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Reference ranges for some major blood tests, sorted by mass.

This reference ranges for blood tests-image is a candidate for featured pictures, but needs more votes. Please have a look at it's nomination page:

Your comments are appreciated. Mikael Häggström (talk) 12:26, 10 November 2008 (UTC)[reply]

Basic topic

I've found an interesting cluster of undersourced and poorly coordinated articles, and think it might be interesting to consider their proper disposition. They are:

Any ideas about how to organize these? Any good sources for this concept? I'm leaning towards a merge. WhatamIdoing (talk) 23:34, 11 November 2008 (UTC)[reply]

I just had to laugh at these findings of yours. Soooo typical. Disorder (medicine) seems like a good title, at least, if you disregard everything in the article, and the huge (understatment) template at the bottom. It then can be broken down into Mental disorder and Physical disorder. Perhaps you want one more formal page, Disorder (medicine), and one page among the others where people can put layman type stuff like political correctness issues. At a glance, without delving, most of the five different definitions of Morbidity seem at best only loosely right, and repetitious, or wrong. Does Morbidity ever mean disability? —Mattisse (Talk) 00:47, 12 November 2008 (UTC)[reply]
If you're going to merge, be very careful about it, and keep as many of the references as possible. These terms are not synonyms, and the decision about which term to use can be emotionally charged. --Arcadian (talk) 02:52, 12 November 2008 (UTC)[reply]
I have no interest in losing information. Does anyone have any ideas about a decent source? I don't really want to resort to regular dictionaries, and I'm not sure that the typical textbook or journal article would bother to define something so basic. WhatamIdoing (talk) 03:17, 13 November 2008 (UTC)[reply]
I don't think a global merge would help. There needs to be a differentiation between medical terminology and layman terms. Some of those would likely be defined in general textbooks, like "disease", "disorder". Some, like "sickness", "ailment" and "malady" I think are just general dictionary terms used by laymen and are not used in medical lingo to mean anything specific. However, lay people and the general press use these terms, so there should be places where people who are not professionals can report information relevant to their concerns (e.g. political correctness issues). —Mattisse (Talk) 15:38, 13 November 2008 (UTC)[reply]

I would start by developing / expanding entries for each of these terms on Wiktionary. I find that helps to clarify things. Get the terms sorted out, then the concepts follow. Also, each of these terms has a history (an etymology) that is somewhat apart from the history of the related concepts. To do a good job, some heavy duty sourcing will be necessary. Think history of medicine. --Una Smith (talk) 18:50, 13 November 2008 (UTC)[reply]

I've added a new 'terminology' section to Disease, which I think helps quite a bit. As a result, the Morbidity and Disorder (medical) stubs now redirect to Disease.
Sickness is a dab page and can stay that way; I'm not sure what to do about Illness, which is positioned as the patient's perception of their (e.g.,) smallpox, which is distinct from the smallpox itself. My plan for the next little while is to not do very much to these articles and see if this much will be stable and settled before moving on.
I have also 'discovered' that we don't have an article on Functional disorder, which seems like a fairly popular term for neurological conditions. If someone feels competent to start a stub there, that would be great. WhatamIdoing (talk) 22:25, 22 November 2008 (UTC)[reply]

Post-viral cough

Can someone please expand on this topic. RE: Post-viral cough. Unsigned, now signing to assist in bot archiving JFW | T@lk 10:09, 23 November 2008 (UTC)[reply]

Mess at ADHD

If you've got an interest in reliable sources and/or ADHD, please let me invite you to join the fray at Talk:Attention-deficit hyperactivity disorder. There's a pretty ugly dynamic between the article's usual editors right now, and the addition of a few level-headed people might resolve things (and even improve the article). WhatamIdoing (talk) 20:35, 19 November 2008 (UTC)[reply]

I would like to thank WhatamIdoing for mentioned this as article could definitely use some more eyes. It has very frustrating ever since I began editing. There is one editor Scuro who spends much of his time changing the rewording edits that are referenced to published research so that they no longer match the reference. Then edit wars when you correct it. Accuses you are edit warring. Threatens other editors with reprimands on a frequent basis. He an Vannin are friends and support one another.
I have lost my patient with these two editors a number of times. I have dealt with comments saying that NICE guildlines are "nice" but that since they controvince the American literature they "prove that the UK is far behind the USA in medical science" and "that UBC in not a world leading research center and therefore their research shouldn't be allowed" or "that since a source is 6 - 8 years out one should be able to use it" or "or that only two scientist agree that ADHD is controversial and it is probably even less then that" or "that Timmins since he is a Scientology and an antipschiatrist everything he publishes even in the British Journal of Psychiatry should be discounted" or " or that since Dr. Barkleys is a world leader in ADHD that one should be able to quote his personal web page or power point presentations and then I get attacked when I ask that people quote his published literature"
All this has happened with exclamations that I should deal with content rather then editors. A least three other editors have had this problems. I have asked for more eyes many months ago at the WP Med page. I also brought forwards an ANI.

P.S. I have paraphrased the comments.

--Doc James (talk) 20:35, 20 November 2008 (UTC)[reply]

Here is a list of pages in which the dispute unfolds.

ADHD

Attention-deficit hyperactivity disorder controversies

http://en.wikipedia.org/wiki/Wikipedia:Village_pump_(policy)/Archive_55#WRT_ADHD_Can_one_cite_web_based_information_from_the_Mayo_Clinic.3F

http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/IncidentArchive481#The_ADHD_article_and_Scuro

Wikipedia:Mediation Cabal/Cases/2008-10-09 Attention-deficit hyperactivity disorder

Wikipedia:Requests for comment/jmh649

User talk:Scuro

--Doc James (talk) 21:01, 20 November 2008 (UTC)[reply]

P.S. I have paraphrased the comments.-I'd characterize it as a first class misrepresentation :). If someone has a medical background and deals with ADHD patients on a consistent basis, your assistance at jmh649's RFC would be appreciated.Wikipedia:Requests for comment/jmh649 It will be tough slogging.--scuro (talk) 04:25, 21 November 2008 (UTC)[reply]

It sounds like time for Wikipedia:Mediation. (Mediation is not about majority rule, but about reaching consensus.) --Una Smith (talk) 06:43, 21 November 2008 (UTC)[reply]

Neonatal jaundice

Neonatal jaundice is pretty bad, and seems like it shouldn't be. Anyone want to have a go at it? WLU (t) (c) (rules - simple rules) 21:57, 19 November 2008 (UTC)[reply]

most of the obgyn articles and neonatal peds articles are not written from an MD standpoint. —Preceding unsigned comment added by 75.43.214.71 (talk) 08:02, 20 November 2008 (UTC)[reply]
They shouldn't be; Wikipedia is written for a general audience. See WP:MTAA. --Steven Fruitsmaak (Reply) 23:15, 20 November 2008 (UTC)[reply]

Brain tumour

Brain tumor is a pretty awful page. Anyone want the challenge? WLU (t) (c) (rules - simple rules) 23:32, 20 November 2008 (UTC)[reply]

Huzzah! Huzzah!

Osteochondritis dissecans has been passed as a GA article! Onwards to FAC, and - with your help - FA status! Jump on the bandwagon and start reviewing! :-) FoodPuma 23:34, 20 November 2008 (UTC)[reply]

Well done and congratulations. JFW | T@lk 10:34, 21 November 2008 (UTC)[reply]
Further comments welcome here. Axl ¤ [Talk] 14:48, 21 November 2008 (UTC)[reply]

Missing Article Trophy

The trophy has passed to WhatamIdoing (talk · contribs). Congratulations, WhatamIdoing, and think about Did you know! --Una Smith (talk) 07:25, 21 November 2008 (UTC)[reply]

Oh, I'm not quite sure that article should count... (I know: "no drama" is one of the rules.) I was just trying to centralize information that was scattered across several other articles, as part of my campaign to keep Fatigue (medical) from getting stuffed full of the names of unimportant military officers.
At any rate, you should all consider the threshold for the next award to be quite low! Earn yourself a beautiful trophy -- pick one of these seven thousand stubs or fix a red link today! WhatamIdoing (talk) 19:41, 22 November 2008 (UTC)[reply]

length drugs positive on utox

would be nice to have an article on how long various drugs on utox stay positive. —Preceding unsigned comment added by 163.40.254.253 (talk) 17:56, 21 November 2008 (UTC)[reply]

Well, you could try the reference desk or check at drug test. C'mon, tell us... What have you taken? JFW | T@lk 18:12, 22 November 2008 (UTC)[reply]
Wouldn't that information be included in each individual article? A person that abuses one drug is unlikely to be looking for information on any other drugs. WhatamIdoing (talk) 19:43, 22 November 2008 (UTC)[reply]
Well I have heard rumors of parties were everyone brings there pills. They put them in a bowl and people take them. Weather or not this is just urban legend I do not know.http://books.google.ca/books?id=dFRd2MMrtiUC&pg=PA312&lpg=PA312&dq=pill+parties&source=web&ots=Z42SUx_oKi&sig=0iwrP4F64t2Fbm2JXMLM0iVXixo&hl=en&sa=X&oi=book_result&resnum=10&ct=result#PPA312,M1 From this book The Pursuit of Oblivion By Richard Davenport-Hines Doc James (talk) 20:06, 22 November 2008 (UTC)[reply]

history of perscription number system

you know how docs write the number 1, 2, 3 on perscriptions? it looks like roman numeral but it is different. what is it? —Preceding unsigned comment added by 163.40.12.37 (talk) 18:58, 21 November 2008 (UTC)[reply]

Have you looked at medical prescription? Might it just be doctors' handwriting? In the UK, most prescriptions are now computer-generated. JFW | T@lk 18:12, 22 November 2008 (UTC)[reply]

Orphaned article

Systemic inflammation is a short stub that has no incoming links, and it seems generally neglected. It needs some love, but I'm not sure what would be best:

--BeardWand (talk) 23:17, 21 November 2008 (UTC)[reply]

Well, the concept of "systemic inflammation" is quite distinct from SIRS. It refers mainly to elevated blood levels of cytokines such as IL-1, IL-6 and TNF alpha. An independent article is needed. Systemic inflammation is related to a number of disease processes such as atherosclerosis and osteoporosis. JFW | T@lk 18:12, 22 November 2008 (UTC)[reply]
I like option two, turning it into a {{main}} article. But is this even the right title? The first sentence specifically names chronic systemic inflammation, and presumably there's also an acute case. WhatamIdoing (talk) 19:46, 22 November 2008 (UTC)[reply]

What is the definition of "skin," "integumentary system"

Yeah, this is actually a matter of contention right now. What is the definition of "skin," and is it different than that of "integumentary system." Find the discussion here, and please consider contributing. kilbad (talk) 22:27, 22 November 2008 (UTC)[reply]

OHS terminology

During my quest to improve obesity hypoventilation syndrome I was wondering when the terminology changed from "Pickwickian syndrome" to the more current descriptive term. This would be of relevance to the historical section. Does anyone have access to PMID 10450601? Does that article officially advocate the descriptive term? JFW | T@lk 10:09, 23 November 2008 (UTC)[reply]

Image request

Could someone create a better alternative of Image:Guaiac01.jpg? A camera phone is not the best option for encyclopedic photogtaphy... --Steven Fruitsmaak (Reply) 14:39, 23 November 2008 (UTC)[reply]

The subject is the Hemoccult brand of stool guaiac test. --Una Smith (talk) 16:51, 25 November 2008 (UTC)[reply]

Major depressive disorder FAC restarted

Just so everyone is aware, the FAC for Major depressive disorder has been restarted at Wikipedia:Featured_article_candidates/Major_depressive_disorder. Cosmic Latte (talk) 02:25, 24 November 2008 (UTC)[reply]

Drug Information in Wikipedia

is there any discussion on doi:10.1345/aph.1L474 in wp? -- Cherubino (talk) 16:00, 25 November 2008 (UTC)[reply]

Found Wikipedia_talk:WikiProject_Pharmacology#Clauson_study - Cherubino (talk) 16:37, 25 November 2008 (UTC)[reply]
The latest anti Wikipedia thrust is "Wikipedia often omits important drug information", "Drug Information Often Left Out On Wikipedia", etc. In Drug Information Often Left Out On Wikipedia says "If people went and used this as a sole or authoritative source without contacting a health professional...those are the types of negative impacts that can occur." So this non expert on statistics and human habits in informing themselves is making unsupported assertions about Wikipedia based on a few articles he reviewed. The news article does mention some Wikipedia articles that could benefit from a review, however. -- Suntag ☼ 16:53, 25 November 2008 (UTC)[reply]
I added a sketch on this to Medscape. --Una Smith (talk) 16:48, 25 November 2008 (UTC)[reply]
I dunno; if I were reviewing the paper, I'd question the appropriateness of comparing Wikipedia to MDR. MDR is a technical reference for a professional medical audience. Wikipedia is a general-knowledge encyclopedia. Apples and oranges. No doubt the PDR also contains more complete drug info that Wikipedia, but you see where I'm going.

The authors state: The comparator database had to be a freely accessible general drug information database. Why a drug information database? They don't really explain this decision, which I think biases the rest of the study. The "sample questions" are similarly skewed - they represent clinical questions that a physician might ask, rather than common questions that a patient or layperson might seek answers to.

I'd be much more curious how Wikipedia's coverage of pharmaceuticals stacks up to, say, Britannica or Encarta - that is, to projects which occupy the same reference niche. I'm somewhat tempted to write a letter to the editor. MastCell Talk 19:16, 25 November 2008 (UTC)[reply]

I tink they missed the policy of wikipedia is not a how to and the point of medmos to exclude dosages to this end, so the summary that wikipedia is a good general guide for consumers but should not be used for prescription information seems like we are getting it right! LeeVJ (talk) 19:31, 25 November 2008 (UTC)[reply]
Yes, that's a good point - WP:MEDMOS explicitly indicates we should default to omitting dosage and titration info - for good reason: this is a general-knowledge encyclopedia, not a drug reference handbook. Yet the article faults Wikipedia for not including this info, which again stems from their confusion about Wikipedia's aims and niche. MastCell Talk 19:50, 25 November 2008 (UTC)[reply]
Please do write a letter to the editor. I think it may help others get a better understanding of the medical coverage on wikipedia. Remember (talk) 20:56, 25 November 2008 (UTC)[reply]
I think we should nominate Fvasconcellos (talk · contribs) for this noble task. JFW | T@lk 21:43, 25 November 2008 (UTC)[reply]

<undent> Ah, just came here to give a headsup to an article I had found and disagreed with and have already emailled the author about... my letter was as follows, and I await their reply:


Dear Kevin Clauson

I read with interest your conclusions at http://www.theannals.com/cgi/content/abstract/aph.1L474v1 on Wikipedia's medicine information. However I think the comparison was always going to be unequal, the conclusions predictable & unsurprising, and the study flawed for assuming a US-centric perspective.

Your implied criticism of "Wikipedia performed poorly regarding information on dosing, with a score of 0% versus the MDR score of 90.0%" is unfair, indeed this result is a positive endorsement that wikipedia's policy of not give dosage information is being correctly followed !

The two sources are not equivalent: Wikipedia is a non-specialist general encyclopaedia and I would no more rely upon its description of the internal combustion engine to service my car, than the finer details of how to self-medicate.

Wikipedia on dosage details
Wikipedia's guideline of http://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style_(medicine-related_articles)#Drugs explicitly states 'Do not include dose and titration information except when they are notable or necessary for the discussion in the article' and goes on to state 'Wikipedia is not an instruction manual or textbook and should not include instructions, advice (legal, medical or otherwise) or "how-to"s'

Indeed the Medical disclaimer should be carefully noted (see http://en.wikipedia.org/wiki/Wikipedia:Medical_disclaimer)

So except for rare occasions, it is not thought appropriate to give dosage details, and thereby a potential patient must seek more appropriate advice elsewhere (instructions on the label or patient information leaflet for a start, and more specifically from one's pharmacist or doctor should be encouraged).

Wikipedia has international reach
There is a general point that an international reader should not exclusively seek advice from Medscape or MedlinePlus, for these are American sites and can only give advice on American licensing dosages and warnings. Wikipedia meanwhile has a global coverage and licensed dosages in America may be very different to say here in the United Kingdom, or elsewhere in Australia, New Zealand, South Africa.

A good example is for the article Aspirin, where the dosage notes are carefully phrased as "For adults doses are generally taken four times a day for fever or arthritis, with doses near the maximal daily dose used historically for the treatment of rheumatic fever. For the prevention of myocardial infarction in someone with documented or suspected coronary artery disease, much lower doses are taken once daily." Previously precise values were very deliberately removed.

Here in the UK such low-dosage prophylaxis is typically 75mg, but I gather rather different preparation strengths are used in America, hence no set value is "correct"; indeed http://www.medscape.com/druginfo/dosage?drugid=21047&drugname=Aspirin+Low+Dose+Oral&monotype=default in its statement of
“Myocardial Reinfarction Prevention take 1 tablet (81 mg) by oral route once daily
take 2 tablets (162 mg) by oral route once daily
take 1 tablet (325 mg) by oral route once daily”
is simply totally “wrong” for a UK reader.

Target audiences
Medscape, whilst free to use, is not meant for the general public, and your comment reported by Reuters http://www.reuters.com/article/healthNews/idUSTRE4AN7BO20081124?feedType=RSS&feedName=healthNews of "You still probably want to go to medlineplus.gov or medscape.com for good quality information that you can feel confident in," seems problematic:
a) Medscape describes itself at http://www.medscape.com/public/about as "Medscape offers specialists, primary care physicians, and other health professionals the Web's most robust and integrated medical information and educational tools." So nothing is implied as being a resource for patients to use, its value to yourself as a Professor of Pharmacy Practice or myself as a General Practitioner entirely misses the point that it is not meant for a general readership and nor therefore is comparison with Wikipedia equitable.
b) By comparison, MedlinePlus is an appropriate source to direct the American public to, for it seeks that "Health professionals and consumers alike can depend on it for information that is authoritative and up to date" http://www.nlm.nih.gov/medlineplus/aboutmedlineplus.html But again, this may be "wrong" in details for a more international audience.

Conclusion on Wikipedia scope
Notwithstanding the above points (that the outcome of your study was a foregone conclusion), I rather think your conclusion of “Wikipedia has a more narrow scope, is less complete, and has more errors of omission” is misphrased in all three subclauses:

  • Wikipedia has a vastly broader scope, covering as it will drug development history, the researchers and companies involved, links to basic biophysiological topics as well as all the non-medical pages in its collection. Neither Medscape nor MedlinePlus have anything on general history or the arts and are thus websites of narrow scope.
  • Wikipedia therefore has a greater breadth, but I agree often limited to some of the specific depths of information coverage.
  • Finally your study has not found “errors of omission” which implies thoughtless missing gaps, but rather a reaffirmation of a positive compliance with not offering medical advice.

Yours truly,


David Ruben


Can anyone though directly write to the editor of the journal ? It is not as if the study was "wrong" per se, just that it seems an ill conceived comparison with naïve misguided conclusions. David Ruben Talk 23:51, 26 November 2008 (UTC)[reply]

I think we should all write a letter to the Editor together, and quickly, because there is usually a time limit for such submissions. --Steven Fruitsmaak (Reply) 16:07, 29 November 2008 (UTC)[reply]
The time limit for Ann Pharmacother is six months AFAIK. I've drafted a brief letter and contacted JFW about this—you should get in touch with him. Fvasconcellos (t·c) 16:18, 29 November 2008 (UTC)[reply]

I saw this thread linked on MastCell's talk page. The letter seems okay, but you may want to reduce or eliminate the 2nd section (about international dosages). It's a bit redundant given that the section right above it precludes including dosage information to begin with. You could use as shorter mention of the "international" argument to support the policy however. You could also mention that MDR has very little information for drugs not commonly used in the U.S. Two examples that came to my mind are furazolidone (only interactions and contraindications are listed on MDR, but nothing is said about usage), and drotaverine (no info on MDR). The conclusion could be simplified along the lines "Wikipedia has a greater breadth of articles, but covers medications in less depth as matter of policy". My 2cents. Pcap ping 18:48, 29 November 2008 (UTC)[reply]

Entirely agree with your points :-) but I had already sent my email before coming here to wikipedia and realising a thread already started. David Ruben Talk 17:30, 30 November 2008 (UTC)[reply]
I've had a thoughtful email reply from Kevin Clauson to my above letter, arguing well for some of the study's design decisions and the paper's conclusions (I don't agree with all points but at least I understand and appreciate better this external perspective). I'm seeking permission to repost his replies here, as they are worthy of consideration and for reflecting on our policies; at the very least he highlights variability in articles (which I think we already know about to some extent). On other points, we may of course decide that Wikipedia policies & guidelines are as good as they can be worded and that Wikipedia will remain inperfect in a world where patients will seek advice whatever guidence/disclaimers we state. David Ruben Talk 15:56, 30 November 2008 (UTC)[reply]

I agree that the failure to mention the Wikipedia policy on dosage information shows a bit of weakness in the Clauson article, and David Ruben's example on Aspirin dosage in international contexts is interesting. Also the wording of "more narrow scope" in the conclussion is based on the narrow idiosyncratic definition of "scope" used in the article (presence of answer to drug related question) rather the meaning of "scope" in other contexts. However, the article addresses other issues in Wikipedia, e.g., drug interactions, contraindications and drug issues in connection with pregnancy. These are areas were Wikipedia has omissions compared to Medscape (according to the article). In my oppinion the article also make an ok argument that consumers are actually using Wikipedia as a resource for health information, and the authors indeed cite Wikipedia as "a project that attempts to summarize all human knowledge". So whether Wikipedians do not attempt to make Wikipedia a drug reference some consumers and healthcare practioners may actually use it as such. — fnielsen (talk) 13:31, 1 December 2008 (UTC)[reply]

Fnielsen, well stated, especially the last point, and indeed that expanded upon in the emails I've had from Kevin Clauson; who has written back agreeing for me to repost his emails here. I think there was much general discussion in the article that we might all agree are important issues that have been discussed before, and points raised in our further discussion I think are worthy of consideration, or at least a starting point for fresh reflection. (PS if anyone can suggest a better method of making this available in WT:MED, eg as a subpage (yuk), then do chip in) David Ruben Talk 23:05, 1 December 2008 (UTC)[reply]

Clauson e-mail exchange

From: Kevin Clauson...
Sent: 29 November 2008 01:21
To: 'Ruben David...

David,

Thank you for your interest in our work. I am unsure if you wrote your email with the intent of soliciting a response or exclusively to share your perspective. However, since it differs from most of the other critical emails I have received (in that it is both well thought out and devoid of the personal attacks and foul language of what is borderline 'hate mail'), my working assumption is that you would like a response. Thus, I will do my best to address the general and specific concerns you outlined.

Overall approach
I would like to point out is that this is not intended to be a negative piece about Wikipedia, nor am I an opponent of it as a philosophy or tool. In fact, in putting the team together, I specifically solicited the involvement of someone who is, at minimum, a wiki enthusiast and possibly an unabashed advocate (Maged Boulos). Maged is actually active enough that he started to correct the errors he found in the drug entries in Wikipedia during the study, but I asked him to cease until the assessment was completed so that we did not act as our own confounder. I also recently spoke at a Medicine 2.0 conference and briefly mentioned this Wikipedia study. I was similarly chastised by Rod Ward (whose opinion I respect) and have since moved to try and see that any remaining errors in Wikipedia that we came across was resolved. This is the same approach I have used in a number of other database evaluations where we contacted the database publishers to alert them to discrepancies we encountered. Additionally, the article did not categorically denounce the use of Wikipedia for drug information; it suggested that a more rationale approach is its use as a point of engagement for consumers.

Flawed comparison/comparator
Agreed, the two sources are not perfectly equivalent. However, part of the impetus of this study was real world practice. And when someone searches online for information about their atorvastatin or their etanercept or their benazepril...Encyclopedia Britannica is not going to be the first result and it probably won't even be in the first 100 results - but Wikipedia will. Choices had to be made regarding the comparator and I am comfortable with our rationale and selection. Additionally, the strength of the findings about Wikipedia stands on its own. Even purposefully selecting a generous comparator for Wikipedia that would have yielded a smaller chasm between the two would not have changed the fact that Wikipedia only provided 40% of the information sought.

Charge of US-centric perspective
Guilty as charged. In fact it took prompting from my co-author from the WHO to at least point out that we should list the limitation of only evaluating the English version of Wikipedia in the article. While I have worked and presented in international venues regarding issues of e-Health, my default is healthcare in the U.S.; consequently it may have benefited the article to point out the inherent related issues with extrapolation. Having said that, I most certainly do not think it makes the study flawed. I absolutely stand behind the methods and results. I do acknowledge that the results may be less specific to an international audience.

Dosage details
I will again bear the brunt of this criticism for not including Wikipedia's guidelines regarding dosage in the article. However, while I believe the Wikipedia policy to be well-intentioned, I wonder if it should be revisited. As part of my duties, I operate a Drug Information Center and over the years have received a number of calls relating to patients self medicating with prescription drugs after using online sites (not necessarily Wikipedia) as their sole information source in doing so. These patients typically are not brought to our attention until the point where something negative has happened. While I am not offering these anecdotal reports as 'evidence', there are case reports of this type of occurrence (J Am Pharm Assoc 2007 Jul-Aug;47(4):436-42), articles by researchers exploring aspects such as sharing and borrowing prescription medications (J Women's Health 2008 Sep;17(7):1073-80), and my other collaborative work with individuals whose efforts in the sociobehavioral aspects all lead me to question if Wikipedia isn't doing a disservice by electing not to provide basics such as maximum dosages? I don't know what the best answer is to that question as I have undoubtedly not given it as much thought as Wikipedia contributors have, but believing that the intended purpose of something precludes it from being used in other ways does not necessarily make it so.

International reach
I believe you are referring to my recommendations made in response to the reporter rather than the article itself. A reporter who identified herself as being from a US news agency called me and asked some questions. I gave responses based on that audience. Given that, I believe my suggestions regarding Medlineplus.gov and the Patient Handouts in Medscape Drug Reference are perfectly sensible. In the past I have written, cited, and been quoted listing additional consumer-centric sources of drug information as well. In this case, the suggested sources in the piece were fewer.

Target audience
a) The Patient Handouts in Medscape Drug Reference reflect very closely what is found in the other consumer sites under the WebMD umbrella that incorporates them all. However, as the MDR has been evaluated in past studies and the others have not, this adds to the confidence in that source.

b) Again, I was asked by an American reporter who self-identified as being from an American company, so I would assert my US-centric responses were right on target.

Conclusion on Wikipedia scope
These are the areas where I disagree with you most fervently.

1) Within the confines of the phrase drug information as it was used in the article (e.g., that as mentioned in the Pew Report, etc.), Wikipedia absolutely had a more narrow scope.

2) Rare common ground...

3) Let's ignore the dosage category for the moment as it only accounted for 10 of the 48 omitted items. So even if you maintained there were only 38 errors of omission (versus purposeful omission), there were still drug entries that were missing vital safety information about interactions, cautions, side effects, etc.. If all safety information were omitted from drug entries as part of a standing (albeit incomprehensible) policy, you could even make the case that those were purposeful and not errors of omission. However, the variability was enormous as there were multiple entries that went into great depth about safety issues and others than ignored it completely. I do not understand what possible intended use for Wikipedia would rationalize a blanket omission of safety information? If you reject that it is a blanket and purposeful omission, then the data supports that some entries purposefully include it while others either purposefully (e.g., the cases of pharmaceutical companies) or unintentionally omit it.

Summary
We just celebrated the Thanksgiving holiday here in the US, so I will be thankful that so many have taken interest in this work. A number of Wikipedia advocates have been critical of aspects of this paper, while others have embraced elements of the results such as that it provides some of the "first scientific proof that the editing process improves entries" (their words not mine). I do appreciate carefully considered and constructive criticism, but would expect those critics to be similarly open to a healthy debate on the subject, rather than simply having an agenda to push. I hope you are on the healthy debate side.

Cheers,

Kevin

P.S. You are welcome to follow-up on any issues with me you feel remain unresolved.

From: David Ruben
Sent: Sun 30/11/2008 23:23
To: 'Kevin Clauson ...

Kevin,

Many thanks for taking the time to respond and help expand on some of the thought provoking issues, I was indeed trying to be constructive and hopefully on the “healthy debate side”. Very sad to hear of the other type of email you have received though.

To be even more positive, I thought your paper’s discussion over the nature of wikis and why there are problems relying on included data (when included) was well thought out and articulated (e.g. if the version of the aspirin article I view is one that has just been vandalized to have maximum dose changed to state 4 tablets every 2 hours, safe to give same dose in children, and always safe to take with warfarin… then problems are more than likely if this followed by a patient).

Many of the issues the paper covered are already appreciated by those who contribute to the Medical Wikiproject, but others are from a perspective that I don’t think our past internal discussions may have considered. Therefore I wonder if you would agree to me posting up your email reply (below) on the Medical Wikiproject discussion page so that other interested editors can consider further the points raised.

  • It is for the very problems of not having moderators checking every edit submission, and need to not restrict dosage levels to a single country, that the guideline not to include dosages was set up.
  • However as you point out there is variability in articles adhering to that, and even more variation in how much side-effect & drug-interaction details are included. That variability perhaps might lead lay readers to assume that where no interactions are included that is precisely because there are no such concerns that could/should be included, and this assumption made upon the basis that other articles looked at do include such details.
  • Often no mention is made, because there is nothing unique in the side-effects or interaction profile of a drug compared to others in its class, and therefore the details are within the article on the overall class of drug, the details not being separately notable within the articles on many specific members of a class.
  • If articles were to uniformly mention major interactions and side effects, then the question arises as to what threshold of risk/likelihood should be included; inclusion of everything on a medication patient leaflet would not make for encyclopaedia articles, for the target audience is meant to be a general reader and not patients looking for “how to” instruction & advice.
  • However as you well point out, whatever may be Wikipedia’s own stated warnings, guidance & disclaimers, this can be separate from how lay-patients nevertheless seek information on the internet.
    • I think this is a major challenge for medicine/pharmacy to help ensure patients have a better understanding of how to be selective & cautious in seeking information other than from more official channels (their doctor, pharmacist, actual drug information sheets, professional bodies, independent “semi-official” support groups), and to locate reliable vetted online sources.
    • Fairly clear guidelines exist in many schools and universities about student essays not citing Wikipedia itself (some are absolute that any such citing will result in an immediate “fail”), but rather that students should find and read the reliable original details (using Wikipedia only as preliminary introduction to a topic or pointer to lines of enquiry, but not directly relied upon) – perhaps as a society we need to get the wider public similarly cautious in the use of wikis/blogs and other similar sites of information ?

As a personal anecdote, I have had a few occasions where patients have come to me clutching sheets printed off the internet or quoting from their online sources that turned out to be Wikipedia articles I myself had either created or co-edited ! This whilst amusing had a mix of outcomes with some come to “demand” of me a treatment approach which is my normal practice anyway, or for an approach they had misread the article as having proposed (phrases such as “not”, “no evidence for” and “since disproved” not having been registered) . Amazing also how angry some get for my agreeing to their desired approach but declining to read the printout, or a somewhat dubious reaction when I show from the article’s edit history that they have been reading my own contributions (been suggested to me that the correct response is always to read the printout, nod thoughtfully, and then comment on how wise the article and its author must be - all the while trying to keep a straight face)

One of the problems with Wikipedia articles is to ensure that various items within any one article are of proportionate coverage (the “undue weight” guideline). Hence the most important encyclopaedic part of say Rosuvastatin is to mention that it is a statin and used to lower cholesterol levels, having campaigners fill the article with details of legal actions for cases of rhabdomyolysis does not make for good articles (yes it can cause this rarely but so can all statins, so worth mentioning been some debate as to whether higher risk than for other statins and unarguably that some additional restrictions/warnings been applied to it - at least here in UK must titrate up and refer to specialist after a certain dosage)

I wonder how you chose the specific facts that you sought to check for inclusion – was this based on needing to cover a range of details (i.e. breadth of examples), or a more practical issue of where such items had caused patient events (i.e. by real-world importance). Indeed was there a study protocol as to how to decide what minimum level of information was thought expected as worthy of inclusion – this might be a useful debating point for more general Wikipedia guideline tweaking (over and above merely seeking out the specific 38 non-dosage items located)

Yours truly,

David Ruben

From: Kevin Clauson...
Sent: Sun 30/11/2008 15:43
To: 'Ruben David...

David,

If you think it would be useful in continuing the discourse about the topic, you are welcome to post my response on your Wikiproject discussion board. Thanks also for providing the additional insight about the formulation of your policy about dosages on Wikipedia.

The ‘threshold of risk’ to determine inclusion of drug information is something everyone struggles with – database publishers, clinical decision support tool designers, etc. Even when something is strictly designed for healthcare professionals, problems with ‘alert fatigue’ have made people reconsider the wisdom of including every single theoretical interaction, etc. What one of the databases does is have a sort of ‘bottom line’ monograph as the one that is accessed by default, but then it has a link to a more in-depth version of each drug entry if the user so chooses…it is a pretty good hybrid solution that takes into account the time-pressed needs of a clinician, but recognizes that sometimes an additional layer is necessary. Have you guys considered partnering with any of those MediPedi/RxWiki types to do something like that? Maybe Wikipedia can serve as that baseline info that remains easy to navigate, but if the reader wants more, you guys can embed a link to their (I assume) more in-depth monograph style? That type of arrangement would also allow you to maintain your policies on things like dosage. I have no idea if that is feasible for you or vice versa…just a thought.

Regarding our approach to information/fact selection that we use for our evaluations – the most recent/best detailed/most easily accessible example is probably for infectious diseases, we used the ATC classifications in the WHO list of essential meds, but then also integrated US-specific data (full details in Category Design & Question Development at: http://www.biomedcentral.com/1471-2334/8/153/abstract). For our pediatrics database analysis, we similarly broke the questions into categories spanning neonates, infants, children, and adolescents. We also weighted the answer key to reflect a percentage of ‘by the book’ package insert-driven information and a percentage of clinical guideline-driven information (which, of course, can conflict). For the Wikipedia analysis, we basically let the literature drive our question development in terms of what categories should be included due to reported perceptions of importance. We also tried to get a representative sample of at-risk drugs, commonly employed drugs, approved and non-FDA approved uses, newly modified/released drugs (which is what Wikipedia ‘beat’ MDR in), etc. Of course, restricting the total to 80 has inherent limitations, which is why we pointed out it is really only a subset of possible questions in the article. Overall, given the number of questions, I believe the areas that were selected were appropriate.

I agree with you that we (‘we’ meaning both healthcare professionals and agencies) need to do a better job of preparing patients how to search and how they manage the health information they find online. Consumer health literacy is also a pet topic of mine, and one of our biggest challenges!

Kevin

Hope the above 2nd, 3rd & 4th emails of this sequence of interest. Any points or discussion we want to have on this either amongst ourselves or further with Kevin Clauson ? (I can pass on points, or would we prefer to write a joint letter to continue this discussion ?) David Ruben Talk 23:05, 1 December 2008 (UTC)[reply]

Newer comments

For medications available by prescription only, why would the typical patient need to look up the dose online? It's written on the script; it's printed on the bottle's label. If you've got a prescription drug in hand, you've already got information about the dose directly from your own personal physician (or other professional with prescribing authority). So why is this considered important information? Lay people cannot self-prescribe prescription-only medications. I'm more concerned about the occasional omission of safety information: while I can (and routinely do) read the prescriber's inserts, the average person doesn't seem to be able to make sense of them. WhatamIdoing (talk) 02:12, 2 December 2008 (UTC)[reply]

The patient may want to know if their prescribed dose is low, normal, or high. For that, they need information other than their own prescription. When the prescription is filled, it may or may not come with a manufacturer insert or a pharmacy printout that includes this information. --Una Smith (talk) 03:27, 2 December 2008 (UTC)[reply]
There are many other issues at play here. Some patients may be mistrustful of manufacturer-provided information (gasp! Big Pharma!), others may turn to the Internet for convenience, and some (most?) may seek information on the drug before they have their prescription filled (I, for instance, usually do, although I usually turn to the scientific literature). Package inserts are also difficult to follow for those people who actually "take the trouble" to read them. WhatamIdoing—lay people most certainly can self-prescribe prescription-only medications. They shouldn't, but they can. There are many ways of obtaining prescription-only medication, even in the U.S. I currently live in a country where prescription-only medications can be purchased simply by walking into a drugstore and asking the duty pharmacist. Fvasconcellos (t·c) 12:09, 2 December 2008 (UTC)[reply]
Yup. That used to be common in the US; I don't know how common it is now, though. Also, patients frequently do veto their prescriptions (by not getting them filled), and they may adjust the dosage themselves. Also, it is common for veterinarians to supply their reliable clients with drugs "just in case", for the client to have on hand and administer as needed with or without consulting the veterinarian. Physicians also may do this, especially for patients who live in or travel to remote places. --Una Smith (talk) 16:33, 2 December 2008 (UTC)[reply]
We can solve this by adding a Daily Med field to Template:Drugbox, as discussed at Template_talk:Drugbox#Revisit_of_this_issue. --Arcadian (talk) 03:58, 2 December 2008 (UTC)[reply]
Why not simply use {{DailyMed}}? I still don't know why this proposal got nowhere. Fvasconcellos (t·c) 12:12, 2 December 2008 (UTC)[reply]
And while we're at it, I personally think the National Cancer Institute's Drug Information Summaries] are really useful. They contain all U.S. trade names, approval status, indications, links to MedlinePlus, the NCI Dictionary (which is a very good source for investigational agents) and active and closed trials. Although we frequently link to RxList, Lexi-Comp, and MedlinePlus, I'd never found a single link to these summaries until today. Fvasconcellos (t·c) 13:14, 2 December 2008 (UTC)[reply]

Accessibility

One thing that I think didn't come up in the email exchange regarding the choice of Medscape as comparator is accessibility. Medscape Drug Reference has several different tabs of drug information. The first is a bare list standard treatment dosages, adverse effects, interactions, etc. (the things that, for better or worse, Wikipedia doesn't want and actively discourages without integration into appropriate context). The most Wikipedia-like part is the "Drug Monograph". However, to access the monograph, one must register, which is free but has no opt-out from a weekly email newsletter and the sign-up process makes very clear (if it wasn't already) that the site is intended for health professionals. Furthermore, answers to consumer questions found in the monograph would not be directly accessible via a google search. It's unclear from the paper whether just the Drug Monographs or the entire set of Medscape Drug Reference results were used, but in either case (since many answers are buried in the monographs) it seems to me that the accessibility hurdle is way too high to make Medscape a realistic alternative source of information for consumers with drug-related questions.--ragesoss (talk) 18:04, 2 December 2008 (UTC)[reply]

Over the past month, three named accounts and three IPs have repeatedly inserted links at Asthma to http://www.azma.com. These additions have been reverted thirteen times by various editors, and at least two detailed discussions have taken place, but the accounts continue to push the disputed link. I have opened a discussion at Talk:Asthma#Azma.com; input requested there. Maralia (talk) 16:14, 26 November 2008 (UTC)[reply]

RfC: Mass removal of "Category:Alternative medicine" from most articles

I have started an RfC: RfC: Mass removal of "Category:Alternative medicine" from most articles. Please comment on this important subject. -- Fyslee / talk 17:14, 27 November 2008 (UTC)[reply]

I'm replying with this to everywhere Fyslee has put this request, though you are of course welcome to comment on what he's created. I need to write where he has put this because the title of this thing, started without Fyslee bothering to talk to me about it at all on my talk page, is inaccurate because as I would have told him if he asked, all I'm doing is moving things into the subcategories, (where they should be) which are still in the category. The reason I'm doing this is because at the top of the page it says (the bolding is the page's, not mine, and it's also in a red box This category may require frequent maintenance to avoid becoming too large. It should list very few, if any, article pages directly and should mainly contain subcategories. So I did what it said. Controversial and shocking "mass deletion" eh?:):):):):) Sticky Parkin 14:30, 28 November 2008 (UTC)[reply]

ok 10 points (and kudos) for any who can think of a plainer english way to say neuroplasticity...

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.
removed bit anyway, wasn't integral to (large) article

thisaway...or can't we. Can we do it without sacrificing meaning? Cheers, Casliber (talk · contribs) 23:30, 27 November 2008 (UTC)[reply]

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Peer reviews need attention

This is a call for anyone willing to peer review medical related articles. There are numerous articles still needing comments and reviews at the peer review backlog. Obviously with these kinds of topics a large number of editors will not be able to provide adequate reviews. Any help is really appreciated. Sillyfolkboy (talk) 07:15, 28 November 2008 (UTC)[reply]

MCOTW time

This one could do with some sorting out. Big range of information, from tololysis to late effects. JFW | T@lk 00:03, 30 November 2008 (UTC)[reply]

Purdue Pharma

There's a grass roots campaign to add some negative material to this article. I've fixed it a bit, so at least is more accurate, but still find the last section off-topic. I don't care a lot about this, just saw it reported on WP:COI/N. More eyes would be good. Pcap ping 22:27, 30 November 2008 (UTC)[reply]

Hmm. It seems that the issue is Purdue's marketing, which misled physicians and the public regarding OxyContin's addictiveness and abuse potential. There were several legal judgements recently against Purdue and some of its executives on this basis - all well and good, and certainly notable and deserving of coverage on Wikipedia. Then there is also an activist using Wikipedia to "increase public awareness" of the verdict - not so good, in that Wikipedia isn't the right venue for advocacy. I think we can cover the legal issues appropriately, because they're well-described in reliable sources. MastCell Talk 23:52, 30 November 2008 (UTC)[reply]

Meningioma

I've started a complete re-write of the Meningioma article. If anyone would wish to collaborate, help would be appreciated. Djma12 (talk) 22:39, 30 November 2008 (UTC)[reply]

Laudanum

This article is not covered in the project, and I believe it should. It also has info on dosage; which should be eliminated. I do not have time to fix it right now. Can anybody do it?--Garrondo (talk) 10:38, 1 December 2008 (UTC)[reply]

Done. Fvasconcellos (t·c) 13:17, 2 December 2008 (UTC)[reply]

Addiction-recovery schools

Are high schools and colleges which are dedicated to recovering addicts part of this project? If so, please add Serenity High School. Thanks. davidwr/(talk)/(contribs)/(e-mail) 19:17, 1 December 2008 (UTC)[reply]

I don't think so, unless the school has pioneered a particular highly innovative treatment that has been adopted universally. This WikiProject already has a very wide scope, including all human anatomy and physiology articles as well as medical conditions and treatments. JFW | T@lk 19:34, 1 December 2008 (UTC)[reply]
I have to second JFW here. We have an incredibly wide scope as it is, I think this would be pushing the boat out a little too far. Perhaps Wikipedia:WikiProject Health is worth a shot? —Matt (talk · contribs · email) 23:27, 1 December 2008 (UTC)[reply]

Ref sources

At the ADHD page we have been discussing for the last few months if the Therapeutics Initiative[1] can be used as a reference source on medical pages. Editors comments to help resolve this dispute would be much appreciated. The exact source in question is http://ti.ubc.ca/en/letter69 Doc James (talk) 19:48, 1 December 2008 (UTC)[reply]

  • The Therapeutic Letter purportedly uses the standardized systematic review methodology, yet has not been published in any journal.
  • The Therapeutic Letter is published in a bimonthly newsletter.
  • No author's name appear on the letter.
  • The newsletter is published by The Therapeutics Initiative whose goal is to, "reduce bias as much as possible" by being "an independent organization, separate from government, pharmaceutical industry and other vested interest groups".
  • The Therapeutics Initiative is funded by the British Colombia Ministry of Health through a grant to the University of BC, in Canada. --scuro (talk) 21:04, 1 December 2008 (UTC)[reply]

It doesn't look like an ideal source. However noble this publication sounds, it is not indexed for Medline and is oddly combative. I've had the same concerns about Prescrire International (which is indexed) which also routinely publishes negative reviews about medications in widespread use. Opposition to big pharma shenanigans is good and well, but that doesn't automatically make it a notable publication. In the same area, bodies like the UK National Instituate for Health and Clinical Excellence have made recommendations that are much more likely to be representative than a review by a maverick little journal that prides itself in saying mildly controversial things.

That all said, I have a phenomenal amount of respect for Bandolier, which is also not indexed and non-partisan, but doesn't seem to need all the anti-bias hyperbole to get its message accross. JFW | T@lk 21:51, 1 December 2008 (UTC)[reply]

Yes agree. The recent NICE guidelines do however come to the same conclusions. This however is done over 370 pages rather then two pages as the new NICE ADHD guidelines cover the entire topic.--Doc James (talk) 17:18, 4 December 2008 (UTC)[reply]

Illustrations of symptoms

Mikael Häggström has been creating these charts of symptoms. There's a whole bunch of them, there quite professional, and well composed, imho. Some of them are illustrative but others, like this one perhaps, seems to add nothing to the text in the article... I would be tempted to remove them if they add little extra value, but I'd like the opinion of others. There's many of them so individual discussions on different talk pages might not be useful. --Steven Fruitsmaak (Reply) 20:14, 1 December 2008 (UTC)[reply]

Maybe I'm alone on this but I feel that lol — Preceding unsigned comment added by Cyclonenim (talk • contribs) 22:20, 1 December 2008 (UTC)[reply]
I have no idea what happened there, it looks like it's been somehow refactored without being in the history... I was going to say that maybe I'm alone on this but I feel that images like this help to summarise what is put in the article in a big block of text. I see no harm in keeping them. —Cyclonenim (talk · contribs · email) 21:08, 1 December 2008 (UTC)[reply]
I think images always add more to an article. Even if they tell the same as the text in the article, they provide a very quick and easy review of what has just been read. Furthermore, the project generally lacks in images, since only a small fraction of the images on the Internet have a compatible license. Mikael Häggström (talk) 20:23, 1 December 2008 (UTC)[reply]
To me, this particular image suggests all these signs and symptoms can occur together in one patient. I think that is very unlikely. --Una Smith (talk) 21:02, 1 December 2008 (UTC)[reply]
Perhaps "possible sites and symptoms of CANCER METASTASIS" would be better then? Mikael Häggström (talk) 17:32, 2 December 2008 (UTC)[reply]

I think there is little merit in this kind of images. The cancer metastasis image, for instance, simply lists all symptoms per organ system, which the article is already doing to a degree. There are some significant omissions (e.g. spinal cord compression), which cannot be easily corrected because the image is a PNG. The image doesn't come with an image map, so a user can't click on a symptom and reach the article in question without having to go through the text... Which is what we wanted to prevent by adding an image!

I still think it's a good thing that there are images, even if their information is provided in the article text as well. Regarding format, it is actually made from an svg file, but the body background, which is imported as a png, won't come with if I upload it as svg. Perhaps anybody knows how to solve this. Else, if anybody tells me any issue I can make the edit and upload it anew. Image map may be added as well. Mikael Häggström (talk) 17:32, 2 December 2008 (UTC)[reply]

I share Cyclonenim's view that some articles are very high on dry text and too low on images. There must be other ways of making images that illustrate the related content. JFW | T@lk 21:56, 1 December 2008 (UTC)[reply]

For the text in this case, that is, symptoms of diseases, it hard to see any better solution. And even with this image included, more images are still needed all in all.Mikael Häggström (talk) 17:32, 2 December 2008 (UTC)[reply]

John Najarian

I surmise that this WikiProject is far less active than the mathematics WikiProject, since I just created the article titled John Najarian, which is quite remote from my usual interests, connected in this case primarily by my attention to the articles about the University of Minnesota. It's a stub and an orphan. Could others help by adding appropriate links to it from other articles and by expanding it? Michael Hardy (talk) 04:16, 2 December 2008 (UTC)[reply]

Actually, I'd say that this project is quite active, but that WPMED considers articles about individual physicians to be of low importance. WhatamIdoing (talk) 04:50, 2 December 2008 (UTC)[reply]

CfD nomination of Category:Diseases

Category:Diseases has been nominated for merging into Category:Diseases and disorders. If you would like to participate in the discussion, you are invited to add your comments at the category's entry on the Categories for discussion page. Cgingold (talk) 14:54, 2 December 2008 (UTC)[reply]

Pharmalot blog

It appears to be run by a professional journalist, although he's a freelancer now. [1] Is it acceptable to use it as a source? It has a few hits in Wikipedia (use search). It was used for some outlandish claims, e.g. [2], but I've only used it to document the Skolek campaign [3], although MastCell removed even that reference, and now Ms. Skolek is back... Pcap ping 22:29, 2 December 2008 (UTC)[reply]

Please see WP:SPS for information on using blogs as sources. Fvasconcellos (t·c) 23:10, 2 December 2008 (UTC)[reply]
As WP:SPS notes, blogs are acceptable if they're run by people who are experts and have been published in reliable publications on the issue. If that guy is a professional journalist and he's been published in reliable publications on the pharmaceutical industry, then I wouldn't have a problem with him being used for limited information related to the pharmaceutical industry, like what you used it for. MastCell is more of a stickler than I am, but he doesn't have veto power. Take it to WP:RS/N and get some uninvolved opinions. II | (t - c) 08:56, 3 December 2008 (UTC)[reply]
Wait - when did I lose my veto power? :) I'll be honest, I don't think this blog is appropriate sourcing for this tidbit. My reading of WP:SPS is that blogs may be acceptable in certain carefully circumscribed settings, but that "if the information in question is really worth reporting, someone else is likely to have done so."

I'm also not clear that a freelance journalist who's had a few articles picked up can create a blog and generate "reliable" self-published content at will - particularly in an area where ample independent, reliable sources exist. It's not like we're hurting for well-sourced info on the topic such that we have to lower the bar. To take this line of reasoning a bit further, I could set up a blog, leverage my real-life credentials, and hold forth my musings on health, medicine, and my field of specialization - and it would be an encyclopedic, reliable source? No.

Is the Skolek campaign covered anywhere besides this one blog? Has there been any indepedent, reliably sourced comment on it? If not, then I have a really hard time seeing encyclopedic notability here. I'm fine with WP:RS/N - I'd just ask that you give me a heads-up if you take it there - and perhaps we should move this conversation to Talk:Purdue Pharma. MastCell Talk 19:18, 3 December 2008 (UTC)[reply]

For whatever it's worth, his blog is being indexed by Google news: [4], and she does get some hits in older newspapers [5]. I don't particularly care for including this in the article. Pcap ping 19:45, 3 December 2008 (UTC)[reply]
My point is: I'd rather have someone write a short NPOV account of this, rather than have Ms. Skolek edit war over her unsourced version of the story. If she gets blocked from Wikipedia over this, you can expect more negative reporting from not so discerning reporters. Pcap ping 19:51, 3 December 2008 (UTC)[reply]
The notability question is a good point, and I thought about that after I turned off the computer. A Google News search for Skolek turns up only one source and it is -- surprise -- the Pharmalot blog.[6] Yet online news is limited. Pharmalot notes that she started a website, which has online copies of at least 3 regional newspaper articles which discuss her in-depth.[7][8][9] Some people don't think regional newspapers (The Express-Times, Courier News) are reliable either. These links also come with the problems discussed in WP:CONVENIENCE. As far as published information on the pharmaceutical industry, I don't know whether it's hard to find, but it seems as if newspaper industry is only going to get smaller. The NYTimes now sells junk bonds. Most business publications lean conservative. With the WSJ now owned by Murdoch, Portfolio.com downsizing, and related changes across the industry, I'm not sure I expect reliable coverage of the pharmaceutical to be all that forthcoming. As far as MastCell citing his blog all over Wikipedia, I wouldn't have a problem with it, although it would probably get replaced by better sources. But if he wanted to discuss the details on some esoteric complicated drug or treatment, he would have had to publish a paper (or a couple) on that issue. Reliability on complicated science seems different than reliability on covering industry news. II | (t - c) 19:52, 3 December 2008 (UTC)[reply]
Try the Google News archives, there are more hits (see my post right above yours). Pcap ping 19:57, 3 December 2008 (UTC)[reply]
Re: II, I couldn't disagree more about the existence of critical reporting on the pharmaceutical industry. It seems quite vibrant to me. The New York Times is currently doing a series on ties between academic medical experts and drug companies, tying in with Charles Grassley's investigations, and they've actually brought down a few very big names, mostly in academic psychiatry ([10], [11], [12], [13], [14]) - and that's all in the last few months. Hell, an editorial from this past Sunday was entitled "Expert or Shill?" And one of the Times' former medical reporters wrote a fascinating book called "Our Daily Meds", which grew from her reporting there - definitely worth a read. Even in this specific case, the Times heavily covered Purdue Pharma's problems. The media is on the case - they love this kind of thing, so I don't think we need to turn to low-profile blogs as the last defenders of journalistic integrity. MastCell Talk 22:14, 3 December 2008 (UTC)[reply]
Yeah, you're right. Would be interesting to see the Murdoch buy the NYTimes,[15] but even then I suppose there will be a fair bit of coverage. However, down the line things may not be so simple if the current trend continues. Incidentally, none of the 3 newspaper articles I noted are in Google News. P-cap might want to use one of the articles in Google News, but they all require registration, which is a bit of a hassle. II | (t - c) 00:18, 4 December 2008 (UTC)[reply]

Medical director

We have an article, Medical director, that is entirely about medical directors that do EMS work -- simply because no one's found any non-EMS information to add to it. Would we like to expand this article? Does someone have sources handy? I realize that this is a low-priority type of article for this project, but if someone has an interest, then I'm sure further information would be welcome. WhatamIdoing (talk) 06:54, 3 December 2008 (UTC)[reply]

Nursing homes and similar custodial institutions have medical directors, but their role is somewhat different. If content about them is added to Wikipedia then I would be in favor of a disambiguation page plus moving the current Medical director to Medical director (emergency medicine). --Una Smith (talk) 15:59, 3 December 2008 (UTC)[reply]

Large expansion of Unverricht-Lundborg disease article

Perhaps you guys should take a look at the Unverricht-Lundborg disease page. A person editing as [[::User:M.scrudato|M.scrudato]] ([[::User talk:M.scrudato|talk]] · [[::Special:Contributions/M.scrudato|contribs]]) and [[::User:128.61.19.203|128.61.19.203]] ([[::User talk:128.61.19.203|talk]] · [[::Special:Contributions/128.61.19.203|contribs]]) has dropped a large ammount of content in the article, untill then just a stub. Did a quick Google test: this does not seem to be a copy-paste job. I am in no way a medical expert, and have this article on my watchlist purely for personal reasons. But as far as I can tell it looks pretty good, and the sources seem genuine. Does M. Scrudato deserve a Medicine Barnstar for this? Cheers, Face 20:46, 3 December 2008 (UTC)[reply]

Looks credible to me... you should go ahead with the barnstar, imho. --Steven Fruitsmaak (Reply) 20:51, 3 December 2008 (UTC)[reply]
I think we should first try to get in touch with him/her, so I've left a welcoming message. - Face 22:00, 3 December 2008 (UTC)[reply]

Physician assistant

If one or two more editors felt like putting Physician assistant on the watchlists for the next week or so, I'd appreciate it. The page is already semi-protected because the major problem (after one editor got blocked) was a pair of anon editors, so at the moment the traffic is the same editor deleting the "wrong" POV (i.e., what the source actually says, along with the reference to the source that s/he is supposedly getting the numbers from).

The edit war is about the number of physician assistants that work in "rural" counties in the United States. The POV-pushers are trying to prove that the profession has abandoned its purpose by working in, say, inner city clinics, instead of in rural areas. Among the problems with the POV is that the cited source doesn't use the word rural anywhere in it, and no possible combination of numbers in the source adds up to the "about 9%" that several editors have been repeatedly adding.

At this moment, the primary goal is to simply keep the reference from being deleted. WhatamIdoing (talk) 06:02, 4 December 2008 (UTC)[reply]

 Done I'll keep an eye out. —Cyclonenim (talk · contribs · email) 08:14, 4 December 2008 (UTC)[reply]
Seems they're still at it. I've left a warning at their talk page, but it's likely he/she will remove it since they've done it with all past messages. I suggest a slightly more blunt warning should it continue and then we could discuss further action. But hey, let's hope the first is enough. —Cyclonenim (talk · contribs · email) 17:24, 4 December 2008 (UTC)[reply]
The user continued his/her attempts to remove sources so I reported to WP:AIV. They've been blocked for 24hrs and we'll see what happens then. —Cyclonenim (talk · contribs · email) 18:30, 4 December 2008 (UTC)[reply]

press review

i started a kind of press review on medical wikipedia-articles in de: de:Wikipedia:Redaktion Medizin/Presse, is there anything similar specific in en: (except Wikipedia:Wikipedia in academic studies/Wikipedia:Press_coverage)? -- Cherubino (talk) 11:51, 4 December 2008 (UTC)[reply]

No, we don't have a list of specific sources, but we provide general advice about selecting sources at WP:MEDRS. WP:DERM has started a list of specific recommended sources... but I'm not actually convinced that it's a good idea. Every source needs to be evaluated according the specific context of how it is being used. WhatamIdoing (talk) 20:31, 4 December 2008 (UTC)[reply]

Wikipedia comes second

see http://www.nature.com/bdj/journal/v205/n10/full/sj.bdj.2008.994.html -- 172.158.55.160 (talk) 13:26, 4 December 2008 (UTC)[reply]

Two in a week. Great. —Cyclonenim (talk · contribs · email) 14:40, 4 December 2008 (UTC)[reply]

Well, this is an opinionating letter, not a quantitative or semi-quantitative study. The author does not demonstrate where NICE provides any information on pica. JFW | T@lk 16:43, 4 December 2008 (UTC)[reply]

Hereditary coproporphyria

the section 'Molecular Biology' in the above article contains contradictory statements. The first paragraph starts with 'The CPO gene is located in chromosome 3'. The second paragraph starts with 'The gene for human coproporphyrinogen oxidase (CPO) is found on chromosome 9 not chromosome 3.' I don't know the subject so am not qualified to edit.

I just watch 'House' too much. —Preceding unsigned comment added by 169.3.169.80 (talk) 16:51, 4 December 2008 (UTC)[reply]

Whoever added that should have known better. OMIM shows that this study (Grandchamp 1983) was later contradicted. The gene is definitely on 3q. Thanks for pointing this out.
Of course this strengthens my view that we should be careful in citing primary research studies, especially when they're dated. Everyone is invited into an ongoing slightly circular discussion on WT:MEDRS on the topic. JFW | T@lk 17:06, 4 December 2008 (UTC)[reply]

Peritrabecular fibrosis

Hello. I'm currently working on the Osteitis fibrosa cystica article, and am attempting to expand a section on preliminary symptoms. Could anyone explain peritrabecular fibrosis? I can hardly form even the most rudimentary definition or explaination of it, and any help would be incredibly appreciated. Strombollii (talk) 17:30, 4 December 2008 (UTC)[reply]

A trabecula is "a small, often microscopic, tissue element in the form of a small beam, strut or rod, generally having a mechanical function, and usually but not necessarily composed of dense collagenous tissue" according to our article. Fibrosis is "development of excess fibrous connective tissue" according to our article. Therefore I'd imagine a decent definition of peritrabecular fibrosis as "Excessive development of trabeculae", but I could be wrong, after all I'm not trained in this stuff. —Cyclonenim (talk · contribs · email) 17:38, 4 December 2008 (UTC)[reply]

Thank you

A family member recently had a health issue, and I looked up the corresponding article on Wikipedia so I could at least have some minor amount of clue when I talked with the doctor. Some of the information in the article conflicted with the doctor’s information, and when I asked for a clarification from him, it turned out he had misspoken, and Wikipedia’s article was correct. It didn’t save a life or anything, but it sure as hell eased our minds in a stressful time.

I know our medical articles aren’t perfect or error-free, but I also know you all volunteer your time and work hard to provide useful information in a complicated area. Thank you.

Is there anything helpful I could do for WP:MED in return? I have really small windows of opportunity to edit every once in a great while, and I don’t know anything about anything, so I can’t research and write articles, but if there is a backlog of WP:MED-related grunt work somewhere that a reasonably intelligent but medically-ignorant editor can do, then I’d be happy to help out when I can. If not, then I'll just stick to my wikignoming and continue to quietly admire you all from afar. --Floquenbeam (talk) 21:05, 4 December 2008 (UTC)[reply]

Hi Floquenbeam, glad to hear you found the article of good use to you. I hope all is well with your family. There are always little tasks which people need doing, and they're usually posted here, so if you're determined you can take your pick. Alternatively, you could pick something from here. —Cyclonenim (talk · contribs · email) 21:10, 4 December 2008 (UTC)[reply]
  1. ^ http://www.ti.ubc.ca/
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