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The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted 16:28, 18 November 2007.

Therapies for multiple sclerosis

[edit]

I'm nominating this article for featured article because after several months working on it I believe it has all main scientific information on the treatment of the disease but at the same time is lain enough to be understandable. On the other hand I think is the best article on the treatment of a disease I have seen in wikipedia. Its alredy a good article but I think it should clearly be a FA. Anyway any improvements will be welcome Garrondo 13:37, 25 October 2007 (UTC)[reply]

SUPPORT. Sorry I forgot to say that obviously I support the nomination --Garrondo 14:31, 27 October 2007 (UTC)[reply]

Support. All my comments are addressed. DrKiernan 10:42, 31 October 2007 (UTC)[reply]

  • I find some of the phrasing curious: in the lead two of the sentences have no punctuation.
  • "better recovery of disability" and "improvement in disability": surely "better recovery after disability" and "improvement after disability"?
  • Why is "Natalizumab was finally approved in May 2006 after a long process" relevant? Surely it is always a long process to get drugs certified? MOVED AND EXPLAINED IN SIDE EFFECTS OF MEDICATIONS
  • Why "have been proven" rather than "are proven"? I HAVE CHANGED IT SIMPLY TO "ARE EFFECTIVE"
  • Why are drug names sometimes italicised and sometimes not? NOW ONLY TRADE NAMES ITALICED
  • The point about mitoxantrone's cardiac toxicity is made three times. NOW ONLY TWO TIMES (I DO NOT KNOW HOW TO SIMPLIFY MORE)
  • I'm not sure what you mean in the section on PML. Was the PML caused by the natalizumab, or were the patients included in the trial misdiagnosed with MS when they actually had PML? DONE
  • "abnormal muscle spasms, or difficulty to move; difficulties with coordination and balance; problems in speech (dysarthria) or swallowing (dysphagia)," please check your use of commas and semi-colons here. DONE
  • Diets: Can you find a better reference than the International Network of Cholesterol Skeptics; I couldn't figure out what this organisation was or whether it is reliable but it looks amateur, and contrasts sharply with the other references, which are excellent. DONE
  • et al. is an abbreviation for et alia and as such should have a stop at the end of it.DONE

DrKiernan 14:50, 26 October 2007 (UTC)[reply]

"Better recovery of disability" and "improvement in disability": surely "better recovery after disability" and "improvement after disability"? My mother language is not English so I´m not sure if what I´m going to say applies; but I'm not sure that is better your proposal than what is alredy in the page. Disability is not really a temporal state but better a trait of the person that suffers the disease, therefore I don't feel very comfortable with the "after" you propose. Nevertheless I don't know if the prepositions that are right now in the article are the better ones for those expresions (prepositions in English are a real pain for forign people like me :-)--Garrondo 17:02, 26 October 2007 (UTC)[reply]
Thanks for the changes. There is only one point which concerns me now: the natalizumab issue. Kappos et al.'s review says that patients "with multiple sclerosis and PML were receiving concomitant interferon beta-1a and natalizumab; however it is unclear whether combination treatment increased the risk of developing PML given the small number of cases." On the basis of this assessment, isn't your wording, "conclude that PML had appeared in these patients due to the the inmunomodulatory effect of interferons combined with the action of natalizumab" too strong? DrKiernan 10:14, 29 October 2007 (UTC)[reply]
I´ll try to find some other citations and rewrite the sentence. I will look at the review you sayGarrondo 10:48, 29 October 2007 (UTC)[reply]
I have changed the sentence to: An intensive safety evaluation was conducted which led to conclude that there was an increased risk of PML in patients taking natalizumab in combination with interferons. I believe its not so strong as before. Garrondo 09:13, 31 October 2007 (UTC)[reply]
I've made one further change, from "increased" to "potential". DrKiernan 10:42, 31 October 2007 (UTC)[reply]

Caution: I would be hesitant about calling this a featured article unless two doctors reviewed it. The article is entitled "therapies for (disease X)". A doctor might see the big picture and say that something major was missed. I have confidence that everyone means well and that everything is supported by citations. For example if there was an article about tooth decay which talked about extraction, crown and bridges, etc., what if a dentist said that a major therapy, brushing teeth and flossing was missed?

The fact that we call it a featured article might cause some people to think some editorial board reviewed it. I think I saw a discussion a while ago about putting warning tags on all medical articles. It was defeated because some people said it looked unsightly but the concern is valid. Another concern is that the feature article is on the main page. That's why I think a doctor needs to look at it. Mrs.EasterBunny 22:35, 30 October 2007 (UTC)[reply]

I´ve been the main author of this article and althought I´m no doctor but a psychologist, I work in investigation of multiple sclerosis in a hospital so I`ve been reading a lot on the theme of the article. Secondly I can assure you that the article follows perfectly the clinical guidelines on multiple sclerosis; where is summarised every treatment that has shown efficacy on the disease so its almost impossible that something major is missed. Every doctor will be welcomed to review it, however I don´t think its a condition to get the featured article status. If what you say applied to every article only history teachers could review an article on history or mathematicians on maths and the truth is that wikipedia doesn´t work like that. On the other hand the fact that two doctors review really doesn´t mean that is more factually reviewed since for example I probably know more about MS that a general doctor, or a surgeon... A different thing would be if it was a neurologist who reviewed it. --Garrondo 08:07, 31 October 2007 (UTC)[reply]
Actually, it would be good if a neurologist reviewed it. MS is more serious than a history teacher's lesson. I'm not saying that you didn't work hard at it or that the article is bad. It's probably good! Mrs.EasterBunny 21:25, 31 October 2007 (UTC)[reply]

I might note that the discussion page of the article had a request for a science review. This shows that there was some concern. There were no responses. This shows that there was a perceived shortcoming that nobody addressed. I don't know what the answer is. If editors are credited, maybe some neurology professor will edit. With funky names (mine included), experts may not come aboard. Overall, my biggest concern is that there is not verification that the article covers the big picture well. Mrs.EasterBunny 21:35, 31 October 2007 (UTC)[reply]

It was me the one asking for peer-review as a way of further improving its quality and not becouse I thought there was anything incorrect. I agree that it would be perfect that a neurologist reviewed it, nevertheless its not easy to find one and I believe that in the absence of them clinical guidelines can give us the full picture of the treatments of the disease as they cover all the aspects that doctors need in their daily labour.--Garrondo 11:15, 5 November 2007 (UTC)[reply]
  • Comments The article is well-referenced, of appropriate length, makes good use of images and is very comprehensive. However, I think it could use further copy editing, particularly of the last few sections. I found a few sentences still too confusing, such as

When several health care and other professionals are involved with a person with MS they should work together with the person and his or her family, as a team towards common agreed goals and using an agreed common therapeutic approach.

  • I also find your addition of links to NLM drug information as footnotes a very interesting approach (I've said this before), but the "References" section should probably be renamed "Notes and references". Fvasconcellos (t·c) 15:35, 3 November 2007 (UTC)[reply]
I´ll try to address all your comments during the week. --Garrondo 11:15, 5 November 2007 (UTC)[reply]
DONE?: I have tried my best to adress both of your comments. Take a look and tell what you think. Garrondo 12:01, 6 November 2007 (UTC)[reply]
Thank you, looks good. I'll have another read—see if I didn't miss anything—but I'm close to supporting. By the way, when using a reference more than once, you don't have to repeat <ref name=example>...</ref>; just use <ref name=example/> instead. (If you were repeating the content for a reason, I apologize; please feel free to revert my edit :) Fvasconcellos (t·c) 14:10, 6 November 2007 (UTC)[reply]
OK, I have three more comments:
  • Could you find a more reliable source for The Optimal Diet? The one in the article now looks a little... promotional :)
  • Does the herbal medicine study (Ho et al.) actually mention potential use in MS? The link seems a little tenuous, and we have to be careful of WP:SYNTH.
  • Would you mind moving "Further reading" up to before "Notes and references", as suggested by WP:GTL? I'd do it myself, but you may object, so... Fvasconcellos (t·c) 15:14, 6 November 2007 (UTC)[reply]
  • Answer
  • A more reliable source for The Optimal Diet: The fact is I cant. As I see it the optimal diet is promotional by itself. I looked in pubmed (no articles) and google, and this was the best I could find... We could either eliminate any references to it since you right on your comment and leave only the other diet (Swank) which is better known; or assume sometimes alternative treatments are a bit of a "bluff" even when you present them in a NPOV. What do you think?
Fine with me... Anyway in that website it said something about MS in a subpage (I found it looking for optimal diet and MS), but as you say if theres nothing in literature is better simply to remove it. Garrondo 17:07, 6 November 2007 (UTC)[reply]
  • Herbal medicine study: You are right I will just eliminate the paragraph since the relation is quite tenous...:::::*Thanks. Fvasconcellos (t·c) 16:59, 6 November 2007 (UTC)[reply]
  • Moving "Further reading" up to before "Notes and references: no problem, i´ll do it.
Garrondo 15:51, 6 November 2007 (UTC)[reply]
One final comment: in "Relapsing-remitting MS", there is a sentence "Comparisons between immunomodulators (all but glatiramer) [...]"—however, glatiramer is an immunomodulator (see e.g. [1], I don't have another proper reference off the top of my head). Perhaps that particular study didn't include glatiramer? If so, that should probably be noted instead. Also, I only noticed now that there is very little mention of IVIG; however, that's probably appropriate, since studies of its use haven't produced encouraging results as far as I know. Fvasconcellos (t·c) 21:05, 6 November 2007 (UTC)[reply]
Thanks for that... it was a mistake, it had to say mitoxantrone; which is an inmunnossupressor. Garrondo 10:07, 7 November 2007 (UTC)[reply]
  • OK, I am ready to support this article. The prose is improved in my view, the references are excellent and, as I said above, the article is both comprehensive and of appropriate length. It is also, as far as I can assess, remarkably accurate. Fvasconcellos (t·c) 21:05, 6 November 2007 (UTC)[reply]
  • Comment My neuroscience professor happens to specialize in imaging for multiple sclerosis, so if you guys want, I could see if she'd be willing to glance over this article for glaring inaccuracies. Pandacomics 21:09, 3 November 2007 (UTC)[reply]
It would be perfect. --Garrondo 11:15, 5 November 2007 (UTC)[reply]
  • I like the article, but I am a little bit concerned a couple of sections. On the treatment for symptoms, it would be good to indicate where products have indications for usage within this population. Any report of efficacy in this setting should be balanced with risks. For example in the donepezil trial about 3-4 times as many patients reported irregular dreams. Also a few comments regarding the Alternative treatments section. The claims regarding the Best Bet diet seem to be based on the ongoing trial involving only 30 patients and this seems to be very small to be generalizable to a broader population. Perhaps this can be deleted? For Swank, Can you check the 2003 Nutrition article on Swank to make it clear that he is not just trying to sell his book? The 1991 Swank article only has 15 folks citing through the years. Somewhat shaky ground. In the therapies under development, you might want to point out the late-stage therapies only (Phase 2 completed or active Phase 3 programs) just to keep the content more narrow. I did not see the BG-12 dimethyl fumarate from BiogenIdec listed. --Chrispounds 20:44, 8 November 2007 (UTC)[reply]
  • I don´t think that indications for usage in this population is needed: as they are precisely symptomatic treatments they would be used in almost any population and disease when the symptom appears.
  • Altought the treatments in the alternative section have also to be referenced and proved, the threshold for the quality of the studies has to be lowered per se with respect to the others sections: alternative treatment means exactly that are used without a proper quality of the studies that prove their efficacy; the moment they are fully proven they become common treatments and not alternative treatments. Therefore I believe the best bet diet ref is enough. On the other hand I would take a look to the Swank article you mention.
How about we make a note that the burden of evidence is different for this section compared to the rest of things? --Chrispounds 02:56, 12 November 2007 (UTC)[reply]
Done--Garrondo 09:09, 12 November 2007 (UTC)[reply]
  • The focus of the therapies under investigation is broad precisely to show that many different approaches are ongoing right now. The treatments that appear in it are only examples of many that are carried on. In this way there is not such a need to maintain it actualized. Nevertheless I´ll look for some references of the treatment you say. (It would be perfect if you alredy had one) --Garrondo 17:11, 10 November 2007 (UTC)[reply]
I have added the reference for Swank. I have also been searching for some info on efalizumab ( BG-12 dimethyl fumarate); but I could not find anything realiable. Do you have a ref for the phase three clinical trial? --Garrondo 10:28, 11 November 2007 (UTC)[reply]
One link to the phase 3 trial is here: [2] with a press release [3]. More background on the chemical as it relates to psoriasis is here [4]. efalizumab is a totally different compound and has not been (publically) studied in MS. --Chrispounds 02:56, 12 November 2007 (UTC)[reply]
Done--Garrondo 09:09, 12 November 2007 (UTC)[reply]

Support --Chrispounds 02:56, 12 November 2007 (UTC)[reply]

Support. The length is appropiate. The assertions properly referenced. MS is a changing subject under heavy research and the article will have to be maintained, but it reflects the current status of the therapies. --Juansempere 21:56, 9 November 2007 (UTC)[reply]

Support well written article, but for consistency, I would suggest moving this page to Treatment of multiple sclerosis, consistent with articles such as Treatment of Crohn's disease, Treatment of bipolar disorder and others. --WS 21:36, 12 November 2007 (UTC)[reply]

I think its a good idea, but I dont know how to do it. Can anybody help? Garrondo 11:18, 13 November 2007 (UTC)[reply]
That's pretty straightforward, but the timing could be better :) There should probably be some discussion on this, preferably at the article's Talk page. I can see a clear precedent, but it's better to be safe than sorry. Fvasconcellos (t·c) 00:26, 15 November 2007 (UTC)[reply]
OK, proposed this on article talk page, I will rename it if nobody objects within the next few days. --WS (talk) 23:34, 16 November 2007 (UTC)[reply]
The above discussion is preserved as an archive. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.
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