Wikipedia talk:Manual of Style/Medicine-related articles/Archive 3

Bolding, linking & coloring of elements in drugbox/infobox chemical formulae
The links to elements inside chemical formulae in drugboxes and infoboxes generally use bold-face, as in Vitamin C, for example. However, in some pages, e.g. Caffeine, the links use non-bold, which is a bit inconsistent. The current MEDMOS seems to be silent on the matter, and I propose it should be updated to give some guidance one way or the other. I'd very much like to hear others' thoughts here, and see what the consensus is. - Neparis (talk) 16:01, 22 February 2008 (UTC)
 * WP:MOSBOLD is not silent. Sandy Georgia  (Talk) 16:02, 22 February 2008 (UTC)
 * What is the consensus regarding the current style in drugboxes, such as in Vitamin C? Is it wrong to use bold face for the links to elements in the chemical formula inside the drugbox? - Neparis (talk) 18:06, 22 February 2008 (UTC)
 * I subscribe to MOSBOLD, that any other bolding is extraneous, disruptive, and ugly. Sandy Georgia  (Talk) 19:10, 22 February 2008 (UTC)
 * I'm a fellow subscriber to MOSBOLD, but I also subscribe to WP:CONSENSUS and IAR, and notice that over 50 different editors to the drugbox in the last two years have apparently decided to ignore all rules and use bold for element symbols. - Neparis (talk) 01:04, 23 February 2008 (UTC)

(outdent) The drugbox template has used bold (and unique element colors too) right under our noses since March 23, 2006 (at the latest). The advantage of bolded element symbols is that they appear more strongly "attached" to their subscripts. The use of multiple visual cues — bolding and unique element colors — creates a Gestalt emergence of the element-subscript pairs as high-salience features, improving the readability of the formula:

Without the bolding and colors, however, the relative salience of the element symbols is reduced:
 * C6H10N4O2S2

Going further by removing the links too has the further disadvantage of making it impossible for readers unfamiliar with chemistry to hover conveniently over the element symbols to see what they mean:
 * C6H10N4O2S2

I think the bolded, colorful, linked formula is the quickest one to decipher at a glance, and also the most useful one for lay readers. I'd like to hear what other people think. - Neparis (talk) 01:04, 23 February 2008 (UTC)


 * Kinda makes ya wonder how any of us got through Chemistry back in the days when textbooks were in black and white. Mixing fonts and colors is ugly and distracting. (Almost as bad as infoboxes :-) Sandy Georgia  (Talk) 01:26, 23 February 2008 (UTC)
 * Nooo... the very foundations of Wikipedia as I know it are being rocked! :) Come on, Sandy, we all know that the occasional breach of guidelines can improve an article (or infobox, as it were). Honestly, I'm so used to this formatting that I've never even considered otherwise; I don't think using regular type (or no element colors) would be an improvement at all. This accessibility-inspired edit was an improvement, however, and I wasn't too enthusiastic about it at the time. Fvasconcellos (t·c) 01:45, 23 February 2008 (UTC)


 * (ec) Yeah, color in a would-be multimedia encyclopedia is truly repulsive. We'll deal with shades of grey later. Signed, the Monochrome Cabal :-) - Neparis (talk) 01:50, 23 February 2008 (UTC)
 * OK, so go over to WP:MOS and get it added there; MEDMOS shouldn't be put in a position of contradicting MOS, since WP:MOS is where bolding and fonts are dealt with. MEDMOS is where we go beyond MOS, for other items specific to health-related articles that aren't addressed in MOS. We need to avoid having MoS subpages contradict each other, and boldface is dealt with elsewhere. I won't fight for it there, since it combines two things I hate (infoboxes and mixed fonts), but I won't oppose it either, since the great Fv has spoken in favor :-))  Sandy Georgia  (Talk) 01:56, 23 February 2008 (UTC)
 * Hey, I may not be as great as the great Fv, but if you wanna imply it again, especially in black-and-white text, I'll lob some c o l o r f u l language in your direction :-) Ok, thanks for your input. I'll take it over to MOS later, no hurry though. - Neparis (talk) 02:22, 23 February 2008 (UTC)
 * Unless it's something you need settled right away, you might want to wait a week or two on MoS, since things have been a bit topsy-turvy over there lately. And see how others here feel, so you'll either have support there, or know what you're up against. who, me, in a bad mood over MoS?  Nah ...  Sandy Georgia  (Talk) 02:30, 23 February 2008 (UTC)
 * See also? Blarg.
 * With a very passing familiarity with chemistry, I think the colors look odd and aren't necessary - capital letters followed by lowercase numbers = chemical formula. Linking the individual letters seems the most useful (theoretically, done once) but is still gratuitous to a fairly large extent.  But I can't speak for someone who has never seen the chemical formula for a carbohydrate.  WLU (talk) 02:33, 23 February 2008 (UTC)


 * Yeah, I saw civility cowering in the corner, and will wait a while before going there again. I was made to feel welcome MOS-style earlier today when I asked whether a 600-kilobyte long talk page could be archived! - Neparis (talk) 02:49, 23 February 2008 (UTC)
 * And you say what a convoluted answer you got to that straightforward and necessary proposal :-) Now just imagine something as earth-shattering as fonts and colors !! Sandy Georgia  (Talk) 04:52, 23 February 2008 (UTC)

I'd like to point out that many of us at wikichem aren't too keen on wikilinking or coloring (and bolding by inference) element symbols. See the past discussions:
 * Wikipedia_talk:WikiProject_Chemistry/archive12
 * Wikipedia_talk:WikiProject_Chemicals
 * WikiProject_Chemicals/Style_guidelines

--Rifleman 82 (talk) 07:10, 23 February 2008 (UTC)


 * Chemical formulae are more like mathematical formulae or, indeed, a picture made out of letters, than prose. I've no strong opinion either way, but note that Manual of Style (mathematics) lists two exceptions to WP:MOSBOLD:
 * Commonly used sets of numbers are typeset in boldface, as in the set of real numbers R
 * Some authors prefer to use an upright (Roman) font for dx, and Roman boldface for i.
 * The MOS is also silent on the use of italic in maths formulae (though mention a case not to use italic).
 * If there isn't a good reason why the pharmacists and chemists should disagree, then both groups should be involved in finding one consistent presentation. Colin°Talk 10:14, 23 February 2008 (UTC)


 * I have no opinion about the bold, but CPK coloring provides guidance about the colors. --Arcadian (talk) 17:28, 23 February 2008 (UTC)

Medical devices
I notice that we have a manual of style for Drugs and for Diseases. However, we lack one for medical devices that have therapeutic (or diagnostic) uses. I've been staring at the MOS for Drugs, which has some applicability, but there has to be some modification. Can we create one? Orange Marlin Talk• Contributions 17:35, 25 February 2008 (UTC)
 * A section could be added to this page; what would it need to say that isn't already covered here or at WP:MOS? Sandy Georgia  (Talk) 17:40, 25 February 2008 (UTC)
 * Well, on the project page it lists out the sections for an article on drugs. Devices require the same detail, but of course, they act mechanically (usually) rather than pharmacologically.  There are probably as many therapeutic devices available for use as there are drugs, and my read of a few of those devices indicates they're more advertising for the device companies rather than an NPOV article.  With a WP:MEDMOS standard for medical devices, we can begin building a strong core of device articles (which is really my expertise).  I propose we do the following:


 * History
 * Indications
 * Contraindications
 * Risks
 * Design of devices
 * Mechanism of action
 * Procedure
 * Legal status (including FDA and EU requirements, including approved products)
 * Veterinary use
 * References
 * External links (avoid if possible) —Preceding unsigned comment added by Orangemarlin (talk • contribs) 17:46, 25 February 2008 (UTC)


 * You might be interested in the archived discussion at Wikipedia talk:Manual of Style (medicine-related articles)/archive1 where I put together some examples from the featured articles. This showed that many of our "best" articles didn't follow what people thought should be standard sections. Some have subsequently been brought into line and possibly MEDMOS changed its set too. I do remember noticing the drugs were all over the place. Since standards should be based on best-practice rather than theory, a good idea would be to collect a set of good "medical device" articles for people to examine. I suspect from your comments, that you think there aren't many good articles in this area.
 * I wonder if therapeutic devices are quite separate from diagnostic (or other) devices (compare Artificial pacemaker with Stethoscope). The former does share a bit with Drugs, as do other therapies such as diet, talking therapies, and physical therapies. As an example, I had a go at reformatting Ketogenic diet according to MEDMOS (the studies/research sections are still an unorganised lump). Perhaps we need a "Therapies" section, with subsections or exceptions/additions for drugs, medical devices, etc. Colin°Talk 18:04, 25 February 2008 (UTC)


 * I realize a lot of FA's don't follow this MOS precisely. However, having a standard keeps articles clean, and really keeps the cruft away (which can get in there fast).  I'm more concerned about therapeutic devices now, moving forward.   Orange Marlin  Talk• Contributions 18:10, 25 February 2008 (UTC)
 * The list looks good to me. Is the italic stuff after "Legal status" necessary? Illicit use? On second thoughts, I probably don't want to know :-). I've just looked at Vagus nerve stimulation, which has effectively no sections. Is this the sort of device article that interests you? It has been on my ToDo list for ages, and I never get round to doing. Colin°Talk 18:21, 25 February 2008 (UTC)
 * How do I put the list on the project page? I'd like to refer to it as we clean up articles.  I don't know this for a fact, but it's clear that a lot of the medical device articles are written by  the device company.    Percutaneous coronary intervention is an example of one that needs total cleanup, starting with that inane title.  And when I read the Vagus nerve stimulation, with cleanup it will quit reading like CAM cruft.   Orange Marlin  Talk• Contributions 18:28, 25 February 2008 (UTC)
 * If you don't mind, please wait for several other editors to weigh in before adding it. We should give it several days.  MoS discussions can become surprisingly contentious for the silliest reasons, so it's best to give others a chance to have a look. For example, I want time to compare it with an advert/COI mess I became aware of at Anti-stuttering devices to see if these sections work.   Sandy Georgia  (Talk) 18:32, 25 February 2008 (UTC)
 * I think I also want to take a look at Deep brain stimulation to see where it would fall. Before we start adding to MEDMOS (which was very stable until our recent drug obsessions), we should make sure we've covered all bases.  Sandy Georgia  (Talk) 18:33, 25 February 2008 (UTC)

Some topics: Colin°Talk 19:00, 25 February 2008 (UTC)
 * I assume "procedure" covers the op to insert an internal device, along with any post-op recovery and adjustment. What about wearable devices like braces, hearing aids, artificial limbs? Is there an alternative term (e.g., "Fitting")?
 * I'm using an unwritten understanding of what a medical device is--it's a therapeutic or diagnostic disposable product. Braces, hearing aids, artificial limbs, and the such are generally categorized as durable medical equipment (DME).  This could go crazy, I know, but a hearing aid does not actually treat a disease in the way a stent or pacemaker might. Therefore, my idea of what is a procedure is how the device is used to treat a disease state, much like a drug. Orange Marlin  Talk• Contributions 22:00, 25 February 2008 (UTC)
 * A device that is left in long term probably needs the equivalent of "prognosis", and may require repeated adjustment, battery replacement, or total replacement.
 * Yes, but I'm not interested in those toys, I'll stick with the ones about which I have knowledge. You'll have to attract someone who might know something about them!!!  :)   Orange Marlin  Talk• Contributions 22:00, 25 February 2008 (UTC)
 * Failure/success rates wrt treatment
 * Yes.  Orange Marlin  Talk• Contributions 22:00, 25 February 2008 (UTC)
 * Risks/Complications
 * Yes.  Orange Marlin  Talk• Contributions 22:00, 25 February 2008 (UTC)
 * Range of products (different kinds, different manufacturers) -- this doesn't really apply to drug articles (more like drug classes like benzodiazepines).
 * Complicated, but yes. Attracts the corporate marketing types, but we can revert their nonsense.  22:00, 25 February 2008 (UTC)


 * I agree an MOS is needed both for diagnostic and therapeutic devices, with a sensible structure that allows for quick navigation to the relevant facts. As such, I would move the "history" section where it belongs - at the end. I agree with Colin that we should try to answer reasonable questions as long as the information is available from reliable sources. We should avoid turning the whole exercise into a Which? Medical devices edition, but I think many people who have an artificial pacemaker or implantable defibrillator will want to know what will happen if the battery runs out and they are non protected! JFW | T@lk  20:38, 25 February 2008 (UTC)


 * I strongly agree with Colin that "Since standards should be based on best-practice rather than theory, a good idea would be to collect a set of good 'medical device' articles for people to examine."


 * I've written about drugs, and also medical devices, for years, and I don't think you could start with a drugs template and modify it. (The US FDA, for example, regulates drugs and devices differently.) There are many issues that work differently in drugs and devices. For example, doctors and regulatory agencies usually expect randomized controlled trials to prove the efficacy of drugs; they very often don't require RCTs for devices. It takes $300 million to develop a new drug; I've talked to surgeons who developed a new device in their (FDA-approved) basement. Also, in my experience, the device companies are much more heavy-handed in promoting their products than the drug companies.


 * A MOS for devices is an attractive idea. It will take a hell of a lot of work. Reading good (and bad) articles is a good place to start. Nbauman (talk) 21:20, 25 February 2008 (UTC)


 * Everyone I've read reads like a corporate shill wrote them. I imagine before this group was founded on Wikipedia, the drug articles probably read like advertising.  I'll look around for one or two.  I guess I can point you to some that really suck.   Orange Marlin  Talk• Contributions 22:01, 25 February 2008 (UTC)
 * Just go back a few months in anti-stuttering devices; it was written by the owner of a company that makes them, cleaned up somewhat since by Slp1 and myself, but still in bad shape. Sandy Georgia  (Talk) 22:04, 25 February 2008 (UTC)
 * Stent, one-time important product to the medical industry, is one article that is badly written. It doesn't give weight to the complications associated with it, it is poorly written, etc.  I'm trying to find one that I tried to edit and watch, but got so frustrated with the JNJ-Cordis marketing nuts editing it.   Orange Marlin  Talk• Contributions 22:05, 25 February 2008 (UTC)
 * This is a big problem; we need to take time to seriously address it. What guidance do we give about manufacturer lists, to keep the articles from becoming adverts, or is that already covered by some other guidelines?  Sandy Georgia  (Talk) 22:12, 25 February 2008 (UTC)


 * One of the problems with medical devices is that most of the information comes from manufacturers. There are no generic vascular stents, AFAIK. Everybody uses manufacturers' names and brand names of stents, because those are the only names. (And the particular device makes a big difference.) When the surgeon buys a stent, he's buying the technical support of the company more than the product. Nbauman (talk) 22:47, 25 February 2008 (UTC)

There are numerous publications about what a stent can and can't do. So there is a "generic" stent that can be derived from the literature. Moreover, there are clinical studies, FDA approvals and recalls, and other reliable and verifiable citations that can be used.

Sticking with stents, in general a stent does one thing--scaffold the stenosis. Now there are radioactive stents, drug-eluting stents, and different materials in stents. But there is a "generic" version. We can take most therapeutic devices (e.g., pacemakers, shunts, or even an iron lung), get substantial amounts of references to support almost everything we write. Yes, the individual products from each manufacturer may be a small article (and we could even write a MOS to cover individual products basically giving the name of the product, it's indications, and referring to the main article). I'm just thinking this thing through, but I'm liking the direction we're going.

BTW, a surgeon doesn't place a stent, an interventional cardiologist or interventional radiologist does. But I'm picky about these things. :)  Orange Marlin  Talk• Contributions 23:17, 25 February 2008 (UTC)


 * I'm working on Drug-eluting stent as a test on how to make this work. Many of the edits appear to be from anonymous editors from Miami Lakes, FL, home of JNJ-Cordis, one of the big promoters of this technology.  Since it was so badly written, let's clean it up testing out an MOS that makes sense.  We're not going to make it any worse than it is now.   Orange Marlin  Talk• Contributions 01:41, 26 February 2008 (UTC)
 * I'm not sure how effective MEDMOS can be at dealing with COI and POV pushing; have you reported to the COI noticeboard? (Not that Slp1 and I got much help there with the stuttering article.) Sandy Georgia (Talk) 01:47, 26 February 2008 (UTC)
 * Besides, you've got this. Put a big bold COI tag on the article, and that'll learn 'em. When you want to track down COI/Spam reports, just check "What links here".  Sandy Georgia  (Talk) 01:51, 26 February 2008 (UTC)
 * And it looks to me like is from New Jersey.  Sandy Georgia  (Talk) 01:56, 26 February 2008 (UTC)
 * Well, I'm not going on the attack (NJ being the other HQ of JNJ-Cordis). I'll just clean it up, since I don't have a COI issue.  Well, other than the fact that I think good old CABG works much better (my opinion, and the literature backs me).  I'd rather cleanup first.  if the COI types come back, I'm going to utilize the various Wikipedia tools.   Orange Marlin  Talk• Contributions 02:11, 26 February 2008 (UTC)
 * Could we develop this new device section in a manner that it could also be applied to medical procedures? Guidance is needed there as well. --Arcadian (talk) 02:24, 26 February 2008 (UTC)


 * I'd like to know in the introduction what the debate is over CABG vs. stents. What are the indications? What do we know on the basis of good randomized controlled trials, and what don't we know? The article that follows is pretty complicated. I'd like to know the question that I'm supposed to be looking for the answer to when I read it. (Incidentally, that FDA link gives a 404 error.)


 * I read those 24 January 2008 NEJM articles, BTW. Does that mean that CABG is always better and we shouldn't use stents any more? How about patients who arent't able to tolerate open surgery? Here's what Cochrane says http://www.cochrane.org/reviews/en/ab004588.html How does that fit in? Nbauman (talk) 05:30, 26 February 2008 (UTC)

Break
I haven't paid attention to this place for a couple of weeks, being distracted by other articles. How do we proceed with a medmos for Medical Devices? I'm new to this arena of Wikipedia, so I don't know how to proceed. I'm willing to get some sort of consensus. Orange Marlin Talk• Contributions 21:01, 21 March 2008 (UTC)

Help???? Or should I just do it? Orange Marlin Talk• Contributions 00:44, 24 March 2008 (UTC)
 * Can you put together a draft in your userspace, and show us what it looks like? --Arcadian (talk) 01:41, 24 March 2008 (UTC)

Virus articles
It seems quiet in here so I thought I would start a discussion about guidelines for virus articles. In some cases it makes sense to have separate articles for the virus and the viral illness, HIV and AIDS for example, but in other "simpler" cases, (Rotavirus, it can be done together. For Rubella, we have three: Rubella, Rubella virus and Congenital rubella syndrome. Clearly CRS needs it own article, but Rubella and Rubella virus? (Yes I know I started the latter). I've discussed this issue with Colin, and without wanting to speak on his behalf would probably agree that Wikipedia needs guidelines on this.

My second related point is about the structure of the simpler virus/viral disease articles. This came up time after time with Rotavirus and as I said in response to a suggestion at its recent FAC, the article had been reorganised more times than a Rubik cube. I really needed formal Wiki guidance on this, but there is none and, to be blunt the MOS for medical articles did not help in this regard. To, hopefully, start the ball rolling I suggest that in the simpler articles, the Virology goes at the end. This section is often the most difficult to read (and write). A History section should follow the Lead, (in contrast to other medical articles), followed by, Signs and symptoms, Disease mechanism(s) (or Pathogenesis), Diagnosis, Treatment and Prevention, Transmission and Epidemiology. Anything particularly peculiar to the virus could go in a separate section after Epidemiology. I'd appreciate any comments on this. Graham. --Graham Colm Talk 13:44, 16 March 2008 (UTC)


 * I don't think there is one overarching principle here. It depends very much on the size of each article and overlapping content as to whether we should be "lumpers" or "splitters". In the HIV/AIDS articles there is a separate article for each. In the case of the rubella series, I would personally advocate a full merge because rubella virus and congenital rubella syndrome are not very long and can be discussed in context. It gets different if one condition is caused by multiple pathogens, or if one pathogen is associated with two radically different diseases (e.g. varicella and herpes zoster).


 * With regard to your second question, I would personally keep the section order as close to "standard" MEDMOS formatting as possible. If someone finds a section too hard they can skip it. Hence: Signs & symptoms, Diagnosis, Pathogenesis (including virology, genetics etc.), Treatment, Prognosis (incl long-term complications), Epidemiology (incl screening and prevention), History. JFW | T@lk  19:35, 16 March 2008 (UTC)


 * Can there be a special sub-rule for viruses that have only one disease? Varicella zoster has chickenpox, and the two articles are way out of synch.  Yeah, I probably just chose a bad example, because Herpes zoster is really VZV, except for timing, I suppose.   Orange Marlin  Talk• Contributions 21:04, 21 March 2008 (UTC)
 * Norovirus is, perhaps a better example as is Astrovirus. I would avoid the herpesviruses because of their latency and reactivation either naturally or as a result of immuno-compromise.--Graham Colm Talk 22:05, 21 March 2008 (UTC)

Naming conventions for mental illnesses
Following a discussion at Posttraumatic stress disorder, I'd like to raise a question about the naming convention for diseases. The current convention says to use the ICD for naming conditions, but I believe the primary source for mental illnesses is the DSM-IV; indeed, that's the source that I was referred to over the naming of PTSD. Would it be appropriate to add to this guideline that we use the DSM standard for mental conditions in cases where that might differ from ICD? -GTBacchus(talk) 23:01, 19 March 2008 (UTC)
 * No, the current page does not prescribe use of ICD-10 (you may be misreading); for example, that wouldn't make sense for the case of Tourette syndrome because ICD-10 has some awful long name I can't even remember. Re-read the current MEDMOS page.  Sandy Georgia  (Talk) 23:17, 19 March 2008 (UTC)


 * I don't think that will help you any more than WP:COMMONNAME does: You can currently invoke the DSM as proof of something being a common name, after all.  ICD use is not required under MEDMOS; it's simply a good example of an international standard.  Anything that reliably indicates an international standard is sufficient to comply with MEDMOS.
 * BTW, were you aware that ICD10 hyphenates PTSD, and ICD9 doesn't? There doesn't appear to be a particular international convention, so I think the "leave it alone" standard is the right solution. WhatamIdoing (talk) 23:27, 19 March 2008 (UTC)


 * Found it. According to ICD-10, Tourette's is "Combined vocal and multiple motor tic disorder (de la Tourette)".  No way are we naming our article that :-)  Sandy Georgia  (Talk) 23:36, 19 March 2008 (UTC)
 * Not that I'm endorsing the section heading of "mental illness" by giving the example of Tourette syndrome, btw; just showing we don't have to use ICD-10, nor does our guideline say we must. Sandy Georgia  (Talk) 23:40, 19 March 2008 (UTC)

Yes, it appears that I misread the guideline as requiring ICD. It does require that the title be the "The article title should be the scientific or recognised medical name rather than the lay term", which seems to imply that WP:COMMONNAME isn't in effect, because that only comes into play where there is no other accepted naming convention. I'm asking because I moved the PTSD article under a mistaken application of commonname, and I was told that people working on mental-health articles had reached a consensus to base naming on DSM-IV. It seemed that it might be appropriate to write down what the consensus agreement is, for the benefit of future editors. -GTBacchus(talk) 01:39, 20 March 2008 (UTC)
 * OK, I see now ... you did this, and Arcadian moved it back. Is our naming section unclear?  Sandy Georgia  (Talk) 01:50, 20 March 2008 (UTC)
 * When I made that move, I was completing a request from the "Uncontroversial proposals" section at WP:RM, and I wasn't aware that there was even a page called MEDMOS. It wasn't about lack of clarity so much as utter ignorance of existence. That said, I think it's pretty clear from the page here that we should use a recognized medical name for the disorder, with the one in DSM-IV presumably being a fine choice. Does that seem correct? -GTBacchus(talk) 02:00, 20 March 2008 (UTC)
 * Welllll ... it's not always that simple :-) A guideline is only a guideline.  For example, I showed you above the silly name TS has in ICD-10, and it's Tourette's disorder in DSM-IV.  Nobody anywhere uses either of those names; the article is Tourette syndrome, the most common name, just like Tourette Syndrome Association.  I'm afraid you'd really have to check in with WP:MED before any "uncontroversial" move.  I'm not sure if we need to tighten up our wording, but with Colin out for Easter, we probably won't have a robust discussion until next week.  Sandy Georgia  (Talk) 02:10, 20 March 2008 (UTC)
 * Huh. So at this point, it sounds as if there isn't a universally applicable general rule for naming articles about diseases. Well, it would be more surprising if there were. If I notice more of those coming through Requested moves, I'll know to check whether they're really "uncontroversial" before pushing any buttons. -GTBacchus(talk) 02:13, 20 March 2008 (UTC)
 * Wellll ... again :-) I think it's more clear for diseases; we use the scientific name, not the common name (not heart attack, but myocardial infarction or whatever it is, I'm not a Dr).  But DSM/ICD business gets trickier.  Sandy Georgia  (Talk) 02:18, 20 March 2008 (UTC)
 * For the record, I only undid the introduction of the capitalization of "Stress" and "Disorder". This search provides examples of Wikipedia capitalization community standards for disorders, these journal article titles show that the term usually isn't capitalized in the published literature, and Manual of Style (capital letters) provides additional guidance. I have no opinion about the hyphen. --Arcadian (talk) 04:31, 20 March 2008 (UTC)

Confusion between what belongs under Etiology and what under Epidemiology
I am working on the Dysmenorrhea article; and I am facing some confusion as to which pieces of information belong under Etiology and which under Epidemiology. For example; one study concluded that there was a greater incidence of dysmenorrhea in females who had been sexually abused. Would this information belong in Etiology, or Epidemiology? Etiology refers to causes, and indeed, another study concluded that sexual abuse is a causative factor for dysmenorrhea. Yet Epidemiology is meant for discussing social factors, where, again, the question of sexual abuse is relevant. This is just one example of the confusion I have faced in organizing this article. I would greatly appreciate suggestions. Thank you. 66.30.221.105 (talk) 14:53, 21 March 2008 (UTC)


 * I think it's left up to editor discretion, which in this case probably means doing whatever you want and seeing how much of it's still left that way a week after you're finished. WhatamIdoing (talk) 19:02, 21 March 2008 (UTC)


 * OK, thanks. 98.217.45.218 (talk) 14:13, 24 March 2008 (UTC)


 * This is a bit of a grey area, but causative factors, associations and risk factors IMHO belong closer to the "signs and symptoms" section, while I personally reserve "epidemiology" for the hard stats (incidence/prevalence, specific outbreaks). Now your example is a bit unusual because I cannot imagine a mechanism by which the phenomenon can be explained; also, while almost every gynaecological complaint should lead to open questions about sexual abuse (it makes the gynaecological examination a much more sensitive issue), it has no immediate bearing on the diagnosis and treatment of dysmenorrhoea. As a result, I would not be opposed to putting this association in the "epidemiology" section. JFW | T@lk  22:15, 22 March 2008 (UTC)


 * I imagine that many different mechanisms come into play. That is what has caused my confusion.  If you feel so moved; if you would take a visit to Dysmenorrhea and view the Etiology and Epidemiology sections, I would be appreciative.  98.217.45.218 (talk) 14:16, 24 March 2008 (UTC)


 * Could I also advise you to use cite journal when citing journal articles? It makes for much better referencing than bare URL references. Dave Iberri has a tool that populates the template for you simply on entering the PMID (see the bottom of each PubMed abstract for the PMID code of that abstract). JFW | T@lk  22:26, 22 March 2008 (UTC)


 * I thank you for this! I was dreading the process of converting nearly 50 refs to the standard format, by hand.  By giving me this tool, you have saved me hours!  Thank you!  98.217.45.218 (talk) 14:17, 24 March 2008 (UTC)

Naming conventions
Can someone clarify an issue for me? I've been chiming in about the Zoster article as my introduction to Wiki, and notice that Acyclovir/Aciclovir are two interchanged spellings. I know the convenvtion is to use INN spelling, with an exception for study drugs which can be spelled as in the original study. Is the non-INN spelling only when specifically referencing the title of a study? Is there a consensus that INN spelling should be used whenever there is any doubt? Cheers Sisyphus (talk) 05:31, 29 March 2008 (UTC)
 * Can you explain the "exception for study drugs which can be spelled as in the original study"? The article body text should use a consistent name throughout. If an alternative name is required when quoting or in the references (article title), that is fine (it happens all the time with US/UK spelling). Colin°Talk 08:25, 29 March 2008 (UTC)
 * I agree completely, but I wanted to be clear before I proceed to mass-spelling correction :). WP:MEDMOS seems to answer this for me and corrects my misunderstanding. The INN name it is, with the non-propietary in brackets if referring to a specific study.Sisyphus (talk) 18:23, 29 March 2008 (UTC)
 * You've still lost me on "non-propietary in brackets if referring to a specific study". Where do you get that guidance? Can you give an example? Colin°Talk 19:44, 29 March 2008 (UTC)
 * Sorry, I meant proprietary in brackets. Here's a quote from WP:MEDMOS about this..."Use the nonproprietary name when referring to a drug in medical articles. Wikilinked instances of the name may be followed by the proprietary name in parenthesis: "trastuzumab (Herceptin)"." I think I've interpreted this correctly.Sisyphus (talk) 00:15, 30 March 2008 (UTC)

History
Why is History listed near the bottom for Diseases? Why is it at the very top, or even included at all, for Drugs?...io_editor (talk) 18:36, 6 April 2008 (UTC)


 * I too am interested to hear other opinions. Drugs certainly have a history but for some it isn't that notable or interesting so sourcing more than a sentence (when licensed and who made it) can be hard. The section order is designed to tell a story and also to ensure the reader isn't presented with info that he may not be able to understand. So there's no point in discussing treatment without knowing what the symptoms are, for example. With diseases, this story is fairly straightforward: what is it, how do I get it, how do I know I've got it, how do I treat it, what will happen to me, who else has this, and how does it affect society? The history story may touch on aspects of the above so the reader is best placed to understand it having read the main article. With drugs, the story is less obvious and many of the sections exist merely to group facts. Clearly, indications/contraindications needs to come early on. Many drug articles can get technical quite quickly and it may well be that the history section is the most readable and entertaining. Having it up front sets the scene for why the drug was developed, how important it is, and whether it is still used. That may encourage the reader to persevere. Examples include paracetamol, aspirin, phenobarbital and heroin. Colin°Talk 19:33, 6 April 2008 (UTC)


 * For the great majority of drugs, the history is damn hard to write and it would be almost counterproductive to cite per-clinical studies (causing for example big arguments in sedative drugs, recent experience). I would bet that for most wikis, the history section can be skipped. Also, usually the most important thing is the need - which will be repeated elsewhere (indications).io_editor (talk) 20:52, 6 April 2008 (UTC)


 * Historical data for drugs is not that hard to locate. It tends to be dull (a paper in J Med Chem by the manufacturer) but can be nice and helps with completeness. I hadn't been aware that amiodarone was developed in Belgium as an anti-anginal until I researched it. JFW | T@lk  21:03, 6 April 2008 (UTC)


 * The history of a disease should be at the bottom because it is relatively unimportant and doesn't easily tie in with the flow of characteristic symptoms, diagnosis, pathophysiology, treatment. My personal practice is to mention the history briefly in the intro to provide historical context, but to leave long discussions about who described it and when to the end of the article. The same applies to drug articles. JFW | T@lk  19:42, 6 April 2008 (UTC)


 * Just a comment that some diseases have had historically profound impacts; and also that their identification history (vast majority being recent) is often interesting too - certainly more interesting than a drug's history.io_editor (talk) 20:52, 6 April 2008 (UTC)


 * I agree that some diseases have a significant historical impact (think plague, tuberculosis). That is why we have an intro; sometimes, notable epidemics may also be mentioned in "epidemiology" (as I have done on rhabdomyolysis). JFW | T@lk  21:03, 6 April 2008 (UTC)


 * This highlights that every reader comes to WP with different needs and interests. I often find the history sections to be fascinating and of more interest than some other sections; a different reader won't care and wants to know about symptoms or side-effects. The history sections in the drugs listed above add to the articles and they would be rather dull without them. The poliomyelitis article has such an interesting history that it spawned a daughter article. Colin°Talk 21:34, 6 April 2008 (UTC)


 * The history of some therapeutics is fascinating, especially for the oldest drugs. For some drugs, in fact, the history is really all that's left.  Additionally, as Io-io editor has good reason to know, there are significant events in some drugs' lives that have very little to do with their pharmacological use, but are still quite important for other reasons.  In a case where it's dull or unimportant, then MEDMOS says "The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition."  There's also no requirement that every single article have a history section; it can be omitted if actually unimportant.  WhatamIdoing (talk) 03:33, 7 April 2008 (UTC)


 * I see you had to personalize the matter. My first question was about Diseases, not Drugs.io_editor (talk) 22:19, 7 April 2008 (UTC)


 * In my view, the history should be mentioned at least in the middle of the article, if not directly after the intro. To reserve it for the end is to create some serious hermeneutic issues, and also to render ideas vulnerable to reification. In order to elaborate, I'll simply copy a comment that I first made here, about a condition especially vulnerable to reification because its status as a "medicial" issue is rather tenuous, before I became aware of WP:MEDMOS:
 * I'd like to suggest that the "history" section of this article be moved from (nearly) rock bottom to at least somewhere higher up in the article. My personal inclination is to move it to the very top, but I'd settle for somewhere in the middle. To describe the "nature" of depression so long before describing the historical context, in which our understanding of that nature has emerged and evolved, is to impose upon the reader a very clunky hermeneutic circle, through which one really has to read the entire article before getting any sense of how the contemporary parts and the historical whole synergistically create a more-or-less NPOV (or at least a thorough) picture of depression. Becausee the current revision emphasizes the ahistorical, it implicitly reifies depression, treating it in an essentialist manner, as if it were as objectively "real" an entity as gold, silver, or even a bona fide mental disease such as neurosyphilis. But, you'll notice that the "history" sections even in the articles for hydrogen, oxygen, and gold--things that can be treated in an essentialist manner--are in the middle of their pages. The historical context for something far less elemental, such as MDD, should feature at least as prominently, if not more so.
 * Now of course, if you're having a heart attack, it is more prudent to get down to basics and get some help than to ponder the historical significance of heart attacks. Hopefully, though, people will be able to get to the ER in time for this, and will use some of the time before or after that to find out from WP what it all means--from articles that obviously include, but do not patently and unequivocally prioritize, the currently-accepted "facts." Cosmic Latte (talk) 08:23, 13 June 2008 (UTC)


 * In general, this is the order that works best for most "disease" articles. That's why we recommend it.  When the history is important, then the regular editors of the specific article can, and do, change the article to what makes most sense for that specific article.  There is no need to get approval from MEDMOS editors for this:  you just need to get consensus at the article.  WhatamIdoing (talk) 17:29, 14 June 2008 (UTC)

Social aspects section
I'm trying this:


 * Prognosis
 * Social aspects (as a sub-section to Prognosis, or if important enough, as a separate section)

I feel MEDMOS is giving mixed signals. It says this:

''Wikipedia is written for the general reader. It is an encyclopaedia, not a comprehensive medical or pharmaceutical resource, nor a first-aid (how-to) manual. Although healthcare professionals and patients may find much of interest, they are not the target audience.''

Then it currently says:


 * Prognosis (social impact may also be discussed)

I feel this is demoting the social aspects somewhat, and has been under debate in the developing Alzheimer's disease article

Wikipedia articles are about the whole subject, and indeed for the "general reader" ('notability' and accuracy allowing, and with the necessary 'technical' information included of course). --Matt Lewis (talk) 19:32, 7 April 2008 (UTC)


 * I think that if there are important social aspects, they shouldn't be muffled away under prognosis. For instance, diseases like breast cancer or multiple sclerosis have a social dimension that completely transcends their prognosis. However, if the social impact is a direct function of the prognosis (e.g. in mesothelioma) this should be integrated with the prognosis section. JFW | T@lk  19:44, 7 April 2008 (UTC)


 * Social aspects may be part of many different sections, don't need a separate heading. Sandy Georgia  (Talk) 19:45, 7 April 2008 (UTC)


 * I cannot agree with that. At Alzheimer's disease we've found we need a sub-section. Where else can we put it? If it is very important (and detailed) why can it not have a full section? --Matt Lewis (talk) 19:50, 7 April 2008 (UTC)


 * You put the information that pertains to social aspects in whichever main section it corresponds to; not all will be prognosis. Sandy Georgia  (Talk) 19:59, 7 April 2008 (UTC)


 * But what would you say "social aspect" is? How would you define it? It's surely too broad a collections of factors to always have "corresponding sections" pre-existing in the article! Alzheimer's has been described by many countries as a future "epidemic". There are huge cost/effectiveness issues (people have marched in the UK over drug availability). Caregiving is a huge issue - who pays for it? Who does it? I've seen police helicopters looking for people at night - dogs sent out for a scent - it's a big expense and a big "social issue"!! We already have a big introduction - and have decided we can't do it justice in there. Can you recommend anywhere else we can deal with these kind of factors? --Matt Lewis (talk) 20:07, 7 April 2008 (UTC)


 * I think you're misunderstanding the guidelines; pls read carefully. They are first-level headings, and they don't prevent you from adding information to whatever section it belongs in.  The lack of a Social aspects main heading doesn't preclude that content from being added to the appropriate sections.   Sandy Georgia  (Talk) 20:17, 7 April 2008 (UTC)


 * What appropriate sections? Can you properly read my points? --Matt Lewis (talk) 20:22, 7 April 2008 (UTC)


 * Undent: I grant it to Matt that we need a good space for social dimensions for particular diseases. Sandy: I don't really agree that we should dissipate all the social stuff into the relevant sections. Matt gives the very good example of Alzheimer's. Here, social aspects IMHO are worth their own main heading because of the phenomenal burden on caregivers that is not done justice by keeping it in "signs and symptoms", "epidemiology" or "prognosis". In the UK, approval for donepezil is the subject of controversy because the regulatory body seems not have included burden on carers in their calculations. I think we should create the possibility for a "social/political/philosophical" section. JFW | T@lk  21:08, 7 April 2008 (UTC)
 * Yes, but he wants to put it all in Prognosis, which is just misguided and based on one disease only. And the heading is misleading; how does it relate for example to all of the text at Sociological and cultural aspects of Tourette syndrome, most of which deal with social issues?  There are social aspects of diagnosis, prognosis, culture, etc.; the text isn't exclusive to one article section.  Using one disease to define a guideline is bound to be problematic; a broader view is needed, not creating a guideline to accomodate one group of editors on one article.  There's a lot of POV and agenda issues going on in that Alzheimer's article, and we need to take a broader view of all conditions.  Nothing in the current guidelines prevent them from adding the text where it's needed. Sandy Georgia  (Talk) 21:26, 7 April 2008 (UTC)


 * I don't know of any 'POV or agendas' in Alzheimer's effecting "social aspects" (I don't know enough to comment on the whole article). I think that's very unfair to us to be honest - we strive to get on, talk and progress (though all seem strong-willed) - and I honestly don't think MEDMOS is helping us at the moment - which is why I'm proposing this change. The "where it is needed" approach is not how it's happened in Alzheimer's (probably partly for practical reasons, and probably because many editors clearly want 'pure' sections). --Matt Lewis (talk) 00:43, 8 April 2008 (UTC)


 * One size fits all isn't going to work for "Social aspects". For epilepsy (ignore the current state of that article), there are social aspects such as stigma, disability benefits, employment law, driving bans, needlessly imposed restrictions (such as many health products), portrayal in fiction (perhaps), myths, and historical social aspects such as when they used to put people with epilepsy into institutions. Perhaps some fit under other sections, perhaps it is useful to deal with it under one top-level heading. Some diseases have a bigger social aspect than others. Colin°Talk 22:07, 7 April 2008 (UTC)


 * Sure - we need some flexibility here (or guidance towards being more flexible). --Matt Lewis (talk) 22:49, 7 April 2008 (UTC)


 * Just imagine, for a moment, some of our more difficult, POV-ridden articles, and what we'll be dealing with if we opt for a top-level section heading. It will be a POV, garbage can magnet.  Sandy Georgia  (Talk) 22:09, 7 April 2008 (UTC)


 * I'm not sure I see the issue. Can you give an example? Surely strictly enforcing policy/guidelines keeps the garbage out and it doesn't matter how you structure the article. I'd demote Cultural references (a cruft magnet if ever there was one) to a sub heading of Social aspects. Colin°Talk 22:37, 7 April 2008 (UTC)


 * We have to 'assume good faith' about the future surely? Wikipedia has a bedrock of policy and guidelines to deal with possible "garbage". It's rather like "throwing the baby out with (theoretical!) dirty bath water"! --Matt Lewis (talk) 22:51, 7 April 2008 (UTC)

SG - I don't want it all in Prognosis - isn't Prognosis merely where it is in MEDMOS already? (which we have followed at Alzheimer's, and I thought you supported?) I would rather simply recommend it being under its own section ("if necessary" etc) - I was just a little worried about daring to suggest such a radical social change!

Currently MEDMOS says:


 * Prognosis (social impact may also be discussed)

Which is I think rather belittles "social aspects", and suggests that they should be under Prognosis.

This was my suggestion:


 * Prognosis
 * Social aspects (as a sub-section to Prognosis, or if important enough, as a separate section)

How about?:


 * Prognosis
 * Social aspects (as a sub-section, or if important enough, as a separate section)

This would leave it more open as to where it goes. It's good to have at least some flexibility over headings. We have been very anxious to adhere to MEDMOS at Alzheimer's - it would be nice to know when and where we can be flexible.--Matt Lewis (talk) 22:49, 7 April 2008 (UTC)


 * There's a difference between the social impact section of prognosis, and social aspects overall, which are generally included in sociological and cultural aspects. (Many people avoid diagnosis of TS for social reasons, and doctors fudge it to tic disorder, so that's a diagnostic issue, but I covered it in social aspects.)  From what I can tell, you want to create a separate section to account for caregiver burden in Alzheimer's when that can be covered in sociological and cultural aspects or prognosis or wherever it belongs.  To Colin, I'm not following how you're distinguishing what we already have (sociological and cultural aspects) from social aspects from social impact on prognosis, so I think we're all talking three different languages and three different issues.  The way I see it, we already have everything covered at some level, but we may all be calling it something different; I'm not seeing a new proposal here, just confusion.   Sandy Georgia  (Talk) 23:05, 7 April 2008 (UTC)


 * I have no agenda other than to keep social issues in the main article - it matters less where they go. You must believe me when I say we are needing advice here, and that MEDMOS isn't fitting the bill here for us - see the latest discussion on AD. --Matt Lewis (talk) 23:26, 7 April 2008 (UTC)


 * I'll look afresh tomorrow. But there is no "sociological and cultural aspects" section heading. We have "Cultural references", which is often taken as fictional and celebrity. Colin°Talk 23:14, 7 April 2008 (UTC)


 * SG means the sub-article after splitting:


 * If the list is (or could be) long enough to support a separate article, then consider splitting it off. The format can be prose, such as Sociological and cultural aspects of Tourette syndrome, or a list, such as List of people with epilepsy. Regardless, such articles must be well verified or they may quickly end up deleted. Wikipedia's Naming conventions generally discourage the use of words such as "notable" or "famous" in such list titles.


 * There are rules on Wikipedia about this though - the main information in "daughter articles" has to be covered in the main article (I asked this once at FA). The main article should at least cover the main issues - they can't be entirely branched off. I've always supported a "Sociological and cultural aspects of Alzheimer's disease" when we are ready for it (just see the Alz Talk). But we are currently working on the main article. --Matt Lewis (talk) 23:26, 7 April 2008 (UTC)


 * Not sure what you're saying there about FA, Matt (you seem to be misunderstanding summary style or something you were once told at FAC), but I'm pretty sure Colin and I are understanding each other now. What I have been calling "Sociological and cultural aspects" we label here as Cultural references (which is junk, agree it should be replaced), and you have introduced a confusion between what we have been calling social impact and social aspects.  I suspect everything is fixed by ditching Cultural references and calling it what we do in practice, "Sociologicial and cultural aspects".  That's why I thought we already had it covered (I've been treating it as all sociological and cultural aspects, when our guidelines actually only say cultural references).  Sandy Georgia  (Talk) 23:32, 7 April 2008 (UTC)


 * So you are saying the guideline errs with the heading Cultural references? That does simply appear to be a references section - no one would guess it is for social aspects! (especially when seeing that line next to Prognosis). OK - lets change that, and I'll go back to Alzheimer's and see if it works for us. I would recommend making the line next to prognosis a little clearer too - it's totally confused us! (eg. social impact elements may also be discussed here too. etc)--Matt Lewis (talk) 23:52, 7 April 2008 (UTC)


 * No, let's not change anything yet in long-standing guidelines until lots of editors have been able to weigh in and consider the impact on lots of different kinds of articles :-) I think we're having some confusion between social impact on prognosis and social aspects, and it all needs to be sorted out in a way that works for many different articles. Nothing keeps you from writing the text and adding it somewhere; the confusion is in how we label the heading.  Sandy Georgia  (Talk) 23:55, 7 April 2008 (UTC)


 * Well I've done it so at least we'll have a diff to refer to if you remove it. I'm a big fan of being bold with these things - people then get to see them in place. --Matt Lewis (talk) 00:01, 8 April 2008 (UTC)

Changing the Cultural references section to include "social aspects"
This is the diff of Sociological and cultural aspects in place of the misleading Cultural references. It makes sense, as the related sub-articles have the same title, with the article-subject appended to them. (eg. Sociological and cultural aspects of autism) --Matt Lewis (talk) 00:01, 8 April 2008 (UTC)


 * Let's decide if it makes sense after looking at a lot of articles, OK? Colin, I can't find (I think I deleted it when I gave up on this Project) the old summary we did of the section headings in all of our FAs, so I'll start a list here (focusing on the recent, as many of the older ones are out of compliance).  Sandy Georgia  (Talk) 00:11, 8 April 2008 (UTC)
 * Clarification: Matt Lewis's proposal above is that we change our current guideline, which recommends a "Cultural references" section to a "Sociological and cultural aspects" section.  Sandy Georgia  (Talk) 00:55, 8 April 2008 (UTC)


 * AIDS – Has Economic impact and stigma listed under Prognosis
 * Asperger syndrome – Cultural aspects, but links to Sociological and cultural aspects of autism
 * Autism – no section in the article, but History links to the daughter article, Sociological and cultural aspects of autism. I'd argue it should have the section.
 * Coeliac disease – Has Social and religious issues
 * Cystic fibrosis – Has public awareness
 * Influenza – has Economic impact (?)
 * Lung cancer – Nothing
 * Polio – Missing
 * Rotavirus – Nothing
 * Schizophrenia – Cultural references (but also has Popular views)
 * Tuberculosis – Has folklore under History
 * Tourette syndrome – Cultural references (but links to Sociological and cultural aspects of Tourette syndrome)

Sandy Georgia (Talk) 00:11, 8 April 2008 (UTC)


 * I am trying to follow along (it started on the AD talk page), and you both seem to have agreed that Cultural references is "junk", so why not indeed replace it with "Sociological and cultural aspects"? It does seem far more pointed and relevant, and I doubt if reviewing the multiple Wikis will change that in your minds.io_editor (talk) 00:20, 8 April 2008 (UTC)
 * Stable guidelines are helpful; it's good to change them based on broad input, not a few hours of discussion with a few editors. Sandy Georgia  (Talk) 00:23, 8 April 2008 (UTC)


 * Based on the list above, I would argue that:
 * Articles that have no section should have one, and are not comprehensive without at least a summary.
 * Articles that have cultural references could have the same content under Sociological and cultural aspects.
 * I'm not sure where Economic impact belongs (and by the way, several articles have Impact on animals sections, which we should consider)
 * With the exception of economic impact (which I'm not clear on), content that is listed in the articles above under different headings could be put under the heading Sociological and cultural aspects, which would include cultural references, folklore, public awareness, social and religious issues and stigma.
 * Add the epilepsy list from Colin: stigma, disability benefits, employment law, driving bans, needlessly imposed restrictions (such as many health products), portrayal in fiction (perhaps), myths, and historical social aspects such as when they used to put people with epilepsy into institutions.
 * That doesn't answer the question of where caregiver burden goes, but I think it would fit under a Sociological and cultural aspects heading. Sandy Georgia (Talk) 00:30, 8 April 2008 (UTC)


 * Any caregiving 'burden' there may be, and the "Economic factors" (perhaps?) can both fit under the Sociological and cultural aspects heading, imo. The financial costs are only relevant from a social perspective - if it was just a private cost, the price of any particular drug etc would hardly matter - unless it was an outrageous price I suppose. --Matt Lewis (talk) 00:43, 8 April 2008 (UTC)
 * I agree that "Sociological and cultural aspects" will likely cover everything, and is what we've mostly used anyway. But we need to hear from more editors, conditions and diseases.  We don't know what we don't know.  Sandy Georgia  (Talk) 00:46, 8 April 2008 (UTC)


 * What are the headings suggested? The current 'Cultural references' (defacto pop-culture references containing famous or notable references to the article) versus being discussed 'Sociological and cultural aspects' (how the subject of the article affects people on an individual and society-wide basis; social impact as a possible shorter title)?  They seem like very different ideas to me, though possibly because of how the first is misused.  Common sense would suggest that depending on the condition the 'how the disease affects people and society' section would be major for conditions which affect a person's ability to interact with others and minor if it's not (like a bone fracture or hangnail).  Of course, more guidance, even suggestions, are never a bad thing in my mind if couched with words that support flexible editing.  WLU (talk) 00:37, 8 April 2008 (UTC)
 * This is what we currently have. No one follows it (except yours truly, see Tourette syndrome).  Sandy Georgia  (Talk) 00:39, 8 April 2008 (UTC)


 * Support Sociological and cultural aspects I must say I like the MEDMOS term and was unaware of it. It is broader than Cultural references and hence can subsume it. As well the heading promotes discourse on a cultural or sociological issue which I feel is fitting rather than a listy trivia section. It can cover cultural references, caregiver burden, stigma, and all sorts of topics. That's my vote..Cheers, Casliber (talk · contribs) 00:53, 8 April 2008 (UTC)
 * Sorry, cas, need clarification. MEDMOS currently recommends "Cultural references".  Which are you in favor of?  Sandy Georgia  (Talk) 00:56, 8 April 2008 (UTC)


 * NB: I do not think the section necessary in something more esoteric like Henoch-Schönlein purpura which just got GA though, and am undecided re rotavirus needing one but the others should. Cheers, Casliber (talk · contribs) 01:00, 8 April 2008 (UTC)
 * Agreed, in fact I think this goes without saying. I think few conditions (mostly chronic diseases?) would have relevant enough impact on the lives of people who have them, care for people who have them etc. Fvasconcellos (t·c) 01:12, 8 April 2008 (UTC)
 * FWIW, I support recommending "Sociological and cultural aspects". I can't believe I'd never noticed, but "Cultural references" is just begging for trivia and cruft. I would like to know, however, whether "sociological" instead of "social" was a deliberate choice in those article titles, e.g. to denote a scholarly viewpoint. Fvasconcellos (t·c) 01:12, 8 April 2008 (UTC)
 * Argh, edit conflict. Sorry, Antelan; at least we mostly said the same thing :) Fvasconcellos (t·c) 01:13, 8 April 2008 (UTC)
 * I remember that either Colin and I, or Tony and I, or Tim and I (or someone and I :-) came up with that phrase for the TS article, and it was always awkward. Fixing it would be good :-)  Sandy Georgia  (Talk) 01:14, 8 April 2008 (UTC)
 * Haha, cheers Fvasconcellos. I was glad to see that, like me, someone else was nitpicking over one word. Antelan talk  01:15, 8 April 2008 (UTC)
 * Comment: This may seem silly or trite, but I think that "Sociological and cultural aspects" could be tightened up a bit. What about something along the lines of "Social and cultural impact"? Antelan talk  01:10, 8 April 2008 (UTC)
 * I'm not a word nerd, so ... do all "aspects" "impact"? I mean, do legal and insurance issues and classroom issues and cultural references (that is, everything in Sociological and cultural aspects of Tourette syndrome) "impact", or are they just "aspects"?  The idea is to get all of that cruft out of the basic medical article.  Sandy Georgia  (Talk) 01:18, 8 April 2008 (UTC)
 * I'm not entirely sure, but point well taken. Let's look for other candidates. How about Social and cultural significance? Antelan talk  01:22, 8 April 2008 (UTC)
 * man that's alot of syllables...undecided really. Cheers, Casliber (talk · contribs) 01:26, 8 April 2008 (UTC)
 * If I may be bold: aspects that do not impact are not notable and should be removed. 'Nuff said :) Significance, I'm not so fond of. It would, IMHO, shift focus from "how having X affects person, family, and subsequently society" to "how X affected society and became stand-up-routine-slash-talk-radio fodder". Fvasconcellos (t·c) 01:27, 8 April 2008 (UTC)


 * OK, Fv, you get to deal with all those editors who want every movie and TV mention of Tourette's added to the main article :-) If I didn't have the TS daughter article, I'd be dealing all day long with editors who want to add all that to the main Tourette syndrome article, and I would give up and lose the battle.  I'm glad I've got a place to park it so they leave the main article alone.  It's a serious matter of practicality.  Do you know how many movies and TV shows make fun of Tourette's?  Is it all "significant"?  :-))) It's definitely an aspect of the condition; that it's made fun of and is the subject of stupid sophomoric movies.  And since they all have articles, they all can argue notability.  Sandy Georgia  (Talk) 01:30, 8 April 2008 (UTC)
 * Goes to my point about leaving out cultural stuff.  Orange Marlin  Talk• Contributions 02:19, 8 April 2008 (UTC)


 * Comment Maybe I'm opening a beehive, but I never liked this section, mainly because it's so wishy-washy. Right now I'm working on Alzheimer's disease, and I haven't looked, but I bet Charlton Heston references have been added already.  Anyways, the section becomes a microfiltration device to capture every notable and non-notable trivial event, movie, person, and idea.  Since no one is asking if we can remove the section, let's keep it semi-scientific and just let it be "Sociological" impact or something similar.  Sociology can includes economic, societal, ethnic, or other "soft sciences".  Leave cultural out.  I know Ronald Reagan had AD, but it's not all that relevant to the article, to be honest.   Orange Marlin  Talk• Contributions 02:15, 8 April 2008 (UTC)


 * Heh, one problem: Sociology of culture Antelan talk  02:25, 8 April 2008 (UTC)
 * We've had some version of this wording in the guidelines for as long as I've been on Wiki, I support it, and I suggest that trying to do away with this will result in all of us being overwhelmed with removing edits all day long:
 * "One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition."
 * And seriously, anyone who wants to cut all the crap that I moved over to the daughter article on TS gets to sign on then to help protect the article; I suspect that deleting all that will destabilize the article and cause it to lose FA status. I'm fortunate that when they try to add it to the main article, I can refer them to the daughter article.  Reagan belongs in AD, Michael Fox belongs in Parkinson's, TS gets more than the usual amount because of the coprolalia-related media fascination, but as long as those mentions all have articles and can argue notability, I don't want to have to fight keeping them out.  I have better ways to spend my Wiki time.  Sandy Georgia  (Talk) 02:31, 8 April 2008 (UTC)


 * Good point. Also, I don't see a problem with splitting the "pop-cultural" from the sociological. Pop culture can have its own section, if necessary, though hopefully not with that name. It doesn't make all that much sense from a rational standpoint to mix a discussion of disease burden on caregivers with some random fact about Charlton Heston. Antelan talk  02:34, 8 April 2008 (UTC)
 * No, no, no !!! We don't want to encourage pop culture, and it's not my intent to do so.  Because of the nature of the condition of TS, I'm stuck with more than the usual amount, and I thought/hoped that the way it was dealt with (scrupulously referenced, kept out of the main article) was a good model. BY No Means am I encouraging pop culture sections in articles !! Only those people who have made a lasting impression on the condition.  Reagan made a lasting impression on Alzheimer's.  Fox on Parkinson's.  And I'm stuck with a bunch of it on TS that became notable because it's gimmicky and gets media attention.  Sandy Georgia  (Talk) 02:38, 8 April 2008 (UTC)


 * Hah, don't get me wrong - I'm not advocating for the creation of a "pop culture" section. I think I've diverted this conversation enough. Should we get back to naming? How about Social impact; Broader impact; Social significance; Broader significance; Societal impact. Just brainstorming here. Antelan talk  03:07, 8 April 2008 (UTC)


 * In Alzheimer we don't need to split a pop-cultural... that's is not the topic. We need a section to talk about social costs and quality of life which covers both the patient (and that part would have some place in other sections) but also caregivers, which don't suit in any place right now. Another interesting part in the future subsection would be studies on macro-economic costs of the disease. Both matters (quality of life and cost) are important in most cronic diseases and there are enough scientific studies to reference them.--Garrondo (talk) 07:29, 8 April 2008 (UTC)


 * OK, I'm on board with Reagan with AD, and Fox with Parkinson's. But it sounds like we have consensus to not include every Tom, Dick, or Henrietta within a pop-culture section of these articles?  Just as a note, the Dinosaur wikiproject removes a lot of pop-culture trivia to main articles to reduce cruft.  We should do the same.   Orange Marlin  Talk• Contributions 19:34, 9 April 2008 (UTC)


 * "Lastingly affected the popular perception" is our guideline; I've got a lot of Brits who insist that Pete Bennett lastingly affected perception of TS in the UK (unfortunately, that may be true), and as long as he's in a daughter article, and not the main Tourette syndrome article, I'm not interested in edit warring with those folk all day long. Seriously, I could spend all of my wiki time defending the TS article against every mention of tics and coprolalia, and I don't wanna do it.  I simply set a higher threshhold for "lasting impression" in the main article than in the daughter article, and that seems to have satisfied everyone.  ONLY significantly historic people get mentioned in the main article, but all those families with ticcing kiddos consider ever athlete and musician who tics as making a lasting impact on their impression of TS, so I feel it's OK to leave them in a sub-article.  Sandy Georgia  (Talk) 19:50, 9 April 2008 (UTC)

arbitrary break

 * Comment. I reread Autism and doubt whether adding a Sociological and cultural aspects section to it would strengthen it. Currently, those aspects are scattered through the article; gathering them together into one section would, to some extent, ghettoize them. For example, to my mind treatment-cost issues fit better into Autism than they would fit into a new section. It makes sense to have such a section for some articles, but I'm a bit skeptical that such a section is advisable for all articles. One other thing: Sociological and cultural aspects is too long; how about Society and culture instead? More concretely, how about the following change instead?
 * Replace "Prognosis (social impact may also be discussed)" with "Prognosis".
 * Replace the "Cultural references" bullet with the following bullet:
 * Other sections may go here as appropriate. Possibilities include Society and culture (or Sociological and cultural aspects), Economics, Research directions, and Infection In other animals (or In other species).
 * Eubulides (talk) 04:06, 8 April 2008 (UTC)


 * Ah, ha. That's what I was trying to explain in the section above this one (that social impact info is often spread out among sections); thanks for the example.  Yes, I like your suggestion.  Sandy Georgia  (Talk) 04:10, 8 April 2008 (UTC)
 * I like it, too. No need to use a hammer when everything isn't a nail. Should we try to formalize a list of "preferred" sections, or would this just be a futile effort? Antelan talk  04:13, 8 April 2008 (UTC)
 * I think Eubulides encompassed everything, but I would avoid Infection in other animals in favor of In other animals or Impact on animals. Equine Tourette's is not an "infection", but I'm realizing I never added it to the article.  Ack.  Sandy Georgia  (Talk) 04:19, 8 April 2008 (UTC)
 * How about In other species? Antelan talk  04:37, 8 April 2008 (UTC)
 * Like it !! Sandy Georgia  (Talk) 04:38, 8 April 2008 (UTC)
 * Me too; I struck "Infection in other animals" and replaced it with "In other species" above. Eubulides (talk) 06:22, 8 April 2008 (UTC)


 * Support Eubulides' proposal. I like "other sections as appropriate," particularly the "research directions" idea.  I've run across a number of rare diseases recently that title research information "prognosis" -- as in, 'the prognosis for this uniformly fatal disease is "someday we hope there will be a cure."'  WhatamIdoing (talk) 04:54, 8 April 2008 (UTC)


 * Sandy: The page with the section headings for featured articles is here but it will be out-of-date.
 * I dislike "Impact" immensely. I've always thought "Sociological and cultural aspects" was a little too grand as a section heading and think Eubulides "Society and culture" is better (but won't work so well as an article title, for which the existing TS/Autism examples are fine).
 * I'm not yet convinced about "In other species" as it seems too general (includes plants) and unnecessarily technical. Is there a problem with "In other animals"?
 * Phytonoses (diseases transmissible from plants to humans) are pretty rare, true. In other animals is fine, for the majority of diseases (it sure beats Zoonoses, the technical term). I changed the proposal to give In other animals as the preferred alternative. Eubulides (talk) 16:56, 8 April 2008 (UTC)
 * I appreciate moving pop culture and famous people out of the article is useful for practical purposes. I'm less sure that "social aspects" should be treated the same way. This is a general encyclopaedia, not a medical encyclopaedia. A discussion of AIDS or Epilepsy would be incomplete if it only covered the medical aspects. Of course, if there is a lot of material, a daughter article makes sense.
 * Although these are good "suggested headings" I don't feel that they fit every disease. Hangnails and headaches are quite different beasts from tuberculosis and tourettes. In the same way that sections grow until a daughter article pops out, sub-sections may grow until they make more sense as top level, or shrink to be absorbed in another section (e.g., a one sentence prognosis could be part of symptoms or management).

Colin°Talk 09:02, 8 April 2008 (UTC)
 * Indeed, there should be obvious wiggle room to adjust as appropriate to each article and that there won't be a single solution for all articles should be obvious in MEDMOS. One thing that would be good is including the statement that issues can be gathered here or dispersed in other appropriate sections as warranted.  Social issues, societal sequela, non-biological sequela, Lifestyle modifications, or just Eub's suggestion of an untitled bullet with suggestions for a new section.  Another suggestion:


 * Other sections may go here as appropriate discussing lifestyle modifications (as in Stroke), economic impacts (as in AIDS), social impact (as in Alzheimer%27s_disease) or these issues may be distributed thorughout the article in appropriate sections (as in the social impact of Autism).
 * WLU (talk) 15:54, 8 April 2008 (UTC)


 * I forsee problems if we become too prescriptive. These suggestions will not be appropriate to all articles. Kuru needs a cultural section, as does AIDS and Alcoholism, but how about, Impetigo and Scabies? Some articles need a social context and one could argue that Rotavirus is to be found wanting, (but it would be essential in Rotavirus Vaccine Program). It depends on the disease. Sorry, not much help I know. Graham Colm Talk 18:08, 8 April 2008 (UTC)
 * I think Eubulides' proposal covers that with "Other sections may go here as appropriate." Sandy Georgia  (Talk) 18:19, 8 April 2008 (UTC)
 * In that case I agree with Eubulides. Graham. Graham Colm Talk 18:35, 8 April 2008 (UTC)
 * Support Eub's proposal. JFW | T@lk  19:48, 8 April 2008 (UTC)
 * Support, but I'm always a fan of more proscriptive. I see it as guidance rather than proscription (particularly with the 'may') but Eub's is fine and better than the extant.  WLU (talk) 20:05, 8 April 2008 (UTC)
 * Support - We should be as prescriptive as is useful, and we may be hitting that limit here or soon, making Eub's proposal apropos. Antelan talk  20:26, 8 April 2008 (UTC)
 * Support, though I would like to see some precautionary wording against trivial celebrity culture, as distinct from the Rock Hudson/Ronald Regan eye-opening effect or the Christopher Reeves/Michael J. Fox/Terry Fox fundraising effect.
 * We have: "One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition." Sandy Georgia  (Talk) 16:05, 9 April 2008 (UTC)


 * Sorry to drag this on but I failed to pick up that the "(or Sociological and cultural aspects)" and "(or In other species)" parenthetical options were intended as guideline text rather than options for discussion. Does anyone actually prefer those options or could we simplify this by removing them. After all, one intention of the guideline is to avoid needless variants. Colin°Talk 16:52, 9 April 2008 (UTC)
 * Remove them. I went ahead and inserted the proposal because I knew that would get you to come out of the woodwork :-)  Sandy Georgia  (Talk) 17:01, 9 April 2008 (UTC)
 * Sounds good to me; I removed them. The proposal had included Sociological and cultural aspects as an option because that's common existing practice, but it's OK to recommend a change to existing practice. The proposal had included In other species only because of phytonoses but they are so rare that we needn't worry about them in a general guideline (phytonoses can simply disobey the guideline). Eubulides (talk) 19:15, 9 April 2008 (UTC)

Economics?
I notice you have Society and Culture and Economics separately. I liked Socialogical (correction) and cultural aspects - as it clearly includes 'economic' issues. As I said somewhere above, all the financial issues relevant to Wikipedia medical articles are surely always in a social capacity. I can envision problems if Economics is a separate section. In fact, I can't immediately think of how to go about writing a separate economics section! (ie. in the sense of keeping all the connected facts together in the prose - it could be hard to disconnect them with involved subjects). --Matt Lewis (talk) 20:22, 9 April 2008 (UTC)
 * I don't see how "social and cultural" is much different from "society and culture" -- they are just different forms of the same root word. I agree economics is an aspect of society. I think we're talking about big economics rather than the economics of funding a particular therapy or paying for specialist practitioners (those aspects are rather country-specific and depend on the healthcare model). Are there any FAs or good disease/disorder articles that have Economics at top level? Let's not invent top-level sections that nobody uses. Colin°Talk 21:11, 9 April 2008 (UTC)


 * The word "aspects" adds a broadening (but still exacting) element to "Sociological and cultural" (I meant to put "Sociological", not "Social" - my mistake). "Society and Culture" are broad words (and too broad-sounding I feel). I personally think the former has a more 'encyclopedic' feel (and I think the subs work well - Sociological and cultural aspects of autism etc). The shorter "Social and cultural" would be an improvement too, I think. --Matt Lewis (talk) 21:37, 9 April 2008 (UTC)


 * We discussed this exact wording at the very start of the "Social aspects section" section of this talk page. Antelan talk  21:39, 9 April 2008 (UTC)
 * But what was the conclusion? I'm not afraid of the word "culture", btw. This "cruft" business should be associated with sub articles, imo (ie it should be kept out of the subs, not the main article - because if this kind of information exists, no-doubt a sub is somewhere along the line). --Matt Lewis (talk) 21:44, 9 April 2008 (UTC) --Matt Lewis (talk) 21:44, 9 April 2008 (UTC)


 * Quite right. I thought we had reached a conclusion, but upon rereading I realize that isn't true. I don't think that "aspects" adds anything beyond "Social and cultural." You could add "aspects" to the end of almost any section and achieve no significant change in meaning for the added verbiage: economy => economic aspects, history => historical aspects. If some word was needed there, I'd prefer significance or something less etymologically metaphorical. Antelan talk  23:22, 9 April 2008 (UTC)


 * "Aspects" is used for the sub-articles and I always liked it. A while ago I tried to think of a better title for a future "social/cultural" sub-article for Alzheimer's other than 'Sociological and cultural aspects of Alzheimer's disease' (per Autism etc) - couldn't think of a better title then, nor have I been able to since. I never thought of it as "etymologically metaphorical". If it aint broke, why fix it?


 * By the way - I've always meant to say this - why is the sub Sociological and cultural aspects of autism so hidden away in the prose of the Autism article? Surely MEDMOS should state these important subs should be highlighted as "Further reading...", or "See also..."?--Matt Lewis (talk) 00:02, 10 April 2008 (UTC)

AIDS should make a good example: I could easily see these being three separate sections for this subject, although I might combine social effects with cultural causes. I'm not sure that I'd put economics in the same section, however, because it just gets to be so long after a while. WhatamIdoing (talk) 22:03, 9 April 2008 (UTC)
 * It currently has a long economic section (filed, oddly, under prognosis), and the disease's economic impact is really more about "how do you cope when a huge section of your workforce dies" than with "drugs are expensive" (although these overlap, because part of what you do is get the expensive drugs to postpone the deaths of your adults).
 * It has important social effects: Lot of orphans out there.  Lot of changes to women's power.  Lot of kids losing their educational opportunities or going hungry because there's no teacher, or no farmer, or no parent to pay for school and food.
 * There are significant culture factors. Cultural roles that support philandering have spread the virus.  Fear of the disease has encouraged (slightly) later sexual debuts and more open discussion of sexuality.  A big cultural shift regarding condom use:  until the early 1980s, condoms were seen as useful specifically for preventing pregnancies and therefore the idea that gay men should use them was laughable.  Now, condom use for STI prevention is entirely normal.


 * Looks like the Prognosis issue has been a problem for a while!! I personally wonder if some of these social issues have been a little bullied out of the articles by tough-talking 'raw-science' editors? I have to say, I don't think MEDMOS has done these issues a favour with the poorly way its been structured. I'm sure no-one here wants to see this "cruft" that people refer to (a weird term), but I think sometimes the alarm-factor associated with the word is used to push an article in an over-riding direction. Under Wikipedias clear "general reader" ethos: (and to quote MEDMOS itself):


 * Wikipedia is written for the general reader. It is an encyclopaedia, not a comprehensive medical or pharmaceutical resource, nor a first-aid (how-to) manual. Although healthcare professionals and patients may find much of interest, they are not the target audience.


 * What would the words "AIDS" or "Alzheimer's'" mean to a "general reader"? What would he or she want and expect to read? Wikipedia articles cover the whole subject, and 'notability' is the key. This guideline clearly states to me that science is no more or less important than the social or the cultural aspects of a subject. We surely must be absolutely fair and objective and move EVERYTHING not needed in the main article into sub-articles, and EVERYTHING not needed in sub-articles (probably the true "cruft") off Wikipedia entirely! Honestly, I find it so much easier to approach when avoiding any bias (ie towards culture, science etc). MEDMOS is great that it forces the science to be represented fairly (and recommending relatively standardised sections is the obvious way to do this) - to be honest, MEDMOS is embarrassing in that it hasn't done this properly for the sociological and cultural issues involved with subjects like AIDS and Alzheimer's.--Matt Lewis (talk) 23:17, 9 April 2008 (UTC)


 * There were always places in the articles for the content; there still is. We've only changed what we call the sections and where we put the content.  Sandy Georgia  (Talk) 23:23, 9 April 2008 (UTC)


 * Bingo. Antelan talk  23:24, 9 April 2008 (UTC)


 * But where do you mean? I have to stress (as others have) that in Alzheimer's we had information to include that just couldn't be put elsewhere (ie with our misunderstanding of 'Cultural references' and 'Prognosis'). I have to disagree if you are returning to your point that there was always a place for social/cultural issues under pre-existing "corresponding" sections - I'm afraid that just wasn't the case at Alzheimer's (and many editors want 'purer' science sections anyway - especially at AD). --Matt Lewis (talk) 23:43, 9 April 2008 (UTC)


 * It's been confusing, admit it! --Matt Lewis (talk) 23:26, 9 April 2008 (UTC)


 * Well, *I* was never confused by it, and therefore I assume that the typical editor wasn't either. For that matter, the majority of editors don't even know that MEDMOS exists, so I doubt that any guidelines here could have confused them.  Do you have a particular example in mind?  If an article needs cleaning up, you can post it to WT:MED.  WhatamIdoing (talk) 23:34, 9 April 2008 (UTC)


 * You said Economics in AIDS was "(filed, oddly, under prognosis)" so obviously editors at AIDS followed MEDMOS (as it was a couple of days ago) in the same way we all did at Alzheimer's - that's a fair bunch of editors. --Matt Lewis (talk) 23:47, 9 April 2008 (UTC)


 * Unlike you, I don't assume that AIDS's editors put ===Economic impact=== under ==Prognosis== because of MEDMOS. MEDMOS has never required that approach -- it doesn't even require that an article follow the suggested list of sections.  WhatamIdoing (talk) 00:24, 10 April 2008 (UTC)


 * What are the odds that the AIDS editors did not follow the long-standing "Prognosis (social impact may also be discussed)" when placing "Econommic impact" and "Stigma" under Prognosis? It's a smoking gun! If you read my input you will see I'm trying to help advance both Alzhemer's and MEDMOS here, as Alzheimer's was getting stuck and MEDMOS was simply misleading us on social issues. --Matt Lewis (talk) 14:38, 10 April 2008 (UTC)

I was told earlier that we had to get it right in discussion before making a MEDMOS change – I’m concerned we are in an “the edit has been made” position now regarding debate. But I still can’t see why Economics is there. I can see clear problems arising over that - it looks MEDMOS is inferring that Society and culture should not cover finance - which is surely always a social factor – and that an Economics section should. The question arising would be "how do we split the prose"? The fact that AIDS has “Economic impact” and is an FA shouldn’t be influencing MEDMOS imo – AIDS actually has it subbed under Prognosis, and FA’s are not always perfect by any means.

In place of "Economics" I would put "Sociological and Cultural aspects (which can include economic impact)", or would simply just leave the economic word out. Or if "Society and culture" (which sounds rather 'arty' to me!?) must stick, I would do the above around that. --Matt Lewis (talk) 15:10, 10 April 2008 (UTC)


 * And if the only "sociological and cultural aspect" that is included is economics, then you think the more precise label is inappropriate? I disagree.  WhatamIdoing (talk) 17:50, 10 April 2008 (UTC)


 * I did not say any section heading is always "inappropriate" - I've explained why I feel confusion will arise from recommending a society/culture section and an Economics one too. As I have said before - I'm in this Talk simply because of what has, and I feel could happen at Alzheimer's - an article which I have, and wish-to, write prose for. I'm not sure why are you just dumping on my arguments the way you are, but I'd be obliged if you change you 'tone' and show some AGF (which I happen to deserve). I don't care how hard anyone is with me - just as long as they are open, direct, and address my actual points. --Matt Lewis (talk) 13:36, 11 April 2008 (UTC)

A number of points:
 * 1) To clear up the speculation above: Yes both Stigma and Economics were moved to subheadings of a new Prognosis section "per MEDMOS" by Orangemarlin (10th March 2008). However, he expressed doubts ("Changing per WP:MEDMOS. Not sure if this works well, however.") I don't think that was a good move (prognosis is very much a personal thing, whereas both stigma and economics are societal things). I think we all accept that "Prognosis (social impact may also be discussed)" wasn't helpful.
 * 2) "Sociological and Cultural aspects" is an inferior section title (but may be fine as an article title prefix). We don't have "Symptomatic aspects" or "Pathophysiological aspects". The "Society and culture" form we have now maintains the style of the other sections.
 * 3) I don't think "Economics" as a top-level-heading has strong evidence-based support. If it isn't obvious that it fits under "Society and culture" (along with lots of possibilities) then we can add a comment.
 * 4) MEMOS makes it clear that all the headings are suggestions and should be included only if appropriate. It also notes that some sections may be merged. Therefore, I suggest we change and simplify the text to:
 * Society and culture (e.g., stigma, economics, religious aspects, awareness, legal issues)
 * Research directions
 * In other animals

Does this fit with existing articles and what people want to do with their current projects? Colin°Talk 18:59, 10 April 2008 (UTC)
 * Works for me, and is no different than the way I always understood the MEDMOS guideline. Maybe add educational issues to your examples.  Sandy Georgia  (Talk) 19:11, 10 April 2008 (UTC)


 * This is a marked improvement. I still think "Society and Culture" sounds like a pull-out section of the Sunday Times, but the main issue is avoiding confusion over where to put things. I notice you have "religous aspects" - aspects is a solid utility word - I would even put it next to economic. It fits very well next to some words (and stops them sounding too general), while others words clearly sound better alone. --Matt Lewis (talk) 13:36, 11 April 2008 (UTC)


 * Would anyone object if Colin puts it in? I'm not happy with Ecomomics highlighted as it currently is, as for me it compromises "Society and Culture" (which unfortunately 'sounds' to me too like it doesn't cover fanancial aspects - but in most cases I'm sure it would). --Matt Lewis (talk) 17:26, 12 April 2008 (UTC)


 * Nobody has put up an objection so I've included it. --Matt Lewis (talk) 15:18, 14 April 2008 (UTC)


 * On the old prognosis: I have always interpreted this as meaning the social impact as applied to the individual person:  you can't visit your friends or go to religious services if you're in a quarantine for tuberculosis.  It had never occurred to me to put major societal issues like, say, cultural views that support domestic violence, under "Prognosis," perhaps because a good deal of that belongs under "Cause"!  WhatamIdoing (talk) 04:28, 11 April 2008 (UTC)

Section on sub-articles is needed
I think a sction on sub articles is needed. Currently we just have this (at the end of 'Notable cases'):

''If the list is (or could be) long enough to support a separate article, then consider splitting it off. The format can be prose, such as Sociological and cultural aspects of Tourette syndrome, or a list, such as List of people with epilepsy. Regardless, such articles must be well verified or they may quickly end up deleted. Wikipedia's Naming conventions generally discourage the use of words such as "notable" or "famous" in such list titles.''

I would end Notable cases with something like "Please see the following section on Sub-articles". I would add the above to a new section, with an extra short paragraph:

Sub-articles (or similar heading, eg Article splitting )

''(Repeated parag:) If the list is (or could be) long enough to support a separate article, then consider splitting it off. The format can be prose, such as Sociological and cultural aspects of Tourette syndrome, or a list, such as List of people with epilepsy. Regardless, such articles must be well verified or they may quickly end up deleted. Wikipedia's Naming conventions generally discourage the use of words such as "notable" or "famous" in such list titles.

''(New parag:) Minor sub-articles can be linked-to in the prose, but major sub-articles should be linked to by using "See also..." or "Further reading..." (per the relevant part of Wikipedia).''

MY POINT:

Sociological and cultural aspects of autism is buried in the Autism prose. I'm concerned that sociological aspects of medical subjects are getting a raw deal in MEDMOS. I think this would make it fairer - and seems pretty sensible to. I don't think we should assume anything is 'obvious' or 'common sense'.--Matt Lewis (talk) 00:20, 10 April 2008 (UTC)


 * Your concern is not specific to medicine-related articles and is better handled in the main MOS. WhatamIdoing (talk) 00:25, 10 April 2008 (UTC)


 * Would you not point people to MOS though - perhaps by adding a line on it? What about the paragraph in Autism that rather buries the "Sociological and cultural aspects" link - maybe you have an opinion on it. In my experience those who use MEDMOS go by it pretty carefully, and a heading and paragraph in MEDMOS would be useful (and surely pretty harmless, too). --Matt Lewis (talk) 00:32, 10 April 2008 (UTC)


 * Sociological aspects of Tourette's are buried in Autism? I'm confused.  Sandy Georgia  (Talk) 00:26, 10 April 2008 (UTC)
 * Well spotted - changed it to Autism. What do you think? --Matt Lewis (talk) 00:32, 10 April 2008 (UTC)

This rule already exists and should not be duplicated here. Why don't you just go make the change that you want to see? You do not need permission to apply pan-Wikipedia rules to a medicine-related article. WhatamIdoing (talk) 05:33, 10 April 2008 (UTC)


 * Who said it should not be duplicated here? MEDMOS is about being a useful guide to people. Haven't Autism and Alzheimer's highlighted the parts where MEDMOS hasn't worked? I'm only here as it was previously misleading us - I don't have the time really: but MEDMOS is an important thing, as are Wikipedia medical articles. I will "be bold" and make that change to the Autism article anyway: I cannot see why sub-articles shouldn't be better covered here though. Just because MOS deals with it somehwere else seems a poor reason for being short on it in MEDMOS - Wikipedia is always dublicating snippets of information (especially in the guidelines, no?). I'm only calling for an extra line or two.--Matt Lewis (talk) 14:23, 10 April 2008 (UTC)


 * This aspect (linking to sub articles) is of no concern to MEDMOS as it is not an issue specific to medical articles. Not every problem we see in a medical article needs to have its solution in MEDMOS. We need to stay focussed. Colin°Talk 15:47, 10 April 2008 (UTC)


 * I'm focusing on MEDMOS being a useful guide to creating a medical article (which to me is a concern to 'MEDMOS' as a whole). I think elucidation here will be helpful - not rigidly exactingly by-the-book urgent - but clealy helpful. And I think the Autism example is a good reason why. Highlighting sub-articles a little would hardly be unhelpful to people: at the moment, what we have comes under "Notable cases". Can't we do better?--Matt Lewis (talk) 13:49, 11 April 2008 (UTC)
 * MEDMOS must be used in conjunction with our other guidelines and policies. Repeating stuff already covered elsewhere will lead to divergence over time, which is not good. The proposed text introduces concepts, like minor and major sub articles, that aren't in common use on WP, need to be defined, and are not specific to medical articles. Colin°Talk 14:17, 11 April 2008 (UTC)
 * It was a proposed 'idea', more than my specific text. The article certainly mentions subbing (under Notable cases - the best place?) - and people have followed it to the word (ie "Sociological and cultural" etc) - as MEDMOS, as style guidelines go, is particularly important to people.


 * Can someone improve what I've done? I'm mainly just calling for an additional comment on how best to link to subs, and a more relevant heading. As I've said above, Wikipidia favours repeating stuff when it's helpful to do so (and guidelines do it all the time - just look around). I'm only calling for a line to two.


 * "divergence over time, which is not good" - but that's just Wikipedia, isn't it? We are supposed to deal with it. It's 'Baby out with the bathwater stuff' to me - I often disagree with that argument: we must show AGF to the future. --Matt Lewis (talk) 14:39, 11 April 2008 (UTC)

Matt, nobody minds having a see link to the subarticle in Autism. Right now, you have spent a lot of time trying to change MEDMOS. Nobody else sees any need for a change here.

Try this: Go make the change that you want to see in Autism. If you actually run into opposition there, then come back and tell us. Then you'll have a real, live, specific case to support your claim, and we'll see what needs to be done. Until then -- it looks to me like you're asking several editors to invest time and effort into re-writing guidelines when you steadfastly refuse to spend fifteen (15) seconds implementing the change under the long-standing WP:MOS rule. Even if we did spend a day or two wordsmithing the change, there's still no guarantee that you will then spend fifteen seconds adding the link to Autism. Can you understand why this process seems disproportionate and even unreasonable to me? The bottom line is this: if you really want to see this change, then you're going to have to prove it by showing me that you have already tried the reasonably available alternatives and that you can't achieve your goal (which I support) without it. WhatamIdoing (talk) 19:14, 11 April 2008 (UTC)


 * I've been "steadfastly" waiting for some support in here! Autism is an FA remember. Also I've been busy lately - thanks for the "See" link (which has saved me some time) - I've just used it to make the Autism edit. --Matt Lewis (talk) 11:00, 12 April 2008 (UTC)


 * The change you made was a stylistic, personal preference, and in general, we should never duplicate and overlap general Wiki WP:MOS guidelines, as that just creates a problem with redundancy and staying in sync. Your proposal is a general guideline issue.  I suspect you're still misunderstanding the role of guidelines vs. policy.  Sandy Georgia  (Talk) 18:07, 12 April 2008 (UTC)


 * How am I confusing guideline and policy? And why the "still"?


 * Using a "See also" for major sub-articles is more than just a personal preference - it is clearly widely-used throughout Wikipedia. And MEDMOS is full of stylistic elements.


 * I come across guidelines and policy all the time that clearly repeat information stated elsewhere in order to highlight it. Sub-articles are clearly critical to many medical articles (which have to balance so much). The decision to split often takes up a lot of Talk time.


 * The idea of guidelines is surely to guide and be helpful too - and not to add to a labyrinthine maze of bureaucracy that cannot overlap. What's wrong with helping people when its relevant and helpful? When something aids understanding, and makes sense, a healthy Talk surely won't dismiss it on the grounds that it is covered elsewhere.


 * I think it's simply wrong to see issues of "redundancy and staying in sync" as being prohibitive factors in these cases – to me it is inflexible, a little regressive, and not in the general spirit of Wikipedia. Would guidelines on "article-splitting" and "see also" links really become "redundancy and sync" issues for MEDMOS? They are far too important not to be immediately noticed and synced, surely. And articles can easily change.


 * Workload should never be an issue on Wikipedia at an individual level. I worry that MEDMOS has been curtailed by a particularly rigid and narrow outlook that is simply not in the ethos or best interests of Wikipedia. The fact that MEDMOS has clearly been regularly edited, yet has remained so misleading for so long on the “social/cultural” issue, certainly highlights something. I also worry about how much input is welcomed here.


 * I've refined the proposal a little:


 * (new heading after Notable cases):Article splitting


 * (exisiting parag): If a list, or section, is (or could be) long enough to support a separate article, then consider splitting it off. The format can be prose, such as Sociological and cultural aspects of Tourette syndrome, or a list, such as List of people with epilepsy. Regardless, such articles must be well verified or they may quickly end up deleted. Wikipedia's Naming conventions generally discourage the use of words such as "notable" or "famous" in such list titles.


 * (new parag to go after it): Split articles (often known as sub-articles) can be wikilinked from the paragraph prose, or have a more direct link under the relevant section heading, usually in the form of "See also:" or "Main article:" (refer to the style guideline, guide to layout)


 * The existing paragraph (which was the last parag under Notable cases) offers some title guidance - surely it can offer placement guidance too? The word "list" referred to Sociological and cultural aspects of Tourette syndrome (which I think belittles "social issues" here) so I've changed the first line to "If a list, or section, is...". This better separates it from Notable cases (although it neatly leads on too). I've wikilinked "splitting" in the existing parag, which would be helpful too. —Preceding unsigned comment added by Matt Lewis (talk • contribs) 01:22, 13 April 2008
 * Matt, I think you have to accept this extra text doesn't have support, for the reasons already given. Colin°Talk 11:45, 13 April 2008 (UTC)


 * I think you need to read the above again. Nobody has addressed the issue of Sociological and cultural aspects of Tourette syndrome being referred to as stemming from a list. I will "move on" when I feel I'm ready - not when I'm told too. Other editors are welcome here too (by me anyway). --Matt Lewis (talk) 12:36, 13 April 2008 (UTC)
 * The text doesn't say SACAOTS "stems from a list". It gives it as an example where a list of notable people has been rendered in prose. The SACAOTS contains more than just a notable people list. The section is about handling notable people, not about how and when (generally) to split sections off into sub articles. Colin°Talk 12:51, 13 April 2008 (UTC)
 * True, but wouldn't it be better to identify more clearly where that rendered-into-prose list is? I attempted to do so with this little change. Eubulides (talk) 07:36, 14 April 2008 (UTC)


 * This is better at least - Sociological and cultural aspects of Tourette syndrome was referred to in terms of stemming from a list - now that the list-section of the sub-article is linked to, things make a lot more sense. Social aspects in MEDMOS (shown here by the sub-article title) at least stand a little firmer now. There is nothing 'tough' about undervaluing (or comparatively demoting) social aspects - my points about how MEDMOS is dealing with it has been consistently ignored. There is a bit of a 'tough-minded' cabal in here imo. Cabals can lose the 'critical dynamic' that Wikipedia needs - too many in the tribe are too inclined towards backing each other up. We've all seen it - maybe it's not so easy to spot when you're part of it. Act too tough and you lose perspective, flexibility and even logic.


 * I'll Wikilink the word 'splitting' (which no-one can argue with) and then I'll 'be bold' and put in Colin's suggested 'social' Section ammendment (which seems to have the backing of SG, and nobody has argued with). After that I'll make a 'diff' of my splitting proposal above - which I accept will be reverted, but I favour doing for a few reasons. If the Sections improvement sticks I'll be happy enough to leave you all to it. --Matt Lewis (talk) 15:01, 14 April 2008 (UTC)


 * Well here's my diff. I worked on it a bit. Re-reading "Notable cases" it's struck me the length that section went to in repeating what is a standard MOS guideline! How can that argument make Article splitting non-relevant? It surely all depends on what is seen as helpful or not. --Matt Lewis (talk) 21:37, 14 April 2008 (UTC)


 * OK, there's nothing more I can do here. I had a feeling "repeats MOS" would be in the reverting edit-note, despite my own referring to Notable cases: Repeating MOS is all Notable Cases does after the first line! (and Article Splitting could easily have such a first line). It's just plain double-standards. And the Article splitting section obviously wasn't intended to be a "general guide" - so it shouldn't have to "make sense" as one. That was rather a disingenuous point - the section made clear sense to MEDMOS.


 * All this is not that important in one sense, but something about it is symptomatic of something that bothers me. Maybe there should be a MEDEMOS for MEDMOS editors?


 * Anyway, at least MEDMOS "in general" makes a little more sense than it did just a while back. --Matt Lewis (talk) 00:02, 15 April 2008 (UTC)

(unindent) Before calling other editors "disingenuous" or suggesting they need special guidance, perhaps you could examine (privately please) why you made a WP:POINTy edit in the first place. You knew it didn't have consensus (didn't have any support for that matter) and would be reverted. The "Article splitting" section (general is so far as it is in a medical guideline -- hey I've only got so many characters in an edit summary) you created contained specific guidance about handling notable cases (problems over AfD, issues with naming "notable people" lists, whether to use list or prose) that are completely irrelevant wrt other sections in a medical article. There. I've made my defence. I have no wish to further a conversation with someone who slights me and other good-faith editors. Colin°Talk 07:18, 15 April 2008 (UTC)
 * I unwatched this page a few days ago, as it was going in circles and becoming a timesink; I thought I'd drop in and see what the problem was still, since Matt Lewis is now over at Talk:Autism questioning the featured status of one of Wiki's finest featured articles. I'm just not seeing the problems that Matt is seeing; maybe I just don't understand Wiki's featured standards. Sandy Georgia (Talk) 03:41, 16 April 2008 (UTC)


 * We don't always see eye to eye for sure (I can't believe Autism is one of Wikipedias finest FA's for example!) but we will have to work together as you move around Wikipedia a lot. I actually have an autistic friend, believe it or not (yes - actually a friend, who is always genuinely happy to see me) - Wikipedia is more than a collection of cabals, we are all welcome. I am forthright but am entitled to my say - it is only for the improvement of Wikipedia, you can be assured of that. --Matt Lewis (talk) 04:21, 16 April 2008 (UTC)


 * Colin, why didn't you say all that with your revert? (ie. make your defence you reasons - you have some points, although all sections can contain lists). If you needed more room for your edit note, then say it here - you can't say there wasn't a discussion, and that it isn't good form to do so. Anyway, you have encouraged me to address your criticisms and post a revision below.


 * Your WP:POINTy example is doubly-ironic to me (I'm British so I must point this out): look at the section called "Gaming the System" - that is now the 3rd time I've seen that text copied and pasted in a Wikipedia guideline - not just "repeated" but copied and pasted. Irony, yes? I'm sorry, but to me editors here have been clearly disingenuous in calling-bad the common Wikipedia practice of repeating a guideline/policy where is it is useful to do so. It is simply to limit the amount of wiki-linking, to be helpful, and limit the 'labyrinthine bureaucracy' element of Wikipedia! Instead of a rational argument I feel I have faced cabal-motivated 'gaming' tactics to fob me off - it's what I've perceived. So double-irony here for me, which I'm simply obliged to pointy out.


 * I did make my edit after discussing it here first and finding no consensus, but on the face of it I think I was entitled to. I often favour 'being bold' even after discussion, and as I have said, sometimes the edit needs to be seen on the page. I did say beforehand too. It's not important enough a section for me to fight over for too long, but the standard of editorial control of this MOS is just not in the best of shape imo, and MEDMOS is important enough for somebody with the inclination to point that out. I only proposed this because I noticed that the Notable cases section had a "social aspects" sub-article in it that was (before it was amended to include a section anchor) referred to as a list. It was the only mention of a sub-article in MEDMOS, and the only comprehensible mention of 'Social aspects' before the Section-list was eventually changed - so more work was clearly needed. Not wanted, clearly - but needed.


 * EXISTING TEXT:


 * Notable cases


 * See also: Biographies of living persons and Lists of people.


 * Articles on medical conditions often include lists of notable individuals who have (or had) the disease. This may be manageable if the disease is rare. For common conditions, it can become a distraction from the main article and contain much unreferenced and dubious material. If you do include such a list, ensure your entry criteria are well defined so that future editors may know if their additions are welcome. One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition.


 * Unsourced additions, particularly for living persons, must be removed. Responsibility for justifying controversial claims rests firmly on the shoulders of the editor making the claim. Be very firm about high-quality references, particularly about details of personal lives. Entries in the list must be notable (a straightforward test of which is the presence, or realistic hope, of a Wikipedia article). Non-notable relatives of notable people should not be included.


 * If the list is (or could be) long enough to support a separate article, then consider splitting it off. The format can be prose, such as Sociological and cultural aspects of Tourette syndrome, or a list, such as List of people with epilepsy. Regardless, such articles must be well verified or they may quickly end up deleted. Wikipedia's Naming conventions generally discourage the use of words such as "notable" or "famous" in such list titles.


 * REVISION TO ADDRESS CRITICISMS ABOVE:


 * Any section in a medical article surely can contain a list - so it is fully relevant to all sections in a medical article. And it's mainly just a matter of wording anyway. I'll look at the line on 'verifying', which I almost removed, then thought twice about it. I'll also specify 'lists' in the 'Naming conventions' line to be more exacting.


 * Notable cases (text as stands)
 * See also: Biographies of living persons


 * Articles on medical conditions often include lists of notable individuals who have (or had) the disease. This may be manageable if the disease is rare. For common conditions, it can become a distraction from the main article and contain much unreferenced and dubious material. If you do include such a list, ensure your entry criteria are well defined so that future editors may know if their additions are welcome. One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition.


 * Unsourced additions, particularly for living persons, must be removed. Responsibility for justifying controversial claims rests firmly on the shoulders of the editor making the claim. Be very firm about high-quality references, particularly about details of personal lives. Entries in the list must be notable (a straightforward test of which is the presence, or realistic hope, of a Wikipedia article). Non-notable relatives of notable people should not be included. If a list is long it can be split (please see the following section on article splitting).


 * Article splitting (removed and amended from Notable cases, as proposed, with some new changes)


 * ''See also: Splitting an article and Lists of people


 * Medicine-related subjects can have areas that are too involved to be sufficiently covered in a single article; examples in section-form could be epidemiology or pathophysiology. If a section, sub-section or list is - or perhaps could be - long enough to support a separate article, then consider splitting it off. Depending on what is required, the resulting sub-article could be in a standard article format, such as Sociological and cultural aspects of autism, or in a list format, such as List of people with epilepsy. A list can also be placed in a broader sub-article, such as Sociological and cultural aspects of Tourette syndrome. Note that Wikipedia's naming conventions generally discourage the use of words such as "notable" or "famous" in the title of a list-format article. Regardless of the type, articles must pass Wikipedia's general notability criterion - those that don't, or are short and not properly verified, may quickly end up deleted.


 * In accordance with summary style, all sub-articles should be summerised in the corresponding section of the main article. Generally sub-articles must be clearly linked-to directly under the corresponding section heading, usually in the form of "See also:" or "Main article:" (see guide to layout). Consensus through discussion is normally achieved before an article is split.


 * -Most of the guidelines referred to are already in the existing Notable cases, so please don't call me up on the duplication issue. Out of interest, article splitting is actually covered over a few articles - and is not represented fully in any single place. If someone is interested he/she might want to improve what I have written. Don't worry - I won't be putting it up again unless I come back and see that a consensus has formed (most likely over a revision if it happens at all), and that no-one has yet made the edit. It's more likely this will just sit here until it's archived, I know. --Matt Lewis (talk) 04:08, 16 April 2008 (UTC)

EL proposal that relates to MEDMOS
After cleaning up yet another external link mess, I have proposed at WT:EL that patient/survivor/personal experience stories be specifically named as inappropriate for the external links section. I started this conversation at EL instead of here because it could apply to any number of things, not just medicine-related articles (personal stories about being a parent, for example). My goal is to have something that really cannot be interpreted as normally allowing direct links to one-page blogs titled "patient experiences and survivor stories."

However, if it's deemed inappropriate or unnecessary as a general rule, then I plan to propose it here, with wording that it specific to disease and drug articles. Consequently (to avoid any WP:PARENT issues, I'd like to invite anyone who is interested to join the discussion here. WhatamIdoing (talk) 17:59, 12 April 2008 (UTC)


 * As a rule, we should never duplicate in our guideline something that is general to all of Wiki. Personally, I think that's already covered by WP:EL, WP:RS and WP:NOT (not a support group), and nothing more is needed, even though it's an ongoing maintenance issue.  Sandy Georgia  (Talk) 18:05, 12 April 2008 (UTC)


 * Yep, I agree: guideline duplication is generally bad, and the situation is covered by existing rules.  It is because of some, um, creative interpretations of the existing guidelines that I propose improving the clarity of the existing guideline.
 * I mention it here only because if it's rejected as a general guideline for pan-Wikipedia use -- say, if people really want to have the freedom to include links to essays like "How I survived going on vacation without taking my laptop" -- then I plan to propose it as a specific guideline for medicine-related articles. You should feel free to reject it in both instances if you dislike it.  WhatamIdoing (talk) 02:08, 13 April 2008 (UTC)

break (2)
WT:EL prefers that this information be included in MEDMOS, on the grounds that the problems are pretty rare outside of medicine-related articles. Here's my proposal for expanding WP:MEDMOS:

Please avoid links such as these:
 * 1) Links that merely duplicate information that is already included in the article or in another external link
 * 2) Links to web-based or email-based support groups for patients, professionals, or other affected people
 * 3) Links to local, state, or regional charities or to meetings or events in a single location
 * 4) Links to more than a few of the most significant national and international charities
 * 5) Links to personal experiences or survivor stories

Given a choice between similar links, or multiple pages on a charity's website, please prefer links that provide information that is likely to be interesting to readers worldwide, such as a FAQ or detailed article on the specific topic.

My specific goal is to have something absolutely unambiguous to deal with:
 * 1) low-content and redundant links
 * 2) discussion groups (over and over and over and over and over and over and over, with the persistent assertion that surely WP:EL's long-standing consensus on this issue doesn't apply to medicine-related discussion groups)
 * 3) links to tiny, local-area-only organizations, or local meetings or conventions
 * 4) endless lists of every possible charity that purports to be "national" or "international"
 * 5) websites that are entirely or primarily personal survivor stories

My current thought is that this would go in the middle of the existing short section. I welcome suggestions on phrasing.

If you don't like this proposal, it would be helpful to me to know whether you don't agree with the overall goals (for example, you think Syphilis should have several links to low-information sites; you think Stroke should link to a charity that serves a single metro area or that HIV should advertise the annual Retrovirus conference; you think that Wikipedia really needs unverifiable stories about individual patients; etc) or that you don't agree that it's a problem (in which case, I will suggest a list of articles for you to add to your watchlist ;-). WhatamIdoing (talk) 23:07, 3 May 2008 (UTC)


 * I think it's a great proposal, I've definitely seen tons of problems with each of the items listed (well, maybe not the survivor stories, but I'm sure it happens all the time). It'd be great to have something unambiguous to point to.   delldot on a public computer   talk  23:38, 3 May 2008 (UTC)


 * I'm unclear how this will help. Numbers 1, 2, 3 and 5 are already covered by WP:EL, WP:RS and WP:NOT and I don't want to encourage number 4 either.  I go even further: if it's already in DMOZ, why do we need it?  Every EL should be justified, and should be there for a reason.  EL already does that.  I won't oppose this addition, but I don't like number 4, and if we really must say something, I hope it would encompass a DMOZ link.  If an FAQ has to be included in EL, then something is wrong with the article, since ELs should only include information that would not be in the article if it reached featured status.  This proposal would expand the amount of linkspam we let in, at least relative to my standards.  Sandy Georgia  (Talk) 23:50, 3 May 2008 (UTC)
 * Agree with Sandy, it will not help. The linkspammers do not read MEDMOS, and, conversely, they do not make trouble and do not refer to guidelines if you delete their links. I would agree, though, that it may be convenient to have 1,2 and 5 in MEDMOS to be able to simply refer to MEDMOS instead of going with the alphabet soup of EL/RS/NOT. I would not include points 3 and 4. If it is a reliable site and offers new and useful information, it does not matter what it is - charity, conference abstracts, local or otherwise. Paul Gene (talk) 01:12, 4 May 2008 (UTC)


 * About my suggestion to point at a FAQ instead of a main page: I agree that WP:ELNO #1 should both be better understood and better enforced, but I'd rather that external links to the MEDMOS-authorized "manageable set of charitable organisations" pointed at a FAQ than at "click here to donate" or "we are the world's leading charity".  Additionally, some rare disease orgs have FAQs that include information that does not properly belong in an FA-status article, like a list of hospitals that have expertise with the disease, or practical suggestions on dealing with schools, employers, or finances.  Finally, as many of the problem articles are stubs or just bigger than a stub, the external links section gives the disappointed reader an alternative.  There are more than ten thousand WPMED-tagged articles; we can't bring them all up to B-class today -- or even this year.
 * WP:RS doesn't help us, because WP:EL's "Links to be considered" explicitly allows links to pages which fail WP:RS. Leaving that aside, you're entirely right:  I'm not inventing anything new here.  The point is to restate the existing consensus in terms that are perfectly plain even to the most POV-blinded editor.  (See this discussion for one example of how the existing guidelines have been interpreted.)
 * Most articles don't have a DMOZ link, but I'm happy leaving out #4 if that seems more appropriate to you. It is the least important of the items in my list, and it is redundant with the existing "manageable set of charitable organisations" language.  WhatamIdoing (talk) 01:23, 4 May 2008 (UTC)


 * Paul, the problem here is not so much about large-scale linkspamming as it is about individuals who want to add a single website to a single article. It's actually rare that I encounter the same link on two articles.  Usually the link is to an organization that they volunteer for.  They tend to be open to reason -- but so dedicated to the desirable outcome that they will grasp at any straw that might favor inclusion.  My goal is to take away the straws.
 * You're right that it won't help the people who don't read any of the guidelines -- but it will help me, because it will give me a crystal-clear, consensus-approved, plain-as-the-nose-on-your-face justification for deleting these links. Not having to waste time and energy arguing over these things would be a positive thing.  WhatamIdoing (talk) 01:30, 4 May 2008 (UTC)
 * I meant the "linkspammers" to include the cases you describe. If they do give you trouble, I wholeheartedly agree - it would be useful to have a single reference to MEDMOS (points 1,2,5) to shut them up. Paul Gene (talk) 10:45, 4 May 2008 (UTC)


 * I approve of WhatamIdoing's proposal, and suggest we also design a template that can easily "substed" on the talkpages of spammers to prevent a further Kosherfroggate. JFW | T@lk  14:50, 4 May 2008 (UTC)
 * I've been thinking further about this proposal in action on the three featured articles I help maintain: Asperger syndrome, autism and Tourette syndrome.  We currently have no linkspam issues on those articles, because 1) WP:EL and WP:NOT give us everything we need to keep it out, and 2) we encourage links to be added to DMOZ.  This proposal could increase linkspam on those articles, and potentially destabilize them with edit wars over which charities to include (I can already imagine the messy debates at autism and Asperger syndrome, no problem at Tourette syndrome since the bogus alternate "national" charity folded a few years ago).  Wikipedia is not a support group, and not a collection of indiscriminate lists (like where to find a certain hospital).  That's "not our job".  I have not yet encountered a situation where WP:EL and WP:NOT weren't sufficient to prune the linkspam, and I'm very worried that this proposal codifies something and gives permission for increased linkspamming.  WhatAmI, if you are having problems with linkspammers on specific articles, perhaps you just need more of us to help you enforce current WP:EL and WP:NOT guidelines, but another guideline won't stop linkspammers, since they don't read the rules anyway. Also, if we branch into covering what is already covered by WP:EL and WP:NOT, then we get the disputes here which would otherwise go to a broader audience at the WP:EL talk page; let's not buy a problem. We will then own it and have to maintain it.  Sandy Georgia  (Talk) 15:13, 4 May 2008 (UTC)

External Links to Medical Online Communities
The current guidelines state that links to discussion forums are unacceptable. For many people suffering from a rare disease, unfortunately, the only source of information regarding their disease may be a medical online community, often small and without a connection to any particular advocacy organization.

A growing body of evidence, made available in peer-reviewed publications shows that well-managed systems of medical online communities can have a profound impact on the quality of care received by the members of such communities. For those suffering from rare diseases, knowing of such online communities can make the difference between life and death.

Therefore a change of policy should be seriously considered.

Disclosure: I am the founder of such a large system of medical online communities. You may consider that fact either as a conflict of interest or on the contrary, as the reason for my expertise in this subject. Kosherfrog (talk) 00:08, 14 April 2008 (UTC)


 * What does the evidence in peer-reviewed journals say? What are some citations?
 * I personally don't have any objectons, but I'm not the Wikipedia community.
 * You can make exceptions to most rules on WP. I'd like to see someone make a case for it.
 * The best example I can think of is ACOR (?) the organization that runs cancer email lists. They might deserve an exception because of the sheer usefulness of their information. If an online community has medical advisors to keep an eye on what people are saying, that would tend to make them a reliable source. If it's just people touting alternative treatments, that would make them less reliable.


 * You could make the case that the burden of proof is on the editor who wants to include them to demonstrate that an online community is a reliable source. Nbauman (talk) 02:39, 14 April 2008 (UTC)


 * Do you think that ACOR has medical advisors? I haven't heard anything about it. It may just be the case of a system designed from the outset to be patient-centered and to promote high quality information.Kosherfrog (talk) 08:50, 14 April 2008 (UTC)


 * No, the burden of proof is on the editor to demonstrate that this link is interesting to or informative for the average reader, not a patient (or a medical student). WhatamIdoing (talk) 05:26, 14 April 2008 (UTC)


 * In the vast majority of cases, these forums are poorly moderated and serve only to perpetuate myths and cloud the communication between patients and their physicians. The only exception should be if these forums have been demonstrated individually to be a major source of information for patients, their carers and the general public. In that sense I agree with Nbauman and WhatamIdoing.


 * When it comes to websites about medical conditions, there is a strong case for preferentially including authoritative sites with a nationwide scope, maintained by a large organisation etc etc. Kosherfrog has already created Participatory Medicine and E-Patient, and I believe we have already crossed swords on this subject in 2007. JFW | T@lk  06:17, 14 April 2008 (UTC)


 * Your statement on the vast majority of medical forums is really ONLY your personal perspective. How many articles in peer-reviewed publications have you authored on the subject to be able to make such a bold statement? Would your statement apply to, say, an ACOR community, since Nbauman says they deserve an exception? And why stop at the ACOR groups? For example, neurological conditions have the BRAINTALK communities who have serviced large numbers of patients and caregivers, with the support of MGH in Boston. And I know quite a few individual lists at yahoogroups that offer similar high quality information. To repeat, I believe that your statement is based solely on a personal opinion, without scientific basis. But it is having a negative impact on the ability of people like me with a specific interest in rare diseases to create the best possible pages on wikipedia about these diseases. Furthermore, your personal page tells us that you are a European doctor. The well-known cultural disconnect between the importance of medical online communities in the American and European public may explain your statement.Kosherfrog (talk) 08:34, 14 April 2008 (UTC)


 * Your statement on websites about medical conditions requires also some clarification. Let's take a concrete example: Leiomyosarcoma, a rare cancer. Based on your opinion links should be made to the NCI PDQ statement on sarcoma, the American Cancer Society website or to the MSKCC website. But in reality, the sites of these "National, highly respected medical organizations" have very little, if any information regarding this medical condition. By far, the best source of information are a couple of sites created by patients, for patients (Leiomyosarcoma.info and LMSDR.org). And none of those sites would have existed without first the existence of the L-M-SARCOMA community at ACOR, which remains to this day the main method of communication between all those involved in creating high quality information sites about the disease. To further provide accurate information on April 14, 2008 the L-M-SARCOMA list has 835 subscribers, a significant number when considering this is a very rare cancer. An equivalent list on Yahoogroups has over 1,300 subscribers.


 * I don't remember when we crossed swords but if we did I am sure it was about a similar topic. As we are collecting more and more data about the long-term value of well-managed medical online communities it is becoming important to change the mindset of those like you who make broad negative statements about services who are now squarely in the public health realm. Kosherfrog (talk) 08:34, 14 April 2008 (UTC)


 * Improving patient care is not WP's concern. The websites you mention can be found with ease on Google. WP:EL has always been clear on this issue. Colin°Talk 09:23, 14 April 2008 (UTC)


 * Braintalk! The old stomping ground of our good friend WP:TOJO! I think this completely proves my point about the weaknesses of online fora, and I have no problem making broad negative statements where there is so much potential for communities like Braintalk to be infested by people who spread misinformation.
 * Colin is completely right that Wikipedia provides general information, and has no duty of care towards patients or carers. I do personally feel that patient-oriented information is occasionally suitable, but only as an example for the general readership. When it comes to rarer diseases, it becomes all the more important that firstly the Wikipedia article is accurate and based on high-quality references (which is much more important than the external links that come underneath) and secondly that the external resources we offer are of the highest quality. Links need to be discussed on a case-to-case basis, but I really don't see why we need to link to six different websites while we could provide so much more information in the article itself, scrupulously sourced to the best evidence available. JFW | T@lk  11:51, 14 April 2008 (UTC)


 * On the strength of Nbauman's recommendation, I looked at ACOR.org's LISTSERVs and chose one of the rarer diseases from the list (about the same incidence as leiomyosarcoma, but substantially higher prevalence because of much better survival rates). I thought it might make a good test case, since one of the pro-forum arguments is about rare diseases (since the local hospital can hardly provide a support group when you're the only patient in town).  There are not very many people subscribed to that list (fewer than 100).  However, I can't tell you whether there's any activity, because I can't get access to the list.  You have to register -- twice:  once for LISTSERVs in general and again for the specific list -- and confirm both of these steps in e-mail, and even though the confirmation links claimed to have worked, it still says that I'm not "authorized" to post messages or read the archives.  It won't even tell me whether there's anything in the archive.  For all I know, "March 2008" is a link to an empty file.  I've tried two different browsers and waited half an hour to see whether there's a secret, third step in the registration process.  At this point, you can put me on the permanent list of people who will oppose ACOR links:  double registration, plus it still doesn't work, does not meet either the Links to sites that require payment or registration to view the relevant content rule, or apparently the Sites that are inaccessible to a substantial number of users rule (100% of users in this test, although n=1).
 * I'd like to point out again that an online forum or a LISTSERV group is not useful or informative to the average reader. Wikipedia articles are not written for patients.  MEDMOS specifically opposes the inclusion of "helpful" external links, such as forums, self-help groups and local charities as being inappropriate because they are for patients, not average readers.
 * There are, however, no rules against linking to a freely accessible FAQ or other informative page that "just happens" to be associated with an online discussion group. For people who would like to promote their groups, then I recommend this as a generally acceptable alternative.  Also, if there are dozens of such groups (far too many to link to all of them), then you can "hint" in the body of an article that online groups exist:  A sentence or two about peer support or patient education is not out of place for many conditions, and it might inspire patients to do an internet search on the topic.  You can also link to a page that "just happens" to provide links to many support groups.  A simple FAQ that says "What is Disease X" -- "What are the symptoms" -- "How can I find other patients like me" is perfectly acceptable under the existing guidelines.
 * KosherFrog, I thought your comment about not being able to see your views clearly from an outsider's perspective was illuminating: Perhaps you are unable to see our view, or the view of an average "healthy" reader, because you are so active in internet discussion groups.  WhatamIdoing (talk) 18:07, 14 April 2008 (UTC)
 * I certainly have gained enough understanding about the mentality of the medical editors of wikipedia to be able to write some really interesting articles in other venues that pay attention to the needs of the long tail of medicine. Thank you very much for the highly illuminating comments the 3 of you have made in the last 24 hours. I will remark one last time that the 3 of you have NEVER discussed this topic based on what is available in peer-reiewed publications, the gold standard of any real discussion in any of the ACOR groups. I find this fact to be absolutely amazing and it certainly doesn't bode well for the future quality of medical articles in wikipedia. But that is only my personal opinion. Gilles Frydman, Founder, ACOR.org. Kosherfrog (talk) 19:54, 14 April 2008 (UTC)


 * I sympathize with the sincere desire to help patients find supportive communities. That said, the folks you've been talking with have simply been relaying Wikipedia policy to you. If you don't like the policy, you can certainly work to change it through consensus. Also, there was a request for you to post information regarding the results of peer-reviewed studies above, but from my reading of this discussion, I was disappointed not to see a response with links to those sources. Antelan talk  20:18, 14 April 2008 (UTC)


 * Gilles, that is a very unkind reply after all the trouble WhatamIdoing has gone through. I think our disinclination to accept external links will not be the determining factor for the quality of medical articles, but then that is my personal opinion.
 * I take it that we should take your message as a GoodBye then? JFW | T@lk  21:44, 14 April 2008 (UTC)


 * Oh, and I hope you'll have the decency to retract your threat of exposing "the Wikipedia editors' mentality" in other venues. I'd rather hope you'd take our comments on board to make your service more accessible and improve moderation. JFW | T@lk  21:57, 14 April 2008 (UTC)


 * Um, KosherFrog, are you aware of any peer-reviewed publications on writing an encyclopedia? I'm not, but I'd be happy to read them if you can point me to any.  Did you by any chance forget that we are writing an encyclopedia, not "helping patients" or "practicing medicine" or "improving healthcare" or anything similar to that?  Wikipedia is an encyclopedia.  It's rather bigger than the World Books they put in elementary school libraries, but still just an encyclopedia.
 * I also admit to being dreadfully curious what your definition of "medical editor" includes. I don't even have CPR certification.  I sincerely hope that you haven't mistaken me for a physician.  WhatamIdoing (talk) 04:22, 15 April 2008 (UTC)


 * Wiki is WP:NOT a support group, it's an encyclopedia, not our job. Adding a DMOZ link to support groups does the job.  Sandy Georgia  (Talk) 03:42, 16 April 2008 (UTC)
 * I understand that wikipedia is an encyclopedia, a work containing factual articles on subjects in every field of knowledge, usually arranged alphabetically. But you keep on talking about support groups while I keep on talking about medical online communities designed primarily to be cooperative systems for the transmission of current, accurate and often authoritative information about a specific condition. In these social networks the social support aspect is NOT the 'raison d'etre'. See How Cancer Survivors Provide Support on Cancer-Related Internet Mailing Lists, How New Subscribers Use Cancer-Related Online Mailing Lists and The Role of an Online Community for People With a Rare Disease: Content Analysis of Messages Posted on a Primary Biliary Cirrhosis Mailinglist.Kosherfrog (talk) 18:04, 16 April 2008 (UTC)
 * You are banging on the wrong door. Try WT:EL. The External link guideline discourages sites requiring registration or discussion forums. MEDMOS is unable to overturn that longstanding restriction. The "it is more about information than support" argument won't work. Most forums on any subject are about information exchange, between amateurs. Oh, and the "often authoritative" claim isn't backed up by what I saw in your sources: only 1% of postings came from a professional. Colin°Talk 18:28, 16 April 2008 (UTC)
 * I forgot to mention that I understand that policy and that for that reason alone the ACOR medical online communities fall outside of the wikipedia purview. FYI, they are setup this way to protect the privacy of the exchanges. For the rest of your comment, it demonstrates one more time how much you don't know about these online communities, where expert patients are indeed authoritative sources, knowing more about their conditions than all expect a small number of physicians in the world. But my job is no longer to convince anyone here. I understand that, as I have been told repeatedly, wikipedia medical entries are not designed to help patients and that they are not designed to help improve medical care. I have nothing else to add because with such a policy I really have nothing of value to contribute to medical pages. Kosherfrog (talk) 22:33, 16 April 2008 (UTC)


 * That's not entirely accurate. Your peds onc center has been cited as a reference in a number of articles, and informative subpages as external links.  It's the discussion groups that can't be listed in ==External links==.  WhatamIdoing (talk) 22:37, 16 April 2008 (UTC)
 * Accuracy is very important. It is NOT MY ped-onc center. ACOR is a co-operative of collaborative resources, just like wikipedia. The PED-ONC resource center is the remarkable work of Patty Feist, who is also doing similar work for a professional pediatric oncology society.Kosherfrog (talk) 22:56, 16 April 2008 (UTC)
 * I'm well aware of the situation where (to some extent) patients know more about their conditions that many non-speciality professionals. Perhaps you mistake me for a professional? Being knowledgeable is not the same thing as being authoritative. I have a mate who knows a lot about cars. I go to him for advice and think it is generally good. But he isn't about to get his own motoring column in a newspaper or be consulted by the government about transport issues. Colin°Talk 23:34, 16 April 2008 (UTC)

break

 * Kosherfrog is absolutely correct that the peer reviewed literature points toward the benefit of online mailing groups and forums as information systems as opposed to simply being online support groups. There are a few content analyses (see  for breast cancer online mailing lists in BMJ, also see  which has some mention of content on message boards in general) which suggest that the information on the specific mailing lists/online groups evaluated was accurate; each article does refer to the fact that the literature on content in health based internet groups or lists is small.  The question is whether this is enough to substantiate online groups as external links based on their content, and I think it definitely warrants MOS discussion.
 * My view is very similar to JFW's: this should be ascertained on a case-by-case basis. If an individual online community is shown in the peer-reviewed literature to be accurate in terms of content, then it definitely should be considered as an EL (consider the breast cancer mailing list above).  However, in the absence of larger content analyses of online groups, I don't think the evidence is there quite yet to link to collections of online communities such as ACOR, with the caveat that this may change if the pendulum of evidence starts to swing more the other way.  JC Petit 03:13, 17 April 2008 (UTC)

JC Petit, can you summarize here for me the benefit that you think the average reader will get from an e-mail list -- any e-mail list? If memory serves, the average reader for Wikipedia is a healthy male in is late teens or early twenties. Let's say he clicks through to something that dumps him at an article about a disease. What value does an e-mail list about that disease provide to that average reader? WhatamIdoing (talk) 03:46, 17 April 2008 (UTC)
 * Hi WhatamIdoing, you raise the key question here. I would argue that mailing lists allow access to specific questions posed and answered in a readable manner (as they are usually written by people with a disease entity as opposed to specialists).  I think this is an important intrinsic advantage if we have evidence that the content therein is valid.  (Mind you, no one has done a readability analysis of any medical e-mail list to my knowledge).  JFW will argue that the focus should be for us to incorporate the same readable text using primary literature as a reference into the article without the need for the EL, and he is correct.
 * This is however hampered by (1) the still extant "content-to-noise" ratio (I will callously refer to the "noise" as the support-type posts which are valuable in patient care but are of lesser importance to an online encyclopedia). For example, the Breast Cancer Mailing List validated as "self-policing" in content from the BMJ article still contains a great deal of support-like posts and I agree this does clutter its value significantly to the content-seeking average reader of an on-line encyclopedia.  (2) Your points regarding accessibility are also a significant deterrent to some mailing lists.
 * My point was that, as KosherFrog says, the paradigm of mailing lists and on-line medical groups has shifted such that the content in some of them can be validated. They have an intrinsic advantage in that they are highly readable sources of information.  We shouldn't blanket discount all of them in the MOS. JC Petit 06:28, 17 April 2008 (UTC)


 * I don't feel like I have a clear answer to my question. So -- you're an average reader.  You go to the link we provide.  The link says "Sign up here for our e-mail discussion group."  What do you learn about a disease at that link?  As far as I can tell, the answer is nothing.  If you disagree, please give me an example of an e-mail subscription page that (a) does not fit under current guidelines and (b) has some actual content.
 * If you can't do that, then please tell me how "Sign up here for an e-mail discussion group about heart disease" is materially different from linking to a subscription page for a free magazine. WhatamIdoing (talk) 17:41, 17 April 2008 (UTC)
 * Perhaps I should be clearer. Sure, subscription pages are useless.  Archives are not and may have been validated in terms of content (for example the Breast Cancer Mailing List).  If the archives also require a subscription then this not useful.  Questions on these list archives are posed and answered by (usually) patients and I posit that they may be valuable as an EL as they are (1) written in readable text and (2) may have validated content. JC Petit 23:14, 17 April 2008 (UTC)


 * The issue at hand is linking to the subscription pages -- the e-mail equivalent of "please join our Internet forum" -- not to pages that have known content. A freely accessible archive, a particular message, or a FAQ page maintained by an e-mail group could all be evaluated on its own merits, of course.  WhatamIdoing (talk) 02:53, 18 April 2008 (UTC)


 * I'm actually having a bit of a problem with the contention that Wikipedia content should be developed for an "average reader" who is an adolescent or young adult male. How many general encyclopedias are created with that assumption? Jonl (talk) 21:48, 18 April 2008 (UTC)
 * Indeed, WhatamIdoing's assertion that Wikipedia is written for the average reader is plain wrong. Wikipedia is for all readers, not just the average one. Guido den Broeder (talk) 00:56, 29 May 2008 (UTC)

break 2: Practical Issues of Disease Management
I would like to refocus this conversation in a potentially more constructive direction. I need to understand what is WP policy on having a section about the practical issues of a specific disease management. I have looked at quite a few pages about various medical conditions and see no trace anywhere of such a section. Is such an absence a result of an official WP policy or just another example of the way the editors look at medicine? If it is a result of the former, I would like to engage a conversation designed to change the policy and will certainly bring in additional supporters of a policy change. If there is no official policy I would like to ask the administrators board to start discussing it. Kosherfrog (talk) 15:59, 18 April 2008 (UTC)
 * Could you elaborate, perhaps with some examples? There are lots of medical articles that have a management or treatment section that doesn't focus solely on e.g., medication. Colin°Talk 16:28, 18 April 2008 (UTC)
 * I can start with one example: if you have RCC and you are treated with Sutent, there seems to be a significant difference on the impact of a certain side effect on the digestive system, if you take the drug in the morning or in the evening. You cannot find this information in the FDA site or in any labeling for the drug. But patient groups are discussing this, conducting polls, etc. So could/should there be a link to an external site where this issue is addressed? If you have to wait until this information is published in a peer-reviewed publication you know as well as I do that we are talking about years of delay. Colin, I saw your opinion about this exact point in the discussion of the diabetes mellitus page. Maybe some other solution can be found like a mention of chronotherapy in this specific instance but we always get back to the issue of validated data.Kosherfrog (talk) 16:52, 18 April 2008 (UTC)
 * Bearing in mind I know nothing about RCC or Sutent, a quick Google for "sunitinib evening morning" throws up a number of peer-reviewed studies or reviews, such as Sorafenib and Sunitinib: Novel Targeted Therapies for Renal Cell Cancer (see the Future Directions section) or the less relevant Update in the Management of Gastrointestinal Stromal Tumors (GIST): A Report from ASCO 2007. Both report on the difference (or not) between morning and evening dosing. An editor familiar with this subject, and with decent journal access, would probably find more.
 * Informal discussions are subject to bias. This is true of any topic: drug side effects, broadband ISPs or widescreen TVs. If you look at some forums, you'd think everyone was either miserable or delirious. Extrapolation from a sample size of one (oneself) is another common failing. The desire to use less reliable sources because the reliable ones don't cover certain aspects, or are not up-to-date, is not unique to this medical subject. Our strict sourcing requirements are a consequence of WP's editing model, and can be frustrating at times. Colin°Talk 17:20, 18 April 2008 (UTC)
 * I certainly hope that all of you have read the fascinating editorial of JAMA entitled Impugning the Integrity of Medical Science,The Adverse Effects of Industry Influence. It puts in perspective the grave dangers of putting too much emphasis and trust in what should be honest, peer-reviewed, scientific publications. I strongly believe that everything written about our conversation shows a greater amount of blind trust in publications and organizations than is shown by most informed patients. And that is, to me at least, a surprise. I am really interested now in what you consider to be authoritative sources.Kosherfrog (talk) 19:13, 20 April 2008 (UTC)
 * So, in answering my own question, "Wikipedia is written for the general reader. It is an encyclopaedia, not a comprehensive medical or pharmaceutical resource, nor a first-aid (how-to) manual. Although healthcare professionals and patients may find much of interest, they are not the target audience." That doesn't mean that you shouldn't have a section about practical issues. Further down, in the Signs of writing to other patients, "You give practical advice, particularly for when medical help should be sought or is required." That is clearly NOT what I am referring to. Patients groups constantly discuss very effective practical issues that are not found in medical textbooks. So my question is "Would it be worthwhile to create a section about practical issues where you would link to external references about these practical issues?" Kosherfrog (talk) 16:41, 18 April 2008 (UTC)
 * If the purpose of that section was "to link to external references", then no. The only section whose purpose is to link to external web sites is the "External links" section. If instead you mean that section contains comprehensive text about practical management issues, citing the best quality sources (which may or may not be online), then yes. But those sources must meet WP:V policy and other guidelines for choosing and using reliable sources. Bearing the previous discussion in mind, WP:V does not regard forum postings as reliable sources. Colin°Talk 17:20, 18 April 2008 (UTC)


 * Management of side effects belongs in a ==Treatment== or an ==Adverse effects== section. There's no need for a separate section.  Additionally, you have to decide whether to include the information in the drug's article or in a disease article.  (Normally, I'd pick the drug article.)
 * When a controlled trial is available, then of course we use that information as the source. If a thorough search really turns up nothing better than an e-mail message, then (if it's sufficiently interesting that you don't want to omit it), you might be able to justify including it with a "Some patients say that..." approach.  WhatamIdoing (talk) 17:32, 18 April 2008 (UTC)

Thank you all for the input of the last week. I think we have discussed all of this enough to understand that nothing will change since we have very different views of the quality of information available in our 2 systems. Therefore, I am going to ask that the ACOR guidelines include, from now on, the following: "If you or a loved one suffer from a rare condition you should not consider any wikipedia article to be an inclusive source of information regarding that condition. Due to the strict editing guidelines of wikipedia, some of the most useful sources of hard to find information regarding your condition, including all patient communities, cannot be mentioned in any article. In conclusion, wikipedia articles should be neither the first nor the principal source of information to give to a newly diagnosed patient, since wikipedia doesn't accept, in principle, mention of any patient-generated information because that information is not considered "authoritative"."

Now go and talk to patients suffering from amyloidosis and ask them if they trust more the patient-generated information or "authoritative" information from the majority of doctors. They will almost universally tell you that they suffered from a very long delay in diagnosis ( a fact sorely missing from the Amyloidosis page in wikipedia!) because the authoritative doctors had never seen a case and suffered from Premature Closure (of Diagnostic Reasoning).

My message is not designed to be inflammatory but merely to be a statement that we have irreconcilable differences in what we view as good medicine and therefore have build irreconcilable information systems. Just a sad fact. Kosherfrog (talk) 20:35, 18 April 2008 (UTC)
 * I don't have a lot of problems with what you say, because WP is limited by its editing policy. However, can I ask you rephrase "some of the most useful sources of hard to find information" to just "some sources of hard to find information". Patient communities can be a source of useful information, but so can medical journals (translated for the "general reader" as WP does) and established charities. To say WP denies "some of the most useful" sources is biased. There are very few WP articles I'd consider as a "principle source of information to give to a newly diagnosed patient". I think that good charities with a medical board do a better job at producing pamphlets for this purpose. Both WP and your forums are sources of information. That they have different models is a good thing, not "a sad fact". Diversity is good. Colin°Talk 22:20, 18 April 2008 (UTC)

I think some of the editors of WikiProject Medicine may find this post at the Healthcare Blog of interest. You are absolutely welcome to provide your own feedback to the conversation.Kosherfrog (talk) 07:24, 25 April 2008 (UTC)


 * I'm sorry you have felt the need to go off-wiki to agitate about this policy, and for me personally it simply indicates that you don't like "no" for an answer. Ample reasons have been given why closed forums such as ACOR are not suitable for external linkage from Wikipedia, and looking at the replies so far (07:35, 25 April 2008 (UTC)) it seems many respondents to your friend's blog post are sensible enough to see that you have been offered a reasonable response. Will you now please go away? JFW | T@lk  07:35, 25 April 2008 (UTC)


 * I am not "agitating". I have stated repeatedly that the "ample reasons" you mention are the proof of a lack of understanding of the value of medical peer communities. I certainly do not intend to "Go away", since I am here to ask now for another change in the WikiProject Medicine policies. You, the editors, were, until this conversation about external links expanded, part of a small number of people knowing what is the target audience for the medial articles. I believe that it would be of great benefit to millions of people (who will access any of these articles to get an authoritative answer about a medical condition they must understand) to be reminded on these pages by a clear disclaimer stating that "Wikipedia provides general information, and has no duty of care towards patients or carers." (That would be a verbatim quote from JFW, himself quoting Colin). How shall I proceed to propose such an addition to the WP:MEDMOS? —Preceding unsigned comment added by Kosherfrog (talk • contribs) 15:16, 25 April 2008 (UTC)
 * Read the last sentence/paragraph of the "Careful language" section. Such a specific disclaimer has been suggested before, and rejected. Look right down at the bottom of your web page and click on "Disclaimers". Follow this to the Medical disclaimer. Anyway, why would one expect an encyclopaedia to have such a duty? You don't get disclaimers in your newspapers, TV news, documentaries, magazines,  dictionary, etc.  Really, you are trying to turn an encyclopaedia into an internet hub, linking to useful information elsewhere. Why don't you guys try writing content for Wikipedia?Colin°Talk 16:09, 25 April 2008 (UTC)
 * Nothing in the Medical Disclaimer says ANYTHING about articles NOT written for patients. It is the standard legal document about the lack of medical advice. That's totally different. I am sure that if you poll the average internet user and ask them about who is the target audience for any medical article on WIkipedia, the majority will say "patients". In fact we will probably design such a survey. Kosherfrog (talk) 16:30, 25 April 2008 (UTC)
 * Er, if I had the money to set up a website intended as an information source for patients, I'd employ doctors and other trained writers. There are quite a few of those around, actually. And some of them are rather good. I suspect your world revolves round patients and think that's the only kind of person who reads medical articles. I read newspaper, magazine and WP articles about medical conditions and treatments I haven't the slightest chance of catching. People watch medical documentaries and dramas because the subject is of general interest. Do you think an article on prostate cancer in a newspaper is written purely for the benefit of old men? Colin°Talk 16:50, 25 April 2008 (UTC)
 * KosherFrog, The proposal above is outside the purview of the manual of style. You might start at Wikipedia talk:Medical disclaimer.  I suggest that you read No disclaimers in articles and its talk page first, along with Perennial proposals.  WhatamIdoing (talk) 18:01, 25 April 2008 (UTC)

Links to sites that require payment or registration
I'd like to know the feeling here about Links to sites that require payment or registration. Strictly speaking, that would prevent us from linking to the major peer reviewed journals, like NEJM, JAMA, BMJ, Lancet, Science, Nature, etc., and the specialist journals. There are a few good free online journals, like CMAJ (at least before they fired Hoey) and Open Medicine, but they're relatively specialized. Even the New York Times and Medscape require registration. Are we going to be left with the BBC and hospital patient information? Nbauman (talk) 23:32, 19 April 2008 (UTC)
 * I think that absurd clause should be removed from WP:EL; we don't require our sources to be available online, and there should be no prohibition against providing a courtesy link to a for-fee or registration-only site, for those who can access them. We don't require newspapers or books or any source to be available online; I see no reason to disallow courtesy links to journals.  It's a silly restriction, and I don't know where it came from.  Sandy Georgia  (Talk) 23:39, 19 April 2008 (UTC)


 * WP:EL may make more sense in non-medical articles, but I don't think it makes sense in medical articles.


 * Does anyone think it makes sense in medical articles?


 * Do we have a consensus in MOS:MEDICINE? Nbauman (talk) 01:14, 21 April 2008 (UTC)

Keeping in mind that WP:EL does not apply to ==References==, can anyone point me at an article that links to a for-pay journal article as under ==External links==? The EL section in an article is supposed to be like "recommended reading that you can conveniently find online." WhatamIdoing (talk) 05:05, 21 April 2008 (UTC)
 * Agree. WP:EL says "The subject of this guideline is external links that are not citations of article sources." WP:EL is a vital guideline for medical articles. Colin°Talk 09:38, 21 April 2008 (UTC)

In other animals
Currently we have the following section headings Could we rationalise these to the same heading, or as an extra suggestion in other species (or similar). I was thinking about the case where there may be an affect or aspect in another genus, say plants, and species sounds sounds better to me ? LeeVJ (talk) 22:42, 20 April 2008 (UTC)
 * In other animals for Diseases/disorders/syndromes.
 * Veterinary use for Drugs.


 * Have you read the comments above at Wikipedia_talk:Manual_of_Style_%28medicine-related_articles%29 on the rarity of phytonoses? WhatamIdoing (talk) 05:07, 21 April 2008 (UTC)
 * Sorry, missed that one! LeeVJ (talk) 22:20, 21 April 2008 (UTC)
 * Don't have a problem with the different names we have. They seem appropriate. Colin°Talk 09:41, 21 April 2008 (UTC)
 * I don't have a problem with them either, just thought that In other animals covered veterinary use and would provide a more unified format if all types of articles used the same headings where possible LeeVJ (talk) 22:20, 21 April 2008 (UTC)

Avoid medical jargon
I'd like to add a link to this CBC story, since the Lancet story is subscriber-only.

The message, which I'd like to add to the guideline, is that ordinary readers, the target audience of Wikipedia, cannot understand medical jargon.

Opinions?

Complicated medical lingo can confuse patients: researchers

Last Updated: Thursday, April 24, 2008 | 4:59 PM ET

CBC News

Using complicated medical jargon can be confusing, anxiety inducing and potentially dangerous for patients, a new study found.

The research, the focus of this week's editorial in the Lancet, finds that when doctors speak to their patients using the terminology they learned in medical school, patients can fail to identify what it is that's being said, be confused about their diagnosis or incorrectly interpret their condition.

According to health experts, the confusion can happen very easily.

"There are words that sound the same, like hypo and hyper," Dr. Peter Lin, a Toronto-based general practitioner, told CBC News Thursday. It would be very easy for a patient to hear the opposite of what was said by a physician, leading to an incorrectly interpreted diagnosis, he said....

Nbauman (talk) 22:02, 24 April 2008 (UTC)


 * We've already got a nutshell "Explain medical jargon or use plain English instead if possible." and later a whole section on careful language where dealing with jargon is covered. What would you like changed or added?


 * You may wish to consider adding the "benign" and "hypo/hyper" confusion to the Careful language section. These are terms to explain, not avoid. We can't change the terms doctors use -- that's up to them.


 * I don't see why we need to link to the article. Seems to be one of those "tell me something I don't already know" stories (which doesn't mean people actually modify their behaviour). I can't read the Lancet but do they suggest an alternative to "benign"? I'm sure if you studied "non-cancerous", half the patients would only hear the C word and get confused or worried ("who said anything about cancer!"). I note the interviewed GP "recommended patients learn some common medical terms particular to their condition, such as acronyms for tests they frequently undergo, to increase their understanding." Where are they going to learn this stuff if WP doesn't help them? Colin°Talk 22:33, 24 April 2008 (UTC)


 * I would like to add that link because it gives a good, logical reason for not using medical jargon. People are more likely to follow rules, and follow them correctly, if they understand the reason behind the rule.


 * People often disparage scientific research with, "Tell me something I don't know." How do you know? You may think it's obvious, but that's not the same as having evidence that it's true. The judgment of the editors of The Lancet is authoritative evidence on medical writing.


 * There are editors on WP who don't know this. You can find lots of WP articles that are written in medical jargon, and their writers sometimes resist letting someone rewrite it in ordinary English.


 * I think the preferred style should be "low blood pressure (hypotension)."


 * If I were writing for an audience that's not all familiar with medical terms, and was likely to have a particular tumor, I would certainly not write that their tumor is "benign." I would say that it is "harmless." I can imagine someone in terror at 3am trying to figure out whether "benign" is good or bad.


 * WP isn't written for patients, but it's written for a general audience, and that includes patients. Nbauman (talk) 17:37, 25 April 2008 (UTC)
 * "Benign" is quite different from harmless. The "jargon" is hard because it carries more precise meaning than colloquial terms. That's why we wiklink. --Arcadian (talk) 19:49, 25 April 2008 (UTC)


 * I agree with you on the value of precise language. We can have both precise language and understandable language.


 * Look at the Merck Manual Home Edition (in contrast to the Professional Edition). They do both. That's where I got the idea of using the format "low blood pressure (hypotension)." They actually did studies of their readers and found out that readers wanted both simple language, so they could understand it, and technical language, so they could understand medical material when they did further research.


 * Here's the way the Merck Manual handles it:


 * PSA levels are high in men with prostate cancer, but levels also are elevated in men with noncancerous (benign) enlargement of the prostate.


 * The WP rule is that WP is written for the average reader, not the specialist. So we have to use language that the average reader can understand.


 * Does everybody agree that the preferred style should be "low blood pressure (hypotension)" and "noncancerous (benign)"? Nbauman (talk) 02:36, 28 April 2008 (UTC)


 * It is what MEDMOS has recommended all along. The format you "got the idea for" is described in the Audience section. The "lay (expert)" form is recommended if the expert term isn't used throughout the article. Otherwise the "expert (lay)" form is suggested as the reader will see the word multiple times and needs to learn what it means. It can be essential to use the correct medical term at times, because it may have a precise definition (e.g., blood pressure below a certain threshold). If that isn't important to the article, I support giving the lay version priority, provided the lay version is a satisfactory replacement.  I don't see we need to add anything. If people aren't following MEDMOS, then point that out to them on the article talk pages. This isn't really a disputed area that needs backed-up by external sources IMO. Colin°Talk 06:54, 28 April 2008 (UTC)


 * MEDMOS says:


 * When mentioning technical terms (jargon) for the first time, provide a short plain-English explanation in parentheses if possible. If the concept is too elaborate for this, wikilink to other articles (or Wiktionary entries).


 * This is too weak. I'm saying that it's preferable to use short plain-English terms, when possible (and it usually is). That follows from "Wikipedia is written for the general reader." To be precise, and to familiarize readers with the technical terms, you can add technical terms in parenthesis. I would change it to:


 * Use terms that the general reader will understand, and add the technical terms in parenthesis, as in "low blood pressure (hypotension)" and "noncancerous (benign) enlargement of the prostate". Subsequent references should use lay terms, or technical terms if that makes the article clearer. If the concept is too elaborate for this, wikilink to other articles (or Wiktionary entries).


 * Even medical journals like NEJM, BMJ or The Lancet will use lay terms over technical terms. Sometimes they refer to cancer as "local," "regional," or "advanced," and you have to look in the "Study Design" section to see how they define it by stage and grade. If NEJM, BMJ and The Lancet can explain things in lay language, we should be able to too. Nbauman (talk) 17:04, 28 April 2008 (UTC)


 * Despite my overall impulse to tell all other editors that they must do everything exactly the way I would do it, I think we can skip this directive as undesirable instruction creep. An average reader's attention span is long enough that if you refer to "hypotension (low blood pressure)" once, s/he'll be able to remember it for the length of the article.  Consequently, I prefer leaving the "mostly technical" or "mostly nontechnical" choice up to the editors of the article.  WhatamIdoing (talk) 18:51, 28 April 2008 (UTC)

(unindent)MEDMOS does go on to say "Alternatively, if the technical word is not used again in the article, it may be appropriate to use plain English and place the technical term within brackets." Now, we can muck-about with the order of presentation if you like, and try a little emphasis change here and there. But I really don't think this is an issue that our editors misunderstand. Which is quite, quite different from being able to put it into practice. For example, there are lots of grammar rules that I fully accept, can spot in other people's text, and would change in my own work if pointed out to me. But I'm old enough that I'm not going to achieve Tony1's levels just because I've read the MOS. I'm finding it difficult to gauge what level of lay-ness you are thinking is possible. When you say "XXX will use lay terms over technical terms" I'm thinking you believe "nearly always". Please show me good, comprehensive medical article that (ignoring words in parenthesis) uses only words a 16-year-old already knows? The NEJM, BMJ and The Lancet most certainly do not "explain things in lay language". I'm sure the physician's that subscribe to those journals would find that extremely tedious. My opinion:
 * Nearly all medical articles will need to introduce and use terms that are unfamiliar to the general reader. This should be kept to the minimum necessary to explain and discuss the topic, while not losing too much of the precision and brevity that technical language affords. Achieving this balance is a skill that cannot be taught in a style guide.

I think it is great that you go round rewriting portions of medical articles to use more lay-friendly language. But I see that improvement in article quality as similar to someone fixing the grammar or making the prose flow better. All these things help the reader and not all of us a good at it. Colin°Talk 19:05, 28 April 2008 (UTC)


 * "Please show me good, comprehensive medical article that (ignoring words in parenthesis) uses only words a 16-year-old already knows?"
 * I just did Nbauman (talk) 20:29, 28 April 2008 (UTC)
 * That article uses jargon (words no 16-year-old would know), but handles it well IMO. The following jargon is explained and then repeatedly used:
 * Diagnostic tests; screening tests; staging; false-positive; false-negative; occult blood; diverticulosis (not re-used); markers; biopsy; laparotomy (not re-used).
 * The following jargon is used without explanation (though context helps the reader)
 * Papanicolaou (Pap); mammography; prostate-specific antigen (PSA); invasive tests; gastrointestinal tract; nonsteroidal anti-inflammatory drug (NSAID); outpatient procedure (explained on second use); sigmoidoscopy; colonoscopy; asymptomatic; ultrasonography; computed tomography (CT); magnetic resonance imaging (MRI); bone scintigraphy; positron emission tomography (PET).
 * This is a really good article, we can agree on that (though it isn't on WP, which is what I was hoping for). The author has decided which jargon words to use a lay(expert) format and which to use an expert(lay) format and which to just leave not fully explained. He knows the reader doesn't have to understand every word to follow the gist, and too many diverting dictionary definitions disrupt the flow. I didn't list the words from the two tables, which have yet more specialist terms. We need this sort of article on WP where a reader studying cancer (for whatever reason) can pick up enough lingo to read and understand material from elsewhere or from doctors. And we have the added benefit of wikilinking so that many of the technical terms in the second list can be wikilinks -- achieving the same goal of keeping the prose tight and focused, but allowing the reader to look up what words they want to. To be honest, I'd much rather link to this article, as an example of how and when to explain technical concepts to the reader, than to link to the preachy study. Colin°Talk 22:56, 28 April 2008 (UTC)
 * I'd like to point out that the target audience of Wikipedia is not 'the ordinary reader', but 'all readers', as can be concluded from the patent. I have changed the text accordingly. This implies that it is not an obligation to avoid all jargon, but rather that there should be a proper balance. If it is possible to avoid jargon without sacrificing neutrality, verifiability etc.: great, but that is not always the case. Guido den Broeder (talk) 00:15, 29 May 2008 (UTC)

ACOR entry
There is no entry in WP for the Association of Online Cancer Resources. I think it's notable enough that there should be.

Can anyone think of a reason why there should not be a page on the Association of Online Cancer Resources? Nbauman (talk) 19:20, 25 April 2008 (UTC)


 * Presumably nobody bothered to write it. (That question really doesn't belong on the Manual of Style page.)  WhatamIdoing (talk) 21:18, 25 April 2008 (UTC)

Audience
Would anyone mind if we added an item to the ==Audience== section, probably under "Signs of writing for (other) patients" to read:
 * You emphasize or de-emphasize facts so that readers will make the "right" choice in the real world.

I'm not sure it really belongs as part of "Signs of writing for (other) patients"; it could just as easily fall under "Signs of writing for (other) investors" or "Signs of trying to influence decision makers at your insurance company/hospital/IRB/regulatory authority". I've seen several articles recently that cite WP:UNDUE as the justification for downplaying or removing criticism, and it would be nice to have something solid to point at while (re-)explaining due weight for significant views. WhatamIdoing (talk) 19:01, 28 April 2008 (UTC)


 * I mind. The manual shouldn't suggest that Wikipedia is not part of the real world. Guido den Broeder (talk) 00:08, 29 May 2008 (UTC)
 * Any writing that gives the impression there is 'right' and 'wrong' choices would be NPOV. There are supported and unsupported treatments, but right and wrong violates verifiability, not truth.  See here - if the facts don't speak for themselves, they shouldn't be there.  WLU (talk) 00:14, 30 May 2008 (UTC)

Audience, part 2
This is incorrect. The target audience of Wikipedia is all readers, which includes professionals and patients. Guido den Broeder (talk) 01:40, 29 May 2008 (UTC)
 * Although healthcare professionals and patients may find much of interest, they are not the target audience.


 * This guideline was approved by community consensus. Wikipedia is written for normal readers, not for experts.  If you don't like it, you need to make a case for changing the existing consensus.  You might consider posting a notice at the village pump's policy page, for example, and explaining why you think pages should be written primarily for the benefit of (for example) medical students or experts.
 * Those who want to understand the broader context should look at Guido's many recent notes at Talk:Da Costa's syndrome. WhatamIdoing (talk) 02:58, 29 May 2008 (UTC)


 * Please provide a diff to where this alleged consensus was formed, as I'm curious to see how this manual came to claim something so blatantly untrue. And yes, it has consequences for articles. Guido den Broeder (talk) 08:42, 29 May 2008 (UTC)


 * For comparison, an approach that is more consistent with Wikipedia principles can be found on e.g. WikiProject_Philosophy/readability. Guido den Broeder (talk) 11:03, 29 May 2008 (UTC)


 * What the sentence in the policy means: the target audience is everyone, therefore one should be careful not to write specifically as if writing for either a professional audience or for patients. I think we are hairsplitting here. What is "untrue", Guido? JFW | T@lk  11:53, 29 May 2008 (UTC)


 * Guido, to find the "alleged consensus," please start reading at the top of Archive 2, which you'll find linked at the top of this page. It begins with a list of all the WikiProjects that were notified, and if you read down the page, you will find the date of the Village Pump notice, and discover that there were many supporters and -zero- editors opposing its guideline status (and several with various proposals for expansion and improvements).  The page was promoted to guideline status on 30-April-2007 and has been widely accepted.
 * Unlike, I might add, the page you reference, which begins, This is a proposed guideline for WikiProject Philosophy. That essay (written in 2005 and essentially abandoned since then) has no official standing at all:  it is essentially one editor's opinion.
 * But let us see what it says: Under ==General and introductory articles==, we have the statement "These articles should be written for the general reader.  Under ==Biographical articles==, we have "As with the main articles, the biographical articles should be written for the general reader.
 * Even if we assumed that a proposed guideline that is specific to the Philosophy WikiProject should trump the approved guidelines for medicine-related articles, I see nothing in your preferred standard that says "Please write for experts" or "Please fill articles with exhaustive catalogs of POV-supporting publications, complete with the number of patients enrolled in the study and hair-splitting descriptions of their exact symptoms and medical histories." WhatamIdoing (talk) 17:33, 29 May 2008 (UTC)
 * That's right, continue your daily incivilities. After all, we are not here to write an encyclopaeaeaeaedia, but to harass other users. Guido den Broeder (talk) 18:19, 29 May 2008 (UTC)
 * Your citations of the philosophy guideline I find highly selective, since you are leaving out all the parts where the proposed guideline says that non-general readers should be taken into account.
 * Meanwhile, thanks for pointing me to where this all started. The problem is more serious, therefore, than I initially thought. It won't do to have an entire corner of Wikipedia applying guidance that is in violation with basic Wikipedia principles. But perhaps it was simply overlooked; this part of the text seems to have been written by a foreign user you may not have understood the difference. I'd like to hear some opinions on this issue. Guido den Broeder (talk) 23:46, 29 May 2008 (UTC)
 * @JWF: the difference between 'general' or 'average' readers and 'all readers' is essential, IMHO. If medical articles are only written with average readers in mind, a lot of useful information gets left out. Guido den Broeder (talk) 18:22, 29 May 2008 (UTC)
 * By writing at a level of detail that seeks to inform professionals (p values and really specific details about eligibility) we will exclude general readers. When you have to click on a whole set of wikilinks to understand what one number is (and without college-level statistics, that's what most readers would need to do to understand a p value), you're excluding and not informing.  Further, since we should not debunk secondary sources with primary and not engage in original research, there's no need to go beyond a generic statement that can be found in an abstract - this works, or it doesn't, or it's unclear.  Our best sources are secondary, summaries, and broad strokes.  And since wikipedia is a general encyclopedia, the information should be general.
 * Also, WAID may have selectively quoted (or not, I've no idea), but she makes a valid point that the one page that seems to support your position was written in 2005, with two minor edits since that year. Either support is lacking, or it's not been sufficiently presented for broad output.  Since so many other pages fall under the same general guidelines for audience, my guess is the former.
 * Finally, the goal of writing for a general reader is not a 'serious problem', it is consensus of the project. It may be a problem if you are seeking the truth or a specific point of view, but not if you're trying to write a general encyclopedia that seeks to inform and not provide advice (see WP:NOT by the way, we're not here for advice).   If the reference can't speak for itself, it probably shouldn't be on wiki; if the reference demonstrates credibly that a particular treatment is of benefit, then there's no need to assert it's worth or break it down.
 * Finally, finally, if experts, doctors, med students, etc. want extra levels of detail, they can check the highly reliable sources which we insist upon for medical pages. The 'useful information' should be in the article and in the sources, but it should be summarized accurately even if it is general.  WLU (talk) 01:10, 30 May 2008 (UTC)


 * For some subjects, it is absolutely essential to include the P values. For example, there are some controversial medical treatments which are commonly used even though they don't meet the P<.05 test. Some commonly-used medical tests have been rejected by the Cochrane Collaboration because they don't meet the P<.05 test -- PSA tests for prostate cancer, for example. How can you explain what the controversy is all about if you don't get into P values? I think you have to give a short explanation of P values in the article.


 * And what's the "general reader"? A high school science student? A janitor? We're actually writing for a range of readers. Nbauman (talk) 03:30, 30 May 2008 (UTC)

Undent: Guido got blocked for a week, so he will not be able to respond here. I think material like p values should only be included when this is absolutely essential (i.e. if a general link to statistical significance will not do the subject justice).

I am with the original guideline that even highly technical dilemmas need to be spelled out in a way that someone with brains will understand. I am not suggesting dumbing down or skirting important issues. I am suggesting that if a subject cannot be captured in such a way it may not be relevant enough for a general purpose encyclopedia. I'm with WLU that a good further in-depth reference may be the way forward for people with a specialist interest. JFW | T@lk  06:21, 30 May 2008 (UTC)


 * Statistical significance is a good example of a link that itself is too technical for an ordinary reader (who has not studied mathematics) to understand. It explains statistical significance using other terms that an ordinary reader would not understand. It's good evidence against the argument that, "If someone doesn't understand the term, they can just click on a link."


 * Suppose I'm trying to decide whether to take a PSA test for prostate cancer (as many American men do), and I read in the Cochrane Collaboration that none of the studies has shown at the P=.95 level of confidence that PSA screening will extend life, although some studies have reached (say) P=.80. I want to figure out whether or not to take a PSA test. Statistical significance won't help me, although it is an interesting essay about some issues of interest to statisticians (much of which seems to be POV not cited to RS). It's a discussion of statistical significance, but not directly applied to the practical problem of deciding whether a PSA test extends life.


 * The solution, I think, is to give a concise, simple explanation of statistical significance in the discussion of PSA testing. That's what newspapers like the Wall Street Journal do.


 * Another solution would be to have a simple introduction to statistical significance, or to have a simple article on statistical significance, but I'm afraid that the pedants on Wikipedia would quickly edit it into a technical introduction that readers can't understand again, as they did in Introduction to Genetics


 * (Wikipedia doesn't practice medicine, but it can legitimately help you understand the practice of medicine. I might want to know about PSA testing because I'm a patient, a doctor, a policy-maker, an economist, or an academic writing a paper.) Nbauman (talk) 14:47, 30 May 2008 (UTC)
 * I see these issues as easily captured through carefully selected wording, avoiding our own opinions and citing discussion. If a journal article says there's a trend, but no conclusion either way, we shouldn't talk about it.  If it says there was a conclusion, we should.  If there's a trend but no conclusion BUT a discussion about how there are trends that are promising even if they've not come down on being conclusive, we should definitely talk about it!  That kind of info would crop up in a review article, a textbook, editorial or some other 'broad strokes' document, the very best kind of information for sourcing.  But for us to say "p=.94 therefore it's not significant but it is promising" is out of line (IMO).  A prose summary is something that is far more valuable to the general reader, and even the specialist, who will review the source document and be able to easily tell that it's promising but not significant.  For me it's common sense to report different p values differently, but mostly I base it on what is said in the abstract - if the conclusion is that a test is an excellent predictor, put it in.  By writing in this manner, we ensure that the reader will understand and will not have to click on the link.  We should only be linking to the statistical significance page when a relible source states something along the lines of 'was good, but not SS'.  I've never found the need to use a specific number, and often replace with prose.
 * Regards your PSA test, given that material I would say "The Cochrane Collaboration suggests that though the PSA test has not been show to extend lifespan/detect early/whatever, it is a valuable tool/promising line of research/whatever the CC opinion is." Best place to look for wording and significance is always the source for me, not my own opinion.  Though an 'intro to SS' article would be a really, really good idea Nbauman; since it's used in scientific testing so much, we should have a set of articles that discusses it at a level that is understandable to different audiences.  I'd offer to help, but I'm notoriously fickle in my interests and my stats is almost 10 years old now : )  I'm a good copyeditor though... WLU (talk) 15:45, 30 May 2008 (UTC)

External links (2)
The last edit by WhatamIdoing doesn't seem to be based on any form of consensus. As far as I can see, consensus was rather that this should be judged on a case by case basis, while following the general guideline on external links. That coincides with my own stance. Guido den Broeder (talk) 01:34, 29 May 2008 (UTC)


 * Your POV is not helpful here. How about gaining consensus before you yourself break 3RR?   Orange Marlin  Talk• Contributions 01:40, 29 May 2008 (UTC)


 * How about you do something useful instead of reinserting faulty citations and language errors, and attacking other users? Guido den Broeder (talk) 01:44, 29 May 2008 (UTC)


 * How about both of you gentlemen restrict your MEDMOS editing to this Talk page for a while? This is a guideline page, and back-and-forth reverting doesn't help anyone. I'm getting flashbacks of when I still had WP:RS on my Watchlist. Fvasconcellos (t·c) 01:46, 29 May 2008 (UTC)


 * Since this page was written in British English originally, encyclopaedic and encyclopaedia are the correct spellings. Copyediting them is erroneous. The definition of readership ("Wikipedia is written for the general reader".) has been in its current form for a long time, and cannot be changed without discussing first. Paul Gene (talk) 01:53, 29 May 2008 (UTC)


 * Manuals should not contradict Wikipedia principles. It doesn't matter how long it has been there. However, I am always willing to exchange arguments. Guido den Broeder (talk) 01:59, 29 May 2008 (UTC)


 * I think WhatamIdoing's 8 May edit actually has very wide consensus, as it sums up several long discussions that include l'affaire Kosherfrog. The fact that it didn't get reverted for 13 days is meaningful on a page that is on everyone's watchlist.
 * WhatamIdoing also addresses a large group of sites that nobody here really likes (invitation-only discussion forums, local organisations, survivor stories, and other low-level noise).
 * Obviously all links should be judged on a case-to-case basis, and this page is "just a guideline", and there are definitely exceptions to the general principles. But in my experience those exceptions are rare and need careful discussion.
 * Wikipedia has reached the stage where an organisation would pay to be linked from Wikipedia if they could, and some linkspammers have been rather forceful with members of this Wikiproject, citing amongst others ethical concerns and special pleading (I've had this illness so you must allow my link or this is a bad illness so you must allow my link) etc etc. JFW | T@lk  05:08, 29 May 2008 (UTC)


 * 13 days is a short time, and the page wasn't on my watchlist before. I didn't know it existed. The principle that such links should NORMALLY be avoided is already covered in WP:EL. What I disagree with is that they should ALWAYS be avoided, and so do you and all others, except for WhatamIdoing, as far as I know. There are instances where such links are relevant, as has been extensively argued. Guido den Broeder (talk) 08:49, 29 May 2008 (UTC)


 * Correction, it was 20 days. I was one week off. Is that better? Anyway, you have made your point, and I think we agree that they are generally to be avoided with certain exceptions that can be decided on a case-to-case basis. JFW | T@lk  11:53, 29 May 2008 (UTC)


 * The words never and always do not appear in the ===External links=== section. We plainly state the normal rules.  Editors can (and do) invoke WP:IAR when appropriate.  I do not see any problem here.  WhatamIdoing (talk) 18:05, 29 May 2008 (UTC)
 * I know that you don't see a problem. But I do, and as JFW says, I have made my point. Guido den Broeder (talk) 18:55, 29 May 2008 (UTC)

Single location?
The article says in WP:MEDMOS that we should exclude "meetings or events in a single location".

I don't think that's what we want to say. Literally, every meeting is in a single location. ASCO is in a single location (McCormick Place, Chicago). I think you mean "meetings or events by local organizations."

And aren't there some local organizations that notable status, like the New York Heart Association?

Can somebody clarify that? Nbauman (talk) 17:22, 29 May 2008 (UTC)


 * Two issues here:
 * Yes: Your phrasing might be better.  However, the specific situation I wanted to address was the use of ==External links== to advertise meetings for non-professionals.  A support group meeting can be a good thing, but if it's in Sydney, and you're in London, it does you no good whatsoever.  Advertising meetings of primarily local interest is a violation of Wikipedia's worldwide nature.  So I wouldn't mind a link to ASCO's annual meeting (on ASCO's page) -- an oncologist realistically might fly halfway round the world to attend -- but if LLS (a large, national organization) decides to have a picnic for leukemia patients in the SF Bay area, then Wikipedia is definitely the wrong place to advertise that meeting.  I will cheerfully support any language that discourages the inclusion of external links that are primarily interesting to people living in a particular geographic area.
 * No: Notability, for the purposes of having a Wikipedia article, has absolutely nothing to do with whether an organization's website would be an appropriate external link in another article.  NYHA could have an article (although it doesn't:  that page links to a scale it created), and that article could obviously link to the organization's website per WP:EL (main rules).  However, the mere fact that a heart disease organization (for example) gets an article does not give us any reason to spam its website all over the heart disease articles.  For one thing, the Spam Event Horizon becomes an issue:  a lot of orgs have, or could have, Wikipedia articles.  For another, Wikipedia is WP:NOT a web directory.  The general goal in medicine-related articles is to avoid including any charities unless the disease is "very rare" (see sentence immediately after the numbered list in that section).  This is even-handed (we don't choose "this" worthy organization over "that" equally worthy organization), and it keeps us to our core mission of providing encyclopedic information.
 * Just my two cents -- I'm happy to hear other opinions. WhatamIdoing (talk) 18:00, 29 May 2008 (UTC)

Citation discussion
See Talk:Lipoma, for a discussion on this edit that asserts that an article can be used as a general reference for all an article. Tim Vickers (talk) 18:40, 1 June 2008 (UTC)

External links: revision needed?
An anon is quoting the 'manageable set of charitable organizations' line at me to promote an internet chat board s/he runs at Arteriovenous malformation. The website in question is (just) a chatroom. Do we need to amend the wording here, or should I assume that a person who flagrantly violates COI rules is going to ignore anything else we write, too? WhatamIdoing (talk) 20:55, 1 June 2008 (UTC)


 * Probably. Discussion fora are not reliable, encyclopedic, and the biggest ones will be found easily via google.  They should not be included in EL sections in most articles, and certainly not on wikipedia.  What information can be gained from discussion fora on a medical article?  Anything reliable should be in peer-reviewed journals or books.  You'll only get unreliable and individual case hisotry info from fora, and any synthesis of information from these sources to say something meaningful would be original research.  WLU (talk) 17:15, 2 June 2008 (UTC)


 * We have been through this ad nauseam on WP:MEDMOS, e.g. recently with Kosherfrog. No is no and also no. JFW | T@lk  06:34, 19 June 2008 (UTC)

Notable cases
What do you think about putting a suggested limit on the (in-article) number of "notable cases" to be included in a disease article? The more common conditions can develop lists a mile long. ALS has about two dozen at the moment, and I'm feeling a lot more like, say, six.

Other views? Should it be hashed out individually at each page? WhatamIdoing (talk) 05:45, 19 June 2008 (UTC)


 * I think this needs judging on a case-to-case basis. ALS is a catastrophic illness that clearly has a habit of affecting prominent sportspeople and scientists. Cases such a Lou Gehrig are still burned into the public's imagination, and Stephen Hawking is usually mentioned in one breath with the disease. I would certainly not object to longer lists of prominent cases, although it would be useful to have a secondary source at hand that demonstrates which ones are more notable than others.
 * Some articles on very common illnesses may need a secondary article to discuss prominent cases. Other articles will have no cases whatsoever because even those prominent people who suffered from them were never in the news because of it. There is a very thin line between a useful list of people whose illness made prominence, and a whole pile of WP:TRIVIA. JFW | T@lk  06:34, 19 June 2008 (UTC)

Images
I've composed an essay with guidance on medical images on Commons:Patient images which might also be useful for readers of MEDMOS, perhaps this can be added at the bottom in a "See also" section? I previously listed it at the top next to the other proposed guidelines for anatomy etc, but was reverted. --Steven Fruitsmaak (Reply) 14:06, 28 June 2008 (UTC)


 * I've read debates about patient privacy in the U.K. and U.S. medical journals. Copyright and patient privacy are 2 separate issues; copyright issues are identical with non-medical issues.


 * There are some proposed standards that would make it almost impossible to publish the kind of medical articles that I read routinely, without any benefit to patients. You couldn't teach medicine if you had to have a patient's permission for every image. So I don't favor tightening privacy restrictions just for the sake of privacy.


 * The usual compromise is that doctors can use patient images or information for teaching or publication without permission if that patient is not identifiable. I don't see any problems with that.


 * I also don't see any problems in the example scenarios you listed. How could a radiology or endoscopy image violate a patient's privacy?


 * I appreciate the value of raising talking points, but you have the burden of proof of finding a strong argument, by an authority, to support it. Are there actually medical ethicists somewhere who have raised objections to this use? If there are no WP:RS to cite for these objections, I would not be convinced. Nbauman (talk) 16:46, 28 June 2008 (UTC)


 * Copyright issues might be less straigthforward for medical images: who owns the copyright of X-rays? The radiologist on call? The nurse who takes the pictures? The patient? The treating physician?
 * "Consent should be requested from patients for all medical photography and for the subsequent use of their images whether or not they can be identified by the picture. Specific consent should be obtained if an image will be used in electronic publishing..." BMJ
 * I've personally experienced that ethics can vary geographically, being very different here in Belgium compared to 100km more to the north in the UK.
 * The aims of the page on Commons are twofold: (1) to establish copyright guidelines to avoid future deletion debates, (2) to discuss confidentiality without wanting to come to a consensus, just explaining pro's and con's. As such I invite you to copy-edit the essay and list some arguments against extreme forms of consent and the needs of medical advances.
 * More importantly, my question was: can we put the link to the Commons page on WP:MEDMOS? --Steven Fruitsmaak (Reply) 17:27, 28 June 2008 (UTC)


 * OK, thanks for the cite. I actually read that BMJ article when it first was published. That's in the "Education and Debate" section. It's just one doctor's opinion, not a consensus.


 * I don't think BMJ itself uses that standard. You couldn't. It would be impossible even for a medical publisher with paid staff to get specific permission from every patient for every medical image. (To start with, the doctor would have to identify every patient to the journal with a signed statement, which would be a greater loss of privacy.) I'd have to throw out my entire medical bookshelf. So I think the costs far outweigh the benefits (of medical education), it's impossible in practice, and the medical profession doesn't follow that standard.


 * Then you ask, can we link to the commons page on WP:MEDMOS. I don't think so. That would suggest that the doubts raised on the commons page are a consensus, when they are not. If you could get a well-developed argument on the commons page, and show with links that this is more than one UK doctor's provocative essay, and reach a consensus on the commons page about WP policy, and a consensus in TALK:MEDMOS, then we could link to it. But I think it would be a difficult (probably impossible) to get a consensus on that standard.


 * It's a service to challenge the accepted boundaries of medical ethics. Well done. But you have to be prepared for the possibility that nobody else will agree. Nbauman (talk) 23:42, 28 June 2008 (UTC)


 * I disagree about putting the link to the Commons page: (1) some of the other pages linked to are not consensus, (2) the page on commons is clearly marked as an essay, (3) if you think the page on commons is a single POV argument then you should create a section with arguments contra. The page is not intended to develop consensus (I agree that would probably be impossible), just to solve copyright concerns and to give arguments from both sides. I don't want anyone to agree, I just want to get people to think about this issue and to bring attention to this debate.
 * Based from my experiences in the UK and from what I have seen at the BMJ Publishing Group author guidelines on informed consent, I think their standards are closer to my point of view than to yours. I'd like to hear from others here too. --Steven Fruitsmaak (Reply) 23:54, 28 June 2008 (UTC)


 * I found a positional view of leading journals in Australia, Canada, NZ, UK & US, plus some fairly explict advice from UK & US sources. Hence black box over eyes wont do, endoscopy pictures are not different from photos etc etc. I've put it, for now, at Commons talk:Patient images. Whilst copyright clearly of direct concern by wikipedia, consent for disclosure of patient images does fall more to the outside real-world professional issues for medical-staff wikipedians - for which wikipedia has more of a tangential role to play... that said, wikipedia does have some very specific and firm rules about biographies of living people (WP:BLP) - perhaps we should seek some input from that experienced policy on real-world individual rights/privacy ? David Ruben Talk 02:56, 29 June 2008 (UTC)

Indeed. In the United States, identifiable images of people are subject to (at least) two categories of legal rights: rights of the creator (copyright and moral rights), and rights of the subject (model release). Copyright generally belongs to the person who executes the image, unless the execution is a work for hire. For commercial use, which includes publication in academic journals, a model release may be necessary. This is in addition to any copyright transfer or licensing. In some cases, health care facilities include in patient registration packets a model release form that attempts to obtain blanket consent for use of any and all images of the patient. A savvy patient will simply refuse to sign. There is also a technical issue: in publishing any medical image, especially in electronic form, extreme care must be taken to ensure that the image is anonymous. That means not only the subject's name does not appear in the image, but the subject's name or any other personally identifiable information is not recorded in the data structure of the file. --Una Smith (talk) 03:00, 29 June 2008 (UTC)


 * Thanks to David Rubin for the research which clarifies the situation, but I think it supports my position. The position cited in WP Commons is the debating point of a few doctors, not a medical consensus.


 * I don't see anything in the material cited here or on WP Commons talk, including the BMJ statements, which says that patients must give specific permisson for images in which patients are not identifiable, for example endoscopy. The BMJ letter from the medical editors is about images in which patients are identifiable. I can't even find the cite in BMJ which says that Minerva requires patient permission to endoscopy images (I don't remember Minerva using many images anyway).


 * There are some doctors who take the position that the patient has a major ownership interest in patient information, and therefore the patient must give permission before it can be used beyond treatment that would directly benefit the patient. That's a commendable philosophical exercise. It forces us to think about patient privacy.


 * If you think about it, it's wrong.


 * There's an interest in patient privacy and an interest in medical education and scholarship. Such an extreme position would contribute nothing meaningful to patient privacy, and substantially disrupt medical education and scholarship.


 * Pathologists have millions of paraffin slides and specimens, including rare diseases, collected over more than a century. They can now use genetic probes to get valuable information from these specimens. Most of those patients are dead. It would usually be impossible to get permission. Should we forbid pathologists from using those specimens -- even publishing photographs in journals and books? Should we delete those photographs from pathology atlases?


 * If the BMJ really believed that patients must give explicit permisson to use unidentifiable images, they would have deleted all their X-rays, endoscopy images, pathology photographs, etc., from their web site, and they haven't.


 * I disagree that a "savy patient" would refuse to sign a generalized release. I had a spirometry test at the launch of a pilot screening program, and, with video cameras around, I signed a generalized release, because I believe it is necessary for medical education.


 * But if practitioners were required to get specific permisson for every foreseeable use of medical images, patients would have to sign a contract with the size and complexity of a TV model release, and they'd have to hire a lawyer to understand it. You would be burdening patients with one more difficult, complex decision at a time when they had to make many more difficult, complex decisions, and it would be a sham contract because they usually couldn't understand it.


 * I stand by my statement that no medical journal, and no medical ethics consensus, follows those proposed standards of privacy that require permission for images in which patients are unidentifiable, such as endoscopy. If you disagree, please supply a link to the contrary. Nbauman (talk) 18:26, 29 June 2008 (UTC)


 * Finally found some official UK sources on issue of ownership and copyright of UK notes; with past regulations predating the internet, it is difficult to easily locate good sources to cite (NB issue of disclosure etc are separate issue discussed above and elsewhere):
 * David Ruben Talk 03:01, 5 July 2008 (UTC)
 * David Ruben Talk 03:01, 5 July 2008 (UTC)
 * David Ruben Talk 03:01, 5 July 2008 (UTC)


 * Those documents are about ownership of medical records. They don't discuss the issue at hand, which is, who gets access to records, how may the records be used, and when can they be used in a lecture or published in a journal. The NHS could "own" the records, but the treating doctor could have the right to publish them in a journal. This is different from the situation in the U.S., in which the patient owns the records, but the treating doctor, and a long list of people, have the right to read and copy the records. In the U.S., I'm pretty sure a doctor can publish images in a journal, without permission from the patient, provided the patient can't be identified from those images.


 * Those documents don't contradict my original statement:


 * No medical journal, and no medical ethics consensus, follows those proposed standards of privacy that require permission for images in which patients are unidentifiable, such as endoscopy.


 * Can you find something that directly addresses that issue? Nbauman (talk) 13:18, 5 July 2008 (UTC)


 * Nbauman, did you read the sources? The second one, at the bottom of page two, says "It is important to remember that the ownership and copyright in these records as a rule is with the NHS Trust or Health Authority, not with any individual employee or contractor."  Just above this sentence, the document specifies what records it applies to, including "Photographs, slides, and other images."  This statement appears to very directly answer the question about who has copyright for patients records, including images, in the UK.
 * If you don't have copyright for the image, you cannot legally publish an image. That's the whole point behind a copyright.  WhatamIdoing (talk) 21:43, 6 July 2008 (UTC)


 * You're not a copyright lawyer, so you don't know that.


 * It's not true that you can't legally publish an image if you don't have copyright. All you need is permission from the copyright owner. For example, photographers own the copyrights to their images, but they license their use. They're published by permission.


 * For all we know, the NHS may have rules that permit doctors to publish an image for educational or scholarly purposes. Certainly UK medical magazines have lots of images, and they must have gotten permission somehow.


 * Even if your interpretation is correct, I'm not sure what that would mean. Maybe we couldn't use images taken by employees of the NHS without permission from the NHS.


 * But it doesn't get to the issue we were discussing, which is, do we need permission from the patient to reproduce an image in which the patient is not identifiable, such as a colonoscopy image?


 * I maintain that no one has found any ethical or legal requirement that we must get permission from the patient to use a picture of an unidentifiable patient. So the answer is no. Nbauman (talk) 22:04, 7 July 2008 (UTC)


 * If in the UK the copyright lies "with the NHS Trust or Health Authority" then whilst I agree that does not necessarily mean they cannot be published, it does clearly indicate from whom permission must be sought. No, I'm not aware of any standard policy across the NHS of how such permission is obtained and whether this is explicitly or implicitly so given. The previous provided article link to consensus opinion of international medical journal editors would I think count somewhat towards a general ethical standard, but the extent of unidentifiableness still requiring patient permission seems difficult to tell.
 * As for ethical/legal requirements - if I were to publish an identifiable image, then the patient has a right to complain to the GMC. They have full (legal) authority to investigate my professional conduct (an ethical requirement) and possibly then remove me from the Medical list (a legal requirement if I wish to continue practising medicine). That the precise boundaries of conduct are not codified in written form, but largely left for good profession judgement, does not mean boundaries do not exist just because we cannot read up a specific document. This is part of being a professional rather than merely a tradesman or office worker.
 * In the UK at least, copyright I think now clear and the normal Wikipedia rules of editor attesting to have rights to publish are appropriate (if the copyright holder then should object then the image must be taken down immediately and the relevant editor suitably reprimanded). The permission to disclose is similar to model release issues and perhaps needs just a warning to uploading editors to adhere to whatever is their local ethical/legal best practices (one might seek that the editor suitable tags the image again attesting to them having permission to disclose the image).
 * A patient is then free to upload their own images (they de facto give their consent to disclosure) provided they have copyright holder permission. The problem is really of anyone else uploading an image (either they have legitimate real-world access to the image and the question is over the permission to disclose, or they do not have real-world permission to access the image in the first place). Cannot we just use whatever is existing model release mechanism for Wikipedia or at very least just require 1) a suitable copyright declaration as all images currently require 2) a suitable declaration that the uploader is following whatever their (unspecified) local ethical/legal practice is for patient consent (it not being Wikipedia's role to specify what these might be, as we cannot follow every nuance of changes to professional practice in every single possible country) David Ruben Talk 00:59, 8 July 2008 (UTC)
 * Someone who uploads an image of themselves does not have to reveal who they are. Commons (and Wikipedia) go a long way to protect privacy.  I think it is useful to treat the various roles as completely independent:  uploader, copyright holder, subject.  --Una Smith (talk) 04:14, 8 July 2008 (UTC)


 * David Ruben, Wikipedia frequently uses illustrations from Gray's Anatomy. Those illustrations were drawn from real bodies of real people. Do you believe that we should stop using Gray's Anatomy, unless we can get permission from the original people? Nbauman (talk) 20:09, 8 July 2008 (UTC)


 * No, illustrations are likely to be amalgamations of studies of more that one body and so not identifiable. Also came from time when permission was not required, and version of Gray's being used to import pictures is now out of copyright. The issue is with modern images from patients or relatives still alive who might object. Lets face it a normal chest Xray used as an example of a normal chest Xray is not going to be identifyable by any patient. One with unusally clear set of cannonball metastasis migt be distinctive enough that a patient self-recognises. David Ruben Talk 22:02, 8 July 2008 (UTC)


 * The fact that Gray's Anatomy is out of copyright isn't an issue. We cover copyright elsewhere on Wikipedia. The BMJ author was arguing for a right of patients that is independent of copyright, and you are arguing for that same right.


 * I think everybody agrees that living patients should have a right to demand that we remove identifiable images of them from WP, similar to WP:BLP.


 * The question is, do you believe, as the BMJ author does, that patients have ownership of all the rights to images of them, outside of direct medical care, and that Wikipedia has to get specific permission from patients to use unidentifiable medical images like colonoscopies?


 * If you believe that, then you should also object to drawings made from individual specimens. I don't believe that older anatomical illustrations are likely to be amalgams of several bodies. Vesalius used single bodies. Vesalius' subjects didn't give permission. You should object to including Vesalius' illustrations. You should object to da Vinci's medical illustrations. Your principle is that patients own the images of their own bodies. Drawings are images just as photographs are. Nbauman (talk) 17:12, 9 July 2008 (UTC)


 * Pathology specimens are a special case. It is not unusual for the patient (or person acting for the patient) to be given a form to sign prior to surgery that releases all rights in any surgical specimens.  --Una Smith (talk) 02:31, 11 July 2008 (UTC)

If a patient undergoing a procedure has to sign a multi-page complicated document that he or she doesn't undertand, that's not informed consent. I don't think most patients appreciate what pathology specimens are, what doctors do with them, or why they are important beyond treating the immediate patient. If you wanted to do an honest job of explaining it to them, it could easily take another hour (and some patients would never understand it).

Doctors have a duty to act in the best interests of their patients, and you can't fully capture that duty in an informed consent contract. Most people agree that using an unidentifiable pathology specimen in teaching is in the best interests of patients in general, and does not harm the individual patient. When the patient is identifiable, they need permission. Nbauman (talk) 17:51, 12 July 2008 (UTC)


 * Can you give an example where an imaging study or pathology slide is ever identifiable? JFW | T@lk  06:36, 13 July 2008 (UTC)

Model release
Model releases are private documents between the subject and the photographer; the photographer does not normally show the model release to anyone else. It might be slightly helpful if on Commons the image summary prompted for "model release=", but existence of a model release should have no bearing on whether the image is acceptable for uploading to Commons. The only issue here is that some publishers do require proof of patient consent, which does involve disclosure to the publisher of the patient's name and signature. Such publishers seem to be a small minority, and I don't see that Commons needs to be in their number. If Commons adopted a "prove it" approach then it would be a matter for OTRS. An in between approach would be to prompt the uploader to indicate in the summary "patient consent to publish=" yes/no/whatever. --Una Smith (talk) 04:11, 8 July 2008 (UTC)
 * I'm happy with that (its the same approach we take on normal photograph copyright where the uploader states that it is a self-made picture, but we do not require submission of the original film negative) David Ruben Talk 22:02, 8 July 2008 (UTC)

Copyright in UK

 * This statement about copyright needs to be verified; what is the basis for this statement?  A statute?  Case law?  Make believe?  It reads like an attempt to discourage hospital staff from publishing patients' images.  If it were true then I would expect to find it reflected in the forms that authors are required to sign when publishing in a UK journal, because almost every medical image published in the UK will need permission to publish from a copyright holder who is not an author. --Una Smith (talk) 04:11, 8 July 2008 (UTC)


 * After all the management reforms in NHS hospitals, I'm sure they have written statements regarding the rights and obligations of staff who want to publish articles, which would include the required permission. That's what we need to see. The above quote is just a general statement of legal principle. Nbauman (talk) 21:27, 8 July 2008 (UTC)
 * I believe the above quote is false. I am a very competent searcher, I have spent hours searching for such documents on the web, including PubMed, and I have found nothing.  I have found the act that gives ownership of the physical records to the government, and read it;  it does not refer to copyright.  The preponderance of practice in the UK medical community indicates that the government does not hold the copyrights to medical images. --Una Smith (talk) 22:57, 8 July 2008 (UTC)

The above 2-page document refers to these possible sources:
 * Appendix B to Health Service Circular HSC 1999/053 (For the Record: Managing records in NHS Trusts & Health Authorities) is based upon long standing good practice
 * Appendix A of the circular provides the background, and scope
 * specific schedules provided by the National Archives
 * Local variations agreed at the Information Governance & Caldicott Committee
 * some via the Health Records Committee