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Medical Specialties

I would like to propose that a template for medical specialties is created. I have searched through the Wikipedia articles on medical specialties yesterday. My findings are as follows (with regards to the articles containing these specific sections)

Introduction (although not usually titled as such) (31) (Hepatology, Neurology, Gastroenterology, Pulmonology, Endocrinology, Intensive Care Medicine, Rheumatology, Immunology, Disaster Medicine, Emergency Medicine, General Practice, Geriatrics, Obstetrics and Gynaecology, Palliative Care, Paediatrics, Rehabilitation Medicine, Preventive Medicine, Psychiatry, Medical Genetics, Medical Microbiology, Radiology, Cardiology, General Surgery, Neurosurgery, Oral and Maxillofacial Surgery, otolaryngology, Paediatric Surgery, Plastic Surgery, Trauma Surgery, Urology, Vascular Surgery) History and Key Discoveries (16) (Hepatology, Gastroenterology, Endocrinology, Dermatology, Disaster Medicine, Emergency Medicine, Geriatrics, Opthalmology, Palliative Care, Rehabilitation Medicine, Psychiatry, Cardiology, Medical Genetics, Neurosurgery, Orthopaedic Surgery, Plastic Surgery) Training/Education/Training Across the World (16) (Neurology, Endocrinology, Nephrology, Dermatology, Disaster Medicine, Emergency Medicine, Obstetrics and Gynaecology, Opthalmology, Paediatrics, Rehabilitation Medicine, Radiology, Neurosurgery, Oral and Maxillofacial Surgery, Orthopaedics, Trauma Surgery, Vascular Surgery) Scope of the Specialty/Field of Work/Diseases managed (12) (Hepatology, Neurology, Pulmonology, Nephrology, Proctology, Dermatology, Geriatrics, Psychiatry, Neurosurgery, Orthopaedics, Otolaryngology, Vascular Surgery) Important Procedures/Treatment/Treatment Settings (12) (Hepatology, Pulmonology, Haematology, Nephrology, Rheumatology, Immunology, Dermatology, Psychiatry, Cardiology, Orthopaedic Surgery, Plastic Surgery, Vascular Surgery) Sub-specialties (8) (Dermatology, Obstetrics and Gynaecology, Opthalmology, Paediatrics, Psychiatry, General Surgery, otolaryngology, Urology) Societies/Organisations around the world (7) (Hepatology, Gastroenterology, Nephrology, Emergency Medicine, Medical Genetics, Oral and Maxillofacial Surgery, Otolaryngology) Diagnosis/Investigations (8) (Pulmonology, Nephrology, Oncology, Haematology, Rheumatology, Immunology, Dermatology, Radiology) Disease Classification/Diseases (7) (Hepatology, Gastroenterology, Endocrinology, Nephrology, Rheumatology, Dermatology, Psychiatry) Scientific Research (5)(Pulmonology, Oncology, Rheumatology, Dermatology, Psychiatry) Current Practice Across the World/Current Trends (5) (General Practice, Geriatrics, Palliative Care, General Surgery, Oral and Maxillofacial Surgery ) Notable Practitioners (4) (Nephrology, Opthalmology, Neurosurgery, Oral and Maxillofacial Surgery) Publications/Journals (2)(Hepatology, Rehabilitation Medicine)Definitions (2) (Disaster Medicine, Emergency Medicine) Ethical Issues (2) (Oncology, Psychiatry) Follow-up (1) (Oncology)Equipment (1) (Intensive Care Medicine) Practitioners Description (1) (Psychiatry) Basic Medical Sciences (1) Haematology Profession (1) (Endocrinology) Work (1)(Endocrinology) Tele-practice (1) (Radiology) Philosophy (1) (Rehabilitation Medicine) Who sees the specialist? (1) (Nephrology) Patient Education (1) (Endocrinology)Popular Textbooks (1) (Rehabilitation Medicine) Social Role of Practitioners (1) (Paediatrics)

If the topics were chosen according to the most popular within the articles they would be:- Introduction, History and Key Discoveries, Training/Education/Training Across the World, Scope of the Specialty/Field of Work/Diseases Managed, Treatment, Sub-specialties, Societies/Organisations around the World, Diagnosis/Investigations, Disease Classification/Diseases, Scientific Research, Notable Practitioners, Definitions, Ethical Issues - then the other categories would most likely be relevant to only a minority of specialties Justinmarley (talk) 06:44, 13 July 2008 (UTC)justinmarley I've missed a few - Current Practice/Current Trends, Publications/Journals Justinmarley (talk) 06:50, 13 July 2008 (UTC)

Those articles are exceptionally hard to source properly. I agree that a MEDMOS outline would help. JFW | T@lk 07:15, 13 July 2008 (UTC)

Is there a process to take this forward or does it involve consensus on this discussion page? Justinmarley (talk) 08:47, 13 July 2008 (UTC)justinmarley

I don't understand the question. Are you asking for something like {{Medicine}}, or for an addition to Wikipedia:MEDMOS#Sections? If the first, then you just create it and use it. If the second, then I suggest that you create a subsection here to propose the exact text that you'd like to see in MEDMOS. WhatamIdoing (talk) 17:56, 14 July 2008 (UTC)

Thanks Justinmarley (talk) 05:45, 16 July 2008 (UTC)justinmarley

Pathophysiology

A few people have brought up in an article I'm working on that 'pathophysiology' is not a well-known term and might be confusing to lay readers. One has mentioned that it might be a problem for lay readers seeing it as a section header in the table of contents in an article about a disease. Do others agree that this is a problem? What else could it be called if it were to be changed? delldot talk 16:12, 16 July 2008 (UTC)

This is the first time I have come accross this concern in many years. I think that anyone with some experience in comprehension will be able to find out from the context what "pathophysiology" means. As a concept it is difficult to translate - it isn't "cause". "Mechanism of disease" is the terminology used by the NEJM. JFW | T@lk 17:20, 16 July 2008 (UTC)

It's absolutely not the first time I've encountered this problem; in fact, I systematically replace it with "Disease mechanism", with a redirect to pathophysiology. I do the same for etiology and cause. I think we should avoid these terms and adopt this practice of redirecting to them per WP:JARGON. --Steven Fruitsmaak (Reply) 17:29, 16 July 2008 (UTC)

Isn't that why the guidelines call for Pathophysiology or mechanism? SandyGeorgia (Talk) 17:42, 16 July 2008 (UTC)

I like "disease mechanism", but then for trauma articles you're going to have a "mechanism" and a "disease mechanism" section: "mechanism" would cover the physical forces (e.g. rotational or sheer stress), while the section formerly called "Pathophysiology" would cover the cellular events. delldot talk 17:57, 16 July 2008 (UTC)

Suggest 'Biological mechanism' to cover more than diseases, if that's the direction this goes in... LeeVJ (talk) 23:40, 11 August 2008 (UTC)

Proposed Structure for Medical Specialty Articles - Please Comment!

Introduction - Introduction to the subject
Scope - Scope of the specialty
History - History of development of field
Current Practice - Global perspective on current practice
Training - Training around the world
Investigations - Investigations/diagnostics used in specialty
Treatments - Treatments used in specialty
Sub-specialities
Notable Practitioners - Within the field - historical and current
Societies - Global list of relevant societies
Research - Research themes in specialty
Textbooks and Journals - Important textbooks and journals in field
Ethics - ethical issues in field
Justinmarley (talk) 05:59, 16 July 2008 (UTC)

"Introductions" are generally discouraged. That's what the lead is for. JFW | T@lk 06:21, 16 July 2008 (UTC)

Or rather, that's what the lead is. As I think Justinmarley made clear above:

"Introduction (although not usually titled as such)" --Hordaland (talk) 10:15, 16 July 2008 (UTC)

The Notable Practitioners, Textbooks, Journals and Societies could be covered in prose within the History section (i.e., only mention them if historically significant) otherwise they might end up as lists that attract spam or be only of interest to physicians. Do we need a "Current practice" section, when presumably the Investigations & Treatments sections covers that? Could Sub-specialities be covered within Scope? Colin°^Talk 10:29, 16 July 2008 (UTC)

I think that Ethical issues is a better section title than "Ethics". While different fields confront different specific dilemmas, the ethics themselves do not change.

Do we really need a "Textbooks and journals" section? It seems so... web directory-ish. WhatamIdoing (talk) 05:38, 17 July 2008 (UTC)

This is a proposed framework for excellence in articles and is constructed entirely from searching through these articles on wikipedia and counting the popularity of these topics. As such it probably serves as a starting point rather than the finished product. I agree that the notable practitioners section could be subsumed under the history section. The current practice section covers service provision e.g. in different countries and therefore extends beyond investigation and treatment. Sub-specialties could be covered within scope - would we be able to have sub-headings within scope? Textbooks and journals didn't score so highly in the overall count. However, I think that they could go in a separate section and be provided in list form - the reason being that readers would then have a straightforward and very valuable resource for further reading on the topic (in the secure knowledge that practitioners in the field place value on these textbooks. Personally speaking I would find a journals section extremely valuable myself). Although this section is 'web directory-ish', I think that combining these valuable lists with the remainder of the article will make this a powerful resource. Societies relates to current practice i.e. what societies exist that relate to this discipline today. Again this will prove useful for the reader who wants further information and can contact the relevant society. Ethical issues seems fine and probably do vary between the specialties. Obstetrics and Gynaecology (e.g. issues that conflict with religious values) might have different ethical issues to a speciality such as ITU (taking someone off the ventilator). Justinmarley (talk) 06:46, 17 July 2008 (UTC)justinmarley

Modern textbooks and journals that are not in themselves highly notable do not deserve mention in a section of their own. Any such "Further reading" section is for the general reader wanting to learn about Neurology in general, for example, not for the trainee physician wanting to become a neurologist. I can't really imagine why a general reader would be interested in a list of current neurology journals. We aren't a directory, so we don't list societies for the purpose of readers contacting them. Unless you can say something interesting about the society, it probably doesn't deserve mention. It would really help if some knowledgeable editors worked on a Speciality article, bringing it up to a decent standard, so we could have an example that works and serves as a model. Colin°^Talk 17:34, 17 July 2008 (UTC)

Gosh, I see so many problems with this proposed structure that I don't know where to start, so I'll leave it to others and say that I think our current structure is much better. I can't see anything in this proposal that could be well applied to Tourette syndrome, and this proposal actually introduces things like Societies, yikes. SandyGeorgia (Talk) 16:12, 17 July 2008 (UTC)

This proposal is for specialties only. --Steven Fruitsmaak (Reply) 16:16, 17 July 2008 (UTC)

For example? SandyGeorgia (Talk) 16:32, 17 July 2008 (UTC)

Obstetrics and gynecology, for example, right Justinmarley? I agree with others above: Notable people sections aren't great because they're spambait, plus I'd like to see sections that are going to be primarily lists discouraged in favor of prose. So subsuming the notable people under history would be a good idea, because you're going to have to mention the people anyway when you're discussing the events. Similarly, I would subsume 'Societies' under history as well: again it's listy and the notability is questionable if you don't have it in prose (i.e. if it's just the name of the society with no other info). I also agree that the Current Practice section would be unnecessary, and it's so vague we wouldn't be getting consistent stuff with this as a guideline anyway. I'm also in agreement that there shouldn't be a textbooks and journals section: again it's listy, and I don't know if 'it's helpful' is that good of an argument. However, I'm not opposed to a 'Further reading' section. I'm also in favor of renaming 'Introduction' to 'Lead' and linking WP:LEAD. Lastly, I think we'd need to explain what 'Investigations' means if we're going to adopt this as a guideline, it's not clear to me anyway. delldot talk 18:19, 17 July 2008 (UTC)

OK, got it, struck my premature and clueless comment. Sorry for multi-tasking and not digesting carefully, SandyGeorgia (Talk) 19:43, 17 July 2008 (UTC)

Alternate proposal

With the above thoughts in mind, plus stealing ideas from MEDMOS, here's another proposal:

Lead - Introduction to the subject, see WP:LEAD
Scope - Scope of the specialty
Sub-specialities
History - History of development of field, including notable people
Training - Training around the world
Investigations - Investigations/diagnostics used in specialty
Treatments - Treatments used in specialty
Research - Research themes in specialty
Ethical and medicolegal issues - ethical and legal issues in field
See also - avoid if possible, use wikilinks in the main article
Notes
References
Further reading or Bibliography - paper resources such as books, not web sites
External links - avoid if possible

Thoughts? delldot talk 18:30, 17 July 2008 (UTC)

Sub-specialties (if any...) could be indented under Scope. Training looks perhaps misplaced, perhaps to bottom (above See also)? Or Ethical.., Training and Research as last 3. Research may need more frequent revision than the others, major points therefrom being moved up & included in History. --Hordaland (talk) 19:36, 17 July 2008 (UTC)

Yeah, I like the idea of having sub-specialties as a subsection of scope. How about investigations, treatments, training, research, ethical? That way you're keeping the more doing stuff-related topics together and the more abstract things (research and ethics) together. delldot talk 19:53, 17 July 2008 (UTC)

Better. How about "Scope - Scope of the specialty; identify important sub-specialities" rather than a separate subsection for subspecialities? WhatamIdoing (talk) 20:19, 17 July 2008 (UTC)

Hmmm, I just hoped that ethical is a part of doing ;-) No problem with your suggestion, delldot. --Hordaland (talk) 21:11, 17 July 2008 (UTC)

*Blushes* Good point. delldot talk 21:52, 17 July 2008 (UTC)

Scope - do people agree this should be included yes/no (just moving through the above template point by point)Justinmarley (talk) 18:22, 19 July 2008 (UTC)justinmarley

Pretty obviously has to be there. Perhaps someone wants to discuss the name of it - possibly the name of it varies among articles - but the content is necessary. IMO. --Hordaland (talk) 22:20, 19 July 2008 (UTC)

Why not, instead, ask about all the points instead of just one. The last 5 don't need discussion. Could do it as below. (If lousy idea, just delete.) --Hordaland (talk) 22:20, 19 July 2008 (UTC)

Scope, incl. subspecialties

I support this provided subspecialties is included as a subheading Justinmarley (talk) 23:30, 19 July 2008 (UTC)justinmarley

History, incl. people

I support this - should be perhaps towards the end of the document Justinmarley (talk) 23:31, 19 July 2008 (UTC)justinmarley

Logical to have History w/people early-on in these types of articles, I think. Ideally the section gives a timeline of what was known when, which is a helpful and interesting extension of Scope. --Hordaland (talk) 10:02, 20 July 2008 (UTC)

If history is at the beginning of the article then perhaps it should lead onto current practice or current service provision Justinmarley (talk) 18:52, 20 July 2008 (UTC)

Investigations/diagnostics

I support this Justinmarley (talk) 23:31, 19 July 2008 (UTC)justinmarley

Treatments

I support this provided it is written as treatment Justinmarley (talk) 23:33, 19 July 2008 (UTC)justinmarley

Ethical and medico-legal issues

I support this - should it be at the end of the article? Justinmarley (talk) 23:34, 19 July 2008 (UTC)justinmarley

Training

I support this - should there be a breakdown according to different geographical locations? Justinmarley (talk) 23:34, 19 July 2008 (UTC)justinmarley

Research themes

I support this Justinmarley (talk) 23:35, 19 July 2008 (UTC)justinmarley

Service Provision

I propose this as another section Justinmarley (talk) 23:37, 19 July 2008 (UTC)justinmarley

Do you have an example or two from existing articles? What's to be included here?

P.S. Why do you, Justinmarley, always sign your comments twice? The name before the time/date is sufficient, and the way most people do it. --Hordaland (talk) 10:06, 20 July 2008 (UTC)

The GP article (http://en.wiki.x.io/wiki/General_practice) is an excellent example. Thanks for the tip about signing by the way Justinmarley (talk) 18:49, 20 July 2008 (UTC)

Things that make you go "Hmmm" in the night

Editors are invited to consider the dispute at Talk:Liaison psychiatry. WhatamIdoing (talk) 05:52, 18 July 2008 (UTC)

My work on the Liaison Psychiatry article has hit a brick wall because there are no current guidelines on structuring information about specialties. We could use the Liaison Psychiatry Article as a pilot for developing a generic structure which could then be applied to other articles. Having such a structure would in my opinion be extremely helpful for medical articles which from the research I have undertaken and shown above, reveals a heterogenous group of articles. May I make a suggestion of going through the proposed list above, point by point, agreeing consensus on whether it should be included or not Justinmarley (talk) 22:26, 18 July 2008 (UTC)justinmarley

(belatedly) there are actually, I will try and sort something out. Cheers, Casliber (talk · contribs) 06:32, 11 August 2008 (UTC)

I've just written a long, B-class article: Sleep medicine. I tried to use the mal suggested on this Talk page, but could make the order of things fit only just sort of. I ended up with this:

• Intro
• Scope
• History
• Training and certification
• Diagnosis

• Tests and other tools

• Treatment
• [Research themes - not yet done]*
• [See also - none]
• References
• External links

* (Unless I can shorten the whole article appreciably, Sleep research will have to be its own article, just barely referred to here.)

(Still missing: almost anything in the 'round the world department. But that will necessarily be a large part of 'Sleep research'.)

Not to say that this is applicable everywhere, but, in this order, the sections lead into each other in this case. FYI. --Hordaland (talk) 10:54, 11 August 2008 (UTC)

Looks promising, just be bold and run with it. I was a bit hasty in saying there was a specific template, but this shouldn't be too difficult. it is similar to psychiatry..Cheers, Casliber (talk · contribs) 11:15, 11 August 2008 (UTC)

Update

Based on the various suggestions here, I've added a list of suggested sections to MEDMOS. The particular trigger was the current state of Public health. WhatamIdoing (talk) 06:11, 18 September 2008 (UTC)

Biting the bullets

I have been working on hypopituitarism. Annoyingly, I find myself resorting to bullet points because any other way of enumerating facts about the different pituitary hormones just seems wrong. For the "causes" section I have used a table instead, but would value others' opinions on how to best present enumerative information. I am opposed to using level 3/4 headers for 2-sentence paragraphs. JFW | T@lk 13:00, 22 July 2008 (UTC)

Steven Fruitsmaak's view

I'd use boldface, like above. For very brief sections it's an alternative to bullets. I agree this is a though situation. I always have to force myself not to use bullets because it provides such nice structure, yet I managed to do so yesterday in enumerating the causes of coughing (although that list is even longer). --Steven Fruitsmaak (Reply) 17:41, 22 July 2008 (UTC)

Allopathic

User:SesquipedalianVerbiage has named MoS as his authority for introducing errors into the title of a reference. I find no such authorization. Would it be worthwhile adding a section about avoiding the word allopathic, primarily so that we can add a line about never changing direct quotes, titles of references, and so forth? WhatamIdoing (talk) 18:42, 24 July 2008 (UTC)

Seems to me that the word allopathic, with its definition(s) and apparently differing connotations, is not the point here. The approach you suggest could theoretically lead to adding rules about each and every word anyone ever introduces (or avoids) in direct quotes, including quoting of titles. There must be an overriding rule somewhere that such behavior is an absolute no-no; it shouldn't actually have to be stated but it probably is somewhere.

Looks to me that a preceding ref in the same article commits the same sin: it is titled Allopathic medicine, while the word allopathic doesn't appear on the linked page. (It is possible to find it on one of the subsequent pages.)

Manipulation of direct quotes in this way is intolerable. (Manipulation by partial quotes out of context is another question which may require discussion.) --Hordaland (talk) 02:24, 25 July 2008 (UTC)

You're right: Presumably such a rule already exists. But where is it? WhatamIdoing (talk) 20:02, 25 July 2008 (UTC)

Mnemonics

How do we feel about external links to mnemonics, such as seen in Auerbach's plexus? WhatamIdoing (talk) 00:16, 27 July 2008 (UTC)

They can probably be deleted, though they could be useful in supporting a mnemonic itself, as in RICE (medicine). --Arcadian (talk) 04:02, 27 July 2008 (UTC)

I appreciate finding them. Given that they are generally just links in an external link section, I would prefer to keep these around. Antelan 04:14, 27 July 2008 (UTC)

We've recently gone through a discussion about mnemonics in general, see this thread. I don't think external links about mnemonics are any different. JFW | T@lk 05:20, 27 July 2008 (UTC)

Whereas mnemonics on WP might be said to inexorably lead to listcruft, the same is not true for mnemonics not on WP. At the same time, one external link to a mnemonic, even if each medical article has one, is not problematic. And despite all this defense of mnemonics, I do not run a mnemonic website. Antelan 07:47, 27 July 2008 (UTC)

Drug navboxes

I've recently noticed that many of our drug navboxes use spaced hyphens ( - ) as list separators, which goes against the Manual of Style (and the conventions of decent typography :). I propose that all drug navboxes be standardized to use {{·}} instead of hyphens (or commas, etc.) Some templates (such as {{NSAIDs}}) already use the middot separator, as suggested in the documentation of {{Navbox}} and Wikipedia:Lists—let's make it a standard. Fvasconcellos (t·c) 17:39, 30 July 2008 (UTC)

Support. --Arcadian (talk) 20:03, 30 July 2008 (UTC)

Support. Much prettier too. JFW | T@lk 20:49, 30 July 2008 (UTC)

Weak support -- consistancy is important, hence my support. But comma-separated lists are more compact and as an example where the use of {{·}} will not look as good (and may mean having to spread the navbox over more lines) is {{Birth control methods}}. David Ruben ^Talk 23:51, 30 July 2008 (UTC)

• Well, that's a valid concern—but the difference is actually barely visible, except in the edit window; compare them both below:

—Fvasconcellos (t·c) 00:09, 31 July 2008 (UTC)

Well, since no one has really voiced any opposition, I'll go ahead and start implementing this. Has anyone though of the wording that will constitute the actual guideline? :) I though of something along these lines:

Navigational boxes should follow a standardized style. Items should be separated by a middot template ({{·}}) followed by a single space; the use of hyphens as list separators is not recommended. As when choosing article titles, drugs should be referred to by their International Nonproprietary Names, using piped links when required. More information about creating navigational templates can be found in the documentation of Template:Navbox.

—Fvasconcellos (t·c) 14:38, 3 August 2008 (UTC)

Are commas still OK as a secondary separator (in parentheses)? I think it makes nesting easier to read. --Arcadian (talk) 12:29, 4 August 2008 (UTC)

I don't see why not. Fvasconcellos (t·c) 14:27, 4 August 2008 (UTC)

Also, could you add something about the punctuation notes (§, ‡, etc) used at the bottom of Template:HIVpharm? I don't know who first introduced them, but I think they're very useful. But if we're going to use them, it would be good to document it as a standard somewhere. --Arcadian (talk) 17:30, 4 August 2008 (UTC)

And also -- this isn't just for the pharm navs, right? I'm assuming this applies for disease and procedure navs too, but I wanted to make sure. --Arcadian (talk) 17:33, 4 August 2008 (UTC)

I believe the footnotes were first introduced by Hopping (talk · contribs), though I'm not sure. I've since taken to using them, as has Carlo Banez, and they are now in place in several templates. There's a "traditional" order of symbols for sequential footnotes, although there isn't much consensus on what it is; Robert Bringhurst recommends asterisk (*), dagger (†), and double dagger (‡), and our article on footnotes has them followed by the section sign (§), double vertical bar or "parallels" (‖), and pilcrow (¶). The Chicago Manual of Style substitutes # for the pilcrow (*, †, ‡, §, ‖, #).

And yes, this would apply to all medicine-related navboxes. Fvasconcellos (t·c) 19:20, 4 August 2008 (UTC)

When will this be added? --Arcadian (talk) 12:26, 21 August 2008 (UTC)

I have added this content. --Arcadian (talk) 16:36, 22 August 2008 (UTC)

Thanks. I seriously neglected this after all the MEDRS hoopla below—will polish the wording tomorrow. Fvasconcellos (t·c) 02:18, 3 September 2008 (UTC)

Addition about primary research vs reviews

User:Leevanjackson added a note about reviews vs primary research. User:Paul gene reverted, saying "unnecessary addition. All changes to guidelines must be discussed on the Talk page first". I reverted again, because I think (a) this is a useful addition, and (b) there is way too much fuss about making changes to this page. If something is obviously a good addition (or even a good faith addition) that is likely to reflect consensus, we don't need to discuss for the sake of discussing. Three words come to mind: WP:BOLD, WP:SNOW, and WP:IAR. Your comments please. --Steven Fruitsmaak (Reply) 23:12, 9 August 2008 (UTC)

I am strongly against it. I do not think WP:BOLD and WP:IAR should be boldly used to ignore others opinions. This addition is obviously not good and unlikely to reflect the consensus. For example, in the field of psychopharmacology the reviews are often written by hacks sponsored by pharmaceutical companies. The only way to obtain objective information is to read the original publications. Paul Gene (talk) 23:58, 9 August 2008 (UTC)

Paul, this has been consensus for months. You are using an exception to prove a rule. A review is reliable (because it is published in the peer-reviewed literature) unless there are clear factors against it. For this, you have been granted editorial judgement. JFW | T@lk 08:11, 10 August 2008 (UTC)

I also agree with Steven that WP:SNOW applies here and that you might need to stop reverting against three independent editors. JFW | T@lk 08:11, 10 August 2008 (UTC)

Several points. First, there have been no consensus on MEDRS on this point, just more loud editors prevailing. Second, MEDRS is far from becoming a guideline. And I do not see why we should abide by what was supposedly decided there. That page was dead for about a year, so nobody was watching it. The recent burst of activity on MEDRS is very limited and they even did not cross post here. Third, the idea that reviews are somehow better than original papers is batty. The pharmacology area, where, in addition, powerful money interests are involved only illustrates the general rule. Fourth, I am all for the editorial discretion, so why do we need this questionable clause? How does it make editing easy? Paul Gene (talk) 10:20, 10 August 2008 (UTC)

I'd like to make two points:

1. This is a style guideline. I purposely split WP:MEDRS off to a separate page: issues of style and issues of sourcing are distinct. Plus, the sourcing issues are more contentious so would have made this style guide less likely to be formally adopted. The "Citing medical sources" already has a link to WP:MEDRS at the top. Therefore, I agree with Paul that this is an unnecessary addition, but for completely different reasons.
2. WP:MEDRS has always preferred secondary sources (and did so when it was part of the draft MEDMOS, which is more than two years ago) and this is in keeping with WP's WP:V and WP:NOR policies, the latter of which says "Wikipedia articles should rely on reliable, published secondary sources." I don't really understand Paul's argument that the industry sponsored secondary sources are betterworse than the (industry sponsored) primary sources. Find some independent sources, then! They'll likely be secondary sources.

If other folk want this statement, as a précis of MEDRS, then I'm happy to include it, as it most certainly does have wide WP consensus behind it. Indeed, if MEDRS said to prefer primary sources, then it would be in opposition to policy and be most certainly rejected by the community. Colin°^Talk 11:07, 10 August 2008 (UTC)

Leevanjackson made a very useful contribution. The paragraph before his addition simply stated that sources were important because some medical topics are controversial. This statement begs the question on what kind of sources is then the most useful. The answer is: find the best secondary source you can find. Links to WP:PSTS and WP:MEDRS are entirely appropriate here.

To answer your specific points:

1. In MEDRS, not only the loudest but also the most experienced contributions (including someone very involved in the featured articles process) have prevailed. If you have a problem with MEDRS, your arena is there and not here.
2. MEDRS was resuscitated because many felt a need for a clear set of rules that could be applied across medicine-related articles. It still attracts edits, and there is quite a lot of support for it becoming an official guideline (see talk page discussions 5-6 August). It was featured in the Signpost. What else do you want?
3. I have taken your point on board about some areas of medicine having reviews that are sometimes biased. That does not invalidate the general rule that primary studies typically provide insufficient context to be useful sources on their own.
4. As I said, there is an element of editorial judgement in the selection of secondary sources. But secondary sources are simply mandatory, as your interpretation of the primary sources might be just as biased from your own perspective. JFW | T@lk 11:17, 10 August 2008 (UTC)

• Here are some quotes from MEDRS discussion showing that there have been no consensus: Paul Gene (talk) 11:29, 10 August 2008 (UTC)

Quoted discussion from MEDRS

WP:MEDRS seems to be at odds with WP:MEDMOS; MEDMOS encourages the use of PubMed references, MEDRS implicitly discourages them. WP:MEDRS states:

In general, Wikipedia's medical articles should use published reliable secondary sources whenever possible. Reliable primary sources may be used only with great care, because it's easy to misuse them. For that reason, edits that rely on primary sources should only make descriptive claims that can be checked by anyone without specialist knowledge. Any interpretation of primary source material requires a secondary source.

In my opinion:

The above (in WP:MEDRS) should be further qualified. Primary sources, IMHO, are accessible to an interested layperson, with the vast amount of credible medical information (e.g. Merck Manual, eMedicine, Medlineplus.org, |Canadian Health Network) out there and the strong base of Wikipedia articles that cover topics in medicine and experimental physiology. Primary sources should be the key references-- secondary sources should be considered supplemental. Primary sources should be explained -- like any good secondary source for the lay public. Good secondary sources base their info from primary sources. I think Wikipedia has enough people with expertise to deliver nuanced interpretations of primary sources that can compete handily with respected secondary sources. Use of secondary sources from PubMed (i.e. review articles) should be encouraged. [...] Nephron T|C 06:12, 24 June 2007 (UTC)

I wonder whether that's an old policy which is now outdated as the 'pedia continues to grow in depth. I don't worry about it myself and often use primary sources as do many others. Have a look at alot of FA nominees.cheers, Casliber (talk · contribs) 06:17, 24 June 2007 (UTC) It seems like a non-sensical sentiment to dismiss pubmed indexed articles as preferred sources. I agree, however, that people who are unfamiliar with some areas will use refs. out of context to prove this or that. The expertise of editors in some of these specialty areas helps to filter the wheat from chafe. Secondary sources like standard medical textbooks, positions of health ministries (eg. FDA, health Canada) etc. can be used to bring contextDroliver 15:37, 24 June 2007 (UTC)

[...]I don't think we should deprecate primary sources (since they're so vital to explaining any medical topic), but I do think we should insist on something along the lines of, "The use of primary sources (e.g. journal articles) is encouraged on medical topics, but interpretations of these sources should hew carefully to that presented by the authors or by reliable secondary sources such as review articles and medical textbooks." This might discourage the inevitable idiosyncratic usage of primary sources while still encouraging their general inclusion. Thoughts? MastCell Talk 15:54, 24 June 2007 (UTC)

[...]The question is: is a reviewer necessarily more credible to comment on the prior science than a researcher discussing a primary study, all else equal? I don't think so -- although there may be a small bias, I don't think the reviewer should be considered immune to these biases. Now, systematic reviews help to eliminate bias by forcing the reviewer to be precise and evaluate all studies -- but these are uncommon, and still susceptible to bias. In summary, more importance should probably be placed on the date of the publication and the comprehensiveness with which it approaches a topic. Very broad reviews are likely to miss important details which specialized papers will discuss. ImpIn | (t - c) 06:44, 28 June 2008 (UTC)

[...]How do you judge what's a quality review? This review is published by the BMJ, but it does not seem high-quality. It is so broad that it offers little, if any, analysis or explanation for why it selected the studies it did. You seem to have this obsession with being mentioned in a review -- but if that review does not explain why it selected the studies it did, it should not be taken as bestowing more credibility on that particular study. The selective citation and discussion of primary studies is an asset when you're trying to report on scientific analysis. II | (t - c) 01:43, 30 June 2008 (UTC)

[...]What makes a review better at evaluating than a primary article? It's the extent of the evaluation and similar studies which matters, not the "review", which whether it is mentioned in a review, which is just a label.[...]I don't agree with the general censorship attitude which is spreading across Wikipedia. MEDRS says that primary studies have less weight; quite right. But several primary studies have more weight, whether they're mentioned in reviews or not. And even only 1 study on a particular subject doesn't mean it shouldn't be included in the article -- nor does MEDRS say that, although people persist in trying to say that such a position is necessary.[..]As far as pushing a point, most reviews are published by people who have published primary articles, hopefully several. Thus they are not immune from bias. II | (t - c)

[...]There is nothing in MEDRS which says you cannot cite primary studies, especially remarkable ones like these. You're actually pushing for a policy which does not exist. The current policy even says that popular press articles can sometimes be cited, and here you're fighting tooth and tail against the addition of remarkable primary studies.

Note: I stand by my censorship comment; whether the censorship is intentional or not, it amounts to censorship. In case you haven't noticed, I'm not at Wikipedia to win popularity contests. You're appealing to your own fictitious policy to keep interesting, encyclopedia worthy-content out of the encyclopedia. Further, this impels other people to do the same, and allows people to justify censorship (recent example). Wikipedia is not conservativopedia; if Einstein had published his paper on Relativity today, we would not want to "wait until it is verified" to note it. There's no reason for that position. There's no rule that a study has to be replicated "or noted in a high-quality review" before it gets noted on Wikipedia. Sure, reviews get greater weight, but when they aren't available, individual studies are citable. Somehow MEDRS even allows for popular press and press releases, as well. II | (t - c) 14:26, 30 June 2008 (UTC)

[...]We should absolutely cite relevant primary studies, but they should not fundamentally drive coverage, particularly of controversial issues.[...] MastCell Talk 19:13, 1 July 2008 (UTC)

[...]I don't understand how/why the introduction/discussion sections of primary articles are categorically "much less reliable" than reviews. In general, what I've read lately suggests the exact opposite. Categorical statements to this effect are misleading. Now, we can all point to examples. I can show you 3-4 poor review articles right now, out of the 5-6 that I've read lately. Many reviews, unfortunately, seem to describe primary articles briefly rather than analyzing them. The reality is that reliability is, as it should be, more connected to the author than the type of publication. This can be assessed by looking at how many papers the author has published on the topic. "Review", "primary article" -- these are simply labels.[...]In general, you may have a better chance of hearing from the real experts, and hearing their in-depth analysis, in the discussion sections of their papers. The subpar "experts" may be more likely to publish reviews than to do "primary research". And these reviews cover such a wide range that often they just describe them in simple sentences, which offers no value over the article's own abstract. II | (t - c) 04:30, 2 July 2008 (UTC)

[...]Thing is: people look to here, and can stonewall you with a few curt words like "look at MEDRS, primary articles are significantly worse, can't do it". In fact, when I tried to put in the above article, SandyGeorgia objected that we need to use reviews.[...]I'd like to hear your reasoning for why we should generally place more weight on the label "review" vrs "primary article" rather than the article's author and content (does it cite lots of sources? does it rigorously analyze those sources? is it understandable by a non-expert?). So far there's been no evidence provided for this general assertion. II | (t - c) 05:28, 2 July 2008 (UTC)

[...]Specifically, I have provided a counterexample to the claim that reviews are more reliable (Hauser is not only a published expert on HRQOL, but his primary paper cites more sources). I can produce many, many more examples if necessary, although my library is fairly weak, and it would take time. Further, I have provided reasoning for why primary articles are often superior: the real experts are publishing primary papers rather than reviews, and these primary papers, since they specifically focus on a single issue, often cite more literature on that topic with more rigorous analysis of the validity of the research. You're operating on assumptions. Please provide evidence (or at least reasoning) for your claim that primary articles are less reliable than reviews. II | (t - c) 06:08, 2 July 2008 (UTC)

[...]I suggested to Eubulides that he look at what the academic community says about reviews. I've found some studies. PMID 1834807 (1991) discusses a system used to rate reviews. This could be of significant use for us, as we need to evaluate reviews. It would be interesting to see where this has gone. Related links in PubMed has a vast amount of related articles. PMID 9496383 (1997) finds that most reviews are hardly systematic (this is a bad thing). PMID 10610646 (1999 - free access) finds the same thing. PMID 17606172 (2007) focuses on meta-analysis, but finds improvement. PMID 16277721 (2005) says meta-analyses are generally poor. PMC 1602036 (2006) evaluates Cochrane reviews vrs industry reviews -- obviously, industry reviews are worse. PMID 9092319 (1997) is a guide for finding systematic reviews. PMC 2379630 (1993) specifically compares OR and reviews. It notes that the answers provided by broad reviews should not be accepted uncritically as valid. Conclusion: Certainly, as my original edit to MEDRS reflects, reviews should generally get priority over primary articles -- but people need to recognize the difference in reviews. Most reviews I've seen are not systematic. Here is an example of an overly broad review. These reviews are less reliable than OR in many cases, since they are often both written by an outsider and give cursory attention to many complex issues. Eubulides has argued that systematic reviews should not get priority; this is directly contradicted by the scientists, and does not make good sense.[...] II | (t - c) 10:08, 2 July 2008 (UTC)

I could go either way on this. Just because something is labeled a "review" doesn't mean that it's really a review, much less than it's a good one. I've seen case studies with a sample size of one labeled as reviews. (I know: several of you are horrified. But it does happen.) I'm also not convinced that when Joe Smith, PhD, writes his "review", that it's materially different from the summary that Joe Smith, PhD, put in his ground-breaking, world-changing paper last month. I think that a substantial level of editor judgment is required here. WhatamIdoing (talk) 06:23, 10 July 2008 (UTC)

Generally good (groaning because I got the opposite advice years ago and replaced a lot of review sources with primary sources on Tourette syndrome, and now I'm going to have to spend hours checking and undoing some sources, and often, the review papers are inferior). But ... when a primary research paper is replicated and cited over and over again in every review and is seminal research in the field, and we don't want to lose that source, is it ok to occasionally cite both? In the case of TS, for example, PMID 9651407 is primary research, we have free, full text linked, and it is seminal in the field and widely cited in every important review (there are other examples). I hate to lose the free, full text link in the article. SandyGeorgia (Talk) 20:20, 10 July 2008 (UTC)

I have some significant concerns about this, perhaps mostly because of the way "rules of thumb" turn into sweeping, iron-clad requirements after a few months, and perhaps because I get the feeling that none of you have any connections to people who write reviews and therefore put too much faith in them. Sure, if you're only working on articles about congestive heart failure and colon cancer and other common conditions, then the concepts here make a great starting point. However, this isn't going to work at all for very rare diseases, where a well-written case study from twenty years ago may actually be your most reliable source. Consider ODDD. I know: you've never heard of it. But go search for oculodentodigital at pubmed.gov, and limit your search to the last five years. You'll get thirty-five (35) papers. The only "review" on the disease in the last five years (as opposed to the genetics and physiology that underlie the disease) is actually a case study involving three patients. It's dated 2004. I don't expect a better review to appear in 2009, or even by 2014. My expectation is based on the fact that there have apparently never been any proper reviews published for this condition. And what is the first thing the editor reads here? "Do not cite primary sources" -- the only sources that exist for this disease.

This also isn't going to work well for many aspects of uncommon diseases. For example: consider some third-string treatment for an uncommon cancer. You've got a twenty-year old paper that gives you a success rate. It's the only randomized controlled study ever done using the specific treatment in this specific cancer. The recent review cites this paper and summarizes the conclusions in two words: "poor prognosis." According to this, the actual survival rate is suddenly not important, because the study was done before the review, and the review doesn't re-report the actual numbers. Is that what you really want? To put an expiration date on data?

I also think that citing any study that is mentioned favorably in recent reviews should be acceptable. For one thing, we get more detailed articles that way. For another, if the original article is retracted, then we know what we need to change. A review that cites Hwang Woo-Suk favorably is not going to be retracted just because the world later discovered that this Korean scientist fabricated much of his stem cell research.

As ImpIn points out, this scheme works poorly in cases where the recent reviews only cover certain aspects of a disease. I frequently see very good reviews in terms of treatment, and that also completely neglect epidemiology. It's hard to find epidemiological information for less developed countries. Sometimes the best we can do is a rather old paper. The fact that an American or European author skips over the prevalence of a disease in Africa or South Asia doesn't mean that this kind of information unimportant for our worldwide encyclopedia: it means that the review is incomplete. In very common diseases, nearly all of the reviews are deliberately incomplete: you'd write a review on a specific aspect or sub-type of hypertension, because otherwise your review would be the length of a book. I won't say that the authors are necessarily biased because of this -- but reviews cannot be assumed to be complete.

Finally, this advice is completely wrong for history sections, for what ought to be perfectly obvious reasons.

Yes, I know: you only meant this to apply to certain "actively-researched areas with hundreds of primary sources and dozens of reviews". But it's not actually that obvious to those who don't already know what you intended to accomplish. The first thing the editor reads is "Do not cite primary sources." As written, I don't think that this communicates what I think you want to say.

I don't mind stating a general preference for recent reviews, although I still prize editor judgement and a good final product over mindless compliance with rules. I could probably support a system of rules like this if it were clearly stated that this guidance only applies to the sections of an article that deal with current practice in diseases where proper reviews are readily available. I might also add that primary papers aren't bad in themselves, so long as they don't actively contradict all of the recent reviews. Fundamentally, I think that if we're going to publish this, then the caveats and restrictions need to go first, not last, and they need to be stated more strongly than the guidance. For example, "Do not cite primary sources..." should be "Consider citing a recent, comprehensive review in a reputable journal instead of older primary sources." The section might begin with the sentence about this advice only applying to articles on actively-researched areas with hundreds of primary sources and dozens of reviews, although the general principles might be applicable in some less common diseases. WhatamIdoing (talk) 02:52, 11 July 2008 (UTC)

Colin: I have the unpopular habit of citing many primary sources, and I really don't see why you would cite a review if you mention a study from 1999. That's very confusing for readers.The reason I mix reviews with a lot of primary sources is because is usually start writing with 2 to 3 review articles or books, UpToDate etc, and for most specific statements (especially high quality evidence, e.g. RCT or meta-analysis in high-ranking journal) I cite the same primary sources as the review cites. This might be "wrong" but I myself would prefer to read an article which cites a lot of primary high-quality evidence rather than a handful of reviews. --Steven Fruitsmaak (Reply) 12:31, 11 July 2008 (UTC)

Please, Paul, let's move this discussion where it belongs: over to WT:MEDRS. Colin°^Talk 12:21, 10 August 2008 (UTC)

Paul asked me to comment on this discussion. I suspect that he expects me to support his view. He loses that bet.

I support the rule as stated in MEDRS. My concerns (carefully selected parts of which are quoted above) have been adequately addressed.

I have no objection to the MEDRS version of WP:PRIMARY being briefly summarized here with a link to MEDRS. I saw and approved of the addition to this page when it was made. Since there is only one (1) editor who objects to this, and many that support it, I have restored the addition.

While this was the obvious page to start this discussion, I also second Colin's suggestion that anyone who wants to discuss MEDRS rules should continue the discussion on MEDRS's talk page -- or even at WP:No original research, because that's where this rule *really* lives. WhatamIdoing (talk) 17:57, 10 August 2008 (UTC)

I've pointed out several times that primary articles are undeniably secondary sources for much of their information, but it just doesn't seem to stick. It is better to call them "original articles" to avoid stating a falsity. There is a discussion ongoing at WT:OR that even the primary research in original articles can be called secondary, because the real primary source in these cases is the data. Reviews are good, but I agree with WhatamIdoing that we need to make the caveats clear from the start, so we don't confuse people into thinking that reviews are categorically better than original articles. I also think we should promote analysis of reviews through some of guidelines used by researchers themselves. Overly broad reviews are not great sources, and reviews which seem to cherrypick from the literature from the literature are even worse. I ran into this over at Alzheimer's disease, where there was a great 2007 review of the aluminium connection from the Journal of Alzheimer's, which looked at 20 epidemiological studies, 15 of them positive, and concluded that there is a clear role. It was contradicted by an extremely broad 2007 review from Occupational Health which stacked 3 aluminium studies, all negative, on top of its analysis of electromagnetic fields, solvents, and everything else. There's also a problem of some reviews not adding much value to original articles, just citing them. In that case, I'd prefer to cite the original article, and I think there are a lot of people that agree with me. Citing both may be good as well. II | (t - c) 19:13, 10 August 2008 (UTC)

We are aware of your position, ImperfectlyInformed. Could you now please go discuss this on WP:MEDRS? With regards to your aluminium example: how often do I need to repeat that editorial judgement is needed in selecting reviews, and that in your case both reviews should be cited? JFW | T@lk 19:39, 10 August 2008 (UTC)

JFD, it was you who brought this debate to MEDMOS. Moreover, when in violation of the guidelines you made this addition, you stated that a consensus has been formed about reviews being better that the original research papers. Now you assert that you are aware of II's position, so you are aware that there is no consensus. Perhaps, you should revert yourself. Paul Gene (talk) 20:11, 10 August 2008 (UTC)

WhatamIdoing, my bet was that you would present a reasonable argument whether pro- or contra- the addition. I lost it. I would gladly discuss the problems of primary vs secondary sources at MEDRS, but the problem was that the addition was made to this page. I do not see the reason why this a page (an established, years-old guideline) should abide by the decisions made at MEDRS page, which is essentially an essay, and which was all but dead until a month ago. Paul Gene (talk) 20:24, 10 August 2008 (UTC)

Eh? It was Leevanjackson who added the précis of MEDRS, not JFD. Also, nothing that II says disagrees with:

Where possible, it is preferable to reference review articles or other secondary or tertiary sources instead of primary sources

Note the "or other secondary...sources", which includes the "background" section of a primary research article (even though there have been well-argued points made that such sections aren't first-choice secondary material). I've actually just noticed the "or tertiary sources" bit, which isn't actually what WP:MEDRS says. I'd recommend that clause is dropped as tertiary sources (while permissible) are not encouraged on WP. Colin°^Talk 20:32, 10 August 2008 (UTC)

JFW returned it so he supports guidelines violation. I actually think that full paragraph in MEDRS sounds better than what leevan posted here. Your note brings back my point that he should have posted the addition here before changing the MEDMOS guideline. I also voted against giving WP:MEDRS guideline status - it is too raw Paul Gene (talk) 20:47, 10 August 2008 (UTC)

I was the third editor to support the addition, after Leevanjackson and Stevenfruitsmaak. Do pay attention. It's just that I have perhaps been more vocal in opposing your stance here. I have justified why we need guidance on sources here, and on MEDRS you are the first editor to oppose its approval as an official guideline. And that because you think a small proportion of secondary sources in your field of interest might be biased. It would be useful if you could try to see the bigger picture. JFW | T@lk 21:30, 10 August 2008 (UTC)

Sorry guys, didn't think it would cause an argument quoting from one of the main style guides! I read this style guide a while ago and happily edited away finding primary refs, but when an article came to GA review the point was raised that it did not use enough secondary refs, so had to trawl through all the old edits and refs finding better reviews - a few turned up better facts and made it clear that the occasional primary source, taken out of context with other research, can be very misleading... I changed the wording to be 'where possible' to reflect the projects preference - maybe I should have added 'and appropriate' too. The intention was to lead editors, reading to this level of the guide, in the rough general direction, to save them the time I wasted :( The arguments should really be raised in the broader guidelines, since they'd have to be accepted there to be applicable at all, wouldn't they? Also I'd like to edit out the 'or tertiary' since it is wrong but am afraid to cause further bother! peace LeeVJ (talk) 22:37, 10 August 2008 (UTC)

I don't really mind saying that reviews are preferable, and I agree with Colin that tertiary should be dropped from it. II | (t - c) 23:08, 10 August 2008 (UTC)

For the record, I am perfectly fine with the addition. This seems to be de facto practice for many editors, and certainly is for me; I always try to use high-level evidence from recent (secondary) sources when building content, and fall back on primary sources when secondary ones are scarce or could be less informative than primary ones (for historical information, etc.). MEDMOS is a guideline, and, as such, does not trump common sense :) Fvasconcellos (t·c) 00:10, 11 August 2008 (UTC)

Paul gene left a post on my talk page and asked me to comment. I share Paul's concern about the influence of industry on the medical literature. That stated, I think reviews are better because they more often reflect consensus.

There are a lot of papers that are on the margins and lay people, if selectively reading and referencing, may totally get the wrong impression (if reading just the primary literature). The best example of this, IMHO, is Bjorn Lomborg's book The Skeptical Environmentalist. Another example is the role of vaccination in autism-- I personally think it is hooey to be frank, but there are a few papers that show the association (which is temporal) and suggest causality.

Stated differently, if one picks and chooses from the primary literature one can draw erroneous conclusions. Scientists and medical doctors don't have a perfect batting average-- some studies have problems. Reviews and meta-analyses examine the primary literature, look for consensus and attempt to get an overview. In the context of Wikipedia, reviews are the most appropriate choice. If only one reference is added-- a review is better than the primary literature. Personally, I think there is a place for primary sources but it should be limited (e.g. large studies -- Framingham Heart Study, Women's Health Initiative, Randomized Aldactone Evaluation Study (RALES), articles in leading journals with disclosure rules that have not faced severe criticism like PMID 11172175 --which the The National Inquirer used to poke at Bill Clinton post-CABG).

Personally, I don't always cite review articles-- but this is not on principle. I like to cite open access work-- something I worked on getting into citing sources‎[1] --with agreement of a majority... but was reverted many times[2] by someone that spends more time on WP than I do. Often, it is convenience-- I find primary articles that say what I read elsewhere (in a book I have)... so, I use 'em. Nephron  T|C 03:24, 11 August 2008 (UTC)

• Guys, thank you for commenting on this issue. I see that I was wrong about there being no consensus on the secondary sources. Your comments also dispel the personal attacks by JFW who suggested on my Talk page that I was somehow trying to stack the voting. I think apologies are in order. Additionally, we see here that most of the editors are opposed to the inclusion of tertiary sources. That proves my main point that all edits to guidelines must be first discussed on the Talk page. Without such discussions, boldly ignorant text of poor editorial quality gets included into the guidelines. Please, let's respect the work of many editors who put these guidelines together and avoid such edits. Thank you Paul Gene (talk) 11:04, 12 August 2008 (UTC)

Tertiary sources have their place, and we aren't rejecting them -- just not encouraging them. A medical dictionary is a tertiary source and also an excellent source for the definition of a medical term. WhatamIdoing (talk) 18:44, 12 August 2008 (UTC)

I was voicing what I thought were legitimate concerns. That is not a personal attack, and consequently no apologies will be extended. JFW | T@lk 22:10, 12 August 2008 (UTC)

Sorry, but I do require an apology though... Please direct personal comments on my editing to my talk page. In response : I am respectful of editors, you're ALL fantastic ! :), but sometimes what seems an obvious and uncontroversial edit may be considered contentious by specialists, and I believe being WP:BOLD prevents stagnation and can always be reverted anyway, so I won't stop:- but I will try to be more careful in future ;) LeeVJ (talk) 23:51, 12 August 2008 (UTC)

Other than the recent addition of tertiary sources, the page seems fine now. SandyGeorgia (Talk) 15:25, 13 August 2008 (UTC)

oopsie, backwards, tertiary is gone now, good; we may occasionally use them, but not optimal. SandyGeorgia (Talk) 15:27, 13 August 2008 (UTC)

Sections for birth control articles

I have proposed a standardized section order for birth control articles (like currently exist for diseases and drugs) at Wikipedia talk:WikiProject Medicine/Reproductive medicine task force#Section order and naming in contraception articles. I hope that such a standard would also be useful for some medical devices or tests, but even restricted to the contraception articles consistent formatting should improve our quality and readability. It is just a proposal at this point and I'm not attached to any particular order; any comments would be welcome. Lyrl^Talk _C 01:12, 11 August 2008 (UTC)

Paul gene

Paul gene (talk · contribs) has now come along and expanded on the summary of WP:MEDRS. I think the additions completely misrepresent previous consensus at MEDRS:

• Previous-work sections in primary papers are useful as secondary sources
• Editorial judgement should be used to choose between primary and secondary sources.

Paul's problem is that he doesn't trust secondary sources, because they might be biased. But I think consensus at MEDRS has been that neither of the above points apply. "Previous work" sections tend to be fairly focused on one particular aspect of a disease or phenomenon, and very often do not discuss problems with previous studies in sufficient detail.

What I have previously tried to explain is that there is really no alternative for secondary sources. They are crucial. Sometimes it is acceptable (or even necessary) to cite primary studies, but always with a supportive secondary source that confirms the relevance of the primary study. If there are several secondary sources, it is up to the editor to apply editorial judgement in deciding which one is more suitable (i.e. less likely to be biased). JFW | T@lk 00:53, 15 August 2008 (UTC)

Agreed. SandyGeorgia (Talk) 01:03, 15 August 2008 (UTC)

After your colon, you have two bullet points. Are you saying those bullet points are the consensus at MEDRS, or that Paul is misrepresenting them as the consensus? Because I think the former is true, but the latter is not. The diff. Paul is simply stating what is stated on MEDRS: previous work sections are secondary sources (primary articles can have a lot of secondary information), and editorial judgment is necessary. That's what his change is. If you're opposed to that, then why did you allow it to be added to the MEDRS article? Primary articles are secondary sources for lots of information. That is indisputable. The question is whether they are good secondary sources, and I think that in many cases they are. As I've showed, and in my limited (and perhaps Paul's more broad experience), previous work sections often go into more detail than a review on the previous studies, and their flaws. When you're studying something specific, you will naturally discuss the specific relationships with previous studies and their findings. In reviews, you're more likely to skip the fine details. I support Paul's change. II | (t - c) 01:05, 15 August 2008 (UTC)

I knew you would support Paul, and I think it goes without saying that my bullet points summarised Paul's stance rather than MEDRS. I think there are two issues: does Paul's edit reflect consensus, and should MEDRS contain these points. I think the answer to both questions is "no". I continue to oppose your position on using "previous work sections" as secondary sources. They are secondary sources, but bad ones. They may contain lots of information, but much of the time the actual context will only be supplied by a review that is written with the intent of being a review. With regards to the fine details, since when do we need to include fine details on Wikipedia? JFW | T@lk 01:46, 15 August 2008 (UTC)

The two caveats I inserted are important, and they are necessary to include here insofar as the secondary vs. primary guidelines prescription is included.

• First, the definition of the secondary sources adopted at MEDRS includes the previous work sections of the research papers. This definition, which differs from the definition at WP:NOR, was instrumental in achieving the consensus at MEDRS and it does represent the consensus at MEDRS. Thus is must be presented here and a simple reference to WP:NOR would not suffice.
• Second, there are many exceptions to the "secondary sources are preferred" rule. Thus, in the process of adoption of this rule, through several discussions, many editors at MEDRS insisted that editorial judgment is essential. I believe that the importance of the editorial judgment should be made explicit. This will help the less experienced editors and will also prevent some of the editors from blindly following this rule and thus creating problems for others. The text of the caveat - "Deciding whether primary or secondary sources are more suitable on any given occasion is a matter of common sense and good editorial judgment, and should be discussed on article talk pages." - is taken verbatim from WP:NOR. It represents wide consensus of the WP editors; moreover, it was placed at WP:NOR following the same reasoning as I am presenting here. Paul Gene (talk) 01:35, 15 August 2008 (UTC)

MEDRS goes further than NOR, and for good reasons too. Because abuse of sources is the hallmark of pseudoscientists, and setting strict standards is a very useful tool in keeping them at bay. You must symphathise with that. There is not a single word on the WP:MEDRS page that supports the use of "previous work" sections. There is also no consensus for such a statement; I am really curious where you have found this consensus you are referring to.

I stated that editorial judgement is applied only when choosing secondary sources. Again, MEDRS goes further than NOR here and for the good reason that it is not too difficult to twist a primary source to your advantage if you're a crank. So I take your points about NOR but I submit that MEDRS is stricter for reasons I have stated. Incidentally, MEDRS presently has the scope to deal with the kind of sources you don't like (reviews written by drug company pawns). JFW | T@lk 01:46, 15 August 2008 (UTC)

Type CTRL-F on the MEDRS page, and then type previous work. This was discussed and nobody raised a fuss. There are many, many cases in which the only reviews available are shoddy or out of date. Also, the fine details are very important. The "devil is in the details" is an apt cliche. Also, how does MEDRS have that scope? II | (t - c) 01:56, 15 August 2008 (UTC)

Don't be so obvious please. The page states unequivocally that "previous work" sections are regarded as less reliable. I'm not keen to have the same discussion with you again and again, because it is really too straightforward for words. MEDRS most certainly has the scope it has because it carries wide support (apart from Paul, because the discussion happened when he wasn't watching). JFW | T@lk 02:06, 15 August 2008 (UTC)

What do you mean by so obvious? II | (t - c) 02:10, 15 August 2008 (UTC)

You are presenting the use of "previous work" sections as uncontroversial and supported by MEDRS, while the guideline itself actually says pretty much the opposite. That's what I mean by "so obvious". JFW | T@lk 02:15, 15 August 2008 (UTC)

The change under discussion would give license to all-too-common abuses in medical articles, and should be rejected for that reason. Also, as a matter of procedure, this was a controversial change made without discussion on the talk page; that's not the right way to go about things here. Eubulides (talk) 02:12, 15 August 2008 (UTC)

Eubulides, I wonder where you were when I tried to revert a controversial change made without discussion on the talk page. Paul Gene (talk) 10:13, 15 August 2008 (UTC)

This conversation is no longer about MEDMOS. This conversation is about Paul Gene's dislike of the MEDRS guidance. This conversation should therefore be continued at WT:MEDRS instead of here. WhatamIdoing (talk) 17:58, 15 August 2008 (UTC)

Fully agree with WhatamIdoing. Paul, you do yourself no favours by lecturing us on "discussion prior to editing of guidelines" and then breaking this rule. And removing text ("instead of primary sources") while calling the edit "necessary additions" isn't fair play. Colin°^Talk 19:44, 15 August 2008 (UTC)

WP:NOR vs. WP:MEDRS

I understand that JFW disagrees with WP:NOR. He disagrees with the definition of secondary sources given by WP:NOR. He disagrees with the sentence "Deciding whether primary or secondary sources are more suitable on any given occasion is a matter of common sense and good editorial judgment, and should be discussed on article talk pages." As a matter of procedure WP:NOR is a Wikipedia policy and thus trumps the essays like WP:MEDRS. WP:NOR represents much wider consensus than the "consensus" of several editors grouped around WP:MEDRS. But of course you are going to boldly ignore the policies when it is convenient for you. Paul Gene (talk) 10:25, 15 August 2008 (UTC)

MEDRS is a guideline that is in the process of approval. It elects to be stricter than NOR, for good reasons. That's what I said above, and I'm repeating it here to refresh your memory. That is not "boldly ignoring policies", that is setting standards. I'm surprised you are singling me out, but that's probably because I have been more forceful than others. JFW | T@lk 13:10, 15 August 2008 (UTC)

And experience in the field is part of good editorial judgment. It would not surprise me if, in general, selective use of primary sources were a more serious problem in some fields than in others; those fields should be more cautious. Septentrionalis PMAnderson 15:25, 15 August 2008 (UTC)

I'd like to know why this discussion about content keeps happening at the style guideline talk page. N.B.:

• We do not change MEDRS through a discussion at MEDMOS.
• Style guidelines are secondary to content guidelines. Wikipedia is not best served by having its style guidelines contradict its content guidelines.

I conclude that anyone who wants to actually change the guidance about medical sources will promptly take his concerns to MEDRS and leave this page alone.

The only question that really needs discussing here is whether this style guideline accurately reflects the minimum amount of text (not "my personal view of what the consensus might be") at MEDRS necessary for a newbie editor to have half a chance at getting things right. I'd say that the current, very minimal text is about right. WhatamIdoing (talk) 17:57, 15 August 2008 (UTC)

Again, I agree with WhatamIdoing that this minimal amount of text is a reasonable "nutshell" of MEDRS. In fact MEDRS doesn't have a "nutshell" banner so if folk want to discuss that then you know where to go.

Can we please, please move sourcing discussions to the relevant talk page. Perhaps this page is being used as it is a guideline and the other isn't (yet). I am most perplexed about this perceived need to contaminate this guideline page or, indeed, to suggest that MEDMOS/MEDRS are in conflict with WP:NOR. Two sentences from WP:NOR actually summarise MEDRS nicely:

Wikipedia articles should rely on reliable, published secondary sources. [full stop!] … Primary sources that have been published by a reliable source may be used in Wikipedia, but only with care, because it is easy to misuse them.

I disagree with JFW (in a good way) that "MEDRS goes further than NOR"; it simply helps one apply the above advice. Colin°^Talk 19:56, 15 August 2008 (UTC)

The pathogen vs. the disease

We really need to make a decision here. How do we separate the article about the pathogen from the article about the disease? It happens time and again, and we have discussed it here without resolution. But if we're really going to clean up articles, we need to firm up the policy. I'm working on Heliobacter pylori, the bacteria, some have theorized, that might be responsible for gastric ulcers (I'm not going to argue one way or the other about it). So, is the article about the bacterium? Or is it about gastric ulcers? If it's about a pathogenic bacteria, how do we follow MEDMOS, or do we follow some microbiology MOS (if there is one). Do we merge the gastric ulcer article to H. pylori? If this were the only problem, maybe we could figure it out. But honestly, do we need a chickenpox and Varicella zoster virus article? We merged shingles to Herpes zoster. But honestly, the two zosters are the same virus with two different manifestations. So they are same virus causing the same disease. H. pylori causes only one disease, but gastric ulcers may have multiple causes. I'm going to reorganize H. pylori to fit MEDMOS, but I'm not sure that makes complete sense.

We need advice here. And let's make a decision, not discuss endlessly, then the everyone moves on to another issues, and this lays fallow. OrangeMarlin ^{Talk• Contributions} 20:06, 30 August 2008 (UTC)

So, in the first step of cleaning up the article to maintain its FA status, I have to determine if "Classification" means taxonomic or disease. And the system falls apart. OrangeMarlin ^{Talk• Contributions} 20:09, 30 August 2008 (UTC)

And I just looked up Poliomyelitis, which was just promoted to FA vs. poliovirus, which isn't FA. No help there. OrangeMarlin ^{Talk• Contributions} 20:14, 30 August 2008 (UTC)

And now, Influenza vs. Orthomyxoviridae. So I'm guessing we have a policy, which helps with the article. OrangeMarlin ^{Talk• Contributions} 20:17, 30 August 2008 (UTC)

In general, I favor keeping disease articles separate from microorganism articles. If they are both quite small, then a merge might be acceptable, but there are so many non-overlapping things to say about each that in general I think separate is better.

I don't think you should reorg H. pylori to fit MEDMOS. I think you should make it fit the (limited) suggestions at Wikipedia:WikiProject Prokaryotes and protists, and parallel Escherichia coli. The possibly relevant sections there, BTW, are:

1. Strains
2. Biology and biochemistry
3. Normal role
4. Role in disease
5. Laboratory diagnosis
6. Antibiotic therapy and resistance
7. Vaccination
8. Role in biotechnology
9. Model organism

It might be relevant to add things like veterinary connections or routes of transmission. Would it be helpful to create such a list here? I haven't found anything similar at any of the relevant projects. We could invite them to help us create such a list. WhatamIdoing (talk) 01:40, 31 August 2008 (UTC)

I agree with WhatamIdoing -- the pathogen and the disease should be kept separate. A disease may involve multiple pathogens, and a pathogen may cause multiple diseases. Merging them together is not a sustainable solution. --Arcadian (talk) 03:14, 31 August 2008 (UTC)

GrahamColm and I struggled with this issue on Rotavirus, which is an article about the virus and the disease it causes. I even produced a draft version of a split into two articles: one virus, one disease. It worked but so does the combined one, which Graham preferred. I think often the split works best as WP likes to classify things and stick info boxes on them. I don't think the chicken pox articles would be improved by a merge. Unless there's a specific name for the ulcers/cancer caused solely by Heliobacter pylori, your stuck with describing those within the article. So I don't think there's a hard rule. Colin°^Talk 09:17, 31 August 2008 (UTC)

If a pathogen is only known for causing one disease, and that disease is only caused by that pathogen (e.g. measles/measles virus) then that's fine; only size restriction is then a determinant. Any other combination necessitates separate articles, with the "pathogen" article containing brief but relevant content about the disease and vice versa, with copious cross-references using the {{main}} template. JFW | T@lk 11:29, 31 August 2008 (UTC)

I'm bringing this up a month later now. So, is there any way to merge HIV and AIDS, since the disease and the pathogen are inextricably linked. HIV just causes AIDS, and AIDS is just caused by HIV. OrangeMarlin ^{Talk• Contributions} 15:57, 4 October 2008 (UTC)

I don't think that would be a good idea. Even in such a case, an article on the pathogen could elaborate on molecular biology etc, which would inevitably be split from a growing disease article. --Steven Fruitsmaak (Reply) 16:12, 4 October 2008 (UTC)

I'd settle for the content being somewhat more rationalized between those two articles. I've never understood why prevention of HIV transmission is primarily in AIDS instead of in HIV. Condoms do not directly prevent AIDS, but they do directly prevent HIV transmission. Leaving that aside, OM, I think those two articles are much too long to contemplate a merge. If you want to try -- {{mergefrom}} and {{mergeto}} and start the discussion over there. I'd be really, really surprised if it was approved, though. WhatamIdoing (talk) 16:46, 4 October 2008 (UTC)

Condoms are a clinical issue so they belong in AIDS: HIV should be an article on true virological issues. So I agree, it's unlikely to be approved. --Steven Fruitsmaak (Reply) 17:13, 4 October 2008 (UTC)

There is a lot of repetitiveness between the articles. And I don't agree that you could distinguish where you describe condoms. It prevents HIV transmission...it doesn't prevent AIDS. See, this can go on and on. I really think we should be rational and make a guideline on this matter. OrangeMarlin ^{Talk• Contributions} 17:34, 4 October 2008 (UTC)

But it is preventing HIV-transmission for the (sole?) purpose of preventing AIDS. I agree with SFS. It's a clinical issue and belongs on the disease article. It really has little to do with the virus itself. The virus page should focus on the virology of the virus itself - it's genetics, structure, biochemical interactions with cells etc.

I agree something very clear needs to be st-up and standardised across wikipedi. I am trying to bring together a discussion and a clear proposal for separating articles for organisim ([[WP:TOL|Tree-of-life) and the disease (Medical). Please come join the discussion and any pointers on developing a proposal (never really started one before) would be welcome. User:ZayZayEM/Proposal:Distinguish disease from infectious organisms.

Part of teh idea is to have a clear relationship between the two article sets so that it will be clearer what information belongs where, and reduce duplication.--ZayZayEM (talk) 23:16, 29 October 2008 (UTC)

I think the discussion belongs right here. --Una Smith (talk) 01:55, 30 October 2008 (UTC)

The discussion should involve TOL participants from Virus, Bacteria and Fungi projects. That si why I have moved it to an external space.--ZayZayEM (talk) 06:05, 31 October 2008 (UTC)

Sections for medical tests

I ran across ACTH stimulation test today (you are invited to join the fun: a really nice, relatively Wiki-inexperienced editor has done some good work there) and it made me think that we could use a suggested article order for medical tests. Presumably the same information should be covered in each of them. Here's my protolist, which you can change as you see fit:

1. Types (if more than one kind or variant of this test)
2. Indications (including contraindications)
3. Preparation
4. Test procedure
5. Adverse effects
6. Interpretation of results (including accuracy/specificity)
7. Mechanism (how the test works, if it's interesting)
8. Legal issues (such as whether special counseling is mandated, if any)
9. History (of the test)

As a general guide, it needs to be flexible enough to cover a handful of articles. I have considered a semi-random selection of tests from Category:Medical tests in thinking about this: Arterial blood gas, Bone mineral density, Fluid deprivation test, Pap test, Pregnancy test, and Skin allergy test in forming my suggestions and think that it probably covers them all.

What do you think? WhatamIdoing (talk) 22:11, 31 August 2008 (UTC)

I like the order, except perhaps mechanism. I reckon that should go before preparation, just like 'pathophysiology' comes before stuff like diagnosis on diseases. —Cyclonenim (talk · contribs · email) 22:19, 31 August 2008 (UTC)

Looks good, not sure, but could Indications be included in Interpretation? Agree mechanism should be earlier in listLeeVJ (talk) 22:24, 1 September 2008 (UTC)

Yep. agree interpretation should be further up the list, otherwise looks ok. Cheers, Casliber (talk · contribs) 00:33, 2 September 2008 (UTC)

Mechanism should be further up. This article worries me. Too many as-matter-of-factly: "test should always be given", "The person must fast at least 8 hours before the test", reads like a medical handbook. Wikipedia is not a Guidebook, and anything that remotely resembles one should be baleeted with predjudice. I have heard some medical grade independent wikiprojects are being attempted to try and create wiki-technology med-guides. I think procedure/administartion/preparation could be made into one section. "Interpretation of results" sections need to be very carefully worded and referenced appropriately (or avoided completely - results/what teh test is used for could be discussed in "Applications" or "diagnosistic applications" or somesuch).--ZayZayEM (talk) 06:12, 31 October 2008 (UTC)

DSM IV-TR vs ICD 10

Hey all, the former is becoming lingua franca in psychiatric diagnosis with many studies in Europe and England using it rather than ICD 10. Unfortunately I cannot find a &(%$(%^##^@%( reference to confirm this. This becomes an issue when working up conditions like borderline personality disorder and major depression for FAC, as much of the research (eg on MDD) then doesn't fit with the article parameters if we use ICD10s depressive disorders. I am proposing we amend the Wikipedia:MEDMOS#Naming_conventions to add DSM IV-TR in the realm of psychiatric disorders. Cheers, Casliber (talk · contribs) 00:52, 2 September 2008 (UTC)

Concur; in the case of Tourette syndrome, there is no reason to refer to ICD-10's frightful long title. SandyGeorgia (Talk) 01:01, 2 September 2008 (UTC)

Per PMID 16220218, "DSM-IV is the most widely used diagnostic classification system in research, whereas ICD-10 is more widely used clinically." --Arcadian (talk) 04:37, 2 September 2008 (UTC)

I don't have access to the full text, but the abstract suggests that they are referring only to Denmark. SandyGeorgia (Talk) 04:46, 2 September 2008 (UTC)

I, too, have only seen the abstract. One could argue that it applies only to Denmark, but it certainly appears to me to be intended to apply universally (at least within Europe). --Hordaland (talk) 07:07, 2 September 2008 (UTC)

It is a relatively obscure journal, so I do not have the access to it, too. From the abstract, it appears to be a value judgment on the part of authors, part of the background section. According to the newly-minted WP:MEDRS guidelines, previous work "sections are typically less reliable than reviews". The most recent study specifically concerned with the relative frequency of use for DSM and ICD (PMID 18408417) found that DSM is used about 5 times as often as ICD. Paul Gene (talk) 10:55, 2 September 2008 (UTC)

I've updated it as there seems to be solid consensus support for this. Colin°^Talk 11:10, 2 September 2008 (UTC)

Just to note, that Danish study is only summarizing the findings of a 2002 article that it cites - International surveys on the use of ICD-10 and related diagnostic systems EverSince (talk) 17:55, 2 September 2008 (UTC)

Agree with the inclusion of DSM. Another example besides borderline personality disorder and major depression, as mentioned above, is antisocial personality disorder (ICD-10's version differs and is dissocial personality disorder. —Mattisse (Talk) 19:47, 9 October 2008 (UTC)

Anatomy

Should appropriate parts of Wikipedia:WikiProject_Anatomy/Guidelines be merged into this document? WhatamIdoing (talk) 03:30, 2 September 2008 (UTC)

Yes. JFW | T@lk 23:07, 2 September 2008 (UTC)

Here are the bits that I think might be useful (note that I've copyedited a fair bit and would appreciate error correction):

Naming conventions

 Done

• Most articles on human anatomy use the international standard Terminologia Anatomica (TA), which is the American English version of the Latin. Editor judgment is needed for terms used in non-human anatomy, developmental anatomy, and other problematic terms. The online version of Dorland's Medical Dictionary at Mercksource.com has terms that conform (look for 'TA' after the word).

Sections

 Done

• Clinical relevance (for discussing diseases and other medical associations with the structure)
• Etymology
• Development (for discussing developmental biology, i.e. embryological/fetal, associated with structure)
• Comparative anatomy (for discussing non-human anatomy in articles that are predominantly human-based)

Not sure where to stick this

 Done

• • Please include the Latin (or Latinized Greek) name of the subject, as this is very helpful to interwiki users and for people working with older scientific publications.
  • Etymologies are often helpful. Features that are derived from other anatomical features (that still has shared term in it) should refer the reader to the structure that provided the term, not to the original derivation. For example, the etymology section of Deltoid tuberosity should refer the reader to the deltoid muscle, not to the definition 'delta-shaped, triangular'. The etymology in Deltoid muscle, however, should identify the Greek origin of the term.

Any other sections? Any suggestions for where to put the where-and-why of etymology? WhatamIdoing (talk) 05:31, 5 September 2008 (UTC)

"Subclinical variation"? Also, the paragraph at Wikipedia_talk:WikiProject_Anatomy/Guidelines#Paired_structures might be useful to integrate. --Arcadian (talk) 17:55, 9 September 2008 (UTC)

I've set up a "Sections" section, and incorporated these ideas into a "form and function" notion at the top. Does that seem reasonable to you? Also, I'm thinking that the etymology explanations will need to go into a section similar to ===Trivia===. WhatamIdoing (talk) 04:10, 18 September 2008 (UTC)

Summary style

I always expect WP:SUMMARY to actually say something about summarizing information. (It doesn't; WP:SUMMARY is largely about how to comply with WP:SIZE by splitting an article when it gets to be too long.) I've seen several medicine-related articles that go into all sorts of details about the study after study (all primary literature, of course). It's all "prospective observational trial with 233 participants enrolled and 218 completing the study" -- not an encyclopedia article, in other words. The current version of Wilderness diarrhea#Degree of risk is a good (bad) example.

I have been wondering whether we should address this by adding a paragraph to WP:MEDMOS#Audience. I'm not really sure how to say "You are supposed to be writing an encyclopedia here", but perhaps something that makes these points would do:

Information about clinical trials and other medical investigations should be reported in an encyclopedic fashion, at a level of detail that is appropriate for the general reader. Generally, this requires a focus on the main results instead of details of study design. Do not write your own comprehensive review of the scientific literature.

I'm sure that it could be much better put. In fact, I'm pretty sure that with a solid night's sleep, I could do better. What do you think? WhatamIdoing (talk) 06:52, 4 September 2008 (UTC) (who is finally off to bed)

There's a big difference, though, between a trial of 2,000 patients, 200 patients and 20 patients. And there's a big difference between a prospective and retrospective trial. These differences can be important when you have different trials with conflicting results. See for example the article on Management of skin and soft-tissue infection in the 4 September 2008 NEJM. If I'm reading an article, I'd like to have that degree of specificity. That's especially important when you're writing about a controversy with less-than-perfect evidence.

That's the level of detail you'd see in, say, WebMD, which is written for both doctors and an intelligent general audience. Nbauman (talk) 07:24, 5 September 2008 (UTC)

I agree with both of you. WP should mostly state facts with encyclopaedic confidence cited via footnotes to secondary sources. Explicit mention of study after study is a warning sign that the editor may be trying to build a case themselves, especially when directly sourced to the primary studies rather than to a quality secondary source. That Wilderness article cites both primary studies and also good reviews -- but largely ignores the reviews, which repeatedly claim that although backpackers in the US get diarrhoea, it almost certainly isn't from drinking surface water and so water sterilisation shouldn't be the focus of health campaigns (personal hygiene is the problem). The article needs work because the text disagrees with the best sources. If the editors stick to the secondary sources, it becomes much easier to write confident text on the risk and not distract and overload the reader with studies they don't have the tools to interpret.

The History section of an article is an obvious place for seminal studies to be mentioned in detail. Elsewhere, if a study is explicitly mentioned at all, then I agree this should generally be kept brief. However, sometimes detail is required for honesty (as Nbauman points out)—it was small scale; uncontrolled; only looked at the US; had no long-term follow-up—or because it is actually interesting. For example, the fact that the hikers spent an average of "139 days" on the trail made me go "woa, that really is a long hike" where some readers might think 5 days was a long hike. While that fact could have been simplified to "several months", the duration is important and "long" wouldn't have been adequate. Having said that, I think WhatamIdoing is right that those explicit studies probably don't need to be mentioned at all and the conclusions in the reviews should have been presented instead.

In the proposed text, the first sentence actually seems to encourage mention of studies ("should be reported"). Even "main results" focusses too much on one primary study rather than moving the focus to what secondary sources, reviewing the literature, say. I like the last sentence. How about something like:

Editors should not attempt to write their own comprehensive review of the literature. Instead, state the facts, conclusions and opinions found in reliable sources. The primary studies that helped form those conclusions and opinions are often not required to be explicitly mentioned, outside of a History section, unless they are particularly interesting or where details of the study's limitations are important to the reader.

I'm not saying the above is ready for inclusion, just some thoughts. Colin°^Talk 10:23, 5 September 2008 (UTC)

Nbauman, I agree that the size of a study can be important, but that information can be contextualized instead of being reported in detail. 200 people is a rather small study for Hypertension. The same number of participants would be an unbelievably large study for ODDD (243 cases ever reported in the literature; approximately 100 cases believed to be living at any time). Therefore I favor using descriptive words, like "large" or "small", or by signaling the informed editor's general level of confidence in other ways: "Wilderness diarrhea is most often caused by poor handwashing and dishwashing techniques,^{[review][review]} although some researchers believe that improper disinfection of water is also a significant cause.^[primary]

The bigger issue, however, is that in most of these cases, the primary literature requires special description specifically because it is weak, and therefore the correct response is to exclude it entirely.

Thinking about other pages that have this problem, such as Freeman-Sheldon_syndrome#Cause, advice to not duplicate bibliographic information in the text might be helpful to new editors. FSS (a rare disease) has a lot of sentences that begin with "Toydemir et al (2006) showed that...", which is poor style, even if for such a rare condition these 20-person studies are appropriately sized. This has been a problem in previous versions of Da Costa's syndrome as well. WhatamIdoing (talk) 19:51, 5 September 2008 (UTC)

The "Toydemir et al (2006) showed that..." style comes from copying the style in some scientific papers. Another aspect of scientific papers that gets copied is directly citing primary studies and we already have a guideline for that :-). Perhaps we need some advice to editors who are over-familiar with that style in either their reading or writings. However, just because you see bad style in certain articles, doesn't automatically mean we need some explicit guidance against it. Legislating against all misdemeanours can cause more problems than it is worth. Is this a widespread problem and have people faced any difficulty when correcting it?

In your example, you need to be careful with the "although some researchers believe" doesn't break WP:WEIGHT. Far better to have that second statement also attributed to the same reviews. And if those reviews thoroughly dismiss the idea, then so should WP (perhaps by not mentioning it). Colin°^Talk 20:19, 5 September 2008 (UTC)

ME/CFS therapies move

Please discuss here

Should ME/CFS therapies be moved to Therapies for chronic fatigue syndrome? Is there a better title? Treatment for..., CFS treatment? Not super familiar with the diagnosis but I do know the naming is controversial in the community. Suggestions? WLU (talk) Wikipedia's rules^(simplified) 11:40, 9 September 2008 (UTC)

Also note ME/CFS treatment, I'm not sure of the difference between the two (would one be better named "management"?) From my reading of the leads, therapies is about management while treatment is about causes. Irrespective, having a slashed page title seems odd, and probably interferes with some syntax somewhere as well as being unnecessary. WLU (talk) Wikipedia's rules^(simplified) 11:49, 9 September 2008 (UTC)

Also turned up ME/CFS nomenclatures, same slash problem. Even if there are multiple names and none are problematic, the slash is not a good solution; if the umbrella term is CFS, that should be the lead rather than a slashed compromise. WLU (talk) Wikipedia's rules^(simplified) 11:55, 9 September 2008 (UTC)

I believe that the "ME" and "CFS" camps are emotionally invested in the choice of names, with mentioning both here seen as a compromise. As I understand it, "ME" means "this is a strictly biological illness, probably due to an infection and certainly not the least bit psychiatric in nature." ME advocates think that non-sufferers believe that CFS is due to character flaws and/or psychiatric problems (e.g., atypical depression), which they find insulting. WhatamIdoing (talk) 18:44, 9 September 2008 (UTC)

All those articles with "ME/CFS" in the title are forks of the main article. Any attempt to move them will lead to an edit war. I totally agree with WhatamIdoing's assessment of the situation. JFW | T@lk 18:50, 9 September 2008 (UTC)

Ya, I figured as much, but CFS is what is used on wikipedia. A good article discussing the controversy about naming and bio versus psychogenic should be reflected in one of the articles (CFS controversies?). I don't make a habit of editing to avoid hurting people's feelings. Perhaps mentioning the controversy prominently in the lead would head off criticisms. It's a poor compromise in my mind, and confusing since the main article isn't ME/CFS. Edit wars can always be dealt with via page protection.

Question, how much does the academic literature reflect the disagreements WAID summarizes? Can a decent article be drafted by drawing on the professional literature and not the grey or taupe literature? WLU (talk) Wikipedia's rules^(simplified) 20:18, 9 September 2008 (UTC)

The article currently lists mostly management therapies, but it also contains one coping strategy which is not a therapy, i.e. the title does not match the content. Note that therapies taking the biological/neurological approach, while not in the article, do exist, but these are for treatment rather than management. I think that is the most important distinction to be made here (treatment v management). Regards, Guido den Broeder (talk, visit) 19:42, 10 September 2008 (UTC)

My overall concern is the ME/CFS use in the title rather than the therapies versus treatments though the distinction between the two is not well made by the names. A better distinction would be captured by using management and treatment and probably reduce confusion due to the titles being essentially synonyms. Guido, do you see a risk of moving one to chronic fatigue syndrome management and the other to chronic fatigue syndrome treatment? Does WAID's comment make sense given your experience and knowledge of the condition? Mostly I think the ME/CFS part should be replaced with just chronic fatigue syndrome. WLU (talk) Wikipedia's rules^(simplified) 21:36, 10 September 2008 (UTC)

WhatamIdoing's perception of what advocates think is erroneous. Typically, advocates want a name that is a good indication of the illness; CFS is not. Advocates don't think that badly about non-sufferers in general at all.

Now, the title of any article should always match the content, and vice versa. From a Wikipedia point of view, it is perfectly OK to create articles named CFS management and CFS treatment as long as that's what they contain and there can be similar articles named ME management and ME treatment. To the average reader, however, this could be a tad confusing. Therefore, my suggestion would be to have one article called 'ME/CFS management' (rather than only therapies) and one called 'ME/CFS treatment' and see to it that each address both psychological and biological approaches. That has the additional advantage that it can be a lot clearer to the reader that CBT in particular can have different aims. Guido den Broeder (talk, visit) 22:01, 10 September 2008 (UTC)

The issue of whether CFS or ME is better or worse has been settled as far as I'm concerned - wikipedia uses CFS. The CFS controversies or CFS naming page should address issues of which is preferred by who and why. But on wiki, we use CFS. I'll move the pages to "CFS management" and "treatment" respectively. WLU (t) (c) ^{(rules - simple rules)} 22:20, 10 September 2008 (UTC)

I'll start the equivalent articles on ME then. Guido den Broeder (talk, visit) 22:38, 10 September 2008 (UTC)

No, Guido, we've already been through this. CFS is the official name, and it is the name used on wikipedia. Currently ME redirects to CFS. The alternative names are discussed in the CFS article. It doesn't make sense to create sub-articles for ME therapies and ME treatments. --Sciencewatcher (talk) 00:06, 11 September 2008 (UTC)

Actually, ME is the official name. It's the name under which the disorder has been classified in the ICD since 1969. These subarticles are necessary because otherwise there is no place anywhere for many relevant treatments and coping strategies. Guido den Broeder (talk, visit) 00:09, 11 September 2008 (UTC)

It's also classified under F48.0 as Neurasthenia. The USA, Canada, UK and many other countries officially call the illness CFS. But as I said, it has already been decided that on wikipedia the name is CFS. --Sciencewatcher (talk) 00:15, 11 September 2008 (UTC)

No, it is not. Nor is it for Wikipedia to decide. Guido den Broeder (talk, visit) 00:19, 11 September 2008 (UTC)

Yes, Wikipedia can decide if its the consensus of the editors.OrangeMarlin ^{Talk• Contributions} 01:59, 11 September 2008 (UTC)

The ICD is maintained by the WHO, not by Wikipedia, thanks. Guido den Broeder (talk, visit) 07:14, 11 September 2008 (UTC)

True, but Wikipedia gets to decide when it follows the ICD names and when it doesn't. Many medical articles choose non-ICD names. WhatamIdoing (talk) 02:59, 12 September 2008 (UTC)

{undent}Verifiability, not truth and consensus determines what the pages say. Not you. So build consensus. On wikipedia, that would be a content fork. We have only one article on chronic fatigue syndrome/myalgic encephalomylitis, therefore we have only one article on the treatment and management of that condition. If there is a perceived difference between the two, it should be documented in reliable sources in one of the pages. Probably the controversies page, possibly the names page. Guido - if you try creating such a page, I will redirect. You know it's a problem, you know you will be opposed by regular members, so don't be a dick, put your efforts into documenting the controversy. That should stand and will be protected by regular members - you'll have a valuable page that's appreciated rather than a pointless fight that you'll lose. WLU (t) (c) ^{(rules - simple rules)} 00:44, 11 September 2008 (UTC)

I did not say that I would create these pages at en:Wikipedia. The bias that exists here is protected from up high so there is little I can do, even though sources and consensus are with me. I am starting on ME at Wikisage sometime next week and in due time you will notice what the en:Wikipedia articles are missing. Guido den Broeder (talk, visit) 00:54, 11 September 2008 (UTC)

I've moved the pages - Controversies related to CFS, Alternative names for CFS, CFS treatment and CFS management. I'll try to get to the redirects tomorrow. WLU (t) (c) ^{(rules - simple rules)} 01:33, 11 September 2008 (UTC)

Right. All against the careful consensus reached by the users that set up these subpages. Guido den Broeder (talk, visit) 01:35, 11 September 2008 (UTC)

Looks good, WLU. Thanks for doing that. WhatamIdoing (talk) 01:41, 11 September 2008 (UTC)

Good job WLU. Looks like you followed consensus. OrangeMarlin ^{Talk• Contributions} 02:00, 11 September 2008 (UTC)

Thanks WAID and OM. Guido - if anyone objects I'll try explaining why to them carefully. I'll be sure to link to WP:CFORK, the main reason to not have several pages with the same content but different names. There is a place for the discussion about CFS' controversies to take place, but it's a) in mainspace, b) not in edit summaries and c) shouldn't involve ignoring rules when it doesn't improve wikipedia. WLU (t) (c) ^{(rules - simple rules)} 12:35, 11 September 2008 (UTC)

I am objecting to the removal of ME from the page titles. The reason is not that a controversy may exist, but that there is a lot of information on ME that is not relevant to CFS, and now this information can't be entered into Wikipedia. The page titles were discussed extensively when the subpages were set up and there was clear consensus for using 'ME/CFS'. The main article has the same problem, which also has been discussed extensively multiple times. Consensus was to create a separate ME article, as in nl:Wikipedia, but the page kept being deleted. Guido den Broeder (talk, visit) 13:31, 11 September 2008 (UTC)

How about some links to the title discussions? And if your argument is to have any real weight, you're going to have to show that ME =/= CFS. You are the only one here who thinks they are not the same thing, and your sources and/or arguments have apparently been unconvincing, because ME redirects to CFS. WLU (t) (c) ^{(rules - simple rules)} 13:50, 11 September 2008 (UTC)

There was a single user in particular that we (not I, but the lot of us) could not convince. Unfortunately, that was an admin. The fact that ME and CFS are different entities follows from their definitions, which are all in the references. CFS, a syndrome, lists only a subset of symptoms that characterize ME, a disease. As the original publication by Holmes e.a. says: CFS is a working diagnosis, to help research along, nothing more. There is some more info in the nl articles, although I never got the chance to complete them. It follows that many aspects of ME are not aspects of CFS. As for the preparatory discussions, they are somewhat scattered over CFS talk and user talk pages, but the preparation continued on User:Strangelv/MEproject where you will find everone happy with 'ME/CFS' as well as a continuing desire to create the ME article. Guido den Broeder (talk, visit) 14:07, 11 September 2008 (UTC)

{bing!} Also moved ME/CFS history to history of CFS. WLU (t) (c) ^{(rules - simple rules)} 13:52, 11 September 2008 (UTC)

That one is not a problem, because ME is in the history of CFS. Guido den Broeder (talk, visit) 14:07, 11 September 2008 (UTC)

No idea what to call this, but it needs to change. And be gutted - lots of empty headings? Come on. Also working on {{MECFS}} which I think I'll re-name {{chronic fatigue syndrome}} WLU (t) (c) ^{(rules - simple rules)} 14:28, 11 September 2008 (UTC)

I guess you're stuck. You really can't call the Canadian consensus definition of ME/CFS a definition of CFS, or the Nightingale definition of ME while the foundation explicitly says that ME is the only correct term. Guido den Broeder (talk, visit) 15:11, 11 September 2008 (UTC)

This is the talk page for discussing the medical MoS and changes to it. Discussion on the application of this guideline to articles (along with Wikipedia:Naming conventions and Wikipedia:Naming conflict) should take place elsewhere, possibly advertised by an RFC or posting at WT:MED. Thank you. Colin°^Talk 15:03, 11 September 2008 (UTC)

Most researchers use the term CFS rather than ME. Do a search on medline and you'll find a lot more references to "chronic fatigue syndrome" than "myalgic encephalomyelitis". I imagine it was for this reason that it was decided to call the articles CFS on wikipedia. There is no good evidence that they are two illnesses - most researchers believe they are the same. This is the mainstream scientific opinion. --Sciencewatcher (talk) 17:37, 11 September 2008 (UTC)

Discussion of names happening here (again?). Per Colin's comment, please centralize. WLU (t) (c) ^{(rules - simple rules)} 18:13, 11 September 2008 (UTC)

Archiving

This page is rather long (120K), so I'm attempting to set up MiszaBot to automatically archive things for us. I've set a relatively long (45 days) wait time, at least to start. Hopefully I haven't screwed up anything in the template. WhatamIdoing (talk) 04:06, 19 September 2008 (UTC)

Good idea. I've set it to a 150KB maximum, too. —Cyclonenim (talk · contribs · email) 17:57, 4 October 2008 (UTC)

Risk factors

Considering Wikipedia:MEDMOS#Diseases.2Fdisorders.2Fsyndromes: Where do you normally put risk factors, such as "obesity is a risk factor for diabetes" or "being over the age of 50 is a risk factor for this kind of cancer"? Under ==Signs and symptoms==, ==Diagnosis==, or something else? (Assume that there aren't enough risk factors to merit an entire section on its own.) WhatamIdoing (talk) 20:52, 5 October 2008 (UTC)

Epidemiology (or Causes if there's a direct link). Colin°^Talk 21:12, 5 October 2008 (UTC)

Broken archives

We have two archive 3s: Archive3 and Archive_3. Can somebody fix this? Colin°^Talk 11:32, 6 October 2008 (UTC)

 Done --Steven Fruitsmaak (Reply) 19:30, 9 October 2008 (UTC)

Presentation

Comments please on the addition by Rcej (talk · contribs) of "Presentation" as an alternative to "Signs and symptoms" or "Characteristics". I removed it as jargon and having a medical-services POV, but it was restored with the edit comment "'Presentation' refers to congenital disorders which are visible at birth." I believe the term concerns the moment when a patient is first examined by (presented to) medical services: what symptoms to expect, characteristics of a typical patient (e.g., age) and what stage of the illness. Discussion of this is perhaps only sometimes of interest to the general reader, and should probably avoid the jargon word "presents". What do the Wikidocs think? Colin°^Talk 12:19, 9 October 2008 (UTC)

Tho I'm not a wikidoc, I think the word presentation will appear in medical articles, whether in a heading or not. Therefore a good explanation should appear at least on the Presentation (disambiguation) page. Wictionary has a better presentation[sic] of the word & meaning. --Hordaland (talk) 12:34, 9 October 2008 (UTC)

I didn't see that definition (don't normally trust Wictionary). The American Heritage Medical Dictionary agrees. Colin°^Talk 13:04, 9 October 2008 (UTC)

As Colin says, the word "presentation" has a very strong medical point of view. It basically suggests that nothing matters about the disease until the patient presents himself (or herself) before a physician for diagnosis. The word emphasizes the superiority of the medical professionals and therefore is deprecated as non-neutral.

Additionally, there are many definitions for this word, and how medical textbooks use it is not going to be apparent to many readers. The word is medical jargon and therefore deprecated as poor style.

Finally, whilte I can see the value of summarizing this conveniently for other medical students, Wikipedia is written for the general reader, not other medical professionals. There is never a need for an article to collect information on what a condition looks like at the time of a first visit. It is always better to divide the information up into the correct categories: "Signs and symptoms" for medical signs and patient-reported symptoms, epidemiology for epidemiological information, and so forth. WhatamIdoing (talk) 18:48, 9 October 2008 (UTC)

I firmly oppose because that is simply medical jargon. We shouldn't be talking about etiology and pathophysiology either. --Steven Fruitsmaak (Reply) 19:26, 9 October 2008 (UTC)

I find the word "presentation" unhelpful; I associate that word with PowerPoint, not with disease features. "Signs and symptoms" is used both in medical and lay literature and covers the content pretty well. "Characteristics" is misleading because a disease might have biochemical, genetic and epidemiological characteristics that would normally not be discussed in that section.

There is no good word to replace "pathophysiology", although I would settle for "disease mechanism" or something similar. The term "etiology" is not suitable and should be replaced with "cause(s)" whenever found. JFW | T@lk 21:42, 9 October 2008 (UTC)

Oppose and agree with WhatamIdoing and others regarding the word "presentation". "Signs and symptoms" is preferable and "presentation" is not an alternative term. Presentation (Obstetrics) is already on the disambiguation page with a specific definition. Wictionary is not a reliable source. —Mattisse (Talk) 22:14, 9 October 2008 (UTC)

For the record, I certainly wasn't suggesting Wictionary as a reliable source. Just pointing out that their definition agrees with the common understanding of the word in medical sources. And, as noted above by Colin, the American Heritage Medical Dictionary agrees in this case. --Hordaland (talk) 08:50, 10 October 2008 (UTC)

I will abide by consensus, however, please allow me to clarify. For a congenital feature such as polydactyly, the characteristic absolutely presents itself upon observation by the attending OB. Presentation, in this case, would easily refer to a symptom which exhibits or presents itself, leading to confirmation. I therefore support the notion that the heading "Presentation" is a suitable alternative to "Signs and Symptoms" or "Characteristics". --Rcej (talk) 08:09, 10 October 2008 (UTC)

The use of the term "presentation" is somewhat loose. In one sense, "presentation" means the reason for arrival at a health care professional: your infant's polydactyly may present on routine ultrasound scan, or at a baby check by the midwife. In most cases, this refers to the patient's symptoms. In another sense, "presentation" refers to both symptoms and clinical signs on first assessment by a health professional. This is Cancerweb's definition. From Cecil's Textbook of Medicine: "Patients commonly present with complaints (symptoms).... Many patients, however, present with undiagnosed symptoms, signs, or laboratory abnormalities that cannot be ascribed immediately to a particular disease or cause." Axl ¤ [Talk] 10:36, 17 October 2008 (UTC)

Naming convention

The beginning of the naming convention section reads "The article title should be the scientific or recognised medical name rather than the lay term[1]..." The citation attempts to link to WP:WikiProject_Clinical_medicine#The_naming_issue, but this defunct project page now redirects to WP:WikiProject Medicine, and there is no "The naming issue" at the new project page. The section in question can be found in the project's history at [3]. I boldly fixed this link, but Orangemarlin (talk · contribs) promptly reverted my effort.[4] I think this link should, at least, be fixed. So I will undo the revert. However, I note that this medicine-related guideline appears to conflict with WP:Naming conventions#Use_common_names_of_persons_and_things, and there is no Medicine-related exception listed under WP:Naming_conventions#Other_specific_conventions or WP:Naming_conventions#Proposed_guidelines_and_guidelines_under_construction. I happen to agree with the MEDMOS. Shall I make a proposal at WP:NAME to bring it in line with MEDMOS? Noca2plus (talk) 19:34, 9 October 2008 (UTC)

Why didn't you just change the link? I just read a huge history of the policy, and promptly fell asleep--I think guidelines like this should be short and sweet. But it's just me. OrangeMarlin ^{Talk• Contributions} 19:37, 9 October 2008 (UTC)

I think a link is better than discussing the whereabouts of the discussion. --Steven Fruitsmaak (Reply) 19:44, 9 October 2008 (UTC)

The collection of links is in a footnote, so the guideline itself isn't really any longer than it was before. I added the discussion links because the Clinical Medicine Project page, in turn, mentioned them, but the links were (are) broken. In particular, I was frustrated that finding the mentioned Village Pump discussion was so difficult. Long term, I think this footnote could probably go away if a specific medicine convention is added to WP:NAME. Noca2plus (talk) 01:26, 10 October 2008 (UTC)

Historically, there have been several medical WikiProjects. There was a defunct "WikiProject Medical Conditions" when I arrived in 2004, and a new effort was started, called WikiProject Clinical Medicine. An overarching WikiProject covering both preclinical medicine, clinical medicine and other areas was formed in 2005; this was WikiProject Medicine. Last year we finally decided to merge WP:CLINMED into WP:MED. However, many relevant policy discussions from WP:CLINMED have bearing on all medical content and were hence grandfathered.

I have mellowed since 2004, and I think that sometimes the lay term for a disease may be more appropriate. That is, if it is precise enough. The medical community now uses stroke preferentially over "cerebrovascular accident" (which was confusing anyway), and so on. However, some terms are inherently imprecise and tend to be abused by ignorant journalists; heart attack comes to mind (could be MI, sudden cardiac death, or cardiorespiratory arrest due to secondary causes). JFW | T@lk 21:42, 9 October 2008 (UTC)

Does this mean you oppose a specific medicine convention on WP:NAME? Or is it that you just don't see a conflict between WP:MEDMOS and WP:NAME? Noca2plus (talk) 01:26, 10 October 2008 (UTC)

I think NAME doesn't address the issue of imprecision of certain lay terms. There is therefore no real conflict. JFW | T@lk 02:25, 10 October 2008 (UTC)

When a lay term (such as "heart attack") has a degree of ambiguity about it, an official medical term should be use. Avoiding ambigious titles is recommended in NAME. I don't see much conflict either. Specifically NAME deals with it through Wikipedia:Naming conventions (precision) "give the reader an idea of what they can expect within an article" and Wikipedia:Naming conventions (common names) "cases where the common name of a subject is misleading, then it is sometimes reasonable to fall back on a well-accepted alternative". The use of Tsunami/tidal wave is good non-medical parallel of where a common name has ambiguity and a more technical term is more suitable.--ZayZayEM (talk) 06:33, 31 October 2008 (UTC)

Notable outbreaks

I'm currently working on cleaning-up the lengthy (and growing) list of local Legionella outbreaks in Legionellosis. The MEDMOS has a Notable Cases section which establishes guidelines for individual case inclusion but not, as I see, for disease outbreaks. Have we discussed general criteria for notable outbreaks of infectious diseases? -- MarcoTolo (talk) 20:50, 19 October 2008 (UTC)

Sounds like time to spin off a list page. --Una Smith (talk) 18:39, 22 October 2008 (UTC)

I thought about that, but in many cases I see lists of outbreaks that aren't really notable - twenty-some-odd cases in some city isn't notable when there are 10k+ cases in the US a year. -- MarcoTolo (talk) 18:53, 23 October 2008 (UTC)

Linking journal titles

It seems to me that everyone has a different approach when it comes to linking journal titles in citations (see Wikipedia talk:WikiProject Medicine#Linking to full-text journal articles), and we ought to settle on a prescribed approach here for consistency.

I propose adding this to the Medical MoS:

If the title of a journal article is hyperlinked in a citation, the url should point to, in descending order of preference:

1. A free online version of the full text
2. An online version of the full text, for which subscription is required
3. An abstract or information page, if no DOI or PMID record is available

If a DOI or PMID is available, the URL should only be specified if it would point to a different page to that which a DOI or PMID would redirect to.

--Phenylalanine (talk) 18:22, 25 October 2008 (UTC)

MEDMOS currently says:

If the full text is freely available online, add this to the "url" parameter in the template (or hyperlink your article title, if doing it by hand).

See also the discussion on WT:MEDRS regarding PMC manuscripts vs final publisher versions. I'm a bit confused, Phenylalanine, because in the linked discussion, you seemed to agree with me regarding the use of hyperlinking the title if and only if the full text is free, yet above you've adopted the cite journal rule (which I wasn't aware of). The above rule seems to mean that a URL will sometimes be supplied even if the full text is not free, meaning we lose the ability for general readers (who are the ones we are writing for) to tell if they can actually read it. Plus the "don't do it if there's an equivalent DOI/PMID link" instruction should be embedded in the rules rather than a confusing afterthought. It isn't at all clear why one should supply multiple URLs if the DOI leads to a different URL from the editor's own. For a subscription journal article, surely both point to a final published edition that should be identical (even if the URLs vary).

We must remember we are writing for the general reader, who almost certainly won't have access to subscription journals. After clicking on a few such links, they would give up depressed at finding that most of them are no more helpful than a 404 "missing" result. Indeed, being informed (each time) of the astonishing cost of buying 24hs access to one article might put them off reading medical article references altogether. Therefore, I'm opposed to this change. However, I agree MEDMOS needs to be updated to mention DOI links. If neither PMID or DOI are available, but either the paper or just the abstract are available online, then some additional link should be provided after the citation: (online text (subscription required); or abstract). Colin°^Talk 20:22, 25 October 2008 (UTC)

I think we do the reader a favor if we give them some way of accessing an article digitally. In the unlikely event that an article has neither a DOI nor a PMID, I have no objections against a direct URL to the publisher's site or some other resource. I agree with Colin that it were better if we indicated clearly that the URL will not necessarily give you the fulltext of the article. JFW | T@lk 23:36, 25 October 2008 (UTC)

Hi Colin, I had not noticed the MEDMOS guideline you provided about. It seems to contradict the broader Cite journal guideline. I think your approach is sensible, although I would be more inclined to specify "full-text available" in the url-parameter rather than to link the article title. As Una Smith mentioned, "PMIDs and DOIs are static; journal websites are not". I agree with you that "if neither PMID or DOI are available, but either the paper or just the abstract are available online, then some additional link should be provided after the citation." It just seems unnecessary to link to a full-text web page when the DOI or PMID redirect to the exact same page (usually an abstract which links to the full-text version). Cheers, Phenylalanine (talk) 01:21, 26 October 2008 (UTC)

Also, is it preferable to link to the full text PDF or to the html version? --Phenylalanine (talk) 00:34, 27 October 2008 (UTC)

PDFs are closer in appearance to the actual print version of an article, and some people (myself included) find them easier to read, but I think HTML should be preferred for the sake of accessibility? (folks with dial-up connections who may find a PDF too heavy to download, etc.). Fvasconcellos (t·c) 00:55, 27 October 2008 (UTC)

I prefer to link the fulltext, for accessibility reasons. If the PDF is free but the fulltext is not (cf Ann Intern Med) the PDF needs linking, not the HTML. JFW | T@lk 07:05, 27 October 2008 (UTC)

Procedures

I do not see any guidelines on pages about procedures? Should we have guidelines for these types of pages?--Doc James (talk) 13:32, 21 December 2008 (UTC)

Good point.

I think an article on any medical procedure should have at least the following sections: (1) Indication, (2) Contraindications, (3) The actual procedure, covering preparation, basic technical description and aftercare, (4) Complications, (5) History.

It will be important to avoid the WP:HOWTO problem. Therefore, the description of the actual procedure should be scrupulously sourced and really only include detail directly relevant to the indication. For instance, when describing a laparoscopic cholecystectomy we might be able to avoid general comments about laparoscopic surgery. JFW | T@lk 20:09, 21 December 2008 (UTC)

Sickness behavior

There's a new article at Sickness behavior that I'm not quite sure what to make of. I discovered it when its author was building the web in basic articles like Disease. WhatamIdoing (talk) 21:06, 22 December 2008 (UTC) :Did you mean to post this in WT:MED? Colin°^Talk 21:11, 22 December 2008 (UTC)

I think he did. —Mattisse (Talk) 21:21, 22 December 2008 (UTC)

Yes, I did. I'll call myself a victim of auto-completion of URLs: I probably typed WT:MED, and the browser probably added "RS" -- dobutless to make my life easier. I'll move the post, and I ask that this one please be ignored. WhatamIdoing (talk) 22:29, 22 December 2008 (UTC)

"low-level facts"

I noticed in a recent Signpost article that this guideline refers to "low-level facts" which should be avoided. What makes one fact more low-level than another, and how do we know where to draw the line? Could that term please be clarified into more descriptive and specific advice for what should and should not be included in drug articles? Thanks. 69.228.208.167 (talk) 14:02, 4 January 2009 (UTC)

Have you read what this guideline already says, immediately after the injunction against low-level facts?

For example, a long list of side effects is largely useless without some idea of which are common or serious. It can be illuminating to compare the drug with others in its class, or with older and newer drugs. Do not include dose and titration information except when they are notable or necessary for the discussion in the article.

If that, plus the good judgement of experienced editors, isn't sufficient, please let us know what your specific question is, and the name of the article that you want to improve. WhatamIdoing (talk) 20:23, 5 January 2009 (UTC)

Fair warning

Just wanted to give folks here a heads-up that I've mentioned the MEDMOS naming convention in opposing a proposed page move from Feminine essence theory of transsexuality (the name found in the recent scientific literature) to Woman in a man's body (the name apparently preferred by bloggers). The editors on those pages aren't getting along so well these days (months, ever?). WhatamIdoing (talk) 06:05, 14 January 2009 (UTC)

That's a complete misrepresentation of the facts. "Woman trapped in a man's body" is the preferred term in the Archives of Sexual Behavior (examples: PMID 6732469 PMID 9415796 PMID 7125886), and it has been used extensively in the last half century by notable psychologists and behavior scientists including Lionel Ovesey, Vern Bullough, Carl Elliott, and John Money, as well as in non-medical publications (such as by Marjorie Garber or biologist Julia Serano). References available upon request for those who can't find them on their own. If "bloggers" is supposed to be shorthand for non-experts or non-scientists, this appears to be yet more POV-pushing by User:WhatamIdoing. Jokestress (talk) 09:15, 14 January 2009 (UTC)

Section structure

This guideline provides a list of suggested section names, however it doesn't seem to provide much into developing a hierarchy ("a system of hierarchical section headings" 2b of WP:FACR). Is there a reason for this, or what is there to say? ChyranandChloe (talk) 05:28, 15 January 2009 (UTC)

Are you interpreting FACR2b as always requiring multi-level section headings? I doubt that this is actually required, but even if it were, it's probably not appropriate for this page to suggest subheadings because there's too much variety, and this is meant to be a general suggestion. However, an article could easily have subsections under these sections. For example, an article about cancer might have a treatment section structured like this:

==Treatment==

=== Surgery ===

=== Chemotherapy ===

=== Radiation ===

=== Palliative care===

It all depends on what makes the specific article work best. WhatamIdoing (talk) 05:50, 15 January 2009 (UTC)

Thanks for clarifying. ChyranandChloe (talk) 04:05, 16 January 2009 (UTC)

Cited articles including trademarks

Do we somewhere have a guideline on whether or not to strip out the ^TM and ^R symbols from drug tradenames that appear in cited titles? It doesn't come up often, as most recent article titles use generic names per the URM style guide, but there are sometimes reasons to cite a source that includes it such as a corporate announcement.LeadSongDog (talk) 18:14, 16 January 2009 (UTC)

We always remove ™ and ® -- anywhere in the encyclopedia, not just for medicine-related articles. The page that discusses it is Wikipedia:Manual of Style (trademarks). WhatamIdoing (talk) 00:53, 17 January 2009 (UTC)

We're going to nitpick wiki-medicine to death - literally

The problem with wiki-medicine is simply the reason why wikipedia is so great. Anyone can participate, and build it up. Unfortunately, that also let people rip it down. Medicine is not as objective as we like it to be. It is a battleground between specialists, GP's, and alternative medicine folks. We are going to lose to formal managed websites like WebMD, Medscape, emedicine, etc. Unless we can make ourselves unique. Why? Wiki contributors do not get credit. Other emedicine contributor gets to keep their contribution as a published work, and credited. Wikicontributor do not. Other emedicine sites have peer review, and editors. We do not - we rely on administrator to manage conflicts. Which does not work well. I am not sure what we can do to capitalize on Wiki's strengths which is also its weakness. I feel that my contribution here is mainly to keep people from being mislead by false beliefs, and to present objective evidence. But why do we need Wiki-medicine, if already other peer-reviewed websites already exist?--Northerncedar (talk) 15:00, 19 February 2009 (UTC)

Suggestions to making Wiki medicine unique or function better: 1. Allow unsubstantiated, unpublished ideas? Open a can of worm, and make this site an open forum? 2. Allow peer review to occur - perhaps credentialling a minimum of 2 specialist to review contribution - which will require an administrator to approve (we can e-mail our scanned credentials and CV's?). These peer reviewer will have a final say in the articles?. 3. Limit the scope of the content of wikipedia medicine articles? I don't know. Somehow, we must have some control over editings, otherwise no one would care to contribute. The contents are pretty bad as it is right now, to be worried about "manual of style". --Northerncedar (talk) 16:13, 19 February 2009 (UTC)

You raise some interesting points. However, on this page, we are constrained by the policies summarized at Wikipedia:Five pillars. We can work to clarify and apply those policies to provide guidance for editors working on medical content, but this isn't an appropriate place to suggest that we overturn the underlying policies. --Arcadian (talk) 20:28, 19 February 2009 (UTC)

Hi Northerncedar. I agree with Arcadian that you raise some interesting points, but I would also observe that your perception of Wikipedia may be a little skewed by an unusually difficult history on the Mohs surgery page. I only recently became aware of it but it seems to be a real outlier, and most medicine-related pages, even contentious ones like HIV and AIDS, work quite well. It has taken some time for me to get used to the WP model, but I really think it works - and I'm in it for the long haul. For-profit sites like Medscape and WebMD have some really ugly issues with regard to conflict of interest. --Scray (talk) 23:27, 19 February 2009 (UTC)

I completely disagree with Northerncedar's view that "no one would care to contribute" under the existing system. There are about fifteen thousand medicine-related articles on Wikipedia. Who do you think wrote all of the existing articles, if no one cared to contribute? Speaking as one of those "nobodies", I think the existing system, while a lot of work in some cases, has significant strengths. Certainly there are people who would rather work in a different system -- one that could make them famous, or rich, or let them work in isolation as a sole author -- and there are several good alternatives for those people, but the production of medicine-related articles in Wikipedia is actually happening under the existing system. WhatamIdoing (talk) 06:59, 20 February 2009 (UTC)

I think my frustration is when what I considered to be vandalism occurred, I did not know who to turn to. Initially, in April 2008, when Nickcoop deleted large portions of contents from Mohs surgery and Basal Cell cancer - stating that MMS is propanganda and "poofery" - I did not know how to report it. The folks I reported it to did not provide much guidance. My suggestion is that there should be a link at the top of each wikimedicine article that can lead a reader to a "wikimedicine talk page" where administrators of the site can quickly review and edit vandalism, or direct the user to the correct person in charge of reviewing that site. It gets frustrating to see biased (depending on whose point of view, mine or Nickcoop) information being spread. Certainly, the end result of such edits improved the content of both articles - but there need to be a way to inform contributors who the administrator's are.--Northerncedar (talk) 13:16, 20 February 2009 (UTC)

This challenge, which is very real, is not specific to medicine articles (so a medicine-specific solution does not seem appropriate). Perhaps the documentation for the appeals process could be made more accessible in general. --Scray (talk) 14:32, 20 February 2009 (UTC)

But we already have such a link. Not at the top of each article, but at the tops of the talk pages. There the user can see what project (if any) an article is a part of, and useful link(s). - Hordaland (talk) 14:19, 22 February 2009 (UTC)

I'm not sure if I understand Northerncedar's concerns. Medicine on Wikipedia has the unusual strength of being aimed at laypeople while remaining tightly sourced to recent medical literature. That makes it more flexible than many sites that feature health information (such as emedicinehealth, the NIH, NHS Direct and what have you). It also means we have an enormous responsibility vis a vis our readers to provide content that is reliable, unbiased and representative of mainstream medical opinion. People read Wikipedia articles after visiting their doctor, and people print out Wikipedia articles to prepare for a visit to a specialilst.

To achieve the above goals we need a very clear set of standards. Within the constraints of those standards, everyone can contribute what they want. Wikipedia has become governed by many rules, and there are some technical things that are difficult for newcomers (e.g. citation templates). Newcomers often also struggle with NPOV and NOR. I disagree with Northerncedar that these are absolute deterrents. Those with enough drive to contribute to this encyclopedia will grasp the rules fairly quickly. There is a continuous slow influx of new contributors to medical articles.

What we cannot tolerate is POV pushing (both pro- and against-big pharma, for instance), inappropriate hyping (according to this case report, chimp urine cures cancer), scaremongering (according to this case report, paracetamol causes cancer) and generalised factionalism. It is our collective task to ensure this WikiProject achieves the above goals. There is no need for credentialling (some of our best contributors have no medical degree), or for relaxing or tightening content rules. JFW | T@lk 11:46, 22 February 2009 (UTC)

I wholeheartedly agree with everything JFW said, except for the last 7 words. I'm certain that the present rules are not perfect, and I would welcome discussion of any specific area of concern. Just my opinion, of course. --Scray (talk) 20:28, 22 February 2009 (UTC)

Scray, which content rules need relaxing or tightening? Northerncedar posted a very broad denunciation of the way Wiki-medicine is run, and his main criticism seems to affect the rules. The current rules in WP:MEDMOS and WP:MEDRS have a very broad consensus base and have been very useful in ensuring that articles are actually relevant and reliable. JFW | T@lk 23:54, 22 February 2009 (UTC)

Perhaps getting a page set up with direction on how to contact administrators about vandalism and destructive edits might be all that we need on all wikipedia pages. It is too muddled on how to reach and report anything here, based on my experience in April 2008. Heck, I still don't know which one of you are administrator, and which ones aren't.--76.226.167.128 (talk) 13:50, 23 February 2009 (UTC)

For subjects relating to the workings of Wikipedia, the place to start your search is to prefix that onto the topic you are interested in. For vandalism, see Wikipedia:Vandalism. There you'll find ample discussion of how to address the issue.LeadSongDog (talk) 17:07, 23 February 2009 (UTC)

Can someone add that link Wikipedia:Vandalism link to the side bar of wiki, under "toolboxes"??--Northerncedar (talk) 18:19, 23 February 2009 (UTC)

That's way off topic here. Try Wikipedia talk:Vandalism.LeadSongDog (talk) 19:20, 23 February 2009 (UTC)

Notherncedar, you didn't have a vandalism problem. You had (or have) a content dispute. Did you try clicking on "Help" in the interaction box, and choosing appropriate links, like "Where to ask questions"? WhatamIdoing (talk) 22:03, 23 February 2009 (UTC)

Agreed. The Mohs surgery article has been involved in ongoing content disputes, so maybe I can bring this conversation full circle to the preceding conversation, and get some feedback about guidelines concerning medical procedures, and regarding what issues you would like seen addressed? kilbad (talk) 18:49, 24 February 2009 (UTC)

Vandalism or not???

Hi, I think that Wikipedia material regarding medicine should be as factual and as well referenced as any other branch of science. When treatments for diseases are listed, then "standard" treatments should receive prominence. It would be helpful if some guidance could be given as to how strong the evidence is in support of a particular treatment. Nickcoop (talk) 00:20, 25 February 2009 (UTC)

Please read this last edit by Dr. Cooper on basal cell cancer. This is his third attempt at shifting or deleting the material, despite warning from other users. He is shifting material to another section to drive his agenda - which is not allowing readers to understand the standard of care in the treatment of skin cancer of the face. It is clearly outined by national organisations. If this isn't vandalism, I don't know what is? --Northerncedar (talk) 23:54, 25 February 2009 (UTC)

1. (cur) (prev) 22:40, 25 February 2009 Nickcoop (Talk | contribs) (23,265 bytes) (I have moved the Mohs advertisment to the Mohs section.) (undo)

You are in completely the wrong forum. Please take your dispute about Mohs surgery elsewhere. Thank you. JFW | T@lk 00:13, 26 February 2009 (UTC)

Colors

A proposal to standardize colors is taking place at Wikipedia_talk:WikiProject_Medicine#request_color_change_on_template. --Arcadian (talk) 18:21, 15 March 2009 (UTC)

Histology section in disease articles

• I have been using wikipedia for several years to get valuable information as a medical student and to find references for talks and papers. I am entering the field of pathology in a few months and my concern for the lack of a dedicated histology section for most disease articles has come to a head. I think that for completeness' sake it is crucial to have this section. In a day when we will soon be making diagnoses based off of molecular studies, we will be merely current if the histologic criteria and images are present in these articles. I welcome your feedback and look forward to becoming an active and dedicated contributor. I think a histology section should be required as a FAC. Bojilov (talk) 19:57, 27 March 2009 (UTC)

I think you'll find strong support for adding more images, but because images are so hard to obtain, that there would be less support for raising the standards for FAC at this time. Adding a "histology" section here might be a good idea, though. --Arcadian (talk) 20:51, 27 March 2009 (UTC)

There already exists in the article layout-suggestion a "Pathophysiology" section and that would be the place for any histology details. That said wikipedia is not meant for us medics, but a general reader and with WP:NOTTEXTBOOK I would question how much histology is needed, and that's just for myself as a general practitioner, so I would dispute that histology should be a requirement for FAC. That's not to say have no details or that help in distinguishing the classification of a disease that is of clinical importance can not be improved, but I don't see need for Pathophysiology section to have obligatory subdivision.David Ruben ^Talk 20:54, 27 March 2009 (UTC)

I think that as a general practitioner you may not be as interested in the histology but for most diseases, the pathology itself is what defines the disease. As I said in the original post, the histology of a given disease is critical for the completeness of the article. Bojilov (talk) 22:22, 28 March 2009 (UTC)

Or perhaps that information belongs under ==Diagnosis==. WhatamIdoing (talk) 04:47, 28 March 2009 (UTC)

I think we have very limited pathology content in most articles. I would suggest the inclusion of histo- and cytopathological information in "diagnosis" only if the disease is diagnosed by histology (e.g. lymphoma). In many other conditions, however, it would be odd to mention the histological appearance in that section. For instance, how often is myocardial infarction diagnosed by histology. In those cases, mentioning the histological changes in the "mechanism/pathophysiology" section would be much more appropriate. JFW | T@lk 08:25, 29 March 2009 (UTC)

Wikipedia:Manual_of_Style_(medicine-related_articles)#Drugs

Hi there

The Chemistry MOS has been ratified. Since drugs are essentially chemicals, I wanted to make sure that our section on chemicals (WP:Manual of Style (chemistry)/Chemicals does not conflict with other sister wikiprojects' MOSs.

I note that your MOS does not mention the synthesis/preparation/extraction of drugs. Since drugs do not appear out of thin air, a section on how they can be synthesized (or extracted from natural products) will greatly add to the quality of the article. This section should of course, be complete with reaction schemes, but should not stray into the area of cookbook chemistry. Descriptions of industrial routes are preferred, but they are understandably hard to cite. At the very least, a feasible route should be described. I have found three reliable sources for these benchtop preps, in order of reliability: J. Chem. Ed., other journal articles, the patent literature.

It is our convention that synthesis/preparation/biosynthesis sections should be right at the top of chemical articles, just below "structure and properties". I have recently added a few reaction schemes to bupropion, lidocaine, amantadine, etc. I have followed our convention of having them near the top of the article. However, I am not sure if your community agrees.

IMO, since drugs are chemicals, synthesis sections should be at the top of the page. They are usually short, anyway, so they should not be viewed as an attempt to hijack the article. What do you guys think? --Rifleman 82 (talk) 08:47, 8 March 2009 (UTC)

Lots of things are just chemicals, and the drug=chemical aspect is rather minor and highly technical. As this is an encyclopaedia for a general reader, I would be opposed to having this section early in the article because it would be off-putting to a reader and very unlikely to be useful information. I'm afraid the sections you indicated above are completely unintelligible to me. I would oppose a FAC with a section like that. Colin°^Talk 09:25, 8 March 2009 (UTC)

Many of a drug's properties derive from their chemical properties. Solubility, hydrolysis, half-life, distribution within the body, etc. --Rifleman 82 (talk) 09:35, 8 March 2009 (UTC) I draw an analogy with the extraction of metals from ores: most readers won't attempt to smelt iron from pyrites, but it is important to know where one may obtain iron. Similarly, most readers may not attempt a chemical synthesis of amantadine, but it is useful to know how they may be prepared. --Rifleman 82 (talk) 09:37, 8 March 2009 (UTC)

What is important for a drug is its indications and side effects. They in many cases are explained via pharmacokinetics and pharmacodynamics (mechanism of action). The chemical synthesis of many drugs is not notable and uses trivial reactions (see aspirin and bupropion). As such it should usually be at the end of the article, if at all present there. Most of the drug properties such as solubility, half-life, distribution within the body etc. are not simply derived from chemical properties. There is a large industry of the in-silico predictions of drug properties, which so far has had only limited success. And, certainly, the properties of the drug have nothing to do with the way it is synthesized. In another example, the total synthesis of quinine is notable, and it has been a matter of significant attention and controversy in chemistry. Nevertheless, it is of interest only to specialists, so the quinine article does not describe it, it only refers to it. Quinine total synthesis is a separate article. The Sceptical Chymist (talk) 13:12, 8 March 2009 (UTC)

Concur & reject general applicability of WP:CHEMMOS guideline to drug article sections per WP:NOT#NOTTEXTBOOK policy (of course some exceptions). In the example of amantadine the main group who encounter it are patients who need to take it and doctors/pharmacists who prescribe/dispense it (it has no other industrial or household usage) - none of these care a jot in day-to-day circumstances as to how it was made (probably not even tablet & capsule manufacturing processes either), but of what the drug is for, does it work, what side effects - manufacture might occasionally of interest to a general readership if there is something notable compared to other drugs' manufacture - but that is an exception, not the rule, and WP:NOT#NOTTEXTBOOK applies as a policy and trumps a mere guideline. Whereas if i'm reading about hydrochloric acid then I'm interest in the chemical per se and its manufacture of course is of relevence. The difference is that if I'm really interested in reading up on say [2-hydroxy- 3-(naphthalen- 1-yloxy) propyl] (propan- 2-yl) amine, then I'm probably wondering about all those "oxy" bits, but for general readership they are more likely to be interest in it as merely the named substance propanolol's role as a pharamceutical product, and for which the couple of sentances in its "History and development" section probably suffices. David Ruben ^Talk 13:36, 8 March 2009 (UTC)

PS re "Since drugs are essentially chemicals" is a bit like saying articles on weapons should have manufacturing processes near their top and mentioned in each case on basis that "since guns are essentially metal alloys". Yes drugs are chemicals, but as child development processes are no more relvant for each biography article on people, so drug articles are about the usage of the chemicals, not their manufacture which is of interest (in most cases) to just a few scientists and technologists :-) David Ruben ^Talk 13:44, 8 March 2009 (UTC)

(reset) My first post at the top was to talk about how we could try to synchronize our MOS with with sister projects. Not to assert some sort of general applicability. Colin mentioned that the synthesis was totally unintelligible. I do not find that an argument for excluding a mention of commercial or benchtop preparation of a drug. 1-Adamantylamine or amantadine, if you prefer, is actually commercially available from Aldrich as a building block chemical. See [5]

Paclitaxel has a huge section on "production". IMHO, manufactured products should have such a section. To extend your example, weapons should have some sort of description about its construction - made of chrome steel? carbon steel? welded, forged, stamped? I can understand how the focus of these articles may be different, and that the chemical synthesis may be less important to be at the top.

But to say that they are drugs, not chemicals, and dismissing the structure, synthesis, reactivity, etc. as gritty, unimportant details totally not worth mentioning is simply being insular. People other than healthcare consumers and providers read drug articles too, you know.

I can think of so many examples where the structure of a molecule has a bearing on its drug properties, apart from the obvious docking conformations. The vast majority of drugs are chiral, thalidomide being a prominent example, and enantioselective synthesis is of great interest to chemists. That paracetamol is conveniently achiral is noteworthy as an exception as well. How the acetyl groups allow heroin to cross the lipophilic blood brain barrier, compared with morphine, when injected. That cisplatin is a classic Werner-type coordination compound. The fact is, drugs are chemical compounds produced in huge volumes, e.g. 115,000 tonnes of paracetamol are consumed each year [6].

Is the chemistry of drugs—a section on the chemical synthesis, as well as a section on the structure and reactivity—too trivial to mention? --Rifleman 82 (talk) 14:27, 8 March 2009 (UTC)

I am 100% behind Davidruben's comments here. I think it's great to include material on structure, synthesis, reactivity, etc. in wikipedia. The question is: how can we include as much material as possible while keeping wikipedia as accessible as possible? A natural solution to me seems to, instead of making rigid rules about where each section goes, make them very loose guidelines and make a point of leaving it up to an individual article. A compound that happens to have minor applications as a drug but multiple applications/uses in synthesizing other compounds, for example, could have a very extended sections on these chemical aspects featured prominently near the top of the article. On a compound that's only notable because it's a drug, these sections could be moved later in the article--and if they get too long, they could be split off. Cazort (talk) 14:47, 8 March 2009 (UTC)

I can live with Cazort's comments. I came here to seek discussion and cooperation, but was taken aback by the outright hostility (synthesis section --> fail FAC!?) --Rifleman 82 (talk) 14:58, 8 March 2009 (UTC)

Rifleman, I would oppose any FAC that contained a section that was 100% unintelligible to the general reader. Stuff that requires undergraduate-level education to follow, probably doesn't belong on WP. Many of the pharma aspects of drugs are also extremely technical and many articles deal very lightly with them. You need to give the reader something to gain from knowing anything about the synthesis of the drug. Is it completely man-made, or is it extracted from plants or animals? Is it hard and expensive to make, or cheap and simple? Is it difficult to make it pure enough? The Paclitaxel production section may be a bit long, but at least I can follow it and find it mostly interesting. The synthesis diagram is much like a mathematical equation, and they say every equation halves your readership. Colin°^Talk 20:43, 8 March 2009 (UTC)

I strongly disagree that "Stuff that requires undergraduate-level education to follow, probably doesn't belong on WP." It would mean deleting large swaths of math, physics and even some chemistry articles. Xasodfuih (talk) 03:46, 10 March 2009 (UTC)

Not entire articles, but they'd be considerably shorter. If we wrote medical articles the way the math/physics/chemistry folk wrote their articles, WP would be intelligible only by specialist physicians and researchers. Most of the chemistry articles I've seen show a gross misunderstanding of what and who WP is for. Colin°^Talk 08:53, 10 March 2009 (UTC)

"1-Adamantylamine may be prepared by reacting adamantane with bromine or nitric acid to give the bromide or nitroester at the 1- position. Reaction of either compound with acetonitrile affords the acetamide, which is hydrolyzed to give 1-adamantylamine:[1]" Well, it actually was spelled out in words. Don't know what a nitroester or a bromide is? That's what the reaction scheme is for. --Rifleman 82 (talk) 02:36, 9 March 2009 (UTC)

I would like to challenge the statement that most drugs are chiral. In addition, thalidomide is not a good example of a chiral drug since its enantiomers interconvert in vivo. Thus its chiral synthesis is of no consequence. Even the chiral syntheses or chiral separations of commercial chiral drugs are of limited interest. In most cases, they use trivial methods known in the art. I think that case-by-case approach advocated by Cazort is right. (I agree with Rifleman that the comment that synthesis section would fail FAC is ridiculous. For example, would we want to exclude Cantor's theorem from Wikipedia because most laypeople cannot comprehend it?) The Sceptical Chymist (talk) 16:04, 8 March 2009 (UTC)

I support the addition of more information about the underlying chemistry in the pharmacology articles. In many cases, the characterization of an article as "chemistry" or "pharmacology" is simply based upon which wikiproject got to it first, and if the infobox is tan or blue. --Arcadian (talk) 19:33, 8 March 2009 (UTC)

I disagree on the characterisation issue. Most drugs have no uses outside pharmacy, and should not follow chemistry guidelines/infoboxes/etc any more than a car follows metallurgy guidelines. Some drugs are simple chemicals with industrial uses, and judgement should be used to determine which aspects the reader is most likely to find informative. Colin°^Talk 20:43, 8 March 2009 (UTC)

I think the addition of information about the preparation or isolation of a pharmaceutical drug is appropriate encyclopedia material, in general. But I wouldn't codify it into a manual of style because the relative importance of such information will vary from one drug topic to another. Some drug articles might be incomplete without it (such as paclitaxel, noted above, in which production of the drug has significant implications on the study, use, and availability of the drug), and to other articles it might be borderline trivial information. If it is to be included, the information should be readily available in the patent literature because every (or nearly every) commercial product will have significant intellectual property associated with it, covered in patents. Making a decision about the inclusion of this information should really be made on a case-by-case basis. -- Ed (Edgar181) 20:34, 8 March 2009 (UTC)

Rifleman82, I don't think the above constitutes a particularly hostile response. It is simply the perspective of writers who want to ensure articles are relevant and readable. I am in complete agreement with Cazort that "basic" chemistry content can be expanded upon if relevant for that particular drug. It is my view that if one compound was developed from another, or the sythetic principles are particularly illustrative, then this should be mentioned in a fashion that the general reader can understand. This is not easy and requires lots of trial and error, but eventually furthers the goal of Wikipedia as a general purpose encyclopedia. JFW | T@lk 21:50, 8 March 2009 (UTC)

I agree with JFW. I do not think the amount of content should be restricted, but the entirety of what is presented must be written for the general reader. kilbad (talk) 21:58, 8 March 2009 (UTC)

I think that the sweeping assumption that all "drugs" are fundamentally or importantly a (single) chemical simply indicates that Rifleman isn't very familiar with the breadth of pharmacology, and not that he really thinks chemistry is more important than medicine, which is how a few commenters seem to be reacting. Additionally, he's probably unaware that the "drugs" outline is used for "drugs" that are properly biologics (desiccated thyroid extract, anyone?) as well, which are much more "biology" than "chemistry", so his proposal simply can't be implemented in a significant fraction of articles.

I have no objection to including an appropriate level of information about the chemistry or manufacturing in articles about regulated therapeutics (especially assuming compliance with WP:MTAA). (For example, I see no reason why Denileukin diftitox couldn't explain that it is a fusion protein produced in E. coli.) However, I personally can't think of a single such article that I'd put such information above "indications", or even "adverse effects". What matters most about that drug is that it keeps people with T cell proliferative disorders alive longer, not the details of its production. The vast majority of readers are looking for information about its use, not its production. (I tend to prefer putting the history section towards the bottom as well, for the same reason, unless the therapeutic is primarily of historical interest.)

We have a recommended place for chemistry; that section might include production as well. For small-molecule drugs, the chemical properties often drive the production process anyway, so I'd be happy to see a note that suggesting that this is appropriate and useful information to include.

Overall, however, my recommendation to CHEMMOS is to refer editors to MEDMOS when writing about chemicals whose only significant use is pharmacologic (exactly like it already defers to WP:PHARM for toxicology). WhatamIdoing (talk) 22:19, 8 March 2009 (UTC)

The reason why "synthesis" together with "occurrence" is placed on top in WP:CHEMMOS, is to have a logical flow. What is it? "structure & properties" How/where do you get this from? "occurrence/production" What can you do with it? "reactions" What is it used for? "applications" I thought it most logical to describe how you got something, before you talked about what you could do with it. If you do not think this is the case for medicine related articles, so be it. I came here to talk about it. --Rifleman 82 (talk) 02:44, 9 March 2009 (UTC)

It's a logical system, but I recommend beginning with "why anybody would ever care" before getting into the what/how/when/where details. WhatamIdoing (talk) 03:28, 9 March 2009 (UTC)

Hi, Rifleman 82. Thanks for drawing WikiProject Medicine's attention to this matter. I understand your point of view. It is reasonable that the majority of chemicals have a description about their manufacture within their articles. However I guess that the majority of readers of drug articles are not particularly interested in the manufacture. [Okay, I don't actually have evidence for that; it's just speculation.] In my opinion, it would be okay to have a brief section about a drug's manufacture in its article, towards the end of the article. However it should be optional; I don't think that it should be a necessary for FA status. Axl ¤ [Talk] 15:40, 9 March 2009 (UTC)

Ok, I've had a rethink following my (somewhat scream of horror) reaction to proposal of synthesis at the top of drug articles (although for paracetamol & aspirin I think deservedly so). So, on those occasions where synthesis notable (unusual process in chemistry, or important for opening up range of other drug development, or perhaps even proved to be ridiculously simple to manufacture after more complex synthesis for initial research), where should such (IMHO optional & brief) info go - as a subsection of "Physical and chemical properties" section ? If so then only courteous we so note this under WP:MEDMOS#Drugs. David Ruben ^Talk 23:48, 9 March 2009 (UTC)

Scream again. I've worked on paracetamol. The manufacturing process used in industry is considerably more involved than the one for the lab, which is the only one detailed in that article. The CHEM MOS guidelines require reactions for industrial production for FA status. I was able to find 1/2 page of text on the synthesis in a drug manufacturing encyclopedia (this one p. 47), but I gave up on drawing the reactions because I wasn't sure I'd get them right (mostly due to the multitude of catalysts and steps involved). Following CHEM MOS you need a graduate-level education in chemistry to write a drug article to FA level. Xasodfuih (talk) 03:52, 10 March 2009 (UTC) Although I had asked for help at Wikipedia:WikiProject_Chemicals/archive06#Paracetamol_at_FAR, and got some support, I had to find the industrial processes myself. All in all, not a good experience if industrial sysnthesis is to become a mandatory section for FAs. Xasodfuih (talk) 04:24, 10 March 2009 (UTC)

Also, adding Paracetamol#Reactions, which really aren't of any real-world importance nowadays (ref is from 1939!), just to comply with the CHEM guideline seems off to me. Xasodfuih (talk) 04:07, 10 March 2009 (UTC)

Those two sections add nothing to the Paracetamol article. You are right that showing lab synthesis is misleading. We can find interesting things to say about the synthesis or production of a handful of drugs -- and those can be mostly explained in everyday language. The vast majority of drugs have nothing notable about their synthesis. Colin°^Talk 08:53, 10 March 2009 (UTC)

Don't get me wrong, I'm all for including a synthesis section in a drug article if somebody is interested enough in contributing it. But I guesstimate that the vast majority of our readers are drug consumers rather than (future) prescribers or producers. I also think that most readers have the ability to skip over sections they don't care about; I'm venturing a guess that sections about the mechanism of action of drugs are also difficult to a non-negligible proportion of our readers. However, pretty much any pharmacology article or textbook will have a basic discussion of a drug's mechanism, whereas for synthesis you generally have to look elsewhere. Making the synthesis section mandatory for a FA-level drug article means that we're asking more from a Wikipedia article than most professional drug information sources normally provide; this would put a non-trivial burden on article writers that would be of little benefit to most of the readers. Xasodfuih (talk) 11:57, 10 March 2009 (UTC)

To clarify, I did not suggest that synthesis sections are mandatory for FA. My original suggestion was to ask your community how we could find a place to put the synthesis section. But to say they are grounds for failing FAC is fails to recognize that there are many different types of readers of this encyclopedia. WP is seen among the chemist community as a reliable resource which quickly gives a quick overview of chemicals, reactions, etc. It is the link of choice in many chemistry blogs, when attempting to describe (something, often technical), which other scientists or the lay public may not be intimately familiar with. WP is not paper, and like Xasodfuih says, readers are able to skip what does not interest them. When I read an article about a chemical/drug, I want to know how it may be prepared. Maybe your "main" audience does not, but they are not by any means your only audience. Lastly, but most importantly:

Wikipedia:Make_technical_articles_accessible#Ideas_for_enhanced_accessibility

Do not "dumb-down" the article in order to make it more accessible. Accessibility is intended to be an improvement to the article for the benefit of the less-knowledgeable readers (who may be the largest audience), without reducing the value to more technical readers.

--Rifleman 82 (talk) 16:37, 10 March 2009 (UTC)

The ideas in that guideline are good, such as leaving the hard stuff to the end of the article. Some people are good at skimming over hard bits but a lot of people will just give up as they will assume this is the level of technical ability required for the rest of the article. However, our Policy at What Wikipedia is not says:

A Wikipedia article should not be presented on the assumption that the reader is well versed in the topic's field. Introductory language in the lead and initial sections of the article should be written in plain terms and concepts that can be understood by any literate reader of Wikipedia without any knowledge in the given field before advancing to more detailed explanations of the topic. While wikilinks should be provided for advanced terms and concepts in that field, articles should be written on the assumption that the reader will not follow these links, instead attempting to infer their meaning from the text.

A reader should not require a pharmacy or chemistry degree (or follow any wikilinks) to get the gist of any section they read in a drug article. That is a hard challenge, and not all of us are gifted with the ability to explain technical stuff to a lay audience. We should only add highly specialised facts, figures and diagrams if they add value to the reader and if we are prepared to explain it to a non-technical reader. If the chemistry community is using WP as one big university wiki-textbook, then they are abusing it IMO. Colin°^Talk 17:28, 10 March 2009 (UTC)

I'm sorry Colin, but this isn't a realistic goal. As far as I can tell, you haven't promoted any drug article to FA status, so I'll take other people's work as examples: Bupropion#Mechanism_of_action starts with "Bupropion is a dopamine and norepinephrine reuptake inhibitor." Similarly sertraline's mechanism section starts with "Sertraline is primarily a serotonin reuptake inhibitor (SRI)." Can you honestly say the average person doesn't need to click to find out what a reuptake inhibitor is? Caffeine's mechanism section: "Like alcohol and nicotine, caffeine readily crosses the blood–brain barrier that separates the bloodstream from the interior of the brain. Once in the brain, the principal mode of action is as an antagonist of adenosine receptors". Xasodfuih (talk) 03:30, 11 March 2009 (UTC)

Xas, I think that the average person reacts to those sentences differently than you do. For example, a person with no technical qualifications probably reads one of those sentences as ""Sertraline is primarily <some words I think I've heard on TV in ads about antidepressants>." The first sentence about caffeine explains itself; it is a perfect model of what Colin is advocating. WhatamIdoing (talk) 05:48, 11 March 2009 (UTC)

I've not seen an add on TV that describe sertaline as SSRI or any psych. med. in terms of receptor mechanism, but then the only ads I can recall are the bouncing smilie for Zoloft, and one about with the lady that goes home and and acts like "crazy", that one was for a SGA for bipolar (abilify or zyprexa, don't recall exactly)—I don't watch TV much, and even then I avoid ads. As for the caffeine article, the 1st sentence is accessible, but I bet the 2nd requires lay persons to click on adenosine receptors, and maybe on antagonist too. Xasodfuih (talk) 06:58, 11 March 2009 (UTC)

I didn't review Bupropion for FA, and if I had, I would have opposed it. The Virus (and the even easier Introduction to viruses) articles show that a complex subject can be explained to a lay audience. The recent meningitis was also generally an easy read. There is no reason why the Bupropion article couldn't have briefly explained what dopamine and norepinephrine are (to a very basic level, for the lead, and a more advanced explanation later), what it means to inhibit reuptake, and why this might change someone's mood, etc. This is the sort of thing magazines like New Scientist do all the time. It is a policy requirement that we explain (within the article) enough that the general reader can follow the discussion. Wikilinks are there for "further study" not as an excuse to avoid having to explain something. This is not an impossible task, but it is probably one of the hardest aspects of writing for WP. Colin°^Talk 09:10, 11 March 2009 (UTC)

I got involved in wikipedia after reading the quote from Jimbo Wales stating "Imagine a world in which every single person on the planet is given free access to the sum of all human knowledge. That’s what we’re doing." Therefore, I favor FAC that require more content over less, whether it be regarding structure, synthesis, reactivity, etc. Why not make synthesis sections, etc mandatory for FA status? To me, that seems more consistent with what Jim was saying. However, regardless, with that being stated, this sum of knowledge should be written for a general audience of assumed laypeople. kilbad (talk) 21:27, 11 March 2009 (UTC)

I think the answer to "why not" is both WP:DUE and WP:RS: Synthesis may be utterly unimportant to the general reader (consider the case of a combination drug like Co-trimoxazole: do you think that synthesis of each component is necessary for that article?), and it may be difficult, if not impossible, to find high-quality, third-party publications that discuss it. (The specification of a patent, which has been noted above as a possible source for some drugs, is self-published.) WhatamIdoing (talk) 23:17, 12 March 2009 (UTC)

a certain degree of science background is as reasonable to expect here as for any other science article. I'm not sure where the balance should be, but anything accessible to a person who has taken one college course in the subject should certainly be acceptable. As for syntheses, normally the synthesis would be with the individual chemical compounds in a combination drug. Patent specification for granted patents have ben always considered an acceptable source, though not as good as actually peer-reviewed articles. Chem Abstracts has always included not just granted patents, but patent applications, and people cite them in scientific articles. DGG (talk) 23:26, 21 April 2009 (UTC)

Looking for help

I am working on a manual of style for dermatology-related articles at MOS:DERM, this after discussing it at the main MOS page. The goal of MOS:DERM is a tailored MoS for dermatology-related content, addressing issues specific to this content. With that being said, I wanted to know if any of you would be interested in helping to develop it. Regardless, thank you all again for your work on wikipedia. ---kilbad (talk) 19:14, 21 April 2009 (UTC)

Guidelines for articles relating to medical procedures

I was recently contacted by a user regarding some "poor" editing of the Mohs surgery article. After reviewing the edits and article, and discussing the situation with several other users and administrators, I have discovered there are currently no guidelines for articles pertaining to medical procedures. Therefore, I wanted to know if others think it would be helpful to create specific guidelines regarding articles about medical procedures? If so, I would be willing to help develop some guidelines. kilbad (talk) 22:24, 14 February 2009 (UTC)

• Strong support. I believe there are some ideas in the archives of this page. --Arcadian (talk) 21:37, 15 February 2009 (UTC)
• I'm willing to help with this if it gets the backing. It'll be hard work, we're currently still perfecting WP:MEDRS, but even so I'm willing to help. —Cyclonenim (talk · contribs · email) 21:42, 15 February 2009 (UTC)
• As long as they don't become overly prescriptive by fixing what section titles should be and in which order, this is a good idea. Xasodfuih (talk) 15:52, 17 February 2009 (UTC)
• Support initiation, though establishing consensus on key issues is likely to be a challenge. --Scray (talk) 03:41, 19 February 2009 (UTC)
• Support. Have started a couple and interested in starting more.--Doc James (talk · contribs · email) 21:38, 20 February 2009 (UTC)

Questions for discussion

Here are some questions I thought we could use to start off the discussion (kilbad (talk) 15:13, 17 February 2009 (UTC)):

• What is the definition of a "medical procedure?"
  • The article at Medical procedure is unreferenced, but would be a good starting point. --Arcadian (talk) 00:54, 19 February 2009 (UTC)
    • I had actually looked at that article before posting here and was not impressed by the "loose" definition given, which is why I posted this question here. kilbad (talk) 01:12, 19 February 2009 (UTC)
  • How about procedures listed in CPT, or some other Procedure codes list? Imperfect, but at least it's a standard reference point. This would make reference to entries easier to track, perhaps. --Scray (talk) 03:37, 19 February 2009 (UTC)
    • I agree with Scray's suggestion. --Arcadian (talk) 20:29, 19 February 2009 (UTC)
  • This discussion is an effort to create clear guidelines for pertaining to medical procedures. Therefore, while I think the CPT listings are going to be a good way to track entries, I think we need a good definition of "medical procedure" in order to define the scope of these discussions/guidelines. With that being stated, I believe I have found a good definition for us to use from the International Dictionary of Medicine and Biology (which I quote first below), but have also posted some other definitions to give a variety of options, or incase we want to make a hybrid definition from them all.

1. "An activity directed at or performed on an individual with the object of improving health, treating disease or injury, or making a diagnosis."
2. "The act or conduct of diagnosis, treatment, or operation."
3. "A series of steps by which a desired result is accomplished."
4. "The squence of steps to be followed in establishing some course of action."

Also, perhaps someone could add these to the medical procedure article? Ok, well let me know what you think. Thanks again! Done. kilbad (talk) 15:07, 20 February 2009 (UTC)

• According to our article Medical procedure: "A medical procedure is a course of action intended to achieve a result in the care of patients, used by medical or paramedical personnel." I note that Discern.org in their efforts to assess "the quality of written information on treatment choices for a health problem" states in their questionnaire's Section 2, How good is the quality of information on treatment choices? that "Self-care is considered a form of treatment throughout this section." Although their topic isn't identical to ours, it seems to me that "used by medical or paramedical personnel" could as well be left out of our definition of medical precedure. Then the word "patients" would need to be changed to something else.

(Whether you doctors like it or not, some online support groups do give more and better treatment information than any doctor the patient is likely to find. My personal experience with this involves a circadian rhythm disorder.) - Hordaland (talk) 14:41, 8 March 2009 (UTC)

Given what you have added, I think the first definition I posted above from International Dictionary of Medicine and Biology may encompass what you are suggesting? kilbad (talk) 02:43, 10 March 2009 (UTC)

Exactly. And you've ordered them from the best on down. Nos. 3 and 4 define any procedure, not especially a medical one: way too much is left out. No. 2 is not bad; No. 1 is best, even pointing at "the object of improving health." I do think that self-care fits the description and that it should be tacitly included, meaning not excluded. - Hordaland (talk) 01:52, 11 March 2009 (UTC)

Agree with #1 but I would do some simplifications a) invert the order, for diagnosis comes before treatment and treatment has (hopefully) outcome of improved health, (b) the "activity directed at or performed on" is needlessly convoluted, indeed the "directed at" suggests analysis of a blood sample might be included which I would reject as being a medical proceedure (c) "treating" disease or injury is itself implying to improve the problem, so the "the object of improving health" seems redundant (d) no proceedure alone "makes a diagnosis", it might confirm or help support the rest of the clinical process (history taking, preliminary tests etc) - so that leaves "An activity performed on an individual to assist with making a diagnosis, or then treat disease and injury."

The #2 is just wrong, for treatment might be taking of oral medication which is hardly a medical proceedure. #3 & #4 fail to specify as medically related, vs say car repair. David Ruben ^Talk 23:55, 30 April 2009 (UTC)

Your suggestion is good except for awkward wording (... or then ...). How about: "An activity performed on an individual for the purpose of making a diagnosis or treating a disease or an injury." - Hordaland (talk) 01:37, 1 May 2009 (UTC)

Yes agree ! much better :-) David Ruben ^Talk 11:36, 3 May 2009 (UTC)

• What is appropriate content for articles pertaining to medical procedures?
  • A good place to start is to look at the articles that have already been identified as high quality, and then reverse engineer from them. I don't see any procedure articles at Category:FA-Class_medicine_articles, but if you go down to B level, you should find several that could serve as models. --Arcadian (talk) 00:54, 19 February 2009 (UTC)
  • I had a chance to review the archives from this page, and found a discussion pertaining to non-drug treatments, which I think might be a starting point for providing a "suggested" structure for procedure related articles. Also, I think articles like Caesarean section provide a decent example of what could be considered appropriate. kilbad (talk) 01:12, 19 February 2009 (UTC)

• What is inappropriate content for articles pertaining to medical procedures?
  • We should be careful to comply with Wikipedia:What Wikipedia is not#Wikipedia_is_not_a_manual.2C_guidebook.2C_or_textbook. --Arcadian (talk) 00:54, 19 February 2009 (UTC)
  • In addition to Wikipedia:NOT#HOWTO, I think guidelines for procedure related articles should briefly reiterate Wikipedia:JARGON and Wikipedia:MEDRS. With regard to references and citations, I think the following quote from WP:MEDRS should be stressed, "In general, Wikipedia's medical articles should be based upon published, reliable secondary sources whenever possible," which I think would cut down on citations like Mohs_surgery#cite_note-pmid15274713-1. kilbad (talk) 03:25, 26 February 2009 (UTC)

• What issues would you like to see addressed with guidelines for procedure-related medicine articles?
  • Need I think to explicitly state for any surgeons or interventionalist medics who might join wikipedia that actual proceedural notes ("divide the lesser x muscle using a small retractor whilst tying off major blood vessels and ensure to proceed infromedialy..." or whatever) are explicitly not the style of an encyclopaedia, per policy of this WP:NOT#MANUAL. Then though to set out how overall approach and intention of the procedure is required, hence Arthroscopy#Knee arthroscopy gets it about right with:
    "During an average knee arthroscopy, a small fiberoptic camera (the endoscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A special fluid is used to visualize the joint parts. More incisions might be performed in order to check other parts of the knee. Then other miniature instruments are used and the surgery is performed."
    - for the details of surface landmarks, mechanical details of how to insert or then hold an endoscope are not set out in what would be needless detail for a general reader. David Ruben ^Talk 11:36, 3 May 2009 (UTC)
    • Perhaps we could create a sentence or two (ultimately for inclusion into MOS:MED) stating how to describe any particular medical procedure? From there, then we can work on the language of the proposed sentences as we did with the basic definition of medical procedure above? ---kilbad (talk) 22:14, 5 May 2009 (UTC)

• Ultimately, where within the Wikipedia:MOSMED document should guidelines for procedure-related articles be placed?
  • In seuence after diagnois tests and drugs - ie between 6.3 and 6.4 ? David Ruben ^Talk 11:36, 3 May 2009 (UTC)
  • I think that this information may need to be divided. The suggested order of sections (compare WP:MEDMOS#Medical_tests should appear where David suggests, but some of the other information (including anything that requires more than one sentence to explain) should probably appear in WP:MEDMOS#Writing_style. WhatamIdoing (talk) 17:00, 3 May 2009 (UTC)

Style, yes please!

WhatamIdoing (talk · contribs) added an excellent section with style recommendations for medical content. Arcadian (talk · contribs) removed it, because it had not been discussed here first. I understand the logic, but I think the recommendations closely reflect previously expressed consensus by other editors. Could we have a quick perfunctory discussion, and then reinstate the excellent recommendations? JFW | T@lk 14:27, 17 April 2009 (UTC)

Agreed. I really like WhatamIdoing's draft content, and support its inclusion. I'd propose some minor edits, such as inserting "abstract," before "conclusions or results", but overall it's an outstanding start. --Scray (talk) 20:28, 17 April 2009 (UTC)

I'm glad that the concept is popular.

I, too, think that it still needs some work -- it was incredibly late when I stopped last night, and it was definitely a case of "stopping" instead of "finishing" -- and I'm grateful to JFW for starting the discussion here.

Scray, I agree with your suggestion above, and I suspect that there are several other issues that should be added. For example, this would be a good place to discuss the deliberate omission of "recommended" drug doses. If there are no objections, perhaps someone will restore the section with a {{Underconstruction|notready=true}} tag so that others can expand/correct/improve for a few days. I think direct editing will be a more efficient system for development at this point (compared to haggling over each sentence here). WhatamIdoing (talk) 02:57, 18 April 2009 (UTC)

With a slight change in the tone, I'd have no objection to the proposal. But we shouldn't be trying to convert this into this. My major concern is that I think I'm seeing an attempt to limit content to what would be of interest to any individual reader. I don't believe that would be in alignment with the precedent or policy of the broader community, and I don't think it would be in concord with the global Wikipedia policies and guidelines. Nobody was asking for an article about Osteochondritis dissecans. Before the article existed, the general reader would have had no interest in it. Yet when it emerged, it was quickly promoted to featured article status. Creating content for "anybody" is not the same as creating content for "everybody". --Arcadian (talk) 05:55, 18 April 2009 (UTC)

Audience and content

I'd like to introduce a quote I read recently, from Arthur Christiansen, a newspaper editor of old:

"It is our job to interest [our readers] in everything. It requires the highest degree of skill and ingenuity."

I like this so much I've added it to my user page. We've set ourselves a hard task and the complex subjects we deal with are, IMO, much harder than biography or literary subjects, for example. I agree with Arcadian that we shouldn't limit our subjects or content to just what already interests our readers, but we need to make sure that whatever we do write will interest our readers. Another quote, from policy (WP:NOT PAPERS):

"A Wikipedia article should not be presented on the assumption that the reader is well versed in the topic's field. Introductory language in the lead and initial sections of the article should be written in plain terms and concepts that can be understood by any literate reader of Wikipedia without any knowledge in the given field before advancing to more detailed explanations of the topic. While wikilinks should be provided for advanced terms and concepts in that field, articles should be written on the assumption that the reader will not follow these links, instead attempting to infer their meaning from the text."

IMO, Osteochondritis dissecans fails this policy requirement and I regret I only found the time to look at and comment on the article after FAC. However, that's a secondary issue, and it is a good example of an obscure topic that WP can cover in detail regardless of reader-demand. My main point is that we don't need to dumb down articles but that we do have to try very hard at making them accessible to the general reader, because that is a policy requirement. Text that can only be understood by a reader who gets the NEJM and BMJ delivered weekly doesn't have a place on Wikipedia. And we are called "editors" for a reason: some bits of information aren't required and actually get in the way of the important stuff.

I think the Style text that WhatamIdoing added is a good addition and worth adopting and working on. Like Arcadian, I think the "bits of information that are unlikely to interest the general reader." rationale isn't a good one but the key aspect of that point was the previous word: "trivial". We don't include trivia that only a medical student would love. Colin°^Talk 21:29, 19 April 2009 (UTC)

Osteochondritis dissecans passed FA six weeks ago, with the assistance of several editors who had no prior experience with the subject, but were able to understand the content because of the article, and edit it into the clearest possible form. That didn't mean reducing it to two paragraphs. The only thing less inaccurate than a blank piece of paper is an unwritten book, but it isn't the role of an editor to unwrite. Because the dispute largely centers around the word trivia, I ask the other editors here to produce a definition of "trivia" that excludes what you want removed but includes the content in the Wikipedia:Featured articles in their current form.--Arcadian (talk) 22:42, 19 April 2009 (UTC)

At this point, I think that we need to start editing, instead of haggling about individual sentences. There's so much that needs to be included -- e.g., that a comprehensive, alphabetized, and bulleted list of every possible symptom or condition that could produce a symptom is dramatically less useful than a paragraph that names the most prominent ones -- that we're no where near the point of copyediting and tweaking. I think that starting with each editor individually fixing whatever s/he dislikes, removing whatever can't be salvaged, and adding major mistakes that s/he's seen in real articles would be much more efficient and productive path towards a decent final product. When we get further along, we can get picky about the details. WhatamIdoing (talk) 01:08, 20 April 2009 (UTC)

Drop "unlikely to interest the general reader" provision. Reading "general reader's" minds reduces encyclopedia to a comic strip. NVO (talk) 02:39, 20 April 2009 (UTC)

I guess that depends on how much contempt you have for the general (that is, non-expert/non-specialist) reader. WhatamIdoing (talk) 15:32, 20 April 2009 (UTC)

Again

About this: So do we think that an encyclopedia article, on, for example, appendicectomy should contain procedural information that can only be interesting to a person that is performing the procedure, such as:

• what equipment should be on hand
• how to sterilize that equipment
• what safety precautions to take
• what kind of stitch to use to sew up the incision

and things like that?

I can see a reader being interested in the details present in this article, such as general anesthesia and where the incision is made. But surely there's a level of detail that quits being encyclopedic and starts being a how-to manual. WhatamIdoing (talk) 03:13, 1 May 2009 (UTC)

That's a false dilemma, and the content you wanted to add was logically incorrect, or at best inchoate. People take MEDMOS very seriously (as the current controversies on the influenza pages make clear) and having sentences like those are worse than having no sentence at all. If you want specific language added, please propose it here before adding it to the guideline. (If you need a counterexample: Sterilization information can be very interesting to the general reader. It is interesting to know why 70% alcohol is better at disinfecting than 95% alcohol, and it is interesting to know what does or doesn't happen when a prion is autoclaved.) --Arcadian (talk) 13:25, 5 May 2009 (UTC)

Sure: sterilization information can be interesting, and we have an entire article on the subject. But do you think it's appropriate and encyclopedic in the context of a specific surgical procedure? For example, do you think that a discussion of ways to sterilize scalpels is important to appendicectomy? Should articles about individual blood tests like ACTH stimulation test include details about how to perform venipuncture and what size vial might be selected?

Based on how you write articles, I don't think you'd include anything like that. In fact, I don't that any experienced editor would consider these details encyclopedic, but I see it occasionally in 'patient education leaflets' of the "What to expect when you go in for this procedure" variety that pretend to be Wikipedia articles.

I don't care about the precise way of saying this, but I think that we need to provide that basic information: Wikipedia is WP:NOTHOWTO and WP:NOTTEXTBOOK, even in medicine-related articles. (Mnemonics, by the way, were previously rejected.) WhatamIdoing (talk) 17:25, 5 May 2009 (UTC)

If you could come up with something along the lines of "you may wish to make sure that" instead of "don't", I'd almost certainly support. For example, for most mnemonics I agree with you, but there are many medical mnemonics that are common and standard enough to be mentioned in journal abstracts, and some are so common that we stop thinking about them as mnemonics and start thinking about them as words. We can usually reason together to get to the right answer, but I'd be concerned about adding language to the guidelines that can be used to end a discussion before it begins. --Arcadian (talk) 19:17, 5 May 2009 (UTC)