Talk:Hyperemesis gravidarum/Archive 2

Use of d/p in HG 'questioned' - use of weasel words, source linked not easily accessible

Use in HG is not questioned in more easily accessible secondary sources, such as here: http://emedicine.medscape.com/article/254751-overview

Also, 'questioned' is too unspecific, especially when the nature of the 'questions' are locked up in inaccessible content. See 'weasel words'. — Preceding unsigned comment added by 76.88.119.75 (talk) 21:12, 10 March 2013 (UTC)

Medical Marijuana

Perhaps there should be some mention of cannabis therapy for HG. there seems to be at least anecdotal evidence of its use, e.g. [1]. Of course it is bound to be even more controversial than other uses of medical marijuana. NTK 01:01, 31 May 2007 (UTC) Lots more anecdotal advice of medical marijauna to treat HG here http://offbeatmama.com/2010/03/marijuana-pregnancy 86.21.10.190 (talk) 22:14, 20 October 2010 (UTC)

PICC line

I suspect that the PICC line statement is actually about parenteral feeding instead of rehydration.

The authors at PMID 16006438 cite a study which suggests that about 10% of HG patients experience at least some symptoms throughout the entire pregnancy. Whether or not this requires parenteral interventions is not obvious to me. WhatamIdoing (talk) 04:04, 9 May 2008 (UTC)

Impact section copied from HER page

The impact section looks like it was copied from the HER description of HG, there may be other sections too, I haven't paid attention to. Needs fixing! 98.197.220.29 (talk) 15:13, 12 July 2008 (UTC)

Thanks for the alert. I have found a better reference on the named website and re-written the "Impact" section. When you feel an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top. The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes — they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to). WhatamIdoing (talk) 19:52, 12 July 2008 (UTC)

Phenergan for treatment of HG

In the article it is stated that Phenergan (Promethazine) has been found to be a safe treatment of HG, but this is not completely correct. Promethazine is not meant to treat anyone under the age of 2yrs. That includes unborn babies. I do not know if the information in the article is old, but there has been new research to suggest some pretty nasty side effects to the fetus when using Promethazine. I think that people should know that Ondansetron (Zofran) was developed for use in pregnant women experiencing HG and in 26yrs there haven't been any birth defects reported. Promethazine lowers the heart rate which can be fatal to a fetus. Working in Emergency Medicine, we have specific rules about the medications we can give to anyone. One of those is if a woman is of child bearing age and unconscious we must assume she may be pregnant. Another is if she may be pregnant we CAN NOT give her Promethazine. And in many states, Promethazine has been pulled completely from emergency medical response vehicles because of the unknown possibilities when it comes to patient conditions.

concerned EMT

Marijuana and HG

I have been using marijuana as a treatment for HG since week 12. I am now at week 21 and carrying a perfectly healthy baby. I don't think this would be the case if I didn't use marijuana. I have been on Zofran, Phenegran, b-6, and Regland and the marijuana trumps all of these! Because of marijuana, I have been able to stay hydrated, decrease vomitting by a substantial amount, appetite is stimulated and I am able to take in a good amount of calories each day, and the nausea is virtually gone. I am sure this is a contraversial subject, but I see marijuana doing no more harm than the man made drugs that are given to us pregnant women...in my opinion it is much safer. I hope this helps someone else going through HG...I wouldn't wish this disorder on my worst enemy. Also I want to note that the misconception that HG is just a severe case of morning sickness is a COMPLETE understatement. I wish people would educate themselves more on this topic...especially doctors and nurses. 3rdEyeMom (talk) 17:18, 28 August 2012 (UTC)

"How To" and missing link

The entire treatment section needs to be rewritten. Since when does an encyclopedia give you folksy popular remedies such as wristbands "worn around the wrist at a traditional acupuncture point, 3 finger-widths from the joint", and who in their right mind would state that since most women with HG "were infected with Helicobacter pylorii" "it is [a] relatively simple [matter] to eradicate H. pylori once you understand its cause. Most people respond to simple nutritional interventions. The first step is to drink 12 glasses of pure filtered, not distilled, water per day" TWELVE GLASSES OF PURE FILTERED WATER A DAY - do you see the stupidity in this?65.93.35.157 (talk) 00:20, 5 December 2012 (UTC)

Thank you for your suggestion. When you believe an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top.
The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to). WhatamIdoing (talk) 19:20, 6 December 2012 (UTC)

Article is a hodge podge...

This article is not very well organized; for instance, some complications are in the symptoms sections, etc. It could sure use a complete rewrite!. This site is excellent to use for information: [2] Gandydancer (talk) 16:15, 6 December 2012 (UTC)

Including information about medical marijuana

I have refactored this talk page by archiving a section to help clear the air following an edit war. See Talk:Hyperemesis gravidarum/Archive 1.

Zad68 and Jmh649 et. al. (e.g. MrADHD), what sort of information about medical marijuana, if any, would you deem acceptable to include in this article? In my opinion, it's time for you to be constructive and contributory and respectful of the consensus that existed among this articles editors from 2007 until Jmh649's edit on 22 January that totally deleted all references to medical marijuana.

Notably, "Treatment of hyperemesis gravidarum is primarily symptomatic." (Gabbe, Steven G. 2012. Obstetrics normal and problem pregnancies. Philadelphia: Elsevier/Saunders. http://site.ebrary.com/lib/uqat/Doc?id=10579609. Page 117.) And the symptoms of HG include nausea, vomiting, and unintentional weight loss, and lack of appetite. And medical cannabis has established effects in the treatment of symptoms such as nausea, vomiting, and unintentional weight loss, and lack of appetite, according to a 2002 review of medical literature by Franjo Grotenhermen that is cited in the medical marijuana article.

Further, Jmh649, aka "Doc James", as a doctor, please be advised of the following from the same page of the Gabbe book, especially because you are not even an obstetrician. Also, because you seem overly-reluctant to include any reference to medical marijuana in this article despite its generally-known and possibly harmful effects being no worse than the torturous effects of severe and intractable cases of HG.

"Finally, there are patients who fail treatment and opt to terminate pregnancy. The exact incidence is unknown. However, a Web-based survey of over 800 women who agreed to be part of a hyperemesis gravidarum registry noted that 15% had at least one termination and 6% had more than one termination as a direct or indirect result of severe hyperemesis gravidarum. These women felt they were too sick to care for their family or themselves or they were concerned about the potential adverse consequences of hyperemesis gravidarum on their baby. Further, these women indicated that health care providers were uncaring or did not appear to understand or acknowledge how sick they were, suggesting that further education within the medical community about the physical and psychological burden of hyperemesis gravidarum is needed." Id., bold emphasis added.

There is more than sufficient notability about medical marijuana being used to treat symptomns that are associated with HG, so there is surely a way that a reference to medical marijiuana could be included in the article that will be acceptable to all currently-active editors of the page. Right? It's your move.

JonathanFreed (talk) 20:39, 1 February 2013 (UTC)

Any secondary source that mentions that THC is useful in HF HG? What you did above is synthesis and primary research. If you cannot find something feel free to publish a review article on the topic in a well respected journal and than we will have something to work with. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:02, 1 February 2013 (UTC)

Jmh649 (aka Doc James), please clarify what you meant by your first sentence. "HF" appears to be a typo, and more to the point, were you trying to say the following: "the sort of information about medical marijuana that I (Jmh649/Doc James) would deem acceptable to include in this article would be any secondary source that THC is useful in the treatment of hyperemesis gravidarum". And if you were not trying to say that, what were you trying to say? JonathanFreed (talk) 01:50, 2 February 2013 (UTC)

Yes you have it. We require a secondary source that says it is useful in HG. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:25, 2 February 2013 (UTC)

Okay, now stay with me here. What is HG? I would like to use the introductory text of the article to answer this seemingly simple question, but that text isn't even a grammatically correct sentence at the moment. And, more relevant to you, that text is not supported by any citations of a secondary source (unless you consider http://www.helpher.org/ to be a secondary source). So, before we can continue about medical marijuana, please tell me, what is HG? Please provide an appropriate secondary source, of course. Alternatively, is the Gabbe source I provided (supra) acceptable as a secondary source to you ? (FYI, its introductory text about HG states that "Nausea and vomiting is a common symptom of pregnancy affecting approximately 75% of pregnancies. Hyperemesis gravidarum is an extreme form characterized by unexplained vomiting, dehydration, and weight loss and frequently results in hospitalization.") Incidentally, I find it hard to assume that you are acting in good faith when you do not appear to have applied your standards of scrutiny to the article's very first few sentences. You instead appear to have an axe to grind about medical marijuana. So, let's prove me wrong, shall we? Please let me know if http://www.helpher.org/ is a secondary source, or please use a secondary source to tell me what HG is, or alternatively let me know if you approve of the Gabbe book as a secondary source. JonathanFreed (talk) 03:54, 2 February 2013 (UTC)

HG is hyperemesis gravidarum which we say in the first sentence of this article? Added a review article to support the lead. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:55, 2 February 2013 (UTC)

Yes, of course HG is hyperemesis gravidarum. Clearly my question was not what "HG" stood for, because I already established that I know what "HG" stands for when I took your typo "HF" and correctly understood you to refer to hyperemesis gravidarum (HG). My question instead was what is hyperemesis gravidarum, aka HG? The article's first sentence still isn't even grammatically correct even after your addition of a citation to a review article. The sentence is currently "Hyperemesis gravidarum (HG) is a severe, debilitating nausea and vomiting in pregnancy that generally leads to more than 5 percent weight loss and may require fluid and nutritional supplements." It could be made grammatically correct if the "a" in "is a severe" was removed, or if something is added after the adjectives "severe" and "debilitating" like, perhaps, "severe, debilitating form of". So, again, because the article's first sentence isn't even grammatically correct, nobody can look to it to understand what HG (hyperemesis gravidarum) is. Please let us know what it HG (hyperemesis gravidarum) is and then we can continue to the next step about determining the relevance of medical marijuana to this article about HG (hyperemesis gravidarum). We of course cannot understand the relevance of medical marijuana to HG (hyperemesis gravidarum) if the article hasn't even established what HG (hyperemesis gravidarum) is. Further, the review article you provided does not support the lead sentence even if it is changed in either way that I suggested to make it grammtically correct. The review article does not say that it "HG is a severe, debilitating form of nausea and vomiting in pregnancy", nor does it say that "HG is severe, debilitating nausea and vomiting in pregnancy". If Wikipedia is going to be very strict about requiring secondary sources in medical articles, we should be sure to say nothing more than what those secondary sources say. So, I am removing your citation and adding a "citation needed" tag. If, on the other hand, you feel that such a level of precision is not needed, then that is further evidence that your requirement of such precision for medical marijuana in this article is not a requirement that you have made in good faith as it is inconsistent with your requirements for other parts of the article. Your move. JonathanFreed (talk) 15:53, 2 February 2013 (UTC)

Seems like a lot of trouble to type all this verbiage out on the Talk page when all that needs to happen is to find a decent WP:MEDRS-compliant secondary source that provides a good definition and use it in the article. It seems that this has been added already (Goodwin 2008) so that's all taken care of now. As for adding content on using marijuana as a management tool for HG, per WP:BURDEN it's up to you as the editor interested in adding such content to provide excellent-quality reliable sourcing for it. I just took a look at this review article: Managing hyperemesis gravidarum: a multimodal challenge and marijuana is not mentioned at all. Do you have source supporting it? Zad68 03:56, 3 February 2013 (UTC)

It was a lot of trouble. Are you going to make a complaint now about how I'm trying too hard to seek consensus? (That's a joke, or at least half a joke, okay?) It's not as easy as me just finding a decent WP:MEDRS-compliant secondary source because I don't have good access to such sources. Also, it's questionable whether anybody will find a single secondary source that ties together the following three separate thoughts, and it appears the Jmh649 feels that putting these three together would constitute an impermissible synthesis: (1) treatment of HG is symptomatic, (2) antiemetics are used to treat the symptoms of nausea and vomiting, (3) cannabinoids are antiemetics. Notably, those three thoughts are already put together through wikilinks because the HG article links to the antiemetics article which discusses cannabinoids. The only question is whether we can bring a mention of cannabinoids into the HG article itself alongside the mentions of other antiemetics in the HG article. JonathanFreed (talk) 06:26, 3 February 2013 (UTC)

You got it! You summarize it very well:

YYY Also, it's questionable whether anybody will find a single secondary source that ties together the following three separate thoughts, and it appears the Jmh649 feels that putting these three together would constitute an impermissible synthesis YYY

Precisely so, what you are describing - take several sources, not any one of which says "The anti-emetic properties of cannabis are useful for managing HG" and stringing them together to state or imply such a conclusion, is indeed textbook forbidden WP:SYNTHESIS (sometimes humorous referred to as a "mortal WP:SYN" ). A single, excellent-quality source that states so is required for inclusion of such content in this article. Until such a source is located, the article can't carry such content. Feel free to look for such a source, but please note that I believe three relatively experienced medical article editors, myself (probably the least experienced of the three), TylerDurden and Doc James (very experienced), have all tried to locate such a source and have not been able to. Zad68 13:46, 3 February 2013 (UTC)

This is a reliable secondary source that has connected the dots for us. It is a first-person report from a patient but it is published in a respected magazine, it seems to be well researched and includes an extensive bibliography. -—Kvng 15:38, 4 February 2013 (UTC)

Kvng, thanks for doing some digging here but that article isn't an acceptable source for biomedical information per WP:MEDRS. We're looking for peer-reviewed review or meta-analysis articles published in reputable MEDLINE-indexed journals, statements of major medical organizations, or the like as specified in the WP:MEDRS guideline. Zad68 15:45, 4 February 2013 (UTC)

Ok. The bibliography of the article appears to list several WP:MEDRSs related to this issue. Someone with access might want to have a look at those. -—Kvng 17:01, 4 February 2013 (UTC)

I looked for MEDRS sufficient sources and there where not any. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:54, 5 February 2013 (UTC)

Thanks for looking. -—Kvng 15:36, 7 February 2013 (UTC)

Now, 8 years later, a relevant review article has been published and it is available as a "secondary source". I've edited this Wikipedia article to include corresponding text and a reference to that review article. Now, nine months after a single responsive edit [3](that I reverted [4]), it appears that the Wikipedia article has an appropriately sourced sentence that has garnered consensus. JonathanFreed (talk) 17:04, 15 November 2021 (UTC)

=Link to Help HER

Per WP:ELNO I have removed this link [5]. It is a little spammy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:11, 31 January 2013 (UTC)

The purpose of the link is not to promote the website, aka spam. JonathanFreed (talk) 06:21, 31 January 2013 (UTC)

The link has been readded as there is clear precedent on Wikipedia for keeping links to support organizations in medical articles. E.g. Diabetes_mellitus#External_links, Diabetes_mellitus_type_1#External_links. If you believe such links are not acceptable in an external links section, then please be consistent and go remove them from other medical articles. Also, please state whether it would be acceptable, in the alternative, to include a reference to the HER Foundation in a new section entitled, for example, "support organizations" (rather than having the reference to the organization in the "external links" section). A precedent for such a section with such references may be found at Breast_cancer#Society_and_culture. JonathanFreed (talk) 16:45, 2 February 2013 (UTC)

And it's been removed again, as a breach of our policies concerning external links. You may indeed find examples of contraventions in other articles, but that simply does not justify edit-warring against multiple editors to attempt to force an external link into this article. WP:ELNO states:

• "... one should generally avoid providing external links to: ... Any site that does not provide a unique resource beyond what the article would contain if it became a featured article."

The HER Foundation does not qualify as the official website. It is clearly a worthy cause, but that is still just one charity in one country - insufficient to qualify by the standards laid out above, and particularly in the light of Wikipedia not being a directory of external resources. If you can make a good case for inserting a section discussing support groups (preferably not just US-based) then the HER Foundation may make a suitable reference. Otherwise, there is the possibility of a single link to an appropriate list at the Open Project Directory, which is generally tolerated for good causes. --RexxS (talk) 21:06, 2 February 2013 (UTC)

Now that I have stumbled across Wikipedia:MEDMOS#External_links, I agree that adding the proposed link to an external links section is inconsistent with the established manual of style for medicine-related articles. While I consider the possibility of a new section about support groups or something similar, let me just say for now that for consistency's sake, I look forward to seeing you all go around to those other articles and removing similar links. I suggest you point complainers to Wikipedia:MEDMOS#External_links, as I wish somebody had done for me. Perhaps you all were as equally unaware of it as I was. I still disagree that WP:ELNO supports the exclusion of an external link to http://helpher.org (which is indeed a unique resource), but in any case, Wikipedia:MEDMOS#External_links clearly does. JonathanFreed (talk) 04:58, 3 February 2013 (UTC)

FYI the HER Foundation is an international support organization. Not saying that meet the criteria for inclusion, but it is international, and if you check other medical sites and nonprofits, HER is the definitive site for information on Hyperemesis Gravidarum.

Article introduction needs correction and support by secondary sources

As has been discussed in the talk section about medical marijuana, the article's first sentence is currently grammatically incorrect, and none of the introduction's sentences are currently and appropriately supported by a secondary source. At best, they represent an unallowable original synthesis based a secondary source or sources. It is my understanding, based on allegations from the active editors involved in the discussion in the past week about medical marijuana, that supporting citations to secondary sources are required in this article. Please assist in rewriting the introduction. JonathanFreed (talk) 16:29, 2 February 2013 (UTC)

Instead of writing a talk topic on it, if you really believe it needs fixing, then fix it. I'm sure you can find a good secondary source that fits the bill. Also, tertiary sources are allowed if you use them sparingly. TylerDurden8823 (talk) 18:26, 2 February 2013 (UTC)

I've fixed it now and repaired some of the damage done by this disruptive editing. Goodwin 2008 is a overview of the subject, published in a respected scientific journal, which draws on other works and the author's own expertise ('Goodwin TM' produces 119 hits on PubMed, many of them discussing pregnancy and HG in particular). The guidance at both WP:RS and WP:MEDRS imply that this is a reliable secondary source. We have a Reliable sources noticeboard to seek a third opinion if there is any doubt of that. --RexxS (talk) 20:36, 2 February 2013 (UTC)

TylerDurden823, your assumption about my ability to find a good secondary source may be complementary but in any case it is also assuming a bit too much because not everybody has easy access to secondary sources. There are others that have much easier access than me and that have also displayed an active interest in this article. (Like yourself, perhaps?) Also, according to WP:MEDREV and related comments addressed to me, a citation to a secondary source is required, and a primary source is insufficient. The Goodwin source currently being cited is not a secondary source -- or at least it does not show up as such in the TripDatabase to which I've been pointed for finding secondary sources -- so unless somebody can verify its status as a secondary source then the introduction still needs a secondary source. Further, WP:MEDREV does not say what you said, which is that "tertiary sources are allowed if you use them sparingly". Indeed, it seems based on WP:MEDREV that some tertiary sources would be appropriate to cite, but others, like Wikipedia, would be wildly inappropriate to cite. JonathanFreed (talk) 21:32, 2 February 2013 (UTC)

Access is not usually a problem. There are resources to use on wikipedia if you don't have access to certain peer-review secondary source review articles. It's true that I have interest in this article, and I have been actively working on it in other ways, but I am working on other articles and have other things to attend to unfortunately. What was most concerning to me in this article was the use of very old references and that's what I worked on. One of your primary concerns, the THC issue aside, seems to be the first sentence and the sources used. If access to proper secondary sources is your concern, my suggestion would be to check out this place: http://en.wikipedia.org/wiki/Wikipedia:WikiProject_Resource_Exchange/Resource_Request And you are right, citing wikipedia would be inappropriate. I didn't say that all tertiary sources are appropriate. Just that tertiary sources can be used. The reason I said sparingly is because secondary sources are usually preferred.TylerDurden8823 (talk) 22:29, 2 February 2013 (UTC)

TylerDurden8823, thank you for the information about ways to access resources. JonathanFreed (talk) 23:03, 2 February 2013 (UTC)

Anytime. =) TylerDurden8823 (talk) 23:06, 2 February 2013 (UTC)

RexxS, regarding alleged disruptive editing, let's review: I removed in good faith two citations that did not appear to be secondary sources (based on my searches [6] [7] at TripDatabase.com that I was advised to use) and that also did not support the introduction as it was written (as required by WP:MEDREV). You apparently agree that the citations did not support the introduction as written because you did not just revert to the version prior to my edits. Instead your edit altered the first sentence and only used one of the two citations in your rewrite. It appears that there was less disruption than there was actual progression, and that's good, right? See pillar # 5 that is linked to WP:IAR. Lastly, you mentioned on my talk page that "If you need guidance on what constitutes a secondary source, then ask for it." So, here goes: Specific to this issue, why isn't the Goodwin source in the TripDatabase as a secondary source? Is that because the TripDatabase just isn't reliable for this particular search, or is my search inadequate, or is the Goodwin source not actually a secondary source? Thanks. JonathanFreed (talk) 23:03, 2 February 2013 (UTC)

I would prefer not to have to repeat the warning against disruptive editing here, so I will try to focus on the task of improving this article (as that is the conventional purpose of this talk page). The lead of a well-developed article generally does not contain citations as it is a summary of the rest of the article, which is already cited. Take a look at any Featured Article and you will see that this is the case. Unless you are challenging what is written in the lead as an inaccurate summary of the following content, then kindly don't insert any more {{fact}} tags as you have clearly used them in this case simply to make a point.

Don't presume to divine my thinking when I didn't simply revert your edit that removed the citations. As it happens you are completely incorrect in the conclusion you leapt to. If I agree with you about anything, I'll tell you, and I didn't agree in this case. Reverting to the previous version would not only have required reverting the edits performed subsequent to that one, but would also have re-introduced the grammatical error (which I do agree was present), and there was no need for that. The lead really requires no citations at all, but rather than have you nit-pick about definitions, I was content to add a single good source that was also used elsewhere in the text.

Even Jon Brassey at TripDatabase won't claim that his database is infallible, and good as it is, it relies on keywords in an journal description or human assessment to determine the features of the sources, such as the "secondary" label. Here's what WP:PSTS says:

• "A secondary source provides an author's own thinking based on primary sources, generally at least one step removed from an event. It contains an author's interpretation, analysis, or evaluation of the facts, evidence, concepts, and ideas taken from primary sources."

Take a good look at Goodman 2008: The abstract describes it thus, "This article discusses the causes, presentation, diagnosis, and management of hyperemesis gravidarum." Surely you would agree that that indicates the source is secondary by our understanding, not primary?

The quality of the source is naturally the question to be determined by examination of the reputation of the journal in which it is published, and if necessary by examining the reputation of the author. On both counts, I am satisfied that Goodman 2008 meets our standards. The only criticism I might have is that it is approaching five years old. The last literature review that I can find searching for "cochrane review hyperemesis gravidarum" dates to 2005 (doi: 10.1093/humupd/dmi021), so perhaps we'll have an up-to-date Cochrane review in the near future. In the meantime, if you disagree with my assertion that Goodman 2008 is compliant with WP:MEDRS, then please understand that edit-warring over the issue is a mistake. You should however feel free to seek a third opinion either at Wikipedia talk:WikiProject Medicine or at Wikipedia:Reliable sources/Noticeboard. --RexxS (talk) 02:07, 3 February 2013 (UTC)

While TRIPdata base is useful to find good secondary sources not all good secondary sources are in TRIP. Pebmed is more exhaustive.Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:00, 3 February 2013 (UTC)

RexxS, you started by suggesting I "take a look any featured article and you will see that" "the lead of a well-developed article generally does not contain citations". (A lead is the section above the table of contents, and "generally" is at least over 50%, if not much more.) This is a health & medicine article, so I looked at the 48 featured health and medicine articles. Of those, only about 14 (~29%) do not have citations in their lead. That's far from "generally". Further, while the Manual of Style for Medicine-related Articles takes no position on citations in leads, it does say that "Medical articles should be relatively dense with inline citations... It is not acceptable to write substantial amounts of prose and then add your medical textbook to the References section as a non-specific or general reference." This category-specific instruction aligns with the finding that about 71% of featured health & medicine articles have citations in their leads, and -- depending on the definition of "substantial" -- it supports the idea that the current lead should have more citations than just one at its conclusion. Kindly provide your thoughts?

You also directed me to take a look at the Goodman (sic; it's "Goodwin") 2008 abstract's description: "This article discusses the causes, presentation, diagnosis, and management of hyperemesis gravidarum." You asked, "[s]urely you would agree that that indicates the source is secondary by our understanding, not primary?" No, I do not based on the definition of "secondary source" at WP:MEDRS. There is nothing in that abstract alone that indicates that the article "summarizes one or more primary or secondary sources, usually to provide an overview of the current understanding of a medical topic, to make recommendations, or to combine the results of several studies", or that the article is a "literature review" or "systematic review" of the sort "found in medical journals, specialist academic or professional books", or that it is a "medical guideline" or "position statement" "published by [a] major health organization". That abstract, which you asked me to look at just by itself, could just as well be used to support the position that a quack wrote the article and just provided his own personal opinions about hyperemesis gravidarum. Notably, you seem to be using the definition of "secondary source" at WP:PSTS instead of the more-relevant definition at WP:MEDRS. Are you satisfied that the Goodwin 2008 source meets the standards in WP:MEDRS instead of WP:PSTS?

Here's a review article that should end this debate. This article should provide a meaningful definition of hyperemesis gravidarum and came up during a PubMed search with the review filter on. It is also a slightly more recent article than the Goodwin article. Please take a look: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913953/ TylerDurden8823 (talk) 06:14, 3 February 2013 (UTC)

P.S. I also added a 2012 review article to the lead that I found during a PubMed search and revised the language of the definition and another sentence in the lead a bit but the overall information in the lead is still basically the same. Let me know if this is an improvement or what else needs fixing in it so we can put an end to this quarreling. TylerDurden8823 (talk) 06:30, 3 February 2013 (UTC)

Yes looks good. There is no lack of high quality sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:58, 3 February 2013 (UTC)

Cannabis

We have this primary ref that states cannabis may cause hyperemesis [8] but is not usable as it is a primary ref. Pubmed infact lists zero refernces for these two terms together.Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:03, 3 February 2013 (UTC)

Cannabinoid hyperemesis syndrome is a very curious condition when you consider that many cannabinoids are widely considered to have antiemetic properties instead of being the cause of hyperemesis. I would certainly support a mention of the syndrome in this article for its value in a differential diagnosis. (See Dr. Cheng's statement about a differential in the eighth paragraph here.) JonathanFreed (talk) 14:28, 3 February 2013 (UTC)

Support Resources?

Perhaps this content would be more appropriate in an external links section? Does anyone else have an opinion? I'd like to know what everyone else thinks. I haven't seen many articles with a support resources section...not exactly sure I would call it encyclopedic. TylerDurden8823 (talk) 17:16, 27 October 2013 (UTC)

JAMA review

doi:10.1001/jama.2016.14337 stuff wot works. JFW | T@lk 14:54, 5 October 2016 (UTC)