findings in current article

I just cut this from the article and put it here.

• In terms of reduction in cigarette consumption, nicotine-containing ECs were more effective than placebo ECs and also significantly more effective than nicotine patches in helping people achieve 50% or greater reduction in smoking.(ref name=Cochrane2014)

That is a pretty dramatic distortion of the Cochrane author's findings. How can this be more accurately summarized? Jytdog (talk) 18:55, 14 January 2016 (UTC)

Page 18 "In terms of reduction in cigarette consumption, nicotine-containing ECs were significantly more effective than placebo ECs and also significantly more effective than nicotine patches in helping people achieve 50% or greater reduction in smoking." Looks like someone inserted a copyvio, but its in there. AlbinoFerret 19:03, 14 January 2016 (UTC)

ack, yes. That is about reduction. What threw me is that it is mixed in with a bunch of stuff about cessation and the section is called "Smoking cessation". Where does content about reduction fit - in this section or in the following "Harm reduction" section? I would think the latter... Jytdog (talk) 19:27, 14 January 2016 (UTC)

Thats a good question because some editors I am sure would qualify that as dual use which has been part of the smoking cessation section. Personally I think it more harm reduction, but lets let a few more editors chime in. AlbinoFerret 19:37, 14 January 2016 (UTC)

Reduction is unfortunately used both for smoking fewer cigarettes and for reducing harm caused by smoking, which are hardly the same thing. It would improve the article if we chose unambiguous terms and used them consistently. Perhaps "cutting down" and "harm reduction". Cloudjpk (talk) 22:32, 14 January 2016 (UTC)

Smoking fewer cigarettes is harm reduction. Each cigarette not smoked reduces the harm. Some have questioned if smoking fewer cigarettes is really quitting calling it dual use if the goal is quitting. The focus should be what the source is talking about. In the paragraph on page 18 the focus appears to be smoking reduction not quitting, the the paragraph says

"In terms of reduction in cigarette consumption, nicotine-containing ECs were significantly more effective than placebo ECs and also significantly more effective than nicotine patches in helping people achieve 50% or greater reduction in smoking. The finding is tempered by lack of biochemical confirmation of the reduction.Future studies should include such measures. There was evidence from intervention cohort studies that dual use may promote smoking reduction, and no evidence that dual use undermined smoking cessation.

To me it does mention quitting in the end but the focus is more on smoking reduction than quitting, even so the last sentence (in bold) isnt in the article and should be in any dual use section we have. AlbinoFerret 22:58, 14 January 2016 (UTC)

I agree that if the focus is cutting down, that's not cessation and probably should be in a different section.

As to terms, I'm fine with "cutting down" and "harm reduction". The sources say they're not one and the same. cutting down exposes the user to nearly the same cardiovascular risks as heavy smoking cutting down by more than 50% has no effect on risk of premature death I will respect the sources and not use the terms interchangeably. I think that would improve the article. Cloudjpk (talk) 23:25, 14 January 2016 (UTC)

That is contrary to the the last paragraph of the "Why it is important to do this review" section on page 7 of this Cochrane review, which says there are benefits from smoking reduction as harm reduction. and the views of a 2010 review[4] that doesnt even mention e-cigs and a study from 2006 [5] that doesnt mention e-cigs either, cant negate the findings of a 2014 Cochrane review. AlbinoFerret 23:48, 14 January 2016 (UTC)

It doesn't say they're the same thing :)

The sources are not actually in conflict. There is hope that cutting down may contribute to harm reduction. That does not make them one and the same. We might also hope that vaccination may contribute to disease prevention, but that does not mean the two are one and the same. I think clear and consistent terms will improve the article. Cloudjpk (talk) 00:27, 15 January 2016 (UTC)

Yes it does "owever, there is also an opportunity to investigate if the EC has potential to aid reduction in cigarette consumption in those smokers who cannot or do not want to stop smoking altogether." thats harm reduction. In any event the weight of newer sources say there is a benefit from even dual use, small but existent, including the WHO[6] in 2014 "dual use will have much smaller beneficial effects on overall survival compared with quitting smoking completely." So there are some benefits not "hopes". AlbinoFerret 00:47, 15 January 2016 (UTC)

I'm fine with that, and I think it furnishes a good illustration of use of terms: quitting delivers harm reduction, cutting down delivers much smaller harm reduction.

BTW I see some sources use "cutting back" or "reducing consumption" but "cutting down" seems to be most used in the sources. Any preferences? Cloudjpk (talk) 00:58, 15 January 2016 (UTC)

Cutting down is ok, but in the harm reduction I think reduce smoking is a little better to differentiate between HR and dual use in cessation. I have rewritten the claim

A review found e-cigs to be much more effective than patches or placebos to help people reduce cigarette smoking by 50% or more. Further study will be needed with biomedical evidence to support these findings.

Thoughts? AlbinoFerret 14:26, 16 January 2016 (UTC)

• OKsounds like the two of you are good with putting this into the harm reduction section. I think we just need to add the Cochrane authors' caveats around it and we are good to... Jytdog (talk) 01:03, 15 January 2016 (UTC)

Semi-protected edit request on 16 January 2016

Laika19 (talk) 06:24, 16 January 2016 (UTC)

Recently, a meta-analysis was published showing that e-cigs might actually make it harder to quit smoking. The new analysis suggests that e-cigs make people 28 percent less likely to quit smoking. Source: http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00521-4/abstract

Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. --allthefoxes ^(Talk) 13:39, 16 January 2016 (UTC)

Interesting abstract, but "Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed " - this appears to be about dual-use. Johnbod (talk) 13:47, 16 January 2016 (UTC)

I also have concerns about one of the authors Stanton Glantz a known anti tobacco activist. More than just an abstract is needed and this is behind a paywall. It is also not pubmed indexed. AlbinoFerret 13:56, 16 January 2016 (UTC)

There's nothing much wrong with being "a known anti tobacco activist", though Glanze is also hardline anti-ecig, and a bit extreme I think. The article is free if you register (in the UK anyway), and just published online. No doubt it will be listed on PubMed in due course - The Lancet is certainly a top journal with an impact factor of 45 (and anti-ecig), though this is I think only a specialist sub-journal. Johnbod (talk) 14:23, 16 January 2016 (UTC)

Yes, and these biases will probably require accreditation if it comes in. Cant find the sub journals impact factor, might not be listed. AlbinoFerret 14:32, 16 January 2016 (UTC)

Having a position is not the same as bias: and this is an excellent journal and a top quality study. From what I can see it should definitely be added to our article and is very pertinent. The prior argument is a prime example of WP:BIAS — per the pertinent and recently debated section of WP:MEDRS:
        "Do not reject a high-quality study-type because of personal objections to: inclusion criteria, references, funding sources, or conclusions."
Ping WhatamIdoing, who may have some insight as to the interpretation of that section. CFCF 💌 📧 15:50, 16 January 2016 (UTC)

Up until TMCk added the links below, my concerns were not to exclude the material but to add in text accreditation per WP:BIASED. AlbinoFerret 16:27, 16 January 2016 (UTC)

Reminds me of the formaldehyde scare or to a lesser degree the ambigoues propylene oxide claim (also Glantz) that remained in the article for far to long. Now we have this new review and (already) plenty of critical responses: "...not scientific."... , "...at best preliminary or at worst “grossly misleading...”, "...tentative and sometimes incorrect.”
So I'm wondering how much weight this flawed article deserves.--TMCk (talk) 15:54, 16 January 2016 (UTC)

You are aware that the Lancet and BMJ similarly criticized the PHE report? Or do we only find rebuttals when it suits us? Wired, The Guardian, BMJ.
To take it to the extreme, this article has a pretty decent title concerning criticism of the PHE report: E-cigarette ‘safety’ study was written by industry funded scientists, Lancet warns. CFCF 💌 📧 16:05, 16 January 2016 (UTC)

The PHE report wasnt written by a anti tobacco/anti ecig activist. Any use will have to be accredited to him. Though looking at the links above, its questionable what use it could have. AlbinoFerret 16:18, 16 January 2016 (UTC)