Wikipedia talk:Manual of Style/Medicine-related articles/Archive 6

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Categorization guidelines

Currently, MEDMOS does not provide any help with article categorization. The only guidance is to put the article in "the categories it belongs in, but use the lowest appropriate sub-level." This is woefully inadequate, and assumes the existing categories are appropriate as they stand. Therefore, I propose that we add guidelines for categorizing articles. I recommend adding subsections to the "Categories" section, similar to the "Sections" section. If existing commonly-used classification schemes exist, these should be the guidelines to follow. For example, drugs should be categorized according to the Anatomical Therapeutic Chemical Classification System, and diseases according to ICD-10 classification. --Scott Alter 19:30, 27 March 2010 (UTC)

This seems to be in response to Immunize (talk · contribs) and his drive to categorise everything atomically. I think ICD-10 isn't a bad way to structure categorisation. Categories should have at least 20 or so articles in them to be of any use. JFW | T@lk 20:32, 27 March 2010 (UTC)

Don't forget the navigation boxes that appear at the bottom of articles (e.g. stiripentol). I thought these also added the relevant category but perhaps I'm mistaken. We have nav boxes for the ATC drugs, for example.

I'm not clear what "subsections" you think should be added below the "Categories" section. I wouldn't want this guideline to try to list lots of categories: it would be more useful to describe the category systems already externally defined (the two you mention, for example). Perhaps we need a "Medical categories" task force in Wikipedia:WikiProject Medicine where changes and additions to the category system can be developed and discussed.

IMO categories should be kept simple, obvious and relatively big. However, the job of categorisation is hard. Fancy and over-precise categories should be avoided in favour of discussing groups of things in body text. Categories have no context, no levels of degree, can only apply to whole articles, and are impossible to precisely source with an inline citation.

Maybe if such a task force manages to formulate how WP should best categorise medical topics, it can then propose some guidelines be included here. Colin°^Talk 20:43, 27 March 2010 (UTC)

For (perhaps non-psychiatric) diseases and disorders, we could largely follow the International Statistical Classification of Diseases and Related Health Problems' ICD-10 system.

To use cancer as an example, that should give us seventeen major categories (e.g., "Malignant neoplasms, lip, oral cavity and pharynx", known to our non-physician readers as Oral cancers), mostly by organ system.

As a general rule, I favor cat names that are in plain English, because the purpose is to help people find articles, not to help people learn what the medical names are. If they can't find it, they can't learn about it. Additionally, non-disease pages end up in medical cats (e.g., editors add [[Category:_____ disease]] to articles about disease-specific charitable organizations), so the formal name can provide a false sense of medical authority.

I also prefer the cat system to be designed so that normally about 50-200 diseases apply. It's small enough to be scannable, but large enough that you can actually find things without clicking through a bunch of pages (especially important for our audience, which is not presumed to know exactly how a physician would classify a given condition). I think we should definitely avoid cats that are so narrow that only a dozen diseases are included (except perhaps in truly unusual situations). As an example, I'd support a cat under Category:Blood disorders that is "Blood cancers" (which currently exists, if you happen to have enough education to know that "Blood cancers" is spelled "Hematologic neoplasms" in medicalese). I'm on the fence about retaining Category:Leukemia (population 36) -- IMO it's a little small -- but I would probably delete the newly created Category:Acute leukemia (population 13, and every single one containing "acute" and "leukemia" in its title), and I would very strongly oppose creating a subcat, "Acute B-cell leukemias" (population estimated to be two pages).

Kilbad has done an enormous amount of work with WP:DERM:CAT. There might be some advantages to letting task forces handle their specialties. WhatamIdoing (talk) 21:01, 27 March 2010 (UTC)

The poor categorization has always bothered me, and Immunize (talk · contribs)'s categorization drive has prompted me to become more involved. I then discovered that דוד55 (talk · contribs) has been slowly and quietly creating ICD-10-based categories since last October. In the past few days, I created {{ICD category}} and have been working on categorization.

The navboxes do not (and IMO should not) automatically categorize articles. The navboxes for diseases are already roughly based on ICD classification, so categorization should not be too difficult.

By subsections, I just mean that the section should be separated by type of article. I don't think subheadings need to be used - perhaps just ";". There absolutely should not be a list of categories in MEDMOS. Here's a rough example of what I am proposing:

Diseases or disorders or syndromes

Diseases/disorders/syndromes should be categorized within Category:Diseases and disorders by their ICD-10 code(s). These articles should not also be categorized by medical specialty if they are properly categorized in a lower-level subcategory.

Drugs

Drugs should be categorized within Category:Drugs by target organ system based on ATC code. Drugs can also be categorized by mechanism of action in Category:Drugs by mechanism of action and by physical structure.

Having a sentence or two for each article type may even be sufficient without further expansion. Other article types could just mention where the high-level categories are (eg Medical specialties in Category:Medical specialties, etc). Using externally defined classification systems should make categorization relatively easy. Of course categories should apply to entire articles and not be overly precise. WHO's ICD and ATC classification schemes seem to be more appropriate than our current lack of organization, yet not too specific as to have many categories with very few articles.

I don't think a separate "categorization task force" needs to be created if a guideline is implemented here. While this was done somewhat successfully for WP:PHARM and less so (IMO) for WP:DERM, I don't think it is also necessary for WPMED. The discussion in WP:PHARM went on for months with debates over extremely minor things and little progress. I initially decided not to get involved with the discussion because the minor details don't matter much to me. Ultimately, after I made a comment like "let's stop talking and start doing something...we can fix things later," progress was finally made. The "categorization task force" of WP:PHARM has been left abandoned since. With WP:DERM, Kilbad (talk · contribs) mostly uses the "derm category task force" as an ideal categorytree for dermatology. Kilbad mostly created that structure on his own without much collaboration from others (not that it wasn't welcomed, but I don't think there are many other derm people in WPMED). Now, Kilbad continuously monitors that page and all the derm categories to make sure they stay as designed. While I like the idea of delegating category structures to the task forces, most do not have a person like Kilbad to get things done and stay on top of them. Also, if there is no one to maintain a "WPMED category task force," why bother making it? I would gladly be involved in the creation of the actual categories, but I won't be watching every single one and maintaining an identical listing on a WP page. Though there may be occasional category name discussion (which could be done at the related specialty's task force), the only thing that maybe should be discussed is if WPMED agrees to use the ICD-10 as the basis for categorization.

While specific content does not need to be discussed here, I am in favor of using common English over medicalese. (Even though it was me that created "Hematologic neoplasms" and other more medical than necessary names in the past few days...I'm not sure lymphoma is considered a "blood cancer," whatever that is! I am in the opinion that something is better than nothing, and if someone disagrees, things can be changed later.) --Scott Alter 22:25, 27 March 2010 (UTC)

I'm not dedicated to the particular example, and I admit that reading "blood cancer" occasionally makes me twitch (lymphoma is not a carcinoma, and carcinomas are the One True™ cancer ;-), but it's far more accessible to non-professionals, and IMO the cats aren't for people who already know the name of the disease. WhatamIdoing (talk) 00:33, 28 March 2010 (UTC)

Sarcoma and Colitis

I have created 2 more categories, Category:Sarcoma and Category:Colitis. Immunize (talk) 14:37, 27 March 2010 (UTC)

Kidney cancer

I have now also created the category Category:Kidney cancer, however just after it's creation I realized that there were benign kidney tumors that needed a category more specific than Category:Kidney diseases, which is what they are in, and that by naming this category "Kidney cancer" I was excluding these articles on benign renal neoplasms from having there categorization improved. I briefly considered proposing a renaming kidney cancer kidney tumors, but I have now decided that the best course of action would most likely be creating a new category, Category:benign renal neoplasm, and then having both Category:Kidney cancer and Category:Benign renal neoplasms as a subcategory of Category:Kidney diseases. I plan to start work on Category:Benign renal neoplasms immediately. Please let me know of your opinions on the matter. Best wishes. Immunize (talk) 17:53, 27 March 2010 (UTC)

Disease subheadings

I have added definitions as an option to the classification heading. Some diseases simply need to be defined.Doc James (talk · contribs · email) 03:05, 23 April 2010 (UTC)

MoS naming style

There is currently an ongoing discussion about the future of this and others MoS naming style. Please consider the issues raised in the discussion and vote if you wish GnevinAWB (talk) 20:57, 25 April 2010 (UTC)

RFC which could affect this MOS

It has been proposed this MOS be moved to Wikipedia:Subject style guide . Please comment at the RFC GnevinAWB (talk) 20:52, 24 May 2010 (UTC)

I have no issue with this proposal.Doc James (talk · contribs · email) 21:55, 27 May 2010 (UTC)

As far as I can make out, the practical effect of this proposal is to change the names of about 30 pages, and to pretend that this name change has improved their contents. WhatamIdoing (talk) 22:44, 27 May 2010 (UTC)

Can we please keep our comment to the RFC please and no one apart from you is claiming the this name change will improve their contents but it will automatically improve the MOS 23:04, 27 May 2010 (UTC)

On the grounds that if you rename 'plutonium' to 'friendly metal', that there's less plutonium in the world? Or is the point that renaming long-standing sections of the MoS will improve the average quality of MoS pages, while equally decreasing the average quality of non-MoS pages?

It's true that transferring a bad employee to another department improves the average skill of your department, but it doesn't help the overall company as much as either training the employee or replacing him with a skilled employee. WhatamIdoing (talk) 23:13, 27 May 2010 (UTC)

As I said no need to have 30 discussion when 1 will do. Can we keep this at the RFC Gnevin (talk) 23:16, 27 May 2010 (UTC)

I look forward to your explanation on the other page of how renaming pages will improve the content of Wikipedia's advice pages. WhatamIdoing (talk) 23:59, 27 May 2010 (UTC)

Notable cases

Well I do not think notable cases should really be part of article if they are included it should be part of a section on society and culture IMO.Doc James (talk · contribs · email) 21:55, 27 May 2010 (UTC)

These sections are unfortunately popular with the victims of our celebrity culture. I'd be happy to see a note discouraging their use, but I think it would be more useful to strictly enforce a requirement for inline, BLP-quality sourcing. WhatamIdoing (talk) 22:44, 27 May 2010 (UTC)

Agree Doc James (talk · contribs · email) 22:58, 27 May 2010 (UTC)

The inclusion should not be based on "did someone famous have this condition" but rather on "did someone's fame have a significant impact upon this condition or perceptions about it" as does occur. Rock Hudson and Magic Johnson changed the stigma around AIDS. Christopher Reeve changed spinal chord injury research. Michael J. Fox changed Parkinson's disease research. Ronald Reagan changed perceptions about Alzheimer's disease. Lou Gehrig, Stephen Hawking and Sue Rodriguez all changed the way Amyotrophic lateral sclerosis is seen. LeadSongDog come howl! 19:06, 7 June 2010 (UTC)

While I agree that disease articles shouldn't be dumping grounds for trivia of any sort, LeadSongDog has done remarkably well to list as many "significant impact" names. Nearly all diseases have none. And those listed names are largely only significant in the US and to a lesser extent the UK. And to a certain generation. And even then I doubt some of those names really did have an impact on the condition/perceptions. WP:WEIGHT serves us well without inventing rules whose only real purpose is to heavily restrict trivia via an arbitrary and ultimately subjective criteria. Colin°^Talk 21:38, 7 June 2010 (UTC)

My intent was twofold. First, that there's no point in listing people just because they are sick and well known. It contributes nothing to understanding of the topic once we acknowledge that fame is not a vaccine against (whatever). Second, that it can be shown in reliable sources that certain famous people have made taboo topics legitimate for discussion in polite company. The Rodriguez case in the Supreme Court of Canada had Canadians discussing assisted suicide at their dinner tables (although she wasn't famous beforehand). Fox, Reeve, and Gehrig are all examples of people whose conditions effectively ended the careers that made them famous who then turned their personal losses into tools for funding research. People with those conditions look to them as examples of how to perservere and maintain some kind of constructive life. I wouldn't say this necessarily made them worth including, but I am quite sure it should put them higher up any priority list than someone whose only connection with the condition is that they had it. LeadSongDog come howl! 16:05, 8 June 2010 (UTC)

I'm sort of saying that the above criteria is a surrogate for the standard WP:WEIGHT argument. We don't mention X (that so-and-so had such-and-such) in an article on topic Y unless reliable sources consider the mentioning of X important when discussing topic Y. However, that same factoid might legitimately appear in the article on person X or in a standalone list of notable people with Y. What is considered trivia varies depending on the context. 90% of Wikipedia is trivia. We have lists of TV episodes and discographies of bands who have released a few downloads. There's room for them all in their place. Writing List of poliomyelitis survivors taught me more about polio's effects on people's lives than reading the article. Based on some messages I've received about it, I think many readers are informed and moved by it. As you say, people with those conditions look to famous names for some inspiration or lesson (which is why nearly all charities publish names of famous people with X and try to recruit them for publicity). So I don't think it "contributes nothing to understanding of the topic". You aren't going to find a published source about people's lives/illnesses unless they are famous and your general reader is more likely to take interest in the story of someone's life/illness if they are famous. That's just the way the world works. Colin°^Talk 21:37, 8 June 2010 (UTC)

Lifting text from your medical textbooks

In the Signs of writing for (other) healthcare professionals, it was mentioned "You are tempted to lift text from your medical textbooks". However, I don't see why this belongs here. To list, in the sense of To steal, is rather a matter of copyright, and is an issue not specific for medicine-related articles. And still, medical textbooks are not necessarily written in a style as if writing for (other) healthcare professionals, and I doubt using them as sources should be totally discouraged. As long as the other advices are there in order to adapt any text taken from textbooks to the recommended style here, this discouragement seems unnecessary.

Yet, I have no direct objection to the presence of the equivalent "You are tempted to lift text from a patient information leaflet or website." in Signs of writing for (other) patients. However, it needs specification about the issue in using them, because they may work, if they are otherwise reliable sources and are adapted to the recommended manual of style. Mikael Häggström (talk) 06:20, 7 June 2010 (UTC)

Research directions

About this change, which discourages information about research:

Previous	New
Research directions (if addressed by significant sources; see Trivia, and avoid useless statements like "More research is needed")	Research or Research directions - avoid if possible; Before including a section of Research or Research directions, it should first be considered if the entries could fit into another section. For example, recent research in new treatments of a disease is more conveniently found in the Treatment section. Also, significant sources should be used. Useless statements like "More research is needed" should be avoided. see Trivia

First, I think that the suggestion to put a description of treatment-related research (including basic, pre-clinical, and clinical testing) into a ==Treatments== section is a bad option. "Something interesting happened when John Smith poured a chemical on some cells in a petri dish" is exactly what we don't want in a Treatment section.

Second, if sources are writing papers like "Whither research in ____?" and "The future of research on ____", then we probably should give that subject its own section. WhatamIdoing (talk) 17:26, 7 June 2010 (UTC)

Agree with WhatamIdoing. I very much oppose the idea of including experimental treatments or research that may lead to treatments within a section called Treatments. Let's leave that to treatments with evidence both of efficacy and of recommended clinical use. WP:WEIGHT is our friend in judging whether a section on research is warranted. What weight do reliable sources give to the topic of research when discussing X? Colin°^Talk 21:41, 7 June 2010 (UTC)

I agree with the above two and frequently removed research from the treatment section. Most of it is uses primary studies rather than reviews for evidence and most of the time does not belong on Wikipedia. The few times it does it should be in its own section per WP:DUE. Research means it is not currently in use thus not currently a treatment.Doc James (talk · contribs · email) 05:28, 8 June 2010 (UTC)

I agree with WhatamIdoing, Colin and Doc James: see Tourette syndrome#History and research directions and PMID 16131414. I have removed the undiscussed changes (which also included unnecessary mention of plagiarism). SandyGeorgia (Talk) 09:13, 8 June 2010 (UTC)

In special populations

Pediatricians always emphasize that children are not just little adults. In the obesity article we have a subsection labeled "Childhood obesity". Wondering if we should add a note recommending placement of this type of section around the "In other animals" section? Other possibles could be "In pregnancy". If these subsection become too large they could be split off into a sub article just leaving a summary. This would prevent small stubs related to diseases in special sub populations with no linkages to the rest of the encyclopedia and address the query here [1]. I have changed it to what I propose feel free to revert if you disagree. Doc James (talk · contribs · email) 17:02, 8 June 2010 (UTC)

Children can be badly behaved but I wouldn't go as far as to equate them with animals. :) I think animal should be deleted from special populations and elderly added in its place. There may be an argument for adding veterinarian section?--Literaturegeek | T@1k? 18:09, 8 June 2010 (UTC)

Agree. Doc James (talk · contribs · email) 18:29, 8 June 2010 (UTC)

In normal English usage, "children" is a proper subset of "humans", which itself is a proper subset of "animals". So while all children are animals, not all animals are children. The disjoint set of "animals that are not human children" can only be named "other animals" at the risk of causing mild confusion: it implies adult humans are "other animals". Of course even the term "animals" causes confusion: some persist in conflating its meaning with "mammals". Since we share many diseases with birds, and even some with reptiles and fish, it is probably simpler to use "non-human" as the generic alternative. LeadSongDog come howl! 18:16, 10 August 2010 (UTC)

I agree with you technically "non humans" would be better. But colloquially everyone knows what other animals means. Both IMO are appropriate.Doc James (talk · contribs · email) 20:25, 10 August 2010 (UTC)

Section ordering: History and Etymology should be ahead of clincal sections

History and Etymology should be the first sections of medicine articles, so that the topics are put in the appropriate critical perspective. This is a standard practice for all the other wikipedia articles, and medicine more than other fields should adhere to this rule, as the debated nature of some of its topics is in particular need for historicization.

An emblematic example is the the article on schizophrenia‎, where right now first prominence is given to an acricital exposition of the controversial definition of the DSM manual, without an historical premise that would put the subject into perspective. This is a problem with all the articles on psychiatry, as it's a field of lesser scientificity than other branches of medicine.

Another point raised in the archived discussions is that "these non-clinical sections often are omitted from clinical reference books, but they are the content that scientists find most interesting. They are arguably what also general readers find most interesting and make Wikipedia so brilliant." (by User:Una_Smith )--Sum (talk) 13:24, 1 August 2010 (UTC)

I think I disagree. The historical context about diseases is interesting, and Wikipedia's great strength is that many medical articles have fairly good history sections, but usually they provide very little information that is directly relevant to the interested reader. I think it is much more important that the reader understands the nature of the disease (symptoms, pathophysiology, diagnostic features) before we start tracing its history back to Hippocrates or Boerhaave or Charcot. JFW | T@lk 17:21, 1 August 2010 (UTC)

With regards to etymology I think it might be appropriate to discuss this early on, although it might be just as easy to lay the groundwork in the introduction and leave the actual discussion for the relevant section later on in the article. JFW | T@lk 17:22, 1 August 2010 (UTC)

I disagree. Most history sections say something like, "This infectious disease was first described in 18xx by John Smith, shortly before the famous description by Robert Jones in his magnum opus, Diseases of the Rich. The initial treatment, which was cutting off the hair and bathing the temples with alcohol, was superseded first by sulfa drugs, and then by antibiotics." The reader doesn't need to know anything about the history to understand the rest of the article.

There are certainly some articles that are best served by leading with the history, but these are the exception rather than the rule. WhatamIdoing (talk) 21:24, 1 August 2010 (UTC)

I think some articles benefit from the history section coming first and others with the history section coming last. I feel that it takes some editorial judgement on a case by case (article by article) basis, on whether the history is notable and interesting to the reader.--Literaturegeek | T@1k? 21:41, 1 August 2010 (UTC)

Wikipedia articles on diseases and conditions need a consistent format so that those who frequently use this source automatically know were to find content and what sections to expect. I think the current layout is good and as we have thousands of article that follow it I think any changes to policy should only be done after extensive consideration.Doc James (talk · contribs · email) 23:26, 1 August 2010 (UTC)

Prevention

While I am usually for following MEDMOS closely I propose a exception for the section on prevention when it deals only with secondary prevention. Secondary prevention is only needed after treatment and thus should come after treatment while primary prevention should come before treatment as we have it now. Doc James (talk · contribs · email) 09:24, 15 August 2010 (UTC)

I agree that this is a sensible variation, but I don't think it's necessary to mention it explicitly. WhatamIdoing (talk) 17:01, 15 August 2010 (UTC)

Genes and proteins

Can we get a cheat sheet here for the text conventions associated with genes, proteins, species, and any other things that might normally be put in italics or all caps, etc.? WhatamIdoing (talk) 17:28, 27 August 2010 (UTC)

Risk factors

Risk factors should be discussed around the same area as causes as the two often overlap. Except age distribution and gender ratio of those affect which should be discussed under epidemiology.Doc James (talk · contribs · email) 16:30, 15 September 2010 (UTC)

Sounds right to me. SandyGeorgia (Talk) 16:35, 15 September 2010 (UTC)

To further differentiate risk factors and epidemiology it should be also made clear that risk factor section should discuss only factors where a causative relation is suspected whereas epidemiology section can include any sort of correlation (eg PMID 7473816 linked from breast cancer calls income a risk factor which is something I would rather avoid). If in doubt it should be called "epidemiology and risk factors":) Richiez (talk) 19:02, 15 September 2010 (UTC)

Agree that risk factors are difficult as some are more similar to causes well others are epidemiological factors. WRT wealth I do not have a strong feeling were it goes. I guess it depends how it is presented. If one discusses wealth as it effects incidence than epidemiology. If one comments that wealth possible decreases factors more closely related to breast cancer than under causes but it is a judgment call.Doc James (talk · contribs · email) 22:37, 15 September 2010 (UTC)

Biographies of medical professionals

When writing about notable doctors, nurses, researchers etc., are there any specific style guidelines in addition to the "standard" MOSBIO and BLP guidelines?

I'm asking because I have started an article about Karin Muraszko. She is notable for being the first ever female professor of Neurosurgery at any medical school in the US and also for the fact that she herself has a neurological impairment, spina bifida. Roger (talk) 21:35, 25 October 2010 (UTC)

No, this page doesn't really cover that type of article. If there's any significant information about the scientific work the person has done, then you might like to look at WP:MEDRS for advice on identifying good sources. (You wouldn't, for example, want to write about a notable pharmaceutical employee and use only the company's marketing materials to describe the value of the employee's work, after all.) But for a WP:PROF, that kind of issue may not be very relevant. WhatamIdoing (talk) 17:23, 26 October 2010 (UTC)

Thanks. I'd really appreciate an editor with experience of such articles taking a look at what I've done so far and pointing out any problems or giving me tips on expanding the article. It's my first BLP and Medical article so I'm feeling a little out of my depth. Roger (talk) 20:28, 26 October 2010 (UTC)

"Classification"

In the standard section ordering, "classification" or "definitions" is placed at the top, right below the introduction. I rarely use such sections, and if I do they are usually much more appropriate further down in the article, when the relevant concepts for clinical presentation, pathophysiology and diagnosis have been introduced. If you need to make definitions to make the article readable, they should usually be introduced in the intro.

Can anyone think of a situation where a "classification" section is relevant in this position? If not, can we move the section down to a more sensible position? JFW | T@lk 13:47, 21 November 2010 (UTC)

Asperger syndrome, Tourette syndrome, Osteochondritis dissecans, Poliomyelitis, Tuberculosis, Acute myeloid leukemia, Oxygen toxicity, Multiple sclerosis Influenza and Lung cancer have Classification at the top. Autism and Subarachnoid hemorrhage have it further down. MEDMOS does not actually specify a "standard section ordering" and the text shouldn't be implying there is a standard IMO. We already say "Establishing the forms of the disease (Classification) can be an important first section. However, if such classification depends heavily on understanding the etiology, pathogenesis or symptoms, then that section may be better moved to later in the article." Colin°^Talk 14:36, 21 November 2010 (UTC)

I have sometimes placed the classification of degrees of a condition in the diagnosis section. Classification used as an introduction to where a disease fits among other similar diseases is sometimes helpful at the start. Doc James (talk · contribs · email) 15:18, 21 November 2010 (UTC)

I think it depends on the type of article. It's important for major disease groups—Diabetes mellitus should have this—and usually omitted in specific diseases (e.g., no point in ODDD). WhatamIdoing (talk) 18:10, 21 November 2010 (UTC)

Does the answer not depend on the topic? In some cases we have syndromes of diverse or uncertain cause, in other cases we have a collection of effects from a single, identified cause. Compare Alzheimer's disease to Human immunodeficiency virus. I'd suggest this should be left to editorial judgement, with perhaps some guidance.LeadSongDog come howl! 14:56, 14 December 2010 (UTC)

Anatomy

I have added a section called society and culture to anatomy as when sexual anatomy is discussed this is fairly applicable. Wondering if we should move Etymology to this section? Doc James (talk · contribs · email) 10:15, 14 December 2010 (UTC)

I would include it in society and culture.--Garrondo (talk) 11:44, 14 December 2010 (UTC)

Defending against rule creep

About this: You all know that "____ is good" easily turns into "____ is required", and we have an ongoing problem with GA reviewers demanding FA-quality citation formatting. If we say "It's good to follow an established style" or "Consistent formatting is good", this will be turned into "I refuse to pass articles for GA unless you jump through these hoops." We're working on it over at GA (culture changes take a long, long time...), but in the meantime, it would be helpful if we didn't go beyond CITE. WhatamIdoing (talk) 22:51, 20 November 2010 (UTC)

WP:CITEHOW says "Citations in Wikipedia articles should be internally consistent." so we're not going beyond the other guideline. Also, I don't think guidelines should refer to FA criteria as that's backwards. I've revised the text in keeping with CITE and dropped the FA bit. I'm not that familiar with GA, but having just looked at WP:WIAGA, I'm a bit puzzled why they only require certain bits of MOS and that they only refer to the WP:Scientific citation guidelines rather than the general WP:Citing sources. A strict reading of those criteria would appear to suggest WP:CITE and WP:MEDMOS/WP:MEDRS aren't relevant to a GA. I'll add a comment over there. Colin°^Talk 08:46, 21 November 2010 (UTC)

I think most medical GA candidates would not pass if they were blatantly non-MEDMOS/MEDRS. JFW | T@lk 09:25, 21 November 2010 (UTC)

Just a drive-by comment: rule creep can be a problem; but it can also be used as a smoke-screen against improving the standards of language and formatting (especially of consistency). Tony (talk) 10:38, 6 February 2011 (UTC)

Copyright

This page doesn't address copyright issues at all. Apparently we had to clean up major copyright violations with the DSM a while ago. It seems that editors didn't realize that the diagnostic criteria are copyrighted material. I was thinking about mentioning that issue here, specifically using the DSM as something that is definitely copyrighted. Does anyone have ideas about how/where to include this? WhatamIdoing (talk) 04:14, 7 January 2011 (UTC)

This seems to be less of a style issue and more of a WP:MEDRS-related concern. There have been similar issues about Mini-mental state examination. JFW | T@lk 13:51, 7 January 2011 (UTC)

Given the scale of the problem, I'm thinking that mentioning it on both pages might be appropriate. WhatamIdoing (talk) 23:09, 23 January 2011 (UTC)

On avoiding medical advice

User:Kainaw/Kainaw's_criterion is intended for the reference desk, but it looks like it might be an interesting link for this page. I'm a little concerned ab out it, because it looks like the user self-declared it to be a guideline last spring, but the content is not unreasonable. What do you think? WhatamIdoing (talk) 23:08, 23 January 2011 (UTC)

Other than the somewhat revisionist language (reading it, I infer that one user finally solved an age-old problem) I think the content is useful. It's useful because the problem still isn't solved. -- Scray (talk) 19:29, 7 February 2011 (UTC)

Punctuation

Proposal

Related to the current page-move discussion at WT:MED, and thinking back to the regular discussions about Down vs Down's syndrome, perhaps we should address that issue directly at WP:MEDMOS#Naming_conventions. Here's my first proposal:

The medical literature has not adopted a single convention for hyphens and possessives in the names of medical conditions. When considering alternative names, follow the use established by high-quality sources (e.g., the widely used red blood cell count, not the grammatically normal red-blood-cell count). When the sources are significantly divided (e.g., Down syndrome vs Down's syndrome), follow the choice of the article's first significant contributor.

What do you think? WhatamIdoing (talk) 22:23, 5 February 2011 (UTC)

Where's the medical-specific aspect of this guidance? A "red blood cell count" isn't a "medical condition". It is just a measurement. Surely these issues apply in surveying, astronomy or cooking? And I'm not over-keen on replicating ENGVAR's rather arbitrary and clumsy dispute-resolution guidance to other matters. Colin°^Talk 23:31, 5 February 2011 (UTC)

Agree with WhatamIdoing in general, but when sources are divided, ICD-10 and ICD-O will usually be more appropriate than the title from the article's first significant contributor. --Arcadian (talk) 23:47, 5 February 2011 (UTC)

Colin, can you think of another field that gets complaints about whether an eponymous entity should have the possessive based on whether or not the person it is named for personally experienced the entity in question (vs describing it in other people)?

The fact is that we get these questions, at a rate of about once a year, and other fields (as far as I can tell) don't. WhatamIdoing (talk) 01:08, 6 February 2011 (UTC)

I agree with Arcadian. Axl ¤ [Talk] 09:16, 7 February 2011 (UTC)

That works for me, but what if the major international sources are divided? Imagine, for example, that the DSM and the ICD conventions are opposed, or even that they don't exist (ICD covers only diagnoses, not procedures). WhatamIdoing (talk) 19:22, 14 February 2011 (UTC)

Hyphens

I think both sides in this debate have valid arguments in their favour. I agree that the hyphenated form is grammatically correct. I suspect some of the reasons for dropping it are ignorance (don't add what you don't understand) and possibly a fear that naive computer-based searches would be unable to find the words if hyphenated. I found a Style Guide and Reference for Medical Transcriptionists that had alternative rationale: that some sets of words are so frequently strung together in the literature that they are recognised as being a single term rather than a phrase the writer has conjured up (and so must use hyphens to aid understanding). The difficulty is of course that our readers aren't so familiar with the term and may stumble on it as Tony/kwami point out.

I'm persuaded by WhatamIdoing's argument that these terms have become almost proper nouns (like the above style guide). They label one thing that the medical community talks about (e.g. small cell carcinoma vs non-small cell carcinoma but never little cell carcinoma or tiny cell carcinoma). The adjective isn't just an arbitrary choice by the writer, who must use exactly the right adjective or else nobody will know that they mean. That the medical community have decided to drop the hyphen will annoy those who respect grammar's rules, but Wikipedia is not the place to change the world.

I prefer when we defer to a fixed standard like ICD rather than debating the merits ourselves or doing Google searches to try to see which is most common. But if there isn't some official source for all of these terms, then I guess searching Google Scholar or PubMed is a reasonable way to see which is generally preferred. I still don't see this as a particularly medical issue but is possibly more common in a field like medicine where one must frequently invent new terms. Surely other sciences have this problem too? Colin°^Talk 09:33, 6 February 2011 (UTC)

Colin, I think your second guess is correct: hyphens are dropped from familiar expressions. And of course to many of our readers they are not familiar as they are to the readers of medical journals. I find it relevant that medical journals tend to drop hyphens, whereas medical reference works are more likely to include them. WP, of course, is more like the latter.

Also, frequency isn't the only consideration. WP:COMMONNAME specifies that there are several criteria for choosing a good article name, and frequency in RSs is only one of them; where several forms are used in RSs, we should also consider accuracy and clarity. Now, a naive reader coming across a small cell carcinoma will parse it the same as they would a small lung tumour; heck, I automatically parse it that way and I should be used to it by now. Thus the hyphen plays a useful role. In some of the other articles I would be happy with the hyphen as an alternate spelling in the lede (e.g. "A basal cell carcinoma or basal-cell carcinoma is a ..."), but in the case of a name that will cause readers to misunderstand it if it is illogically hyphenated like small cell carcinoma, it is only responsible for us to use the unambiguous form as the title of the article.

As for the idea that these are set names, the words in them are set, but the punctuation is certainly not. "Small-cell carcinoma" is in fact common. And a set phrase is not the same as a proper name. "Up-stairs" is a set phrase in English (you can't call it "above-the-stairs"), but that doesn't make it a proper noun. In any case, even if it were a proper noun, the hyphenated form is accepted in the medical lit, esp. in reference works. — kwami (talk) 10:00, 6 February 2011 (UTC)

As I have just said here, " let's remember that WP ... is read on monitors and by people all over the world, of all varieties of English, and of many second-language backgrounds; it addresses a generalist audience more than medical specialty publications." Following the normal rules of hyphenation is even more important, when the readership is not confined entirely to specialists, then in normal text. Medical text, like the text of many scientific areas, abounds in compound nominal groups that are difficult to parse if you don't see them every day. Not only difficult: potentially ambiguous. So the practices of hard-copy in-house academic journals are only one reference-point. WP has a unique readership under very different conditions from those of medical journals. Hyphenation is an important device for easing the burden of comprehension by non- and semi-experts. Thanks to Colin for alerting us to this thread, at the location linked to above. Tony (talk) 10:36, 6 February 2011 (UTC)

I am sympathetic to the argument. But even lay publications have yet to adopt such practice. The Guardian and New York Times both rarely hyphenate. Patients in the UK seeking help from Cancer Research's website won't find it hyphenated either (here and here). MacMillan also (here and here). The NHS also (here and here). I could go on. I think this is an example of trying to use Wikipedia to fix the world. Colin°^Talk 14:22, 6 February 2011 (UTC)

But clarity isn't an attempt to fix anything, it's just an attempt at reader understanding. As a general rather than specialized reference, we should make every attempt at making our articles accessible. If that means introducing the precise form and then continuing with the more common unhyphenated form, so the reader is exposed to both, that would be fine.

Searching "small cell" without "non-small" in GoogleScholar,[2] 6 out of the top 10 hits hyphenate, as do 19 out of the top 30. This includes prestigious journals like Nature.[3] (An GoogleBooks with previews,[4] the percentage is smaller, with 8 hits out of the top 30.) This is exactly the kind of situation that WP:COMMONNAME addresses: two forms are common, but one is more accurate and clear. — kwami (talk) 23:53, 6 February 2011 (UTC)

I agree with Kwami. Tony (talk) 01:21, 7 February 2011 (UTC)

I really do wish people wouldn't count Google search results in an effort to prove some point. Google's purpose is to return promising web links in its first page of results. Beyond that, it really couldn't give a damn. It is not a research tool for counting word usage. Google Scholar frequently repeats books and articles in its results. Let's look at the figures using a real research tool. If one searches PubMed for '"small cell"[Ti] NOT "non-small"[Ti]', expand the results to the first 200 and then use IE to count the word occurrences of "small-cell" and repeat 10x, one gets a figure of 28.6% for the first 2000 results. But "small-cell" is an anomaly. The other usages such as "renal cell" and "basal cell" get 2.25%. Indeed, searching for '"cell carcinoma"[Ti]' gives a figure of 2.20% for the hypenated "-cell" form in the first 2000 results. So one can argue that wrt to "small-cell carcinoma", a significant minority of researchers use the hyphenated form (about a quarter). For the other cases, the numbers are to all intents and purposes negligible. BTW: the Nature link above is merely a letter to the editor. The main argument for your spelling reform campaign seems to be helping the lay-reader. So I'm more interested in how quality lay resources deal with it. I listed eight such links above, all of which use the non-hyphenated form. Do you want me to search some more? Perhaps we should write to Cancer Research UK and MacMillan and the NHS and tell them they are failing their patients by using confusing punctuation? Perhaps The Guardian and the New York Times would like to update their house style guides with this? Reform has to happen outside of Wikipedia first. Colin°^Talk 09:08, 7 February 2011 (UTC)

Well said, Colin. Axl ¤ [Talk] 09:19, 7 February 2011 (UTC)

But this isn't reform, and it has already happened elsewhere first. For the other cases the numbers may be so low that we can't justify a hyphen apart from an alternate punctuation in the lede, but the numbers for 'small-cell' are significant. Even if we take your figure of a quarter, remember that article titles are not based solely on what it most common. There's good reason for hyphenating 'small-cell' in particular: it's the name that lends itself to the most egregious misreading. Thinking that a carcinoma is basal or squamous won't matter much, but thinking that it's small is a serious misunderstanding. — kwami (talk) 11:55, 7 February 2011 (UTC)

You are probably right that this is the reason for "small-cell"'s anomaly in the stats. There's much less chance of confusion for "renal cell carcinoma" and others. I think that saying a good quarter of the scientific literature uses "small-cell carcinoma", plus it is grammatically correct, plus it helps lay readers altogether makes a strong argument that we should pick that form for that particular article title. That the lay literature doesn't seem to use it and that it then becomes inconsistent with other forms is a counter argument. I wouldn't oppose the change for "small-cell". On balance it is probably a benefit IMO. For the others, I'm not convinced we should attempt to fight against 98% of the literature for no real gain as far as reader-understanding is concerned. Colin°^Talk 12:32, 7 February 2011 (UTC)

I would find that acceptable (with similar treatment for "large-cell") as long as we maintain the precise form of the others as an alternate title in the lede. — kwami (talk) 12:42, 7 February 2011 (UTC)

What do others think? Colin°^Talk 12:56, 7 February 2011 (UTC)

Small-cell for lung cancer wouldn't be a disaster, since there is a substantial minority using it, unlike the others. However, it's a minority, and I think that we ought to follow the majority.

Large-cell doesn't work for me as a universal rule (nor does giant cell). To give one example of the challenges: A B cell is a single "word" and properly shouldn't be hyphenated (although it often is, by at least a substantial minority, especially in longer names [so it's a B cell, not a B-cell, but it is frequently Diffuse large B-cell lymphoma). So hyphenating "large cell" gives us Large-B cell lymphoma, which makes me wonder where the Lowercase-b cell lymphoma is. This is, IMO, not an improvement in clarity, no matter how well intended it might be.

I think we are best off following the conventions as we find them in the high-quality sources. Trying to make the world fit into our decisions about the True™ way to hyphenate these names is a foolish consistency. WhatamIdoing (talk) 16:33, 7 February 2011 (UTC)

Your objections don't reflect English hyphenation rules: no-one would hyphenate it "Large-B cell lymphoma", because 'large' does not modify [B], it modifies [B cell]. There are two choices here, an en dash or to hyphenate 'B-cell' as well: large–B cell lymphoma or (IMO more clearly) large-B-cell lymphoma. Partial hyphenation would result in large B-cell lymphoma. This is because the structure is {[large (B cell)] lymphoma}; your proposal would parse to [(large B) (cell) lymphoma]. There's no reason not to hyphenate 'B cell'; things like that are done all the time. — kwami (talk) 21:17, 7 February 2011 (UTC)

Agree but we don't always follow the majority on naming. I think the fact that "small cell carcinoma" is potentially confusing is the reason why over a quarter of scientific papers on the subject choose to hyphenate the term in their title, and that the others aren't confusing is why nearly nobody hyphenates those. In the interests of compromise, that seems to be a reasonable one to give on. But it is interesting what you say about some other apparently similar formulations not actually being adjectives. I don't think there's support for hyphenating any of the other variants, nor indeed for mentining the issue in the lead sentence of those. The lead should not be cluttered with a rather minor hyphenation issue that is virtually a fringe spelling variant. Colin°^Talk 17:19, 7 February 2011 (UTC)

The point is not to give a minor spelling variant, but to help the reader parse the jargon. A "basal cell carcinoma" is not what it claims to be, and so should be clarified. — kwami (talk) 21:17, 7 February 2011 (UTC)

Colin, while we're at it, why not remove the hyphen from the name of this page? I'm sure you'll find sloppy examples of no-hyphen as a model in quite a few instances in the journals. Tony (talk) 12:34, 7 February 2011 (UTC)

Actually, I've found several, such as the Standard Periodical Directory. — kwami (talk) 12:42, 7 February 2011 (UTC)

Tony, we aren't discussing prose here. We're discussing the names of things. Names only work if we use the same name to mean the same thing. Perhaps we disagree over whether a hyphen is part of a name or not. Plenty people have argued over hyphens and apostrophes in place names, so I guess the consensus is that they are part of a name. Colin°^Talk 12:56, 7 February 2011 (UTC)

"Names only work if we use the same name to mean the same thing." This is quite evidently not true: Variants can often be used without problem, sometimes in the same text. One might start out with 'congestive heart failure' and then continue with CHF; one article may say 'small-cell carcinoma' and another 'small cell cancer', etc. Certainly variation in hyphenation and capitalization are not likely to cause the names to fail. — kwami (talk) 13:19, 7 February 2011 (UTC)

Well abbreviations and initials are one thing. But "small cell-cancer" is quite another, as you point out as being the potential confusion. If you mixed "small cell cancer" and "small-cell cancer" in one article, it would certainly confuse the reader. So hyphens do matter. The people of "New-York City" might disagree too :-) Colin°^Talk 14:22, 7 February 2011 (UTC)

Proper names like "New York" are never hyphenated. The capitalization is considered enough to link them.

If it would be confusing to vary the hyphenation, then we should only use the precise form. — kwami (talk) 20:58, 7 February 2011 (UTC)

But clarity isn't an attempt to fix anything...

Of course improving clarity is an attempt to fix something: It is an attempt to fix misunderstandings.

However, when we depart from the conventional names, whether in the name of grammatical purity or for some other reason, we are decreasing clarity and making it harder for the reader by springing unfamiliar styles on him. We need to follow the convention as it exists, not the convention as it ought to exist, if only more people understood basic grammar and punctuation. WhatamIdoing (talk) 16:07, 7 February 2011 (UTC)

But "small-cell carcinoma" is not a departure from conventional spelling, and it's the same name regardless. — kwami (talk) 20:58, 7 February 2011 (UTC)

Kwami, I think you need to stop moving these pages. You know that you have multiple editors opposing these changes, and yet I see a number of page moves, of exactly the type opposed here, in my watchlist. Please stop: It's uncollegial, anti-consensus, and inappropriate. WhatamIdoing (talk) 21:32, 7 February 2011 (UTC)

I agree. I also oppose these changes. ---My Core Competency is Competency (talk) 15:49, 8 February 2011 (UTC)

We seem to have general consensus on 'small-cell' etc. I'm not touching the others. — kwami (talk) 21:37, 7 February 2011 (UTC)

This medical specialist arrogance about "owning" the language has to stop. We have a broad readership, and the mission of WP is to bring knowledge to everyone. Frankly, I wonder at most of the compound medical names, not knowing which way to parse them. To persist with this arrogance in the face of ordinary readers like me is unacceptable. Tony (talk) 09:29, 9 February 2011 (UTC)

I understand the points made by Kwamikagami. However I disagree with the inclusion of a hyphen in "small-cell carcinoma". In my opinion, we should be following the majority of the medical literature. Axl ¤ [Talk] 09:55, 9 February 2011 (UTC)

But if the "minority" of the medical literature observes correct typographical standards, and those standards are what WP uses, and they are easier for ordinary people to comprehend, what basis do you have for insisting on this? Tony (talk) 09:58, 9 February 2011 (UTC)

It's the majority usage. I understand your point; I just disagree. Axl ¤ [Talk] 10:23, 9 February 2011 (UTC)

I deal with researchers and their specialist text every day. I'm aware of the tension between unfortunate viral habits that have grown in the disciplines—often concerning key items, where you blink and think "that was unwise decision, whoever did it to start with, to use that acronym, spell that without a hyphen, use all caps for that"; and thus I end up not applying some aspects of style I believe are standard and "correct" for readers, even the semi- and non-experts who tend to judge competitive research text. I do understand why you might think this way, but I ask you to consider WP's readership and its pillar of neutrality (i.e., not being governed by professional elites). There's a case for going with minority typographical usage where it's clearly easier for ordinary mortals—perhaps not always, but sometimes. That, I think, is the basis of what kwami is saying. Tony (talk) 11:34, 9 February 2011 (UTC)

Um, "neutrality" on Wikipedia means something much closer to "follow the sources, even if you think they're headed off the cliff" than "do what I personally declare that the sources ought to have done". Taking the punctuation from reliable sources complies with all of our policies. WhatamIdoing (talk) 17:22, 9 February 2011 (UTC)

For too long, my friends, the lay reader has been left wandering in confusion. Is this a small carcinoma or does it affect small cells? Why is this knowledge kept secret by the physicians and scientists? Surely man can devise a means to bring an end to this unfortunatel situation. To render text understandable by all people, not just those in white coats. Could, perhaps, some grammatical device be employed to enlighten the reader? I tell you I have the answer and it is simple. At a stroke we can separate the two possible meanings. Let us join together to free oncological nomenclature from the tyranny of the professional elite! Ladies and gentlemen, I offer you the hyphen. -- Colin°^Talk 17:31, 9 February 2011 (UTC)

Apostrophes

Apostrophes and the possessive are a very common source of naming dispute in the real world. See our article on it for examples, particularly with place names. On Wikipedia we can defer to whatever authority in naming is appropriate for the word. There's little logic to our use. For example, we like to use the possessive for shops ("Sainsbury's"), which I guess is short for "J Sainsbury's store". But we also use it for stores where the name is not the owner ("Tesco's"). We don't follow this pattern for names ending in "s" ("Waitrose"), where the name clearly isn't an owner ("B&Q") and I suspect Mr Boot dropped the apostrophe for "Boots".

What doesn't seem to happen elsewhere is folk inventing ridiculous reasons for dropping the apostrophe or the possessive form. The "had it vs described it" issue is IMO an invented rationalisation. It is quite simple. The possessive is carelessly dropped when you can't hear the "s" in speech. In medicine, the "s" is lost, for example, when the second word is "syndrome" but kept for "disease". We have "Down syndrome", "Tourette syndrome", "Graves' disease", "Crohn's disease", "Hodgkin's lymphoma", "Hansen's disease" and "Alzheimer's disease". There appears to be a movement to drop the possessive in some circles, but this is more to do with simplifying English like Webster did than because of some sensible rationale.

So I agree that the possesive-debate is purely one of personal preference and Wikipedia should not endlessly debate which one is better. But I disagree ENGVAR's "first wins" approach is a reasonable solution. I much prefer a "leave it be" solution, which surely is enshrined in our consensus guidelines somewhere? Colin°^Talk 09:33, 6 February 2011 (UTC)

"First wins" is the "leave it be" notion. It just assumes that the only people who need to bother looking up the rule have been edit warring over it, and doesn't want to "leave it to the most determined edit warrior". WhatamIdoing (talk) 16:36, 7 February 2011 (UTC)

"It just assumes that the only people who need to bother looking up the rule have been edit warring over it". Sadly I wish that were true. I've twice seen an editor show up at an FA article written in one form of English (largely by the FAC nominator) and insist the entire text be reverted to some other form of English that it had back in 2004. I think that a major rewrite (as typically happens when someone decides to improve an article towards FA) should reset the ENGVAR/CITEVAR rules. The thing these rules are trying to prevent is someone changing some style as their only edit, leaving the folk who actually have written content and put the effort into maintain it to adapt to the new alien form. We should respect these people and give less of a damn to the state of an article when merely an infant. So by "leave it be", I mean, "If you've come here just to change the style of english/citations, please don't". Colin°^Talk 16:52, 9 February 2011 (UTC)

Orthopedics tests

People here may be interested in this comment on my user talk page. Let's have the discussion there, to keep it all together. WhatamIdoing (talk) 21:24, 15 March 2011 (UTC)

Indications vs Therapeutic uses

I'm not convinced about this change that altered the suggested heading for drug/medication articles from "Indications" to "Therapeutic uses". Only a tiny percentage of our drug articles use the latter, so this altered guideline isn't following practice. If it is intended to change current practice, it should be discussed first. The former term has a formal meaning that I think is valuable for WP articles. It implies there are current guidelines specifically recommending the clinical use of the medication for a given purpose. So the sources should be clinical guidelines or a respected drug formulary. IMO, not is not appropriate to use research papers or to use reviews whose purpose is not to make clinical recommendations. For example, a drug that is being used experimentally or for which the jury is still out. Such uses belong in a research section. There's also the question of "off label" use.

The danger with "therapeutic uses" is that it will be interpreted to mean that if one can cite a paper showing a therapeutic effect, and that somebody somewhere has used it, then it can be included. This will lead to distorted articles: if we mix established and experimental uses in one section, the reader will be confused and it will lead to the sort of trial-by-talk-page endless discussions that we see on controversial articles.

The other problem with the change is that the corresponding "contraindications" section matches the former term but not the new term. I accept that "indications" is a jargon word, but it is typically possible to use the word in a way that makes its meaning clear, and one must learn it in order to know what "contraindications" means. Colin°^Talk 10:53, 26 March 2011 (UTC)

It is being discussed on the PHARMA wikiproject and a note was posted on the talk page of this one. Indications seems to imply legal approval. Much stuff is used off label and these uses should also be addressed. Thus I feel therapeutic uses is clearer.--Doc James (talk · contribs · email) 23:16, 26 March 2011 (UTC)

BTW here is the link to the discussion [5] Doc James (talk · contribs · email) 23:32, 26 March 2011 (UTC)

I don't see a project discussion. You and User:Anypodetos seem to be the only ones actively discussing any pharma style guide issues. I can't find any posting here or on the medicine project talk page. I'm concerned that the pharma styleguide has been proposed as a WP styleguide. This proposed guideline seems to offer little that isn't currently in MEDMOS. There's no way it should be adopted as a WP guideline with so much overlap -- it will only lead to issues where one guideline recommends one name and the other another. I think there should be a posting on both project pages to discuss whether pharma should have its own guideline and then to remove the overlap from MEDMOS if that is what is decided. Currently, I'm sceptical that a guideline on two people's watchlist is viable.

I strongly feel that your comment "Therapeutic uses seems more evidence based." and "[the section should be] a discussion of the research on a usefulness of drugs for certain conditions highlights a vital mistake. There is a gap between a drug being found to have therapeutic effect and that drug being used widely for something or that drug being recommended for clinical use for something. That gap must not be jumped by Wikipedians as that would be WP:OR and lead to endless discussions on talk pages over whether a drug had enough of a therapeutic effect to be noted. There are several aspects to consider:

Is the drug effective for X. Best source: Reviews of clinical research.
Is the drug recommended for treating X. Best source: Clinical guidelines.
Is the drug widely used for treating X. Best source: A review or book on X.
Is the drug licensed for treating X. Best source: Government licensing authorities.

I believe Indications should be point 2. A proposed "Therapeutic uses" is an extension of point 1 that cannot be made by Wikipedians (the joining of "therapeutic" and "uses" is the key mistake). If the efficacy aspects of a drug are worth discussing, then create an "Efficacy" section and discuss them there. If there is research pointing towards efficacy in an condition where it is not yet clinically used, then that belongs in a "Research" section. If the unlicensed/off-label use of a drug is widespread and notable, then those could also be discussed in a section on licensing. There's more to a drug being used than just the research on efficacy. Cost, availability, side-effects and formulation (pill, coated tablet, injection) are factors too.

At present, I'm strongly opposed to a Therapeutic uses section based on research evidence but not evidence of clinical use or recommendation by experts and authorities. This would make Wikipedians the author of a Wikipedia clinical guideline and be a very bad move IMO. Colin°^Talk 08:54, 27 March 2011 (UTC)

The addition of the proposal as a style guideline was a merge of two different pages and not something I was things is truly needed. The discussion posted here could have been clearer I now realize [6]. The problem with indications is they vary by country. Some indications do not necessarily have evidence for them.

I guess as a procedure point where should we continue on this discussion? Here or at WP:PHARM? If it is here and WP:PHARM is inactive should we combine it as a task force of WP:MED?Doc James (talk · contribs · email) 09:04, 27 March 2011 (UTC)

There are two issues here: the indications section and the pharma project/styleguide. Perhaps we should create new sections here or wherever to discuss these separately. Yes, indications may vary from one country to another, but perhaps we just have to deal with that. It may well be relevant to the reader that X is a first-line therapy for Y in the UK but is unavailable in the US. I hope you appreciate my point about the OR that would be involved if we start writing clinical guidelines ourselves. In the past (and ongoing) we have a battle with folk using primary research to conduct their own literature reviews. Sometimes they have a POV to push but other times they are "experts" who think they can do a better job than the "biased" or "ignorant" authors of existing reviews. I think we have the same issues wrt presenting the indications for a medicine: we should rely on the opinion of published experts and not try to turn evidence into good-practice guidelines ourselves. Yes, some indications (and some guidelines even) are not evidence-based, but we can't change the world on WP so we must document the indication and we are only allowed to say "but there is no/little evidence to support this indication" if someone else already has.

Wrt to the pharma project/styleguide. I have no problem if a separate drug styleguide is felt useful but I do feel we must all agree to this and then remove the overlap. My biggest concern with such a styleguide is the viability of developing and maintaining it if there are few contributors. I think the first step might be to work out how many active members the pharma project has (is there a list anywhere?). If there are less than a dozen then it may well be best to fold it into Medicine. Colin°^Talk 09:56, 27 March 2011 (UTC)

I do not have strong feelings either way which term we go with in the end as long as it is consistent and this topic area goes first as a section.

We need to get more contributer to PHARMA articles. If the articles where more geared towards a general audience rather than chemists I think we could attack more editors which is the purpose of my efforts. No idea how many active members there are I just started on this 2 weeks ago and invite others to join in.

I do agree folding it into medicine would be best and have posted the question on WT:PHARM.--Doc James (talk · contribs · email) 10:45, 27 March 2011 (UTC)

The key here is to expand the pool of contributing editors without demotivating existing editors. Many of these articles would not exist without the contributions of pharmacologists and medicinal chemists. Furthermore, without chemistry, there would be no drugs. Boghog (talk) 04:57, 28 March 2011 (UTC)

Yes do not wish to exclude anyone. Agree we do need more contributors.--Doc James (talk · contribs · email) 19:02, 28 March 2011 (UTC)

I've not been involved in this discussion so far, and haven't undertaken the research to contribute to it productively, but I'd just like to add my two-cents anyway that if we're going to mention indications at all, I'd prefer to see "Indications for use" employed rather than just the bare word "Indications". The standalone word might be more formally correct (?) but I'd guess the full phrase would be meaningful to a considerably higher percentage of our non-technical readers. – OhioStandard (talk) 19:22, 28 March 2011 (UTC)

It's kind of complicated. Here's my understanding:

An approved indication is strictly a matter of drug regulation. Approved indications may vary from country to country. Approved indications are issued by individual product and sometimes by formulation, patient population, and prior treatment or other circumstances: This particular chemical has an approved indication for treatment of this named condition. For example: Pimecrolimus has an approved indication in the US for "Treatment of patients aged 2 years and over with mild or moderate atopic dermatitis where treatment with topical corticosteroids is either inadvisable or not possible."
An indication (plain) is a claim that something is appropriate for a situation. These may be very broad statements. For example: Antibiotics are not indicated for treatment of the common cold. Antibiotics are indicated for treatment of strep throat.
It may also refer to far more than pharmaceuticals: Surgery is indicated for some types of hernias. Walking through the person's home to look for tripping hazards is indicated for people at risk of falling. For that matter, calling your bank is indicated if you have questions about your account, leaving the house is indicated if you smell smoke in the middle of the night, and driving more slowly is indicated in weather that reduces visibility.

"Indications for use" sounds okay to me. I agree that it might be more accessible to non-technical readers. WhatamIdoing (talk) 21:14, 28 March 2011 (UTC)

A very helpful explanation, What. Thanks for that. I will just muddy the waters a bit, though, by saying that I think "Therapeutic uses" could be helpful in at least one very particular circumstance. I don't use illegal drugs myself, but I provided frequent respite care for a dear friend's dying mother over an 18 month period not long ago. Despite having tried over 60 different prescription drugs, nothing but medical marijuana, provided under a doctor's supervison, would control her overwhelming nausea. For that reason, I became interested in our article on the subject, and there has been some considerable acrimony in that forum at various times over what constitutes an "indication". There still aren't any approved indications, AFAIK, not in the Federal/FDA sense of the word, anyway, despite the Federal Government holding a patent on some uses of the drug for medical purposes, which I find somewhat amusing, actually. But it seems to me that "Therapeutic uses" might suit the case rather well in that one instance, at least. – OhioStandard (talk) 23:07, 28 March 2011 (UTC)

How about Clinical indications It is slightly shorter and spells out what should be discussed. To follow up on Ohio's statement we do have indications for the use of medical THC here in Canada. It comes in pill form. Doc James (talk · contribs · email) 11:40, 1 April 2011 (UTC)

THC is also available in pill form in the US. Patients usually complain that it is either too expensive, that it is "not natural", or that it's a pill, and they'd rather smoke (described as "better control of the dose" to lay people and sympathetic physicians, but not to pharmaceutical chemists, who might laugh themselves silly at the idea that a variable fraction of a variable amount of a highly variable product produces "better control of the dose" than any standardized product). It's also preferred by the staff of institutions, because it's easy to steal a pinch of marijuana without anyone noticing, but impossible to take one pill without the inventory coming out wrong.

I wouldn't be surprised to hear that the physician never bothered to prescribe it, although it probably would have worked. WhatamIdoing (talk) 17:04, 1 April 2011 (UTC)

@DocJames: Well, "Clinical indications" sounds to me like yet another television show about the lives of young, good-looking interns. ;-) I have no substantive objection, though, except that I think "Indications for use" would be more readily understood by most people.

@WhatamIdoing: Your assumption of what pharmaceutical chemists think re dose titration of cannabinoids via inhalation versus pill form seems reasonable, but it's incorrect, as I've explained on your talk page. (permalink). Best, – OhioStandard (talk) 16:50, 4 April 2011 (UTC)

I think the major argument for using the term 'therapeutic uses' is mostly to avoid using some medical technical jargon and bring the article down a notch for the average reader. We're not writing official drug guides from the manufacturer here, we're producing an encyclopedia. 'Therapeutic uses' could cover much of the off-label use of many drugs, as well as the official indications. 'Clinical indications' isn't bad, but it still wouldn't address the off-label use very well. WTF? (talk) 14:03, 1 April 2011 (UTC)

I am okay with either as long as we are consistent. Should we have a RfC to help with this issue? Doc James (talk · contribs · email) 14:08, 1 April 2011 (UTC)

As WhatAmIDoing points out, the word "Indications" on its own does not imply approval from a licensing authority. There's nothing stopping folk describing off-label use of a drug in the Indications section provided some authoritative source recommends it for that purpose. In other words, somebody or somebodies with sufficient WP:WEIGHT indicate that use. The wording "therapeutic uses" opens us up to original research and IMO will lead to WP editors trying to create their own clinical guidelines on talk page discussions. I don't see how adding "clinical" in front of the word makes any difference. How does that adjective change the meaning or make it any more accessible? An RfC might be worthwhile but remember that plain old "Indications" is used in thousands of existing drug articles so you've got to build a strong case for changing that. Colin°^Talk 15:18, 1 April 2011 (UTC)

I consider "indications" too vague. IMO it does imply approval from a licensing authority. Will add this to the RFC I have just started. Doc James (talk · contribs · email) 15:57, 1 April 2011 (UTC)

My primary concern is that "therapeutic uses" seems to imply that it actually works, i.e., it is an effective therapeutic. It's also a "harder" word for people with limited English skills, but I'm not sure that should given any significant weight. WhatamIdoing (talk) 17:04, 1 April 2011 (UTC)

Yes there is the same issue with cause as not everything we discuss under causes actually is a cause a lot of them are risk factors or theories. But I think it would be too complicated to have three section in all articles for thing we know are causes, things that are risk factors, and things that are theories. We will hopefully make these find distinction in the text rather than the section heading. We could end up with no end of argument to when a risk factor becomes a cause... The same with respect to the implications of "medical uses".Doc James (talk · contribs · email) 15:03, 4 April 2011 (UTC)

FWIW, the OED gives it as the second definition for "indication, n.":

b. spec. in Med. A suggestion or direction as to the treatment of a disease, derived from the symptoms observed. (App. the earliest use in English.)

?1541 R. Copland Galen's Fourth Bk. Terapeutyke sig. Bivv, in Guy de Chauliac's Questyonary Cyrurgyens, It is euydent yt none indication is taken of the cause that hath excited and made the vlcere.
?1541 R. Copland tr. Galen Terapeutyke sig. Ciiv, What is the indicacyon curatyfe taken of olde Sores?
1651 R. Wittie tr. J. Primrose Pop. Errors 43 The use of indications, without which no remedy can be applyed.
1793 T. Beddoes Observ. Nature & Cure Calculus 261 It is probable that the true indication of cure in typhus is to restore the oxygene.

1875 H. C. Wood Treat. Therapeutics (1879) 19 The term or expression indication for a given remedy, being in constant use, ought to be distinctly understood; by it is meant the pointings of nature, or, in other words, the evident needs of the system.

That said, however, as a lay reader I'm always jarred by this usage even if it is common in medical circles, taking it to refer to diagnostics rather than prescriptives. Perhaps "indication of cure" per Beddoes would be less apt to confuse the common usage with this term of art? LeadSongDog come howl! 21:09, 1 April 2011 (UTC)

Continuation

Under medical uses / indication there is often a section called "off label". This is a regional thing which typically refers to FDA none approval. IMO as it is not global it should be discouraged. This is part of my argument why we should use something like medical uses instead. Another benefit of medical uses is that it would balance nicely with sections / subsections on recreational uses ( as apposed to illegal uses which is POV / based on local laws ) and veterinary uses... Comments? Doc James (talk · contribs · email) 23:06, 8 April 2011 (UTC)

I like ==Indications for use==, as it feels to me much like ==Reasons for use==.

However, if the substance has multiple uses, a series of section headings along the lines of ==Medical uses==, ==Recreational uses==, ==Industrial uses==, ==Chemical uses==, ==Veterinary uses==, ==Pest control uses==, ==Military uses== (etc.) might be appropriate.

What do other people think? WhatamIdoing (talk) 00:18, 9 April 2011 (UTC)

Great a few more I had not though of. Doc James (talk · contribs · email) 00:31, 9 April 2011 (UTC)

Historical references

In the GA review of thrombophilia, WhatamIdoing and myself wondered whether it was necessary/appropriate to provide references to historical articles. I have always enjoyed digging up original citations, and from an encyclopedic standpoint I think original descriptions of diseases are extremely valuable. At the same time, they are typically primary studies that would not normally satisfy WP:MEDRS unless supported by an additional secondary source. I'm curious to hear what others think, and whether we should mention this in the MEDMOS framework.

On a separate note, I think it is very interesting how some journals are providing DOIs to ancient references (e.g. the 1931 paper describing spontaneous pneumothorax or the 1863 descriptions of Friedreich's ataxia. JFW | T@lk 19:18, 28 March 2011 (UTC)

Such sources are often reprinted on anniversaries 50 or 100 years after the original paper with added commentaries which can be useful. LeadSongDog come howl! 22:08, 28 March 2011 (UTC)

There are reviews that look at the history of the literature. This paper for example on ASA Fuster, V (2011 Feb 22). "Aspirin: a historical and contemporary therapeutic overview". Circulation. 123 (7): 768–78. PMID 21343593. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Doc James (talk · contribs · email) 23:14, 8 April 2011 (UTC)

Sure, we can find sources for the fact that these papers are important. But the question is this: If there's a famous paper from a century ago, is it good to list the famous paper itself as a WP:Reliable source, under ==References==?

Imagine that the article is about the dread disease whosiwhatsis. We have a sentence under ==History== that says the disease was originally described in 1903 in a historically important paper by J. Random Stuffy. We have (and cite) Alice Smith's 2010 "Modern Review of Whosiwhatsis" to support the fact that Stuffy's paper was important.

Should we also cite Stuffy's 1903 paper as a reliable source? Should a citation to the 1903 paper be completely omitted? Should it perhaps listed under ==Further reading==? WhatamIdoing (talk) 00:14, 9 April 2011 (UTC)

I think it is reasonable to cite both the new and the historical paper. But just citing the historical paper would not support the text.Doc James (talk · contribs · email) 00:32, 9 April 2011 (UTC)

My view is that we owe it our readers to provide citations to such articles, even though strictly speaking they are not necessary.

A while ago I had to dig up the original reference for Quick's description of the prothrombin time. Strangely, many citing papers provided the wrong reference, which had simply been copied incorrectly from one author to the other! Seeing that both J Biol Chem and Am J Med Sci are fully online now, it was possible to provide an actual citation to the journal article. JFW | T@lk 21:29, 9 April 2011 (UTC)

Lists of causes

In a number of recent articles I have struggled with the task of formatting a list of causes of a particular medical problem. In hypopituitarism I settled for a table that followed the surgical sieve approach. In thrombophilia I used prose, because each cause needed to be discussed in context with separate causes.

I have now encountered this again in rhabdomyolysis, which is undergoing peer review). On the peer review page, Axl (talk · contribs) suggested that I modify the current table of causes along the lines of a secondary source (such as The Oxford Textbook of Medicine), which in turn uses a surgical sieve. On this occasion I followed the grouping of causes from one secondary source (separating physical from non-physical causes) with separate groups for drugs (as they were a large subgroup of the "non-physical causes" and sometimes cause the condition through a physical abnormality) and for congenital/hereditary causes (which require specific diagnostics).

What is the feeling about these lists and tables? I suspect that no firm rule can be formulated, but are tables sometimes useful, and what should dictate the groupings in such tables? JFW | T@lk 09:16, 5 May 2011 (UTC)

As another formatting option, have you considered a definition list? It would look like this:

Tumors Most cases of hypopituitarism are due to pituitary adenomas compressing the normal tissue in the gland, and rarely other brain tumors outside the gland—craniopharyngioma, meningioma, chordoma, ependymoma, glioma or metastasis from cancer elsewhere in the body. Infection, inflammation and infiltration The pituitary may also be affected by infections of the brain (brain abscess, meningitis, encephalitis) or of the gland itself, or it may be infiltrated by abnormal cells (neurosarcoidosis, histiocytosis) or excessive iron (hemochromatosis). Empty sella syndrome is unexplained disappearance of pituitary tissue, probably due to outside pressure. Autoimmune or lymphocytic hypophysitis occurs when the immune system directly attacks the pituitary.

I think that we want causes divided according to some natural or sensible scheme, e.g., congenital causes separated from acquired causes. Fortunately, our reliable sources typically do this for us, so the first rule of thumb is 'follow the sources'. WhatamIdoing (talk) 03:57, 12 May 2011 (UTC)

I prefer ordering causes by there frequency or there seriousness ( when thinking of differential diagnosis ). But I do not think one can say there is one correct method. Doc James (talk · contribs · email) 15:36, 26 May 2011 (UTC)

Agree with WhatamIdoing's suggestion of starting with the scheme of a reliable source, if available. Otherwise, the choice is arbitrary and some orderings could verge on synthesis if based on a particular opinion about pathogenesis, for example. -- Scray (talk) 00:07, 27 May 2011 (UTC)

Classification

This content often fits best under diagnosis as it is often only during the diagnostic stage of things that one figures out the diagnosis anyway. Comments? Doc James (talk · contribs · email) 06:41, 18 June 2011 (UTC)

RFC: restructuring of the Manual of Style

Editors may be interested in this RFC, along with the discussion of its implementation:

Should all subsidiary pages of the Manual of Style be made subpages of WP:MOS?

It's big; and it promises huge improvements. Great if everyone can be involved. Noetica^Tea? 00:43, 25 June 2011 (UTC)

Adding medical guidelines

I added the following note on adding medical guidelines to articles - [7]. Further comments or ideas in this matter are appreciated. Mikael Häggström (talk) 06:20, 3 September 2011 (UTC)

Images

From this email message: I wonder if we could produce a useful section here that deals with how to take good images of people for medicine-related articles. I'm thinking far more about the "please put the person in the standard anatomical position" than the "figuring out what paperwork you're legally required to do is complicated" aspects. Any ideas or advice you'd give? Imagine the case of a person with an easily visible medical condition, and he wants to take a picture of himself to illustrate an article that currently has zero images. WhatamIdoing (talk) 17:13, 28 September 2011 (UTC)

I've had a go at this; please feel free to boldly improve it. I'm sure there is plenty of room for improvement. WhatamIdoing (talk) 19:11, 16 November 2011 (UTC)

Thanks for making a start on this. I'm too tired tonight to work on it so I'm not feeling very bold. Some thoughts. Drop the first sentence. We should link to Commons: Patient images. I'd like to see that essay become a guideline some day. Also Commons: Photographs of identifiable people. On "Identifiable people", I'd drop the first clause (no value) and the final sentence about "people who are strongly associated with the condition". Images of famous people are likely to appear in History or Social aspects of a disease, if at all, but very unlikely to illustrate medical aspects of a disease, for which we rely on amateur material or doctors releasing patient images. The "Sexual images" section is rather long. The "POV pushing" section contains some weird examples. I'll take your word for it that these have arisen but I'm not sure they are generally useful. Does anyone add an image for its "shock value"? Certainly editors differ in the ability to be shocked, offended or just made uncomfortable. I'd like to be able to say something like "Where images have equal value in illustrating a medical topic, be reluctant to use those that may shock, offend or make the reader uncomfortable." However, I suspect some NOT:CENSORED zealots will regard such a basic editorial wisdom as infringing on their rights to shock, offend and make readers uncomfortable. Colin°^Talk 20:13, 16 November 2011 (UTC)

I've a couple comments. As someone who gags at some of the more grotesque images (i.e. massive infections, examples of debrided wounds from necrotizing fasciitis), advice on shock images is appreciated. Also, unlike say, images of Muhammad (a discussion I was involved in recently) where the aversion or shock is learned, finding gore aversive is an innate, fairly universal reaction. Colin, I've encountered every single example of POV-pushing WAID lists (I wrote an essay about one). It'd be nice if editors could simply select the best image based on the relevant section, but such is not the case. It might be worth including a link to the new image filtration software too. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:33, 16 November 2011 (UTC)

I've started making your changes, but it's time for lunch, and I'm not going to process them all now. Here are my initial thoughts:

commons:Commons:Photographs of identifiable people has been largely incorporated into WP:IUP#Privacy_rights (which links it), so it's probably redundant.
Yes, all three of the specific examples at the POV pushing are real.
For "shock value", I'm trying very hard not to canonize bloody aborted fetuses as an example of shock value pictures (because they can actually be appropriate and encyclopedic, despite very few such uses ever appearing in Wikipedia's history). But, yes: it happens, especially when activists are trying to "raise awareness". Images of nearly dead children with flies crawling on them "sell better" than images of more moderate cases of malnutrition. WhatamIdoing (talk) 20:39, 16 November 2011 (UTC)

I wonder whether the relatively lengthy "Sexual images" could be split into two points, one mostly about sex and the other about how to take or select a good anatomy article. I just can't quite see how to make it happen. WhatamIdoing (talk) 06:17, 18 November 2011 (UTC)

Medical procedures

I notice there isn't a section covering medical procedures. Is it worth a separate section, or could it just be folded into drugs and medications? WLU (t) (c) Wikipedia's rules:^simple/_complex 14:33, 1 November 2011 (UTC)

A separate section, I think. Talk:Reduction (orthopedic surgery) includes a suggested system for orthopedic surgeries. Alternatively, bits of the "Medical tests" section might be appropriate. WhatamIdoing (talk)

Thus?

Indications
Contra-indications
Technique
Risks/Complications
Recovery/Rehabilitation
History
Society and culture
In special populations
In other animals

I moved the prognosis section up a bit, made more sense there. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:18, 11 November 2011 (UTC)

What do you think about merging some of the related items, e.g., "Description (including synonyms)" or "Indications (including contra-indications)"? WhatamIdoing (talk) 01:23, 12 November 2011 (UTC)

Indications IMO should go first followed by contra indications / risk / complications. Synonyms and the general description will be in the lead. An indepth discussion of the procedure will be in the technique section.Doc James (talk · contribs · email) 12:38, 12 November 2011 (UTC)

I've removed "controversies" (should go in history), description and synonyms, merged contraindications, risks and complications and put them just below indications. Looks good? WLU (t) (c) Wikipedia's rules:^simple/_complex 19:48, 13 November 2011 (UTC)

What about a section on "society and culture" as well? Some procedures such as circ have a significant cultural / societal aspect.Doc James (talk · contribs · email) 04:53, 14 November 2011 (UTC)

Added to the list, as well as "in special populations" (useful for things like joint replacements say) and "in animals" for the rare procedure that can be done by vets. Looks ready to paste in? It hybridizes a series of other sections in a way that seems sensible. It does need a lead-in paragraph; any surgeons at WP:MED we could ask? I believe MastCell is one, I'll drop him a line. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:26, 15 November 2011 (UTC)

I'd probably leave out "prognosis"; generally, prognosis is tied to underlying medical conditions, not to a specific procedure (for instance, a bowel resection performed for mesenteric ischemia carries a very different prognosis than a resection performed for Crohn's disease). I'd also leave out "pre-operative workup"; this may vary substantially by locale and will be difficult to globalize. "Post-operative rehabilitation" and "Timecourse of recovery" could be folded into a single section (e.g. "Recovery"). Overall, though, I think it's a good idea. I just think less is probably more here. MastCell ^Talk 04:40, 15 November 2011 (UTC)

Changed to in other animals to be consistent.Doc James (talk · contribs · email) 04:56, 15 November 2011 (UTC)

It may be an anomaly, but a large proportion of the literature re circumcision is concerned with prophylactic effects (such as reduction in HIV risk). How would such material fit into such a structure? Jakew (talk) 08:51, 15 November 2011 (UTC)

Also, can I suggest making "pre-operative work-up" a subsection of "technique"? And also, perhaps, merging the "Post-operative rehabilitation" and "Timecourse of recovery" sections (which could be simply labelled "recovery")? I think that would probably make the TOC look more approachable, from a layperson's point of view. Jakew (talk) 08:57, 15 November 2011 (UTC)

It's now "recovery/rehabilitation" and a similar change to contraindications/risks/complications. Pre-op workup for when there is a recognized procedure, can simply be folded into technique I would think. Jakew, I would personally put that sort of information into "indications".

Anyone have any suggestions for a lead-in paragraph? WLU (t) (c) Wikipedia's rules:^simple/_complex 11:59, 15 November 2011 (UTC)

I don't think it works all that well under "indications". Positive health effects can be reasons for performing the procedure, but that isn't necessarily the case. Could we instead rename "Contra-indications/Risks/Complications" as "Contra-indications/Health consequences"? Would that be workable? Jakew (talk) 14:14, 15 November 2011 (UTC)

I don't think that's a good idea. Most health consequences are unambiguously positive (the most common "health consequence" of bowel resection is "the patient doesn't die in horrible pain.") We may have to IAR with some of these less-common issues, but if we were going to add this, I'd add it as part of Recovery/Rehabilitation, perhaps as "Outcomes" or "Health effects".

I'm also not sure that contra-indications and risks/complications make a natural pair. Indications and contra-indications are the "should we do this at all?" question. Risks and complications are "since we already did this, what could go wrong?" question. WhatamIdoing (talk) 19:18, 16 November 2011 (UTC)

Okay, good point. Perhaps that's best left as an optional extra section. Jakew (talk) 19:46, 16 November 2011 (UTC)

I think in cases where surgery is optional but has health benefits, it can be dealt with via common sense. No need to be proscriptive when it might only impact a minority of pages.

Moved risks/complications to below technique, seems to make more sense there. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:20, 16 November 2011 (UTC)

As there have been no further comments for a few days, I've added the current list. Please feel free to boldly improve it. WhatamIdoing (talk) 02:51, 22 November 2011 (UTC)

Wikipedia:Manual_of_Style/Medicine-related_articles#Infoboxes contains expired links

The following links in Wikipedia:Manual_of_Style/Medicine-related_articles#Infoboxes lead to errors (specifically, Error 403: User Account Expired):

Pmillerrhodes ^Talk_Contrib 18:26, 8 January 2012 (UTC)

Fixed in this edit. A new server may be found here. Boghog (talk) 19:17, 8 January 2012 (UTC)

RFC – WP title decision practice

Over the past several months there has been contentious debate over aspects of WP:Article Titles policy. That contentiousness has led to efforts to improve the overall effectiveness of the policy and associated processes. An RFC entitled: Wikipedia talk:Article titles/RFC-Article title decision practice has been initiated to assess the communities’ understanding of our title decision making policy. As a project that has created or influenced subject specific naming conventions, participants in this project are encouraged to review and participate in the RFC.--Mike Cline (talk) 19:07, 16 February 2012 (UTC)

Position of portal links

MEDMOS deprecates the See also section, which is where WP:MOS recommends placing portal links. I have attempted a compromise by putting a portal bar directly above the navboxes in Drowning. There are several other medical articles within the scope of the Underwater diving portal which I will change once this has been decided. Another possible alternative is a portal bar below the navboxes. Peter (Southwood) ^(talk): 19:13, 3 June 2012 (UTC)

I believe that in the absence of the "ideal" section, you take the next MOS:APPENDIX section down. WhatamIdoing (talk) 20:26, 3 June 2012 (UTC)

Yes I do not have an issue with this. The SCUBA portal should be hidden further such that it is only a single line however like the consequences of external causes.Doc James (talk · contribs · email) 21:41, 3 June 2012 (UTC)

@WhatamIdoing: The next appendix down may not be an appropriate place. The appendix order recommended in MOS is:

See also (Normally most appropriate place for Portal link, but which you do not use)
Notes and/or References (Not appropriate for Portal link which is neither a note nor a reference)
Further reading (Best option so far}
External links (Not appropriate, as a portal is not external)
Navigation templates (footer navboxes) (not appropriate per se as it is not a navigation template, and nav templates to not have a section header, but a portal bar can go anywhere and is in a way its own header)
Geographical coordinates (also not a proper section, and would not be appropriate for a portal link as it is not geographically defined in any way)

So, if there is a Further reading section, a portal link could go there, though I dont consider it the best option, whereas a portal bar above or below the navboxes is the least obtrusive place for it while retaining an appropriate identity. Peter (Southwood) ^(talk): 10:08, 4 June 2012 (UTC)

@Doc James: The Underwater diving (not just scuba) portal bar is a single line, but inside a frame, which makes it a bit more obtrusive. However this is a standard template, and seems to work OK most places.

The least obtrusive place would probably be after the navboxes. The two "underwater" navboxes below it are related obviously, but not part of the portal link.

In case you are wondering, there are two "underwater" navboxes because drowning is listed in Underwater diving under diving hazards (not much question that it is the single greatest hazard in all forma of diving), and as an immersion injury in Diving medicine, physiology and physics. I agree it may not be ideal to include it in two navboxes associated to the same portal, but really, drowning is a serious matter for divers and I for one would not want to try to decide which of the navboxes it should be removed from. The third blue navbox, Lifeguarding and lifesaving, is from another completely independant Wikiproject, and is the same colour simply because that blue is the default color for navboxes.

I will move the portal bar link in Drowning to below the navboxes, also move the Consequences of external causes navbox to the top of the navbox list, as drowning is primarily a medical topic. Please check if this works for you. Cheers, Peter (Southwood) ^(talk): 10:08, 4 June 2012 (UTC)

The portal bar is an interesting approach.

Placing a portal box inside a ==References== section is okay. People aren't likely to be confused by it. We do the same sort of thing with sister links, with the only difference being that the sister links start at the bottom and work their way up, rather than starting at the top and generally working their way down. WhatamIdoing (talk) 18:14, 8 June 2012 (UTC)

From your reference: Sister links are not normally included in See also sections or navigational templates, which are reserved for links to pages within the English Wikipedia itself. Portal links are links to pages within the English Wikipedia, so presumably should be treated differently.

References sections may contain: Explanatory footnotes, citation footnotes and/or general references that are not explicitly related to any specific parts of the text or are the target of a short citation. Portal links are obviously neither explanatory footnotes nor citation footnotes. General references may be stretching the point a little, but probably not too much as portals are a sort of meta-reference. I will make a few experiments and see what it looks like. Cheers, Peter (Southwood) ^(talk): 07:25, 9 June 2012 (UTC)

Fits better in the external links section IMO. We usually have two columns for references and thus it gets in the way a bit. This is typically where we put other projects.Doc James (talk · contribs · email) 09:56, 9 June 2012 (UTC)

I can see that it could be a slight problem with double columns. Not sure what you are referring to as other projects, but portals are not external in any way normally used for the term in WP, therefore putting them in external links is, at best, misleading. I will look for a less obtrusive option for References, or we may have to reconsider the portal bar option. Peter (Southwood) ^(talk): 07:52, 10 June 2012 (UTC)

I have tried an inline portal link in the references section. This should allow column format without interference, but I will go test it on an article with columns to make sure. If you prefer the box frame format in this position I think this can be arranged using yet another template. Peter (Southwood) ^(talk): 08:26, 10 June 2012 (UTC)

They are not references either. The external links section contains lots of stuff that is not external links (like to commons, likes to other languages).--Doc James (talk · contribs · email) 08:43, 10 June 2012 (UTC)

Check out the EL section of gout http://en.wikipedia.org/wiki/Gout#External_links it contains likes to commons. Doc James (talk · contribs · email) 08:44, 10 June 2012 (UTC)

While I concede that a portal is not an explanatory footnote or citation footnote, it is no less a general reference than it is an external link, which it patently is not. The links in the example of External links that you refer to are links out of English Wikipedia, hence external. Portals are in English Wikipedia, therefore not external. Commons and other language Wikipedias may be considered external as they are not in English Wikipedia. This can not be logically extended to portals without excluding all the rest of English Wikipedia. Since it would seem that none of the MOS:APPENDIX sections with formatted headers are appropriate, we are left with a portal bar above or below the navboxes, or renaming External links as the only options left.

I looked for an example of a column formatted References section in a medical article, but gave up after about 30 attempts. They seem to be elusive, but if we are not to use References it does not matter. I did find a proponderance of articles with a See also section, which I assume will be edited out at some stage.

A further argument against External links is that it, like See also, is deprecated in Wikipedia:Manual_of_Style/Medicine-related_articles#Standard_appendices. Peter (Southwood) ^(talk): 10:09, 10 June 2012 (UTC)

Yes I guess we could consider changing the of the section to just links and that would solve this issue. The template are internal links and they are in the external links section. Doc James (talk · contribs · email) 10:43, 10 June 2012 (UTC)

While we wait for a satisfactory resolution, I have reverted to a portal bar below the navboxes as the least problematic solution currently available. I have raised the matter at Wikipedia talk:Portal. Peter (Southwood) ^(talk): 07:49, 26 June 2012 (UTC)

The position you moved it to is good IMO. Doc James (talk · contribs · email) (please reply on my talk page) 14:17, 26 June 2012 (UTC)

Two notes:

The Commons templates you see under ==External links== are external links. It is external to Wikipedia (not to the WMF). Interlanguage links, although typed at the end of the page, are not visible in the ==External links== section. Neither are categories or navboxes, although those are also typed there.
You are not going to find a perfect solution. There is exactly one appendix used for links to other pages on the English Wikipedia. It is called ==See also==. When that section does not exist, you are forced to put the portal link in some other section. No matter what section you choose, it is guaranteed to be the "wrong" section. It will always be a section that contains something other than internal links. Your options are basically two: you can shove the portal link up into the article or down into the other appendices. My recommendation is that you move it down into whatever appendix is next (assuming any exist). That might be ==References== or ==Further reading== or ==External links==, but I suggest that you move it down, whenever there is at least one appendix. When no appendix exists, then you will be forced to move it up, in which case I recommend putting it at the top of the last section on the page, whatever that section is. As I said earlier, this is very much parallel to the sister links process. (The portal bar is usually used when multiple portals exist, which is probably not the case here. It doesn't make sense to add any portals directly to navboxes, which appear on many pages, when the problem exists only on one page.) WhatamIdoing (talk) 18:02, 28 June 2012 (UTC)

I have never understood the pompous attitude to See also, just making problems for yourself dolfrog (talk) 19:04, 28 June 2012 (UTC)

@WhatamIdoing: In essence I agree with most of your analysis but not with your recommendation. There are other options, like creating an appropriate appendix for the portal link. This is what I have done by putting it below the navboxes as a portal bar, where it has become a terminal appendix containing only portal links, for a minimum of one portal link. Like the navboxes, it does not have a section header as it is self evident what the appendix contents may include. I am not sure whether you are suggesting that the portal bar is an addition to the navbox, but in order to dispel all ambiguity on this point, it is not part of a navbox, it is adjacent to a navbox. It could be placed above the navboxes, which may be preferable, or even between navboxes, but I think that would be inappropriate. It could also be placed in the same position that a ==See also== section would normally be found, but some might consider that slightly obtrusive, particularly for a portal like Underwater diving, which would be a secondary portal for a medical subject.

@dolfrog: I prefer to leave the policy for MEDMOS to those who are involved more deeply in the creation and maintenence of medical articles, so will not comment on the attitude to See also, but I will mention that most of the medical articles that are linked to the Underwater diving portal and Diving medicine, physiology and physics navbox, have a See also section, including a few that are featured articles. Cheers, Peter (Southwood) ^(talk): 12:21, 29 June 2012 (UTC)

The fact is that the medical project is not at liberty to simply opt out of standard appendices. It certainly should not be ccoking up its own way of doing things which is contrary to that of the rest of the encyclopedia: the portal bar system is designed for edge cases, not for whole projects. I'd far rather that MEDMOS be updated not to give editors bad advice (such as altering MOS-compliant articles to follow some Wikiproject-specific guideline). Chris Cunningham (user:thumperward) (talk) 13:18, 29 July 2012 (UTC)

Sure however see also sections are not recommended per "we are not a collection of internal links" (thus many articles do not have them). These do not fit in the reference section as they move all the references over. The best place is someplace below the references section (external links or below the nav bars). I am happy with where it is now on the article on drowning. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 16:45, 29 July 2012 (UTC)

We are a collection of internal links. The placement at drowning ironically manages to make the template significally more prominent than if it were just under a section heading. I'd strongly oppose any general move towards the use of portal bars simply out of some misguided belief that medical articles shouldn't contain a given common appendix. Chris Cunningham (user:thumperward) (talk) 11:39, 30 July 2012 (UTC)

I am happy with them in the external links section or in below the nav bars. Regarding the rest of it we will simply have to disagree. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 15:48, 30 July 2012 (UTC)

That's odd, my reading of wp:SEEALSO doesn't conflict with the MEDMOS deprecation of such sections, in fact it explicitly advises the use of editorial judgement with respect to that section.LeadSongDog come howl! 16:01, 30 July 2012 (UTC)

Editorial discretion implies a freedom to make the choice as one wishes. That is contradicted by a WikiProject flatly stating what should be done. Chris Cunningham (user:thumperward) (talk) 09:01, 31 July 2012 (UTC)

To be fair, MEDMOS does not flatly state that it should not be done, "Avoid the See also section when possible" is the way they put it, and if you look at a sample of medical articles you will find that quite a large fraction do have a See also section. I assumed that these would eventually be removed if someone who cared ever got around to it, and as I would prefer that the portal links are not deleted at the same time, or put in inappropriate sections, I made the original query. Cheers, • • • Peter (Southwood) ^(talk): 19:39, 31 July 2012 (UTC)

As a minor point, this page is part of the regular, community-wide Manual of Style. It's not a WikiProject advice page. WPMEd and WPPHARM have such WikiProject advice pages, but this isn't one of them. WhatamIdoing (talk) 23:55, 4 August 2012 (UTC)

Order of sections

Sandy has disagreed with my bold edit here, so here's what I'm thinking:

We currently have an existing problem, which is people wrongly insisting that sections be presented in exactly the suggested order. As only one recent example, Snowmanradio pushed at Wikipedia:Featured article candidates/Pneumothorax/archive1 for the ==Classification== section to be moved up to the first position, even though that section is particularly called out in our existing advice as an example of a section that should frequently be moved lower.

This is not the first example of editors believing that the order was being required rather than merely suggested, and if we don't do a better job of communicating the "suggested, not required" aspect of these lists, it will certainly not be the last. In actual practice, it has not been good enough to rely on people to understand that MEDMOS is "just" a guideline, so there will be exceptions. The suggested order has a much higher exception rate than the average guideline, and IMO we need to call this out. WhatamIdoing (talk) 21:38, 28 January 2012 (UTC)

He he. A while back I suggested we should make it "more explicit" that the "list of suggested sections does not dictate an order that works for all disease articles". WhatamIdoing pointed out that the guideline already said "The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition". Now I didn't spot that sentence and I wrote it. I conceded that the point was being made already, however maybe it isn't being made in a place where it is noticed. And maybe it needs to be bold. I have had to remind people it is only a suggestion at several FACs and other discussions, so this is clearly a problem.

For history. When this guideline was being drafted we had an early discussion on top level headings. I composed a list of FA section headings at the time: it was a right mixture. The guideline was never based on "best practice", only on a consensus of "best guess" as to what might be generally appropriate.

So I support making it more explicit that these are just suggestions. Colin°^Talk 22:16, 28 January 2012 (UTC)

Using a consistent ordering of sections makes Wikipedia not only easier to use but much easier to edit. IMO we should be recommending the ordering of sections more strongly not less.Doc James (talk · contribs · email) 21:44, 3 June 2012 (UTC)

It depends on the content. Our readers will be pretty unhappy with us if they read through a whole long list of symptoms, diagnosis, treatments, and so forth, and only then discover that the "disease" they've been reading about is purely historical and hasn't been given any credence since the 18th century. For a typical disease, I always follow the suggested format. But they aren't all typical, and we shouldn't impose a one-size-fits-most system when it doesn't actually fit. WhatamIdoing (talk) 18:09, 8 June 2012 (UTC)

Agree regarding having the history section first for historical diseases.Doc James (talk · contribs · email) 21:17, 8 June 2012 (UTC)

I think that, following the abstract/introduction of an article, which cursorily addresses the most important things about, say, a disease, the following thing would be history or description and then description or history, respectively, as these sections can readily dovetail into one another and it is reasonable to expect it do so. Further, substantially more clinical details have their time too, but not at the very front of an article. --Qwerty Binary (talk) 11:25, 5 August 2012 (UTC)

For the historical diseases, it should be mentioned in main introductory paragraph of disease. I strongly suggest the chronological order of sections. That way we can keep things simple and in harmony with what actually happens in practice. Like this:

Section	Sequential justification for order
Classification	NOT first, but as subsection in relevant section. For example, Aetiological classification as subsection of causes. Pathological classification as subsection of pathophysiology, etc.
Cause	A disease has a cause/s
Pathogenesis	Cause/s act to produce a disease
Symptoms	Manifestations experienced by patient
Signs	Manifestations externally observed by physician
Diagnosis	Physician diagnoses the disease
Management	Physician treats the patient
Prognosis	What is the outcome after that?
Epidemiology	The status of disease in community
Prevention	How can it be prevented
Special populations
History
Research directions
Other animals

-Saurabh (talk) 10:57, 5 December 2012 (UTC)

I completely agree with Prevention following Epidemiology. In most/all articles it makes sense in that they are logically connected, and also it avoids Prevention intruding between Diagnosis and Treatment. Would it not make sense to make that change to the 'list of suggested headings' to encourage a more logical sequence ? (more logical/comprehendable to the readers - who are more important than the [fewer] editors) - Rod57 (talk) 18:38, 25 March 2013 (UTC)