Wikipedia:Mediation Cabal/Cases/2009-12-08/Bioidentical hormone replacement therapy

Where is the dispute?
Bioidentical hormone replacement therapy. See discussion page.

Who is involved?

 * User:WLU
 * User:Hillinpa
 * User:Riverpa

What is the dispute?
We have a dispute over definitions, and over how to decide what belongs in the article. It's convoluted and requires some understanding of the subject. The article begins with a definition of BHRT as menopausal hormone therapy using molecules that are chemically identical to the human hormones--those molecules are estradiol and progesterone. It goes on to say that BHRT is commonly associated with pharmacy compounding, saliva testing, and other practices. There is this confusion in the definition because bioidentical hormone therapy is available in two forms, FDA-approved products available in any pharmacy, well studied and regulated, and individually-compounded products made in compounding pharmacies with a doctor's prescription. BHRT is a hot topic because it is an alternative to conventional HRT which has been shown to be dangerous, so one would think that any high-quality citations indicating greater safety of estradiol and progesterone, the bioidentical molecules belongs in this article. WLU insists that no organizations' statements and no reviews regarding greater safety of FDA-approved progesterone or estradiol can be included unless the article uses the word "bioidentical" in the title or text. He's trying to create a distinction between "biodenticals" and the actual bioidentical hormones, estradiol and progesterone. He claims that otherwise one is guilty of original research--even though the article defines BHRT as using estradiol and progesterone at the start! So for instance: even though the International Menopause Society says that progesterone may carry less risk of breast cancer than non-bioidentical progestins, WLU edits out the citation since the word "bioidentical" wasn't placed in front of progesterone in the position statement, and the position statement was not about "bioidentical hormone replacement therapy", but only about postmenopausal hormone therapy.

He's insisting essentially that the article is about the word, "bioidentical", where it is found and what is said where the word is found, and NOT about what the word signifies--the female hormones estradiol and progesterone. Scientist just don't use the word "bioidentical" routinely in peer-reviewed literature or organizational statements--they know, and they know that their colleagues know that estradiol and progesterone are the endogenous hormones. The word "bioidentical" was invented to communicate to the public the idea of using only endogenous hormones. So insisting on the appearance of the word "bioidentical" means that lots of important, relevant expert opinion and research are excluded. WLU claims that any evidence that FDA-approved bioidentical hormones are better than FDA-approved non-bioidentical hormones is not admissible unless the study or review was specifically about "bioidenticals". Is it original research to make this "stretch" from "biodenticals" to the actual bioidentical hormones? I don't think so. He argues that all information about estradiol and progesterone that doesn't use the word "Bioidentical" belongs in another article--say on estradiol and progesterone specifically. I've told WLU that this is like writing an article on atomic energy, and refusing to use any sources that only say "nuclear" and not "atomic".

What would you like to change about this?
I want WLU to stop insisting that the word "biodientical" appear in any citation used in the article, even when the citation is about the hormones estradiol and progesterone--which are the bioidentical hormones. WLU should allow high-quality citations regarding the greater safety profile of FDA-approved bioidentical estradiol and progesterone in this article. I want this article to clearly deal with the two separate issues--the evidence in scientific literature about FDA-approved estradiol and progesterone compared to FDA-approved non-bioidenticals, and the questions/problems surrounding the compounding of the bioidentical hormones--which the article already deals with in great detail. Both issues should be included and kept appropriately separate. No one is preventing WLU from presenting his selections from the literature, but he is preventing everyone else from including important information and citations. I want this to stop.

Also WLU should not use "BHRT" throughout the article according to the second definition only, failing to differentiate between FDA-approved BHRT and compounded BHRT and other practices that are often attached to "BHRT" in articles. It must be clear at every point exactly which "BHRT" definition one is using. A Wiki article should define things clearly and keep separate what is separate. The goal is to transmit information effectively, not spread confusion.

How do you think we can help?
Please decide if no sources but those specifically using the word "bioidentical" can be included, as WLU maintains, or whether, since the bioidentical hormones in question are actually estradiol and progesterone by definition, that therefore studies/statements concerning the safety and efficacy of estradiol and progesterone replacement in menopause, using FDA-approved bioidentical hormone products, also deserve to be included in an appropriate section of the article.

Also decide on how the two definitions of BHRT seen in the beginning of the lead are to be handled in the article--shouldn't we have separate sections dealing with 1. the scientific evidence regarding estradiol and progesterone vs. non-bioidenticals, and 2. the safety and reliability issues surrounding compounding and other less-regulated practices? Using "BHRT" throughout the article to mean one or both these ideas is very confusing.

I guess it comes down to the question of whether a Wiki article about a word, or about an idea?? I think articles are about ideas. In this case, the idea is that of using only the molecules identical to the endogenous human hormones, and how this compares to using non-bioidentical hormone molecules. All aspects of this issue that can be well-documented should be included.

Please communicate your decision/ideas/advice to the editors. As it is this article is stuck.

Mediator notes
You folks seem to have this under control. I'll keep an eye on it, but not going to open or participate. Xavexgoem (talk) 19:12, 17 December 2009 (UTC)

Discussion
Sorry. Nothing is under control here. Please see recent discussion.Hillinpa (talk) 12:30, 23 December 2009 (UTC)
 * I'm inclined to agree that the page remains messy and contentious. WLU (t) (c) Wikipedia's rules: simple/complex 05:31, 28 December 2009 (UTC)