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.

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)

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. ..."[2].

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[3] 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" [4], but that might not be enough. CFCF 💌 📧 19:16, 17 January 2016 (UTC)

Not really considering Forbes isnt alone

• Reuters [5] "But some researchers say activists like Glantz may have been prejudiced against e-cigarettes by their past battles with the tobacco industry."
• CNN [6] "Stanton Glantz, senior researcher on the study, a professor at University of California-San Francisco and tobacco control activist" [7] "Stanton Glantz, a longtime anti-tobacco advocate"
• NY Times [8] "Stanton A. Glantz, a doctor and anti-tobacco crusader"
• The Telegraph [9] "Glantz is known for his anti-smoking activism, and is one of the founders of the lobbying group Americans for Nonsmokers' Rights."
• SFGate [10] "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 [11],[12].
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[13] 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 [14] "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 [15] in a paragraph on anti smoking activists Glantz is shown to be against e-cigs.
• Sacramento Bee [16] "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 [17] "Stanton A. Glantz, a doctor and anti-tobacco crusader"

Other sources

• Forbes [18] which includes "Speakers at the meeting included Stanton Glantz, an anti-tobacco activist,"
• CNN [19] "Stanton Glantz, senior researcher on the study, a professor at University of California-San Francisco and tobacco control activist" [20] "Stanton Glantz, a longtime anti-tobacco advocate"
• The Telegraph [21] "Glantz is known for his anti-smoking activism, and is one of the founders of the lobbying group Americans for Nonsmokers' Rights."
• SFGate [22] "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)
• No Obviously not. Damotclese (talk) 16:19, 26 January 2016 (UTC)
• No - In text attribution is unnecessary. Meatsgains (talk) 17:56, 26 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)

• I really do not see your point here, An anti-smoker can also be an anti-vaping activist and is highly probable. Same logic really, you wouldn't want someone smoking a cigarette next to you in the movie theater so why would vaping be any different? It still has nicotine to keep people hooked. An Anti-smoking activist is highly likely to be also an Anti-vaping activist too as it is the same logic. Davidbuddy9 Talk  04:08, 27 January 2016 (UTC)

Or strongly pro-them, like Action on Smoking and Health (UK) and many others. Johnbod (talk) 08:27, 27 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)

Done --allthefoxes ^(Talk) 05:16, 23 January 2016 (UTC)

@Allthefoxes: The removed sentence isn't the same information. It's a joint statement by Public Health England, Action on Smoking and Health, Association of Directors of Public Health, British Lung Foundation, Cancer Research UK, Faculty of Public Health, Fresh North East, Public Health Action, Royal College of Physicians, Royal Society for Public Health, Tobacco Free Futures, UK Centre for Tobacco and Alcohol Studies, and UK Health Forum. What's left in the article is an excerpt from the position of PHE only. It shouldn't have been removed. P Walford (talk) 13:38, 24 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[23] 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)

I'm gonna be bold and remove some of the more egregious parts. Marcus erronius (talk) 08:01, 23 January 2016 (UTC)

All you've done is removed well-sourced material, the only part of what you removed that is even remotely questionable is the IB-Times sourced statement. CFCF 💌 📧 10:15, 24 January 2016 (UTC)

Pardon me, but you are incorrect. The sources for what I removed didn't cite anything, just made unsourced statements. While that might fly for some things, it doesn't fly for speculation about motives. You restored two statements, neither of which are well-sourced. The first has a cites an article which cites another article, where an expert expresses that "There is concern that e-cigarettes may..." appeal to children. This morphs to the more assured statement "E-cigarettes may..." (dropping concern) in the cited article, then the rather certain "E-cigarettes can" in the wikipedia source. At minimum, the wikipedia article should match the original source, which clearly lays out the statement as speculation; but honestly, it should be removed, since it is speculation. The other statement claims to know the motives of cigarette manufacturers ("...are designed to appeal to young people"). The source given to back that up is a group that does non-smoking advocacy, and they don't try to back up their statement. If they linked to e-cig manufacturer documents saying why they make flavored e-cigs, it would be a well-sourced statement; but as it is, it is certainly not. Marcus erronius (talk) 21:57, 26 January 2016 (UTC)

Agree with CFCF Cloudjpk (talk) 22:49, 25 January 2016 (UTC)

I have restored the content in question, omitting the IB-Times sourced material. See the below sourced from CDC for additional support of the statements. CFCF 💌 📧 15:03, 26

Ping Jytdog—who had some ideas about copyediting to remove concerns of inaccuracy. CFCF 💌 📧 15:13, 26 January 2016 (UTC)

I don't want to start an edit war, so for now I'm just going to edit the statements so that they are factually correct. This means I will say who said the statement, and ensure that it is obvious that the statements were not backed up with citations. Marcus erronius (talk) 22:00, 26 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)

Semi-protected edit request on 24 January 2016

In Construction, "When the user pushes a button. or inhales a pressure sensor activates the heating element that atomizes the liquid solution" should be "When the user pushes a button (In some variations the user inhales) the heating element atomizes the liquid solution to a temperature of roughly 100-250 °C within a chamber to create an aerosolized vapor." Apaphasia (talk) 04:02, 24 January 2016 (UTC)

I'd suggest a slightly change to the parenthesis "When the user pushes a button (In some variations, when the user inhales) the heating element atomizes the liquid solution"82.111.139.27 (talk) 12:17, 25 January 2016 (UTC)

Done Yes, that flowed awfully. I changed the edit a bit from the suggestion, to make it as small a change as possible while still, I think, resolving the issue. Marcus erronius (talk) 00:27, 26 January 2016 (UTC)

Nice wording, Ill make the change on the construction page to keep it in sync. AlbinoFerret 04:13, 26 January 2016 (UTC)

What about the older sources that said they only had to heat to 55 degrees? CFCF 💌 📧

55 C looks like an error. One trend is 4th generation devices, that include temp control that is adjustable. Some will even go as low as 100C and high as 300 C. So the 55 C claim was replaced by a RS that was closer. AlbinoFerret 15:20, 26 January 2016 (UTC)

Removal of image on faulty grounds

Fruit or candy flavored e-liquids may appeal to younger people.

In this edit [24] an image of e-liquid with fruit flavor was removed — because it was deemed "advertising" by AlbinoFerret. This is frankly unsupported by any policy and would rely on ties to the producer of the e-liquid in question. Neither is the image sourced from the producers website, but from an independent photographer. We do not remove all items on Wikipedia because they can be identified to be of a specific brand. This image should be reinstated. With this a section of sourced content was also removed. CFCF 💌 📧 15:54, 26 January 2016 (UTC) 

Then past removal and future removal of devices that have branding on them wont fly. It has been standard procedurre to remove items with branding on them in this article, even if they are from the commons, are you suggesting we change that? Because if we do I will be bookmarking this section in the archives. AlbinoFerret 18:02, 26 January 2016 (UTC)

And just to add to AlbinoFerret's comment: The use of such an image and associated text, displays a particular WP:POV, and that won't fly... particularly when we have high quality sources that dispute the assertion. --Kim D. Petersen 19:28, 26 January 2016 (UTC)

KimDabelsteinPetersen, since you have responded in this section, what do you think of the replacement and the caption underneath, does it follow the WP:CAPTION guidelines? AlbinoFerret 19:51, 26 January 2016 (UTC)

Also elaborate on which high quality sources you are referring it—the article body currently carries the statements associated with the image. CFCF 💌 📧 21:37, 26 January 2016 (UTC)

The problem isnt the sources, its that captions are supposed to be descriptive of the image. There is a lot of information in the caption that isnt about the image. AlbinoFerret 21:41, 26 January 2016 (UTC)

Mechanical engineers design and build power plants and engines, such as this Volkswagen Group designed Bugatti W16 engine.

If you even took two seconds to look at the examples at WP:CAPTION you can see that the current caption and the older one were very relevant, see the image I copied. It is also very similar to the images the CDC presents to illustrate ecig marketing to youth http://www.cdc.gov/vitalsigns/ecigarette-ads/.CFCF 💌 📧 21:48, 26 January 2016 (UTC)

Is it controversial that WV uses Bugatti engines? No. Is it controversial that e-liquids appeal to youth? Yes. As for sources, look at the PHE report. Therefore it shouldn't be used. Yes high-quality sources do state that it does, but other high-quality sources disagree - therefore its contentious. As for WP:CAPTION - i find that rather irrelevant considering the WP:NPOV issue - NPOV is a policy, CAPTION is a guideline. --Kim D. Petersen 22:27, 26 January 2016 (UTC)

Generally it can be said that "Think about the children!" is a so commonly used advocacy/rhetorical point, that one should always be cautious about using it, unless it is within a context that explains the pro- and contra-arguments. And this most certainly doesn't. --Kim D. Petersen 22:33, 26 January 2016 (UTC) [And that includes the current usage of the caption - with a more neutral image. This section is not about youth - but about motivation, and most users (the significant majority) are not youths. Combine that with the controversial nature of "Think about the children!" advocacy strategies - and we are still in WP:POV land. --Kim D. Petersen 22:54, 26 January 2016 (UTC)]

Except that this is in the section concerning use among youth and adolescents— and the PHE report actually supports the statement – page 34 (Stating the the preferred flavour was among a number of respondents fruit, qualifying that they did not have enough respondents to prove this on a larger scale, it does not refute the statement). CFCF 💌 📧 22:58, 26 January 2016 (UTC)

This section is not about youth vapers - in fact it is about motivation of vapers. Of which youths are a very tiny minority. As stated above Think about the children! is a generic rhetoric ploy, that should never be used without significant caution. As for the PHE - it doesn't support your assertion, since it makes it very very clear that youth smokers is so insignificant, that flavor determination is impossible "The proportion of youth reporting current use was too small to assess the most frequently used types or flavours in current users". The whole youth argument is basically rhetorical if we use the PHE as a guide. --Kim D. Petersen 00:46, 27 January 2016 (UTC) [note on the youth prevalence issue: "Overall, the adult and youth data suggest that, despite some experimentation with EC among never smokers, EC are attracting few people who have never smoked into regular use." --Kim D. Petersen 00:54, 27 January 2016 (UTC)]

I find it interesting that the percentage of young users is small according to the PHE report, but take up 1/4th of the section. AlbinoFerret 03:10, 27 January 2016 (UTC)

Smoking prevention has traditionally focused on those who start young because they are most likely to develop a habit and addiction—which is also why a significant portion of the literature concerning ecigs discusses use among youth—it reflects the literature and relevance to prevention, not the actual proportion of users. Also of note is that portions of the literature have chosen to define anyone over the age of 15 as an adult which is troubling when it comes to accurate statistics–see Kalkhoran 2016. CFCF 💌 📧 10:04, 27 January 2016 (UTC)

First of all this isn't about "smoking prevention", which is an entirely different category. Once again: This is the motivation section. As for your 15 years of age claim, i looked at Kalkhoran et al(2016) which doesn't present this as a problem, it just mentions that they looked at studies where the youngest ages was between 15-30. And if one looks at the appendix, it gets obvious that this wasn't pointed out as a problem because only Gallus et al(2014), which was a population study, had an age of 15 as its lower bound - the rest are, as far as i can determine, without looking into each paper 18+. So quite simply you are using WP:OR to justify the WP:POV. --Kim D. Petersen 12:30, 27 January 2016 (UTC)

I think you'll find that the CDC 2016 reports E-cigarette Ads and Youth, E-cigarette ads reach nearly 7 in 10 middle and high-school students strongly target the effect of advertising on motivation, so your claim that they are entirely disassociated topics is quite shallow. Smoking prevention by necessity needs to target underlying motivation, and the same is true from prevention of ecig use, this is not a controversial position, and you can look to much of the literature for support:

• PMID 26449875—Tobacco smoking: From 'glamour' to 'stigma'. A comprehensive review. - (Yes, it specifically mentions ecigs despite its title)

etc. (can provide many more upon request)

As for the last point which you spent most time on, it was minor issue and is still relevant despite what you claim—but no it would not alone be enough to justify the claims.CFCF 💌 📧 13:11, 27 January 2016 (UTC)

It is quite refreshing to see that you display your own personal interpretation of data, but it is not refreshing to see it used within a Wikipedia frame to justify a WP:POV. Both CDC links that you give are about exposure, not targeting. That you call/interpret it as targeting is a direct indication of POV. To illustrate the difference between exposure and targeting, i am going to assume that exposure of car advertising amongst youths is very close to 100% - but i doubt if they are targeting the youths as a purchasing audience. Do you see the difference?

It would be nice if you could seperate your personal POV from the subject matter. --Kim D. Petersen 13:45, 27 January 2016 (UTC)

“The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes,” said CDC Director Tom Frieden, M.D., M.P.H.

From: E-cigarette ads reach nearly 7 in 10 middle and high-school students

E-cigarette advertisements target youth
Tobacco remains the leading cause of death and disease in the US, and the Secretary of HHS said that the proposed rule is the “latest step in our efforts to make the next generation tobacco-free."[2] Even though the proposed rule would institute a minimum age of 18 for purchasing newly covered products including e-cigarettes, the rule will not combat the tobacco epidemic if it does not also prohibit the marketing of these products to youth. Age limits on e-cigarettes will be ineffective without advertising restrictions.

From: UCSF – Center for Tobacco Control Research and Education

CFCF 💌 📧 14:32, 27 January 2016 (UTC)

Very nice. You can cherrypick the opinion - but not understand the data. Where is the data about targeting? Please provide it. --Kim D. Petersen 14:34, 27 January 2016 (UTC)

I btw am amused that you, in a POV argument, are using Glantz' blog and their advocacy letter as an argument. Because the second quote is clear and unadulturated advocacy. --Kim D. Petersen 14:40, 27 January 2016 (UTC)

This cherry picking and POV insertion is very troubling. Especially as Glantz is a anti-tobacco advocate. AlbinoFerret 14:47, 27 January 2016 (UTC)

Considering that Glantz is generally considered the worlds premier anti-vaping advocate, just ahead of Simon Chapman.. then yep its troubling. Imagine if e-cig advocates were to state blogs from eg. Farsalinos as evidence for something... guess what the sentiment would be :) --Kim D. Petersen 15:01, 27 January 2016 (UTC)

We've been through this discussion before, please follow up any such statements with sources. CFCF 💌 📧 16:55, 27 January 2016 (UTC)

Just scroll up to the RFC above for all the Glantz sources needed. AlbinoFerret 17:10, 27 January 2016 (UTC)

No, they did not say anything about being anti e-cig. Neither are they sources permissible under WP:MEDRS. CFCF 💌 📧 17:12, 27 January 2016 (UTC)

Incorrect, Ruters, the first source does.[25] AlbinoFerret 17:19, 27 January 2016 (UTC)

Not WP:MEDRS-compliant, as was mentioned in the above discussion. CFCF 💌 📧 18:29, 27 January 2016 (UTC)

There are various other factors - it is cheap and easy to survey schoolkids or students (much more so than with a normal adult population), and it is easy to generate shock headlines, and increased regulation, from the results. Having caught the tobacco industry pushing its product at youth, much research, especially in America, assumes the ecig manufacturers will be doing the same. There is also concern that ecigs will be a gateway drug to tobacco; a much-questioned concept in the first place, for which the evidence in this context is very limited. Johnbod (talk) 13:12, 27 January 2016 (UTC)

While there is support for those statements there is also evidence of e-cig manufacturers targeting youth with advertising. The CDC's position is pretty clear from the sources, and we should present it as is. CFCF 💌 📧 13:15, 27 January 2016 (UTC)

Likewise PHE's. It may indeed be (as the research output from the 2 countries would suggest) that there is a large real difference between US and UK prevalence in youth, as I think there is with eg use of marijauna, or certainly in the risk of getting shot. Possibly advertising is a factor there. Johnbod (talk) 13:23, 27 January 2016 (UTC)

No, as mentioned above, the CDC doesn't state that position at all. They are talking exposure, where you are talking targeting, which are two different things. But once again this is moot because this isn't a section about youths, but a section about motivation, and youths are a tiny minority amongst vapers. --Kim D. Petersen 14:31, 27 January 2016 (UTC)

I suggest you reread the pages and see the quote from the CDC director which I quoted above. CFCF 💌 📧 14:34, 27 January 2016 (UTC)

I suggest that you stick to peer-reviewed material and data, rather than opinion - that would be nice - and an indication that you aren't married to your WP:POV. --Kim D. Petersen 14:37, 27 January 2016 (UTC)

WP:MEDRS allows for use of position statement or opinion from major and recognized medical bodies. I have not strayed from this, and their do intend to. CFCF 💌 📧 15:28, 27 January 2016 (UTC)

Its not a position statement, its a blog post from an anti-tobacco advocate. AlbinoFerret 16:10, 27 January 2016 (UTC)

Two separate position statements and you refer to them as a blog post? Also we have been through the discussion, and being anti-tobacco is something that is entirely general across all of medicine – doctors are paid to be anti-tobacco. CFCF 💌 📧 16:53, 27 January 2016 (UTC)

Neither of those two are position statements CFCF. I have a really hard time understanding that a longterm wikipedia editor doesn't understand the difference between formal position statements and regular webcontent and blog posts (from Glantz) about certain peoples opinions of the CDC's stance. Should we expand this article to include viewpoints and opinions from experts in general - is that what you are arguing? --Kim D. Petersen 16:57, 27 January 2016 (UTC)

The first one is most assuredly a statement from a prominent source (CDC) and as such allowed as per MEDRS. The second source concerns marketing which does not necessarily require MEDRS-sourcing. CFCF 💌 📧 17:00, 27 January 2016 (UTC)

The first is a selected quote from a pressrelease on CDC's webpage, about a statistics (WP:PRIMARY, and opinion) - do you think pressreleases are WP:SECONDARY CFCF? The second is a blog, describing a letter from some people to the CDC (pure opinion, corresponding roughly to a "letter to editors" => PRIMARY).

Not everything on webpages from organizations such as the CDC is usable information from a WP:MEDRS perspective. --Kim D. Petersen 17:22, 27 January 2016 (UTC)

Deceitful qualifiers added to section on appeal to youth

With this edit: [26] Marcus erronius chose to qualify the National Association of County and City Health Officials as "some advocates" as well as the Heart and Stroke Foundation as an advocacy group. This is both dishonest and attempts to portray these organizations in a negative light. This should be fully evident to any editor here is disruptive and should not remain in the article. CFCF 💌 📧 23:12, 26 January 2016 (UTC)

As far as i know the Heart and Stroke foundation describe themselves as an advocacy organization.[27] But i do agree that this is probably used as POV - just as the youth argument is in the above. Sometimes (even often) things can be true, while still be misleading and POV. --Kim D. Petersen 00:49, 27 January 2016 (UTC)

POV: Opinion articles used to counter secondary reviews?

I find this edit[28] disturbing. Since it directly breaks with WP:MEDRS and WP:POV. From WP:MEDREV:

Primary sources should not be cited with intent of "debunking", contradicting, or countering any conclusions made by secondary sources. Synthesis of published material advancing a position is original research, and Wikipedia is not a venue for open research. Controversies or uncertainties in medicine should be supported by reliable secondary sources describing the varying viewpoints. Primary sources should not be aggregated or presented without context in order to undermine proportionate representation of opinion in a field. If material can be supported by either primary or secondary sources – the secondary sources should be used. Primary sources may be presented together with secondary sources.

Here an anonymous editorial (opinion => primary source) is being used in exactly this way. --Kim D. Petersen 15:06, 27 January 2016 (UTC)

I was wonding if the reference name ":0", which looks rather like an emoticon, is used here as WP:POINT? Particularly since it bears no relevance to the reference, if so, then it is really troubling. --Kim D. Petersen 15:10, 27 January 2016 (UTC)

The :0 is added automatically when using visual editor to add references. It then continues with :1, :2, :3, etc. CFCF 💌 📧 15:21, 27 January 2016 (UTC)

This is the position statement of an authoritative medical organization — namely The Lancet. It is attributed to the journal itself, it is not a primary source and does not present any original results. CFCF 💌 📧 15:22, 27 January 2016 (UTC)

The edits were removed by AlbinoFerret in this edit [29] which is very faulty. CFCF 💌 📧 15:25, 27 January 2016 (UTC)

I can imagine the uproar if someone other than a wikiproject medicine editor inserted an editorial to counter a MEDRS source. AlbinoFerret 15:33, 27 January 2016 (UTC)

No, the Lancet editorial is not a position statement, otherwise it would have been tagged as such. It is simply an anonymous editorial. So Yes, it is a primary source - and opinion to boot. Apologies for misunderstanding the visual editor inserts. Nb: Please do not outdent at level 1, it disturbs the ability to follow and reply to threads in text (see Help:Using_talk_pages#Indentation). --Kim D. Petersen 15:29, 27 January 2016 (UTC)

Btw. Editorials are even within the less restrictive bounds of WP:RS, as opposed to WP:MEDRS, always considered opinion, and thus not usable for general content, and can in no way be considered secondary! That you believe that it should be otherwise within MEDRS is disturbing. --Kim D. Petersen 15:37, 27 January 2016 (UTC)

There is an enormous difference between an "anonymous editorial" and one which the journal body puts its own name behind. The position of the article is endorsed by the Lancet, and is also one which is shared with numerous other sources. CFCF 💌 📧 15:42, 27 January 2016 (UTC)

An editorial (which is a primary source and not MEDRS) is not a good source to counter a MEDRS source. AlbinoFerret 15:46, 27 January 2016 (UTC)

Also note that the Lancet Editorial Board is not anonymous, you have at least twenty people standing behind the position at [30]. It is recognized as one of the most prestigious journals in the world and as such its positions hold much weight, enough that this statement illicited first page news around the world:

• Wired – E-cigarettes 'safer than tobacco' study faces Lancet criticism
• Wall Street Journal – U.K. Government Agency’s E-Cigarettes Report Based on ‘Flimsy’ Evidence, the Lancet Says

Neither does it counter the source, but the criticism should be included in the article, seeing as it comes from a high profile respected source.CFCF 💌 📧 15:52, 27 January 2016 (UTC)

Doesn't change the fact that editorials are opinion and primary sources. Do please read WP:MEDRS#Biomedical_journals(first paragraph) where it makes it very clear that such material is to be avoided. WP:MEDASSESS has two nice images that show you where editorials are placed within the ranking of level of evidence. Your insistance at trying to get opinion in as equivalent to reviews is disturbing. And your reliance here on Wired and the Wall Street Journal to "vet" the opinion is even more disturbing. Newspapers go for the controversy - not for the evidence! As any wikipedia science/medical editor should know. --Kim D. Petersen 16:01, 27 January 2016 (UTC)

I am sure CFCF knows about the ranking images, he had a hand in placing them there. AlbinoFerret 16:08, 27 January 2016 (UTC)

I know. Which makes this discussion even more disturbing with regards to POV. --Kim D. Petersen 16:40, 27 January 2016 (UTC)

What is clear is that The Lancets position is permitted by WP:MEDRS, it is accordingly on the top of those pyramids (which I created). CFCF 💌 📧 16:52, 27 January 2016 (UTC)

No, The Lancets editorial (not position) is not permitted by WP:MEDRS. Position statements are a specific category of statements - that are always marked as such. They are formal, and from medical bodies - not journals. --Kim D. Petersen 17:01, 27 January 2016 (UTC)

Insertion of image dealing with illegal drugs

CFCF inserted an image without discussing it.[31] The top image is an electronic cigarette. The bottom one contains images of illegal substances and devices used to inhale them which are not e-cigs. AlbinoFerret 15:30, 27 January 2016 (UTC)

The source PMID 26308021 makes it entirely clear that these are electronic cigarettes, it is even in the caption of the image. That they can be used for other things has no impact on whether they are ecigs or not. This article overlooked the use of cannabis in electronic cigarettes, something which is covered heavily in the literature. CFCF 💌 📧 15:39, 27 January 2016 (UTC) 

No, an electronic cigarette and a Vaporizer (inhalation device) are very different things, you should move them to that page if you feel they belong on WP. E-cigs are one type of vaporiser, but not all vaporisers are e-cigs. AlbinoFerret 15:44, 27 January 2016 (UTC)

I prefer to follow the statement from the review article that I linked above instead of your personal definition. It clearly states (not only from its title E-Cigarettes: A Review of New Trends in Cannabis Use.) in the first sentence:

The emergence of electronic cigarettes (e-cigs) has given cannabis smokers a new method of inhaling cannabinoids.

CFCF 💌 📧 15:59, 27 January 2016 (UTC)

It is disturbing, that when looking upon the article and only taking in the pictures, then we get a different view of what the article is about, than when reading the article. --Kim D. Petersen 15:55, 27 January 2016 (UTC)

I agree with Albino here. The Giroud paper uses a definition of e-cigarettes that is significantly different from the norm. The majority of those devices are vaporisers and not e-cigarettes. SPACKlick (talk) 16:01, 27 January 2016 (UTC)

I agree, its a very fringe view. AlbinoFerret 16:06, 27 January 2016 (UTC)

No it isn't. It is a view shared by a number of sources, among others:

• PMID 26347431 – High School Students' Use of Electronic Cigarettes to Vaporize Cannabis.
• Healthline – Teens Using E-Cigarette Devices to Smoke Marijuana
• PMID 24680203 – E-cigarette prevalence and correlates of use among adolescents versus adults: a review and comparison.

You can not chose terminology according to your personal preference, this is in established sources, you have yet to provide sources that make the clear distinction, or that say how e-cigs can not be used with cannabis or cannabinoids. CFCF 💌 📧 16:50, 27 January 2016 (UTC)

The healthline link uses the same definition used on this page and that the rest of the world uses, that e-cigarettes vaporize liquid using a heating element. Items which vaporise solids, which have been used for cannabis inhillation long before e-cigarettes were invented are a different thing both in terms of engineering and health effects. The third link (Chapman paper) also uses that definition. It is atypical use to refer to vaporisers as e-cigarettes. SPACKlick (talk) 17:04, 27 January 2016 (UTC)

File:File:Ijerph ecig variants.jpg

SPACKlick, they are categorized as ecigs as per the source, which also takes up the difference between traditional vaporizers and e-cigs used for cannabis/cannabinoid e-liquid.
Would you be more comfortable using the image: File:Ijerph ecig variants.jpg which has that section cropped out?

Youth vaping images

To expand: 5 out of 16 pictures are on the subject of youth vaping. With WP:WEIGHT in mind, this is disturbing. And now a push for an image that indicates that e-cigarettes are associated with illegal drug usage? Hmmm. The CDC's view is also rather overrepresented in the images, considering that the US view and (as an example) the UK view is, if not directly opposite, then certainly not in agreement, i would consider that something to fix as well. --Kim D. Petersen 16:49, 27 January 2016 (UTC)

The reason we use CDC content to such an extent is because of their licensing practice, that is to say beyond the face that their positions holds very much weight. Their most recent position also concerns young and e-cigarettes, and making up less than 30% of the articles images is not undue burden. Neither do 5 out of 16 images have to do with use among youth, that is a miscategorization. CFCF 💌 📧 16:58, 27 January 2016 (UTC) 

(edit conflict)Lets count the images then[32], since you seem to think that it is a miscategorization:

• image 1-3 not about youth
• image 4 "showing teens using e-cigarettes are more likely to start smoking tobacco"
• image 5 "may appeal especially to younger users"
• image 6 "may appeal to younger users"
• image 7 "middle and highschool students"
• image 8 "Ads and Youth which concerned marketing towards adolescents"
• image 9-13 not about youth
• image 14 "Youths are exposed to e-cigarette advertisements..."
• image 15 not about youth.

You are correct - i miscounted. There are 6 images out of 15 that are about youth, which is 40% of all images. An even higher percentage than i counted. Lets talk about WP:WEIGHT again? --Kim D. Petersen 17:12, 27 January 2016 (UTC)

Way to many images on one subject. AlbinoFerret 17:21, 27 January 2016 (UTC)