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Pathophysiology section at the Sexual addiction article

Opinions are needed on the following matter: Talk:Sexual addiction#"Pathophysiology" section. A WP:Permalink for that discussion is here. The discussion is about whether or not text that Seppi333 included is a WP:Synthesis matter, and whether or not the text should be presented as though sexual addiction is a valid concept, given that some researchers dispute that sexual addiction exists. Flyer22 (talk) 00:04, 10 September 2014 (UTC)

Indeed. User:Seppi333 has inserted a great blob of material from the FOSB article into at least three other articles -- Addiction, Substance dependence and Sexual addiction -- in a context which seems to suggest that the FOSB theory of addiction is the be-all and end-all of addiction research (not to mention the end of the discussion regarding the existence of sexual addiction), in a way that seems to break WP:NPOV and border on being WP:SYNTH.

When I removed and queried their edits, they were most forthright in laying down the law that this was settled, uncontrovertible medical fact. Which is interesting, because that's not what researchers in the field appear to say about it. (see, for example, , where the author makes it very clear in the abstract that this is a tentative conclusion)

From Seppi333' user page, I can't see any claim that they have any background in biochemistry or medicine. Asking them about this seems to have annoyed them quite a lot. I'd appreciate it if any medically knowledgeable editors could take a look at this. -- The Anome (talk) 00:11, 10 September 2014 (UTC)

The Anome (talk · contribs · logs) has been deleting entire sections of content on ΔFosB in substance dependence, sexual addiction, addiction for reasons (largely irrelevant to wikipedia policy) that this user is arguing at Talk:Sexual addiction. I could use some assistance in dealing with this. Virtually all of these sources are also used in Amphetamine.Seppi333 (Insert 2¢ | Maintained) 00:12, 10 September 2014 (UTC)

Edit: noticed a section was already posted since I last opened the create section window. Again, all of these sources are used in an FA-nominated article, so whether or not this material is factually accurate is a very important issue. Seppi333 (Insert 2¢ | Maintained) 00:14, 10 September 2014 (UTC)

My point is this. The material you've added is perfectly fine Misplaced Pages article material, supported by WP:MEDRS, etc. etc. I have no problem with that. The way you've inserted it into these articles, though, is contrary to WP:NPOV and appears to me to constitute WP:SYNTH, in giving a misleading impression that this is the end of the discussion as far as medical research goes. As the abstract of J.K. Ruffle's recent review article on the matter shows, it clearly isn't, and Ruffle is a proponent of the hypothesis.

Their language is clear:

" This induction is likely to, at least in part, be responsible for the mechanisms underlying addiction, a disorder in which the regulation of gene expression is thought to be essential. In this review, we describe and discuss the proposed role of ΔFosB as well as the implications of recent findings." (My italics.)

You clearly have very strong opinions on the matter, which you don't hold back on, and present yourself as an arbiter of truth in these matters, yet you (self admittedly) have no relevant professional expertise in thse matters.

I have no problem with the FOSB hypothesis -- it sounds perfectly reasonable to me, it might wellbe true, who am I to say? I also have no problem with it being mentioned in all of these articles. But, if it is to be in those articles, it needs to be mentioned at much shorter length, with attributions as to who is putting forward the hypothesis, and to in particular to cite references that explicitly say that the FOSB hypothesis applies to the particular article it's being mentioned in. Otherwise, this is just original research on your part. -- The Anome (talk) 00:30, 10 September 2014 (UTC)

• I've deleted all but 1 citation for every behavioral addiction clause, so there obviously can't be any synth in the text now. Go ahead and WP:V check.
• You realize Ruffle's publication is a primary source, right?

• I don't think you understand what I'm talking about with WP:SYNTH, but I will check.
• Regarding Ruffle's paper, I'm not citing it in a Misplaced Pages article -- I'm just using it as evidence, here, that an actual credentialled medical researcher advanced those opinions in a peer-reviewed journal -- The Anome (talk)

I just noticed pubmed doesn't call it a review, though the article itself indicates this. Since it is a review, I'll download and read it and then use it to write/cite text for these articles later this week when I get around to updating FOSB again. Also, you're correct, I'm a bit clueless as to how text cited by a single source could constitute WP:SYNTH, a policy on combining material from multiple sources. Seppi333 (Insert 2¢ | Maintained) 01:08, 10 September 2014 (UTC)

Thanks. The WP:SYNTH policy is about original research by synthesis, where an editor combines reliably sourced statements in a way that makes or suggests a new statement not supported by any one of the sources. For example, unless your sources refer to sexual addiction directly, then you would be making the inference yourself that it's relevant to that article -- making the (possibly correct) inference that because FOSB is likely involved in sexual and other reward pathways, it's necessarily also implicated in sexual addiction -- and that would be original research on your part.

In the meantime, can you please take the disputed sections out of the articles for now, or allow me to do so? As you can see, I've got no objection to either the FOSB hypothesis or its presence in those articles per se, it's just that it needs to be done in such as way that WP:NPOV and WP:OR are followed, and in particular the clear absence of WP:SYNTH. -- The Anome (talk) 01:15, 10 September 2014 (UTC)

Is there any reason for the urgency here? It's not like the WP:DEADLINE is upon us. Why not just leave it alone until someone can improve it? WhatamIdoing (talk) 03:56, 10 September 2014 (UTC)

You may want to try WT:MCB if you'd like to get feedback from an appropriate project to review content on molcular biology. Seppi333 (Insert 2¢ | Maintained) 01:10, 10 September 2014 (UTC)

Absoutely. I've got no problem with the molbio content of the FOSB material, it's the implicit linkage to clinical concepts like addiction, substance dependence, sex addiction etc. where everything gets blurry. -- The Anome (talk) 01:21, 10 September 2014 (UTC)

@The Anome: The relevant sections to sex addiction are the introduction, "sexual reward", and "concluding remarks" sections of this ref. Since you don't appear to have a problem with the reference, instead of deleting all the content, it might be better if you simply read the sections (they're not that long), wrote your own version, and we arrived at a compromise version. That's a bit more constructive than deleting everything. It's also a solution I don't strongly oppose.

Edit: The other review on sex addiction is this one. The quoted excerpt is the only part of that review supporting the article text on sex addiction, so it's much shorter than the first review. Seppi333 (Insert 2¢ | Maintained) 02:28, 10 September 2014 (UTC)

References

1. Blum K, Werner T, Carnes S, Carnes P, Bowirrat A, Giordano J, Oscar-Berman M, Gold M (2012). "Sex, drugs, and rock 'n' roll: hypothesizing common mesolimbic activation as a function of reward gene polymorphisms". J. Psychoactive Drugs. 44 (1): 38–55. doi:10.1080/02791072.2012.662112. PMC 4040958. PMID 22641964. It has been found that deltaFosB gene in the NAc is critical for reinforcing effects of sexual reward. Pitchers and colleagues (2010) reported that sexual experience was shown to cause DeltaFosB accumulation in several limbic brain regions including the NAc, medial pre-frontal cortex, VTA, caudate, and putamen, but not the medial preoptic nucleus. Next, the induction of c-Fos, a downstream (repressed) target of DeltaFosB, was measured in sexually experienced and naive animals. The number of mating-induced c-Fos-IR cells was significantly decreased in sexually experienced animals compared to sexually naive controls. Finally, DeltaFosB levels and its activity in the NAc were manipulated using viral-mediated gene transfer to study its potential role in mediating sexual experience and experience-induced facilitation of sexual performance. Animals with DeltaFosB overexpression displayed enhanced facilitation of sexual performance with sexual experience relative to controls. In contrast, the expression of DeltaJunD, a dominant-negative binding partner of DeltaFosB, attenuated sexual experience-induced facilitation of sexual performance, and stunted long-term maintenance of facilitation compared to DeltaFosB overexpressing group. Together, these findings support a critical role for DeltaFosB expression in the NAc in the reinforcing effects of sexual behavior and sexual experience-induced facilitation of sexual performance. ... both drug addiction and sexual addiction represent pathological forms of neuroplasticity along with the emergence of aberrant behaviors involving a cascade of neurochemical changes mainly in the brain's rewarding circuitry.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Agreed. I'm working on another off-wiki project at the moment, but I will have a go at this tomorrow. In the sexual addiction article, I think it probably belongs in the "Causes" section of the article, alongside the "Psychological distress theories" and "Heterogeneous theories" subsections, perhaps with a subheading like "FOSB hypothesis" or "Biochemical hypothesis". I think it should be a brief one or two paragraph summary of the views of authors who explicitly link FOSB to sexual addiction, per WP:NPOV with a link to the FOSB article itself for the full details of the FOSB/addiction hypothesis.

For example, the reference above could be used to support a sentence of something like the form "In a 2012 paper, Blum et. al. proposed the hypothesis that DeltaFOSB played a critical role in both drug addiction and sexual addiction." There should be similarly customized treatments for addiction and substance dependence, with the section in addiction being larger than the others. I don't believe there's any need to introduce large chunks of the FOSB article into other articles, that's what wikilinks are for. -- The Anome (talk) 11:08, 10 September 2014 (UTC)

Seppi333 (Insert 2¢ | Maintained) 13:08, 11 September 2014 (UTC)

No, really, it's not resolved, unless your idea of problem resolution is to steamroller all other opinions out of existence.

Not only have have you completely ignored my offer above to submit an NPOV version that meets policy as a starting point for meeting consensus, you've now gone back and shoved all the FOSB stuff back in, and also, as a bonus, now removed anything about competing psychological theories. Please see my revision here, which I believe references the FOSB material in a balanced way that I believe follows the WP:NPOV guidelines, and allows the reader to follow the link to the FOSB article to read about the FOSB theory in detail.

As I said in my comment to you in my comment on your talk page, added a few minutes ago, some experts think sexual addiction does not exist. Yet others think it not only exists, but has a clear biochemical mechanism. Yet if it doesn't exist, it can't have a cause, and if it has a cause, it must exist. It's clear that these two positions are logically incompatible, but are both held by experts: therefore neither of these views are uncontroversial, and WP:NPOV applies.- The Anome (talk) 21:14, 13 September 2014 (UTC)

Reanalyses of Randomized Clinical Trial Data

An interesting paper in JAMA which provides a wonderful illustration of why we should insist on secondary sources. Of course, it too is a primary source in some regards... LeadSongDog come howl! 14:39, 10 September 2014 (UTC)

"Reanalyses differed most commonly in statistical or analytical approaches (n = 18) and in definitions or measurements of the outcome of interest (n = 12)." I don't have access to the full text, but isn't that pretty much the definition of post-hoc analysis? The original trial endpoints and statistical analysis are pre-specified as good statistical practice requires. Overall (and admittedly without having seen the full text), this strikes me more as a warning of some of the potential problems with reanalysis of trial data than direct evidence of its benefits (which have been demonstrated in other sources). Formerly 98 (talk) 14:59, 10 September 2014 (UTC)

My understanding is that these were reanalyses of the original study hypothesis (primary outcome), as distinct from post-hoc sub-group analyses. Therefore, such reanalyses aim to verify the published findings by conducting an alternative (improved?) analysis of the original data set. The findings of the paper published in JAMA are relevant to key questions regarding transparency and the desirability of open access to trial data. The accompanying editorial concludes:

The recognition that one trial can potentially lead to different findings and conclusions depending on many discretionary decisions that are made about the data and reanalyses almost mandates that those choices are transparent and described in detail—and that others have the chance to replicate them. Rather than the rare exception, open science and replication should become the standard for all trials and especially those that have high potential to influence practice.

Support, 86.164.164.123 (talk) 18:32, 10 September 2014 (UTC)

The problem is not just retrospective subgroup analysis, nor is it that the newly chosen endpoints and statistical methods are "non-transparent". It is that any non-prespecified analysis of the data creates a problem of multiple hypothesis testing. This is part of why the EMA for a while (I don't know the current status) was pushing for data release only to those who provided advance protocols of what their re-analysis endpoints and statistical methods would be. The issue is similar to why the FDA does not allow companies to substitute "improved" endpoints or statistical analyses for proving efficacy after their data is unblinded.

Interestingly, just today, this news report by Derek Lowe of a biotech suspending development of a drug due to what they call "fraud" by employees who conspired to view unblinded clinical trial data and reformulate the trial endpoints after unblinding of the data to make the drug look better. Formerly 98 (talk) 19:19, 10 September 2014 (UTC)

Evidence of willful malpractice is another matter. Imo, providing open access to data sets is ultimately relevant for transparency (as well as to possible pooled analyses). Quite what credence to give to an alternative analysis, in the light of the methodological questions it will inevitably raise, is a question that must be open to peer review and debate. As of course is the original report of the study design, analysis and interpretation... 86.164.164.123 (talk) 22:53, 10 September 2014 (UTC)

Let me restate that in a way that might be clearer. Its not a subtle question of methodological questions that are equally applicable to the original and re-analysis that I am referring to. I'm specifically referring to the well-established issue of the multiple comparisons problem. This is an important potential source of statistical error and even "cherry picking" for reanalyses that do not prespecify both the endpoints and the statistical method. It is normally not a potential source of these problems in the original analysis because the FDA requires pre-specification of both the endpoints and the statistical plan for any trial designed for regulatory approval. My point is simply that in order to be valid, the reanalyzers need to publically pre-state their analysis plan like Cochrane does and not go on a fishing expedition. (Though even Cochrane has been criticized for deviations from its prespecified analysis)

In general, whatever the flaws in pivotal clinical trials reviewed by the FDA for approval purposes may be, they are all based on efficacy endpoints and statistical analyses that are selected in advance of unblinding of the data, e.g., the investigators are blind to any effect their choice of one endpoint or statistical method vs another will have on the conclusions ("statistical significance") of the study. They cannot cherry pick. This can never be rigorously known to be true for any re-analysis, except in the narrow situation in which patient-level data is released by companies or regulatory authorities only after the re-analyzer pre-specifies an analysis plan. Formerly 98 (talk) 23:17, 10 September 2014 (UTC)

Of course those are all valid points. But ones that do not (imho, at least) militate against the principle and potential of open access, per se (although that would presumably preclude the possibility of prespecified reanalyses, which at present are somewhat rare anyway). 86.164.164.123 (talk) 08:11, 11 September 2014 (UTC)

I wish they were all valid points, but they are not. Not all trials are subject to FDA review (accupuncture practices, for instance). Even when they are, investigators, funders, and journal editors can and do cherry pick. The simple fact is that investigators (or their funders) quite regularly choose not to publish, rather than publish a "failed" trial which merely found the "wrong" conclusion. Simply search through clinicaltrials.gov and you'll see a huge proportion of trials which have not published conclusions, despite being long past their end dates. One sees extraordinary levels of this in trials of homeopathic preparations, herbals, manipulation therapies and many other alt-med interventions. LeadSongDog come howl! 16:59, 12 September 2014 (UTC)

@LeadSongDog: I agree with much of that, but a lot of the studies of non-publication have their own problems, including the COI problem that a paper is always more publishable if you get an "interesting" result, and that many of the authors are seeking to publicize or add support for pre-existing publicly held positions.

This paper for example, found that 29% of "large" (large was used as a marker of "importance" for the purposes of this study) clinical trials remained unpublished, and concluded (more accurately, simply assumed) that this 29% corresponded to negative trials that were being covered up for commercial purposes. But if you go to the listing of the unpublished trials in the supplementary material, here is what you find for the first 10 unpublished Industry-sponsored trials.

1. NCT00005918 is just a comparison of an immediate release to an extended release version of stavudine from 2002. Should have been published, but this was a really minor drug and calling the non-publication of this trial a coverup seems a little extreme.
2. NCT00046761 is a 2005 trial of a drug that was never approved. Not exactly a coverup of negative results for marketing purposes
3. NCT00057239 is a 2003 trial of an antidepressant that was dropped from development and never approved.
4. NCT00057382 is a 2003 trial of a cancer drug that was dropped from development and never approved.
5. NCT00062582 is a trial of an approved drug in an indication for which it was never approved. Probably should have been published anyway.
6. NCT00071266 is a trial of an approved combination pill for hypercholesterolemia. It should have been published.
7. NCT00083421 is a trial of an Alzheimers drug that was abandoned and never marketed.
8. NCT00087724 also a trial of an Alzheimer's drug that was abandoned in development and never marketed
9. NCT00097344 is a trial of a breast cancer drug that was abandoned while in development and never marketed
10. NCT00106509 is a trial of an antibiotic that was abandoned in development and never marketed.

So I'd say there are some problems, but I'd look beneath the headlines before concluding that every unpublished trial is a coverup. I for one, would rather see researchers spend their time trying to find new drugs than writing up unsuccessful trials of drugs that will never be marketed. Formerly 98 (talk) 16:05, 19 September 2014 (UTC)

A fascinating and insightful discussion and I would agree with most of what has been said above. However I would disagree about the value of writing up unsuccessful drug trials. There is a lot to be learned from failed drug trials, especially for refractory diseases such as Alzheimer's. The cost for researchers to write up the results of a failed clinical trial are minuscule compared to the cumulative sunk cost of developing that drug candidate. Furthermore the volunteer participants in these trials were put at risk. In my opinion, drug sponsors and journals have a moral responsibility to recoup as much as possible the financial and human capital that went into developing and testing a failed drug candidate by publishing the results. Boghog (talk) 19:35, 19 September 2014 (UTC)

Fair point.Formerly 98 (talk) 23:43, 19 September 2014 (UTC)

Term definitions infobox/template

Is there a particular infobox or other template that we use or anyone can suggest for defining a list of topic-related terms for transcluding to multiple related articles? Most of the terms related to the two notable addiction paradigms (the pharmacological one and another termed the reward-reinforcement paradigm ) aren't defined as a group on addiction or anywhere else I've looked. The former is mainly a clinical/diagnostic paradigm, whereas the latter is a research paradigm (e.g., used by all the reviews cited in ΔFosB).

A second related point that I figure I'll mention: addiction and dependence are essentially used interchangeably in virtually every addiction and addictive drug article on wikipedia, and also in template:infobox drug's dependence liability (I'm guessing this is influenced by the DSM's framework). See the dependence liability field at Caffeine for a high-traffic article example of where this is weird. It makes the meaning of the term "dependence" very vague in drugboxes/articles at the moment. Seppi333 (Insert 2¢ | Maintained) 13:08, 11 September 2014 (UTC)

No idea what you mean by `Is there a particular infobox or other template that we use or anyone can suggest for defining a list of topic-related terms for transcluding to multiple related articles?` Why would we want to transclude lists of terms to articles? We have the boxes at the bottoms of pages. We have blue links. We are not a dictionary. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:19, 11 September 2014 (UTC)

Ideally, I'd want to transclude a column box that could be used to list terms and had a right-aligned box, similar to an infobox. I figured I'd seen something like this before, I just don't remember the article. This would be a substitute for transcluding a whole section of prose solely on definitions that covers these in the text. Also, most of these articles have tiny infoboxes and giant TOC's, so there's usually a lot of room in the right-column. From the recent statements made during the dispute at sex addiction, I gathered that there's at least a minority of people who think the establishment of diagnostic criteria is equivalent to the medical/clinical identification of an addiction. This isn't even remotely true, and most articles include text associated with both frameworks, which is why I think it would be useful to indicate that there's two addiction frameworks and the associated terminology, or, at the very least, a link to a page of those terms. Seppi333 (Insert 2¢ | Maintained) 13:43, 11 September 2014 (UTC)

Do you mean something like this: {{Docking glossary}} or {{Transcription factor glossary}}? Boghog (talk) 14:01, 11 September 2014 (UTC)

That's exactly what it was, thanks! Seppi333 (Insert 2¢ | Maintained) 14:04, 11 September 2014 (UTC)

Boghog, I just changed the formatting at {{Docking glossary}}. I think it's easier to read, but if you don't like it, feel free to revert. WhatamIdoing (talk) 15:29, 11 September 2014 (UTC)

Thanks! I agree the new formatting is easier to read. Cheers. Boghog (talk) 16:34, 11 September 2014 (UTC)

And from an accessibility point-of-view, it's also an improvement. A glossary is a perfect example for the use of a definition list. --RexxS (talk) 21:52, 11 September 2014 (UTC)

Would support their addition at the bottom of the page with the rest of the boxes. Adding to the lead is a little much. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:30, 11 September 2014 (UTC)

If you need the glossary to make any sense out of the article, then it needs to be towards the top. Discovering what all those words mean when (if) you get to the end is not very helpful. WhatamIdoing (talk) 01:06, 12 September 2014 (UTC)

There has been talk about creating pages that are glossaries and adding a link to this page somewhere. I think LT was working on this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:22, 12 September 2014 (UTC)

I think the goal is to follow the Make technical articles understandable guideline, not to transclude an full glossary of drug-dependence terms. MOS:JARGON recommends that editors “Avoid excessive wikilinking… as a substitute for parenthetic explanations…” (emphasis mine). However, when several articles share the same jargon, it might be wise to provide a consistent (and properly referenced) set of definitions in that style. —Shelley V. Adams ‹blame
credit› 13:34, 13 September 2014 (UTC)

WikiProject Medicine and WikiAfrica

This article says Wikipedians are delivering Ebola information in Africa. Blue Rasberry (talk) 21:32, 12 September 2014 (UTC)

Yes, we've been working very hard over at WP:MEDTRANS, and you're very welcome to participate in any way you can, and we have a number of new guides out there showing you what can be done–even for an English-only speaker. We recently hit ~60 languages with a translated Ebola article and you can find all the links here WP:RTTS. -- CFCF 🍌 (email) 07:28, 13 September 2014 (UTC)

P.S. Newsletter with all this and more due out in a few days! -- CFCF 🍌 (email) 07:28, 13 September 2014 (UTC)

Excellent to see this :-) Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:25, 16 September 2014 (UTC)

Acupressure mat

This article seems to be making medical claims:

People who used an acupressure mat on their upper to lower back experienced the following effects:

• Improving conditions of liver, kidney, and spleen • Alleviating headache, fatigue, depression, and insomnia • Easing spinal problems, sciatica, muscle spasm, cramps • Better immune system, digestion, and elimination

The source cited (http://www.alfombramagica.es/smarty/templates/09-003/web/research.pdf) is a dead link, and somehow I doubt it would pass WP:MEDRS anyway. Comments? AndyTheGrump (talk) 02:23, 13 September 2014 (UTC)

Agreed, the sentence before that one states it came from a 1996 pilot study anyway. Definitely sounds like it would have failed WP:MEDRS. TylerDurden8823 (talk) 04:25, 13 September 2014 (UTC)

I added one sentence. QuackGuru (talk) 04:49, 13 September 2014 (UTC)

Sigh, it's unfortunate so much effort needs to go into finding and combating such nonsense. One way to make it easier to monitor is to rate all such pages under WP:MED or WP:ALTMED. Then it's possible to track changes automatically (or at least this used to be possible with toolserver). User:Kephir/gadgets/rater is an excellent tool for that. By monitoring these pages we can make sure this dribble never gets accepted in the first place. -- CFCF 🍌 (email) 07:39, 13 September 2014 (UTC)

MEDDATE when no newer sources have been identified

We are having a bit of discussion at Talk:Acupuncture#MEDDATE regarding what the MEDDATE section of MEDRS suggests that we do when sources used by the article are more than five years old but no newer sources have been identified to replace potentially outdated information. Do we summarily remove the source and information cited to it? Do we add a tag such as {{update inline}} or {{medrs}} to indicate to readers that the article may not reflect current understanding? Do we leave it alone until newer sources of similar caliber are identified? This article is covered by WP:FRINGE as well as WP:MEDRS, but the sources in question are all solid medical reviews that are more than five years old. - 2/0 (cont.) 16:49, 14 September 2014 (UTC)

I think that WP:MEDDATE is clear on the matter; we should not remove a medical source simply because it's not published in the last five years or so. Unless, of course, more recent reviews are available. But WP:MEDDATE points out, "Within this range, assessing them may be difficult. While the most-recent reviews include later research results, do not automatically give more weight to the review that happens to have been published most recently, as this is recentism." And it gives space to areas that are less researched, stating that sourcing "may need to be relaxed in areas where little progress is being made or few reviews are being published." My opinion on the particular case you are citing is that "we leave it alone until newer sources of similar caliber are identified." Flyer22 (talk) 16:59, 14 September 2014 (UTC)

How certain are we that nothing has been published about this in the last five years?

How elderly are the sources? Are these maybe just six, eight, or ten years old? Or are they from the previous century? WhatamIdoing (talk) 02:32, 15 September 2014 (UTC)

A 2008 review. See Talk:Acupuncture#The_source_we_are_working_with_.5B34.5D. QuackGuru (talk) 02:47, 15 September 2014 (UTC)

(e/cx2) Largely in agreement with Flyer22 here; we should update information as we find newer source of equal or better quality, but not remove material just because it is cited to a review that is 6 years old. Some fields are incredibly fast moving (HIV treatment) in which 5 years may be too old; others have so little research that a 20 year old textbook might be the best source. I would not tag sources that are arbitrarily older than x years as they may still be the best sources available on the subject. Yobol (talk) 02:53, 15 September 2014 (UTC)

I'm not going to look at the source or what it supports or why people are fighting over it. Instead, I'll tell you my general opinion:

• If you've got a review article, and there have been no more recent review articles on that particular point, and the review is less than ten (10) years old, then leave it alone.
• If there are more recent reviews (notice the plural: it means "two or more") on that particular point (not just the field in general), then update or replace to reflect newer sources.
• Otherwise, it's complicated, and we need to talk about specifics.

WhatamIdoing (talk) 15:07, 15 September 2014 (UTC)

The tags were targeting any source older than five years without any objection to the text. Even a 2005 Cochrane review was tagged. They thought sources older than five years should be tagged even if no newer source was found. QuackGuru (talk) 18:41, 16 September 2014 (UTC)

Another discussion about the sources. See Talk:Acupuncture#Regarding_new_consensus_on_MEDDATE.27s_application. QuackGuru (talk) 19:53, 17 September 2014 (UTC)

Ejection fraction edits

Recent edits to Ejection fraction appear to me to have made the article less helpful to the reader. I have no medical background and am not sure how to correct the article. I would be grateful if an editor with a medical background could look over the introduction. Thank you. SchreiberBike talk 05:12, 15 September 2014 (UTC)

Which edits exactly? Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:19, 16 September 2014 (UTC)

Though Lbeben appears to be a medical professional, his edits have been problematic in the past. The second paragraph is wordy and uses too much jargon. Also the historical background in the second paragraph doesn't seem appropriate for the lead. Thanks for your help. SchreiberBike talk 16:54, 16 September 2014 (UTC)

Perfluorooctanoic acid

I raised this article last year but failed to make any headway in cleaning up what looks to be content with a very decided POV built on iffy sources against the backdrop of legal action in the US. Am I seeing that right? would appreciate a sanity check before attempting clean up again ... Alexbrn 18:14, 15 September 2014 (UTC)

Needs some primary sources trimmed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:15, 16 September 2014 (UTC)

Fun clean up job: Splints

Splint (medicine) is pretty weak. I'm sure that anyone who has taken a basic first aid class, or even just spent ten minutes reading online, could improve it easily. WhatamIdoing (talk) 02:27, 16 September 2014 (UTC)

Students 4 Best Evidence edit-a-thon starting now!

Hi everyone,

The Students 4 Best Evidence edit-a-thon is starting now! Join us in the Google Hangout

See the list of students and articles being worked on at the course page. Education Program:Students 4 Best Evidence/Students 4 Best Evidence, September editing campaign () Sydney Poore/FloNight♥♥♥♥ 11:28, 16 September 2014 (UTC)

Thanks to all who joined in! We've had some useful outcomes, not least is the work done on articles - and the confidence gained by the new(ish) editors who have made a small dent in the list of tasks, but have pledged to continue working with this initiative.

Other valuable developments are: a proposed follow-up session towards the end of this term as a joint effort between Cochrane and Cancer Research UK; and an offer from some of the Cochrane reviewers to inform us when they publish new reviews that they feel would interest us. I'm hoping we could make a subpage of WPMED to house a place where the reviewers could leave announcements of new reviews - does that seem like something the regulars here would like to see? Cheers --RexxS (talk) 18:32, 16 September 2014 (UTC)

Edward Tobinick

I am new at editing and am attending the Students 4 Best Evidence Cochrane event in Oxford. I came across this medically questionable active page recommending injection of etanercept for stroke. There are active arguments but they are not being debated on medically relevant grounds. The intervention is without reliable evidence and the author has lost his license to practice medicine in other states. Is it possible to mark this page for examination by the medical project for relevant evidence and accepted practice.AmyEBHC (talk) 13:45, 16 September 2014 (UTC)

The article is nominally a biography but appears to be used as a WP:COATRACK for convincing readers of the subject's belief that injections of Enbrel are good treatments for back pain, Alzheimer's, and stroke (and possibly other things).

It looks like the article recently received some significant changes that removed negative information and added a lot of praise. The page has been protected due to edit warring twice in the last two months.

The person who removed it was technically correct: proper (in this case, newspaper-type) sources for the governmental disciplinary actions like this one should be used instead of court documents. It might have been better to WP:PRESERVE the accurate information and improve the source than to blank it, but that's not actually required.

I'm not entirely convinced that the subject is notable. It's difficult to find properly published sources that both (a) aren't written by him and (b) say more than a couple of sentences about him. This criticism of his research isn't proof of notability, and descriptions on blogs like Science-Based Medicine and QuackWatch aren't, either.

AmyEBHC, thanks for letting us know about this problem. I candidly cannot recommend that you try editing this as your first introduction to Misplaced Pages. I think this is going to need to have attention from multiple highly experienced editors (and maybe admins). WhatamIdoing (talk) 22:16, 16 September 2014 (UTC)

Have trimmed a bunch of primary sources making medical claims. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:49, 17 September 2014 (UTC)

Thanks, James. I was doing the Cochrane training with User:RexxS and User:HenryScow, & suggested Amy post here rather than doing anything herself. Prima facie it seems a clear case of medical POV-pushing and promotion using the cover of the protection we give to WP:BLPs. Wiki CRUK John (talk) 10:18, 17 September 2014 (UTC)

Another brand new account has just showed up. Many need some protection this article may. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:24, 18 September 2014 (UTC)

Misplaced Pages:Articles for deletion/Edward Tobinick (2nd nomination). I don't think this guy is notable enough for an article. It's been to AfD before in 2006, and I don't think it was wisely closed then (the argument he was going to be as notable as Pasteur hasn't quite come true). Alexbrn 03:47, 18 September 2014 (UTC)

There seem to be related problems at:

• Etanercept#Experimental and off-label uses
• Alzheimer's disease research#Etanercept
  Alexbrn 05:34, 18 September 2014 (UTC)

Addressed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:56, 18 September 2014 (UTC)

Anyone looking for a project? Look at Throat culture

Throat culture needs some serious serious work...... NickCT (talk) 14:35, 16 September 2014 (UTC)

I just worked on it a bit. It definitely needs a lot more work, but this should be a good start. The article needs considerable expansion and needs WP:MEDRS-compliant references (currently sporting zero). Another thought-this might be a good project for students 4 best evidence if anyone is still looking for a project. TylerDurden8823 (talk) 17:45, 16 September 2014 (UTC)

Misplaced Pages:Administrators' noticeboard/Incidents#Proposal: six month interaction ban between Flyer22 and zzz

Opinions are needed on the above linked discussion. I and the other editor edit medical articles. Flyer22 (talk) 01:56, 17 September 2014 (UTC)

A WP:Permalink for the discussion is here. Flyer22 (talk) 01:58, 17 September 2014 (UTC)

Yes a strange situation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:23, 17 September 2014 (UTC)

Recreational drug use

Has been changed significantly. Wondering what others thoughts are per Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:59, 17 September 2014 (UTC)

Notice of intention - working on clinical coding articles

As several of the below articles are under the WP:MED umbrella (and as a coder there being a potential WP:COI), I thought it best to declare here that I intend to start cleaning up the articles around clinical coding in the near future.

I'm currently looking at a structure similar to below:

• Clinical coder - the specific occupation.
• Clinical coding - new (currently a redirect) - the practice of applying codes from a classification to a health service encounter (irrespective of the practitioner).
• Medical classification - the tools used in clinical coding.

as this seems to reflect the separation between practitioner, mechanisms and implements used in other articles around occupations.

Related articles that may also need work during or afterwards:

• Medical billing
• Diagnosis code
• Procedure code
• Pharmaceutical code
• Topographical code
• Case mix
• Diagnosis-related group

For various reasons, including the COI, I'm going to assume that all should this be done in sandbox; with consensus/fresh eyes being sort when ready to publish. However, I need to ask; do articles have their own sandbox area? If not, is it possible to have multiple sandboxes in my user space? Little pob (talk) 13:05, 17 September 2014 (UTC)

Yes it is possible to have many sandboxes in your own userspace.

Being a coder is not really a COI. IMO you should be able to edit the articles directly without concern. Drop us a note here and we will be happy to look at your work. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:37, 17 September 2014 (UTC)

Working for/with a particular coding system might represent a COI, though as I think there is relatively muted competition between the various systems which different countries/organization use (is this right?) it may not be too serious. I agree you should be able to edit directly, but you need to declare your potential COI. You've done this on your user page, which is great, as well as here. You might also consider a note declaring it on the talk page of articles you intend doing major work on, especially if your edits might be considered controversial. And/or in your first edit summary on a page. You could ask here for a check when pretty much finished with an article. But it doesn't seem a very controversial area, not that I'd know. Best of luck! Wiki CRUK John (talk) 14:06, 17 September 2014 (UTC)

Being an expert or professional is not usually considered a conflict of interest. You might like to read WP:MEDCOI. WhatamIdoing (talk) 14:32, 17 September 2014 (UTC)

Can someone please look at these two articles?

• Ankaferd BloodStopper
• Hüseyin Cahit Firat

Some medical claims which I don't think are well sourced. --NeilN 23:27, 17 September 2014 (UTC)

Not sourced at all, Neil, if we require MEDRS-compatible sourcing. I've gently revised the first and commented on the two talk pages. They probably both ought to be gutted down to whatever can be reliably sourced (assuming the latter survives). --RexxS (talk) 23:00, 18 September 2014 (UTC)

Thanks very much RexxS. I can usually judge the reliability of sources pretty well but when it comes to medical studies, I prefer to leave it to expert volunteers. --NeilN 23:12, 18 September 2014 (UTC)

Useful free sources

Mostly WHO stuff but in an easy to access format. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:51, 18 September 2014 (UTC)

Health claims

We have an interesting situation here Pantyhose#Risks were a bunch of health claims are made using poor quality sources. Attempted to add a Lancet review and a user have removed it twice without joining the discussion here Talk:Pantyhose#Risks. Peoples thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:02, 19 September 2014 (UTC)

Agree that the sources are poor quality. Removed some of them and asked for medical citations compliant with WP:MEDRS. Also asked for a few clarifications with respect to who is making these health claims. TylerDurden8823 (talk) 03:00, 20 September 2014 (UTC)

Unusual citation activity in Monoclonal antibody

Would someone please check this series of recent edits? I get worried when I see low volume numbers on things that have plenty of articles in journals with high volume numbers, but maybe that's just me. EllenCT (talk) 01:29, 20 September 2014 (UTC)

they were funky, thanks. fixed. Jytdog (talk) 04:30, 20 September 2014 (UTC)

Is a MEDRS suggesting systemic bias suitable to establish noteworthyness of non-MEDRS secondary sources?

Regarding the discussion at Talk:Environmental impact of hydraulic fracturing#WP:WEIGHT of new study: "Proximity to Natural Gas Wells and Reported Health Status" (2014), I believe (PMID 24413211) is a WP:MEDRS which may establish the noteworthyness of secondary news source coverage of . If this is incorrect, please explain why.

Also, which articles at 7 are WP:MEDRS? Is 8? EllenCT (talk) 02:44, 20 September 2014 (UTC)

i don't understand what the section header means. As for specific questions... Your link 5 is not an article about health, it is about lobbying/politics/jurisprudence and is indexed that way by medline as you can see here. Your link 6 is a WP:PRIMARY source and not what MEDRS calls for (and notewothyness has nothing to do with MEDRS). your link 7 is a blank search page. your link 8 is WP:PRIMARY and not what MEDRS calls for. Jytdog (talk) 03:23, 20 September 2014 (UTC)

The medline link says the article is a "Review" in Reviews on environmental health and its abstract says "money can buy favors and determine policies that are often counter to the public interest and can even lead to failure to protect the health of the public" (emphasis added.) Is the article about health and lobbying/politics/jurisprudence both? EllenCT (talk) 07:47, 20 September 2014 (UTC)

yes medline reports the title of the article. it doesn't classify it as health-related review - the classifications are jurisprudence, etc as I mentioned above. Jytdog (talk) 12:29, 20 September 2014 (UTC)

To what extent does the subject matter of the journal bear on the question? EllenCT (talk) 18:23, 20 September 2014 (UTC)

Primary studies should rarely be used in articles because we need secondary sources to establish their significance. (You have not provided secondary sources.) Remember the warning for opinion polls, "these numbers are accurate within 5% 19 out of 20 times?" Primary studies have similar problems and need corroboration before they become accepted or rejected. Sometimes too they are attacked on methodology. TFD (talk) 04:23, 20 September 2014 (UTC)

Sorry, link 7 should have been NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy Volume 23, Number 1 / 2013 (Special "Fracking" Issue: FREE Content) -- which of those articles are WP:MEDRS? And link 8 appears to me to be a review of more than 38 primary source studies. Why is it primary and not secondary? If it is secondary, is it WP:MEDRS? EllenCT (talk) 07:29, 20 September 2014 (UTC)

Link 8 appears to me to report the results of a survey of 108 individuals (p 59), though referring to many other studies. That's very primary. Johnbod (talk) 12:36, 20 September 2014 (UTC)

Indeed, its discussion of these references is its most secondary part:

14. T. Colborn et al., “Natural Gas Operations from a Public Health Perspective," Human & Ecological Risk Assessment 17 (5) (2011): 1039-1056, doi: 10.1080/10807039.2011.605662.

15. L. M. McKenzie et al., “Human Health Risk Assessment of Air Emissions from Development of Unconventional Natural Gas Resources,” Science of the Total Environment 1 (424) (2012): 79-87, doi: 10.1016/j.scitotenv.2012.02.018.

16. M. Bamberger and R. E. Oswald, “Impacts of Gas Drilling on Human and Animal Health,” New Solutions: A Journal of Environmental and Occupational Health Policy 22 (1) (2012): 51-77, doi: 10.2190/NS.22.1.e.

The only question that remains is which of these articles are literature reviews, or better yet, we could summarize all of their secondary sections, right? EllenCT (talk) 18:32, 20 September 2014 (UTC)

Hi, I'm not seeing any of these articles as review articles. And we can not take the finding of each review and combine them to create our own review. There is more to high quality reviews than the summary of findings. They do a vigorous review of data sets looking for similarities, biases, and COI among other things. And then base the results on the combination of factors. Sydney Poore/FloNight♥♥♥♥ 19:05, 20 September 2014 (UTC)

Some of them have more substantial review sections than others. What is the proper course of action to take when articles about both policy and health are unlikely to be incorporated in a systematic review? E.g. if we wanted to adapt the data from depicted in ? Does WP:OI ("so long as they do not illustrate or introduce unpublished ideas or arguments") allow that? EllenCT (talk) 22:51, 20 September 2014 (UTC)

from my perspective none of the sources you have brought are suitable per MEDRS for sourcing content about effects of fracking on health. Whether they are suitable for other content (e.g. policy, law, lobbying, or politics) is a question for different board. Please be careful not to WP:COATRACK health content in any policy/politics/legal/lobbying content that gets generated based on these sources, if any of them are found suitable for policy etc. Jytdog (talk) 23:12, 20 September 2014 (UTC)

Another article in need

Pontocerebellar hypoplasia is in serious need of expert attention, if anyone is up for it. Nikkimaria (talk) 04:26, 20 September 2014 (UTC)

TylerDurden8823 and I have made a start, but it could do with some solid secondary sources and further sections - Diagnosis, Screening, Management, Epidemiology, History are the obvious ones. I've dropped 3 secondary sources onto the talk page if anybody cares to do a little more work on the article. --RexxS (talk) 22:10, 20 September 2014 (UTC)

GA reassessment of Traditional African medicine

I've initiated a reassessment, my reasons are described here: Talk:Traditional African medicine/GA2. Page was created as part of an educational assignment in 2010 and marked as GA two weeks afterwards. Would any other users like to contribute? --Tom (LT) (talk) 06:13, 20 September 2014 (UTC)

1. Street, R.A.; Stirk, W.A.; Van Staden, J. (2008). "South African traditional medicinal plant trade—Challenges in regulating quality, safety and efficacy". Journal of Ethnopharmacology. 119 (3): 705–710. doi:10.1016/j.jep.2008.06.019. ISSN 0378-8741. PMID 18638533.
2. Müller, Adrienne C.; Kanfer, Isadore (2011). "Potential pharmacokinetic interactions between antiretrovirals and medicinal plants used as complementary and African traditional medicines". Biopharmaceutics & Drug Disposition. 32 (8): 458–470. doi:10.1002/bdd.775. ISSN 0142-2782. PMID 22024968.
3. Ncube, Bhekumthetho; Ndhlala, Ashwell R.; Okem, Ambrose; Van Staden, Johannes (2013). "Hypoxis (Hypoxidaceae) in African traditional medicine". Journal of Ethnopharmacology. 150 (3): 818–827. doi:10.1016/j.jep.2013.10.032. ISSN 0378-8741. PMID 24184189.
4. Gruca, Marta; van Andel, Tinde R; Balslev, Henrik (2014). "Ritual uses of palms in traditional medicine in sub-Saharan Africa: a review". Journal of Ethnobiology and Ethnomedicine. 10 (1): 60. doi:10.1186/1746-4269-10-60. ISSN 1746-4269. PMID 25056559.{{cite journal}}: CS1 maint: unflagged free DOI (link)
5. Chitindingu, Ethel; George, Gavin; Gow, Jeff (2014). "A review of the integration of traditional, complementary and alternative medicine into the curriculum of South African medical schools". BMC Medical Education. 14 (1): 40. doi:10.1186/1472-6920-14-40. ISSN 1472-6920. PMID 24575843.{{cite journal}}: CS1 maint: unflagged free DOI (link)

The references are not properly formatted in the Notes section. The lede does not summarise the body. More sources are needed to update the article. The article easily fails GA. QuackGuru (talk) 07:44, 20 September 2014 (UTC)

Thanks, I've copied these to the reassessment page for posterity. --Tom (LT) (talk) 22:26, 20 September 2014 (UTC)

There will be an effectiveness and safety section in the article and it will be summarised in the lede. QuackGuru (talk) 23:48, 20 September 2014 (UTC)

WP:PULSE August/September double issue soon out!

I'm currently fleshing out the content on the Pulse newsletter. If anyone would like to help please feel free to polish upon it up until it is released. I've provided much of what is there, and am working on the medical translation parts, but if anyone want to add anything else, please do! Misplaced Pages:WikiProject_Medicine/Newsletter/August_2014
Ping LT910001, Bluerasberry
-- CFCF 🍌 (email) 16:23, 20 September 2014 (UTC)

hi im new

I've been helping on the talk page and with other editors for the,, "Ebola virus west Africa outbreak" article, is that within the scope of what the wikiproject medicine does?,,or is there something else I should do?,,,,--Ozzie10aaaa (talk) 00:05, 21 September 2014 (UTC)