Wikipedia talk:Biomedical information/Archive 1

Archive 1

Archive 2

Defining biomedical information

Per what was stated here by Seppi333 and me, this essay is lacking if people come away from it thinking that biomedical information only concerns diseases. The bullying example I gave in that aforementioned discussion is an example of a topic that is not a disease but has biomedical effects, such as depression, anxiety, low self-esteem, violence and suicide. While major depressive disorder can be considered a disease, there are a lot of experts that distinguish between mental disorder and disease, just like a lot of them distinguish between disease and infection, which is why there was that recent big sexually transmitted disease vs. sexually transmitted infection debate. General depression (the depression (mood) topic I linked to above), anxiety, low self-esteem, violence and suicide are not typically thought of as diseases. Flyer22 (talk) 12:35, 30 January 2015 (UTC)

Obviously, we need to expand the page. I'd like to give some examples specific to alt med, too. WhatamIdoing (talk) 04:42, 13 February 2015 (UTC)

This is a good start to what I commented on above. I appreciate that edit. Flyer22 (talk) 04:44, 13 February 2015 (UTC)

LD50s

In response to your question about LD50s, I’m going to go with a spectrum. I would say that e.g. the LD50 in rats for cigarette smoke is medical information, but not the LD50 in guppies of a chemical that’s only used for euthanizing diseased fish. An environmental pollutant, especially one that’s known or suspected to have human effects, would be somewhere in between. The questions I think I’d want to know about would be:

• Are humans exposed or claimed to be exposed to it? (e.g. through consuming it)
• How similar is the species to humans? (e.g. mammal LD50s are much more relevant than insect or plant LD50s)
• Why are we interested in this information? Was the research done because of claims of human toxicity, or was it done to help us save an endangered species of frog?
• Does MEDRS information about the effect in humans exist? I have two competing inclinations for this one. If it causes or is claimed to cause effects in humans, I’m inclined to ask for MEDRS. On the other hand, if the information about effects in humans is described neutrally in the same article, I’m inclined to think readers should be able to recognize that the human data takes precedence.

--Sunrise (talk) 09:06, 14 August 2015 (UTC)

Beliefs

This (from the ;Beliefs item) is unclear:

MEDRS context is necessary if a belief is presented as factual (not just the fact that people hold it), or if it could otherwise have implications about biomedical information, such as by argumentum ad populum.

User:Sunrise, can you give me an example or two? WhatamIdoing (talk) 15:55, 22 August 2015 (UTC)

Of course! Let me know if this makes sense.

• The first case is intended to communicate the difference between attributed and non-attributed statements - for example, the difference between "Group X believes that homeopathy cures diabetes by exorcising evil spirits" and "Homeopathy cures diabetes by exorcising evil spirits." It might be clearer just to say that if we're no longer identifying something as a belief, it's no longer a statement about beliefs (though of course the identification could be implicit). In this example, "MEDRS context" would really be "MEDRS", but I wanted to make the original wording broader to account for cases I might not have considered.
• For the second case, say "Homeopathy is used worldwide for treatment of diabetes," which may be a true statement (which is non-medical and contains implicit beliefs), but is very misleading without context that includes MEDRS statements.

--Sunrise (talk) 05:28, 23 August 2015 (UTC)

It's the second case that's the issue. I don't think we should go that far. If it's DUE to say that there are gullible people around the world, then we should say that, and stop. We should not do a little I'm-more-rational-than-you dance at the end of such a statement to make sure that everyone knows that we disapprove. You may call me a hopeless idealist, but I prefer to believe that our readers are smart enough to remember our disapproval from the lengthy Homeopathy#Evidence and efficacy section, and therefore don't need a statement like "In case you forgot after reading the 4,500 words about our disapproval in the previous section, it still doesn't work now that we're in the prevalence section!".

I suppose that if it's mentioned in another article, then a plain, brief statement that "There is no evidence that this works" might be appropriate. I don't see this as "MEDRS context" or as a "MEDRS statement", though; I see this as purely giving DUE weight to the mainstream POV. I'm not going to require a peer-reviewed review article from the last five years to support it, either. Probably the same newspaper or magazine article that says people use it will also be adequate to say that the mainstream POV is that it's a waste of time and money. WhatamIdoing (talk) 05:59, 25 August 2015 (UTC)

I definitely don't mean that the context needs to be in the next sentence! If we've already discussed the evidence about homeopathy earlier in the article, I generally wouldn't say it needs to be repeated, and I wouldn't think that anything more than a brief statement is necessary in other articles either. The only caveat I'd add is that in a poorly written or poorly structured article, referring to medical sources in the next sentence can be the easiest way to ensure MEDRS compliance without doing a full rewrite.

I don't see mentioning efficacy several times as pushing it on people or as expressing "our" disapproval, just as being cautious. I don't see the general reader as posing as much of a concern as the people who are in a rush, having a bad day, skipped their coffee that morning, etc. Those are who I typically think of when deciding whether the context is clear enough. Either way, I'd be fine with leaving out the comment on implications, since I see it as essentially a restatement of other points on the page, included because it's one of the more common situations where this happens. There may be more discussion to be had on that point though. :-) Sunrise (talk) 21:21, 2 September 2015 (UTC)

"beliefs" in the lead

Lead currently says: "The English Wikipedia gives detailed advice on sources to support claims about biomedical information in Wikipedia:Identifying reliable sources (medicine) ("MEDRS"). The goal of this guideline is to help Wikipedia editors identify the current mainstream (conventional) medical beliefs, and to appropriately represent those beliefs as being the mainstream positions in articles."

That lead maybe described what you originally intended this document to do, but the revisions below describe (inmy view) what this document actually does...

Could this perhaps say: "The English Wikipedia gives detailed advice on sources to support claims content about biomedical information in Wikipedia:Identifying reliable sources (medicine) ("MEDRS"). The goal of this guideline is to help Wikipedia editors identify the current mainstream (conventional) medical beliefs differentiate biomedical content from other content, and to appropriately represent those beliefs as being find sources that comply with MEDRS - that present the mainstream positions in articles on biomedical information.

thoughts? Jytdog (talk) 19:08, 22 August 2015 (UTC)

Looks good to me, though I'd change 'the mainstream positions' to 'accepted knowledge and mainstream positions'. Alexbrn (talk) 19:16, 22 August 2015 (UTC)

I encourage you both to WP:Be bold. This page needs a lot of work. The worst thing that can happen is that I'll revert you, and then we can talk about it.  ;-) WhatamIdoing (talk) 22:04, 22 August 2015 (UTC)

Bicycles

As currently written, our article on Bicycles is "biomedical information". Bicycles affect human health. Bicycles are safe (compared to motorcycles, but not compared to staying home). Bicycle riding is beneficial to general health. Bicycles are definitely not nutritious. The definition used in the health effects section is too broad. Also, the population data section seems like it belongs under "what is not biomedical information". --Guy Macon (talk) 07:19, 30 October 2015 (UTC)

Note: With regard to Guy Macon's view that the population data aspect seems like it belongs under "what is not biomedical information", there is currently a big dispute at the WP:MEDRS talk page about whether or not epidemiology/population material should be subject to WP:MEDRS. My view contrasts Guy Macon's view on the matter. Flyer22 Reborn (talk) 07:33, 30 October 2015 (UTC)

Guy, MEDRS applies to individual statements, not to entire articles. Some statements about bicycles should be cited to a MEDRS standard ("bicycle riding improves cardiovascular health") and others shouldn't ("bicycles have two wheels"). With regards to population data, I would want to know what sort of information is being discussed. As used here, (biomedical) population data refers to things like "50% of Ebola patients die," "the yearly influenza infection rate is 10% in adults," or "wearing a bicycle helmet reduces the risk of head injury by 70%." Of course, there are always gray areas. Sunrise (talk) 08:16, 30 October 2015 (UTC)

The dispute arises from editors pushing an interpretation along the lines of: Riding bicycles can result in injury, which is related to health - therefore statistics about who rides bicycles is related to health. That however is spurious because the statistics are not related to the health aspect of bicycles. Rhoark (talk) 14:06, 30 October 2015 (UTC)

Incorrect interpretation of the dispute. Flyer22 Reborn (talk) 14:17, 30 October 2015 (UTC)

Yes, completely inaccurate. Statics related to bicycle deaths or injury are definitely health aspects and their sourcing is governed by MEDRS. That means that any statistic that refers to % of rides that don't end up in injury is also a health statistic, as well as health effects achieved when xx % of the population ride bikes. Not once has anyone stated that presenting general statistics unrelated to health would be governed by MEDRS - such as the number of cyclists, but as soon as you tie it together with health effects MEDRS applies. CFCF 💌 📧 15:12, 30 October 2015 (UTC) 

Comments

Hi WhatamIdoing! This is a list of a few things from my notes that I’m still not sure of right now:

1. Information that a particular person is diagnosed with a particular condition. I’d probably accept a primary statement by a doctor, but probably not a person’s self-identification, because of things like hypochondriasis. Of course, how the person chooses to identify in public would not be MEDRS.
2. Regulatory information with medical implications, such as statements that a drug is approved to treat a particular condition, especially in the US and Europe. Approval by e.g. the US FDA is almost a gold standard for effectiveness, and I’m not sure if this can be separated. For example, I'd want to replace any news citation reporting FDA approval with a citation to the FDA itself (since it's primary for the fact of regulation but secondary or tertiary for information on effectiveness).
3. Amount of productive work lost to a disease. It’s inherently an economic analysis, especially when taken at the level of the population, but as soon as it’s applied more specifically (e.g. average amount of productive work lost per person), that leads to conclusions about recovery times.
4. Cost-effectiveness or cost-benefit analyses for a treatment. A bit less inherently economic, since it presumably includes analysis of things like side effects, but the acknowledgement of such an analysis existing directly implies that the treatment has some level of effectiveness. Similarly, an incorrect claim that a treatment is not cost-effective could cost lives.

--Sunrise (talk) 09:06, 14 August 2015 (UTC)

I've numbered the items for convenience.

1. If Paul Politician says that he has ____ disease, then that's not biomedical information. It doesn't matter whether he's right or not, because there's no "bio" in that. Depending upon what the sources say, and upon other context, one might choose to qualify the statement suitably: "After a trip to the local garden show, George Gullible believed that he had rose leaf blight" or "In Octember 2014, Paul Politician announced that he was not seeking re-election for health reasons. His press secretary ended months of speculation by disclosing that the politician had been diagnosed with Blank Disease". But it's still not "biomedical" information.
2. The bare fact that an agency assigned a particular legal status is not biomedical. It implies efficacy (and safety and adequate characterization), but "This received marketing approval from the FDA on 17 Octember 2014 for the following indications" is legal information, not biomedical information. Actual efficacy would ideally be supported by something stronger (and broader, because drugs are often effective for more conditions than they are approved for) than a legal document. However, in saying that this is not biomedical information, there is still nothing that prohibits you from citing a better source.
3. I can see what you mean. So first let me begin with pedantry: Cost-effectiveness analysis presumably implies only that someone believed that there might be efficacy, since "all cost, no benefit" is a possible outcome. Also, saying that something is "not biomedical" doesn't mean that you can use a lousy source. Plain old RS has a strong bias in favor of high-quality scholarly sources, too. And, this is all written from the perspective of the claim, rather than from the perspective of the source. If you're citing a study about cost-effectiveness to make biomedical claims (like "this one works for 90% of patients with Blank Disease" rather than "this one is more cost-effective than that one"), then you're writing biomedical information, even if your source is all about the money. But perhaps this is sufficiently complicated that it would be better moved to the "Special cases" section (which needs some attention). WhatamIdoing (talk) 17:07, 22 August 2015 (UTC)

1. Yes, I definitely wouldn't want to require MEDRS for Paul Politician's claims that he has the disease - I'm thinking about when we can state as a fact that he has the disease. I agree that your quoted examples don't require MEDRS (with the caveat that since "disclosing" implies the statement is true, I'd prefer "said" or "stated"). On consideration, I'm thinking that WP:ABOUTSELF might be more relevant in this case: if it might be self-serving, like during Paul's re-election campaign, then we might need a better source, but if the context is e.g. Paul's uncontroversial retirement from office, it might be much less of an issue.
2. I do see that as a reasonable perspective, but I also think it's reasonable to say that FDA approval is almost the same thing as an efficacy statement. In general, I see the important question to consider as "can this information be included if we have good RS available but no MEDRS?" As an example, suppose a respected newspaper says the FDA has approved a drug for a certain condition, but we can't find any information about this in the FDA databases. In fact, we can't find any reviews about the drug's effectiveness in the literature either. Outside of specific circumstances, I think we're justified in excluding the information under MEDRS.
3. Those are good points. I didn't intend to describe this from the perspective of the source, so "Citing the conclusions of cost-effectiveness or cost-benefit analyses" might be a better description. "X is more cost-effective than Y" (or "X is cost-effective," or "Y is not cost-effective") are the types of statements I see as ambiguous, because they all communicate some information about effectiveness. I'd be happy for this to go into Special cases.

--Sunrise (talk) 05:28, 23 August 2015 (UTC)

While it would be okay to use a non-MEDRS source for somebody's statement that they had a disease, I can think of some circumstances where it wouldn't be right to state as fact that they in fact had it. In the altmed world there are a number of notable figures who claimed to have had cancer (and then been 'cured') for example (the case of Belle Gibson is recent). I'm not sure if this is strictly a MEDRS issue however. Alexbrn (talk) 05:38, 23 August 2015 (UTC)

(Add) Coincidentally, I just noticed in John A. McDougall‎: "In 1965, at age 18, McDougall suffered a massive stroke, which he attributed to his high animal product diet" - sourced to a self-published source. Now the "massive stroke" (and subsequent healthy-living) is all part of the narrative of how McDougall diet products are marketed. Does MEDRS have a role to play here? Alexbrn (talk) 06:41, 23 August 2015 (UTC)

Here's the problem with "requiring MEDRS" (whatever that means) for statements about individuals: How many review articles have you ever seen on whether a BLP's diagnosis is correct? The answer is pretty close to zero. While a BLP might get mentioned in a review, or or even be a major focus, even for cases that changed the practice of medicine (e.g., Betty Ford, Shirley Temple, and Angelina Jolie, to name just three breast-cancer patients) there are no review articles that actually consider any evidence about whether any BLP's diagnosis is correct.

I agree with Alex that when reliable sources are hesitant to agree with the claimed diagnosis (e.g., that George Gullible has become infected with a plant pathogen, that some tout has a history of deadly diseases that nobody knew about back then, etc.), that we should be equally hesitant. But for the clear majority of cases, I see no reason at all not to take plain news stories or self-published press releases or blog posts at face value when there is no such dispute. A story in any decent newspaper or magazine ought to be sufficient for us writing – in Wikipedia's voice, as actual, undisputed fact – that Jolie was diagnosed with a BRCA mutation and then had decided to have a mastectomy.

Sunrise, if we ever get a newspaper claiming that the FDA has taken an action, and the FDA shows no evidence of having taken that action, then I'd wait a day and see what the SEC is saying about stock fraud (seriously). We have no need to "exclude under MEDRS", because the information would be excluded under DUE. (This is one of our major long-term problems: editors keep trying to invent MEDRS-based rules when they need to be standing on NPOV.) I don't think that FDA approval should be treated as tantamount to a statement of efficacy. One hopes for it, of course, but my local pharmacy is still selling "FDA-approved" dextromethorphan as a cough suppressant.  ;-) WhatamIdoing (talk) 05:47, 25 August 2015 (UTC)

Yeah, I think using WP:ABOUTSELF resolves the problem I saw, so I agree MEDRS shouldn't need to play a role for individual diagnoses. (By the way, by "requiring MEDRS" I just intend for the acronym to be replaced by "medically reliable sources.")

On the FDA example, I see that situation as the key issue. If we have MEDRS supporting the same information, then the question of whether MEDRS excludes the lower-quality source is no longer very important. I don't see how DUE would effectively exclude it without referencing the higher standard for medical content. Since this example only has a single source, there's no alternative viewpoint in other sources that it could be weighed against, so it's easy for someone to argue for inclusion. DUE could be used relative to the other sources in the article, but since there aren't any medical sources available, it's possible this newspaper could be the strongest source in the article. However, we can use MEDRS to tell us about the importance of the medical information a priori.

I'd need examples to comment on the MEDRS-based rules you refer to, but I think you're referring to something I see as a feature more than a bug. I think a large part of the usefulness of MEDRS is in setting a clear minimum standard that requires considerably less editor time and effort than a full NPOV analysis. (The same idea applies to RS - we could theoretically use NPOV alone to exclude unreliable sources, but it's not feasible). It's possible to recast a request for MEDRS in terms of DUE: as long as the content is actually medical, any non-MEDRS source will carry no weight. We could get people to say "non-MEDRS have no weight for medical content" instead of "MEDRS are required before we can consider including this," though I don't see a major difference between those. Sunrise (talk) 21:21, 2 September 2015 (UTC)

I don't generally like using FDA approval to support a statement of efficacy, on the grounds that it's often incomplete and occasionally wrong. By the time we reach that point, there are usually other sources available to support claims of efficacy anyway. But have you ever seen an edit that said "The FDA approved this drug to treat Blank Disease", and citing a newspaper article that said this, when it wasn't true that the FDA approved that drug for that indication? I don't recall having encountered that. Consequently, I'm not worried about prohibiting something that doesn't seem to happen.

The problem with abusing MEDRS for DUE issues is that it produces disputes. Imagine that someone finds a primary source by Alice Expert that says she fed candy to cows, with the candy wrappers still on it, and that the cows produced more milk when given the extra sugar from candy. Someone thinks this is funny (it is) and writes in an article that "Alice Expert reported that cows in her study produced more milk when they were fed candy with the wrappers still on". We have a good match between the source and the content. This statement, with that hypothetical source, is indeed verifiable. The primary source is reliable to support a statement like that.

But whether that statement should be included at all is a question for DUE, not for RS or MEDRS. And if you go to the editor who added that and say, "That's not reliable, because it's only a primary source", then they'll be confused and correctly disagree with you. Instead, if you go to the same person and say, "Hardly any source ever mentions this; it seems like trivia and isn't DUE", then they're far more likely to understand your position. You might have a discussion about whether "encyclopedic" means "boring", but you're not going to waste time debating whether the source supports the specific statement in question. You'll get straight to the real issue. WhatamIdoing (talk) 02:16, 30 October 2015 (UTC)

To briefly address the FDA issue first, I'm not familiar enough with them to give any examples, but I'll point out that their evaluation is based on primary data, specifically clinical trials, so they don’t necessarily have to wait for other sources. They’re also highly specific about addressing things like dosing information and routes of administration, which may not receive much attention in the literature.

Now, for the main subject: I agree that a source is always reliable for an attributed statement of its own contents, and I don't see MEDRS as coming in at that point. Suppose MEDRS applied to the Alice Expert example, e.g. maybe there are claimed effects on human health. I don't see MEDRS as regulating the attributed statement directly, but rather the statement's implications. Inclusion means a reader could reasonably conclude that at some level it’s a possibility, and I think its effect would be analogous to including an advertising testimonial. In a context where the statement can’t be included without also including the implication, that's the reason I would require MEDRS. It's also possible with minor rewording to cast this as a DUE issue, partly because MEDRS itself can be interpreted as codifying how DUE applies for medical content.

I really see this as similar to RS though. As a parallel to your example, suppose we consider the claim, "Joe Blogger says that aliens have taken over the government." It's reliable for the attributed statement that the blog made that claim, but (assuming the blog is non-notable, Joe is not a public figure, etc) I don't think anyone is going to argue that we can or should include the statement anywhere, even with attribution. If it actually did become relevant to an article, I would want it to be placed in the context of sources refuting it. Again, it's possible to cast that as a DUE issue ("this blog does not carry any weight"), but RS guides us in making that conclusion. Specifically, RS identifies the source as one that should typically be avoided – or in other words, it should be given no weight.

To summarize/restate the previous paragraph, the idea is that the same reasoning you're describing for MEDRS can also be applied to RS. My point is that saying "this blog is not a reliable source for whether aliens have invaded" is a valid response. (And to bring the analogy back: "this news article is not a reliable source for medical information." We can still say it doesn’t carry any weight, but that conclusion is based on the guidance in MEDRS.)

I also think the point about effort is an important one: a sourcing guideline is much easier to discuss and explain, and it places the responsibility on the proposer. By contrast, if you say that "Hardly any source ever mentions this," it frames the conversation as requiring yourself to prove a negative. And if they respond by producing several other low-quality sources, the greater subjectivity of the statement means they can say they addressed the objection, and it will become an uphill argument to convince them otherwise. I think that's a recipe for a lot of burned-out editors. Sunrise (talk) 10:27, 28 November 2015 (UTC)

Accepted knowledge and mainstream positions

The first paragraph ends with an endorsement of "accepted knowledge and mainstream positions". I think we probably have a small divergence from NPOV here. NPOV wants to see articles include "accepted knowledge and all significant positions" (with the mainstream position being presented as the mainstream position, and minority POVs presented as minority POVs), not just the mainstream one alone and the others ignored. NPOV's requirements still apply even if the mainstream POV is science-y and the minority POV is non-science-y. But I can't think of a way to re-write it that isn't likely to cause problems.

So here's a pair of examples, in case they will help:

• There are a couple of surgical techniques that are "accepted" by surgeons and opposed by various advocacy groups (e.g., on grounds of outcome).
• The "accepted" treatment for Alzheimer's patients is to keep them well-vaccinated and on heart-healthy diets and drug regimens, and the minority POV is to let them eat candy for breakfast, if that makes them happy.

My goal is to get this page to briefly mention that we're not trying to exclude significant minority POVs, including non-medical/non-scientific POVs, from articles. WhatamIdoing (talk) 23:10, 28 May 2016 (UTC)

Well-vaccinated? typo i reckon :) maybe you mean "well-nourished" per this...

To the points, thank you for raising this.

I agree with what you are saying with respect to minority views that are actually discussed in MEDRS sources.

but are non-medical/scientific POVs "bioemedical information"? Maybe not, and maybe they go in "society and culture" and can be sourced from regular RS? Jytdog (talk) 23:32, 28 May 2016 (UTC)

No, I meant well-vaccinated. People in memory care facilities are routinely given influenza and pneumonia immunizations, so that they won't die from an infectious disease. The US government actually requires it for nearly all nursing facilities. To get out of the vaccination and have a higher chance of dying from a relatively quick illness, you typically need a medical contraindication (usually allergy or imminent death) or a legal representative insist that you prefer dying of pneumonia after a week or two ("the friend of the aged"[1]) to living in a nursing home for months or years, until the facility agrees that you have refused consent.

The idea that you should keep people with advanced Alzheimer's comfortable, even if it means a shorter life, is very much a "medical" POV (also, a "humane" one). It's not, however, a "scientific" POV. How can you have a "scientific" POV on the question of whether quality of life matters more than quantity of life? You could scientifically calculate how much quality is, for the average person, equal to how much quantity (that's the purpose of a DALY and similar calculations), but there is no scientific method for figuring out whether any individual should get more quality or quantity. That's a question of human values, not a question of science. One person might decide that there is spiritual benefit in an extended life of suffering (a POV I've heard is common among conservative elderly Catholics), and another person might decide that Alzheimer's is best met with booze and bacon. There's also no "scientific" POV on whether it's good to treat cancer pain in actively dying patients with increasingly high doses of morphine, despite knowing that the morphine will kill the patient. There's a "medical" POV on that question (answer: "yes!"), and an ethical POV (answer: "get informed consent first!"), but there's no "scientific" one. Science doesn't tell us what's good or bad. It tell us what is.

Also, the calculation doesn't even stay stable for the same person. There are patients who want sometimes quantity at any cost – just until Christmas, just until the wedding, just let me hang on until the baby's born – but who revert back to preferring quality or even preferring an earlier death as soon as the milestone has passed. There is no "scientific" POV about whether you should see your first great-grandchild.

I think that POVs from field X – whatever that field is – are usually best sourced to the academic (or equivalently "serious") literature from that field. So let's have an example: Let's say that "mainstream medicine" and "advocacy groups" disagree about whether being a Little Person is, by itself, a "medical condition" or a "normal human variation". In a situation like that, I suspect that we want both the "medicine says it's a disorder" POV, sourced to MEDRS-style sources, and also the "normal human variation" POV, sourced to (probably) an academic sociology treatise. Neither POV is scientifically wrong (defining what's "normal for humans", beyond the statistical sense, requires making value judgments about what it means to be a human, and that is not the domain of science), so the goal should be the a good source for the POV, not a good source for science.

(If I keep typing, I'm going to start rambling, and I don't think that will help. So I'm going to stop, and if I've missed something, please remind me to respond to that later.) WhatamIdoing (talk) 23:05, 31 May 2016 (UTC)

biology and health

Agree mostly with this. Two things I am struggling with"

• the exclusion of sociomedicine there. If you read what is at that link there is all kinds of biology involved - "understand(ing) how social and economic conditions impact health, disease and the practice of medicine" definitely involves claims about health. For instance content in Environmental racism (an important topic) or Cancer cluster that presents epidemiological data and draws conclusions about causation 'should be MEDRS sourced, yes?
• also in my view psychology should also come under MEDRS and I am not sure if this language is intended to exclude that. The effectiveness of a given talk-therapy approach, be it purely talk or also about driving behavioral change, should be MEDRS sourced. This makes the biology and medicine aspect problematic. Jytdog (talk) 22:28, 31 May 2016 (UTC)
  • That's probably a poor link (i.e., doesn't perfectly communicate what I meant). I'm more concerned about the role of human values and different social manners. For example, our article about ultrasounds should mention something about the unusually high use of ultrasounds in Japan. If you go to a doctor's office, you must – purely reasons of social expectations – depart with either a prescription for a drug or an order for a medical test. Needless ultrasounds are ordered there to meet that social expectation in a low-harm (beyond overdiagnosis) manner. You shouldn't need to have a MEDRS-style source for a description of that situation. A plain old magazine article ought to be sufficient to verify that.
    Psychology is hard. Some of it's science. Some of it's not. Some of it's pseudoscience. Some of it's actually psychiatry (and therefore presumed to have some biological basis and therefore have a "biomedical" component). We need to spend more time thinking about where to draw the line and how to describe that line to others. WhatamIdoing (talk) 23:14, 31 May 2016 (UTC)
  • Also, the problem with "health" is that some definitions of "health" are impossibly broad. According to the popular definition from the WHO's charter, for example, no human is, or even can be, healthy. If the biology is functioning perfectly (including mental health), but you belong to any socially disadvantaged group whatsoever – if your set of racial/gender/sexual orientation/employment status/etc. social privileges is not absolute on all scores – then you are "not healthy". If the girl next to you at school delivers a put-down to show the bystanders that she's better than you (in her opinion, of course), then she made you "unhealthy". This is the outcome of a definition that says "health" requires "complete physical, mental, and social well-being". You didn't have "complete social well-being" when you were being insulted, so that insult makes you "sick" rather than "embarrassed" (or even "oblivious". Under this definition, you don't have to notice the problem for it to be a problem, so long as it could affect your social standing, however slightly or temporarily). If we can agree upon a more plausible definition, then I'd be less concerned about that word, but right now, it's a serious obstacle. This one is a wikilawyer's dream. WhatamIdoing (talk) 23:32, 31 May 2016 (UTC)

I hear all that. Jytdog (talk) 06:15, 1 June 2016 (UTC)

I’m still thinking about parts of this, so my apologies if this is TLDR, but I think the original version is better for several reasons. I don’t really see the changes as clarifications; it seems to me they’d likely be interpreted too narrowly, and would exclude topics in a way that I think could be dangerous. Things like the results of mammography screening, the effectiveness of bicycle helmets, or how a doctor evaluates diet or behavior in a diagnosis could all be argued to be unrelated to biology. In the other direction, the genetic cause of cystic fibrosis (which doesn’t impact treatment), the nutritional effects of a vitamin, or the effectiveness of an experimental cancer drug in mice could all potentially be argued to be unrelated to medicine.

I also see the use of a two-criterion definition when it isn’t necessary as something that’s likely to make discussions more difficult. I think the issue is challenging enough to address without splitting the concept into two terms that are just as ambiguous once you get into the grey areas, and where both are relevant it could lead to discussions running on two parallel tracks at once. (And on a related note, remember there are editors who would like even broader language than we already have!)

On more specific points: for purposes of the introduction, I'd be fine with including examples up front, but I don’t think sociomedicine is a good example of non-MEDRS information, since it potentially includes aspects of public health like preventative care or the medical effects of health policies. It’s probably better to use a more unambiguous example, like information on medical ethics, then if it becomes necessary sociomedicine or various parts of it can be added to the list with everything else instead of giving it prominence. But I’d support adding specific exclusions the role of human values and related subjects, if those are your primary concerns. Likewise we could discuss drawing a general boundary along the lines of "you can't derive an ought from an is" (just keeping in mind that "is" can still include statements about human happiness or well-being and other unspoken assumptions behind "ought" statements).

For myself, I do have an idea of what I’d consider “health” in this context, but no two people are likely to fully agree on that anyways, and to me that’s the purpose of the rest of the page. If we want to endorse a specific definition, it might be helpful to link directly to Health and acknowledge the differences. The current version of that article does mention the WHO definition as well, but it’s noted as controversial and I think it should probably be de-emphasized. Still, since both versions of this page use the word, the changes don't address this either way.

It might also be relevant that I don’t think the examples given above are that problematic. If I were to translate the “insult” example into the type of statement that might be relevant to an article, it would be something like “high school bullying is associated with the development of depression” which I think is unambiguously MEDRS. Likewise, while social expectations are outside of MEDRS, the circumstances under which ultrasounds are or are not needless should not be, and so forth. More generally, we ultimately have to accept some ambiguity, but since the purpose of MEDRS is to prevent harm, I would strongly prefer that we have a broader definition where specific cases can be excluded based on common sense, rather than a narrower definition that common sense must then be used to extend. Sunrise (talk) 23:36, 1 June 2016 (UTC)

I appreciate your detailed thoughts. There's a lot to think through. In the meantime, I've restored the actual original, as opposed to the previous change, so you can see where we started. It's hard to know where to draw the line, and harder to find a description that will result in everyone understanding the line (especially when someone really, really doesn't want to!).

A few thoughts on your examples:

• What could be "not (not even party) biological" about screening mammography results? I need to understand how a determined wikilawyer might get there, because I want to prevent that line of argument.
• How a healthcare provider evaluates diet and behavior in a diagnosis isn't purely biomedical. There are cultural components to that.
• The gross nutritional effects of a vitamin (e.g., Vitamin C prevents and treats scurvy) are generally accepted to be "medical".

I agree that some disease-related human "biology" isn't properly "medical" – or at least not "clinical medicine" – and I'm okay with that. The community has a higher tolerance for less-than-gold-plated sources when you're writing about which enzyme is disabled by poison X (or, to build on your example, statements about exactly which molecules Vitamin C binds to, to make blood cells).

I would very much like to have a less ambiguous example. Medical ethics is probably good, your idea of explicitly naming human values is great, and perhaps we could come up with a phrase about cultural components of clinical medicine.

What do you think about a section that says ==Does this cover everything about health?== with a "reply" of "That depends upon what your definition of health is"? We could address that problem directly.

On the question of embarrassment, it's a bit of a leap to go from a one-time insult to actual bullying (=normally defined as a sustained pattern, rather than normal behavior). If one-time insults are bullying, then every normal human is both victim and perpetrator.

I don't think the purpose of MEDRS was to prevent harm. (I think it was to prevent "stupid".) But I'm finding that common sense is in short supply, and that MEDRS is being used like a bludgeon in POV disputes, and that using common sense is discouraged by editors (especially anti-woo editors, since MEDRS is an effective tool for them). WhatamIdoing (talk) 15:59, 6 June 2016 (UTC)

I restored Sunrise's text because it is the more stable version, but also because I feel it is the least confusing one.

My suggestion is that it is better to be overly broad in defining the scope (there aren't really any rights or wrongs when it comes to the definition) — and then to have a detailed and exhaustive list of things where MEDRS does not apply.

It is easier to challenge a wikilawyering editor who has a faulty idea of what MEDRS covers. A recent example is those who suggested that epidemiology was outside of the scope of medicine — and it led to time-consuming discussion where it had to be proven far beyond any reasonable doubt that most authorities do consider epidemiology (and public health) as relating to medicine.

I think adding the type of section you suggest would go a long way in addressing some of the concerns of overbroad application while still allowing us to use MEDRS to stop nonsense additions based on primary sources.

My take on what the purpose of MEDRS is different — that it is a tool to make sure that what we add is the most accurate description of scientific knowledge available — so it has nothing to do with harm or stupid. There is a ridiculous amount of poor quality research out there surrounding medicine — more so that in other fields, and MEDRS is a toolkit which we can use when people try to misinterpret or are quick to cast judgement based upon preliminary results.

That said I also have some concerns about not requiring MEDRS for economic claims surrounding medicine. The most reliable economic analysis of medical practices is performed by governments and in various systemic reviews. They should follow strict guidelines concerning the methodology — and for this reason I suggest MEDRS should be applied here as well. It is not proper to pretend that the ravings of Donald Trump should have the same weight as the Agency for Healthcare Research and Quality or the WHO which routinely publishes such analysis. Carl Fredrik 💌 📧 16:24, 6 June 2016 (UTC) 

"Not requiring MEDRS" ≠ "not requiring a high-quality source". American Economic Review should be a perfectly fine source for information about health-related economics – in fact, it's likely to be better than 99% of medical journals on that subject – even though MEDRS doesn't countenance any non-medical journals. WhatamIdoing (talk) 20:37, 6 June 2016 (UTC)

Thanks for the reply! Details for the specific examples are collapsed.

Examples
The following discussion has been closed. Please do not modify it.
For mammography, one line of argument might be “the screening procedure is purely physical, relating to the interaction of EM waves with matter. On the other hand, the doctor doesn’t even have to come into contact with the patient, because they can just look at a picture on a computer screen.” The same kind of argument would apply to X-rays and indeed most medical devices, such as by trying to set up a distinction between “data” and “medicine” where the fact that the former is used for the latter is argued to be unimportant. Another approach might be to say that mammography results are not directly used in treatment decisions, but only to decide whether or not more invasive tests should be performed. Of course, I don’t claim that these are valid arguments, but if I were arguing maliciously I think I could waste at least a few hours of your time. :-P For evaluation of lifestyle, it does meet the “at least partly related” standard that you set up for the previous point. But the hypothetical wikilawyer might point out that any doctor’s decision can be influenced by cultural components, or even say that the entire concept of diagnosis is cultural. This would be easier to do the more controversial the evaluation is, such as for mental disorders (and there are many legitimate criticisms in this regard, but e.g. I wouldn’t want to include content suggesting that they don’t exist at all). I agree for the use of vitamins as treatment. I was thinking more of claims of improvement from baseline, like e.g. “vitamin C boosts the immune system” or “drinking chlorophyll extract improves energy.” The main point of contention I’m thinking of here is whether something used by a healthy person gets considered medicine. A sufficiently creative wikilawyer could also argue for excluding anything that doesn’t involve a doctor’s diagnosis (completely the opposite of the last point), and then start adding poor sources on things like the short-term effects of smoking (e.g. “having a cough for a couple of hours is not something people usually go to the doctor for”). For the embarrassment example, I generalized because I’m not sure what circumstances could make the single example relevant to Wikipedia in this context. Without generalizing in some way (either to the use of many different insults, or to repeated use of the same insult), presumably it would fall in the “Notable cases” category, even if someone makes the specific claim that there were medical consequences.

With regard to defining health, I’d adjust the framing that so it doesn’t appear to conflict with the definition we’re using. That said, I’d support acknowledging the existence of different definitions with a followup comment like “for practical guidance we use the following lists.” I’m aware of circumstances like the example “poison X disables enzyme Y,” and that’s somewhere I’d hope common sense would allow exceptions. But they'd have to be case-by-case, because I’d want MEDRS to be enforced as soon as someone starts selling powdered enzyme Y as an antidote. I see MEDRS as fulfilling essentially the same role as BLP, in part because the high potential for harm is what distinguishes medicine from other scientific subject areas, many of which share similar challenges in regard to reliability. But the analogy to other fields is also one of the reasons I don’t see over-application of MEDRS as much of a problem (which I think I've described in more detail before).

I don’t think that medical culture should be excluded as a whole. I think most of it should be fine, but we could also get statements like “diagnoses of X are based in the following medical philosophy...” I expect that an AIDS denialist might push for including that kind of thing in the AIDS article, or in Philosophy of medicine for that matter. Or they might find a paper that says AIDS is sometimes subject to overdiagnosis or overmedication, and say that this reflects a cultural issue. The main tension there is with the “Medical decisions” section, which on reflection I think could actually cause an issue with values as well. But I’m mainly thinking of values as being what leads to culture, and culture being the proximate influence of society on medical decisions. So I think evaluating whether an ultrasound is necessary should be MEDRS, including relevant cultural factors relating to ultrasounds, but the values underlying those cultural factors are excluded (as long as the statement isn’t e.g. making a direct inference about the medical decision itself). A similar analysis could apply to the relationships of cultural practices with the Health effects section. Perhaps an exclusion for “the relationship between human values and medical culture” would work? I’m still speculating, and I’m not actually sure it’s possible to draw such clean boundaries in the first place, but the idea is to distinguish these from medical practice and its results.

Maybe one option is to treat each field separately, and say that sources of equivalent quality in non-medical fields may be acceptable in some circumstances. Then medical ethics content would acceptable when sourced to review articles (but not primary literature) from ethics journals, medical economics would be acceptable when sourced to review articles from economics journals, and so on. That could also apply to the issue you were discussing in the section below. Sunrise (talk) 11:15, 20 June 2016 (UTC)

Health economics

Per my comments above I chose to move the economics section into the section of what is covered under the term biomedical information. The field is similarly sensitive to other facets of medicine — if not even more so because the economic interests are so great. There is quite a deal of literature on the topic, and I am more than willing to help find sources that support handling it with utmost care. Carl Fredrik 💌 📧 16:47, 6 June 2016 (UTC) 

Please explain why you believe "This costs US $10" is actually "biomedical information". Or why a statement such as "In the US, this expense is not normally covered by health insurance" is "biomedical information". Where's the connection to biomedicine?

NB that I'm not asking whether high-quality scholarly sources exist for these statements. I'm asking why they're biomedical, and therefore these statements should be supported by a citation to Journal of Fancy Medicine instead of to the equally reputable Journal of Complicated Economics (=a journal type that MEDRS does not approve of). WhatamIdoing (talk) 20:28, 6 June 2016 (UTC)

Those are not necessarily the statements that I would consider most important — but when you look at statements such as:

• Lack of timely access to treatment of disease X causes cost $Y after Z years.

   or

• Treatment W is the most cost-effective under circumstance U, but treatment T is most effective under circumstance S.

   etc.

These are all statements that are unarguably best handled by MEDRS-sources and depend on extensive biomedical analysis.

I think it is harmful to blanket-allow non-MEDRS statements when it comes to health economics. Carl Fredrik 💌 📧 20:41, 6 June 2016 (UTC)

1. What you wrote covers the statements that you don't consider important. If you don't want to cover things like "The cost of an MRI machine ranges from US $200K to $3M" or "There are only two MRI machines in all of Nigeria, because they're expensive", then we need to find some other language.
2. What kind of "biomedical analysis" is necessary for "Lack of timely access to treatment of disease X causes cost $Y after Z years."? The main economic cost for lack of treatment is usually lost wages: "How much money you did not earn because you were sick?"
3. Why wouldn't you accept any sources from a top-quality economics journal for that question? WhatamIdoing (talk) 21:29, 6 June 2016 (UTC)

Revert

WAID, I reverted your edit because it would be a major change. An RS has to be appropriate, not just something that an editor has added in good faith. "Appropriate" for biomedical information means MEDRS-compliant. SarahSV ^(talk) 15:50, 25 April 2017 (UTC)

Limits of BURDEN

This page has misrepresented WP:V for several months. We need it to be accurate and to not contradict the actual policies. The actual policy says "The burden to demonstrate verifiability... is satisfied by providing a citation to a reliable source that directly supports the contribution." and goes on to clarify that for the purpose of 'your right to summarily blank other people's contributions', reliable is defined as "any source that he or she [the other editor, not you] believes, in good faith, to be sufficient", which includes sources that editors ultimately, by consensus, agree are not actually reliable for the claim made.

So let me explain the main options, and we'll see whether we can come up with a better way to say this.

What's in the essay	Your options
Medical claim that you believe to be accurate, neutral, and appropriate for this encyclopedia article, but not sourced at all: "Smoking tobacco increases your risk of dying from lung cancer."	You are permitted to blank unsourced content (that's "zero sources whatsoever", not "zero sources that I approve of") under WP:BURDEN, but you probably shouldn't, at least as a first step. Add a {{fact}} tag, or add a good source yourself.
Medical claim that you believe to be accurate, neutral, and appropriate for this encyclopedia article, but sourced weakly: "Smoking tobacco increases your risk of dying from lung cancer.[newspaper article]"	If you want a MEDRS source, then you have to provide it. You are not permitted to say "this is unreliably-sourced content, so I just get to blank it". BURDEN doesn't permit this, full stop. You only get to invoke BURDEN on unsourced material (and material that is so poorly sourced that no reasonable editor would expect the source to be accepted, because we didn't want to leave a door open for trolling).
Medical claim that you believe does not meet the goal of accurate, neutral, and appropriate information for this encyclopedia article, no matter what the source is: "Smoking tobacco cures lung cancer.[ideal MEDRS source]"	Blank it, but say that you're doing it because of WP:UNDUE. It complies with WP:V and BURDEN.

So – yes, you can blank bad content, but you can't blank it because of BURDEN. BURDEN doesn't permit that. Bad content can and should be removed for other reasons. WhatamIdoing (talk) 15:57, 25 April 2017 (UTC)

The phrase you're quoting from BURDEN is in a footnote, and it's consistent with this page. It says:

Once an editor has provided any source that he or she believes, in good faith, to be sufficient, then any editor who later removes the material has an obligation to articulate specific problems that would justify its exclusion from Wikipedia (e.g., undue emphasis on a minor point, unencyclopedic content, etc.). All editors are then expected to help achieve consensus, and any problems with the text or sourcing should be fixed before the material is added back.

For biomedical information, a "specific problem that would justify its exclusion from Wikipedia" would be that the source isn't MEDRS compliant. SarahSV ^(talk) 16:23, 25 April 2017 (UTC)

Indeed, obviously so. We should definitely not be trying to swerve around core policy here: MEDRS attracts attacks enough as it is, and we don't want to encourage more by twisting it in odd directions. Alexbrn (talk) 19:56, 25 April 2017 (UTC)

I also agree that it would be best not to make that change. I guess I can see the point that BURDEN itself does not explicitly require MEDRS-level sourcing, so in one way of misunderstanding the intention here, one could say that it is not BURDEN that justifies what this page says. But I do understand BURDEN to require sourcing that is adequate to the content that it supports, so just as we require BLP-level sourcing for BLPs, we can require MEDRS-level sourcing here, and consider the "burden" unmet when the sourcing fails MEDRS. --Tryptofish (talk) 23:59, 25 April 2017 (UTC)

Sarah, I don't think that "the [first] source [supplied by the original editor] isn't MEDRS compliant" is a "specific problem that would justify its exclusion from Wikipedia". This isn't some children's game like Mother, May I?. If you already know that perfectly reliable sources exist for this information, then you must not blank it on grounds of poor sourcing. "Gee, I happen to know that what you added is absolutely factually accurate, neutral, encyclopedic, and appropriate to this particular article, but – ha ha! You "only" cited a highly reputable news source or a lay-oriented book instead of a peer-reviewed review article from a journal that I approve of, so I get to blank it!" would actually be a stupid outcome (and that's what's been written on this page for months). The policy doesn't support that and shouldn't support that, and this page should match the policy. WhatamIdoing (talk) 01:00, 26 April 2017 (UTC)

The reason that I disagree with this edit you made is because, in the edit summary, you stated that WP:BURDEN doesn't require reliability, and you added the following: "The WP:BURDEN on the original editor is only to provide only one (1) 'source that he or she [i.e., not you] believes, in good faith, to be sufficient', not to provide an ideal one." But WP:BURDEN does require reliability; it specifically states, "The burden to demonstrate verifiability lies with the editor who adds or restores material, and is satisfied by providing a citation to a reliable source that directly supports the contribution. Attribute all quotations and any material whose verifiability is challenged or likely to be challenged to a reliable, published source using an inline citation." Flyer22 Reborn (talk) 01:20, 26 April 2017 (UTC)

As for a lay-oriented book, I agree that we shouldn't be removing that unless it's actually inaccurate, unreliable and/or outdated. WP:MEDRS does support lay-oriented books. As for news sources, WP:MEDRS does not completely reject news sources, but it does caution against them. Flyer22 Reborn (talk) 01:26, 26 April 2017 (UTC)

In terms of fulfilling BURDEN, a reliable source isn't "what the consensus determines is actually reliable". It's "what the original editor [sincerely] believes to be reliable". This means that it's possible to fulfill the BURDEN by providing an unreliable source (and for me to blank your content later on any of several grounds, but not on grounds of BURDEN).

BURDEN simply does not authorize someone to blank good, verifiABLE content just because editor #1 [sincerely] believes that a given source is a reliable, and editor #2 thinks that it's not. (And, of course, you and I both have seen people blank content many times by claiming that books and news sources "aren't MEDRS".) WhatamIdoing (talk) 02:26, 26 April 2017 (UTC)

WAID, the problem with your edit is that it didn't reflect WP:BURDEN. As Flyer says, BURDEN requires that anyone adding or restoring information provide "a citation to a reliable source that directly supports the contribution". Not any source that they believe is okay, but a reliable one, and for biomedical information that's MEDRS. SarahSV ^(talk) 02:32, 26 April 2017 (UTC)

And then the policy goes on to say that once you've supplied a source that you personally believe is reliable, then your BURDEN is fulfilled and now everyone is equally responsible for providing a True™ reliable source. That's the meaning of the bit that begins "All editors are then expected to help": "All editors" means "not just the original one". WhatamIdoing (talk) 03:28, 26 April 2017 (UTC)

WAID, it doesn't say that. You're reading something into it that isn't there. The footnote you're relying on says: "Once an editor has provided any source that he or she believes, in good faith, to be sufficient, then any editor who later removes the material has an obligation to articulate specific problems ... etc." And the material should stay out until that problem is fixed.

So if I see you add "1.1 million died in Auschwitz" sourced to the National Enquirer, I'll either remove it entirely or remove the source and tag it. It sounds about right, but I can't trust it, and the burden is on you to supply an RS. In any event, we're not writing for each other, but for the reader. It's not a question of whether any of us thinks it might be correct, but whether a reader can be satisfied that it's reliably sourced. SarahSV ^(talk) 03:47, 26 April 2017 (UTC)

Do you actually not see the words "All editors are then expected to help" in that policy? Or are you just trying to tell me (i.e., a person heavily involved in creating that footnote) that you don't think I know what I intended it to say? WhatamIdoing (talk) 04:11, 26 April 2017 (UTC)

I don't know what you intended it to say. I know only what it does say. And in any event, it's just a footnote. BURDEN has always required an RS and still does. It would be pointless otherwise. SarahSV ^(talk) 04:14, 26 April 2017 (UTC)

Maybe it will make more sense if we deal in practical terms. Sarah, imagine that (in your excellent judgment) a particular article ought to contain the sentence "Smoking tobacco increases your risk of dying from lung cancer".

Now imagine that someone adds exactly that sentence, and – making a reasonable effort, but not necessarily being familiar with our complex guidelines – that editor adds a citation to a reputable news article. The news article fully supports that sentence.

Is Wikipedia best served by having you blank that sentence and its "unreliable source"? WhatamIdoing (talk) 03:32, 26 April 2017 (UTC)

You've chosen too simple an example. Choose one instead that might be right, but you're not sure, and it will take a while to track down a source. But it's an important medical issue, so you can't just leave it standing in the meantime. SarahSV ^(talk) 03:49, 26 April 2017 (UTC)

How about if someone adds "vaccinations have been shown to produce autism" with a dubious website as reference—a website which they sincerely and enthusiastically believe to be true? Perhaps the ref could be described as a reputable news article that is parroting stuff the journalist received via email. Bad stuff needs to be reverted, not kept until someone finds the perfect reference. Johnuniq (talk) 03:52, 26 April 2017 (UTC)

No, I've chosen exactly the right example for isolating the sourcing issue.

Something that "might be right" could be left standing temporarily; BURDEN recommends {{fact}} tags, and I recommend talk-page discussions. (For example, in such a case, I might leave a note at WT:MED.) Something that's known to be wrong should be removed on grounds other than sourcing (UNDUE, in Johnuniq's example).

But my question stands: If you are absolutely confident that the sole problem with the edit is that someone cited "RS" rather than "MEDRS", then what should you do? WhatamIdoing (talk) 04:07, 26 April 2017 (UTC)

That question doesn't make sense, because what counts as an RS varies depending on the topic. An RS for biomedical info is a MEDRS. SarahSV ^(talk) 04:18, 26 April 2017 (UTC)

Sorry, I meant to add that, with your smoking example, I would quickly add a MEDRS, because it would take seconds to find one. That's why you should choose a more complicated example, where it would take longer. For anything more time-consuming, I would remove the text or at least remove the source and tag it, unless I happened to be in the mood to track down the issue myself. SarahSV ^(talk) 04:26, 26 April 2017 (UTC)

So if I added that uncontestable fact, and I "only" cited a newspaper article or a non-professional-healthcare book to support it, then you would not blank it out of hand for having a bad source, right? Would you approve of someone else blanking it? WhatamIdoing (talk) 03:14, 27 April 2017 (UTC)

The mission of Wikipedia, as defined in WP:NOTEVERYTHING, is to provide the pubic with articles that summarize accepted knowledge. Content that ~might~ summarize MEDRS sources is not something I am comfortable presenting to the public as "accepted knowledge", and in my view Wikipedia is better served by sourcing it, moving it to Talk per WP:PRESERVE or tagging it and then removing it (or moving to talk) if it is not sourced in a reasonable amount of time. We need to aim for the mission as much as possible. Especially for content about health which is extra charged on several levels. Jytdog (talk) 04:29, 26 April 2017 (UTC)

My example isn't dealing with something that "might" be verifiable in MEDRS sources. My example is something that you and I both absolutely know to be the mainstream medical opinion, but it's "only" sourced to a lay source. What do you do with that? WhatamIdoing (talk) 03:14, 27 April 2017 (UTC)

At this point, I think the consensus here is becoming pretty clear, but I'll add that what we have here is something roughly (albeit not 100%) like BLP. If someone edited a BLP page, adding some content for which there are plenty of reliable sources, but also something that falls afoul of BLP, it would be the wrong response to tag it, requesting a better source, or to leave it, while adding another reliable source. The correct response would be to delete it, and BURDEN and the rest of Verifiability really have little to do with that. The BLP policy sets important standards about content, based largely on the goal of not doing harm. In a somewhat similar manner, there is a consensus that content that might lead readers to make medical decisions should also not do harm – and in this case, that means that sources for such content must satisfy MEDRS. And again, the solution to non-MEDRS compliant content is to remove it, rather than to leave it while hoping that better sourcing will emerge. I understand that the concern here is about content that really could be MEDRS-compliant, but just needs a better source. I'm pretty sure that most editors who know that it's good content and who can easily find a MEDRS source would just replace the source – but I don't think that we want to enshrine the idea that if someone does not bother to do that, and simply reverts, that makes them a disruptive editor. I know there is language at WP:V about encouraging a cooperative approach to BURDEN, and that language came out of concerns about editors who revert excessively, but that is also about content in general, not content that falls into special cases such as BLP or MEDRS. --Tryptofish (talk) 00:12, 27 April 2017 (UTC)

Your analogy fails because BLP says nothing of the sort. BLP reserves the immediate-blanking treatment solely for "contentious" content (i.e., a small minority of BLP-related content). I believe that I can state without fear of contradiction that none of us in this discussion consider the connection between smoking tobacco and dying of lung cancer to be the least bit controversial or contentious.

So: I add a sentence saying that smoking tobacco causes lung cancer, and I cite a news article. This is strictly non-contentious content; the equivalent for a BLP statement could live in an article completely unsourced. Would you personally blank that content? Do you think that any editor (assuming that said editor hadn't lived under a rock for the last half-century, and therefore was also aware that smoking tobacco is a health risk) actually should?

(I get what you're saying about not wanting to label an editor as being disruptive. Not everyone knows what I know, and I don't know what everyone else knows. But if we think that this is actually a bad idea, then I also don't want to say that this is a lovely idea that ought to be done at every opportunity, either.) WhatamIdoing (talk) 03:19, 27 April 2017 (UTC)

About BLP, please note that I had said "something that falls afoul of BLP", so I was indeed referring specifically to contentious content, because that is the kind of content that has the potential to do harm. The short answer to your question to me is that, no, I personally would not have blanked a statement that is so obviously factual as that. The longer answer is that I agree with what Jytdog says just below. What I'm talking about here is medical-related content where there is similarly the potential to do harm, if the content tells the reader something that is not supported by MEDRS sources.

And I am also talking about the reverted edit that started this discussion thread. The existing language that was reverted back to actually says to SOFIXIT in the kind of example you gave here: If WP:MEDRS can be found to support the information, and it is relevant and encyclopedic, then ideally provide a better source yourself. Also, the existing language says that improperly sourced content may be removed, not must be removed. --Tryptofish (talk) 00:15, 28 April 2017 (UTC)

• I am kind of uncomfortable with the line of argument you are making here WAID.

Most fundamentally, RS fleshes out what V means by "reliable source" with regard to everything that isn't Biomedical Information and MEDRS defines what V means by "reliable source" for Biomedical Information. They are parallel guidelines in different domains and refer to each other as such (RS refers to MEDRS and MEDRS refers to RS). This has broad and deep consensus. But in your OP you structure this as though MEDRS is somehow "under" RS. Yikes!

Additionally, if we consider the universe of content that is Biomedical Information, "blue sky" things like your two examples (the one widely accepted and the other widely not) are going to be unhelpful 99% of the time. Most times it is going to something like an editor adding "nausea" to a list of "very common" (>10% of people have them) side effects of a drug, let's say where there is also a list of common (between 1% and 10% of people have them) side effects, without adding a source. This is the kind of thing we see all the time and it doesn't fall into either of those buckets and to be honest most times I just revert per unsourced.

But to answer your question i have sometimes let slide content like "smoking increases the risk of lung cancer" cited to a high quality ref like the NYT. Usually if I am in a hurry trying to get to something that is more pressing. If not I find a MEDRS source. if someone removed it and it was important I would probably stop and FIXIT. If someone removed it and it was mundane I wouldn't care. if two people actually started spending time warring over it I would call them both idiots under my breath and if it was important would just FIXIT. It is just not an interesting or helpful question really. Jytdog (talk) 04:03, 27 April 2017 (UTC)

• Here are a couple of examples from my watchlist crawl today. diff; diff. I just reverted both of those. The first cited to a university press release about publication of a clinical study and the 2nd is a recent, very small clinical trial (at least cited to the actual paper). Jytdog (talk) 06:23, 28 April 2017 (UTC)

So when I look back over this, I see very wide agreement on this point: When you encounter a situation in which "a source has been supplied for apparently accurate, relevant, encyclopedic information", and "you want it to have a better or more appropriate source", then the best practice (chosen from among the multiple "legal" options) is to "provide a better source yourself".

Not one person thought that removing that information was the best option. So why doesn't this page just say what we all agree the best practice is? What potentially bad results are we afraid of, if we first say what the best practice is, instead of first threatening removal? WhatamIdoing (talk) 20:15, 13 September 2018 (UTC)

I think the actual takeaway from the (now long-ago) discussion was that we don't need to change this. I guess the potential bad result depends on just how much that information really is "accurate, relevant, encyclopedic". There can be borderline cases, and we don't want to get into needless arguments with someone who added something that is on the borderline, and then wants to argue that someone who reverted them is being disruptive. I'll turn your question around and ask: what is the problem that you are trying to solve? --Tryptofish (talk) 20:32, 13 September 2018 (UTC)

In the long-term, I'd like to reduce the still all-too-common behavior of blanking a good addition because the source is does not conform to some hypothetical ideal. I want this page to be one less source of reinforcement for lazy patrollers and mindless rule enforcers.

In the short term, I want this page to stop misrepresenting what WP:V says on this point. There is nothing in WP:V about "information not sourced to a WP:MEDRS may be removed". WP:V actually says that the editor need only provide "any source that he or she believes, in good faith, to be sufficient" – not whatever "a MEDRS" is, but "any source" that the initial editor believes is sufficient. IMO there is a material gap between "you have to use a MEDRS" and "you have to use any source that you personally think is sufficient" (even if your first "any source" is followed by someone saying, "Here, please read MEDRS. Do you still think that your first source is truly 'sufficient'?"). WhatamIdoing (talk) 20:53, 17 September 2018 (UTC)

I guess the reference to BURDEN is not really needed here, and we could add something conditional about removal:

Biomedical information not sourced to a WP:MEDRS may be removed in accord with WP:BURDEN which states "Any material lacking a reliable source directly supporting it may be removed and should not be restored without an inline citation to a reliable source", especially if it seems likely that WP:MEDRS do not support it. If WP:MEDRS can be found to support the information, and it is relevant and encyclopedic, then ideally provide a better source yourself. If you cannot find an appropriate source but the material seems accurate, consider adding a {{Medical citation needed}} tag.

I don't think we should go much farther than that. It should be permissible to revert improperly sourced material, and the existing language already does say "ideally" about fixing it yourself. --Tryptofish (talk) 23:25, 18 September 2018 (UTC)

Above, SlimVirgin (SarahSV) and I addressed WhatamIdoing's argument that "WP:V actually says that the editor need only provide 'any source that he or she believes, in good faith, to be sufficient.' " SarahSV noted that WhatamIdoing was referring to the footnote, and then challenged the rest of WhatamIdoing's argument. If it's poor material that is supported by poor sources, no, I don't think that it can or should ideally be removed only if the editor contesting it takes the time to tweak or otherwise improve the material themselves and then re-add it. The WP:ONUS is on the editor wanting to include the contested material. Yes, I support WP:Preserve and have cited it enough times, such as in this case, but material can be preserved on the talk page, and I'm not for stating or implying that we should be letting poor material stand in an article until we fix it ourselves. WP:BURDEN states, "If you think the material is verifiable, you are encouraged to provide an inline citation yourself before considering whether to remove or tag it." The "encouraged to" wording was added following objections (on that policy talk page) to the notion that we should fix it ourselves. As for patrollers, such as myself, yes, we routinely revert large additions of unsourced material. Flyer22 Reborn (talk) 23:43, 18 September 2018 (UTC)

I was just offering that as a possible resolution, but I personally don't feel strongly about it, and I certainly wouldn't want to implement it if there is consensus against it. --Tryptofish (talk) 00:03, 19 September 2018 (UTC)

I know that it was just a suggestion. Also, to be clearer on why I feel the way that I do regarding removing material... Some material may not need to be included. It might be irrelevant or WP:Fringe. WP:Preserve is about including appropriate material that should be included. It's not about whether the content is verifiable (although verifiability is an aspect of inclusion). Flyer22 Reborn (talk) 00:10, 19 September 2018 (UTC)

Poor material can be removed without invoking BURDEN.

This is one of the long-term frustrations. We have (usually) newbies adding complete garbage – remember the guy who copied whole sections of virusmyth.com into an article? – and we say "You forgot to add a MEDRS! Go back to the start!" like it's a game of Mother, May I?. Garbage should be removed because it is garbage, without reference to either MEDRS or BURDEN.

The decision tree should look like this:

1. Is this appropriate, encyclopedic information?
   • If no, then kill it now.
   • If yes, then proceed to question 2.
2. Is this appropriate, encyclopedic information already supported by a reliable source?
   • If yes, then see if you can collaborate to improve it.
   • If no, then proceed to question 3.
3. Is this appropriate, encyclopedic information actually verifiable?
   • If no, then kill it now. (Cite MEDRS if you feel like explaining.)
   • If yes, then:
     • Can you add a source? (Best practice for appropriate, encyclopedic material) If you can't, then consider tagging it, so someone else might add a source.
   • If you're uncertain whether this appropriate, encyclopedic material is actually verifiable, then
     • Consider tagging it.
     • Consider removing it under BURDEN.

What we're writing here is a lot closer to "Hey, they didn't get it perfect on the first try, so UNDO!" than what BURDEN says. I'd like to have something closer to the actual policy. WhatamIdoing (talk) 23:13, 21 September 2018 (UTC)

• just responding to the OP here. I am absolutely opposed to this. Without reservation. It is already hard to enough to keep spam and fringe-pushing content out of WP. This would drain the time of experienced editors in endless trench warfare.

This has been tested at ANI - see for example here which had this CWOT village pump discussion behind it and a bunch of other stuff here. And that is just one example of many times this sort of behavioral thing has been dealt with by the community, where people demand to retain badly sourced content about biomedical stuff. There is broad and deep consensus that biomedical information must be sourced per MEDRS. Which is a happy thing. Many good things flow from wise policy. We cut off POV pushing, refspamming, company or product advertising, etc at the knees by discussing sourcing. That is what we do here. Focus on sourcing and generating high quality content from them, based on the P&G. Jytdog (talk) 23:52, 21 September 2018 (UTC)

1. I thought we were supposed to be here to 'build an encyclopedia', not to 'do sourcing'. I don't this it's good for people cry MEDRS over advertising. That's what the NOT and NPOV policies are for, and advertising is still advertising, even if you put a systematic review behind it. Do you feel like lodging an objection related to sourcing is the only effective tool in the toolbox? I feel like some people only know how to use a hammer named MEDRS, so they try to address every problem as if it were a nail that's sticking out. I'd like to see people learn to use multiple tools.
2. I would rather remove this section than have it misrepresent what WP:V says on this point. WhatamIdoing (talk) 14:50, 22 September 2018 (UTC)

• Yes we build an encyclopedia by starting with reliable sources and generating content per the P&G. That is how the community has decided we work to generate articles summarizing accepting knowledge, as opposed to being some website full of indiscriminate ... content, that may or may not be accepted knowledge. As i said -- and very clearly -- many good things flow from wise policies and guidelines. I understand you have concerns about how MEDRS is cited in discussions, but with that effort to distort what I wrote, I have nothing more to say here. Please never misrepresent what I write again. Jytdog (talk) 15:11, 22 September 2018 (UTC)
• And that's a silly false dichotomy. Doing sourcing (properly) is how we build an encyclopedia (instead of, say, a blog or a forum or a work of fiction).  — SMcCandlish ☏ ¢ 😼  05:59, 23 February 2020 (UTC)

• It looks to me like we have reached the point where further discussion is not going to actually change anything, and therefore is probably not worth pursuing. --Tryptofish (talk) 18:19, 22 September 2018 (UTC)