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Process

Hi MastCell. I responded a bit impulsively today in the heat of the moment in the thread that alleges misrepresentation of sources. I sort of wish now that I'd held off, since I really appreciate your suggestion that we get back to the process we started. I think that's a good suggestion. TimidGuy (talk) 00:29, 29 April 2013 (UTC)

OK. But since you're here, I want to ask you something. Our content on the purported health benefits of Transcendental Meditation is heavily influenced by editors affiliated with the TM movement. Do you think that raises questions about bias (either conscious or unconscious) in our coverage? I think the best practice (one that is recommended, but not demanded, by WP:COI) would be for editors with close connections to the movement to participate in talkpage discussion, but for independent, unaffiliated editors to manage the actual editing of article content.

I'm not a big fan of analogies, but let's say that our coverage of an antihypertensive drug from Merck were dominated by a small group of single-purpose accounts closely affiliated with Merck. That situation would rightly raise concerns about our ability to present accurate and unbiased medical information. I see a similar problem on the TM articles, at least as far as they intersect with medical claims. Do you?

Finally, I'm sort of disappointed in the lack of restraint shown by TM-affiliated editors. Frankly, there are a number of Misplaced Pages articles, both medical and biographical, which I avoid because I want to manage any potential conflicts of interest on my part. These are areas where I believe I could undoubtedly improve our coverage, but I recognize that my connections (which are not financial, but rather personal or professional) would potentially bias me. So I don't edit those articles, as a simple but healthy form of self-restraint. I sort of wish that some level of introspection would take place here so that people wouldn't need to beat the drum confrontationally about it. MastCell  17:53, 29 April 2013 (UTC)

Explanation for RfC post..

I think perhaps you misunderstood my statement but I appreciate your invitation to discuss it elsewhere. I hope it's ok here. My superscript is interspersed:

• : I stated: We've seen the malpractice often enough in cases like Michael Jackson, etc. but what about the following NPR report? Things keep getting crazier.
• : You replied, Yes, you're proving my point. Michael Jackson's treatment was grossly negligent and his physician lost his license as a result. He's an outlier who transgressed his fundamental professional responsibilities. To point to him is analogous to saying that the actions of Andreas Lubitz invalidate the entire profession of commercial airline piloting. Malpractice, by its definition, implies that there is a professional standard of care to which physicians must adhere, and physicians are punished if they fail to uphold these standards. I'm not aware of any such concept, nor any such level of regulation, in homeopathy, for instance. Off-label prescription is a complex topic which I think you've grossly oversimplified, but I'd be happy to discuss it elsewhere. MastCell Talk 12:05 pm, Today (UTC−4)

As an old school journalist/writer (before the pundits inundated the internet, well actually before the internet) I believed journalistic integrity was of the utmost importance. I also employed a common sense realist approach that was surpassed only by my skepticism. Sorry, but I cannot turn a blind eye to the fact that the legal profession and insurance industry built empires on medical malpractice. You focused only on the MJ case which, on the flip side, was a gross oversimplification but let's just chalk it off to brevity and be done with it. I'm not trying to lessen the importance of science or mainstream medical opinion, the latter of which was actually one of my beefs with a few editors who kept misrepresenting my intent. However, we cannot ignore the fact that big pharma dangles (💰) in front of medical practitioners and researchers all the time. They are also relentless in their attempts to bypass laws and the FDA which was part of my reason for including the off-label prescription article. The number of times big pharma has been convicted and fined for illegal activity is also significant but none of this is really in my area of interest. The world has changed and values we once held in the highest regard, such as journalistic integrity and the Hippocratic Oath, have all but fallen by the wayside, . Granted, alternative medicine practitioners don't undergo the extensive schooling and training of MDs but they do have some licensing and regulatory requirements as exampled below:

• In all 50 states and the District of Columbia, chiropractors must be an accredited Doctor of Chiropractic (D.C.) and must pass special state exams, exams administered by the NBCE, or both.
• Only 17 states and the District of Columbia license naturopathic physicians. In general, licensure requires graduating from an accredited 4-year naturopathic school and passing a postdoctoral board examination.
• Most states regulate massage therapists by requiring a license, registration, or certification. However training standards and requirements for massage therapists vary greatly by state and locality, but most states that regulate massage therapists require a minimum of 500 hours of training.

Your comment about professional standards and the like is what led me to this information. Atsme 22:35, 12 May 2015 (UTC)

If you were agreeing with me, I must have misunderstood your comment. Regarding the medical malpractice system in the US, it is deeply flawed on pretty much every level. At the same time, it is the only real mechanism for people to seek redress if they're harmed by medical care. So I'm always suspicious of "tort reform" proposals which limit the ability to sue without providing some alternate means of redress. There have been sporadic efforts to do things better; the example I'm most familiar with is the so-called "Michigan model", initially developed at the University of Michigan.

Reminding me that the pharmaceutical industry expends immense resources to influence physicians is like reminding me that the Sun rises in the east every day. I'm well aware of that fact—much more so than most of the people who bloviate about Big Pharma on this site—so there's no need to try to convince me. The pharmaceutical industry's track record is atrocious—if you're interested, recommended reading would include White Coat, Black Hat by Carl Elliott and Bad Pharma by Ben Goldacre. But usually, when people bring this up in the context you've done, they're implicitly trying to make the point that we should look more favorably on "natural" remedies. After all, you brought up the evils of Big Pharma in response to my attempt to draw a distinction between physicians and homeopaths. Right?

So put on your critical-thinking hat for a moment. Alt-med is a $33 billion industry in the US. The top-selling dietary supplements often generate as much revenue as widely used pharmaceuticals. The difference, of course, is that the alt-med industry (in particular, the supplements industry) operates with zero regulatory oversight. As bad as pharma can be, they have to spend the money to develop and test a compound and prove its efficacy and safety before they can make a dime. In contrast, there is no requirement that dietary supplements are shown to be safe or effective. There isn't even a requirement that the supplement actually contains any active ingredient (many don't). So I think it's completely legit—and in fact essential—to critique the pharmaceutical industry, but if you want to claim the mantle of critical thinking, "integrity", "common-sense", "realist", "skeptic", etc. then you need to apply the same level of scrutiny to the alt-med industry. And trust me, it will fare even more poorly than Big Pharma.

Off-label prescribing is a complex issue. To take one example, there are, to my knowledge, no drugs that are FDA-approved for use in bone marrow tranpslantation. None. So every drug used in a bone marrow transplant is being used off-label. Now, these drugs have a track record and extensive medical evidence supports their use, but the manufacturers have not sought nor has the FDA granted an approval. If not for off-label prescribing, we in the US would have to stop doing bone marrow transplants until a lengthy, expensive, and completely redundant and unnecessary approval process could play out. People would be harmed and resources would be squandered. So in this instance, off-label prescribing is operating as intended, by allowing physicians to use their judgement and the medical literature to use approved drugs off-label. Off-label prescribing is not always simply a matter of greed and abusiveness, and to present it as such is incredibly simplistic and misguided. MastCell  17:56, 13 May 2015 (UTC)

My preferred model is to treat them all alike: if most people who buy and take X are trying to prevent or treat a medical condition, then it's a drug for regulatory purpose. It doesn't matter if it's "natural" like Premarin or "synthetic" like most Vitamin C pills, or how the company marketed it: how people use it should determine regulatory status. WhatamIdoing (talk) 21:13, 13 May 2015 (UTC)

Hopefully this isn't considered bloviating, but FDA-approved and regulated drugs are the fourth leading cause of death in the U.S. - and that's when taken according to doctors' orders. From Harvard:

Few people know that new prescription drugs have a 1 in 5 chance of causing serious reactions after they have been approved. That is why expert physicians recommend not taking new drugs for at least five years unless patients have first tried better-established options, and have the need to do so.

Few know that systematic reviews of hospital charts found that even properly prescribed drugs (aside from misprescribing, overdosing, or self-prescribing) cause about 1.9 million hospitalizations a year. Another 840,000 hospitalized patients are given drugs that cause serious adverse reactions for a total of 2.74 million serious adverse drug reactions. About 128,000 people die from drugs prescribed to them. This makes prescription drugs a major health risk, ranking 4th with stroke as a leading cause of death. The European Commission estimates that adverse reactions from prescription drugs cause 200,000 deaths; so together, about 328,000 patients in the U.S. and Europe die from prescription drugs each year. The FDA does not acknowledge these facts and instead gathers a small fraction of the cases.

Why does WP reserve its heavy duty skepticism for alt med drugs? Besides potentially cutting into pharma profits, are they more dangerous than those we've been told are safe? I love healthy skepticism, but it isn't healthy unless applied with a NPOV showing no favoritism. petrarchan47คุก 18:23, 15 May 2015 (UTC)

@Petrarchan47: Not bloviating at all; thanks for your comment. I agree with the statement about newly approved drugs. When a drug is approved, it has typically been tested in several hundred patients. Some of the most serious side effects of many drugs occur at rates of 1% or less, so it is unlikely that they'll be identified with that sort of sample size. In contrast, if a drug is used by 1 million people annually and has a serious adverse event risk of 0.1%, then you'll have 1,000 serious adverse events a year. That sort of signal is much easier to identify. So yes, I share the recommendation that it is unwise to jump on a newly approved medication unless there are no good alternatives, because it likely takes years of post-marketing surveillance before side-effect profiles are fully understood. But do you see the underlying problem? How do you identify rare but serious side effects that occur in 1-in-1,000 or 1-in-10,000 without exposing millions of people to a medication? I mean, this isn't solely a matter of greedy doctors and evil drug companies; it is a serious challenge.

The question of drug-related hospitalizations and deaths is a tricky one, in my view, and my experience leads me to discount gaudy numbers or black-and-white thinking. To take one hypothetical example: suppose a person has atrial fibrillation, a relatively common arrhythmia which predisposes to the formation of blood clots in the heart and subsequent strokes. We know that the stroke risk can be reduced by treating people with anticoagulants, but these drugs obviously carry a risk of bleeding. The risk/benefit ratio has been worked out relatively well, so we can say with some confidence that if we anticoagulate 100 people with high-risk A-fib, we are helping them in aggregate because there will be more strokes prevented than bleeding events caused. But when an individual patient on a blood thinner falls, hits his head, and develops a fatal intracranial bleed, that person is chalked up as a casualty of the medical-industrial complex, greedy docs, Western medicine, and so on—even though his treatment was correct based on the current state of human knowledge. (In contrast, if he'd gone without anticoagulation and had a fatal stroke, it would be viewed as an unfortunate but natural occurrence, even though he was technically a victim of malpractice). Contrary to the piece you quote, I think that both the FDA and many physicians acknowledge these realities, but a lot of other commentators don't.

To repeat a book recommendation above, I'd strongly recommend you check out White Coat, Black Hat by Carl Elliott. He's an ethicist (and non-practicing physician) at the U. of Minnesota, and he writes thoughtfully and very critically about academic medicine, the pharmaceutical industry, and the relationship between the two. (He's also currently supporting an investigation of his own university for ethical violations in psychiatric clinical trials, which is an interesting and sad story in its own right). I think you'd find what he has to say congenial and thought-provoking. MastCell  18:46, 15 May 2015 (UTC)

I remember when remoxipride came out - had a really good side effect profile and patients tolerated it well...aaaand then it disappeared quick-smart because of its side effect of aplastic anaemia....Cas Liber (talk · contribs) 21:37, 15 May 2015 (UTC)

My mother was killed by Vioxx. Just sayin'. The idea that all science editors are pro-drug schills, anti-alt-anything, and all alike is just pig-headed. I've done plenty of quackery in my time ! More importantly, Cas, did you get the morchella pics ? SandyGeorgia (Talk) 21:42, 15 May 2015 (UTC)

Yes I did - they were very nice and I am jealous. I am sure they tasted nice too.....Cas Liber (talk · contribs) 00:15, 16 May 2015 (UTC)

@MastCell, as always, I so appreciated your measured, informative response. @Sandy, after some time away I've come back, realizing that I expected too much of WP editors, and of WP as a whole. We are all imperfect and full of our own innate POV, with our personal histories playing a large role in the way we view the world, and ultimately how we edit. There are indeed editors here who are up to no good. But the majority of us are just doing our best to follow PAGs without being tripped up by our own biases and blind spots. Ultimately, I am finding that staying clear of dichotomizing is the best way forward. I would not be on this earth were it not for pharmaceuticals and Western medicine. I had a very serious accident which should have ended my life, but heroic actions by people in the medical field, as well as the copious use of pharmaceuticals, reversed the inevitable. I have a gratitude for those in the field that cannot be put into words. As an editor, however, none of that can play into my evaluation of sources and claims we wish to include in WP articles. That is a challenge we all share, and I now appreciate that it is in the sometimes heated conversations that our blind spots and biases are addressed, and hopefully a more NPOV is attained for the benefit of the reader. petrarchan47คุก 21:25, 19 May 2015 (UTC)

MastCell, thank you for your response, and for the book recommendation. I'll check it out. You said, After all, you brought up the evils of Big Pharma in response to my attempt to draw a distinction between physicians and homeopaths. Right? No, actually, not quite. I had just seen an article about criminal actions filed against some of the big pharmaceutical companies, and couldn't understand why there aren't a whole bunch of CEOs spending time behind bars. You had also mentioned professional standards and that you weren't aware if alt-med practitioners (like homeopathy) were held to as high a standard, so I looked it up for you and posted the results. I have no clue who you are professionally so I'm not aware of what you are exposed to on a daily basis or I would have been more careful to not inundate you with more of the same. I am very happy to hear that you are suspicious of tort reform - it's the worst thing that could happen in the US because all it does is hurt victims worse than what they've already been hurt. If we must have tort reform it needs to focus on the frivolous lawsuits filed by prison inmates every year: . --Atsme 01:53, 20 May 2015 (UTC)

Americans don't put CEOs in prison. It's just how we roll. Did any CEOs go to prison for the Deepwater Horizon spill? Or the 2007-2008 financial meltdown? We (as a country) apparently believe that Justice requires 5- to 10-year mandatory minimum sentences for possession of 5 grams of crack (about enough to fill a sugar packet), but also that CEOs who preside over immensely negligent human and environmental catastrophes can't be held accountable. Although we do occasionally put a few people from middle management on probation for these sorts of things. The irony is that the outrageous trends in CEO compensation are usually justified by invoking the degree of responsibility that CEOs assume, but in reality they aren't accountable or responsible in any measurable way. That is true of, but not unique to, the pharmaceutical industry.

As to professional standards, the mere existence of licensing bodies means nothing. I can form a licensing body tomorrow and incorporate it tomorrow, and then start licensing people to use crystal energy to cure cancer. The real question is how these licensing bodies operate. Do they have an investigative arm to handle complaints? Do they hand down sanctions for unprofessional conduct? Are they publicly accountable? For example, you can go to pretty much any state medical board and find a mechanism to handle public complaints, a a clear description of how complaints are handled, and a full and public listing of disciplinary actions taken. (I used the Michigan Medical Board website, but you can pick a state of your choosing). Do the boards you mentioned provide this level of oversight and accountability? Because licensing alone doesn't mean anything without some sort of enforcement of professional standards. MastCell  21:21, 20 May 2015 (UTC)

ROTFL. Medical boards are accountable? — Preceding unsigned comment added by 173.206.249.137 (talk) 19:46, 23 May 2015 (UTC)

Yes. In my view, state medical boards provide an important layer of accountability for physicians—a layer which is either non-existent or comically ineffectual in alternative-medicine fields. Do you have anything intelligent to say about that? MastCell  04:20, 25 May 2015 (UTC)

MastCell - I really do want to learn both sides of the argument and hope you will be generous enough of your time to help me understand. The questions you posed motivated me to do the research in that direction (in between laptop crashes and having to work on my iPad). I came across the following and was hoping you could provide input with regards to the organization: . Legit from your perspective, or not? --Atsme 20:49, 23 May 2015 (UTC)

MastCell, your question "anything intelligent to say about that" was inserted above the question I asked you two days earlier so I hope it was directed to the IP who made a stupid comment and interrupted our discussion. Firstly, I am seeking knowledge and secondly, I actually do need to know the answers to my questions in order to grow as an editor, especially in areas considered to be controversial. I am not here to create disruption, mock, debunk, promote or annoy. My purpose as an editor is to contribute factually accurate information to the project and to help however I can to improve and expand what I perceive to be a remarkable undertaking in education on a world-wide scale. I have the utmost respect for the medical community and the regulatory/governing organizations that serve to protect us. I came to you because you initially invited me to participate in further discussion regarding this topic. I apologize if I've done anything to make you think otherwise. It was certainly not my intent. The topic I am trying to better understand involves WP's position on CAM which is a highly debated topic that breeds disruption to the point TBs are imposed, the latter of which I wish to avoid. I am somewhat confused over what is happening and am now looking to you as a highly respected and knowledgeable administrator with remarkable expertise in the medical field to help me learn a bit more. My confusion over WP's position on CAM is rooted in the conflicting information we're finding in RS and how that information and sourcing is treated when used in an article. It appears we agree that state medical boards provide an important layer of accountability but what I find confusing is your belief that it doesn't apply to alt med practitioners and that is what I'm trying to understand. In April 2002, the House of Delegates of the FSMB adopted the following guidelines for CAM in medical practice which includes all health care professionals, presumably those licensed by State Medical Boards which would include MDs, DOs, and CAM practitioners, correct? See the following: . What it tells me is that alt med is regulated by FSMB and that there are medical guidelines in place that all licensed practitioners are expected to follow. Right or wrong? --Atsme 12:48, 25 May 2015 (UTC)

My comment was directed at the IP editor, and wasn't meant to suggest anything negative about you at all; please don't interpret it that way. To answer your post, I don't think that there is any actual conflicting information here. The FSMB is an umbrella organization representing state medical boards (the practice of medicine in the US is regulated at the state level, by individual medical boards which are arms of state government). These medical boards have jurisdiction over physicians (and usually over allied healthcare providers such as PAs, nurse practitioners, nurses, and DOs). They do not have any jurisdiction over homeopaths, naturopaths, or other alt-med providers. Those providers are poorly regulated, if they are regulated at all.

State medical boards are in charge of issuing medical licenses to physicians, and the ultimate sanction that they can impose is to revoke a physician's medical license. For a physician, this is basically equivalent to being excommunicated from the profession, so it's a serious sanction. But since alt-med practitioners don't have medical licenses in the first place, the FSMB and state medical boards can't regulate them. The CAM guidelines apply to physicians who choose to offer complementary modalities as part of the their practices. (The document to which you linked makes this clear; it states upfront that it applies to physicians who either use CAM themselves or who work in partnership with CAM practitioners).

If that's tl;dr, the short version is: no, CAM practitioners are most definitely not regulated by the FSMB or by state medical boards, unless they also happen to be licensed physicians. MastCell  03:38, 26 May 2015 (UTC)

Thank you, MastCell. Your explanation was well-received on my end, and your time and patience are much appreciated. --Atsme 18:57, 26 May 2015 (UTC)

Possible impersonator

It appears someone may have created the account User:MasfCeII to impersonate you. Do you think that is the case? Everymorning talk 02:37, 1 June 2015 (UTC)

It's always a promising sign when a new user's first edit trivially bluelinks their user page and their second edit trivially bluelinks their talk page. Short Brigade Harvester Boris (talk) 02:39, 1 June 2015 (UTC)

American politics 2 arbitration proposed decision posted

Hello. The proposed decision for the American politics 2 arbitration case, which you are listed to as a party, has been posted. Thank you, --L235 (t / c / ping in reply) via MediaWiki message delivery (talk) 03:32, 1 June 2015 (UTC)

User:MastCell/Daily Mail links

Hi MastCell! I came across this and realized it hadn't been updated for awhile. Would you mind sharing how you generated the list? I'd be interested in keeping it updated as a subpage of WP:MED. Thanks! :) Emily Temple-Wood (NIOSH) (talk) 19:43, 11 June 2015 (UTC)

Hello Emily; I apologize for the delay in responding to you. I just haven't felt much like checking in or editing for awhile. To answer your question, I wrote a short Python script to generate the list - it basically just takes the list of pages with a WP:MED template, and the list of pages with Daily Mail external links, and calculates the intersection of the two sets. The entire script is as follows:

import mwclient
import sys
wp = mwclient.Site('en.wikipedia.org')
wpmed_template = wp.Pages
url_usage_list = wp.exturlusage("*.dailymail.co.uk", namespace=0)
dailymail_links = set()
for dm_link in url_usage_list:
        dailymail_links.add(dm_link)
        sys.stdout.write('.')
print "\nFinished collecting Daily Mail links..."
wpmed_articles = set()
for link in wpmed_template.backlinks():
	wpmed_articles.add(link.page_title)
	sys.stdout.write('.')
print "\nFinished collecting WP:MED articles..."
link_articles = wpmed_articles.intersection(dailymail_links)
print "Performed intersection operation..."
print "Identified %d WP:MED articles with Daily Mail links..." % len(link_articles)
print "Listing them:"
for link in link_articles:
        print "* ]" % link

I hope that's helpful. Feel free to use or adapt it. It requires the mwclient Python library, which is freely available. Please let me know if you have any questions, and take care. MastCell  17:23, 24 June 2015 (UTC)

Thanks so much for your response! I really appreciate it. All the best, Emily Temple-Wood (NIOSH) (talk) 19:35, 24 June 2015 (UTC)

Oversight and advice, please?

Hi MastCell - I've been doing my homework and believe I have a pretty good handle on how MEDRS works now thanks to your input here and at various TP and noticeboards. There is a discussion at Project Medicine regarding Kombucha (which is subject to DS) wherein I posed a few questions to Doc James who confirmed what I believed to be true regarding the sourcing of extraordinary claims. Unfortunately, despite the lengthy discussions at both Proj Med and the article TP, the editing conflicts continue primarily as a result of tendentious editing, repeated reverts by the regular CAM-haters due to the product's claims of health benefits, and the result is noncompliance with MEDRS, V, NPOV and UNDUE. Extraordinary claims have been made in the article linking consumption of kombucha products to toxicity and death based on a handful of anecdotal random (and rare) case reports (most of which date back to the 90s) but because those case reports are cited to RS (books) that published those same reports, the reverters believe they are correct. Moreover, attempts to add factually accurate information using intext attribution from a 2014 review are also being reverted.

The highest quality source regarding kombucha is a 2014 review in Comprehensive Review in Food Science and Food Safety published by the Institute of Food Technologies. Their conclusion states:

• "Although kombucha tea cannot be granted official health claims at this time, it can be recognized as an important part of a sound diet. Not exactly a traditional beverage, kombucha tea is now regarded as a “health” drink, a source of pharmacologically active molecules, an important member of the antioxidant food group, and a functional food with potential beneficial health properties. Research on kombucha demonstrating its beneficial effects and their mechanisms will most likely continue to increase substantially in the next few years. It is apparent that kombucha tea is a source of a wide range of bioactive components that are digested, absorbed, and metabolized by the body, and exert their effects at the cellular level. Kombucha tea's current status as a functional food as summarized in this review, lends credibility to what has been believed by kombucha tea drinkers for a long time."

Also, a 2013 article by Scott Gavura at Science Based Medicine concluded:

• "The bottom line - The best that can be said about kombucha is that it probably won’t kill you. There are no documented health benefits, so unless you really like the taste, there’s no clear reason to consume it. As I have written before, health decisions should be based on an evaluation of the risks and benefits. In the case of kombucha, the benefits, other than the subjective, are unsubstantiated. The risks are real, but also rare. So if that bet still looks attractive, kombucha may be for you. To each his own fermentation. As for me, I’ll stick with my own favourite fermentations: IPA and wheat beer, and pass on the moonshine panacea."

Considering there is a very small number of random case reports (most, if not all, of which are included in the 2014 review) all lacking in conclusive scientific evidence for causality, it appears to me the claims should be considered FRINGE per MEDRS, therefore not included in the lead but possibly mentioned in the body as long as it isn't given undue weight, correct? We should also use in-text attribution from the highest quality sources (the 2014 Review) that are up-to-date (not more than 5 yrs old). I don't see why Kombucha (natural ingredients) shouldn't receive the same consideration as articles like Red Bull (which is full of chemical additives) with regards to inconclusive case reports linking death and toxicity to the beverage. Your advice and attention to this matter will be greatly appreciated.  --Atsme 16:08, 13 June 2015 (UTC)

She makes a good point. Red Bull reads like a brochure for the drink, ignoring multiple linked deaths, whilst Kombucha has an entire gang working to cover the immense dangers of a 2,000 year old drink with one supposedly linked death.

Last of three paragraphs in Red Bull Lede:

Red Bull was criticized for health risks in the past; however, the European Food Safety Authority (EFSA) concluded that the levels of taurine and glucuronolactone used in Red Bull and other popular energy drinks are safe.

Second of two-paragraph Kombucha Lede:

Although kombucha is claimed to have several beneficial effects on health, the claims are not supported by scientific evidence, and the drinking of home-brewed kombucha has been linked to a variety of adverse effects including muscle inflammation, poisoning, infection, and the death of at least one person.

petrarchan47คุก 22:30, 15 June 2015 (UTC)

Looking back at this conversation motivated me to go through the Red Bull health information, which I agree was very poorly done. The MEDRS appear to be predominantly negative, so the article now reflects that - the sources probably justify even more than I included. There's more information at the Energy drink article as well, which I also went through because it was in even worse condition. (No comment on the dispute which led to this being brought up.) Sunrise (talk) 05:28, 13 August 2015 (UTC)

Misplaced Pages:Arbitration/Requests/Case/American politics 2 closed

This arbitration case has been closed and the final decision is available at the link above. The following remedies have been enacted:

1. Remedy 1 of the American Politics case is rescinded. In its place, the following is adopted: standard discretionary sanctions are authorized for all edits about, and all pages related to post-1932 politics of the United States and closely related people.
2. Ubikwit (talk · contribs) is banned from any page relating to or making any edit about post-1932 politics of the United States, and closely related people, in any namespace. This ban may be appealed no earlier than 18 months after its adoption.
3. MONGO (talk · contribs) is admonished for adding to the hostility in the topic area.

For the Arbitration Committee, L235 (t / c / ping in reply) via MediaWiki message delivery (talk) 19:41, 19 June 2015 (UTC)

Discuss this at: Misplaced Pages talk:Arbitration Committee/Noticeboard#Misplaced Pages:Arbitration/Requests/Case/American politics 2 closed

Email

Dropped you a note to your WP email address over the weekend (sent directly instead of through Special:EmailUser/MastCell, so I hope it's still your account). Not urgent, so feel free to respond whenever you have time. NW (Talk) 01:36, 6 August 2015 (UTC)

Read and responded; sorry for the delay. MastCell  23:43, 13 August 2015 (UTC)

What happens when a homeopathy proponent becomes a Misplaced Pages administrator?

Perhaps it wouldn't matter. Nonetheless this was not far from happening a few months ago (RfA vote was split until the candidate withdrew). Personally I would regard belief in homeopathy to be a symptom of deeper issues. Such a believer would probably be in conflict with several of Misplaced Pages's core policies and principles, either knowingly or unknowingly.

There is a mantra that admins don't make content decisions, but in some cases they effectively do, though in practice it usually amounts to just keeping nonsense out of Misplaced Pages. If an editor is consistently making edits that are in clear violation of WP:PSCI, and other avenues of dealing with the editor have been exhausted, then an admin may apply discretionary sanctions. But wait -- how did the admin know that the edits violate WP:PSCI? An admin has to "get it", so to speak. My fear is that one day an admin who doesn't get it (such as a homeopathy advocate) will wield discretionary sanctions, making determinations that are opposite to what others would make.

(There's no particular reason I'm ranting here rather than elsewhere, except that I assume you know where I'm coming from.) Manul ~ talk 01:44, 9 August 2015 (UTC)

So if a homeopath admin closes a complaint as "no action" does that mean the user is indef blocked? (Sorry, some openings are just too obvious to resist...) Short Brigade Harvester Boris (talk) 04:03, 9 August 2015 (UTC)

In real life, I know some very intelligent and competent people who believe in homeopathy (or who, at least, refuse to dismiss it). So I don't think that a belief in homeopathy alone disqualifies a person from serious discourse on general topics. However (and this is the rub), I've found that Wikipedians who make a point of advocating for homeopathy do tend to have more serious generalized misconceptions about this site's policies and guidelines. As a generalization, Wikipedians tend to be much more obsessive and dogmatic than the sample of people I know in real life, so I'm consequently less willing to take a flier on a Wikipedian with a weird belief system. MastCell  23:42, 13 August 2015 (UTC)

I'm pretty sure Manul is talking about me. My most recent RFA was split, but it was still far from being successful, which is why I withdrew (it was so obvious it was not going to pass). Everymorning (talk) 01:50, 14 August 2015 (UTC)

Saying homeopathy is pseudoscience is one thing. Saying anyone who thinks there is any scientific evidence to support it in reliable sources must have "deeper issues" is another thing entirely--almost a personal attack. Also, MastCell: The "ultra-obscure" journal you criticized on the homeopathy talk page is Drug Research (journal) (formerly Arzneimittelforschung). The journal has an impact factor of 0.701 and is Medline indexed. If there's something about this journal that makes it unreliable, feel free to tell me, but it doesn't seem that bad a source to me. In situations like this I often wonder if any amount of evidence would suffice to overturn or at least credibly challenge the "consensus" that homeopathy doesn't work. Everymorning (talk) 01:55, 14 August 2015 (UTC)

Anybody who believes in homeopathy is fundamentally unreasonable, and anybody who takes an accommodationist stance towards homeopathy is a useful idiot. I'd see both as redflags for anybody with admin ambitions. Alexbrn (talk) 05:17, 14 August 2015 (UTC)

A long-growing problem with RfA is an obsession with box-checking and editcountitis, at the expense of more important but less easily-quantifiable criteria. It doesn't need to take ten thousand edits, a Featured Article, ten Did-You-Knows, one hundred TfD posts, five hundred AfD comments, an encyclopedic – nay, photographic – knowledge of arcane Misplaced Pages policy minutiae, and an assortment of shrubberies for an individual to demonstrate the qualities we should require from an admin.

Beyond a basic reading list of policies and guidelines, rote knowledge is less important than temperament and an awareness of the limits of one's own skills. A good admin doesn't need to know every word of every guideline. A good admin needs to know when he has reached the limit of his knowledge and what to do when that happens: when his current skills and experience are not up to the task he wishes to attempt, when to request assistance, and when to defer to more-experienced judgement. Any editor who jumps in with both feet to an area where he isn't fully competent can cause problems; doing so while using admin buttons has the potential to be particularly destructive.

In this instance, Everymorning, it looks like you're trying to read selected elements of WP:MEDRS as a checklist (""Medline...check!") that you can use to mechanically declare a source 'reliable' and thereby compel inclusion of content amenable to a particular fringe point of view. To an editor familiar with the scientific literature, a sub-unity impact factor is a big red flag, indicating that a journal is rarely cited by other scientists. (I'm surprised that you would call attention to it as part of your argument in favor of a source.) This journal isn't just part of the long tail, but right at the end of it, sitting in the bottom quartile or decile of related journals. Well-executed papers in such journals have results which are unimportant, unexciting, or hopelessly-narrowly-focused; papers which make substantial or significant claims are likely dubious—if their results were robustly-supported, the authors would have published in a higher-profile journal. Repeatedly bringing up this journal demonstrates that you don't understand the limits of your competence in this area.

The problem isn't your personal beliefs about homeopathy, whatever they may be. The problem is that when presented with something that is admittedly a very difficult task – trying to determine the credibility of a published journal article – you're stubbornly resistant to advice from others with more expertise. TenOfAllTrades(talk) 13:18, 14 August 2015 (UTC)

Everymorning, "deeper issues" was merely a segue into the next sentence, which suggested exactly what your response indicates: that you are in conflict with Misplaced Pages's policies. It would appear that your motivation for adding these sources to the homeopathy article is found here: I often wonder if any amount of evidence would suffice to overturn or at least credibly challenge the "consensus" that homeopathy doesn't work. It would appear that you are attempting to use Misplaced Pages as a tool for challenging the scientific consensus on homeopathy, which would be a misuse of Misplaced Pages. That you put "consensus" in quotes is alarming, the kind of evidence one would include in an AE request for a topic ban.

I don't mean to be harsh. Really. Ultimately I blame the educational system. Nobody should leave high school (I noticed your birthdate on your user page) without having some understanding about the distinction between science and pseudoscience. Not knowing can be deadly, literally. WP:FRINGE and related PAGs tend to be somewhat unapprehended for those lacking exposure to the demarcation problem. Whatever you do, please don't take the path of simply labeling others biased, parlaying ignorance into prejudice. Seek to understand the issue instead -- read The Philosophy of Pseudoscience or Nonsense on Stilts or whatever floats your boat. Manul ~ talk 03:42, 20 August 2015 (UTC)

• I used to think homeopathy was bullshit. Then I looked for evidence that it is not and found a fair amount thereof. As for the "checklist" comment above by TOAT, I see it differently--as me trying to abide by objective measures of whether a journal is respectable (indexing, whether it's published by a reputable publisher, etc.) If it's true that "To an editor familiar with the scientific literature, a sub-unity impact factor is a big red flag, indicating that a journal is rarely cited by other scientists." then we should start a policy page about fringe journals that says something about very low impact factors being a red flag of some sort. Everymorning (talk) 11:24, 20 August 2015 (UTC)

The problem is that MEDRS tries to encapsulate some rules of thumb which some people over-interpret as iron-clad rules (see, for instance, the thread right below this one)—and creating another page of rules of thumb will tend to make that problem worse, rather than better. There really isn't a way to produce a one-page summary or flowchart to evaluate the reliability of papers or journals (especially where that evaluation must also include consideration of how those papers are intended to be used on Misplaced Pages). Knowing the various and subtle ways that flaws creep into the scientific literature is hard, and it takes years of experience in working with that literature.

Incidentally, the way that you chose to phrase the statement "Then I looked for evidence that it is not and found a fair amount thereof" is interesting. A problem with the literature is that it's almost always possible to find confirmation of something if you look hard enough. There's a lot of iffy and just-plain-bad science that appears in middling-to-poor journals. There's even some good science that was unlucky enough to get a spurious result. (The Green Jelly Bean problem.) There's the effect of selective publication (the file drawer effect), which can sometimes favor the publication of 'interesting' but wrong results. Then there are the dogs that don't bark—the literature results that you would expect to see in other fields and journals if a particular result were real rather than spurious. (For example, if homeopathic effects were real physical effects rather than placebo- and chance-driven, we would expect to see homeopathy incidentally affecting and being noticed in thousands of other biological and chemical experiments.) One of the reasons why we strongly favor robust secondary sources for medical content is as a partial patch over these sorts of gaps and errors, but it's an imperfect shield. TenOfAllTrades(talk) 16:01, 20 August 2015 (UTC)

← TenOfAllTrades speaks wisely, but I'd like to dig a little deeper into this question of the evidence on homeopathy, and how to interpret it. It's an excellent case study in Bayesian probability, clinical-trial interpretation, and common conceptual pitfalls in parsing clinical evidence. In fact, it's an example that I use didactically when I teach about these subjects. Let's start with a simple and (for now) hypothetical example.

1. What is the likelihood that homeopathy works (or that it is, to use the vernacular, "not bullshit")? This is what a Bayesian would call "prior probability" or pre-test probability. Based on fundamental knowledge of physics, chemistry, and pharmacology, the prior probability that homeopathy is effective is, let's say, 0.001%. (I think this is ridiculously charitable, and a true prior probability would be much closer to 0% than to 0.001%, but we have to start somewhere).
2. Now let's say you open the current issue of Lancet and read a well-conducted randomized controlled double-blinded clinical trial which finds that homeopathy is significantly more effective than placebo in treating some condition. (In technical terms, let's say that the study had 80% power to detect such a difference with an alpha of 0.05, as these are standard thresholds in clinical-trial design).
3. Here's the simple, but essential question: having read the study, and assuming its results are valid and properly reported, how likely is it that homeopathy is effective?

There is a mathematical solution to this problem, of course, and we can talk about how to derive it. But the central point is qualitative. @Everymorning: I'd like to hear your thoughts. MastCell  23:50, 20 August 2015 (UTC)

• The main issue with the statement that homeopathy has little to no "prior probability" is the fact that a materials science perspective on homeopathy has been excluded from your question. As you and the other watchers of this page may know, I have added some articles to homeopathy pertaining to the proposed materials science-hoemopathy connection, which, to me, indicates that there may be a way it could work while remaining in line with scientific principles. See here, here and here for some of what I am referring to. Everymorning (talk) 00:02, 21 August 2015 (UTC)
  • If you're claiming that there is support in the mainstream materials science community for the principles of water memory or homeopathy, I'd say you're badly off-base. I'm pretty sure that if you ask a dozen, or a hundred, materials scientists about the plausibility of homeopathy, they'll come up with numbers like mine, or even lower. The papers you cite are beyond fringey, although apparently they were picked up by fixherpes.com per your first link, a site which I categorically deny ever having visited regardless of what my browser history says... :P The one from BMC Complementary & Alternative Medicine is particularly embarrassing, as it's a cringeworthy exercise in hand-waving that boils down to "because nanoparticles!!!!" These papers don't represent anything remotely close to modern thinking in materials science. MastCell  01:04, 21 August 2015 (UTC)
  • Gorski has a post on the "because nanoparticles!!!!" paper. Manul ~ talk 02:04, 21 August 2015 (UTC)
    • Gorski who?? :P Just kidding. He's a smart fella. I couldn't have said it better myself. MastCell  02:30, 21 August 2015 (UTC)
      • More nanoparticle homeopathy research: Everymorning (talk) 02:46, 21 August 2015 (UTC)
        • I would also like to point out that some of the papers I have adde to Homeopathy are hardly ringing endorsements of the practice, eg and Everymorning (talk) 15:22, 22 August 2015 (UTC)

FWIW, almost any treatment will have very low prior probability to start with. How you choose the prior can vary, but a couple of options are "how likely is it that an arbitrarily chosen treatment will cure this disease?" and "how many treatments exist for this disease relative to how many have been tested?" For drugs, high-throughput screening means that millions of compounds are tested for every one that ultimately becomes a treatment, which would make the prior less than 1 in 1,000,000. This is true regardless of the proposed mechanism - it's the probability that the treatment is effective for any reason, whether plausible or not. We could start adding complexity penalties in such circumstances, e.g. from Occam's Razor, but it really isn't necessary. (Either way, I do recommend that you answer the question.) Sunrise (talk) 05:56, 23 August 2015 (UTC)

I honestly don't think I know enough about medical statistics to answer MastCell's question (I don't even have an undergraduate degree). I would probably give the paper published in the Lancet an exceptionally large amount of credibility because that journal is so highly regarded. But it does seem that, per MEDRS, the results of an individual primary study such as the one he described above may well be spurious, and it is better to look at meta-analyses instead. One study cannot prove that anything works or doesn't work. But one thing to bear in mind is the number of positive studies on homeopathy. In fact there were two published just last year. Everymorning (talk) 11:35, 23 August 2015 (UTC)

MastCell's comment illustrates how the extent to which you consider homeopathy plausible hugely influences the way you view the clinical trial evidence. But as Johnson et al. noted, "Basic science research appears to suggest that the use of extremely dilute solutions may not be as implausible as has been claimed." Everymorning (talk) 11:58, 23 August 2015 (UTC)

Yes, the Johnson paper has completely overturned our prior understanding. Everyone is talking about it. It has been cited 13 times! Short Brigade Harvester Boris (talk) 14:23, 23 August 2015 (UTC)

As compared with Grimes' paper claiming homeopathy violates physics and chemistry that has been cited exactly 0 times on Google Scholar? Everymorning (talk) 11:36, 26 August 2015 (UTC)

I'm not familiar with Grimes' paper, but it doesn't surprise me that it hasn't been cited. I wouldn't expect a paper demonstrating that the moon is not made of green cheese to garner a lot of citations either. The homeopathy proponents are hardly going to cite a paper which conclusively debunks the underpinnings of their treatment system, and the rest of us (speaking as scientists) don't really have a lot of need for citations demonstrating that homeopathy is nonsense. Who's going to cite the paper? In what context?

The fundamental cognitive error here—which I was trying to outline in my example above as well—is that you're treating the "homeopathy works" evidence and the "homeopathy is nonsense" evidence as if they're equally valid a priori. They're not. The former is an incredibly far-fetched extraordinary claim, which would overturn much of modern physics, chemistry, and pharmacology. You would need an exceptionally strong evidence base to even consider making that sort of claim credibly. In contrast, the view that homeopathy-is-nonsense is entirely consistent with multiple lines of evidence and basic, well-established laws of nature. It's like saying that the moon is not made of green cheese.

You can't apply the same level of scrutiny to those two claims and believe whichever one produces the better p values. I know that sounds like how science works, but it's not. What you're doing is more like rolling a 1d20 and deciding to believe in magical water if you happen to roll a 1. (Actually, it's more like rolling 20d20, and then pretending that only the rolls of 1 exist—this is the effect of publication bias and various other experimental biases in the homeopathy literature). There are useful summaries of this concept here and here (more technical), an explanation of why it's unscientific to test a completely implausible hypothesis in a randomized clinical trial here, and a specific deconstruction of the low quality of "basic science" research supporting homeopathy here. MastCell  17:15, 26 August 2015 (UTC)

I'll add briefly to MastCell's comment with another XKCD comic, on the difference between frequentist and Bayesian approaches: . (In a diagnostic test, it would roughly correspond to the difference between sensitivity and specificity.) TenOfAllTrades(talk) 18:15, 26 August 2015 (UTC)

Right, so 2d6 rather than 1d20... :) A minor clarification: both sensitivity and specificity are "frequentist" measures analogous to null-hypothesis significance testing; they do not take into account the underlying prevalence of the condition being tested for (that is, they ignore pre-test probability), but rather make an assumption about the presence or absence of disease and then describe the test's performance given that assumption. Bayesian measures of diagnostic test accuracy would include positive and negative predictive values. MastCell  18:32, 26 August 2015 (UTC)

I suggest that MastCell and the other editors watching this page look up the research of Anisur Khuda-Bukhsh and Paolo Bellavite. I'm not saying it will change your mind about homeopathy being nonsense, but their research does indicate that there are at least a few scientists who consider it a topic worthy of studying. Everymorning (talk) 01:07, 27 August 2015 (UTC)

Scientists study all kinds of things. Even Nobel Prize winners have been known to study and promote some very dubious stuff. Short Brigade Harvester Boris (talk) 01:22, 27 August 2015 (UTC)

Penance

Since you started this whole "Respect secondary sources" thing, I am inviting you to look at this Misplaced Pages:Identifying reliable sources (medicine)/FAQ#So if primary sources can be used in rare cases, what are those rare cases? and see if you can help expand the list.

(At some point we really do need to deal with the toxicology problem. As far as I can tell, there aren't any Cochrane reviews on LD50 levels, and that's still appropriate and encyclopedic information that we should be including.) WhatamIdoing (talk) 00:26, 13 August 2015 (UTC)

I really regret ever starting the whole "secondary sources" thing. There have been some benefits—we now have many fewer problems with people cherry-picking primary sources to create an alternative-reality narrative. But the intent was always to respect secondary sources, not to outlaw primary sources categorically. Unfortunately, but perhaps not unforeseeably, the clause has been interpreted in very absolutist terms. I personally don't have a problem with primary sources per se, as long as they're used judiciously. In fact, I've cited quite a few primary sources in the articles I've written (back when I used to write medical content). The problem only arises when people use primary sources in a misleading or unbalanced manner. If someone is objecting to including LD₅₀ levels on primary-source grounds, then that's just silly. That said, while I appreciate the attempted guilt trip , I barely have enough remaining time/interest to log in here once in a while, and I definitely don't have the wherewithal to edit policy pages. MastCell  23:38, 13 August 2015 (UTC)

As much as I hate restricting to secondary sources, I concede in medical articles is is the lesser of two evils. It is a way of gatekeeping a whole pile of crud from enthusiastic researchers of all persuasions. Looking though the history of schizophrenia, keeping that page manageable would have been a whole lot trickier, not just from antipsychiatry but a whole lot of folks in the medical field as well. Cas Liber (talk · contribs) 01:58, 27 August 2015 (UTC)

It's difficult. I basically agree with the "lesser of two evils" assessment, but our enforcement is inappropriately rigid. Failing to teach our zealous enforcement what exceptions are appropriate is part of the problem, and therefore fixing up this FAQ might make the result slightly less-bad.

Cas has reminded me that one of the things that ought to be emphasized is that rarity matters. Schizophrenia should be written from a dozen gold-plated reviews, maybe three widely used textbooks, a couple of good history-of-psychiatry, a couple of sociology or public policy books, and not much else. The whole thing ought to be possible with just two dozen carefully chosen, top-quality sources. (In practice, we have 168 sources, and I will be truly astonished if we ever have fewer than 100 again.) But when you're talking about diseases for which each year might see just one combined "Case study and literature review" article, then anything peer-reviewed in a decent journal should probably be embraced with open arms. WhatamIdoing (talk) 07:22, 2 September 2015 (UTC)

Gwen Ifill

I fully ref'd that modest edition to the CNN article. How can it be a BLP violation? Capitalismojo (talk) 16:12, 4 September 2015 (UTC)

Damn. Apprarently the ref isn't there. I will re-add. Good catch. Capitalismojo (talk) 16:15, 4 September 2015 (UTC)

A barnstar for you!

	The Barnstar of Diplomacy
	Well deserved. MONGO 03:51, 6 September 2015 (UTC)

Heh. I would say I'm definitely not feeling at my most diplomatic on Misplaced Pages anymore, but I appreciate the thought and the kind words. In all seriousness, while I don't doubt we disagree about various things, I have a lot of respect for you. Take care. MastCell  15:10, 8 September 2015 (UTC)

Montanabw RfA

I'm saddened that you used your oppose vote to berate me, and I wonder if you have any idea of the sheer volume of attacks Montanabw made against me this year. She followed me everywhere I went, tried to recruit others to do the same, and smeared my reputation at every turn. I probably can never recover from the lies she spread about me, but I never bothered to collect all the diffs, because they made me sick to my stomach, and I just about quit Misplaced Pages to avoid her. Here's just the ones she made at my talk (), after having been asked politely many times to stay away. I lost count of how many times she accused me of being a sock, but she never opened an SPI like she should have. Here's a sample of what she considered evidence against me: (), (), and here's an example of her terrible judgement in general when it comes to socks: Misplaced Pages:Sockpuppet investigations/ZuluPapa5/Archive. No matter how many people asked her to stop, she just kept coming. In fact at least nine editors asked her to leave me alone, but she persisted for months (diff available upon request).

I might have gone too far at the RfA, but if I did so it was less out of vindictiveness and more out of sincere concern for the community. The beginning was staged and timed to provide minimal challenge, and had others asked her difficult questions about her problematic behavioral patterns I would have stepped back sooner. Yes. She has lots of good qualities, but none of them pertain to adminship. I too hope she continues to create content and doesn't quit after this failed attempt, but until she stops taking sides and stalking people she is a terrible candidate for the block button, as bad as any I've seen here. RO 18:16, 21 September 2015 (UTC)

And this recent oppose: () comes from yet another editor who MBW harassed. In this case, for a full year! RO 20:22, 22 September 2015 (UTC)

Thanks for approaching the topic civilly

Thanks for taking such a generous, civil tone in the Talk section that you and I are communicating across. It seems to me that you might have maneuvered through these kinds of discussions before... SocraticOath (talk) 19:42, 21 September 2015 (UTC)

Hey MastCell, I know you've been involved in that article before... could you please take a moment and do a history review of my changes there from the last week or so? Thanks, 146.23.3.250 (talk) 21:11, 22 September 2015 (UTC)

A barnstar for you!

	The Admin's Barnstar
	I have participated on nearly 300 RfA and I know how hard it sometimes can be to make a decision. Your comment here is probably the most objective, thoughtful, and well expressed I've ever seen. Thank you. Kudpung กุดผึ้ง (talk) 01:00, 22 September 2015 (UTC)

Arbitration Request

I have filed a request for arbitration over my last block:

Misplaced Pages:Arbitration/Requests/Case#jps vs. Spinningspark.

jps (talk) 14:36, 27 September 2015 (UTC)