Wikipedia talk:Identifying reliable sources (medicine)

The Lancet

This is about [1]. It might sound funny, but The Lancet has less draconian editorial standards than Wikipedia. E.g. WP:PRIMARY medical studies are allowed to make medical claims. tgeorgescu (talk) 03:33, 23 April 2023 (UTC)

I don't think that's quite true. The Lancet has different standards, but not necessarily lower ones. WhatamIdoing (talk) 23:31, 23 April 2023 (UTC)

More tarnish on those holy systematic reviews. The need for open access

Reminds me of mortgage-backed securities helping cause the 2007-2009 Great Recession. Wrapping crap up in fancy paper with a bow. We need people with money to pay all medical journals to make everything open access. Including the mega-problematic anonymized individual participant data (IPD). Then peer review would consist of millions of readers, and Wikipedia editors who aren't easily fooled.

Medicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed? By Richard Van Noorden. July 18, 2023. Nature. Subheading: Investigations suggest that, in some fields, at least one-quarter of clinical trials might be problematic or even entirely made up, warn some researchers. They urge stronger scrutiny.

Excerpts. Emphasis added.

But faked or unreliable RCTs are a particularly dangerous threat. They not only are about medical interventions, but also can be laundered into respectability by being included in meta-analyses and systematic reviews, which thoroughly comb the literature to assess evidence for clinical treatments. Medical guidelines often cite such assessments, and physicians look to them when deciding how to treat patients. ... His work has had a wide impact: researchers found that 27 of Sato’s retracted RCTs had been cited by 88 systematic reviews and clinical guidelines, ... “Untrustworthy work must be removed from systematic reviews,” says Stephanie Weibel, a biologist at the University of Wuerzberg in Germany, who co-authored the review.

--Timeshifter (talk) 06:31, 20 July 2023 (UTC)

Call me naive, but I thought people went into medicine and medical research to try to make people better. But it seems they are human just like everyone else. If truth doesn't matter any more to a large chunk of politicians, and businesses, is it any surprise that truth doesn't matter any more to a large chunk of medical researchers.

In terms of evidence, they are still our best source. And from the article you cite, it seems some groups like Cochrane are starting to include checks for untrustworthy trials. So that would be an extra level of scrutiny above the initial editorial and peer review a paper gets. I think the main issue I've complained about wrt systematic reviews is that they only address a very small aspect of a comprehensive article, and so they aren't great sources for building an article. But the other sources will cite those systematic reviews, so we can't escape them. -- Colin°^Talk 08:42, 20 July 2023 (UTC)

So they say that "in some fields, at least one-quarter of clinical trials might be problematic or even entirely made up". In translation, that means we have a reliable source saying that about three-quarters of clinical trials are probably good in the worst fields (as low as 60% for ivermectin+COVID, but that's not a whole field), and that in most fields, a higher proportion of trials are non-problematic.

That's better than I had hoped for. When the dataset is large enough, having a minority of data faked will not necessarily throw off the overall result. In the Yoshihiro Sato example they give, excluding his work only changed some of the results in half of the reviews that cited his papers. In half the reviews citing the fake work, all of the results were unaffected; in the other half, most of the results were unaffected.

The bit about citing retracted studies is an unsurprising temporal problem: An RTC gets published one year, cited in a review the next year, and retracted in the third year. It would only be surprising if past reviews didn't cite papers that had been retracted later.

BTW, in terms of understanding the scope, it's useful to know that less than 50% of modern medicine is evidence-based to begin with. If you read this thinking that you get 100% evidence, and now it's really just 80% or 90% evidence overall, then you might feel like you had a serious loss. But you're starting somewhere below 50%, and the difference this makes, on average, is both small and expected. WhatamIdoing (talk) 19:36, 20 July 2023 (UTC)

I will always appreciate the oncology prof in grad school who had us read this under-cited article on the staggering failure of cancer prevention treatments (especially vitamin supplements) (by John D. Potter, who, at 129, has the highest h-index I've ever encountered for someone without a Wikipedia article). Intro:

Chemoprevention employs pharmaceutical agents to reduce the likelihood of disease progression, predicated on the assumptions that individuals at risk can be identified, we understand progression and we have effective agents.
In the case of cardiovascular disease (CVD), these assumptions largely hold but for cancer chemoprevention, although we can identify some high-risk individuals, most potential agents have been identified by inference from epidemiologic or laboratory studies; we have a multiplicity of theories of carcinogenesis that do not provide clear understanding of what is causal (1) and, thus, an incomplete understanding of the role these agents might play in cancer.
As a result, cancer chemoprevention is an almost universal failure.
There are enthusiasts for the possibilities of cancer chemoprevention (2) but they have been selective about their review of the evidence as I will show below.

Basically, only aspirin and tamoxifen seem to be at all beneficial in high-risk individuals, and even those drugs shouldn't be encouraged as preventative measures in non-high-risk people. JoelleJay (talk) 23:43, 20 July 2023 (UTC)

My favorite prof once said that the main result of taking a multivitamin (for an otherwise healthy person) was "expensive urine". That throwaway comment may have saved me more than a thousand dollars over the years. WhatamIdoing (talk) 00:18, 21 July 2023 (UTC)

I am surprised that an experienced editor such as yourself passes down such info as received wisdom. You have the right to believe what you want to believe. Like doctors who used to smoke in hospitals and said it was fine. Or that white bread was as good as whole-grain bread because the white bread had vitamins added to it. Or that food grown on poor soil is as healthy as food grown organically. I prefer this:

https://www.google.com/search?q=epidemiological+studies+of+natural+diets

https://www.google.com/search?q=epidemiological+studies+of+diets+with+many+synthetic+additives

https://www.google.com/search?q=human+vitamin+deficiencies+from+foods+grown+in+poor+soil

https://www.google.com/search?q=dietary+supplementation+for+people+eating+foods+grown+in+poor+soils

Dirt Poor: Have Fruits and Vegetables Become Less Nutritious? Scientific American. Subheading: Because of soil depletion, crops grown decades ago were much richer in vitamins and minerals than the varieties most of us get today.

I bet there were systematic reviews back in the day that said smoking in hospitals by doctors and patients was fine.

https://www.google.com/search?q=doctors+used+to+say+smoking+was+healthy

--Timeshifter (talk) 02:19, 21 July 2023 (UTC)

Timeshifter, WhatamIdoing was specifically referring to multivitamin tablets. None of the links you give address whether taking them does anyone any good (or even, causes harm, which seems to be the case for antioxidant supplements, particularly if you smoke as well). We know that a few specific vitamins and minerals are worth supplementing in our diets. So there is advice for example of folic acid, iodine and vitamin D. Some of these get added to our processed food or are encouraged as supplements (e.g., the UK advises vitamin D in winter months).

And, no, I don't think there were ever systematic reviews saying smoking was fine. The big pyramid pictures on this guideline page have systematic reviews at the top, wrt quality advice, and "background information / expert opinion" at the very bottom. Those doctors in the past, who smoked, who said it didn't cause me any harm and a good hearty cough each morning was a good thing, were very much demonstrating the low quality of opinion by so called "experts" who lack actual research data but were in the pocket of tobacco firms.

There is a danger in becoming too disillusioned about the science. That opens us up to the deliberate tactics used by anti-science organisations such as climate change deniers and the supplement industry that want folk to think the science is uncertain or that everyone is a crook so who can you trust (the bright orange politician, or the pretty actress of course). -- Colin°^Talk 07:58, 21 July 2023 (UTC)

"There is a danger in becoming too disillusioned about the science". Fun fact, the discoverer of Prions and Nobel Prize winner was funded by the tobacco industry (https://www.aan.com/siteassets/home-page/footer/about-the-aan/history/prusiner-interview.pdf) in this sort of "anti mainstream" / "who knows anything" / "look at all the other dangerous things" play. Kind of conflicting isn't it! Talpedia 12:10, 21 July 2023 (UTC)

Cigarettes were once ‘physician’ tested, approved. March 10, 2009. In HemOnc today (Hematology/Oncology). Subheading: From the 1930s to the 1950s, ‘doctors’ once lit up the pages of cigarette advertisements. "The pages of The New England Journal of Medicine and The Journal of the American Medical Association were home to many tobacco advertisements throughout the 1930s, 1940s and beyond. ... finding researchers who could substantiate the medical claims that the company was making in advertisements. Now the company was able to refer to research findings in their advertisements, both to consumers and to physicians." --Timeshifter (talk) 15:38, 21 July 2023 (UTC)

"finding researchers who could substantiate" is not the same thing as finding "research" that can substantiate the medical claims, and a long way from a systematic review of high quality research (e.g. RCTs). All it means is that in those days you could pay anyone to say anything about tobacco. -- Colin°^Talk 07:44, 24 July 2023 (UTC)

And decades later, there is still no scientific evidence supporting multivitamins for the general public: doi:10.1001/jama.2022.8970, doi:10.7326/0003-4819-159-12-201312170-00011, doi:10.3945/ajcn.112.049304. WhatamIdoing (talk) 02:48, 22 July 2023 (UTC)

The Evolving Role of Multivitamin/Multimineral Supplement Use among Adults in the Age of Personalized Nutrition. 2018 Feb 22. doi: 10.3390/nu10020248. Nutrients (journal). "Micronutrient deficiencies occur in segments of the adult population in the United States. Multivitamin/multimineral supplements (MVMS) are widely used by this population, which reduces inadequacies in micronutrient intake, ... The role of MVMS in health maintenance and chronic disease prevention remains controversial. Conducting studies in this area has been hampered by, among other factors, inconsistent definitions of MVMS, ranging from as few as three vitamins to broad-spectrum products containing more than two dozen vitamins and minerals. Results from some observational studies and large-scale, randomized, controlled trials suggest that MVMS may reduce the risk of some forms of cancer and, potentially, cardiovascular disease. The ongoing COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is expected to build on this research and provide additional insights into these areas." --Timeshifter (talk) 03:24, 22 July 2023 (UTC)

Did you notice that the lead author of that study is "a consultant to companies that manufacture or market dietary supplements", and another is being paid by the COSMOS study, and all of them were paid to attend conferences and spout the party line by major manufacturers of vitamins and supplements? And even then, they didn't feel like they could make a statement stronger than "some" (cherry-picked?) students "may" have a positive effect. WhatamIdoing (talk) 03:47, 22 July 2023 (UTC)

Effects of vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries: A systematic review. 26 June 2021. https://doi.org/10.1002/cl2.1127 - Campbell Systematic Reviews. "The findings suggest that MMN [multiple micronutrient] and vitamin supplementation improve maternal and child health outcomes, including maternal anaemia, LBW, preterm birth, SGA, stillbirths, micronutrient deficiencies, and morbidities, including pre-eclampsia/eclampsia and diarrhea among children. MMN supplementation demonstrated a beneficial impact on the most number of outcomes. In addition, MMN with >4 micronutrients appeared to be more impactful than MMN with only 3 or 4 micronutrients included in the tablet." --Timeshifter (talk) 04:19, 22 July 2023 (UTC)

Normal lifespan: 1000 months.

Amount of time most women in developed countries spend pregnant: 18 months.

I'm willing to admit that a Prenatal vitamin has some value. Are you willing to admit that 99% of the (modern) human life is spent in a non-pregnant state? WhatamIdoing (talk) 21:11, 22 July 2023 (UTC)

Also, I want to say that this whole exchange feels very weird. Unless you have some sort of massive conflict of interest (maybe you're involved in one of those MLM companies like Melaleuca or Shaklee?) and you think that my comment will somehow have a substantial effect on vitamin sales, I really can't imagine why you should care whether or not I buy multivitamins. WhatamIdoing (talk) 21:17, 22 July 2023 (UTC)

Believe it or not, my posts were not about you. And I have no conflicts of interest. I learned a lot from this exchange, and the web reading I did. I found various trials of multivitamins, multiminerals, etc.. that got positive results. But I didn't want to clutter up the page with single trials.

What I learned is that the best trials broke down the results by subgroup. Then there were some positive significant results. But if the results were measured and averaged out for the group as a whole, then then there may have still been a positive result. But not a significant one. Because of the averaging.

It makes sense. Especially if your group includes people of all incomes in a developed western country spread out across the country. But if you do studies of people with higher nutritional needs, like pregnancy, or poor people living in food deserts. Or people in poorer countries or regions. Or people getting their food from poor soils in densely populated regions. Or old people in nursing homes. Etc., etc.. Or people who are sick.

I could go on and on, but I don't want to waste the time of people on this forum. And people who take multivitamins, etc. are mostly taking them as insurance. The shotgun approach. You never know if your particular genetics may need them. Or if you are beginning to get sick, etc.. Or you are someone who needs the higher limits of the RDAs, but foods no longer provide as many nutrients as before.

It don't want to argue with people who don't see the value of organic food, and avoiding synthetic additives. More and more studies show doing both help. But I remember decades ago when few studies were done. Because you can't patent anything to make money from the knowledge. But the logic is obvious. Every year more additives are found to be dangerous. Every year more medical conditions are found to be improved in some way by some nutrients.

From my first post: "We need people with money to pay all medical journals to make everything open access." Then we all can provide constructive criticism. Like why are you not breaking down your huge group into subgroups. Why aren't you doing a systematic review of trials with those subgroups. --Timeshifter (talk) 03:38, 23 July 2023 (UTC)

You opened this topic by noting that dodgy research was making its was into systematic reviews and then conclude by citing dodgy research that supports the opinion that we should take multivitamins. Multivitamins are not "insurance". For one, while you cite your genetics being unknown, so is whether you currently have a cancer growing. Taking antioxidants if you have cancer[2] may actually make things worse or make you more likely to develop it ("Some of the largest clinical trials, in fact, had to be aborted because the patients receiving antioxidants had a higher incidence of cancer than patients who did not receive them."). The overwhelming advice for vitamins and minerals is that they do you good when packaged inside fruit and vegetables, but when you take them in a pill, only a few are recommended and even then not necessarily to take all the time by everybody. The second reason is the idea that one could continue to eat junk food or insufficiently healthy food, and just pop a multivitamin to make up for it. No evidence for that. And anyone concerned about eating "synthetic additives" should certainly avoid supplement pills, which are..... synthetic. They don't grow on trees. -- Colin°^Talk 08:51, 24 July 2023 (UTC)

I did not cite any dodgy research saying that we should take multivitamins. To the contrary, the article I cited said: "The role of MVMS in health maintenance and chronic disease prevention remains controversial."

And it is well-known that taking vitamins and minerals in megadoses can be dodgy. There are many studies that break down what are dangerous levels. Vitamins may be synthetically made, but are usually identical to the versions found in nature. If not, they should be considered to be a pharmaceutical. Like the form of Vitamin E (dl-tocopherol) that is not found in nature. Substituting supplements for healthy foods is dodgy. But some people don't get enough sun, and have to take vitamin D.

Some people eat food from regions with low iodine in the soil. So they eat iodized salt. Some people have vitamin deficiencies created by their medications. So they have to take supplements. I have taken medications where I had to be tested for those vitamin deficiencies. I could go on and on. Nutraceuticals are another area. Many may not be essential to one's health. They have to pass muster with studies, too, as to safety, effectiveness, etc.. Just like pharmaceuticals. Of course, there is little incentive to do those necessary studies since there is no patentability and profit motive. I believe in studies. I wish more were done. --Timeshifter (talk) 18:22, 24 July 2023 (UTC)

WhatamIdoing already pointed out what is dodgy about the studies you cited. Lots of the additives in food are "found in nature" and aren't classed as pharmaceuticals either. Here's Tesco Multivitamin pills:

• Bulking Agents (Microcrystalline Cellulose, Calcium Carbonate)
• Vitamin C
• Vitamin E
• Modified Maize Starch
• Niacin
• Glazing Agents (Hydroxypropyl Methyl Cellulose, Talc)
• Pantothenic Acid
• Anti-caking Agents (Silicon Dioxide, Magnesium Salts of Fatty Acids, Fatty Acids)
• Colours (Calcium Carbonate, Iron Oxides and Hydroxides)
• Vitamin B6
• Thiamin
• Riboflavin
• Vitamin A
• Folic Acid
• Antioxidants (Alpha-Tocopherol, Sodium Ascorbate)
• Vitamin K
• Biotin
• Vitamin D
• Vitamin B12

Nothing in this pill is a fruit or a vegetable or a cake your mum just made. It is even more artificial than a highly processed fried chicken, sausage roll, or ready meal lasagne, because at least those contained actual chicken or actual pork or actual beef, whereas this contains no actual food at all. This is 100% additive. -- Colin°^Talk 10:46, 25 July 2023 (UTC)

"Lots of the additives in food are 'found in nature'". I don't have a problem eating foods with those additives.

And that multivitamin is not that bad. Most of the additives are found in nature. And I don't see any artificial colors or flavors.

There are multivitamins, multiminerals, and single vitamin/mineral supplements with all the additives being found in nature.

I am not trying to convince you or anybody else to take supplements.

I am looking at how systematic reviews function, or don't function. Something that has interested me for awhile. Systematic reviews don't say that you should or should not take supplements. They pretty much can only point out the dangers of particular supplements at certain levels. Same is true for food. Eating too much of almost anything can be unhealthy. Drinking too much water can kill you. --Timeshifter (talk) 11:13, 25 July 2023 (UTC)

One does want to be careful about the "nature is good" idea. Aside from the obvious – what, nobody fancies a nice salad of organic poison ivy today, with crunchy natural asbestos topping? – I see two "natural" inactive ingredients in that list above that are known carcinogens (though one is really only a concern if you inhale it, rather than swallowing it).

Systematic reviews function better than all of the available alternatives for their main purpose, which is determining whether there is an overall trend in the published global data. There are limitations (e.g., they cannot account for unpublished data or undetected fraud) but the limitations are less than the alternatives (e.g., relying on a single study, which might be 100% fraudulent rather than merely including some fraudulent data among the honest data). WhatamIdoing (talk) 16:21, 25 July 2023 (UTC)

Some multivitamin/multimineral studies with positive results are found here:

• Should I Take a Daily Multivitamin?. "Last reviewed June 2023". The Nutrition Source. Harvard T.H. Chan School of Public Health. Wikipedia: "currently ranked as the best school for public health in the world by both the Academic Ranking of World Universities and EduRank. It is also ranked as the second (tie) best public health school in the nation by U.S. News & World Report."

Scroll down to the section called: "Who May be at Risk for a Nutrient Deficiency?" it says: "Certain groups are at higher risk for a nutrient deficiency:" It lists them.

Scroll down to "Multivitamins and Health". It says: "There is no arguing that multivitamins are important when nutritional requirements are not met through diet alone."

Then scroll down to this paragraph near the end:

For many diseases, but especially for cancer, only long-term trials are informative. The following studies looked at the effect of multivitamins on specific diseases and included healthy people as well as those with chronic diseases at the start of the study:

Click the 4 dropdowns for: Cancer. Cardiovascular disease. Mortality. Cognitive Health. Positive results for 2:

Cancer:

A randomized double-blind placebo-controlled trial provided a multivitamin or placebo to more than 14,000 male physicians, some with a history of cancer. After 11 years, the men taking a MVI had a significant 8% reduction in total cancers, compared with men taking a placebo. The results did not differ among men who had a history of cancer at the start of the study and men who were healthy at baseline.

Cognitive Health:

The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a large randomized controlled trial that followed more than 21,000 older men and women (≥60 and ≥65 years, respectively) ... Results showed that taking a daily multivitamin-mineral supplement improved memory and executive functioning (e.g., time management, planning, self-monitoring) more than a placebo. The benefit appeared strongest for participants with a history of cardiovascular disease (CVD);

There is some contradictory info above those positive results. The difference seems to be "only long-term trials are informative."

This is a very useful caveat as to whether a systematic review is the final word on something. Was it a systematic review of short-term studies?

Concerning systematic reviews the more transparency the better. We need funding to make all medical journals and studies open access. The Nature article in my original thread post said: They urge stronger scrutiny.

Billionaires and the government need to put money in this area. Researchers make many mistakes. More readers and reviewers allows more useful feedback. And it makes healthcare more effective. Especially, cost effective. --Timeshifter (talk) 22:39, 25 July 2023 (UTC)

I think we are getting off the track for what MEDMOS talk page is for. Consider two things. You aren't citing any systematic reviews, which is what this section is about, but citing individual trials. And secondly, take your cancer trial for example. If a trial in 2012 truly demonstrated that popping a simple multivitamin pill each day significantly prevented cancer, you'd think that in 2023 various government and cancer bodies would recommend we all do that. They don't. And no, there's no conspiracy. This is a hundred billion dollar industry. If they could push for those recommendations, they certainly would. This suggests to me there were other possibly better trials that found no effect. Which is what systematic reviews are designed to achieve. Any old "expert" (particularly if their shiny new supplement research lab was funded by industry) can cherry pick research that supports their opinions. That's one of the reasons we love systematic reviews for evidence on Wikipedia and don't want articles to directly cite primary research studies. -- Colin°^Talk 08:29, 26 July 2023 (UTC)

How this applies to certain articles

I'm not sure if this is the right place to ask this. Here's an example, from Dandelion coffee:

Dandelion root has been linked to a possible treatment for cancer.

The source for this is strictly primary. There are many similar statements on other pages about, generally, plants. Does this not violate WP:MEDRS? ByVarying | talk 01:46, 12 August 2023 (UTC)

@ByVarying, saying that something cures cancer (or even that it might be kinda-sorta linked to a possible treatment for cancer – it doesn't matter how many weasel words are put in there), based on any single primary source, is generally not a desirable way to write an article. If you were going to keep the section, I might change the "It has been linked" approach to something that sounds more like "Someone did some research in 2016".

However, in this particular case, you might be able to do better than that. It's possible that it could be updated based on secondary sources such as PMID 33719631, PMID 33187200, PMID 32377288, or PMID 36207736. (Some of these may be lousy journals or may not prove to be useful in practice; caveat lector.) WhatamIdoing (talk) 04:39, 12 August 2023 (UTC)

MEDRS required for activities of an NGO?

I would like to seek clarification on whether MEDRS are required in a section on the activities of an environmental NGO working on, for example, toxic chemicals and drinking water contamination. My interpretation is that the second example in WP:MEDRS#Biomedical v. general information is pretty comparable, as long as the content is what they do, rather than what they have proven. Wikipedia:Biomedical information does not contradict this interpretation either. (The situation would obviously be different if an NGO's publications on such a topic were used in articles on chemicals as sources of information on, for example, their effects or human exposure.) --Leyo 08:55, 23 September 2023 (UTC)

I haven't looked at the article in question, but in general it would depend if there was any biomedical implication. A statement like "${CHARITY} is working to improve water quality in ${LOCATION}" is WP:NOTBMI, but "${CHARITY} is working to raise awareness of the cancer-causing contaminant ${SUBSTANCE}" would be. Bon courage (talk) 09:17, 23 September 2023 (UTC)

Thanks. Do you agree that if "cancer-causing" is deleted (and ${SUBSTANCE} is linked to its article), also your second example would be WP:NOTBMI? --Leyo 13:52, 23 September 2023 (UTC)

It would be difficult to do it in a way which either didn't imply there was something harmful at hand, or leaving out information to the extent it would be mysterious and baffling to the reader. Having now looked at the article, I see this is about Per- and polyfluoroalkyl substances. Surely there's some mainstream sourcing on what the risk of this is to contextualize any mention of advocacy around it? Relatedly, I notice the Per- and polyfluoroalkyl substances has some dodgy claims from non-MEDRS sources. Bon courage (talk) 14:56, 23 September 2023 (UTC)

I have seen more than one discussion where the question has been raised as to whether MEDRS is needed for the activities of a particular NGO. --Leyo 19:21, 23 September 2023 (UTC)

Like almost all hypothetical questions, it depends. If 'what they do' is make fringey medical claims, MEDRS is going to come into it very rapidly. If 'what they do' is block whaling vessels, then obviously it won't. It isn't going to be possible to get any kind of blanket answer on this. MrOllie (talk) 19:30, 23 September 2023 (UTC)

Are we talking about Environmental Working Group? It would be better to see what statement in which context we are talking about. It is often easier to generalize from one or more examples than the other way around. Polygnotus (talk) 20:44, 23 September 2023 (UTC)

Yes, that's indeed a recent example. See this RfC for details, including a text proposal. --Leyo 21:24, 23 September 2023 (UTC)

Yeah, the EWG page is where there's been opposition to MEDRS lately. The short of it is that the EWG is known for pushing a lot of fringe stuff between anti-GMO, vaccines=autism, etc., so we've been trying to stick to what MEDRS sources have to say about the groups advocacy to sort out what's really WP:DUE there for some time now. That's in part because WP:MEDPOP sources aren't reliable for the EWG since they frequently cite their reports uncritically (a problem addressed in MEDRS sources actually). Things like the Dirty Dozen list are one such example, but that did make the cut because MEDRS sources mention it (and point out the fringe nature of that activity).

Others like PFAS advocacy really haven't had MEDRS sources presented that significantly mention the EWG's work in this subject (as opposed to all the other research groups out there) outside of brief one-liners or name dropping at best. That's where the main rub has been. Their activity in this subject just doesn't come across as WP:DUE in MEDRS sources, much less whether EWG is even semi-reliable in this topic compared to all their other fringe stuff. In these cases, news reports about primary studies the EWG has put out have been the main sources being used to try to insert content, so there's always that tie to primary research without good secondary sources that runs into issues with MEDRS. The main questions for a group like this is if their research activity is noteworthy according to reliable sources (i.e., MEDRS, not newspapers) and also if that research is considered accurate. KoA (talk) 03:32, 24 September 2023 (UTC)

• The difficulty is less when discussing an NGO and more when discussing pseudoscience claims, whether pushed by an NGO or anyone else. Which does need MEDRS backing in order to put plainly in an article, because even if the claims are accurately being sourced to the NGO, the accuracy of the claims themselves are not being properly balanced with scientific sourcing. Silverseren^C 22:01, 23 September 2023 (UTC)

Exactly. Who made the claim shouldn't affect how we deal with it imho. Polygnotus (talk) 22:58, 23 September 2023 (UTC)

The one caveat I'd say with that is it can matter when it's a fringe advocacy NGO on health subjects saying something. We're usually going to be more cautious and lean into MEDRS even more then, but the pathway in how we deal with it isn't substantially different. KoA (talk) 03:32, 24 September 2023 (UTC)

The (majority of) EWG's on PFASs is clearly not pseudoscience. They have even been collaborating with a university. And again, it's about text on their activities in their article, not in an article on a scientific or medical topic (e.g. about specific chemicals and their health effects). Furthermore, the text can be phrased in a way what makes it clear that their findings are not accepted by all stakeholders (if applicable).

KoA, may I ask you to refrain from using pluralis majestatis, when it's actually your own position? Thanks. --Leyo 05:58, 24 September 2023 (UTC)