Talk:Paroxetine

/Archive 1 /Archive 2

I downgraded the article to Class C

This article is seriously lacking in several areas, most notibly, an interactions section, a contraindications section. I recommend that these sections be added before putting the article back to a B class article. I also noted that mania and hypomania had been neglected from the side effect list. These are one of the most important side effects of antidepressants. I have added these side effects tonight.--Literaturegeek | T@1k? 22:21, 23 March 2009 (UTC)

I've restored information on preventing / managing withdrawal symptoms that had previously been deleted (by whom I dare not say, lest someone take offense). The link was graciously provided to me by Literaturegeek, and I think it helps the article a lot.TVC 15 (talk) 04:29, 27 March 2009 (UTC)

Please dare say. Stating a disagreement and then declining to identify the offending party is tendentious and passive-aggressive. Skinwalker (talk) 01:38, 28 March 2009 (UTC)

Here you go again. Please, civility! The Sceptical Chymist (talk) 11:07, 28 March 2009 (UTC)

TVC 15 is referring to Mwalla who was blocked for 3 months for using sockpuppets and stalking or harrassing several members on their sockpuppets. See Suspected_Wikipedia_sockpuppets_of_Mwalla and Wikipedia:Sockpuppet_investigations/Mwalla/Archive.--Literaturegeek | T@1k? 01:42, 28 March 2009 (UTC)

Actually, the information had been deleted by Skinwalker.[1]TVC 15 (talk) 07:15, 28 March 2009 (UTC)

Well to be fair to Skinwalker, his deletion was justified. Wikipedia does not give medical advice, especially not uncited medical advice. If data like that is readded it will need to be cited and it would need to be reworded in a factual tone rather than instructional tone.--Literaturegeek | T@1k? 11:53, 28 March 2009 (UTC)

Umm, I cited and quoted the source that you gave me.[2] Skinwalker then "chopped" the quote.[3]TVC 15 (talk) 22:16, 28 March 2009 (UTC)

To address the remaining reasons why the article was downgraded to class C, I have added sections on contraindications and interactions. Combined with the improvements made by Literaturegeek and The Sceptical Chymist, I think the article has recovered from Mwalla and is actually better now. Is it ready to restore/upgrade?TVC 15 (talk) 09:14, 31 March 2009 (UTC)

Changed the rating to B. The article meets the formal definition for B and is close to an average pharmacology B-article. The difference between B and C is subjective to a significant degree, anyway. But please use this tool [4] when adding references. Thank you. The Sceptical Chymist (talk) 10:39, 31 March 2009 (UTC)

Thanks Sceptical Chymist :) Looking ahead to possible future improvements and upgrades, I think this article (and other pharmacology articles) would benefit from more direct comparisons of the number of patients who experience efficacy. You wrote above that paroxetine efficacy for depression "goes without saying," but the data seem to show efficacy in only around 20% of patients. Most study subjects seem to get no benefit. For example, a study on 'late-life depression' reported the following:

Response, defined as a score of 1 or 2 on the Clinical Global Impressions-global improvement scale, was achieved by 72% of paroxetine CR patients (LOCF; p < .002 vs. placebo), 65% of paroxetine IR [Immediate Release] patients (p = .06 vs. placebo), and 52% of placebo patients. Remission, defined as a HAM-D total score < or = 7, was achieved by 43% of paroxetine CR patients (LOCF; p = .009 vs. placebo), 44% of paroxetine IR patients (p = .01 vs. placebo), and 26% of placebo patients... CONCLUSION: Paroxetine CR and paroxetine IR are effective and well tolerated treatments for major depressive disorder in elderly patients, including those with chronic depression.

The response difference between paroxetine IR (the originally approved version) and placebo is only 13%; the new patented Paxil CR is only slightly better, 20%. The remission difference for both versions is less than 20%. In other words, four out of five patients taking the drug did not benefit from it. Yet, the conclusion seems nearly as enthusiastic as the TV ads. Similarly, a study on Generalized Anxiety Disorder reported:

reductions in total score on the Hamilton anxiety scale were significantly greater for both paroxetine groups. Response was achieved by 62% and 68% of the patients receiving 20 and 40 mg of paroxetine, respectively, compared with a 46% response rate in the placebo group. Remission was achieved by 30% and 36% of patients in the 20- and 40-mg paroxetine groups, respectively, compared with 20% given placebo... CONCLUSIONS: This study demonstrates that paroxetine is an efficacious and well-tolerated treatment for generalized anxiety disorder.

Again, only around 20% experienced "response," and even fewer experienced remission. The remaining 80% did not respond favorably to the drug. While I recognize even 20% response rates provide some support for the studies' conclusions, I think the WP article would benefit from comparisons to alternatives like increased exercise. For example, "A 2001 study by the Duke University in North Carolina found that exercise is a more effective treatment for depression than antidepressants, with fewer relapses and a higher recovery rate." In the USA, the TV advertisements exhort the entire audience to "ask your doctor" about the advertiser's pill, and doctors complain they are besieged by patients asking about pills they've seen on TV; the #1 complaint of general practitioners is patients lying to get prescriptions for drugs they don't need. (An almost equally widespread complaint is struggling with insurance companies to get payment for things the patients actually do need.) While I understand that some people can't go out for a daily walk, and that even some physically fit patients may still benefit from medication, I think a general-audience encyclopedia like WP should mention reliably sourced data comparing the subject drug to non-drug alternatives.TVC 15 (talk) 22:13, 31 March 2009 (UTC)

The results of single studies may vary widely. That is why we have to look at the results of meta-analyses, which reliably show that antidepressants perform better than placebo. However, it is widely acknowledged that effectiveness of all antidepressants is weak to moderate and that companies relentlessly spin the positive results (for more information see this open-access article Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R (January 2008). "Selective publication of antidepressant trials and its influence on apparent efficacy". N. Engl. J. Med. 358 (3): 252–60. doi:10.1056/NEJMsa065779. PMID 18199864). Nevertheless, in real-life situations, antidepressants are highly effective because the medication effect and placebo effect add up to 60-70% response. Psychotherapy has similar effectiveness (see here Treatment_for_depression#Efficacy_of_medication_and_psychotherapy). Thus, the comparison between treatments is based on side effects (favors psychotherapy) and cost-effectiveness (favors antidepressants). The direct advertisement to consumers is allowed only in Australia and the US, and it is not a problem worldwide. One can hope that the US Congress/Obama administration eventually get to that issue as a part of the health care reform. The Sceptical Chymist (talk) 10:55, 1 April 2009 (UTC)

Thanks for the reply and links :) Regarding direct to consumer (DTC) advertising, alas a side effect of the WWW may be to spread drug ads worldwide. The prognosis for health care reform is difficult because once a revenue-driven system gets big enough to entrench powerful political lobbies, it metastasizes and spreads. The U.S. does seem to have the most, where a symbiotic relationship has developed between the evening news ("if it bleeds, it leads;" "world to end at ten, details at 11") and the advertisers (anxiolytics, antidepressants, antihypertensives, antacids, headache relief, etc.), but others might catch up. Most users of the English-language Wikipedia are either already within reach of DTC drug ads or soon may be, and may check here for more balanced information. It seems notable that at least 80% would be better off going outside for a daily walk. They won't hear that from drug companies, or any other revenue-driven enterprise, because there is no revenue involved. Also I wonder if the improvement in the placebo group might simply reflect the inherently transient nature of most people's mental state. For example, a common feature of both depression and happiness is the feeling that life has always been this way and always will be, just as someone traveling over hills and valleys sees only hilltops when on hilltops, and sees only valleys when in valleys. Depression and anxiety study subjects may thus contain a high proportion of people whose condition would improve even with no therapy, and it seems inaccurate to count the placebo effect among the benefits of treatment.TVC 15 (talk) 22:44, 1 April 2009 (UTC)

Discontinuation or withdrawal syndrome? - Both! - Straight from the horse's mouth

Now I remember where I read that! Straight from the horse's mouth, that is from the recent review by Haddad on the discontinuation/withdrawal syndrome [5]: "The terms ‘antidepressant discontinuation symptom’ and ‘antidepressant withdrawal symptom’ are used interchangeably in the literature. ‘Discontinuation’ is preferred by some authorities, as it does not imply that antidepressants are addictive or cause a dependence syndrome, whereas the term ‘withdrawal’ may imply this. Both terms are likely to remain in use and it is more important to be clear about what they refer to rather than which is preferable." The Sceptical Chymist (talk) 11:32, 29 March 2009 (UTC)

Thanks for remembering that :) I've added some etymology to the history section of the SSRI discontinuation article; according to the World Health Organization and the New York Times, withdrawal was renamed "discontinuation syndrome" after a symposium sponsored by Eli Lilly and Company, maker of fluoxetine.TVC 15 (talk) 08:06, 31 March 2009 (UTC)

Pregnancy: I Don't want an edit war!!

First of all, Ddave2425, current recommendations from both the FDA and GSK indicate that paroxetine can cause congenital defects during the first-trimester. Second, I'm not sure why Literaturegeek reverted all the way back to CliffC's edit since you sent me a message earlier commending those edits to this page!! I can only surmise it was because my name is in red and you assumed it was a vandalism without thinking or reading. My edit not only slightly reworded the issue for clarity, but also added reliable citations. Please indicate if there was any other reason for reverting my edits as well. DKqwerty (talk) 15:28, 4 May 2009 (UTC)

Sorry about that. I just reverted to the version before Ddave made any edits and unfortunately reverted one of your edits which was inbetween. It had nothing to do with your name being red. I assumed that your edits were just undoing Ddaves edits and didn't realise that I was actually losing good edits.--Literaturegeek | T@1k? 16:31, 4 May 2009 (UTC)

The FDA does not ban the use of paroxetine for pregnant or nursing mothers. Ddave2425 (talk) 21:13, 9 May 2009 (UTC)ddave2425

The article does not say it is "banned", only that they "should avoid using paroxetine" and "[consider]...either discontinuing paroxetine therapy or switching to another antidepressant". There is nothing stating it is forbidden. DKqwerty (talk) 21:50, 9 May 2009 (UTC)

I agree with qwerty.--Literaturegeek | T@1k? 10:45, 11 May 2009 (UTC)

That is not what the FDA reference says. Besides, the FDA advisory is from 2005 and based on unpublished studies. I included a published study from 2009. Ddave2425 (talk) 12:18, 16 May 2009 (UTC)ddave2425

It is current FDA guidance. The article does not rely soley on the current FDA guidance but also on citations to review articles which are secondary sources. Please read this page WP:MEDRS to understand why primary sources are of poorer quality than secondary sources. As FDA issues national guidelines a single small primary study is not valid enough to justify deletion of FDA guidance. This is not be being awkward but is the way wikipedia medicine related articles work. If you disagree with this policy you can challenge the policy on the talk page of this WP:MEDRS article.--Literaturegeek | T@1k? 14:47, 16 May 2009 (UTC)

What is "it"? Can you give a source before reverting a good faith edit? Ddave2425 (talk) 01:25, 17 May 2009 (UTC)ddave2425

"It" is the information you insist on removing despite both Literaturegeek's and my advisement that a singular, isolated study does not constitute medical consensus. And the sources you're pretending don't exist are the "^{[10][11][12]" after the text you are continually removing. I seriously question your objectivity. Please, explain why you are so insistent that both the FDA and the manufacturer are incorrect in their assessment of the pregnancy risks and why you feel that your source is valid enough to supersede Wikipedia's criteria for reliable sources in medicine-related articles. Otherwise, we will continue to revert your edits in observance of these policies and you will most likely ultimately be blocked. DKqwerty (talk) —Preceding undated comment added 01:53, 17 May 2009 (UTC).}

Wikipedia is not a place for original research. My edits added neutrality. You are misinterpretting the FDA. You should quote it directly instead of spinning it. Ddave2425 (talk) 13:34, 13 June 2009 (UTC)ddave2425

I have explained that your source is a primary source and worse still discussing antidepressants in general. You are using it to delete FDA guidance. I gave you a link to WP:MEDRS. You aren't a banned user by the way? You are mwalla, great, you're back to sockpuppets again. How many sock puppets is this now? 11 or 12 are we up to now? Should have figured it out earlier, I did wonder how a brand new user knows about the admin notice board and knows how to use lingo like "good faith" etc to manipulate conversations. I hope I don't have to have another check user done again to verify this allegation.--Literaturegeek | T@1k? 01:47, 17 May 2009 (UTC)

Yup and it is you following my contribs around and you coincidently showed up immediately below my discussions regarding scurio on admin notice board.--Literaturegeek | T@1k? 01:57, 17 May 2009 (UTC)

DKqwerty, I would not engage anymore in any debates regarding sources. The user you are talking to is a vandal and sock puppeteer who is meant to be banned for 3 months. I am 99% certain of this. Please see sock puppet investigation for more information. Wikipedia:Sockpuppet_investigations/Mwalla/Archive Just revert their vandalism. They are an experienced editor and playing games.--Literaturegeek | T@1k? 02:00, 17 May 2009 (UTC)

Duly noted. DKqwerty (talk) 02:16, 17 May 2009 (UTC)

I bounced here from AN/I. I'm not interested in addressing the socking, but the content. I note that back in April, Mwalla provided, in edits, multiple gov't studies demonstrating no ill effects, and now provides an NIH citation. Wouldn't it be the most responsible thing to report that different parts of the government have, in fact, provided conflicting reports about the safety of the drug, presenting both 'pro' and 'con' sections? from the size of the material, it looks like it should be structured Con/pro in this case, but we can neutrally report that different governing bodies say differing things. ThuranX (talk) 17:24, 13 June 2009 (UTC)

I don't know what gov ref he added in April. If a recent gov report exists contradicting the FDA findings by all means add it. I would Thurax avoid jumping to conclusions. If you read the sockpuppet investigation one of the problems raised was that Mwalla faked and made references say the opposite of what they said etc and then created arguments using sockpuppets to fight over his faked data basically to be disruptive etc. I honestly do not care, like really really do not care about what the article says about paroxetine in pregnancy. It is a matter of not allowing a sockpuppet to intentionally delete referenced data distort info and create arguments to get revenge for the sockpuppet investigation which I was involved in which got him banned. I would urge you not to feed the troll.--Literaturegeek | T@1k? 17:47, 13 June 2009 (UTC)

Also pubmed indexes every medical article ever published. So an medical abstract archived on NIH pubmed does not make it a differing "gov opinion". Please also read WP:MEDRS regarding using priumary sources to delete secondary sources.--Literaturegeek | T@1k? 18:03, 13 June 2009 (UTC)

Mm. Hostile, defensive, and offensive, all in one. link since you claim there was none. the NIH, as well as medical journals, are all WP:RS. I'm more disturbed by the amount of 'GlaxoSmithKline says XYZ' stuff in the version being defended. ThuranX (talk) 18:07, 13 June 2009 (UTC)

I appologise if it comes across that way but you accused me on ANI of persecutiing someone who is meant to be banned who are using sockpuppets to follow me around on several articles and cause arguments. It is immensely frustrating when a sockpuppet intentionally files a bogus reports and then to see the response belittling my response telling the truth and admins defending the banned sockpuppeteer. I shall request a checkuser to resolve this. I do not believe admin noticeboard is the right place to deal with sockpuppets.--Literaturegeek | T@1k? 18:15, 13 June 2009 (UTC)

I have done very little developing to this article. So please don't hold me accountable for the content of this article. This article only ended up on my watch list after I followed a request for opinions on the wiki medicine project. I have no big interest in the article. My problem is a sockpuppet causing me grief who is ban evading. thank you for listening.--Literaturegeek | T@1k? 18:15, 13 June 2009 (UTC)

I don't understand what you mean by showing the diff you gave as those refs that Mwalla added to the article are still in the article in pregnancy section. Like I say the issue is a ban evading user edit warring using sockpuppets. This convo should end as it is not related to the article but should be taken up at a checkuser request which I intend to do when I have the time. Thank you.--Literaturegeek | T@1k? 18:23, 13 June 2009 (UTC)

Dear Thuran. The consensus views on paroxetine in pregnancy are collected in one of the Talk topics above, see [[6]] for your convenience. Unfortunately, one of the problems with Mwalla was that he would provide random links to support his views. Those links would look legitimate until you started checking them. The Sceptical Chymist (talk) 11:17, 14 June 2009 (UTC)

I second that observation, and am writing to express my continued appreciation for the contributions of Literaturegeek and The Sceptical Chymist. Thuran, mwalla's indefensible use of sockpuppets resulted in a 3-month block (due to expire soon). To understand the history you might look at these diffs: [7], [8], [9], [10]. If you are unfamiliar with trolls, you might read [11] and [12].

As for the specific issue of paroxetine vs. pregnancy, risks include congenital defects and withdrawal syndrome (aka "discontinuation effects"). Reported discontinuation effects include miscarriage and neonatal convulsions, as noted in the article. Note that discontinuation may in some instances be involuntary, for example if paroxetine is first prescribed during pregnancy and produces intolerable side effects, or if the mother loses access to the drug. (In the U.S., the drug requires a prescription typically every 90 days, which can become prohibitively expensive if, for example, the customer had been getting insurance through an employer and then loses coverage.) One reason why reliable sources say that pregnant women, or women who may become pregnant, should avoid paroxetine is because commencing a habit-forming teratogen is an especially bad idea for them, especially when alternative therapies are available. (Alternatives include other SSRIs, other drugs, non-drug therapy, and the simplest and cheapest of all: increased physical exercise, which reportedly is more effective and doesn't cost anything.) I suspect another reason may be the extraordinary history of dishonesty promoting paroxetine; when a product is promoted so dishonestly, so widely and for so long, common sense suggests skepticism.TVC 15 (talk) 19:00, 14 June 2009 (UTC)

Got it. Get the fuck out, we've owned this page. I see perfectly good references being removed for saying a medicine is safe, not secretly deadly and being marketed by the evil corporations, and any challenge to that POV is unwelcome. I'm gone. ThuranX (talk) 23:29, 14 June 2009 (UTC)

What a rude dick ThuranX is. TVC I wouldn't take any offense. ThuranX knows he is wrong I feel but is one of these people that can't just say hey I made a mistake and has to get nasty etc. He is pissed because he was asked to apologise to me for calling me stupid on the admin noticeboard, which he wouldn't do and that he was then proven wrong about Mwalla. He is also aware of the sockpuppet investigation into Mwalla where multiple admins and checkusers agreed Mwalla was a disruptive sockpuppet and banned him for 3 months but I guess they are all wrong. The so called claim of well referenced stuff in the link being deleted that ThuranX gave above by Mwalla actually is not mwalla adding refs as all but one ref was already added. It was Mwalla deleting every single ref he didn't like LOL. Oh well I guess ThuranX is another victim of Mwalla's sockpuppet games.--Literaturegeek | T@1k? 00:11, 15 June 2009 (UTC)

The perfectly good references claim ThuranX makes is also bogus as I explained WP:MEDRS and gave him a link to it on admin noticeboard. He is aware that wiki guidelines say that primary sources should not be used to delete or debunk secondary sources and is aware the primary source itself was irrelevant to this article, (perhaps relevant to other antidepressant articles) as it only had a small number of paroxetine users and was on antidepressants in general.--Literaturegeek | T@1k? 00:32, 15 June 2009 (UTC)

Listen up, if you want to engage in personal attacks, I can play that game better than you ever could. I happen to have read through his citations, and they look like they provide a different viewpoint which, per WP:NPOV ought to be represented in the article. Had dave not reported on AN/I the insult you'd made, I wouldn't be back here at all. But I'm back this time, and hopefully not again, to state plainly :The sources he provides appear to me to represent a significant alternate opinion which needs Due Weight representation in this article, as I regard the NIH, and medical journals, to be significant reliable sources for Wikipedia articles. As I stated before, I do also find the amount of OWN going on to be onerous, and I'm not going to argue here anymore, because the reply to my previous comment about your OWN was to insult me for a paragraph. ThuranX (talk) 03:19, 15 June 2009 (UTC)

Okay, here's an article that states the opposite. Who is right? Given that they are both primary sources, it is appropriate to wait until a secondary source has weighed in on the research he keeps citing per WP:MEDRS. Ddave2425 continues to treat this primary source study as gospel, so far as to state, "Paroxetine is not associated with birth defects nor harmful effects in nursing newborns," which is flat out incorrect and misleading as it ignores long-standing associations to the contrary. He also misrepresents the FDA's position on prescribing Paroxetine to make it seem that the FDA doesn't regard it as a risk to the fetus, which it clearly does in the given citations, which he also removes. If he were to find reliable (secondary) sources, we'd welcome his adding this information to the article, but not substituting it for cited, reliable information. DKqwerty (talk) 03:38, 15 June 2009 (UTC)

That ref that you gave is a meta-analysis and a review article so it is a secondary source. In the case of Mwalla on his sockpuppets I suggest whenever possible not engaging in debating his sources and arguing over them as it feeds the troll and encourages them to create disruption which is why they do this. They are now a permanently banned abusive sockpuppeteer who has no right to edit/vandalise wikipedia. Next time they are suspected of editing/vandalising wikipedia they should be reported with a view to banning their sockpuppet.--Literaturegeek | T@1k? 11:37, 15 June 2009 (UTC)

Ddave2425 has been confirmed as a sockpuppet of Mwalla, and both have been blocked indefinitely.[13],[14],[15]TVC 15 (talk) 08:37, 15 June 2009 (UTC)

You are more than welcome ThuranX to follow wikipedia medicine related article guidelines and find a good quality secondary source to dispute the FDA findings. If you feel that reliable sources for medicine articles guideline WP:MEDRS is inaccurate you are also more than welcome to go to the talk page there and challenge the guidelines. There is no ownership issues. Cite a recent secondary source and you will see that it won't get rreverted not by me anyway. Mwalla has now been blocked indefinitely as well as Ddave. You are welcome to engage in the personal attack game if you wish, you seem to enjoy it. You seem to think you have a right to insult people become aggressive with people but if they respond similarly in return you think their behaviour is out of order. Ddave and Mwalla have now been permanently banned from wikipedia so I think this issue is resolved. I would suggest ThuranX that you give this issue a rest and quit taking things so seriously. You do not even know me and you do not even have an interest in this article.--Literaturegeek | T@1k? 11:30, 15 June 2009 (UTC)

Where the positive spin on Paroxetine for pregnant women comes from

From the Wall Street Journal

More details are coming out about the relationship between Emory University psychiatrist Zachary Stowe and GlaxoSmithKline, which made payments to Stowe at the same time he was conducting federal research about the use of antidepressants, such as Glaxo’s Paxil, in pregnant women.

Emory has reprimanded Stowe, who was instructed to immediately eliminate conflicts related to current federal grants. In a statement, the school said Stowe had informed it of “previously unreported activities and has disclosed his failure to abide by Emory policies.” Stowe, through the university, declined an interview request. Here’s more on the story.

In a letter this month to Emory, Sen. Charles Grassley said records he obtained from Glaxo indicated Stowe was paid $154,400 by the drug company in 2007 and $99,300 during the first 10 months of 2008. Stowe is listed as the primary investigator on at least three National Institutes of Health grants, beginning in 2003 and continuing through last year, that involve antidepressant use in pregnant women and the effects on children delivered by those women.

The study, conducted by Stowe, found Paxil is safe for breast-feeding mothers. The PR firm’s email to Glaxo reads: "Please review the attached press release and forward me any comments/edits. As you may know, Dr. Stowe is on board for publicity efforts and Sherri and I are coordinating time to meet with him next week to arm him with key messages for this announcement, which is slated for early February. We are sending the release for his review at the same time in efforts to secure distribution on Emory letterhead (as you know, would provide further credibility to data for the media)."[16] The Sceptical Chymist (talk) 18:57, 20 June 2009 (UTC)

So Ddave2425 == Zachary Stowe?   ;) DKqwerty (talk) 19:24, 20 June 2009 (UTC)

No, Ddave2425 = Fndlytrucker talk ;(( The Sceptical Chymist (talk) 10:13, 24 June 2009 (UTC)

NPOV Noticeboard

I've created a summary of my concerns about this article at the NPOV Noticeboard here. I welcome outside opinions, comments, and ideas. ^blurred_peace ☮ 04:10, 24 June 2009 (UTC)

I have taken a break from editing the usual articles that I edit and decided to address these concerns that you have raised on my talk page regarding violations of NPOV on these two articles. I have started adding in some of the benefits of paroxetine as I felt it focuses too much on the negatives. As life is rather unpredictable I might end up giving up on doing this and revert back to my usual editing arena or I might remain active on the antidepressant articles bringing balance to them, time shall tell. Despite some side effects when on them or coming off of them they are very effective drugs for many people, even in the long term! The benefits outweigh the risks I feel for most people! Check out my recent edits to this article and let me know what you think. More work to be done? :)--Literaturegeek | T@1k? 00:44, 28 June 2009 (UTC)

I was away and missed that discussion, but I would like to read it. Is it archived somewhere? Meanwhile, I did find some others' edits overly enthusiastic about the drug. For example, singling out paroxetine as "highly effective" for severe PMS when in fact the linked study was of several SSRIs, and omitting paroxetine's unique teratogenicity. Likewise calling paroxetine a 'first-line treatment' for GAD seems biased when the linked source merely included paroxetine among other (possibly better) options like escitalopram and the WP article on GAD says CBT is more effective anyway. I assume good faith, but as the health care reform debate in the US heats up there seems to be a big push for PhRMA and the AMA (and the insurance and hospital corporations) at the expense of other priorities like education, exercise, nutrition, and basically everything else.TVC 15 (talk) 22:07, 15 August 2009 (UTC)

Yeah, well, you don't assume good faith. You assume that those who edit differently from you are shills for PhRMA/AMA/etc, even though the article has not been significantly edited during the health care debate. We can work together on improving the article, but you've got to stop making these sort of commments. Skinwalker (talk) 16:33, 16 August 2009 (UTC)

I look forward to working together to improve the article, but you've got to stop deleting reliably sourced information as you did today. I do try to assume good faith, but this article has drawn blatant misconduct including the now-blocked mwalla. Also you make it difficult to assume good faith when, for example, you delete references to the manufacturer's own prescribing information as "trial attorney puffery;" I asked you to explain that, but you never do. The recent edits are significant and are date-stamped, so please explain why you deny they are occurring "during the health care debate?" There was consensus on retaining most of what you removed today, so I will restore those parts. You used to make edits like that without even discussing them, until I drew you into the discussion page, so at least this is progress.TVC 15 (talk) 23:38, 16 August 2009 (UTC)

Let's start with something simple. The word "falsely" in the first sentence of the controversy section communicates an overt value judgement that is not present in the sources cited. It therefore violates NPOV. I've tagged the section accordingly. Skinwalker (talk) 23:00, 18 August 2009 (UTC)

In this article, the word "falsely" communicates a clearly proven fact; GSK was ordered to stop advertising the drug as "not habit forming" because that statement was false. Therefore, it does not violate NPOV. Many people do attach a negative value judgment to false advertising, especially when the false ads (1) are directly opposite to the facts and (2) continue until ordered to stop by courts and regulators. Since that is what happened, and on an obviously notable scale, suppressing it or sanitizing it would not be NPOV.TVC 15 (talk) 23:57, 18 August 2009 (UTC)

No, it is not a "clearly proven fact". It is your opinion that you've formed from reading the two sources cited. You did read the sources? Neither use the word "false". Look, it's not my responsibility to teach you the difference between an opinion and a fact. The first source describes a warning about the addictive potential of seroxat. The second describes a judicial ruling enjoining GSK from describing it as non-habit forming. Why can't you just summarize what the sources say instead of bashing the reader over the head with an obvious value judgement that does not describe the specifics? Skinwalker (talk) 00:09, 19 August 2009 (UTC)

Also, you've neglected to mention that the injunction preventing GSK from describing the drug as not habit forming was later lifted.[17] This sort of cherry-picking of sources is endemic to this article. Skinwalker (talk) 00:16, 19 August 2009 (UTC)

In fact, the judge reversed herself one week after ruling against GSK. This was in 2002. Why doesn't the article say this? A simple google news search must have turned this up along with the original injunction. Why are you cherry-picking sources like this? Skinwalker (talk) 01:34, 19 August 2009 (UTC)

In answer to your first question, yes I did read the sources. In answer to your second question, "stated falsely" summarizes accurately what the sources say. Regarding the injunction in that specific case, (1) the subsequent technical ruling was based on federal pre-emption (a doctrine the US Supreme Court has since revisited in a different drug case); (2) the case settled on confidential terms; (3) publicly, the company stopped the ads and acknowledged the withdrawal symptoms (which it called "serious discontinuation symptoms"). As for the factual statement that the ads were false, there are many more sources (e.g. [18], [19]). In light of your edit history on this article, it is surprising that you try to invoke NPOV, since you previously removed citations to reliable sources (including even the prescribing information) and insisted on using the manufacturer's preferred term "discontinuation syndrome" and deleting every occurrence of the more commonly understood "withdrawal syndrome." Lastly, there seems to be a pattern here: I make a comment that you don't like in the discussion section, and you retaliate against the article. The section you're attacking currently had been stable for months, and was the consensus version after editing among several different editors; even you had accepted it, until I made a comment here about the ongoing debate about healthcare reform. Frankly, your own comments are not particularly civil, but I don't respond by retaliating against the article. Please try to refrain from passive-aggressive editing, and to improve your tone if you can.TVC 15 (talk) 02:04, 19 August 2009 (UTC)

You didn't answer my question about cherry-picking at all. Social Audit (a non-notable NGO) and citypages (an alternative weekly) are exceedingly poor sources for medical topics. Look, it's clear that you are approaching this article as an activist and not as neutral editor. I've tagged the entire article for an NPOV dispute, and I will seek outside intervention since it is clear that you are not open to collaborative editing. Skinwalker (talk) 10:37, 19 August 2009 (UTC)

Since this topic causes such a heated discussion, the best is to cling to the sources as close as possible and attribute value judgments to a certain source. For example, "according to independent watchdog organization Social Audit, GSK knowingly mislead ...". "The XYZ court injunction noted ... This injunction was later lifted, and as a result of confidential settlement GSK stopped... and ..." Just my 2p The Sceptical Chymist (talk) 10:39, 19 August 2009 (UTC)

That's what I've been advocating. If we strictly report what reliable sources say, there is no need to add commentary about "falsely" or whatever. TVC is insistent on presenting this material in the most negative possible light, and as I discovered above he is cherry-picking sources. I intend to seek assistance at Wikiproject Medicine. Skinwalker (talk) 10:47, 19 August 2009 (UTC)

I hope TVC will fix that (hint, hint). The evidence speaks for itself. Additional judgmental words like "falsely" could, actually, make reader doubt the overall objectivity of the article.

On the other hand, Skinwalker, it is unfair to tag the whole article only because you disagree with TVC about one part. You did not offer any concrete evidence as to why and how the rest of the article is skewed. You did not try to add any well regarded independent studies about paroxetine that would be more objective to it (which is what you should have done first). Overall, you decision to tag the whole article was not very well thought out. Please reconsider it. The Sceptical Chymist (talk) 10:54, 19 August 2009 (UTC)

[outdent]Acting on Skeptical Chymist's hint, I've edited the relevant sentence and added two sources. Skinwalker, WP's sourcing standards can be found in WP:RS and you cannot limit the article to industry-sponsored publications. Beth Hawkins is an award-winning investigative journalist and the article has stood the test of time. In contrast, medical journal articles sometimes turn out to be ghost-written by PHrMA marketing,, and sometimes whole journals turn out to be advertisements in disguise, and of course there is the Emory story discussed above, where the underlying studies were conducted by a researcher who concealed drug-company payments. Your MSc marks the beginning of an education, but not the end; if you insist on blinkering yourself and disregarding critical sources, then you deprive yourself of the faculty of reason, critical thinking, and comparative analysis. WP is not so limited, and should not be. Lastly, I did answer your accusation about cherry-picking, but perhaps I put it too politely so you didn't notice. As I stated above, the subsequent reversal was related to federal preemption, i.e. the question of who has authority to decide a particular question. The court did not decide that GSK's ads were true, but rather the court accepted FDA's argument that it was for FDA to decide. GSK then prudently settled. In a subsequent case, Wyeth made a similar argument, and the Supreme Court ruled against them. (That case involved a violinist who lost the use of her arm due to an undisclosed side effect of a Wyeth product.) Your endless accusations (calling me an activist because I disagree with you, which is what Sarah Palin calls judges she disagrees with; accusing me of cherry-picking instead of reading why a decision was reversed) are becoming excessive. Also, your refusal to explain your own behavior casts doubt on your motives, for example deleting references to the manufacturer's FDA-mandated prescribing information as "trial attorney puffery." You wrote about your bad experience with venlafexine, and I hope you've found something better since, or that you will soon.TVC 15 (talk) 19:28, 19 August 2009 (UTC)