Wikipedia talk:WikiProject Medicine/Archive 119

Nicotine addiction

Sorry if this is a stupid question, but should a reader typing in "Nicotine addiction" be redirected to Nicotine#Reinforcement_disorders(now Nicotine#Reinforcement disorders and cognitive effects), or Nicotine dependence? I realize that there exist differing definitions of substance dependence and addiction, but a reader may not (and perhaps the adverse consequences of smoking, and the fact that most smokers want to quit, make it a bit moot). Is content quality in Nicotine dependence a factor? HLHJ (talk) 06:05, 21 October 2018 (UTC)

I know ICD treats addiction and dependence as synonyms (see .2 at F10-F19). Other narcotic addictions redirect to either a "use disorder" or "dependency" article, rather than the article on the substance – or a subsection thereof; examples opioid addiction, cocaine addiction and cannabis addiction. Little pob (talk) 12:16, 21 October 2018 (UTC)

Addiction and dependence are not synonymous, but the distinction is probably lost on the average reader. Seppi333 (Insert 2¢) 23:59, 21 October 2018 (UTC)

The Nicotine dependence article discusses both use as synonyms and distinctions, without refs, so I've taken the liberty of adding your ref, Little pob. The article also discusses things that are addiction by any definition. Perhaps a rename of the article would be the best way to deal with this?

Separately, the Nicotine article is in terrible shape. I had a go at it to try and make it vaguely conform to MOS:MED, but it still contains a lot of contradictions and some dubious sources. Doc James, I've seen you fix up such things before, and know that you are much better at it than I. Could you possibly have a look at it? If I've made it worse I apologize. HLHJ (talk) 05:27, 27 October 2018 (UTC)

Nicotine is not strictly a drug. It should be structured like Alcohol, not like Aspirin. WhatamIdoing (talk) 15:21, 27 October 2018 (UTC)

Thank you, WhatamIdoing. Alcohol and Ethanol seem to be structured quite differently; what guidelines would apply here? HLHJ (talk) 16:34, 27 October 2018 (UTC)

How does one reach the conclusion that alcohol and nicotine are not strictly drugs?--Literaturegeek | T@1k? 17:34, 27 October 2018 (UTC)

Nicotine is not just a medication but also a drug of abuse I think is what WAID means. Doc James (talk · contribs · email) 17:55, 27 October 2018 (UTC)

Also that nicotine has uses that have nothing to do with human consumption, most famously as an insecticide, and that it is a naturally occurring substance whose existence is independent of any uses that we might put it to.

There are various definitions of drug. The FDA's definition is that a drug is whatever they've approved. A more generic is anything that you give with the intent to treat a condition. In that model, a glass of water is a drug if you give it to someone with a dehydration headache, and a cup of orange juice is a drug if you give it to someone whose blood sugar is low. I see the utility of this definition, but I don't subscribe to it. My personal definition of drug never includes water, and it is not even broad enough to encompass lime juice, even though that lime juice has been given with the intention of treating a deadly disease. Lime juice IMO is a food, and only tangentially a treatment for nutritional deficiency. Nicotine's claim to being "a drug" is debatable – it falls somewhere on the drug–non-drug spectrum between lime juice and cyclophosphamide – but I personally place it closer to lime juice than to cyclophosphamide. WhatamIdoing (talk) 01:00, 29 October 2018 (UTC)

I think WaID is being just a bit reductive here for argument's sake. The FDA's definition of "drug" is found in 21 USC 321 as seen here. Good luck deciphering what all the "and"s mean. Tobacco products fall under their own definition. LeadSongDog come howl! 19:08, 29 October 2018 (UTC)

(edit conflict) Seppi333, you reverted all of my edits (except one fairly minor edit), stating that "Content on performance enhancement goes under uses; several new statements (e.g., cognitive decline and carcinogenicity) cite sources that state this about smoking and tobacco, but not nicotine (WP:V); lastly, non-clinical neuropsychopharnacology claims requires only SCIRS, not MEDRS" and "I reverted a few constructive edits, but the majority of the changes made were not an improvement". I'd like to put the constructive edits back, so I'd like to clear up what the problems were. I've re-tagged some of my concerns.

I'm not sure why a "Psychoactive effects" section came right at the head of the article. Initially, I just tried to balance it by adding info about the negative mental effects of nicotine (with MEDRS). This was the first edit you reverted; I assume that you objected to the use of a review on the effects of nicotine in cigarettes. However, the review discusses measurements of blood nicotine and statements about nicotine.

I think you are acting on the assumption that e-cigarettes deliver just nicotine, so studies using e-cigarettes can be used to make statements about the effects of nicotine, while studies using cigarettes cannot. I don't think either of these views are supported by MEDRS. E-cigs essentially emit a wet low-temperature smoke, as they char a tobacco extract and simultaneously vapourize the water it was suspended in. Then they cool the vapour into a cloud of wet steam, which visually hides the smoke generated by pyrolysing the tobacco extract (though it still smells like pipe smoke). MEDRS seem to draw conclusions about the effects of nicotine from NRT studies and from findings of similar effects from a variety of nicotine-delivery devices; snus, cigarettes, and e-cigs are all relevant (the carcinogenicity statement was made about snus and drawn from a review on the global disease burden from smokeless tobaccos). Conclusions are also drawn from animal studies. I think that if MEDRS makes statements about nicotine, Wikipedia can.

The section on the use of nicotine as a performance-enhancing drug contains no sources that actually say that it is used in this manner. The section on fetal harms seems structured to bury information on the fetal harms of nicotine. You removed two good MEDRS sources I added there, and a fix of another ref that had failed to include two institutional authors; were those the constructive edits you reverted? The statement "Nicotine also extends the duration of positive effects of dopamine and increases the sensitivity of the brain's reward system to rewarding stimuli" seems to me to be about biochemistry and need MEDRS; can you explain why not?

Overall, I was worried that the article starts off by giving the impression that the mental effects of nicotine are all positive, and it isn't harmful. This does not seem to me to reflect MEDRS. These statements are mixed with bits of neuroscience which have far to little context to actually support the general statements, but lend a certain scienciness to them. HLHJ (talk) 19:03, 27 October 2018 (UTC)

I’ll restore the constructive edits by tomorrow evening. I’m very busy off-wiki. The real issue with the edits is that the nicotine article is about pure nicotine and most of the sources you cited made statements about tobacco and smoking. The only form of pure nicotine commercially available is NRT, so reviews of clinical studies involving that are appropriate for the article. Drug monographs could also be used.

The statement requires SCIRS because it’s not clinical. I would, however, remove “positive” - that part is nonsensical.

Seppi333 (Insert 2¢) 20:28, 27 October 2018 (UTC)

Thank you. I'll try and make sure future statements about nicotine are directly supported by source statements about nicotine. I withdraw my suggestion that you view e-cigarette use to be nicotine consumption, as I think it was unfair. Sorry. HLHJ (talk) 22:30, 27 October 2018 (UTC)

Content still not OK

Hi, Seppi333. I'm sorry, but I'm not really happy with the current state of the article. Obviously I don't want an edit war with you and QuackGuru. I would like to discuss the issues below. I'd also welcome more third-party views.

I didn't get pinged from this, so my apologies for my late response. Seppi333 (Insert 2¢) 07:58, 14 November 2018 (UTC)

Brain damage

Nicotine is known to cause permanent cognitive and behavioural deficits; it's a developmental neurotoxin not only in fetuses, but in children, teens, and young adults. The lede currently summarizes this as "The general medical position is that nicotine itself poses few health risks, except among certain vulnerable groups".

Since essentially all people who get hooked on nicotine do so before the age of 25, this is a rather serious omission of highly relevant information. My attempt to insert this information is the lede by adding ", such as young adults" to the end of the sentence was changed, to a statement about adolescents added deeper in the article. Most people getting addicted are also desperately trying to be very grown-up, and identify as young adults. Stating, incorrectly, that nicotine is just bad for adolescents is a well-known way to get more adolescents addicted. So this is not just wrong, but wrong in a way that seriously misleads (and harms) readers. HLHJ (talk) 03:00, 8 November 2018 (UTC)

I'm not sure that "young adult" would be a fair summary of the sentence later in the article that you describe as being about "adolescents". WhatamIdoing (talk) 16:18, 8 November 2018 (UTC)

Hello, WhatamIdoing. The sentence added was "Adolescents seems to be vulnerable to the negative effects of nicotine on the central nervous system". The Surgeon General's report discusses human (correlations, dose-response relationship) and animal (causality) data for adolescents and young adults, and underlying mechanisms, then says "The effects of nicotine exposure on cognitive function after adolescence and young adulthood are unknown" (the US SG also put out a video pointing out that no-one would volunteer their child for a test of how nicotine damaged their cognitive development). I'm not sure how best to summarize this; suggestions? HLHJ (talk) 01:26, 9 November 2018 (UTC)

It appears that the evidence is strongest for an effect in utero, and the picture gets murkier as the user gets older. So why did you choose to emphasize "certain vulnerable groups, such as young adults"? Why did you not choose something uncontroversial, such as "certain vulnerable groups, such as children" or even "certain vulnerable groups, such as children and teenagers"? WhatamIdoing (talk) 16:36, 9 November 2018 (UTC)

Basically, because the lede already covered harms to fetuses (it doesn't cover breastfeeding, but I missed that). I don't think that the non-whole-tobacco nicotine use evidence for post-weaning children is particularly different from that for any older group, with the exception of that single long-term NRT study on adults. The source does not use the well-defined word "teenagers" in relation to cognitive effects; it uses "adolescents" and "young adults". "Adolescents" is extensively used to refer to rats, in the source and its sources, many of which are also MEDRS. The source does not specify these groups by chronological age; it fairly vaguely classifies them by developmental stage, talking about developing brains (fairly necessary if you are going to draw analogies to rats, which don't generally celebrate their fourth birthdays even with the best of care). It mentions that the (human) brain development continues longer than previously thought, into young adulthood.

I've come across this area of research separately in research on learning and memory; as I recall, age and development seem not to be that tightly correlated, especially at older ages, and activities and experiences seem to have a strong effect. Humans generally change cognitive environment with age, and these life-stage-related changes have changed over time (e.g. a couple of generations ago, many English speakers expected to leave school at 16, take a job, and work at the same company until they were 65). So it's difficult to study such age-related changes in a way that makes it clear that we are not just measuring cultural customs. There is obviously a cultural link between "ages where you are doing lots of new stuff" and "ages of 11-25" or some such. The source (and many of its sources) are vague about chronological age, and that probably actually reflects reality.

So I wanted to be non-specific in a way that reflected the sources. I'd read a fair bit of research saying that no-one identifies as an adolescent, and that telling teens that a product was bad for adolescents tended to cause them to think it was safe for them (because they themselves are unusually mature and basically adults). The term "adult" has commonly been used as including teens by people around me, which I realize is a cultural bias I wasn't paying attention to (most age categories are culture-specific; no one says "There's a lot of ephebi on Wikipedia"). "Young adults" seemed sourced and likely to give an accurate impression, communicating information missing from the existing information. It was also short. I thought it likely that I was going to face opposition, and did not want to write a long text before the basic issue of including the information or not was settled.

Rough summary of the info I've seen follows. Evidence is strongest for in-utero and for breastfeeding babies, because their mothers often take NRT. There is a bit of a gap for young children. While some small children do use nicotine, and photos and even old ads show them doing so, I do not know of any research on the effects on them. There is evidence for the harms of second-hand smoke, and children in this age group often die of acute nicotine poisoning, being more susceptible to it, even allowing for body weight, and very prone to stick things (including the tobacco suspensions used to fill e-cigs) in their mouths. At an age around seven or so, children become more independent, and a fair proportion start using nicotine before the age of ten.[1] We have little experimental data on the effects of long-term non-whole-tobacco nicotine use on post-weaning children, teens, and twens. There's hardly much more on long-term use in adults.

Nicotine taken in adulthood (including by eating peppers and tomatoes) may have a protective effect on age-related cognitive decline, especially Parkinson's, and this effect is seen in independent studies too, so I think including it in the article is a good idea. There are prospective observational studies showing that smoking is associated with faster cognitive decline, but of course there are a lot of confounding factors there; for instance, low socieo-economic status seems to make people smoke more and get ill more even when they don't smoke. ("Smoking is a prospective risk factor for impaired cognitive function in later life"[2], based on [3][4]) Some of these prospective studies followed people from birth; some made extensive efforts to eliminate confounding factors. Apart from evidence of developmental neurotoxicity, they found some negative mental effects. Some cognitive abilities oscillate around normal, following blood nicotine levels, averaging out about the same. However, mood goes down with withdrawal and a hit just brings it back to where it would otherwise be, meaning smoking worsens average mood ("Nicotine/smoking thus comprised an additional source of psychobiological distress, irrespective of experiential background... No prospective study has found that the uptake of smoking leads to psychobiological gains. Instead they show the opposite, with smoking leading to increased levels of stress and depression").

The chance of an ethics committee passing a study that randomizes nonusers to a long-term dose of nicotine is pretty low. Experimentally giving ten-year-olds something that the medical research community thinks likely to lead to emotional distress, addiction, and long-term cognitive impairment seems even less likely to meet with ethical approval. Such an experiment would be likely to cause suicides. I think our choice is between describing the best guesses of reliable sources as such and not mentioning the issue at all. HLHJ (talk) 08:50, 14 November 2018 (UTC)

I don't see where in this source - - it says that nicotine causes either brain damage or cognitive deficits. The only thing I found in this source that refers to cognitive deficits pertains to smoking: Smoking during adolescence has been associated with lasting cognitive and behavioral impairments, including effects on working memory and attention, although causal relationships are difficult to establish in the presence of potential confounding factors (Goriunova and Mansvelder 2012). That's not sufficient to claim that nicotine causes cognitive deficits or even might cause cognitive deficits, because tobacco contains a very large number of bioactive compounds. If I missed something, please quote the statement from the source so that I know what you're referring to. Seppi333 (Insert 2¢) 08:03, 14 November 2018 (UTC)

Sure, Seppi333; from the intro of that 2014 SGUS report: "The evidence is sufficient to infer that nicotine exposure during fetal development, a critical window for brain development, has lasting adverse consequences for brain development... The evidence is suggestive that nicotine exposure during adolescence, a critical window for brain development, may have lasting adverse consequences for brain development". In chapter five, "Nicotine exposure during adolescence also appears to cause long-term structural and functional changes in the brain... Thus, adolescents appear to be particularly vulnerable to the adverse effects of nicotine on the CNS[central nervous system]. Based on existing knowledge of adolescent brain development, results of animal studies, and limited data from studies of adolescent and young adult smokers, it is likely that nicotine exposure during adolescence adversely affects cognitive function and development. Therefore, the potential long-term cognitive effects of exposure to nicotine in this age group are of great concern". By 2016 the doubt seems much reduced; again just from the intros: "Nicotine exposure can also harm brain development in ways that may affect the health and mental health of our kids [obviously a press summary]... Compared with older adults, the brain of youth and young adults is more vulnerable to the negative consequences of nicotine exposure. The effects include addiction, priming for use of other addictive substances, reduced impulse control, deficits in attention and cognition, and mood disorders. Furthermore, fetal exposure to nicotine during pregnancy...Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain... Nicotine can cross the placenta and has known effects on fetal and postnatal development. Therefore, nicotine delivered by e-cigarettes during pregnancy can result in multiple adverse consequences, including sudden infant death syndrome, and could result in altered corpus callosum, deficits in auditory processing, and obesity."

I used the term "brain damage" in the heading after I found myself trying to write something like "neurodevelopmental toxicity causing alteration to structural and functional aspects of the central nervous system and associated long-term cognitive and behavioural deficits" and decided to go for succinct. It is not, to my knowledge, found in the reports by the surgeon general's office, nor the article, and if there are reasons not to summarize it that way, please let me know and I'll avoid it too. HLHJ (talk) 06:05, 15 November 2018 (UTC)

I've edited this again in response to QuackGuru. Also added content on the differing addictive potential of different delivery forms. HLHJ (talk) 06:07, 15 November 2018 (UTC)

Brain damage typically refers to lesions in the brain; this sounds more like maladaptive neuroplasticity. Seppi333 (Insert 2¢) 01:55, 16 November 2018 (UTC)

WhatamIdoing, I've added a specific statement with specific chronological ages to the lede, with solid sourcing to a 2016 US surgeon general's report; I've tried to make it unambiguous, any criticism welcome. HLHJ (talk) 07:16, 16 November 2018 (UTC)

Pregnancy

I inserted two good MEDRS sources on the effects of nicotine (specifically nicotine), in pregnancy; you reverted this to the current content, which has a long paragraph on how other components of smoke are bad, and ends with what sounds like its lede. Could you please explain why? The removed content:

During pregnancy and breastfeeding, mothers are advised not to use any products containing nicotine, as nicotine harms the fetus. One 2010 review concluded "Overall, the evidence provided in this review overwhelmingly indicates that nicotine should no longer be considered the ‘‘safe’’ component of cigarette smoke. In fact, many of the adverse postnatal health outcomes associated with maternal smoking during pregnancy may be attributable, at least in part, to nicotine alone".

Thanks. HLHJ (talk) 03:00, 8 November 2018 (UTC)

Given the quoted statement - "The use of any products containing nicotine likely will have adverse effects of fetal neurological development." - I'm fine with re-adding the assertion:

During pregnancy and breastfeeding, mothers are advised not to use any products containing nicotine since nicotine could harm the fetus.

Seppi333 (Insert 2¢) 08:05, 14 November 2018 (UTC)

I've added this to the section you linked above. Seppi333 (Insert 2¢) 08:08, 14 November 2018 (UTC)

Thanks. I've reordered the section so that it doesn't start with specific statements about smoking. We probably need some more up-to-date refs (here's [https://www.ncbi.nlm.nih.gov/pubmed/27297020 a 2016 one). HLHJ (talk) 09:13, 14 November 2018 (UTC)

Looks good. Seppi333 (Insert 2¢) 09:27, 14 November 2018 (UTC)

Also edited again in response to QG, who had a point that the quotes and the statements did not line up any more. HLHJ (talk) 06:32, 15 November 2018 (UTC)

Used because addictive, not because medicinal

Nicotine

The current article says that nicotine is used for its stimulant effects, replacing content that said that it is used because it is addictive (source says : "Most smokers use tobacco regularly because they are addicted to nicotine"; QuackGuru, why is this FV, given that I specified that it was mostly smoked for its addictive effects?).

Content citing surveys to state that most smokers use unwillingly were removed on grounds that they were not MEDRS. I'm not sure that stats on smokers' own opinions on why they smoke are biomedical claims (removed article text: "Adult smokers mostly want to quit and can't; they commonly feel addicted, and feel misery and disgust at their inability to quit, according to surveys done in the US.") I realize that some nicotine users are not smokers, but a very large proportion of nicotine use is by smokers. Cigarettes are the best-studied nicotine product, so I think studies on cigarettes making statements relevant to nicotine are on-topic. Content about smokers is highly relevant to the point here, namely: according to admittedly imperfect evidence, nicotine is mostly used by addicts because they can't stop. Not just by people who like the mental effects, which are, on average, negative.

Users crave nicotine for its acute effects on mood, which are positive; however, negative mood effects set in shortly after use (20–60 minutes after a cigarette, in smokers). This rapid mood oscillation is associated with addictiveness. Smokers need the nicotine hits to feel normal. Regular use causes chronic depressed moods (including higher reported stress and less energy) which are reversible on quitting (unlike some of the cognitive harms, which are probably permanent effects of the brain)..

All this is inadequately covered in the current Nicotine#Reinforcement disorders section, which is confused and self-contradictory.

Finally, the article has a large section under "Uses" on an unsourced use of nicotine as a performance-enhancing drug. I do not think this is a significant use; I think this is unfounded marketing puffery (like a lot of dodgy health claims which circulate on the internet and are naively added to Wikipedia). I therefore think this section should be removed. If you disagree, please let me know why. HLHJ (talk) 03:00, 8 November 2018 (UTC)

I did not tag it as FV. I tagged another sentence as FV content. The content was removed because it was off-topic. QuackGuru (talk) 20:46, 8 November 2018 (UTC)

If content saying that nicotine is used because it is addictive is off-topic, why is content saying that nicotine is used because it is a stimulant on-topic, QuackGuru? HLHJ (talk) 01:17, 9 November 2018 (UTC)

The content added did not state that nicotine is used because it is addictive. You stated in part no source with statement on reasons for nicotine use as a whole found, so using statements about smoking clearly identified as such. Smoking and nicotine are different topics. It is better to use sources that are directly related to recreational drug use. The section name is "Recreational". Content about recreational drug use pertaining to nicotine is on-topic. Current wording is "Nicotine is used as a recreational drug.[42] Recreational drug users commonly use stimulants such nicotine for its mood-altering effects.[43]" Both sources I cited are related to recreational nicotine use. QuackGuru (talk) 03:21, 9 November 2018 (UTC)

Quack, do you think that the statement is actually untrue? Do you believe, or disbelieve, the claim that some nicotine users use nicotine because they're addicted?

(Just so we're all on the same page, "recreational drug use" means "drug use for any purpose other than to treat a disease." Taking nicotine to raise your blood pressure, if you have hypotension, is not recreational. Taking it because you like it is recreational.) WhatamIdoing (talk) 16:42, 9 November 2018 (UTC)

It is irrelevant if it is true or not true. The definition of "recreational drug use" is also irrelevant. The content is relevant when the source indicates it is discussing recreational nicotine use.

The section name is "Recreational". Sources that are not specifically about recreational nicotine use are generally off-topic to the section. QuackGuru (talk) 17:40, 9 November 2018 (UTC)

Nearly all nicotine use by humans recreational, according to that definition. Therefore, nearly all sources about nicotine in general are on topic. Indeed, the recreational use so overwhelms other uses that I would accept all sources that don't say that they're specifically talking about some rare medicinal or functional use as being on topic for that section. WhatamIdoing (talk) 22:38, 11 November 2018 (UTC)

would generally agree w/ WAID--Ozzie10aaaa (talk) 10:58, 20 November 2018 (UTC)

People don't use a drug that's addictive (i.e., rewarding and reinforcing) merely because it's addictive unless they're addicted to it. I can't imagine most people would casually use nicotine due to its rewarding effects because it's not a particularly euphorogenic substance (i.e., nicotine consumption doesn't induce a pleasurable affective state like certain other psychostimulants do). Case in point: I use nicotine lozenges periodically solely to improve my focus at times when I find it difficult to concentrate; nicotine has a very well-established attentional performance-enhancing effect in humans based upon meta-analyses of clinical trials. I don't take it merely because it's reinforcing and I certainly don't use it for modifying my affect (NB: I've never noticed it having any effect on my affect), which is what I assume you mean by "people take it because it's addictive" (to be clear, many addictive drugs induce a positively-valenced or "pleasurable" affective state when consumed, but this is not typical for nicotine). In any event, I doubt we have a source which asserts that people use nicotine recreationally simply because it's "addictive". Seppi333 (Insert 2¢) 08:20, 14 November 2018 (UTC)

I am not sure why you put "addictive" in scare quotes with respect to nicotine. I'd put "recreational", as something that makes you depressed is not my idea of recreation. If we are to go by anecdote, all of the nicotine users I know or have ever known are addicted to it, including the ones who insisted they weren't. The mood swings were pretty obvious; they got antsy and short-tempered before they used it. When given excellent medical reasons to give it up, namely cancer, they could not. I am not arguing that all nicotine use is because it is addictive; that would be absurd, as obviously someone using it for the first time is not using it because they are addicted. I am arguing that most use is because it is addictive. The same source cited for the statement "Recreational drug users commonly use stimulants such as nicotine for its mood-altering effects" actually clarifies it in a way that agrees with your statement about euphorogenicity; it also says "Stimulant drug users suffer a range of negative states when off-drug and feel better in numerous ways when on-drug, hence the strong addictiveness of every CNS stimulant." If you are an addict, you have chronic mild low mood, briefly relieved by a nicotine hit, which brings mood up to normal for a few tens of minutes. I've found a source for the statement that most use is due to nicotine's addictiveness, and I've modified the mood-alteration statement to accord with the source (and what you say):

It is widely used because it is highly addictive. People addicted to nicotine suffer depressed mood, and commonly take nicotine for its mood-normalizing effects.

I hope this is OK. HLHJ (talk) 09:49, 14 November 2018 (UTC)

Just to be clear, the term “addictive” describes a drug property. An addiction is a brain disorder which is induced by drugs with that property. People only use addictive drugs compulsively if they have an addiction to one of those drugs.

With that in mind, I think what you mean to say is, “It is widely used because many people are addicted to it.” The clause “because it is highly addictive” comes off sounding like it’s a motivation for using it (i.e., it suggests that people use it because they want to develop an addiction); consequently, that wording is really awkward. I’m sure you’re aware that many people begin using tobacco products for social reasons (e.g., fitting in with a group, a belief that it’s perceived as cool, etc.), not because their goal is to become an addict.

What you’ve described in the second sentence pertains to psychological dependence and the associated emotional-motivational withdrawal symptoms, not an addiction. So, just change “People addicted to nicotine” to “People dependent upon nicotine” and that sentence will be fine. Seppi333 (Insert 2¢) 02:13, 15 November 2018 (UTC)

On the second, I'd changed it to "dependent" before seeing this. I've changed the first to "Nicotine has become widely used because it is highly addictive, which makes it hard to quit using it" now, as I agree that the idea of aspirational addiction is odd. HLHJ (talk) 06:17, 15 November 2018 (UTC)

Performance-enhancing drug

I still think this Nicotine#Enhancing performance section should go; we have no independent source that this use is significant, and the only sourced sentence with the context to make it comprehensible is isolated from important context found in the Nicotine#Reinforcement disorders section (that the effects are acute and counterbalanced by negative effects of dependence, such that dependent nicotine users are not cognitively better off on average). I have tagged the section accordingly. HLHJ (talk) 06:29, 15 November 2018 (UTC)

You’re conflating cognitive deficits that arise from an addiction with a short-term drug effect, so I don’t see a reason to cut that section. A number of articles on other addictive performance-enhancing drugs use that same section to cover the effects on performance. Seppi333 (Insert 2¢) 07:30, 15 November 2018 (UTC)

The "Use/Enhancing performance" section reads:

Nicotine-containing products are sometimes used for the performance-enhancing effects of nicotine on cognition. A meta-analysis of 41 double-blind, placebo-controlled studies concluded that nicotine or smoking had significant positive effects on aspects of fine motor abilities, alerting and orienting attention, and episodic and working memory. A 2015 review noted that stimulation of the α4β2 nicotinic receptor is responsible for certain improvements in attentional performance; among the nicotinic receptor subtypes, nicotine has the highest binding affinity at the α4β2 receptor (k_i=1 nM) which is also the biological target that mediates nicotine's addictive properties. Nicotine has potential beneficial effects, but it also has paradoxical effects, which may be due to the inverted U-shape of the dose-response curve or pharmacokinetic features.

We do not have a MEDRS saying that performance enhancement is, in itself and not as a component of dependence, a significant use of nicotine. The second sentence statement was until recently found later in the article, amid more relevant context. The 2015 review in the third sentence mentions nicotine once, to say "Importantly, the non-selective agonist nicotine is less likely to generate such enhancements, in part because nicotine...", so I'm not sure this sentence isn't WP:SYN. The source for the fourth and last sentence says in the abstract "...potentially intervening in age-related changes in diverse molecular pathways leading to pathology. Although nicotine has therapeutic potential, paradoxical effects have been reported, possibly due to its inverted U-shape dose-response effects or pharmacokinetic factors". It is talking about slowing age-related cognitive decline (a use with MEDRS, so we could include that). The point (that high doses of nicotine can have negative effects on cognition, I think) is also made in the first source, in equally obscure language. Anyone else want to weigh in on what this means?

I templated that paragraph as an ad because it looks like a lot of the sciencey industry marketing materials I've read. It make a bold but unsupported claim in plain English, then follows it with a bunch of scientific terminology and claims that sort of look as if they are relevant, but descend into incomprehensibility. This has been shown to be an effective technique for making readers trust claims.[5] The section also leaves out or obfuscates all of the balancing information (for instance, that the benefits in the review are short-term; that a nicotine habit does not give you improved cognitive abilities, and does give you cognitive fluctuations which can cause distress and deeper dependence, and the negative cognitive effects of the maladaptive neuroplasticity described above, which are long-term, with evidence of them in old age).

There are some problems with the cognitive-effects meta-analysis; they included studies of smokers who had not smoked for up to two hours; as the article says, many smokers would be nicotine-deprived by this point. Nearly half the studies did not state funding or were funded by the nicotine industry, and the authors did not examine whether funding source made a difference. They also did not look for publication bias in these mostly very small studies, or separate NRT from smoking (a study on that here, looking at the effect of NRT and cigarettes with almost no nicotine in them). Unfortunately they also do not publish supplementary data, so the reader can't simply run these tests themselves. The Surgeon Genreal's 2014 report also summarizes the review by saying there is no clear evidence for cognitive benefit except for those in withdrawal. There are, however, other sources for the idea that cognitive abilities fluctuate with blood nicotine level in dependent smokers (and more slowly in NRT users), and this fluctuation helps condition dependence. The idea seems likely to be correct and I think it should be included under the mechanisms of dependence. Given more detail and closer sourcing, would you object?

I do not think the short- and long-term, or pre-dependency and withdrawal-based cognitive effects, are the same. I do think they are a factor in addiction (a statement that was sourced in the article). Someone dependent on nicotine feels muzzy and out-of it, so they take nicotine and feel sharper and more focussed. You removed the sentence "Nicotine has clinically significant cognitive-enhancing acute effects at low doses, particularly in fine motor skills, attention, and memory. These beneficial cognitive effects may play a role in the maintenance of tobacco dependence" citing WP:Crystal ball. I think this is more scientific uncertainty than unfounded speculation. I see you also moved the section on dependency and withdrawal from under "adverse effects" to under "Overdose". While the idea that any dose large and swift enough to cause dependence is an overdose is not without merit, and finds some reflection in the proposals to lower the nicotine levels in commercial products to non-addictive levels, I don't think this terminology is widely used in reliable sources, and dependence is certainly a negative effect. We could resolve this by including the section on overdoses as an adverse effect, but I'm not sure if this is acceptable formatting (comments, anyone?).

This is a difficult paragraph; I've tried not to cause offense, and owe you apologies if I fail. I understand from what you posted above that you personally use nicotine lozenges at a level you judge to be non-dependency-inducing; you gave acute cognitive effects as your reason. I'm not attempting to judge whether you are nicotine-dependent; I can't, I shouldn't, and if you wanted to know you'd presumably ask your doctor. But regardless of dependency, you are motivated to believe that the way you use nicotine is harmless. Regardless of the truth of this belief, that motivation will contribute to your POV bias, just as my POV bias is affected by people having first told me they only used nicotine once or twice a month and weren't addicted, and later that they couldn't stop. I am not in any way suggesting that you are being dishonest or otherwise in bad faith in your conceptions around nicotine dependency. I'm just worried; I have learned from experience not to trust any reasoning affecting self-assessments of nicotine dependence.

I also moved the excessively detailed information about plants containing nicotine out of the lede into a separate section. I am a bit worried about the heavy reliance of this section on one source (Siegumund et al. 1999) as I cannot access it and it seems to contradict at least one other source.[6] HLHJ (talk) 06:37, 16 November 2018 (UTC)

@HLHJ: But regardless of dependency, you are motivated to believe that the way you use nicotine is harmless. I never stated this and I don't think this; I'd suggest not making unfounded assumptions about my beliefs and/or knowledge about drugs in general and nicotine in particular. For me, nicotine lozenges have an unpleasant taste, can cause nausea, and promote stress ulcers when used in combination with amphetamine, among other things. I'm also cognizant of the fact that nicotine has been shown to promote cognitive deficits in the offspring of laboratory animals that consume it via transgenerational epigenetic inheritance of methylated histone amino acid residues (i.e., epigenetic marks), which is something that occurs when nicotine is used at sufficiently high doses over a period of time. The possibility that this phenomenon could occur in humans and knowing that sufficiently high doses and/or frequent use of nicotine induces epigenetic changes in the human brain and sperm cells is just one of three reasons why I only take low doses and avoid using it with any regularity.

Large blob of text – collapsed by Seppi333 (Insert 2¢)

In any event, it's not particularly difficult to self-diagnose addiction or dependence so long as one is marginally familiar with a handful of concepts in cognitive and behavioral psychology. Personally, I don't like using nicotine (using it is usually mildly unpleasant) and I've never felt a need to use it. The distinction between what motivates a non-addicted/dependent person like me and a person with an addiction to or dependence upon nicotine to use nicotine is that a non-addicted/dependent individual chooses to use the drug for a perceived benefit that is unrelated to any past or present use of it, whereas a dependent person uses it to stave off an undesirable physical/cognitive state and an addict uses it to satisfy a craving/desire for drug reward. It's worth mentioning that I suffered from an addiction to something in the past (that something was not nicotine; this admission is somewhat of a bombshell since it's the first time I've disclosed this on Wikipedia; it's also why I've written so much about the molecular neurobiology, neuroepigenetics, and cognitive neuropsychology of addiction) and I know unequivocally that I'm not addicted to or even just dependent upon nicotine (NB: it's much easier to become dependent upon a drug than it is to become addicted to it; it's also much easier to overcome dependence than addiction). I don't use nicotine lozenges on regular basis and, on days that I choose to use them, I take them maybe once or twice during that day. In contrast, the way an addiction to a drug works is: an addicted individual uses the drug they're addicted to just once, then they develop a craving for it (NB: if relapse [i.e., the development of an irresistible craving] had not occurred prior to the initial re-use of the drug [this would arise from exposure to an arbitrary conditioned reinforcer], then relapse is extremely likely to occur at this point [the initial re-exposure to the drug] due to the drug functioning as a primary positive reinforcer of continued drug use) and use it again, then again, and again, and again, and again until they either run out of it or reach a physiological limit that forces them to focus on other biological needs like eating or sleeping – that's the form of compulsive use that characterizes an addiction. I'm not telling you this to try to convince you that I'm not addicted to or dependent upon nicotine; rather, I'm stating this because you don't seem to really understand how people behave when they have an addiction as opposed to dependence. It's not withdrawal symptoms that motivate continued use with an addiction; it's the assignment of an excessive amount of incentive salience to the addictive stimulus, which manifests as a craving (i.e., extreme "wanting"/"desire") for doing/using it. I'm not going to try to explain the cognitive psychology of addiction (i.e., how an addict thinks when they're exposed to conditioned environmental cues or an addictive stimulus) because understanding that thought process requires at least some working knowledge of specific cognitive processes (i.e., incentive salience, inhibitory control, Pavlovian-instrumental transfer, and reward sensitization) and forms of associative learning (namely, operant conditioning and classical conditioning), the awareness of and hence the capacity to recognize changes in the aforementioned cognitive processes in oneself, and the awareness of and capacity to recognize a personal failure to exert inhibitory control over one's behavior in particular.

On an unrelated note, the idea that a psychostimulant like nicotine does not confer any marginal cognitive benefit at low (or in some cases even high) doses in nicotine-naive individuals is almost as absurd as thinking that an addiction to nicotine doesn't induce cognitive deficits. The occurrence of a benefit from the use of a cognition-enhancing drug is always dependent upon one's underlying neurobiological state factors (i.e., things like one's current state of wakefulness/cognitive arousal, capacity to focus attention, degree of psychological stress or relaxation, motivational state, etc.) at the time of use and the current task and/or goal one is working to complete. In a nutshell, what I mean by this is that one can, but not necessarily will, obtain a performance benefit from using a cognition-enhancing drug for a given task. A person needs to be in the right "state of mind" to obtain a benefit from using a cognition-enhancing drug to improve task performance (e.g., as a general rule, the use of a psychostimulant drug while in a state of low arousal will improve performance on almost any simple task, but not necessarily on complex tasks; that should be obvious). That meta-analysis isn't the only literature which supports the occurrence of improvements in attentional performance from nicotine use by nicotine-naive individuals. It's just the only meta-analysis that the article cites. There's also evidence that nicotine has ergogenic effects in humans, but those are not as clear-cut as nicotine's cognitive effects; the article currently says nothing about physical performance-enhancing effects. Seppi333 (Insert 2¢) 03:03, 21 November 2018 (UTC)

• Re: The point (that high doses of nicotine can have negative effects on cognition, I think) is also made in the first source,[1] in equally obscure language. Anyone else want to weigh in on what this means? That inverted U-shape on a dose-response (i.e., task performance) curve for complex/difficult tasks is applicable to all psychostimulants (e.g., caffeine, amphetamine, methylphenidate, etc.). That's also why that whole clause contains a piped wikilink to the Yerkes-Dodson law. More generally, most psychostimulants improve some aspect of cognitive control (i.e., one or more of the cognitive processes which compose it) in low doses and impair cognitive control at high doses. These phenomena are certainly not unique to nicotine.
• Re: for instance, that the benefits in the review are short-term; that a nicotine habit does not give you improved cognitive abilities, and does give you cognitive fluctuations which can cause distress and deeper dependence, and the negative cognitive effects of the maladaptive neuroplasticity described above, which are long-term, with evidence of them in old age. Read Amphetamine#Enhancing performance and keep in mind that every one of those effects is "short-term" in the sense that they persist for a period which is less than or equal to amphetamine's duration of action. I also want to draw attention to the fact that an amphetamine addiction entails cognitive deficits. Again, nicotine isn't special; virtually all psychostimulants act as cognition-enhancing drugs with respect to cognitive arousal (i.e., they increase "wakefulness") over their duration of action (NB: the Yerkes–Dodson law article covers the empirical relationship between cognitive arousal and task performance). All addictive psychostimulants necessarily induce cognitive deficits when an individual becomes addicted to one of them. Addiction involves impairments in inhibitory control; that specific cognitive impairment is one of two changes to a cognitive processes that results in compulsive drug use (the other one being the sensitization of incentive salience). Seppi333 (Insert 2¢) 03:07, 21 November 2018 (UTC)

Section reflist

References

IP refspam

I'm canvassing here for more input on this issue that no one has any proposed solutions for at ANI. Someone has been using a variety of IP addresses (12 that I found) to insert his own primary research papers as references in many biomedical articles. He's done this in batches since 2012. He has been blocked twice but doesn't care. Does anyone have any ideas of how to stop this? Natureium (talk) 21:12, 16 November 2018 (UTC)

If it's the same papers, maybe an edit filter? I don't know how to do them, so I can't help there, but it's a thought. ♠PMC♠ (talk) 21:19, 16 November 2018 (UTC)

Yah not sure of any good solutions. Doc James (talk · contribs · email) 00:45, 17 November 2018 (UTC)

Keeping the content, but replacing the refs with citations to review articles or textbooks might help. He's adding content, not just citations. WhatamIdoing (talk) 16:52, 18 November 2018 (UTC)

But most of the content is supported by his own primary sources, which means there are probably not (yet) any secondary sources to verify it. Natureium (talk) 22:08, 20 November 2018 (UTC)

I'm not sure about that. You reverted this and this, which cite a review article (and this but without removing the content, which was additionally cited to an older review article).

You reverted this, which cited both a review article and a primary source. The primary source is PMID 30213873, which was just published in Blood two months ago, so it has probably not been cited anywhere yet. But if it were not quite so new, PubMed or Google Scholar (or several other resources) would give you a list of papers that did cite it, and you could figure out from that list whether any reviews had cited it. (That would probably be faster than just searching for the content generally.) WhatamIdoing (talk) 19:33, 21 November 2018 (UTC)

TAR syndrome

I just stumbled on the article TAR syndrome and it looks terrible: lots of unsourced content, an entire empty section, etc. Definitely could use some eyes. IntoThinAir (talk) 04:15, 23 November 2018 (UTC)

might help[7]--Ozzie10aaaa (talk) 21:11, 23 November 2018 (UTC)

Sperm information regarding the Child abuse article

Can I get some opinions at Talk:Child abuse#MEDRS and a PubMed Review? A permalink for it is here. As seen with this revert, Chris Howard wants to add the following to the article: "Study results indicate that childhood abuse is associated with DNA methylation in human sperm." Flyer22 Reborn (talk) 18:17, 21 November 2018 (UTC)

give opinion(gave mine)--Ozzie10aaaa (talk) 01:42, 24 November 2018 (UTC)

National Library of Medicine talking about WikiCite in Webinar

United States National Library of Medicine is hosting a talk on meta:WikiCite and d:Wikidata:Scholia. This is more of a Wikidata thing but it is medicine. I think that more organizations without a history of regular engagement with Wikimedia projects in medicine are starting to take interest in Wikidata.

Wikidata = 60 million items, 25 million are citations (this slice is mostly WikiCite), 15 million are citations to PubMed.

• https://nnlm.gov/class/wikidata

Dec 7, 2018, 2:00PM - 3:00PM ET

Here is something from this presenter -

• "The Role of Librarians in Wikidata and WikiCite". NDSR at BHL. 6 June 2017.

Blue Rasberry (talk) 23:18, 20 November 2018 (UTC)

Wikidata:Scholia is excellent--Ozzie10aaaa (talk) 13:44, 24 November 2018 (UTC)

Review of recent cite spam

Hello, could a knowledgeable editor double-check my reverts of the edits from User:117.17.155.57 please? First of all, they are blatant cite spam to popularize the research of 1 author (or a small group of authors). Secondly, most if not all of them add little of direct relevance to their respective topics (limited clinical trials, secondary research for tangential aspects, passing mentions, redundant sources, etc.). However, it's entirely possible that 1-2 of these edits may be of some limited value from an uninvolved point of view - please feel free to revert any such removals. Thank you for any help with assessing these edits. GermanJoe (talk) 15:03, 24 November 2018 (UTC)

Yup thanks for the clean up User:GermanJoe. Doc James (talk · contribs · email)

Drugs for impotency

Opinions needed here, thanks in advance. Brandmeister^talk 14:55, 25 November 2018 (UTC)

• give opinion(gave mine)--Ozzie10aaaa (talk) 11:41, 26 November 2018 (UTC)

Sbelknap is appealing TBAN

Please see Wikipedia:Administrators'_noticeboard#Topic_ban_appeal_by_Sbelknap. Jytdog (talk) 18:06, 26 November 2018 (UTC)

give opinion(gave mine)--Ozzie10aaaa (talk) 10:19, 27 November 2018 (UTC)

PCORI hiring a Wikipedian in Residence for a one-year term

Located Wash, DC

The Patient-Centered Outcomes Research Institute, a Washington D.C.-based nonprofit nongovernmental organization receiving some government funding, is seeking to hire a full-time Wikipedian in Residence for a one year term, perhaps beginning in February 2019. In this role the Wikimedian in Residence will seek to integrate health information from PCORI into Wikipedia.

See the description on the PCORI website. I understand that applications are open. I am passing this message along to WikiProject Medicine. Currently I am Wikimedian in Residence at the Data Science Institute at the University of Virginia, which is not far from DC, and I am keen on collaborating with the person at PCORI by visiting them there and inviting them to my university. Of course I also want someone who engages with WikiProject Medicine and the broader Wikimedia community.

In these roles every organization wants someone who is an expert Wikimedian and an expert in their field. If this is not possible, the next consideration is whether to hire a Wiki-expert with less medical experience, or someone who is proficient with medical information but inexperienced with wiki. Depending on the goals I think either of these could work. If socializing with peers is essential, then I recommend subject-matter experience over wiki experience, and if wiki community outreach is essential, then I recommend wiki experience or at least online community management experience.

Please refer the job posting to anyone whom you think might be interested. Thanks to physician zidovetz of Wiki Project Med Foundation for his visit to this organization in September 2018.

I do not speak for PCORI or have a particular relationship with this organization, but if anyone has questions about Wikimedian in Residence roles in medicine, then I can speak to that as I have been doing this since 2012. Thanks. Blue Rasberry (talk) 17:08, 20 November 2018 (UTC)

thanks for posting Bluerasberry--Ozzie10aaaa (talk) 21:07, 23 November 2018 (UTC)

Appreciate all your help, LaneNytodc (talk) 15:58, 27 November 2018 (UTC)

Alzheimer's disease

Alzheimer's disease brain comparison

It's still very new but this paper in Nature (with a MedNews quicky) looks to be a major clarification of some mysteries of sporadic Alzheimer's pathology. It isn't exactly an independent review, but no doubt there will be true secondary mention soon. As this area of our article has long reflected the confusing state of research, some revisitation will be due. Anyone itching to tackle the cleanup of the Genetics section? LeadSongDog come howl! 20:47, 26 November 2018 (UTC)

the 'cause' section also has unreferenced text suggested mechanism of action is that when TREM2 is mutated, white blood cells in the brain are no longer able to control the amount of beta amyloid present....its FA--Ozzie10aaaa (talk) 00:24, 28 November 2018 (UTC)

Bot to add PMID to DOI citations

Does anyone have information about this, if it exists? May be useful over at French Wikipedia as well. Thanks! JenOttawa (talk) 19:58, 27 November 2018 (UTC)

@JenOttawa: See User:Citation bot. Headbomb {t · c · p · b} 00:03, 28 November 2018 (UTC)

Thank you @Headbomb:. JenOttawa (talk) 00:47, 28 November 2018 (UTC)

Orbital compartment syndrome

Hello WikiProject Medicine,

I am new to editing Wikipedia and interested in writing an article on orbital compartment syndrome. Looking through Wikipedia, it seems that there isn't an article for this topic specifically but references to orbital compartment syndrome in several other pages without much in the way of specific information. Also, the compartment syndrome page does not mention orbital compartment syndrome. With this in mind, is it appropriate (and would it be helpful) to draft an article on this subject.

I'd love to hear your thoughts!

Thanks,

Poseysfriend (talk) 21:49, 27 November 2018 (UTC)

might you have a suitable reference for the 'syndrome'--Ozzie10aaaa (talk) 23:27, 27 November 2018 (UTC)

A quick online search gives what looks like a reasonable review, and I'm sure an ophthalmogist would be able to find a textbook that deals with it! As it is a fairly rare condition, there are not many secondary references (the one cited before is the only review), so it may be reasonable to use some relevant primary sources about particular asects, if of high quality. Kitb (talk) 10:10, 28 November 2018 (UTC)

Sounds like a great idea, I suggest taking a look at what adequate sources are at WP:MEDRS (brief summary: review articles or higher-level textbooks). For writing style WP:MEDMOS is a good guide. And don't be afraid to write a shorter summary that you can add in the Compartment syndrome article with the {{main}} link to your article. Or, if you only think you will be writing a few sentences, try and incorporate it into a subsection of compartment syndrome, maybe under a ===Location=== header under the ==Pathophysiology== header. Carl Fredrik ^talk 03:35, 28 November 2018 (UTC)

I agree it sounds a great idea! I suggest you try using the tip user:RexxS suggested to me a few entries above - why not draft your proposed article in your userspace User:Poseysfriend/Orbital compartment syndrome (just click on that red link and Wikipedia will automatically set it up for you). You can then work on it there. I - and I'm sure others here - would gladly look it over for you if you were at all unsure whether it was ready for mainspace. That would avoid several problems, while allowing you time and space to develop a new topic without the interference you get working directly in mainspace. Kitb (talk) 10:10, 28 November 2018 (UTC)

____

References

Advice needed with a draft article on 'Comprehensive geriatric assessment', please!

Dear colleagues, I am having problems with Draft:Comprehensive_Geriatric_Assessment.

The article has been declined on the grounds that it: 'reads more like an advertisement than an encyclopaedia entry', and '...should refer to a range of independent, reliable, published sources, not just to materials produced by the creator of the subject being discussed.'

I have quoted no materials which I have produced myself, and among several other references (including a Cochrane review of the topic), the four most authoritative multi-authored textbooks of geriatric medicine, of which 'comprehensive geriatric assessment' [CGA] is a (or possibly the) key element. Indeed, CGA (or 'multidimensional geriatric assessment') has at least one chapter devoted to it in three of them.

References

I also need guidance as to why my draft '...reads more like an essay than an encyclopedia article' and how I should change it to be '...from a neutral point of view in an encyclopedic manner.' Since there is no disagreement about how effective CGA is, and it is used pretty much universally in clinical practice, I cannot see how to make it 'more neutral'. I have read the style guides, but cannot work out from there where I am going wrong.

Questions:

1) Could someone show me an example of what would be accepted as an '...independent, reliable published source.' that would be preferable to, or necessary in addition to, these?

2) Could someone give me some guidance as to how this might be made more neutral, please?

3) Could someone show how to make it more encyclopaedic, rather than 'like an essay', please?

Many thanks, Kitb (talk) 09:04, 25 November 2018 (UTC)

The article has been accepted, so I guess these questions are now redundant (although any helpful advice re style would still be appreciated)!! Kitb (talk) 10:12, 25 November 2018 (UTC)

Well...

The "essay" complaint is supposed to mean something like a personal reflection ("When I think about this, I feel..."), but it tends to appear on anything that that the editor adding the tag thinks doesn't have quite the right MOS:TONE. Consider a statement such as "They have more than 20,000 stores worldwide": When accurate, that's just the plain facts, but that's non-neutral, "promotional" language according to some editors (namely, the people who aren't volunteering to update the count every time a Starbucks store is opened or closed, which happens many hundreds of times per year).

It is unfortunately typical for some editors, perhaps especially those who spend a lot of time processing new articles, to assume that nearly all new articles on subjects they're unfamiliar with fall into two categories: either it's spammy (self-)promotional editing, or it's an attack page. There is a lot of this, partly because our requirements for notability as so low, so you can probably imagine how they end up in that state after a while. You wrote an article about a fairly basic medical concept that isn't in the news much (so it's unfamiliar), and the article represented the idea favorably (because no reliable source actually thinks that older patients should get disjointed, uncoordinated, fragmented medical care, right?). That's all perfectly correct, but in this model of positive=promotional and negative=attack, writing a decent article about a good idea means that the reviewers who don't know anything about the subject will suspect you of engaging in self-promotion until proven otherwise. Fortunately for you, the misunderstanding was cleared up promptly in this case.

The bigger question for me: Why are you using the draft space at all? WhatamIdoing (talk) 01:15, 26 November 2018 (UTC)

Thanks for this valuable feedback, User talk:WhatamIdoing, I appreciate your comments. I used the draft space simply because this was the first article I had identifed and written completely from scratch, it was a while since I had undertaken a big edit, and I felt it important to have experienced the whole process before either launching off enthusiastically or teaching others. My confidence in my abilities has now improved as a result of both the experience itself, and also the feedback received, so thanks for your time and neuronal activity! Kitb (talk) 15:51, 26 November 2018 (UTC)

It is in the main space now Comprehensive geriatric assessment. I adjusted a few patient's-->people. I think that the next step is to determine the appropriate headings to use as per [WP:MEDMOS] the text could be simplified in places to be more suitable for a general audience overtime. Kit, I think that you did a great job here! It is great to have you contributing to WikiProject Med! JenOttawa (talk) 01:21, 26 November 2018 (UTC)

Thanks, for your input, both editing & advice, JenOttawa - looks like I'm working along the right lines; this gives me great encouragement to contribute further! Kitb (talk) 15:51, 26 November 2018 (UTC)

If I might make a suggestion, Kit, you should draft any new medical articles in your userspace, so you could have created User:Kitb/Comprehensive geriatric assessment and worked on it there. I would have gladly looked it over for you if you were at all unsure whether it was ready for mainspace, and I'm sure many of the experts here would offer to do the same. That would avoid the problems WAID identifies above, while allowing you time and space to develop a new topic without the interference you get working directly in mainspace. Cheers --RexxS (talk) 17:30, 26 November 2018 (UTC)

Great advice, RexxS, thanks - I have already suggested it to another fledgling editor!

Overall, this was a huge and useful learning exercise for me - thanks to all for your patience & support! Kitb (talk) 21:10, 28 November 2018 (UTC)

Russian speakers in WikiProject Med?

I noticed this edit. Rather than assume it is vandalism, I figured I would ask here first to see if anyone can check the source for the real name. Infectious Mononucleosis edit JenOttawa (talk) 01:14, 30 November 2018 (UTC)

Looks like clear vandalism. Natureium (talk) 01:48, 30 November 2018 (UTC)

CRISPR

GRNA-Cas9

interesting--Ozzie10aaaa (talk) 20:15, 26 November 2018 (UTC)

And someone has been promoting the subject here lately aswell. Doc James (talk · contribs · email) 23:49, 1 December 2018 (UTC)

Yeah we have an article on the person who did it, that I have been minding. See He Jiankui. Jytdog (talk) 00:01, 2 December 2018 (UTC)

Issue with the WP:Med WikiProject welcome template

Used it very recently to welcome an editor, and a section involving Doc James was included. I removed the section from the editor's talk page. Flyer22 Reborn (talk) 19:16, 1 December 2018 (UTC)

Which template? Jo-Jo Eumerus (talk, contributions) 19:48, 1 December 2018 (UTC)

This one Template:WPMED_welcome. The template must have gotten added without substitution which resulted in this issue. Also important to add "subst:". Could be I forgot to. Doc James (talk · contribs · email) 23:47, 1 December 2018 (UTC)

The page in question was created today in this state: https://en.wikipedia.org/w/index.php?title=User_talk:Mcoren8387&oldid=871531783

Doc James added the extra text to the template by mistake on 8 November. It's now fixed. You know where to find the trout, James. --RexxS (talk) 00:09, 2 December 2018 (UTC)

Mmmm... I'd like mine pan-fried with garlic–lemon–butter sauce, please. WhatamIdoing (talk) 01:59, 2 December 2018 (UTC)

WikiProject Medicine: Most popular articles

Is this tool still accurate? JenOttawa (talk) 15:10, 26 November 2018 (UTC)

Does anyone know why something like this and in ALS views happens in page views as quantified with the statistics tool? JenOttawa (talk) 15:35, 26 November 2018 (UTC)

The first spike shows ~60K page views in a single day, possibly within a much shorter time period, on a page that nobody typically visits. This is usually attributed to a script (e.g., a search engine spider) getting "stuck" and accidentally re-loading the page thousands of times. The second type is a popular page that usually sees ~5K page views, but it saw more than 20K on Thanksgiving Day and almost 40K the next day (UTC, so much of those page views could have been the evening of Thanksgiving Day in the US). In that case – a smaller spike in an already-popular article, spread across a couple of days – I'd assume that some ALS charity ran ads during the Thanksgiving football shows, or that ALS was otherwise in the news. Having had a quick look around the news, I think you'll find that there's an strong correlation with the page views for these two BLPs about football players with ALS. WhatamIdoing (talk) 16:21, 26 November 2018 (UTC)

Very interesting! Thanks @WhatamIdoing:. JenOttawa (talk) 16:40, 26 November 2018 (UTC)

Specifically, Greene was on the US 60 minutes show talking about it - that will easily get you 40k views. There also seems to have been a number of media stories about Deter recently, like this, and there may be a reddit or something sparking this off. Johnbod (talk) 17:51, 26 November 2018 (UTC)

[8]was not aware of this media coverage--Ozzie10aaaa (talk) 11:57, 6 December 2018 (UTC)

Merge proposal at Military sexual trauma article

See Talk:Military sexual trauma#Merger proposal. A permalink for it is here. Flyer22 Reborn (talk) 23:24, 28 November 2018 (UTC)

give opinion(gave mine)--Ozzie10aaaa (talk) 11:20, 7 December 2018 (UTC)

The question here is whether the specific subject of Military sexual assault (e.g., rape) should be merged into the general subject Military sexual trauma (i.e., any kind of unwanted sexual experience, including rape but also including things like low-grade harassment).

I'm not convinced that this is primarily a medical subject. Maybe at note at MILHIST or WP:SEX would be more pointful? WhatamIdoing (talk) 17:00, 7 December 2018 (UTC)

perhaps... sexual trauma' as indicated on the talk/article[9]--Ozzie10aaaa (talk) 17:08, 7 December 2018 (UTC)

Template:GeorgiaPhysiology now leads to a deadlink

{{GeorgiaPhysiology}} links to http://humanphysiology.tuars.com. This domain is dead, it does seem to be archived at archive.org if the template can be recoded to point there instead. Nthep (talk) 12:28, 7 December 2018 (UTC)

You beat me to it. For now, I've changed the link to the Google Books page. Does anyone have a replacement link? If not, someone knowledgeable needs to update the citations in the articles that transclude this template. utcursch | talk 18:29, 7 December 2018 (UTC)

More orphans

Hello! Looking for help with the following orphans:

• Egg hatch assay - well referenced but I can't figure out where to link it from  Done; created link in Antiparasitic Jytdog (talk) 02:56, 2 December 2018 (UTC)
• Hydrolipoclasy - still not sure if this can be merged or should remain standalone (and if so, where to link it?) - thinking about this. have been wanting to create a parent Fat removal procedures page and will probably merge this there Jytdog (talk) 02:56, 2 December 2018 (UTC)
• Leucoerythroblastic - unreferenced, a little too technical for me to figure out if its mergeable  Done; merged to Anemia Jytdog (talk) 02:56, 2 December 2018 (UTC)

As always, I'm happy to do any legwork, I just need to be pointed in the right direction. ♠PMC♠ (talk) 21:04, 1 December 2018 (UTC)

"Leucoerythroblastic" seems to have a lot of meanings. Jo-Jo Eumerus (talk, contributions) 21:30, 1 December 2018 (UTC)

Yeah, that's why I was confused by it, lol :) ♠PMC♠ (talk) 21:53, 1 December 2018 (UTC)

IMO Leucoerythroblastic is notable; have provided some very basic citations based on a google search to demonstrate this. It may remain an orphan for some time as it's a little bit too specific to be linked from most articles. --Tom (LT) (talk) 01:28, 2 December 2018 (UTC)

[10]... (and Pubmed[11])--Ozzie10aaaa (talk) 01:37, 2 December 2018 (UTC)

Egg hatch assay probably wants to be linked from Drug resistance, which seems (from a quick glance at the table of contents) to need a section that explains how one tests for drug resistance. It might be possible to link to it by adding contents to specific antiparasitic drugs/classes (i.e., to add a couple of sentences saying that you determine whether a parasite is susceptible to the drug in question by doing an egg hatch assay – there ought to be something in some antibiotics articles that could be adapted to this subject). WhatamIdoing (talk) 02:45, 2 December 2018 (UTC)

Notes above. Jytdog (talk) 02:56, 2 December 2018 (UTC)

I created the Fat removal procedures and merged a bunch of stuff into it. Been meaning to do that for a while. Am getting my affairs in order, as it were. :( Jytdog (talk) 21:39, 2 December 2018 (UTC)

Sure sounds good. Doc James (talk · contribs · email) 10:53, 6 December 2018 (UTC)

Thank you all for your help dealing with these, as always. ♠PMC♠ (talk) 05:05, 7 December 2018 (UTC)

By the way what was merged into Fat removal procedures included Cryolipolysis and Hydrolipoclasy among a few other minor procedures. Doc James (talk · contribs · email) 18:36, 9 December 2018 (UTC)

COIN

in Jyt's absence we need more editors to help fill the void(I for one will try) thank you...Wikipedia:Conflict of interest/Noticeboard--Ozzie10aaaa (talk) 11:44, 9 December 2018 (UTC)

• Wikipedia:Conflicts_of_interest_(medicine)--Ozzie10aaaa (talk) 23:06, 9 December 2018 (UTC)

Discussion about wikipedia "Wikipedia:Help desk"

Xmrv

You are invited to join the discussion at Wikipedia:Help desk#Article is full of discredited information, but I have a conflict of interest , which is about a wikipedia that is within the scope of this WikiProject. – Finnusertop (talk ⋅ contribs) 12:56, 9 December 2018 (UTC)

will look[12]--Ozzie10aaaa (talk) 22:59, 9 December 2018 (UTC)

TLDR: XMRV is so out of date that even Snopes.com has more recent information than the English Wikipedia. If you happen to know anything about the subject, you could probably improve matters quickly. WhatamIdoing (talk) 05:05, 10 December 2018 (UTC)

I did[13]--Ozzie10aaaa (talk) 13:42, 10 December 2018 (UTC)

Links to DAB pages

Left hip-joint, opened by removing the floor of the acetabulum from within the pelvis. (Trans. ligament labeled at center.)

I have collected another batch of medicine-related articles which contain links to DAB pages. As always, search for 'disam' in main text and for '{{d' in edit mode; and if you manage to solve one of these puzzles, post {{done}} here.

• Chronic cough Done (this article's lead might benefit from some attention; "Chronic cough syndrome is one of the most common causes of chronic coughs" - really?)
• Portugal (an editor may have confused modern regions with population groups; the link to Alpine states in the flagged sentence may not be beyond criticism)
• Clinician Done (this is a list entry: the whole list might benefit from an educated look)
• Surgeons of Hope Done (reads like an advertisement, needs attention)
• CARD domain Done
• Oncotic pressure  Done
• Paper-based microfluidics Done
• Michal Schwartz Done¨
• Vagus nerve stimulation Done
• Lumbar fascia Done
• FATE1 Done
• miR-324-5p Done
• Tonsillectomy Done (this looks to me like notifiable disease; in which case there may be a missing entry on the DAB page)

This may be the shortest list I have ever posted: I'm now cycling through the backlog in 4 or 5 weeks. Thanks in advance for your help. Narky Blert (talk) 07:17, 8 December 2018 (UTC)¨

thanks for posting(did one[14])--Ozzie10aaaa (talk) 21:18, 8 December 2018 (UTC)

Not sure what you mean by tonsillectomy and/or "undocumented" is a notifiable disease – would you mind explaining that note Narky Blert? --Treetear (talk) 23:35, 9 December 2018 (UTC)

@Treetear: I looked, puzzled, at undocumented for a minute or two until notifiable disease came to mind. That's the UK term. Is 'documented/undocumented disease' a term of art in US federal or in any US state law? If it is, then a reader searching for the term could benefit from an easy way to find the relevant article. If it isn't, it's an unlikely search term and nothing need be done. Yrs, Narky Blert (talk) 00:34, 10 December 2018 (UTC)

@Narky Blert: Oh, now I understand your note! I thought undocumented meant that the previous illnesses the patients reported were undocumented as in "not confirmed by a medical practitioner" and "not noted in the patient's medical journal". Sorry I won't be able to help more than that, I'm neither American nor a native English speaker. --Treetear (talk) 14:11, 10 December 2018 (UTC)

Pseudoscience article lede content supported in body

The article Pseudoscience mentions harm from anti vaxxers in lede but there is not a substantial, referenced discussion of this in the content. This seems important. MrBill3 (talk) 13:45, 8 December 2018 (UTC)

The final paragraph of the article reads

On December 8, 2016, Michael V. LeVine, writing in Business Insider, pointed out the dangers posed by the Natural News website: "Snake-oil salesmen have pushed false cures since the dawn of medicine, and now websites like Natural News flood social media with dangerous anti-pharmaceutical, anti-vaccination and anti-GMO pseudoscience that puts millions at risk of contracting preventable illnesses."

References

although that is not a substantial discussion. Perhaps that paragraph could be augmented using sources from Vaccine controversies (which is linked from the lead)? --RexxS (talk) 14:09, 8 December 2018 (UTC)

I think that's probably okay. Mentioning homeopathy and anti-vaxxer beliefs at the end of the lead is an example to help people understand the real-world harms. The examples are interchangeable, and could just as easily be something like inaction on climate change or people losing money on ineffective products or bad investments (e.g., cars that allegedly don't require any fuel). WhatamIdoing (talk) 16:18, 8 December 2018 (UTC)

Then there are those motors that burn water. If only. LeadSongDog come howl! 20:25, 11 December 2018 (UTC)

Jytdog

I'd really appreciate it if everyone would stop posting about this person on wiki. It's not seemly to talk about an individual editor in a highly public forum, when that editor can't join the discussion. WhatamIdoing (talk) 18:54, 12 December 2018 (UTC)
The following discussion has been closed. Please do not modify it.
those who wish to leave a messageUser talk:Jytdog#That's all folks--Ozzie10aaaa (talk) 11:34, 4 December 2018 (UTC) As one of the most active medical editors and one of the few who dealt with COI here, this is a huge loss for the project. Doc James (talk · contribs · email) 16:45, 4 December 2018 (UTC) Yup: such was the volume of his work that, all other things being equal, his loss will mean that our medical content will improve significantly less quickly, and may even start to deteriorate. Alexbrn (talk) 16:58, 4 December 2018 (UTC) And as I guessed, over at Talk:Specific carbohydrate diet (the proximate cause of all this), we're getting renewed attacks on MEDRS now that Jytdog's not there to defend it.--RexxS (talk) 01:55, 5 December 2018 (UTC) FYI, Petrarchan47 just recently had to be topic-banned from GMOs (where they also had major problems with MEDRS) for ad-hominems like those you mentioned at the talk page. If that continues, a wider biomedical topic ban might need to be brought up at AE under alternative medicine DS. I don't see any edits being proposed currently though, so I'd be more apt to leave the page be for now unless things get worse. Kingofaces43 (talk) 02:13, 5 December 2018 (UTC) Not what I wanted. I had posted in that user's support at special:diff/872116397#Statement_by_bluerasberry. Blue Rasberry (talk) 19:20, 10 December 2018 (UTC) I love all the recognition he's gotten on his talk page in light of this development. Just shows how important his work was and still is and the positive impact he's had. Flyer22 Reborn (talk) 00:58, 11 December 2018 (UTC) Well everyone agrees that what Jytdog did was inappropriate (including him), the reaction of arbcom was a little over the top. We need an arbcom that better reflects the positions of the editing community. Doc James (talk · contribs · email) 14:34, 11 December 2018 (UTC) This is getting off-topic but ... my understanding is that Arbcom had received a lot of private information that they found compounded the offence. I suppose we'll never know what that was. I note that Jytdog had accumulated a lot of enemies among the paid-editing and quackery editing fraternities here, so I would not be surprised if some "evidence" offered to Arbcom would have been partial. Alexbrn (talk) 14:48, 11 December 2018 (UTC) While I did not support an indef based on Jytdog's usefulness and work on Wikipedia, I also have to trust and hope that multiple arbs when faced with further private information are not stupid enough to be duped. Respectfully, I disagree with Doc and others who assert the arbs should reflect the editing community. In fact the opposite is true; the Arbs should represent our overriding behavioral policies. Policy is how we represent the totality of the community as best we can and avoid being sucked into the ebb and flow of community position and ultimately bias. The end can never justify the means. Everyone must adhere to the rules. Everyone. When we allow the means to outstrip our own established policies our next step can be a combination of chaos, witch hunts and damage to individual editors. None of this provides a safe or even comfortable editing environment for WP editors and their ultimately, best work. Jytdog admits to making mistakes and he had the opportunity to face the arbs and discuss a way forward. He chose to leave. Even now, as very few editors are ever truly banned from editing, he likely has room to negotiate coming back. Littleolive oil (talk) 16:13, 11 December 2018 (UTC) If the arbs are detached from the editing coalface it's possible they have limited ability for cannily parsing submissions from opponents of Jytdog. One need only look at some of the statements during the case or some of the gleeful grave-dancing that's followed to appreciate that some of these opponents have a less than fulsome relationship with truth. Alexbrn (talk) 16:41, 11 December 2018 (UTC) If I read it correctly, the indef was issued pursuant to Jytdog's expressed wish, and should that wish eventually change then the door is not permanently closed, although it will go through the Arbcom passageway. In the meantime, there does need to be policy progress on resolving the intrinsic tension between wp:OUTING and wp:COI. The inability to act against problematic COI and paid editors has been allowed to fester far too long, to the point where it leads frustrated users such as Jytdog or OrangeMarlin into trouble. There must be a better way to deal with this.LeadSongDog come howl! 17:13, 11 December 2018 (UTC) Scapegoating Once again I find an odd disconnect between WP:MED and the wider WP community. The latter having a huge WTF and the former coalescing round one-of-their-own, protecting and praising them, trying their hardest to overlook the problems others see, viewing those that disagree as "opponents". You are kidding yourselves if you think Jtdog is gone just because he chose to. Taking an on-wiki dispute into "I know who you are, where you live/work" phone-call-out-of-the-blue territory, while retaining anonymity oneself, is a horrific power dynamic. But the issues with Jtdog's editing were not unique to him, and don't scapegoat him in order to avoid some WP:MED self reflection. One example at the Arb discussion stood out: this statement by User:Julia W. (I'm pinging Julia out of courtesy, but don't really want to drag her into anything she doesn't want to). I know Julia from featured pictures, and she's a very friendly sensible editor, and great photographer too. My guess is the dispute she refers to is at Osimertinib in January and later Rociletinib in March. On Osimertinib, Jytdog removed some text added by Julia about resistance developing, citing MEDRS. Jytdog then has an edit war over this text with another editor who is now blocked. Julia then restored the text citing a review article. This demonstrates that the information was never actually in dispute, and if Jytdog had either expert knowledge or bothered to do a search himself, he could have replaced the source. Further Jytdog didn't ask Julia to provide a better source, in a courteous and professional manner, but simply removed it all. I just googled "Osimertinib resistance" and my thoughts are that any editor modestly familiar with the article subject should know that resistance is an essential issue to note. Instead of regarding Julia as a valued editor who clearly has an interest in the topic and understands oncology research, he created conflict and vandalised her contributions. In March, Julia added some good extra information to Rociletinib. The issue Jytdog seemed to have with that, is that a section was titled "Medical uses" when the drug was never licenced. The conflict here is how to refer to experimental medicines? According to the linked papers, this drug was used by 456 patients who had specific mutations in their cancer that meant existing drugs were ineffective. These patients were given this drug by doctors in the hope it would treat their cancer. That's a medical use: the drug isn't cosmetic or a food supplement. It didn't reach routine clinical practice, though. Anyone with a rare or terminal disease will know that there are a number of treatment options only available as part of a clinical trial. These treatments are given by doctors to patients to make them better. Even approved, licenced drugs are often given to patients out of hope rather than confidence. Julia made several improvements to the short article over a few days. Jtdog's response was to remove the entire "Medical uses" section and another sentence, with the comment "there was never a clinical use - it was only in clinical research". This is a nuance that could have been dealt with with a small change to the section title, while retaining all that Julia had added. There followed an edit war where both parties reverted equally, though Jytdog got in first with the user page template to warn Julia for edit warring. He twice referred to Julia's additions as "spam". He even dumped a patronising "Welcome" section on her page -- an editor who has been here for 10 years. On the article talk page, he accused Julia of editing like a newbie, so deserving of the patronising response. Jytdog admitted following her from the other article, though doesn't seem to have noticed that the text he edit warred over there, and boasts about fighting a crazy banned user, was actually already restored by Julia with an acceptable ref. Julia writes "Rather than completely reverting me, pasting welcome templates, and calling me a "newbie", I would appreciate specific, helpful feedback in the future". I hope we can all see that is a complaint, and "in the future" is not a request for immediate paragraphs of mansplaining, but that's what she got. My point of adding this is example is that this style of battleground editing is typical of WP.MED. You all praise Jytdog for being thoroughly and dependably hostile to your "opponents". But not only is this editing disrespectful bullying, it also drives away experts and good faith knowledgable editors like Julia. My guess is Julia knows more about third-generation epidermal growth factor receptor tyrosine kinase inhibitors than most folk here. Perhaps anyone here. Wikipedia's loss. I think WP:MED editors should be careful editing subjects where they are not experts (and having MD or Dr in your name, doesn't make you an expert in all the medical sphere). They should take more care to collaborate than to fight. Accept and retain imperfect work knowing that WP is a work-in-progress and try to collaborate to polish rather than bin it. Reverting text with weak MEDRS sources should be a last resort, when you know the text is wrong or likely to be wrong. Don't go calling 10-year-WP editors "newbies". Recognise that if you revert work someone has spent several days on in good faith, then you are the vandal. And if you revert more than once without genuinely seeking and working towards consensus with a good-faith-editor, then you are an edit warrior. -- Colin°Talk 19:50, 11 December 2018 (UTC) @Colin:, I think everyone here recognizes that Jytdog wasn't a perfect editor. What people bemoan is that one of the most prolific predatory/crap/junk science/quack medicine fighter is gone. Jytdog was very, very, effective at finding and removing crap, even if his false positive rate was higher than desired when dealing with non-crap. The best analogy is Jytdog is to crap what radiation therapy is to cancer. It'll kill cancer cells very well, but will also kill some healthy cells as a collateral. Sure there are other ways to fight cancer, but losing access to that method of treatment would be a net negative. Headbomb {t · c · p · b} 20:31, 11 December 2018 (UTC) Great analogy and Jytdog will be sorely missed, but moving forward, I think the entire project needs to move towards a more targeted therapy with an improved risk–benefit ratio. Boghog (talk) 20:47, 11 December 2018 (UTC) Agreed. WP:CRAPWATCH will help with that, once it's finalized. It's in a usable state now, just not very friendly, with some kinks still needing to sorted out. Headbomb {t · c · p · b} 20:59, 11 December 2018 (UTC) The thing is I really don't want to make this just about Jytdog's failings, but there is something really weird about WP:MED's comments about him. I have looked at many posts about this incident. Two WP:MED editors have predicted or claimed there is much gravedancing, but I haven't found any at all. Perhaps it is on individual articles. I have found at Arb a truly shocked community but it stands out like a sore thumb when a WP:MED editor has posted there, because they have put their blinkers on. And Jytdog's talk page is nothing but eulogy. Contrary to views expressed above, it was not just COI editors and POV pushers that had a problem with Jytdog's bullying. I see no recognition of this. But also I see no recognition that the problem was not limited to Jytdog, hence the title of this section. It is institutional here: the revert warrior bully who thinks gaining consensus is something only other people need to do; the editor who applies the 3RR warning template to their "opponent"'s talk page just before reverting for themselves a second time; the editor who treats anti-vac loopies and PhD researchers with exactly the same contempt and patronising attitude; the editor who has no respect for topic experts; the editor who clearly knows absolutely nothing about an article topic but will revert-blank sections they are ignorant of just because of MEDRS and has to be tediously and slowly taught by their "opponent" about the subject before they gatekeep the content back again..... This is my experience of WP:MED and the experience of others I know here. I see it from multiple editors in 2018 and in the years before. Lots of WP:MED editors have expressed wishes for Jytdog to return. I don't share that view. Partly because what he did crossed a line we, and I hope WMF, would be unhappy with editors ever crossing, and is very scary, but also because he was a bully. Nobody is all bad, of course, as you have all recognised, but still. There are other bullies here. It isn't too late to examine whether your "cancer radiation therapy" mode of editing is where you want to be. What are you guys doing to spot experts making their first steps here and protecting rather than fighting them? Or the lay enthusiast who has a good knowledge of the subject, good indentions, but lacks article access. How about recognising this is a wiki and it is ok to keep imperfect material added in good faith, rather than always reverting back. A software analogy: Wikipedia should be like beta-quality software all the time -- the "pre-release" rather than the "stable" branch. What are you doing about calling each other out over bullying and stamping it out? Earlier this year I was contacted by several editors grateful that I had stood up to bullying from WP:MED, who felt very alone and powerless against this institution. These were not loopy anti-vacs or vandals but editors you want. JuliaW wasn't one of them (I just saw her post at Arb) but look at her user page. That's a Wikipedian you want working with you. What are you doing to make sure that doesn't happen again? Don't use Jytdog as a scapegoat. -- Colin°Talk 08:36, 12 December 2018 (UTC) "I see no recognition of this", if you want to ignore the part where I said "I think everyone here recognizes that Jytdog wasn't a perfect editor" or "his false positive rate was higher than desired when dealing with non-crap", that's on you. Jytdog was good at fighting crap. He was really good at it. He was bad at other things, including taking a more measured, nuanced approached in cornercases. If your goal is 'help to bring experts in', Jytdog wasn't the one to do that. Jytdog was a watchdog that prevented crap to get in. As for the gravedancing, it won't be so much reliable editors doing the grave-dancing, but rather unscrupulous shills and quacks that will be glad to see Wikipedia's immune system weakened. Headbomb {t · c · p · b} 13:08, 12 December 2018 (UTC) Lovely gravedancing for all to see here. I thought this project immune, but you live and learn. -Roxy, the dog. wooF 13:46, 12 December 2018 (UTC) @Colin: "it stands out like a sore thumb when a WP:MED editor has posted there, because they have put their blinkers on": Had I got my blinkers on when I posted there, Colin? What had I missed? Inquiring minds want to know. "also I see no recognition that the problem was not limited to Jytdog": What problem was that, then, Colin? Who are these other editors who are displaying the same problem? Don't be coy. If it's important, then tell us (but you'd better have good evidence backed up with diffs, because unsubstantiated slurs on editors in good standing are not going to go down well). "What are you guys doing to spot experts": Which experts would those be, Colin? The ones who claim huge expertise (see WP:ESSJAY), but then repeatedly demonstrate a complete ignorance of the difference between a trial and a meta-analysis, or between a single study and and a review? How should we be protecting them? By accepting their edits that make an article worse? By doing nothing when they edit-war to repeatedly remove good quality secondary sources and replace them with a mishmash of primary sources, OR and editorialising? By shrugging our shoulders when they ignore advice for the sixth time to actually read MEDRS? Go ahead, feel free to give some practical advice for when those things happen. 'examine whether your "cancer radiation therapy" mode of editing is where you want to be': Nice analogy, but what's your implied alternative? Palliative care for Wikipedia until it finally passes away under the weight of undisclosed paid editing, pharma shills and single purpose accounts who know the Real Truth™ about medicine. Make no mistake, the editors here are able to hold back that tide only by maintaining a strict adherence to the principles that the community has agreed: WP:OR, WP:NPOV, and WP:MEDRS. I understand what we will lose if we fail to do that, but I feel you should tell us what we will gain by not doing it. --RexxS (talk) 17:53, 12 December 2018 (UTC) I'm not celebrating at at Jytdog's block at all. Your response fills me with despair for this project. This is exactly the kind of snarky childish abuse that Jytog gave to Julia in the example I gave. -- Colin°Talk 18:09, 12 December 2018 (UTC) I didn't say you were celebrating anybody's block. What I do say is that you are vindictively tarring other unnamed medical editors with the same brush as has been used. Those are cheap shots that reflect your disdain for MEDRS and for all the editors working so hard to maintain the quality of medical articles in the face of unending pressure. Julie is a friend of mine and I'm a damn sight more familiar with the troubles she's had from rogue editors and admins than you are, so I'll thank you not to blather about what you're ignorant of. Your contributions here are a disgrace and you should be ashamed of the smears you've made. --RexxS (talk) 19:16, 12 December 2018 (UTC)

Antivax on Wiley

doi:10.1002/9781118663721 may be a source to keep an eye on: https://twitter.com/SmutClyde/status/1072564116550754305 Looks like it's been removed before from some articles like Immunologic adjuvant, judging from spam reports. Nemo 14:40, 12 December 2018 (UTC)

thanks for post--Ozzie10aaaa (talk) 22:23, 12 December 2018 (UTC)

Neuroscience of sex differences article

More eyes are needed at Neuroscience of sex differences (edit | talk | history | protect | delete | links | watch | logs | views).

On a side note: This is another article that Jytdog was concerned about. Flyer22 Reborn (talk) 01:44, 13 December 2018 (UTC)

The article is currently undergoing WP:Student editing. Flyer22 Reborn (talk) 01:49, 13 December 2018 (UTC)

will watch--Ozzie10aaaa (talk) 19:51, 13 December 2018 (UTC)

How to keep an eye on drafts at Articles for Creation

We sometimes have medical articles at AfC which languish for lack of expert reviewers. I see that you already have Wikipedia:WikiProject Medicine/Article alerts linked at the bottom of the project page. The "Newly Created Article" service run by InceptionBot creates User:AlexNewArtBot/MedicineSearchResult, which lists two weeks worth of new articles that meet the criteria, including drafts. Please link to this on the main project page and consider encouraging editors to take a look at medical drafts. Thankyou. StarryGrandma (talk) 00:16, 12 December 2018 (UTC)

User:StarryGrandma appears to be a fairly non specific list. Most do not relate to WP medicine. A good underlying concept though and I would be happy to go through medicine specific ones. Doc James (talk · contribs · email) 09:51, 12 December 2018 (UTC)

Thanks Doc James The rules used when parsing the articles are fairly wide-ranging (sensitivity rather than specificity). But they seem to have picked up all the new medical-related drafts in the last couple of weeks, so that makes it useful. I've accepted Hemodynamics of the aorta and rejected Draft:OCT blood glucose monitoring. It will be good to have medical eyes. StarryGrandma (talk) 18:16, 12 December 2018 (UTC)

User:EpochFail was going to work on extending ORES to do automatic 'suggestions' of relevant WikiProjects. I don't know what the status is, but I'm hopeful that it would be more effective than AlexNewArtBot's keyword-based system. WhatamIdoing (talk) 18:30, 12 December 2018 (UTC)

Still no good implementations yet. But the "drafttopic" prediction system works really well for medical article drafts. E.g. take the first revision of "Maturity onset diabetes of the young" (revid: 7821351). If we ask ORES to predict what topics that article draft covers, it settles on "STEM.Medicine" with 99.3% confidence. I'm still pitching this routing technology to Wikimedia Product teams. As far as I know, there's nothing concrete on their road maps yet. I'd be happy to work with some bot/tool developers in the meantime. Maybe AlexNewArtBot could be adapted to use ORES. --EpochFail (talk • contribs) 21:11, 12 December 2018 (UTC)

It looks like User:Bamyers99 is the person to ask about that. Oooh, and he knows PHP, which is generally a good sign. Aaron, what kind of shape is the project in? I assume it's going to take more than a few minutes, but is this weeks/months/years? WhatamIdoing (talk) 23:58, 12 December 2018 (UTC)

From an external perspective, it seems like it would pretty darn easy to apply ORES here. The greatest difficulty is in making an external call to the ORES service. E.g. https://ores.wikimedia.org/v3/scores/enwiki/<revision ID>/drafttopic will get you the prediction in a JSON format. Once you have that prediction, routing should be relatively straightforward. E.g. if score.probability["STEM.medicine"] > 0.5, route to WikiProject Medicine. --EpochFail (talk • contribs) 17:07, 14 December 2018 (UTC)

An ORES rule type has been added to InceptionBot. The Medicine rules have been updated to use this rule. You can see what pages matched the new rule in the Medicine log. The ORES topics that are available are listed at the end of the User:AlexNewArtBot#Create the rules section in a collapsed box. --Bamyers99 (talk) 23:08, 15 December 2018 (UTC)

Multiple chemical sensitivity

A trio of new accounts making FRINGEy changes to Multiple chemical sensitivity. Please send reinforcements. Natureium (talk) 02:55, 15 December 2018 (UTC)

I haven't looked in on that article for two and a half years, and it looks like the people who used to follow it, such as User:Sciencewatcher are not very active right now. The traditional difficulty with that article is that new editors want to make it reflect the views of MCS-supportive clinicians, as opposed to reflecting the views of the average clinician.

The thing that always seems weird to me is that the more MCS-skeptical parts of the literature indicate that most people who show up in a doctor's office and say that 'chemicals' make them sick actually have anxiety or depression that can be treated, and that the 'chemical' symptoms go away when those conditions are treated. But the new editors who say that they (or their loved ones) "really" have MCS don't want to say that anyone might mistakenly self-diagnose themselves with MCS. It's weird: if you "really" have something (anything), what's the value to you in letting people who don't actually have it claim that they do? It'll just screw up research that could benefit you. (See: all the people who are tired all the time and claim that they have Chronic Fatigue Syndrome, because that the same thing, right?) WhatamIdoing (talk) 05:12, 15 December 2018 (UTC)

I'm not sure how if they have that much of a plan re self-diagnosis, but in the realm of wikipedia, I have removed the new material and another account adds it back. Natureium (talk) 02:25, 16 December 2018 (UTC)

Request move

Health Centre

So far there is not much participation in the discussion whether or not to move Health care to Healthcare. Feel free to join if you wish. Marcocapelle (talk) 10:52, 16 December 2018 (UTC)

• give opinion(gave mine)--Ozzie10aaaa (talk) 12:37, 16 December 2018 (UTC)

Research project on wiki

Please see Wikipedia:Village pump (miscellaneous)/Archive 60#Heads-up: problematic survey research ongoing on English Wikipedia if you get an invitation to participate in a research study. Most are great, and apparently one of the recent ones isn't so great. WhatamIdoing (talk) 05:59, 16 December 2018 (UTC)

thanks for info WAID--Ozzie10aaaa (talk) 11:21, 17 December 2018 (UTC)

He Jiankui

need eyes on this article editors such as Special:Contributions/CRISPR_Editor and others are having 'field day' (Jyt use to edit this article and it is in the scope of Wikiproject Medicine)thank you--Ozzie10aaaa (talk) 11:53, 9 December 2018 (UTC)

This article is about someone who's been in the news. As usual for subjects of media attention, it'll probably be easier to clean up (and your improvements more likely to 'stick') if you wait for a week or so. WhatamIdoing (talk) 22:00, 9 December 2018 (UTC)

Agreed, but the same tactic doesn't work for the requested move on the talk page. --RexxS (talk) 22:41, 9 December 2018 (UTC)

its been more than a week and still [15]--Ozzie10aaaa (talk) 10:38, 19 December 2018 (UTC)

Comment on draft

Your comments on Draft:Neuropelveology are welcomed. Please use either Yet Another Articles for Creation Helper Script by enabling Preferences → Gadgets → Editing → Yet Another AFC Helper Script, or use {{afc comment|Your comment here. ~~~~}} directly in the draft. Thank you. Sam Sailor 11:24, 17 December 2018 (UTC)

article/draft needs to follow MEDRS(secondary sources)...IMO--Ozzie10aaaa (talk) 21:54, 19 December 2018 (UTC)

Sativex (1:1 CBD/THC formulation) at the CBD article

Cannabidiol

Hi all,

I'm having some disagreement with an editor at the Cannabidiol article. From my understanding of WP:MEDRS and WP:RS, we can't extrapolate beyond what the source tells us.

The first paragraph of the article is a section about Sativex (half THC) and its use for MS pain. It makes no mention of CBD other than the fact that it's included. We are giving the reader no information about the effect CBD has on MS pain. My removal of the (erroneous?) material was reverted. I'm hoping to get feedback from others here. The talk page section is here. I'm sure someone here can help. Thanks in advance, petrarchan47คุก 00:43, 29 November 2018 (UTC)

• give opinion(gave mine)--Ozzie10aaaa (talk) 11:26, 29 November 2018 (UTC)

Much appreciated, Ozzie, as always. petrarchan47คุก 06:09, 1 December 2018 (UTC)

thank you for posting--Ozzie10aaaa (talk) 11:31, 11 December 2018 (UTC)

• per [16]should be updated...IMO--Ozzie10aaaa (talk) 11:54, 21 December 2018 (UTC)

Move discussion notice - Talk:Dracunculus_medinensis#Requested_move_15_December_2018

Dracunculus medinensis

Hey there! I'm Flooded with them hundreds. There is a move discussion at Talk:Dracunculus_medinensis#Requested_move_15_December_2018 requiring more participation, please consider commenting/voting in it along with the other discussions in the backlog (Wikipedia:Requested moves#Elapsed listings). Flooded with them hundreds 08:00, 22 December 2018 (UTC)

• more opinions(gave mine)--Ozzie10aaaa (talk) 19:18, 22 December 2018 (UTC)

Need eyes on diabetes and related articles

Blue circle for diabetes

WP:Articles_for_deletion/Malcolm_Kendrick has prompted an influx of medical SPAs, apparently; see for example Talk:George_D._Lundberg#Edits_by_Amandazz100. Eyes may be needed, for example, on Diabetes_mellitus and History of diabetes. I lack the background to help effectively. EEng 19:42, 9 December 2018 (UTC)

The user Amandazz100 is a low-carb high-fat fanatic. Her edits have not been helpful, they ignore several Wikipedia policies. If her behaviour continues I will report. Skeptic from Britain (talk) 21:16, 9 December 2018 (UTC)

Having looked at their contributions (and speaking as a fellow British skeptic), I can understand your frustration, Skeptic from Britain. Nevertheless, in these cases, I recommend avoiding making any statements prejudicial to the other editor, especially when their contributions are much more justifiable targets than the person anyway. You are likely to find that ANI reports are easy to derail if the other party can counter-claim by criticising your civility or complaining about personal attacks. Cheers --RexxS (talk) 00:04, 10 December 2018 (UTC)

Good advice. Focus needs to stay on the content question, much as the desire to strangle people can become overwhelming at times. I didn't write the prior sentence, my evil twin did. Anyway, that's why I asked for eyes with knowledge in this domain to keep an eye, since I'm out of my depth. EEng 00:12, 10 December 2018 (UTC)

Similar stuff is happening at Tim Noakes. Skeptic from Britain (talk) 00:38, 14 December 2018 (UTC)

This is a general reminder for everyone: Please remember to only Wikipedia:Comment on content, not on the contributor when disputes like this come up. We'll probably see more enthusiastic newbies writing about diets for the next month or so, until they give up on their New Year's resolutions. Just hang in there with good sources and a healthy dose of realistic m:eventualism. This, too, shall pass. WhatamIdoing (talk) 06:14, 14 December 2018 (UTC)

Unfortunately you are not informed about all of this, they are not "enthusiastic newbies". Go on twitter and search up LCHF and Wikipedia or Malcolm Kendrick, Tim Noakes etc. These conspiracy theorists are campaigning against Wikipedia, they are trying to boycott and cry "censorship" because a few articles were deleted for low-carb writers. They have also been sending spam emails and threatening emails to the WMF office. I have read multiple conservations on Reddit and Twitter and their warped idea is to send their proponents to Wikipedia and remove criticisms of low-carb dieting. The Tim Noakes article is just a start of this. I would suggest that all these articles need to be watched. Skeptic from Britain (talk) 13:25, 14 December 2018 (UTC)

You registered your account last February, right? So you probably don't know that every January, we get a lot of newbies (that is, new to Wikipedia, not newborns with no history elsewhere) signing up and trying to edit. You might have been the very tail-end of last year's crowd. ;-) Articles related to their New Year's resolutions seem to be a common thing for these enthusiastic newbies to edit. For example, we'll see newbies trying their best in diet and exercise articles, and an uptick in self-promotion by small business owners. But they go away again; it's just a matter of patiently explaining the concept of neutrality – that Wikipedia is neither "for" nor "against" low-carb diets (whatever that term means this week) – for a few weeks, until they either adapt or go away. Then things get back to normal until the September wave of students arrives. It's manageable, if you stick to basic principles. You'll just drive yourself crazy if you worry about trying to win a WP:BATTLE about which diet is The One True™ Scientific Diet For Everyone. WhatamIdoing (talk) 20:54, 14 December 2018 (UTC)

agree w/ WAID--Ozzie10aaaa (talk) 11:10, 24 December 2018 (UTC)

PET response criteria in solid tumors

redirect/merge above to Positron emission tomography#Oncology(or other)...opinions--Ozzie10aaaa (talk) 19:49, 25 December 2018 (UTC)

• please comment at PET response criteria in solid tumors/talk--Ozzie10aaaa (talk) 11:37, 26 December 2018 (UTC)

Pulmonary thromboendarterectomy

Hi, Can anyone advise on pulmonary thromboendarterectomy, (PTE) pumonary endarterectomy (PEA), Chronic thromboembolic pulmonary hypertension, Pulmonary hypertension, Balloon pulmonary angioplasty. PTE and PEA are used interchangeably...Should it be consistent or mentioned that both are the same? There are probably other articles with PTE and PEA, or does it not matter.[17]. Thanks Whispyhistory (talk) 08:20, 27 December 2018 (UTC)

Flying visit I have set up a redirect for pulmonary endarterectomy and pointed it to pulmonary thromboendarterectomy. Little pob (talk) 10:35, 27 December 2018 (UTC)

selfie wrist?

Hello, is "selfie wrist" considered as a disease name! or type of Carpal tunnel syndrome? or only popular name?

1. The Selfie Wrist – Selfie induced trauma - Galway Universtiy Hospitals
2. Beware of ‘Selfie Wrist,’ Which Is Apparently an Actual Thing - Eelevant magazine
3. google specific search

--Alaa :)..! 22:10, 28 December 2018 (UTC)

PubMed only offers...--Ozzie10aaaa (talk) 14:00, 29 December 2018 (UTC)

I would say this is only a popular name based on the results I can find online (all popular media). (And I personally hope it's not adopted by the medical community. Ick.) Natureium (talk) 18:39, 29 December 2018 (UTC)

Adult-onset vitelliform macular dystrophy and related questions

Wikipedia doesn't have an article (or redirect) for Adult-onset vitelliform macular dystrophy (NIH link), but it does have one for Vitelliform macular dystrophy. Are these the same diseases, or separate diseases?

Also, the article Peripherin 2 links to Vitelliform macular dystrophy, but not vice-versa, nor does that first article belong to WikiProject Medicine. Should those two things be changed? -- John Broughton (♫♫) 00:53, 29 December 2018 (UTC)

actually Adult-onset vitelliform macular dystrophy is mentioned here--Ozzie10aaaa (talk) 02:37, 29 December 2018 (UTC)

I created a redirect to where it's discussed as a valid search term. Natureium (talk) 18:41, 29 December 2018 (UTC)

thanks Natureium--Ozzie10aaaa (talk) 00:44, 30 December 2018 (UTC)

Adult-onset foveomacular vitelliform dystrophy

[If the section immediately above seems a little odd, that's because I didn't ask the right question. This is try number two.]

Wikipedia doesn't have an article or redirect for Adult-onset foveomacular vitelliform dystrophy (AOFVD) (link)

On a NIH.gov webpage (link), this is said to be an alternative name for Adult-onset vitelliform macular dystrophy (AOVMD or AVMD), but I'd like other opinions on that.

Also, the list of alternative names on the NIH.gov page includes Foveomacular dystrophy, adult-onset, with choroidal neovascularization, which is a red link at List of OMIM disorder codes; is this in fact considered to be another name for the same thing? -- John Broughton (♫♫) 01:06, 30 December 2018 (UTC)

orphanet--Ozzie10aaaa (talk) 11:40, 30 December 2018 (UTC)

Inversion therapy and Spinal decompression

Spinal Decompression

Dear medical experts: The Inversion therapy article says that it is a type of spinal decompression, but the Spinal decompression article says that it is a surgical procedure. It seems to me that there are other kinds of spinal decompression besides surgery, and that the second article needs adjustment to the lead section, but perhaps I am wrong and it's the first article that needs changing. In any case, I'm pretty sure that inversion therapy just means hanging upside down, not having surgery, so something needs to give.—Anne Delong (talk) 22:37, 31 December 2018 (UTC)

This is an interesting pair of notes, because I think that inversion therapy is actually a kind of Traction (orthopedics). It decompresses the spine (in plain English) but I think it isn't truly spinal decompression (in medical jargon). WhatamIdoing (talk) 08:27, 1 January 2019 (UTC)

generally agree w/ WAID--Ozzie10aaaa (talk) 12:01, 1 January 2019 (UTC)

I removed the mention of decompression because the source on which it was based (Mayo Clinic) does not mention it. JFW | T@lk 17:49, 1 January 2019 (UTC)

Thanks!—Anne Delong (talk) 19:07, 1 January 2019 (UTC)

Traction (orthopedics)

Dear medical experts: While reading this article I came across a reference to "our study" which makes it seem as though Wikipedia has carried out a study (unlikely). Could someone who understands the subject please modify the text to indicate whose study it was, or remove the paragraph if the information is not well supported? Thanks.—Anne Delong (talk) 22:30, 31 December 2018 (UTC)

Doc James & WAID took care of it --Ozzie10aaaa (talk) 22:43, 1 January 2019 (UTC)

Thanks!—Anne Delong (talk) 02:48, 4 January 2019 (UTC)