Talk:Electronic cigarette - Misplaced Pages

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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."

Might be useful for mentioning the issues with conflict of interest in the literature. Doc James (talk · contribs · email) 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." AlbinoFerret 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.—S Marshall T/C 10:13, 2 February 2015 (UTC)

The statement is speculation. AlbinoFerret 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:

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.

Levelledout (talk) 02:59, 3 February 2015 (UTC)

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.

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.—S Marshall T/C 10:56, 3 February 2015 (UTC)

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.

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 Nicotine Page SPACKlick (talk) 11:08, 3 February 2015 (UTC)

Are you seriously contending that e-cigarettes are harmless, SPACKlick?—S Marshall T/C 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 SPACKlick (talk) 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.Levelledout (talk) 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?—S Marshall T/C 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:

Safety subsection: As of 2014, e-cigarettes cannot be regarded as harmless.

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:

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.

Levelledout (talk) 16:57, 3 February 2015 (UTC)

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.—S Marshall T/C 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.Levelledout (talk) 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. Mihaister (talk) 07:53, 4 February 2015 (UTC)

Can you please provide evidence for these assertions.Levelledout (talk) 15:37, 4 February 2015 (UTC)

New UK guidelines

The UK's National Centre for Smoking Cessation and Training has issued new guidelines downplaying concerns and stating that smoking cessation professionals should support e-cigarette users.--InfiniteBratwurst (talk) 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" ~~Not a suitable source.~~ Doc James (talk · contribs · email) 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. Link Levelledout (talk) 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.

Doc James (talk · contribs · email) 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. Johnbod (talk) 03:58, 1 March 2015 (UTC)

Looks like a position statement to me. AlbinoFerret 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.--InfiniteBratwurst (talk) 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".Levelledout (talk) 13:23, 1 March 2015 (UTC)

They would certainly count as that. Their website is not terribly clear on their status, but this report on their first 3 years to March 2012 is clearer. The Department of Health (ministry) put 3 years of funding for NHS smoking cessation training out to tender, which was won by University College London, & 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 Public Health England. 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 Cancer Research UK'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 Wikipedian in Residence there. So I should declare an interest. At the very least a para should be added to the UK section of Positions of medical organizations regarding electronic cigarettes, so I have done that. Johnbod (talk) 13:46, 1 March 2015 (UTC)

This is the full briefing (much longer) as a PDF. Although not (presumably) peer-reviewed, it includes a review of studies, with 82 given in the references at the end. Johnbod (talk) 15:03, 1 March 2015 (UTC)

Thanks, in fact we are using this as a source in the article in the construction section.Levelledout (talk) 20:28, 1 March 2015 (UTC)

RFC on daughter page

There is an RFC on the Safety of electronic cigarettes. HERE The RFC is asking if Sources like Press releases should be used to make medical claims. AlbinoFerret 22:44, 19 February 2015 (UTC)

they are position statements. Only one of the two was released in the form of a press release. Formerly 98 (talk) 15:28, 20 February 2015 (UTC)

Edit request

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". Axl ¤ 12:47, 4 March 2015 (UTC)

Thanks agree. Doc James (talk · contribs · email) 20:16, 5 March 2015 (UTC)

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