User talk:Geraldwgaines

Welcome!

Hello, Geraldwgaines, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are some pages that you might find helpful: I hope you enjoy editing here and being a Wikipedian! Please sign your messages on discussion pages using four tildes ( ~ ); this will automatically insert your username and the date. If you need help, check out Questions, ask me on my talk page, or ask your question on this page and then place  before the question. Again, welcome! Jytdog (talk) 01:05, 22 July 2014 (UTC)
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July 2014
Your account has been blocked from editing Wikipedia with this username. This is because your username, Depressionrecoverycenters, does not meet our username policy. '''Your username is the only reason for this block. You are welcome to choose a new username (see below) and continue editing.''' A username should not be promotional, related to a "real-world" group or organization, misleading, offensive or disruptive. Also, usernames may not end in the word "bot" unless the account is an approved bot account. You are encouraged to choose a new account name that meets our policy guidelines and create the account yourself. Alternatively, if you have already made edits and you wish to keep your existing contributions under a new name, then you may request a change in username by:
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If you feel that you were blocked in error, you may appeal this block by adding below this notice the text, but you should read our guide to appealing blocks first. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:23, 18 July 2014 (UTC)

Sorry for the unintended name violation, would have thought you would want disclosure of related-party posting, was not meant as advertising. Depressionrecoverycenters (talk) 11:51, 18 July 2014 (UTC)
 * I didn't know about this rule and appreciate the transparency. Please do put a bit of an introduction on your talk page though :) Testem (talk) 14:14, 18 July 2014 (UTC)

COI/advocacy
Hi Geraldwgaines. I saw your posting over at Testem's Talk page, where you provided this link. A couple of notes. Please read our WP:COI guideline, with special attention to the section on Wikipedia's Terms of Use. If editing Wikipedia is part of your job, and your contributions would be considered "paid contributions", you would need to declare that as per the Terms of Use. Separately, if you have a financial conflict with regard to people and doctors choosing to use ketamine, you should follow the COI guideline. We also have a "plain and simple guide" for editors with a COI - please see here: PSCOI. I also want to give you a heads up about advocacy on Wikipedia -- please see WP:Advocacy. There is a thin line between the two.

I've also added a standard "welcome" message above, which has links to key "policy and guidelines" (PAG) that govern our behavior and interactions here. Wikipedia is a pretty complex place. Being a radical democacy - "an encyclopedia that anyone can edit" - our PAG have evolved over the years to form a foundation for what we do here. Without them, this place would be an ugly, wild west kind of place. With them, this place can be exhilarating and even beautiful. One of the hardest things for new editors to grasp, is that PAG exist and provide the foundation for what we do here, and how we do it. I hope you are able to get grounded in them - glad to help if you have any questions. Finally, a quick note about passion. This is a volunteer project, and many folks who edit do so out of passion for some issue. This is a double edged sword. That passion can drive productive contribution, but it can also drive people to edit like advocates, and to behave tendentiously. Disputes among advocates - people here to drive their point of view into the encyclopedia, are among the ugliest and most protracted conflicts that break out, around here. I hope you can avoid that, and keep your eyes on our mission and the PAG through which we try to achieve it, together. There is a lot to learn, and it takes some time, reading (please do read the links I provided above!), and watching, to get the hang of things. Good luck! and as i said, glad to help. Jytdog (talk) 01:04, 22 July 2014 (UTC)

Hi Jytdog,

Thanks for the good advice. I won't cross any of the wiki ethical or practice guidelines because all I care about is the truth, and I don't assume any corner on that market. The fact of the matter is that with regard to ketamine wiki is dangerously out of date with the facts on the ground. All I'm trying to do is make it accurate, with appropriate caveats, so it is a level playing field for the uninitiated compared to those who are already benefiting either as patients, providers, researchers or investors.

My motivation is simple - that page is going to explode in use, if it hasn't already. I say this as someone who founded a ketamine clinic that has taken about half of the ECT business in town in one year of operation. I hate to guess the % of people that make medical decisions based on wiki alone, but whatever it is it is we would probably agree it is too high. I think I am totally in the wiki spirit by not wanting readers to be mislead by a flawed page? Not trying to be harsh, but the page was and is to some extent littered with unfounded propaganda using studies that are not relevant to the point the author makes. There have been some very strong hidden agendas in the writing, I prefer open agendas myself.

I am also concerned about exploding abuse as people try to self-medicate for emotional and pain illnesses since the medication is cheap but the treatment right now is expensive. I think an accurate wiki page can go a long way to helping people make good decisions.

As for process of change and wiki wars, I have neither the time nor the patience. If someone edits a contribution, we've discussed that like civilized people until they realize I'm right :) - OK, until I change the entry to meet wiki standards, with their often expert help. Works for me - I'm big on delegation. The active editors want an accurate page - I'm just giving them fresh data and suggested language. Now that I know better, I can keep all of that off the page until it is more settled language. THEN, it will get interesting.

Thanks again,

Ger Geraldwgaines (talk) 01:53, 22 July 2014 (UTC)


 * I hear you! It is not for me to decide if you have a COI, but please do read the guideline and reflect what you should do.  OH, I should have pointed you to this too Conflicts of interest (medicine).  That guideline is really great for someone like you, since it shows really clearly how your expertise can bring incredible value here  -- and also how not to use it.  With regard to driving content changes on the ketamine page, the best thing you can do is fine sources that comply with WP:MEDRS and generate content based on them.   Because we are all anonymous "editors", no one's authority in the real world matters here.  We love experts but (as I just mentioned) only when they use their expertise to bring great sources and summarize them eloquently and accurately.   Please also be aware of WP:MEDMOS (the style guideline for medical articles).  Thanks and good luck! Jytdog (talk) 02:18, 22 July 2014 (UTC)


 * what are you looking for help with, gerald? Jytdog (talk) 02:26, 22 July 2014 (UTC)

First, thanks for being so helpful. Having read your very reasonable standards on the Conflict of Interest Question, and on the standards for sourcing edits, I wanted to check with a real person as I have no interest in anything other than an accurate page. Simply, we have more data on the use of ketamine for depression than any clinic or research facility in the world. By we, I mean a 35-year experienced research scientist/entrepreneur, a 30-year experienced PhD. Psychologist and and 20 plus year experienced Anesthesiologist. We've conducted over 700 infusions, and I know more than a little about collecting the right data. Frankly, having already making a couple of fortunes, that is not my main goal, although I seldom turn money down. More to the point would be helping people like my three adult children not suffer needlessly from an illness that has an effective treatment.

So, path one is I take $250,000 from my family foundation and pay for an academic study that will take two years and be immediately challenged if even allowed to be published. Path two is I freely offer our data for anyone to review, and I suggest some conclusions that result from that data, and try to get it as broadly published as possible. I am trying to follow both paths. My question is that, with full disclosure, and assuming that my specific editing actions are completely within the wiki spirit and guidelines, do you feel this approach is appropriate?

Thanks,

Ger Geraldwgaines (talk) 02:50, 22 July 2014 (UTC)


 * Not sure what you mean about "a real person"... or if you are looking for me to answer. I will answer anyway, which you are free to ignore.  You are asking two very different questions.  One is essentially a biotech business question, or perhaps, a medical information dissemination question.    In my experience, if you want your work to be taken seriously by the medical community you are going to have to publish it in  a quality journal and get out to conferences and present your work to your colleagues.   Otherwise you will be seen (to be frank) as a flake.  If your work is solid it should indeed be publishable.  I imagine that if you indeed know something about collecting data, the data you have now is probably publishable in a crappier journal (since it is not a DB RCT).  Of course the DB RCT is the gold standard that everybody will be looking for and I reckon that is what you are aiming for with the $250K.   There seems to be a business opportunity here, opening treatment clinics where you offer infusions on an outpatient basis.  But to avoid getting in trouble with the FDA for marketing a drug off-label you would have to go for a 505b2 approval.  And to get referrals, again you will need solid publications, good talks at meetings, and FDA approval would be a huge validator and would allow you to market the clinics openly.   I imagine there are already reimbursement codes so you won't have to convince insurance companies.   If you wanted to get really gutsy you could work with Auspex and get rights to their novel deuterium-containing form of ketamine and bring that to market.  And you could probably attract third party investment with a novel compound (but i know that defeats the purpose of just using plain old ketamine). Anyway, that is that set of issues.      I agree 1000% that we need better treatments for depression.  STAR*D showed us that.  Ideally with a companion diagnostic to show who would benefit so patients don't have to go through the hell of titrating up, finding things don't work, titrating down, and starting the next one...


 * On the COI thing... my sense is that your clinic would make more money if more people knew about you and bought into your findings about ketamine. I would say you have a COI with respect to the use of ketamine to treat depression.   But you could post about your self at the COI noticeboard  - here: WP:COIN and ask for community input there.


 * Finally, as I wrote above, you are going to have a very hard time driving change in the Ketamine article without MEDRS-compliant sources about ketamine and depression. Jytdog (talk) 03:15, 22 July 2014 (UTC)


 * I think Jytdog already answered your questions better than I could have done; I have thus set the helpme tags to "helped". If you have further questions, please simply add a new helpme tag and ask away. Huon (talk) 19:50, 22 July 2014 (UTC)

July 2014
Hello, I'm MrBill3. I noticed that you recently removed some content from Ketamine without explaining why. In the future, it would be helpful to others if you described your changes to Wikipedia with an accurate edit summary. If this was a mistake, don't worry; I restored the removed content. If you would like to experiment, please use the sandbox. If you think I made a mistake, or if you have any questions, you can leave me a message on my talk page. ''The above message is generated by a template and is not completely applicable (you did provide an appropriate edit summary). The content you removed is supported by specifics with references later in the article. If you feel Moore and Turner's deaths and the reference given doesn't support that by all means make a case on the talk page. If consensus supports the removal I will remove it. It would seem that as you have disclosed information that would create a conflict of interest regarding this article it would probably be appropriate to propose changes on the talk page and get consensus rather than editing directly and boldly.'' MrBill3 (talk) 02:51, 27 July 2014 (UTC)

The removed content had no source. That is grounds alone for removal from wiki, on any page, much less a medical page. The link in the sentence has nothing to do with the content of the sentence. I'll let your change stand for now but, really? And as far as I know, the same point is made in my delete, but I'll check. Geraldwgaines (talk) 05:55, 27 July 2014 (UTC)
 * You are mistaken, as I pointed out the statement in the lead reflects sourced content in the body of the article. The lead summarizes content elsewhere in the article. If that content is sourced elsewhere an inline citation is not needed in the lead. I would suggest if you have objections to content you attempt to find consensus on the talk page of the article.
 * I repeat my urging that you post a clear COI statement. Your contributions can be welcomed and valuable if you follow policy, failure to follow policy can result in notice board discussions, topic bans, blocks etc. As you are new I am assuming good faith but involvement in editing an article where a COI is so blatant with no disclosure strains such good faith. I also question your assertions that no research is being done into the use of ketamine for mental health issues. That isn't what the article currently states and it references a 2013 study. I also repeat letting you know that WP is not the place to right great wrongs. Biomedical information requires MEDRS until the logjam/conspiracy/ignorance of the mainstream medical/governmental community is broken with high quality published research The Truth goes unacknowledged on WP. - - MrBill3 (talk) 07:25, 27 July 2014 (UTC)


 * With respect, please lay off the COI stuff and check the talk page of ketamine. I am using my own name and completely disclosed COI on the Ketamine question. Not on my user page as COI only relates to ketamine. If you think appropriate, I can copy or duplicate that here, but I am a little busy. Second, wiki is the place for verifiable proof, and the ketamine page is littered with exactly the opposite with use of sourced material that either does not meet wiki standards when examined or whose written statements have used results from limited studies and taken them out of context. Case in point, the sentence in question now has a source - and it is MAPS. MAPS is an agenda-driven organization that would never be able to get anything into mainstream medicine and has a wiki entry in the first section based it appears on a book they published. Is this the wiki standard in medicine you are trying to defend? Check my other edits, they are all changes in wording to reflect what is actually presented in the underlying research. So you understand completely where I am coming from, I am a very accomplished data nerd with a clear COI on this issue, and well armed from life experience to change the page EXACTLY according to wiki standards, with admittedly a few stumbles as I learn. Again, I will not delete the sentence at this point, partly because it so well demonstrates the problem on the page, but it will be deleted by consensus, I would bet. Geraldwgaines (talk) 13:47, 27 July 2014 (UTC)


 * Ger, quick note. Although you are a very accomplished guy and are very busy, you appear to want to work on Wikipedia, and as I told you, there is a learning curve to working here - it takes time and there is a boatload you don't know yet. A way more productive and self-aware response to MrBill3 would have been something like: "First, I thought I did make a COI disclosure.  If there is some other way I am supposed to make the disclosure that I am not aware of, would you please explain that to me or point me to the place where I can figure it out for myself?   Second, I don't understand what you think I did wrong in deleting that text - it wasn't referenced and I thought that meant it could be deleted.  Would you please explain why you think it is OK to leave it? (and btw I did leave an edit note...)"  Something like that - where you ask real questions and try to learn.  If you continue and continue in the attitude of your response above,  here is what will probably happen --  you are going to get frustrated and stop working here, and you are going to waste the time of a bunch of other editors and frustrate them, and if you establish a pattern of editing and responding like this, they will likely start working to get you topic-banned (if you haven't quit already)  It could unfold quickly or in a slow-motion ugly death spiral - I've seen it play out many times.  None of those are good outcomes.  You will of course choose to do as you will. Good luck. Jytdog (talk) 16:33, 27 July 2014 (UTC)
 * Jansen 2001 is an acceptable source for the high profile deaths from recreational use of ketamine. If you feel otherwise take it to the Reliable sources/Noticeboard. - - MrBill3 (talk) 23:10, 27 July 2014 (UTC)
 * Thank you for stating you have a conflict of interest. I have added the involved contributor template to the ketamine article. Please do not interpret this in any way as intending to have a chilling effect on your participation on Wikipedia. Editors with a COI are welcome to contribute so long as policy is followed. As a self described data nerd I encourage you to find and provide high quality sources. Best wishes and happy editing. - - MrBill3 (talk) 23:34, 27 July 2014 (UTC)

Welcome to WP
Welcome to Wikipedia and thank you for your interest in improving the encyclopedia. I want to strongly suggest you post a clear conflict of interest notice. Take some time to familiarize yourself with the core policy here Verifiability and the guideline WP:MEDRS. Note that WP is not the place to right great wrongs. If information is not published in reliable sources it does not belong on WP. If you run a clinic which administers Ketamine a conflict of interest clearly exists in relation to the article on Ketamine. All that said, if you have suggestions for content backed up by quality sources post them to the talk page of the article for consideration and if they are supported by consensus they will be included. If there are not MEDRS quality sources for biomedical information it doesn't get on WP. I hope you enjoy editing Wikipedia and continue to contribute. - - MrBill3 (talk) 03:21, 27 July 2014 (UTC)

Recreational use has led to high-profile deaths.[7] - Really??
Is this what you want wiki to be? Recreational use of everything from skateboards to cars has resulted in "high=profile deaths". Is that in their first section in wiki?

No one has died of an overdose of ketamine.

The indirect deaths referenced are already in the recreational use section, where this sentence belongs anyway, if at all.

Where is the language to put the number of deaths in the context of the number of lives saved?

Where is the COI disclosure of the poster, and is it really complete? I know mine is.

Is the source according to the wiki medical guidelines?

Every time a sentence about abuse is edited to put it in some context, it is deleted. There is an undisclosed COI agenda working this page, IMHO. Geraldwgaines (talk) 02:55, 28 July 2014 (UTC)


 * First I have raised the question on the talk page of the article, where this discussion belongs. Second deaths related to cars and skateboards is irrelevant to the ketamine article and are in fact discussed. Third recreational use of ketamine is a substantial part of the discussion of the drug in the literature and the WP article, a summary of this content belongs in the lead, as mentioned in my query on the talk page. Surely you're aware of the depth and volume of literature that discusses the recreational use and that much of the literature on medical use discusses it's recreational use. Third read and understand the MEDRS guideline, the deaths of two prominent figures historically involved in ketamine use while using ketamine is not biomedical information. As I have said if you don't think the reference supports the content take it to RSN.
 * And finally, your assertion of COI is rather ridiculous. What interest would you be asserting? Read the COI policy. While you are at it read the policy on No personal attacks and the guideline on Disruptive editing. I am working to Assume good faith but your statements and attitude demonstrate a lack of understanding of the WP:NOT policy section Wikipedia is not a battleground. I think has given you some sage advice you would do well to heed. Your clearly battleground mentality and personal attacks are not appropriate please consider your actions on WP with some care. I am weary of dispute resolution mechanisms and notice board reports but a failure to maintain civility and collaborate to build consensus will lead to problems that require these processes.
 * You might note some of the proposed additions of content I have made on the talk page of the ketamine article and take a look at some of the sources I have added or proposed adding.
 * Statement - I have no conflict of interest that would in any way effect my editing of the article Ketamine.
 * Best. - - MrBill3 (talk) 03:52, 28 July 2014 (UTC)
 * I just wanted to drop you a note and let you know it seems you have identified what seems to me to be a problem with the article. The discussion in the subsection "Long term" of "Side effects" doesn't seem clear enough in distinguishing when the effects of medical use vs the effects of recreational use/abuse are being discussed. This is one of the issues I am likely to mention when I bring the article up at Project Medicine. There are also issues with the Administration section, it doesn't adequately describe the dose ranges for various uses. As a note we are unlikely to include dose ranges for off label uses without a strong source. The issue of side effects occurring at abuse dosages vs medical use ranges I think should be clear, additionally the med dose ranges for pain (and I'm guessing mental health conditions) are substantially less than those for anesthesia. It seems there are three dose ranges: abuse, anesthesia, low-dose and the side effects/risks are almost certainly different. I am about half way through the existing references in terms of formatting and a quarter of the way through in verification. Also the possible issues with neurological side effects is actually described in the literature as hotly debated, this will probably be included.
 * As you have self described as a data nerd perhaps you could find the existing studies on the uses of ketamine you are interested in having included in the article. Please post them to the talk page of the article if you do so. They will need to be considered for due weight and evaluated per WP:MEDRS but the article is long enough some discussion of moderate quality studies can possibly be included. I understand your frustration another editor knows from experience ketamine is often used for asthma in ITU/ICU but the sources seem scant. Science, the academic mainstream and published literature can lag behind practice. While not wanting to sign up for a conspiracy theory generic drugs studies don't get the funding of patented meds.
 * Just so you know I edit WP because I enjoy it, I value the knowledge I gain in the process and I care about bringing knowledge and accurate information to those who seek it. I hope you find the time and have the interest to bring your skills and knowledge to improving the encyclopedia. - - MrBill3 (talk) 16:06, 28 July 2014 (UTC)

Mrbill3 and the wiki community at large - As I have on the ketamine page, I will not edit anymore directly and instead seek competent help that has the time to do so. I will post on talk pages as the preparation is much less and the timeliness less critical. As for my tone, I mean no offense, but I also am not known for my subtlety when I think direct methods are called for - and this is one of those cases. I think people would assume from my COI disclosure that I am interested in editing this page to promote the use of ketamine for emotional disorders. That is not the case. It is the unintended consequences of having a grossly inaccurate page I am worried about. Based on my reading of the situation, the rush to ketamine to treat various disorders that a compound that causes dramatic neurogenesis works on is now becoming an inevitable wave. I've seen these technical tsunamis hit industries multiple times and I don't think this is going to be any different. And the wiki ketamine page is going to be the first stop of many people in deciding whether they should seek medical treatment or self-medicate. With treatment prices at $5,000 per hour in some cases, you are going to get a lot of self-medicating going on. And thus a lot of abuse. Wiki can help people make good decisions by accurately representing the medication as one used in standard medical practice at controlled doses that has been used as a drug of abuse at high doses.

Unfortunately, as it stands, the ketamine page is a classic case in lying with statistics, using studies with very limited subjects, in limited exposures, to make claims that are often out of the scope of the research. This is not the kind of thing on this scale that happens accidentally - it does not take conspiracy theory to realize that a generic medication with no economic support is not going to fare well against tens of billions of dollars in sales of patented medications. I have been on the board of directors in large companies in multiple similar instances and it would be considered a management failure not to dedicate a million dollars or so to manage the wiki page. That is just real life. Most importantly, the very sources that wiki depends on are not reliable in a case of a generic vs. patented medication. The FDA has been funded primarily by pharma since the mid 1990's. The vast majority of the medical journal editors and the research they review is sponsored by large pharma. It is not even close to an even playing field for a generic medication. There is no conspiracy, just economics. They teach this stuff at Harvard Business School.

Finally, and I am really amazed by the lack of knowledge here, is that there is no serious money behind the neurotransmitter theory of mental illness anymore. This is what is meant by the euphemism that there is "nothing in the mental health pipeline". The neurotransmitter-based drugs have been proven multiple times over to not work any better than placebo. All of the money in mental health research is in neurogenesis or epigenetics. And no one is talking or publishing. The only people who still believe in the neurotransmitter theory are drug salespeople and practitioners. The patients certainly don't believe anymore. Ketamine is at the front lines of those battles as it binds to receptor sites in the brain, causes neurogenesis in what may be an anti-inflammatory mechanism and is also known as a strong epigenetic compound. Oh, and it lowers ego boundaries in a way that facilitates effective therapy. Wiki is missing out on all of this due to the publishing standards, but I would ask editors to consider what should be included in the non-medical sections to properly reflect what is happening on the ground.

Mrbill3, if you are interested in help, I would be happy to review your edits and suggest more data or different interpretations to help make the additions be more accurate and contextually correct. Based on your comments, we don't have a difference in objectives, just a difference in perspective regarding the challenge of this wiki page. Oh, and you're a much nicer guy (assumption on gender) than I am.

Geraldwgaines (talk) 11:49, 30 July 2014 (UTC)


 * To respond, No. No to pretty much everything you said above about the ketamine article and about Wikipedia.   You still don't understand Wikipedia.  It is not a blog or platform for advocacy.  We express mainstream knowledge as expressed in reliable sources.  You don't seem to have taken the time to read WP:MEDRS yet nor to grasp how essential that guideline is to the whole encyclopedia.  Like many advocates, you want to allow or push all kinds of positive content into the article you care about.  What you fail to take into account, is that lowering the sourcing standards opens the entire encyclopedia to boatloads of quackery pushed by advocates who are as passionate as you are.  Do you want to see long articles in WP about how great Psychic surgery and magnet therapy and the like are?  Real question!  There are people as passionate as you who would have that.    MEDRS is what prevents that.    Advocates are generally not here to build an encyclopedia and you are demonstrating that.  You are free to keep making statements like this on your Talk page of course.  But I don't see how it is helpful to you.  I do see how it is harmful to you.   By now, I am pretty much out of patience and this is probably the last time I will respond to you.


 * I will however say the following one more time, which I have already suggested to you a couple of times. If you are an expert in the field, you should be very aware of literature that supports the kind of content you want.  It should be brain-dead easy for you to 1) provide citations to articles that comply with WP:MEDRS and 2) suggest actual content for the Ketamine article based on those sources.  You can post the proposed content and the supporting citations on the article Talk page.  That is a constructive and efficient way to actually improve the article.  Anyway good luck to you. Jytdog (talk) 12:27, 30 July 2014 (UTC)

This is the kind of response that makes me question other COI around here. I clearly stated I was no longer posting other than the talk page, and the advice after 500 words is for me to post on the talk page?? Mmm. And I clearly have stated the need to maintain high medical standards in posting, and I'm accused of suggesting a lowering of the standards? Mmmm. I'm called an "Advocate" when I give full disclosure about my position and my credentials to analyze data objectively? Mmmm. I would point out that this response is a beauty of disinformation that makes it appear as if I've suggested the things listed when I have expressly not done that. Just like the Ketamine page itself. Mmmmm. Interesting. Geraldwgaines (talk) 19:28, 2 August 2014 (UTC)
 * and again, instead of asking real questions and trying to learn, you are asking rhetorical questions, making arguments, and accusing other editors of COI. And you still haven't suggested any articles you think are of high quality, nor suggested content that you feel would help people. I don't know how to help you. Jytdog (talk) 19:59, 2 August 2014 (UTC)

Apparently there is fairly substantial investigation of ketamine for depression
Jytdog has found a pair of reviews and some other sources discussing ketamine for depression (see the talk page of the article). UCSD also seems to have developed a protocol see. - - MrBill3 (talk) 11:24, 29 July 2014 (UTC)