Talk:Electronic cigarette/Archive 4

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Do E-cigarettes produce second-hand or third-hand smoking risks?

It would be helpful if there were a section addressing the question: Do E-cigarettes produce second-hand or third-hand smoking risks? Without any facts to establish the answer, it would seem easy for the non-smoking public to be lulled into thinking it is safe around "smokers" using e-cigarettes, when this may not be true. The first person in the first section of this talk page ("Deadly risk for the general public not yet expressed or understood") states that e-cigarettes can produce SMOKE, not just "vapor". I went to the WP article to find facts to calm a friend who thought she was affected by someone else's "smoking" an e-cigarette on the bus, but found nothing either to confirm or deny this.Anonnymos (talk) 02:18, 16 June 2013 (UTC)

Electronic cigarettes do not produce any smoke at all, only vapour. So there will be no second or third hand smoke risks at all, as there is no smoke. In fact does third hand smoke even exist?? Or is it a dream in the ANTZ mind? — Preceding unsigned comment added by 81.155.191.156 (talk) 17:26, 10 August 2013 (UTC)

Lack of criticism section?

I came here because I heard that there had been a fair bit of criticism of e-cigarettes and I wanted to know what the criticism was. While in the history of the opinions of medical associations there might be some clues, this isn't really a good summary. I think this section should be added - it doesn't matter if the criticism is valid or not, but it exists and should be included in the article. One of the first times I've gone to wikipedia to try to figure out what the controversy was about and have been disappointed. Definitely worth including. — Preceding unsigned comment added by Ekrst (talk • contribs) 16:07, 21 June 2013 (UTC)

Several categories

I'm new to Wikipedia and was wondering if this page should be split in two sub-categories : ecigarettes that ressemble real cigarettes (and that are throwable) and ecigarettes that can be used and refilled with eliquid, that don't look like a real cigarette. Do you think that's a good idea? 88.180.227.82 (talk) 18:06, 28 June 2013 (UTC)

Welcome and thanks for your comment! My recent review of the quoted references on this page suggests to me at least that much public and political opinion seems to stem from the "appearance" of the devices, i.e. [75]. I don't think it warrants two separate categories, but appearance and as you say "throwability" should be borne in mind.

I would further suggest that any legitimate comment on health and safety aspects of the devices should separate their electronic vaporization (as simply a means of delivery) from the chemical analysis of the individual liquids that might be available and used from one region or market to another. Ianactually (talk) 03:13, 31 July 2013 (UTC)

Do users anywhere know if these are safe?

"Because clinical studies about the safety of e-cigarettes have not been submitted to the U.S. Food and Drug Administration (FDA), users in the United States may have no way of knowing if they are safe" I don't think the bold part of that sentence should remain in the article. I get that the FDA isn't a global authority, but how do users outside the United States know if it's safe? I removed the section once, but I was reverted. Jackmcbarn (talk) 01:28, 30 July 2013 (UTC)

I never intended to embolden the edit "in the United States may", merely to correct the logic, since as you now accept the FDA applies solely to the USA. I wonder if the "health concerns" heading should be merged with the more lengthy legality section that follows... on the basis that any objections to e-cigarettes ought to be based upon (hopefully researched) health concerns in each country or territory? Ianactually (talk) 01:52, 30 July 2013 (UTC)

You didn't make that bold. I just did that here to make it easier to see what I'm talking about. My point is that e-cigarettes don't have different effects on health in different countries or territories. Jackmcbarn (talk) 01:54, 30 July 2013 (UTC)

Hehe. Pretty funny sentence. Products could be safe for the people in one country but not another. Your particular country's authorities have to declare them safe for your race. It's a DNA thing. Science!

But yeah, silly. "The US FDA has yet to evaluate clinical studies of e-cigarettes" is probably enough. No need for the extra bit of stupidity. Equazcion ^(talk) 01:56, 30 Jul 2013 (UTC)

I wasn't suggesting that effects on health differ by country or region. They might or might not. But we shouldn't derive any conclusion in the absence of clinical evaluations or other such scientific study, and so I agree with Equazcion: the statement regarding the lack of clinical evaluation by the FDA should be simply a glib statement of that fact alone. My sole objection to the original wording was that the lack of FDA evaluation suggested users of e-cigarettes (globally) could have no knowledge of their safety or otherwise. Not everyone sees the FDA as an authority! Hope no offence taken... none intended! Ianactually (talk) 01:11, 31 July 2013 (UTC)

I think there is variation on safety regionally (due to various countries' difference in safety standards; id est, China), but that has more to do with the contents of the "juice" manufactured in different regions. However, ignoring some regional manufacturer's less than safe products (in re of China, not restricted to "juice" but an array of products), the basic liquid used (which, in its most basic acceptable form, may contain one or a combination of propylene glycol, vegetable glycerin, water, flavoring, and/or nicotine) has safety implications applicable to any region of the world. FDA evaluation results/opinions can be used in world-wide section on safety, as would any other regions results and/or opinions. Breaking it down, IMHO, into regions should only be necessary/reasonable if one or more regions has a substantial amount of text (say, more than 2 paragraphs) associated with it in comparison to a substantial amount for other regions (individual or the rest of the world). IMHO, at least. It may be also noteworthy to mention that most of these basic ingredients (except for nicotine) is generally considered safe by most of the world for inclusion in foods, medicine, and injection (as well as found naturally within plants and animals). PG is not considered safe for cats to eat. Nicotine, itself, is found in various foods, most notably tomato, eggplant, and potato (all nightshades, BTW). Sorry for cramming more thoughts into this reply beyond the direct topic (although, indirectly, is applicable). Sorry, I didn't dig up any references, although I have encountered a few, and other wiki articles do have references we can draw upon for the individual ingredients, although things can be slightly different for inhaling these items. — al-Shimoni (talk) 11:45, 31 July 2013 (UTC)

Organization of health effects section

It makes no sense to organize health effects by country or group the statement came from. Should be organized by the type of health effect. 1) effect on smoking cessation 2) toxicity 3) addition Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:14, 31 July 2013 (UTC)

Have trimmed a bunch of primary sources. Per WP:MEDRS medical content (which include health effects of something) should be based on proper secondary sources of position of national or international bodies. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:39, 31 July 2013 (UTC)

Not sure what was with this

"When nicotine addiction is considered a medical condition, then e-cigarettes become classed as smoking cessation devices or nicotine replacement products" And no ref provided. Additionally how they are classed is not a health effect.

Not sure why "As of July 2013 no rigorous studies have been conducted showing that electronic cigarette are safe or that they are effective as nicotine replacement therapy" was changed to "The World Health Organisation advise people not to use e-cigarettes until they deem e-cigarettes to be safe and effective as nicotine replacement products". No one is claiming good evidence exists. Thus IMO it was better before. Health effects is a better headline than safety as health effects is more general and includes safety. Also includes evidence around effectiveness for different indications which is separate from safety.

No sure what happened to the Health Canada and FDA concerns around addition. Thus restored this content.Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:36, 31 July 2013 (UTC)

Regarding (pure) Nicotine in small quantities such as NRT & ECigs

Nicotine is partly responsible for the dependence of tobacco products. Comparisons of animal studies and studies of human drug use show, however, that pure nicotine has little potential for addiction, tobacco cigarette smoke a very high potential for addiction.--Merlin 1971 (talk) 17:35, 5 August 2013 (UTC)

Are you pulling my leg? 1. Jmh649 has deleted my changes concerning "addiction" because they are "primary research"? That are the orginal papers! 2. Jmh649 has reverted my changes in the editorial - Hey man: Over 100 Papers concerning ECigs is NOT "poorly studied"! What is wrong here?--Merlin 1971 (talk) 09:41, 6 August 2013 (UTC)

I haven't examined these refs but offhand I think you'd need studies specific to e-cigarettes or else it's WP:SYNTH; and the "poorly studied" phrasing evolved from a statement about lack of clinical trials, which could be more accurate than the current phrasing. Equazcion ^(talk) 12:48, 6 Aug 2013 (UTC)

I'm out... This article is not basend on science - this is politics.--Merlin 1971 (talk) 17:53, 6 August 2013 (UTC)

We are to base content on reliable secondary sources not on primary sources especially for medical content. Whether or not something is "well studied" is not a count of the number of papers published. It determined how and in how many people it has been studied. This is how science works Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:54, 6 August 2013 (UTC)

What's going on here?

I cite a peer reviewed study showing that e-cigs are effective as a smoking cessation aid and it gets deleted. Meanwhile, hysterical crap about marketing to children is allowed to remain. WP:COIN, anyone?--FergusM1970^{Let's play Freckles} 16:58, 10 August 2013 (UTC)

It's called WP:BRD (and WP:OTHER STUFF EXISTS). As I said in my edit summary, you can't refute secondary sources with a primary source. BTW, per BRD, you should not have restored without discussion. -- Scray (talk) 18:00, 10 August 2013 (UTC)

"You can't refute secondary sources with a primary source" sounds all very well, but what it boils down to is saying that you can't refute vague "concerns" about effectiveness with a study proving effectiveness. The WHO etc. have been "concerned" about the effectiveness of e-cigs as a cessation method because there weren't any studies. Well, now there is a study. The "concerns" of the ANTZ may be well referenced, but they're also obsolete, misleading and in the case of some WHO statements flat-out dishonest.--FergusM1970^{Let's play Freckles} 22:52, 10 August 2013 (UTC)

Once a secondary source tells us how to interpret that primary source, we'll know whether the concern has been addressed adequately. From my point of view (not that it matters - secondary sources are key) the effect was modest, and being published in a second-rate journal diminishes the impact even further. -- Scray (talk) 23:11, 10 August 2013 (UTC)

What do you mean "the effect was modest"? If you're talking about the study I think you are - the Drexel one - it wasn't looking for an effect. It was measuring vapour constituents. That isn't something that requires interpretation; it's a simple measurement. Even stating that the detected levels are well below known safe levels (generally <1%) isn't interpretation; it's a simple statement of fact.--FergusM1970^{Let's play Freckles} 23:38, 10 August 2013 (UTC)

Removed more primary research

This "Trials have confirmed that e-cigarette vapour is significantly less cytotoxic than tobacco smoke." Does not prove that e-cigs are less toxic than tobacco smoke. First it is a primary research study. Second it was done on cultured cells not humans. While there is tentative evidence that e-cigs are safer and we are using secondary sources already to say this much the evidence is not great one way or the other. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:06, 7 August 2013 (UTC)

By the way per WP:MEDRS we do not use primary sources to refute the conclusions of secondary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:13, 7 August 2013 (UTC)

I'm fairly certain that any e-cig which contains no tobacco products is almost necessarily less cytotoxic than actual cigarettes (that's really dependent on the vapor-producing medium); nicotine isn't a known carcinogen or cytotoxin at doses contained in a typical (regular) cigarette (or several cigarettes), whereas some compounds present in tobacco and/or produced from burning it are known carcinogens. Any cytotoxins would therefore have to be in or produced when drawing on the base/medium which produces e-cig vapor. Fortunately, that's more or less already stated in the article where it says: "E-cigarettes should theoretically have less toxins than traditional cigarettes.[12] Concrete evidence to back this up however is lacking as to its safety;[12] nevertheless, tentative evidence supports that electronic cigarettes are safer than real cigarettes and possibly as safe as other nicotine replacement products.[10]"

I think that's fine in the meantime, pending a reasonable secondary source to validate it's safety or lack thereof.Seppi333 (talk) 23:37, 7 August 2013 (UTC)

What's with the using pro-e-cig blogs and unpeer-reviewed articles funded by e-cig advocates as references? Seems misleading to even list them as references. Should those lines just be deleted? Dancingsnails (talk) 18:47, 8 August 2013 (UTC)

I agree, the recent "review article" that wasn't PUBMED-indexed or published in a peer-reviewed journal (appeared to be self-published) wasn't a good source, so I have removed that source and associated content. Zad68 18:52, 8 August 2013 (UTC)

Someone reverted that deletion with a comment that the source was published by Drexel Univiersity. As stated in the referenced source, the source is a technical report (not submitted to a journal) funded by CASAA. I've added a comment to that effect on that paragraph. Not sure how to respond to the request for a citation of this. Should I move the comment to precede the already listed citation? Rewriting the whole paragraph would make sense too, to be clear that this is a position being clamed by CASAA, as opposed to being a widely accepted fact. Dancingsnails (talk) 18:48, 9 August 2013 (UTC)

I rewrote it with the citation at the end. Equazcion ^(talk) 19:04, 9 Aug 2013 (UTC)

Without it being published in an independent peer-reviewed journal there's nothing to support the idea that it's noteworthy or complies with WP:MEDRS, so removed. Zad68 19:12, 9 August 2013 (UTC)

Deleting the paragraph and associatied source makes sense to me. Googling showed the only other links to this report as being on CASAA or vaping websites. Dancingsnails (talk) 19:57, 9 August 2013 (UTC)

Great, does not seem to be consensus to include it at this time. Zad68 20:08, 9 August 2013 (UTC)

Well, there isn't consensus to remove it either. As for "Without it being published in an independent peer-reviewed journal there's nothing to support the idea that it's noteworthy or complies with WP:MEDRS" then I better get busy removing all the non-peer-reviewed scaremongering about marketing to children and "passive vapour."--FergusM1970^{Let's play Freckles} 15:59, 10 August 2013 (UTC)

You'd have a point if this study was widely cited/reported. As it is this is just one guy's opinion.Dancingsnails (talk) 18:16, 10 August 2013 (UTC)

I removed one thing about children that was pretty out-of-place, and removed the Drexel University study again. The Drexel paper isn't even a study, it's just a paper by one guy, not peer-reviewed or even subject to any editorial review, as far as I can see. Fergus, studies that are not subject to peer review, especially small-scale studies, should probably be removed (my opinion) if you see more of that in this article. Adding more of it for the other side is probably not the best solution. Equazcion ^(talk) 21:23, 10 Aug 2013 (UTC)

If a peer-reviewed study is the required standard, that's fine; I'm happy with that. It's nice and rigorous. However if we're aiming for that level of rigour we also need to get rid of all the references to vague, ungrounded "concerns" such as Health Canada's nonsense about nicotine addiction. The whole point about e-cigs is that 99% of users are people who are already addicted to nicotine. The devices are not creating nicotine addicts; they are giving existing addicts a way to use it that doesn't also involve inhaling 91 known carcinogens at a dangerous level. All this emphasis on "concerns" is giving the impression that e-cigs are potentially dangerous, whereas in fact we know exactly what's in the liquid and it compares pretty well with a licensed nicotine inhaler or a cup of coffee.--FergusM1970^{Let's play Freckles} 22:56, 10 August 2013 (UTC)

You may have a point, but it's not up to us to pick sources based on how much their logic makes sense to us. All we do here is report what the reliable sources say, and weed out the unreliable ones. That said, I removed the Health Canada concerns, as all three uses were based on a 5 year-old public service announcement from back when electronic cigarettes were new on the market, and it didn't note any sources (WP:MEDRS#Medical and scientific organizations). If an actual scientific report is released by Health Canada then it should be included. Equazcion ^(talk) 23:16, 10 Aug 2013 (UTC)

If an actual scientific report was released then yes, that would be appropriate. However as far as I know the only decent study into e-cig use by non-smokers is the UK one done by ASH. It turns out that uptake of e-cigs by non-smokers, including non-smoking children, is essentially nil. As, of course, everyone knew anyway. My concern here is that the article looks like a propaganda piece. I have no issue with it saying we don't know the long-term health risks; we don't. However right now it includes several inferences to us not knowing if they're safer than smoking actual cigarettes, which is frankly demented. Both e-liquid and vapor have been examined in several studies, and while nobody is saying they're completely safe it's not even slightly rational to imply that they might be as hazardous as tobacco smoke. They contain absolutely nothing that's known to be harmful at the detected levels.--FergusM1970^{Let's play Freckles} 23:33, 10 August 2013 (UTC)

If you know of such a study then maybe it should be added to the article. That aside, you should consider that, for better or worse, the article may simply reflect the current predominate understanding of the electronic cigarette issue. We can disagree with that, but we can't slant the article to reflect it. If you can point out specific passages in the article that you feel are unduly weighted on one side then we can perhaps start addressing it. Equazcion ^(talk) 23:53, 10 Aug 2013 (UTC)

OK, I've added the ASH study in the "Addiction" section; it shows that, at least in the UK, e-cig use is confined to current and former smokers and there is zero uptake among children who have never smoked. As for the article in general I would say that there isn't a predominant understanding; at least as many medical professionals support e-cigs as oppose them and most of the opposition is in fact coming from vested interests. There is no evidence that they're dangerous, which is where the burden of proof should surely lie; it's very hard to demonstrate that there is no risk from anything and, by implying that e-cigs are dubious because this hasn't been demonstrated, I would say that the article is currently slanted towards the ANTZ agenda. The fact is that these are a product which repeated studies have shown doesn't deliver dangerous levels of anything, hasn't been linked to a single death and whose increasing popularity is linked to a sudden fall in smoking prevalence in the UK.--FergusM1970^{Let's play Freckles} 01:20, 11 August 2013 (UTC)

When it comes to medicine, generally there is actually a burden of proof on the other side. Something must be shown to to be safe according to certain standards before it's considered viable. If you know where to find these repeated studies and good sources stating the link to the fall of smoking prevalence, and they're not currently in the article, then let's take a look at them. Equazcion ^(talk) 01:32, 11 Aug 2013 (UTC)

Yes, but e-cigarettes aren't medicine; they're a safer alternative to smoking. The FDA study, which didn't find hazardous levels of anything in any sample tested, was already cited. I've added the Health New Zealand one showing the same thing - no hazardous levels. I'll look for the UK smoking prevalence figures, but I suspect citing them as evidence for the efficacy of e-cigs as a cessation method would fall victim to WP:SYNTH.--FergusM1970^{Let's play Freckles} 01:58, 11 August 2013 (UTC)

You seemed to indicate you had some good source that showed the link between prevalence and e-cig use, but I could have been mistaken. The figures themselves would indeed constitute WP:SYNTH, if that's all you know of. Whether or not e-cigarettes are medicine is something of a subjective question, and thus far, several national agencies are treating them as such. The FDA was apparently instructed not to, but the WHO et al appear to disagree, and we aren't at liberty to try and diminish their stance in the article just because we might disagree with them. Equazcion ^(talk) 02:05, 11 Aug 2013 (UTC)

I may have worded it badly on the smoking prevalence figures. My bad. As for the medicine/not medicine question, it seems we're risking giving the WHO etc. unnecessary weight. Yes, the WHO, MHRA and some others claim they're medicines. However the companies who make them and the people who use them say they aren't. I mean, how many online forums are there about the best nicotine patch? The article should mention that some people claim they're medicines, but I don't think it should go with that classification as a default.--FergusM1970^{Let's play Freckles} 02:24, 11 August 2013 (UTC)

We're not actually classifying anything here, but merely stating what the various organizations are saying. If they're choosing to hold e-cigarettes to medicinal standards then we don't really have the option to present their claims any other way. For better or worse, the companies and people (etc) aren't reliable sources, so we can't include their collective opinions (also due to WP:SYNTH) -- unless a good secondary source discusses that. Equazcion ^(talk) 02:34, 11 Aug 2013 (UTC)

Reporting that some organisations think e-cigs are medicines is fine; treating e-cigs as medicines simply because some opponents label them as such seems wrong. Why do the WHO get to decide what they are but the manufacturers and users don't? If they're medicines, what are they treating? It certainly isn't nicotine addiction. I do see where you're coming from and I have no objection to the article saying "the WHO, MHRA and assorted ANTZ, neo-Puritans and other killjoys say e-cigs are medicine." However on POV grounds I don't think the article should be written on the basis that they actually are medicines, because the only people saying that are people who want them banned.--FergusM1970^{Let's play Freckles} 02:42, 11 August 2013 (UTC)

I don't think anything in the article currently treats e-cigarettes as medicines, except where organizations and studies have made statements on that basis. If you see other parts where it does, you should point them out so we can address that. Equazcion ^(talk) 02:47, 11 Aug 2013 (UTC)

You're right; the article itself currently doesn't. However there are several comments on this talk page implying that medical standards should be applied. I don't see why, as nobody is making medical claims. My opinion is that the article is not impartial; it gives too much prominence to the frankly wild claims of the WHO, and too much emphasis to trace elements of toxins. The article on nicotine patches - which are a medicine - doesn't mention TSNAs. Why is it so important that this one does? Anyway, I'm 100% sure that not vaping is healthier than vaping. I don't actually care though, because for me the alternative to vaping isn't not vaping; it's smoking. Every other vaper I know feels the same way. I'm trying not to let personal feelings get in the way of good editing and I'm perfectly happy for any genuine health risks to be included, but I think this article is biased.--FergusM1970^{Let's play Freckles} 02:57, 11 August 2013 (UTC)

TSNAs in nicotine patches

The Health New Zealand study says that e-cigs and nicotine patches contain about the same level of TSNAs. However the actual study on patches which I cited showed that in fact patches contain around 20 times as much as 1ml of e-liquid does. This is why I cited it!--FergusM1970^{Let's play Freckles} 02:02, 11 August 2013 (UTC)

The comparison between two studies might constitute WP:SYNTH, which is why I removed the one that didn't mention e-cigarettes. It was unnecessary anyway, since the e-cigarette study did already mention that TSNA levels were comparable to those found in nicotine patches. Equazcion ^(talk) 02:10, 11 Aug 2013 (UTC)

Um yes, but the levels aren't comparable. Patches contain TSNAs at far higher levels than e-cig liquid does. I suppose that could be called SYNTH, but it seems like an unnecessarily strict interpretation.--FergusM1970^{Let's play Freckles} 02:20, 11 August 2013 (UTC)

According to the e-cigarette study, they are comparable. You're essentially suggesting the use of a different source for that particular part because it better supports your opinion, and that's WP:SYNTH in a nutshell (it's actually a little worse). Equazcion ^(talk) 02:26, 11 Aug 2013 (UTC)

Well, the e-cig study doesn't show any figures for patches; the one I cited does. To quote from Wikipedia:What_SYNTH_is_not, "SYNTH is when two or more reliably-sourced statements are combined to produce a new thesis that isn't verifiable from the sources." The conclusion that patches contain around 20 times as much TSNAs as e-liquid clearly is verifiable from the sources, because the actual TSNA content was given. I'd see your point if I was cherry-picking from two sources with conflicting figures, but I'm not; I'm giving precedence to test results over a throwaway comment. If you have another reference for patches that shows a comparable TSNA level to e-liquid I'd be perfectly happy to accept it.--FergusM1970^{Let's play Freckles} 02:33, 11 August 2013 (UTC)

Page 7 of the HNZ study states: "Tobacco-specific nitrosamines (TSNAs) were found, equal to 8 ng, in the 1g of liquid of the 16 mg cartridge. This amount is extremely small, equal for example, to the amount reported to be present in a nicotine medicinal patch. (8 ng in 1g = eight parts per trillion)." Equazcion ^(talk) 02:40, 11 Aug 2013 (UTC)

Yes, but that's an unsourced comment and it's contradicted by tests of how much actually is present in a nicotine patch. The HNZ study doesn't cite any results for patches. The UCSF one does.--FergusM1970^{Let's play Freckles} 02:44, 11 August 2013 (UTC)

It's an unsourced comment within a reliable source though :) and I'm pretty sure our reliable sources don't need to be reliably sourced. I see what you're saying, but either way, I don't think we can combine this with your second study on nicotine patches in order to imply a conclusion. That is a SYNTH problem, and I think you're going to have to settle for the HNZ claim. Equazcion ^(talk) 02:49, 11 Aug 2013 (UTC)

OK, I can live with that. However I think, in the interests of fairness, I'll add sections on TSNA toxicity to the various NRT articles too.--FergusM1970^{Let's play Freckles} 02:58, 11 August 2013 (UTC)

WHO "Questions and answers on electronic cigarettes..."

I would suggest that while this document is an acceptable reference on what the WHO says about electronic cigarettes it is well below the standard required to back up any claims about the products themselves. It's in no way impartial or objective, nor is it backed up by any science. It's just a diatribe. Here are a few gems:

• "some products claim to contain no nicotine" - Some products do indeed contain no nicotine.

• "A number of ENDS are offered in flavours that can be particularly attractive to adolescents." - Because adults prefer a diet of unseasoned white rice and distilled water, obviously.

• "They are also sometimes made to look like everyday items such as pens and USB memory sticks, for people who wish to use the product without other people noticing." - Blatant lie.

• "there is no way for consumers to find out what is actually delivered by the product they have purchased." - I look at the label on the bottle.

• "This illusive ‘safety’ of ENDS" - Implying that they are not safer than smoking, an implication that if true would require the violation of laws of nature.

• "the chemicals used in electronic cigarettes have not been fully disclosed" - Blatant lie. In most countries the law requires informative labeling. It certainly does in Europe.

• "The efficacy of ENDS for helping people to quit smoking has not been scientifically demonstrated." - Yes, it has. As well as anecdotal evidence there is now a study showing they are more effective than NRT.

• "None of the approved, regulated cessation aids, such as nicotine patches and chewing-gum, delivers nicotine to the lungs." - Yes - and none of them work!

This travesty of a document is riddled with weaselly qualifications like "claim to," "can be," "has not been demonstrated" and so on. By all means use it to illustrate the WHO's opinion, but that's all it's good for.--FergusM1970^{Let's play Freckles} 00:01, 11 August 2013 (UTC)

Some of this is valid. Makes me suspicious enough to post. There's only one organization that I can think of that would benefit from spreading FUD (Fear, Uncertainty and Doubt) about e-cigarettes, when intuitively they must be as safe or safer than tobacco products (water vapor and nicotine, vs. a long list of carcinogens), and that would be the Tobacco Lobby, so thing #1 would be for editors to keep this possibility in mind when perceiving any anti-e-cigarette information, and thing #2 might be to create a "controversy" section to document any kind of negative effort to unjustifiably diminish the perception of e-cigarettes, as they are certainly going to make a large dent in Big Tobacco's revenues if they are proven to be a safe, and safer alternative to tobacco, and Big Tobacco is certain to push back, if they have not started already.Jonny Quick (talk) 05:27, 12 August 2013 (UTC)

The WHO is deemed to be a reliable source, thus it is perfectly usable. You appear to be attempting to contradict the WHO yet do not provide a single reference that does so. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:04, 12 August 2013 (UTC)

Doc, is there something from the WHO not currently in the article that you want to add? Let's get specific so we know exactly what we're arguing over. Equazcion ^(talk) 07:09, 12 Aug 2013 (UTC)

Assuming we're talking about this, WP:MEDRS would seem to indicate that it's not very reliable since it seems to be more of a public service announcement. Equazcion ^(talk) 07:17, 12 Aug 2013 (UTC)

That looks like it's largely a summery of this, which as a technical report from WHO would be covered by WP:MEDRS. Dancingsnails (talk) 17:33, 12 August 2013 (UTC)

I just wanted to add this in response to Jonny; as I understand it (or rather, as my experience has shown me), the liquids are not "water vapor and nicotine" but rather propylene glycol, vegetable glycerin, & nicotine vapor (in most cases...& obviously flavoring). But only some brands of liquids (and a minority, it seems to me) contain any distilled water & even those that do seem to only contain small amounts of it mixed with larger portions of PG & VG. But with all of that said, I live in the USA, so perhaps that plays a role in which brands I tend to purchase. If my observations seem to contradict your own, then I guess I stand corrected, but that's been my experience.

Oh, and Fergus, I appreciate what you're doing here & I largely agree with most of what I read here from you, please continue doing so :) (I realize you did most of it within the scope of like one specific week but please do keep an eye on the article every now & then, in the interest of neutrality & fairness! You do a good job)

(Psychonaut25 - 13355p34k / C0n7r1b5 01:16 PM EST, 24 August 2013 (UTC))

Removed some "concerns"

I've removed a couple of references to unspecified "concerns" from the health effects section as I don't think they belonged there. This section should cover actual known or suspected health effects, not just something somebody claimed to be worried about in a press release.--FergusM1970^{Let's play Freckles} 19:48, 11 August 2013 (UTC)

If major health organizations raise concerns. These concerns are notable in the health effects sections as they are discussing possible health effects. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:09, 12 August 2013 (UTC)

WHO statements as an overview

Have moved the WHO statement to the opening of this section as it summarizes both safety and effectiveness.[1] Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:50, 12 August 2013 (UTC)

No. It summarises the WHO's opinion on safety and effectiveness. However as the WHO says cigarettes are safer "because they have filters" that doesn't actually mean much.--FergusM1970^{Let's play Freckles} 02:04, 12 August 2013 (UTC)

^I agree there, I don't think the WHO statement should be used to summarize the section, any more than BMA statements should be used in that fashion. Plus, if the WHO statement were used that way, then more statements would be added (rightly) for the other side of the fence, and so on, ad nauseum. Summarizing the health effects this way is really asking for trouble since it's so controversial. I think it's better to leave it up to the reader to determine how more specific stuff in the section adds up. Equazcion ^(talk) 02:49, 12 Aug 2013 (UTC)

Most other secondary sources agree with WHO. There appears to be many attempts to contradict these sources with primary references and the popular press. Thus we have an issue. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:06, 12 August 2013 (UTC)

Attempting to summarize a controversial debate, especially when you have a clear POV (but even if you don't), is asking for trouble in an article. I really think it's best to skip it. A section summary isn't a requirement, so there is no issue policy-wise. If you want to include something specific that the WHO said in a good scientific review they published then it can be done less hazardously within the individual subsections. Equazcion ^(talk) 06:58, 12 Aug 2013 (UTC)

Sure it is a minor point of layout. Summarizing their position in each section is fine too. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:43, 12 August 2013 (UTC)

Primary source?

This edit claims the following is a primary source: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0066317. Near as I can tell, it's a peer-reviewed journal with an editorial staff. I could be wrong though. Equazcion ^(talk) 01:42, 12 Aug 2013 (UTC)

Please read primary source and secondary source as it does not depend on peer review or not. Also please read WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:53, 12 August 2013 (UTC)

MEDRS is where I got that whole little peer-review thing from. This isn't a primary source according to that policy, near as I can tell. What exactly would you say makes it one? Equazcion ^(talk) 01:57, 12 Aug 2013 (UTC)

Doc James is correct, and you have not understood the policies to which he's pointed. Primary source makes this very clear, as does MEDRS. Here's a quote from WP:MEDRS: "A primary source in medicine is one in which the authors directly participated in the research or documented their personal experiences. They examined the patients, injected the rats, filled the test tubes, or at least supervised those who did. Many, but not all, papers published in medical journals are primary sources for facts about the research and discoveries made." Those linked documents have the info you need. -- Scray (talk) 02:01, 12 August 2013 (UTC)

Plane to catch. Internet poor. Back soon. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:03, 12 August 2013 (UTC)

Scray, you're right, thanks for explaining. My bad. Equazcion ^(talk) 02:10, 12 Aug 2013 (UTC)

Intro wording

This edit introduces some slanted wording that I'm not a particular fan of. "Poorly studied" is weasely and "making claims" is accusatory. The current wording seems much more NPOV from where I'm standing. Equazcion ^(talk) 01:48, 12 Aug 2013 (UTC)

Fixed it with a better source.--FergusM1970^{Let's play Freckles} 02:06, 12 August 2013 (UTC)

I'm not too fond of that wording either. "The majority of available evidence" is a permeating statement and I'm not sure if a single journal article can ever really back it up. The other intro statement about no evidence of harm to date is a much more verifiable thing to say, IMO. I would change "The majority" to "there is some evidence", or something similar, unless we have some real good secondary media sources that back up your claim. Equazcion ^(talk) 02:17, 12 Aug 2013 (UTC)

OK, I see your point. My concern is that there isn't any evidence at all in the opposite direction, i.e. that they're as dangerous as cigarettes are, so I don't think giving an impression of balance is accurate. Frankly, suggesting that the risk level is even remotely comparable is well into WP:FRINGE.--FergusM1970^{Let's play Freckles} 02:24, 12 August 2013 (UTC)

There might not be any evidence in the opposite direction, but summarizing that lack of evidence ourselves is a SYNTH problem. A good source would need to state that conclusion for us before we can state it, I think. Equazcion ^(talk) 02:32, 12 Aug 2013 (UTC)

Frankly this is a bit arse. Any attempt to present the evidence falls foul of WP:SYNTH or gets deleted as a primary source. Meanwhile unfounded nonsense by the WHO gets in because it's just reporting of someone's "concerns", which don't need to be based on any research. Oh well.--FergusM1970^{Let's play Freckles} 02:34, 12 August 2013 (UTC)

Daily mail

Per WP:MEDRS the popular press is not a reliable source of medical information. Thus this reference is not appropriate. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:55, 12 August 2013 (UTC)

I disagree. The Daily Mail may not be a reliable source of medical information, but that's not relevant here. It's perfectly fine as a source for what someone said, which is what it's being used for in this case.--FergusM1970^{Let's play Freckles} 02:15, 12 August 2013 (UTC)

This is kind of a sticky issue. There's a legislative debate over whether e-cigarettes should be considered medical devices, so we have no clear guidance there. However this is still arguably a medical question. For example, if the article on tobacco smoking made a claim about health risks, MEDRS would probably still apply. Equazcion ^(talk) 02:36, 12 Aug 2013 (UTC)

Disagree there's any question whether this is related to human health, it clearly is. Per WP:MEDRS popular press (includes the Daily Mail) cannot be cited to source content with biomedical health implications, and this clearly falls into that category. The original journal article the Daily Mail is talking about is PMID 21150942, copy can be found here. The article reads like original research arguing a novel position, disagree it can be used here. Zad68 02:38, 12 August 2013 (UTC)

Yes; however the Daily Fail is only being used to reference what someone said, not a fact.--FergusM1970^{Let's play Freckles} 02:39, 12 August 2013 (UTC)

If we're only using it to attribute claims to UC Berkley then it's not necessary since we have the primary source for attribution. The secondary source is only helpful if it confirms that the study can be used as something other than primary, and unfortunately MEDRS does seem to indicate that it's no good for that. Equazcion ^(talk) 02:43, 12 Aug 2013 (UTC)

Agree, sounds right. If Researcher X releases a report stating something relevant to human health, and Newspaper Y reports on it, per WP:MEDRS it's not OK to use the popular press cite to support content. We should not be using Newspaper Y to try to get around the underlying principle of not using popular press to support biomedical content by using it just to say Researcher X said something, which happens to be a biomedical claim. Zad68 02:47, 12 August 2013 (UTC)

FDA as reliable source?

OK, I removed the claims from the New York Times article about what the FDA found in e-liquid. Also the primary sources from the FDA themselves. Are we all agreed on that?--FergusM1970^{Let's play Freckles} 02:53, 12 August 2013 (UTC)

Hehe. FDA is an interesting question. The examples of "medical and scientific organizations" listed in Wikipedia:Medrs#Medical and scientific organizations would seem to indicate that the FDA isn't one of those more scholarly institutions, so I'm going to say tenuously that I'm alright with the removal of stuff the FDA publishes itself, at least until someone can provide a good argument against that. Equazcion ^(talk) 03:00, 12 Aug 2013 (UTC)

It seems sensible. After all the FDA isn't impartial, so anything it publishes itself in support of its own agenda doesn't seem like an RS.--FergusM1970^{Let's play Freckles} 03:03, 12 August 2013 (UTC)

The FDA's possible agenda isn't something we can use to determine RS. It's just an opinion held by some. The question, I think, is whether it rises to the level of a major medical/scientific organization. It's more of a regulatory agency IMO. The examples at MEDRS of US organizations in this category are U.S. National Academies, U.S. National Institutes of Health, and Centers for Disease Control and Prevention (not that the wording of the policy is binding, but still, the FDA is conspicuously absent). I'd go out on a limb and say the spirit of MEDRS excludes the FDA as a reliable neutral source. Equazcion ^(talk) 03:14, 12 Aug 2013 (UTC)

That's pretty much what I meant. It has political, rather than purely scientific, concerns. It's not doing pure research.--FergusM1970^{Let's play Freckles} 03:16, 12 August 2013 (UTC)

So neither the FDA nor the WHO are reliable sources? All I can say is wow... Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:36, 12 August 2013 (UTC)

A scientific review by the WHO (as opposed to a public service announcement) is a reliable source if we have one, I would say. Equazcion ^(talk) 06:50, 12 Aug 2013 (UTC)

The USFDA is a reliable source for toxicity information; Health New Zealand (a "consultancy company" with a stated advocacy role) is pretty much as far away from RS as you can get. Frankly, I'm surprised this is even being discussed. Alexbrn ^{talk|contribs|COI} 07:38, 12 August 2013 (UTC)

The advocacy part refers to one of that person's websites (endsmoking.org.nz), not to the HNZ publication. Equazcion ^(talk) 07:43, 12 Aug 2013 (UTC)

On the company's home page it states its "business" is (among other thing), "Advocacy: Safer, effective alternatives to smoking". (And even if it wasn't, is somebody here seriously suggesting that an obscure commercial consulting operation in New Zealand is a superior source to the FDA for toxicity information? Seriously?) Alexbrn ^{talk|contribs|COI} 07:50, 12 August 2013 (UTC)

You're right, the HNZ homepage does seem rather one-sided. Although it's not necessary to compare the two. HNZ may be unreliable but that doesn't speak to the FDA's reliability for its own published material. Again, MEDRS seems to point to more scholarly national organizations rather than regulatory agencies as reliable government sources (regardless of the "obvious" knee-jerk reaction to consider the FDA reliable). Equazcion ^(talk) 07:55, 12 Aug 2013 (UTC)

Please point out what section, specifically, leads you to believe this. -- [ UseTheCommandLine ~/talk ]# ▄ 08:04, 12 August 2013 (UTC)

There's nothing wrong with the FDA's toxicity information (which found trace amounts of TSNAs at about the same level as found in FDA-approved nicotine inhalers, and diethylene glycol at a level fractionally above what the FDA allows in food additives.) The issue is the way it's being presented, i.e. to make e-cigs look like an escapee from a chemical weapons stockpile.--FergusM1970^{Let's play Freckles} 08:07, 12 August 2013 (UTC)

(edit conflict) I explained above, but this: WP:MEDRS#Medical and scientific organizations. The idea appears to be sticking with universities and similar types of research organizations that aren't prone to politics, and I think that's the best way to go. I'd pile on the fact that the FDA was struck down in its e-cigarette efforts thus far, so hanging on to their findings in the article seems all the more iffy IMO. Equazcion ^(talk) 08:10, 12 Aug 2013 (UTC)

That section specifically references the NIH and CDC, which are both government agencies, and both are agencies housed under the umbrella of the US Department of Health & Human Services, like the FDA. (It would be rather unwieldy to place every extant agency whose output is considered RS there.) Please explain further how you think the FDA differs? -- [ UseTheCommandLine ~/talk ]# ▄ 08:42, 12 August 2013 (UTC)

and FWIW, the NIH dropped funding for gun violence studies back in the 90s because of pressure from the NRA (ref) so I'm not sure what you mean by "aren't prone to politics" either. -- [ UseTheCommandLine ~/talk ]# ▄ 08:45, 12 August 2013 (UTC)

(edit conflict) As I did explain above, I of course don't expect every possible member of the category to be named in the Wikipedia policy, but the FDA comes up predominately enough that its absence as an example does seem to provide a hint. Again, the NIH and CDC are research associations. The FDA is a regulatory agency (to protect and promote public health through regulation and supervision, according to the Wikipedia article). It seems like there's a marked difference between the two. Equazcion ^(talk) 08:52, 12 Aug 2013 (UTC)

I'm sorry, I find "it wasnt in the list, so I didn't think it was RS" and "of course I understand that the list cannot be exhaustive" to be rather at odds. Perhaps you could explain a bit more why, exactly, you feel this way, or why you didn't ask (or, apparently, search at) WP:RSN? I guess it would be too much to point out that the FDA actually conducts quite a bit of research; it's necessary in order to come up with meaningful regulatory standards. -- [ UseTheCommandLine ~/talk ]# ▄ 09:08, 12 August 2013 (UTC)

Why didn't you ask at RSN? Why didn't anyone else? There's also the fact that I don't care, and I'm rather just attempting to referee this little POV tug-of-war between the I-like-[topic] bunch and the I-don't-like-[topic] bunch, who are each trying to get their respective opinions to stand dominant in the article. I realize the FDA does research, thanks, but they are an administration with a mandate to make and enforce rules, and are not as academic and independent as we tend to like sources to be. And yes, your chosen paraphrases are indeed at odds, but they have little to do with what I actually said. Equazcion ^(talk) 09:20, 12 Aug 2013 (UTC)

And, again, we have the way the information is being presented. Read the Toxicity section of this article and an uninformed reader would walk away with the impression that e-cigarette liquid is an unusually hazardous substance riddled with toxins. The fact is, of course, that all the carcinogens and toxins found in e-cigarettes are found at comparable levels in other products licensed by the FDA. By all means let's list what has been found in some cartridges, but let's also mention the implications of them being present at those levels. If we leave that out then we are giving a very misleading impression of the actual toxicity risk, and I'm sure none of us would want to do that.--FergusM1970^{Let's play Freckles} 09:34, 12 August 2013 (UTC)

You look pretty directly involved in the dispute to me. In addition, I can't find any evidence that you are previously familiar with the MEDRS policy you are now citing as (what seems to me like) a rationalization for removing a reference you don't like. But perhaps I'm misjudging that, and there is a perfectly reasonable explanation for that, which I hope you'll share with me. -- [ UseTheCommandLine ~/talk ]# ▄ 10:18, 12 August 2013 (UTC)

Oh, I'm quite happy for the FDA study to stay despite it being a primary source. What I'd like to see is some additional information, such as how these levels of toxins relate to human health and the level found in other products. The information that e-liquid can contain up to 8ppb of TSNAs isn't very informative on its own; we should also give suitably referenced information on what that means. A comparison with the level found in FDA-approved nicotine patches and inhalers would be a good start, I'd say.--FergusM1970^{Let's play Freckles} 10:25, 12 August 2013 (UTC)

That sounds a lot like WP:OR to me. -- [ UseTheCommandLine ~/talk ]# ▄ 10:27, 12 August 2013 (UTC)

No it doesn't. What's OR about citing an RS for the level of TSNA found in a nicotine patch?--FergusM1970^{Let's play Freckles} 10:29, 12 August 2013 (UTC)

I don't think that the TSNA level really needs to be cited at all. WP is for a general audience. The comparison would be appropriate in an article about relative TSNA levels in smoking-cessation methods maybe, but citing it here would seem intended to evoke an impression of relative safety/danger. That's OR. -- [ UseTheCommandLine ~/talk ]# ▄ 10:34, 12 August 2013 (UTC)

OK, fine. Let's get rid of it. There's no indication that TSNAs at that sort of trace level are toxic anyway, so I don't think the toxicity section really needs it.--FergusM1970^{Let's play Freckles} 10:36, 12 August 2013 (UTC)

Actually no, I've changed my mind. When discussing toxicity it's actually vital to mention levels, because anything has a toxicity threshold. If we don't state how much of the toxin is there, and how that relates to health, the information is misleading. If we just say "e-cigs contain TSNAs" then it is, as you say, evoking an impression of relative danger. Clearly we agree that this is undesirable, so what's the best way to avoid it? How about "However the levels are comparable to those found in FDA-approved nicotine replacement products"?--FergusM1970^{Let's play Freckles} 10:56, 12 August 2013 (UTC)

Removal of secondary sources

Why were these two pieces of text supported by secondary source removed?

• The benefits and risks of electronic cigarette use are uncertain as they have been poorly studied.
• The World Health Organization states that as of July 2013, no rigorous studies have been conducted showing that electronic cigarettes are safe or that they are effective as nicotine replacement therapy.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:21, 12 August 2013 (UTC)

Here is the edit were the user in question replaces the 2012 review article with a 2011 non-review article [2] Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:34, 12 August 2013 (UTC)

I added this stuff back in, though with slightly tweaked wording. As I've stated, I'm not fond of the "poorly studied" wording. The source doesn't say that, and summing it up that way sounds slanted. The criticism the source does mention refers to a lack of clinical trials and I think it's best we state that specifically. Equazcion ^(talk) 06:47, 12 Aug 2013 (UTC)

I'm slightly concerned about the emphasis on clinical trials anyway. That would only seem relevant if e-cigs are a medicinal product, which unless they're being prescribed as a smoking cessation aid they are not; they're a delivery system for a recreational drug. How many other consumer products are expected to go through clinical trials?--FergusM1970^{Let's play Freckles} 07:33, 12 August 2013 (UTC)

I cut down the intro to simply say things are uncertain. I'm hoping everyone can be somewhat satisfied with that. It's a compromise, which means that perhaps neither side is getting their way in full, but this is hopefully something both can live with. Equazcion ^(talk) 07:41, 12 Aug 2013 (UTC)

It works for me.--FergusM1970^{Let's play Freckles} 07:43, 12 August 2013 (UTC)

Yes that is reasonable. I have added a date to this. And added two high quality references that support it. Just because something is not a medicinal product does not mean that it does not need clinical trials to show effectiveness. I prefer the current wording however as it is easier to understand. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:31, 12 August 2013 (UTC)

Well, I can't agree about clinical trials. Does coffee need clinical trials? Beer? Nope. So why do e-cigs need them? E-cigs are just another way to deliver a legal recreational drug, so clinical trials don't seem relevant. At any rate the intro now seems acceptable to everyone, which is progress.--FergusM1970^{Let's play Freckles} 12:52, 12 August 2013 (UTC)

There are lots of clinical trials on both coffee and alcohol showing various positive and negative effects. So the answer is yes. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:15, 12 August 2013 (UTC)

They don't seem to be mentioned in the respective articles, which seems odd given the determination to mention them on this one. You'd almost think there was a concerted effort by powerful industries to strangle e-cigs before they gain market share.--FergusM1970^{Let's play Freckles} 13:21, 12 August 2013 (UTC)

If you think someone has a COI issue, let's not be coy about it - take it to the appopriate authority/board; otherwise, please drop the innuendo. This should not be a drama board. Doc James and I edit quite broadly, and I have no reason to think either of us has a COI. -- Scray (talk) 15:42, 12 August 2013 (UTC)

Hmm. A POV tag was put on the article because it contained the (accurate) statement that e-cigs contain about the same level of toxins that nicotine patches do, and removed when that statement was taken out. I personally find that quite odd, don't you?--FergusM1970^{Let's play Freckles} 20:35, 12 August 2013 (UTC)

Please provide highly-reliable secondary sources that show the broad consensus among experts reflects your claim; otherwise, it is not neutral. It's not odd, it's how things work based on policy, applicable guideline, and consensus. -- Scray (talk) 22:22, 12 August 2013 (UTC)

Uh what? Does it really need a broad consensus among experts before we can say that 8ppb is about the same as 8ppb? There's verifiability and there's anal retentiveness.--FergusM1970^{Let's play Freckles} 23:22, 12 August 2013 (UTC)

(←) Perhaps you could ask over at WP:ORN instead of continuing to push your agenda here? If things are as self-evident as you seem to think, then surely they will agree with you. -- [ UseTheCommandLine ~/talk ]# ▄ 23:28, 12 August 2013 (UTC)

I'm not talking about original research, am I? I'm talking about using an RS. If you think it's OR to say 8=8 then frankly you have issues.--FergusM1970^{Let's play Freckles} 23:55, 12 August 2013 (UTC)

What you're talking about is in fact OR, from my perspective. But again, if it's not, then a discussion at ORN should be quick and settle things. I'm happy to ask over there, if you're unwilling. and I don't much appreciate the assertion that i "have issues", thanks. -- [ UseTheCommandLine ~/talk ]# ▄ 00:03, 13 August 2013 (UTC)

I have asked at ORN. Personally I don't much appreciate the assertion that saying 8=8 means I am spouting "material—such as facts, allegations, and ideas—for which no reliable, published sources exist." Oh well, there you go, eh?--FergusM1970^{Let's play Freckles} 00:10, 13 August 2013 (UTC)

There seems to me to be a difference between saying "you have a problem" and "i think that might be problematic, why don't we ask someone else?" -- [ UseTheCommandLine ~/talk ]# ▄ 00:21, 13 August 2013 (UTC)

I didn't say you have issues. I said "If you think saying 8=8 is OR you have issues." As you can operate a keyboard I'm assuming you're not stupid enough to actually think that, so no, I don't believe you have issues.--FergusM1970^{Let's play Freckles} 00:24, 13 August 2013 (UTC)

We simply need to summarize recent high quality secondary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:15, 13 August 2013 (UTC)

Have you looked at the article on caffeine? Lots of evidence provided from reviews of clinical trials. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:02, 12 August 2013 (UTC)

NHS commentary

OMFG.

"The UK National Health Service noted that the toxic chemicals found by the FDA were at levels one thousandth that of cigarette smoke, but that there is no certainty that even these small traces are harmless"

Great. Except that's not quite what the source said, is it? Let's try this:

"compared with regular cigarettes, they are certainly the lesser of two evils... smoking e-cigarettes (known as ‘vaping’) is generally regarded a safer alternative to smoking for those unable or unwilling to stop using nicotine... We cannot be certain that these traces of toxins are harmless, but tests on animals and a small study of 40 smokers are reassuring, providing some evidence that e-cigarettes are well tolerated and only associated with mild adverse effects (slight mouth or throat irritation, a dry cough)."--FergusM1970^{Let's play Freckles} 09:40, 12 August 2013 (UTC)

Read on: "Others are more wary. Some health professionals do not recommend them because they believe the potential for harm is significant". Also, in answer to the question "Are e-cigarettes safe?" they reply "We don’t really know". As one might expect, the NHS adopts the kind of NPOV reporting we should aspire to, and so mirror. Alexbrn ^{talk|contribs|COI} 09:51, 12 August 2013 (UTC)

I did read on. In fact I'm familiar with that document. The fact remains that the edit you made based on it did not reflect the source; you completely ignored anything that didn't imply e-liquid is potentially dangerous. What the source actually said is that it's impossible to be certain that TSNAs etc. at that level are harmless (NB: It's impossible to be certain that anything is harmless) but on the evidence so far it's looking good. Is that what your edit implied? Um, no, not really.--FergusM1970^{Let's play Freckles} 09:56, 12 August 2013 (UTC)

Well, it carefully says there is "some evidence" that is reassuring, but goes on to state some health professionals "believe the potential for harm is significant" (which you haven't included). Rather than go off into the weeds on this I included the main point only. If the "reassuring" thought is included, the "potential for harm" bit needs to be included too for balance (as in the source). It's better to have neither IMO. Alexbrn ^{talk|contribs|COI} 10:01, 12 August 2013 (UTC)

And the "some health professionals believe..." linked to an article in the Grauniad that was so full of cack - and so badly savaged by their readers as a result - they had to shut down comments on it. Not exactly very relevant, is it? Anyway, if it's better to include neither in your opinion why not just get rid of the whole thing? Does "we can't be certain of something it's actually impossible to be certain of under any circumstances" actually add anything to the article or is it just misleading?--FergusM1970^{Let's play Freckles} 10:12, 12 August 2013 (UTC)

We don't discount portions of a source on the basis of your personal view it is "cack", or the BTL contributions of newspapers readers (probably the least reliable source for anything on the web). The reason for including this NHS information is that it mentions the relative levels of the toxins in e-cigs as compares to normal ones, which is relevant to the section, surely? If we are to include the mention of "some evidence" of reassurance, we need - per MEDRS - to be as scrupulous about balance as the NHS source. Alexbrn ^{talk|contribs|COI} 10:43, 12 August 2013 (UTC)

The "portion of a source" you are referring to was a link to a newspaper article written by a staff quack who was expressing his own opinion and cited no supporting evidence for them. Is that an RS for a medical article? No. It isn't. The "some evidence" of reassurance was based on studied cited by the NHS. The "some health professionals" was a paid hack whose piece included some egregious falsehoods. Not the same.--FergusM1970^{Let's play Freckles} 10:47, 12 August 2013 (UTC)

And if the reason for including the NHS info is the relative levels, we could just leave it at that. I'd be fine with doing so. How about simply saying "The UK National Health Service noted that the toxic chemicals found by the FDA were at levels one thousandth that of cigarette smoke."? I would be perfectly happy with that wording.--FergusM1970^{Let's play Freckles} 10:49, 12 August 2013 (UTC)

Because the NHS source is careful to control the implications of this statement, and we should follow suit. Alexbrn ^{talk|contribs|COI} 11:21, 12 August 2013 (UTC)

But in my opinion that does not mean we should be linking indirectly to a newspaper opinion piece. All the Guardian article said was that one doctor thinks e-cigs can be harmful. No supporting evidence, no proposed mechanism, just "Well, I think..." Not really relevant.--FergusM1970^{Let's play Freckles} 11:30, 12 August 2013 (UTC)

We are not linking to it directly. In the NHS's opinion, this was a caveat worth mentioning (in the context of their earlier statement that "we don’t really know" if e-cigs are safe or not). Whose opinion counts: yours or theirs? Alexbrn ^{talk|contribs|COI} 11:38, 12 August 2013 (UTC)

Well, where does that end? The NHS source in question is just an article, not any kind of academic paper, and what's more important? The article itself or its own sources? The points about reassuring evidence are from studies. The "some health professional" was from a newspaper opinion piece. If the NHS had any actual evidence that e-cigs might be harmful they'd have included it. They don't, which is why they had to mention Riddington's pile of dishonest bollocks.--FergusM1970^{Let's play Freckles} 11:53, 12 August 2013 (UTC)

The NHS piece is a reliable source. We use those as the basis of our articles (to state the obvious), in preference to our own research. Alexbrn ^{talk|contribs|COI} 12:17, 12 August 2013 (UTC)

Tell you what; I'll swap you "some health professionals do not recommend them" for "compared with regular cigarettes, they are certainly the lesser of two evils." Fair enough?--FergusM1970^{Let's play Freckles} 11:58, 12 August 2013 (UTC)

I have no objection to that text appearing somewhere, though it's not an "answer" to the safety question. Alexbrn ^{talk|contribs|COI} 12:17, 12 August 2013 (UTC)

Well, there is no "answer" to the safety question. Are e-cigarettes safe? No. Is anything safe? Not really. It's all about relative risks, and at this point I don't think anyone can honestly believe they're not a hell of a lot safer than smoking. We know what's in the liquid, and the chemical that causes most concern is so toxic it's licensed for use in asthma inhalers and hospital air conditioning. ANTZ are trying to portray e-cigs as dangerous. Yes, they contain chemicals that may cause adverse reactions in some and there could be long-term health hazards. However the same ANTZ are quite happy to promote Varenocline, and people who use that have a funny habit of either having a heart attack or shooting themselves. By all means let's list the toxins in e-cig liquid, but let's keep it in perspective. The FDA has knowingly approved products that are much more dangerous.--FergusM1970^{Let's play Freckles} 12:41, 12 August 2013 (UTC)

One of the concerns is that of addiction. While e-cigs increase the number of people who start smoking due to perceived safety? To put this in historical perspective we do know that filtered cigs were marketed as safer and was one of methods used to convince women to pick up the habit. If never smokers start using e-cigs while they than start using full cigs once addicted to the nicotine? E-cigs appear to generally give less than full cigs. At a population level this could worsen harm overall. While find refs for this in a bit but it is the concern of many major organizations. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:07, 12 August 2013 (UTC)

Ah. We have data on this from the ASH study. The answer is no. E-cig use seems to be confined more or less entirely to current or former smokers. Anyway, if someone was using e-cigs why would they want to switch to sticking dried leaves in their face and setting fire to them? As for "concerns," I'm not interested. Evidence that non-smokers are taking up e-cigs would be relevant, but in fact that's not what the evidence says.--FergusM1970^{Let's play Freckles} 13:14, 12 August 2013 (UTC)

Health concerns raised by major national and international organizations are still notable. Will put something together. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:06, 12 August 2013 (UTC)

They're notable, but not under health effects. A "controversy" section might be a better place for them, but Health Effects should be kept for actual health effects, not "concerns."--FergusM1970^{Let's play Freckles} 20:47, 12 August 2013 (UTC)

We disagree than. Statements from major health organizations on health effects belong in the section on health effects. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:13, 13 August 2013 (UTC)

I don't really see why. If they're based on evidence then yes; that would be the appropriate place for them. But the "concerns" about e-cigs acting as a gateway to smoking, for example, don't seem to have any place there because it's just an argument being used to justify restricting their availability; it doesn't actually have any connection to health (or reality.)--FergusM1970^{Let's play Freckles} 23:15, 13 August 2013 (UTC)

When it comes to a notable body like the World Health Organization, their concerns about impact on human health are notable. -- Scray (talk) 23:40, 13 August 2013 (UTC)

Their concerns are notable, if often stupid ("Real cigarettes are healthier because they have filters" - WHO spokesman Florante Trinidad) but the health effects section is for health effects, not people's opinions.--FergusM1970^{Let's play Freckles} 23:45, 13 August 2013 (UTC)

FTR, I am strongly suspicious of the "gateway" claim as well, but that doesn't matter. They said it, it's notable. See also the WP:ENEMY essay. -- [ UseTheCommandLine ~/talk ]# ▄ 23:47, 13 August 2013 (UTC)

It's notable, but it is not a health effect. It's a claim which all the available evidence suggests is incorrect. The Health Effects section should be restricted to effects on health which have been observed or can be reasonably inferred from the contents or use of e-cigarettes, not any old random nonsense people make up.--FergusM1970^{Let's play Freckles} 23:54, 13 August 2013 (UTC)

Seems a bit of a straw horse there. No one's suggesting that we take everything that any WHO spokesman says as gospel truth. The sources in question though, have all presumably gone through some internal review.Dancingsnails (talk) 00:12, 14 August 2013 (UTC)

However that's not the same as saying they belong in the Health Effects section. Staying with the "concerns" that e-cigs could lead to people taking up smoking, they are not based on any evidence (and in fact are flatly contradicted by all the evidence that exists) and there isn't even any plausible argument behind them. Why would people take up a relatively safe, cheap habit then move to something that's several times more expensive, tastes and smells foul, is banned in many places and is known to kill half the people who do it? It's not a health effect of electronic cigarettes, and while it's notable (and instructive) that people are saying stuff like this it belongs in a "Crazy shit people say" section and not in the "Health Effects" one.--FergusM1970^{Let's play Freckles} 00:39, 14 August 2013 (UTC)

(edit conflict) We could include a "Crazy shit people say" section. We could call it something like "Controversy" though, just for the sake of creativity. I'd be concerned about it becoming a dumping ground for more of the back-and-forth cruft that gets articles like these in trouble though. Equazcion ^(talk) 00:51, 14 Aug 2013 (UTC)

Or alternatively we could just not bother including unsupported claims that are contradicted by all the available evidence, such as the various utterances about e-cigs leading people to start smoking.--FergusM1970^{Let's play Freckles} 00:57, 14 August 2013 (UTC)

Please stop with the original research. Please stop working under the assumption that the views of Wikipedia editors will outweigh those of the NHS or the WHO. Is there a specific edit being proposed? What is the proposed content change and what are the sources? Zad68 00:47, 14 August 2013 (UTC)

WHAT original research? We were talking about whether or not the "concerns" that e-cigs could act as a gateway to smoking belong in the Health Effects section. I say they don't, because that section is for known or reasonably suspected health effects, not unsupported claims. The WHO, NHS or whoever can express all the "concerns" they like about non-smokers taking up vaping and it doesn't count for shit, because an actual study has been done and the "concerns" are completely spurious.--FergusM1970^{Let's play Freckles} 00:50, 14 August 2013 (UTC)

Addiction is a health effect. Am I convinced that these will be a gateway drug? No. But my opinion does not matter. It is the opinion of reliable secondary sources from major journals and national or international bodies. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:20, 14 August 2013 (UTC)

So what is a better source - an unsupported claim by someone at the WHO that they have "concerns" about e-cigs being a gateway, or an actual study by ASH showing that they're not? In fact all the evidence is that e-cig users are almost exclusively current or former smokers - people who're addicted to nicotine anyway. The claims that they could lead people to start smoking are not backed by evidence and do not make sense, so it would seem perverse to elevate them above the verifiable facts. By all means we can include those claims somewhere, but it shouldn't be under Heath Effects because that's not what they are.--FergusM1970^{Let's play Freckles} 01:26, 14 August 2013 (UTC)

Fergus, you are engaging in original research when you say things like Why would people take up a relatively safe, cheap habit then move to something that's several times more expensive, tastes and smells foul, is banned in many places and is known to kill half the people who do it? as an argument against using a source provided by an authoritative organization. All we (are supposed to) do as Wikipedia editors is identify the best-quality sources and summarize them with due weight. The statement The WHO, NHS or whoever can express all the "concerns" they like about non-smokers taking up vaping and it doesn't count for shit, because an actual study has been done and the "concerns" are completely spurious. isn't in line with how we handle sources, per WP:MEDREV we do not use individual primary studies to contradict conclusions of secondary sources (if indeed that's what's happening).

But, Fergus, I do think you do have a point in observing that if a statement from even an authoritative, influential organization like the WHO (see WP:MEDASSESS) isn't provided with supporting evidence and/or is delivered as the opinion of an individual (but speaking for the organization), that will affect how much weight we give it and how we present it in the article.

There's been a lot of stuff added to and removed from the article, and there's a big discussion in this section--actually appears to be two separate discussion--I don't see any links provided, and I've lost track of what sources are being considered to support what content. Could you please provide at least links to the sources being considered here, I apologize if they're assumed obvious to everyone else but I think it'd be helpful to have pointers to exactly what we're talking about. Appreciate it... Zad68 01:22, 14 August 2013 (UTC)

My understanding is that for the worries expressed by the WHO to be a secondary source they would need to be based on a primary source, which they aren't. The claim that e-cigs could lead people to smoking came from this. The ASH study showing that non-smokers aren't taking up vaping is currently cited under "Appeal to children."--FergusM1970^{Let's play Freckles} 01:32, 14 August 2013 (UTC)

Thanks, that was helpful. In my view, this page you provided the link to is what I'd call a position statement by the WHO on e-cigs. Presumably the WHO has access to primary research that they used to base this statement on, including the results of this ASH survey, a primary source, which came out a few months before the WHO statement. Further presumably, the WHO didn't find the evidence provided by that survey convincing enough for them not to include nicotine addiction in non-smokers to be a possible risk of the e-cig. Unfortunately the WHO did not provide a list of primary sources providing the evidence they used in deriving their position.

Going by our guidelines, we should not include the ASH study as it's a primary source resulting from a study conducted by an advocacy group (albeit one associated with a reputable and well-recognized medical organization, the RCP). We should include content based on the WHO statement as the statement is a secondary source and the WHO is a large, influential and reputable organization, but because it's a position statement and not a meta-analysis or the like published in a peer-reviewed journal, it should be attributed to the WHO. This is based on applying our guidelines to the sources, and not whether I agree with them. Zad68 02:08, 14 August 2013 (UTC)

No, that seems to be making an assumption that the WHO is basing its "concerns" on a primary source when there is no evidence that such a source exists. I have never heard of any study showing that non-smokers are becoming addicted to nicotine through e-cigs. I suspect that's because there isn't one; every single one of the (many) vapers I know is either a current or former smoker. I know that's anecdotal; I'm simply mentioning it to illustrate how unlikely it is that the WHO claim is based on a primary source. I really don't think the intent of Wikipedia's rules is that we throw out a study saying one thing in favour of an unsupported statement saying the opposite, especially when the unsupported statement is so counter-intuitive.--FergusM1970^{Let's play Freckles} 02:35, 14 August 2013 (UTC)

Wouldn't the WHO Q&A be a public guide, which WP:MEDRS#Medical and scientific organizations tells us aren't very reliable? Equazcion ^(talk) 02:48, 14 Aug 2013 (UTC)

That's not what the guideline says. WP:MEDRS doesn't say they're not reliable, it says they have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature. Zad68 03:01, 14 August 2013 (UTC)

(edit conflict) Well, by "less authoritative" I'd assume it means "less reliable", not that the exact phrasing has much to do with anything. This is a policy on how to gauge which sources are reliable, so the message here seems to be that public guides are on the lower end of the spectrum; this particular one doesn't even appear to have any stated "underlying medical literature", as far as I can see, though maybe someone sees something there that I don't. Equazcion ^(talk) 03:10, 14 Aug 2013 (UTC)

The problem here is that, when we're talking about e-cigs getting non-smokers addicted to nicotine, there isn't any underlying medical literature.--FergusM1970^{Let's play Freckles} 03:03, 14 August 2013 (UTC)

Wouldn't it make sense that the WHO might be better skilled than you and I are at locating relevant literature? We as encyclopedia editors look to authoritative secondary sources like the WHO because we need to rely on the conclusions of experts and not our own analysis. Zad68 03:11, 14 August 2013 (UTC)

Then why haven't they referenced this literature? Why hasn't it been presented to the EU committee that's currently considering regulation of e-cigs? Why hasn't it been produced to counter the ASH study?--FergusM1970^{Let's play Freckles} 03:14, 14 August 2013 (UTC)

Fergus, well, then you're making an assumption that the WHO is making a position statement based on no evidence at all, which seems (at least) equally surprising. Reading the statement itself clearly shows they're referring to the evidence base, they say things like "The safety of ENDS has not been scientifically demonstrated", "scientific testing indicates that the products vary widely in the amount of nicotine and other chemicals they deliver", and "The testing of some of these products also suggests the presence of other toxic chemicals, aside from nicotine" among many other statements. Clearly the WHO is referring to a base of evidence from primary studies they used, they just haven't provided a list of what they used. Zad68 03:09, 14 August 2013 (UTC)

I've already mentioned the WHO spokesman who claimed that e-cigarettes are more dangerous than actual cigarettes because they don't have filters. Clearly there are some people at the WHO who are willing to make statements based on no evidence at all.--FergusM1970^{Let's play Freckles} 03:14, 14 August 2013 (UTC)

(edit conflict) You're making a similar assumption from the other side, Zad. The fact is, without any references in the document, we don't know what the WHO is basing their position on. I think that's the point of the statement in MEDRS about public guides. They're not exactly scientific unless they have some stated underlying literature. A mere positional statement, as it's been called above, isn't a proper medical source. Equazcion ^(talk) 03:16, 14 Aug 2013 (UTC)

Yes and it's an appropriate assumption. Regardless I appear to have found the technical document the WHO is using, see below. Adding: A position statement from an authoritative body like the WHO can be cited with attribution, as was my recommendation. Zad68 03:18, 14 August 2013 (UTC)

Break 1

Here is the technical report, including a list of referenced sources--some primary, some secondary--that the WHO appears to be basing their position statement on. Zad68 03:17, 14 August 2013 (UTC)

How do you know that's what the Q&A is based on? Is that stated somewhere? The Q&A is from 2013 and that document appears to be from 2009. I'd think if the Q&A is based on scientific evidence then they'd be using something more up-to-date. Equazcion ^(talk) 03:21, 14 Aug 2013 (UTC)

And do any of them show that e-cigarettes are being used by non-smokers who then become nicotine addicts? I believe the answer is "No."--FergusM1970^{Let's play Freckles} 03:23, 14 August 2013 (UTC)

Equazcion, because there's a link to it directly from the Q&A page itself. A 2009 technical report falls within WP:MEDDATE. It looks like the WHO is actively working in this area. Fergus, we don't do the synthesis of and draw conclusions from the primary sources, we simply summarize what the authoritative reliable secondary sources say. Zad68 03:27, 14 August 2013 (UTC)

And the source doesn't say that e-cigs are being used by non-smokers. Therefore causing nicotine addiction is not a health effect of e-cigs, is it?--FergusM1970^{Let's play Freckles} 03:29, 14 August 2013 (UTC)

(edit conflict) Are you referring to the link under "related links"? That's all I see, and it seems far from a sourcing statement... Equazcion ^(talk) 03:30, 14 Aug 2013 (UTC)

Equazcion, we can resolve your concern about using the Q&A which you're describing as falling under "public guide" and not the more authoritative underlying technical report by simply sourcing the content about risks to the WHO Technical Report, which supports the same risk statement about appeal to non-smokers that the Q&A says. For example, the Technical Report says (pp. 10-11) "Regulators should weigh the theoretical benefits of ENDS as smoking cessation aids against those of current NRT products and the risk that the products will appeal to nonsmokers, that is, the risk that nonsmokers will be drawn into nicotine addiction." That would also solve the problem of citing a secondary source that doesn't specify its primary sources too. How about that, would that be acceptable? Zad68 03:40, 14 August 2013 (UTC)

Fergus, the WHO statement says e-cigs pose "a risk for addiction to nonsmokers of tobacco products". How about locating article content saying something to that effect in a new subsection called Risks under Health effects, would that be OK? Zad68 03:33, 14 August 2013 (UTC)

As long as it's preceded by the words "The WHO say" that's fine. What the document proves is that the WHO say that. It doesn't prove that there is a risk of addiction to non-smokers, and of course we already have a link to the evidence that non-smokers aren't using them.--FergusM1970^{Let's play Freckles} 03:40, 14 August 2013 (UTC)

Agree, that's acceptable to me. Let's give other a chance to comment and then we'll make the change to the article. Zad68 03:42, 14 August 2013 (UTC)

And I would prefer if that was under a "Controversy" section rather than health risks, because it's not a health risk; it's just the opinion of someone at the WHO. It isn't backed by any research and is contradicted by the research that's actually been done.--FergusM1970^{Let's play Freckles} 03:45, 14 August 2013 (UTC)

For a "The WHO has concerns that..." type of statement, I still don't think that's valid (in response to Zad's suggestion above, to base the content on the WHO's 2009 technical document). I'd be alright with a more complete summary or direct quote: "Regulators should weigh the theoretical benefits of ENDS as smoking cessation aids against those of current NRT products and the risk that the products will appeal to nonsmokers, that is, the risk that nonsmokers will be drawn into nicotine addiction." There's some important context there. Equazcion ^(talk) 03:54, 14 Aug 2013 (UTC)

To be honest I don't see any point in including it at all; it's just confusing. Sure, the WHO have concerns that e-cigs might appeal to non-smokers. However this has been investigated, and amazingly enough people who have never smoked aren't attracted by a device that simulates smoking. However if it really must be included it's important that it's presented as an opinion and not as something that's backed up by evidence. That's why I don't think it should be in the Health Effects section; it's a concern about a hypothetical health risk that both the evidence and common sense suggest does not in fact exist, rather than an actual risk of the sort that belongs in that section.--FergusM1970^{Let's play Freckles} 03:59, 14 August 2013 (UTC)

I'd say it should go in a new section but I'm wary of starting a "controversy", "risks", or similar type of section, for aforementioned reasons. How about adding this after the current WHO content at the beginning of the Health Effects section: "In 2009, the WHO recommended that the theoretical benefits of ENDS should be weighed against current NRT products and the risk that the products will appeal to nonsmokers." Would that suit everyone? Equazcion ^(talk) 04:08, 14 Aug 2013 (UTC)

I'd rather that it wasn't in the Health Effects section at all because it's not a health effect. As it's directed at legislators maybe it could be fitted in under Legal History?--FergusM1970^{Let's play Freckles} 04:13, 14 August 2013 (UTC)

We'd probably have to include the part about "regulators" then but I guess that would be alright. Waiting for Zad's take. Equazcion ^(talk) 04:19, 14 Aug 2013 (UTC)

Should go in the section on health effects under a subsection called addition. Many raise the concern of addition not just the WHO. Does anyone specifically refute it? Saying that their is no risk of addition? Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:38, 14 August 2013 (UTC)

No, because it is not a health effect. If I have a table in the corner it is a piece of furniture. If I say "That corner would be a good place for a table" that is not a piece of furniture. The WHO's concern about non-smokers becoming addicted to e-cigs is not a health effect of e-cigs because non-smokers are not in fact using them.--FergusM1970^{Let's play Freckles} 14:23, 14 August 2013 (UTC)

Effects on lungs

This ref states "Studies have shown that e-cigarettes can cause short-term lung changes that are much like those caused by regular cigarettes" [3] Wondering if we should add a summary of this? Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:48, 14 August 2013 (UTC)

I assume the ref is talking about the Greek study that found a temporary increase in airway resistance after e-cig use. There are probably better secondary sources mentioning that, because the one you linked is an advocacy piece with a lot of factual errors in it, but it would definitely be an appropriate thing to include under Health Effects.--FergusM1970^{Let's play Freckles} 14:29, 14 August 2013 (UTC)

Existing regulation

"In nine Member States (see Annex), with no specific rules, e-cigarettes are subject to existing product safety legislation." That's from the EU library briefing; it is not "incorrect original research." I'll get a source for the labeling requirements too. It is inaccurate to portray e-cigs as being unregulated in the EU market. They are not unregulated. They have to meet exactly the same standards of safety and suitability for purpose as any other consumer product, even if there are no specific national regulations in place.--FergusM1970^{Let's play Freckles} 17:33, 15 August 2013 (UTC)

At some level every market is "regulated" by general regulatory provisions. However, the concern of Cancer Research UK is that: "Currently e-cigarettes are not regulated in the way that approved nicotine replacement therapies (NRT) such as patches and gum are. This means they haven’t undergone all the rigorous tests needed to ensure their safety and effectiveness" (their bold). For you to produce some general EU document and assume that the kind of regulation it mentions applies to the UK and contradicts CRUK's statement, is purest OR. Alexbrn ^{talk|contribs|COI} 17:56, 15 August 2013 (UTC)

I don't care about the concerns of CRUK. The market is NOT unregulated and claiming that it is unregulated is deliberately misleading. Please stop inserting this rubbish.--FergusM1970^{Let's play Freckles} 18:11, 15 August 2013 (UTC)

And OF COURSE the legislation it refers to applies to the UK! Or are you now saying it's OR to claim the UK is an EU member?--FergusM1970^{Let's play Freckles} 18:12, 15 August 2013 (UTC)

EU law does not directly apply in member states; localised versions of it are later enacted from state to state. you are edit-warring a change into the article based on your own OR assuming you understand health regulation in the UK better than its leading cancer organisation. Alexbrn ^{talk|contribs|COI} 20:31, 15 August 2013 (UTC)

There is no OR involved. The EU document I linked to clearly says that the consumer protection law applies in the nine EU states with no specific legislation. Anyway, what makes CRUK uniquely qualified to comment on legislation? They're a cancer charity, not legislators, and if they are saying that e-cigs are not regulated then they are either mistaken or lying. E-cigs are regulated in the UK - just as consumer products, not as NRT. Why is that? It's because they are consumer products! They're not regulated the way CRUK want them to be, but that is very different from not being regulated. Please stop accusing me of OR.--FergusM1970^{Let's play Freckles} 20:36, 15 August 2013 (UTC)

Everything on the market is regulated by general regulation, but your qualification of CRUK's concerns makes it look like their specific concerns about dosage and consistency are unfounded. Which is OR/SYNTH. And misleading. And, you've edit-warred it into the article. Alexbrn ^{talk|contribs|COI} 20:44, 15 August 2013 (UTC)

If everything on the market is regulated then e-cigs clearly aren't unregulated, are they? CRUK is complaining that they're not regulated as NRT, but that's because they are not NRT, so why would anyone expect them to be? This is not a health effect of e-cigs; it's a category error by CRUK.--FergusM1970^{Let's play Freckles} 20:47, 15 August 2013 (UTC)

According to your OR it is. For their meaning of the word "regulated" e-cigs are not regulated; you are supplying your own meaning from elsewhere to undercut the source. It would be better to clarify with something like "according to CRUK, e-cigs are not regulated so that consumers can be sure they deliver consitent dosage...." Alexbrn ^{talk|contribs|COI} 20:53, 15 August 2013 (UTC)

What fucking OR? E-cigs are a consumer product and they are regulated as a consumer product. They aren't checked for dosage because they're not a medicine. Nobody CARES about consistent dosage.--FergusM1970^{Let's play Freckles} 20:56, 15 August 2013 (UTC)

In fact I'll expand on that. "Consistent dosage" is exactly what consumers do not want. Why do you think VV and VW devices are so popular? It's because they let users adjust the "dosage" to suit. CRUK are complaining because, in their opinion, e-cigs lack a feature that is in fact undesirable.--FergusM1970^{Let's play Freckles} 21:02, 15 August 2013 (UTC)

Now, as far as existing regulation goes, all e-liquid must be accurately labeled with its nicotine content in mg per ml. If that's not consistent then it isn't because the market is unregulated; it's because the regulation is not being enforced. All the liquid I use is TüV-certified for nicotine content, and I trust the TüV standard. "Dosage," at the level of nicotine content, is therefore consistent. Beyond that the only way to ensure a consistent dose with each inhalation is to preset the device so that each activation has an identical burn time, identical airflow volume and identical power delivery to the head. That is not physically possible and nobody would buy such a device anyway. For that reason alone, never mind the others I've stated (not an NRT, no actual health effect mentioned etc.) CRUK's concern whoring does not belong in the Health Effects section. It is not a health effect; it's just a whine about e-cigs not being regulated the way they want them to be. As of now CRUK's official position is that they're no longer going to discuss their stance on e-cigs because they don't like the answers they got.--FergusM1970^{Let's play Freckles} 21:22, 15 August 2013 (UTC)

Seems like appropriate place for safety concerns due to lack of regulation. In "Herbalism" that concern's listed under "safety" - which seems pretty equivalent the the "health effects" section here.Dancingsnails (talk) 02:24, 16 August 2013 (UTC)

But what is the "safety concern"?! There isn't any given. It's just "Oh well, not regulated as medicines." That may just possibly be because the people who make them, the people who sell them and the people who use them are all insisting vehemently that they are not medicines. The "consistent dose" thing is just waffle. Are coffee machines tested to ensure they deliver a consistent dose of caffeine? No. So why is it a health effect if e-cigs aren't tested to ensure they give a consistent dose of nicotine (which, as I've already explained, the users don't want them to do anyway)? The Health Effects section is for effects on health, not irrelevant complaints from people who don't even understand the subject.--FergusM1970^{Let's play Freckles} 02:32, 16 August 2013 (UTC)

And what's with the "lack of regulation" stuff anyway? I've already provided an RS to demonstrate that e-cigs are regulated in the UK. Can we please stop pretending that they aren't?--FergusM1970^{Let's play Freckles} 02:33, 16 August 2013 (UTC)

ECigs are not unregulated - Indeed... They are not regulated as a medical product but under consumer protection legislation. And this is the crucial point of the "health lobby" when complaining about "an unregulated product" - They mean "not regulated as medicines" when they say "unregulated". Most products fall under general consumer protection legislation and therefore also ECigs.--Merlin 1971 (talk) 16:36, 16 August 2013 (UTC)

This would be a fine argument for changing some wording so as to be clearer.Dancingsnails (talk) 18:31, 16 August 2013 (UTC)

Yes. It would also be a good time to consider if "Not regulated as a medicine" is actually a health effect. Which it clearly isn't.--FergusM1970^{Let's play Freckles} 19:32, 16 August 2013 (UTC)

Stick to actual health effects

This article contains a section on health effects. That's great. However what is not great is that it keeps attracting vague, unfounded "concerns." These do not belong in it. A health effect is an effect on health. It is not somebody's unsupported statement that "Well, if non-smokers were using these - which we know they're not, but anyway - they might get addicted to nicotine" or "There would be no regulation on these products if the market was unregulated. We know it is regulated, but we want to express our concerns anyway." So what if e-cigs aren't subject to the same checks as NRT? Neither are coffee machines. There's even a reason for that: Neither of them are NRTs. CRUK's whining about e-cigs not being regulated as medicines is many things, but it is not a health effect of e-cigs and it doesn't belong in that section.--FergusM1970^{Let's play Freckles} 18:20, 15 August 2013 (UTC)

We follow reliable secondary sources from major national and international bodies. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:29, 17 August 2013 (UTC)

Yes, I know that. However that doesn't change my basic point that vaguely expressed concerns about a hypothetical risk are not health effects. If non-smokers were becoming addicted to nicotine by using e-cigs that would be a health effect. Someone saying that if non-smokers used them they would become addicted to nicotine is not. If people pounded e-cigs into their ears with a hammer then e-cigs would cause intracranial bleeding, so should we list that as a health effect, too? I know it isn't happening, but neither is uptake by non-smokers.--FergusM1970^{Let's play Freckles} 10:35, 17 August 2013 (UTC)

Doc James, I'm not sure if this helps but I think Fergus is saying that health organizations could say a wide range of things that although notable can nevertheless belong under several different headings. Just because a prominent health organization has said something doesn't automatically make it viable medical information. We can use some common sense to file things where they belong, rather than say medical organizations' statements always necessarily equal medical data. Equazcion ^(talk) 15:04, 17 Aug 2013 (UTC)

Yes, that's pretty much what I mean. Just because the WHO/CRUK/whoever express "concerns" about something doesn't mean it's an effect e-cigs have on health. The whole thing about getting non-smokers addicted to nicotine falls under that heading. If non-smokers used e-cigs they may well become addicted to nicotine, but that isn't actually an effect e-cigs have on health because as we already know from the existing research non-smokers don't use them.--FergusM1970^{Let's play Freckles} 15:50, 17 August 2013 (UTC)

E-cigs are still fairly new. The truth is no one knows if non-smokers will start trying e-cigs as they become more popular. Health organizations have to deliver warnings and guidelines based on incomplete information. This doesn't mean that they're pulling them out of their ass. They're reading what studies have been done and extrapolating from other problems encountered. The "concerns" are real. They may not stay real however, and we'll need to be careful to not propagate fears that have since been determined to be unfounded.Dancingsnails (talk) 17:58, 17 August 2013 (UTC)

Why would non-smokers try something that simulates smoking? As it happens I think in the future some non-smokers will take up vaping, but they'll be the ones who otherwise would have taken up smoking. Anyway, warnings and guidelines are not health effects and don't belong in that section of the article, especially as the ASH study seems to show that they are indeed unfounded.--FergusM1970^{Let's play Freckles} 18:10, 17 August 2013 (UTC)

You may be right that non-smokers won't take up vaping, but I can guarantee that some marketing departments will try to change that. In any case this the wrong forum for that discussion. As far as where the place to put warnings and guidelines from health organizations, for users coming to find the current state of research into health effects of e-cigs, you're correct; this would be fluff they'd need to wade through. For users coming with a question like "are e-cigs safe?", this is an entirely appropriate place for these kinds of warnings.Dancingsnails (talk) 18:35, 17 August 2013 (UTC)

Electronic hookah

You're invited to vote at Wikipedia:Articles for deletion/Electronic hookah. Equazcion ^(talk) 00:37, 20 Aug 2013 (UTC)

Efforts to remove a ref to WHO

Not sure why the efforts to remove this reference in the smoking cessation section.[4] [5] Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:32, 27 August 2013 (UTC)

Looks like I inadvertently removed it while reverting an edit that put some bad grammar back in. Sorry about that. It's a good source for what the WHO are saying, even if I personally think it's bollocks.--FergusM1970^{Let's play Freckles} 10:20, 29 August 2013 (UTC)

One suggestion however. The WHO's negativity seems to contradict the emerging consensus that e-cigs, while not actually intended or marketed as a smoking cessation aid, do seem to be effective when used for that purpose. Therefore it might be better to move it to the bottom of the section rather than the top.--FergusM1970^{Let's play Freckles} 10:23, 29 August 2013 (UTC)

No one was trying to remove it. They were moving it to the article intro instead of the cessation section. When you restored it to the cessation section you basically duplicated it -- the full ref code is now in both places. As for where it should be, I don't think it's all that relevant to the intro statement, and should have probably stayed in cessation. Equazcion ^(talk) 11:30, 29 Aug 2013 (UTC)

It is usual to have the same ref more than once when it is used to support more than one statement. It was already in the intro thus, it was not being moved. This statement is a little strange "The WHO's negativity seems to contradict the emerging consensus" There is no emerging consensus. Everyone agrees that there is very little evidence. Most want some before making any conclusions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:50, 29 August 2013 (UTC)

Actually an increasing number of organisations are saying straight out that vaping is safer than smoking. The WHO is one of the few that's saying it might not be. As for their effectiveness at smoking cessation that's becoming more accepted too because, while there haven't been any clinical studies yet, it's far too obvious for any sane person to deny.--FergusM1970^{Let's play Freckles} 11:27, 30 August 2013 (UTC)

Okay can you provide refs. The FDA is obviously not one of them [6] NICE also had reservations "The PDG recognised that electronic cigarettes and similar products could, without regulation, be marketed in a way that may ultimately promote smoking" and "All available evidence relates to electronic cigarettes (e-cigarettes). There is no evidence on the long-term safety of e-cigarettes, whether used alone or with concurrent cigarette smoking. There isn't a large volume of reliable evidence on the short-term safety of e-cigarettes."Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:00, 30 August 2013 (UTC)

That FDA page is not a credible source. It doesn't link to any studies and it's based on out of date information. There have been several recent studies on the contents of e-cig vapour and it contains nothing that presents a significant hazard.--FergusM1970^{Let's play Freckles} 13:13, 30 August 2013 (UTC)

You stated that "an increasing number of organisations are saying straight out that vaping is safer than smoking" I asked for a ref. Any references? The FDA is an organisation that is credible that does not come out and say e-cigs are safer than smoking. But that is not really the only question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:21, 30 August 2013 (UTC)

Watch a BMA spokesman say that vaping is safer than smoking here.--FergusM1970^{Let's play Freckles} 13:30, 30 August 2013 (UTC)

A video posted on http://www.redheadfullofsteam.com? Do they state this on the British Medical Association website? How about in a review article? Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:35, 30 August 2013 (UTC)

The unedited version is also available. Would you prefer that?--FergusM1970^{Let's play Freckles} 13:40, 30 August 2013 (UTC)

I want a review article or text either publish on the website of the organization in question or in a journal. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:42, 30 August 2013 (UTC)

Well I'm not giving you one, because this is a talk page and I don't need to RS my comments.--FergusM1970^{Let's play Freckles} 13:43, 30 August 2013 (UTC)

Position of WHO statement

As WHO is an internationale health organization it makes sense to have its statement listed first rather than that of a national organization. Thus restored the position. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:23, 30 August 2013 (UTC)

However this is just a comment by a WHO official; it isn't a reliable secondary source like the BMA etc's statements about emerging evidence of efficacy. Studies have been done. E-cigs help people quit.--FergusM1970^{Let's play Freckles} 13:28, 30 August 2013 (UTC)

It's a WHO organizational statement cleared through their media centre. It's good to have it prominent. Alexbrn ^{talk|contribs|COI} 13:31, 30 August 2013 (UTC)

So neither the FDA nor the WHO are reliable source? Sorry no. Things would go much better if you started providing refs for statements like "E-cigs help people quit." Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:33, 30 August 2013 (UTC)

I have no interest in providing refs for statements like "E-cigs help people quit" because I'm not planning to add it to the article. I don't have to source statements on talk pages. However I know that e-cigs helped me quit. I'm currently chatting to someone else who quit thanks to e-cigs. I know dozens more. I don't know anyone who successfully stayed quit with patches.--FergusM1970^{Let's play Freckles} 13:38, 30 August 2013 (UTC)

But why should it be more prominent than more detailed statements by other organisations that actually contain useful and accurate information? The WHO say no studies have been conducted but they are wrong.--FergusM1970^{Let's play Freckles} 13:36, 30 August 2013 (UTC)

But that's not what they say, is it? Alexbrn ^{talk|contribs|COI} 13:39, 30 August 2013 (UTC)

We are not referencing your personal opinion which is why you need to provide refs. Simply stating your personal opinion does not improve the article in question and thus is not appropriate for the talk page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:41, 30 August 2013 (UTC)

No. I do not need to provide refs because this is a talk page.--FergusM1970^{Let's play Freckles} 13:43, 30 August 2013 (UTC)

Lancet published study, e-cigs vs nic patches

In reference to the new study published in the journal The Lancet regarding eCigs being as effective as patches (7.3% for eCigs, 5.8% for patches).
• The Huffington Post, Electronic Cigarettes Help You Quit Smoking As Well As Nicotine Patches: Study, Amanda Chan, 2013-09-07
• Another, but less useful to WP First trial to compare e-cigarettes with nicotine patches
— al-Shimoni (talk) 17:35, 9 September 2013 (UTC)

The protocol for this study by Bullen is here: PMID 23496861 ... the study itself is so recently published that it doesn't even have a PMID yet. As is normal for a freshly-published primary study, we read it with interest but should wait until a secondary source has picked it up before including in the article... Zad68 17:44, 9 September 2013 (UTC)

Yes definitely interesting with great promise. Am with Zad and interested to see what the secondary sources make of it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:46, 9 September 2013 (UTC)

Reader feedback: I want to know if someone is...

198.207.222.136 posted this comment on 30 September 2013 (view all feedback).

I want to know if someone is smoking electronic cigarettes in my house, how will it affect me?

Any thoughts?

FergusM1970^{Let's play Freckles} 23:00, 11 October 2013 (UTC) Yes. It won't affect you. The vapour that's released is mostly water and propylene glycol. Propylene glycol is safe to inhale - it's used in nightclub "smoke" machines, asthma inhalers and hospital air conditioning. If someone is vaping an electronic cigarette near you (not smoking one - they don't give off smoke) you may be able to smell the flavourings depending on what sort of liquid they're using, but there is no risk to your health. The best evidence we have right now says there's little or no risk to their health either. Don't worry about it!

Personally, I don't have an opinion yet, as there is practically no solid research on e-cigarettes. However, Dow states that "breathing spray mists of [propylene glycol] should be avoided." (http://msdssearch.dow.com/PublishedLiteratureDOWCOM/dh_0047/0901b803800479d9.pdf#page=36) Here is the full quote:

"Inhalation of the vapors of propylene glycol (PG) appears to present no significant hazard in ordinary applications. However, limited human experience indicates that breathing of mists of propylene glycols may be irritating to some individuals. Prolonged inhalation of saturated vapors of PG have produced only minor effects in animals (irritation). However, such concentrations may be irritating to the upper respiratory tract and eyes of humans. Therefore breathing spray mists of these materials should be avoided. In general, Dow does not support or recommend the use of Dow’s glycols in applications where breathing or human eye contact with the spray mists of these materials is likely, such as fogs for theatrical productions or antifreeze solutions for emergency eye wash stations."

I'm going to be very interested to see what the research on this shows over the next 5-10 years. Lex.shrapnel (talk) 01:04, 12 October 2013 (UTC)

So am I, and not in an academic sense. However given that I already know the lethal potential of Varenicline and the uselessness of NRT, it's a risk I'm willing to take. The existing literature doesn't indicate any cause for concern from PG, and it's in widespread use with no apparent problems, so I'm pretty relaxed about it.--FergusM1970^{Let's play Freckles} 01:27, 12 October 2013 (UTC)

Reader feedback: Is it safe taking this with patches.

212.30.1.205 posted this comment on 4 October 2013 (view all feedback).

Is it safe taking this with patches.

Any thoughts?

FergusM1970^{Let's play Freckles} 23:13, 11 October 2013 (UTC) Not really. Recreational nicotine products like e-cigarettes or tobacco, and some nicotine replacement therapies like inhalators, let you adjust your nicotine intake. Patches don't. You should never use patches with another product that contains nicotine. The harmful dose of nicotine is a lot higher than most people think, but vaping or smoking while using a patch could still make you feel dizzy or ill.

Reader feedback: Can an e cigarette cause a f...

67.171.217.99 posted this comment on 11 October 2013 (view all feedback).

Can an e cigarette cause a fire? Are they safe in dormitory settings? Illustrate a serious of the products from past to present in comparison, perhaps including wooden devices, with psychological commentary on the physical component of holding an object? Is there any evidence that people use this as a gateway to smoking tobacco? Is it safe for others to breathe the vapor? Could the article condense the most recent legislation into one box?

Any thoughts?

FergusM1970^{Let's play Freckles} 23:17, 11 October 2013 (UTC) Lots of questions. OK. An e-cig is as likely (or unlikely) to cause a fire as anything else with a lithium ion battery in it, like a laptop or mobile phone. For this reason they're also just as safe in a dormitory setting. There is very strong evidence that e-cigs are NOT a gateway into smoking tobacco (look for the UK ASH studies) and most e-cig users are actually former smokers; it's a gateway out. The contents of the vapour have been tested in various studies and none of them have found harmful levels of anything, so at the moment it looks like it's perfectly safe for others to breathe it.— Preceding unsigned comment added by FergusM1970 (talk • contribs)

I think e-cigs are perhaps a teensy bit more likely to start fires than something like a cell phone, as e-cigs tend to contain actual heating circuitry. All modern commercial e-cigs contain an automatic cutoff of about 5 to 10 seconds, so it's still pretty unlikely; I just wouldn't put it quite at the same probability as just any other electronics. equazcion� 01:01, 12 Oct 2013 (UTC)

On the other hand the heating circuitry is tiny and very prone to popping if it overheats. If the tank has liquid in it the coil is cooled quite efficiently; if the tank is empty you have to pulse the coil when dry-burning or it'll almost certainly pop. I dare say I could set something on fire with my gennie atomizer, but I'd need to work at it; it certainly isn't going to happen by accident.--FergusM1970^{Let's play Freckles} 01:25, 12 October 2013 (UTC)

Incorporating new references

In researching this topic today myself, I found three interesting meta-analyses/summaries from CADTH (Canadian Agency for Drugs and Technologies in Health). The strongest, and most detailed, source is here: http://www.cadth.ca/media/pdf/htis/aug-2012/RC0380%20E-cigarettes%20Final.pdf. Some points from it:

- Some evidence found in support of cessation benefits

- Minor side effects from e-cigarettes

- One case of exogenous lipoid pneumonia has been associated with electronic cigarette use

The other two reports are here: http://www.cadth.ca/media/pdf/htis/sept-2011/RB0424_E-Cigarettes.pdf and here: http://www.cadth.ca/media/pdf/htis/july-2012/RA0590%20Propylene%20Glycol%20Inhalation%20Final.pdf. Both of these cover similar points to the previous reference.

Thought I'd suggest them here to get other authors' opinions on them, as this page appears to be active. They are notable references, so they should be included, but how best to include them is surely an open question. Lex.shrapnel (talk) 02:12, 28 September 2013 (UTC)

concerning "exogenous lipoid pneumonia": This case is a myth! See: http://tobaccoanalysis.blogspot.de/2013/05/german-cancer-research-center-lies.html --Merlin 1971 (talk) 18:04, 29 September 2013 (UTC)

As I am not a chemist, I cannot comment on the author's technical reasoning (i.e., lipoid pneumonia being caused by oils). Nevertheless, that's irrelevant, as a blog post cannot be used to discredit information from research papers released by two separate government agencies (Germany and Canada). Lex.shrapnel (talk) 19:22, 29 September 2013 (UTC)

In addition, the original German research report, that the blog mentions, would also be worth adding: http://www.dkfz.de/en/presse/download/RS-Vol19-E-Cigarettes-EN.pdf. As would the original research report that documented the pneumonia case: http://journal.publications.chestnet.org/article.aspx?articleid=1206478. Lex.shrapnel (talk) 19:30, 29 September 2013 (UTC)

Just for your information: The German research report had been corrected after this "blog post"! See: http://tobaccoanalysis.blogspot.de/2013/06/german-cancer-research-center-corrects.html — Preceding unsigned comment added by Merlin 1971 (talk • contribs) 21:35, 29 September 2013 (UTC)

Another information: Pls have a look at the original research report that documented the pneumonia case. Cite: "The patient reported a recent exposure to fumigation chemicals, as the result of a bedbug infestation of her apartment building 2 weeks prior to her hospitalization." This kind of bedbug infestation CAN lead to exogenous lipoid pneumonia - propyleneglycol, glycerol will not! So.. the unreflective takeover of the baseless headline "An Unexpected Consequence of Electronic Cigarette Use" by two government agencies is a kind of... relevant!?--Merlin 1971 (talk) 21:44, 29 September 2013 (UTC)

None of this is relevant. If you have third-party sources that counter the sources I've highlighted, then those would be relevant. Blogs and text added to pastebin are not relevant. Lex.shrapnel (talk) 23:04, 29 September 2013 (UTC)

Well the case is not relevant either. No medical result (or single paper) that is based upon a single observed incident can be interpolated to a generic result. Otherwise we'd have our articles in general would be populated by "In some cases (insert injection method here) to (insert compound here) can cause complete healing of (insert malady here)"... Suddenly homeopathic stuff would flood our articles on serious medical conditions. :) --Kim D. Petersen 23:24, 29 September 2013 (UTC)

Please refer to what I actually stated in my reference to the Canadian study. The statement "One case of exogenous lipoid pneumonia has been associated with electronic cigarette use" is absolutely supported by the references. There is no "interpolation to a generic result" being performed here. Every paper I highlighted so far has emphasized that MUCH more research is required. That would also be worthwhile highlighting. Lex.shrapnel (talk) 23:28, 29 September 2013 (UTC)

There are at least X documented cases of cancer going away after the patient got "treated" with homeopathic "medicine" - does that infer that we should use that in an encyclopedic article on those kinds of cancer? No, it most certainly doesn't. WP:WEIGHT and WP:MEDRS are the relevant policies here. WP is not an indiscriminate repository for information. If and when more research/cases show up, and the references become significantly better than this - possible. But that is a bridge to cross once it is reached. --Kim D. Petersen 00:24, 30 September 2013 (UTC)

That is a very poor analogy. The amount of research on cancer is mammoth, so in your hypothetical the "X documented cases" would be a tiny, tiny percent of all documented and researched cases. The amount of research on electronic cigarettes is, as highlighted by the sources, very small. The sources for the research papers are absolutely notable, easily passing MEDRS, and considering the distinct lack of existing research, and the acceptance of the findings by very significant organizations, the references easily pass WEIGHT as well. Lex.shrapnel (talk) 00:33, 30 September 2013 (UTC)

What is talked about here is inhalation of propyleneglycon and glycerine - this is not areas where the research is lacking. The particular case is a surprising find, something that the paper also stresses... and no further investigation was done. What we have is a small note at the end of a description of the paper in the CADTH report, in which they do not in any form focus on the paper, and the paper itself. Nothing that merits weight. Once more: If and when more cases show up, then we can cross the bridge towards including it in the article - but right now it is a nothing more than a curious case that may or may not be e-cig caused. --Kim D. Petersen 03:21, 30 September 2013 (UTC)

"What is talked about here is inhalation of propyleneglycon and glycerine - this is not areas where the research is lacking". Great, then it should be easy for you to find an overwhelming amount of references that directly counter the claim and then they can be included too. Until then it's just your opinion, which is irrelevant. "What we have is a small note at the end of a description of the paper in the CADTH report". It's highlighted in the "key message" section of the paper, so they obviously deemed it important. "but right now it is a nothing more than a curious case that may or may not be e-cig caused". Once again, that's just your opinion, which is irrelevant. Find a notable source that shares that opinion, however, and it will become relevant. Lex.shrapnel (talk) 15:51, 30 September 2013 (UTC)

Sigh! We cannot include something where the recorded instances of it happening is singular/unique/non-replicated. This is an encyclopedia not a newspaper. --Kim D. Petersen 16:18, 30 September 2013 (UTC)

You have already tried to claim that the reference(s) are not notable, which I directly addressed - i.e., two different government research agencies believe they are notable. In this regard, their professional views are relevant, your opinions are not. Lex.shrapnel (talk) 20:10, 30 September 2013 (UTC)

Please read WP:NOT with regards to WP as not an indiscriminate repository. As to notability, what you have is not really notable - CADH rapid responses are basically press-releases/responses to inquiries, which doesn't meet WP:MEDRS, the paper itself doesn't meet WP:MEDRS either (i quote):

Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources.

All in all, there is nothing here to meet WP:WEIGHT. And none of this is my opinion. --Kim D. Petersen 20:21, 30 September 2013 (UTC)

Your opinion about CADH is irrelevant. Nevertheless, while the Wikipedia policy regarding case studies does leave some wiggle-room (i.e., "generally"), and one could argue that it is relevant in this context (for the reasons I suggested), I'll concede (as I appear to be alone in my views). Lex.shrapnel (talk) 01:31, 1 October 2013 (UTC)

The claim that e-cigs were linked to a case of lipid pneumonia is one of the most notorious examples of ANTZ smear tactics, and rightly so. The cause of lipid pneumonia is - as the name suggests - inhalation of lipids. E-liquid does not contain lipids, for exactly this reason. The claim is based on the words of one ill-informed coroner and the wife of the victim, who spent quite a while shrieking to the press, "It was the oil in them e-cigs what done it." There is no oil in an e-cig. The claim does not belong in the article.--FergusM1970^{Let's play Freckles} 15:29, 12 October 2013 (UTC)

These opinions of yours are irrelevant. Beyond the obvious reasons (covered in Wikipedia policies), the fact that you didn't even bother to read the research report is particularly telling (especially considering I provided a link to it above). "The claim is based on the words of one ill-informed coroner and the wife of the victim [...]" The case in question was of a 42-year old woman, who did not die. Regardless, no one else seemed to share my view, and consensus would obviously be required to make such an addition in the face of such motivated opposition, so the debate need not continue. Lex.shrapnel (talk) 17:08, 14 October 2013 (UTC)

Irrelevant image or image description

Vapor production levels on an electronic cigarette

This image is irrelevant when considering the vapor production of an electronic cigarette. A lot of things influences the vapor prodduction: coil resistance vs battery voltage, airflow behavior inside of the atomizer, PG/VG ratio of the juice ect etc etc... In short, Vapor production vary greatly from one e cig to the next as you can see in this video. The image gives the wrong impression that all e cigs are the same.... Not true... I'll remove it. TheNorlo (talk) 15:51, 27 October 2013 (UTC)

You are correct. How can this be treated?...It's a common concern among cigarette smokers things like that, if they are going to try electronic cigarettes they want to know if it's gonna be the same..or very alike...things like taste, well, you can accept relatively easy a change on flavor, but the visual placer of seeing the "smoke"...not so easy to quit on that one..that's why patches and pills are not so effective. — Preceding unsigned comment added by Merak Marey (talk • contribs) 04:53, 28 October 2013 (UTC)