Wikipedia talk:WikiProject Medicine/Archive 82

Suicide bag
Not quite sure where to bring this up, but there are several articles on suicide methods that make me really uncomfortable and I think they're arguably illegal. Not sure if the best way to handle it was to view them as medical articles and keep an eye that they're not making biomedical claims without proper sourcing or if there's some other legal avenue to pursue. They're really good using a tone that sounds unbiased, like it's an objective discussion on the ethics of suicide, but they're really just pro-suicide sites and they're really dangerous. These people like to tag anything about suicide prevention as lacking NPOV or as demonstrating a "American" perspective. Reddit and other social media sites don't allow content or even links to websites that explicitly tell people how to comment suicide. Since they can't link to these articles, people will tell each other "Google suicide bag and read the wikipedia article." I would think if this content is illegal enough for reddit, it shouldn't be on wikipedia.

I think it could be argued that some of these are encouraging suicide. The suicide bag article is about exactly how to make your own suicide bag, including a diagram, with easily accessible items. The hardest thing to get would be helium or a propane-butane mixture and the rest are household items. Then look at what links there, literally any article about bags (purses, backpacks, etc.) links to suicide bag. Suicide methods is exactly what it sounds like and this is what links there: Teenage suicide in the United States, suicide prevention. Basically any article about suicide links to an article that tells you specifically how to kill yourself. Lots of them have a handy dandy suicide infoboxes that link to suicide methods. alt.suicide.holiday is an article on former usenet group that is clearly just a pro-suicide article.

This 2012 study showed that pro-suicide content on social media can increase the risk of completed suicide because it normalizes and glorifies the act and provides people with access to information about lethal methods. It specifically mentions methods using gas. This 2015 study discusses an increase in helium-related suicide deaths as a direct result of discussion about it in online forums. There have been stories in the news over the years about people who have been convicted for encouraging suicide on internet forums. Here's one from 2010 about a woman who was convicted for encouraging suicide online. What do other people think? PermStrump (talk) 14:35, 8 April 2016 (UTC)
 * insofar as the article suicide bag it seems well referenced--Ozzie10aaaa (talk) 17:42, 8 April 2016 (UTC)
 * This might be a good topic to take to the WP:VILLAGEPUMP. Obviously Wikipedia is not censored in so far as the content is not illegal in the United States (i.e. libel and child pornography). The dividing line is not always clear though I would think in this case the line is the difference between is and ought. Sizeofint (talk) 07:29, 9 April 2016 (UTC)


 * The article's subject itself is notable and therefore is worthy of an entry in Wikipedia. However I am concerned that Wikipedia and/or the editors of the article might be construed as assisting suicide, especially if a high-profile case is reported in the media (e.g. "Robin learnt suicide technique from Wikipedia"). This article requires a formal legal assessment. Axl ¤ [Talk] 10:27, 12 April 2016 (UTC)


 * I don't know about legal assessment. I reviewed it and I think it is stays on this side of WP:NOTHOWTO.  I noticed that for a while it had a suicide hotline hatnote, like this.  It was taken off pursuant to this RfC at the Suicide article. Jytdog (talk) 11:15, 12 April 2016 (UTC)


 * , Did you mean the idea lab or the main village pump? I'm trying to put together a more cohesive argument so it does sound like I'm just trying to censor wikipedia., that's a good point about NOTHOWTO. Something definitely didn't feel encyclopedic about it to me, but I couldn't put my finger on it and I think you hit the nail on the head. I don't know if it's a coincidence or someone who read this thread, but for the past 2 days an IP editor has repeatedly removed the diagram from the Suicide bag article on the grounds that it's OR. It's a bit of a slow motion edit war. I think they each have 2 reverts now, but there have been a few hours in between each one. I wonder how long it will go on. I never would have considered arguing that an image was OR, but I think the IP has a good point. I'm not getting involved yet though, because I'd rather focus my energy on trying make a policy that specifically addresses this topic. If that fails, my back up will be NOTHOWTO for the majority of the text and OR for the image. , that's also my concern (that it could be construed as assisting suicide) plus that it likely is assisting suicide based on the 2015 study that I linked above. PermStrump (talk) 18:24, 12 April 2016 (UTC)
 * I was talking about gaining wider input from the community at the village pump. Sizeofint (talk) 20:37, 12 April 2016 (UTC)
 * we have disclaimers all over the place; i see the concern about bad press but the disclaimers are WMF and as I understand it they are solid. And Permastrump what i wrote was I think we are OK per WP:NOTHOWTO.  There are a few places it could be tweaked but generally it is good. There aren't actually instructions there. Jytdog (talk) 18:36, 12 April 2016 (UTC)
 * Hi all. I've been talking to medical doctors, researchers, and major suicide awareness charities about this article, and some others, for the past two years, with full in-person meetings every few months. Their view is that not only is Wikipedia classed as a "pro-suicide" website in terms of the information it provides, but that the occasional spikes in attention that come to these articles are probably reflected in real-life suicide attempts. They are particularly concerned about the diagram: their research indicates that the existence of the diagram does cause suicides and attempts at suicides that would otherwise not happen. We've been a bit stuck on how to move forward with this on Wikipedia, though - a big discussion about it could work both ways. Chase me ladies, I'm the Cavalry (Message me) 14:28, 14 April 2016 (UTC)
 * Can you tell us what standards they use to decide whether an information source is "pro-suicide"? WhatamIdoing (talk) 04:14, 15 April 2016 (UTC)
 * I don't know how many people are researching this so I kind of wonder if I'm about to quote any of the people has been talking to, but here's how Collings and Niederkrotenthaler (2012), and Kemp et al. (2011) define prosuicide websites... Sites that:
 * have detailed suicide instructions or descriptions of suicide methods
 * advocate suicide or describe suicide methods in detail
 * are permissive or encouraging of suicidal behaviors
 * promote or enable suicide by describing suicide methods.


 * Both papers put prosuicides sites in direct contrast with "suicide prevention, and suicide support" sites that offer resources, psychological, social, or practical support to reduce suicidal behaviors. Collings and Niederkrotenthaler said, "many websites [have] life-promoting characteristics (such as the opportunity to contact a support service) and potentially suicide-promoting characteristics (such as detailed descriptions of suicide methods) have been found to be closely intertwined" This is definitely true on reddit where they like to call themselves "pro-choice" and claim to be places for "discussion about the moral, ethical, and religious implications about the right to choose the time of your own death." But they all contain links that tell you ways to kill yourself. They are NOT "pro-choice" or "suicide neutral" as they claim. Same with the Wikipedia article that sounds "NPOV." It's really just a prosuicide site that normalizes, glamorizes and encourages suicide attempts in individuals who are already high-risk. This is all supported by the studies I've linked, especially Gunnell et al. (2015). PermStrump (talk) 06:27, 15 April 2016 (UTC)
 * Permstrump I hear and understand your passion on this, but it seems that you want WP to take a moral stance. Have a look at Abortion.  Is that a "pro-abortion" article because it doesn't have hotline information for counseling?  (real question for you).  I could see someone arguing that.
 * I also want to note that we have a whole article on Suicide methods and a Template:Suicide_sidebar. There has been some of this kind of discussion at both talk pages over the years (!) as well as Talk:Suicide and they get shot down each time. Jytdog (talk) 06:54, 15 April 2016 (UTC)
 * Jytdog, this isn't a moral stance, if I'm honest. The article on abortion does not tell people how to perform an abortion (especially not with at-home methods) - instead it talks about the procedure from a medical/scientific standpoint. Secondly, I would argue that our general goal - "a world in which every single person on the planet is given free access to the sum of all human knowledge" - means that we shouldn't be promoting suicide methods in the way we currently are. Moral issues aside, (and this may seem quite cold, but) if vulnerable people use the information on our site to end their lives unnecessarily, then we're not adding the the world's knowledge - we're working to reduce it. Chase me ladies, I'm the Cavalry (Message me) 14:20, 15 April 2016 (UTC)
 * WhatamIdoing, to answer your question: I don't know the specifics, but two key points came through: first, that Wikipedia articles are often a "how-to" guide rather than a sensible, neutral analysis, and secondly that the vast majority of people who are looking for suicide methods online turn to Wikipedia as a source.


 * : Re: the abortion article, is there notable documentation in peer reviewed sources that say Wikipedia.specifically. is contributing to a public health issue by facilitating people to follow through with abortions that are illegal in their jurisdiction by normalizing, glamorizing, promoting, and providing access to the means for performing self-abortions at home (normalizing them by discussing them at length without balance from opposing viewpoints and linking to list articles and websites about regular people who have had abortions with a focus on how quick and painless their abortions were; glamorizing them by listing all of the celebrities who had abortions and the exact methods they used; promoting them by inserting pro-abortion infoboxes in every article someone on the fence might visit, and links at the bottom of completely unrelated articles to articles detailing abortion methods; and providing the means by detailing all of the information someone would need (including illustrated diagrams) to perform a "quick and painless" self-abortion at home without a medical provider using easy to access household items)? Because if that were the case, then yeah, I'd say we should definitely rethink what we're doing with our abortion articles. Because that's exactly what the suicide articles do and that's exactly what scholars have directly connected to spikes in actual suicides that correspond with spikes in page views of wikipedia articles on that method following major news reports on noteworthy people committing suicide. Gunnell et al. (2015) use Robin Williams's suicide as a very disturbing example. He did not actually use asphyxiation, but for 1 hour the suicide bag article said he did and the visits to that page increased astronomically, as did suicides completed by asphyxiation with gas. Look at Suicide_bag - what links there, literally any article about bags (purses, backpacks, etc.) links to suicide bag. PermStrump (talk) 15:33, 15 April 2016 (UTC)
 * That was a navigation template at work, I've changed it pending discussion. Certainly wp:NOTHOWTO, but the topic is clearly notable. It is also very current event driven. The Canadian parliament is (unwillingly) grappling with medically assisted suicide issues at present, as no doubt are others. The hard part will be finding NPOV sources without legitimizing self help approaches. LeadSongDog come howl!  18:17, 15 April 2016 (UTC)
 * I haven't spent much time thinking about medically assisted suicide, but I do sometimes wonder why even a few people bother with it. In comparison to the unregulated "homemade" methods – which are often so simple that even a brief explanation is "detailing all the information someone would need" – it seems like a lot of work for no benefit, except maybe the emotional comfort of having your decision "approved" by some medical or government authority (think "certified proof for my loved ones that I'm not mentally ill").
 * I'm not sure that every single article about suicide should have a "right to respond" section. If an article is about a particular method, then it makes sense for the information to be restricted to that particular method.  For example, in the suicide bag article, editors could reasonably include information about, say, the ethics of this choice vs others (e.g., it's probably more ethical than jumping off a bridge and thereby triggering a search and rescue mission that could endanger emergency response workers).  But I don't see room in an article like that for something on the ethics of committing suicide at all; it's off-topic.  WhatamIdoing (talk) 03:29, 16 April 2016 (UTC)
 * Some of the sources I've linked above talk specifically about the suicide bag and ethics of suicide, so it wouldn't be off topic. I have it on my to-do list. I'm not really concerned about medically assisted suicide for people with terminal illnesses. The problem is that that's not who these prosuicide sites are usually aimed at/who they hurt. PermStrump (talk) 10:42, 16 April 2016 (UTC)

Oh dear, this issue again. Suicide bags exist. They have for decades. As an encyclopedia, WP covers them. The article describes them, what they look like, their history, what people have said about them, etc. There are no step by step instructions (such instructions are readily available elsewhere   etc etc). As for the panic about increasing numbers of people using this method, it should also be noted that total numbers of suicides have not risen (indeed, suicide rates are stable or falling in most countries)



The fact that a slightly increasing percentage of suicides (the numbers are tiny) are choosing this method (for euthanasia as well as suicide) is to be expected, since it is painless, non-toxic, aesthetically acceptable and easily obtained (until recently), compared, for instance, to carbon monoxide poisoning, hanging and other brutal and distressing methods (some of which are also extremely dangerous to bystanders and medical response personnel, e.g. CO poisoning). Those who would bury the suicide bag article probably have good motives (nobody wants to see depressed youngsters making this error), and are not on a religiously-motivated campaign, but the outcome, if we suppress it, is unlikely to be good. People who are absolutely determined to kill themselves will find a way, and that way will generally be much more distressing and dangerous for all concerned. In addition, helium canisters these days are "cut" with 20% oxygen (due to a global shortage of helium), so the method does not work for many who try it. To make it effective, you have to get argon or nitrogen, and these are simply NOT casually available. Buying these gasses is not something most people are equipped to do. Ratel (talk) 21:50, 17 April 2016 (UTC)


 * From :
 * Balloon Time, a major supplier, has issued a statement to say that in the future all of their “balloon gas” will be diluted with 20 per cent air. “Our helium is rated from 98-99.99 percent pure. However, due to global helium supply issues, we are now mixing helium with air. All tanks will have 80 percent or more helium. This allows us to deliver a quality product at an affordable price.”


 * Without balloon helium tanks, potential suicides have to order very large canisters from gas suppliers. They are heavy, come delivered by a truck, and are expensive. This whole topic is becoming moot ... Ratel (talk) 22:22, 17 April 2016 (UTC)


 * Interesting. Diluting 99.x% helium with 20% air will give a hypoxic mixture (roughly 4% oxygen), which should be quite effective at asphyxiating a human at normal atmospheric pressure. However, I was under the impression that balloon helium has 20% oxygen added, specifically to avoid accidents with people breathing it from balloons to produce squeaky voice effects. Maybe this varies between countries. &bull; &bull; &bull; Peter (Southwood) (talk): 09:44, 20 April 2016 (UTC)
 * resonant frequencies are many times higher in a human vocal tract that has helium in contrast to one that just has "air"--Ozzie10aaaa (talk) 10:41, 30 April 2016 (UTC)

Suicide bags result in quick and painless death — MEDRS or not?
Discussion currently ongoing at: Talk:Suicide_bag Please comment. Carl Fredik  💌 📧 21:30, 9 May 2016 (UTC)
 * Should we allow primary sources?
 * Should we allow images without references on controversial issues?
 * Are case reports WP:DUE?
 * Who is this "We" you refer to, and where do they get the authority to make this decision? &bull; &bull; &bull; Peter (Southwood) (talk): 13:45, 10 May 2016 (UTC)


 * 'Please note, the suicide bag article is right now undergoing what appears to be a concerted tag team attack to destroy the content. Is this what wikipedia is coming to, a censored portal? All editors need to examine their consciences here, and decide if we are going to reflect what's going on in the world, or play a more paternalistic role. Ratel (talk) 22:19, 9 May 2016 (UTC)
 * Having multiple editors disagree with your position is not the same as a tag team. Carl Fredik   💌 📧 22:50, 9 May 2016 (UTC)
 * A sudden, concerted mass deletion of material, by several editors, on a longstanding article, is most definitely a tag team effort. Ratel (talk) 06:26, 10 May 2016 (UTC)
 * Actually you need to read WP:TAGTEAM and be careful about levelling false accusations of it because it's not WP:CIVIL and can lead to you being sanctioned. If you have grounds for your accusation you need to take them to WP:AN/I. Alexbrn (talk) 12:23, 10 May 2016 (UTC)
 * How else explain an article (that has been more or less ignored for years) getting 3 or 4 new editors, all with the same agenda (mass removal of text to the point of aggressive edit-warring), in the space of a week? If it looks like a duck, walks like a duck etc. But I may be wrong. Incredible coincidences can happen, perhaps this is just a chance occurrence. Ratel (talk) 12:38, 10 May 2016 (UTC)
 * Take it to WP:AN/I then, with your evidence. Here is not the place. It is very common for poor articles build with a spurious WP:LOCALCON to get heavily edited when they receive fresh eyes and a widened consensus, for example as a result of their being raised at a Noticeboard. Alexbrn (talk) 12:43, 10 May 2016 (UTC)

Real life precludes ANI action. But I'd welcome an admin freezing the article as it was so that all the reverting can stop and things can get sorted on Talk Ratel (talk) 12:56, 10 May 2016 (UTC)

As an uninvolved editor with a small amount of experience in editing medical articles related to diving, the editing interventions based on claimed biomedical information do seem rather over the top.• • • Peter (Southwood) (talk): 13:37, 10 May 2016 (UTC)
 * Diving and suicide methods have quite different implications do they not? Controversy dictates how important it is to adhere to quality sources, this is a principles of WP:RS. Carl Fredik   💌 📧 14:44, 10 May 2016 (UTC)
 * Not really. Divers accidentally die through the same biological mechanisms that kill the users of suicide bags.  The fact that one death makes some people more queasy than the other doesn't really change the biomedical facts about what happens if you get your Nitrogen/Oxygen balance wrong (or Helium/Oxygen, for really deep dives).  They both need good-enough sources, and neither absolutely requires gold-plated-only sources.  "Controversial" only applies to BLPs.  What you're probably thinking of is the "extraordinary claims" idea, and the biochemistry here isn't the least bit extraordinary.  WhatamIdoing (talk) 02:51, 11 May 2016 (UTC)
 * As far as I can tell, no-one on Wikipedia is prescribing suicide bags as a medical intervention, or claiming that this would be an acceptable medical practice. Therefore why should the article on suicide bags be considered within the scope of MEDRS? A more appropriate standard for reliability should be applied to the sources used.&bull; &bull; &bull; Peter (Southwood) (talk): 07:51, 11 May 2016 (UTC)


 * we need more opinions at Talk:Suicide_bag--Ozzie10aaaa (talk) 18:08, 10 May 2016 (UTC)
 * It is well-known that breathing a severely oxygen-deficient atmosphere (4 to 6%) results in unconsciousness after a few breaths, and that the exposed person has no warning and cannot sense that the oxygen level is too low (http://www.csb.gov/assets/1/19/SB-Nitrogen-6-11-031.pdf). No warning would imply no pain, but I don't expect to find peer reviewed studies or Cochrane reviews confirming or disproving that assumption.
 * Maybe it's time to clearly define the limits of MEDRS, and ban "off-label use". Prevalence  21:32, 10 May 2016 (UTC)
 * Changing MEDRS won't stop POV pushing.
 * Speaking of which: I suspect that part of the public health concern about this uncommon method stems from the population that chooses it, and I wonder whether that's addressed.  It's not the method of choice by sympathetic old cancer patients; instead, it's largely used by men with traditional risk factors for suicide (e.g., impulsive, young, white, recreational drug users).  So I'm wondering whether there is real-world POV pushing at play here, too:  parts of society have decided that this is a 'bad suicide' (a young person acting independently, if probably stupidly) rather than a 'good suicide' (a terminally ill elderly person ending up equally dead, but with the explicit blessing of a government bureaucracy and the medical establishment).  Because, you know, if you truly wanted to stop suicides, you'd stop worrying about this method, and this article, and instead make it illegal for my local (American) pharmacy to sell an unlimited number of bottles containing 375 extra-strength pills of liver failure each to any kid who can use a credit card.  WhatamIdoing (talk) 02:54, 11 May 2016 (UTC)
 * Changing (or more precisely, specifying the limits of) MEDRS will not stop POV pushing, but it would make using MEDRS as an excuse/ weapon by the POV pushers easier to refute/dismiss, hence a good thing. &bull; &bull; &bull; Peter (Southwood) (talk): 07:37, 11 May 2016 (UTC)
 * I agree, of course, but I don't think that we'll get there until WP:MEDDUE exists. People cite MEDRS because it's a good hammer, even when the tool they really need is a screwdriver.  WhatamIdoing (talk) 13:23, 12 May 2016 (UTC)

I surprised there seems little pushback at this article to what seems very dubious proposals. The latest is to source a description of how "peaceful" death-by-helium is, to eyewitness accounts. Alexbrn (talk) 12:54, 12 May 2016 (UTC)
 * Perceived peacefulness is not WP:Biomedical information. Therefore, plain WP:IRS guidelines apply, and that guideline probably requires nothing more than a newspaper article and WP:INTEXT attribution.  WhatamIdoing (talk) 13:23, 12 May 2016 (UTC)
 * How the human body reacts physically to a substance / the nature of the death that subsequently occurs is biomedical information. The proposed source is the book Final Exit. Alexbrn (talk) 13:56, 12 May 2016 (UTC)
 * "Causes myoclonus" is biomedical information. "Seemed subjectively peaceful to bystanders" is not.  WhatamIdoing (talk) 14:09, 12 May 2016 (UTC)
 * Possibly, but that's not the proposed wording and not the intended meaning of the edit, which is justified by the proposer thus: "We have ample evidence from numerous sources that this is a quick and easy way to die, and deleting that simple fact from the page by impugning the source is POV". The "evidence" being proposed for this "simple fact" is somebody saying "When I witnessed the helium death of a friend of mine it could not have been more peaceful". This seems to be way worse than using a well-published case report even: it falls off the bottom of WP:MEDASSESS. Alexbrn (talk) 15:52, 12 May 2016 (UTC)
 * Um no. That was not the evidence proposed, that was merely an example. There are different sources for the fact that the death is quick and peaceful. You can also go to the WP article Inert gas asphyxiation for data such as and  And of course Ogden's studies draw on a large number of eyewitness accounts. And backing this up, autopsy does usually not show any notable findings, (lots of RS for this) suggesting an absence of unconscious death struggle. Ratel (talk) 22:29, 12 May 2016 (UTC)

The CSB.gov source that and  are referring to has nothing to do with suicide bags. It’s about accidental, gradual exposure to nitrogen in the workplace in a contained environment like a small room. I’m going to quote few sources that talk about death by nitrogen asphyxiation to illustrate how irrelevant the CSB source is. But I want to clarify something first... There are 2 different statements by 2 separate people about the physical reaction (or lack there of) to the inhalation of inert gas using a suicide bag. One is a primary source in a low-impact, peer-reviewed journal written by Ogden, a right-to-die advocate and criminologist, that talks about how quick, painless and peaceful death is with helium and a suicide bag. The other statement is from a self-published newsletter written by Nitschke in which Nitschke says that helium has a risk of adverse effects, but nitrogen is much better in comparison. I’m NOT suggesting that the sources quoted below that talk about nitrogen should be used in the article since they’re about nitrogen asphyxiation using masks or in a contained environment in the workplace, not suicide bags.


 * 1) This CNN article from 2015 is about Oklahoma looking for humane alternatives if the Supreme Court ruled that lethal injections were inhumane: While the Supreme Court case was pending, Gov. Mary Fallin signed a bill that would allow the state to perform executions with nitrogen gas if lethal injection is ruled unconstitutional or becomes unavailable. While the medical community has voiced concerns about the method, at least one group thinks the Sooner State might be onto something. Philip Nitschke, director of the right-to-die group Exit International, said the increasing difficulty in obtaining pentobarbital has prompted him to consider gas as an alternative...”

Perfect illustration of how Nitschke doesn't represent the mainstream, medical view. By the way, Nitschke already sells suicide kits with pure nitrogen for $690, so I wonder if that has anything to do with why he claims there are zero adverse effects compared helium, the product gas of choice promoted by his right-to-die competitors, who have essentially rejected Nitschke and his methods. Not to mention the Medical Board of Australia suspended his medical registration, to which Nitschke replied, ‘Oh yeah? Well I was going to break up with you first. So there.’
 * 2) This Time article is about the same debate in OK: Changing the context could prove problematic. Administrating the gas within a prison is much different than the instances in which pilots and divers have slowly and accidentally experienced a lack of oxygen. Dr. Michael Weiden, a pulmonary expert at NYU School of Medicine, says that while nitrogen could be administered without medical professionals, using it for capital punishment could create an ironic consequence: the need for sedation… somebody who thinks that an individual who’s asphyxiating will not freak out without sedation is foolish.”
 * 3) This peer-reviewed case study from 2015 about a suicide by nitrogen asphyxiation with a scuba mask, says, “Deliberate nitrogen asphyxiation is also viewed by some as a more humane way to end human life. Nevertheless, execution by nitrogen asphyxiation is not used by any nation in the world.”

In 2010, Ogden had a case study published in a low-impact, peer-reviewed journal where he talks about 4 assisted-suicides he observed that involved helium asphyxiation using face masks. This is the primary source cited to support the claims that suicide with helium and a suicide bag is quick and painless.
 * 4) In contrast, this peer-reviewed study from 2013, which is unlisted by PMID (see WP:PARITY), says that one of the two cases they studied had "bilateral eyelid petechiae and large amounts of gastric content in the airways. These findings challenge the assumption that death by this method is painless and without air hunger, as asserted in Final Exit." They also found that the time to death varied from 5-10 minutes to up to 40 minutes.

This is exact situation is why WP:MEDRS exists! I shouldn’t need to create an argument for using MEDRS from scratch just for this specific article. PermStrump (talk) 03:58, 13 May 2016 (UTC)


 * Permstrump, you're confused by the fact that there are several ways to die from inert gas exposure, some much more efficacious than others. If you'd read Final Exit and The Peaceful Pill Handbook you'd know that there are very specific instructions to follow for using a suicide bag. Those instructions are not on WP because of WP:NOTHOWTO. The chapter from the latter book on how to use the suicide bag correctly runs to ~50 pages of instructions and videos, about all manner of aspects that must be done correctly. But in summary of the basic process, one has to put a completely flattened bag at the top of the head above the ears with collar loosely on head, turn on nitrogen to fill the bag like a tent with pure nitrogen/inert gas (takes ~2 minutes) and wait till nitrogen is escaping from the bottom of the bag, take rapid deep breaths (hyperventilate), then exhale completely (expel all air from lungs), then lower bag over head and take a deep breath, with cord and toggle snug against neck. This is a very precise sequence of events; if it is not done right, if there is insufficient nitrogen flow, or if the bag is not fully compressed and empty of air when the process begins, then failure to die quickly and peacefully can ensue, and this would be why we see some (a few) autopsies that show petechiae and aspiration of vomitus. If there is still air in the bag, that can delay the onset of unconsciousness and death. As Ogden says, "done correctly" the method is just about foolproof. I'd hazard a guess that most people who get a bag and a canister of helium don't know what to do, and there is a real chance they'll fuck it up. Sorry to have to be brutally specific, but these are the facts. Now perhaps you can think of a way to incorporate this information into the article as a warning? Ratel (talk) 04:25, 13 May 2016 (UTC)
 * , no, I cannot think of a way to incorporate that into the article without original research or synthesizing multiple sources. That's one of several reasons why the current version isn't WP:NPOV. There are virtually no actual experts in the field who share the same view and had their work on the topic published in a solidly reliable, independent source that we could cite in lieu of Nitschke and Ogden's weak sources. There aren't even enough other people giving it the consideration to publish statements contesting their claims, making it next to impossible to appropriately contextualize. WP:FRIND says, "Points that are not discussed in independent sources should not be given any space in articles. Independent sources are also necessary to determine the relationship of a fringe theory to mainstream scholarly discourse." The current wording, despite attribution, still sounds like there's general consensus in the medical field that these 2 methods are quick and painless and all you need is a plastic bag and inert gas. Even if we take for granted that their statements are true (which in my opinion is dubious given the sources in my previous comment), even then their statements would only be true if the method is used properly, which the article technically says, but doesn't adequately emphasize, and likely can't without SYNTH due to the dearth of coverage on the topic outside of a small, radical group. PermStrump</b> (talk) 05:43, 13 May 2016 (UTC)
 * I also think you should strikeout/delete the extraneous details from your last comment unless you're deliberately trying to scare other editors away from contributing to this discussion/article. I didn't need to understand the any of the details you gave about how to use the method properly in order to comprehend that there are more likely to be adverse reactions when you do it wrong. <b style="color:indigo;">PermStrump</b> (talk) 05:52, 13 May 2016 (UTC)


 * I maintain that Ogden and Nitschke are not "weak sources". I think you need to RfC that.
 * I don't see the current page as not NPOV. It has a nice balance when I read it. I don't get a sense of slant at all.
 * FRINGE does not apply. Nitschke is discussed in thousands of sources, and his views on suicide with nitrogen published widely. One of numerous examples : If he were clearly wrong, we'd have seen heavy pushback to the numerous such statements he has made in press worldwide; we'd have most definitely heard about it by now. And Ogden? Well, he is in Scientific American! Fringe &#x1F602; ?
 * I could insert something about proper procedure being imperative, and cite it to Nitschke's book. Unfortunately it is behind a paywall.
 * No, no dearth of coverage of this topic, thousands of news articles, but no mainstream coverage of the warnings.
 * Me trying to scare off other editors? Sorry, I don't understand your meaning. Ratel (talk) 07:36, 13 May 2016 (UTC)
 * Me trying to scare off other editors? Sorry, I don't understand your meaning. Ratel (talk) 07:36, 13 May 2016 (UTC)


 * At this moment, I'm only saying Ogden and Nitschke are weak sources for the statements about how quick and painless nitrogen/helium+suicide bag are and that there aren't adverse effects. They're weak because there isn't a single independent reliable source that can be used in addition or in place of Ogden and Nitschke. The sources you just liked are blog/newspaper articles by journalists who were quoting/paraphrasing Nitschke's beliefs. The fact that Nitschke said those things doesn't need more sources. I've explained multiple times in various threads on Talk:Suicide bag how their views qualify as fringe on wikiepdia. It's a slam dunk. There's really no doubt about it. The argument of editors who disagree with me has basically boiled down to, "Nuh huh. Their views aren't fringe," but no one has been able to provide a single independent reliable source to show that other SCHOLARS agree with them. It doesn't matter how many people "in-universe" hold the same view. That's how WP:FRINGE works. "Statements about the truth of a theory must be based upon independent reliable sources... Points that are not discussed in independent sources should not be given any space in articles. Independent sources are also necessary to determine the relationship of a fringe theory to mainstream scholarly discourse." The editors claiming something isn't fringe are the ones who have to prove that support from mainstream scholars in the field exists. Until proven otherwise the WP:ONUS is on the editors  who want to include the disputed content to find the better sources. It really should be removed until then.  <b style="color:indigo;">PermStrump</b> (talk)  08:44, 13 May 2016 (UTC)

said: ''Ogden and Nitschke are weak sources for the statements about how quick and painless nitrogen/helium+suicide bag are and that there aren't adverse effects. They're weak because there isn't a single independent reliable source that can be used in addition or in place of Ogden and Nitschke.'' So if we ignore two of the experts who have made this their life's work, we have no sources? Perm, that's only true if you ignore the great sources I gave above showing almost immediate unconsciousness ("one or two breaths"), and the existence of studies featuring inert gas asphyxia autopsies without petechiae or inhalations (therefore without what is called in veterinary science an "unconscious death struggle" example). Do you need links to the U.S. Chemical Safety and Hazard Investigation Board document and more studies showing unremarkable autopsies? For FRINGE to come into play, Nitschke and Ogden and Humphry and Dr Bruce Dunn and etc would all have to be claiming something that flies in the face of the wording of FRINGE, namely: an idea that departs significantly from the prevailing views or mainstream views in its particular field. For example, fringe theories in science depart significantly from mainstream science and have little or no scientific support. Ratel (talk) 09:48, 13 May 2016 (UTC)
 * Like I already said above, the CSB source has nothing to do with suicide bags. The Auwaerter et al. source doesn't support Nitschke and Ogden's statements; it repeats them, but doesn't support them. Auwaerter: "In the last years, right-to-die activists promoted suicide methods by asphyxiation with use of gases as being relatively quick and painless." WP:FRINGE says, "Statements about the truth of a theory must be based upon independent reliable sources." Auwaerter et al. did not attest to the truth of that theory. None of the names you mentioned are independent of the topic. They're part of the small, radical group, so no, the fact that they agree with each other doesn't make it mainstream. <b style="color:indigo;">PermStrump</b> (talk) 10:02, 13 May 2016 (UTC)
 * *, we're going round in circles
 * CSB source has nothing to do with suicide bags — of course not, but CSB source is about breathing a pure inert gas in an enclosed space, which completely agrees with the statements of Nitschke, Ogden et al, so let's not play semantics, it just wastes everyone's time.
 * Statements about the truth of a theory — it's not a theory. Plenty of people have died like this, some filmed by Dignitas, some observed directly & reported to researchers like Ogden, some scuba divers by mistake, some workers around inert gases. Where's the theory? Where's the fringe claim? If you do it properly then just a couple of breaths and you're out, 10 mins later (or longer if there is a vestige of oxygen) you're dead. If you don't do it properly you can take ~10-50 seconds to lose consciousness and up to 50 mins to die, with some twitching and movements, and possibly some signs at autopsy (inhalations, heart congestion, a few other signs I forget now, but none of which would have been felt consciously by the unconscious suiciding person, so relevance is moot). This is not controversial, nobody has contested it except the one source you have who looked at only 2 deaths by inert gas asphyxia and based his doubts on the one case with petechiae and inhaled vomitus, but this case also took a known emetic before breathing nitrogen, and in any case there is no proof that case experienced any pain, so the author's questioning of the painlessness of the method is strange. You can complain all you like about lack of numerous independent verifiable sources that echo these details, but you're never going to get a lot of researchers doing this kind of research when you see what happened to Ogden, who got himself unavoidably into a legal minefield that hobbled his career, so bleating about lack of verification from other sources gets us nowhere. And then you have the latest review study in this field that calls bag+inert gas an "easily understood and generally effective suicide method". Want to quote that? Ratel (talk) 11:30, 13 May 2016 (UTC)
 * Quoted above too... Changing the context could prove problematic. Administrating the gas within a prison is much different than the instances in which pilots and divers have slowly and accidentally experienced a lack of oxygen. Dr. Michael Weiden, a pulmonary expert at NYU School of Medicine, says that while nitrogen could be administered without medical professionals, using it for capital punishment could create an ironic consequence: the need for sedation… somebody who thinks that an individual who’s asphyxiating will not freak out without sedation is foolish.” Time. <b style="color:indigo;">PermStrump</b> (talk) 13:35, 13 May 2016 (UTC)
 * The Howard source doesn't support "quick and painless" or "peaceful" or "without adverse reactions." It would be much better in place of those 2 citations. The "easy to understand and effective" comment was also specifically about a plastic bag alone, not with gas, BTW. If you include all 3, it severely lacks NPOV. <b style="color:indigo;">PermStrump</b> (talk) 13:40, 13 May 2016 (UTC)
 * Most people who do not want to die would freak out if they knew someone was actively killing them. I would guess that it has more to do with the fact that someone is killing them than the actual method in use. Would it be unreasonable to suggest that the reaction might not be the same if the subject actually wants to die? &bull; &bull; &bull; Peter (Southwood) (talk): 09:36, 4 June 2016 (UTC)

Mainstream?

 * Ogden is WP:INDY according to Wikipedia's standards.  He gets nothing from his papers except what any other academic gets from their papers.  If we start declaring that experts aren't independent, then we will never be able to cite any journal article – no surgeons on surgical methods, no drug manufacturers on drugs, no pesticide researchers on pesticides, etc.  Ogden actually is that "single independent reliable source" that you're looking for.
 * When you have one reliable source saying X, and no reliable sources saying anything about it, then saying X (perhaps with WP:INTEXT attribution) is DUE.  For example, we don't reject LD50 numbers when there is only one source for that number.
 * Here's how we know that "other SCHOLARS" accept Ogden: Multiple other scholars cited his paper.
 * Permstrump, you're saying in your comments here that government sources about the proven effects of occupational exposure to Nitrogen is irrelevant, but that vague speculation in a newspaper about using it for lethal execution is just fine. This sounds like cherry-picking sources based upon their POV to me, and that won't produce an acceptable article.  WhatamIdoing (talk) 13:53, 13 May 2016 (UTC)
 * 1) Capital punishment: Using nitrogen for capital punishment would be difficult to impossible without sedation because to make it work properly you need complete co-operation (see instructions above). Some condemned prisoners will co-operate, most will not.
 * 2) Without adverse reactions : The ultimate adverse reaction is death. And since the autopsy-discovered sequelae, which are rare, occur after loss if consciousnesses, they are moot. So why are you making an issue of them? To the user, the process is still painless, otherwise we'd have seen people interrupt it (note the eyewitness accounts and films by Dignitas showing some involuntary movements but no attempt to remove bag or mask).
 * 3) BTW did you get access to the full text of the Kleespies paper? That paper seems to be more about a "debreather" than a suicide bag. Ratel (talk) 20:24, 13 May 2016 (UTC)
 * , Yes, capital punishment is different from suicide, but so are the situations CSB was referring to that involved people who were unaware of accidentally and gradually being exposed to nitrogen while in a small room. Obviously that would be different than what if feels like when you have a plastic bag over your head. My point was essentially that the policies and guidelines exist for a reason. It's so easy to draw false conclusions with honest intentions, but WP:SYNTH and WP:COATRACK prohibit us from drawing conclusions from 2 separate works and from citing sources that aren't directly relevant to the topic at hand. It makes it really straight forward: CSB isn't talking about suicide bags, so it's irrelevant to this article. That should save us from wasting time arguing about sources that are unlikely to be useful for anything other than POV pushing. Yes, I have access to the full text of Kleespies (and pretty much any academic journal) through the library at work. I'll respond to your comment on Talk:Suicide bag after this and C&P some quotes from Kleespies.
 * : "Mr. Ogden is director of the Farewell Foundation, which advocates for assisted suicide." Source. <b style="color:indigo;">PermStrump</b> (talk) 00:30, 14 May 2016 (UTC)
 * So? Being employed in your field of expertise is not a conflict of interest for that scientific field.  If it were, then we'd have to stop citing prominent world experts in nearly every subject.  No more citing Peter Piot on infectious diseases, for example, because he's running a non-profit organization that relates to to his scientific expertise.  WhatamIdoing (talk) 04:11, 14 May 2016 (UTC)
 * I don't know if Peter Piot is, but I assume you mentioned him because he's well accepted an expert in his field by other exerts in his field, which is not true of Ogden. He's one of few adherents to a view well outside of the mainstream in his field (aka WP:FRINGE) that he has some financial and much personal investment in. I didn't say he can't be cited in that article or any other article, but when it comes to this topic, it needs to be properly contextualized and his statements can't be given false weight. <b style="color:indigo;">PermStrump</b> (talk) 15:22, 14 May 2016 (UTC)
 * You keep saying that, but the reliable sources keep saying things like "internationally known assisted-suicide expert", "a world-leading researcher", "a respected social scientist doing research on illegal behavior", "one of the world’s foremost experts on assisted suicide" who "altered fundamentally the way the situation is looked at". So unless we're redefining this to mean "the mainstream of the field, counting only people who agree with the One True POV™", then I think we're going to have to give up on calling him FRINGEy or "outside the mainstream".  He is definitely too accepting of suicide to please the pro-life people, and he is reportedly too restrictive to please the right-to-die people, but I checked about a dozens news sources, and I didn't find a single one that said he was anything other than a prominent researcher doing fairly good work in the legally fraught field of (sometimes) watching people commit crimes (i.e., watching people assist in a suicide attempt, when their assistance is illegal in that jurisdiction).
 * My mind is open on the point, but if you want me to change my mind, then you need to come up with some reliable sources (=not merely a repetition of this unverifiable assertion) that say he's not an expert. You might start with Canadian political sources; since he and his research has influenced every piece of Canadian legislation about assisted suicide for years, you might be able to find a political hatchet job in any magazine that opposed the legislation.  If it's not there, it's probably not going to be in any standard news source.  WhatamIdoing (talk) 04:19, 15 May 2016 (UTC)
 * I'm not sure what the question is anymore. He's "in-universe" as evidenced by the fact that he founded Farewell Foundation. No other scholars call him an expert. The only people who call him an expert are a few journalists, and even then they're calling him an expert in "assisted suicide", which isn't even a field of anything. (notability vs acceptance). There's also his legal conflict of interest:
 * —PermStrump ( talk )  09:39, 15 May 2016 (UTC)
 * —PermStrump ( talk )  09:39, 15 May 2016 (UTC)
 * —PermStrump ( talk )  09:39, 15 May 2016 (UTC)

This is a a silly, fatuous, vexatious charge. Russel Ogden IS an expert in the field of assisted suicide and voluntary euthanasia, as his long list of Pubmed indexed studies into this field show objectively. Not only is he called an expert in the field of assisted suicide by numerous major news sources, but his list of published studies into the topic, more than any other researcher AFAIK, speaks volumes. Let's stop this pointless discussion now please. Ratel (talk) 11:16, 15 May 2016 (UTC)
 * It doesn't matter if the "pro-life" people say that he's "in-universe" with the "pro-suicide" people. Ben Goldacre is "in-universe" with the evidence-based medicine people, and we don't say that he's FRINGEy or not an expert.  Having a firm opinion on a socially controversial subject doesn't change anyone's status as an expert on assisted suicide.
 * Also, there are healthcare professionals right here on Wikipedia who have "been subpoenaed". That's what happens to the victims and witnesses of a crime, not to the alleged criminals.  "Pushing for legal reform" (according to one source, his goals are to reduce the number of painfully botched suicides and suicide attempts that turn into murder, and to make it clear in Canadian law that merely sitting in the same room as a suicide attempt, especially in the capacity of a journalist or scholar, without physically trying to stop it, is not itself a crime) is not a "legal conflict of interest".  Conflicts of interest are spelled out pretty clearly in law, and they involve tangible benefits (money, goods, or services).
 * All you've proven is that he's WP:BIASED. It would hardly be surprising if a scholar in the social sciences hadn't formed a strong opinion about his subject area.   WhatamIdoing (talk) 16:33, 15 May 2016 (UTC)
 * "Assisted suicide" isn't a field of study so one can't be an expert in it. WP:INDEPENDENT says, "A third-party source is not affiliated with the event, not paid by the people who are involved, and not otherwise likely to have a conflict of interest or significant bias related to the material." See also WP:Third-party sources. Clearly not independent on multiple fronts. —PermStrump  ( talk )  05:30, 17 May 2016 (UTC)
 * yes that's true--Ozzie10aaaa (talk) 10:23, 27 May 2016 (UTC)

Proposal to merge articles about patient participation in health care decisions
I think that all of these articles are discussing the same concept by different names.
 * Shared decision-making
 * Patient participation
 * Patient-centered care
 * Participatory medicine
 * Health consumerism

I would appreciate comments on merging any or all of them at Talk:Patient_participation. Thanks.  Blue Rasberry  (talk)  19:25, 23 May 2016 (UTC)
 * Agree. SDM is the most often used term IMO. I suggest merging it all to that. Doc James  (talk · contribs · email) 21:32, 23 May 2016 (UTC)
 * I support the idea of merging these articles.
 * There's probably another set of articles, with various names that amount to "patients using the internet" that could also be merged into one sensible one.  WhatamIdoing (talk) 16:32, 26 May 2016 (UTC)


 * more opinions please(gave mine)--Ozzie10aaaa (talk) 10:54, 5 June 2016 (UTC)

‎194.74.238.137 on "Mixed affective state"
This user had removed a paragraph that was supported by a secondary source (Swann 2013) and replaced it with a paragraph that was only partially supported by a primary source (removing the secondary source), without giving the reason:

https://en.wikipedia.org/w/index.php?title=Mixed_affective_state&type=revision&diff=723351811&oldid=722383241

I partially reverted the edit, removing the poorly supported paragraph added and restored the original paragraph:

https://en.wikipedia.org/w/index.php?title=Mixed_affective_state&type=revision&diff=723434214&oldid=723388982

I made a comment on the IP address's talk page informing the user that their paragraph had been reverted and explaining why (sourcing):

https://en.wikipedia.org/wiki/User_talk:194.74.238.137#June_2016

Without responding to the talk page comment, the user changed the paragraph again, without giving the reason, messing up the formatting, and adding statements that aren't supported by the secondary source in question (while keeping the secondary source as the only source cited):

https://en.wikipedia.org/w/index.php?title=Mixed_affective_state&type=revision&diff=723529352&oldid=723478315

The user's edits are at least partially correct, but the user has not added any sources to support their statements. I'm not sure what to do, however. Please assist.--Beneficii (talk) 18:41, 3 June 2016 (UTC)
 * left note w/ IP/talk--Ozzie10aaaa (talk) 10:50, 5 June 2016 (UTC)


 * I am not sure that article should exist; i agree that the IP editor is trashing this article and the article on bipolar. have been meaning to fix it but haven' gotten there. Jytdog (talk) 10:53, 5 June 2016 (UTC)
 * Cas (or anyone else who knows about this kind of stuff), is "Mixed affective state" the current terminology for this subject? I'm not seeing many recent sources that use this exact phrase.  WhatamIdoing (talk) 19:11, 5 June 2016 (UTC)
 * I'm no expert, but a Gscholar search shows uses of the term, mostly in older sources. Again from searches, mixed episode or (bipolar) mixed state seem more common. Here is a relatively recent review that prefers mixed state. ICD-10 and DSM-IV-TR use both mixed state and mixed episode. Cyclothymia seems some part of nomenclature, too. --Mark viking (talk) 19:33, 5 June 2016 (UTC)
 * Yes we still use the term, though I tend to see it more as a hypomania/mania with dysphoric mood. I have not looked at literature or current thinking on this...and need a coffee and some uninterrupted time, hopefully later today. Cas Liber (talk · contribs) 21:01, 5 June 2016 (UTC)
 * Agree. I am not a mental health professional, but my impression from searches like this one is that the terms "mixed mania" and "mixed depression" are commonly used in the literature, and "mixed affective state" seems to fit with the pattern (e.g. ). &mdash; soupvector (talk) 22:48, 5 June 2016 (UTC)
 * about your correction I quite liked "patter". ") Jytdog (talk) 10:51, 6 June 2016 (UTC)

Taurolidine
The article about the medicine taurolidine has been rewritten by an editor whose username matches the name of a company that produces the drug,. I've left a COI message on the user talk page and reported at WP:UAA. In addition, older versions of the article are essentially the sole work of another SPA,, so that version may have COI issues as well. It would be helpful if someone from this WikiProject with expertise in this area had a look. Deli nk (talk) 12:10, 6 June 2016 (UTC)
 * Will look. Doc James  (talk · contribs · email) 12:12, 6 June 2016 (UTC)
 * Okay blocked the account in question and trimmed a bunch of the primary sources and replaced them with reviews. Doc James  (talk · contribs · email) 12:49, 6 June 2016 (UTC)

Conference spam
We discourage the use of conference "papers" to support biomedical information, but they do get mentioned and cited occasionally anyway. Under some circumstances, that might even be okay(ish). But there seems to be a world of basically fraudulent conferences out there, using impressive names or names that are trivially confused with reputable conferences, including these 160 academic conferences, which are all allegedly happening in the same hotel on the same two days next month. (The hotel has 235 guest rooms, if you're curious.) These 160 alleged conferences cover many areas, mostly tech- or business-related.

I don't know how easily we'll be able to spot this stuff. The example given is the perfectly legitimate 6th International Conference on Cyber Security vs the apparently illegitimate [ http://www.waset.org/conference/2016/07/zurich/ICCS 18th International Conference on Cyber Security], which "just happens" to have the same name. Blanking anything with a name that matches the list won't do. However, for this particular example, all of them come from waset.org, which means that we [ https://en.wikipedia.org/w/index.php?target=*.waset.org&title=Special%3ALinkSearch can find them when we have links to their website].

User:Beetstra, what do you think about putting World Academy of Science, Engineering and Technology's website on the spam blacklist, with a whitelist entry for the article about the business? These aren't likely to be accepted as reliable sources. WhatamIdoing (talk) 05:59, 6 June 2016 (UTC)
 * Hmm, I generally discourage a direct blacklisting just because it is unreliable and should not be used as a source. It does however happen that there is a good consensus among a reasonable group of editors that this is a better solution (so it becomes a community consensus blacklisting).  I would however then encourage to get such a consensus on the reliable sources noticeboard to attract people outside only one (or a few) wikiprojects.  (personally, I would not be against the idea: if a source is notoriously unreliable and its use would make those parts of Wikipedia where it is used worse, that that source could then be blacklisted.  It is however not what the spam-blacklist was made for, and that is what editors would argue against.  If only WMF XOR developers would perform the long awaited overhaul of the spam-blacklist to make a more flexible system and detach it from the 'spam' pejorative ... then this would become much easier to do/consider).  --Dirk Beetstra T  C 06:09, 6 June 2016 (UTC)
 * I would support blacklisting that. Thanks WAID. Jytdog (talk) 07:56, 6 June 2016 (UTC)


 * Support Yes as soon as you publish something you get an endless stream of emails to speak at this "fake" conferences and to publish in "fake" open access journals. They basically make money from those who speak at them or publish in them. Doc James  (talk · contribs · email) 11:55, 6 June 2016 (UTC)
 * I'll start a discussion at RSN. Dirk's right that it would be good to get other people's opinions.  WhatamIdoing (talk) 14:45, 6 June 2016 (UTC)

Some questionable edits by a new account on Swimming-induced pulmonary edema
Someone who has access to paywalled medical refs please check recent edits to the article by. There have been significant changes which appear to rely on existing references which I cannot access. • • • Peter (Southwood) (talk): 07:50, 2 June 2016 (UTC)
 * A bunch of primary sources when reviews are avaliable. Doc James  (talk · contribs · email) 16:15, 2 June 2016 (UTC)

Are Immersion pulmonary edema and Swimming induced pulmonary edema different? This is implied by the Pulmonary edema article, but what is the difference? • • • Peter (Southwood) (talk): 12:52, 6 June 2016 (UTC)
 * DAN says they are the same thing. So one should redirect to the other. Done Doc James  (talk · contribs · email) 12:56, 6 June 2016 (UTC)
 * Trimmed a bunch of primary sources. More to go. Doc James  (talk · contribs · email) 13:12, 6 June 2016 (UTC)
 * Thanks, I will sort that out. &bull; &bull; &bull; Peter (Southwood) (talk): 06:45, 7 June 2016 (UTC)
 * I see it has already been done. Thanks, &bull; &bull; &bull; Peter (Southwood) (talk): 06:47, 7 June 2016 (UTC)

Merge discussion for topics in nanomedicine
A rapidly emerging technology sector affecting some $131 B in nanomedicine product sales this year, there are several overlapping but disjointed articles here (health impacts), here (environmental concerns), here (toxicology) and here (main nanomedicine article). A merger discussion is underway. Thoughts on consolidation? --Zefr (talk) 15:02, 7 June 2016 (UTC)
 * have commented(BTW this is a projection from 2012)--Ozzie10aaaa (talk) 01:36, 8 June 2016 (UTC)
 * Thanks for the feedback here and on the merge Talk page, Ozzie10aaaa. The difficulty in obtaining accurate market numbers for nanomedicine sales is that they only appear in expensive reports, this 2015 version priced at US$6000, so only promotional summaries are generally available. The 2012 projection I used above was quoted more widely in expert reviews, whereas the 2015 report projects 2016 sales at a considerably higher value of $328 B (calculated). --Zefr (talk) 02:22, 8 June 2016 (UTC)

Copyright issues
Just a reminder when reviewing edits, no one few people make a more than 5k byte edit in one go. Therefore when you see edits such as this https://en.wikipedia.org/wiki/Special:Contributions/Pandeysandeep check them for copy and pasting issues. Best Doc James  (talk · contribs · email) 22:26, 7 June 2016 (UTC)
 * Not to go against the general point here, but I make edits that are >5k bytes on occasion. Ten or twelve references will do it. <b style="color:#F60;font-family:Times New Roman">Sunrise</b> <i style="font-size:11px">(talk)</i> 00:53, 8 June 2016 (UTC)
 * Looking there your last couple of thousand edits all edits over 5k were moves. But yah could happen. Doc James  (talk · contribs · email) 02:01, 8 June 2016 (UTC)
 * I've been known to do this too. Usually when creating a new article, though, because a whole load of refs and templates will go in at once. Opabinia regalis (talk) 02:20, 8 June 2016 (UTC)


 * Where on earth have you got no one makes a more than 5k byte edit in one go from? When I'm composing a section (or rewriting an entire article) in a sandbox prior to sending it live, I do this all the time—here's a 123kb addition if you want a particularly extreme example. &#8209; Iridescent 10:24, 8 June 2016 (UTC)
 * I stand corrected :-) I have been doing a lot of follow up of copyright issues  Doc James  (talk · contribs · email) 14:06, 8 June 2016 (UTC)

Mechanics of blood flow
Jeigu ne netaip atsiranda kraujuotakos sutrikimai širdije. Galvuoje atsiranda insuitas,tai pagal paskalo desnis ir mano mechanika ir biomechanika.{mano 111-S DESNIS tai Marcelio Atsiranda [ŠN]širdies nepankamumas, kuria rekalaujia ko grešžčio likvyduoti simptomai.TAI medicinos ir mechanikos teisioginiai ryšiai,tame tarpe prežiastiniai ryšia. Ryšai laike tampa prežaistiniai; — Preceding unsigned comment added by 193.219.55.113 (talk) 13:09, 7 June 2016 (UTC)
 * Unable to understand. G translate gives "If not, not right there kraujuotakos širdije disorders . Galvuoje occurs insuitas This is according to Pascal's Law and my mechanics and biomechanics . { My 111 -S is Marcel 's Law Appears [ HF] heart deficiency, which rekalaujia what grešžčio likvyduoti simptomai.TAI medicine and mechanics teisioginiai communications, including prežiastiniai connection. Rys time becomes prežaistiniai"
 * Doc James (talk · contribs · email) 14:39, 7 June 2016 (UTC)
 * Bing translate isn't much better "If a person who is not širdije kraujuotakos appears in the disorders. Galvuoje appears in the insuitas, the desnis and my paskalo mechanics and biomechanics. {My 111-S DESNIS it Appears [ŠN] Marcel heart nepankamumas, which rekalaujia what grešžčio likvyduoti symptoms. THIS is the medical and mechanical connections, including prežiastiniai teisioginiai ryšia. Time Ryšai becomes prežaistiniai" Sizeofint (talk) 18:32, 7 June 2016 (UTC)
 * I believe that there are a couple of typos in it, which cause serious problems for machine translation. But the overall idea seems to be about Pascal's law and the mechanical (fluid dynamics) cause and effect of blood flow on heart disease.  WhatamIdoing (talk) 18:54, 7 June 2016 (UTC)
 * And in philosophy, Marcel's Law seems to be: Anxiety and jealousy make the heart grow fonder.. --Mark viking (talk) 19:32, 7 June 2016 (UTC)

I guess this "Lithuanian" text is already autotranslation. It makes no sense at all. Hugo.arg (talk) 15:25, 8 June 2016 (UTC)

Articles on salt have taken the side of the "low salt intake is bad" camp
Perhaps the MEDRS guidelines are not sufficient to deal with controversies within the peer reviewed realm. As pointed out in this article the "low salt intake is bad" camp is arguing for a position that is untenable when considering the totality of the evidence. All they have are results of cohort studies where the statistical analysis cannot correct for confounding factors to a sufficient degree to allow such conclusions to be drawn. Such results do get published because things are done "by the book", but that should not distract from the obvious issues when drawing such conclusions. E.g. among the people who have low sodium intake there will be more frail people who don't eat much. Such effects are not going to be corrected for to the degree necessary to be able to see any effect due to low salt intake as explained in detail in the article. This has to be contrasted with the evidence that does exist about the health effects of very low salt intake from intervention studies and indigenous populations who have extremely low salt intakes. Count Iblis (talk) 01:18, 8 June 2016 (UTC)
 * User:Count Iblis would you please point to the specific articles so we can see? thx Jytdog (talk) 01:21, 8 June 2016 (UTC)


 * The main salt article is already problematic, the section on "Diet and health" obviously does have to summarize the evidence, but the way this is done makes it look like both sides have equally good arguments, while one side's arguments are far more plausible. Far more problematic are the articles Health effects of salt and Salt and cardiovascular disease as they report on the results of large cohort studies without putting these results in the context of the discussion in the scientific community where the problems that I referred to above are raised. Count Iblis (talk) 01:33, 8 June 2016 (UTC)
 * Thx, will look. Jytdog (talk) 01:36, 8 June 2016 (UTC)
 * Here we have a good review of RCTs and  And this good review.   Doc James  (talk · contribs · email) 02:17, 8 June 2016 (UTC)
 * ..Wow, the sourcing at Salt and cardiovascular disease is pretty pathetic. Results from 1971 treated as current? It certainly needs some attention. LeadSongDog come howl!  04:53, 8 June 2016 (UTC)
 * review--Ozzie10aaaa (talk) 09:59, 8 June 2016 (UTC)
 * I've seen a lot of headlines about this recently, so it's hardly surprising. It might be more efficient to wait a couple of weeks, when the media's attention has moved on to something else.  WhatamIdoing (talk) 23:30, 8 June 2016 (UTC)
 * Often true, but the article views seem pretty steady before yesterday (8 June) - sometimes the readership moves on too. There only seem 1-2 editors adding such stuff. Johnbod (talk) 03:29, 9 June 2016 (UTC)

I would like to know how I can start discussions about a collaboration between Wikiproject medicine and ISBT
I have the authority of the International Society of Blood Transfusion (ISBT) to start discussions about a formal collaboration between ISBT and Wikipedia to improve the Transfusion Medicine information on Wikipedia.

There is an international conference in September in which I would like to promote a collaboration to all working groups so that ISBT members can contribute to Wikipedia

Can you please let me know how I can develop this relationship — Preceding unsigned comment added by TransfusionDoctor (talk • contribs) 08:55, 9 June 2016 (UTC)
 * you need to speak w/ Doc James  ...  --Ozzie10aaaa (talk) 12:50, 9 June 2016 (UTC)
 * Thanks User:Ozzie10aaaa. I have emailed User:TransfusionDoctor Doc James  (talk · contribs · email) 13:19, 9 June 2016 (UTC)

Desert safety
Any hikers or desert-dwellers around here? There's a brand-new safety-related article at Arid region safety, and the editor who started it would deeply appreciate some help expanding it. Wikivoyage is much simpler than writing a Wikipedia article on the same subject: They want sensible advice, aimed at travellers and based upon experience, with no need to cite sources (although you're welcome to list sources that you recommend on the talk page). If you know a bit about safety issues in deserts and other arid regions, please "Plunge forward" and help them out. WhatamIdoing (talk) 21:45, 9 June 2016 (UTC)


 * User:Doc James has run marathons in the Sahara desert. Count Iblis (talk) 00:37, 10 June 2016 (UTC)


 * See Category:Survival skills.—Wavelength (talk) 00:50, 10 June 2016 (UTC)


 * See b:Category:Survival.—Wavelength (talk) 00:53, 10 June 2016 (UTC)

Welcome video
I just noticed this a new user's page and had never seen it. They use content about vaccines starting at about 1:15 as an example about NPOV.



How do you all feel about this? Jytdog (talk) 15:47, 2 June 2016 (UTC)
 * It is from 2010. The comments about vaccines are horrible. We are not a newspaper that goes out of its way to find two "sides" to give weight to. Will see about fixing this. Doc James  (talk · contribs · email) 16:06, 2 June 2016 (UTC)
 * Recommendation is we remove it as outdated. Doc James  (talk · contribs · email) 16:28, 2 June 2016 (UTC)
 * probably best to do so--Ozzie10aaaa (talk) 16:38, 2 June 2016 (UTC)


 * I have nominated that video for deletion here. Jytdog (talk) 11:01, 5 June 2016 (UTC)
 * A claim that the material is wrong and shouldn't be used for education is not usually accepted as a justification for deletion on Commons. WhatamIdoing (talk) 19:00, 5 June 2016 (UTC)
 * User:WhatamIdoing What can you do to help get this video taken out of use? It is a bunch of places on meta for Outreach and the Education program; help, training, bookselves, etc. Jytdog (talk) 03:38, 6 June 2016 (UTC)
 * Getting it overwritten (by something good) is likely to be the most efficient option. If anyone has a good idea for a replacement example, that might increase the chance of success.  WhatamIdoing (talk) 05:40, 6 June 2016 (UTC)
 * The reason I asked you is because your first response wasn't helpful and you work at least part time for the WMF and I thought you might know who would be useful to talk to about getting it taken down every where it has been posted and have a good one made. It appears to have been made and propagated by WMF and I assume that they paid the person who made it (who no longer works there) and paid for it to be made, and will pay someone to take it down and make a new one.  Jytdog (talk) 07:53, 6 June 2016 (UTC)
 * The file was created by a video company and uploaded by the head of the Wiki Education Foundation. I could be wrong, but the WMF is unlikely to touch it.  They try to stay out of content disputes.  WhatamIdoing (talk) 14:44, 6 June 2016 (UTC)


 * please give opinion(gave mine)for deletionthank you--Ozzie10aaaa (talk) 10:34, 6 June 2016 (UTC)

Copying Pine, who is working on a video project. Producing a replacement video for this would be helpful. Thanks, James Hare (NIOSH) (talk) 13:12, 6 June 2016 (UTC)
 * I've reached out to the uploader via email who said they would take care of taking down the video. Yay. Jytdog (talk) 18:03, 6 June 2016 (UTC)
 * Well done! I'm glad that has . I've been complaining about that very video for almost two years now: Wikipedia talk:Training/For students/Verifiability. Thanks Jytdog. --RexxS (talk) 16:34, 10 June 2016 (UTC)
 * Well done! I'm glad that has . I've been complaining about that very video for almost two years now: Wikipedia talk:Training/For students/Verifiability. Thanks Jytdog. --RexxS (talk) 16:34, 10 June 2016 (UTC)

Popular pages lists
The tool is now officially no longer maintained WikiProject_Medicine/Popular_pages Doc James  (talk · contribs · email) 21:56, 10 June 2016 (UTC)
 * I liked that. :( Jytdog (talk) 22:08, 10 June 2016 (UTC)
 * We have a new one here thankfully. It includes mobile viewership but only contains the top 5K articles and is weekly rather than monthly. Doc James  (talk · contribs · email) 22:11, 10 June 2016 (UTC)

Cutaneous leishmaniasis
There is an outbreak of cutaneous leishmaniasis in the Middle East. —Wavelength (talk) 03:09, 10 June 2016 (UTC)
 * PLOS Neglected Tropical Diseases: Old World Cutaneous Leishmaniasis and Refugee Crises in the Middle East and North Africa (May 26, 2016)
 * will look--Ozzie10aaaa (talk) 10:51, 11 June 2016 (UTC)


 * article needs more editor help/edits,thank you--Ozzie10aaaa (talk) 10:30, 10 June 2016 (UTC)

Eagle syndrome
This seems like it was written by a non-primary English speaker paraphrasing a medical textbook. It's a pretty short article. I tried to simplify the language, but I'm having to look up every other word, so I'm giving up now. Maybe someone with a better anatomy vocabulary will want to take a stab at it? :)

Eagle syndrome led me to Temporal styloid process, which doesn't have any in-line citations and this is the entire reference section: This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918), and also to Temporomandibular joint, which has been tagged as technical since 2014 (and the tag still applies). I figured I'd point those out while I'm on the topic. —PermStrump ( talk )  23:31, 10 June 2016 (UTC)
 * this could be used for Temporal styloid process, --Ozzie10aaaa (talk) 20:11, 11 June 2016 (UTC)

Heat maps
Visualization of data is useful. We have some great new tools here

Am currently trying to figure out how to get some of them to work. Doc James (talk · contribs · email) 17:04, 9 June 2016 (UTC)
 * Ooh, very nice. Hadn't seen this before. Carl Fredrik   💌 📧 22:17, 9 June 2016 (UTC)
 * Not working that well yet unfortunately. Doc James  (talk · contribs · email) 14:22, 10 June 2016 (UTC)
 * Cool! The syntax is somewhat complicated, but they seem to work as advertised. Boghog (talk) 15:45, 10 June 2016 (UTC)
 * Nice, I am saving this one for later. Was actually thinking about making epidemiological maps somehow of the data that is available, this could come in handy. EllenvanderVeen (talk) 23:37, 13 June 2016 (UTC)

It's advocacy week in WP
New account,. -- Jytdog (talk) 04:55, 9 June 2016 (UTC)
 * actually that antibiotic is very effective--Ozzie10aaaa (talk) 10:41, 9 June 2016 (UTC)
 * Account now blocked. Doc James  (talk · contribs · email) 13:20, 9 June 2016 (UTC)
 * I mean, Cipro kills billions of E. coli..... Keilana (talk) 13:43, 9 June 2016 (UTC)
 * haha keilana!EllenvanderVeen (talk) 23:40, 13 June 2016 (UTC)

Tea tree oil
Further comments here Talk:Onychomycosis appreciated. Doc James (talk · contribs · email) 12:12, 6 June 2016 (UTC)


 * need opinions(gave mine)--Ozzie10aaaa (talk) 10:23, 7 June 2016 (UTC)
 * gave my opinions too :) EllenvanderVeen (talk) 00:17, 14 June 2016 (UTC)

What's the best online critique of Hasty's "study"?
http://www.ncbi.nlm.nih.gov/pubmed/25288710

Anybody? --Anthonyhcole (talk · contribs · email) 06:39, 12 June 2016 (UTC)
 * --Ozzie10aaaa (talk) 22:55, 12 June 2016 (UTC)
 * Ok, the first comment below is good, plus one from Lane R with other links. There was This on the Cochrane blog, by Doc James and others, with several comments also. Johnbod (talk) 15:39, 13 June 2016 (UTC)
 * Thank you both. That's what I was after. --Anthonyhcole (talk · contribs · email) 15:03, 14 June 2016 (UTC)
 * There is also this "review of the criticisms" written by Tilman Bayer. As an aside, I originally wanted to include a more scathing statement – the assessors were inadequately trained and/or incompetent at the task assigned to them. However James overruled me. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 12:42, 15 June 2016 (UTC)

New Wiki-GLAM Project at the Wellcome Library
The Wellcome Library and Wikimedia UK are jointly supporting a Wikimedian in Residence. For those unfamiliar with the Wellcome Library, as per their website they are "one of the world's major resources for the study of medical history... [and] also offer a growing collection of material relating to contemporary medicine and biomedical science in society."

We'd love for WikiProject Medicine members to get involved. For example, you could:


 * 1) use one of the thousands of images uploaded to Wikimedia Commons to illustrate an article
 * 2) use some of the library's digitised materials to write an article
 * 3) get involved with editathons by attending, suggesting pages to be added, or events to compliment the editing (the main theme of the residency will be history of mental health and psychiatry, but we're happy to support other contributions too!)
 * 4) … or something else – feel free to suggest things!

Please get in touch via the project page or my user page if you'd like to get involved in any way. Zeromonk (talk) 10:56, 14 June 2016 (UTC)
 * great opportunity--Ozzie10aaaa (talk) 10:58, 14 June 2016 (UTC)
 * Very exciting!, given the multi-disciplinary scope of mental health, you may also want to cross-post to Wikipedia talk:WikiProject Psychology. —Shelley V. Adams ‹<small style="display:inline-block;vertical-align:middle;font-size:70%;line-height:1em;">blame credit › 14:37, 14 June 2016 (UTC)
 * Some of these images are excellent. Have begun adding. Big thanks to all those involved User:Zeromonk. Doc James  (talk · contribs · email) 20:30, 15 June 2016 (UTC)

News story about medical content
Getting medical info from Wikipedia isn’t always a bad idea...
 * Barbara (WVS) (talk) 18:19, 15 June 2016 (UTC)
 * another--Ozzie10aaaa (talk) 21:24, 15 June 2016 (UTC)

Empty nose syndrome
Some fierce battles going on there and the article protected and a request for MED folks made via a tag on the article. Jytdog (talk) 09:39, 7 June 2016 (UTC)
 * Currently protected. Doc James  (talk · contribs · email) 15:26, 7 June 2016 (UTC)


 * I'd really appreciate some help from some otorhinolaryngology folks in getting the article into something that resembles scientific consensus. It risks becoming an advocacy page for a particular view of the syndrome. Is there a way to call for help specifically from people with expertise in the field? Dubbin u &#124; t &#124; c 08:07, 8 June 2016 (UTC)


 * See Template:Expert needed.—Wavelength (talk) 05:26, 16 June 2016 (UTC)
 * It has usually been my experience that this template does not attract responses from experts. WhatamIdoing (talk) 05:16, 17 June 2016 (UTC)

After a sudden onflux of new users who identify as ENS sufferers, I found a forum posting directing people to the page. I am now the subject of considerably vitriol there and a Facebook has apparently also been mobilised. I am doing what I can to keep the discussion productive and civil. Any help would be appreciated. Dubbin u &#124; t &#124; c 12:43, 8 June 2016 (UTC)
 * There were three recent reviews so I used them to rewrite the whole thing. Please review if you like, folks.  But we may be in for an onslought from internet forums which are apparently an important source of support for people with ENS, so eyes at least will be useful.  Doc James has added some protections. Jytdog (talk) 15:19, 8 June 2016 (UTC)
 * I was doing a trawl through PubMed and Trip database at the same time. There seems to be something to the syndrome, and opinion seems to have shifted on the issues over the last few years, but there aren't many secondary sources that I could find. I suspect that a group of advocates have coined a catchy phrase for "iatrogenic atrophic rhinitis" and it's caught on. There's nothing wrong with that, but it results in a lack of breadth of sources that would lead to good secondary reviews. I've watchlisted the article anyway. --RexxS (talk) 17:50, 8 June 2016 (UTC)
 * I was doing a trawl through PubMed and Trip database at the same time. There seems to be something to the syndrome, and opinion seems to have shifted on the issues over the last few years, but there aren't many secondary sources that I could find. I suspect that a group of advocates have coined a catchy phrase for "iatrogenic atrophic rhinitis" and it's caught on. There's nothing wrong with that, but it results in a lack of breadth of sources that would lead to good secondary reviews. I've watchlisted the article anyway. --RexxS (talk) 17:50, 8 June 2016 (UTC)


 * Kuan EC, Suh JD, Wang MB. Empty nose syndrome. Curr Allergy Asthma Rep. 2015 Jan;15(1):493. Review.  (excellently done)
 * Leong SC. The clinical efficacy of surgical interventions for empty nose syndrome: A systematic review. Laryngoscope. 2015 Jul;125(7):1557-62. Review.  (really excellent, Cochrane style)
 * Sozansky J, Houser SM. Pathophysiology of empty nose syndrome. Laryngoscope. 2015 Jan;125(1):70-4. Review. - By one of the advocates for the condition.  Still remarkably not woo.
 * Coste A, Dessi P, Serrano E. Empty nose syndrome. Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Apr;129(2):93-7. Review.
 * Hildenbrand T, Weber RK, Brehmer D. Rhinitis sicca, dry nose and atrophic rhinitis: a review of the literature. Eur Arch Otorhinolaryngol. 2011 Jan;268(1):17-26. Review.
 * Payne SC. Empty nose syndrome: what are we really talking about? Otolaryngol Clin North Am. 2009 Apr;42(2):331-7, ix-x. Review.
 * Jytdog (talk) 17:56, 8 June 2016 (UTC)

Straw poll on COI editing
The other day, a medical journal editor asked me if Wikipedia is being manipulated by pharmaceutical or device manufacturers, and I told her there's no way of knowing for sure, short of a confession, and to the best of my knowledge no one's confessed. It did make me wonder, though, what the general feeling was here. Do you suspect there are shills at work on Wikipedia? (Let's not argue the point here, I'm just wondering about your level of suspicion/conviction, if any.) --Anthonyhcole (talk · contribs · email) 12:31, 22 May 2016 (UTC)
 * in terms of pharmaceutical or device manufacturers they probably (unfortunately) see opportunity, since their goal is to "make a profit", they most likely come at us w/ multiple accounts,there simply aren't enough people to handle COI, we need to be more proactive to stop them(when they sign up-directly ask if they have COI and if so... deny them access...IMO)--Ozzie10aaaa (talk) 13:09, 22 May 2016 (UTC)


 * We have strong evidence of editors targeting specific companies/drugs/treatment plans, even with a proven COI. It is possible that these simply act out of poor judgement, not realizing that Wikipedia abhors COI, but I think it's very naive to think that is always the case. We will likely not see any true confession, as it is not illegal and the editor only needs to create a new account. While not pharmaceutical in nature, there is at least on user who has confessed to paid-editing who worked on medical topics: User:FergusM1970. Carl Fredik   💌 📧 13:55, 22 May 2016 (UTC)
 * Sometimes an editor has a more obvious COI due to their username, e.g. this exchange. Scray (talk) 15:09, 22 May 2016 (UTC)
 * It's likely happening. My impression is that editors are likely choosing to hide their coi as best they can rather than disclose, but it's just an impression from the lack of disclosures I encounter in these type of articles vs other topics. My solution is to mention WP:COI to every new editor that I contact. --Ronz (talk) 16:41, 22 May 2016 (UTC)
 * Within central topics the issue with company editors is small. At the smaller / less central topics company editors are fairly common. We got a write up about it here http://www.theatlantic.com/business/archive/2015/08/wikipedia-editors-for-pay/393926/ Doc James  (talk · contribs · email) 17:31, 22 May 2016 (UTC)
 * I've seen occurrences on dietary supplements and phytochemical articles where developing consumer trends and marketing opportunities evolve readily from misinformation spread by celebrities and quacks. It requires an editor to keep skepticism sharp, apply WP:5P1 and WP:5P2 and adhere to WP:MEDRS sourcing if clinical efficacy is claimed. --Zefr (talk) 17:45, 22 May 2016 (UTC)
 * The FDA wrote rules a few years ago on what the manufacturers/marketers of regulated drugs can and can't say on social media sites (Wikipedia counts as social media), and that encourages a certain amount of caution. We have occasionally had a few good pharma contributors, including some from GlaxoSmithKline who identified their employer in their usernames, years before that option was even explicitly permitted in the username policy.  In my experience, pharma contributors are rare, scrupulous about following the rules, and very happy to supply sources.  I don't remember encountering any device manufacturers (which is too bad, because there's much to say about those products, and overall less risk of problems with clinical efficacy claims). But AFAICT there are no such regulatory rules for sellers of dietary supplements or alt med products, and that's an endless problem area.  WhatamIdoing (talk) 21:13, 22 May 2016 (UTC)
 * We had a device manufacturer quite recently, and nutriceuticals and alt-med is rife with them, and they are allowed to continue despite that. I hold extremist mainstream views mind you. -Roxy the dog™ woof 21:17, 22 May 2016 (UTC)


 * Interesting. Thank you all. I'll point her to this thread. --Anthonyhcole (talk · contribs · email) 01:56, 23 May 2016 (UTC)


 * I find that I come across very little COI editing from bigger pharma/biotech companies about the companies themselves.  I have seen promotional editing around new drugs, especially mAbs for cancer, some of them from bigger companies.  But mostly it is startups (see for example Alacris which is undergoing AfD now) or smaller companies (see Talk:Peregrine Pharmaceuticals) - and often this takes the form of hyping clinical trial results.  Reagent companies do it too.  We had an article created (pretty clearly for pay) about Exon Bio's mAb-making platform and then another editor spammed wikilinks to that article into several others.  Medical device companies are the most aggressive.  I actually emailed the founding scientist of a MED-EL as their employees were pretty relentless adding content about their devices and how they work into Wikipedia and to their credit, the spamming stopped.  And the Atlantic article tells about James' experience with Medtronic.  Yes the dietary supplement space is pretty rife with conflicted editing.
 * Two other things I want to mention about WP that no one else has yet. The first is that advocacy editors are a huge problem - no one can quantify if people with a financial COI or who are advocates harm WP more, but both are a big problem.   In the medical space, we see that especially with people upset about side effects.   All our articles about Quinolones had been extensively worked on by someone who disclosed on-wiki that he was head of a patient advocacy group and had made those articles into horror stories; an editor who is no longer here cleaned most of that up. Likewise we get folks wanting to dramatically emphasize side effects of SSRIs (especially sexual side effects).  Likewise articles about circumcision have been beset by people opposed to the practice.  Lots of the alt-med issues arise from advocates, perhaps more than from people with a financial COI.  We have had super fierce battles about chronic Lyme for example and our article about acupuncture is a militarized zone.  And very recently we have had .. what shall i call them, bio-hackers maybe? -- writing all kinds of promotional how-to content about nootropic drugs.
 * The other thing I want to say is that I think most everybody in WP:MED is very watchful and I think we do a pretty good job keeping promotion and advocacy out of our articles. Article maintenance is a ton of work.  WAID will not like it that I say this, but one of the beneficial "side effects" of our strong sourcing guideline is that generally it is hard to get lousy (i.e. driven by promotion or advocacy) content about health into WP because generally MEDRS sources won't support it.  The strong sourcing guideline along with our active maintenance is powerful.
 * Finally, Anthony one thing I would love for your journal editor friend to be aware of, is that when they publish reviews that make claims that are really not supported by the work that has been done in the field this harms Wikipedia.  Everything in WP starts with sources, and when those articles enter the literature, they are MEDRS sources, and we are stuck with them and advocates use them like hammers.  I for one am very grateful for high quality medical editing. I don't know if your friend is aware of how dependent we are on the work he/she and their colleagues do.  Jytdog (talk) 03:42, 23 May 2016 (UTC)
 * Talking about people (very probably) involved in litigation coming here - a fresh example: Special:Contributions/Enmeshed. Jytdog (talk) 05:00, 31 May 2016 (UTC)


 * There is no instance in the popular Wikipedia community consciousness of any medical organization corrupting Wikipedia content, or even attempting to do so. There are hardly any examples of any medical organization engaging Wikipedia in any way that has an impact the Wikipedia community would recognize. I am aware of numerous claims outside the Wikipedia community among advocates of alternative medicine that Wikipedia is controlled by agents of big pharma that wickedly add evidence-based medical content to Wikipedia as a way to suppress the public availability of alternative medicine. I really wish the big pharma shills would come here and do that, but have seen no evidence that this happens. The rumors that circulate complain about regular Wikipedians in this forum, and not unknown actors, and I think no one in this forum is suspected by other forum members to be a secret big pharma spy. The rumors are based on a misunderstanding that regular Wikipedians are commercial actors.  Blue Rasberry   (talk)  19:34, 23 May 2016 (UTC)
 * Of course Big Pharma don't go out of their way to discredit alt med. Alt med products earn Big Pharma billions of dollars each year, often through specialist alt med companies that are owned by major pharmaceutical companies. Giant pharmaceutical firms actually own the bulk of the industry. Pfizer owns Centrum, Bayer owns One a Day, and Procter & Gamble owns supplement maker New Chapter; See also. Adrian J. Hunter(talk•contribs) 10:22, 6 June 2016 (UTC)
 * I think you are confusing alternative medicine with the dietary supplement business. The two are ENTIRELY different. — kashmiri  <sup style="font-family:Candara; color:#80F;">TALK  18:55, 6 June 2016 (UTC)
 * Well, there's certainly some overlap. Shark cartilage pills are sold as dietary supplements, but that's alt med.  It probably makes sense to think of it on a continuum that runs from mainstream medicine through dietary supplements and out to the fringiest ends of alt med.
 * But I don't think I'd describe mainstream brands of basic multivitamins as "alt med". "Anti-evidence med", maybe, but still mainstream.  WhatamIdoing (talk) 03:45, 7 June 2016 (UTC)
 * All I'm trying to say is that Big Pharma has no financial incentive to support our mission, because they profit tremendously from an ignorant and gullible public. That's true whether they're selling plausible but discredited "mainstream" products (antioxidants?) or patent nonsense (chlorophyll tablets). Adrian J. Hunter(talk•contribs) 02:53, 11 June 2016 (UTC)
 * While I do not support "big pharma shills" coming here due to some less than positive interactions. Agree that the rumors of a significant impact are untrue. Alt med folks are unhappy with WP:MEDRS. Doc James  (talk · contribs · email) 21:38, 23 May 2016 (UTC)
 * Yes, although not always. There is a bunch of editors with a truly messianic approach, who seem to go over the top in bashing alt medicine. Look at Burzynski Clinic, it not just states that the guy is a fraud (which he likely is): the bunch of editors seem to take weird pleasure in debating every single court case, even ongoing one, in the lengthy article; at detailing every single negative mention of the clinic. Any attempts to restore balance get you attacked and reverted. I gave up long ago. That's the approach I guess which makes some question the motives of some WP editors. — kashmiri  <sup style="font-family:Candara; color:#80F;">TALK  06:39, 24 May 2016 (UTC)
 * It seems increasingly hard to get people to remember what an encyclopedia article looks like. On both sides of the alt med subject (and other controversial subjects), we have people who want to provide very lengthy expositions of every detail that supports their POV.  WhatamIdoing (talk) 01:46, 25 May 2016 (UTC)
 * unfortunately, yes--Ozzie10aaaa (talk) 09:28, 17 June 2016 (UTC)

Category:Canadian Medical Hall of Fame has been nominated for discussion
Category:Canadian Medical Hall of Fame, which is within the scope of this WikiProject, has been nominated for deletion. A discussion is taking place to see if it abides with the categorization guidelines. If you would like to participate in the discussion, you are invited to add your comments at the category's entry on the categories for discussion page. Thank you. RevelationDirect (talk) 01:23, 18 June 2016 (UTC)

give opinion(gave mine)--Ozzie10aaaa (talk) 11:32, 18 June 2016 (UTC)

Bias in MEDR sources
brings up such an excellent point that I think that it is worthy of discussion! I thought bias was assumed. Don't authors disclose their affiliations in their publications?
 * Barbara (WVS) (talk) 10:19, 17 June 2016 (UTC)
 * This sort of hits a tangent to my concerns. Bias in sources themselves is a very valid concern that everyone should take into account, but it doesn't concern bias in finding sources. I will answer above. Carl Fredrik   💌 📧 14:22, 18 June 2016 (UTC)
 * yes they do--Ozzie10aaaa (talk) 20:47, 17 June 2016 (UTC)
 * Ideally, yes, but it's actually inconsistent (cf ). &mdash; soupvector (talk) 00:29, 18 June 2016 (UTC)
 * That is an interesting source, I hadn't thought about looking for a systematic review of poor regulations — but really there was bound to be one ;). It amazes me how few know that many studies aren't actually published — and I'm going through our resource pages right now to try and summarize and point to some places to get informed, I'll definitely use this. Carl Fredrik   💌 📧 14:22, 18 June 2016 (UTC)

Doctors' handwriting
Doctors' handwriting (handwriting of doctors) seems to be a notable topic. —Wavelength (talk) 20:38, 17 June 2016 (UTC)
 * Doctor Handwriting
 * Poor handwriting remains a significant problem in medicine—Journal of the Royal Society of Medicine (December 2006)
 * Doctors' handwriting so bad it's putting patients at risk—Mail Online (May 16, 2014)
 * Doctor's illegible handwriting creating confusion, causing death—The Economic Times (April 20, 2015)
 * The truth about doctors' handwriting: a prospective study—The BMJ (December 1996)
 * The End of Prescriptions as We Know Them in New York—The New York Times (March 14, 2016)
 * Cause of Death: Sloppy Doctors—Time (magazine) (January 15, 2007)
 * The truth about doctors' handwriting: A prospective study—ResearchGate (December 1996)
 * Top authors, journals and related keywords for Doctors Handwriting—SciCurve
 * The BMJ like to do a joke "study" in their Christmas issue; I doubt much else there meets MEDRS. Johnbod (talk) 20:41, 17 June 2016 (UTC)
 * Are you really suggesting that handwriting is a medical term which requires MEDRS only? — kashmiri  <sup style="font-family:Candara; color:#80F;">TALK  22:43, 17 June 2016 (UTC)
 * In this sense, yes. Reducing iatrogenic injury is medicine.

LeadSongDog come howl!  03:24, 18 June 2016 (UTC)
 * Prescribing errors in hospital practice. British Journal of Clinical Pharmacology 2012
 * The effect of electronic prescribing on medication errors and adverse drug events: a systematic review J Am Med Inform Assoc. 2008
 * It would depend upon what you're writing. "Poor handwriting hurts patients, when they end up with the wrong drug/dose/whatever" is a medical claim, but "Doctors are popularly believed to have worse handwriting than schoolteachers" is not.  WhatamIdoing (talk) 04:42, 18 June 2016 (UTC)
 * It's a interesting topic, though there may be few statements strong enough to state it hurts patients — but there is bound to be historical analysis and sociology papers looking at why or even if it is true that they have bad handwriting. My own thoroughly unscientific theory is that its because doctors tend to take so much notes while studying/consultations/rounds that they start to write in autodidactic steganography, which noone else can read but they themselves. Carl Fredrik   💌 📧 14:14, 18 June 2016 (UTC)
 * Your theory agrees with the first externally linked page in my original post.
 * Doctor Handwriting
 * —Wavelength (talk) 15:19, 18 June 2016 (UTC)

Talk:Oxandrolone
Some more voices here would be useful. Thanks. Jytdog (talk) 21:05, 19 June 2016 (UTC)


 * more opinions(gave mine)--Ozzie10aaaa (talk) 08:32, 20 June 2016 (UTC)

Haemophilia
should any editor have the time, the above article could use some help/edits,(as well as related articles below) thank you--Ozzie10aaaa (talk) 10:30, 21 June 2016 (UTC)


 * Coagulopathy
 * Haemophilia A
 * Haemophilia B
 * Haemophilia C

GLILD draft
New to Wikipedia. Be grateful for opinions and edits on my draft talk GLILD. Dr John Hurst (talk) 06:24, 20 June 2016 (UTC)
 * Draft:Granulomatous-Lymphocytic Interstitial Lung Disease (GLILD) Jytdog (talk) 06:25, 20 June 2016 (UTC)
 * Welcome!  We generally source articles about health from recent reviews in the biomedical literature (I set a banner on Talk page, which produces this search) or statements by major medical bodies.  That is described in WP:MEDRS.  Also please see WP:MEDMOS generally for style, and the section on typical sections we use for articles about conditions.   Again, welcome! Jytdog (talk) 06:38, 20 June 2016 (UTC)
 * The article says that no guidelines exist and that the scientific evidence is limited to retrospective case studies, and review articles on the specific subject are few and far between.
 * The regulars at WT:MEDRS may recall that I regularly mention the problem of trying to apply a one-size-fits-hypertension-and-breast-cancer guideline to rare diseases. Well, GLILD is an uncommon complication of a rare disease.  It affects about one in a quarter-million people in developed countries.  You are an order of magnitude more likely to get hit by a lightning strike next year than you are to develop this condition.  And if you're trying to figure out how difficult "reviews only" sourcing can be for something like that, I'll point out that PubMed finds only nine (9) review articles on lightning injuries published during the last five years, and this is even rarer than that.
 * The PubMed link you created gives an error message, because it finds no reviews during the last five years. If you do a manual search with somewhat less specific terms, you'll find the Verma review (which has been repeatedly cited in the article) and one by Prasse  that might be interesting (or might say the same things as the already cited sources).  There are also a few reviews of CVID that mention this complication at least briefly (but, again, might not add any actual information).  Overall, however, I think that this is one of those situations in which we really do have to accept the evidence that actually exists, rather than the evidence we (and all patients with this life-shortening complication) wish existed.  When it comes to very rare conditions like this, our sourcing guidelines do not mesh well with reality.  WhatamIdoing (talk) 07:16, 21 June 2016 (UTC)
 * I don't know what is going on with your browser WAID, but that search produces 3 reviews, 2 in English and one in French, every time I click it:
 * Verma N, Grimbacher B, Hurst JR. Lung disease in primary antibody deficiency. Lancet Respir Med. 2015 Aug;3(8):651-60. Review.
 * Hadjadj J, et al [Lung disease in adult common variable immunodeficiency]. Rev Mal Respir. 2015 Dec;32(10):991-1001. Review. French.
 * Fernández Pérez ER. Granulomatous lymphocytic interstitial lung disease. Immunol Allergy Clin North Am. 2012 Nov;32(4):621-32. Review.
 * - Jytdog (talk) 08:30, 21 June 2016 (UTC)
 * I get "Quoted phrase not found." WhatamIdoing (talk) 14:20, 21 June 2016 (UTC)
 * And not those three reviews? Jytdog (talk) 17:35, 21 June 2016 (UTC)

SciCurve
Can SciCurve (http://scicurve.com) benefit this wikiProject?—Wavelength (talk) 01:01, 15 June 2016 (UTC)
 * interesting--Ozzie10aaaa (talk) 10:18, 15 June 2016 (UTC)
 * I just did a test drive and ended up very pleased with the number of good MEDR sources that were returned. Just make sure that what ever topic you want information for include the word 'review' after the topic. Best Regards,
 * Barbara (WVS) (talk) 18:41, 15 June 2016 (UTC)
 * It gives trends for topics? Not sure how that would help... Doc James  (talk · contribs · email) 20:21, 15 June 2016 (UTC)
 * I like that you can get returns for 'review' on any med topic and that, I'm not sure exactly what you mean by trends, but I find that the number of 'cites', i.e., the number of times a review article is cited by other articles, to indicate a trend of sorts. Best Regards,
 * Barbara (WVS) (talk) 23:00, 15 June 2016 (UTC)
 * It looks interesting, and should find some use for niche topics. The map of papers is nice for a subject like "decompression sickness" where not too many papers exist - and I like the ability to zoom in using the mouse wheel. If hasn't already seen it, I'll recommend Trip database for the ease that you can select "All secondary evidence" and it matches our definitions pretty accurately. --RexxS (talk) 13:30, 16 June 2016 (UTC)
 * It looks interesting, and should find some use for niche topics. The map of papers is nice for a subject like "decompression sickness" where not too many papers exist - and I like the ability to zoom in using the mouse wheel. If hasn't already seen it, I'll recommend Trip database for the ease that you can select "All secondary evidence" and it matches our definitions pretty accurately. --RexxS (talk) 13:30, 16 June 2016 (UTC)

I'm concerned of bias here — it doesn't explain how it weights different papers to produce its top list. Is it some algorithm of relevance that depends on MESH-codes, citations, or just whichever papers support what is sold by the pharmaceutical company that pays SciCurve the most money? This is especially concerning as it gives itself out to be a source for performing systematic reviews — which it really can't be if the underlying system isn't disclosed. I would be extremely wary of using this site, simply because using its algorithms may bias which articles we or anyone else chooses to cite. Carl Fredrik  💌 📧 18:12, 16 June 2016 (UTC)


 * These links may or may not be helpful for evaluating SciCurve.
 * http://connectedresearchers.com/tag/scicurve/ and
 * http://connectedresearchers.com/online-tools-for-researchers/ and
 * http://www.chieftain.com/opinion/4691948-120/drug-marijuana-effects-health (with a link to http://scicurve.com/paper/23721532) and
 * https://scholar.google.com/scholar?q=scicurve.com&btnG=&hl=en&as_sdt=0%2C5 (with a reference to http://scicurve.com/paper/25517079) and
 * http://guides.library.illinois.edu/c.php?g=425289&p=2955135 (with a link to http://scicurve.com)
 * —Wavelength (talk) 20:26, 16 June 2016 (UTC)

I'm not sure everyone here got what my concern was: but it's about where you find sources, not necessarily the sources themselves. We should always be critical when reading a source, and when considering what it in turn has cited. But the problem is when we use these types of services such as Sci-curve or Google-scholar to find sources to cite. These are commercial actors which are under no obligation to disclose any bias in their search algorithms. Using results from their searches is akin to using a list produced by a pharmaceutical company of what they consider to be good reviews of the field. This list can be awesome and really cover most of the field, but the problem is we just don't know — they might be biased towards omitting certain negative results. A number of papers have been published on why you shouldn't use Google scholar for systematic reviews, and this argument extends to other similar commercial services which are opaque in how their weight their articles. I don't know if these are the best studies on the topic, I haven't really reviewed them or the field, but they are a start. Soupvector also raises good points about the way unpublished studies skew science, and it is a major problem — but this is a different one, akin to the FUTON bias that already plagues Wikipedia. Carl Fredrik  💌 📧 14:38, 18 June 2016 (UTC)
 * Google Scholar as replacement for systematic literature searches: good relative recall and precision are not enough.
 * Google Scholar is not enough to be used alone for systematic reviews.

Problem is that it is impossible for almost any reasonably good search engine to prove that it is unbiased. Sure it can publish its own source code. But many search engines also have some machine learning in place, which is based on search logs (what queries were written, what results users clicked on, ...). To make this transparent, the search engine would need to publish the logs and this would lead people to stop using it. 158.195.30.2 (talk) 06:40, 22 June 2016 (UTC)