Wikipedia talk:WikiProject Medicine/Archive 108

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Video Wikipedia talk:WikiProject Medicine/Archive 108

Dangerous Wikipedia prostate suite of articles

PMID 29406053, March 2018 review

Casliber Anthonyhcole Colin Jytdog Doc James MastCell RexxS Johnbod

Prostate cancer -- Prostate cancer screening -- Prostate-specific antigen

So, here I sit, in between radiology and surgery. Never imagined I would fall prey to grossly outdated, poorly written Wikipedia artcles, but here I am. And I cannot deal with an unfavorable cancer prognosis and fixing Wikipedia artcles at the same time.

If this suite of articles cannot be updated and written with the accuracy warranted for a condition that will affect one man in six, then these articles should be gutted. At minimum, the biased and outdated preferencing of poor information regarding PSA screening should be removed. I tried and have been reverted, even though there are MANY more journal reviews and professional guidelines than the one I listed above.

For years, Wikipedia has preferenced the USPSTF information in the entire suite, and has completely left out multiple other guidelines. This is bias of the dangerous kind. And this is costing men's lives.

For years, medical editors have tried to patch up articles, but the finger in the dike approach to the repair needed in this entire suite is not adequate. Please, either dedicate the resources this topic deserves, or gut the articles to remove the dangerous and outdated sections. PSA screening saves lives. A lack thereof, thanks to one guideline bias, results in advanced prostate cancer, that is harder to treat. Please join me in at least alarm, if not sadness. SandyGeorgia (Talk) 16:32, 27 February 2018 (UTC)

Very sorry to hear this news. Health editing on Wikipedia is largely a damage limitation exercise. It was a situation which paralleled yours which first interested me in editing medical articles. I don't see what we editors can do except keep hammering away at the content. Alexbrn (talk) 16:59, 27 February 2018 (UTC)

so sorry I did not ping you, Alexbrn .... probably forgot others, hard to edit from iPad. I accept that wikipedia has problems, but again, as always has beeen the case, we could solve it by treating biomedical content like a BLP. If we cannot provide decent content, then the articles should be gutted. No info is better than faulty info. There are good sources out there for prostate info. Our information is horrible. SandyGeorgia (Talk) 17:24, 27 February 2018 (UTC)

I am sorry for the situation you are in SandyGeorgia; i figured something like this was going on based on your edit notes. I will get back to this, this week. I don't know that our articles are so bad. That state of the science and commercialization for prostate screening and diagnostics, is bad. PSA remains a very bad screening test - it drives zillions of unneeded biopsies and those are positively medieval. "Here i will stick a bunch of needles in you multiple times and then only really examine some of the tissue that is extracted, and we will see what we can generalize from that." No good blood test, no good medical imaging for this. Lots of people are trying to find better ways for sure but as of 2018 still nothing great. Jytdog (talk) 17:50, 27 February 2018 (UTC)

This is not meant as a goad, but you've got to be kidding, right? Half of the Prostate cancer screening article was sourced by the New York Times. Barbara (WVS) ?  ? 21:49, 27 February 2018 (UTC)

You will get back to this, this week? I disagree. We can get back to this right away. This is an urgent request. Time for QuackGuru to edit. QuackGuru (talk) 19:01, 27 February 2018 (UTC)

What's urgent about this? Wikipedia has no deadline, and is a project of continual improvement. Natureium (talk) 19:05, 27 February 2018 (UTC)

See WP:YESDEADLINE and per comments by original poster. QuackGuru (talk) 19:26, 27 February 2018 (UTC)

 ??? That essay is about the loss of knowledge when sources are destroyed. No one is physically destroying all reference to current medical guidelines. Natureium (talk) 19:39, 27 February 2018 (UTC)

See WP:DEADLINENOW. Wikipedia articles are mostly outdated and/or contain inaccurate content. QuackGuru (talk) 20:25, 27 February 2018 (UTC)

Very sorry to hear this news. I've tried to update the few references to the UK situation, but I have to say they pretty much agree with the USPSTF on general screening. Johnbod (talk) 18:17, 27 February 2018 (UTC)

I'm sorry to hear that things are complicated, Sandy.

I haven't read the review linked above, but the abstract is not convincing. Lead time bias, improved treatment (which usually means no treatment for most men with prostate cancers), and other biases can all lead to the perception of "decreased mortality" without actually saving any lives that were actually threatened. This is exactly the sort of thing that breast cancer patients have been dealing with.

It looks like the NHS is working on a large-scale trial for PSA testing, with almost half a million men enrolled. That's the sort of trial that finally demonstrated that Breast self-examination didn't actually save any lives in average-risk women. (NB: BSE provides some net value for high-risk women.) We should be watching for those results, and updating the articles as soon as we have them. WhatamIdoing (talk) 18:52, 27 February 2018 (UTC)

@WhatamIdoing, And here they are, a week later. Johnbod (talk) 15:44, 9 March 2018 (UTC)

On the worries about readers: Most internet users prefer to look at multiple sites, as a way of making sure that they've got the whole story. So they're going to read our articles plus articles such as this from WebMD, which mostly discourages it, this from Scientific American, which discourages it, and this from the Mayo Clinic, which mostly recommends it. They don't necessarily read the scientific literature, but people who are seriously looking for information don't read just one webpage and assume that it's correct, either. WhatamIdoing (talk) 19:09, 27 February 2018 (UTC)

Yes, we have had that argument before. Our article, and our approach to editing, is still wrong. At minimum, as Casliber points out, we could focus on getting screening info correct, so people will know when to consult further. I cannot answer all of this from iPad, but will when I am home. Not only are there plenty of reviews, and guidelines left out (how about NCCN), but I will address the faulty logic about why we (Wikipedia) are wrong in our cherry picking. We do not get to choose to preference one biased guideline, and ignore or downplay the rest. More when I am next home from hospital. Well, yes, there is no rush for our case ... we are already too late to pay attention to screening. One thing is life expectancy-- another thing is quality of life. When women lose their breasts (which can possibly be reconstructed) are they looking at a lifetime of urinary or fecal incontinence or reduced sexual function, even if they survive the cancer? Apples and oranges. SandyGeorgia (Talk) 19:20, 27 February 2018 (UTC)

I understand that, after comparing all of the apples and oranges, the worldwide DALYs for breast cancer are approximately two to three times worse than the DALYs for prostate cancer. None of which matters in individual cases, of course.

I do think that we should name multiple significant guidelines for common conditions like this. The NCCN's earlier guidelines were a significant cause of PCa overdiagnosis and overtreatment (they were derided at the time as "test early, test often, biopsy many"), so I'm not particularly attached to the idea of including their new one (although I don't actually object to including it, either). I wish that NICE had one, because I think it's particularly valuable to have a non-American POV (I couldn't find one, and I spent about half an hour searching for it). WhatamIdoing (talk) 23:36, 27 February 2018 (UTC)

Indeed, the emperor is wearing no clothes. Perhaps we can come up with a list of health screening articles to attack. I am currently working on the screening for hypothyroidism in women-also pretty important. While the IPs keep editing medical Rabbit test article, which has over 1500 views a day, we can get busy and do some real editing. Best Regards, Barbara (WVS) ?  ? 20:06, 27 February 2018 (UTC)

Incredible...the prostate screening article is actually an anti-screening essay supported by terrible referencing. Ouch. Barbara (WVS) ?  ? 20:55, 27 February 2018 (UTC)

BINGO. PRECISELY!! And given that I cannot deal with a chronic condition and have time to also fix the article, I hat-noted one article, that was removed, and the article was not fixed. Can this piecemeal semi-fix approach please stop? And there are so many MEDRS sources that are just ignored. I have a one-hour trip each way to hospital, and am too tired today to write more. The sources are out there to do this right, and most of you have better access to full-text of recent journal articles than I do. I do not have time or energy to fix this. The idea that we have any excuse for such bad text about a screening issue-- one that has kept physicians and patients alike from paying attention to valid combinations of PSA and DRE-- should be set aside, as we have a clear example of an entire suite of articles that is important and needs work. One in six men will get prostate cancer, PSA screening saves lives, and we have an anti-PSA-screed which amounts to cherry picking of one source, and poor contextual framing on other sources. I should not have to tell the personal details of how this came about in my case-- this should only be about reliable sources, and they are there. But I will come back another day and share the personal part so more of you might understand just how misleading our content is. Perhaps before I do that, some more medical editors will have taken the time to actually look up the dozens of recent reviews I was able to find, and get the full text of them. SandyGeorgia (Talk) 23:22, 27 February 2018 (UTC)

Sandy, in your honor and understanding the frustration of not being able to improve vital info when you can't, I'll take a stab at the other articles. Feel free to leave a 'to-do' list on my talk page that will help me prioritize those improvements that you feel are necessary. I feel like you have the 'bigger' picture and I don't. But I sure can put together an (imperfect) article with good referencing that others can edit and critique. Please be well. Best Regards, Barbara (WVS) ?  ? 16:19, 28 February 2018 (UTC)

The Prostate cancer screening#Alternative techniques section is obsolete. There are new tests available. See here. The table summarizes the tests and indications. QuackGuru (talk) 21:49, 27 February 2018 (UTC)

@SandyGeorgia: terrible news and my condolences - prostate cancer is the start. We should make a hit list somewhere.....Cas Liber (talk · contribs) 23:33, 27 February 2018 (UTC)

Screening for prostate cancer using the DRE or PSA is controversial. Some reviews state it reduces mortality.[1] Others do not.[2][3] The 2012 USPSTF specific recommended against it.[4] It appears they are softening that position in 2017/2018 but this remains in a draft.[5] Yes Wikipedia sometimes lags behind. Doc James (talk · contribs · email) 12:10, 28 February 2018 (UTC)

By the way cancer.org says as of Feb 6th 2018 "The issue of prostate cancer screening is controversial. In the United States, most prostate cancers are diagnosed as a result of screening, either with a PSA blood test or, less frequently, with a digital rectal examination. Randomized trials have yielded conflicting results.[16-18] Systematic literature reviews and meta-analyses have reported no clear evidence that screening for prostate cancer decreases the risk of death from prostate cancer, or that the benefits outweigh the harms of screening.[19,20]"[6]

Canadian Guidelines recommend against routine screening as of 2014 for all age groups.[7]

A diagnosis of cancer is always terrible news. Doc James (talk · contribs · email) 12:23, 28 February 2018 (UTC)

Made more terrible when diagnosis was delayed for four years because GP did not pay attention to regular and valid screening tools and information, meaning the cancer had time to progress when it could have been detected at a curable stage. (I put my personal story on Anthonyhcole's talk page, as it should not be part of this discussion.) There has long been MEDRS reliably sourced objections to the USPSTF (review posted at head of this section is useful-- please read full text).

The real issue here is the cherry picking and bias throughout out poorly written prostate cancer suite of articles. Wikipedia outright preferenced one source (a controversial one), to end up with an article that is an anti-screening essay, while ignoring many other reliable sources. Besides, that the main points of how to screen, when to screen, who to screen, how to correctly combine PSA and DRE into patient recommendations, are poorly covered to inaccurate. I hope you all are concerned, but past experience tells me ... to expect something different. I do appreciate any and all attempts to clean up these articles for the next guy. One in 6 men gets prostate cancer, so it will affect several of you here. Good luck. SandyGeorgia (Talk) 15:18, 28 February 2018 (UTC)

Ok, ready for an informal review of Prostate screening. Over 300 of you have already taken a look. It would be great to have all the comments above related to this topic appear on the article's talk page. I haven't been able to locate the "who to screen", "when to screen", and the combination of screening practices. From what I got from the sources is not crystal clear on this (no algorithm). If one type of screening indicates that there may be an issue, then screening continues to rule out prostate cancer or at least to stage it. Best Regards, Barbara (WVS) ?  ? 16:09, 28 February 2018 (UTC)

I think that this group (taken as a whole/not every individual) appreciates the science-only POV of the USPSTF. One criticism of the USPSTF's recommendation is that it doesn't answer the "But now what?!" question. By law, they're not supposed to care whether they produce a recommendation in favor of anything. They're only supposed to say what has been proven, to a certain scientific standard, to work. When the answer is "nothing", then they recommend against everything. But if you're the clinician, "can't do anything - nothing is proven to work!" isn't functional. USPSTF's model is that if there are no double-blind randomized trials of parachute use, then they have to recommend against using parachutes due to insufficient evidence. This is why the USPSTF and clinician groups produce different guidelines. They're both right: the evidence for PSA tests alone is weak, the harms from testing are substantial - and "always do nothing for all men everywhere" isn't necessarily the best response. That kind of situation is why Shared decision-making in medicine is a thing. WhatamIdoing (talk) 16:19, 28 February 2018 (UTC)

I cannot tell you all how much I appreciate the work. I disagree that USPSTF is "science-only"-- as the review I posted above indicates, their position is more likely driven by the economics. I understand there are a lot of Gleason 6 men running around hysterical, and a lot of unscrupulous practitioners willing to milk that cash cow, but that is NOT our situation. And I am in no (emotional) position to be involved in fixing these articles-- I am living the failure. We have yet to celebrate our fifth wedding anniversary. Four years ago, PSA screening DID detect my husband's cancer, and four years ago, his cancer was most likely treatable if not curable. Today, it is not (based on a number of factors and features, but I digress-- it was curable when GP ignored PSA). BOTH PSA and DRE DID DETECT the cancer, which GP ignored, because he was following USPSTF bullshit. All I ask is that our articles use all sources to cover the issue correctly and completely-- not cherrypick and overrely on one source. You will not find a urologist who discounts PSA screening to the extent that USPSTF recommendations advocated. USPSTF was a player in my husband's prognosis. Our articles can do a better job of covering the whole matter, and our articles did not do that previous to now. It would be much too upsetting for me to look in on those articles now, and I appreciate anyone who is trying to help. Wish I did not now understand prostate cancer as well as I do, but I do. As a patient living the nightmare, and as an editor with knowledge of our medical sourcing and neutrality policies, I find that our articles are (were) horrible. For a condition that will affect one in six men, that should bother us. SandyGeorgia (Talk) 16:55, 28 February 2018 (UTC)

The screening article now contains info on a variety of other diagnostic procedures. PSA testing may be controversial, but a digital exam done as a regular part of a check-up is still used along with advancements in imaging. Best Regards, Barbara (WVS) ?  ? 23:44, 28 February 2018 (UTC)

"The Task Force does not consider the costs of a preventive service when determining a recommendation grade (A, B, C, D, or I). While the Task Force has congressional authority to review evidence related to cost-effectiveness, it excludes costs from its determination of the benefits and harms of a clinical preventive service. This deliberate decision was made to maintain a clear focus on the science of clinical effectiveness (i.e., "what works"), and not consider cost, in part to avoid any misperception that the Task Force's purpose is to limit health care based on cost."

I understand that the USPSTF's position is that the test hasn't been proven to have any net value and therefore shouldn't be performed (without individual reason, e.g., symptoms or family history). I don't believe that they've said the results should just be ignored after you've already run two tests and both came back positive.

I'm really sorry to read about what you're dealing with. WhatamIdoing (talk) 16:59, 1 March 2018 (UTC)

See Prostate cancer. See here and here for changes and previous wording. One source failed verification and the current source says 69. Editors should be carful when adding more than one citation for each claim because different sources make different claims. It currently says "Informed decision making is recommended when it comes to screening among those 55 to 69 years old.[12]" It is sourced to the USPSTF. That seems controversial. Is there another source with better information? I found a list of prostate cancer screening guidelines by various organizations [8]. QuackGuru (talk) 16:05, 28 February 2018 (UTC)

Your changes are tendentious as hell. Jytdog (talk) 05:58, 1 March 2018 (UTC)

I prefer the anti-screening stuff removed from the lead. See below for my review. QuackGuru (talk) 17:22, 1 March 2018 (UTC)

• It seems to me that part of the problem is that Prostate cancer screening, which refers to mass testing in a way that is currently not standard anywhere as far as I can see, is the only article, or decent section, that we have on the detection and diagnosis of prostate cancer. Indeed that article begins "Prostate cancer screening is the assessment and detection of prostate cancer in men", which is surely not a correct definition? That article is very largely about the pros and cons of having screening programmes, with very little about the interpretation of the results and follow-up. The diagnosis section at the main PC article seems pretty thin, and Prostate-specific antigen covers in some detail the use of PSA levels after a diagnosis (D'Amico Criteria etc), but has very little on how PSA contributes to diagnosis, just: "PSA levels between 4 and 10 ng/mL (nanograms per milliliter) are considered to be suspicious and consideration should be given to confirming the abnormal PSA with a repeat test. If indicated, prostate biopsy is performed to obtain tissue sample for histopathological analysis." Johnbod (talk) 15:14, 1 March 2018 (UTC)

• Another problem right now is that the prose at prostate cancer screening is quite problematic, borderline unintelligible in several places. There are multiple instances where I have no idea what the lead is attempting to say. I cannot outline those--I have been at the hospital every day this week, and am heading back. But there are significant enough prose problems that anyone should easily see them. I continue to say that articles on a highly traficced website that cannot present a minimum level of reliably sourced and decently written medical content should be gutted, so that readers will move on to the large numbers of reliable sources available. Wikipedia is not able to systematically produce reliable medical content. SandyGeorgia (Talk) 17:08, 1 March 2018 (UTC)

I appreciate the feedback, but the definition is difficult to nail down because the sources all say: "PSA"=Prostate cancer screening. Since there are other screening tests and exams available for detecting prostate cancer, I balk at the definition being only about PSA. All efforts to help with the article are appreciated. Best Regards, Barbara (WVS) ?  ? 16:36, 2 March 2018 (UTC)

Lets review Prostate cancer:

• Current wording:

Prostate cancer screening is controversial.[10][3] Prostate-specific antigen (PSA) testing increases cancer detection but it is controversial regarding whether it changes the risk of death from the disease.[10][11] Informed decision making is recommended when it comes to screening among those 55 to 69 years old.[12][9]

• Previous wording:

Early detection of prostate cancer via prostate cancer screening may help with prognosis and treatment before disease advances.[10] Prostate-specific antigen (PSA) testing increases cancer detection but also increases unneeded subsequent testing and procedures due to false positives.[1][3] As of 2013 it was unclear whether results of PSA testing change the risk of death from the prostate cancer.[11] Broad use of prostate cancer screening resulted in a reduction in mortality.[12] Informed decision making is recommended when it comes to screening among those 55 to 69 years old.[13][10]

• The word controversial does not tell the reader much. Stating "controversial" even once is too much for the lead. It looks like a mini anti-screening essay is staying in the lead without any wiggle room for improvement. QuackGuru (talk) 17:22, 1 March 2018 (UTC)

This should really be taking place at the article on prostate cancer not here. Yes prostate cancer screening is controversial. Some well respected organizations recommend against screening. Others shared decision making with screening and no screening both being options as it is not clear what effect screening has.

This sentence is vague "Early detection of prostate cancer via prostate cancer screening may help with prognosis and treatment before disease advances". Many excellent sources says it is "unclear" if prostate cancer screening improves prognosis.

We often give US government sources a great deal of weight. In this instance we are giving weight to NCI and USPSTF. These conclusions are also supported by a bunch of review articles and the WHO.

Yes in the last couple of years some in the US mostly have advocated that we simple let patients decide if they want or do not want screening. The argument is not that screening would not help anyone (yes it would help some people) but it also harms some people. So at a population level it is unclear if it helps or harms more people. Doc James (talk · contribs · email) 11:26, 2 March 2018 (UTC)

Individuals get tested. Population groups get screened. Let's stick to that distinction, or things get horribly confused. Johnbod (talk) 17:15, 2 March 2018 (UTC)

This can also be discussed here. Telling our readers that prostate cancer screening is controversial in the lead is a mini anti-screening essay in the lead. QuackGuru (talk) 17:05, 2 March 2018 (UTC)

What does that even mean? "Controversial" means there's views on both sides, which indeed seems to be case here. Alexbrn (talk) 17:08, 2 March 2018 (UTC)

What does that mean when I initially read it? It means testing for prostate cancer is controversial (not really necessary). Skipping testing is dangerous (and life-threatening). QuackGuru (talk) 23:10, 2 March 2018 (UTC)

Again, "testing" and "screening" are not the same thing. Testing is dangerous for some individuals (possible infection or damage from blood draws; needless biopsies in healthy people), and skipping testing is dangerous for other individuals (the fraction of people with cancer that would be discovered earlier by the test and that early discovery would change the actual outcome). Screening asymptomatic people, nearly all of whom don't have a given condition (and therefore have no possibility of receiving any benefit) can have more harms than benefits.

I think that some people might be interpreting the word controversial as meaning "bad". I don't think that's a fair interpretation, but it might be common. Maybe we could look for other ways of explaining it, such as "Researchers disagree about whether screening causes more harms than benefits". WhatamIdoing (talk) 01:34, 3 March 2018 (UTC)

An embarrassment still

This version, which still largely neglects PMID 29406053, a March 2018 review

Doc James, you mention this discussion should be occurring at article talk. I maintain that it belongs here, because it highlights the long-standing systemic failure of Wikipedia to produce accurate, reliable, unbiased, updated, well-written content -- not even on an important article about a condition that will affect one in six men. A week and hundreds of edits later, the article has not significantly improved, reflects multiple instances of medical misunderstanding and confusion, is still POV, and still has garbled prose in the lead.

Is there anyone participating in the editing of this article who has experience with cancer, other than Johnbod (whose post at 15:14, 1 March 2018 UTC indicates a real understanding of the problem?)

Has anyone who is participating in editing the article actually read the full text of the March 2018 review I posted above? I see three direct quotes from the article abstract have been added, but no overall correction to the article based on a read of the full text of the review. The appearance is that someone grabbed quotes from the abstract without reading full text. Doc James, have you read the full text of the review, because your statements here (and WAID's) continue to advance points that do not indicate that you have digested the review. You continue (on this talk page) to advance positions taken by government entities that have been shown to be wrong and dangerous. If you intend to ignore the review, knowing it clearly states that PSA screening reduces death, then please state so clearly and take responsibility for such a dramatic position.

I don't believe that they've said the results should just be ignored after you've already run two tests and both came back positive. WhatamIdoing (talk) 16:59, 1 March 2018 (UTC) How are you using the term, come back positive? What, in your view, is a "positive" PSA test? Do you have some understanding of when to watch PSA levels, when to advise followup, when to make sure a good DRE is done, when to refer on to urology, etc? Screening for prostate cancer is not a matter of a binary outcome (positive or negative test).

Testing is dangerous for some individuals (possible infection or damage from blood draws; needless biopsies in healthy people) ... WhatamIdoing (talk) 01:34, 3 March 2018 (UTC) These arguments are not persuasive: we have MEDRS sources. Have you read the full text of the March 2018 review I posted? There are many that say the same. BTW, when a man gets a physical, he has blood drawn anyway. If unscrupulous or uninformed physicians are performing unneeded biopsies, because they don't know how to interpret PSA and DRE, or nervous men are incorrectly educated about how to interpret PSA and demand unnecessary testing, that is a separate (education) matter.

... and skipping testing is dangerous for other individuals (the fraction of people with cancer that would be discovered earlier by the test and that early discovery would change the actual outcome). WhatamIdoing (talk) 01:34, 3 March 2018 (UTC) I hope you are not equating the unlikely "possible infection from a blood draw" with the serious issue of missing cancer. We have a March 2018 review which explains how the USPSTF got it so wrong, and states that When correctly interpreted, the data are clear: PSA screening significantly reduces suffering and death from PCa(ncer).

Screening asymptomatic people, nearly all of whom don't have a given condition ... WhatamIdoing (talk) 01:34, 3 March 2018 (UTC) "Nearly all of whom" is misleading-- one in six is a significant number of men with cancer.

The current lead asserts that: "It is not clear whether early detection reduces mortality rates." Catalona March 2018 disagrees, and clearly states that PSA screening reduces death. The second sentence of the lead asserts bias as fact.

"Screening for prostate cancer may include the use of the digital rectal examination (DRE), during which the prostate is assessed manually through the wall of the rectum or the measurement of prostate-specific antigen (PSA) in the blood." People. Really? This is the lead! Unconvolute the wording, and add punctuation.

"The evidence remains insufficient to determine whether screening with prostate-specific antigen (PSA) or digital rectal exam (DRE) reduces mortality from prostate cancer." Again, referencing government sources to assert a statement as fact, when Catalona (and many others) lay out the problems clearly. PSA screening reduces death from prostate cancer.

"A 2013 Cochrane review concluded it results in "no statistically significant difference in prostate cancer-specific mortality between men randomized to the screening and control groups."" Cochrane 2013, Catalona 2018. Sloppy preference for Cochrane, and again, it appears that editors have not read Catalona.

"The American studies were determined to have a high bias. European studies included in this review were of low bias and one reported ... " WHAT American studies? This is the lead of the article, and the issue of the American v European studies has not even been introduced yet. How is the reader to know WHAT American studies are being referenced? (Hint, the ones that were misinterpreted.)

"Others recommend screening with a PSA ... " Others WHO? The previous sentence referenced studies ... who is doing the recommending here? This lead is full of garbled prose. Besides, it is a non-sensical sentence. "Others recommend screening with a PSA test or DRE who are at high risk and anticipate a long life expectancy."

So, hundreds of edits later, the article is still not only biased-- the writing is horrible. I will check back in a few days, and tag the article POV or whatever it still is if these items are not corrected (throughout the prostate cancer and PSA articles). Catalona specifically details the FLAWS in the USPSTF recommendations, and yet we have Wikipedia editors still referencing those deadly mistakes, while ignoring other sources. A big enhancement to the article and the lead would be an understanding and mention of indolent tumors. "Screening for PCa has been challenged because of concerns about the risk of triggering unnecessary biopsies and the over diagnosis and over treatment of screen-detected, indolent tumors with possible untoward side effects". We really don't need to be suggesting on this talk page that the issue is possible infection from a blood draw, when we are comparing to cancer. If two editors want to ignore sources, then please say so outright and take responsibility for the information you spread on a highly trafficked website. There are already enough stupid doctors out there a) ordering biopsies when they shouldn't, or b) ignoring valid prostate cancer screening. Maybe Wikipedia can get it right. PS- there are NO urologists or oncologists on the USPSTF panel, but anyone who read Catalona would know that. I suspect that anyone saying the flawed USPSTF recommendation was science-based, and not economic-based, did not read the review I posted. Are we not ashamed? Or is the problem here that this is an issue affecting men v. women? SandyGeorgia (Talk) 09:57, 3 March 2018 (UTC)

I was referring to the article on prostate cancer not prostate cancer screening. The first article's lead accurately reflecting NCI/NIH/CDC/USPSTF, Cochrane, and the WHO.

We have some sources that say PSA screening reduces prostate cancer specific mortality and others that say it does not. The more important question though is does it reduce overall mortality when used as a screening test?

This is not a significant concern "possible infection from a blood draw". What is a concern is that if a PSA comes back positive people often than go for biopsies and if the biopsies come back positive people can end up with fairly extensive surgery when the cancer in question was unlikely to have caused them any problems.

Catalona is NOT the only source. We have a 2018 draft from USPSTF and we have a Feb 2018 NCI review. Both are also reasonable sources. Doc James (talk · contribs · email) 14:19, 3 March 2018 (UTC)

Speaking of COI "Dr. Catalona developed the PSA test as a screening test for prostate cancer."[11] He has recent patents on it.[12] They are also associated with Ohmx Corporation.[13] Doc James (talk · contribs · email) 14:24, 3 March 2018 (UTC)

Here is rates of cases of prostate cancer and mortality from prostate cancer in the USA.[14] We see a huge drop in prostate cancer cases between 1992 and 2014. Why because screening has decreased. We also see a steady drop in deaths from prostate cancer from 1992 and 2014. It results in the death of 2 per 10,000 males per year. And current rates of death are lower than at any time since recording began in 1975. For screening tests one is looking for independent epidemiologists not urologists who hold patents in the test in question. Claiming that NCI, CDC, WHO, Health Canada, Doc James (talk · contribs · email) 14:35, 3 March 2018 (UTC)

The World Cancer Report in 2014 says "Screening for prostate cancer is controversial. Screening with serum PSA level has increased detection of all prostate cancers, including indolent prostate cancers. PSA emerged as one of the most-used serum tests to screen for cancer, particularly in the USA but also in Europe. Recent data from the Prostate, Lung, Colon, and Ovarian Cancer Screening Trial showed no benefit to screening, and the European Randomized Study of Screening for Prostate Cancer showed a 20% reduction in relative risk of cancer-specific mortality, which translated into an absolute reduction of prostate cancer-related deaths of 0.71 per 1000. Each trial has criticisms that may or may not have affected power and outcome, although the rate ratios comparing screening to not screening are similar. Definitive evidence for or against screening is still lacking [15]."

"The detection via screening of both clinically significant and potentially clinically insignificant prostate cancer has created a dilemma as to which patients should receive aggressive treatment [16]. Overtreatment of screen detected tumours is a major concern. In the USA, most men with screen-detected cancers undergo aggressive treatment. Such treatment is unlikely to yield a survival benefit in those with indolent disease or in men older than 65 years, but it can result in a considerable decrease in quality of life as a result of potentially persistent urinary, sexual, and bowel dysfunction [16]."Doc James (talk · contribs · email) 14:42, 3 March 2018 (UTC)

You wrote "The more important question though is does it reduce overall mortality when used as a screening test?" That question is not the right question to ask. It is not about overall mortality among populations or groups. It is about writing articles for individual readers. Does the current lead for prostate cancer provide useful content for our readers? No. People are not statistics. We don't go by the numbers for our readers. QuackGuru (talk) 16:18, 3 March 2018 (UTC)

The first words of MEDRS are "Wikipedia's articles are not medical advice ..." so we need to be cautious about writing for individuals. Our task is simply to represent faithfully the information on a topic contained in the best sources (and that might contain advice from reputable bodies which we might neutrally relay as a matter of fact - here for example is something from the NHS). Alexbrn (talk) 16:31, 3 March 2018 (UTC)

Thanks User:Alexbrn for the UK position. Will add. Doc James (talk · contribs · email) 11:44, 5 March 2018 (UTC)

Update

Ok all, I have made Wikipedia:WikiProject Medicine/Priority maintenance - everyone is welcome to add to it. Two categories so far - screening articles and (common) OTC meds. If someone wants to make more comprehensive tables I'd be grateful. This can then be updated over time. Cas Liber (talk · contribs) 23:56, 27 February 2018 (UTC)

I agree that the parts of articles relating to before medical advice is sought should have the highest priority, but shouldn't we say diagnosis, signs and symptoms or something rather than screening, "a strategy used in a population to identify the possible presence of an as-yet-undiagnosed disease in individuals without signs or symptoms", which only applies to some diseases? Johnbod (talk) 15:50, 2 March 2018 (UTC)

It's unclear to me on the priority page what is meant by "needs rechecking". I think we need to be more specific about what exactly needs to be rechecked. TylerDurden8823 (talk) 08:56, 4 March 2018 (UTC)

It means I haven't looked at it yet. i was just starting to get some idea of the scope of the problem and sorts of priorities. Cas Liber (talk · contribs) 12:35, 4 March 2018 (UTC)

Ah, I see. Thank you for clarifying, Cas Liber. TylerDurden8823 (talk) 21:17, 6 March 2018 (UTC)

+----------------------------------------------------------------------------------------------------+ Further update: this is an interesting piece. It maybe raises questions which intersect interestingly with our stance on sourcing and what constitutes the best evidence ... Alexbrn (talk) 18:37, 8 March 2018 (UTC)

They might perhaps have waited longer than 2 days before criticising the lack of coverage! But in the UK it received considerable mainstream coverage, as usual taking a lead from specialist sources like Cancer Research UK. I alerted Talk:Prostate_cancer_screening#New_mass_study_results_in_UK on the 7th, and there has been some discussion there - with some editors for and against using the study results themselves. Johnbod (talk) 16:11, 11 March 2018 (UTC)

Maps Wikipedia talk:WikiProject Medicine/Archive 108

Quaternary prevention

Is there value in this article? The concept is real and there is discussion in healthcare on it, but what about the title? And the diagram is very confusing to be because the difference between illness and disease is not defined. Should this article be heavily pruned? Natureium (talk) 15:46, 13 March 2018 (UTC)

Disease and illness are terms used in the medical anthropology field. See Disease#Terminology. It's commonly said that a patient goes to the doctor with an illness and comes home with a disease. I don't have a good sense of the notability of the topic, but it is not bollocks. --Mark viking (talk) 18:26, 13 March 2018 (UTC)

That should be explained then, because at present, it looks like bollocks. Natureium (talk) 18:32, 13 March 2018 (UTC)

src: upload.wikimedia.org

One of your project's articles has been selected for improvement!

thank you for posting--Ozzie10aaaa (talk) 19:41, 12 March 2018 (UTC)

Not in our scope, and no longer tagged as such. This is a singer who suffered from psychiatric illness, doesn't really belong. Carl Fredrik ^talk 23:55, 12 March 2018 (UTC)

was so tagged on[15]--Ozzie10aaaa (talk) 09:20, 14 March 2018 (UTC)

src: upload.wikimedia.org

Suitability of primary sources

Suitability of primary source material that is in collective agreement when secondary sources are lacking or absent on a subject that had its genesis in high-quality, medical literature for 1-2+ years ago.

It's disheartening to see when all of one's efforts for bringing a collection of primary source knowledge to the table that points to the same thing when there has been no secondary source material on it for a very long time (1-2 years or longer), is quickly taken away, leaving the edit one has made a husk of its former self when it comes to accurate and comprehensive referencing or gone entirely. As mentioned, my concern relates specifically to areas where primary sources through many independent teams of researchers conducting studies on a common research subject all point to the same thing on a subject that had its genesis in high-quality, medical literature for 1-2+ years ago. I have quoted some passages from WP:MEDRS partly on the feasibility of primary sources in this situation.

Quoting from WP:MEDRS: "Text that relies on primary sources should usually have minimal undue weight, only be used to describe conclusions made by the source, and must describe these findings clearly so that all editors even those without specialist knowledge can check sources." " Keeping an article up-to-date while maintaining the more-important goal of reliability is important. These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or where few reviews are published."

I think that edits with primary sources that qualify for the inclusion made by these terms and the title of this topic should be allowed to stay. Right now I'm trying to discern the suitability of a number of primary sources, and one secondary source, for updating the schizophrenia page on the well documented effect of negative symptom improvement from several (if not all) atypical antipsychotics. This has been known for decades for medicine like clozapine and has become more relevant with some more modern antipsychotics like asenapine and cariprazine. I have to say that finding secondary sources and an umbrella reference for this area, as with many other medicine articles, has proven to be like finding a needle in a haystack. The sources I'm interested in adding to the schizophrenia article are listed below. Meanwhile many articles are mouldering away with outdated medical information because of a lack of up-to-date secondary sources and because of unnecessary deletions of primary sources that point to the same thing on a subject where secondary sources have been absent for a long time. Would like to hear some opinions on the subject. Reixus [Talk] [Contribs] 08:03, 9 March 2018 (UTC)

• From a policy point of view I think the issue is that "primary source knowledge" is a contradiction in terms. Material in primary sources is more information, which only rises to the level of knowledge when subject to analysis and synthesis in secondary sources. The information in primary sources is often wrong - building content on it effectively makes Wikipedia an ersatz secondary source; we should be a tertiary source building on (yes) 'knowledge' embodied in secondary sources. There are occasions when primary sources are useful, but care is needed. Alexbrn (talk) 08:38, 9 March 2018 (UTC)

See my response further down. Reixus [Talk] [Contribs] 12:29, 11 March 2018 (UTC)

• I oppose any further laxness with evidence on the schizophrenia article. The fact that this information hasn't been reviewed over a period of several years is likely a red flag that it is controversial in the scientific community -- and thus does not belong in our article. This provision to allow primary sources exists primarily for rare topics, such as Alström syndrome, where we allow a "case report and review" article (there are some other things that should be removed from that article though). There is no reason to think that information on Schizophrenia should be locked away, with hundreds of reviews being published every year. It's another thing when there is one review article on a disease every five or so years...
  In fact I support stricter rules for major diseases such as Schizophrenia, because narrative review articles are equally plagued by nonsense.
  Here is a narrative review that argues that Schizophrenia is caused by possession by evil spirits: PMID 23269538, Schizophrenia or possession?, Journal of Religion and Health Jun. 2014
  Quote from the abstract:

  Demonic possession can manifest with a range of bizarre behaviors which could be interpreted as a number of different psychotic disorders with delusions and hallucinations. The hallucination in schizophrenia may therefore be an illusion--a false interpretation of a real sensory image formed by demons. A local faith healer in our region helps the patients with schizophrenia. His method of treatment seems to be successful because his patients become symptom free after 3 months. Therefore, it would be useful for medical professions to work together with faith healers to define better treatment pathways for schizophrenia.

This is ostensibly peer-reviewed, PubMed-indexed, and a review article. Let's not open the flood-gates more than they already are.

Carl Fredrik ^talk 09:29, 9 March 2018 (UTC)

I disagree that silence indicates controversy. Controversy produces publications. Producing decent research on something that "everyone knows" produces silence. WhatamIdoing (talk) 23:33, 9 March 2018 (UTC)

WhatamIdoing -- with yearly reviews of the evidence on such major diseases, that something isn't picked up is a sign. Silence doesn't necessarily mean controversity, but in medicine ground-breaking new evidence is often picked up quickly. If you disagree with this analysis I suggest you propose a change to WP:MEDRS. Carl Fredrik ^talk 16:00, 11 March 2018 (UTC)

You know what's interesting, some people get so engrossed in the white and black biblical world view that, by some combination of bad influences from this, genetics, upraising, and lifestyle, they develop these "demonic" traits in their personality, which can become more apparent when they're high and/or psychotic. Although the idea that schizophrenia is intrinsically linked with "demonic possession" and can be healed in 3 months by a faith healer is something I find both amusing and silly. Reixus [Talk] [Contribs] 10:07, 12 March 2018 (UTC)

• Well, there is a meta-analysis (https://www.ncbi.nlm.nih.gov/pubmed/25528757) with the conclusion: "Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement.". Of course this study, does not include the new study in Lancet (2017) referenced above. Regarding the general problem: I'd be careful considering the results of secondary sources (like meta-analysis) automatically as knowledge. Many meta-analyses of anti-depressants have been done since 20 years and there is still no end to the debate of whether anti-depressants produce a clinically significant improvement or not.Lucleon (talk) 12:31, 9 March 2018 (UTC)

No-one is saying that meta-analysis is perfect, but would you say it's better to base the debate on data from meta-analysis or single studies? Carl Fredrik ^talk 12:49, 9 March 2018 (UTC)

On the anti-depressant thing, here is a blog from one of my favorite bloggers, Neuroskeptic, about that last antidepressant meta-analysis by Cipriani, which concluded that they do work (modestly) and that the media went "bananas" over (in the words of the blogger).

Neuroskeptic looked at Standardized Mean Difference (SMD) in each paper:

SMD in Cipriani 2018: 0.30 (conclusion; they work modestly) PMID 29477251

SMD in Turner 2008: 0.31 (conclusion; they work modestly) PMID 18199864

SMD in Kirsch 2008: 0.32 (conclusion: they don't work) PMID 18303940 Jytdog (talk) 15:02, 9 March 2018 (UTC)

Two things always amuse me. Firstly, when Jytdog forgets to sign, and secondly, when newbies want to change established and well proven policy. Roxy, the dog. barcus 13:54, 9 March 2018 (UTC)

Didn't mean to save yet. whoops :) Jytdog (talk) 15:02, 9 March 2018 (UTC)

Re: Carl Fredik: In general, meta-analyses (of course) are stronger unless there is something wrong with them. My point is simply to be also cautious about meta-analyses.Lucleon (talk) 14:11, 9 March 2018 (UTC)

Re: The quote from Neuroskeptic: Many thanks for this, I think that's important information that we should probably add to the corresponding wiki pages. I added the effect size of the Cipriani study yesterday to the pages on SSRI and antidepressants. To be fair with Kirsch et al. 2008: they do say that they found an effect which was, however, only significant for severely and not for moderately depressed. But maybe with 'conclusion' you are referring to the representation in the media which is unfortunately not very helpful. Besides that: I also like that blog.Lucleon (talk) 14:16, 9 March 2018 (UTC)

• Hope to get back to discussing this on Monday (schedule's too tight right now and I'm exhausted). Had to update the topic because I made a glaring error in not specifying the range of time worth waiting for secondary sources after a subject has its genesis in high-quality, medical literature. CFCF: The primary sources I conceptualized were those that use medically accepted scales for measuring changes in a given area, not ones postulating unquantifiable phenomena. I guess I didn't make myself clear in that respect. I fully agree with you on keeping the nuttiness out of the picture when it comes to referencing. I'll try replying to others and developing on and expressing more of my views on Monday after reading others' responses. Reixus [Talk] [Contribs] 16:35, 9 March 2018 (UTC)

Thanks for your original post. There are reviews from the past few years. It appears that you are trying to use primary sources to build a mini-review argue against these actual reviews. This is not what we do here per WP:MEDREV. We are editors, not authors. Jytdog (talk) 23:38, 9 March 2018 (UTC)

Thanks, I also appreciate the views expressed by you all. My position was based not on an argument against the reviews but a support of them. I'm trying to show that several primary sources, in addition to one secondary/primary source, all reached a conclusion about one or another (or in one case all collectively) atypical antipsychotic: that according to their studies, the atypical antipsychotics mentioned in them effectively reduce negative symptoms of schizophrenia. However, with what you just linked, I see now that my idea prospect fits in this category from WP:MEDREV and means that this prospect I had is a no-no: "Primary sources should not be cited with intent of "debunking", contradicting, or countering any conclusions made by secondary sources." Moreover, I agree with the process many of you spoke to the effect of. The idea of scrupulously analyzing results of multiple backgrounds to glean the the gems from the rough when making a secondary source. A little bit skeptical of the suggestion by Alexbrn that information in primary sources is often wrong. What if all the primary sources analyzed and synthesized through a secondary source were wrong, would that make the secondary source right? Another thing I found that makes things a bit confusing is this information on WP:MEDREV: "Primary sources may be presented together with secondary sources." Can the primary sources then by proxy of the secondary source be used to debunk, contradict, or counter another secondary source? Well, it's not that important. The key thing is that I'll now be judicious about striving to strictly find secondary sources for making edits on biomedical information, save for the few rare exceptions mentioned for primary sources. Thanks everyone for your input! Reixus [Talk] [Contribs] 12:29, 11 March 2018 (UTC)

@Reixus: I am a psychiatrist - the area of psych meds is extremely murky with many controversies, some widely known...some not so widely so. I'd not be lax in this area. I'll try to take a look at the papers above. Cas Liber (talk · contribs) 12:55, 11 March 2018 (UTC)

While an essay, Jytdog's Wikipedia:Why MEDRS? is a good explanation why MEDRS sources are preferred on medical articles. Secondary sources are often less reliable than primary sources for raw facts since they tend to be secondhand information and thus oversimplified, but that is more a concern in popular culture and in non-medical science. Worth noting finally that "secondary source" and "MEDRS compliant source" are in no way synonyms, there are plenty of sources that are an author's own thinking based on primary sources, generally at least one step removed from an event. It contains an author's analysis, evaluation, interpretation, or synthesis of the facts, evidence, concepts, and ideas taken from primary sources and thus secondary sources per policy but don't meet MEDRS. Jo-Jo Eumerus (talk, contributions) 13:16, 11 March 2018 (UTC)

Sounds good, glad you took an interest to it. Reixus [Talk] [Contribs] 10:07, 12 March 2018 (UTC)

Atypical Antipsychotics

For starters, I find it hard to take seriously any scientist who uses this term with a straight face, given that the side effect profiles of both first gen and second gen psych drugs are so wildly different that many are more similar to each other than their own "group" (eg: chlorpromazine, olanzapine, clozapine are highly anticholinergic, and risperidone, amisulpride and haloperidol have virtually no anticholinergic activity but do have parkinsonian effects.). They'll push the serotonin activity...but amisulpride has none and aripiprazole has little (ironically my personal experience is that these two have the most effect on negative symptoms (after clozapine) but that is completely anecdotal). The Grayson paper has so many assumptions in it is funny - e.g. (a) that PCP intoxication is chemically equal to psychosis, (b) that rat and human brain chemistry are similar enough to make an assumption, (c) that the rat's non-recognition was not simply a spot of bradykinesia from haloperidol, that (d) clozapine and risperidone are waving the banner for the "atypical class" and hence an assumption about the "group" can be made. But never mind, I have seen this study quoted at meetings as to why typicals are toxic and atypicals are neuroprotective....Cas Liber (talk · contribs) 13:11, 11 March 2018 (UTC)

NB: That Grayson paper has no declaration of COI in it. Cas Liber (talk · contribs) 13:21, 11 March 2018 (UTC)

But, looking at this (note some of the same authors) there is a coi statement at the bottom (funded by Allergan and Gedeon Richter...who make cariprazine...) . Cas Liber (talk · contribs) 13:28, 11 March 2018 (UTC)

Um, that wasn't a reference I added. Reixus [Talk] [Contribs] 10:07, 12 March 2018 (UTC)

I just added that as it was the same principal authors - it shows their funding. I suspect they'd have been funded somehow for the earlier study. Cas Liber (talk · contribs) 10:43, 12 March 2018 (UTC)

• The paper here is old news indeed. Clozapine's superiority was covered I thought. Must read the review articles. Cas Liber (talk · contribs) 13:32, 11 March 2018 (UTC)

It is, I just thought it was a particularly well worded analysis. Reixus [Talk] [Contribs] 10:07, 12 March 2018 (UTC)

• And this....hmmmm...why not run depot risperidone against low dose depot haldol....? Cas Liber (talk · contribs) 13:36, 11 March 2018 (UTC)

Just wanted to show that risperidone is also good for negative symptoms. Reixus [Talk] [Contribs] 10:07, 12 March 2018 (UTC)

Still, if you're trying to demonstrate that, why not run it against Haldol? Cas Liber (talk · contribs) 10:43, 12 March 2018 (UTC)

• Then there is this paper where in the second last para of the article they are trying really really hard to make asenapine's side effect profile sound really good (in reality it is pretty much like risperidone - but they are downplaying that much and embellishing the non weight gain, non sedating properties. On the plus side, it doesn't stimulate prolactin...but...) Cas Liber (talk · contribs) 13:43, 11 March 2018 (UTC)

The study showed a 50% PANSS score superiority of asenapine 5 mg 2x/d versus 3 mg/d risperidone. What is your take on the dosing used? Hard to argue with asenapine's binding profile too. Almost all atypical antipsychotics are sedating (something solved for most of them just by taking it at night, the H1 receptor effect desensitizes after a while and D2 antagonism (and in somes cases partial agonism leaning more towards the antagonistic side) has also been shown to be sedating) and result in weight gain.

Err, no - not many antipsychotics are sedating. In the highly sedating category we have CPZ, olanzapine, quetiapine and clozapine. In practice, just about everything else falls in a somewhat mildly (but not often, but occasionally alot) sedating - haloperidol = asenapine = risperidone = lurasidone = ziprasidone = paliperidone, and then there are amisulpride and aripiprazole which can be either like that bunch or quite activating. Anyway, that's my take after prescribing all these drugs for hundreds (if not thousands) of people over the past 25 years. Cas Liber (talk · contribs) 10:43, 12 March 2018 (UTC)

@Casliber: Mild or not, most are still sedating. Do you still find sufficient time for studying by the way? Would be fun to trade words on research :D Can email me through my user page if you want. Reixus [Talk] [Contribs] 10:03, 14 March 2018 (UTC)

@Reixus: Err.....studying what? WRT sedatingness - there is a huge difference in the sedative effects between most and least sedating. Cas Liber (talk · contribs) 10:19, 14 March 2018 (UTC)

Psychiatry, psychology, neuroscience, molecular and cell biology. Right now I'm reading up on some of the more nuanced features of various neurotransmitter receptors. Also got started in the past few weeks reading up on depolarization and certain enzymes and molecules in the synapses. Any of this catch your eye? Reixus [Talk] [Contribs] 10:24, 14 March 2018 (UTC)

I'm also in a book club and I'm pretty absorbed with the current book we're covering, The Shadow of the Wind. Alright, lunch time! Later! Reixus [Talk] [Contribs] 10:40, 14 March 2018 (UTC)

• Then there is this also funded by the drug maker...the doses of risperidone used are larger than what I generally use and I would be suspicious that they'd be inducing more parkinsonism than what I'd normally see with the drug. And parkinsonism can look like negative symptoms. Cas Liber (talk · contribs) 13:48, 11 March 2018 (UTC)

Good point, should've paid more attention to the study sponsor. Still the result was promising. Reixus [Talk] [Contribs] 10:07, 12 March 2018 (UTC)

No it wasn't! Patients are often moaning of sedation or EPSE on those sort of risperidone doses! Cas Liber (talk · contribs)

Was talking about the negative symptom reduction in the two groups. Yeah, EPS is often very problematic with high potency antipsychotics like risperidone and haloperidol. High potency antipsychotics tend to have "tight and long" binding to the D2 receptor which can lead to EPS becoming very problematic, whereas lower potency antipsychotics like clozapine and quetiapine tend to have a more rapid dissociation from the D2 receptor (which last long enough to produce an antipsychotic effect), and this rapid dissociation property is postulated to reduce these side effects. Reixus [Talk] [Contribs] 10:03, 14 March 2018 (UTC)

There might be other better articles out there..but I reckon if there were they'd be being brandished about now as evidence. I mean, I hope I am wrong....Cas Liber (talk · contribs) 13:48, 11 March 2018 (UTC)

src: upload.wikimedia.org

Community genetics

Wikipedia has a Community genetics article, but it's about community genetics in biology. There is also a medical community genetics, as covered by the Journal of Community Genetics etc. Is anyone up for starting a Community genetics (medicine) article (or some other title}? Bondegezou (talk) 13:29, 13 March 2018 (UTC)

Some relevant stuff:

• Pigsonthewing created Bernadette Modell, a leading figure in the field. (COI: I know Bernadette a bit.)
• doi:10.1159/000016129 is a useful background paper on the field (by Modell & Kuliev).
• doi:10.1093/fampra/cmg519 is a 2003 review paper.
• A WHO report on community genetics in low and middle-income countries. Bondegezou (talk) 13:52, 13 March 2018 (UTC)

I have to say these papers are all well over 5 years old. Johnbod (talk) 13:56, 13 March 2018 (UTC)

Why not just start a section on medical applications in the Community genetics article? Natureium (talk) 15:03, 13 March 2018 (UTC)

Despite the name, there is very little connection between the two fields. Two articles makes more sense to me (with a disambiguation note). Bondegezou (talk) 15:45, 13 March 2018 (UTC)

I'm not sure I understand the difference between personal genetics and community genetics then. Is it not the interaction of the community with genetics? Like GxE? Natureium (talk) 15:47, 13 March 2018 (UTC)

The WHO report above offers the following: "Community genetics has been defined as "the art and science of the responsible and realistic application of health and disease-related genetics and genomics knowledge and technologies in human populations (communities) to the benefit of individual persons."" (p. iv). Bondegezou (talk) 18:07, 13 March 2018 (UTC)

Is there a more straightforward definition? I have a degree in genetics and I'm lost there. Natureium (talk) 18:39, 13 March 2018 (UTC)

The definition given sounds like "public health, but for genes and DNA instead of infectious diseases and lifestyle factors". WhatamIdoing (talk) 04:44, 14 March 2018 (UTC)

But this is distinct from the topic of Public health genomics? Natureium (talk) 20:41, 14 March 2018 (UTC)

src: upload.wikimedia.org

Wikipedia:WikiProject Medicine/Collaboration of the Month

Any interest in reviving this? Cas Liber (talk · contribs) 22:50, 10 March 2018 (UTC)

its been some time since the last one, which was Transverse myelitis--Ozzie10aaaa (talk) 10:52, 11 March 2018 (UTC)

I think it's a good idea to revive it since it spurs us to collaborate and leads to significant leaps forward in improving article quality. TylerDurden8823 (talk) 19:49, 11 March 2018 (UTC)

What I think would work best is if it followed a plan like Wikipedia:WikiProject Dinosaurs/Dinosaur collaboration - namely that there is no time limit. Instead, a new collaboration is chosen when the current one achieves GA status. This way, each collaboration is essentially parked at a stable point that can be in future referred to (FA would be ideal but might be a tad ambitious. Of course there is nothing stopping someone taking the baton and running it to FA-hood. Cas Liber (talk · contribs) 09:33, 12 March 2018 (UTC)

I think that the overall difficulty is that relatively few people want to collaborate, once they realize that "collaboration" means "intentionally work on articles that I don't necessarily care about". As with all WikiProjects, the first question should be "Is there actually a group of people that want to work together as a group?" If there's a group, then the group can talk about details. WhatamIdoing (talk) 23:25, 12 March 2018 (UTC)

I don't think that's it either. To be honest, I think the project halted on Transverse myelitis because of how rare that disease is. Many editors, including me are motivated by people reading and being helped by our edits. If we want to resurrect the project I would suggest sticking to the 1000 top articles at [16], at least for starters. Some of the articles there are still really low quality, even those on comparatively much more common diseases. While it would be enviable to have a "Rare disease collaboration of the week", we're just not there -- and with the amount of work left on common diseases it might not be the best time-investment.

The following are all pretty bad and could use work (and are far more common)

• Ankylosing spondylitis
• Septic shock
• Edema
• Gangrene
• Panic attack
• Autoimmune disease
• Hypoglycemia
• Chest pain (top 2000)

I think restarting the project like that would gain more interest. Carl Fredrik ^talk 23:53, 12 March 2018 (UTC)

In terms of being helpful to the readers of the articles, I think being able to focus on the rarer conditions can have a major benefit as good quality information is harder to come by than some of the more common conditions. I have my pet project of Kallmann syndrome since I am a patient with the condition and like to make sure the article is as accurate as possible to help fellow patients. The numbers might be lower than with other articles but the ability to help people with rarer conditions gain information could be very beneficial. Neilsmith38 (talk) 00:06, 13 March 2018 (UTC)

Rarer/narrower articles are generally being worked on already. It's broader articles that need more eyes and hands on. @WhatamIdoing: agree in part, though it mainly needs at least one really dedicated person per article to really ferry it along and coordinate it. Any article could have any one of use more or less interested than others. Cas Liber (talk · contribs) 00:37, 13 March 2018 (UTC)

I would be happy to help contribute. JenOttawa (talk) 00:18, 15 March 2018 (UTC)

src: upload.wikimedia.org

Will this be used for health, too?

I read this article: https://www.theguardian.com/technology/2018/mar/13/youtube-wikipedia-flag-conspiracy-theory-videos about how Youtube will use Wikipedia on conspiracy theory videos to act as a built-in debunking tool - could this be used for medicine and health, too? --122.108.141.214 (talk) 03:27, 14 March 2018 (UTC)

I imagine they will for HIV/AIDS_denialism, MMR_vaccine_controversy, and Chronic Lyme disease, etc. But I guess we will need to wait and see.

I remember there was mention of Wikipedia being provided to help people read about the reputation of sources. I think FB was thinking of doing this. Not sure if it has happened yet. Doc James (talk · contribs · email) 05:33, 14 March 2018 (UTC)

Thanks, hopefully it'll be used for things like the cervical cancer vaccine, too. Just wondered if perhaps the project was... something that wikiprojects could actively advocate for, but maybe it'll all be through robot learning. --122.108.141.214 (talk) 07:38, 14 March 2018 (UTC)

In any case looks like a good idea. As a translator I've been getting dozens of conspiracy videos to translate, both on YT and FB. Their amount, topics and claims are absolutely mind-blowing. Brandmeister^talk 08:56, 14 March 2018 (UTC)

By the way I have started a discussion here regarding efforts that may help to prepare for this. Doc James (talk · contribs · email) 20:53, 14 March 2018 (UTC)

commented[17]--Ozzie10aaaa (talk) 15:30, 15 March 2018 (UTC)

src: upload.wikimedia.org

Effects of a Vegan Diet on Type 2 Diabetes

This new article, apparently created by a student as a class assignment, could use review by a medical expert for compliance with Wikipedia policy. Thank you. 108.16.196.194 (talk) 11:55, 3 March 2018 (UTC)

That was bad; have blanked and redirected to Veganism#Health effects where there are at least some reliable pertinent sources for this topic. Alexbrn (talk) 13:08, 3 March 2018 (UTC)

In that case, other pages from the class will likely have similar problems. From Wikipedia:Wiki Ed/Northeastern University/Advanced Writing in the Health Professions (Spring 2018), below are other page the students are working on. 108.16.196.194 (talk) 13:42, 3 March 2018 (UTC)

• Quantum Tunneling in DNA (in progress at User:G-tay617/sandbox) -- (note - was moved to mainspace; i moved it back to draft space: Draft:Quantum Tunneling in DNA Jytdog (talk) 17:57, 5 March 2018 (UTC))
• Sugar substitute (already mostly reverted by User:Zefr)
• Medication errors in the Emergency Department -- (note - condensed and then merged to Emergency department Jytdog (talk) 17:57, 5 March 2018 (UTC))
• Sleep Deprivation on college students (in progress at User:Koo.b/sandbox)
• Pain management in children - this student editor is doing a fine job on this article and I will oversee their effort. Barbara (WVS) ?  ? 01:20, 7 March 2018 (UTC)
• Veterinary pharmacy
• Home automation for the elderly and disabled
• Access to medicines
• Community health
• Animal assisted therapy
• Blood-injection-injury type phobia
• Dr. Celine Gounder (in progress at User:Cb31337/sandbox)
• Tropical Medicine
• Antidepressant
• Intermittent fasting
• Physiological Effects of Marathon Running (in progress at User:Yacar.d/sandbox)
• Venom in medicine (in progress at User:Ryanpan007/sandbox)

We already have an article on Medical error, and now there's Medication errors in the Emergency Department. Should this be merged into medical error, or generalized into Medication errors? Natureium (talk) 17:53, 5 March 2018 (UTC)

would think the former is a better choice...IMO--Ozzie10aaaa (talk) 12:03, 16 March 2018 (UTC)

src: upload.wikimedia.org

Help with Tuberculous lymphadenitis

Hi, I was looking something up for work and ended up on the Tuberculous lymphadenitis page. A recent edit has done something to the diagnosis section but I have no idea which version I should revert to. Any help is greatly appreciated Red Fiona (talk) 19:27, 5 March 2018 (UTC)

Thanks. A couple of edits ago, the ==Diagnosis== section was completely empty. I reverted to the penultimate version, which had the most favorable ratio of content to obvious typos. OTOH, the page is entirely unsourced and most sections are nearly empty or missing entirely, so anyone who is interested should grab the nearest textbook and replace it all. It should be easy to turn that into a decent article. WhatamIdoing (talk) 20:25, 5 March 2018 (UTC)

added ref to diagnosis section/ cleaned up EL--Ozzie10aaaa (talk) 11:42, 6 March 2018 (UTC)

• more help/edits needed at Tuberculous lymphadenitis, thank you--Ozzie10aaaa (talk) 12:03, 16 March 2018 (UTC)

src: upload.wikimedia.org

Is Draft:King-Devick technologies, inc. (King-Devick Test) a proper overview, or a POV advert? (cognitive/concussion test)

I volunteer in Articles for Creation and ran across this draft: Draft:King-Devick technologies, inc. (King-Devick Test)

It is extremely, very comprehensive, down to paragraph after paragraph citing the details of specific studies with positive conclusions for the Test. It's setting my POV radar off that there doesn't appear to be any criticism or controversy mentioned at all despite the extreme length and level of detail.

Could someone more savvy let AFC know if this is a really legit new article, or if this is a self-serving POV advert? Please feel free to just post your thoughts directly at the top of the page itself so other AFC reviewers can see it, or discuss here and ping me, as you like.

Pinging @Conniezimmer: so submitter can be aware of the discussion. MatthewVanitas (talk) 05:46, 16 March 2018 (UTC)

Note in May 2017 King-Devick Test was CSDed for G11:

18:50, 6 May 2017 Athaenara (talk

MatthewVanitas (talk) 05:48, 16 March 2018 (UTC)

Thanks for bringing this here. I left a note at the draft page. Jytdog (talk) 16:23, 16 March 2018 (UTC)

Yup paid editors producing promotional content :-( Doc James (talk · contribs · email) 16:45, 16 March 2018 (UTC)

Various firearm articles added to this project

I'm looking for comments on the recent addition of Firearm, Handgun , Gun violence, and Gun violence in the United States to this project. Respective discussions at Talk:Firearm#Contested project, Talk:Handgun#Contested projects, Talk:Gun violence#Contested project and Talk:Gun violence in the United States#Contested projects. Meters (talk) 22:59, 14 March 2018 (UTC)

I don't see how any of these are relevant to the medicine project. Plenty of pages have short sections on public health, etc, that aren't a part of this effort. SEMMENDINGER (talk) 00:11, 15 March 2018 (UTC)

I've commented at Talk:Gun violence in the United States #Contested projects and I suggest that we keep comments to a single talk page to avoid fragmentation of the debate. --RexxS (talk) 02:03, 15 March 2018 (UTC)

Links added to other three pages. I should have done that to start... Meters (talk) 02:39, 15 March 2018 (UTC)

See WP:PROJSCOPE. An article is in scope if the participants want to support it (even if you think they shouldn't) and it's out of scope if they don't (even if you think they should).

My guess is that the folks here are going to be interested in Gun violence and Gun violence in the United States, but less interested in Handgun, and much less interested in Firearms. Does anybody have a different POV?

Also, in the future, please don't remove WikiProject tags just because someone outside of a group has complained about them. WhatamIdoing (talk) 05:36, 15 March 2018 (UTC)

The tags were not added by anyone in the project. You restored them so they are your tags now, including the ones for Wikiproject Law, which you are not a member of. Meters (talk) 06:00, 15 March 2018 (UTC)

I notice that Gun violence in the United States is missing some medicine-specific information, such as Florida banning physicians from even gently inquiring about whether families were leaving loaded guns within reach of kids (there was an exception for suicidal kids). (The law was finally overturned last year as an unconstitutional infringement on physician's free speech rights.) WhatamIdoing (talk) 06:14, 15 March 2018 (UTC)

None of those are relevant to WP:MED. People need to stop trying to make political statements through categorization. Natureium (talk) 14:06, 15 March 2018 (UTC)

Agree that well these articles may deal with medical issues they are not central enough to medicine that they should be included within this project. Doc James (talk · contribs · email) 15:37, 15 March 2018 (UTC)

One way to simplify this problem is to be as clear as possible in the project scope statement. Articles that are easy to identify as out of scope can be detagged without discussion. · · · Peter (Southwood) ^(talk): 15:57, 15 March 2018 (UTC)

Firearm and Handgun should definitely not be. I am more sympathetic to Gun violence which has a significant public health perspective.

I tried to think of some parallel examples, so I looked at asbestos (analogous to firearm) and health impact of asbestos (kind of analogous to gun violence), expecting the former not to be in WikiProject Medicine, but the latter to be. I was surprised that they both are. Road traffic safety is also in WikiProject Medicine. Domestic violence is too. Those examples would support including gun violence. Bondegezou (talk) 16:24, 15 March 2018 (UTC)

Yes gun violence would be okay / on the edge. Not handgun though. Doc James (talk · contribs · email) 17:33, 15 March 2018 (UTC)

I think the closest gun violence and domestic violence could be to medicine is public health, which is a distinct discipline. Natureium (talk) 18:01, 15 March 2018 (UTC)

I find that I agree with Bondegezou. Natureium, those subjects might be dominated by another discipline in the real world, but it's not a distinct group of editors on this wiki. WikiProject "Medicine" doesn't restrict itself to a narrow definition of medicine (or a consistent one: we reject all articles about hospitals, which are clearly part of the structure of conventional medicine, but we accept articles about nursing, chiropractic, and altmed, all of which are also distinct disciplines). Also, this "categorization" isn't visible in the article, so if it's meant to be a "political statement", then it's a very ineffective one. WhatamIdoing (talk) 18:35, 15 March 2018 (UTC)

There is no WikiProject Public Health: public health topics come under WikiProject Medicine. Bondegezou (talk) 23:05, 15 March 2018 (UTC)

• Kill it. Kill it with fire. I am getting tired of this "everything that involves injuries is automatically a public health issue" delusion. What next? List of countries by traffic-related death rate? Sailing ship accidents? Jellyfish stings in Australia? Injuries in netball? Motorcycle racing? Running of the Bulls? Accidents and incidents involving the V-22 Osprey? I agree with Doc James when he says that while these articles may (arguably) involve medical issues they are not central enough to medicine that they should be included within this project. We have plenty on our plate without adding marginally-related articles to WikiProject Medicine. --Guy Macon (talk) 23:59, 15 March 2018 (UTC)
  • Note that 29 minutes after pasting this (duplicate) message here, Guy posted on the article talk page that he agreed that Gun violence should be tagged for this project.[18] I think that nearly everyone is reaching the same conclusion: yes to the "cause of death" articles and no to the "objects" articles. WhatamIdoing (talk) 06:24, 16 March 2018 (UTC)
    • Note the reason I gave; because that page actually discusses something related to medicine. I strongly oppose adding either "cause of death" or "objects" articles. I support only adding articles that actually discuss something related to medicine. --Guy Macon (talk) 10:46, 16 March 2018 (UTC)

Then we have agreement? No to firearm and handgun; yes to gun violence and therefore presumably yes to Gun violence in the United States. Bondegezou (talk) 10:58, 16 March 2018 (UTC)

PS: I note that injuries in netball is in WikiProject Medicine... Bondegezou (talk) 11:00, 16 March 2018 (UTC)

I think that's the plan, Bondegezou.

Guy, I think we usually tag things that should have substantial content related to medicine, broadly defined, even if that content hasn't been added yet. WhatamIdoing (talk) 15:21, 16 March 2018 (UTC)

Doing that is just opening up the door to drive-by-tagging abuse. If you think that an article needs content that is related related to medicine but are unwilling or unable to add it yourself, make your case on the WikiProject Medicine page and see if anyone is interested, only adding the tag when there is actual medical content on the page. --Guy Macon (talk) 20:04, 16 March 2018 (UTC)

1. I wrote most of WP:MED?, and I've done more work in that area than anyone else in the entire history of the project. I have tagged, assessed, and removed tags from ten thousand articles over the years. If any editor has a reasonably well-informed idea of what this group does and doesn't want to include, it's me. And I'm telling you that this group wants to watch articles that should have medical content even if they're currently incomplete, e.g., articles about medical device manufacturers that tout the companies but don't have any "real" medical content in it yet.
2. This system might theoretically "open up the door" to problems, but in practice, we've had remarkably few problems with it. WhatamIdoing (talk) 01:31, 17 March 2018 (UTC)

• injuries in netball is a thinly veiled advertisement for PhysioWorks. Am cleaning it up. Doc James (talk · contribs · email) 16:59, 16 March 2018 (UTC)
  • Okay no secondary sources on pubmed. Have condenses and merged into the netball article. Doc James (talk · contribs · email) 17:39, 16 March 2018 (UTC)

My final batch of medicine-related links to DAB pages

These are the only medicine-related articles I know of which still have {{dn}} tags. As usual - search for "disam", and if you fix one, mark it here as {{done}}.

• Nucleoside-diphosphate kinase Done
• Hemidesmosome Done
• Prevertebral fascia Done
• Pleiotropy (drugs) Done
• Aminophenazone Done
• Drug reaction with eosinophilia and systemic symptoms Done
• List of diseases (H) Done
• Ubiquitin C Done
• Methylmalonyl-CoA mutase deficiency Done
• Severe cutaneous adverse reactions  Done
• Shirley Ratcliffe  Done (target page was a set index)
• Transurethral resection of the prostate syndrome Done

There may be a new article or two with a bad link which no-one has spotted yet. But, if you experts can solve those problems, WP:WikiProject Medicine might become one of those "clean as a whistle" WikiProjects. Thanks in advance. Narky Blert (talk) 23:35, 18 March 2018 (UTC)

Thank you, Treetear for getting two of them done so quickly. I've done two more.

It looks like that leaves us just 8 more (out of all of our 41,263 articles!) to fix up. Who else can help today? WhatamIdoing (talk) 03:03, 19 March 2018 (UTC)

Done. The last one (TURP syndrome) was a bit crude, because it had linked to hyperglycinemia but that term is used for inborn errors (ketotic and non-ketotic forms). A better solution would be a section of glycine or even a page on iatrogenic glycine toxicity, which is really what's going on with TURP syndrome secondary to glycine irrigation. -- soupvector (talk) 05:19, 19 March 2018 (UTC)

And that, ladies and gentlemen, may be that. So long as readers get pointed to the right places, job done. Narky Blert (talk) 06:25, 19 March 2018 (UTC)

Core Entrustable Professional Activities (EPAs) for entering residency

I've been reading about Competency-based Medical Education (CBME) and EPAs for something I'm writing. Y'all in medicine are doing groundbreaking work with regard to developing best practices for health profession education. At any rate, I wrote a list of the 13 Core Entrustable Professional Activities (EPAs) for Entering Residency for an eventual section or article on EPAs, although it's not something I can work on very much presently. The draft article is on a subpage in my user space: User:Markworthen/Core Entrustable Professional Activities list. Feel free to edit my draft article there (in my user space) or copy what you want for a new article or section.   - Mark D Worthen PsyD (talk) 06:27, 18 March 2018 (UTC)

thank you for posting--Ozzie10aaaa (talk) 10:01, 19 March 2018 (UTC)

Hiding spam links with "good references"

Seeing this more an more such as:

• here
• here

Good ref does not support the content in question. Other is simple spam. Doc James (talk · contribs · email) 18:28, 12 March 2018 (UTC)

will be more attentive to this type of spam--Ozzie10aaaa (talk) 13:48, 13 March 2018 (UTC)

Probably an SEO tactic, we discussed something very similar to this a while ago. They seem to have moved from replacing good but dead sources with spam; to now adding good but irrelevant sources alongside spam. Maybe this is something Beetstra would be interested in. Carl Fredrik ^talk 17:11, 13 March 2018 (UTC)

This post seems to have been pretty popular: https://www.matthewwoodward.co.uk/tutorials/easy-wikipedia-link-building/

... may have found the blog that suggested this first:

• https://exposureninja.com/blog/build-backlinks-wikipedia/

86.31.184.35 (talk · contribs · WHOIS) should be banned

Carl Fredrik ^talk 17:29, 13 March 2018 (UTC)

If no recent edits why ban the IP? Doc James (talk · contribs · email) 19:01, 13 March 2018 (UTC)

It's a clear of paid editing, where several IPs associated to the firm that have edited. The blog strongly suggest that there are a number of accounts under that IP that actively edit. Block the IP would get rid of the accounts as well. It's a good first step before we start with a sockpuppet-investigation, but of course only doing that is rather pointless. Carl Fredrik ^talk 20:08, 13 March 2018 (UTC)

Good point User:CFCF. How long does "Prevent logged-in users from editing from this IP address" last? Is it indefinite? Doc James (talk · contribs · email) 02:07, 14 March 2018 (UTC)

Doc James -- It should be indefinite. Carl Fredrik ^talk 12:06, 19 March 2018 (UTC)

This is a quite normal technique - finding {{citation needed}} tags, and replace them with some document on the server which you want to spam. Specifically, find articles in your attention area - say a medical technique - find those with a missing citations, and then just spam your site there. To the untrained eye the references look to-the-point and appropriate, and there is a significant chance that your spam stays. Often it involves blogs or small (very localized) companies. See WP:REFSPAM.

In case of doubt, post the spammed links to WT:WPSPAM - if only to create a record, all others can quite directly go for blacklisting on WT:SBL. As it often includes SEOs (which tend to use multiple IPs/accounts) and persistent editors, all other methods of mitigation do not really help, the links are generally not suitable anywhere (except for primary data on own articles, if notability is reasonable - which can easily be handled by whitelisting). Please don't waste your time keeping reverting or removing this stuff (if possible, look for cross-wiki problems and go to the meta blacklist, but COIBot will take care of showing that).

Regarding the blog, I will blacklist material that is offered for paid spamming, even if it wasn't spammed yet if it is along material that was spammed. --Dirk Beetstra ^{T C} 07:49, 18 March 2018 (UTC)

Thanks, Carl Fredrik ^talk 12:06, 19 March 2018 (UTC)

Another link to a DAB page

I've found a stray, which as usual needs expert input to resolve. Japan Academy Prize (academics) links to DAB page Hyperglycinemia. Thanks in advance for any help, Narky Blert (talk) 21:43, 19 March 2018 (UTC)

 Done -- soupvector (talk) 00:14, 20 March 2018 (UTC)

Postpartum immune function

I added some questions to Talk:Postpartum physiological changes about a paragraph in that article that I found surprising. The passage seems to say that after birth, it is routine for the mother to get a blood test to assess whether she is immune to rubella and other diseases. I have never heard of this being done. Does the passage make sense to the other editors here? Clayoquot (talk | contribs) 16:39, 19 March 2018 (UTC)

Yes. I've commented there. -- soupvector (talk) 00:24, 20 March 2018 (UTC)

Thanks! Clayoquot (talk | contribs) 03:36, 20 March 2018 (UTC)

Topic ban proposed for Doc James

Separated from section above, Wikipedia_talk:WikiProject_Medicine#Osmosis_concerns per TOCLIMIT problem SandyGeorgia (Talk) 21:23, 28 March 2018 (UTC)

Discussion

where is the COI?--Ozzie10aaaa (talk) 19:09, 28 March 2018 (UTC)

What is this nonsense? I think it prompts an answer in kind, or a boomerang ban. This is rediculous. Carl Fredrik ^talk 19:21, 28 March 2018 (UTC)

Impressive that you consider supporting including video as a conflict of interest. Doc James (talk · contribs · email) 19:23, 28 March 2018 (UTC)

I have now removed the File:Autism spectrum disorder video.webm from Autism, Asperger syndrome and Autism spectrum. It is quite ridiculous to claim that the same video is a lead for all three articles. And watching just a minute or two from the video shows that it draws from entirely different material to any of them. Particular to note that Autism, Asperger syndrome are FA-quality articles. If any of our articles do not require supplementing by wiggly-font videos, it is these. -- Colin°^Talk 19:38, 28 March 2018 (UTC)

I have reinstated these videos, this is WP:DISRUPTIVE Colin. Carl Fredrik ^talk 20:02, 28 March 2018 (UTC)

I repeat my warning that I made to Doc James. CFCF, you are both now restoring material to Wikipedia that knowingly violates WP:V. In addition, both of you have made bogus claims about these videos being "leads" for the articles. -- Colin°^Talk 20:08, 28 March 2018 (UTC)

FYI, the following articles have also had their videos removed:

• Breastfeeding here by Gandydancer, who noted "Colin...It was your commentary on Jimbo's page that gave the the "courage" to delete the breastfeeding video. I've worked with Doc James long enough to know that until now a delete would have been reversed in short order (and perhaps it will be shortly). He rules the roost when it comes to medical articles."
• Coeliac disease here by BallenaBlanca, reverted by Doc James. removed again by BallenaBlanca, reverted by Doc James, removed again by SlimVirgin.
• Dementia with Lewy bodies here by User:SandyGeorgia but [reverted by Doc James and again by Doc James.
• Tic disorder here by SandyGeorgia.

Are Doc James and CFCF going to edit war on those too? If not, why not? I would be interested to know what policy grounds they have for why I should not remove some more. None of them meet WP:V. -- Colin°^Talk 20:29, 28 March 2018 (UTC)

They do meet WP:V and are based on articles. The specific cases you've linked have all been challenged individually, which is vastly different from simply removing videos without so much the prospect of discussion. I have not looked into the specifics of those cases, but would imagine some solution could be found. Simply removing things without discussing the issues is WP:DISRUPTIVE, WP:NOTCONSENSUS and indicates WP:NOTHERE because it is not in the search of a solution. Also note that for the time being, especially with the current ongoing discussion any individual challenges you make are likely to be interpreted as WP:DISRUPTIVE, as they are based on your opposition to videos and not specific issues. Blanket removal can only be possible with community-wide consensus. Carl Fredrik ^talk 20:35, 28 March 2018 (UTC)

CFCF They are not "based on articles". You have made this claim twice now ("been near-exact copies of the ledes"). These statements are quite easily demonstrated to be false. Not even a tiny bit false, but great big Trumpy pants-on-fire false. You've been challenged on this, have had opportunity to check again and correct yourself, and instead repeat the false claim. CFCF, you forget that the onus is on the person adding material to show it meets WP:V and other policies. Any editor, in good faith, can challenge and remove material they believe to fail that. That you are now knowingly restoring the material puts you in an extremely dodgy position and if you keep doing it, a block is likely. -- Colin°^Talk 20:50, 28 March 2018 (UTC)

I repeat my warning that I made to Doc James. CFCF, you are both now restoring material to Wikipedia that knowingly violates WP:V. In addition, both of you have made bogus claims about these videos being "leads" for the articles. -- Colin°^Talk 20:08, 28 March 2018 (UTC)

Restoring edits that clearly violates WP:V is WP:DISRUPTIVE. Graham Beards (talk) 21:21, 28 March 2018 (UTC)

But they don't, and we're not even having that discussion. If we were, there is no way this would be so infected. They are based off articles, even if they aren't exactly verbatim. Carl Fredrik ^talk 21:33, 28 March 2018 (UTC)

@Ozzie10aaaa: I suggest that it is no one's best interest for you to be closing someone else's thread on this page. Unless you are just asking for this to spill over to ANI. SandyGeorgia (Talk) 02:49, 29 March 2018 (UTC)

i'll let the revert stand[19]...for now, thank you for the ping--Ozzie10aaaa (talk) 02:58, 29 March 2018 (UTC)

logic and objectivity dictates 10(and growing)-2 is not in your favour, hence the section should be closed, to leave it open signifies a fundamental flaw in your logic,(additionally JYT[20] seems to have been scared away)...."to what end"... thank you--Ozzie10aaaa (talk) 11:22, 29 March 2018 (UTC)

Ozzie it's normal for Jytdog to delete that sort of thread from his talk page. He hasn't been scared away. Adrian J. Hunter^{(talkocontribs)} 12:29, 29 March 2018 (UTC)

to what end @Ozzie10aaaa:? i take that to mean you defend his sustained personal attacks on anyone who disagrees with him? that, in and of itself, is yet another indication of how and why this project has fallen so far. if you have science and MEDRS on your side, you don't need to keep treating people like animals. logic and objectivity dictate that it was foolish for someone aligned with Doc James on this issue to close the discussion above; have none of you any understanding of wikipedia-wide operation? by doing that, you were just asking for this mess to end up at ANI, where this project has already made an embarrassment of itself repeatedly over a number of year. precisely by the way, for example, Jytdog treats people, and then you all rush in to defend him. why it matters? the way you all behave jeopardizes the MEDRS some of us fought so hard to put in place. SandyGeorgia (Talk) 16:33, 29 March 2018 (UTC)

@ Adrian, of course it's normal for him. do we think he wants to have evidence in his archives of how often people have asked him to curb his behaviors? that this project condones, furthers and supports it is disgusting. not curious that so few in here today were around in the days of the scholarly gentlemen who founded this project. SandyGeorgia (Talk) 16:37, 29 March 2018 (UTC)

Sandy I share your concerns about Jytdog's behaviour. Adrian J. Hunter^{(talkocontribs)} 04:53, 30 March 2018 (UTC)

4th WP:FAC nomination of ?-Hydroxy ?-methylbutyric acid

Since this article is now a GA, I re-nominated this article at FAC a little under 2 weeks ago: Wikipedia:Featured article candidates/Beta-Hydroxy beta-methylbutyric acid/archive4.

It would be very helpful and very much appreciated if other editors from this WikiProject would comment and review the article against the WP:Featured article criteria. It is incredibly difficult to get a pharmacology article promoted at FAC, and unless editors who are familiar with the subject matter (i.e., editors from WP:MED/WP:PHARM/WP:MCB) review and comment on a pharmacology nomination at FAC, it very likely will not be promoted. For instance, amphetamine required five consecutive featured article nominations before being promoted in WP:Featured article candidates/Amphetamine/archive5 for that very reason.

So, if you're an active editor at WT:MED and edit drug articles on a somewhat regular basis, your input at the this nomination would be invaluable. Moreover, if any of you intends to nominate a drug article at FAC at some point in the future, reviewing another pharmacology nomination as well as reading the reviews by other editors at that nomination will give you a good idea of what to expect and prepare for at your own FAC nomination(s).

For those who haven't reviewed an article at FAC before, this is the "FAQ" page for reviewing articles at FAC. Seppi333 (Insert 2¢) 03:38, 2 February 2018 (UTC)

Seppi333, I did the GA review on Norepinephrine but I couldn't do an FA review on my own for the first time. So I would be glad to help with the review and think if we could find another co-reviewer then this could really happen. I know there are biochemists in the project but can't recall who they are at the moment. I have created articles on medications, a degree in chemistry and coursework in pharmacology. I can't evaluate the referencing of an article because, well, I'm not the best editor for this task. The guild of copy editors might like to help. I would really be thrilled to see this happen. Best Regards, Barbara (WVS) ?  ? 13:08, 4 February 2018 (UTC)

The main difference between reviewing a FAC and a GA candidate is that there's no official reviewer or structured process for reviewing and the reviewers aren't the ones who decide whether or not the article is promoted or fails the FAC process, although there are structured review criteria. To review a FAC, you basically just add your comments about the article's compliance with the FA criteria to the FAC nomination page and, if the nomination has received sufficient support within 2 months of the nomination date, the FAC coordinators will promote it; otherwise, the nomination is archived (i.e., the article fails).

Just to clarify: the FAC coordinators decide whether or not an article is promoted based upon their assessment of the consensus among reviewers about its compliance with the FA criteria. If 3 reviewers oppose for a stupid reason (e.g., "I just don't like it") and 5 support it after extensively reviewing the article against the criteria, the coordinators will probably promote the article to FA status. Seppi333 (Insert 2¢) 02:55, 5 February 2018 (UTC)

As of right now, only 1 reviewer supports the promotion of this candidate and 0 reviewers oppose it. There's a lot of comments/discussion at the moment though. Seppi333 (Insert 2¢) 07:18, 9 February 2018 (UTC)

I have also contributed. It would be appreciated if other editors could put in their 2¢ given that this is the fourth nomination. --Tom (LT) (talk) 00:10, 11 February 2018 (UTC)

I think this article might actually be promoted to FA status this time around. Seppi333 (Insert 2¢) 00:18, 20 March 2018 (UTC)

Kudos to Seppi333 and all who did the heavy lift for this FAC! -- soupvector (talk) 16:07, 24 March 2018 (UTC)

Great job Seppi333! Thank you for all your hard work and perseverance. Boghog (talk) 16:47, 24 March 2018 (UTC)

Thanks guys. This article wouldn't have been promoted had it not been for the input from editors affiliated with this WikiProject, so I wanted to thank everyone from WP:MED who provided constructive feedback/comments or otherwise assisted with reviewing this article in any of the 4 featured article nominations (@Doc James, Jytdog, WhatamIdoing, Sizeofint, Axl, CFCF, Tom (LT), DePiep, Soupvector, Evolution and evolvability, and Barbara (WVS): i.e., you).  Thank you very much! Seppi333 (Insert 2¢) 01:20, 25 March 2018 (UTC)

@Boghog: exactly like the previous article you helped me with, getting this article promoted to FA status likely wouldn't have been possible without your assistance with writing the chemistry section or as a co-nominator at FAC. Seppi333 (Insert 2¢) 01:20, 25 March 2018 (UTC)

Congrats... Doc James (talk · contribs · email) 02:37, 25 March 2018 (UTC)

well done!--Ozzie10aaaa (talk) 10:11, 25 March 2018 (UTC)

Congratulations! You did all the work and deserve all the credit. Ping me when you want a review of your next FA. You should be proud to have brought the article to such a high level of scholarship. I admire your editing. The Very Best of Regards, Barbara ?  ? 15:57, 25 March 2018 (UTC)

Lengthy treatment section

I can't help but feel that the treatment section of this article reads more like an advertisement for Anakinra. Could someone else take a look please. CV9933 (talk) 21:01, 22 March 2018 (UTC)

SPA?--Ozzie10aaaa (talk) 21:18, 22 March 2018 (UTC)

Typically we don't called editors with 3 edits SPAs. Their edits can still be problematic though. Carl Fredrik ^talk 22:27, 22 March 2018 (UTC)

Thanks for addressing my concerns; the article looks in better shape now. CV9933 (talk) 09:38, 23 March 2018 (UTC)

Thanks for bringing this. Have further worked over the Schnitzler syndrome page and the anakinra both of which were horrible. Our article on the drug was mostly copy/pasted from the label :( Jytdog (talk) 16:53, 23 March 2018 (UTC)

Borderline seemingly promotional articles on doctors

CanadianBiographies11111 (talk · contribs) has created several borderline biography articles [21]. Even though the user has been instructed to submit their articles via WP:AFC, they don't. I've AfDed one of the articles (the dentist, which the user recreated after it was CSDed), and I'd like this project to check the articles on the doctor and the physicist to see if they meet notability. Thanks. Softlavender (talk) 03:25, 28 March 2018 (UTC)

blocked[22]--Ozzie10aaaa (talk) 13:37, 28 March 2018 (UTC)

Source of article : Wikipedia