Wikipedia talk:Manual of Style/Medicine-related articles/Archive 2

Archive 1

Archive 2

Archive 3

Archive 4

Archive 5

Ready for further review?

Are we ready to take this to a wider audience for consensus? If others agree, pls add to the list of Projects we should notify for consensus prior to the stage of going to Village Pump:

• Wikipedia talk:WikiProject Medicine
• Wikipedia talk:WikiProject Clinical medicine
• Wikipedia talk:WikiProject Preclinical Medicine
• Wikipedia talk:WikiProject Medicine/Collaboration of the Week
• Wikipedia talk:WikiProject Medical Genetics
• Wikipedia talk:WikiProject Pharmacology

And, after we've done all the tweaking per the primary medical groups, then to:

• Wikipedia talk:WikiProject Dentistry
• Wikipedia talk:WikiProject Molecular and Cellular Biology (TimVickers et al)
• Wikipedia talk:WikiProject Psychology

and any other related projects. SandyGeorgia (Talk) 13:28, 13 April 2007 (UTC)

Perhaps a copyedit would be in order? Other than that, I think it's ready for prime time. Fvasconcellos 15:32, 13 April 2007 (UTC)

I asked Tony to have a preliminary look, but 1) it will probably get tweaked a lot when others come on board, so we shouldn't expend too much effort, and 2) Colin has it in good shape already (particularly when you compare to where we were last November). SandyGeorgia (Talk) 15:34, 13 April 2007 (UTC)

Hmm. OK, then. I hope any ruthless edits it gets are productive... Fvasconcellos 15:37, 13 April 2007 (UTC)

Let's go for it and why not just include the dentists, biologists and psychologists in the first round? Can we either move the the above sections to the archive or put an "archived discussion" box round them. It is sooo long that it is hard to edit and may only get worse once other folk join in. I do want people to read it, but to add new comments in new sections. Colin°^Talk 16:43, 13 April 2007 (UTC)

I'd go for that. From what you propose, this would be an initial discussion whose result was to move for general consensus, and any comments from now on could be the "building" of said general consensus? Fvasconcellos 16:47, 13 April 2007 (UTC)

Any further comments on confusing terms?

Since there's been a recent resurgence of activity here, I was wondering if anyone has any comments on the section I discussed with Colin. It concerns easily-confused terms and the thread has now been archived here: Wikipedia talk:Manual of Style (medicine-related articles)/archive1#Turning practical and specific pointers to vague. I don't care to press the issue, since it's not all that important, but I have found those terms to be the single most common source of confusion in drug articles. KonradG 16:49, 13 April 2007 (UTC)

BTW, there was a recent related discussion on Wikipedia talk:WikiProject Pharmacology#Is there another name for an Off-licenced drug ?. I've said my bit earlier, so I hope some others respond. Colin°^Talk 16:56, 13 April 2007 (UTC)

Comments on readiness for guideline

Colin, Stevenfruitsmaak, and others have put a lot of work into this proposal since last November. This section is for gauging consensus on the readiness of this proposal to beome a guideline (which, as in all Wiki articles, doesn't preclude further work or tweaking of the guideline). You may indicate your support here, or if you oppose making it a guideline, please explain what changes you would like to see. Please make your objections specific and actionable, so they can be addressed. Also, if you oppose, please be sure to check back on the discussion to see if your concerns have been addressed.

Note: Previous discussions have been archived. These contain material that you may find helpful in reaching a decision or when making suggestions.

• Support guideline status. Gudelines for medical articles are needed; all concerns I had have been worked out and I endorse that the current proposal is ready to become a guideline. SandyGeorgia (Talk) 20:37, 13 April 2007 (UTC)
• Support. I had no concerns with the wording of this guideline to start with; over the past few months, it has improved, becoming clearer and more comprehensive. Many editors already follow and cite this proposal as a de facto guideline; let's make it official. Fvasconcellos 21:16, 13 April 2007 (UTC)
• Support. --Arcadian 21:49, 13 April 2007 (UTC)
• Support, of course. It is ready for guideline status. Colin°^Talk 21:53, 13 April 2007 (UTC)
• Support - I opposed the last time this was voted on, and my major concerns have been addressed in this revision. KonradG 22:44, 13 April 2007 (UTC)
• Support --Dpryan 23:57, 13 April 2007 (UTC)
• Partial Support - but oppose it being titled and framed as a guideline for medical or medicine-related articles, when medicine is only one of the scientific/professional approaches to the topic of human health and functioning (or healthcare and disability). It seems that the general Wikipedia principle of NPOV indicates we should have a neutral guideline inclusive of different professional views and scientific disciplines in this area, rather than priveleging the medical POV. It seems that it would be quite easy to adapt this guideline to achieve this. Discussion moved to section "Just Medical?" below... Comment revised by me, as per Note section below. EverSince 10:33, 30 April 2007 (UTC)
• Weak support - I have some reservations, such as the references to "doctors" which should probably be to "healthcare professionals" to include nurse prescribers etc. Otherwise, looks good. Waggers 13:52, 14 April 2007 (UTC)
  • I've replaced "doctors" as requested. Did you have any other concerns you want to mention that are "weakening" your support? Colin°^Talk 17:19, 14 April 2007 (UTC)

Maybe make it "healthcare providers" or "healthcare team", which properly includes the patient and patient's family or other support. --Una Smith 14:17, 9 July 2007 (UTC)

The current text is "healthcare professionals" which deliberately excludes patients and their families. The context where the words are used, is one where we are contrasting professional and lay readers. We do indeed want to include all the "healthcare team", as well as uninvolved readers who are just interested. Colin°^Talk 15:37, 9 July 2007 (UTC)

Okay in Audience; I'll read through the rest and comment elsewhere if I have any problems. --Una Smith 16:03, 9 July 2007 (UTC)

• Support, though I agree with Waggers that the references to "doctors" should probably be changed to the more inclusive "healthcare professionals" or words to that effect. --Kyoko 14:00, 14 April 2007 (UTC)
• Support TimVickers 00:51, 25 April 2007 (UTC)
• Weak support - Some sections of the guideline address but do not quite state their underlying principles. Before this guideline goes "live", I would like to see a clear statement of each principle at the start of each section. --Una Smith 16:01, 9 July 2007 (UTC)
  • Una, this guideline went "live" on the 30th April. That doesn't meant your comments aren't welcome or that it can't be changed. But further suggestions are probably best made in a new section at the bottom. Colin°^Talk 16:08, 9 July 2007 (UTC)

Issues in current draft

Dear contributors

Sandy has asked me to take a quick look at the text. I've made minor changes to it, and have written comments below.

• "The article title should be the scientific or recognized medical name rather than the lay term[1] and where an eponym has been superseded". I don't understand the link "and" between the clauses. What is the status of the eponym bit in relation to the previous statement? Is this in BrEng or AmEng? Need to decide whether eses or zeds are to used maximally in "ise/ize" and their variants; it's inconsistent. I've gone for the "s" because I'm encountering more of them than "z"s, but consensus is required.
  • My fault. The article was mostly written by Colin in British English, but I added some American English spelling. SandyGeorgia (Talk) 23:20, 13 April 2007 (UTC)
    • Oh, I may have extensively revised it, but I can't claim credit for its creation or for the basic content. User:Stevenfruitsmaak started it, and he's from Belgium! Colin°^Talk 13:27, 14 April 2007 (UTC)
  • I've rephrased the lay and eponym name bit. Better? Colin°^Talk 17:16, 14 April 2007 (UTC)
• "The title is subject to the same sourcing standards as the article content." I edit scientific text for a living, and I don't understand the intended meaning here (in relation to the foregoing text).
  • It came from a discussion (towards the end of the archive) concerning article naming. Arcadian suggested some text, which I adapted/incorporated. The title can be as much an issue of dispute as article text. In such cases, we'd like the title to be sourced to a reliable respectable authority. Can you suggest alternative text? Colin°^Talk 13:27, 14 April 2007 (UTC)
  • I've started a new paragraph, since it is a new issue, unrelated to redirects. Added link to WP:RS. Colin°^Talk 17:16, 14 April 2007 (UTC)
• "between the varieties of English"—I removed this.
• ", with explanations of the latter"—Remove?
  • I've removed it. Not sure what it means. I can't remember writing that bit. Colin°^Talk 17:16, 14 April 2007 (UTC)
• More broadly, there's insufficient cohesion in "For example, heart attack redirects to myocardial infarction, with explanations of the latter. The title is subject to the same sourcing standards as the article content. Where there is a dispute over the name, editors should cite recognised authorities and organisations rather than conduct original research." There needs to be a smoother, more logical flow.
  • I've chopped the title section into two, that hopefully work better alone. Is this better or does it still need more work? Colin°^Talk 17:16, 14 April 2007 (UTC)

Infoboxes

• If you're going to insist on their use, perhaps a full list is required—or at least a link to it. Unsure why this is given priority as the second issue. Audience appears to be more important.
  • The info box came first since it is the first entry in the wikitext for an article. The order of sections in this guideline is very approximately the order within an article. Do you think it should be moved then? I suppose Audience covers the whole article, so wouldn't be out-of-place at the top. Colin°^Talk 13:27, 14 April 2007 (UTC)
  • I've moved the infobox down to just above Sections. Colin°^Talk 17:16, 14 April 2007 (UTC)

Audience

• "seeking out sources from other countries"—Should you say "preferably in English"?
• While on audience, who is your audience for these guidelines? I hope it's an intelligent non-medical person.
  • Rather than what? I hope a medical person would find it useful - many medics have been involved both in its creation and adding bits to it. Colin°^Talk 17:16, 14 April 2007 (UTC)

I haven't gone further than "Audience". Tony 23:15, 13 April 2007 (UTC)

Thanks very much. Please let me know if they haven't been fully resolved. Can you look at the rest? Colin°^Talk 17:16, 14 April 2007 (UTC)

Adding to the list per above comments: doctors vs. "health care professionals". I'll leave the edits to Colin, since my prose stinks. SandyGeorgia (Talk) 15:12, 14 April 2007 (UTC)

Done. Colin°^Talk 17:16, 14 April 2007 (UTC)

Section ordering

Well done everyone on the great work and clarity to this proposed guideline. Can I query the section ordering though, in particular Classification as 1st section seems wrong and inappropriate.

If, as I presume, Classification is to distinguish various forms of a disease, then its placing at the start of the article seems premature given that no description of the underlying scope or pathophysiology has yet been made - eg currently for pneumonia the "Types of pneumonia" is number 4 in the list after Symptoms, Diagnosis & Pathophysiology. By comparison, in Myocardial infarction it comes 3rd after Epidemiology and Pathophysiology. In Diarrhoea also 3rd section with Causes, Mechanism, Types of Diarrhea.

Likewise, whilst I'm generally no great fan of reading medical sociology, as an encyclopaedia should not the scope of a disease, i.e. the Epidemiology, come a little higher up in the order ? There is little point having fantastically detailed and well researched information on a disease, if right at the end it is stated that the incidence is just a few cases worldwide, conversely Myocardial infarction is such a major killer that its Epidemiology section is almost the most important and rightly takes pride of place. David Ruben ^Talk 00:18, 14 April 2007 (UTC)

While I agree in principle with regard to epidemiology, in practice, the ordering that you want might be for healthcare pros and not for the average reader. Epidemiology helps us with differentials and so belongs at the top for us, but for the average reader, epidemiology might contribute slightly less to an understanding of the disease. I always learned Iain Aird Says Good Pathology Makes Many Surgeons Proud - Incidence, Age, Sex, Geography, Pathology (includes aetiology, pathophysiology, histopathology etc), Macro, Micro, Surgery (Treatment in other words) Prognosis. It's not complete but works for most things. Note that epidemiology takes up the first 4 sections. The headings listed in this manual are better and possibly in good order. Long time no see BTW. How's things? Dr-G - Illigetimi non carborundum est. 00:50, 14 April 2007 (UTC)

The guidelines don't specify that an article *must* follow this order. In Tourette syndrome, classification had to come first, but Prognosis had to come before Treatment/Management, or Treatment wouldn't make sense. Understanding Prognosis in TS is key to Management. SandyGeorgia (Talk) 01:10, 14 April 2007 (UTC)

Wrt David's Epidemiology concerns, I would hope that the lead would give some brief indication of the significance of the disease. Therefore, the reader should be under no illusion as to whether it is rare or common (or perhaps geographically or ethnically restricted). I think the guideline Wikipedia:Lead section says all that needs to be said. Is there something specifically medical that requires highlighting? Colin°^Talk 11:20, 14 April 2007 (UTC)

The Epilepsy article has Classification first but perhaps it would be OK later. We do state that the order "may be varied" but it would still be helpful if the order was the most useful one. I can see that for some conditions, it would be necessary to have Signs and symptoms before Classification if such a scheme relied on symptom variation. Other classifications (possibly genetic, or by etiology) might produce the same symptoms and require to be moved after the Causes section. Diagnosis inevitably mingles with classification. Perhaps it should be moved to just above Diagnosis? There appears to be little existing consistent practice on which to base a decision, so I encourage you to move it to where you think is best. Colin°^Talk 17:50, 15 April 2007 (UTC)

Concerning the preferred order of sections in "medical condition" articles, there are basically two approaches:

1. From population to individual, and from individual symptoms through diagnosis and treatment to cure/ relapse / management / late effects. Prognosis is a floater. This ordering may put etymology and history (of science and/or medicine, and natural history) ahead of clincal sections. Note that these non-clinical sections often are omitted from clinical reference books, but they are part of what makes Wikipedia so brilliant. And they are the content that scientists (and perhaps also general readers) find most interesting.
2. Best differentials first. This depends very much on the medical condition.

Regarding the idea that a rare disease merits less detail, I would say just the opposite. Some rare diseases are exceptionally difficult to diagnose, even if there is a clear differential, simply because they are omitted from many books for reasons of (a) cost and (b) lack of relevant expertise. In theory, neither of those reasons applies to Wikipedia. --Una Smith 14:44, 9 July 2007 (UTC)

Screening and Diagnosis

Surely Screening should come just before Diagnosis, in any article that has Screening, since that's the normal order these actions are done. (I ran into this problem just now when editing Autism.) The case for Prevention (Screening's alternative) just before Diagnosis is less clear, but arguable. Anyway, for now I just moved Screening to precede Diagnosis. Eubulides 07:35, 28 June 2007 (UTC)

The guideline makes it clear the order may be varied but the one suggested is encouraged (at least as a starting point). So, with individual articles it might be essential to present the information in a different order. There is overlap between the sections and also great variation between disease/disorder types. Screening could involve techniques unrelated to diagnosis (some prenatal screening) or may use exactly the same techniques as diagnosis. In the latter case, it might help the reader to know how a diagnosis is performed and what the criteria are before discussing screening. I'm not sure that the "normal order these actions are done" necessarily determines the order of the prose. The screening described in the Autism article seem to be hints that something may be wrong, which can be discussed in the prose prior to giving the full formal diagnosis.

I'd like our suggested orders to be based on

1. a consensus among editors that the order is generally useful
2. the order used by our best articles.

A while ago, I looked at our FA articles and their ordering. I produced a table of sections here. It is probably out-of-date now. I've had another quick look at some FAs and can't find one where screening comes before diagnosis. For example, Coeliac disease has Screening as a subsection at the end of Diagnosis, and this works well IMO. In Cystic fibrosis, the two are intermingled. In Schizophrenia, Diagnosis is a major topic and Screening is combined with prevention and is only discussed briefly. In Tourette syndrome Screening follows Diagnosis and I can't imagine a reason to change that order since the diagnostic criteria are so critical in defining what TS is.

I think the previous order is best supported by the existing FA/GA articles (can you find any that are different?) and has some good arguments for it. Have you any stronger arguments for changing the order than just that one (sometimes) happens before the other?

BTW: It would be wonderful if Autism was featured again. I'm glad someone is working on it. Colin°^Talk 10:34, 28 June 2007 (UTC) Colin°^Talk 10:34, 28 June 2007 (UTC)

Yes, Colin, that table is now out of date because I worked on a lot of them. No, screening wouldn't work before diagnosis in TS; you have to know what TS is and how it's defined and how it relates to comorbids before you can know how to screen or what else to look for. Yes, MEDMOS is flexible about section ordering, but we should leave the list as the most often used, and I don't know of any where screening comes before diagnosis (maybe that's because some of the more typical "diseases" don't have screening sections?). I would think Autism would be similar; that is, you have to know what it is before knowing how to screen for it. Autism has a chance to be re-featured to the extent that special interests don't interfere; although MEDMOS accommodates a non-disease, non-disordered view of neurological conditions, extreme positions (undue weight) make it hard to work on any of the autism-related articles, and there is frequent introduction of sources that are less than the best, external link farms, See also farms, and other agendas. I hope the exclusive use of top-notch sources, very tight External links and no See also (rather a navigational template) in Tourette syndrome can serve as a model—I also reject the "disease-oriented" view, yet MEDMOS worked for TS. I tried to do a similar navigational template for the autism-related articles once, and it was shouted down by groups who wanted their (own by the way) groups listed in See also. Anyway, yes, glad to see that article getting cleaned up now! SandyGeorgia (Talk) 12:58, 28 June 2007 (UTC)

Citing medical sources

I was wondering if you'd be amenable to including something in the Citing medical sources section outlining what are and are not suitable for inclusion in medicine-related articles? A number of editors, myself included, have to fight running battles to stop opinion websites getting cited in articles like Smoking bans, Asthma, Passive smoking, and so on, and it would be wonderful if we could have something in the guidelines related to the article. I'm happy to draft a sentence or two if you'd like, but given my involvement in several of the disputes it might be better if someone else did. My concerns are probably best understood by looking at discussions like:

• Talk:Passive smoking#Debunkify.com
• Talk:Smoking ban#ACSH vs. CSPI: wikipedia requirements for sources
• Talk:Electroconvulsive therapy#Latest cut-and-paste job

Ideally, such a guidance would summarise parts of Attribution (or V, NOR and Reliable sources), Wikipedia:NPOV, and Wikipedia:Forum_for_Encyclopedic_Standards.

Appreciate your thoughts. Nmg20 19:40, 15 April 2007 (UTC)

Have you looked at Wikipedia:WikiProject Medicine/Reliable sources? We're working on that separately; you could put suggestions on that talk page. SandyGeorgia (Talk) 19:49, 15 April 2007 (UTC)

Sister projects

Here are some informal guidelines used by sister projects. Some are more active than others. Colin°^Talk 13:19, 16 April 2007 (UTC)

Related Project Guidelines

Project	Type	Status
Anatomy	Guideline	Informal
Medical Genetics	Guideline	Informal
Molecular and Cellular Biology	Diagrams, references, style guide and advice	Informal
Pharmacology	Style guide	Informal
Preclinical Medicine	Guideline	Informal
Psychology	Manual of Style	Proposed
Viruses	Guideline	informal

Just Medical?

The article title says 'medicine-related articles' while the intro relates it to "medical articles." What set of articles is this guideline intended to apply to? What will happen in the case of topics that are centrally related to both medicine and other fields? In particular the area of psychological conditions or mental disorders is a busy junction of multi-disciplinary practice and theory, incorporating views from neuroscience, psychiatry, clinical psychology, social work etc, and medical and social models of disability. A psychological framework for addressing these was recently discussed at WikiProject Psychology before the above-mentioned activity and broadening of things here (glad a link has now been added here to the archived recent discussions). To avoid duplication of effort, and potentially several conflicting guidelines applicable to many of the same pages, why not a style guideline on "clinical articles" or "scientific articles", which could have subsections on issues specific to medicine or psychology etc? The alternative seems to be several similar but potentially conflicting guidelines or - and this seems to be the way the momentum is purposely heading - all these things being listed under the heading of medicine? EverSince 00:12, 14 April 2007 (UTC)

Can you provide something specific in this guideline which you think would cause a conflict? It will be easier to address concerns if you're more specific about them. SandyGeorgia (Talk) 01:03, 14 April 2007 (UTC)

Why label this a medical guideline for medical articles when its contents have been broadened to accommodate and incorporate other clinical perspectives? The goal mustn't be to advance project territories but to facilitate the NPOV organization of Wikipedia. EverSince 03:59, 14 April 2007 (UTC)

I'm not following, EverSince. On the one hand, I think you're saying to rename it (to something like "clinical" articles), but on the other hand, you seem to be saying not to broaden it to cover all clinical conditions? It's not trying to advance territories; it's trying to broadly encompass things the medical profession deals with. I guess I'm still not following you, and a concrete example of a concern you have with the proposal's content might help me understand. SandyGeorgia (Talk) 04:15, 14 April 2007 (UTC)

I'm not sure what your view is either SandyGeorgia, what do you think about potentially renaming it, are you opposed? EverSince 05:32, 14 April 2007 (UTC)

Until I understand what your concern is, I can't be either opposed or in favor. What wording isn't working for you, and how would you propose to fix it? SandyGeorgia (Talk) 13:10, 14 April 2007 (UTC)

I'm happy with the scope being medicine-related articles (with "medical" being an adjective of medicine). There is overlap between disciplines and projects, as you mention, and it is up to the editors and projects to decide (probably on an article basis) which guidelines apply and to what extent. Perhaps I complicated things by my comments at Wikipedia talk:WikiProject Psychology? I don't think it is helpful to try to provide such a clear boundary that one can say this guideline (and only this) applies 100% to article X. There will be some overlap with science articles. It is very hard to divide the world into clean hierarchies. We could spend forever trying to create non-overlapping guidelines rather than getting on with writing articles! BTW: I'm a bit puzzled at the idea that "clinical" has a wider scope than "medicine". Colin°^Talk 13:17, 14 April 2007 (UTC)

I'm also confused about the exact nature of EverSince's concerns. For an example, consider some of the articles that are tagged by and conform with guidelines for the Bio, Music, and Film projects simultaneously. Or MilHist articles that conform with Bio or Country projects. We need specific examples of what the conflicts may be, if there are any (I hope there aren't, since we've worked to avoid any). SandyGeorgia (Talk) 13:22, 14 April 2007 (UTC)

I appreciate your responding directly to the concerns I've raised, Colin. Did it not strike you as inappropiate, then, that "clinical" redirects to "medicine"? It did me. If you search Wikipedia for clinical you get dozens of pages including clinical audit, clinical ecologist, clinical depression, clinical neuropsychologist, clinical science, clinical linguistics, clinical governance, clinical psychology, clinical biochemistry, clinical study.... I think it should be a disambiguation page and will change it to that unless any disagreement. That redirect is actually an example of what I'm trying to address here - things wrongly being tied to just medicine. The content of this guideline deliberately now accommodates and incorporates other clinical perspectives (e.g. an alternative term to "signs and symptoms" very similar to one on the outline psychology style guide made a few days previously). When you say you may have complicated things before, did you mean the suggestion that psych should be subsumed into this guideline and a separate one not needed? Are you now favoring different guidelines? SandyGeorgia seems to be saying there should'nt be a need for them, because possible areas of conflict have been deliberately worked around? Although I agree that taxonomic issues will always be present, I think this particular issue is important (for reasons I can try to clarify if you like) and seems to be a sticking point for you and SandyGeorgia (why, if it's not important?). EverSince 05:32, 16 April 2007 (UTC)

I linked "medicine" because I was working with definition there: "Medicine is a branch of the health sciences, and is the sector of public life concerned with maintaining or restoring human health through the study, diagnosis, treatment and possible prevention of disease and injury." Does this not also apply when you use "clinical" as an adjective in front of psychology, etc? (Avoiding any argument over the word "disease" rather than "condition/disorder/syndrome/etc"). I did notice "clinical" was a redirect. I have no medical training, so other folk will be more knowledgeable about the distinctions than me.

I'm not conscious of a "sticking point" (but perhaps I misunderstand). In fact, the opposite, since you are the one that said "delay"! What I'm concerned about is that this almost-guideline could get derailed by trying to accommodate too much. I don't particularly want to have to perform another round of begging for comments. It is hard to get folk to participate.

The "characteristics" option was added to "Signs and symptoms" from Tourette syndrome. Sandy commented that it worked better with those conditions where folk don't necessarily consider themselves ill.

Yes, I was referring to the merge with the psychology MOS. At the moment, I can't see so much difference between your section headings and ours, that we couldn't accommodate them as options. I can see an overlap with Psychology on ill-health articles (which is what your headings focus on too – what about psychology that doesn't involve treatment?). Let's not get too hung up on e.g. the section headings. They actually only really apply to a minority of medicine-related topics too. We have plenty of articles on signs, treatments, minor ailments, hospitals, notable doctors, etc, etc.

Would you consider changing your "delay" to a "support", with the door open for future discussions on either merging or cross-referencing one another where appropriate? Remember, becoming a guideline doesn't cast it in stone. Colin°^Talk 08:10, 16 April 2007 (UTC)

(edit conflict) Yes, the guidelines deliberately try to be comprehensive now; why would neurology and psychiatry be left out of medicine? I used the suggested headings at least as far back as August, [1] if not earlier. What are you trying to say about "a few days previously" and "before the above-mentioned activity" here? It sounds like you're saying that Steven (who wrote most of MEDMOS months ago, looking at all the medical FAs) "copied" from you a few days ago, when TS has long used these headings. Even if he had, consistency across Projects would be a good thing. I'm glad Psychology has decided to follow suit, but I don't see why articles can't fit into more than one Project; most Wiki articles do. And no, I have not said there "shouldn't be a need for [different guidelines]"; in fact, I specifically pointed to examples or articles that fit into multiple Projects. SandyGeorgia (Talk) 08:28, 16 April 2007 (UTC)

The "Characteristics" option was only added on the 12th – "a few days previously". It is similar to "Features or Aspects" but was done in ignorance (on my part) of those guidelines. Colin°^Talk 08:42, 16 April 2007 (UTC)

Thanks for clarifying; since I'm flooded, I didn't check. Maybe you added it after you summarized and reviewed the current FA section headings? I thought it was there all along; now I feel so ignored. :) I still don't understand why it concerns EverSince, though; he seems to be implying a plan to subsume Psychology guidelines into Medicine guidelines; the idea was to make the guidelines more comprehensive to fields like psychiatry and neurology. SandyGeorgia (Talk) 14:51, 16 April 2007 (UTC)

I didn't mean to imply anything in particular but just wanted to clarify intentions. I think that the psychology MOS framework is neither here nor there at the moment (basically just some bits scavenged from here anyway). I think maybe I should have posted here to see what the views were here, before I started down that road. I do feel that the most collaborative guideline possible would be best, linking up as many wikiprojects as possible, and feel that 'medicine' isn't necessarily the real common theme here. For example, Neurology is one thing, but if you click on the guideline button at Wikipedia:WikiProject_Neuroscience you're taken to this guideline - yet neuroscience isn't a branch of medicine. The common theme is maybe "human health and functioning". Medicine being one (often dominant) approach to that. Other scientific and clinical (applied) specialities also being directly and importantly tied in, and founded on different paradigms/terminology. The fact that 'characteristics' is now included as an option in this guideline for conditions where, as you say, there are views that it isn't necessarily an illness, shows to me that this guideline isn't just about a medical model. I'd like to help contribute to developing this guideline rather than splitting things off perhaps prematurely (could be done later if necessary), but would not feel able to do so with it labelled as medicine. EverSince 17:09, 16 April 2007 (UTC)

(unindent) Don't read too much into 'characteristics' and 'not an illness' to mean these guidelines are expanding to include articles on basic human or biological 'functioning'. This was done to accommodate the wishes of editors on articles such as Tourette syndrome and Autism where there is a substantial group of people who reject the idea that they are ill. These are, rightly or wrongly, still medical conditions, diagnosed by a doctor. Almost all the headings apply to these conditions. The Neurology project guideline probably links to ours because they don't have one rather than because ours encompasses all of neurology. Editors on that project, writing about neurological illnesses, would find this a suitable guideline. Someone writing about the neuron would not.

I'm opposed to expanding these guidelines to "human health and functioning" and at this stage this is a diversion we could do without. I'd love if you would help contribute to this guideline but does that mean we have to "delay" making it official? Colin°^Talk 17:31, 16 April 2007 (UTC)

It was the Neuroscience project but I take your point (shouldn't that be made clear though, my point again about inappropriate redirects to medicine). That's not the whole truth about diagnoses like Autism and Tourettes - diagnosis is commonly made by clinical psychologists, with help from e.g. speech & language therapists, educational psychologists, social workers etc. You don't explain why my suggestion is an unnecessary or unfocused diversion, the International Classification of Functioning, Disability and Health is quite relevant and focused. You were OK, just below, using "healthcare professional" rather than medical professional - once again the issue of flexibility to expand the content but not the title. If you or others don't want to have any more delay addressing these issues then obviously that's your decision. EverSince 18:03, 16 April 2007 (UTC)

I've not heard of the ICF before; I just read it's entry, and I'm still not that clear. Is it ICD "plus other stuff"? Can you provide an example of differences and similarities between the two? Is our current version of the guidelines focused only on ICD, and if so, what would be an example of how ICF would change the current focus? Since I'm a layperson, and since I lobbied for expanding the section headings to encompass a non-disease model of medical conditions diagnosed by physicians (neurologists, psychiatrists and otherwise), I want to make sure I'm understanding the differences. SandyGeorgia (Talk) 18:20, 16 April 2007 (UTC)

EverSince, you're operating on a semantic level higher than me. You must forgive my ignorance. By "functioning" I thought you meant how the body/cells/proteins/etc work normally. This ICF seems to be concerned with "beyond disease and mortality" and into health as a spectrum to be quantified and assessed. Statements like "Functioning and disability are viewed as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors." make my head hurt. The phrase "placing the emphasis on function rather than condition or disease" seems more like looking at things a different way rather than looking at different things. Are you saying that "medicine" treats everyone as diseased to some extent where as "health" views everyone as healthy to some extent? Colin°^Talk 22:12, 16 April 2007 (UTC)

Forgive me for not initially expanding on the sense of functioning I was meaning - my head hurts too :/ The WHO language used to describe the ICF can be unclear (been meaning to tackle that ICF wikipage, did add a section about it to disability) - but I referenced it just to support the idea of guidelines covering health/illness and functioning/disability - as inextricably intertwined issues, and ones that have both medical and non-medical perspectives (determinants, interventions etc). This is getting over-complicated, but I basically suggest this guideline is implictly doing something similar by accommodating ways in which conditions can be described as being (or at least involving) functional human traits (potentially positive, may need support) rather than as medical illnesses (dysfunctional, to be cured), and by referencing healthcare professionals rather than medical professionals (cf Allied health professions, Mental health professions). And that it could make this issue explicit.

I can see, however, that "medical" is a nice neat term and a predominant perspective, with a (superficially) clear referent that people can recognize. I feel I've been able to raise and try to clarify my issues. I'll alter my delay comment - I don't want to feel like a spanner in works that people are behind. I would still personally argue that the guideline would be more NPOV (and more open and useful to more contributors) if framed as covering articles related to healthcare and disability (or something). But hopefully the non-medical issues could be addressed separately in any case, eventually. EverSince 14:59, 17 April 2007 (UTC)

This may go without saying, but WikiProject Dentistry will consider this guideline relevant to dental articles. I am glad there was enough support to move the discussion to some action. - Dozenist talk 12:54, 10 May 2007 (UTC)

Note

For what it's worth this page looks reasonable and commonsensical to me, and would be a worthwhile addition to the manual of style. >Radiant< 11:34, 24 April 2007 (UTC)

I agree. TimVickers 00:21, 25 April 2007 (UTC)

I agree. Are we ready to make it a guideline now, as weeks have gone by, and there are no objections? SandyGeorgia (Talk) 00:17, 30 April 2007 (UTC)

I have made the change. --Arcadian 02:09, 30 April 2007 (UTC)

It says at the top of this page "Are we ready to take this to a wider audience for consensus? If others agree, pls add to the list of Projects we should notify for consensus prior to the stage of going to Village Pump". So I was under the impression that discussion on this page was just preliminary before going to a general audience for a final decision, and I changed my comment to partial support on that understanding and because Colin asked me not to delay things here (I thought). Has there been some other discussion on not now taking it to the Village Pump? It looks like there was a delay of 2 hours today between the question above - are we ready to make it an official guideline? - and it being made a guideline. I think this is wrong and should be undone to give a reasonable chance to actually reply to what is an important question - a guideline for the formatting of a huge number of articles on Wikipedia. And I would like the chance to strongly propose and request that it goes to village pump. There have been several requests to broaden it to healthcare at specific points, and I think it's fairly clear I've made a more general objection of that sort. I'm going to change my partial support comment to clarify. EverSince 10:14, 30 April 2007 (UTC)

This is my fault, I should have written a progress update. Here's the timeline:

• 5th April: Main medicine projects and interested editors are notified of a renewed push towards finishing this guideline off.
• 13th April: We finished reviewing and tweaking the guideline. All the medicine-related projects were notified that we indended making this a formal guideline and asked for support/oppose/comments.
• 24th April: I asked User:Radiant! for advice and he suggested going to the Village Pump. I then placed a notice at the village pump (proposals).
• 30th April: Arcadian made it a formal guideline.

I think we've advertised as often and as widely as necessary. There have been no objections. If Arcadian hadn't beaten me to it, I'd have done the deed tomorrow. A week on the Village Pump has resulted in only supportive comments from Radiant and TimVickers.

I haven't forgotten your arguments for delay or change of focus. However, nobody else was joining that discussion. There need to be more voices heard for those ideas to move forward. The top of the guideline page says "it is not set in stone".

Colin°^Talk 11:10, 30 April 2007 (UTC)

Yes I think it should have been notified here that the decision had been made to take the proposal on to the village pump. I would have added a comment there if I had known. I think the basic question needs to be raised there of actually whether it would be NPOV to have medical style guidelines or would it be better to have health-related (incorporating medicine) guidelines. I think there needs to be some more general input of that sort, otherwise this isn't really being put through on a general consensus based on general Wikipedia views, don't you think? I'll perhaps try to raise this question there in due course unless any objections, and do personally think it should'nt yet have been tagged as having been generally accepted. EverSince 15:23, 30 April 2007 (UTC)

• This is not in fact a problem; just because it's a guideline doesn't mean it can't be edited, fixed, or otherwise improved. >Radiant< 09:38, 1 May 2007 (UTC)

It has seemed important for some to make it a formal guideline ASAP, in recent weeks. Has there actually been a discussion of the whole issue of separate style guides, on a general Wikipedia forum? I know there's quite a few of them now, related and unrelated to this one. Be grateful if anyone could point me to it. For example, about how they might influence NPOV, what to do if style guidelines conflict, or if editors on a given page disagree about which apply, or if specific guidelines only exist for certain approaches towards a subject? EverSince 12:31, 2 May 2007 (UTC)

The reason for the push ("ASAP") was that people quickly lose interest. Once a request-for-comment has been made on a talk page, it quickly becomes stale and the number of contributors tails off. We lost momentum before, and ended up with the guideline being tagged "historical" due to lack of participation.

I'm no expert on the formation of guidelines or policy. Have a look at Wikipedia:Policies and guidelines. It seems to me that many projects have a collection of informal guidelines. I've listed some of the ones on sister projects above. This one got started last July, but various bits of it have been kicking around in some form for longer than that. Colin°^Talk 16:15, 2 May 2007 (UTC)

I was actually referring to the period since 4th April - the discussions and changes from then were all archived immediately but looks like they were triggered by Radiant marking this guideline as historical on the 5th April, after several weeks of no activity here. For the record this was (coincidentally?) immediately after I posted on the psych project about developing an alternative psychology guideline to this one. And one of the actions after those discussions and changes here was to add comments at the psych project about the suggested alternative guideline suggesting it was perhaps not necessary and could be incorporated into this one - and it seems that coincidentally some changes had been made since the 5th April that made this more possible.

It's hard to understand why you are still on the idea that the timing on this guideline has anything to do with anything written on the Psych Project. The page was archived per Fvasconcellos and Colin's request here. Comments were added at the entire list of Projects above, not just the Psych Project. SandyGeorgia (Talk) 10:58, 10 May 2007 (UTC)

Anyway, does no one feel there needs to be any kind of general discussion on a general forum, about these diffferent manuals of style and ensuring they work in an NPOV way, and what to do if they conflict? Assuming there hasn't been. EverSince 09:13, 10 May 2007 (UTC)

I don't think that you'd get much participation trying to discuss a vague potential problem on a general forum. Are there specific concerns you have with applying this MOS to medicine-related articles, assuming everyone uses a bit of common-sense? Colin°^Talk 12:32, 10 May 2007 (UTC)

Thanks Colin but potential conflicts was only one aspect I mentioned. I would just like to ask if no one thinks any discussion is needed by the general Wikipedia community about how these guidelines fit in to Wikipedia? EverSince 13:42, 10 May 2007 (UTC)

Eversince, whatever is the concern that you have over the timing of this guideline — which I can assure you is misplaced — it would be most helpful if, rather than playing games with my posts and appearing to indicate you think something nefarious was afoot, you would just assume good faith, and recognize that the timing of this guideline was in response to Radiant tagging it historical. The archiving of the talk page and the posts to other WikiProjects is fully discussed above, and had nothing to do with any discussion on WikiProject Pyschology, which I first saw when I went to post to the Project as I did other Projects. There's really no need for paranoia here, and no reason two Projects can't co-exist. SandyGeorgia (Talk) 14:03, 10 May 2007 (UTC)

Further, when I posted to WikiProjectPsychology (on 21:00, April 13, 2007) I also posted to at least twelve other related WikiProjects (as discussed above), so it's really hard to understand why you keep bringing up something about the timing with respect to Psychology, and flagging my posts to that Project, and what your concern is. SandyGeorgia (Talk) 14:23, 10 May 2007 (UTC)

SandyGeorgia, I am very mcuh assuming good faith - I'm not sure you are in what you've just said. As I outlined above, I realised that this was all probably triggered by Radiant tagging this guideline as historical shortly after I referenced it on the psych project (I dont know if the two events were related). If that discussion hadn't been immediately archived I might have realised sooner. I object to your claiming I have been "playing games" with your posts. There's no need to get worked up - I simply wanted things to be clear, and simply tried to put your posts in chronological order - and to clarify their order when you reverted them back out of chronlogical order - as per guidelines. Not sure what your point is about Projects (or guidelines?) co-existing, of course they can and do, I can just no longer personally be bothered with trying to have psych guidelines.

Anyway, I would rather not get sidetracked in to personal or accusatory stuff in that way, I would still like to ask the question of whether no one thinks there should perhaps be some discussion in the general Wikipedia community about how these guidelines fit in to Wikipedia? EverSince 14:27, 10 May 2007 (UTC)

If you don't want to get sidetracked, then stop sidetracking and moving my posts around, and flagging the timing of my posts (which my timestamp already does). Since these guidelines were proposed, your posts have implied 1) that we "copied" sections from the Psych Project, 2) that we archived the talk page prematurely for some nefarious reason, and 3) now some new issue about the timing of my posts to the Psych project. Please stop moving other people's posts. I post below the response I'm replying to, with the correct indentation. SandyGeorgia (Talk) 14:50, 10 May 2007 (UTC)

(dedent) Guys (girls?), let's not allow this discussion to deteriorate over the order of posts (!) out of all things. EverSince, I'm not sure I understand your question: what exactly do you mean by "how these guidelines fit in to Wikipedia?" Fvasconcellos (t·c) 14:59, 10 May 2007 (UTC)

For the record, I never said stuff was copied - if anything stuff was (openly) copied from this guideline, only that there was some similar broadening but Colin previously clarified that was coincidence which I accepted. And I just think things should be left clear as possible and as per etiquette guidelines - I understand that comments should not generally be inserted back in between other's comments.

Fvasconcellos, as I mentioned above, it just seems there may not have been any discussion of the whole issue of separate style guides. That is, separate to the main manual of style. There seem to be quite a number of guidelines now which each advance particular views on what the style should be in a particular area. Does it not seem like potentially quite an important issue, that might potentially influence Wikipedia quite generally? I just wondered what people's views were. EverSince 15:17, 10 May 2007 (UTC)

In my very humble opinion, different topics warrant specific style guidelines. As long as they don't conflict with general guidelines and policies, I'm OK with them and will follow them and recommend that they be followed. Perhaps you'd like to bring this up at the MoS talk page? Fvasconcellos (t·c) 15:45, 10 May 2007 (UTC)

That sounds like a good idea, I guess I'll post there if anywhere. I do personally agree that specific style guidelines are warranted and helpful, but do wonder how it is to be ensured that all notable styles (out there in the world) for a given topic are fairly represented in Wikipedia guidelines, as per the core principle of NPOV. EverSince 16:17, 10 May 2007 (UTC)

Looks good, but needs work IMO

Hi, this is great! I've always wondered about a guideline page on writing medical wikipedia articles and only recently found this page via Wikipedia talk:WikiProject Clinical medicine.

It's good, but I don't think it provides people with enough material and directions when writing medical articles. Personally, I've always struggled with using the "ae" vs. "e" in words that are adapted from their Latin forms: haemo-/hemo-, orthopaedics/orthopedics, paediatrics/pediatrics...you can fill the rest of this list ;) But which form should be used??? This guideline doesn't say anything about that. If one were to check for every word which variant is mostly used, it will pose problems:

• There won't be a uniform style on Wikipedia, i.e. one page may mention orthopedics while the other mentions haemolysis. I find this confusing :S
• Checking which form is used the most is time-consuming and doesn't guarantee reliability: e.g. you can google haemolysis and hemolysis to find which term gives the most results, but many pages on the net are behind a login. Also, the internet isn't the only medium: there's also written/printed media.
• Even if one does find the right variant to use, this is still subject to change over time.

Besides, I don't think this is the right way to go at it. IMO there should be some kind of "universal" rule that states which form is to be used, based on concrete arguments.

This issue is similar to the discussion that's brought up by the user about the ise/ize (see above).

Also, looking at the clinical medicine talk page, I've seen certain topics in discussions that always return. E.g. the never-ending discussion about EBM. How many patients does it take until a medical procedure is considered evidence-based? And what about something that can not be explained using common sense but does provide (weak) evidence in literature?

I believe there's tons of other issues/topics on medical talk pages that keep returning. IMO these things need attention. Other than that, I'm glad that there's a page where I can always come to in order to find some guidelines on how a medical article should look like. Keep up the good work! Greets, A. Rad 12:32, 30 April 2007 (UTC)

Thanks for your compliments. The naming issues you mention aren't specific to medical articles and are mostly covered by WP:ENGVAR. MEDMOS does try to point users towards using an international standard for the article title, rather than editors using their own metrics (google hits, etc). WP:SPELLING is another related page. Perhaps there are some words, e.g. fetus, were there is some consensus amongst academic/medical writers?

We have proposed guidelines for choosing and using reliable sources: WP:MEDRS. Guidelines regarding EBM probably belong there. That page is quite young, so please make some suggestions or edits!

This is just a style guide. On an earlier (archived) discussion, I hinted that ultimately there could be a WP:MEDGUIDE (either through combining guidelines or using summary-style). One step at a time... Colin°^Talk 14:56, 30 April 2007 (UTC)

Hi, I've been to WP:ENGVAR before, but it doesn't really offer specific guidelines on the ae/e variants. The advice on that page is not very specific. About the article title, if you mean the following: Article titles use the scientific or medical name, then that's a good choice for "heart attack" vs. "myocardial infarction". However, both hematology and haematology are scientific names... :) As far as I know (I admit, I don't know that much), there's no consensus about the correct spelling. This makes it harder to argue what the "correct" spelling should be. In literature though, each book uses 1 form. Maybe we should consider Wikipedia as 1 book and agree on using 1 form, regardless as to whether it's the correct form...

I've added MEDRS to my watchlist. It looks promising. Will look at it later. It's a good idea to link to it from MEDMOS somewhere (or is it already linked?). Greets, A. Rad 19:22, 30 April 2007 (UTC)

It is linked to a couple of times (in italics at the top of the guideline, and also in italics at the top of "Citing medical sources"). I agree that it should be more prominent but I'm not sure how. Certainly, we should find a way for the project page to link directly.

Wrt spelling. My vote is for British English throughout Wikipedia. If only those folk across the pond could learn to spell properly! Good luck on getting consensus for that one ;-) Colin°^Talk 20:03, 30 April 2007 (UTC)

oh my gosh :-) Coeliac, Coeliac, Coeliac ... gets me every time. SandyGeorgia (Talk) 20:06, 30 April 2007 (UTC)

Somehow I totally didn't see those links to MEDRS, sorry! :D I think it has something to do with me ignoring those italic texts below each heading :S

FWIW, I also think the British English spelling (with the "ae" variants, and words like coeliac, foetus, etc.) is better. But I think there will never be a majority of users voting for one of the 2 variants. This is why I thought it would be a good idea to come up with concrete reasons why one of the two variants is the most "correct", and therefore should be used.

Lack of having such a rule can result into edit wars in the most extreme cases. And no one is right or wrong in such a case, cause there's no consensus on which variant should be used :) Greets, A. Rad 16:02, 1 May 2007 (UTC)

Without wishing to sound like a Philistine (not that the rumours about them were necessarily true), wouldn't less letters (in less unusual combinations) generally be considered simpler and more accessible to a general audience? (if not necessarily to Her Majesty's scientists). EverSince 12:37, 2 May 2007 (UTC)

Well, œ and æ are just single letters :-) There's always Simple English Wikipedia. Colin°^Talk 16:25, 2 May 2007 (UTC)

Person-first revisited

I don't watch this page, but I noticed that it was added as a guideline. I see that I missed a secondary debate, and a few changes I'd made (I felt reflecting the consensus on the talk page as well as elsewhere on Wikipedia and in society) were basically changed back by Colin. For those who missed it prior, see Wikipedia talk:Manual of Style (medicine-related articles)/archive1#Dramatic changes without discussion: basically, after a CFD in which a fairly strong majority opposed a rename of "Diabetics," it was noted that MEDMOS was seemingly out of sync with the consensus expressed there. There was some chatter on the issue, and after the discussion had passed a week without further comment and with the support of some other editors, I made the change and left thinking that everyone was okay with it. Colin responded later with this, which I did not see originally:

The following lines were removed by Snowfire:

• Be careful not to define a person or group of people by their medical condition. For example, seizures are epileptic, people are not.
• For more information, see Guidelines for Non-Handicapping Language in APA Journals.

I don't see why the second guideline was removed. It wasn't discussed. It contains much standard advise on careful language when writing about medical conditions.

As for removing the first guideline, I'm extremely disappointed at the lack of participation in discussing MEDMOS. Perhaps the talk-page section title didn't help? The first guidelines is overwhelmingly supported by professional and charitable bodies (I can supply refs if required). I don't believe MEDMOS should be "neutral on the issue". Snowfire - you've just come from a discussion on "Diabetic" where I accept there isn't strong felling against the term (though both Diabetes charities and journals disapprove of the term as a noun). However, there is no strong feeling for the term. If it is possible to write articles in a clear and no-clumsy way without causing offence to people-groups then that should be done. One way of doing that is to advocate person-first as a preferred writing style. Colin°^Talk 09:09, 14 February 2007 (UTC)

Okay, as before, I'd like to avoid a general debate on the merits of person-first terminology and hopefully ground this in Wikipedia's core policies. Now, I understand that you apparently feel strongly on the issue, and I also understand that you're probably far more qualified than I am to speak on most medical topics (nice work on getting this page as a whole to be a guideline, by the way). Nevertheless, I must renew my protest detailed before. To put it bluntly, I don't believe that person-first is as "overwhelmingly supported" by professional bodies as you say it is. I am no expert here, but the two doctors I consulted with had both never heard of this debate (yes, anecdotal, I know. Perhaps regional or specialty issues are at play here?). As far as the usage in the "professional" press, a quick search of The New York Times and The Economist indicates that at least for some conditions, yes, the adjectival form is still used. Furthermore, the question of whether person-first terminology will cause less offense than adjectival terminology differs drastically by condition. No doubt, for some conditions this is true; but for others such as deafness, this may be false, and for perhaps the majority of cases it simply won't matter. All this presupposes that causing offense is something that Wikipedia should address at all; and while Wikipedia should not cause gratuitous offense, that is not the case here.

This issue is entirely too murky to be prescribing a preferred form across all articles, especially on a site like Wikipedia which allows British and American English, BC-AD/BCE-CE year titles, European and American date styles, and multiple different referencing formats on a per-article basis. I think/hope we can both agree that grammatically, there is nothing wrong with either construction. "A person who is deaf" and "a deaf person" mean exactly the same thing. With the cultural/societal issues still muddy and confused at best, I believe that the Manual of Style should be descriptive and not prescriptive in this case. It can perhaps remind people that this controversy exists, and let the form choice be done on a per-topic basis; "picking a side" does not seem to be consistent with the way Wikipedia works. SnowFire 23:45, 2 May 2007 (UTC)

All the guideline says is "be careful"; it doesn't say "never". I think it's well worded. I'm having a hard time understanding a situation that would differ with the guideline as worded, notwithstanding that you spoke to two doctors who may routinely offend their patients :-) For example, I would hope any reference to a "tourettic" in place of a person with TS would be quickly removed. SandyGeorgia (Talk) 23:58, 2 May 2007 (UTC)

Yes, and on a per subject matter, that is fine. And the wording now is much better than it was in February, for sure; it's pretty good. However, the current wording still assumes the central thesis of advocates of person first terminology to be correct. For reference:

Many patient groups, particularly those that have been stigmatised, prefer person-first terminology. For example: seizures are epileptic, people are not. In contrast, not all medical conditions are viewed as being entirely disadvantageous by those who have them. Some groups view their condition as part of their identity (e.g. some deaf and autistic people) and reject this terminology. For more advice, see Guidelines for Non-Handicapping Language in APA Journals.

So, the only reason why a group would not prefer person-first is if they identify with their condition? This continues the assumption that "Xic person" over "person with X" more strongly ties X to the person. Now, again, some groups do in fact consider this to be so, as noted. But I would hypothesize that many more fail to see any distinction whatsoever. Might I suggest something along the lines of this instead:

Be aware that not all medical conditions are viewed as being entirely disadvantageous by those who have them. Also, some patient groups prefer "person-first terminology;" for instance, referring to "a person with epilepsy" rather than "an epileptic person." In contrast, others prefer an adjectival form, such as some deaf and autistic people. Please be sensitive to any known preferences for styles in referencing a condition.

SnowFire 02:25, 3 May 2007 (UTC)

Firstly, a minor correction. Your change didn't have "support of some other editors". Only one other editor contributed to the discussion: User:KonradG. Lack of participation in these discussions is a real hindrance to establishing consensus. The change I made latter on, was an attempt to include both sides rather than say nothing on the issue.

The CfD on Diabetics proved nothing that countless studies on "disabling language" have already shown: that the general public is largely indifferent to and ignorant of the issues. Remember that the discussion did not ask "I'm planning to create an category and would like advice on which name to pick. Should it be 'People with diabetes' or 'Diabetics'?" If someone had pointed out that the main diabetes charities and journals prefer the former and disapprove of the use as a noun, I'm sure there would be overwhelming support for choosing the former. As it was, people were asked to recommend a change from "Diabetics" to "People diagnosed with diabetes". This clumsy alternative naturally did not find favour. Finally, many participants disapproved of the category itself (which was subsequently deleted).

Your main protest is "I don't believe that person-first is as "overwhelmingly supported" by professional bodies as you say it is". Everywhere I've looked for guidelines on language to use when referring to people with medical conditions or disabilities, the "person-first" terminology is promoted. The only people-groups I've found that reject this terminology are some members of the deaf and autistic communities. They also reject the very idea they are disabled, regarding their difference as a trait rather than a defect. There may well be many people-groups who care less about how they are described (as you point out). Their attitude should not be interpreted as a reason to reject a preference towards one style in professional writing.

The APA guidelines are often cited. Another set of guidelines are the

• Guidelines for Reporting and Writing about People with Disabilities (pdf) (Also available as HTML here)

Those guidelines are the result of discussions with more than 100 disability organisations and have been distributed to more than 1 million people. Portions are included in the Associated Press Stylebook.

A readable overview of the issues can be found in Sticks and Stones ... and Words CAN Hurt: Eliminating Handicapping Language (pdf), Darrow and White (1997), University of Kansas. One point they make is that "deference is usually given to those individuals being described". The advocates for such people-groups should be heard above the opinions of the unaffected.

One article I found looked at Preferred language practice in professional rehabilitation journals. The introduction for this confirms several points:

• A general consensus has developed that language communicates attitudes and that inappropriate language encourages negative stereotypes.
• The primary general language recommendation of the past decade is that "person" or "people" should precede the disability.
• Disability descriptors should not be used as nouns because this tends to identify the person with, or in terms of, the disability.

Disappointingly, the article goes on to find that the professionals did not always practice what they preach.

In summary, I think the current text (as quoted above) is OK. I appreciate you are trying to find some middle ground. However, your version isn't substantially different from the current one. The main differences is on order, which affects the emphasis, and on significance (many → some). I disagree that the emphasis or significance needs to change. Colin°^Talk 17:32, 3 May 2007 (UTC)

I want to mention that in the LCME-mandated course on society/patient/physician interactions taught at Hopkins, "person-first" is presented as the appropriate way to speak about medical conditions. (The phrase "person-first" is not invoked, but the concept is taught repeatedly.) So, while it may not be the norm in medical practice, it is what is being taught to current medical students. Antelan ^talk 18:38, 24 May 2007 (UTC)

Dealing with CAM

I think we need guidelines for dealing with complementary and alternative medicine (CAM), and untested therapies, including non-conventional therapies and therapies that most people regard as crackpot.

I don't think we can ignore them, because many people, tens of millions, believe in them.

I think that the best way of dealing with it is to describe the treatments, the arguments for and against them as objectively and NPOV as we can. The only issue is undue weight. For example I would be willing to have a one-paragraph mention of an alternative cancer therapy, with pros and cons and a link to another entry on the treatment, but I think it would be inappropriate to give the alternative treatment equal weight to established treatments with published randomized, controlled trials.

This is what we do anyway in many medical articles, but I'd like to have a written guideline to cite when the problem comes up. Nbauman 19:09, 10 May 2007 (UTC)

I'm nervous jumping into this fray, but I agree with Nbauman -- this is a very common problem, and people on both sides (those that don't want CAMs to be given disproportionate weight, and those who are fervent believers of the CAM in question) have strong opinions on how they should be handled in articles. A guideline would help. CerebralMom 06:02, 12 August 2007 (UTC)

Dosages of Drugs

The sentence "Do not include detailed dosage and titration information. Such details can be construed as medical advice, they border on trivia, can be country-specific and become quickly out-of-date or easily subject to uninformed edits."

This is Medicine Wikiproject (?Wikipedia) policy, right? I completely agree with this. Wikipedia isn't a formulary and its easy for patients to make mistakes with dosages. Also easy for people/vandals to change a figure so can't guarantee accuracy or safety. And in many cases doses are determined and vary depending on factors like weight, renal function, severity of illness, etc.

However note: on WikiProject Pharmacology they have a section on how to detail "Indications and dosages".

If this is going to be our guideline, it should be made clearer on the MOS page as this is frequently not adhered to (eg. Clozapine, Quetiapine, Quinine, Tazocin to name a few). And maybe discussed with WP:Pharmacology?

Providing what size/doses of a particular tablet/drug are available is slightly different but I think we should be very careful not to advise or prescribe the dose so that people reading it could conclude it is the right dose for them. Tsumo^@ 00:17, 25 May 2007 (UTC)

In the long run, it would probably be best if we could better sync with WP:Pharmacology. But in the short run, it is probably appropriate to say that any dosage data without a specific reliable source should be immediately deleted. --Arcadian 01:26, 25 May 2007 (UTC)

I wholeheartedly agree with MEDMOS on this one, and fully intend to overhaul WP:Pharmacology's style guide in the future. I've been waiting to see if there is any interest/more activity on the Talk page, as I'd hate people to think of it as "one-man consensus", but the project hasn't been seeing much action lately. In time, we (WP:PHARM) should certainly align the Project's style guide, which is unofficial, to this guideline. Fvasconcellos (t·c) 02:22, 25 May 2007 (UTC)

I agree that this information is entirely inappropriate for Wikipedia. As Fvasconcellos says, we should certainly talk this over with WP:PHARM; is there any official Wikipedia body we can run this past, too? Nmg20 08:51, 25 May 2007 (UTC)

I think it is a big omission to leave out dosage information. It is certainly not trivia and there is a huge difference between giving objective information and giving medical advice. For an example on how this can be done in a nice and objective way see the (featured) paracetamol article: It is commonly administered in tablet, liquid suspension, suppository, intravenous or intramuscular form. The common adult dose is 500 mg to 1000 mg. The recommended maximum daily dose, for adults, is 4 grams. In recommended doses paracetamol is safe for children and infants as well as for adults. --WS 14:35, 25 May 2007 (UTC)

There is quite a big difference between noting the maximum safe dosage of one of the most widely used OTC drugs in the world and, say, the dosage section in Quetiapine (as mentioned above), which is extensively detailed, completely uncited and probably contains some original research :) If we can make this information encyclopedic and avoid medical advice and anecdotal reports (which always semm to "find their way" into drug articles), I'm all for it. Meanwhile, I've boldly reworded WP:PHARM's style guide; it should comply with this guideline, unless and until there's a change here. Fvasconcellos (t·c) 14:43, 25 May 2007 (UTC)

Non-drug treatments

Do we have a recommended section order for these? I've been trying to reorganise the electroconvulsive therapy article, and have suggested something based on the drugs section list here - comments appreciated:

1. Introduction
2. Indications
3. Administration
4. Adverse effects
5. Mechanism of action
6. Legal status
7. History
8. Role in culture
9. References

Ta. Nmg20 23:27, 7 June 2007 (UTC)

(Very late reply) IMHO this has worked quite well, actually; the article looks pretty good. It does seem to be somewhat of an omission not to cover articles on procedures. Does anyone have further thoughts on this? Fvasconcellos (t·c) 13:11, 28 June 2007 (UTC)

Thanks, Fvasconcellos - and I agree, it's probably made the article more manageable. That it's worked in an article like that makes me think it's worth persevering with and perhaps codifying for other articles. The current running order on the electroconvulsive therapy article has the advantage of having had criticism from both vehement supporters of the traditional medical model, vehement opponents to it, and indeed me, and looks like this (my comments in brackets):

1. Introduction
2. Indications
3. Treatment procedure (~= administration in the drugs list)
4. Effectiveness (this has been essential to the ECT article, and should probably be considered for inclusion in the drugs template)
5. Adverse effects
6. Mechanism of action
7. Legal status
8. History
9. Role in culture
10. See also
11. References

As an aside, may I just say that it's a credit to those responsible for the drugs template that it has adapted itself so readily to treatment procedures? Ta. Nmg20 00:02, 29 June 2007 (UTC)

Quality assessment per DISCERN

One study (PMID 16533758) reports that (emphasis added):

"The Internet is now the single largest source of health information and is used by many patients and their families who are affected by childhood brain tumors. To assess the quality of pediatric neuro-oncology information on the Internet, we used search engines to look for information on five common tumor types (brain stem glioma, craniopharyngioma, ependymoma, low-grade glioma, and medulloblastoma). The Web sites were evaluated for content quality by using the validated DISCERN rating instrument. Breadth of content and its accuracy were also scored by a checklist tool. Readability statistics were computed on the highest-rated sites. Of 114 evaluated Web sites, the sources were as follows: institutional, 46%; commercial, 35%; charitable, 15%; support group, 2%; and alternative medicine, 2%. Good interobserver correlation was found for both ratings instruments. The DISCERN tool rated Web sites as excellent (4%), good (7%), fair (29%), poor (39%), or very poor (21%). Only 5% of the Web sites provided one or more inaccurate pieces of information. Web sites were found deficient in topics covering etiology, late effects, prognosis, and treatment choices. Few sites offered information in languages other than English, and readability statistics showed an average required reading level of U.S. grade 12+ (the suggested level being grades 6-8 for an adult audience). The Internet is increasingly being used as a source of oncology information for patients and their families. Health care professionals should be actively involved in developing high-quality information for use in the next generation of Web sites."

This DISCERN tool and some other tools mentioned in the study may be useful to many contributors here who write "disease" pages, both for evaluating their own pages, and for evaluating sources to select those that are high quality.

Trials - Studies

I am proposing to add a paragraph (to drug articles only) with this heading to those already suggested by the Manual of Style. There are certain drugs that have been licensed on the back of well known trials (a good example is 4S study and simvastatin). However rather than starting a separate article for each trial (as has been in the case of the 4S study) I suggest that these are included within the article of the drug they helped bring to the market. If such a paragraph ends up containing too much information it can then be moved to its own separate article. StephP 00:55, 29 August 2007 (UTC)

I think that this is a promising idea, but rather than editing the manual-of-style right now, I'd recommend adding this section to a few specific articles, so it can be seen in context. Then, assuming there is support for the section on those pages (after a month or so), the manual-of-style guidance could be reverse engineered from the consensus prose. (It's also possible that this content would be more appropriate under a more general header such as "History" or "Current research", but it's hard to say until we have an example to look at.) --Arcadian 03:51, 29 August 2007 (UTC)

Please don't add section headings "Trials - Studies" as that doesn't comply with either WP:DASH or WP:MSH. In proposing a new section, pls don't breach WP:MOS. SandyGeorgia (Talk) 12:22, 29 August 2007 (UTC)

I presume Steph meant Trials and/or studies. We'd smooth it out soon enough ;) Fvasconcellos (t·c) 12:50, 29 August 2007 (UTC)

Thinking about this further, I would suggest a heading of Seminal or Landmark Studies. If we take simvastatin as an example, there are numerous in-vitro and in-vivo studies that helped develop this drug, but some of them represent milestones that most clinicians then refer to. When I get a minute, I will create a (hopefully half decent) example and will post the link here for further ideas/discussion/evaluation. StephP 13:18, 30 August 2007 (UTC)

Please see WP:MSH, and that heading seems a bit POV. SandyGeorgia (Talk) 13:25, 30 August 2007 (UTC)

Well, it would represent the POV of say the Food and Drug Administration, if they used a phase III study to justify granting a license to a particular drug. Would you argue that the FDA may have a biased (and not evidence based) POV? StephP 22:39, 1 September 2007 (UTC)

Drugs: Do not include detailed dosage and titration information.

The current MEDMOS guidelines on drugs state: "Do not include detailed dosage and titration information. Such details can be construed as medical advice, they border on trivia, can be country-specific and become quickly out-of-date or easily subject to uninformed edits."

It seems that in a recent discussion on the talk page to the FA Bupropion a different consensus was reached. As I understand it, the editors agreed that a piece of medical information, that may be construed as a medical advice, is acceptable in Wikipedia on the following condition.

It is made clear that any advice is not coming from Wikipedia but is an opinion taken from a reputable source, which is named in the main text with the citation provided.

I asked a question: Is the following a medical advice? "treatment is supportive, and focuses on maintaining airway patency and controlling seizures (usually with intravenous benzodiazepines). The manufacturer recommends gastric decontamination through use of activated charcoal and gastric lavage soon after ingestion, and electroencephalographic monitoring for 48 hours subsequently"

and received the following answer from Fvasconcellos:

Erm, no. We are noting standard procedure and backing it up with a reliable reference. If we mention, say, in the myocardial infarction article: ”Aspirin should be given at the first signs of a heart attack.”, that is inappropriate, prescriptive, and medical advice. If we say, however: ”Aspirin has an antiplatelet effect which inhibits formation of further blood clots that clog arteries. According to the American College of Cardiology and the American Heart Association, 911 dispatchers may advise people suffering heart attack symptoms to take 160–325 mg of aspirin, preferably a non–enteric-coated formulation and as long as they are not allergic to it, while they await the arrival of EMS.[74]” that’s not medical advice. We are reporting the generally accepted recommendation of a relevant “authority”, and supporting it with a reference. That’s encyclopedic. Fvasconcellos (t·c) 11:47, 24 August 2007 (UTC)

I cannot but agree with Fvasconcellos.Paul gene 01:23, 2 September 2007 (UTC)

I'd like to add the following:

1. As Paul stated above, "It is made clear that any advice is not coming from Wikipedia...": I would like to add that my personal opinion is "any content that may be construed as advice". Advice is advice; IMHO, all it takes for constructive, accurate content to become it is careless wording and poor referencing.
2. My "myocardial infarction" passage is not a quote from the actual current article; it's just an off-the-cuff example.
3. I'm still uncertain as to the appropriateness of such information. I do believe, however, that it's time the discussion was rekindled, whether it ultimately reinforces the current guideline or changes it.

By the way, I'm linking to this discussion at WT:PHARM. Probably best to have as much input as possible :) Fvasconcellos (t·c) 01:53, 2 September 2007 (UTC)

I wasn't following the Bupropion discussion but have skimmed the talk page. I don't get the impression that the condition you mention (in bold above) is actually the important distinction. Rather, in the examples given, the distinction is between an active prescription of behaviour and a passive description of behaviour. Whether you explicitly cite the source of the information in the body text or the references shouldn't matter. For example, saying

According to the American College of Cardiology and the American Heart Association, aspirin should be given at the first signs of a heart attack.

is still medical advice, albeit second-hand advice. Aspirin's role in emergency medicine should be described by WP. This is a tricky area and I think it is hard to give strict rules to follow. Actually, I think the most common problem with medical advice on WP is doctor-focussed advice rather than patient-focussed advice. The dosage/titration details come into that area since most patients (I hope) don't try to work out the dose of prescription medicines themselves.

The text "take 160–325 mg of aspirin" is a good example where detailed dosage information doesn't work on WP IMO. For starters, there's a typo in that it should be 162–325 (according to the source). Secondly, any UK readers will be scratching their heads at how to cut their tablet into 162 mg, since the standard size here is 300 mg, with 75 mg as the "low dose" rather than 81mg. I guess your tablet is based on 5 grains. Chewing "half to one tablet" would seem to be the real-world units that most readers could relate to.

Perhaps the guideline "Do not include detailed dosage and titration information" needs to be revised? This discussion at WP Medicine is relevant here. Is there a difference between OTC and prescription medicines? Is the text at Trimipramine#Dosage or Haloperidol#Doses, to pick just two, encyclopaedic? Is there a difference between a short drug article (that could so easily become just a clone of an online drug website) and an article comprehensive enough to be featured?

I think one problem is that we lack a good selection of FA-quality drug articles. We don't really know how WP should handle them. I think the list of suggested headings for drugs is much less mature than for diseases. There's also a difference between well known drugs (aspirin, heroin, paracetamol, diazepam, etc) and the other 99%. More input required...

Colin°^Talk 18:26, 3 September 2007 (UTC)

Let me just say that the mailing list thread linked to at WP Medicine is an excellent sample of just how varied people's opinions are on this matter. Maybe we should just take thing on a case-by-case basis—nuke what's inappropriate, rewrite what's halfway there, polish what's sourced and reliable? We do certainly need more consistency across articles. Fvasconcellos (t·c) 18:41, 3 September 2007 (UTC)

First, the dictum "Do not include detailed dosage and titration information.", is too strict and unnecessarily limits the comprehensiveness of the article, which is important for encyclopedia.

Second, there has never been general consensus among the editors regarding the dose information. See the mailing list thread mentioned by Colin as well as the thread "Dosages of Drugs" above in MEDMOS talk [2].

Third, the text at Trimipramine#Dosage or Haloperidol#Doses can be struck out based on other guidelines as not properly referenced or plagiarized.

I agree with Colin's point that we lack a good selection of FA-quality drug articles to use as examples. So, why not just use common sense, as Fvasconcellos suggests, until we have enough good examples to come up with detailed directions. Thus, I would propose doing one of two things: return to the earlier wording ("Think twice before including detailed dosage and titration information. Often such details border on trivia, can be country-specific and become quickly out-of-date or easily subject to uninformed edits.") or to make the current version milder: "Do not include overly detailed dosage and titration information", so that the common sense and precedent determine what is overly detailed. Paul gene 23:30, 3 September 2007 (UTC)

Nice to re-read my comments from 4 months ago, which I'd (shamefully) forgotten about: "If we can make this information encyclopedic and avoid medical advice and anecdotal reports (which always seem to 'find their way' into drug articles), I'm all for it." The question remains as to how we can make such information "encyclopedic". Fvasconcellos (t·c) 00:30, 4 September 2007 (UTC)

Hello there from Wikiproject Chemistry. My approach when dealing with "cookbook" style instructions (e.g. preparation of buffers, etc) was to describe it briefly and qualitatively only. No numerical values at all. For your aspirin case, perhaps you can say that

On noticing the signs and symptoms of a heart attack, taking aspirin is recommended by ....(followed by reference)

This is especially with regard to WP:NOT a cookbook, directory, manual, etc. --Rifleman 82 02:35, 5 September 2007 (UTC)

I've just been reviewing the suggestions and noted the MEDMOS discussion cited. I agree there is no strong consensus against including any dose and titration information. The opinions are quite divided. Changing "Do not" to "think twice" does soften the guideline but doesn't really help the editor decide what to do after thinking twice. This is a Guideline, not Policy, so we can deviate when justified. The other suggestion to include the word "overly" is perhaps too subject to interpretation. I wonder if the existing wording, which says "detailed dosage and titration information" is actually enough? Is anyone arguing for "detailed" information here? Since WP is aimed at the "general reader", detail on this subject is probably not interesting/required/useful. Ideally, some interpretation (without OR) would be useful. For example, having to take a medicine three or four times a day makes compliance a problem. Needing to slowly increase/decrease the dose of a drug may make it unsuitable for some conditions. Comparisons of dosage between related drugs may be interesting. Is the dose for one indication (e.g. stroke) significantly different from that for another (e.g. pain)? Colin°^Talk 14:36, 6 September 2007 (UTC)

We shouldn't include any dosing information that doesn't have a reliable source. Fortunately, nearly every pharma article has an extremely reliable source: the World Health Organization's ATC code is actually an "ATC/DDD" code, with the DDD standing for "Defined Daily Dose". From the WHO: "The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults...." You can see the DDD by clicking on the ATC code's external link for the specified indication. --Arcadian 23:10, 6 September 2007 (UTC)

I think detailled dosage info is inappropriate for most drugs, irrespective of a suitable source (one can quote British National Formulary for any drug - and that is authorative). The issue is whether mentioning a dosage would suggest that that is what a patient should be on and this is against the well intentioned medical disclaimer. Many, if not most, drugs must be given at a different dosages in children (and this varies by age &/or weight), liver or renal impairment. WP is not a directory or technical manual listings - such information belongs in the prescribing datasheet or a pharmaceutical formulary and is then interpreted by the person who comes to prescribe - ie the doctor. Dosages are only occasionally notable, in the sense that they are a piece of info appropriate to be included in a general encyclopaedia. Self-medicated items such as aspirin, paracetamol & Ibuprofen and a few emergency drugs (aspirin in MIs as mentioned above), self-injected adrenaline (being lower if given iv vs im) seem to me the sort of limited occasions this may be appropriate. But I agree with above points re not even giving specific numerical values of aspirin in an MI - tablet formulations vary by country and wikipedia is global, and not just US (nor UK as I might add details on) - Colin's suggested wording re aspirin is fine by me :-) David Ruben ^Talk 23:27, 6 September 2007 (UTC)

• I looked through a dozen of featured medical articles and they ALL do an admirable job of not mentioning ANY doses and still staying relevant. The general opinion in this discussion seems to be that we should not mention doses except if notable or necessary for the discussion in the article. I have gripes, however, with the justification used in the current version of guidelines: dosage and titration information "details can be construed as medical advice, they border on trivia, can be country-specific and become quickly out-of-date or easily subject to uninformed edits." This justification contradicts other parts of MEDMOS, for example, "listing of available forms" and country-specific information recommended by the current version of MEDMOS actually encourage trivia-like information. Any information in a new field or for a new drug can become quickly outdated but it is not a reason for not including it into WP. And anyhting in WP is eventually subjected to vandalism and uninformed edits. In addition, the notion of medical advice in WP is extremely ill-defined. I do like suggestions to justify the exclusion of unnecessary details based on WP:not. So I propose the following phrasing:

"Do not include dose and titration information except when they are notable or necessary for the discussion in the article. Wikipedia is not an instruction manual or textbook and should not include instructions, advice (legal, medical or otherwise) or "how-to"s.WP:NOT#HOWTO

I tried to reflect most of the opinions above. As the general discussion seem to have ended, please suggest concrete changes to the wording I propose. Thank you Paul gene 14:12, 16 September 2007 (UTC)

The first sentence is more restrictive than the current form (by dropping "detailed"). I'm OK with this but is everyone else happy with that? I don't think anyone here would have problems with the "except when" bit. I hope, in fact, this encourages folk to write prose in drug articles rather than the tendency towards lists of bare facts. The second sentence merely repeats other WP guidelines/policy and I think it isn't necessary. An earlier section on "Careful language" warns against medical advice. So, IMO we only need the first sentence. BTW: I assume the bold is merely for the purpose of this discussion, rather than the final text. Colin°^Talk 19:01, 16 September 2007 (UTC)

I'm a bit confused about the comment about '"listing of available forms" and country-specific information recommended by the current version of MEDMOS actually encourage trivia-like information'. The text has Indications as a section heading with "(available forms, if notable)" as a comment. Listing all the available oral forms might become trivia, whereas indicating that a drug is also available via IV, nasal or buccal routes might well be notable. I can't spot a recommendation for "country-specific" information. Also, I wonder if the Trivial section here could be expanded with some examples?

I can't stress enough that IMO the drug part (particularly the headings) is the least mature part of MEDMOS. I encourage everyone to read MEDMOS critically and compare it to what you consider to be "best practice" on WP (if you can't find it). I'm really pleased to see constructive criticism and consensus editing here. Colin°^Talk 19:59, 16 September 2007 (UTC)

More restrictive language aligns drug articles with the rest of med-related articles where in med-related FA no doses are mentioned at all. I believe that the WP:NOT policy bears repeating for two reasons. First, it is a good justification for not including doses. While there may be disagreement as to what "medical advice" is, there is much less disagreement about avoiding cookbook and instruction manual style. Second, for convenience. It is hard to remember all the WP policies verbatim, and there may be confusion as to what in particular we are referring to, so I took the most relevant two sentences from WP:NOT. If I am to remove doses from an article, I can refer to MEDMOS and quote it, instead of referring to both MEDMOS and WP:NOT and having to explain what I mean. Including the explanation bit will also help newbies to learn. Paul gene 10:40, 18 September 2007 (UTC)

Citing journal articles

If you have a PMID, is it necessary or a good idea to have a doi too, or will one or the other do? Thanks, delldot talk 14:12, 28 January 2008 (UTC)

I prefer to use both. Some sites don't link to the PubMed abstract (e.g. JAMA - I have written to them about this), and Pubmed has certain functions that are very useful (e.g. "cited in PMC", "related articles"). JFW | T@lk 16:57, 28 January 2008 (UTC)

Thanks! delldot talk 05:19, 29 January 2008 (UTC)

Sorry, one more: In cases where you don't have a doi, is there any point in including the URL to an abstract? What if you already have a PMID? Thanks, delldot on a public computer talk 03:33, 31 January 2008 (UTC)

If no DOI can be found, a PMID is sufficient if only the abstract is free (provided PubMed actually have an abstract to show). We typically turn the article title into a hyperlink to the full free text, if available, and not bother if not free. If you didn't have a PMID or DOI but did have a URL to an abstract, then I'd prefer if you made a hyperlink like (abstract) at the end of the citation. Most of your readers will not have any subscription journal access. Colin°^Talk 07:49, 31 January 2008 (UTC)

Here's another question. Which version of the free full text should you choose? There are occasionally several options:

1. The copy held on the publisher's web site.
2. The copy at PubMedCentral.

and

1. The PDF copy.
2. The HTML copy.

The PDF is the closest to the original print edition, is easy to read, and looks good when printed out. The HTML loads much quicker, doesn't have a habit of crashing your browser, and often has the refs formatted as hyperlinks (with an indication of which are just abstracts and which have free full text).

The PubMedCentral copy sometimes claims to be the "Author Manuscript" and the "final edited form" is at the publisher's site. This isn't always the case, and sometimes PubMedCentral is the only free copy.

Some examples:

• Publisher's HTML vs
• Publisher's PDF download page vs
• Publisher's PDF URL.

and

• PubMedCentral HTML vs
• PubMedCentral PDF.

My preference is the HTML version since a link to the PDF is usually provided. What do you think?

One observation: PubMed isn't always reliable when it comes to linking to the full text. It may be wrong about the text being free or it may not tell you when it is. It also often doesn't have a link when the full text is available. I have found full free texts (at the publisher's sites) via Google or through the publisher's website. So don't always give up if PubMed has no link. Colin°^Talk 09:11, 31 January 2008 (UTC)

I tend to link to the publisher's fulltext, as everyone has HTML but not everyone should be assumed to have Acrobat. I only link to PDF with older papers which are not available in HTML. With PMC I tend to dually link to the publisher as well as PMC, as both have their upside. For instance, PMC automatically generates a list of references that are free in PMC, while the publisher's sites (especially HighWire-based) have a list of articles that cite the study in question. JFW | T@lk 11:36, 31 January 2008 (UTC)

Thanks to both of you, very helpful! delldot on a public computer talk 06:44, 1 February 2008 (UTC)

Proposal to formalise the relationship between MOS and its sub-pages

Dear fellow editors—The idea is to centralise debate and consensus-gathering when there are inconsistencies between the pages.

The most straightforward way is to have MOS-central prevail, and to involve expertise from sub-pages on the talk page there, rather than the fragmentary discourse—more usually the absence of discourse and the continuing inconsistency—that characterises WP's style guideline resources now. If consensus has it that MOS-central should bend to the wording of a sub-page, so be it. But until that occurs in each case that might occasionally arise, there needs to be certainty for WPians, especially in the Featured Article process, where nominators and reviewers are sometimes confused by a left- and right-hand that say different things.

Of course, no one owns MOS-central, and we're all just as important to its running as other editors. I ask for your support and feedback HERE. Tony (talk) 12:21, 5 February 2008 (UTC)

Also, mention there that gene names are typically italicized. This currently isn't part of MOS or MEDMOS, so needs to be rationalized, worked into both, discussed. To date, to my knowledge, MEDMOS is the only WikiProject guideline that was subjected to broad community consensus (via posts to over 20 other Projects and the Village pump). We have other sub-pages of MoS being added without any apparent attempts at consensus or conformity with MoS. SandyGeorgia (Talk) 02:45, 7 February 2008 (UTC)

Italicized gene names is already part of WP:ITALICS, so I don't know what that discrepancy was even about; nothing needed in MEDMOS because it's already in MoS. SandyGeorgia (Talk) 03:58, 7 February 2008 (UTC)

MEDMOS has been through the community and is accepted at least by this WikiProject as the standard. Tony1, could you point out any discrepancies? JFW | T@lk 14:08, 7 February 2008 (UTC)

Overciting?

Is there a problem with citing a source too much, like if you use so much material from a source you end up citing it 20 times? (This is assuming you have enough other sources as well, of course there'd be a problem with relying heavily on only one source.) Thanks, delldot talk 16:09, 7 February 2008 (UTC)

If it's a very high quality review in a highly respected journal, no. If it's a book or another non-refereed, non-peer reviewed source, could be a problem. SandyGeorgia (Talk) 16:10, 7 February 2008 (UTC)

Thanks much! delldot on a public computer talk 02:56, 9 February 2008 (UTC)

Drug names in non-main articles

There's a discussion at Crohn's disease, and I'm surprised that there's no guidance here (though perhaps a more generic MOS page is more helpful). The gist is, should the brand name be mentioned in the page (i.e. "Natalizumab (Tysabri)" versus just "Natalizumab")? It seems like either there should be guidance on this, or there is and I just haven't seen it. WLU (talk) 16:56, 15 February 2008 (UTC)

I don't know how helpful a general rule would actually be. Some generic names are well known; some brand names are well known. I'd personally rather read about Vicodin® than about "hydrocodone and acetaminophen." I think that may need to be hashed out in each individual article, with the goal of making it intelligible to the average reader. You'd hate to have someone saying, "I wonder why my doctor put me on this awful Coumadin®, when this article says that something called warfarin is the standard treatment." WhatamIdoing (talk) 20:35, 15 February 2008 (UTC)

Yes, WLU, we should probably attempt to clarify this; bringing in Colin (talk · contribs) and Fvasconcellos (talk · contribs) should probably get this dealt with. In the meantime, see the way Fvasconcellos had me handle trade vs. generic names at Tourette syndrome (we have to avoid US-centric trade names). SandyGeorgia (Talk) 20:38, 15 February 2008 (UTC)

Of course, each drug should have its brand and generic names in the lead, if not the first sentence of its own page. I'm a big fan of wikilinks for extra info like that, but it's been pointed out that this isn't as useful for print versions. Natalizumab is an odd duck in and of itself, as before I edited the article it was referred to as Tysabri throughout. That is confusing in my mind.

Regards working it out with each article, then you face the decision of what is most useful, which leads to 'for what reader', and how do you measure the popularity of brand name versus generic drugs? Blarg but she be a knotty problem. WLU (talk) 21:03, 15 February 2008 (UTC)

The standard medical book and journal style is to use the generic name first (in lower case), with the brand name (in initial caps) in parenthesis, on first reference, for example natalizumab (Tysabri). There were some medical journals that avoided brand names, and the main reason for that was to avoid the appearance of promoting drugs that are also their advertisers. But now more than formerly, the journals, even the NEJM, add the brand names when relevant. But the doctors who read medical journals know every drug they prescribe by generic and brand name, while the general reader may not.

One of the overriding rules in Wikipedia is that we are writing for the general reader, not medical professionals, and we should make every effort to make every article understandable by the general reader. Someone who researches drugs on the Internet will find pages that mention the generic name only, or the brand name only, and it can be difficult to figure out which is which. We should include both names, because it's necessary information for the reader.

This is especially true for certain drugs that doctors routinely refer to by brand names. For example, they routinely refer to doxorubicin as Adriamycin. Doctors, and even well-edited textbooks, refer to standard cancer treatments as "CA" (or "AC"), that is, cyclophosphamide and Adriamycin. They refer to docetaxel (Taxotere)-doxorubicin-cyclophosphamide as TAC. If you don't know the brand names, you won't understand the abbreviations. You won't understand doctors and textbooks. Therefore, you have to include brand names.

It's difficult for a reader to read about "doxorubicin" and have to mentally translate it to "Adriamycin" and vice versa. You want to make it as easy as possible for the reader, and therefore you have to include both names -- in every article that will be read by somebody who is not intimately familiar with both names.

If a patient has been talking to a doctor about chemotherapy, and the doctor has been referring to "Adriamycin," and the patient reads a long Wikipedia article that refers to it only as "docorubicin," that article will be unnecessarily confusing and difficult to read. Writers shouldn't be unnecessarily confusing and difficult.

It's also especially true for new drugs that drug companies are promoting. A reader with an interest in Crohn's or multiple sclerosis will frequenly hear about "Tysabri" in news stories, without the generic name, and want more information. It's important information for them that Tysabri is natalizumab and you have to make it easy for them to get that straight.

It's also especially true for drugs that have been heavily promoted, but have serious adverse side effects -- like natalizumab. You want to tell people in simple, direct, understandable langauge that natalizumab, or Tysabri, or whatever term they're familiar with, has new, unexpected dangers. Nobody should die or get a stroke because he didn't know that a warning about (generic drug) actually referred to (brand name) that he was taking.

The basic rule of medical writing is that you must make it as easy as possible for the reader to understand it. Since some readers will be familar with the brand name, and others will be familiar with the generic name, you have to give both. Nbauman (talk) 21:54, 15 February 2008 (UTC)

All generic and brand names should be mentioned in the lead (of the drug's wikipage - WLU (talk) 02:37, 16 February 2008 (UTC)) and generic or brand names should redirect to the main page, so finding information shouldn't be a problem for readers. Tysabri currently redirects to natalizumab, and both names are in the first sentence. Irrespective, in the body text, the name used should be the page name, however that is chosen. WLU (talk) 22:09, 15 February 2008 (UTC)

In Crohn's disease you list infliximab, adalimumab, and natalizumab, but you don't give the brand names in the lead (and don't mention them at all in the lead). So you mean that we should only give the brand names in the lead of the main article on each individual drug.

Are you saying that if someone reading the Crohn's disease article sees infliximab, adalimumab, and natalizumab, and wants to know what the brand names are, he should click to the links of 3 more articles and get the brand names there?

Wouldn't it be easier for the reader if you gave the brand names in parenthesis right there, and he wouldn't have to click 3 times to 3 new windows? Nbauman (talk) 22:31, 15 February 2008 (UTC)

I think WLU is referring to the lead of the drug article. I disagree about "all". MEDMOS says "The initial brand name and manufacturer follows", though (especially with older drugs) there may be more than one "initial brand" (i.e., the patented drug). There are some drug articles where every man and his dog has added some variant that is either a minor "brand" or some non-English-speaking country's brand. Anyway, this discussion is about the reference from the non-main article. Colin°^Talk 23:43, 15 February 2008 (UTC)

Firstly, we have no responsibility to ensure a reader does not "die or get a stroke because he didn't know that a warning about (generic drug) actually referred to (brand name) that he was taking". I've seen that kind of argument used in a lame edit war over article naming.

I'm not keen to encourage the use of brand names, but there are probably some occasions when an editor may justifiably mention them. In the UK, brands of prescription drugs aren't advertised to patients and the generic name usually appears on your prescription. Two extremes in my experience: nobody says Sabril, even though that's the only brand of vigabatrin; and nobody says levetiracetam (Keppra). A brand that appears in the popular press, and/or is still in-patent, is more likely to be usefully mentioned. Once it gets old and off-patent, it is hard to justify IMO. Colin°^Talk 23:43, 15 February 2008 (UTC)

Colin agree. Generally we should mention as primary in an article the term used for the relevant article name (this for drugs will of course tend to be the INN generic term). Then where the brand name has particular notability mention that in brackets. Hence in an article on erectile dysfunction one would state "sildenafil (viagra) was the first drug to have widespread media commentary". Even when the drug is under initial patient, the brand name may vary country to country and English-wikipedia must not be centric to any one English-speaking country; look at Ezetimibe, which of the 3 brand names would one use ? Later as drugs come off patent, so the brand names are nolonger unique terms to teh original developing manufacturer, with a whole host of other brand names being produced by other manufactures. So "ibuprofen (nurofen)" is not helpful because in an article on treating children, the current heavy UK advertising by one company means "ibuprofen (calprofen)" would be most recognised, and I'm sure something entirely different in the US, Australia etc. PS Colin, I'm so dutiful in prescribing generically here in UK, that any epileptic of mine would be on levetiracetam, if anyone mentions Keppra I'll probably have to look it up ! Sildenafil(viagra), paracetamol/acetaminophen, epinephrine(adrenaline). diazepam(valium), and perhaps some of the combination preparations eg Diclofenac/Misoprostol(arthrotec) (given, I think a UK-only product) perhaps warrent common inclusion in articles of their worldwide-used commonly-known trade names in brackets. But wikipedia is not a listings service for US-centric or UK=centric readers as we must not exclude readers from Australia, Ireland, New Zealand, Canada etc David Ruben ^Talk 01:07, 16 February 2008 (UTC)

Re: Keppra. There's a difference between selecting or reading a word that sounds like an Old Testament king, and pronouncing it out loud! BTW: I think if we do mention the brand, it should have a capital letter but no ® thingy. Newspapers don't bother with it, so why should we. Colin°^Talk 11:08, 16 February 2008 (UTC)

While the subject is up, would anyone like to have a look at the lead in Crohn's disease? I think it's OK, but I wouldn't mind a review of the changes to make sure. My experience isn't with a lot of medical articles and any of these very experienced eyes would be appreciated. WLU (talk) 02:54, 16 February 2008 (UTC)

Oh, now I understand where you're coming from. In the U.S., a lot of people wanted to make generic names the standard, but we haven't been successful. I think that's wrong, but that's the world I have to live with. If you go to a medical conference in the U.S., a lecturer will be likely to switch between generic and brand name in the course of his presentation. If I ignored brand names, I couldn't follow them. Doctors often use brand names and not generics in talking to their patients. News reports often give brand names and not generics. Lots of people knew they were taking Prozac, but most of them couldn't tell you that it was fluoxetine.

While it may be US-centric to use US brand names, isn't it UK-centric to follow the custom (however commendable) used in the British empire countries and write in a way that many people in the US, especially ordinary readers, would not easily understand? Can't we give both? Nbauman (talk) 03:11, 16 February 2008 (UTC)

Nbauman, the primary problem with always giving both is that "both" sometimes means multiple brand names. So it's not "ibuprofen;" it's "ibuprofen (Act-3, Advil, Brufen, Dorival, Espidifen, Herron Blue, Panafen, Motrin, Nuprin, Ibusal, Dolormin, Ipren or Ibumetin, Ibuprom, Fenpaed, Nurofen -- and more)." Surely in that instance, the article would would benefit from a plain mention of ibuprofen. Furthermore, some brand names are basically unknown because the generic name is widely used, and in those cases, using the brand name is unhelpful to the average reader.

In simple cases with well-known brand names -- sildenafil/Viagra in an article on erectile dysfunction -- I think it's fine to list both if it seems good to the article's regular editors. I just don't think that a single, simple rule that's either "for" or "against" alternate names is going to be adequate for all drugs in all articles. WhatamIdoing (talk) 09:28, 16 February 2008 (UTC)

So, WhatamIdoing, we agree. The main article on the drug should give the brand names. The non-main articles should give the brand names when that would make it easier for the reader to understand the article. The non-main articles shouldn't give long lists of brand names when that makes it more difficult for the reader.

So in the article on erectile dysfunction, we should list the phophodiesterase-5 inhibitors as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), as the article does. That makes sense, because those are the terms that are most familiar to most readers. It would be more work, and be more confusing, for the reader to have to click to the vardenafil page to find out that it's Levitra, etc.

(BTW, the current NEJM referrs to "Rituximab (Rituxan, Genentech and Biogen Idec)" at 358:679. So I'm recommending that we follow NEJM practice.)

I think that's reasonable. Do we have consensus? If not, I'd like to hear a simple explanation of why anyone thinks that's not reasonable. Nbauman (talk) 18:01, 16 February 2008 (UTC)

Are you really suggesting "Rituximab (Rituxan, Genentech and Biogen Idec)", which is precisely the sort of disruptive parenthetical advertising that we don't want to bother our readers with. The NEJM has a completely different readership to WP and is content to have a US bias in its choice of brand names. In that example, UK readers would not be helped since the drug is called MabThera here. I can't find much UK press about this drug (tried all three names), in comparison to trastuzumab (which is nearly always referred to as Herceptin by the UK press). So I'm unconvinced it is needed for your example.

We disagree on emphasis. You say "should give the brand names when ...", I'd rather say "shouldn't give the brand name unless". And "make it easier for the reader to understand the article" is a subjective and weak requirement. I'd rather WP was largely free of brand names, because of the above-listed problems they present, but am willing to accept their use in a few select places. Colin°^Talk 20:15, 16 February 2008 (UTC)

• BTW, the NEJM rules are not intended to provide convenient identification of a brand name. Scientific reports list the supplier and the supplier's preferred name so that if someone wants to duplicate your work, they can use exactly the same reagents, equipment, and statistical software that you did (and so they can write snarky letters for the next edition about faults in your work because of contaminations, software bugs, or equipment problems that you didn't know about). WhatamIdoing (talk) 23:00, 16 February 2008 (UTC)

Undent. Could I propose that we refer to the generic name throughout, but mention the most common brand name(s) on first mention? This is not quite as intrusive as the NEJM policy, yet makes it clear to the reader which drug is being discussed.

I am sure that Wikipedia should follow conventional naming, but the question is: "Which convention?" In popular press articles, you will never hear about trastuzumab. In medical journal articles, you will read the name Herceptin once or twice if you're lucky. JFW | T@lk 21:56, 16 February 2008 (UTC)

Which is (I think, after all this discussion), what Fv had me do at Tourette syndrome, with a footnote at the bottom about the name(s) used. I must be missing something. SandyGeorgia (Talk) 22:29, 16 February 2008 (UTC)

Here's how the Cochrane Collaboration does it: [3] "Natalizumab (Tysabri®, Elan Pharmaceuticals and Biogen Idec)" I don't think anyone would accuse Cochrane of advertising (or U.S.-centricism).

I would abbreviate it to "Natalizumab (Tysabri)" in a non-main article (and I wouldn't use the ® symbol anywhere). Nbauman (talk) 23:05, 16 February 2008 (UTC)

And here's the way BMJ does it: [4] "On 28 February 2005 Biogen Idec and Elan voluntarily suspended marketing natalizumab (Tysabri or Antegren)..." Nbauman (talk) 23:17, 16 February 2008 (UTC)

Re JFW's comment: I don't think anyone is suggesting mentioning the brand name every time the generic name is being used in an article. That comment may be seen as more supportive than his talk-page response: "I prefer to stick with the generic name of a drug as much as possible (see sildenafil) and only mention the brand name when necessary for context. The names of drugs are carefully chosen to reflect their use or effect (e.g. Tamiflu for oseltamivir, Tracleer for bosentan), and technically become a marketing gimmick." My impression of the current consensus is that brand-name-mentioning should be the exception rather than the rule. In this regard, I'm not particularly interested in how a medical journal handles it, because the readership is totally different. Nbauman, like some (but not all) of the wikidocs here, you are much more brand-aware than the average reader. Wrt erectile dysfunction drugs, only Viagra is well known, the other two will only be known to non-medical or non-patient groups if they read the pharmaceutical business news on a regular basis. Click on the "What links here" for a drug. Ignoring the template links, drugs are actually quite frequently linked. If we start polluting WP with brands, what's to stop some company rep going through adding his brand to all the J&J drugs or the Novartis drugs, or whatever. It would certainly boost the Google rating. Consider: what other product does this? Do I expect "lawnmower (Qualcast, Flymo)" when I read about garden equipment? OK the analogy is poor, but this is an encyclopaedia. Colin°^Talk 23:25, 16 February 2008 (UTC)

That is my concern and the slippery-slope that I'm worried about as well. For wikipedia specifically, the name of the drug's page seems the most useful - easiest to link to, and a very easy standard. On top of that, any google search will turn up related drug names with ridiculous ease - if the individuals don't just click on the wikilink in the first place. Barring isolated cases when the brand name has huge recognition, I don't see the advantage of multiple names. WLU (talk) 00:34, 17 February 2008 (UTC)

Colin, my talkpage response does not contradict my response here, in the sense that I would like to use the brand names of drugs as little as possible without making the article incomprehensible for the reader. I like the BMJ style, where the most common names for drugs used internationally are listed once in parentheses. Sometimes, drugs are marketed under different names for specific indications, e.g. sildenafil as Revatio for pulmonary hypertension; this should be spelled out if this is the case. I am also with WhatamIdoing that medical journals list the suppliers of drugs with the specific aim of making the trial data reproducible (as evident from "materials & methods" sections that list the manufacturers of all laboratory equipment used). JFW | T@lk 08:09, 17 February 2008 (UTC)

arbitrary break

If I may leave a concise response here, as the discussion appears to be going quite nicely :)—I would support using the generic name (that is, the INN) throughout, even in "non-main" articles (i.e. an article not about the drug itself). I believe trade names should be noted on first mention (but no later) despite the sounds-like-marketing/some-drugs-have-dozens-of-them debacle simply because they are well known to the lay public, and that's who we're (primarily) here for. I honestly think there cannot be a hard and fast rule on this; for some drugs such as ibuprofen, or mostly anything OTC for that matter, it would be much more confusing to try and list every major trade name than simply say "ibuprofen". OTC drugs are available as generics pretty much everywhere, and I don't believe many people would have trouble making the "ibuprofen" → "stuff that goes in Advil" connection. As has been noted above, however, some drugs are better-known by their trade name; "Herceptin" versus trastuzumab immediately comes to mind.

Where there is a "universal" (or nearly so) trade name, I think there is no harm whatsoever—in fact, I consider it a courtesy to the reader—to first mention a drug as "INN (trade name) etc. etc. etc." Noting manufacturers is completely unnecessary IMHO (except in the main drug article :). When a drug has several trade names or trade names vary significantly throughout the English-speaking world—to the point where the drug has more than, say, two or three trade names notable enough to mention—I'd drop them altogether and just go with the INN.

So, CliffsNotes version of the above (get it? CliffsNotes? A widely diluted trademark? Oh, never mind.)

• In "non-main" articles, I would mention no more than two or three trade names, in parenthesis following the INN, at first mention of the drug and use the INN as necessary throughout the rest of the article; trade names are not mentioned again unless you're introducing a notable formulation (different route of administration, protein-bound paclitaxel vs. paclitaxel, first OTC version of a previously Rx-only drug, etc.)
• In a non-main article where drug names will be used extensively, such as Tourette syndrome above, I believe the "method" I suggested to Sandy back then (using all-US, or all-UK, etc. trade names and noting so in a footnote) is an excellent approach.
• In a main drug article, note prominent trade names in the lead (in parenthesis, with or without manufacturer) and not mention them again later, except as for non-main articles above.

Fvasconcellos (t·c) 12:50, 17 February 2008 (UTC)

Note that I've left a note on Wikipedia_talk:WikiProject_Pharmacology#Discussion_at_MEDMOS regards this, which might bring in more opinions. WLU (talk) 13:47, 17 February 2008 (UTC)

One bit of opinion - if the drug is mentioned in the lead, in the interest of brevity I think that only the generic/wikilinked name be used; the first occasion after the lead should, but in the lead itself, I say nay. I also think it might be the rare article that the specific drug treatment might be used (erectile dysfunction and viagra perhaps). Anyway, this might also be worth discussing. WLU (talk) 13:55, 17 February 2008 (UTC)

Let me make sure we're all starting from the same place. Wikipedia is written for the general reader, and that's our primary audience. The first consideration of a writer is that his reader understands his writing. If your reader doesn't understand you, there's no point in writing. I assume we all agree on that. Right? Any objections? Nbauman (talk) 15:50, 17 February 2008 (UTC)

We're not schoolchildren, Nbauman. Colin°^Talk 17:15, 17 February 2008 (UTC)

Colin, is your answer agree or disagree? Nbauman (talk) 19:59, 17 February 2008 (UTC)

I wonder if there would be a consensus to change "The BAN or USAN variant may also be mentioned, with the word in bold. The initial brand name and manufacturer follows, in parentheses." to ""The BAN or USAN variant may also be mentioned, with the word in bold. The initial brand name and manufacturer follows, in parentheses. Unless notable and widely used other brand names should not be mentioned." (Boldface is used for convenience). In many drug articles the lists of brand names are huge and ugly, and sometimes are even larger than the rest of the article. Paul Gene (talk) 19:05, 17 February 2008 (UTC)

That'll lead to possibly ugly fights over what a notable or widely used brand name is, but it at least provides more guidance than the extant version. I'd say there's merit to that. WLU (talk) 19:54, 17 February 2008 (UTC)

(BTW: there should be a comma after "widely used".) Seem like instruction creep. Sometimes there's more than one "initial brand" (among English-speaking countries) but additional brands of generic versions are, in general, not notable. On the few occasions when the current restriction is unsatisfactory, WP:IAR applies. Colin°^Talk —Preceding comment was added at 20:33, 17 February 2008 (UTC)

Makes sense, since people do not generally read instructions. But what is the purpose of this particular discussion, then? And referring to the instructions creep is the instructions creep in itself. instruction creep is not even a guideline but an obscure assay. Paul Gene (talk) 22:24, 17 February 2008 (UTC)

Paul, I wasn't citing WP:CREEP as a formal guideline, but I do think it is a good one. I agree with the principle of your suggested addition, but want to consider carefully whether it is strictly necessary. The more you write, the more people will disagree with and the less they will actually read or take notice of. If you still think the addition is a good one, then I've not got any formal reason to object. Colin°^Talk 22:56, 17 February 2008 (UTC)

As an exercise, print off List of 200 bestselling drugs and show it to your non-medical friends and their children (if old enough). Ask them to circle the brands or drug names they recognise. They'll do well to get more than a few. Now compare the brand with the INN name, of the drugs you don't know. The brand you can probably pronounce, the drug you might be able to guess its family (if you are medically experienced). Either way, it is just noise and the unfamiliar "general reader" will gloss over it. The number of readers "helped" by these brand names is only a minority. Even a UK GP, who is probably familiar with more drugs than any of us will ever even know about, admits to having to "look up" a top-selling drug brand. There far more important obstacles to our readers understanding our articles than the absence of a brand name (or two, or three). Colin°^Talk 21:09, 17 February 2008 (UTC)

Thank you Colin for putting things in perspective. JFW | T@lk 22:44, 17 February 2008 (UTC)

Colin's experience with people not knowing drug names may be true in the UK, but it's not true in the US.

I regularly meet people who are taking drugs, particularly elderly people, who know all of the major drugs in the category that is used to treat their conditions. And they know the brand names much more than the generic names. My mother knew that she was talking Prilosec, but she didn't know what omeprazole was. (And younger people know about the psychiatric drugs, which they refer to almost exclusively by brand name -- Wellbutrin, Prozac, etc.)

First, the drug companies heavily promote brand names in TV and in print. This is a problem that American doctors and journals regularly complain about, and American doctors have written in UK journals warning of the consequences of letting drug companies advertise to "consumers" elsewhere.

(But this was true even before they started advertising to consumers. My father knew he was taking Lasix, but he didn't know what furosemide was.)

Second, as we've seen, the news media that non-specialists use, even in the UK, tend to use brand names and not generic names. Additionally, doctors and pharmacists usually refer to brand names when they talk to patients. Among other reasons, brand names are easier to pronounce and remember (the drug companies do that deliberately).

So how could our readers in the general public even know the generic names, if their information sources use only brand names?

True, this may be a selected sample of the public -- but it's also a sample of the kind of people who are most interested in medicine and drugs and most likely to look things up on Wikipedia.

So I don't agree that most Wikipedia readers don't know the names of drugs, either brand name or generic. I think that many people do know the names of drugs, and I think that they're more familiar with brand names (unfortunately) than generics.

I'd be interested to see any published research on the subject. But until then we don't have consensus on that point. Nbauman (talk) 23:19, 17 February 2008 (UTC)

Nbauman, I made a proposal a bit earlier. Do you disagree with this proposal? JFW | T@lk 23:25, 17 February 2008 (UTC)

The U.S. isn't the sole audience of wikipedia, nor should it tailor it's contents exclusively to that audience. And individual experience is not a reliable source particularly convincing - my mother-in-law takes 'blood pressure medication', but I wouldn't advocate for that being an approach to take in naming drugs. WLU (talk) 23:31, 17 February 2008 (UTC)

JFW, you mean, "I would like to use the brand names of drugs as little as possible without making the article incomprehensible for the reader. I like the BMJ style, where the most common names for drugs used internationally are listed once in parentheses."?

I think I agree with you, but let's talk about how it would apply to specific cases.

In the page on Crohn's disease, do you want it to read,

Medications used to treat the symptoms of Crohn's disease include 5-aminosalicylic acid (5-ASA) formulations, prednisone, immunomodulators such as azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab, and natalizumab.

or do you want it to read,

Medications used to treat the symptoms of Crohn's disease include 5-aminosalicylic acid (5-ASA) formulations, prednisone, immunomodulators such as azathioprine, mercaptopurine, methotrexate, and newer biological medications, such as infliximab (Remicade), adalimumab (Humira), and natalizumab (Tysabri).

I prefer the latter.

In the page, on Erectile dysfunction, do you want it to read,

The prescription PDE5 inhibitors sildenafil, vardenafil and tadalafil are prescription drugs which are taken orally.

or do you want it to read,

The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.

Again, I prefer the latter.

My test for a writing decision is, "Does this make it easier for my reader to understand important information?"

Wikipedia is written for the ordinary reader. Some ordinary readers will know the generic name, some ordinary readers will be more familiar with the brand name, and we should make it easy for them to read it, whichever they know. It's easier to read medical writing if it contains familiar words. It's difficult to read medical writing if it contains unfamiliar words. (I think that's obvious, but there's also research to support this, published in JAMA and elsewhere.) If the reader is familiar with Remicade, Humira, and Tysabri -- as he would be if he listens to the BBC, or reads the New York Times, or sees drug company ads in New Zealand or Nigeria -- then we should include those familiar brand names in those non-main articles. This makes it easier for the reader to understand it.

I want a reasonable rule, not a cookbook rule. When you write a short review about a disease, you have to read it and ask yourself, "Is there anything in here that will be difficult for my reader to understand?" There should be no automatic rules about generic or brand name drugs. If it's easier for a reader to understand it with familiar brand names, they should go in. If a long list of brand names of a generic product makes it more difficult to read, they should go out.

I personally would prefer to have e.g. "natalizumab (Tysabri)" at first reference, and "natalizumab" at subsequent reference, which is the style I use in the publications I write for. My feeling is, "let the reader do some work, and learn the generic name." But that may be arrogant. If I'm writing for laymen, and it makes it easier for my readers to understand what I'm writing about if I alternate "Prozac" with "fluoxetine", it would be pompous of me to insist on "fluoxetine" -- and defeat my purpose, of explaining medicine to my reader.

I know lots of fancy words. I don't use them in my writing.

I strongly object to inserting a simple cookbook rule in the MOS (medicine-related articles) that brand names should be deleted from "non-main articles", and replaced by a link to the drug's page.

I especially object to giving a license to somebody to patrol medical pages, even when he hasn't been working on the entry, and delete all mention of brand names, whether their use in context makes sense or not. The easiest way to make an easy article difficult to read is to replace all the easy words with difficult words -- and that's not trivial; there actually are people who deliberately write and edit like that (according to many essays about this in the New Scientist, which has rejected a lot of articles).

So the rule should be left simple and flexible, such as,

Generic names of drugs should always be supplied. Brand names of drugs should be added, in the style, "natalizumab (Tysabri)", with the generic name in lower-case and the brand name (a proper noun) in intial caps. (The (R) and (TM) symbols should not be used, since they are only used by trademark holders.) Brand names should be added on first mention in the entry whenever it would make the entry easier to understand. They should be added when the brand name is familiar to readers. Most drugs that are covered by patent have one or two, and rarely three names, in different parts of the world. Since Wikipedia is an international encyclopedia, all national brands should all be used on first reference. When their patent has expired, or when they are not covered by patent, they may be sold under many brand names. Long lists of brand names should be avoided when they make the entry difficult to read, or are unnecessary. Since Wikipedia is not advertising, avoid mentioning brand names when it serves a promotional purpose rather than making the entry easier for the reader to understand.

That's not so simple any more, but I'm trying to avoid a simple rule to just delete brand names.

People object that using brand names "looks like" advertising. Well, I'm sorry, but my main goal is medical writing that my readers can understand, and if they can more easily understand it when I include brand names, that's more important than the appearance of advertising or offending someone's sensibilities. I don't think it "looks like" advertising, it's just acknowledging that brand names are familiar and commonly used in the real world. If I'm writing for breast cancer patients, and their doctors and nurses told them that they're taking Adriamycin, I'm not going to be a pedant and insist that they refer to it as doxorubicin. If the Cochrane Collaboration, NEJM, BMJ and BBC don't have a problem with it, I don't see why we should.

One last point: We do have a readability problem with Wikipedia medical articles. People frequently leave messages on talk pages that they can't understand an article because it's too technical. That's a problem with Treatment of Crohn's disease, as CrohnieGal found out Talk:Treatment of Crohn's disease when she asked people to look at it.

When your readers tell you on Talk that they can't understand your article, they're sending you a message that a writer should listen to. The solution is not to be more pedantic, and more technical, and replace simple words with medical words, and show off how smart you are. The solution is to figure out what kind of language your readers understand, and talk to them in that language. And in the examples we're discussing, they are clearly more familiar with some brand names than generic names, and brand names would make the entry easier to understand. Nbauman (talk) 01:04, 18 February 2008 (UTC)

I thought my proposal was quite clear. The first time a branded drug is mentioned, the most common brand name(s) should be mentioned in parentheses after the rINN. All further instances should be rINN. Provided the reader has a reasonable IQ, that should be easy to parse and keeps the article uncluttered without compromising on clarity. So I would support the second one of your two examples. JFW | T@lk 01:30, 18 February 2008 (UTC)

So you think the page on Crohn's disease should read,

"Medications used to treat the symptoms of Crohn's disease include 5-aminosalicylic acid (5-ASA) formulations, prednisone, immunomodulators such as azathioprine, mercaptopurine, methotrexate, and newer biological medications, such as infliximab (Remicade), adalimumab (Humira), and natalizumab (Tysabri)."

And the page on Erectile dysfunction should read,

"The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally."

Nbauman (talk) —Preceding comment was added at 01:55, 18 February 2008 (UTC)

I really like the addition Nbauman proposing but I would remove the repetitions to cut it a bit to: Generic names of drugs should always be supplied. Brand names of drugs should be added, in the style, "natalizumab (Tysabri)", with the generic name in lower-case and the brand name in initial caps. The most popular UK or US brand could be used in such an entry. The (R) and (TM) symbols should not be used, since they are only used by trademark holders. Brand names should be added on first mention in the entry as well as later if it makes the entry easier to understand. Lists of brand names make the entry difficult to read and are unnecessary. Avoid the overuse of brand names, remember that Wikipedia is not a vehicle for advertising. Paul Gene (talk) 12:00, 18 February 2008 (UTC)

This seems to follow a style similar to wikilinks - link the first use of the term, then only re-link again if it's been a while (or unusually important to the section). Seems reasonable. I'm curious about the 'UK or US', which leaves out many other english-speaking countries (Canada, Australia, the Bahamas and other Caribbean countries). WLU (talk) 12:29, 18 February 2008 (UTC)

Gosh, I can hear consensus approaching in the distance! JFW | T@lk 14:42, 18 February 2008 (UTC)

Don't get your hopes up, JFW.  ;-)

Paul gene's most recent proposal is entirely too accepting of brand names for me. I think my thoughts are much closer to Colin's: Brand names should not be mentioned (at all) in articles about diseases unless there are good reasons to include them.

I have specific concerns about the most recent proposal that "Brand names should be added on first mention in the entry..." According to this, editors should always refer to "amoxicillin (Amoxil)" in the first instance, when just plain "amoxicillin" has long been considered perfectly adequate on Wikipedia (see sinusitis for an example).

Similarly, under the second half of that sentence, "... as well as later if it makes the entry easier to understand," could be (wrongly) used to justify the inclusion of "(Viagra)" after every mention of sildenafil. It might be better here to make explicit reference to the rules for wikilinking the generic name.

I want a plain, simple, direct sentence that permits the inclusion of brand names in disease articles only when there are good reasons to include those brand names. I'm willing to be flexible -- even generous -- about what constitutes good reasons, but IMO some reasons that seem good to the regular editors of a page should always exist before a brand name is included. WhatamIdoing (talk) 19:48, 18 February 2008 (UTC)

If you think that a particular rule is needed in order to prevent a particular problem, could you link to an example where that problem came up? Nbauman (talk) 20:09, 18 February 2008 (UTC)

The problem is that the article becomes inundated with information that is not likely to be beneficial to the reader. So if I read WhatamIdoing (and Colin) correctly we should only be using the brand names if the drug would not otherwise be recognised by many readers. I think this is eminently sensible. The amoxicillin example is very good - we don't always require brand names. JFW | T@lk 20:57, 18 February 2008 (UTC)

arbitrary break 2

Sure: see MCL, CTCL and Histiocytosis for unnecessary inclusions of trade names. See Acquired pure red cell aplasia and this biography (and the MCL article) for the use of trade names instead of a generic name. I'm sure there are more; I spent less than two minutes looking for examples. Searching Wikipedia on "Viagra" and "Motrin" will provide interesting examples.

JFW is right: always requiring a brand name would be silly. WhatamIdoing (talk) 21:02, 18 February 2008 (UTC)

---

It seems only fair to make a proposal instead of complaining about others', so here is my attempt. Please note that I think that the appropriate place for the result of this conversation is in the guidelines for diseases/disorders/syndromes, and not the rules for articles about the drugs themselves. I don't think that my concerns are relevant for the articles on the drugs themselves. (For example, a complete list of brand names is important for some drug articles and appropriate in nearly all of them.)

I propose that we add four sentences to the "diseases and conditions" section:

Unless the use of a brand name is necessary for clarity or concision, nonproprietary names for drugs and other treatments should always be used instead of brand names. When the inclusion of a familiar brand name will particularly make the article easier to understand, the brand name may be included once (twice in a long article), in parentheses immediately after a linked nonproprietary name: trastuzumab (Herceptin). Avoid the use of brand names that are unfamiliar to the majority of readers or that are not in use in many English-speaking countries. Long lists of brand names should never be included in these articles.

IMO, the key words are "instead of" in the first sentence and "particularly" in the second sentence. This proposal has these virtues in my mind:

• It requires (within reason) the exclusive use of generic names throughout all articles on diseases and conditions.
• It allows the inclusion of those brand names which are necessary in terms of either content (i.e., when "the same" drugs are not actually interchangeable) or style (e.g., for awkwardly named combinations of drugs).
• It specifically allows the inclusion of those brand names which are especially likely to be helpful to readers, (e.g., when a brand name is very widely used in place of an unpronounceable generic name).
• It discourages the inclusion of unnecessary, unhelpful and even only-maybe-helpful brand names in articles on diseases and conditions.
• It does not needlessly duplicate the existing rules about ® and ™.

In actual practice, I am willing to accept any actual evidence of average-reader confusion as a justification for the inclusion of a brand name. My proposal is about the "default setting:" skip the brand name unless (or until) you can justify it. WhatamIdoing (talk) 22:14, 18 February 2008 (UTC)

All of the language proposed needs to be softened to recognize that this is a guideline; language like "should never be included" is rarely used in guidelines, in recognition that 1) they are only guidelines, and 2) WP:IAR. SandyGeorgia (Talk) 22:18, 18 February 2008 (UTC)

I welcome your assistance in fixing the language. I chose the word "should" because it means less than "must," and more than "may (if you happen to feel like it)." I am absolutely open to your suggestions for more clearly communicating the advisory nature of the guideline. WhatamIdoing (talk) 00:40, 19 February 2008 (UTC)

All right. With those specific examples -- What's the problem here, which entries violate existing WP rules, and which ones require new rules? I think most of them could be fixed under the old rules. Don't we already require generic names?

I think that what you and I agree on is that we should describe the drugs as In-111 ibritumomab tiuxetan (Zevalin), I-131 tositumomab (Bexxar), rituximab (Rituxan, Mabthera), etc. on first reference, and try to use the generic names thereafter. That's the consensus, right? We agree on that.

The worst of all worlds is to have "tositumomab" by itself in one place, and "Bexxar" by itself in another place, because that way readers can't follow which is which. An article is going to describe tositumomab, and an editor will see a news story and get the bright idea that he should add a paragraph on Bexxar too. (I've seen that in adverse event databases.)

Bexxar is a problem. There is no generic Bexxar. I was at ASCO when the first results were announced, and I had to write about it in a newsletter that was read by GPs, nurses, social workers, cancer patients, and other non-specialists. I knew from talking to them that social workers and patients didn't know most of the medical terminology or concepts that you and I take for granted. I hated to promote a brand name, but "I-131 tositumomab" is a mouthful. (Furthermore, Tositumomab is also a brand name, as far as I could figure out. There is no generic tositumomab.) Everybody, the newspapers, NPR, BBC, the NEJM, even the British and Australian oncologists, were referring to it as the Bexxar protocol. So people would be looking in my newsletter for more about Bexxar, not tositumomab. I gave up and wound up calling it Bexxar. What's the point in writing about something if people don't understand your writing?

With Bexxar, bad cases make bad law. Bexxar is one of the few examples when the manufacturer successfully forced me to use the brand name. On Wikipedia, I would try to refer to it as I-131 tositumomab, but if people leave messages in Talk saying that the article is too technical for them, you have to reconsider your assumptions. But that's an unusual case.

That's the problem with a "generic names only" policy. People hear on the BBC about Zevalin, Bexxar, Rituxan, Mabthera, etc., and those are easy names to remember and follow. It's like telling them, "Oh, well, you've been reading about this on Google News in English, but now you're going to have to read about it in Latin, because we only use Latin names."

The Mantle cell lymphoma article should obviously be better edited; the Immunotherapy section repeats the Chemotherapy section. The Chemotherapy section did use "rituximab (Rituxan, Mabthera)" in the first mention, as I think we both agree on.

"Landmark medicine" is a phrase that grates on me and violates WP:POV among other existing rules, so no new rules are necessary. I think that a lot of these entries are rewritten from company press releases, and a lot of them are rewritten from news stories that are rewritten from company press releases. That's why they have all this hyperbolic language (OTOH, that's why they have a lot of overcautious language required by their lawyers to pass FDA review, and that's why they use the (R) marks).

What else -- the CTL entry? Obviously that paragraph also needs a good copy editor; this laundry list of treatments isn't too useful. Generic names should not be capitalized. Exactly what is the problem with brand names here? "Liposomal doxorubicin (Doxil)" seems reasonable to me, since (I think) it's the only formulation of liposomal doxorubicin. If somebody's doctor tells him that he wants to put him on Doxil, it makes the article easier for the patient to understand. Methotrexate is left as a generic. Some other stuff I'm not familiar with.

It sounds to me as if we don't have any major disagreements. Nbauman (talk) 23:14, 18 February 2008 (UTC)

I agree some of the newer drugs do not have reader-friendly names. It is late here but I'll just say I'm not keen on "should" but could be persuaded to compromise on "may" wrt brands. As you say, sometimes the press have little choice but to use the brand as their readers would struggle to read never mind pronounce the IIN name. But to say the brands are "English" is stretching things a little. Rituxan and Mathera are the son and daughter of Bexxar, king of Doxil and sworn enemies of the evil Zevalin... Colin°^Talk 23:41, 18 February 2008 (UTC)

By the way, besides pointing out that the wording above isn't the way guidelines are usually written, I haven't taken a position yet; the verbosity of the debate is hard to follow. When there are concrete proposals, I'll opine. As far as I know to this point, what I've done on Tourette syndrome makes sense, so I'm unlikely to endorse anything that requires changing it, unless someone can say something sensible about it in two sentences or less. SandyGeorgia (Talk) 00:25, 19 February 2008 (UTC)

Nbauman, here's how I see our respective beliefs:

• Everyone agrees that brand names should not be used repeatedly in articles.
• You want every drug to include a brand name at the first mention, unless there's a good reason to exclude it: thus you will always write about "rituximab (Rituxan, Mabthera)".
• I want every drug to be listed solely by its nonproprietary name, unless there's a good reason to include a brand name: thus I will normally write about "rituximab" -- but also about "trastuzumab (Herceptin)" because Herceptin is clearly the dominant name worldwide.

Do you see the difference? WhatamIdoing (talk) 00:35, 19 February 2008 (UTC)

The summation is good. Indeed, for the exception of suggestion that a brand name can be used only once (or twice) in an article, Whatiamdoing's version really does not offer anything but common sense. That suggestion will never go through. I do not think it makes sense to continue the debate as clearly there is not going to be a consensus on the crux of the matter. Paul Gene (talk) 01:15, 19 February 2008 (UTC)

When I said we agree, I was responding to JFW. JFW and I agree (I think) to the following:

The page on Crohn's disease should read,

Medications used to treat the symptoms of Crohn's disease include 5-aminosalicylic acid (5-ASA) formulations, prednisone, immunomodulators such as azathioprine, mercaptopurine, methotrexate, and newer biological medications, such as infliximab (Remicade), adalimumab (Humira), and natalizumab (Tysabri).

The page on Erectile dysfunction should read,

The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.

Does everybody else agree with that? Nbauman (talk) —Preceding comment was added at 01:26, 19 February 2008 (UTC)

Nbauman, from your example I deduce that names such as azathioprine etc do not need a brand name because adding {Imuran} to it does not enhance the content for the reader. I can find myself agreeing with that. JFW | T@lk 08:29, 19 February 2008 (UTC)

Yes, if I saw azathioprine alone in an entry I would leave it. It's off-patent. I myself think of azathioprine rather than etc. Even the Wall Street Journal refers to it as azathioprine. So azathioprine is familiar enough to use it alone.

However, if people started leaving messages on Talk saying, "My doctor gives me Azasan, what about that?" that would be evidence that adding Azasan would enhance the content.

I'm a scientist. I have my preferences, but I defer to evidence. I assume you agree. Nbauman (talk) 14:56, 19 February 2008 (UTC)

The user would be encouraged to look up Azasan on Wikipedia, and discover rapidly that it is identical to azathioprine. The same, mutatis mutandis, would apply to any patient taking a drug labeled with a slightly non-standard brand name. We can't deal with every eventuality. JFW | T@lk 17:52, 19 February 2008 (UTC)

What about doxorubicin (Adriamycin)? Even oncologists and nurses routinely refer to Adriamycin, at professional meetings, among themselves, and with patients. Many of the combination treatments involving doxorubicin use acronyms based on Adriamycin, like CA and TAC. Nbauman (talk) 18:55, 19 February 2008 (UTC)

Yep, and O for vincristine (oncovin). Exceptions can be found, and clearly more so in oncology than in other branches of medicine. Perhaps in that context the name Adriamycin will need to be used a bit more often to clarify.

I think we have a basic policy, to which exceptions can be made at the editor's discretion. JFW | T@lk 20:43, 19 February 2008 (UTC)

A shorter proposal

After reading the above discussion, there are a few things we agree on that can be added to MEDMOS, but some things we disagree on that need to be left to editors to sort out without formal guidance. We've also found some cases that appear as exceptions to any rule we have yet suggested, and agree these are also best left unformalised. I'm not happy with the proposed guidelines so far, which seem to me to be too wordy and, as Sandy says, we must be careful not to word the guideline more strongly than its limited authority allows. The above proposals contain too much explanation and example, and have some technical flaws. For example, the first sentence of the latest proposal appears to allow an editor to drop the nonproprietary name entirely, on the basis of "clarity or concision". The "twice in a long article" exception is far too precise and arbitrary.

We all agree on the format to be used when mentioning the brand name, but haven't formed a consensus to force or ban the practice either entirely or in a well-defined subset of cases. Most of the brand examples given above are for drugs in the top 200 list, and are all still under patent. Drugs with many common brand names are also typically off patent and their initial brand may no longer be particularly dominant or well known. I propose something shorter, that contains a restriction, an allowance and a clarification.

Use the nonproprietary name when referring to a drug in medical articles. The first wikilinked instance of the name may be followed by the proprietary name in parenthesis: "trastuzumab (Herceptin)". Proprietary names are generally inappropriate for drugs no longer under patent.

The first sentence is long-standing practice and a restriction we all agree on. Nbauman highlights a few exceptional cases where the nonproprietary name is such an awkward construction that the article may be harmed by its frequent appearance: WP:IAR can handle such cases.

The second sentence allows something we agree is useful at times (though we disagree on the extent), and is also current practise among some editors. The use of "may" gives editors freedom to drop the brand name should they wish.

The last sentence highlights the most obvious class of drugs that benefit least from branding. Even then, the use of "generally" allows one to make exceptions.

I've left out anything that is really best left to editor wisdom case-by-case. In terms of location for this guideline, the "Naming conventions" is more appropriate than the "Diseases/disorders/syndromes" section, as the latter is in a section of MEDMOS dealing with article structure, not body text. I'd place it as a new paragraph, just after the bullet-point list. Thoughts? Colin°^Talk 18:16, 20 February 2008 (UTC)

Not a doctor, so I must rely on the experience of others. How often is XYZ (ABC, DEF, GHI, JKL, MNO) going to come up (i.e. how many times will it happen that there are 3+ brand names for a drug)? If it's a lot, some guidance would be good. If it's extremely rare, then it becomes common sense. I still think once per article of ABC (XYZ) is adequate and am fine with Colin's suggestion. Print versions have both names for reference, electronic versions can be wikilinked multiple times as suggested in MOS:LINK and wikilinks lead to an article where the lead should have all the trade names. I find it amusing that my simple, three sentence question has required no less than three section breaks. Is there a Talk Page Oil Gusher's barnstar? WLU (talk) 18:46, 20 February 2008 (UTC)

Not a doctor either. I think it is pretty common once the drug is off-patent. While on-patent, it should be uncommon in the globalised marketplace. I guess different names for such drugs may reflect some sort of joint-licensing agreements between drug companies, but someone else can answer that one. As an example of an older off-patent drug, let's take diazepam:

According to the ILAE Drug Database, there are seven brands of diazepam in the US (Diastat, Dizac, Emergent-Ez, T-Quil, Valium, Valrelease, Zetran); eleven in the UK (Alupram, Atensine, Dialar, Diazemuls, Evacalm, Rimapam, Solis, Stesolid, Tensium, Vaclair, Valium); six in Ireland (Anxicalm, Atensine, Calmigen, Diazemuls, Stesolid, Valium); six in Australia (Antenex, Diazemuls, Ducene, Pro-Pam, Valium, Valpam); fifteen in South Africa (Benzopin, Betapam, Calmpose, Dialag, Diaquel, Diazepan, Doval, Dynapam, Ethipam, Katium, Divalen, Pax, Radizepam, Scriptopam, Valium); seven in Canada (Apo-diazepam, Diastat, Diazemuls, Meval, Novo-Dipam, Valium, Vivol).....

Now that's such a well known drug, there is a case for (Valium) when discussing certain uses of diazepam, but certainly not any of the other brands! Colin°^Talk 21:40, 20 February 2008 (UTC) Oh, and this is why MEDMOS says just to list the initial brand name in the lead of a drug article. If there really is a good reason to list more, then they could be mentioned later on. Spoiling the lead sentence with a list of brand names looks awful. Colin°^Talk 21:48, 20 February 2008 (UTC)

I will accept Colin's proposal. WhatamIdoing (talk) 20:19, 20 February 2008 (UTC)

FWIW, sounds perfectly sensible to me, especially the "I've left out anything that is really best left to editor wisdom case-by-case" part :) Fvasconcellos (t·c) 22:02, 20 February 2008 (UTC)

If you want a consensus, you don't have it. I don't agree with "Use the nonproprietary name when referring to a drug in medical articles." That's begging the question. You don't believe brand names should be used at all, and you're trying to bias the guidelines towards your view. You're taking a practice that we now handle by common sense and writing rules that would often violate common sense.

"Proprietary names are generally inappropriate for drugs no longer under patent." What does "generally inappropriate" mean? This is too vague. I wouldn't accept this in a guideline unless it gave specific guidance as to when proprietary names were appropriate and when they weren't. For example, I don't want somebody who doesn't understand oncology patrolling Wikipedia and deleting every mention of Adriamycin.

This is from the current (358:768) NEJM: "You know you are in the presence of dysfunctional regulations when people can't easily tell what they are supposed to do." A phrase like "generally inappropriate" doesn't tell people what they are supposed to do.

You haven't given a good reason for your bias against brand names. I don't want to promote commercial products, and I strongly agree with the policy that Wikipedia isn't advertising, but the mention of a brand name in proper context is not advertising. The BMJ, NEJM, Cochrane and BBC have strict standards against commercialization, and they use brand names. It's absurd to try to be purer than the BMJ, NEJM, Cochrane and BBC.

My belief has always been that brand names should be avoided when they promote a product, but they should be used when they make the writing easier for the reader to understand. You don't seem to accept that, and I don't understand why.

If you want consensus for this guideline, I'd like you to explain when you think the entry should include the brand name, precisely enough that people know what to do. Otherwise, a guideline would do more harm than good, as the NEJM said. Nbauman (talk) 01:13, 21 February 2008 (UTC)

• Perfect, allows discretion, clear. (Nbauman, please understand this is how guidelines are worded. And Colin's proposal allows the editor to make it perfectly clear to the reader as needed.) SandyGeorgia (Talk) 01:19, 21 February 2008 (UTC)
  • Support -- nuanced, clear, and sufficiently flexible. --Arcadian (talk) 01:49, 21 February 2008 (UTC)

Consensus is not a vote or a poll. Consensus requires us to consider all the objections and answer them. We don't have a consensus. Colin has not responded to several important objections.

Colin, I'd like you to answer a simple question. Do you agree with the following:

Wikipedia is written for the general reader, and that's our primary audience. The first consideration of a writer is that his reader understands his writing. If your reader doesn't understand you, there's no point in writing. Nbauman (talk) 03:20, 21 February 2008 (UTC)

I think we do have a consensus. It's true that we don't have total agreement by all parties on every single related point. Fortunately, that is not the standard that Wikipedia requires. WhatamIdoing (talk) 04:17, 21 February 2008 (UTC)

• <edit conflict> Support, but could we then qualify (both ways) how many brands are mentioned as per extreme examples given above that we surely all agree are poor, so from "The first wikilinked instance of the name may be followed by the proprietary name in parenthesis: ..." to "The first wikilinked instance of the name may be followed by the main globally-notable proprietary name in parenthesis:...". (or some similar-meaning rephrasing) This makes a minor brand that is pushed in minorville fail to surface above the horizon of notability, yet worldwide recognised names such as Viagra, Valium, Betnovate, Diflucan are not unduely excluded. Likewise if there are a plethora of country specific brands and none of them has international recognistion then this wording would imply (but not instruct as a policy would) that they should not be used. Does that help limit brand-creep that some fear, but show acceptance of our rule-of thumb reasonablness that others are keen to preserve ? David Ruben ^Talk 04:24, 21 February 2008 (UTC)

WhatamIdoing, this is the standard that Wikipedia requires. WP:PARENT And by that standard, we don't have a consensus. Nbauman (talk) 04:50, 21 February 2008 (UTC)

I have no idea what WP:PARENT has to do with this. This isn't a repeat of some old stale discussion, being asked once again in the hope that new editors form a different "consensus". This is a single, long discussion, and all the people involved here are WP:MED regulars. Colin°^Talk 08:55, 21 February 2008 (UTC)

Strongly oppose to the last sentence of Colin's proposal. (Proprietary names are generally inappropriate for drugs no longer under patent.) In most cases even the drugs off the patent are still mostly known under their proprietary names. No one would recognize metronidazole, fluoxetine, sertraline, bupropion, so their proprietary names Flagyl, Prozac, Zoloft, Zyban have to be included. Paul Gene (talk) 11:20, 21 February 2008 (UTC)

How about "Proprietary names are generally inappropriate for drugs with multiple competing brands, which often occurs once the drug is no longer under patent." or suggest your own alternative. If we can't agree on this last sentence (though I'd prefer more than one dissenter), then it can be dropped. I'm trying to find the essence of what we agree on, which is very little. Colin°^Talk 14:33, 21 February 2008 (UTC)

Retracted response

Response to Nbauman

Let's take your points in turn.

• 'I don't agree with "Use the nonproprietary name when referring to a drug in medical articles."' How is this different from your "Generic names of drugs should always be supplied"? Note the specific "medical articles". In an article discussing a pharmaceutical company and its bestselling brands, the brand name is fine. Similarly, in an article discussing a person, if they take Epilim then you can say Epilim. Elsewhere, I don't see a reason to relax this, and I've already mentioned you can invoke WP:IAR for the really odd drug names.
• 'You don't believe brand names should be used at all' Not true. I've mentioned numerous cases where they could be mentioned. My main argument above was to point out that the idea that adding a particular brand name in parenthesis "helps the reader" is not always true, and probably rarely true for old drugs.
• 'you're trying to bias the guidelines towards your view' I sincerely hope not. I didn't reword the guideline as "should not, unless". I think "may" is as neutral as we can get, given that different editors here have different inclinations.
• 'You're taking a practice that we now handle by common sense and writing rules that would often violate common sense.' Guidelines should not prevent editors doing sensible things. Sometimes the sensible thing is to ignore the guideline, but that should be the exception. I'm not aware of any editor here (I don't know your work) who ever uses brand names as the only name for a drug.
• 'This is too vague. I wouldn't accept this in a guideline unless it gave specific guidance as to when proprietary names were appropriate and when they weren't.' You will never get such a guideline. The wording was a compromise that added only as much guidance as we all agree on. It seems that deciding the "appropriateness" of proprietary names is too variable to be legislated for.
• 'dysfunctional regulations when people can't easily tell what they are supposed to do.' The guideline isn't so vague that it isn't worth adding. You are supposed to use a certain name. You are allowed to put the brand in parenthesis, and gives the format. You are advised that old drugs probably don't warrant the brand. The rest is up to common sense.
• 'You haven't given a good reason for your bias against brand names.' I see brand names as a lot less useful than you do. I have given some examples of when they are troublesome.
• 'The BMJ, NEJM, Cochrane and BBC.. use brand names' This generalisation is false. I'll explain more below.
• 'You don't seem to accept that...[brand names] should be used when they make the writing easier for the reader to understand.' Which are we talking about? Adding brand names in parenthesis or using brand names instead of nonproprietary names? In medical articles, I see no reason for the latter and plenty reasons why it generally a bad idea.
• You say that unless the guideline is precise, it does "more harm than good". It is as precise as it can be, and no more.
• Of course I agree that the general reader must understand what we've written. If you'd been on the receiving-end of one of my reviews, you'd know that. I'm insulted that you keep asking this.

This isn't journalism and we're not writing (generally) about current affairs in the news. In a news item, the writer decides the key story he wants to get across and will sacrifice several holy cows in order to achieve that. That's fine but this is an encyclopaedia. There is no key story. Readers browse, follow hyperlinks, skip sections, and learn. The purpose of news is information transfer about current events; its purpose is not education. One factor that journalism sacrifices is precision. If an article on some epilepsy syndrome states the benefit of carbemazepine over sodium valproate, is the reader helped by saying Tegretol and Depakene? Not only does this confuse the UK reader (who knows the second drug as Epilim) but it is wrong. By saying that e.g., Tegretol is the recommended treatment, the reader will believe that only this brand is recommended. Earlier you said that NEJM, BMJ and newspapers "used brand names". This is wrong as a generalisation. In the kind of peer-reviewed studies and reviews we cite, they use the generic name. Brand names feature in news parts of those journals. Let's look at an article in The Guardian newspaper on epilepsy drugs during pregnancy. It uses the nonproprietary names: valproate, carbamazepine, phenytoin, lamotrigine. The UK brand Epilim is mentioned once, but only as a means to introduce its manufacturer, who is being sued. (Though I accept if you look at news articles on newly launched drugs, the brand is more prominent).

Newspapers and weekly journals often cover material that WP is less interested in, and usually isn't relevant to WP:MED pages. The business news is interested in share prices, affected by the success of drug brands and, of course they use the brand since it is the market-share of that brand that counts. Licensing news is also interested in the brand since it is the particular manufacturer's pill that is being licensed. Prescribing news (such as NICE's decrees) is also interested in the brand since it is the cost of a particular treatment that affects whether NICE feels it worthwhile. Personal news may also mention the brand because if the intervewee says he takes Tegretol, the journalist will repeat that. This is a different world from what WP:MED is generally concerned with. Colin°^Talk 10:34, 21 February 2008 (UTC)

I think I am tired of this discussion. We are reaching the point where dispute resolution is going to be necessary. JFW   T@lk 12:52, 21 February 2008 (UTC)

Dispute resolution? No. This is tame, if overlong. We've reached the point where everything's been said that needs to be said, and more besides. I've tried to trim the proposed text to what little we do agree on, and would consider dropping the third sentence if that's still contentious. If we still can't agree then forget it. We've gone this far on common-sense alone. Colin°^Talk 14:33, 21 February 2008 (UTC)

Sorry guys. Took that too personally and said too much you don't want to waste your time reading. Need a break. Colin°^Talk 17:22, 21 February 2008 (UTC)

I think Colin's suggestion is a good one, I think it's adequate guidance and allows for exceptions when necessary. I prefer having the final statement about drugs not under patent, but am not terribly upset in its absence. A point about INNs - on average they are the most useful as all doctors in the world will know what is being referred to, and even proprietary medications will have it attached somewhere. Proprietary names will be useful in specific countries while completely useless in other. In cases where there's a limited number of world-wide proprietary names, then IAR and discussion can lead to this being reflected on the page. WLU (talk) 19:46, 21 February 2008 (UTC)

Agreed, I'm not terribly fussed one way or another about the last sentence. I think we've got a good and reasonable proposal now, that almost everyone can support. SandyGeorgia (Talk) 19:49, 21 February 2008 (UTC)

We don't have consensus. WP:PARENT says, "Wikipedia's decisions are not based on the number of people who showed up and voted a particular way on a particular day; they are based on a system of good reasons. Attempts to change consensus must be based on a clear engagement with the reasons behind the current consensus." We haven't done that.

I keep asking for good reasons, and don't get an answer. I keep raising objections, and nobody answers my objections.

Here's one basic question that I keep asking, that I don't get an answer to. Do you all agree with the following statement:

Wikipedia is written for the general reader, and that's our primary audience. The first consideration of a writer is that his reader understands his writing. If your reader doesn't understand you, there's no point in writing.

Colin? What's your answer? Do you agree? Nbauman (talk) 20:18, 21 February 2008 (UTC)

Nbauman, you are welcome to read my "retracted response" (press the little [show] link), where I answer your points in tedious detail. But it is clear that nobody else wants to sit through us arguing between ourselves since we obviously don't see eye-to-eye. If you must respond to my comments, please continue on my talk page, but only if you've got something new to say. What is it about the above proposed text that would prevent you doing what you want to do? Can you give examples of cases where you'd frequently need to break the rule? If you are able to live with that guideline, and others want it, why be the block? Colin°^Talk 20:37, 21 February 2008 (UTC) Wrt to your PARENT point. The editors commenting here are seasoned WP writers. They'll have their reasons, even if they don't all articulate them in 1000 words. Consensus is about accepting that intelligent, informed people will have different ways of tackling the same problem, and different viewpoints. It isn't about persuading everyone to accept one viewpoint with some powerful arguments. Colin°^Talk 20:41, 21 February 2008 (UTC)

And to add to the pile, this is a guideline and therefore anything it says is meant to help in cases of ambiguity, not proscribe. Colin is not alone in this either, the endorsement of many other editors means they have to agree your disagreement has sufficient merit to prolong the discussion. WLU (talk) 20:42, 21 February 2008 (UTC)

(undent) Thanks, Colin, for your patient explications. SandyGeorgia, I think the recent addition is good enough for now. If we ever have actual, specific problems in the future, we can revisit it in the context of a live complaint. Otherwise, I'm DNFTT on this discussion and am taking this page off my watchlist for the next week. WhatamIdoing (talk) 21:32, 21 February 2008 (UTC)

No consensus

Let's look at the history of how this came about. WLU edited Crohn's disease to eliminate the brand names as in the following sentence:

Medications used to treat the symptoms of Crohn's disease include 5-aminosalicylic acid (5-ASA) formulations, prednisone, immunomodulators such as azathioprine, mercaptopurine, methotrexate, and newer biological medications, such as infliximab (Remicade), adalimumab (Humira), and natalizumab (Tysabri).

In Talk:Crohn's disease#Brand names of drugs, I explained my objections, and asked him why he did, it for the purpose of discussing it and getting a consensus, WLU looked it up on WP:MEDMOS, to try to justify his position. It turned out that WP:MEDMOS didn't justify his position. WP:MEDMOS#Drugs has what I think is a reasonable policy:

The lead should highlight the name of the drug as per normal guidelines. The BAN or USAN variant may also be mentioned, with the word in bold. The initial brand name and manufacturer follows, in parentheses. Indicate the drug class and family and the main indications... [etc.]

Instead of discussing it and trying to reach consensus on Talk:Crohn's disease according to WP guidelines, WLU decided to change WP:MEDMOS to support his position, which violates consensus:

Policies and guidelines document communal consensus rather than creating it.

WLU rounded up people who agree with him to get a vote for his position, which violates WP:PARENT:

It is very easy to create the appearance of a changing consensus simply by asking again and hoping that a different and more sympathetic group of people will discuss the issue. This, however, is a poor example of changing consensus, and is antithetical to the way that Wikipedia works. Wikipedia's decisions are not based on the number of people who showed up and voted a particular way on a particular day; they are based on a system of good reasons. Attempts to change consensus must be based on a clear engagement with the reasons behind the current consensus — so in the new discussion section, provide a summary and links to any previous discussions about the issue on the articles talk page, or talk page archives, to help editors new to the issue read the reasons behind the consensus so that they can make an informed decision about changing the consensus.

The proposal was to change WP:MEDMOS to discourage brand names more than it does at present. I repeatedly asked people who favored that proposal to give me their justification in support of that change. In my writing, when I have an opinion about something, I always try to find the best argument against my opinion. As I review Wikipedia Wikipedia_talk:Manual of Style (medicine-related articles)#Drug names in non-main articles, I can't find a good, serious argument to support the proposal. (Maybe that's my failing but it's your job as an advocate to make it easy for me.) I would classify most of the answers as WP:IDONTLIKEIT OR WP:ITANNOYSME.

OTOH, I asked several questions, and I don't think they were seriously answered. I raised several objections and I don't think they were seriously answered either. I take great offense when somebody brushes my questions aside with sarcasm. It's not an offense to me personally; it's an offense to logical debate

My strongest argument is that one of the main considerations in writing WP is that the average reader should be able to understand it, and we should give weight to using the brand name if it makes the article easier for the reader to understand. If you include that in a guideline (and with specific language to clarify when you think brand names shouldn't be included, such as long lists of brands of diazepam) I'd support it.

I proposed a consensus guideline which Paul Gene (who wrote his own proposed language), and (I think) JFW, basically agreed with. I think WhatamIdoing and SandyGeorgia were close enough that we could reach a consensus.

Colin responded with his own proposed language. I thought his language, "Proprietary names are generally inappropriate for drugs no longer under patent." was too strong, but I thought we could modify it to exclude brand names in those circumstances that we both agree on (commercial promotion) while allowing brand names in those circumstances in which I thought it was appropriate (names like Adriamycin, Oncovin and Tysabri that are more familiar to the non-professional Wikipedia reader than the generics).

But Colin wasn't willing to work for a consensus. He said that all the exceptions can be handled by WP:IAR. He wasn't willing to respond to the specific examples that we had raised. WLU said that the exceptions can be handled by WP:UCS. SandyGeorgia said that guidelines don't have to be precise.

We don't have a consensus. I don't think Colin's proposal would improve the guidelines. If they're not specific enough to let people easily tell what they are supposed to do, then they're not useful. If they're going to be modified by WP:IAR and WP:UCS, then who needs them? If they serve WLU's original purpose, they'll allow him to accomplish edits in Crohn's disease that he couldn't get by consensus in Talk:Crohn's disease , which violates consensus.

(As an example of the questions that I can't get answered in this discusion, I'd like to know whether I could refer to "infliximab (Remicade), adalimumab (Humira), and natalizumab (Tysabri)" in Chron's disease under Colin's language.)

So Colin's proposal isn't consensus. I oppose them and other people oppose them. The supporters are trying to get it in the guidelines by counting noses rather than discussion, resolution and consensus WP:PARENT.

I don't accept inserting this into WP:MEDMOS, and if you insist then we'll have to go to dispute resolution.

Like most people here, I'm getting tired of this tedious discussion. I think we'd be better off dropping it and leaving WP:MEDMOS#Drugs the way it is.

If anyone does want to continue, I'd like to see a good, balanced proposal, and I'd approve it if it truely represented a consensus. I think the brand names policy could be improved to be clearer and discourage brand names where they're not appropriate. (I also hate commercializing WP and I regularly delete spam links.) But in order to reach consensus, you have to incorporate the reasonable proposals and objections on all sides, not just round up votes for your side.

You can start by giving me a good, short simple argument for why your change is necessary, and telling me whether you accept my argument (and if not, why not) that we should use brand names when it would make the entry easier for the reader to understand.

Sorry if I've offended anyone and thanks for your efforts to explain your views to me. Nbauman (talk) 17:45, 22 February 2008 (UTC)

You've kinda offended me, we disagree but that's no reason to not AGF. To respond quasi-point by point:

1. I changed one article, then sought guidance. This impacts far more than Crohn's disease.
2. I believe the section of MEDMOS you are citing is for writing articles about drugs, not about the use of drugs in disease pages.
3. I started the discussion here because it's guidance that will influence how many pages are written, not just this one. And again, it's apparently needed. Why discuss on one page when it obviously affects hundreds?
4. PARENT doesn't apply, as was pointed out before this is the first time this issue has come up as I've seen no reference to other sections or the archives. I'm not consensus shopping, a group of editors are trying to find a helpful guideline.
5. IDONTLIKEIT and ITANNOYSME are for deletion discussions, not MOS.
6. I have repeatedly pointed out that drug names are wikilinked, making it easy to see a much more comprehensive list of drug names in the drug's wikipage. Further, the consensus is to link the generic name, then include prominent brands in brackets the first time.
7. A bucket of people agreed that Colin's proposal was good. None reverted Sandy's change. Consensus but you apparently.

My username has come up a lot. Is his something that you and I alone should take to dispute resolution and avoid cluttering up MEDMOS? WLU (talk) 19:41, 22 February 2008 (UTC)

Nbauman, nobody wants to continue this. You didn't get the precise guideline that would let you settle the dispute on that article one way or another. That's really disappointing but we're a mix of cultures and a mix of personalities and this seems to be one area where we can't agree. So, all that has ended up in MEDMOS is clarification that what people have been doing is OK. It may be inadequate for the purpose you were hoping but that's the extent to the consensus we have. I dispute that "WLU rounded up people who agree with him to get a vote for his position". Both you and Paul thought "Proprietary names are generally inappropriate for drugs no longer under patent" was too strong and I offered to modify or drop it. So to say I "wasn't willing to work for a consensus" is unfair. It didn't make it into MEDMOS. I fail to see how adding what was added can disturb you so much that you want to persist this to the point of dispute resolution. I think we'd all like to move onto more important things... Colin°^Talk 20:47, 22 February 2008 (UTC)

While I feel that this addition to WP:MEDMOS is not harmful, it is not very useful either. It is also wrong to just brush aside the legitimate objections of an informed and well-intentioned editor. Besides The first wikilinked instance of the name may be followed by the proprietary name in parenthesis: "[[trastuzumab|trastuzumab]] (Herceptin)" is a bit too strong. For example, a proprietary name Haldol is encountered twice in the Tourette FAC. God forbid, somebody will go around and delete all the second mentions of proprietary names. So, I am reverting the change because there is no consensus. Paul Gene (talk) 12:35, 23 February 2008 (UTC)

Paul, please don't. This guideline says nothing about the second instance (it doesn't say "only the first"). That is left up to editor wisdom. On Tourette syndrome the two instances are far enough apart that the reader might have forgotten. Colin°^Talk 12:38, 23 February 2008 (UTC)

My point exactly. Tourette is an excellent page, and the suggested guideline is creating a confusion as to whether the second mention of Haldol is legitimate. If we leave the second, third etc mention to editor's discretion, why say at all that "the first instance ... may be followed"? — It implies that the first mention may be OK, but not really the second. I would agree with the following: The wikilinked instance of the name may be followed by the proprietary name in parenthesis: "[[trastuzumab|trastuzumab]] (Herceptin). But before placing this back on the MEDMOS page I would suggest to be polite and to wait a few days for the comments from all concerned, including Nbauman, who in this case will have to say specifically what he objects to and why . Paul Gene (talk) 13:13, 23 February 2008 (UTC)

This is splitting hairs but is the sort of fine detail we can resolve without reverting each other. WP:MOSLINK appears to be more permissive in allowing repeat links that most people realise. It (currently) advises once per subsection, and no more than once per line or paragraph. So dropping the "first" and allowing the parenthetical brand after every wikilink could see even more instances than the previously proposed "(twice in a long article)". Dropping the "first" makes the reason for adding the brand a bit obscure -- why do we add it after wikilinks, someone might say. We're really just adding it the first time the reader encounters an unfamiliar word, and in a long article, it may still not be familiar in a later section. Perfect is the enemy of good, as they say. So, while I see the point behind dropping it, it introduces its own problems too. Anyone else got opinions on this? Colin°^Talk 14:25, 23 February 2008 (UTC)

This is a guideline, meaning it is not absolute. If it's a long article, then there is merit in having a second mention. On short there's not. The addition provides valuable guidance and your second mention of haldol is not precluded by the guideline. WLU (talk) 12:59, 23 February 2008 (UTC)

I agree that Paul gene's example is covered generally under WP:MOSLINK, the intent of the original wording was clear, and the proposed wording is less clear, as it makes it seem that all instances should include the proprietary name. But, since we currently have no guideline, and are tangled up in minor differences, editors actively preparing for FAC are simply ignoring MEDMOS, which makes sense. Guidelines should only guide; if we don't do that, editors will rightfully ignore. SandyGeorgia (Talk) 15:06, 23 February 2008 (UTC)

OK, if you suggest that wikilinks guidelines apply, would this do? — Use the nonproprietary name when referring to a drug in medical articles. Only wikilinked instance of the name may be followed by the proprietary name in parenthesis: "trastuzumab (Herceptin)". (the change bolded). This will preclude both using the proprietary names without wikilinking to generic name, and preclude deletion of second instances in the long articles. Paul Gene (talk) 16:03, 23 February 2008 (UTC)

Also opens the door to the pages being overlinked in order to have the bracketed proprietary name, but that's easily dealt with. I don't know if it's necessary to include this in the guideline (anyone familiar enough with linking will realize the use of trade names is comparable) but it's not a bad rule of thumb to have. WLU (talk) 16:07, 23 February 2008 (UTC)

The wording may be heading in the right direction, but is written in stronger language than usually employed on guidelines. Guidelines guide, policies mandate. If you drop the bold only and the emphasis with italics on may, you accomplish the same thing without dictating and leave leeway for editor consensus. You could also change "wikilinked instance" to "first occurrences or wikilinked instances" or something to be more general and get away from WLU's concern. Honestly, where is any of this level of nitpicking ever going to be a concern? Can someone give me an example? SandyGeorgia (Talk) 16:10, 23 February 2008 (UTC)

First occurrences are usually wikilinked, so there is probably no need to mention that. Will this do? – Wikilinked instances of the name may be followed by the proprietary name in parenthesis: "trastuzumab (Herceptin)". Paul Gene (talk) 16:33, 23 February 2008 (UTC)

Saying "A wikilinked instance of the name" achieves the same without the implication that multiple instances are the norm (they aren't). While I wouldn't oppose this form if others support it, I see no benefit in the change as it just obscures the reason for adding the parenthetical brand. No reasonable, concise guideline is going to be bullet-proof from those who would like to wikilawer to get their way, or help those who are unable to apply some common sense. Colin°^Talk 16:48, 23 February 2008 (UTC)

Here's what we had:

Use the nonproprietary name when referring to a drug in medical articles. The first wikilinked instance of the name may be followed by the proprietary name in parenthesis: "trastuzumab (Herceptin)".

Here's Paul gene's latest proposal:

Wikilinked instances of the name may be followed by the proprietary name in parenthesis: "trastuzumab (Herceptin)".

I have article space to attend to; I don't see the big issue one way or another. It's a guideline, intended to guide: the first was fine, but I think we've spent too much time on this. Wikilawyering is the correct term. SandyGeorgia (Talk) 16:53, 23 February 2008 (UTC)

Call me names if you like it. Wikilawyering is good if it helps us reach consensus. So, I have now Sandy and Colin as not being against this:

Use the nonproprietary name when referring to a drug in medical articles. Wikilinked instances of the name may be followed by the proprietary name in parenthesis: "trastuzumab (Herceptin)

Paul Gene (talk) 17:12, 23 February 2008 (UTC)

No one called you a name. We need rational guidelines or editors preparing medical articles for FAC will rightly ignore MEDMOS, as they are now doing. SandyGeorgia (Talk) 17:23, 23 February 2008 (UTC)

Paul, I didn't say you were wikilawering. I perceived that your were trying to make this guideline bullet-proof against such editors. I'm not keen on keeping the "instances of" plural. Two editors being "not against it" isn't enough on its own. Colin°^Talk 18:13, 23 February 2008 (UTC)

Well there are two editors on the record, me and Nbauman, against the current version. I emphasize that consensus have never been reached on it, so it was posted a bit prematurely. It is OK since the WP process is post-revert-discuss. But it will have to be taken down if the agreement is not reached. You and Sandy are not keen on what I am proposing, neither am I because I would prefer a proprietary name after each wikilinked generic name. The question is can all three of us live with what I am proposing or not? Paul Gene (talk) 19:39, 23 February 2008 (UTC)

Only the first occurrence of terms is typically linked, so we're saying the same for most purposes. What's the issue? Articles shouldn't be WP:OVERLINKed. Your proposal gets us crossed up in two different guidelines, linking and what we want to do about drug names. Please, again, I need to see an example of where this is an issue. Is what is done at Tourette syndrome not logical, common sense? Please give an article that shows what the concern here is; I'm not getting it. SandyGeorgia (Talk) 19:45, 23 February 2008 (UTC)

The current text (plus the bit about drugs no longer under patent) got the support of me, Sandy, WLU, Fvasconcellos, Arcadian, WhatamIdoing and David Ruben, some of them enthusiastically. Paul and Nbauman didn't like the patent bit so that got dropped. The three of us are currently discussing something that is truly, truly unimportant, and certainly not a reason for the text to be "taken down if agreement is not reached". It is so tedious that the only response you'll likely get is whatever. You say "I would prefer a proprietary name after each wikilinked generic name" and you can do that now or with your suggested change. The only thing you can't do is force such an edit by quoting MEDMOS, because (a) it is just a guideline anyway and (b) we all have irreconcilable differences on the amount of branding we would prefer. If this is the only thing blocking your consent, make the change if it makes you happy, but neither Sandy or I think it is an improvement. Colin°^Talk 20:00, 23 February 2008 (UTC)

This guideline revision started as an attempt to eliminate all drug brand names from Wikipedia, except on first reference in the main drug entry. This proposal failed, because it didn't have consensus. There are still people who want to eliminate all brand names in non-main entries, so I don't think we can get consensus.

The use of brand names in non-main entries requires judgment. You can't write a rule in advance that incorporates that much judgment. If you're going to write a strict rule like WLU and Colin want, and then say, "but ignore this when common sense requires it," then you might as well not have the rule and just use common sense directly.

We don't need a new guidleline on this subject. A guideline that is flawed or difficult to understand does more harm than good. We can just use common sense along with the old guidelines. Less is more. Nbauman (talk) 20:18, 23 February 2008 (UTC)

The only thing that makes sense or is even remotely true in what you just wrote is "The use of brand names in non-main entries requires judgement." and "Less is more". Take a break. Colin°^Talk 20:50, 23 February 2008 (UTC)

I am so confused by Nbauman's last post. Who tried "to eliminate all drug brand names from Wikipedia, except on first reference in the main drug entry"? Who ever disagreed that what was at Tourette syndrome was perfectly logical and readable for both professionals and laypersons, who might not know generic names? I'm going to go find an anti-SSRI and try to work up a healthy obsession over drug names. Until it takes affect, I just can't decipher what the big issue is. SandyGeorgia (Talk) 20:57, 23 February 2008 (UTC)

Another break

<undent>I really, really see this ongoing debate as silly. What's the problem with the current guideline? I don't see any problem with the guidance and agree that tangling it up with proscription and wikilinking is unnecessary. Any experienced editor will automatically wikilink the term and put a notable brand names based on this guideline. More dictation is not necessary. WLU (talk) 21:53, 23 February 2008 (UTC)

I like the addition of "notable", since it's not necessary to list every obscure manufacturer, just to give some guidance to laypersons who may not know that sertraline is zoloft. SandyGeorgia (Talk) 22:08, 23 February 2008 (UTC)

Note that the page has changed [5], leading to SG's comment. WLU (talk) 22:12, 23 February 2008 (UTC)

Paul has reverted that change. I suggest we just live with what we have for now. In a couple of months we can all look at it again with fresh eyes and perhaps examples of where it is working or not. Colin°^Talk 12:29, 24 February 2008 (UTC)

And JFW has reverted that now, prompting Paul to delete the whole thing. I've reverted it back to Paul's earlier edit as I think WLU is more likely to accept the loss of his edits (he's on wikibreak too). I've been reluctant to do any editing, never mind reverting, but frankly that last rv was just disruptive. Give it a rest, everybody. Colin°^Talk 22:42, 24 February 2008 (UTC)

I just stepped in and read most of this because I saw the reverts. I actually mostly agree with Paul Gene and Nbauman, at the very least in their assertion that consensus has not been reached. "Consensus" doesn't mean "some people getting bored and others burnt out and somebody deciding for everyone"... I'm not sure how this whole thing got so heated, but if you really think the only way consensus will actually be reached is to take a break, then I think it's reasonable to leave the addition out of the MoS altogether until then. I *don't* think what's being argued over is unimportant; if you've ever seen any WP debate about wording, let alone for a guideline, you'll know this is not trivial by comparison (not intending to insult anyone by this). --Galaxiaad (talk) 02:55, 25 February 2008 (UTC)

Colin, thank you for your efforts to calm the passions. I apologize if my last edit appeared to be disruptive. All I was trying to do was, in the spirit of Wikipedia, to restore the last valid (and uncontroversial) version of the guidelines. But as I said I can live with the version you restored. Thank you again for being civil. Paul Gene (talk) 03:00, 25 February 2008 (UTC)

et al in citations

A new issue to keep up with;[6] sorry about the verbosity that prevails at WT:MOS (oh, we have that here, too :-), but this may affect Diberri-generated citations. SandyGeorgia (Talk) 03:08, 21 February 2008 (UTC)