Wikipedia talk:Manual of Style/Medicine-related articles

To-do list

• Add advice on how to incorporate the psychological, emotional, and social effects of health problems into articles.
  • should be infused throughout
  • may need some subsections, e.g., reaction to a life-threatening diagnosis
• Add advice on how to present costs.
  • accuracy ("the wholesale list price in Ruritania in 2017 according to Alice", not "the price")
  • WP:MEDMOS2020 results
• Turn bullet point on when to describe something as altmed into a section.
  • altmed vs folk medicine vs controversial vs disproven; avoiding altmed as disparaging term or a catchall for non-scientific
  • importance of representing that classification depends upon time and place
  • role of WP:DUE and WP:INTEXT attribution
• Add statement about gender-neutral language.
  • Avoid unexpected neutrality for subjects very strongly associated with one biological sex (e.g., pregnancy, menstruation, and ovarian cancer affect "women"[1]; prostate cancer and orchiditis affect "men") but encourage gender neutrality for all others (e.g., heart disease)?
  • Defer to MOS for any individual person.
• Reading levels
• (Your idea here)

Proposal to change "Medical uses" to just "Uses"

The term "medical uses" is recommended as a subject heading in #Drugs, treatments, and devices, #Surgeries and procedures, and #Medical tests. It was changed by Doc James from the harder to understand "Indications" back in 2014 (Wikipedia_talk:Manual_of_Style/Medicine-related_articles/Archive_8#Indications_versus_medical_uses) with a prior discussion back in 2011 (Wikipedia_talk:Manual_of_Style/Medicine-related_articles/Archive_6). Pretty much all of the discussion has related to drugs with the idea being that it distinguishes between clinical and other uses (such as recreational, as a stimulant, etc.)

However, I am editing in the surgical and medical test space at the moment and I really feel that this needlessly disambiguates as a section title. For example, editing Lithotomy or Lithotripsy it just feels weird to add "Medical uses" (as these are surgical procedures) or, when editing Antibiotic sensitivities, it's weird to add "Medical uses" as the article is in relation to antibiotics and, why do I need to mention medical everywhere? And what about veterinary or epidemiological use of these tests?

I would like to propose that we replace "medical uses" with just "Uses" at the very least for the surgeries and medical tests areas, for the following reasons:

1. It needlessly disambiguates the section titles. A section about how a procedure or test is used is clearly about how that surgery or test is used.
2. Our encyclopedic mission is to describe how things are used via secondary sources etc., not to provide a list of how they should be used (ie. the indications). I say this because of WP:NOT referring to "not a textbook" and "not a how to"
3. It is weird and clunky to describe a surgical procedure as having a medical use (as opposed to a surgical use)
4. The use of tests is more than just medical, as mentioned above

If there are many uses then, as per usual, we can split the section into subsections; however for the vast majority of articles I think this simplification makes sense

I note that after the notification about the change in 2014, a number of editors also described "uses" as being equally acceptable. I'd like to hear what other editors think about this suggestion.--Tom (LT) (talk) 07:58, 4 July 2020 (UTC)

I'm not opposed to "Uses" when it's the better heading. WP:MEDSECTIONS is clear that we don't have to be strict with headings. And in the Condom article, "Uses" "Use" is currently there because what is mentioned in that section are are not just medical uses. But "Medical uses" might be best in some cases. I definitely agree about unnecessarily disambiguating. I don't see "Medical uses" or "Uses" as conflicting with WP:NOT, or "Medical uses" conflicting with "surgical procedures", though. Flyer22 Frozen (talk) 05:45, 6 July 2020 (UTC)

I have no objection to trying this. It could be a very good idea. WhatamIdoing (talk) 18:10, 6 July 2020 (UTC)

Try what, though? Which specific aspect of the proposal? We could also state "Medical uses or Uses." We do use "or" in the guideline to present an alternative title. Flyer22 Frozen (talk) 19:15, 6 July 2020 (UTC)

I think we should try "Use" (or "Uses"). I think we also need to retain "Medical uses" when there are non-medical uses. ==Uses== could in some cases be sub-divided into ===Industrial uses=== and ===Medical uses===. WhatamIdoing (talk) 15:13, 7 July 2020 (UTC)

I would think that changing the guidance to state "Medical uses or Uses" per Flyer22 Frozen makes sense. For articles like surgical procedures, "Uses" would be preferred, and for articles on chemicals that have other uses, "Medical uses" would be the sensible choice for the section that discusses those medical uses. Editors will surely be able to use common sense on which is better for a given article. --RexxS (talk) 21:42, 7 July 2020 (UTC)

Exactly. Flyer22 Frozen (talk) 21:46, 7 July 2020 (UTC)

Agreed. Johnbod (talk) 23:32, 7 July 2020 (UTC)

Agree. --Tom (LT) (talk) 00:27, 9 July 2020 (UTC)

 Done Special:Permalink/967734442 --Tom (LT) (talk) 00:02, 15 July 2020 (UTC)

"Impact" section

Hi WhatamIdoing, I saw your to-do list above and have been thinking about this as a section title to capsure the effects of a condition, test etc on a person. Perhaps we can insert this somewhere in the guideline as a section that can be included in articles if relevant, rather than approaching it from the perspective of each particular article type (eg disease, test, etc.). --Tom (LT) (talk) 04:21, 6 July 2020 (UTC)

Not sure what "impact" would cover that wouldn't already be covered in one of the other sections. For example, the "Society and culture" section. Flyer22 Frozen (talk) 05:45, 6 July 2020 (UTC)

The current set-up is comprehensive, I agree; I just propose this in response to WAID above and as I do think its prominence in some articles could increase. Society and culture seems to be and impact and interpretation of something at a group level; whereas "Impact" (or something similar) relates to an individual. I do think something could be said for increasing this from a subsection to a section title. As, after all, most encyclopedic articles represent actual topics that have the potential to be life altering or lifechanging and have large impacts on people. So it's weird that something so central to people's experience of the articles is hidden in a subsection. Such an approach would certainly be in line with the way medicine has been taught and recorded, but I don't think it necessarily means it's right for us. Happy to hear what others think though. --Tom (LT) (talk) 06:16, 6 July 2020 (UTC)

Tom (LT) (thanks for pinging me), I can see the value of this idea. Stevenfruitsmaak suggested something along those lines recently, and you can read the discussion in the archives here.

If you look at Diagnosis of HIV/AIDS, I'm not finding words (such as fear, anxiety, emotion) that suggest that the subject of the effect of this diagnosis on the actual person is mentioned anywhere in the article at all. Recommending a specific section might encourage inclusion of such information. I don't think that this information is about ==Society and culture==. That section is for stigma, or for culture-specific information. The fact that most people are frightened when you tell them they have life-threatening diseases is not about "society". Individual psychological reactions are about each individual separately.

I'm not sure whether we need a separate section, or if we need to produce a sort of parallel checklist for completeness ("If the article is about a substantially disabling pediatric condition, then you need to mention the rest of the family. If the article is about a life-threatening or disabling condition, then you need to mention psychological stuff. If the article is about a debilitating hereditary condition, then mention fertility choices. If the article..."). In edu-speak, that would be called an "infusion area", which means that you never teach a specific lesson about (e.g.,) women's careers, but you make sure that this information is "infused" throughout the curriculum. WhatamIdoing (talk) 23:41, 6 July 2020 (UTC)

Looking at the "Common sections" area ("WP:MEDSECTIONS), we have some of those referring to specific sections in general ("Society and culture", "etymology", "External links"). I recently edited Ostomy system, which has such a huge multidimensional impact on someone, and it was weird that didn't have a place do go. We could add a subsection to the "MEDSECTIONS" group called something like "Impact" with the text something like:

Impact Many articles within the scope of this guideline have a significant impact on a personal level, whether receiving a diagnosis, physically preparing for a test, recovering from surgery, or living with a chronic condition, or assisting as a carer. This information should be included within articles. This could be throughout the article, or if can be included with in a separate section called "Impact". When included, this information still requires reliable sources to be used.

What do you think? I remember SandyGeorgia mentioning this during a discussion about DLB as well (Apologies Sandy for multiple recent pings). --Tom (LT) (talk) 00:28, 7 July 2020 (UTC)

That description looks good. We should consider adding something about education and career effects. The "society" effect for a widespread disabling condition would be the loss of a zillion dollars to the global economy; the "individual" effect is that you lose your job.

Can we find a more specific term than "Impact"? ==Psychosocial effects==? ==Effects on life==? The loss of a zillion dollars to the global economy is also an "impact", and I'd prefer a suggested section heading that is clear that this is about the individual instead of the whole world. WhatamIdoing (talk) 15:20, 7 July 2020 (UTC)

You stated, "The fact that most people are frightened when you tell them they have life-threatening diseases is not about 'society'. Individual psychological reactions are about each individual separately." I disagree. As noted in the "Diseases or disorders or syndromes" section in MEDSECTIONS, "Society" in "Society and culture" is something that "might include social perceptions, cultural history, stigma, economics, religious aspects, awareness, legal issues, and notable cases." The word might indicates that "this is not all it can include." Something else it includes are individual experiences on the aforementioned matters or other matters...meaning how the disorder or disease, for example, affects people in some way and others in another. It's not like we typically cover how a medical issue or perceptions of anatomy affect one individual. The "Society and culture" section is going to include information about how people react (whether frightened or not) when they are told that they have a life-threatening disease. Some of these sections in our medical articles already do that, and that includes the Cancer article. I'd rather not start seeing "Impact" sections in articles when that impact material can go in the "Society and culture" section without incident. But regarding Tom's proposal, I think that the wording "This could be throughout the article, or it can be included within the 'Society or culture' section, or a separate section called 'Impact'." would be better. Still, something like "Psychosocial effects" or "Effects on life" could be a subsection of "Society and culture." It's what I would do, if I wanted such a specific heading.

I'll leave a post about this at WP:Med for wider input. Flyer22 Frozen (talk) 19:36, 7 July 2020 (UTC)

Cancer#Diagnosis says "Cancer diagnosis can cause psychological distress". Would you put that in ==Society and culture== instead? Cancer#Management mentions "emotional, spiritual and psycho-social distress" and says that some people "need help coping with their illness". Would you move that to a different section, or leave it where it is?

What is in Cancer#Society and culture section that sounds to you like it's really about the typical experiences of individual patients? The paragraphs there are about

1. stigma (due to incurability),
2. Western individualism vs the rest of the world (in the context of when, whether, and how the patient learns about the diagnosis),
3. metaphors used to describe it (hmm, the UK metaphor of a journey seems to have disappeared),
4. the positive-thinking nonsense from the 1970s, and
5. a bit of philosophy. 

I don't think that any of that is about the effects of a condition, test, etc., on an individual patient. WhatamIdoing (talk) 19:44, 8 July 2020 (UTC)

I agree "Impact" doesn't necessarily convey that it's about an individual. "Individual impact?" "Experience?" --Tom (LT) (talk) 00:26, 9 July 2020 (UTC)

On talk pages, we sometimes talk about "patient experience", but MEDMOS rejects the "patient" language, and it's not appropriate in many circumstances anyway. WhatamIdoing (talk) 02:11, 9 July 2020 (UTC)

Whether to have something in the "Management" section as opposed to it being in the "Society and culture" section is a case-by-case basis thing. The takeaway is that the material will fit better in one of those sections. And so an "Impact" section, or rather an "Impact" heading, is not needed. The "Psychosocial effects" or "Effects on life" headings are better because they aren't as vague, and they could fit in either the "Management" or "Society and culture" section. You speak of "effects of a condition." That's vague. It could mean physical, psychological, or psychosocial effects. And physical effects aren't covered in our "Society and culture" sections. Stigma (due to incurability) can have a psychosocial effect. So if that is what is meant by "impact" in whatever case, then it fits in a "Psychosocial effects" or "Effects on life" section...wherever they are placed. Stigma is a society and culture thing that impacts people individually. Flyer22 Frozen (talk) 05:46, 9 July 2020 (UTC)

There is no content about individual psychological reactions to a cancer diagnosis in Cancer#Society and culture, and I'm having trouble imagining what would belong there. I have the same problem with heart disease, STIs, life-limiting genetic diseases, or all the other things that I think would cause some distress upon diagnosis. Could you make up an example sentence about someone's individual psychological response to a distressing diagnosis that you think belongs in the "society" section, so I can figure out why you think that would ever be the right place for it? WhatamIdoing (talk) 18:50, 9 July 2020 (UTC)

Hmm. Unless we are misunderstanding each other, this seems like it's a case where we simply disagree. WP:Med and WP:Anatomy editors haven't always agreed on what belongs in whatever section or how to set up an article. It's why WP:MEDSECTIONS states, "Changing an established article simply to fit these guidelines might not be welcomed by other editors. The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition." It's why this discussion even exists. In this case, I don't understand how you are delineating things. And, no, I don't need more examples for your rationale. "Cancer#Society and culture" currently states, "People with a 'cancer personality'—depressed, repressed, self-loathing and afraid to express their emotions—were believed to have manifested cancer through subconscious desire. Some psychotherapists said that treatment to change the patient's outlook on life would cure the cancer. Among other effects, this belief allowed society to blame the victim for having caused the cancer (by 'wanting' it) or having prevented its cure (by not becoming a sufficiently happy, fearless and loving person). It also increased patients' anxiety, as they incorrectly believed that natural emotions of sadness, anger or fear shorten their lives." This is psychological/psychosocial material. And if this were still going on today, it would still fit in the "Society and culture" section. In fact, the section in question also states, "Although the original idea is now generally regarded as nonsense, the idea partly persists in a reduced form with a widespread, but incorrect, belief that deliberately cultivating a habit of positive thinking will increase survival. This notion is particularly strong in breast cancer culture." Another example of psychological/psychosocial material belonging in the "Society and culture" is what is currently here at the Vulva article. Labia stretching and how it affects women is a society and culture matter that includes psychological/psychosocial aspects. And, yes, I know that the Vulva article is an anatomy article. But above, I did state "It's not like we typically cover how a medical issue or perceptions of anatomy affect one individual." You stated, "someone's individual psychological response to a distressing diagnosis." For me, when discussing what we've been discussing in this section, it is not about someone's individual psychological response to a distressing diagnosis. It's about how the disorder or disease may affect people's lives, including socially. Naturally, the individual aspect will be covered by the fact that some people will go through it (the effect in question) while others won't. If we are talking about "psychosocial" -- the word that was suggested -- instead of "psychological", yes, that material may very well fit best in the "Society and culture" section. To me, what fits best in the Management (or Treatment) section, as opposed to the "Society and culture" section, really depends on the content (and personal opinion). Flyer22 Frozen (talk) 02:29, 10 July 2020 (UTC)

Telling people that they have a disease can increase their short-term risk of suicide. Where would you put that fact? WhatamIdoing (talk) 19:32, 10 July 2020 (UTC)

Not in the "Society and culture" section, obviously. Unless, of course, it had to do with mean-spirited or misinformed people spreading an unfounded claim that a certain disease can or will increase their short-term risk of suicide.

Again, "psychosocial" is one of the terms that was used in two of the proposed headings. Merriam-Webster defines psychosocial as "1: involving both psychological and social aspects // psychosocial adjustment in marriage [...] 2: relating social conditions to mental health". One example it includes is the following: "This arrangement requires students to balance their education and domestic realities, including psychosocial concerns like food and housing insecurity, violence, family illness and parents leaving home as essential workers." Another is the following: "Health workers and people in quarantine lacked psychosocial support and suffered from conditions such as post-traumatic stress disorder, PTSD." Yourdictionary defines psychosocial as "relating to the combination of psychological and social behavior. An example of psychosocial is the nature of a study that examines the relationship between a person's fears and how he relates to others in a social setting."

All of that (not just the bolded parts) is what I am talking about with regard to adding material to the Society and culture section. Social aspects are usually covered in the Society and culture section. Marriage stuff would normally fit best in the Society and culture section. Flyer22 Frozen (talk) 02:32, 11 July 2020 (UTC) Tweaked post. Flyer22 Frozen (talk) 02:44, 11 July 2020 (UTC)

So "Parents are distraught upon learning that their baby has leukemia" maybe gets filed under "Diagnosis – reaction to", but "Families go bankrupt from medical bills" or "Schools are notoriously bad at accommodating this disability" would go under ==Society and culture==. What about "Managing this condition requires so many hours per day that most parents are unable to remain employed"? WhatamIdoing (talk) 22:00, 14 July 2020 (UTC)

Given what I stated above, with emphasis on "case-by-case basis", I see no need to keep entertaining these alternatives or scenarios you are unnecessarily throwing out there. It's already clear we don't fully agree. Flyer22 Frozen (talk) 02:17, 15 July 2020 (UTC)

Because when I don't understand the metes and bounds of our (dis)agreement, then I'm more likely to come up with a bad suggestion for how to describe this in the guideline. WhatamIdoing (talk) 06:21, 18 July 2020 (UTC)

iPad/iPhone typing apology. At both Tourette syndrome and dementia with Lewy bodies, when we discussed this before, [2] I found that everything could be accommodated in the current suggested headings. I don’t think we need more Suggestions. But they are only suggestions. If something cannot be accommodated In this scheme, nothing stops you from adding a new section. I guess a broader question is whether there are problems with the current scheme. SandyGeorgia (Talk) 20:09, 7 July 2020 (UTC)

Yeah, the "If something cannot be accommodated In this scheme, nothing stops you from adding a new section." viewpoint is how I feel. Flyer22 Frozen (talk) 21:25, 7 July 2020 (UTC)

I agree that there is nothing critical about this proposal, and that really it is a matter of wording (I guess that's why we are discussing at this venue). I think the root problem that I refer to here is that the collective and individual impacts are described in the same section. We don't need to rigidly adhere to that rule, but I find it unusual that the impact on an individual is discussed in a subsection, whereas so much information is discussed with greater prominence. Although nothing stops an editor, I thought I would discuss it here because adherence to this guideline has been enforced somewhat concretely. If we are able to amend the guideline on the other hand, the likelihood of drive-by article reformatting is much lower, as would be the wasted time justifying the section to reverting editors.--Tom (LT) (talk) 00:26, 9 July 2020 (UTC)

Experienced editors know they can create a new (sub)section, and they know they can discuss psychosocial effects in the Society and culture section. But what about less experienced editors? One of the primary purposes of a guideline is to educate less experienced editors. We should therefore highlight the importance of discussing the psychosocial effects of disease. ¶ There is another—perhaps even more important—reason to emphasize a malady's mental and emotional impact: Wikipedia's guidelines, policies, and procedures communicate our ethos. The minimal attention we currently pay to the mental and emotional impact of illness suggests an apathetic, insensitive attitude toward human suffering.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 08:42, 18 July 2020 (UTC)

References

===Mental and emotional aspects=== might be a good heading for some articles (the "scary disease in adults" category). I think you wouldn't need/want it for Common cold, and we might want something separate for caregiving content. WhatamIdoing (talk) 16:18, 19 July 2020 (UTC)

Good ideas. :0)   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 00:15, 24 July 2020 (UTC)

Should we suggest "Pharmacodynamics", "Mechanism of action", or both?

At Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs,_treatments,_and_devices we suggest titling a subsection on a treatment's mechanism of action as "Mechanism of action" or "Pharmacodynamics". I propose we drop the "Pharmacodynamics" suggestion. In an unscientific study I just asked a few non-clinicians around me, and no one had a good sense of what "Pharmacodynamics" means. They each reported being more likely to click on a "Mechanism of action" section. I'll leave you all to repeat the same study and see if you arrive at the same conclusion. These are just suggested section headings, so changing this wouldn't mandate any particular way. I'm just suggesting we no longer suggest "Pharmacodynamics". Thoughts? Ajpolino (talk) 23:52, 14 July 2020 (UTC)

• I absolutely 100% agree. "Mechanism of action" is much clearer to lay readers. I personally think we should specifically note that the term is preferred to pharmacodynamics. I think it is very important that the information we write about can be understood. --Tom (LT) (talk) 00:23, 15 July 2020 (UTC)
• I think it's more of a biochemist thing than a normal-person thing. It's going to be clinically important for some drugs (e.g., those with a narrow therapeutic index, or a half-life that's eitherr particularly long or short). I don't know if it's relevant to most. WhatamIdoing (talk) 06:19, 18 July 2020 (UTC)

@WhatamIdoing: I could be mistaken here, but I think we recommend a drug's half-life, distribution, et al. be covered in a subsection just after "Pharmacodynamics" titled "Pharmacokinetics". Ajpolino (talk) 18:07, 18 July 2020 (UTC)

It looks like that's meant to cover half-life but not therapeutic index?

Separately, I don't think that Pharmacodynamics and Mechanism of action are synonyms. WhatamIdoing (talk) 16:13, 19 July 2020 (UTC)

Some anatomy edits

I have made some minor edits to parts of the guideline that refer to anatomical articles, based on my experience about what happens in practice (diff here: Special:Diff/967735076/967736285):

• For the title, clarify that TA assists finding the English language title; remove reference to 'developmental anatomy' as an area of difficulty (hasn't been while I've been here), and insert reference to 'common name', as this usually IS an area of difficulty
• In the anatomy guideline, remove "There is no need to duplicate information provided in the infobox". This usually results in uncited and noncontextualised information within the infobox, so I have removed it. It is better for the information to also be included in the article so that it can be cited, and details about that thing can be included (for example, listing External iliac artery as blood supply is not as useful as detailing how the blood travels through smaller arteries to get to that point, and use of reliable sources to verify that statement)
• In the anatomy guideline, in "Structure", remove "brief" from "including a brief description of location and size". I don't think "brief" has assisted any editors in practice and it's weird to have it there, seeing as the whole article is about an anatomical structure, and it should be covered in as much depth as required. --Tom (LT) (talk) 00:25, 15 July 2020 (UTC)
• In the anatomy guideline, put "Microanatomy" as the first term to "Histology", reflecting most of our articles (it's also more easy for lay readers to understand)
• In the anatomy guideline, insert in "Development" that it can also be used to cover changes in later life where appropriate (eg for Prostate and Thymus)
• One or two small grammatical changes

Hope these are not too controversial, --Tom (LT) (talk) 00:21, 15 July 2020 (UTC)

Tom, I'm fine with most of the changes. But regarding this? "Microanatomy" is used in most of our anatomy articles now because you led the way on that. Also, you commonly change "Histology" to "Microanatomy" when you see it. I'm not complaining. I understand wanting to be consistent across articles. But in the 2018 discussion we had on it, there was no consensus to use "microanatomy" instead, and it was pointed out in that discussion that "histology" is still significantly more common than "microanatomy." I still think that readers will understand "histology" better than "microanatomy." And in the #"Impact" section above, you did complain about "drive-by article reformatting."

As for this? I prefer that the development section be about the development in the womb (and early life development if the material is available on that and the content fits better there). That has been standard, including for the Human brain article. I think that aging material beyond that typically fits best in a different section, such as the "Clinical significance" section that may include an "Aging" subsection. And why would the development section need to be separate from the structure section if "lengthy"? It seems you are saying it might be better to have it separate if the structure section is already lengthy (with subsections) and the development section is also lengthy due to subsections it may have? Otherwise, I don't see why it wouldn't just be a subsection of the structure section. Yeah, the Human brain article currently has them separated, but that's not necessary. A compromise could be to have the guideline state that aging material can go in the development section or in a separate section. Flyer22 Frozen (talk) 02:17, 15 July 2020 (UTC)

And speaking more on "development" with regard to an organ/body part, sources are usually speaking of development in the womb when speaking on the matter. Our Development of the reproductive system and Development of the urinary system articles, for example, are reflective of that. Flyer22 Frozen (talk) 02:35, 15 July 2020 (UTC)

Thanks Flyer22, you make some good points

Regarding microanatomy and histology you are right to identify that I have a point of view relating to the use of microanatomy, for the reasons stated in the previous discussion (ie. that it's more understandable to lay readers, micro + anatomy, as compared with histology which they have no linguistic point of reference other than 'ology')... I had forgotten about that discussion however. I respect your reversion and happy to hear what other editors think about this particular matter

Regarding development, you do make a good point that development is commonly taken to mean just until the structure is developed (ie before adulthood). I have occasionally mentioned aging, but the most prominent example I did use got its own subsection (Thymus#Involusion). So I can see where you're coming from here... happy to leave this one lie, and given it is quite occasional I wonder if just leaving it and dealing with it on a rare case by case basis is better than formalising it at this stage.--Tom (LT) (talk) 09:12, 15 July 2020 (UTC)

Thanks, Tom. Flyer22 Frozen (talk) 02:27, 16 July 2020 (UTC)

Proposal to include ethnicity and geographic distribution

In keeping with the global spirit of WP:WORLDVIEW, I propose specifically mentioning "ethnicity" and "geographic distribution" among the items listed beside Epidemiology under
== Diseases or disorders or syndromes ==

FROM:

• Epidemiology: factors such as incidence, prevalence, age distribution, and sex ratio.

TO:

• Epidemiology: factors such as incidence, prevalence, age distribution, and sex ratio, ethnicity, and geographic distribution.

86.186.155.159 (talk) 12:37, 24 July 2020 (UTC)

• Support - sounds like a sensible addition. --Tom (LT) (talk) 12:56, 24 July 2020 (UTC)
• Support, but ... - it does sound sensible. At the same time, there's always the possibility of "unintended consequences" or "unforeseen complications" when making significant changes. Perhaps add such (sub)sections to a few of articles to serve as exemplars and as a way to (maybe) identify unforeseen complications. If the consensus is to support without such "tests" (for lack of a better term), then I will also support the proposal.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 17:05, 25 July 2020 (UTC)

  I appreciate your thoughtfulness Mark, and I absolutely agree about the "unintended consequences" part at least (epidemiology does tend to be somewhat complicated and nuanced, and – like other medical content – calls for careful wording). Part of my thinking is that "geographic distribution" is so key to epidemiology that it really needs to be elicited alongside age, sex, etc. And that "ethnicity" also needs to be there, and is another key factor that often needs to be covered. 86.191.67.230 (talk) 18:39, 25 July 2020 (UTC) [OP]

  I'm not an epidemiologist, but I'd say ethnicity is almost never a factor in disease, never mind a key factor. I'm willing to be educated, though, if anyone can provide enough examples where it is actually a key factor. Boing! said Zebedee (talk) 17:24, 26 July 2020 (UTC)

  (@Boing! said Zebedee: I have no wish to be drawn on this extensive invitation, but just one aspect here: PMID 30978304 ) 86.191.67.230 (talk) 18:25, 26 July 2020 (UTC)

  Thanks, I'll check that out. But I must reflect what RexxS points out below, that (though there can be overlap) genetics is not ethnicity, and those links are not about ethnicity. For example, I have a genetic aspect to an illnes, but it's not ethnic. Boing! said Zebedee (talk) 18:30, 26 July 2020 (UTC)

  Thanks for that, @Boing! said Zebedee: Obviously they're not the same thing, but they can sometimes be linked. Just by way of an example, if you look at the abstract of PMID 30978304 I think you'll see the problem of how focusing on a single ethnicity (in this case, a supergroup of "populations of European descent") can potentially skew our scientific understanding of genetic risk factors. Well, that's a general methodological concern, I hear you say... For an all too immediate example of how an ethnically-related risk factor can impact on *multiple* diseases, you might look at betel (a page I've tried to improve from a health perspective, despite pov pushers). A couple of years after discussing this "neglected global public health emergency" with Johnbod over a convivial pizza after meeting up at Cancer Research UK, one of my closest friends sadly fell ill with esophageal cancer of the squamous-cell type, for which betel nut chewing is a major risk factor ([3][4]). She was British-born (of mixed European heritage), but had spent part of her life in countries (and among ethnicities) where betel nut chewing was somewhat analogous to tobacco smoking in Europe. I feel this personal memory provides a tangible example of how risk factors related to ethnicity can be both very real and, at the same time, not altogether straightforward. And, in fact, epidemiology - which looks at variations in morbidity and mortality among different groups/populations of people (including different ethnicities) - is intriguingly complex. But, as you may rightly say, that's not what we're talking about here under the Disease section heading of == Epidemiology == . And I'll agree with you. But, if we reflect about how COVID-19 in Britain, the US, and elsewhere, has disproportionately affected minority ethnic groups – obviously something that requires explanation – then I think you can see how pertinent it can be to cover variations among ethnic groups (which clearly isn't the same thing as claiming that ethnicity causes disease [I know you didn't say that :-]). Though, as I've tried to make clear below, my intention here, as OP, was basically to encourage more truly global coverage, without fixating on any particular *word*. 86.191.67.230 (talk) 20:43, 26 July 2020 (UTC)

  I certainly agree with the desire "encourage more truly global coverage, without fixating on any particular *word*", but when the word is "ethnicity" then it could be opening a door to problems. The betel story is interesting (my mother-in-law chews the stuff), but I'd use the word "cultural" for that factor rather than ethnicity. If we drew a Venn diagram of genetic/ethnic/cultural factors there'd be certainly be some overlap, but I'm really not sure how much (and I think at least some of the factors would be controversial). Then again, ethnicity is surely based on cultural distinctions at one end of the spectrum and genetic distinctions at the other end. And, as far as science/medicine goes, there isn't really any such thing as ethnicity at all. I think we could benefit from considering all these factors, but I disagree with the idea of lumping them all under ethnicity. Perhaps we should go with "geographic, genetic, cultural and social factors"? But might that be getting a bit too wordy? Boing! said Zebedee (talk) 07:24, 27 July 2020 (UTC)

  I'll also add that yes, I do think the fact that minority ethnic groups appear to be more seriously affected by Covid-19 in the UK and US is important. But the effect is on multiple different ethic groups, which suggests it's not actually an ethnic effect. And I think seeing it as an ethnic effect can keep us away from considering the underlying reason. Is it social (eg relative deprivation, as some suggest)? Is it simply wealth, where wealthier people generally live in situations of more effective social distancing? There's a whole bunch of possible factors, and I'm sure it's being covered in our articles without the MOS having to say "ethnic" specifically. Boing! said Zebedee (talk) 07:32, 27 July 2020 (UTC)

• Oppose including ethnicity as a determining factor in epidemiology. Ethnicity is a social construct, as much as race is. Without a definitive means of establishing ethnicity, figures linking linking ethnicity to a particular disorder are at best speculative, and at worst misleading because of the presence of confounding co-factors. --RexxS (talk) 19:11, 25 July 2020 (UTC)
• Oppose including ethnicity, unless there is clear MEDRS research showing different prevalence among ethnic groups, typically in settings involving immigration at some point. Sickle cell disease would be one example. Apart from Rexx's point just above (though epidemiologists do seem to believe ethnicity exists, unlike sociologists) the ethnic makeup of those affected will largely follow geography for diseases. Johnbod (talk) 20:08, 25 July 2020 (UTC)
• I Oppose including ethnicity too. I think RexxS and Johnbod have explained the reasons well. Boing! said Zebedee (talk) 11:49, 26 July 2020 (UTC)
  • @RexxS and Johnbod: Are you opposing "ethnicity" alone (rather than the spirit of the proposal to encourage greater WP:WORLDVIEW in our descriptive coverage of the occurrence and distribution of diseases/disorders/syndromes under == Epidemiology ==)? 86.191.67.230 (talk) 09:24, 26 July 2020 (UTC)
    • I think I was clear that I support including "geographic distribution", and perhaps less so that I support including ethnicity where there is good research supprting this. So Sickle cell disease yes, but not probably African trypanosomiasis. I must say that most of the disease pages I look at seem to have geography/ethnicity covered in a reasonably appropriate way already, but no doubt there are many where just the US (perhaps and the UK) is covered, and any ethnic element is restricted to prevalence among African-Americans. COVID 19 is an example where the extensive early reseach on ethnicity should be mentioned, but extremely tentatively, given it seems clear that socio-economic factors have large confounding effects. The paper you link to just below sums up the issues well, I think. The author does not seem to agree with RexxS that "Ethnicity is a social construct, as much as race is", but seems to admit the difference between the two is often in the eye of the beholder. Johnbod (talk) 14:46, 26 July 2020 (UTC)
      • Indeed. Where there is a clear and well-documented relationship with ethnicity (and I think "ethnicity" spans a spectrum from genetics to social construct), it can be included. But adding it to the MOS as something that should be included will surely encourage people to add it where it isn't scientifically validated. Boing! said Zebedee (talk) 14:54, 26 July 2020 (UTC)
        • To be clear: I support the use of geographic distribution as that is a clearly defined criterion. I have a problem with treating ethnicity in the same way. Firstly, because ethnicity is either going to be self-reported or assumed by the the data collectors. That leaves considerable margin for error or misinterpretation. Secondly, because I don't believe a mechanism exists for connecting ethnicity with disease transmission. Does anybody seriously propose that being Jewish or African-American or Basque makes you more or less susceptible to a disease or to transmitting it? The social factors governing those are far more important: relative poverty and cultural-specific behaviours can be seen to play a far greater part. Finally, it is a mistake to confuse ethnicity with genetics. You only need examine studies like "Genetic diversity and the emergence of ethnic groups in Central Asia" to see evidence that ethic groups are far from genetically homogeneous, and that there is often more variably in genetics within a group than between groups. --RexxS (talk) 15:23, 26 July 2020 (UTC)
          • Re:"it is a mistake to confuse ethnicity with genetics". Yes, that's a good point, but then there are groups widely considered ethnic groups who share a crucial bit of genetics. The example of our Sickle cell disease article does make mention of "ethnic group"s and "ethnic origin", and I don't see anything wrong with the way it does it. Sickle cell disease transmission really has got nothing to do with social factors, but is down to genetic characteristics shared by some ethnic groups. Anyway, this is essentially why I think any relevant ethnic characteristics can be covered without the MOS saying so - after all, the vast majority of diseases really have no ethnic connections at all. Boing! said Zebedee (talk) 15:48, 26 July 2020 (UTC)
          • (edit conflict)To be clear: per my cmt below, I wasn't really expecting the "ethnicity" suggestion to be discussed here as a *determinant* (cause, risk factor, etc) of disease, but, primarily at least, as a *descriptor* (similarly to "geographic distribution"), per my understanding of how == Epidemiology == as a page *section* (as distinct from the field) fits into MEDMOS likes to structure the diseases/disorders/syndromes group of MED pages (although understanding of causality/etiology often emerges, eventually, following observations of particular *variations* in distribution). And given that there seems to be some consensus here on the descriptive aspect, I'm really, really happy to step back for the time being from debating the precise wording. As you (both :) point out, the idea is simply to help stimulate appropriate breadth of descriptive coverage to fit current knowledge on the topic of each page, while avoiding unintended consequences. (And, of course, I fully recognize the work-in-progress aspects here and elsewhere on Wikipedia.) 86.191.67.230 (talk) 16:18, 26 July 2020 (UTC)

References

(sub-) proposal to include geographic distribution

In view of the expressions of concern above regarding the relevance of ethnicity to epidemiology in general [5] (which, frankly, I hadn't altogether foreseen - and I think entering into discussion on some of the points and claims raised might not be helpful here), I feel it may be better to confine this proposal to "geographic distribution" (or something similar - e.g. perhaps "...across different populations" [?]). In practice, I feel mention of this key element should encourage broader *descriptive* coverage (per the MEDMOS listing, I understood "determinants" primarily fit under == Causes == [ Causes: Includes risk factors... ]). And it clearly doesn't exclude appropriate, reliably-sourced, coverage of other pertinent epidemiological descriptors.

FROM:

• Epidemiology: factors such as incidence, prevalence, age distribution, and sex ratio.

TO:

• Epidemiology: factors such as incidence, prevalence, age distribution, and sex ratio, and geographic distribution.

  86.191.67.230 (talk) 09:24, 26 July 2020 (UTC)

• Support this, though I would be prepared to go further, as above. Johnbod (talk) 14:46, 26 July 2020 (UTC)

Actively consider the possible role of sociodemographic, cultural, geographic, racial/ethnic, and sex/gender variables

First a little comprehension check for yours truly. If I understand correctly, we are discussing the Manual of Style for Medicine-related articles, specifically with regard to the Diseases or disorders or syndromes section of an article, under which are suggested headings, one of which is epidemiology, and we are further discussing how to best describe (prescribe?) the content of epidemiology sections. Is that correct?

Assuming I'm oriented x 4, allow me to proceed to my main point.

I am not sure the best way to accomplish this goal, but I am sure that our objective should be to encourage editors to consider the potential role that sociodemographic, cultural, geographic/environmental, racial/ethnic, and sex/gender variables might play in the cause(s), exacerbations, diagnostic challenges, and epidemiology of a disease, disorder, or symptom.

By "consider" I mean, in part, to look for such factors when searching the literature. If we don't look for them, we will assume they don't exist. These sociodemographic, cultural, geographic/environmental, racial/ethnic, sex/gender, and other variables might fall under Epidemiology or they might merit discussion under the Society and culture section, or they might not be relevant at all.

Headings are simply a classification scheme. Consequently, we will often need to describe factors that do not fit neatly under one or another heading. The most important thing is that we remain awake and thoughtful about the possibility that sociodemographic, cultural, geographic/environmental, racial/ethnic, sex/gender, and other variables might play an important role in the development or maintenance of a disease/disorder/syndrome.

As a side note, here are some Wikipedia articles I stumbled across that offer food for thought: Race and health, Hispanic paradox, Mexican paradox, French paradox.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 08:18, 27 July 2020 (UTC)

@Markworthen Yes indeed, that was the intention, and I agree with pretty much everything you say here (including "I am not sure the best way to accomplish this goal." :-) Leaving aside the evident misconstruals contained in this thread, I acknowledge a general lack of appetite here for these particular MEDMOS proposals, and fully accept the potential for unintended consequences. This does not alter my longstanding belief in the relevance of not overlooking such factors, including socioeconomic / occupational ones. I believe the present juncture – in which current events have brought such factors to wider public attention – could be a good time for MED contributors to consider them, somehow, in a rational and informed way. Imo, we would do well to acknowledge the potential relevance (e.g., see PMID 23224324 / above) of systemic bias here, especially considering the global reach of the English-language Wikipedia as a freely available source of reliable health information. 86.191.205.25 (talk) 14:46, 30 July 2020 (UTC) [OP]

Wrt this and the above discussion, I think we should be careful not to allow the "suggested sections" of this MOS to so dominate our thinking about how to write and structure an article. It is just a list of suggestions. The basic policy here is WP:WEIGHT: what does the body of high quality literature say about aspects of this subject? What proportion and prominence do they give to these aspects? There is a danger that we have a heading and editors go looking for material to fill that heading and end up finding on PubMed or GoogleBooks material that is biased or horribly out-of-date or mere brief mention, and include it for the sake of saying something. This isn't speculation: such editing occurs. Instead, I would encourage editors to first find the most recent and comprehensive sources on the topic (academic/professional textbooks, chapters in such, expert clinical guidelines, reviews) and look at the section headings and aspects the sources consider important. I agree of course it is useful to have a check-list of possible sub topics to consider for inclusion and not to overlook something, but don't treat it rigidly and be aware that there may be good reason why many sources don't cover that aspect (at all, or in any detail). Of course, not every source is comprehensive: a review by a neurologist may be lacking in coverage of social, carer, nursing or economic aspects of a disease, say. -- Colin°^Talk 09:26, 27 July 2020 (UTC)

What Colin said. Please stop the CREEP here— the section is just a suggested list, and it is not possible to encompass everything, nor will every topic be the same. And the entire page needs to be rewritten, to get back to how a guideline should operate. Colin, wish you would do that :) SandyGeorgia (Talk) 12:36, 27 July 2020 (UTC)

• Yes, I much prefer this approach, especially the way Colin puts it. A check-list of possible sub topics to consider for inclusion is clearly a useful thing to have, but if we over-stress it we could be making a tool for literalists to beat us with (and we have far too many literalists here as it is). Boing! said Zebedee (talk) 12:50, 27 July 2020 (UTC)

Chemical names aren't cultural

Paclitaxel#Society and culture has a ===Names=== section that I don't think should be under ==Society and culture== at all. I suspect that it was put there because of MEDMOS's suggested section order. WhatamIdoing (talk) 18:48, 6 August 2020 (UTC)

The "names" section also includes information about stereochemistry/structure, so per WP:PHARMOS, the logical place to put this information is under "chemistry". I was bold and moved it. Boghog (talk) 22:11, 6 August 2020 (UTC)

I prefer to have an "Etymology" or "Definitions" section separate from the "Society and culture" section, but it makes sense to me when one or both aspects are included in the "Society and culture" section. Flyer22 Frozen (talk) 04:35, 8 August 2020 (UTC)

In this case, though, the section was/is about the nomenclature. Flyer22 Frozen (talk) 04:39, 8 August 2020 (UTC)

Removing guidance about the lead, and adding a bit about terminology and technical language

Colin, regarding this and this, what WP:Consensus is there for removing guidance about the lead? That we have a WP:Lead guideline does not mean that we cannot also have a section in this guideline about how to handle leads. In addition to medical articles, I sometimes work on film articles. And as you can see at MOS:FILM, we have a section there about handling leads. Different topics might require that leads are handled in ways specific to those topics. This is even the case regarding the WP:MEDMOS#Anatomy section. It mentions how we handle leads in anatomy articles. It doesn't mean that the guidance conflicts with WP:Lead, any more than WP:MEDRS conflicts with WP:Reliable sources or WP:Verifiability. It has often been the case that editors have wondered how to handle the lead of a medical article because it's a medical article. Pointing them to the WP:Lead guideline, the general guideline about leads, will show them how leads are generally written. But it won't give them an idea of how we generally write the leads of medical articles. And I've seen enough WP:Student editors who will write the lead of a medical article like it's the lead of a media topic or something else. It's because Wikipedia treats medical information so seriously and as a special case that we even have WP:MEDRS and WP:MEDMOS. Anyway, because of all of this, I reverted you. I reverted back to the WP:Status quo. We can re-craft the WP:MEDMOS lead section, but I see no valid reason to get rid of it entirely.

I also want editors' opinions on this bit you added. For example, I don't think we should state "low-literacy adults."

I'll contact WP:Med and WP:Anatomy to weigh in. No need to ping me when you reply. I only pinged Colin to get his attention. Flyer22 Frozen (talk) 04:20, 13 August 2020 (UTC)

The text about leads removed by Colin had nothing to say that was specific to medical writing. Nothing. It merely repeated, awkwardly, what was already available in general guidelines. As far as I know, there is nothing specific to say about how medical leads are written, so removing the WP:CREEP is beneficial.

Perhaps you can suggest an alternate phrase for “low-literacy adults”? SandyGeorgia (Talk) 04:50, 13 August 2020 (UTC)

What is the basis for the claim that

Part of the role of an encyclopaedia is to teach the reader new words and help them build confidence with harder ones.?

--Whywhenwhohow (talk) 04:53, 13 August 2020 (UTC)

(edit conflict) When editors (especially newbies) look to this guideline, they will also want information about how to write the lead of a medical article. Having a short section on it, even if essentially stating that writing the lead of a medical article doesn't differ much from writing the lead of a general article, is beneficial. But I disagree that it doesn't differ much. To repeat, "It has often been the case that editors have wondered how to handle the lead of a medical article because it's a medical article. Pointing them to the WP:Lead guideline, the general guideline about leads, will show them how leads are generally written. But it won't give them an idea of how we generally write the leads of medical articles. And I've seen enough WP:Student editors who will write the lead of a medical article like it's the lead of a media topic or something else." WP:MEDMOS would benefit from guidance on how best to write the lead of a medical article. For example, at Cancer, I do like the "Definition and symptoms", "Cause and diagnosis", "Prevention and treatment", and "Epidemiology" hidden note setup in the lead. That setup is neat and does work for numerous medical articles. And I've already pointed to WP:MEDMOS#Anatomy noting how we go about the first sentence of the lead for anatomy articles. Flyer22 Frozen (talk) 05:00, 13 August 2020 (UTC)

As you have repeated yourself, I will too ... there was nothing in the deleted text that addressed anything specific to medical leads. Also, we cannot be guided by students, who seem to rarely read guidelines or instructions of any type about how to edit. The idea that the order of text in the lead should be the same across all articles has been detrimental in numerous cases, and I oppose introducing that. Every topic is different, and the flow for one article may be different than for another. SandyGeorgia (Talk) 05:07, 13 August 2020 (UTC)

I'm not saying that we are guided by students. I'm saying that students and others need guidance. I'm saying that having a section about writing the lead of a medical article in a guideline about how to write medical articles is beneficial. To me, not having it would be a glaring omission. It would be as glaring an omission as MOS:FILM not having a section about writing the leads of film articles. Like MOS:FILM, WP:MEDMOS is not about being strict when it comes to article setup (not usually anyway); WP:MEDSECTIONS is clear about that. But WP:MEDSECTIONS also shows that we do typically opt for consistency. And having a consistent lead setup like the one seen at Cancer or Autism is a good thing. When deviations are best for the article, we go with those deviations. That's always been the case. Other things, like first and foremost letting readers know what the topic is about (its definition), are best across the board. Flyer22 Frozen (talk) 05:18, 13 August 2020 (UTC)

Students won’t read it, students almost never write leads (although they often plop text into leads that does not belong there, but that is covered by WP:LEAD already), and for most of MEDMOS’ history, we did not feel the need for this sort of instruction creep, and we did better without it than with it, by sending people to the consensus and better written Wikipedia-wide guidelines. Leads were damaged and made less readable by the forced/imposed order (for example, Tourette syndrome did not work with the forced order, nor did dementia with Lewy bodies, and Casliber also had a hard time with schizophrenia forced order). What the topic is about being established first is covered by LEAD ... again, as far as I know, there is nothing specific to be said about medical leads, and we can point to LEAD for better guidance for everyone. SandyGeorgia (Talk) 05:59, 13 August 2020 (UTC)

Sandy, I've guided a lot of students over the years, and many of them have read (or at least skimmed enough for an understanding) WP:MEDRS and WP:MEDMOS. There are far more student editors than the regular medical editors, and they are the main ones editing medical articles. As someone with a lot of articles on her watchlist and who patrols with WP:Huggle, I see this every day. Besides, like I stated, students aren't the only ones who need guidance on writing medical leads. Newbies in general and those who don't, or usually don't, edit medical articles need guidance as well. I think that leads like Cancer or Autism are very good examples of how our leads should be written. I don't see that the current piece in the guideline has hurt leads, especially if it, as argued by you, Colin, and Tom, is just a regurgitation of WP:Lead. It's not like it should conflict with WP:Lead anyway. Like WP:FILMLEAD, we can still send people to WP:Lead with a link in the section. But this guideline should have guidance on leads regardless of it goes over things already covered in WP:Lead. That is not WP:CREEP. I disagree that there is nothing specific to be said about medical leads. The fact that we cover "definition and symptoms", "cause and diagnosis", "prevention and treatment", and "epidemiology" in the lead is specific to medical articles. And, again, there should be no forced/imposed order. Should we typically be consistent? Yes. Just like we are typically consistent with article setup. More below in response to Colin. Flyer22 Frozen (talk) 02:09, 14 August 2020 (UTC)

Then we just disagree on all counts I guess. I think the autism lead is dreadful, and for that and other reasons (lack of maintenance as the lead was downgraded) that article unfortunately needs to be defeatured. One of our most highly read medical articles. And to give you an idea of how this notion that we must cover certain points in leads caused me problems at dementia with Lewy bodies ... the fact that I had to include the 8 years life expectancy to conform with one editor's idiosyncratic ideas about leads is problematic. Knowing the full body of literature and what goes in to how that number is built and what is known now about the prodomal phase with earlier diagnosis of REM sleep behavior disorder based on sleep studies (new knowledge), I think that 8-year number is weak as all heck, and doesn't belong in the lead. But if I didn't go along with one person's views about what goes in leads, I would not have been able to have the article featured. You won't find that baloney mentioned prominently in any secondary review-- it's cooked up based on a formulaic approach to leads, and uses the weakest underlying (NIH) sources. (Another serious problem that has taken over medical content since 2015 and needs to be addressed via restoring MEDRS to what it once was, and recognizing that we should be relying more strongly on the authoritative underlying literature, not silly and oversimplified fact sheets from the WHO and the NIH. That essentially every lead in the medical realm suffers that problem now concerns me greatly, because I know how often the NIH and the WHO don't tell the whole story-- it took years to get the NIH to correct simple errors in their Tourette's fact sheets. I would MUCH rather rely on the top journals and top researchers, all of whom are easily identified in TS and in DLB. And actually, even in autism.) I'm sorry, but we completely disagree on how a lead should be written. The autism lead may cover the bases that certain kinds of physicians may think are important, but I think it does a very poor job of informing the average reader looking for information about autism. For that same reason, I resisted the attempts to similarly damage the lead at Tourette syndrome. SandyGeorgia (Talk) 02:21, 14 August 2020 (UTC)

Thanks for pinging WP:ANAT. I tend to agree that it is just restating what is in the manual of style / lead section and think it would be better preserved as an essay or explanatory supplement than part of the guideline itself.--Tom (LT) (talk) 05:34, 13 August 2020 (UTC)

As a separate but related point, I think this kind of move is in the right direction. A lot of this (and I feel the majority of WP:MEDRS) is not what I would expect in a guideline. They are often of the "explanation" type statements that, which providing helpful guidance, do not actually establish a clear expectation. I am personally in favour of a much shorter MEDMOS and MEDRS with some attached either essays or explanatory notes as to how the guideline should be used, rather than long and verbose guidelines explaining again common principles. I think that tends to scare off new editors, make it easier to enforce complex rules, is unlikely to be read in its entirity ever, and results in needless conflicts over wording when there is no actual change to expected practice for end editors (case in point here). --Tom (LT) (talk) 05:34, 13 August 2020 (UTC)

Look back in history before 2015, when they were both in fact guidelines, and good ones, without all the CREEP, and in sync with Wikipedia-wide guidelines. We need to get both back there. SandyGeorgia (Talk) 05:59, 13 August 2020 (UTC)

I agree with Colin's edits in removing the section about lead. All of it is covered elsewhere and none is specific to medical articles. The lead needn't be written more simply than other parts of the article. Minimising the wall of text is prudent. Cas Liber (talk · contribs) 06:14, 13 August 2020 (UTC)

I find it hard to believe that most of the editors quoting MEDRS these days have actually read it... the wall of text makes that unlikely. We have this issue now at MEDMOS, MEDRS and at the WPMED project page, where it was so globbed up with unnecessary verbosity that it made it hard for a new editor to find where or how to engage, or for an experienced editor to easily find links to maintenance tasks and important discussions ... I moved the tasks back up. SandyGeorgia (Talk) 06:28, 13 August 2020 (UTC)

Flyer22 Frozen, the Film lead guidance looks reasonable and very film specific. Films are also a narrow subject domain, unlike Medicie-related articles, so it is possible to give more specific guidance. Most of that guidance is about the key points the project think should regularly be covered in a film lead, rather than forking existing guidelines in order to introduce an idiosyncratic writing style, to push personal agendas or support off-wiki projects. The Lead section was added to this guideline relatively recently and only ever reflected the writing approach of one editor.

For an example of the harm the MEDLEAD section has done, have a read of Paracetamol and Ibuprofen. Both are drugs you will have in your medicine cabinet and you probably carry one of them in a bag or in your desk drawer at work. Every parent will have used them to pacify their ill child. They are vital drug articles of the 1st importance and yet the leads of both are just awful awful. Short stubby sentences and just a random collection of factoids. Paracetamol is worst though ibuprofen's inclusion of the "patent ductus arteriosus" factoid in the third sentence is pretty bad. Both avoid saying "oral" even though "oral medicine" is a thing and every modern parent will have used an "oral syringe" to give their child Calpol, but instead use the weird "It can be used by mouth". Paracetamol can't bring itself to say "intravenously" and so has the ungrammatical nonsense "is also available by injection into a vein". Paracetamol has 31 citations in the lead. Apparently "is a medication used to treat pain and fever" needs two citations, as do several other basic facts. The statement "How it works is not entirely clear" has the three citations, as does the inclusion of maximum daily dose, the inclusion of which is against MEDMOS (but not against MD Wiki). Compare Donald Trump and Barack Obama. Both highly controversial figures with complex lives. Trump has no citations in the lead and Obama has a few. Both use sentences that make one think the writers have mastered joined-up-writing and can hold more than one thought in their heads at any point in time.

So, I'd appreciate if someone would once again remove this misguided section. If there is medicine-specific guidance we can say about leads, I'd be interested to know. Nothing in that section was medicine-specific at all.

I think the added text about technical language is probably best discussed separately in another section. -- Colin°^Talk 09:27, 13 August 2020 (UTC)

Colin, like I told Sandy above, I don't see that the current piece in the guideline has hurt leads, especially if it, as argued by you, Sandy, and Tom, is just a regurgitation of WP:Lead. It's not like it should conflict with WP:Lead anyway. Like MOS:LEAD film, we can still send people to WP:Lead with a link in the section. But this guideline should have guidance on the leads regardless of it goes over things already covered in WP:Lead. That is not WP:CREEP. I disagree that there is nothing specific to be said about medical leads. The fact that we cover "definition and symptoms", "cause and diagnosis", "prevention and treatment", and "epidemiology" in the lead is specific to medical articles. And, again, there should be no forced/imposed order. Should we typically be consistent? Yes. Just like we are typically consistent with article setup.

I fail to see why the guideline should guide editors on everything except the lead. We should let editors think that there's no big deal to writing the leads of medical articles even though there is? I can't agree. And as for typically following an order, why wouldn't we begin with "definitions" first and usually "symptoms" (or effects) after that? That even works in the case of the Ibuprofen article. The Paracetamol article takes a slightly different approach. Why wouldn't we typically have "epidemiology" come last, after addressing the more important aspects first?

You stated, "So, I'd appreciate if someone would once again remove this misguided section." As you know, from December 2019 to January 2020, we had a big RfC on this section: Wikipedia:Manual of Style/Medicine-related articles/RFC on lead guideline for medicine-related articles. And there was no consensus to remove it. And yet you came along months later and removed it? Ymblanter, the closer of the RfC, stated, "Unfortunately, the RfC did not attract so many participants, however, I am comfortable with closing it as no consensus. There is clearly a numerical preference of opposes over supports, plus there are some people who doubt that the RfC was formulated in the best accessible way, on the other hand, the support arguments are stronger since the global consensus is stronger than the local one. Well, we are where we are, and, unless suddenly way more users would develop interest in the issue, MEDLEAD is not going to be fully replaced by MOSLEAD. If somebody is interested in pursuing the cause further, I would suggest to try implementing changes one by one, identifying statements in MEDLEAD which the majority would perceive as problematic, and trying to change these."

I don't know where to go from here, but there clearly is no consensus to remove this section. Sandy often points to a 2015 version of this guideline. That was five years ago. This guideline, and that includes thoughts on covering the lead, has been worked on by various editors since then. Their opinions, those collaborations, don't just go out the window because one or two editors disagree with the results five years later. As seen above, Ymblanter mentioned the RfC not having a lot of participants. One thing I'm going to do now, which is allowed per WP:APPNOTE, is ping medical editors who have been involved with crafting information on lead material in this guideline (and that includes whether or not the lead should have citations) within the last five years, and see what their thoughts are on retaining or removing the section in this guideline. Some are more active than others. So we should allow at least two weeks of commentary on this matter, to see if we have formed a consensus on it. Or we may need to start another RfC. But before that new RfC, let's try this. Pinging: Doc James, FloNight, Bluerasberry, Fse809 (Brenton), Wouterstomp, Seppi333, TylerDurden8823, WhatamIdoing, Johnbod (also known as Wiki CRUK John), Kashmiri, Bakerstmd, Anthonyhcole, Iztwoz, Ozzie10aaaa, Natureium, Johnuniq, AlmostFrancis, RexxS, Ian Furst, JenOttawa, Tryptofish, Levivich, John Cummings, BEANS X2, Clayoquot, Avicenno, and SUM1. I suppose I will ping CFCF as well, but he hasn't been around for months. I didn't ping QuackGuru because he is currently topic-banned from this area. Doc recently commented on his talk page; so I pinged him. I also pinged all of the editors from the aforementioned RfC (except any editor already commenting in this thread and QuackGuru). Flyer22 Frozen (talk) 02:09, 14 August 2020 (UTC)

You are still arguing that leads must contain certain items, I have explained above the problems with that with examples, and that approach goes against WP:LEAD. And now by pining select editors of your choice, you've affected early on any likelihood of effective dispute resolution, and essentially poisoned the well. Tsk. This should take us right back to !voting rather than discussing, as if we've learned nothing from the last year. And if there is to be an RFC on leads, I will insist it be done correctly this time, and held at LEAD, not here. We have been down this road before, and the arbs have ruled on it. Local consensus on one project cannot overwhelm global consensus on Wiki-wide guidelines, and we have already seen this guideline try to go against a broader guideline. You are heading right down the path that the arbs cautioned against, so I suggest you read their findings from the medicine-related arbitration case. It's very disappointing to find you pinging select editors for reinforcement rather than engaging in discussion.

And please, stop using excess markup in talk discussions: we don't need bolding to know what to read. Excess markup in talk discussions is almost as disruptive as pinging in select editors to reinforce your viewpoint rather than discussing to understand. Have you digested the examples I've given above ? SandyGeorgia (Talk) 02:36, 14 August 2020 (UTC)

• I think we should have something here on leads, since it doesn't make sense to have to point editors, including student editors, to two or more separate pages to explain how these articles should be written. It seems like it would make this incomplete to ignore that matter entirely. Crossroads ^-talk- 16:10, 13 August 2020 (UTC)

Do you have a suggestion about what that content would be? Something that is specific to medicine? SandyGeorgia (Talk) 02:33, 14 August 2020 (UTC)

Technical language

One aspect of writing that is medicine specific, or at least a big challenge when writing a medical article, is how to handle the technical language and the jargon. That's why MEDMOS has long had various points of advice on how to deal with that. Above it is asked what the basis is for Part of the role of an encyclopaedia is to teach the reader new words and help them build confidence with harder ones. I'm actually rather surprised that is even questioned? Wikipedia isn't a patient information leaflet. Nor does it require a pharmacy degree to read a drug article. The point of all professional-level educational writing is to teach, not just explicitly, but also implicitly. We demonstrate how good-quality idiomatic English is written. People grow their vocabulary and their confidence with words by reading great quality prose, either in newspapers or factual writing or good fiction, and not by looking up dictionary definitions all the time.

A 12-year-old might not be able to tell you what a mortgage is and how it works, but might be aware that it's something their parents have to pay for the house. I'd expect a financial article on Wikipedia to talk about mortgages and not invent the term "house loan" instead. Similarly I'd expect an article on an anticonvulsant drug to include the words "anticonvulsant" early on, and not just "is a medicine". Because that's a concept "there are a class of drugs that treat epilepsy that we call anticonvulsants" that the reader should really know when reading about that drug. The reader's uncle might be taking anticonvulsants for his epilepsy, say. The reader might not be confident enough in that word to give you a definition or even to spell it but they know it or need to know it if they are to learn or say anything much about this drug. You looked up "carbamazepine" and learned the word "anticonvulsant" too.

The best writing on Wikipedia introduces these slightly advanced words to the reader in a way you don't even notice. We don't use advanced words gratuitously, and we avoid technical words that aren't necessary for the article subject, but the point of that sentence is to remind us not all hard words are the enemy to be eliminated, but are part of our educational mission. -- Colin°^Talk 10:02, 13 August 2020 (UTC)

Medical example from Tourette syndrome. Many people have never heard of a premonitory urge. But you cannot understand TS without knowing that phenom, and you cannot read TS literature without encountering it (unless you read the sixth grade CDC patient leaflet which is useless and you will then have to find something else to really understand the condition, so the CDC wasted your time). Because premonitory urges are what distinguish tics from other movement disorders, we have to teach the reader the term; it is unavoidable. The Wikipedia article teaches you what a premonitory urge is, which allows you to read even more about TS, just as it teaches you what a tic is, what coprolalia is, echolalia,etc. Most medical writing on Wikipedia is naturally teaching vocabulary to some level. The short choppy sentences and artificial language at paracetemol (I wish I could unsee that) do not make the lead more digestible; along with the citation overkill, they make it worse. Expanding reader vocabulary happens in medical writing, so how to effectively address vocabulary is a worthy topic for a guideline. I did not get an answer to my query above about an alternate way to phrase “low-literacy adult”, but I think we can improve that. SandyGeorgia (Talk) 10:38, 13 August 2020 (UTC)

Wrt “low-literacy adult”, that was a term used by the source, and worth reading the source before considering an alternative. For example, it isn't the same thing as this "reading grade level" thing that north Americans are so fixated about. -- Colin°^Talk 10:52, 13 August 2020 (UTC)

I believe so-called 'level/s' of literacy also fails to capture comprehension issues which are affected by the *type* of reading people are familiar with (rather than just how good they're supposed to be at comprehension in general). For example, some highly educated/literate people in the 'humanities' feel intimidated or alienated by almost any technical discourse. Other people with much less formal education may be highly literate in terms of written communication within their local communities, but feel that almost anything technical is alien to them... And then maybe some of these non-technically inclined people find they need (or wish) to understand what a particular diagnosis, for example, entails.

Wrt "Part of the role of an encyclopaedia is to teach the reader new words and help them build confidence with harder ones" - personally I find the assumption that Wikipedia's role is partly to "teach" people somewhat patronizing. At the same time, I do agree about its pertinence as a potential educational resource. I'd feel more comfortable with something along the lines of Part of the role of an encyclopaedia is to give readers an opportunity to understand relevant terms and gain familiarity with them. 86.190.132.140 (talk) 12:46, 13 August 2020 (UTC)

Wrt the first part, yes we can only target a "general reader" and not adopt a different voice and approach to suit personalities. For better or worse, we are an encyclopaedia rather than some other fact-giving medium such as a blog or a youtube channel, and so a certain encyclopaedic voice and tone are expected.

If "to teach" is too direct and active, then "to give readers an opportunity to " is too indirect and passive. Let's not concern ourselves with worries like "patronising": one reads an article because one wants to learn and one expects the writer of that article to have a significantly superior grasp of the concepts and subject along with the talent to help one learn in an enjoyable way. All good writing should have a purpose, otherwise it is just a collection of words and numbers. Good non-fiction isn't about passively consuming facts as one progresses down the page, but being led by the writer, who builds your understanding step by step until you grasp with point they are making. -- Colin°^Talk 13:03, 13 August 2020 (UTC)

Regarding 'teach' vs 'learn' etc, my own inclination is to make pages as easy as possible to *consult* [actively] by a wide range of users with different backgrounds - and then (passively :) just leave them to get on with it actively, based on their own needs and reading styles (cf. informal learning). Fwiw, I feel that to be a sufficiently 'active' purpose. But I'm not pretending that it's at all easy, or that there are one-size-fits-all solutions. 86.190.132.140 (talk) 13:19, 13 August 2020 (UTC)

To "teach" is just "to impart the knowledge of ". It implies one is aiming to successfully transfer knowledge, rather than just that one is flinging it out there on the off chance someone is so keen to learn that they can assemble the information packets into something sensible. I used to have a quote from a newspaper editor on my user page: "It is our job to interest [our readers] in everything. It requires the highest degree of skill and ingenuity.". No matter how interested or inclined-to-learn our readers may be or may not be to begin with, it is our job to interest and education them and hook them into reading more. -- Colin°^Talk 14:22, 13 August 2020 (UTC)

(edit conflict)Well, the teaching perspective is clearly central to your pov here, Colin. While I feel we almost certainly agree on many aspects of the need for gradual (and deepening) presentation of technical content in as painless a way possible, my own pov (and I'm sure there are many others) would prioritize the learning aspect. To me, this perspective seems more pertinent in the context of an encyclopedic work of reference that we wish to be as open as possible to many different types of readers with a variety of informational and learning needs. I would argue that a work of reference is there to *consult* in ways that suit the user, and it's good to have a broadly user-centered (more 'learning-centered') approach that is as open as possible to different needs and reading styles. But those are both legitimate povs, I believe (I'm no authority on educational theory :-). Rather, I imagine this sort of topic must have been explored in some depth (or length??) elsewhere on WP pages, and I'm wondering whether any sort of community consensus has been reached. Particularly regarding the writing of content to "teach"? 86.190.132.140 (talk) 15:23, 13 August 2020 (UTC)

What if we altered 86’s “Part of the role of an encyclopaedia is to teach the reader new words and help them build confidence with harder ones" to Good encyclopedic writing will naturally teach the reader new words and help them build confidence with harder ones ? SandyGeorgia (Talk) 15:41, 13 August 2020 (UTC)

Got that backwards ... or 86’s suggestion to Good encyclopedic writing gives readers an opportunity to understand relevant terms and gain familiarity with them. SandyGeorgia (Talk) 16:00, 13 August 2020 (UTC)

I feel the current section on technical terminology could be shortened considerably without losing much meaning. Bullet points 1, 4, and 5 give related messages about jargon. As I understand it, the intended messages are 1 (explain necessary jargon through links or parentheses), 4 (introduce necessary jargon by placing it in clear context), and 5 (use jargon that's necessary; avoid jargon that's unnecessary). Bullet 2 (spell things the way they're spelled) seems like an odd note left over from an old dispute. Thinking about more concise wording, but perhaps a better writer can beat me to it? Ajpolino (talk) 15:17, 13 August 2020 (UTC)

As a starting point (I'm not at all wedded to this language), how about:

• Medical texts often contain technical terms unique to medicine. For jargon essential to understanding an article's topic, introduce technical terms in a context that makes their meaning clear. Where possible, use wikilinks to provide extra support for an interested reader to explore a new concept or word.

I feel this is the minimal meaning of the three bullets, but I'm open to adding more filler. If folks feel strongly about further explanation (e.g. on reading-level scores, examples of explanatory wikilinks, cross-wiki links to wiktionary...) we could also add a footnote. Bullet 2 seems to me to be screaming for footnote status, but again I can't think of where to put it... Thoughts? Ajpolino (talk) 15:32, 13 August 2020 (UTC)

I've had a go at reordering the section to be more logical and get rid of the bullet points. Very slightly trimmed and dropped the odd comment about spelling. It isn't just "jargon" but any advanced word or technical term. I'm not sure I want to shorten this too much. This really is an area where editors struggle, so I don't mind if we labour the point a little. -- Colin°^Talk 15:50, 13 August 2020 (UTC)

Are we wedded to the order in “provide a short plain-English explanation first, followed by the jargon in parentheses”? Is there a benefit to which is first and which in parentheses? Looking over “my” FAs, I see I have not been consistent within articles, and whichever is first should be throughout and I need to make adjustments. But I think I prefer the jargon first and the plain English in parens. Does it matter as long as we are consistent? @Spicy: to check complete blood count. SandyGeorgia (Talk) 15:55, 13 August 2020 (UTC)

I did wonder about that when I read it again. I wonder how that crept in? It used to say "When mentioning technical terms (jargon) for the first time, provide a short plain-English explanation in parentheses if possible. If the concept is too elaborate for this, wikilink to other articles (or Wiktionary entries). Alternatively, if the technical word is not used again in the article, it may be appropriate to use plain English and place the technical term within brackets." I was changed. I think we should go back to how it was. -- Colin°^Talk 16:05, 13 August 2020 (UTC)

Sandy, I picked your first suggestion. Not so keen on the second (it isn't just about "terms"). Also I've mostly restored how the original text put it. -- Colin°^Talk 16:13, 13 August 2020 (UTC)

Allright, you forced me to guzzle caffeine and get out of bed to a real computer. Multiple items. First, with your rewrite, I think that the entire low-literacy thing is no longer needed. The point has been made, and people are going to reject that which they perceive (incorrectly or not) as an unintended insult. Is there another way to work in your citation while avoiding "low-literacy"? Second, perhaps I am overvaluing consistency, but sometimes jargon in parens and sometimes plain English in parens bugs me. Third, a bigger issue: jargon should link instead to WP:JARGON which is a top-level MOS section. Because it is a main item at MOS, we should stay in sync. We can see how medical articles (leads in particular) got so out of whack by referring back to MOS guidance. Lately, medical articles have been linking/piping plain English to technical terms which is precisely what we should not be doing (ala lack of interest) according to MOS. Can you have a look at WP:JARGON in terms of keeping us in sync? And rejig the whole thing? Meanwhile, I need to review all of "my" FAs to see what else I can add on consistency and MOS conformance. I think we agree with MOS on not introducing unnecessary technical jargon if it isn't later used in the article, so I need to check, for example, Dementia with Lewy bodies for things like hyposmia. SandyGeorgia (Talk) 16:44, 13 August 2020 (UTC)

I made a couple of tweaks. Does that help? I'm reluctant to make the text rigid about how writers should go about explaining technical terms -- that's exactly the mistake we just removed because it suggested only one order. Improving that text probably requires more input from other writers. -- Colin°^Talk 17:04, 13 August 2020 (UTC)

I like it, but need to review "my" FAs, and looking forward to tweaks from others. SandyGeorgia (Talk) 17:09, 13 August 2020 (UTC)

I still think the part you added recently Good encyclopedic writing... reading level grade should be trimmed substantially and maybe incorporated into the paragraph below. I understand that it's ok to labour points that are important and often misunderstood. But I don't think we need to wax poetic on the virtues of good encyclopedic writing either. Can we just note somewhere in the second paragraph that technical terms should be placed in a context that helps make their meaning clear? I most often see this violated in symptom lists, where writers expect the wikilinks to give the reader a medical education. Ajpolino (talk) 18:41, 13 August 2020 (UTC)

Unfortunately we've had a focus on trashing good encyclopaedia writing for quite long, so I feel this is worth the emphasis. I'd be very glad if you feel you agree so strongly that it doesn't need to be said. Lets see what other writers think. -- Colin°^Talk 19:09, 13 August 2020 (UTC)

Example

Well, that was fast. Contrary to MOS:JARGON, we have in the first paragraph of dementia with Lewy bodies

• but the number of people affected is not known accurately

(a pipe to a medical term), which then forces another problem-- because the word prevalence is used repeatedly in the article, but is hidden in the lead via a pipe, and I believe is a useful medical term to introduce, I end up relinking the term later on, which creates another MOS breach-- duplicate links. And this occurs throughout because I was forced (by old and faulty guidance here) to pipe terms needed in the article. Suggestions? Introduce the parens in the lead? I have MUCH more of same ...

• but the prevalence (number of people affected) is not known accurately ...

SandyGeorgia (Talk) 17:18, 13 August 2020 (UTC)

In this particular example, I believe the second option ( ie ...the prevalence (number of people affected)...) is preferable. Fwiw, here, I've tried to use the first option - introducing some pertinent terms such as 'myocarditis' after the lead - mainly because that seemed to me to be the way consensus here had been moving (though I'm still by no means happy with the readability).

Personally, I can envisage potential advantages and drawbacks to both those general approaches, which I fear are methodologically tricky to verify comprehensively by research. One important (and challenging) aim, imo, should be to provide reliable encyclopedic information while not scaring off our general readership. Yikes, easier said than done... 86.190.132.140 (talk) 20:28, 13 August 2020 (UTC)

O-kay - I see writing as an algorithm. Use the plainest English way of expressing a concept as possible unless meaning is lost or confounded. In this case (which I have boldly changed) "number of people affected" loses or obfuscates meaning to the point that it is a net negative compared to "prevalence". I think "prevalence" is a plain enough word that it does not need a parenthetical explanation. Some others do though. Need to think of one. Unfortunately I have found examples where plainer words have compromised the meaning (e.g. [6] [7] [8]).Cas Liber (talk · contribs) 23:07, 13 August 2020 (UTC)

Appreciated ... I have made further adjustments, as this business of obscuring accurate terms in the lead created a duplicate links problem in the body of the article. SandyGeorgia (Talk) 23:20, 13 August 2020 (UTC)

Copyright

The copyright section contains some medical specific advice about DSM, questionnaires. We recently got stung with ICD-10 copyright issues. But some of the section contains general advice:

Write in your own words whenever possible, and ask for help about the fair use of images and text when you need it.

Attribution is required for copying content in the public domain and under various licenses. See WP:Compatible license, WP:COPYPASTE, WP:PLAGIARISM, WP:FREECOPYING, Template:PD-notice, and Template:CC-notice. Copying content under a compatible license requires a template under the correct license. Removing it for copied content under a compatible license will result in a copyright violation.

The second paragraph was added here. I propose the above text be deleted as non-medical-article advice that belongs elsewhere. -- Colin°^Talk 16:20, 13 August 2020 (UTC)

It is also incorrect; a template is not the only way to do it. Scroll down in this diff to see the technique I learned from Diannaa, a copyright admin. I think that people were trying to make this page cover all bases, and by doing so, creating unnecessary forks and instruction creep; we are generally always better referring people back to the main guidelines, and students will not read stuff anyway. SandyGeorgia (Talk) 16:51, 13 August 2020 (UTC)

Agree I think there has been an attempt to make this a one-stop-shop for all the problems student editors typically introduce. And yes, they don't read the manual anyway. -- Colin°^Talk 17:09, 13 August 2020 (UTC)

Discussing before making significant changes

Yes, WP:BOLD is a thing. But we all know that this guideline is subject to much debate (including disagreement). That is clear by even the recent RfC: Wikipedia:Manual of Style/Medicine-related articles/RFC on lead guideline for medicine-related articles. So can we discuss significant changes, ideally ensuring that consensus has been achieved, before implementing those changes? Flyer22 Frozen (talk) 02:15, 14 August 2020 (UTC)