Wikipedia:Articles for deletion/Clinical trials with surprising outcomes

Clinical trials with surprising outcomes

Clinical trials with surprising outcomes (edit | talk | history | protect | delete | links | watch | logs | views) – (View log)

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inclusion criterion is "important"; subjective to determine clinical trails that are surprising and which are not; many clinical trails are conducted but to determine a surprising outcome is subjectiveCurb Chain (talk) 12:49, 1 October 2011 (UTC)

Note: This debate has been included in the list of Medicine-related deletion discussions. —Tom Morris (talk) 14:26, 1 October 2011 (UTC)

• Delete. If secondary sources could establish strong criteria for inclusion and article set, the utility of the list would outweigh the problem of deciding what is "surprising" vs. "merely unexpected". A resource for some good "game changing" research in medicine would be nice, but a list that would exclude Jenner's vaccination study or Pasteur's rabies series because they didn't have an acronym (weren't formal trials by modern standards) isn't. The current list suffers from recentism, and the arbitrary character seems too great a gap to bridge.Novangelis (talk) 14:58, 1 October 2011 (UTC)

• Delete. Inherently subjective, I can't see that this can be rescued. Clinical trials often differ in their results, for all number of reasons, e.g. see Publication bias, Decline effect. Any null result of a new pharmaceutical is probably a surprise to the company that funded the development of the drug (though that could of course be debated at length). Fences&Windows 19:26, 1 October 2011 (UTC)

Comment. The clinical trials in this article have more significance than e.g. a disappointing result for new drug X or Y. Rather the findings in the cited studies changed clinical practice. Andrew73 (talk) 03:26, 5 October 2011 (UTC)

• Keep. This page clearly demonstrates the importance of clinical trials; even the best assumptions need to be tested, or we risk harming people with sub-optimal treatments. Isn't education/enlightenment of the non-specialist a fundamental purpose of an encyclopaedia? Norman21 (talk) 19:40, 1 October 2011 (UTC)

Not this encyclopedia, and are we supposed to list every clinical finding? How do you determine which are surprising and which are not?Curb Chain (talk) 03:17, 2 October 2011 (UTC)

To answer all three of your points in turn, (a) why not? (b) who is suggesting this?? (c) yes, "surprising" is subjective, but subjective lists can have value - for example, List of films considered the best. Norman21 (talk) 13:25, 2 October 2011 (UTC)

• Comment The example you provided, "List of films considered the best" employs an objective criterion: "have all been mentioned in a notable survey". (Wikipedia has developed criteria for notability.) It is not the subjectivity of "surprising" itself, but coming up with a standard basis for inclusion which is problematic. "Selection criteria should be unambiguous, objective, and supported by reliable sources." Novangelis (talk) 13:48, 2 October 2011 (UTC)

While there may not be an obvious, standard, unambigious, objective reference to firmly guide studies that are included, I don't think the absence of this necessarily means that this article should not be included in Wikipedia. (Perhaps one could be found if one looked more thoroughly). One of the motivations for including these studies is that they serve as examples why medicine relies on randomized clinical trials and not just on observational studies. Andrew73 (talk) 17:08, 2 October 2011 (UTC)

The example I gave is based on polls and surveys, the results of which are objective, but the subject matter is still subjective. If I did a "straw poll" of "clinical trials with surprising outcomes" amongst my colleagues and managed to get the results published, would you then be happy for the page to remain? Norman21 (talk) 15:33, 2 October 2011 (UTC)

• Keep. Full disclosure, I'm the editor who started this article. By definition, this article will inherently have recentism as a concern since clinical trials are a relatively recent phenomenon in the history of medicine. My sense is that this is meant to be a starting point, and as a a result, some of the criticisms may stem from the fact that this article is not as comprehensive as it could be or could use a better title. I am not aware of a secondary source that could be used to decide which trial is considered "surprising." On the other hand, here's a reference that mentions two of the trials (bone marrow transplant in breast cancer and liberal blood transfusions) here as having unexpected findings [1]. Ultimately, there is value in having an article that has examples of trials with unexpected outcomes or trials that failed to confirm conventional medical dogma or observational findings. Andrew73 (talk) 22:46, 1 October 2011 (UTC)

What other title could we use instead? What benchmark would we use to define a trial that failed to confirm conventional medical dogma or observational findingsCurb Chain (talk) 03:20, 2 October 2011 (UTC)

Open to suggestions for alternative titles. I agree that there isn't a well-defined gold standard for defining a trial that failed to confirm observational findings, some of this is subjective and would reflect consensus from the medical community. However, I don't think that the absence of this gold standard means that this article would necessarily be flawed. Andrew73 (talk) 05:48, 2 October 2011 (UTC)

What titles are there? I don't know of any. This article may be valuable elsewhere, simply, but not on wikipedia.Curb Chain (talk) 17:32, 2 October 2011 (UTC)

• Leaning towards delete. A large proportion of trials achieves an unplanned result - either it is negative where initial studies had suggested a positive or there are other unexpected outcomes. The number of trials to discuss is potentially limitless unless we can tighten up on the definition of "surprising". JFW | T@lk 21:29, 2 October 2011 (UTC)

Which is impossible to prove and pointless. There's no adjective you can replace that won't be emotional for the intention of the article, or POVed.Curb Chain (talk) 23:26, 2 October 2011 (UTC)

• Comment I noticed that the objections raised with this article would also be relevant to the content here: Wikipedia:WikiProject_Science_pearls. Andrew73 (talk) 17:27, 3 October 2011 (UTC)

• Reply The objections raised here are relevant to those articles to which they apply, but only at their own deletion discussions, not this one. One of the lists was recently deleted (Wikipedia:Articles for deletion/List of important publications in biology) for absence of objective inclusion criteria, making the list original research. That deletion does not impact this discussion, and I raise it only because it is so similar that it can educate inexperienced editors on the process. No one debates that there are important publications in biology, but the list was evaluated and failed to meet standards established in policy. This list is unlikely to have objective criteria and is not to be judged based on what other articles exist, but rather on its capacity to satisfy the standards for lists on Wikipedia. The question for this discussion is the possibility of constructing a list using objective criteria, based upon Wikipedia policy, and not based on the existence or nonexistence of any other article.Novangelis (talk) 18:25, 3 October 2011 (UTC)

I think there is a risk of missing the point. The article in question was never intended to be a comprehensive list; rather, it is simply a collection of a few examples illustrating the importance of randomised controlled trials. See the comment by Andrew73 above. Norman21 (talk) 15:54, 4 October 2011 (UTC)

There is no missing the point. This article describes clinical trials with surprising outcomes. This article does not illustrate the importance of randomised controlled trials, as I can find nothing on it that hints at this.Curb Chain (talk) 13:22, 5 October 2011 (UTC)

Are you sure you have read the correct article? Phrases such as "As a result, medications of this specific drug class are no longer routinely given ...", "...associated with a dose-dependent increase in mortality...", "As a result, HRT is no longer routinely recommended...", and "...supplementation increased the incidence of lung cancer and the risk of death." These are not "hints", but examples that clearly demonstrate people would have suffered and/or died unnecessarily if it were not for these clinical trials. Norman21 (talk) 15:08, 5 October 2011 (UTC)

There are an unsurmountable number of studies with these findings. I do not know how you can include them all, but more specifically, choose which ones to include or are worthy of inclusion.Curb Chain (talk) 03:40, 6 October 2011 (UTC)

Here is a reference in Hepatology [2] and in the New England Journal of Medicine [3] that cites three of the studies in the article (the CAST study, hormone replacement therapy, BMT for breast cancer) as examples of clinical trials with unexpected outcomes. Again, the point is that the studies mentioned in this article are recurrently mentioned as significant examples of clinical trials with unexpected outcomes. Andrew73 (talk) 03:19, 5 October 2011 (UTC)

::::This is all your original research. I know of many studies that are significant. And they were clinical trials. And they have unexpected outcomes. I don't see how this is not your own view/editorial judication of what is surprising and what is not.Curb Chain (talk) 13:22, 5 October 2011 (UTC)

Since the studies in this article are mentioned in reputable medical publications as examples of clinical trials with unexpected outcomes (e.g. based on the references I provided in Hepatology and NEJM), there is some external validation and thus the viewpoints in this Wikipedia article reflect general medical consensus and not necessarily only my viewpoint. Again this list is not meant to be exhaustive but just meant to provide some key examples, so I'd hesitate to throw the baby out with the bathwater. Andrew73 (talk) 15:21, 5 October 2011 (UTC)

So another inclusion criterion is involved: "key". How do you define that?Curb Chain (talk) 03:38, 6 October 2011 (UTC)

A "key" study is a study that's frequently cited because it changes medical practice/sets a new standard of practice. Andrew73 (talk) 04:20, 6 October 2011 (UTC)

• An alternative title proposal. Suppose the title of this article were changed to something like, "Randomized clinical trials showing ineffectiveness of widely used treatments" or something more succinct, would that help address some of the above criticisms? Andrew73 (talk) 15:33, 5 October 2011 (UTC)

:"Ineffectiveness" is hard to objectify (it is not a bright line rule) in the medical sciences.Curb Chain (talk) 03:42, 6 October 2011 (UTC)

Sorry, I mean "widely".Curb Chain (talk) 03:43, 6 October 2011 (UTC)

• Keep, for the same reasons discussed in great detail at Wikipedia:Articles for deletion/List of important publications in mathematics and other related discussions. In particular, accusations of "original research" regarding this page are spurious. Editorial decisions regarding the inclusion of content are fundamental to Wikipedia. The act of reading sources and choosing material to include in Wikipedia is not OR according to the policies here. Just read WP:OR: Research that consists of collecting and organizing material from existing sources within the provisions of this and other content policies is fundamental to writing an encyclopedia and so on. It seems clear that the content of this page is supported by sources. I agree that the name of the page isn't ideal, but I don't have enough subject-specific knowledge to propose a good alternative. Jowa fan (talk) 22:47, 5 October 2011 (UTC)

Look at the key phrase "within the provisions of this and other content policies". This and the other related lists fall outside these provisions.Curb Chain (talk) 03:46, 6 October 2011 (UTC)

Comment. I added this discussion to Wikipedia:WikiProject Deletion sorting/Lists. The arguments there are relevant to this discussion. Andrew73 (talk) 03:06, 6 October 2011 (UTC)

• Delete. Entirely subjective criteria. What's surprising to one person will be unsurprising to another. I don't see anything in the references that describes the results as 'surprising'. Such language is usually confined to reports in the popular press but such reporting is by its nature of little use as references for science articles.--JohnBlackburne^words_deeds 17:18, 6 October 2011 (UTC)
• Delete very subjective criteria. Fails the policy of what wikipedia is not: WP:NOT says articles are not case studies and are not indiscriminate information (read: subjective compilations). Dzlife (talk) 17:45, 6 October 2011 (UTC)

Comment The criteria for inclusion, as discussed elsewhere, is not entirely subjective. The trials here are frequently mentioned as clinical trials showing ineffectiveness of widely used treatments, see e.g. a reference in Hepatology [4] and in the New England Journal of Medicine [5]. In some respects, there is almost a "core list" of clinical trials that clinicians frequently reference as justification for why clinical trials are done and why medicine does not rely on observational studies or expert opinion alone. Such a list is inherently notable/significant. I agree though that the title of this article could be changed, and perhaps that would help with addressing some of the criticisms that have been brought forward. Andrew73 (talk) 20:46, 6 October 2011 (UTC)

• Delete as above. But some of these cases may be discussed in the clinical trial main article. Neutrality^talk