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Moved here

Our general WP:COI guidelines state "Editors with a financial conflict of interest, including paid editors, are advised not to edit affected articles; they may suggest changes on the talk page and must disclose their COI."

To clarify this for medical topics:

• Editors who are professors or research scientists do not generally have a conflict of interest with respect to their area of expertise and are free to edit without disclosure.
• People who work at independent charities or at governmental agencies do not generally have a conflict of interest with respect to the subject matter their charity covers. Editing articles about the charity or government agency itself however would be viewed as a conflict of interest.
• Drug representatives, employees of pharmaceutical companies, and public relation firms of pharmaceutical companies have a conflict of interest with respect to health content. As such they are not to directly edit health care content on Misplaced Pages. They are welcomed to make suggestions on the talk pages but must disclose their conflict of interest.

Will add more once I have read what is here. Doc James (talk · contribs · email) 04:33, 30 August 2015 (UTC)

That is great! Would be good to broaden that from drug companies to include medical devices, diagnostics, CROs, reagent companies, and health IT companies as well. And also include reference to WP:SELFCITE in the first bullet, so maybe:

• Editors who are medical professionals, professors, or research scientists do not generally have a conflict of interest with respect to their area of expertise and are free to edit without disclosure. However, do not use Misplaced Pages to promote yourself, your medical practice, your institution, or lines of research you are pursuing, and generally avoid citing your own publications. Please see WP:SELFCITE.
• People who work at universities, hospitals, independent charities, or at governmental agencies do not have a conflict of interest with respect to medical or scientific subjects, but editing articles about your school, hospital, charity or government agency itself would create a conflict of interest, and you should disclose the COI and not edit those topics directly, but instead should propose content on the article's Talk page.
• Employees of pharmaceutical, medical device, diagnostic, research reagent, and health IT companies and CROs, and public relation firms representing them, have a conflict of interest with respect to health content covering products and services they offer, as well as the diseases and conditions they address. You must disclose your COI and you are welcome to make suggestions about content changes on the talk pages of articles, but you should not directly edit.

how is that? Jytdog (talk) 05:45, 30 August 2015 (UTC)

Excellent. How about "generally avoid citing your own publications". I want the authors of Cochrane reviews and USPSTF reviews to add one sentence summaries to appropriate articles. Doc James (talk · contribs · email) 20:36, 30 August 2015 (UTC)

I am good with that. I would rather have it be stronger than weaker - we get so many self-promoting editors, but I will bow on that. Jytdog (talk) 20:40, 30 August 2015 (UTC)

Yes agree just blocked these three here

I would also change "but you should not directly edit" to "are not to direly edit" to make the language stronger. Doc James (talk · contribs · email) 20:49, 30 August 2015 (UTC)

(ec) I support this, but I'd also like to see paid health-content editors (those in the third category) advised not to offer rewrites on draft pages. These are regularly carried over with little or no checking, so that you end up with a company rep having effectively written the article about the company's own product. Talk-page intervention is welcome to correct errors, but not to offer rewrites or take up a lot of volunteer time.

I would suggest something like: "You must disclose your COI and may make suggestions on the talk pages of affected articles, but you should not edit those articles directly, suggest rewrites, or take up a disproportionate amount of volunteer time with inquiries and arguments." Sarah 20:56, 30 August 2015 (UTC)

I like User:SlimVirgin suggestions. Doc James (talk · contribs · email) 21:21, 30 August 2015 (UTC)

While credulous acceptance of suggested edits is a problem, we're much more likely to be effective in modifying the behavior of the volunteers than of the people paid to be obnoxious timesinks. Asking the existing set of credulous volunteers to do the rewriting is more likely to produce a confused muddle of misinformation than an accurate, neutral edit based on information and sources supplied by the COI editor. Opabinia regalis (talk) 21:29, 30 August 2015 (UTC)

User:Opabinia regalis am not sure what you are suggesting? Doc James (talk · contribs · email) 22:43, 30 August 2015 (UTC)

I'm suggesting that SV's suggestion is unlikely to do much good. If the problem is that volunteers are accepting rewrites suggested by COI editors without thorough investigation, those volunteers - however well-meaning - are also not competent to do their own rewrites. Opabinia regalis (talk) 05:07, 31 August 2015 (UTC)

Sigh. Reproducing the substance of my comments on this at WT:MED, as they don't seem to have gotten much attention after the move here.

• Bullet points 1 and 2 are not specific to medical content, are not related to the problem of paid advocacy about branded products, and don't really belong here. Worse, they are basically WP:BEANS warnings to fringey types about how to attack experts editing health-related content.
• It is still strange that you want to add specific commentary about research scientists and government employees but not clinicians or care providers, who are at least as likely to have an interest in health- and health-care-related content. In fact, existing references to possible editing infelicities by clinicians have been removed.
• We already know that marketing employees and PR firms have a COI with respect to their own products. The third bullet adds nothing to this general statement. Opabinia regalis (talk) 21:29, 30 August 2015 (UTC)

added healthcare providers, thx Jytdog (talk) 21:42, 30 August 2015 (UTC)

Yup a lot of what we do is explain WP:BEANS. This is advice how not to attack experts as we are saying it is okay and not a COI. Doc James (talk · contribs · email) 22:45, 30 August 2015 (UTC)

Hoping to head off new trouble, Doc added, "And don't accuse the experts of COI! See, they may edit 'without disclosure' - which definitely doesn't sound like we're letting people get away with something - except under conditions A, B, P, Q, and Z." Sure. And don't stuff beans up your nose. Opabinia regalis (talk) 05:07, 31 August 2015 (UTC)

Sure. To simplify I would like to propose adding

• "Employees of pharmaceutical, medical device, diagnostic, research reagent, and health IT companies and CROs, and public relation firms representing them, have a conflict of interest with respect to health content covering products and services they offer, as well as the diseases and conditions they address. You must disclose your COI and you are welcome to make suggestions about content changes on the talk pages of articles. You are not to directly edit."

Doc James (talk · contribs · email) 22:46, 30 August 2015 (UTC)

Is that proportional? Are we exceeding the rules that are established for the whole community?

Consider this scenario: Alice Expert works for Big Pharma, Inc. Big Pharma, Inc. is developing a drug to treat Common Annoyance. As a direct result of her work, Alice is currently looking at a top-quality, independent source on the prevalence of Common Annoyance. She also notices that Misplaced Pages article contains zero information about epidemiology.

You propose here that Alice should banned from adding the information to the article, and if she does so much as suggest on the talk page that the WHO has decided that that the prevalence is 239 per 100,000 people, then she has to tell everyone where she works. Is that really the outcome we want? WhatamIdoing (talk) 01:22, 31 August 2015 (UTC)

Yes. So if you work for Medtronic and notice that Misplaced Pages gives the blinded systematic review and meta analysis of your treatment greater prominence than the unblinded systematic review your 18 billion company paid someone you like to write. You are not allowed to come to Misplaced Pages and try to remove the unfavorable blinded systematic review. And if you wish to complain endlessly on the talk page you need to disclose. This will save the community time because they can say, oh these two new accounts are simply two of the heads of marketing at medtronic or course they are going to say this.

The same if your marketing department decides to "invent" a new disease and use Misplaced Pages to introduce said disease. The problem is the number of poor faith COI editors substantially outnumber the number of good faith ones. Doc James (talk · contribs · email) 01:41, 31 August 2015 (UTC)

I believe that we have a remarkable number of good-faith COI editors that cause very few problems, including quite a number of productive WPMED members. We take more notice of the obviously bad-faith ones, but we don't pay any attention to the ones that don't cause us problems.

I share your concerns about someone trying to change content in a way that affects sales. But I don't understand why Alice Expert should be banned from adding epidemiological information: How does that hurt us? How does that help her employer? I note that your proposed language includes everyone, even the janitorial staff. Also, this proposal amounts to a ban, and I believe that the actual guideline is at the "strongly discouraged" level, not a complete ban on editing related articles. We cannot really set a different standard for medical articles than we do for, say, computer articles. WhatamIdoing (talk) 02:29, 31 August 2015 (UTC)

With respect to advertising, much of the world has different laws for medicine than other stuff. So I do not see why we cannot have a slightly different standard here.

I have heard many times from editors with serious COIs that they can still edit the article because we ONLY discourage it we do not disallow it.

Yes it is a ban on directly editing medical content by those with a significant conflict of interest such as PR representatives and heads of marketing of pharmaceutical firms. You say that we have lots of productive good faith editors who are paid by pharmaceutical companies to edit Misplaced Pages? I know a lot of medical editors and have not meet any of this group you mention. Doc James (talk · contribs · email) 03:12, 31 August 2015 (UTC)

You keep going back to the idea that the target 'audience' here is PR flacks, but that's not what you're writing in your proposed text. Do you actually intend to exclude everyone - the basic science/R&D staff, the IT people, the accountants, and the janitors - from editing anything remotely related to their company's products or product pipeline? Even companies that sell research reagents? All to have a redundant policy basis for stopping the people plopping stuff like "ZYRPLYVYX® (foobarinib) may be the right choice for people suffering from excess nose hair growth" into articles? Opabinia regalis (talk) 05:07, 31 August 2015 (UTC)

Sure how about

• "Employees of pharmaceutical, medical device, diagnostic, research reagent, and health IT companies and CROs, and public relation firms representing them, may have a conflict of interest with respect to health content covering products and services they offer, as well as the diseases and conditions they address. If you receive, or expect to receive, compensation for contributing to a topic you must disclose your COI. While you are welcome to make suggestions about content changes on the talk pages of articles you are not to directly edit the health content in the articles."

It makes it clear that such compensation must be for said edits. This would exclude the janitor unless they decided to hire him to edit Misplaced Pages. Doc James (talk · contribs · email) 05:38, 31 August 2015 (UTC)

I think this would be more efficient if you started by articulating what, specifically, you're trying to prevent, and why it needs a new guideline, rather than starting with the kitchen sink and then removing bits and pieces.

For example, the list (added by Jytdog above, I believe) includes CROs and companies selling research reagents. These companies may well be sources of spam (there's a notoriously unreliable antibody supplier that always makes an appearance in my spam folder....), but they are very unlikely to be sources of spam about health content. On the other hand, you've said several times that you want PR firms and marketing representatives to be part of the 'audience' here, but now you emphasize that compensation must be directly for the offending edits. Being paid on contract for specific editing tasks is different from being paid a regular salary for a general PR job that may include Misplaced Pages editing in the course of business.

It seems that you want to say something like "Editors who are paid representatives of a company or its products have a COI; they should not directly edit Misplaced Pages articles on related topics and must disclose their COI", except that's already policy. The only innovation I see here - outside unnecessary and inconsistent enumeration of who should be covered - is the language "are not to directly edit". Introducing narrower constraints than provided for in the TOU for a specific topic area needs, at minimum, broader community consensus than this backwater talk page. Opabinia regalis (talk) 23:49, 31 August 2015 (UTC)

So "Editors who are paid representatives of a company or its products have a COI; they are not to directly edit health content in Misplaced Pages articles on related topics and must disclose their COI" Doc James (talk · contribs · email) 23:58, 31 August 2015 (UTC)

That is coming right up to a line in policy. When I interact with conflicted editors, I explain that we have a two-step process for managing COI: disclosure and two kinds of peer review (AfC for article creation, and posting proposals on Talk for review for existing articles), and I ask them to follow that process. People generally do. But I ask them. Currently there is no basis in policy for forbidding conflicted editors from directly editing or creating articles, and WP:MED will be out in front of the community if we say "are not to directly edit". If we go there, it should be intentional, and expecting blowback from the vocal minority of the community that prizes anonymity and focuses on content only. (btw if you want to see how I ask people to follow the two step COI management process and if you have the patience, the conversation flowed perfectly in this thread this thread - i was careful to never forbid them to directly edit and the editor was happy to comply.) Jytdog (talk) 00:54, 1 September 2015 (UTC) (correct link, sorry Jytdog (talk) 11:56, 2 September 2015 (UTC))

Yes and thus this proposal. I am stating that we should "forbid" certain conflicted editors from directly editing medical content.

I am requesting that we give admins permission to block this sort of account User:Arr4 back in Feb of 2015 before they have a chance to try to extort money and made us look bad with their armies of socks per

This will partly deal with this problem. You combine this with reporting their accounts on Elance/Upworks. And you add in higher notability standard and we may have a leg to stand on. Plus you increase the requirements before someone can create a new article. Doc James (talk · contribs · email) 01:24, 1 September 2015 (UTC)

That is indeed a big mess, but it's fraud that has little apparent overlap with "health content" based on the list of articles. If anything, it should be motivating stricter scrutiny of articles about people and businesses. The reasons why the particular topic of health should be special here remain entirely opaque. Opabinia regalis (talk) 05:47, 1 September 2015 (UTC)

Not much health spam shows up because I have deleted most of it. Health spam takes advantage of people who are unwell and looking for accurate knowledge. It is worse than most types. Doc James (talk · contribs · email) 07:07, 1 September 2015 (UTC)

You've skipped the step where you provide evidence that your proposal actually solves your problem. You're already deleting the spam, apparently, so it already violates existing policy. Since you've seen so much of it, I'm sure you'll have extensive evidence available when you start a community-wide RfC on why standards stricter than those applied to BLPs should be used uniquely for a topic area that is much less well-defined than a BLP and that is already often subject to scope creep. Opabinia regalis (talk) 23:54, 1 September 2015 (UTC)

• User had issues here . We would have blocked them sooner.
• Here is the case in detail if you wish to read it

Doc James (talk · contribs · email) 00:21, 2 September 2015 (UTC)

Erm, yes, I've read it. You linked to it above. I responded. It is a very good example of a problem that wouldn't be solved by your proposal.

You don't seem to have read much of this thread, really, or you're responding with the first vaguely related thing that comes to mind instead of engaging with the actual issue, so I'll leave it be. Good luck with the RfC. Opabinia regalis (talk) 02:13, 2 September 2015 (UTC)

No worries I get it. You do not see paid promotional editing as a problems and thus feel we should not do anything about it. Doc James (talk · contribs · email) 07:35, 2 September 2015 (UTC)

You know, it is actually possible to both think it's a problem and disagree with your proposed solution. Opabinia regalis (talk) 15:10, 2 September 2015 (UTC)

Do you have any thoughts on solutions? Doc James (talk · contribs · email) 20:26, 2 September 2015 (UTC)

A couple of thoughts:

• The latest draft is a significant improvement. A person paid to mop the floor at a pharma company should not be prohibited from editing an article about a disease that the pharma company happens to sell treatments for. This draft solves that problem.
• If you want to ban certain people from editing articles, then you really, truly, actually do have to get buy-in from the whole community. It's no good slipping it into an essay. (Also, kudos to Jytdog for staying within the current policies and guidelines, even though those policies make his COI-related work harder.)
• If you want to make the split between the "evil paid PR flacks" and the "innocent employees", then you should deal with those in separate paragraphs. WhatamIdoing (talk) 06:22, 2 September 2015 (UTC)

User:WhatamIdoing if I want to get a ban on PR professionals directly editing medical content I FIRST need to get buy in from WPMED. I have no delusions that this is the end of the process. Doc James (talk · contribs · email) 07:36, 2 September 2015 (UTC)

This sounds like a chicken-or-egg problem. I suspect that many WPMED folks won't support this type of ban unless the whole community agrees to it first. At minimum, my own enthusiasm for this is tempered by my doubts that community-wide support will be forthcoming. WhatamIdoing (talk) 23:54, 2 September 2015 (UTC)

Patients

This shows Doc James removing all mention of patients and healthcare providers, on the grounds that they have no COI. This shows Jytdog adding healthcare providers back into the list. I'm not happy with either of these changes.

Patients and their families can and do put their personal interests ahead of the interests of the encyclopedia, and therefore have a "conflict of interest". For example: Let's re-write the article on this condition to talk about how patients need sympathy and practical assistance, because I'm going to link to it on social media, my friends will read it, and I want them to clean my house! Or, Let's re-write the article to tout the treatment I want my insurance company to pay for! Insurance employees do sometimes read Misplaced Pages articles, and a favorable impression might benefit me financially. User:SlimVirgin may be better able to say whether that's still considered a problem under the current version of WP:COI. (I haven't followed the guideline closely for a couple of years.) However, it does seem likely that if you are corrupting an encyclopedia article for the actual purpose of personally benefiting from it, then you have a conflict of interest.

As for healthcare providers, I think we should go back to the parallel structure, and I don't object to the issues given. However, the basic "spam" issues now listed (a) apply to a lot more than just healthcare providers and (b) are much easier to spot than adding or removing information because you don't think that patients should have access to certain information or because you want to influence the choices made by a particular patient. User:Davidruben can't be the only doc in the world who has had a copy of a Misplaced Pages article (that he wrote!) waved under his nose by a patient who was demanding that treatment conform to the recommendations of the Misplaced Pages article. WhatamIdoing (talk) 01:56, 31 August 2015 (UTC)

Those are examples of bad Misplaced Pages writing I agree. Yes I guess one could list them as COIs but they are more simply dealt with by WP:MEDRS. And yes I too have had patients bring in articles I have written. Doc James (talk · contribs · email) 02:23, 31 August 2015 (UTC)

MEDRS cannot "deal with" a physician blanking parts of an article because he wants a patient to quit asking him for a test or treatment that he doesn't want to offer, or re-writing a section to introduce happy fluff about the treatment he prefers while reducing the visibility or importance of others. MEDRS is not WP:DUE – and even if it were, trying to manipulate a real-world decision (whether it's the decision of the editor's friends to clean house, or the decision of a patient to accept a particular treatment plan) by editing a Misplaced Pages article still feels like a COI to me. WhatamIdoing (talk) 02:33, 31 August 2015 (UTC)

I have not seen "physician blanking parts of an article because he wants a patient to quit asking him for a test " I am happy to restore it if you feel it is important. But this is a non problem unlike that of paid promotional editing funded by pharmaceutical and device manufacturers. I just spend the day cleaning up a bunch of our eye articles that have been hit hard by a good dozen paid account over the last 6 years. And not that long ago done the same for our hearing aid articles.

These are WP:DUCK accounts.. They are not here to write an encyclopedia in any neutral fashion. They are here only to promote what they have been paid to promote. Doc James (talk · contribs · email) 03:10, 31 August 2015 (UTC)

I agree that healthcare providers don't usually announce that they have blanked parts of an article for the purpose of helping their patients, but I have seen something suspiciously like that. WhatamIdoing (talk) 06:39, 2 September 2015 (UTC)

• WhatamIdoing, re: your question about people with medical conditions, someone with flu writing about flu wouldn't have a COI, though they should avoid adding original research (e.g. adding "honey and lemon soothes the throat better than commercial cough mixture," just because that's what they prefer). But there is no conflicting role or relationship in being someone with an illness. If you could show that someone was pushing a certain treatment to persuade an insurance company to pay for it, that would be a COI, but we would need reason to suspect that was happening. Sarah 21:10, 1 September 2015 (UTC)
  • Right: you wouldn't have a COI if you are merely sick, especially with something so common and boring as influenza. However, you might have a COI if you are trying to re-write the article to get tangible real-world benefits, whether those are "insurance company pays for this treatment" or "I get paid sick leave for a week". This happens on occasion. It is probably more common in the psych area than in articles about common infectious diseases. At the risk of being BEANSy, the insurance company example is probably most effective for rare diseases.
    I don't know how you would classify another case, which is someone re-writing a (usually cancer-related) page to contain information about a diagnosis or treatment for the purpose of manipulating a loved one's medical decisions. Their interest (their family member's choices) and ours (an NPOV-compliant article) are different, and sometimes conflicting. But it's definitely not a financial COI, and I believe that only financial COIs are fashionable these days. WhatamIdoing (talk) 06:39, 2 September 2015 (UTC)

• most problematic patients i have dealt with are running afoul of WP:NOTADVOCACY, of which COI is a subset. The crux is how we want to consider "external relationship", right? A person has some very positive experience with a doctor or institution or drug and becomes a fan and wants to write glowing content about him/her/it, or has some very negative experience and comes here to denigrate. We deal with that sort of positive relationship between people in COI where we have "You should not create or edit articles about yourself, your family or friends"; we deal with negative relationships between people at WP:BLPCOI. But the fan or hater of a doctor/institution/drug/company is definitely here as an advocate. I would be happy to draft something about patient advocacy for this essay, if that sounds reasonable. btw a lot of the problems with alt-med content falls in this too - somebody is a true believer in Vitamin C or yoga or whatever and wants to add content about what it does way beyond what the evidence supports or beyond mainstream practice. Jytdog (talk) 11:48, 2 September 2015 (UTC)

Jytdog, liking something a lot does not give you COI, so be careful not to confuse advocacy with COI. Advocacy often exists in the absence of COI, and COI can exist in the absence of advocacy. Sarah 17:46, 2 September 2015 (UTC)

I don't confuse them and specifically said "patient advocacy". Jytdog (talk) 19:04, 2 September 2015 (UTC)

You wrote that a patient liking a doctor and wanting to add positive content would give them a COI. But that's to confuse COI and POV. A Michael Jackson fan has no COI in regard to Michael Jackson. They have a COI if they're head of his fan club, selling merchandise, a member of his family, etc. Sarah 19:21, 2 September 2015 (UTC)

Paragraph removed

I've removed this, because it seemed to encourage COI editing, including financial COI/paid editing. Also, it equated healthcare professionals and people with medical conditions, neither of whom have a COI, with pharmaceutical employees, who do have a COI. Bringing it here for other views:

Adding non-controversial information. Employees in the medical manufacturing industries might be in a unique position to provide commercial, regulatory, and historical information for products. Healthcare professionals are often skilled at explaining complex disease processes. Patients with chronic medical conditions often understand the prognosis and social impact of a medical challenge. Within your expertise, focus on the 90% that everyone agrees on, rather than the 10% that is disputed.

Sarah 18:57, 1 September 2015 (UTC)

Thanks User:SlimVirgin Doc James (talk · contribs · email) 20:56, 1 September 2015 (UTC)

Back when I started this, the idea wasn't "everyone listed here is bad", much less that everyone was equally likely to have a COI. It was more like "depending upon your individual situation, you might have a COI or you might not. Here's what's typically a problem for different types of editors, and here's what each type can usually do without getting into trouble".

For example, most healthcare providers and patients aren't destroying articles for the sake of filthy lucre or fame, but some of them are (see: any patient who has written an autobiography and spammed it around on Misplaced Pages). Similarly, you should take a long spoon to sup with most public relations staff, but some public relations staff are relatively helpful (e.g., providing copies of newspaper articles and pointing out subtle vandalism or blatant factual errors). With the exception of official public relations staff, I don't want to anoint any group as being either entirely pure or entirely foul. My experience is that individuals in these groups are heterogeneous. WhatamIdoing (talk) 06:50, 2 September 2015 (UTC)

Hi WAID, it's not a question of pure or foul, but of COI. COI isn't about a person's state of mind. It is entirely about whether they have a clash of roles or relationships. We're not necessarily criticizing a judge's state of mind when we expect her to stand down from a case involving her husband. She might be perfectly able to judge the case well, but to any outsider it would have the appearance of corruption. Similarly, it would have the appearance of corruption if a PR person for a pharmaceutical company were to write the Misplaced Pages articles on that company's products. Sarah 17:41, 2 September 2015 (UTC)

Sure, but the question with patients is more like "If the judge re-writes a Misplaced Pages article to prevent her husband from making a choice she disagrees with, then does that create 'the appearance of corruption'?" I think it can, in which case even patients and their family members can indeed have a COI, and therefore should be mentioned. WhatamIdoing (talk) 23:51, 2 September 2015 (UTC)

Anyone can have a COI. The question is whether people with an illness have a COI in relation to that illness simply because they suffer from it. The answer is no. We could imagine all kinds of scenarios that might lead to a COI (but what if they did this or the that?). There was a case of a patient who felt he had been harmed by a hospital who arrived to add criticism of the hospital. He had a COI because he felt he had been harmed by that institution, so it had become a personal dispute. But it was not because of his status qua patient. Sarah 00:05, 3 September 2015 (UTC)