Wikipedia talk:Identifying reliable sources (medicine)

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Frequently asked questions (FAQ)

These are some Frequently Asked Questions about Wikipedia's guidelines on sourcing for medical content, manual of style for medicine-related articles, and how the guidelines and policies apply to biomedical content.

General
Why do you have special rules for medical information?
Different types of sources have different strengths and weaknesses. A type of source that is good for scientific information is not usually as reliable for political information, and vice versa. Since Wikipedia's readers may make medical decisions based on information found in our articles,[1] we want to use high-quality sources when writing about biomedical information. Many sources that are acceptable for other types of information under Wikipedia's general sourcing guideline, such as the popular press, are not suitable sources for reliable medical information.[2][3] (See also: WP:MEDPOP and WP:WHYMEDRS)
When do I need to follow MEDRS?
MEDRS-compliant sources are required for biomedical information. Like the policy on the biographies of living people ("BLP"), MEDRS applies to statements and not to articles: biomedical statements in non-medical articles need to comply with MEDRS, while non-medical statements in medical articles (such as in a History section) do not need to follow MEDRS. Also like BLP, the spirit of MEDRS is to err on the side of caution when making biomedical statements. Content about human biochemistry or about medical research in animals is also subject to MEDRS if it is relevant to human health.
Sourcing
I used a peer-reviewed source, but it was reverted, and the editor said I needed to use a review. I did, didn't I?
Probably not. Most peer-reviewed articles are not review articles. The very similar names are easily confused. For most (not all) purposes, the ideal source is a peer-reviewed review article.
Why can't I use primary sources?

Primary sources aren't completely banned, but they should only be used in rare situations. Whenever possible, you should cite a secondary source such as:

So if primary sources can be used in rare cases, what are those rare cases?

Primary sources might be useful in these common situations:

  • when writing about a rare disease, uncommon procedure, etc., for which no high-quality secondary literature is available, or for which the available secondary sources do not cover all of the information normally included in an encyclopedia article.
  • when mentioning a famous paper or clinical trial that made a recognized substantial impact, as part of a purely historical treatment of a topic.
  • when describing major research that has made a significant impact (i.e., continued and substantial coverage). While recent research results are normally omitted, it is sometimes necessary to include it for WP:DUE weight. In this case, it is usually preferable to read and cite the primary scientific literature in preference to WP:PRIMARYNEWS sources. Later, these primary sources can be replaced or supplemented with citations to high-quality secondary sources.
Can I use websites like Quackwatch?
Quackwatch is a self-published website by an author who is an expert in problems with complementary and alternative medicine. Whenever possible, you should use a scholarly source instead of Quackwatch. However, if no scholarly sources are available, and the subject is still notable, then it might be reasonable to cite Quackwatch with WP:INTEXT attribution to the POV.
Can I cite Chinese studies about Traditional Chinese Medicine?
As of 2014, there are concerns regarding positive bias in publications from China on Traditional Chinese Medicine.[4][5] Such sources should be used with caution. The problem also includes issues with the academic system in China.[6]
Can I cite NCCAM (now NCCIH)?
Yes, but again only with WP:DUE weight. Unlike other branches of the National Institutes of Health, which are generally accepted as authoritative in their fields, NCCAM has been the focus of significant criticism from within the scientific community.[7] Whenever possible, you should cite the established literature directly.
What if I can’t find any MEDRS-compliant sources on a subject?
MEDRS contains a section about finding sources which may be helpful. Alternatively, a more experienced editor may be able to help you find them (or to confirm that they do not exist).
Neutrality
What is a fringe medical claim?
How should fringe medical claims be described?
When fringe claims have been widely reported in the press, have a large popular following, and/or have a long history, it may be appropriate to describe them in terms of that reporting, popularity, or history. However, weight should be determined by MEDRS-compliant sources, and the context (or lack thereof) should not make implications about medical statements that are not supported by such sources. Guidance on the additional considerations relevant to fringe subjects can be found at WP:FRINGE, as well as at other places such as WP:WEIGHT and WP:EXCEPTIONAL.
In the case of alternative medicine, medical statements are often derived from an underlying belief system, which will include many propositions that are not subject to MEDRS. These propositions are subject to the usual sourcing requirements and the usual requirements for determining fringe status.
If a treatment hasn't been shown to work, can we say it doesn't work?

There are three possible situations:

  • no evidence exists (i.e., studies for the treatment have not been published, or the evidence base is too small or weak to draw any conclusions);
  • evidence exists, and it shows no effect;
  • evidence exists, and it shows an effect.

In the first case, we cannot say that it does not work, but we can say that there is no evidence to determine whether it works. In the second, we can say that there is no evidence that it works. In the last, we should say that there is evidence that it has an effect.

After multiple, high-quality independent studies have been published, it is reasonable to understand "no evidence that it works" as "some evidence that it does not work". You should follow the lead of review articles and other secondary sources for determining when this threshold has been crossed.

Reports may conflict with each other. For example, a clinical trial may produce no evidence of an effect, but the treatment's manufacturer might produce testimonials claiming a positive effect. You should follow the lead of review articles and other secondary sources for determining how to balance these claims.

Should medical content be attributed?
Why not say there is a call for more research?
How can Quackwatch be considered a reliable source?
Finding and using sources
How can I find good sources using PubMed?
Are there ways to find good sources other than PubMed?
Besides being a secondary source, what else indicates a source is of high quality?
I found what looks like a good source, but can't access the full text – what next?

Most scholarly journals are behind paywalls. Some options to access these articles include visiting a local university library, visiting The Wikipedia Library, and WikiProject Resource Requests.

Note that paywalled articles are frequently pirated and made available on the open web. When linking to a journal article, care must be taken not to link to such a pirate copy, as such a link would be a copyright violating link in contravention of Wikipedia's policy. In general if you find such a copy and it is not accompanied by text explicitly stating that it is made available with the permission of the copyright holder, assume that it is potentially infringing, and do not link to it. This holds for all edits in Wikipedia, not just in article space.

How do I reference a medical article?

Almost all medical articles are indexed by the PubMed search engine and have a Digital object identifier (DOI) assigned to them. All articles included in PubMed are assigned an eight-digit PubMed identifier (PMID). These identifiers can be used to refer to articles, which is preferred to URLs as it makes a reliable link which is resilient to changes beyond our control – i.e. the publisher being acquired by another publisher and it's "normal" web URLs changing as a consequence.

Once you have the PMID, there are a number of tools such as this one which you can use to generate a full citation automatically.

In article references, the "doi" and "pmid" parameters are preferred to the "url" parameter for such reasons.

On Talk pages, when referring to journal articles, is it good practice to make any link using these types of identifier also:

  • Typing "PMID", a space, and the 8-digit PubMed identifier will be automagically turned into a link by the Wikipedia software (e.g. PMID 21148220).
  • Any DOI can be turned into a resolvable web address by prepending "http://dx.doi.org/" to it (e.g. http://dx.doi.org/10.1136/bmj.c6801).
Conflict of interest
Are there special rules on conflicts of interest for health content?
What if I am being paid to edit medical content?
References

References

  1. ^ Laurent, MR; Vickers, TJ (2009). "Seeking health information online: does Wikipedia matter?". J Am Med Inform Assoc. 16 (4): 471–9. doi:10.1197/jamia.M3059. PMC 2705249. PMID 19390105.
  2. ^ Schwitzer G (2008). "How do US journalists cover treatments, tests, products, and procedures? an evaluation of 500 stories". PLoS Med. 5 (5): e95. doi:10.1371/journal.pmed.0050095. PMC 2689661. PMID 18507496. Lay summaryGuardian (2008-06-21).
  3. ^ Dentzer S (2009). "Communicating medical news—pitfalls of health care journalism". N Engl J Med. 360 (1): 1–3. doi:10.1056/NEJMp0805753. PMID 19118299.
  4. ^ Li J, et al The quality of reports of randomized clinical trials on traditional Chinese medicine treatments: a systematic review of articles indexed in the China National Knowledge Infrastructure database from 2005 to 2012. BMC Complement Altern Med. 2014 Sep 26;14:362. PMID 25256890
  5. ^ Further information:
    • "Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries." Vickers, Andrew (April 1, 1998), Do certain countries produce only positive results? A systematic review of controlled trials., Control Clin Trials, PMID 9551280
    • Ernst, Edzard (2012). "Acupuncture: What Does the Most Reliable Evidence Tell Us? An Update". Journal of Pain and Symptom Management. 43 (2): e11–e13. doi:10.1016/j.jpainsymman.2011.11.001. ISSN 0885-3924. PMID 22248792.
  6. ^ Qiu, Jane (January 12, 2010), Publish or perish in China, Nature
  7. ^ Some examples:
    • Nature Reviews Cancer: "the subject of rancorous scientific and political debate over its mission and even continued existence"
    • Clinical Rheumatology: "The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile."
    • Nature News: "still draws fire from traditional scientists", "Many US researchers still say such funding is a waste of time and money."
    • Science News: "[NCCAM] is a political creation"; "This kind of science isn't worth any time or money" (quoting Wallace Sampson)
    • Science Policy Forum: "[NCCAM] was created by pressure from a few advocates in Congress"; "NCCAM funds proposals of dubious merit; its research agenda is shaped more by politics than by science; and it is structured by its charter in a manner that precludes an independent review of its performance"; "NCCAM is unable to implement a research agenda that addresses legitimate scientific opportunities or health-care needs"
Other helpful resources

What is medical content ?[edit]

I would like the meaning of medical content, (bio)medical information, non-(bio)medical information to be clarified in WP:MEDRS. I would like the article to begin with a definition of these 3 terms, and possibly the article WP:MEDRS to be reviewed according to the definition of each term.

2 different kinds of information can be confused:

  1. a non medical information on a medical subject (e.g. "Germany allows the medical use of cannabis", "cannabis use for MS is approved in ten countries")
  2. a medical information on a medical subject (e.g. "cannabis is not proven to be effective in relieving chronic pain", "when cannabis is inhaled, blood levels of cannabinoids rise faster than when oral products are used")

According to what is written at the beginning of WP:MEDRS ("non-medical information in medicine-articles – is covered by the general guideline"), the first kind is covered by WP:RS and the second kind by WP:MEDRS; and both kinds can figure in medicine-articles.

Riffstilde (talk) 15:35, 24 September 2018 (UTC)

Your number 1 just needs RS as it is primarily about regulation ("society and culture" stuff). Your #2 needs MEDRS, as it is biomedical information. See WP:Biomedical information. There is a link to it in this guideline. Jytdog (talk) 15:40, 24 September 2018 (UTC)
Thanks. I just added the link to WP:Biomedical information after reading your reply. Riffstilde (talk) 16:41, 24 September 2018 (UTC)
It was already there. Please slow down and read more carefully. You are wasting everyone's time, including your own. Jytdog (talk) 16:46, 24 September 2018 (UTC)
Hello Jytdog, I am sure you are right and the link is somewhere on the page. I could not find it and I still cannot find it. This is why I added it where I feel it belongs to, which is where I looked for the information when I read and reread the page. I believe it will save people time to have the info where they need it. I believe it would be good if you side stepped a little and let a day or 2 pass before you jump on any modifications : people take time to think and prepare their edits (In my case I had studied this for a couple hours). They need to feel respected , and they may not be as wrong as it may seem at first. So, I will put this stuff back on, and please take some time to consider it. It tries to solve an issue. Maybe you have a better way to solve the issue. The issue is that what is and what is not biomedical info can only be found in another page, but this is not indicated in this page introduction. That's why I feel it needs to be part of the introduction. Riffstilde (talk) 17:08, 24 September 2018 (UTC)
It there in the lead already, in the second sentence. Please read more carefully. Jytdog (talk) 17:34, 24 September 2018 (UTC)
Thanks. You are right, but I still think it needs to be in the text because that's where it belongs to (when reading the paragraph, you can ask yourself how to define medical content, and you will not figure out that the answer is actually in another page about biomedical info, not about medical info):
"Wikipedia's articles are not medical advice, but are widely used as a source for health information.[1] For this reason, all biomedical information must be based on reliable, third-party published secondary sources, and must accurately reflect current knowledge. This guideline supports the general sourcing policy with specific attention to what is appropriate for medical content in any Wikipedia article, including those on alternative medicine. Sourcing for all other types of content – including non-medical information in medicine-articles – is covered by the general guideline on identifying reliable sources. In case of doubt about whether an information is to be treated as (bio)medical, check WP:biomedical information." Riffstilde (talk) 18:22, 24 September 2018 (UTC)
We use "biomedical" in relation to Wikipedia:Biomedical information. We've discussed "biomedical" extensively at this talk page. See Wikipedia talk:Identifying reliable sources (medicine)/Archive 21#Clarifying "biomedical" and Wikipedia talk:Identifying reliable sources (medicine)/Archive 25#Biomedical and health. Especially see that latter discussion, which closed with WP:RfC consensus for "biomedical" over "biomedical and health." Stop WP:Edit warring over long-standing content at this guideline, and seek WP:Consensus. Flyer22 Reborn (talk) 19:44, 25 September 2018 (UTC)
Regarding this and this, I thought you had removed "biomedical." But regarding replacing "medical" with "biomedical," I feel that this could be used as a WP:Gaming the system tactic, where some editors will claim that, in their view, certain content is not biomedical and therefore doesn't fall under this guideline. As seen by the aforementioned debates, that likely needs further discussion. After all, we aren't going to remove every mention of "medical" from the guideline or replace every mention with "biomedical." Flyer22 Reborn (talk) 20:04, 25 September 2018 (UTC)
It is "in the text". The changes were not helpful. Please stop changing this and try to understand it first, instead. Thanks. Jytdog (talk) 20:29, 25 September 2018 (UTC)
I still find the beginning of the article confusing: I would like the meaning of medical content, medical information, non-medical information to be defined, or the wording simplified. I think my edits were rightly simplifying, but it was not in the purpose of replacing medical with biomedical. It was a purpose of simplifying to make the text unambiguous by eliminating medical content which I found excessively confusing. I also replaced medical by biomedical for another reason: I believed the 2 words had the same signification in the article. If you still keep biomedical information, medical content and medical information, it makes it not understandable what must and must not follow biomedical guidelines. How can you keep 2 different words: medical and biomedical and ask to refer to biomedical guidelines for both of them? What about medical content? What is it? Will you refer me to biomedical guidelines, as the article does? Riffstilde (talk) 12:45, 28 September 2018 (UTC)
The reason for this, is discussed in the archives of this page. Jytdog (talk) 12:48, 28 September 2018 (UTC)
Hello Jytdog, (1) I am not seeing how your reply addresses my remark about removing ambiguity and poor wording. Whatever the policy expressed in the article, it must be stated clearly. (2) If you want to refer me to the archive, please indicate a precise reference. Thanks. Riffstilde (talk) 17:21, 9 October 2018 (UTC) ↓

→ Two points from my perspective: (1) This kind of language, particularly early in a discussion, is disrespectful: "Please slow down and read more carefully. You are wasting everyone's time, including your own." At a time when Wikipedia needs more good editors, tact, courtesy, and respect are much more important than being right.

(2) I agree with Riffstilde, who is simply trying to improve understanding for the average Wikipedia customer (visitor, consumer, reader). Those of you who have used (and helped improve) WP:MEDRS for years seem to (at times) forget that you know these issues inside and out, whereas the average Wikipedia reader (and editor) is encountering them for only the first or second time. Therefore, making it relatively easy for the average reader/editor to discover how we define "biomedical information" improves their understanding, makes them a better editor, and forestalls questions about the term on this Talk page and elsewhere.

I support Riffstilde's proposed edit:

Wikipedia's articles are not medical advice, but are widely used as a source for health information.[1] For this reason, all biomedical information must be based on reliable, third-party published secondary sources, and must accurately reflect current knowledge. This guideline supports the general sourcing policy with specific attention to what is appropriate for medical content in any Wikipedia article, including those on alternative medicine. Sourcing for all other types of content – including non-medical information in medicine-articles – is covered by the general guideline on identifying reliable sources. In case of doubt about whether an information is to be treated as (bio)medical, check WP:biomedical information.

  - Mark D Worthen PsyD (talk) 17:40, 8 November 2018 (UTC)

P.S. When I write that I "support" Riffstilde's proposed edit, I do not mean to imply that I support their exact wording only, i.e., we might want to hash out precise wording that we agree on (consensus).   - Mark D Worthen PsyD (talk) 20:17, 8 November 2018 (UTC)

Draft:TAPSE: Tricuspid Annular Plane of Systolic Excursion[edit]

Hi, I came across this draft while going through the WP:AFC queue. I'm not sure if this qualifies as an article, or if the sources are reliable. If a member of the project could have a look and advise, I would appreciate it. --K.e.coffman (talk) 23:17, 22 October 2018 (UTC)

Assessing pertinence based on the number of patients?[edit]

I had a disagreement with another contributor on the pertinence of some sources. The sources are systematic reviews on clinical trials (on humans), published by notable publishers. For this, no disagreement. But the disagreement comes from the fact that these reviews are made on not enough patients (we talk here about hundreds when doing the total over all reviewed trials). The context is that this is pertaining to "innovative" fields, in the sense that there is not as much interest (and thus funding or patients) as in others like Alzheimer. In my opinion, this context should be taken into account, and if all other reliability factors are greenlight, the source is admissible. But the other contributor has the opposite view Face-wink.svg. I checked MEDRS and found no mention of accounting for the number of patients. Here is an example source where we disagreed: [1]. Also, to add a bit more context, the goal was to say that "to date, this compound has shown no significantly beneficial effect", which is a non extraordinary claim (negative result). So, should the number of patients be accounted? Thank you in advance for your advices/thoughts! --Signimu (talk) 21:54, 2 November 2018 (UTC)

You can have strong evidence of an effect from a small numbe of patients if the effect size is large. The harder thing to do is to interpret negative results based on a small number of trials/patients. It makes sense to me to be guided by the wording in the systematic review being referenced. Bondegezou (talk) 23:53, 2 November 2018 (UTC)
@Bondegezou: Thank you very much for your reply! How would you define "small number of trials/patients" in the case of negative results? Or should I just use the systematic review wording, in order to avoid any personal interpretation of "small"? --Signimu (talk) 02:42, 4 November 2018 (UTC)
Generally safest to stick to the systematic review's own wording, so as to avoid WP:OR. Bondegezou (talk) 13:27, 4 November 2018 (UTC)

Template:CC-notice[edit]

Moonriddengirl, regarding this and this, should we include the "Removing the CC-notice for copyrighted content will result in a copyright violation." sentence in this guideline? After all, Template:CC-notice states, in part, "This template should not be used when you cite a source, but still write all the article content in your own words." Flyer22 Reborn (talk) 06:33, 11 November 2018 (UTC)

"Copying content under a compatible license requires a template under the correct license. Removing it for copied content under a compatible license will result in a copyright violation." When the content is written in your own words is not relevant to this discussion. This is for content that is not written in your own words for copied content under one of the various compatible licenses. It is also a good idea to add a template for content in the public domain. QuackGuru (talk) 09:44, 11 November 2018 (UTC)
It is an ongoing problem. Numerous editors think if the content is under an appropriate license they can copy the content without using one of the templates.
This is happening across numerous topics. Even for content in the public domain it is required to use a template to avoid plagiarism. QuackGuru (talk) 16:26, 11 November 2018 (UTC)
Hi. Just because I was pinged by Flyer22 Reborn, popping in to say that I don't have any real strong opinion over whether this information is included in this guideline or not. It's included in several relevant policies, guidelines, and protocol pages, so I don't regard it as essential. Not all pages can or should include all information.
If it is included, I prefer the text as presented by [User:QuackGuru|QuackGuru]] just above - the starker "Removing the CC-notice for copyrighted content will result in a copyright violation." is misleading, at least by itself. The content remains copyrighted whether it is copied or properly paraphrased. When properly paraphrased, citation is necessary to avoid plagiarism, but the CC-notice is not. The language "Copying content under a compatible license requires a template under the correct license. Removing it for copied content under a compatible license will result in a copyright violation" is clearer. That said, again, I don't have a strong opinion. Perhaps some of the editors who work on these particular suite of guidance pages might be better at guiding consensus here. --Moonriddengirl (talk) 02:50, 12 November 2018 (UTC)
Thank you, Moonriddengirl. Flyer22 Reborn (talk) 02:52, 12 November 2018 (UTC)
And just to be clear, I was asking about the accuracy of the "Removing the CC-notice for copyrighted content will result in a copyright violation." statement (even though my question above was about inclusion). You answered that. Flyer22 Reborn (talk) 02:59, 12 November 2018 (UTC)
The content is accurate but doesn't belong here -- WP:OFFTOPIC. This guideline is WP:Not the kitchen sink... Jytdog (talk) 09:37, 13 November 2018 (UTC)