Wikipedia talk:Manual of Style/Medicine-related articles/Archive 10

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Not writing for patients or professionals

WP:MEDMOS#Writing for the wrong audience is one of my favorite sections, because I think it's very useful for many editors, without creating "rules". We don't write for (other) professionals and we don't write for (other) patients. This particular line:

You use a writing style appropriate only for graduate-level courses, because that's what you see in peer-reviewed journal articles and professional reference works.

was previously balanced by a line that said:

You use a writing style appropriate for 12 year olds, because the sixth grade reading level is recommended for patient information leaflets.

This seems to have disappeared sometime in the last couple of years, and I think it should be restored. Does anyone object? WhatamIdoing (talk) 21:53, 29 May 2018 (UTC)

Not from me. Didn't we (generally) use to have a recommended native-speaker reading age target of 18, or am I imagining that? We don't seem to have one now. Johnbod (talk) 01:16, 30 May 2018 (UTC)
- I don't think it was ever in the guideline, although that specific age has been discussed repeatedly in the past. For a longer article, I think the actual goal is to be a bit less uniform. It's often desirable to write (very approximately) the first bit of the lead and important sections at a level that could be understood by a typical 12 year old. But from there, the ideal diverges: You might write a history section at a level that is best suited to 15 year olds, the main bulk of a technical section at a level that's only easy for graduate students, the diagnostic section at the level you would expect for a first-year university student, and so forth.
  (For reference: the first paragraph of Aspirin is written for 18 year olds, and the lead for Hypertension is more complex than that. The lead for Alcohol intoxication was recently cleaned up and sourced for translation. It was previously written at a post-graduate level, and now it is written at a level that will be understandable to 17 year olds. http://hemingwayapp.com/ will estimate a reading level if you paste content into the middle (over-writing the directions), but to get an accurate score, you have to manually remove the "[1]" refs.) WhatamIdoing (talk) 05:46, 31 May 2018 (UTC)
  - I certainly agree about a "rising" level through the course of the article, which has been generally accepted by the wikiproject in the past, though actually achieving a 12-yo level per the Kincaid etc tests is near-impossible, even in the lead, as any word over 8? letters costs you points. I put a lot of emphasis on this when I was at CRUK in 2014 - they were horrified at typical WP reading levels. We also have a large non-native-speaker readership, whose issues are somewhat different. This is especially the case for medical articles; in my research some non-native readers said they mostly used their native language WP, but used the English one for medical matters, in which they had greater trust. They often find long Latinate terms relatively easy, as they know them from their own language, but can be thrown by informal language. I don't know any tests for that. Johnbod (talk) 14:11, 31 May 2018 (UTC)
I think an 18-year old reading level would be a good suggestion. Some technical language should be ok when appropriate. Wikipedia is an encyclopedia, and shouldn't try to be a patient information repository, although that doesn't seem to be the opinion of some WPMED regulars. Per WP:ONEDOWN, the standard should vary based on the topic. An 18-year old reading level seems appropriate for aspirin, but should be more technical in an article on a specific type of cancer. One of my biggest pet peeves about this is that there is one person who insists that in all articles, "vertigo" needs to be replaced with "feeling like the world is spinning" and has reverted many, many editors who have changed it. Natureium (talk) 13:54, 31 May 2018 (UTC)

Medical issues are not generally "homework" ones, so I don't think WP:ONEDOWN is so relevant, though "The lead section should be particularly understandable" most certainly applies - myself I think a "rising" level through the course of the article is the way to treat virtually all technical subjects. I have some sympathy with the "vertigo" guy, not least because (thanks to Hitchcock?) I suspect a rather high % of people think it means "fear of heights". I might be inclined to use "vertigo (feeling like the world is spinning)" or something. Johnbod (talk) 15:27, 31 May 2018 (UTC)

Didn't you ever have to write papers on health topics when you were in school? I did, and it seems to be a pretty common thing (typical among the 10-to-12-year-old kids seem to be "Don't do drugs" and "Wear a bike helmet").

The point here isn't to recommend a particular reading level. The point is to say that you're probably doing it wrong if you're insisting upon a standard designed for a different type of publication (regardless of whether your preferred type is "peer-reviewed journal articles" or "patient information leaflets"). WhatamIdoing (talk) 16:31, 31 May 2018 (UTC)

Then why don't we take those 2 lines out altogether, since we all seem to be in agreement that the writing style will vary? Natureium (talk) 17:06, 31 May 2018 (UTC)

I don't think it appropriate for an internet encyclopedia to aim for a 12-year-old level. If folks are looking for simple, they can go to NIH or any number of websites that really dumb down the medical text to a less than high school level. I hope Wikipedia aims higher; not graduate level, but something like 18-ish at least. There are so many simple websites that dumb down the topics to a grammar school level already out there, and Wikipedia can aim for something different. SandyGeorgia (Talk) 03:09, 2 June 2018 (UTC)

Completely agree with SandyGeorgia. The English language is richly expressive. By all means clarify content (making use of the English language) and this really does not need to involve dumbing down. Particularly when there is such an abundance of links to make use of. A "sore thumb" example of this is the use of the word 'smaller' to describe a seriously muscle-wasted leg on a polio sufferer - this use is on a featured article, Poliomyelitis. Attempts to change this have always been reverted. Where is the sense in this type of dumbing down? (Or any type) --Iztwoz (talk) 09:35, 2 June 2018 (UTC)

Has anyone ever actually accused WP medical articles of being written at a 12-yo level? I doubt it. Almost all of them, when tested, give graduate++ levels. The struggle is to get them, or the leads at least, to a level where you don't need (according to to the tests) a science degree to understand them. Has everyone grasped that the quotes at the top are about what NOT to do? Johnbod (talk) 14:09, 2 June 2018 (UTC)

Agree. Cancer.gov has some great basic information about many facets of cancer. Wikipedia does not need to duplicate these efforts. Natureium (talk) 18:48, 2 June 2018 (UTC)

IMO different parts of the article should be written at different reading levels. Using technical language so we sound erudite is a much greater issues than using language that is overly simple. There is nothing wrong with Wikipedia using high quality secondary sources such as cancer.gov among others. The language used is very different from whether or not we are writing for patients, which of course we are not. Do we have any leads of medical articles written at a "6 or 7th grade level"? Doc James (talk · contribs · email) 19:44, 2 June 2018 (UTC)
I don't have an opinion about the exact age level of the readers (which is pointless because education levels vary between countries) but I do have an opinion about readability. Many, many Wikipedia articles have very low readability which makes them difficult to understand for laypersons and for people whose native language is not English (and makes them difficult to translate!). There is a great website with which you can easily check the readability score of any Wikipedia article: http://www.readabilityofwikipedia.com/ I know it is difficult to assess an article with such tools only but it gives a good general indication. A score of higher than 50 or 60 would be good. Many of the important WikiProject medicine articles have very low readability. E.g. the one on diarrhea: 38, the one on gastroenteritis: 36. This website is very helpful in improving readability scores: http://www.hemingwayapp.com/ - So could the Manual of Style say something about aiming for fairly high readability scores? In the WikiProject Sanitation we have explained it like this: https://en.wikipedia.org/wiki/Wikipedia:WikiProject_Sanitation#Improve_readability EMsmile (talk) 12:28, 3 June 2018 (UTC)
- I get 54 for just the lead of the EN article on diarrhea. One does not need to remove the references like with the other tool which is nice. Doc James (talk · contribs · email) 19:42, 3 June 2018 (UTC)
Keep 6th grade reading level / 12 educated years of age Wikipedia needs to be accessible to its target audience and match the standards of what other similar publications do. NIH and CDC publish many of their consumer guides targeting a 4th grade reading level, which is more simplistic than anyone has proposed for Wikipedia. Voice of America publishes using a 6th grade reading level with restricted vocabulary which is good for non-native English speakers but not what we are doing here. In English Wikipedia we should use a mix of high freedom to drop technical terms in wikilinks with a goal of otherwise making text, even technical text, highly readable to a general audience.

I cannot speak for the entire publishing industry but at Consumer Reports I worked on a project called Choosing Wisely which published educational materials for doctors and patients. After doing audience testing the team found that even physicians more frequently choose to read texts with more plain language and shorter sentences when the goal is to introduce and summarize a topic. In recent years various universities in the United States have begun hosting plain language medical writing conferences, but so far as I know, this profession and field is not well established.

I feel that this is a controversial topic and that it is difficult to get good information. Simple English Wikipedia has faltered in part because of great difference of opinion about what constitutes "Simple English", which is a more standardized concept. There is even less formalization in what English Wikipedia does. 6th grade English is a familiar reading level which all sorts of people enjoy. The Harry Potter book series targets 12-year old readers by telling stories of protagonists from age 12. Various readability rankings put Harry Potter books at 6th grade reading level. Although it is hard to define exactly how English Wikipedia can achieve this, I want Wikipedia's medical content to be accessible to anyone who might read a Harry Potter book. Blue Rasberry (talk) 14:13, 3 June 2018 (UTC)

And we have this article here which states "Wikipedia was used by 341 students (94%) while studying medicine. The most common reasons reported for using Wikipedia were ease of access (98%) and ease of understanding (95%)."[1]

The fact that we are often easier to understand is why many medical students turn to use. Doc James (talk · contribs · email) 19:31, 3 June 2018 (UTC)

Lane, there's nothing to "keep" here, because MEDMOS has never recommended that articles be written for 12-year-old children. I'm not sure that everyone really understands what this reading level means. Your most recent mainspace contribution was "A 2018 study examined the way that Wikipedia integrates new scientific information." That sentence scores at age 18. Your most recent new article scores at end-of-university reading level (~age 22). There isn't a single sentence in that article that scores below age 15. These aren't even technical subjects. If someone who is fully convinced of the value of simpler writing styles isn't managing to get anywhere near his goal on non-technical subjects, then I really don't think that we're going to get technical pages written in a way that typical 12 year olds can read fluently. WhatamIdoing (talk) 22:23, 9 June 2018 (UTC)

@WhatamIdoing: You are completely correct that we have no wiki community labor to copyedit to a professional standard. Editors are awesome and they easily do amazing things with text that non-professionals cannot. While I aspire for simpler text, I would not want anyone to use the wish for readability to impair anyone's attempt to edit articles as best they can. Readers are important but at this stage being welcoming to editors is our priority and I do not want anyone deterred.

Writing for 12 year olds is much harder than reading the same texts. Neither 12-year olds nor anyone without professional training can write at this level. If somehow WikiProject Medicine were able to standardize the reading level of articles, either by recruiting a professional-quality copyeditor or technological innovation, then 12-year old reading level is the mark I am choosing. I already mentioned Harry Potter. Here are more examples of the standard that I want. DK publishes for 8-12 year olds and is a model for Wikipedia style and scope. Check "first pages" to see actual text by clicking the amazon image.

The last one has more text but the writing style is still their own. DK translates their books so also they write anticipating that. Blue Rasberry (talk) 22:16, 10 June 2018 (UTC)

I typed the first paragraph of DK Eyewitness Medicine into these tools. Both agree: That's a college-level text, in terms of its readability. It averages 20 words per sentence and uses several complex sentence structures. The others you list are also not written for children. They are, in order, formally rated at a typical reading level for age 14, age 13, and age 15. According to this library-oriented website, that series of books isn't written for age 8 to 12; they're written for teenagers in grade 8 to 12. If your goal is to mimic the writing in those books, then your goal is not writing for 12 year olds.

I doubt that writing more simply actually requires professional training. Tech News (put out by one of my teammates) regularly scores around the US fourth grade level (10 year olds). Most of the announcements that I write with translation in mind score around age 13 to 15 (according to the Hemingway app, which I use to check long items before posting them for translation). I'm pretty sure that nobody on my team has had any special training. It requires some thought and effort, but anybody here could likely do the same with a little practice. WhatamIdoing (talk) 03:16, 11 June 2018 (UTC)

Here's a recent example re my point above: "The mean Flesch Kincaid reading ease score for all of the [55] Wikipedia articles we analyzed is 31.10, which indicates that a college-level education is necessary to understand them." - abstract of Readability and quality of wikipedia pages on neurosurgical topics. Johnbod (talk) 17:34, 5 June 2018 (UTC)

well that is at least about brain surgery. I wonder how technical our "rocket science" pages are :) Jytdog (talk) 18:12, 5 June 2018 (UTC)

"Rocket science" is a disambiguation page that leads to Aerospace engineering, which seems to score favorably. WhatamIdoing (talk) 22:30, 9 June 2018 (UTC)

Not quite the same. That's the basic overview of aerospace engineering. They looked at pages on neurosurgical topics, not neurosurgery. Natureium (talk) 11:46, 10 June 2018 (UTC)

The problem is more that when leads of articles are simplified down to a "16 to 18 year old level" some complain that Wikipedia is being "dumbed down" or that those who attempt to simplify to this level should leave English Wikipedia and go someplace else. Some appear to think that writing which is at a grade 12 level is at a grade 6 level. I get the impression that they feel all parts of English Wikipedia should be written at a post doc level.
Our article on WP:Audience says "Make your article accessible and understandable for as many readers as possible." Writing for a general audience is much harder than writing for a technical audience. We all need to work on our skills writing for the former rather than the latter. Doc James (talk · contribs · email) 19:26, 14 June 2018 (UTC)
The risk that we will write at too low a level is negligible, and I do not agree we should restore this sentence. On the other hand, writing in too complicated a fashion is very common. I have much more to say on this, but I tend to agree with Bluerasberry — and there is an important distinction between the lede and body of articles. Carl Fredrik^talk 12:36, 17 June 2018 (UTC)
While I agree with Doc James's comments just above, I support restoring the balancing line about not writing WP as if for children. This is not simple.wikipedia.org. That's a separate project for a reason. I'm among the first to criticize writing in obtuse jargon when it can be avoided, specifically because millions of children and ESL leaners are among our audience. But WP isn't written specifically for them. Rather, we apply WP:JARGON, MOS:TONE, and various aspects of WP:NOT, among other guidance, to produce text that most of our readers can figure out, though sometimes this requires branching off to side articles. Hypertext also exists for a reason. A balance is required, and it's just a fact that the more technical the topic is the more technical our article's wording will be – to a constrained extent – otherwise we rapidly lose precision and accuracy. Go read some Simple English Wikipedia articles on technical topics and you'll see this effect in action. Such writing does in fact dumb down the content. — SMcCandlish ☏ ¢ 😼 20:40, 17 June 2018 (UTC)
Support restoring the sentence per WAID. Not at all surprised at who was involved in removing/restoring/removing it. Let's write for grown-ups please. If you know anything about how children learn, or about how people with English as a second language learn, you know that text which is above the level they know already is a fantastic way to stretch their vocabulary. Children are quite capable of reading text written for adults, looking up words, asking questions, etc. If Doc James thinks the lead should be understandable by young children, then go make that proposal to the wider WP community and get the MOS changed. Most of the article titles in WP:MED's remit are words that themselves are above the level James thinks our leads should be dumbed down to. Influenza, Poliomyelitis, Tuberous sclerosis, ketogenic diet. Writing well involves meeting multiple goals, some of which conflict. It isn't possible to accurately define, describe and explain complex topics using baby words. -- Colin°^Talk 10:45, 19 June 2018 (UTC)
- I don't think that Doc James actually holds the POV that has been repeatedly attributed to him through the years. Even for the leads, which most editors agree should be somewhat more accessible than sections covering technical details, he seems to have been writing for older teenagers and young adults (age 16 to 18). WhatamIdoing (talk) 02:14, 20 June 2018 (UTC)

Digression: simple.wikipedia.org

I think the first thing we need to get on board with, is to smash the notion that Simple Wikipedia has any usefulness or utility for anyone. It has roughly 1/500th the readership of en-wiki, and I've never met a single person outside Wikimania or Wiki-meetups that was even aware of it existing. I've also never met anyone who actually edits it.

The second point is that it is rediculously out of date, and poorly maintained — and has no community interested in working on its medical articles.

And for a third point — it doesn't even do what it's supposed to do. Just take a look at this:

It consistently scores horribly in readability — so even if the articles weren't horrible, they aren't much more readable. In fact the only article I found on some of our most important topics that was at all useful was:

http://www.readabilityofwikipedia.com/check/safe%20sex

But, on the other hand, it's so horrible and short that it's useless anyway. It defines "safe sex" as: "to have sex in a safe way." That article saw 55 views in the past month — while the en-wiki one saw 25,000.

I think any argument that builds on the existence of simple-wiki should be ignored on sight. (Not direct at you SMcCandlish, but I don't think people realize how useless and ignored simple-wiki is. It's worse than Wikipedia Zero, and I'm entirely convinced that the only reason it hasn't been closed down is because it has a handful of editors who would get very mad if it did, while Zero was run by foundation employees). Carl Fredrik^talk 21:11, 17 June 2018 (UTC)

Since you say that you have never met anyone who edits at simple, then let me introduce you to some of your fellow enwiki admins: @Auntof6, Bsadowski1, Mentifisto, Only, and Djsasso:. And Doc James, of course, since he's made a few hundred edits there. You might also be interested in w:simple:User:Bluerasberry/WikiProject Medicine; WikiProjects are too bureaucratic for a small community, but editors who are interested tend to get in touch and sometimes set up a userpage to make themselves easier to find.

I agree that simplewiki isn't a substitute for clear writing here, but I don't agree with bashing of simplewiki. WhatamIdoing (talk) 03:31, 18 June 2018 (UTC)

Thank you, WhatamIdoing, but I am an admin at Simple, not here at en. --Auntof6 (talk) 03:38, 18 June 2018 (UTC)

I looked at and worked on simple.WP a while ago. It is trying to write in language simpler than I can manage or than I think is desirable here. Often it does not succeed in the goal it has set out for itself. Doc James (talk · contribs · email) 07:40, 18 June 2018 (UTC)

Whether simple.WP is failing its mission or not (I agree that it is) isn't very relevant to this conversation. My point in mentioning it at all was for people in this conversation to go have a look at the actual, palpable dumbing-down effect when highly technical topics are reduced to elementary-to-secondary-school English. I'm not at all suggesting any sort of "you should shut up and go write at simple.WP instead" fallacy. :-)

If people want to save (and make "actually workable") the idea of applying some combination of the Simple English limited lexicons to WP topics, the eventual solution is probably integrating it into en.WP itself, as some kind of sidebar option. If the huge active editorial base of en.WP were also creating the simplified versions of articles, it would get done more often and better. — SMcCandlish ☏ ¢ 😼 06:25, 18 June 2018 (UTC)

Q: Is there a gadget to highlight the longest sentence in an article? Just doing this would go a long way to improving readability. Cancer has two sentences of 46 words. This is commonplace in medical articles, for no sound reason.LeadSongDog come howl! 21:10, 18 June 2018 (UTC)
Ooh, that would be nice. I would ask at WP:VPTECH. If no one's made such a tool yet, it might inspire someone to do so. — SMcCandlish ☏ ¢ 😼 07:02, 19 June 2018 (UTC)
Excellent idea User:LeadSongDog :-) Doc James (talk · contribs · email) 15:28, 19 June 2018 (UTC)
Requested at Wikipedia:Village_pump_(technical)#Looking_for_a_gadget_crafter. LeadSongDog come howl! 16:49, 26 June 2018 (UTC)

I've been staying out of the discussion because others have stated what I would state on the matter, which is that I don't think we should be unnecessarily dumbing down our articles or aiming for Simple English Wikipedia level. I agree that we should use clearer language when we can, especially for the lead, but even in those cases I consider pipelinking to the technical wording and/or putting the simpler wording in parentheses to briefly explain what the technical word is. We definitely shouldn't forgo wikilinks that will help explain matters, and all because those wikilinks are technical terms. A lot of technical articles, such as the Human brain article, can't help but use a lot of technical terminology. Same goes for a lot of our math articles. Often, in cases such as the Human brain article, there are no simpler words. Flyer22 Reborn (talk) 02:12, 20 June 2018 (UTC)

LEAD redux

About this, the lead has been discussed several times here:

Removing the entire section was somewhat... extreme, so I have restored it. We can certainly discuss this more. Jytdog (talk) 14:51, 24 July 2018 (UTC) (added last bullet per note below Jytdog (talk) 16:22, 24 July 2018 (UTC))

btw, the section on LEAD was first added by me, in this diff. This arose from the WMF reading team reacting to cluttered first sentences by grabbing the "description" field from Wikidata and adding that as the first line of en-WP articles in mobile views and the apps (they use the Wikidata description field a bunch of other places too, like navigation in all versions of WP). The discussions over that led to this discussion at FAC. The original LEAD section here reflected that and was discussed at Wikipedia_talk:WikiProject_Medicine/Archive_100#Change_to_each_of_MEDMOS_and_PHARMMOS_re_leads. Jytdog (talk) 14:56, 24 July 2018 (UTC)

See here @Jytdog:. Only in death does duty end (talk) 16:19, 24 July 2018 (UTC)

yes, i should have linked that as well. thanks. Jytdog (talk) 16:21, 24 July 2018 (UTC)

Why avoid "See also" sections?

MOS:MED#Standard appendices says to Avoid the See also section when possible; prefer wikilinks in the main article and navigation templates at the end. I'm curious about the reasoning behind this advice. Is there some property of Medicine-related articles specifically that makes "See also" sections problematic for them? I tried searching the talk archives for "See also", but the best I could find was this discussion from 2012 which (starting from dolfrog's comment) briefly touches on the rationale for the guideline, with Doc James mentioning WP:NOTLINKFARM. But I'd like to learn more about the reason for the guideline and its genesis - I'm wondering if it was originally hashed out on a different page, which is why I can't find it in the archives? Colin M (talk) 17:56, 26 June 2019 (UTC)

Better question is who writes these new rules. Anybody can edit these Manuals of Style articles and make up ludicrous rules. Wikipedia is finished. Nashhinton (talk) 17:19, 2 August 2019 (UTC)

"See also"s tend to proliferate uncontrollably, & many have always disliked them. Often people add stuff already linked in the articles. FACs with them get complaints, on any subject. There is actually Wikipedia_talk:Manual_of_Style/Layout#Change_the_general_rule? a move to change the MOS saying that they shouldn't repeat things in navboxes, given how bloated these now are, and how mobile viewers don't see them. Generally changes to MOS need extensive debate, if they are remotely significant, but these debates tend to be dominated by a few exhaustingly talkative specialists. Johnbod (talk) 17:52, 2 August 2019 (UTC)

If that's the case, let's get rid of all See alsos, regardless if they're medical or not. Nashhinton (talk) 18:14, 2 August 2019 (UTC)

@Nashhinton: Please indent your posts on talk pages, discussion pages, message boards, etc. 2600:1700:B7A1:9A30:A4EE:4873:FD0E:E744 (talk) 18:48, 2 August 2019 (UTC)

Placement of addiction, dependence and withdrawal

After some very heated back and forth, there seems to be a general consensus in favour of option 4. --Brustopher (talk) 20:45, 20 August 2019 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Were should this content generally be placed? Doc James (talk · contribs · email) 08:34, 17 May 2019 (UTC)

1) Section on "side effects"/"adverse effects"

Support Often addiction is listed as a black box warning. It is generally seen as potential a adverse effect. Doc James (talk · contribs · email) 08:34, 17 May 2019 (UTC)
support generally agree w/ Doc James...generally seen as potential adverse effect--Ozzie10aaaa (talk) 10:55, 17 May 2019 (UTC)
Support From a lay point of view, all three conditions (addiction, dependence and withdrawal) are considered "adverse effects". It seems clear to me that these three topics should be sub-sections of Adverse effects. --RexxS (talk) 11:25, 17 May 2019 (UTC)
Oppose Putting addiction, dependence and withdrawal section under adverse effect can be misleading and cause unnecessary panic to parents with child with the indicated syndromes. In general public's impression, adverse effects means "unexpected physiological effects under therapeutic dose". It's the case in Taiwan. --It's gonna be awesome!✎Talk♬ 13:52, 17 May 2019 (UTC)
Comment: It's also confusing/controversial even in the academic community as many papers mis-recognize adverse effects of dopaminergic drugs at therapeutic dose as "signs and symptoms of overdose and addition". (See Dopamine_dysregulation_syndrome) --It's gonna be awesome!✎Talk♬ 16:22, 17 May 2019 (UTC)
Strong oppose per my comments in discussion. Seppi333 (Insert 2¢) 17:28, 17 May 2019 (UTC)
Support. Addiction etc. are certainly adverse effects, even though not every user suffers from these problems. I understand that there is topical sensitivity about this since the opioid addiction crisis has led to opioids being withheld from patients who badly need the pain relief. But addiction is still really not a good thing. Logophile59 (talk) 03:02, 18 May 2019 (UTC)
Support dependence formation is unequivocally an adverse effect Cas Liber (talk · contribs) 12:51, 20 May 2019 (UTC)
Support per Casliber.--Literaturegeek | T@1k? 18:57, 20 May 2019 (UTC)
Support strongly -- There are differences in meaning between "adverse effects" and "side effects", and implied differences of degree between "adverse effects" and "undesirable side effects", not to mention "dangerously adverse effects" or "trivial side effects". There also are such things as "desirable side effects", or if you prefer, "incidental benefits"; for example a drug that is a specific for a painful or upsetting condition might incidentally induce drowsiness and prolonged sleep that promotes recovery or alleviates suffering. And fairly commonly one plays off desirable side effects against adverse effects. All such expressions should be used with precision in our articles; sometimes the difference hardly matters, but WP is an encyclopedia, not a cocktail party, and that justifies effort to express distinctions clearly. Quality matters. JonRichfield (talk) 15:22, 21 May 2019 (UTC)
Support This has been Wikipedia's status quo and the usual interpretation of Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs,_treatments,_and_devices. Pharma companies group these things with other side effects on the warning labels. To me this seems like the conventional choice established off-wiki in medical publishing and carried into wiki. I am open to change and I see lots of discourse in this discussion, but I need the case to be made more orderly and briefly. If anyone came up with a few bullet points and a few sentences making a case for change, even in particular circumstances, then I am open to hearing that. I recommend support just because it seems conventional and I have trouble understanding the argument for change because the conversation is long and wanders. Blue Rasberry (talk) 13:26, 31 May 2019 (UTC)

2) Section on "overdose"

Oppose The term overdose is generally used for a significantly larger than usual dose that has the potential to result in serious toxicity not a gradual increase in dose such as results in addiction / dependence. Doc James (talk · contribs · email) 08:34, 17 May 2019 (UTC)
- MeSH description for a "Drug overdose": "Accidental or deliberate use of a medication or street drug in excess of normal dosage." @Doc James: Your definition seems to be at odds with the conventional medical definition of an overdose. Seppi333 (Insert 2¢) 08:39, 17 May 2019 (UTC)
  - That is oversimplified and not the common usage which more fits with "The inadvertent or deliberate consumption of a dose much larger than that either habitually used by the individual or ordinarily used for treatment of an illness, and likely to result in a serious toxic reaction or death."[2] Doc James (talk · contribs · email) 08:41, 17 May 2019 (UTC)
Oppose not all occurrences of addiction, dependence or withdrawal happen as a result of overdose. It seems clear to me that we should not include these as sub-sections of Overdose.
- I have no idea who I'm responding to given that this is unsigned, but as I described below, addiction almost never occurs when addictive drugs are used at therapeutic doses for any of their indicated uses. Dependence that arises from the use of therapeutic doses is fairly common for drugs that belong to certain drug classes. With that in mind, it is far more common for both disorders to occur from overdose than from therapeutic doses of drugs with addiction and/or dependence liabilities, so that is a rather misinformed justification for opposing this option. Seppi333 (Insert 2¢) 17:28, 17 May 2019 (UTC)
Support For instance, methylphenidate addiction and dependence can only happen in overdose scenario rather than an adverse effect under therapeutic dose or under dose titration with supervision. Putting addiction, dependence and withdrawal section under adverse effect can be misleading and cause unnecessary panic to parents with child with the indicated syndromes. Addtionally, a lot of papers investigated doses from 72 mg / day to 130 mg / day to dig out what they called "opitimal doses" and they didn't report addication. Furthermore, I tried to find the cutting dose for addiction and got nothing. It's, therefore, a relatively safer and effective medication compared to other durgs with the abusive potential.--It's gonna be awesome!✎Talk♬ 13:47, 17 May 2019 (UTC)
Oppose per above. Undue weight and does not make sense. --Tom (LT) (talk) 06:08, 19 May 2019 (UTC)
Oppose per my comments in discussion. Seppi333 (Insert 2¢) 08:09, 20 May 2019 (UTC)
Oppose as two different definitions that not necessarily overlap Cas Liber (talk · contribs) 12:58, 20 May 2019 (UTC)
Oppose Overdose almost always refers to an acute event involving, typically, very very large quantities of a drug or drugs resulting in serious toxicity. In terms of addiction an overdose is only referred to when a drug abuser takes a dose that causes serious systemic toxicity.--Literaturegeek | T@1k? 19:03, 20 May 2019 (UTC)

3) Place in its own section

Oppose gives undue to weight to the subject in question.Doc James (talk · contribs · email) 08:34, 17 May 2019 (UTC)
oppose undue weight is a problem...IMO--Ozzie10aaaa (talk) 11:00, 17 May 2019 (UTC)
Comment Of course each of addiction, dependence and withdrawal require their own section if sufficient sources exist discussing them. However, that does not mean that these have to be a level 2 section. It seems to me that a level 3 section under Adverse effects meets the requirement for having their own section(s). --RexxS (talk) 11:25, 17 May 2019 (UTC)
Oppose per above. Undue weight. --Tom (LT) (talk) 06:08, 19 May 2019 (UTC)
Comment My proposal has gained no traction, so I guess this isn't a viable alternative. Seppi333 (Insert 2¢) 08:09, 20 May 2019 (UTC)
Oppose Undue weight Cas Liber (talk · contribs) 13:07, 20 May 2019 (UTC)
Weak oppose undue weight generally, although not a big deal that I would lose sleep over.--Literaturegeek | T@1k? 19:05, 20 May 2019 (UTC)

4) Place both "overdose" and "addiction" under "adverse effects"

Support as possible option as an overdose is an adverse effect aswell. Doc James (talk · contribs · email) 08:47, 17 May 2019 (UTC)
Support From a lay point of view, addiction, dependence, withdrawal and overdose are all possible adverse consequences of a particular drug. It seems clear to me that they should all be level 3 sections under the level 2 Adverse effects. --RexxS (talk) 11:25, 17 May 2019 (UTC)
~~Weak~~ support - This is were I'd expect to find the information as a lay reader. However, the reason it's only a weak support from me is BNF and Drugs.com don't list addiction or dependency in their side effects sections (I wouldn't expect them to list withdrawal or overdose). For example BNF (via MedicinesComplete) has a general "Cautions" section for all opioids, which is separate to - and listed before - the side effects. Little pob (talk) 12:24, 17 May 2019 (UTC)

Strike weak; on the proviso, after taking into consideration Colin's comments below[3], of using an alternative section heading. Something like "Risks", "Guidance and risks", or "Cautions and risks" might work. This would allow the section to cover things like contraindications (e.g. ibuprofen in chicken pox) in addition to the content at the root of the RFC. Little pob (talk) 09:56, 20 May 2019 (UTC)

Weak support, a decent option. A new sub-section for overdose/addiction should be created under adverse effect section. --It's gonna be awesome!✎Talk♬ 13:50, 17 May 2019 (UTC)
Per Adverse effect,
In medicine, an adverse effect is an undesired harmful effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or procedure, this is called a medical error and not a complication. Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. Some adverse effects occur only when starting, increasing or discontinuing a treatment.
--It's gonna be awesome!✎Talk♬ 15:08, 17 May 2019 (UTC)
Support - this is the least bad of the first 4 options IMO. Seppi333 (Insert 2¢) 00:10, 18 May 2019 (UTC)
Weak oppose. To me, an adverse effect is something that occurs when the drug is being used at the approved dose, in the approved way. Negative effects (e.g. overdose) that are the result of mistakes or abuse are different.Logophile59 (talk) 03:08, 18 May 2019 (UTC)
@Logophile59: adverse effects are almost always negative. It makes sense to discuss adverse effects that occur with normal dose use as well as from an overdose and to do so under the main adverse effect section.--Literaturegeek | T@1k? 19:18, 20 May 2019 (UTC)
@Literaturegeek: Sorry if I was unclear. Of course, adverse fx are negative by definition. My point was that there is a difference between an adverse effect (an unavoidable consequence of using the drug at the approved dose, often (but not always) an unwanted effect that is a direct result of the drug's mechanism of action) and an overdose (avoidable if the drug is taken correctly). From the scientific point of view the distinction is important, and if anything it's more important (IMO) to distinguish the two for the lay reader. Logophile59 (talk) 01:08, 21 May 2019 (UTC)
Support. Overdose and addiction are problems because of the adverse effects of the drug on a person, their body and behaviour, so it make sense to talk about them in this section. Also, the title has a logical name and is likely to be widely understood in English-speaking countries. --Tom (LT) (talk) 06:08, 19 May 2019 (UTC)
support per Tom and Doc James--Ozzie10aaaa (talk) 12:38, 19 May 2019 (UTC)
Support both can be classed as adverse effects (alternately overdosage (and dosage) could be placed in a pharmacokinetics section I guess) Cas Liber (talk · contribs) 13:08, 20 May 2019 (UTC)
Support it is sensible to place this section as a subsection of adverse effects because it is describing adverse effects that occur from the drug in an overdose situation.--Literaturegeek | T@1k? 19:18, 20 May 2019 (UTC)
Support as per discussions below Ian Furst (talk) 13:58, 31 May 2019 (UTC)
Support (via FRS) - This seems the most-balanced approach. StudiesWorld (talk) 11:04, 10 June 2019 (UTC)

5) Either "Overdose" or "Adverse effects", depending upon the drug as per the original proposal

Support - I find it pretty irritating that the current approach specified in the MOS wasn't even listed as an option considering that it stemmed from a consensus that was established over 4 years ago. The placement of these sections in one section or the other for the past 4+ years has been determined by whether or not the use of a drug in clinical practice at commonly prescribed therapeutic doses results in one of those disorders.
Except in very rare cases (i.e., psychostimulants for narcolepsy and opiates for end-of-life care), it is extremely unusual for an addictive drug to be commonly prescribed at doses which carry an addiction risk. To be perfectly clear, sustained dosing patterns that do carry the risk of inducing an addiction do not cause an addiction by chance: the development of an addiction when a drug is used at those doses is inevitable and would occur in a significant fraction of patients who are prescribed those doses.
Dependence, on the other hand, is a much more common occurrence at therapeutic doses for certain drug classes. Consequently, the placement of sections on addiction and dependence under the overdose/adverse effects sections varied by drug article and the two sections weren't necessarily located together under the same level 2 section. Seppi333 (Insert 2¢) 17:28, 17 May 2019 (UTC)
Support: Compelling evidence except for Seppi's example of narcolepsy. To my knowledge, the doses of methylphenidate used for treating narcolepsy is more or less comparable with doses used to treat ADHD. --It's gonna be awesome!✎Talk♬ 20:10, 17 May 2019 (UTC)
Comment: In DailyMed, overdose, dependence, adverse effects have their own sections in leaflets respectively. Amphetamine, a featured article, has the same arrangement. They are good guidances for us IMO. --It's gonna be awesome!✎Talk♬ 08:14, 19 May 2019 (UTC)
Oppose Would love to see a reference for this "it is extremely unusual for an addictive drug to be commonly prescribed at doses which carry an addiction risk". Opioids are prescribed at addictive doses all the time as are benzos. Doc James (talk · contribs · email) 11:17, 19 May 2019 (UTC)
- @Doc James: Benzodiazepines cause dependence, but not addiction; a number of drugs can cause dependence at therapeutic doses, including both benzos and opioids. I'm not aware of any sources that indicate that the chronic use of opioids at therapeutic doses is associated with the development of an addiction (excluding in the case of end of life care, which I have read about in both medical reviews and textbooks); however, if you can supply one, I will concede my entire argument. In particular, that would imply that the maximum recommended dose of some addictive drugs is not below the threshold for ΔFosB accumulation. Also, the maximum time period over which an addiction could potentially develop, assuming that the dosing pattern of the drug is stable, is equal to the length of time that phosphorylated ΔFosB proteins persist in the brain, which is approximately 2 months.^[1]^[2] Chronic use over longer periods with a stable dosing pattern would not induce an addiction if it hasn't developed by then.
  Also, to further clarify, my argument about the placement of that section under the "Overdose" heading does not apply to addictive drugs that currently have no medical uses, like MDMA, since the concept of an "Overdose" isn't well-defined with respect to a range of therapeutic doses.
  Addendum: I've cited my assertions about benzos and opioids in my response to Cas Liber below. Seppi333 (Insert 2¢) 07:29, 20 May 2019 (UTC); edited 17:56, 20 May 2019 (UTC)
  - FosB does not explain everything about addiction, it is an important part of addiction but you talk about it as being the beginning and end. Plenty of recovering addicts still crave drugs after two months or more clean, when their FosB levels would have normalised. And yes benzodiazepines can be addictive, albeit modestly so, the major issue with benzodiazepines is the risk of physical dependence and serious withdrawal, which is very high. Much of the drug seeking behaviour of benzodiazepines is often about alleviating acute withdrawal effects and is often best treated with reinstating the benzodiazepine followed by gradual titration of dosage over months or longer. Opioids do have a higher risk of addiction and drug seeking to get high than benzodiazepines.--Literaturegeek | T@1k? 19:47, 20 May 2019 (UTC)
    - @Literaturegeek: FosB explains virtually nothing about addiction. DeltaFosB governs its development, not the prognosis. Conditioned memory persists long after DeltaFosB proteins are no longer present in neurons and that is what explains reinstatement. I never once suggested or even wrote anywhere that DeltaFosB governs the presence or absence of an addiction, only its development, because that is what multiple independent sources say. I honestly can't believe that you would offhandedly dismiss the singular importance of that protein in addiction if you've read even one of the review articles about it. Moreover, I've never once stated that it is the only factor involved in the development of an addiction; countless epigenetic proteins (most of which are enzymes) facilitate this process and a unique set of those proteins appear to mediate addictions to specific drugs. Also, your statement about benzos being addictive contradicts the following source as well as the sources it cites in support of its assertions. Seppi333 (Insert 2¢) 20:02, 20 May 2019 (UTC)
    - Plenty of recovering addicts still crave drugs after two months or more clean, when their FosB levels would have normalised. I never even implied that DeltaFosB expression-dependently regulated the intensity of cravings. Even if I did, it would take more than two months for the expression of its downstream targets to subside back to normal levels, so I wouldn't have asserted that to begin with. You are making a lot of erroneous assumptions about what and how I think. Seppi333 (Insert 2¢) 20:12, 20 May 2019 (UTC)
      - Okay, fair enough, but anytime I see you on talk pages talking about addiction, you cite FosB and nothing else to make your points, so it gave me that impression. I have not dismissed the importance of FosB, please reread what I wrote in my prior statement, I clearly said it was an “important part of addiction”.--Literaturegeek | T@1k? 20:33, 20 May 2019 (UTC)
        You see me talking about it so often simply because its overexpression is what causes addictions. Seppi333 (Insert 2¢) 23:25, 20 May 2019 (UTC)
Oppose WTF? we have epidemics of codeine and benzo addiction, stimulants are incredibly tightly regulated in Australia. Many people get addicted to these things in vaguely normal practice Cas Liber (talk · contribs) 13:25, 20 May 2019 (UTC)
@Casliber: Despite the fact that this area has been a primary focus of my editing for about six years, my statements seem to be summarily disregarded quite often in this RfC.
From [4]: "Although authors of the guidelines should be commended for not suggesting that addiction is a direct consequence of long-term benzodiazepine use, they do not do enough to clarify the distinction between dependence and addiction in this context. For example, they state that ‘patients should be advised that benzodiazepines may produce both tolerance and dependence, with the risk of withdrawal symptoms’. Several studies (reviewed by Starcevic, 2014) have demonstrated that dose escalation (i.e. tolerance) occurs rarely during a long-term treatment of anxiety disorders with benzodiazepines. In contrast, withdrawal symptoms after an abrupt cessation of long-term benzodiazepine use or precipitous decrease in the dose of benzodiazepines are common, although not inevitable; patients should be rightly cautioned about them, but not intimidated. The important point here is that pharmacological dependence (characterised by tolerance and/or withdrawal symptoms) denotes no more than a normal physiological adaptation to the long-term presence of a substance that affects the central nervous system (O’Brien et al., 2006) and that it is erroneous to consider as addicted all individuals who are dependent on benzodiazepines. Substance addiction is a compulsive drug-seeking behaviour, associated with craving and loss of control, which persists despite multiple adverse consequences (Shaffer, 1999). Addiction-like pattern of benzodiazepine use is rarely seen among patients with anxiety disorders who do not have another substance use disorder (Starcevic, 2014). Therefore, withholding benzodiazepines from such patients on the grounds that they cause addiction and substituting them for medications that may be more harmful represents poor clinical practice." So again, benzos cause dependence, but not addiction. The distinction between those two disorders is very significant. Dependence is relatively transient and generally very unpleasant; addiction is long-term, extremely self-destructive, and generally upends if not ruins a person's life for at least a few years. Seppi333 (Insert 2¢) 14:13, 20 May 2019 (UTC)
That's a false dichotomy. One sees all grades of dependence/addiction in clinical practice - there is no zone of rarity between dependent and addicted patients. Some people do remain on a long term stable dose of benzos for years but many do escalate (and not just the "nasty addicts"). Cas Liber (talk · contribs) 15:16, 20 May 2019 (UTC)
Hmm, I'm not sure I entirely understand what you're saying. Are you arguing that a drug necessarily must be able to cause an addiction if it can cause dependence? Also, I would appreciate it if you didn't use the phrase "addict" in a pejorative sense; addiction is a brain disease, not a way of life. Seppi333 (Insert 2¢) 15:21, 20 May 2019 (UTC)
(edit conflict) Yes. Any dependence-forming drug (in the classical sense - benzos, narcotics, stimulants) can have addicts who resort to great lengths to procure the drugs. Regarding pejorative, do you understand the use of quotation marks? It is the material you are posting that is highlighting the distinction between dependence and addiction, not me Cas Liber (talk · contribs)
Addiction and dependence have entirely distinct biomolecular mechanisms in the brain, as mentioned in their respective articles, so a number of drugs do in fact cause one but not the other. But, you don't have to take my word for it: "While physical dependence and withdrawal occur with some drugs of abuse (opiates, ethanol), these phenomena are not useful in the diagnosis of an addiction because they do not occur with other drugs of abuse (cocaine, amphetamine) and can occur with many drugs that are not abused (propranolol, clonidine)." (page 367). Seppi333 (Insert 2¢) 15:35, 20 May 2019 (UTC)

As for opioids: "Research has long demonstrated that patients with no prior history of opioid abuse treated with opioid pain medications over extended periods do not experience euphoria—these patients are therefore unlikely to become addicted [1]. Still, there is a risk that a small percentage (3.27–11.5%) of patients treated with opioids for chronic pain may develop addiction or abuse with negative consequences, complicating the management of chronic pain [9]." To be perfectly clear, this source is saying that the misuse or "abuse" of these drugs as a euphoriant is necessary for the development of an opioid addiction when they're used to treat chronic pain. Moreover, from this review: "The administration of opioids has been used for centuries as a viable option for pain management. When administered at appropriate doses, opioids prove effective not only at eliminating pain but further preventing its recurrence in long-term recovery scenarios. Physicians have complied with the appropriate management of acute and chronic pain; however, this short or long-term opioid exposure provides opportunities for long-term opioid misuse and abuse, leading to addiction of patients who receive an opioid prescription and/or diversion of this pain medication to other people without prescription." This is essentially the same assertion as was made by the preceding review. Seppi333 (Insert 2¢) 14:52, 20 May 2019 (UTC)
Err, yes, obviously many people can take them safely, but the incidence of dependence and addiction problems is high. In fact the first page you link really goes on about it at great length! Cas Liber (talk · contribs) 15:29, 20 May 2019 (UTC)
I haven't been arguing that they're not abused. I've been saying that if they're used the way they're supposed to be, the risk of addiction is negligible. These sources corroborate my assertion. Seppi333 (Insert 2¢) 15:40, 20 May 2019 (UTC)
Well, the argument that patients don’t escalate their benzodiazepines dose is a bit silly as they are not in charge of the dose! The doctor is! The doctor writes the prescription, not the patient! Yes this weak argument is POV pushed that benzos don’t cause tolerance and rarely addiction, originally by researchers tied to the manufacture of Xanax, now repeated by a small number of naive academics. There are lots of flawed research out there. Yes, benzodiazepines have moderate risk of addiction and very high risk of physical dependence and severe withdrawal. The addiction risk is higher with opiates though. As for opiates, sometimes people accidentally discover the euphoriant effects of opiates by taking an extra tablet or two for severe pain relief and this then turns into an addiction coupled often with a physical dependence. Seppi, I have for a while had increasing concerns about your editing, e.g., you have had a very literal interpretation of the word overdose, you have ridiculed my mainstream interpretation of tolerance and dependence and claim you have “corrected me”, you are overly fixated on FosB to the exclusion of other important factors involved in addiction, etc., etc. You appear to latch onto things to the exclusion of other important data and academic viewpoints and then POV push a narrow angle that in my view is out of context. I worry what impact this might have on our articles.--Literaturegeek | T@1k? 19:47, 20 May 2019 (UTC)
you have ridiculed my mainstream interpretation of tolerance and dependence I'm not sure what you're talking about, as I don't remember doing this; can you clarify?

you are overly fixated on FosB to the exclusion of other important factors involved in addiction See my reply to your comment above.

You appear to latch onto things to the exclusion of other important data and academic viewpoints and then POV push a narrow angle that in my view is out of context. That's a bold assertion. You're the one pushing a POV about benzos that contradicts sources. In any event, what viewpoints have I excluded then? I'm sure you can give me at least ONE concrete example of a viewpoint I've omitted. @Literaturegeek: Also, I don't want a hand-waivey bullshit argument; cite a review that covers the viewpoint(s) which you're alleging that I've excluded. Seppi333 (Insert 2¢) 20:18, 20 May 2019 (UTC)
We discussed tolerance and dependence here: Talk:Lisdexamfetamine#Option_1:_Use_"disputed" and then you appeared to reference this previous discussion on this page: talk:Methylphenidate#Overdose_section where you claim you have previously “corrected me”... The subject of benzodiazepines is controversial with a general consensus that the risk of physical dependence and tolerance is too high to justify long-term use for most patients. Yes some researchers and doctors publish papers challenging the mainstream consensus and you latch on to their arguably weak methodology as if it were the sole and only WP:TRUTH. Addiction risk requires high doses of benzodiazepines to stimulate dopamine release and activate the reward pathway but low dose physical dependence and tolerance is a very well proven risk of benzodiazepines, even a single sleeping tablet per night. My source is the U.K. guidelines in British National Formulary. My other evidence is that the community is roundly rejecting — with a strong consensus — your overly literal interpretation of the term overdose and it’s usage on our articles.--Literaturegeek | T@1k? 20:33, 20 May 2019 (UTC)
The subject of benzodiazepines is controversial with a general consensus that the risk of physical dependence and tolerance is too high to justify long-term use for most patients. I never asserted anything about this being true or false. The only thing I've stated about benzo dependence is that it occurs at therapeutic doses, so I don't know why you said "Yes some researchers and doctors publish papers challenging the mainstream consensus and you latch on to their arguably weak methodology as if it were the sole and only WP:TRUTH." I don't know how I've "latched on" to an opposing argument about that if I've never even commented on it.
My source is the U.K. guidelines in British National Formulary. Link the source.
My other evidence is that the community is roundly rejecting — with a strong consensus — your overly literal interpretation of the term overdose and it’s usage on our articles. Point to me an article in which I've used a "literal interpretation of the term overdose" in the article text. I'd really like to know because I'd like to see how you think I've incorporated that into an article. Seppi333 (Insert 2¢) 20:46, 20 May 2019 (UTC)

Re your statement in the link you provided about physical dependence: you said "I don’t think so, the fact tolerance and partial tolerance (a need to take increased doses to achieve the same effect) as a result of chronic use of stimulants followed by a withdrawal syndrome occurs is the very definition of physical dependence". Our article on Physical dependence doesn't describe it that way and it never did, even prior to my first edit; it has always qualified the withdrawal syndrome as one involving unpleasant physical/somatic symptoms, not unpleasant physical and psychological symptoms in accordance with your definition. All I said was "It's not the [definition] we use", as in, it's not the definition used in the article. I've added very little text to the article, but if you think what it says is wrong, then cite some sources and fix it. Seppi333 (Insert 2¢) 21:00, 20 May 2019 (UTC)
@Seppi333: The word physical in physical dependence refers to physiological neuroadaptations in response to the drug which cause a withdrawal syndrome during dose reduction or cessation. It does not mean physical bodily withdrawal symptoms only. This link defines physical dependence better and it includes ‘affective symptoms such as anxiety’ as being part of the withdrawal syndrome consequent of a physical dependence. So anxiety is a psychological symptom that is caused by a physical dependence. Obviously our physical dependence article has been flawed for many years then. Shame on us.--Literaturegeek | T@1k? 21:21, 20 May 2019 (UTC)
So how do they define psychological dependence in that textbook?
I’m still waiting for a link to that source you mentioned about benzodiazepines. Seppi333 (Insert 2¢) 01:59, 21 May 2019 (UTC)
Here is the benzodiazepines BNF link

Yes, anxiety, craving etc., can also be caused by a psychological drug dependence just like gambling addiction because neuroadaptations as a result of addiction can occur. And sometimes there are psychological reasons for taking the drug to cope which can cause these symptoms as well. But you won’t see sources talk about psychological/psychiatric symptoms of withdrawal such as psychosis, mania, paranoia, hallucinations, delirium etc., being caused by psychological dependence like you will with physical dependence and the resultant physical withdrawal syndrome. So, yes psychological symptoms (including anxiety and depression), often severe, are very much part of the physical withdrawal syndrome (caused by neuroadaptations to counteract the effects of the drug). Obviously the main editors of physical dependence article were confused and have made poor editing choices when building that article. Shame on us.--Literaturegeek | T@1k? 09:05, 21 May 2019 (UTC)

@Literaturegeek: the only thing I see when my browser loads that page is:
“BNF is only available in the UK
The NICE British National Formulary (BNF) sites is only available to users in the UK, Crown Dependencies and British Overseas Territories.“ Seppi333 (Insert 2¢) 00:36, 22 May 2019 (UTC)

I haven't been arguing that they're not abused. I've been saying that if they're used the way they're supposed to be, the risk of addiction is negligible. - this is a simplistic and naive attitude. How does any doctor know whether a percentage of his patients unbeknown to him actually get euphoric on codeine/morphine. It is exceptionally common for people to minimise their enjoyment or overuse of things if society frowns on it. Look, I think narcotics and sedatives are highly effective and valuable drugs, but time and time again patients can become dependent or addicted despite their prescribers' best efforts. With vigilance, a decent prescriber can make them safer but nothing is 100% foolproof. The book referred to isn't bad but is simplistic and reductionistic at a psychological level (ummm...gambling addiction anyone?). It is a pity they don't get more input from psychiatrists and psychologists but whatever... Cas Liber (talk · contribs) 20:54, 20 May 2019 (UTC)
this is a simplistic and naive attitude. Wtf? That's literally what the 2 ~~sources~~ reviews that I quoted say.
The book referred to isn't bad but is simplistic and reductionistic at a psychological level That textbook didn't mention psychological dependence in the statement I quoted, so I don't know what you're referring to. Seppi333 (Insert 2¢) 21:00, 20 May 2019 (UTC)
That's the point. It doesn't. And doesn't take on board that if psychological dependence is severe (i.e gambling) then it can be as bad as an addiction (by their definition of addiction). Cas Liber (talk · contribs) 21:10, 20 May 2019 (UTC)
Psychological dependence typically doesn't last for more than a few weeks. It's unpleasant, but it's nowhere near as severe or protracted as an addiction. Edit: One last point before I need to get off: problem gambling, per our article, entails both an addiction to and dependence upon gambling, not just dependence. Seppi333 (Insert 2¢) 21:13, 20 May 2019 (UTC)
I am not sure you fully understand physical dependence and psychological dependence as you failed to pick up a flaw in our article, see a wee bit above, my reply to you on this subject.--Literaturegeek | T@1k? 21:25, 20 May 2019 (UTC)
The article isn’t flawed since “physical dependence” is a term that has 3 different definitions. Do you know what the third is or would you like me to tell you? Seppi333 (Insert 2¢) 01:59, 21 May 2019 (UTC)
Tell me the third one, it’ll make everyone think you are really clever and you’ll win the ego battle. Replied above a little bit as well.--Literaturegeek | T@1k? 09:05, 21 May 2019 (UTC)

My bad about the pissing contest. I was rather irritated yesterday. In any event, if you look at older sources (like >3 decades ago) on pubmed, you will find that the terms “addiction” and “physical dependence” are fully conflated and used as synonyms in countless articles. Also, you might be interested in reading PMID 26740398 since it elucidates the distinction between physical dependence and psychological dependence on the basis of pathophysiology (NB: this paper uses the phrase “reward tolerance and dependence” in lieu of “psychological dependence”; since that entails a motivational and/or hedonic deficit, it’s consistent with how the author defines psychological dependence in his neuropharmacology textbook). Seppi333 (Insert 2¢) 14:34, 21 May 2019 (UTC)

Oppose as a silly idea, per above.--Literaturegeek | T@1k? 19:51, 20 May 2019 (UTC)

Discussion

These listed under both "side effects" and "overdose". They do not make sense under overdose as addiction and dependence are gradual processes well the subsequent withdrawal does not occur as a result of overdose.

This ref defines overdose "The inadvertent or deliberate consumption of a dose much larger than that either habitually used by the individual or ordinarily used for treatment of an illness, and likely to result in a serious toxic reaction or death."[5] Doc James (talk · contribs · email) 06:58, 17 May 2019 (UTC)

See the proposal below. Seppi333 (Insert 2¢) 08:26, 17 May 2019 (UTC)

Re above - MeSH description for a "Drug overdose": "Accidental or deliberate use of a medication or street drug in excess of normal dosage." Seppi333 (Insert 2¢) 08:39, 17 May 2019 (UTC)

Am just thinking that much drugs, such as clonidine, many antidepressants, requires a tapering off after the ceasation is decided. Not sure if these drugs also warrant the potential of dependence. It seems to me that a lot of drugs give rise to withdrawl symptoms but not all of these drugs are attributed to "having potential of dependence or addition". --It's gonna be awesome!✎Talk♬ 14:13, 17 May 2019 (UTC)

Proposal: restructuring the layout of drug articles for drugs with an addiction liability

ΔFosB accumulation from excessive drug use

Top: this depicts the initial effects of high dose exposure to an addictive drug on gene expression in the nucleus accumbens for various Fos family proteins (i.e., c-Fos, FosB, ΔFosB, Fra1, and Fra2).
Bottom: this illustrates the progressive increase in ΔFosB expression in the nucleus accumbens following repeated twice daily drug binges, where these phosphorylated (35–37 kilodalton) ΔFosB isoforms persist in the D1-type medium spiny neurons of the nucleus accumbens for up to 2 months.^[1]^[2]

The original proposal for placing sections on "Addiction", "Dependence", and/or "Withdrawal" in articles on drugs implicated in substance use disorders is located at Wikipedia_talk:Manual_of_Style/Medicine-related_articles/Archive_8#Section_ordering_for_addictive_drugs. There was unanimous consensus for the current approach at the time the proposal was archived.

Doc James seems to have a problem with it now despite agreeing with it back then; he wishes to move all of these sections to the "Adverse effects" section of drug articles even for drugs that lack the capacity to induce an addiction at low doses (NB: the reason as to why dosage of an addictive drug matters is that all addictive drugs have a threshold dose beyond which stable and long-lasting [i.e., phosphorylated] DeltaFosB isoforms start to accumulate, and without the accumulation of those isoforms, DeltaFosB overexpression is literally impossible; the overexpression of that transcription factor in the nucleus accumbens is the biomolecular trigger for the development of an addiction, hence, no DeltaFosB overexpression → no addiction). I won't accept this approach due to how grossly misleading the implication is; if there were consensus for it, I would actively oppose its implementation even knowing that I'd probably get banned for doing that.

So, in order to avoid implicitly suggesting that all addictive drugs with a clinical use carry the risk of inducing an addiction even at low/therapeutic doses in our articles, I am now proposing that these sections be placed in their own level 2 section instead of a level 3 subsection under either "Overdose" or "Adverse effects" (see MOS:MED#Drugs, treatments, and devices for how the layout of these articles is currently specified). Unless someone has another idea, this seems like the only feasible solution that addresses both of our concerns. Seppi333 (Insert 2¢) 08:23, 17 May 2019 (UTC)

No it should not be in its own section. It fits best under "adverse effects" or "side effects" which is were it should go. Doc James (talk · contribs · email) 08:30, 17 May 2019 (UTC)

We could also simple put "overdose" under the side effect heading. Doc James (talk · contribs · email) 08:40, 17 May 2019 (UTC)

@Doc James: While I'm not particularly keen on doing that, juxtaposing those two sections under Adverse effects seems markedly less misleading than throwing the addiction section under that heading by itself; it would no longer carry a clear implication of "this is a possible drug effect at normal doses", but it would carry an ambiguous implication of "this is a possible drug effect at either normal or high doses". Perhaps there's another alternative that we can both agree on. Anyway, I need to go to sleep. Seppi333 (Insert 2¢) 08:53, 17 May 2019 (UTC)

This RfC is malformed given that up until today, these sections weren't "generally placed" in either "Adverse effects" or "Overdose". Their placement depended entirely upon the prevailing opinion in medical literature about the potential for individual addictive drugs to induce an addiction when used at commonly prescribed doses. In other words, the placement has been on a case-by-case basis. Consequently, I can't support or oppose either of the first two options despite having a clear opinion about them. The wording of the RfC does not take my position into account. Seppi333 (Insert 2¢) 08:43, 17 May 2019 (UTC)

That may be how you have been doing it. You could add that as an option. But it is one I disagree with. Doc James (talk · contribs · email) 08:46, 17 May 2019 (UTC)

Comment: MEDMOS does not dictate the order or presence of sections, and never has done. I know this, because I wrote those parts of MEDMOS. While developing the guideline, I analysed the current medical FAs and GAs and found absolutely no pattern. The guidance is MEDMOS has always been "suggested sections" for new articles or where there is a substantial rewrite. In my experience, it is only ever harmful for editors to require a certain article structure "compliant with MEDMOS". Far better to argue for article structure because it benefits the flow of ideas presented in the article to the reader, or wrt prominence in the subject. For what it is worth, I can't understand the demand that "Addiction and dependence" be placed under "Overdose". I can't see the discussion that User:Seppi333 refers to. The current wording added by Seppi333, that suggests the same subheadings of "Overdose" as well as "Adverse effects" is symptomatic of both editors not "getting it" about this being "suggested" and not "the law". A topic ban on rearringing articles "compliant with MEDMOS" is long overdue. Given that both Seppi333 and Doc James are currently edit warring here and at Methylphenidate suggests that both editors should be blocked for warring. -- Colin°^Talk 09:25, 17 May 2019 (UTC)
- @Colin: Wikipedia_talk:Manual_of_Style/Medicine-related_articles/Archive_8#Section_ordering_for_addictive_drugs (also linked at the top of this subsection) Seppi333 (Insert 2¢) 17:28, 17 May 2019 (UTC)
  - User:Seppi333 I see a very confused proposal containing "either .. or.. " but not explicitly saying you intend "both" in the guideline. Your claim for 100% unanimous support is really ridiculous. I see there is an agenda at play here, with claims that certain drugs are not addictive at "therapeutic" dose, only at "overdose". For that reason, I strongly oppose including addiction under "overdose" rather than the NPOV of "adverse effects" or its own section if prominence in literature. Really it would be better if you and James stopped using MEDMOS to force your POV or to restrict editorial choices per article. These are matters to be argued per article based on how the best quality literature approaches the topic, and in as neutral a way as we can. -- Colin°^Talk 17:45, 17 May 2019 (UTC)
    - @Colin: Uncontested support from 2 out of 2 people would correctly be described as "unanimous". I left that section open for 6 months before implementing it; at the very least, I can't force more people to provide their feedback.
      I see there is an agenda at play here, with claims that certain drugs are not addictive at "therapeutic" dose, only at "overdose". I'm sorry, what? I'm assuming you didn't read my explanation as to the mechanisms of how it arises at the top of this section (in small font). Developing an addiction is entirely determinsitic and is fully dependent upon an individual's genetic loading and the sustained dosing pattern of an addictive drug. If the dosage is increased above the threshold dose at which stable DeltaFosB isoforms readily accumulate within neurons, then an addiction is bound to occur in a significant fraction of people who are prescribed those doses, specifically, in people with higher genetic loadings for addiction. If the dose prescribed is below the threshold dose, those isoforms do not accumulate. If, after reading this and my explanation about mechanisms above, you still think I have an agenda, then it's clear you think I'm talking out of my ass when I explain how addiction develops, in which case, there's literally no point in continuing this conversation any further.
      FWIW, given that an addiction is a lifelong disorder with extreme personal and excessive societal consequences, the notion that a typical doctor would knowingly prescribe an addictive drug at a dose that would induce an addiction with sustained use is just fucking stupid. IMO it's blatant malpractice for a doctor to prescribe an addictive drug at doses which carry that risk (NB: the overprescription of opioids is a fairly common malpractice case). The extremely limited exceptions (re: psychostimulants for narcolepsy and opiates for end of life care) for when this is a common practice are very unique cases with mitigating circumstances for prescribing them in that manner. Seppi333 (Insert 2¢) 18:18, 17 May 2019 (UTC)
    - Addendum re the "confused proposal": I used the language "substance dependence and/or addiction" in the original proposal because for any given drug, the former, the latter, or both may result from its use. I was not waffling over what to specify in the header since those are entirely distinct disorders that may occur together or alone. If a drug can cause dependence but not addiction, it should not have a section on addiction and vice versa; if it can cause both, it should have sections on both.
      My use of the DSM-IV's conflated diagnostic label ("substance dependence") in the second paragraph to refer to them does seem like a cause for confusion though. Nowadays, I generally avoid using diagnostic labels to refer to those disorders unless I'm discussing their diagnosis. Seppi333 (Insert 2¢) 00:04, 18 May 2019 (UTC)
      - I read the responses from two people and no they did not give you "uncontested support". WAID's comment was quite negative, rightly questioning the confusion of addiction and dependence, which you are again confusing in your proposal. James's comment was also that addiction in opiates occurs at therapeutic doses. But even if those two responses were positive, you cannot claim they represent consensus. I suspect your proposal was so confused that most people went "meh" and waited to see what change you might actually make. Now we see the change and see your agenda.

The definition of "overdose" is a dose "much higher" than normal e.g. "An excessive and dangerous dose of a drug", "A quantity of a drug well in excess of the recommended dose". You appear to have a binary definition of "therapeutic dose" that is always safe, non-addictive, always helpful, and anything above that is "overdose". I see you arguing above with Doc James about this. I'm afraid you are simply wrong. Once again I see you take language and apply your own interpretation of it, unshakable despite other editors disagreeing. You are also only considering the use of drugs for medical therapeutic purposes. What you write about DeltaFosB is all very well in lab rats and the latest theory, but a bit of humility about our understanding of the human brain is necessary. Your language about "entirely deterministic and is fully dependent" is just so wrong headed and I suspect driving your agenda.

Addiction, just like having permanent toxic effects on an organ, is dose-related and duration-related but there is no precise formula for working out therapeutic dose, and nobody except Seppi333 considers "overdose" to be any dose above that level. Working out the dose to use is based on many factors, including the patient's response (genes in future), duration of therapy, how ill the patient is, what other drugs they are on, etc, etc. Let's leave the question of what is therapeutic and what is overdose separate from the toxic, addictive, dependency and other ill effects of a drug. By putting "addiction" inside "overdose" one is claiming that therapeutic doses are not addictive and that the drug is only addictive in doses well in excess of normal doses. I don't think that is a common enough and proven enough scenario to warrant MOS change. Also I don't think Seppi has made the case for dependency and withdrawal to be sub-sections of overdose. But I repeat again, I wish you guys would stop using MEDMOS as the hammer to force rigid structure to medical articles. MEDMOS does not have the power to settle arguments at article level over where to put this section inside that section. It can only make a suggestion for the generally most likely useful case.

Lastly I would like to plead with James to stop making RFCs with numerous options and immediate voting. That is always disruptive. Please read the many wiki guidelines against voting: it should only be done after there appears to have developed a community consensus, and that prior to voting, your intention should be to encourage the community towards finding a consensus. By laying out 5 different possible options, you confine the discussion to your own imagination of possible options, you make it very time-consuming for anyone to argue "none of the above, this instead...." and you force the discussion along railway tracks. Instead you should open the discussion with a neutral explanation of the conflict and ask people to make a comment and suggest solutions. How anyone is supposed to make sense of the random arrays of support votes and comments here, I do not know. -- Colin°^Talk 10:13, 18 May 2019 (UTC)

No one disagreed with me in that proposal; hence it was uncontested. Doc James agreed with me. Hence, that's uncontested support from 2/2 people. I don't see why that's so hard for you to follow. I don't see anything confusing about it. Your definition of overdose is completely different from the MeSH definition; so if anything, it's you misusing language, not me. That said, unlike you, I realize words have multiple definitions, and the MeSH descriptor happens to be the conventional medical definition.
DeltaFosB overexpression has been confirmed in human addicts postmortem; you should probably reserve your opinions for topics you actually understand anyway, since you clearly do not understand what an addiction is, how it develops, or what it entails.
Your language about "entirely deterministic and is fully dependent" is just so wrong headed and I suspect driving your agenda. This would be you talking out of your ass. Try to read some research before you open your mouth and talk. You could have alternatively read the addiction article since it corroborates this statement with a citation to the statement: "exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict." To explain that for you in plain English since I know you're struggling with this stuff: that means anyone can become an addict if the dose is high enough.
I don't think Seppi has made the case for dependency and withdrawal to be sub-sections of overdose. That's because I'm not making the case that they go in the overdose section? Do you even understand what I'm advocating or are you just trying to argue with both Doc James and I for no apparent reason?

Facepalm Seppi333 (Insert 2¢) 12:59, 18 May 2019 (UTC)

Addiction, just like having permanent toxic effects on an organ That is an entirely incorrect interpretation of an addiction; addiction may be lifelong due to learning, but its neuroplasticity is fully reversible; differences in brain structure and function from healthy adults are eventually undetectable with abstinence.

but there is no precise formula for working out therapeutic dose, and nobody except Seppi333 considers "overdose" to be any dose above that level. Lol? Really? Give me an example of an addictive controlled substance that does not have a maximum recommended dosage then. Also, it should be therapeutic doses, as I'm talking about a dose range, not a single arbitrary dose, when I say "a therapeutic dose" in generality. As all controlled substances have maximum recommened doses, that's the upper bound for that range. It's not an upper bound for what a doctor can prescribe, but it's the amount that the vast majority of prescriptions are less than or equal to in the US. In any event, the underlined part is you talking out of your ass again because you didn't know what I've stated here despite ranting about the absence of dosing limits like this. Seppi333 (Insert 2¢) 13:25, 18 May 2019 (UTC)

Working out the dose to use is based on many factors, including the patient's response (genes in future), duration of therapy, how ill the patient is, what other drugs they are on, etc, etc. Let's leave the question of what is therapeutic and what is overdose separate from the toxic, addictive, dependency and other ill effects of a drug. True for some drugs; not true at all for controlled substances. I'd concede my point if there were uncontrolled addictive drugs, but none exist.

By putting "addiction" inside "overdose" one is claiming that therapeutic doses are not addictive and that the drug is only addictive in doses well in excess of normal doses. I don't think that is a common enough and proven enough scenario to warrant MOS change. Your notion that modern medicine is trying to turn patients into addicts deserves an extra

Facepalm. Seppi333 (Insert 2¢) 13:25, 18 May 2019 (UTC)

Strongly agree we write as far as what the science says. No exception. No original research. --It's gonna be awesome!✎Talk♬ 14:55, 17 May 2019 (UTC)

Alternate proposal

An alternate proposal is to group together all possible adverse consequences under a level 2 Adverse effects section. Where the sections Addiction, Dependence, Withdrawal, and Overdose have sufficient sources to discuss separately, they should be level 3 sub-sections of Adverse effects. If any of these are routinely linked together closely according to the sources, then they may be combined, such as in Addiction and withdrawal, or in Overdose and addiction. Any well-documented relationships between these factors will naturally be discussed in the appropriate section – for example, where addiction only occurs under circumstances of chronic overdosing. For what it's worth, my lay understanding of overdose (confirmed by reading through numerous results of a Google search) is that it is principally concerned with situations where too much of a drug is consumed. Whether that is 'too much' for safety or 'too much' to avoid issues of addiction is probably no more than semantics, and is the likely root of the disagreement between Seppi and James. --RexxS (talk) 11:44, 17 May 2019 (UTC)

Support. Seems perfectly reasonable.--Iztwoz (talk) 11:53, 18 May 2019 (UTC)
I don't think it makes sense to put an Overdose heading under Adverse effects since "taking an overdose" is not an adverse effect. Of course, the adverse effects (and much more) are likely to appear in an overdose scenario. So, if overdosing on a given medicine is rare and seldom discussed per WP:WEIGHT then it likely does not require a section at all, and could me noted (if necessary) inside the Adverse effects section. -- Colin°^Talk 17:23, 18 May 2019 (UTC)
Support but, taking Colin's comments into consideration, with an alternative section heading. Something like "Risks", "Guidance and risks", or "Cautions and risks" might work. Little pob (talk) 09:18, 20 May 2019 (UTC) Strike duplicate !vote. Little pob (talk) 09:57, 20 May 2019 (UTC)
Comment: This proposal is more-or-less identical to option #4 above; !votes should really go there. Seppi333 (Insert 2¢) 09:22, 20 May 2019 (UTC)

Idiosyncratic language and agenda pushing

It is clear that two editors here have their own idiosyncratic interpretations of language and are here to push an agenda. It is also clear that this MOS is being altered because of a dispute at Methylphenidate and wrong-headed use of MOS in which to settle disputes. Above Seppi33 is now resorting to throwing insults, and I have no wish to argue with such editors. What matters, with language, is how people generally use the terms and what our readers expect to find in sections and sub-sections. Misusing language because (a) you have misunderstood what a dictionary says and does not say about usage or (b) to push an agenda, is harmful to our readers. It is also important to remember that drugs are not always used in a therapeutic setting. This may include illegal usage of drugs but also legal usage such as smoking, vaping and alcohol.

Overdose Most people regard this as describing a single event where someone has greatly exceeded the normal dose and as a result need urgent medical attention. The most common consequence of overdose is elevation of the adverse effects and consequences of toxicity, which may be permanent or fatal. In that regard, they would not expect to find addiction or dependence under that heading. Acute overdose is often a result of addiction and tolerance, not a cause of it. Even in the disputed Methylphenidate the section on overdose only describes "acute overdose" and makes no mention of, for example, someone regularly taking a dose above normal prescribed levels.
Adverse effects This includes all ill effects from taking the drug. One user with an agenda is arguing that addiction, dependence and withdrawal should not be listed as adverse effects if they are generally not seen at therapeutic levels: "Putting addiction, dependence and withdrawal section under adverse effect can be misleading and cause unnecessary panic to parents with child with the indicated syndromes."

So we have two editors with their reasons to choose idiosyncratic definitions of overdose and adverse effects in order to emphasise that methylphenidate is not addictive or causes dependence at therapeutic doses. And they want MOS to agree with this agenda so they can force it on one article. I strongly oppose this and agree with Doc James recent edit to the page to keep Addiction, Dependence, Withdrawal as Adverse effects and not under Overdose. -- Colin°^Talk 17:23, 18 May 2019 (UTC)

I never once insulted you; I stated that you didn't understand the topic about which you were talking, that you were talking out of your ass (which means the exact same thing), and that you said something worthy of a facepalm.

You've been pushing your own agenda by taking a clear position on this and attempting to convince others of your viewpoint, so welcome to the club? Also, your definition of overdose is the conventional one only in the context of toxicity. The NLM definition is by far the more widely used. Seppi333 (Insert 2¢) 17:40, 18 May 2019 (UTC)

Also re - your block comment in the edit summary, I'd support a block of your account. :) I don't know why you make pointlessly inflammatory remarks like that. Seppi333 (Insert 2¢) 17:46, 18 May 2019 (UTC)

Would it be too unacceptable to use a simpler section heading Unwanted effects this could also encompass allergic reactions, and effects of alcohol with drugs? --Iztwoz (talk) 20:29, 18 May 2019 (UTC)

Iztwoz, "unwanted" would simply be a non-standard way of saying "adverse effects". This discussion is the first time I have ever encountered anyone claiming that "adverse effects" should not discuss effects at therapeutic doses, lest we scare parents who might otherwise give their children stimulant drugs. Let us not bend language into unnatural ways simply to appease those who are here to push an agenda, or have invented idiosyncratic meanings. It is most disappointing that the above abuse by Seppi333 doesn't invoke an immediate block. -- Colin°^Talk 19:56, 19 May 2019 (UTC)

simply to appease those who are here to push an agenda Such as yourself.

Seppi333 (Insert 2¢) 21:45, 19 May 2019 (UTC)

Expert consultation

I have a colleague, who is one of Canada's leading experts on toxicology, dependence, and addiction. Here is his CV page for reference. I explained the debate we are having, and asked for both his input and open source references. Here is his response.

I coauthored a paper a few years ago on addiction and dependence. It's open source. ^[3] The use of opioids for chronic noncancer pain has increased dramatically over the past 25 years in North America and has been accompanied by a major increase in opioid addiction and overdose deaths. The increase in opioid prescribing is multifactorial ... Dependence is absolutely a side effect. I discuss it here (although it likely won't meet your criteria for citation).^[4] Withdrawal is a side effect too, in that it DEFINES dependence in its pharmacologic sense. It's a weird side effect of course, in that one wouldn't experience it if they kept taking the drug. But because dependence is a drug-related harm, and because it's defined by withdrawal upon cessation, you're on safe ground calling it a harm I think. I think most people recognize addiction as a potential harm of opioids, even though we don't know the true incidence. Tolerance - this is also a side effect, in that it (that is, a rightward shift in the dose-response curve) only arises because of exposure to the drug. I'm sorry I don't have a lot of other open-source reviews. If I find one I will send it along. Hope this is of some use. dave.

In current literature, there is a debate about the definition of dependence and addictions. If we reach consensus on the topic, I can pull textbook references. However, I agree that dependence, addiction, and withdrawal should be under adverse effects (which, to me, is synonymous with harmful effects). All are clinically undesirable effects we balance against positive effects like pain-relief. Ian Furst (talk) 10:56, 21 May 2019 (UTC)

Since Doc James and I, as well as most of the !votes, support option 4, placing overdose, addiction, and dependence under adverse effects seems like the it’ll be the outcome of this RfC. Seppi333 (Insert 2¢) 14:50, 21 May 2019 (UTC)

Maybe standardized 3 level-3 sections, with drugs that have the risk profile, all under Adverse effects. Dependence and withdrawal, Addiction, Overdose. Ian Furst (talk) 17:03, 21 May 2019 (UTC)

Amendment to the last note; I was over at methamphetamine, and the side effects title works well. There are lots of effects that are neither therapeutic, nor harmful (erection, in response to sildenfil for pulmonary hypertension comes to mind). Aside from the Dependance, withdrawal, addiction, and overdose discussion , it raises the question of harmful vs routine or trivial side effects. Ian Furst (talk) 11:59, 22 May 2019 (UTC)

I really like "harmful effects" User:Ian Furst. Might be better than side effects or adverse effects. Harmful effects and clear and concise. Doc James (talk · contribs · email) 11:17, 22 May 2019 (UTC)

I can agree to that. Side effects, while accurate, is non-intuitive for a casual reader and too broad imo. Ian Furst (talk) 11:46, 22 May 2019 (UTC)

Amendment to the last note; I was over at methamphetamine, and the side effects title works well. There are lots of effects that are neither therapeutic, nor harmful (erection, in response to sildenfil for pulmonary hypertension comes to mind). Aside from the Dependence, withdrawal, addiction, and overdose discussion , it raises the question of harmful vs routine (or trivial) side effects. Ian Furst (talk) 11:59, 22 May 2019 (UTC)

References

^ ^a ^b Nestler EJ, Barrot M, Self DW (September 2001). "DeltaFosB: a sustained molecular switch for addiction". Proc. Natl. Acad. Sci. U.S.A. 98 (20): 11042–11046. doi:10.1073/pnas.191352698. PMC 58680. PMID 11572966. Although the ΔFosB signal is relatively long-lived, it is not permanent. ΔFosB degrades gradually and can no longer be detected in brain after 1–2 months of drug withdrawal ... Indeed, ΔFosB is the longest-lived adaptation known to occur in adult brain, not only in response to drugs of abuse, but to any other perturbation (that doesn't involve lesions) as well.
^ ^a ^b Nestler EJ (December 2012). "Transcriptional mechanisms of drug addiction". Clin. Psychopharmacol. Neurosci. 10 (3): 136–143. doi:10.9758/cpn.2012.10.3.136. PMC 3569166. PMID 23430970. The 35–37 kD ΔFosB isoforms accumulate with chronic drug exposure due to their extraordinarily long half-lives. ... As a result of its stability, the ΔFosB protein persists in neurons for at least several weeks after cessation of drug exposure. ... ΔFosB overexpression in nucleus accumbens induces NFκB
^ Juurlink, David N.; Dhalla, Irfan A. (2012-12). "Dependence and Addiction During Chronic Opioid Therapy". Journal of Medical Toxicology. 8 (4): 393–399. doi:10.1007/s13181-012-0269-4. ISSN 1556-9039. PMC 3550262. PMID 23073725. {{cite journal}}: Check date values in: |date= (help)
^ Juurlink, David (August 8, 2018). "Tox and Hound – Dependence Isn't Addiction, But It's Still A Problem". emcrit.org. Retrieved 2019-05-21. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)

About face

@Doc James: See my edit summary for explanation. I prefer option 1>5>4>2 in that order now since option 1 is more parsimonious than 5 and doesn’t necessesitate changing a lot of articles like 4. My reasoning about 2 was explained in detail somewhere in the massive blob of text that this RfC has become. ~~The unexpectedly large number of erroneous preconceived notions and various misinterpretations in this RfC made me change my mind vis a vis my nihilistic edit summary.~~ (struck since my meaning wasn’t clear; I was referring to most of the responses I quoted in green) If you want to close it, go ahead. Seppi333 (Insert 2¢) 00:25, 22 May 2019 (UTC)

This is a tangential issue, but are the terms "adverse effects" and "side effects" completely synonymous with exception for the fact that a side effect includes non-harmful drug effects? These sources didn't help - [6][7][8] - other than to equate "adverse reactions/events" with "side effects". Seppi333 (Insert 2¢) 01:08, 22 May 2019 (UTC)

[9] makes a distinction between "adverse drug effect" and "side effect" based upon dosage, but also asserts "side effect" is an imprecise term. Seppi333 (Insert 2¢) 01:25, 22 May 2019 (UTC)

The WHO provides the same definition [10][11] for side effects. Seppi333 (Insert 2¢) 01:32, 22 May 2019 (UTC)

One is simple the more technical term for the other. I am happy with either.

Looks like there is consensus to have addiction and dependence under side effects / adverse effects generally.

Also looks like "overdose" could either go under side effects / adverse effect or be on its own below that section. Doc James (talk · contribs · email) 11:10, 22 May 2019 (UTC)

If "side effects" is used in the article, a level 2 "Long-term adverse effects" section is the approach I'm going to take. I strongly disagree about putting overdose under a side effects heading; if the WHO defines it as an effect of a normal dose, then there are likely many individuals who interpret that term to be defined that way. The Merck ref indicates that it's often used in that manner. Seppi333 (Insert 2¢) 19:44, 22 May 2019 (UTC)

I'd prefer overdose not in a side effects section either. It'd be better in a dosage or pharmacokinetics section. Cas Liber (talk · contribs) 20:28, 22 May 2019 (UTC)

Example: eyes needed

Right folks, can folks take a look at Amphetamine (Talk:Amphetamine#Addiction_under_Overdose_vs_side_effects) as this falls under the category of what we've been discussing above? Cas Liber (talk · contribs) 04:03, 22 May 2019 (UTC)

Refs 8, 9, and 10 above. Seppi333 (Insert 2¢) 05:04, 22 May 2019 (UTC)

Which means what. You are the only person on this page who wants to put addiction into overdose and you are reverting to keep it that way. Cas Liber (talk · contribs) 07:20, 22 May 2019 (UTC)

I explained the problems with your edit on the article talk page, but if that’s what you want to believe, feel free to continue making stupid assumptions about my motivations. Seppi333 (Insert 2¢) 07:55, 22 May 2019 (UTC)

I'm not making any assumptions, just trying to align articles and prevent material being misrepresented Cas Liber (talk · contribs) 20:26, 22 May 2019 (UTC)

Right, so you go into an article you've never edited before which just happens to be my topmost edited article and start completely fucking it up. How would you like it if I did the same to you? Seppi333 (Insert 2¢) 02:57, 23 May 2019 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Abortion - definition conflict with Unsafe Abortion

Hi!

There is a discussion that I am participating in over at Talk:Abortion#Viability focused on the conflict between the definition of "abortion" as "the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus" (status quo, Abortion) and the definition of an "unsafe abortion" as "the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both" (status quo, Unsafe abortion). Under the current use of these two definitions, Wikipedia's answer to "what makes an abortion risky" completely overlooks the well-known increase in risk as a pregnancy progresses week by week.

I believe that the article Abortion is worse than it would be if we followed the suggestion to allow that a late termination of pregnancy (i.e. one after viability) were included with the definition of abortion, because it would give a much more informative answer to the average Wikipedia reader's straightforward question, "what makes an abortion risky?". 170.54.58.11 (talk) 20:27, 22 November 2019 (UTC)

Yes, I notice that you've been arguing this unsuccessfully for some time on the talk page. Guy (help!) 14:16, 6 December 2019 (UTC)

Coatracks and tangents

I've removed the section on Coatracks and tangents. There is nothing specific about editors using a coatrack or going off on a tangent. Surely better if we can point to existing general guidelines on WEIGHT or sticking to the article subject. Are there specific issues here that frequently occur in medical articles and have a medical specific argument against/for. -- Colin°^Talk 10:57, 12 November 2019 (UTC)

These changes are mostly a question of whether you want "no duplication" or "one-stop shopping". Both approaches have value. "No duplication" is less work for people who maintain and de-conflict pages like this. "One-stop shopping" is more effective for someone who's trying to teach someone how to edit. I don't have strong views myself about which approach this page should take. WhatamIdoing (talk) 15:26, 14 November 2019 (UTC)

It seems better to point to the broader guideline than to repeat it here, for ease of reading. But unlike the other examples above, at least this text doesn't seem to go beyond Wikipedia-wide policy, so isn't as bad as some of the other changes that have crept into this guideline over the years. I don't think it is needed, but if someone explains that it may be (with specific examples from articles), I would not object to it. SandyGeorgia (Talk) 20:18, 8 December 2019 (UTC)

DMOZ/CURLIE

My post above in the lengthy pricing discussion got no response, so separating out here.

MEDMOS (for about a decade) recommended DMOZ specifically as an external link, but that text was removed in 2018 because DMOZ no longer existed. The new {{Curlie}} template, which replaced DMOZ, was never added back in. (Sample [12])

Because this page is fully protected, unless anyone objects, I will submit an edit request to reinstate our long-standing text, but corrected to CURLIE from DMOZ. SandyGeorgia (Talk) 19:04, 11 December 2019 (UTC)

I have no concerns with it being returned. Doc James (talk · contribs · email) 19:36, 11 December 2019 (UTC)

SandyGeorgia, overall I have a big "don't care" about this, but much of DMOZ was undermaintained before it officially closed. Are we sure that the transferred version is actually active enough to be worth recommending? WhatamIdoing (talk) 06:44, 12 December 2019 (UTC)

I suspect that most of us (active medical editors) don't much care one way or the other, but the links greatly simplified our editing. When novice editors add external links to support groups, we can easily point them to the guideline, and to the EL page, and suggest they add the link to Curlie instead. It saves a lot of editing time to provide the kind of information some readers are seeking, and some novice editors add, in one external link. I will wait to submit an editrequest until we have agreement on several items. SandyGeorgia (Talk) 15:09, 13 December 2019 (UTC)

My impression is that there just aren't that many new editors trying to add ==External links== to medical articles these days. I still follow WP:ELN, and I don't think we've had a question about DMOZ/Curlie there for multiple years. WhatamIdoing (talk) 19:09, 14 December 2019 (UTC)

@Doc James, Colin, and WhatamIdoing: please let me know if I should submit edit request (2) as below. We need to get some stuff cleared off of this 800KB talk page. SandyGeorgia (Talk) 14:10, 6 January 2020 (UTC)

My comment above is clear. I am happy for Curlie to be used rather than extensive ELs to charities here etc. Doc James (talk · contribs · email) 14:24, 6 January 2020 (UTC)

I have no objections. I don't think this is important (either way). WhatamIdoing (talk) 16:10, 6 January 2020 (UTC)

This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

Proposal for edit request (2)

Please let me know if there is any disagreement, so we can submit the editrequest and get this section dealt with. SandyGeorgia (Talk) 15:21, 28 December 2019 (UTC)

In the External links section:

Merge the existing sentence (Normally, however, it is better to link to an external web page that lists such charities, rather than try to provide such a list ourselves.) in to the previous paragraph (If the disease is very rare ... such as a detailed article on the specific topic.)

and re-word it to:

strike the word very before rare (redundant), and add:
... such as a detailed article on the specific topic. It is usually better to link to an external web page that lists such charities, rather than try to provide such a list ourselves. The {{Curlie}} template links to a directory based on the Open Directory Project that contains many such links. For example, on the Tourette syndrome page:

* {{Curlie|Health/Conditions_and_Diseases/Neurological_Disorders/Tourette_Syndrome/Organizations}}

gives:

Tourette syndrome at Curlie

Done After reading the discussion, it seems like there is no opposition to this change and rational arguments in favour (it also does not seem to be related to the pricing dispute). Jo-Jo Eumerus (talk) 09:30, 8 January 2020 (UTC)

Archiving

WhatamIdoing I'm not sure it's a good time to speed up the archiving bot: I haven't submitted the edit requests yet to deal with this section and the next, and the page is protected. How about leaving the archiving time as before, but manually archiving any sections already addressed?

While I'm here, I view this DMOZ/Curlie thing as something that may not help, but doesn't hurt. There doesn't seem to be opposition if we re-instate it. Shall I go ahead and do the edit requests? SandyGeorgia (Talk) 19:28, 27 December 2019 (UTC)

The page is over 500KiB before processing, which is beyond what some people will be able to edit, or even read. This section wouldn't have been affected for another week (even before today's comments). WhatamIdoing (talk) 19:41, 27 December 2019 (UTC)

WhatamIdoing, how about if we do this instead? Leave the archiving bot and numbers as typical, but start a separately named archive for all of the RFC stuff? That's what I've seen done in other cases ... keep all of the RFC stuff in one separate archive, and then we can do that manually, and put a hatnote to it on the top of the new RFC sections. SandyGeorgia (Talk) 19:51, 27 December 2019 (UTC)

That is, leave the bot currently archiving at number 10 with 60 days, but move all of the RFC stuff to a separate Wikipedia talk:Manual of Style/Medicine-related articles/Archive 10b, which can then be a hatnote at the top of the new RFC section, to remind us to archive everything manually together. SandyGeorgia (Talk) 19:54, 27 December 2019 (UTC)

Whatever else, I would prefer not to archive anything that might feed into how we formulate the RfC, until we have the RfC finished. --Tryptofish (talk) 23:29, 27 December 2019 (UTC)

Should I submit the two editrequests now, to be done with these two sections? SandyGeorgia (Talk) 23:32, 27 December 2019 (UTC)

Just noting that I did set the archive time to 14 days from 45 days for now. We are at over 169kb of readable prose here according to XTOOLS which is very large indeed. Right now this page is larger than AN and ANI combined. Barkeep49 (talk) 23:42, 6 January 2020 (UTC)

Treatment/management

This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

What happened to Management as an alternate for Treatment in Wikipedia:Manual of Style/Medicine-related articles#Diseases or disorders or syndromes for those conditions where no treatment (in the conventional sense) is needed? It was long an alternate here and is now gone. WikiBlame is not working, so I can't tell why that occurred. SandyGeorgia (Talk) 01:33, 12 December 2019 (UTC)

It's still being used in articles. It has the particular virtue of not implying "permanent cure" for incurable diseases and chronic symptoms.

It looks like Doc James removed it in March 2017 because (according to the edit summary) some students typed ==Treatment or Management== as their section headings. WhatamIdoing (talk) 06:48, 12 December 2019 (UTC)

Yup lots of students added "==Treatment or Management==" rather than just picking one. This has decreased since that change. I do not care which is used. Doc James (talk · contribs · email) 04:28, 13 December 2019 (UTC)

I'm not sure it made sense to delete something useful from a guideline because students are misusing it; rather, the heading could have been clarified, using the same format that is used for other sections that have multiple possible names. I will wait til we have sufficient feedback on several items to submit an edit request. SandyGeorgia (Talk) 15:06, 13 December 2019 (UTC)

Agree that mentioning management would be nice, else articles like NAFLD may seem like using a wrong layout. Signimu (talk) 19:47, 13 December 2019 (UTC)

Damn, I always remembered I could use either. "Management" should come back IMHO, it i very useful for diseases for which we write that no treatment is known. — kashmīrī ^TALK 21:09, 13 December 2019 (UTC)

Perhaps "Treatment (or Management, especially for chronic conditions):" would be less confusing. I wonder if they made the same mistake with other section headings (like ==Prevention or Screening==). WhatamIdoing (talk) 19:05, 14 December 2019 (UTC)

Edit request pending, so archiving bot will leave this section. SandyGeorgia (Talk) 19:29, 27 December 2019 (UTC)

@WhatamIdoing, Doc James, Signimu, and Kashmiri: please respond to Xaosflux below so we can finish up this section; this talk page is sprawling. SandyGeorgia (Talk) 13:11, 4 January 2020 (UTC)

Proposal for editrequest (1)

Please let me know if there is any disagreement so I can submit the editrequest and we can get this section dealt with. SandyGeorgia (Talk) 14:58, 28 December 2019 (UTC)

In "Content section", change Treatment: to Treatment (or Management, especially for chronic conditions):

Administrator note Once a decision has been made, please reactivate the edit request if the page is still protected. — xaosflux ^Talk 15:38, 2 January 2020 (UTC)

Xaosflux the last comment on this aspect of the page was made on 14 December, and no one was in disagreement. I waited two weeks before adding the editrequest. Now the talk page is so large, we want to get a few of these things moved off the page. SandyGeorgia (Talk) 12:22, 4 January 2020 (UTC)

Reactivated. — xaosflux ^Talk 12:34, 4 January 2020 (UTC)

Done — Martin (MSGJ · talk) 14:05, 6 January 2020 (UTC)

Thank you ever so much, MSGJ-- one thing we can now get off of this 800KB talk page! SandyGeorgia (Talk) 14:08, 6 January 2020 (UTC)

Lead

I have removed some additions to the lead section. MEDMOS needs to stick to dealing with medicine/health article issues and not become some fork of standard guidelines. We already have guidelines on lead sections and on making technical articles accessible, so no need to add more. Given that "people don't read the manual", the shorter and more to-to-point this guideline can be, the better. As an aside, there is more skill involved in making an article accessible and engaging than just replacing words with more basic simple words. -- Colin°^Talk 10:16, 12 November 2019 (UTC)

Disagree. Having these basics here is still important. Doc James (talk · contribs · email) 18:19, 21 November 2019 (UTC)

Colin, do you think the other guidelines on lead sections and making technical articles accessible do a good job of making it clear that those guidelines also apply to medical articles? If so, can you point me toward the guidelines you referred to, please? I would like to have a look. Thanks! I do think that is important. Many analyses of Wikipedia medical articles have found them to have too much jargon, which can be confusing to our readers. I do agree that the lead should be kept fairly simple (target is ~8th grade reading level) and we can go into more depth in the later parts of the article. TylerDurden8823 (talk) 20:13, 21 November 2019 (UTC)

A level of grade 12 is more realistic and what we appear to be managing for the leads.[13] Doc James (talk · contribs · email) 22:35, 21 November 2019 (UTC)

Tyler, general guidelines apply to all articles; they need not explicitly say so.

Doc James, you have cited an off en-wiki document to justify your addition, rather than an on-wiki policy or guideline. SandyGeorgia (Talk) 21:10, 8 December 2019 (UTC)

Doc James, you restored the lead text you wrote prior to attempting to achieve consensus and prior to posting your above "Disagree" comment. You are simply edit warring. As I made clear in my above comment, there is nothing James has written that is specific to medical articles. The same is true of any potentially complex topic on Wikipedia. We do not fork such guidelines. I really don't think James is in any position to lecture others about good writing technique. If it isn't specific and relevant to health/medicine, it does not belong here. If someone is including a "Reader Native Language by Language" chart in MEDMOS, then you can tell they are desperately trying to make point to meet an agenda, rather than stating something that has Wikipedia-wide consensus. Let's leave the advice on writing leads to the whole Wikipedia community, where those who are actually competent writers can craft competent guidelines. -- Colin°^Talk 21:49, 23 November 2019 (UTC)

I support Doc's changes with regard to the lead material. I don't see an issue without spelling out those aspects in this guideline. Flyer22 Reborn (talk) 03:38, 26 November 2019 (UTC)

This is what I refer to as a "me, too" support, which offers no analysis of how this page conforms with/differs from WP:LEAD. In many areas of Wikipedia discussion, the closing admin or coordinator is empowered to ignore reasoning that does not offer a rationale. This text specifically departs from or extends beyond WP:LEAD, the relevant guideline page; it is up to the editors supporting this addition to explain how they believe it interprets the Wikipedia-wide guideline for medical content. If consensus is to be found in medical guideline pages, it behooves us all to discuss rather than !vote with "me, too" and WP:ILIKEIT supports. We can't come to consensus when given nothing to understand upon what !voting is based. SandyGeorgia (Talk) 21:07, 8 December 2019 (UTC)

Another disputed section

Regarding this addition, which is also not based on consensus, ~~we have had this discussion many times, and yet here we are again. O~~ one of the reasons the Medicine Project guidelines were widely accepted years ago is because they did not contradict or extend beyond Wikipedia-wide policy or guideline, rather explain how to interpret policy or general guidelines for medical content.

This addition goes beyond WP:LEAD, ~~and because we have had this conversation many times and in many places,~~ I am concerned about why it was again added as if it had consensus. This is a sample of the broader WPMED disputes mentioned at ANI, and should also be tagged disputed and considered part of the same issue, where we see personal preferences being written into guidelines and being applied to broad swatches of articles (even FAs that comply with Wikipedia-wide policy).

Almost every piece of this non-consensus version of WP:MEDLEAD either extends beyond what WP:LEAD says, or is at variance with what LEAD says, or repeats what LEAD says-- the biggest problem is where it extends beyond what LEAD says and is used to impose a structure on leads that is at variance with what LEAD calls for and what is called for in Featured articles.

The lead of an article, if not the entire article, should be written as simply as possible without introducing errors or ambiguity. Around a third of readers of English Wikipedia, have English as a second language. Language can often be simplified by using shorter sentences, having one idea per sentence, and using common rather than technical terms. The British National Formulary for example often uses "by mouth" rather than "oral". It is also reasonable to have the lead introduce content in the same order as the body of the text. Avoid cluttering the very beginning of the article with pronunciations or unusual alternative names; infoboxes are useful for storing this data. Most readers access Wikipedia on mobile devices and want swift access to the subject matter without undue scrolling. It is useful to include citations in the lead, but they are not obligatory. Two reasons for using them are:
Medical statements are much more likely than the average statement to be challenged, thus making citation mandatory.
To facilitate broad coverage of our medical content in other languages, the translation task force often translates only the lead, which then requires citations.

As can be seen by the concluding sentence, these extensions to Wikipedia-wide guideline are being imposed apparently to facilitate a different project, that is, translation of leads only to other languages, which has been a focus of WPMED for several years now, as opposed to focusing on having English-language articles comply with English-language policies and guidelines.

As in article editing, the burden to explain an addition should be on the editor adding the addition, so rather than have me go line-by-line to explain why all of this text is disputed, I believe it would be helpful for the editor(s) who want to add this text to go line-by-line and explain why they believe this text is supported by broader, Wikipedia-wide guidelines. It is not, and the application of this ~~personal preference~~ has caused FAs to be out of compliance with English-language standards only to make translation easier.

This text is disputed, and is part of the same problem discussed at the pricing ANI. A disputed tag should be added. SandyGeorgia (Talk) 20:12, 8 December 2019 (UTC)

I have struck portions that may be construed as "rehashing of past grievances", although my intent was to provide history. I can see that this text could be problematic. SandyGeorgia (Talk) 01:58, 9 December 2019 (UTC)

There is a fair bit of guidance recommending we use easier to understand language such as "Make your article accessible and understandable for as many readers as possible." and Wikipedia:Make technical articles understandable Doc James (talk · contribs · email) 03:01, 9 December 2019 (UTC)

Thanks, Doc, but there is nothing in those pages that is at odds with WP:LEAD, nothing that justifies the proposed additions to MEDLEAD, and even some portions of those guideline and supplement pages that the proposed addition to MEDLEAD is at odds with (eg, a lot of what is in medical articles now is oversimplified because of this trend). I have done the work of reading a page that doesn't respond to my concerns, and I don't see that you have answered my query. Could you please justify the proposed additions, point-by-point, so we can all understand why you think this proposed text complies with the broader and widely accepted WP:LEAD guideline? SandyGeorgia (Talk) 03:41, 9 December 2019 (UTC)

The reading level of our leads has improved, in my opinion, from a reading level close to grade 16 to just over grade 12.[14] I would call that neither over nor necessarily under simplified.

Here is the discussion in 2015 when the main sentence in question was added.[15]

IMO "The lead of an article, if not the entire article, should be written as simply as possible without introducing errors or ambiguity." is another way of saying

"The content in articles in Wikipedia should be written as far as possible for the widest possible general audience."

Doc James (talk · contribs · email) 22:13, 9 December 2019 (UTC)

Doc James, it would help if you would engage the entire issue, as we have discussed many times over the years. Citations are being added unnecessarily to the leads of every medical article, including FAs. No guideline requires this, and it is important that FAs conform with WP:LEAD, as from the lead the mainpage blurb is written. Overciting a lead can prevent FAs from providing a compelling summary. Similarly, a specific structure is being imposed on leads, which presents the same problems. Well-written leads that pass FAC are being altered in ways that are not compelling to read only so that a specific structure can be imposed, based on no Wikipedia-wide guideline, and taking FAs out of compliance with WP:WIAFA. And language is being dumbed-down in many cases to the point of lost clarity. None of this has consensus, none is based on guideline, all jeopardized FA status, and all is being done not for en.wikipedia, but for the an off-en.wiki translation project. If this were being done only to B- or C-class articles, I would be willing to be silent, but adding a non-consensus issue to a guideline, that takes this guideline out of compliance with general guidelines, while altering FAs to comply with a non-consensus guideline is a problem. SandyGeorgia (Talk) 03:29, 10 December 2019 (UTC)

No guideline prohibits addition citations to leads. It makes them much easier to maintain / verify. Doc James (talk · contribs · email) 03:42, 15 December 2019 (UTC)

There are various guidelines on citations in leads. But, as with all of MEDMOS's disputed section on leads, there is no evidence that there is a uniquely medical aspect to the content or citation guidance, vs personal opinion more appropriate for an essay. Firstly, "Citations are often omitted from the lead section of an article, insofar as the lead summarizes information for which sources are given later in the article, although quotations and controversial statements, particularly if about living persons, should be supported by citations even in the lead" emphasises that the norm is to omit citations from the lead, where the text summarises the article. This is something that editors who write article body content, and then summarise that content in the lead, will find more natural, than editors who add factoids mostly in the lead. Secondly, "The necessity for citations in a lead should be determined on a case-by-case basis by editorial consensus". Can anyone please give examples where editors working on an article reached a consensus wrt the need for citations in the lead for a given sentence or claim? I can find reverts and edit wars, but have been unable to find examples of collaborative editing or editors respecting each other and working towards consensus. This suggests to me, that perhaps a dogmatic approach at odds with general policy and guideline has taken dominance. Further reason that we should not have a MEDMOS fork of community guidelines. I would, of course, be overjoyed to read of examples of an article-consensus approach to lead citations. -- Colin°^Talk 15:29, 15 December 2019 (UTC)

Doc James, I am unsure why you are entering a comment that "No guideline prohibits addition citations to leads" on 15 December as if we had not already discussed this at 20:38 9 December and 21:47 at 11 December at the Schizophrenia talk page. No one has said a guideline prohibits adding citations to leads; the problem is what a preference for this style (not supported by WP:RS or WP:V) is doing to prose in leads. We have had this discussion already, so I am confused why you keep raising the same point, without addressing the other points. SandyGeorgia (Talk) 00:34, 16 December 2019 (UTC)

CFCF, I have reverted your addition of a separate section heading here on talk, which separated the section I started from the section it was directly responding to, and mischaracterized the nature of the dispute.

As you are a very involved party in these discussions, I request that you refrain from closing discussions, archiving discussions, or altering other editors' posts. I also ask you to please take greater care to read the case being discussed. The disputed text involved much more than what you call language. Since we have a neutral admin following the page now, if you feel it necessary to alter, close or archive something, you might find it useful to query Barkeep49 first.

Barkeep49, this section (LEAD) of the guideline is also disputed, and is part and parcel of everything discussed at the ANI (an issue that keeps being added in spite of no consensus). Because the article is protected, I am unable to add a disputed tag. What would it take to make that happen? SandyGeorgia (Talk) 16:05, 9 December 2019 (UTC)

Also, Barkeep49, I should explain the significance: I rarely edit drug articles, so while the pricing issue is quite important, it does not affect my daily editing. But these extensions of LEAD are affecting/have affected every single FA in the medical suite, so directly impact the articles I edit and WP:MED's top content. It has been hard to keep FAs up to standard when their leads are being edited in non-compliant ways, so IMO it is important that this section be tagged as disputed, not a consensus version.

Here is a sample from this week; it is the first FA I checked, the only one I have checked so far, and it is concerning that the first FA I checked after a not-so-lengthy absence from medical editing shows the very issues of concern (leads edited only, so that the body of the article is out of sync with the lead, and language in the lead oversimplified to the point of losing clarity, with the structure of leads altered in ways that do not lend the prose quality required of FAs). This kind of editing takes FAs out of compliance with WP:WIAFA, and valuable editor time (eg Casliber) is then needed for repair to avoid a WP:FAR. SandyGeorgia (Talk) 16:30, 9 December 2019 (UTC)

SandyGeorgia, I didn't receive your ping and this page has so much discussion that I had not noticed it until now. What is it that you're asking me to do? What I am reading is an argument over content (in this case the composition of the MOS) and would be inappropriate for me to weigh in without becoming INVOLVED. Best, Barkeep49 (talk) 02:45, 10 December 2019 (UTC)

Sorry, Barkeep49, I am not sure about the pinging problem. I will also, then, separately post this to your talk page to make sure you see it.

What I am asking is, considering the page is protected, how can we have an {{disputedtag}} added to the WP:MEDLEAD section? I was also pointing out, ala full disclosure, that although this is a separate dispute from the pricing issue, it is also related, as this is another of the ongoing disputes that was mentioned in the ANI you closed. Would it be appropriate for me to add an {{editrequest}} to ask another admin to add the disputed tag, or are you able to do it as part of the overall issue? We have a protected page because of the pricing edit warring, but there is a separate but related dispute in another section, which should be tagged as that section does not have consensus; it is an ongoing smaller matter that has been obscured by the larger pricing dispute. SandyGeorgia (Talk) 03:06, 10 December 2019 (UTC)

SandyGeorgia, ah now I got you (and I did get this ping - dunno what happened with the last one. Did you have to fix the ping or signature?). Let me look into this a little before responding on the substance of what you wrote now that I understand. Best, Barkeep49 (talk) 03:10, 10 December 2019 (UTC)

Barkeep49, When it comes to pinging, I am old school and never know what works or what I do right or wrong. Thanks for having a look, no hurry; the issue with leads has been unresolved for a very long time, and a day or a week changes little. Regards, SandyGeorgia (Talk) 03:16, 10 December 2019 (UTC)

SandyGeorgia, ok I think I have a grasp on this issue having looked through the edit history. The language of the lead has indeed been an ongoing disagreement for a longtime. As for moving forward I also don't think it's helpful for anyone if I make all sysop related decisions because I am uninvolved and am currently watching this page. So what I would ask is that you go ahead and make a formal edit request and that will hopefully draw the attention of someone else to decide what state to leave the LEAD in while this is protected. You, James, Colin and others are of course welcome to continue discussion and if consensus can be reached that could of course be implemented at any time. Best, Barkeep49 (talk) 03:36, 10 December 2019 (UTC)

Barkeep49, thanks so much, and seems like a wise course of action. I will compose the editrequest tomorrow-- past my bedtime and there may be further feedback when I check in tomorrow. Thanks again, SandyGeorgia (Talk) 03:41, 10 December 2019 (UTC)

Fully protected edit request for MEDLEAD

This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

See discussion above, beginning at LEAD.

The WP:MEDLEAD section of this guideline page has been constantly disputed for several years, as can be seen in the page history. Multiple past local discussions have been used to claim local consensus, which is not apparent, (sample 1, and sample 2), or not enough to override broader Wikipedia-wide policy or guideline.

The version of MEDLEAD that has been alternately removed and re-instated for several years here has a particular impact on Featured articles; FAs must conform with WP:LEAD because the lead is used to write the mainpage blurb. MEDLEAD is at variance with LEAD in ways that have an extra impact of the project's top content, as medical articles must now answer to two different lead guidelines. A sample from this week only (but repeated across many other FAs) can be seen at FA Schizophrenia.

The wider community should be involved in a WP:CENT RFC when a WikiProject guideline is out of sync with Wikipedia-wide policy or guideline, and local consensus has not resolved the problem. The specific issues are:

"Language can often be simplified by using shorter sentences, having one idea per sentence, and using common rather than technical terms." No such restriction is in LEAD, and this leads to short, choppy sentences in leads that are not up to FA standards. It has also led to a loss of clarity and the precision required in medicine (see Schizophrenia example).
"It is also reasonable to have the lead introduce content in the same order as the body of the text." This is not true for every article, and forcing the lead to a specific flow causes prose deterioration in articles (particularly Featured articles with carefully written leads) where the flow of information may need to be presented differently than the set structure that has been imposed. There is no such requirement at LEAD.
"Avoid cluttering the very beginning of the article with pronunciations or unusual alternative names". This is distinctly at odds with the wider guideline, LEAD.
"Medical statements are much more likely than the average statement to be challenged, thus making citation mandatory." At odds with LEAD, and based upon an unproven (and often inaccurate) assumption. Again, see example at Schizophrenia.
The final sentence now in MEDLEAD indicates why these deviations are being introduced: "To facilitate broad coverage of our medical content in other languages, the translation task force often translates only the lead, which then requires citations." So, to facilitate a non-en.wiki project, restrictions in medical articles that go beyond WP:V and LEAD are being added to MEDMOS.

This page is fully protected because of a separate, but related, dispute. An independent admin, not involved in adminning the separate dispute, is requested to add

{{Disputed tag|section=yes|talk=Lead}}

to the WP:MEDLEAD section (using the "section =yes" option), as it will be some time before the separate dispute can be resolved via RFC and the page unprotected. It is likely that a community-wide RFC will also be needed to resolve this conflict. SandyGeorgia (Talk) 19:54, 11 December 2019 (UTC)

PS, Barkeep49, who is adminning the pricing discussion, agreed that I should submit a separate edit request, see the section just above this one. SandyGeorgia (Talk) 19:57, 11 December 2019 (UTC)

SandyGeorgia, it would be helpful if you could make clear exactly what you would like the section to read as (maybe throw it in a collapsed section if it's long?) Best, Barkeep49 (talk) 20:33, 11 December 2019 (UTC)

Thanks, Barkeep49, but I was hoping to avoid asking an admin to revert, reinstate or otherwise get involved to help resolve the dispute-- just to tag the guideline to indicate that there is a dispute. If we were to revert to the last, undisputed wording, it would be to one where there was no section on LEAD at all; there is nothing in our current MEDLEAD that is not disputed and is in sync with LEAD. The table that is presented is related to the translation project, so not part of this guideline per se, and every addition there is disputed. The dynamic that led to the wording being retained was discussed at length in the ANI, which is why the disputes are related. SandyGeorgia (Talk) 20:48, 11 December 2019 (UTC)

SandyGeorgia, it is beyond doubt that this is disputed so I have added the tag. Guy (help!) 00:29, 12 December 2019 (UTC)

JzG, the over-worked admin corps appreciates your response, as do I. I added the "answered=yes" parameter to the template so another admin won't need to come by. SandyGeorgia (Talk) 00:55, 12 December 2019 (UTC)

SandyGeorgia, sure, I left it unanswered in case there was dispute but I don't think there is. Guy (help!) 09:36, 12 December 2019 (UTC)

Comment As Sandy indicated I thought it helpful for someone beyond me to respond to this request. I have looked into the matter and am happy to answer any questions you have or to serve as a second opinion as I remain UNINVOLVED. For reference I believe the key talk page discussion is here. In looking at the project page history, the dispute goes back to March of 2018 from best I can tell. Best, Barkeep49 (talk) 20:36, 11 December 2019 (UTC)

Barkeep49, the dispute actually dates to 2015, when the order of sections in all medical articles (even FAs) and their leads were altered. But ... I can't make WikiBlame (or the alternate) work today, so I can't find when the additions occurred ... I only know the LEAD section was first added in 2015, and that year corresponds with the end of FA production from a once very vibrant medical FA-writing community, because it became impossible to obey two masters (two different guidelines). Again, as mentioned at the ANI, it is an entrenched dynamic, that will probably require another community-wide RFC. SandyGeorgia (Talk) 20:54, 11 December 2019 (UTC)

I think that the specific edit that is being requested here is to add:

{{Disputed tag|section=yes|talk=Lead}}

just under the nutshell near the top of the page. Sandy, please correct me if I'm wrong.

For what it's worth, I think it's a reasonable request. --Tryptofish (talk) 21:31, 11 December 2019 (UTC)

Thanks, I fixed the template above (but not under the nutshell at the top of the page ... I am asking that it be added to the top of WP:MEDLEAD to single out that specific issue. I don't think we need to indicate the entire page is disputed, as we don't have editors adding prices now and that is under a general restriction until resolved. SandyGeorgia (Talk) 21:54, 11 December 2019 (UTC)

OK, with that clarification, the requested edit is as shown, but does not go where I said, instead going at the top of WP:MEDLEAD. (I confused one lead with another!) --Tryptofish (talk) 23:50, 11 December 2019 (UTC)

Further discussion

Oppose change — I don't understand how the above has been construed as an edit request, and frankly find it bizarre the section was tagged disputed.
I oppose points 1—5 above on the grounds that neither is anything in odds with WP:LEAD, and that which is stated as an "unproven and often inaccurate assumption" — is in fact reasonable and well-known. The example given is unconvincing, and the insistance on FA as the pinacle of our work is misleading. Having a corpus of 100 decent or good articles trumps 1 FA. Carl Fredrik^talk 22:26, 15 December 2019 (UTC)

You oppose that the section is disputed, yet your post indicates that there is a dispute?
I understand that you could be confused about how a disputed tag is used, because the norm on this page/project has not been to come to consensus on disagreements, but this is the usual process for addressing a disputed guideline. It ended up at editrequest because I couldn't add the tag myself due to the protection, but there is no doubt there is a dispute; adding a tag is uncontroversial.
The usual procedure is to discuss with each other to develop a consensus, while this page tends to devolve to "me, too" or "I don't like it" discussion, and then claim a consensus. I am willing to go forward with a community-wide RFC if we are unable to come to local consensus. I am intentionally not putting up the RFC (so far) while we are formulating a different RFC.
I understand that some editors have said they see no problem with choppy prose and poorly worded leads in medical articles; many others have expressed that the prose damage is a problem, and that the deviation from Wikipedia-wide guideline (LEAD) is also a problem. We can let the community decide: I would be surprised if the community endorsed a WikiProject Guideline that deviates from Wikipedia's broader guideline. But I would much rather that WPMED not have to bring two issues from one page to the community in a short timeframe. SandyGeorgia (Talk) 00:21, 16 December 2019 (UTC)

I contest that what has been written here justifies the tag, yes. I do not contest that someone may find it disputed. The text as it stands is long-standing and there is nothing to indicate that an interpretation of "general consensus" as opposed to "local consensus" justifies calling for a general dispute.

The norm is not to tag with disputed: that which has been discussed by hundreds of editors and is long-standing — when one or two editors (even policy-knowledgeable editors) calls it into question. Carl Fredrik^talk 06:54, 16 December 2019 (UTC)

@CFCF: There is nothing "long-standing" here. The disputed text is not even 4 weeks old.[16] It has also been added without establishing consensus first. Please read with more attention, including diffs. — kashmīrī ^TALK 09:33, 16 December 2019 (UTC)

Actually part of that text was added in 2015 and was based on this talk page discussion.[17] Doc James (talk · contribs · email) 23:55, 16 December 2019 (UTC)

Another discussion between five editors on a local guideline, discussing text that is at odds with a Wikipedia-wide guideline, and where one of the five dissented. Four editors are insufficient to install something that is not in accordance with a wider guideline. SandyGeorgia (Talk) 18:00, 17 December 2019 (UTC)

Regarding that which has been discussed by hundreds of editors and is long-standing, CFCF, could you produce an example of hundreds of editors supporting these accumulated additions to MEDLEAD? Alternately, could you produce a dozen? A Wikiproject guideline can not extend beyond a Wikipedia-wide guideline. Local "Me, too" and "I like it" supports are unhelpful in any case, but particularly insufficient to trump a Wikipedia-wide guideline page.

If you could please engage the five specific issues, we might be able to come to consensus without a centralized RFC to consult the broader community. SandyGeorgia (Talk) 18:00, 17 December 2019 (UTC)

This is not one of the many Wikipedia:WikiProject advice pages. MEDMOS is part of the site-wide MOS, and it is required to remain consistent with the rest of the MOS. It is also, as a part of the site-wide MOS, open to changes by people outside any WikiProject group. If WPMED wants to write its own advice pages, it can do so in the group's equivalent of a userspace essay. This particular page, however, belongs to the entire community. WhatamIdoing (talk) 06:11, 18 December 2019 (UTC)

RFC on MEDLEAD

Wikipedia:Manual of Style/Medicine-related articles/RFC on lead guideline for medicine-related articles
Limited engagement, stalled discussion, broader RFC launched. SandyGeorgia (Talk) 22:27, 22 December 2019 (UTC)

Treatment v. Management in infobox

We have agreement at MEDMOS that Management is sometimes preferred to Treatment, but we have an infobox that forces the term Treatment at {{Infobox medical condition}}. We have the same for Symptoms v. Characteristics. SandyGeorgia (Talk) 16:24, 13 January 2020 (UTC)

Do you think Management should have its own sections or just that the entry should allow both labels?AlmostFrancis (talk) 21:35, 13 January 2020 (UTC)

Hopefully, the parameter could toggle between Treatment/Management. If not, both options provided, so articles could choose one or the other. SandyGeorgia (Talk) 08:55, 14 January 2020 (UTC)

Changes to that infobox template are, in my experience, usually most successful when they're requested at the infobox's talk page. User:RexxS could probably make the change you want. WhatamIdoing (talk) 06:38, 15 January 2020 (UTC)

@Sandy and WhatamIdoing: Pinging also works. I've implemented the ability to use |management=. If the management parameter is used instead of treatment, the label changes to "Management". If both parameters are present, treatment overrides management. --RexxS (talk) 17:13, 15 January 2020 (UTC)

Cool beans, it worked! @RexxS: (I hate pingie-thingies almost more than I hate infoboxes :) SandyGeorgia (Talk) 17:18, 15 January 2020 (UTC)

@RexxS and WhatamIdoing: I moved Treatment of Tourette syndrome to Management of Tourette syndrome, did a lot of updates, and now there is a pending changes box at the bottom of the article, that apparently I can't deal with. I thought I had the appropriate pending change-thingie, but don't know what the deal is here. SandyGeorgia (Talk) 14:52, 16 January 2020 (UTC)

@Sandy and WhatamIdoing: Sandy: The article seems to have been under pending-changes protection for some years, so I would expect the PC to transfer with the page moving. Was there no box at the bottom of the article at its previous name? You have the Pending changes reviewer right, so you can manage the changes on the article. When you make an edit, you accept any pending changes because you have the right. The box at the bottom shows that the revisions up to the present are all accepted (you made the last edit), so there's nothing you need to do there as far as I can see. WAID: do you see the same box with [Accept revision] greyed out? --RexxS (talk) 15:42, 16 January 2020 (UTC)

User:RexxS, the dialog box at the bottom of the page offers me the option to "unaccept" User:SandyGeorgia's changes. Everything's done, and (like some admin buttons) the box is only visible to those of us who have the privs to use it. WhatamIdoing (talk) 20:09, 16 January 2020 (UTC)

Sometimes I amaze myself :) Well, at least I know how to correct a malformed FAC :) Thanks, RexxS and WhatamIdoing. SandyGeorgia (Talk) 20:13, 16 January 2020 (UTC)

[pmid11572966-1] Nestler EJ, Barrot M, Self DW (September 2001). "DeltaFosB: a sustained molecular switch for addiction". Proc. Natl. Acad. Sci. U.S.A. 98 (20): 11042–11046. doi:10.1073/pnas.191352698. PMC 58680. PMID 11572966. Although the ΔFosB signal is relatively long-lived, it is not permanent. ΔFosB degrades gradually and can no longer be detected in brain after 1–2 months of drug withdrawal ... Indeed, ΔFosB is the longest-lived adaptation known to occur in adult brain, not only in response to drugs of abuse, but to any other perturbation (that doesn't involve lesions) as well.

[Nestler2-2] Nestler EJ (December 2012). "Transcriptional mechanisms of drug addiction". Clin. Psychopharmacol. Neurosci. 10 (3): 136–143. doi:10.9758/cpn.2012.10.3.136. PMC 3569166. PMID 23430970. The 35–37 kD ΔFosB isoforms accumulate with chronic drug exposure due to their extraordinarily long half-lives. ... As a result of its stability, the ΔFosB protein persists in neurons for at least several weeks after cessation of drug exposure. ... ΔFosB overexpression in nucleus accumbens induces NFκB

[3] Juurlink, David N.; Dhalla, Irfan A. (2012-12). "Dependence and Addiction During Chronic Opioid Therapy". Journal of Medical Toxicology. 8 (4): 393–399. doi:10.1007/s13181-012-0269-4. ISSN 1556-9039. PMC 3550262. PMID 23073725. {{cite journal}}: Check date values in: |date= (help)

[4] Juurlink, David (August 8, 2018). "Tox and Hound – Dependence Isn't Addiction, But It's Still A Problem". emcrit.org. Retrieved 2019-05-21. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)

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Wikipedia talk:Manual of Style/Medicine-related articles/Archive 10

Not writing for patients or professionals

Digression: simple.wikipedia.org

LEAD redux

Why avoid "See also" sections?

Placement of addiction, dependence and withdrawal

1) Section on "side effects"/"adverse effects"

2) Section on "overdose"

3) Place in its own section

4) Place both "overdose" and "addiction" under "adverse effects"

5) Either "Overdose" or "Adverse effects", depending upon the drug as per the original proposal

Discussion

Proposal: restructuring the layout of drug articles for drugs with an addiction liability

Alternate proposal

Idiosyncratic language and agenda pushing

Expert consultation

About face

Example: eyes needed

Abortion - definition conflict with Unsafe Abortion

Coatracks and tangents

DMOZ/CURLIE

Proposal for edit request (2)

Archiving

Treatment/management

Proposal for editrequest (1)

Lead

Another disputed section

Fully protected edit request for MEDLEAD

Further discussion

RFC on MEDLEAD

Treatment v. Management in infobox

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