Talk:Electronic cigarette/Archive 7

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Reviews 2013 that aren't yet in the article

I've found two reviews that are as of now not referenced or cited. I don't have time to read them now but just throwing it out there that these may have been missed:

• https://www.ncbi.nlm.nih.gov/pubmed/?term=Animal+models+of+nicotine+exposure%3A+relevance+to+second-hand+smoking%2C+electronic+cigarette+use%2C+and+compulsive+smoking
• https://www.ncbi.nlm.nih.gov/pubmed/23978314

CFCF (talk) 17:11, 24 November 2013 (UTC)

This could be an interested bit to add "According to a recent survey, 3.4% of the total population, including 11.4% of current smokers, 2.0% of former smokers, and 0.8% of never-smokers, use e-cigarettes" to the section on usage. It is a better ref than the ASH one in the Usage section. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:32, 24 November 2013 (UTC)

Well it is not a correct statement - the paper it quotes for this is Pearson et al(2010)[1] - which only states that the 0.8% have tried e-cigs (not that they are users), same is btw the case of all the other figures:

"Utilization was higher among current smokers (11.4%; 95% CI = 9.3, 14.0) than in the total population (3.4%; 95% CI = 2.6, 4.2), with 2.0% (95% CI = 1.0, 3.8) of former smokers and 0.8% (95% CI = 0.35, 1.7) of never-smokers ever using e-cigarettes."

There is a difference between "ever using" and "using", just like in the CDC survey, it could be that they've tried it once. (btw. the 0.8% is divided into 0.5% former smokers and 0.3% never smokers) --Kim D. Petersen 20:10, 24 November 2013 (UTC)

I think btw. that the objection against ASH was the non-academic nature, which was incorrect We should add this ref to the ASH brief link imho.

A rather never US study is the CDC one (so the "recent" is rather foolish as well in the above), as well as Zhu et al(2013) --Kim D. Petersen 20:33, 24 November 2013 (UTC)

Refs above:

The Zhu study is particularly interesting. It shows that 1% of never smokers have tried e-cigs and 0.04% are current users. It seems clear by this point that no study is showing significant uptake by never smokers or any evidence of a gateway effect. As WP:MEDRS makes clear that position statements are less authoritative than the underlying data, I think it's now reasonable to balance the various gateway concerns with something a bit more empirical.--FergusM1970^{Let's play Freckles} 00:05, 25 November 2013 (UTC)

"The Zhu study is particularly interesting" according to which review source? The point of wp:UNDUE is that we don't apply our own judgement to the selection of primary sources, we defer to the judgement of secondary sources instead. Do we have a MEDRS that says the "gateway effect" only pertains to never smokers? The more obvious concern would be to formerly addicted smokers, who are (one would think) far more likely to relapse to smoking than are never smokers to start ab initio. LeadSongDog come howl! 18:22, 26 November 2013 (UTC)

Well, those promoting the "gateway" fallacy explicitly say they're worried about the initiation of new nicotine addicts, which clearly means never smokers. As for former smokers, most of them relapse anyway. The advantage of e-cigs is that instead of relapsing they can start vaping, which everyone agrees is orders of magnitude less harmful. As for WP:UNDUE I've been arguing for weeks that giving more weight to unfounded "concerns" than to all the actual evidence is about as undue as you can get.--FergusM1970^{Let's play Freckles} 19:55, 26 November 2013 (UTC)

The current Cochrane report Pharmacological interventions for smoking cessation: an overview and network meta-analysis is fairly clear that different NRTs are largely equivalent in effectiveness, though it does not distinguish e-cigarettes from other inhalers:

Combinations of NRT products
The evidence now suggests more strongly that using a combination of NRT products is better than one product alone. Two recent trials (Piper 2009; Smith 2009) have increased the evidence base. Both compared a combination of patch and lozenge with either alone. The trials showed fairly consistent effects, with a range of different comparators. The combined therapies all included the patch and an acute dosing type. In a sensitivity analysis we did not find any difference according to whether the control was the patch or an acute dosing form. The 2008 US clinical practice guidelines (Fiore 2008) state that the long-term use of nicotine patch with another form of ad lib NRT is more effective than nicotine patch alone and recommend that physicians consider this option. It is not entirely clear whether the benefit of combination therapy is due to the sensory effects provided by multiple types of delivery systems, to the higher percentage of nicotine substitution achieved, the better relief of craving by ad lib use of acute dosing forms or some combination of these and other factors (Sweeney 2001).

— [[Cochrane Tobacco Addiction Group ]]

also

Addictive potential of NRT
Some successful quitters continue to use NRT products beyond the recommended treatment period (Shiffman 2003), but few develop true dependence (Hughes 2004b; Hughes 2005). Although nicotine has the potential to cause harm, it is very much less harmful than tobacco smoke, so while complete abstinence from nicotine is preferred, the risk to health from NRT use is small compared to the risk from continued smoking.

— Cochrane Tobacco Addiction Group

LeadSongDog come howl! 20:40, 26 November 2013 (UTC)

That's largely irrelevant because e-cigs aren't NRTs.--FergusM1970^{Let's play Freckles} 20:42, 26 November 2013 (UTC)

Good points about the lack of addictiveness and low health risk though.--FergusM1970^{Let's play Freckles} 20:46, 26 November 2013 (UTC)

Where do you get that ecigs aren't considered NRTs? In some countries they are. CFCF (talk) 21:59, 26 November 2013 (UTC)

I'm curious as to which countries that consider them NRT's? To my knowledge no country has classified them as a therapy - if so, then the only possibility (iirc) is New Zealand, since (afaik) this is the only country where ecigs are regulated as medicine.. --Kim D. Petersen 14:12, 27 November 2013 (UTC)

The manufacturers say they're not NRTs. The retailers say they're not NRTs. The users say they're not NRTs. There's only one sane conclusion that can be drawn from that: They're not NRTs. They are a recreational item.--FergusM1970^{Let's play Freckles} 22:40, 26 November 2013 (UTC)

Not sure that this Cochrane review protocol article would support those conclusions:

Web-survey data from EC users suggested that over three quarters are using the devices to quit smoking (Etter 2011).

— - reviewed in Cochrane Tobacco Addiction Group "Electronic cigarettes for smoking cessation and reduction" (2012)

LeadSongDog come howl! 04:38, 27 November 2013 (UTC)

They're still not NRT.--FergusM1970^{Let's play Freckles} 05:36, 27 November 2013 (UTC)

I have to agree that this first Cochrane report on NRT isn't on-topic enough for use in this article, as it doesn't mention e-cigs and I'm pretty sure the "inhalers" they're talking about are special-purpose devices designed to deliver metered amounts of nicotine. Additionally cigarette smoking has all sorts of social factors involved that e-cigs mimic and that using an inhaler doesn't. Zad68 04:43, 27 November 2013 (UTC)

Exactly. Also inhalers are deliberately made to look medicinal and have limited appeal. E-cigs are recreational devices and attention is paid to appearance, build quality and the flavour of liquids. They're really not similar to NRT inhalers at all. Given the dates of the studies cited in the Cochrane report (2008 and 2009) I seriously doubt they looked at e-cigs at all.--FergusM1970^{Let's play Freckles} 05:36, 27 November 2013 (UTC)

The second Cochrane paper clearly indicates that e-cigarettes are used as tobacco smoking reduction/cessation aids, even if the precise term NRT may be disputed. LeadSongDog come howl! 06:02, 27 November 2013 (UTC)

E-cigs that don't contain nicotine are widely used and can hardly be classed as NRT. E-cigs are a safer substitute for smoking, not a medical treatment. Many users argue that they haven't quit smoking; they've switched to a better way of using nicotine recreationally.--FergusM1970^{Let's play Freckles} 15:40, 27 November 2013 (UTC)

There is nothing "disputed" about it. I have never seen them classified as NRTs ... never. The first Cochrane report that you refer to is quite specific about which products they are referring to when they use the term NRT (ecigs is not amongst them). And the second paper also differentiates between EC and NRT.

NRT's are generally medicinal products, and ecigs are not in that category. If you want to argue that they are NRT's then i'd expect you to at the very least give a ref that classifies them as such. --Kim D. Petersen 14:18, 27 November 2013 (UTC)

LeadSongDog I agree the second Cochrane item provided, the "Electronic cigarettes for smoking cessation and reduction" protocol, will be definitely relevant and useful for this article, but as it's just a protocol right now I'm not sure what the standards are for using it. I'd think we'd lean against using it, and I would not at all agree with using that protocol to support the idea that the inhalers referenced in the first Cochrane item provided, "Pharmacological interventions for smoking cessation: an overview and network meta-analysis", include e-cigs... that would be a straight-up WP:SYNTH problem. I don't have any doubt that some use e-cigs as smoking cessation devices, and some use them with nicotine as a NRT tool, we've got sources that discuss that. Although e-cigs may not be designed or marketed that way, that is what some people do with them, and if secondary sources comment on the use and effectiveness of that ("off-label") strategy it should be included here, but I don't think either of these two particular Cochrane items are useful for this article at this time. Zad68 15:37, 27 November 2013 (UTC)

Clearly it is at best sloppy to call a drug delivery system (be it a cigarette, "e-cig", "hookah", "bong", or needle) a "therapy". An ENDD is not an NRT, but it is in some eyes potentially a delivery system for nicotine by addicts trying to control or stop smoking. There are clearly primary sources that discuss the use of ENDDs by addicts and describe the reduction in urgent craving. These include gradual tapering-off of nicotine content in the fluid, which can only be seen as a form of ad-libido NRT. Do we have a better term available for such use? LeadSongDog come howl! 17:22, 27 November 2013 (UTC)

Smoking Replacement? The fact is that e-cigs are just a recreational device that people can use in any way they want. Some use them to wean themselves off nicotine. Many more just want to continue using nicotine in a way that's cheaper, tastes better and doesn't harm themselves or others.--FergusM1970^{Let's play Freckles} 17:35, 27 November 2013 (UTC)

You're free to believe what you like, but the article has to reflect what published MEDRS have to say, not private opinions. LeadSongDog come howl! 18:52, 27 November 2013 (UTC)

No MEDRS says they're NRT, which neatly ends that argument.--FergusM1970^{Let's play Freckles} 19:25, 27 November 2013 (UTC)

Being one thing doesn't exclude it from being something else thing as well. Sources state them as both NRT and as recreational devices, currently the article reflects this. CFCF (talk) 20:04, 27 November 2013 (UTC)

What source (never mind sources) states them as NRT? I haven't seen such. The NR i can accept, i doubt if the T can be justified! --Kim D. Petersen 02:09, 28 November 2013 (UTC)

If MEDRS sources comment on them for their effectiveness as an NRT because people try to use them for that purpose even if they're not designed for it, this article will carry that information. Zad68 20:08, 27 November 2013 (UTC)

I'd say there's a difference between use for smoking cessation and use as an NRT. No RS that I know of has even suggested that they're used in the same way as NRT, so I don't think the article can say that. Even if one did it would be reasonable to say they can be used in a similar way to NRT, but completely wrong to say they are NRT. Because they're not designed, marketed or generally used as such.--FergusM1970^{Let's play Freckles} 21:24, 27 November 2013 (UTC)

break

Certainly no competent MD is going to give a prescription for the commercial products as NRT given the lack of quality controls at present, but that does not mean they are not used for that purpose on a non-prescription basis. "Impact of an Electronic Cigarette on Smoking Reduction and Cessation in Schizophrenic Smokers: A Prospective 12-Month Pilot Study" PMID 23358230 (obviously not a MEDRS) looks directly at their use for NR.LeadSongDog come howl! 15:00, 28 November 2013 (UTC)

Again, just because they're being used for smoking cessation doesn't mean they're being used as NRT. The two things are not equivalent. Bear in mind that Bullen et al found that 0mg e-cigs were almost as effective as nicotine containing ones. As for the lack of quality control, that's something of a red herring. The quality control is just the same as for many other consumer products. It's not what you'd find in a medical device, but then why would you expect it to be?--FergusM1970^{Let's play Freckles} 15:22, 28 November 2013 (UTC)

Aside from the fact that that study doesn't refer to ecigs as NRTs - it is interesting, because that one doesn't look like it is the ECLAT trial - but it is categorized in PubMed as a controlled trial - lets see if we can find secondary sources that cite it..... --Kim D. Petersen 15:34, 28 November 2013 (UTC)

Cited in this review, which we haven't looked at yet:

• Meier, Ellen; Tackett, Alayna P.; Wagener, Theodore L. (2013), "Effectiveness of Electronic Aids for Smoking Cessation" (PDF), Current Cardiovascular Risk Reports, 7 (6): 464–472, doi:10.1007/s12170-013-0343-8

Which may finally nail the controlled trial indicates effectiveness problem we had above.... now to read it :) --Kim D. Petersen 15:52, 28 November 2013 (UTC)

Relevant quote for the controlled trial ref was "To date, a handful of preliminary studies indicate that e-cigarette use leads to significant reductions in total number of regular cigarettes smoked with some smokers achieving total abstinence from nicotine [38, 39••, 40••]" (where citation 38 is the controlled trial mentioned above). So with this review in hand there should not be discussion about the current text ... which is "There are both controlled and non-controlled studies that show possible benefit." - objections? --Kim D. Petersen 16:04, 28 November 2013 (UTC)

Also refers to the double-blind ECLAT study in a positive light - as well as points out with regards to the Schizophrenic study that e-cigs trials were positive in reduction here, in a group that is comparatively difficult with regards to smoking cessation.. All in all rather good support for the current text in the article. --Kim D. Petersen 16:13, 28 November 2013 (UTC)

Not sure about the journals status with regards to WP:MEDASSESS - isn't a high impact journal - but as said above, it is not my field so i'm a bit at loss here - i'd like for others to chime in on that part :) --Kim D. Petersen 16:30, 28 November 2013 (UTC)

As it's supporting a fairly simple statement - that controlled studies exist - it should probably be adequate. If it was saying something controversial it might be different, but that isn't really the case here.--FergusM1970^{Let's play Freckles} 16:46, 28 November 2013 (UTC)

One concern is that it is not pubmed indexed. I would be supportive of its use to state that there is tentative evidence of benefit in a RCT. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:38, 28 November 2013 (UTC)

The reason that it is not pubmed indexed, is the date of publication (Dec 2013). The earlier issue is pubmed indexed, so i assume it is a question of time :) --Kim D. Petersen 06:34, 29 November 2013 (UTC)

Ah yes of course. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:00, 29 November 2013 (UTC)

Indeed, now listed as PMID 24319519. LeadSongDog come howl! 20:21, 13 December 2013 (UTC)

Ah! Thank you, it wasn't there when i checked last. :) --Kim D. Petersen 20:32, 13 December 2013 (UTC)

Edit Request : Dec-12-2013 : History - Ruyan's Patent

History section

"Hon Lik, ..Ruyan , .. before receiving its first international patent in 2007."

Add

However, most devices sold these days (2013) do not use the piezoelectric effect (though they do use a battery to heat a liquid solution).

Reason

This is important to contrast the basic mechanism of e-cigs and the patent situation, especially as the paragraph that follows reports Imperial Tobbaco having bought Ruyan's patents.

Preroll (talk) 10:07, 12 December 2013 (UTC)

Not done for now: Sorry, but I can't enact your request unless it is cited to a reliable source. (See Wikipedia:Verifiability for the policy on this.) If you can find a source that backs up this specific fact, please add it here and reactivate the {{edit protected}} template. Best — Mr. Stradivarius ^{♪ talk ♪} 10:13, 12 December 2013 (UTC)

The only sources have already been quoted in the articles references. Anyone clicking on either the US or EU patent links show a 'high-frequency' mechanism device. The problem is that the industry and it's users know this fact without explicity stating it. E.g 'I eat burgers' vs 'I eat burgers that -are not flamed grilled-'. They don't report it because it isn't there.

(I suggest this request to be put to discussion. Preroll (talk) 10:30, 12 December 2013 (UTC) )

We probably shouldn't be using patents as sources, as they count as primary sources - Wikipedia should be based mostly on secondary sources, and primary sources should only be used sparingly and in certain circumstances. (See the link for details.) And if we can't cite something to a source, then usually it shouldn't be in Wikipedia at all. I suggest you read the verifiability policy to get a sense of the rules at work here, and then reactivate this request after you have left some time for discussion. (Edit requests should only be used to implement an edit after a consensus has been formed through discussion - they shouldn't be used as a means to attract new editors to a discussion.) — Mr. Stradivarius ^{♪ talk ♪} 11:02, 12 December 2013 (UTC)

I have edited the request and found secondary source to confirm the patent,

http://www.nbcnews.com/id/29435175/

"Ruyan .. — introduced the world's first electronic cigarette in 2004. It has patented its ultrasonic atomizing technology.."

Although , I feel it's not enough since I cannot find any sources say current e-cigs do not use ultrasonics. Preroll (talk) 01:07, 13 December 2013 (UTC)

Any description of a modern e-cig will include terms like "wick," "coil" or "heating element," and no mention of ultrasonics. Unfortunately it's unlikely we'll find a source saying "current e-cigs don't use ultrasonics" because there's no reason for anyone to write that - the issue simply doesn't come up. However it should be possible to find a source that says something like "e-cigs use a heating element to vapourise liquid."--FergusM1970^{Let's play Freckles} 02:02, 15 December 2013 (UTC)

Removal of WP:MEDRS secondary source in the article.

Apparently some editors feel that this:

• Meier, Ellen; Tackett, Alayna P.; Wagener, Theodore L. (2013), "Effectiveness of Electronic Aids for Smoking Cessation" (PDF), Current Cardiovascular Risk Reports, 7 (6): 464–472, doi:10.1007/s12170-013-0343-8, PMID 24319519

isn't a WP:MEDRS secondary source - despite us discussing it earlier. The text in this review specifically supports that there are tentative positive results from controlled studies (amongst others the schizophrenia study discussed earlier) that e-cigs are effective as a cessation mechanism. To quote what i wrote earlier:

Relevant quote for the controlled trial ref was "To date, a handful of preliminary studies indicate that e-cigarette use leads to significant reductions in total number of regular cigarettes smoked with some smokers achieving total abstinence from nicotine [38, 39••, 40••]" (where citation 38 is the controlled trial mentioned above). So with this review in hand there should not be discussion about the current text ... which is "There are both controlled and non-controlled studies that show possible benefit." - objections? --Kim D. Petersen 16:04, 28 November 2013 (UTC) Also refers to the double-blind ECLAT study in a positive light - as well as points out with regards to the Schizophrenic study that e-cigs trials were positive in reduction here, in a group that is comparatively difficult with regards to smoking cessation.. All in all rather good support for the current text in the article. --Kim D. Petersen 16:13, 28 November 2013 (UTC)

Please explain? --Kim D. Petersen 20:05, 13 December 2013 (UTC)

I also find the complete lack of talk-page comments on this source to be rather strange considering that my addition of the review has be readded/reverted several times (by other editors than me) since my inclusion of it. --Kim D. Petersen 20:08, 13 December 2013 (UTC)

I'm quite willing to change the text into "there are both controlled and uncontrolled studies that tentatively evidence benefit." (to nod to User:Jmh649[2]) --Kim D. Petersen 20:16, 13 December 2013 (UTC)

Kim requested that I explain my revert here. Having followed these discussions for several weeks now, my concern about that text is different than what has previously been raised. As I read it, that text implies there are multiple controlled studies, which implies a high level of evidence is available. There is one controlled study, unless I'm reading the source incorrectly; the source refers to other studies on other topics as controlled studies, but in this case does not use the word "controlled", instead mentions that there are "preliminary" studies (which is what raised my curiosity and led me to check citations 38, 39, and 40 to determine what kinds of studies those are). When checking those citations, we find two small studies, one larger controlled study, and all of them by the same group of researcher. Do we know if those were the same populations or different studies? Do we have any secondary review that shows more than one controlled study backing the proposed text? If not, why is our proposed text giving such importance to one study, or three studies from the same source, when the source seems to pointedly call it "preliminary"? I am not averse to using this source, but if we are going to assert as fact that there is high-quality evidence from multiple controlled studies, I'd rather see another secondary source verify that. If there isn't one, then a wording tweak would satisfy. SandyGeorgia (Talk) 21:44, 13 December 2013 (UTC)

38 and 39 can by default not represent the same population since 38 is specific to schizophrenics and 39 is generic. So unless something is entirely wrong in the papers (which should have been caught in the regular scientific process) i can't see it. As for 40 that study was submitted (Nov 2010) before the recruitement of the population in 38 had started (June 2010– February 2011). So your concern that this might be the same clinical trial that is referred to can be ruled out. (if we trust the scientific literature).

As for the overlap of authors/researchers i would agree - but we also have ref 41 referred to in this review - which is a large-scale randomized controlled study by Bullen et al. And we already have a 2nd review that addressess the Bullen et al study.add: correction, the Bullen study was not cited in this paper, it was another paper by Etter+Bullen that was referred to which wasn't a controlled trial - the Bullen trial mentioned in the article is another large scale controlled trial though, which we have a secondary review mention as well. --Kim D. Petersen 22:23, 13 December 2013 (UTC)

As a note here: I'm quite uncomfortable with the assessment process done here - we are no longer sticking to what secondary sources tell us, or assessing the reliability of the sources, but are instead conducting our own investigations and interpretations of the material. What we should (imho must) do is let the secondary WP:MEDRS's guide our editing, and not our personal opinions. I'm quite willing to accept it if different secondary sources contradict each other, that the information then is contentious or wrong ... but in this case we've already seen that the tide of secondary sources are driving in this direction. In this instance we have waited for a secondary review to confirm what we already knew to be the case - and in the meantime we haven't seen any sources refute or cast doubt upon it. So i think this leads to a more general problem? --Kim D. Petersen 22:17, 13 December 2013 (UTC)

No, I'm not conducting my own investigation; when the source didn't call them controlled studies, but our text did, that piqued curiosity, so I dove in to see exactly what we had. We didn't have multiple controlled studies; we had one, and I happened to note while in there all of them were from the same group, which I do find curious, but it is what it is. So I question the plural and the relative strength we're giving to this finding in our text. A wording adjustement would satisfy me. SandyGeorgia (Talk) 22:31, 13 December 2013 (UTC)

The schizo trial is registered in pubmed as a controlled clinical trial[3] (thats 38), 39 is labelled a controlled trial in the paper, and 40 is uncontrolled. Along with this we have the Bullen trial referred to as the 2013 study in the article already. Which comes to a plurality of studies. By the proposal of the text "there are both controlled and uncontrolled studies that tentatively evidence benefit." i do not think that we've overplayed our hand - but are being rather conservative. Please do propose an alternative text though. --Kim D. Petersen 22:41, 13 December 2013 (UTC)

I'm not comfortable drilling down into secondary sources to tease out their methodology - that's not the job of an encyclopedia editor. To be honest, unless Meier 2013 is contradicted by another recent MEDRS-compliant secondary source, I'd summarise the bit that you're arguing about as

• Users of e-cigarettes reduce the number of cigarettes they smoke significantly.

and cut the fluff about "study type X said Y" altogether. It doesn't much help general readers of an encyclopedia - and medical students need to be reading our sources anyway. Naturally if there is a contradictory recent MEDRS-compliant secondary source, then neutrally summarise and attribute each of them. --RexxS (talk) 01:15, 14 December 2013 (UTC)

My discomfort was the way we are trying to cobble this together; the review said "preliminary" (and minimized it further with "handful"), we're adding it to another source to get a plural on controlled studies, then we have one review of several studies all from the same source that themselves (two of three) are very new ... all making me uncomfortable with dropping the word "preliminary" that the source used, and adding it to another to get a plural. How about:

• Preliminary reports show users of e-cigarettes reduce the number of cigarettes they smoke significantly.

SandyGeorgia (Talk) 01:25, 14 December 2013 (UTC)

Note to Sandy: plural is more than one. There are 2 seperate controlled clinical trials mentioned in the review => plural. Outside of those two mentioned in the review - we have a 3rd - thus just confirming/enforcing that there is a plurality. With regards to your "same source", that is not entirely correct is it? (One of the authors recur - but not all authors recur) Nor is it up to us as editors to assess whether this makes the trials more or less relevant, that part is entirely up to secondary sources to vet/comment on. --Kim D. Petersen 22:15, 14 December 2013 (UTC)

I can get behind that edit @SandyGeorgia18:56, 14 December 2013 (UTC) — Preceding unsigned comment added by CFCF (talk • contribs)

I do not disagree about having text such as this, somewhere, since it accurately reflects the secondary source... But the proposed text does not address/match the context in which the text is being proposed. The context here is whether or not there are controlled and/or uncontrolled studies, and what if any their conclusions are. You address the conclusion - but not the context. --Kim D. Petersen 22:15, 14 December 2013 (UTC)

Why on earth does a general encyclopedia need to examine the question of whether or not there are studies of one type or another and how many of each there are? That's researcher navel-gazing and we should actually be in the business here of giving up-to-date relevant information about electronic cigarettes to the general audience. As for "context", the content is either undisputed and supported by a good quality reliable secondary source or multiple RS present a range of views - in the former case we simply state the content; in the latter we present all significant views and attribute them. WP:ASSERT gives a good overview of the process. --RexxS (talk) 23:03, 14 December 2013 (UTC)

I do not see any controversy in secondary reliable sources about there being both controlled and uncontrolled trials that tentatively evidence benefits - do you? Thats not "navel-gazing" but is rather context relevant text considering the intro statement from the WHO. The trouble here is that some editors are fighting to keep the current sentence "There are some non-controlled studies that reported possible benefit" despite secondary sources saying that there are both controlled and non-controlled studies that do so. It is not a question of expanding with content or detail on the studies... --Kim D. Petersen 00:31, 15 December 2013 (UTC)

Ie. we start the section with a statement that no scientific studies show efficacy - and note within the section that there are studies that tentatively show this - which is (afaics) an accurate description of the state of the field - isn't it? --Kim D. Petersen 00:34, 15 December 2013 (UTC)

I don't see any controversy about there being both controlled and uncontrolled trials, but I also don't see why you want to talk about that in an article about e-cigs. Look, you have (1) WHO 2013, (2) Ziegel 2011, (3) AAPH, (4) BMA, (5) O'Connor 2012, (6) Polosa 2013, (7) Caponnetto 2013 and (8) Meier 2013 - all of whom have something interesting to say about smoking cessation. There are multiple viewpoints there and they can all be summarised and attributed: "WHO says efficacy hasn't been demonstrated; but Ziegel says they show promise; AAPH recommends considering e-cigs; BMA thinks there may be possible benefits ..." and so on for efficacy. Then you can say something about safety. There's lots of content there that is useful for the reader and sourced to decent reviews and position statements from respected bodies, so why are you bothered about primary studies like Bullen 2013? Are our general readers looking for information on what kind of trials were used? No, of course not; they want to know about safety and efficacy for smoking cessation. Anybody who is really interested in the minutiae of the way that evidence was collected will be reading our sources anyway, so we don't need to clog up the article by trying to spell all that out in that amount of detail. --RexxS (talk) 03:16, 15 December 2013 (UTC)

I disagree with you on what our general readers are looking for. You seem to make a dichotomy between (a) people who are just casually interested and (b) people who have a medical interest. You fail (imho) to recognize that there is a large segment of e-cigarette users who are interested in where exactly the current research is at, they are quite a bit more interested than the people in (a) but not as competent as (b). If you've read a bit more on this topic then you would have recognized this - it is even covered in primary sources (for instance in [4] and [5])

Basically (again imho) it comes down to harm-reduction, people are interested in the choice they are making - they know that there is risk, but they also suspect that the risk is slighter than with analogues. So there is an actual interest in where we currently are, and what studies currently are saying. Imho we need both the simplified description that you are arguing for, but also the extra information. --Kim D. Petersen 18:32, 15 December 2013 (UTC)

Regarding Caponnetto 2013: It looks useful but I oppose using it for a statement like "there are uncontrolled studies". Use secondary sources for their conclusions they draw from the primary sources, not their blow-by-blow rundown of the primary sources themselves. The conclusion this secondary source draws from its review of the primary sources is "This could hint a role for electronic cigarettes to be used for smoking cessation, and therefore merits further evaluation for this purpose."--its conclusion is that e-cigs might prove interesting some day but there's certainly not enough evidence to recommend them yet. The problem with article content like "there are uncontrolled studies" is that it misleads our readers into concluding for themselves that there has been proven utility ("Look there are scientific studies say so!") when the actual conclusion the secondary source draws is much more tentative and qualified.

Regarding Meier 2013: I oppose its use here. This article was not published in a MEDLINE-indexed journal and per WP:MEDRS that's a red flag raising questions about its reliability. It was also published days ago, it looks like. There's certainly no reason to rush to try to push in content from a brand-new article from a non-MEDLINE-indexed journal when we already have MEDLINE-indexed secondary sources and an up-to-date statement from perhaps the world's most prestigious organization, the WHO. Zad68 03:37, 15 December 2013 (UTC)

The statement from the WHO isn't up to date; that's the whole point. The WHO are saying there's no evidence of efficacy. There is.--FergusM1970^{Let's play Freckles} 11:18, 15 December 2013 (UTC)

I disagree. The WHO statement is correct with regards to the current science - e-cig research is not (yet) at the point where you can say that the efficacy is scientifically shown. The research is certainly trending in that direction - but the necessary mass of research to state with a reasonable certainty that they are efficient as a cessation means is not yet there.

My problems with the WHO statement is in their dismissal of e-cigs a harm-reduction means, based on the current state of research,i do not see the mass of literature as agreeing with them on that. But then again that is a policy issue rather than a scientific one... ie. where and how do you apply the precautionary principle most effective in a situation such as this... a discussion that we currently aren't covering in the article - but should. --Kim D. Petersen 18:42, 15 December 2013 (UTC)

Agree with the reasoning by Zad68, RexxS; we should be summarizing the conclusion of sources, not listing specific primary sources like this in an WP:undue manner. Yobol (talk) 16:41, 15 December 2013 (UTC)

I don't think that there is any WP:UNDUE issues with going into more details - if there is, then we most certainly should be able to reach a consensus on what to expand upon and what not to, just as we do with every other article on wikipedia. --Kim D. Petersen 18:49, 15 December 2013 (UTC)

If Meier 2013 is an unreliable source per WP:MEDRS, then we of course shouldn't use it. But i'm not certain that it is unreliable for usage in this context: 1) because red-flags do not mean unreliable it means that it might be suspect 2) the usage proposed is on something we already knew to be the case 3) the usage is on a non-controversial issue.

Again (to repeat) i disagree with the dichotomy people are making with regards to the level of information that readers of this article are interested in. We have a non-insignificant demographic of readers who fall between the casual and scholarly reader groups. --Kim D. Petersen 19:04, 15 December 2013 (UTC)

Sorry, maybe I missed it but what is the proposal here for the use of Meier that can't be sourced to something else? If what Meier is saying is in line with better-quality (per WP:MEDASSESS) secondary sources then we should just use those sources and not Meier. If Meier is saying something that isn't in agreement with what better-quality sources are already saying then we shouldn't use Meier, a more questionable source, to contract what the better-quality sources we have say. Either way there isn't a case to use Meier. Zad68 03g:14, 16 December 2013 (UTC)

The context is "There are both controlled and non-controlled studies that show possible benefit." we know of the ECLAT trial, as well as the schizo trial. But as for now we only have Meier (and another review (Polosa et al(2013)) which i would judge not usable in this context, since Polosa is a coauthor in the ECLAT trial) that references this. Of course we could wait - there is no doubt at all that reviews will include these - but in the mean time we are indicating something in the article that we know is wrong (that only uncontrolled trials exist). --Kim D. Petersen 03:40, 16 December 2013 (UTC)

OK, if that's all we're looking to use Meier for, again I (along with Yobol and RexxS it looks like) don't support this sort of content, "There exist X studies of type Y indicating Z." We need to use secondary sources for their conclusions. If the secondary source acknowledges "there exist studies that indicate efficacy" but then their actual conclusion is very far from saying there's anything actionable, like actual recommendations, based on the studies, we'd be irresponsible to mislead our readers into thinking there's something useful here when the sources don't say that. Zad68 03:48, 16 December 2013 (UTC)

What the devil are you talking about? We're not recommending, nor stating that there is anything actionable - we are simply describing the progress of research. Had this been a controversial result then i would've agreed with you - but it isn't. (otherwise i'd like to see some evidence to show that it is controversial). I usually edit in the climate change area, and what you are saying is that we shouldn't describe that science is trending towards lower and lower estimates for when the summer ice in the arctic is going to be gone - or whether there might be indications that strong hurricanes can be stoked by a warmer ocean surface temperature. Both of these are tentative results that carry with them some uncertainty. But we shouldn't mention it, because we can only describe research when it is settled entirely? --Kim D. Petersen 04:12, 16 December 2013 (UTC)

@KimDabelsteinPetersen:, there's a world of difference between "non-controlled studies that show possible benefit" and "non-controlled studies that suggest possible benefit". That difference hinges on the expert assessment of the reported evidence which a MEDRS review provides. Pseudonymous editors cannot do this in a way that is verifiable without sacrificing their pseudonymity. At "the encyclopedia anyone can edit" any such requirement is a non-starter. I'm not clear why we would want to muddy the discussion by injecting climate change denial, that is just one step removed from Godwin's law. LeadSongDog come howl! 05:34, 16 December 2013 (UTC)

I'm not in any way or form married to the wording - and the more accurate the wording the better, what i am objecting to is the complete lack of interest displayed above in actually presenting the current state of research. (not any specific research - but where the body of the research is currently at). --Kim D. Petersen 07:17, 16 December 2013 (UTC)

Proposal for new Research section

OK based on all this I think we can come up with a compromise that should be acceptable to everyone. Kim would like some content regarding the state of the research; I, LeadSongDog and several others are uncomfortable with content talking about the primary sources in the Health section and making some sort of leading evaluation of them. How about this: We create a new section called Research toward the end of the article (per WP:MEDMOS) and put something in it like: "Researchers have been investigating the possible use of electronic cigarettes for smoking cessation. There have been both controlled and non-controlled studies into this use." -- This moves the state of the research out of the Health section to address the inline discussion of research that I and others find problematic, makes a Research section for those readers interested in finding out about the state of the research, and the proposed wording removes "suggest possible benefit" so our article is not carrying an evaluation of the primary sources and leaves the conclusions to the secondary sources. Sound good? Zad68 14:41, 16 December 2013 (UTC)

I am uncomfortable with any such categorization of the research (per all of the reasons given above). We have, according to one review cited "preliminary research" from a "handful" of studies, and as one of the most read websites, Wikipedia has a responsibility to not push ahead of what the research supports, or do our own analysis (controlled v. non-controlled) to imply something about the quality of the research. As someone who was on Wikipedia as the MMR-autism war unfolded (MMR vaccine controversy, where we did have editors here pushing the demonstrably false information that vaccines caused autism, and those claims killed people), I remind that we have a responsibility to our readers to get this right. Creating a "Research" section opens the door to original research based on primary sources. What we have right now is "preliminary data"; we shouldn't be saying more than that or doing original research to categorize it any further than that. If these things are eventually proven undeniably safe and effective, then Wikipedia can say so. For now, why are we trying to get ahead of the research? SandyGeorgia (Talk) 15:08, 16 December 2013 (UTC)

Just a comment on the "preliminary" argument here... We are currently making a very large fuzz out of the FDA's preliminary findings.. which later research and reviews have (basically) dismissed as being too inconclusive and too vague. Had i been a cynic i would wonder why that is considered good enough to be in the article (even with a secondary source dismissing it at the end), but that newer research is being dismissed. --Kim D. Petersen 00:05, 17 December 2013 (UTC)

Sandy, hmm... I was trying to come up with a creative compromise solution to address Kim's desire to have the article mention what areas are being researched, but without crossing the line into having the article carry actual evaluations of the results of the research. My proposed wording is "Researchers are looking into X." and not "Researchers are looking into X and so far the results from the primary studies indicate Y."--I think the former is OK, especially as we have review article abstracts that pretty state exactly that, but the latter is not OK. The formal use of e-cigs for smoking cessation is relatively new, and the abstracts of several of the MEDLINE-indexed review articles say things like "A few studies have evaluated..." and "The efficacy of electronic cigarettes has been evaluated in studies " (PMID 22797832), "Recent uncontrolled studies... " and "[electronic] cigarette[s] could become a tool--if studied more extensively--in the fight against tobacco" (PMID 23741941), "Despite many positive findings from surveys among e-cigarettes users, there is need for comprehensive state-of-the-at clinical trials to show efficacy of e-cigarette as smoking cessation tool." (PMID 23421096) I think based on this a mention of the research direction is warranted, but it needs to be done in such a way that it doesn't interfere with the clear "not enough data to recommend" conclusions of the secondary sources in the Health section. So, putting the Research section proposal out here as a possible compromise way to handle this, and seeing if there's an appetite for it, although I really won't be all that bothered if it doesn't make it into the article. Zad68 15:30, 16 December 2013 (UTC)

My response to "Kim's desire to have the article mention what areas are being researched, but without crossing the line into having the article carry actual evaluations of the results of the research" is: WP:NOT (news) and WP:RECENTISM. It is not our job, and we are crossing the line into advocacy via original research. We have "preliminary data" showing X according to reviews; that is all we need to say. SandyGeorgia (Talk) 16:03, 16 December 2013 (UTC)

As long as we are sticking to what review articles are saying, and keeping away from things that are contentious (such as when research shows opposite results), then i have a problem with regarding it as recentism or news. It is simply informative about the state of research. I'm not arguing that we should present anything about the primary sources themselves that isn't already presented in secondary sources. Now i can appreciate that WP has been stung in the MMR debacle - but i have troubles seeing this as equivalent. No one is proposing that we should present WP:FRINGE material or divert from what the bulk of secondary sources tell us.

Why should this area of science be so different from all other areas of science, where we do present ongoing research and do talk about uncertainties, preliminary results, probabilities and what the current state of evidence is indicating? This baffles me. --Kim D. Petersen 22:27, 16 December 2013 (UTC)

Kim, per MEDMOS, I (at least, don't know about others) never use the Research section of any medical article to park miscellaneous "ongoing research" ... discussing "uncertainties, preliminary results ... " etc. MEDMOS says, "Research directions: Include only if addressed by significant sources. See Trivia, and avoid useless statements like "More research is needed". Wikipedia is not a directory of clinical trials or researchers." I don't use the "Research" section for anything other than what broad, secondary overviews discuss as important Research directions on the subject.

As an example, at TS, I included one sentence on "Research directions"-- a sentence based on a broad topic overview, that says: "Questions remain regarding how best to classify Tourette syndrome, and how closely Tourette's is related to other movement disorders or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk free and not always well tolerated." A "Research" section is not a parking place for recentism, news, or primary source speculation.

I think we should be very careful that a "Research" section not become a place to park speculation, and this is an encyclopedia, not a newspaper; we should stick to what MEDMOS calls for. It's not our job to cover RECENTISM and NEWS or to speculate on the state of research by cobbling together pieces from various sources, and that is not what the Research section of MEDMOS calls for.

Again, we present what we have in secondary sources; we have "preliminary results" saying X, Y or Z. (And yes, I feel very burned by the MMR scandal; it was a constant battle to stick to what the secondary reviews said, "we" didn't always win that battle, at times our articles promoted the notion that vaccines caused autism, and we should not let ourselves again get ahead of what the highest quality secondary reviews say.) SandyGeorgia (Talk) 01:38, 17 December 2013 (UTC)

I don't want a "parking section" - i have just as bad experiences with such as you have. I want a section that explains where current research is, reflecting the secondary sources that we have say. Currently even what the majority of secondary MEDRS sources is saying is being removed or vetoed. That is not how wikipedia is supposed to work. We are ignoring WP:WEIGHT. --Kim D. Petersen 02:14, 17 December 2013 (UTC)

Kim, to clarify: Are you stating that you support the Research section as I am proposing: A separate new section near the end of the article where we describe the areas of research but we do not describe the results of primary studies? That's actually what Sandy is describing as something she's supported before, at least in TS. What I'm proposing is pretty much just like what Sandy is describing she did at TS. Zad68 02:27, 17 December 2013 (UTC)

right ... I'm saying we don't want a section where we do the competing, Review A says X but Review B says Y and Review C says Z ... more research is needed .... What I support are Research sections that say, Review A (most recent, high quality) says current research is aimed at resolving X, Y and Z. SandyGeorgia (Talk) 03:21, 17 December 2013 (UTC)

Yes! (finally :)) It is not about presenting the controversy, it is about presenting what current knowledge (or lack thereof) is, where is the research headed, what is current status etc. I'll even argue that if two reviews are at odds on such, then it shouldn't be added (or should be removed). --Kim D. Petersen 05:44, 17 December 2013 (UTC)

Yes, but i'm not certain if it should be at the end of the article, but i will agree that it should be after the health section (as the article currently stands). --Kim D. Petersen 05:44, 17 December 2013 (UTC)

Add: With regards to results ... that is a bit more of a problem, part of such a section should tell what the current status is (as the secondary reviews state it), which is a result, but not what individual studies are saying. Statements such as "there is research into the cytotoxicity of e-liquid" is fine (and enough) as long as there isn't general agreement on what the results are. If we have 5 studies on this, and all say that there is a low, high or negligible cytotoxicity, but not enough evidence to rule out(or in) cytotoxicity, then that is exactly what such a section should say. [this was a constructed example - i don't believe that there is enough material in secondary sources to even merit mention of cytotoxicity of e-liquids] --Kim D. Petersen 05:53, 17 December 2013 (UTC)

OK I think we're close to being able to agree on something. Would you mind writing up your proposed content? Zad68 04:44, 18 December 2013 (UTC)

I'll give it a go as soon as a get the time (hopefully next week), holidays have been hectic :) And i'll post a proposal on the talk page for discussion first. --Kim D. Petersen 03:22, 1 January 2014 (UTC)

Lung function

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

WP:RS-backed information I added concerning lung function was recently removed [6] from the article because the source was not considered secondary. While I agree that review articles are preferable, until someone comes up with reviews about this particular issue, individual studies are the best evidence we have. I suggest restoration of the content. DavidLeighEllis (talk) 02:04, 24 December 2013 (UTC)

• Oppose this proposed use of this primary source, this was a small study N=30 or so, results studied were short term only so significance is not established, and this was published 2 years ago, since then there have been several authoritative secondary sources commenting so this primary source isn't necessary. Zad68 02:17, 24 December 2013 (UTC)
• We should wait for a secondary source IMO as per WP:MEDRS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:22, 24 December 2013 (UTC)
• Oppose - per Zad68. United States Man (talk) 17:30, 25 December 2013 (UTC)

• Oppose - per Zad68. I don't feel strongly about this; for my part the material could stand, be reinstated or replaced by something better or more suitable or up-to-date. However, it also does not seem vital to the theme nor strongly cogent, so unless someone can think of a more important reason for reinstatement, I reckon we are better off leaving it out. JonRichfield (talk) 06:19, 26 December 2013 (UTC)
• Oppose - it's a primary source for biomedical content; we generally don't use those. Alexbrn ^{talk|contribs|COI} 03:17, 1 January 2014 (UTC)
• Oppose - there is wp:NODEADLINE. We can wait for a secondary MEDRS. LeadSongDog come howl! 05:46, 1 January 2014 (UTC)
• Oppose - This study says nothing but false claims. The weakness of the study design of Vardavaz et al. is, that the authors compare the inhalation of nicotine-containing liquids with the inhalation of pure air, ultimately coming to the conclusion that the Propyleneglycol is responsible for the narrowing of the airways. The long-proven effect of nicotine to the bronchial tubes was ignored by Vardavaz et al. (which is clearly recognized as major cause for the first phase of the effect of tobacco smoke). A simple comparison of the inhalation of nicotine-containing liquid with a Liquid nicotine-free could have eliminated two major weaknesses of the study!--Merlin 1971 (talk) 15:14, 4 January 2014 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Changes in E-Cig Industry

I'd like to add Altria's latest move into the e-cig industry as it is timely and relevant. Thoughts? Comments? Itsabouttime (talk) 20:30, 19 February 2014 (UTC)

• Good luck, the editors seem mostly interested in reverting edits then adding content. --→James Kidd (contr/talk/email) 02:31, 5 March 2014 (UTC)

There's no harm in adding it, but it doesn't seem to be a big deal. One more company releases a cigalike, to join the hundreds of cigalikes already on the market; wow. The article is about e-cigs, not the manufactured concerns of zealots and fanatics who'd say a banana was bad if it had a tobacco company label on it.--FergusM1970^{Let's play Freckles} 18:07, 6 March 2014 (UTC)

I've added a couple of sentences on Big Tobacco involvement to the existing material already there. Barnabypage (talk) 07:55, 7 March 2014 (UTC)

Mechanical Box Mods

I think that the following paragraph should be refined:

These mods are broken up in two form factors: box mods and tube mods. Box mods are often made by individual from a project box, a battery holder, a 510 connector and an "off the shelf" switch. This is where the term mod came into use; a person would modify these project boxes. They are the original form of the mechanical mod. Tube mods were first produced in late 2011. Originally made from copper plumbing pipe or LED flashlights, they started to be commercially produced in early 2012.

I'm not saying that the gist of it is incorrect, but saying that "These mods are broken up in two form factors: box mods and tube mods" is somewhat misleading. Box mods are not intrinsically mechanical as this paragraph suggests. In fact, most current box mods are electronic (the MVP, Hana Mod, the Duke etc...) and the overwhelming majority of commercially available mechs are tubular.

Again, don't get me wrong, I am not opposed to an historical approach to mech mods and if they really started as boxes, I have no objection for it to be mentioned in the article. But this systematic break down into box and tube categories, seems to me, irrelevant, misleading and obsolete. TheNorlo (talk) 06:51, 10 April 2014 (UTC)

As I understand it the first mods were modified torches (flashlights, to you colonials). As you said, most box mods don't qualify as mechs because even if they aren't electronic they do contain wiring.--FergusM1970^{Let's play Freckles} 16:29, 17 April 2014 (UTC)

E-Cig ≠ Cigarette

"Cigarette - A thin cylinder of finely cut tobacco rolled in paper for smoking" - OED

E-cigs are not cigarettes, so to class them as a "type" of cigarette is frankly ridiculous and its only effect can be to associate them with tobacco, which they don't contain. Repeatedly adding them to the "cigarette" category makes the article look POV.--FergusM1970^{Let's play Freckles} 22:38, 31 March 2014 (UTC)

There's a mistake in the template. It doesn't list Candy cigarettes.--FergusM1970^{Let's play Freckles} 23:00, 31 March 2014 (UTC)

I see that e-cigs have, yet again, been added to the "Cigarette" category. Why is this being done? They are not cigarettes. They do not contain tobacco. They do not produce smoke.--FergusM1970^{Let's play Freckles} 15:29, 17 April 2014 (UTC)

That is not a WP:Category, that is a template WP:NAVBOX. See this discussion where consensus was reached that e cigarettes could be added under a "related products" category. Yobol (talk) 15:34, 17 April 2014 (UTC)

Whether it's a category or a navbox is irrelevant, because the only thing e-cigs have in common with cigarettes is the name. Nobody's arguing for candy cigarettes to carry the navbox, so why should e-cigs?--FergusM1970^{Let's play Freckles} 15:36, 17 April 2014 (UTC)

If you feel it is not appropriate, take it to the template talk page and get consensus. 3 editors already agree that it is appropriate as is. Yobol (talk) 15:39, 17 April 2014 (UTC)

Actually one of the three says that if ecigs belong on the template so does NRT - a compromise I'd be happy with - and a second is you. I'm not really seeing a huge weight of support for adding something that meets no reasonable definition of "cigarette" to a cigarette template.--FergusM1970^{Let's play Freckles} 15:45, 17 April 2014 (UTC)

Take it to that talk page, and get consensus, then. Yobol (talk) 15:46, 17 April 2014 (UTC)

As two of three editors who've expressed an opinion say NRT products should also be in the "related products" section I've added them. This is a compromise I'm happy with.--FergusM1970^{Let's play Freckles} 01:15, 19 April 2014 (UTC)

POV pushing

I challenge this pair to produce one or more diffs in which they have built content which is against e-cigs. You should not be editing here, you are POV pushing. Lesion 18:06, 19 April 2014 (UTC)

And I challenge YOU to come up with a single piece of evidence that is against e-cigs. Not a press release, not a CDC study that's announced as showing a gateway effect but actually showed tobacco consumption falling and not a piece of carefully slanted innuendo; EVIDENCE.--FergusM1970^{Let's play Freckles} 18:08, 19 April 2014 (UTC)

Is it really that hard for you to conform to WP:MEDRS's standards? Seriously. Seppi333 (Insert 2¢ | Maintained) 23:28, 19 April 2014 (UTC)

It's not me that's ignoring WP:MEDRS. Those standards are quite clear that position papers, no matter who they're from, do not carry the same authority as actual evidence. That means a statement of "concern" about a hypothetical gateway effect, even if it comes from the CDC, is a less good source than multiple studies showing that no such effect exists. I'll also note that whether or not a source is secondary is not determined by who wrote it.--FergusM1970^{Let's play Freckles} 06:26, 20 April 2014 (UTC)

I hope you're joking, quite obviously position papers are not all regarded equally, no matter who they're from. CFCF (talk · contribs · email) 10:20, 20 April 2014 (UTC)

Joking? Not at all. A position paper from the WHO saying "We're worried about werewolves" is a less authoritative source on the werewolf menace than a handful of research papers showing that there's no such thing. Similarly, a CDC statement expressing concerns about a "gateway effect" from e-cigs to smoking pales into utter insignificance when set beside multiple studies showing the exact opposite (including, I might add, one of their own studies).--FergusM1970^{Let's play Freckles} 11:06, 20 April 2014 (UTC)

If you are serious then the correct venue is WP:ANI, here it is not acceptable by WP policy. Thank you. --Kim D. Petersen 02:04, 20 April 2014 (UTC)

Smoke

E-cigs do not release smoke. Please stop adding the word "smoking" to refer to their use. It is factually inaccurate. We've been through this before.--FergusM1970^{Let's play Freckles} 11:31, 20 April 2014 (UTC)

Double standards?

How come a statement by the RCP, on the RCP website, isn't MED:RS but a press release from the WHO is? --FergusM1970^{Let's play Freckles} 22:00, 11 April 2014 (UTC)

Because it is not a statement by the RCP. It is an opinion from Bogdanovica, Bauld and Britton written in the RCP's Commentary magazine, the opinion is even caveat'ed with The views expressed are those of the authors.. --Kim D. Petersen 03:29, 12 April 2014 (UTC)

OK, fair one. --FergusM1970^{Let's play Freckles} 14:34, 12 April 2014 (UTC)

Why is it that only sources that aren't critical of e-cigs need to be MED:RS, while press releases from the WHO etc can be used to make alarming statements about addiction that aren't backed up by any actual evidence? This article is being used to push a pro-ANTZ agenda by exaggerating "concerns" and hypothetical risks.--FergusM1970^{Let's play Freckles} 15:24, 17 April 2014 (UTC)

Position statements by leading medical organizations such as the WHO clearly meet WP:MEDRS, see WP:MEDRS#Medical_and_scientific_organizations here. That after all this time you have not bothered to read/understand MEDRS is disappointing. Yobol (talk) 15:28, 17 April 2014 (UTC)

Actually that's not quite what the MED:RS criteria say, is it? The WHO's diatribe against e-cigs is only a FAQ, and things like that "are generally less authoritative than the underlying medical literature". As there isn't a single paper showing a single case of addiction from a pure nicotine product, and substantial evidence that pure nicotine is not significantly addictive, that FAQ doesn't really carry much weight.--FergusM1970^{Let's play Freckles} 15:41, 17 April 2014 (UTC)

It is a position statement from the WHO, and is therefore MEDRS compliant. Whether or not you believe that their position is supported by evidence is beside the point. We as editors do not substitute our own judgments for those of highly reliable sources such as the WHO. Yobol (talk) 15:43, 17 April 2014 (UTC)

Agree. FAQs by leading medical organizations are MEDRS-compliant. They release the information in this format to make it reach more people. --Enric Naval (talk) 14:28, 20 April 2014 (UTC)

It's a FAQ and it's written in a blatantly slanted manner, for example statements like "some products claim to contain no nicotine," "flavors that can be particularly attractive to adolescents," "this illusive 'safety' of ENDS" and so on. It's full of ludicrously inaccurate information, such as the claim that e-cig cartridges can contain more than 100mg of nicotine or that e-cigs are disguised as USB memory sticks so they can be used covertly. To treat it as an authoritative scientific source is absurd.--FergusM1970^{Let's play Freckles} 15:51, 17 April 2014 (UTC)

Again, your personal opinion about the correctness of their position is irrelevant. It meets WP:MEDRS. Might I suggest you try to get outside opinion from the reliable sources noticeboard to get outside comments on whether the WHO is reliable for health claims? Yobol (talk) 15:53, 17 April 2014 (UTC)

What, like the claim from a WHO spokesman that cigarettes are healthier than e-cigs "because they have a filter"?--FergusM1970^{Let's play Freckles} 15:55, 17 April 2014 (UTC)

I have no idea what you are referring to, and we have no such commentary in this wikipedia article. Again, if you feel the WHO is not reliable for health claims, you are more than welcome to follow the typical WP:DR process, which includes soliciting outside comments at WP:RSN or asking at WP:MED. Yobol (talk) 15:57, 17 April 2014 (UTC)

The thing is, of course, that their e-cig FAQ isn't making health claims. It's just a dreary list of "concerns," hypothetical risks and carefully phrased innuendo. The most striking feature about it is that it completely fails to reference any actual evidence. Nevertheless, as the science builds up and more actual medical experts and smoking cessation groups back e-cigs this article is still dominated by the "reliable secondary sources" like the WHO and BMA, which are remarkable for the absence of primary sources to justify their status.--FergusM1970^{Let's play Freckles} 16:03, 17 April 2014 (UTC)

Primary source which reads like an advertisement in the lead

This text "First generation of electronic cigarettes were usually designed to simulate smoking implements, such as cigarettes or cigars, in their use and/or appearance. Since they are not as powerful as new generation personal vaporizers, first generation e-cigs do not offer the same level of efficacy when delivering nicotine to the end-user, they also produce less vapor than their counterparts." is based on this primary source [7] which looked at 23 users of ECs using a single type of "first generation" ecig and single type of new generation device.

This makes it sounds like we are promoting these new devices "not as powerful as new generation personal vaporizers, first generation e-cigs do not offer the same level of efficacy". Wow that is overreaching. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:44, 20 April 2014 (UTC)

Not a WP:MEDRS section of the article. No medical claims are made (the amount of vapor is not such). And for such a section the Nature article is a reliable secondary source. We are in agreement (by consensus) that this isn't a review, and thus cannot be used in the medical section though. --Kim D. Petersen 16:39, 20 April 2014 (UTC)

"same level of efficacy" is a health claim and actually secondary sources are required for all content not just medical stuff. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:54, 20 April 2014 (UTC)

No, secondary sources are not required for all content. Primary sources can be used. Please stop trying to gold-plate the rules.--FergusM1970^{Let's play Freckles} 20:16, 20 April 2014 (UTC)

Nope it is not. Power, efficacy and vapor production are technical and mechanical claims - not medical ones. --Kim D. Petersen 17:05, 20 April 2014 (UTC)

"delivering nicotine to the end-user" is a health claim and even with it wasn't this ref is not suitable and especially not suitable for the lead. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:07, 20 April 2014 (UTC)

No, "delivering nicotine to the end user" is not a health claim; it's a fairly basic mechanical one. Any statement about what tht nicotine then did would be a health claim, but simply discussing the volume of nicotine moved from point A to point B is not.--FergusM1970^{Let's play Freckles} 19:06, 20 April 2014 (UTC)

Since this is the particular medical issue that Farsalinos et al was examining in this particular paper, then with regards to nicotine absorbtion i agree with Doc James, that it is a primary source (on that particular issue) and a medical statement. Common sense is often not a good indicator as to how physics or mechanics work. For instance it is not a given that nicotine evaporates faster with more power added to a nicotine containing liquid, since this is an issue of fluid dynamics. Btw. have you noticed how your e-liquid in a tank becomes more and more "murky/dark brown"? Some of this comes from nicotine building up in the tank from not being evaporated - so even from a common sense viewpoint it is not given :) I have no doubt that the nic delivery issue will be expanded upon within review articles in the future - and we should wait for that. As for the rest, those are physical claims and not medical ones. --Kim D. Petersen 19:20, 20 April 2014 (UTC)

Cut the sentence "when delivering nicotine to the end-user," from the paragraph then (i actually agree then). As for the rest, the text is important with regards to the topic area, since it is one of the best WP:RS's we have to the existance of first/second/third generation devices. I can't really figure out your "advertisement" claim though - since (close to) all producers have at least 2nd and 3rd gen devices. --Kim D. Petersen 17:15, 20 April 2014 (UTC)

The ref does not support the content in question such as "Since they are not as powerful as new generation personal vaporizers" Comparing on device of each in 23 people? Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:27, 20 April 2014 (UTC)

You really should look into the mechanics of this. 1st and 2nd gen devices cannot deliver more than 4.1 volts (at peak with full battery) to the vaporization process, 3rd gen can deliver constant voltage (and voltage >4.1). 1st gen differs from 2nd gen by the battery size (thus 2nd gen deliver the average 3.7 volts for a longer time).

There is nothing surprising in the observation that such devices are more powerful - since their specs by definition makes them so. We are talking pure physics here (as basic as 2+2=4) --Kim D. Petersen 17:32, 20 April 2014 (UTC)

Nb. this would not automagically hold for nicotine delivery, as that would require that the fluid-dynamics within the liquid dissolving the nicotine when vaporized is was simple - which it may or may not be, thus the nicotine claim does not automagically follow, while the power and vapor claim does. --Kim D. Petersen 17:37, 20 April 2014 (UTC)

Sure so we could say second generation devices generally use a higher voltage. This could go in the body of the text. "Powerful" is an unclear term with many meanings. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:52, 20 April 2014 (UTC)

(edit conflict)Power is not voltage - it is work done over time. It is measured in Watts. If you really want to be pedantic, then you can add the wording "electrically powerful" instead of "powerful". --Kim D. Petersen 18:17, 20 April 2014 (UTC)

I will rephrase it, but whoever deleted the entire paragraph about first gen e cig should not have done that. I used the word powerful because second gen ecigs brings more wattage to the atomizer and watts, you see, is a measure of power. So I though that the word powerful was pretty accurate. I will remove the phrase that says that it brings less nic to the end user even though anybody with half a brain can see that if you vaporize more liquid, that liquid will deliver more nicotine the user. TheNorlo (talk) 18:16, 20 April 2014 (UTC)

"Powerful" is definitely the correct term; raising the voltage is only important because, thanks to Ohm's law, it results in more power at the coil.--FergusM1970^{Let's play Freckles} 19:00, 20 April 2014 (UTC)

OR?

You reverted my edit on the grounds that it was a primary source being used for OR. It isn't a primary source - it's a review of statistics from the NHS's regional stop smoking services across England - and there was no OR; my edit simply repeated the conclusions of the source. Why did you remove it again?--FergusM1970^{Let's play Freckles} 17:53, 19 April 2014 (UTC)

It's OR because you are adding the term "unsupported" to content about why a country banned e-cigs. Lesion 18:06, 19 April 2014 (UTC)

Firstly Wales is not a country, has not banned e-cigs and isn't planning to. Secondly the word "unsupported" is perfectly appropriate, because there is no evidence that e-cigs are "undermining tobacco control efforts" or "renormalizing smoking" and quite a lot that says exactly the opposite. Thirdly there's no OR because Drakeford is citing exactly the concerns that Smoking in England explicitly say are unsupported by the actual evidence.--FergusM1970^{Let's play Freckles} 18:10, 19 April 2014 (UTC)

Please present the article. There is no summary of this ppt available. CFCF (talk · contribs · email) 10:12, 20 April 2014 (UTC)

Can you explain why Smoking in England is an unreliable source? Also can you explain why you changed "using e-cigarettes" to "smoking or inhaling e-cig gas," a sentence that's clunky, poorly phrased and factually inaccurate?--FergusM1970^{Let's play Freckles} 11:15, 20 April 2014 (UTC)

There's a link in the article.--FergusM1970^{Let's play Freckles} 11:07, 20 April 2014 (UTC)

• Smoking in England may be an authority but their official statements ought to be cited, not their summaries for public presentation. Science operates in considered publication like articles or organizational statements. Blue Rasberry (talk) 15:02, 20 April 2014 (UTC)

In that case the WHO's FAQ about e-cigs, which is a summary for public presentation (and, unlike the Smoking Toolkit Study, isn't based on empirical evidence) shouldn't be used either. The main problem I'm seeing here is that on one side of the argument opinions and vague "concerns" are being given weight simply because of who said them while any material that disagrees with these sources is being rejected on often spurious grounds.--FergusM1970^{Let's play Freckles} 19:18, 20 April 2014 (UTC)

FergusM1970 Yes, the WHO publishes many things carelessly so give the same treatment to that source. Feel free to keep in the fact that the WHO has a published statement but do not treat that as a medical claim. If you go to the WikiProject Medicine board right now you can see a discussion of the WHO copying Wikipedia without attribution in its most prestigious publication. It is a huge organization with a range of quality in what it produces, which is why consensus is that peer-reviewed secondary source academic papers are what is acceptable for medical claims. I have no knowledge whatsoever about the nature or sides of this debate so please do not associate me with a position in this debate, other than my position on evaluating sources. Blue Rasberry (talk) 21:46, 20 April 2014 (UTC)

Thanks for that. In fact this is very much what I've been arguing - that a statement has to be evaluated on its own merits, not regarded as authoritative simply because it comes from the WHO.--FergusM1970^{Let's play Freckles} 22:52, 20 April 2014 (UTC)

Oh look, cherries

It's not just the sources that matter; it's how they're translated into article content. For example this, a paper arguing that most of the grounds for regulating e-cigs are utter nonsense and their use as a tobacco harm reduction product should be encouraged, was used as a source for the statement "some feel that regulation is required." It's not wrong as such, but it's certainly a rather idiosyncratic take on what the paper is actually saying.--FergusM1970^{Let's play Freckles} 21:00, 20 April 2014 (UTC)

There is a sentence in the abstract that states "Obviously, these products need to be adequately regulated, primarily to protect users." Thus do not see the concern. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:37, 20 April 2014 (UTC)

I'm sure you don't see the concern. I'll rephrase it for you. A secondary source which argues that e-cigs are a safe product with enormous potential benefits has been stripped down to "some people think more regulation is needed." That is not the conclusion the authors of the review reached; they argue that there is enough regulation already and more would likely be counterproductive. At best this is distorting a source in a misleading manner.--FergusM1970^{Let's play Freckles} 22:57, 20 April 2014 (UTC)

The paper then goes on to argue that this protection is already in place under regulation relating to other consumer products. The paper is very emphatically not arguing for more regulation, and in fact argues that restrictions on availability would be counterproductive and potentially dangerous.--FergusM1970^{Let's play Freckles} 22:50, 20 April 2014 (UTC)

The text has now changed to "Many feel that, after appropriate research to determine if any problem exists, enabling regulations should be enacted to encourage consumers to switch to electronic cigarettes" [8]. What text from the reference supports this? Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:43, 20 April 2014 (UTC)

Okay this bit seems to "Clive Bates, former director of the UK’s Action on Smoking and Health, pointed out that for these alternative products, ‘there is place for regulation, but it should be to create an “enabling framework” for these new, much less risky, alternatives to smoking to enter the market in a way that gives consumers confidence in switching from smoking’" Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:47, 20 April 2014 (UTC)

Proposed restoration of STS statement

So far my edit about the Smoking in England review has been removed four times at least. I think this information should be in the article as it adds valuable context to many of the concerns that have been expressed by opponents of tobacco harm reduction. These concerns tend to focus on concepts like "renormalization" of smoking and the worry that e-cigs may undermine tobacco control efforts or act as a gateway to smoking. However, as is usually made clear by those expressing them, they are fears about what might happen, not conclusions drawn from the evidence. Smoking in England's work is drawn from the evidence, in the shape of smoking prevalence studies carried out throughout an advanced economy of around 50 million people, and they have drawn certain conclusions from that evidence, namely that the evidence conflicts with (as opposed to merely does not support) the concerns about renormalization and undermining tobacco control. I don't see these conclusions as being at all controversial either. If e-cigs were undermining tobacco control efforts then we would expect to see smoking prevalence stabilize or even increase as e-cigs become more popular. Instead it's still falling, with most of the evidence (including the CDC's NYTS) suggesting that the decline has actually accelerated.--FergusM1970^{Let's play Freckles} 19:33, 20 April 2014 (UTC)

Here is a diff showing the sentence I am trying to add. And here is a link to the source. The relevant information is on slide 22, the last page.--FergusM1970^{Let's play Freckles} 19:44, 20 April 2014 (UTC)

A primary source in the form of a power point presentation that has not been peer reviewed is not suitable. Doc James (talk · contribs ·

email) (if I write on your page reply on mine) 19:52, 20 April 2014 (UTC)

Change the record, would you? The file format is irrelevant and it's not a primary source.--FergusM1970^{Let's play Freckles} 19:58, 20 April 2014 (UTC)

See #PPT. NE Ent 20:02, 20 April 2014 (UTC)

We have several non-peer-reviewed sources in this article. Amongst these is the WHO FAQ (as well as the CDC which we use as a primary source - also disallowed per WP:MEDRS). And interestingly both the WHO and the CDC are used to contradict WP:MEDRS secondary review articles.... Should we remove them as well then? The format is (as said previously) irrelevant. --Kim D. Petersen 20:19, 20 April 2014 (UTC)

I'd say that the case for removing the WHO FAQ is a lot stronger than the case for not using the STS data. After all there is no secondary source claiming that e-cigs are undermining tobacco control, while we have a review concluding that they're safe and effective and the WHO FAQ is being used to debunk that.--FergusM1970^{Let's play Freckles} 20:37, 20 April 2014 (UTC)

Well, the trick is to follow the breadcrumbs to get to the info from better sources.

One of the authors of the STS stuff is Lesley Owen. Searching his publications on ResearchGate leads to [9] from National Institute for Health and Care Excellence which seems to be government (UK) sponsored but not exactly government. In any event, reviewing that leads to links on a Medicines and Healthcare Products Regulatory Agency website, which clearly is a government agency (it's just not the US or UN), so the stuff on [10] -- including "The current evidence is that electronic cigarettes have shown promise in helping smokers quit tobacco but the quality of existing NCPs is such that they cannot be recommended for use." NE Ent 19:56, 20 April 2014 (UTC)

Does anyone have any valid objection to the Smoking Toolkit Study or the information it contains? I'll just note that it does not seem to be a primary source and, even if it is, it's still OK to use it because it isn't being used to debunk a secondary source. If someone can come up with a secondary source (i.e. a proper review, not just someone's opinion) that shows e-cigs are undermining tobacco control efforts I will withdraw my edit, but unless someone can show where it violates WP rules I'm going to restore it.--FergusM1970^{Let's play Freckles} 20:10, 20 April 2014 (UTC)

The applicable policy is WP:Consensus, and I don't know what the count is of who's in favor and who is against. Jmh is obviously against, Fergus is for, I'm mildly supportive... NE Ent 20:18, 20 April 2014 (UTC)

Count me as mildly supportive as well. It is not the best source, and if someone could provide WP:WEIGHT to a counter argument, then i'd flip on this - but so far nothing has come up. --Kim D. Petersen 20:20, 20 April 2014 (UTC)

The NICE paper is a good source [11] Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:39, 20 April 2014 (UTC)

Not really. It contains very little information on e-cigs and most of what it does have is badly outdated, for example "products new to the market will need a medicines licence once the European Commission's revised Tobacco Products Directive comes into effect in the UK". The European Parliament threw that out six months ago. E-cigs are a consumer product in the EU (and UK), not a medicinal one, and will not have to get an MHRA license. Unless the source says something else about e-cigs that I'm missing it's of little value, because it's been overtaken by events.--FergusM1970^{Let's play Freckles} 23:03, 20 April 2014 (UTC)

First generation device.

Why does this statement keeps getting deleted under the claim that it is against WP:MEDR blabla?

First generation of electronic cigarettes were usually designed to simulate smoking implements, such as cigarettes or cigars, in their use and/or appearance.

It does not make ANY medical claims what so ever. The only reason that the study is being cited here is because it mentions the existence of first and second generation devices.TheNorlo (talk) 01:28, 21 April 2014 (UTC)

PPT

A power point presentations are not reliable sources thus removed [12] Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:41, 19 April 2014 (UTC)

Excuse me? Format of publication does not reliability confer or remove. The PPT is the official statistics material for this particular data: See here.

We can discuss whether it is WP:DUE in this particular context, or we can discuss whether or not the Department of Health (United Kingdom)/Cancer Research UK/.. (the publishers) are WP:RS for this information. Editorial oversight can also be discussed. But the format they chose to give their information is not. --Kim D. Petersen 13:13, 19 April 2014 (UTC)

I don't think WP:DUE is an issue here. There's a rapid shift among smoking cessation experts towards embracing e-cigs. At this point it seems to be only zealots with an ideological opposition to (non-pharma) nicotine use who still oppose them. In the UK, for example, ASH are supportive, the NHS have no significant safety worries, the RCP are solidly onside and an increasing number of NHS-run regional stop smoking services are recommending them. The only opposition comes from pharma-funded interests like the MHRA and Martin McKee.--FergusM1970^{Let's play Freckles} 15:13, 19 April 2014 (UTC)

The issue is that this is a primary rather than secondary source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:41, 19 April 2014 (UTC)

Really? This morning the issue was that it was a PowerPoint presentation. It's not a primary source. It's a review of statistics from stop smoking services throughout England.--FergusM1970^{Let's play Freckles} 17:40, 19 April 2014 (UTC)

In any case WP:MEDRS doesn't say that primary sources cannot be used; it says they cannot be used to debunk a secondary source. As all the secondary sources also say that smoking prevalence is going down as e-cig use goes up, there's no problem with it.--FergusM1970^{Let's play Freckles} 17:45, 19 April 2014 (UTC)

I disagree, it is a secondary source by definition. The primary source is the statistical material (the surveys) from which the observations is drawn, this is an summary (cross-sectional) of what smokinginengland (thus Department of Health (United Kingdom), Cancer Research UK etc) consider relevant - thus secondary, and published by a respected agency. --Kim D. Petersen 01:50, 20 April 2014 (UTC) [nb. i'm not married to the section, i reverted on the clearly wrong rationale given for the removal. Relevant argument here is (imho) WP:WEIGHT] --Kim D. Petersen 02:24, 20 April 2014 (UTC)

So, the format is not a problem, and it's not a primary source. And nobody doubts the authority of Department of Health (UK) and Cancer Research UK, right? So, there is no reason left for keeping this particular source out of the article?? --Enric Naval (talk) 14:38, 20 April 2014 (UTC)

One is chronically POV pushing, the other is just here for trouble. Topic ban more than justified. Already. Lesion 17:44, 19 April 2014 (UTC)

I'm not here to cause trouble; I'm here to restore NPOV to an article that places far too much emphasis on vague, unsupported "concerns". One of my own concerns is that the WP:MEDRS ban on using primary sources to refute secondary ones has been gold-plated into a ban on using primary sources at all.--FergusM1970^{Let's play Freckles} 17:49, 19 April 2014 (UTC)

Excuse me? --Kim D. Petersen 01:34, 20 April 2014 (UTC)

It might be useful if everyone familiarizes themselves with what a secondary source is with respect to medicine. This is a good overview Secondary_source#Science.2C_technology.2C_and_medicine Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:45, 20 April 2014 (UTC)

• Not a reliable source This is source not appropriate for presenting the epidemiological claim proposed. Presumably this source is derived from a more authoritative source. The more authoritative source from which this slideshow was derived should be presented because the source presented is an abbreviated, ambiguous, and nonstandard way to present the claim made. If the original source cannot be found then this information should not be in the article. Blue Rasberry (talk) 15:00, 20 April 2014 (UTC)

(edit conflict)Here's a [PDF version] with the same content. Format is not important, it's clearly a secondary source, and this page is supposed to be about discussing content, not other contributors. NE Ent 15:04, 20 April 2014 (UTC)

Except that it is clearly NOT a secondary source. Agree that we are here to discuss content. Not evidence that this is anything other than a presentation of primary evidence. And no evidence of peer review. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:24, 20 April 2014 (UTC)

The definition of secondary source is WP:SECONDARY: A secondary source provides an author's own thinking based on primary sources, generally at least one step removed from an event. Primary evidence is found in primary sources; therefore it's a secondary source. NE Ent 15:31, 20 April 2014 (UTC)

To use WP:MEDRS for figuring out whether this is a primary source - we are directed towards WP:Identifying_and_using_primary_and_secondary_sources#Characteristics_of_a_secondary_source, where this particular item adheres to all of the three first bulletpoints of a secondary source, the fourth bulletpoint is a WP:WEIGHT argument that selects amongst secondary sources. (and as i stated before WP:WEIGHT may be an issue here). Where i think you are falling is considering the next section (All sources are primary for something) as if this is the definition... it isn't.

As to your argument that the (ppt) is nothing other than presentation of primary data - that is not correct. The sentence extracted from the document is an interpretation/analysis of primary material - and thus secondary. Peer-review is not a requirement for primary/secondary or tertiary material. In fact both the WHO and CDC material that we have in the article at the moment has no indications of peer-review, so if PR is a requirement for WP:MEDRS then both of those sources are out the window. --Kim D. Petersen 16:19, 20 April 2014 (UTC)

Per "In general, secondary sources are self-described as review articles or meta-analysis."[13] Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:55, 20 April 2014 (UTC)

Per this article is marked as such[14] - here is the intro from the Smoking in England (emphasis mine):

"This section provides a summaries of useful national statistics for the current year, including information on smoking prevalence, motivation to stop, quit attempts, what people use when they try to quit, actual quit rates, regional differences, use of the stop smoking services and more."

So that argument falls. Imho. you are using WP:MEDRS quite alot stricter than what is actually written. While this can be acceptable when there is consensus for it, such as in this article when we are talking about direct medical claims, it is not in actual fact something that is written in WP:MEDRS. --Kim D. Petersen 17:03, 20 April 2014 (UTC)

In this version it cites 20 studies as references. --Enric Naval (talk) 21:11, 20 April 2014 (UTC)

You could try a RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:17, 20 April 2014 (UTC)

No, i could try to build consensus - as should you. Playing the "RfC" card as if something ultimate is not a good indication of consensus building. (at least not this early in the process) --Kim D. Petersen 17:23, 20 April 2014 (UTC)

To get consensus we will need more opinions. RfC are good for consensus building. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:54, 20 April 2014 (UTC)

The more logical way is to go to WP:RSN to figure out whether this is a reliable secondary source or not. Since that is the community board for such disputes. --Kim D. Petersen 20:30, 20 April 2014 (UTC)

• Do not use I disagree with Doc James. It is a secondary source. However, it is not a peer reviewed publication. This is one person's notes and seems like an preprint. It is neither the position of the organization Smoking in England nor is it a scientific publication. It should not be presented as either of those things. Blue Rasberry (talk) 21:56, 20 April 2014 (UTC)

• A review is a review of other sources. This ppt [15] has a serious lack of listing the other sources it is supposedly based on.
• This pdf is a little better [16] but I do not see which parts of it supports the content in question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:08, 20 April 2014 (UTC)

Hardly as a surprise, as it's three years older and doesn't contain the same data.--FergusM1970^{Let's play Freckles} 23:52, 20 April 2014 (UTC)

Hummm, I suppose I can agree with Rasberry's concerns. Sort of. For me, it's still adequate for reporting trends of e-cig usage. Whatever. I suppose that the same data will eventually re-surface on a better source. Wikipedia lagging behind reality because of excessive sourcing requirements, and stuff. --Enric Naval (talk) 22:06, 21 April 2014 (UTC)

"[O]ne person's notes and seems like an preprint" does not get published on the official website of the organization under "latest statistics": "STS140122 08/04/2014 Electronic cigarettes in England - latest trends"[17]

As for peer-review, none of the organizational links/documents that we use in the article are peer-reviewed. This goes for the WHO and the CDC papers which we quote. (in fact to contradict secondary WP:MEDRS review articles (but that is another game))

Finally with regards to the sources used - they are well documented in the Protocol Documents for the Smoking Toolkit Study.[18]

Perhaps we could get some serious discussions instead of speculation and insinuation? Please actually research what the material is, i've pointed to it several times now. --Kim D. Petersen 02:42, 22 April 2014 (UTC)

Secondary sources being removed in this edit

This text "Most people who use electronic cigarettes have a history of smoking cigarettes while some young people who have never smoked cigarettes have tried electronic cigarettes at least once." was removed. Not sure why? Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:33, 21 April 2014 (UTC)

Agree, this is sourced to a review article, also the edit that made this change replaced it with a small n=23 primary study, so reverted. Zad68 04:22, 21 April 2014 (UTC)

I did not mean to delete the secondary source in my las edit.... I did however meant to revert (again) for the nth time the deletion of the "first gen ecig...." Why are you guys keep deleting this??? Because of the Farsalino study? Fine, I removed the study. there!!! TheNorlo (talk) 10:02, 21 April 2014 (UTC)

You restored the text without a source. No source = no text. QuackGuru (talk) 16:22, 21 April 2014 (UTC)

I restored that text with the source exactly 10¹⁰⁰¹⁰⁰ times and it keeps being deleted under the pretext that it goes against WP:MEDRS, which is not the case, since the text in question does not, and let me repeat myself again, make any medical claims what so ever. The source is there only to show that first generation and second generation devices exist. It is a source published on a reputable journal. And even if it is a primary source does not mean that it cannot be used. TheNorlo (talk) 18:38, 21 April 2014 (UTC)

There is a whole section above discussing this. I really cannot fathom what the problem here seems to be. If it had made medical claims then current consensus here is to only use review articles, but this is quoted for purely market information and mechanical/physical description. --Kim D. Petersen 02:47, 22 April 2014 (UTC)

The text is currently unsourced. We can wait for the study (PMID 24569565) to be reviewed or start a RfC and/or go to the WP:RS/N and ask for help. QuackGuru (talk) 04:29, 22 April 2014 (UTC)

I am not sure about prior zillion edits to which User:TheNorlo refers, but info added in the edit linked by User:QuackGuru lacks inline citations. While the paragraph discusses "first generation", "second generation", and "new generation" devices, this is not verifiable with the references cited for the paragraph, currently numbered 2, 3, and 4, and none of which mention "generation" except in reference to younger generations of humans. While the statements are not medical claims, statements should still be verifiable.

The statement that "there is no way to boost the voltage output" on first generation devices sounds dubious, whether it means simply increasing the voltage or it means integrating a boost converter (there are small ones, e.g., TPS65132, around 1x2 mm); perhaps there are design tradeoffs which favor not doing so (e.g., efficiency), or perhaps the statement means it is difficult for consumers to modify the microcircuitry, but as it stands I don't think the current statement is accurate. Agyle (talk) 05:22, 22 April 2014 (UTC)

While it certainly is possible to boost any battery in voltage by using a chip such as the one you link to (which basically is what the 2nd generation VV mods use), the design (cig-a-like [limited space for battery]) and the cartomizers (fixed to the product) are there to maximize lifetime of the small battery. And more importantly no cig-a-like product with variable voltage has been produced to my knowledge. The reason that you do it on 2nd generation is that the tank/vaporizer/cartomizer is exchangeable between products, and thus you can get a variety of resistance/quality/... to fit onto it. 3rd generation goes a bit further (and larger) by using interchangable standard lithium batteries (fx. 18650). --Kim D. Petersen 07:16, 22 April 2014 (UTC)

Nb. a cig-a-like with variable voltage would be a 2nd generation device not a 1st gen one. --Kim D. Petersen 07:17, 22 April 2014 (UTC)

I tried a compromise. QuackGuru (talk) 05:36, 22 April 2014 (UTC)

Fair enough, I'll take that.TheNorlo (talk) 23:17, 22 April 2014 (UTC)

Inventor

I guess this has been dicussed earlier but here it goes.

While I don't oppose Mr.H. A. Gilbert to be mentioned in the opening of this article I think that we should also mention Mr. Hon Lik who actually invented the modern, comercially successfull, vapor producing, nicotine containing, electronic cigarette. I think that crediting only Mr. Gilbert in the openning is somewhat americano-centric. Without Hon Lik, there would be no e-cigs today.TheNorlo (talk) 23:42, 22 April 2014 (UTC)

Hon Lik, a Chinese pharmacist, is widely credited[2][64][65][not in citation given] with the invention of the first generation electronic cigarette.[citation needed] The text in the body should be rewritten. QuackGuru (talk) 00:41, 23 April 2014 (UTC)

Mouthpiece sub section

I doubt that drip tips deserves their own subsection. Especially the way it is now, I think that it is inaccurate and irrelevant.

Mouthpieces come in a variety of colors and designs intended to give the user a way to customize the look of their electronic cigarette.

This is not why drip tips exists. TheNorlo (talk) 19:44, 1 May 2014 (UTC)

Advocacy Groups

I am thinking of starting a section for the multiple e cig advocacy groups that popped up every where around the world. CASAA, AIDUCE, TVECA etc etc.. I am not to sure how to go about it yet, and I don't know if I should make it a subsection of health or its own section.... What are your thought or objections? TheNorlo (talk) 00:30, 2 May 2014 (UTC)

Unless there are wp:RS sources substantially about those groups, just don't. If there are, consider whether they belong here.LeadSongDog come howl! 02:15, 2 May 2014 (UTC)

Etymology of vape

This article needs to clarify for the etymology of vape. Several sources call the use of ecigs as smoking them, while the industry itself refers to the process as vaping (a word not found in any dictionary as far as I can tell). Where is consensus that we should not be using the form smoking ecigs, and why is it not even mentioned if there is a debate over naming use. CFCF (talk · contribs · email) 12:18, 20 April 2014 (UTC)

1. http://healthland.time.com/2013/12/13/smoke-from-e-cigs-still-poses-some-second-hand-risk/ - Refering to smoke from e-cigs
2. http://motherboard.vice.com/read/teens-are-using-e-cigs-to-quit-smoking-and-failing-miserably - Refers to e-smoking, which as a term is mentionable. WP:RS for the term.
3. http://metro.co.uk/2013/03/22/manchester-city-ban-supporter-for-smoking-electronic-cigarette-after-thinking-its-real-3555276/ - Refers to smoking e-cigs
4. http://www.webmd.com/smoking-cessation/features/ecigarettes-under-fire - Craig Youngblood (industry professional) calls them: electronic, alternative smoking devices
5. http://www.ft.com/intl/cms/s/2/ed185b54-c5e0-11e3-a7d4-00144feabdc0.html#axzz2zQeQdEWo Ruyan CEO calls the use guilt-free smoking

Using the term smoking e-cigs is not unheard of, and should be represented in the article. CFCF (talk · contribs · email) 12:28, 20 April 2014 (UTC)

So we should because of journalists not familiar with the topic area use incorrect terms? Smoke is incorrect, while Vapor is correct - by the definition of the terms. Strangely all of your articles specify that they are not referring to smoking, but to (scare-quote)"smoking", emissions, vaping or specify that (WebMD)"E-cigarettes don't make real smoke". The headlines of articles are generally not reliable, since they are written after editorial review for promoting the article.

I'm not against an etymology section, or a section explaining the difference between smoke and vapor - but using an incorrect term, because some media is unfamiliar with the topic they write about, is silly. --Kim D. Petersen 16:35, 20 April 2014 (UTC)

I've been through this already with CFCF. The argument he/she used then was that we should say "smoking" because "vaping" was just industry propaganda. I disagree. YOu cannot smoke something that produces no smoke and to argue otherwise is ridiculous.--FergusM1970^{Let's play Freckles} 18:58, 20 April 2014 (UTC)

But things on which you disagree with can still be of value for a reader. CFCF (talk · contribs · email) 07:51, 24 April 2014 (UTC)

Trouble here is that you appear to be starting from a faulty position. The mentions of "smoking" e-cigs only exists because journalists haven't (or hadn't) a clue about the topic they were writing about. What comes out of an e-cigarette is vapor, not smoke. The liquid is evaporated, not combusted. etc. Thus smoke is simply wrong.

With regards to your mention of "industry"... i don't really know what to do with that, since i can't see that there is an "industry" creating such terms - i do see that there is quite a large subculture thing going, where such terms come from.

Finally i can't really see that we can make an etymology section without resorting to WP:OR, at this point. --Kim D. Petersen 11:13, 24 April 2014 (UTC)

I see only one remotely usable secondary etymology source here. In turn, it cites (and questions) a scarce magazine source at New Society, Volumes 65-66 (1983) New Society Ltd. with neither issue nor page number given. I will inqure at wp:RX to see if anyone can locate that primary source. That Wordspy entry may, however, be indirectly derived from this wiktionary citation by wikt:user:Equinox. LeadSongDog come howl! 18:03, 24 April 2014 (UTC)

Ok, so the early article cited was Rob Stepney "Why Do People Smoke", New Society at Google Books, Volume 65, Number 1080 (28 July 1983) New Society Ltd. pp. 126-128. That piece is snippet view, but it clearly backs the text quoted by Wordspy (and by Wiktionary). LeadSongDog come howl! 19:07, 24 April 2014 (UTC)

If we are going to call it smoking just because some journalists calls it smoking, why not call it what it actually is aswell is since tons of journalist calls it vaping as you can see here, here, here, here, here and here.... Oh... and here, here and here as well.TheNorlo (talk) 00:43, 27 April 2014 (UTC)

Inhaling "air" ist breathing, inhaling "tobaccosmoke" is smoking, inhaling an asthma aerosol is "using an asthma inhaler"! So: Inhaling a non-combustible vaporized liquid with nicotine is not "breathing" or "smoking" - It is "vaping"! The Etymology "vaping" is established since 1980 (have a look)--Merlin 1971 (talk) 11:27, 10 May 2014 (UTC)

New review in Circulation

Not sure if anyone has seen this review yet, but it looks pretty good. [19] Ian Furst (talk) 03:15, 19 May 2014 (UTC)

No, it is not pretty good. It is biased and according to Prof. Dr. M. Siegel: "this article is little more than a hatchet job on e-cigarettes." and:

"To illustrate this, let's consider the five studies which the authors cite as providing evidence that electronic cigarettes inhibit smoking cessation. Presumably, these five studies examined the rate of quitting among smokers who used electronic cigarettes in an attempt to quit smoking. Question: Of these five studies, how many examined the rate of smoking cessation among smokers who were trying to quit using electronic cigarettes?"

Answer: "The rest of the story is that none of these studies examined quit rates among smokers who were trying to quit using e-cigarettes. None of these studies were in fact designed to examine the role of e-cigarettes in smoking cessation in the first place." Source: The Rest of the Story: Tobacco News Analysis and Commentary--Merlin 1971 (talk) 20:03, 19 May 2014 (UTC)

Circulation is a well respected journal. It is a recent review article. Good find. We can definately use this as a source. Now the blog we can definately not use. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:35, 20 May 2014 (UTC)

Have you read the "review" Doc James? I find the paper questionable, even without looking at Dr. Siegel's blog... First thing that strikes me is: It reads more like policy advice/advocacy than a review, Second thing is how far the "narative" in the paper is from the other reviews that we've examined, Third thing is that the references in the paper seems both incestrous and picked to toe a line (cherry-picking may be too far, but not that far), Fourth the summary of some of the papers do not match well with the description in the papers, and finally the primary authors affiliation is a bit problematic. Now after reading Siegel's commentary, i'm even more critical.

Yep, it is a WP:MEDRS... but frankly i wouldn't use it for the problems mentioned above, and if using it, then i would say that the weight given to the paper must be small considering these observations. Not everything in RS or MEDRS is good. --Kim D. Petersen 21:56, 20 May 2014 (UTC)

Just glanced at it. Read a lot of circulation. It is the journal of the AHA and is very well respected. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:00, 20 May 2014 (UTC)

Even good journals sometimes print dodgy papers... i'm not questioning the journal at all. --Kim D. Petersen 23:18, 20 May 2014 (UTC)

Some of the language in the "review" doesn't belong in this article. For example: "Although research is limited, it is transparent that e-cigarette emissions are not simply "harmless water vapor," as is commonly claimed." Research is actually extensive - Glantz just won't acknowledge it unless it matches his views - and the way the sentence is phrased practically accuses e-cig manufacturers and harm reduction advocates of lying.--FergusM1970^{Let's play Freckles} 00:35, 21 May 2014 (UTC)

There are some fairly opinionated assertions in there such as "E-cigarette advertising on television and radio is mass marketing of an addictive nicotine product". At the same time this is somewhat odd because under the disclosures section it states that "Dr Benowitz is a consultant to several pharmaceutical companies that market smoking cessation medications".

I also wonder whether a cardiovascular journal is an appropriate place for this review. Very little of the review appears to focus on cardiovascular issues. As an example would the peer reviewers have expert knowledge and experience of propylene glycol breaking down due to heat and forming toxic substances such as acrolein? Levelledout (talk) 01:17, 21 May 2014 (UTC)

This review is written by tobacco experts, and reviewed in an appropriate journal (smoking cessation clearly falls under the purview of a cardiovascular journal as a topic). If it is incorrect, there will be plenty of other reviews that will come to the opposite conclusion and we can add those if/when they are published. That specific editors disagrees with the conclusion or specific tone of the source is not a valid reason to rule a source unreliable. Yobol (talk) 03:36, 21 May 2014 (UTC)

Actually reviewing sources and assessing their individual merit is exactly what we should do. Considering the tone of a source as well as compare it to other reviews, is one of the things that we as editors are supposed to do, no matter whether it is science, medicine, history or politics. In this particular case, the review is written by anti-tobacco advocates, and that tone can be detected in both their conclusions and their tone.

Let me state an example from the paper that i don't think has been commented upon by others: In the review they refer to a study by Dr. Farsalinos regarding the cytotoxicity of flavored e-cig concentrates, and give some results as if these were actual e-liquid for consumption... they weren't (i noticed this because i myself was thinking that i should keep away from cinnamon flavor based on a quick reading at the time), in fact these were the basic food-flavoring (in 100 and 50% solution) that were cytotoxic at concentrate level but not at e-liquid levels (typically with contrate dissolved at 6-20% in PG/VG mix).

So i'd be very careful in using this review as gospel. --Kim D. Petersen 23:41, 21 May 2014 (UTC)

Is it? At least one of the authors is an aeronautical engineer. This is the third study he's produced this year that's attracted ferocious criticism from within the tobacco control community, up to and including accusations of intentional dishonesty, because the conclusions it draws aren't supported by the data. He's making claims about the effectiveness of e-cigs as a quit aid based on studies that didn't ask people if they were using e-cigs as a quit aid. That's activism, not science.--FergusM1970^{Let's play Freckles} 04:01, 21 May 2014 (UTC)

Your personal opinion of the MEDRS compliant source has no weight in the discussion. QuackGuru (talk) 04:09, 21 May 2014 (UTC)

Fergus is entitled to their opinion and has explained their reasoning. Whether the source has taken a neutral approach or is a biased position paper is actually relevant in determining whether it is WP:MEDRS compliant. On the other hand stating that it is WP:MEDRS compliant without providing a reason is insufficient in accordance with WP:CON.

I have tried to think of a compromise to address some of the grievances discussed here and there is only one that I can think of at the moment that would keep personal opinions and unreliable sources out of the actual article. This would be that if this source is used then the disclosures should also be added to the article. For example:

++info about study++ One of the authors of the study "is a consultant to several pharmaceutical companies that market smoking cessation medications and has been a paid expert witness in litigation against tobacco companies"Levelledout (talk) 10:06, 21 May 2014 (UTC)

FDA

Is the FDA website a reliable source? See diff. QuackGuru (talk) 20:48, 18 May 2014 (UTC)

This would be a position statement from a internationally recognised expert body. So yes Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:35, 19 May 2014 (UTC)

If I suspected that might be the case then I would not have removed it but clearly the "Adverse Event Reports for e-Cigarettes" section of the FDA page is not a position statement. The section is merely a relaying of information that happens to consist of a summarisation of anecdotal reports. The FDA themselves state that "Whether e-cigarettes caused these reported adverse events is unknown. Some of the adverse events could be related to a pre-existing medical condition or to other causes that were not reported to FDA."

There are various anecdotal yet compelling reports out there of how e-cigarettes have had a positive impact on a person's health, yet obviously we should not introduce those due to their very nature. It is therefore impossible to balance these unconfirmed side-effects with any opposing views due to the fact that firm evidence of either simply does not exist. Whilst I am not saying that absence of an opposing valid source invalidates the original source I do think that we have to be careful to maintain a NPOV. In this case I find it hard to justify alarming, unproven medical reports that would likely remain unchallenged.Levelledout (talk) 00:55, 20 May 2014 (UTC)

In general, the FDA is a reliable source. However, that particular piece of information is a voluntary reporting of possible adverse events (possible form of selection bias) and the FDA has not confirmed any of those events were actually caused by e-cigarettes. I'm not sure it deserves to be included given the tentative nature of the data; if it is included, we have to be sure to note that it is unknown if these events are actually caused by the e-cigarettes (which would argue against even putting it in in the first place). Yobol (talk) 00:43, 19 May 2014 (UTC)

It is kind of hard to work out what the point of it is. Right now the article basically says "E-cigs cause all sorts of diseases. Except we're just saying that; there's no evidence."--FergusM1970^{Let's play Freckles} 00:48, 21 May 2014 (UTC)

"The FDA has received voluntary reports of adverse events involving e-cigarettes which include hospitalization for illnesses such as pneumonia, congestive heart failure, disorientation, seizure, hypotension, and other health problems but it is unknown whether e-cigarettes caused these adverse events."

As long we are using a reliable source and the text is neutrally written I think it is okay. QuackGuru (talk) 17:35, 19 May 2014 (UTC)

But what's the point of it? All it really says is "some people who use e-cigs got ill." Great. Some people who don't use e-cigs got ill too. I honestly can't see what it adds to the article.--FergusM1970^{Let's play Freckles} 15:42, 21 May 2014 (UTC)

I am going to remove it, since it is A) A primary source for this info per WP:MEDRS B) per WP:MEDASSESS this is just about as poor information as is possible. Without analysis these are simply anecdotal. --Kim D. Petersen 21:24, 21 May 2014 (UTC)

I agree, what I don't get is how the information got back there in the first place. In the middle of a dispute, it seems to have reappeared like magic. Anyone know where the diff is? Combined with other things I am beginning to think that there are some genuine issues occurring regarding this article.Levelledout (talk) 22:08, 21 May 2014 (UTC)

Was reintroduced here. --Kim D. Petersen 23:31, 21 May 2014 (UTC)

I don't think it should be in the article, and I don't think the other sentence, "Although some people have a desire to quit smoking by using e-cigarettes, other common explanations for the use of these products are to evade smoke-free laws and to cut back on traditional cigarettes, which may reinforce delaying or deterring to quit smoking." should be there either. That's incredibly POV, as well as making claims - delaying or deterring smoking cessation - that have been thoroughly disproven.--FergusM1970^{Let's play Freckles} 13:59, 22 May 2014 (UTC)

Systematic Review not accepted?

So... you're not accepting this systematic review?Why? It's a published, peer-reviewed secondary source! --Merlin 1971 (talk) 16:24, 8 May 2014 (UTC)

It appears that their are a couple of issues. One was it was a copyright violation. We must paraphrase.

The other is that it is not pubmed indexed. Will need to look at the whole article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:35, 19 May 2014 (UTC)

My university carries it. Should be usable with appropriate wording. It does say "Riccardo Polosa is a Professor of Medicine and is supported by the University of Catania, Italy. He has received lecture fees and research funding from GlaxoSmithKline and Pfizer, manufacturers of stop smoking medications. He has also served as a consultant for Pfizer and Arbi Group Srl (Milano, Italy), the distributor of Categoria™ e-Cigarettes. His research on electronic cigarettes is currently supported by LIAF (Lega Italiana AntiFumo)." Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:38, 19 May 2014 (UTC)

I removed it due to lack of MEDLINE indexing. We have plenty of secondary sources, no need to use sub-optimal ones. Yobol (talk) 00:39, 19 May 2014 (UTC)

Sure... I can already see what happens here... This is WP, right? Not a political webpage, is'nt it?--Merlin 1971 (talk) 20:03, 19 May 2014 (UTC)

There's no requirement for sources to be either PubMed or MEDLINE indexed.--FergusM1970^{Let's play Freckles} 00:30, 21 May 2014 (UTC)

We have better sources on this topic. QuackGuru (talk) 04:09, 21 May 2014 (UTC)

"Better" in what way?--FergusM1970^{Let's play Freckles} 15:53, 21 May 2014 (UTC)

I'll second Fergus here, and add the comment that we actually do not have "plenty of secondary sources", Pubmed search coughs up 70 reviews, where most are non-related (papers such as "Impact of diet and exercise on lipid management in the modern era.") or so old that they are basically useless. --Kim D. Petersen 16:23, 21 May 2014 (UTC)

User:Yobol, it has been a while since I have read WP:MEDRS, but is that really something that is supported by policy? MEDLINE indexing isn't the be-all and end-all. This article is listed in EMBASE, as a quick search shows me, and there is only a 34% overlap between those two databases (doi: 10.1097/BLO.0b013e31802c9098). NW (Talk) 17:30, 22 May 2014 (UTC)

Under "Biomedical journals" in WP:MEDRS, "Other indications that a journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE..." This has been a necessary addition to MEDRS due to the proliferation of genuinely bad journals out there. MEDLINE indexing seems to be a fairly low bar to hurdle (crap journals like Homeopathy are MEDLINE indexed, after all). Yobol (talk) 01:48, 23 May 2014 (UTC)

@Yobol: Thanks for the quote. This is a conversation for a different page, WT:MEDRS or WT:MED, but briefly: I disagree with that statement. Nearly every bit of systematic review writing advice, including PRISMA, stress that relying on just one database, even MEDLINE, will lead to biased results. Now that is less of an issue for Wikipedia than writers of systematic reviews, but the principles are similar. Journals that aren't listed in PubMed but do show up in EMBASE or Web of Science Science Citation Index aren't necessarily unreliable. NW (Talk) 02:47, 23 May 2014 (UTC)

Happy to take it to either of the aforementioned talk pages to discuss further. Yobol (talk) 03:04, 23 May 2014 (UTC)