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Vitamin D and COVID-19

Can I ask for more eyes and comments on this at Vitamin D. A well-respected editor has twice reverted the section which I have tried hard to give balance and due weight, when others have tried to rush in. There were a lot of primary research citations here to show the amount of interest (see the talk page). All of this is published, peer-reviewed articles, and the COVID-19 literature is moving too fast for systematic reviews. There are several narrative reviews, including one full review which unfortunately is in a Frontiers journal -- but the quality is excellent (yes I know that is my POV!) The mainstream press has picked up on this and there are articles for Time and the Times. I think we need to show the rationale for the current interest in this topic. Interestingly, pageviews went from 3000 to 7000 when the latest trial was in the press. All views appreciated! Jrfw51 (talk) 18:27, 1 October 2020 (UTC)

If the COVID-19 literature is moving too fast for systematic reviews, then it's moving too fast for inclusion in Wikipedia. There is a reliable secondary source (NICE) stating that there was insufficient evidence, so you shouldn't be using primary sources and opinion pieces to contradict it, and WP:MEDRS makes that clear. You should also take note that articles discussing COVID-19 are subject to general sanctions and when your additions are challenged, you should take it to the talk page and not simply re-insert the challenged material. --RexxS (talk) 22:51, 1 October 2020 (UTC)

I second what RexxS is putting forth. We stick to current reviews when we have them. IF warranted, it can be noted that the field is rapidly evolving. What we should not do is review the current primary sources ourselves. Headbomb {t · c · p · b} 23:15, 1 October 2020 (UTC)

@RexxS, it looks to me like you were reverting out https://pubmed.ncbi.nlm.nih.gov/32758429/ which appears to be a review article (and more recent than the NHS website, which is from June). That's probably a good source for the article to use. WhatamIdoing (talk) 00:06, 2 October 2020 (UTC)

@WhatamIdoing: it's probably easier for you to comment constructively if you read the article first. You'll find that https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398646/ comes to no conclusions and offers nothing more than the NICE statement does when taken as a whole. There is some speculation and suggestions for lines of future research, but that's all. Why do we feel the need to write stuff like As of October 2020, there are several additional published reports of case series looking at direct associations between vitamin D deficiency, COVID-19 infection and severity, but only some of these have been further reviewed. It's absolute twaddle and doesn't advance the readers' understanding of the relationship between Vitamin D and COVID-19 one iota. This is another classic case of editors trying to keep up with breaking news and when there are no sources available yet to say anything new, they decide to write "there are no sources available yet to say anything new" as if that improved the article. It doesn't. --RexxS (talk) 01:53, 2 October 2020 (UTC)

I think there's no difficulty citing PMID 32758429 (which small piece PUBMED classifies as a "review", although it is called by the journal itself "comment") — but it doesn't verify the text that was used. What this piece seems to be saying is that designing studies for measuring any impact of Vitamin D supplementation on COVID-19 is hard, and the authors suggest that there's no harm in making sure everybody takes enough anyway. I think we could reflect that. Before though, the situation where we were citing long lists of primary sources spiced up with lay press excitement was very bad, and exactly the sort of thing MEDRS was designed to quash (thinking MMR/autism?). (I believe the backstory to the current spike of interest in vitamins is some rumour Anthony Fauci is chugging large quantities of Vitamin D tablets and that this is the elites' secret method to ward off coronavirus that is being kept secret from the masses?) Alexbrn (talk) 05:43, 2 October 2020 (UTC)

PubMed doesn't classify articles. Those come from the publishers, who map their labels onto PubMed's scheme. WhatamIdoing (talk) 15:35, 2 October 2020 (UTC)

I should know that, having written the systems to generate such journal submission records (admittedly it's been a few years since I did that mind!). However, from the current description of publication types[1] it seems this particular item would be better classified as "comment" than "review". Which is not to say it's not secondary in nature and so quite useful for us. Alexbrn (talk) 16:12, 2 October 2020 (UTC)

I've skimmed it. It is technically a secondary source (i.e., a source that uses other/pre-existing sources to create its own novel content). We just have to remember that Wikipedia:Secondary does not mean good. WhatamIdoing (talk) 16:30, 2 October 2020 (UTC)

Thanks for these comments. Would someone at least correct the first sentence so the reason for this section is clear -- and allow the Editorial, and Time article. I note that some people think PMID 32758429 merits inclusion as a Review, which is why I replaced the unwanted primary articles on the associations with this. Regarding my Twaddle and the views in the last two comments, there are a lot of new sources, but then I am a scientist. I would ask you to read the backstory in the talk section where I have been the one trying to maintain WP standards. Do we allow editors to speculate on strange conspiracy theories even in the Talk pages? Jrfw51 (talk) 08:20, 2 October 2020 (UTC)

Piling up long lists of primary sources is precisely not maintaining Wikipedia standards for health content. I'm finding it hard to understand why you think it is when you've been around long enough to know better. Alexbrn (talk) 08:37, 2 October 2020 (UTC)

One of the reasons I'm staying out of editing Covid articles is the battleground that has developed there, which tends to lead editors into making polarising statements that rather over-state one side of their argument. Lets be clear "If the [--] literature is moving too fast for systematic reviews, then it's moving too fast for inclusion in Wikipedia." is baloney. Systematic reviews are a rare thing, focus on very narrow aspects of medicine, and very often (including with NICE) conclude that there isn't enough good/great evidence about things that are actually used (successfully and otherwise) in practice. Only some bits of "medicine" is evidence based, and only some of that has robust evidence that is demonstrated by a formal systematic review that can build an argument from a wide collection of well designed studies.

Many such reviews, like the NICE one conclude that none of the studies they looked at either answered the question they want or were of sufficient quality. They find "we don't know" rather than "we know it does/doesn't work". The next step from "we don't know" to giving advice (which they do) is not an algorithm but just the committee giving its personal (hopefully experts) opinions. The NICE one decided not to emphasise supplementation any more than existing advice on the vitamin. But, like the other paper cited above, they could have decided "Popping a low dose vitamin D pill won't do any harm and might help you if you happen to be deficient". I note that NICE review says "Disclaimer: The content of this evidence review was up-to-date on 18 June 2020." which is a heck of a long time in Covid."

I agree we are an encyclopaedia not a news site or TV program (which is why I get my more than enough Covid information from those). But the existence or non-existence of a systematic review does not determine "inclusion in Wikipedia". It might determine what we say, but the question of whether we say something is WP:WEIGHT. -- Colin°^Talk 09:43, 2 October 2020 (UTC)

And your absence from the attempts to maintain standards in COVID-19 articles is exactly why you're not qualified to comment on the issues. Let's be equally clear: when you assert that "If the COVID-19 literature is moving too fast for systematic reviews, then it's moving too fast for inclusion in Wikipedia" is baloney, you're talking out of your backside. If we don't maintain a bright line of MEDRS-compliance for biomedical content in COVID-19 articles, we'll end up filling them with every piece of crackpot speculation and unreproducible conclusion that gets generated by news media, opinion pieces and low-grade research. No thanks. The existence of a systematic review (or its equivalent in terms of statements from respected inter/national health bodies) does determine "inclusion in Wikipedia", because we should not be including lower-quality sources to debunk it. We have one that is a few months old, and we don't need you encouraging editors to contradict that by adding lower-quality sources. --RexxS (talk) 15:28, 2 October 2020 (UTC)

RexxS, I don't think you meant what you said. The comment was about systematic reviews. There are about 900 systematic reviews about COVID-19 in PubMed this morning. There are also about 250 meta-analyses and more than 6,000 (non-systematic) reviews. MEDRS does not limit articles to systematic reviews. WhatamIdoing (talk) 15:48, 2 October 2020 (UTC)

I did mean it. How many systematic reviews about the effect of vitamin D on COVID-19 did you find? What MEDRS tells us to do is find the best quality sources, read them and then write the article using those sources. What you're supporting is this: an editor spots a piece of news or primary study; adds content to the article based on that; gets reverted; then starts scratching around for better sources that might tangentially support the text they wrote. That really is not the way to develop articles. Once we have the best quality sources, we don't use lower-quality ones, so yes, in this case, MEDRS does limit the article to review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies. Hope that clarified my position for you. --RexxS (talk) 16:05, 2 October 2020 (UTC)

You really did mean that if there's no systematic review (NB: not 'some MEDRS-type source, which includes but is not limited to systematic reviews') about something, then it should not be included in Wikipedia? How many of your own contributions would have to be reverted if we applied that standard? I can't find any systematic reviews about COVID-19 pandemic in Russia, and the only systematic review related to COVID-19 pandemic in India is a preprint about mobile app downloads. There's no systematic reviews about those subjects. Would you really say those subjects should not be included in Wikipedia? WhatamIdoing (talk) 16:23, 2 October 2020 (UTC)#

Which part of "review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies" didn't you get? --RexxS (talk) 12:42, 3 October 2020 (UTC)

I guess the part I must have missed was the part where you didn't say 'when you assert that "If the COVID-19 literature is moving too fast for systematic reviews, then it's moving too fast for inclusion in Wikipedia" is baloney, you're talking out of your backside' and instead you said something like 'Well, of course we don't require systematic reviews exclusively, but we do want to see a proper review article or another similarly high-quality secondary source.' :-p WhatamIdoing (talk) 20:26, 3 October 2020 (UTC)

In my opinion, and from what I see from Colin and WAID, there is a desire supported by MEDRS to include current research (i.e. where there is no definitive review with a conclusion, but at least one review says studies are ongoing) in a neutral, clarified way - which is certainly permissible by MEDRS. We should not use "no deadline" to justify not including current information that exists - if studies are ongoing and there is no current conclusion in the literature, that should be included where appropriate sourced to a review article stating that. We do not need to wait for a systematic review to have a definitive answer on the subject to say it is being researched. If there's a (non-preprint) review from two weeks ago that says "there's no definitive answer as to the effect of vitamin D on COVID-19, but multiple studies are ongoing" then including that it is being studied for potential effects on COVID-19 in articles is both permissible by MEDRS and important encyclopedic information. Regards -bɜ:ʳkənhɪmez (User/say hi!) 16:13, 2 October 2020 (UTC)

@Berchanhimez: Take a look at the article. It already states

An evidence summary published in June 2020 by NICE for England and Wales, concluded that there was insufficient evidence to support taking vitamin D supplements specifically to prevent or treat COVID-19. It was recommended that everyone continued to follow the advice on daily vitamin D supplementation during the COVID-19 pandemic to maintain bone and muscle health.

So there's no controversy about stating the conclusions of NICE (a top-quality secondary source). What I'm objecting to, and Colin and WAID are supporting, is adding another sentence effectively stating "two months later there's still no evidence of benefit against COVID-19, but there have been more studies". How does that improve the article? --RexxS (talk) 16:28, 2 October 2020 (UTC)

No. I support using more recent, peer-reviewed secondary sources to replace this content. The article should stop using WP:INTEXT attribution to imply that only NICE believes this. Also, there are COVID-related review articles that say it's biologically plausible for Vitamin D supplementation to be helpful, since it works in similar respiratory infections, so this could be considered for inclusion. (I've left a link to one such review on the article's talk page.) WhatamIdoing (talk) 16:35, 2 October 2020 (UTC)

WhatamIdoing, I've also found doi:0.1016/S2213-8587(20)30183-2 A growing body of circumstantial evidence now also specifically links outcomes of COVID-19 and vitamin D status. and doi:10.1530/EJE-20-0665 While the data are far from conclusive in attributing a role for vitamin D in influencing the risk and outcome of this disease, it is nevertheless also clear that more research would be timely and revealing.

It seems that NICE thinks there's insufficient evidence to support, but the majority of outside articles I find say that good evidence doesn't exist yet. Keep in mind that "insufficient evidence to support" does not mean the same as "evidence against", nor does it mean that the evidence that does exist should not be included and discussed. In fact, when "insufficient evidence exists", we should continue by discussing what evidence does exist and what further evidence is necessary - this is a complete view of the subject. -bɜ:ʳkənhɪmez (User/say hi!) 16:45, 2 October 2020 (UTC)

@WhatamIdoing: You're making the mistake of thinking that "two months more recent = better". The quality of https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398646/ isn't the same standard as the NICE advisory statement IMHO, but please feel free to argue otherwise on the article talk page. I agree that there should be no in-text attribution for an undisputed fact (per WP:ASF) and I've just amended to text to reflect that. --RexxS (talk) 16:56, 2 October 2020 (UTC)

@Berchanhimez: This is an encyclopedia, whose purpose is to summarise accepted, published knowledge. It is not a discussion forum. If the best sources say there's no evidence, that's what we write. When "the evidence that exists" is only found in lower quality sources, we don't decide that we should be discussing that instead. I'd love to write all sorts of content based on my take on various sources, but that's not the job of a Wikipedia editor. --RexxS (talk) 16:56, 2 October 2020 (UTC)

RexxS, The sources don't say "there's no evidence". One source (NICE) says there's "insufficient" evidence to conclude at this time. That is not the same as "no evidence". The NICE is literally saying "we can't make a determination at this time" - thus a discussion of why is necessary in our article(s). Is there evidence, but it's not good quality/large enough? Is the evidence contradictory? What's currently being researched? You seem to be using the "insufficient evidence" to claim that it's a settled thing - and it's not.

Furthermore, when NICE disagrees with newer reviews, it's important to state what the newer reviews say with attribution. MEDRS doesn't say "we use the highest quality even if newer/other sources disagree with it". A summary of accepted published knowledge isn't provided by saying "there's insufficient evidence per one organization" - it's provided by saying "NICE found insufficient evidence in June 2020 to support vitamin D supplementation. Since that time, -summary of what reviews of newer evidence say-". Accepted knowledge changes - but as others have said, it takes time for guidelines/systematic reviews to be updated - that is why newer reviews may be used to update the information before NICE goes back and reviews its guideline. -bɜ:ʳkənhɪmez (User/say hi!) 17:04, 2 October 2020 (UTC)

@Berchanhimez: The source does say there's no evidence. You're simply playing semantics by trying to draw a distinction between insufficient and none. In neither case is there evidence of efficacy and that's what the article must say. If you want the article to discuss why, then you need to be reporting a good quality secondary source that discusses it. You are not qualified to substitute your own editorial opinion on why. You don't get to make the determination about whether the evidence is good quality, etc. In addition, a discussion of the methodology of studies of the effect of vitamin D on COVID-19 is WP:UNDUE for the Vitamin D article. The lay reader wants to know the conclusions, not the detail of how they were arrived at. I'm afraid you're falling into the trap of thinking that vitamin D ought to have an effect on COVID-19 and now you're looking for sources to support that view. --RexxS (talk) 12:40, 3 October 2020 (UTC)

RexxS, I'm sorry, but it's not "semantics" at all. Sure, the NICE source says it found "no evidence". We have at least two reputable MEDRS sources (I linked and quoted above) that disagree with the NICE statement and say that there is "circumstantial evidence", while the other says the data are "far from conclusive". Sure, NICE is allowed to state what it wants. When multiple other MEDRS disagree with NICE, it's not up to us to determine that NICE is somehow a "more solid" source.

I've never once said I think the article shouldn't state there is no current evidence directly supporting efficacy. I do, however, think you are wrong when you say that because NICE is somehow "better" in your opinion that we do not need to attribute the statement to them. NICE is one clinical guideline from one country, and review articles since then have discussed "a growing body of circumstantial evidence" which would benefit from "more research [that] would be timely and revealing". If research is ongoing that may conflict with the current (well, it's from 3 months ago, it's hardly current by now in the COVID research era) understanding, then that research has been included. I've added two sources that implicitly disagree with the NIH/NICE guidelines, and reattributed those guidelines to their organizations, as they are not universal.

I also take personal offense that you're accusing me of "looking for sources to support that view". Literally all I did was type "vitamin D COVID-19" into pubmed, filter by systematic review and meta analysis, then expanded to review when there was no useful information in the three articles the first search found. I attempted to discount potentially lower quality journals/sources, and I found two that disagreed with the NICE/NIH guidelines - both of which newer than the guidelines. The lay reader certainly would want to know what's been happening in the field since the summer guidelines. Information regarding ongoing research into the connection is certainly not UNDUE for the vitamin D article.

I'm not sure why you are attempting to fight so vehemently against including encyclopedic information on the use of vitamins. As virtually every article covering vitamin D and COVID 19 agrees, there is a strong connection between Vitamin D and the severity of respiratory infections - thus the average person is likely very interested as to the research ongoing to determine if this also applies to COVID-19. We do readers a disservice when we attempt to find the "best" without consideration for the "rest" and their relevance to the article. -bɜ:ʳkənhɪmez (User/say hi!) 03:38, 4 October 2020 (UTC)

@Berchanhimez: yes it is just semantics. "No evidence", "circumstantial evidence", and "inconclusive evidence" are just ways of saying the same thing: we don't have the evidence to make a statement. If the topic was "flat Earth", would you be arguing that it's okay to to say there is circumstantial evidence that the Earth is flat, or that the evidence for it being flat is far from conclusive? Of course not. It's just using semantics to make an implication that is unsupported by real evidence. And so it is for the effect of vitamin D on COVID-19.

Before you start referring me to articles that you've discovered by searching for "vitamin D COVID-19", you need to make sure the links work, because the first one doesn't. The second one, https://eje.bioscientifica.com/view/journals/eje/183/5/EJE-20-0665.xml doesn't say what you claim. It's a decent overview of the effects of vitamin D on a lot of things, but SARS-CoV-2 isn't one of them. Here's a selection of the conclusions it reaches about the effect of vitamin D on COVID-19:

Although not demonstrated for coronaviruses, such as SARS-CoV-2, for other viruses and other respiratory pathogens, activation of innate immunity leading to increased local 1,25(OH)2D production has been shown to enhance viral neutralization and clearance while modulating the subsequent proinflammatory response. Whether this sequence of events will be the case for SARS-CoV-2 remains to be seen.

Although these results come from studies with a variety of pathogens, viral and bacterial, the relevance of these protective actions on SARS-CoV-2 merits further investigation.

further studies evaluating the role of vitamin D in COVID-19-related cardiovascular and thrombotic events may prove critical to gaining insights into both mechanism and therapeutics.

The available clinical data, in brief, are still very preliminary with regard to vitamin D status and COVID-19 disease. Many reports, to date, have been published without rigorous peer-review, are retrospective, and only associative

An increasing number of clinical trials are being registered to investigate the effect of vitamin D supplementation or 25-OHD levels on various COVID-19 outcomes (159). Until the results of these trials are known, a prudent, general health measure is to ensure vitamin D sufficiency.

While the data are far from conclusive in attributing a role for vitamin D in influencing the risk and outcome of this disease, it is nevertheless also clear that more research would be timely and revealing.

In other words, it's a collection of speculation about the possible preventative and curative properties of vitamin D on COVID-19, based on guesswork from other diseases. There is zero evidence in that article of any effect, and it simply recommends avoiding vitamin D deficiency. How you can claim it "implicitly disagree with the NIH/NICE guidelines" is completely beyond me.

I am indeed vehemently opposed to editors reading into articles conclusions that are not there. The information in the review you cited is encyclopedic for the effect of vitamin D on many conditions, but the evidence for COVID-19 isn't there. There's no disagreement about the value of vitamin D in combating many respiratory diseases, but you are synthesising by extrapolating that to include COVID-19. for which there is no evidence. The average person is interested in a lot of things – you only need to check YouTube for the latest conspiracy theories: – but we do our readers a disservice by feeding them misinformation that is not based in fact. Here's what WP:MEDASSESS tells you: Even in reputable medical journals, different papers are not treated as of equal value. Studies can be categorized into levels of evidence and editors should rely on high-quality evidence, such as systematic reviews. Lower quality evidence (such as case reports or series) or non-evidence (such as anecdotes or conventional wisdom) are avoided. ... Do not reject a high-quality type of study ... in favor of a source from lower levels of evidence ... because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. I can't be any clearer than that. --RexxS (talk) 15:29, 4 October 2020 (UTC)

There are three aspects to Vitamin D and COVID-19 that I think need separating: (1.) Has there been public interest in the topic? (2.) Is there reliable scientific evidence of any association for vitamin D levels on incidence, severity and outcome? (3.) Is there high quality consensus evidence that giving vitamin D will benefit people with or at risk of infection? MEDRS is clearly important for 3. I believe other types of review should address the scientific aspect. Jrfw51 (talk) 17:54, 2 October 2020 (UTC)

(1.) This is an encyclopedia, not a newspaper. We report the accepted mainstream view of reliable, published work. "Public interest" is not a factor in that.

(2.) No evidence for COVID-19.

(3.) No evidence for COVID-19. Beware of WP:SYNTH.

The effect of vitamin D on COVID-19 is a biomedical claim and it requires MEDRS sources in every case. The scientific aspect of the putative effect of vitamin D on COVID-19 is WP:UNDUE for vitamin D. The article uses the best quality sources we have, and summarises them. No matter how much you think vitamin D ought to have an effect on COVID-19, without the high-quality secondary sources to support that, you've nothing to add to the article. --RexxS (talk) 12:40, 3 October 2020 (UTC)

For (1), public interest is very much a factor, but it's an indirect factor. Public interest determines in whether we'll be able to find sources about the subject. Also, as a practical strategy, if everyone's talking about ____ this week, then mentioning ____ in the article tends to discourage people from adding bad information about ____.

For (2), there's a difference between Vitamin D supplementation and Vitamin D levels. I believe it's generally accepted now that people with low Vitamin D levels are statistically worse off (more likely to get infected, more likely to die) than people who have naturally high Vitamin D levels. WhatamIdoing (talk) 20:43, 3 October 2020 (UTC)

RexxS, WhatamIdoing, I'm old enough on Wikipedia to remember Theralizumab (aka TGN1412), which much like a mini-series Covid, dominated the British news for several days. The lives of six volunteers hung in the balance as we watched in horror at a clinical trial gone terribly wrong. Within a few days the article was created and expanded to this. Our readers, having followed the news, turned to Wikipedia for more information on the topic. I dare say a few journalists did too. I made a bunch of edits along with everyone else at WP:MED. That drug was thus withdrawn at phase I level of trials, and provoked investigations into how to perform such trials and changes were made. There are no systematic reviews performing meta-analysis of the many Class I trials that showed this was a wonder drug. There is no NICE or Cochrane commentary on the evidence. It appears in no textbooks as a therapy. And yet here it is on Wikipedia. WP:WEIGHT is not determined by the weight of systematic reviews, and only a tiny bit of Wikipedia content and our readers are interested in the very specific aspect: does it work or doesn't it, which is largely what concerns such reviews. They are interested in these treatments because a president is advised to take it by his world-leading doctors in a world leading hospital. Because it is part of a very important Covid trial in the UK. We are all impatient for an effective treatment so we can stop worrying about our elderly or sick relatives or hearing of it devastating communities in some countries. Because the first 15 minutes of every 30 minute news program discusses it. Because it makes the front page of every news website every day. Because the share price of pharma companies will swing wildly on any promising results. And because the entire global stock market will rise and fall with the good or bad outcomes of any one of these promising therapies. -- Colin°^Talk 09:21, 4 October 2020 (UTC)

Both User:Berchanhimez and User:RexxS have put words into my (and WhatamIdoing's) mouth, claiming I am advancing a position I have not made. I am not directly supporting any specific text or source or version, nor am I "encouraging" any editor to do so. RexxS, defending the "bright line" does not mean we have to tell "lies to the children" to make them stop messing with an article. Nor is it necessary to quite so personally hostile towards those who disagree with you. -- Colin°^Talk 19:01, 2 October 2020 (UTC)

You're a fine one to talk about being personally hostile. Think about that before you call my opinion "baloney" next time. Pot, meet kettle. --RexxS (talk) 12:40, 3 October 2020 (UTC)

If we do talk about Vitamin D and its relationship to COVID-19, we should make sure the discussion is balanced. e.g., by including references to the risks of too high vitamin D. The "Frontline COVID Guide" (see section on "Looking for COVID-19 sources" above) put together by frontline physicians around the world does not mention any vitamin other than vitamin C. So I don't think that the importance/notability of "Vitamin D and COVID" is very high - not high enough to warrant getting ahead of expert consensus. I would vote for leaving out mention of COVID-19 and Vitamin D until the literature and secondary sources become more robust on the issue. If despite this line of consideration, we really want to write that "Vitamin D has no role in COVID-19" we should also write the same thing about all the other vitamins (except C). Jaredroach (talk) 20:46, 2 October 2020 (UTC)

References

Jaredroach, I'm not seeing where that Frontline guide mentions Vitamin C in a good way. In the document it is under "Ineffective/Likely ineffective". There are different weight considerations wrt different Covid articles and the vitamin articles. In some places, a treatment's lack of demonstrated evidence means it should not be mentioned (e.g. under a list of known treatments or prevention measures), in other places the weight of discussion in reliable secondary sources might warrant mention of why that treatment was/is proposed, along with a summary of research and the consensus expert opinion of where we are with it wrt recommendations. As with all Wikipedia, we are guided by the weight given to these aspects when writing about each different topic, in reliable sources. One Google Doc is one Google Doc, and a crowdsourced information page may well be useful but not the last word on whether we do or don't mention something. -- Colin°^Talk 21:22, 2 October 2020 (UTC)

I did not claim it was mentioned in a good way. I was merely making a case that Vitamin C was notable, and that Vitamin D was not. Infamy is a type of notability. Jaredroach (talk) 22:41, 2 October 2020 (UTC)

But notability is not established by mere mention in a crowdsourced scratch pad aimed at frontline doctors. To be honest, I'd never heard of any association with Vit-C and Coronavirus, whereas Vit-D got significant coverage and continues to be mentioned. The Google Docs page is a bit like the talk page of an article someone intends to work on. A rough collection of interesting and hopefully reliable sources, but not authoritative and barely merits the term "published". Remember also their authorship and audience is frontline doctors, so they aren't much concerned with community preventative measures or political decisions of whether people should work from home. -- Colin°^Talk 09:27, 3 October 2020 (UTC)

As a counterpoint to my own point above, the Washington Post just published this a few minutes ago (after I wrote the above paragraph): "[Conley] said the president completed his treatment “without incident,” and that Trump is also taking zinc, vitamin D, famotidine, melatonin and a daily aspirin. A team of experts is evaluating and advising the president, Conley said." If the president of the USA is taking Vitamin D for COVID-19, maybe that makes it "notable" even if not otherwise notable in the medical literature. But maybe he was taking vitamin incidentally, not directly related to his new diagnosis of COVID-19. Maybe create a brand new article on "Vitamins and COVID-19"?Jaredroach (talk) 22:39, 2 October 2020 (UTC)

What Donald Trump does/says tells us nothing of medical value, though it may be due at the article on him (which I have no intention of touching even with a trans-Atlantic length bargepole!) Alexbrn (talk) 04:46, 3 October 2020 (UTC)

I agree that generally "what Trump has taken" is of no more medical concern that what your gran did to get rid of a wart. Now Trump's gone into hospital and received remdesivir and REGN-COV2, we are perhaps seeing what a doctor might give if money was no object and they absolutely mustn't lose the patient. Our readers will likely expect Wikipedia to tell them why vitamin D was/is considered as a possible help for Covid, about the help it gives for other respiratory infections, and then about how there is no evidence, as of June 2020, it is effective for Covid, and whether research continues or has stopped. Simply reducing all that to "there was insufficient evidence to support taking" is patronising our readers and failing in our mission to educate fully. Wikipedia isn't a pamphlet that must be reduced to only the bare essentials. Wikipedia is about giving information our readers want, not about following made-up rules. Perhaps one way of thinking about it, is considering what facts a reputable newspaper journalist would want to inform their readers when covering a story. They are going to want more than "insufficient evidence". This antibody drug REGN-COV2 is in the middle of being studied for the RECOVERY Trial, has zero published results of any kind on PubMed, never mind a systematic review, and our readers will want to know about it. It would be good if Wikipedia had more about it than I can get from the Guardian article I read this morning. That would be being an encyclopaedia that was up-to-date. As I said, "If the [--] literature is moving too fast for systematic reviews, then it's moving too fast for inclusion in Wikipedia." is baloney. -- Colin°^Talk 09:27, 3 October 2020 (UTC)

Just to clarify my point about the journalist, as it wasn't clear. By "want" I meant "want to know" rather than "want to write". I meant "what encyclopaedic facts a journalist might want to find out about, so as to inform their readers when covering a story". I didn't mean everything a journalist might write, which includes interviews, speculation, local politics, etc. -- Colin°^Talk 20:29, 4 October 2020 (UTC)

Agree. People will want to ask whether vitamin D has any rational basis and if it is being studied. Jrfw51 (talk) 09:51, 3 October 2020 (UTC)

As I said earlier, Colin, you're talking out of your backside. Of course we don't attempt to keep up with the mess of preprints and primary studies that are being churned out. That's not the purpose of an encyclopedia and when top-quality secondary sources are available, we use them. That's not patronising, that's simply being responsible, and advocating for inclusion of weak information and misinformation is completely irresponsible. We should be giving our readers the best quality information, not "what they want" – they have the popular press for that. Comparing the process of writing an encyclopedia article to the work of of newspaper journalist really is a telling indictment of your attitude to Wikipedia's medical content. --RexxS (talk) 12:53, 3 October 2020 (UTC)

RexxS, your personally aggressive approach to disagreeing with others is unacceptable, and must stop. When you find yourself writing the hateful phrase "Which part of ... didn't you get", while citing MEDRS at a good natured editor with more guideline and policy experience than pretty much all of us in the discussion put together, you have lost your compass. We are supposed to be on the same side, but right now you have gone into battle with your flamethrower mounted backward. -- Colin°^Talk 20:50, 3 October 2020 (UTC)

I concur. TylerDurden8823 (talk) 04:22, 4 October 2020 (UTC)

Fwiw, I've also found parts of this thread quite painful to read. 86.172.165.218 (talk) 12:08, 4 October 2020 (UTC)

Colin, when you stop dismissing other editors' sincerely held views about suitability for inclusion – based on guidelines that have served us well for many years – by personalising them as "baloney", then you'll find you don't get push-back. Until you learn not to start a fight, you'l find yourself in a lot of them because editors won't put up with your antics. If you want to argue for the inclusion of lower-quality sources (or even for good quality sources that already duplicate the current content) then make your case, but do it without deliberately insulting those who disagree with you. There's always the possibility that you may be wrong, and until you've learned to accept that fact, you're going to have to put up with others who have valid arguments to make. --RexxS (talk) 15:40, 4 October 2020 (UTC)

RexxS, "personalising" doesn't mean criticising (robustly or mildly) what someone just said. It doesn't even mean your "you're talking our of your backside" comment, though that is a somewhat vulgar comment to make about someone and not exactly friendly or civil. No, it is where you go "your absence from the attempts to maintain standards in COVID-19 articles is exactly why you're not qualified to comment on the issues". That's a direct personal attack: you have attacked me rather than explaining why what I said was wrong. Similarly, with your aggressive "Which part of ... didn't you get", comment to WhatamIdoing, that is just a plain insult of her intelligence. You might as well written "God, I am dealing with morons" (Btw, reminder for future use, the idiom only really works with something extremely simply in the middle, like "no" or "fuck off", and falls apart if you actually insert something complicated like MEDRS inside). As for your other comments, I'm not going down that rabbit hole where you put lots of words into my mouth and I have to argue about things or motivations I didn't say or don't hold. -- Colin°^Talk 16:59, 4 October 2020 (UTC)

IP 86, this is by no means the only-- or even the worst-- example of "painful to read" personalizing on this talk page right now. The other one veers even into casting of aspersions. Relatively speaking, this one is milder than other instances seen at WPMED. I do appreciate that people are calling this out and reminding everyone to stay on track. We can do better with this Vitamin D issue, and I applaud Berchanhimez for trying. I don't get involved because I threw up my hands long ago at any notion that we can write neutral and accurate articles while they are on the mainpage in OTD or ITN. SandyGeorgia (Talk) 17:24, 4 October 2020 (UTC)

Notability is not at issue when adding content in another already-created article. Notability refers to criteria for article creation not article content. We add content when that content meets sourcing guidelines and is significant to the article.

If we cannot source content to MEDRS compliant sources in a heath related article we can't add it. If there is no compliant research yet we don't say, there is no research yet, unless that statement is result of a MEDRS compliant source. Remember, in 2 years "yet" has no meaning unless the word is tethered to a source which provides the context of date and the research showing that whatever was carried out did not provide results indicating efficacy. At no point should we be adding content on other vitamins to somehow create "balance" for Vitamin D content assuming there is any. That's synthesis and creates original research.

Wikipedia is not meant to educate our readers per se. I have never allowed my students to use Wikipedia except as reference guide. Wikipedia is a guide, as is any encyclopedia, and informative, but educating is a big step past the information an encyclopedia provides.

And again, what our readers want is not what we keep in mind when writing an article. If we go this way we will sink into a morass of what we assume a readers wants, and then the question becomes: how do you know, which readers, when do we draw the line at what we think is wanted, which editor decides what the reader wants? We are a resource for published, verifiable, reliably sourced information. That is our very simple remit. All we can do is provide a beginning place to look for information. Littleolive oil (talk) 23:11, 3 October 2020 (UTC)

Wikipedia's jargon is confusing, especially when we re-use real-world terms to mean something different. Wikipedia:Notability is about having a separate article. In this discussion, we're really talking about what's Wikipedia:Due weight for mentioning inside an article.

I think our purpose is entirely to educate people (but maybe not the narrow sort of education that involves formal instruction in an organized school setting). WhatamIdoing (talk) 00:41, 4 October 2020 (UTC)

Yes, but we confuse each other less when we use Wikipedia jargon consistently. It seemed to me, in reading this discussion, that what is being discussed is not Weight but first, whether content is compliant per our own guidelines. We can't add content on Vitamin D unless we have compliant sources. and we can't discuss how much of content/ weight until we know the content is sourced appropriately. The talk of adding other vitamins is not a weight issue but an issue of synthesis. We can't introduce other vitamins to an article on Covid or Vitamin D unless we have compliant sources that make those same connections. A further point seemed to be about allowing content that declared a lack of efficacy,"yet". We don't edit for content that says we don't have something. Wikipedia is about what we have. One of the reasons we have policies and guidelines is so that we all can apply the same language and understanding to discussions in order to reach agreement and consensus-a collaborative end product of a collaborative project. I am rigid about out policies and guidelines especially as concerns MEDRS content. MEDRS was a product of a need for strict guides on health related articles; I don't see that we should be more flexible for some reason, or that we try to guess when language is not accurate. I am still learning the Wikipedia language. I guess I expect we all are so that if clarification is needed we clarify.

Education to me applies to a deeper and more complete understanding than what we have in many articles. An encyclopedia seldom if ever contains complete or even in depth knowledge of any one subject. But I agree there is a blurred line between education and information and Wikipedia's place there. I don't think that I as an editor ever feel I am responsible for educating anyone. I am responsible for providing accurate, reliably-sourced content that is written from a neutral POV. If I go further, I risk involvement I probably shouldn't have. My opinions, such as they are, but seems to me that clarifying our own language and policies will clarify discussion. Littleolive oil (talk) 03:31, 4 October 2020 (UTC)

Colin. You are suggesting we ignore our own policies to satisfy the reader's desire to have immediate information, but that is not the remit of this encyclopedia no matter the perceived importance of the situation. While there are situations where consensus on a given article can override policy (IAR), doing so is risky; Wikipedia needs to have a consistent, very stable approach to sourcing for health related articles. You didn't address me, I know, but I was so surprised by your idea that we can override our own policies because the reader might want immediate information or even that Wikipedia might affect research in some way. We cannot assume that kind of responsibility. And this is exactly backwards. We use a source to support our content not create content to potentially impact research. Littleolive oil (talk) 11:24, 4 October 2020 (UTC)

Littleolive oil, you may be confusing policy and guideline. Our policies are at WP:V and WP:DUE; guidelines exist to help us interpret how to apply those policies. That MEDRS has strayed away from doing that (and has come to be broadly misapplied) leaves the Wikipedia in a bad way when something like COVID happens. It is POLICY that we don't override. The MEDRS problem is aggravated by COVID being ITN and OTD; I can't recall ever seeing an article recover from the hits they take when on the main page for an extended time, and anyone with a mouse can add anything they find on the Internet. (This is a particular problem in political articles; I am working on one now that has been on the mainpage nine times and has taken on POV that will be very difficult to address, because everyone with an opinion got to add undue, POV and blatantly inaccurate material.SandyGeorgia (Talk) 17:18, 4 October 2020 (UTC)

I have been using the terms here interchangeably-in the cmt before I say guideline-to make a general point about overriding policy and guideline which I'm sure was confusing. Probably would have been more careful to use both words everytime had I not been so tired. Apologies everyone for any confusion. But my points hold. I have never, ever seen MEDRS overridden and I would disagree that any guideline is simply used to support policy understanding/interpretation. That's not how I've seen it used here in all the years I've been editing. I think it's risky to override MEDRS since doing so opens the door for abuse which in health related articles is an issue. The problem with overriding MEDRS is who is going to decide we override our own application of this particular guideline and or any other guideline or policy and when. IAR and local consensus allows for that of course. If there is a change in how MEDRS is used that needs to be considered across Wikipedia. I'm not attached to any of this. I was surprised by suggestions on this page which don't coincide with Wikipedia's generally agreed upon consensus. I'm inserting this here to answer specifically my confusing post. Littleolive oil (talk)

Littleolive oil, I'm not suggesting we ignore our own guidelines, and that would be an odd thing for me to do, having helped form them. A large part of MEDRS is concerned with "efficacy": does it work or doesn't it (and are the side effects tolerable). And for that we have a pyramid of "evidence" quality with systematic reviews and clinical practice guidelines at the very top. But my point, and the mistake I think RexxS is making, is to be blinkered in thinking this is all about efficacy -- does vitamin D help with covid D or not -- and assume that if "not" or "we don't know" then we should say nothing about it at all. Saying nothing about an ineffective or unproven therapy for some obscure form of epilepsy is likely appropriate WP:WEIGHT. But Wikipedia, as an encyclopaedia, is about all knowledge, and there are scientific, political, economic and social aspects to these proposed treatments that go beyond some analysis of efficacy. The "vitamin D and Coronavirus" angle is about more than what NICE concluded in June or what those nice Cochrane folk think. Trump's hydroxychloroquine and bleach injection nonsense was a big political thing that will form an enduring part of commentary about his presidency and the relationship between the US government and medical science. There's more to the WP:WEIGHT aspect of these than just what appears in systematic reviews. -- Colin°^Talk 17:30, 4 October 2020 (UTC)

Colin. I didn't see that anyone was suggesting we use only sources that pertain to efficacy. What I understood and what I believe is that if we say something about Vitamin D not working that and specific wording has to be sourced as well. If we don't source statements about a lack of efficacy we could add anything anytime about what doesn't exist which makes zero sense to me. I have never in any health related article seen agreement to include content about health that is not RS. This is just my experience. My concern is that MEDRS is being reinterpreted which opens the door for future abuse. Littleolive oil (talk) 18:13, 4 October 2020 (UTC)

I don't think anyone is suggesting MEDRS be overridden or reinterpreted. I agree with Sandy that "MEDRS has been misused as a bludgeon and misunderstood" by some editors. Sometimes things can be looked at from many angles, and if we only look at them from one angle, and only have one tool/weapon, then I think that is unhelpful. It is also particularly important that folk just don't start inventing imaginary rules in order to win an argument, which I what I saw happening here. -- Colin°^Talk 20:18, 4 October 2020 (UTC)

Then your eyes were deceiving you, and you are attempting to reinterpret MEDRS just to score points. My criticism was clearly aimed at the misuse of primary and inappropriate sources and your repeated accusation of "in order to win an argument" is a spectacular failure to assume good faith. --RexxS (talk) 13:16, 5 October 2020 (UTC)

It is perfectly possible to criticise the misuse of primary sources without making up stuff about systematic reviews. -- Colin°^Talk 13:31, 5 October 2020 (UTC)

That was exactly what I did, and the only one making up stuff about systematic reviews is you. I was quite clear in my response to the original post: There is a reliable secondary source (NICE) stating that there was insufficient evidence, so you shouldn't be using primary sources and opinion pieces to contradict it You won't find anything made up in that. See WP:MEDPRI for the guidance I rely on. What's the guidance you're basing your accusation on? --RexxS (talk) 13:53, 5 October 2020 (UTC)

You are quoting a different sentence than the one I complained about. It is quite easy to tell which sentence I complained about, because I put it in quotes. *sigh*. -- Colin°^Talk 14:27, 5 October 2020 (UTC)

Non-arbitrary section break

I've redone Vitamin D § COVID-19 in this edit to try and make a middle ground here. I think part of the problem with this discussion here has quite frankly been that people have been treating it in two or more different extreme ways. On the one hand, RexxS is very correct that we are NOTNEWS, that we do not need to get everything right instantly, and that we must follow MEDRS to say things in Wikipedia's voice about medical statements. On the other hand, users like Jrfw51 are correct that this is being actively studied in many instances, ranging from multiple clinical trials to laboratory/literature examinations of potential cellular mechanisms. Jrfw51 is also correct that it is encyclopedic to include information about ongoing research when such research is well reported on in third party sources - and a simple google search would show anyone that the subject of Vitamin D and COVID is being discussed by many reliable sources. Headbomb is correct that for the evaluations we give (ex: "Hydroxychloroquine does not have use in COVID-19"), we need strong MEDRS compliant secondary sources, and we do not override those based on primary/"lower secondary" sources.

Colin is very correct that the weight is an issue here, and that we do not need to "wait" for systematic reviews or meta-analyses to edit an article. In my opinion, the weight of Vitamin D research section basically requires us to include more information than simply "it's not currently recommended for use based on insufficient evidence". Nowhere in MEDRS does it tell us "pick one source and don't use anything else" - we should include all due-weight information possible for the sake of completeness. For this reason, I have added a note about the fact both guidelines (NIH/NICE) recommend consideration of supplementation for those who are getting less sun exposure due to COVID-19, as well as a line about multiple review articles stating that further research is necessary before a conclusive outcome can be determined. I disagree fully with User:Littleolive oil - saying "no research has been done" or "research is ongoing" does not require a MEDRS source - that is in fact a primary statement that can be sourced to a study abstract/enrollment itself if there is one, or to a news article if there's not. Littleolive oil brings up a very good point, however, that we must qualify things such as "yet", "to date", or "currently" with specific date information.

RexxS has said multiple times that we are never to distrust the guidelines and good sources - if a guideline is wrong or incomplete, we still must use it completely, even if other perfectly fine MEDRS disagree with it. This is quite worrisome to me as it results in cases like this where literally hundreds of other sources, all saying different things, all with potentially encyclopedic information, are being ignored and not even considered for addition simply because "there's already a guideline". Wikipedia isn't a paper encyclopedia where we have to limit ourselves to one sentence on things, and Jrfw51 is very correct that we serve the reader, who is going to want to know "well, if they said that in June, what have we learned since then?" Going along with this, Jaredroach is also correct that this topic is likely to be much more viewed by readers in the short term as the news that Donald Trump was taking it (even though I haven't seen it specified whether this was because of his COVID diagnosis or if he was taking it before). In this instance, saying "it's not recommended by two organizations currently" with no further information is basically equivalent to lying by omission to readers - it's not recommended now for the public because of a lack of evidence - not because it doesn't work. Given how politicized these treatments have become, that is quite frankly something that must be considered - we must word our prose on these treatments exceedingly cautiously, as well as consider when determining due weight the impact outside of the information being considered itself.

I've seen multiple people claiming things along the line of "we don't care what the reader wants". That's, to quote Colin, baloney. Wikipedia is an encyclopedia to serve the reader - it is not a clinical practice guideline to serve medical professionals, it's not a database of current trials to list every single trial ongoing, but it is an encyclopedia - for the readers. We can still provide up to date information without violating MEDRS, and in this case that is what needed done. The simple solution here is to add what multiple review articles stated: "research is ongoing" or "more research is needed to determine a definitive conclusion". However, the amount of vitriol I've seen in this thread led to this simple solution being drowned out by what seems like 75% misinterpretation/arguing and 25% people trying to be heard above the arguing with a valid idea - I think all of us who participated in this thread need to review what happened here with an eye towards improving further interactions. Please feel free to modify my edit to the article if you see fit or further discuss it, but I encourage everyone to think about whether the section as it stands now actually does violate any policies - because I spent a good 2-3 hours mulling over the changes before making them. If anyone thinks that section as it stands has something wrong with it, please ping me here and I'll do my best to attempt to explain why my interpretation of the policies is on the side of the current version as I edited it. Hopefully this can solve this issue and give this discussion a "defibrillation" and bring it back on track to improving the article. Thanks, -bɜ:ʳkənhɪmez (User/say hi!) 14:40, 4 October 2020 (UTC)

I believe you are misunderstanding what I, at least, am saying. We never in my opinion write to the opinions of anyone. Our articles are meant for readers but the reader does not dictate how an article is written; the readers' perceived needs do not dictate how we write or add content. We can not maintain neutrality on content if we are supposing a reader wants a particular kind of information. Littleolive oil (talk) 18:25, 4 October 2020 (UTC)

We never in my opinion write to the opinions of anyone. Now this is again a misinterpretation or misunderstanding of MEDRS, overstretching it beyond Wikipedia policy. I discussed at length months ago an example with RexxS, which I never finished working on at habit cough. The consensus criteria for habit cough vs. somatic cough disorder vs. tic cough changed. The new criteria have been nothing but contentious since they were passed even by the very panel who passed them. It is impossible to describe where that debate stands today without expressing that there are different opinions held by different members of the panel. And because it is a poorly researched topic, there are not secondary sources to use exclusively without relying on the journal-published commentary from the different parties. (Well, I haven't checked in the last few months-- when I came across this many months ago that was the situation-- there may be something new by now, and I never finished fixing that article.)

Similarly, we can absolutely write that ""The most fraught decision in the management of DLB relates to the use of antipsychotic medications", according to B.P. Boot, which is a well-grounded, consensus, but nonetheless opinion. We can also write that According to Boot (2013), "electing not to use neuroleptics is often the best course of action". We can also write that According to St Louis and Boeve, firearms should be locked away, out of the bedroom. All of these are opinions, but due weight opinions expressed in the highest quality sources that require attributon. Or According to Dickson, "Lewy bodies are generally limited in distribution, but in DLB, the Lewy bodies are spread widely throughout the brain, as was the case with Robin Williams." Ian G. McKeith, professor and researcher of Lewy body dementias, commented that Williams' symptoms and autopsy findings were explained by DLB.

We write opinions all the time.

Again, that MEDRS has been misused as a bludgeon and misunderstood is part of the problem we are looking at now wrt COVID, and it's too bad we let this misunderstanding go on for so long. Guidelines are best practices, suggestions, for how we implement policies. The underlying policies cannot be overridden by guidelines. It is not a matter of IAR; it is about understanding how a guideline explains best practices in support of policy. We have become so accustomed to whack-and-delete per MEDRS, that we are now in a position of not being able to add something coherent to serve our readers explaining the situation wrt Vitamin D and COVID, although we have a real WP:DUE matter and a need to say something more than "insufficient evidence". (But we can certainly view this as a good example of the things we need to iron out, and I'm confident we can do it without insulting each other for having different beliefs.) SandyGeorgia (Talk) 20:18, 4 October 2020 (UTC)

@Sandy: yes, we do write opinions regularly, and we take care to attribute them. As you know, that's all documented at the policy WP:WIKIVOICE. But those are the opinions expressed in reliable sources, and – at the risk of putting words into Olive's mouth – she expressed concern at writing to an opinion. I took that to mean we don't write content to support or contradict a particular opinion (other than to neutrally summarise another opinion (source) that either agrees or disagrees with the first opinion, taking into account the WP:DUEWEIGHT given by the prominence of the opinion expressed in mainstream sources). I admit that I'm as guilty as anybody in strictly enforcing MEDRS in the COVID-19 articles, but considering the state that some of them were in, riddled with preprints and speculative claims based on primary sources, I don't regret my efforts. Yes, it's a pity that there's no evidence of effectiveness of vitamin D in preventing or treating COVID-19. We'd all love to have a cheap and widely-available prophylactic drug against the disease, but we shouldn't be writing something just because we all wish it were so. Unfortunately vitamin D has a long history of being hyped with unsupported medical claims (as well as concerns about Vitamin D toxicity) and major bodies like NIH and NICE are likely to be very cautious in changing their advice to ensure that the RDA is taken for reasons of general health. Perhaps new evidence will emerge and we can expand our content further, but we ought to be cognisant of the evidence that vitamin D is ineffective against many diseases that it's been touted as useful for in the past. Our article on vitamin D does a good job of giving the context to all that, and I think we should be no less cautious in dealing with the issues surrounding vitamin D and COVID-19. --RexxS (talk) 00:19, 5 October 2020 (UTC)

Ah, in that case, my apologies to Olive for going off on a tangent. And I recognize there has certainly been a good deal of whacking needed in our COVID articles. But I'm not sure my conclusion changes. There are boatloads of RS (not MEDRS) sources to tell us readers are likely to be looking for info about Vitamin D. I think we can give them something in between "insufficient evidence" and the editors who are plopping in scores of primary sources to argue a case. That is, I don't want to see us go the Cochrane route; if we followed their pattern, we'd have to gut a lot of content on their frequent "insufficient evidence" for everything they look at, according to them. If there's insufficient evidence, we can at least tell our readers more about what the issues are, and who stands where. That is, we can get somewhat into different opinions (which is what I mistakenly thought Olive was denying). It's OK to say that A holds X and B holds Y, but there is no high quality evidence to support X or Y, for example. If we take Cochrane’s view, ther is insufficient evidence for a whole lot of what is practiced. SandyGeorgia (Talk) 01:46, 5 October 2020 (UTC)

It seems to me that User:Berchanhimez deserves considerable gratitude for these efforts. As an outsider to the above discussion, I find myself agreeing with both the approach here and the well-contextualized page content. From an EBM perspective, I believe the current wording - per the actual CDC Guidelines - "There is insufficient evidence to recommend for or against taking vitamin D supplements specifically to prevent or treat COVID-19" (as introduced here) is appropriate, honest, helpful, and the sort of unbiased information that Wikipedia users should all ideally expect (and I think it's worth remembering here that, in many countries, this question may be of particular interest to people of colour, who often risk being disproportionately harmed by the disease anyway). 86.172.165.218 (talk) 15:19, 4 October 2020 (UTC)

@Berchanhimez: I have some issues with the expansion you've made to the section, particularly the part about "before a link can be ruled out" as that presupposes that the default position is that a link exists and may be ruled out (but I see someone else beat me to that). I also don't agree that either NIH or NICE needs to be attributed, because I don't accept that the content of any of the sources you added contradicts the content of the NIH/NICE statements. The first article comes closest to reaching a conclusion in support of a link, but still ends up only arguing for testing vitamin D as an adjuvant treatment. That's probably worthy of inclusion in its own right, but I still feel it's important not to "jump the gun" and make more of a source than the authors are willing to. --RexxS (talk) 16:09, 4 October 2020 (UTC)

@Berchanhimez:, thanks for your edits to the article and attempting to summarise positions. While I'm sure your text can be tweaked and editors may hold different opinions about whether to attribute positions or state them in Wikipedia's own voice, it does improve on what what there before: a big vacuum of information our readers will come here to find out. Someone recently here talked about trying to write for an intelligent young teenager. When the news mentions (as it has repeatedly done throughout the year) vitamin D and Coronavirus, ones first thought could be "Why D? Why not a B or C or E?" I'd expect Wikipedia to tell me. When the news mentions that it is an unproven therapy, my next thought might be "So are they continuing to investigate it in trials or is it just nonsense that scientists have discarded". I'd expect Wikipedia to tell me. Heck, even NICE's systematic review answers both those questions (background and ongoing studies). -- Colin°^Talk 17:51, 4 October 2020 (UTC)

I agree with your assessment, Colin, but my view would be why wasn't the NICE review used to address those questions, rather than the previous jumble of primary studies whose removal sparked off this debate? I'm happy that more quality sources have been found, even if they bring little new to the NIH/NICE statements, and my preference for WP:ASF is a minor difference of opinion compared to objections surrounding primary sources. --RexxS (talk) 18:38, 4 October 2020 (UTC)

No experienced WP:MED editor was arguing for primary sources. The fact the NICE review mentioned ongoing studies in an appendix was just a chance find, rather than something I'd expect to see in a systematic review. Perhaps it suggest all the more that the authors felt their assessment would only be relevant for a short period of time. -- Colin°^Talk 20:18, 4 October 2020 (UTC)

@RexxS: Just to correct where this started: the NICE review was prominently there and addressed the evidence for supplementation, but in response to other editors had a weaker addition. There were several narrative reviews of perhaps better quality than what is there now, and some more recent primary studies giving balance addressing the associations with incidence and severity, and confounding factors, which have now been deleted. I expect and hope we can continue to improve the content of this article with due attention to detail, WP process and good faith. Jrfw51 (talk) 18:58, 4 October 2020 (UTC)

@Jrfw51: Nice try at revisionism, but this debate was precipitated by your three edits [2], [3], [4] which contained a dozen primary and unsuitable sources – are we really using the Evening Standard for our medical information now? does a Frontiers journal really carry the weight to contradict NICE as in your text The validity of their conclusions has been criticized as new data have been published? Moreover, your edits twice introduced the text there are increasing numbers of published reports of case series showing direct associations between vitamin D deficiency, COVID-19 infection and severity. That is complete synthesis and a misrepresentation of the content of the sources you were citing, none of which concluded with any certainty that there was "direct associations between vitamin D deficiency, COVID-19 infection and severity". MEDRS applies to those efforts and yet, after being reverted, you still twice reinserted the disputed content. You're lucky you're not topic-banned from editing articles under the COVID-19 general sanctions. Let's see how many of the editors here leap to defend those three edits in their entirety instead of focusing on the sideshow about a single one of those sources. Colin, WAID, anybody? --RexxS (talk) 20:01, 4 October 2020 (UTC)

Thank you. I know these articles well and asked for further comments. I am pleased to have yours as I am sure you are now familiar with the evidence. My insertions were modified to try and comply with block deletions and I know each can be criticised as imperfect. Too many citations (or primary articles) can be seen as overdue weight; too few as being synthesis or original research for a summary, as in there are increasing numbers of published reports of case series showing direct associations between vitamin D deficiency, COVID-19 infection and severity. We have lost information about multivariate analyses including ethnicity, obesity, and vitamin D binding protein polymorphisms. This is not just about whether taking a supplement is recommended. Jrfw51 (talk) 20:31, 4 October 2020 (UTC)

RexxS, that's such a deeply unpleasant and threatening paragraph. Jrfw51 I don't think you will find support here for citing primary research studies or newspaper articles to support medical claims. -- Colin°^Talk 20:59, 4 October 2020 (UTC)

Thank you for your comments @Colin: -- and your civility. Newspaper articles were there to show public interest not medical fact. Many "primary" sources were actually narrative reviews or primary sources which I felt updated the reviews we had. I will return to scientific writing elsewhere and remember that writing this has different rules and social norms. Jrfw51 (talk) 11:12, 5 October 2020 (UTC)

@Colin: it's such a pity that your only condemnation is of my listing of the problems caused by Jrfw51's edit-warring. Your personal animosity to me is so great that you couldn't even bring yourself to criticise the behaviour of twice re-inserting that unsupportable text. You have done nothing to defend the integrity of our sourcing guidelines. If you can't help solve those problems, at least you might have the decency not to take cheap shots at the folks who are trying to. --RexxS (talk) 23:23, 4 October 2020 (UTC)

And more personal attacks from you. I commented on something that was written here that was wrong. It is important at WP:MED that when discussing sourcing, and reminding others of sanctions, that we don't just start inventing rules on the fly to win an argument or state things that aren't true, and quite obviously aren't true if you look around at other articles and topics. I did so without claiming anyone here was unqualified to comment due their personal activity choices, or calling anyone foolish with vulgar language, or explicitly insulting anyone's intelligence, or suggesting anyone here has "great" "personal animosity", or openly speculate about their bad faith motives. -- Colin°^Talk 09:24, 5 October 2020 (UTC)

It's typical of your style of argument that you label every criticism as a "personal attack". You called something quite accurate that I wrote "baloney", and you've doubled down on that attack consistently. It's especially important for articles under general sanctions that we scrupulously adhere to our agreed standards for sourcing; and it is obviously true from both WP:NOTNEWS and WP:MEDRS that when primary literature is being produced too fast for the secondary literature to catch up, we wait for the secondary literature. There is nothing "made up" or "untrue" about that. Your denial of our policies is not helpful, and encourages editors to write content based on unreviewed and preliminary sourcing – quite unsuitable for our medical articles. You know better, but it leaves the impression that you are taking that line simply to attack my attempts to remind another editor of the sourcing standards that apply. Your personal animosity is quite real and does you no credit. You are also well aware that no Wikipedia editor, yourself or myself included, is qualified to analyse primary sources, and we have clear guidelines that insist on that, yet you choose to criticise me for pointing that out. How can I be expected to AGF your comments to me in the face of so much overwhelming evidence to the contrary? I've done you the courtesy of quoting the policies and guidelines that support my stance, while you have simply made your contrary proclamations in an ipse dixit manner. Where's the policy that you are relying on for calling my statement baloney, or are we expected to accept your statements as infallible truth? --RexxS (talk) 11:56, 5 October 2020 (UTC)

RexxS, many moons ago, you could have written, "Yeah, that line: 'If the COVID-19 literature is moving too fast for systematic reviews, then it's moving too fast for inclusion in Wikipedia' line seemed like a great soundbite when I wrote it, but I agree with you all here that it doesn't really stand up to scrutiny and I could have explained my position much more clearly." -- Colin°^Talk 12:54, 5 October 2020 (UTC)

So what's the policy that supports your assertion that what I wrote was baloney? Or are you just relying on the Force to guide your pronouncements? --RexxS (talk) 13:21, 5 October 2020 (UTC)

RexxS, I think we are done discussing something you wrote in haste. I'm quite sure the patience of everyone here has been tested too much already. I'm not going to continue this conversation. -- Colin°^Talk 13:31, 5 October 2020 (UTC)

I'm certainly done discussing your unwarranted and unsupported attack on my completely reasonable original comment. You're well aware that your re-interpretation of MEDRS isn't going to fly, so I commend you on backing out now. --RexxS (talk) 13:53, 5 October 2020 (UTC)

@Jrfw51: I'm also well acquainted with the articles under COVID-19 general sanctions, as I've been struggling for the past several months to keep unfounded and speculative content out of them. You actually were called out on your repeated insertion of content backed up only by primary and other unsuitable sources, and came here to look for support for your breaches of MEDRS. Congratulations, you found some. Your insertions were gradually pared down as you slowly accepted just how unsupportable your contributions to that article had been. Too many citations are a clear sign of either synthesis ("A lot of published reports of case series found that ...") or an attempt to compensate by adding lots of weak sources in the hope that they add up to one strong one. They don't. You only need one good reliable secondary source if you read it and summarise it neutrally and accurately. You're still jumping to a conclusion about the effects of vitamin D on COVID-19 and then looking for sources to support that view. That's not how we write articles. The lay reader is not going to worry about losing information about multivariate analyses. They are probably interested in solid conclusions about ethnicity and obesity (and some may even have an interest in vitamin D binding protein polymorphisms), but we don't do them any favours by making claims that aren't supported by evidence that meets the MEDRS standards. When we have that quality of evidence, we can write the content, but until then, Wikipedia and its readers have lost no information whatsoever. --RexxS (talk) 23:44, 4 October 2020 (UTC)

Thank you RexxS. It is difficult for a scientist used to writing secondary sources that WP follows these standards and can ignore recent science updates. I would prefer to see discussion based on scientific merit and content rather than just the source, and certainly not personal attacks. I have other things to do so I wish you well. Jrfw51 (talk) 11:12, 5 October 2020 (UTC)

@Jrfw51: Thank you for your gracious response. I do understand the difficulty for professional scientists, who are used to analysing primary sources, when confronted with Wikipedia's policy on "no original research", but we've found it a necessary and successful policy for so long that it is ingrained into our methods of generating content. I would also be happy to see discussion based on scientific merit and content, but our article talk pages are reserved for discussion of how to improve the article, not as a forum for discussing the topic. We are left in the position of discussing how we may use existing sources (mainly secondary ones) to improve content. That may be less intellectually satisfying, but it goes a long way toward avoiding the otherwise inevitable arguments about whether one editor's analysis is better than another editor's. I hope our paths will cross again under more auspicious circumstances. --RexxS (talk) 11:31, 5 October 2020 (UTC)

A quite arbitrary section break

As with mask wearing [5], from an evidence-based prevention perspective one particular concern here may regard the balance of potential benefit versus potential harm. Not fully MEDRS-compliant perhaps (and scarcely agnostic), but the concluding remark here (PMID 32758429) seems pertinent:

...there is a chance that their implementation [to achieve reference intakes] might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain.

The assertion that "there is nothing to lose" may be somewhat overstated, but as with facemasks[6], plausible downsides would presumably need to be balanced against the potential gains. 86.172.165.218 (talk) 16:29, 4 October 2020 (UTC)

One reason why I cite this point is to question the ultra-purist view that it's enough to identify 'best evidence', ratchet up a yes/no answer, and game over. If EBM worked like that irl, clinical decisions could all be decided (or passed over) by algorithm. And, like Trump and Company, we doubtless wouldn't even be bothered to use masks. This is potentially very relevant stuff which, imo, requires careful contextualization, and therefore nuanced explanation (with appropriate MEDRS-based sourcing), capable of addressing Wikipedia users' needs to know. 86.172.165.218 (talk) 20:21, 4 October 2020 (UTC)

It's not a matter of being "enough" to identify, read and summarise the best quality sources we can find, making sure that we only make biomedical claims when they derive from secondary sources, it's actually "all" we can do. The mistake is confuse how EBM works in real life with how we report its conclusions in Wikipedia. It is precisely because of the need for careful contextualisation, and nuanced explanation that we require secondary sources to do that job, because we don't accept that Wikipedia editors are qualified to do it. Because you think you can do the source analysis yourself, you end up getting the process back-to-front. We don't write our nuanced explanation and then look for MEDRS-sourcing to back it up; we read what conclusions the best secondary sources have come to, and then report them neutrally and accurately. The question of what you might think our readers need to know doesn't come into it. --RexxS (talk) 00:43, 5 October 2020 (UTC)

Thank you for the response RexxS. We evidently fully agree about the need for careful contextualization and explanation of reliable information. The question of what it is reasonable to believe that our readers may be looking (or needing) to know when consulting Wikipedia does seem to me to be a of potential editorial relevance (broadly per "Assume readers are reading the article to learn"). And, yes, I am indeed trying to use MEDRS appropriately (e.g. here). I don't believe I'm getting the process backwards by raising a more general pertinent consideration on a talk page, not necessarily wholly based on a directly citable source. My understanding has always been that this was also appropriate talk page use. 86.190.128.126 (talk) 08:55, 5 October 2020 (UTC)

I certainly also agree that readers come to Wikipedia to learn, but that places a greater onus on us to ensure that what they read is accurate. That sometimes means we have to wait until we have solid, reliable sources that are conclusive about a fact: we don't have the luxury that media outlets enjoy to report the latest news even when it later turns out to be wrong or misleading. I can see that your edit to vitamin D met MEDRS and improved the article, but I'm going to have to disagree with your belief that raising issues not based on appropriate sourcing is an appropriate use of article talk pages. The specific guidance is at WP:TALK #TOPIC: "Stay on topic: Talk pages are for discussing the article, not for general conversation about the article's subject ... Keep discussions focused on how to improve the article. If you want to discuss the subject of an article, you can do so at Wikipedia:Reference desk instead." The only way to improve an article is by making use of appropriate sources. --RexxS (talk) 12:11, 5 October 2020 (UTC)

(Hey, RexxS, my considerations above were actually centered around one potential[?] MEDRS - which actually, I think, illustrates the NICE rationale for guidance to individuals - and related considerations that I believe are of real relevance to WP:MED; also bearing in mind that this is a project talk page, rather than an article talk page :) 86.190.128.126 (talk) 13:31, 5 October 2020 (UTC)

• (edit conflict)I would like to invite Spaully (ping :) to consider joining this thread (preferable perhaps to discussing on the article talk page, given that this conversation of broad WP:MED relevance is already in course here) to explain, or reconsider, why key guidance for individuals from the concluding section of the cited NICE statement is deemed "Unnecessary detail for this article". Clearly this has nothing to do with MEDRS versus non-MEDRS-compatible sourcing [the issue that initially prompted the overall thread], but rather with what constitutes appropriate coverage and how we weight reliable medical information. Here, it's to do with the way we report the content of one particular 'ideal' MEDRS. I think this case provides an interesting example of the real risk in misrepresenting - or incompletely representing - the overall message of guidance if we elect to focus predominantly on the 'top line' (i.e., here 'evidence for' versus 'no evidence for'), etc, while neglecting, at least in part, to summarize key guidance in the body of the recommendations. I believe that information provided by NICE (in an ideal MEDRS) for the benefit of people whose sunlight exposure may have changed "during the COVID-19 pandemic" and "people with dark skin" (who, in the UK, as in the US and some other English-language speaking settings, generally belong to ethnic minority groups at disproportionate risk of harm or death from COVID-19) should not be considered "unnecessary detail" under === COVID-19 ===.

  Of note, the rather more succinct NIH guidance[7], which also considers (in passing) the fact that "persons of Hispanic ethnicity and Black race [in whom Vitamin D deficiency is common]... are overrepresented among cases of COVID-19 in the United States", takes into consideration studies of high doses of Vitamin D administered to critically ill patients. At present, we make no mention in our COVID-19 section of the existence of this quite different strategy (something that might conceivably be sourced to a MEDRS-appropriate review). NICE guidance clearly cautions that "people should not take more than 100 micrograms a day because it could be harmful" (reliable medical information that might also be considered for inclusion here, imo). 86.190.128.126 (talk) 13:17, 5 October 2020 (UTC)

• Thanks. I wont get drawn into a long discussion, but my thoughts are that we ought not to get too drawn into over-emphasis of the pandemic in articles where is has only a passing relevance. Vitamin D is one of those perennial 'cure alls', and while in my personal and professional lives I recommend supplementation to anyone, I don't think there is sufficient evidence it has much to do with the pandemic to warrant more than a couple of paragraphs. So my more general point is that we ought to limit the amount of pandemic information in general articles. This will happen over time anyway of course. Case in point - Dexamethasone#History definitely shows undue weight to recent times. As for your specific addition - I think you could achieve the same by tweaking the previous sentence. Best wishes |→ Spaully ^~talk~  17:19, 5 October 2020 (UTC)

• Thank you for that Spaully. I may take up your valid suggestion... I wish to stand back a bit right now, as I don't like insisting on stuff, especially on pages where volunteers are putting in a lot of highly-skilled work in their own time. I think I've expressed my broader concerns above, which I still feel repesent a valid viewpoint here - one that deserves expression. In reality, I think experienced MED editors tend not to stop at the yes/no evidence sort of dichotomy, as indeed was the case here. But when I read cases being outlined that this is really what counts most for the project, I do feel concerns. For instance, turning to "best evidence" in terms Cochrane reviews (I don't mean here :), tends to leave so many relevant questions pending as hmm, "insufficient evidence"... Which may be true, but isn't terribly helpful for people who want/need a reasonably balanced, if fuzzy, response. In the present instance, I feel NICE's decision to encourage otherwise routine levels of supplementation that have an extremely low or absent risk profile and *could* potentially be of real clinical value is a valid evidence-based public-health rationale (also per PMID 32758429, etc) which deserves coverage, per its 'ideal MEDRS' status, perhaps not just under == Research ==. But, as I said originally (in an earlier subsection), I think the work on this page has been really valid. Thank you all again, 86.190.128.126 (talk) 18:00, 5 October 2020 (UTC)

• I am not sure why this piece was removed. As a layperson, I interpret it as, “if you have been couped up indoors, think about getting your Vit D levels checked to make sure you are not now deficient”. That strikes me as a useful piece of the NICE info. Do we have something contradicting that generally? SandyGeorgia (Talk) 18:36, 5 October 2020 (UTC)

  SandyGeorgia, I see it as redundant to the sentence before - but you aren't the first to comment on it so I'm going to clarify it and separate it into another sentence. Hopefully it's clear now without being redundant. -bɜ:ʳkənhɪmez (User/say hi!) 18:41, 5 October 2020 (UTC)

World Health Organization

Ajpolino suggested somewhere that world health supranational organizations need some more coverage. After creating Global Certification Commission, I have realized this is something I may good at and may be able to help this project with. I have identified the following redlinks that could be turned blue: WHO Regional Office for the African Region, WHO Regional Office for the Americas, WHO Regional Office for the South-East Asia Region, WHO Regional Office for the European Region, and WHO Regional Office for the Western Pacific Region. Also Pan American Health Organization and WHO Regional Office for the Eastern Mediterranean need significant improvement.

Can anyone identify other organizations of greater importance for me to focus on first? --- C&C (Coffeeandcrumbs) 04:41, 3 October 2020 (UTC)

This sounds good to me, Coffeeandcrumbs. They're all mentioned (and should be linked from) at World Health Organization#Regional offices. It might be possible to get sub-stubs started just by copying the different descriptions out of that article. WhatamIdoing (talk) 21:10, 3 October 2020 (UTC)

@WhatamIdoing:, are you suggesting stand-alone articles be made for each one of them? That goes against what WP:BRANCH is saying. I would say one page for "regional offices of World Health Organization" would be more reasonable. Graywalls (talk) 18:30, 6 October 2020 (UTC)

Excellent! As far as supranational health organizations, I'm mostly familiar with those in the infectious disease realm. No major redlinks, but several of the major global NGOs driving public health improvements have fairly rough pages here. A few jump to mind: GAVI (a quick scroll shows the page looks fairly messy. I see some {{cn}} tags and some weird images), Drugs for Neglected Diseases Initiative (at a glance the page looks fine, but there's not much about what DNDi actually is and how it works), Global Polio Eradication Initiative (could use some serious TLC and expansion), Medicines for Malaria Venture (has an advertisement tag at the top), International AIDS Vaccine Initiative (has an empty section tag), TB Alliance (has a needs more refs tag). Lastly I'm working on Buruli ulcer now and saw the WHO arm responsible for BU control, the Global Buruli Ulcer Initiative, is a redlink. I haven't looked to see if there are sources to support an article on the topic, but it might be worth a Google. Best of luck! If there's anything I can do to help let me know (and if your interest is limited to WHO/PAHO bodies, I won't be offended). Ajpolino (talk) 03:53, 4 October 2020 (UTC)

I don't feel pages should be created for regional offices per WP:BRANCH. Graywalls (talk) 04:36, 4 October 2020 (UTC)

Graywalls, I am going to start with office in the African Region, which is the most discussed in RS. If that does not meet the caveat (unless they are substantially discussed by reliable independent sources that extend beyond the chapter's local area), I will move on to the other orgs such as those suggested above. --- C&C (Coffeeandcrumbs) 14:38, 6 October 2020 (UTC)

@Coffeeandcrumbs:, essentially any page created about organizations would have to meet WP:NORG, which means meeting all the criteria such as WP:SIRS. What WP:BRANCH is saying is that a stand-alone about individual office is seldom warranted. If the main page for WHO is too full to add contents about regional offices, then ONE page for "regional offices of WHO" for things about individual region offices can go WITHIN that. You could then make redirects (which will make links blue...) to that one page.. instead of creating a bunch of pages. Does this make sense? Graywalls (talk) 18:24, 6 October 2020 (UTC)

Not sure yet. It depends on how much material is available on each office that is distinct, unique and notable. --- C&C (Coffeeandcrumbs) 18:29, 6 October 2020 (UTC)

DONTHIDE - estrogen template problems

See samples at High-dose_estrogen#Side_effects, breaching MOS:DONTHIDE. Permalink. Too many of these for me to fix. They shouldn't be collapsed, and they would probably be better if right-justified. They are all over the estrogen-related articles. They are being created by AmazingCosima and @Medgirl131:. They may also be using sources (primary) incorrectly (in this case, the template is plopping a primary study in to multiple articles and may need to be deleted.) Some of them may also be creating WP:NOT (advice) or WP:UNDUE issues. If anyone can take this on, we'll need a list. SandyGeorgia (Talk) 19:05, 21 August 2020 (UTC)

(edit conflict)I came across these lovely, no informative, no useful... okay they're just bad templates - when I was working on depot injection. They are so contrary to what Wikipedia is for - WP:INDISCRIMINATE applies here too I think. For depot injection I just pulled the references in those templates that I figured had information applicable to the article, verified, and "prosified" the information. Most of the information is not useful in articles, and it's definitely not useful as a template. The information should ideally be subst:ed into each article using it, and then immediately replaced with prose versions of only the applicable information to that specific article. I'm sorry to say, however, that after how long it took me to get through the Template:ATC navboxes project I had, I'm not really ready to take on another big project like this. Heck, even that project is never going to be truly finished, as there's probably hundreds of drug articles with multiple ATC codes that apply, thus needing multiple ATC navboxes, which don't yet use the wrapper (which makes it easier to see in the edit window as well, in addition to making the bottom of the article a little cleaner). I'll definitely continue to provide input here if I can, just can't see myself taking this on right now at least. -bɜ:ʳkənhɪmez (User/say hi!) 20:19, 21 August 2020 (UTC)

Oh my, there are many many of these templates at Estradiol_(medication) and Estrogen (medication) now. I also feel they're not appropriate for encyclopedia articles. Most of them are tables of data that would be uninterpretable to most readers. Some are lists of products, dosage recommendations, et al. that should either be made into prose or are too detailed for the article they're in. For a particularly extreme example see Estrogen_(medication)#Pharmacodynamics. Ajpolino (talk) 21:15, 21 August 2020 (UTC)

Estrogen (medication) is an example of how extreme this problem is; a whole boatload of hidden templates scattered throughout the entire article. I think all of these templates need to be sent to TfD, but I'm no good at AfD, much less TfD. Best I can do for now is remove them when I encounter them. We don't write articles this way; I wonder where Medgirl131 and AmazingCosima got the idea to do this. SandyGeorgia (Talk) 22:35, 21 August 2020 (UTC)

There are about 169 such templates. They are here: Category:Medication templates. In my personal opinion, apart from "Don't hide", many of these templates are rich in content derived from primary sources, which I believe is likely to violate WP:MEDRS as well as potentially WP:NOT a directory / textbook. --Tom (LT) (talk) 07:05, 29 August 2020 (UTC)

We need to deal with these, they are out of control, I am encountering them everywhere, is anyone aware of any place where their use is appropriate? SandyGeorgia (Talk) 14:48, 3 September 2020 (UTC)

Every one of the 169 templates at Category:Medication templates that I have glanced at so far use primary sources. They are inserted into articles in breach of WP:DONTHIDE. And they are used in ways that are UNDUE and even off topic in most places I have checked. Their use is basically marring a huge number of articles. They are basically the work of AmazingCosima and @Medgirl131:, pinged several weeks ago to this discussion, but who have not responded here. Many of us here believe the lot of them need to go to TFD. Does anyone disagree? That is, can anyone locate a correct and well-sourced and DUE and appropriate use of any one of these templates? SandyGeorgia (Talk) 20:05, 3 September 2020 (UTC)

Just a heads up - I have fixed a few Medication pharmacology articles with duplicate reference names like this. Such articles now rely on citations that are transcluded via the templates, so mass template deletion may produce a red "Cite error: The named reference (pmid…) was invoked but never defined" message in the ref section of those articles. CV9933 (talk) 16:06, 4 September 2020 (UTC)

User:CV9933 - I'm not sure - would the anomie bot (or whichever it is that fixes orphaned ref names) be able to fix those if removed? -bɜ:ʳkənhɪmez (User/say hi!) 05:29, 9 September 2020 (UTC)

Status update? If we're all in agreement that everything in that category needs deleted, and nobody wants to take it on, I'm happy to pose a batch deletion request similar to what I did for the ICD10 copyvio lists, and I can follow up on comments/concerns with individual templates thereafter. In fact, given how little time I've had to work on my pet project of injection articles recently (COVID is spiking here leading to a lot of calls/extra work for me), this may just be something I can handle right now. -bɜ:ʳkənhɪmez (User/say hi!) 05:29, 9 September 2020 (UTC)

It is unfortunate that User:Medgirl131 is unwilling or unable to make a talk page comment here, as they are such a prolific contributor, and it is clear to me that a lot of effort has gone into creating those templates. However, in the absence of an explanation, we need to have assurance that they won’t recreate and implement them. I would say off to TFD with them, and article cite repair can be dealt with, as and when required. CV9933 (talk) 08:55, 9 September 2020 (UTC)

Status update

User:Berchanhimez/HIDE - I'm using this page to record the results of my perusal through Category:Medication templates. If the template has only a few transclusions and/or is a blatant violation of WP:INDISCRIMINATE, I'm removing them all. If it may have some use, I'm either fixing the templates so they aren't hidden, substituting them into the article (if it's only useful for one article), or leaving them in my various "holding pens". -bɜ:ʳkənhɪmez (User/say hi!) 00:50, 13 September 2020 (UTC)

Hopefully nobody minds, but I formatted the categorization (to take a break from acutally categorizing/working on the templates) so it transcludes nicely here. Okay, so I fully understand the irony of using hidden containers to hold the template lists in... but they're huge. I was able to power through the A, BCD, and EFG sections a bit earlier. I tried to divide the category up into subsections of about equal numbers of templates, so that ideally if anyone has time they can assist in the process. I'm not starting TFDs or anything yet on any of the "can be deleted" templates, but just the sheer number of templates in that section should show how large this problem is - I'd really appreciate any help categorizing and delinking as appropriate that anyone feels they can provide. Thanks :) -bɜ:ʳkənhɪmez (User/say hi!) 04:34, 13 September 2020 (UTC)

Update: I've gotten through the ones starting with H as of last night.. but I can't bring myself to do any more tonight. I'll note that Medgirl131 has an editnotice on their talkpage that they prefer not posting on talk pages onwiki because of privacy concerns of some kind - so we should likely not expect a response here unless someone is able to start an email conversation with her. If anyone can assist with these templates I'd greatly appreciate it, especially with "final clean up" of the ones that are in "can be deleted" category. If not, I'll keep chugging along when I feel up to it. -bɜ:ʳkənhɪmez (User/say hi!) 05:56, 16 September 2020 (UTC)

If you scroll down to the ref section here it is turning into a sea of red as there are many named reference errors. I suspect that when the templates are substituted as they have been here, the corresponding cites (PMID1150068) for example, contain slightly different information. Of course it's fixable but I expect we are going to see a lot more of this. These errors usually flag up here CV9933 (talk) 21:20, 19 September 2020 (UTC)

@CV9933:I noticed that too... which is part of the reason I paused. I’m not intentionally causing more work, but it is much easier and manageable to do this repetitively if I move from one template to the next... if I stop and fix all the mistakes, then it gets much more annoying to do. This isn’t even to mention that as you say many of these errors are likely to crop back up after more templates are substituted/altered. I will be more than happy to go back and fix it all and in fact I do plan to, but I think it’s best in more ways than one to just wait until all templates that are taken care of are. This is compounded because substitution isn’t the only problem, I’ve also been fixing the references in templates that aren’t removed or substituted altogether - before, the references were “see template” and didn’t show in the articles it was transcluded in at all. Unfortunately, that also is going to make some of these errors fun to fix. I may be able to power through categorizing and “fixing” another section of the alphabet or two tonight, but if someone else wants to help it would be faster and greatly appreciated. Alternatively, if I don’t feel up to the repetitive work of categorizing/fixing I may just go ahead and try to look for and fix errors that arose, even if they’ll need more fixing later on. To note, there’s also been some orphaned names occasionally if I remember right, but anomiebot or whichever it is seems to have no problem fixing those itself. -bɜ:ʳkənhɪmez (User/say hi!) 00:18, 20 September 2020 (UTC)

Thanks for the effort that you have put in. The problem is, when a bot identifies two ref-names with different content, it doesn't know which one is correct, so the fix requires a manual edit. I have fixed the errors I mentioned above and I will keep an eye out for any that crop up related to this issue. CV9933 (talk) 14:26, 20 September 2020 (UTC)

User:Berchanhimez I noticed that this edit seems to have had some undesireable effects, such as in the table position in Lynestrenol phenylpropionate. CV9933 (talk) 15:23, 30 September 2020 (UTC)

CV9933, That's being caused by the fact that these articles are extremely short and have infoboxes, meaning that the table either has to be centered with whitespace around it or be floated left with text sandwiched in between. I'm okay if you want to remove the "floatright" class so it goes back to being centered that one on the pages. -bɜ:ʳkənhɪmez (User/say hi!) 17:40, 30 September 2020 (UTC)

Berchanhimez If the rendering of the template table is different depending on the article construction, perhaps it makes sense to just recreate the table locally.CV9933 (talk) 17:52, 30 September 2020 (UTC)

CV9933, I agree - I haven't gotten to the "P's" yet in the alphabet of templates, and quite frankly, it's very daunting so I'm not sure when I'll have 4-5 hours free where I actually want to work on that section... it's part of why I've been asking for help for a while (and why I'm so appreciative of your work on the references) - I get burned out when I'm the only one doing them :( -bɜ:ʳkənhɪmez (User/say hi!) 23:53, 30 September 2020 (UTC)

Berchanhimez I commented out the table template and moved it to a link in "see also" which is a compromise and leaves a place holder for later. I agree it is a daunting task and suspect your scary sort table has got editors hiding behind the sofa. CV9933 (talk) 15:18, 1 October 2020 (UTC)

Can be deleted

This category contains templates which were/are "low utility": Very few transclusions (subst: the use(s)) Scope too narrow to have potential use in articles An indiscriminate collection of non-encyclopedic information Templates should not be placed in this category until they are "fully useless" - meaning no current transclusions, no viable hope to be re-added to an article, and citations from the templates have been re-added to any article that required them as named references.

Templates beginning with A Template:Affinities of selected ligands at the androgen receptor Template:Affinities of selected androgen receptor ligands 2 Template:5α-Reductase inhibitors marketed for clinical or veterinary use Template:Absolute activities of tibolone and metabolites Template:Affinities of 5α-dihydroethisterone for steroid hormone proteins Template:Affinities of a selection of androgen receptor ligands at steroid hormone receptors Template:Affinities of RU-59063 and other androgen receptor ligands at steroid hormone receptors Template:Affinities of a selection of androgen ligands at steroid hormone receptors Template:Affinities of dydrogesterone and related steroids Template:Anabolic and androgenic activities of anabolic steroids Template:Antiandrogens marketed for clinical or veterinary use Template:Antigonadotropic effects of estradiol Template:Antigonadotropic effects of estradiol undecylate Template:Antigonadotropic effects of polyestradiol phosphate Templates beginning with B, C, D Template:Beneficial and adverse effects of ethinylestradiol-containing birth control pills Template:Bicalutamide and other antiandrogens at the androgen and progesterone receptors Template:Bicalutamide levels during therapy with bicalutamide Template:Bicalutamide monotherapy and breast side effects in dose-ranging studies in men Template:Changes in hormone levels with bicalutamide monotherapy Template:Clinical dosage ranges of oral and injectable androgens and anabolic steroids Template:Combined injectable contraceptives marketed for clinical use Template:Composition of conjugated estrogens and properties of constituents Template:Cyproterone acetate levels with oral and intramuscular cyproterone acetate Template:Dose of ethinylestradiol in birth control pills and risk of venous thromboembolism Template:Rates of venous thromboembolism with different doses of ethinylestradiol in birth control pills Templates beginning with E, F, G Template:Effects of feminizing hormone therapy in transgender women Template:Endogenous estradiol production rates and plasma estrogen levels Template:Endogenous progesterone production rates and plasma progesterone levels Template:Gallery of available forms of estradiol Template:Available forms of estradiol gallery Template:Gallery of available forms of estradiol gallery Template:GnRH agonists marketed for clinical or veterinary use Template:GnRH antagonists marketed for clinical or veterinary use Templates beginning with H Note: virtually all of the H templates were just obfuscating the material off the page - I substituted them but haven't completely verified the material belongs on the page to begin with - I've listed those pages in the last section Template:Hormone levels with estradiol and estradiol esters by intramuscular injection Template:Hormone levels with intramuscular estradiol esters Template:Hormone levels with estradiol esters by intramuscular injection Template:Hormone levels with estradiol benzoate by intramuscular injection note: this was previously kept at TFD by spamming it into another article along with a bunch of other useless templates. Template:Hormone levels with estradiol benzoate/estradiol dienanthate/testosterone enanthate benzilic acid hydrazone by intramuscular injection Template:Hormone levels with EB/EDE/TEBH by intramuscular injection Template:Hormone levels with intramuscular estradiol dienantate Template:Hormone levels with intramuscular estradiol dienanthate Template:Hormone levels with estradiol dienanthate by intramuscular injection Template:Hormone levels with estradiol dienantate by intramuscular injection Template:Hormone levels with estradiol by intravenous administration Template:Hormone levels with intravenous estradiol Template:Hormone levels with estradiol cypionate by intramuscular injection Template:Hormone levels with intramuscular estradiol cypionate Template:Hormone levels with estradiol dipropionate by intramuscular injection Template:Hormone levels with intramuscular estradiol dipropionate Template:Hormone levels with estradiol enanthate by intramuscular injection Template:Hormone levels with intramuscular estradiol enantate Template:Hormone levels with estradiol undecylate by intramuscular injection Template:Hormone levels with intramuscular estradiol undecylate Template:Hormone levels with estradiol valerate by intramuscular injection Template:Hormone levels with intramuscular estradiol valerate Template:Hormone levels with hydroxyprogesterone caproate Template:Hormone levels with medroxyprogesterone acetate Template:Hormone levels with norethisterone Template:Hormone levels with oral estradiol Template:Hormone levels with oral estradiol valerate Template:Hormone levels with oral progesterone Template:Hormone levels with polyestradiol phosphate by intramuscular injection Template:Hormone levels with intramuscular polyestradiol phosphate Template:Hormone levels with polyestradiol phosphate Template:Hormone levels with progesterone by intramuscular injection Template:Hormone levels with rectal progesterone Template:Hormone levels with sublingual estradiol Template:Hormone levels with transdermal estradiol gel Template:Hormone levels with transdermal estradiol patches Template:Hormone levels with transdermal estradiol (used on one userspace page) Editing Template:Hormone levels with vaginal estradiol Templates beginning with I, M, N, O Template:Introduction of first-generation birth control pills Template:Introduction of first-generation oral contraceptives Template talk:Major androgens/anabolic steroids marketed for clinical or veterinary use Template:Major AAS marketed for clinical or veterinary use Template:Major estrogens marketed for clinical or veterinary use Template:Normal progesterone levels in women Template:Progesterone levels in women Templates beginning with P  Not yet started Templates beginning with R  Not yet started Templates beginning with S  Not yet started Templates beginning with T, W  Not yet started

May be okay

Templates may be okay (as in valuable to the encyclopedia in some way) if: Multiple articles transclude them The information is relevant and encyclopedic The scope of the template is broad enough to be reused on multiple articles There's some information/data in the template that would be useful to write into an article The information in these templates may be better presented as prose, in which case it can be removed from articles as that occurs.

Templates beginning with A Template:Affinities of selected androgen receptor ligands Template:Relative potencies of selected antiandrogens Template:Relative potencies of antiandrogens in testosterone-treated castrated immature male rats (unused) Template:Relative potencies of selected antiandrogens in rats (used) Template:Affinities of selected androgen receptor ligands Template:Available forms of progesterone Template:Available forms of testosterone Templates beginning with B, C, D Template:Biochemical parameters affected by estrogen therapy Template:Proteins affected by estrogen therapy (unused) Template:Proteins and lipids affected by estrogen therapy (unused) Template:Classification of estrogens and antiestrogens by receptor–estrogen complex retention Template:Classification of estrogens and antiestrogens after a single injection (except where noted otherwise) (unused) Template:Classification of estrogens and antiestrogens by receptor-estrogen complex retention (unused) Template:Classification of estrogens and antiestrogens after a single injection (used) Template:Comparison of early clinical experience with antiestrogens for advanced breast cancer Templates beginning with E, F, G Template:Estrogen dosages for breast cancer Template:Formulations and brand names of norethisterone and esters Template:Glucocorticoid activity of selected steroids in vitro Templates beginning with H Template:Hormone levels with gonadotropin-releasing hormone agonists and antagonists Template:Hormone levels with nandrolone esters by intramuscular injection Templates beginning with I, M, N, O Template:Major side effects of bicalutamide alone (may need rename) Template:Major side effects of bicalutamide monotherapy by frequency and group (unlikely redirect, parent template okay) Template:Medications and dosages used in hormone therapy for transgender men Template:Medications and dosages used in masculinizing hormone therapy for transgender men (unlikely redirect, parent template okay) Template:Medications and dosages used in hormone therapy for transgender women Template:Methadone at opioid receptors, monoamine transporters, and the NMDA receptor Template:Oral potencies of estrogens (needs a look to see if the dosages can be simplified a bit) Template:Oral potencies of progestogens (likely has too much info but may still be useful if trimmed) Templates beginning with P  Not yet started Templates beginning with R  Not yet started Templates beginning with S  Not yet started Templates beginning with T, W  Not yet started

Needs further discussion

The templates in this category are "high risk" so to speak: Having a relatively high number of transclusions (over a dozen or so) Having a complex history of template/page moves/edits Having a large number of named references which, if deleted, would orphan references in multiple articles These templates merit further discussion before mass removal of transclusions and/or deletion occurs. This may be best at TFD or another venue.

Templates beginning with A Template:Affinities of estrogen receptor ligands for the ERα and ERβ Template:Relative affinities of estrogens for the estrogen receptors (unused) Template:Relative binding affinities of estrogens at the estrogen receptors (unused) Template:Affinities of estrogens at the ERα and ERβ (unused) Template:Relative affinities and efficacies of estrogens at the ERα and ERβ (unused) Template:Relative activities of estradiol and related estrogens at the estrogen receptors (unused) Template:Activities of estradiol and related estrogens at the estrogen receptors (unused) Template:Relative affinities of estrogens at the estrogen receptor (unused) Template:Androgen/anabolic steroid dosages for breast cancer Template:Available forms of estradiol Template:Androgen replacement therapy formulations and dosages used in men Template:Androgen replacement therapy formulations and dosages used in women Templates beginning with B, C, D None Templates beginning with E, F, G Template:Estrogen dosages for menopausal hormone therapy Template:Estrogen dosages for prostate cancer Template:Estrogen dosages for breast and prostate cancer (used) - and misleading! Templates beginning with H None Templates beginning with I, M, N, O None Templates beginning with P  Not yet started Templates beginning with R  Not yet started Templates beginning with S  Not yet started Templates beginning with T, W  Not yet started

Articles which need review

These are articles for which templates have been substituted or replaced in which may need general cleanup, as observed during the process of cleaning up specifically these templates. This may include: Review of graphs/images to determine appropriateness Removal of extraneous information Moving images/galleries around Et cetera

Articles for cleanup Pharmacokinetics of estradiol Pharmacokinetics of progesterone Estradiol valerate Estradiol cypionate - some graphs probably appropriate but there's a lot of them right now

Help categorize templates or add comments

I haven't followed this discussion in detail, so apologies if I've misunderstood something, but if one of the issues is that a different style (e.g., float right, center, or other) might be more appropriate in one article than another, then there is a better solution than just slurping the template content into the article, which has the disadvantage of leading to possible divergence and the problem of keeping multiple copies all in sync with each other.

That solution is to simply include a template parameter, say, |style=, and then you can code whatever style you want. Or, if "float" is really the only issue here, it could be reduced to |float=right with the default set to =center, or vice versa. If you're not familiar with template coding, I could change one of the templates for you and then you could just propagate it to the other templates. A minor change to the /doc page would be required, to document the change, but that can be copy/pasted as well. Let me know if you're interested in this option. (please  mention me on reply; thanks!) Mathglot (talk) 20:59, 7 October 2020 (UTC)

Forgot to ping @Berchanhimez and CV9933:. Mathglot (talk) 21:00, 7 October 2020 (UTC)

Mathglot, That's the issue with some of those in the "more discussion needed" category - I didn't know how to do that at first but I do now know and will revisit those later... but I haven't even gotten through more than half of the templates yet. The only ones getting copied into articles directly are those that are only used in one article and only have the potential to be. Thanks for the input, and if you'd like to help please do feel free - but if not that's fine too. -bɜ:ʳkənhɪmez (User/say hi!) 21:12, 7 October 2020 (UTC)

Template:Biochemical parameters affected by estrogen therapy

I agree that it's copied from the source cited and that is likely violating the copyright - would you recommend CSDing it, TFD, or what's the best way to go about a template that's a copyvio? If you think CSDing is the best thing to do, and want to nominate it, feel free - I may have limited internet for a day or so. Thanks, -bɜ:ʳkənhɪmez (User/say hi!) 22:26, 22 September 2020 (UTC)

The copyvio is just a very small part of a big problem that I hadn't noticed until now. Having looked over quite a few of those templates, apart from primary and don'thide, I see elements of copyvio, original research and synth. I believe that an experienced admin familiar with copyright policy is required to intervene. Ironically I made this hidden comment to hide suspect templates temporarily, but most likely, the real solution is to send them all to TFD. The various graphs need looking at as well, this one for example is sourced to clinical trial data so that is sub-primary in my opinion and should not be in our articles. It is almost as though these templates and files are circumnavigating policy because they are typically remote and nobody is paying attention to them. Regards CV9933 (talk) 10:27, 23 September 2020 (UTC)

(Moved from my talk to prevent fragmentation) CV9933 (talk) 10:40, 24 September 2020 (UTC)

UpdateI have tagged this template for speedy deletion. CV9933 (talk) 18:17, 25 September 2020 (UTC)

The result was, that there was no copyvio infringement. I was also informed by the template and graphs originator, who created these in good faith, that charts, graphs and tables are not subject to copyright protection. I hope that clears things up a bit. CV9933 (talk) 12:46, 26 September 2020 (UTC)

I was under the impression that charts, graphs, and tables can be subject to copyright protection, specifically when the contents are selective and/or the presentation or arrangement is intentional. For example, an alphabetical list of all the members in a specified group is not copyrightable, but a list arranged into subgroups based upon relationships might be. I'm convinced that charts such as File:Countries in 1700.png and File:Pie chart of origin of the children 1917.jpg and File:Helios Sonnenuhr Schnitt.jpg were copyrightable. WhatamIdoing (talk) 16:56, 1 October 2020 (UTC)

Yes in certain instances, but see the pdf document that the template originator pointed me to here. CV9933 (talk) 19:38, 1 October 2020 (UTC)

Pneumovax

Could we define induration and sort out the situation in the UK? We have a nine-year-old “preliminary” recommendation. I now know what induration is, because I have the full list of side effects, and because I speak romance languages (endurecer), but the general reader may not. SandyGeorgia (Talk) 15:02, 6 October 2020 (UTC)

Could a UK person please look into this? I got nowhere trying to understand the JCVI, and replaced it and the Green Book with the current NHS recommendation.[8] SandyGeorgia (Talk) 14:05, 7 October 2020 (UTC)

That update looks good (and needed). As a "UK person" I'm sure the NHS stuff is the best source. I've been aware, the last few years, when getting a flu jab at the pharmacy these vaccines are mentioned on "public health" posters - I once asked about them and was told they were weren't really intended for fit young chaps like me! Alexbrn (talk) 15:08, 7 October 2020 (UTC)

@Sandy: The update is fine, and I wouldn't hesitate to use the NHS source. If you want more UK-based opinions, the real expert is likely to be Jacob, but I know how busy he is right now. --RexxS (talk) 15:32, 7 October 2020 (UTC)

Thanks to both! I took some snapshots of my "induration", thinking I would do a Spicy and "sacrifice my own blood for Wikipedia" to upload an image, but found that it's hard to get an image of a hugely painful swollen red arm that feels like a nuclear bomb went off in it without revealing more of my anatomy than desirable :) Growin' old ain't for sissies, and both Shingrix and Pneumovax 23 made me quite quite ill! So of course, I was wondering if the pneumovax was really necessary, when I saw it wasn't recommended in the UK, and that I had every adverse effect in the extreme ... I am still under a brain fog. So, when you turn 65 and get these jabs, make sure you have a clear calendar for three days, just in case! SandyGeorgia (Talk) 15:42, 7 October 2020 (UTC)

I sympathise. I came down with COVID-19 symptoms last night, and at the age of 68, that's quite scary. I had a test today and I'm stuck in the house at least until I get the results. I feel awful, although it might just be the flu or a bad cold. Wish me luck. --RexxS (talk) 15:50, 7 October 2020 (UTC)

Oh my; please do keep us posted. My husband was pacing nervously, worried if my symptoms suggested COVID-19, so I am fortunate that I can point to the huge ugly mess on my arm, and find journal articles that document all of my symptoms as pneumovax related [9] (and I am better today)-- otherwise, we would have been quite frightened. I share your fright, RexxS, and wish you the best. SandyGeorgia (Talk) 15:56, 7 October 2020 (UTC)

Yup, get well soon! Stay cool... I mean warm, hydrated, and nice and relaxed. Cheers, 86.144.125.239 (talk) 21:11, 7 October 2020 (UTC)

I hope you feel better RexxS. I'll have a look at pneumovax later too.Whispyhistory (talk) 04:31, 8 October 2020 (UTC)

"Induration" is translated very well with "thickening or hardening of the skin" but it bears pointing out that it is transient. The etymology is the same as "dura mater" ("big momma"). JFW | T@lk 21:43, 8 October 2020 (UTC)

RexxS

Everyone, just a note to see Rexx’s talk page: [10] SandyGeorgia (Talk) 15:18, 8 October 2020 (UTC)

Medical procedure template titles

Hi all, seeking some opinions at this common venue about how to title procedure templates, which are currently titled in a varied format. In general my questions are:

1. What's the best general title? (I'm leaning towards "Tests and procedures involving / of / relating to..."
2. Do you think readers understand that "test" includes "medical imaging", or does that need to be included separately in the title?
3. Do you think readers understand that the term "procedure" includes "surgery", or do we need to include some variant of "surgery and procedures" in all the titles?

I realise there will be some variation navbox-to-navbox depending on contents but would like opinions relating to some of these general themes so that I can get to work tidying up their contents. Cheers --Tom (LT) (talk) 03:58, 27 September 2020 (UTC)

My guess is that readers would understand "tests" to include medical imaging, and "procedures" to include surgery. So I think your proposed "Tests and procedures involving..." or "Tests and procedures of..." would be well-understood. Ajpolino (talk) 15:36, 30 September 2020 (UTC)

Thanks, appreciated. Have standardised the titles and also started working on the contents. --Tom (LT) (talk) 00:34, 9 October 2020 (UTC)

New article on Black maternal mortality in the US

Hello! I am planning to create a new article about Black maternal mortality in the US with the current article Maternal mortality in the US as its parent. So far, I am thinking that the new article would include sections on historical context (subsection on trends to the present), access to peri- and post-natal care, intersection of race and SES, medical racism, and reproductive and sexual health and rights (subsection on access to abortion). Much more detailed information can be found in my user sandbox. I welcome any feedback! Thanks! Akandru (talk) 04:25, 30 September 2020 (UTC)

Hello, @Akandru. I see that you've got a detailed outline and a list of sources in User:Akandru/sandbox. One of the sources is from 2002, which is older than ideal. Have you already checked to see if you can find something more recent on the same subject?

There's a Black Maternal Health Week each year.[11] I think that this is the most recent Morbidity and Mortality Weekly Report on the subject. WhatamIdoing (talk) 04:58, 30 September 2020 (UTC)

Hi @WhatamIdoing, thank you so much for your input! You make a very good point about the source from 2002, and I will look for something more up to date on that. I will also check out the source you provided for Black Maternal Health Week! I'll be starting to draft this new article in my sandbox in the next week or so. Thanks again! Akandru (talk) 19:33, 8 October 2020 (UTC)

Hi @Akandru:. This is a great topic for a Wikipedia entry. I have to say the stories in the sources shocked me. I haven't looked at every source listed, but overall the sources seems pretty strong. One thing I would suggest is to structure the article as follows:

1. In a section called "Maternal mortality rates", describe the discrepancies in outcomes, i.e. how maternal mortality rates differ by race, class, etc.
2. In a section called "Causes", discuss *all* proposed causes of these discrepancies, giving due weight to each proposed cause. Subsections of this section could be things like "History of slavery", "Access to perinatal and postnatal care," "Pre-existing health conditions", "Access to abortion", and "Clinician decision-making".
3. In a section called "Prevention", discuss the ways in which the Black maternal mortality rate could be brought down.

If you use this kind of structure, it will read more like an encyclopedia article rather than an essay.

A challenge with this topic is that (from my brief review), many of the sources you've found don't use terms like "medical racism" or "misogyny" when they're talking about things like clinicians ignoring pain in Black women. They give the facts, they tend to use cooler language like "unconscious bias", and they let the reader come to her/his own conclusion about whether this stuff means that healthcare providers are racists. Wikipedia articles are expected to reflect the terminology and the tone of the reliable sources, so we sometimes have to hold back on calling things what we want to call them. However if you do have a reliable source that says, "What's going on here is medical racism", you can include that point of view with explicit attribution to the author of that point of view.

Again, thanks for choosing to write on such an important topic. Good luck! Clayoquot (talk | contribs) 04:58, 2 October 2020 (UTC)

Hello @Clayoquot, thank you so much for these suggestions. I will definitely incorporate these sections in the article, which I will begin drafting in my sandbox over the next week or so. I also appreciate your input regarding some of the language, and will make sure to keep that in mind as I am writing. Thanks again! Akandru (talk) 19:33, 8 October 2020 (UTC)

Akandru, You're most welcome! I'm looking forward to seeing your article. Clayoquot (talk | contribs) 02:14, 9 October 2020 (UTC)

naming input requested for place where drug addicts go use drugs under supervision

Currently, it is Supervised injection site.

I renamed needle exchange with the naming help from this project a while ago. Now I am seeking input on what to name the place where drug addicts go to shoot up, snort, smoke, drink or whatever to introduce illegal drugs into themselves under supervision?. They are known to go by various names such as "safe consumption space" "safe injection site". After learning that some locations are not restricted to injection only, the "supervised injection site" is no longer fitting. What is a globally accepted name for such to rename the article into and what additional redirects should be made for it? Graywalls (talk) 02:05, 3 October 2020 (UTC)

I suggest writing a draft article for "safe consumption space" (or similar) after conducting a search of the peer-reviewed literature for articles or book chapters on the topic. Then post here again with a link to your draft article (presumably located in your sandbox). ¶ Thank you for your work on the Supervised injection site article. I think we (English Wikipedia) offer more detailed, empirically sound harm reduction information (articles) than most other sources, which is a feather in our cap, and your contributions significantly enhance the quality of our harm reduction database. Mark D Worthen PsyD (talk) [he/his/him] 03:12, 3 October 2020 (UTC)

I'm not planning on entirely redoing the article. I am just trying to pick an article title that is in line with globally accepted title for such a facility and simply renaming to that from "supervised injection site"; then creating several redirects as needed for local variants. Who.int doesn't appear to have a name for such facility. Graywalls (talk) 04:40, 3 October 2020 (UTC)

Supervised injection site#Terminology has six options, and this Canadian source says they're also called safe consumption sites. It looks like anything called "safe" also has a "safer" variant. WhatamIdoing (talk) 21:08, 3 October 2020 (UTC)

The Government of Canada uses "supervised consumption site". Are we okay we renaming it to that? Graywalls (talk) 05:20, 7 October 2020 (UTC)

That works for me. WhatamIdoing (talk) 05:45, 9 October 2020 (UTC)

Bio/Med-tech and precision medicine startup accelerators

Background information about PathoGene

As many of you are probably aware, I've been on a wikibreak to work on my startup company, which is commercializing third-generation DNA/RNA sequencers from Oxford Nanopore Technologies for clinical use in infectious disease diagnostics (NB: I have already discussed what we're doing with Oxford Nanopore Technologies in regard to licensing their tech). Technically, we're doing far more than just that, but I can't really discuss the specifics of our medical device or how the design allows for its use for specific use cases for another 3-4 months due to patent-related issues (i.e., prior art). I can say that we're designing it so that it'll be approved for use by nurses and doctors – as opposed to just trained medical technologists – for diagnosing all infectious diseases caused by microscopic pathogens (at least eventually - my initial plans are to work toward conducting 3 simultaneous multicenter pivotal trials for sepsis, meningitis, and pneumonia, as those diseases entail very high costs to hospitals), detecting all forms of antimicrobial resistance in pathogen genomes and the biofluid/tissue-site sample, surveilling all infectious diseases globally, and auto-reporting all notifiable diseases to relevant authorities (e.g., WHO/CDC for diagnostics in the US; Doc James actually motivated that idea, as he's a member of my corporate advisory board). I intend to work closely with BSL-3 and BSL-4 labs when we obtain funding to start our analytical studies since I want to ensure our device can diagnose emerging, rare, and/or highly lethal pathogens like the Marburg virus and Naegleria fowleri as well. Upon successful completion of our first 3+ multicenter pivotal trials and FDA approval of our PMAs, we're going to rapidly expand internationally by working to obtaining regulatory approval for our device in every country/regulatory region. Assuming my company successfully commercializes our device for the use cases I've described, we'd end up supplanting countless IVD devices and microbiological culture for infectious disease diagnostics with our tech in virtually all hospitals globally and revolutionize infectious disease diagnostics with precision medical tech; so, if that comes to pass, I apologize in advance for the workload I'm going to create for everyone in terms of updating the diagnostics sections of WP's infectious disease articles.

With all that in mind, I need to move relatively fast on pursuing funding for this; while we're still programming the software right now, I need around $100,000 worth of seed funding to purchase the parts to build our prototype and hire a few consultants. We've already applied to Y Combinator's winter cohort (FWIW, despite the 2% acceptance rate, I'm very optimistic about our chances of acceptance due to a number of reasons), but I need to apply to additional accelerators in the event that doesn't pan out. I literally need to raise over $100 million USD for our series A round, which is a rather large amount for that funding round (for context, provided I can raise that amount, an extremely conservative DCF of our annual profits over the next 20 years - i.e., the lifetime of our device patent - is $4 billion USD), in order to commercialize the aforementioned device in this manner. An ideal accelerator for our purposes would put us face-to-face with a large number of venture capitalists.

In any event, I wrote this post for two reasons:

1. I don't really know of many startup accelerators or any accelerators geared specifically for medtech/precision medicine startups. If you know of any, please let me know. I don't have a whole lot of time to research this due to the fact that I've got a ton of work to do on our product.
2. The reason I believe we have a really good chance of getting into Y Combinator is due to networking; someone I knew from college is a YC company founder who convinced me to apply, recommended us to YC, connected me with a YC-accelerated patent law firm (Cognition IP) which we're working with, and put me in touch with one of the partners at YC who spoke with my entire team in Google Meet about how to position ourselves before we applied. If anyone has similar connections to other startup accelerators which are relevant to what we're doing, we could really benefit from leveraging your network before applying.

If anyone knows of any startup accelerators that'd be a good fit for us – and particularly if anyone has any connections to such accelerators that you're willing to allow us to leverage – I'd greatly appreciate your response. Seppi333 (Insert 2¢) 07:36, 7 October 2020 (UTC)

Addendum: we're also pursuing grant funding from the US CDC and NIH through the SBIR and CRP program grants. If approved for both, that'll only net us about $4.5 million though, so we need VC financing regardless; to improve our odds of successfully raising the required funds, we really need to get into a good accelerator. Seppi333 (Insert 2¢) 07:41, 7 October 2020 (UTC)

Got the info I needed and one accelerator connection; applying to 2 more ATM, so this is no longer an issue. Would always welcome additional connections though. Seppi333 (Insert 2¢) 11:13, 9 October 2020 (UTC)

Trump recipient of specific medications

What are your thoughts about adding content to each medication article that it was used to treat Trump for COVID-19? A concern was raised on the Remdesivir talk page and there is a discussion on the Dexamethasone talk page. --Whywhenwhohow (talk) 06:44, 9 October 2020 (UTC)

I suspect this fact will have enduring notability. It has significant repercussions for the drug licensing, availability and the company share price, going well beyond the welfare of one man.[12] A "Society and culture" section may be a suitable place. Neither article is in good shape. Dexamethasone has the "administration by mouth" in the Society and Culture section, and Remdesivir has a random collection of studies, including one comment added back in July, sourced to Bloomberg, "According to international experts from the British Medical Journal, ..." with a statement that is likely out-of-date. It was actually "according to a panel of international experts convened by the British Medical Journal", since the BMJ is a publication, not a research institution. So, I think a sentence saying the president of the USA, Donald Trump, took it, is the least of the problems. -- Colin°^Talk 10:29, 9 October 2020 (UTC)

Since remdesivir isn't approved for marketing yet, a high-profile use could have durable effects. I'm not convinced that there will be any similar long-term effects with dexamethasone, so I doubt that it's worth mentioning there. WhatamIdoing (talk) 15:58, 9 October 2020 (UTC)

Ditto for REGN-COV2. And I agree that this probably doesn't have lasting importance for dexamethasone. Ajpolino (talk) 17:19, 9 October 2020 (UTC)

Easy way to help

Please see c:Commons:Photo challenge/2020 - September - Mobility aids for the handicapped/Voting. Voting is open to all registered contributors who have held accounts for at least 10 days and made 50 edits, and also to new Commons contributors who have entered the challenge with a picture. There are some good photos that would be useful for improving Wikipedia articles about mobility. WhatamIdoing (talk) 18:23, 9 October 2020 (UTC)

Multiple sclerosis Featured article review

I have nominated Multiple sclerosis for a featured article review here. Please join the discussion on whether this article meets featured article criteria. Articles are typically reviewed for two weeks. If substantial concerns are not addressed during the review period, the article will be moved to the Featured Article Removal Candidates list for a further period, where editors may declare "Keep" or "Delist" the article's featured status. The instructions for the review process are here. SandyGeorgia (Talk) 14:38, 9 October 2020 (UTC)

Thank you for making the nomination. I previously hoped I would have time to make some of these nominations myself, but that hasn't happened. Biosthmors (talk) 18:41, 9 October 2020 (UTC)

I am still clinging to the hope that we will get together as a group and save a few of them :( SandyGeorgia (Talk) 19:31, 9 October 2020 (UTC)

Draft:Role of nicotinic acetylcholine receptors (nAChRs) and their importance

Is there any good content in this draft that should be merged elsewhere, or should it be declined and sent to the trash heap? Thanks, Calliopejen1 (talk) 22:26, 6 October 2020 (UTC)

I can't find the source, but this reads suspiciously like a copyvio of various research papers, see for example the phrases we carried out a genome-wide affiliation examine for ESCC using single nucleotide polymorphisms (SNPs) as genetic markers. and We also observed 5 new genome-wide great signals for smoking behavior, such as a variant in NCAM1 (chromosome 11) and a variant on chromosome 2 (between TEX41 and PABPC1P2) that has a trans effect on expression of NCAM1 in brain tissue. Really, the author did all that so they could write this draft? It is also poorly written to the point of being incoherent in places: Disclosure to tobacco smoke is a built-up chance for lung malignant growth, albeit a potential job for hereditary powerlessness in the improvement of lung malignant growth has been deduced from familial bunching of the sickness and isolation investigation. ??!!? I suspect it has been either machine translated or run through a content spinner, which would explain why I can't easily find the source of the copyvio... Spicy (talk) 22:38, 6 October 2020 (UTC)

Yeah, it's a massive copyvio. I searched for snippets like "between TEX41 and PABPC1P2" that are unlikely to have been affected by the machine translation/whatever it is that they're doing and found the original sources.

Article	Source
These variations also confirmed affiliation with COPD, consisting of in humans with no history of smoking. The variety of copies of a one hundred fifty kb location containing the 5′ stop of (KANSL1), a gene that is necessary for epigenetic gene regulation, used to be related with extremes of (FEV1). We also observed 5 new genome-wide great signals for smoking behavior, such as a variant in NCAM1 (chromosome 11) and a variant on chromosome 2 (between TEX41 and PABPC1P2) that has a trans effect on expression of NCAM1 in brain tissue	These variants also showed association with COPD, including in individuals with no history of smoking. The number of copies of a 150 kb region containing the 5′ end of KANSL1, a gene that is important for epigenetic gene regulation, was associated with extremes of FEV1. We also discovered five new genome-wide significant signals for smoking behaviour, including a variant in NCAM1 (chromosome 11) and a variant on chromosome 2 (between TEX41 and PABPC1P2) that has a trans effect on expression of NCAM1 in brain tissue. Source
A declared union of smoking-related methylation patterns in the F2RL3 gene with forecast in steady coronary heart sickness patients which has currently been described. Even so, surprisingly little concrete information on the epigenetic adjustments in the development of cardiovascular ailments and function of specific genetic editions in human beings who smoke has been concentrated	A pronounced association of smoking-related methylation patterns in the F2RL3 gene with prognosis in patients with stable coronary heart disease has recently been described. Nonetheless, surprisingly little concrete knowledge on the role of specific genetic variants and epigenetic modifications in the development of cardiovascular diseases in people who smoke has been accumulated. Source
The people conveying both hereditary hazard components could decrease their danger of ESCC up to 28-crease less (from 189.26 to 6.79) by restricting their liquor utilization and smoking. In any case, even without way of life chance variables, they despite everything have higher hazard than those without hereditary hazard factors who do smoke and drink liquor (OR of 6.79 and 3.44, separately)	The individuals carrying both genetic risk factors could reduce their risk of ESCC up to 28-fold less (from 189.26 to 6.79) by limiting their alcohol consumption and smoking. However, even without lifestyle risk factors, they still have higher risk than those without genetic risk factors who do smoke and drink alcohol (OR of 6.79 and 3.44, respectively). Source

Should probably be presumptively deleted. Spicy (talk) 23:01, 6 October 2020 (UTC)

Thanks all! I deleted it. Calliopejen1 (talk) 23:43, 9 October 2020 (UTC)