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.

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 [1]. 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)

• S Marshall inserting the content above was premature, as it is still under discussion here. Please don't make big changes without clear consensus. Thanks. Jytdog (talk) 18:18, 17 January 2016 (UTC)

• Jytdog, this has been discussed since 8th December. Here's a list of editors who agreed to the idea unconditionally:- Me (as proposer); AlbinoFerret; SpackLICK; P Walford. Here's a list of editors who have previously expressed reservations but now do not object:- CFCF; DocJames (with the USPSTF matter addressed, as in my edit it was). Three editors object, one of whom is topic-banned for disruptive behaviour. The other two are you and Cloudjpk. There's also Johnbod, who hasn't been clear one way or the other but as far as I can tell, feels the section should be clearer but has specific concerns about this section version. That's a clear rough consensus after a long discussion. If this was an RFA, it would be promoted. Can I ask, for how long do you intend to hold this up?—S Marshall T/C 22:30, 17 January 2016 (UTC)

Things could move right along if you would be so kind as to provide the sources for your draft so it can evaluated. I have asked you three times now, I think. I really cannot figure out what sources you mean. Jytdog (talk) 22:34, 17 January 2016 (UTC)

• I'm having enormous trouble assuming good faith here, Jytdog. I literally have no idea how you could possibly fail to see the sources. Surely you must be capable of reading the article and seeing the sources which are there now (I have added none to the list). Surely you must be capable of going back to the version you reverted and clicking the links I put in. When I've directly linked sources you've requested on this talk page (as I have twice now), you haven't responded to them. I've noticed that there's a pattern of successive editors exhibiting these behaviours: QuackGuru, Mystery Wolff, now you, all with IDHT about sources, and all wanting to interpret Wikipedia's consensus rules to mean that they personally have a veto over changes. I'm almost completely out of patience with it and I find it rather suspicious. Would you kindly confirm that you can see the sources please and thank you.—S Marshall T/C 22:56, 17 January 2016 (UTC)

I am sorry you having trouble complying with policy, S Marshall. The request for sourcing - and answering it - is Wikipedia 101. I will just copy the thing you added below so we can discuss something concrete. Jytdog (talk) 23:25, 17 January 2016 (UTC)

S Marshall's proposal, with sources

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.

References

OK< there is an actual proposal. This is copied from here which was S Marshall's implementation of his proposal above. Now we have something to discuss.... Jytdog (talk) 23:37, 17 January 2016 (UTC)

I would be OK with the 1st paragraph if the end of the last sentence was changed from the unsourced "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", to "to, on the other hand, the United States Preventive Services Task Force 2015 recommendations that advised only use of conventional NRTs in smoking cessation, found that current evidence is insufficient to recommend electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women, and raised concerns about the unknown toxicities about and poisoning of children who gain access to e-liquids." and cited to the Siu2015 source. Jytdog (talk) 00:00, 18 January 2016 (UTC)

in the 2nd paragraph, apparently the "Reviews in 2014 and 2015 " are the 2014 cochrane review and the 2015 PLoS meta-analysis. The PLoS paper has the 20% figure but does not say "e-cigarette users had 20% higher cessation rates than users of nicotine replacement products". It says "We compared findings from this meta-analysis to cessation rates known to be achievable with existing NRTs. Two studies reported that the 12-month quit rate achieved using NRTs was approximately 10%, and would not exceed this level in the longer term.[3, 4] Our meta-analyses demonstrated a higher smoking cessation rate of 20% achieved with e-cigarettes, suggesting that factors beyond nicotine replacement alone may contribute to smoking cessation." which is a very different statement (it is 10% higher, not 20%). and they make it clear that that is their own comparison, not a comparison from head-to-head studies. In fact they say: "Furthermore, whilst we were able to comment on the efficacy of nicotine e-cigarettes vs. non-nicotine e-cigarettes for smoking cessation, we were unable to comment on the efficacy of e-cigarettes vs. other interventions for cessation, given the lack of comparator groups in the studies included in this meta-analysis.". I didn't find anything like ""e-cigarette users had 20% higher cessation rates than users of nicotine replacement products" in the Cochrane paper which specifically noted that they couldn't make comparison with NRT. This paragraph cannot go in... Jytdog (talk) 01:42, 18 January 2016 (UTC)

The third paragraph seems OK except for the clause "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 don't see how it makes sense to highlight single trials anywhere in the article. Jytdog (talk) 03:50, 18 January 2016 (UTC)

• This is an attempt to defeat the proposal and retain the current text by turning it into a game of bring me a rock. Please re-insert the consensus edit and then propose your changes to it on the talk page.—S Marshall T/C 08:42, 18 January 2016 (UTC)

S Marshall please reconsider your statement. I pointed out that the second paragraph misrepresents the sources - no source says e-cigs 20% better than NRT (one source says they are 10% better but that is not from RCTs, so not in the way you say it does). And the second sentence of that paragraph misrepresents Cochrane too. That is not a bad faith response to your proposal. Please reconsider your statement. Jytdog (talk) 13:58, 18 January 2016 (UTC)

AlbinoFerret thanks for correcting the 20% to 10% in this dif. The content is still incorrect for two reasons. It says that two sources say that, and only one does. Secondly, that finding is by the authors of the review when they compared the results of their meta-analysis of the data on e-cig trials, to other data about the efficacy on NRTs. The review is a primary source for that finding. I wouldn't object if the content said something like "authors of a 2015 meta-analysis on clinical trials of e-cigs that found that compared with an e-cig device with no nicotine, e-cig use helped 20% of people quit smoking. They compared that finding with the results from other studies of the success of conventional NRT, which found that they help 10% of people quit. There has never been a study comparing e-cigs to NRTs as smoking cessation tools. " The first 2 sentences would be sourced to the 2015 review - the third sentence is supported by both Cochrane and the 2015 review. Jytdog (talk) 15:55, 18 January 2016 (UTC)

I just made an edit, you know, what we are supposed to be doing? The PLOS review gives NRT 10% and e-cigs 20% a difference of 10%. Jytdog. When you find small errors in a edit, reverting the whole thing isnt a great idea, just fix the issue and post on the talk page. AlbinoFerret 15:58, 18 January 2016 (UTC)

When I reverted the whole thing it was because it had not been presented here with sources so everyone could actually evaluate it. I don't know why you all agreed to it, before checking to see if it was actually supported by the sources. I did not revert again after Spacklick re-inserted it. In any case, please address the points about content above. Thanks. Jytdog (talk) 16:01, 18 January 2016 (UTC)

Its quite possible that we have all been editing this topic for a very long time and are well versed in the sources. While you are coming into this without that. I also looked at what was there already in the article, but for the benefit of editors who may not have all the info it may be a good idea (strongly advisable) to include sources in proposed edits. I dont think the review is a primary source when discussing the results of different sources and comparing them, that is reviewing. AlbinoFerret 16:21, 18 January 2016 (UTC)

• Please would a neutral editor re-insert this text, which has undergone a great deal of discussion and is widely agreed.—S Marshall T/C 17:36, 18 January 2016 (UTC)

It appears SPACKlick replaced it, though I did make one small edit from 20% to 10%. AlbinoFerret 17:42, 18 January 2016 (UTC)

There have been several reviews in 2014 and 2015 and I don't know how anyone knew which were meant. In any case, you all signed off on inaccurate content (fresh eyes are useful). Most importantly, the content is still inaccurate. Again, instead of discussing contributors, please discuss the problems with the current content I raised above. Thanks. Jytdog (talk) 18:12, 18 January 2016 (UTC)

I have taken the 2014 review out as it isnt referenced. If the refrence is added we can add it in again. AlbinoFerret 19:23, 18 January 2016 (UTC)

I went ahead and fixed the rest. In this dif I took out the following as it misrepresents what the Cochrane authors found -

• 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.

References

They did not make a judgement about patches in cessation b/c there is insufficient data about that. The review does say that e-cigs were better than patches at reducing smoking, which is different. I did not find discussion about reducing "withdrawal symptoms and mitigated the desire to smoke" in the conclusions, nor the overall health risk claim. Maybe they are there and I missed them. Jytdog (talk) 19:41, 18 January 2016 (UTC)

It appears you are partially incorrect from the review:

page 20 "EC with low nicotine delivery was as effective as nicotine patches at helping smokers to quit long-term, but confidence intervals were wide."

So they were compared to patches, but its long term not short as the article said.

page 6 "They also reduce tobacco withdrawal symptoms, including urges to smoke and low mood"

page 9 "However, among those brands of EC that have been tested, levels of toxins have been found to be substantially lower than in cigarettes, and are present at levels that are unlikely to represent a significant risk to health to either the user or to bystanders

This was found with a short reading of the source.AlbinoFerret 20:50, 18 January 2016 (UTC)

about comparison with NRT yes you found it and quoted part of it. The whole thing is " In the one trial that evaluated it, a first-generation EC with low nicotine delivery was as effective as nicotine patches at helping smokers to quit long-term, but confidence intervals were wide." (they are talking about the ASCEND trial) So yes there is one trial. They give very little weight to it. That does not = "Cochrane Collaboration concluded that they were as effective as nicotine patches for quitting smoking over the short term". Their "implications for practice" on this was: "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. ECs are an evolving technology and newer devices may be more effective, but research is needed to confirm this." S Marshall's proposed text was too definitive.

the text you quote from page 6 is about de-nicotinised cigarettes, not e-cigs. So this is still not supported.

The last bit yep it says that. Which is different from the much more prescriptive " personal e-cigarette use may reduce overall health risk in comparison to traditional cigarettes"

This would work if it said. "A 2014 Cochrane Collaboration review found one study that showed that electronic cigarettes may be as effective as conventional NRTs in helping people quit after six months of use, and it noted that for the specific electronic cigarettes that have been tested, levels of toxins were substantially lower than in cigarettes and were unlikely to cause harm to the user or people around them." Jytdog (talk) 21:13, 18 January 2016 (UTC)

• Jytdog, please do not directly edit the consensus text without discussing it here first.—S Marshall T/C 23:31, 18 January 2016 (UTC)

Sure! Same for you - this would have been NBD had you kept talking and responded before adding it. Thanks. Jytdog (talk) 00:41, 19 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[2] that doesnt even mention e-cigs and a study from 2006 [3] 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[4] 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)

• I think it's pretty obvious that we need to include this source in the article. I propose that it belongs in the dual use section that we're discussing above, and the tricky issue will be how much weight to give it. Off the cuff, I would suggest that a controversial paper in The Lancet should get less weight than the Cochrane Collaboration and somewhat less than clinical practice guidelines from major Western democracies, but more than most other sources.—S Marshall T/C 17:18, 16 January 2016 (UTC)

It's not about dual use; it measures the effect of e-cigarette use on cessation of smoking. It does not break out users who were or were not dual users. So the Cessation section seems appropriate.

As to weight, it uses the same methods as Cochrane but includes more and newer studies than were available to Cochrane. Cloudjpk (talk) 22:55, 16 January 2016 (UTC)

• I think Johnbod's right and it's at least partly about dual use; the fact that it doesn't break out dual users from quitters is a design flaw. Simply put, the Cochrane Collaboration is the most reliable source in medicine, and the idea that a brand new just-published study proves Cochrane wrong is the sort of thing that we might normally see coming from an IP address on Talk:Homeopathy.—S Marshall T/C 09:56, 17 January 2016 (UTC)

While I think that may be putting it very harshly, I essentially agree. The new study seems to be very high quality and follows proper methodology, but the Cochrane report weighs heavier. A few years down the line, or when/if the Cochrane report is pointed out as being significantly outdated we might need to revise that opinion, but for now it holds. CFCF 💌 📧 14:43, 17 January 2016 (UTC) 

I agree with you. The scientific writer in me wants to dismiss this paper for all the flaws in it. However by policy it must be included and I agree that it meets the criteria for inclusion and reasonable weight. I would also assess it for the same weighting as S Marshall. SPACKlick (talk) 20:24, 16 January 2016 (UTC)

S Marshall, TracyMcClark, and SPACKlick what is your opinion on in text accreditation per WP:BIASED? AlbinoFerret 20:48, 16 January 2016 (UTC)

I don't think it's necessary, this may be one of those times where it's best just to put it in knowing the data will become clearer as more studies and response appear. SPACKlick (talk) 11:02, 17 January 2016 (UTC)

I agree that by policy it should be included, flawed or not. It will be interesting though, to see the responses in the peer-reviewed press - since i find the criticism by Pf. Ann McNeill to be particularly damaging "This review is not scientific. The information included about two studies that I co-authored is either inaccurate or misleading. ..."[5].

I think this is one of the studies that we are going to have to keep an eye on, particular with regards to replies/commentaries if we are to take Pf McNeill's commentary seriously. --Kim D. Petersen 00:17, 17 January 2016 (UTC)

It took me a moment to figure out that AlbinoFerret meant WP:INTEXT attribution, when he (or his spilling chucker  ;-) typed "accreditation". I don't think this is necessary; you're never going to see "News flash: Professors of Medicine oppose tobacco!" in the headlines.

On the question of the MEDRS line above, it helps to read it in context. Don't replace a meta-analysis with primary sources because you personally believe that the author is "extreme" (or whatever your objection to him is). Of course, if you've got dozens of meta-analyses, then you should pick from among the best; you can't cite them all. And no matter what, you should accurately describe the actual results, e.g., "People who use both are no more likely to quit that people who use only one" rather than "Science proves that ecig users are incapable of quitting". WhatamIdoing (talk) 05:11, 17 January 2016 (UTC)

Thank you for the canvassed opinion, this isnt a personal opinion, WP has a whole section on Stanton Glantz's activism with plenty of references. It took me about 2 minutes to find a good source, Forbes[6] which includes "Speakers at the meeting included Stanton Glantz, an anti-tobacco activist,". AlbinoFerret 13:46, 17 January 2016 (UTC)

I pinged WhatamIdoing as the primary author of the relevant section of MEDRS seeking input to improve quality of the discussion — something which WP:Canvas explicitly refers to as "not canvasing".
The CDC is known to be anti-tobacco, having a science-based opinion is not the same as bias and does not disqualify the CDC from expressing views concerning tobacco use. Being an anti-tobacco activist does not call into question the scientific veracity of the research — nothing in the linked section suggests that Glantz's research would be of inferior quality or that his opinion is not based upon scientific results. CFCF 💌 📧 14:28, 17 January 2016 (UTC)

You called in an expert on MEDRS to discuss WP:BIASED which isnt on MEDRS? Thats mixing apples and oranges. The CDC is a organization, which to my knowledge doesn’t have highly respectable RS like Forbes calling them anti tobacco activists. AlbinoFerret 18:35, 17 January 2016 (UTC)

MEDRS definitely has sections that relate to bias, for example the one I cited.
The CDC runs "anti-tobacco campaigns" [7], but that might not be enough. CFCF 💌 📧 19:16, 17 January 2016 (UTC)

Not really considering Forbes isnt alone

• Reuters [8] "But some researchers say activists like Glantz may have been prejudiced against e-cigarettes by their past battles with the tobacco industry."
• CNN [9] "Stanton Glantz, senior researcher on the study, a professor at University of California-San Francisco and tobacco control activist" [10] "Stanton Glantz, a longtime anti-tobacco advocate"
• NY Times [11] "Stanton A. Glantz, a doctor and anti-tobacco crusader"
• The Telegraph [12] "Glantz is known for his anti-smoking activism, and is one of the founders of the lobbying group Americans for Nonsmokers' Rights."
• SFGate [13] "Stanton Glantz, a longtime antismoking activist"

Stanton Glantz is shown by these very reliable sources to be a activist, that more than one exists speaks volumes. There are probably a dozen more reliable sources that dont have the stature of the ones listed here. The Reuters source even links his activism to e-cigs. The sources show him to be a biased source and as such should have in text attribution, perhaps "...by anti tobacco activist Stanton Glantz said..." AlbinoFerret 19:53, 17 January 2016 (UTC)

Beyond several high quality sources (World Lung Foundation etc.) — the CDC themselves call their campaigns anti-tobacco [14],[15].
Repeating that while ignoring the multitude of sources pointing out flaws in the PHE-methodology seems pretty disingenuous — unless we should attribute the PHE report similarly as per Wall Street Journal – U.K. Government Agency’s E-Cigarettes Report Based on ‘Flimsy’ Evidence. CFCF 💌 📧 20:11, 17 January 2016 (UTC) 

Now you are going off topic and pointing out other stuff exists. I am not suggesting we allow non MEDRS sources to rebut findings of a source. But for indicating the bias of an author of a review. Do you have any source that points out the bias of a specific author of any review? That any of them are activists? AlbinoFerret 21:34, 17 January 2016 (UTC)

That is both a false dichotomy, and neither does one need to look very far — seeing as link just above yours from the Wall Street Journal states (concerning the central tennet of the paper — the 95% risk-reduction):

The Lancet also criticized Public Health England for failing to acknowledge the “potential conflicts of interest” of the study authors. The 2014 paper disclosed that one of the authors, Riccardo Polosa, had served as a consultant to Arbi Group SRL, an e-cigarette distributor.

CFCF 💌 📧 22:02, 17 January 2016 (UTC)

The PHE 95% paper was in 2015, not 2014 thats a different one, so you are confusing papers. A consultant also is not the same as an activist. AlbinoFerret 00:27, 18 January 2016 (UTC)

The PHE report (2015) just, as they say, took the 95% figure from an earlier paper, by Nutt and a long list of others, not doubt including Polosa, who is a name in the field. There are links in earlier sections on this page to it. I think Nutt said in a radio interview there were 19 people (for 2 days) involved in coming up with the figure, using modern risk analysis techniques. Johnbod (talk) 14:22, 18 January 2016 (UTC)

Having industry ties is a far more serious allegation than being an anti-tobacco activist; something which one could deem each medical doctor to be — seeing as they are actively paid to promote smoking cessation. These things are not really on the same level, and the criticism of the PHE report is far more scathing:

The Lancet said these caveats meant “the opinions of a small group of individuals with no pre-specified expertise in tobacco control were based on an almost total absence of evidence of harm.” It branded the study “extraordinarily flimsy” and said that in using it, Public Health England had “fallen short of its mission” to rely on the highest-quality evidence.

CFCF 💌 📧 16:00, 18 January 2016 (UTC) 

A consultant is not "seeing as they are actively paid to promote smoking cessation". You had better have a RS for that accusation. But we are getting off topic. The topic of this section is a review whoes author is Glantz. He is proven to be an activist by multiple highly regarded RS. AlbinoFerret 16:05, 18 January 2016 (UTC)

I have to provide an RS to tell you that medical doctors have as part of their job description to get their patients off cigarettes? No, the topic of this section is the conclusions of the review. You are trying to paint a perfectly fitting study in the light of coming from a biased source because it does not agree with your view. CFCF 💌 📧 16:33, 18 January 2016 (UTC)

Thats incorrect, what I want to see is that readers know the source of the information and its bias. I advise you to WP:FOC and not on what reasons you may think other editors want to include things. You on the other hand are posting non sourced claims of others like they are being paid to promote things when hired as a consultant, you do know the meaning of a consultant is one who consults or advises right? Polosa has also been a consultant for Pfizer and Global Health Alliance for treatment of tobacco dependence[16] looks like he has advised people on both sides of the issue. AlbinoFerret 16:42, 18 January 2016 (UTC)

It looks like you've misunderstood some essential points here. Cessation is the same as quitting, and I haven't stated a single thing about either individuals — I have only cited comments from reputable sources about perceived bias concerning a specific source. Criticism from two major journal bodies (BMJ & the Lancet) take up some major concerns, of which the ones I cited are only a subsection.
Following your logic we need to present these issues when we mention the PHE report, and actually more so as the ties were mentioned as relating to the report itself — while the anti-tobacco ties to the author of this review are only mildly related. CFCF 💌 📧 18:15, 18 January 2016 (UTC)

I appears we are at an impasse as you have chosen to address other sources/authors while confusing which source applies to which report, and have come to conclusions like paid promotion that are not in your sources. AlbinoFerret 18:31, 18 January 2016 (UTC)

• (ec) Re CFCF's "Having [ecig] industry ties is a far more serious allegation than being an anti-tobacco activist..." - that very much depends on what view you take of ecigs. If you are a hardline opponent of ecigs it may be regarded as dammning, just like getting funding from a tobacco company. If you favour the view that ecigs are a potent source of good in terms of smoking cassation and harm reduction, then it is just like taking funding from big pharma, which many researchers have to do, for lack of other sources. Whether the potential COI should have been disclosed by PHE (it was disclosed in Nutt) is a different question, but the Lancet's apparent view that merely mentioning this omission, regarding one of many authors of the Nutt piece, is sufficient to dismiss the whole paper and its conclusions, won't be accepted by everyone, to put it mildly. Johnbod (talk) 18:32, 18 January 2016 (UTC)

Undisclosed pharmaceutical industry ties are considered a major issue, and a big problem in modern medicine — often prompting front-page headlines and rebuttals:
     Hcpro: "'Undisclosed drug industry ties prompt tighter JAMA policies"' (specifically mentions consultancy)
     WSJ: FDA Advisers’ Financial Ties Not Disclosed (here a consultant is mentioned as having made $100,000 — hardly a negligible amount)
The issue the Lancet and BMJ brought up was that one of the central points of the PHE-report is based upon a source which they found questionable, not that only one of the sources in the paper had issues. CFCF 💌 📧 17:23, 19 January 2016 (UTC)

RFC: Should Stanton Glantz require in text attribution per WP:BIASED

Should sources that list Stanton Glantz as the author include in text attribution per WP:BIASED as an "anti-tobacco activist"?

Sources on e-cigs and Glantz as an activist

• Reuters [17] "But some researchers say activists like Glantz may have been prejudiced against e-cigarettes by their past battles with the tobacco industry." Linking his activism to e-cigs.
• NewRepublic [18] in a paragraph on anti smoking activists Glantz is shown to be against e-cigs.
• Sacramento Bee [19] "In response, anti-smoking activists are pushing to have them regulated like tobacco. Stan Glantz, a professor of tobacco control at UC San Francisco who supports Corbett's bill, said e-cigarette companies brought the increased scrutiny upon themselves."
• NY Times [20] "Stanton A. Glantz, a doctor and anti-tobacco crusader"

Other sources

• Forbes [21] which includes "Speakers at the meeting included Stanton Glantz, an anti-tobacco activist,"
• CNN [22] "Stanton Glantz, senior researcher on the study, a professor at University of California-San Francisco and tobacco control activist" [23] "Stanton Glantz, a longtime anti-tobacco advocate"
• The Telegraph [24] "Glantz is known for his anti-smoking activism, and is one of the founders of the lobbying group Americans for Nonsmokers' Rights."
• SFGate [25] "Stanton Glantz, a longtime antismoking activist"

Please leave all comments below. AlbinoFerret 18:35, 18 January 2016 (UTC)

No

• SPACKlick (talk) 18:37, 18 January 2016 (UTC)
• I agree that he is an activist, even his own WP:BLP article tells us so. But i do not agree that we need inline identification of this potential bias. The journal is responsible for vetting the authors, and ensuring that the scientific basis for its inclusion is sufficient. What this may affect is the assessment of the source, but considering the journal this shouldn't be a factor. What is much more problematic is the critiques that we've seen so far... but unless these reach the scientific press, then they can only give us a cautionary approach to the source and its usage. --Kim D. Petersen 21:15, 18 January 2016 (UTC)
• —S Marshall T/C 21:56, 18 January 2016 (UTC)
• No. Any more than we identify sources who are e-cigarette advocates as such. Cloudjpk (talk) 18:45, 19 January 2016 (UTC)
• No to the specific attribution. See discussion below Jytdog (talk) 19:15, 19 January 2016 (UTC)

Discussion

Really we need to answer 2 questions 1) What threshold of sourcing for bias justifies/requires in text attribution of the source of a claim? 2) Does Stanton Glantz meet or exceed this threshold? From my point of view the threshold for 1) Requires multiple RS's on 2) We only really have Reuters here making a claim of a relevant bias. Stanton Glantz is an activist in the area of tobacco control and non-smokers rights and my personal opinion from having read his publications is that he is prejudiced against THR strategies. However, I can only find that sourced to non-RS other than the single reuters quote AF already mentioned. Without better sourcing I don't think he needs in text attribution for claims on the basis of Bias. SPACKlick (talk) 18:37, 18 January 2016 (UTC)

I added a couple more that link his anti tobacco activism to e-cigs and will be looking for more. AlbinoFerret 19:06, 18 January 2016 (UTC)

• Being an "anti-smoking activist" does not define a position on e-cigs. Such a person could be predisposed to LOVE e-cigs as a way to get people away from smoking, or HATE them as another way for companies to make a lot of money by getting people addicted to nicotine that is possibly dangerous. In Glanz' case, his opposition to e-cigs appears to arise from his work on regulation and on the effects of smoking on bystanders - from a quick look one of his biggest contributions was helping lead the way on protecting people from second-hand smoke which is what really led to the spread of no-smoking zones. His opposition to e-cigs seems to be related to that - unknown effects of e-cigs on bystanders and the e-cigs industry's efforts to resist regulation (which probably makes them just like the tobacco industry in his eyes - "they brought this on themselves"). If the attribution said something like "a long time antismoking activist particularly concerned with protecting nonsmokers and with industry's resistance to regulation" then I would have supported it. Jytdog (talk) 19:15, 19 January 2016 (UTC)

Thoughts about health section

It seems to me that the health section could be best structured by:
1) Naming the questions about health that are relevant - that everybody wishes we had very clear and definitive answers to
a) are they harmful on their own to users and people around them?
b) are they less harmful than cigarettes to users and people around them?
c) Do they help people quit smoking? How does their use compare with NRT for this purpose?
d) Do the they help people smoke less? How does their use compare with NRT for this purpose?
e) Do they increase the amount of people addicted to nicotine?
f) What recommendations should the public receive, about use of e-cigs?

2) Discussing the difficulties of answering those questions - why we don't have clear answers on many of the questions
a) e-cig technology is new, rapidly evolving, not standardized, and is customizable by users. This means that there is not that much published research on e-cig use at all (compared to cigarette use and NRT use, each of which have been around a long time), and that we cannot yet understand the consequences of long-term use. It also means that any single research study needs to be interpreted with care, and that any given study is difficult to generalize to the use of any e-cig device.
b) All scientific research is artificial. Generally a study will use one kind of e-cig device and liquid but in the real world, how much an individual likes to use a given device and liquid will strongly effect how much he or she uses it. This makes it hard (not impossible) to generalize the results when discussing the use of e-cigs in quitting smoking and reducing smoking.
c) There is a lot at stake in the results of the research and what recommendations are made based on it (tobacco money, NRT money, e-cig money, public health with regard to the stark known risks of cigarette use and with regard to the possible risks of e-cigs which are becoming widespread)
d) There is a growing body of published research on e-cig use. Researchers choose different populations to study, do different things with them, and ask different questions of them; every scientific study takes care to understand and takes care to apply to any general conclusions
e) There is a growing body of expert reviews of the research, done by scientists and by public health-oriented institutions. Those reviews have come to different conclusions about we know and have made contradictory recommendations about e-cigs. This is based on part on what questions the reviewers are asking, what criteria they use to include or exclude the published studies, and what is at stake for them.

3) Answers
3a) Summarize the answers to the questions in a brief section, simply. On a few of these questions I think there is consensus in the literature and we can say "yes or no". If there is not consensus in the literature, then we just say "Expert reviews come up with different answers on this question." Very simple and brief.
3b) Provide the details of reviews from the past two years or so on the questions, to support the summaries provided above. (this is the clutter that some people will just skip over, but that people who really want to know will read)

What do you think of this? Jytdog (talk) 17:33, 16 January 2016 (UTC)

One common complaint is this talk page moves to fast, and we have recently see it slow down a little. Please notice the number of archives. Adding sections to the page that already has other ongoing discussions will likely not help keep this page slowed down. But I am glad to see you recognise the problems pointed out in section #2. AlbinoFerret 18:12, 16 January 2016 (UTC)

Folks can respond or not as they please. There is no deadline. Jytdog (talk) 19:17, 16 January 2016 (UTC)

Semi-protected edit request on 21 January 2016

From the Positions of medical organizations section, please remove the last sentence from the first paragraph, beginning "In a 2015 joint statement, Public Health England and other UK medical bodies". This would be appear to be adequately covered by the third paragraph in the section which covers the same information in greater detail. 90.216.206.148 (talk) 23:41, 21 January 2016 (UTC)

Bias in the "Motivation" section?

I'm pretty sure there is a lot of bias in the "Motivation" section. I picked a few of the more questionable statements, and attempted to verify them:

• "Young people and children are tempted by flavored e-cigarettes."
  • This seemed like a pretty difficult statement to verify, so I checked the cited article. It quoted the head of an anti-smoking, anti-ecig activist group as saying "My research with young people and children shows they are tempted by these flavours." This could be misleading in many ways: since the study wasn't cited, it could have terrible methodology; also she didn't say they are tempted by e-cigarettes in those flavors, just that they are tempted by the flavors she listed (gummy bear and strawberry milkshake). Since I couldn't find this study of which she spoke published anywhere (I searched her website and her organization's website for clues), it is impossible to say whether the statement is true, or if it even means what it seems to.
• "Candy and fruit flavors e-cigarettes are designed to appeal to young people."
  • Also seemed difficult to verify, since I doubt e-cigarette marketers came out and said "Yeah, that's what we were trying to do". The linked article gave it as an unsourced statement, even though they gave lots of sources for other statements. The writers of the article want to ban the sale of any flavors that might appeal to children; combined with the non-attributed statement, it sounds like "We firmly believe this, and don't need a study to back it up".
• "E-cigarettes can appeal to youth because of their high-tech design, assortment of flavors, and accessibility online."
  • Following the link, the actual statement said "E-cigarettes may appeal"; and the link to the paper (finally found it on archive.org) said "There is concern that e-cigarettes may appeal". You can see the bias drifting in on this statement.

These were the only three I took the time to check, which took a lot of time since the actual studies (if they exist) were buried deep in references. While on the face, these paragraphs are dense with citations, the citations I checked are of such poor, dubious quality, that I'm of the opinion that each statement should be removed unless it is cited, and the citation is of good quality, and you can easily tell where a statement came from. Unless there are objections, I'll try to come back here in a few days and clean up that section. Marcus erronius (talk) 00:25, 22 January 2016 (UTC)

Whatever you think of them, these statements can all be found in MEDRS-compliant reviews (along with a lot of other crap). I think from memory the WHO & US Surgeon-General have included versions of some in their statements. Johnbod (talk) 04:05, 22 January 2016 (UTC)

I am looking at the sources, and they are problematic.

One has already been pointed out by S Marshall The claim "Candy and fruit flavors e-cigarettes are designed to appeal to young people.[72]" cited to International Business times[26] Which in turn used an advocacy group as the basis for the claim.

Another claim "Young people and children are tempted by flavored e-cigarettes.[69]" fails validation "Marketing and promotion of e-cigarettes is common. Youth are targeted with the addition of attractive candy or fruit flavours." the source doesnt mention children.

I also think "can" replacing "may" is a problem. AlbinoFerret 04:57, 22 January 2016 (UTC)

some tweaks would care of those first two issues easily - the first one can be removed as it is redundant to what directly follows it. Fine to remove "children" from the second (not a big deal - same point). No big scandal there, just some copyediting. Jytdog (talk) 05:16, 22 January 2016 (UTC)

• That section reads as it does because of yet another of my massive arguments with QuackGuru which is now in talk archive #25 entitled In North Wales, girls who use e-cigarettes consider them appealing." Quack was a stickler for MEDRS when it came to some edits, but he liked the claim that e-cigs were being deliberately marketed to children and he kept that in based on an article in a Welsh regional newspaper. In the end I asked Doc James for help on his talk page and Doc James removed the offending source. It needs cleaning up further but I've used up all my reserves of patience with the persistent obstructionism on this page and I've unwatched it; only here because pinged.—S Marshall T/C 08:48, 22 January 2016 (UTC)

CDC E-cigarette Ads and Youth

The CDC's new 2016 campaign about E-cigarette Ads and Youth could assuredly help expand and clarify this section. The CDC suggest children may be at risk and guides preventative efforts from parents and healthcare providers. CFCF 💌 📧 06:12, 22 January 2016 (UTC)

The CDC Office on Smoking and HealthE-cigarette Information November 2015 report also expands upon some concerns. CFCF 💌 📧 06:17, 22 January 2016 (UTC)