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| == Move discussion in progress == | |||
| ==Lead section== | |||
| I've looked hard at this article recently while closing a couple of RfCs, and the lead section is annoying me. The first paragraph is full of information about what e-cigarettes aren't, and about what they don't contain. I think this is unsatisfactory. I suggest rephrasing the lead so that it tells us in simple English what e-cigarettes are, who uses them, how they're used and why.—] <small>]/]</small> 23:46, 22 January 2015 (UTC) | |||
| :Agreed, there are many times in which the intro compares against a worse product to give E-Cigs the appearance of being a positive product. The intro actually uses the word "benefit" as though the product improves people's health. The intro also uses "tiny" as a weasel/advertisement word. | |||
| :The article is quite poor, due to both poor sources and poor extraction. Under Harm reduction, the sentence "Smoke from traditional tobacco products has 40 known carcinogens among the 10,000 chemicals it contains, none of which has been found in more than trace quantities in the cartridges or aerosol of e-cigarettes." appears. The source for that statement said they had not been found YET, the source also stated that high levels of diethylene glycol had been found in an E-Cig, I won't even get started on probable carcinogens ignored by the paper such as acetaldehyde, or completely ignored carcinogens found in even higher concentrations than tobacco cigarettes like formaldehyde. The source then states that the FDA has found carcinogens at detectable levels. The source also claims no adverse effects have ever been reported which is obvious bullshit. | |||
| :I think some of these sources need to be dumped and replaced with more up to date studies from better journals. ] (]) 02:44, 23 January 2015 (UTC) | |||
| ::I think the removal of sourced information is unacceptable within a 5 year limit. Misplaced Pages is not a crystal ball, if something hasnt been found, we cant look into the future for what "might" be found. The article already reads like a medical journal and is full of "uncertain", "unknown", and "unclear" statements. The negative pov is so prominent it is a problem. None of the chemicals you mention is missing, they are on a page that was broken out called Safety of electronic cigarettes. Unfortunately that page will likely be swamped with non ] secondary sources and formaldehyde claims on that page because of sensationalism and poor methodology () that the news has jumped on. ] 02:59, 23 January 2015 (UTC) | |||
| *Thank you both. Could we refocus on the first paragraph please?—] <small>]/]</small> 09:31, 23 January 2015 (UTC) | |||
| ::Sure, do you have any specific changes? ] 14:02, 23 January 2015 (UTC) | |||
| :::I can draft something if you like? Means I won't be closing any more RfCs here, but hey ho. :-)—] <small>]/]</small> 14:19, 23 January 2015 (UTC) | |||
| ::::With the limited amount of closers that may not be a good idea in the long run. I have read the first paragraph, and like most of the article it is bloated. In fact the whole lede is bloated. something as simple as | |||
| :::::An electronic cigarette (e-cig or e-cigarette), personal vaporizer (PV) or electronic nicotine delivery system (ENDS) is a battery-powered vaporizer which has a similar feel to tobacco smoking. In general, they have a heating element that atomizes a liquid solution known as e-liquid. E-liquids are usually a mixture of propylene glycol, glycerin, nicotine, and flavorings. Others have similar ingredients but without nicotine. | |||
| :::: might be better. ] 14:41, 23 January 2015 (UTC) | |||
| {{unindent}} Here's my effort:<p>{{quote|E-cigarettes are electronic devices that mimic the sensation and effects of cigarette smoking. They are generally cylindrical in shape, roughly the size of a conventional cigarette, and often made of plastic. Typically, when the user takes a puff from the e-cigarette, a liquid within the body of the device is vapourised by a heating element. The user inhales this vapour, which usually contains nicotine and flavourings. Most e-cigarettes have refillable cartridges for this liquid and so can be reused, although there are some disposable models.<p>In contrast to normal cigarettes, e-cigarettes create almost no odour, and they are considerably cheaper to use. E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes as well, although medical sources are cautious about these claims. Use of e-cigarettes has been steadily increasing since the first models were marketed in 2004. Almost all users are smokers or ex-smokers.}}<p>Any good?—] <small>]/]</small> 14:57, 23 January 2015 (UTC) | |||
| ::Commenting on the inaccuracies you mentioned. I see these: | |||
| ::*"roughly the size of a conventional cigarette, and often made of plastic" This may be ok for first generation e-cigs but not second and third which commonly have components made of glass and metal. They are also larger and dont use the same form of a tobacco cigarette. | |||
| ::*"Most e-cigarettes have refillable cartridges" again, this is a first generation device, second and third to not use cartridges. | |||
| ::*"although medical sources are cautious about these claims." not all medical sources are cautious, some have already stated that use in harm reduction (for those who are addicted to nicotine and cant or wont quit tobacco) there is a good reason to use them. | |||
| ::This was just from a quick reading. ] 15:45, 23 January 2015 (UTC) | |||
| : I think AF's is better than yours S.M. simply because yours actually contains some inaccuracies. Most e-cigs are larger than a cigarette by a significant margin, contain more metal than plastic. Typically a button is required to activate rather than a puff. The second paragraph is pretty good. | |||
| :''Preceeding unsigned comment by ]'' | |||
| :<br>AF, also remember that we have to generalise to some extent to keep the lead simple even if cartridge is not always technically correct. I think you will find that the vast majority of medical sources are naturally cautious, regardless of whether they are mainly supportive of the technology or not. AF's idea is the same as what we already have, with a couple of lines removed. I think that ]'s idea is more descriptive and informative, in fact very well written, disinterested and impartial as it should be. Just need to replace | |||
| :<blockquote>They <s>are generally cylindrical in shape, roughly the size of a conventional cigarette</s>, and often made of plastic.</blockquote> | |||
| :To be replaced with: | |||
| :<blockquote>They vary in physical shape and size and are often made of plastic '''and metal'''.</blockquote>] (]) 15:51, 23 January 2015 (UTC) | |||
| ::Thats better. I can agree to let the medical experts line go, for the reason you mentioned. But how about a slight change to the cartridges line to "E-cigarettes can have refillable cartridges". ] 16:09, 23 January 2015 (UTC) | |||
| :::So basically remove "Most e-cigarettes have" and replace with "E-cigarettes can have? Yeah I have no issue with that since it's more accurate.] (]) 16:18, 23 January 2015 (UTC) | |||
| ::::Yes, the rest of the line stays. ] 16:23, 23 January 2015 (UTC) | |||
| There is a move discussion in progress on ] which affects this page. Please participate on that page and not in this talk page section. Thank you. <!-- Talk:Usage of electronic cigarettes#Requested move 28 November 2023 crosspost --> —] 13:48, 28 November 2023 (UTC) | |||
| I think SM's wording is better and raises a very important issue that AF's editorial comments address. Many devices after first generation eCigs are less eCigs and more PV's. This could be considered semantical, but is akin to saying a cigar is a cigarette or vice versa. Both have strong similarities, but both are generally kept distinct as two different type of products, consumed by different group of users (generally speaking). I would also note that most of the scientific studies (sourced on the article page) are using first generation devices or ones that operate like them. Lumping everything together in one big article is doable, but continues to be a challenge because a) they are distinct devices and b) users of more advanced gear tend to harp on items that may not be the case with first generation-like devices (i.e. advanced gear is ideal for smoking cessation). If the goal here is to shorten up the lead, present info on what an eCig is and stay away from what an eCig is not, then I'd prefer SM's wording. But if goal is to be as comprehensive as possible with all current devices that could plausibly fall under the eCig umbrella and present an article that tries to cover everything, including all political angles, then I would think we'd continue in vein that is already existing. And continue in vain attempt to appease pro-cessation crowd mixed with anti-tobacco (or tobacco control) crowd. ] (]) 18:01, 23 January 2015 (UTC) | |||
| *OK, so I've made those changes, lightly copyedited and reduced the beautiful spellings of Her Majesty's English down to the simplified American dialect used in this article. I get: {{quote|E-cigarettes (also known as electronic cigarettes, e-cigs, personal vaporizers, PVs, etc.) are electronic devices that mimic the sensation and effects of cigarette smoking. They are somewhat larger than conventional cigarettes, and are made of metal and plastic. Typically, when the user takes a puff from the e-cigarette, a liquid within the body of the device is vaporized by a heating element. The user inhales this vapor, which usually contains nicotine and flavorings. E-cigarettes can have refillable cartridges for this liquid and most can be reused, although there are some disposable models.<p>In contrast to normal cigarettes, e-cigarettes create almost no odor, and they are considerably cheaper to use. E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes as well, although medical sources are cautious about these claims. Use of e-cigarettes has been steadily increasing since the first models were marketed in 2004. Almost all users are smokers or ex-smokers.}}<p>Any better?—] <small>]/]</small> 22:36, 23 January 2015 (UTC) | |||
| :For the sake of accuracy, I would still prefer "They vary in size" but will accept "they are somewhat larger than conventional cigarettes" since the vast majority probably are larger than a standard size cigarette to some degree or other. I may just be nit-picking on that point, over all it looks pretty good.] (]) 22:52, 23 January 2015 (UTC) | |||
| ::I think the "They vary in size" is important, because most cigalikes (first generation devices that look like a tobacco cigarette) are larger than a combustible cigarette. Leaving out the vary in size ignores the second and third generation. Another note for accuracy, cartridges for the most part are not refillable, while some may refill them, they are not designed to be refilled. Cartridges are meant to be unscrewed and disposed of. Being able to refill really started in the second generation with clearomizer tanks. ] 00:01, 24 January 2015 (UTC) | |||
| *"They vary in size" gives the uninformed reader no useful information at all, so it's better to remove the phrase completely. I'll also tweak the "taking a puff" sentence and the "cartridges" sentence to remove inaccuracies that have been pointed out during this discussion, which gives me: {{quote|E-cigarettes (also known as electronic cigarettes, e-cigs, personal vaporizers, PVs, etc.) are electronic devices that mimic the sensation and effects of cigarette smoking. They are made of metal and plastic. Typically, the user activates the e-cigarette by taking a puff or pressing a button. This causes a heating element to vaporize a liquid within the body of the device. The user inhales this vapor, which usually contains nicotine and flavorings. Most e-cigarettes can be refilled and reused, although there are some disposable models.<p>In contrast to normal cigarettes, e-cigarettes create almost no odor, and they are considerably cheaper to use. E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes as well, although medical sources are cautious about these claims. Use of e-cigarettes has been steadily increasing since the first models were marketed in 2004. Almost all users are smokers or ex-smokers.}}<p>Are we nearly there, do you think?—] <small>]/]</small> 00:17, 24 January 2015 (UTC) | |||
| :The last one was OK by me and this one, being an improvement, is obviously also fine.] (]) 01:33, 24 January 2015 (UTC) | |||
| :Looks good, though they may need to be combined into one paragraph to satisfy the restrictions on the lede size. ] 01:51, 24 January 2015 (UTC) | |||
| ::"they are considerably cheaper to use." | |||
| :::Which ref supports this? | |||
| ::"E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes as well, although medical sources are cautious about these claims." | |||
| :::Oppose this wording. Health effects are discussed in the second paragraph. We want the evidence not the marketing claims first. | |||
| ::"Almost all users are smokers or ex-smokers." | |||
| :::Some refs are reporting that a fair number of users have never used cigs. Thus maybe most. But this is discussed in the 4th paragraph. | |||
| ::"The user inhales this vapor" | |||
| :::Not a vapor technically but an aerosol. | |||
| ::] (] · ] · ]) 02:58, 24 January 2015 (UTC) | |||
| :::We will need refs to support this content as it is controversial. ] (] · ] · ]) 03:02, 24 January 2015 (UTC) | |||
| ::::Please provide language in the article and source that says most e-cig users have never smoked cigs. The forth paragraph says "About 60% are smokers and most of the rest are ex-smokers". ] 04:10, 24 January 2015 (UTC) | |||
| ::::It would seem odd that you have chosen to describes the words of an up until now, heavily active uninvolved editor as "marketing claims". I put it to you that the claims made would not be particularly controversial to most people without a heavy interest in the subject and in many cases qualify as obvious facts.] (]) 04:38, 24 January 2015 (UTC) | |||
| ::::As an example you oppose the wording ""E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes". Yet it is patently obvious that most users think they are healthier since that's the reason that they use the product. And hardly "controversial" that manufacturers think they are healthier either.] (]) 04:50, 24 January 2015 (UTC) | |||
| {{unindent}}Doc James' view is reasonable and I was hoping he'd weigh in.<p>1) '''Are e-cigarettes cheaper?'''<br>This will obviously depend on the tax treatment of tobacco in any particular jurisdiction. In June 2013, here in the UK, e-cigarettes were about 20% cheaper to use than conventional cigarettes (, ). In other jurisdictions the difference will vary, but I think cost is a major motivator for people to switch from cigarettes to e-cigarettes.<p>2) '''Marketing claims'''<br>There are no marketing claims in my draft and I emphatically deny any connection with the e-cigarette industry. My motivation in writing this draft is exactly as I posted right at the start of this discussion: "rephrasing the lead so that it tells us in simple English what e-cigarettes are, who uses them, how they're used and why". The "why" part of that is the key one here. If you're under the impression that it's a good idea to start an article about e-cigarettes with the criticisms of them, then I disagree with you. A thorough criticism section belongs in the article. It doesn't belong in the first couple of paragraphs.<p>3) '''Vapor vs aerosol'''<br>The lead needs to be a non-technical introduction to the subject for the curious and intelligent, but uninformed, reader. An "aerosol", to the uninformed, is a kind of spray can. "Vapor", to the uninformed, is a suspension of droplets. I think we can, and should, go into this later and explain why aerosol is the correct technical term, but I think that the lead needs to be the view from 30,000 feet, and will therefore necessarily not be strictly accurate on all the details.<p>I hope this clarifies?—] <small>]/]</small> 09:27, 24 January 2015 (UTC) | |||
| :It's not so much what is often said on here but the inflammatory way in which its said, which I commend you for not reacting to. In any case you don't need to look far to realise that all of the things requested are backed up by MEDRS sources that are already in the article: | |||
| == Cannabis == | |||
| :*''Claim'': "they are considerably cheaper to use." | |||
| :*'''': "Electronics cigarettes... are relatively inexpensive" | |||
| Vaping isn't only for nicotine. I'd like to see this article expanded to include the increasingly common practice of vaping cannabis products. ] (]) 22:57, 28 March 2024 (UTC) | |||
| :*''Claim'':""E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes as well, although medical sources are cautious about these claims." | |||
| :*'''':"Users report buying them to help quit smoking, to reduce cigarette consumption, to relieve tobacco withdrawal symptoms due to workplace smoking restrictions and to continue to have a ‘smoking’ experience '''but with reduced health risks'''" | |||
| :*'''': "Grana and Ling 3 reviewed 59 single-brand e-cigarette retail Web sites in 2012 and found that the most popular claims were that the products are healthier (95%)" | |||
| :* Incidentally, Caponnetto even goes as far themselves as to say: "Smokers who decide to switch to electronic cigarettes instead of continuing to smoke would achieve large health gains." | |||
| :They have different nomenclature and health effects. E-cigarettes replace cigarettes. THC vapes are not intended to simulate cigarettes and are often referred to as vape pens. | |||
| :*''Claim'': "Almost all users are smokers or ex-smokers." | |||
| :While all e-cigarettes are based on glycerin and/or propylene glycol, THC vapes usually use an oily substance. ] (] • ] 02:29, 18 April 2024 (UTC) | |||
| :*''Grana'': "All population-based studies of adult use show the highest rate of e-cigarette use among current smokers, followed by former smokers, with little use among nonsmokers" | |||
| ==Even unguided e-cigarette use among smokers unwilling to stop smoking is effective in causing smoking cessation== | |||
| :*''Claim'': "The user inhales this vapor" | |||
| :*''Public Health England'': "Electronic cigarettes typically comprise a re-chargeable lithium ion battery, and a battery powered atomiser which produces vapour... Not all electronic cigarettes include nicotine; some simply produce vapour for inhalation" | |||
| :*Many medical sources use "vapour" exclusively, a couple like Grana point out that this is not technically correct. | |||
| :*Furthermore there was a on this topic which decided that either vapor or aerosol was fine to use, regardless of what word a particular source uses.] (]) 14:30, 24 January 2015 (UTC) | |||
| We still have two paragraphs. | |||
| Most reviews state that the health effects are unclear These changes mix content in later paragraphs in the first paragraph (two paragraphs?). The first paragraph should just discuss contruction.] (] · ] · ]) 14:57, 24 January 2015 (UTC) | |||
| ] (] · ] · ]) 14:57, 24 January 2015 (UTC) | |||
| :We could just simply replace the first two paragraphs in the lead with the two being suggested, which would help to simplify and shorten a lead that is currently complicated and confused. This would be my preferred option. Alternatively the paragraphs could also be combined into one by dropping the paragraph tag and the text would still flow perfectly well. "Most reviews state that the health effects are unclear" is probably roughly correct and is represented in this proposal with "medical sources are cautious about these claims". However, reviews also remark that users and manufacturers think they are healthier. Misplaced Pages represents all prominent opinions, not just the medical community's. Certainly the medical reviewers of the likes of Grana and Caponnetto thought these were prominent enough to include in their reviews and I'm pretty sure that these opinions are also voiced in the mainstream media. I can find no suggestion that only construction should be discussed in the first paragraph at ]: | |||
| :<blockquote>"The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points, including any prominent controversies"</blockquote> | |||
| :<blockquote>The first paragraph should define the topic with a neutral point of view, but without being overly specific. It should establish the context in which the topic is being considered by supplying the set of circumstances or facts that surround it. If appropriate, it should give the location and time. It should also establish the boundaries of the topic</blockquote> | |||
| :] (]) 16:25, 24 January 2015 (UTC) | |||
| ::I agree that the lede as it is now is overly complex and way to detailed. ] 16:34, 24 January 2015 (UTC) | |||
| I propose simplifying the first paragraph to: | |||
| What is this meant to mean?—] <small>]/]</small> 16:31, 18 April 2024 (UTC) | |||
| <blockquote> | |||
| An '''electronic cigarette''' (also known as '''e-cig''', '''e-cigarette''', '''personal vaporizer''' or '''electronic nicotine delivery system''' ('''ENDS''')) is a ]-powered ] which has a similar feel to ].<ref name=Caponnetto2012>{{cite journal|last1=Caponnetto|first1=Pasquale|last2=Campagna|first2=Davide|last3=Papale|first3=Gabriella|last4=Russo|first4=Cristina|last5=Polosa|first5=Riccardo|title=The emerging phenomenon of electronic cigarettes|journal=Expert Review of Respiratory Medicine|volume=6|issue=1|year=2012|pages=63–74|issn=1747-6348|doi=10.1586/ers.11.92|pmid=22283580}}</ref> In general, they have a ] that atomizes a ] known as e-liquid.<ref name=Weaver2014>{{cite journal|last1=Weaver|first1=Michael|last2=Breland|first2=Alison|last3=Spindle|first3=Tory|last4=Eissenberg|first4=Thomas|title=Electronic Cigarettes|journal=Journal of Addiction Medicine|volume=8|issue=4|year=2014|pages=234–240|issn=1932-0620|doi=10.1097/ADM.0000000000000043|pmid=25089953}}</ref> This produces an ],<ref name=Grana2014/><ref name=Cheng2014>{{cite journal|last1=Cheng|first1=T.|title=Chemical evaluation of electronic cigarettes|journal=Tobacco Control|volume=23|issue=Supplement 2|year=2014|pages=ii11–ii17|issn=0964-4563|doi=10.1136/tobaccocontrol-2013-051482|pmc=3995255|pmid=24732157}}</ref> which is frequently referred to as ].<ref name=Cheng2014/> E-liquids are usually a mixture of ], ], nicotine, and ].<ref name=Grana2014/> Others have similar ingredients but without nicotine.<ref name=Saitta2014/> They may be single use or refillable. | |||
| :It looks like someone read a study, took it as fact, and copied the text into the lead. I've tried to remedy it. ]] 17:09, 18 April 2024 (UTC) | |||
| </blockquote> | |||
| ] (] · ] · ]) 21:49, 24 January 2015 (UTC) | |||
| :That appears to be almost the exact same thing that is in the article. ] | |||
| ==Revert 24th April 2024== | |||
| ::I think its a bit of an improvement. As Marshall states, the old version suffers from the "what e-cigarettes are not" syndrome. They aren't a lot of things, but that isn't how they should be defined. | |||
| Re: {{diff2|1220517884|this revert}}. | |||
| ::I tend to disagree with Marshall though on the statement "Misplaced Pages represents all prominent opinions, not just the medical community's." Misplaced Pages does and should represent the opinions of competent authorities, especially on medical topics per ]. | |||
| AlexGallon, I can see why you've done this, but with this particular article we need to bear in mind our audience. A substantial proportion of the people who type "electronic cigarette" into the search box are teenagers considering taking a puff—and English isn't necessarily their first language. So the lead of this particular article tries to use the simplest possible grammatical constructions. Short, declarative sentences in the active voice with as few subclauses as possible. We can use college level English in the body text; it's just the lead that needs to be super-accessible.—] <small>]/]</small> 08:06, 24 April 2024 (UTC) | |||
| :::::"Ideal sources for biomedical assertions include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally reputable expert bodies. Being a "medical source" is not an intrinsic property of the source itself; a source becomes a medical source only when it is used to support a medical claim. It is vital that the biomedical information in all types of articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge."" | |||
| :Understood, and I agree with your reasoning{{snd}}very well explained, so thank you. ] (]) 18:59, 25 April 2024 (UTC) | |||
| ::We don't include the opinion of horticulturalists on the subject of surgery, nor that of chemists on the subject of world history. Everyone is entitled to an opinion, but having an opinion does not make one a reliable source for medical or other technical information. ] (]) 22:15, 24 January 2015 (UTC) | |||
| :::Yes because chemists and world history is a great analogy for e-cigarette users and e-cigarettes isn't it? It is simply hard to believe that it is being claimed that e-cigarette users' reasons for using e-cigarettes are irrelevant to an article about e-cigarettes. Yet the medical community's opinions are relevant. Even though that same medical community considers these views relevant and includes them in their research.] (]) 22:41, 24 January 2015 (UTC) | |||
| ::::Since the opinions are in the medical research, and are therefore sourced to MEDRS sources the argument falls flat. Its an argument about something that isnt being done. ] 23:01, 24 January 2015 (UTC) | |||
| :::::Yes the arguments being presented might fall flat, but the intended effect is achieved. The previously active steps towards consensus and compromise are averted and the discussion instead heads towards no consensus, the non-negotiable ] effectively being disregarded for other policies seemingly considered more important.] (]) 23:12, 24 January 2015 (UTC) | |||
| ::Yep precisely the same thing with the odd insignificant word swapped and "They may be single use or refillable" stuck on the end of it. In other words although the points raised above challenging what is wrong with the previous suggestion have not been answered, the editor simply wants to keep the original for an unknown reason.] (]) 22:19, 24 January 2015 (UTC) | |||
| *''I tend to disagree with Marshall though on the statement "Misplaced Pages represents all prominent opinions, not just the medical community's."''----This quote is misattributed. I did not say this, and I've never said it. But my position is that e-cigarettes are not medical devices, and they're not available on prescription or recommended for therapeutic use. We need to give priority to the medical community's view only insofar as the article makes medical claims.<p>I'm not keen on DocJames' version, which gives in great detail the exact chemical names and technical terms by which the vapour is produced, without making any attempt to explain what e-cigarettes are, who uses them or why they do it.—] <small>]/]</small> 23:45, 24 January 2015 (UTC) | |||
| == Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes. == | |||
| ::::Agree with ] that eCigs are not medical devices and that medical community's view comes into play when an article is overtly conveying medical related information about the topic. The lead need not do this, precisely because current medical information is unclear, inconclusive. Where it is not so unclear, it is biased. Our talk pages are full of those biases which amount to some editors wanting to tout eCigs as smoking cessation tools or other editors wanting to tout eCigs as potentially harmful based on claims from anti-smoking propagandist. There's a place for all that to occur, but not in the lead paragraph of what an eCig is, so that a reader gets an idea of what they are before getting entrenched in the ongoing political battle over what they could be. ] (]) 22:29, 25 January 2015 (UTC) | |||
| :::::I agree with 95% of what you say including the bit about the lead. However you say that "Our talk pages are full of those biases which amount to some editors wanting to tout eCigs as smoking cessation tools or other editors wanting to tout eCigs as potentially harmful based on claims from anti-smoking propagandist". It isn't quite as clear cut as that, no doubt there are at least a few editors on both sides trying to do that. But on what is frequently accused of being the "e-cig advocate" side, there are a good number of editors who want neither, instead simply wanting all sides of the debate described proportionally instead of exclusively the medico-cynical one. On the MED side of the debate, I see little appetite for that, I only see the opinion that the article should be treated as a medical one, e-cigs should be treated as medical devices and that therefore only the medical community's opinions (and organisations that derive their opinions directly from the medical community) should be allowed into any part of the article. With a few of these editors, but by no means all, this is even restricted to those sections of the medical community that are sufficiently cynical enough about the technology. This is what causes the problems since this article's subject is not a type of medical treatment and Misplaced Pages is meant to be NPOV and informative, not partisan and persuasive. I apologise for going off-topic but this needs saying since we very rarely make any significant progress towards consensus on here.] (]) 00:17, 26 January 2015 (UTC) | |||
| :::::::We use medical sources for health care content. We do not allow non medical sources to make medical claims. ] (] · ] · ]) 01:08, 26 January 2015 (UTC) | |||
| ::::::::I'm certainly not disagreeing with that a basic premise. But the main reason other sources are excluded from making medical claims is presumably on the grounds of public safety and consequent legal reasons, not simply as an excuse to promote one particular point of view over another on any subject. So it has to be weighed and balanced against other policies, some of which are non-negotiable, not just simply pursued at all costs without even common sense applied which is often what seems to happen.] (]) 01:43, 26 January 2015 (UTC) | |||
| {{unindent}}Well, it's basic common sense. It's not just on grounds of public safety. Homeopathic remedies, for example, won't do you any harm at all if you take them, so there are no public safety grounds why we'd insist on medical sources. When it comes to homeopathic remedies we'd insist on medical sources simply because the non-medical sources are, all too often, a tissue of lies written by people with a commercial motive for concealing the truth.<p>But I think it's important to restrict the reliance on medical sources to the actual medical claims. I mean, to take this to ludicrous extremes, if we wrote an article about cars based on medical sources, then it'd go something like: ''Cars are petrol-powered devices that emit toxic chemicals. They are the single largest cause of accidental death in the western world. By far the majority of hospital admissions caused by cars involve blunt force trauma...'' and we might get a few paragraphs about transporting people from place to place halfway down the article.<p>I'm being a bit facetious but the e-cig article genuinely does have this problem. It goes into details about toxins and harms before describing the essential purpose of the device.—] <small>]/]</small> 09:52, 26 January 2015 (UTC) | |||
| : Thank you for that analogy SM, that's exactly the right way to look at it. I really like the slightly simplified lead and believe the whole article would be improved if that attitude were taken more often. ] (]) 10:02, 26 January 2015 (UTC) | |||
| ::I agree. The whole article suffers from over reliance on medical sources as S Marshall pointed out in his analogy, it reads like a medical journal. What better place to start fixing it than at the top. ] 14:58, 26 January 2015 (UTC) | |||
| ::*Just to be clear, my position is that the sections about medical claims ''do not'' suffer from over-reliance on medical sources and in fact I'll argue for the removal of phrases such as "The limited evidence suggests that e-cigarettes are probably safer than traditional cigarettes", because I don't think we have enough medical evidence to say that in Misplaced Pages's voice. (We might say things like, "Sources X, Y and Z claim that e-cigarettes may be safer than traditional cigarettes" instead. That's a discussion for later.) In this discussion I'm trying to separate the parts of this article that should be written based on medical sources on the one hand, from the parts of the article that should be written from general sources on the other.—] <small>]/]</small> 15:29, 26 January 2015 (UTC) | |||
| ::::{{u|S Marshall}} You might want to consider where "The limited evidence suggests that e-cigarettes are probably safer than traditional cigarettes" is located. Its part of the daughter page Safety of Electronic cigarettes. On that page the line is completely dwarfed by negative statements. That page/section has been bloated beyond belief since it was moved. ] 15:56, 26 January 2015 (UTC) | |||
| ::::*Well, this is what I get for losing focus on the lead. Let's worry about that first. :)—] <small>]/]</small> 16:00, 26 January 2015 (UTC) | |||
| :::My thinking would be along the lines that if somebody is given advice to take homeopathic "medicine" for an infection, this could be potentially dangerous, even though the homeopathic treatment would not do any direct harm in itself. I have almost zero interest in homeopathy which is a theory of nothing in my opinion. But if it was up to me, an article about homeopathy would at some point, explain why most people use homeopathic medicine, why the medical community thinks that these reasons are effectively based on nonsense and it would be made clear that there is zero evidence to support any claims about homeopathy being effective. If you do not explain why people take homeopathic "medicines", then the counter-claims are almost meaningless and the article ends up looking confused and failing to include a basic description of the subject.] (]) 16:57, 26 January 2015 (UTC) | |||
| Response to ]' comments mis-posted in the sourcing section below: | |||
| * ], please combine the two paragraphs into one then we won't have any more complaints about two paragraphs being used. | |||
| * The bit about it sounding like an advert, it is simply a statement of fact. We are allowed to say things that might be perceived as being positive about a technology if it happens to be true. Your bet that this would not be the case globally is original research, please stick to what the sources say. Both Grana and PHE attribute cheap cost to the main reasons for use. | |||
| *"This is undue weight..." - we need to explain the reasons that people use the technology, cost and suspected health benefits are two of the main reasons as identified by ] sources such as Grana. Why not suggest a rephrasing of sentence if you aren't happy with the wording? | |||
| *"Usage is already discussed in the usage section" - So are the health effects, I don't see your point. <small><span class="autosigned">— Preceding ] comment added by ] (] • ]) 18:18, 26 January 2015 (UTC)</span></small><!-- Template:Unsigned --> <!--Autosigned by SineBot--> | |||
| ::Since Grana is the report for the WHO, I cant think of a more global perspective when dealing with cost as a reason. ] 19:01, 26 January 2015 (UTC) | |||
| This line is not supported by it's own sources, especially in the context of it's section regarding "gateway drugs". It has a heavy lean towards the negative. | |||
| ====Break for editing convenience==== | |||
| *Here's a re-edited version that attempts to address DocJames' concerns.{{quote|E-cigarettes (also known as electronic cigarettes, e-cigs, personal vaporizers, PVs, etc.) are electronic devices that mimic the sensation and effects of cigarette smoking. They are made of metal and plastic. Typically, the user activates the e-cigarette by taking a puff or pressing a button. This causes a heating element to vaporize a liquid within the body of the device. The user inhales this vapor, which usually contains nicotine and flavorings. Most e-cigarettes can be refilled and reused, although there are some disposable models.<p>In contrast to normal cigarettes, e-cigarettes create almost no odor, and in many jurisdictions they are cheaper to use. Some users feel that they are less harmful than conventional cigarettes as well, although in medical sources the benefits and risks of e-cigarettes are unclear. Use of e-cigarettes has been steadily increasing since the first models were marketed in 2004. Most users are smokers or ex-smokers.}}<p>Is this an improvement?—] <small>]/]</small> 19:44, 26 January 2015 (UTC) | |||
| > Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes. | |||
| ::I see this as improvement as it is simplifying things. Editors of this page ought to realize by now that the rest of the article will not be overly simplified like the lead is, but that the lead needs to be because all the sourced information is either inconclusive or caught up in a propaganda battle. So, the lead ought to really strive to present a simplified introduction of "what is an e-cigarette." | |||
| Suggest changing this to: | |||
| ::My only dispute, and perhaps it is minor, is that I'd prefer to see "user" replaced with "use" and make it less focussed on the person. Emphasize the product to help simplify the presentation. Example, "typically, an e-cigarette is activated by taking a puff or pressing a button on the device." I also don't think "and in many jurisdictions they are cheaper to use" is necessary. The observational differences between an e-cigarette and combustible cigarette are: 1) less odor (wording we have is fine), 2) no ash and 3) no side-stream vapor as the heating element is not constantly activated as a combustible cigarette is. Whether we mention any or all of these is TBD. The parts of "some users" and "medical sources" are items I'd rather see removed from the lead. And mostly because it introduces the controversy that I'm fairly certain (now) that editors of the page want to have on this article page, but need not be present in the lead. If truly deemed necessary in the opening paragraph(s) of what is an eCig, then I would propose a third paragraph that is distinct from what previous paragraphs were intending to do: present a simple understanding of what an e-cigarette actually is. ] (]) 20:13, 26 January 2015 (UTC) | |||
| > There is little evidence to suggest that e-cigarettes act as a gateway to traditional smoking at present, and further research is needed to clarify the strength and veracity of any correlations between the two. However, evidence does suggest that those who have smoked e-cigarettes will try a traditional cigarette at least once in their life. | |||
| ::*Hmm. ]. Either there are no objections left or else I've exhausted the objectors. I have no way to know which.—] <small>]/]</small> 13:10, 30 January 2015 (UTC) | |||
| :::I can't find medical material that claims e-cigarettes are more harmful than cigarettes. In fact the opposite is the case. While there is debate on ''how'' much less harmful they are, there really isn't a debate on them being at least somewhat less harmful. --] 13:19, 30 January 2015 (UTC) | |||
| ::::If most / all users continue with duel use than they are not less harmful. | |||
| ::::Do not see this an an improvement over what we currently have ] (] · ] · ]) 01:54, 31 January 2015 (UTC) | |||
| :::::That is incorrect, the WHO 2014 report said that duel users would have less benefits than quitting completely. Not that there were no benefits. As {{u|KimDabelsteinPetersen}} pointed out, the argument isnt "if" there is less harm, but how much less. ] 06:03, 31 January 2015 (UTC) | |||
| {{unindent}} As far as I can see there isn't an argument. There's a lack of data, which rather understandably means a significant proportion of the scientific community is unwilling to comment. I think it's well established that using NRT (which gives the nicotine without all the other harmful stuff that's in cigarettes) is better than smoking, and on this basis a few medical sources are speculating that e-cigarettes may possibly turn out not to be a completely terrible idea. What isn't established is whether there are any other harms from using e-cigarettes. For all we know they might contain chemicals that future doctors will realise are as harmful as lead and CFCs. (Probably not, though...)<p>I don't think that this Misplaced Pages article should suggest that e-cigarettes are a good idea on health grounds, and I'm trying to be careful not to imply that in the lead.—] <small>]/]</small> 16:30, 31 January 2015 (UTC) | |||
| :I think you misunderstand the uncertainty. There is loads of uncertainty as to how dangerous, or safe e-cigarettes are. But there is not a lot of uncertainty on them being safer than cigarettes. And we are not talking about ''"a few medical sources are speculating"'' - it is a common theme throughout all of the reviews that we have that e-cigarettes are considered safer than cigarettes... how much safer? No one knows .. but certainly safer. We can go through the reviews one by one if you want (which i don't think we have time for), but to address my point: Which review considers e-cigarettes less safe than cigarettes? If there is no such review, then we have to consider that reviews generally consider them safer. --] 16:55, 31 January 2015 (UTC)<small>Ie. saf'''er''' != safe, less harmfull != harmless --] 17:55, 31 January 2015 (UTC)</small> | |||
| ::Okay. What the draft says is ''in medical sources the benefits and risks of e-cigarettes are unclear''. I submit that this is accurate.—] <small>]/]</small> 19:54, 31 January 2015 (UTC) | |||
| :::Yes {{u|S Marshall}}, unclear, but not non existent. I dont think non existent is what you are thinking, if so please comment on it. I think this is a tangent that serves no purpose. Some people though do get the difference between safe/safer and less harmful/harmless mixed up, I wonder why though in some cases. Tobacco Harm Reduction is a major reason for use and the health sources are backing it up, though rather slowly, 2013/2014 seems to be a turning point to looking at THR. ] 20:32, 31 January 2015 (UTC) | |||
| --- | |||
| :::"... X thinks it is safer, although Y thinks it is unclear" - what sentiment to you gather from such a sentence structure? I'm in agreement with most of the text except that particular part. --] 23:16, 31 January 2015 (UTC) | |||
| This source does not even discuss the topic, it is not a research paper related to the discussion: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006416 | |||
| ::::Most of it looks OK. Criticisms: | |||
| ::::*"within the body of the device" seems unnecessary. | |||
| ::::*I think legality is at least as important as cost, so maybe "In some jurisdictions they are cheaper to use; in others, they are illegal", unless you can think of a better place? A link to a table of ''which'' jurisdictions might also be helpful, and we could probably compile one without too much debate :) . ] is a bit disorganized and out-of-date, and could do with graphics for areas other than Europe. | |||
| ::::*Both legality and cost seem more important than odor, and less important than medical benefit and risk. Generally, I'd say more important stuff should go first, in lede style. | |||
| ::::*"Some users feel that they are less harmful than conventional cigarettes as well, although in medical sources the benefits and risks of e-cigarettes are unclear." I agree with Mr. Petersen here. First, the balance of medical evidence takes precedence over the feelings of users if we are discussing medical risks and benefits. The feelings of users are irrelevant to the actual risks and benefits, though not irrelevent to the reasons people take up vaping. How about splitting the two, to get: "Some people use e-cigarettes because they believe that they are less harmful than conventional cigarettes, but the medical evidence is unclear." Is this true? Do we really have no idea if they are likely to be safer? If we have some, how about "...but the medical evidence for this is weak" (indicating that there is some evidence for it). | |||
| ::::*I think the harm-reduction/harmless difference is also important (since there are some non-smokers who take up e-cigs), so we might want "E-cigarettes are not harmless, but their full medical effects are not yet known.". Is that a fair assessment of the evidence? | |||
| ::::*I think we should mention bystander effects (other than odor) and put odor in the "user experience" section. | |||
| ::::*"Use of e-cigarettes has been steadily increasing since the first models were marketed in 2004." My impression is that the rate of increase has been increasing. Most new technologies increase in use exponentially. Do we have data or a graph to check this? | |||
| The only thing remotely related is from the Author of the study speaking their personal opinion regarding potential ethical concerns, for it to be _potentially_ a gateway drug: | |||
| ::::So: {{quote|E-cigarettes (also known as electronic cigarettes, e-cigs, personal vaporizers, PVs, etc.) are electronic devices that mimic the sensation and effects of cigarette smoking. They are made of metal and plastic. Typically, the user activates the e-cigarette by taking a puff or pressing a button. This causes a heating element to vaporize a liquid. The user inhales this vapor, which usually contains nicotine and flavorings and is almost odorless. Most e-cigarettes can be refilled and reused, although there are disposable models.<p>E-cigarettes are not harmless to users or bystanders, although their full medical effects are not yet known. Some people use e-cigarettes because they believe that they are less harmful than conventional cigarettes, but the medical evidence is weak. Most users are smokers or ex-smokers. In some jurisdictions, e-cigarettes are cheaper than conventional cigarettes; in others they are illegal. Use of e-cigarettes has been increasing (exponentially?) since the first models were marketed in 2004. }}<p> | |||
| ::::] (]) 20:07, 1 February 2015 (UTC) | |||
| :::::A few things. So far no harm has been found to my knowledge. Its all concerns and unknowns at this point. So saying it is not harmless really isnt supported. The reasons why people may use them is sourced to medical sources, so its removal is questionable. The source isnt weak, but the one of the most used sources on the page. At present there are no known risks, again its all concerns and unknowns. As far as safety is concerned, there is evidence that they are safer than combustible cigarettes. The controversy is how much safer. This has been covered in this discussion. If you look below in the next section you will see a start at what has been sourced, all to review articles and already in the article. ] 23:05, 1 February 2015 (UTC) | |||
| {{unindent}}I broadly agree with HLHJ's well-reasoned changes.—] <small>]/]</small> 09:44, 2 February 2015 (UTC) | |||
| *I can't see why legality is such an issue? It is only illegal in very few places, so it seems undue to focus on this. And AlbinoFerret has a point with the fact that no harm has actually been established.. it is reasonable to assume that there would be some to the user, but we certainly can't state it this way, and most certainly can't make claims about second-hand harm. To illustrate: All second hand emissions found so far, are below limits set for work-place standards.. lots of speculation exist in the literature, but no actual tangible evidence. --] 23:05, 2 February 2015 (UTC) | |||
| ::*Exactly, and the proposed edit actually states speculation as fact. ] 02:40, 3 February 2015 (UTC) | |||
| ====Break==== | |||
| I think we might be getting too bogged down with singular statements and words here, the proposal has already been edited several times to encompass editors' concerns. Are we in agreement that the proposal is, broadly speaking, an overall improvement on what we have at the moment? We can agree to sort out the minor details at a later date. We also need to answer DocJames' question (see sourcing section) of whether we are intending to replace the first paragraph or the first two paragraphs of the lead.] (]) 19:41, 3 February 2015 (UTC) | |||
| :My own inclination would be to replace the 1st and 2nd paragraphs, we do not need two paragraphs on the health implications. Parts of the current 2nd paragraph could possibly be combined with the 3rd which needs trimming and simplifying.] (]) 19:50, 3 February 2015 (UTC) | |||
| "The growing ubiquity of e-cigarettes lends itself to ethical scrutiny. Many have expressed concern about the potential for e-cigarettes to act as a “gateway” to cigarette smoking.39,40 Unlike other NRTs, e-cigarettes provide a recreational function and could feasibly entice unintended product users (eg, nonsmokers and youth) to engage in smoking-like behavior when they otherwise would not. However, it is unclear how many youth or nonsmokers are purchasing these products." | |||
| ===Sourced Version=== | |||
| Added after one comment: <b>This section is for sourcing, please make edit suggestions of complaints in the section above.</b> ] 18:07, 26 January 2015 (UTC) | |||
| I have started sourcing out some of the claims. | |||
| :E-cigarettes (also known as electronic cigarettes, e-cigs, personal vaporizers, PVs, etc.) are electronic devices that mimic the sensation and effects of cigarette smoking.<ref name=Caponnetto2012 /> They are made of metal and plastic. Typically, the user activates the e-cigarette by taking a puff or pressing a button.<ref name=McRobbie2014>Hayden McRobbie, National Centre for Smoking Cessation and Training, 2014. </ref> This causes a heating element to vaporize a liquid within the body of the device.<ref name=McRobbie2014 /> The user inhales this vapor, which usually contains nicotine and flavorings.<ref name=NHE2014>{{cite web|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/311887/Ecigarettes_report.pdf|title=Electronic cigarettes – A report commissioned by Public Health England |publisher=]|date=15 May 2014|author1-first=John |author1-last=Britton|author2-first=Ilze|author2-last=Bogdanovica}}</ref> Most e-cigarettes can be refilled and reused, although there are some disposable models. In contrast to normal cigarettes, e-cigarettes create almost no odor, and they are considerably cheaper to use<ref name=NHE2014/>. E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes as well, although medical sources are cautious about these claims.<ref name=Grana2014/><ref name=Caponnetto2012>{{cite | |||
| journal|last1=Caponnetto|first1=Pasquale|last2=Campagna|first2=Davide|last3=Papale|first3=Gabriella|last4=Russo|first4=Cristina|last5=Polosa|first5=Riccardo|title=The emerging phenomenon of electronic cigarettes|journal=Expert Review of Respiratory Medicine|volume=6|issue=1|year=2012|pages=63–74|issn=1747-6348|doi=10.1586/ers.11.92|pmid=22283580}}</ref> Use of e-cigarettes has been steadily increasing since the first models were marketed in 2004.<ref name=Farsalinos2014>{{cite journal | author = Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V | title = Nicotine absorption from electronic cigarette use: Comparison between first and new-generation devices | journal = Scientific Reports | volume = 4 | pages = 4133 | year = 2014 | pmid = 24569565 | pmc = 3935206 | doi = 10.1038/srep04133 }}</ref> Almost all users are smokers or ex-smokers.<ref name=Grana2014>{{cite journal|last=Grana|first=R|author2=Benowitz, N |author3=Glantz, SA |title=E-cigarettes: a scientific review.|journal=Circulation|date=13 May 2014|volume=129|issue=19|pages=1972–86|pmid=24821826|doi=10.1161/circulationaha.114.007667|pmc=4018182}}</ref> | |||
| But we will probably need more. Point one out, and I will add it here. ] 16:24, 26 January 2015 (UTC) | |||
| ::Lots of issues | |||
| ::This sounds like an ad "considerably cheaper to use" when it is not at all clear that this is true globally (my bet is it isn't) | |||
| ::This is undue weight "E-cigarette manufacturers and some users feel that they are less harmful than conventional cigarettes" | |||
| ::This is not the position of most organizations "although medical sources are cautious about these claims" | |||
| ::The current summary that "the benefits and risk of e-cigs are unclear" is a more accurate summary | |||
| ::Usage is already discussed lower in the lead. | |||
| ::Additionally it is not clear why we are replacing one paragraph with two? This suggestion contravenes WP:LEAD] (] · ] · ]) 17:47, 26 January 2015 (UTC) | |||
| :::This section is for sourcing, if you have edit suggestions or problems please make them above. ] 18:04, 26 January 2015 (UTC) | |||
| ::::They're not unreasonable suggestions so I'll post a re-edited version above.—] <small>]/]</small> 19:37, 26 January 2015 (UTC) | |||
| :::::I just wanted to keep this section on a specific purpose so the discussion above doesnt fragment and happen in different places. As soon as you work through the issues I will repost it here and move the sources in. ] | |||
| :::::::Still not clear if this is to replace the first paragraph or first two paragraphs. ] (] · ] · ]) 00:36, 2 February 2015 (UTC) | |||
| {{reflist-talk}} | |||
| -- | |||
| This source specifically states there is not enough evidence: https://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf | |||
| ==New review== | |||
| "Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless." | |||
| Quote (Page 6, point D): | |||
| Might be useful for mentioning the issues with conflict of interest in the literature. ] (] · ] · ]) 09:25, 2 February 2015 (UTC) | |||
| :I think this part should come in "Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest." ] 09:44, 2 February 2015 (UTC) | |||
| ::The statement that "they can hardly be considered harmless" seems uncontroversial to me and I would recommend that it's included in the article. E-cigarettes contain nicotine; nicotine isn't harmless; so e-cigarettes can hardly be considered harmless. QED.—] <small>]/]</small> 10:13, 2 February 2015 (UTC) | |||
| :::The statement is speculation. ] 02:40, 3 February 2015 (UTC) | |||
| :::No nicotine isn't harmless but neither is any drug/medicine, I doubt that we are going to make a point of saying "nicotine patches / NRT can hardly be considered harmless" or "ibuprofen can hardly be considered harmless" even though both are true. However the review uncovers some important facts and is a lot more neutral than some I have seen in the past, it also found significant conflicts of interests involving both the pharmaceutical industry and e-cigarettes companies, something I've suspected for sometime. It describes the main Harm Reduction vs Cessation debate going on within the medical community relatively well: | |||
| :::<blockquote>Health professionals who advocate “harm reduction” compare ECs with CCs, focus on smokers only, believe that ECs have no negative long-term health effects, that nicotine is a harmless recreational drug and that smokers are unwilling/unable to quit. These views are strongly supported by the EC/tobacco industry. On the other hand, health professionals working with public health point out that CCs are the most harmful legal products on the market (everything seems safe compared to smoking) and fear potential long-term health hazards. Other major concerns are that the product is spreading to never-smokers and ex-smokers, citizens unexposed to CCs, that many smokers have dual use (using both products) or switch instead of quitting, and that widespread EC-use will re-normalize smoking. This view is supported by the medical industry producing smoking cessation products.</blockquote>] (]) 02:59, 3 February 2015 (UTC) | |||
| {{unindent}}Well, I don't agree with either of you. There's overwhelming evidence that nicotine is toxic. It's certainly not speculation to say so.<p>As far as Levelledout's point is concerned, to say "Nicotine isn't harmless but neither is any drug/medicine" is to treat e-cigarettes like drugs and medicines, which I think we've overwhelmingly agreed is inappropriate. They aren't drugs or medicines, and the fact that they do cause harm isn't to be concealed behind weaselling language. We ought to come straight out and say so.—] <small>]/]</small> 10:56, 3 February 2015 (UTC) | |||
| :{{TQ|There's overwhelming evidence that nicotine is toxic.}}. As there is for Caffeine, Taurine, Ethanol, and Capsaicin. Use of all of which is common in recreational consumer products. As with all toxicity the danger is in the dose and nicotine toxicity is not in itself, so the real question is Is nictoine toxic in doses associated with e-cigarettes. And the answer to that is in usage no and in storage of liquids maybe/yes depending on strength and size. | |||
| {{quote|It is unlikely that a person would overdose on nicotine through smoking alone, the US Food and Drug Administration (FDA) states in 2013 "There are no significant safety concerns associated with using more than one OTC NRT at the same time, or using an OTC NRT at the same time as another nicotine-containing product—including a cigarette." Spilling a high concentration of nicotine onto the skin can cause intoxication or even death, since nicotine readily passes into the bloodstream following dermal contact.}} | |||
| The above is from Wikipedias ] Page ] (]) 11:08, 3 February 2015 (UTC) | |||
| *Are you seriously contending that e-cigarettes are harmless, SPACKlick?—] <small>]/]</small> 12:26, 3 February 2015 (UTC) | |||
| ::That wasn't the point I was advocating. The point I was advocating was that saying "E-cigarettes are harmful BECAUSE nicotine is toxic" is incorrect. In order for me to answer whether or not I consider e-cigarettes harmless, I'd need a fixed definition of harmless because in the literal sense, nothing is Or rather there is at most one action at any given time that is harmless and all other actions are harmful relative to it. But all of this is a sidebar ] (]) 14:24, 3 February 2015 (UTC) | |||
| ::Of course they aren't harmless, but there is a difference between harmless and what is generally considered to be "safe". Harmless means no risk attached to them whatsoever and the vast majority of things have some risk attached to them. Making a point out of the fact that they have finite risk is a fallacy itself in my opinion. What really matters is the quantity of risk of harm associated with them.] (]) 12:34, 3 February 2015 (UTC) | |||
| ::*So your position is this excellent medical source says e-cigarettes "can hardly be considered harmless", but we should leave that out because making a point of it is a fallacy?—] <small>]/]</small> 13:33, 3 February 2015 (UTC) | |||
| ::::Well no not exactly. We already basically have the statement in the article, there's no need to add it again: | |||
| ::::<blockquote>Safety subsection: As of 2014, e-cigarettes cannot be regarded as harmless.</blockquote> | |||
| ::::But my problem is that negative opinions like this rarely get attributed to the author, instead simply being spoken in Misplaced Pages's voice. They also generally end up appearing as bytesize quotes looking like weasel words since we say that they can't be considered as harmless, but don't say how this is true or to what extent. My position is that statements like this should be attributed, fully explained and put into perspective. Public Health England provides also provides a good balanced explanation: | |||
| ::::<blockquote>Despite some manufacturers’ claims that electronic cigarettes are harmless there is also evidence that electronic cigarettes contain toxic substances, including small amounts of formaldehyde and acetaldehyde, which are carcinogenic to humans, and that in some cases vapour contains traces of carcinogenic nitrosamines, and some toxic metals such as cadmium, nickel and lead. Although levels of these substances are much lower than those in conventional cigarettes, regular exposure over many years is likely to present some degree of health hazard, though the magnitude of this effect is difficult to estimate.</blockquote>] (]) 16:57, 3 February 2015 (UTC) | |||
| {{unindent}}Ah, I'm sorry, you're quite right: it does say that. That part of the article is so incredibly boring to read that my brain shuts down in self-defence, so I've failed to observe it until now.—] <small>]/]</small> 17:24, 3 February 2015 (UTC) | |||
| :Yep, that particular subsection is very disjointed to the extent that its a chore to read and contains some very poorly written statements. I think I might suggest some improvements soon.] (]) 19:31, 3 February 2015 (UTC) | |||
| ::You do realize the irony, right? The Pisinger "review" criticizes studies for conflicts of interests, yet both authors have deep and long-standing associations with Pharma and smoking-cessation services. ] (]) 07:53, 4 February 2015 (UTC) | |||
| :::Can you please provide evidence for these assertions.] (]) 15:37, 4 February 2015 (UTC) | |||
| "These data do not allow the conclusions to be drawn as to whether this is a sign | |||
| == New UK guidelines == | |||
| of adolescent smokers switching to ENDS, an established pattern of dual use, or a temporary | |||
| experimentation fashion. Therefore, in the absence of longitudinal data, existing evidence does | |||
| not allow an affirmation or rejection of the role of ENDS in increasing nicotine addiction | |||
| among adolescents above existing uptake rates, much less as to whether ENDS lead to smoking | |||
| in these countries. Among adults the pattern of dual use seems also the predominant one, | |||
| resulting in a reduction of smoked cigarettes and with few never smokers starting to use ENDS | |||
| (below 1% of the population)" | |||
| -- | |||
| The UK's National Centre for Smoking Cessation and Training has issued downplaying concerns and stating that smoking cessation professionals should support e-cigarette users.--] (]) 14:10, 17 February 2015 (UTC) | |||
| ::Not a government or medical position. Appears to be an "interest group". Would be interesting to know who funds said interest group? | |||
| ::Goal is "support the delivery of smoking cessation interventions provided by local stop smoking services" <s>Not a suitable source.</s> ] (] · ] · ]) 22:55, 28 February 2015 (UTC) | |||
| :::Interest group? It was set up with a Department for Health grant in partnership with the National Health System (and academics) and has received funding from Public Health England. ] (]) 01:15, 1 March 2015 (UTC) | |||
| ::::Yup here right lower corner it says "community interest company" | |||
| ::::The website in question does not call itself "NHS Centre for Smoking Cessation and Training" but the "National Centre for Smoking Cessation and Training" | |||
| ::::It appears they are selling their content | |||
| ::::Just because they may have received a grant from the NHS does not mean there conclusions are that of the government. | |||
| ::::] (] · ] · ]) 01:53, 1 March 2015 (UTC) | |||
| :::::It sort of does actually. Their main function is training NHS & other staff to run smoking cessation courses etc, set up and funded by the NHS/PHE/government. The "community interest company" is for reasons such as so they don't count as civil servants with vast pensions, unions etc etc. They won't make their own policy I think you'll find, and will not be out of step with government/NHS/NICE views. But they are not the ideal source for public-facing government pronouncements, which is not really their role. ] (]) 03:58, 1 March 2015 (UTC) | |||
| ::::::Looks like a position statement to me. ] 04:11, 1 March 2015 (UTC) | |||
| :::::::How is it that press releases from antis are position statements but position statements from NHS-funded cessation groups aren't? I think some people need to take a step back from this article and look at their POV issues before contributing again.--] (]) 11:28, 1 March 2015 (UTC) | |||
| ::::::I don't disagree with Johnbod's view that they don't technically represent government opinion. But they are an organisation set up in partnership with government that provides expert advice to government agencies (NHS stop smoking services) and therefore I see no problem with using them for position statements on the basis of them being a "nationally recognised expert body".] (]) 13:23, 1 March 2015 (UTC) | |||
| :::::::They would certainly count as that. Their website is not terribly clear on their status, but is clearer. The Department of Health (ministry) put 3 years of funding for NHS smoking cessation training out to tender, which was won by ], & they are the vehicle set up by UCL for this. The idea was I think, that after that period they would get much of their income by charging the NHS employers for their courses; not sure how that has turned out. Now their core funding is from ]. As an NHS "smoking practicioner"(!) I think by now you need to be "accredited" by them, having passed their courses. From the report (p8) UCL "hosting" ceased in 2012, and they are apparently supposed to be self-supporting. On a further point raised by Doc James, from "NHS Centre for Smoking Cessation and Training" to "National Centre for Smoking Cessation and Training" was a name change, in 2012 (p 9, and at the start of the report). By March 2012 9K people had received training courses and 5K had passed, at least 75% NHS staff (p.14). The report included a list of research publications they have produced/contributed to, on the effectiveness of cessation interventions and such like. I've just noticed that ]'s (old) logo is at the bottom of the start of the report, with others, so they probably get or got some cash from them, or help from the CRUK funded health behaviour unit at UCL, a group of whom I trained when ] there. So I should declare an interest. At the very least a para should be added to the UK section of ], so I have done that. ] (]) 13:46, 1 March 2015 (UTC) | |||
| :This is the full briefing (much longer) . Although not (presumably) peer-reviewed, it includes a review of studies, with 82 given in the references at the end. ] (]) 15:03, 1 March 2015 (UTC) | |||
| ::Thanks, in fact we are using this as a source in the article in the construction section.] (]) 20:28, 1 March 2015 (UTC) | |||
| This source does not draw conclusions, only specifically stating there is a strong correlation between: | |||
| ==RFC on daughter page== | |||
| There is an RFC on the Safety of electronic cigarettes. The RFC is asking if Sources like Press releases should be used to make medical claims. ] 22:44, 19 February 2015 (UTC) | |||
| ::they are position statements. Only one of the two was released in the form of a press release. ] (]) 15:28, 20 February 2015 (UTC) | |||
| - EVER having used e-cigs and EVER smoking a cigarette (what kind of e-cig use? In passing? Habitual? Etc?) | |||
| == Edit request == | |||
| - Current users of e-cigs and EVER having smoked a cigarette (this does not support the statement above, it is not a gateway if someone who uses e-cigs tries a cigarrette out of curiosity, nothing else being available, or simply tried it at some point in their life, etc). | |||
| From the lead section, paragraph 3: "''Emissions from e-cigarette may contain tiny ultrafine particles of flavors''." This should use the plural form "e-cigarettes". ] <span style="color:#3CB371">¤</span> </small>]] 12:47, 4 March 2015 (UTC) | |||
| ::Thanks agree. ] (] · ] · ]) 20:16, 5 March 2015 (UTC) | |||
| "Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p<0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p<0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p<0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up." | |||
| -- | |||
| The only source (https://bmjopen.bmj.com/content/11/3/e045603#T1) which seems to support the lean this statement has, is very unclear with regards to whether the measured effect was "never users becoming habitual tobacco users after using e-cigarrettes", or "former cigarettes users who tried e-cigarettes relapsing to cigarettes", or "never users having _ever_ smoked a cigarette after first using e-cigarettes" and so on. It cannot support the statement it is attempting to. ] (]) 23:48, 15 July 2024 (UTC) | |||
| *This is a medical article, so we apply medical sources in accordance with ]. The systematic review and meta-analysis published in the BMJ trumps the WHO paper.—] <small>]/]</small> 19:43, 16 July 2024 (UTC) | |||
| *:Regardless, one source which itself does not claim a gateway effect, only a correlation between vaping and smoking, still does not support this statement. It itself makes no claims to a ‘gateway theory’. | |||
| *:Only that vapers will eventually try a cigarette at some point. The heavy lean in the context of that section implies use of one leads to habitual use of the other. There is _no_ evidence to support this. ] (]) 21:22, 16 July 2024 (UTC) | |||
| *::I'm afraid I read the source very differently. It says: {{tq|meta-analysis showed e-cigarette users were much more likely than non-users to go on to smoke combustible cigarettes, even after adjusting for covariates}}, and {{tq|meta-analysis showed a markedly higher odds of combustible cigarette use in those who had used e-cigarettes}}.{{pb}}My position is that the first of those is not a claim of a correlation. It's a claim that vapers ''go on'' to smoke tobacco, and the sequence is clear: first they vape, then they become more likely to start smoking. "Gateway" is a reasonable way to summarize this.—] <small>]/]</small> 23:32, 16 July 2024 (UTC) | |||
| *:::You are implying causation, when there is only correlation. A "gateway" must in itself be the cause, but as we all know, people do not start smoking because they start smoking. The evidence is unclear, and that is clear. ] (]) 23:45, 16 July 2024 (UTC) | |||
| *::::For example, I could find a strong correlation between those who drink water, and those who eat food. People who eat food at the start of their life are 9001x more likely to drink water, and people who start drinking water in their life are extremely likely to also begin to eat food. However, neither of these things are caused by each other. | |||
| *::::There is simply too many other factors here to suggest that e-cigarrette usage is _the_ cause of later tobacco usage. ] (]) 23:57, 16 July 2024 (UTC) | |||
| *:::::The article doesn't say it's _the_ cause. I do understand the difference between correlation and causation, and in my view the BMJ source is clearly claiming the latter and not the former, so there doesn't seem to be much possibility of us agreeing about this.—] <small>]/]</small> 08:49, 17 July 2024 (UTC) | |||
| *::::::I do not believe that making alarmist statements based on personal interpretations of semantics is valid documentation, reporting, or science. | |||
| *::::::Given the three other sources mentioned do not even remotely appear to agree, or are not even remotely related to the topic, it seems very clear that statement was ham fisted in with an intended bias. I’m not sure how that’s not very obvious to you. ] (]) 12:40, 17 July 2024 (UTC) | |||
| *:::::::Well, hang on. This article does have quite a number of phrasing problems, and there's definitely a lot of hamfisted language.{{pb}}The article was started by a problematic editor, who is now not allowed to edit any medical articles at all. There was quite a lot of drama about him. The article needs properly checking and rewriting. That's an exercise I've been slowly chiselling away at for years and will continue when I get the opportunity.{{pb}}I won't make the specific edit you ask for, but that doesn't mean I won't listen to you and it doesn't mean I oppose other changes. I would particularly welcome proposals that make the article more accessible (reduce the reading age, simplify convoluted sentences, but without simplifying the underlying thoughts), and I'd also welcome proposals to replace poor sources with meta-analyses and systematic reviews published in medical journals. I do expect you'll be able to find places where previous editors have been unduly skeptical about e-cigarettes, and I do hope to work with you to fix them.—] <small>]/]</small> 14:18, 17 July 2024 (UTC) | |||
| == Semi-protected edit request on 15 July 2024 == | |||
| {{edit semi-protected|Electronic cigarette|answered=yes}} | |||
| Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes. | |||
| Suggest changing this to: | |||
| There is little evidence to suggest that e-cigarettes act as a gateway to traditional smoking at present, and further research is needed to clarify the strength and veracity of any correlations between the two. However, evidence does suggest that those who have smoked e-cigarettes will attempt a traditional cigarette at least once in their life | |||
| See talk page: https://en.wikipedia.org/Talk:Electronic_cigarette ] (]) 23:57, 15 July 2024 (UTC) | |||
| *Not done. I'll reply in the other section you started, explaining why.—] <small>]/]</small> 19:39, 16 July 2024 (UTC) | |||
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Move discussion in progress
There is a move discussion in progress on Talk:Usage of electronic cigarettes which affects this page. Please participate on that page and not in this talk page section. Thank you. —RMCD bot 13:48, 28 November 2023 (UTC)
Cannabis
Vaping isn't only for nicotine. I'd like to see this article expanded to include the increasingly common practice of vaping cannabis products. Tad Lincoln (talk) 22:57, 28 March 2024 (UTC)
- They have different nomenclature and health effects. E-cigarettes replace cigarettes. THC vapes are not intended to simulate cigarettes and are often referred to as vape pens.
- While all e-cigarettes are based on glycerin and/or propylene glycol, THC vapes usually use an oily substance. Zvi Zig (talk • contribs 02:29, 18 April 2024 (UTC)
Even unguided e-cigarette use among smokers unwilling to stop smoking is effective in causing smoking cessation
What is this meant to mean?—S Marshall T/C 16:31, 18 April 2024 (UTC)
- It looks like someone read a study, took it as fact, and copied the text into the lead. I've tried to remedy it. Reconrabbit 17:09, 18 April 2024 (UTC)
Revert 24th April 2024
Re: this revert.
AlexGallon, I can see why you've done this, but with this particular article we need to bear in mind our audience. A substantial proportion of the people who type "electronic cigarette" into the search box are teenagers considering taking a puff—and English isn't necessarily their first language. So the lead of this particular article tries to use the simplest possible grammatical constructions. Short, declarative sentences in the active voice with as few subclauses as possible. We can use college level English in the body text; it's just the lead that needs to be super-accessible.—S Marshall T/C 08:06, 24 April 2024 (UTC)
- Understood, and I agree with your reasoning – very well explained, so thank you. AlexGallon (talk) 18:59, 25 April 2024 (UTC)
Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes.
This line is not supported by it's own sources, especially in the context of it's section regarding "gateway drugs". It has a heavy lean towards the negative.
> Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes.
Suggest changing this to:
> There is little evidence to suggest that e-cigarettes act as a gateway to traditional smoking at present, and further research is needed to clarify the strength and veracity of any correlations between the two. However, evidence does suggest that those who have smoked e-cigarettes will try a traditional cigarette at least once in their life.
---
This source does not even discuss the topic, it is not a research paper related to the discussion: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006416
The only thing remotely related is from the Author of the study speaking their personal opinion regarding potential ethical concerns, for it to be _potentially_ a gateway drug:
"The growing ubiquity of e-cigarettes lends itself to ethical scrutiny. Many have expressed concern about the potential for e-cigarettes to act as a “gateway” to cigarette smoking.39,40 Unlike other NRTs, e-cigarettes provide a recreational function and could feasibly entice unintended product users (eg, nonsmokers and youth) to engage in smoking-like behavior when they otherwise would not. However, it is unclear how many youth or nonsmokers are purchasing these products."
--
This source specifically states there is not enough evidence: https://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf
Quote (Page 6, point D):
"These data do not allow the conclusions to be drawn as to whether this is a sign of adolescent smokers switching to ENDS, an established pattern of dual use, or a temporary experimentation fashion. Therefore, in the absence of longitudinal data, existing evidence does not allow an affirmation or rejection of the role of ENDS in increasing nicotine addiction among adolescents above existing uptake rates, much less as to whether ENDS lead to smoking in these countries. Among adults the pattern of dual use seems also the predominant one, resulting in a reduction of smoked cigarettes and with few never smokers starting to use ENDS (below 1% of the population)"
--
This source does not draw conclusions, only specifically stating there is a strong correlation between:
- EVER having used e-cigs and EVER smoking a cigarette (what kind of e-cig use? In passing? Habitual? Etc?)
- Current users of e-cigs and EVER having smoked a cigarette (this does not support the statement above, it is not a gateway if someone who uses e-cigs tries a cigarrette out of curiosity, nothing else being available, or simply tried it at some point in their life, etc).
"Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p<0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p<0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p<0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up."
--
The only source (https://bmjopen.bmj.com/content/11/3/e045603#T1) which seems to support the lean this statement has, is very unclear with regards to whether the measured effect was "never users becoming habitual tobacco users after using e-cigarrettes", or "former cigarettes users who tried e-cigarettes relapsing to cigarettes", or "never users having _ever_ smoked a cigarette after first using e-cigarettes" and so on. It cannot support the statement it is attempting to. J. Christ Denton (talk) 23:48, 15 July 2024 (UTC)
- This is a medical article, so we apply medical sources in accordance with WP:MEDRS. The systematic review and meta-analysis published in the BMJ trumps the WHO paper.—S Marshall T/C 19:43, 16 July 2024 (UTC)
- Regardless, one source which itself does not claim a gateway effect, only a correlation between vaping and smoking, still does not support this statement. It itself makes no claims to a ‘gateway theory’.
- Only that vapers will eventually try a cigarette at some point. The heavy lean in the context of that section implies use of one leads to habitual use of the other. There is _no_ evidence to support this. J. Christ Denton (talk) 21:22, 16 July 2024 (UTC)
- I'm afraid I read the source very differently. It says:
meta-analysis showed e-cigarette users were much more likely than non-users to go on to smoke combustible cigarettes, even after adjusting for covariates
, andmeta-analysis showed a markedly higher odds of combustible cigarette use in those who had used e-cigarettes
.My position is that the first of those is not a claim of a correlation. It's a claim that vapers go on to smoke tobacco, and the sequence is clear: first they vape, then they become more likely to start smoking. "Gateway" is a reasonable way to summarize this.—S Marshall T/C 23:32, 16 July 2024 (UTC)- You are implying causation, when there is only correlation. A "gateway" must in itself be the cause, but as we all know, people do not start smoking because they start smoking. The evidence is unclear, and that is clear. J. Christ Denton (talk) 23:45, 16 July 2024 (UTC)
- For example, I could find a strong correlation between those who drink water, and those who eat food. People who eat food at the start of their life are 9001x more likely to drink water, and people who start drinking water in their life are extremely likely to also begin to eat food. However, neither of these things are caused by each other.
- There is simply too many other factors here to suggest that e-cigarrette usage is _the_ cause of later tobacco usage. J. Christ Denton (talk) 23:57, 16 July 2024 (UTC)
- The article doesn't say it's _the_ cause. I do understand the difference between correlation and causation, and in my view the BMJ source is clearly claiming the latter and not the former, so there doesn't seem to be much possibility of us agreeing about this.—S Marshall T/C 08:49, 17 July 2024 (UTC)
- I do not believe that making alarmist statements based on personal interpretations of semantics is valid documentation, reporting, or science.
- Given the three other sources mentioned do not even remotely appear to agree, or are not even remotely related to the topic, it seems very clear that statement was ham fisted in with an intended bias. I’m not sure how that’s not very obvious to you. J. Christ Denton (talk) 12:40, 17 July 2024 (UTC)
- Well, hang on. This article does have quite a number of phrasing problems, and there's definitely a lot of hamfisted language.The article was started by a problematic editor, who is now not allowed to edit any medical articles at all. There was quite a lot of drama about him. The article needs properly checking and rewriting. That's an exercise I've been slowly chiselling away at for years and will continue when I get the opportunity.I won't make the specific edit you ask for, but that doesn't mean I won't listen to you and it doesn't mean I oppose other changes. I would particularly welcome proposals that make the article more accessible (reduce the reading age, simplify convoluted sentences, but without simplifying the underlying thoughts), and I'd also welcome proposals to replace poor sources with meta-analyses and systematic reviews published in medical journals. I do expect you'll be able to find places where previous editors have been unduly skeptical about e-cigarettes, and I do hope to work with you to fix them.—S Marshall T/C 14:18, 17 July 2024 (UTC)
- The article doesn't say it's _the_ cause. I do understand the difference between correlation and causation, and in my view the BMJ source is clearly claiming the latter and not the former, so there doesn't seem to be much possibility of us agreeing about this.—S Marshall T/C 08:49, 17 July 2024 (UTC)
- You are implying causation, when there is only correlation. A "gateway" must in itself be the cause, but as we all know, people do not start smoking because they start smoking. The evidence is unclear, and that is clear. J. Christ Denton (talk) 23:45, 16 July 2024 (UTC)
- I'm afraid I read the source very differently. It says:
Semi-protected edit request on 15 July 2024
 | This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request. |
Evidence shows that many users who begin by vaping will go on to also smoke traditional cigarettes.
Suggest changing this to:
There is little evidence to suggest that e-cigarettes act as a gateway to traditional smoking at present, and further research is needed to clarify the strength and veracity of any correlations between the two. However, evidence does suggest that those who have smoked e-cigarettes will attempt a traditional cigarette at least once in their life
See talk page: https://en.wikipedia.org/Talk:Electronic_cigarette J. Christ Denton (talk) 23:57, 15 July 2024 (UTC)
- Not done. I'll reply in the other section you started, explaining why.—S Marshall T/C 19:39, 16 July 2024 (UTC)
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