User talk:Orangemarlin/Herpes zoster

The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was not promoted 21:43, 27 December 2007.

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Herpes zoster

previous FAC

Renominating this article incorporating comments from the previous FAC. I've added a history section, added more information to the Prognosis section, added references, and cleaned up the lead. OrangeMarlin ^{Talk• Contributions} 17:28, 10 December 2007 (UTC)

• Support a nice read, pretty--Keerllston 10:54, 11 December 2007 (UTC)

• I have to say that I disagree with you. Even the introduction reads wrong to me: "After chickenpox runs its course, varicella zoster virus remains dormant in some nerves of the infected person". I find simplification often misses the point in this article. I have not looked it up recently, but my recollection is that virus DNA is incorporated in the DNA of nerve cell bodies. The article may include a few good points, but it is far from a finished product. Snowman (talk) 15:51, 20 December 2007 (UTC)

• • Withdrawn per Tony1--Kiyarrllston 15:23, 27 December 2007 (UTC)
• Strong support for a well-written, comprehensive and accurate article. It has excellent images and appropriate citations. It's just the right length for the subject and a pleasure to read. I have worked in this field for many years yet I learnt something from this article. It still requires some tweaks, but an article that Wikipedia can be proud of none the less! Well done.--GrahamColm^Talk 13:39, 11 December 2007 (UTC)

I have now discovered that the article requires more than some tweaks and following an intense team-effort on the article over the past few days many cracks have been revealed. I am sorry to have to withdraw my support for the article, particularly after having worked so hard on it. The lesson that I have learned is to ask for expert help before nominating.--GrahamColm^Talk 15:29, 19 December 2007 (UTC)

Actually, I didn't know that Wikipedia had a requirement that an expert write the article. What is great about the project is that intelligent, interested, and hard-working individuals volunteer their time to create these articles. When I found the article, it was nothing but CAM cruft, mostly discussing how you can obtain treatments from African Witch Doctors. I kid you not. I did not think anyone needed a degree in viral biochemistry to help write it. But if I could impose, what is it that needs fixing? Can you bullet point them, which helps all of us work it out. My personal concern about these articles is that as Wikipedia becomes the #1 location for health care information (just check out google for this disease), they make assume they will be cured by African Witch Doctors. You, and some other editors, are seeking perfection (a problem with engineering that I rarely see in science), when all that is necessary is good enough. I don't think it's critical how the virus is latent (not that you yourself care). I don't care if it's transmitted 0.0004% of the time by sneezes. What the casual reader needs to know is 1) what is the disease, 2) how do you get it, 3) what are the consequences of the disease, 4) how do I treat it, and 5) what are the known effects. We are trying to do too much. But that's just my opinion. OrangeMarlin ^{Talk• Contributions} 05:18, 20 December 2007 (UTC)

I think (I may be wrong) that Graham meant "expert" in terms of experienced Wikipedia editors, not subject experts. We are very fortunate to have some of those but I agree with you in believing it is possible for non-experts to write an FA; I've seen it done. Most good FAs had one or two enthusiasts behind them, who then recruited some extra team help towards the end, prior to FAC. If I can be slightly critical (as much as one can on a volunteer project) its that I expected the nominator to be more active during FAC, responding to issues raised. But I see now you thought, and still think, the article was good enough. I disagree about the standard required of an encyclopaedia and the level for FA. The information you believe the reader "needs to know" is readily available, in lay-friendly form, at any *.gov or *.gov.uk site (NHS, CDC, NIH, whatever). Wrt to what is wrong, Eubulides provided an excellent summary, which I agree with. There are some basic WP issues like text agreeing with the sources. On the surface, the article looks reasonable, which is why I think it attracted initial support. Colin°^Talk 07:47, 20 December 2007 (UTC)

• I meant exactly that.--GrahamColm^Talk 09:12, 20 December 2007 (UTC)

I think the criticism was pointed towards me. I thought I was fairly active during the process. But I am almost certainly not a viral biochemist, and once the discussion turned towards the esoteric, and Una Smith became disruptive, my interest waned. I personally felt that the article was being demolished for unknown reasons, but because I do not own the article, I gave up. My suspicion is that this FAC will fail, all of you will go away, and I I can spend a couple of months reviewing some literature and slowly improving the article as I have done over the past 6 months. I'll slowly implement most of the criticisms and suggestions I see here, and it will round into shape, without edit conflicts. I'm quite patient about these things. I've just given up here. This was no fun at all. OrangeMarlin ^{Talk• Contributions} 15:11, 20 December 2007 (UTC)

• Support, meets all the criteria. Its strongest side is its accessibility for the educated layman, which is a real compliment for a medical article. --Steven Fruitsmaak (Reply) 22:11, 11 December 2007 (UTC)

But it could be a lot better, I think. A key image of the characteristic rash affecting an easily recognisable dermatome is missing. Snowman (talk) 10:00, 22 December 2007 (UTC)

• Support. Thorough and covering all bases. One minor point: perhaps we shouldn't lecture the audience about combining cimetidine and aciclovir (unless the reference already does that). JFW | T@lk 23:40, 11 December 2007 (UTC)

I don't know what to do about that reference. Honestly, while rewriting the article a few months ago, I just left it in, using a reference that's probably 20 years old. I guess someone could go pick up a package of Tagamet, and treat HZ! I don't think Aciclovir was around when the reference was written. OrangeMarlin ^{Talk• Contributions} 02:12, 12 December 2007 (UTC)

There is no interaction listed in BNF 53 between acyclovir and cimetidine, but there are interactions listed between cimetidine and the anti AIDS drugs atazanavir and amprenavir. I guess that most mild interactions would be better placed on pages for the drugs rather than on this page. Snowman (talk) 10:57, 21 December 2007 (UTC)

*Support - conditional on adding a sentence or two on lysine. If it works why isn't it used...or is it? I was bold and massaged it a bit. cheers, have to abstain until I read the whole thing again. I can see that my support was premature, sorry. Will try to do a bit of copyediting soon. Casliber (talk · contribs) 02:23, 12 December 2007 (UTC)

• I added something about lysine, but honestly, there isn't much good evidence that it works. Another case where so-called alternative medicine has hit the popular mindset, but no scientific proof has been shown. Frustrating. OrangeMarlin ^{Talk• Contributions} 04:11, 12 December 2007 (UTC)

Ok then, even just a few words on the strength of the evidence. Could always add that as it is just a lousy old amino acid no harm in taking some (or is there.....) cheers, Casliber (talk · contribs) 05:25, 12 December 2007 (UTC)

• Strong Support At most needs some minor copy editting. I also would suggest wikilinking any journal names that have articles on Wikipedia already. Overall, extremely informative and interesting.--Filll (talk) 02:56, 12 December 2007 (UTC)

• Oppose The History section, an issue in the previous nomination, still is weak, and poorly referenced. But for me a larger problem is that the lead does not begin to explain the connection between chickenpox in childhood and shingles decades later. Chickenpox is introduced in the second paragraph in a manner that is telegraphic. Telegraphic here means that rather than explain, the article reminds the reader of something the reader is assumed to already know. I did fix one small point of confusion elsewhere in the article. --Una Smith (talk) 03:17, 12 December 2007 (UTC)

  I made a small change that makes it very clear that VZV infection is called chickenpox. I hope this satisfies your concern. OrangeMarlin ^{Talk• Contributions} 03:49, 12 December 2007 (UTC)

  Slightly better. The lead invites many questions not clearly answered in the article. Do all chickenpox infections leave behind virus in the spinal cord? What about the chickenpox attenuated live virus vaccine?Do any cases of shingles result from secondary infection, rather than a flare-up of virus left behind from the original infection? Is shingles ever seen in children? Is shingles really just a limited form of chickenpox (ie, does chickenpox also infect nerves, just unlike shingles it infects many nerves at once)? Or, if not, exactly how is it really different? --Una Smith (talk) 22:39, 12 December 2007 (UTC)

Yes, latency is a defining feature of the Herpesviridae all of them do it; CMV, HSV, EBV HHV8. I don't know about the vaccine and that's a very good question, (it's contra-indicated during pregnancy). No, shingles always follows the lines of the dermatomes, chickenpox does not. Shingles is not seen in children but neonatal zoster is deadly but I don't think this is within the scope of this article. VZV seems to retreat to the nerves post chickenpox symptoms. Una, I think it would not be helpful in this article to try to explain the latency phenomenon of Herpesviruses, this is not fully inderstood (well at least by me!). Of course the article must be accurate and comphrehensive but given the "lay" friendly comments already made about the article, are we in danger of going to far? Just my two English pennies worth.--GrahamColm^Talk 23:10, 12 December 2007 (UTC)

As a completely lay reader, even I've heard the term "latency" used wrt herpes viruses. I was rather surprised that the word isn't mentioned at all. Colin°^Talk 23:38, 12 December 2007 (UTC)

Una, I'm not sure how to answer your questions. We don't know if all chickenpox infections leave behind virus, nor are there answers for the other questions. I guess an article could anticipate every question, but it would be difficult to answer. The problem here is that VZV and HZ are the exact same virus. No on knows how it goes from one to the other. In addition, the poorly written VZV article needs to be rewritten eventually to be a companion piece to this article. But this article is definitely not about chickenpox, so I don't think it's within the scope of the article to discuss what chickenpox does or does not do, especially since it is so poorly understood how one becomes the other. OrangeMarlin ^{Talk• Contributions} 23:37, 12 December 2007 (UTC)

"The problem here is that VZV and HZ are the exact same virus." Exactly. That problem needs to be stated up front, in a manner that helps to define the scope of this article. I would prefer this article to be titled "Shingles", by the way, for that very reason. The article is not about Herpes zoster which includes shingles and chickenpox, but about shingles. This is a discussion for Talk:Herpes zoster, don't you think? --Una Smith (talk) 17:24, 13 December 2007 (UTC)

I think we have cleared-up this confusion, herpes zoster is a disease, not a virus. The disease is commonly called shingles; the virus is called Varicella zoster virus.--GrahamColm^Talk 06:21, 14 December 2007 (UTC)

That VZV article is on my "to be found wanting" Macbeth (William Shakespeare) list. Herpesvirus reactivation "No on knows how it goes from one to the other" is for Herpesviridae to embrace. Not this article.--GrahamColm^Talk 23:58, 12 December 2007 (UTC)

• An enormous amount of work on this article has been completed, but still more work remains. Here are just two areas of work:

1. History and etymology both have considerable interest but the History section remains weak and the etymology is limited to a sketch on the talk page.
2. The problem has yet to be solved re how to describe, correctly and gracefully, the long time between chickenpox and herpes zoster. I think it would help to improve related pages (particularly varicella zoster virus, late effect, incubation period, and viral latency), then link those pages.

I have spent a lot of time on Herpes zoster and am willing to do more, but much of this work would be better done by someone who has access to a good medical research library. --Una Smith (talk) 23:08, 18 December 2007 (UTC)

• Weak oppose for now. I think this is a good article, generally very readable and lay friendly. However, it needs a little work IMO to take it to featured quality. The lead is not yet a comprehensive summary of the topic, nor answers all the basic questions a reader unfamiliar with shingles may have. Double and triplet footnote numbers are IMO unnecessary where the uncontroversial text could be sourced to one good review. Rather than approximate words (may/could/rarely/often/etc), some figures would be useful at times. The prose could be polished a bit more. The treatment section misses a few types of treatments. I've only read 2/3 of the article, so far. Rather than overload this FAC with detailed minor comments, I've added them to the article talk page. I'll update/continue later when I get the chance. Colin°^Talk 18:50, 12 December 2007 (UTC)
  • Several editors, myself included, are working on your recommendations. I might disagree with one or two of those recommendations, however :) OrangeMarlin ^{Talk• Contributions} 06:09, 13 December 2007 (UTC)
• I appreciate the article is currently being worked on but three serious issues have developed:
  • There are "verify" tags for some paragraphs
  • Some sections have been heavily rewritten (particularly the lead) and the prose quality has deteriorated. Copyediting required.
  • Most importantly, I have encountered some careless wording when expressing statistics:
    • "Herpes zoster occurs in about 50% of very elderly persons." The use of the present tense here can be read to mean 50% of elderly persons currently have herpes zoster, the disease! The source used doesn't seem to contain anything that might support a 50% figure.
    • "In the United States, herpes zoster affects about 10–20% of the population", again this implies 10-20% have active shingles.
    • "Herpes zoster ... occurs more often in persons who have reduced function of their immune system". More likely to occur is not the same as occurs more often.
    • "A subset of 50% of these patients" could be clearer. Is it the full 50% or a subset of the 50%?
    • "By the mid-1960s, several studies identified the gradual reduction in cellular immunity in old age by observing that in a cohort of 1000 people who lived to the age of 85, approximately 500 would have one attack of herpes zoster and 10 would have two attacks." The reference given contains no such cohort study of "1000 people who lived to the age of 85". The reference says "Should a cohort of 1000 people live to be 85 years old, ..." (my italics). The article tense changes from "lived to the age of 85" to "would have". The paragraph says that "several studies identified" XYZ "by observing that...". They didn't. The observation is based on the several studies, not the other way round. It is clear from a quick reading of the (old) paper, that this hypothetical cohort is based on little more than guesswork and extrapolation from small and conflicting studies.

I'm afraid that for now, I'll have to change to strong oppose. The above examples are probably not the only ones, I'll continue to review/investigate as I find time. Colin°^Talk 18:04, 14 December 2007 (UTC)

• Dear Colin, clearly there is some more work to be done, you are right, thanks; we will try to fix this. My best wishes to you.--GrahamColm^Talk 23:32, 14 December 2007 (UTC)
  • Update: I'm pleased to report that the article is improving again. Several editors have contributed, GrahamColm in particular seemed to have spent most of Saturday on it. Issues remain but it is getting there.... Colin°^Talk 00:41, 17 December 2007 (UTC)
• Update2: Despite some great team effort, it now appears there is more work to do than we have the energy to maintain while at FAC. IMO, the nomination should be allowed to fail, and the article improved at a more gentle pace perhaps with less editors stepping on each other's toes. Remaining work has been detailed on the talk page and by Eubulides below. When those issues have been addressed, I recommend posting a notice at WikiProject Medicine for expert reviewers to check it over. Once the content is satisfactory, a copyedit by one of our suitably gifted editors would be nice. With that preparation, the next FAC should sail though. Colin°^Talk 18:10, 19 December 2007 (UTC)

• Support. Well-written and comprehensive. In my experience, the "History" section of medical articles is particularly difficult to expand with appropriate references. Here, the "History" section is okay. Axl (talk) 12:28, 13 December 2007 (UTC)

• Oppose. Orangemarlin (who is now renominating this article for Feature status) suddenly archived all of the Talk page on December 10, 2007 (the same day he/she renominated the article), without any concensus or warning, which is against Wikipedia policy. There were many valuable and important discussions and issues and even consumer information being raised on the Talk page, yet now there are only posts from December 10, 2007 on. I don't support the featuring of any article whose discussion has been, if I may be so bold, virtually censored without concensus or warning. I would also like to request the restoration of the removed material. Thank you. Softlavender (talk) 05:05, 18 December 2007 (UTC)

• It's all still there, I have just re-read it. It has been archived to make some room for the current discussions. It has not been deleted. --GrahamColm^Talk 06:34, 18 December 2007 (UTC)

If you'll note, I said "archived" -- meaning removed from the page to an archive -- not "deleted." It was done against Wikipedia policy, which is to do so only after discussion and consensus. One result of the archiving is the absence any immediately visible discussions about any problems that existed with the article. I'm all for archiving that info given due notice and thorough consensus. Without consensus, it violates Wikipedia policy. Softlavender (talk) 07:18, 18 December 2007 (UTC)

Against which policy? I am not aware of any such policy. Wikipedia:Talk page guidelines (which is only a guideline, not policy) says: When a talk page has become too large or a particular subject is no longer being discussed, don't delete the content — archive it. There is no need to reach consensus. If you think any active discussions were moved to the archive, archiving can easily be undone. --WS (talk) 09:35, 18 December 2007 (UTC)

You're opposed because I archived a Talk section which makes it easier to read? I'm sure the FAC director will give lots of weight to this issue. OrangeMarlin ^{Talk• Contributions} 17:59, 18 December 2007 (UTC)

Be careful, Orangemarlin. There's no need to be sarcastic. For what it's worth, I don't see a problem with the archiving. Axl (talk) 08:39, 19 December 2007 (UTC)

Why shouldn't I be sarcastic? OrangeMarlin ^{Talk• Contributions} 05:20, 20 December 2007 (UTC)

Because, Orangemarlin, you are asking to get blocked, and then Wikipedia would be denied the benefit of your more constructive edits. Looking at your contributions, the edit summaries alone make me wonder why you have not already been blocked. --Una Smith (talk) 05:36, 20 December 2007 (UTC)

Whatever. Go for it. OrangeMarlin ^{Talk• Contributions} 21:39, 20 December 2007 (UTC)

• Oppose. I took a first look at this article after Colin°^Talk and GrahamColm^Talk asked me to look at some of the confusing statistics in its Epidemiology section. I have now made so many changes in the last two days that I am no longer a neutral observer, but Colin just now asked me to weigh in here, so here's my opinion. My impression in making the changes so far is that the article still needs a lot of work. The article has a good deal of promise: its heart is clearly in the right place and it's a good topic. However, while editing I found several howlers where the sources did not at all support the article's text, or where the text relied on obsolete and now-incorrect sources; for details please see the talk page sections Stats (again), Lysine, Cimetidine, Corticosteroids as causes, and Hospitalization rate. I fear that many problems still remain. Here are some examples:
  • The Epidemiology section is now howler-free but it is still disjointed; it is not yet an example of the best that Wikipedia has to offer.
  • The Management section needs to be worked on as well: its coverage of corticosteroids is quite dated and its coverage of anticonvulsants, topical anesthetics, opioid analgesics, and tricyclic antidepressants is either wholly inadequate or entirely lacking. It should not have all those little subsections; it should be just one integrated text.
  • The article is missing sections on Classification, Mechanism, and Prognosis, sections that are all recommended by WP:MEDMOS and all of which would improve the article's structure. Much of the material is already there, but it could stand the reorganization.
  • The lead needs a severe rewrite. It contains some topics (e.g., etymology) that are not in the body, and it fails to mention crucial topics (e.g., diagnosis, complications, prevention) that are covered in the body.
  • Someone with a good deal of free time (i.e., not me) needs to verify all the citations in all the sections other than Prevention and Epidemiology. The rate of citation failures in the stuff that I checked was alarming: I think more of the citations were bogus than were correct!
  • I haven't had the time to read through all the sections carefully. No doubt there are more problems, but the set of problems described above is already way too large for a Featured Article.

At the current rate of editing the problems will be fixable in a couple of weeks, but I doubt that we'll keep the pace up. (I myself am running low on free time.) This is not an article that was almost ready for featured status and is just getting polished; it's an article that's getting rewritten and where it's not clear (to me, at least) when the rewrite will get done. Eubulides (talk) 21:57, 18 December 2007 (UTC)

• Oppose. Treatment section inadequate without mention of tricyclic antidepressants. The last paragraph of the introduction on treatment is too oversimplified at best, and misleading at worst. Steroid treatment, morphine analgesia are too prominent and not in perspective. Badly written in parts, for example "Palliative care is often needed after postherpetic neuralgia occurs." Article seems western orientated in parts. Snowman (talk) 15:49, 19 December 2007 (UTC)

• I'd like to see this succeed, but it still needs work. See my edits at the top, including a few inline queries, as an indication of how it's easy to find issues. Tony (talk) 14:01, 20 December 2007 (UTC)

• Is that an appose, support, "not yet support", a "do not know", or something else? Snowman (talk) 16:45, 20 December 2007 (UTC)

• I cannot speak for Tony1 - however if a comment is not otherwise marked it is a comment. - given that Tony expressed a negative opinion - in the eyes of the directorship it might count as worse than an oppose from a generally disliked (imo) reviewer like me :D - Please, don't focus so much on counting votes, focus on improving the article--Kiyarrllston 23:36, 26 December 2007 (UTC)

• Not Yet SupportI agree with Tonyl and would like to see it work, having invested some time into it myself, at an early time. I know Orangemartin has invested much in it too. My major critisizms then and now is that the Article is predicated on the assumptions 1. that anti-virals are readily available throughout the English speaking world. 2. That they can be accessed by everyone within the very short lead time of 3 days. (I can't even get a doctors appointment in that time!) 3. The Article does not address (now) what to do if that lead time is missed. Some alternatives (ie earlier) treatment models need also to be included for these reasons, and in the circumstances I describe. See Archive 1 for suggestions. Jagra (talk) 04:23, 21 December 2007 (UTC)

Having copy-edited the lead a while ago (see above), I chanced a look at the first section.

• Two MOS breaches: "after 1-2 days (but as long as 3 weeks)"—spell out single-digit numbers; en dash for ranges (but why not "after one to two days, although occasionally after as long as three weeks"?).
• "The pain and rash most commonly occurs on the torso"—grammar.
• "a stripe or belt-like pattern limited to one side of the body and not crossing the midline" --> "a stripe or belt-like pattern on one side of the body that does not cross the midline"?
• "Over time, the rash evolves"—evolution does take time, so remove the first two words.
• "further flu-like symptoms"—sorry, I'm trying to hunt down where you told us about the flu-like symptoms that have already occurred.
• "After the crusts fall off, people are typically left with scarring and discolored skin."—"People", suddenly, is a bit awkward. What about "The crusts fall off to reveal scarring and discolored skin."—No indication of how permanent ...?
• Then the remainder:

"Herpes zoster may have additional symptoms, depending on the dermatome involved. Herpes zoster ophthalmicus involves the orbit of the eye and occurs in approximately 10–25% of cases. It is caused by the virus reactivating in the ophthalmic division of the trigeminal nerve. In a minority of affected people, symptoms may include conjunctivitis, keratitis, uveitis, and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain.[10]

Herpes zoster oticus, also known as Ramsay Hunt syndrome type II, involves the ear. It is thought to result from the virus spreading from the facial nerve to the vestibulocochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness).[1]

Zoster sine herpete describes a patient that has all symptoms of herpes zoster except the characteristic rash.[11]"

• The last parastub is puzzling to me. "That" is wrong for a person.
• Start: "Additional symptoms are associated with specific dermatomes."
• I'd remove "approximately" for such a wide range.
• "the virus reactivating" and "the virus spreading" are, strictly speaking, ungrammatical. "The reactivation of the virus" and "the spreading of the virus".
• "Affected people"? = "Patients"? Remove "may" and clarify that not all of these symptoms occur in all patients. Remove "sometimes" ("can" is sufficient).

Now having given this nomination the benefit of the doubt earlier, I have to declare Oppose. I think it should be renominated after proper treatment. Tony (talk) 13:36, 27 December 2007 (UTC)

The above discussion is preserved as an archive. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.