Talk:New England Compounding Center meningitis outbreak

Anyone
Anyone please contribute to this as the numbers change. Thank you so much. Kenn

Wonderful work adding folks, again thanks


 * Don't forget to WP:SIGN your comments. WhatamIdoing (talk) 23:06, 9 October 2012 (UTC)

CDC link
The link CDC Multistate Meningitis Outbreak Investigation page is to a page that is continually updated and changing. It's not a WP:RS, because it's not verifiable -- when somebody tries to get a fact, they get a page that doesn't support the claim that cites it.

We should change it to a fixed, unchanging page at the CDC, as I've been trying to do. In fact, since the CDC is a primary source, and WP:RSs should be reliable secondary sources, we should link to reliable secondary sources. The Wall Street Journal and New York Times have been publishing good stories about the epidemic, although some people may find other reliable sources. Just stay away from Yahoo News; they delete their stories before very long. --Nbauman (talk) 16:02, 11 October 2012 (UTC)


 * You removed my ref to the CDC for this statement: The investigation also includes fungal infections (septic arthritis) associated with injections in a peripheral joint space, such as a knee, shoulder or ankle. Those patients injected in peripheral joints only are not believed to be at risk for fungal meningitis but could be at risk for joint infection. Are you certain that the ref site will not bring the reader to that date's information? I worked extensively on the recent flu article and never had that happen. Also, nobody suggested that the CDC was not a good ref for the flu article. We used it a lot. I'm not trying to be ornery, just that I am surprised with what you suggest. BTW, I'm not sure why someone added, "(septic arthritis)" and I think it should be removed. Gandydancer (talk) 23:38, 14 October 2012 (UTC)


 * OK, I did a little checking and found that my ref went to "Current Situation" at the CDC and I can understand that site may be updated and the current information will move to a previous updates page. Even still, it does not seem right to me to add a "source needed", which usually suggests inaccurate information, to something that (I think) is important for the article and we both know is accurate. Gandydancer (talk) 23:59, 14 October 2012 (UTC)


 * Please read WP:RS. Every statement in Wikipedia, right or wrong, needs a citation to a WP:RS. doesn't suggest inaccurate information. It can be accurate, but it doesn't do us any good if it's not supported by a WP:RS. We can't tell whether it's accurate or not if it doesn't have a WP:RS. It's good scholarship. --Nbauman (talk) 04:21, 15 October 2012 (UTC)


 * Please quit telling me to read the WP guidelines and suggesting I know nothing about "good scholarship". The CDC is an excellent reference for this article and I did have a reference until you removed it. It should be returned and can be changed if new information is released. Gandydancer (talk) 05:15, 15 October 2012 (UTC)


 * I was trying to explain the meaning of . I don't understand what your objection is. You can't use a constantly-changing page as a WP:RS. Every statement in Wikipedia has to be verifiable. If I try to verify the Wikipedia article content by checking the page, the page has changed and it no longer verifies the content. I have to choose between adding or deleting the text entirely. You have to link to a fixed page.


 * Could you address that problem? --Nbauman (talk) 15:52, 15 October 2012 (UTC)

Colleagues: I feel that the CDC is a reliable secondary source for the aggregated statistical data. It meets the basic WP:RS criteria: 1) It is not anonomyous, 2) it has a longstanding and good repuation, and 3) It is aggregating and reporting data from primary sources. the traditional press is not the only possible type of secondary reliable source, and in some contextsw the traditional press is not to be trusted: see WP:MEDRES. It is true that there are problems with using the ephemeral page at CDC instead of a permanent page. Let's work together to fix this. The ephemeral page will be very useful for interested readers, so we should link to it somehow. However, we may need to use the (less ephemeral) topmost CDC page for formal references. Can we find an acceptable way to do this? -Arch dude (talk) 23:55, 25 October 2012 (UTC)

Reuters background story
Here's a good story from Reuters about how compounding pharmacies became popular to supply specialized formulations and generic drugs that were no longer available because they went off patent, how they had infections and other problems, which led to attempts at regulation, which they defeated by lobbying.

http://www.medscape.com/viewarticle/772696 Reuters Health Information Insight: How Compounding Pharmacies Rallied Patients to Fight Regulation By Sharon Begley Medscape, Oct 16, 2012

--Nbauman (talk) 21:10, 20 October 2012 (UTC)

Three cases of peripheral joint space infection
Some editors add this number to the article. Does anyone have a source for "three cases"? Gandydancer (talk) 13:30, 22 October 2012 (UTC)
 * That's a footnote on the CDC page: . We repeat that footnote on our table. the number is up to five now. -Arch dude (talk) 23:57, 25 October 2012 (UTC)
 * Thanks. What does "CNS" refer to here: Injuries 323 meningitis and CNS Why is it necessary to call meningitis a CNS injury? (The 5 non CNS makes sense) Gandydancer (talk) 01:42, 26 October 2012 (UTC)
 * CNS is "central nervous system." I Linked it. However someone has removed it. ~---
 * I now re-added this stuff, with the reference. It's necessary to refer to "meningitis and CNS" because while meningitis is a CNS injury, not all of the CNS injuries are meningitis. The fungus is attacking things in the CNS other than just the meninges. -Arch dude (talk) 08:53, 26 October 2012 (UTC)


 * The problem is, they seem to be referring to abscesses, etc. (Osteomyelitis, abscess or other infection (e.g., soft tissue infection) of unknown etiology, in the spinal or paraspinal structures at or near the site of injection following epidural or paraspinal injection), not further CNS injuries. Gandydancer (talk) 15:21, 26 October 2012 (UTC)
 * Well, yes, but this is far too much info to put in the infobox, so I shortened it up as best I could. The CDC is attempting to discriminate "infections that threaten the CNS" from those that do not. A better solution would be a one-word description for the CDC definition, with a link. -Arch dude (talk) 23:03, 26 October 2012 (UTC)


 * I think it would be better to either provide more info in the body of the article to explain it because to state CNS is not correct because it actually refers to meningitis and not an infection in the tissues near the injection site. I'd like to remove it... BTW, sad to say it seems that we are not going to be able to include info at the Meningitis article--that what happens when you get a bunch of editors more interested in their own sense of what's right for WP rather than what the average reader is actually looking for. More and more I find that the medical articles are reading like a medical textbook rather than including information that our unique position could offer. C'est la vie... Gandydancer (talk) 15:46, 27 October 2012 (UTC)

Reminds me of the Poly Implant Prothèse scandal, and the reasons
This event actually reminds me a lot of the Poly Implant Prothèse (PIP) scandal. Things starts out fine. Then the company directors starts to encourage or take short cuts that are dangerous for patients. But there are no checks or they check the wrong things. In the PIP case the sterility of the assembly were checked but not the substances used (breast implants). Patients start to get sick and the cause is traced. Media shock and court battles ensue. The actual culprints seems to be:
 * Shipped orders of the contaminated drug without waiting for final results of sterility testing
 * Failed to sterilize products for "even the minimum amount of time necessary to ensure sterility."
 * Mats used to trap dust and dirt outside the rooms were dirty
 * Sterile hoods were not properly cleaned
 * Boiler was leaking next to a clean room

Poor inspections (wrong things, too few, not thorough, etc), lack of vigilance on correlated compliance failures, insufficient regulation, all applies. As usual. Next some Harrisburg-II ..? Electron9 (talk) 01:06, 29 October 2012 (UTC)

Litigation section
I don't believe that we should list every single suit that has been filed. Thoughts? Gandydancer (talk) 03:16, 5 November 2012 (UTC)
 * Why not? it's not that large list. Electron9 (talk) 03:57, 8 November 2012 (UTC)
 * Why not? Because it's not encyclopedic to know that 61-year-old Lyn Laperriere of Michigan, 47-year-old Natalie Copass of Indiana and 46-year-old Brenda Bansale of Michigan have filed lawsuits. Gandydancer (talk) 15:24, 8 November 2012 (UTC)
 * WP:MEDMOS "Extract the pertinent information rather than just dumping low-level facts in a big list." --Nbauman (talk) 20:15, 23 November 2012 (UTC)

"In July 2015 the 14 suspects accused of being involved in a criminal conspiracy that led to the fungal meningitis outbreak were scheduled to go to trial in April 2016." This needs adding; a source is here: http://www.tennessean.com/story/news/health/2015/07/02/date-set-fungal-meningitis-criminal-trial/29639717/ Mydogtrouble (talk) 18:12, 25 October 2015 (UTC)

Politicizing of Overreach in Federal Government Regulations as 2012 Presidential Election Topic
This is a charged topic and I would like to see a section added to the article. Numerous mentions were made by GOP candidate Mitt Romney of burdensome regulations and this situation seems to epitomize the necessity of those regulations. Any thoughts? --Wikipietime (talk) 06:25, 8 November 2012 (UTC)
 * I can't imagine how you would relate it to this article without using OR. Gandydancer (talk) 15:28, 8 November 2012 (UTC)
 * If newspapers and other reliable sources had made such a connection (in more than just passing), we could incorporate that. Otherwise, as Gandydancer says, it's a WP:NOR violation to include any discussion. -- John Broughton (♫♫) 20:04, 8 November 2012 (UTC)

NECC should have been under FDA regulations as a drug manufacturer, but escaped that through some kind of political deal. WHO cut the deal to put it back under the MA Board of Registration in Pharmacy, which doesn't regulate manufacturers is the question. FDA regs would have been sufficient. Political deal-cutting caused this, not insufficient regulations on the books.--Anonymous209.6 (talk) 04:26, 16 November 2012 (UTC)
 * Article talk pages are intended for discussion about improving the article, not for discussions about the subject of the article. Yes, it's blatently obvious that politics and lobbying prevented FDA oversight, but unless we can find assertions of this in at least two reliable sources (WP:RS,) we cannot put it in the article. Furthermore, it belongs in the Compounding article, not here. If it were in that article, we could mention it in passing here, also. So, your mission, should you decide to accept it, is to find those reliable sources. If you find them but prefer not to update the article yourself, please just stick the sources here and maybe someone will have time to do the update. -Arch dude (talk) 17:37, 18 November 2012 (UTC)
 * Actually, that was a response to the question of whether Romney's general attitude to lower or more simple and exact federal regulations somehow could be used to coatrack onto this scandal. Answer is of course, no. However, it is also relevant to the current Congressional lobbying/advocacy of moving local compounding pharmacies (that actually function as compounding pharmacies) to obligatory sole regulation by the FDA. It also refers to the present entry that asserts the 2002 Supreme Court ruling simply reduced drug oversight; it only set the line between what States and the Federal Government SHOULD regulate, except by agreement. The allegation that the FDA could not have or should not have been in charge of NECC are false, and part of the story is not just that a political deal was at fault, but that current regs, IF FOLLOWED, would have prevented this tragedy. --Anonymous209.6 (talk) 00:43, 23 November 2012 (UTC)
 * The statement in the present entry that the 2002 Supreme Court ruling reduced drug oversight comes from the Wall Street Journal, a WP:RS. If you have a better source please supply it.
 * If the current regulations, if followed, would have prevented this tragedy, please supply a WP:RS to support that and we'll put it in. --Nbauman (talk) 10:04, 23 November 2012 (UTC)
 * WSJ is a little glib and superficial on why the FDA was "stymied", "in part" due to the 2002 ruling. Fortunately, the NEJM article has a table of what existing FDA regulations were violated. It remains that every reference lays the blame at NECC clearly acting not as a compounding pharmacy (state regs), but as a manufacturer (therefore under FDA regs and oversight). --Anonymous209.6 (talk) 23:55, 26 November 2012 (UTC)

Political content
I'm not really going to wade into this article as its a bit outside my interests, but just as a comment I was struck by its tone, which seems to be to obsessively calculate the exact level of blame assignable for every person and entity involved, and ensure that each of them is castigated appropriately.

We all know there was criminal behavior here, no shortage of regulatory negligence, and lots of legislative failure as well. But the moralizing is so thick it could be cut with a knife. As the truism goes, its not necessary to tell our readers that Hitler was evil. And to do so to some extent is insulting to the reader's intelligence. Just tell the story, they'll figure it out on their own! Formerly 98 (talk) 15:15, 15 October 2014 (UTC)

RE info that was removed
With this edit summary:

''Prescribing of steroids for back and joint pain: entire section gave a 1-sided view of a procedure that is supported by most systematic reviews published post-2013. Rehashing that debate here would be off-topic, so removed)'' and IP editor removed this section. I have restored it while I wait to see the recent reviews that the editor speaks of.  I don't see anything since the last Cochrane review.  Gandydancer (talk) 03:53, 21 September 2015 (UTC)

Criminal charges
Already formatted the source if someone wants to add to the article. MartinezMD (talk) 19:50, 3 January 2017 (UTC)

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Legislation
The article is somewhat long at 59kB (recommended divided at 60kB) and is about the outbreak. Why are the incremental dates of the vote steps of subsequent legislation needed when the final passage date is already in the section? The name, link, description, and passage date of the law are all in the paragraph as I had left it. The legislation is linked and it gives a detailed account of preliminary steps to pass it. In your reversion, you commented that it is not an improvement, but reducing long article sizes is. MartinezMD (talk) 16:50, 12 January 2018 (UTC)
 * Thanks for the note. The article is not too long and most certainly will not continue to grow.  The legislation section is not at all long and after the large number of deaths, the lack of federal oversight, the discovery of an unknown, to that date, health condition related to medical care for which treatment was as yet unsure, the scandal regarding the lack of safety in the drug factories and the almost unbelievable tactics used to cover it up, and on and on, I do not see the coverage of the legislation to address the incident to be overly long.  Gandydancer (talk) 17:50, 12 January 2018 (UTC)
 * We may have a difference of opinion as to whether the article is somewhat lengthy or not. The article size guidelines say "> 50 kB May need to be divided" and "> 60 kB Probably should be divided". The article is currently 59 kB, so it isn't some svelt trimmed piece of prose. The legislation section itself is not a straw that breaks a camel's back, but in the context of the article is a part that could be trimmed without affecting the overall quality, especially since there is an entire other article covering the topic. I would welcome other editor's opinions so we can see another perspective. MartinezMD (talk) 19:55, 12 January 2018 (UTC)
 * This is a lengthy article, but doesn't seem excessive. If you want to word things in a more concise way without removing information, go ahead. Natureium (talk) 19:58, 12 January 2018 (UTC)
 * That is my point. My question is is the reduction I made appropriate? I think I left all the relevant information, with all the greater details in the other article.MartinezMD (talk) 02:18, 13 January 2018 (UTC)


 * It should be kept in mind that we do not have a fungal encephalitis article and so this one serves that purpose as well. I put a lot of work into this article and IMO it has stood up very well. Also, the compounding article is IMO confusing and hard to read and it's hard to locate stuff as well.   Gandydancer (talk) 03:15, 13 January 2018 (UTC)

Deaths
The first paragraph states that there have been over 100 deaths, but the infobox only says 64. The number of sickened people and non-fatal injuries also varies. RajanD100 (talk) 01:23, 31 October 2021 (UTC)


 * Quote from the source "October 30, 2015 further updates to the case counts are not anticipated at this time." so it looks like the source is no good and we have to use the others. MartinezMD (talk) 05:54, 31 October 2021 (UTC)