Talk:Charlotte's Web (cannabis)

Medical uses

Evidence

There is little evidence about the safety or efficacy of cannabinoids in the treatment of epilepsy. A 2012 Cochrane review did not find enough evidence to draw conclusions about its use. A 2014 review by the American Academy of Neurology similarly concluded that "data are insufficient to support or refute the efficacy of cannabinoids for reducing seizure frequency".

A 2014 review concludes that available evidence is insufficient to draw conclusions about the safety and efficacy of cannabinoids in the treatment of epilepsy. The authors suggest that cannabinoid drugs for epilepsy be reserved for people with symptoms that are not controllable by other means, who have been evaluated by EEG-video monitoring to confirm diagnosis, and are not eligible for better established treatments such as surgery and neurostimulation. A second review described four placebo-controlled trials of cannabadiol including 48 people with a disease that was not manageable by other means. Three out of four trials reported some reduction in seizures, but no comparison with placebo was possible due to the small number of people in the trials. The drugs were well tolerated. A third review found that no reliable conclusions about the effect of cannabis on epilepsy could be drawn due to the poor quality of available data, but further research may be warranted because of the good safety profile observed in small clinical trials.

Statements

Due to the anecdotal nature of the health claims being made medical bodies have published statements of concern.

A position statement by the American Epilepsy Society states:

"The recent anecdotal reports of positive effects of the marijuana derivative cannabidiol for some individuals with treatment-resistant epilepsy give reason for hope. However, we must remember that these are only anecdotal reports, and robust scientific evidence for the use of marijuana is lacking... at present, the epilepsy community does not know if marijuana is a safe and effective treatment, nor do they know the long-term effects that marijuana will have on learning, memory and behavior, especially in infants and young children."

Cannabis-derived products are not mentioned in the National Institute for Health and Care Excellence epilepsy treatment guidelines.

References

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Charlotte Figi's death in lead?

Should Charlotte Figi's death be in the lead? I know the lead should usually be succinct and be a summary/intro of the most important points of the article. So I'm wondering if others think her death is important enough to this topic to include it in the lead. - Whisperjanes (talk) 03:41, 16 April 2020 (UTC)

No one has added any input yet, so I'll add my thoughts for now.

The mention of her death does not seem to help summarize this article, and leads are usually meant to summarize. Her death and COVID-19 also don't seem to be directly connected to this cannabis strain, so I'm not sure if it should be in the lead. I'll take it out unless anyone has any objections. - Whisperjanes (talk) 02:43, 10 May 2020 (UTC)

Applicability of MEDRS for non-medical claims

KoA, although you have the ONUS for removal because this content is very, VERY, old (many years), I don't want to edit war, nor give the impression that MEDRS is unimportant. I'm a huge opposer of quackery and fale medical claims, so have been a huge supporter of MEDRS, but I have also seen it invoked for things where it does not apply. The only part that could possibly be relevant for MEDRS is "used to treat epilepsy in toddlers and children." It is an undeniable fact that that is what's happened. Families and doctors have done that. Here's the disputed content you deleted:

Media coverage increased demand for products high in CBD, which have been used to treat epilepsy in toddlers and children. One of the initial strains developed by the Stanley Brothers was originally called "Hippie's Disappointment" as it was a strain that had high CBD and could not induce a "high".

The statement documents the facts and sums up content in the body of the article, without indicating anything about medical status or FDA approval. Maybe that could be tweaked so no one thinks that doctors are using it as an approved product for that purpose? (They are, but then they are using Epidiolex. )

You seem to have gotten carried away and even deleted the last sentence which has no possible relation to MEDRS. Deleting that last ref has created redlinks. -- Valjean (talk) 20:37, 25 July 2021 (UTC)

The epilepsy part is in part why I invoked MEDRS. If something is going to used to say it has been used to treat X, that needs a MEDRS source, especially because it implies effectiveness, even if that meaning is not intended. As you mention, we see that kind of text a lot of quackery stuff, but also even in just simply untested (or poorly tested) medical claims that might come to fruition someday. However, we do have MEDRS sources saying there currently is not evidence for efficacy for seizures. The latter sentence is also making a medical claim about high CDB and could not induce a high. I also removed the ref that caused the redlink since it isn't being used anymore.

Admittedly, part of that higher scrutiny is also because we have a lot of junk filter in to a cannabis strain articles, so where MEDRS is applicable, it does help keep focus when it comes to human health claims. For the time being though as I looked through the sources that are used, there doesn't seem to be a really strong case for the content I removed from a WP:DUE perspective, even disregarding MEDRS. Hopefully that outlines a few things going on when I decided to remove it. KoA (talk) 22:50, 25 July 2021 (UTC)

KoA, thanks for the prompt reply. The statement is not a claim of efficacy, but a required statement, based on content in the body, of a basic fact upon which the whole article is based. It is a fact that people and doctors were and are using CW for seizures. That is not a claim of efficacy. Such a claim would indeed require a MEDRS. (The efficacy is proven by the FDA approved use of CBD when in the form of Epidiolex.)

This article has been edited by our top medical editors, including User:Doc James, and no one has ever questioned that wording. It has been there for many years. You are the first, and that indicates we should probably tweak, but not remove, the required wording. How can we do that so no confusion exists? We are not claiming efficacy for a non-approved product, just stating what the article is about, that Charlotte's seizures were treated with CW. We can't leave out that fact. -- Valjean (talk) 01:57, 26 July 2021 (UTC)

I'll mention that this article has been on my to-do list for awhile, but much of it is actually a WP:COATRACK a lot of it doesn't deal with the strain Charlotte's Web. A lot of the medical uses section for instance really belongs in a different more general article, especially Epidiolex. This particular edit is part of a much broader swath of issues I hope to get to in the coming weeks, at least in terms of finding a better home for some of the content.

So for the content at hand, maybe the best example is how we normally handle things like folk cures, etc, especially where a plant or natural substance had some active ingredient in question. Usually there is a careful line between the plant/substance article and the active ingredient article. Honey#Medical_use_and_research is one example that comes to mind for how it's approached. Typically when we say people frequently try something for a medical treatment like that, we need a qualifying statement stating whether Charlotte's Web in this case has been shown to have any effect. Saying doctors, etc. use it implies efficacy, which is where my hangup is. "At-home" or unregulated treatments can unfortunately get finicky like this. I won't be around for the next few days, but I'll see if I can draft something that can maybe address that when I get back if no one else has. KoA (talk) 02:03, 27 July 2021 (UTC)

At the time I created this article, this was the story. It was a human interest story with lots of coverage in RS, and also a story about a new use for high CBD cannabis. Since then the article has undergone a lot of change, but the basic stories are still there as they are and were notable.

That does not mean that some revision might not be good, but let's discuss it first, since the current version enjoys a solid consensus, and one editor who comes along with new ideas, even legitimate ones, does not justify bold editing that is contested. So let's see what changes you propose and we may end up with a different version in which topics get split off into legitimate forks.

Note that my observation about doctors using it was a comment made on this talk page. That is a notable fact that is basic to the whole story. LEAD requires that we mention that fact in the LEAD. It's just a matter of how to do it, rather than completely delete it, as you have done. That is an ONUS violation, so I'll restore it until you suggest a better version.

The article touches on how doctors are legally allowed to experiment with unregulated products and the story of how pressure was placed on the FDA to make changes to existing laws. This story is what "broke the dam" that prevented experimentation with cannabis, and a flood of changes to state regulations has followed. -- Valjean (talk) 14:14, 28 July 2021 (UTC)

I'm going to try to get a few edits in sometime today to address some more core issues before this original edit since it's on lead content. That will help with diffs to refer to as well. However, I will say that this looks much less like an article that has consensus, but more just one that has lacked attention and scrutiny (i.e., WP:SILENCE) for many years. That guidance does help inform ONUS a bit. For instance, this edit restored a non-MEDRS source. Primary research articles are almost never usable per that guideline and there's really no way for that to remain. KoA (talk) 15:47, 28 July 2021 (UTC)

One thing I had a quick second to work on is the Medical uses section and removing some of the WP:COATRACK issues with mentioning cannabidiol. There is a little bit of a WP:DUE aspect to include some of the MEDRS sources that are more general and not mentioning this strain specifically, but the section might be able to be pruned further depending on what remains in the rest of the article after edits there.

I managed to get a bit more time this morning, so I took a once through on the article to help focus the scope of it a bit. Basically, there was a lot of content that really belonged at either at Charlotte Figi when it comes to documentaries, etc. she was featured in, or else cannabidiol. Even then, those probably need some pruning, but I'm just focusing here. Much of the discussion out there in the medical realm is just about CBD in general with nothing that's particularly specific to this strain compared to others. The only thing that stands out pertinent to this article is that it was showcased as a single example in popular stories, but that can easily turn into a WP:COATRACK as I tried to fix. The etymology and publicity sections maybe need a bit more careful reworking, but I'm going to hold off on that for awhile. It might be better to merge those to be a more streamlined summary of Charlotte Figi so readers can be directed to the BLP for details that don't fit well here. KoA (talk) 17:22, 28 July 2021 (UTC)

I see that you have ignored my appeal for collaborative editing and plowed ahead with BOLD editing where you knew it would be contentious. Not good. That's a big FU to the work of many editors and to several policies. Otherwise, I am sympathetic to several of your concerns; it's just your approach that irks me. You have violated WP:Preserve big time by not reducing content in a proper manner, which is by splitting off content to appropriate articles. You have mentioned that option, so you're aware that it remains to be done, and since you deleted it, please take a good look through what you've deleted and then actually use the content and RS where they can be used. (Yes, I'm aware that some content will be lost in the process (we don't want duplication), but at least give it a try. That would at least show your good faith. Sins of omission are just as egregious as sins of commission.) Thanks. -- Valjean (talk) 20:54, 28 July 2021 (UTC)

So there were two things going on here. What we were initially discussing was the usage of the strain and how MEDRS applied to those statements. I left that and the lead alone for the time being. I also left the etymology and publicity sections alone since those require a bit more care and likely need some talk discussion. Personally, I'm leaving that be until the rest of the article is settled.

What was new though is that much of the content just simply did not belong, so there's nothing uncollaborative about removal, and I wouldn't reasonably expect anything contentious about it. This is just unfortunately what happens when an article becomes a coatrack. All the content is preserved in the diffs, which is also why I did it piecemeal instead of a blanket removal so anything specific could be discussed if needed. Much of the removed content I'm simply not sure if it even belongs in the other articles, otherwise I might have done that at the time (and I actually was following PRESERVE with that in mind), but WP:NODEADLINE also applies for the other articles. If someone feels strongly about removed content, they are free to work it into other articles per WP:ONUS. I also only have so much time to edit and am focusing on this article first.

There's also no real easy to way or need to bring all of those edits on to the talk page. That was a lot to sort through, and someone had to do it. If there was something in my edits that actually did cause an issue, feel free to bring up the diff(s) on the talk page so it can be discussed. That's largely why I stopped where I did in order to work iteratively instead of all at once. It might be easier to make a new talk section with that in mind. KoA (talk) 23:56, 28 July 2021 (UTC)

That sounds reasonable. -- Valjean (talk) 01:40, 29 July 2021 (UTC)