User talk:MastCell

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Welcome to Wikipedia![edit]

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Process[edit]

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 Wikipedia 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 Talk 17:53, 29 April 2013 (UTC)

Explanation for RfC post..[edit]

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:

  • [1]: I stated: We've seen the malpractice often enough in cases like Michael Jackson, etc. but what about the following NPR report? [2] Things keep getting crazier.
  • [3]: 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. 👈 I intentionally proved your point and agreed with you. To point to him Not just him, there was an "etc." 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.I know little of homeopathy 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, [4]. 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. [5]

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 Talk 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. petrarchan47คุ 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 Talk 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. petrarchan47คุ 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: [6]. --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 Talk 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 Talk 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: [7]. 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: [8]. 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 Talk 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)