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Issue 23—November 2024

WikiProject Medicine Newsletter

Hello all. A short edition to get the newsletter going again. As it says at the bottom, if you have thoughts on how the newsletter could be useful/interesting to you, please post at Wikipedia talk:WikiProject Medicine/Newsletter:

Recent recognized content

Myalgic encephalomyelitis/chronic fatigue syndrome nom. Femke Tumor necrosis factor nom. AdeptLearner123, reviewed by IntentionallyDense Abdominal angina nom. IntentionallyDense, reviewed by Sammi Brie Adrenal crisis nom. IntentionallyDense, reviewed by DoctorWhoFan91 Desquamative interstitial pneumonia nom. IntentionallyDense, reviewed by Nub098765 Neurocysticercosis nom. IntentionallyDense, reviewed by DoctorWhoFan91 Eilish Cleary nom. B3251, reviewed by Actuall7 Owen O'Shiel nom. SkywalkerEccleston, reviewed by IntentionallyDense Oladipo Ogunlesi nom. Ibjaja055, reviewed by Vanderwaalforces Elizabeth Ward (British campaigner) nom. Jonathan Deamer, reviewed by IntentionallyDense Abortion in Sierra Leone nom. Vigilantcosmicpenguin, reviewed by Chipmunkdavis

Nominated for review

Vitamin E nom. David notMD, under review by ChopinChemist Kawa model nom. Significa liberdade Fred Binka nom. Vanderwaalforces Abortion in Zambia nom. Vigilantcosmicpenguin Abortion in the Gambia nom. Vigilantcosmicpenguin Crohn's disease AdeptLearner123 has requested feedback at peer review. Link here.

WP:MED News

• Help WikiProject Unreferenced articles with their November backlog drive by addressing the 130 medicine articles lacking sources.
• Reminder that you can follow medicine-related deletion discussions, GA nominations, merge requests and more by watchlisting Wikipedia:WikiProject_Medicine/Article_alerts. Many of these discussions would benefit from more attention.

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MediaWiki message delivery (talk) 22:26, 10 November 2024 (UTC)[reply]

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Inspired by Worm That Turned's re-RfA where he noted administrators don't get a lot of feedback or suggestions for improvement, I have decided to solicit feedback. I'm reaching out to you as you are currently one of the users I've selected as part of my recall process. I hope you will consider taking a few moments to fill out my feedback form. Clicking on the link will load the questions and create a new section on my user talk. Thanks for your consideration. Best, Barkeep49 (talk) 15:43, 2 December 2024 (UTC)[reply]

Hi @Barkeep49. I'm not really active enough in admin activities to be familiar with your work other than when it involves me directly. I have thoughts and opinions on that, of course, but I suspect you're looking for wider feedback that isn't biased from personal consequences of your decisions and actions. Wrt your recall process, if you are looking for someone who might proactively spot when Barkeep has gone off the rails, then I'm probably not your man. On the other hand, if you got into bother and wanted feedback, then I'd try my best to investigate at the time. -- Colin°^Talk 08:46, 4 December 2024 (UTC)[reply]

Thanks Colin. I am more looking for general feedback at the moment and my recall list was a good group to message for potential feedback (as I know I have some people on it who are more critical than favorable towards me). I appreciate what you've said here and your offer if that should ever come to pass. Best, Barkeep49 (talk) 21:14, 4 December 2024 (UTC)[reply]

	The Teamwork Barnstar
	I really like what you said, "… it needs both sides to be working under an assumption of good faith and collaborative spirit". Thank you! --Dustfreeworld (talk) 15:41, 5 December 2024 (UTC)[reply]

Thanks @Dustfreeworld. Unfortunately complaining about lack of teamwork doesn't magically make people collaborate well. -- Colin°^Talk 16:48, 5 December 2024 (UTC)[reply]

You are right Colin [sigh]. --Dustfreeworld (talk) 17:44, 5 December 2024 (UTC)[reply]

Colin, as to the approach the AAP has taken culturally, I can send you a very good article on delusional parasitosis once I re-locate it ... dermatologists had to take a particular stance to be able to offer some treatment, even in resistant cases. The approach here seems similar, considering that PANS is related to OCD, which can be familial. SandyGeorgia (Talk) 20:50, 17 December 2024 (UTC)[reply]

From here, I can't recall if it was Campbell or Moriarty -- free full-text is not available, but one of them went into great detail about the language and approach needed to gain the trust of the patients and families, so they could at least have a chance of offering some treatment rather than seeing the patient continue to consult multiple doctors until they got the desired outcome. Telling a delusional patient that they need an antipsychotic will only guarantee they move on to the next doctor, so careful use of language, rather than blunt truth, is the recommended approach for DP.

The PANDAS network helps parents lobby state legislatures to force insurance companies to pay for treatment. On one support group message board, PANDAS is included in the same group as Lyme disease.

How is MEDRS set to handle the incoming administration in the US? You might recall that from the day of its (MEDRS) inception, I lobbied against elevating sources like NIH, CDC, etc, for the very reasons we are likely to see going forward. I could always point out errors in NIH information; PANDAS was born at the NIH. SandyGeorgia (Talk) 21:03, 17 December 2024 (UTC)[reply]

Perhaps I'm naive but I think the UK legal system and medical system is less prone to political or financial interference. So I'm probably more favourable to bodies linked to government (NHS, NICE). Do we think these bodies are any more or less likely to adopt a controversial POV than something that appears more grassroots like some association of [insert disorder here] healthcare professionals. I guess anything that attempts to describe a consensus of experts is great. At times it may not always be ideal. -- Colin°^Talk 10:05, 18 December 2024 (UTC)[reply]

I can't speak to the UK legal/medical compared to the US, but I suspect we will see issues with sourcing from the incoming NIH, CDC, FDA et al relative to what high-quality peer-reviewed publications say. I think the current MEDRS wording encompasses that eventuality, but I'm not entirely sure whether the wording is sufficient to avoid unnecessary battleground. Recall, for example, that the FDA succumbed to advocacy organization pressures and approved aducanumab, overriding its own advisory panel's recommendation and leading several renowned panel members to resign in protest. And the drug was eventually abandoned by the manufacturer (it never worked and had safety issues as well). There are so many examples of politicization of medical decisions in the US, that I worry if MEDRS wording is up to the task of the coming years. SandyGeorgia (Talk) 14:41, 18 December 2024 (UTC)[reply]

Bodies like NICE and SIGN involve patient groups and a range of medical professionals and so can be influenced by advocacy groups as well as looking at systematic reviews. Perhaps this is a WP:RIGHTGREATWRONGS situation where we get the governments and government institutions we deserve, and have to live with it on Wikipedia. Sometimes we win sometimes we lose.

Just because a drug is approved, for example, doesn't mean clinical guidelines recommend it, or maybe it is third-line. And maybe a lot of first-line drugs are so because of big pharma lobbying and not because they really are so much better than the generics. And maybe a drug is prescribed/taken more than it should be. And so on. We know that so-called peer review isn't perfect either. Your US gov bodies may have their flaws, but maybe on balance they are right more often than the alternative. At least for now.

If we are conflicted between one set of guidelines and another government report, which disagree, maybe that's not such a terrible problem. Compare that to the gensex mess, where activist editors think random PDFs, the contents of which change with the wind, and are written to win US legal battles rather than inform medical professionals, stand higher than six systematic reviews and an health service report that was enthusiastically accepted by the health service it was for. Or where talk pages mention articles in lifestyle magazines to spread conspiracy theories or editors face xenophobic comments on talk pages. I can live with "one set of grown ups disagree with another set of grown ups". -- Colin°^Talk 14:58, 18 December 2024 (UTC)[reply]

I 'spose if you aren't worried, then I won't be :)

On aducanumab, "Just because a drug is approved, for example, doesn't mean clinical guidelines recommend it", was the approach I took when it was speedily added in the Treatment section at Alzheimer's after the FDA approved it, although no guidelines or peer-reviewed articles recommended it. No one challenged me when I removed it from the Treatment section to the Research directions section, but I can imagine scenarios where a battleground will develop.

The NIH has long advocated for PANDAS and the related hypotheses, which were born at the NIH. In the longrun, will the peer-reviewed literature on the topic go the way of peer-reviewed literature in the GENSEX area, which is supplanted by blogs and random PDFs. I am concerned we'll see more of this. SandyGeorgia (Talk) 15:21, 18 December 2024 (UTC)[reply]

I've seen several comments about insurance companies, but the very much pro-PANDAS group https://www.pandasppn.org/flowchart/ and https://www.liebertpub.com/doi/10.1089/cap.2016.0148#T5 (which it links to) indicate that the recommended first-line drugs are cheap: a couple of weeks of ordinary amoxicillin and over-the-counter Aleve, with the option of adding some ordinary prednisone. IVIG is pricey (though not compared to hospitalization), but even if you assume PANDAS exists and is moderately common, it looks like most kids would get treated cheaply. There would be no financial incentive for an insurance company to deny such a cheap treatment. Even if it only worked as a placebo, it might save them money by preventing a second office visit. WhatamIdoing (talk) 01:21, 19 December 2024 (UTC)[reply]

If what WAID says is true, why the battle to get insurance companies on board. It seems relatively few states mandate treatment for PANS/PANDAS and we see posts on the talk page complaining about Wikipedia encouraging insurance companies to say no. The article does describe what WAID suggests, that people are giving out antibiotics like Smarties in the belief that this cheap and usually harmless treatment might help. But that makes me wonder: antibiotics are as close to miracle drugs as we have. You can cure an infection in 10 days. You can't cure depression or TS or epilepsy in 10 days. So if that approach had merit, surely the effectiveness of treatment would be pretty easy to demonstrate in a trial.

Wrt Sandy's comment above. It isn't that I'm not worried about the US government healthcare situation. It is that I don't see demoting a whole class of sources as a solution to situations where editors believe they have an example of where it goes wrong. In the gensex area, we have activist editors demoting three sources: Anything British, The Guardian and the BBC. You can find sources and issues with all three if you go looking. And those issues are then cited as a reason to demote that entire class of source, whenever anyone wants to push that source to say something you don't want to say (but conveniently forgotten about if the source says something you do want to say). And I find it surprising since the US is much worse than the UK, and the Guardian and BBC generally news-report these issues with neutrality, and are much better than the alternatives (Pink News might say what you want to say, but nobody argues it is neutral. The Telegraph and Times don't say what you want to say, but are paywalled). So generally I'm nervous about demoting eg NIH or CDC because Sandy can find examples of where they fall down. But maybe we are right to be concerned that in 2025 these bodies might start promoting quack theories and discouraging good medicine. -- Colin°^Talk 09:32, 19 December 2024 (UTC)[reply]

I have a very full day ... doctors plus dentist plus church board meeting and budget ... will catch up tomorrow if I can. SandyGeorgia (Talk) 13:57, 19 December 2024 (UTC)[reply]

~ ~ ~ Greetings of the season ~ ~ ~

Hello Colin: Enjoy the holiday season and winter solstice if it's occurring in your area of the world, and thanks for your work to maintain, improve and expand Wikipedia. Cheers, Spread the love; use {{subst:User:Dustfreeworld/Xmas3}} to send this message.

--Dustfreeworld (talk) 09:46, 24 December 2024 (UTC)[reply]

Thank you @Dustfreeworld. Hope you have a merry Christmas too. -- Colin°^Talk 17:23, 24 December 2024 (UTC)[reply]

Merry Christmas and a Prosperous 2025!

Hello Colin, may you be surrounded by peace, success and happiness on this seasonal occasion. Spread the WikiLove by wishing another user a Merry Christmas and a Happy New Year, whether it be someone you have had disagreements with in the past, a good friend, or just some random person. Sending you heartfelt and warm greetings for Christmas and New Year 2025. Happy editing, Abishe (talk) 23:45, 24 December 2024 (UTC)[reply] Spread the love by adding {{subst:Seasonal Greetings}} to other user talk pages.

Abishe (talk) 23:45, 24 December 2024 (UTC)[reply]