Misplaced Pages

Revision as of 18:12, 24 July 2015

June 2015

Hello, I'm Happysailor. I noticed that you recently removed some content from Cranial electrotherapy stimulation  with this edit, without explaining why. In the future, it would be helpful to others if you described your changes to Misplaced Pages with an edit summary. If this was a mistake, don't worry, the removed content has been restored. If you think I made a mistake, or if you have any questions, you can leave me a message on my talk page. Thanks. - Happysailor 15:45, 26 June 2015 (UTC)

Conflict of interest in Misplaced Pages

Hi ColumbiaLion212. Along with working on health related content in Misplaced Pages I work a lot on conflict of interest issues.

Your account is what we call a single purpose account and your edits are promotional for Cranial electrotherapy stimulation‎. I'm giving you notice of our Conflict of Interest guideline and Terms of Use, and will have some questions for you below.

Hello, ColumbiaLion212. We welcome your contributions to Misplaced Pages, but if you have an external relationship with some of the people, places or things you have written about on Misplaced Pages, you may have a conflict of interest or close connection to the subject.

All editors are required to comply with Misplaced Pages's neutral point of view content policy. People who are very close to a subject often have a distorted view of it, which may cause them to inadvertently edit in ways that make the article either too flattering or too disparaging. People with a close connection to a subject are not absolutely prohibited from editing about that subject, but they need to be especially careful about ensuring their edits are verified by reliable sources and writing with as little bias as possible.

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Please familiarize yourself with relevant content policies and guidelines, especially those pertaining to neutral point of view, verifiability of information, and autobiographies. Note that Misplaced Pages's terms of use require disclosure of your employer, client, and affiliation with respect to any contribution for which you receive, or expect to receive, compensation.

For information on how to contribute to Misplaced Pages when you have a conflict of interest, please see our frequently asked questions for organizations. Thank you.

Question

Misplaced Pages is a widely-used reference work and managing conflict of interest is essential for ensuring the integrity of Misplaced Pages and retaining the public's trust in it. As in academia, COI is managed here in two steps - disclosure and a form of peer review.

Disclosure is the most important, and first, step. Would you please let me know if you have any relationship with companies selling Cranial electrotherapy stimulation‎ devices?

You can reply here - I am watching this page. Once you do, we can take it from there. Thanks in advance for talking! Jytdog (talk) 15:02, 20 July 2015 (UTC)

Response to COI

Dear Jytdog:

Thank you for the invitation to engage in a dialog re: the editing of the Cranial Electrotherapy Stimulation page. I am fairly new to editing Misplaced Pages and initially created my account for the purpose of editing the page. I am a subject matter expert as a result of working for a medical device company, but am not paid to promote any product or write Misplaced Pages content. I discovered the page to contain misleading information and wished to correct it. Cranial Electrotherapy Stimulation is a technology category that is in the public domain (all CES tech that I’m aware of is out of patent), so there are no companies or private interests that control or exclusively benefit from Cranial Electrotherapy Stimulation, and those companies that do make CES devices are very small, unlike the giant pharmaceutical companies that produce competing products. Indeed, one of the obstacles that CES companies have faced is the overwhelming influence of competitors that often use well-placed, influential surrogates to disseminate misinformation about CES.

Following is my assessment of content on the page that is grossly misleading:

There is insufficient evidence to determine whether or not CES with alternating current is safe and effective for treating depression.

Kavirajan HC, Lueck K, Chuang K. Alternating current cranial electrotherapy stimulation (CES) for depression. Cochrane Database Syst Rev. 2014 Jul 8;7:CD010521. Review. PMID 25000907

This extremely misleading statement is supported (in citation) by a published literature review, not a clinical trial, and the publisher of this review is a small undergraduate teaching college within the University of Bristol.

In a 2010 literature review, published in a much more respected journal, Journal of Psychosocial Nursing and Mental Health Services, the conclusion is reached: “To date, whether used alone or in conjunction with pharmaceutical agents, CES has been shown to be an effective and economical therapy for mild to moderate depression.”

Gunther M1, Phillips KD. J Psychosoc Nurs Ment Health Serv. 2010 Nov;48(11):37-42. doi: 10.3928/02793695-20100701-01. Epub 2010 Jul 22.Cranial electrotherapy stimulation for the treatment of depression.

More importantly, there are at least two well-controlled clinical trials that have been published in respected peer-reviewed journals that provide statistically significant evidence of CES safety and effectiveness in treating depression:

Krupitsky et al. The administration of transcranial electric treatment for affective disturbances therapy in alcoholic patients. Drug and Alcohol Dependence 27:1-6, 1991

J Affect Disord. 2014 Aug;164:171-7. A Clinical Trial of Cranial Electrotherapy Stimulation for Anxiety and Comorbid Depression, doi: 10.1016/j.jad.2014.04.029. Epub 2014 Apr 21.

I attempted to add this evidence to the page, yet it was repeatedly deleted.

Critics of CES research may point to the fact that subject sizes for most studies are not large when compared with drug studies, but CES study subject sizes are typical of non-invasive medical device studies. Drug studies need to be much larger because drug therapy is a chemical intervention and causes much more serious side effects. Critics may also point to the fact that CES studies examine varying patient populations and that device brands used in the studies have slight variance in electrical output. Varying patient populations are more representative of the real world, and the variance in output of different device brands is too small to skew data. The three most important aspects of studies – quality of controls, statistical significance and rigorous peer review – are soundly met in the studies listed above. In short, the Effectiveness section of this page should not be allowed to mislead the reader into thinking that there is a complete lack of evidence when in fact there is sufficient evidence

Another sentence on the page which, left alone, is very misleading:

The exact mechanism of action of CES is unclear.

9. Rosa MA, Lisanby SH (2012). "Somatic treatments for mood disorders". Neuropsychopharmacology 37 (1): 102–16. doi:10.1038/npp.2011.225. PMC 3238088.PMID 21976043.

The author of the source (Dr. Lisanby) has a documented conflict of interest with CES. Dr. Lisanby recused herself from the 2012 FDA Panel on CES Reclassification as a result of having a conflict of interest – she has financial ties to Transcranial Magnetic Stimulation, a competing technology. Interestingly, Transcranial Magnetic Stimulation is listed in the See Also section of the Cranial Electrotherapy Stimulation page, along with Trancranial Direct Current Stimulation, another competing technology. In short, Dr. Lisanby’s review is an inappropriate citation for a statement which misleads readers into thinking that the way CES works is a complete mystery. It is not a mystery.

The mechanism of action of most brain related interventions, whether drug or device, are never completely clear, because the brain is so complex and imaging is only beginning to tell the whole story. But the way CES works is by no means a complete mystery. There is very strong evidence, published in respected journals, that CES stimulates the production of serotonin and other neurochemicals responsible for reducing and eliminating depression, anxiety and insomnia:

Liss. S. and B. Liss. Physiological and therapeutic effects of high frequency electircal pulses. Integrative physilogical and behavioral science 31:88-94, 1996

Shealy et al. Cerebralspinal fluid and plasma neurochemicals: response to cranial electrical stimulation. J. Neurol. Orthop. Med. Surg. 18: 94-97, 1996

Shealy et al. Depression: a diagnostic, neruochemical, profile & threapy with cranial electrical stimulation. J. Neurol. Orthop. Med. Surg. 10: 319-321, 1989

2005Gilula MF, Kirsch DL. (2005). Cranial electrotherapy stimulation review: a safer alternative to psychopharmaceuticals in the treatment of depression.Journal of Neurotherapy, 9(2), 2005.doi:10.1300/J184v09n02_02

Kennerly, Richard. QEEG analysis of cranial electrotherapy: a pilot study. Journal of Neurotherapy (8)2, 2004.

My efforts to provide this research have been met with repeated deletion.

The page as it stands right now seems intentionally designed to make readers think that Cranial Electrotherapy Stimulation is a risky, unproven technology. Not only is there sufficient evidence, but CES is prescribed by thousands of doctors, many at the top of the psychiatric field. The New York City Health and Hospitals Corporation recently approved the device for use in its 11 hospitals – including Bellevue, Jacobi and Metropolitan Hospitals. The page should reflect the scientific evidence and broad clinical support the technology has behind it.

Sincerely ColumbiaLion212 (talk) 19:00, 21 July 2015 (UTC)

Thanks for writing back!

Quick notes: I was going to paste the comment that you left on my talk page here, but I see you already copied it above. One place is all we need! :) I also cleaned up your message a bit - not something we usually do, just trying to help a bit with housekeeping.

Turning to the substance of your message - let's separate out the COI issues with regard to you (which we should discuss here on your talk page) from the content issues with the article (which we should discuss on the article Talk page, and which I will gladly do once the COI issues are worked through). User Talk pages like one are for discussing issues with editors (that is what they are for), while article Talk pages exist for talking about the article itself - that is what they are for. The COI stuff should not take long to work through, and then we get to content which is what we all care about. Is that acceptable to you? I won't write more for now. Jytdog (talk) 20:51, 21 July 2015 (UTC)

let's finish the COI discussion, OK? Thanks. Jytdog (talk) 23:51, 21 July 2015 (UTC)

I'm happy to discuss anything further. ColumbiaLion212 (talk) 14:14, 22 July 2015 (UTC)ColumbiaLion212

Great! OK - above you wrote that you work for a medical device company. Does that company make/market/sell/lease etc CES devices? Thanks. Jytdog (talk) 16:32, 22 July 2015 (UTC)

You are back at the article, but have not replied here yet. Would you please finish this discussion? Having a conflict of interest does not bar you from Misplaced Pages - not at all. It just means disclosure and peer review - and it builds good faith. Please do answer. Thanks. Jytdog (talk) 23:30, 23 July 2015 (UTC)

Jytdog, I have furnished you, Alexbrn, Doc James and SandyGeorgia with COI queries and look forward to your responses. AlexBrown works for consulting firm Griffin Brown, a firm that is hired to influence and edit Misplaced Pages pages (among other services). This raises grave concerns given the possible coordinated effort that the four of you have made in editing the CES page in a manner that misleads readers. I have already furnished you with an answer re: my own potential COI - that I do work for a medical device firm. The firm makes alternating and direct current devices, include TENS and CES type devices. I have no more conflict of interest in the CES page than a car company employee would have in the page for the internal combustion engine. There are many special interests, however, that are financially incentivized to mislead readers about CES - companies that have much to loose if CES grows in popularity. I plan to be vigilant not only in preserving the integrity/neutrality of the CES page, but in making as transparent as possible the conflicts of interest that are producing a highly coordinated editorial attack on the CES page. I am confident that soon I won't be the only editor who takes a stand.

Thank you for disclosing your relationship with a company that makes CES devices. You have a COI. I will tag the Talk page of the article so that editors there are aware of the COI. Please do not edit the article directly going forward, but rather (as you have been) please continue to discuss proposed changes on the Talk page.

Again, you are new here, and it is in general a bad idea to get into arguments when you arrive at a new place, where there are rules that you don't understand... in this case, with added intensity due to your conflict of interest. This is not a good path, that you are following. Please do keep in mind that editing Misplaced Pages is a privilege, not a right. Your leaving those COI notices, is we call "pointy behavior", and if you continue behaving that way, you will end up getting indefinitely banned. Do not continue doing that. As you can see, I approached you respectfully above, and simply asked you about your COI, based on the promotional nature of your edits (which I can judge, as I have been editing WP a long time, and know what new editors with a COI tend to do, when they arrive here).

For what it is worth, I have no relationship with any company that makes CES devices, nor with any company that competes with such companies. Jytdog (talk) 18:12, 24 July 2015 (UTC)

July 2015

Hello, and welcome to Misplaced Pages. You appear to be engaged in an edit war with one or more editors according to your reverts at Cranial electrotherapy stimulation. Although repeatedly reverting or undoing another editor's contributions may seem necessary to protect your preferred version of a page, on Misplaced Pages this is usually seen as obstructing the normal editing process, and often creates animosity between editors. Instead of edit warring, please discuss the situation with the editor(s) involved and try to reach a consensus on the talk page.

If editors continue to revert to their preferred version they are likely to lose editing privileges. This isn't done to punish an editor, but to prevent the disruption caused by edit warring. In particular, editors should be aware of the three-revert rule, which says that an editor must not perform more than three reverts on a single page within a 24-hour period. Edit warring on Misplaced Pages is not acceptable in any amount, and violating the three-revert rule is very likely to lead to a loss of editing privileges. Thank you. Alexbrn (talk) 18:22, 22 July 2015 (UTC)

Misplaced Pages etiquette

In this diff, you changed another editor's comment, exchanging a link to your username with a link to their username. Please, never do this again. Editors who do that get banned from Misplaced Pages - it is a very serious breach. Just letting you know. Jytdog (talk) 23:35, 23 July 2015 (UTC)

I sincerely apologize. I believe it was an honest mistake in trying to gather content, and assure you and the community that I will not do this again. Thank you for bringing this to my attention. I will not make the same mistake twice. I have every desire to adhere to Misplaced Pages rules and am doing my best to learn them as I go along. As I mentioned in the past, I'm a relatively new user trying to understand the nuances.ColumbiaLion212 (talk) 17:13, 24 July 2015 (UTC)

COI notices

Please stop sending COI notices to editors with whom you appear to disagree. The editors you're templating are experienced editors who are active in medical topics. Accusing them of a COI can be considered a personal attack absent clear and compelling evidence. Being a health care professional is not a conflict of interest. Please stop trying to "win" a dispute through accusations of COI. Acroterion (talk) 17:20, 24 July 2015 (UTC)

Acroterion My intention is not to initiate a personal attack. Simply looking at the history of these editors' contributions and patterns of responding to me for one another, I would like to make sure there's no possible COI. There have been instances of double standards in the way that certain edits have been made or reverted. Furthermore, Alexbrn works for consultling firm Griffin Brown , a firm that is hired to influence and edit Misplaced Pages pages (among other services).

I have collaborated with the editors on various talk pages and have tried to resolve any differences in a civil manner. As you can see from my contributions, I have tried my best to ask for clarification on rules and to collaborate with editors who have contrary viewpoints. I have no desire to "win." I only care to uphold Misplaced Pages standards. My COI notice is simply reflective of a pattern of events I would like to get a better understanding on.

I also would like to ask a question to you. Does being an experienced editor exempt someone from having a possible COI? From my understanding, only Doc James is a medical professional. I've actually found that he's engaged me very well and most frequently, though, as my talk page will reflect, he neglected to answer straightforward questions that I asked him.ColumbiaLion212 (talk) 18:10, 24 July 2015 (UTC)