Talk:Choosing Wisely

A WikiProject for Choosing Wisely
The Choosing Wisely project includes a program for developing a large number of health articles on Wikipedia. Anyone may read more about that program at WP:Choosing Wisely.  Blue Rasberry   (talk)   14:21, 25 February 2013 (UTC)

Collecting review for this article
Before this article was live I submitted it to Articles for Creation for third-party review. I posted in some places that I created this article as a paid employee working with the Choosing Wisely project. I centered the discussion at WikiProject Medicine here. Now that the article is live, comments about this project can go here.  Blue Rasberry   (talk)   14:21, 25 February 2013 (UTC)

Comments
I keep seeing vague (and unencyclopedic?) language. Things like "some analysts" and "some reports". Biosthmors (talk) 19:12, 21 February 2013 (UTC)
 * The analysts and reports could be named in the article if that improves the article; I hope that all analysts and reports are explicitly named in the footnotes immediately following the claims and that content could be replicated in the body of the article.  Blue Rasberry    (talk)   04:02, 22 February 2013 (UTC)
 * I think naming the analysts would help. In my mind it's good to attribute for neutrality/specificity/clarification/verifiability. Biosthmors (talk) 18:01, 22 February 2013 (UTC)

Why doesn't citation #9 show anything? Biosthmors (talk) 20:29, 21 February 2013 (UTC)
 * In restructuring the article somehow this citation was broken. I restored it. 04:02, 22 February 2013 (UTC)

"The campaign addresses the problem of patients receiving unnecessary health treatment, reasoning that this results in poor outcomes for the patient and could create significant waste in the United States healthcare system" (my emphasis). It doesn't take any reasoning to know that unnecessary treatments result in the potential for unnecessary side effects. Does it? And what's the definition of significant? Or the odds of could? Again, this seems to be an example of vague language intended to be somehow neutral, perhaps, but the reader is left with nothing to really be confident of when it comes to facts. Biosthmors (talk) 18:08, 22 February 2013 (UTC)

And what's the definition of "waste" when it comes to health care spending expenditures anyways (since the idea of that kind of article has been proposed below)? Biosthmors (talk) 18:10, 22 February 2013 (UTC)

Choosing Wisely white paper
I think the article is significantly improved, but I still get this feeling that it has the flavor of a Choosing Wisely white paper at times, like it's making a point that Choosing Wisely is addressing a problem that needs to be fixed, and proposing Choosing Wisely as the solution to that problem. I'm not quite sure how to address this, but it might be improved by providing a more representative summary of the literature on health care costs rather than just the ones that support the Choosing Widely initiative. Or reducing the teleological/essay-like component where the page builds the reader towards a conclusion and then evaluates that conclusion critically. Instead, a more neutral history section may be useful. I've bolded the sections where I think this is most apparent. Ocaasit &#124; c 15:31, 22 February 2013 (UTC)
 * I think you are right - the campaign is proposing Choosing Wisely as "the solution" to a particular problem. I would love to find counterpoints to this but so far as I know, there are no extant published counterpoints which I have not already included in the article. If I find published criticism or other perspectives then I would rush to include them.
 * I also feel a serious lack of summary of literature. Choosing Wisely has limited utility without some other Wikipedia articles being developed. There is an article on overutilization, but that is different from overtreatment, and perhaps overprescription is something different still. Choosing Wisely talks a lot about Healthcare wastes, which implies that people regret the loss of the resources, whereas the other terms imply no such regret and indeed all parties including doctor, patient, and hospital often want all these things. There seems not to be standard terminology, and although I would like to start these articles, I was thinking to not do so without talking it over with others. Someone redlinked the topic Healthcare costs in the United States and definitely this topic is discussed enough to merit its own article, especially if those costs could be compared to the costs elsewhere in countries with similar economies.
 * The history section is what I pulled from publications which give the history about the campaign, and I hope not something that I put together myself. The same is so with the health assertions I wrote - rather than identifying independent sources, I pulled the rationales from papers which were describing the Choosing Wisely campaign because I felt that to do otherwise would be WP:SYNTHESIS and WP:OR. Because of Wikipedia "synthesis" rules, I am a bit skeptical of the utility of pulling research from outside the context of Choosing Wisely and applying it to the campaign, but as you said, any other writing strategy inherently pulls the argument in a certain direction.
 * The only thing that I am disinclined to do is to remove references without a reason. Other than that I am thinking about what more I can do in response to comments. Let me look some more...  Blue Rasberry    (talk)   15:54, 22 February 2013 (UTC)
 * I thought more about this. The solution that you proposed was to provide more viewpoints on the fundamental problems which the campaign addresses; while I think that is the best solution, that is also a massive undertaking that I feel would necessitate the creation of at least two more Wikipedia articles on fundamental health topics. I am interested in doing this, but not alone, and not as the preferred prerequisite to getting this article to an acceptable status.
 * As a counterproposal, I added disclaimers to the POV content. The situation is that there are numerous third-party sources which did research and came to the conclusion that healthcare waste exists and that the US would be better if this waste were lessened. The POV aspect of this is that the Choosing Wisely campaign chose to be influenced by those reports. The disclaimers I added are "The Choosing Wisely campaign presents the following background and narrative to explain its motivation" and "The Choosing Wisely campaign identifies the following difficulties in achieving its goals:", so that readers will know that the background to the campaign or the difficulties identified are not objective truths, but rather points which the campaign itself identified and wove into its own narrative. After I added these disclaimers, I unbolded the text you emphasized. How do you feel about my addition of disclaimers as a quick fix to your complaint? How strongly do you feel that Wikipedia readers would expect at this time to see a network of related articles on healthcare resource waste created and interlinked with this article? Other thoughts? Thanks a lot for your attention.  Blue Rasberry    (talk)   18:19, 22 February 2013 (UTC)

History section
Unless the historical tidbits are tied directly into the formation of Choosing Wisely (as demonstrated by secondary sources) then these things should be moved to the background section. I remember seeing something from 2002 about the ABIM foundation and I thought that it was inappropriate to present it as Choosing Wisely history instead of background information. Biosthmors (talk) 17:59, 22 February 2013 (UTC)
 * I took the historical narrative from this article in JAMA, which I think counts as a good secondary source. Other sources also give parts of the history but this one is in a respectable publication and shares citations for the academic precedents to this campaign. The reason why that 2002 study is cited is only because it is part of the recorded history of Choosing Wisely as given in that source. You may see that particular part of the story in the free preview of the above-linked article. In response to your confusion, I have tried to clarify all this by citing both the historical narrative and the paper described by the narrative in all cases, so that there is a common reference to the base story in all sentences.  Blue Rasberry    (talk)   19:31, 22 February 2013 (UTC)

More confusion
User:Jarry1250 just said the same thing - "→History: -> NPOV. Not clear what the objective link to Less is More is really about; it's coatracking to my eyes in this section". I proposed a different presentation for the same content, keeping Jarry's changes and additions but restoring the removal of some of the credit I was trying to give. In this presentation, the history is a list of items rather than a narrative, so I hope that clarifies that Choosing Wisely credits several independent and unaffiliated projects for contributing to its establishment. I hope it is not coatracking; it is supposed to be giving credit and properly citing the work of others by referring to a source which meets WP:RS.

I would like for someone to comment on my proposal that credit for all participants be given since it comes from another source. I think that Biosthmors and Jarry were confused by the poor connection I made between various named projects and Choosing Wisely.  Blue Rasberry   (talk)   17:26, 25 February 2013 (UTC)

Other notes
This source stands out as a review of the campaign.  Blue Rasberry  (talk)  11:00, 12 May 2014 (UTC)

I do not know when Consumer Reports first started talking about overuse of medical resources, but I just found a 2007 article on the subject. This is the earliest I have seen but coworkers tell me that the organization has even older work. I do not know how to find it. I found this because some guy named Joseph Mercola mentioned that 2007 article in something he wrote about Consumer Reports in 2010, and I realized that this campaign has been going on longer than I knew.  Blue Rasberry  (talk)  15:35, 16 June 2014 (UTC)

Added sources
In this edit I added sources to existing content and added a "further reading" section for a journal article which gives another general explanation of the campaign.  Blue Rasberry   (talk)   20:56, 15 April 2013 (UTC)
 * I just added more. This edit shows the entirety of what I did. I only added citations to medical journals which further commented on content which was already present.  Blue Rasberry    (talk)   15:48, 16 April 2013 (UTC)

Pending additions
I am not sure if this should be inserted.
 * In 2013 the campaign's organizers received an award from the National Research Center for Women and Families for being "Health Policy Heroes".

 Blue Rasberry   (talk)   21:01, 29 April 2013 (UTC)

Check in
I added more content in the last month. I have a conflict of interest in editing this article. Here is what I have done lately. Have of what I have done is add sources to previously poorly-sourced content. Another part of what I have done is add sentences which I hope were blandly informative along with citations.

I added a statement of criticism to the article. I make it a priority that I seek out anything negative said about the subject of this article and if I find criticism of any kind I will insert it immediately if the source even remotely looks like a reliable source. Thanks and I am always here for comment.  Blue Rasberry   (talk)   16:31, 7 June 2013 (UTC)

I just became aware of another review of the campaign and I added it. Probably there are other reviews that I could have missed, but I am not sure. I especially try to be conscious to find criticism and this paper I think tries to be critical. Anyone who wants to talk about this or what I do with Choosing Wisely content on Wikipedia can message me for a chat.  Blue Rasberry   (talk)   14:50, 23 January 2014 (UTC)
 * I just added this sentence and citation:

The campaign has been described as an attempt to encourage doctors and patients to recognize the illusion of control or "therapeutic illusion" in choices to use treatments which have a basis outside of evidence-based medicine.


 * I tried to present a neutral one-sentence summary of a commentary of this health campaign in a major publication. As has been the case for a while, sometimes when there are articles published about this campaign, I summarize and cite them in this space. I still have an employment affiliation with this campaign in that I share information from this campaign on Wikipedia.  Blue Rasberry   (talk)  16:57, 31 March 2016 (UTC)

General feedback


 Blue Rasberry  (talk)  16:13, 16 June 2014 (UTC)

Please don't move the ABIM Foundation into the Choosing Wisely wiki. The foundation is very controversial and will be moreso over the next few months due to scrutiny on their highly questionable "nonprofit" practices. It wasn't noteworthy before but now that it is, there is an effort to hide its internet presence. Feels suspect.˜˜˜˜ — Preceding unsigned comment added by 76.88.43.72 (talk) 01:07, 18 March 2015 (UTC)

ABIM Foundation Wikipedia Page
The ABIM Foundation page was nominated for deletion and the consensus was to merge it into the Choosing Wisely page (March 12, 2015). I have since added several updates to the ABIM Foundation page, and would like for the Wikipedia team to reconsider the merger. Note that I work for an agency for which ABIM, ABIM Foundation, and Choosing Wisely are clients.

Chloe.m.yeung (talk) 14:36, 24 March 2015 (UTC)


 * What you have added is pure directory information, and promotional statements. It is xactly the sort of material that does nto belong in an encycopedia.  DGG ( talk ) 01:48, 20 May 2015 (UTC)

Neutrality Reply Comment
Today McSly reverted additions from Neurosurgeon2be123. I disagree with the reversion and agree with Neurosurgeon2be123 that these additions added needed neutrality. Neurosurgeon2be123 had one source, and gave more neutral wording for some old unsourced statements in favor of Choosing Wisely. Some of Neurosurgeon2be123's additions could use a citation needed tag, but they don't deserve deletion, considering how biased the article is in favor of Choosing Wisely. Neurosurgeon2be123 began an important process of balancing the article. Numbersinstitute (talk) 16:14, 13 May 2018 (UTC)

Neutrality, primary, secondary
On 22 June 2018, @JzG reverted my addition of "Opponents ... say" which was meant to balance the preceding statement of "Proponents ... say". JzG said, "WP:PRIMARY. We need a secondary independent source for context. (TW))".

First, to have Proponents without Opponents in the lead is not neutral, so better to add a note calling for a secondary citation than delete.

Second, the 2 sources for Opponents are in fact secondary sources: each is "an author's own thinking based on primary sources, generally at least one step removed from an event. It contains an author's analysis, evaluation, interpretation, or synthesis of the facts, evidence, concepts, and ideas taken from primary sources."
 * The article in the monthly newsletter of the American College of Emergency Physicians (ACEP) is a review which analyzed and synthesized reports of 3 ACEP taskforces, which in turn had analyzed the Choosing Wisely campaign at arms length, concluding that it had a high chance of discouraging valid medical treatments. WP:SECONDARY says "For example, a review article that analyzes research papers in a field is a secondary source for the research." This is secondary analysis by an expert in the field. We may or may not agree with ACEP's conclusions, but they are a reliable secondary source on Choosing Wisely.
 * The article in the magazine of the Texas Medical Association, 3 years after Choosing Wisely went public, analyzes, evaluates, and interprets the claims of Choosing Wisely. Again we may or may not agree with Dr. Lanier's conclusions, but his article is a reliable secondary source on Choosing Wisely.

The 4 news reports cited for Proponents are very close in time to the initial Choosing Wisely announcement, and don't go far beyond what seems to have been a press packet, but they do include some evaluation by the reporters, so they are secondary sources too, though again we may or may not agree with the reporters.

Third, even primary sources may be used "to make straightforward, descriptive statements of facts that can be verified by any educated person with access to the primary source..." If these were primary sources they can still be used to state that "Opponents ... say." Numbersinstitute (talk) 11:17, 22 June 2018 (UTC)


 * What I want to see is third party coverage establishing the significance of, and degree of support for, these criticisms. As it happens I also have reservations about Choosing Wisely, including the fact that some quack treatments are recommended, but that's neither here nor there. Guy (Help!) 11:45, 22 June 2018 (UTC)


 * @JzG I must be missing something. I don't see any requirement in Wikipedia for more sources, when reputable citations directly support the statement. And I do not understand deletion of an Opponents sentence, when there is already a Proponents sentence, and there are in fact legitimate reputable opponents. Both sources involve reputable opponents in reputable publications.The first source for "Opponents ... say" is the President of the American College of Emergency Physicians, summarizing and endorsing 3 taskforces  of other emergency physicians, which opposed Choosing Wisely. The special advantage of emergency physicians is that they have to be familiar with the work of all medical specialties, so they are strongly placed to give an independent view of whether Choosing Wisely makes sense. That first source gives stronger evidence that the opponents are significant, than is cited that the proponents are significant, which is just news reporters reporting on a press event.  As it happens I think Choosing Wisely is worth considering when I need care, but opponents exist. Numbersinstitute (talk) 16:59, 22 June 2018 (UTC)
 * Reliable independent secondary sources. So while a group's website might be reliable about the group, it is not sufficient to establish the significance of any fact. Much of the content about these overseas initiatives is supported solely by the websites of the initiatives themselves. Guy (Help!) 08:28, 25 August 2018 (UTC)
 * It seems time to put the material supported by secondary sources into the article, since no counter-argument has been made in 3 months. @TransfusionDoctor @JzG @Jytdog @HereToHelpOthers Numbersinstitute (talk) 00:50, 21 November 2018 (UTC)
 * I addressed this. The article still has far too much puffery and many statements based on Cassel's article in JAMA. She was head of ABIM Foundation, so is not an independent source. Numbersinstitute (talk) 00:40, 24 November 2018 (UTC)


 * Countries, Finances

@JzG @Jytdog @HereToHelpOthers After the edit series cools down, I think we should reinstate the info on other countries which have adopted Choosing Wisely, and Newsweek's findings on ABIMF's finances, along with a brief version of ABIMF's reply. These are factual and are needed to lessen the US focus and maintain neutrality. Numbersinstitute (talk) 15:45, 23 June 2018 (UTC)
 * Those were generally terrible, policy-violating edits. I just worked it over.  What we do here is summarize what sources say.  You cannot deploy sources to generate commentary.  See WP:SYN.  You might find user:Jytdog/How to be helpful to get better oriented to what we do here, how we do it, and importantly, why we do things as we do. Jytdog (talk) 22:27, 24 November 2018 (UTC)
 * I'm glad you agreed with most of the information, appreciate your re-writes and deleting the "Motivation" section, and agree with consolidating Issues with Reception. I further cleaned it up a bit. Article still has a major dependence on a JAMA article by Choosing Wisely (11 citations). Wikipedia needs independent sources. In the meantime I added notes that the article and video are by a proponent. There may be better ways to make this clear, short of deleting the references and video. Also insulting fellow editors is not appropriate in Wikipedia. Numbersinstitute (talk) 21:23, 25 November 2018 (UTC)

Spam added to lead
this and this is chock full of spam with embedded URLs which we don't do per WP:EL. Nonprofit spam is just as much as much spam as for-profit. Please build content from independent sources. Also please keep in mind that per WP:LEAD, the part of the article above the table of content just summarizes the body of the article. Please don't add new content only to the lead. Thanks. Jytdog (talk) 15:16, 22 August 2018 (UTC)

I am not trying to be in an edit war. I removed all the external links from the main text, used references from review articles form 3 different medical journals (secondary citations) and placed some external links in the external links section. I was confused therefore why after taking your advice these changes were removed--TransfusionDoctor (talk) 16:06, 22 August 2018 (UTC) --TransfusionDoctor (talk) 16:10, 22 August 2018 (UTC)
 * It seems time to put the material supported by secondary sources into the article, since no counter-argument has been made in 3 months. @TransfusionDoctor @JzG @Jytdog @HereToHelpOthers Numbersinstitute (talk) 00:50, 21 November 2018 (UTC)