Wikipedia talk:Manual of Style/Medicine-related articles/Archive 8

Variations heading for anatomy layout
Hey, everyone. I still object to the Variations heading, a heading that LT910001 very recently added to the anatomy layout. I take it that since I was the only one to object to it, LT910001 reasoned that there is WP:Consensus to add it. The initial comment I made in the Guidelines mark 2 section shows why I object to the heading; I stated, "More than one aspect of an organ can have variations, and it will likely be best to discuss those variations in the appropriate sections instead of trying to lump them all in one section. So I don't see the Variations listing as needed." In my "03:30, 19 December 2013 (UTC)" post, I suggested that LT910001 make it clearer that the Variations listing is optional by adding "as appropriate," but LT910001 added "if information exists" instead, which doesn't satisfy my objection, because, like I stated, "Of course information regarding variations is very likely to exist." I started a new talk page section about this here since LT910001 considers the previous extensive discussions closed and suggested that any new discussion about the anatomy layout be addressed in a new, separate section. Here is the previous discussion on this matter, taken from the Guidelines mark 2 and Guidelines mark 4 sections above:

Comments from people other than us on this matter would be appreciated. Flyer22 (talk) 00:36, 7 January 2014 (UTC)


 * I don't feel strongly either way, I just want a recommended list of articles that I can apply to anatomy articles please. Lesion  ( talk ) 15:23, 15 January 2014 (UTC)
 * I think that since anatomy books often have such a section, it would be appropriate for us to do the same, at least in some instances. I wouldn't necessarily want a one-sentence section (with no hope of expansion), but if there are a lot of variations, then I think it would be efficient.  For example, given the promotional work we saw a while back on labiaplasty, I could see the value of a ==Variations== section in the related anatomy articles, complete with a gallery showing the range of normal variation.  That would make more sense than an all-purpose ==Additional images== section.  WhatamIdoing (talk) 16:13, 21 January 2014 (UTC)
 * As shown above, I am more than okay with having sections that discuss variations. I am somewhat okay with having a section titled Variations and which discusses variations. What I am not okay with is having the Anatomy WP:MEDMOS section recommending a Variations subsection "if information exists." We all know that some editors are militant in their application of WP:MEDMOS and will think that, if there is information on variations (which there almost always will be), there should be a Variations section simply because WP:MEDMOS recommends it. Like I already made clear above, such a heading does not work in every case. In some cases, an organ has many or several parts and it is best to discuss the variations of those parts in the sections about those parts instead of lumping them all into one section titled Variations. Take the Brain and Human penis articles, for example. The brain has many parts and variations specific to those parts. The Human penis has several parts and variations specific to those parts. I don't think that it's a good idea to have a section titled "Variations" in either article covering these many or several different variations. Variation information with regard to the glans penis, for example, is (in my opinion) best covered in a section about the structure of the glans penis. The Human penis article, which currently needs some more reorganizing, currently has a Normal variations section; the bit in that section is just the tip of the iceberg with regard penile variations. And because of all of these points, I believe that it's very reasonable to add "where appropriate" or "if appropriate" in place of "if information exists" to the Anatomy WP:MEDMOS section. Flyer22 (talk) 02:25, 24 January 2014 (UTC)
 * I've got no objection to saying "if appropriate" or even "if discussed extensively in secondary sources". WhatamIdoing (talk) 03:30, 24 January 2014 (UTC)
 * We do not add a "where appropriate" qualifier to other aspects of medical articles, because we regard them all as essential for a complete articles. This is the same for anatomical articles, an article would not be complete without some description of variation. With regard to variations of components of organs, as described editors often exercise judgement as to what is important enough for inclusion in a parent versus a child article. Use of "if discussed extensively" would eliminate almost all the variations data available, and I feel we have established consensus that anatomical articles are unique in terms of what sources may be used, due to the lack of such studies, and the reliance on Gray's Anatomy as a basis for other sources. Perhaps another user could propose a compromise statement? Ping to, who it seems has a good knack for doing this. --LT910001 (talk) 02:15, 26 January 2014 (UTC)
 * Article completeness is determined by the facts contained in them, not by the presence of section headings. If the only variation is that the foo is usually attached only to the bar, but sometimes it's also attached to the baz, then it should be perfectly adequate to include that variation in the original statement:  "Foo is attached to the bar.  In some instances, it is secondarily attached to the baz."  That doesn't require a section heading called ==Variations==, and the article is not incomplete if these sections are merged.  WhatamIdoing (talk) 02:22, 26 January 2014 (UTC)


 * We have "if" (or similar) qualifiers for other medical fields in WP:MEDMOS, and we have such qualifiers, including "where appropriate," in the Anatomy WP:MEDMOS section already due to the extensive recent discussion we had with regard to designing that layout. And I've already been extensively over why I am not okay with the Anatomy WP:MEDMOS section recommending a Variations subsection (the heading, more specifically) "if information exists." It is also abundantly clear above that I am not stating that we should exclude information on variations from anatomy articles or that such information is not essential for anatomy articles. I prefer "if appropriate"...and "if appropriate" is specifically with regard to creating a Variations heading, not whether or not to include information about variations. I agree with you having pinged Zad68; great choice. Flyer22 (talk) 02:29, 26 January 2014 (UTC)
 * In retrospect, it does seem reasonable to include 'if appropriate' for the 'variations' heading... this also would have particular relevance for embryological and neurological articles, where it may or may not be important. I would support a change to 'if appropriate', with us three all in agreement, let's make the change.--LT910001 (talk) 03:15, 26 January 2014 (UTC)
 * Changed it. Flyer22 (talk) 20:34, 21 February 2014 (UTC)

Help?
I'm starting to rewrite and expand aspergillosis as it is in dire need of it! However, this is a disease entity compromising of various subtypes. The only thing these have in common is their causative agent; the mechanisms, diagnoses, treatments and outcomes for the various subtypes are all radically different. How do I best arrange this article? Is it worth encompassing all of the subtypes within the same article, or merely using it as a summative page for the different entities? How do I best make it comply with MEDMOS?

Thanks for the help! --— Cyclonenim | Chat 15:13, 28 January 2014 (UTC)


 * Are they true subtypes or just the same infection at different bodily sites? Lesion  ( talk ) 15:32, 28 January 2014 (UTC)
 * True subtypes. ABPA, for example, is an allergic disease but invasive aspergillosis is classical infection in (mostly) immunocompromised people. Chronic pulmonary aspergillosis and simple aspergilloma sit somewhere between to the two, restricted to the lung parenchyma. --— Cyclonenim | Chat 21:34, 28 January 2014 (UTC)
 * Sounds like it might be an option to deal with each type on a stand alone article... Lesion  ( talk ) 22:05, 28 January 2014 (UTC)

Treatments
There's a dispute at DRN about whether commonly used but non-evidence-based treatments should be included under ==Treatment== or cordoned off in another section, like ==Society and culture==. IMO the guideline's statement of "any type of currently used treatment" is clear enough, but I think we could reduce these disputes by specifically naming alternative medicine, and/or by adding a note that says "regardless of the level of evidence for the treatment's effectiveness".

To give an example, common self-care treatments for Hiccups, like drinking a glass of water, were apparently moved to ==Society and culture== a while ago, even though the guideline specifically names self-care as something to include under ==Treatment==.

What do you think? How would you reduce these disputes? WhatamIdoing (talk) 16:21, 21 January 2014 (UTC)


 * Do you have a link to that DRN? It sounds important...
 * I personally don't have a problem including CAM therapies in Treatment/Management, especially if they are commonly used by patients, but ideally (1) in a subsection headed Complimentary and alt med" and (2) not saying anything (mainstream or CAM) is efficacious unless there is a good systematic review to say so. Here is an example: Temporomandibular joint dysfunction. IMO, it is more appropriate to include historic and traditional therapies which are now very rarely used the Society and culture section. It is difficult because CAM often takes its structure from such treatments. I would distinguish what belongs in the Treatment section based on whether the treatment is used in modern times or not. Lesion  ( talk ) 18:28, 21 January 2014 (UTC)
 * Dispute resolution noticeboard, but I'd describe it as a pretty boring dispute. The OP started with a source that is (at best) moderate in quality.  It turns out that it's not the only source, and a statement that this treatment is used (in India, where Ayurvedic treatment is common) is easily supported.  The fact that people use other herbal treatments can also be supported (e.g.,  says that 40% of patients in a different country used herbal medicines for this disease—that's less than used acetaminophen but more than used corticoids).  NB the important gap between "is used" and "actually works", which the source itself noted.  But, you know, the same thing can be said about most of the stuff that people use for Common cold.  People spend about US $2 Billion on cold/sinus medicines, even though we've got pretty good evidence that the major cough suppressant does not work at all.  But if you went to Common cold and found no mention of cough syrup, you'd rightly think the article was incomplete.
 * I'd put outdated treatments under ==History== (which is what this guideline suggests). Current CAM, though, IMO belongs under ==Treatment==, right along with ineffective-but-still-used conventional medicine.  WhatamIdoing (talk) 22:17, 21 January 2014 (UTC)
 * Responded there, but this is not just ineffective, it is actively toxic treatment. There's no way we should be endorsing in any way, shape, or form the use of cinnabar (mercury (II) sulphide) as medicine. LeadSongDog come howl!  22:40, 21 January 2014 (UTC)
 * "Real people with this real disease really do take this stuff" is not generally considered an "endorsement" of the stuff they take. WhatamIdoing (talk) 00:59, 22 January 2014 (UTC)
 * If there is a sufficient ref that its use is notable then yes it can go in the treatment section. Otherwise should probably not have it anywhere. Thus I have removed the bit from the article in question. We cannot become simply a list of everything that everyone has every tried for X and got it reported by someone. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:09, 21 January 2014 (UTC)
 * The question here is about the ideal location for such information, were we to agree to include it anywhere on the page. Are we going to list all the currently used treatments (if WP:DUE) under ==Treatment==, or should we consider clarifying it, perhaps by renaming the section to something like ==Treatments that we think you ought to prescribe==?  WhatamIdoing (talk) 00:59, 22 January 2014 (UTC)
 * ...Or ===Evidence-based treatment=== ?
 * I tend to agree with WAID here that if a lots of people are using an treatment, then it is notable to include in the treatment section, but we should make clear statements of evidence of efficacy or lack thereof for every treatment mentioned. Lesion  ( talk ) 01:12, 22 January 2014 (UTC)

At the moment, I agree that we should lean towards including separate sections inside of the society & culture section, to demarcate what is and what is not a currently-accepted evidence-based treatment, eg society and culture#Traditional X medicine. --LT910001 (talk) 02:05, 26 January 2014 (UTC)
 * Where would you put non-traditional alternative medicine? For example, where does guided imagery go?  It's altmed, it sort of works for pain and anxiety, and it's just a few decades old.
 * Where do you put conventional medicine with zero evidence in its favor? Dextromethorphan is an alleged and popular cough suppressant that pretty good evidence says doesn't suppress coughs.  How about cartilage-shaving knee surgery, which is in the same boat?  Are those just social and cultural expressions rather than medical treatments?  WhatamIdoing (talk) 02:32, 26 January 2014 (UTC)
 * Okay agree that the treatment section under an altmed sub heading is best. Ref is not good enough to include at all in this case. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 08:37, 26 January 2014 (UTC)
 * I'd skip the subsection heading unless there's more than one paragraph. Most altmed treatments can be adequately covered in a single sentence:  "People [or people in this country, or whatever] sometimes also take ____ for this."  I wouldn't want to have a section heading for that because it would tend to draw attention to it.  WhatamIdoing (talk) 01:16, 18 February 2014 (UTC)
 * The linguistic disconnect is that most lay readers will presume that "treatment" implies an intervention has some value for a specific condition. There must be a better term.  Intervention? LeadSongDog  come howl!  21:03, 26 January 2014 (UTC)
 * ==Interventions== doesn't work when the appropriate treatment is non-intervention, e.g., Watchful waiting or Supportive treatments. WhatamIdoing (talk) 01:16, 18 February 2014 (UTC)

Naming
Hi everyone, according to this guide we should name articles as per the ICD-10 or DSM-5 and as the latter only applies to mental/behavioural illnesses the ICD-10 is the preferred for physical illnesses. Consequently I would like to bring your attention to the fact that the following articles are not named accordingly (in brackets is the applicable section of the ICD-10):

and its subtypes (like Acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia and chronic myelogenous leukemia) and its subtypes
 * Tularemia (A21)
 * Methemoglobinemia (D74)
 * Leukemia (C91)
 * Anemia (D50)

and the list goes on. Now I think we need to reach a consensus otherwise we're contradicting ourselves by saying physical illnesses should be named as per the ICD-10 and then naming these differently. Fuse809 (talk) 11:31, 12 February 2014 (UTC)

'''EDIT: I am NOT talking about American vs. British English! I know the rules with regard to these changes I am talking about ICD-10 as it is where this manual of style does not line up with what's actually occurring in practice!'''


 * "An article should not be edited or renamed simply to switch from one valid use of English to another." [bolding as in the original] is a quote from MOS:RETAIN. (And there are interesting sections above and below that one on that page.)
 * If an editor renames an article from American spelling to British spelling or vice versa, it is recommended that the following be placed on her/his talk page:
 * "[[Image:Information.svg|25px|alt=Information icon]] In a recent edit, you changed one or more words or styles from one national variety of English to another. Because Wikipedia has readers from all over the world, our policy is to respect national varieties of English in Wikipedia articles.

For a subject exclusively related to the United Kingdom (for example, a famous British person), use British English. For something related to the United States in the same way, use American English. For something related to another English-speaking country, such as Canada, Australia, or New Zealand, use the variety of English used there. For an international topic, use the form of English that the original author used.

In view of that, please don't change articles from one version of English to another, even if you don't normally use the version in which the article is written. Respect other people's versions of English. They, in turn, should respect yours. Other general guidelines on how Wikipedia articles are written can be found in the Manual of Style. If you have any questions about this, you can ask me on my talk page or visit the help desk. Thank you. "


 * Leukaemia and Leukemia are the same word, and according to policy the one should not be changed to the other.
 * Hordaland (talk) 15:26, 12 February 2014 (UTC)


 * P.S. In my opinion the above mentioned articles, originally written in British English, should have the redirects removed and the titles restored to the original British English.  --Hordaland (talk) 15:35, 12 February 2014 (UTC)

What I'm talking about here isn't simply changing from American to British English, I'm talking about the ICD-10 as we're supposed to be following it. I know about these rules regarding American to British English but what I'm talking about is different, are we keeping to the ICD-10 or are we making it up as we go along? Fuse809 (talk) 15:46, 12 February 2014 (UTC)
 * I consider these minor variations in spelling to represent simply the difference between American and British English spelling. They are not really different words. I do not think we need to use the same spelling as the ICD10. Just the same word. Which we do. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:07, 14 February 2014 (UTC)

That's not entirely true; essential thrombocytosis should be called essential thrombocythaemia according to the ICD-10. Fuse809 (talk) 20:47, 15 February 2014 (UTC)

Consequently I'm moving this page to make it in accordance with the ICD-10. Fuse809 (talk) 21:11, 15 February 2014 (UTC)


 * Wikipedia is agnostic about the difference between e/ae/æ. However, if the article is written in American English, then you may not move it to a British English title, and vice versa.  As a result, it's possible that your newly created essential thrombocythaemia really ought to be at essential thrombocythemia instead.
 * We don't always follow these, because sometimes their names are outdated or not really used by anyone, e.g., Tourette syndrome vs "Combined vocal and multiple motor tic disorder [de la Tourette]" (what ICD-10 calls it). You can call that "making it up as we go along" if you want; I call it "using good editorial judgment".  WhatamIdoing (talk) 01:25, 18 February 2014 (UTC)

Ordering
Hi, the order of drug articles suggested by this guide aren't in agreement with WP:PHARMMOS and its recommended article order. I hence suggest that we change this article, accordingly. I would just do it myself, but as I doubt I'm the first person that's realised this inconsistency I thought I should start a discussion first. Fuse809 (talk) 07:17, 17 February 2014 (UTC)


 * PMARMMOS is just a WP:WikiProject advice page; this is a community-approved guideline. So if you were going to make one match the other simply to have them match, then you would make PHARMMOS match this one, not the other way around.  But what's really ideal is what you have just done:  start a discussion to find the best order (for the typical drug) and improve both pages as a result.  Here are the lists:


 * So let's see:


 * One says ==Adverse effects== with three subsections: Contraindications, Interactions, Overdose.  The other says ==Contraindications==, ==Adverse effects==, ==Overdose==, and ==Interactions== get their own sections.  I prefer separate sections, but I'll go along with what other people like best.  The order is slightly different, but it probably doesn't matter which is chosen.  Editors should put them in the order that gives the most important information first.  For example, ==Overdose== is probably important for opiates, but it should probably go last for something like Trimethoprim/sulfamethoxazole, where contraindications (allergy), adverse effects (lots) and interactions (with birth control pills) are more significant.
 * ==Chemical properties== and ==Mechanism of action== are reversed. Medical people are going to want the mechanism first; chemists will want the chemistry first.  I don't think it matters.
 * One lists ==Measurement in body fluids== and another omits it. That sounds like something focused on street drugs or forensic medicine rather than one everyday drug use.

I think that's it. Any other differences? Anyone else have any opinions on what to do?

If it were entirely up to me, I might add a section on manufacturing process and pull legal approvals (for regulated pharmaceuticals) out into a separate section. I might do the same with economic information. But perhaps others would not agree. WhatamIdoing (talk) 01:51, 18 February 2014 (UTC)
 * IDK if this is what you meant, but virtually every pharmacology article includes a synthesis section due to WP:CHEMICALS co-involvement and consequently, MOS:CHEM's layout guide. Seppi  333  (Insert 2¢ &#124; Maintained) 03:04, 18 February 2014 (UTC)
 * The current MEDMOS layout has a better organization and logical ordering than the PHARMMOS layout.
 * In any event, I'm not sure why we use mechanism of action and pharmacokinetics instead of pharmacodynamics and pharmacokinetics. MoA and pharmacodynamics aren't perfectly synonymous - pharmacodynamics is a more general term (that's sort of obvious from the definitions of those terms though).  E.g., gene expression typically isn't associated w/ drug MoA, but it is a component of drug pharmacodynamics. Why not generalize that section name or just indicate the use of either?
 * I should probably note that in every pharmacology article I write, I make "Pharmacology" a level 2 header, and include "pharmacodynamics" and "pharmacokinetics" as level 3 sub-headers of pharmacology for the aforementioned reason.  Seppi  333  (Insert 2¢ &#124; Maintained) 03:00, 18 February 2014 (UTC)
 * I think that there might be two reasons for MoA vs pharmacodynamics: one is that clinicians probably think more about MoA than about the non-MoA aspects of pharmacodynamics.  The other is that it's easier for non-technical people to figure out what MoA is than what pharmacodynamics is.  Something in plain English like ==How it works== would probably be adequate.  WhatamIdoing (talk) 22:09, 21 February 2014 (UTC)
 * The differences between the two are small. I prefer MoA as it is easier to understand and we are writing for a general audience. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:01, 22 February 2014 (UTC)
 * As one of the general audience, I agree that "mechanism of action" is more generally comprehensible. Even that may be pushing it a bit with some readers. "How it works" is pretty obvious for any reader likely to make sense of the contents, but may be dumbing it down a bit much. &bull; &bull; &bull; Peter (Southwood) (talk): 07:56, 15 March 2014 (UTC)
 * Second thoughts - "How it works" is actually exactly what people will look for. It is simple, straightforward and unambiguous, and may encourage editors to stick to that point. &bull; &bull; &bull; Peter (Southwood) (talk): 08:01, 15 March 2014 (UTC)
 * Yes I could be convinced that "How it works" is the way we should go. I image that simple English uses this already. We could also change prognosis to outcomes. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 08:49, 15 March 2014 (UTC)

Indications versus medical uses
I have boldly made this change. IMO "medical uses" means what is done and what is supported by the evidence. Indications on the other hand is what has the FDA rubber stamped which is not always done and not always evidence based. Also a local / US centric term which we as a global encyclopedia should avoid. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:22, 14 March 2014 (UTC)
 * It is not a local term... neither does it have any particular FDA connotations for people outside that part of the world. Lesion  ( talk ) 22:53, 14 March 2014 (UTC)
 * The first page you get when you type in approved indications is this . Which divides indications in approved and not approved / off label. All of it is about the FDA Doc James  (talk · contribs · email) (if I write on your page reply on mine) 08:47, 15 March 2014 (UTC)
 * That is not the case in my browser. Must depend where you are located. Before you suggested that the term indications was associated with the FDA I did not know this. If you want to change the heading from indications, this rationale is not valid. The argument that lay readers would not understand the term is a better reason... although one I disagree with. Lesion  ( talk ) 12:42, 15 March 2014 (UTC)
 * I support your change, though I think it would be more orderly/organized to lump the types of uses together in a "Uses" section (excluding veterinary).  Seppi  333  (Insert 2¢ &#124; Maintained) 22:56, 14 March 2014 (UTC)
 * Yes I am happy with that too. If it is just recreational I use just recreational uses. If it is nearly all medical. I uses medical uses in the first section and recreational uses under Society and culture. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 05:00, 15 March 2014 (UTC)
 * Support in my experience and locale, this word is not widely understood outside of the medical profession. --LT910001 (talk) 00:52, 15 March 2014 (UTC)
 * Copmmenting as a general reader, "Medical uses" will more likely convey a correct and unambiguous meaning. &bull; &bull; &bull; Peter (Southwood) (talk): 08:06, 15 March 2014 (UTC)
 * But "medical uses" is not an exact equivalent. Indications are reasons to do something, or a certain set of signs/symptoms can be indicate that a specific disease is present. Switching medical uses for this use of the term does not make sense. It might work in the context of a pharmacology article, but elsewhere I see problems. Lesion  ( talk ) 12:42, 15 March 2014 (UTC)
 * Perhaps a clear definition of the full meaning of indications in this context would suggest alternatives. &bull; &bull; &bull; Peter (Southwood) (talk): 17:25, 15 March 2014 (UTC)
 * Agree that it is confusing, but I think this is the flip-side of the issue. A layperson is more interested in knowing when a procedure is done (ie Medical uses for a procedure), but a practitioner is interested when something ought to be done (ie Indications for a procedure to be used). --LT910001 (talk) 01:54, 16 March 2014 (UTC)
 * Support per above, plus this brings this page more in line with WikiProject Pharmacology/Style guide. It is true that "medical uses" and "indications" are not the same, but "uses" reduces any impression that we are treating any subject in a medical professional rather than an encyclopedic way. Wiki at Royal Society John (talk) 04:40, 16 March 2014 (UTC)
 * I'm open to changing this suggested section heading, but the rationale given above is wrong. The FDA (and all drug regulators) determine what the " approved indications" are; they do not determine what the "indications" are.  The word "approved" here means "an indication that is approved of by the regulatory agency".  This contrasts with the other kind of indication, namely the indications that aren't approved of by that regulatory agency.  This second type still exists, and is still "an indication".  WhatamIdoing (talk) 22:07, 24 March 2014 (UTC)
 * This has already been changed. Diff: . I understand that the main support for this change on WTMED and here was that laypersons would not understand the exact "medical meaning" of indications and contra-indications. Lesion  ( talk ) 00:23, 25 March 2014 (UTC)

We really need to lay out a standard for medical abbreviations
In short, we need a MOS guide (basically a supplement to this section MOS:ABBR) for common medical terms (first occurrence rule, wikilink rule, sub/super-script rule (where relevant), etc). E.g. on the use of s.c., i.p., and i.v. administration routes or LD50 vs ld50 vs m.l.d.. Some terms should also be consistently abbreviated, as m.l.d. is sometimes used for median or minimum lethal dose which also may abbreviated as LD50 or LDmin respectively.

As far as I can tell, we have no guidance on the use of these terms in the wiki MOS or our MOS supplement; many medical substance articles use abbreviated terms like these and it appears that there's a lot of heterogeneity in the use of these terms as well. I'm not making a formal proposal on this - have too much other stuff on my wiki to-do list at the moment. Hoping someone else can hop on this, assuming this isn't already covered elsewhere in the MOS. Seppi  333  (Insert 2¢ &#124; Maintained) 03:45, 19 June 2014 (UTC)


 * Are you seeing disputes around this, or just thinking that a sort of cheatsheet would be handy? WhatamIdoing (talk) 04:03, 19 June 2014 (UTC)
 * It's not particularly urgent; it'd just help standardize formatting and the use of language in our articles. I've noticed a fair amount of variability in some of the recent pages I've read or edited.  Seppi  333  (Insert 2¢ &#124; Maintained) 07:28, 19 June 2014 (UTC)

PubMed Health Drugs as good EL?
It seems to me that Drugs pages from PubMed Health (a site developed by Hida Bastian, alias, among others, dedicated to reliable information regarding clinical effectiveness) may provide external links that could be genuinely helpful to our readers. Worth of inclusion in this guideline? 86.169.210.196 (talk) 17:42, 24 March 2014 (UTC)
 * Much of the content is from "Truven Health Analytics" Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:48, 24 March 2014 (UTC)


 * Is that an issue? 86.169.210.196 (talk) 17:58, 24 March 2014 (UTC)
 * Erm, sorry, I've just spotted the blanket discouragement of EL at WP:PHARMMOS... 86.169.210.196 (talk) 18:02, 24 March 2014 (UTC)


 * The PubMed Health drug topic pages have an aggregated feed of the clinical effectiveness resources associated with that drug. They include drug product information for background on basic information. For drugs where there is little clinical effectiveness information, then the links to the Micromedex drug product information (now owned by Truven Analytics) amounts to most of the information. Where there's a lot of clinical effectiveness resources, most of the links are then to those. Clinical effectiveness resources don't unfortunately usually serve the background information role. Medicine product information is complex, occupying a zone that sort of straddles clinical effectiveness research and what's agreed as valid statements to make about a drug with a regulatory authority (in this case, as it's USA, the FDA), which is based on agreed frameworks (that include clinical trials on questions of efficacy/effectiveness. Medicine product information in widely understood language across a large spectrum of drugs is currently a business enterprise, in one way or another. Don't know if that helps. Hildabast (talk) 09:53, 26 March 2014 (UTC)

Usage
I have added a "usage" section to medication articles to match the "epidemiology" section we have in disease related articles Thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:53, 23 June 2014 (UTC)


 * That the difference between "indications" and "usage" will be difficult for most people to grasp. WhatamIdoing (talk) 02:31, 25 June 2014 (UTC)
 * Hum good point. "Frequency of use" maybe? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:41, 25 June 2014 (UTC)

Amphetamine articles and the need for consensus
Introduction

I have tried to edit this style guide to reflect the fact that when it comes to amphetamine-related articles we generally keep to the USAN instead of the INN, but the edit was reverted by CFCF. I am personally in favour of changing the name of amphetamine articles to the corresponding INN names, but I realize that due problems of recognizability most Wikipedians I have come across favour the USAN (e.g. Seppi333 and Jmh649). Which is fine, they're entitled to their opinion, as I am entitled to mine, but I think we need to reach a consensus and finally put all this pedantic arguing (yes, mostly on my part, not trying to point the finger of blame at anyone else) to bed.

My argument for the move to INN titles for these articles

The INN is something I would favour based on the grounds of lisdexamfetamine's naming and the fact that virtually every medical association or organization worldwide has adopted this naming which perfectly reflects the INN for dextroamphetamine, dexamfetamine. Plus the British Approved Names for the amphetamines tends to conform better with the INN, hence given enough time for these naming conventions to sink in it may just become a regional preference as to which naming convention is preferred, that is, if you live in the U.K. dexamfetamine and metamfetamine may become common use, whereas if you live in the U.S. dextroamphetamine and methamphetamine may still be commonplace. It is also nice to have a "one glove fits all" for the naming of drug articles, in my opinion, at least.

The arguments against such a move I am aware of

Recognizability and chemical correctness are the major ones I've seen. Chemical correctness refers to the phenyl (which is used by chemists) vs. fenyl (which is the spelling that is implied by the INN). But I would just like to add that if we accept this argument and do not criticize it we would have to rename the fenfluramine article as phenfluramine. As for recognizability well we can have redirects (which would be in place as soon as any of these articles are moved, by default) in case people search for the more conventional names so it is unlikely anyone will get lost, especially if we mention in the lead the alternate spellings. It is sort of like the variations of English, so long as we mention the alternate spellings, and create redirect pages at the alternate spelling or terminology it is unlikely that readers and/or editors will get lost.

Bottom line

All I am here to propose is that we reach a consensus, here and now, and either vote in favour of naming all articles based on the INN, or in favour of making occasional exceptions to this general rule for amphetamine-related articles like methamphetamine, dextroamphetamine, amphetamine, levoamphetamine, etc. If I am ranting and raving about a consensus that has already been reached please do direct me to this consensus so I may henceforth remain silent, as I am willing to accept the consensus of Wikipedia's editors. Thank you for everyone's time it is much appreciated.

By the way, I believe the standard is to leave your remarks below my comment, instead of editing my comment, I hope so as I think we all deserve to give our own opinions and hear each other's opinions, regardless of how ridiculous some of us may find them so that we can reach a unanimous consensus. Brenton (contribs · email · talk · uploads) 21:31, 18 July 2014 (UTC)
 * I am in favor of using INNs as the name of the articles rather than the USAN. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:01, 19 July 2014 (UTC)


 * Comment – If you really want to go through with this, you need notify relevant wikiprojects - those from the article talkpage, listed below - especially if their MOS indicates a different naming convention (i.e., MOS:CHEM → Naming conventions (chemistry)),.
 * WT:WikiProject Chemicals
 * WT:WikiProject Pharmacology
 * WT:WikiProject Medicine
 * WT:WikiProject Neuroscience
 * It might be worth looking at pubmed for some insight though: do researchers that publish in journals on pubmed use the chemical contraction, alpha-methylphenethylamine or the weird INN version more, to the exclusion of the other, in papers they publish?
 * Search term with current name, without INN: (amphetamine) NOT (amfetamine) - Results: 13060
 * Search term INN, without current name:(amfetamine) NOT (amphetamine) - Results: 20 I think we should go with this one!
 *  Seppi  333  (Insert 2¢ &#124; Maintained) 00:13, 19 July 2014 (UTC)


 * True you get fewer results but that could just be because over 50% of English-speakers worldwide speak American English, hence they favour the USAN. Plus you should limit these articles to reviews and last 5 years as they're the preferred articles per WP:MEDRS. Gives 7 articles for amfetamine NOT amphetamine, 212 articles for amphetamine NOT amfetamine. Plus the preference for the USAN here could be that only the US and Canada market Adderall which is the only preparation that goes by the generic name "mixed amphetamine salts", both of which countries generally prefer the USAN over the INN. As for WP:PHARM they favour the INN in WP:PHARMMOS, over the USAN. WP:CHEM favours recognizability as their only real alternative, when we're talking generally for chemistry-related articles, is the systematic name which is tedious. But as WP:PHARM articles are by definition part of the scope of WP:CHEM we would expect to favour WP:PHARMMOS as our style guide here, as WP:CHEMMOS is too generalized for it to be all that applicable to WP:PHARM articles. Brenton  (contribs · email · talk · uploads) 23:04, 19 July 2014 (UTC)


 * Further if you limit to English articles only (as any non-English article gets its abstract translated into AMERICAN English) you get 7 results vs. 208 articles. Brenton  (contribs · email · talk · uploads) 23:15, 19 July 2014 (UTC)
 * Actually, only the abstract gets translated; I also suspect a foreign language INN would translate to the English INN. The point of my "one NOT other" filter was to remove these 27062 papers with both terms from the total population of 40349 articles on the compound.
 * I'm not sure what point you're trying to make with filtering out anything but MEDRS quality reviews in English though.  Seppi  333  (Insert 2¢ &#124; Maintained) 01:17, 20 July 2014 (UTC)
 * I am making the point that the only time PubMed searches are relevant to us here, at Wikipedia, are those limited to review articles from the past 5 years as only these should be used for supporting Wikipedia material. As otherwise it's not a fair comparison. Plus the 5 year requirement is also helpful as many of the articles included in your search are older than I am and hence are hardly relevant if we're interested in the modern day. Brenton  (contribs · email · talk · uploads) 01:26, 20 July 2014 (UTC)


 * I'm kind of having trouble caring about this issue. Having said that, if the drug is only marketed in the US and Canada, then using the spelling chosen by the American and Canadian regulators would appear to be the preference under WP:ENGVAR.  One would not normally use a British spelling on an American _____, or the other way around.  WhatamIdoing (talk) 23:38, 19 July 2014 (UTC)


 * Just because mixed amfetamine salts are solely used by Canada/America doesn't mean other amfetamines aren't used by the rest of the world. For instance, dexamfetamine is a drug used worldwide. Brenton  (contribs · email · talk · uploads) 23:59, 19 July 2014 (UTC)


 * In other languages, the INN isn't amfetamine. The English INN is amfetamine; It's anfetamina, amfetamina, amfetamin, amfetamine, amfetamīn, Амфетамин, etc, depending on the language. If someone really wanted to find the English page, they'd navigate to it in their language and click the appropriate language link on the sidebar. That's what wikidata is for.  Seppi  333  (Insert 2¢ &#124; Maintained) 01:17, 20 July 2014 (UTC)


 * The English INN is amfetamine and the non-English INNs are just translations of the English INN and as this is the English Wikipedia I fail to see the point of this part of the conservation. Brenton  (contribs · email · talk · uploads) 01:28, 20 July 2014 (UTC)
 * The point was to bring up the obvious question: how is amfetamine any more recognizable than amphetamine to someone from, say, Russia who doesn't know English? I have no idea what amphetamine is in a lot of other languages even though I've spent a lot of time on the wikidata page. Championing the recognizability of an INN to non-English speakers is a bit inane.  Seppi  333  (Insert 2¢ &#124; Maintained) 01:38, 20 July 2014 (UTC)


 * I fail to see what a non-English speaker would be doing reading a language that they do not understand enough to even know what a simple word, like amfetamine, is in said language. But if they are there is such a thing as Google Translate and other translation tools, which I assume is what they're going to be using to read these articles anyway. I don't see how this conversation is going to either support or weaken either argument for or against using the INN as article titles, so I think I'll leave it here. If you can show me this conversation is relevant, I will gladly argue my points, but otherwise I think it's a waste of time. Brenton  (contribs · email · talk · uploads) 01:51, 20 July 2014 (UTC)

Prevention section
I think it could be helpful to specify that this section is for prevention strategies that are actually in use, rather than potential strategies (which could go under Research directions). 86.157.144.73 (talk) 12:37, 12 August 2014 (UTC)
 * Agree. Some prevention strategies are in use because they make sense but have little evidence for them. These would still go in the prevention section IMO. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:31, 20 August 2014 (UTC)
 * Yup, like we do with treatments. 86.157.144.73 (talk) 20:46, 20 August 2014 (UTC)

Alternative Medicine Section Order Disparity
Hi everyone, I have a question I would like to open to the community here about something I've noticed on alternative medicine pages. I have noticed several pages such as herbalism, ayurvedic, homeopathy, naturopathy, and applied kinesiology have a certain order but others such as acupuncture and chiropractic (more the former than the latter article) serve as examples of contrast and do not put the history section in the beginning (though the chiropractic article does have conceptual basis in the beginning and it could be argued that is at least somewhat related to the history section). So, is there a page that guides us on this or a policy about how to order sections in alternative medicine (system) articles? If so, can someone direct me to this page please?. If not, perhaps we should discuss this issue since there seems to be a lack of uniformity in the articles. TylerDurden8823 (talk) 06:45, 10 August 2014 (UTC)

Not sure if there would be an advantage to uniformity. The altmed space is diverse enough that different topics may require different ordering. Generally, a chronological basis for ordering gives a natural reading order - so if there is a "History" section having it first would be reasonable. One thing to be alert to is a propensity from some POV-pushers to try and gather the "negative" material in one section and then push it down the article. Alexbrn talk|contribs|COI 07:41, 10 August 2014 (UTC)
 * WP:MEDMOS, we can discuss it further. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:43, 10 August 2014 (UTC)
 * The above is copied from the initial discussion on Wikiproject talk Medicine. In response to Alex's comments, a few points. First, both the medicine and alternative medicine spaces are quite diverse yet for the medicine articles we do have a clear section heading standard even though articles sometimes deviate to this to a certain extent. However, good and featured articles (aka our well-written medical articles) tend to have a significant degree of uniformity when it comes to how we order our sections, so I don't see why this should not extend to the alternative medicine space too. The diverse argument doesn't seem to hold up. Second, I agree that it makes sense to have the history section earlier in the article due to the majority of articles having it that way and because, as you mentioned, it holds a certain chronologic appeal. Lastly, I'm not sure how POV pushers would "gather the negative material in one section and then push it down the article" successfully. Unless we're talking about an enormous article like acupuncture, then I suppose such an action could partially succeed in an article like that. However, most alternative medicine articles I see are nowhere near that size. On top of that, the menu of sections early in the article would still show the existence of a critical/criticism section in the article for readers and the lead of any halfway decently written article with a criticism section should allude to the fact that there is criticism (and this would render a POV pusher's attempts to shove negative material out of sight at the bottom of the article meaningless). So, overall, I don't think that's really something we need to be alert for as you say. It seems like a non-issue to me. I'm not saying POV-pushing is a non-issue, but I think they would be largely unsuccessful hiding criticism from readers with a simple reordering of sections. That just sounds paranoid to me. We should focus on the main issue here though which is whether a guide similar to MEDMOS should be written or if MEDMOS should be edited to be more inclusive and have a set of guidelines for alternative medicine articles. On the main WP:MEDMOS page here for example I really didn't see anything talking about standard efficacy/effectiveness or criticism sections, yet I see such sections in many medical and alternative medicine articles. I think that merits further discussion. TylerDurden8823 (talk) 16:03, 10 August 2014 (UTC)
 * If you are going to have unifirmity as the goal, then altmed pages like, Chiropractic, should be organized the same way that conventional med pages, like Orthopedics, are.
 * Overall, though, I think that the conformity seen in FAs is a symptom of a problem rather than a feature to be emulated. WhatamIdoing (talk) 01:35, 22 August 2014 (UTC)

The flow of articles regarding diseases
I suggest the flow of such articles to be like this : cause & transmission --> symptoms & signs --> pathophysiology --> diagnosis --> treatment/management --> prognosis --> prevention --> epidemiology --> history. This is supposed to be also the "flow" of getting and tackling a disease, isn't it? Biomedicinal (talk) 04:28, 13 August 2014
 * We have many thousands of articles that follow the current style. There are arguments for many orders. Do not really see this as the flow of tackling a disease. Many medical sources put epidemiology first. Would need clear consensus for a change. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 01:43, 14 August 2014 (UTC)
 * Starting with ==Cause== makes sense for many infectious diseases. However, if the cause is unknown, then it isn't such a good section to lead with.  WhatamIdoing (talk) 01:37, 22 August 2014 (UTC)

Section ordering for addictive drugs
Can we specify the section ordering in addictive drug articles for sections on substance dependence and/or addiction (this would also affect the current placement of withdrawal) in our MOS for standardization? I'm bringing this up since the section ordering came up in my FA nomination for amphetamine, which has withdrawal placed under overdose.

We currently indicate placing withdrawal under adverse effects; this concept, in a clinical context (per the DSM), is closely related to substance dependence (i.e., more or less, "drug addiction") since it is always paired with physical dependence and/or psychological dependence. Ideally, I think these topics should either be together in a new level 2 section titled "Addiction" or "Substance dependence" (these two terms are apt/appropriate section headers for any subsections on tolerance, withdrawal, sensitization, physical dependence, and psychological dependence) or be placed as a subsection of either "Overdose" or "Adverse effects" – the prevailing position in current medical reviews would then be used to determine which of the two headers is more appropriate for addiction-related subsections in a given drug article. I think overdose would be a more apt section heading than adverse effects for these, primarily because I'm not aware of any addictive pharmaceuticals which have the capacity to induce a true addiction (i.e., ruinously compulsive drug use) when taken as indicated (i.e., at therapeutic doses), except in rare cases/unusual circumstances.

This isn't a particularly urgent proposal, but I think it is necessary to develop the layout for these sections in our articles on addictive drugs. I'd also like to have amphetamine's layout agree with the MOS.  Seppi  333  (Insert 2¢ &#124; Maintained) 22:59, 6 October 2014 (UTC)
 * I am happy with the section under either side effects or overdose. A side effect of using opioids can be addiction. If used for end of life care this is typically not a big issue. drugs.com puts it under a heading called precautions along with other side effects  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:10, 7 October 2014 (UTC)
 * Touché. Come to think of it, benzos are another example of a drug class that have a high addiction risk from chronic therapeutic use...  I've modified my proposal to reflect this; I think it may be best to use the prevailing opinion/position in medical reviews to determine which level 2 section (Adverse effects vs Overdose) is more appropriate for subsections covering addiction/dependence/withdrawal. I think this approach would be flexible enough to appropriately and logically organize sections on those topics in any addictive drug article.  Seppi  333  (Insert 2¢ &#124; Maintained) 10:17, 7 October 2014 (UTC)
 * While recognizing the context, it bothers me to see people say that dependence and addiction are even roughly the same thing. People with type 1 diabetes are dependent on insulin, but they are definitely not addicted to it.  Whatever you write with opioids and benzos in mind should not screw up articles about insulin therapy (or any of the dozens of other take-this-or-die drugs on the market). WhatamIdoing (talk) 00:02, 10 October 2014 (UTC)
 * I agree; I've edited the proposal to limit the scope to addictive drug articles. They're obviously not the same thing, but they're used interchangeably in large part because of the DSM.  Seppi  333  (Insert 2¢ &#124; Maintained) 21:13, 10 October 2014 (UTC)

Limitation to "medical"
The lead to MEDRS is written carefully to broadly cover health-related content. I wonder, why is this guideline narrowly focused on "medical" articles? Shall we broaden it? Jytdog (talk) 10:19, 27 October 2014 (UTC)


 * Broadening of WP:MEDRS to other areas would require a broad based consensus which I think would be very difficult to achieve. While secondary sources are preferred for all articles, the need for secondary sourcing in medical articles is more urgent than in many other disciplines because of (1) the larger potential impact on peoples lives (WP:MEDICAL notwithstanding), (2) many biological studies cannot be repeated, (3) the results of clinical trials frequently contradict each other, and (4) the unavoidable tendency for journalists and lay people to make unwarranted extrapolations from test tube to animals to humans. For other scientific disciplines, IMHO the more nuanced WP:SCIRS is more appropriate. Boghog (talk) 11:30, 27 October 2014 (UTC)


 * One of the things that makes MEDRS effective is its focus on medicine. The examples in the current guideline make it much clearer how the guidelines apply specifically to health-related content.  Widening the scope would require a major rewrite and the examples given would have to be made more general diluting the impact of these guidelines on medicine. It would be much better to leave the existing guideline in place and instead use it as a template to produce a guideline with wider scope. However I think it will be very difficult to achieve consensus with either approach.  Boghog (talk) 11:56, 27 October 2014 (UTC)


 * I'd personally like to see SCIRS improved and elevated to guideline status so we can have a general guideline for scientific research while keeping the very (at least relatively) pointed MEDRS. Whenever I've thought about this topic, it's largely Boghog's point #1 that makes medical content really unique here. Points 2-4 happen in primary literature all the time regardless of whether it's medical content or not. That would be justification for really cautioning against primary literature in SCIRS if not having almost the same standard as we do at MEDRS (although maybe being a little more lenient yet still cautioned on using introduction sections of primary literature). That's probably a conversation for a different time, but I do agree that we need a general guideline for using scientific research in general as sources, which I think SCIRS is a good stab at, but I wouldn't expand MEDRS out for that purpose. Maybe in time MEDRS could be a specific case of SCIRS as that seems a more logical ordering.


 * The question on where MEDRS is currently limited potentially may be ambiguous too. Awhile back I posed the question on where veterinary medicine falls, and other editors weren’t too sure. It’s very clearly medicine, except just not in humans, and is subject to much the same issues (points 2-4 again) as human medicine. Veterinary deals with animals, but you can get into plant health or just general organismal health, and you’re still dealing with most of the core underlying principles we deal with in human medical research. Even though MEDRS is not currently written to be specific to humans, some editors are really uncomfortable with the idea of medicine not just meaning human health. Why this is entirely escapes me, but it might be worthwhile to have a conversation on the scope of MEDRS. Working in non-human health in the real world, whether it be livestock or more on the wildlife end of things, I’m dealing with medical topics all the time, so I don’t see any problem applying MEDRS to a big chunk of the biology based research out there even if it’s not about humans. The only distinguishing feature of human medical research I see is that we often use animal models to try to extrapolate to humans, but that is only one piece of suite questions we pose for reliability and due weight of scientific sources. Kingofaces43 (talk) 16:54, 27 October 2014 (UTC)

Question about citations
I'm trying to learn about the ways people prefer to see medical content presented, and have a question about this example from the guideline:



I know that people like these figures, but I'm wondering what the benefit is of providing them all in one citation, when in the above example the URL and DOI lead to http://bioinformatics.oxfordjournals.org/content/24/20/2339. And the PMC shows that it's available via PubMed, so is there a benefit of adding the PMID alongside the other identifiers? Any info would be much appreciated. SlimVirgin (talk) 01:17, 28 October 2014 (UTC)


 * Sorry, I tweaked the above after it had been replied to. Original here. SlimVirgin (talk) 03:35, 28 October 2014 (UTC)


 * PMID is super useful to get you to pubmed, where you can a) verify it is indexed at Pubmed; b) check if it in indexed at MEDLINE too; (both of which tell you right away if it is a serious journal or not)  c) check to see if it is classified by Pubmed and/or Medline as a review to satisfy WP:SECONDARY;  d) easy to see if there are links to a free version or not.  I personally dislike those citation templates and just do something like this: "Li M et al.  Stem Cell Treatment for Alzheimer's Disease. Int J Mol Sci. 2014 Oct 23;15(10):19226-19238. " which is much less cluttered, but people change to those cite journal things all the time. Jytdog (talk) 03:08, 28 October 2014 (UTC)


 * Thanks. I can see the benefit of PMID, and if it's free then PMC (but would both ever be needed?). I'm just wondering whether it would ever be helpful to have them all in one citation (the URL, the DOI, and the other two), when three of them lead to the same place. Perhaps it's that people access articles via different services. SlimVirgin (talk) 03:31, 28 October 2014 (UTC)
 * It's actually surprisingly hard to get from the PMC page back to the PMID page, and you need both (for different purposes). The PMC page lets you read the source, but the PMID page lets you find out how the source was classified (e.g., as primary or secondary). It's not always obvious from the source, especially for people who are unfamiliar with the conventions and/or when you are dealing with a source that reasonable people could classify as either primary or secondary, depending on which aspect seemed more salient to them.
 * In this example, I'd lose the URL but keep the others. WhatamIdoing (talk) 05:06, 28 October 2014 (UTC)
 * per my example i would lose the URL and the doi. some people really like the doi (i am sure they have good reasons but i don't know them) and just use the PMID.  the PMC is OK but if it exists you can get there with one click from the PMID page.  if it is not indexed at pubmed, my next fallback is a hyperlink to a URL under the title of the source.  i really value lack of clutter.  Jytdog (talk) 09:02, 28 October 2014 (UTC)


 * Thanks, and . The URL is helpful in edit mode; otherwise you have to come out of edit mode to find the source. I can see the benefit of PMID to check type of article and of PMC when free, so perhaps it's the DOI that I could leave out. SlimVirgin (talk) 01:46, 30 October 2014 (UTC)
 * You could; I'm happy to let you set any citation style you want. But I feel compelled to point out that a librarian would make the opposite choice, because the whole point of the doi is that it's permanent, and URLs are not.
 * By the way, it's easy to get from PMID to PMC. It's only the other way around that's difficult.  So if you were looking to streamline the citation, you could keep the PMID and drop the PMC, since the PMID page always has two links to the PMC page (see  as an example:  "Free PMC Article" in brown text under the abstract is a link, and so is the gray box in the upper right).  It would add an extra click for the reader, and it wouldn't signal "free full text" in the way that the direct PMC link does (to the minority of people who know what PMC is in the first place), but IMO it wouldn't be a serious hindrance.  WhatamIdoing (talk) 03:15, 30 October 2014 (UTC)


 * Okay, maybe I should keep those then. I suppose I'm confused because the DOI leads to the same URLs that I would use (and the DOI contains some of the same URL identifers). Do you happen to know whether adding three templates to each citation would cause slower loading, when added up over quite a few refs? SlimVirgin (talk) 04:13, 30 October 2014 (UTC)


 * I should have read the WP article first: "Referring to an online document by its DOI provides more stable linking than simply referring to it by its URL, because if its URL changes, the publisher need only update the metadata for the DOI to link to the new URL." Okay, got it. SlimVirgin (talk) 04:22, 30 October 2014 (UTC)

People, women, and females
About once a year or so, someone changes some sex-specific articles to refer to "people" rather than "males" or "men". This has happened, for example, at Pregnancy, which is a condition that only affects biological females (among humans). It also happens (perhaps more often) at articles that are more complicated on the sex and gender front, such as articles about conditions that disproportionately affect intersex people.

In broad overview, the relevant cases are:


 * 1) The article (or specific point) is sex-specific, and not related to intersex or transgender issues.
 * 2) The article is not sex-specific, and not related to intersex or transgender issues.
 * 3) The article is about an issue that is associated with intersex or transgender conditions.

The last two are the easy ones: You should avoid talking about "males" or "men" when the information applies to everyone equally. You should be especially careful about gendered language when writing about intersex and transgender issues.

The first is the complicated case, and the one that I'd like to get people's opinions on.

If you write, "X% of women and Y% of men died of heart attacks last year", then people who don't identify with the gender binary will feel excluded, and people whose biological sex does not match their gender identity may not know which statistic applies to themselves. This will include some intersexed people, but not all of them.

If you write "X% of females and Y% of males died of heart attacks last year", then people may complain that the text is harder (in readability terms, the less-familiar word males is a slightly 'harder' word than men). Lay- and patient-oriented websites tend to use words like women more often than females. It may also seem less warm and human(e), similar to calling people "patients" or "cases" rather than "people". Because "male" applies from (before) birth, writing about males will sometimes be interpreted as meaning both men and boys, even if the context is only relevant to adult (or even aged) males. This will include transgendered people, but it will still exclude intersexed people.

If you write "Z% of people died of heart attacks last year", then you lose the sex-specific information. In other cases, you may not be able to convert: If the source says that "Y% of women became pregnant last year", you cannot convert that into "Z% of people" (which includes the entire population of the world) or re-phrase it as "Y% of females" (which implies all ages of females, including infants), because your answer will be wrong and you will violate WP:NOR.

I think we can take it as read that NOR-violating transformations are unacceptable. However, that leaves us a lot of room. Here are some questions that I'd like you to think about:


 * If something could be phrased as either males or men (or as females or women), when would you choose the one, and when the other? Which word(s( do you think you use the most when writing Wikipedia articles?
 * If a condition could apply to an intersexed or transgendered person, when would you choose inclusive language or when would you choose non-inclusive language?
 * If you were writing a brief note in this guideline to reduce disputes about this type of phrasing (perhaps something similar to the guidance we provide about the word patient), what would you say? Would you say anything?  What advice would you give a new editor who was contemplating a change in this type of language (either to or away from whichever you think is "normal")?

I'm interested in hearing opinions. As far as I'm concerned, the more opinions, the better. WP:There is no deadline for figuring out what ideas we have on this question. WhatamIdoing (talk) 00:43, 26 October 2014 (UTC)


 * I'm going to reiterate what I recently stated at WP:Med: As for wording, "people with ovaries" is jargon, in my opinion. My issue regarding these topics is what I have stated above -- we should be sicking to what the WP:Reliable sources state with WP:Due weight. In [a previous WP:Med discussion], for example, I pointed to Talk:Human penis/Archive 1; that was a WP:Due weight issue. I worked out a compromise wording for the lead in the case of that article, as seen in that discussion. But as for the rest of the Human penis article, we should not be stating "people with penises" throughout the article and avoiding the word "man" and/or "male." If we are talking about anatomical sex, then it stands that a trans woman who has not undergone reconstructive surgery to change her genitalia has a penis; this does not mean that she is a man. What it does mean is that her genitalia is male...at least going by the vast majority of definitions for male and female sex organs. Stating that the penis is a male sex organ is not negating her gender identity. And in the case of trans men, they usually know (once they become well-informed on the topic of transgender issues) that not having a penis does not mean that they are any less of a man. Transgender people often distinguish anatomical sex from gender identity, and often state that their bodies do not align with their gender identity. For many trans women, the penis, as a male sex organ, is a body part that is somewhat foreign to them and is not something they want to own. And, generally, anatomy and other medical topics should distinguish anatomical sex from gender identity in cases such as the ones noted [at WP:Med]; by that, I mean, for example, Wikipedia editors should not edit with a WP:Undue weight approach regarding intersex, transgender and genderqueer people simply because they assume that "because we are calling this a male sex organ, it means that we are calling that individual male or are stating that all men have a penis." or that "this condition being exclusive to anatomical females means we are stating that this person is therefore a female/girl/woman, plain and simple."


 * In cases where we can forgo gendered text and still be clear/not sacrifice the context of the article, similar to what Wnt did in this case at the Polycystic ovary syndrome article, I don't mind that. Flyer22 (talk) 02:10, 26 October 2014 (UTC)


 * I also reiterate that the vast majority of intersex and transgender people (excluding the genderqueer categories) identify as male/man or as female/woman. The genderqueer categories are even more of a minority than a transgender identity that is unrelated to being genderqueer. Flyer22 (talk) 02:17, 26 October 2014 (UTC)


 * Women sometimes complain about being called "females" on the basis that that somehow refers to animals. Whether or not that's reasonable, I wouldn't go there because we use terms like "daughter", "mother", etc. anyway.  I also agree that find-and-replace editing of sourced text is hazardous; even changing from "women" to "people with ovaries" (social to biological sex) can be technically inaccurate if the source actually just asked people whether they are male or female.  I made just a few changes "to be nice", where I saw a chance to tighten up the prose with no obvious change in meaning, but I'm not suggesting everyone has to do that.  My thought was to address the definition of woman directly, but that edit was reverted.  To me directly introducing people to the distinction between gender and sex, and disclaiming that the way we deal with sex in a medical context doesn't necessarily mean we have to treat it that way everywhere, seemed fair (especially since apparently PCOS has some correlation with FTM transsexuality). Wnt (talk) 02:42, 26 October 2014 (UTC)


 * Yes, I've encountered the "don't state 'females'" reasoning a few times on Wikipedia, including the assertion that it's sexist. In those few cases, it was two men who objected to use of the term females. And the debate about "female vs. woman" can be seen online. However, it is more accurate to use the word female than to use the word woman when we are referring to girls and women (or even to girls, women and non-human female animals), instead of just women, and we don't state "woman sex organ." We state "female sex organ"; for example, the female reproductive system.


 * On a side note: I alerted WP:Anatomy to this discussion. Flyer22 (talk) 02:54, 26 October 2014 (UTC)


 * Unless the topic is specifically about family aspects, the words daughter, mother, etc. won't be able to be used in place of "female," "girl" or "woman" in most cases. A recent case of an editor having traded out the words women and men for females and males so that the text can be inclusive of children/adolescents is this edit by SqueakBox at the Cunt article. Flyer22 (talk) 03:09, 26 October 2014 (UTC)
 * My reasoning was that as this is a term particularly used by teenage Brits to say it was just used against men and women was patent nonsense, and I am sure totally unsourcable. ♫ SqueakBox talk contribs 03:29, 26 October 2014 (UTC)


 * To be clear, polycystic ovary syndrome uses "daughters" in a genetic context. "Offspring with ovaries", well... anyway, I'm not liking it.  Once we accept that sometimes we use these terms in science articles for biological sex, and sometimes in articles about society in general for official or unofficial gender identity, we admit an ambiguity arises that may at times be best to dispel explicitly. Wnt (talk) 03:42, 26 October 2014 (UTC)


 * I don't blame you, SqueakBox; I was simply giving an example as to why using "women" (or "men" and "women"), as opposed to "females" (or "males" and "females"), might not always be a good route to follow. Flyer22 (talk) 04:07, 26 October 2014 (UTC)


 * On that note, though, SqueakBox, a lot sources do simply use the term cunt in reference to men and women only, especially in reference to women as far as the United States goes; although the terms man and woman usually mean adults, they can refer to children and adolescents (especially in the case of underage post-pubescent adolescents who are fully biological adults). Flyer22 (talk) 04:17, 26 October 2014 (UTC)
 * You'd be better off saying men, women and children as thinking readers will assume men and women refer to children too is problematic. In the UK anyone can be called a cunt, in spite of it being a very vulgar term. ♫ SqueakBox talk contribs 04:49, 26 October 2014 (UTC)


 * I agree that it's clearer/safer to not refer to children/adolescents as men or women. And, yes, I know that the United Kingdom is more "equal opportunity" with the term cunt than the United States is; this is also clear in the Cunt article. Flyer22 (talk) 05:02, 26 October 2014 (UTC)
 * Figuring out where "boy" and "girl" stop, and "man" or "woman" begins is complicated. I've talked to women who believe that menarche is an immediate dividing line.  Most people are uncomfortable calling an six year old with precocious puberty a "woman", though. WhatamIdoing (talk) 17:58, 26 October 2014 (UTC)
 * "I think we can take it as read that NOR-violating transformations are unacceptable" - if only! Most of the changes I've seen were unreferenced. It seems reasonable to insist on MEDRS refs before departing too far from the traditional terms. Typical medical literature certainly does not yet go at all far in accommodating "rainbow" minority concerns, and that constrains us. Male & female have the age-related advantages you mention in many areas (though eg I believe the youngest UK diagnosis for pancreatic cancer was a 47 yo man), but are often slightly harder to work into phrasing. Wiki CRUK John (talk) 11:40, 27 October 2014 (UTC)

Thanks for dropping a note @ WPANATOMY, Flyer22. From my perspective, there are a few things that I'd take into account:
 * 1) Firstly, I don't like to use man/woman in scientific descriptions because I agree there is a difference between sex and gender, man/woman is laced with social connotations, and that most literature in this regard is reported as male/female.
 * 2) Secondly, in sex-specific articles, if disambiguation is required I would probably use the terms phenotypic female and genetic female, or something like that. Obviously we have choose some language, and I think that's the best of what we've got. I can't guarantee I've exactly lived up to my expectations espoused here, but they are my thoughts at the moment.--Tom (LT) (talk) 21:39, 27 October 2014 (UTC)

Note: We have another case here regarding the Vaginismus article; it concerns an edit by. Flyer22 (talk) 03:59, 31 October 2014 (UTC)

Regarding Sourlacte's changes, some of them are reasonable (and I tweaked this bit), but it's not reasonable to remove every instance of "woman" from the article. Same goes for stating "female" in this case. Flyer22 (talk) 04:08, 31 October 2014 (UTC)

If "some of them are reasonable" then all of them are. Vaginismus could be suffered by women as much as by non-transitioned trans men, transitioned trans men and intersex people. It's therefore innacurate to be sex-specific when it's merely about the vaginal opening, not, say, the whole biological female reproductive system. I would still refrain from total sex-specificity since we can simply refer to organs or systems by themselves, but it's even more reasonable in this case. And no, you don't just rely on "they know". Dysphoria is a delicate thing, it's not 42% of us suiciding out of nothing. I'm not saying we should hold responsibility on this, but merely that if trans people are a reality, then you simply adjust to that, and avoid being innacurate when talking about sex-related information: we're not covering the people, we're covering the body. I'm editing it again. Sourlacte (talk) 15:52, 31 October 2014 (UTC)


 * No,, all of them are not reasonable, and that is per everything that has been stated above by others, including me, in this section. You're new to editing Wikipedia, so I know that you don't quite grasp how things are supposed to work here. But we generally follow what WP:Reliable sources state for article content. And per, WP:Due weight, we generally give far more space to the majority than to the minority. The sources in this case, use the words women and/or female. I stated that "some of [your changes] are reasonable" because, for example, the word individuals can be used in some cases that won't take away from the focus of the article. The focus of the article, as the sources show, is generally about vaginismus in women and how that affects them. Not vaginismus in girls, intersex people or trans men...unless, of course, in some cases, these people weren't clear about their gender identity. Furthermore, vaginismus is not simply about the vaginal opening. If you resort to the same exact editing you did before, or employ the majority of what you did before, you will be reverted. And if you continue WP:Edit warring on this matter, you will likely be WP:Blocked for it.


 * Also, remember to sign your posts on Wikipedia talk pages. All you have to do to sign your post is simply type four tildes (~), like this: . I signed your post for you above. Flyer22 (talk) 16:21, 31 October 2014 (UTC)

What is it?
I'm looking at the list for drugs and devices, and I am thinking that it was written for drugs (chemicals) and not necessarily for things. For devices, it might make more sense to start off with what the thing is. WhatamIdoing (talk) 17:51, 26 October 2014 (UTC)
 * i agree with that, and have thought that for a while. Thanks for bringing it up. Jytdog (talk) 10:21, 27 October 2014 (UTC)
 * Yes, but one could say the same for the drugs - most drug articles I've seen start with a good dollop of chemistry, but there's nothing about that here. Wiki CRUK John (talk) 11:16, 27 October 2014 (UTC)
 * I think that's what the "Physical and chemical properties" section is supposed to be. I'm not sure about that, though.  I think that putting the chemistry there would have the advantage of putting the scary technical bits lower in the article, after the content that the non-chemistry/non-professional readers are looking for.  However, if editors are actually putting the chemistry first, and they're generally thinking that this makes the most sense, then perhaps we should change the order to reflect what they think is best for drugs, too.  WhatamIdoing (talk) 22:05, 27 October 2014 (UTC)
 * had the same thought about moving physical drug bit earlier - often too technical. if there is something funky about the drug at a high level -  like it is only injectable -  i've often seen that handled in the Medical use section. Jytdog (talk) 23:14, 27 October 2014 (UTC)
 * Putting an in depth technical discussion of what something is before what it is good for IMO is not the best. This is the same reason why we do not discuss the chemical structure of pharmaceuticals / drugs first Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:38, 31 October 2014 (UTC)

"Types" for diseases too?
For disease articles, could ==Types== be a useful alternative to ==Classification==? "Types" might be an appropriate and more reader-friendly option, imo, for selected content that is intended for lay readers (per WP:AUDIENCE). 109.157.83.50 (talk) 16:38, 23 November 2014 (UTC)
 * Fine with that. Wiki CRUK John (talk) 09:14, 24 November 2014 (UTC)
 * not fine with that ... too much of this going on. We aren't writing for one outside group on one individual topic.  I'm finding it a concern that one UK Cancer Group (editing as ips no less) is pushing through such broad changes to MEDMOS based on one disease.  Sandy Georgia  (Talk) 10:39, 3 December 2014 (UTC)
 * See my talk. Sandy Georgia  (Talk) 14:28, 5 December 2014 (UTC)
 * Hardly, and 109.157.83.50 (familiar to the Medical Wikiproject for years under various guises) has no connection with the CRUK project, or cancer, other than helping with volunteer editing like many others. A poor breach of WP:AGF Sandy, and, as it happens, completely wrong! You might want to set out arguments why "types" is not applicable to anything much but cancer, if that is your position. That "We aren't writing for one outside group" is rather the point. Wiki CRUK John (talk) 10:50, 3 December 2014 (UTC)
 * PS, I also disagree with the change (above) of "Outcomes" instead of "Prognosis" ... see my comments under the old discussion above, which I missed. We have to take care not to represent only a "disease" model, that is, conditions that have a somewhat defined beginning and end, as opposed to "conditions" that one lives with.  Outcomes would sound utterly stupid in Tourette syndrome, and there was nothing wrong with Prognosis.  So much work to be done in here, and we're dorking around with sections that worked.  Ditto, how would I use "Types" for most neuropsych conditions?  Sandy Georgia  (Talk) 10:54, 3 December 2014 (UTC)
 * You seem to have missed the point that these are adding alternatives not mandating changes. What % of our WP:AUDIENCE actually know what a "prognosis" is, do you think? Wiki CRUK John (talk) 10:59, 3 December 2014 (UTC)
 * Not missing the point, "prognosis" has been dropped from our guideline, so we now have multiple articles and FAs out of compliance with the most common word for just what it is in most cases ... prognosis.   I could understand providing perhaps one more choice for editor discretion, but we now have three choices instead of one common word, and multiple articles out of compliance (FAs must comply with MOS), since the common word was dropped. Sandy Georgia  (Talk) 15:24, 3 December 2014 (UTC)
 * If we label it as types IMO this should be a subsection of diagnosis. Often this sort of content is rather technical. Doc James  (talk · contribs · email) 11:39, 3 December 2014 (UTC)
 * Really, folks, don't be trying to change a guideline just when an article is at FAC. Discuss the guideline before, or discuss the guideline after, but editing an article to introduce a brand new concept at the time an article is at FAC, and then trying to change the guideline to reflect that, is not the best way to either gain consensus for a change or argue that the article at FAC is stable and complies with MOS.  Sandy Georgia  (Talk) 15:20, 3 December 2014 (UTC)
 * It does say "If relevant. May also be placed as a subheading of diagnosis" and "Do not discourage potential readers by placing a highly technical section near the start of your article." Doc James  (talk · contribs · email) 16:10, 3 December 2014 (UTC)
 * Three thoughts:
 * The reason that "prognosis" is in bold-faced text is because—like all the other bold-faced words—it is suggested as a section heading.
 * "Don't be trying to change a guideline just when an article is at FAC" means "don't be trying to change a guideline ever", because there is always some article at FAC. Furthermore, these proposals were made in August, which by my calendar is "before" any current FACs.
 * It would be difficult for any article to be "out of compliance" with headings that are explicitly labeled as "suggested" rather than required, especially when the introductory text says that there are many times when you will want to do something different. I expect FAC folks to be able to use their best judgment, rather than applying rules like a robot, even if Sandy's not there to guide them.  WhatamIdoing (talk) 15:21, 4 December 2014 (UTC)
 * 1. Thanks for the clarification that dropping Prognosis as suggested was unintended: I've rectified.  2.  There is very rarely a medical article at FAC, and when there is, editing an article to make a change to that article based on a suggested guideline that is still under discussion does not speak well to crit 1e (stability).  3. I expect you do.  That FAs must comply with MOS guidelines is in the criteria; whether they do under the current FA administration is debateable.  Sandy Georgia  (Talk) 15:31, 4 December 2014 (UTC)
 * On the actual question: ==Types== is going to work very well for some conditions, especially conditions that have explicitly labeled subtypes.  Using ==Types== rather than ==Classification== for Diabetes mellitus's Type 1 and Type 2 is preferable, because it follows the sources more closely:  they say "types", we say "types".  For other conditions, possibly including Leukemia, I might prefer ==Classification==.
 * One of the problems with ==Classification== is that it could be classification going down (Diabetes mellitus is subdivided into Types 1 and 2) or going up (Diabetes mellitus is an endocrine disorder). ==Types== is clearer about its contents.
 * My preference is for what the OP suggested: an alternative, to be used when it seems more appropriate, with neither ==Types== nor ==Classification== being officially preferred more than the other.  WhatamIdoing (talk) 09:29, 5 December 2014 (UTC)
 * small note from the OP: ...though I have to say I find the opening Classification section in this recent potential medrs on diabetes is presented both simply and clearly. 109.158.8.201 (talk) 13:22, 31 December 2014 (UTC), previously 109.157.83.50 etc
 * Support that. It is noticeable that in fact most disease articles I see don't have such a section at all, even when, as with many cancers, they are crying out for one. Diabetes mellitus is an example, putting it all in the lead to the near-exclusion of everything else, and pancreatic cancer didn't have one until I added it recently. Having the alternative section title may encourage people to actually follow MEDMOS. Wiki CRUK John (talk) 10:42, 5 December 2014 (UTC)
 * I see that for diseases. I do wish people would keep in mind, when changing these guidelines, that not all "conditions" have underlying disease processes.  Classification works quite well for many neuropsych conditions, and there is no such thing as "Types" for Tourette syndrome as an example.  That is the whole point I'm trying to get across, that seems to have led to the upset of IP 86.  Sandy Georgia  (Talk) 14:31, 5 December 2014 (UTC)
 * It's not a question of "diseases" versus "conditions". It's a question of whether the subject actually has "types" (think "subtypes") or not.  Tourette syndrome has no types.  Birthmarks do.  You can't use "Types" for Tourette.  You could use it for birthmarks.  WhatamIdoing (talk) 22:44, 5 December 2014 (UTC)

The page seems to be growing unnecessarily. Per the comment above that all bolded words are now suggestions, we also have: So, why do we need four possible choices, and how is the new-to-Wikipedia editor to sort which to use? What was wrong with one, perhaps two, terms? Really, this all seems to be fiddling for the sake of fiddling, and I'm not yet convinced clarity has been added. Sandy Georgia (Talk) 16:58, 5 December 2014 (UTC)
 * Causes: Includes Risk factors, triggers, Genetics or genome, Virology (e.g., structure/morphology and replication).
 * Sandy, in eg your version of 8 June 2010, this was: "Causes (e.g. Risk factors, Triggers, Genetics/Genome, Virology (e.g., structure/Morphology, replication))". These are possible sub-sections, or things to cover, and always have been. Wiki CRUK John (talk) 22:08, 5 December 2014 (UTC)
 * That version, to my understanding, always showed one suggestion: Causes.  The parenthetical afterwards provided examples of what was meant by or meant to be included in Causes.  Now we've got some unclear to vague suggestion on this talk page that anything in bold might also be a section heading (we lost the parenthetical and attached some significance to bolding). Sandy Georgia  (Talk) 22:12, 5 December 2014 (UTC)
 * Yes, there probably needs to be some copyediting to make things clearer. Yes these are contents (and probably don't need bolding) but Prognosis and Outcomes are alternatives. Wiki CRUK John (talk) 22:17, 5 December 2014 (UTC)
 * There are different options because, as Sandy keeps reminding us, different subjects have different needs. If the only aspect of etiology you need to talk about is risk factors, then you can (and probably should) name the section ==Risk factors== rather than ==Cause== (and definitely rather than "Cause" followed immediately by a subheading "Risk factors").
 * I expect the new-to-Wikipedia editor to use two main approaches: First, I expect the new editor to pick whatever's first in the list, because it's the most prominent.  Second, I expect the new editor to pick whatever's most relevant, because I assume that editors, even new ones, use their best judgment.  And I expect that my main approach is to cheerfully change the new editor's choice of section heading if I believe that I can improve on it.  WhatamIdoing (talk) 22:38, 5 December 2014 (UTC)

Pregnancy info in drug articles
Two questions: Thoughts? Jytdog (talk) 16:39, 1 January 2015 (UTC)
 * In the body, MEDMOS is silent on where this goes. Some articles have Precautions sections (not a category in MEDMOS) and it fits nicely there.  But with the standard sections, where should pregnancy classifications go?  Adverse effects?  Contraindications?
 * Should pregnancy info go in the lead?  I would say generally no, since this content concerns a sliver of the population - in 2008 there were about 6.5 M pregnancies (source) and the US population was 304 M (source), so ~2% of the population are possibly affected (and only some percentage of pregnant women would possibly be prescribed a given drug)  But I could see it it being in the lead if a drug should not be taken by pregnant women.
 * Happy new year. I think this is an issue the MEDMOS should address - perhaps along with effects on ability to drive and use machines.
 * Sometimes, featured articles set helpful precedents in style issues. There are, sadly, only two medication FA's: the article on bupropion mentions nothing in the text, only in the infobox; linezolid gives relevant information in a subsection called Use in special populations, in the Pharmacokinetics section, which doesn't look like a very good idea.
 * Guidelines from drug regulatory administrative agencies could help. The EMEA template for medicinal product information documents requests a separate subsection on "Fertility, pregnancy and lactation" in the "Clinical particulars" section; it falls after the "Contraindications", "Special warnings and precautions for use" and "Interactions" subsections, and before the side effects subsection.
 * A solution could be to come up with a new section; something like "warnings", or "special warnings", ehich could also contain information on administration of the drug in other special populations (e.g. pediatric) and its effect on driving. One could be concerned though that this could make the article look too much like giving medical advice.
 * And another solution could just be to include pregnancy info in contraindications (not side effects). That's not where it usually appears in a medical book, but Wikipedia is not a textbook.
 * For the very last reason I would be skeptic against including pregnancy info in the lead, even when a drug is contraindicated (there are lots of them), unless it is truly significant for the specific medication - I can think of thalidomide, but not much more beyond. --NikosGouliaros (talk) 19:44, 1 January 2015 (UTC)
 * IMO including one sentence on use in pregnancy in the lead is a good idea. Just because only a small percentage of the US population is currently pregnant we are not writing just for the US population. We are writing for a global population. A fairly large percentage of the global population is of a potential age at which they or their partner may become pregnant.
 * Within the body of the text the details on pregnancy and lactation should be together. Were it should be placed I do not have a strong feeling. Could go under medical uses, in a section on special populations. It is usually not really a contraindication. Doc James  (talk · contribs · email) 05:13, 2 January 2015 (UTC)
 * Additionally am working on a project to improve all the leads of the Essential Medicines articles for translation into other languages.
 * An example of one is here Cefalexin. The lead discusses use in pregnancy, breast feeding, among the elderly and those with kidney problems over a few short sentences.
 * Or leads are supposed to be 3 to 4 paragraphs summary. Doc James  (talk · contribs · email) 06:07, 2 January 2015 (UTC)
 * By the way 25% of the population is a women of childbearing age . The number of males of childbearing child eligible age is even greater. Doc James  (talk · contribs · email) 06:12, 2 January 2015 (UTC)
 * yep Cefalexin has your fingerprints all over it, Doc James. :)  pregnancy info added to the lead and not to the body here and here by you, and even today there is no parallel content in the body. This is also content that makes me scratch my head - there are not special precautions with regard to Cefalexin in pregnancy.  Jytdog (talk) 06:57, 2 January 2015 (UTC):
 * Am working to improve the leads rather than the body
 * I am summarizing the literature not the body of the article
 * When you state "This is also content that makes me scratch my head - there are not special precautions with regard to Cefalexin in pregnancy." to what content do you refer? Doc James  (talk · contribs · email) 07:27, 2 January 2015 (UTC)
 * (A childbearing male has got to be a female). --Iztwoz (talk) 07:04, 2 January 2015 (UTC)
 * Yes should have said child eligible male :-) Doc James  (talk · contribs · email) 07:27, 2 January 2015 (UTC)
 * actually the guideline WP:LEAD is very clear that the lead is a summary of the body; by definition nothing should be in the lead unless it is the body and therefore summarizable.  It is a newbie mistake to load new content into the lead.  I really don't understand that behavior from someone as experienced as you Doc James.  Likewise, UNDUE applies to the lead (see the "Relative emphasis" section which says: "Significant information should not appear in the lead if it is not covered in the remainder of the article, although not everything in the lead must be repeated in the body of the text. Exceptions include specific facts such as quotations, examples, birth dates, taxonomic names, case numbers, and titles."  If pregnancy content is important enough to include in the lead it is crazy not to include it in the body.   But part of my initial question, was whether pregnancy info is all that important.  And the head-scratching thing here - for Cefalexin -  (to answer your question) is that there is no precaution - the content is negative.  And there are boatloads of negative content we could include in the lead... there is no end to information about what a drug is not.  I do get it, that you want  the lead to serve as a manual and a doctor checking it would want to know whether or not there is a pregancy warning so the negative content is useful.   But WP is WP:NOTMANUAL. Jytdog (talk) 07:34, 2 January 2015 (UTC)


 * I have added the content to the body . There; however, is also a rule called WP:IAR which someone as experience as Jytdog should be aware of. The body does not need to be perfect before making changes to the lead.
 * It is not just physicians that are interested in the use of medication in significant populations such as those who are potentially pregnant. These are not "pregnancy warning" these are discussions of the use of medications in pregnancy.
 * Attempting to apply WP:LEAD so rigidly is not reasonable. In fact some article are only a lead. Yes in a high quality article nothing in the lead should not be also discussed in the body of the article. What we are discussing however is not high quality articles. Doc James  (talk · contribs · email) 07:44, 2 January 2015 (UTC)

thanks for putting that into the body - I was going to do that, today. I'm not wikilawyering LEAD and i am speaking to its heart. And while IAR is great, you and I both know that we need guidelines and you yourself cite them all the time in making changes and reverting others. To the point... I don't get the focus on putting pregnancy info in the lead - that is the bigger issue. Since you are so prolific James, and since seems to have become part of your editing style, it seems to be something that we should all discuss with regard to MEDMOS. It is really not clear to me whether pregnancy info always belongs there. Maybe we'll all decide it belongs there. Maybe not. Jytdog (talk) 14:34, 2 January 2015 (UTC)
 * The discussion should really be broader and about what and how much of each we think should be in the lead of a medication related article. I would propose:
 * One paragraph on medical uses
 * One paragraph on side effects / use in special populations (which could include pregnancy, the elderly, peds, liver and kidney issues)
 * One paragraph on history, society and culture
 * This is already supported by our MOS though as this is the layout we typically use for the body of the article. Doc James  (talk · contribs · email) 21:15, 2 January 2015 (UTC)


 * back to my original question - where should pregnacy content go in the body of the article? Shall we add it to MEDMOS?  Jytdog (talk) 00:08, 3 January 2015 (UTC)
 * I would say after adverse effects / overdose and before interactions we should have a section on "Pregnancy and breastfeeding". Doc James  (talk · contribs · email) 02:04, 3 January 2015 (UTC)
 * I think that the best location depends on the nature of the content. It would be kind of weird to have a section called ==Pregnancy and breastfeeding== in an article about an abortion drug, no?  If you have nothing to say (e.g., whatever category means "nobody knows if this is safe or not") or very little to say, then I would not support a separate section.  If there's more than three or four sentences to be written, and especially if there is something special about that drug (e.g., the pregnancy registry for that acne drug), then I could see some benefit to putting it in its own section. WhatamIdoing (talk) 06:19, 3 January 2015 (UTC)
 * Most drugs are used for many things. Methotrexate is not just an abortion drug but autoimmune diseases among other reasons.
 * Whether or not they are safe is a wide range of greys. All medications have animal studies so it is not a case of "nothing is known"
 * It could fit as a subsection of either "medical uses" or "adverse effects" as well. Doc James  (talk · contribs · email) 20:10, 4 January 2015 (UTC)

A change to some of our headings
We had a meeting at Cancer Research UK at which we discussed simplifying some of our terms. We should discuss them one by one and then I guess have a support oppose to determine if we should move in this direction. The plan is to have a bot make the changes that have consensus. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:36, 20 August 2014 (UTC)

Outcomes instead of Prognosis
Outcomes ? Really? With "prognosis" completely removed, not even an alternate. So, how does that work for neuropsych conditions? It sounds like wording put through by editors mostly dealing with "diseases" (that have more of a defined beginning and end) than those dealing with "conditions", eg neuropsych conditions, that don't necessarily have an "outcome" ... one just lives with them. As I was absent when this silliness went through, I suggest we add back Prognosis, alongside this new Outcomes. Sandy Georgia (Talk) 10:47, 3 December 2014 (UTC)

Epidemiology?
Not sure if there is a simpler term we can use. Statistics maybe but it is not that similar. Can others think of suggestion? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:36, 20 August 2014 (UTC)


 * Don't know what the answer is, but this title has always stood out for me as the classic example of how WP medical articles are not lay-reader friendly. Alexbrn talk 20:02, 20 August 2014 (UTC)


 * Why not "population distribution" (i.e., what segments of a population are most affected by the disease or condition)? Per WP:HEAD, it is not necessary to repeat the title of the article in section headings and therefore it is understood that "population distribution" refers to the disease. Boghog (talk) 20:28, 20 August 2014 (UTC)


 * Suggest Frequency. Certainly not perfect, but good enough, imo. More specific than "Statistics" and simpler than "Population distribution", which would still sound forbiddingly technical to many lay readers, imo. Clearly a worldwide perspective is important, though many articles currently lack this even under the current "Epidemiology" heading. 86.157.144.73 (talk) 20:40, 20 August 2014 (UTC)
 * Certainly a change would be good. I also note that typically we have "causes", including eg % of cases attributable to smoking, in its own section, so that "Epidemiology" is just frequency/statistics, whereas an epidemiologist would I think typically feel that "Epidemiology is the study of how often diseases occur in different groups of people and why" (my bolding), and that our approach therefore only covers half his/her subject in the section named after it. Another reason to change. Really we just cover the demographics side in these sections, but that's another "ology". "Frequency" might puzzle some in this context, whereas "statistics" is pretty clear and straightforward, unless anyone has a better idea.  Not sure about "population distribution", but it's possible.  Or just "distribution"? If we used questions as headings it would be easier, but we don't.  Wiki CRUK John/Johnbod (talk) 22:08, 20 August 2014 (UTC)
 * Yes agree that we usually split out half of epidemiology into causes and thus our epidemiology sections do not contain all the epidemiology. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:30, 20 August 2014 (UTC)
 * Just "Distribution" would do nicely, I think. Implicitly includes demographics, prevalence, and avoids the lay reader's conception that it pertains to infectious disease only. LeadSongDog come howl!  22:34, 20 August 2014 (UTC)
 * Yes distribution may work. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:39, 20 August 2014 (UTC)
 * +1 for "Distribution". Fwiw, a classic definition of epidemiology is: "The study of the distribution and determinants of health-related events or states in specified populations..." In this section we summarize the distribution, while the determinants go under "Causes". All while trying to achieve or maintain a global perspective for the various populations. 86.134.200.29 (talk) 08:31, 21 August 2014 (UTC) [previously 86.157.144.73]
 * My inclination is to try out an alternative like ==Distribution==, and to see where it works and where it doesn't. I'm not sure that Pregnancy would be improved by changing it to "Distribution", which has a very geographical feel.  ("Q:  What is the distribution for pregnancy?"  "A:  Well, pretty much the entire inhabited world.")  WhatamIdoing (talk) 01:42, 22 August 2014 (UTC)
 * That's not even correct in the geographical sense of distribution, but clearly we intend a statistical meaning, as we're still discussing epidemiology by another name. Some countries have far higher rates than others, or compare rural to urban. Certainly there are significant distributions against age, sex (d'oh!), religion, marital status, economic status, time since previous pregnancy, perhaps political orientation? And then there's the question of exposure to the, erm, "infectious" agent. Any of these could be subsections of interest to the reader. LeadSongDog come howl!  21:52, 22 August 2014 (UTC)

Populations affected? --Anthonyhcole (talk · contribs · email) 17:56, 23 August 2014 (UTC)
 * Support "distribution" The WHO uses this word too.  Blue Rasberry   (talk)  15:20, 22 August 2014 (UTC)
 * Maybe? Or maybe "People affected"?  That might sound weird when you're writing about one of those rare diseases that kills babies in infancy, since "people" usually refers to adults.  WhatamIdoing (talk) 05:58, 1 September 2014 (UTC)


 * Rather than having an across the board change as their might not be one term that works for all articles, we could simply add to the number of possible headings that can be used for this section and use which everyone is simplest and appropriate. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:20, 23 August 2014 (UTC)
 * I'm fine with that, but I think we are agreed that "Epidemiology" is generally a problem because a) lots of general readers don't understand it and b) we typically cover only the statistics/distribution part of it in this section. If we recommend a variety of terms we should probably come up with thinking as to when the different ones might be the best choice. For example, taking from above, I don't see that "Populations affected" works well with "Pregnancy". It might with "Dengue fever", but then so does "Distribution". Both do perhaps have a "very geographical feel", but I think "distribution" works better where things like age, gender and occupation are big factors. Most people will take "Populations affected" to mean "the populations of which countries". If we are getting a bot to make the changes I imagine we need to make a default choice, which people can then change manually where they think that best. Wiki CRUK John/Johnbod (talk) 22:59, 23 August 2014 (UTC)
 * How many other options can we come up with? I'd be happy to hear more ideas, even if they might only work for some types of articles.  I'll add another to the list:  What about something like "Characteristics of patients" (although we usually avoid the term 'patients')? WhatamIdoing (talk) 05:58, 1 September 2014 (UTC)

My immediate thought would be to use Those affected. -- CFCF  🍌 (email) 07:07, 1 September 2014 (UTC)


 * Support "distribution" I think this feels the most generally applicable - I agree that there may be situations where it doesn't quite fit but I think they're more likely to me minority cases. Distribution is also not necessarily geographic - it can also be socioeconomic, ethnic, etc. So, yeah, 'distribution' gets my vote HenryScow (talk) 16:51, 18 September 2014 (UTC)
 * This is a bunch of very good proposals; simplifying language is always a good idea, as long as it doesn't come at the cost of accuracy.
 * So I oppose [Update: weakly oppose (see later discussion) ] any of the above alternatives to "epidemiology". When one checks the definition of epidemiology it's clear that none of the proposed terms are anywhere near a synonym for it - even if one excludes the part of epidemiology that has to do with causes of disease. Moreover, if one checks some random featured articles on diseases, none of the above alternatives would be an inclusive heading to the relevant section: in acute myeloid leukemia epidemiology contains information on the percentage of AML within all leukemias; in Alzheimer's disease a fine distinction is made between incidence and prevalence; and in Asperger syndrome half the epidemiology section is dedicated to comorbidities. All these cannot be considered to be included in "distribution", "populations affected", or any alternative I've read or can come up with. NikosGouliaros (talk) 20:18, 1 November 2014 (UTC)


 * Stick with epidemiology. Sandy Georgia  (Talk) 10:48, 3 December 2014 (UTC)
 * Since this has revived a bit, I'd point out that the sections of this set of proposals that have closed have both done so using "guideline adjusted to recommend (not require)...." and nothing previously allowed is now outlawed. I think it would be helpful if the two above, the only commenters who support no change at all, could comment on the following questions:
 * a) Do you agree that "Epidemiology" represents a significant problem in terms of WP:AUDIENCE?
 * b) Do you agree that there is a problem in that much of the subject of "Epidemiology" is normally covered in other sections, per WP:MEDMOS?
 * c) Do you agree that there a large number of disease articles where the alternative headers discussed above would fit the section contents, where they exist and as they currently are in year 13 of Wikipedia? Wiki CRUK John (talk) 13:32, 3 December 2014 (UTC)
 * If they were "recommend (not require)", why was Prognosis removed? What purpose does that serve?  This business:
 * Outcomes: For the prognosis. May also be labeled "Possible outcomes" or "Outlook".
 * is a bunch of words for what is commonly known as "Prognosis", and I can see no reason for three new suggestions to replace one common one, that has served us well for years. Why all this fiddling anyway?  Sandy Georgia  (Talk) 14:49, 3 December 2014 (UTC)
 * And, PS, no, I do not agree that Epidemiology is an Audience problem: as can be seen by the difficulty in coming up with a word to replace it, it is what it is, and there is not a better word that covers it.  If some of the new suggestions are better for some articles, a) why are we up to three (or four if you bring back prognosis, which is the most common), and b) no, I don't think any of the current choices are better than prognosis.  If we are going to be driven by external models, let's just go to Mayo and use some gibberish like "Coping and support" ... they have no prognosis section, under any name, and every place you go on the internet has something different, but Prognosis is quite common.  Sandy Georgia  (Talk) 15:17, 3 December 2014 (UTC)
 * Because, at a guess, but I will see if I can find specific research on this, about 3% of the general population will know what a "prognosis" is, and that's in English-speaking developed countries. I'd guess "epidemiology" is even lower.  That's why no professional writing, online or off, directed at patients, carers or the general public will use this term, at least unexplained. For years we have had policies like WP:AUDIENCE, Make technical articles understandable, WP:JARGON and Manual_of_Style/Medicine-related_articles and very widely ignored them.  The idea now is to start taking them more seriously. Whether the current MEDMOS wording exactly matches the closing comment by WhatamIdoing of the section here is a question. Wiki CRUK John (talk) 15:07, 3 December 2014 (UTC)
 * I can't find specific research on these words, but there is a good deal of research on the subject, which is why we have always had these policies (this and this are recent examples, with lots of others in the refs). I can't understand why you complain about using "external models" in this respect when that is exactly what MEDMOS and MEDRS insist on for this and almost everything else. You rightly often complain about medical students dumping ill-considered material in med articles, but surely part of the reason for this is precisely that much medical WP content looks like a place for them to do that, to them and their under-instructed instructors, and the lack of resistance to jargon is part of that. You've answered the first question above, what about the other two? Wiki CRUK John (talk) 16:39, 3 December 2014 (UTC)
 * I am not seeing a much easier term than epidemiology. Doc James  (talk · contribs · email) 17:33, 3 December 2014 (UTC)
 * I don't think that the percentage of people who don't know what a prognosis is are likely to be the same population accessing the internet for health information. So, no, I don't think we should be dumbing down our content in those instances where the medical word is the best word for the situation (that applies to Prognosis and to Epidemiology ... I don't have a problem with Mechanism instead of Pathophysiology, although I do think that Mechanism is very limiting for the many conditions where the mechanism is unknown, but the pathophysiology is well studied.  As to whether these suggestions were meant to be just that, see the section headings above on this page, where the discussions were for one term instead of another.  There may be a problem with my reading comprehension, but to me, that means replacing one with another, as in, eliminating one. Sandy Georgia  (Talk) 15:43, 4 December 2014 (UTC)
 * Maybe, but both sections closed so far have been in terms of "...guideline adjusted to recommend (not require)...". To say "I don't think that the percentage of people who don't know what a prognosis is are likely to be the same population accessing the internet for health information" simply flies in the face of all the very considerable body of research on who these groups (especially the latter) are. You're just wrong about that I'm afraid. I won't go into the problems with the specific terms again - well rehearsed already. Wiki CRUK John (talk) 16:16, 4 December 2014 (UTC)
 * My delayed answer to dear co-editor Wiki CRUK John:
 * a) I am no native english speaker and don't reside in an english-speaking country; therefore I cannot be certain about how intelligible "epidemiology" is to the average reader; I have no reason to doubt you when you say it isn't.
 * b)I hadn't thought about that, but I do not particularly mind; the "patterns" and the statistics are among the core issues of epidemiology of a disease and are still included in the "Epidemiology" section of medical articles.
 * c) This, I cannot deny. However, a guideline recommending "distribution" will lead to many relevant sections with information that exceeds the definition of this word be termed "distribution".
 * Finally, it wasn't clear to me from the beginning that these words would be additional suggestions instead of replacements of previous terms.
 * In any case, and mainly because I'm not a native english speaker and my opinion cannot be given the same value as a native speaker's, I'm toning it down to weakly oppose. NikosGouliaros (talk) 15:49, 5 December 2014 (UTC)
 * Thanks for this considered response. I expect these two terms can be used pretty freely in Greek without losing general readers! Wiki CRUK John (talk) 16:49, 5 December 2014 (UTC)
 * My handy Consise Oxford Dictionary has a simple, common-sense definition for the noun epidemiology: the "study of epidemics". While it clearly has become far more general than that to readers in the medical community, many readers will continue to think that is what it means. The same source explicitly contrasts "epidemic" with "endemic". Using "epidemiology" in infectious disease articles will not surprise many, but using it for non-transmissible endemic diseases (or for lifelong conditions as SandyGeorgia raised) will, at best, confuse lay readers. Why not simply have a small selection of alternative section headings in MEDMOS, to be applied as required? LeadSongDog come howl!  17:15, 11 December 2014 (UTC)
 * Indeed. I've been surprised by a couple of very intelligent lay people who thought the term was restricted to infectious diseases. Wiki CRUK John (talk) 17:26, 11 December 2014 (UTC)
 * weakly support "population distribution". No doubt epidemiology is a tough one. I sort of think we should stick with it since there isn't a good alternative. BakerStMD  T&#124;C 17:08, 14 January 2015 (UTC)

Contraindications
Earlier this year the heading "indications" was changed to uses. This followed a discussion in 2011. A "use" may not be indicated; it could just be optional, so the meaning was changed a bit here.

Should "contraindications" likewise be changed to be the opposite of "uses"? A contraindication is a strong deterrent, but sometimes there is discouragement which is not a contraindication. For example, sometimes doctors and mothers somehow decide to have caesarean section surgery when it is not medically indicated, and various authorities say that this ought not happen and people should not be choosing to have surgeries without a medical indication. Similarly, there are other treatments which are discouraged but not contraindicated. Wikipedia was criticized for not giving information about FDA drug safety alerts, which again frequently are not contraindications but may be reasons to avoid using something. Is it the intent of this heading to usage warnings which are not contraindications?

Does this heading need to exist at all, or should it just be part of uses? There is always a uses section in articles. The contraindications section may or may not appear.

Other names could be "When to not use", "Uses to avoid", "Reasons to avoid", "Usage warnings", or just "Warnings". Note that for drugs we already have an "adverse effects" section and for procedures a "risks and complications" section in addition to the contraindications section of each of those.

I like "Warnings". Does that fit here?  Blue Rasberry  (talk)  21:51, 16 September 2014 (UTC)


 * I don't like ==Warnings==. I think that we'll end up with fights about whether only official warnings should be included, or whether adverse effects should be included, or whether this is the right section for "call your doctor if you experience..." medical advice.  (The "right section" for that last one is "on some other website".)
 * "Reasons to avoid" is my current favorite out of your list, but I'm flexible. WhatamIdoing (talk) 23:24, 16 September 2014 (UTC)
 * Indications is a legal term as is contraindications. The preferred term IMO is side effects. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:47, 17 September 2014 (UTC)
 * Actually, indication is not (just) a legal term. A suspected broken bone is a very good indication for getting an X-ray of said bone, for example.  WhatamIdoing (talk) 23:54, 9 October 2014 (UTC)
 * Contraindication says (unrefed) "Relative contraindications may also be referred to as cautions, such as in the British National Formulary.", but suggests no alternative term for absolute contraindications. As I said last time, I'm softer on "contraindications" than "indications", partly because the former is really only found as a medical term. I like "reasons to avoid" best of the suggestions so far. I think (as we discussed last time) both these terms are even less familiar to UK readers than US, and a search of the huge NHS Choices website shows no use of "contraindication" at all, while the 20 uses of "indication" all seem mainly directed at prefoessionals rather than patients . So an alternative is very desirable.  If we do use it as a header we should begin the section with something like "Reasons not to use this drug/treatment include ....", instead of eg "Simvastatin is contraindicated with pregnancy, breast feeding and liver disease.[6]", as we typically now have.  The article Contraindications to thrombolysis currently manages to avoid completely either explaining or linking the term at all! This seems to be our only "Contraindications only" article, and should surely be merged back - I've tagged it for the project. Wiki CRUK John (talk) 10:53, 17 September 2014 (UTC)
 * Support "reasons to avoid". "Side effects" doesn't cut it, as total avoidance in some cases is necessary.   --Hordaland (talk) 13:29, 18 September 2014 (UTC)
 * And side effects is a whole different concept. Pregnancy is a contraindication for all sorts of things, but not a side effect of them. Wiki CRUK John (talk) 15:04, 18 September 2014 (UTC)
 * Support Reasons to avoid. Definitely not risks or side effects for the reasons mentioned above. "When not to use" and "Reasons not to use" are too wordy and simplistic. BakerStMD T&#124;C 17:12, 14 January 2015 (UTC)