Talk:Attention deficit hyperactivity disorder/Archive 8

Merger proposal
Merging with Attention-deficit hyperactivity disorder controversies will improve both pages. Both are biased at this point and poorly referenced. Neither one has proper references in place and many of the references are from poor sources. Rather then having two poor pages they should be combined into one good page. There is lots of good scientific literature supporting a balanced treatment approach. Some good sources include This is a decent review by the AAP If you are using PMIBs this tool can give formatted templates. diberri's tool
 * www.pubmed.com
 * www.uptodate.com
 * www.emedicine.com
 * http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/4/1033

Doc James (talk) 16:49, 11 September 2008 (UTC)


 * Strongly against Both articles are long enough already. Instead, will create a separate link/notice on top of article for that matter, which I will be doing shortly. Prowikipedians (talk) 19:14, 13 September 2008 (UTC)


 * Do we need to vote to deal with common sense stuff? How about simply spinning off some the ADHD sections like History which are a bit on the long side? That allows more room for a merger. See the autism "star" article which spins off several subsections.--scuro (talk) 19:19, 13 September 2008 (UTC)


 * Strongly for Yes I agree splitting off section makes sense once they are long and sufficiently good enough to stand on there own.  Read thru the history section.  The references there indicate that it is POV of the wikipedian editor rather then referenced to a review or book.Doc James (talk) 16:07, 16 September 2008 (UTC)


 * Against, and note that this has previously been suggested by scuro on the ADHD controversies page and was rejected then. The current quality of either article is not reason for a merge, but what should be considered is whether there would be enough content for two articles if they were both good or featured articles. I think there easily would be. 92.5.41.40 (talk) 05:51, 20 September 2008 (UTC)

Message from controversies article talk page "I'm going to remove the merger tag if nothing changes in the debate by friday, right now I think it's about 6-2 against, and although it isn't a vote exactly, it's damn clear these articles aren't going to be merged. The discussion has however highlighted the lack of mention of controversy or this article on the main ADHD page. I suggest it would be best to have a section in the main article linking to this one, the same way the ADHD medications article is treated." Turns out there is a section on this page, although it's title is kinda watered down.92.2.223.10 (talk) 18:05, 24 September 2008 (UTC)


 * How exactly did you get the 2:6 for the merger? From the above it looks like 2:2 --Doc James (talk) 18:23, 24 September 2008 (UTC)


 * It was more an estimate than a count, but bearing in mind this idea has been floating around for months on two talk pages I think if anything it could be more than 6. The various comments have been spread across different sections (at least on the other page) and I think some may have been archived, but if you check the other page as well as this it should be fairly easy to spot more than two against. 92.2.223.10 (talk) 18:52, 24 September 2008 (UTC)

GA review
I would like to draw everyone's attention to the last Good Article review that was done on this page. We have multiple other editors says many things similar to what I have been trying to do. Please read and then we can move forwards from there.

Featured article candidates/Attention-deficit hyperactivity disorder/archive1 Doc James (talk) 02:46, 23 September 2008 (UTC)

Thank you for the link. I'd like some ground rules first. Particularly around posting and edit wars. Lets deal with that.--scuro (talk) 04:38, 23 September 2008 (UTC)

Sure deal. The first rule I want is that all posts be formatted properly using templates. And second that we all read and follow the guidelines about hierarchy of evidence.

--Doc James (talk) 04:56, 23 September 2008 (UTC)

No problem on formatting, and I would like to take the time to truly understand the hierarchy of evidence because what they said at the village pump wasn't meshing with what you told us. I haven't had the chance to digest either nor have I had time to fully digest all of your edits to date. In a nutshell, for this community we need you to slow down and be focused on one thing so that we can catch up. So I would like to go at this systematically: !)That we stop editing the article unless it is done together, 2)that we start by looking at the intro because the intro contains links that were removed. In understanding how to format the links we would be killing two birds with one stone. That would all be very helpful to me as an editor.--scuro (talk) 11:21, 23 September 2008 (UTC)

They did mention at the village pump that published peer reviewed literature is preferred over web pages. The concern that the page didn't make enough references to the literature and too many to web pages was mentioned a couple times in the GA review. Some of these comments were made by very experienced editors. Sandy is one of the most well know in the field of medicine and commented about this being an issue. --Doc James (talk) 15:18, 23 September 2008 (UTC)

Generally I think you are right. If there is only one source no issue. If there are two or more sources then a judgement will need to be made, and again I agree with you, it will come down to the quality of the references. Just like the Mayo Clinic had short comings single studies can have major shortcomings and even reviews can have some shortcomings. If you are open to discussion, if and when this would occur, I believe we will find a lot of common ground on this issue. I just need some time to read more about this so I am not wasting everyone's time.--scuro (talk) 16:05, 23 September 2008 (UTC)


 * I agree with you. Single studies should not usually be used as they are primary sources.  There are exceptions which Reliable sources (medicine-related articles) makes clear.JFW made this very clear to me when I first started editing.  Secondary sources such as peer reviews are much prefered.  Look at a pages like Alzheimer's disease or even more so Autism.  If you look at the reference section almost all the references are to journal article.  These are the pages that wikipedians have ranked as the highest quality and were we want to bring the page on ADHD.  WRT the Autism page all of the references in the lead are to journal articles and most of them are to reviews.


 * These pages use a few none journal references but they are in the sections about culture and social aspects of the condition were the requirements on references are not so tight.

--Doc James (talk) 17:42, 23 September 2008 (UTC)


 * Doc, I would love to do some research, really. But simply watching the poor revisions that are happening, trying to correct them, and responding to personal attacks takes up all my free time here. Here is my goal tonight. I want to share what was said at the village pump about citing web based info and the Mayo Clinic web page. It will be enlightening to anyone who didn't follow that exchange.


 * * Not formatting to Wikipedia standard is not disqualification of the source (although annoying)
 * * Popular science (aimed at lay person) is perfectly acceptable
 * * That it is neiter evidence based nor a literature review is problematic* Many sites and organisations do not attribute information to a single author (has often nothing to do with bravery but with institute policy), this is not necessarily a disqualification of the source.
 * * Peer review would make the souce better; self publication is not very strong; and references to literature would be preferable.
 * Altogether I would judge this source as marginally acceptable in the context where the claim is not exceptional (so no exceptional evidence required) and the soure being a fairly well-known serious institute. A better soure maybe desirable.


 * I would consider Mayo Clinic pages to be reliable sources. Now, a reliable source may be mistaken, and in that regard primary literature and literature reviews do have higher authority than websites. Doc James, if you want to challenge this, I don't buy your arguments that that Mayo Clinic web pages should simply be ignored. However, I would buy an argument that literature sources describe ADHD as not chronic, or evidence that they refrain from using that word. So, in my opinion, simply believing that the Mayo Clinic pages may be wrong isn't adequate ("verifiability, not truth"), but if you can show via other sources that they are likely to be wrong, then that would justify removal.--scuro (talk) 03:26, 25 September 2008 (UTC)


 * I can definitely see DJs objection; chronic is not a word I think most people would use to describe this condition, where chronic medical conditions are usually considered to be permanent with a high degree of suffering. Plus the sources describing ADHD as chronic are american doctors/clinics websites trying to sell you their treatment. If it were up to me, I definitely wouldn't use it, but in this case as scuro insists I do think 'verifiability over truth' wins out, there isn't a clear consensus against to use IAR. So although I'm personally not fond of the term being used in this way, I think it should be left in until/unless contradictory sources are found. 92.3.169.248 (talk) 06:33, 25 September 2008 (UTC) Upon reading the full discussion which scuro has quoted parts of, it's clear that DJ has provided very good sources and the argument is dead and buried: chronic should not be used. 92.3.169.248 (talk) 06:54, 25 September 2008 (UTC) Reading even more I stepping out of this discussion for the time being, it's getting messy. 92.3.169.248 (talk) 06:59, 25 September 2008 (UTC)


 * As I have said previously Uptodate does not use the word chronic. I have provided a few good resources and as you have said the mayo web pages are not the best quality of evidence.  From the good article review and when one looks at featured articles web pages are not used especially not used in the lead.


 * I guess the question is Do we want to bring this page up to featured article / good article quality?  If so we need to look at other featured articles and emulate them / follow the requirements needed.  I am not saying that the mayo clinic web site cannot be used ever all I am saying is that we should use better sources if we want to improve this article add that we shouldn't use it in the lead.


 * I think we need a policy that anything that does not refer to peer reviewed literature is deleted. Today I removed something that was refered to someones power point.  This is garbage pure and utter garbage.  Making references to someones power point in not good enough.  We have talked lots about what makes good evidence.

--Doc James (talk) 16:19, 25 September 2008 (UTC)


 * Not all refereces are peer reviewed. Never have been, never will be. Wikipedia references books, video clips, songs, blogs, newspapers, and yes, powerpoint presentations. Extraordinary claims need incredibly strong sources, some sentences don't need sourcing at all, and between those two extremes there's a lot of grey shades. Finding a better source is always a good thing, but don't throw stuff out just because it's not peer reviewed, and certainly don't object to sources because the submitter doesn't know (and really really can't be bothered to find out) exactly how to format them. 92.3.169.248 (talk) 18:52, 25 September 2008 (UTC)

If you want to write a good medical article references should be from good sources. Maybe those who cannot be bothered to edit properly should not be editing. Doc James (talk) 20:28, 25 September 2008 (UTC)


 * I appreciate the work you're putting into the article, but I don't think your manner of interacting with other editors is very helpful. Try to realise that other editors are trying to help just like you are.
 * If you want to talk about policy for sources try http://en.wikipedia.org/wiki/Wikipedia_talk:Reliable_sources. 92.3.169.248 (talk) 21:24, 25 September 2008 (UTC)


 * As this is a medical article I think we should use the policies Reliable sources (medicine-related articles). They are disccued in great detail at Wikipedia talk:Reliable sources (medicine-related articles)

From this page:

Doc James (talk) 23:27, 25 September 2008 (UTC)


 * The key word there being IDEAL. I agree that those kinda sources are ideal, but that doesn't mean other sources are automatically rejected, we don't live in an ideal world. 92.0.130.10 (talk) 12:11, 27 September 2008 (UTC)

flogging the Zametkin dead cat(part 3)
Zametkin was the dude who did the brain scans. Part 2 of the dead cat is on the archives page 5 but the informative look at this issue is on page 3 of the archives. Read down from here: http://en.wikipedia.org/wiki/Talk:Attention-deficit_hyperactivity_disorder/Archive_3#zametkin--scuro (talk) 01:34, 26 September 2008 (UTC)

The Zametkin issue has been raised three times. A link above has been provided. Take a look because there was a lot of highly intelligent reasoning that went into those replies, along with some good links. It is an image that one associates with ADHD, probably one of the most famous. It was a landmark study. You could probably write a whole article on it, since it was with this study that some felt, and many still do, researchers had the smoking gun they were looking for. It has been explained it to me, that the PET scans showed that the harder a person with ADHD concentrated, the "slower" their brain went vs the exact opposite for the non ADHD group. However, that result changed when the ADHD subjects took stimulant medication. So if you want to change the wording, by all means throw a trial balloon up here with proper citations. I'll certainly look at it.--scuro (talk) 01:21, 28 September 2008 (UTC)

Right now the image tag reads "PET scans measure the activity of various parts of the brain. The image on the left illustrates glucose metabolism in the brain of a person without hyperactive person while doing an assigned task. The image on the right illustrates glucose metabolism in the brain of a normal subject when given that same task. The significance of the research by Dr. Alan Zametkin that produced these images is still not definative." Which doesn't even make sense and even if it did make sense I'm pretty sure it's inaccurate, and even if it were accurate I don't think it's very clear that those aren't actual brain scans pictured. 92.5.155.82 (talk) 18:12, 28 September 2008 (UTC)

If you read the link above at the start of the thread you will find that came up with ideas for a caption. Why reinvent the wheel? Also, If we are not looking at PET scans what are we looking at?--scuro (talk) 19:09, 28 September 2008 (UTC)


 * Okay, I'm just going to rewrite it myself on the grounds that any comprehensible sentence is better than what is there now. AS for the not pet scans, at the time I remembered reading somewhere that they were synthesised images illustrating the general theme of the findings rather than the specific scnas of patients #27 and #32, but now I think about it I'm kinda vague on where I got that from. 92.5.155.82 (talk) 11:11, 29 September 2008 (UTC)


 * Oh hang on, seems to be fixed up on this page.92.5.155.82 (talk) 11:12, 29 September 2008 (UTC)

returning stripped citations
A number of citations were stripped in recent edits. I'd like to return some of them because they were good citations. Granted most are probably not the top quality citations as outlined by Doc James. Still, many were good and should stay there until something better is found. I'll do this by a case by case basis posting first in talk and doing the edit a day or two later.

1) "neurobehavioural", "developmental", and "chronic" from the first two lead sentences had the following citations: i)Laboratory of Neuro Imaging, ii)UCLA, the National Institute of Neurological Disorders and Stroke, and iii) the Mayo Clinic. --scuro (talk) 19:20, 28 September 2008 (UTC)


 * While I'm no expert, ADHD doesn't fit in with any definition of developmental disorder I've heard. As for the mayo clinic...I'm going to go read the discussion on that other page (rather than selected quotes from the discussion) and see what happened there. I have no particular opinion on neurobehavioural as long as the first couple of sentences don't get crammed with too many adjectives. 92.5.155.82 (talk) 10:58, 29 September 2008 (UTC)


 * Developmental is appropriate because it is a condition that must be present in childhood in order to be diagnosed - hence the use of the word developmental by professionals. You are right in that this is a jargon use of the term and many people would think that the word refers to something changing and "developing".  Perhaps at some point in the article (not the lead though) this should be explained a bit more--Vannin (talk) 17:08, 1 October 2008 (UTC)


 * KK 92.4.125.88 (talk) 17:12, 1 October 2008 (UTC)


 * Having looked the village pump discussion seems to pretty much come to the conclusion that the higher standard sources provided by DJ trump the mayo clinic, and I'm inlcined to agree to a point. Later in the article the chronicness/not of ADHD could be discussed but I don't think the word is very helpful in the lead. 92.5.155.82 (talk) 11:04, 29 September 2008 (UTC)


 * Read the village pump again. DJ provided BOGUS citations that had nothing to do with chronic. Take a look for yourself. Tell you what. I'll reinsert so you can see what it looked like. If you think it is getting adjective heavy let us know. If we don't get a few counter opinions I'll move it further down myself.--scuro (talk) 23:48, 30 September 2008 (UTC)

More opinions needed for disputes on controversies article
http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder_controversies Dispute 1 - Are there controversies relating to Ritalin and similar drugs (and therefore is a picture of a ritalin pill better than nothing as an image for the article) I say yes to both points, Scuro says no.

Dispute 2 - this is the attribution thing Scuro does all over the place, being applied to the lead. Right now Scuro is insisting on the introductory sentence of the article reading

"In the Harvard Review of Psychiatry, three authors from departments of political science and psychology at the University of California campuses in Richmond and Berkeley stated, "ADHD is one of the most controversial psychiatric disorders, in part because it is also the most commonly diagnosed mental disorder among minors." "

Which I think is an awful lead sentence.

I prefer (EDIT: Actually when I say prefer, I'm not entirely happy with 'despite...' I can see why it was put in for balance issues but it seems a little weasely, suggestions for alternatives are more than welcome.)

"Attention-deficit hyperactivity disorder (ADHD) is one of the most controversial psychiatric disorders despite being a well validated clinical diagnosis. "

Which is pretty similar to what was already there.

I'm not necesarily asking people to choose between the two, but to give their view on the basic assertion of controversy....i.e, should the lead say something like 'ADHD is a controversial disorder', or should it be something like 'Two guys who are accountants once claimed ADHD is a controversial disorder' 92.5.98.114 (talk) 10:49, 30 September 2008 (UTC)
 * I think some of this discussion may have been lost in the shuffle above, the talk page did get a little confusing for a while. I've already commented on this, and said that I think the lead should summarize the article.  The controversy issue is not a big part of this article (whether it should be or not is another point) thus I'm not even sure that this statement belongs in the lead.  I do find that the extra detail helps to put it in context, and should probably stay.  --Vannin (talk) 14:53, 30 September 2008 (UTC)


 * No no, thanks for your response but you misunderstand, I'm talking about the ADHD controversies article http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder_controversies
 * I should have made it clearer92.5.98.114 (talk) 16:05, 30 September 2008 (UTC)

I'd like to weigh in with the opinion that much of the sociology of ADHD is controversial and I don't think that fact is escapable, especially as we move forward in the US government investigations about the extent of drug company involvement into various aspects of research. On the one hand one we see overwhelming evidence that a minority of persons diagnosed with ADHD have actual brain dysfunction, genetic predisposition, anatomical variation et cetera but on the other hand we find too many paid "experts" making patently false assertions as to the deniability of alternative diagnoses and basic prevalence of the disorder.Trilobitealive (talk) 18:27, 30 September 2008 (UTC)


 * 92, you got it wrong in the translation. The above first sentence is a direct quote, from three people only and in the field of political science. It should be attributed because it is not majority opinion and comes from a field not normally associated with ADHD. I agree, it's a stinky opening line but I believe it's the one you jammed in there. Why start with minority opinion? I offered that you do a rewrite but I don't think you got my drift. I didn't mean that you should strip the attribution away again, but rather that it be "water it down" a bit so you could make a more generalized statement that we could all agree too.--scuro (talk) 23:45, 30 September 2008 (UTC)


 * To suggest that I am the one who 'jammed it in there' is a patent contradiction of reality. As you agree it's a sinky opening line I'm going to go change it. I will repeat my statement on the other talk page that it would be extremely helpful if you would actually say what your objections are. 92.1.168.244 (talk) 08:32, 1 October 2008 (UTC)


 * 92,better would be to seek consenus instead of jamming another new opening line in that you know others disagree with. That is might is right approach. The process that should be followed, especially on a controversy page, and with contributors on either side of an issue, is to always seek consenus.


 * I'm flabbergasted that you believe that I haven't made my objections clear. Every post on this issue probably contains my objections. On my previous post you will find the objections on lines 2 and 3.--scuro (talk) 16:07, 1 October 2008 (UTC)


 * Your version of the lead was a quote, which should indeed be attributed, my version of the lead did not contain any quote or opinion. I believe that the approach I have taken is more 'being correct is right' than might is right. Happily the issue is now resolved with a citation to the Encyclopedia Britannica 92.4.125.88 (talk) 16:28, 1 October 2008 (UTC)

no impairment no disorder
There is no grey area here. If you have a diagnosis of ADHD as a child it does not mean you have it for your whole life. For instance: if life is great on all fronts now but you are just a little hyper in older age, in reality you are no longer ADHD. You do not fit one of the prime criteria of ADHD which is impairment in life functioning.--scuro (talk) 04:16, 1 October 2008 (UTC)

POV2
Well it looks like two editors are once again doing all they can to decrease the quality of the references used on this page and decrease the over all quality of the page. They are trying to force there own opinion. A shame. Wikipedia can be do great things but this is unfortunately an example of it not working. Continue sprouting you POV.

Doc James (talk) 07:20, 1 October 2008 (UTC)

The village pump stated clearly that citations need not be reviews or a study. A number of citations were stripped away under false pretenses. If there are contributors who believe there are better citations then currently sit on the page, then the ball is in their court. Go find them.--scuro (talk) 11:52, 1 October 2008 (UTC)


 * The village pump actually said that the references I added were better then the references you had there. The Good Article review said that the references that were there were bad.  You say you want to discuss thing but I do not think you do.  I gave you the benefit of the doubt.  We set rules on following the reference guild lines but YOU do not follow them.  Even after saying you would.  You do not format your references even after saying you would.  You miss represent other peoples comments.  You no longer deserve good faith.  I now see that you are only intent on pushing your own point of view and keeping this article bad.  --Doc James (talk) 16:29, 1 October 2008 (UTC)
 * I have brought this to the ANI http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/Incidents#The_ADHD_article_and_Scuro --Doc James (talk) 16:48, 1 October 2008 (UTC)


 * Doc James. The village pump said that my reference was perfectly acceptable and stated that if you have better ones you should bring them forward. The references you brought forward were totally bogus. In general, don't disagree with hierarchy of references but when there are no other references for a point, medium quality references are perfectly acceptable.


 * I've put a warning on your page. Your personal attacks and obvious assumption of bad faith must stop. The fruitless ANI report that you launched is a clear indication that other contributors who know policy, don't agree with you. If you can change your behaviour, I am still open to meaningful consensus building.--scuro (talk) 10:47, 2 October 2008 (UTC)


 * I do not believe Scuros summary of the villiage pump discussion is accurate, and strongly suggest that anyone interested read it themselves. 92.4.125.88 (talk) 11:31, 2 October 2008 (UTC)


 * By all means go have a look. I encourage it.--scuro (talk) 16:05, 2 October 2008 (UTC)

Controversy
Here are some more links about the controversy. But I am sure they will not do as Scuro has his own beliefs.

First is a textbook on Developmental Psychopathology that describes the controversy well. This is a secondary source. http://books.google.com/books?id=UlQjE-Ka09sC&pg=PA358&dq=ADHD+controversy&ei=WivjSJLXF4TkygS_3I3iBA&sig=ACfU3U1RIgDI45e5ETkBaR8iWd929M1ysA#PPA358,M1

Next is the cyclopedia Britannica. Yes even more famous then wikipedia. It has a section on the controversy. This is a tertiary source. http://www.britannica.com/EBchecked/topic/279477/attention-deficithyperactivity-disorder/216017/Controversy-mental-disorder-or-state-of-mind

Medscape discusses it. http://www.medscape.com/viewarticle/442882_5

How about the US government. http://www.ahrq.gov/clinic/epcsums/adhdsum.htm

Another well know site. http://www.medicinenet.com/script/main/art.asp?articlekey=50774

The controversy is even discussed in the BJP. http://bjp.rcpsych.org/cgi/content/full/184/5/453

I know all these refers boil down to three political science profs to Scuro but... maybe they would actually provide a more balance picture of the who thing. That's just me though I think some people have already made up their minds. --Doc James (talk) 07:56, 1 October 2008 (UTC)


 * thanks for some brilliant links, these will be very helpful on the controversies article I'm sure :) 92.1.168.244 (talk) 08:44, 1 October 2008 (UTC)

The assumption of bad faith is blaringly clear. Doc James, all I ever asked for was good citations. Why make it personal, again? --scuro (talk) 12:04, 1 October 2008 (UTC)


 * I believe that telling other people to assume good faith/declaring that they're not, is in itself considered a failure to assume good faith. 92.4.125.88 (talk) 13:42, 1 October 2008 (UTC)


 * Do you now? Show me the policy page. I'm not going to allow swift boating- "an ad hominem attack or a smear campaign". I'll set the record straight everytime. I'd always prefer to talk content but sometimes other contributors can't focus on content. That's not my fault.--scuro (talk) 15:59, 1 October 2008 (UTC)


 * WP:AAGF And some people might suggest that DJs comment is talking about content, namely the word 'controversy' and its derivatives that you object to so. 92.4.125.88 (talk) 16:22, 1 October 2008 (UTC)


 * For me the key is that the main body of the article should be dealt with first, and then the lead can summarize what is in there rather than introducing new information.--Vannin (talk) 17:05, 1 October 2008 (UTC)
 * Wait, then why aren't you addressing the links posted? It sounds like their credibility should be the first thing of interest to you, and it's not like we're running out of space here...146.201.161.171 (talk) 09:29, 5 November 2008 (UTC)

Shakespeare
I'm not sure what to do about the shakespeare quote. I found the required secondary source - barkley so that is quite solid - but he actually misquotes it - it is from Henry IV, II not Henry VIII. Of course, I don't want to do OR so have tried to put in both. Any ideas welcome--Vannin (talk) 22:03, 1 October 2008 (UTC)


 * This looks like a pretty good situation to use WP:IAR. Can't imagine anyone sensible objecting to the OR in this case. 92.4.125.88 (talk) 23:17, 1 October 2008 (UTC)


 * Thanks!--Vannin (talk) 03:23, 2 October 2008 (UTC)

Disruptive editor
Have looked into Scuro's editing behavior further. I have recommend you Scuro stop your disruptive behavior and stop pushing you fringe point of view. You do not seem to have any true desire to discuss the issues at hand or work together. This has been sited by a number of editors not just myself. You are trying to control the content and POV of the article.

Have been looking at other comments on your talk page and it seems like lots of other editors have been having similar problems with your edits on many other pages. Seems like you are trying to control a whole bunch of pages threw edit warring and other tactics.

--Doc James (talk) 12:10, 2 October 2008 (UTC)

Doc James, you can frame it any way you want, but anyone who looks seriously at this issue will not agree with you. No editor of any standing is backing your ANI complaint, or your viewpoint on the village pump, which was that webpages can't be a source of info to be cited. Speaking of control, editors should look at the edit history on the ADHD. Clearly there is an editor trying to control everything, resorting to edit warring to dominate with a might is right approach, and it ain't me. Also noticed that you deleted the warning from your talk page with links to clear examples of personal attacks. What are you trying to hide?

Finally I do stick with a few pages and usually they are controversial mental health issues. These pages come under frequent attack and they take up all of my time here on Wikipedia. I am very proud that in the end these pages usually stay balanced. I welcome you to assume good faith and to build consensus. Any time that you are ready, we can begin. I will note that I am no longer going to tolerate personal attacks. Enough with your petty attacks which amount to harassment. Desist or I will immediately take action.--scuro (talk) 11:50, 3 October 2008 (UTC)


 * Please Scuro "immediately take action". The way I recommend you do this is by finding reliable sources to back up your arguments so that we can discuss contents rather then cry about hurt feelings.Doc James (talk) 16:26, 6 October 2008 (UTC)

creating a controversy section
Have added the line about ADHD being controversial back into the lead. It is referenced to a recent textbook, a US governmental website, and a peer reviewed psychiatric journal.

Now all we have to do is have all other statements match these same standards :-)

--Doc James (talk) 12:29, 2 October 2008 (UTC)

You know, usually you create a subsection and flush that out, from which you summarize the main points in the lead. I'll be working on that subsection if anyone is interested in collaborating. --scuro (talk) 12:25, 3 October 2008 (UTC)


 * I very much agree about the statement that we usually do the lead sections by summarizing the content in subsections. DJ seems to be relatively new to WP and may not realize that. I will volunteer to help collaborate on that (new) section. For what it is worth, I believe ADHD is the subject of a number of sharp differences, but no single "controversy". I am not sure when differences rise to the level of controversy. My acceptance of the current lead content sort of hinges on that. I also think that the confusing terminology used by the psychiatric portion of the medical community via the DSM adds to misinformation and hence some of the controversy. (I am under the impression that psychiatrists are medical doctors with additional training; doesn't that make them a part of the medical community?) The changes in the DSM seem to be done in good faith as I tried to explain in a section DJ totally eliminated after claiming he would edit it. I am still waiting to see if there is any good faith effort in that regard. Vaoverland (talk) 13:15, 3 October 2008 (UTC)


 * Talking and the assumption of good faith is a start. Really I don't think there is any current contributor who can't be reasoned with. If we can come from the stance that at times we must give ground because our position is weak, then we have headed a long way towards collaborative editing. Focusing on the content instead of the contributor would be another huge step. Civility would be the final cornerstone...and even better yet politeness. Really all we have to do to begin, is to turn the page and start fresh.--scuro (talk) 19:47, 3 October 2008 (UTC)

Things to think about with regards to ADHD and controversy...some thoughts:
 * ADHD has mostly been thought of as a childhood disorder.
 * more children are diagnosed with this disorder then any other in the US.
 * medication is the prime treatment because it is immediately effective and therapeutic stimulants are regarded as the safest class of mental health medication.
 * scientology and other segments of society are dogmatically opposed to any medication or even the notion that behaviour can be abnormal.
 * politics also plays into this. Libertarians have positions that oppose entitlements such as paying for the diagnosis of ADHD or treatments with public funds.
 * of all the mental disorders besides perhaps depression, the symptoms of ADHD are not that different from normal behaviour. While a three year old can easily be overly hyper impulsive, and distracted....that is highly unusual in a ten year old. The key to ADHD is impairment. The regular child develops while the ADHD child stalls in development. This creates all sorts of social problems when they interact with their peers or are expected to act at a certain age level.
 * the medical community and scientific community see no real controversy. --scuro (talk) 23:41, 3 October 2008 (UTC)


 * You need to reference your opinion to someone. Please provide these.  Doc James (talk) 16:23, 6 October 2008 (UTC)


 * I can, but these are talking points that I see as important in the discussion of controversy. You are welcome to add more. I simply want to start a discussion so that communication actually happens. Consensus is possible, wiki shows us how. If in the future, we make progress and some fact checking is needed, I'll find citations.


 * So lets begin. What exactly is this controversy? We have many sources which speak to controversy. Is controversy everything to do with ADHD? From my vantage point I just wonder if we are piecing together tidbits of info to make a narrative. Some tidbits being excellent and others poor. If we are, then this could be WP:OR. A true controversy has proponents on both sides of the issue. Take Childhood-Onset Bipolar Disorder. We have highly notable proponents in the field taking very strong viewpoints on that issue. Where is that taking of sides with ADHD, especially in the medical and scientific fields? Yes we have Britanica and a few other sources calling it highly controversial, but why? Is the controversy in the popular media, is it everywhere? Wikipedia always wants attribution of viewpoint. So list the proponents and we can go from there.--scuro (talk) 02:52, 7 October 2008 (UTC)

No longer valid
I would like to bring everyone's attention to this page. The guideline specifically says that it is no longer valid. Therefore I think we need to find something more recent. It is on the right hand side of the page.

--Doc James (talk) 12:35, 2 October 2008 (UTC)


 * I'm not clear on what you are talking about - which page is not valid? Is the document you are referring to not valid?  By "on the right hand side" are you referring to the classification box?  Which guideline are you using?--Vannin (talk) 13:56, 2 October 2008 (UTC)


 * Is this about the chronic point again? This article makes it 100% clear that the condition should be considered chronic.  Given this article we should remove the "generally" from the lead--Vannin (talk) 14:12, 2 October 2008 (UTC)


 * The problem is that the guildline says plainly that it expires 5 years after publication and therefore it should not be used. Read it carefully.  I am not saying there is anything wrong with the info it is just that the ref has expired.

--Doc James (talk) 20:10, 2 October 2008 (UTC)


 * ok, So the guideline that you are using has expired. I'm not clear on what page you want to draw my attention to, and what you want me to do about it.  Sorry--Vannin (talk) 20:38, 2 October 2008 (UTC)


 * I would assume since you practice in canada that you are aware of the CADDRA guidelines Is there something else that you are looking for?--Vannin (talk) 21:52, 2 October 2008 (UTC)


 * Sure --Doc James (talk) 22:14, 7 October 2008 (UTC)


 * See http://pediatrics.aappublications.org/cgi/content/full/108/4/1033/DC2 --Doc James (talk) 21:59, 2 October 2008 (UTC)
 * Yes, and again, what do you want me to do?--Vannin (talk) 22:20, 2 October 2008 (UTC)


 * I don't think he wants you to do anything, just looks like he's bringing the issue to our attention and suggesting we find something more recent. 92.3.127.176 (talk) 12:53, 3 October 2008 (UTC)


 * Thanks - how about the CADDRA guidelines then? Their intro also includes reference to other guidelines as well.  --Vannin (talk) 14:39, 3 October 2008 (UTC)


 * sure --Doc James (talk) 22:14, 7 October 2008 (UTC)

What is with this line?
The protocol for medical and mental health professionals working with issues relating to ADHD is to follow the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association.

The medical profession does NOT follow the DSM as a protocol. Therefore removed. Stuff must be referenced.--Doc James (talk) 20:21, 2 October 2008 (UTC)


 * Sorry JMH - the grammar and typos are making it a little hard for me to understand. what do you mean "the medical profession does not follow the dsm line a protocol"?  Can you rephrase your statement for me, please.   And what "stuff" must be research?  Thanks--Vannin (talk) 20:37, 2 October 2008 (UTC)


 * The medical profession does NOT follow the DSM as a protocol. Therefore removed.  Stuff must be referenced.--Doc James (talk) 20:21, 2 October 2008 (UTC)


 * Ok, the "as" helps here. Could you edit rather than remove?  This is another jargon issue - people inside medicine use "protocol" to mean something specific  but the DSM is the diagnostic manual.  How about "Medical and Mental Health professionals working with issues relating to ADHD use the DSM for diagnostic purposes" (to my mind this does not seem to warrant a reference as it is pretty obvious but if you feel it must have one could you put a cite tag on rather than remove "stuff"? )  Thanks --Vannin (talk) 22:26, 2 October 2008 (UTC)


 * Yes I think that that would be reasonable. Removed the previous as it was no incorrect. --Doc James (talk) 02:20, 3 October 2008 (UTC).

What is with the section: Labels and the DSM: an ongoing process
The first section tells about the DSM. Not pertinent to ADHD.

The second section is about history and doesn't belong in this section of the article.

None of this section really deals with Terminology.

Will edit further.--Doc James (talk) 20:27, 2 October 2008 (UTC)

I would like to bring people attention to: Manual of Style (medicine-related articles)--Doc James (talk) 20:31, 2 October 2008 (UTC)


 * Explaining about the confusion about ADD vs. ADHD, etc. seems to me to be very much a terminology and DSM-related issue. This section could probably benefit from some trimming, but provides useful information. I see no harm in most of it staying. Vaoverland (talk) 20:36, 2 October 2008 (UTC)


 * I've already commented on this and think it would be very helpful. A number of people get quite confused about ADD/ADHD.  --Vannin (talk) 20:42, 2 October 2008 (UTC)


 * Doc James, rather than just simply reverting your blanket deletion, I will give you a chance to respond and see if we can arrive at whatever is best for the article. It is difficult to work with other editors who say "let's discuss it on the Talk page" but then act without doing so themselves. I did note that the MOS for medicine-related article states that they are to be written for the general public and not medical folks. It is a fact that there is a great deal of confusion regarding the various names. A few sentences about the DSM as it applies to this syndrome and all the naming confusion history is certainly pertinet to ADHD, especially if we can clarify it without a lot of words. Thus, I disagree with all 3 of your opinions:  (DSM not pertinent to ADHD, history and doesn't belong in this section, none of this really deals with Terminology). However, if there are errors in what is being said, then let's correct them. Vaoverland (talk) 04:36, 3 October 2008 (UTC)

New approach by contributors
As was suggested, a new attempt at mutual respect and balance by contributors would benefit this article greatly. Along those lines, may I copy for all of our what was said in threads which may get lost in earlier headings? Vaoverland (talk) 06:02, 5 October 2008 (UTC)

"Talking and the assumption of good faith is a start. Really I don't think there is any current contributor who can't be reasoned with. If we can come from the stance that at times we must give ground because our position is weak, then we have headed a long way towards collaborative editing. Focusing on the content instead of the contributor would be another huge step. Civility would be the final cornerstone...and even better yet politeness. Really all we have to do to begin, is to turn the page and start fresh.--scuro (talk) 19:47, 3 October 2008 (UTC)

"Things to think about with regards to ADHD and controversy...some thoughts: scuro (talk) 23:41, 3 October 2008 (UTC)
 * ADHD has mostly been thought of as a childhood disorder.
 * more children are diagnosed with this disorder then any other in the US.
 * medication is the prime treatment because it is immediately effective and therapeutic stimulants are regarded as the safest class of mental health medication.
 * scientology and other segments of society are dogmatically opposed to any medication or even the notion that behaviour can be abnormal.
 * politics also plays into this. Libertarians have positions that oppose entitlements such as paying for the diagnosis of ADHD or treatments with public funds.
 * of all the mental disorders besides perhaps depression, the symptoms of ADHD are not that different from normal behaviour. While a three year old can easily be overly hyper impulsive, and distracted....that is highly unusual in a ten year old. The key to ADHD is impairment. The regular child develops while the ADHD child stalls in development. This creates all sorts of social problems when they interact with their peers or are expected to act at a certain age level.
 * the medical community and scientific community see no real controversy. --

I think the current lead is a balanced and well written as I can recall, perhaps a good start in the right direction, although I believe in the concept that the lead should reflect a summary of content in the sections.

Best wishes to all. Vaoverland (talk) 01:11, 4 October 2008 (UTC)

Why thank you for your input and kindness.--scuro (talk) 12:33, 5 October 2008 (UTC)


 * I think we need some references for these comments and hope you can provide them:


 * therapeutic stimulants are regarded as the safest class of mental health medication.
 * the medical community and scientific community see no real controversy.


 * Scuro do you have a reference saying that the medical community sees no real controversy? Would LOVE to see it.Doc James (talk) 15:30, 6 October 2008 (UTC)


 * when the word controversy is used it conjures up images of those who deny the condition exists at all (a la scientology etc). This is in contrast to the International Consensus Statement on ADHD which has the statement "The views of a handful on nonexpert doctors that ADHD does not exist are contrasted against mainstream scientific views that it does, as if both views had equal merit.  Such attempts at balance give the public the impression that there is a substantial scientific disagreement over whether ADHD is a real medical condition.  In fact, there is no such disagreement"--Vannin (talk) 22:24, 6 October 2008 (UTC)


 * There are people saying ADHD does not exist and not just Scientology. It is funny how the ADHD article links all who do not believe in ADHD with Scientology.  There is controversy around the medications safety, the frequency that ADHD is diagnosed, its cause and method of diagnosis.


 * Here is an article from 34 scientists who disagree with the International Consensus Statement on ADHD http://www.ingentaconnect.com/content/klu/ccfp/2004/00000007/00000001/00481523;jsessionid=b58986937lfgm.alexandra


 * The insults really fly. These discussions are kind of funny to read.  One never hears discussions like this for say stroke, heart disease, or fractured bones.


 * You can not get ride of a controversy just by denying that it exists. There are actually lots of scientist and physicians who disagree about the exsistance of ADHD as per the above ref.  --Doc James (talk) 23:37, 6 October 2008 (UTC)


 * Here is a more accessible copy. http://www.critpsynet.freeuk.com/Acritiqueofconsensus.htm --Doc James (talk) 23:39, 6 October 2008 (UTC)


 * This is what Barkley has to say about "controversy" as reported in the media


 * many other professionals have had the same experiences as my colleagues and I have had in dealing with superficial, biased, or sensational media accounts of ADHD… - conflicting views of ADHD described as if they were some sporting event, with two sides being presented on the issues as if there was nothing but controversy in the professional community over the existence of ADHD, its causes, or its treatment with medication, when nothing could be further from the truth. The International Consensus Statement, … confronts such misrepresentations head on by showing that conclusions about the nature, causes, and management of ADHD … are science-based and shared widely by the clinical scientific community researching ADHD”   in the chapter of his hand book on History  --Vannin (talk) 00:29, 7 October 2008 (UTC)


 * Sami Timimi, the lead author, is way out there, I think you could make a good case that he is fringe viewpoint. You provided a link recently that noted that he was an anti-psychiatry proponent. You can read the critique here. http://www.critpsynet.freeuk.com/Acritiqueofconsensus.htm#Two. All the proponents are listed also. At first glance none of them are notable in the field of ADHD research or hold key positions in national mental health institutions. I'm actually surprised by the citation. We have been extolled to focus on strictly scientific sources and we are given this nonscientific creed as the support that their is controversy within the medical and scientific community. I wonder if anyone in the scientific or medical community took this seriously or was the critique simply ignored? I'd bet it was ignored. You can't have a wikipedian controversy when one side is not notable.--scuro (talk) 03:08, 7 October 2008 (UTC)


 * The article is published in Clinical Child and Family Psychology Review a peer reviewed journal. Please let me know in what journal your refs were published.  http://www.springer.com/psychology/child+&+school+psychology/journal/10567
 * The controversy is NOT fringe. And it is notable.


 * There are peer reviewed publications
 * It is commented on by the US government which says who the controversy involves The controversy involving clinicians, teachers, policymakers, parents, and the media
 * It is commented on by the ecyclopedia britanica


 * Who exactly says that Timimi is way out there and that his view point is fringe? I get the feeling that this is POV.

--Doc James (talk) 14:15, 7 October 2008 (UTC)

Let look at Timimi qualifications:

Sami B Timimi, Consultant Child and Adolescent Psychiatrist Lincolnshire Partnership NHS Trust, Ash Villa, Sleaford, Lincolnshire NG34 8QA

--Doc James (talk) 15:16, 7 October 2008 (UTC)


 * I've already said - Barkley's Handbook - his chapter on history. So I think what we have here is that you asked for a good reference stating that the mainstream medical and science opinion did not feel there was a controversy.  While this can be quite difficult to find in many subjects, in this one, because of the media presentation that there is a controversy, Barkley has quite clearly stated that there is not a controversy about the condition, except among a fringe group.  This is supported by the international consensus which has tons of highly respected researchers signing it, including Johnston from UBC.   You asked for such a statement, and I found it for you.  Interestingly, most of the names on the other article are from the UK, which  has tended to lag a bit here, and also is signed by fewer academics and more people like Timimi who do not have academic positions, and when they do publish tend to be more popular in their writing and less research based.  The media certainly have reported a controversy, and I would not dispute this, particularly around the issue of medication.--Vannin (talk) 19:01, 7 October 2008 (UTC)


 * Yes I have read the consensus statement I definitely agree that there is a group of physicians who believe that there is no controversy among scientist. There is lots of name calling from both sides.  HOW you can say the "UK has tended to lag a bit here" is a strange comment.  ADHD is very American centric.  Europe uses the ICD10 and calls the condition something else.  That is all part of the controversy.


 * But there are many who disagree. It is more of a position statement rather then a consensus.

--Doc James (talk) 19:09, 7 October 2008 (UTC)

Timimi may not even meet the criteria of notability. WP:PEOPLE

A person is presumed to be notable if he or she has been the subject of published[3] secondary source material which is reliable, intellectually independent,[4] and independent of the subject.[5]

* If the depth of coverage is not substantial, then multiple independent sources may be needed to prove notability; trivial coverage of a subject by secondary sources may not be sufficient to establish notability.[6] * Primary sources may be used to support content in an article, but they do not contribute toward proving the notability of a subject.

From what I know of Timimi he is viewed as an antipsychiatrist. He produces content for scientology. http://h11.protectedsite.net/index.cfm/7276. Clearly he is outside of the mainstream, and would not be minority. He is fringe. He is ignored by anyone within the medical or scientific communities. He doesn't fit the bill of minority proponent.--scuro (talk) 03:31, 8 October 2008 (UTC)


 * Were does that say he produced this content for Scientology? Or that he is an adherent to Scientology?  What about his BJP publication or do you only see what you want to see?  First we had just three political science guys.  Then just Timinis?  How did you discredit the other 34 people who signed his BJP publication again?  Oh yes you did some original RESEARCH.  Funny that.  Happy editing.  Doc James (talk) 04:39, 8 October 2008 (UTC)


 * I guess it is entirely possible that Scientology stole Timimi's voice recordings, put them in podcast form on their website, and he is still ignorant of this. I doubt it because his viewpoint is similar to scientology's viewpoint on mental health. Interesting thing about Timimi in the oft quoted BJ Psych article: It's not an article devoted to his viewpoints, rather it's a Debate article. They picked him because he makes a stark contrast, with his "social construct theory", to the mainstream viewpoint. This is not serious peer reviewed scientific literature. Perhaps this tongue in check tidbit within the article gives it away.

''
 * Declaration of interest''


 * E.T. has received menaces from an anti-psychiatry organisation, which may have biased him against their views. He and his department have received fees for lecturing at educational meetings and scientific conferences that had sponsorship from pharmaceutical companies – including Eli Lilly and Janssen-Cilag, who manufacture drugs used in ADHD. He is a lead clinician in a National Health Service trust, so could have an interest in keeping costs of treatment down.


 * Strike off one of the peer reviewed publications.--scuro (talk) 00:37, 10 October 2008 (UTC)


 * "Scuro do you have a reference saying that the medical community sees no real controversy? Would LOVE to see it." Do you mean that virtually everyone in the scientific and medical field doesn't believe that everything about adhd is controversial? It just doesn't work that way. They really don't all get in a room that holds thousands, vote, and make statements. Interestingly enough, you seemed to have trouble finding one credible scientific minority viewpoint that everything about adhd is controversial. Have you given up defending Timimi et al?--scuro (talk) 01:41, 10 October 2008 (UTC)


 * Your turn, where are the good "wiki standard", minority opinion, scientific proponents to these claims?...and please don't cite Timimi.
 * "controversy around the medications safety",
 * "the frequency that ADHD is diagnosed"
 * "its cause" and
 * "method of diagnosis"--scuro (talk) 04:51, 10 October 2008 (UTC)

Controversy
The medical and scientific community do see a controversy. See the references provided in the lead paragraph. And this is the consistent issue. Scuro sees no controversy and does not recognize references that do speak about and recognize this controversy. There are many reasons for the controversy not just the fact that ADHD has a high rate of diagnosis. The rest of these points should be discussed in the section on the controversy however.

--Doc James (talk) 13:44, 6 October 2008 (UTC)


 * Please talk about content instead of contributors. You are putting words in my mouth, and that is not appreciated. To always negatively focus on a particular contributor, is an ad hominem attack. Along with name calling, this will no longer be tolerated. Wiki policy specifically speaks out against this practice.


 * Could you please state which particular references speak of the medical controversy in the first paragraph. The first three references in the article are not references that you put in. Wikipedia states that with every controversy you will have adherents on both sides. Who would be the leaders of minority opinion?--scuro (talk) 16:05, 6 October 2008 (UTC)


 * Scuro I do talk about content well you complain about "ad hominem attacks" The three references are attached to the quote about how controversial ADHD is.Doc James (talk) 16:21, 6 October 2008 (UTC)


 * Well, we can do this playground style. I promise to strictly focus on content if Jmh649 does. Your next entry would be your chance to reciprocate. I will look at your references.--scuro (talk) 02:29, 7 October 2008 (UTC)


 * Doc James, I was hoping that you accept this offer, and we could move forward.--scuro (talk) 15:53, 7 October 2008 (UTC)


 * I always make reference to the literature. Please do the same.  --Doc James (talk) 15:56, 7 October 2008 (UTC)


 * It is not the wiki way to spurn offers of consensus building. We need to work together.--scuro (talk) 16:05, 7 October 2008 (UTC)


 * Then do some work...--Doc James (talk) 03:57, 8 October 2008 (UTC)


 * Are you being funny? The phrase included two words. The second word was, "together". You would do well to read, WP:EQ


 * Here are the first nine points.


 * ''* Assume good faith. Wikipedia works remarkably well based on a policy of nearly complete freedom to edit. People come here to collaborate and write good articles.
 * Remember the Golden Rule: Treat others as you would have them treat you – even if they are new. We were all new once…
 * Be polite, please!
 * Sign and date your posts to talk pages (not articles!), unless you have some excellent reasons not to do so.
 * Work towards agreement.
 * Argue facts, not personalities.
 * Do not ignore questions.
 * Concede a point when you have no response to it, or admit when you disagree based on intuition or taste.
 * Be civil.'' --scuro (talk) 04:12, 8 October 2008 (UTC)


 * Yes that would be great. Thanks you and thanks for agreeing that you disagree based on taste.  I accept your apologies for you being a difficult editor.  Really it was no trouble for me to provide all these excellent references.  I enjoy doing this in my spare time between seeing patients.  I appreciate you coming around.


 * Happy editing my dear fiend :-) --Doc James (talk) 04:33, 8 October 2008 (UTC)

elimination of DSM info in the classification section
The DSM is not a classifier disorders, it is a diagnostic tool. I eliminated DSM4 info from the classification section. The DSM4 info is already in the article in another subsection. --scuro (talk) 12:13, 5 October 2008 (UTC)

unraliable source tag
There are these strange tags. Wondering if we should use them thru out? Have added a couple to the lead. Or is this just becoming WP:LAME :-) Doc James (talk) 14:02, 6 October 2008 (UTC)

I think we can agree that they do not meet the highest standard for a source. On the other hand, the institutions cited are excellent, and as indicated at the village pump, the sources are acceptable. Personally I'd be using that tag for fringe sources, not for sources that don't meet the standard of excellence.--scuro (talk) 15:56, 6 October 2008 (UTC)


 * The village pump did not say that your sources were "excellent". They said that they were usable but if better ones were found that the better ones should be used instead.Doc James (talk) 16:22, 6 October 2008 (UTC)


 * So if they are usable they are not unreliable, so the unreliable tag would not be the most appropriate. --Vannin (talk) 16:48, 6 October 2008 (UTC)


 * I agree with both of you. Better ones can be found but until then I see no reason why the tags are on.--scuro (talk) 02:25, 7 October 2008 (UTC)


 * Doc could you remove the tags?--scuro (talk) 16:06, 7 October 2008 (UTC)


 * Go ahead let remove them all then. --Doc James (talk) 16:13, 7 October 2008 (UTC)


 * What about the rest of the tags?--Doc James (talk) 22:13, 7 October 2008 (UTC)

More on the ADHD controversy
Here is another psychiatrist comments on the controversy. He is with the NHS. D B Double, Consultant Psychiatrist Norfolk and Waveney Mental Health Partnership NHS Trust

I referenced it above but here it is again.

http://bjp.rcpsych.org/cgi/content/full/184/5/453 --Doc James (talk) 14:44, 7 October 2008 (UTC)

I must emphasis that this is not just one physician that has concerns there are many physicians. The controversy is published in peer review psychiatry journals. This makes it a main stream issue. It is not therefore fringe and it definitely has notoriety.

I have also provided references from a meta analysis of all randomized trials of ADHD drug safety by the therapeutics initiative. There are concerns. We need to provide a balanced overview. --Doc James (talk) 14:52, 7 October 2008 (UTC)

To continue I would like to talk about the importance of the impact factor of journals. The above article about the controversial nature of ADHD was published in the BJP (British Journal of Psychiatry which has the highest impact factor of any psychiatric journal. http://bjp.rcpsych.org/cgi/content/full/183/1/1-b

Please reference all comments to the literature!

--Doc James (talk) 14:59, 7 October 2008 (UTC)

There are differences between "concerns" and true controversy as seen by Wikipedia. Wikipedia believes that controversy will have notable proponents on both sides of an issue. Yes I have seen a few dozen names, over time, of Dr.'s who claim that ADHD is controversial. Personally, I ask who are these people? They are not active and/ or notable in the field. Where is the debate between truly respected people in the field? It's not there and if it is, show me. That is the Wikipedian standard that is needed for the claim of minority/ majority controversy. On some very specific issues within everything to do with ADHD, I think you can find this. But instead we have a blanket statement covering all of adhd, in the lead, and I think it should be tempered as do other contributors. As an example we can go back to using the example of childhood BPD. Every criteria stated can be met in spades. --scuro (talk) 03:45, 8 October 2008 (UTC)


 * Read there biographies. Lot are practicing physicians, psychiatrist, and pediatricians at medical institutions that have published in peer reviewed journals.  Even in some of the top journals in the world.  No different then those who are for ADHD and prescribing greater amounts of amphetamines to kids.  Exactly what criteria are met?  --Doc James (talk) 03:56, 8 October 2008 (UTC)

"Exactly what criteria are met"? Why the criteria of what wikipedia thinks is a controversy is, and that is true minority and majority disagreement. I can expand on that, if need be.--scuro (talk) 00:14, 10 October 2008 (UTC)


 * "Here is another psychiatrist comments on the controversy. He is with the NHS. D B Double, Consultant Psychiatrist Norfolk and Waveney Mental Health Partnership NHS Trust. I referenced it above but here it is again. I must emphasis that this is not just one physician that has concerns there are many physicians. The controversy is published in peer review psychiatry journals. This makes it a main stream issue. It is not therefore fringe and it definitely has notoriety. To continue I would like to talk about the importance of the impact factor of journals. The above article about the controversial nature of ADHD was published in the BJP (British Journal of Psychiatry which has the highest impact factor of any psychiatric journal."


 * Pllllleeease. This citation and the way it was framed, is highly questionable. Yes you cited the BJPsych. BUT, what you cited is a letter to the editor. Right beneath that letter is the writer's declaration of interest which states, "he is a member of the Critical Psychiatry Network". As a Dr. you know the difference between peer review literature and letters to the editor. Why waste our time with this sort of stuff? Here is another high quality citation for controversy which seems to be lacking.--scuro (talk) 05:06, 10 October 2008 (UTC)

Vaoverland calls the lead balanced yet it is reverted with out discussion
"I think the current lead is a balanced and well written as I can recall, perhaps a good start in the right direction, although I believe in the concept that the lead should reflect a summary of content in the sections". --Vaoverland

Here we have an experienced editor who comes in and calls the lead balanced yet an editor reverts the lead without discussion. This is not the wiki way nor does it build consensus. --scuro (talk) 16:03, 7 October 2008 (UTC)


 * Please reference the literature. --Doc James (talk) 16:13, 7 October 2008 (UTC)


 * The literature can be referenced. The problem is that there is so much unilateral editing happening that I can't even follow what is happening on the page, let alone look for references. To edit, and disregard the input of several contributors is highly disruptive.--scuro (talk) 21:43, 7 October 2008 (UTC)


 * If you are not able to look for references then do not edit. --Doc James (talk) 22:13, 7 October 2008 (UTC)


 * Doc James, a new and independent contributor called the sentence in the lead balanced, you reverted that sentence unilaterally back to your sentence, without discussion in talk. Next, instead of explaining your actions, instead you talk about me and references. This is totally off topic and avoiding the issue. You are disruptively editing. Explain yourself.--scuro (talk) 02:52, 8 October 2008 (UTC)


 * I didn't revert it. I improved it. He he he :-) --Doc James (talk) 03:51, 8 October 2008 (UTC)


 * I'll be improving it back to it's original state. Reverts will be considered disruptive editing. Comments welcome.--scuro (talk) 04:23, 14 October 2008 (UTC)

define the controversy and who are the adherents of the controversy
What exactly is this controversy? Can someone define exactly what it is? We have many sources which speak to controversy. Is controversy everything to do with ADHD? From my vantage point I just wonder if we are piecing together tidbits of info to make a narrative. Some tidbits being excellent and others poor. If we are, then this could be WP:OR. A true controversy has proponents on both sides of the issue. Take Childhood-Onset Bipolar Disorder. We have highly notable proponents in the field taking very strong viewpoints on that issue. Where is that taking of sides with ADHD, especially in the medical and scientific fields? Yes we have Britanica and a few other sources calling it highly controversial, but why? Is the controversy in the popular media, is it everywhere? Wikipedia always wants attribution of viewpoint. So who are the main proponents and where has this been documented? Using the Childhood onset bpd example - this controversy has clearly been documented by secondary sources--scuro (talk) 16:12, 7 October 2008 (UTC)


 * Please do not repeat yourself. Please read what has been written and read the references provided as above. --Doc James (talk) 16:15, 7 October 2008 (UTC)

This post is a modified post from the, "Labels and the DSM: an ongoing process". It is the last post in that thread and no one responded to it. The issues of recognizable proponents is very important. The issue of defining exactly what the controversy is, is important. The issue attribution is very important. I'd like to hear answers instead of repeated requests for references. To not respond to directly to questions goes against wiki policy.--scuro (talk) 21:57, 7 October 2008 (UTC)

From the WP:UNDUE page.

''From Jimbo Wales, paraphrased from this post from September 2003 on the mailing list:
 * If a viewpoint is in the majority, then it should be easy to substantiate it with reference to commonly accepted reference texts;
 * If a viewpoint is held by a significant minority, then it should be easy to name prominent adherents;
 * If a viewpoint is held by an extremely small (or vastly limited) minority, it does not belong in Wikipedia regardless of whether it is true or not and regardless of whether you can prove it or not, except perhaps in some ancillary article.''

See ref 16 --Doc James (talk) 22:22, 7 October 2008 (UTC)

Ref 16 is a nine year old document. We find on the top of the document this warning, "It is maintained for archival purposes only". I am going to do a lot of assuming, because once again, direct questions are not answered. I assume that the belief that everything to do with ADHD is highly controversial is supported by these proponents as mentioned on the webpage (ref 16). "ADHD has been surrounded by great controversy involving clinicians, teachers, policymakers, parents, and the media. Notwithstanding the outdated notion presented, the sentence doesn't name proponents, it speaks to where the controversy was happening about 10 or more years ago. Who are the proponents of the viewpoint that everything about ADHD is highly controversial today? Is it Sami B Timimi?--scuro (talk) 03:13, 8 October 2008 (UTC)


 * Okay so are you saying all refs older then 8 years shouldn't be used? That get ride of alot.  I think that eliminates the ICD10 the DSM4 and well about half the rest of the article sorry stupid argument.  And no we are NOT going to say in 1999, or 1984 or what have you when for everything.  Yes a lot if not everything to do with ADHD is controversial.  There I answered one for you.  But will you understand the answer?  That is another question.  The proponent were the 34 scientists who signed the critique of ADHD.  The three political scientists, many parant groups,  teachers groups,  a whole bunch of book authors http://www.amazon.com/s/ref=nb_ss_gw?url=search-alias%3Daps&field-keywords=ADHD+controversy&x=0&y=0.


 * Scuro first of all you said all there was was three political science profs now you say there is just Timinis.


 * Why do you not find good references rather then making a pain of your self. There are lots of the pro ADHD references in desperate need of improvement.  They are there for you to find.  And please stop whining. --Doc James (talk) 03:46, 8 October 2008 (UTC)


 * You are putting words in my mouth again. If the document states, it should be used as archival material only, that is a warning that should be heeded. We can't use teachers, policymakers, parents, the media, and clinicians as the proponents of this viewpoint. As noted before they were commented upon because the author, back in 1999, saw that this was were controversy was happening. He wasn't naming proponents.


 * Here is the list of 34 scientists you mentioned as being proponents. ''Ash Villa, Sleaford, Lincolnshire, United Kingdom. Joanna Moncrieff (University College London, London, United Kingdom); Jon Jureidini (Department of Psychiatry, University of Adelaide, Adelaide, Australia); Jonathan Leo (Western University of Health Sciences, Pomona, California); David Cohen (College of Health and Urban Affairs, Florida International University, Miami, Florida); Charles Whitfield (PO Box 420487, Atlanta Georgia); Duncan Double (Norfolk Mental Health Care NHS Trust, Norwich, United Kingdom); Jonathan Bindman (Institute of Psychiatry, London, United Kingdom); Henry Andrews Karon (Michigan State University, East Lansing, Michigan); Brian Kean (Southern Cross University, Australia); Michael McCubbin (Faculty of Nursing Sciences, Laval University, Chemin Sainte-Foy, Quebec, Canada); Begum Miatra (Lower Clapton Child and Family Consultation Service, London, United Kingdom); Loren Mosher (Soteria Associates, 2616 Angell Avenue, San Diego, California); Sue Parry (ADD Watch Hawaii, Honolulu, Hawaii); S DuBose Ravenel (611 Lindsay Street, (Barnet Enfield and Haringay NHS Trust, Chase Farm Hospital, Enfield, United Kingdom); Eia Asen (Marlborough Family Service, Marlborough Place, London, United Kingdom); Pat Bracken (Centre for Citizenship and Community Mental Health, School of Health Studies, University of Bradford, Bradford, United Kingdom); Barry Duncan (8100 Royal Palm Blvd, Suite 108, Coral Springs, Florida); Michaele Dunlap (818 NW 17th Avenue, Portland, Oregon); Albert Galves (Salud Family Health Centers, Fort Lupton, Colorado); Michael Green (4 Martindale Road, London, United Kingdom); Tom Greening (1314Westwood Blvd, Suite 205, Los Angeles, California); Janice Hill (the Overload Network Scotland and England, 58 North Fort Street, Edinburgh, United Kingdom); Rhodri Huws (St. Georges Community Health Centre, Sheffield, United Kingdom); Bertram Suite 102, High Point, North Carolina); Dominick Riccio (International Centre for the Study of Psychiatry and Psychology, 1036 Park Avenue, New York, New York); Richard Shulman (Volunteers in Psychotherapy Inc. 7 South Main Street, West Hartford, Connecticut); Jeanne Stolzer (University of Nebraska, Otto Olsen 205D, Kearney, Nebraska); Phil Thomas (Centre for Citizenship and Community Mental Health, School of Health Studies, University of Bradford, Bradford); Graham Vimpani (Hunter Children’s Heal Network, Wallsend, Australia); Al Wadsworth (Marinoto North Youth Services, Auckland, New Zealand); Dave Walker (Yakama Indian Health Service, Toppenish WA, Yakama Nation Washington); Norbert Wetzel (Princeton Family Institute, Princeton); Rupert White (Banham House, Bodmin Hospital, Bodmin, Cornwall, United Kingdom).''


 * Just taking a quick glance at this list, I doubt many if any of them are scientists, and that would also include Timimi. --scuro (talk) 04:00, 8 October 2008 (UTC)


 * There you go with original research again. YOU I presume have researched all of these fellows and found that none of them are scientist or physicians.  Well done.  Now get that comment published in the BJP and Scuro you can you it.--Doc James (talk) 04:28, 8 October 2008 (UTC)


 * That's only needed if you're making a direct statement in the article, not when discussing if something is accurate or not as an actual source. -- Ned Scott 04:47, 8 October 2008 (UTC)


 * There seems to be some confusion here. Doc James, these are the proponents that you indicated were minority opinion in the scientific field. It was you who claimed they were scientists. I doubt that many, if any of them are scientists. For instance, lets look at Dominick Riccio, of the (International Centre for the Study of Psychiatry and Psychology). The ICSPP is an organization that can't even meet the standard of being notable enough to have a wiki article. Another contributor eliminated the article on this organization because no notable secondary source has ever written about it. The organization is not a scientific organization. It was an organization founded by Peter Breggin who is a noted antipsychiatry advocate. I think you could safely characterize it as an anti-psychiatry organization. For example on the opening page we see that one of lead links is to ADHD FRAUD. http://www.icspp.org/. The article is written by the bombastic critic Fred Baughman.


 * To speed up this process, please list any three of these 34 people whom you know to be active scientists in the field, so we can verify this claim.--scuro (talk) 11:44, 8 October 2008 (UTC)


 * Okay then. We do not have a clearly defined controversy and we do not have wilkipedian acceptable proponents for minority opinion. Changes will be made to the intro to reflect this unless a contributor responds to these issues.--scuro (talk) 04:16, 9 October 2008 (UTC)


 * "Ref 16 is a nine year old document. We find on the top of the document this warning, "It is maintained for archival purposes only". This is not a suitable reference. Nor is the text quoted which is supported by the reference suitable. Both will be eliminated shortly. Input welocme.--scuro (talk) 01:46, 10 October 2008 (UTC)


 * The article from pediatrics is 9 years old and is expired. I brought up this point and no one seems to keen on changing it.  Why the difference with this one?  There seem to be different criteria for evidence you believe is true vs evidence you do not believe is true.

Doc James (talk) 18:25, 10 October 2008 (UTC)


 * Notwithstanding that the website's own warning that the material, "is maintained for archival purposes only", the information has a context. Here is the original line in the link:
 * "ADHD has been surrounded by great controversy involving clinicians, teachers, policymakers, parents, and the media. The range of opinion regarding the validity of ADHD extends from those who do not believe it exists and regard it as a myth, to those who believe that there is genetic and physiological evidence supporting its existence".


 * Here is the snippet current in the lead:
 * "The controversy involving clinicians, teachers, policymakers, parents, and the media with opinions regarding ADHD ranging from those who do not believe it exists to those who believe that there is genetic and physiological basis for the condition".


 * The original writer of the piece was commenting on what was going on at the time. They were observing, they were not identifying proponents. At the time there was the Ritalin trials, PBS's frontline major show featuring debate between clinicians and people like Breggin, policymakers were holding congressional hearings about ADHD, Clinton I believe also got into the debate. The media was very much in the act also. Things are not the same now in the US. The public is no longer focused on this issue as it was then. Nor are the media and politicians.


 * Turn to the new sentence. It is now using controversy in the wikipedian manner. The context is different. The time is different. Who are the minority proponents of this viewpoint? It certainly isn't minority figures, in the wikipedian sense who are: "clinicians, teachers, policymakers, parents, and the media".


 * For these reasons the sentence must change or be deleted. That will be done shortly. Input is welcome.--scuro (talk) 04:45, 14 October 2008 (UTC)


 * Since there are no objections to this line of reasoning I see no reason why the deletion of the sentence should have been reverted. When a POV tag was placed on the sentence I see no reason why it should stripped twice. Would this sort of behaviour not qualify as edit warring?--scuro (talk) 22:44, 3 November 2008 (UTC)

ADHD
ADHD does not appear in ICD-10 - the 		  classificatory system published by the World Health Organisation (WHO, 1992) and the preferred system  		  used in the UK and Europe. In ICD-10 the nearest equivalent diagnosis to ADHD is that of hyperkinetic 		  disorder (HKD). This would be why most of the research comes out of the US.

http://www.adhdtraining.co.uk/about.php

--Doc James (talk) 19:22, 7 October 2008 (UTC)

A little WP:OR thinking might be happening here. Simply because Europe has a different name for hyperactivity, doesn't prove causation between the different terms and a lack of overseas research. Furthermore, ADHD is researched around the world. How do we know that most research occurs in the US. "Most" is kind of a weasel word. Do you mean the "vast majority" by the word "most"?--scuro (talk) 22:09, 7 October 2008 (UTC)

I agree. It is Vannin who was saying that the UK was behind the US in research. I am waiting for a reference making that claim. --Doc James (talk) 22:11, 7 October 2008 (UTC)

Scuro 3
Well it has been fun having this discussion with Scuro, but I must really do some editing. Have added some more info talking about the different issues in the ADHD controversy from a peer reviewed publication and properly formatted. I am not sure many more of Scuro's comments and accusations are worthy of comment. --Doc James (talk) 04:43, 8 October 2008 (UTC)


 * From my perspective it looked like you two were starting to get along, so I'm a bit disappointed to see this comment being made. -- Ned Scott 04:48, 8 October 2008 (UTC)


 * My fellow editor just doesn't recognize evidence. How about the most recent NICE guildlines?

--Doc James (talk) 05:35, 8 October 2008 (UTC)

Content and not the contributor, remember?--scuro (talk) 04:12, 9 October 2008 (UTC)

The controversy continues
Here is a great article about the controversy: http://pn.psychiatryonline.org/cgi/content/full/36/21/20 --Doc James (talk) 05:39, 8 October 2008 (UTC)


 * DJ: Too bad it is already 7 years old. Perhaps it should go in the history section. And the link you provided before this (the 2008 one) requires a paid subscription, which is a Wikipedia no-no, sicne it is not verifiable. Vaoverland (talk) 06:00, 8 October 2008 (UTC)


 * Okay so the cut off for references is now 6 years. Great...  Please show me were it says that paid subscriptions cannot be used?  Anyone can go to the nearest university library and get a copy.

--Doc James (talk) 13:02, 8 October 2008 (UTC)


 * Here is something more recent that talks about the ADHD controversy. It is published by the NHS and is endorsed by the UK government and the UK psychiatrists.  It was published in Sept, 2008.


 * It speaks about all areas of the ADHD controversy and would count as an excellent secondary source.


 * http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf


 * --Doc James (talk) 14:06, 8 October 2008 (UTC)


 * On first glance that does look like a nice secondary source from England no less. There were no subheadings about controversy. It will be interesting to look at it more closely.--scuro (talk) 04:10, 9 October 2008 (UTC)

Controversy over black box warning
There is an interesting controversy over weather or not ADHD meds should contain black box waring. Currently it looks like a number of them do.

http://www.newsinferno.com/archives/1216

From the FDA http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4152b2_01_01_02_Methylphenidate%20AE.pdf

Interesting article from the pharmaceutical literature http://www.pharmaceutical-business-review.com/article_feature.asp?guid=785DCDF6-E511-4BB8-9446-0982965026F7

From the NEJM http://content.nejm.org/cgi/content/full/354/21/2296

USA today http://www.usatoday.com/news/health/2006-02-09-adhd_x.htm

--Doc James (talk) 17:06, 8 October 2008 (UTC)

I've heard different things too. Apparently some drugs carry them others don't. I'm still seeking clarification from a Dr. in the field. He is going to speak to his nurses. --scuro (talk) 04:08, 9 October 2008 (UTC)

I don't live in the states but in contacting two US professionals, both say black box is in use.--scuro (talk) 04:37, 17 October 2008 (UTC)

The black box warning for cardiovascular effects applies to the stimulant medications, i.e. methylphenidate and amphetamine-based drugs. It does not apply to other medications used for ADHD. However, some of the other medications carry other black-box warnings (e.g. atomoxetine has one for suicidal ideation - see http://www.clinicalpsychiatrynews.com/article/PIIS027066440570936X/fulltext). Guacmol (talk) 05:10, 17 October 2008 (UTC)

Article on non prescription use of medications
http://www3.interscience.wiley.com/journal/118739143/abstract?CRETRY=1&SRETRY=0

http://findarticles.com/p/articles/mi_qa5351/is_200606/ai_n21396390/pg_2?tag=artBody;col1

--Doc James (talk) 17:43, 8 October 2008 (UTC)


 * This really is about the drugs themselves and not the disorder though, and should be in a different article. We are starting to confuse the disorder with its treatment.  There already is a good article on treatment, whereas this is the article on the disorder itself.  --Vannin (talk) 18:38, 8 October 2008 (UTC)


 * Yes certainly.--Doc James (talk) 19:01, 8 October 2008 (UTC)

Sorry about that though you were referring to something else. Non prescription use of ADHD drugs is part of the controversy around them. Clarified the previous statement.

--Doc James (talk) 21:21, 8 October 2008 (UTC)

I guess we could add this to the treatment article but it just as equally applies under the controversy section. I do not think the article on treatment talks about drug misuse but still need to read thru it.

Cheers. --Doc James (talk) 21:23, 8 October 2008 (UTC)


 * I think to be consistent with other topics - see for example pain, that we should put the issue of treatment misuse in the treatment article and not in the article on the disorder itself. The misuse of pain medications has a huge cost to society, likely greater than the misuse of ritalin because of the addiction issue, so this is a good example for us to follow.--Vannin (talk) 21:32, 8 October 2008 (UTC)


 * Sure I have moved it to that page. Which has a greater cost to society misuse of pain meds or misuse of stimulants I do not know.  Have you seen research on the cost of both? Both are addictive and schedule 2 drugs.  Amphetamines carry warning to this effect. --Doc James (talk) 13:41, 9 October 2008 (UTC)


 * This is wandering a bit off topic and I think it is a difficult area to research but there is some showing higher rates of misuse of pain meds than stimulants in teens . I was surprised by this much pain med misuse in teens - I've certainly seen pain med misuse in older adults and in medical professionals (but that of course would be anecdotal) --Vannin (talk) 17:56, 9 October 2008 (UTC)


 * "Non prescription use of ADHD drugs is part of the controversy around them". Okay, for controversy in wiki land you need mainstream opinion and minority proponents to be arguing against each other. What exactly is the argument? That abusing drugs is bad? That too many people are abusing drugs? Pretty well everyone can agree to this. They all see the problem. No one side states there is no problem, or...no one should have drugs because of the problem. Enlighten us, specifically define the controversy.--scuro (talk) 05:21, 10 October 2008 (UTC)

sub-articles
The last threads about what belongs in separate sub articles brings to mind my opinion that in the past few weeks, all the edits regarding controversy have just about taken over this entire article, instead of being covered in the sub-article we created specifically several years ago for that purpose. Vaoverland (talk) 21:55, 8 October 2008 (UTC)


 * I was thinking the same thing. -- Ned Scott 03:47, 9 October 2008 (UTC)


 * There are different perspective on ADHD. The NICE guideline discusses this.  The definition of ADHD does not get to be determined by one physcian from the US who claims he is the most important ADHD researcher in the world and that his perspective is the only one that matters.--Doc James (talk) 13:20, 9 October 2008 (UTC)


 * Have moved most of the content about the controversy to the controversies page since this seems to be the opinion of the majority and to maintain consistency with the rest of the article. We also had a fair bit of overlap between the two pages.--Doc James (talk) 13:44, 9 October 2008 (UTC)


 * Controversy should be over here on thi page. Minority opinion belongs on the main page. Fringe opinion belongs on a separate article. What happens with the ADHD controversy article is that every psychiatry hate group webpage is quoted directly and liberally as fact. The page attracts a lot of POV pushers. No one wants to edit it and soon you have a coatrack.--scuro (talk) 05:25, 10 October 2008 (UTC)


 * Actually, judging from the discussion archives, that separate page was at least in part intended as a temporary solution; as a place to hash out the edit-wars about the controversy without disturbing this page, and then when that was done, to bring over (at least a summary of) the controversy content here to the main page. Funny how that hasn't worked out yet, eh?CRConrad (talk) 13:12, 17 October 2008 (UTC)

medcab started
See top of talk page. I've had enough of behaviour that is highly disruptive on this talk page and article.--scuro (talk) 03:49, 9 October 2008 (UTC)

more tags removed unilaterally without talk
Jmh removed a balance tag from the intro again without any discussion in talk before or after the deletion.--scuro (talk) 04:19, 9 October 2008 (UTC)


 * This was discussed above and we agreed these tags should be removed.--Doc James (talk) 13:28, 9 October 2008 (UTC)


 * we discussed the unreliable source tag not the balance tag--Vannin (talk) 19:40, 9 October 2008 (UTC)


 * Yes exactly, Jmh, can you put those tags back on please?--scuro (talk) 23:07, 9 October 2008 (UTC)

unilaterally stripped links
''
 * Current research indicates that up to 60% of children with ADHD carry their symptoms into adulthood.  - stripped by Jmh649 Oct 9/08--scuro (talk) 01:08, 10 October 2008 (UTC)
 * '' - Stripped by Jmh649 Oct 9/089--scuro (talk) 01:12, 10 October 2008 (UTC)


 * Yes I stripped it. Why because it link to a pharmaceutical company page that said nothing about what it refered to.  Look at the ref.  The second one said the oposite of what it was referenced to.  --Doc James (talk) 01:46, 10 October 2008 (UTC)


 * the alternative is to take the reference out and put a cite tag on.--Vannin (talk) 01:49, 10 October 2008 (UTC)


 * There always is the possibility that one can be wrong in one's assumptions. Stripping the citation might not have any justification. For instance I've already commented on why false logic was used in assuming the second citation was not suitable. Declaring first on the talk page what you intend to do, allows for other editors to offer feedback. That would be the civil thing to do in a community. Best would be to put a unsuitable tag on the reference with comment, editors would have a chance to find another citation that is more suitable. This approach is far better when one knows that several editors are unhappy with your editing style.--scuro (talk) 01:57, 10 October 2008 (UTC)

undue weight issues with the controversy section
This section is far too large for a controversy section that already has it's own article. A fair bit of material is duplicated on both articles. I will attempt to summarize and shrink this section shortly. Input welcome.--scuro (talk) 01:28, 10 October 2008 (UTC)

Recent chaos and editing is not in sync with the spirit of WP
I fear we are heading for administrator intervention with the chaos in this article edit process unless there are some changes more in sync with the spirit of WP. I see several major areas to consider:
 * 1. Deleting the work of others - I would like to suggest that we (any of us) NOT remove something which is not properly cited UNLESS it is clearly incorrect. The correct protocol is to request verification and place a flag if you have reason to doubt. That alerts our readers that there may be a question or issue about veracity. Newer editors may not be aware that over the past few years, we have been raising the bar for credibility of Wikipedia content, and the criteria for citing sources has changed and is now a moving target. However, those of us who have been working to build Wikipedia for years know that a lot of content predates that change. Statements may have been placed in good faith and accurate, although it may not meet the newer source standards and/or may have come from now-dead links. If I may suggest as a good rule of thumb: "Easy does it on wiping out the work of others." Remember, you can easily ADD to the article(s) and point out opposing views or stats.
 * 2. Structure of article(s) - On a complex subject, such as this, Wikipedia MOS is organized to function much like an outline. (REMEMBER: Some users around the world have hardware/software which cannot process exceptionally long articles). WE HAVE LOST THAT STRUCTURE CURRENTLY. What is happening now I think is that, whether they realize it or not, editors with differing viewpoints are vying to present their position in the most prominent places, lead and sections respectively and deemphasize anything they are in conflict with.
 * a. Lead vs. sections - The lead should be a summary of the content of article sections and sub articles. The lead needs to be brief and balanced. On a subject as broad as this one, there should be NOTHING in the lead that isn't covered in sections and sub articles.
 * b. Sections in main article vs. sub articles - The section topics which have sub articles should only briefly refer to major points and leave details to the sub articles.
 * c. Sub articles - This is the place where there is room to go into details about a specific aspect of the main article. Differing POVs are fine, so long as presented honestly and reasonably balanced.
 * 3. Not just a single controversy; more complex - In 5 years of experience working on this article and related ones, I have come to realize that there is no single major controversy or aspect of disagreement. Rather, it is more complex because there are MANY aspects in which professionals and others differ. Whether each rises to the level of "controversy" may be hard to quantify. Fortunately, we have space on WP to elaborate quiet a bit in the sub articles. As long as we clearly articulate that we are presenting positions and opinions from sources which are not in agreement with each other, our readers can ferret out their own conclusions.
 * 4. "My Way" and POV editing - In reviewing edits over the past 60-90 days, it is clear to me that some of the current editors have come to their own strong opinions and conclusions about some of the controversial aspects, and whether they realize it or not, may be using the article as a vehicle to present their positions and discredit or deemphasize others. Not only in structure, but in total, the article is presently not balanced, largely due to deletions.
 * 5. Consider Wikipedia Readers - Remember, despite collaboration, we are not writing for other Wikipedia editors, nor solely for medical professionals. Wikipedia is NOT a medical journal for physicians. It is also to offer a wolrdwide perspective whenever possible and/or balance of differences. This article and sub articles should provide a non-medical level understanding and include the presentation of variations around the world. As an example, editor recently decided to unilaterally remove the explanation about the DSM terminology and its chaotic history (which is still widely used in the US). In its place, he prefers that the article present a different format, which may well be more recent, accurate and in preferred use in some places. My point isn't that the DSM method is better (it almost certainly isn't), but rather, that it is has and is being used widely and is still relevant to many, and not just as an item of history, at least yet. That makes understanding it meaningful to many Wikipedia readers. We have the opportunity to clarify what all the DSM jargon means, a subject of a lot of confusion. BOTTOM LINE: We shouldn't eliminate discussing it at all just because others have come up with what may well be a better system. Instead, include information on both, and make that point. If the newer stuff from NICE and Canada is better, let's elaborate and explain why, not simply delete what is bing done not as well elsewhere.

To summarize, participants in editing this article need to focus additional priorities on following WP MOS structure guidelines, respect of other editors, and remember: The good of Wikipedia as a whole is more important than any of us winning conflicts with each other as individual editors. Frankly, it would be encouraging to see some good faith along the lines I have set forth above. If you disagree or have additional thoughts or comments, please be sure express yourself here as we are being monitored to see if we can get back on a steady course with all this. Assuming all are in good faith, Thank you.
 * Vaoverland (talk) 05:12, 10 October 2008 (UTC)


 * You have made many excellent points. Thank you for taking the time to write that. I am now "telegraphing" all future edits on the article first in talk. This gives all a chance to comment before the edit is done. It might not be a bad way for us all to go in this current environment. The editing is currently chaotic and manic. If we could only all work together on a common purpose, a specific goal, a great article could be written.--scuro (talk) 05:57, 10 October 2008 (UTC)

Thanks. I am keeping the CAB updated as well, and just updated again. I hope we can get back on track. Please read my user page if want to understand more about my priorities and dedication to Wikipedia. Vaoverland (talk) 06:20, 10 October 2008 (UTC)


 * This is really good and brings us back to the big picture. Thank-you--Vannin (talk) 16:31, 10 October 2008 (UTC)


 * Also I support the idea of telegraphing future edits. We are beginning to go around in circles - see the removal of the term "neurobehavioural" in favour of "behavioural" and then the reinstatement of neurobehavioural and now the removal of behavioural.  Discussion and collaboration may help to avoid this by reducing hasty chopping of material.--Vannin (talk) 17:49, 10 October 2008 (UTC)


 * We could be making great progress if Doc James would also agree. How about it?--scuro (talk) 20:55, 13 October 2008 (UTC)


 * From a newly-arrived outsider's perspective, after going through a bit of the history of this Talk page, it seems rather obvious what the problem is. CRConrad (talk) 13:25, 17 October 2008 (UTC)

editorializing statement needs to be removed-pov pushing
"The controversy is discussed in depth in the Sept. 2008 UK publication of the NICE guidelines on ADHD. " This document does not focus on controversy or even has a subsection on controversy. It is a guideline document about ADHD. The contributor who posted this statement is editorializing. It will be removed shortly. Input is welcome.--scuro (talk) 05:46, 10 October 2008 (UTC)
 * I have read through the DRAFT copy of it (huge) and generally agree with you. Perhaps we are losing it in terminology here. The NICE guidelines address some of the many issues which some consider controversial and takes positions on some. However, it really doesn't cover them thoroughly or as an outline of the controversies. It simply states the conclusion these professionals have reached. Vaoverland (talk) 05:55, 10 October 2008 (UTC)

This NICE document focuses on ADHD but also speaks about the controversial aspects of it. I do not think we need to have sources that focus on the controversy of ADHD. This one doesn't have a subsection about the controversial aspects of ADHD, it discusses the controversy thru out the text. This is in fact what we should be doing. The NICE guidelines treat alternate view as an intergral part of the discussion rather then trying to box the controversial in a seperate section or article.

Yes it is three hundred pages long but it is comprehensive, recently published, and from a well respected source. A length of a reference does not determine its worth. The references I used from this guideline are basically direct quotes from the article. Therefore you want to remove it? I think it is important to present a balanced picture of ADHD. One needs to also explain how it might be viewed differently in different parts of the world from groups other then drug companies and those supported by them.

This brings me to my next point. Some editors have tried to discredit those who have differing views on ADHD from their own. These editors often preface there quotes by saying the ref is a member of antipsychiatry or are members or scientology. In science one discusses ideas rather then hurals insults. Barkleys get lots of funding from drug companies but one does not write "Barkley well know to receive large amounts of funding from the ADHD drug manufacturer says that ADHD is chronic". Then why is it okay to try to discredit all people who have a differing view to his?

Doc James (talk) 14:07, 10 October 2008 (UTC)


 * Response to point 1 - "The controversy is discussed in depth ".- how do we know this about the NICE article? Because you say so? Are you citable? It is editorializing plain and simple. I want to remove your personal opinion of what the article is all about, and not any text from NICE. I do not question the source.


 * Response to point 2 - I agreed with you before, in that controversial items should be directly inserted into the main article and the controversy page should be deleted. If you want both articles, then really you can't expect to get major space about controversy. That would be better handled allowing the reader to see all controversy together on a separate page.


 * Response to point 3 - I am not discrediting your viewpoint. I am merely questioning citations which you claim to be of the highest quality. As you have claimed drug company citations are obviously biased, would you also not concur that Scientology with it's war on anything Psychiatry, and anti-psychiatry viewpoints such as mental illness does not exist, is biased, or at least fringe opinion? See the difference, it's not your viewpoint, it's the source. You can't have your cake and eat it too by banning only the citations you don't like. The difference also being that I try very hard not to make this personal and steer away from name calling and smear tactics. The difference further being that if I did such a thing, and you called me on it, I would apologize.


 * Response to point 4 - Barkley is clearly a leader in the field. Unlike your individual sources he has been researching in the field of ADHD for over 30 years. This is what experts do, they research, talk to others in the field, build a body of evidence, and form theories. They don't cherry pick info to create WP:OR papers.--scuro (talk) 02:49, 11 October 2008 (UTC)


 * Since the statement is a contributors opinion which can't be suorced, it will be removed shortly.--scuro (talk) 11:56, 13 October 2008 (UTC)

More balanced
I think this article is currently much more balanced and well rounded then it once was. Before it presented only one view point and there were some editors who tried to and still try to keep it all one sided.

For example there were no comments on the side effects of ADHD drug ( a point supported by documents from the FDA ), the lack of evidence for long term effectiveness and safety ( a point which is supported by a resent meta analysis ), concerns over use of drugs in pre schools was not addressed ( a point supported by a UK guideline ).

This provides balance and context for the statements such as ADHD med are the most effective treatment for ADHD ( this from the peads guideline that is now expired ). Alternative theories of the cause are now below and of shorter lenght then the majority opinion but are now present in the same section. These are all posite changes.

There is still work to better summerize the article on the controverial aspects of ADHD. My preference would be to see this combined into the main parts of the article but it seems to be the wish of the majority of editors to have a seperate article about the controversy. I have worked to move the content in this direction.

Here is another source it is not peer reviewed but does provide some interesting perspective from a physician.

http://www.netdoctor.co.uk/adhd/whyisadhdcontroversial.htm

--Doc James (talk) 18:17, 10 October 2008 (UTC)

"Before it presented only one view point and there were some editors who tried to and still try to keep it all one sided." Can you only make your points by taring others? Your example is bogus because the examples you speak of were in the subarticles. I wrote the section on pre-school drug use. This angers me when you use swift boating tactics. You knew all this because we have had this discussion before. Is this a meaningful attempt at communication?--scuro (talk) 22:46, 10 October 2008 (UTC)

Evidence
I think the main difficulty we are having is with evidence. It seems that certain ideas are being held to a much higher quality of evidence then other ideas. And even when these much higher quality evidence is provided it is doubted.

We have Dr. Barkley's official website. It is from an expert in the field however is not peer reviewed and is not published. I am not saying we cannot use this but when we take a journal article from another expert who might not share his point of view it has gotten covered in tags. So the best quality evidence available a recent systematic review of the evidence published in a government supported guideline is used and it still draws complaints.

Next we have a page http://www.loni.ucla.edu/Research/Projects/ADHD.shtml#CurrentResearch. This is put out by a laboratory of neruo imaging. I am not saying it cannot be used. Others however have made this complaint during the last GA review, please see above. This is not a peer reviewed source and if something of this quality was used to support other ideas it would be picked to pieces as it probably should be.

I think we really need to concentrate on portraying the ideas of researches in the main part of this page and we need to concentrate on using good source. I am not against ADHD or drug treatment as some above have implied. I have removed no material that has been well sourced. Everyone however agrees that there are side effects to treatment just as there are problems with not treating. We need to provide what is known and no known about both option.

Doc James (talk) 18:40, 10 October 2008 (UTC)


 * Oh, I'd say the main problem is not working together, not using talk as it should be used, and unilateral editing.


 * We have talked about the citation issue and have gone to village pump for answers. The citations you mention above are usable, although not the best citations possible. If Barkley's personal website bothers you why not use his online web course. http://www.continuingedcourses.net/active/courses/course003.php In effect this is an online text book of sorts. Better yet the course is certified by the association of social work boards, the american psychological association, the California board of Behavioural sciences. If there are other experts certainly we can look at them. But as far as poor references go, why offer the Double's letter to the editor as justifying controversy? He is a member of the Critical Psychiatry Network which has viewpoints like' "lets scrap schizophrenia". Honestly, that is fringe and several notches below the citations you felt were of questionable quality.


 * I certainly agree that two sides of a story is the wiki way to go, but that has to fall under wiki guidelines of undue weight and fringe sources. Just as important is that we don't sift info, looking to make points which are not generally held to be mainstream or minority viewpoints. Even reviews are not like the ten commandments, or god given. They are static in a moment of time and varying in quality. That is what talk is for, to deal with such issues and vet things out in a civil and collaborative way. Not every issue is black and white and sometimes you have to define grey. Really, the above ideas were not at all the approach that was used in the past. The door is always open until it is shut. Here is to new beginnings.--scuro (talk) 21:22, 10 October 2008 (UTC)


 * Somehow I do not think we will ever agree. If we cannot agree on what constitutes good evidence and some editors are unable to follow Reliable sources (medicine-related articles) it makes it difficult to discuss things.  Doc James (talk) 22:11, 10 October 2008 (UTC)


 * In drama when one improvises, there is a rule. The rule is never block. Phrases such as, "I do not think we will ever agree", is a block. The discussion ends with that phrase. Close one door and more doors will be closed. Be open and things will open up. Where is the disagreement about the hierarchy of evidence? Do you not agree with what was said at the village pump? --scuro (talk) 22:30, 10 October 2008 (UTC)

tags and their removal
In the past we have had several tags removed by an editor without discussion in talk. I was involved in a medcab where this practice was seen as unacceptable. If a contributor believes there are issues with an article, no one should unilaterally remove them, especially when such an editor also edit wars to block other editors from making changes to text. That is a serious case of POV pushing. I've put a tag on the controversial paragraph in the lead. There are several issues with this section and readers should know that this community does not fully accept the version posted on the article.--scuro (talk) 21:11, 13 October 2008 (UTC)

tag added to controversy section
This section is unbalanced. Tag to be added.--scuro (talk) 21:12, 13 October 2008 (UTC)

Russell Barkley you tube talk on ADHD and future of DSM5
Thought this might be of interest. http://www.youtube.com/watch?v=q3d1SwUXMc0&eurl=http://www.addforums.com/forums/showthread.php?t=58570 --scuro (talk) 11:41, 17 October 2008 (UTC)

genetics section of article
Has been stripped of large sections of content. This will be rectified shortly. Input welcome.--scuro (talk) 11:49, 23 October 2008 (UTC)

Fringe theories of causes
To be moved out of causes and mentioned in controversy section. This will be done shortly. Input welcome.--scuro (talk) 11:51, 23 October 2008 (UTC)


 * I think this is a bad idea. One of the "fringe" ideas is supported by an article by the NHS.  Therefore returned.--Doc James (talk) 10:50, 29 October 2008 (UTC)


 * I have yet to see the link. Revert is in order without the link.--scuro (talk) 22:28, 3 November 2008 (UTC)


 * Try looked at it then the references are right there.--Doc James (talk) 22:40, 3 November 2008 (UTC)
 * James, I did look, you are blocking communication.--scuro (talk) 03:42, 4 November 2008 (UTC)

landmark Zametkin image states nothing in the caption
First Thomas Armstrong has no expertise in the field of PET scans so his opinion is not noteworthy for a caption. This citation will be removed shortly. We see no mention why this image is considered part of a landmark study. The caption ends with this quote, "the significance of the research by Dr. Alan Zametkin that produced these images is still not definitive". While this may be true the reader should at least know why it is considered a landmark study. I will be editing this section shortly. Input welcome.--scuro (talk) 04:17, 24 October 2008 (UTC)

Manual of style for medical disorders
http://en.wikipedia.org/wiki/Wikipedia:MEDMOS#Diseases.2Fdisorders.2Fsyndromes I'll be reordering the sections of the article shortly to follow this standard. Extraneous material will be removed. Input welcome as is assistance.--scuro (talk) 04:33, 24 October 2008 (UTC)

elimination of fringe wiki links in "see also' section of the article
The anti psychiatry Biopsychiatry links are fringe opinion and consequently do not meet the criteria of wiki controversy. They should be removed. Input welcome. --scuro (talk) 04:44, 24 October 2008 (UTC)


 * Both have well referenced pages on wikipedia and apply to this topic.--Doc James (talk) 11:09, 29 October 2008 (UTC)


 * Simply because a topic can be referenced and has a wiki page, doesn't mean that the viewpoint isn't fringe.--scuro (talk) 19:35, 29 October 2008 (UTC)

mediation cabal and moving forward
James, you have been requested at the mediation cabal here -> http://en.wikipedia.org/wiki/Wikipedia:Mediation_Cabal/Cases/2008-10-09_Attention-deficit_hyperactivity_disorder

This sentence,"ADHD is one of the most controversial psychiatric disorders", was seen by a separate editor as not being balanced. A new sentence was created which this editor was pleased with. ( see "new approach by contributors" in talk )The continued reverting back to a previous version, with no prior discussion in talk, is disruptive editing. James your cooperation is requested to solve such issues. I welcome you to join the mediation cabal so that we can move forward.--scuro (talk) 16:09, 24 October 2008 (UTC)
 * Please do :-) (I'm the mediator)... I know you have your reasons, so it's best we talk about them :-) Xavexgoem (talk) 18:02, 24 October 2008 (UTC)


 * Ditto. I am not engaging in what seems to be potentially an edit war, for this very reason. Doc, please come to the table. Thanks, Vaoverland (talk) 09:41, 25 October 2008 (UTC)


 * James, compromise is always possible and I consider Vaoverland to be a contributor who is conciliatory but more importantly considerate. He would be willing to hear what you have to say about the controversy section in the lead, as would I. An independent administrator is also willing to hear what you have to say and I am certain that they would fully consider your point of view. James, reverting a section where at least two other editors disagree with you, and making no attempt to communicate in talk is disruptive and takes on the appearance of edit waring. I would kindly ask you to become familiar withWP:RFM and WP:ARB. Your cooperation is requested. --scuro (talk) 13:33, 26 October 2008 (UTC)


 * I happy to discuss things. We can go thru the issues point by point. --Doc James (talk) 20:01, 28 October 2008 (UTC)


 * How about "telegraphing" your edits as I have done. That would be really appreciated and go a long way in establishing a collaborative partnership.--scuro (talk) 19:37, 29 October 2008 (UTC)

I leave for two years and it all goes to Hell. ;-)
Hi guys, long time no chat. For those who are new, or just don't remember me, I used to be a frequent editor for this article. On two separate occasions I went through and did a full rewrite of the entire article. Didn't change any facts, just reworded and organized the information. I was about to start on a third rewrite when I noticed all the controversy. So I'll lay off for now. Anyway I just wanted to poke my head and say hello again.--*Kat* (talk) 13:39, 25 October 2008 (UTC)

I remember you. Welcome back. --scuro (talk) 15:28, 25 October 2008 (UTC)

Any "global" thoughts on change? No reason we can't move forward, especially if a number of good editors are on the same page. --scuro (talk) 22:56, 25 October 2008 (UTC)
 * I'd like to see the subsections be expanded. With few exceptions they are extremely brief.  I'd also like to see a more global viewpoint in this article.  A section on international attitudes towards ADHD might be in order as well.--*Kat* (talk) 07:05, 26 October 2008 (UTC)

Welcome back, Kat. Vaoverland (talk) 07:46, 26 October 2008 (UTC)
 * Thanks, Vaoverland --*Kat* (talk) 13:17, 26 October 2008 (UTC)

Alternative Theories
Doc James requested that we discuss the issue of Alternative Theories.

Myself, I agree that they do have their place in this article. However I'd like to see those subsections fleshed out and include points about how these are (if I recall correctly) views held by the minority. (Note to James: Citations are not required on talk pages. ;-) --*Kat* (talk) 11:17, 29 October 2008 (UTC)


 * Yes we do need to determine who and how extensively these views are held. However they are more then fringe as they are backed up by lots of published data including the most recent article by the National Institute of Health.--Doc James (talk) 11:33, 29 October 2008 (UTC)

However just deleting them as Scuro did should not be done.--Doc James (talk) 11:49, 29 October 2008 (UTC)


 * The farmer hunter theory is backed up by the NIH?!??? That one is an extraordinary claim and I'd like to see a citation. The theories were simply moved to the society and cultural section except for the social construct theory which believes that ADHD does not exist. That is fringe viewpoint. --scuro (talk) 19:26, 29 October 2008 (UTC)


 * Yes please do. Try reading.--Doc James (talk) 04:23, 30 October 2008 (UTC)
 * Honestly James, can we try to be a little more helpful and provide a link?--scuro (talk) 05:21, 30 October 2008 (UTC)
 * Link still not provided.--scuro (talk) 22:27, 3 November 2008 (UTC)


 * Dear Scuro it is not another editors job to answer every silly WP:LAME question brought up by another editor. You need to start reading the references to quoted text.--Doc James (talk) 22:42, 3 November 2008 (UTC)
 * Wikipida asks us to answer all questions. You have stated that my questions are lame several times. Each time though, these concerns have been found to be well grounded. As can most recently be seen here in your mediation cabal. http://en.wikipedia.org/wiki/Wikipedia:Mediation_Cabal/Cases/2008-10-09_Attention-deficit_hyperactivity_disorder#Lets_resolve_one_issue_and_go_from_there So let your words stand on their own merit, and back them up when called upon to do so.--scuro (talk) 03:36, 4 November 2008 (UTC)

Reverting of edits
Next lets discuss the line "A minority of professionals consider ADHD to be a controversial pediatric disorder"

This statement is unreferenced and a weasel word. Scuro keeps reinserting it. Do others have opinions on this.

How about the line "In the US, in 1999 ADHD was a considered a controversial issue." We have not done this to all other points in the article so why to this one? We do not say were the idea comes from or the year it was published well at the same time removing the reference to it as Scuro has done.

Thanks--Doc James (talk) 11:49, 29 October 2008 (UTC)

Wikipedia asks that we attribute controversy which I did. If you believe that a majority of the scientific and medical professionals of this world believe that ADHD is a controversial disorder then it would be up to you to provide a citation of this. Minority is not a weasel word it quantifies. In reality I think minority is a bit generous because the number of scientific and medical bodies and experts in the field that hold this view could be counted on a hand...perhaps two. I used year 1999 to attribute the controversy. It used to a highly contentious issue in the US with congressional hearings, much media coverage, and lawsuits. All of that has fallen away. Using a time frame is more accurate and gives the reader more information. --scuro (talk) 19:33, 29 October 2008 (UTC)

As ADHD is included in the DSM-IV, this by definition would imply that it is considered to be a valid diagnosable condition by the majority of American psychiatrists. Similarly, the fact that the ICD-10 lists hyperkinetic disorder implies strongly that there is a strong international majority in favor of this as a real condition. To the extent that any real controversy exists, it is between the diagnostic criteria listed in the DSM-IV and the ICD-10. The ICD-10 seems to focus far more on the hyperactive components of the disorder than the DSM currently does, which reflects a viewpoint that was more common in the US in the past. Now, this could indicate either that the DSM has cast too broad a net in terms of diagnostic criteria, or (more likely in my opinion) that the DSM has expanded diagnostic criteria to focus on both the inattentive and hyperactive components equally based upon more recent evidence. Furthermore, the fact that ADHD-combined type is a far more common diagnosis than either ADHD-Hyperactive-Impulsive or ADHD-Predominantly Inattentive lends credence to the viewpoint that both inattention and hyperactivity tend to be symptoms of the disorder. Early interest in ADHD did focus mostly on the hyperactive symptoms at least partly because hyperactive symptoms are more noticeable and easier to quantify. Furthermore, the fact that the same medications tend to work on both sets of symptoms implies a similar (or at least related) aetiology.

However, the basic point I am trying to make is that the fact that ADHD is included in the DSM-IV and is recognized as a valid diagnosable condition by American Psychiatric Association, the American Psychological Association, the American Academy of Pediatricians, and the American Academy of Neurology strongly implies that a majority of professionals do not seem to consider it a controversial disorder. Hyperion35 (talk) 14:04, 18 November 2008 (UTC)

Who sees ADHD as controversial.
Well I have decided to start a list of all the groups who view ADHD as a controversial condition. Feel free to add in.

Here is a paper from the World Health Organization from 2004. http://www.euro.who.int/document/MNH/ebrief14.pdf

Here is a paper that describes it as most controversial: http://www3.interscience.wiley.com/journal/63002582/abstract?CRETRY=1&SRETRY=0

--Doc James (talk) 10:54, 30 October 2008 (UTC)

adhd
this is very biased. it is saying people can't live with adhd and it is a huge impairment and disability! that is incorrect. i have adhd and i am fine!


 * Dear editor. If you are "fine" then you do not have ADHD.  Or have out grow ADHD.  Or it have resolved.  This is often not something that stays with people forever.  Please read the page about how controversial the diagnosis is.  If you are having no problems then I would recommend you discuss your diagnosis with your doctor.  Mistakes are often made.

--Doc James (talk) 22:32, 30 October 2008 (UTC)

No impairment, no disorder. It's as simple as that.--scuro (talk) 16:01, 31 October 2008 (UTC)

Indeed, true scuro. However he may saying hes fine because he has learnt to cope and is sucessful avoiding situations say where it is a problem. I think you are very keen to critise, look further and don't ridicule what he is saying unless you know his exact case, which I am damn sure you don't. Jatos (talk) 00:49, 20 November 2008 (UTC)

Neurological disease
I have come across a few papers says that ADHD is not a neurological disease. I am wondering if we should remove the neuro part from the lead sentence? The NICE guildline specifically says: "Nevertheless, the disorder remains one that is defined at a behavioural level, and its presence does not imply a neurological disease."

--Doc James (talk) 12:35, 31 October 2008 (UTC)

ADHD is not a disease, it is a disorder. Hence the term Attention Deficit Hyperactivity Disorder. To call it a disease is a mistake in terminology and perhaps the NICE draft has overlooked this. Could you kindly provide the page number to the quote you posted. The document is about 300 pages long and you would save me a lot of time. Thanks!--scuro (talk) 16:00, 31 October 2008 (UTC)


 * Thats what the reference says. ADHD IS a disorder and is NOT a neurological disease.  Just do a search on the PDF file.  What is in the quotes is a direct cut and past.  Doc James (talk) 20:37, 31 October 2008 (UTC)


 * This one is obvious. I agree with what NICE states. If you have ADHD you do not have disease.--scuro (talk) 12:23, 2 November 2008 (UTC)

Is the quetion whether it is a disease (clearly not, it is a disorder) or whether it is neurological? Clearly there is a wealth of peer-reviewed, published data using functional neuroimaging procedures such as PET and SPECT scans to indicate neurological differences in individuals with ADHD as compared to those without the disorder. These differences appear to involve regions of the brain where, in non-ADHD individuals, activity is often correlated with various functions that are lacking in ADHD individuals. This further implies that these findings are clinically relevant. Where "controversy" exists in this area, it is in regards to issues such as whether the lower levels of neurological activity are due to excess dopamine uptake or a abnormally low levels of presynaptic vesicular dopamine and, if so, what the cause is for that.

Besides, all behavior is neurological in origin, just ask any good primatologist and they'll be happy to explain how most of our social behaviors aren't much different from those of chimps...ie neurological responses to stimuli developed and passed on genetically via natural selection. Hyperion35 (talk) 14:18, 18 November 2008 (UTC)

Safety
Currently there is a study underway by the FDA looking at CV safety of ADHD drugs. They are doing this as CV safety is not verified:

From NICE "Consequently, the FDA has initiated a large-scale study to investigate the association of sudden death and ADHD treatment, which was still on-going when this guideline was being prepared in 2007."

Amoxitine also has concerns:

On 15 September 2005 the Medicines and Healthcare Products Regulatory Agency (MHRA) was informed by the marketing authorisation holder for atomoxetine (Eli Lilly) that clinical trial data had identified a statistically significant increased risk of suicidal thoughts with atomoxetine compared with placebo in children with ADHD. On discussion with the CSM it was agreed that these new data warranted a full risk–benefit evaluation of atomoxetine in its licensed indications, particularly in light of previous concerns about its safety profile including serious hepatic reactions and seizures.

So I think are discussion of safety warrants more then just a blanket statement that they are safe.

Doc James (talk) 12:54, 31 October 2008 (UTC)

Here is more

The Pharmacovigilance Working Party of the Committee for Medicinal Products for Human Use (CHMP) considered safety of atomoxetine in January 2006 and advised that the overall balance of risks and benefits of atomoxetine remained positive in its licensed indication but recommended that the amendments to the product information included the potential risk of seizures and QT prolongation.

--Doc James (talk) 12:54, 31 October 2008 (UTC)

Barkelys in 2000 said there is no studies on long term safety. http://books.google.com/books?id=KStJo6hRS48C&pg=PA281&dq=long+term+safety+of+stimulant+medication&ei=6YILSdOaN4W-tgOEscyhBQ

--Doc James (talk) 22:16, 31 October 2008 (UTC)


 * James if you could put this stuff into layman's terms, I'd really appreciate it. For example, I know Atomoxetine is Strattera and IIRC (If I recall correctly) hepatic is another name for the liver and QT has something to do with the heart, but I don't really understand what is meant by QT prolongation or what CV stands for.--*Kat* (talk) 13:22, 31 October 2008 (UTC)


 * Yeh sure. QT prolongation is an electrical abnormality of the heart detected by a test called an ECG or EKG depending on were you are from.  It is a risk factor for sudden cardiac death.  CV is the short form for cardiovascular.  Aromoxetine is the only none stimulant ADHD drug.  These are direct copy and pastes from the NICE guideline.

Doc James (talk) 20:33, 31 October 2008 (UTC)

'' "Barkelys in 2000 said there is no studies on long term safety". '' http://books.google.com/books?id=KStJo6hRS48C&pg=PA281&dq=long+term+safety+of+stimulant+medication&ei=6YILSdOaN4W-tgOEscyhBQ The link provided by James states exactly why there have been no long term studies. Barkley states it's about ethics.--scuro (talk) 12:14, 3 November 2008 (UTC)


 * Here is an interesting quote from the most recent safety studies. ADHD studies “have major

methodological deficiencies which are compounded by their restriction to school-age children, relatively short follow- up, and few data on adverse effects.”

--Doc James (talk) 15:52, 3 November 2008 (UTC)

I agree with the study. It is extremely difficult to run long term RCT studies and be highly methodical. What are the right doses, can they be adjusted, what if they stop taking meds, or even take them intermittently? How can you force parents who may have ADHD themselves to be diligent with their children's medication? Worse the "blind group" might start taking medication because nothing else works. Then there is the issue of subjects dropping out of studies. Did the article suggested a different form of study? I remember reading an article where they suggest other forms of assessment because of all these problems.--scuro (talk) 03:20, 4 November 2008 (UTC)

Just out of curiousity, what are the usual periods of time for which long-term RCT studies on the safety of other drugs done? Given that the difficulties in running long term RCTs are not really limited to any single medication, I'd think that this would be a limitation common to many medications. I would be concerned that it might be misleading to make it sound as if ADHD medications were particularly unsafe because of a lack of studies lasting more than 2 years. Furthermore, in the absence of long-term data, it is best to only make definitive statements about what is currently known. So for instance it makes sense to mention if current studies have failed to find serious evidence of risk up to their time limit. The concerns over seizures with atomoxetine certainly do make sense, especially given that bupropion, which has somewhat similar pharmacodynamics, is known to lower the seizure threshold.

In short, it makes sense to mention black-box warnings, and it makes sense to mention known health risks. I think that it also makes sense to mention if current studies have failed to find health risks, and I don't think that the lack of long term data should be presented as evidence of a lack of long-term safety. Remember that absence of evidence is not evidence of absence. Hyperion35 (talk) 15:08, 18 November 2008 (UTC)

Welcome Hyperion, I read somewhere that ADHD medication is different from other medication in that are clear and very obvious therapeutic benefits which have been proven through many studies. Take antidepressants, the benefit is not so clear so longer term studies are not so much of an issue. But stimulants do have a major proven benefit. Ethical issues have been brought up with long term studies. Perhaps this can simply be cited and mentioned in the article.--scuro (talk) 16:43, 18 November 2008 (UTC)

poor references
Here is a great example of a poor reference. http://www.continuingedcourses.net/active/courses/course034.php

It is not peer reviewed. It is not published. And it is not properly formatted. Even though what it says is correct a much better reference should be found.

--Doc James (talk) 15:18, 4 November 2008 (UTC)

In the ideal references section it states this: widely recognised standard textbooks written by experts in a field. This reference is an online textbook for an online credit. It is recognized by American Psychological Association, Association of Social Work Boards (ASWB), National Board for Certified Counselors (NBCC), California Board of Behavioral Sciences (CA-BBS), and the Ohio Counselor, Social Worker, & Marriage and Family Therapist Board (OH-CSWMFT). Russell Barkley would certainly be considered an expert in the field. You could debate if this is an ideal source, it certainly isn't a poor source.--scuro (talk) 16:32, 4 November 2008 (UTC)
 * No it is NOT a online textbook. And it is definately not a widely recognised standard textbooks.--Doc James (talk) 19:15, 4 November 2008 (UTC)


 * Why I think it is definitely an online text for an online course. There is no other learning material offered for the course. Under that definition it would be an online textbook. Since the course is recognized so widely by national and state run government agencies, the information within the text has definitely been fact checked by these agencies since these agencies recognize the course. I would think this would make this particular reference a very good reference. Now didn't you once make reference to the Critical Psychiatry Network? That would be an example of a fringe group and a poor reference for any sort of fact based information on ADHD. --scuro (talk) 23:56, 4 November 2008 (UTC)
 * Definitely not a textbook. It looks like online course notes. The course being recognised doesn't mean the notes are endorsed. Verbal   chat  10:15, 5 November 2008 (UTC)
 * No it is not a recognized standard textbook. It is the online text to his course. The course is "approved" by all the associations mentioned above as a "Continuing Ed Course". These are the courses that Dr.'s and counsellors would take to update their knowledge on these subjects. As such it would most definitely be fact checked and would be information that these associations would mostly be in agreement with.--scuro (talk) 13:07, 5 November 2008 (UTC)

Is not a course for MD's. See http://www.continuingedcourses.net/  It is not peer reviewed. It is not from a governmental group. This is unlike the TI which is from a governmental organization, is for physicians, and is peer reviewed. Doc James (talk) 13:39, 5 November 2008 (UTC)

All psychiatrists are also doctors so doctors are taking this online course. Course material, such as a textbook, for any course offered is not "peer reviewed" as an academic paper would be peer reviewed. Course material, such as a textbook...as far as I know, never comes from government agencies. Are we not going way out on a limb to find fault with this source?--scuro (talk) 17:11, 5 November 2008 (UTC)


 * Says Psychology not Psychiatrist. Another editor agrees with me.  Therefore the vote is in my favor.--Doc James (talk) 13:40, 6 November 2008 (UTC)


 * Wikipedia is not a democracy and this is not an attempt at consensus. I'd be doing some reading on protocol. --scuro (talk) 06:39, 9 November 2008 (UTC)

If this is the textbook for a course, and both the course and the textbook are recognized by the APA and several other professional organizations, then I think it would clearly fit under the guidelines for being a widely recognized standard textbook, since it is recognized by several relevant national and state organizations, and it is written by a widely recognized expert in the field.

I would think that this is clearly an acceptable source Hyperion35 (talk) 14:28, 18 November 2008 (UTC)

link to sleep problems
I understand that there is serious academic study into an ADHD/Sleep disorder link. Does anyone know more about this? It seems like something that should be added to the article. Boxter1977 (talk) 10:02, 10 November 2008 (UTC)


 * Here is a good references.
 * http://www.ncbi.nlm.nih.gov/pubmed/18803919?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

--Doc James (talk) 14:24, 10 November 2008 (UTC)

Therapeutics Initiative (UBC) citation is a poor reference?
This citation was discussed at length in Doc James's med cab. http://en.wikipedia.org/wiki/Wikipedia:Mediation_Cabal/Cases/2008-10-09_Attention-deficit_hyperactivity_disorder I cut and pasted the discussion starting below.

If a systematic review of randomized controlled trials published in a peer reviewed source disagree with what you previously believed one has to consider if what they previously believed is wrong. Doc James (talk) 04:21, 31 October 2008 (UTC)

I agree with you, that is generally excellent evidence. The question I have is the UBC source for q#1, a systematic review of randomized controlled trials published in a peer reviewed source? And if it is not how would you characterize this source?--scuro (talk) 04:34, 31 October 2008 (UTC)


 * The paper from UBC is a review of randomized controlled trials published in a peer reviewed source. It came out in 2008.  Now if there were another current paper of similar quality that had a different conclusion then one would state one found one thing and the other found something different.  I however have not seen another systematic review that claims long term safety.
 * Another plus to this source is that there are no pharmaceutical conflicts of interest by the authors. They are completely government funded and accept no pharmaceutical funding.  This is a serious problems with Barkley's work.  He receives lots of drug company funding and there is very good evidence showing that drug company funding effects study's results and conclusions.

Doc James (talk) 11:18, 31 October 2008 (UTC)

Who are the authors and what academic peer reviewed journal was it published in?--scuro (talk) 11:34, 31 October 2008 (UTC)

Here is the web site. You can read all about the organization. http://www.ti.ubc.ca/en/AboutUs --Doc James (talk) 12:19, 31 October 2008 (UTC)

In examing the website I see no outside link to an academic peer reviewed journal, that has this "systemic review" within it. I have also not found an author(s) to the "systemic review". James, have you seen this SR in a academic peer reviewed journal? And if you have, can you kindly provide a link to the APRJ?--scuro (talk) 15:53, 31 October 2008 (UTC)


 * The web page explains the process that is taken to produce the Therapeutics Letter. It is produced by an arms length governmental funded organization.  Some of the authors are listed on the page.  This is like the FDA of NHS guidelines and reviews which are published by the organization itself.  Doc James (talk) 21:03, 31 October 2008 (UTC)


 * Here is a paragraph about ADHD medications from the NICE review "10.14.1Quality of evidence reviewed. The quality of the evidence reviewed was generally moderate to low. Efficacy studies were typically of short duration only (range, 21 to 238 days) and authors were usually not explicit regarding the inclusion or exclusion of ADHD coexisting conditions. Most studies compared a single active drug with placebo. There are few direct ‘head-to-head’ comparisons of active drugs.  Interpretation of harm-related outcomes was limited to a small number of short-term clinical trials that reported harm data. Overall, adverse events have been reported infrequently and poorly, and further research is recommended."


 * This means that long term safety data is lacking. I have found another systematic review on long term safety from 2008 however am unable to get a copy of the whole article.  If anyone has access please let me know.  Otherwise I might order it.  http://www.jpnonline.com/view.asp?rID=30274

--Doc James (talk) 22:01, 31 October 2008 (UTC)


 * So what we have here is a source that is not peer reviewed, nor published in any academic journal. It is a bi-monthly newsletter. http://www.ti.ubc.ca/en/TherapeuticsLetters It is a review of literature by different working groups of the "Therapeutics Initiative". Who are members of the International Society of Drug Bulletins. Who are the specific authors of this review?


 * Would you agree then, that this is not an ideal source for a biomedical article, as posted in your link below on sources?--scuro (talk) 03:52, 1 November 2008 (UTC)

No it is peer reviewed. It is published by the therapeutics initiative. It is medical position statements from nationally and internationally reputable expert bodies. It is a secondary source and is a literature review.

Now the NICE guideline and a book from Barkley's also say the same thing as the TI. That there is no good long term evidence of safety beyond 2 - 3 years is in many citations. It is interesting as Barkley has defined long term safety as 18 months in his more recent books. And the uses this to claim long term safety. The guy's books are a bit of a joke. The drug funding has obviously biased his conclusions. Doc James (talk) 06:07, 1 November 2008 (UTC)


 * Lets start with facts and focus on this source alone. The newsletter is not published in any reputable medical or academic journal and consequently is not subject to a peer review of scholarly experts within that field. The newsletter is subject to a review and this review could be undertaken by nurses, lawyers, doctors, pharmacists etc...all from the province of British Colombia in Canada. http://ti.ubc.ca/en/AboutUs#ScientificCommittee This sort of review may suit the needs British Colombia but by no means should be considered scholarly work, nor should it be considered work that has been subject to the review experts from around the globe, within this field of expertise. Their findings should not be extrapolated to be our scientific understanding of the long term safety of stimulant drugs. That would be improper synthesis. Could we agree to this?--scuro (talk) 13:04, 1 November 2008 (UTC)


 * No I think that your analysis is incorrect. Other sources however say the same thing.  So I can add multiple references to this statement.  But will do so in a few days.--Doc James (talk) 23:05, 1 November 2008 (UTC)


 * "You think it is incorrect"? We could save a lot of time here. All we simply need is a statement that the citation is not what it was made out to be. I'm sure it's obvious to everyone that this citation is not a scholarly work. What scholar(s) wouldn't put their name on their paper? What systemic review isn't published in any journal? At this point we could be discussing next steps: what value does this citation have, should the citation be removed, are there any conclusions on the article that were taken from the citation, what should be stated instead? If you find it necessary to find a citation, simply provide the best source you can find, multiple sources are not needed.--scuro (talk) 12:17, 2 November 2008 (UTC)

Once again let let others comment. We disagree. We all know your point of view. For your info some of the authors are listed on the TI page. One is James McCormack. It is peer reviewed. And what it says as you previously mentioned is not controversial as mentioned on the talk page. And no you do NOT get to unilaterally removed these references. Doc James (talk) 14:17, 3 November 2008 (UTC)

I had hoped that when the obvious is in front of us, that both us would admit as much. It's going to be a long drawn out process if the most obvious things are challenged to the 9th degree, and for what end? Is this not wiki lawyering? But sure, if you want outside opinion, then let me put it into a clear cut question. Is the UBC an ideal source, in that it is both published in a medical journal and has a proper peer review by scholarly experts in the field as chosen by that journal?--scuro (talk) 16:48, 3 November 2008 (UTC)


 * I would view it as a review, comparable with other reviews. I don't think I would put it ahead of other reviews, though.  Reviews, and meta-analyses are all subject to some bias in that they have a set of criteria for which studies to include and also in what they conclude from the studies they review.  The therapeutics letter is focussed on one set of criteria.  It is a bit short, though, and so does not have the same scope as the more traditional academic book chapter to go into depth with discussion of the issue.  --Vannin (talk) 03:39, 4 November 2008 (UTC)


 * Does the opinion below change your mind about the issue Vannin? Here is what a researcher who I contacted about the Therapeutic letters stated.

''Well, I had no clue what a "therapeutics letter" was. My first guess was a literature review that isn't peer-reviewed. My second guess was an opinion piece. A Google search answered that one very quickly, but it is disguised to make it appear academic to the non-scientist.''

''A therapeutics letter is what the "Theraputics Initiative" calls each of their bi-monthy newsletters! http://www.ti.ubc.ca/en/TherapeuticsLetters''

''The group is part of a larger group who are aggressively fighting what they call "big pharm". It sounds like a great initiative - to promote research that is financially independent of the pharm companies, but what the layperson does not know is that most research is not funded by those companies. Most research is conducted by universities under private foundation and government-funded grants.''

''The short-term compares only two articles. Meta-analysis or not, it's the perspectives of two authors and not a first-hand evaluation of evidence.''

Their criticism of the MTA study is rediculous. ''- They mislead the reader by saying a majority in the "community care" group received stimulant medication. While this is true (it was 67% that received it at some point during the study), the layperson might think this meant they received the same treatment as the medication group. They didn't. Compliance is a huge issue, but it is more closely monitored by the researchers when it is the treatment (the medication group). One follow-up study that used data collected in the MTA found that the most influential factor in determining the success of treatment was the treatment. Those who received medication were on track for success. The second most interesting factor was the mother's level of depression. Depressed mothers = no compliance. The findings suggest that children respond to medication, but only when they take it!'' ''-Although there are comparisons in the MTA study that are not significant after a Bonferonni correction, this is misleading. The study was extremely over-analyzed and the researchers were conscienteous in correcting for the number of hypothesis tests. I don't know your statistics knowledge, so I'll assume you haven't been exposed to Bonferonni. It's an adjustment to the acceptable error. We normally set our criteria for statistical significance at .05, which is the probability that our test statistic would occur if there were no treatment effects. If the observed value is less than this, we take that as evidence that there ARE treatment effects. If we run 2 tests, the probability that one of the tests results in this kind of error is nearly doubled. Each test increases this probability. A Bonferonni correctioin divides the acceptable error into equal pieces, so if I run 5 tests, each has a criteria of .01. The corrections in the MTA studies made several of these probabilities appear nonsignificant even though the observed proabilities were extremely low (<.001, .0003, etc.)'' -They say there were no differences on an anxiety scale that is not a measure of ADHD symptoms. ''-They present the follow-up findings as if they showed no differences among the treatment conditions. Indeed, the follow up measures do not differ among the groups. This is probably because more than half of the children, regardless of their original treatment group, were taking medication.''

EVEN THESE PEOPLE couldn't deny the benefits, though. --scuro (talk) 12:22, 4 November 2008 (UTC)


 * They mislead the reader by saying a majority in the "community care" group received stimulant medication. While this is true (it was 67% that received it at some point during the study), the layperson might think this meant they received the same treatment as the medication group. They didn't.... They present the follow-up findings as if they showed no differences among the treatment conditions. Indeed, the follow up measures do not differ among the groups. This is probably because more than half of the children, regardless of their original treatment group, were taking medication.


 * Interesting passage. First he says the TI mislead by saying that the majority were on stimulants.  THEN he says that yes the majority were on stimulants.  They he says accuses the TI of presenting the finding such that they found no difference.  Then HE says that they found no difference.


 * This guy is great. He agrees with everything he says he disagrees with.  Then throws in some stats to make his analysis sound smart.  --Doc James (talk) 13:22, 6 November 2008 (UTC)


 * He does however make a bunch of inaccurate statements. This is not an anti pharma group.  This is a group who look at evidence based medicine.  They prefer that one basis there decisions on evidence rather the drug company published material.


 * Yes most research is government funded. But this obfuscates the point.  Research comes in two different types clinical research and basic research.  The first being based on the second.  Basic research is almost all government funded and is the majority.  Drug studies are mostly pharma funded.  What his point is I do not know.


 * Does everyone remember Vioxx (venlacoxib) and Celebrex (celecoxib)? The TI published an article on it in 2001.  I have never prescribed either having always stuck to cheaper and safer NSAIDS based partly on the TI assesment.  Then what happens in 2005?  The shit hit the fan when what the TI said four years earlier became common knowlegde.


 * Then what about the new cholesteral med Ezetimibe. Well much of the US jumped on the band wagon based on pharma advertising we Canadian held back and waited for the evidence.  What did they find?  That it doesn't help and just cost lots of many.


 * The USA it seems is ready to follow what ever big pharma tells them. And to pay what every big pharma asks.  They do this often blindly.


 * We in Canada are much more advanced. We wait and see what the evidence show.  This gives us health care which cost half as much as that in the USA well at the same time giving better patient oriented results.  I have seen much hype come and go.  Doc James (talk) 13:36, 6 November 2008 (UTC)


 * Focussing on the question at hand, which is the Therapeutics letter, (and not going off on yet more tangents), I would say that it is one of a number of reviews. It does not "trump" other reviews and is limited in that it does not have a lot of analysis.  If I was writing an article for publication I would include it in the literature review but it is not definitive and I would include the conclusion from the other chapter review that I provided, which goes beyond the therapeutics letter and is much more positive about long-term safety.  --Vannin (talk) 18:20, 6 November 2008 (UTC)


 * Since I am the author of the passage quoted by Scuro, I will defend it (& myself). Your criticisms are not valid. You have either misread parts of the message or misunderstood it; this is understandable since it is slightly out of context here. I did not "agree" with what I "disagreed" with at all. So please allow me to clarify.


 * First, I said it was MISLEADING. It is framed to MISLEAD. I did not say it was "incorrect". It is missing important context and leads the reader to a WRONG conclusion.


 * The statements made in the newsletter regarding the failure of the MTA study to find a difference in anxiety are IRRELEVANT. Anxiety is not an ADHD symptom, and stimulants are not prescribed for anxiety. This "systematic review" is not systematic at all. It is a witch hunt.


 * I certainly did not include a description of statistical methods to "sound smart". It was an EMAIL TO A FRIEND, not a "letter to the editor" and Scuro knows my background. I have no need to impress Scuro and had no reason to think my words would appear elsewhere (although I have no objection to this, either). My experience has been that this kind of attitude is generally a defensive one; if you don't understand it, the person who said it must be arrogant.


 * The point I made was that analysis of the follow-up data is EXTREMELY CONSERVATIVE. Nothing in science is black & white and it is, IMO, unreasonable to reject outright a finding that has a 3 out of 10,000 chance of error, especially given the context of these particular findings.


 * The "Therapeutics Initiative" IS an anti-pharm activist group. The "independence" they describe in their mission is a facade.
 * I do not draw scientific conclusions from drug-company literature, either. I prefer peer-reviewed academic journals to activist propaganda. The former is free of ANY biased influence - drug company funding or political agenda. The authors of the newsletter are not relevant and neither are their credentials. Science does not recognize such things. What is relevant is what evidence exists to support the argument.


 * My point? My point is that people with the knowledge and training to conduct and criticize scientific research (i.e., scientists) publish their findings in academic journals, not newsletters. People who conduct research that is published in these sources do so without the funding or agenda of drug companies OR activists.


 * The bottom line: peer-reviewed academic journals are not perfect, but they are the least biased source of knowledge. There is no shortage of them, either. Although scientific research is often flawed, the flaws are detected, discussed, and corrected for BY SCIENTISTS because science is transparent. Politics are not.


 * ICBSeverywhere (talk) 04:47, 8 November 2008 (UTC)


 * House keeping notes: I moved ICB's post so as not to cut into Jame's post and put it in chronological order. She is new.


 * There it is in a nutshell...not a review at all because it is not published in a peer reviewed medical or scientific journal. A dead give away also is that no author put their name to that piece. ADHD attracts all sorts with an agenda and they can go to any length to make their case....that is, except proper science. On a different note, James can we finally give up the ghost on this citation? Time to move on? Once again I have demonstrated that I am on the right side of an issue. So can we stop the brush off and get back to the concept of: good faith, proper polite communication, an end to edit warring, and seeking consensus?--scuro (talk) 05:51, 8 November 2008 (UTC)

End of cut and paste.--scuro (talk) 00:07, 19 November 2008 (UTC)

Would like to add a list of the authors for the TI as well as a summation of their approach:

The process leading up to publication involves a literature review by different Working Groups of the Therapeutics Initiative, creation of a draft which is circulated for peer review among a sizable group of local, national and international specialists with expertize in the particular therapeutic area and the commission of original artwork/illustration.

Dr. James M. Wright, M.D., Ph.D., FRCP(C)

Managing Director and Chair, Therapeutics Initiative Professor, Departments of Anesthesiology, Pharmacology & Therapeutics and Medicine, UBC Clinical Pharmacologist, Vancouver Hospital James (Jim) Wright is a Professor in the Departments of Anesthesiology, Pharmacology & Therapeutics and Medicine at the University of BC, Vancouver, Canada. He obtained his MD from the University of Alberta in 1968, his FRCP(C) in Internal Medicine in 1975 and his Ph.D. in Pharmacology from McGill University in 1976. He is a practicing specialist in Internal Medicine and Clinical Pharmacology. He is also Managing Director of the Therapeutics Initiative, Editor-in-Chief of the Therapeutics Letter and Coordinating Editor of the Cochrane Hypertension Review Group. He sits on the Editorial Boards of the following journals: Open Medicine, PLoS One and the Cochrane Library. Dr. Wright's research focuses on issues related to appropriate use of prescription drugs, Clinical Pharmacology, clinical trials, systematic review, meta-analysis and knowledge translation.

Dr Barbara MintzesDr. Barbara Mintzes, B.Sc., Ph.D.

Assistant Professor, Dept of Anesthesiology, Pharmacology & Therapeutics, UBC Michael Smith Foundation for Health Research Scholar Barbara Mintzes holds a BA in geography from Simon Fraser University and a PhD in health care and epidemiology from the University of British Columbia. She carries out evaluations of drug safety and effectiveness that provide background information for provincial drug financing decisions. She also works as a clinical reviewer with the Common Drug Review. The focus of her research is pharmaceutical policy, and her main area of expertise is on the effects of direct-to-consumer advertising of prescription drugs on prescribing and medicine use. She is also involved in research on the influence of regulatory standards for drug promotion on the quality of information provided. She coordinates a global research project on rational use of medicines with Health Action International, a network of consumer, health and development organizations representing public interests in pharmaceutical policy, and is involved in a collaborative World Health Organization project to develop curriculum for pharmacy and medical students on drug promotion and interactions with the industry. She also works with the Pharmaceutical Policy Unit at UBC’s Centre for Health Services and Policy Research, and is a member of the Steering Group of Women and Health Protection.

Dr Stan BardalDr. Stan Bardal,. BSc(Pharm), MBA, PhD (Pharmacology).

Senior Instructor, Island Medical Program, UBC Dr. Bardal is a pharmacologist and faculty member with the UBC medical undergraduate program (MDUP) and the Division of Medical Sciences, University of Victoria, and is the Pharmacology theme director for the MDUP. He lectures frequently in the MDUP, has experience designing curricula and curricular materials, and is co-authoring a pharmacology textbook that will be published by Elsevier in 2011. His research interests include drug policy and pharmacogenomics, as well as basic science pharmacology research in diabetes and angiogenesis. Dr Tom PerryDr. Thomas Perry jr, M.D., FRCP

Clinical Assistant Professor, Department of Medicine, UBC Clinical Pharmacologist, General Internist, Vancouver Hospital Thomas L. Perry graduated from McGill University Medical School in 1978. After a rotating internship at Dalhousie University, he started a residency in general internal medicine at UBC, broken by 2 years of locum tenens general practice in isolated communities in B.C., Yukon, and Ontario. After completing his specialty residency and achieving Fellowship in the Royal College of Physicians of Canada, he spent one year on a Medical Research Council fellowship studying metabolism of tricyclic antidepressants with Dr. Leif Bertilsson at the Karolinska Institute Department of Clinical Pharmacology in Stockholm, and a further 2 years at UBC's Department of Pharmacology & Therapeutics. Dr. Perry was then elected to the Legislative Assembly of B.C. where he served as Opposition Health Critic from 1989-1991, as Minister for Advanced Education, Training & Technology from 1991-93, and as a government MLA from 1993-96. Dr. Perry returned to clinical medicine in 1996 and now practices general internal medicine at UBC Hospital and Vancouver General Hospital. He teaches internal medicine in the Department of Medicine Clinical Teaching Unit program at VGH and clinical pharmacology through seminars, lectures and elective student clinical training at UBCH. His outpatient practice focuses on pharmacological treatment of chronic pain and high blood pressure. He has a special interest in the use of videography to teach students and doctors about drugs. He is a member of the Drug Assessment Working Group, and the SIEC and participates frequently in the development of TI Letters. Dr. Perry's other interests include wilderness canoeing and hiking, environmental conservation, peace and social justice, music, reading, and his family. Dr. Vijaya Musini, M.D., M.Sc., Ph.D.

Assistant Professor, Dept of Anesthesiology, Pharmacology & Therapeutics, UBC Manager, Drug Assessment Working Group, Therapeutics Initiative Vijaya Musini has conducted and supervised over 200 systematic reviews and meta-analyses on prescription drug therapy. She is an Editor of the Cochrane Hypertension Review Group and has been actively involved in teaching Cochrane Collaboration systematic review methodology and critical appraisal skills on evidence based drug therapy to undergraduate, graduate, medical students and residents. Dr. Musinigraduated from Mumbai University Medical School in 1982. After completing her rotating internship she joined the Department of Community Medicine in 1984 and graduated with a Diploma in Public Health from Mumbai University Medical School in 1985. She has worked as a Family Practitioner and as a Medical Officer in primary health care centres in Mumbai, India for several years. She also worked as a research assistant in the Departments of Gynaecology and Obstetrics, and Health Care and Epidemiology, Faculty of Medicine, Kuwait University. She immigrated to Canada in 1996 and graduated with a Masters Degree in Pharmacology and Therapeutics from the University of British Columbia in 2000.

Ciprian Jauca, B.A.

Program Coordinator, Therapeutics Initiative, UBC & UVic Ciprian Jauca studied linguistics at the Babes-Bolyai University in Cluj-Napoca, Romania (major in Romance Languages, minor in Germanistic Studies). In 1991 he earned an International Diploma of Business Management and Intercultural Communication from the University of Osnabruck, Germany. He speaks several languages and has worked as translator and interpreter before joining the TI in 1994. He has been the Program Coordinator for the Therapeutics Initiative since its inception in 1994. He created the Therapeutics Initiative website and was its first webmaster from 1996 to 2006. He is involved in the international Cochrane Collaboration and since 2001 he has been the Review Group Coordinator for the Cochrane Hypertension Review Group.

Maud van Breemen, B.FA., M.F.A

Graphic Designer, Therapeutics Initiative, UBC Maud graduated from the University of Miami, Florida, USA. She has worked as the graphic design and desktop publisher for the Therapeutics Initiative since 1994. She has also provided assistance during the Drug Therapy Courses.

http://ti.ubc.ca/en/node/10

216.174.136.2 (talk) 12:46, 20 November 2008 (UTC)


 * The process leading up to publication involves a literature review by different Working Groups of the Therapeutics Initiative, creation of a draft which is circulated for peer review among a sizable group of local, national and international specialists with expertize in the particular therapeutic area and the commission of original artwork/illustration. - blurb from the TI.


 * What these folks call a "peer review" does not equate with what wikipedia defines as a peer review. We are comparing apples and oranges here. The "Therapeutic Letter" is not published in any scientific or medical journal. There is no author to the "Therapeutic Letter" so one can't even establish who exactly did the "research". "Working groups" of the "Therapeutics Initiative" create a draft. That is not how research is done. This could be an organization wanting a voice in the scientific community without doing the work that is needed for true legitimacy. Or, it could be a group POV pushing info. If one wanted to present it as legitimate research without going through the rigorous examination that scientific papers get, one would present evidence such as the letter. It has the window dressing of legitimate peer reviewed research, but has no "beef". You are left with the two buns...nothing of substance because the conclusions drawn have not been filtered through a scholarly lens for potential bias.--scuro (talk) 20:34, 20 November 2008 (UTC)


 * There seems to be some misunderstanding here. If the "Therapeutic Letter" is as described, it is a secondary source. That can be better -- more reliable -- than ordinary "peer-reviewed" articles. Now, if the organization putting it out has an axe to grind, that's another matter, I'm not weighing in on that issue. Rather, I'm noting that if there is a responsible review by a working group of experts in a field, that's what peer review is about. We can use books as reliable source; there, being published by a responsible publisher suffices. If there is suspicion that a publisher is biased, we attribute, we don't merely remove the material.


 * Some, at least, of this controversy should not be in this article, it should be in the Controversies article, with a brief summary here in summary style. That summary doesn't need to be sourced; sources would be in the Controversies article (it's similar to an article introduction or lead. --Abd (talk) 04:13, 21 November 2008 (UTC)


 * How would you know that this is a "responsible review"? What true peer review is about, is an attempt to eliminate as much bias as possible. That the "letters" are not published in a medical or scientific journal is a major red flag here. Who checks for bias? With academic journals that responsibility rests with the journal which is independent of the researcher who submitted the paper. At the "Therapeutic Initiative" everything is in house, the dangers of bias increase exponentially. Worse yet, no author claims the research. In science there is nothing more important then your reputation. To not publish research with the authors name attached to the work is really lame and creates further bias risks. Any one with a basic understanding of scientific methodology would understand all of this. We are comparing apples to oranges.--scuro (talk) 05:18, 21 November 2008 (UTC)

THE AUTHORS ARE ALL LISTED ABOVE... WITH ALL THEIR CREDENTIAL.. --Doc James (talk) 05:28, 21 November 2008 (UTC)


 * Well actually are they? From the TI webpage, "The process leading up to publication involves a literature review by different Working Groups". Different working groups would indicate plural, more then one. Why use that particular term when the group is always the same? Do you think Maud van Breemen, (B.FA., M.F.A) helped write the letters? Was she part of the "working group"? "She has also provided assistance during the Drug Therapy Courses".....perhaps she did, you never know.


 * For give that tongue and cheeck, but honestly Jhm, we all know better. This is not true peer reviewed research. In group interactions there needs to be reciprocity. Where is the "give" when it is the right time to give?--scuro (talk) 06:15, 21 November 2008 (UTC)

Some of the author of the TI also work for or have worked with the International Cochrane Collaboration http://www.cochrane.org/. Everyone listed above takes part in putting out the TI. There are more authors however.

I will quote a passage I have already quoted once before as it speaks for itself "The draft of this Therapeutics Letter was submitted for review to 54 experts and primary care physicians in order to correct any inaccuracies and to ensure that the information is concise and relevant to clinicians."http://ti.ubc.ca/en/letter69

Doc James (talk) 08:30, 21 November 2008 (UTC)