Talk:Bexarotene

Alzheimer's

The recent Alzheimer's reports are quite sensational. The closest thing we yet have to a secondary source is this and this. In both cases the news sources relate doctors expressing caution, e.g.

Dr. Landreth insisted it’s far too soon to consider bexarotene a breakthrough. “I would like to say loudly and clearly,” he warned, “we have to be cautious about extrapolating to whether this is going to work in humans.”

— Globe

Dr Simon Ridley, head of research at Alzheimer's Research UK, said the findings were "promising" but any effect was still unproven in people.

"There are a number of drugs in development that aim to clear amyloid from the brain, and the jury is still out on whether this approach will be successful as a treatment for Alzheimer's."

David Allsop, professor of neuroscience at Lancaster University, said: "I would say that the results should be treated with cautious optimism.

"It looks promising in the mouse model but in recent years, these types of experiments in mice have not translated well into humans."

— BBC

There is absolutely no way this should be put in a "clinical use" section of an article.LeadSongDog come howl! 23:00, 9 February 2012 (UTC)

I agree that it should be in a "directions" subsection. However, all science reporters always find some doctor or professor who did not make the discovery to say something negative, which, when decoded says, "I didn't discover this, and science is based on skepticism, so I am going to throw cold water on my competitors, thanks for the opportunity." In fact, all that we need in the article are the words "IN MICE". Speciate (talk) 23:06, 9 February 2012 (UTC)

The paper hasn't even been published yet. here's the Science Express preprint abstract. If you read the "supporting material", you'll see it not only was in mice, but it was in a very small sample of mice. (They used n=5 and n=6.) Wikipedia is not news, we can wait for substantive, reviewed results. Stuff like this comes up every few months at Alzheimer's disease, and so far it's never been borne out in further testing, though of course we'd all love to be shown wrong. wp:MEDRS was developed for very good reasons. LeadSongDog come howl! 23:23, 9 February 2012 (UTC)

I think we're arguing at right angles to each other here. My concern is more stylistic, trying to turn the sources into the best possible language. So I want to indicate the weakness of the results directly, by picking out the actual problems, such as in-mice, engineered-model, small-sample, rather than what statistically we know to be the likely outcomes; failure to replicate in mice when a large scale study is done, and failure to extend to humans in any case. It is WP:OR to include such speculation. As for the word "megadoses", when combined with the low solubility, this should be taken as a warning to desperate people not to try and administer this drug to their loved ones without educating themselves on it a bit more. Speciate (talk) 23:36, 9 February 2012 (UTC)

Have you read wp:MEDRS? It is quite clear about needing secondary sources to support medical assertions. Physorg and its ilk are barely better than a press release, and certainly do not rise to the reliability level of even a peer-reviewed primary study (which, so far, the ScienceExpress paper is not). We can wait for serious secondary sources to publish on the matter. We can certainly take the time to discuss it before pushing it into articlespace. Remember that there is wp:NODEADLINE. LeadSongDog come howl! 01:34, 10 February 2012 (UTC)

I've added the MEDCN template to address these concerns. I just feel that saying the news sources are unreliable is going too far. They are merely insufficient. Speciate (talk) 02:28, 10 February 2012 (UTC)

Came here from posting on WT:MED. Agree that we should wait for secondary sources in the medical literature before we add material on this to provide appropriate context. WP:NOT#NEWS seems to apply here. Yobol (talk) 17:44, 10 February 2012 (UTC)

Well, you're wrong. No policy or guideline says that these sources cannot be used in an article. It is not Wikipedia's job to censor early results until some standard of "truth" arrives. Speciate (talk) 19:43, 10 February 2012 (UTC)

It seems pretty clear that you don't care what wikipedia's policies are, you simply want it your way. Is there some reason for this? LeadSongDog come howl! 21:37, 10 February 2012 (UTC)

I think you are incorrect in your assessment of the source (WP:MEDRS would seem to suggest this source is probably not the best to be using here at this time), but you are also incorrect in your assumption that just because something is found in a source that is not explicitly forbidden, it has to be included. We exclude information from reliable sources for other numerous other reasons such as WP:WEIGHT (which likely applies here) and WP:SYNTH (which does not apply here). Wikipedia has no deadline, so let's add the information when it is appropriate, not just because something popped up in the news. Yobol (talk) 21:46, 10 February 2012 (UTC)

Take a look at the views the article has received since the results came out. Are you proposing that the information be removed, based on your opinions that it won't pan out? Are people to rely entirely on the hype in the news media? Is my article on adipotide to be deleted based on the likelihood that it won't cure the worldwide obesity epidemic? Speciate (talk) 22:30, 10 February 2012 (UTC)

I have no opinion on whether or not it will pan out. I do have an opinion on what constitutes a reliable article for medical claims as well as what deserves WP:WEIGHT. We should be waiting on when this is seen in a secondary source in the medical literature, not jumping on any news article or preview. The study itself hasn't even been published yet! That the media hyped this doesn't mean we should; we follow our own guidelines. Yet again, WP:NOT#NEWS applies here. Yobol (talk) 22:37, 10 February 2012 (UTC)

One of our guidelines is the use of secondary sources. The Wall Street Journal is now reporting that Alzheimer's Families Clamor for Drug. Since this alone constitutes a secondary source on the discovery, serious misgivings about it, and the hype; some information on the Alzheimers connection must be in the article. Now, let us collaborate on a way to integrate this WSJ source into the article in a way that will best help our readers. Speciate (talk) 04:15, 11 February 2012 (UTC)

I basically agree with Speciate.

Science Express is publication in a peer-reviewed journal. It's published online first, which is how lots of journals, such as the NEJM, handle important papers. At any rate, it's published on paper now.

It's also been reported in reliable secondary sources like the WSJ, BBC, NPR, Washington Post, Los Angeles Times, New Scientist, including many sources which have been given high ratings by professional evaluators. http://www.healthnewsreview.org/charts/ That satisfies WP:WEIGHT.

Furthermore, most of these sources reported the story with caveats about applying animal studies to humans.

The most important limitation here is that this is a mouse study. However, it is striking that not only did bexarotene reduce Aβ plaque, but it also improved cognitive function. Even if bexarotene turns out to have no benefit in human AD, it raises an important question of why and how it improves cognitive function.

Forget the medical claims. I don't care about humans. I care about mice. I care about what this experiment tells us about the brain mechanisms in this mouse model. Does plaque reduction restore cognitive function, as it seems to? This is important basic research. Useful human treatments are years or decades away, and most animal studies don't pan out as drugs. I don't care. I don't know of any WP guideline that forbids us from writing about basic research. I'm not over-emphasizing a mouse study, I'm saying that it's for biological insight only.

>20,000 people viewed this page in the last 2 days, and they were obviously trying to get information about the AD study.

I think it's appropriate to summarize what the peer-reviewed report says, and what WP:RSs say about it, so they'll know what's going on, and understand the significance of an early animal study. -- Nbauman (talk) 16:22, 11 February 2012 (UTC)

Agree with Lead that this should not be included in the section on "medical uses" until a proper secondary source has appeared. A study of 11 mice is exactly the type of primary source that WP:MEDRS tells us not to us.Doc James (talk · contribs · email) 16:53, 12 February 2012 (UTC)

Yes, the mouse study is not "medical use." It's a study of one of the mechanisms that seems to be involved in Alzheimer's. Nobody should be using Wikipedia to practice medicine. They can use Wikipedia to understand the biological mechanisms of Alzheimer's, though. --Nbauman (talk) 01:42, 13 February 2012 (UTC)

In addition to the other issues with the Science Express source, it appears that the authors failed to declare that they were principals of a company Rexceptor Theraputics, created (sometime previous to last August) for the purpose of marketing this drug for use in AD and applied for a new patent covering that use. This just reeks both of COI and of evergreening, given that another company was preparing a generic equivalent for sale after the existing patent was to lapse (next year). Note that according to the supplementary material the dosages that mice got were equivalent to iirc $38/kg/day under current pricing, which would be catastrophically expensive were it to be used as a cronic-care drug in humans. Of course it could be simply a defensive patent, but how are we to know? LeadSongDog come howl! 22:22, 13 February 2012 (UTC)

They did disclose it in the full text of their article online doi:10.1126/science.1217697 :

PEC and GEL hold a US Provisional Patent Application No.: 61/224,709 regarding bexarotene as a potential therapeutic for Alzheimer's disease and are founding scientists of ReXceptor, Inc., which has licensing options from CWRU on the use of bexarotene in the treatment of Alzheimer's disease.

I always thought that financial and COI issues should be discussed in Wikipedia articles. If you can find a WP:RS that says it, without violating WP:OR or WP:SYNTH, put it in. --Nbauman (talk) 21:24, 19 February 2012 (UTC)

I meant to say in the edit box, It's not a preprint. A preprint has not been peer reviewed. This eprint has been peer reviewed. --Nbauman (talk) 21:31, 19 February 2012 (UTC)

Odd that is buried in the text rather than in the "author affiliations" which are shown in the abstract, but at least it's disclosed. Thank you for clearing that up. Unfortunately there's multiple meanings to the term "epub". Pubmed shows this article as "epub ahead of print". Some call peer reviewed epubs "postprints", but that's hardly a consistent usage either. LeadSongDog come howl! 04:50, 20 February 2012 (UTC)

Medical uses

I have several problems with this section:

Bexarotene is indicated for the treatment of cutaneous manifestations of cutaneous T-cell lymphoma in people who are refractory to at least one prior systemic therapy (oral) and for the topical treatment of cutaneous lesions in patients with CTCL who have refractory or persistent disease after other therapies or who have not tolerated other therapies (topical).

First, it's too technical for a non-professional reader. I had to read it twice. Why not say "skin" instead of "cutaneous"?

Second, this is simply the FDA indication. It's not the only medical use. As the introduction indicates, there are other uses. (In fact it seems to be cut and pasted from the package insert.)

Third, it's so detailed that it sounds like giving the practice of medicine. --Nbauman (talk) 01:51, 13 February 2012 (UTC)

Schizophrenia

In the History section

A 2008 pilot study showed improvements in positive, negative, dysphoric, and extrapyramidal symptoms in schizophrenia patients receiving neuroleptic drug treatment. The medication was recognized as safe by laboratory measures with the exception of increased total cholesterol serum level.

was removed for not having a medical review source (per WP:MEDRS). A review in Molecular Psychiatry, before the study, talks about the drug as an add-on in schizophrenia. Gaba amine (talk) 04:16, 16 May 2012 (UTC)

References

Orphaned references in Bexarotene

I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Bexarotene's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "MSR":

• From Protein kinase inhibitor: "[Drug Name]". Medscape Reference. WebMD. Retrieved 27 January 2014.
• From Capecitabine: "Xeloda (capecitabine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. 25 January 2014.

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT⚡ 11:30, 28 January 2014 (UTC)

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