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)

"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)

agree w/ comments above and posted below by Flyer22--Ozzie10aaaa (talk) 14:42, 14 August 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)

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)

I support including this, both geography and ethnicity. Think about subjects such as Medical genetics of Jews, the Finnish heritage diseases, Health among the Amish, and others. If you're writing about any of the uncommon diseases that would get mentioned in those articles, then it is DUE to mention it in the article, and the ==Epidemiology== section is usually going to be the correct place. WhatamIdoing (talk) 20:46, 14 August 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)

Yes. I wonder whether it would be helpful to turn this list into a table, so that we could have "Suggested heading(s)" in one column, and "Suggested content" in another. Please have a look at voy:STICK for one idea about how to organize a list like this. (They do theirs the other way around, with "Content" in the first column and "Heading" in the second.) WhatamIdoing (talk) 20:49, 14 August 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)

Yes, we disagree then. But I will again reiterate that I'm not stating that we should write all leads of medical articles the same way. I feel the same way about the articles as a whole, which is why I've often pointed to what the beginning of WP:MEDSECTIONS states. I will also reiterate that regardless of if we add more specific guidance to the section about leads, I feel that this guideline should have a section on leads. I look forward to seeing what other WP:Med editors have to state on this matter.

You added, "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." WP:MEDRS, in its WP:MEDORG section, already states, "Guidelines by major medical and scientific organizations sometimes clash with one another (for example, the World Health Organization and American Heart Association on salt intake), which should be resolved in accordance with WP:WEIGHT. Guidelines do not always correspond to best evidence, but instead of omitting them, reference the scientific literature and explain how it may differ from the guidelines. [...] The reliability of [statements and information from reputable major medical and scientific bodies] ranges from formal scientific reports, which can be the equal of the best reviews published in medical journals, through public guides and service announcements, which have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature." Flyer22 Frozen (talk) 02:38, 14 August 2020 (UTC)

Please write the above post in a digestible format without the excess markup so that I don't have to trudge through something to figure out who said what and what you are adding. I know what I wrote and don't need it repeated with italics, and I think these are discussion techniques that lend to argument rather than resolution. The excess markup is a poor way to engage discussion. And if you think what MEDRS says has anything to do with how it has been applied, I suggest you have been editing in a bubble. That is what we need to fix here. OVER and OVER we see that WHO or NIH and Cochrane are preferenced over other sources, and MEDORG viewpoints are excluded. Writing leads almost exclusively from NIH and WHO factsheets is symptomatic of that problem, which has permeated medical content, with much of it becoming mirrors of NIH and WHO, adding nothing of interest. SandyGeorgia (Talk) 02:46, 14 August 2020 (UTC)

Stay on topic. You can read the quoted material just fine with or without italics. You stated, "And if you think what MEDRS says has anything to do with how it has been applied, I suggest you have been editing in a bubble." That is a behavior issue. WP:MEDRS says what it says. You are the one who stated "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." I simply noted what WP:MEDRS says. Flyer22 Frozen (talk) 03:11, 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)

Thanks for the ping, Flyer22 Frozen. Sorry, but I'm going to be entirely hands-off with this. --Tryptofish (talk) 20:59, 14 August 2020 (UTC)

Tryptofish, going by the recent emails I've gotten and a recent post on my talk page, a number of editors have decided "to be entirely hands-off with this." Flyer22 Frozen (talk) 00:17, 15 August 2020 (UTC)

Flyer22 Frozen, count me as hands off due purely to lack of time, but thanks for the ping and thanks for all your hard work on this. Clayoquot (talk | contribs) 05:21, 16 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 pinging select editors of your choice, you've affected early on any likelihood of effective dispute resolution, and essentially poisoned the well. Tsk. Shall I ping the many editors here I know disagree? 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 so early on. 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)

You stated, "You are still arguing that leads must contain certain items." I'm not. And I'm not going to spend days, weeks, or months arguing this. I made my points. Wikipedia:Manual of Style/Medicine-related articles/RFC on lead guideline for medicine-related articles got you all nowhere. So, yes, I pinged 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 to see what their thoughts are on retaining or removing the section in this guideline. Those editors don't all agree with one another, as is clear by Levivich disagreeing with me below. And alerting them to this discussion is very much in compliance with WP:APPNOTE. I mentioned WP:APPNOTE when pinging them just in case an editor (specifically you or Colin) tried to bring about some bogus "you canvassed" claim. Those are not "select editors for reinforcement rather than engaging in discussion." They are 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. They are seen in the archives. And pinging them is not disruptive in the least. If you think you have a case on that, take me to WP:ANI. Same goes for your "you are being disruptive by occasionally bolding" claim. If all or most of these editors disagree with you and Colin, then it shows that you and Colin need to back off. Everyone knows that Casliber agrees with you, and you didn't see me lodging some "you pinged him for reinforcement" claim. I never stated or implied that "local consensus on one project [can] overwhelm global consensus on Wiki-wide guidelines." I am very aware of the WP:LOCALCONSENSUS policy and have cited it times before. As made clear by various editors, including those in the aforementioned RfC, this lead guideline does not conflict with WP:Lead. Even you and Colin argue that it offers nothing new. I don't appreciate threats like, "You are heading right down the path that the arbs cautioned against." I will never be sanctioned. And you won't be driving me away from WP:Med or Wikipedia in general. I had thought that discussing these matters with you could remain civil. But, clearly, you turn hostile whenever anyone disagrees with you. You will need to extensively argue with someone else on these matters, because I'm not having it. I won't be condescended to. Flyer22 Frozen (talk) 03:11, 14 August 2020 (UTC)

(responding to ping) I agree with Colin's removal and with everything Cas Liber wrote above, especially: All of it is covered elsewhere and none is specific to medical articles. ... Minimising the wall of text is prudent. I also agree with what Colin wrote just above about the leads of Paracetamol and Ibuprofen being bad, and that "medical" is a broad category, probably too broad to have any particular guidance on writing a lead for a "medical" article. However, guidance about how to write a lead for an article about a pharmaceutical drug would be helpful (as would similar guidance a physician, medical school, surgical procedure, virus, disease, organ, etc.), so perhaps expanding those sections of MEDMOS with lead advice, rather than having one "lead" section in MEDMOS. Lev!vich 02:55, 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)

Don't intend to get into a discussion since I don't really have any time for WP right now, but here's my 2 cents. User:Colin wrote the following at WT:MED People have noted that medical articles have unreadable leads. They are "unreadable" not because they are hard, but because you get past the first few sentences and lose the will to live. They are unreadable because although the sentences are short, they are just a collection of random facts presented without thought to developing or introducing concepts. And they often fail in an important part of our educational mission and encyclopaedic purpose, which is teaching our readers some of the difficult words that their doctor will use and are necessary to understand a topic. As an example, I've seen text saying when a drug was "discovered" changed to saying when it was "found", as though a chemist just came across it in the street, or perhaps had lost it the day before, and I've seen an article saying when a drug was first "synthesized" changed to saying when it was "made". But drug discovery and chemical synthesis are both terms a reader will expect to find in an encyclopaedia, and will be surprised by our choice of baby words instead. I 100% agree with this sentiment. Nonetheless, I disagree with his removal of the lead guidance from MEDMOS; it should simply be reworded to incorporate this justification for using certain technical language. I also disagree with the removal of the assertion about lead citations; it's become a convention, and frankly, medical articles ought to cite the lead's medical content (or even all of it) for the same reason every medical statement ought to be to be cited in the body.

Given that the use of lead citations is based upon a value judgement about the utility of lead refs, I doubt anyone is going to change other editors' minds/opinions about whether they should be included simply by discussing their personal viewpoint or rationale for inclusion/exclusion. Seppi333 (Insert 2¢) 05:28, 14 August 2020 (UTC)

Arbitrary break on leads

There are some fundamentals that F&F wants to break. We don't repeat MOS just because it is handy to point students to a one-stop-shop for all advice on writing their article. If you want to write some essay, personal views on how to craft a medical article, aimed at students, be my guest and if it is really good, the project will link to it. But this page needs to focus on help that is specific to the challenges of writing medical articles. The lead is not that area. We all have personal opinions about language and citations but the big big point is those opinions are not medical. Go knock yourself out arguing at MOS:LEAD about it.

This section was created simply to allow deviation from MOS. To require leads contain "simplest possible" language, even though MOS doesn't say that. To require lead order to follow article order, even though MOS doesn't say that. To permit citation excess in leads, even though MOS doesn't say that. These were all just personal views about leads. The only aspect of leads that was ever claimed to be medical was that the translation task force used our leads as the basis of their translations, and therefore simple language and excess citations apparently helped them. This turned out not to be true. The TTF uses a copy of the leads held on project namespace (and now, it appears, copied to an external wiki which is deviating from Wikipedia policy and guidelines).

Let's not argue "it is useful" or "it helps students" or other vague reasons to retain material in a general area (lead) that has been a specific source of conflict on the project. I ask again: is there anything at all about medical leads that cannot be adequately covered at MOS:LEAD? So far, nobody has offered anything. We need to get lighter-weight, more wiki, about modifying this guideline in order to reflect best-practice and focus specifically on medical content. And we need to get better at realising we are part of en:wp and so if you feel strongly about article guidelines (for students, for newbies or for academics or whatever) then go to the wider guidelines and join in the discussion there. I think eliminating MEDLEAD and forcing any editors with strong views about leads to go argue with the wider community will be the healthiest thing for this project. -- Colin°^Talk 09:12, 14 August 2020 (UTC)

As you know, I replied to you in the #Removing guidance about the lead, and adding a bit about terminology and technical language section above. I stand by that reply. In my opinion, you are entirely off. You have again gone on about the lead section of this guideline deviating from WP:Lead even though the RfC on the matter shows editor after editor stating that it doesn't and, as I've stated before, different topics might require that leads are handled in ways specific to those topics. It doesn't mean that the guidance conflicts with WP:Lead. I'd rather not be debating anything about the guideline's lead text, but you are the one who tried to get rid of the lead section when there is no consensus to do so. Per above, editors clearly disagree with you removing it. Or if not that, they disagree with the guideline not having any information about writing leads of medical articles. And there are those like Seppi333 who very much disagree with your take on references in the lead. References in the lead have been debated times before on this talk page. You stated, "These were all just personal views about leads." That also applies to not wanting citations in the lead for whatever reason. If having citations in the lead was so much of a problem, then WP:CITELEAD wouldn't state what it states. WP:MEDLEAD requires no order; all it states is the following: "When writing the lead, editors should ensure that they write a comprehensive summary of all of the main points of the article. One way to achieve this is to follow the order of the content in the body of the article, although this is not required." That is a suggestion. Suggestions make up guidelines. A lot of it is personal opinion that has found consensus among editors. If someone tries to enforce a suggestion like the one I just quoted, that is a behavioral issue. It doesn't mean that the suggestion should be removed. The guideline does not "permit citation excess in leads." Citation overkill is not ideal and I often cut it when I see it.

You stated, "I ask again: is there anything at all about medical leads that cannot be adequately covered at MOS:LEAD? So far, nobody has offered anything." Not true. I've stated that the fact that we cover "definition and symptoms", "cause and diagnosis", "prevention and treatment", and "epidemiology" in the lead is specific to medical articles. I've asked, "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 just disagree.

We just aren't going to agree on the lead matter. And I don't want to keep debating it, as if we are going to change each other's minds or agree on anything regarding it (except for not enforcing an order that can't be enforced anyway). No need to talk in circles. Flyer22 Frozen (talk) 00:17, 15 August 2020 (UTC)

I don't know why you keep claiming "we cover "definition and symptoms", "cause and diagnosis", "prevention and treatment", and "epidemiology" in the lead". We don't. Those words appear nowhere. Nor have we had "editor after editor stating that it doesn't" conflict with guideline. We've had a few medical editors wanting to keep it for various reasons, wanting to keep those deviations, but none who want to keep it who have ever stated any reason why medical article leads should have different guidance to the rest of wikipedia wrt language, citations, structure etc. All the current text in the lead was added without consensus Flyer22 Frozen. As WAID says, this is a wikipedia wide guideline, not the personal guideline of this project or some people in the project. I see lots of opposition to keeping this section, and no valid reasons stated so far for keeping it. -- Colin°^Talk 10:08, 15 August 2020 (UTC)

It's not a claim. And we do. That is why, above, I stated, "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." This and similar setups, via the WP:Hidden note feature, are in many leads of our medical articles (the ones with the most traction at least), and it's been that way for years. And it has been helpful. They are outlines that are hidden via the WP:Hidden note feature. Of course, the leads aren't divided into sections that mention the words in non-hidden text. If this setup didn't exist across medical articles, there wouldn't be discussion above about forcing lead order. But, again, no particular lead order should be forced. And, yes, in the aforementioned RfC, where you tried to get the lead section of this guideline removed, we see editor after editor (and not just medical editors) stating that it doesn't conflict with WP:LEAD. Ymblanter, the closer of the RfC, stated, "There is clearly a numerical preference of opposes over supports." Ymblanter stated more than that, but I already quoted Ymblanter above. You stated, "All the current text in the lead was added without consensus Flyer22 Frozen." That is not true. Check the archives. We've had multiple discussions about that section, especially about citations in the lead. You stated, " I see lots of opposition to keeping this section, and no valid reasons stated so far for keeping it." I don't. Flyer22 Frozen (talk) 00:10, 16 August 2020 (UTC)

Ah, so you are talking about the hidden note feature, rather than about MEDMOS, which doesn't mention hidden notes nor encourage their use. And in fact WP:Hidden note guideline page does not list "Enforcing the order and grouping of lead sentences to match that of sections in the article body or to match the suggested sentences in MEDMOS". It doesn't even encourage anything like this. It would help if we are to have a discussion about this guideline, that we stick to discussing this guideline. Wrt talk pages, we shall have to disagree because the disagreement and lack of consensus is pretty apparent. The recent RFC was, as Sandy openly admits, a confused mess from the start.

The fundamentals of a guideline page is that it reflects only the areas upon which the community have found common agreement, consensus. Therefore, if there are areas where there is significant disagreement, no consensus, then those should not be included in the guideline. Otherwise we have the case where a group within the community can impose their opinions on everyone with the falsehood that their group's opinions actually represent a consensus of the whole community. So, Flyer22 Frozen, unless you can offer suggestions as to how to change the text in a way can all agree on, it's going to have to retain the Disputed tag indefinitely, which is more or less the same as saying: the following section has no weight or authority. I would personally, far rather see members of this project engage with and actually read the guideline and policy pages elsewhere, and become part of the wider community in terms of documenting how best to write articles. -- Colin°^Talk 09:48, 16 August 2020 (UTC)

This reads to me like a threat that the tag will stay forever unless you get your way. Consensus is not unanimity, and if there is no consensus to change, then the material's WP:STATUSQUO stays without a tag of shame. The RfC showed there was no consensus for replacing MEDLEAD with MOS:LEAD, nor for the ideas that they are in conflict or should be synchronized, and suggested discussing changes one by one, which is what I am saying. But the tag will be removed once changes are done being made. If a couple of holdouts declare themselves to be "significant disagreement" and don't like the lead portion of the guideline even after that, that's just too bad; that's Wikipedia for you. We all have content somewhere that we don't like but have to live with. Crossroads ^-talk- 16:16, 16 August 2020 (UTC)

This section is widely disputed by many many editors. It is the very definition of "no consensus". Of course unanimity isn't required. I think a more important lesson is "Not all personal preferences should be documented in topic guidelines". There's much to benefit from this project's members "agreeing to disagree" and not documenting contentious opinions at all. By forcing these personal opinions here, all it does is provoke an adversarial conflict, which has been ongoing for years, rather than "Hmm, ok, that's how you write, interesting..." Wikipedia is big enough for people to have different ideas of how to write leads, without having to agree on them and write them down here. -- Colin°^Talk 17:04, 16 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)

Looking at the recent changes, the jargon–parentheses bit was the only substantive change (still on the page) that I think should be discussed. We used to recommend "People with TS can feel in advance that they will need to tic soon (a premonitory urge)", and now we are recommending writing it the other way around: "People with TS will experience a premonitory urge (a feeling that they will need to tic soon)". Do we care what the order is? WhatamIdoing (talk) 21:10, 14 August 2020 (UTC)

As I worked through several examples in two articles, I came to prefer the latter, that is, the wikilinked, “real”, aka jargon or technical term first, with the explanation in parens. Several reasons. Getting the wikilink first helps build the encyclopedia, emphasizing that the other article is not an after-thought, but the thought, encouraging editors to further develop sub-articles. The “real” term in parens feels like a diminishment, an afterthought. Second, it is typically the term readers will need to know as they consult sources. Third, putting the technical word first makes it more clear that what follows in parens may be only a rough approximation, while “real” info is at the wikilinked technical term. That takes some pressure off of what goes in parens. And finally, I don’t have data, but I am pretty sure that is more the norm in top-level content (FAs), and reflects best practice.

But I am not wedded to this—I am more inclined to value consistency in whichever we decide. SandyGeorgia (Talk) 00:25, 15 August 2020 (UTC)

A major consideration in the lead must surely be to use diction that non-technically inclined users feel more comfortable with. I know that studies have highlighted the issue of users being scared off by terminology (e.g. "premonitory urge"). From this pov, I suspect that placing the 'difficult' words in (the 'difficult') brackets with a blue wikilink may *generally* be preferable. Though, fwiw, my own impact with "...they will need to tic soon..." was something of a double-take: not being familiar with the usage of "tic" as a verb, I found myself tracking back to check my understanding. 86.191.67.158 (talk) 12:28, 15 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' 'vasulitis' 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)

As an aside, I think over worrying about repeating links isn't helpful. In a really long article, if a term for some obscure test or body part is repeated much further down the article, it seems a bit anal to insist there is no link. People don't necessarily read the article 100% and from top to bottom. But I'm not going to start arguing that at MEDMOS. -- Colin°^Talk 09:19, 14 August 2020 (UTC)

I think this question is based on a false assumption. There is no violation of the MOS or any other guideline if we link to Prevalence twice, with seven thousand words in between the two links. That said, I might have kept the "number of people affected" language in the lead, and dumped the link. People might expect that link to take them to a page that talks about how many people are affected by DLB. WhatamIdoing (talk) 21:15, 14 August 2020 (UTC)

Some reviewers at FAC are aggressive about MOS:DUPLINK, which lays out where one can duplicate. One can argue the case for more, because it is a guideline, but you have to be prepared to defend extras. I can’t justify in my own mind prevalence twice ... SandyGeorgia (Talk) 21:20, 14 August 2020 (UTC)

MOS:DUPLINK is pretty upfront about the exception that "if helpful for readers, a link may be repeated ... at the first occurrence after the lead.", although I must admit, I don't see that exception being used much. Personally, if I'm working on a larger article that is made up of somewhat disconnected sections, I assume that a reader might want to jump in part-way through, so I'm more inclined to repeat a link that's a long way from the previous link. The counter-argument of course is "sea-of-blue", where high-value links are swamped by low-value ones, and getting a good balance is very much a matter for editorial judgement, rather than hard-and-fast rules. --RexxS (talk) 23:41, 14 August 2020 (UTC)

Back to policy

Maybe getting back to Wikipedia's policies and guidelines will give us a more positive framework for discussion.

Procedural policy page-- Wikipedia:Policies and guidelines says

Maintain scope and avoid redundancy. Clearly identify the purpose and scope early in the page, as many readers will just look at the beginning. Content should be within the scope of its policy. When the scope of one advice page overlaps with the scope of another, minimize redundancy. When one policy refers to another policy, it should do so briefly, clearly and explicitly.

Not contradict each other. The community's view cannot simultaneously be "A" and "not A". When apparent discrepancies arise between pages, editors at all the affected pages should discuss how they can most accurately represent the community's current position, and correct all the pages to reflect the community's view. This discussion should be on one talk page, with invitations to that page at the talk pages of the various affected pages; otherwise the corrections may still contradict each other.

At that page, in December 2012, WhatamIdoing added: if two or more guidelines or two policies conflict with each other, then the more specific page takes precedence over a more general page of the same type. (That is, in a dispute, the specific page MEDLEAD would take precedence over LEAD until the dispute is resolved.) That was immediately reverted and we have no such wording today. MEDLEAD cannot take precedence over LEAD, and the policy today states that a) guideline pages should minimize redundancy and not overlap, and b) differences between guidelines have to be resolved at both pages.

In many places (not only MEDLEAD), MEDMOS does not follow these two policy points; that is why the page has been in a continual state of dispute for about five years. By writing redundant non-medical guideline content here—that already exists elsewhere—we have often introduced error or ambiguity. That is why we can’t keep going down this same path, and need to resolve the dispute on this page, which unlike some have represented, goes well beyond a couple of editors. Throughout the medical guidelines today, there is redundant information that is explained less well than in policy or other broader guideline pages, and often even includes errors. Staying focused on scope may help us resolve this.

Scope—Wikipedia:Policies and guidelines

Wikipedia's policies and guidelines are developed by the community to describe best practices, clarify principles, resolve conflicts, and otherwise further our goal of creating a free, reliable encyclopedia.

Guidelines describe best practices; that is exactly what the framers were doing when we wrote the pages. The statement on this page that "It's because Wikipedia treats medical information so seriously and as a special case that we even have WP:MEDRS and WP:MEDMOS" is not true. We have MEDMOS and MEDRS because WPMED participants between 2006 and 2008 were describing best practices as demonstrated in our best articles, in an era when Google did not cough up Wikipedia first on a search, and we weren't focused on "medical information as a special case'. The framers of our guidelines who are still active exemplify the extent to which we were focused on reflecting best practices, guideline style, as the number of FAs written in medicine was escalating. Most of us wanted to help others produce top content (Casliber, Colin, Fvasconcellos, Graham Beards, MastCell and Tony1 .. Eubulides and others active then are now gone). At one point, we all got busy/distracted and the MEDMOS guideline proposal page was marked historical (!?!?!?), so we got busy and got it done. But note the opposes along the way: (QUOTES)

• Redundant information from other guidelines should be removed unless there's a specific reason why it applies to medical articles. For example, the top ten tips should not include "be bold" and "look for the appropriate category". On the other hand, I have no problem with the disclaimer tip, since that addresses a problem which is particularly common in medical articles.
• Unnecessary detail should be removed. Does it matter if disease naming was discussed at some NIH conference in 1975? I've read that section several times and I still don't know if a Wikipedia policy on disease names exists.
• Less of a wish-list, more of a practical guide. Is anyone going to completely re-organize a perfectly good medical article just so that the top level headers conform to the list given in this guideline? If not, is the list anything more than a wish-list that's cluttering up the page? What we need is a practical guide for the editors of medical articles, which will be used by them because they find it useful. In short, I propose some ruthless pruning before making this a guideline.
• I oppose the cookie-cutter sections listed

So when you see editors who went through this process for months (years?) stating that the page has spun away from optimal guideline writing, it’s because we confronted those opposes.

Next, as we were going through the same process a year later for MEDRS, WhatamIdoing inquired about the process (which was a bit haphazard in those days), and moved forward with a proposal. There was no process in those days, so WAID got busy with an RFC (one of her strengths), and got wording about how to approve new Policies and guidelines put in place. Considering the opposition we faced, statements on this page like, “WP:MEDRS has stricter standards than WP:RS, so I'm not seeing why this page can't be stricter than MOS:LEAD” are wrong on multiple counts. Wikipedia:Verifiability is policy. Wikipedia:Reliable sources is a guideline that discusses various kinds of sources and how to use them generally to meet the WP:V policy. It doesn't extend policy or change policy; it explains how policy is applied in best practive. And MEDRS is guideline that cannot be any stricter than WP:V policy; it only extends WP:RS to explain what kinds of sources are considered reliable, primary, secondary, etc in medical content. WP:V is still the underlying policy, and MEDRS still can’t be any "stricter", no matter that the page has spun out of control and is often misapplied and misunderstood these days.

Audience

Some of our disagreement on this page might be lessened if we all factored in all of the points discussed above. But we have additional disagreements on who are audience should be. The initial framers of the pages were clear that we were defining best practices for how to write best content and what the best practices were, aka, this is what an excellent article on Wikipedia looks like. Later, the guidelines began to change focus to other-language Wikis and translation, which some editors found worthy and others felt diminished the quality of content on English Wikipedia. Hence, the disputes ever since. And we have another subset of editors advocating that the guidelines should be teaching materials for students, although between this Project and Wiki Ed, there is a proliferation of teaching materials already available for students. I remember a phase where we kept churning out one after another, hoping to stem the problems, yet nothing changed, because most of them are never read. And if we want them to be read, they had best be short and accurate!

So part of our disagreement is that this page has expanded and expanded to meet the perceived needs of different target audiences. I hope that by having a look at what Wikipedia:Policies and guidelines says about scope, and refocusing our discussion along those lines, and considering the history of how these pages came about, we can find mutual ground for less hostile discussion.

Local consensus—WP:CONLEVEL

Consensus among a limited group of editors, at one place and time, cannot override community consensus on a wider scale.

This is another frequent matter of disagreement. The reminder that this page is a Wikipedia-wide page (since I launched the proposal, I expect I know that : ) is true, but overlooks the basic point. During the discussions about how to resolve differences between guidelines, SlimVirgin (who is as active on policy pages as WAID is) argued that "When two guidelines conflict, we have an established set of core guidelines", and WAID disagreed "I don't think it's possible to express the concept of 'core guidelines', and even if we could, it wouldn't be sufficient. The MoS regularly contradicts itself." The conclusion was simple: regardless if there are "core" guidelines, they can't say A and not A at the same time, and conflicts must be resolved.

But on the matter of limited versus wider consensus, even if this page "can" be edited and watched by anyone (it does not "belong to medicine") it is not edited and watched to the same extent that pages that enjoy broader consensus are. A limited group of editors participates at MEDLEAD relative to LEAD. That small group cannot override wider community consensus. Even if we could, WP:P&G tells us we need to resolve the conflicts.

Page	Watchers	Editors	Edits	Pageviews in 2019
WP:MEDMOS	232	177	899	31,000
WP:LEAD	590	823	2,248	238,000

Those are discussion ideas intended to get us moving forward towards resolving disputes and on this pages, and helping us talk together about ways to re-focus these guideline pages so that, should we point a student at them, they might actually read them! Perhaps if we can discuss more civilly here, we can get this page back in shape and move next on the many more serious problems at MEDRS. The lengthy discussions a decade ago to get these pages passed as guidelines remained largely civil (with the exception of a couple of PHARM editors, IIRC), I believe we should be able to do this civilly today. As long as we have disputed sections, and a page so long no one will read it, we aren't doing any editor or student or article any good. SandyGeorgia (Talk) 23:06, 16 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)

Huh? Student editors and editors who write poor content often don't read WP:NOR too, so we might as well delete it then? I'm not seeing why "they don't read the instructions" is a valid reason to remove instructions. They can be pointed to instructions after the bad edits anyway. Crossroads ^-talk- 03:44, 14 August 2020 (UTC)

NOR is a Wikipedia-wide policy page. The concern here is that we fork information to a local page, trying to be one-stop shopping, while providing information that is often at odds with Wikipedia-wide pages. Certainly we can and should point them to the accurate, Wikipedia-wide, consensus pages, like NOR ... even if they don’t read them. SandyGeorgia (Talk) 04:21, 14 August 2020 (UTC)

I am in partial agreement. I think this small section is mostly easy to read and, at least in my small corner, highly relevant. I think there needs to be a general reference to the idea of copyright problems to highlight we operate under a more broad manual of style, and there also needs to be some specifics highlighted, particularly PD and attribution as mentioned.

I do agree this sentence is completely unhelpful: See WP:Compatible license, WP:COPYPASTE, WP:PLAGIARISM, WP:FREECOPYING, Template:PD-notice, and Template:CC-notice, and this kind of link farming would be better if replaced by a single reference to WP:COPYRIGHT (or if there's a better link, the top-most article about this topic).

To be clear, I think with exception of that sentence I feel the rest of the content is quite useful to our guideline and should be preserved.--Tom (LT) (talk) 08:35, 14 August 2020 (UTC)

I've trimmed it back to the previous text, which mentioned DSM and questionnaires. Whether the other text was "quite useful" is completely irrelevant if it merely duplicates guideline and policy elsewhere. Arguments to keep or add content to this page need to be firmly grounded in why medical articles are different or why writing them is different. -- Colin°^Talk 14:04, 14 August 2020 (UTC)

I think it's a good idea to (continue to) document the DSM situation, and questionnaires/screening instruments/rating scales are another area where a desire for accuracy and precision can accidentally lead editors into copyvio problems. As for the rest – there is much to be said in favor of one-stop shopping, but the risk of de-synchronization is significant here. Copyright is a specialty area, and we're better off pointing editors to the specialists. WhatamIdoing (talk) 20:26, 14 August 2020 (UTC)

Also, given how much time we spend complaining about people (e.g., students) who don't "write in your own words", maybe we'd like to keep that. WhatamIdoing (talk) 21:16, 14 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)

I think discussion would be much easier and more productive if we avoided mucking up this talk page with multiple sections and excess markup. It would also be very helpful for you to read this, and the entire page again. We cannot again come up with a local consensus guideline for lead that is in conflict with the broader consensus at WP:LEAD. I am curious as to why you thought this new section was needed; could you please enlighten me? SandyGeorgia (Talk) 02:54, 14 August 2020 (UTC)

You keep changing the topic (in this case acting as though occasionally bolding one's commentary is more of an issue than adhering to the WP:Consensus policy), and being passive-aggressive. I wonder why. To repeat what I stated above, "I am very aware of the WP:LOCALCONSENSUS policy and have cited it times before. As made clear by various editors, including those in the aforementioned RfC, this lead guideline does not conflict with WP:Lead. Even you and Colin argue that it offers nothing new." Flyer22 Frozen (talk) 03:22, 14 August 2020 (UTC)

Much better, thanks: no excess markup, much easier to read. Eliminating the “I repeat” will also help keep discussion moving forward. The aforementioned RFC has no bearing on this discussion; it reached no consensus (hence is meaningless) because I mangled the format and several editors disrupted. (Although if you read it in its entirety, you will see that very good progress was made in people adjusting their initial opinions via discussion.) There are differences of opinion regarding what you call the page “Status quo”. Let’s not repeat the past— meaning, pinging people to a mangled talk page, that is made difficult to read, is likely to lead to !voting rather than productive discussion. I am ignoring the rest of the personalization, and hope we can move forward without it. The lead content you propose is out of sync with WP:LEAD, but that discussion is above. SandyGeorgia (Talk) 04:39, 14 August 2020 (UTC)

Uh-huh. More condescension. Got ya. Unless actually disruptive, I will talk how I want to talk, like many others on this site (including admins at WP:ANI) who occasionally use bold and italics in their posts. Hardly anyone complains about that stuff, and it's not banned anywhere at WP:TALK. Not that it could be banned there since that is a guideline, not a policy. But, hey, you can go and make a proposal at Wikipedia talk:Talk page guidelines about this. We'll see if editors there take that proposal as seriously as they took the far more important "breaking up people's comments" thing that I took care of in 2017. Either way, we both know your complaint is about being frustrated with the fact that I disagree with you on the lead matter. You speak of personalization...and yet you have personalized this. If this went to ANI, you better believe that more than one editor would point this out.

I stand by everything I stated above, including the very reasonable request to discuss before making significant changes to this guideline. Those comments that you call votes are more than just votes. There is also nothing wrong with RfC discussions or RfC-style discussions. That is one way we achieve consensus on this site. And when we have one or more editors enforcing a big change after a recent RfC very clearly stated "no consensus", that is an issue. It is an issue that might require another RfC. RfCs are supposed to judge the weight of arguments. No one is going to just go by an editor brow-beating others into compliance. No, they are going to want to know what a variety of other editors, especially those within their field of expertise, think and gauge consensus or lack thereof. You state that "the lead [I] propose is out of sync with WP:LEAD, but that discussion is above." I didn't propose a thing. And even if I had proposed the lead setup that I mentioned that I favor (a setup that is already in place and doing wonderfully at various medical articles), it would not be out of step with WP:LEAD, any more than WP:FILMLEAD is out of step with WP:LEAD. I already stated that different topics might require that leads are handled in ways specific to those topics. It doesn't mean that the guidance conflicts with WP:Lead, any more than WP:MEDRS conflicts with WP:Reliable sources or WP:Verifiability.

You can keep debating. Obviously. But I'm not going to keep debating you on these things. There is no point. You have made yourself clear. I have made myself clear. And I don't tolerate being condescended to. If I were a newbie, maybe. But I am a very experienced Wikipedia editor, and I don't need lessons from you. Flyer22 Frozen (talk) 05:16, 14 August 2020 (UTC)

Holy wall of text! SandyGeorgia (Talk) 05:27, 14 August 2020 (UTC)

Sigh. As if you don't often make long posts. Next time just stay on topic instead of trying to distract with condescension. If there is no "your markup is so bad" and "you need teaching to, young lady", things should be fine. Flyer22 Frozen (talk) 05:35, 14 August 2020 (UTC)

A request to follow talk page guidelines need not be met with walls of hostility. Good practices for talk pages about bolding and italics is found at WP:SHOUT. SandyGeorgia (Talk) 07:45, 14 August 2020 (UTC)

More of the same. Wow. You start with the hostile nonsense and then say I'm being hostile. So ridiculous. This is ridiculous. Since you want to point to WP:SHOUT, as if I am not aware of that section, then I will quote the following from it: "Bolding may be used to highlight key words or phrases but should be used judiciously. Italics are often used for emphasis or clarity but should be avoided for long passages." So is the use of bolding or italics banned? No, just like I stated. Do I use both occasionally? Yes. And, yes, I used italics in two three quotes, which you would probably classify as long passages. So have many others. So do many others at ANI every day. Either go report me there or move on. Flyer22 Frozen (talk) 08:19, 14 August 2020 (UTC)

I also see the use of italics after the use of italics for quotes in the #Technical language section above. Sighs again. Flyer22 Frozen (talk) 08:27, 14 August 2020 (UTC)

Way too much text. In short. This is a wiki. If you look at the history, the contentious parts of this guideline were added completely without discussion. We, as a project, have got way too stuck in this asymmetric rut that to impose something on the project requires only a simple edit, but to argue against that requires thousands of words of argument and RFCs and arbcoms. This guideline should say less than it does. If something is contentious it should be removed. If something is against wider community guideline and policy then it should be removed without fuss. And yet, here we are with thousands of words and fuss. -- Colin°^Talk 09:23, 14 August 2020 (UTC)

For clarity: This is a community-wide guideline. Unlike with a WikiProject advice page (e.g., WP:PHARMMOS), what "we, as WikiProject Medicine" do or think is irrelevant. What matters is what "we, as the English Wikipedia" do. The 'rules' and processes for changing this page are the same ones that get used at the main Wikipedia:Manual of Style page. I say this because I think it's important for all editors, not just long-time WPMED folks, to know that they are welcome to participate in improving this page. WhatamIdoing (talk) 20:21, 14 August 2020 (UTC)

Colin, you've contributed much to the "wall of text" on this talk page, and you often do type a long post. You type long posts more often than I do. If you are stating that you are going to make contentious edits to this guideline without discussion, such as first proposing the change, then you should prepare to be reverted more often than not. You should be prepared to debate and realize that not everyone is just going to go along with your edits. And, for me, it matters not how much hostility I am subjected to for simply disagreeing. If I disagree, I disagree. Being condescended to won't change my mind. It's not a smart tactic to get one to agree with another. It's also nothing compared to the harassment I face daily from socks and/or trolls. Like WhatamIdoing just stated, this is a community-wide guideline. A lot of things in this guideline have been subject to discussion. I should know; I've been here helping to craft it while you've been away, though you've occasionally popped up at WP:Med to complain about WP:MEDRS and about how some supposed gold standard version of WP:MEDMOS existed a few years back is gone. I'm going to state again that this guideline 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. And at this point in time, you have no consensus whatsoever for removing the lead section of this guideline. Flyer22 Frozen (talk) 00:17, 15 August 2020 (UTC) Tweaked post. Flyer22 Frozen (talk) 00:27, 15 August 2020 (UTC)

Flyer22 Frozen, please don't make personal attacks. -- Colin°^Talk 10:11, 15 August 2020 (UTC)

I made no personal attacks against you. Perhaps you want to visit WP:ANI and see what they rule and don't rule as personal attacks time and time again. And perhaps you'd want to state the same to your editing partner. Flyer22 Frozen (talk) 00:10, 16 August 2020 (UTC)

Lead

How the MEDLEAD got added and why it is bad:

• "The leads of articles, if not the entire article, should be written as simple as possible without introducing errors" added by James without prior discussion.
• "Write the lead in plain English, especially the first two paragraphs. Avoid cluttering the very beginning of the article with a raft of alternative names and pronunciations; infoboxes are very useful for storing this data. Most of our readers access Wikipedia on mobile devices, and we want to provide swift access to the subject matter so that readers can move on or dig deeper without undue scrolling." added by Jytdog without prior discussion.
• "To facilitate broad coverage of our medical content in other languages, the translation task force often translates only the lead; to facilitate that, it is useful to add citations to the lead, even though they not necessary as described in WP:LEAD." was "boldly" added by Jytdog without discussion. A subsequent discussion had opposition and it was removed.
• "It is useful to include citations to the lead, even though they are not obligatory per WP:LEAD. There are essentially two reasons for this: medical statements are much more likely than the average statement to be challenged, thus making citation mandatory. To facilitate broad coverage of our medical content in other languages the translation task force often translates only the lead, which then requires citations." was added by CFCF despite opposition to it inclusion.
• "Part of the reason for this [simple English] is that for around a third of readers of English Wikipedia, English is a second language." + a chart added by James without prior discussion.

Looking at the talk pages, any attempt to control how the lead is written or cited meets significant opposition and there can't in good faith be regarded as any consensus for MEDMOS containing such advice. And yet such text is reverted back and retained, usually by those who support such deviations from MOS. Why is this asymmetrical? That we somehow require unanimity to remove contentious guideline changes but didn't in order to add them? That we some how require extensive discussion to remove guidelines in clear conflict with MOS and yet those are added without any previous discussion?

• "should be written as simply as possible" This is not what Wikipedia:Make technical articles understandable which talks about the text being "as understandable as possible to the widest audience of readers who are likely to be interested in that material." and in particular "the lead section to be understandable to a broad readership". WP:MOSLEAD says "It should be written in a clear, accessible style with a neutral point of view" and "It is even more important here than in the rest of the article that the text be accessible". The key words are "understandable" "broad readership" and "accessible". Not "as simply as possible". En:wp is not Simple English.
• "Many readers of the English Wikipedia have English as a second language (non-native language)." How is this medical?
• "Language can often be simplified by using shorter sentences, having one idea per sentence, and using common rather than technical terms." How is this medical? Here is where the "short stubby sentences" that the rest of Wikipedia mock medical articles for. One idea per sentence is what makes our leads into a collection of six-word factoid sentences, rather than an introduction to the subject with natural idiomatic language structures. There is no medical justification why our leads should be written weirdly compared to the rest of Wikipedia.
• "When writing the lead, editors should ensure that they write a comprehensive summary of all of the main points of the article" This contradicts MOS:INTRO which says "The lead section should briefly summarize the most important points covered in an article in such a way that it can stand on its own as a concise version of the article" There's a different focus on what to include.
• "One way to achieve this is to follow the order of the content in the body of the article, although this is not required" Again, this is not medical and is not guidance found in MOS. We have the "get out" clause "although this is not required" which doesn't eliminate the problem: this text is used to justify arbitrary reordering of leads "per MEDMOS" when an editor may have written the lead differently in order to introduce and lead the reader through their summary of contents. For a lead that is not simply a jumble of factoids, this sort of reordering can be disruptive. The straightjacket here is further compounded by some editors insistence that the MEDMOS suggested sections ordering must actually be adhered to, despite MEDMOS saying it doesn't and should not be imposed on existing articles without prior agreement.
• "Avoid cluttering the very beginning of the article with pronunciations or unusual alternative names; infoboxes are useful for storing this data. Most readers access Wikipedia on mobile devices and want swift access to the subject matter without undue scrolling." Nothing medical here. You know, we do have MOS:LEAD.
• "It is sometimes useful to include citations in the lead, but they are not obligatory." Again, despite the "but they are not obligatory" this gets used to justify citation clutter in article leads, and is why paracetamol has 30 citations in its lead but donald trump has none.
• "As in any content area, direct quotes, data and statistics, or statements that are likely to be challenged should be cited." This is in violation of the very guideline it links, because it neglects to include the important parts from the "When a source or citation may not be needed" which is: "Cited elsewhere in the article: If the article mentions the fact repeatedly, it suffices to cite it once. Uncontroversial content in the lede is often not cited, as it is a generalization of the cited body text." None of the lead of paracetamol is controversial, where as some of the lead of donald trump likely is, but they cope.
• "When translating content to other languages, the translation task force often translates only the lead; their work is facilitated by citations." The translation task force translate from copies such as Simple Cellulitis and it appears those are now being taken off wiki. There was never any justification for medical articles to be made unreadable to justify simpler translation.

The lead section at MEDMOS has caused harm to medical articles on Wikipedia. There is nothing within it that has consensus, that is justifiably medical or that is not in some way an attempt to deviate from wider Wikipedia guideline and policy. -- Colin°^Talk 11:01, 15 August 2020 (UTC)

I'm really not seeing why a couple of editors keep bringing up how such and such was added years ago. It's not like any of us want to take the time to trawl through talk page archives here and elsewhere and see who supported and opposed this or that. And more to the point, WP:Consensus states, Any edit that is not disputed or reverted by another editor can be assumed to have consensus. This means that while these parts of the guideline were in place without active on-wiki dispute, there was consensus for them. There is nothing in the Medicine ArbCom case stating that anyone's past contributions are somehow invalidated, nor that a couple of editors can retroactively declare a portion of a guideline to not actually have had consensus all these years. And this page is a guideline, same as MOS:LEAD is a guideline. Equal status - neither is more "local consensus" than the other. WP:MEDRS has stricter standards than WP:RS, so I'm not seeing why this page can't be stricter than MOS:LEAD.

I think a fruitful way forward is to try to get a new consensus for proposed changes. And I for one am not opposed to the idea of changes in general. For example, I don't think we need to require very short sentences in the lead, or the simplest English possible, so long as it is understandable to the layman.

Regarding citations in the lead, I do oppose any downplaying of instructions supporting their use. I do not believe in the concept of "citation clutter" in the lead, aside from opposing an excessive number of citations for a single sentence. WP:Verifiability is policy (greater than a guideline), and it is especially important on medical topics that readers can see that the material is supported by reliable sources, including in the lead. Not everyone reads the body. And readers have no way of knowing whether any given Wikipedia article was written by a medical professional. A bunch of unsupported material in the lead does not look good. If the editors at Donald Trump have foregone citations, that's their choice, but we should not imitate their poor example. Crossroads ^-talk- 16:51, 15 August 2020 (UTC)

The point about history is that it shows the lie to the claim that changing MEDMOS today requires some prior discussion and universal agreement. That was never the case in the past. As for consensus, well, actually those changes did meet disagreement and dispute, but were kept simply by reverting them back if anyone complained, or not removing them even if people objected. Bad times, not just for MEDMOS but also for the quality of medical articles. I'm glad you agree there is scope to change, but wrt citations, no, you really have absolutely no authority to demand that medical articles should conform to stricter guidelines than the rest of Wikipedia. Community consensus guideline is that a fact needs only be cited once. If that is in the article body, then fine. If you have a problem with that, you need to change Wikipedia policy, not MEDMOS. -- Colin°^Talk 22:05, 15 August 2020 (UTC)

Regarding history, no one said anything about "universal agreement". Consensus is not unanimity, which also means that if a couple of editors disagreed back then with the majority, that did not make that consensus invalid, nor does it mean they can act like the "bad times" have now been overthrown and retroactively declare past consensus to be invalid. Others have also pointed out that past discussions and even an RfC have been held on the lead matter. I also just noticed that in your original comment in this section you stated, This is in violation of the very guideline it links, because it neglects to include the important parts from the "When a source or citation may not be needed". Except that is not from a guideline at all; it is from an essay: Wikipedia:When to cite. The WP:Verifiability policy, WP:CITELEAD portion of the MOS:LEAD guideline, and this guideline supersede both the essay and your blanket claim that "a fact needs only be cited once". Sure, I have no authority to demand anything stricter here, but the pre-existing consensus guideline text does, and I explained why I oppose changing it in a certain direction. Crossroads ^-talk- 04:16, 16 August 2020 (UTC)

I agree with Crossroads. Exactly. I also noted in the #Arbitrary break on leads section above that we've had multiple discussions about the lead section, especially about citations in the lead. The section was built on consensus. Flyer22 Frozen (talk) 00:10, 16 August 2020 (UTC)

Proposal to remove a sentence about etymology being interesting

The current version of MEDMOS says "The etymology of a word can be interesting and can help the reader understand and remember it." While anything might be interesting to some people, and some etymologies help people remember of understand the name (others, especially for older disease names, mislead), I don't think this is specific to medical content, and I suggest removing it. WhatamIdoing (talk) 21:01, 14 August 2020 (UTC)

I saw that bit and was confused by its inclusion. It may help to look at the history to why/when it was added. I wonder if it is specifically about hard anatomical words (it follows from that bit about anatomical locations). Was it suggesting that such words in particular are easier to remember if we know their Latin meaning or origin? But otherwise I agree that there seems to strong reason to recommend including etymology. -- Colin°^Talk 11:04, 15 August 2020 (UTC)

Ugh. But that one little piece is like the rest of the page; can't fix it (etymology subsection) without fixing the whole thing. Just removing it doesn't solve the overall (and I'm unconvinced all of it should be removed). So, with a talk page that has already spiraled out of control with personalization, should I put the bigger picture in this talk section, or start a new talk section to describe all the problems at Wikipedia:Manual of Style/Medicine-related articles#Content sections, of which Eymology is only one part? My suggestion is that by fixing the WHOLE thing, we fix etymology. How to best discuss this to maintain some readability of this page for subsequent visitors ... let me know ... SandyGeorgia (Talk) 12:31, 15 August 2020 (UTC)

Not really sure what the "it" in your comment is. The sentence WAID mentions is in the Technical terminology advice sub-section of Writing style. I see now there is a later Etymology sub-section of Content sections, which further states the apparent importance of this wrt anatomy. I think it would be worth checking how many anatomy articles have such a section and warrant such a section. Is this advice based on best practice, or just some random idea? Wrt content sections, this has consumed a huge amount of guideline edits and discussion, and to be honest, I'm not over bothered about arguments about these as long as the fundamental principle remains: they are merely suggestions. -- Colin°^Talk 12:49, 15 August 2020 (UTC)

I was referencing the entire Etymology section, which is only one problem of multiple in the Content sections. MOST of the new ("new" being relative to when we wrote the page, which is "old" now :) suggestions added to Content are just plain wrong ... we need to fix the whole thing. Do I start a separate section or continue here? My point is that the entire page has gotten so out of whack that looking at individual pieces is counterproductive. On how to get this talk page under control and useful after the discussion became personalized .. if this section had been placed under our other terminology discussion, I might have understood that WAID was being specific to that one sentence rather than the other section (since we have that duplicated in an entire Etymology section-- another but separate problem). SandyGeorgia (Talk) 13:57, 15 August 2020 (UTC)

Removing the sentence about etymology (in the technical terminology section) sounds good to me. Ajpolino (talk) 16:46, 15 August 2020 (UTC)

Some of our medical or anatomy articles will need to cover etymology and/or definitions, which is also true of Wikipedia articles in general. I think we should continue to mention something about etymology in this guideline, but I don't think we need it addressed in two different sections. And, yes, I've seen these sections etymology sections as helpful for anatomy articles because of the eponym matter or something else. Pinging Tom (LT), our most prolific anatomy editor, who likely added that etymology material with respect to anatomy articles to the guideline. We recently had to deal with a newbie adding uncommon eponyms to the leads of anatomy articles. Flyer22 Frozen (talk) 00:10, 16 August 2020 (UTC) Tweaked post. Flyer22 Frozen (talk) 00:32, 16 August 2020 (UTC)