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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

Patient blood management: need to remove puffery

I think (?) that the actual medical claims down the article are reasonably sourced. However, it also contains a lot of non-medical, puffery material (e.g. "patient blood management is a patient-centric approach" looks good on a marketing brochure, but it has zero actual meaning in an encyclopedia article). I have cut the worst from the lead, but much remains. At that point I am afraid to cut actually useful content with the puff - if anyone wants to give it a go... Tigraan^{Click here for my talk page ("private" contact)} 10:26, 22 November 2022 (UTC)

thanks for post--Ozzie10aaaa (talk) 14:18, 27 November 2022 (UTC)

Pandemic's over?

Discussion could probably use medical editor input at

• Talk:COVID-19 pandemic#Extended-confirmed-protected edit request on 17 November 2022

About whether Wikipedia needs to move on from the "stubborn" WHO and stop saying that there is still a pandemic.

Relatedly,

• Endemic phase of COVID-19 (edit | visual edit | history) · Article talk (edit | history) · Watch

has been nominated[1] for GA. I am concerned this is in large part an assemblage of what various politicians have said at various times about COVID being endemic in their countries, with little explanation of what that means and/or how accurate it is. Bon courage (talk) 07:20, 24 November 2022 (UTC)

thank you for posting here...yes the COVID-19 pandemic article has not been easy --Ozzie10aaaa (talk) 14:06, 24 November 2022 (UTC)

Given that Ghebreyesus of the WHO said that "the end is in sight", I don't understand why any editor would seek to waste time getting it declared over by Wikipedia (as if that means much anyway) when it might actually be over in the not too distant future and then we would just change it without any controversy. Crossroads ^-talk- 21:29, 24 November 2022 (UTC)

I don't think there is any standard by which the pandemic could be deemed to have concluded globally. BD2412 T 22:03, 24 November 2022 (UTC)

Lots of the endemicity content is actually emergent across many months and last year. I recently added a section on Lebanon from a source published in February. Malaysia transitioned toward endemicity in October 2021. The endemic article was spun off Living with COVID which was then integrated boldly back into the endemic article. While endemicity is a bit constraining it serves as the assemblage of endemicity/living with covid/new normal etc in aggregate. There's plenty of substance and nuance here and in the interest of building an encyclopedia it is beneficial to readers to include this material in the project, since sources observe it. We defer to sources and we use due weight accordingly. This is a subject that hasn't been well-represented on wiki and I am happy to have contributed significantly to the project by expanding it. As I said on the COVID pandemic talk page, the lead currently does not mention this material, which is not compliant with MOS. SmolBrane (talk) 04:14, 25 November 2022 (UTC)

The transition to endemicity is an ongoing process at varying phases all around the world, so I don't see how that article could be stable anytime soon. Maybe in the future when the WHO has declared it no longer pandemic, and COVID policies have been stable for a while, it could be nominated if it meets the criteria, but right now I would suggest withdrawing the nomination and refocusing on documenting how things are right now, rather than jumping the gun and trying to edit based on ideas about how close or not full endemicity is. Crossroads ^-talk- 05:14, 25 November 2022 (UTC)

Instability in the WP:GACR refers specifically to edit wars and content disputes, and the article isn't changing day to day. "Good faith improvements" and "potential instability in the future" are not grounds for failure either, according to the criteria. Editing on this article has been pretty straightforward and reasonably infrequent actually, not much different from the COVID-19 pandemic article which was also recently reviewed.

I'm also really interested in the general quality of the article currently; it doesn't need to pass if it isn't ready. There are six criteria for good article status and I'd love to hear feedback on the other five areas regardless. This is the first article I've created and I learned lots from the review of the COVID pandemic article. Based on criteria at WP:GVF I think the endemic article is certainly within the reach of being "decent". More editor participation on the article is desired--as per WP:GAN "anyone may nominate an article" and "nominators should respond positively to constructive criticism and work with the reviewer to improve the article" which is precisely my intent here. In my pursuit of collaboration and consensus-building the nomination will not be withdrawn. SmolBrane (talk) 18:16, 25 November 2022 (UTC)

The article has a systemic POV problem. What is the purpose of relaying that Jair Bolsonaro said Brazil was entering an endemic stage in March 2022? He said a lot of stupid things. What actually is Brazil's status? There seemed to be a wave following Bolsonaro's pronouncements. We're in danger of Making Wikipedia an uncritical relay of politicians' anti-scientific talking points.[2] Bon courage (talk) 18:37, 25 November 2022 (UTC)

Not sure if that source is due; they cite their own podcast--you could add it to the article, I suppose, but you know sources well and you haven't for some reason. Not a lot of substance in that article. Anyway, we defer to RSes of course--kindly aim your concerns of rigor at them. If 'endemic' is being misused by politicians it needs to be established by secondary sources. Some of these statements are coming from experts--the Lebanese commentary I mentioned earlier comes from Abdul Rahman Bizri, a specialist of Infectious Diseases and Clinical Microbiology. Unless you have a suggested edit I see nothing actionable in your comment here. SmolBrane (talk) 02:23, 26 November 2022 (UTC)

@SmolBrane, I skimmed over the article. I had a lot of paragraphs that said "On this exact date, someone said something". What I was hoping to find was something more like this:

"This country had lockdowns and other significant restrictions from March 2020 to July 2021, but then changed the policy in August 2021 to _______, and further loosened restrictions a year later, to the point that COVID-related restrictions are nearly the same as how they approach seasonal influenza. The two main differences are that healthcare workers and some others who experience any COVID-related symptoms must test negative before returning to work (which they don't have to do for flu) and that it's no longer unusual for people to wear masks indoors, which was nearly unheard of in this country before the pandemic started", maybe followed by a description of how the situation is going (e.g., case load).

I was really hoping for a general, non-politician-focused summary of the overall situation. WhatamIdoing (talk) 03:23, 26 November 2022 (UTC)

Most of my additions to this article were intended to be concise; you can probably find more context in the sources and expand the content if you find them DUE. Let's be clear that these are qualified individuals discussing endemicity, not simply some people saying some things. We don't have sources casting doubt on these individuals despite the fact that they are often politicians(often heads of states, in fact).

It's also possible that the sources simply don't offer what you are 'hoping for'; it is of course our job to follow the sources. It is not our job to try to project what endemicity might look like on the behalf of our sources. We have to assume that endemicity is endemicity; to do otherwise is WP:OR(analysis or synthesis of published material that serves to reach or imply a conclusion not stated by the sources). SmolBrane (talk) 05:37, 26 November 2022 (UTC)

To take the example above, Bolsonaro is not qualified[3] for anything in the realm of science (or reality probably). Politicians say things for political reasons and that might include giving their country "good news" about the end of the pandemic, no matter whether it's true or not. Bon courage (talk) 09:25, 26 November 2022 (UTC)

Of course Bolsonaro is not a qualified scientific expert. But he's a highly qualified person when you understand the statement less as a statement of scientific fact, and more as a statement of government policy. The wording of that sentence strikes me as quite carefully written: "the country is looking to downgrade COVID-19 to the status of an endemic." The linked source says "countries have expressed their desire to start treating COVID-19 as an endemic disease like the seasonal flu". This is a statement about future government policy plans. Science does not "have a desire to start treating COVID-19 as", well, anything. WhatamIdoing (talk) 20:33, 26 November 2022 (UTC)

This article should reflect scientific knowledge, the only form of reliable knowledge. Hence articles not linking to WHO, Nejm, lancet etc, I simply dont click. Arguments based on media ...well are aimply not valid. Cinadon36 07:59, 26 November 2022 (UTC)

• Note Talk:Endemic phase of COVID-19/GA1 has ended as a quickfail, with similar concerns being raised to here. Bon courage (talk) 09:34, 26 November 2022 (UTC)

  There's more to this subject than science. Science doesn't determine whether we should do something or what we should call it. Science can tell you that requiring hospital staff to test for COVID frequently will reduce in-hospital transmission of COVID and staffing levels. Science can even, eventually, if the right data is collected, tell you whether the variable and lower staffing levels will kill more patients than COVID, and what the effect would be if the same was applied to influenza. But science can't tell you whether a given society should value reduced transmission in a hospital more than it values reliable staffing levels in a hospital, and it can't tell people how they should feel and how they should respond when their needs are being de-prioritized in favor of someone else's needs. This article needs some science, but it also needs some non-science. Don't be fooled by the slogan that non-science is nonsense. Human values are not nonsense. WhatamIdoing (talk) 20:28, 26 November 2022 (UTC)

  I'm with you on this, and this fits nicely with another social media phenomenon that we'll need to watch out for lest it bleed into Wikipedia, which is implicitly using "science" to mean simply "suppressing transmission", and valuing that above all else. Science can tell you how to suppress transmission, but it cannot tell you how much to value normalcy, unhindered socialization, and so forth. It's pretty obvious that most societies at this point (except maybe the Chinese Communist Party) value things other than maximal transmission suppression.

  Mainstream scientists understand this, which is why reputable groups and public health agencies throughout the world have been updating recommendations and regulations to not simply be focused on case numbers and to account for the fact we have vaccines and so forth. We have to watch out for undue weight for the fringes on either side, both the "we should have done nothing" camp and the "restrictions for as long as the virus exists" camp. Crossroads ^-talk- 22:44, 26 November 2022 (UTC)

  @WhatamIdoing: Indeed, an interesting (lay source) article in The Atlantic[4] discusses how the term is contested in politics (and even among scientists) and how even some people think because it begins "end..." it means the "end of COVID". I'd prefer to see an article where pronouncements by various people are contextualized by a discussion of what endemicity is, rather than have an assumption it means something like "we're free!" and then listing people who've used the term. Bon courage (talk) 09:33, 27 November 2022 (UTC)

  @WhatamIdoing sorry for the delayed reply. I am well aware that there is much in love outside science, ie our choices, what to do etc. But when it comes to epistemology, that is understanding reality or the nature of reality, nothing beats science. So, if there is a flying object orbiting around earth, if there is a disease spreading around, if there is climate change, all these issues are within Science domain. Wikipedia should reflect how Science perceive reality, not to dictate our actions (suggest what we should be doing). Cinadon36 07:27, 28 November 2022 (UTC)

Arbitrary break

Not sure what the goal with the sentiments here are. We have DUE material sourced to secondary sources. I feel like editors(including myself) are at an impasse, and I feel like I've made myself clear. There is a lack of suggestions here for editing. Perhaps a wider RfC or nomination for deletion should be attempted. Wider community input can resolve this issue one way or another and develop a precedent so we can stop talking past each other. Regards, SmolBrane (talk) 21:47, 26 November 2022 (UTC)

I'm not sure if this is stated anywhere in guidelines, but IMO some articles just cannot be made GA at this time due to their controversial nature. If it was years from now, the pandemic having been officially declared over years ago, all Covid policies basically matching those of seasonal flu pre-Covid, and those haven't changed in years, then the topic will be much easier to edit. I look forward to that day, but we're just not there yet. In the meantime, a lot of good work can still be done. In fact, there's a number of articles and sections, like here, that document things like the imposition of restrictions in excruciating detail and that speak as if they are still in place, and like everyone is behaving like they did in 2020, which is not true. The end of these things and the ever-gradual return to normalcy need to be documented too. Crossroads ^-talk- 22:25, 26 November 2022 (UTC)

I'm not too concerned about the cursory rejection of GA status, it was mostly a nomination in the pursuit of improving the article in a nuanced way. I'm not sure if I got what I wanted there, but there is work to be done and I have limited time for wiki anyway. Getting any feedback in an active way is appreciated. Changes in COVID related interventions at the public health level need to be documented and I have been working in the relatively explicit area of endemicity for this reason. Many articles are not well updated and I am also trying to help POV to some degree by staying focused here.

More generally I am fascinated with how wiki deals with divergence in professional statements and what appear to be emergent POV forks and the related challenges. Not to mention the challenges of politicians making MEDRS-type statements. We outsource our rigor to RSes, and we cannot presume that non MEDRS RSes are misusing terms without sources suggesting as such. What concerns me is the sentiments in this section that seem to suggest that the secondary sources are not saying what they should. Endemicity is a big statement, and it needs accurate representation on the project. I will continue working in this area, and it will be telling to see how long the MOS:LEAD noncompliance(my opinion) remains on the COVID-19 pandemic article. Let me be clear that I am not trying to canvas on that matter, simply observing the issue as I currently see it. SmolBrane (talk) 02:12, 27 November 2022 (UTC)

I won't even go look at the lead, to avoid being tempted to "fix" it, especially since I wouldn't be fixing it properly.

I would love to see (the sources existing so we could re-write the article to use) a regional or category-based approach. From what I hear, the public health positions of most low-income countries were tuned towards endemic status a long time ago. This isn't a case of "this one country"; it's a case of "the entire Africa continent, with one or two exceptions". Similarly, while it's easy enough to say "France did this" or "Germany said that", the EU countries did most things in concert, so the case is really "Europe, with one or two exceptions". WhatamIdoing (talk) 00:40, 28 November 2022 (UTC)

I had looked for commentary in Africa and elsewhere a few weeks ago but didn't find anything. What you hear may very well be the case but I haven't seen a source on it.

Ozzie10aaaa had made an image for the endemic phase section on the COVID-19 pandemic article but it only featured Mexico as an example. If it is straightforward to generate a similar image that demonstrates COVID status by region it would be helpful and productive. SmolBrane (talk) 04:17, 28 November 2022 (UTC)

The Atlantic article mentioned by Bon Courage (above) [5] summarizes the situation regarding the definition of 'endemic' exceptionally well. Any editor thinking of modifying a relevant article may wish to consider it a "must read". Jaredroach (talk) 17:45, 27 November 2022 (UTC)

I did read it and it does make some good points regarding us not really knowing yet what endemicity will be like, though I would be a bit cautious of treating one pop-media article as too much of an authority. The media isn't always good at getting a representative sample of experts, and even the best written article can become out of date as the situation evolves and as endemicity gets closer and possibly clearer in nature. The article notes some researchers who don't even agree that the flu is endemic, but of course the flu isn't pandemic either.

Since it isn't endemic yet we can't say for certain what it would look like, but when we do get there we should rely on sources describing that time, and even thereafter be ready to keep updating because things will still probably be normalizing after it's officially declared for some time. And right now describing some jurisdictions and health authorities who have moved towards endemicity, directly relevant sources are important for that as well. Crossroads ^-talk- 02:26, 28 November 2022 (UTC)

I agree with the critical component of what you said about the Atlantic article here--I mean, it's literally titled "Endemicity is meaningless". Still not sure what the reticence is towards endemicity, the recent Finland addition comes from virologist Mika Salminen, the director of the Finnish Institute for Health and Welfare--he has twelve thousand citations on google scholar... SmolBrane (talk) 03:35, 28 November 2022 (UTC)

I don't think anyone is challenging that Finland addition, nor should they. That doesn't mean it's truly endemic worldwide yet, but it is a noteworthy development. The situation is always changing and has been ever since the pandemic began, and so it's always taken a balance about being careful not to make excessive assumptions about the future while also not being stuck in the past, leading to good-faith disagreement. With time more sources and developments appear and it becomes clearer to all eventually. Crossroads ^-talk- 04:19, 28 November 2022 (UTC)

A "world view" from Nature earlier this year:

• Katzourakis A (January 2022). "COVID-19: endemic doesn't mean harmless". Nature (World view). 601 (7894): 485. doi:10.1038/d41586-022-00155-x. PMID 35075305.

again noting the disconnect between political and epidemiological uses of the term "endemic". Bon courage (talk) 04:25, 28 November 2022 (UTC)

"World view" isn't a peer-reviewed research article, and is more about presenting the views of a particular scientist as far as I can tell. While it's correct that endemic does not in itself mean "do nothing", at the same time that article seems to take a stance of 'we should still fight transmission intensively with restrictions etc.' This should not be given undue weight; judging by how things have been going since then, it seems that most public health agencies are relaxing restrictions on personal behavior even while they do other things like focus on vaccination, etc.

Central to the issue, of course, is that knowing what endemicity will look like isn't even possible now, let alone in January 2022 when the Omicron variant was causing massive waves in cases and hospitalizations all around the world. We still don't know what endemic levels of disease from Covid-19 would even look like, so nobody can possibly know what society's response will or should be.

Also, "politics" cannot be entirely disentangled from this subject; as WhatamIdoing said earlier, "Science doesn't determine whether we should do something or what we should call it....But science can't tell you whether a given society should value reduced transmission in a hospital more than it values reliable staffing levels in a hospital, and it can't tell people how they should feel and how they should respond when their needs are being de-prioritized in favor of someone else's needs. This article needs some science, but it also needs some non-science. Don't be fooled by the slogan that non-science is nonsense. Human values are not nonsense." What endemicity will look like and what material on it should be included is not simply a matter for epidemiologists. Crossroads ^-talk- 06:30, 28 November 2022 (UTC)

I don't think there can be a "peer-reviewed research article" of definitions, and it would just be the authors' views also. Unlikely to be a secondary MEDRS source on it. What endemicity is, is entirely science. How policymakers choose to react to it (or misrepresent it) is maybe important non-science. So long as these aren't blurred that's fine. Bon courage (talk) 06:38, 28 November 2022 (UTC)

Anyway, maybe you could stop edit warring [6] to delete the comments of the head of the World Health Organization, the literal authority over what is or is not a pandemic? Pointing to WP:SYNC is a disingenuous justification since it was you who removed it from the other article just moments before. And when Ghebreyesus speaks about the "end of the pandemic", what is he talking about if not endemicity? Crossroads ^-talk- 06:43, 28 November 2022 (UTC)

This is an example of the problem. Taking sources that don't mention endemic covid and blurring them into service. WP:NOR is a core policy. Bon courage (talk) 06:46, 28 November 2022 (UTC)

WP:NOR: Rewriting source material in your own words while retaining the substance is not considered original research. Does anyone seriously believe that Ghebreyesus could possibly mean anything other than endemicity? Excluding relevant material about 'after the pandemic' or the like on the grounds that it doesn't use the magic word even though it is clearly the same topic is itself a huge problem. Crossroads ^-talk- 06:49, 28 November 2022 (UTC)

"Does anyone seriously believe that Ghebreyesus could possibly mean anything other than endemicity" ← yes; interpreting what "he means" is OR. This is one of the central points here. Editors trying to coerce everything to do with "good news" into meaning "endemic" is not what our good sources are doing (or in this case any source). Why should Wikipedia be doing something so odd? Bon courage (talk) 06:55, 28 November 2022 (UTC)

Looking forward to hearing from others on this, but anyway here's a source [7] explaining the incredibly obvious. Crossroads ^-talk- 06:58, 28 November 2022 (UTC)

prevention.com!?!? Looks like some kind of spam site, advertising "detox" on its front page. I suggest not clicking the link unless your antimalware software is in shape. (Rum to be citing this while being snffy about Nature above.) Bon courage (talk) 06:59, 28 November 2022 (UTC)

I don't know what you're talking about, the site is cited in other Wikipedia articles and is probably equivalent in reliability to CNN, and contains material from interviewing WHO epidemiologist Dr. Kerkhove. Looks fine to me. It's unnecessary anyway because excluding Ghebreyesus talking about the end of the pandemic because he didn't use the exact word "endemic" smacks of WP:WIKILAWYERING anyway. Maybe the article should be retitled "Post-pandemic COVID-19" if that's how people are going to be. Crossroads ^-talk- 07:06, 28 November 2022 (UTC)

"How to detox your home" looks fine to you? Might be okay for lifestyle stuff but not serious medical content. I think your final suggestion actually hits the nail on the head. The article isn't really about endemic COVID, it's about the COVID-19 pandemic aftermath. Even for the most major endemic diseases (Malaria) we don't have such articles: no Endemic malaria, no Endemic HIV/AIDS. But we do have Epidemiology of HIV/AIDS. Why don't we have Epidemiology of COVID-19? Bon courage (talk) 07:15, 28 November 2022 (UTC)

Prevention (magazine) is a pop health magazine. I would not recommend that magazine to anyone for any purpose, but the fact that they are aimed at a lay audience does not prove that they are wrong about every single thing they write. On wiki, I'd suggest double-checking anything they say against other sources (or your own prior knowledge, if you happen to be highly familiar with the specific subject area).

@Bon courage, your line about '"peer-reviewed research article" of definitions' above is one of the reasons that I started Wikipedia:Biomedical information. There's no such thing as a systematic review on whether we should call that bone the femur or the patella, or whether this definition or that definition is the appropriate one. Systematic reviews and meta-analyses are good for statistical questions, such as whether a drug prevents a death. They are frequently inappropriate sources for, well, pretty much everything else. Literature reviews, practice guidelines, and position statements are good for the current state of mainstream thinking. Graduate-level textbooks are the MEDRS ideal for definitions and other human-decided facts. In this case, we should be looking to textbooks for standard definitions, and to non-systematic secondary sources for the application of the standard concepts to COVID, until the textbooks start incorporating that content directly. And, as always, the goal is to accurately represent mainstream expert views in the article's text, not to have a single cited source score perfectly on some checklist for ideal sources. If you have to use a couple of second-best sources to get the content right (where "right" means "matching the most common views in the wide range of reputable sources"), then please remember that a second-best source isn't a bad source. (Please don't use sources that are actually bad.)

In terms of steps forward:

Expanding the ==Background== section to explain what endemic means, in the general scientific sense, would probably help. The article in The Atlantic or similarly reputable sources would be good for adding, at the end of that explanation, that politicians/non-scientists do not always use the word correctly. It probably also needs some List of common misconceptions-type content (e.g., people say they want endemicity, but they probably don't want holo-hyperendemicity).

Should we resurrect the List of endemic diseases, or add a column in that table to mark endemic/etc. status? Can we add more (sourced) links to Holoendemic and Hyperendemic? Turn Mesoendemic and Hypoendemic into articles (or at least get these words and their definitions added to Endemic (epidemiology))? WhatamIdoing (talk) 17:15, 28 November 2022 (UTC)

Exactly. As I put I don't think there can be a "peer-reviewed research article" of definitions. I did however find a review article about COVID-19 endemicity! (now added to the article). Bon courage (talk) 17:30, 28 November 2022 (UTC)

• "I would not recommend that magazine to anyone for any purpose" ← note however that now that Crossroads and SmolBrane are edit warring to get this back into the article. I agree this is a bad source, and especially so for a serious topic like COVID-19.

Bon courage (talk) 09:28, 2 December 2022 (UTC)

Then remove the source if that is the issue. You are the one edit warring to purge the head of WHO's viewpoint entirely. Crossroads ^-talk- 09:31, 2 December 2022 (UTC)

I think you were the one with edit-warring in your mind with your snarky "mind the 3RR" edit summary, while not acknowledging your WP:ONUS and the disagreement on this matter here and elsewhere. This reflects poorly on you. The WHO guy was not talking about endemicity and even the comments he did make had to be walked back later, so no - what you're doing looks like edit-warring in service of a OR and a certain POV. Bon courage (talk) 09:35, 2 December 2022 (UTC)

I don't know what "walked back later" is referring to. Regarding ONUS, we did have a consensus because you were at the time the only one saying that the head of WHO should not be included, but the material was pre-existing and had support from 2 editors. I don't know what POV I supposedly am pushing, and I could just as easily make similar vague complaints. I would have preferred hashing it out on the talk page first and maybe figuring out a compromise or something rather than just taking a hatchet to it. Oh well. Hope future interactions can be less fraught. Crossroads ^-talk- 09:47, 2 December 2022 (UTC)

The whole point at issue in these extensive discussions is that "end of the pandemic" should not be smudged by editors into "endemic", so thinking there was a consensus to do so and edit warring over it was poor. As to "walking back", per PMID:36220172 the issue is that a clarification was issued over these apparently incautious WHO comments. Bon courage (talk) 09:55, 2 December 2022 (UTC)

Holy heck, a lot has happened while I was sleeping. I'll try to catch up but it might take me a while! SmolBrane (talk) 15:54, 28 November 2022 (UTC)

(regarding WHO 'end in sight')During the GA review of the COVID-19 pandemic article, Reviewer Tom_LT wrote under Focus that "In February 2022, the Icelandic Ministry of Health lifted all restrictions and adopted a herd immunity approach" (the article later says the disease is endemic in many countries, I'm not sure how this is in fact any difference). This never produced an edit but it does lend credence to what Crossroads is saying here--if herd immunity in Iceland is functionally the same as endemicity, then why would "[The world has] never been in a better position to end the pandemic" be functionally different? I have to assume Tom is a robust commentor here. I haven't yet decided to revert Bon courage's alleged edit warring but I will try to review the situation and the new source when I can. SmolBrane (talk) 17:06, 28 November 2022 (UTC)

Here's my puzzle. We have good sources, WP:MEDRS sources even, specifically on COVID-19 endemicity. Surely the job is to relay the knowledge found in them? Instead editors are picking sources not on COVID-19 endemicity, deciding for themselves that must be relevant, and using those. So far as I can see the WHO is very careful about discussing endemicity, yet editors are deciding "oh, this is what they must mean". The WHO have talked about the end of the pandemic, but this is a different thing. It's as if we had an article on The Empire Strikes Back and editors want to fill it with descriptions of what happened at the end of Star Wars. Bon courage (talk) 17:13, 28 November 2022 (UTC)

Not a good interpretation here--we have a long list of secondary sources observing endemicity or the transition towards in various countries in the world. We cannot assume they are faulty in their words simply because they are not MEDRS. I am surprised that I have to keep saying this. SmolBrane (talk) 17:34, 28 November 2022 (UTC)

Sources are very clear that the end of the pandemic, and entering the endemic phase, are exactly the same thing and same topic. Incidentially, our The Empire Strikes Back article does mention what happened in the original Star Wars, for obvious reasons. Crossroads ^-talk- 19:11, 28 November 2022 (UTC)

(Further) the same can be said of Biden's statement, which also doesn't explicitly refer to endemicity but 'pandemic is over' is pretty darn DUE and has lasted on the article. SmolBrane (talk) 17:11, 28 November 2022 (UTC)

The fact that political declarations that the "pandemic is over" feel DUE suggests that Wikipedia editors are just as shaky on the concept of what endemicity means as the politicians. Malaria and tuberculosis are endemic, and they were among the top infectious disease priorities before COVID crowded everything else out of our minds. Those two represent about a quarter Billion-with-the-big-B people getting sick every year and a couple million dying. People who read Endemic COVID-19 should not leave the article thinking that the endemic phase looks almost the same as the pre-pandemic phase, despite the empty promises of politicians. They should be thinking that endemic COVID is uncertain and changeable: It could be as severe as malaria, as deadly as tuberculosis, as mild as the common cold, as universal as chickenpox, or as rare as rabies. Above all, they should know that endemicity isn't guaranteed at all, and it definitely isn't guaranteed forever. It could be as variable as influenza. WhatamIdoing (talk) 17:35, 28 November 2022 (UTC)

Let me suggest a different way to understand this.

Endemicity means (only) that there is a stable rate of infection.

For easy math, let's assume that stable rate for our hypothetical disease, Scaryitis, is 100% annual infection, evenly spaced through the year with no long-term immunity conferred, and 50% mortality per infection. There are 8 billion humans this year. There are 8 billion infections this year. There are 4 billion deaths this year. There are 4 billion humans left next year. There are 4 billion more infections. There are 2 billion deaths next year. In year 3, there are 2 billion humans, 2 billion infections, and 1 billion deaths. In year 4, there are 1 billion humans, 1 billion infections, and half a billion deaths.

This is "endemic". The rate of infection is stable. And not only would there be severe social disruption, but modern civilization would basically be destroyed in the space of a few years. "Endemic" doesn't mean "good". Endemic means "predictable" – including predictably bad. WhatamIdoing (talk) 17:43, 28 November 2022 (UTC)

I wouldn't consider it the least bit plausible that a disease killing half of humanity every year would be classified as anything other than pandemic. Endemic doesn't mean "nobody needs to think about it", true, but it also doesn't mean just "infection rates are stable". The first source I cite below describes it as a kind of détente, and the last as not causing significant disruption in our daily lives. This wouldn't apply to a virus killing half the world every year.

People who read Endemic COVID-19 should not leave the article thinking that the endemic phase looks almost the same as the pre-pandemic phase, despite the empty promises of politicians. Disagree, because it very well might. In much or most of the world it already does, and it isn't even truly and fully endemic yet. Never mind politicians - public health agencies, who count as the most prominent experts for the purposes of weight, in country after country have shifted many or most policies to lift restrictions on personal behavior, and this is a process that is still ongoing. I would be very leery of giving undue weight to the minority of people who essentially solemnly intone that 'just because it's endemic doesn't mean you can ever go back to living like you did in 2019 even when not sick'.

It's pretty easy to find sources taking a different tone. This August 2022 UMass source interviewing a virologist, for example, draws a comparison with the four existing common cold coronaviruses, states there are plenty of virology experts who are entertaining this as a possible end game, and I think it’s likely that we will go back toward a situation like what we had pre-pandemic. This Council on Foreign Relations November 2022 source notes that "endemic" can still involve a policy response as we do with flu, however, the responses are typically not as intense as those during a pandemic, when surging infections prompt the type of tight restrictions seen throughout the COVID-19 crisis. Another noteworthy quote is that Some countries are already treating COVID-19 as an endemic disease, while others, namely China, are keeping rigid pandemic measures in place. These policies can depend on infection trends as well as on the social mood, says CFR’s Jennifer Nuzzo. “In terms of when a pandemic is over, it’s really a social term,” she says. “We don’t have an epidemiologic criteria for the end of a pandemic.” This American Medical Association source from April 2022 states, The U.S. has a chance to move COVID-19 from being a pandemic to an endemic, which “means that the disease is still around but that it's at a level that is not causing significant disruption in our daily lives,” said Dr. Parodi, an infectious diseases physician....“This shift to looking at it from a severity of disease standpoint is important,” Dr. Parodi said. “A measure of endemicity really is going to look at how many people are developing severe disease at a given time. If we're seeing increases in that, we've got to take action. If we're not, that's a different set of actions, and that's similar to what we do for influenza year over year.” Incidentally, these are all newer than the Atlantic piece. Crossroads ^-talk- 18:38, 28 November 2022 (UTC) expanded Crossroads ^-talk- 20:12, 28 November 2022 (UTC)

It very well might, and it very well might not. Part of it's going to depend on what you count. For example:

• I'm expecting annual booster shots for COVID. Is that "the same" or "different"?
• Laws in some countries have changed to strengthen, weaken, and/or clarify the authority of public health agencies. You won't see it in practice until another novel virus appears. Is that "the same" or "different"?
• People are voluntarily wearing face masks in public places. Is that "the same" or "different"?
• Many people are feeling more disconnected from society than before. Is that "the same" or "different"?
• More people are voluntarily using contactless payment systems, self-checkout, online shopping, and delivery services. This reduces weak ties in society for everyone, not just the people using these systems (because even if you do everything the same, you're less likely to see your neighbor at the grocery store). Is that "the same" or "different"?
• Some older people and people with riskier health conditions stopped working or had to retire earlier than they wanted to, because of the pandemic. They will have less money to live on for the rest of their lives. Is that "the same" or "different"?
• People are choosing more holiday trips that they can reach by automobile instead of mass transit (planes, trains, buses). Is that "the same" or "different"?
• Three times as many people in the US workforce now work remotely, compared to pre-pandemic levels. A quarter of the customers for downtown businesses that served office workers are no longer potential customers for those businesses. Is that "the same" or "different"?

Lifting the legal restrictions on personal behavior is not the same as returning to the pre-pandemic world. Government officials can promise an end to legal restrictions. They cannot give orphans their dead parents back, even though those children had living parents in the pre-pandemic world. They cannot even give children the education they lost due to school closures.

The doctor who said "the disease is still around but that it's at a level that is not causing significant disruption in our daily lives" is technically wrong. Endemicity means that the rate of infections is stable. Even stable levels can cause significant disruption, and at the hyperlocal/individual level, it almost always does. Nobody gets malaria – widely called endemic – and says "No big deal; that didn't cause any significant disruption in my daily life". More generally, finding sources who claim the likely outcome is the only possible outcome does not actually re-write the definition. WhatamIdoing (talk) 20:52, 28 November 2022 (UTC)

I don't have much to say right now and I've skimmed these comments. But human behavior does normalize. Maybe not to the same level as previous, but a pandemic ending and endemicity being declared seems to be cut from the same type of cloth. Living with COVID, new normal etc are all in the same basket imo. Doesn't make our job easy though. SmolBrane (talk) 05:09, 29 November 2022 (UTC)

a pandemic ending and endemicity being declared seems to be cut from the same type of cloth. Living with COVID, new normal etc are all in the same basket imo. No, they're not. Something becoming endemic is not the same as "living with COVID" or a "new normal". The current attempt at an Endemic COVID-19 article is a mess because people keep dumping unconnected journalistic coverage of various public health measures ending, which is not the same as moving to endemicity, a topic that comes under WP:MEDRS. (See discussion at Talk:Endemic_COVID-19#Fundamental_problem.) If editors want content about decisions to end public health measures or "living with COVID", that is already covered in COVID-19 pandemic and related articles for specific countries/regions, where it is placed in an appropriate context. Bondegezou (talk) 17:41, 30 November 2022 (UTC)

BTW, I've expanded Endemic (epidemiology) with a section on terminology. One thing that has been interesting to learn recently is the epidemiologists don't consider influenza to be endemic. We "live with the flu", but it's epidemic flu (with occasional bursts into pandemic flu), not endemic flu.

Also, anyone who is interested in malaria should look into this, because some of the finer points of the definitions seem to have been developed primarily with malaria in mind, and it's interesting. WhatamIdoing (talk) 21:01, 30 November 2022 (UTC)

See also Talk:Endemic (epidemiology)#What people say is not biomedical information. I do not think we should push the idea that COVID-19 will become either mild or (technically) endemic. WhatamIdoing (talk) 07:36, 1 December 2022 (UTC)

We should not push the idea that it definitely will, true, but it should be mentioned, as neither should we push the idea that it will not be mild. Some in the media like to write articles and thinkpieces debunking people's hope for normalcy or whatever - negativity gets more views and always has - but we should not think that MEDRS mostly think this is the most likely possibility. e.g. [8] Crossroads ^-talk- 19:55, 1 December 2022 (UTC)

Yes, that one source, which was first published when the delta variant was dominant, says that iff COVID-19 becomes endemic it "could be" mild. That's one source, it's out of date, and it's not making strong claims. It's talking about multiple possibilities, only one of which you mentioned in the article about endemicity as a concept – where, IMO, I don't think that the predicted disease severity for one disease that may or may not ever become endemic, is actually a relevant point. It's possibly relevant to say that COVID could become endemic; it is not IMO relevant to say that COVID could become endemic plus that if that happens, it "could be mild". WhatamIdoing (talk) 20:53, 1 December 2022 (UTC)

I don't know of any reliable medical source suggesting any end for the COVID pandemic except that it will become endemic. There's nothing "out of date" about that source at all; nothing it says about coronaviruses, immunity, or epidemiology has been contradicted or disproven by Omicron or anything else. It's odd to see you disparage a model MEDRS review article, while a thinkpiece in The Atlantic is cited instead. Again, it's undue weight to only emphasize a version of endemicity in which it is severe, like we're the media or our mission is to debunk misconceptions or the public's hopes and wishes. We are supposed to relay the views of experts in general with due weight and in a neutral tone. Crossroads ^-talk- 00:28, 2 December 2022 (UTC)

Here's Christopher J. L. Murray discussing the end of the pandemic: PMID:35065006. He does not talk about "endemic" disease but reckons "COVID-19 will become another recurrent disease that health systems and societies will have to manage". Bon courage (talk) 08:05, 2 December 2022 (UTC)

The review article doesn't support the sentence that I wrote. The sentence I wrote says, in polite terms, that politicians don't understand science, which should surprise approximately none of the regulars on this page. The Atlantic article supports this content, and is a reliable source for this content.

The review article says that when the pandemic ends, COVID could become epidemic or endemic (but almost certainly won't be eradicated), and that in addition to being either constant (like the common cold) or variable (like the flu), the disease could be mild or not.

"I'm a scientist and I say that whenever the pandemic technically ends, it might become endemic, and it might become a milder disease" is not a relevant source for a sentence that says "Hopes for COVID-19 to become endemic make a similar mistake; generally, the speaker expresses a wish that COVID-19 will become relatively harmless." WhatamIdoing (talk) 21:27, 2 December 2022 (UTC)

It's worth noting, though, that regarding things like rates of feelings of disconnection, voluntary mask wearing, remote work, etc., these sorts of things are still very much in flux, and we're not even in the endemic stage yet. Even once we are, those things will take even more time to reach whatever steady-state they will. So who knows how that will all end up. Crossroads ^-talk- 01:41, 1 December 2022 (UTC)

I think the point is it might never be judged endemic, but sporadically epidemic. We will have to wait for the epidemiologists. Bon courage (talk) 04:10, 1 December 2022 (UTC)

Proposed merge

Okay, from all the above I think these issues could be dealt with by merging. So, see:

• Talk:Endemic COVID-19#Proposed merge

Thoughts welcome. Bon courage (talk) 08:47, 2 December 2022 (UTC)

Generalized hypoxia: all but one sentence fragment cited to the US Department of Transportation

Iatroapathetic topics part III! I recently linked to Generalized hypoxia (on account of this[9]), and it's a bit scant. It cites two souces, "A Quick Look at Reflexes", from the Health Encyclopedia of the University of Rochester Medical Center, and the non-inline cite to the "Pilot's Handbook of Aeronautical Knowledge: FAA Manual H-8083-25", by the Flight Standards Service of the US Federal Aviation Administration.

I would appreciate any improvements to the article, especially if it starts getting more pageviews from COVID-19 sufferers. Alternately, is there a useful merge or alternate target? Suggestions welcome. HLHJ (talk) 04:57, 26 November 2022 (UTC)

If Pbsouthwood is around, he knows a lot about what oxygen (and its absence) does to the body. Generalized hypoxia seems to mostly be about circumstances (like high-altitude settings) than about a disease. Tissue hypoxia, which appears to be the localized version (e.g., in case of infarction or stroke), redirects to Hypoxia (medical). WhatamIdoing (talk) 21:28, 26 November 2022 (UTC)

Thank you, WAID. I've used anemia as a target for now as it's more comprehensive and seems to apply regardless of the precise mechanism by which one's blood is pooched. The article seems to have once been titled "Hypoxic hypoxia" (which it defined as "insufficient oxygen available to the lungs", a somewhat different scope). I'm not up to judging if a merge is a good idea; I'd be glad if Pbsouthwood has a view. HLHJ (talk) 00:34, 27 November 2022 (UTC)

My knowledge of oxygen metabolism is largely related to the effects of variation in partial pressure in the breathing gas on underwater divers, who are usually in fairly good general health, and by extension, to effects due to hyperbaric and hypobaric exposures on reasonably healthy subjects. Not sure if this is likely to be of any use. Cheers, · · · Peter Southwood ^(talk): 06:28, 27 November 2022 (UTC)

Turns out it is good enough to fix most of the problems. · · · Peter Southwood ^(talk): 13:19, 27 November 2022 (UTC)

The FAA source appears to be [10] and probably to be more precise [11], which talks about various types of hypoxia i.e. Hypoxic Hypoxia, Hypemic Hypoxia, Stagnant Hypoxia and Histotoxic Hypoxia (obviously from an avaition point of view). Does this actually support the article?Nigel Ish (talk) 10:22, 27 November 2022 (UTC)

A bit, but not much, but I have found and added more relevant sources, expanded a bit, and cleaned out a lot of tangential, unsourced, dubious, and out of scope content. What remains is mostly good. · · · Peter Southwood ^(talk): 12:45, 27 November 2022 (UTC)

Anemia is still probably a better link for the original purpose. · · · Peter Southwood ^(talk): 12:47, 27 November 2022 (UTC)

I'll keep using anemia . Thank you very much, the article is much better. I'm still very confused by the ontology. Hypoxia (medical) says that hypoxia is generalized when it affects all tissues, and localized when it doesn't. That makes sense. But then altitude sickness, carbon-monoxide poisoning, anemia and circulatory hypoxia would be forms of general hypoxia, though presumably some tissues would be worse-affected. But the Hypoxia (medical) article lists low hemoglobin as a cause in its section on local hypoxia. And the Generalized hypoxia article seems to contradict the Hypoxia (medical) article on scope. A hierarchical list of forms of hypoxia, in order of the progression of oxygen into the body, like the one in Generalized hypoxia#Other types of medical hypoxia and Generalized hypoxia#Causes but more comprehensive, would be useful.

An article on COVID-19 and hypoxia would also be very useful, as it's now a notable, complex topic of high public interest (and there's some confusing pop science content out there). We have silent hypoxia, which is clearly related but different as you can get silent hypoxia (defining it broadly as hypoxia without distress) very fast by breathing helium (or any gas containing neither oxygen nor CO2, a fact the article does not note). HLHJ (talk) 18:20, 27 November 2022 (UTC)

The helium containers available to the general public have ~20% oxygen these days, for safety reasons. WhatamIdoing (talk) 02:33, 28 November 2022 (UTC)

The precise meaning and scope of generalised hypoxia also bothers me. It is claimed to be synonymous with hypoxic hypoxia by the sources I used, but I agree that other sources appear to use it differently, and that the use in Cavezzi et al appears to be using it as a distinction between affecting all tissues and having localised effects. I would explain that in the article, but cannot find a suitable source. I will leave a comment on the talk page, maybe someone who is an actual expert will know where to look.

Balloon helium contains oxygen, technical helium (five nines - 99.999% He) does not. Both are available from industrial gas suppliers. Pure nitrogen is probably the cheapest and most easily available asphyxiant which you would not notice and would probably not be identifiable by standard pathology tests. Nitrogen has a large range of industrial uses, from fizzing beer to inflating tyres. Cheers, · · · Peter Southwood ^(talk): 04:53, 28 November 2022 (UTC)

It may be that there isn't a single clear meaning agreed upon by the medical community, in which case I guess we should have descriptive title for the meanings and make the disputed term a disambig. I think it was unfair to call this topic iatroapathetic, it may just be a muddled term people avoid.

Pure argon also has a variety of uses. These gasses are often delivered in huge pressurized carboys, as tall as a person and sometimes made of glass, which are often refrigerated until delivery, at which point they are wheeled into a small windowless basement room and hooked up. I'm told that if you breathe a pure inert gas, you may feel slightly lightheaded or dizzy just before you actually lose consciousness. So the safety proceedure for major leaks, or feeling a bit off, or seeing someone apparently slumped unconscious, is to exit yelling and evacuate the building, sending someone else in a SCBA back to retrieve any bodies. RS sources for this could probably be found. I can't help liking the safety precaution often taken on boats, where dangerous gasses are placed so that if they leak, they will drain (or vent, if they are lighter than air) outside the boat. There may be some naval sources on that, regulations perhaps. Argon is heavier than air, helium lighter, and nitrogen, of course, only very slightly heavier... it would be safer to have a storage room with separate ventilation, as in a medical isolation room, and a sensor that could be read before opening the door. Someday there'll be a major accident and they'll do that. HLHJ (talk) 15:52, 28 November 2022 (UTC)

Bulk industrial and medical gases are usually stored and transported in high pressure cylinders or in large amounts as liquefied gas at cryogenic temperatures in very well insulated containers. Storage is usually in very well ventilated areas, sometimes outside or just under a roof to protect fron the worst of the weather. I am not familiar with the OSH requirements for most countries, but fairly sure they exist. I would not consider this a medical aspect, more occupational safety.· · · Peter Southwood ^(talk): 09:59, 9 December 2022 (UTC)

Comment invited at Talk:Hypoxia (medical)#What next?

I have done a bit of work on the article, ungraded it to B-class, and would appreciate constructive comments on what is still needed to get it to GA some time. It is a level 4 vital article and rated high importance by this project, so worth a look by those who can spare the time, particularly if you have specialist knowledge of the topic. Cheers, · · · Peter Southwood ^(talk): 10:09, 9 December 2022 (UTC)

Comment invited at Talk:Generalized hypoxia#Hypoxic hypoxia

The article has an odd history, and it is not clear what the scope is intended to be as the current title is ambiguous. As I see it, the name change should be reverted, or the article may be redundant. Expert opinion requested. · · · Peter Southwood ^(talk): 11:23, 9 December 2022 (UTC)

Gradient of infection

Do we have an article on the concept that some (infectious) diseases are worse than others? This book calls it a biological gradient or gradient of infection. It would be nice to be able to link to something about disease severity in Endemic (epidemiology). WhatamIdoing (talk) 06:23, 30 November 2022 (UTC)

Geir Bjørklund

Hello all, I am a little bit concerned about Geir Bjørklund. I have shortend again a lot of irrelevant information, whitewashing and advertisement.

Impo you can delete this article, it is just constructed to promote Bjørklund - the lack in secondary sources acc. to WP:MEDRS shows that clearly. Best, --Julius Senegal (talk) 20:18, 1 December 2022 (UTC)

SPA?--Ozzie10aaaa (talk) 01:08, 2 December 2022 (UTC)

Definitely.

Interestingly, the Norwegian wikipage (as well those of other languages) are still short, so Ruth_Dahle seems not be Bjørklund himself (he is Norway, so should have interest to improve his page). Still, the issue remains. --Julius Senegal (talk) 18:49, 2 December 2022 (UTC)

Is this person actually notable? I'm a bit worried about the concerns User:Tournesol expressed here when this article was simultaneously created on en.wiki and on several other language wikipedias. How does one go about getting an article deleted in all the wikis? Dr. Vogel (talk) 03:17, 3 December 2022 (UTC)

That requires individual nominations at each wiki. WhatamIdoing (talk) 20:19, 3 December 2022 (UTC)

Thanks for clarifying that @WhatamIdoing. That's what I feared. I'm not saying this is spam, and I don't know if this person is notable or not. But if you were going to spam Wikipedia... a good trick would then be to write up an article, Google-translate it into other 6 or 7 languages, and create it in all those wikis, making it look like an important subject that's covered in several languages. Sorry for going so off-topic.. I'd just never thought about this before. And this may or may not be what happened here. Dr. Vogel (talk) 21:21, 3 December 2022 (UTC)

I've seen it happen at least once before. (You wouldn't necessarily need to use machine translation. Plenty of educated people in the world can write several languages fluently.) WhatamIdoing (talk) 21:35, 3 December 2022 (UTC)

The SPA has removed now much content, still did not improve anything the article is lacking.

I have started AfD. --Julius Senegal (talk) 15:39, 6 December 2022 (UTC)

Fields Condition

A mention of this, as reportedly the rarest rare disease, was added unsourced to Rare disease which is on my watchlist, and I reverted it. But I see it is also mentioned in Ribose-5-phosphate isomerase deficiency, though only sourced to a news item about the patients' family's living arrangements, which doesn't name the condition. I've found another news item which mentions "Fields condition". Can any find a WP:MEDRS for this disease? Is it recognised, either by this name or by some other name? I'm not an expert medical editor, just a rare disease patient with an interest in my own and related ailments. PamD 23:33, 1 December 2022 (UTC)

I've also found a 2005 BBC news item which names the condition. PamD 23:40, 1 December 2022 (UTC)

rather difficult, only found this "Medical Definition of Fields' disease Doctor Written". MedicineNet. Retrieved 2 December 2022. which isn't MEDRS,--Ozzie10aaaa (talk) 00:54, 2 December 2022 (UTC)

Not in OMIM or PubMed or Google Scholar. But, if you do a web search for the names of the twins (with last name 'Fields') mentioned in the news article that you link, you find a number of webpages, such as this one [12]. Jaredroach (talk) 20:33, 4 December 2022 (UTC)

Wikipedia:Reference_desk/Science#Demand_for_unvaccinated_blood?

Reference desk question, if you know anything. Gråbergs Gråa Sång (talk) 15:02, 2 December 2022 (UTC)

WAID answered--Ozzie10aaaa (talk) 13:33, 4 December 2022 (UTC)

Thanks! For the interested, Vaccine_hesitancy#Blood_transfusion. Gråbergs Gråa Sång (talk) 16:34, 9 December 2022 (UTC)

Nurse-Family Partnership

Hi, I would like to suggest some knowledgeable editors to look at the WP page(s) relating to NFP. As you may know, this is a program of intervention originating from the US but widely rolled out in the UK (and possibly elsewhere, I'm not sure) see 1. I'm not in a position to sensibly suggest edits, but there have recently been large trials of the scheme see 2 and I wonder if this should be reflected in the page or pages. Thanks. JMWt (talk) 07:16, 4 December 2022 (UTC)

@FloNight, @Sectionworker, have either of you heard about this? WhatamIdoing (talk) 17:12, 4 December 2022 (UTC)

02:03, 5 December 2022 (UTC)

I had never heard of them except for a mention in information of them in research I was doing, which I ignored because I had no idea what they were talking about and it was just mentioned along with doula, etc., and I just thought something in the UK since I know they do more home work with women than we do here in the US where we use fewer midwives. Anyway, I am very enthusiastic about this form of assistance as I have long been concerned about these forgotten girls and young women who are still in need of mothering themselves when they are forced into the role of motherhood. And now the added burden of making it next to impossible to obtain badly needed abortions... I could go on and on about this... Anyway I have added it to the new pregnancy split article on birthing plans and classes. I'm also going to add it to the teenage girl section of the pregnancy article. Thanks to JMWt and Waid for passing this information along. Sectionworker (talk) 03:39, 6 December 2022 (UTC)

Systematic reviews

"Systematic reviews and meta-analyses are good for statistical questions, such as whether a drug prevents a death. They are frequently inappropriate sources for, well, pretty much everything else. Literature reviews, practice guidelines, and position statements are good for the current state of mainstream thinking. Graduate-level textbooks are the MEDRS ideal for definitions and other human-decided facts." by WhatamIdoing (talk) 17:15, 28 November 2022 (UTC)

Compare the nutshell of WP:MEDRS

"Ideal sources for biomedical material include literature reviews or systematic reviews in reliable, third-party, published secondary sources (such as reputable medical journals), recognised standard textbooks by experts in a field, or medical guidelines and position statements from national or international expert bodies.

The lead says

"Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals...."

So WhatamIdoing's comment is clearly heretical. I'm joking. And actually, I'd go further and wonder if we can "rely" on them to be "good", in practice, for statistical questions. Is it just me or does it seem like just about anyone can write a "systematic review and meta-analysis" these days. There seem to be more of them than there are actual studies. There are even systematic reviews that include other systematic reviews. Perhaps Covid lockdown is to blame, when everyone was stuck at home with just the internet and no patients to study. I wonder if some of them, in trying to answer a difficult question with a high bar and rigid algorithm, end up concluding we are more ignorant than is actually the case. Or that when the studies prove to not be suitable for meta-analysis, that the authors then cherry pick whatever conclusions they want from their carefully and systematically collected set. Is there some useful way we can classify systematic reviews that identify their value? For example, is there a difference whether the review successfully performed a meta-analysis that gave a result (adding to knowledge) or whether the review fails and merely describes our lack of knowledge.

But aside from whether they have problems, they are only really seeking to answer one specific question, and as such, I think we are elevating them way way too high at MEDRS in recommending editors consider them "ideal sources". The vast majority of a systematic review is spent documenting their system, describing the studies, producing tables of figures and then a short conclusion. For us, trying to write an article, it is thin stuff. I suggest we re-order the sequence of ideal sources and drop one. I'd place medical guidelines and consensus statements first. They both document something much closer to actual reality than some academic exercise that began and ended at someone's computer desk. Often, they describe the quality of evidence and get to the point quickly. Both represent a consensus (at least, on what should be happening, and what we agree we know), which is very much what Wikipedia should be prioritising. International statements can also represent a consensus of global opinion rather than just documenting what "our" hospital does or thinks is best. I'd keep the professional textbooks next (most likely to be comprehensive, though harder to get hold of), with literature reviews following. And then systematic reviews should be eliminated from both nutshell and lead, and dealt with in the section on assessing evidence quality.

In the "Biomedical journals" section, we note that the background section of a research paper isn't as good as a dedicated literature reivew (it may be incomplete and less reliable). Presumably the peer reviewers and editors are not nit-picking that section as much as the actual research itself. The same is sure true of a systematic review, with the added problem that the authors of the systematic review may not even be subject experts at all. Just academics of evidence-based medicine. I think we should include "systematic review" in that cautionary part of MEDRS about background sections.

In short, a systematic review is only useful for its conclusion, and even then, its conclusion may not often be worth wasting our readers time with (we know nothing). -- Colin°^Talk 19:28, 4 December 2022 (UTC)

Take a look a Cochrane's systematic reviews [13]. I think you will find them to be about as close to 'ideal' as any source, and that much in them besides the conclusion is useful, and they often reward the time spent reading them. Jaredroach (talk) 20:22, 4 December 2022 (UTC)

I've read several Cochrane reviews with great disappointment. I know they are respected and used as a source of information when creating clinical guidelines. I suspect the algorithmic nature of such reviews makes it attractive to folk with little clinical or research experience who want a paper published.

Could you list any Cochrane reviews that you've been able to use to write a serious portion of an article? Like one of those sources that end up with "a b c d e f g h i j k l m" in front of them in your references section?

An "ideal" source would be one that one could build a whole article from (should one wish). It would be comprehensive and up-to-date and neutrally represent the consensus of medical opinion while also encyclopaedically including social and cultural aspects. There is no one ideal source, but systematic reviews are for our purposes, closer to primary research papers, in that they mainly deal with one claim and produce what the authors hope are novel findings. Articles are more than one fact and healthcare is not an algorithm. -- Colin°^Talk 22:07, 4 December 2022 (UTC)

If one wants both 'comprehensive' and 'ideal' then perhaps one is looking for a textbook chapter or an encyclopedia article. Jaredroach (talk) 17:14, 5 December 2022 (UTC)

I agree. If you're trying to (re-)write an article, rather than just drop in a single fact, a textbook chapter can be an absolutely golden source. We were able to make real progress on Multiple chemical sensitivity#Diagnosis when we finally got a few pages from a regular medical textbook, instead of people bringing in this or that source with the "right" POV. WhatamIdoing (talk) 17:26, 6 December 2022 (UTC)

+1. Yes, I've long felt the WP:MEDRS advice on systematic reviews is out of touch with reality. A systematic review is a statistical exercise meant to eat clinical results, chew them up, and poop out quantified claims with associated confidence levels. Their utility when writing an encyclopedia is limited since giving an overall view of a topic (i.e. our mission) is not their goal. When trying to write an encyclopedia article I tend to find literature reviews and textbook chapters most helpful for giving me a sense of a topic. Medical guidelines and consensus statements are often essential for writing "Treatment" and "Diagnosis" sections, but sometimes are too narrow to be useful outside of that. Ajpolino (talk) 20:29, 4 December 2022 (UTC)

• I think systematic reviews are limited yes, but the questions they answer are often important ones that need coverage - which will necessary often be quite brief. One systematic (hah!) issue is perhaps that parts of MEDRS are seemingly written with a clinical-decision-making mindset, which is why evidence levels are emphasized so much there. Bon courage (talk) 17:21, 5 December 2022 (UTC)

  I think part of the problem with MEDRS's history is that there are two uses for it. The first is the advice to writers of medical articles where to find the best sources to help them in that task. The second is as a hammer to hit the heads of anyone pushing fringe or alternative medicine. Editors who enjoy(ed) doing the latter I suspect over emphasised systematic reviews, because they are excellent way of dismissing therapies (no evidence the therapy works) and research (it's always low quality). I do sometimes wonder if those same editors read the systematic reviews of the mainstream medicine they casually write about (if they do) which are often pretty low quality too. -- Colin°^Talk 12:16, 6 December 2022 (UTC)

  At the risk of distracting people from Bon courage's very interesting insight about the clinical-decision-making mindset, and the general notion of re-thinking how helpful this advice is for us in general, I wonder whether the most immediate problem with the nutshell could be solved with formatting. Compare:

  "Ideal sources for biomedical material include literature reviews or systematic reviews in reliable, third-party, published secondary sources (such as reputable medical journals), recognised standard textbooks by experts in a field, or medical guidelines and position statements from national or international expert bodies."

  vs

  "Ideal sources for biomedical material include:

  • literature reviews or systematic reviews in reliable, third-party, published secondary sources (such as reputable medical journals),
  • recognised standard textbooks by experts in a field, or
  • medical guidelines and position statements from national or international expert bodies."

We could probably also remove a few words (e.g., "reliable, third-party, published secondary sources (such as reputable medical journals)" → "reputable medical journals". And maybe list reviews last of the three, rather than first, if that would help people notice that more than one thing exists. WhatamIdoing (talk) 18:56, 5 December 2022 (UTC)

Getting back to the more interesting and complex question: I've been thinking for some time that we are over-emphasizing evidence levels. I've mostly felt this about the sections that attempt to educate editors about evidence issues. I think it might be better to link editors to the Wikipedia articles on those subjects, and then skip straight to the "advice" parts. WhatamIdoing (talk) 18:59, 5 December 2022 (UTC)

The formatting certainly helps, as the sentence is too long and there is a temptation to think "literature reviews or systematic reviews" are the nutshell, because we then explain where to find them (which I agree isn't necessary in the nutshell, and what is a third-party anyway?) I also agree with changing the order. Can I suggest sticking "professional or academic" in front of "textbooks" and dropping "recognised standard". The latter smells too much of medical students advising other medical students, and we aren't just dealing with undergraduate textbooks anyway. -- Colin°^Talk 12:03, 6 December 2022 (UTC)

Yeah, "standard" raises more questions than it answers. Though with my fringe antenna twitching I'm not sure about professional either. Is this a professional textbook for medical content? Bon courage (talk) 12:11, 6 December 2022 (UTC)

It may well be if one is writing about homeopathic medicine, but not if making claims about medicine that actually works. I'm thinking about books like Epilepsy: A Comprehensive Textbook (3 volumes) or Plotkin's Vaccines which aren't exactly an undergraduate-level (here's the heart and all the chambers) stuff. Colin°^Talk 12:21, 6 December 2022 (UTC)

Agreed, but I can foresee arguments that anything "professional" is "an ideal source" and WP:MEDRS for biomedical information. Hmmm. Can't think of the wording. It's somewhere in between established, reputable and mainstream. Bon courage (talk) 12:28, 6 December 2022 (UTC)

I think some of that is covered by our existing advice on WP:RS which state that the publisher of the work has an impact on reliability. The ones I linked were published by Lippincott Williams & Wilkins and Elsevier whereas yours was published by Full of Life Publishing. We also have the WP:MEDBOOK section to go into details. -- Colin°^Talk 13:23, 6 December 2022 (UTC)

I think even nominally reputable publishers these days have low standards. OUP gives us this which is something that has come up before. It's bursting with woo. Bon courage (talk) 13:59, 6 December 2022 (UTC)

Actually WP:SOURCE has a better list of things we think about for sources. Yes publisher is a vague term which can range from a particular newspaper or journal (The Guardian/Lancet published my article), to series of books, to imprints, to publishing house to a hierarchy of owning companies. They can all affect reliability. Here the OUP series was "Weil Integrative Medicine Library".

Anyway, the point of a nutshell is not to finesse the specifics of selecting the best such books. I think if we just say "textbooks" many people will just think of books you need for school, college or university, whereas we are really aiming for the kind of textbooks for undergraduate/graduate learning and for professional learning. Beyond that, is a matter for WP:MEDBOOK. -- Colin°^Talk 15:45, 6 December 2022 (UTC)

The problem with altmed textbooks is usually that the POV is undue for claims of efficacy, not that the source is unreliable for all fact-based statements. Homeopathy textbooks are reliable for statements like "Practitioners use arnica for bruises". WhatamIdoing (talk) 16:57, 6 December 2022 (UTC)

Right. But since we're talking about changing WP:MEDRS it's the biomedical content we're interested in. I think everybody in this thread has plenty of experience of how even slightly incautious wording in WP:MEDRS can open the door to a storm of wikilawyering. Bon courage (talk) 17:05, 6 December 2022 (UTC)

We attempted once to write a "MEDDUE" section in MEDRS, which would be the place to explain that "A hot toddy is a folk remedy for the common cold" is okay, but "A hot toddy cures the common cold" is not. WhatamIdoing (talk) 17:21, 6 December 2022 (UTC)

Generally, for books, we are hoping to find graduate-level textbooks (e.g., Harrison's Principles of Internal Medicine, which I wish were in Wikipedia:The Wikipedia Library, so pinging Samwalton9 (WMF) – also, anything from Doody's Core Titles, which is the modern version of the old Brandon–Hill list). We are also interested in professional reference works (e.g., medical dictionaries).

Perhaps "recognised standard textbooks by experts in a field" could be replaced by "graduate-level textbooks and professional reference works". WhatamIdoing (talk) 17:19, 6 December 2022 (UTC)

I think "professional or academic textbooks" is sufficient for a nutshell, whereas the above is twice as long and even more restrictive (not all professional books are for "reference" and I'm not sure we need to explicitly exclude undergraduate texts in a nutshell). -- Colin°^Talk 11:43, 7 December 2022 (UTC)

I'm not sure about that. Are there professional textbooks or non-academic textbooks? WhatamIdoing (talk) 20:31, 8 December 2022 (UTC)

Someone should do a systematic review;-P · · · Peter Southwood ^(talk): 11:39, 9 December 2022 (UTC)

Apo (drink)

This isn't formally listed under this wikiproject, but is making quite a lot of strong claims about this beer's medicinal properties. The article doesn't inspire confidence but I don't have the time or knowledge to untangle fact from pseudoscience, so dropping it here in case anyone wants to take a look. Rusalkii (talk) 01:17, 5 December 2022 (UTC)

I had a look at the cited references (and a couple of the references they cite); they aren't looking at trials of efficacy, but rather surveys of local practice. I've hence refined some of the text in the context of local tribes believe .... — Preceding unsigned comment added by Klbrain (talk • contribs)

MELISA

Another totally broken POV brand article by SPA Vitalpost. The article claims a lot, has a lot of non WP:MEDRS compatible literature (a lot of single studies or studies not proving some claims), there is not a real secondary literature about this method, and it seems like it was a 90s thing but then "disappeared" out of notability.

Also, if there is a least some better literature, i. e. meta reviews like #9 (doi:10.1016/j.tripleo.2003.12.027), it is wrongly placed. The meta-review is not applying MELISA whatsoever, but rather just referring to another reference which have used it. Also, this particular reference #9 does not cover anything about the claim ("Hypersensitivity to dental metals may be associated with local oral reactions including oral lichen planus, stomatitis and ulceration"). So you see the problem - many references pretending notability, but are of no use.

If not deleting it - a strong overhaul (i.e. deletion of many parts) is needed. --Julius Senegal (talk) 16:24, 6 December 2022 (UTC)

The more recent review says it doesn't work, as does this clinical trial. This one says it (and other/similar tests) has "unconvincing evidence for screening". This book will let you source a statement about a high number of false positives. This book describes the development history. This book says it's patented. This book has most of a chapter on it, but I haven't read it, so I can't give you any idea what to expect.

I suggest, though, that you consider re-writing the article to give an accurate view of its flaws, rather than sending it for deletion. WhatamIdoing (talk) 17:42, 6 December 2022 (UTC)

Thx WhatamIdoing, that is what my first look also provided me with.

Better a short, well sourced article than an ad-flyer. --Julius Senegal (talk) 13:25, 7 December 2022 (UTC)

POV forking of "Longevity medicine"

I am bringing to your attention an article (Longevity medicine (aging)) that may need to be looked at by an expert; I described the issues on the article's talk page. The older article is redirected to from Longevity medicine, and is named Age management medicine. What I believe should happen is that the articles should be merged, but I am unable to determine if there is any content worth merging in the POV fork article. Thank you. tw^sabin 18:01, 7 December 2022 (UTC)

thanks for posting--Ozzie10aaaa (talk) 13:18, 13 December 2022 (UTC)

Functional neurological disorder

Hi all, touching base after running into a medical article in a concerning state. I just removed a number of totally unsourced claims (including claim about recommended treatment) from the Functional neurological disorder page. I am not an expert on medical sourcing, by a long shot, and mainly know enough to know there are likely other issues? If someone more expert has the time and inclination to look it over, that would be wonderful. Thank you all for all you do; it’s incredibly valuable that WP has rigorous standards of evidence for medical articles. Innisfree987 (talk) 07:33, 10 December 2022 (UTC)

As an update: I reviewed MEDRS and MEDREF and made a pass removing the most obvious problems (as best I understand them), but there are still a number of sources I’m uncertain about, as well as places where it’s not immediately obvious whether a citation is meant to cover one sentence or a whole paragraph. Checking those of course is a heavier lift tho. Innisfree987 (talk) 00:32, 13 December 2022 (UTC)

@SandyGeorgia, is this related to the TikTok tics thing? WhatamIdoing (talk) 17:00, 14 December 2022 (UTC)

Yes. Anyone who wants to further improve this article might have a look at the sources at Tourette syndrome#Differential diagnosis. I looked over the article, and it's in bad, but not egregious, shape. I can't offer to work on it soon as I am doubly impaired; I sprained my wrist and my computer is getting a new hard drive. SandyGeorgia (Talk) 11:18, 15 December 2022 (UTC)

Gates MRI request

Hi editors, I'm Lee and I work for the Bill & Melinda Gates Medical Research Institute. I suggested some updates to the article that I think help it be more complete and read a bit better. Because of my conflict of interest, I won't make any edits myself. Would anyone here be willing to take a look? I'd really appreciate it! LBGatesMRI (talk) 16:13, 12 December 2022 (UTC)

Implemented, noting that there may be more similar edits to come if others are also interested in helpful. Klbrain (talk) 21:33, 12 December 2022 (UTC)

Ileo-anal pouch

Hi all, can we get some eyes on this article? We have a lightning-fast editor adding information in several revisions (of which I haven't gotten to the bottom of). Cheers. X750. Spin a yarn? _{Articles I've screwed over?} 00:57, 14 December 2022 (UTC)

It looks like there have been lots of edits over the last week or so by someone who apparently knows something about this subject and has been working on the article for months. It might be easier to let it rest for a bit, and then go through the article less with of the patroller's "what changed?" mindset, and more with "what do we need here?" The content before this editor arrived was undersourced and incomplete, so IMO preserving the old state should not be prioritized. WhatamIdoing (talk) 17:00, 14 December 2022 (UTC)

Yeah nah for sure, I just wanted a third opinion of sorts, I wasn't trying to insinuate that their contributions were bad per se, that would be bad faith on my part. Thanks WhatamIdoing. X750. Spin a yarn? _{Articles I've screwed over?} 18:54, 14 December 2022 (UTC)