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Wikipedia talk:Identifying reliable sources (medicine)

Frequently asked questions (FAQ)

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

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

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

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

Primary sources might be useful in these common situations:

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

There are three possible situations:

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

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

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

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

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

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

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

How do I reference a medical article?

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

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

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

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

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

References

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

Contents

System Still BrokenEdit

From seven months ago on this TALK page (now archived) [1]

This week the NEJM published a blinded placebo-controlled multicenter trial of the drug tafamidis, a putative small molecule treatment for ATTR cardiomyopathy. The trial found the drug cut mortality rates (p<.001) and hospitalizations and improved clinical outcomes. It is inductively supported by some work with tafamidis in the neuropathy of ATTR and also by basic biochemical studies showing how the drug works to stabilize ATTR so amyloid does not form from it. But there are not yet any confirming studies, and won't be for some years. So I put in a paragraph saying what the trial had found, but I didn't add what you can read in an NEJM editorial: Given the dearth of acceptable treatments for this disorder, these robust efficacy results, combined with a benign safety profile, suggest an important role for tafamidis in the treatment of transthyretin cardiomyopathy. (NEJM Sept 13, 2018, p. 1084).

Now, I care nothing about tafamidis. I have no horse in this race. But I'm interested in amyloids, so I added the study for what it found, and nothing more. My addition was then completely reverted by user:Jytdog here with the somewhat rude comment that we avoid primary sources, along with a comment on my talk page that I had formatted the references wrong.

Why should I work to get them right, if somebody is just going to remove rather than improve? That's why I stay away from the medical content of Wikipedia. From what I know of ATTR (including familial amyloid polyneuropathy) I would be willing to bet a large sum that this drug is active. I would also be willing to bet a lesser sum that, given the important nature of this study, somebody will succeed in adding some review of ATTR treatment that contains this study as centerpiece (but nothing more that confirms it), as a "secondary source" in WP, and it will "stick." Or more likely, the FDA will use the same study (or the same multicenter data) as basis to approve the drug for this use. THEN, WP will mention it. But the FDA's endorsement (with no more data) adds nothing epistemologically, either. NONE of it is better than just the primary source and editorial, no matter who else signs-on. The evidence is just as good (or bad) as it ever was. Meanwhile, you're just fooling yourselves. But you on WP will do that. Wait and see.

(Sept 2018)


Fast forward to yesterday May 6, 2019 [1] The FDA approved tafamidis for ATT-CR (cardiomyopathy) based on the single NEJM study above, and no other data. (Projected cost for patients is $225,000 a year. Two cheers)

Apparently I am clairvoyant, as this is exactly what I predicted would happen last September (see above). Alas, nobody took me up on my bet.

However, I was not allowed to enter the study upon which this drug was approved, into the article on amyloid polyneuropathy. Although it was in the NEJM, it was seen as a primary study, and thus not include-able in WP, despite being the best clinical study available (and thus actually not in violation of WP:MEDRS until there was some statement of it being an accepted treatment-- it would have to put as "experimental treatment." But I wasn't given that option either.) A fight in the WP:AN3 erupted with me being reported by user:Jytdog [2]. This did nobody any good. A long discussion on this TALK page featured Jytdog giving a dissertation on how medical journals are corrupt and even NATURE has to withdraw articles, and THEREFORE this NEJM article could not be mentioned on WP. See the above reference-- I do not want to repeat it all here, but go and read. And it featured me saying this whole argument was ridiculous (see above) because the FDA was going to approve the drug anyway, based on this single study that we refuse to mention on WP. Which is just what happened.

Now that the drug is approved, the study I wanted to include has been made notable by the fact that the FDA used it as data to approve the drug. However, the study itself is still a primary source. Mentions in secondary reviews do not change that, as a review of one paper is not a review, but simply a mention by somebody else, with nothing to add. No new knowledge or reliability is added.

At the end of the discussion referenced above, I was asked what my solution was. I had none. I still have none. Against stupidity, the gods themselves contend in vain. WP's MEDRS edit-warring is really stupid. Common sense do I not see. Although I am able to predict the future, so there's that. SBHarris 01:29, 8 May 2019 (UTC)

Well, I just found out that the editor Jytdog who blocked my inclusion of the NEJM article cite last September, and then took me to the 3RR noticeboard over it, was actually banned last December, a few months later, for some completely unrelated WP infraction, but which also involved total intractability over editing. Where there is smoke, there is fire. Where is my apology??? for the crap this editor and WP put me through on this single citation for this single drug-- the wikilawyering, and the bad faith, and the perverted process, and (finally) the poorer encyclopedia that came out of the process because not one of you stood up for my side of what was happening? 03:31, 23 July 2019 (UTC)

Wikipedia and the systematic obfuscation and denial of HomeopathyEdit

Hello I see the fundraising button on wiki. I would gladly donate but I have a few issues.

  1. I am a homeopath and the homeopathy page you have does not reflect the true nature of homeopathy
  2. I am a homeopath and your medical reference sections do not list anything about herbology or homeopathy, only allopathic treatment options
  3. I am a book writer and medical researcher and your human biology sections do not include anything about the wealth of information on herbal and homeopathic drugs that treat any of these conditions.
  4. I am a practitioner that works with children who have vaccine damage and no content about vaccines on Wiki talks about the damages that vaccines do.
  5. Because I am a homeopath and work with vaccine damage not only are my medical or research needs not met by wikipedia, I am cast out as a charlatan, liar, practicing pseudo- science, and criminally negligent for not being pro-vaccine. I remember when the internet was developed. The vision was for a vast vault of knowledge for a better world or free information. It appears that that is not possible when there is an agenda to censor and manipulate the information being presented. Homeopathy has been around for over 2000 years and Herbology is ancient. There needs to be more complete information on the internet to reflect and fulfill the quest humans have to know. A medically driven myopic view of the world is not helping anyone.

When wikipedia is able to support something other than the pharmaceutical driven medical agenda I would be happy to contribute.

Plus also the homeopathy page has been taken over by anit-homeopathy people. It is locked and there is not talk page. Until Wikipedia and all the volunteers who work the platform allow representative from the profession who understand the 200 year old practice of homeopathy, and are willing to discuss it in a descriptive rather than opinion based context I will stand by my 'I would donate but..' I can't support an organization that actively denies the reality of my life, practice and the patients who I see every day that are helped with homeopathy.

If you would please forward this on to people who might review this. There is money to be had in this world and money to shared for the good of humanity. I know I will not be sharing any of my money with wikipedia and it volunteer editors when they/it is bent on trying to destroy not only my financial livelihood, but that of 500,000's or more other homeopathic practitioners around the world and the 200 million people who utilize homeopathy worldwide and the multi-million dollar industry of homeopathic remedies. The action by wikipedia and its editors such as the likes of Ben Goldacre, taken against one sector of the GDP and the international practice and trade of homeopathic remedies and knowledge. Homeopathy would never had gotten to this level of econimic growth if it did not work.

This action taken by the editors on Wikipedia is worthy of antitrust legal action. I will need to be taking with my people on how to take steps along these lines.


Thank you for your careful consideration into this matter. Please forward to the people who need to know. — Preceding unsigned comment added by Katebhom (talkcontribs) 00:19, 12 July 2019 (UTC)

@Katebhom: To be perfectly blunt, homeopathy is considered to be a WP:FRINGE theory and therefore not worthy of any coverage in any capacity but that.--Jasper Deng (talk) 00:32, 12 July 2019 (UTC)
There is little to respond here except to point at WP:QUACKS. Headbomb {t · c · p · b} 18:40, 7 August 2019 (UTC)
Also, we do not take legal threats lightly; you may be blocked or banned if you continue to claim legal action. --Masem (t) 18:59, 7 August 2019 (UTC)
Yes, do stop with the legal threats. Flyer22 Reborn (talk) 00:19, 8 August 2019 (UTC)
Homeopathy would never had gotten to this level of econimic [sic] growth if it did not work. So the huge size of the gambling industry shows that gambling works for those who engage in it? It's a ridiculous argument. Snake oil may have been discredited, but snake oil products abound, sadly. Peter coxhead (talk) 07:42, 9 August 2019 (UTC)

The use of blogsEdit

Can a blog be used to proof a point in an article, even if this is from a relative reputed scientist? KFvdL (talk) 20:28, 1 August 2019 (UTC)

As it says at the top, this page is "for discussing improvements to the Identifying reliable sources (medicine) page", not for general queries. If your question is whether blog posts can be reliable sources, the answer is yes. It depends on the precise use. The question should be asked at the article's talk page or (with a specific example as stipulated there) at WP:RS/N. Alexbrn (talk) 13:28, 2 August 2019 (UTC)
Thank you, I will bring it up there. KFvdL (talk) 22:17, 3 August 2019 (UTC)

A question of applicability of MEDRSEdit

Due to several articles coming out in mainstream sources, I am looking to have a better article to cover the issues of "violence and video games" which is presently buried among the article Video game controversies. I am initially tackling this from a history standpoint, focusing only on when various govt actions and other key statements and actions were made. Not a MEDRS question yet.

However, I do feel that at some point we will need to include some cross section of studies - of which there have been numerous - that claim there's no connection between video games and violence, with a few that do make that assertion. This is where I ask: would MEDRS cover this side of the issue, if the nature of these studies that will be used should meet MEDRS? This does have to do with psychiatry and mental health, so I think it will just slip into MEDRS coverage for that.

Assuming this is the case, I suspect that I as I dig into politician responses, they are going to cite studies that do fail MEDRS. Assuming the politician's statement is appropriate and not UNDUE, is linking to the non-MEDRS study appropriate or not? Do we call this out as a bad source (I don't thnk we can).

(I do recognize there are other facts on the current Video game controversies page where there are medical claims being made - eg playing video games releasing endorphins-type stuff and that's going to need a better cleanup for MEDRS compliance, but I'm voicing on if a study suggesting video games lead to violence has to be handled by MEDRS sources?) --Masem (t) 23:08, 9 August 2019 (UTC)

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