Wikipedia talk:Manual of Style/Medicine-related articles

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"Mechanism" or "Biology"?[edit]

I would like to propose "Biology" as a section heading for disease articles, in place of "Mechanism".

While I fully support the communication/accessibility aims of adopting "Mechanism" as a heading instead of "Pathophysiology", I do have serious misgivings about the appropriateness of the term. As I mentioned at the meeting before Wikimania at CRUK, I've spent years trying to help writers deploy the term appropriately , reserving it for (postulated) biological mechanisms of disease, rather than pathophysiological considerations in general. I think our current "Mechanism" sections tend to concern the biology of the disease in question, rather than the actual biological mechanisms. (For instance, a reported association between a given disease and a particular gene mutation is not in itself a mechanism; researchers look for mechanism/s to explain the association.)

In the discussion here regarding the change, Blue Rasberry raised a somewhat related concern. I suppose I should really apologise for not coming up with this alternative proposal at the time.

Wouldn't "Biology" be just as simple as a heading... And rather more correct? 109.158.8.201 (talk) 12:03, 27 December 2014 (UTC)

I have never seen the term used like this. Do we have refs that use it this way? Doc James (talk · contribs · email) 12:57, 27 December 2014 (UTC)
Well, "biology of disease" is used quite commonly (eg [1], [2], etc). I agree that "Biology" [of disease] is not a straight synonym for "Pathophysiology" (which regards the study of disturbances in organic function [3]), but imo the two concepts are closely enough related (per [4]) for our purposes. In practice, I think "Biology" [of a disease] is a suitably broad term to cover the kind of content that normally goes into these sections, including genetics, molecular biology, pathophysiology, biomechanics, etc, etc. 109.158.8.201 (talk) 13:55, 27 December 2014 (UTC)
I think we first need to get our definitions straight. The MOS currently reads:
Shouldn't the link be changed from pathophysiology (functional changes associated with or resulting from disease or injury) to pathogenesis (source or cause of an illness or abnormal condition)? Boghog (talk) 13:33, 27 December 2014 (UTC)
The difference between "pathophysiology" and "pathogenesis" is analogous to "mode of action" (cellular) and "mechanism of action" (molecular). So on second thought, perhaps the scope of this section should include both. Hence "biology" (including molecular biology) for a section heading may not be such a bad idea. Boghog (talk) 14:03, 27 December 2014 (UTC)
(edit conflict) Agreed... My impression is that what actually tends to go into these sections is often (though certainly not always) basically information about the "biology" of the disease, which often gets relatively little coverage elsewhere in the article. Obviously, I think there should be nothing here to prevent (sub-)sections on the "Mechanism/s" [of the disease] / Pathogenesis. 109.158.8.201 (talk) 14:12, 27 December 2014 (UTC)
A revised definition would then read:
Yup, that'd be good, imo. 109.158.8.201 (talk) 14:14, 27 December 2014 (UTC)

Mechanisms of drugs are often as much about chemistry as biology. Most of the antihyperphosphatemia drugs act by mechanisms in which anything that could reasonably be called "biology" is peripheral. Ditto for bile acid sequesterants. Nucleosides have been around for 60 years, but sofosbuvir is the antiviral of the decade because of better chemistry - its a prodrug that overcomes barriers to oral bioavailability and drug entry into cells. Cancer drugs alkylate DNA and penicillin alkylates PBPs. Forgive me if I'm sounding partisan here, but as someone who spent 20 years in drug discovery as a medicinal chemist, I see calling mechanism "biology" akin to calling Europe "Germany". Formerly 98 (talk) 14:24, 27 December 2014 (UTC)

Please keep in mind that there are two sections in the MOS, one covering diseases and a second, drugs. I completely agree with you on the later (I have also spent 20+ years in drug discovery as a medicinal chemist), but the current discussion is about the former. Boghog (talk) 14:35, 27 December 2014 (UTC)
Per Boghog's comment (edit conflict), please note that my proposal only regards articles on diseases etc. (Also, as regards biochemical considerations in disease articles: in the biomedical context at least, "biochemistry" is generally commonly considered to be a branch of the "biological sciences" [5].) 109.158.8.201 (talk) 14:46, 27 December 2014 (UTC)
Or maybe the reverse?. ;-) Boghog (talk) 15:23, 27 December 2014 (UTC)
Well, yes... and certainly in the context of Life, the Universe and Everything ;-) (though I think it should be ok within this particular editorial context). 109.158.8.201 (talk) 15:47, 27 December 2014 (UTC)
While meant to be humorous, the cartoon does accurately reflect an underlying reality. Biochemistry is the chemistry of life and the ultimate molecular explanations of disease are fundamentally chemical in nature. Boghog (talk) 13:40, 28 December 2014 (UTC)
...and fwiw, my allusion to the book was meant to be a humorous take on that ultimate mechanistic point. 109.158.8.201 (talk) 15:44, 28 December 2014 (UTC)
On a serious note, I don't see anything about the definition of biochemistry as "the study of the composition, chemical structures, and chemical reactions of living things" that defines it as a part of biology. I interpret that definition as saying exactly the opposite. The words "biology" and "biological" don't even appear in the definition. "Composition", "Chemical structure", and "chemical reactions" are all clearly refering to chemistry. I'd also note that the most widely cited biochemistry journal is published by the American Chemical Society.Formerly 98 (talk) 15:44, 27 December 2014 (UTC)
Seriously, I think the position on the MeSH tree of "Biochemistry" beneath "Biological Science Disciplines" highlights the editorial sense, at least from a broadly biomedical perspective. 109.158.8.201 (talk) 16:15, 27 December 2014 (UTC)
Not to quibble, but MeSH also lists biochemistry as a subdiscipline of chemistry. Formerly 98 (talk) 22:43, 27 December 2014 (UTC)
Fwiw, my point was that it can be seen as a branch of the biological sciences (not that it must be seen in that way). 109.158.8.201 (talk) 00:45, 28 December 2014 (UTC)
...or to put it another way: Is the broad term "Biology" (as used in "biology of disease", tumor biology, etc, etc) editorially pertinent here? Imo, yes. And I'm suggesting that this term doesn't suffer from the semantic restrictions and associated editorial inconsistencies to which the current advice to use "Mechanisms" (as in "pathogenesis") as a heading is almost inevitably prone. 109.158.8.201 (talk) 16:45, 27 December 2014 (UTC)
Yup, the proposal only regards articles on "Diseases, or disorders or syndromes". I think "Biology" could be a reasonable default term, per Boghog's wording above (fwiw, personally I'm not a fan of editorial straightjackets, but I realize other editors' mileage on editorial flexibility varies). 109.158.8.201 (talk) 16:03, 27 December 2014 (UTC)
I oppose the use of "Biology" as the preferred heading, because it is actually too narrow and ultimately not descriptive. I find "mechanism" more useful because it describes how a particular condition arises and leads to symptoms. When I hear "biology" I think of diseases caused by other organisms, but it wouldn't be the term of choice in conditions that relate to physical phenomena (e.g. trauma or poisoning). I think I am with Formerly 98 here. JFW | T@lk 22:26, 27 December 2014 (UTC)
Well, that's certainly a fair enough view, and I agree we shouldn't be forcing square pegs into round holes – a possible concern imo with having a single default heading. In that case, should we expect "Mechanism" sections to focus specifically on "how a particular condition arises and leads to symptoms"? Frankly, that's not what I'm always seeing at the moment. And I'm not at all sure it would be desirable to restrict ourselves in that way... 109.158.8.201 (talk) 00:43, 28 December 2014 (UTC)
I also oppose for similar reasons. "Mechanism" is a more useful and appropriate title. --Tom (LT) (talk) 23:04, 27 December 2014 (UTC)

The OP has identified a specific problem with many of our articles: people are putting stuff under ==Mechanism== (or similar headings) that does not belong there. Perhaps one small practical improvement we make could be this: we could all try to keep an eye on those sections, and move information about ==Causes== and ==Epidemiology== to their correct places whenever we see it. WhatamIdoing (talk) 06:06, 3 January 2015 (UTC)

An alternative is to just add a more specific heading name as necessary. E.g., to make it completely clear that I wasn't talking about some vague psychological process in mechanism sections that cover the neuronal signal transduction which gives rise to addiction, I used "Biomolecular mechanisms" in place of "Pathophysiology" or just "Mechanisms" in most addiction articles that I've edited (e.g., amphetamine#Biomolecular mechanisms, addiction#Biomolecular mechanisms, sex addiction#Biomolecular mechanisms, drug addiction#Biomolecular mechanisms, behavioral addiction#Biomolecular mechanisms, etc). Using this approach to title the section or, if other content is included, the relevant subsection, seems (to me) to circumvent the need to rename the section heading. Our MOS doesn't indicate/dictate the titles of subheadings to the indicated sections anyway. Seppi333 (Insert  | Maintained) 06:26, 3 January 2015 (UTC)

Arbitrary break - 2c[edit]

  • Following the opposition expressed above I'll withdraw this specific proposal. At the same time, I'd like to reiterate that I think the editorial issue it was trying to address is genuine. For instance, in a cancer article we really shouldn't need to be providing highly relevant content (which doesn't seem to fit in elsewhere under MEDMOS) about the clinical significance of precancerous lesions in a section (titled "Mechanism") regarding tumor biology. But that's how it seems to turn out at the moment...

    Fwiw, my own 2 cents would be that MEDMOS is trying to do too much, in that it's seen simultaneously as a Help guide for newbies and a style manual for everyone, as well as a sort of checklist for GA/FA, etc. And so it ends up being inappropriately rigid, and (arguably) editorially stifling. But that's a separate issue really... 109.158.8.201 (talk) 12:22, 28 December 2014 (UTC)

Mechanisms I think is sufficient Doc James (talk · contribs · email) 13:18, 30 December 2014 (UTC)
  • Support changing "Mechanism" to Biology. I'm trying to imagine what a non-scientific, non-medical person who happened across an article like Atherosclerosis or Peripheral artery disease would want the section in question to be called, and I think the answer is "Biology" rather than "Mechanism". BakerStMD T|C 17:32, 14 January 2015 (UTC)

Operations vs 'surgeries'[edit]

@user:Flyer22, If you are talking about the discipline, it is surgery. If you are talking about an operating room in the UK, it is called a surgery, so multiple operating rooms might be surgeries. But the procedure is an operation. Multiple surgical procedures are called operations, not 'surgeries'. BakerStMD T|C 15:56, 14 January 2015 (UTC)

I'll admit that colloquially, people use the singular "surgery" synonymously with "operation". But the plural should not be done. As far as clarity, I think "Operations" is just as clear as "Surgeries" in context. We might instead get around this issue by titling the section in question "Procedures and Surgery". Hows that for compromise? BakerStMD T|C 16:09, 14 January 2015 (UTC)
Bakerstmd, regarding this edit you made, which I reverted, I thought you were making that edit because the word surgery gave you unpleasant mental images; after all, you used the word cringe in your edit summary. But I see that you mention the topic of surgery on your page. Given that, and what you stated above, it seems that I was wrong about why you added "operations" in place of "surgeries." As for my preference, "surgeries" is clearer to me than "operations" because of how broad the term operation is. We have a Surgery article, not an Operation article (though, yes, the Surgery article mentions the interchangeability of the two terms). Flyer22 (talk) 16:18, 14 January 2015 (UTC)
Yes I was reacting to the misuse of the term, not the idea of surgery, with which I am quite comfortable. Am I off base here? Is anyone else bothered by this bastardization of the english on our guidelines for style? BakerStMD T|C 16:50, 14 January 2015 (UTC)
Afaik "an operating room in the UK" is a theatre (note correct spelling); it always is on tv anyway. GPs (family doctors) and vets have consulting rooms called surgeries; medical consultants and members of Parliament hold surgeries, sessions when people come for appointments. Actually I think everyone has surgeries except surgeons, but maybe a UK medic can confirm. Can't we use "Surgical procedures"? Is that murdering anyone or anything? Wiki CRUK John (talk) 01:46, 15 January 2015 (UTC)

Include "treatments" in place of "medication" in section called "Drugs, medications, and devices"[edit]

I just changed the title of a section to read "Drugs, treatments, and devices" when previously it said ""Drugs, medications, and devices". I did this because I think this section should be applied to treatments, including perhaps exercise, lifestyle changes which have been researched as medical interventions, alternative therapies which are not drugs and not devices, and anything else that is a treatment but not a drug or device. Thoughts? Blue Rasberry (talk) 15:17, 20 February 2015 (UTC)

In general this is an improvement - the section should include mainstream behavioral recommendations along with drugs and devices used in mainstream medicine. This section should not include "alternative treatments" if that means things like dietary supplements or other quackery. I can't think of anything outside of drugs, devices, and behavioral recommendations backed by treatment guidelines that should go here, and we should name those three in guideline.... Jytdog (talk) 15:23, 20 February 2015 (UTC)
Not entirely sure that's an improvement for a section intended for pharmacological interventions, as indicated by the {{main}}. If non-drug treatments go into this section then that main link has to change too. LeadSongDog come howl! 02:16, 21 February 2015 (UTC)
I'm not wild about it. I don't share the worry about dietary supplements: if they do anything, then they should be treated (sort of) like drugs.
My worry is more like this: The most effective treatment for cancer (taken as a whole) is surgical excision. There's a separate section on writing articles about surgical procedures. But this seems to say that you should use the 'drug' pattern for "anything that is a treatment but not a drug or device", which would include all surgical procedures. Something like "Drugs, devices, and similar treatments" might be okay. (I'm not sure that manufactured devices should be treated like chemicals, either.)
Also, I think it would be a serious mistake to re-write an article like Physical exercise as a medical article. The subject is much broader.
However, there are types of articles that we don't have a pattern for. So here are a few examples, and you tell me what you think would be good for them: Radiation therapy, Talk therapy, Hyperbaric oxygen therapy, Speech therapy, and Joint mobilization therapy. WhatamIdoing (talk) 00:28, 27 February 2015 (UTC)

Gender-neutral language[edit]

I had a go at creating a new section in Wikipedia:Gender-neutral language#Precision and clarity. Since nobody's commented there, and since I used some healthcare-related examples, I thought I'd ask some of you all to take a look. Comments should go on the talk page over there, I think. WhatamIdoing (talk) 18:33, 4 March 2015 (UTC)

Thanks WhatamIdoing. I agree what you've written about "male" and "female" and think what you've written is very sensible and also clearly written. I'd also add that in some instances (such as when talking about Sexual determination) I think it's necessary to talk about "biologically female" and "biologically male" to remove ambiguation, as in sexual development it's a bit confusing to explain that the initial biological sex might not reflect the person's sexual characteristics, let alone the gender a person assigns themselves when fully developed. That said I don't think there's a need to include this thought in your addition :). I wonder how languages other than English deal with this issue? --Tom (LT) (talk) 09:35, 9 April 2015 (UTC)
I don't know. I have heard some speculation that gendered languages (like Spanish or French) mightn't produce the same level of concern about language. The idea is that if everything is masculine or feminine, and with a defined default for what to do with the mixed-group setting, then it feels less "wrong" because you're used to the language not matching you. Everyone puts on their feminine socks and their masculine shoes, and the fact that the words for your clothes don't match your own gender is just no big deal. WhatamIdoing (talk) 22:12, 9 April 2015 (UTC)

Pediatric populations[edit]

See new section added to bottom of Pain management; I don't think MEDMOS (section suggestions) addresses this ... should it? SandyGeorgia (Talk) 21:55, 8 April 2015 (UTC)

Not too sure but would definitely like to see "In children" replace "In paediatric populations" --Tom (LT) (talk) 09:38, 9 April 2015 (UTC)
WP:MEDMOS#Drugs, treatments, and devices doesn't include a special populations section. Perhaps it should. In the meantime, I think that this is a good solution. BTW, "In children" seems to have changed to the more difficult word "Pediatrics" a while ago (in the "Diseases" list). Perhaps it should be changed back. WhatamIdoing (talk) 22:25, 9 April 2015 (UTC)
Ah, now I see it ... down there in Special populations! SandyGeorgia (Talk) 22:49, 9 April 2015 (UTC)