Wikipedia talk:WikiProject Medicine

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List of archives

Merged Archive WikiProject Preclinical medicine: 1 Merged Archive WikiProject Clinical medicine: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 WikiProject Medicine Archives: Index, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171

Featured article candidates

β-Hydroxy β-methylbutyric acid

HMB FAC

Round 2

Cross-posted at WT:WikiProject Pharmacology and WT:WikiProject Molecular and Cell Biology

The beta-hydroxy beta-methylbutyric acid article has been renominated for FA status. at Wikipedia:Featured article candidates/Beta-Hydroxy beta-methylbutyric acid/archive2. It still needs at least 1 more reviewer. Seppi333 (Insert 2¢)

November 2016 update: The article now has enough medical reviewers; the pharmacology content still needs reviewers though. Seppi333 (Insert 2¢)

Third time through the meat grinder

January 2017 nomination: See Wikipedia:Featured article candidates/Beta-Hydroxy beta-methylbutyric acid/archive3. Seppi333 (Insert 2¢)

Acne vulgaris FAC

Acne vulgaris on a very oily skin

See Wikipedia:Featured article candidates/Acne vulgaris/archive1. Seppi333 (Insert 2¢)

January 2017 nomination: Wikipedia:Featured article candidates/Acne vulgaris/archive2. Seppi333 (Insert 2¢)

• need more opinions at above FA's,thank you--Ozzie10aaaa (talk) [Timestamped at 15:59 on 12 Jan 2017 (UTC)]

@Ozzie10aaaa: I've edited your timestamp to prevent the bot from archiving this thread. This is the reason I've been signing my posts with 3 tildes instead of 4 in this thread. Seppi333 (Insert 2¢)

cool ;-)--Ozzie10aaaa (talk)

Granular myringitis

En editor requested deletion under db-duplicate but the article Otitis media doesn't mention Granular myringitis and online search suggests that it may be a valid medical topic. Any thoughts? --Vejvančický (talk / contribs) 08:43, 28 January 2017 (UTC)

Not a common condition but seems to deserve its own article. Doc James (talk · contribs · email) 08:54, 28 January 2017 (UTC)

Thank you, doctor. --Vejvančický (talk / contribs) 08:56, 28 January 2017 (UTC)

Lots of textbooks here as sources[1] Doc James (talk · contribs · email) 09:01, 28 January 2017 (UTC)

[2]--Ozzie10aaaa (talk) 10:40, 7 February 2017 (UTC)

Essential Medicines List at Featured List

Hey All. I and a number of others have worked over the last few years to improve the leads of articles on essential medicines. We are now more or less done and I have nominated the list for FL status. Thoughts welcome. Doc James (talk · contribs · email) 13:17, 30 January 2017 (UTC)

• Wikipedia:Featured_list_criteria--Ozzie10aaaa (talk) 12:03, 31 January 2017 (UTC)

Still looking for further people to weight in. As a list it is a fairly simple review unlike that required for a full article. Doc James (talk · contribs · email) 07:37, 10 February 2017 (UTC)

MEDRS and clinicaltrials.gov

Can someone explain to me why clinicaltrials.gov isn't considered a reliable source? Natureium (talk) 20:06, 30 January 2017 (UTC)

This is a registry of clinical trials, but as I understand it, doesn't review results. As a secondary source, it is probably relaible for basic facts about a trial, such as does it exist, who is running it, etc. But the results of the trials are not reviewed by the site, so this registry cannot be considered a reliable source for those results. --Mark viking (talk) 20:34, 30 January 2017 (UTC)

I've cited it as a source for the fact that a trial is in progress for a specific indication, but several times I've had them removed, almost always by the same editor. I wanted to make sure there wasn't some policy on the subject that I couldn't find. Natureium (talk) 20:46, 30 January 2017 (UTC)

It's a valuable site for human research in progress, but does not stand alone as providing a confirmed result that would be encyclopedic. IMO, it falls under WP:NOTNEWS and this MEDRS section. It is often included in disease articles under External links – which might be valid as a progress report – but some restrictions under WP:ELNO also apply. Better to wait for the acceptable MEDRS review or dig harder to find a review that supports a conclusion. --Zefr (talk) 22:41, 30 January 2017 (UTC)

I think a clinicaltrials.gov URL is "reliable" for the claim that a particular clinical trial is planned or recruiting patients. However, because it is a non-independent source, it's also a poor indicator that anyone ought to care about this particular trial.

A link to a pending or recruiting trial is exactly the kind of thing that should not be used as an ==External link==, per Wikipedia:Manual of Style/Medicine-related articles#External links. Generally speaking, even outside of ==External links==, writing something like "as of 2017, there's one clinical trial in progress" is not encyclopedic information because it's such temporary information. WhatamIdoing (talk) 03:44, 31 January 2017 (UTC)

Natureium: This is an example where secondary review of clinicaltrials.gov leads to encyclopedic information, as stated in the abstract conclusions. --Zefr (talk) 14:22, 31 January 2017 (UTC)

@Zefr: clinicaltrials.gov is a perfectly acceptable source to document that a drug is in clinical trials for a certain indication (this is not a medical claim) and this information may or may not be encylopedic. clinicaltrials.gov is not an acceptable source to support that the drug is efficacious (a medical claim). You may not be interested in the drug development pipeline, but others might be. Boghog (talk) 14:48, 31 January 2017 (UTC)

What about a lot of stage II and III developmental drugs like copanlisib? It's not in clinical use, and review articles aren't available for clinical trials that haven't published any data yet. The information about a drug should include what it can be used for, which is what is being investigated in the clinical trials. The only other source covering most clinical trials are press releases. Is it better to use clinicaltrials.gov as a source, where the information was submitted by the trial sponsor and reviewed by the NIH, or a press release?

It seems it would be better to include information that is "temporary" (trials usually last several years), because even in a few years, it would still be useful information. e.g. "Copanlisib was investigated in a large-scale phase III trial for renal cell carcinoma, but was found to be ineffective for this type of cancer." The reason I think people would care about clinical trials is because it's a major part of the development of the drug, and in the case of a targeted drugs can tell you things that may not be obvious. e.g. "Xyzmab targets ABC, which is expressed on melanoma cells and myeloma cells, but clinical trials done by the drug developer found efficacy only in patients with melanoma." There also might not be any other source for the anticipated indication for the drug or reason it's being developed. Natureium (talk) 15:03, 31 January 2017 (UTC)

• Lots of drugs go to clinical trials. Of those, about 1 in 10,000 clinical trials leads to a drug being recommended as a treatment for some medical condition. Because of the noise, and because of the highly likelihood that readers or even medical professionals will not understand the significance of saying "drug is being researched for treating X", and because clincialtrials.gov is a primary source as a database of self-published drug information, I think it is out of scope for citing in articles about drugs or medical conditions. There is almost nothing there that is relevant from any perspective except the most specialized slice of research. I have experimented with citing some information from clinicaltrials.gov for use in articles about clinical trials themselves. See PARAMOUNT trial for example. Although this trial is about a drug and a medical condition, I do not think that this trial merits much description in the Wikipedia articles about either the drug or the condition. If anyone is considering talking about a less prominent study than this quite large one, I think even less mention is merited. Blue Rasberry (talk) 15:02, 31 January 2017 (UTC)

I'm not talking about articles about individual clinical trials, I'm talking about developmental drugs that have an article but not much other information. Possible indications seem like critical information in an article about a pre-market drug.

I don't think I've seen any articles so far about drugs in phase I trials, which is when a lot of them fail. And clinicaltrials,gov is information submitted to the NIH by the drug developer. It's not just information anyone can post without review. Natureium (talk) 15:08, 31 January 2017 (UTC)

My trust in the information at CT .gov is limited. "It's not just information anyone can post without review" but it also is low quality information. I know you are talking about articles about drugs. If you have an example to share then let's see but the usual answer is no, because it is self-published low quality information. Beyond that, most people who try to add information about primary research do it in a way that misrepresents the source, so even if it is possible to share information, "no" is just a short way of saying "yes but it is complicated and please talk it through". Blue Rasberry (talk) 15:12, 31 January 2017 (UTC)

about 1 in 10,000 clinical trials leads to a drug being recommended Where did you get this number? That sounds way, way, off. This source suggests it is closer to 1 to 10. With 1 in 10,000 success rate, there would no longer be a pharmaceutical industry. Boghog (talk) 15:29, 31 January 2017 (UTC)

That My number is completely wrong. The rubric is 10,000 preclinical, 1,000 phase 3 (safety), 100 phase 2 (efficacy), 10 to market, 1 useful drug. Error margin - could be great but order of magnitude is close. Sorry for miscommunication. I would rather use the number 1000 than 10,000. The number 10 seems low to me - I doubt that 1 in 10 trials listed at CT. gov result in a treatment recommendation, but would be curious if that were so. I am unable to read the Nature article. I might be ignorant about numbers but still, most studies are dead ends. Blue Rasberry (talk) 15:45, 31 January 2017 (UTC)

Do you mean 1,000 phase 1? Phase 3 is the last phase before marketing. And we are only writing articles about phase II and III drugs, so it seems like it would be closer to 10 anyway. I'm inclined to trust Nature. Natureium (talk) 15:55, 31 January 2017 (UTC)

I think you should correct your above statement that "about 1 in 10,000 clinical trials leads to a drug being recommended as a treatment", then. "10,000 preclinical" means 10,000 tests that are not clinical trials. (The name "pre-clinical" comes from the fact that these tests happen "before" the clinical [i.e., in living humans] trials.) Even according to your rubric, that's 10,000 non-clinical tests but only 1,110 clinical trials to produce one marketable drug.

Also, the claim above is misleading in another sense: very few single trials lead to a new drug being approved. The regulatory agencies look at the overall mass of evidence, not just one isolated trial. WhatamIdoing (talk) 06:50, 1 February 2017 (UTC)

I should rethink all my comments. For now, I want to just say that I provided incorrect information and step away until and unless I can do better fact checking for myself. Blue Rasberry (talk) 19:11, 1 February 2017 (UTC)

While there's likely almost-universal respect for a registry from NIH, the drug analysis pipeline represented by clinicaltrials.gov is not encyclopedic because it is basically "news-in-the-making" and has strong applicability to WP:CRYSTAL and a high failure rate. Should a drug advance into Phase III success, it would typically be published under peer-review in a clinical journal, at which time it would warrant mention in a Research section of a WP article. There is also possibility of reporting bias or data censoring in the registry, as reported here and here. Such examples are major caveats to WP editors, indicating too much potential for misleading conclusions from the registry to warrant its use alone as a source for discussing a disease mechanism. --Zefr (talk) 15:47, 31 January 2017 (UTC)

I think we're all in agreement that results shouldn't be used from clinicaltrials.gov. The information being sourced from clinicaltrials.gov is the mere fact that the compound is being investigated, for which it seems to be an adequate source. Natureium (talk) 15:52, 31 January 2017 (UTC)

On success rate for drug candidates across the whole development process, we have this: 9.6% of 'new drug application' candidates make it to market, according to this industry review (Fig. 1). --Zefr (talk) 16:01, 31 January 2017 (UTC)

• The OP and I have bumped heads on this before. The specific edits under discussion are:
  • "A phase II trial of patients with pancreatic cancer who failed FOLFIRINOX is in progress." cited to the bareURL https://clinicaltrials.gov/ct2/show/NCT01834235. I removed that here with edit note: "WP:NOTNEWS, primary source.
  • Then the OP restored it in this form: "A phase II trial of patients with pancreatic cancer who failed FOLFIRINOX is in progress and is expected to be complete in October 2017." again cited to the bareURL ref>https://clinicaltrials.gov/ct2/show/NCT01834235. I removed that here with edit note "WP:CRYSTALBALL on a primary source" then left this note at the article Talk page: "User:Natureium about this - please read WP:RELTIME (please), please don't refer to "patients" per WP:MEDMOS, and please don't add crystalball content based on primary sources as you did there. We are an encyclopedia not a newspaper so things should not be in the present tense, and our role is not to give blow by blow on drug development steps. If you use secondary sources you can avoid that problem. Please do that. Thanks. "
  • I didn't cite MEDRS anywhere, fwiw.
  • Discussing clinical trials is kind of complicated in my view.
    • The fact that a trial is happening or has happened just needs a RS, and as with everything in WP, that should be a secondary source so that we know it deserves any WEIGHT at all per NPOV, and avoid WP:NOTNEWS issues etc as mentioned above. If no independent, reliable sources discuss it, why should the WP article?
    • To the extent people want to discuss outcomes of early stage trials, appropriate content should express the uncertainty that besets clinical development of drugs, something like "promising enough to continue development" or "not promising enough to continue development" which may be based on signals of toxicity, signals of efficacy, as well as how the results compare to competing drugs (the latter is discussed with regard to the development of a different drug, Fulvestrant, in endometrial cancer in PMID 26882357 - in that ref the authors ask for people to re-evaluate the potential of this drug in that indication, which the company stopped working on for business reasons - namely they didn't think doctors would use it and they would therefore get insufficient sales to justify further investment, because the drug didn't show much differentiation from already-marketed drugs in the Phase II). If content isn't elaborate about outcomes then I use plain old RS sources; if outcomes are interesting enough to be elaborated on, that needs a MEDRS in source as it is getting into biomedical science.
    • We ~sometimes~ get into fusses with the regard to Phase III trials, like what happened on the Fulvestrant article where a new editor demanded discussion of a phase III trial published in the Lancet, and got so angry that they opened an ANI on it here. These are borderline cases and are exactly discussed in WP:MEDREV; I can see times where we would temporarily add content based on the primary source about the Phase III trial, if it was clear from other MEDRS refs that the outcomes were super important for some reason (answering some long standing question with wide consequences or something), but then replaced by a MEDRS asap. The editor in this case was too angry to even get there. But almost especially for Phase III results, secondary MEDRS sources are best. I think folks are well aware that publications of Phase III results driven by companies are shaped (as was the design of the trial itself) to try to show differentiation from other drugs or treatments. Some publications are better than others at not warping the description of the results and their interpretation in order to achieve that. Jytdog (talk) 16:37, 31 January 2017 (UTC)

btw WAID, the competing "treatment" in the original development of PCSK9 inhibitors like Alirocumab is apheresis - a device based treatment, not a drug. That is discussed in the last paragraph at Alirocumab#Society_and_culture and drove pricing decisions. Jytdog (talk) 16:37, 31 January 2017 (UTC)

This edit is what made me ask the question today, but it's come up in the past as well, and I don't care right now to go through every article I've edited to see what's been removed. Most of the time, I've given up, because I'm a non-confrontational person. However, your NOTNEWS argument assumes that clinical trials are fleeting, rather than essential parts of the development of a drug that are going to be relevant even after the clinical trial is over. You may only care about the current status of a drug once it's marketed, but its history is important as well. Natureium (talk) 16:44, 31 January 2017 (UTC)

Content about a clinical trial being ongoing is very fleeting. Extremely fleeting. The essence of fleeting. Once a trial is completed that is an enduring fact. The fact that a trial was started, is an enduring fact - it is also one that may never have any significance if the trial is not completed (insufficient enrollment, runs out of money, etc) or the results are never made public. WP:NOTNEWS is policy and you should read it and edit according to it. Jytdog (talk) 19:27, 31 January 2017 (UTC)

I agree that just being listed on clinicaltrials.gov is not enough to show notability. We have MEDRS to help keep content we contain notable. We are not a directory of trials. Best to stick with high quality review articles. Doc James (talk · contribs · email) 02:23, 1 February 2017 (UTC)

I'm seeing several points above, and thought I'd make a quick summary-with-my-notes for anyone whose eyes might be glazing over:

• Clinicaltrials.gov is neither the best nor (unfortunately) the worst source we've ever seen for statements about temporal/historical fact about a clinical trial.
  • If that source says that the manufacturer is running a clinical trial in X city or of Y phase, then it's unlikely to be wrong (unless the page contains the unfortunately common warning about not having been updated recently).
  • But please don't use it for "conclusions" about a trial, such as whether the thing works.
• Putting clinical trials information into an article about a medical condition is, and should be, different from putting the same information into an article about the investigational drug itself.
  • If you write an article for an investigational drug, and you do not specify the current status of the drug (e.g., "in Phase II trials {{as of|January 2017}}"), then you have made a mistake. Citing clinicaltrials.gov is not the best way to support that, but it's better than nothing.
  • In terms of disease articles, relevance (as demonstrated by the existence of high-quality sources) becomes the most important factor. For example, there are lots of trials about reducing cholesterol, so who cares about this one? The ==Research directions== section for that article should speak about general trends. But a clinical trial to cure a currently untreatable rare disease should probably be included (possibly with an even better source).
  • We don't want articles to function as a patient-recruiting mechanism for clinical trials.
• There are multiple potential audiences for an article about an investigational drug:
  • Patients (and their loved ones) – We don't want them to misunderstand the status or meaning of a trial, and, since we assume that none of them are as informed as us and some of them are desperately seeking a hopeful prognosis, we are afraid that they will misunderstand everything.
  • Pharmaceutical industry (from researchers to investors) – We want them to get reasonably current, factual information (e.g., about their competitors' work) from Wikipedia, just like the computer industry or the entertainment industry can get some factual information about their competitors' areas of interest and strategic decisions from Wikipedia.
    • Informing this audience requires us to include information about past clinical trials and treatments that failed or for which development was discontinued. (I like Jytdog's suggested language of "not promising enough to continue development".)
    • Wikipedia is NOTNEWS, but Wikipedia does and should reflect the business/financial news for all industries. Statements such as "Mega Corporation discontinued development of this product in 2015, after spending six jillion dollars on it" or "BigPharma, Inc. sponsored clinical trials of Their Product for X indication from 2014 to 2017" (in an article about the business or the product).
    • We tend to be bad at this. On the one hand, we're afraid that patients will read them and make the wrong choices, so we don't want to say anything beyond "statistically, whatever the drug is, it's not going to work". We also don't have very many people who are interested in these articles, so the articles become out of date. To prevent out-of-date articles, we try to limit articles to 'eternal' information. It's not a good approach, but it might be the best we can do in some instances.
  • Healthcare professionals (e.g., physicians) – They mostly don't care about investigational drugs, because they haven't been approved (yet) in their home country and are therefore irrelevant to daily practice (for >98% of healthcare professionals who provide direct care). A lot of WPMED folks fall into this category; one of the results of this fact is that we tend to overemphasize this audience's concerns at the expense of other people's concerns.
• The exact wording and the exact location and the exact circumstances really, really matter.

Okay, that might be too long to be as potentially helpful as I'd originally envisioned. Did I miss anything important? WhatamIdoing (talk) 07:41, 1 February 2017 (UTC)

"Wikipedia is NOTNEWS, but Wikipedia does and should reflect the business/financial news for all industries. Statements such as "Mega Corporation discontinued development of this product in 2015, after spending six jillion dollars on it" or "BigPharma, Inc. sponsored clinical trials of Their Product for X indication from 2014 to 2017" (in an article about the business or the product)."

This is a big point for me. It seems that a lot of editors don't care about including business/economic information in articles about pharmaceuticals, but that's a major part of the information about a drug.

"Putting clinical trials information into an article about a medical condition is, and should be, different from putting the same information into an article about the investigational drug itself." and "In terms of disease articles, relevance (as demonstrated by the existence of high-quality sources) becomes the most important factor. For example, there are lots of trials about reducing cholesterol, so who cares about this one? The ==Research directions== section for that article should speak about general trends. But a clinical trial to cure a currently untreatable rare disease should probably be included (possibly with an even better source)."

I agree. I don't think an individual clinical trial would be notable in an article about a medical condition, but a mention of something like "tyrosine kinase inhibitors are being investigated as a treatment for this condition, although none have been approved" would be.

"If you write an article for an investigational drug, and you do not specify the current status of the drug (e.g., "in Phase II trials {{as of|January 2017}}"), then you have made a mistake. Citing clinicaltrials.gov is not the best way to support that, but it's better than nothing. "

This is something that I think it important. Jytdog is saying that clinical trial status is "The essence of fleeting." but so is the fact that a famous person is attending a certain university, and that's certainly put in articles, because it's important information. Clinical trials generally last several years and are still important after they're concluded.

I'm not trying to create long lists of clinical trials, but rather say things like "Examplemab is being investigated in phase II trials for the treatment of pancreatic cancer[1] and colorectal cancer[2]. A phase III trial to determine efficacy in small cell lung cancer was terminated.[3]" How would this not be notable in an article about the experimental drug examplemab, which isn't approved for anything yet? Without mentioning what it's being developed for, you're missing a major part of the information. Even failed clinical trials are relevant for the business/financial information of a drug.

We aren't just a drug information database. A myriad of those already exist. If we want to have comprehensive articles about drugs, they should include comprehensive information, not just information for people who are taking/wanting to take the drug. Natureium (talk) 15:16, 1 February 2017 (UTC)

I care a great deal about the business end of things. My additions to Ensituximab were almost entirely about what has gone on with that compound moving it from antigens in a freezer to where it stands today. Doing that in an encyclopedia is entirely different from what Seeking Alpha does. (WAID, a class of readers you left out is "Stockholders and people who day trade'.) Crazy hype follows publicly traded biotech companies in forums like Seeking Alpha and stock prices bounce and crash based on Phase I and II outcomes, and people anticipate their end-dates and do things like buy stock or short it as clinical trial end-dates approach. I stumbled across Peregrine Pharmaceuticals and related on articles on drugs in their pipeline that were just a mess and cleaned them up. I later found out that members of a stock trading board had hijacked these pages and were using them to hype the company and the drugs. (see here for the reaction at that board.) This is not what WP is for.

But we should indeed provide encyclopedic information about the business stuff - all the work that it actually takes to bring to a new drug to market. There is stuff there for lots of different kinds of people to learn from.

There is no encyclopedic value to saying X trial is ongoing and projecting its end-date. Jytdog (talk) 16:50, 1 February 2017 (UTC)

The rhino in the room is that a very large proportion of trials listed on clinicaltrials.gov never report results: there's rarely a profit in reporting "failed" trials. The result is an unacceptable bias toward positive results. It is especially common for camwoo trials to remain listed as ongoing long past the time they should have reported. LeadSongDog come howl! 18:31, 1 February 2017 (UTC)

No one is suggesting that we use clinicaltrials.gov to document that a drug is efficacious (a medical claim). We are only suggesting that it may be used to document that a drug has been in clinical trials (not a medical claim). Reporting bias is irrelevant in this context. Boghog (talk) 19:14, 1 February 2017 (UTC)

If there are no independent RS discussing it (plain old RS) there is really no justification per UNDUE to include it. clinicaltrials.gov postings are basically SPS with respect to the sponsor of the trial. There is a high bar for submitting info and requirements that must be met, but it is still entirely done by the sponsor. kind of similar to a patent, which is explicitly discussed in WP:SPS. You can contrast that with a drug label which is scrutinized like crazy by regulators before it is published. Jytdog (talk) 20:02, 1 February 2017 (UTC)

Again, completely missing the point. clinicaltrials.gov and patents may be used to document that a company has tested a drug in clinical trials or claimed an invention, not that it works. No medical claims are being made here. The fact that drug companies are exploring a target in itself may be notable. Boghog (talk) 20:16, 1 February 2017 (UTC)

And again, it appears that you are completely missing the point. If the only source available to us that discusses a trial is Clinicaltrials.gov, then we are not in a position to decide for ourselves that the fact that a compound or intervention is in trials is notable. Establishing notability requires independent sourcing, not merely the existence of a Clinicaltrials.gov entry. Note, as well, that because Clinicaltrials.gov relies on study sponsors to submit updates for their records, the site is often very badly out of date. Studies may be delayed, suspended, or terminated without notice; reports of success, failure, or just plain abandonment of trials can appear months or years late—or never appear at all. In other words, the existence of a record on Clinicaltrials.gov reporting that a trial is underway is not actually a reliable indicator that a trial is actually underway. TenOfAllTrades(talk) 20:34, 1 February 2017 (UTC)

It is a reliable indicator that an IND has been filed and the FDA has approved the trial and that fact alone may be notable. Boghog (talk) 20:46, 1 February 2017 (UTC)

I really, really don't like arguments like that bypass normal policies and guidelines; like that a secondary school exists makes it notable, or that a radio station has a license to broadcast makes it notable, or that a journal haveing an impact factor makes it notable. Per NPOV we need independent secondary sources to assign WEIGHT; if there are none it is UNDUE. Really boghog please don't go there. Jytdog (talk) 20:50, 1 February 2017 (UTC)

And I really, really don't like arguments that overextend normal policies and guidelines. From a medical standpoint, clinical trials that have not been covered by secondary sources clearly have no significance. From a business stand point, clinical trials are expensive and the fact that a company has started one may be notable. Boghog (talk) 21:08, 1 February 2017 (UTC)

It's is true that those facts indeed "may" be notable for a particular drug or other intervention. Then again, they may not be. Either way, we shouldn't – and don't need to – be in the business of making that notability call ourselves, solely on the basis of a Clinicaltrials.gov entry. Again, if those particular facts are notable and relevant in any specific instance, then we would expect (and should require) the existence of independent reliable sources to support that assertion of notability. TenOfAllTrades(talk) 20:56, 1 February 2017 (UTC)

We have a number of articles on investigational drugs that have not yet been approved for human use. Most of these have been covered by secondary sources so the subject itself is notable. In these cases, clinicaltrials.gov may be useful in documenting the current status of the drug candidate. And of course, once secondary sources that cover these trials appear, the clinicaltrials.gov citation should be replaced. Boghog (talk) 21:25, 1 February 2017 (UTC)

break for clinicaltrials.gov

Let's back up a minute. Imagine the typical clinical trial for a new drug: sick people (including advocacy groups) + hospital (including researchers) + pharma company, right?

That's a minimum of two, and probably three or more organizations, right? And that means a minimum or two, and probably three or more publicity departments. What do you think the odds are that a clinical trial like that will never get a little news article somewhere?

I don't know about you, but I'm putting the odds right down at zero. My guess seemed testable, so I went to clinicaltrials.gov and set the search to find the most recent additions (=the trials least likely to have publicity, because they're new), in Phase II (=the earliest stage that we typically have an article about).

First drug (well, really a biologic) in the list: a vaccine against norovirus, with a news article here about the fact that trials are happening, easily found in Google News. The next couple are already approved (so lots of sources will be available), so I skipped them. Varlilumab has several business articles; Motley Fool has mentioned the drug and its clinical trials five times during the last month alone. Third one: Durvalumab's trials are all over the news.[3][4]

I stopped there. IMO the question shouldn't really be whether anyone pays attention to clinical trials for investigational drugs (specifically; I explicitly exclude the clinical trials that answer questions like "does exercise make you healthier" or "is aspirin better than ibuprofen"). The business news definitely pays attention to the existence and status. The question is really just: is this an adequate citation to verify these facts? It depends on the exact circumstances, but overall, I think we can assume that for an as-yet-unapproved investigational drugs, it will almost always be WP:DUE to note the existence of clinical trials (i.e., what phase of development the product is in).

Separately – given that we've already determined that this information is almost always DUE, in the same category as "should we normally include a birth year in biographies, even if we don't have independent sources making a big deal out of the person's birthday?" – a current entry at clinicaltrials.gov is not ideal for this information, although IMO it is probably adequate for it. We could do worse. WhatamIdoing (talk) 21:52, 1 February 2017 (UTC)

Thanks WAID for getting the discussion back on track. I think everyone especially myself needs to chill out. Keep Calm and Carry On. Cheers. Boghog (talk) 17:50, 2 February 2017 (UTC)

I do not agree that anything in Wikipedia is "almost always DUE". That is an essentializing notion that people inevitably abuse. Everything actually does depend on sources, other than truly blue sky things.

I agree that for most Phase II trials one should be able to find at least one independent, reliable source for it and that instead of arguing about clinicaltrials.gov folks just should get off their asses and find such sources.

And btw MotleyFool is a stock-traders board and full of SPS, reprinted press releases, etc. Not great. Jytdog (talk) 19:28, 2 February 2017 (UTC)

Of course we should use the best available sources. However there are times when clinicaltrials.gov is the best available source. You are raising all kinds of off topic issues. Patents, MotleyFool. Calm down. Boghog (talk) 19:35, 2 February 2017 (UTC)

No, the issues are not OFFTOPIC at all. If clinicaltrials.gov is the only source, the trial is not noteworthy and content about is UNDUE. Nothing is "inherently noteworthy" or "inherently notable" or "inherently DUE". But as WAID pointed out, cases where there are no independent secondary sources for a Phase II trial should be rare and not worth wasting time arguing about in a general discussion. Jytdog (talk) 20:02, 2 February 2017 (UTC)

Agree that clinicaltrials.gov is not, alone, evidence of notability; it is a reliable source for info about a trial. — soupvector (talk) 23:45, 2 February 2017 (UTC)

It doesn't matter if the trial is notable. We're not writing separate, whole articles about each trial! We're just trying to decide if it's DUE to say things like "this is being tested in a clinical trial" (aka "No, you can't buy this at the pharmacist's yet"). IMO this basic information about whether a product can be legally sold is always due, and the fact that someone has (currently) cited a minimally acceptable source doesn't change that.

Oh, and once a single apparently acceptable source has been presented, the BURDEN's on the editor who wants a better one, not on the guy who's being told "bring me a source – no, not that kind, bring me another source". WhatamIdoing (talk) 00:35, 3 February 2017 (UTC)

I did not confuse notable (for articles) and noteworthiness/DUE-ness for article content. They are distinct. Editors often get confused about "inherent" qualities of things (topic X is always notable, or topic X is always DUE) and it is the same essentialist fallacy underlying both arguments. And no primary sources should not be used willy nilly. They should be used with care not as the go-to ref; if an editor goes looking and all they find is clinicaltrials.gov, they should not add it. They should not be lazy and reach for clinicaltrials.gov and force other editors to waste their time trying to determine if the specific clinical trial has indeed received attention in secondary sources. The approach you are advocating here is opening the door to wide to UNDUE content and wasting other people's time. Jytdog (talk) 02:33, 3 February 2017 (UTC)

I hope that nobody misinterprets my words that clinicaltrials.gov is "a minimally acceptable source" as recommending it as "the go-to ref".

As for "wasting other people's time", I think that goes both ways: if someone adds a minimally acceptable source about reasonable content, then reverting them and telling them that it's not the best possible source is a waste of their time. My time and yours are not the only limited resources here. WhatamIdoing (talk) 17:30, 3 February 2017 (UTC)

that is where the rubber hits the road. it will generally be newbies or people trying to promote the company or the trial, and both need to learn how to edit aiming for high quality. Good faith editors will learn to use better refs. Jytdog (talk) 21:05, 3 February 2017 (UTC)

Experienced editors will look for better refs and if not available will use minimally acceptable sources. Boghog (talk) 22:39, 3 February 2017 (UTC)

Sure if they are driven by what they think is important, and not what reliable, independent sources say - sure they will. That is an endemic problem, for sure. Jytdog (talk) 18:55, 8 February 2017 (UTC)::::::::::Well, experienced editors should have a whole range of responses available to them. A very quick and easy response to this type of situation would be accepting the minimally acceptable source but tagging it with {{better source}} or {{third-party inline}}.

One of the problems with assuming that good-faith editors will learn to use better sources is that learning requires understanding why the contrbution disappeared in the first place. Typically, when people's first substantive contributions get blanked, they don't know what happened, they don't know how to check the history page to see any edit summaries that might explain it, and they just give up. Remarks along the lines of "I tried to expand a page, but I looked at the page a couple of days later, and my contribution was gone. I guess Wikipedia doesn't think that my work is good enough, so I quit trying" has turned up time and again in user research about why people quit contributing.

Also, I think it would be more appropriate to say that learning our complex sourcing policies requires dedication, rather than the mere presence of good will. People who aren't being paid to cram some fact into Wikipedia might not be dedicated enough to get past the barriers that we're erecting for them. WhatamIdoing (talk) 20:56, 4 February 2017 (UTC)

I hear that and I wish that WMF marketing and training materials managed expectations better and put more emphasis on the fact that while there is lots of things missing from WP and lots of underdeveloped articles, great swaths of Wikipedia are mature. Especially in those mature areas (but in many others), initial efforts to try to edit are going to be rejected because they aren't good enough in any number of ways. When I look at WMF materials I worry they are setting people up for disappointment. Hard balance to strike, but there is a learning curve here. For newcomers who weren't exposed to WMF marketing/training and give up after a failure or two, there is not a lot we can do about that.

About half the time (?) I revert an obvious newbie error i follow up with a note on the editor's talk page about whatever the problem was. Not always. Should probably do that more. But there is never enough time.Jytdog (talk) 18:55, 8 February 2017 (UTC)

<rearranged into mostly chronological order here, ending here>

To the extent clinicaltrials.gov documents that a clinical trial has occurred is both reliable and independent. Boghog (talk) 19:27, 8 February 2017 (UTC)

Boghog how is an entry at clinicaltrials.gov different than a patent with respect to WP:RS? (please do read WP:SPS before you answer) It is a real question. Jytdog (talk) 23:21, 8 February 2017 (UTC)

The critical point is what the source is being used for. A patent is reliable source to document someone has claimed an invention, but not to document that the invention works. An entry in clinicaltrials.gov is a reliable source to document that a clinical trial has started or has completed, but not to document that the drug is efficacious. So in that respect, patents and entries in clinicaltrials.gov are similar. It is also important to keep in mind that the hurdles for starting a clinical trial are much higher than filing a patent application. Boghog (talk) 06:15, 9 February 2017 (UTC)

"Has completed"? No, because many trials never report there completion, particularly when the results are unfavourable to the funders. Perhaps "has reported" but that's not even close to the same thing. LeadSongDog come howl! 07:10, 9 February 2017 (UTC)

"Has completed"? Yes, because one needs to stick to what the source says. If clinicaltrials.gov says completed, it has completed. If clinicaltrials.gov has not said the trial has completed, of course one cannot state that in Wikipedia. The problem of course is that many trials have never reported any results so it is impossible to say what has happened, but at a minimum, we do known that the trial has been registered with the FDA. The good news is that reporting standards have recently been strengthened. Boghog (talk) 07:40, 9 February 2017 (UTC)

Since when do we echo the words of primary, (nearly self published) sources in the voice of the encyclopedia? We're fine with "On clinical trials.gov, the investigators reported that "the study is complete". We will not simply say "the study is complete" without in-text attribution unless there is a reliable, secondary source. LeadSongDog come howl! 08:53, 9 February 2017 (UTC)

If it says on clinicaltrials.gov that the study has completed, the study has completed. The possible issue is the opposite. Results are not always updated, so it may say a study is in progress when it has been completed but it hasn't been updated in the NIH database. Natureium (talk) 18:57, 9 February 2017 (UTC)

LeadSongDog, think about that: When do we echo the words of primary, unambiguously self-published sources in the voices of the encyclopedia?

Well, pretty much every minute of the day. Every time we report the track listing for a music album without adding a qualifier that amounts to "remember, this is just what the band says is on the album – they might not know what the songs they recorded!" Every time we use a DVD to make a list of actors. Every time we cite a corporate or organizational website about their staff and products. Nobody ever writes "Microsoft Office is word processing software – well, according to Microsoft, so take that claim with a grain of salt". And so forth. We do this all the time. WP:INTEXT attribution isn't used for every self-published source, because the self-published sources can be reliable or even authoritative.

The question we have to answer is this: If the researchers actually report to clinicaltrials.gov that the trial is closed or completed, then what's the chance that they're factually wrong about that claim? If you wanted to get someone into a clinical trial, and it was listed there as closed, would you realistically phone up the researchers and say, "Hey, I saw that the trial is listed as closed, but I figured that might be wrong, so I'm calling about this person that I think you should enroll"? Or would you, realistically, rely upon that information being correct, and look for a different trial? WhatamIdoing (talk) 22:34, 9 February 2017 (UTC)

Please tell me you don't seriously wish to see WPMED adopt the level of sourcing used in discography articles;-) It is not our place to "answer" questions. We summarize answers already published in RS and by citation permit readers to make their own determination whether to accept those answers. The circumstance of a CT having completed without findings published should be a transient one. If it is not transient, that would be very troubling, albeit that we may have grown accustomed to this happening. Since WP is NOTNEWS, waiting for the transient state to pass should be the norm. If investigators get a few phone calls because they haven't published findings, perhaps that could be considered a good thing? LeadSongDog come howl! 23:11, 9 February 2017 (UTC)

Well, you didn't specify medical content, so I answered the question that you asked.  ;-)

I'd rather see "This trial on investigational drug completed" sourced to clinicaltrials.gov than "This trial is currently underway", sourced to an out-of-date source, no matter how stellar it used to be.

And the researchers aren't going to get those calls. The profession relies upon the information about recruiting status being correct. The best-case scenario is that the healthcare world will read our article, check clinicaltrials.gov (which they need for inclusion and contact information), discover that our articles are out of date, and think that Wikipedia is an unreliable source of information.

P.S. And when the results are reported, the report will be a primary source, and someone will refuse to allow us to include that because it's not a review. So we'll be stuck with "BigPharma launched a clinical trial for indication X in 2011", sourced to a financial news story, in the article for years, because the ending of the trial is "transient" and should wait for the results to be reported, and when the results are reported, then the existence of only primary-source peer-reviewed papers is "temporary" and should wait for a proper review. In the meantime, we are providing out-of-date and incomplete information to readers for largely artificial reasons, instead of providing historical facts (e.g., the trial finished) from the best reliable source that's available to the world. WhatamIdoing (talk) 17:13, 10 February 2017 (UTC)

WPMEDF report of activities of 2016

Is out here Best Doc James (talk · contribs · email) 02:20, 1 February 2017 (UTC)

great work/results--Ozzie10aaaa (talk) 11:23, 9 February 2017 (UTC)

Laryngospasm notch‎: is this for real?

Laryngospasm notch - out of my pay grade. • • • Peter (Southwood) ^(talk): 09:20, 1 February 2017 (UTC)

This (or something very much like this) certainly seems to have appeared in the medical literature: see https://www.ncbi.nlm.nih.gov/pubmed/19928512 , https://www.ncbi.nlm.nih.gov/pubmed/26426878 . The term "Larson's maneuver" seems to be used for this. This 2014 paper puts it under the heading "Anecdotal treatment options with limited evidence base". It would be good if this article could be reviewed by someone with relevant knowledge. -- The Anome (talk) 09:33, 1 February 2017 (UTC)

Well I am aware of this as a treatment for laryngospasm, I have never heard of it refereed to be this term. Let me look. Doc James (talk · contribs · email) 10:56, 1 February 2017 (UTC)

Good number of book sources [5] Doc James (talk · contribs · email) 11:15, 1 February 2017 (UTC)

Seems to be pain stimulus (specifically mandibular pressure) combined with a jaw-thrust maneuver. Was not aware of this name. To me it is unclear whether this deserves its own article especially as the name appears to be somewhat informal. Carl Fredrik 💌 📧 12:16, 1 February 2017 (UTC)

If it passes review, perhaps a better title for this article might be Larson's maneuver, as this seems to be the thing that makes this particular notch of interest. -- The Anome (talk) 13:56, 1 February 2017 (UTC)

[6]--Ozzie10aaaa (talk) 10:21, 11 February 2017 (UTC)

I think this is just an informal term some anaesthetists use to refer to the site for pressure for a jaw thrust. I agree with Anome that it should probably be renamed if kept, but would it not be better to simply add a summary of the information in this article as a section in the jaw-thrust maneuver article? Basalisk ^{inspect damage}⁄_berate 12:17, 12 February 2017 (UTC)

Merge into Laryngospasm or Jaw-thrust maneuver with redirect? • • • Peter (Southwood) ^(talk): 14:41, 12 February 2017 (UTC)

Advertisement tag

An article that I edited the other day Quantitative phase-contrast microscopy is tagged with reading like an advertisement. I’ve read it a couple of times over since then, but I’m struggling to see what the editor sees as promotional. I know that is possible to not see the wood for the trees sometimes so I wonder if anyone else cares to comment. Thanks.CV9933 (talk) 12:22, 2 February 2017 (UTC)

I looked it over and the prose looks clean of explicitly promotional material. It is possible that the advert tag was placed due to references 11, 12, and 14 to company web sites at the end of the article. These company sources could be removed without harming the article. --Mark viking (talk) 20:06, 2 February 2017 (UTC)

The tag was added in December by an IP from Swiss Federal Institute of Technology in Lausanne, who complained that it was "Written like an advertisement for PhiAB products". (PhiAB is Phase Holographic Imaging AB.) If you disagree with that opinion, then you can remove the tag. WhatamIdoing (talk) 00:30, 3 February 2017 (UTC)

Ah okay so the microscope image in the article must be what is causing the offence because it clearly displays a logo which presumably identifies that organisation. That really is a case of not seeing the wood for the trees on my part, but I’m not sure what we would do about that. CV9933 (talk) 10:00, 3 February 2017 (UTC)

That objection is a bit over the top if it is about the logo on the microscope. I doubt that one in a thousand readers would notice the logo and have any idea what organisation it represents. If it is the manufacturer's logo then it is quite normal for it to be there. • • • Peter (Southwood) ^(talk): 12:42, 3 February 2017 (UTC)

agree w/ Peter--Ozzie10aaaa (talk) 11:42, 13 February 2017 (UTC)

Eyes needed at Molecular_pathological_epidemiology

We seem to have an extraordinary number of sources from one research centre, and apparently-connected editors. @Bluerasberry: did you ever get any response on the COI inquiry?LeadSongDog come howl! 07:45, 4 February 2017 (UTC)

I think you want Bluerasberry, LSD. Axl ¤ [Talk] 13:04, 4 February 2017 (UTC)

Thank you. LeadSongDog come howl! 15:49, 4 February 2017 (UTC)

That article definitely needs cleanup; has been on my to-do list for a few years now. Definitely some in-bubble inflation going on there. Jytdog (talk) 17:06, 4 February 2017 (UTC)

LeadSongDog Sorry - I checked the talk page of Molecular pathological epidemiology and I do not see an organization involved. What was the user or organization? I write to these regularly so not sure which one is being discussed. Blue Rasberry (talk) 23:39, 5 February 2017 (UTC)

WikiProject Med Foundation board

Shani Evenstein and James Hare, our two new board members, strike me as insightful, intelligent, quick, diligent and articulate. I'm thrilled they're on board.

WikiProject Med Foundation will soon apply to the Wikimedia Foundation for recognition as a thematic organisation. (Presently, we're a user group.) As a thematic organisation, WPMF gets an extra delegate at Wikimedia's annual conference, and more money.

This is our bank account, and our representation at the big table. You can use the money to improve our medical offering, and use the board to influence the WMF and the wider world. You don't have to be a member. (But please join within 10 months if you want to vote in the next board election.) --Anthonyhcole (talk · contribs · email) 16:00, 4 February 2017 (UTC)

Anthonyhcole, thanks for the vote of confidence and for all the work you've done so far. I hope to see us all grow WPMED Foundation together, to a point where we can indeed become a thematic organization. We have a lot of work ahead of us. :) Shani. (talk) 17:25, 4 February 2017 (UTC)

Sooner or later, then. --Anthonyhcole (talk · contribs · email) 17:56, 4 February 2017 (UTC)

Thanks User:Anthonyhcole. Hopefully we will apply for thematic org status in the next few months :-) Do not think it comes with more money though. Right now we have zero income but hopefully that will change and we can convince an organization like Gates that we are worth funding. We likely need to create more fancy promotional peices in addition to doing great work. Doc James (talk · contribs · email) 01:58, 5 February 2017 (UTC)

Recognition as a thematic organisation entitles us (once we've demonstrated competence in handling project grants) to apply to the WMF for theoretically unlimited funding via annual plan grants. [7] While Gates, Wellcome and other foundations are definite potential sources of funding, too, I think our most important potential funding relationship at present is with WMF. --Anthonyhcole (talk · contribs · email) 04:14, 5 February 2017 (UTC)

Proposed reorganisation of cerebral palsy management

Would it be possible to move Occupational therapy in the management of cerebral palsy to just plain Management of cerebral palsy (like Management of Parkinson's disease and Management of multiple sclerosis) and merge the bulk of the Cerebral_palsy#Management section into the retitled article? The only downside I can see is that it might be hard to tease out the therapies that work only for one kind of CP. Thoughts, please? @Ozzie10aaaa:, @Doc James:, all? --122.108.141.214 (talk) 11:42, 6 February 2017 (UTC)

The Management section of the main article is probably too large currently so I agree with your proposal to merge to the subarticle and repurpose it as a more general management article. Matthew Ferguson (talk) 19:57, 6 February 2017 (UTC)

concur--Ozzie10aaaa (talk) 22:15, 6 February 2017 (UTC)

Sounds good. Will do the first move. Doc James (talk · contribs · email) 00:06, 7 February 2017 (UTC)

Digoxin

Digoxin

"...as well as a higher acute sense of sensual activities" is listed as a side effect with a book reference. Also there is other strange, quasi-vandalism in the article. I removed the claim that the med produces breast enlargement. My editing time is very limited at the present time and I wish I could clean this up myself, the article could use another look by an editor. Best Regards,

  Bfpage  _{let's talk...}  00:47, 7 February 2017 (UTC)

It looks like the gynecomastia claim has been partially restored, but with an elderly (1993) source. http://clincancerres.aacrjournals.org/content/18/8/2133.long is one of the few relatively recent reviews to discuss this, and it seems that gynecomastia is accepted as a known side effect (mind the gap between 'accepted' and 'actually has good evidence behind it'). WhatamIdoing (talk) 03:29, 7 February 2017 (UTC)

[8] and maybe[9]--Ozzie10aaaa (talk) 13:10, 8 February 2017 (UTC)

CAM definition

Seeking input as to whether the definitions of CAM in Harrison's and the National Academy of Medicine (formerly IOM) are important enough to include in the lede. These sources conflict, in part, with current lede. Pls comment here: Talk:Alternative_medicine#Issues_with_definition_in_lede. Thx --Middle 8 (t • c | privacy • COI) 18:03, 7 February 2017 (UTC)

For the last couple of months, the first sentence of Alternative medicine has amounted to "AltMed is anything that's not truly scientific medicine". As Harrison's explicitly states, that definition includes an awful lot of conventional medical care. WhatamIdoing (talk) 22:57, 7 February 2017 (UTC)

Liposomal vitamin c

Liposomal vitamin c, currently a redirect to Vitamin C but previously an article, has been nominated at Wikipedia:Redirects for discussion/Log/2017 February 7#Liposomal vitamin c. Your input to the discussion is invited. Thryduulf (talk) 18:31, 7 February 2017 (UTC)

Why delete? Standard practice is to redirect other formulations to the generic name which is what this is? Doc James (talk · contribs · email) 01:58, 9 February 2017 (UTC)

Chronic stress - what is it?

Is chronic stress a sort of quasi-condition, and we should treat it like that per MEDMOS and have signs/symptoms, pathophysiology, diagnosis, treatment, prevention, epidemiology, etc?

Or is it a physiological state - just an extension in time of stress (biology)?

Am asking b/c popular press discussing health definitely treats like it is a condition and there is a bunch of biomedical literature that comes darn close, but as far as I know this is not defined in DSM or ICD (which does have, however Stressful work schedule under occupational things)

It seems like it is becoming something, kind of like lipid levels themselves became something to manage. But with chronic stress there are no well defined biomarkers as far as I know.

Went through a bunch of crap in the fall with a class trying to edit Chronic stress and treating it like a disease, which has led me to ponder this.

What kind of beast is this? Jytdog (talk) 19:20, 7 February 2017 (UTC)

[10]--Ozzie10aaaa (talk) 02:56, 8 February 2017 (UTC)

Perhaps it's more about long-term psychological stress than long-term biological stress.

I'm thinking about how people talk about this concept. You never hear someone describing a pleasant, voluntary activity that is hard on the body, such as dancing, as "chronic stress" – even though it's physically stressful to the point that some professional dancers end up with significant disabilities. But you do hear people talking about the "chronic stress" of caring for a disabled person, even when that care requires no extra physical effort. You could be a thousand miles away from Grandma and still experience chronic stress from trying to coordinate her care from a distance. WhatamIdoing (talk) 05:03, 8 February 2017 (UTC)

i think part of why people find the "chronic stress" paradigm so compelling is that it grounds consequences of long-term negative emotional stuff in the body in a very science-y way and makes psychological stress into physical "poison" that effects all kinds of body systems (overactive HPA axis and the harms and all that). The alt-med, the mindfulness people, and bodywork people talk about this all the time.

I've seen the [APA link that Ozzie provided and it discusses "chronic stress" like it is a condition: "Research has shown that chronic stress can be treated with appropriate interventions such as lifestyle and behavior change, therapy, and in some situations, medication" But again, no DSM or ICD code that i can find. hm Jytdog (talk) 18:10, 8 February 2017 (UTC)

Chronic adjustment disorder, a type of adjustment disorder, is a response to chronic stress. It is in the DSM and ICD ontologies, although not without controversy. --Mark viking (talk) 22:14, 8 February 2017 (UTC)

oh that is so helpful! interestingly that article doesn't mention "chronic stress".. that is a lead for me to follow, however! Jytdog (talk) 23:19, 8 February 2017 (UTC)

New user seeks comment at Talk:Pregnancy

Talk:Pregnancy#Duration

This person wrote in by email ticket:2017020510008135 and I asked them to post to the talk page. They created a wiki account and made the post.

I have been thinking a bit lately about how many people write in by email with medical comments like this, and what happens to them. Probably hundreds of people every year write in with comments about medical topics. I am not sure what to think. Blue Rasberry (talk) 21:25, 8 February 2017 (UTC)

Maybe we need a special OTRS for medical comments? Than a few of us who are OTRS volunteers can watch them. Doc James (talk · contribs · email) 01:38, 9 February 2017 (UTC)

Thanks Lane. Adjusted per feedback. Doc James (talk · contribs · email) 01:45, 9 February 2017 (UTC)

Wikidata talk on Thursday

Asaf (who is very good) is giving a presentation on Wikidata from 11:00 a.m. to 2:00 p.m. California time tomorrow (9 Feburary 2017), which is 19:00 to 22:00 UTC. You can watch it live at https://www.youtube.com/watch?v=eVrAx3AmUvA or any time after that.

This is a gentle, friendly introduction to Wikidata and why anyone should be interested in it. It's based on some highly rated in-person workshops that's he's done. If Wikidata is a source of stress or confusion for you (that's most of us, right?), then please try to find time to watch this. WhatamIdoing (talk) 23:15, 8 February 2017 (UTC)

good opportunity, thank you WAID--Ozzie10aaaa (talk) 00:45, 9 February 2017 (UTC)

Thanks for sharing this WAID. TylerDurden8823 (talk) 02:06, 12 February 2017 (UTC)

Nicotinamide adenine dinucleotide

Could use more eyes, likewise Nicotinamide riboside

See: Talk:Nicotinamide_adenine_dinucleotide#new_content -- Jytdog (talk) 00:58, 9 February 2017 (UTC)

will keep on both(and commented[11])--Ozzie10aaaa (talk) 11:19, 9 February 2017 (UTC)

PR Newswire

IMO it is time to simply remove all links to PR Newswire. They are a re-publisher of press releases and are a good marker of spam / paid editing. Doc James (talk · contribs · email) 02:48, 9 February 2017 (UTC)

I'll step up and say that there are times when I use that source for content about the history of a drug or a company when I have good refs for some early step and some later step but none for an intermediate step in the story; in other words with good reason. a whole passage sourced solely to press releases is not acceptable under a bunch of policies and guidelines. Jytdog (talk) 02:59, 9 February 2017 (UTC)

The content and distribution targets of PR Newswire are organized, composed and paid by the private sponsor, or in other words, the 'news' becomes a self-published advertisement. I'd agree with removing its links per WP:PROMO and WP:NOTNEWS, especially for WP medical topics. Should it also be abolished from Talk pages? I don't think this, for example, serves any useful purpose for the Hypertension article. --Zefr (talk) 03:12, 9 February 2017 (UTC)

Yes they are WP:SPS and generally unreliable for statements about reality; they are reliable for statements about the source of the SPS (we hired X person; we did X deal). For publicly traded companies they are actually regulated speech; for private companies they are not. Jytdog (talk) 03:17, 9 February 2017 (UTC)

I assume that you're using "reality" to mean "scientific facts". "We hired X person" is also reality – and a reality that will be very desirable news from the POV of X's landlord.  ;-) WhatamIdoing (talk) 22:43, 9 February 2017 (UTC)

No. We should not systematically remove these links. They're press releases; {{cite press release}} is perfectly valid for some statements. You should no more systematically remove press releases (written by a company's publicity department) than should should systematically remove websites (written by that same publicity department). Self-published sources are perfectly reliable sources for some (limited) purposes. Those purposes include factual statements about an organization's size, staff members, finances, and some types of legal and political actions (e.g., a quotation from the CEO about why they filed a lawsuit). If you'd accept the organization's own blog, website, SEC filings, annual report, or other publications for a given statement, then you should accept their press releases (and vice versa). WhatamIdoing (talk) 22:43, 9 February 2017 (UTC)

This is the PR Newswire release that initiated this discussion and displays why such a source is not WP:RS, but rather is WP:PROMO, as it is just the beginning of a Phase II trial. The release contains misleading, early-stage information, such as its drug candidate can "repopulate the microbiome with ammonia oxidizing bacteria to lower blood pressure" and "anti-inflammatory properties of our bacterial platform" – results which have not been proven yet and are the objective of the trial series – so should be seen as promotional news only and non-compliant with MEDRS. --Zefr (talk) 22:55, 9 February 2017 (UTC)

Yes that was a fine revert with the tools we already have - of course that should have been reverted! WAID, that is the kind of thing i (sloppily) referred to with "reality". :) You are right that deals and hiring people are real. Jytdog (talk) 23:53, 9 February 2017 (UTC)

Zefr, that is a perfectly fine source for some very limited purposes, most significantly including statements like "In December 2016, the company announced that it would conduct a Phase 2 clinical trial of its live bacteria product (B244) for the treatment of hypertension" and "the company reported in December 2016 that it completed a two-week study of its live bacteria product for acne".

If it weren't for SYNTH, we could also use it as a source to say that the company is buzzword compliant.  ;-) WhatamIdoing (talk) 17:24, 10 February 2017 (UTC)

My concerns is just because someone has published a lot of press releases about themselves or their company does not make them notable. I guess I should say press releases including those published by Newswire cannot be used to show notability and if that is ALL the refs present the article should be deleted. Doc James (talk · contribs · email) 03:23, 10 February 2017 (UTC)

I agree, which is why press releases are #1 in the list of stuff that doesn't count towards notability at WP:ORGIND. They are also called out, by name, as non-proof of notability in the WP:GNG.

Because of WP:ARTN, your test for deletion doesn't work. If some newbie cites press releases, advertisements, and the company's website, but could have cited The Wall Street Journal and The Times, then the business is still notable. But if regional news attention doesn't exist, then of course it's not notable. (Anyone working in this area will want to note that WP:CORP specifically limits the use of 'hometown' newspapers, because the biggest employers in any small town will always be discussed in the local newspaper.) WhatamIdoing (talk) 17:21, 10 February 2017 (UTC)

Wikipedia:Templates_for_discussion/Log/2017_February_10#Template:PubMed

Please give your input here. Headbomb {talk / contribs / physics / books} 17:58, 10 February 2017 (UTC)

MEDRS source?

User:Zefr and I disagree on whether this should be considered a MEDRS source for biomedical content about dietary supplements and nutrients. Thoughts? Jytdog (talk) 03:21, 11 February 2017 (UTC)

Looks like these are review articles. I guess my question is, are they considered peer reviewed and "independent" as per MEDRS. Here is a quote pasted from the Oregonstate website: "For each article, Ph.D. nutrition scientists critically review and synthesize basic, clinical, and epidemiological studies in the peer-reviewed literature and provide references throughout. Each article is then additionally reviewed by an expert in the field; the names of the authors and reviewers are listed at the bottom of each article. This multiple review process minimizes bias and presents objective information." http://lpi.oregonstate.edu/mic/about JenOttawa (talk) 03:45, 11 February 2017 (UTC)

On the garlic article, for example, I see that the PhD's are all from the same institute, and the expert from the field is a research director at https://www.niim.com.au/ I am not familiar enough with these institutes to contribute any more. Will follow with interest. Thanks. JenOttawa (talk) 03:50, 11 February 2017 (UTC)

Is this the only source that presents this information? Do we have any reason to believe that other sources contradict it?

If there's no good reason to worry about the actual content, then arguing over the exact source that gets cited in the article may not be the best use of anyone's time. WhatamIdoing (talk) 16:43, 11 February 2017 (UTC)

It is very hard to find consistently reliable sources about health effects for this kind of thing like nutrients, vitamins, etc. For pete's sake. Jytdog (talk) 18:19, 11 February 2017 (UTC)

The highest standard of MEDRS explained within WP:MEDORG pertaining to individual nutrients and dietary antioxidants is from the US Institute of Medicine (IOM) which employs a multi-expert panel of US and Canadian academics to write the Dietary Reference Intakes, dietary antioxidants here. Of note concerning this discussion about phytochemicals vs. true dietary antioxidants (only vitamins A-C-E) and the role of the Linus Pauling Institute (LPI) at Oregon State University, example systematic review on phytochemicals here, is that LPI faculty member and vitamin E expert, Dr. Maret Traber, is on the IOM panel. Rather than WP users having to navigate the comprehensive reviews on nutrients by IOM, the LPI reviews seem considerably more consumer-friendly, yet are sufficiently rigorous for MEDRS to me. --Zefr (talk) 18:48, 11 February 2017 (UTC)

My assessment is that these reviews are MEDRS-compatible but not all that authoritative. If information in published review papers contradicts them, it should trump them. It is particularly worth noting that Linus Pauling was notorious for fringe views concerning nutrition, so an institute named after him should be scrutinized closely. Looie496 (talk) 15:08, 12 February 2017 (UTC)

in my view the site (and you can compare LPI's Vitamin E article to UMD's Vitamin E article to see what i mean here)

• provides reviews of the literature on dietary supplements, phytochemicals, etc that are kept up to date (the IOM ref linked above is from 2000)
• has summaries that are generally science-based (little to no explicit woo) and usually assign WEIGHT as we would (e.g for essential nutrients, deficiencies are generally discussed first); organized like a WP article with LEAD and body
• is online/open access
• is well cited with in-line refs.
• is written in language that is a bit science heavy (managed with hyperlinks to definitions, however)
• however the summaries they write are pretty in-bubble (coming from the place: "there is something useful here and with more research we will find it!"), surprisingly downplay risks, and sometimes overemphasize core woo principles.. For instance in the LEAD of the LPI Vitamin E article
  • the 2nd bullet is about antioxidant-ness, and the 3rd bullet is deficiency, which is backwards and woo-oriented (the UMD site handles this better, actually, giving much more WEIGHT to deficiency)
  • the 5th bullet says "Randomized controlled trials investigating primary and/or secondary prevention of chronic diseases, such as cardiovascular disease, cancer, and cataracts, do not currently support a preventative effect of supplemental α-tocopherol" which fails to mention the two large prospective clinical trials that found Vitamin E supplementation increases the risk of cancer instead of preventing it. Those trials are discussed down in the body, but the lack of mention in the lead is very disappointing. The UMD article also doesn't discuss the risks, but is much more woo about the "possibility" of cancer prevention saying only "Antioxidants may provide protection against serious diseases including heart disease and cancer" -- not discussing the lack of good evidence for that to date much less the risks.
• both the LPI and UMD sites are more like edited books that a peer-reviewed journal. Neither are "major medical/scientific bodies" as we usually consider them. Not great with respect to our normal MEDRS analysis. A bit like Science-based Medicine in that regard, but tending over on the woo/quackademic medicine side (UMD farther than LPI)

for me the LPI is better, but not much better than UMD. Both are very "in-bubble" (saying that more rigorously, are invested in the hypothesis that there is "something" there in these natural products/alt med) , UMD moreso than LPI. Jytdog (talk) 20:02, 12 February 2017 (UTC)

• User:Zefr, this was surprising, as this discussion is still ongoing. Jytdog (talk) 22:46, 12 February 2017 (UTC)

If better reviews are found, any editor, including myself, can insert the replacement. --Zefr (talk) 22:52, 12 February 2017 (UTC)

This is not a great practice, Zefr. If you question a woo-pushing source and the other editor insists on keeping using it, what will you possibly be able to say to them that will not contradict the position you are taking here? Please be patient and let's get a sense of the WP:MED consensus on this. Jytdog (talk) 23:09, 12 February 2017 (UTC)

For those of us watching the phytochemical and nutrient literature for sourcing in WP articles, you summarized it yourself yesterday: "It is very hard to find consistently reliable sources about health effects for this kind of thing like nutrients, vitamins, etc." We are unlikely to find peer-assessed journal reviews or meta-analyses on individual non-nutrient phytochemicals (their organ and cellular fates in vivo cannot be defined). Likely for the same reason, government bodies like the IOM/FDA or EFSA do not publish guidance documents on phytochemicals except to regulate what cannot be stated on food labels. We are left with food science groups at universities like LPI, UMD or UC-Davis publishing discussions of nutrients and phytochemicals. Among them, LPI is the most extensive I know for covering relevant literature and maintaining neutrality within limits of interpretation we would see in any secondary review article. So far, we have 5 discussants in this thread, with no dissents against using the LPI sites. That is reasonable agreement per WP:CON. --Zefr (talk) 23:33, 12 February 2017 (UTC)

No one has explicitly endorsed this either. Again you are acting just like a woo-pushing editor would do. Please be patient. It will be a happy thing if we can get explicit consensus to use this widely (and if we don't, then we shouldn't) Jytdog (talk) 23:42, 12 February 2017 (UTC)

I feel that it is better to air on the side of caution when inserting information into wikipedia. If there is a risk that the source may be biased, I feel it would be better to not insert this information until a more reliable source is found. I would not feel comfortable using this site in my edits, from what I have read so far and from Jytdog's observations re "invested in the hypothesis".JenOttawa (talk) 03:13, 13 February 2017 (UTC)

Well, Linus Pauling was interested in the hypothesis that mega-dosing Vitamin C had health benefits, but he's been dead for more than 20 years. I don't know whether his POV has adherents among any of the current researchers there.

From the diff posted above, it appears that much of the material being inserted says things like there's no evidence that phytochemical supplements prevents cancer or do anything else useful. I kind of doubt that anybody's worried about that kind of content. WhatamIdoing (talk) 04:12, 13 February 2017 (UTC)

The first thing I did was look at the site's coverage of vitamin C, and despite its connections to Pauling and his well known hypotheses, I found it agreeably neutral in its treatment of the many issues. In general, it seems to present issues rather baldly, but provides the sources it examines related to them. I can't say that the conclusions it reaches would stand the test of using MEDRS-sourcing, because it rather uncritically (IMHO) endorses conclusions of primary studies, without seeming to apply any critical analysis of those sources – which is what I would expect a good secondary source to do. Without the rationale for why it accepts particular studies, we are left with the authority of its contributors and its editorial policies to give us confidence in its conclusions, and I don't think that is going to be good enough in every case. My view would be that it's fine for uncontroversial statements (but then other MEDRS-sources are likely to be available), and especially for the "Further reading" section of articles, where it could serve as a tertiary source by giving editors leads to other relevant sources. Disclaimer: I take 500 mg of vitamin C as a daily supplement, so you may have to take my views with a pinch of salt (or at least with a pinch of calcium ascorbate) --RexxS (talk) 18:07, 13 February 2017 (UTC)

I am with User:RexxS on this. Okay for non medical or non controversial content. Doc James (talk · contribs · email) 06:05, 15 February 2017 (UTC)

List of beneficial weeds

There are a bunch of medical and quasi-medical claims at List of beneficial weeds, especially in the Medicinal use section. If someone who knows what they are talking about could give this some attention, Wikipedia (and the world) would be better for it. Thank you.  SchreiberBike | ⌨  05:04, 11 February 2017 (UTC)

It's not just the medical and quasi-medical claims that need attention; there's also the largely pseudo-scientific notion of companion planting, apart from the problem that "weed" is almost impossible to define clearly. Ideally the whole article should simply be deleted. Peter coxhead (talk) 12:10, 11 February 2017 (UTC)

Companion planting isn't pseudoscientific; it's just the agricultural version of Mutualism (biology). Some of the benefits of intercropping are due to this effect. WhatamIdoing (talk) 16:54, 11 February 2017 (UTC)

This isn't the place to discuss this issue, but if there is sound scientific evidence for many of the claims about particular "companion plants", then please add the sources to companion planting. Peter coxhead (talk) 21:58, 11 February 2017 (UTC)

Whether or not companion planting is a scientific or pseudo-scientific notion is not for me to say. That is something that seems rather out of the scope of our concerns here at WP Medicine. What is also not for me to opine on in what defines a "weed" and what does not, because honestly, my definition would probably be unacceptable for most. What is of concern are any claims of medicinal benefits of certain plants. However, such claims should be backed by sound evidence. Otherwise, I can't say that it's necessarily safe to deem such claims as reliable merely based on hearsay or popular belief. As members of the scientific community, we need objective evidence, not biases of certain individuals. I'm aware that some plant-based medicine does have scientific evidence to back it up. Let's start by critically evaluating that evidence and seeing how it fits in with the rest of the puzzle. As for other claims, the possibilities are endless for research opportunities! What we can do is work with our colleagues in WP:Plants and WP:Agriculture to curate a list of "medically-important plants", and then sift through the literature to find evidence backing up those claims.N. Jain talk to me 01:28, 12 February 2017 (UTC)

I frequent both medicine and agriculture projects, but both perspectives give me a headache when looking at this list. I'd pretty much be in favor of gutting the list of anything that isn't referenced, and a lot of poorly referenced things could go to. As others mentioned, companion planting is a thing in agriculture (planting oats to give your alfalfa some cover so it can establish comes to mind as a normal mainstream use), but there is a lot of woo in that overall topic (biodynamic agriculture, organic, etc.). I'm not sure if the list could be considered notable since a weed with a use isn't really a weed anymore, but I'll take a closer look when work settles down at least. Kingofaces43 (talk) 00:56, 13 February 2017 (UTC)

Kingofaces43 I see your point, that a weed with a use isn't really a weed anymore. I'm of the belief that a weed is any plant that is introduced or invasive in a particular region. That definition would conflict with most people's idea of a weed I think. I don't necessarily mean to have a Wikipedia page dedicated to such a list, but rather a list, similar to a things-to-do list just for personal reference for anyone interested in working on the realm of medically-important plants. 18:26, 13 February 2017 (UTC) — Preceding unsigned comment added by Njain1091 (talk • contribs)

Phytochemical

Need more eyes, thanks. Jytdog (talk) 16:02, 11 February 2017 (UTC)

will do[12]--Ozzie10aaaa (talk) 09:38, 12 February 2017 (UTC)

Cycloidal vibration technology

I've declined the speedy on this article but the content and sources should be checked by experienced editors. --NeilN ^{talk to me} 15:28, 13 February 2017 (UTC)

I would have to agree w/ [13]--Ozzie10aaaa (talk) 18:31, 13 February 2017 (UTC)

Thank you for bringing this up here, and I would appreciate some scientific/medical editors looking at this. Sorry if I got the procedure wrong. The citations I looked at seemed to be to either be unreachable by easy means, some were only tangentially connected to the subject, and some downright dubious (I deleted off a citation to a very questionable 1969 experiment on just one child, a 7 year child with severe learning disabilities in an orphanage). The whole page looks to me like a construction to justify a commercial enterprise (Niagara Therapy) selling vibrating chairs to the elderly, using scientific journals to justify the medical claims. (I added a relevant section on the Niagara Therapy page about an Advertising Standards Authority ruling, I'm not quite sure how to link directly to it on here) I understand how scientific research works but I have no useful knowledge of this field. Mramoeba (talk) 22:05, 13 February 2017 (UTC)

You have some very useful knowledge: you were able to turn the marketing gobbledegook into plain old English: they're "selling vibrating chairs to the elderly". A little more plainness like that would doubtless be helpful to the article.

It might also be interesting to count up the number of WP:Independent sources that are actually about the product (rather than justification for making the product), and seeing whether the number exceeds one. WhatamIdoing (talk) 22:27, 13 February 2017 (UTC)

I've taken an axe to the claims that are not supported by MEDRS, and what's left has gone to AfD: Wikipedia:Articles for deletion/Cycloidal vibration technology. Mramoeba: you may want to comment there. Let's see how that turns out. --RexxS (talk) 00:24, 14 February 2017 (UTC)

• It looks like it was written by someone close to the subject. QuackGuru (talk) 02:43, 14 February 2017 (UTC)

Wikipedia talk:WikiProject Chemistry#Shortcuts,_revisited

There is currently and RFC on what do do with the shortcuts used for the chemistry-related projects. Please comment. Headbomb {talk / contribs / physics / books} 16:17, 14 February 2017 (UTC)

Medical stats

Hey All Unfortunately User:West.andrew.g no longer has the band width to generate medical stats for us. He is happy to explain and hand over the code to someone else who is interested. Do we have anyone here with the interest and technical ability? Doc James (talk · contribs · email) 05:42, 15 February 2017 (UTC)

Is the problem that there are too many medical articles for his bandwidth to handle now? TylerDurden8823 (talk) 01:02, 16 February 2017 (UTC)

Article class&importance rating

Hi,

I just noticed the large backlog of >1000 unrated medical articles. I realise that it's largely busywork (most of them will turn out to be low importance stub/start articles), however it is still pretty useful to have them categorised. I've started going through some of the genetics and biochem-related ones.

If you're able to devote 30 mins to rating a few, the combination of the following two tools makes it very rapid:

1. The list of unassessed articles
2. The "Rater" plugin by Kephir. Just go to your Special:MyPage/common.js and add the text importScript('User:Kephir/gadgets/rater.js'); // [[User:Kephir/gadgets/rater]]. It adds a tab that allows you to edit the class and importance of a page from the Article (without having to switch back and forth to the talk page), and auto-fills an edit summary

All the best, T.Shafee(Evo&Evo)^talk 06:58, 15 February 2017 (UTC)

will look(approx. first 120 on list)--Ozzie10aaaa (talk) 13:12, 15 February 2017 (UTC)

It also helpt a lot if you enable "Display an assessment of an article's quality in its page header" under gadgets in the user preferences. --WS (talk) 19:07, 15 February 2017 (UTC)

Competent editor needed

To merge Draft:Oroantral fistula into Oroantral fistula please. Two broadly similar drafts were submitted to AFC at about the same time (by different editors). One got accepted and the author of the other was advised to merge their draft into the accepted article. However it seems that neither of the original authors are comfortable with this task. Roger (Dodger67) (talk) 14:09, 15 February 2017 (UTC)

Relevance of secondary sources to chiropractic article

Two secondary sources have been removed from the chiropractic article, suggesting in the edit summary that This is not really relevant. Chiros don't do knees. The sources are reviews of manual therapy and exercise for knee arthritis: [14] & [15].

• It has been noted that 30% of chiropractic visits are for musculoskeletal problems besides the neck and back [16] and that reliable medical organizations, such as the NHS, describe chiropractic treatments as “often used for musculoskeletal conditions (which affect the muscles, bones and joints). These conditions include: [...] pain or problems with hip, knee, ankle and foot joints” [17].
• It has also been noted that chiropractors employ “a combination of therapies such as spinal manipulation, massage, heat and cold therapies, electrotherapies, the use of mechanical devices, exercise programs, nutritional advice, orthotics, lifestyle modification and patient education.” [18]
• One of the sources that was removed explicitly mentioned in the introduction how it was relevant to chiropractors: “Management [of knee OA] aims to control pain and reduce disability...Manual therapy is a physical treatment used by physiotherapists, chiropractors, osteopaths and other practitioners to treat musculoskeletal pain and disability, and includes massage therapy, joint mobilisation and manipulation.".[19]

It is still being argued that the sources are not relevant for the chiropractic article, on the basis that "They relate to the puzzling (to the reader) knee, they are weak evidence and not in any way compelling, and the sources themselves don't even mention chiropractic in the abstract or categories. It gives the storng impression of a standard SCAM tactic of using a positive study on a closely related practice, to imply validity." Further, it has been suggested that "we need reliable independent secondary sources that say chiropractic, (not arbitrary manipulation therapy) has a significant effect on knees that is clearly not down to bias." Any additional comments would be helpful. Here is a link to the talk page discussion. 2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 01:06, 16 February 2017 (UTC)