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To discuss reliability of specific sources, please go to Misplaced Pages:Reliable sources/Noticeboard or to the talk pages of WikiProject Medicine or WikiProject Pharmacology.

view · edit Frequently asked questions This is the talk page for discussing improvements to the Identifying reliable sources (medicine) page. Put new text under old text. Click here to start a new topic. New to Misplaced Pages? Welcome! Learn to edit; get help. Assume good faith Be polite and avoid personal attacks Be welcoming to newcomers Seek dispute resolution if needed Archives: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32Auto-archiving period: 30 days  Biomedical information This note is to explain the correction that I made here: MEDRS applies to "biomedical information". It does not apply to all medical content; It does not apply to all health content; it definitely does not apply to all content that could be (mis)construed as being health content. MEDRS only applies when you are making a statement that has both "bio" and "medical" components. Whether patients choose to comply with a prescription more frequently if the prescriber comes from their class is "medical" content. However, it is not subject to MEDRS, because there's no "bio" in that. Whether there are typically 46 chromosomes in a human cell is "bio", but it's not "medical". It's plain human biology. Therefore MEDRS is not required for that, either. I realize that this "limitation" is not popular with certain woo-fighters, who occasionally wish (for example) to demand MEDRS-compliant sources on the strictly non-biological (and therefore non-biomedical) fact that a huge number of licensed physicians choose to recommend chiropractic or acupuncture treatment to their patients – but that kind of statement is not covered by MEDRS. What we think of as a "MEDRS-compliant" source is required only for the biomedical subset of all medical- and health-related information in Misplaced Pages. WhatamIdoing (talk) 06:15, 6 August 2015 (UTC) Why Under the question "Why do you have special rules for medical information?", it says that we want to get it right "Since Misplaced Pages's readers may make medical decisions based on information found in our articles". This is probably true for some people. However, I'm not sure that this is "the (sole) reason"; we want to get it right because we want to get it right. Also, the consequence doesn't follow logically: If the sole rationale is that people make health decisions with Misplaced Pages, then we need to get the information right. (We would also need to write in lay-friendly English and omit information that might cause someone to make the "wrong" choice.) Using high-quality sources is a means to an end, not an end in itself. WhatamIdoing (talk) 00:06, 13 August 2015 (UTC) When The section "When do I need to follow MEDRS?" says, "Content about human biochemistry or about medical research in animals is also subject to MEDRS if it is relevant to human health." I think this is too sweeping. Is there any aspect of human biochemistry that isn't – somehow, perhaps indirectly – "relevant to human health"? Also, why human biochemistry and not human biomechanics? And how far do you want to take this? Do you need a MEDRS-compliant source to say that children sometimes cry when they fall down? There's a whole lot of biochemistry involved in that process. Ditto for medical research in animals. This kind of oversimplification makes it very hard to write solid science about toxicology and environmental health research. I think this is going to lead to writing bad articles and blanking good content over needless sourcing disputes. It's a gift to POV pushers. We need to find a better way to say this. WhatamIdoing (talk) 00:15, 13 August 2015 (UTC) Review: ideal? I query the recommendation "For most (not all) purposes, the ideal source is a peer-reviewed review article", which goes along with "and the editor said I needed to use a review". As MEDRS pyramid diagram shows, clinical practice guidelines are probably the closest we have to "ideal". When such guidelines come from an international body of experts, reviewing and grading evidence, and combining that with "best practice" for all the things that RCTs don't necessary cover, then they really can be a gold mine for sourcing. We are, after all, supposed to reflect the expert consensus. There are various kinds of reviews. A narrative review may only reflect the opinion of the authors . A systematic review can be so algorithmically constrained, that the authors end up saying little that is useful. A meta-analysis can only be done if there is homogeneity in the studies. Editors seem often over-focused on "efficacy" and perhaps "adverse effects" which are important when covering treatments, but in a disease-focused article, or a treatment that is more complex than just taking a pill, that may only cover a small aspect of the article topic. A professional and condition/treatment-specific textbook may outclass all of these for some aspects of an article, as it can be more comprehensive and holistic than a journal review paper. Of course, such a book requires one to make more of an effort and commitment than following a PubMed link. So, in short, I don't think we should push "review article" as "ideal". It is merely "good" and "better" than a research study paper. I think we should also encourage editors to immerse themselves in the literature on a topic, before doing significant work on it. That is the only way we can determine WP:WEIGHT. I often see the addition of factoids linked to this or that review. The result is many of our articles are a fairly disorganised collection of facts, that neither introduce and explain nor are comprehensive. So really, what one needs is not "a review" but to collect several high quality sources, read them all, and cite one or two. That would be my advice in a FAQ. -- Colin° 16:10, 8 January 2019 (UTC) Agree. One problem I have noticed with review papers is that in aggregating the results of many separate trials a significant outlier may be omitted or downgraded, e.g. a result that only applies to a particular genetic population or diagnosis. Of course that is exactly what a review is supposed to do! But useful, reliable information (even from primary sources) may be lost, and the article may be misleading, especially with negative results such as "Xxxx has not been found to have any effect greater than placebo on Ccccc". D Anthony Patriarche (talk) 18:51, 2 January 2023 (UTC) Fake heading The navigation (esp. mobile) and editing of the page is a bit difficult now. This seems to have a reason, which I’m not sure I understand. Can we change it back? --Dustfreeworld (talk) 18:15, 27 January 2024 (UTC) This FAQ is transcluded at the top of WT:MEDRS (in a collapsed section). I suspect that @Seppi333 changed the formatting so that the section headings in the FAQ didn't appear in the Table of Contents for WT:MEDRS. WhatamIdoing (talk) 18:36, 27 January 2024 (UTC) Thanks WAID; your explanation clears things up! --Dustfreeworld (talk) 21:30, 3 February 2024 (UTC) It makes this page very hard to use though. Bon courage (talk) 06:05, 9 February 2024 (UTC) We could put {{vanchor}} on each section heading and something like #General • #Sourcing • #Neutrality • #Finding and using sources • #Conflict of interest • #Other helpful resources (only prettier) at the top of the page, if that would make it easier. WhatamIdoing (talk) 23:15, 9 February 2024 (UTC)

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RfC about appropriateness of medical sourcing

Watchers of this page might be interested in an RfC on Safety of electronic cigarettes regarding the appropriateness of statements released by medical organizations as sourcing for medical content. Arguments have been made that only published review articles can be used, and that tertiary sources are not allowed to be used on Misplaced Pages for medical content. Comments would be appreciated. Yobol (talk) 20:50, 19 February 2015 (UTC)

No one at all is arguing that tertiary sources are not allowed to be used on Misplaced Pages - that is simply a strawman. --Kim D. Petersen 21:50, 19 February 2015 (UTC)

Striked, and corrected. Yobol (talk) 22:05, 19 February 2015 (UTC)

The RFC is asking if sources like Press releases should be used on a medical page for medical claims. AlbinoFerret 22:50, 19 February 2015 (UTC)

Medical and scientific organisations

It was not obvious from the wording of this section that it would also include specialist academic centres of national or international reputation such as Memorial Sloan-Kettering Cancer Center, as well as government bodies and quangos. I have clarified this. Guy (Help!) 17:36, 30 March 2015 (UTC)

I don't think it should. The IARC, EMA, FDA, EPA, ACR, and ACP have dedicated groups that consider data, draw conclusions, and these are vetted before becoming official positions of the orgsnization. MSKCC has no such organized process that I am aware of, and statements "from MSKCC" are likely to be those of individual physicians, vetted only by the hospital press office. Formerly 98 17:50, 30 March 2015 (UTC)

Agree with Formerly 98; statements from individual medical centers' websites can be hit-or-miss as they may not be properly vetted as would a statement from a major medical organization be. This is to say, I view statements from individual centers' websites as borderline; often useful for uncontroversial statements, but better to use higher quality refs for anything remotely controversial. Yobol (talk) 18:11, 30 March 2015 (UTC)

Some academic sources can be reliable but a lot are unreliable. Editors can decide that on the talk page rather than suggesting they are all reliable. QuackGuru (talk) 18:21, 30 March 2015 (UTC)

Right now, editors are asserting that they are blanket not reliable because they aren't listed. In what way is a specialist academic centre of national or international standing, not reliable? Guy (Help!) 23:08, 30 March 2015 (UTC)

Maybe this might work. Proposed wording: "Reputable academic sources may be reliable, depending on the quality of the source." Thoughts. QuackGuru (talk) 00:04, 31 March 2015 (UTC)

It won't work, because those fighting quackery will always find a way to reject a source that does not serve their needs. The only thing that works is a set of pre-defined criteria to separate the reliable from the unreliable. -A1candidate 17:40, 31 March 2015 (UTC)

A list is impossible to manage. Proposed wording: "Reputable academic sources may or may not be reliable. This depends on the quality of the source." If it is carefully worded it might work. I'm not sure the best way to write this. QuackGuru (talk) 17:50, 31 March 2015 (UTC)

If you can't manage a simple list, see WP:CIR and read my previous comment again. -A1candidate 18:10, 31 March 2015 (UTC)

You're either drastically oversimplifying or don't understand all the nuances involved in determining the appropriateness of a particular use of a particular source in a particular context. Zad68 18:27, 31 March 2015 (UTC)

• I have always argued that it would make much more sense to create a separate list of reliable medical sources based on several pre-defined criteria, rather than arbitrarily listing a source as reliable (or unreliable) based on whether it serves the needs of those fighting quackery. The MSKCC definitely is a reliable source due to its status as a designated NCI cancer center, but I could imagine the followers of Gorski and other SBM advocates desperately trying to bring it into disrepute as it speaks favorably about some CAM therapies per prevailing medical consensus. -A1candidate 17:33, 31 March 2015 (UTC)
  • A1, honestly, please knock it off. Zad68 18:27, 31 March 2015 (UTC)

Veterinary medicine

Does, or should, MEDRS cover Veterinary medicine? I have seen twice in the past week editors write that MEDRS may be applicable. I can provide diffs if necessary, but these comments were asides to other discussions, and the main issue here is whether animal health is within or outside of the scope of MEDRS. If this were made explicit, we could avoid future arguments over animal health sources.Dialectric (talk) 23:20, 8 April 2015 (UTC) @Dialectric: can yo provide the diffs in question? Montanabw 19:59, 17 April 2015 (UTC)

There have been some slight discussions on this in the past, but the main one is here: . Personally, I would say yes (or mostly) coming from a veterinary background. The only difference between the field of veterinary medicine and human medicine for us as editors here is that animal models aren't as much of an issue because the animal can be tested directly without the ethical issues of testing humans for certain things (e.g. lethal treatment groups, etc.). Beyond that, what MEDRS describes is pretty much parallel for the medical sciences or really science in general. Reasons why we as editors avoid primary studies for instance are pretty ubiquitous across disciplines. Kingofaces43 (talk) 23:34, 8 April 2015 (UTC)

Thanks for the link - that discussion was a good start. Your bolded question 'Does MEDRS apply to non-human branches of medicine? If not, why?' is similar to what I'm asking here, and there are a few interesting questions raised about the bounds of MEDRS.Dialectric (talk) 04:55, 9 April 2015 (UTC)

I would be against WP:MEDRS as it currently exists being applied to veterinary medicine (vet med). At the moment, WP:MEDRS contains sections called -

1) Avoid over-emphasizing single studies, particularly in vitro or animal studies

2) Use up-to-date evidence (<5 yrs old)

The first will be difficult to apply to vet med for several reasons. Vet Med often depends on single case studies (e.g. surgical techniques, diseases of zoo animals). These are published, but are very unlikely to be subjected to further research; their efficacy is subsequently reported and tested by word of mouth, electronic noticeboards, etc. but not in the scientific media. This first section is also problematic because it advocates not using studies on animals. Of course if a vaccine is being developed for cats, it should be tested on cats. This is a relatively minor point - I think a simple wording of "target species" could cover application to both humans and non-human animals.

Section 2 (up-to-date evidence) is likely to be problematic due to the nature of research in vet med. Once a practice, procedure, whatever, is established, it is extremely difficult to get further funding for this. Therefore, over time, the sources will slip past this 5 year cut-off (where does this come from anyway?). I have never seen guidelines applying a "recency" component to vet med writing.

I am not saying WP:MEDRS can not be applied to vet med, but I feel that as it stands, this would cause problems. For example, the section on suitable sources discusses the strength of experimental design/sources. It states that "meta-analyses of randomized controlled trials (RCTs) are the best design/source". It then describes the other exptl designs almost as if they should be never be cited. They are probably out there somewhere, but I can't ever remember seeing meta-analyses of randomized controlled trials in vet med. Unfortunately, an over zealous editor could quite easily use this to prevent an article from progressing. I also agree as suggested above, it would need to be clearly stated what is the scope of vet med or perhaps even veterinary science. Just thoughts - I hope these help.__DrChrissy (talk) 15:04, 11 April 2015 (UTC)

Not too problematic tweaks indeed. The caveat with 1. is using findings from one species to infer something about another. That's the real meaning of the animal studies point, so it might actually be good to be specific about that anyways. For 2. that's really meant to say use the most recent studies available. 5 years is a decent cut-off in most sciences if reviews come out very often, so it basically means newer than 5 years, if none are available then use the most recent. I don't think availability of reviews is a problem though. I just checked Web of Science for reviews using "veterinary" alone in the last 5 years and got 608 reviews. I have never run into issues finding a review for veterinary topics I'm interested in either. Overall though, the spirit and scope of MEDRS would seem to be appropriate for veterinary med with some slight clarifications, so it would seem simple with slight clarifications. Kingofaces43 (talk) 01:45, 12 April 2015 (UTC)

• Comment: Per the comment above, WP:SCIRS already does apply. I take no position for or against looking at bringing in MEDRS, except that given how some people treat MEDRS with extreme literalness, I'd suggest having a specific subsection for veterinary medicine that addresses the very legitimate concerns that DrChrissy raises. Also, because alternative medicine is more openly accepted in the veterinary world, we may want to note that some things that would not fly in human medicine may be acceptable in a veterinary article (so long as there is adequate sourcing) - for example, many veterinarians also do animal chiropratic medicine or acupuncture. Montanabw 22:39, 12 April 2015 (UTC)

Question The article Specialty (medicine) lists psychiatry as a specialist topic. The Psychiatry article defines this as "the medical specialty devoted to the study, diagnosis, treatment, and prevention of mental disorders." There are analgous processes in the veterinary world. Are people arguing to use WP:MEDRS on articles such as Dog training, Clicker training, Obedience training, Separation anxiety in dogs, etc, etc? This is not a rhetorical question.__DrChrissy (talk) 10:59, 13 April 2015 (UTC)

• I think that animal training is closer to education as an analogous comparison to humans. By and large, I think that falls under a "don't scratch this if it doesn't itch" category. (And if some idiot is arguing for MEDRS, point them to SCRIS instead. Montanabw 05:13, 14 April 2015 (UTC)
  • I agree with you totally. I was thinking more about animal behavioural therapy rather than training per se. My concern here is that imposing WP:MEDRS on Vet Med, especially without carefully defining the topics, will wipe many articles from the project and cause an enormous amount of disruption. For example, the article describing a piece of veterinary medicine equipment, the Elizabethan collar, would not survive even the lightest of touches with WP:MEDRS, but currently reads sufficiently well for the average reader. If people want to get a flavour of articles, perhaps look at the categories pages. states there are 1,072 articles in this category (I have no idea how up-to-date this is). has 22 sub-categories (YIKES! I have just seen Winged cat! That needs to go!)__DrChrissy (talk) 08:40, 14 April 2015 (UTC)

Forgot to reply to this, but for an example like Elizabethan collar I don't really see anywhere that MEDRS would apply. Basic equipment normally doesn't fall under a need peer-reviewed sources. It's when you start getting into details about a specific treatment that you'd really start digging into vet med journal articles. For instance, over at trocar, I wouldn't really think MEDRS sources are needed to describe what it is and what it is used for. How well it actually works for dealing with bloating cattle and survival after using it would be the specific piece of content I'd look for journal articles on. I believe this is how most medical equipment articles are currently handled as well. Kingofaces43 (talk) 00:37, 16 April 2015 (UTC)

A lot of thoughts here, so bear with me. Training type articles would be describing what is done in training and doesn't really fall into the realm of any particular science (I'm not aware of journals covering something like this). That would be equivalent to say an article on human parenting methods where we don't really apply MEDRS per se. Saying whether a particular method is effective really does require scientific studies though. Once you start getting into actual health content though (i.e., diseases, disorders, nutrition, etc.), those are areas where there are plenty of scientific publications where we should be pulling from our best available sources (typically review articles). This is the area I see clearly within the scope of MEDRS because we are pulling from exactly the same kinds of studies in either discipline with the tweaked caveat about extrapolating findings from model organisms to the species of interest (human or otherwise).

That all does start going towards the question I asked here though about SCIRS. After wrestling with that question for awhile I would take the MEDRS approach for obvious health content (i.e. reviews and reputable organizations) because we as editors still should not be interpreting the findings of primary studies. As you move away towards more tangential topics that are not so much about health, but maybe general social behavior of wolves, chickens, etc. you still have scientific research there, so I'd look to SCIRS still looking to secondary sources, but acknowledging we might need to look to the introductions of primary sources in place of formal literature reviews with the cautions that come with that. Behavior is one topic that can straddle the line between MEDRS and SCIRS, so it really depends on what a specific piece of content is about.

So, I would put all of the training articles you listed as generally under SCIRS since there is a mix of topics in play. If one was to comment on how effective training methods are, that’s where I would be looking towards scientific topics specifically, but otherwise general sources are fine for general descriptions. The separation anxiety article would clearly be a health topic though, so I would be looking to journal articles for information there as opposed to people who just write about their ideas on it. The take home message is to pull from our best available sources regardless of MEDRS, SCIRS, etc. labels. Kingofaces43 (talk) 20:04, 14 April 2015 (UTC)

• Question: Why is this even being raised? Is there an actual problem somewhere? Otherwise, we may be discussing solutions in search of a problem! If nothing itches, I advise not scratching. JMO. Montanabw 06:55, 16 April 2015 (UTC)

If you worked on bird, frog, or bee articles, for examples, and the ways that various chemicals may be affecting them, you would understand. IMO. Gandydancer (talk) 07:41, 16 April 2015 (UTC)

I do work on articles like that and I believe User:Montanabw also does (please correct me if I am wrong). Let's talk about the content, rather than the editors, please.__DrChrissy (talk) 08:50, 16 April 2015 (UTC)

To be clear, the editor states: "... the main issue here is whether animal health is within or outside of the scope of MEDRS. If this were made explicit, we could avoid future arguments over animal health sources". Suggestions have been made that MED:RS should apply to animals as well and I am answering to that question. I do work in those areas (bees, etc.) and I have not noted Montana's involvement though certainly I could be wrong. Gandydancer (talk) 13:08, 16 April 2015 (UTC)

My question is if there is an article within the scope of WP:Veterinary medicine where this issue is actually being raised; it should be noted here so that we can be discussing ACTUAL problems and not theoretical ones. @Gandydancer: I work on some articles within the scope of WP:Veterinary medicine (for example, I created Colitis-X, and Parascaris equorum). Knock off the condescension and personal attacks. Montanabw 16:53, 16 April 2015 (UTC)

Good grief, I had no intent of being condescending or attacking you! I always thought that I liked you and the work you do here and I've always considered you to be one of our best editors. I'm aware of the work that you do related to horses. I just wanted to point out that if we begin to insist of MED:RS for animals, animals include the health of birds, bugs, frogs, etc., which have of late seen a lot of connections to the ever increasing use of chemicals and their demise. I've already been told to leave chemical articles by chemists because they are supposed to be about the chemical and not about the way that a chemical is used when it is used as a pesticide and that this or that study is not acceptable because it is not MED:RS approved. I have no intent to argue here and am sorry that I said anything. Gandydancer (talk) 17:14, 16 April 2015 (UTC)

Is there an actual problem in these topics though? We generally rely on reviews to interpret science sources in general (i.e., we're not qualified to assess the actual findings of primary sources). When it comes to chemicals and pesticides, reviews tend to come out pretty often summarizing the literature, so I'm not seeing any particular problems coming around by taking a more MEDRS approach there. The issues with primary journal articles and why we avoid them are generally the same across disciplines, so what distinction are you seeing here Gandydancer? I personally don't see any issues on the pesticide front. Kingofaces43 (talk) 19:00, 16 April 2015 (UTC)

The problem I see here is that adherance to secondary sources has not been as stringent in science articles outside of what is currently covered by WP:MEDRS. In my own editing of animal related articles, I very, very frequently use primary sources. TuT TuT I hear you say ;-). But, I follow with strict 100% adherance that content is verifiable. There would also be a problem with newspaper articles. WP:MEDRS views these as primary sources, but in other subjects they are viewed as secondary sources. In some subjects, newspapers might be the only source of information (e.g. attacks by animals, spread of a disease). I appreciate that in the human medical world it is critically important to have the most robust reporting of the appearance and spread of a new flu virus, but do we need the same adherance to report that "In 2014, an individual of species X was seen in location Y for the first time - as reported in The Guardian"?__DrChrissy 11:32, 17 April 2015 (UTC)

I'll be away from any computer for the weekend, so I'll have to respond a bit more later. The problem with using primary sources is using their results or conclusions. I'm fine with using the introductions carefully when literature reviews aren't available, but we are no in position to use the findings of primary studies. That's the main thrust of MEDRS I'm looking at here. Newspapers articles generally wouldn't be reliable because they don't do a good job reporting on science with respect to research, but mundane things like a dog bite or reports of a disease occurring aren't exactly cutting edge science. There's a big difference between what's within the scope of journals in terms of research, and more basic biology that can be described by any number of sources. For instance, your "MEDRS" example here would be taking MEDRS a bit too far. Most of your secondary source required pieces of content do not need a review because they are just basic biology that are reported on in other acceptable sources such as extension publications, journal article introductions, etc. That's more SCIRS-y kind of content there. Content that requires more in-depth knowledge, such as your "The honey bee's venom . . ." would need some commentary form an outside source more in line with MEDRS though.

Basically, if it's basic biology, we'll have plenty of sources to pull from that are still reliable even if they aren't journal publications. When it comes to describing research that's more in-depth though, primary sources don't really work for us here, and that's where the general concepts behind MEDRS kick in. I'm not sure if you were picking that up reading over that example you made, so is that distinction making a bit more sense now? Kingofaces43 (talk) 17:01, 17 April 2015 (UTC)

Seems to me that WP:SCIRS covers most of what is needed. Montanabw 19:59, 17 April 2015 (UTC)

In that particular case yes. It doesn't really get into the realm of vet med though. Kingofaces43 (talk) 21:07, 17 April 2015 (UTC)

BBC and Brussels Sprouts

I'd appreciate some comment, w.r. WP:MEDRS, on the following reverted edit and its immediate reinstatement . The content was removed with the summary "copyedit; rv WP:PRIMARY research; rv blog sources, WP:RS". This is not PRIMARY research or a blog, it's the BBC providing secondary reporting of it under their imprimatur, just as we look for. Also the Science Daily website, which I'm unfamiliar with, but again it's rather more than "a blog".

Looking at Special:Contributions/Zefr there is a rather obvious pattern here. Bulk removals of sourced content, claiming the sources are inadequate, with plenty of edit-warring to strong arm the changes into place. Looking at Ginger we see where work being published out via PubMed is getting removed as "rv WP:PRIMARY, not WP:MEDRS".

I'm no medic. I have no idea if Zefr is either (their userpage is silent). However I see their pursuit of source pruning as going way beyond any sensible imposition of sourcing policies, particularly when it comes to stripping sources for being too primary alone. That is not the purpose of WP:PRIMARY, when that primary material is being published via the route of credible academic bodies and peer-reviewed journals. Andy Dingley (talk) 22:27, 22 April 2015 (UTC)

Hi Andy Dingley,

BBC News (typical articles, including this one) is an independent source but not a secondary source. A secondary source is an intellectual work that does more than just repeat what someone else says by transforming it through critical analysis. See WP:PRIMARYNEWS for more details (spoiler: it's complicated, because some news sources really are secondaries). WhatamIdoing (talk) 19:40, 27 April 2015 (UTC)

Is Quackwatch a reliable source?

I have recently been editing the Acupuncture article. This has citations to pages posted on the Quackwatch web-site. e.g. I have concerns about whether these pages are a suitable source for a medicine article on Misplaced Pages. I have raised this issue here because in the past I have been told to seek questions about reliability here, rather than the article talk page. I also suspect this might affect other WP articles. These concerns are -

1) (minor concern) The articles are well out of date - considerably older than the MEDRS rule-of-thumb of more recent than 5 years old.

2) The articles appear to be blogs - they are attributed to a single author and therefore represent only the opinion of this one individual.

3) The articles may or may not be peer-reviewed. The FAQs on the Quackwatch website states "Are your articles peer-reviewed? It depends on the nature of the article and how confident I am that I understand the subject in detail. Most articles that discuss the scientific basis (or lack of scientific basis) of health claims are reviewed by at least one relevant expert. Some are reviewed by many experts. News articles are not usually reviewed prior to posting" So, how do we know which articles have been peer-reviwed and which have not?

My question is simple - are articles on the Quackwatch web-site reliable sources?

1. Stephen Barrett (March 9, 2006). "Massage Therapy: Riddled with Quackery". Quackwatch.
2. Barrett, S (30 December 2007). "Be Wary of Acupuncture, Qigong, and "Chinese Medicine"". Quackwatch. Archived from the original on 29 September 2010. Retrieved 3 November 2010.

DrChrissy 11:31, 27 April 2015 (UTC)

It depends on context. For example, a statement like Acupressure is oftentimes described as "acupuncture without needles" does not need a top MEDRS (is there any doubt about that statement?), and WP:PARITY tells us that Quackwatch is fine for commentary on Traditional Chinese medicine. Johnuniq (talk) 12:01, 27 April 2015 (UTC)

WOW! I have not come across that one before. It states "In an article on a fringe topic, if a notable fringe theory is primarily described by amateurs and self-published texts, verifiable and reliable criticism of the fringe theory need not be published in a peer reviewed journal." So, if someone uses a really rubbish reference to support a fringe medical practice, this can be discredited by an equally rubbish reference? This really does not sound like the principles of high quality sources behind WP:MEDRS.DrChrissy 12:42, 27 April 2015 (UTC)

It's focused around the idea that fringe content typically is ignored in publications by definition. It's not saying we use rubbish sources, but just acknowledging that if we need to describe a fringe piece of content, it's not afforded time in what we consider out most reliable sources. Without parity, fringe content can sneak it's way in through a deluge of books, blogs, etc. when they are considered semi-reliable sources, while scientific literature ignores what happens in that realm. It can be easy to create undue weight for re fringe theory without this in mind, so that's what parity is really trying to get at. Kingofaces43 (talk) 13:05, 27 April 2015 (UTC)

Yes, I can see that. But returning to the Acupunture article, surely there are more robust (and recent) sources than what appear to be articles on the opinions of just one medic?DrChrissy 13:10, 27 April 2015 (UTC)

If there are such sources that address a specific piece of content, then by all means use those instead. Parity just helps give a baseline in dealing with fringe content, especially in context to how quickly fringe claims can be generated and the sheer number of them that scientific publications don't really deal with that well for our purposes. If a better source accomplishes ascribing due weight about a fringe view, that's what should be used. Kingofaces43 (talk) 13:55, 27 April 2015 (UTC)

Thanks for that, I appreciate the explanation. I can't but help feel that this parity concept rather lowers the high bar that WP:MEDRS states it wishes to achieve. If as a reader I was to look at the Acupuncture article, I think I would expect a higher quality of medical article as a source being used to debunk the practice. Perhaps parity leads to rather lazy editing - the fringe practice is quickly debunked by a low quality source, but nobody goes back to replace this source with one of higher quality.DrChrissy 14:05, 27 April 2015 (UTC)

From the way I understand things, claims like Acupressure is oftentimes described as "acupuncture without needles" could conceivably be sourced by Quackwatch if nothing else is available, but it would best be sourced by textbooks or other high quality sources, and there are plenty of sources other than Quackwatch that define acupressure. Why don't we use those instead? Quackwatch is clearly not a MEDRS source, so we cannot use for medical claims. I don't have a problem with using it for some claims, like claims about what acupuncture skeptics believe, but statements like TCM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care. I'm not sure Quackwatch is reliable enough to state what the scientific community does and does not believe, as a whole, or what TCM believes, as a whole, since Quackwatch is clearly a partisan source. If the FDA or the NIH or TCM bodies made claims like this, that would be reliable. But not only does this statement exist on the acupuncture page, it's in block quotes! So not only is it unreliable in this particular instance, it's also a weight problem because we're block quoting it, giving it a stage, lights and a megaphone. LesVegas (talk) 16:11, 27 April 2015 (UTC)

As a side note, I wonder if any editors happen to be connected to Quackwatch in some way? To use Quackwatch as a source to define acupressure is a little strange, and almost seems like some editors are trying to get a backlink for Quackwatch to help in SEO. I would hate to think that is the case. I might have to look into this further. LesVegas (talk) 19:05, 27 April 2015 (UTC)

You don't need to worry about search engine optimization, because links in Misplaced Pages have the "nofollow" attribute set. Search engines ignore them, so they do not help with SEO efforts. (Plain old spam still works, though: if you post your link to a high-traffic article, people might still click on it.) People who cite it are either looking for something easy and free, or because it aligns with their deeply held POVs. WhatamIdoing (talk) 19:58, 27 April 2015 (UTC)

I wonder if it is worth pointing out at this juncture that it would be equally correct to say that acupressure is often characterized as delusional nonsense? There being no such things as meridians, qi and such. It has even less prior plausibility than acupuncture, but at least you probably won't end up with cardiac tamponade or sepsis I guess. Guy (Help!) 08:14, 28 April 2015 (UTC)

If would not be worth pointing it out, because it is factually wrong. Acupressure is not "often" characterized as delusional nonsense. Only a very small minority of rather strident sources choose inflammatory characterizations like that. acupressure "delusional nonsense" gives me just 30 ghits, and if you exclude blogs and reader comments, it's almost zero. It's much more common for reliable, non-self-published, non-activist sources to say that it's really no different from any other type of massage, and might provide some temporary pain relief or a relaxation effect. WhatamIdoing (talk) 22:50, 28 April 2015 (UTC)

I have some reservations about PARITY. More precisely, I have some reservations about how PARITY is (mis)used on occasion. It seems to be used and presented to making angry, pointed statements. We rarely see something neutrally phrased, like "Critics like Quackwatch say this doesn't work". Instead, the statements tend to say things like "Critics like Quackwatch say that this is 'irrational pseudoscience-y quackery performed by evil charlatans on unsuspecting innocents'".

In an ideal world, we would cite Quackwatch (and all similar websites, regardless of POV) approximately never. If a source can be found that either is more academic in nature (any journal, even a minor one) or has better editorial control (any newspaper or magazine), then we should use that other source instead.

NB that I advocate replacing Quackwatch with more formal sources (see WP:NOTGOODSOURCE for a list of criteria to consider). I do not advocating blanking any barely reliable source and leaving the material unsourced. It's better to cite Quackwatch for its views than to cite nothing for views held by Quackwatch (and others). WhatamIdoing (talk) 19:58, 27 April 2015 (UTC)

I agree very much with excluding sources attributable to Quackwatch, however, I disagree with "It's better to cite Quackwatch for its views than to cite nothing for views held by Quackwatch (and others)" If we use that argument, we should be allowing sources by PETA or the Animal Liberation Front to stand.DrChrissy 20:42, 27 April 2015 (UTC)

We will not be excluding Quackwatch from Misplaced Pages, it has been time and again found to be useful and reliable in certain circumstances, but especially as a WP:PARITY source when better sources are not available. How reliable it is depends, as with all reliability questions, on context of what text it is being sourced to. Yobol (talk) 20:47, 27 April 2015 (UTC)

OK...users citing WP:MEDRS as the spine of all that is good in medical articles are now supporting the inclusion of non-peer reviewed, opinion articles. No wonder Misplaced Pages has the bad name that it does.DrChrissy 20:53, 27 April 2015 (UTC)

@Yobol Please could you provide links to where this has been discussed before. DrChrissy 20:58, 27 April 2015 (UTC)

Extensively discussed at WP:RSN, see here. Note that we do not take any individual policy or guideline (whether it be MEDRS or NPOV or OR or RS, etc) in isolation, but apply them together to determine what goes in a Misplaced Pages article. There is no contradiction in using WP:MEDRS when appropriate and WP:FRINGE when appropriate. Yobol (talk) 21:13, 27 April 2015 (UTC)

• If the topic is "acupuncture", then we should not really be relying on Quackwatch since there are numerous better-quality sources available. On the other hand, for obscure forms of charlatanry, Quackwatch may be the best available source, and so if we feel compelled to maintain articles on such topics then Quackwatch may in fact be the most reliable source available. The main point here is that reliability depends on context. MastCell  21:16, 27 April 2015 (UTC)

Sorry to keep banging on about this, but how can a source that is not peer-reviewed ever be considered to be a suitable source for a medical article? It flies completely in the face of good editing and the purported high standards of WP:MEDRS editing. Would there be a problem tagging all citations of Quackwatch as "potentially not peer-reviewed"?DrChrissy 21:42, 27 April 2015 (UTC)

WhatamIdoing, so let me give you a real-world scenario where we were just having a discussion on the acupuncture talk page here where an editor found a statement from a textbook published by the Royal Society of Chemistry that directly contradicts Quackwatch. So in that case, you think it's best if we use the much more reliable source and delete Quackwatch as a source in that particular instance? What about using Quackwatch as a source for what skeptics say, provided that we don't give skeptics more weight than they deserve? It seems to me like that would be a reasonable instance where we would use it; other instances not so much. And as for the backlinks, you're right, Misplaced Pages links are no follow. That doesn't mean they don't generate web-traffic from articles as you said. I mean, really, it makes me wonder when we're defining acupressure with a QuackWatch source. Then again, maybe that's the only source some editors around here read so they wouldn't know better sources actually do exist in this universe for claims like that. LesVegas (talk) 21:32, 27 April 2015 (UTC)

Quackwatch is a reliable source for commentary on claims in the supplements, alternative and complementary medicine (SCAM) industry. It is cited by other reliable sources, the U.S. Department of Health and Human Services Science Panel on Interactive Communication and Health characterised it as a credible source, the American Cancer Society endorse it and so on. This is all in the Quackwatch article.

Obviously it is unpopular with the SCAM industry, but we must always remember Ersnt's Law: if you are investigating alternative medicine and the quacks don't hate you, then you're not doing your job.

I presume this question is motivated by your ongoing campaign to sanitise critical material form the article on acupuncture? Guy (Help!) 08:09, 28 April 2015 (UTC)

I presume this question is directed at me. As I have made clear above, the reason I started this thread is because I believe (and continue to believe) that non-peer reviewed, single-author, opinion articles do not belong in medical articles. It would be the height of futility to try to sanitise an article of material by starting this thread. The Quackwatch articles are so old I am certain more recent, peer-reviewed articles exist, but perhaps the "medics" like Quackwatch because it provides lovely cherries for them to pick.DrChrissy 08:46, 28 April 2015 (UTC)

And I question why you have suddenly pitched up at a mature article and set about removing sources that you denigrate as not meeting our standards, all of which, purely coincidentally, appear to cast doubt on the elaborate charade that is Maoist acupuncture. Some of us have been aorund Misplaced Pages's alt med articles for a very long time, and I'm afraid this gives me a bad case of déjà-moo. I freely acknowledge deep cynicism here. Barrett is a source cited by major national institutions, and is a perfectly valid source where used int hat article - you will not find papers in the learned journals saying that acupuncture is implausible nonsense and why, because it's obvious and doesn't need to be stated, scientifically, but this is an encyclopaedia article so it does need sources written for the general reader discussing the many and varied problems with alternatives to medicine. Guy (Help!) 21:32, 28 April 2015 (UTC)

_{Guy, are you sure you didn't mean "déjà-woo"? Atsme☯ 22:42, 28 April 2015 (UTC)}

Have you guys not thought that perhaps the reason that this issue is rearing its head again is because new editors come along and have the same concerns? Perhaps you really need to have a look at this WP:Parity concept. It seems absolutely ridiculous that intelligent people should argue "let's fight rubbish with rubbish"...surely if the evidence is that convincing, replace the very low quality primary source of Quackwatch with a decent secondary source and we can all go our separate ways satisfied. Is there not a single editor out there willing to take responsibility and put in suitable RS references ...or do you all just prefer to sit around insulting anyone who might question your dogma.DrChrissy 22:02, 28 April 2015 (UTC)

LesVegas, all sources are reliable for some statements, and all sources are unreliable for other statements. Your actual problem is with WP:DUE weight, not with reliability, and the policy at WP:YESPOV is pretty clear on how to handle it. WhatamIdoing (talk) 22:45, 28 April 2015 (UTC)

A convenient little break

• I have always argued that it would make much more sense to create a separate list of reliable medical sources based on several pre-defined criteria, rather than arbitrarily listing a source as reliable (or unreliable) based on whether it serves the needs of those fighting quackery. QW definitely is an unreliable source due to its status as a non-peer reviewed, self-published blog, but I could imagine the followers of Gorski and other SBM advocates desperately trying to push any source that opposes CAM therapies against prevailing medical consensus. -A1candidate 22:21, 28 April 2015 (UTC) (UTC)
  • It's impossible to make such a list, because reliability depends upon context. You could create a list of sources that meet most or all of the typical objective criteria (see WP:NOTGOODSOURCE for a bulleted list; Quackwatch meets three of the five), but that wouldn't help you determine whether a source is "reliable", because "reliable" is actually shorthand for "reliable for the specific statement being made in the article", not "reliable in general". Furthermore, even a source that is reliable might not be WP:DUE. WhatamIdoing (talk) 22:45, 28 April 2015 (UTC)
    • I agree, which is a large reason why I wrote the essay on identifying primary and secondary sources; an individual source may contain both primary and secondary content. However, Quackwatch articles are not (may not be) peer-reviewed. To my mind, this puts them way at the bottom of reliable sources for any article on WP, let alone medical articles for which we purport to have the highest standards. There really should be a ban on using these single-authored opinion articles.DrChrissy 22:55, 28 April 2015 (UTC)
    • The context is obviously within the realm of the Great Battle against Quackery, as the OP clearly indicated.

      Unreliable - All self-published Internet blogs participating in the Great Battle against Quackery including QuackWatch, SBM, "New England Skeptical Society", Committee for Skeptical Inquiry, Quackometer, Dcscience.net, The Nightingale Collaboration, xkcd.com, Orac's Respectful Insolence, and other advocacy sites. The personal blogs of actual CAM researchers such as Edzard Ernst and Ben Goldacre might be okay, but these should be used with caution if there are no better sources.

      Reliable - All major medical societies, reputable journals, widely used medical textbooks and reference works.

In other words, MEDRS is reliable. Non-MEDRS is unreliable, but many editors participating in this discussion are unable to accept the core policies and guidelines of MEDRS, so it makes the list necessary.

-A1candidate 23:16, 28 April 2015 (UTC)

User:WhatamIdoing User: A1candidate User: DrChrissy I'm afraid A1Candidate is right that proponents of Quackwatch will keep pushing for spamming or shoehorning it everywhere unless there's hard rules. But WhatamIdoing is right in that there are cases, albeit rare ones, where Quackwatch is a reasonable source. Or, as MastCell said, in cases of clear cut yet obscure quack remedies where it's the only reliable source. Perhaps the best way to end this perpetual standoff with diehard proponents of Quackwatch would be an RfC where we ask if the source is appropriate to use in condition x, condition y, and so on. Then proponents will have to live with the outcome across Misplaced Pages's articles instead of engaging in a constant knee-jerk revert of its removal. Would it be best to do the RfC here, since it's used on medical articles or would it be better elsewhere? And what would the reliability circumstances be? I'm thinking along the lines of "Is Qw reliable as a MEDRS?" "Is it reliable for claims of scientific consensus?", "is it reliable if it contradicts a statement by a government health body?", "is it weighty enough for parity if it is up against a peer reviewed medical journal?", and so on. LesVegas (talk) 00:34, 29 April 2015 (UTC)

Of course, if there is a more direct option I'm all for that as well. If our policies are already clear enough I'm all for removing Quackwatch where it's a violation and reporting those that edit war it back in, but my experience thus far has been that they're let off with light warnings only to do it over and again. LesVegas (talk) 00:48, 29 April 2015 (UTC)

Asking whether Quackwatch is reliable is not a useful question. It's like asking whether a particular piece of software is good. The only accurate answer is "it depends", and the answer you'll probably get is "yes, Quackwatch is always 100% reliable for everything" (which is factually wrong).

A more useful question would be something like "Is Quackwatch.com a {{better source}} than a (this particular peer-reviewed journal article, a book published by an academic press, etc.) for (this particular statement)?" The question isn't how to get Quackwatch's POV out of the article. It's how to fairly represent all of the POVs, including the skeptic's POV. WhatamIdoing (talk) 01:56, 29 April 2015 (UTC)

So you think the only way to remove it via an RfC would be on a case by case basis with specific examples and not broader generalities or abstractions, like those I suggested? That would take forever, 1000's of RfC's as many times as it's poorly cited! It seems like there has to be a better way. Surely this encyclopedia isn't THAT broken, is it? LesVegas (talk) 02:27, 29 April 2015 (UTC)

On a case by case basis has always been the decision in RfCs and ArbCom decisions about the use of Quackwatch, just like any other source. It's a highly respected mainstream source. It's not a blog. It has a large group of experts used to vet its content, even when the article might happen to be signed by Barrett. It is not generally used for MEDRS content, but for the opinions of skeptics and medical experts on the topics of alternative medicine, health fraud, etc..

It is hated by pushers of pseudoscience, and thus any editor who opposes its proper use reveals their intentions, and those intentions are contrary to Misplaced Pages's aspirations to be a mainstream, scientifically reliable, encyclopedia. I suggest you read the many discussions about its use here. Several are listed at the top of Talk:Quackwatch.

BTW, MEDRS applies to specific types of content in ALL articles, and never to entire articles. Well-written medical articles, especially about controversial subjects, will contain a blend of MEDRS sourced content, popular RS content, and subject expert/skeptical content which documents the controversies. The latter will use QW and similar sources. -- BullRangifer (talk) 03:20, 29 April 2015 (UTC)

I agree with WhatamIdoing above, but I have to add that for claims on medical efficiency, QuackWatch really should not be used. This works in both ways, though: any claim by fringe sources on medical claims should not be accepted unless it's accepted by a MEDRS compliant source. And when it's accepted by a MEDRS compliant source, where do we need the fringe source anyway? The same goes with QuackWatch.

As said above, there might be some fringe topics that are not paid enough attention to by the mainstream academic research. For these instances, QuackWatch might serve as a reliable source, but only on case-by-case basis. As far as I am concerned, the very topic has been discussed at Talk:Acupuncture more than once, and this was the conclusion.Jayaguru-Shishya (talk) 16:09, 29 April 2015 (UTC)

The mainstream sources in academic world are the peer-reviewed ones, those where any ambitious academic tries to get his work published. QuackWatch is a blog (and blogs naturally cannot be peer reviewed), and therefore I hardly find it as a "respected mainstream source". It's a website, a blog. However, I agree with BullRangifer that it can be helpful in some marginal cases, but should not be used with claim on medical efficiency. Marginal sources like QuackQWatch should only be used when the subject area is also marginal enough not to catch any wider academic attention. Jayaguru-Shishya (talk) 16:13, 29 April 2015 (UTC)

@BullRangifer: Please excuse this intrusion into the main topic of this thread. I totally agree with your summary above of what a well-written medical article should contain. However, this is not what is happening! Please look at the recent edits on Acupuncture. I introduced a tertiary source summarising multiple Cochrane reports on human studies of acupuncture. The source has been thrown out...because the summary was published in a veterinary handbook! Furthermore, I have researched acupuncture in (non-human) animals and written a brief section into Acupuncture titled "veterinary acupuncture". This has now been labelled in an edit summary as "See WP:COATRACK. There should be only one sentence at the end of Acupuncture#Related practices. Some of the text is misleading and poorly sourced. See WP:MEDRS." There are editors out there who are so insistent on POV that they are seriously threatening the perceived standard of medical editing in the project.DrChrissy 10:49, 29 April 2015 (UTC)

BullRangifer, you seem to know quite a bit about the history of Quackwatch on this encyclopedia. As you said, Quackwatch is undoubtedly reliable for some claims and unreliable for other claims. Has it ever been discussed as to whether or not Quackwatch is reliable enough to make claims about scientific consensus, or at least what broad scientific opinion is on a subject? Or has it ever been discussed as to whether or not it should be used for parity purposes against claims made by MEDRS sources? Or even, do you know if there been any discussion on whether or not the stronger claims made by Quackwatch should be attributed? I'm mostly curious if the discussion has delved this deeply, or if it's been more binary in nature. LesVegas (talk) 04:04, 29 April 2015 (UTC)

It's been some time since I did any research about QW. I once contributed quite a bit to the article and learned a lot in the process. I don't know of any cases where QW has been proven unreliable, at least not in any serious manner. That's just a claim we often hear, and the claimants never back up their claims. On further examination, they are wrong, usually because they are parroting unreliable sources like Natural News, Mercola, NVIC, etc.. Their sources are often blacklisted here, they are that unreliable!

The discussions aren't fresh in my mind. I'm pretty sure they have gone much deeper than a binary discussion. The statements and POV expressed on QW are usually sourced, and they are therefore always in harmony with scientific evidence, where it exists. When it doesn't exist, then that's what QW says. Many articles and much content are not written by Barrett. QW amounts to a huge database. I have always been amaze at what one can find there. There are many government documents and research unavailable elsewhere. There are some areas where Barrett has sided with some forms of herbal therapy as being potentially useful, but the evidence base might not be enough for us to make such a case using MEDRS compliant sources. That would just be his opinion, and we can't use that for such content. If there is ever any serious disagreement with MEDRS sources, we would use them. If the QW opinion was still significant, it would be attributed as such.

I have always favored attribution when there might be any doubt. If an opinion is clearly allied with mainstream science, attribution may not be necessary, but otherwise it's often a good idea. -- BullRangifer (talk) 04:26, 29 April 2015 (UTC)

LesVegas, it wouldn't take thousands of discussions. It might take dozens. It's only linked in about a hundred articles.

BullRangifer, Quackwatch isn't really a "highly respected" source. It's a popular source, particularly among people who hold a particular POV about altmed (just like Fox News is particularly popular among people who hold a particular POV about American politics). There's a difference. Quackwatch is like Snopes.com: it's fine as far as it goes, but it has nowhere near the level of respect that a good peer-reviewed paper or a book published by a university press deserves. WhatamIdoing (talk) 04:36, 29 April 2015 (UTC)

I would agree that they serve very different functions, and thus enjoy different types of respect. QW is a specialty site which has won many awards, and your comparison to SNOPES is quite appropriate. It's highly respected as a consumer protection, false health claims debunking, site, and is usually listed in university, library, medical, and governmental sources as a consumer protection resource. It's the largest and most well-known of its kind. -- BullRangifer (talk) 14:24, 29 April 2015 (UTC)

I agree, the reliability depends on the context. When it comes ot claims on medical efficiency, QuackWatch doesn't really meet the requirements. After all, it's a non-peer reviewed, self-published blog. Acupuncture, however, is a largely studied subject, and there sure are better sources available. There's been discussions over this at Talk:Acupuncture, and the consensus has been that QuackWatch is not reliable per se, but should only be used on case-by-case basis. Oh... Guy, you stated that: "you will not find papers in the learned journals saying that acupuncture is implausible nonsense and why, because it's obvious and doesn't need to be stated, scientifically". Exactly, that's why we don't include such things in Misplaced Pages. Cheers! Jayaguru-Shishya (talk) 16:05, 29 April 2015 (UTC)

If QW is not reiable, it is not reliable. How can context suddenly make it reliable? ...unless of course it suits those who like to pick cherries.DrChrissy 19:38, 29 April 2015 (UTC)

I'm losing patience with you a little bit, because people have repeatedly explained how context matters. Hell, it's explicitly written into our guidelines: Proper sourcing always depends on context (emphasis in original). We even have a handy policy shortcut: WP:CONTEXTMATTERS. Start by reviewing those, and by re-reading the responses you've gotten here, and then maybe drop the belligerent tone and try again if you're still confused about context. MastCell  21:57, 29 April 2015 (UTC)

Not sure where you think I am being belligerent, but in future, please refrain from comments on the editor and stick to comments on the content - OK?DrChrissy 22:21, 29 April 2015 (UTC)

Of course context matters. I have just written an essay showing just that.Misplaced Pages:Identifying primary and secondary sources for biology articles. But what if a source is so totally rubbish that it should not be used in any context? Please realise that you are arguing Misplaced Pages should include in its top medical articles, sources that are not peer-reviewed and perhaps a single-author opinion piece. I for one would not be prepared to put my editorial name to inclusion of such low grade information. Use it at your peril - the standards of Misplaced Pages medical articles continue to plummet...DrChrissy 22:31, 29 April 2015 (UTC)

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