Wikipedia talk:WikiProject Medicine

Welcome to the WikiProject Medicine talk page. If you have comments or believe something can be improved, feel free to post. Also feel free to introduce yourself if you plan on becoming an active editor!

We do not provide medical advice; please see a health professional.

• Unsure about something? Make sure to look at our style and source guidelines.
• Please don't shout, remain civil, be respectful to all, and assume good faith.
• Put new text under old text. Click here to start a new topic.
• Please sign and date your posts by typing four tildes (~~~~).
• Threads older than 10 days are automatically archived.
• Please see Wikipedia:WikiProject_Medicine/Newsletter/Mailing_list

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, 172

We need better health images — an IEG project!

Some images I've provided earlier One of the featured images I've uploaded An image showing the prevalnce of HIV/AIDS in the world as well as a cell infected by HIV. A image of the caloric reflex test

I've done a whole lot of work with images, from adding Sobotta's atlas of Anatomy to Wikipedia, working with X-rays, and contacting different organizations about errata concerning their images and uploading their works. I've also previously taken part in two rounds of IEGs for the Medical Translation Project. I want to tie these two together, focusing on getting images and videos out to a wider audience — both in English and in other Languages. Please take a look at the IEG I've drafted, all the details aren't finalized — but the focus is getting more image through collaborations guides on how to produce acquire images for Wikipedia!

If you feel this is worthwhile feel free to endorse or comment on the proposal — all your ideas are appreciated, and as the project isn't set in stone I will also respond to and criticism about what I plan on doing and what I plan on improving. Check it out here

Note: The page may see some substantial updating in the coming days

Best, CFCF 💌 📧 21:53, 12 April 2016 (UTC)

More "heat maps" would be great. We have a new tool for making these. Doc James (talk · contribs · email) 19:10, 13 April 2016 (UTC)

Created by the Gunnmap tool

Created through editing a human-readable SVG

Gunnmap is a free tool that can create heat-maps based off country data (all under a compatible license). There are also a number of other projects, and getting these to work within collaborations would be really useful, yes. Are those the tools you are referring to? CFCF 💌 📧 08:19, 14 April 2016 (UTC)

great idea, (heat-maps look good)--Ozzie10aaaa (talk) 10:30, 24 April 2016 (UTC)

May be an interesting opportunity to work with Figure_1- they might welcome a partnership opportunity. Their images are thoroughly anonymized and fairly comprehensive. Their ToS would appear to grant them at least in principle the ability to CC-BY license the images that their users upload. Richardjames444 (talk) 16:11, 30 April 2016 (UTC)

That definitely sounds interesting Richardjames444 — have you been in touch with them before, do you know if they are easy to reach out to? Carl Fredik 💌 📧 14:49, 9 May 2016 (UTC)

CFCF I have corresponded and spoken with their Community Management Associate on another relationship-building project they recently launched, and a couple of other matters. I think they're still small enough to be responsive and have been open to conversations. I would be happy to sound them out- but not sure of the wiki-process needed to approve such a thing. Richardjames444 (talk) 13:43, 11 May 2016 (UTC)

User:Ocaasi can probably point you in the direction of any relevant wiki-processes. WhatamIdoing (talk) 12:47, 12 May 2016 (UTC)

I will Be Bold and get in touch with them to see if they'll even consider the notion.Richardjames444 (talk) 19:16, 13 May 2016 (UTC)

Since I was in Toronto for the past few days, I set up a meeting with their Medical Director to broach the subject in person. She had not heard of this project, and I am going to follow up with her since she did seem to have a genuine interest and to sense an alignment in goals. Whether or not this will result in anything for this particular need, or any other, remains to be seen. However, Figure1 has tremendous reach amongst clinicians and if they would collaborate in any way, it might attract broader interest and participation. Also, Figure1's HQ was like a scene from a Hollywood movie about a startup: 20-somethings riding hoverboards on walking desks whilst simultaneously hacking PHP and playing table tennis. I'll report back as this unfolds- please let me know where there is the potential for over-reach!Richardjames444 (talk) 16:07, 19 May 2016 (UTC)

Richardjames444, that is great, and if they are willing to work with us it could have a major impact - both for us, and for them as it would get their content out there and viewed on a massive scale. Feel free to mail me and include me in the discussions, I just want you to know that this project isn't started yet, it would start in July. If you're willing to sign to endorse or to suggest yourself as a volunteer you can still go to the project page on meta and do so. Carl Fredik 💌 📧 15:04, 25 May 2016 (UTC)

Medical app

Our offline medical app now has 5,000 to 10,000 downloads [1]. We have ZIMs in other languages now as listed here [2] Hope to figure out how to allow them to be added to the app soon.

Doc James (talk · contribs · email) 15:13, 7 May 2016 (UTC)

impressive[3]--Ozzie10aaaa (talk) 16:36, 7 May 2016 (UTC)

Have put together a notice to inform our readers about this here Things of maybe putting it on a dozen or so pages. Thoughts? Doc James (talk · contribs · email) 21:30, 16 May 2016 (UTC)

People get really emotional about non-content banners on article content - as we just saw with the "research" template. Seems OK to trial it on a few of the more highly trafficked medical articles (Zika maybe?) but be ready for blowback. Before a broader Phase II test an RfC would be good, and hopefully you are gathering data from this pilot that you can use to sell the Phase II.... Jytdog (talk) 21:45, 16 May 2016 (UTC)

Yes agree that may occur. How about 6 banners that rotate around our medical content with there not being more than 6 instances? Doc James (talk · contribs · email) 03:22, 18 May 2016 (UTC)

Yes, the problem seems to be that we basically have only an on/of solution and what we need is probably something smarter able do show/hide the banner depending on visitor characteristics (languages, country, etc...). I would be interested if we have had in the past discussion/trials/researches to try to provide such a system. Kelson (talk) 10:51, 18 May 2016 (UTC)

Count me in if I can offer any technical help. We obviously can't use server-side solutions like we do for QRpedia - although we could test them at WMUK - but I've been looking at language detection in browsers for another project. It's probably just the language we need to know, rather than the country, I guess.

If we are going to put banners on pages as a pilot, please consider trialling them on article talk pages in the first instance. I know it will be mainly reaching editors rather than readers, but considering the blow-back the WMF got from the research project appearing on article pages, I'd recommend getting as much testing done as possible on non-article pages. Only then would it be sensible to argue for a time-limited trial on article pages, and that would need a very well advertised RfC. --RexxS (talk) 15:30, 18 May 2016 (UTC)

We know that they are EN readers as they are on EN Wikipedia. Doc James (talk · contribs · email) 17:47, 18 May 2016 (UTC)

Although the banner says it's an offline version, it also says "access all this content when there is internet". As I understand it, after downloading the offline content is by definition accessible without internet, so probably the wording should be fixed. Brandmeister^talk 17:52, 18 May 2016 (UTC)

Thanks and fixed. Doc James (talk · contribs · email) 17:56, 18 May 2016 (UTC)

feature comparison pages for consumer medical devices

WP has a number of pages with tables comparing software technologies (both commercial and non-commercial). With the proliferation of medical devices being marketed to consumers, would it be appropriate to develop similar pages to compare features (not prices) for cardiac, glucose, apnea, etc., monitoring. AFAICS, there is no such wiki repository on the web; at best, such tables are rare and not updated. Given the national (and international) health focus, this would seem a most helpful addition. For examples of software comparison pages, see Comparison of open-source operating systems, Comparison of file comparison tools, and many others shown from a WP search for <comparison table software>. Thoughts and guidance welcome. humanengr (talk) 12:02, 9 May 2016 (UTC)

if such references exist Wikipedia:Identifying_reliable_sources_(medicine) for what your proposing, and is done in an encyclopedic manner..i don't see why not...--Ozzie10aaaa (talk) 12:23, 9 May 2016 (UTC)

thx, Ozzie10aaaa. The sources here would, in general and as for the software tables, be vendor literature and review articles. I would expect it to be encyclopedic as editors contribute info on devices as they learn about them. I've broached the possibility of a wiki on some fora wrt devices monitoring irregular heartbeats, and have seen some interest there. I think this is at the point where it makes sense to mock up a page in my sandbox. Agree? humanengr (talk) 17:44, 9 May 2016 (UTC)

I think you should get more opinions on this before going forward (though I don't see an immediate problem)--Ozzie10aaaa (talk) 17:49, 9 May 2016 (UTC)

thx and understood … FYI, then, there was some preliminary discussion on this at Wikipedia:Teahouse/Questions#WP policy on commercial product comparison pages. humanengr (talk) 17:58, 9 May 2016 (UTC)

Everything in the first list of open-source operating systems is free, so that's kind of different. My first thought is that it sounds like it would become WP:SPAMBAIT, even if that wasn't the original intention. Are there countries where patients get to pick which medical device their doctor uses? I'm wondering how exactly having that information in table form will be helpful/encyclopedic for the general public. PermStrump(talk) 18:43, 9 May 2016 (UTC)

My focus is on devices sold directly to consumers either in stores or online rather than devices doctors use. Re that latter set, iiuc, in the U.S. at least, folks do ask doctors about particular devices that require prescriptions. So maybe 'devices doctors use' or 'devices requiring prescriptions' would a) not be included; b) be included as a separate table; c) be included with a column to indicate those constraints? Re the 'open-source' list, I shouldn't have included that as an example. But Comparison of file comparison tools does have commercial products and has not been spammed. (That is the case for the other software comparison pages as well.) And I now see that page includes prices for the commercial products. Re utility for the general public; my entire reason for starting down this path is that I found it incredibly difficult, after seeing some devices in my local pharmacy that monitor irregular heartbeats, to identify and get specifications re the full range of such devices. HTH humanengr (talk) 19:25, 9 May 2016 (UTC)

Permstrump, the English Wikipedia is agnostic about commercialism. Nothing on Comparison of iOS devices is free. The fact that something costs money does not affect the subject's eligibility for an article at all. WhatamIdoing (talk) 06:27, 10 May 2016 (UTC)

• One of the key ways we keep promotional garbage out of our articles about health is that the guideline for sourcing content about health is MEDRS; we use reviews published in the biomedical literature or statements by major health organizations to source biomedical content (like how well a device works and whether it is safe). This is where health-related content is really different from video games or consumer products. In those topics editors are open to using low-quality bloggy sources (pushing RS as far toward bottom-scraping as it will go) but for health content we try to raise source quality. So I don't know if you could find enough good enough sources to do what you have in mind. This is probably the most surprising thing editors encounter who enter health topics from other topics within WP.

Also as you acknowledge the work would be WP:OR. We summarize accepted knowledge here, we don't create it. Also, Wikipedia is WP:NOTHOWTO and WP:NOTCATALOG. Finally, this would become an absolute magnet for spammers. We can't even list the brand name of a drug with out spammers from generic companies around the world wanting to come and add the brand for their version of a drug.

I don't think this is a good thing. Jytdog (talk) 19:57, 9 May 2016 (UTC)

• • Thx for the feedback, Jytdog. You raise a number of good QA issues. Re MEDRS: Presumably, as marketed devices have gained regulatory approval, wouldn't that cover at least some minimal standard of "how well a device works or whether it is safe"? Wrt the concern of MEDRS re "primary sources … often include unreliable or preliminary information, for example early in vitro results which don't hold in later clinical trials", not-yet-approved devices could either not be included or so marked. Re reviews: A key initial source for info on cardiac monitors would be the reviews Prof. James W. Grier has kindly put online (https://www.ndsu.edu/pubweb/~grier/Comparison-handheld-ECG-EKG.html, http://www.favoriteplus.com/prodimages/reviews/ecg-comparison.pdf). (The former was commended at http://a-fib.com/guide-to-diy-heart-rate-monitors-handheld-ecg-monitors.) But 1) there are other devices that are on the market (presumably passing regulatory criteria) not in his reviews, 2) those pages and others similar would benefit from a tabular, user-friendly, front-end. That would seem to support argument for a wiki table online somewhere for that purpose. Re WP:NOTHOWTO: This would not be a 'how to', though the reviews cited might contain some such info. Re WP:NOTCATALOG: This is more than a catalog; it would compare specifications. Reviews cited might have links to such embedded but that would not generally be included directly. Re generics: Is that an issue wrt devices as it is for drugs? Re the WP:OR issue: How do manufacturer's user manuals rank wrt that criteria? They are often the only source directly or indirectly published that clearly indicates specifications. humanengr (talk) 21:18, 9 May 2016 (UTC)

The things posted by that professor are exactly the kind of bloggy garbage sources that are not OK here but that are just fine over there in software/gadget land. A "review" is a Literature review/systematic review/meta-analysis - academic papers published in the biomedical literature. Not somebody's blog "reviewing" products. Please actually read WP:MEDRS before you reply again. Thanks. Jytdog (talk) 21:53, 9 May 2016 (UTC)

MEDRS does not address product design specifications; it addresses product performance. humanengr (talk) 00:08, 10 May 2016 (UTC)

That is true but claiming that that any design element (or lack thereof) has some better safety or efficacy does require MEDRS sourcing. Unclear to me how much you will be able to say that is meaningful. What I am saying here is my own take on things, of course. Others may differ. In general (in my view again) our coverage of medical devices needs a lot of work; I am just not happy about product guides in WP in general for the WP:OR. WP:NOTHOWTO aspect of them. Jytdog (talk) 01:34, 10 May 2016 (UTC)

I agree with the points Jytdog raised. It sounds like something that might be on Consumer Reports, but I'm failing to see the encyclopedic value and I there are several sections of What Wikipedia is not that probably apply. Besides what people have already said, I'll add WP is not an indiscriminate collection of information. To be blunt, it sounds like it would quickly turn into an indiscriminate collection of linkspam. PermStrump(talk) 02:54, 10 May 2016 (UTC)

Speaking of Consumer Reports: Bluerasberry, do you have any thoughts about this idea?

Also, Jytdog, I'm not seeing anything up there that sounds like "you acknowledge the work would be WP:OR". It sounds like the goal is to include only information that is actually verifiable in a suitable source. For example, presumably there no MEDRS issues at all in saying "only runs on Windows boxes", but that is informative. As a someone accustomed to a Microsoft-free computing environment, I would need that information if I ever had to deal with a medical device. An investor might look at a long string of "Windows-only devices" and see a market for an Android-oriented device, since there are more Android devices than Windows desktop computers in the world. I don't see any reason why this type of non-biomedical information needs to be supported by the ideal sources for WP:Biomedical information. WhatamIdoing (talk) 06:27, 10 May 2016 (UTC)

• I see two issues being discussed here. One is the value on Wikipedia of comparison articles, and the other is whether WP:MEDRS should guide a comparison article on consumer medical devices.

About comparison articles - there are many comparison articles listed at Category:Software comparisons. My personal opinion of these is that most or all of these deviate from typical Wikipedia practice of providing citations to verify content. The current practice is that these charts are made without matching their information with references. I advocate that all content in Wikipedia be matched with citations to sources, and since these sorts of articles include more original research than is allowed in other sorts of Wikipedia articles, I do not recommend this model of presentation. If somehow someone committed to making one of these comparison articles and had citations for every entry in the table, then I think that would be great. If these kinds of comparison articles could in the future be generated from information in Wikidata, then I think that would be best.

About considering consumer medical devices on par with traditional medical devices - Consumer Reports has not published deep opinions on the matter. Different staff in-house have raised this issue every week for months. Personal medical devices are sold as a consumer novelty, and come with instructions that they should not be used to guide medical decisions. At the same time, the consumer perception of the devices is that they do provide health data for guiding health care decisions, and even health care providers make decisions based on data reported by these consumer devices. There is a disconnect between how activity trackers and home testing kits are overtly marketed and how consumers perceive that marketing and respond. I would love for Wikipedia to provide clear information on the matter, but I am not aware of any organization which has published white papers or taken clear positions for consumers about what to expect of these devices. The best information that I have to offer from Consumer Reports on the matter is Better Healthcare: Your Medical Data, which is an introduction to the concept that consumer devices might produce data that can be used to influence health care decisions. Even the basics in this field are controversial and uncertain. It is difficult to know where to begin in discussing these things. If there is a discussion on this, then I expect that the sources cited would not come from medical journals, but rather from product review organizations. Those would not be MEDRS sources of the sort typically used here. Blue Rasberry (talk) 17:33, 11 May 2016 (UTC)

Would it suffice for such tables to include a caption, footnote, or field for regulatory approval and caveats? Maybe something like: "The manufacturer has provided reasonable assurance of the device’s safety and effectiveness [as per FDA]; regulatory approval does not indicate satisfaction of any specific quality standards; and (unless otherwise indicated) entries do not satisfy WP:MEDRS criteria."? Also, FWIW, Prof. Grier’s link (cited above) does broach regulatory approval issues with links to further discussion. As I now see that Prof. Grier still intends to construct a summary table, I’ll wait before proceeding further. I trust the above foray will prove helpful more generally. Thank you all for the feedback. humanengr (talk) 05:14, 17 May 2016 (UTC)

Suicide bag

Not quite sure where to bring this up, but there are several articles on suicide methods that make me really uncomfortable and I think they're arguably illegal. Not sure if the best way to handle it was to view them as medical articles and keep an eye that they're not making biomedical claims without proper sourcing or if there's some other legal avenue to pursue. They're really good using a tone that sounds unbiased, like it's an objective discussion on the ethics of suicide, but they're really just pro-suicide sites and they're really dangerous. These people like to tag anything about suicide prevention as lacking NPOV or as demonstrating a "American" perspective. Reddit and other social media sites don't allow content or even links to websites that explicitly tell people how to comment suicide. Since they can't link to these articles, people will tell each other "Google suicide bag and read the wikipedia article." I would think if this content is illegal enough for reddit, it shouldn't be on wikipedia.

I think it could be argued that some of these are encouraging suicide. The suicide bag article is about exactly how to make your own suicide bag, including a diagram, with easily accessible items. The hardest thing to get would be helium or a propane-butane mixture and the rest are household items. Then look at what links there, literally any article about bags (purses, backpacks, etc.) links to suicide bag. Suicide methods is exactly what it sounds like and this is what links there: Teenage suicide in the United States, suicide prevention. Basically any article about suicide links to an article that tells you specifically how to kill yourself. Lots of them have a handy dandy suicide infoboxes that link to suicide methods. alt.suicide.holiday is an article on former usenet group that is clearly just a pro-suicide article.

This 2012 study showed that pro-suicide content on social media can increase the risk of completed suicide because it normalizes and glorifies the act and provides people with access to information about lethal methods. It specifically mentions methods using gas. This 2015 study discusses an increase in helium-related suicide deaths as a direct result of discussion about it in online forums. There have been stories in the news over the years about people who have been convicted for encouraging suicide on internet forums. Here's one from 2010 about a woman who was convicted for encouraging suicide online. What do other people think? PermStrump(talk) 14:35, 8 April 2016 (UTC)

insofar as the article suicide bag it seems well referenced--Ozzie10aaaa (talk) 17:42, 8 April 2016 (UTC)

This might be a good topic to take to the WP:VILLAGEPUMP. Obviously Wikipedia is not censored in so far as the content is not illegal in the United States (i.e. libel and child pornography). The dividing line is not always clear though I would think in this case the line is the difference between is and ought. Sizeofint (talk) 07:29, 9 April 2016 (UTC)

The article's subject itself is notable and therefore is worthy of an entry in Wikipedia. However I am concerned that Wikipedia and/or the editors of the article might be construed as assisting suicide, especially if a high-profile case is reported in the media (e.g. "Robin learnt suicide technique from Wikipedia"). This article requires a formal legal assessment. Axl ¤ [Talk] 10:27, 12 April 2016 (UTC)

I don't know about legal assessment. I reviewed it and I think it is stays on this side of WP:NOTHOWTO. I noticed that for a while it had a suicide hotline hatnote, like this. It was taken off pursuant to this RfC at the Suicide article. Jytdog (talk) 11:15, 12 April 2016 (UTC)

Sizeofint, Did you mean the idea lab or the main village pump? I'm trying to put together a more cohesive argument so it does sound like I'm just trying to censor wikipedia. Jytdog, that's a good point about NOTHOWTO. Something definitely didn't feel encyclopedic about it to me, but I couldn't put my finger on it and I think you hit the nail on the head. I don't know if it's a coincidence or someone who read this thread, but for the past 2 days an IP editor has repeatedly removed the diagram from the Suicide bag article on the grounds that it's OR. It's a bit of a slow motion edit war. I think they each have 2 reverts now, but there have been a few hours in between each one. I wonder how long it will go on. I never would have considered arguing that an image was OR, but I think the IP has a good point. I'm not getting involved yet though, because I'd rather focus my energy on trying make a policy that specifically addresses this topic. If that fails, my back up will be NOTHOWTO for the majority of the text and OR for the image. Axl, that's also my concern (that it could be construed as assisting suicide) plus that it likely is assisting suicide based on the 2015 study that I linked above. PermStrump(talk) 18:24, 12 April 2016 (UTC)

I was talking about gaining wider input from the community at the village pump. Sizeofint (talk) 20:37, 12 April 2016 (UTC)

we have disclaimers all over the place; i see the concern about bad press but the disclaimers are WMF and as I understand it they are solid. And Permastrump what i wrote was I think we are OK per WP:NOTHOWTO. There are a few places it could be tweaked but generally it is good. There aren't actually instructions there. Jytdog (talk) 18:36, 12 April 2016 (UTC)

Hi all. I've been talking to medical doctors, researchers, and major suicide awareness charities about this article, and some others, for the past two years, with full in-person meetings every few months. Their view is that not only is Wikipedia classed as a "pro-suicide" website in terms of the information it provides, but that the occasional spikes in attention that come to these articles are probably reflected in real-life suicide attempts. They are particularly concerned about the diagram: their research indicates that the existence of the diagram does cause suicides and attempts at suicides that would otherwise not happen. We've been a bit stuck on how to move forward with this on Wikipedia, though - a big discussion about it could work both ways. Chase me ladies, I'm the Cavalry (Message me) 14:28, 14 April 2016 (UTC)

Can you tell us what standards they use to decide whether an information source is "pro-suicide"? WhatamIdoing (talk) 04:14, 15 April 2016 (UTC)

I don't know how many people are researching this so I kind of wonder if I'm about to quote any of the people Chase me ladies, I'm the Cavalry has been talking to, but here's how Collings and Niederkrotenthaler (2012), and Kemp et al. (2011) define prosuicide websites... Sites that:

• have detailed suicide instructions or descriptions of suicide methods
• advocate suicide or describe suicide methods in detail
• are permissive or encouraging of suicidal behaviors
• promote or enable suicide by describing suicide methods.

Both papers put prosuicides sites in direct contrast with "suicide prevention, and suicide support" sites that offer resources, psychological, social, or practical support to reduce suicidal behaviors. Collings and Niederkrotenthaler said, "many websites [have] life-promoting characteristics (such as the opportunity to contact a support service) and potentially suicide-promoting characteristics (such as detailed descriptions of suicide methods) have been found to be closely intertwined" This is definitely true on reddit where they like to call themselves "pro-choice" and claim to be places for "discussion about the moral, ethical, and religious implications about the right to choose the time of your own death." But they all contain links that tell you ways to kill yourself. They are NOT "pro-choice" or "suicide neutral" as they claim. Same with the Wikipedia article that sounds "NPOV." It's really just a prosuicide site that normalizes, glamorizes and encourages suicide attempts in individuals who are already high-risk. This is all supported by the studies I've linked, especially Gunnell et al. (2015). PermStrump(talk) 06:27, 15 April 2016 (UTC)

Permstrump I hear and understand your passion on this, but it seems that you want WP to take a moral stance. Have a look at Abortion. Is that a "pro-abortion" article because it doesn't have hotline information for counseling? (real question for you). I could see someone arguing that.

I also want to note that we have a whole article on Suicide methods and a Template:Suicide_sidebar. There has been some of this kind of discussion at both talk pages over the years (!) as well as Talk:Suicide and they get shot down each time. Jytdog (talk) 06:54, 15 April 2016 (UTC)

Jytdog, this isn't a moral stance, if I'm honest. The article on abortion does not tell people how to perform an abortion (especially not with at-home methods) - instead it talks about the procedure from a medical/scientific standpoint. Secondly, I would argue that our general goal - "a world in which every single person on the planet is given free access to the sum of all human knowledge" - means that we shouldn't be promoting suicide methods in the way we currently are. Moral issues aside, (and this may seem quite cold, but) if vulnerable people use the information on our site to end their lives unnecessarily, then we're not adding the the world's knowledge - we're working to reduce it. Chase me ladies, I'm the Cavalry (Message me) 14:20, 15 April 2016 (UTC)

WhatamIdoing, to answer your question: I don't know the specifics, but two key points came through: first, that Wikipedia articles are often a "how-to" guide rather than a sensible, neutral analysis, and secondly that the vast majority of people who are looking for suicide methods online turn to Wikipedia as a source.

Jytdog: Re: the abortion article, is there notable documentation in peer reviewed sources that say Wikipedia.specifically. is contributing to a public health issue by facilitating people to follow through with abortions that are illegal in their jurisdiction by normalizing, glamorizing, promoting, and providing access to the means for performing self-abortions at home (normalizing them by discussing them at length without balance from opposing viewpoints and linking to list articles and websites about regular people who have had abortions with a focus on how quick and painless their abortions were; glamorizing them by listing all of the celebrities who had abortions and the exact methods they used; promoting them by inserting pro-abortion infoboxes in every article someone on the fence might visit, and links at the bottom of completely unrelated articles to articles detailing abortion methods; and providing the means by detailing all of the information someone would need (including illustrated diagrams) to perform a "quick and painless" self-abortion at home without a medical provider using easy to access household items)? Because if that were the case, then yeah, I'd say we should definitely rethink what we're doing with our abortion articles. Because that's exactly what the suicide articles do and that's exactly what scholars have directly connected to spikes in actual suicides that correspond with spikes in page views of wikipedia articles on that method following major news reports on noteworthy people committing suicide. Gunnell et al. (2015) use Robin Williams's suicide as a very disturbing example. He did not actually use asphyxiation, but for 1 hour the suicide bag article said he did and the visits to that page increased astronomically, as did suicides completed by asphyxiation with gas. Look at Suicide_bag - what links there, literally any article about bags (purses, backpacks, etc.) links to suicide bag. PermStrump(talk) 15:33, 15 April 2016 (UTC)

That was a navigation template at work, I've changed it pending discussion. Certainly wp:NOTHOWTO, but the topic is clearly notable. It is also very current event driven. The Canadian parliament is (unwillingly) grappling with medically assisted suicide issues at present, as no doubt are others. The hard part will be finding NPOV sources without legitimizing self help approaches. LeadSongDog come howl! 18:17, 15 April 2016 (UTC)

I haven't spent much time thinking about medically assisted suicide, but I do sometimes wonder why even a few people bother with it. In comparison to the unregulated "homemade" methods – which are often so simple that even a brief explanation is "detailing all the information someone would need" – it seems like a lot of work for no benefit, except maybe the emotional comfort of having your decision "approved" by some medical or government authority (think "certified proof for my loved ones that I'm not mentally ill").

I'm not sure that every single article about suicide should have a "right to respond" section. If an article is about a particular method, then it makes sense for the information to be restricted to that particular method. For example, in the suicide bag article, editors could reasonably include information about, say, the ethics of this choice vs others (e.g., it's probably more ethical than jumping off a bridge and thereby triggering a search and rescue mission that could endanger emergency response workers). But I don't see room in an article like that for something on the ethics of committing suicide at all; it's off-topic. WhatamIdoing (talk) 03:29, 16 April 2016 (UTC)

Some of the sources I've linked above talk specifically about the suicide bag and ethics of suicide, so it wouldn't be off topic. I have it on my to-do list. I'm not really concerned about medically assisted suicide for people with terminal illnesses. The problem is that that's not who these prosuicide sites are usually aimed at/who they hurt. PermStrump(talk) 10:42, 16 April 2016 (UTC)

Oh dear, this issue again. Suicide bags exist. They have for decades. As an encyclopedia, WP covers them. The article describes them, what they look like, their history, what people have said about them, etc. There are no step by step instructions (such instructions are readily available elsewhere [4] [5] [6] etc etc). As for the panic about increasing numbers of people using this method, it should also be noted that total numbers of suicides have not risen (indeed, suicide rates are stable or falling in most countries)

The fact that a slightly increasing percentage of suicides (the numbers are tiny) are choosing this method (for euthanasia as well as suicide) is to be expected, since it is painless, non-toxic, aesthetically acceptable and easily obtained (until recently), compared, for instance, to carbon monoxide poisoning, hanging and other brutal and distressing methods (some of which are also extremely dangerous to bystanders and medical response personnel, e.g. CO poisoning). Those who would bury the suicide bag article probably have good motives (nobody wants to see depressed youngsters making this error), and are not on a religiously-motivated campaign, but the outcome, if we suppress it, is unlikely to be good. People who are absolutely determined to kill themselves will find a way, and that way will generally be much more distressing and dangerous for all concerned. In addition, helium canisters these days are "cut" with 20% oxygen (due to a global shortage of helium) [7], so the method does not work for many who try it. To make it effective, you have to get argon or nitrogen, and these are simply NOT casually available. Buying these gasses is not something most people are equipped to do. Ratel (talk) 21:50, 17 April 2016 (UTC)

From [8]:

“ Balloon Time, a major supplier, has issued a statement to say that in the future all of their “balloon gas” will be diluted with 20 per cent air. “Our helium is rated from 98-99.99 percent pure. However, due to global helium supply issues, we are now mixing helium with air. All tanks will have 80 percent or more helium. This allows us to deliver a quality product at an affordable price.” ” — Exit International

Without balloon helium tanks, potential suicides have to order very large canisters from gas suppliers. They are heavy, come delivered by a truck, and are expensive. This whole topic is becoming moot ... Ratel (talk) 22:22, 17 April 2016 (UTC)

Interesting. Diluting 99.x% helium with 20% air will give a hypoxic mixture (roughly 4% oxygen), which should be quite effective at asphyxiating a human at normal atmospheric pressure. However, I was under the impression that balloon helium has 20% oxygen added, specifically to avoid accidents with people breathing it from balloons to produce squeaky voice effects. Maybe this varies between countries. • • • Peter (Southwood) ^(talk): 09:44, 20 April 2016 (UTC)

resonant frequencies are many times higher in a human vocal tract that has helium in contrast to one that just has "air"--Ozzie10aaaa (talk) 10:41, 30 April 2016 (UTC)

Suicide bags result in quick and painless death — MEDRS or not?

Discussion currently ongoing at: Talk:Suicide_bag#Removed_swaths_of_original_research_and_primary_sourced

• Should we allow primary sources?
• Should we allow images without references on controversial issues?
• Are case reports WP:DUE?

Please comment. Carl Fredik 💌 📧 21:30, 9 May 2016 (UTC) 

Who is this "We" you refer to, and where do they get the authority to make this decision? • • • Peter (Southwood) ^(talk): 13:45, 10 May 2016 (UTC)

• 'Please note, the suicide bag article is right now undergoing what appears to be a concerted tag team attack to destroy the content. Is this what wikipedia is coming to, a censored portal? All editors need to examine their consciences here, and decide if we are going to reflect what's going on in the world, or play a more paternalistic role. Ratel (talk) 22:19, 9 May 2016 (UTC)

Having multiple editors disagree with your position is not the same as a tag team. Carl Fredik 💌 📧 22:50, 9 May 2016 (UTC) 

A sudden, concerted mass deletion of material, by several editors, on a longstanding article, is most definitely a tag team effort. Ratel (talk) 06:26, 10 May 2016 (UTC)

Actually you need to read WP:TAGTEAM and be careful about levelling false accusations of it because it's not WP:CIVIL and can lead to you being sanctioned. If you have grounds for your accusation you need to take them to WP:AN/I. Alexbrn (talk) 12:23, 10 May 2016 (UTC)

How else explain an article (that has been more or less ignored for years) getting 3 or 4 new editors, all with the same agenda (mass removal of text to the point of aggressive edit-warring), in the space of a week? If it looks like a duck, walks like a duck etc. But I may be wrong. Incredible coincidences can happen, perhaps this is just a chance occurrence. Ratel (talk) 12:38, 10 May 2016 (UTC)

Take it to WP:AN/I then, with your evidence. Here is not the place. It is very common for poor articles build with a spurious WP:LOCALCON to get heavily edited when they receive fresh eyes and a widened consensus, for example as a result of their being raised at a Noticeboard. Alexbrn (talk) 12:43, 10 May 2016 (UTC)

Real life precludes ANI action. But I'd welcome an admin freezing the article as it was so that all the reverting can stop and things can get sorted on Talk Ratel (talk) 12:56, 10 May 2016 (UTC)

As an uninvolved editor with a small amount of experience in editing medical articles related to diving, the editing interventions based on claimed biomedical information do seem rather over the top.• • • Peter (Southwood) ^(talk): 13:37, 10 May 2016 (UTC)

Diving and suicide methods have quite different implications do they not? Controversy dictates how important it is to adhere to quality sources, this is a principles of WP:RS. Carl Fredik 💌 📧 14:44, 10 May 2016 (UTC)

Not really. Divers accidentally die through the same biological mechanisms that kill the users of suicide bags. The fact that one death makes some people more queasy than the other doesn't really change the biomedical facts about what happens if you get your Nitrogen/Oxygen balance wrong (or Helium/Oxygen, for really deep dives). They both need good-enough sources, and neither absolutely requires gold-plated-only sources. "Controversial" only applies to BLPs. What you're probably thinking of is the "extraordinary claims" idea, and the biochemistry here isn't the least bit extraordinary. WhatamIdoing (talk) 02:51, 11 May 2016 (UTC)

As far as I can tell, no-one on Wikipedia is prescribing suicide bags as a medical intervention, or claiming that this would be an acceptable medical practice. Therefore why should the article on suicide bags be considered within the scope of MEDRS? A more appropriate standard for reliability should be applied to the sources used.• • • Peter (Southwood) ^(talk): 07:51, 11 May 2016 (UTC)

• we need more opinions at Talk:Suicide_bag--Ozzie10aaaa (talk) 18:08, 10 May 2016 (UTC)

It is well-known that breathing a severely oxygen-deficient atmosphere (4 to 6%) results in unconsciousness after a few breaths, and that the exposed person has no warning and cannot sense that the oxygen level is too low (http://www.csb.gov/assets/1/19/SB-Nitrogen-6-11-031.pdf). No warning would imply no pain, but I don't expect to find peer reviewed studies or Cochrane reviews confirming or disproving that assumption.

Maybe it's time to clearly define the limits of MEDRS, and ban "off-label use". Prevalence 21:32, 10 May 2016 (UTC)

Changing MEDRS won't stop POV pushing.

Speaking of which: I suspect that part of the public health concern about this uncommon method stems from the population that chooses it, and I wonder whether that's addressed. It's not the method of choice by sympathetic old cancer patients; instead, it's largely used by men with traditional risk factors for suicide (e.g., impulsive, young, white, recreational drug users). So I'm wondering whether there is real-world POV pushing at play here, too: parts of society have decided that this is a 'bad suicide' (a young person acting independently, if probably stupidly) rather than a 'good suicide' (a terminally ill elderly person ending up equally dead, but with the explicit blessing of a government bureaucracy and the medical establishment). Because, you know, if you truly wanted to stop suicides, you'd stop worrying about this method, and this article, and instead make it illegal for my local (American) pharmacy to sell an unlimited number of bottles containing 375 extra-strength pills of liver failure each to any kid who can use a credit card. WhatamIdoing (talk) 02:54, 11 May 2016 (UTC)

Changing (or more precisely, specifying the limits of) MEDRS will not stop POV pushing, but it would make using MEDRS as an excuse/ weapon by the POV pushers easier to refute/dismiss, hence a good thing. • • • Peter (Southwood) ^(talk): 07:37, 11 May 2016 (UTC)

I agree, of course, but I don't think that we'll get there until WP:MEDDUE exists. People cite MEDRS because it's a good hammer, even when the tool they really need is a screwdriver. WhatamIdoing (talk) 13:23, 12 May 2016 (UTC)

I surprised there seems little pushback at this article to what seems very dubious proposals. The latest is to source a description of how "peaceful" death-by-helium is, to eyewitness accounts. Alexbrn (talk) 12:54, 12 May 2016 (UTC)

Perceived peacefulness is not WP:Biomedical information. Therefore, plain WP:IRS guidelines apply, and that guideline probably requires nothing more than a newspaper article and WP:INTEXT attribution. WhatamIdoing (talk) 13:23, 12 May 2016 (UTC)

How the human body reacts physically to a substance / the nature of the death that subsequently occurs is biomedical information. The proposed source is the book Final Exit. Alexbrn (talk) 13:56, 12 May 2016 (UTC)

"Causes myoclonus" is biomedical information. "Seemed subjectively peaceful to bystanders" is not. WhatamIdoing (talk) 14:09, 12 May 2016 (UTC)

Possibly, but that's not the proposed wording and not the intended meaning of the edit, which is justified by the proposer thus: "We have ample evidence from numerous sources that this is a quick and easy way to die, and deleting that simple fact from the page by impugning the source is POV". The "evidence" being proposed for this "simple fact" is somebody saying "When I witnessed the helium death of a friend of mine it could not have been more peaceful". This seems to be way worse than using a well-published case report even: it falls off the bottom of WP:MEDASSESS. Alexbrn (talk) 15:52, 12 May 2016 (UTC)

Um no. That was not the evidence proposed, that was merely an example. There are different sources for the fact that the death is quick and peaceful. You can also go to the WP article Inert gas asphyxiation for data such as

According to the U.S. Chemical Safety and Hazard Investigation Board, in humans, "breathing an oxygen deficient atmosphere can have serious and immediate effects, including unconsciousness after only one or two breaths. The exposed person has no warning and cannot sense that the oxygen level is too low."

and

suddenly breathing pure inert gas causes oxygen levels in the blood to fall precipitously, and may lead to unconsciousness in only a few breaths, with no symptoms at all

And of course Ogden's studies draw on a large number of eyewitness accounts. And backing this up, autopsy does usually not show any notable findings, (lots of RS for this) suggesting an absence of unconscious death struggle. Ratel (talk) 22:29, 12 May 2016 (UTC)

The CSB.gov source that Ratel and Prevalence are referring to has nothing to do with suicide bags. It’s about accidental, gradual exposure to nitrogen in the workplace in a contained environment like a small room. I’m going to quote few sources that talk about death by nitrogen asphyxiation to illustrate how irrelevant the CSB source is. But I want to clarify something first... There are 2 different statements by 2 separate people about the physical reaction (or lack there of) to the inhalation of inert gas using a suicide bag. One is a primary source in a low-impact, peer-reviewed journal written by Ogden, a right-to-die advocate and criminologist, that talks about how quick, painless and peaceful death is with helium and a suicide bag. The other statement is from a self-published newsletter written by Nitschke in which Nitschke says that helium has a risk of adverse effects, but nitrogen is much better in comparison. I’m NOT suggesting that the sources quoted below that talk about nitrogen should be used in the article since they’re about nitrogen asphyxiation using masks or in a contained environment in the workplace, not suicide bags.

1) This CNN article from 2015 is about Oklahoma looking for humane alternatives if the Supreme Court ruled that lethal injections were inhumane: While the Supreme Court case was pending, Gov. Mary Fallin signed a bill that would allow the state to perform executions with nitrogen gas if lethal injection is ruled unconstitutional or becomes unavailable. While the medical community has voiced concerns about the method, at least one group thinks the Sooner State might be onto something. Philip Nitschke, director of the right-to-die group Exit International, said the increasing difficulty in obtaining pentobarbital has prompted him to consider gas as an alternative...”

Perfect illustration of how Nitschke doesn't represent the mainstream, medical view. By the way, Nitschke already sells suicide kits with pure nitrogen for $690, so I wonder if that has anything to do with why he claims there are zero adverse effects compared helium, the product gas of choice promoted by his right-to-die competitors, who have essentially rejected Nitschke and his methods. Not to mention the Medical Board of Australia suspended his medical registration, to which Nitschke replied, ‘Oh yeah? Well I was going to break up with you first. So there.’

2) This Time article is about the same debate in OK: Changing the context could prove problematic. Administrating the gas within a prison is much different than the instances in which pilots and divers have slowly and accidentally experienced a lack of oxygen. Dr. Michael Weiden, a pulmonary expert at NYU School of Medicine, says that while nitrogen could be administered without medical professionals, using it for capital punishment could create an ironic consequence: the need for sedation… somebody who thinks that an individual who’s asphyxiating will not freak out without sedation is foolish.”

3) This peer-reviewed case study (PMID 23899346) from 2015 about a suicide by nitrogen asphyxiation with a scuba mask, says, “Deliberate nitrogen asphyxiation is also viewed by some as a more humane way to end human life. Nevertheless, execution by nitrogen asphyxiation is not used by any nation in the world.”

In 2010, Ogden had a case study (PMID 20211999) published in a low-impact, peer-reviewed journal where he talks about 4 assisted-suicides he observed that involved helium asphyxiation using face masks. This is the primary source cited to support the claims that suicide with helium and a suicide bag is quick and painless.

4) In contrast, this peer-reviewed study from 2013, which is unlisted by PMID (see WP:PARITY), says that one of the two cases they studied had "bilateral eyelid petechiae and large amounts of gastric content in the airways. These findings challenge the assumption that death by this method is painless and without air hunger, as asserted in Final Exit." They also found that the time to death varied from 5-10 minutes to up to 40 minutes.

This is exact situation is why WP:MEDRS exists! I shouldn’t need to create an argument for using MEDRS from scratch just for this specific article. PermStrump(talk) 03:58, 13 May 2016 (UTC)

• Permstrump, you're confused by the fact that there are several ways to die from inert gas exposure, some much more efficacious than others. If you'd read Final Exit and The Peaceful Pill Handbook you'd know that there are very specific instructions to follow for using a suicide bag. Those instructions are not on WP because of WP:NOTHOWTO. The chapter from the latter book on how to use the suicide bag correctly runs to ~50 pages of instructions and videos, about all manner of aspects that must be done correctly. But in summary of the basic process, one has to put a completely flattened bag at the top of the head above the ears with collar loosely on head, turn on nitrogen to fill the bag like a tent with pure nitrogen/inert gas (takes ~2 minutes) and wait till nitrogen is escaping from the bottom of the bag, take rapid deep breaths (hyperventilate), then exhale completely (expel all air from lungs), then lower bag over head and take a deep breath, with cord and toggle snug against neck. This is a very precise sequence of events; if it is not done right, if there is insufficient nitrogen flow, or if the bag is not fully compressed and empty of air when the process begins, then failure to die quickly and peacefully can ensue, and this would be why we see some (a few) autopsies that show petechiae and aspiration of vomitus. If there is still air in the bag, that can delay the onset of unconsciousness and death. As Ogden says, "done correctly" the method is just about foolproof. I'd hazard a guess that most people who get a bag and a canister of helium don't know what to do, and there is a real chance they'll fuck it up. Sorry to have to be brutally specific, but these are the facts. Now perhaps you can think of a way to incorporate this information into the article as a warning? Ratel (talk) 04:25, 13 May 2016 (UTC)

• Ratel, no, I cannot think of a way to incorporate that into the article without original research or synthesizing multiple sources. That's one of several reasons why the current version isn't WP:NPOV. There are virtually no actual experts in the field who share the same view and had their work on the topic published in a solidly reliable, independent source that we could cite in lieu of Nitschke and Ogden's weak sources. There aren't even enough other people giving it the consideration to publish statements contesting their claims, making it next to impossible to appropriately contextualize. WP:FRIND says, "Points that are not discussed in independent sources should not be given any space in articles. Independent sources are also necessary to determine the relationship of a fringe theory to mainstream scholarly discourse." The current wording, despite attribution, still sounds like there's general consensus in the medical field that these 2 methods are quick and painless and all you need is a plastic bag and inert gas. Even if we take for granted that their statements are true (which in my opinion is dubious given the sources in my previous comment), even then their statements would only be true if the method is used properly, which the article technically says, but doesn't adequately emphasize, and likely can't without SYNTH due to the dearth of coverage on the topic outside of a small, radical group. PermStrump(talk) 05:43, 13 May 2016 (UTC)

@Ratel: I also think you should strikeout/delete the extraneous details from your last comment unless you're deliberately trying to scare other editors away from contributing to this discussion/article. I didn't need to understand the any of the details you gave about how to use the method properly in order to comprehend that there are more likely to be adverse reactions when you do it wrong. PermStrump(talk) 05:52, 13 May 2016 (UTC)

Permstrump:

1. I maintain that Ogden and Nitschke are not "weak sources". I think you need to RfC that.
2. I don't see the current page as not NPOV. It has a nice balance when I read it. I don't get a sense of slant at all.
3. FRINGE does not apply. Nitschke is discussed in thousands of sources, and his views on suicide with nitrogen published widely. One of numerous examples [9]:

   Nitrogen can provide people quite a quick, peaceful, totally legal and totally undetectable death.

   If he were clearly wrong, we'd have seen heavy pushback to the numerous such statements he has made in press worldwide; we'd have most definitely heard about it by now. And Ogden? Well, he is in Scientific American! Fringe 😂 ?
4. I could insert something about proper procedure being imperative, and cite it to Nitschke's book. Unfortunately it is behind a paywall.
5. No, no dearth of coverage of this topic, thousands of news articles, but no mainstream coverage of the warnings.
6. Me trying to scare off other editors? Sorry, I don't understand your meaning. Ratel (talk) 07:36, 13 May 2016 (UTC)

At this moment, I'm only saying Ogden and Nitschke are weak sources for the statements about how quick and painless nitrogen/helium+suicide bag are and that there aren't adverse effects. They're weak because there isn't a single independent reliable source that can be used in addition or in place of Ogden and Nitschke. The sources you just liked are blog/newspaper articles by journalists who were quoting/paraphrasing Nitschke's beliefs. The fact that Nitschke said those things doesn't need more sources. I've explained multiple times in various threads on Talk:Suicide bag how their views qualify as fringe on wikiepdia. It's a slam dunk. There's really no doubt about it. The argument of editors who disagree with me has basically boiled down to, "Nuh huh. Their views aren't fringe," but no one has been able to provide a single independent reliable source to show that other SCHOLARS agree with them. It doesn't matter how many people "in-universe" hold the same view. That's how WP:FRINGE works. "Statements about the truth of a theory must be based upon independent reliable sources... Points that are not discussed in independent sources should not be given any space in articles. Independent sources are also necessary to determine the relationship of a fringe theory to mainstream scholarly discourse." The editors claiming something isn't fringe are the ones who have to prove that support from mainstream scholars in the field exists. Until proven otherwise the WP:ONUS is on the editors who want to include the disputed content to find the better sources. It really should be removed until then. PermStrump(talk) 08:44, 13 May 2016 (UTC)

Permstrump said: Ogden and Nitschke are weak sources for the statements about how quick and painless nitrogen/helium+suicide bag are and that there aren't adverse effects. They're weak because there isn't a single independent reliable source that can be used in addition or in place of Ogden and Nitschke.

So if we ignore two of the experts who have made this their life's work, we have no sources? Perm, that's only true if you ignore the great sources I gave above showing almost immediate unconsciousness ("one or two breaths"), and the existence of studies featuring inert gas asphyxia autopsies without petechiae or inhalations (therefore without what is called in veterinary science an "unconscious death struggle" example). Do you need links to the U.S. Chemical Safety and Hazard Investigation Board document and more studies showing unremarkable autopsies? For FRINGE to come into play, Nitschke and Ogden and Humphry and Dr Bruce Dunn and etc would all have to be claiming something that flies in the face of the wording of FRINGE, namely: an idea that departs significantly from the prevailing views or mainstream views in its particular field. For example, fringe theories in science depart significantly from mainstream science and have little or no scientific support. Ratel (talk) 09:48, 13 May 2016 (UTC)

Like I already said above, the CSB source has nothing to do with suicide bags. The Auwaerter et al. source doesn't support Nitschke and Ogden's statements; it repeats them, but doesn't support them. Auwaerter: "In the last years, right-to-die activists promoted suicide methods by asphyxiation with use of gases as being relatively quick and painless." WP:FRINGE says, "Statements about the truth of a theory must be based upon independent reliable sources." Auwaerter et al. did not attest to the truth of that theory. None of the names you mentioned are independent of the topic. They're part of the small, radical group, so no, the fact that they agree with each other doesn't make it mainstream. PermStrump(talk) 10:02, 13 May 2016 (UTC)

* Permstrump, we're going round in circles

CSB source has nothing to do with suicide bags — of course not, but CSB source is about breathing a pure inert gas in an enclosed space, which completely agrees with the statements of Nitschke, Ogden et al, so let's not play semantics, it just wastes everyone's time.

Statements about the truth of a theory — it's not a theory. Plenty of people have died like this, some filmed by Dignitas, some observed directly & reported to researchers like Ogden, some scuba divers by mistake, some workers around inert gases. Where's the theory? Where's the fringe claim? If you do it properly then just a couple of breaths and you're out, 10 mins later (or longer if there is a vestige of oxygen) you're dead. If you don't do it properly you can take ~10-50 seconds to lose consciousness and up to 50 mins to die, with some twitching and movements, and possibly some signs at autopsy (inhalations, heart congestion, a few other signs I forget now, but none of which would have been felt consciously by the unconscious suiciding person, so relevance is moot). This is not controversial, nobody has contested it except the one source you have who looked at only 2 deaths by inert gas asphyxia and based his doubts on the one case with petechiae and inhaled vomitus, but this case also took a known emetic before breathing nitrogen, and in any case there is no proof that case experienced any pain, so the author's questioning of the painlessness of the method is strange. You can complain all you like about lack of numerous independent verifiable sources that echo these details, but you're never going to get a lot of researchers doing this kind of research when you see what happened to Ogden, who got himself unavoidably into a legal minefield that hobbled his career, so bleating about lack of verification from other sources gets us nowhere. And then you have the latest review study in this field that calls bag+inert gas an "easily understood and generally effective suicide method". Want to quote that? Ratel (talk) 11:30, 13 May 2016 (UTC)

Quoted above too... Changing the context could prove problematic. Administrating the gas within a prison is much different than the instances in which pilots and divers have slowly and accidentally experienced a lack of oxygen. Dr. Michael Weiden, a pulmonary expert at NYU School of Medicine, says that while nitrogen could be administered without medical professionals, using it for capital punishment could create an ironic consequence: the need for sedation… somebody who thinks that an individual who’s asphyxiating will not freak out without sedation is foolish.” Time. PermStrump(talk) 13:35, 13 May 2016 (UTC)

The Howard source doesn't support "quick and painless" or "peaceful" or "without adverse reactions." It would be much better in place of those 2 citations. The "easy to understand and effective" comment was also specifically about a plastic bag alone, not with gas, BTW. If you include all 3, it severely lacks NPOV. PermStrump(talk) 13:40, 13 May 2016 (UTC)

Mainstream?

• Ogden is WP:INDY according to Wikipedia's standards. He gets nothing from his papers except what any other academic gets from their papers. If we start declaring that experts aren't independent, then we will never be able to cite any journal article – no surgeons on surgical methods, no drug manufacturers on drugs, no pesticide researchers on pesticides, etc. Ogden actually is that "single independent reliable source" that you're looking for.
• When you have one reliable source saying X, and no reliable sources saying anything about it, then saying X (perhaps with WP:INTEXT attribution) is DUE. For example, we don't reject LD50 numbers when there is only one source for that number.
• Here's how we know that "other SCHOLARS" accept Ogden: Multiple other scholars cited his paper.
• Permstrump, you're saying in your comments here that government sources about the proven effects of occupational exposure to Nitrogen is irrelevant, but that vague speculation in a newspaper about using it for lethal execution is just fine. This sounds like cherry-picking sources based upon their POV to me, and that won't produce an acceptable article. WhatamIdoing (talk) 13:53, 13 May 2016 (UTC)
• Permstrump:

1. Capital punishment: Using nitrogen for capital punishment would be difficult to impossible without sedation because to make it work properly you need complete co-operation (see instructions above). Some condemned prisoners will co-operate, most will not.
2. Without adverse reactions : The ultimate adverse reaction is death. And since the autopsy-discovered sequelae, which are rare, occur after loss if consciousnesses, they are moot. So why are you making an issue of them? To the user, the process is still painless, otherwise we'd have seen people interrupt it (note the eyewitness accounts and films by Dignitas showing some involuntary movements but no attempt to remove bag or mask).
3. BTW did you get access to the full text of the Kleespies paper? That paper seems to be more about a "debreather" than a suicide bag. Ratel (talk) 20:24, 13 May 2016 (UTC)

• Ratel, Yes, capital punishment is different from suicide, but so are the situations CSB was referring to that involved people who were unaware of accidentally and gradually being exposed to nitrogen while in a small room. Obviously that would be different than what if feels like when you have a plastic bag over your head. My point was essentially that the policies and guidelines exist for a reason. It's so easy to draw false conclusions with honest intentions, but WP:SYNTH and WP:COATRACK prohibit us from drawing conclusions from 2 separate works and from citing sources that aren't directly relevant to the topic at hand. It makes it really straight forward: CSB isn't talking about suicide bags, so it's irrelevant to this article. That should save us from wasting time arguing about sources that are unlikely to be useful for anything other than POV pushing. Yes, I have access to the full text of Kleespies (and pretty much any academic journal) through the library at work. I'll respond to your comment on Talk:Suicide bag after this and C&P some quotes from Kleespies.

WhatamIdoing: "Mr. Ogden is director of the Farewell Foundation, which advocates for assisted suicide." Source. PermStrump(talk) 00:30, 14 May 2016 (UTC)

So? Being employed in your field of expertise is not a conflict of interest for that scientific field. If it were, then we'd have to stop citing prominent world experts in nearly every subject. No more citing Peter Piot on infectious diseases, for example, because he's running a non-profit organization that relates to to his scientific expertise. WhatamIdoing (talk) 04:11, 14 May 2016 (UTC)

I don't know if Peter Piot is, but I assume you mentioned him because he's well accepted an expert in his field by other exerts in his field, which is not true of Ogden. He's one of few adherents to a view well outside of the mainstream in his field (aka WP:FRINGE) that he has some financial and much personal investment in. I didn't say he can't be cited in that article or any other article, but when it comes to this topic, it needs to be properly contextualized and his statements can't be given false weight. PermStrump(talk) 15:22, 14 May 2016 (UTC)

You keep saying that, but the reliable sources keep saying things like "internationally known assisted-suicide expert"[10], "a world-leading researcher"[11], "a respected social scientist doing research on illegal behavior"[12], "one of the world’s foremost experts on assisted suicide"[13] who "altered fundamentally the way the situation is looked at"[14]. So unless we're redefining this to mean "the mainstream of the field, counting only people who agree with the One True POV™", then I think we're going to have to give up on calling him FRINGEy or "outside the mainstream". He is definitely too accepting of suicide to please the pro-life people, and he is reportedly too restrictive to please the right-to-die people, but I checked about a dozens news sources, and I didn't find a single one that said he was anything other than a prominent researcher doing fairly good work in the legally fraught field of (sometimes) watching people commit crimes (i.e., watching people assist in a suicide attempt, when their assistance is illegal in that jurisdiction).

My mind is open on the point, but if you want me to change my mind, then you need to come up with some reliable sources (=not merely a repetition of this unverifiable assertion) that say he's not an expert. You might start with Canadian political sources; since he and his research has influenced every piece of Canadian legislation about assisted suicide for years, you might be able to find a political hatchet job in any magazine that opposed the legislation. If it's not there, it's probably not going to be in any standard news source. WhatamIdoing (talk) 04:19, 15 May 2016 (UTC)

I'm not sure what the question is anymore. He's "in-universe" as evidenced by the fact that he founded Farewell Foundation. No other scholars call him an expert. The only people who call him an expert are a few journalists, and even then they're calling him an expert in "assisted suicide", which isn't even a field of anything. (notability vs acceptance). There's also his legal conflict of interest:

Vancouver-based Ogden has been researching assisted death as a criminologist since 1991 and began pushing for legal reform with the birth of his Farewell Foundation last year. Behind the political advocacy, he’s also quietly performed the far more ethically thorny work of supporting those who can’t wait for the legal and political debate to play out.... Ogden’s work as a death facilitator has led to police questioning on seven occasions, he says. He was subpoenaed three times to court (in 1994, 2003 and 2004)." (source)

—PermStrump(talk) 09:39, 15 May 2016 (UTC)

This is a a silly, fatuous, vexatious charge. Russel Ogden IS an expert in the field of assisted suicide and voluntary euthanasia, as his long list of Pubmed indexed studies into this field show objectively. Not only is he called an expert in the field of assisted suicide by numerous major news sources, but his list of published studies into the topic, more than any other researcher AFAIK, speaks volumes. Let's stop this pointless discussion now please. Ratel (talk) 11:16, 15 May 2016 (UTC)

It doesn't matter if the "pro-life" people say that he's "in-universe" with the "pro-suicide" people. Ben Goldacre is "in-universe" with the evidence-based medicine people, and we don't say that he's FRINGEy or not an expert. Having a firm opinion on a socially controversial subject doesn't change anyone's status as an expert on assisted suicide.

Also, there are healthcare professionals right here on Wikipedia who have "been subpoenaed". That's what happens to the victims and witnesses of a crime, not to the alleged criminals. "Pushing for legal reform" (according to one source, his goals are to reduce the number of painfully botched suicides and suicide attempts that turn into murder, and to make it clear in Canadian law that merely sitting in the same room as a suicide attempt, especially in the capacity of a journalist or scholar, without physically trying to stop it, is not itself a crime) is not a "legal conflict of interest". Conflicts of interest are spelled out pretty clearly in law, and they involve tangible benefits (money, goods, or services).

All you've proven is that he's WP:BIASED. It would hardly be surprising if a scholar in the social sciences hadn't formed a strong opinion about his subject area. WhatamIdoing (talk) 16:33, 15 May 2016 (UTC)

"Assisted suicide" isn't a field of study so one can't be an expert in it. WP:INDEPENDENT says, "A third-party source is not affiliated with the event, not paid by the people who are involved, and not otherwise likely to have a conflict of interest or significant bias related to the material." See also WP:Third-party sources#Conflicts of interest. Clearly not independent on multiple fronts. —PermStrump(talk) 05:30, 17 May 2016 (UTC)

yes that's true--Ozzie10aaaa (talk) 10:23, 27 May 2016 (UTC)

References

Can freely licensed videos from institutions include copyrighted logos in end credits?

see the five seconds of logo animation at the end of the 4-minute video

• File:American Chemical Society - What Chemists Do - Nathan Allen.ogg

The American Chemical Society has applied a free license to a video. I expect that in the future more organizations will consider sharing videos. It is fairly common for videos to include credits somewhere. It is also common for online video for the credit to be in the form of a logo, and perhaps a copyrighted logo.

As the Wikipedia community negotiates these kinds of institutional partnerships and gets video donations, are credits acceptable in videos? What about the inclusion of copyrighted logos? I started a discussion on Commons. Anyone may comment either here or there.

• Commons:Commons:Village_pump/Copyright#Advice_on_noting_non-free_logo_animations_in_freely_licensed_videos

I am presenting this to WikiProject Medicine because this particular video talks about a partnership between science organizations and another website called Reddit. A collaborator and I (Peter.C) have noted this science outreach project here several times in the past -

• archive 56
• archive 63
• archive 68

I continue to be impressed by that reddit project's ability to recruit leading health thinkers to have discussions with the general public.

• Francis Collins, director of NIH, in discussion on April 25, 2016

In general, I wish Wikipedia could be more clear on the boundaries for how organizations can share content on Wikipedia. Sorting out allowance for credits is a basic issue on which we ought to be clear. Blue Rasberry (talk) 16:58, 11 May 2016 (UTC)

there is certainly a lot to gain, however its important not to allow too much time for "logos"...IMO--Ozzie10aaaa (talk) 10:53, 12 May 2016 (UTC)

If they are released under an open license, they can be re edited to remove parts of the logo if the logo is too long. Hopefully most will be reasonable if it is simply discussed. Doc James (talk · contribs · email) 20:19, 13 May 2016 (UTC)

yes that would work--Ozzie10aaaa (talk) 10:31, 23 May 2016 (UTC)

Brand names at Metoclopramide article

Input would be helpful at Talk:Metoclopramide#Brand_names. Thanks. Jytdog (talk) 20:46, 15 May 2016 (UTC)

give opinion(gave mine)--Ozzie10aaaa (talk) 22:03, 15 May 2016 (UTC)

I have questions about brand names being deleted from any/ and ALL prescription drug articles, not just this one. Thank-you for any help making this clear. I'm having trouble understanding why brand names should be deleted from these highly-regulated products, or if there is a reason why they should be. TeeVeeed (talk) 22:57, 15 May 2016 (UTC)

Might be good to have a rfc around this issue. My position is that one or two brandnames should be in the lead. Maybe three in the infobox and others can go in the society and culture section if people so choose to put them there and reference it. Doc James (talk · contribs · email) 23:04, 15 May 2016 (UTC)

I don't see any need for an RFC. MEDMOS and PHARMOS both say that brand names ought to be included in the article, ideally as a ===Brand names=== subsection under ==Society and culture== when there are more than a couple. Also, they say that the original brand name ought to be in bold-face type in the lead, along with the name of the original manufacturer. We just need more people to be aware of the existing advice (and also to be aware that the advice isn't an absolute requirement. There are some good reasons to vary the standard approach on occasion [e.g., when different forms have different trade names, then you might as well give the brand names with the forms, for concision; also, there's no need for a whole section on brand names if there's only a couple of brand names], and some GA articles on drugs are sensibly adjusting the suggested sections to better fit each case). WhatamIdoing (talk) 05:06, 16 May 2016 (UTC)

No the two MOS are not in sync. WP:PHARM says list them all but MEDMOS advises away where it explicitly says' "Try to avoid cloning drug formularies such as the BNF and online resources like RxList and Drugs.com.". There is no encyclopedic value to a CATALOG of drug names that you can find at dozens of sites. I generally list the originator name and then "there are many brands available worldwide" and cite the laundry list at drugs.com. I often do that in the context of writing a history section that talks about who discovered it when and where, and the series of relationships that were struck to bring the drug to market, and when it went generic. I most recently did that a couple of days ago when i completely revised the Trospium chloride article; the history took a few hours to work out and I am still not clear on the relationship between the 2 German companies. There was also some interesting litigation around trademarks on names that I added content on here: Trospium_chloride#Society_and_culture. There is no encyclopedic value to a LAUNDRYLIST of names. I am baffled that people are claiming there is and no one has articulated any encyclopedic value, nor why we should contravene the policy, WP:NOTCATALOG. Jytdog (talk) 06:25, 16 May 2016 (UTC)

That's not what we actually meant when we said to avoid cloning drug formularies.  :-/ A drug formulary tells you chemical and clinical information about the drug, e.g., side effects and contraindications. It does not (traditionally) tell you business information, such as the variety of trademarks or manufacturers (although online ones probably do, to help with search engine optimization).

IMO the main value in that "laundry list" of names is helping people figure out if they're at the right page. Every one of those names should have a redirect that points to the article, and it is standard practice to mention terms that redirect to a page (except for trivial variations). WhatamIdoing (talk) 13:22, 16 May 2016 (UTC)

The two sources cited in the MEDMOS, RxList and drugs.com both list all the tradenames, so I have no idea what you are talking about. People can figure out if they are at the right article but clicking on the link to a reference that has the laundry list. Now you seem to be saying that we should be in the business of SEO, and that Wikipedia editors should waste their time copying lists of drug brand names into Wikipedia and then maintaining those laundrylists when people spam unsourced trademark-sounding names into the list, which happens all the time. You are not dealing with that. You are just armchair quarterbacking and I have no idea what is at stake for you in this discussion. Jytdog (talk) 15:17, 16 May 2016 (UTC)

What's at stake? How about a decent encyclopedia article that contains information beyond the medical POV? Maybe we could even getting some shared agreement of what PHARMOS and MEDMOS mean, when they (both of them) say that there should normally be a subsection called ===Brand names===, so that we can stop having disputes between editors who read the advice and added this business-related information, and editors who blank their efforts as spam.

Back on the original point: a drug formulary is a list of ingredients and other information about how to make a drug. See these two examples from a traditional drug formulary. The lists ingredients, dosing, and sometimes side effects. It does not list any brand names. Now, it's possible that modern online drug formularies list brand names for SEO purposes (NB, I didn't say that Wikipedia should do SEO efforts; instead, I said that Drugs.com might be doing that). However, traditional drug formularies didn't include that information. MEDMOS gives a specific example on the subject of how not to be like a drug formulary, and that example is about creating laundry lists of side effects (=a component of traditional drug formularies). MEDMOS doesn't say anything agains listing business information, nor about removing brand names (which ought to redirect to that article). WhatamIdoing (talk) 15:23, 19 May 2016 (UTC)

Price of medications

I have been including pricing information in medication articles. We have a good source here that gives the price range found internationally and in a number of countries in the developing world. Often the variation between prices is less than 5 fold. I have also been providing the US price as presented in this book but there are other good options. The US is not only a large portion of the EN speaking population but a large percentage of our readership. Also most other countries are somewhere between the global price and the US price. Doc James (talk · contribs · email) 22:44, 15 May 2016 (UTC)

Previous discussions:

• [15]
• [16]
• [17]

Support including pricing details

• Support as proposer. Doc James (talk · contribs · email) 22:44, 15 May 2016 (UTC)
• Support Shelley V. Adams ‹blame
  credit› 03:30, 16 May 2016 (UTC)
• Support It is encyclopedic information, with decent sources available. With that said, ideally we could handle this with WikiData or something and pull it in, which would allow for things like automatic charting II | (t - c) 04:03, 16 May 2016 (UTC)
• Support inclusion of the wholesale prices when decent sources are available. Drugs are manufactured products produced by large corporations; the price that a product sells for on the market is relevant commercially, even when/if it is unimportant medically. WhatamIdoing (talk) 04:09, 16 May 2016 (UTC)
• Support. It would be good to be able to easily compare the average wholesale price of a drug in one market with the average in another/others. In one of the discussions he linked to above, James suggested a drop-down list of price x country in the infobox or sidebar, updated at Wikidata.

Knowing how slow Wikipedia and Wikidata can sometimes be in updating information, it might be prudent to always associate a price with its date: "The average 2015 wholesale price in the U.S. was x per standard dose. The average 2015 wholesale price in Australia was y per standard dose." --Anthonyhcole (talk · contribs · email) 04:14, 16 May 2016 (UTC)

• support when reliable sources are available--Ozzie10aaaa (talk) 10:14, 16 May 2016 (UTC)
• support only per my comment in the middle previous discussion, and not in infoboxes: "If, as with some cancer drugs, the cost is exceptionally high, placing them out of reach of many patients even in the West, and that has been the subject of RS (it need not always be MEDRS-compliant) coverage, then certainly that should be added, in a section in the text. In England these matters are done in public in the National Institute for Health and Care Excellence approval process, generating lots of RS coverage in some cases. Equally that aspirin is dirt cheap can easily be referenced. But I think we should avoid saying much about the mass of mid-price drugs, for the reasons set out above, plus the need (which we may not be able to cope with) to update when they come off-patent etc. We should just cover the extremes. Johnbod (talk) 15:51, 15 June 2015 (UTC)" Johnbod (talk) 14:51, 16 May 2016 (UTC)
• Support. I wish to respond to Kashmiri's opposition arguments below, because they are all excellent reasons which must be directly addressed.
  • Kashmiri refers to this English Wikipedia policy which historically says, "no prices". Wikipedia:What_Wikipedia_is_not#Wikipedia_is_not_a_directory. There is more discussion on this topic at WP:PRICES. I do not think the prohibition in the policy is on prices specifically, but instead, the prohibition is on primary data and information which is not backed by reliable sources. Prices often are those things, but not always. Sometimes reliable sources make price information available for consumer reference, and in that case, Wikipedia might include the information.
  • I agree that if price data is included then there has to be continual mindfulness about global markets. It is not acceptable to present only United States prices. I do not think Wikipedia has to be global, but there should be diversity in presenting data. If prices were presented, they could either be "international" somehow, or they could present more than one marketplace.
  • I disagree that price data is irrelevant in OECD countries. I work for a consumer organization, Consumer Reports, which does activism and lobbying that more medical pricing data be made more public. Consumer REports advocates for greater public awareness of how drugs are purchased, and what happens to the many people who for whatever reason seek to buy drugs on the open market without the support of other funding programs.
  • I am able to provide an organizational opinion that providing drug pricing information is not medical advice. Consumer Reports has published drug price information for decades and has done so in a way is not medical advice, and that establishes a precedent. Example publications presenting price information include the yearly Best Drugs for Less report, educational materials directing consumers to consider price, and consumer guides for ~50 classes of drugs (statins, for example) which compare "effectiveness, safety, and price". It often happens that there can be multiple drugs available to treat a medical condition and price is a major guiding factor in choosing which one is appropriate for the patient. It is politically difficult to acknowledge that people get different medical care depending on the money they have, but it is the reality, and having access to information on drug prices makes it easier for consumers have discussions with their health care providers about what sort of treatment matches their health care needs and the money they have.
  • I might agree that there is not consensus to add prices, but at the same time, I disagree that there is consensus to exclude them. I think it would be best to say that lots of people have varying opinions on the matter, and it is difficult to come to agreement on what is best. I do think there is consensus that without good sources to cite, Wikipedia definitely should not attempt to include price information.

Here are things that I would want to see if prices remained in Wikipedia articles:

1. Excellent sourcing. Right now International Drug Price Indicator Guide and the Tarascon Pharmacopoeia 2015 Professional Desk Reference Edition are proposed as sources. It might be worthwhile to critique these or any sources to confirm or deny that they are respected, reliable, and presenting the sort of information which meets Wikipedia goals to be international and meet general reader needs.
2. Discussion about what kinds of prices are acceptable, and what are not acceptable. For example, there might be consensus that Wikipedia only present prices at the consumer level, and exclude prices at the industry or wholesale level. Whatever the case, perhaps it would be helpful to discuss restrictions and limits in advance. Johnbod makes a sensible suggestion that only the best established prices be mentioned. In the case of drugs, it is easier to describe the cheapest off-patent drugs and the latest, most expensive and highly controlled drugs. Discussing the mid-level markets where the variation is greatest is most difficult. I am not sure what is possible.
3. There should be discussion about international relevance. I have a lot of sympathy for India, which Kashmiri mentioned. In India practically everyone buys out of pocket from local pharmacies. India is a major drug market and would be a great contrast to pricing information from OECD countries. Even if there is no ready solution to providing drug information relevant to Wikipedia readers in India, I think it would be helpful to state that it is a problem if Wikipedia were presenting price information for some places but was not providing a solution for price information in India. China would be another good market to address, but I think it would be easier to eventually get data relevant to India since India's drug market responds to international drug import and export markets more than China's more state controlled market.

Blue Rasberry (talk) 15:23, 16 May 2016 (UTC)

• Support — as long as we use international price points and not only US. Also preferable to solve this using Wikidata and including the information in the infobox. Carl Fredik 💌 📧 18:13, 16 May 2016 (UTC)

Thanks CFCF have been looking at importing prices by bot into Wikidata. Doc James (talk · contribs · email) 18:19, 16 May 2016 (UTC)

• Support — If someone wants to go through the effort of putting prices in, and other editors update them from time to time and it's clear to the reader what the source of the data is, then I would see it as a valuable contribution. EvMsmile (talk) 06:09, 18 May 2016 (UTC)
• Cautious support. We're not a price comparison website (CHEAP VIAGRA HERE) but medication pricing is a public health issue and would be encyclopedic. JFW | T@lk 09:48, 19 May 2016 (UTC)

Oppose including pricing details

• Strongly oppose on various grounds, including WP policies:
  • WP:PRICE states clearly that Wikipedia is not a sales catalogue and item's current pricing is NOT encyclopaedic information.
  • Wikipedia articles are (mostly) about specific compounds used in pharmacology; WP even requires use of INN names. Whereas pricing can only be given for commercial products.
  • Per WP:GLOBAL, Wikipedia is a GLOBAL ENCYCLOPAEDIA and the majority of English Wikipedia readers are based outside of the US.[18]
  • US drug prices are among the highest in the world [19] [20]. Consequently, quoting US prices will be very misleading.
  • The majority of OECD countries offer public health insurance coverage to their populations, with many (or sometimes all) drugs paid for by the state. Prices found in US pharmacies are utterly irrelevant for those populations.
  • We run a real risk that if we advertise lower prices, patients might be discouraged from buying the medicines they need, instead hoping to find them somewhere cheaper; and thus harming their health. That's the reason Wikipedia is very clear that IT SHOULD NOT OFFER ADVICE.
  • From the links listed by OP, there seems to be a consensus on not adding retail pricing on Wikipedia at all.

— kashmiri ^TALK 09:25, 16 May 2016 (UTC)

You missed the qualifiers at WP:NOTDIRECTORY which is "unless there is an independent source and a justified reason for the mention"

It is not a medical product unless you can actually buy it.

43% of our readers are in the USA [21]

As mentioned we are providing a range of prices which applies to dozens if not more than a hundred countries. There is also a global market in medications.

US prices are among the highest in the world and therefore giving US prices typically provides an upper limit.

That the majority of OECD countries pays for medications for outpts will need a reference. It is not the case in Canada.

Doc James (talk · contribs · email) 15:30, 16 May 2016 (UTC)

• I don't really know what section to comment in. Is the question whether prices can sometimes be included, or that we should include prices routinely? I don't think anyone will argue that pricing information is never appropriate – but if the proposal is to include prices routinely, then the proposal appears to violate WP:NOT. From NOTDIRECTORY, the use of pricing information requires a "justified reason," and specifically excludes "passing mention." The prices here appear to be passing mentions; the source is a database page with no commentary or context. I don’t have access to the Tarascon Pharmacopoeia, but I infer from the description that it's similar.

The standard here is that inclusion should require a source that includes the price as part of a discussion; simply listing it should not be sufficient. This is also in accordance with the comments of several other editors, including a couple in the discussion section that I think are otherwise most easily categorized as Opposes. If e.g. a drug's price has been criticized in the media, that's important information and it should be sourced appropriately. But finding the price in a database, or in any other context where it is presented without commentary, does nothing to establish its relevance to the article.

I also agree with the editors who oppose listing of prices in infoboxes; I see not listing prices in such a manner as one of the key qualitative differences that distinguish us from catalogues and other commercial websites. But inclusion in Wikidata is a different matter, and could be worth considering assuming that their policies allow it. Sunrise (talk) 19:53, 16 May 2016 (UTC)

The proposal is for whether prices can sometimes be included. Yes some are arguing that they should never be included it appears. Doc James (talk · contribs · email) 20:15, 16 May 2016 (UTC)

To clarify that part of my comment, I don't think editors will argue that sources like this should be excluded - in this case, we have an article in the New York Times where the drug's price is the main subject, and I'll support the use of that source in articles. But the sources being proposed above don't seem to be sufficient to meet the requirements at WP:NOT. (Also, allowing databases or other price reference guides would be essentially the same thing as allowing routine inclusion, assuming the guides are comprehensive). Sunrise (talk) 06:09, 18 May 2016 (UTC)

The main source I have been using just deals with WHO essential medicines. Doc James (talk · contribs · email) 18:26, 19 May 2016 (UTC)

• Oppose. Nothing good can come out of this - what seriously is it supposed to achieve? We know for a fact that the British NHS pays within a five-fold (what does that mean? 5 orders of magnitude? Five times?) difference of the wholesale price in India? I think, knowing how international products are traded, that's highly unlikely. And a conversion from USD to the local currency is going to mean almost nothing, as the wholesale price in any given market is going to vary enormously based on many different factors, so suggesting that it is "available" for this price means almost nothing outside of the USA. And the fact that 43% of readers are in the USA (which I doubt anyway) means that 57% are not. Why should the rest of us be fed information which is only relevant to a minority of readers in the USA? If you want USA-centric information, why don't you start your own digital encyclopedia. JMWt (talk) 17:03, 17 May 2016 (UTC)

5 fold means five times. What is being provided is both the US price and the global wholesale price. Doc James (talk · contribs · email) 21:02, 17 May 2016 (UTC)

And what do you think that's telling someone who isn't in the USA? You are presumably aware that a "global wholesale price" doesn't exist, right? JMWt (talk) 21:14, 17 May 2016 (UTC)

Did you look at http://erc.msh.org/dmpguide/ Doc James (talk · contribs · email) 22:31, 17 May 2016 (UTC)

Brilliant, although on quick search, "buyer prices" are only available for South Africa, Sudan and one or two developing countries. Still, hope you don't intend to duplicate this database on Wikipedia? — kashmiri ^TALK 22:39, 17 May 2016 (UTC)

@Doc James: I don't think I can access that page, but there is pretty good evidence that global prices vary much more than the quotes you've given, which appear to compare spot prices in a small number of locations. It is fairly easy to find wide disparities in price for specific medications in the literature, for example this recent article from the Lancet [22] "The price per bottle of all originator DAAs varied substantially: for sofosbuvir it ranged from $300 (India, Pakistan) to $20 590 (Switzerland); for daclatasvir from $175 (Egypt) to $14 899 (Germany); for simeprevir from $241 (Egypt) to $14 865 (Australia); for ledipasvir-sofosbuvir from $400 (Egypt and Mongolia) to $24 890 (Germany); and for ombitasvir-paritaprevir-ritonavir (or 2D regimen) from $400 (Egypt) to $20 215 (Switzerland)." I accept that's not talking about wholesale prices, but I'm not sure why we should have confidence that the reference you're using is fully comparing the full range of prices worldwide. JMWt (talk) 09:14, 18 May 2016 (UTC)

It is the range of prices in the developing world rather than the developed world. Doc James (talk · contribs · email) 17:16, 18 May 2016 (UTC)

@Doc James: In this section, editors are invited to present their arguments. Room for discussion is below, in the following section. It will be helpful if you, the proposer of this RFC, patiently wait for the outcome, refraining from picking an argument instantly with those who dare to oppose. Try not to discourage people from commenting please with such a behaviour! Thanks, — kashmiri ^TALK 18:19, 18 May 2016 (UTC)

User:kashmiri you have made your position clear. User:JMWt asked a specific question and I responded. Doc James (talk · contribs · email) 18:57, 18 May 2016 (UTC)

Strong, strong oppose per Kashmiri who makes a number of very good points including about our global nature, national insurance schemes, not listing prices, and misleading readers. A global wholesale price doesn't reflect at all the large amount of other English-speaking countries who may subsidize or nationally or regionally negotiate or mandate prices. Some of these other large countries include the UK and India and as per JMWt 57% of our readers. As a non-US reader I am completely opposed to a misleading and potentially harmful effort that doesn't reflect the reality of sale prices for 57% of our readers, nor take into account insurance rebates etc. I don't think this issue can be dealt with in the same nuance that we'd expect of a WP article, and such a nuance certainly not in an infobox.--Tom (LT) (talk) 02:27, 18 May 2016 (UTC)

Strong oppose - see my comment in the discussion below for my rationale, and Kashmiri's excellent comment. This does not belong in Wikipedia. Garzfoth (talk) 03:29, 18 May 2016 (UTC)

• Strongly Oppose. Per NOT. While there are many cases where prices can and should be included as part of encyclopedic content, it has to be on a case-by-case basis. Unless I'm overlooking something, I'm not seeing arguments that clearly show NOT should be overruled for all medications. --Ronz (talk) 17:52, 20 May 2016 (UTC)
• Weak Oppose with basically the same caveats as Johnbods support above. Per WP:NOT we shouldn't attempt to become a pricing list but where price has been a factor in the coverage then prices should be included. I don't think it should be in the infobox as it will always need more clarification than an infobox can provide as to where and when the price is from. SPACKlick (talk) 16:03, 24 May 2016 (UTC)
• Oppose I am not terribly excited about this, but I generally agree with the foregoing opposes, and in any case I am generally reluctant to support any form of tabular data that requires regular updating. It is an invitation to error, confusion and embarrassment, as well as being doubtfully encyclopaedic. I an unconvinced anyway, that any such table could give comprehensive and intelligible information on the subject, but am not inclined to study how deeply I am in error on this point. If instead there were to be a link to an off-WP site that could supply the service, I reckon I could hold still for that. JonRichfield (talk) 14:56, 25 May 2016 (UTC)
• (Summoned by bot) Oppose, basically per User:Sunrise above, with no opposition to inclusion on a case to case basis (when price of a single drug or a group of few drugs has been discussed by an RS); strong oppose to listing retail prices in a particular country.

The most deciding argument in my mind is "which price"? Just as for pretty much any product, "the" price does not exist as there are various retail/wholesale prices (this has been said multiple times already), but unlike any products, few if any drugs have a large international market with listed prices for similar products. On a particular day, bananas or oil have an "international" value on the market (despite minor differences among the products); drugs except maybe aspirin or other big-quantity-sellers do not have that.

I think however that the updating issues is not a problem, if we decide we want to include prices we can just use prose with WP:ASOF. Tigraan^{Click here to contact me} 11:45, 27 May 2016 (UTC)

Discussion

• Cost benefit analyses are done in many areas of the world and these rely on the cost of medications.
• Cost is also taken into account by the World Health Organization when they put together their essential medicines list.
• In many areas of the world medications are purchased in the international market. Medicine San Frontier for example puts together a price list to help with their work. Thus the international price applies to around 100 countries. Doc James (talk · contribs · email) 22:48, 15 May 2016 (UTC)

I personally don't feel like we should include price information in an encyclopedia. Here's why:

• The price varies depending on country
  • In Canada, the end-user price varies depending on province/insurance. Wholesale prices are controlled to some extent by the government.
  • In the UK, the end-user price is a flat fee set by the NHS. Prices are controlled to some extent by the government.
  • In the US, the end-user price varies depending on insurance status (have insurance vs. paying cash) and insurance benefits (lots of different ways to handle drug coverage - percentage-based, flat copays, deductables, etc). Additionally:
    • It varies based on what pharmacy you go to (store X (e.g. CVS) vs. store Y (e.g. Walgreens), retail vs. discounted retail (e.g. Walmart) vs. mail-order)
    • It varies if you use discounts, which can be third party ("drug savings card"?), manufacturer coupons (usually time-limited), manufacturer-paid (low income programs), etc
    • It varies based on the pharmacy benefits manager used and the drug formulary.
    • It varies based on insurance plan

Another major point is that when a generic for a brand-name drug comes out, prices can change drastically overnight. Medication prices are always changing, and there's no way that we can keep up with prices, which will be completely inaccurate for anyone seeking pricing information anyways as we're generally listing wholesale prices, which do not factor in several additional layers of profit margins, and are utterly useless to the average person. Here's a personal example for a hypothetical drug (although this is actually based on a real medication I'm on). I pay a fixed copay for this drug of $A. The pharmacy claims the drug cost $B on the info accompanying the drug (and that my insurer saved me $(B - A)). My insurer's report says they paid the pharmacy $C for the drug. $B is much greater than $(A + C). The cash price that pharmacy would charge for the same drug is $D according to GoodRX, which is close to the pharmacy's official cash price of $B. If you use GoodRX's discount program, you would pay $E. Confusing, right? Garzfoth (talk) 23:55, 15 May 2016 (UTC)

• I don't much like the idea of simply including the price indiscriminately or as a matter of routine. And considering what Garzfoth said just above, it may be better to use wholesale than retail pricing, or to indicate a range of prices. But I think the decision about whether to include pricing at all depends upon context. As Doc James said, it becomes relevant in the context of cost-benefit analysis, etc. So if, for a particular drug, there is content about something significant concerning cost-benefit or other analyses or classifications, then specific pricing information can and probably should be stated explicitly in that content. On the other hand, simply saying routinely for each drug that its typical price is such-and-such strikes me as unencyclopedic, and I would not want to see prices in infoboxes. --Tryptofish (talk) 00:22, 16 May 2016 (UTC)
  • User:Tryptofish We are using the whole sale price and we are providing a range of prices. We are not writing for "patients". Someone pays. Many people care about the price and price often determined what meds are covered.
  • This is not typically true "Medication prices are always changing" Medication prices are typically more or less stable for years. For example:
    • Price for salbutamol in a bunch of countries in 2014 between 0.0056 and 0.0132 per dose[23]
    • 2006 0.0043 to 0.0145 per dose[24]
    • 1996 0.0055 to 0.0095 per dose[25]
  • 20 years and the lowest price per dose changed by only one hundredth of a cent
  • Yes when meds become generic the price decreases. It is notable not only when the med becomes generic but the new lower cost if any.
  • By the way we are talking about meds on the WHO essential medication list. All these meds have had cost benefit analysis done.
  • Doc James (talk · contribs · email) 02:36, 16 May 2016 (UTC)

Is that adjusted for inflation? Seppi333 (Insert 2¢) 05:26, 16 May 2016 (UTC)

Do not think so. So a slight decrease in price over the years than. Doc James (talk · contribs · email) 05:29, 16 May 2016 (UTC)

US cell-phone pricing—which depends on carrier, contract-length, special promotions, etc.—is almost as confusing as US drug pricing, but the iPhone article is full of prices. Complicated pricing schemes (and the resulting obfuscation) are all the more reason to include an approximate "market price" that might be difficult for the average reader to locate independently. —Shelley V. Adams ‹blame
credit› 03:30, 16 May 2016 (UTC)

Yep, they seem to be violating WP:PRICE in the iPhone article. But that article has been cared for by Apple fans, and here we are dealing with serious stuff, not tech gadgets :) — kashmiri ^TALK 09:29, 16 May 2016 (UTC)

The lone opponent has some interesting ideas, but I don't think that they hold up under scrutiny:

• "WP:PRICE states clearly that...current pricing is NOT encyclopaedic information."
  1. PRICE says that encyclopedic relevance can be established if the prices are discussed in good sources, and discussion of price is typical for generic drugs and universal for drugs still under (or recently released from) patent protection.
  2. Who said that it would only include "current pricing"? It'd be far more interesting to include information about how the price changed over time (e.g., once a decade for as far back as our sources go).
• "pricing can only be given for commercial products."
  • If it gets sold, then it's a commercial product, so this seems like a tautology. Perhaps you mean that prices can only be given for particular combinations of brand name/manufacturer/location/time? That wouldn't be factually true; we have good sources that give wholesale prices from around the world, based upon the compound itself.
• "quoting US prices will be very misleading....Prices found in US pharmacies are utterly irrelevant for those populations."
  • Who said that we'd be quoting only US prices? Who said that we'd be giving prices for any pharmacy? The goal is the wholesale price, not retail.
• "We run a real risk that if we advertise lower prices, patients might be discouraged from buying the medicines they need"
  • Wikipedia is WP:NOTCENSORED, even to protect people from their own ignorance about the difference between global wholesale prices and local retail prices. WhatamIdoing (talk) 13:34, 16 May 2016 (UTC)
• It strikes me that WP is the wrong place for such data to reside, though (depending on discussion results) it might be a good place for readers to find it. Price data is still data, and there's no real reason to bind it to an English language text format. It would be much more at home on Wikidata in a language-neutral form. Then insertions, revisions, national prices, currencies, and references inserted there once will be reflected on all using wikis simultaneously. We should avoid creating a local crapheap on w:en that just has to be cleaned up after the fact. LeadSongDog come howl! 16:12, 16 May 2016 (UTC)

Yes Wikidata has now been set up from what I understand to handle this data. I am not much of a Wikidata editor though.

I have just shown that the price of salbutamol internationally has not changed in 20 years User:LeadSongDog so not sure what "cleanup" you are referring to? Yes medications become generic once in their existence. We have a number of currencies that are used internationally with the USD and Euro being two of them. Many countries in the developing world either us USD or prefer it to their national currency.

Doc James (talk · contribs · email) 16:56, 16 May 2016 (UTC)

@Doc James:Every wp article that gets price info added into it would then need it removed once there's a way to use d: instead. It would seem simpler and better to just get the location right the first time. LeadSongDog come howl! 19:27, 16 May 2016 (UTC)

Hum okay thanks. Are we using d: for anything outside of the infobox at this point? I could look into doing that. Doc James (talk · contribs · email) 20:18, 16 May 2016 (UTC)

Doc James: For sure you mean Zimbabwe? [26] Neither China, nor India, nor Brazil, nor Russia (which combined account for more than 50% of world's population) do not "prefer USD" in drug pricing to the best of my knowledge. But ok, let's agree on USD or EUR, that still does not address the key questions raised above. And BTW even if price of salbutamol, a patent-free small molecule, has not changed in 20 years (I can't locate your proof, though), the most problematic and expensive drugs are those still covered by patents and/or in the marketing exclusivity period, and their prices can vary several orders of magnitude between countries. — kashmiri ^TALK 17:58, 16 May 2016 (UTC)

If you look at were I provide prices for salbutamol by year you will notice a link to the reference beside each.

With respect to countries that like USD I am thinking of Cuba, much of Central America, and much of Africa. In Tanzania they request payment of not only bribes but entry fees and hotel rooms in USD. Iran also requires payment of hotel fees and tour fees in either USD or Euro.

You mention "vary several orders of magnitude between countries". Several orders of magnitude fold is very small. If they varied by 10 or 100 fold that would be a stronger argument.

We already give a price range of salbutamol of 1.12 to 50 USD. Doc James (talk · contribs · email) 18:15, 16 May 2016 (UTC)

It's probably worth pointing out here that one order of magnitude is 10 fold; two orders of magnitude equals 100 fold. In any event, I'm not entirely convinced that it is a good idea to quote an "international price" in USD due to currency inflation and changes in forex valuations. Seppi333 (Insert 2¢) 18:24, 16 May 2016 (UTC)

Yes thanks. I have not seen prices vary by several orders of magnitude (100 fold) among OECD countries (except for brief periods of time). Would be interested in seeing a reference for this if one can be found.

Our sources often quote the price in USD. I know the MSF uses Euros. Doc James (talk · contribs · email) 18:43, 16 May 2016 (UTC)

I'm not saying an international price shouldn't be quoted in USD; if one quoted at all, it should be in USD because that's easily the most actively traded/liquid currency in the world. I'm just not convinced that a USD quote would be particularly useful to someone who doesn't live in the US because they'd literally need to look up their exchange rate and convert it to their currency for context (i.e., to compare the price of the drug relative to the price of other things they buy in their currency). Seppi333 (Insert 2¢) 18:54, 16 May 2016 (UTC)

Many outside the US know the conversion between their own currency and USD. Otherwise it is fairly easy to look up. Would be interesting to build a tool that uses a readers IP add the local currency in brackets. Doc James (talk · contribs · email) 16:31, 17 May 2016 (UTC)

Many outside the US know the conversion between their own currency and USD. - you know that how? Seppi333 (Insert 2¢) 16:36, 17 May 2016 (UTC)

That's a bit of a red herring. Whether or not individuals know this, the USD is the reference currency for interbank transactions on the foreign exchange market.(see http://www.bis.org/press/p130905_fr.pdf) We already have guidance at wp:CURRENCY saying that country-non-specific articles should use United States dollars, euros, or pounds sterling. We also have templates that can do the conversion {{EUR}}, {{GBP}} and apply historic inflation {{inflation}} where needed, and even a navbox: {{Exchange Rate}}, which renders as, e.g.

Current EUR exchange rates
From Google Finance:	AUD CAD CHF CNY GBP HKD JPY USD RUB INR
From Yahoo! Finance:	AUD CAD CHF CNY GBP HKD JPY USD RUB INR
From XE.com:	AUD CAD CHF CNY GBP HKD JPY USD RUB INR
From OANDA:	AUD CAD CHF CNY GBP HKD JPY USD RUB INR

.LeadSongDog come howl! 18:49, 17 May 2016 (UTC)

ok, but that's quite misleading, because there are lots of reasons why products have different wholesale prices in different markets. An item might well be available for $x in the USA but be a completely different price elsewhere. Given that some medications are particularly sold in some jurisdictions at or below cost and some are vastly expensive in others, some spot wholesale price in one place is totally useless when one desires to know how much it would be to get a wholesale purchase where I am, Unless I happen to be in the USA. There is no "global wholesale" price of anything. How are you imagining this information would be informing the global WP reader? JMWt (talk) 21:25, 17 May 2016 (UTC)

@LeadSongDog: It's not a red herring at all. It's a real problem that is resolved by listing the US price with the price quoted in other major English speaking countries' currencies; the converted price needs to be updated with the closing exchange rate from the preceding day in order to circumvent the issue. Seppi333 (Insert 2¢) 22:28, 17 May 2016 (UTC)

@Seppi333 not just a matter of exchange rates at all. You can look at how national pricing of the new Hepatitis drugs such as Sofosbuvir to gain some insight into the determinants of pricing in non-US countries. As you may have encountered there are legislative approaches to essential and nonessential drugs, pricing of generies, and national or regional negotiation strategies that countries employ -- not to mention that many of these costs are not passed on in many non-US countries to the end users, who may have national or private insurance policies that reduce or rebate the costs of the drugs. Not an issue that can be simply dealt with by exchange rates.--Tom (LT) (talk) 02:32, 18 May 2016 (UTC)

I realize this. There's 4 price issues that have been discussed in this section: wholesale price variability in USD over time, USD inflation, pricing USD in other currencies, and the additional cost of a drug above the wholesale price which is unique to each nation and varies by government subsidization and/or private insurance. I'm just talking about the forex issue here. Seppi333 (Insert 2¢) 02:42, 18 May 2016 (UTC)

It seems rather obvious that we cannot provide "it costs X at the retail pharmacy at the corner of Main and Bank in city Y" for every retailer. Sensible retail pricing is likely not going to be at all feasible. It might be attainable to say that globally the wholesale prices for a standard quantity range from a low seen at about INR M to a high seen at about SFR N, with dated USD equivalents and citations of the form "On that date, one SFR was worth USD d. The reader can do the arithmetic if sufficiently interested, it's good practice for them.LeadSongDog come howl! 16:19, 18 May 2016 (UTC)

So many editors keep focusing on individual consumers. There's more to the economy than the guy who got prescribed antibiotics this morning and is trying to figure out whether he can save a little bit of money by going to a different pharmacy. Average global wholesale prices are far more important (to the world, to public health, to the global economy, to governments) than whether a given individual pays X or Y.

Also, we should just use whatever currency is used by our sources. It happens that it will be mostly US dollars. WhatamIdoing (talk) 14:49, 19 May 2016 (UTC)

The problem is, "global average prices" simply do not exist. Of course, if a drug is sold in US for $100 and in Bhutan for $1, one could say its "global average price" would be $50.50. But of course nobody sane will agree - the two economies or populations simply don't compare. An improvement would be, of course, to weight the "country wholesale price" for country population, getting closer to median price per global inhabitant. But this would not account for actual drug price, because drug consumption per inhabitant varies greatly from country to country. So, a still better way would be to try to calculate the mean price per unit sold globally – this would perhaps be the most informative of anything we can ever have. Not the "US wholesale price" as proposed by OP. However, the problem is that quite a number of payers (for example, nearly all payers across EU) procure drugs (or at least all reimbursed drugs) under confidential contracts and never disclose the quantities purchased or the prices paid; nor is patient aware of the price if the drug is received through government-funded healthcare.

These are all considerations one has to keep in mind when proposing to come up with any statistics that involve a large number of countries as well as data that is only estimated, not actual. And that's the reason we don't have sources that give "global average price" for drugs. — kashmiri ^TALK 16:04, 19 May 2016 (UTC)

Or one could provide a price range. Doc James (talk · contribs · email) 18:24, 19 May 2016 (UTC)

Sources

Let's make a list of sources that could be used for finding wholesale (=not end-user costs) for medications. Here's a few that I know about; feel free to add others. WhatamIdoing (talk) 21:25, 19 May 2016 (UTC)

• WHO price list for Africa; prices given are for governments and non-profits only
• Red Book Online, complete with links to their policy and methodology for calculating the average wholesale price for each drug
• International Drug Price Indicator Guide covers multiple countries
• Medicaid's National Average Drug Acquisition Cost for US-specific information
• MSF's price list[27]
• Tarascon Pocket Pharmacopeia
• Canadian Goverenment[28] Gives "international median" This link also useful [29]

Other projects addressing same issue

The discussion here is about Wikipedia presenting prices. Other projects right now are also starting to consider this issue, and also considering where to get sources. This week Robert Wood Johnson Foundation announced the start of their Prescription Cost and Coverage Challenge, which is a developer conference asking who can make the best app to deliver drug prices to American consumers. I think that anyone who could put prices in Wikidata and pull prices out according to any established formula would have a better product than anything else likely to be submitted. Whatever the case - there is a community of developers there also might be looking at data. At this point the contest just wants a design mockup. Blue Rasberry (talk) 13:49, 24 May 2016 (UTC)

Interesting. Would be cool to see this happen at a global level. Doc James (talk · contribs · email) 01:24, 25 May 2016 (UTC)

category for early psychosis

I wonder if we can create a category for early psychosis, which would be a sub-category of psychosis, to organize at least 3 articles: at-risk mental state, early intervention in psychosis, and basic symptoms of schizophrenia. These articles all relate to the early detection of psychosis, so it may useful to have a category for them.--Beneficii (talk) 07:08, 16 May 2016 (UTC)

What would be the purpose? Carl Fredik 💌 📧 09:57, 16 May 2016 (UTC)

To create an organized category on early psychosis from which people can access the relevant articles.--Beneficii (talk) 18:06, 16 May 2016 (UTC)

I created the category, called Early psychosis.--Beneficii (talk) 18:28, 17 May 2016 (UTC)

Referencing popular culture in medical articles / Amyotrophic_lateral_sclerosis

This text was added

A storyline in the ''Incredible Hulk'' series in 2000 saw [[Hulk (comics)|Bruce Banner]] dealing with the revelation that he has ALS<ref>''The Incredible Hulk'' vol.2 #12</ref>[30]

Often people reference the comic itself or the tv show etc. IMO this is primary research? Wondering what others thoughts are? Doc James (talk · contribs · email) 15:37, 16 May 2016 (UTC)

agree this edit [31] does not enhance the Society and culture section of Amyotrophic_lateral_sclerosis...IMO(while the Research section could use help/edits)--Ozzie10aaaa (talk) 21:41, 16 May 2016 (UTC)

That edit is actually valid in terms of fiction and TV shows. MOS:PLOT says: The plot summary for a work, on a page about that work, does not need to be sourced with in-line citations, as it is generally assumed that the work itself is the primary source for the plot summary. However, editors are encouraged to add sourcing if possible. If a plot summary includes a direct quote from the work, this must be cited using inline citations per WP:QUOTE. Sometimes a work will be summarized by secondary sources, which can be used for sourcing. Otherwise, using brief quotation citations from the primary work can be helpful to source key or complex plot points. Presenting fictional material from the original work is allowed, provided passages are short, are given the proper context, and do not constitute the main portion of the article. If such passages stray into the realm of interpretation, per WP:PRIMARY, secondary sources must be provided to avoid original research. Plot summaries cannot engage in interpretation and should only present an obvious recap of the work.

Feels terribly like OR to me but that is how those people roll. There isn't a basis in policy/guideline to exclude it in the Society and culture section. Maybe split off in a subsection about popular culture/media or something. Jytdog (talk) 23:08, 16 May 2016 (UTC)

Jytdog makes a fair point about MOS:PLOT, but there is something that feels weird about it. I think it arguably goes against MOS:INUNIVERSE, unless there are independent sources saying the same thing. I'm not familiar with the comic, but if there aren't other sources saying the same thing, I wonder if the comic explicitly said he had ALS or if it was just heavily implied. Tagging Doc James since this thread is getting a little old. —PermStrump(talk) 17:06, 17 May 2016 (UTC)

Oh no, that happened. I remember buzz in ALS-land when that issue published. Jytdog (talk) 21:42, 17 May 2016 (UTC)

Hah, well then I would assume it could be backed up with a more reliable source. —PermStrump(talk) 02:42, 18 May 2016 (UTC)

I have generally always stood by the principle that cultural allusions should be supported by a secondary source, ideally one that documents the impact on the public perception of a medical condition. Just saying that a disease is used a plot device is not encyclopedic in my view. JFW | T@lk 09:46, 19 May 2016 (UTC)

If diseases as plot devices were notable, there'd be about 1 disease/popular culture reference for every episode of House (TV series) (177 total), which includes ALS. Seppi333 (Insert 2¢) 17:52, 20 May 2016 (UTC)

Yeah, see that. Shall we then exclude the series from all the "In popular culture" sections? Not sure whether the series left a lasting impression on popular culture - although, again, I am not based in the US. — kashmiri ^TALK 07:43, 21 May 2016 (UTC)

Wouldn't it be simplest and most consistent to base inclusion on notability in reliable sources? If a RS indicates that a mention on House is notable, then include it. I see no consistency in having an arbitrary approach to one series. But, I don't watch TV so I may be overestimating the value of sourcing on this topic. — soupvector (talk) 15:58, 21 May 2016 (UTC)

The question is did whatever bit of popular culture have a meaningful impact on the disease? If no we should not mention it at the disease article. Could go on the article about the popular culture thing though. I see much of this as trivia unless if gets significant third party press. Doc James (talk · contribs · email) 17:38, 22 May 2016 (UTC)

Added summary here [32] Doc James (talk · contribs · email) 17:45, 22 May 2016 (UTC)

From what I understand http://www.imdb.com/title/tt2082580/?ref_=ttep_ep4 is user generated thus would not be a sufficient source for [33]? Doc James (talk · contribs · email) 01:52, 25 May 2016 (UTC)

IMDB is user-generated, so it shouldn't be used to establish WEIGHT for including the citation. I'm not sure how one would decide that though. —PermStrump(talk) 02:18, 25 May 2016 (UTC)

RfC: Wikidata in infoboxes, opt-in or opt-out?

There is currently an RfC at Wikipedia:Village_pump_(policy)#RfC:_Wikidata_in_infoboxes.2C_opt-in_or_opt-out.3F which has the potential to have a major impact on how we use templates. The new Template:Infobox medical condition(new) is a ß-version displaying a number of great uses of Wikidata for diseases and medical conditions — see for example Gout. Changing policy of Wikidata items to opt-in would undermine the entire venture and lose a potential source of quality data for article infoboxes.

Please comment. Carl Fredik 💌 📧 18:05, 16 May 2016 (UTC) 

• give opinion(gave mine)--Ozzie10aaaa (talk) 19:00, 16 May 2016 (UTC)

CFCF I asked this over at the RfC but how would "opt-in" prevent using WikiData in infoboxes like you used it at gout? Jytdog (talk) 21:26, 16 May 2016 (UTC)

We are "opt-out" right now. I am not exactly sure what that means. What difference will opt-in make? Doc James (talk · contribs · email) 22:54, 16 May 2016 (UTC)

Am trying to figure that out. From what I can tell with "opt in" you would need to add some kind of flag to the infobox (or maybe to each field?) to allow WikiData in. I think that is better, based on the little I know. WikiData gets manipulated by SEO folks all the time (there are SEOs who market themselves as doing that for clients), there is all kinds of unsourced data in it from what I gather, and i have no idea how well or how carefully curated it is. Also changes it makes to the actual infobox should show up in the history and therefore in watchlists, and they don't now. Jytdog (talk) 23:03, 16 May 2016 (UTC)

Yes thanks, that makes sense.

At least for now I agree "opt in" makes sense. Doc James (talk · contribs · email) 23:08, 16 May 2016 (UTC)

The statement "WikiData gets manipulated by SEO folks all the time" is misleading. While there is no question that, like any other entity on the internet, SEO people do look at and try to leverage Wikidata, it is not a good argument against using it in the context of building infoboxes on Wikipedia. A lot more SEO energy goes into manipulating Wikipedia itself and, because its text and not just data, this manipulation can be much more subtle. (e.g. See http://www.theatlantic.com/business/archive/2015/08/wikipedia-editors-for-pay/393926/ ). The other argument about unsourced statements is also misleading. Yes, there are many unsourced statements on Wikidata - the great majority of these were taken directly from Wikipedia hence its a little backwards to suggest that Wikipedia text is by default more reliable. That aside, there is no reason that unsourced statements need to appear in any infoboxes. Infobox code can be used to check what references exist on claims and make sure they match the infobox creator's criteria for inclusion before being rendered. --Benjamin Good (talk) 16:47, 20 May 2016 (UTC)

User:I9606 My comment was not misleading; it is an absolutely valid concern. What would address it, would be an explanation of what efforts are made in WikiData to patrol and ensure that changes made to WikiData are neutral and well-sourced. We spend a lot of effort here at WP:MED just maintaining articles; we are acutely aware of efforts to create and manipulate WP articles for promotion. So please address the concern instead of spinning away from it. If you cannot, then I for one will just need to oppose opt-out. Jytdog (talk) 17:05, 20 May 2016 (UTC)

Wouldn't it depend upon the type of data? For example, I'm not sure how a GeneReviews id number could be non-neutral, and it's pretty much self-sourcing (the id number is all you need to build a URL to the entry in the database [we're doing that right now in infoboxes]). WhatamIdoing (talk) 20:50, 20 May 2016 (UTC)

Bot implementing wiki-data driven infobox for genes

See this diff which was made by a bot, User:ProteinBoxBot. Jytdog (talk) 03:48, 20 May 2016 (UTC)

External link being added to many bacteria articles

Hi folks, I was wondering about links to this database [34] being added to numerous articles about bacteria. Here's one example: [35]. The two editors adding the links, User:L.C.Reimer and User:AnnaVetci), appear to be authors of the paper describing the database: [36]. They seem to be promoting the website. So far, they've added these links to over a thousand Wikipedia articles. CatPath (talk) 16:55, 17 May 2016 (UTC)

Agree. There is a "mass rollback" ability but not sure how to get it to work. Doc James (talk · contribs · email) 20:34, 17 May 2016 (UTC)

User:CatPath have removed the links in question. Doc James (talk · contribs · email) 21:41, 17 May 2016 (UTC)

Would be good to check the value of this database. It is managed by DSMZ, and judging from their website they are a bona fide research institution in Germany.[37] [38]. Their data might actually be valuable enough to be included on Wikipedia, although I'd imagine Wikidata would be the place to go. — kashmiri ^TALK 21:43, 17 May 2016 (UTC)

(edit conflict) For what it's worth, there's still about 100 instances of this link on Wikipedia, many of them added by an IP editor a few weeks ago. - Aoidh (talk) 21:45, 17 May 2016 (UTC)

It is basically another database. Content belongs in wikidata. Import could be done. Doc James (talk · contribs · email) 22:00, 17 May 2016 (UTC)

It can only be imported into Wikidata if the contents of the database aren't copyrighted. Wikidata requires public domain/CC-0 licensing. WhatamIdoing (talk) 14:28, 19 May 2016 (UTC)

Hi, I am one of the two editors inserting all the links. We are researchers, working for a german non-commercial research institute DSMZ. We started this as a project to provide additional information for bacterial type strains (which are ~10,000), since many of these strains are poorly described. We are not able to improve thousands of wikipages, also the data of our database are complex and diverse and can not be incorporated into wikipedia. Though our links provide useful scientific data regarding various aspects e.g. taxonomy, morphology, physiology, growth conditions, media recipes, isolation source, molecular biology and so on. Before starting this, we looked up the guidelines and found for Wikipedia:External links "Some acceptable links include those that contain further research that is accurate and on-topic, information that could not be added to the article for reasons such as copyright or amount of detail, or other meaningful, relevant content that is not suitable for inclusion in an article for reasons unrelated to its accuracy." So, our content is absolutely accurate and on-topic and the amount of detail is too high to incorporate. That's why we thought, this would be the right way to do it. By inserting those links we stumbled over a lot of links to other databases, (as for example to Encyclopedia of Life or to http://www.bacterio.net/) which also provide additional information as we do. So we felt confirmed in our doing. I really would appreciate if you rethink about the roll back, since we really offer high quality research data as additional information to the wikipedia users and we do not have any commercial interest or advantage. I am open for questions. L.C.Reimer (talk) 05:30, 18 May 2016 (UTC)

I really don't see what the issue is here. Inserting database links in articles seems completely fine. We do it in every chembox, drugbox, and proteinbox/pbb on every page where those templates are transcluded anyway. Seppi333 (Insert 2¢) 05:38, 18 May 2016 (UTC)

We could likely do a bot import into Wikidata if there is consensus. Each of these bacteria has a Wikidata entry. Doc James (talk · contribs · email) 05:48, 18 May 2016 (UTC)

Thanks for posting here User:L.C.Reimer. In general the editing community welcomes WP:BOLD efforts to improve the encyclopedia. However, when engaging in a large-scale project like this, it always wise to at least give people a heads up, and even better to get consensus first. This is discussed a bit in WP:CAUTIOUS. Just doing it raises concerns about spamming and promotionalism as well as the quality of the data in the link (that is the concern, [[[User:Seppi333]]).

It just so happens that there is another editor who is doing a similar thing but more radical - basically rewriting articles about proteins based on a database maintained at the lab where he used to work; many other kinds of problems arose there. (being discussed here).

L.C.Reimer If would be great if you and your partner paused for a bit while we discuss what you are doing. Is that OK?

For folks who want to see what they are up to with this database, they published on the most recent iteration of the database. See PMID 26424852, free fulltext (cited on their website here). Jytdog (talk) 05:51, 18 May 2016 (UTC)

Thank you for the answers. I agree, that we should have talked to someone before, but I haven't figured out how, so we thought it would be okay to just start that. Of course, we will stop and wait where this discussion ends! Hope you'll find a consensus and let me know if you have further questions.L.C.Reimer (talk) 05:57, 18 May 2016 (UTC)

(edit conflict) I think there is a conflict of interest issue here. It would have been better if the authors first cleared this with WP:Microbiology. Also it would have been better to implement this as a template with a link to a Imprint (database) stub explaining what the database is about. Another problem is that the database concerns bacterial strains, where as Wikipedia has very few articles on strains. Most of the links were added to bacteria species articles, hence these links in general appear over specialized. Boghog (talk) 06:02, 18 May 2016 (UTC)

Though our database is based on strain-linked information, we only linked type strains which are "representives" of a speciesL.C.Reimer (talk) 06:21, 18 May 2016 (UTC)

Boghog that makes tons of sense, that the discussion should happen at that WikiProject rather than here. Would you mind starting the discussion there, linking back here so folks there have this context? thx Jytdog (talk) 06:17, 18 May 2016 (UTC)

In my experience WP:Microbiology is as dead as a doornail, but there may be some active editors around. Or try the biology WPr. Johnbod (talk) 16:05, 18 May 2016 (UTC)

Please keep an eye on the WP:Micro discussion and feel free to chime in again to help reach some kind of meaningful consensus. Thanks! Ajpolino (talk) 01:02, 19 May 2016 (UTC)

Notified them here [39] Doc James (talk · contribs · email) 05:41, 19 May 2016 (UTC)

L.C.Reimer, are you familiar with our sister project, Wikispecies? WhatamIdoing (talk) 14:28, 19 May 2016 (UTC)

List of youngest birth mothers article -- defining the teenage age range.

Opinions are needed on the following matter: Talk:List of youngest birth mothers#Teenage category. A WP:Permalink for it is here. The discussion also concerns the Teenage pregnancy article. Flyer22 Reborn (talk) 05:58, 18 May 2016 (UTC)

need opinions(gave mine)--Ozzie10aaaa (talk) 11:14, 18 May 2016 (UTC)

NUCCA

"A pilot study[7] concludes that alignment of the atlas vertebra results in notable and sustained reduction in blood pressure. The methodology of that study has been criticized.[8]" See NUCCA#Literature. Both sources are unreliable, I think. QuackGuru (talk) 18:12, 18 May 2016 (UTC)

[40]?--Ozzie10aaaa (talk) 20:16, 18 May 2016 (UTC)

Removed the primary source. Doc James (talk · contribs · email) 05:38, 19 May 2016 (UTC)

Links to their own website

We have an editor here at Targeted intra-operative radiotherapy who is adding links to their own website. And continues to add primary research. Thoughts. Doc James (talk · contribs · email) 18:52, 18 May 2016 (UTC)

Looks like self-promotion by a guy who claims to have developed this technique - although the first version of the article only mentions him twice[41], in the current version, edited by him, the majority of references are to his papers. Self-promo, although not the first one of a medical doctor that I see on WP. — kashmiri ^TALK 19:19, 18 May 2016 (UTC)

Alcohol for lice

Further comments appreciated here Doc James (talk · contribs · email) 06:00, 19 May 2016 (UTC)

• give opinion(gave mine)--Ozzie10aaaa (talk) 20:02, 19 May 2016 (UTC)

Date of Med talks at Wikimania moved

The medical day at Wikimania has moved from Jun 22nd to Jun 23rd.[42]

Doc James (talk · contribs · email) 17:25, 19 May 2016 (UTC)

Several new medical articles could use some review

Several new medical articles created by one user could use review by experienced editors:

• Skin-to-Skin Sexually Transmitted Diseases and Infections
• Contact-to-Contact Sexually Transmitted Diseases and Infections

There may be COI issues with these articles because the same editor has created several highly promotional articles about related businesses/products: Biiosmart (currently nominated for speedy deletion), Bioniix (also at speedy deletion), and Intelligent Molecular Therapeutics. Deli nk (talk) 12:44, 20 May 2016 (UTC)

I speedied both of them for duplicating each other and our Sexually transmitted diseases article. Jytdog (talk) 13:01, 20 May 2016 (UTC)

Thanks for bringing this, User:Deli nk. All gone. Jytdog (talk) 16:07, 20 May 2016 (UTC)

Traffic reporting

I started an essay or guide at meta called meta:Traffic reporting.

Consider any category, like for example, Translation Task Force's Category:RTT which contains 310 medical articles queued for translation.

Put that category and a date range into this tool.

• Massviews Analysis tool

The output is data about the pageview traffic to all of those pages in that date range. Example with category RTT for March 2016 - 23 million views in that month for English, and reports on other languages are available by request through the drop down language menu.

Thanks to MusikAnimal for making this.

Any Wikipedia contributor who has a partnership with organizations knows that organizations continually ask, "How many people read Wikipedia articles in our field of interest?" For the first time ever, there is a quick and easy way to answer that question. Blue Rasberry (talk) 19:37, 20 May 2016 (UTC)

[43]great!--Ozzie10aaaa (talk) 22:03, 20 May 2016 (UTC)

Very similar to this tool [44]. The benefit of this one is that one can also include subpages.

I am looking for a tool that will give monthly pageviews (mobile and desktop) for all of WPMED. Does anyone know of one? Doc James (talk · contribs · email) 03:32, 21 May 2016 (UTC)

I do not. Blue Rasberry (talk) 13:13, 21 May 2016 (UTC)

When you need data on thousands of pages, it's better that we do a special-request one-time run. Massviews is capped at 500 pages because querying much more than that through the API is either going to leave you with incomplete data, or you'll have to wait a considerably long time -- for the entire WP:MED project perhaps an hour or more. Tag on mobile vs desktop views and you're doubling the execution time! Since you want monthly data, perhaps we could instead create a service to suit this need, so that it is ran only once per month. How does that sound? — MusikAnimal ^talk 17:35, 21 May 2016 (UTC)

That would be great User:MusikAnimal. User:Ladsgroup might be working on something but not sure were he is at. Doc James (talk · contribs · email) 03:53, 22 May 2016 (UTC)

I already made an issue in the github repository [45]. I also talked with Dan to see what we can do on pageview API when we are trying to get page view for lots of pages. It seems we need to make parallel requests and there is no support for batch requests yet. Building a table and storing data monthly was my idea since the beginning but it has its own complications. :)Ladsgroup^overleg 15:24, 22 May 2016 (UTC)

Would be cool if we could get this data for Wikimania and if we could run it back in time :-) Doc James (talk · contribs · email) 17:34, 22 May 2016 (UTC)

Juvenile degenerative disc disease

Cervical Spine MRI showing degenerative changes closeup

Hello all. Saw reference to juvenile degenerative disc disease (JDDD) aka juvenile disc disease (JDD) and was curious if we should have an article on the subject. Here is one mention: Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging Thanks. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 19:48, 20 May 2016 (UTC)

[46] and book[47]--Ozzie10aaaa (talk) 20:31, 20 May 2016 (UTC)

Do you think that this is a different 'thing' from plain old degenerative disc disease, or is it the regular thing in a special population? WhatamIdoing (talk) 21:00, 20 May 2016 (UTC)

I don't know WhatamIdoing. The article on DDD says it is a "disease of micro/macro trauma and of aging", which may or may not be accurate. If accurate, then maybe a separate article would make sense. Or perhaps it's better described as an and/or relationship with regard to aging. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 13:45, 27 May 2016 (UTC)

That suggests that JDDD and DDD are separate topics. Maybe per User:soupvector's idea, it could start life as a section of Childhood arthritis, and WP:SPLIT if it grows too big?

We need more rheumatologists around here. WhatamIdoing (talk) 23:23, 27 May 2016 (UTC)

This certainly falls into the topic of Childhood arthritis, not sure if it warrants separate coverage. — soupvector (talk) 21:02, 20 May 2016 (UTC)

• BTW,Degenerative_disc_disease could use editor help/edits, thank you--Ozzie10aaaa (talk) 15:07, 22 May 2016 (UTC)

Chemical imbalance

What do other people think about this title and the article in general? It's about the hypothesis that chemical imbalances cause depression. It seems like this article is turning this into a straw-nature vs nurture debate. There's also a bit of big pharma conspiracy theory. To the best of my knowledge, the mainstream view is that depression, like all mental illness, is caused by a combination of biopsychosocial factors. It's my understanding that a lot of psychiatrists no longer love the phrase "chemical imbalance" because it's an inaccurate analogy as to why the body's natural level of serotonin isn't working effectively, not that they reject the idea that neurotransmitters and serotonin are involved. My questions for others are: (1) Does it seem like this article is supposed to be about (a) neurological hypotheses for the cause of depression in general or (b) is it actually about the acceptance, or lack there of, of the phrase "chemical imbalance"? (2) If it's option A, is this the best title for the topic and should it be merged with Biology of depression? —PermStrump(talk) 22:46, 20 May 2016 (UTC)

I don't have a direct answer, but I thought these were particularly germane: PMID 25682806 and PMID 24657311. There are many like this - gleaning scientific consensus will be important to responding to your questions. — soupvector (talk) 05:47, 21 May 2016 (UTC)

Seems like it should just be redirected to monoamine hypothesis. Jytdog (talk) 09:02, 21 May 2016 (UTC)

Better than a freestanding article, but I'm not sure there should be anything at this title, even a redirect. Although it's most commonly used in reference to depression, it's easy to find references to many other mental illnesses, and the phrase "chemical imbalance" in isolation could mean all sorts of things. Opabinia regalis (talk) 09:16, 21 May 2016 (UTC)

What do you suggest? Jytdog (talk) 09:19, 21 May 2016 (UTC)

I don't know, is the history actually worth keeping? Maybe put it somewhere like chemical imbalance theory of depression? Opabinia regalis (talk) 09:33, 21 May 2016 (UTC)

@Soupvector: Those articles were really interesting to read, even just for personal reading. What search terms did you use? @Jytdog and Opabinia regalis: I don't know if I'm following the options you guys are talking about. What are you suggesting happens if someone searches "chemical imbalance"? A dab page with articles like Causes of mental disorders and Biology of depression, etc. or just nothing? Where does "chemical imbalance theory of depression" fit in? I don't know if I'm still allowed to say I'm new, but so far when people have brought up redirecting things during AFDs, etc, I've mainly paid attention to the content parts of the argument and skimmed the bits where people are talking about the actual mechanics redirecting things, but since I brought this one up, I suppose I should make it my business to make sense of the lingo. :) —PermStrump(talk) 18:34, 21 May 2016 (UTC)

I don't know if I'm still allowed to say I'm new — since you were clearly not new from the moment your account was created last September, no, you are not allowed to claim newness. I mean, this was your 10th edit on your 2nd day. You must think we're all idiots. Ratel (talk) 21:47, 21 May 2016 (UTC)

• @Permstrump: I'm glad you enjoyed those. I sometimes do tricksy things in Pubmed, but in this case my search was very simple: "chemical imbalance AND depression" — soupvector (talk) 03:14, 22 May 2016 (UTC)

@Permstrump: Jytdog turned the title chemical imbalance into a redirect to Biology of depression#Monoamines (also the target of monoamine hypothesis). I agree with him that there shouldn't be an article with the title "chemical imbalance", but think the term is too general to redirect to something specifically about depression. Skimming the Google results shows the term in use to describe anxiety, bipolar disorder, ADHD, and schizophrenia, among other more general descriptive uses. (Strictly speaking, any metabolic abnormality would fit the description.) I suggested that the page history of chemical imbalance be moved to the longer term chemical imbalance theory of depression or something similar, which would turn up as a suggested item in the drop-down as you type in the search box. I imagine the search results page would look similar to the current status.

Incidentally, I just noticed we also have Chemical imbalance (mental health), which redirects to biopsychiatry controversy, which is another article that could use some attention. Opabinia regalis (talk) 03:22, 22 May 2016 (UTC)

@Opabinia regalis: thanks for the explanation! Your suggestion of moving the page history to "Chemical imbalance theory of depression" makes sense to me. I think you're right that people commonly say "chemical imbalance" to refer to things other than depression, so it wouldn't be obvious to most people that that's what they'd find in the page history of "Chemical imbalance". I'll take a look at biopsychiatry controversy. I'm cringing at what I can already guess I'll find there.

@Ratel: since you're being such a detective, I assume you noticed that my account was created in September, but I didn't make my first edit until late November. Maybe I spent some of that time reading about how to edit wikipedia, so I wouldn't screw the whole thing up (my main fear at the time) and maybe by the time I made my first edit, I knew a little bit about a little bit. But anyway, I meant "I don't know if I'm still allowed to say I'm new" in a tongue-in-cheek sort of way because I was asking a noob question. I'm keeping a list of all of the false accusations you make against me, so keep 'em coming. —PermStrump(talk) 03:56, 22 May 2016 (UTC)

It's not just my opinion that you were never a noob, but also that of a senior sysop (who shall remain forever nameless). You're keeping a list? I'm also keeping track of you. Ratel (talk) 05:03, 22 May 2016 (UTC)

This part of the conversation makes me sad, and I suspect that it's not making anyone more interested in editing or collaborating. Please don't post comments like this here. WhatamIdoing (talk) 20:54, 22 May 2016 (UTC)

I'd be OK with it moving to Chemical imbalance theory of mental illness. An article outlining the various instances (e.g., schizophrenia, depression, others?) of that hypothesis would be useful, in my opinion. --Anthonyhcole (talk · contribs · email) 12:16, 22 May 2016 (UTC)

Am with User:Anthonyhcole on this one. The topic is broader than just depression. Doc James (talk · contribs · email) 17:33, 22 May 2016 (UTC)

"depression, like all mental illness, is caused by a combination of biopsychosocial factors"

This is probably true, except when the depression is caused entirely by endocrine problems, failing livers, etc. But perhaps they solve that problem by declaring all of those forms of depression to be non-mental-illness depressions. WhatamIdoing (talk) 20:54, 22 May 2016 (UTC)

I wasn't saying I think that or trying to debate if it's true. I was only saying I thought that the biopsychosocial perspective was the predominant mainstream view when talking about the cause of depression as a whole. —PermStrump(talk) 02:23, 23 May 2016 (UTC)

@Anthonyhcole and Doc James: This particular article focused exclusively on depression and was really poorly written, nothing worth saving, so the question was where to move the page history. What you guys are talking about would mean starting a whole new article from scratch, which you're welcome to do... but I don't think that's what you meant. —PermStrump(talk) 02:30, 23 May 2016 (UTC)

The article devotes roughly equal space to depression and schizophrenia, and, though all writing can be improved, I don't agree this is "really poorly written". As User:Opabinia regalis suggests above, there may be other syndromes that this theoretical model has been applied to, and they can (if they exist) be added over time by interested readers and editors. --Anthonyhcole (talk · contribs · email) 02:45, 23 May 2016 (UTC)

I feel like I'm going crazy. I could have sworn it was specifically about depression! I can't imagine what I was thikning when I said that in my OP. It's gone from my memory now. —PermStrump(talk) 02:49, 23 May 2016 (UTC)

But there is already this article Causes of mental illness that could use work. —PermStrump(talk) 02:53, 23 May 2016 (UTC)

I'm sort of late to this discussion, but I figured I'd just drop this here since this came up on my talk page at one point. The more current "monoamine hypothesis" of depression is described below.

Long block of referenced text
References (Note: "target neurons of monoamines" refers to the postsynaptic neuron in a monoamine pathway)

The original monoamine hypothesis basically focused entirely on the level of the synaptic cleft - the area between 2 neurons. The more recent version (which reflects the underlined theory in the citation above) posits that antidepressant efficacy arises from the changes that they induce inside the postsynaptic neuron following chronic exposure, much like how addictive drugs induce a state of addiction following chronic exposure. Seppi333 (Insert 2¢) 19:49, 25 May 2016 (UTC)

Thanks for posting this, Seppi. I thought it was really interesting. WhatamIdoing (talk) 02:48, 26 May 2016 (UTC)

Assistance needed

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Some expert assistance would be appreciated at Nigella sativa. I have attempted to discuss recent additions/reversions but with no success at getting the user involved (Hyperforin) to respond other than with personal abuse (which Jytdog has retracted). Peter coxhead (talk) 21:12, 21 May 2016 (UTC)

Hyperforin is OK they are just a bit excitable. :) Jytdog (talk) 21:13, 21 May 2016 (UTC)

Some of the above statements by Peter coxhead are false. First of all, the sentences added to the article were adequately sourced using multiple published review references, yet they were repeatedly reverted because some editors simply can't accept that a natural substance can actually have meaningful biological effects. This has already been discussed by me on the Talk page of the article. Moreover, a false argument was made in the revert summary by user Zefr, claiming that the added citation was a primary source, even though it was not. If it helps, there are numerous other reviews for Nigella found on PubMed that can be added, but this shouldn't be necessary at all. --Hyperforin (talk) 21:19, 21 May 2016 (UTC)

it seems to be the Preliminary human research that's the source of the problem , these two refs however only offer abstracts,(no access)[48][49] making it difficult to assess their validity in regards to the text--Ozzie10aaaa (talk) 21:29, 21 May 2016 (UTC)

FWIW, Sci-hub and Google Scholar Button are your friends. In any event, excerpts/quotes were included in the references within the article to assist with verification, although the journal articles certainly contain additional useful text beyond what was quoted. --Hyperforin (talk) 21:36, 21 May 2016 (UTC)

I deeply resent the assertion made by Hyperforin that I "simply can't accept that a natural substance can actually have meaningful biological effects". This would be a stupid view to hold. I simply consider that the reviews do not show enough to make the information worth including. (I do have full access to the two papers Hyperforin used.) The more important point is that whether I am right or wrong, and of course I may be wrong, Hyperforin shouldn't keep re-adding material that is under discussion. Peter coxhead (talk) 21:42, 21 May 2016 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Noncompaction cardiomyopathy

the above article could use some help, if any editor has time, thank you--Ozzie10aaaa (talk) 10:36, 22 May 2016 (UTC)

Help

Hi. I could really use some help with managing an expert review of Parkinson's disease.

I need someone with medical or scientific literacy and access to an online medical library to find strong recent sources that support some of the changes my reviewers are recommending. In the areas of their individual expertise they have no problem identifying the best sources but when they notice errors outside their specific fields, they struggle. I have searched the freely available literature and found a lot but now I need the help of someone with paywall access.

The review is basically complete but we can't bring it to the talk page without bringing sources too.

I've learned a lot from this experience, and look forward to sharing that once we're done. --Anthonyhcole (talk · contribs · email) 11:00, 22 May 2016 (UTC)

Happy to help, time permitting. Where are the questions to be addressed? — soupvector (talk) 13:32, 22 May 2016 (UTC)

Seeing this section my guess is that you might have a Word file with diffs in Track Changes. Feel free to email me and I can work readily with that. — soupvector (talk) 13:46, 22 May 2016 (UTC)

That's great. Thank you soupvector. (Sorry, I should have pointed out I was going to bed after leaving the above.) I've moved the review from the shared Word document to my sandbox (trying to get them onwiki - dragging horses to water, actually). In the left column I've pasted all paragraphs that contain proposed changes, and the relevant comments/discussions are in the adjacent right-hand column. I've added your name and initials (SV) to the introduction. Please add sources (and a relevant quote, preferably) to the right-hand column and initial your comment.

Would you like me to distil it down to a list of unsupported proposed changes? Happy to do that if it makes it easier, though I'd appreciate your oversight of the whole review, too, if it interests you and you have the time. --Anthonyhcole (talk · contribs · email) 02:17, 23 May 2016 (UTC)

This looks fine - thanks - I'll have more context looking over the whole review. Okay if this takes me a few days to complete? — soupvector (talk) 02:23, 23 May 2016 (UTC)

There is no deadline, soupvector. Do it when it feels like fun. --Anthonyhcole (talk · contribs · email) 03:09, 23 May 2016 (UTC)

Straw poll on COI editing

The other day, a medical journal editor asked me if Wikipedia is being manipulated by pharmaceutical or device manufacturers, and I told her there's no way of knowing for sure, short of a confession, and to the best of my knowledge no one's confessed. It did make me wonder, though, what the general feeling was here. Do you suspect there are shills at work on Wikipedia? (Let's not argue the point here, I'm just wondering about your level of suspicion/conviction, if any.) --Anthonyhcole (talk · contribs · email) 12:31, 22 May 2016 (UTC)

in terms of pharmaceutical or device manufacturers they probably (unfortunately) see opportunity, since their goal is to "make a profit", they most likely come at us w/ multiple accounts,there simply aren't enough people to handle COI, we need to be more proactive to stop them(when they sign up-directly ask if they have COI and if so... deny them access...IMO)--Ozzie10aaaa (talk) 13:09, 22 May 2016 (UTC)

• We have strong evidence of editors targeting specific companies/drugs/treatment plans, even with a proven COI. It is possible that these simply act out of poor judgement, not realizing that Wikipedia abhors COI, but I think it's very naive to think that is always the case. We will likely not see any true confession, as it is not illegal and the editor only needs to create a new account. While not pharmaceutical in nature, there is at least on user who has confessed to paid-editing who worked on medical topics: User:FergusM1970. Carl Fredik 💌 📧 13:55, 22 May 2016 (UTC)
• Sometimes an editor has a more obvious COI due to their username, e.g. this exchange. Scray (talk) 15:09, 22 May 2016 (UTC)
• It's likely happening. My impression is that editors are likely choosing to hide their coi as best they can rather than disclose, but it's just an impression from the lack of disclosures I encounter in these type of articles vs other topics. My solution is to mention WP:COI to every new editor that I contact. --Ronz (talk) 16:41, 22 May 2016 (UTC)
• Within central topics the issue with company editors is small. At the smaller / less central topics company editors are fairly common. We got a write up about it here http://www.theatlantic.com/business/archive/2015/08/wikipedia-editors-for-pay/393926/ Doc James (talk · contribs · email) 17:31, 22 May 2016 (UTC)
• I've seen occurrences on dietary supplements and phytochemical articles where developing consumer trends and marketing opportunities evolve readily from misinformation spread by celebrities and quacks. It requires an editor to keep skepticism sharp, apply WP:5P1 and WP:5P2 and adhere to WP:MEDRS sourcing if clinical efficacy is claimed. --Zefr (talk) 17:45, 22 May 2016 (UTC)
• The FDA wrote rules a few years ago on what the manufacturers/marketers of regulated drugs can and can't say on social media sites (Wikipedia counts as social media), and that encourages a certain amount of caution. We have occasionally had a few good pharma contributors, including some from GlaxoSmithKline who identified their employer in their usernames, years before that option was even explicitly permitted in the username policy. In my experience, pharma contributors are rare, scrupulous about following the rules, and very happy to supply sources. I don't remember encountering any device manufacturers (which is too bad, because there's much to say about those products, and overall less risk of problems with clinical efficacy claims).
  But AFAICT there are no such regulatory rules for sellers of dietary supplements or alt med products, and that's an endless problem area. WhatamIdoing (talk) 21:13, 22 May 2016 (UTC)
• We had a device manufacturer quite recently, and nutriceuticals and alt-med is rife with them, and they are allowed to continue despite that. I hold extremist mainstream views mind you. -Roxy the dog™ woof 21:17, 22 May 2016 (UTC)

Interesting. Thank you all. I'll point her to this thread. --Anthonyhcole (talk · contribs · email) 01:56, 23 May 2016 (UTC)

• I find that I come across very little COI editing from bigger pharma/biotech companies about the companies themselves. I have seen promotional editing around new drugs, especially mAbs for cancer, some of them from bigger companies. But mostly it is startups (see for example Alacris which is undergoing AfD now) or smaller companies (see Talk:Peregrine Pharmaceuticals) - and often this takes the form of hyping clinical trial results. Reagent companies do it too. We had an article created (pretty clearly for pay) about Exon Bio's mAb-making platform and then another editor spammed wikilinks to that article into several others. Medical device companies are the most aggressive. I actually emailed the founding scientist of a MED-EL as their employees were pretty relentless adding content about their devices and how they work into Wikipedia and to their credit, the spamming stopped. And the Atlantic article tells about James' experience with Medtronic. Yes the dietary supplement space is pretty rife with conflicted editing.

Two other things I want to mention about WP that no one else has yet. The first is that advocacy editors are a huge problem - no one can quantify if people with a financial COI or who are advocates harm WP more, but both are a big problem. In the medical space, we see that especially with people upset about side effects. All our articles about Quinolones had been extensively worked on by someone who disclosed on-wiki that he was head of a patient advocacy group and had made those articles into horror stories; an editor who is no longer here cleaned most of that up. Likewise we get folks wanting to dramatically emphasize side effects of SSRIs (especially sexual side effects). Likewise articles about circumcision have been beset by people opposed to the practice. Lots of the alt-med issues arise from advocates, perhaps more than from people with a financial COI. We have had super fierce battles about chronic Lyme for example and our article about acupuncture is a militarized zone. And very recently we have had .. what shall i call them, bio-hackers maybe? -- writing all kinds of promotional how-to content about nootropic drugs.

The other thing I want to say is that I think most everybody in WP:MED is very watchful and I think we do a pretty good job keeping promotion and advocacy out of our articles. Article maintenance is a ton of work. WAID will not like it that I say this, but one of the beneficial "side effects" of our strong sourcing guideline is that generally it is hard to get lousy (i.e. driven by promotion or advocacy) content about health into WP because generally MEDRS sources won't support it. The strong sourcing guideline along with our active maintenance is powerful.

Finally, Anthony one thing I would love for your journal editor friend to be aware of, is that when they publish reviews that make claims that are really not supported by the work that has been done in the field this harms Wikipedia. Everything in WP starts with sources, and when those articles enter the literature, they are MEDRS sources, and we are stuck with them and advocates use them like hammers. I for one am very grateful for high quality medical editing. I don't know if your friend is aware of how dependent we are on the work he/she and their colleagues do. Jytdog (talk) 03:42, 23 May 2016 (UTC)

• There is no instance in the popular Wikipedia community consciousness of any medical organization corrupting Wikipedia content, or even attempting to do so. There are hardly any examples of any medical organization engaging Wikipedia in any way that has an impact the Wikipedia community would recognize. I am aware of numerous claims outside the Wikipedia community among advocates of alternative medicine that Wikipedia is controlled by agents of big pharma that wickedly add evidence-based medical content to Wikipedia as a way to suppress the public availability of alternative medicine. I really wish the big pharma shills would come here and do that, but have seen no evidence that this happens. The rumors that circulate complain about regular Wikipedians in this forum, and not unknown actors, and I think no one in this forum is suspected by other forum members to be a secret big pharma spy. The rumors are based on a misunderstanding that regular Wikipedians are commercial actors. Blue Rasberry (talk) 19:34, 23 May 2016 (UTC)

While I do not support "big pharma shills" coming here due to some less than positive interactions. Agree that the rumors of a significant impact are untrue. Alt med folks are unhappy with WP:MEDRS. Doc James (talk · contribs · email) 21:38, 23 May 2016 (UTC)

Yes, although not always. There is a bunch of editors with a truly messianic approach, who seem to go over the top in bashing alt medicine. Look at Burzynski Clinic, it not just states that the guy is a fraud (which he likely is): the bunch of editors seem to take weird pleasure in debating every single court case, even ongoing one, in the lengthy article; at detailing every single negative mention of the clinic. Any attempts to restore balance get you attacked and reverted. I gave up long ago. That's the approach I guess which makes some question the motives of some WP editors. — kashmiri ^TALK 06:39, 24 May 2016 (UTC)

It seems increasingly hard to get people to remember what an encyclopedia article looks like. On both sides of the alt med subject (and other controversial subjects), we have people who want to provide very lengthy expositions of every detail that supports their POV. WhatamIdoing (talk) 01:46, 25 May 2016 (UTC)

Rudy's List of Archaic Medical Terms

Editors of medical articles might benefit from this website, mentioned at WP:RD/S at 15:34, 22 May 2016 (UTC).

• Rudy's List of Archaic Medical Terms

—Wavelength (talk) 21:20, 22 May 2016 (UTC)

useful link, thank you Wavelength--Ozzie10aaaa (talk) 10:28, 23 May 2016 (UTC)

FYI

Wikipedia:Articles for deletion/Information-theoretic death Jytdog (talk) 14:21, 23 May 2016 (UTC)

give opinion(gave mine)--Ozzie10aaaa (talk) 22:00, 23 May 2016 (UTC)

Health effects of eating breakfast

Is anyone interested in reviewing Breakfast#Effect on health? This morning I read this meta-analysis, which appears pretty thorough:

• Carroll, Aaron E. (May 23, 2016). "Sorry, There's Nothing Magical About Breakfast". The New York Times.

Breakfast#Effect on health doesn't reflect this analysis at all. I also noticed that the section relies on a couple of MEDRS-questionable sources, and that its neutrality was questioned on article talk. --Dr. Fleischman (talk) 17:50, 23 May 2016 (UTC)

The community at WikiProject Breakfast probably outranks this forum on matters related to breakfasts. I messaged them requesting that they comment here and provide insight from their field of expertise. Blue Rasberry (talk) 19:22, 23 May 2016 (UTC)

Thanks, good thought! On the other hand that group is probably less experienced with interpreting medical sources and applying MEDRS. --Dr. Fleischman (talk) 19:45, 23 May 2016 (UTC)

I edited partially, added content and another reference, and changed the section banner for citation improvement. The article by Brown et al., "Belief beyond the evidence..." is not a study in itself but rather a meta-analysis to position a debate on "research lacking probative value" and "biased research reporting" where skipping breakfast was related for or against as a factor in obesity onset. I don't think the Brown study warrants it being used in the Breakfast article as it is convoluted and potentially confusing for the lay user per WP:NOTJOURNAL. The Carroll article in today's NY Times was a good lay summary though. --Zefr (talk) 20:31, 23 May 2016 (UTC)

Proposal to merge articles about patient participation in health care decisions

I think that all of these articles are discussing the same concept by different names.

• Shared decision-making
• Patient participation
• Patient-centered care
• Participatory medicine
• Health consumerism

I would appreciate comments on merging any or all of them at Talk:Patient_participation#Proposal_to_merge_articles_on_similar_concepts. Thanks. Blue Rasberry (talk) 19:25, 23 May 2016 (UTC)

Agree. SDM is the most often used term IMO. I suggest merging it all to that. Doc James (talk · contribs · email) 21:32, 23 May 2016 (UTC)

I support the idea of merging these articles.

There's probably another set of articles, with various names that amount to "patients using the internet" that could also be merged into one sensible one. WhatamIdoing (talk) 16:32, 26 May 2016 (UTC)

WP:Categories for discussion/Log/2016 May 22#Category:Lists of people by proposed medical condition

People at this project might be interested in this discussion. —PermStrump(talk) 22:58, 23 May 2016 (UTC)

• Not my area of interest but we do have List of people with epilepsy as an FA and this seems to be an overhead category for this. We have a lot of "List of people with X articles" Doc James (talk · contribs · email) 23:14, 23 May 2016 (UTC)

• This category has existed since 2006 and only has 3 things in it, two of which don't really fit the description and there's also a category with a more grammatically correct title: Category:Retrospective diagnosis, which seems to be what this other category was aiming for. —PermStrump(talk) 00:04, 24 May 2016 (UTC)

And we have Category:Lists_of_people_by_physical_attribute Doc James (talk · contribs · email) 00:25, 24 May 2016 (UTC)

Plumpy'nut

hm. Jytdog (talk) 01:10, 24 May 2016 (UTC)

Have been watching this product and article for a few years. We won't see MEDRS-style sourcing behind it because this is a therapeutic food pressed into rapid distribution to meet an urgent malnutrition need, i.e., no significant clinical research has been done on it, but the rapid positive results in helping malnourished children to recover are more than enough evidence. It has an appealing taste (I enjoyed a packet) designed to be nutrient-rich in a long-shelf life, heat- and moisture-stable format that serves starving children in some of the world's poorest countries. Press coverage here and here. Supported by UNICEF. --Zefr (talk) 01:39, 24 May 2016 (UTC)

The United Nations is a reliable source. Doc James (talk · contribs · email) 08:47, 24 May 2016 (UTC)

Mention of bipolar disorder in biography articles

Opinions are needed on the following matter: Wikipedia talk:Biographies of living persons#Bipolar disorder. A WP:Permalink for it is here. Flyer22 Reborn (talk) 04:03, 25 May 2016 (UTC)

• please give opinion(gave mine)--Ozzie10aaaa (talk) 12:49, 25 May 2016 (UTC)

Is Cureus a reliable journal?

I am curious what editors opinions are regarding the relatively new journal Cureus. It might be a reliable journal because it seems peer-reviewed, has a solid editorial board and is indexed in Medline. It might be an inappropriate journal because it is new and uses a novel open access platform. Thoughts? 2001:56A:75B7:9B00:F155:3651:86CD:A6E4 (talk) 17:10, 25 May 2016 (UTC)

It's not listed on Ulrich's Periodical Directory as peer-reviewed. Also, Beall's list has some questions about the quality of its peer review. I'd say it would be better find a stronger source and if one doesn't exist, it's probably because the material is undue. —PermStrump(talk) 17:41, 25 May 2016 (UTC)

It appears to be rather indiscriminate in what it accepts (anything that passes peer review). The peer review seems to be conducted by whomever is available on short notice. WhatamIdoing (talk) 19:34, 25 May 2016 (UTC)

[50]?--Ozzie10aaaa (talk) 19:47, 25 May 2016 (UTC)

No impact factor as of 2013 per http://cofactorscience.com/blog/journal/cureus so agree it is not sufficient. Doc James (talk · contribs · email) 07:46, 26 May 2016 (UTC)

Fun fact #1: "Impact factor" isn't even mentioned in MEDRS. Neither the existence of an impact factor, nor any particular minimum threshold, is actually required by any guideline on reliable sources. I think, considering their newness and lack of selectivity (what Co-factor Science diplomatically calls a "mega journal"), that we can safely assume that their impact factor, should anyone ever bother to calculate it, would be low.

Fun fact #2: Cureus' founder's blog links to our article on impact factors. WhatamIdoing (talk) 16:40, 26 May 2016 (UTC)

Policy/guidlelines grow from practice. We bring in impact factors all the time when weighing sources on article Talk pages and it is probably time we add it MEDRS. Jytdog (talk) 17:26, 26 May 2016 (UTC)

I don't claim to be a MEDRS expert by any stretch, but it seems to me that the impact factor concept provides potent evidence of a journal's reputation, which is already a central component of MEDRS. In other words, impact factor is highly relevant even if it isn't explicitly referenced in the guideline. --Dr. Fleischman (talk) 17:40, 26 May 2016 (UTC)

If compared to a similar journal, you can get some idea of the number of scholars who cite the articles in the one versus the other, which is probably a decent marker of interest or relevance, or at least the fashionability of its subject matter. That's not quite the same thing as "reputation", since even Medical Hypotheses has an impact factor above 1 (a commonly proposed threshold in such discussions).

The main problem is when editors use impact factors to compare non-comparable journals. Magazine circulation, the number of articles published each year, and the FUTON bias significantly affect the impact factor, irrespective of actual quality. Niche journals have lower impact factors than general medical journals, even when the niche journal is higher quality. Review journals get more citations than original experiments (this bias works well for our purposes, of course). An impact factor of 1.0 is decidedly weak for some types of journals, but rather good for others.

I agree with Jytdog that people do talk about impact factors, usually when they're trying to provide a rational-sounding reason for rejecting a source they dislike. However, these discussions frequently involve such ham-fisted, one-size-fits-all notions, and with no effort to determine whether the journal's average popularity among authors is relevant to the particular proposed claim, that the result is some poor decisions. We're probably headed to the same place with impact factors that WP:NSCHOOLS reached long ago: some editors will assert that all elementary schools are non-notable, even if you have provided dozens of top-quality sources, but every high school in the developed world is notable, even if the only (semi-)independent source you've found is the neighborhood newspaper. That doesn't demonstrate good editorial judgment.

I keep hoping that User:DGG will write up a good explanation of the pitfalls at Wikipedia:Impact factor, but I recognize that this is a time-consuming request. WhatamIdoing (talk) 01:38, 27 May 2016 (UTC)

Just dealing with this journal, no journal can as a matter of definition have an impact factor until it has been published for two full years--that is required before the computation can be done. Whether this is a RS depends on the quality of the peer review which is promised.

More generally, and very briefly: the key thing about impact factor is that it is field-depoendent--it depends on the density of citations in a subject. Since articles in clinical medicine very heavily cite each other , high impact factors are to be expected. If we take the journals indexed by science citation index as the totality of the reputable journals, the most interesting statistic is where the journal stands in the list of those for the particular subject, and ISI specifically publishes those rankings.

There are multiple factors which additionally need interpretation. Since all articles in a field cite the most recent review articles, review journals as distinct from primary journals have unusually high impact factors. Citation measures interest as much as merit--journals concentrating on topics heavily in vogue also have higher impact factors than they would otherwise warrant. These are questions of interpretation, rather than error, but there are also sources of error, such as a journal having one or two heavily cited articles not representative of the whole, and the various modes of self-citation that cause unrealistically high impact factors. ISI normally correct for these, or if extreme, removes the journal.

It's just like judge RSs for WP, or judging whether a scientist is an authority: judging the reliability of a journal is not mechanical, and takes judgment. One key non-impact related factor that is particularly pertinent in this field, especially with alt med, is that a few journals will quite deliberately publish what they know to be controversial articles in order to encourage discussion--the famous journal most noted for doing so every once in a while is Nature. DGG ( talk ) 03:52, 27 May 2016 (UTC)

Mazumdar et al.

This Mazumdar et al. reference has been added to a few articles recently, in particular this new article called Primary care service area. Thoughts? —PermStrump(talk) 06:08, 26 May 2016 (UTC)

maybe coincidence? --Ozzie10aaaa (talk) 10:39, 26 May 2016 (UTC)

Isn't researchgate.com blacklisted? Carl Fredik 💌 📧 12:03, 26 May 2016 (UTC)

good point--Ozzie10aaaa (talk) 13:02, 26 May 2016 (UTC)

I didn't know that about researchgate.com, but I'm glad to hear it. Not because of this, just in general. —PermStrump(talk) 15:31, 26 May 2016 (UTC)

"Reinforcement disorders" = addiction?

In drug articles there is an "adverse effects" section. For addictive drug articles, I would expect "addiction" to be listed as an adverse effect, and it is. But "addiction" is currently under a heading called "Reinforcement disorders" with related issues, like dependence or withdrawal.

• Ethanol#Reinforcement_disorders
• MDMA#Reinforcement_disorders
• Morphine#Reinforcement_disorders
• Opioid#Reinforcement_disorders
• Caffeine#Reinforcement_disorders

I am not familiar with the term "reinforcement disorder". There is no wiki article on the concept. Is this the best section title? Here are some other possible names -

• Addiction
• Addiction and related issues
• Habitual use
• Dependence
• Substance abuse

I know that some of these are technical terms. Is there a common name that can be used? Blue Rasberry (talk) 13:37, 26 May 2016 (UTC)

Addiction is a disorder involving positive reinforcement. Dependence is a disorder involving negative reinforcement. Removing the grouped heading probably wouldn't be a problem, but merging dependence and addiction into 1 heading is a bad idea. Seppi333 (Insert 2¢) 15:30, 26 May 2016 (UTC)

Seppi333: Do you have a source for that? I've never heard that distinction made before about positive vs negative reinforcement. I've also never heard of reinforcement disorders. Bluerasberry, what about calling the sections "Substance use disorders"? —PermStrump(talk) 15:39, 26 May 2016 (UTC)

This review makes the distinction between addiction and dependence at the molecular level when discussing their mechanisms. This review can give you a primer on how reinforcement drives compulsive behavior in SUDs, particularly through secondary reinforcement; it uses the terms "addiction" and "dependence" interchangeably though, so this might be confusing. This textbook chapter is a slightly less focused but covers essentially the same material. Personally, I don't really care what the heading is titled so long as the subheadings are kept separate. An alternative would be to just remove the heading and increase the heading level of the subsections. Keeping the discussion of addiction and dependence separate in an article reflects the distinction we've been making in MOS:MED/MOS:PHARM and in the drugbox fields for addiction vs dependence liabilities. Seppi333 (Insert 2¢) 16:38, 26 May 2016 (UTC)

"Substance use disorders" may be adequate. Sizeofint (talk) 17:02, 26 May 2016 (UTC)

Then where do the "addictive" behavioural disorders (sex, videogame, gambling, etc.) go? If the underlying neurochemistry is the same, shouldn't they share the same top-level article?LeadSongDog come howl! 18:13, 26 May 2016 (UTC)

Reflist
References

media coverage - "Why getting medical information from Wikipedia isn’t always a bad idea"

• Masukume, Gwinyai; Heilman, James; Häggström, Mikael (24 May 2016). "Why getting medical information from Wikipedia isn't always a bad idea". The Conversation. Retrieved 26 May 2016.

Thanks to @Doc James and Mikael Häggström: for authoring this. Does Gwinyai Masukume, the third author, have a Wikipedia account that is public? Blue Rasberry (talk) 15:46, 26 May 2016 (UTC)

well done--Ozzie10aaaa (talk) 22:08, 26 May 2016 (UTC)

My role was very minor. Mostly Gwinyai. Doc James (talk · contribs · email) 23:17, 26 May 2016 (UTC)

Contraindications

Every FDA label that I have ever read has listed a known hypersensitivity to the drug itself or any of the excipients in a drug as a contraindication. Sometimes it's literally the only contraindication for a drug, e.g., nitazoxanide (brand: Alinia).

So, should I do this even though I probably can't cite this exact statement? I normally wouldn't care to add a statement like this to an article on a biologically active compound which isn't an FDA-approved prescription drug, but I intend to improve this article to FA status and figured it should conform to the MOS. I can probably find a source which states (in generality) that drugs which one has a known hypersensitivity to are contraindicated in that individual, but would that suffice as a citation in this specific case, or would that be WP:OR? Seppi333 (Insert 2¢) 20:44, 26 May 2016 (UTC)

if you intend to improve it to FA, (IMO)I would find a ref that states "in general...."--Ozzie10aaaa (talk) 22:11, 26 May 2016 (UTC)

Sorry, I should clarify. I know it needs to be cited; the question is would citing the statement in generality suffice ( = the statement is not WP:OR if cited in generality) or should the statement/section be deleted ( = the statement is WP:OR if cited in generality)? IMO, it seems obvious that a hypersensitivity reaction is a drug contraindication, so I'm fairly confident that I can find a ref supporting a general statement about drug contraindications and hypersensitivity reactions fairly easily. Seppi333 (Insert 2¢) 00:46, 27 May 2016 (UTC)

the statement would not be WP:OR...IMO--Ozzie10aaaa (talk) 01:02, 27 May 2016 (UTC)

I think it would be better to leave that kind of statement out entirely, in all articles. "Don't take X if you're allergic to X itself" is obvious, and requiring that tends to mean stuffing articles full of trivia. It'd be better to adjust the suggested(!) sections in the MOS than to have a section with essentially meaningless information. WhatamIdoing (talk) 02:54, 27 May 2016 (UTC)

That sounds reasonable. In any event, while looking at regulatory guidelines I was surprised by the laxness FDA guidance on hypersensitivity contraindications. It doesn't even mention excipients and suggests not mentioning hypersensitivity reactions at all when there are no reported cases of a reaction to the active compound alone. The EU's guideline is much stricter: Hypersensitivity to the active substance or to any of the excipients or residues from the manufacturing process should be included, as well as any contraindication arising from the presence of certain excipients (see Guideline on excipients in the label and package leaflet of medicinal products for Human Use). Seppi333 (Insert 2¢) 03:33, 27 May 2016 (UTC)