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Text and/or other creative content from Electronic cigarette was copied or moved into Regulation of electronic cigarettes. The former page's history now serves to provide attribution for that content in the latter page, and it must not be deleted as long as the latter page exists. Text and/or other creative content from Regulation of electronic cigarettes was copied or moved into Electronic cigarette. The former page's history now serves to provide attribution for that content in the latter page, and it must not be deleted as long as the latter page exists. Text and/or other creative content from this version of Nicotine was copied or moved into Electronic cigarette with this edit on 12:42 24 January 2019. The former page's history now serves to provide attribution for that content in the latter page, and it must not be deleted as long as the latter page exists. Text and/or other creative content from Electronic cigarette was copied or moved into Usage of electronic cigarettes. The former page's history now serves to provide attribution for that content in the latter page, and it must not be deleted as long as the latter page exists. Text and/or other creative content from Electronic cigarette was copied or moved into Effects of electronic cigarettes on human brain development. The former page's history now serves to provide attribution for that content in the latter page, and it must not be deleted as long as the latter page exists. Text and/or other creative content from Electronic cigarette was copied or moved into Electronic cigarette and e-cigarette liquid marketing. The former page's history now serves to provide attribution for that content in the latter page, and it must not be deleted as long as the latter page exists. Text and/or other creative content from Electronic cigarette was copied or moved into 2019–20 vaping lung illness outbreak. The former page's history now serves to provide attribution for that content in the latter page, and it must not be deleted as long as the latter page exists. This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 January 2019 and 30 April 2019. Further details are available on the course page. Student editor(s): Sailorbo (article contribs). Peer reviewers: Skyguythor.

This is the talk page for discussing improvements to the Electronic cigarette article. This is not a forum for general discussion of the article's subject.

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Include info about E-Cigarettes and Seizures, remove inappropriate references

To resolve a dispute I am seeking consensus/ideas about including a sentence reguarding seizures and their link to vaping products in the intro -- in a close location to the vaping related lung outbreak. There have been over 100 reported cases of these instances, which may be linked to the e-cigarettes high nicotine content. https://www.fda.gov/tobacco-products/ctp-newsroom/some-e-cigarette-users-are-having-seizures-most-reports-involving-youth-and-young-adults

Also would like to remove the sentence "The risk of early death is anticipated to be similar to that of smokeless tobacco." from the intro or change it to emphasize the fact that it is likely additional hazards will be discovered. In 2019, it is not possible to anticipate the chronic side effects of vaping, just as the long term effects of smoking were not fully revealed until after many decades of research. And with the rise of both THC and Nicotine only vaping related lung illnesses, it is no longer up to date to compare vaping to products like chewing tobacco because vaping is shown to more substantially impact the lungs and arteries.

Also, a similar sentence in the lead "The risk from serious adverse events was reported in 2016 to be low." should come out of the intro because again it does not account for the most recent incidents. More importantly though, this sentence is a total misrepresentation of the original source, which was about "Corneoscleral Laceration and Ocular Burns Caused by Electronic Cigarette Explosions". The concluding paragraph of this study says "ECs pose a number of health safety risks beyond nicotine content and gateway drug concerns."

The only thing even along the lines of this sentence is embedded in the paragraph "Protective eyewear and even mouthguards may be advisable during EC use, although strict compliance is unlikely. Although the number of serious adverse events is small compared with the number of EC users worldwide, the consequences may be devastating to those involved in an EC-related blast. Because the FDA collects only voluntary reports,2 adverse events may be underreported. Further study is warranted to investigate the explosion hazard presented by these devices."

Lastly, at some point I think it would be appropriate to expand on the fact that some experts now think vaping may be more addicting than burned cigarettes. This is due to the fact that nicotine content has increased almost 3X in the leading brands (in unregulated markets like US) and e-cigarettes are capable of delivering nicotine to the brain faster than paper cigarettes. SCBY (talk) 21:38, 25 September 2019 (UTC)

See "Seizures or convulsions are known potential side effects of nicotine toxicity and have been reported in the scientific literature in relation to intentional or accidental swallowing of e-liquid." Content about seizures belongs in the Adverse effects of electronic cigarettes subarticle.

The content in the lede is a summary of the body. Rather than delete it should be replaced with similar content like this. QuackGuru (talk) 21:55, 25 September 2019 (UTC)

I added more content about the seizures to the appropriate article. QuackGuru (talk) 22:06, 25 September 2019 (UTC)

I still think it isn't right to keep info on many recently discovered adverse effects out of the main article while keeping the two dated studies finding little harm so prominently. The more adverse effects that come up, the more the balance of the article and its tone from the beginning should change. But adding the info about seizures to sub-article is a step in the right direction. I see it is up to 127 cases being reported in popular press but CDC website only shows those 30 something cases. SCBY (talk) 22:19, 25 September 2019 (UTC)

The seizures are not "recently discovered adverse effects". See "Major adverse events reported to the FDA in 2013 included hospitalizations for pneumonia, congestive heart failure, seizure, rapid heart rate, and burns. However no direct relationship has been proven between these effects and events and e-cigarette use, and some of them may be due to existing health problems."

The reported seizures from the FDA will continue as long as people are vaping. The lede is a general summary of the subarticles. The specific details go in the subarticles. QuackGuru (talk) 22:28, 25 September 2019 (UTC)

OkSCBY (talk) 22:31, 25 September 2019 (UTC)

This source is tagged with the public domain notice inside the citation. You can copy the content word for word and expand the subarticle. QuackGuru (talk) 22:39, 25 September 2019 (UTC)

Added a sentence to the body. Agree not enough coverage / evidence for the lead. Doc James (talk · contribs · email) 04:39, 1 October 2019 (UTC)

That was a WP:SYNC violation. I updated 'Safety' per WP:SYNC. The lede is already pretty long. 'Safety' is a summary of three subarticles: Safety of electronic cigarettes, Adverse effects of electronic cigarettes, and Composition of electronic cigarette aerosol. QuackGuru (talk) 09:23, 1 October 2019 (UTC)

Thanks User:QuackGuru. I am happy with "Serious adverse events related to e-cigarettes were hypotension, seizure, chest pain, rapid heartbeat, disorientation, and congestive heart failure but it was unclear the degree to which they were the result of e-cigarettes." Doc James (talk · contribs · email) 16:31, 1 October 2019 (UTC)

Content fork?

+See "Research reveals potential health risks in aerosolizing nicotine salts and metal toxins that are produced." That content failed verification. It is not a falsehood masquerading as a fact?

Unsourced content and failed verification was restored after the article was redirected. No content was merged. That would be inappropriate to merge unsourced or failed verification content. The main article has content about a variety of different devices, including pod mods. I hope other editors will help remove the unsourced and failed verification content. E-cigs including pod mods produce aerosol rather than smoke. Is it appropriate more than half the article contains unsourced content? See current discussion. Also see WP:REDUNDANTFORK. QuackGuru (talk) 06:22, 27 September 2019 (UTC)

minthreadsleft = 4. Minimum threads left

minthreadsleft = 4

Minimum threads left = 4

This is the default setting at User:Lowercase sigmabot III/Archive HowTo. Example 2: Incremental archives.

It encourages discussion. Auto archiving avoids problems with arguments about premature closing of discussions. -- Timeshifter (talk) 15:52, 29 September 2019 (UTC)

See Content fork? above. That is an important discussion. Too many threads is not helpful, especially when they are resolved. QuackGuru (talk) 16:04, 29 September 2019 (UTC)

This is a relatively busy talk page with many archives. You deleted a thread that was started only a few days ago. Please let the bot auto archive threads. It usually has a delay before archiving new threads.

4 threads left is not too many discussions. And you should not be the one deciding when a discussion is finished. Let a bot do it, and there is no argument about prematurely closing discussions.

And __TOC__ and {{skip to TOC}} helps with people finding threads of interest fast on busy talk pages such as this one.

See also: Help:Archiving a talk page: "Note: Make sure to establish consensus before setting up lowercase sigmabot III or ClueBot III on a talk page other than your user talk page."

minthreadsleft = 4. This was the setting before I arrived here. Please keep it at that. And please do not manually archive threads. It avoids arguments.

Changed algo parameter to 14 days. It was set to 31 days. That is too long for a busy talk page with a lot of archives. Thread archiving delay is now 14 days.

I added this below the archive links banner: {{Auto archiving notice|bot=Lowercase sigmabot III|age=14}}

-- Timeshifter (talk) 01:49, 30 September 2019 (UTC)

List of vaping bans in the United States

There is content about the sales ban in Massachusetts in the subarticle.. This article is the not the best place to add the sales ban in Massachusetts. List of vaping bans in the United States is the best place to add the bans.

The NY 90-day flavor ban also does not belong in this article. I'm sure there are more bans and the List of vaping bans in the United States subarticle can cover those. QuackGuru (talk) 10:12, 1 October 2019 (UTC)

We mention that they are banned in a number of countries. Listing that they are banned in some states would also be fine in the body IMO. Doc James (talk · contribs · email) 16:30, 1 October 2019 (UTC)

There are several bans being discussed or proposed in various states. These are only temporary bans. There is tough talk about a US on most flavors. It is still too early to add a proposed ban on flavors in the US to this article. It is too detailed to discuss different state bans here. City bans is also too detailed. The subarticles go into detail about the regulations and bans. This section is meant to be a summary. QuackGuru (talk) 16:59, 1 October 2019 (UTC)

Other names

For medications we often have 100s or 1,000 of brand names. For drugs we often have 100s of lay terms.

We often have sections under "Society and culture" were we cover this. Putting them in a hatnote here is not the best formatting as it makes things harder to edit and somewhat hides them. Doc James (talk · contribs · email) 09:19, 27 October 2019 (UTC)

The edit introduced new content to the first sentence. "An electronic cigarette, also known as e-cigarette among other names," failed verification. QuackGuru (talk) 21:18, 27 October 2019 (UTC)

I tried to include the name that the FDA and other U.S. entities have adopted- Electronic Nicotine Delivery Systems (ENDS) in an effort to assist readers and researchers, but it has been repeatedly reverted. I do not consider it a 'lay term'. I have also (for 8 years) restrained myself from being an editor on these pages because I am an e-cigarette user and Harm Reduction advocate. Over these 8 years I have also read and collected over 1900 papers, articles on all aspects of the subject mainly for my own health decisions. I chose to trust in the WikiPedia community's purported and theoretical pillar of Neutrality, but this page, it's constant editing (some justified as vandalism, others clearly to set a tone to the subject), and my recent experience leaves me with no confidence in WikiPedia, and have turned from an advocate of it as trustworthy, to just another web info source that requires close and time consuming scrutiny. This, after criticizing others on the web for bashing it rather than helping to correct it by properly and in good faith contributing. It's likely that this statement is a "violation" of some sort of WikiPedia rule, and it will get deleted but I needed to make it clear that this page was the final straw for me with WikiPedia.Jd4x4 (talk) 17:20, 19 February 2020 (UTC)

UNC study. More ingredients meant greater toxicity

Here is some info that might be included somehow in the Misplaced Pages article. Others with more time than me might check this out, and its deeper sources.

• Some e-cigarette ingredients are surprisingly more toxic than others. By University of North Carolina Health Care. March 27, 2018. From the article (emphasis added):

-- Timeshifter (talk) 11:42, 3 November 2019 (UTC)

That's a 2018 study. No reviews cited it yet that I could find. I added a lot of content to the subarticle. QuackGuru (talk) 12:29, 3 November 2019 (UTC)

Navboxes section heading

(unindent). I didn't see all the subarticles. I saw some of the subarticle links found at the beginning of subheadings. It is hard to see the full spread of health-related subarticles unless one remembers the navbox at the bottom of the main page. It is in the external links section. I think it should be in its own section: "See also".

-- Timeshifter (talk) 11:49, 4 November 2019 (UTC)

Navboxes are placed in the external links sections. This is a new navbox. It was just added to the e-cig articles. QuackGuru (talk) 11:58, 4 November 2019 (UTC)

You will need to propose a new section called "See also. Navigation box" than...

Traditionally these have just gone at the bottom. I do not think they need a seperate section. Doc James (talk · contribs · email) 12:02, 4 November 2019 (UTC)

See WP:IAR. And I am not sure the WP:MOS is ironclad for all its style rules. -- Timeshifter (talk) 12:08, 4 November 2019 (UTC)

WP:MOS says there are exceptions. -- Timeshifter (talk) 12:11, 4 November 2019 (UTC)

You will need to get consensus somewhere. I do not support this being adding across the board to Misplaced Pages articles and I do not support it being added here. I do not see a reason for an exception. Additionally for medical articles we try not to add "see also" sections. Doc James (talk · contribs · email) 12:13, 4 November 2019 (UTC)

I gave you a reason, and you did not address it before your revert war. And this is an exception. You are allowed to think independently according to WP:MOS: "It is a generally accepted standard that editors should attempt to follow, though it is best treated with common sense, and occasional exceptions may apply."

And on the other hand this is a perfect example of why in this case you should follow the WP:MOS and allow a see also section. Rules should not override common sense. -- Timeshifter (talk) 12:22, 4 November 2019 (UTC)

I did a test edit to an unrelated article. QuackGuru (talk) 23:26, 5 November 2019 (UTC)

Let's hope it stays. :) -- Timeshifter (talk) 12:34, 7 November 2019 (UTC)

For a new related article I created a 'Navigation box' section. QuackGuru (talk) 20:42, 18 November 2019 (UTC)

"Navigation box" or "Navigation boxes" (as in your previous example) is clearer than no section heading at all. "External links" section heading is for external links, not the navigation boxes that follow the external links. Since navigation boxes consist of internal links. -- Timeshifter (talk) 05:09, 19 November 2019 (UTC)

For another new article I added a 'Navigation box' section QuackGuru (talk) 23:02, 24 November 2019 (UTC)

Great! -- Timeshifter (talk) 04:25, 25 November 2019 (UTC)

Navbox at top. Would act as a 2nd table of contents for e-cigarettes

{{Electronic cigarettes}}. I think it would serve a much more useful purpose if it were added to the top of the article rather than to the bottom.

I am not saying this idea of putting navboxes at the top of an article is always a good idea. Some navboxes only cover sideways-related articles, not directly related articles.

For example; {{Cigarettes}} should not go to the top of this article. It should go on the bottom of the article, if it goes on this article at all. -- Timeshifter (talk) 14:01, 9 November 2019 (UTC)

Misplaced Pages:Hatnote: "More pages on the same topic ("Further information ...")"

-- Timeshifter (talk) 08:29, 10 November 2019 (UTC)

A hatnote and a navbox both take up one line. I prefer a horizontal navbox to a sidebar navbox. Because sidebars can mess up the page formatting, floating, and alignment, especially on mobile phones. Mobile view is so narrow. Whereas a standard horizontal navbox just pushes everything down when it is open.

The e-cigarette topic has basically become a book with many chapters. A book table of contents goes at the beginning, not at the end. -- Timeshifter (talk) 22:31, 10 November 2019 (UTC)

Sidebar navbox would work too

Misplaced Pages:Navigation template: "The two main types of navigation template are navboxes and sidebars."

See also: Misplaced Pages:Article series. -- Timeshifter (talk) 08:21, 10 November 2019 (UTC)

I added an example of a sidebar navigation template: Template:Operation Condor. The pages it is transcluded on can be found here. -- Timeshifter (talk) 13:57, 22 December 2019 (UTC)

@QuackGuru: Do you have an opinion about this? Also, I suggest you redirect your user page to your talk page rather than leave your user page as a red link. (Later note: See User talk:QuackGuru‎). -- Timeshifter (talk) 02:08, 9 January 2020 (UTC)

The color could be changed to be more noticeable like the flow chart. QuackGuru (talk) 13:30, 19 January 2020 (UTC)

@QuackGuru: Color? I don't know what you are referring to. Are you talking about the sidebar navbox idea? -- Timeshifter (talk) 01:48, 22 January 2020 (UTC)

The current color looks similar to periwinkle. If the color was changed it would be much more noticeable. QuackGuru (talk) 12:18, 22 January 2020 (UTC)

@QuackGuru: OK, that's true. But what about the idea of using a sidebar navbox instead of the bottom-of-the-page navbox? -- Timeshifter (talk) 14:30, 22 January 2020 (UTC)

There are two images in the lede. It would clutter the lede to add a sidebar. QuackGuru (talk) 14:54, 22 January 2020 (UTC)

@QuackGuru: The top image is historical and could be moved to the history section, and/or to an appropriate sub-article. That would leave room for a sidebar navbox above or below the other image. The sidebar navbox is far more important at the top than the historical image. -- Timeshifter (talk) 17:44, 23 January 2020 (UTC)

I would not move the images. I would change the color of the current navbox. QuackGuru (talk) 18:59, 23 January 2020 (UTC)

A lot of your work is going to waste. Many people are not seeing the subarticles. Navboxes at the bottom of pages are usually links to related topics, not subtopics. Most people, even longtime editors such as myself, will not think otherwise. Even if there is a different color navbox.

Look at the Operation Condor navbox to the right. Those are subtopics in subarticles. It is, in effect, an extended table of contents. By convention those go near the top of web pages.

That navbox is in the first section right after the table of contents. So we could do the same here. -- Timeshifter (talk) 23:00, 23 January 2020 (UTC)

A lot of work is being blocked or is being undone. I am gearing up for AN/I or arbcom for next week. I prefer a color change rather than the current mundane color. QuackGuru (talk) 00:30, 24 January 2020 (UTC)

This article is part of a series about Michael Bloomberg
Political positions Electoral history Bloomberg L.P. Terminal News Television Radio Businessweek Markets Mayor of New York City Mayoralty Elections 2001 2005 2009 2020 presidential campaign Primaries Endorsements Bloomberg Philanthropies Beyond Coal Everytown for Gun Safety Willett Advisors Draft Bloomberg movement Portable Bloomberg: The Wit and Wisdom of Michael Bloomberg
v t e

@QuackGuru: I, or somebody else, could create a sidebar navbox with a different background color. But first we need some agreement on it, and its placement. There is room in the section right after the table of contents. There is no essential image in the way. There is a small image that can be put after the navbox. See image to the right. -- Timeshifter (talk) 18:21, 25 January 2020 (UTC)

Template history You could ask the editor who created the original e-cg template if they can create a sidebar. I would first need to see the sidebar before deciding if it would work. QuackGuru (talk) 21:04, 25 January 2020 (UTC)

(unindent). I left a note on their talk page: User talk:Ambrosiawater. -- Timeshifter (talk) 00:29, 26 January 2020 (UTC)

{{style}} is the sidebar navbox at Misplaced Pages:Manual of Style/Layout. -- Timeshifter (talk) 04:27, 26 January 2020 (UTC)

I like the Michael Bloomberg page sidebar navbox. {{Michael Bloomberg series}} The header box at the top with the small image makes it clear what it is. See navbox to the right. The Bernie Sanders sidebar navbox also has an image header box. See: {{Bernie Sanders series}} -- Timeshifter (talk) 05:55, 6 February 2020 (UTC)

Pod mod discussion

See https://en.wikipedia.org/Wikipedia_talk:WikiProject_Medicine#Pod_mod QuackGuru (talk) 13:52, 6 December 2019 (UTC)

This article seems out of date now; relying on old sources. Change to past tense or revise

This article has content presented as present circumstances, but supported by old sources. It requires serious re-writing now. A first step would be to change the present tense claims to past tense. When the only source to support a "present condition," is from 2014, the statement at least should be changed to past tense. For example, if the article says,

"There is no strong evidence of harm from vaping" supported by a 2014 source, that statement should be changed to "As of 2014, it was claimed that there was no strong evidence of harm from vaping." It is also a formal fallacy to make such a statement as "there is no evidence," since no source could know that, as no writer ever searched everybody's basement or visited all the nations of the world.

After temporarily changing all the present tense claims to dated past tense claims ("as of 2015 there was"), then the entire article requires revision based on 2019-2020 sources. (PeacePeace (talk) 00:34, 26 December 2019 (UTC))

This article should not contradict itself.

A 2019 source supports this statement: "In 2019, an outbreak of severe lung illness across multiple states in the US was linked to vaping." The material which precedes that statement seems to contradict that statement. And note that this statement in past tenses supported by 2019 source, is preceded by contrary claims presented using the present tense, though their source may be 2014 or 2015. Many articles on Misplaced Pages seem to err by using a present tense where the content will soon become obsolete since the situation in at a given time may change in the future, making the present tense claim false. (PeacePeace (talk) 00:42, 26 December 2019 (UTC))

US cancer death rate sees largest-ever single-year drop

I am just getting things started. Others with more time will have to dig up the WP:MEDRS sources.

US cancer death rate sees largest-ever single-year drop, report says. By Audrey McNamara, Jan 8, 2020. CBS News. Article quote with emphasis and info added:

-- Timeshifter (talk) 02:15, 9 January 2020 (UTC)

CDC report about cause of lung illness

CDC just released this report. https://www.cdc.gov/mmwr/volumes/69/wr/mm6902e2.htm?s_cid=mm6902e2_w

I don't have time right now, but its content should be added to the article about the lung illness. Among the main facts is that the vast majority of those with lung illness consumed THC cartridges from informal sources, 82% and 78% respectively. KristofferR (talk) 21:31, 30 January 2020 (UTC)

That does not verify the change. QuackGuru (talk) 21:40, 30 January 2020 (UTC)

How so? What do you dispute? KristofferR (talk) 21:42, 30 January 2020 (UTC)

That's a SYN violation to come to a conclusion not found in the source. See in the subarticle. "80% reported THC use, 35% reported exclusive THC use, about 54% reported using nicotine-containing products, and 13% reported exclusive use of nicotine-containing products." QuackGuru (talk) 21:45, 30 January 2020 (UTC)

The disputed line doesn't contain the word THC. However, I agree that the word "black-market" could theoretically be problematic, since it is not totally synonymous with informal sources. So I removed it. I don't think there's a dispute over the line now. KristofferR (talk) 21:55, 30 January 2020 (UTC)

The CDC has not stated what caused the outbreak yet. The CDC has also stated people vaping only nicotine got sick. Those were not all adulterated products. This edit also failed verification. We are going to have to wait for the investigation to be concluded. QuackGuru (talk) 22:17, 30 January 2020 (UTC)

Per "we're not talking about approved additives". There are approved additives User:KristofferR? Care to provide a source... Doc James (talk · contribs · email) 00:52, 3 February 2020 (UTC)

I should have been more precice, I meant licit. Please continue this discussion in the new section below. KristofferR (talk) 04:52, 3 February 2020 (UTC)

Request redirects for deletion

• Marketing for e-cigarettes
• Marketing of e-cigarettes
• Marketing of e-cigs
• Marketing of electronic cigarettes

These redirects are duplication or similar to other redirects. No readers is going to first type "marketing of/for" to search for an e-cig article. I don't know how to bundle the redirects and nominate them together. QuackGuru (talk) 02:26, 2 February 2020 (UTC)

Violation of consensus

https://en.wikipedia.org/Wikipedia:Deletion_review/Log/2019_December_30

https://en.wikipedia.org/search/?title=Hospitalized_cases_in_the_vaping_lung_illness_outbreak&action=history

Article was deleted against the Deletion review. QuackGuru (talk) 03:03, 2 February 2020 (UTC)

CDC "are confident that Vitamin E acetate is strongly linked to the EVALI outbreak". Somehow it is controversial to quote CDC verbatim

CDC has multiple times stated very clearly that Vitamin E acetate adulteration has been linked to the EVALI outbreak.

"Vitamin E acetate is strongly linked to the EVALI outbreak. Vitamin E acetate has been found in product samples tested by FDA and state laboratories and in patient lung fluid samples tested by CDC from geographically diverse states. Vitamin E acetate has not been found in the lung fluid of people that do not have EVALI." https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

"Thanks for joining the call today. As the year draws to a close based on extensive investigations by state and local public health authorities, CDC scientists, our partners at FDA, and expert clinicians, we are able to make more definitive conclusions about the outbreak of e-cigarette or vaping product use-associated lung injury or EVALI. Some of the support for these conclusions comes from CDC-authored articles being released today in the New England Journal of Medicine as well as two articles in today’s early release of the Morbidity and Mortality Weekly Report. As of December 17, 2019, a total of 2,506 patients have been hospitalized for EVALI including reports from all 50 states. Sadly, there have been 54 deaths from 27 states. But based on the data being released today, we can make more definitive statements about the trajectory of the epidemic.

Second, we are confident that Vitamin E acetate is strongly linked to the EVALI outbreak. In a second report in the New England Journal of Medicine, CDC scientists found Vitamin E acetate in lung fluid washings, what we call bronchioloalveolar lavage samples in 48 of 51 samples of patients with EVALI but not in a variety of comparison patient groups. The patients with EVALI came from 16 different states, suggesting this was not a single local supplier of tainted products. These expanded patient clinical specimen results are consistent with previous work including identification by FDA and others of Vitamin E acetate in THC-containing products collected from patients with EVALI, as well as Minnesota’s recent report that Vitamin E acetate was in seized THC products from 2019 but not in any samples from 2018.

Given all of these findings, including today’s study, we can conclude that what I call the explosive outbreak of cases of EVALI can be attributed to exposure to THC-containing vaping products that also contained Vitamin E acetate." https://www.cdc.gov/media/releases/2019/t1220_telebriefing_update_lung_injury.html

Some here also disagree that Vitamin E acetate is an adulterant, but not the CDC: "It’s pretty clear when you look at Vitamin E acetate, it’s a goopy, viscous liquid that’s pretty similar in the liquid viscousness to THC oil. So if you were kind of trying to extend your THC oil, it would be a pretty good way to do it. So how word of mouth or social media helped — contributed to this phenomenon, I don’t think right now anyone believes it was a single dealer or single producer that added Vitamin E acetate to THC oil. I think there is a sense that this was a distributed adulterated supply."

--- Are any of you still disputing that the CDC has been quoted correctly above? KristofferR (talk) 05:05, 3 February 2020 (UTC)

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html This is the latest source from the CDC. The CDC has not come to a conclusion yet. It usually takes a year or longer to come to a conclusion. QuackGuru (talk) 12:56, 3 February 2020 (UTC)

That's inaccurate, please read the text above. "Some of the support for these conclusions"

Anyway, it's irrelevant. The terminology is "linked", not "concluded", the two words mean totally different things. As quoted above, CDC "are confident that Vitamin E acetate is strongly linked to the EVALI outbreak".KristofferR (talk) 17:20, 3 February 2020 (UTC)

This is too much detail for this article for now. After CDC has come to a conclusion then this can be revisited. QuackGuru (talk) 17:37, 3 February 2020 (UTC)

Strongly disagree, the CDC are "are confident that Vitamin E acetate is strongly linked to the EVALI outbreak" and it is vital context. I removed a completely outdated statistic to shorten the lede.KristofferR (talk) 17:52, 3 February 2020 (UTC)

It is not outdated until a newer source is found. When the CDC has concluded their investigation or has provided new information then we can resist this. This edit can be reverted. QuackGuru (talk) 18:28, 3 February 2020 (UTC)

Stop talking about "conclusion", it is a completely irrelevant term. "Linked" is the term in question, and CDC has confirmed the linkage. The edit can not be reverted. KristofferR (talk) 18:50, 3 February 2020 (UTC)

Because the CDC has not come to a conclusion then we should not try to come to a conclusion. This edit can be reverted by anyone. QuackGuru (talk) 18:53, 3 February 2020 (UTC)

Do you know what "link" means? It means a connection between two things. Link does not mean exclusive conclusive causation, despite you saying it.KristofferR (talk) 06:48, 4 February 2020 (UTC)

Isn't there plenty of evidence that tocopherol acetate is harmless to vape? E.g., . Isn't there evidence here that the vitamin E oil is being used to dilute as-yet unidentified substances and sold as cannabis extract? It seems like a pretty bad idea to even use the word "linked" for this situation without further context for a substance that is known to be harmless for aerosol administration when there is no question that it's being used for its color and consistency with some other unknown psychoactive compounds likely to blame. The CDC has never actually said vitamin E is harmful if inhaled, have they? EllenCT (talk) 22:01, 20 February 2020 (UTC)

Overly Verbose

I think this is the most verbose and hard-to-read article I've ever read on Misplaced Pages. This doesn't look at all like some definitive article, rather a case where every damn person who wanted to was able to add something. Sanpitch (talk) 16:30, 3 February 2020 (UTC)

The tag is bogus. It is a summary of a complex topic. QuackGuru (talk) 16:43, 3 February 2020 (UTC)

The cigarette page is 485 kB, with 9 kB references, while the electronic cigarette page is 1090 kB with 42 kB of references; the article size seems unreasonable. I think that the article should be broken up or otherwise condensed, including shortening the lede and condensing the references. Even so, I've removed the tag from the article, which I guess was an overreaction on my part.Sanpitch (talk) 19:28, 5 February 2020 (UTC)

@Sanpitch: I agree with your assessment, and put up the {{too long}}, specifically for its recommendation to condense. The problem is not that the topic is very complicated and takes a long time to explain, it's that the writing is choppy and overly verbose. There are too many details presented in the lede, making it more of a mini-article than a quick summary. The body has some sentences that aren't really needed, like "The scientific community in US and Europe are primarily concerned with their possible effect on public health", and lots of sentences that repeat what other sentences have already said. I think this is probably due to some overly slavish referencing, where every source gets its own sentence rather than overlapping sentiments from multiple sources being combined into a single more general sentence. (This issue affect several articles and has been raised at Misplaced Pages:Arbitration/Requests/Enforcement#QuackGuru.) There's not much to be done but plow through the article and fix these problems one by one. -- Beland (talk) 04:44, 10 February 2020 (UTC)

• I've made an attempt at reorganizing this article at User:Jd4x4/Jd4x4 Electronic Cigarette Reorganization Proposal and it still has a horribly long way to go i.m.o., but I think it will allow for easier editing of the contentious parts. What should be my next step before replacing the current version here? rfc, submit it from my sandbox, or just replace it by cut & paste?Jd4x4 (talk) 21:20, 20 February 2020 (UTC)

New sources

New sources were recently added to the article. User:Sunline09, can you put all the new source here on the talk page. QuackGuru (talk) 21:26, 5 February 2020 (UTC)

References

I noticed Electronic cigarette#Frequency did not follow WP:SYNC. Since all the previous versions did not follow SYNC I copied the content from the lede of the subarticle. QuackGuru (talk) 23:53, 7 February 2020 (UTC)

I’m unfamiliar with this violation, can you better explain what this means? Sunline09 (talk) 18:22, 11 February 2020 (UTC)

See other sections such as Electronic cigarette#Construction. It is a copy of the lede of the subarticle.

See WP:SYNC: "To keep articles synchronized, editors should first add any new material to the appropriate places in the detailed article, and, if appropriate, summarize the material in the summary section."

I did update the subsarticle and I made a change to the Frequency section per SYNC. Before content is added to the lede of the subarticle it is usually added to the body first. QuackGuru (talk) 18:48, 11 February 2020 (UTC)

RfC for nicotine pouch article

See https://en.wikipedia.org/Talk:Nicotine_pouch#Proposal QuackGuru (talk) 13:06, 6 February 2020 (UTC)

Reintroduction of deleted line

Request reintroduction of this line, deleted by QuackGuru. Genetics4good (talk) 17:30, 9 February 2020 (UTC)

By my reading, QuackGuru's edit summary reason ("not a summary of the body") was incorrect. I restored this to the intro, but modified it to fit in better and have more context. This might be a detail that needs to be pushed into the body to keep the lede length down, but I haven't read enough of the article to opine on that. -- Beland (talk) 04:51, 10 February 2020 (UTC)

It is not in the body this article. You wrote "this variation is in fact mentioned in the body in the Construction section" This article is not the Construction article. This change is also not a summary of this article and it is unsourced. A similar change to Safety fails verification and it is not a summary of content in Safety. QuackGuru (talk) 18:48, 11 February 2020 (UTC)

I want to say

that the medical community in different countries takes a different view of e-cigarettes. Here in the UK the strategy is to get people off tobacco by any route possible. Quitting with conventional NRT is preferred, but for those who can't or won't, converting to e-cigs is viewed as preferable to continuing with tobacco. But I think that in other countries, the medics tend to take a more skeptical view. Is that an accurate and fair thing to put in the article?—S Marshall T/C 17:01, 19 February 2020 (UTC)

Only if you can find sources saying so. -- MelanieN (talk) 01:09, 20 February 2020 (UTC)

• , but it doesn't say so explicitly; the point is, imo, implicit in the first few paragraphs.—S Marshall T/C 10:55, 20 February 2020 (UTC)

There have been articles published that do state that exact point, I will try to find them and check that they are "approved" sources for citingJd4x4 (talk) 13:33, 20 February 2020 (UTC)

While this mainly addresses the differences between UK and US policies, perhaps something from here S Marshall? (https://www.rcplondon.ac.uk/projects/outputs/rcp-advice-vaping-following-reported-cases-deaths-and-lung-disease-us)

• Thanks. I think that the point is implicit rather than explicit in that source too. I can't find one sentence that says it unambiguously. There's also this which gives us in the UK, e-cigarettes are widely supported as a reduced risk nicotine alternative for smokers, and has received support from a number of agencies (page 2, column 1, paragraph 2) but doesn't explicitly contrast that with the rest of the world, and this which gives us Recently, authoritative UK groups, including Public Health England (PHE), the Royal College of Physicians, the Smoking in Pregnancy Challenge Group, and the National Centre for Smoking Cessation and Training (NCSCT) who provide training for all SSS staff, have stated that they believe benefits from e-cigarettes are likely to be far greater than harms, including in pregnancy and then, after several intervening pages, gives us In the U.S., surveys of health professionals caring for pregnant women have indicated that many appear to have concerns about the use of e-cigarettes; obstetricians and gynecologists were uncertain about how to advise on e-cigarettes due to lack of guidance, and of US family physicians who provided obstetric care, most respondents thought that e-cigarettes are unsafe to use during pregnancy but again that's comparing UK vs US and I'm sticking together sentences from different parts of the document to get there.—S Marshall T/C 15:25, 20 February 2020 (UTC)

Needs Major Organizational Rework, IMO

This article could sorely benefit from major existing section reorganization, beginning with putting the TOC immediately after paragraph 1, and moving what are currently paras 2, 3 and 4 into the relevant current TOC sections, adding sections as appropriate. I would certainly volunteer to do that, but I don't have much experience with Wiki Markup. Is the visual editor an option for this page?Jd4x4 (talk) 18:16, 19 February 2020 (UTC)

• This article is horribly written. It's made of snippets from reliable sources cut out of context, then roughly grouped by topic. It desperately lacks structure and totally fails to proceed from premise to thesis to conclusion. The prose is narcoleptically boring and our target reader, an uninformed but curious person, is very unlikely to get past the first few turgid paragraphs. Fixing it is going to be laborious. But we do need the lead (i.e. the section above the TOC) to contain a summary of the medical literature about the health effects, as this is a likely reason why a reader might come here. So I don't agree that we can reduce the lead to what's currently paragraph 1. I do agree that the lead is much too long at the moment.—S Marshall T/C 11:12, 20 February 2020 (UTC)

I'm not sure why you think that the health effects necessarily need to be in the intro/overview/desc para (1st, imo) rather than putting it as the 1st heading topic, and using the TOC? It would go a long way to cleaning up the look and highlight the health effects, I think.Jd4x4 (talk) 13:26, 20 February 2020 (UTC)

In retrospect, maybe leave the construction bits as 2nd (+ whatever) paras, then start Health as 1st section?Jd4x4 (talk) 13:28, 20 February 2020 (UTC)

• Predictably, Misplaced Pages has a guideline about this. It's in the Manual of Style, at MOS:INTRO. Personally, I've often been infuriated by the Misplaced Pages Manual of Style, because of the number of times I've clashed with editors who've reached a "consensus" of half a dozen American teenagers on an obscure MOS subpage that I don't have watchlisted, and now feel entitled to screw up every article in the encyclopaedia because of it. But I think the rule about beginning articles with four paragraphs that summarize every major theme in the article is well-thought-out, and it's based on this decent, widely-advertised discussion that led to a proper consensus after reasoned debate.

How to clean up this article is a substantial challenge. The best strategy I've got is to go through it sentence by sentence, removing the redundant, simplifying the convoluted and clarifying the incoherent or unintelligible. When I've done that I'm hoping that I'll be able to make out what the article actually says on each of its various themes. Then hopefully I can unify it into one consistent referencing format and evaluate how heavily it leans on each of its sources. (I have the vague impression that it's overly reliant on a small number of increasingly outdated sources such as Grana 2014 but I can't quantify that at the moment). Suggestions for better strategies would be very welcome.—S Marshall T/C 15:03, 20 February 2020 (UTC)

• I'm currently doing a major(!) re-organization of this page in my sandbox. It is a work in progress:User:Jd4x4/Jd4x4 Electronic Cigarette Reorganization Proposal. Because of the lack of proper structure/categorization there are numerous repeated & conflicting sentences, citations, and paragraphs. I am trying to keep all contributions so far, but will clearly have to exchange some things, with a preference towards removing outdated info. Any constructive feedback is appreciated!Jd4x4 (talk) 15:34, 20 February 2020 (UTC)
  • Looking at your rearranging and I am not seeing an improvement in the lead. An overview is missing. Doc James (talk · contribs · email) 21:58, 20 February 2020 (UTC)

I fail to see why the paragraphs before the TOC box are not a concise overview of of the subject, and then expanded upon in detail in the following sections. Explain what you think needs adding?Jd4x4 (talk) 23:00, 20 February 2020 (UTC)

The rearranging broke a bunch of references and duplicated a bunch of content. Restoring to the prior stable version. Doc James (talk · contribs · email) 01:26, 22 February 2020 (UTC)

By doing so, you've just added back all the duplication that I painstakingly removed.—S Marshall T/C 01:43, 22 February 2020 (UTC)

The trouble with restoring the "stable" version is that the stable version is almost universally agreed by uninvolved editors and administrators to be crap. I wish you hadn't deleted the bit where we discourage non-smokers from vaping. I also think it's a great pity that you've almost entirely restored QuackGuru's convoluted, repetitive and tortuous phrasing. Why would you do that?—S Marshall T/C 01:53, 22 February 2020 (UTC)

Secondary sources

This is based on a primary suorce "In a study comparing the birth weight of babies born to mothers who smoked, vaped, or did neither it was found that the birthweight of infants born to EC (e-cigarette) users is similar to that of non‐smokers, and significantly greater than cigarette smokers.."

We should be using secondary sources per MEDRS. Doc James (talk · contribs · email) 21:56, 20 February 2020 (UTC)

References

1. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16110

I agree in principle, but what I have noticed happening here over the years is that those who remove primary sources only add the MEDRS sources that agree with their POV. For example, people reading page 16 of this MEDRS source will be left with vastly different impressions than those reading this article, which is heavily weighted in favor of older, smaller, inconclusive studies which are zealously guarded along with inconclusive language. How long is this going to go on? EllenCT (talk) 22:07, 20 February 2020 (UTC)

Yes the FDA and UK government have taken different positions. Both are suitable sources. Doc James (talk · contribs · email) 01:31, 22 February 2020 (UTC)

• I won't take this up on the live page or here until some form of sanity prevails with this article, but I suggest using the addition I made under the Pregnancy section at User:Jd4x4/Jd4x4/sandbox:ECigReorg#Pregnancy. This sites a review article that I would hope meets MEDRS criteria! (pasted below):

As of 2018, the health effects of Electronic Cigarette Use in Pregnancy for mother or fetus remain unknown. In it's summary review<ref>{{Cite book| isbn = 978-0-309-46834-3| last = NASEM - IOM| title = Public Health Consequences of E-Cigarettes| accessdate = 2018-03-06| date = 2018-01-23| url = https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes}}</ref> the U.S. National Institute of Medicine concluded that "Although the extensive research on tobacco and limited evidence on nicotine in isolation gives some focus to the questions regarding the potential effects of e-cigarettes, the need for direct evaluation is clear.", (''Conclusion 13-1'') "There is no available evidence whether or not e-cigarettes affect pregnancy outcomes.", and (''Conclusion 13-2'') "There is insufficient evidence whether or not maternal e-cigarette use affects fetal development."<ref>https://www.nap.edu/read/24952/chapter/18#468</ref>Jd4x4 (talk) 02:51, 21 February 2020 (UTC)

• I've subsequently used the above in my organization/readability change edits. fwiw. Jd4x4 (talk) 16:03, 21 February 2020 (UTC)

Reorganization, structure- I just "did it"

• I followed the advice to Be Bold. Edit wars and controversy were not being helped by the redundancy and confusion in much of this article. There is still redundancy, and everyone may not like my "sections", but that can be changed easy enough with edits, and I think organization of some sort makes this article better going forward. Jd4x4 (talk) 13:19, 21 February 2020 (UTC)
• The lead does need to discuss risks and health effects, no question about that. We're writing for a general audience and a likely reader is a young person who's considering taking a puff. However, I do strongly endorse the removal of the previous section in the lead on the grounds that it was unreadable. We should write a new paragraph on the health effects, starting from scratch. I will do this shortly if nobody else does.—S Marshall T/C 13:54, 21 February 2020 (UTC)

Works for me. Over to you, lol. If I were going to tackle it, I'd also key in on the youth-brain development (in nicotine-containing products) that I think exists already in the article, and the NASEM bits on exacerbation of asthma (which they concluded may be the opposite with adults, where improvement possible). Also that it's illegal in the U.S. and U.K. Under 21 now in the U.S., not sure about U.K. We should also bear in mind that our readers may also be combusted tobacco users that are weighing the benefits of using them to quit.Jd4x4 (talk) 15:17, 21 February 2020 (UTC)

There's a nice web readable version of the NASEM which has a great TOC and a section on Youth. I wish the UK NHS & RCP had that, but I haven't found it if they do. — Preceding unsigned comment added by Jd4x4 (talk • contribs) 15:25, 21 February 2020 (UTC)

• I've roughed in a draft. Please do edit ruthlessly, but I'm keen to keep the sequence of ideas there: (1) If you're a non-smoker, don't try vaping; (2) If you're a smoker, try to quit using proper, regulated smoking cessation products; and (3) If you're a smoker who can't or won't quit that way, then e-cigs might be for you. The fact that the previous version of the article didn't articulate these things was one of my biggest criticisms of it.—S Marshall T/C 16:51, 21 February 2020 (UTC)

Thanks for that. I'll have a look (I haven't yet) but I'm inclined to add to point (2) that having failed cessation with all of the methods you listed, vaping is unarguably safer than combusted tobacco. (as per PHE, RCP, and even ACS (https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21455) until the EVALI outbreak.) Jd4x4 (talk) 18:22, 21 February 2020 (UTC)

• In my view, vaping's very likely to be safer than smoking tobacco, but the matter is hardly unarguable. The long term health effects of vaping are simply unknown (and won't be known for quite a while), because so many vapers have a history of smoking tobacco that it'll be hard to disentangle the effects of vaping from the effects of smoking. I say that vaping's probably safer because (a) I'm British and therefore all the doctors I know are willing to advocate vaping as a quitting aid; and (b) because I think smoking tobacco is so harmful to so many aspects of health that almost any alternative is likely to be preferable.

  Personally I'm an ex-nicotine addict; I smoked tobacco for thirty years and then quit using conventional NRT. This was before I'd ever heard of vaping. If I'd known about e-cigs at that time, I might very well never have quit.

  I understand why so many nicotine addicts are evangelical about vaping. I think it's important that this article reflects the medical sources' caution about how safe vaping is or isn't.—S Marshall T/C 23:38, 21 February 2020 (UTC)

I understand what you are saying, as well as your viewpoint. And, agree about being cautious to maintain the medical facts, but we shouldn't always equate nicotine with vaping, imo. I considered how & where I might find a citation for the part I removed- "Nicotine is (extremely?) dangerous", but thought that dangerous was to vague and best removed. It also made no distinction about nicotine vs. non-nicotine e-cigarettes. So I focused on the youth uptake bits, and nic vs. no-nic probably best left "short & sweet" in the part about never starting.

If we just limit the topic to those two sub-topics (nicotine use (by aerosol ingestion i.e. vaping) and vaping without nicotine) for a moment, we can then see that they are unique and multi-faceted (and controversial as well) among themselves. To fully understand the implications they have when finally combined without discussing each first just causes more confusion and debate. In short, muddies the waters, imo. Also the actual percentage of nicotine vapers vs. non-nicotine vapers is not documented well at all, with the most research being with youth, and that by itself is contentious. Lastly as NASEM notes, current understanding of many aspects of nicotine itself is only best understood from it's historical administration methods and not as well when we are talking about extracted nicotine (or salt versions) without the other alkaloids normally present, and certainly not well when it comes to ingestion by aerosol "vapor devices".

By the way, I'm an ex-smoker (47 year) who tried to quit & failed for about 20 of those years, was able to quit within 1/2 hour of my 1st e-cig 8 years ago (consider that cessation speed- this is why "we" appear "evangelical", imo), and am a current "addict" who at this point still uses nicotine. My viewpoint is that I'm a strong advocate of current combusted tobacco cessation first, then everything after is, well, better imo. :-)

I think this article desperately needs both of our viewpoints in addition to youth & medical contributors! Jd4x4 (talk) 16:04, 22 February 2020 (UTC)

• I forgot the "unarguable" part- Can a MEDRS secondary source be cited for Lung Cancer from vaping as it can for Smoking? I'm not sure a MEDRS can yet be found for vaping and heart disease. So for me I consider not carcinogenic unarguable, at least today and conversationally. If PHE and the NHS are MEDRS citable, then they (and PHS Scotland) are "on the record" as "safer". Jd4x4 (talk) 16:44, 22 February 2020 (UTC)

The revised lead was better

The introduction in this recent revision is so much better and easy to read than the current and previous very difficult to read version, I want to know what precisely it's detractors feel is inferior about it? EllenCT (talk) 16:54, 22 February 2020 (UTC)

• I think it would be very helpful if Doc James would kindly answer this question.

  I do think that revert was problematic. Looking at Doc James' logged edits for that evening, we can see how many articles this user maintains, how fast he edits, and how little time he spent looking at the article before deciding to revert. He took a little less than eight minutes over it, during which time he was actively editing the article. Now, I'm willing to stipulate that Dr Heilman is an extremely fluent reader, but I do not think it's plausible that in that tiny amount of time, he was able to thoughtfully and critically evaluate each of the 42 (forty-two) revisions he removed with that revert. In other words, I see this as good evidence that Doc James is reverting revisions he doesn't understand.

  This is a problem behaviour that's been ongoing for at least five years and has gone all the way up to Arbcom. In Misplaced Pages:Arbitration/Requests/Case/Editor conduct in e-cigs articles in 2015, I specifically discussed this issue of misdiagnosing good faith edits as advocacy, bad faith, or vandalism. I'm disappointed that we're back here again. In that case, Arbcom reminded another editor, CFCF, to contact the editor they are in dispute with before resorting to reverting, and I would like to ask Doc James to reflect on their advice.—S Marshall T/C 18:43, 22 February 2020 (UTC)

Thank you for that EllenCT and S Marshall for the revisions you made in the lead without causing bloat. When I reordered it I tried to retain everything in the previous versions that were not duplicated elsewhere in the entire text, and tried to categorize the rest without deleting. I too felt that it read and presented better if the lead remained concise but there were other points that were felt to be needed in the summary, one of note was the emphasis on youth cautions. Having said that, I would also like to hear Doc James comment on the need for more paragraphs rather than a synopsis of topics expanded upon later in the article. I hope that the comments I made on his talk page prior to my reorg re:undo's weren't upsetting but I didn't think the edit stats for this article looked much like consensus in action. Jd4x4 (talk) 22:22, 22 February 2020 (UTC)

If you look at this text you will quickly notice a bunch of misformatted text in the "popularity section"

Next you will notice a bunch of text that occurs twice such as "The prevalence of vaping among adolescents is increasing worldwide" "There appears to be an increase of one-time e-cigarette use among young people worldwide" "Most e-cigarette users among youth have never smoked" "Many youth who use e-cigarettes also smoke traditional cigarettes" "Vaping seems to be a gateway to using traditional cigarettes in adolescents. Youth who use e-cigarettes are more likely to go on to use traditional cigarettes" "The evidence suggests that young people who vape are also at greater risk for subsequent long-term tobacco use" "E-cigarettes are expanding the nicotine market by attracting low-risk youth who would be unlikely to initiate nicotine use with traditional cigarettes" "Adolescents were more likely to initiate vaping through flavored e-cigarettes" "There are varied reasons for e-cigarette use" "Many users vape because they believe it is healthier than smoking for themselves or bystanders" "Usually, only a small proportion of users are concerned about the potential adverse health effects"

The references supporting the text in the lead were removed as we are left with this an unreferenced "The health effects of electronic cigarettes are unknown, but they are widely believed to be less harmful than smoking tobacco."

Yes I realize that those who promote e-cigs want to just concentrate on the risk in smokers, but their is population risks and the concerns around e-cigs potentially causes non smokers to become smokers. If e-cigs create smokers they will result in harm not benefit at the population level. This is most of the uncertainty with respect to health benefits.

Yes reflecting on what happened is required S Marshall. These edits were not an improvement. Doc James (talk · contribs · email) 00:04, 23 February 2020 (UTC)

@Doc James: I agree about the formatting and missing reference, but those are easy fixes. What intrigues me is the gateway to smoking hypothesis. I could only find one MEDRS source:

"While trying electronic cigarettes may causally increase smoking among some youth, the aggregate effect at the population level appears to be negligible given the reduction in smoking initiation during the period of vaping’s ascendance." Levy, David T.; Warner, Kenneth E.; Cummings, K. Michael; Hammond, David; Kuo, Charlene; Fong, Geoffrey T.; Thrasher, James F.; Goniewicz, Maciej Lukasz; Borland, Ron (1 November 2019). "Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check". Tobacco Control. 28 (6): 629–635. doi:10.1136/tobaccocontrol-2018-054446. ISSN 0964-4563. Retrieved 23 February 2020. (Review.)

There are also a variety of non-MEDRS sources, such as, "little evidence that renormalisation of youth smoking was occurring during a period of rapid growth and limited regulation of e-cigarettes from 2011 to 2015." and "Data from the NYTS do not support claims of a new epidemic of nicotine addiction stemming from use of e-cigarettes, nor concerns that declines in youth tobacco addiction stand to be reversed after years of progress. Among current e-cigarette users who had never tried tobacco products, responses consistently pointed to minimal dependence."

So where do your suspicions on this come from? EllenCT (talk) 03:18, 23 February 2020 (UTC)

CDC states they have the potential to benefit some and harm others.

And "Young people who use e-cigarettes may be more likely to smoke cigarettes in the future."Doc James (talk · contribs · email) 05:39, 23 February 2020 (UTC)

@Doc James: the only one of the sources on the CDC web pages which supports the corresponding second statement you quoted is chapter 22 of the National Academies of Sciences, Engineering, and Medicine (2018) Public Health Consequences of E-Cigarettes book, and that second statement is exactly the assertion that the MEDRS source I cited above debunks, restating it as the first sentence of its abstract, and concluding with the quantitative description of the extent as "negligible."

The 2011-6 data from page 530 of that NAP book shows that the number of kids who smoked in the past 30 days halved over that period, and while vaping took off from 2011-5, it fell in 2016. So who cares if you can prove conclusively that some of the kids who tried vaping also tried smoking later on, if the total number of them smoking fell by half? As points out, the number of kids currently smoking fell even further through 2018. And I just checked the NYTS raw files and see that the drop was even more dramatic from 2018 (5.2% on Q10, smoked in past 30 days) to 2019 (3.7%). Saying that vaping "may" increase the likelihood of subsequent smoking is meaningless when it happens much less often than not, and when the overall rate of smoking is going down while the rate of vaping is going up.

Anyway, I'd like to know if you really think we should add that second quote when we have a MEDRS source specifically debunking it and it's clear why it's deceptive. I have no objection to the first of the two statements you wrote in your previous reply above.

I'm also curious whether you agree that casting vaping in negative light here in this article represents a real harm to smokers inhaling carcinogenic smoke who might otherwise decide to try vaping. Lung cancer is an absolutely grueling death that we have a chance to help people avoid, in huge, many hundreds of thousands numbers annually by making responsible editorial choices. The prudent abundance of caution was reasonable years ago, but now it's just cruel. EllenCT (talk) 13:12, 23 February 2020 (UTC)

The CDC is a high quality perfectly suitable source. The goal is to provide a neutral overview.

We clearly say "but e-cigarettes are likely safer than tobacco products". The concern is re-normalizing cigarettes and around increasing the number of future people that may smoke. Doc James (talk · contribs · email) 15:18, 23 February 2020 (UTC)Not

@Doc James: what policy or guideline suggests that a government source is okay when there is a review specifically debunking the claim you want to include from it? Even if the statement you quoted had not been debunked by a MEDRS source specifically evaluating it, why would hypothetical future increases ever take precedence over stating what the reliable sources say about the recent plummeting prevalence of smoking while vaping increased? EllenCT (talk) 21:23, 23 February 2020 (UTC)

WP:MEDRS Doc James (talk · contribs · email) 23:43, 23 February 2020 (UTC)

That policy's WP:MEDDATE section says, "editors should try to find ... newer sources, to determine whether the expert opinion has changed since the older sources were written." In this case, a systematic review examined the single specific statement you want to include and found it technically accurate but quantitatively "negligible." EllenCT (talk) 01:20, 24 February 2020 (UTC)

• I'm underwhelmed with the sentence: "Those who want to promote e-cigs". Even after QuackGuru's ban I'm still prevented from editing the article because I'm presumed to be an advocate, shill or bad actor. That's completely unacceptable, Doc James, and I invite you to retract it.

  I shall restore the contested revision, which enjoys widespread support here, and says in plain English "non-smokers should not try vaping", and I will add a little more to reflect Doc James's concerns. It's right that the article shouldn't evangelize for vaping but I insist on being allowed to make it readable.—S Marshall T/C 09:35, 23 February 2020 (UTC)

You can try a RfC.

You are still duplicating large amounts of text in the body. Not sure how that makes it readable

Plus why write this in all caps "Legislative, Scientific, and Medical Positions"

Your revert is problematic in that it did not deal with all the issues, or even the ones I specifically raised.

I was referring to "those who promote e-cigs" not you.

Doc James (talk · contribs · email) 15:18, 23 February 2020 (UTC)

RfC: Article readability

Please consider joining the feedback request service. An editor has requested comments from other editors for this discussion. This page has been added to the following lists: Maths, science, and technology Economy, trade, and companies When discussion has ended, remove this tag and it will be removed from the lists. If this page is on additional lists, they will be noted below.

Rfc participants are asked to support any of the following position statements, give their reasoning, and make any general comments or observations they might have.

Position statement #1: This article's readability is poor.
Position statement #2: The lead requires improvement to comply with Misplaced Pages:Summary style.
Position statement #3: Article version #1 is unacceptably pro-electronic cigarette, advocates that readers should take up electronic cigarettes, or evangelises for e-cigarettes in any way.
Position statement #4: Article version #1 is preferable to article version #2.

Thanks for participating!—S Marshall T/C 16:37, 23 February 2020 (UTC)

Participants' views

• Support positions 1, 2 and 4. Oppose position 3.—S Marshall T/C 16:37, 23 February 2020 (UTC)
• As for positions 1 and 2, my issues are almost entirely with the third paragraph of the introduction, which needs to be completely rewritten to be consistent with the preponderance of recent MEDRS sources and drop the outdated uncertainty and now-concluded fake THC adulteration scare; and the fourth paragraph which needs to explain that youth smoking has plummeted and continues to plummet with the rise of vaping. I could care less whether position 3 is true or not as long as we give smokers responsible information about the fact that vaping has been enormously successful for reducing smoke inhalation, harm reduction, and smoking cessation. I've already stated I prefer the newer revision of position 4. EllenCT (talk) 21:12, 23 February 2020 (UTC)
• The article has become more of a mess in the last few days. Large sections of it contains the EXACT same text multiple time. And this duplication has been edit warred back into place. Why I am still not sure. It is unclear what version #1 and version #2 are in this RfC as the diffs link to a single edit. Doc James (talk · contribs · email) 03:38, 24 February 2020 (UTC)

Duplication specifics? Or, "edit warred" by whom? As I mention below there were/are still many duplicates. Jd4x4 (talk) 04:59, 24 February 2020 (UTC)

I'm unable to make sense of this objection because on my screen, the diff for "article version 1" is not the same as the diff for "article version 2". They are separate edits by separate editors made at separate time stamps. Doc James's confusion here probably arises from the fact that position statement 3 and position statement 4 both mention "article version 1" using the same diff. I would ask Doc James please kindly to slow down and read attentively. If your entire objection to the contested edit is duplication further down, then it would make sense to cancel the RFC, make the contested edit, and then fix the duplication. If you do have other objections, please list them now.—S Marshall T/C 13:49, 24 February 2020 (UTC)

• I'm not clear on what section(s) are thought to be unacceptably pro-e-cigarette. Can you specify? The Lead or other sections? The article was at the height of non-readability and replete with duplicated as well as conflicting statements prior to my "massive" reorg on 21 Feb. At that time I mentioned here that while I removed some of the duplicated bits, many still remained as well as some conflicting sentences scattered throughout the article. That revision was intended to shorten the Lead to a key item summary and to focus and contain edits on the multiple areas (as subheadings) of discussion and controversy, which also seemed to have the most duplication. I changed very little of the previous text/sentences otherwise. Jd4x4 (talk) 04:53, 24 February 2020 (UTC)

More to your question (prior to clarification), I prefer a shorter, more concise lead with possibly a link to other sections if there are more important subjects that are felt to need being in the lead, but need a lot of explanation.Jd4x4 (talk) 05:56, 24 February 2020 (UTC)

• To clarify my position, I agree with Position 1 at the time the RfC was raised, disagree with Position 3, and currently agree with Position 4 should it be decided to revert the lead from what it currently is.

Vaping associated lung disease

Not sure why this was removed "In 2019 an outbreak of severe vaping lung illness in the US was linked to e-liquid containing vitamin E acetate."? Doc James (talk · contribs · email) 03:41, 24 February 2020 (UTC)

@Doc James: because it was localized geographically and chronologically, and is no longer occuring. The idea that tocopherol acetate could be dangerous when the police intercepting the products stated outright that it was being used to cut unknown adulterants to pass off as THC vape oil was absurd enough to begin with, but the fact that the literature is replete with studies of its therapeutic uses e.g. just makes the idea that vitamin E was to blame stupid. But look at the history of this talk page, how many times did you defend QuackGuru's wording that it was "strongly linked" when the CDC didn't even go that far? EllenCT (talk) 04:09, 24 February 2020 (UTC)

Ah User:EllenCT the CDC states "Vitamin E acetate is strongly linked to the EVALI outbreak."

Of course agree that this outbreak has almost ended. But does exemplifies the concerns around additives to e liquids. Doc James (talk · contribs · email) 04:23, 24 February 2020 (UTC)

I'm sorry I missed that source of the word "strongly." I am still looking for the CDC's source that, "previous research suggests when vitamin E acetate is inhaled, it may interfere with normal lung functioning," and have been for months. Any idea where that comes from? EllenCT (talk) 04:37, 24 February 2020 (UTC)

I do not think the text "previous research suggests when vitamin E acetate is inhaled..." is needed. Were do you see me supporting it? Doc James (talk · contribs · email) 04:45, 24 February 2020 (UTC)

I'm not suggesting anyone wants it in the article, I was just asking if you've ever seen a source supporting it. EllenCT (talk) 05:15, 24 February 2020 (UTC)

"However, previous research suggests that when vitamin E acetate is inhaled, it may interfere with normal lung functioning." Doc James (talk · contribs · email) 05:25, 24 February 2020 (UTC)

I mean, do you know which previous research the CDC is referring to? This NEJM article from three days ago just speculates about phosphatidylcholines in liquid crystal phase and decomposition to ketene, but doesn't cite any such previous research. But it does state, "Cutting THC oil with vitamin E acetate has been reported to be common in the illicit market. The FDA reports that most case-associated THC product fluids contain vitamin E acetate, at an average concentration of 50% by weight, ranging from 23 to 88%. By contrast, the FDA detected no vitamin E acetate in 197 case-associated nicotine products analyzed to date." If it's not even in 197 of the associated products, that doesn't seem very strong of a link to me. EllenCT (talk) 05:43, 24 February 2020 (UTC)

Primary source / Original research

West, Robert; Brown, Jamie; Jarvis, Martin (7 October 2019). "Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey reveal about high school e-cigarette use in the USA? (Preprint)". Qeios. doi:10.32388/745076.3. ISSN 2632-3834. Retrieved 24 February 2020.

This source is not pubmed indexed. Is a preprint. And is a primary source.

Hallingberg, Britt; Maynard, Olivia M.; Bauld, Linda; Brown, Rachel; Gray, Linsay; Lowthian, Emily; MacKintosh, Anne-Marie; Moore, Laurence; Munafo, Marcus R.; Moore, Graham (1 March 2020). "Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales". Tobacco Control. 29 (2): 207–216. doi:10.1136/tobaccocontrol-2018-054584. ISSN 0964-4563. Retrieved 24 February 2020.

Another primary source. It is pubmed indexed and published in a good journal. We should really be going with reviews though.

"Historical NYTS Data and Documentation | CDC". www.cdc.gov. Centers for Disease Control and Prevention. 17 December 2019. Retrieved 24 February 2020.

Appears the person who added this is doing their own original research after looking at US data. Doc James (talk · contribs · email) 04:37, 24 February 2020 (UTC)

The simplicity of looking at the percentages for the answers to Q10 comprising smoking more or fewer than 30 days ago is within WP:CK. EllenCT (talk) 06:42, 24 February 2020 (UTC)

Sources being removed

Including the US Surgeon General from 2016

"Research has found that youth who use a tobacco product, such as e-cigarettes, are more likely to go on to use other tobacco products like cigarettes"

The WHO from 2014

"Although ENDS present a range of potential benefits to smokers, there is an extensive and often heated debate about whether ENDS will prove to have a positive or negative impact on population health and particularly tobacco control. Areas of legitimate concern include avoiding nicotine initiation among non-smokers and particularly youth while maximizing potential benefits for smokers... the possibility that children (and generally non-smokers) will initiate nicotine use with ENDS at a rate greater than expected if ENDS did not exist"

In WP:MEDRS, WP:MEDDATE says, "editors should try to find ... newer sources, to determine whether the expert opinion has changed since the older sources were written." EllenCT (talk) 06:42, 24 February 2020 (UTC)

The National Academies of Science Engineering Medicine in 2018

"For youth and young adults, there is substantial evidence that e-cigarette use increases the risk of ever using combustible tobacco cigarettes."

We should look to see what their updated positions are sure but replacing these better sources with primary ones is not an improvement. Doc James (talk · contribs · email) 04:54, 24 February 2020 (UTC)

I'm not sure that NASEM/IOM has an updated position. The original charge to them was by the FDA in order to help with regulatory policies going forward. I'll try to see if they were charged at that time or later to provide an update as was the charge to NHS/PHE in the UK, but I don't think so.Jd4x4 (talk) 05:19, 24 February 2020 (UTC)

Surgeon general still includes these concerns "Some studies show that non-smoking youth who use e-cigarettes are more likely to try conventional cigarettes in the future than non-smoking youth who do not use e-cigarettes." And in 2018 "Besides increasing the possibility of addiction and long-term harm to brain development and respiratory health, e-cigarette use may also lead to the use of regular cigarettes that can do even more damage to the body."

Basically many very well respected organizations still have concerns. Doc James (talk · contribs · email) 05:09, 24 February 2020 (UTC)

WHO in 2020 says "Furthermore, there is a growing body of evidence in some settings that never-smoker minors who use ENDS at least double their chance of starting to smoke conventional tobacco cigarettes later in life." Doc James (talk · contribs · email) 05:12, 24 February 2020 (UTC)

While we are talking about secondary sources, why the removal of Public Health Scotland in the references to characterization/quantification of harm vs. smoking in the lead?Jd4x4 (talk) 05:19, 24 February 2020 (UTC)

Guess. "E-cigarettes definitely less harmful than smoking". healthscotland.scot. Public Health Scotland. Retrieved 2 February 2020. EllenCT (talk) 05:33, 24 February 2020 (UTC)

Guess? It's called out on their site as their revised, updated policy, so it's the official PH policy of the country.. Jd4x4 (talk) 13:04, 24 February 2020 (UTC)

MEDRS sources added

I included these two sources and their summaries updating older sources:

Glasser, Allison M.; Collins, Lauren; Pearson, Jennifer L.; Abudayyeh, Haneen; Niaura, Raymond S.; Abrams, David B.; Villanti, Andrea C. (1 February 2017). "Overview of Electronic Nicotine Delivery Systems: A Systematic Review". American Journal of Preventive Medicine. 52 (2): e33 – e66. doi:10.1016/j.amepre.2016.10.036. ISSN 0749-3797. Retrieved 24 February 2020.

Farsalinos, Konstantinos (1 January 2018). "Electronic cigarettes: an aid in smoking cessation, or a new health hazard?". Therapeutic Advances in Respiratory Disease. 12: 1753465817744960. doi:10.1177/1753465817744960. ISSN 1753-4666. Retrieved 24 February 2020.

EllenCT (talk) 05:23, 24 February 2020 (UTC)

@EllenCT- It would have been better (imo) to have combined the 1st cite in a sentence along with the MEDRS secondary source "95% safer" a little bit below (or moved that up) and divorced it from the benefits & risks part of the sentence. just sayin'. Also, your second cite is a primary MEDRS cite (I think) and is likely to get deleted. WP:USINGPRIMARY just sayin' again. Jd4x4 (talk) 05:50, 24 February 2020 (UTC)

Please go ahead and edit it to make it the way you think is best. Pubmed says they are both secondary reviews: PMID 27914771 and PMID 29214890. EllenCT (talk) 06:12, 24 February 2020 (UTC)

I hadn't seen that the Farsalinos paper was listed as a review. Thanks., and never mind :-) Jd4x4 (talk) 13:11, 24 February 2020 (UTC)

Youth "concerns" in lead

So now the intro has a new paragraph about kids:

There are strong concerns about youth use of E-cigarettes due to the potential lack of awareness of nicotine's addictiveness, the physiological differences between youth and adults, and the ease of adulteration of e-liquids with other substances. see: #Youth, #Addiction and dependence, and #Gateway theory

That's not compliant with the manual of style, violates WP:CRYSTAL, and has no sources whatsoever. This is just the same kind of ridiculous alarmism which has always plagued messaging about youth substance use and abuse. The fact is that kids are smoking a quarter as much as they were before vapes were easily available. The only evidence about the "potential" harm speculations are the fact that most kids who take nicotine are now doing it in a way that harms them 0.5% as much. We need to stop reaching for euphemism and alarmism. EllenCT (talk) 18:37, 24 February 2020 (UTC)

So I'm not sure where you live, or if you are aware of the massive amounts of State and federal legislation proposed and being passed in the U.S. on not only flavor "attractiveness to youth" but also around the "alarmism" over youth vaping, but I can assure you that you don't need a "crystal ball" to be aware of it. The proposed wording was meant to take the (otherwise obvious) statement about concern for youth use and hopefully direct it to more appropriate sections rather than fill the lead space with long winded and citation filled with proofs of what I thought were socially obvious & citable from many sources. If we want to classify the entire article as medical and only stating medical facts then there's just no hope for Misplaced Pages as a NPOV reference, imo. I had put (and solicited for) comments here under the RfC for readability above in the hope that the talk page wouldn't get quite as schizophrenic as the main article, but...Jd4x4 (talk) 18:55, 24 February 2020 (UTC)

• I added cites for the statement of concern, can we cover the 3 concerns mentioned in the topic areas or would you rather we cite each one in the lead? Jd4x4 (talk) 19:30, 24 February 2020 (UTC)

The fact that everyone is panicking when the actual rate of teen smoking has been plummeting is the reason we should be more responsible. There aren't any sources saying how much more likely people are to smoke after they try vaping, because it's entirely speculative. Yes people are panicking, but that's not a suitable fact to summarize in the intro. If there was a MEDRS source which quantified the issue, that would be fine, but there can't be, because it's (1) entirely speculative, and (2) contrary to the plain WP:CK evidence from the prevalence rates. EllenCT (talk) 01:53, 25 February 2020 (UTC)

• Thanks for the clarification. In the US there is also hysteria that we are damaging young brains at an alarming rate, and the youth topic has been characterized as "epidemic" by our Surgeon General. For that reason I thought something about youth in the lead was desired by other editors. My sole intent has always been to keep the lead a short summary and the rest confined to sections.Jd4x4 (talk) 04:34, 25 February 2020 (UTC)

The definition of "epidemic" is a widespread occurrence of disease. Vaping is the widespread occurrence of what the MEDRS sources call an effective nicotine replacement therapy with 0.5% the harm. EllenCT (talk) 05:53, 25 February 2020 (UTC)

You may not realize it but you are "preaching to the choir" here. Do you want to delete it or should I? And check what I wrote here just now under the RfC Readability heading.Jd4x4 (talk) 05:57, 25 February 2020 (UTC)

As a statement about opinion/controversy, references to strong concerns about youth use should be qualified by restricting to US (or N America?) where this is indeed, rightly or wrongly, a big issue, and was even before Juul. Johnbod (talk) 16:09, 25 February 2020 (UTC)

Thanks for that suggestion. In the current version (on hold until resolution of RfC above) I had attempted to mitigate the concern by removing the bold, and offering the the 3 broad areas that I think there is global concern for with respect to youth. Even if they are not being actively debated, or other jurisdictions do not see it as an "issue", I think it's reasonable that there would be thought given to them. Much of what is now or has been in the lead section is very wordy and long imo, and I think is best described/discussed either in existing sections or in other articles. Jd4x4 (talk) 17:33, 25 February 2020 (UTC)

NPOV?

As I (barely) understand it (and the jargon), isn't an NPOV tag without a talk page topic on it a WP:DRIVEBY? Or, was the tag in reference to or caused by the Readability issue, and/or specifically my attempts to clean up the Lead? If not, it's confusing the readability topic resolution and I don't see the specific problems. I have refrained from editing the lead until readability is resolved so if the current version lead POV acceptable please remove the tag, or list the specifics please. Jd4x4 (talk) 17:22, 25 February 2020 (UTC)

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