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A recent edit by CrescentRidge added a note about examining whether guidelines adhere to The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. It got reverted, but I think we should review this section.
Eubulides first created the section and his text is essentially what is our second paragraph. What are now the first and third paragraphs were added CFCF and tweaked by two others. One problem is that Eubulides was talking about "Statements and information" generally not really about official "guidelines" aimed at medical professionals. The "guides" he mentions are aimed at the public: think NHS advice to the public about coronavirus, thus the qualification that they "have the advantage of being freely readable but are generally less authoritative than the underlying medical literature" is fair enough.
But the added material, which now surrounds this paragraph, is about "Guidelines and position statements provided by major medical and scientific organizations" and "Guidelines by major medical and scientific organizations" (repetition!) The guidelines published by "Medical and scientific organizations" are first mentioned in the "Summarize scientific consensus" section which notes we should present the "prevailing
medical or
scientific consensus, which can be found in recent, authoritative
review articles, in statements and
practice guidelines issued by major professional medical or scientific societies (for example, the
European Society of Cardiology or the
Infectious Disease Society of America) and widely respected governmental and quasi-governmental health authorities (for example,
AHRQ,
USPSTF,
NICE, and
WHO), in textbooks, or in scholarly
monographs.
"
So a reader might confuse these "public guides" with "guidelines for professionals". I'm not in fact seeing much text of any merit in the first and third paragraphs.
I think the " Referencing a guideline" diagram is dubious. There are things on that line that are not clearly distinct or support being ranked. Why is health technology assessment (HTA) at one end. Surely any one of these guidelines could follow that standard. Where does GRADE fit in with that? What is an "Authoratative Editorial Board"? What makes something an "International guideline" other than the nationality of its authors? The diagram dismisses "Patient advocacy groups" as being below the "MEDRS threshold" but that's perhaps more prejudice than fact.
For example, the various guidelines concerning Tuberous sclerosis are published after an international consensus conference, which gets together professionals in the field from around the world. It is supported by TSC International (the Worldwide Organization of Tuberous Sclerosis Complex Associations) which are all fundamentally patient support/advocacy groups. These are the groups who raised the money that pay many of these scientists grants, and which finds the genes and therapies. With Ketogenic diet the best recent recommendations are from the "International Ketogenic Diet Study Group" PMID 29881797 and that group is really just an international collection of top doctors and researchers in the field, encouraged to get together by the Charlie Foundation and Matthews Friends, which are US and UK patient advocacy groups respectively.
I suggest we remove the first and third paragraphs, pending a rewrite, and ditch the diagram. Then reconsider how we discuss "statements and practice guidelines issued by major professional medical or scientific societies". We already encourage their use per the importance of representing consensus. What extra, if anything much, do we need to say? -- Colin° Talk 17:35, 3 August 2021 (UTC)
Hello! I would like to invite additional opinions at Talk:Ginkgo biloba#Removing information about traditional uses of Ginkgo biloba. The discussion concerns how to present information about ginkgo's long use in traditional Chinese medicine without violating WP:MEDRS or misleading readers. Thanks. Nosferattus ( talk) 16:37, 12 August 2021 (UTC)
I tried to add following text: ″Original researches with serious methodological flaws shouldn't be used as sources for their results at all. Such methodological flaws include lack of control group (in case of efficiency if such a trial can be performed with control group without any problems), violations of randomization or blinding procedures and data falsification″ ( [1]). My edit was cancelled with reasonable thoughts that editors can reject sources on their own thoughts about serious methodological flaws.
1. I think we could specify recommendations at least about uncontrolled studies in situations where trials with control group can be performed without any problems. Uncontrolled trials can be perfect for 100% case fatality rate disease, but in common diseases such studies can be very biased and cannot be used to determine efficiency.
2. We can add disclaimer about serious methodological flaws with remark that such flows must be specified in other reliable sources.
--
D6194c-1cc (
talk)
05:17, 18 August 2021 (UTC)
2. We can add disclaimer [...] that such flows must be specified in other reliable sources.I disagree with this one. In most cases it's obvious that the study in question lacks certain methods or approaches. Additional references proving that are always welcome though. No need for specific provisions for that. AXONOV (talk) ⚑ 08:17, 4 September 2021 (UTC)
Above,
Talpedia writes One case that seems interesting for me is extremely large epidemiological studies with little interpretation. E.g. "the prevalence of heart attack is 1%". You often won't get many such studies so they are not necessarily reviewed, and can almost constitute government data if say, the UK's NHS released their data for statistics.
. This reminded me of when I looked at the Epidemiology at
Chronic obstructive pulmonary disease and wrote up some comments on the
talk page. (still haven't found the time to revise it). Firstly that experience supports the "you often won't get many such studies". In that case there was the Global Burden of Disease study, the WHO data, and there was also some UK data. These are periodically/haphazardly updated. But I question the "studies with little interpretation". Perhaps heart attack is more clear-cut, but with COPD there seemed to be huge variation in how the disease is diagnosed (both methods used and criteria used) and variability from country-to-country about how reliably it was diagnosed. If a disease is significantly under-reported, the meaning of a % figure is questionable.
Then there's the matter that these huge studies don't actually perform a census and get everyone in the country to tick a box saying what dreadful diseases they have. And they don't examine every death certificate for cause of death. They sample, extrapolate and manipulate the figures, and out pops a number like 3.1 million deaths. That looks like a simple, easy to understand number. If I tell you that next decade there were 2.9 million deaths you might conclude the deaths were falling, and an editor might engage in original research and claim as much. But if the confidence interval on those estimates was 2.9-3.3 and 2.7-3.2 then we might more reasonably conclude we don't know, as the change is within expected sampling noise. (I'm no statistician, so forgive me if I'm making mistakes or explaining this wrongly). Even just telling the reader that the numbers were 3.1 million and then 2.9 million next decade is suggesting to them that there is a change, and that we do know the numbers to two significant figures. Perhaps the experts really believe the number is closer to 4 million if it weren't so under-diagnosed. Better perhaps to just write 3 million.
So what value do the reviews or other secondary sources provide? It is a mixed picture. One review I looked at made a mistake (IMO) with the numbers, and it would have been bad if we'd used those numbers. But likely both the Global Burden and the WHO numbers are fairly well respected and one could pick either. A reviewer may pick the larger number if they want to make it look like the disease was more important. Or they might pick numbers that demonstrate a trend they want to discuss. The GOLD report hinted that they thought the WHO data was poor, but didn't go into much detail as to why. Certainly I struggled to find the confidence intervals for the WHO figures. WHO's own fact sheets were variable in quality. An old one that we had used claimed a similarity between sexes that wasn't supported by the data IMO, and newer fact sheets don't make that claim.
I wished the GOLD reports had more detailed data, with which to say more in our article. But perhaps they know the data is weak and best not examined or discussed in detail? I feel that statistics are hard enough that both reviewers and Wikipedians can get them wrong, and that it is easy to mislead the reader with numbers that are too precise, or to claim the numbers are an actual count of people with a disease rather than crude estimates.
Anyone got any other experiences here, or opinions? -- Colin° Talk 09:28, 5 September 2021 (UTC)
Articles should rely on secondary sources whenever possible. For example, a paper reviewing existing research, a review article, monograph, or textbook is often better than a primary research paper. When relying on primary sources, extreme caution is advised. Wikipedians should never interpret the content of primary sources for themselves. The danger with easy access to so much primary data, whether disease statistics or drug prices, is that history tells us Wikipedians will interpret it, invent their own calculations, claim illusory precision and confidence, juxtapose incompatible figures, and neglect to mention important caveats. The "extreme caution" warning gets neutralised by illusory superiority, where editors think they are careful and clever enough. It is frustrating when the secondary literature doesn't mention interesting stuff, or facts we personally consider important, but I think that's just one of the things we have to accept on Wikipedia that makes it different to other publishing platforms. -- Colin° Talk 17:07, 5 September 2021 (UTC)
Elsevier journal Toxicology Reports appears to publish pseudoscience (via Sj). We have a dozen articles citing it. Nemo 06:49, 25 September 2021 (UTC)
More information: https://blogs.harvard.edu/sj/2021/09/30/journal-level-fraud-elsevier-fakes-peer-review-of-covid-click-bait/ Nemo 14:50, 1 October 2021 (UTC)
At Talk:Julian_Assange#Mini-stroke the inclusion of a report by the fiancee of a person that he suffered a mini-stoke and had an MRI and is on medication is being opposed on the basis that it is a medical conditio,, to quote ""Any medical information should come from a qualified professional who has examined Assange." Is this true? NadVolum ( talk) 12:19, 16 December 2021 (UTC)
This text of mine is copied from a discussion on Talk:Cannabis_(drug)#"Inappropriate"_source. I'm tossing it out just because I'd be interested in what opinions or approaches people here might have on this general topic.
>>>>>>>>>>>>>>
Here, and in WP:BMI, I totally get now that the consensus is that text in Wikipedia stating "facts" about cannabis needs to have a WP:MEDRS quality reference. Although I don't totally agree, I have no trouble adhering to that.
However (and this is explicitly a *personal opinion*), a whole bunch of scientific secondary references (including ones meeting WP:MEDRS) are in fact shit. E.g., they may cite a lame and invalid primary study without any actual evaluation (thus propagating false material). They may take speculative conclusions ("possible relationship" or "potential link") in a primary source and state it as a fact. Now, as a semi-professional I can find stuff in WP:MEDRS secondary sources that are blatently inaccurate, but Wikipedia requires them to be taken as absolute encyclopedia truth (note that I am *not* arguing against WP:NOR; I totally approve of it).
Also: although "The Pot Book" is a lay-oriented book and doesn't technically meet WP:MEDRS, it was edited by an MD/psychiatrist, Julie Holland. Some of the articles are solid articles by academic writers ( e.g., the Kirkpatrick and Hart chapter I originally cited), and some are not "science" (e.g., Julie Holland's interview with Tommy Chong). However, the Kirkpatrick and Hart article (*read the entire article* before you criticize it) does meet WP:Verifiability by my standards, and, IMO, ought to qualify for WP:MEDRS (but doesn't). I believe there was a comment above that stated the the Kirkpatrick article was problematic because some sentences didn't cite references. That is also frequently true of WP:MEDRS qualifying secondary sources.
The above is not an attempt to argue against WP:MEDRS, but just a description of some of its weaknesses. And I'd be interested in people's opinions about whether there are any ways to address these problems.— Preceding unsigned comment added by Finney1234 ( talk • contribs) 04:34, 4 December 2021 (UTC)
I mostly agree with AXONOV's comment at 22:06, 3 December 2021 (UTC) on the other discussion page):
I've checked the book ( The Pot Book). Generally speaking the source in question (added on [21:05, December 1, 2021]) in fact cites some primary studies (like [1]). However, the attributed text (worded a bit differently), which is mentioned on the page 28 under the SUBJECTIVE EFFECTS IN THE LABORATORY subtitle, does not contain any specific attributions... The same goes for the phrase rapid onset in a context of use of Sativex on the page 219 (NEUROPATHIC PAIN subtitle) - no attribution given. I conclude that claim is mostly speculative. On the other side I don't see how WP:BMI/ WP:MEDRES applies here... It's certainly not a curative effect. But I would propose to bring a better source on that anyway...
My only quibble is that I see the psychoactive effects of cannabis falling under WP:BMI and WP:MEDRS.
"The Pot Book" was written for a lay audience, therefore it doesn't qualify as a reputable textbook, treatise, or scholarly book. However, that does not mean it is "junk". In fact, it contains book chapters written by biomedical researchers and scholars from a range of disciplines. Like most edited books, quality varies, but it's much more grounded in science than the many "wonders of weed" books on the market. I would perhaps use "The Pot Book" as a jumping off point in my search for reliable sources.
I wholeheartedly agree that in the United States (and elsewhere) we have cut off our nose to spite our face with regard to cannabis. While we reduced cannabis consumption in the 1980s, we continued to essentially ban research on marijuana and we lied about marijuana so much and for so long that Americans born in the 1990s onward have a hard time trusting anything our government says about cannabis, even if it comes from leading researchers who don't have a political agenda.
Finney1234 - You are a really good writer and have obviously worked long and hard to add a lot of valuable content to Wikipedia. And you seem to have an open mind and you seek to understand along with seeking to be understood. There are a couple of relatively minor aspects of MEDRS that I don't agree with, and there are a handful of editors who use the policy to bludgeon others into submission or to justify their authoritarian behavior (I am not referring to Alexbrn), but they are a very small minority. Over all, WP:MEDRS is a thoughtful, conscientious, and well-reasoned set of policies and guidelines. All the best, Mark D Worthen PsyD (talk) [he/his/him] 07:13, 4 December 2021 (UTC)
[…] psychoactive effects of cannabis falling under WP:BMI and WP:MEDRS
Mark D Worthen PsyD Thanks! However, my personal (and semi-professional) opinion is that some Wikipedia articles (like the current version of Cannabis_(drug) ) have a huge non-factually-based negative bias. I'm just trying to work on making it more factually based (and WP:neutral) to match Wikipedia guidelines. Some editors apparently think this approach is WP:WL. Finney1234 ( talk) 23:11, 4 December 2021 (UTC)
I propose to close this discussion and tag it as {{ moved}} per duplicate (the same policy is being discussed): WP:BMI#Is this biomedical information. Objections? -- AXONOV (talk) ⚑ 10:25, 4 December 2021 (UTC)
Warning: this section has turned into a long contentious discussion, but the key issue (providing a simple example of a (plausibly) WP:MEDRS review article that is factually flawed, which was all I was trying to demonstrate) is covered in the very first section.
_____________________
This first example is provided in response to User:Alexbrn's request above.This secondary source has been an ongoing issue at Cannabinoid hyperemesis syndrome (CHS). This is an example of what I expect is a valid WP:MEDRS secondary source (BMJ: British Medical Journal) that uncritically cites a lame primary study. See the CHS article and Talk page for discussion and fuller references (e.g., if I've mistyped the DOI's below. Please correct or expand the references if you can).
Background: CHS is a nasty, sometimes fatal (at least 5 reported deaths) syndrome that sometimes occurs in heavy cannabis users. The acute symptoms involve very serious nausea and vomiting that often requires emergency room (ER) care. Exceedingly hot showers or baths are reported to help relieve the symptoms.
In Habboushe et al, 2018 , Journal = "Basic and Clinical Pharmacology and Toxicology", (DOI 10:1111/bcpt.12962), 155 emergency room (ER) patients who admitted to cannabis use (but were *not* currently in the ER for nausea or vomiting problems) were asked to rate (on a 0-10 Likert scale) whether a hot shower or bath had been helpful when they had previously had cases of nausea or vomiting. 33% of the subjects rated the helpfulness level of hot showers at 5 or higher. Habboushe concludes that about 33% of daily marijuana users in the US (so: about 27,000,000 users) are likely to suffer from CHS (with the explicit caveat "...if this is extractable to the general population").
Chocron et al., 2019, Journal =BMJ (DOI 10.1135/bmj.14336) (a WP:MEDRS-qualifying secondary source, I believe) cites this result uncritically: "Extrapolating those results to the population of the United States, it is estimated thatcounty 2.1-3.3 million people might suffer from CHS annually".
Some issues with the (primary source) Habboushe study:
Also, given the seriousness of CHS, 2.7 million sufferers would have overwhelmed the ER's in the US. But it obviously hasn't. So: this is a blatantly incorrect published claim.
However, because Chocron et al. is (I believe) a WP:MEDRS source (much more strictly defined than WP:Verifiability), it is virtually impossible to argue for its falseness, because that would be WP:NOR.
Again, I'm not trying to argue here that WP:MEDRS should be changed to reflect this issue, but I am interested in people's perspectives on it. I couldn't avoid dealing with the issue when editing the CHS article. Finney1234 ( talk) 09:48, 4 December 2021 (UTC)
From talk section higher up:
Just as an addendum to this Finney1234, if you're interested in a WP:MEDRS-quality debunking of the Habboushe primary source you dislike so much, check out PMID:31241817, a systematic review. Once again, and as Markworthen observes, the way out of problems like this is to find better sources! Alexbrn ( talk) 13:40, 7 December 2021 (UTC)
An email from the suspect says she didn't do it. Therefore, she didn't do it. That's exactly how we do things on Wikipedia. And the community is fine with it. Discussion probably soon to be archived, but for now it's here. Talk:COVID-19 lab leak theory#RfC about how we should use the Frutos source. The underlying sources are these: [9] [10] Adoring nanny ( talk) 19:50, 6 January 2022 (UTC)
An RFC related to a conflict on the use of WP:MEDRS sources on this topic has been posted at Talk:Cannabis_(drug)#RFC:_Cannabis_overdose. Please feel free to chip in, whatever your opinion. Finney1234 ( talk) 18:19, 7 January 2022 (UTC)
|lay-date=
, |lay-format=
, |lay-source=
, and |lay-url=
have been deprecated. If a 'lay' source is important to an article, it should be given its own citation with all of the appropriate bibliographic detail. |lay-url=
is recommended at
WP:MEDPOP:
|lay-url=
parameter of {{
cite journal}}."That recommendation should be reconsidered.
— Trappist the monk ( talk) 16:55, 26 January 2022 (UTC)
Trappist the Monk would you please:
The recommendation now being made Template:Cite journal#Lay summary is to separately cite the lay article, which encourages novice editors to breach WP:MEDRS by using lay sources. The lay source parameters were designed, and intended, to work with MEDRS by adding a lay source only to a journal citation which conforms to MEDRS, thereby allowing a more accessible explanation to readers. (I believe it may have been designed or added by User:Eubulides, who helped develop MEDRS and wrote several medical FAs, but has been gone for ten years now; I could be wrong on that.)
Examples of how the lay parameters are used can be seen in many medical articles (I know not how to go about finding all of its uses in medical content). Encouraging editors to directly cite the lay press in medical content is unwise; the parameter was specifically intended to provide for an add-on to a MEDRS-compliant source, while not replacing a MEDRS-compliant source. A useful parameter has been removed. Why? We should not be encouraging direct citations to the laypress in medical content; as can be seen in the examples below, the lay parameters allowed for an additional link to aid readers who may not have journal access, or who may find it difficult to digest journal writing.
{{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help)SandyGeorgia ( Talk) 18:06, 26 January 2022 (UTC)
This wording has been written into this very widely used and cited guideline with
One possibility is to cite a higher-quality source along with a more-accessible popular source, for example, with the
|lay-url=
parameter of {{ cite journal}}.
since at least the end of 2008 (that's a lot of years on a highly used guideline for a couple of editors to be undoing). WP:MEDRS has 389 page watchers, and has included the text about the lay source parameter, with text unchanged for all those years. The cite journal template page has 130 watchers, but editors there feel empowered to make such a change without notifying this page.
When deprecating a parameter with such wide and long-standing acceptance, why was this page not notified of the proposal? This de facto, fait accompli method of operating on citation templates should be addressed by the community more broadly. SandyGeorgia ( Talk) 19:47, 26 January 2022 (UTC)
First, I think it's important to remember that this isn't an emergency. The parameters are still there, and they're still working. Also, almost none of our readers actually click on a ref, so even though the danger–danger-danger red text is there, it's mostly editors like us who will notice it.
Second, I think there are several ways to accomplish the goal.
I think that any of these could work, and I think that the last has some advantages over the traditional approach in terms of WP:LINKROT risks. WhatamIdoing ( talk) 04:20, 27 January 2022 (UTC)
It worked. As designed. By a prolific content writer, who also spoke geek and helped write MEDRS. I look forward to seeing all of that above written in to MEDRS. SandyGeorgia ( Talk) 04:32, 27 January 2022 (UTC)One possibility is to cite a higher-quality source along with a more-accessible popular source, for example, with the
|lay-url=
parameter of {{ cite journal}}.
{{cite journal ... |lay-url= |lay-date= |lay-source=}}
{{cite journal and summary ... |lay-url= |lay-date= |lay-source=}}
|lay-url=
family of parameters before, but I see how they're useful. I like WAID's option #3 quite a bit, and if this is the new normal, I think we could formalize in
WP:MEDRS that providing a separate lay source in this manner is acceptable. If we go with this, I assume a bot could convert citations to this new format to prevent anyone from "fixing" the citations by manually removing the lay sources.
Ajpolino (
talk)
18:07, 28 January 2022 (UTC){{
lay source}}
. Rewriting the lay summary part of Editor WhatamIdoing's example 3 using {{lay source}}
gives this:
{{lay source |template=cite news|last=Dasgupta |first=Shreya |date=20 April 2015 |title=Why do women have periods when most animals don't? |url=https://web.archive.org/web/20210801180159/http://www.bbc.com/earth/story/20150420-why-do-women-have-periods |work=BBC Earth}}
{{
sfn}}
and similar templates. |template=
accepts the name of any of the standard cs1|2 templates so if a good lay source is in a book, it can be noted with this template; |url=
not required.|template=
parameter is. Does it matter?
WhatamIdoing (
talk)
01:15, 30 January 2022 (UTC)
|doi=
, |volume=
, |issue=
, etc; or suppose that the lay source is a chapter in a text book; |chapter=
and possibly |chapter-url=
might apply; suppose that the lay source is in a conference proceedings.... Telling {{
lay source}}
which of the cs1|2 templates to use ensures that the rendering is correct for the source you are !citing. Default when |template=
is omitted is {{
cite web}}
.Having removed the MEDRS-compliant lay-url, over at the citation template discussion, the best I can decipher, an IP is rewriting MEDRS to their own interpretation of how to use laysources, with statements like “lay sources that pass RS should be preferable”. Help_talk:Citation_Style_1#A_proposal SandyGeorgia ( Talk) 05:45, 28 January 2022 (UTC)
There is a medical sourcing discussion related to toxicology at Wikipedia:Village_pump_(policy)#In_general,_are_animal_and_in_vitro_studies_acceptable_sources_to_support_toxicology_statements?. MarshallKe ( talk) 18:50, 8 March 2022 (UTC)
Christopher J Blunt wrote in 2015 a PhD Thesis dedicated to evaluate the usefulness and limitations of hierarchies of evidence on the clinical practice. As part of his work, he freely published a systematic compilation of hierarchies of evidence up to 08/10/2020 [12]. This may be useful for MEDRS which only currently suggests 2 hierarchies (which may produce the illusion that there are only 2 competing hierarchies, when there are at least 195 from various institutions worldwide). Maybe just adding a link would be good so that the curious reader can dig further into the subject if they so wish. Best regards. -- Lyrono ( talk) 05:34, 6 April 2022 (UTC)
"Be careful of material published in disreputable journals or disreputable fields. (See: Sokal affair.)"
I'm not sure what the link to the Sokal affair article is doing here? The implication seems to be either that Social Text is a disreputable journal or Postmodernism a disreputable field. Whatever opinion one may have of Social Text, it remains a relatively popular and prominent journal in it's field. At bare minimum it is certainly considered reputable in the field. And postmodernism is... just not a "disreputable field", whatever that would mean? I'd love some clarification here, otherwise I think this should be removed. -- Donna's Cyborg ( talk) 19:47, 10 May 2022 (UTC)
How should we handle articles like Aromaticum rosatum, which only cite to one ancient source? BD2412 T 05:54, 5 August 2022 (UTC)
Eyes would be helpful at COVID-19 vaccine and Talk:COVID-19 vaccine, where some editors and IPs continue pressing non-MEDRS sources in support of theories about the vaccines. Cheers! BD2412 T 20:17, 26 November 2022 (UTC)
For your consideration, an essay I came across on social media today: The rise and fall of peer review
I have occassionally been bothered by an editor's excessive credulity for peer-reviewed papers based just on the mere fact of their having been reviewed, but this essay explores the topic more incisevely than I could hope to. Sennalen ( talk) 17:09, 14 December 2022 (UTC)
You are invited to join the discussion at
WP:MCQ § Proactive request for input. --
Marchjuly (
talk)
19:44, 23 February 2023 (UTC)
The inline text acknowledges that the figure on the left at WP:MEDASSESS in this article has been deprecated and that the source now presents a pyramid that differs in important ways from the one in the figure. Would it be possible for somebody to clean this up? (Deleting the left figure would be the simplest fix.) sbelknap ( talk) 13:05, 28 December 2022 (UTC)
Assess evidence quality
When editors are writing about treatment efficacy, epidemiology, survival rates, and similar subjects, evidence quality helps editors distinguish between minor and major views, determine due weight, and identify accepted information. Even within the same journal, different types of papers should not be given equal weight. Research studies can be categorized into different levels of evidence. [1] There are multiple accepted models for ranking evidence levels, but they all rank sources that combine the results of multiple research studies higher than other types of sources.
Wikipedia editors should rely on sources that offer higher levels of evidence, such as systematic reviews, meta-analyses of randomized controlled trials, narrative reviews, medical guidelines, and position statements by internationally or nationally recognized expert bodies (see WP:MEDORG).
Sources that present lower levels of evidence or non-evidence should be avoided. Lower levels of evidence in medical research come from primary sources (see WP:MEDDEF). Roughly in descending order, these include: individual randomized controlled trials; quasi-experimental studies; prospective observational (non-experimental) studies, such as prospective cohort studies (one type of longitudinal study); case control studies; cross-sectional studies (surveys), and other correlation studies such as ecological studies; case reports, other retrospective analyses (including retrospective cohort studies); and non-evidence-based expert opinion, clinical experience, or conventional wisdom.
Speculative proposals and early-stage research should not be cited to imply wide acceptance. For example, results of an early-stage clinical trial would not be appropriate in the 'Treatment' section of a typical disease article, because possible future treatments have little bearing on current practice. The results might, in some cases, be appropriate for inclusion in an article specifically dedicated to an experimental drug or procedure in question, or to the researchers or businesses involved in it. Such information, particularly if analyzed by secondary sources, may be appropriate in research sections of disease articles. To prevent misunderstanding, the text should clearly identify the level of research cited (e.g., "first-in-human safety testing").
Note: Editors should not perform detailed academic peer review. "Assess evidence quality" means that Wikipedia editors should identify and use the appropriate type of source and quality of publication for the subject at hand. Do not reject a higher-level source (e.g., a meta-analysis) in favor of a lower one (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source.
References
This is about [13]. It might sound funny, but The Lancet has less draconian editorial standards than Wikipedia. E.g. WP:PRIMARY medical studies are allowed to make medical claims. tgeorgescu ( talk) 03:33, 23 April 2023 (UTC)
Reminds me of mortgage-backed securities helping cause the 2007-2009 Great Recession. Wrapping crap up in fancy paper with a bow. We need people with money to pay all medical journals to make everything open access. Including the mega-problematic anonymized individual participant data (IPD). Then peer review would consist of millions of readers, and Wikipedia editors who aren't easily fooled.
Medicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed? By Richard Van Noorden. July 18, 2023. Nature. Subheading: Investigations suggest that, in some fields, at least one-quarter of clinical trials might be problematic or even entirely made up, warn some researchers. They urge stronger scrutiny.
But faked or unreliable RCTs are a particularly dangerous threat. They not only are about medical interventions, but also can be laundered into respectability by being included in meta-analyses and systematic reviews, which thoroughly comb the literature to assess evidence for clinical treatments. Medical guidelines often cite such assessments, and physicians look to them when deciding how to treat patients. ... His work has had a wide impact: researchers found that 27 of Sato’s retracted RCTs had been cited by 88 systematic reviews and clinical guidelines, ... “Untrustworthy work must be removed from systematic reviews,” says Stephanie Weibel, a biologist at the University of Wuerzberg in Germany, who co-authored the review. |
-- Timeshifter ( talk) 06:31, 20 July 2023 (UTC)
Basically, only aspirin and tamoxifen seem to be at all beneficial in high-risk individuals, and even those drugs shouldn't be encouraged as preventative measures in non-high-risk people. JoelleJay ( talk) 23:43, 20 July 2023 (UTC)Chemoprevention employs pharmaceutical agents to reduce the likelihood of disease progression, predicated on the assumptions that individuals at risk can be identified, we understand progression and we have effective agents.
In the case of cardiovascular disease (CVD), these assumptions largely hold but for cancer chemoprevention, although we can identify some high-risk individuals, most potential agents have been identified by inference from epidemiologic or laboratory studies; we have a multiplicity of theories of carcinogenesis that do not provide clear understanding of what is causal (1) and, thus, an incomplete understanding of the role these agents might play in cancer.
As a result, cancer chemoprevention is an almost universal failure.
There are enthusiasts for the possibilities of cancer chemoprevention (2) but they have been selective about their review of the evidence as I will show below.
Effects of vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries: A systematic review. 26 June 2021. https://doi.org/10.1002/cl2.1127 - Campbell Systematic Reviews. "The findings suggest that MMN [multiple micronutrient] and vitamin supplementation improve maternal and child health outcomes, including maternal anaemia, LBW, preterm birth, SGA, stillbirths, micronutrient deficiencies, and morbidities, including pre-eclampsia/eclampsia and diarrhea among children. MMN supplementation demonstrated a beneficial impact on the most number of outcomes. In addition, MMN with >4 micronutrients appeared to be more impactful than MMN with only 3 or 4 micronutrients included in the tablet." -- Timeshifter ( talk) 04:19, 22 July 2023 (UTC)
Believe it or not, my posts were not about you. And I have no conflicts of interest. I learned a lot from this exchange, and the web reading I did. I found various trials of multivitamins, multiminerals, etc.. that got positive results. But I didn't want to clutter up the page with single trials.
What I learned is that the best trials broke down the results by subgroup. Then there were some positive significant results. But if the results were measured and averaged out for the group as a whole, then then there may have still been a positive result. But not a significant one. Because of the averaging.
It makes sense. Especially if your group includes people of all incomes in a developed western country spread out across the country. But if you do studies of people with higher nutritional needs, like pregnancy, or poor people living in food deserts. Or people in poorer countries or regions. Or people getting their food from poor soils in densely populated regions. Or old people in nursing homes. Etc., etc.. Or people who are sick.
I could go on and on, but I don't want to waste the time of people on this forum. And people who take multivitamins, etc. are mostly taking them as insurance. The shotgun approach. You never know if your particular genetics may need them. Or if you are beginning to get sick, etc.. Or you are someone who needs the higher limits of the RDAs, but foods no longer provide as many nutrients as before.
It don't want to argue with people who don't see the value of organic food, and avoiding synthetic additives. More and more studies show doing both help. But I remember decades ago when few studies were done. Because you can't patent anything to make money from the knowledge. But the logic is obvious. Every year more additives are found to be dangerous. Every year more medical conditions are found to be improved in some way by some nutrients.
From my first post: "We need people with money to pay all medical journals to make everything open access." Then we all can provide constructive criticism. Like why are you not breaking down your huge group into subgroups. Why aren't you doing a systematic review of trials with those subgroups. -- Timeshifter ( talk) 03:38, 23 July 2023 (UTC)
Some multivitamin/multimineral studies with positive results are found here:
Scroll down to the section called: "Who May be at Risk for a Nutrient Deficiency?" it says: "Certain groups are at higher risk for a nutrient deficiency:" It lists them.
Scroll down to "Multivitamins and Health". It says: "There is no arguing that multivitamins are important when nutritional requirements are not met through diet alone."
Then scroll down to this paragraph near the end:
For many diseases, but especially for cancer, only long-term trials are informative. The following studies looked at the effect of multivitamins on specific diseases and included healthy people as well as those with chronic diseases at the start of the study:
Click the 4 dropdowns for: Cancer. Cardiovascular disease. Mortality. Cognitive Health. Positive results for 2:
Cancer:
A randomized double-blind placebo-controlled trial provided a multivitamin or placebo to more than 14,000 male physicians, some with a history of cancer. After 11 years, the men taking a MVI had a significant 8% reduction in total cancers, compared with men taking a placebo. The results did not differ among men who had a history of cancer at the start of the study and men who were healthy at baseline.
Cognitive Health:
The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a large randomized controlled trial that followed more than 21,000 older men and women (≥60 and ≥65 years, respectively) ... Results showed that taking a daily multivitamin-mineral supplement improved memory and executive functioning (e.g., time management, planning, self-monitoring) more than a placebo. The benefit appeared strongest for participants with a history of cardiovascular disease (CVD);
There is some contradictory info above those positive results. The difference seems to be "only long-term trials are informative."
This is a very useful caveat as to whether a systematic review is the final word on something. Was it a systematic review of short-term studies?
Concerning systematic reviews the more transparency the better. We need funding to make all medical journals and studies open access. The Nature article in my original thread post said: They urge stronger scrutiny.
Billionaires and the government need to put money in this area. Researchers make many mistakes. More readers and reviewers allows more useful feedback. And it makes healthcare more effective. Especially, cost effective. -- Timeshifter ( talk) 22:39, 25 July 2023 (UTC)
I'm not sure if this is the right place to ask this. Here's an example, from Dandelion coffee:
Dandelion root has been linked to a possible treatment for cancer.
The source for this is strictly primary. There are many similar statements on other pages about, generally, plants. Does this not violate WP:MEDRS? ByVarying | talk 01:46, 12 August 2023 (UTC)
I would like to seek clarification on whether MEDRS are required in a section on the activities of an environmental NGO working on, for example, toxic chemicals and drinking water contamination. My interpretation is that the second example in WP:MEDRS#Biomedical v. general information is pretty comparable, as long as the content is what they do, rather than what they have proven. Wikipedia:Biomedical information does not contradict this interpretation either. (The situation would obviously be different if an NGO's publications on such a topic were used in articles on chemicals as sources of information on, for example, their effects or human exposure.) -- Leyo 08:55, 23 September 2023 (UTC)
HealthNewsReview.org is now defunct. Are there any good alternatives?
In the meantime, I am removing from the article all mentions of this website. Thatsme314 ( talk) 06:38, 10 November 2023 (UTC)
Why does the SUNY Downstate picture need an update? Thatsme314 ( talk) 08:25, 10 November 2023 (UTC)
Does MEDRS apply to the content in this section?
Does Wikipedia:Biomedical information sufficiently address a scenario such as this? SandyGeorgia ( Talk) 10:28, 17 November 2023 (UTC)
It also discusses a junk article published by Sage Publishing. Doug Weller talk 14:02, 30 January 2024 (UTC)
Hello, I've been looking at a recent significant piece of investigative journalism that talks about health effects that manifested in connection with meditation retreats. Can such reporting be included in Wikipedia? At the Help Desk, I've been advised that the journalistic piece doesn't prove cause and effect. But neither does the story claim to prove cause and effect! It is a reliable source not from a medical standpoint but from a journalistic standpoint. Can you help me make the distinction clearer for readers? Arided ( talk) 10:25, 15 February 2024 (UTC)
"News media play critical roles in public understandings of health issues. Media presentation of scientific evidence seems to involve the 'facts', which are then discussed and interpreted by various 'experts'. From an ethnomethodological or social constructionist perspective, however, news 'facts' themselves are socially constituted. Examining how health science is reported thus offers important insight into the social construction of health policy problems. We offer an interpretive account of United States newspaper coverage of passive smoking during a time in which several major scientific studies of the issue were conducted and reported upon. We argue that newspaper journalists, through the use of several rhetorical devices, constructed an account of the passive smoking issue in which scientific 'facts' were less important than moral 'facts'. Rather than (or sometimes, in addition to) explicating science, newspaper coverage conveyed a moral narrative highlighting tensions between American cultural values of individual liberty and protection of the public health." — " Science in the News: Journalists' Constructions of Passive Smoking as a Social Problem"
![]() | This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 25 | ← | Archive 29 | Archive 30 | Archive 31 |
A recent edit by CrescentRidge added a note about examining whether guidelines adhere to The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. It got reverted, but I think we should review this section.
Eubulides first created the section and his text is essentially what is our second paragraph. What are now the first and third paragraphs were added CFCF and tweaked by two others. One problem is that Eubulides was talking about "Statements and information" generally not really about official "guidelines" aimed at medical professionals. The "guides" he mentions are aimed at the public: think NHS advice to the public about coronavirus, thus the qualification that they "have the advantage of being freely readable but are generally less authoritative than the underlying medical literature" is fair enough.
But the added material, which now surrounds this paragraph, is about "Guidelines and position statements provided by major medical and scientific organizations" and "Guidelines by major medical and scientific organizations" (repetition!) The guidelines published by "Medical and scientific organizations" are first mentioned in the "Summarize scientific consensus" section which notes we should present the "prevailing
medical or
scientific consensus, which can be found in recent, authoritative
review articles, in statements and
practice guidelines issued by major professional medical or scientific societies (for example, the
European Society of Cardiology or the
Infectious Disease Society of America) and widely respected governmental and quasi-governmental health authorities (for example,
AHRQ,
USPSTF,
NICE, and
WHO), in textbooks, or in scholarly
monographs.
"
So a reader might confuse these "public guides" with "guidelines for professionals". I'm not in fact seeing much text of any merit in the first and third paragraphs.
I think the " Referencing a guideline" diagram is dubious. There are things on that line that are not clearly distinct or support being ranked. Why is health technology assessment (HTA) at one end. Surely any one of these guidelines could follow that standard. Where does GRADE fit in with that? What is an "Authoratative Editorial Board"? What makes something an "International guideline" other than the nationality of its authors? The diagram dismisses "Patient advocacy groups" as being below the "MEDRS threshold" but that's perhaps more prejudice than fact.
For example, the various guidelines concerning Tuberous sclerosis are published after an international consensus conference, which gets together professionals in the field from around the world. It is supported by TSC International (the Worldwide Organization of Tuberous Sclerosis Complex Associations) which are all fundamentally patient support/advocacy groups. These are the groups who raised the money that pay many of these scientists grants, and which finds the genes and therapies. With Ketogenic diet the best recent recommendations are from the "International Ketogenic Diet Study Group" PMID 29881797 and that group is really just an international collection of top doctors and researchers in the field, encouraged to get together by the Charlie Foundation and Matthews Friends, which are US and UK patient advocacy groups respectively.
I suggest we remove the first and third paragraphs, pending a rewrite, and ditch the diagram. Then reconsider how we discuss "statements and practice guidelines issued by major professional medical or scientific societies". We already encourage their use per the importance of representing consensus. What extra, if anything much, do we need to say? -- Colin° Talk 17:35, 3 August 2021 (UTC)
Hello! I would like to invite additional opinions at Talk:Ginkgo biloba#Removing information about traditional uses of Ginkgo biloba. The discussion concerns how to present information about ginkgo's long use in traditional Chinese medicine without violating WP:MEDRS or misleading readers. Thanks. Nosferattus ( talk) 16:37, 12 August 2021 (UTC)
I tried to add following text: ″Original researches with serious methodological flaws shouldn't be used as sources for their results at all. Such methodological flaws include lack of control group (in case of efficiency if such a trial can be performed with control group without any problems), violations of randomization or blinding procedures and data falsification″ ( [1]). My edit was cancelled with reasonable thoughts that editors can reject sources on their own thoughts about serious methodological flaws.
1. I think we could specify recommendations at least about uncontrolled studies in situations where trials with control group can be performed without any problems. Uncontrolled trials can be perfect for 100% case fatality rate disease, but in common diseases such studies can be very biased and cannot be used to determine efficiency.
2. We can add disclaimer about serious methodological flaws with remark that such flows must be specified in other reliable sources.
--
D6194c-1cc (
talk)
05:17, 18 August 2021 (UTC)
2. We can add disclaimer [...] that such flows must be specified in other reliable sources.I disagree with this one. In most cases it's obvious that the study in question lacks certain methods or approaches. Additional references proving that are always welcome though. No need for specific provisions for that. AXONOV (talk) ⚑ 08:17, 4 September 2021 (UTC)
Above,
Talpedia writes One case that seems interesting for me is extremely large epidemiological studies with little interpretation. E.g. "the prevalence of heart attack is 1%". You often won't get many such studies so they are not necessarily reviewed, and can almost constitute government data if say, the UK's NHS released their data for statistics.
. This reminded me of when I looked at the Epidemiology at
Chronic obstructive pulmonary disease and wrote up some comments on the
talk page. (still haven't found the time to revise it). Firstly that experience supports the "you often won't get many such studies". In that case there was the Global Burden of Disease study, the WHO data, and there was also some UK data. These are periodically/haphazardly updated. But I question the "studies with little interpretation". Perhaps heart attack is more clear-cut, but with COPD there seemed to be huge variation in how the disease is diagnosed (both methods used and criteria used) and variability from country-to-country about how reliably it was diagnosed. If a disease is significantly under-reported, the meaning of a % figure is questionable.
Then there's the matter that these huge studies don't actually perform a census and get everyone in the country to tick a box saying what dreadful diseases they have. And they don't examine every death certificate for cause of death. They sample, extrapolate and manipulate the figures, and out pops a number like 3.1 million deaths. That looks like a simple, easy to understand number. If I tell you that next decade there were 2.9 million deaths you might conclude the deaths were falling, and an editor might engage in original research and claim as much. But if the confidence interval on those estimates was 2.9-3.3 and 2.7-3.2 then we might more reasonably conclude we don't know, as the change is within expected sampling noise. (I'm no statistician, so forgive me if I'm making mistakes or explaining this wrongly). Even just telling the reader that the numbers were 3.1 million and then 2.9 million next decade is suggesting to them that there is a change, and that we do know the numbers to two significant figures. Perhaps the experts really believe the number is closer to 4 million if it weren't so under-diagnosed. Better perhaps to just write 3 million.
So what value do the reviews or other secondary sources provide? It is a mixed picture. One review I looked at made a mistake (IMO) with the numbers, and it would have been bad if we'd used those numbers. But likely both the Global Burden and the WHO numbers are fairly well respected and one could pick either. A reviewer may pick the larger number if they want to make it look like the disease was more important. Or they might pick numbers that demonstrate a trend they want to discuss. The GOLD report hinted that they thought the WHO data was poor, but didn't go into much detail as to why. Certainly I struggled to find the confidence intervals for the WHO figures. WHO's own fact sheets were variable in quality. An old one that we had used claimed a similarity between sexes that wasn't supported by the data IMO, and newer fact sheets don't make that claim.
I wished the GOLD reports had more detailed data, with which to say more in our article. But perhaps they know the data is weak and best not examined or discussed in detail? I feel that statistics are hard enough that both reviewers and Wikipedians can get them wrong, and that it is easy to mislead the reader with numbers that are too precise, or to claim the numbers are an actual count of people with a disease rather than crude estimates.
Anyone got any other experiences here, or opinions? -- Colin° Talk 09:28, 5 September 2021 (UTC)
Articles should rely on secondary sources whenever possible. For example, a paper reviewing existing research, a review article, monograph, or textbook is often better than a primary research paper. When relying on primary sources, extreme caution is advised. Wikipedians should never interpret the content of primary sources for themselves. The danger with easy access to so much primary data, whether disease statistics or drug prices, is that history tells us Wikipedians will interpret it, invent their own calculations, claim illusory precision and confidence, juxtapose incompatible figures, and neglect to mention important caveats. The "extreme caution" warning gets neutralised by illusory superiority, where editors think they are careful and clever enough. It is frustrating when the secondary literature doesn't mention interesting stuff, or facts we personally consider important, but I think that's just one of the things we have to accept on Wikipedia that makes it different to other publishing platforms. -- Colin° Talk 17:07, 5 September 2021 (UTC)
Elsevier journal Toxicology Reports appears to publish pseudoscience (via Sj). We have a dozen articles citing it. Nemo 06:49, 25 September 2021 (UTC)
More information: https://blogs.harvard.edu/sj/2021/09/30/journal-level-fraud-elsevier-fakes-peer-review-of-covid-click-bait/ Nemo 14:50, 1 October 2021 (UTC)
At Talk:Julian_Assange#Mini-stroke the inclusion of a report by the fiancee of a person that he suffered a mini-stoke and had an MRI and is on medication is being opposed on the basis that it is a medical conditio,, to quote ""Any medical information should come from a qualified professional who has examined Assange." Is this true? NadVolum ( talk) 12:19, 16 December 2021 (UTC)
This text of mine is copied from a discussion on Talk:Cannabis_(drug)#"Inappropriate"_source. I'm tossing it out just because I'd be interested in what opinions or approaches people here might have on this general topic.
>>>>>>>>>>>>>>
Here, and in WP:BMI, I totally get now that the consensus is that text in Wikipedia stating "facts" about cannabis needs to have a WP:MEDRS quality reference. Although I don't totally agree, I have no trouble adhering to that.
However (and this is explicitly a *personal opinion*), a whole bunch of scientific secondary references (including ones meeting WP:MEDRS) are in fact shit. E.g., they may cite a lame and invalid primary study without any actual evaluation (thus propagating false material). They may take speculative conclusions ("possible relationship" or "potential link") in a primary source and state it as a fact. Now, as a semi-professional I can find stuff in WP:MEDRS secondary sources that are blatently inaccurate, but Wikipedia requires them to be taken as absolute encyclopedia truth (note that I am *not* arguing against WP:NOR; I totally approve of it).
Also: although "The Pot Book" is a lay-oriented book and doesn't technically meet WP:MEDRS, it was edited by an MD/psychiatrist, Julie Holland. Some of the articles are solid articles by academic writers ( e.g., the Kirkpatrick and Hart chapter I originally cited), and some are not "science" (e.g., Julie Holland's interview with Tommy Chong). However, the Kirkpatrick and Hart article (*read the entire article* before you criticize it) does meet WP:Verifiability by my standards, and, IMO, ought to qualify for WP:MEDRS (but doesn't). I believe there was a comment above that stated the the Kirkpatrick article was problematic because some sentences didn't cite references. That is also frequently true of WP:MEDRS qualifying secondary sources.
The above is not an attempt to argue against WP:MEDRS, but just a description of some of its weaknesses. And I'd be interested in people's opinions about whether there are any ways to address these problems.— Preceding unsigned comment added by Finney1234 ( talk • contribs) 04:34, 4 December 2021 (UTC)
I mostly agree with AXONOV's comment at 22:06, 3 December 2021 (UTC) on the other discussion page):
I've checked the book ( The Pot Book). Generally speaking the source in question (added on [21:05, December 1, 2021]) in fact cites some primary studies (like [1]). However, the attributed text (worded a bit differently), which is mentioned on the page 28 under the SUBJECTIVE EFFECTS IN THE LABORATORY subtitle, does not contain any specific attributions... The same goes for the phrase rapid onset in a context of use of Sativex on the page 219 (NEUROPATHIC PAIN subtitle) - no attribution given. I conclude that claim is mostly speculative. On the other side I don't see how WP:BMI/ WP:MEDRES applies here... It's certainly not a curative effect. But I would propose to bring a better source on that anyway...
My only quibble is that I see the psychoactive effects of cannabis falling under WP:BMI and WP:MEDRS.
"The Pot Book" was written for a lay audience, therefore it doesn't qualify as a reputable textbook, treatise, or scholarly book. However, that does not mean it is "junk". In fact, it contains book chapters written by biomedical researchers and scholars from a range of disciplines. Like most edited books, quality varies, but it's much more grounded in science than the many "wonders of weed" books on the market. I would perhaps use "The Pot Book" as a jumping off point in my search for reliable sources.
I wholeheartedly agree that in the United States (and elsewhere) we have cut off our nose to spite our face with regard to cannabis. While we reduced cannabis consumption in the 1980s, we continued to essentially ban research on marijuana and we lied about marijuana so much and for so long that Americans born in the 1990s onward have a hard time trusting anything our government says about cannabis, even if it comes from leading researchers who don't have a political agenda.
Finney1234 - You are a really good writer and have obviously worked long and hard to add a lot of valuable content to Wikipedia. And you seem to have an open mind and you seek to understand along with seeking to be understood. There are a couple of relatively minor aspects of MEDRS that I don't agree with, and there are a handful of editors who use the policy to bludgeon others into submission or to justify their authoritarian behavior (I am not referring to Alexbrn), but they are a very small minority. Over all, WP:MEDRS is a thoughtful, conscientious, and well-reasoned set of policies and guidelines. All the best, Mark D Worthen PsyD (talk) [he/his/him] 07:13, 4 December 2021 (UTC)
[…] psychoactive effects of cannabis falling under WP:BMI and WP:MEDRS
Mark D Worthen PsyD Thanks! However, my personal (and semi-professional) opinion is that some Wikipedia articles (like the current version of Cannabis_(drug) ) have a huge non-factually-based negative bias. I'm just trying to work on making it more factually based (and WP:neutral) to match Wikipedia guidelines. Some editors apparently think this approach is WP:WL. Finney1234 ( talk) 23:11, 4 December 2021 (UTC)
I propose to close this discussion and tag it as {{ moved}} per duplicate (the same policy is being discussed): WP:BMI#Is this biomedical information. Objections? -- AXONOV (talk) ⚑ 10:25, 4 December 2021 (UTC)
Warning: this section has turned into a long contentious discussion, but the key issue (providing a simple example of a (plausibly) WP:MEDRS review article that is factually flawed, which was all I was trying to demonstrate) is covered in the very first section.
_____________________
This first example is provided in response to User:Alexbrn's request above.This secondary source has been an ongoing issue at Cannabinoid hyperemesis syndrome (CHS). This is an example of what I expect is a valid WP:MEDRS secondary source (BMJ: British Medical Journal) that uncritically cites a lame primary study. See the CHS article and Talk page for discussion and fuller references (e.g., if I've mistyped the DOI's below. Please correct or expand the references if you can).
Background: CHS is a nasty, sometimes fatal (at least 5 reported deaths) syndrome that sometimes occurs in heavy cannabis users. The acute symptoms involve very serious nausea and vomiting that often requires emergency room (ER) care. Exceedingly hot showers or baths are reported to help relieve the symptoms.
In Habboushe et al, 2018 , Journal = "Basic and Clinical Pharmacology and Toxicology", (DOI 10:1111/bcpt.12962), 155 emergency room (ER) patients who admitted to cannabis use (but were *not* currently in the ER for nausea or vomiting problems) were asked to rate (on a 0-10 Likert scale) whether a hot shower or bath had been helpful when they had previously had cases of nausea or vomiting. 33% of the subjects rated the helpfulness level of hot showers at 5 or higher. Habboushe concludes that about 33% of daily marijuana users in the US (so: about 27,000,000 users) are likely to suffer from CHS (with the explicit caveat "...if this is extractable to the general population").
Chocron et al., 2019, Journal =BMJ (DOI 10.1135/bmj.14336) (a WP:MEDRS-qualifying secondary source, I believe) cites this result uncritically: "Extrapolating those results to the population of the United States, it is estimated thatcounty 2.1-3.3 million people might suffer from CHS annually".
Some issues with the (primary source) Habboushe study:
Also, given the seriousness of CHS, 2.7 million sufferers would have overwhelmed the ER's in the US. But it obviously hasn't. So: this is a blatantly incorrect published claim.
However, because Chocron et al. is (I believe) a WP:MEDRS source (much more strictly defined than WP:Verifiability), it is virtually impossible to argue for its falseness, because that would be WP:NOR.
Again, I'm not trying to argue here that WP:MEDRS should be changed to reflect this issue, but I am interested in people's perspectives on it. I couldn't avoid dealing with the issue when editing the CHS article. Finney1234 ( talk) 09:48, 4 December 2021 (UTC)
From talk section higher up:
Just as an addendum to this Finney1234, if you're interested in a WP:MEDRS-quality debunking of the Habboushe primary source you dislike so much, check out PMID:31241817, a systematic review. Once again, and as Markworthen observes, the way out of problems like this is to find better sources! Alexbrn ( talk) 13:40, 7 December 2021 (UTC)
An email from the suspect says she didn't do it. Therefore, she didn't do it. That's exactly how we do things on Wikipedia. And the community is fine with it. Discussion probably soon to be archived, but for now it's here. Talk:COVID-19 lab leak theory#RfC about how we should use the Frutos source. The underlying sources are these: [9] [10] Adoring nanny ( talk) 19:50, 6 January 2022 (UTC)
An RFC related to a conflict on the use of WP:MEDRS sources on this topic has been posted at Talk:Cannabis_(drug)#RFC:_Cannabis_overdose. Please feel free to chip in, whatever your opinion. Finney1234 ( talk) 18:19, 7 January 2022 (UTC)
|lay-date=
, |lay-format=
, |lay-source=
, and |lay-url=
have been deprecated. If a 'lay' source is important to an article, it should be given its own citation with all of the appropriate bibliographic detail. |lay-url=
is recommended at
WP:MEDPOP:
|lay-url=
parameter of {{
cite journal}}."That recommendation should be reconsidered.
— Trappist the monk ( talk) 16:55, 26 January 2022 (UTC)
Trappist the Monk would you please:
The recommendation now being made Template:Cite journal#Lay summary is to separately cite the lay article, which encourages novice editors to breach WP:MEDRS by using lay sources. The lay source parameters were designed, and intended, to work with MEDRS by adding a lay source only to a journal citation which conforms to MEDRS, thereby allowing a more accessible explanation to readers. (I believe it may have been designed or added by User:Eubulides, who helped develop MEDRS and wrote several medical FAs, but has been gone for ten years now; I could be wrong on that.)
Examples of how the lay parameters are used can be seen in many medical articles (I know not how to go about finding all of its uses in medical content). Encouraging editors to directly cite the lay press in medical content is unwise; the parameter was specifically intended to provide for an add-on to a MEDRS-compliant source, while not replacing a MEDRS-compliant source. A useful parameter has been removed. Why? We should not be encouraging direct citations to the laypress in medical content; as can be seen in the examples below, the lay parameters allowed for an additional link to aid readers who may not have journal access, or who may find it difficult to digest journal writing.
{{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help){{
cite journal}}
: Unknown parameter |lay-date=
ignored (
help); Unknown parameter |lay-source=
ignored (
help); Unknown parameter |lay-url=
ignored (
help)SandyGeorgia ( Talk) 18:06, 26 January 2022 (UTC)
This wording has been written into this very widely used and cited guideline with
One possibility is to cite a higher-quality source along with a more-accessible popular source, for example, with the
|lay-url=
parameter of {{ cite journal}}.
since at least the end of 2008 (that's a lot of years on a highly used guideline for a couple of editors to be undoing). WP:MEDRS has 389 page watchers, and has included the text about the lay source parameter, with text unchanged for all those years. The cite journal template page has 130 watchers, but editors there feel empowered to make such a change without notifying this page.
When deprecating a parameter with such wide and long-standing acceptance, why was this page not notified of the proposal? This de facto, fait accompli method of operating on citation templates should be addressed by the community more broadly. SandyGeorgia ( Talk) 19:47, 26 January 2022 (UTC)
First, I think it's important to remember that this isn't an emergency. The parameters are still there, and they're still working. Also, almost none of our readers actually click on a ref, so even though the danger–danger-danger red text is there, it's mostly editors like us who will notice it.
Second, I think there are several ways to accomplish the goal.
I think that any of these could work, and I think that the last has some advantages over the traditional approach in terms of WP:LINKROT risks. WhatamIdoing ( talk) 04:20, 27 January 2022 (UTC)
It worked. As designed. By a prolific content writer, who also spoke geek and helped write MEDRS. I look forward to seeing all of that above written in to MEDRS. SandyGeorgia ( Talk) 04:32, 27 January 2022 (UTC)One possibility is to cite a higher-quality source along with a more-accessible popular source, for example, with the
|lay-url=
parameter of {{ cite journal}}.
{{cite journal ... |lay-url= |lay-date= |lay-source=}}
{{cite journal and summary ... |lay-url= |lay-date= |lay-source=}}
|lay-url=
family of parameters before, but I see how they're useful. I like WAID's option #3 quite a bit, and if this is the new normal, I think we could formalize in
WP:MEDRS that providing a separate lay source in this manner is acceptable. If we go with this, I assume a bot could convert citations to this new format to prevent anyone from "fixing" the citations by manually removing the lay sources.
Ajpolino (
talk)
18:07, 28 January 2022 (UTC){{
lay source}}
. Rewriting the lay summary part of Editor WhatamIdoing's example 3 using {{lay source}}
gives this:
{{lay source |template=cite news|last=Dasgupta |first=Shreya |date=20 April 2015 |title=Why do women have periods when most animals don't? |url=https://web.archive.org/web/20210801180159/http://www.bbc.com/earth/story/20150420-why-do-women-have-periods |work=BBC Earth}}
{{
sfn}}
and similar templates. |template=
accepts the name of any of the standard cs1|2 templates so if a good lay source is in a book, it can be noted with this template; |url=
not required.|template=
parameter is. Does it matter?
WhatamIdoing (
talk)
01:15, 30 January 2022 (UTC)
|doi=
, |volume=
, |issue=
, etc; or suppose that the lay source is a chapter in a text book; |chapter=
and possibly |chapter-url=
might apply; suppose that the lay source is in a conference proceedings.... Telling {{
lay source}}
which of the cs1|2 templates to use ensures that the rendering is correct for the source you are !citing. Default when |template=
is omitted is {{
cite web}}
.Having removed the MEDRS-compliant lay-url, over at the citation template discussion, the best I can decipher, an IP is rewriting MEDRS to their own interpretation of how to use laysources, with statements like “lay sources that pass RS should be preferable”. Help_talk:Citation_Style_1#A_proposal SandyGeorgia ( Talk) 05:45, 28 January 2022 (UTC)
There is a medical sourcing discussion related to toxicology at Wikipedia:Village_pump_(policy)#In_general,_are_animal_and_in_vitro_studies_acceptable_sources_to_support_toxicology_statements?. MarshallKe ( talk) 18:50, 8 March 2022 (UTC)
Christopher J Blunt wrote in 2015 a PhD Thesis dedicated to evaluate the usefulness and limitations of hierarchies of evidence on the clinical practice. As part of his work, he freely published a systematic compilation of hierarchies of evidence up to 08/10/2020 [12]. This may be useful for MEDRS which only currently suggests 2 hierarchies (which may produce the illusion that there are only 2 competing hierarchies, when there are at least 195 from various institutions worldwide). Maybe just adding a link would be good so that the curious reader can dig further into the subject if they so wish. Best regards. -- Lyrono ( talk) 05:34, 6 April 2022 (UTC)
"Be careful of material published in disreputable journals or disreputable fields. (See: Sokal affair.)"
I'm not sure what the link to the Sokal affair article is doing here? The implication seems to be either that Social Text is a disreputable journal or Postmodernism a disreputable field. Whatever opinion one may have of Social Text, it remains a relatively popular and prominent journal in it's field. At bare minimum it is certainly considered reputable in the field. And postmodernism is... just not a "disreputable field", whatever that would mean? I'd love some clarification here, otherwise I think this should be removed. -- Donna's Cyborg ( talk) 19:47, 10 May 2022 (UTC)
How should we handle articles like Aromaticum rosatum, which only cite to one ancient source? BD2412 T 05:54, 5 August 2022 (UTC)
Eyes would be helpful at COVID-19 vaccine and Talk:COVID-19 vaccine, where some editors and IPs continue pressing non-MEDRS sources in support of theories about the vaccines. Cheers! BD2412 T 20:17, 26 November 2022 (UTC)
For your consideration, an essay I came across on social media today: The rise and fall of peer review
I have occassionally been bothered by an editor's excessive credulity for peer-reviewed papers based just on the mere fact of their having been reviewed, but this essay explores the topic more incisevely than I could hope to. Sennalen ( talk) 17:09, 14 December 2022 (UTC)
You are invited to join the discussion at
WP:MCQ § Proactive request for input. --
Marchjuly (
talk)
19:44, 23 February 2023 (UTC)
The inline text acknowledges that the figure on the left at WP:MEDASSESS in this article has been deprecated and that the source now presents a pyramid that differs in important ways from the one in the figure. Would it be possible for somebody to clean this up? (Deleting the left figure would be the simplest fix.) sbelknap ( talk) 13:05, 28 December 2022 (UTC)
Assess evidence quality
When editors are writing about treatment efficacy, epidemiology, survival rates, and similar subjects, evidence quality helps editors distinguish between minor and major views, determine due weight, and identify accepted information. Even within the same journal, different types of papers should not be given equal weight. Research studies can be categorized into different levels of evidence. [1] There are multiple accepted models for ranking evidence levels, but they all rank sources that combine the results of multiple research studies higher than other types of sources.
Wikipedia editors should rely on sources that offer higher levels of evidence, such as systematic reviews, meta-analyses of randomized controlled trials, narrative reviews, medical guidelines, and position statements by internationally or nationally recognized expert bodies (see WP:MEDORG).
Sources that present lower levels of evidence or non-evidence should be avoided. Lower levels of evidence in medical research come from primary sources (see WP:MEDDEF). Roughly in descending order, these include: individual randomized controlled trials; quasi-experimental studies; prospective observational (non-experimental) studies, such as prospective cohort studies (one type of longitudinal study); case control studies; cross-sectional studies (surveys), and other correlation studies such as ecological studies; case reports, other retrospective analyses (including retrospective cohort studies); and non-evidence-based expert opinion, clinical experience, or conventional wisdom.
Speculative proposals and early-stage research should not be cited to imply wide acceptance. For example, results of an early-stage clinical trial would not be appropriate in the 'Treatment' section of a typical disease article, because possible future treatments have little bearing on current practice. The results might, in some cases, be appropriate for inclusion in an article specifically dedicated to an experimental drug or procedure in question, or to the researchers or businesses involved in it. Such information, particularly if analyzed by secondary sources, may be appropriate in research sections of disease articles. To prevent misunderstanding, the text should clearly identify the level of research cited (e.g., "first-in-human safety testing").
Note: Editors should not perform detailed academic peer review. "Assess evidence quality" means that Wikipedia editors should identify and use the appropriate type of source and quality of publication for the subject at hand. Do not reject a higher-level source (e.g., a meta-analysis) in favor of a lower one (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source.
References
This is about [13]. It might sound funny, but The Lancet has less draconian editorial standards than Wikipedia. E.g. WP:PRIMARY medical studies are allowed to make medical claims. tgeorgescu ( talk) 03:33, 23 April 2023 (UTC)
Reminds me of mortgage-backed securities helping cause the 2007-2009 Great Recession. Wrapping crap up in fancy paper with a bow. We need people with money to pay all medical journals to make everything open access. Including the mega-problematic anonymized individual participant data (IPD). Then peer review would consist of millions of readers, and Wikipedia editors who aren't easily fooled.
Medicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed? By Richard Van Noorden. July 18, 2023. Nature. Subheading: Investigations suggest that, in some fields, at least one-quarter of clinical trials might be problematic or even entirely made up, warn some researchers. They urge stronger scrutiny.
But faked or unreliable RCTs are a particularly dangerous threat. They not only are about medical interventions, but also can be laundered into respectability by being included in meta-analyses and systematic reviews, which thoroughly comb the literature to assess evidence for clinical treatments. Medical guidelines often cite such assessments, and physicians look to them when deciding how to treat patients. ... His work has had a wide impact: researchers found that 27 of Sato’s retracted RCTs had been cited by 88 systematic reviews and clinical guidelines, ... “Untrustworthy work must be removed from systematic reviews,” says Stephanie Weibel, a biologist at the University of Wuerzberg in Germany, who co-authored the review. |
-- Timeshifter ( talk) 06:31, 20 July 2023 (UTC)
Basically, only aspirin and tamoxifen seem to be at all beneficial in high-risk individuals, and even those drugs shouldn't be encouraged as preventative measures in non-high-risk people. JoelleJay ( talk) 23:43, 20 July 2023 (UTC)Chemoprevention employs pharmaceutical agents to reduce the likelihood of disease progression, predicated on the assumptions that individuals at risk can be identified, we understand progression and we have effective agents.
In the case of cardiovascular disease (CVD), these assumptions largely hold but for cancer chemoprevention, although we can identify some high-risk individuals, most potential agents have been identified by inference from epidemiologic or laboratory studies; we have a multiplicity of theories of carcinogenesis that do not provide clear understanding of what is causal (1) and, thus, an incomplete understanding of the role these agents might play in cancer.
As a result, cancer chemoprevention is an almost universal failure.
There are enthusiasts for the possibilities of cancer chemoprevention (2) but they have been selective about their review of the evidence as I will show below.
Effects of vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries: A systematic review. 26 June 2021. https://doi.org/10.1002/cl2.1127 - Campbell Systematic Reviews. "The findings suggest that MMN [multiple micronutrient] and vitamin supplementation improve maternal and child health outcomes, including maternal anaemia, LBW, preterm birth, SGA, stillbirths, micronutrient deficiencies, and morbidities, including pre-eclampsia/eclampsia and diarrhea among children. MMN supplementation demonstrated a beneficial impact on the most number of outcomes. In addition, MMN with >4 micronutrients appeared to be more impactful than MMN with only 3 or 4 micronutrients included in the tablet." -- Timeshifter ( talk) 04:19, 22 July 2023 (UTC)
Believe it or not, my posts were not about you. And I have no conflicts of interest. I learned a lot from this exchange, and the web reading I did. I found various trials of multivitamins, multiminerals, etc.. that got positive results. But I didn't want to clutter up the page with single trials.
What I learned is that the best trials broke down the results by subgroup. Then there were some positive significant results. But if the results were measured and averaged out for the group as a whole, then then there may have still been a positive result. But not a significant one. Because of the averaging.
It makes sense. Especially if your group includes people of all incomes in a developed western country spread out across the country. But if you do studies of people with higher nutritional needs, like pregnancy, or poor people living in food deserts. Or people in poorer countries or regions. Or people getting their food from poor soils in densely populated regions. Or old people in nursing homes. Etc., etc.. Or people who are sick.
I could go on and on, but I don't want to waste the time of people on this forum. And people who take multivitamins, etc. are mostly taking them as insurance. The shotgun approach. You never know if your particular genetics may need them. Or if you are beginning to get sick, etc.. Or you are someone who needs the higher limits of the RDAs, but foods no longer provide as many nutrients as before.
It don't want to argue with people who don't see the value of organic food, and avoiding synthetic additives. More and more studies show doing both help. But I remember decades ago when few studies were done. Because you can't patent anything to make money from the knowledge. But the logic is obvious. Every year more additives are found to be dangerous. Every year more medical conditions are found to be improved in some way by some nutrients.
From my first post: "We need people with money to pay all medical journals to make everything open access." Then we all can provide constructive criticism. Like why are you not breaking down your huge group into subgroups. Why aren't you doing a systematic review of trials with those subgroups. -- Timeshifter ( talk) 03:38, 23 July 2023 (UTC)
Some multivitamin/multimineral studies with positive results are found here:
Scroll down to the section called: "Who May be at Risk for a Nutrient Deficiency?" it says: "Certain groups are at higher risk for a nutrient deficiency:" It lists them.
Scroll down to "Multivitamins and Health". It says: "There is no arguing that multivitamins are important when nutritional requirements are not met through diet alone."
Then scroll down to this paragraph near the end:
For many diseases, but especially for cancer, only long-term trials are informative. The following studies looked at the effect of multivitamins on specific diseases and included healthy people as well as those with chronic diseases at the start of the study:
Click the 4 dropdowns for: Cancer. Cardiovascular disease. Mortality. Cognitive Health. Positive results for 2:
Cancer:
A randomized double-blind placebo-controlled trial provided a multivitamin or placebo to more than 14,000 male physicians, some with a history of cancer. After 11 years, the men taking a MVI had a significant 8% reduction in total cancers, compared with men taking a placebo. The results did not differ among men who had a history of cancer at the start of the study and men who were healthy at baseline.
Cognitive Health:
The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a large randomized controlled trial that followed more than 21,000 older men and women (≥60 and ≥65 years, respectively) ... Results showed that taking a daily multivitamin-mineral supplement improved memory and executive functioning (e.g., time management, planning, self-monitoring) more than a placebo. The benefit appeared strongest for participants with a history of cardiovascular disease (CVD);
There is some contradictory info above those positive results. The difference seems to be "only long-term trials are informative."
This is a very useful caveat as to whether a systematic review is the final word on something. Was it a systematic review of short-term studies?
Concerning systematic reviews the more transparency the better. We need funding to make all medical journals and studies open access. The Nature article in my original thread post said: They urge stronger scrutiny.
Billionaires and the government need to put money in this area. Researchers make many mistakes. More readers and reviewers allows more useful feedback. And it makes healthcare more effective. Especially, cost effective. -- Timeshifter ( talk) 22:39, 25 July 2023 (UTC)
I'm not sure if this is the right place to ask this. Here's an example, from Dandelion coffee:
Dandelion root has been linked to a possible treatment for cancer.
The source for this is strictly primary. There are many similar statements on other pages about, generally, plants. Does this not violate WP:MEDRS? ByVarying | talk 01:46, 12 August 2023 (UTC)
I would like to seek clarification on whether MEDRS are required in a section on the activities of an environmental NGO working on, for example, toxic chemicals and drinking water contamination. My interpretation is that the second example in WP:MEDRS#Biomedical v. general information is pretty comparable, as long as the content is what they do, rather than what they have proven. Wikipedia:Biomedical information does not contradict this interpretation either. (The situation would obviously be different if an NGO's publications on such a topic were used in articles on chemicals as sources of information on, for example, their effects or human exposure.) -- Leyo 08:55, 23 September 2023 (UTC)
HealthNewsReview.org is now defunct. Are there any good alternatives?
In the meantime, I am removing from the article all mentions of this website. Thatsme314 ( talk) 06:38, 10 November 2023 (UTC)
Why does the SUNY Downstate picture need an update? Thatsme314 ( talk) 08:25, 10 November 2023 (UTC)
Does MEDRS apply to the content in this section?
Does Wikipedia:Biomedical information sufficiently address a scenario such as this? SandyGeorgia ( Talk) 10:28, 17 November 2023 (UTC)
It also discusses a junk article published by Sage Publishing. Doug Weller talk 14:02, 30 January 2024 (UTC)
Hello, I've been looking at a recent significant piece of investigative journalism that talks about health effects that manifested in connection with meditation retreats. Can such reporting be included in Wikipedia? At the Help Desk, I've been advised that the journalistic piece doesn't prove cause and effect. But neither does the story claim to prove cause and effect! It is a reliable source not from a medical standpoint but from a journalistic standpoint. Can you help me make the distinction clearer for readers? Arided ( talk) 10:25, 15 February 2024 (UTC)
"News media play critical roles in public understandings of health issues. Media presentation of scientific evidence seems to involve the 'facts', which are then discussed and interpreted by various 'experts'. From an ethnomethodological or social constructionist perspective, however, news 'facts' themselves are socially constituted. Examining how health science is reported thus offers important insight into the social construction of health policy problems. We offer an interpretive account of United States newspaper coverage of passive smoking during a time in which several major scientific studies of the issue were conducted and reported upon. We argue that newspaper journalists, through the use of several rhetorical devices, constructed an account of the passive smoking issue in which scientific 'facts' were less important than moral 'facts'. Rather than (or sometimes, in addition to) explicating science, newspaper coverage conveyed a moral narrative highlighting tensions between American cultural values of individual liberty and protection of the public health." — " Science in the News: Journalists' Constructions of Passive Smoking as a Social Problem"