Template talk:Estrogens and progestogens

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Retention of this template[edit]

Nuvola apps edu languages.png Relevant discussion at WT:PHARM#Large navboxes
User talk:El3ctr0nika#new estrogenics etc. templates

This template was recently changed to a redirect to a much larger and harder to navigate template. For the purposes of the hormonal contraceptive articles, [this version] of the template is much more useful. It gives the generations, and lists many of the major hormones used in those articles. The full on template has so much on it that finding anything is a challenge, and it would be likely to turn away the reader.

If there was any discussion about doing away with this version of the template, I haven't figured out where it is. I think it should be discussed in a broader forum than just this talk page, with a note in Wikiproject medicine, as well as any other projects that are likely to be affected. I have to sign off now, more later. Zodon (talk) 07:05, 2 May 2012 (UTC)

Hi. I recently made Template:Estrogenics and Template:Progestogenics for the purpose of replacing this template (as well as Template:Androgenics to replace Template:Androgens (link to old). I have already replaced this template with the new ones on all of the relevant articles and as far as I know this template is no longer actually used on any article. When I attempted to redirect this template to Template:Estrogenics (since it is now redundant and unused, as well as significantly less useful), Zodon reverted the change, citing diminished accessibility. However, in regards to virtually all of the many drug templates by mechanism of action (click to see all on the same page), this is the kind of template style that is used and has been used for years without issue or complaint. Discuss. el3ctr0nika (Talk | Contribs) 07:39, 2 May 2012 (UTC)
Since I typed the above message out before I saw yours Zodon I'll address yours now. There has not been any discussion yet about replacing this template with the new one. This is because, as mentioned above, this template style is the trend for drug templates by mechanism of action and there are many templates like this one that exist already. In regards to the hormonal contraceptive articles, I agree, this template probably is not suitable for them. Instead, I think a template of drugs based on usage/indication (i.e., as hormonal contraceptives) as opposed to mechanism of action would be more appropriate. Since such a template does not appear to exist already, I will go ahead and create one. Hopefully doing so will resolve this conflict. It might be a little while though, depending on whether I have free time or not. el3ctr0nika (Talk | Contribs) 07:39, 2 May 2012 (UTC)
Edit: Here's the template: Template:Hormonal contraceptives. How is that? el3ctr0nika (Talk | Contribs) 10:40, 2 May 2012 (UTC)
Hi El3ctr0nika! While I very much appreciate your tireless work on pharmacological substances, I have already stated that I disagree with your approach to navboxes. I would prefer to have the contents of the new steroid hormone templates in lists (with sources if possible), and keep the navboxes navigable, i.e. restrict them to existing articles about clinically used substances that actually make use of the mechanism the box is about.
An example: Etomidate is an anaesthetic agent. As far as I know, its affinity to 20,22-desmolase has no clinical relevance, and its anti-estrogenic/progestogenic/androgenic action is more or less theoretical. Placing five navboxes at the bottom of the article does not aid navigability of the pedia, which is the use of these boxes, but merely confuses readers. (It confuses me, and I know a bit about pharmacology.) There are countless other examples, mainly neurology drug articles that seem to have about six navboxes on principle (adrenergic, cholinergic, dopaminergic, serotoninergic, GABAergic, adenosinergic) just because someone found them to have receptor or enzyme affinity in vitro. Please let's keep navboxes simple, and discuss the subtleties in articles and lists, with references. --ἀνυπόδητος (talk) 18:51, 2 May 2012 (UTC)
Hi Anypodetos. I have a lot of stuff I need to do today (appointments, shopping, etc.) so I cannot respond right now or maybe even today altogether, but when I get some free time (probably late tonight or tomorrow) I will certainly do so. I do agree with some of your points (e.g., etomidate), and I have some ideas that I'll share later that could remedy the issues at hand. Also, I sent Meodipt a message to join this discussion as well since he's the other major person aside from myself that works on these templates. Please wait for him and I before attempting to come to any sort of consensus or making any changes. Thanks! el3ctr0nika (Talk | Contribs) 21:01, 2 May 2012 (UTC)
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Sorry for the delay.

Hi El3ctr0nika! While I very much appreciate your tireless work on pharmacological substances, I have already stated that I disagree with your approach to navboxes.

Ah. I had either not seen discussion or forgotten about it since I did. I redact my statement that there has been no opposition to the template style then.

An example: Etomidate is an anaesthetic agent. As far as I know, its affinity to 20,22-desmolase has no clinical relevance, and its anti-estrogenic/progestogenic/androgenic action is more or less theoretical.

[nitpick] Well, etomidate has in fact been shown to inhibit P450scc (20,22-desmolase) as well as a few other enzymes involved in steroidogenesis (at least in vitro, but I'm sure it has been shown in vivo before as well) (source), but you're right in that, at least for single, acute uses, its P450scc inhibitory properties are considered to be clinically insignificant (source). Chronic use may be a different story though. As an example, continuous use of etomidate for sedation in critically ill trauma patients in intensive care units is associated with a greater risk of mortality on account of its suppression of corticosteroid synthesis by 11β-hydroxylase inhibition (see here). Though less potent than 11β-hydroxylase, its actions on P450scc could have clinically relevant effects under similar circumstances (i.e., chronic use). Hence, I added the templates just in-case that is the case (the inhibition was described as "potent" by study authors after all, and most enzyme inhibitors require multiple administrations before they really begin to start working anyway). [/nitpick]

Placing five navboxes at the bottom of the article does not aid navigability of the pedia, which is the use of these boxes, but merely confuses readers. (It confuses me, and I know a bit about pharmacology.) There are countless other examples, mainly neurology drug articles that seem to have about six navboxes on principle (adrenergic, cholinergic, dopaminergic, serotoninergic, GABAergic, adenosinergic) just because someone found them to have receptor or enzyme affinity in vitro.

I agree for the most part actually. When I added those navboxes to the end of the etomidate article I had somewhat mixed feelings about doing so and only did so for the sake of inclusiveness and consistency (i.e., continuing to follow the same rules that I had been for all of the other articles). That being said, I did expect that someone would probably remove them and if they had done so I would not have protested.
In the case of a drug like etomidate, I think something like an "enzyme inhibitors" navbox specific to steroidal enzymes or, actually, even specific simply to just P450scc (as well as another one to go along with it for 11β-hydroxylase) would be much more preferable. In fact, I have been pondering the idea of coming up with a new way to handle enzyme inhibitors in navboxes anyway as, as you might have seen, often times the exact same lists (which each need to be individually maintained) are duplicated across multiple navboxes (e.g., MAO inhibitors in adrenergics, dopaminergics, serotonergics, and melatonergics, or the steroidal enzymes in androgenics, estrogenics, and progestogenics as well as would be glucocorticoids and mineralocorticoids if they were at present done in the same style). Not to mention, for an MAO inhibitor like say phenelzine, under the principles of the current setup, you would have to include four entire navboxes simply because they associate with a single action. So I agree, it's a bit of a redundant mess at the moment, to say the least.
It's a shame that the current navbox system isn't more modular. To be able to do something like simply placing the code {{P450scc inhibitors}} inside of the 20,22-desmolase section in say the estrogenics template and flawlessly include that information while being able to use the same {{P450scc inhibitors}} code simultaneously as a navbox on a relevant drug article like etomidate would be extremely helpful. It would be possible to completely avoid the issues and confusion associated with having to use multiple and ambiguous navboxes on articles (e.g., androgenics, astrogenics, progestogenics, glucocorticoids, etc., -> P450scc inhibitors) while at the same time not losing the benefit and usefulness of being able to have an entire -ergics navbox in which all of the drugs that affect a specific system are listed on an article where doing so would be useful (e.g., the serotonergics template on the serotonin neurotransmitter article) (otherwise we'd just be shifting the mess (e.g., having to have a bunch of navboxes—e.g., "5-HT receptor ligands", "MAO inhibitors", "SERT ligands" "VMAT ligands", etc.—on the serotonin article instead of a nice, simple and compact "serotonergics" template—yuck)). In addition, on say a tricyclic antipsychotic article, instead of similarly having to have a million different navboxes to cover all of the different actions, we could considerably simplify things by having the option to simply use say a "monoaminergics" navbox with collapsible sections to cover their combined adrenergic, dopaminergic, and serotonergic actions. Assuming histaminergics and cholinergics also had to be included, we could reduce the navbox load from five to three.
I wonder if something like that is possible on Wikipedia. Perhaps I should look into it. If it is in fact possible (though a fork of the navbox template might have to be made to make it work), I would be happy to do the work and implement it as well as migrate all of the current templates to the new system. Anyway, I just mention all of this because we're on the subject of modifying the drug navbox template system anyway and I thought I'd throw some ideas out there. Such a system certainly would solve most of the issues we're discussing right now I believe.

Please let's keep navboxes simple, and discuss the subtleties in articles and lists, with references.

I agree that the details of the pharmacological actions should be discussed in the articles in question as well, but as much as I would love to do it myself, adding such content to every single article, for me, would be overwhelming and much too much to handle. Hence, having a navbox at the bottom of the article is an easy way to indicate that a certain drug possesses a certain pharmacological effect without actually having to go into detail about it. And more often than not I think, such actions are in fact likely to be clinically relevant. After all, if a drug has say for example 100-fold lower affinity for a certain site compared to others it's probably not relevant under any circumstance, and hence, I won't add the navbox associated with the site of action in question.
el3ctr0nika (Talk | Contribs) 04:27, 5 May 2012 (UTC)

Hi guys. Personally I think there are advantages and disadvantages to both approaches, when there are a very large number of research ligands for a particular target it can be very useful to have them all laid out in a big navbox split by subtype selectivity etc. But then when you want to compare one prescription medicine to another one, you only really need the few drugs marketed for that condition listed, not every known research ligand for that target. I don't see the harm in having multiple navboxes at the bottom of an article, so long as they are all collapsed neatly, and the information and organisation they provide is complementary, not just repetitive. At the same time though, there is definitely a strong argument to keep the smaller navboxes tidy and only have key drugs and topics listed, and if you want to add lots of obscure research ligands to a big chart then have a different navbox for that, which might appear at the bottom of the page for research ligands but maybe not on all widely used drugs. Meodipt (talk) 22:00, 2 May 2012 (UTC)

I agree. There are benefits to both approaches. Personally, I think keeping medicine-associated navboxes (i.e., drugs by use/indication) simple (e.g., only including marketed drugs/drugs that made it to clinical trials) and allowing pharm-associated navboxes (i.e., drugs by mechanism of action) to be complex is a good and effective solution that allows for both approaches to be used. After all, though there is overlap, they are basically the territory of two completely different WikiProjects (i.e., WikiProject Medicine and WikiProject Pharmacology). For example, it would not be appropriate to limit a pharm navbox to marketed drugs only nor would it be appropriate to include every single drug ever patented for a certain indication in a med navbox. In this case (in my opinion at least) the med navbox style was basically being used on a pharm navbox and, upon it becoming restyled (to maintain consistency with the other pharm navboxes as well as to make it more useful and inclusive), due to the fact that there were no appropriate med navboxes to replace it (e.g., "hormonal contraceptives", "drugs used for hormone replacement therapy", etc.), this conflict inevitably arose. I apologize as I should have taken into account the fact that I would essentially be deleting the med equivalent navbox without properly substituting it when I went ahead and redirected the page to the new navbox. In any case, I think a good solution to this matter would be to create new med navboxes to replace the old one (e.g., "hormonal contraceptives" and "drugs used for hormone replacement therapy" namely, the former of which I already made here). That being said, I do recognize that there are still issues related to the navboxes within WikiProject pharm itself that need to be addressed though. I don't think it would be appropriate to discuss those issues here though. el3ctr0nika (Talk | Contribs) 05:35, 5 May 2012 (UTC)
1) One issue I see here is that we have multiple wikiprojects working in an area, and I am not sure there has been any discussion/communication between the groups on the area. Specifically this template and the one on androgens are parts of a huge system of templates {{Medicine navs}} covering anatomy, physiology, conditions, procedures, etc. (That is what those little boxes at the bottom are all about). So, while this template may have been removed from the pages it covered, it is still linked to by a lot of other templates. (All of which follow the same standards for coloring, layout, etc.)
user:Arcadian and others have spent a lot of work developing this system, they should also be involved in these discussions. I suspect that these matters are of sufficient impact to both wikiproject medicine and wikiproject pharmacology that this discussion should be publicized to both groups (and any others involved), and possibly held in a more public/accessible location. I don't know if there is a standard place for discussing matters relating to the medicine navigation template system, or if it should be in the talk area of one or the other wikiprojects, or what. (I don't care where it is discussed, just figure we should pick a good spot and then publicize it well.) Zodon (talk) 01:02, 3 May 2012 (UTC)
See my response immediately above. el3ctr0nika (Talk | Contribs) 05:35, 5 May 2012 (UTC)
2) As far as the {{Hormonal contraceptives}} template, thank you for creating it. I haven't analyzed it in detail, but it seems to give more focused coverage for that use. However I am not sure how viable the approach is. For instance, many of these drugs are used for other things (treating menstrual symptoms, hormone replacement therapy, etc.) If we start having templates for each specific use there is going to be a lot of overlap. (And a lot of template buildup on some articles.) There is also the problem of point of view - contraception can be rather politically charged, etc. Some groups frown on them, even though they may have other uses. Consider if we have a template of abortifacients. That may tend to bias the view of the reader towards those chemicals, even if in a given application they are not being used as abortifacients.
The system that had been worked out for the medicine navboxes seemed to work fairly well. This template for instance does not cover all the hormonal contraceptives, but it covers a fair number of them. It also is applicable to drugs for other conditions as well. There didn't seem to be a lot of overlap and duplication in these navboxes, and I had not noted them building up to where there were an overwhelming number of them on a page.
Although I have edited some of the medicine templates, I am not one of the major architects of the system, I trust others can speak better to its overall successfulness, strengths and weaknesses. Zodon (talk) 06:27, 3 May 2012 (UTC)

As far as the {{Hormonal contraceptives}} template, thank you for creating it. I haven't analyzed it in detail, but it seems to give more focused coverage for that use. However I am not sure how viable the approach is. For instance, many of these drugs are used for other things (treating menstrual symptoms, hormone replacement therapy, etc.) If we start having templates for each specific use there is going to be a lot of overlap. (And a lot of template buildup on some articles.)

Personally, I think that the pharm and med-styled navboxes should remain separate. Hence, I don't think the solution to this issue is to replace the new navbox with the old one (or even a new one styled similarly to the old one). Again, see my response above for more on why I feel that way. In any case, I recommended creating new med navboxes based on indication (e.g., "hormonal contraceptives" and "drugs used for hormone replacement therapy" namely, the former of which I already made here) to solve the conflict. However, I see your concern with having multiple navboxes for that purpose. I think hormonal contraceptives and abortifacients could be included in the same navbox (I basically actually already included abortifacients in the new hormonal contraceptives navbox for the most part when I made it) and I also think drugs used in hormone replacement therapy and drugs used for the treatment of menopausal symptoms (since they're practically the same thing) could be combined into the same navbox as well. That would only be two navboxes, and in my opinion, would not be too bad. There could be other indications that I'm missing though. Alternatively, they could all be combined into a single navbox (e.g., "drugs used as contraceptives, in hormone replacement therapy, and for related indications"). It would probably overlap with the pharm navbox, but I think that would be fine as again, I think med and pharm navboxes should stay separate.

There is also the problem of point of view - contraception can be rather politically charged, etc. Some groups frown on them, even though they may have other uses. Consider if we have a template of abortifacients. That may tend to bias the view of the reader towards those chemicals, even if in a given application they are not being used as abortifacients.

I don't really agree with you on this point. But it is simply a matter of opinion, so I won't say anymore than that, except that I simply don't think it would be an issue. And, if it were, the navbox could be combined with hormonal contraceptives to make the uses of the contents more ambiguous (i.e., more difficult to tell what's what). As mentioned above, the hormonal contraceptives navbox I made basically already includes abortifacients (I included them because there is quite a lot of overlap between the two kinds of drugs after all).

 :The system that had been worked out for the medicine navboxes seemed to work fairly well.

As discussed above, there are advantages to both approaches. And again, as discussed above, I think med and pharm navboxes should remain separate. If that means keeping both this navbox and the new one I made, then so be it (though I do think this one could use a little work personally as I think it's sort of, well, eck, but that's just my opinion), I actually don't think that would be a half bad idea. I think there are better approaches myself (like the ones I talked about above), but it would work anyway.

This template for instance does not cover all the hormonal contraceptives, but it covers a fair number of them.

What hormonal contraceptives did I miss? I was pretty sure I got all of them. Unless there are clinically-used hormonal contraceptives that act on non-steroidal targets that exist.

It also is applicable to drugs for other conditions as well. There didn't seem to be a lot of overlap and duplication in these navboxes, and I had not noted them building up to where there were an overwhelming number of them on a page.

Again, different navbox styles intended for completely different purposes. From a med perspective I completely understand the problems you see with the new navboxes. But they were not intended for med, they're for pharm.
el3ctr0nika (Talk | Contribs) 05:35, 5 May 2012 (UTC)
3) At this point I hope that no more of the replacement of the {{Medicine navs}} templates will take place until the various interested parties have had a chance to discuss this thoroughly and reach some consensus. That includes any interested editors from medicine, as well as pharmacy, and any other projects that would likely be affected. Since the new navboxes violate some of the principles at WP:NAVBOX and Wikipedia:Navigation templates, input from editors there should also be sought. (I don't mean to get caught up on venue, but I feel like this change has suddenly been sprung on folks, so would like to make sure other people don't have a similar experience.) Some specific questions:
  • To what other projects/places should this be publicized?
  • Is this the appropriate place for this discussion? (If not, what is a more public venue?- one of the project talk areas, request for comment, ?)
  • Should we just go inform folks at the relevant places that this discussion is happening here? [Edit: Thank you νυπόδητος for posting a mention of this discussion on the pharmacy talk. I added one at WP medicine.]
  • Which of the Medicine navs have been replaced or are proposed to be replaced? (Should probably include a notification banner on any navs that were replaced or are proposing to replace, so that editors of affected articles know what is happening).
Zodon (talk) 07:06, 3 May 2012 (UTC)
Replaced templates are {{Calcium channel blockers}}, {{Androgens}} and {{Sex hormones}} (the latter previously redirected to {{Estrogens and progestogens}}). Changed and expanded were {{Hypnotics and sedatives}} and {{Antidepressants}}, which now do not fit the colour scheme and have become difficult to navigate (in my opinion). Not sure this list is complete. --ἀνυπόδητος (talk) 16:30, 3 May 2012 (UTC)
This is a complicated issue since it involves not only WP:PHARM, but also WP:MED and possibly WP:MCB and maybe a few others I haven't thought of. At a minimum, I think we need to retain a set of drug navboxes free of any red links that are restricted to approved drugs + drugs undergoing clinical testing. It might be worthwhile to have a parallel set of templates that include drugs earlier in the R&D pipeline, but I think we should be careful not to generate too many navboxes and also be careful that the size of any one navbox does not become too big (see my previous comments). Whether it is better to have indication or target focused navboxes probably needs to be determine on a case by case basis. Boghog (talk) 19:41, 3 May 2012 (UTC)
For med navboxes I think restricting red links and non-approved drugs is a good idea, but I do not agree with that when it comes to pharm navboxes. el3ctr0nika (Talk | Contribs) 05:35, 5 May 2012 (UTC)

I think the medicine-related navigation templates (those that contain marketed/late-stage clinical candidates) are most useful for the Wikipedia community. They list topics that are more sought after, in general, than the topics listed on the more extensive mechanism of action templates. I haven't had a chance to read everything relating to this discussion, so I'm not sure if this has been suggested already or not, but what about including both templates since they serve two different purposes. The larger mechanism of action templates can be set by default to be collapsed so that they don't interfere with the readability of the article, or distract from the generally more relevant medicine templates, but they can be expanded and used by those that are interested. -- Ed (Edgar181) 12:12, 8 May 2012 (UTC)

  • Agree. Slight redundancy is tolerable. --Arcadian (talk) 00:07, 9 May 2012 (UTC)

Moving forward[edit]

Okay, I'm trying to sum up the results of the above discussion. Please contradict me if I got anything wrong.

  • Consensus for keeping the ATC-based navboxes (called medicine-associated above, although they are part of WP:PHARM as much as of WP:MED, but never mind).
  • Consensus for keeping the mechanism-based navboxes. Boghog raised concerns about the boxes getting too large, but as long as they are collapsed (and, my addition, placed below the ATC boxes), and given el3ctr0nika's intention to remove redundancies, this is hopefully not a big issue.
  • No consensus on removing redlinks. Although redlinks violate WP:NAV, I won't keep nitpicking here. WP:NAV is not policy, after all.

el3ctr0nika, unless you or someone else have complaints about this summary, would you be so kind and reinstate the ATC-based boxes? These are {{Calcium channel blockers}}, {{Androgens}} and {{Sex hormones}}, and any others you might know of. I'd ask you to add them on top of the mechanism boxes, because (as has been pointed out somewhere above) they are probably the most useful for most people and certainly the easiest to navigate. Hope everyone is happy with my conclusions. --ἀνυπόδητος (talk) 13:49, 13 May 2012 (UTC)

Sounds good to me. Though I should note that I may or may not be able to reduce redundancy in the mechanism of action navboxes in the way that I'd like to (due to potential limitations with the template system). In any case, I'll sooner or later get around to seeing if it can be done and implementing the changes. I'll look into reinstating {{Calcium channel blockers}} and {{Androgens}} as well. Though, it should be noted that I'm starting to develop wiki burnout, so I may procrastinate. If anybody else wants to do it instead please, feel free. Also, it should be noted that the {{Sex hormones}} template just redirected to {{Estrogens and progestogens}} when I edited it, so that navbox did not actually exist (at the time at least, I don't know if it did before or not). And finally, sure, I always do med/indication templates followed by pharm/mechanism of action templates for navboxes anyway. Seems like the best order. el3ctr0nika (Talk | Contribs) 04:11, 15 May 2012 (UTC)