Wikipedia talk:Identifying reliable sources (medicine)
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Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Identifying reliable sources (medicine).
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To discuss reliability of specific sources, please go to Wikipedia:Reliable sources/Noticeboard or to the talk pages of WikiProject Medicine or WikiProject Pharmacology. |
These are some Frequently Asked Questions about Wikipedia's guidelines on sourcing for medical content, manual of style for medicine-related articles, and how the guidelines and policies apply to biomedical content. General
Does Wikipedia have special rules for medical information?
Yes, but the guidelines for medical information follow the same broad principles as the rest of Wikipedia. Examples of this include the requirement for reliable sources and the preference for secondary sources over primary sources. These apply to both medical and non-medical information. However, there are differences in the details of the guidelines, such as which sources are considered reliable. Why do you have special rules for medical information?
Different types of sources have different strengths and weaknesses. A type of source that is good for scientific information is not usually as reliable for political information, and vice versa. Since Wikipedia's readers may make medical decisions based on information found in our articles,[1] we want to use high-quality sources when writing about biomedical information. Many sources that are acceptable for other types of information under Wikipedia's general sourcing guideline, such as the popular press, are not suitable sources for reliable medical information.[2][3][4] (See also: WP:MEDPOP and WP:WHYMEDRS) When do I need to follow MEDRS?
MEDRS-compliant sources are required for all biomedical information. Like the policy on the biographies of living people ("BLP"), MEDRS applies to statements and not to articles: biomedical statements in non-medical articles need to comply with MEDRS, while non-medical statements in medical articles do not need to follow MEDRS. Also like BLP, the spirit of MEDRS is to err on the side of caution when making biomedical statements. Content about human biochemistry or about medical research in animals is also subject to MEDRS if it is relevant to human health. Sourcing
I used a peer-reviewed source, but it was reverted, and the editor said I needed to use a review. I did, didn't I?
Probably not. Most peer-reviewed articles are not review articles. The very similar names are easily confused. For most (not all) purposes, the ideal source is a peer-reviewed review article. Why can't I use primary sources?
Primary sources aren't completely banned, but they should only be used in rare situations. An individual primary source may be flawed, such as being a clinical trial that uses too few volunteers. There have been cases where primary sources have been outright fraudulent. Furthermore, a single primary source may produce a different result to what multiple other primary sources suggest, even if it is a high-quality clinical trial. Secondary sources serve two purposes: they combine the results of all relevant primary sources and they filter out primary sources that are unreliable. Secondary sources are not infallible, but they have less room for error than a primary source. This follows a principle that guides the whole of Wikipedia. If a company announces a notable new product, Wikipedia would not cite a press release on the company's website (a primary source) but instead would cite a newspaper article that covers it (a secondary source). The difference with medical information is that the popular press are not suitable sources. Whenever possible, you should cite a secondary source such as:
So if primary sources can be used in rare cases, what are those rare cases?
Primary sources might be useful in these common situations:
Why can't I use articles from the popular press?
The popular press includes many media outlets which are acceptable sources for factual information about current events, sometimes with significant caveats. It also includes media outlets which are discouraged in all cases because the quality of their journalism is inadequate. However, even high-quality media outlets have disadvantages in the context of medicine. Firstly, news articles on medicine will frequently be reporting a new medical primary source, such as the results of a new study. This means that they are effectively acting as a primary source, which as explained above makes those articles generally unsuitable for medical information. These articles also tend to omit important information about the study. If a medical primary source is to be cited at all, the academic paper should be cited directly. Secondly, media coverage of medical topics is often sensationalist. They tend to favor new, dramatic or interesting stories over predictable ones, even though studies that reflect the current scientific consensus tend to be predictable results. They tend to overemphasize the certainty of any result, such as reporting a study result as a conclusive "discovery" before it has been peer-reviewed or tested by other scientists. They may also exaggerate its significance; for instance, presenting a new and experimental treatment as "the cure" for a disease or an every-day substance as "the cause" of a disease. The sensationalism affects both which stories they choose to cover and the content of their coverage. High-quality media outlets can be good sources of non-medical information in an article about a medical topic. Another acceptable use is using a popular press article to give a plain English summary of an academic paper (use the I have a source from PubMed, so that's reliable right?
Not necessarily. PubMed is merely a search engine and the majority of content it indexes is not WP:MEDRS. Searches on PUBMED may be narrowed to secondary sources (reviews, systematic reviews, meta-analyses, etc.) so it is a useful tool for source hunting. It is a common misconception that because a source appears in PubMed it is published by, or has the approval of, the National Institutes of Health (NIH), National Center for Biotechnology Information (NCBI), or the US government. These organisations support the search engine but lend no particular weight to the content it indexes. Can I use websites like Quackwatch?
Quackwatch is a self-published website by an author who is an expert in problems with complementary and alternative medicine. Whenever possible, you should use a scholarly source instead of Quackwatch. However, if no scholarly sources are available, and the subject is still notable, then it might be reasonable to cite Quackwatch with WP:INTEXT attribution to the POV. Can I cite Chinese studies about Traditional Chinese Medicine?
As of 2014, there are concerns regarding positive bias in publications from China on Traditional Chinese Medicine.[5][6] Such sources should be used with caution. The problem also includes issues with the academic system in China.[7] Can I cite NCCAM (now NCCIH)?
Yes, but again only with WP:DUE weight. Unlike other branches of the National Institutes of Health, which are generally accepted as authoritative in their fields, NCCAM has been the focus of significant criticism from within the scientific community.[8] Whenever possible, you should cite the established literature directly. What if I can’t find any MEDRS-compliant sources on a subject?
MEDRS contains a section about finding sources which may be helpful. Alternatively, a more experienced editor may be able to help you find them (or to confirm that they do not exist). Neutrality
What is a fringe medical claim?
A fringe medical claim is one that differs significantly from the prevailing views or mainstream views in the scientific medical community. This is similar to Wikipedia's general definition of a fringe claim. A claim can still be a fringe medical claim even if it has a large following in other areas of public life (such as politics and the popular press). How should fringe medical claims be described?
When fringe claims have been widely reported in the press, have a large popular following, and/or have a long history, it may be appropriate to describe them in terms of that reporting, popularity, or history. However, weight should be determined by MEDRS-compliant sources, and the context (or lack thereof) should not make implications about medical statements that are not supported by such sources. Guidance on the additional considerations relevant to fringe subjects can be found at WP:FRINGE, as well as at other places such as WP:WEIGHT and WP:EXCEPTIONAL. In the case of alternative medicine, medical statements are often derived from an underlying belief system, which will include many propositions that are not subject to MEDRS. These propositions are subject to the usual sourcing requirements and the usual requirements for determining fringe status. If a treatment hasn't been shown to work, can we say it doesn't work?
There are three possible situations:
In the first case, we cannot say that it does not work, but we can say that there is no evidence to determine whether it works. After multiple, high-quality independent studies have been published, the understanding may transition from "no evidence" to "some evidence" of either an effect or no effect. You should follow the lead of review articles and other secondary sources for determining when this threshold has been crossed. Reports may conflict with each other. For example, a clinical trial may produce no evidence of an effect, but the treatment's manufacturer might produce testimonials claiming a positive effect. You should follow the lead of review articles and other secondary sources for determining how to balance these claims. Should medical content be attributed?
In other words, is it necessary to say in the article's text the source which supports a medical statement (with attribution)? Or can it simply be stated as an unchallenged fact, with the source only mentioned in the citation (without attribution)? A statement without attribution will come across as being a stronger claim than one with attribution. A result or statement from a reliable secondary source should be included without attribution if it is not disputed by any other recent secondary sources. You should do a search to check that the secondary source you are citing is the most up-to-date assessment of the topic. If there have been two recent secondary sources that contradict each other, then you should attribute the disputed findings. On the other hand, if the findings of one or more recent secondary sources are disputed by one or more secondary sources from many years ago, but not by any recent ones, the recent findings can be stated without attribution. You should also take into account the relative weight secondary sources have. For example, Cochrane Collaboration reviews provide stronger evidence than a regular secondary source. In the rare cases where primary sources can be used, they should be attributed. Why not say there is a call for more research?
It is common for scientific publications to say something like this, either directly or indirectly. There are several reasons for this. It could be argued that more research is always a bonus, even if the topic has already been thoroughly researched. Sometimes, these statements may be made partly because authors need to convince readers that the topic is important in order to secure future funding sources. As such, saying this does not communicate much information, and it may also mislead readers into thinking that the existing information on a topic is less reliable than it really is. How can Quackwatch be considered a reliable source?
As noted above, Quackwatch does not meet the usual standard as a reliable source, but it can be used (with attribution) for information on a topic of alternative and complementary medicine if there are no scholarly sources available for the same purpose. The guidelines on fringe theories includes the concept of parity: if a notable fringe theory is primarily described by self-published sources, then verifiable and reliable criticism of the fringe theory does not need to be published in a peer-reviewed journal. It only needs to come from a better source. Finding and using sources
How can I find good sources using PubMed?
National Library of Medicine (NLM), PubMed, NCBI, & MEDLINE help, tutorials, documentation, & support
Full, searchable list of all tutorials - training materials in HTML, PDF and Video formats YouTube channel for the National Library of Medicine: Tutorial videos from the National Center for Biotechnology Information (NCBI), part of the U.S. National Library of Medicine. Includes presentations and tutorials about NCBI biomolecular and biomedical literature databases and tools. PubMed FAQs
National Library of Medicine (NLM) Catalog
NLM Catalog Help - This book contains information on the NLM Catalog, a database which provides access to NLM bibliographic data for journals, books, audiovisuals, computer software, electronic resources, and other materials via the National Center for Biotechnology Information (NCBI) Entrez retrieval system. The NLM Catalog includes links to full text materials and the library's holdings in LocatorPlus, NLM's online public access catalog. NLM Catalog (rev. December 19, 2019). Finding journals that comply with WP:MEDRS standards
For full comprehensive instructions, go to: Searching for Journals in NLM Catalog Determine if a specific journal is indexed in MEDLINE
If you know the full or abbreviated name for a journal, and you want to see if it is indexed in MEDLINE, see the instructions at searching by journal title, which I will also reproduce here:
Review the list of Abridged Index Medicus journals
Via a search of the NLM Catalog: List of Abridged Index Medicus journals, also known as "Core clinical journals". Stand alone list: List of current Abridged Index Medicus (AIM) journals (118 journals as of 5 May 2020) Create a list of all Index Medicus journals
Search the NLM Catalog using ====Create a list of all journals indexed in MEDLINE}}
Search the NLM Catalog using MEDLINE, PubMed, and PMC (PubMed Central): How are they different?
MEDLINE, PubMed, and PMC (PubMed Central): How are they different? Are there ways to find good sources other than PubMed?
Besides being a secondary source, what else indicates a source is of high quality?
I found what looks like a good source, but can't access the full text – what next?
Most scholarly journals are behind paywalls. Some options to access these articles include visiting a local university library, visiting The Wikipedia Library, and WikiProject Resource Requests. Note that paywalled articles are frequently pirated and made available on the open web. When linking to a journal article, care must be taken not to link to such a pirate copy, as such a link would be a copyright violating link in contravention of Wikipedia's policy. In general if you find such a copy and it is not accompanied by text explicitly stating that it is made available with the permission of the copyright holder, assume that it is potentially infringing, and do not link to it. This holds for all edits in Wikipedia, not just in article space. Google Scholar
Search for the title of the article on Google Scholar. On the results page, click on "All n versions" (where n = the number of available versions of that article) at the bottom of a listing. The resulting page might contain PDF or HTML versions of the article. Unpaywall
Consult Unpaywall.org for journal articles available without a subscription. Install the UnPaywall extension for Chrome or Firefox to immediately identify articles with a free version. After you install the extension, look to the right side of the page (when you are on the website for an article) for either a grey locked symbol (no free version) or a green unlocked symbol (click on that symbol to access the full text version of the article). Librarian's advice
An article by librarian John Mark Ockerbloom, titled, "Why Pay for What’s Free? Finding Open Access and Public Domain Articles" offers helpful suggestions.[9] How do I reference a medical article?
Almost all medical articles are indexed by the PubMed search engine and have a Digital object identifier (DOI) assigned to them. All articles included in PubMed are assigned an eight-digit PubMed identifier (PMID). These identifiers can be used to refer to articles, which is preferred to URLs as it makes a reliable link which is resilient to changes beyond our control – i.e. the publisher being acquired by another publisher and it's "normal" web URLs changing as a consequence. Once you have the PMID, there are a number of tools such as this one which you can use to generate a full citation automatically. In article references, the "doi" and "pmid" parameters are preferred to the "url" parameter for such reasons. On Talk pages, when referring to journal articles, is it good practice to make any link using these types of identifier also:
Conflict of interest
Are there special considerations for conflicts of interest for health content?
See WP:MEDCOI. What if I am being paid to edit medical content?
See WP:PAID. References
References
Other helpful resources
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This page has been mentioned by multiple media organizations:
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Meta-analyses need careful scrutiny, peer-reviewed or not.
This
- Glenza, Jessica (28 April 2024). "Junk science is cited in abortion ban cases. Researchers are fighting the 'fatally flawed' work". The Guardian.
Of the 22 studies cited by the meta-analysis, 11 were by the lone author of the paper itself. The meta-analysis "failed to meet any published methodological criteria for systematic reviews" and failed to follow recommendations to avoid statistical dependencies, according to a criticism published in the British Medical Journal (BMJ).
is a cautionary tale. 𝕁𝕄𝔽 (talk) 19:15, 28 April 2024 (UTC)
- Thanks, that's interesting.
- I have been wondering recently why peer review doesn't involve putting each article through an evidence-based checklist (e.g., the Newcastle–Ottawa scale for non-randomized studies; the most relevant checklist for the subject matter could be agreed upon by the reviewers and the editor) and the results published alongside the article. It might make it easier to discover junk science before publication. WhatamIdoing (talk) 21:47, 28 April 2024 (UTC)
- A number of journals now require (or at least strongly encourage) articles to follow appropriate guidelines including completed checklists (usually as part of Supplemental Material). EQUATOR has guidelines/checklists that cover many types of articles. For example, here is part of my boilerplate for rejecting bad MR papers:
- "As you prepare your manuscript for submission to another specialty journal, you may be able to improve it by following one or more of the EQUATOR Guidelines's checklists (https://www.equator-network.org). Mendelian randomization studies must adhere to the best practice as described in the following guideline https://wellcomeopenresearch.org/articles/4-186/v3 and be accompanied to MR-STROBE checklist (https://www.equator-network.org/reporting-guidelines/strobe-mr-statement/)." Jaredroach (talk) 21:27, 12 July 2024 (UTC)
- This is also the reason why this guideline is flawed.
- It puts too much emphasis and trust in academic books & reviews, neglecting that these need careful scrutiny as well. It's not rare in the medical field to find reviews where authors review themselves (or collaborating academic colleagues). There are Cochrane reviews that got redrawn due to inherent bad science (not new data). And academic books do not necessarily represent proper science (e.g. often occuring in psychosomatic literature). A book can be more easily published compared to an article in a serious journal. Yet, the guideline would favour a random academic book over a Nature article.
- This problem is most evident for many Wiki pages where the origin of a disease is not well known. Where you often have a group of psychiatrists asserting a psychosomatic root cause vs a group of biological proponents. In this case, psychiatrists reviewing themselves doesn't give any more credibility, neither does a review by psychiatrists on psychosomatic literature.
- In the end, as mentioned before, all sources need to be checked for credibility. Unfortunately, this is difficult to do on Wikipedia, where scientific "discussion" is not desired on the talk page. 2003:EC:6F4B:2200:68E5:5719:3D0:F25F (talk) 21:53, 26 August 2024 (UTC)
- The difference between a good type of source and a good source is an important but sometimes subtle distinction – similar, you might say, to the difference between discussing science vs repeating claims that I personally believe. I often find that when a person has recently been diagnosed with a significant illness, their view has very little to do with science and quite a lot to do with their emotional state. Some people with "random bad luck" diseases blame themselves, when that is absolutely not warranted; some people blame others when it was their own fault; some people blame irrelevant body systems. Fervent belief that something is (or isn't) a biological illness does not make it so. WhatamIdoing (talk) 03:31, 27 August 2024 (UTC)
Reconsidering a blanket-ban of primary sources
The express reason given is essentially a re-hash of the "reproducibility crisis," but I have to say, should we even be trusting these "fact-checking"-like organizations for whom we essentially defer the power of keeping out bad knowledge?
Did you know, for example, the American Psychological Association, known for such works as the DSM-V and numerous textbooks likely to pass as verified work through here without a second thought, is actually a trade organization with the express intent of lobbying on behalf of practicing psychologists, in exchange extracting registration dues, and licensing fees?
Or that the American Pain Society, this time a non-profit society that nominally advocated on behalf of patients by publishing clinical practice guidelines, actually instead acted on behalf of pharmaceutical companies to propagate a treatment mandate to prescribe more products, in essence acting as a marketing channel where physicians were not primed to regard it critically?
I think it might be beneficial to re-investigate the ultimate authority of the organizations/publication guidelines we choose to let pass uncritically with more ability afforded to well-informed individuals to make their case that enough primary research exists to effectively include a consensus on matters of pathology and lines of inquiry related to potential treatment paradigms. We do ourselves a disservice when we shut out promising potential, and similarly to our readers too when academic literature acts more like a thicket than it does pathway. Additivefreesb (talk) 17:52, 12 July 2024 (UTC)
- Which blanket-ban on primary sources are you referring to? Firefangledfeathers (talk / contribs) 17:56, 12 July 2024 (UTC)
- Wikipedia:Identifying reliable sources (medicine)#Avoid primary sources isn't a blanket ban. Wikipedia:Identifying reliable sources (medicine)#Avoid over-emphasizing single studies, particularly in vitro or animal studies is just common sense.
- We have had multiple problems with primary sources, including:
- editors cherry picking the one source that says something completely different from all the others (e.g., cigarettes don't cause lung cancer)
- editors using obviously bad primary sources (e.g., the patent claiming that colloidal silver cures HIV, but it didn't test whether people had HIV in the first place)
- editors believing the media hype (can result in bad content [because newspapers don't always get technical details right] and unbalanced articles [because it's all about what's in today's news, and next week it'll be some other vegetable that everyone's supposed to eat to prevent cancer])
- authors spamming their own publications into as many articles as possible (this happens much less often with review articles)
- plus, of course, all the problems with the reproducibility crisis and the general difficulty of figuring out which primary source to 'believe in', if the data is conflicting.
- Primary sources are more likely to be tolerated in veterinary content or for very rare conditions. WhatamIdoing (talk) 18:38, 12 July 2024 (UTC)
I think something needs to be said of primary sources often also overwhelming both the average reader or editor, owing to both their sheer number, and the fact that even many well-intentioned editors are not deeply knowledgeable about all issues they write about.
Further, there is simply no blanket ban on primary sources. For instance, there is actually not even a recommendation to refrain from using secondary summaries from within primary sources (i.e. background sections or well chosen parts of discussion sections). One of the problems to allay is keeping Wikipedia from reading: xx et al. found 80% mortality, while xy found 79%, and zy found 81% - with WP:OR prohibiting us from summarizing these (which would be a problem due to evidence grading). This becomes less of a problem upon listing authoritative secondary sources, as they already do summation for us, and readers are likely to want to know what, for instance, both the CDC and WHO think about a specific issue.
This guideline already discusses pitfalls of relying on industry and industry-funded sources, and I would not object to a well-thought out extension on issues of industry influence on practice guidelines or biases in professional associations. WP:MEDORG (part of this guideline, which I worked extensively on) points to industry guidelines or guidelines from patient advocacy groups being considered below the threshold of MEDRS.
Perhaps, in the spirit of giving background to a well-though-out question, Colin has input on considerations when MEDRS was originally drafted. CFCF (talk) 17:54, 13 July 2024 (UTC)
- Lots of people worked on the early drafts of MEDRS. My significant part was realising the medical project's guideline, which was becoming MEDMOS, needed the RS stuff pulled out of it into a new page. But the key battles we had then were editors who thought they knew better than these secondary sources or who thought journalists on their favourite paper did better. Citing the secondary literature was something academics are taught to avoid so it didn't come naturally.
- Coming back to the original question about our favoured MEDORG guidelines having a malign influence behind them. Consider then if we let editors build our medical articles much like someone might write their own review from the primary research studies. That same malign influence would appear on Wikipedia as editors cherry picking primary sources. There isn't a mechanism whereby Wikipedia might be expected to do better, and a fair amount of evidence that it would do worse.
- Wikipedia has a unique editing model where anyone can edit but the consequence of this is we agreed to make the selection and summarising of primary research studies into "somebody else's problem". We found alignment with Wikipedia's preference for "secondary sources" with readily available reviews, guidelines and textbooks. Our model, of relying on existing publications and a crude grading system for those publications, isn't perfect. It is too easy to find oneself reading a journal by a bad publisher. As you point out, it is possible that some apparent authorities are merely fronts for vested interests. But this surely also malignly affects medicine as a whole, so is something the real world needs to fix for itself, rather than us hope we can work around the problem. -- Colin°Talk 09:47, 14 July 2024 (UTC)
- I think that there is sound reason for Wikipedia:Identifying reliable sources (medicine)#Avoid primary sources. For example, consider the following:
- Piper, Kelsey (2024-08-23). "The staggering death toll of scientific lies". Vox. Retrieved 2024-08-23.
- The article highlights cardiologist Don Poldermans's use of apparently fake data in studies that then led to a faulty conclusion that beta blockers were beneficial before heart surgery.
- The article then goes on to state:
[E]xperts who study scientific misconduct believe that thousands of people may be dead because of him.
After the revelations,
[of the falsified data]a new meta-analysis was published in 2014, evaluating whether to use beta blockers before cardiac surgery. It found that a course of beta blockers made it 27 percent more likely that someone would die within 30 days of their heart surgery.
Tens of millions of heart surgeries were conducted across the US and Europe during the years from 2009 to 2013 when those misguided guidelines were in place. One provocative analysis from cardiologists Graham Cole and Darrel Francis estimated that there were 800,000 deaths compared to if the best practices had been established five years sooner. While that exact number is hotly contested, a 27 percent increase in mortality for a common procedure for years on end can add up to an extraordinary death toll.
- Note the clarifying & corrective effects of secondary sources in this situation. Peaceray (talk) 18:02, 23 August 2024 (UTC)
Editorials and op-eds
This guideline lacks the equivalent of what WP:RSOPINION is to WP:RS. Having a section on how to use opinion pieces would enhance the accuracy and reliability of medical articles. It is not uncommon for editors of scientific journals to provide their own commentary on various issues; however, these editorials are distinct from the peer-reviewed articles that form the core content of the journals. 124.104.164.12 (talk) 21:13, 24 July 2024 (UTC)
- Can you give me a couple of examples of opinion pieces that you'd like to cite in a Wikipedia article? WhatamIdoing (talk) 00:36, 25 July 2024 (UTC)
Question about need for MEDRS in Rikishi (sumo wrestlers) health section
Hi all, looking for some guidance on what, if any content in Rikishi#Health effects requires MEDRS? This is for a Good Article nomination that is currently ongoing. Rollinginhisgrave (talk) 14:59, 14 August 2024 (UTC)
- @Rollinginhisgrave, the most important thing to do is to use the best sources that you can. Most of MEDRS is directed towards questions about whether a particular medication is safe and effective for a particular condition, and is not relevant to content about whether people in a small profession have shorter lifespans. There is relatively little formal research available.[1]
- You might consider whether some of the sources used in that section are out of date. For example, the sentence about body fat percentage is cited to a 30-year-old book, so it might not have up-to-date statistics. (20% body fat is probably an appropriate obesity cutoff for East Asian people.) WhatamIdoing (talk) 00:50, 15 August 2024 (UTC)
- As always, thankyou WhatamIdoing for your help. Rollinginhisgrave (talk) 00:55, 15 August 2024 (UTC)
- Statements about life expectancy are getting into the realm of MEDRS, but the following phrase about
as the diet and sport take a toll on the wrestler's body
is where it is making medical claims (although vague). The source used there[2] is a primary source and looks to be a short communication rather than a full research article. I checked Web of Science, and it only has 5 citations, but one of them is a review that may be worth using where it mentions sumo, especially in the context of the previous source.[3] - The second paragraph is where I'd be looking for more medical related sources though. Really anything that says that X results in higher incidence of Y for health issues is something pretty squarely needing medical sourcing. That said, this can be a gray area where you might range from commentary from coaches to those trained in sports medicine. At a glance I can't really assess the sources used there, but it's probably worth searching for more up to date sourcing while looking for medical sources there. KoA (talk) 01:45, 15 August 2024 (UTC)
There are currently two RFCs at Talk:Imane Khelif. Interested editors are invited to participate at Talk:Imane Khelif#RfC lead and Talk:Imane Khelif#RfC on weight of "misinformation" in lead. TarnishedPathtalk 10:45, 23 August 2024 (UTC)
- You might get more responses if you post it at Wikipedia talk:WikiProject Medicine. WhatamIdoing (talk) 17:14, 23 August 2024 (UTC)
- Thanks for the advice. TarnishedPathtalk 09:40, 27 August 2024 (UTC)
Does WP:MEDRS apply to medical information about individuals?
In a previous discussion on this talk page, some editors concluded that no, WP:MEDRS does not apply to diagnosis (see here); however, this was a brief discussion with few comments and no formal closure. The issue was also raised on the Julian Assange talk page, and different views on the relevance of WP:MEDRS were expressed (see here). In two RfCs on Trump's mental health (RfC 2019 and RfC 2021), the consensus was "Do not bring up for discussion again until an announced formal diagnosis or WP:MEDRS-level sources are provided" [4], implying that WP:MEDRS applies to medical diagnoses. I suspect that this issue has arisen elsewhere (e.g. regarding the athlete Imane Khelif here). The intersection between BLP and MEDRS has far-reaching implications for content (e.g., should we remove from Vladimir Putin the statement In April 2022, tabloid newspaper The Sun reported that based on video footage Putin may have Parkinson's disease
?) that are hard to foresee. Gitz (talk) (contribs) 10:52, 27 August 2024 (UTC)
- Firstly, to state the obvious, even if WP:MEDRS didn't apply, both WP:RS and WP:BLP would. Which implies that we shouldn't be making statements regarding any diagnosis concerning a living individual without (a) very good sourcing, and (b) a legitimate reason to consider such diagnosis to be of real enduring significance to public life of the individual concerned. In such a context, I'm finding it hard to see how a non-medical source could be used for sourcing in very many circumstances, beyond possibly the subject themselves stating that they had been diagnosed with something. Wikipedia certainly shouldn't be republishing tabloid speculation without good cause, even if framed in text attributing it to said tabloid sources.
- As for whether WP:MEDRS should apply, I'm doubtful that it could in practice. Very few medical diagnoses will involve peer-review etc, or be discussed in systemic reviews. Quite possibly what we need is an amendment (or rather clarification) to 'WP:BLP policy, making it clear that speculation about a living individuals' medical status does not belong in articles except in very exceptional circumstances, and that repeating poorly-sourced 'diagnoses' is an unacceptable breach of the requirement to respect the privacy of individuals etc, regardless of how it is attributed or framed. AndyTheGrump (talk) 12:34, 27 August 2024 (UTC)
- Yup, and I think common sense applies. The yardstick is whether or not the statement implies anything about biomedicine. Saying Taylor Swift had a cold (say) does not; saying a celebrity was diagnosed with Morgellons would imply that was a real condition, so would. Bon courage (talk) 13:30, 27 August 2024 (UTC)
- Agreed. MEDRS does not apply to an individual's diagnosis, but BLP/RS does. In the Trump case you quote, there's an "or" as an announced formal diagnosis in a regular RS would be fine. We should generally strive for the best sourcing available, so MEDRS-level sourcing is to be encouraged generally. Bondegezou (talk) 14:12, 27 August 2024 (UTC)
- I agree with all the comments above, but I'd like to understand if there's anything specific to medical diagnoses (e.g. the high level of expertise required to make one) that makes their coverage different from other sensitive areas of a BLP such as, say, sexual orientation. If this is the case, then perhaps a few lines could be added to either WP:MEDRS or WP:BLP to make it clear. Otherwise, the usual WP:BLP + RS apply, including WP:BLPGOSSIP, and if multiple news organisations report, for instance, that according to The Sun Putin may have Parkinson's, we can do the same. If they report that a public figure may have some medical condition (something that does imply questionable biomedical statements: not Morgellons or any other alternative diagnoses/delusional disorders) we can include this. Gitz (talk) (contribs) 15:32, 27 August 2024 (UTC)
- IF The Sun, a British tabloid that is deprecated by RSP at WP:THESUN, speculates that a public figure has a medical condition, and this gets repeated by other media companies, then we should probably not include that.
- Spend a while thinking about what some celebrity articles (Britney Spears?) would look like if the standard was "One unreliable source said it, and a bunch of media companies decided that they wanted some of that traffic". WhatamIdoing (talk) 17:14, 27 August 2024 (UTC)
- I agree that the example from Putin is a bit extreme - we should probably remove that content from the article. But what about articles like Claims of Vladimir Putin's incapacity and death and Age and health concerns about Donald Trump? These subjects are notable and the content is potentially contentious. It would be impossible to write these articles if MEDRS-compliant sources were required. This suggests that WP:MEDRS does not apply to diagnoses of individuals, but only to content that presupposes or explicates biomedical knowledge. It seems that the purpose of WP:MEDRS is not to protect the privacy of living persons, but to ensure that reporting on biomedical topics reflects scientific consensus. Gitz (talk) (contribs) 08:48, 28 August 2024 (UTC)
- I agree with all the comments above, but I'd like to understand if there's anything specific to medical diagnoses (e.g. the high level of expertise required to make one) that makes their coverage different from other sensitive areas of a BLP such as, say, sexual orientation. If this is the case, then perhaps a few lines could be added to either WP:MEDRS or WP:BLP to make it clear. Otherwise, the usual WP:BLP + RS apply, including WP:BLPGOSSIP, and if multiple news organisations report, for instance, that according to The Sun Putin may have Parkinson's, we can do the same. If they report that a public figure may have some medical condition (something that does imply questionable biomedical statements: not Morgellons or any other alternative diagnoses/delusional disorders) we can include this. Gitz (talk) (contribs) 15:32, 27 August 2024 (UTC)
- Agreed. MEDRS does not apply to an individual's diagnosis, but BLP/RS does. In the Trump case you quote, there's an "or" as an announced formal diagnosis in a regular RS would be fine. We should generally strive for the best sourcing available, so MEDRS-level sourcing is to be encouraged generally. Bondegezou (talk) 14:12, 27 August 2024 (UTC)
- Yup, and I think common sense applies. The yardstick is whether or not the statement implies anything about biomedicine. Saying Taylor Swift had a cold (say) does not; saying a celebrity was diagnosed with Morgellons would imply that was a real condition, so would. Bon courage (talk) 13:30, 27 August 2024 (UTC)
- Context: Gitz was banned from Imane Khelif article for WP:MEDRS and WP:BLP violations. See User_talk:Gitz6666#August_2024_2 Bluethricecreamman (talk) 16:07, 27 August 2024 (UTC)
- This "context" is irrelevant: the issue is of general interest and does not concern me or my partial block. I opened this thread because 331dot suggested that if I felt the policy needed clarification (which I do), this should be sought at WT:MEDRS rather than in the unblock request. But this discussion has no direct bearing on my block: even if everyone agreed that WP:MEDRS does not apply to individual diagnoses, my block would still remain in place. Gitz (talk) (contribs) 11:00, 28 August 2024 (UTC) .
- Further Context Gitz had an unblock request denied at User_talk:Gitz6666#August_2024_2 as they did not provide a convincing reason why they should be unblocked from Imane Khelif. TarnishedPathtalk 11:14, 28 August 2024 (UTC)
- Do you just want to provide "further context" or do you also have an opinion on the topic of this thread? I remember you arguing that we need MEDRS-level sources to include a diagnosis in a BLP if it belongs to the GENSEX topic area (or something like that). Gitz (talk) (contribs) 15:29, 28 August 2024 (UTC)
- On the Trump RFC outcomes: The community is allowed to set higher rules for an individual article, particularly when repeated discussions are wasting the community's time and wearing on its patience. "Come back when you've got a MEDRS source" is not very different from "One-year moratorium on this subject, because the answer is not changing" or "All future discussions will be subject to WP:EXTCONFIRMED rules, because we've wasted enough time on throw-away accounts". WhatamIdoing (talk) 17:10, 27 August 2024 (UTC)
- Yes, I understand. Let me expand on what you've said. In a talk page discussion, when an editor says "we need WP:MEDRS sources for this statement", this might mean either: 1) "WP:MEDRS applies here". Based on our discussion, this is wrong if the statement is about an individual's diagnosis as opposed to general biomedical knowledge. To include content about a diagnosis in a BLP, we need sufficient coverage from generally reliable sources to ensure due weight, but MEDRS-level sources aren't strictly necessary; 2) Or, "Given the contentious and complex nature of this topic, we should require MEDRS-level sources - the usual NEWSORGs are not sufficient". This would be a suggestion, not a policy requirement; it may gain consensus on the talk page, but doesn't reflect the standard use of MEDRS. Gitz (talk) (contribs) 09:46, 29 August 2024 (UTC)
- I think there's a danger of over-thinking this. For Wikipedia to say any living person has a serious medical condition there would need to be a proper diagnosis and (in reality) that private information would need to be made public in a decent, reputable WP:RS. Speculation about a condition, or armchair diagnosis – if ever due – would need to come from a MEDRS source of some sort. Bon courage (talk) 12:02, 29 August 2024 (UTC)
- I think that if there is a consensus on this approach, then we should write it down somewhere in unambiguous terms, because I keep coming across BLPs that do not follow it. From the article about a recently deceased woman, Tamara Press:
Both sisters were accused of being either secretly male or intersex
; from the article about her sister Irina Press:Some have suggested that the Press sisters were male or intersex. Another allegation was that they were being injected with male hormones by the Soviet government in order to make them stronger
. Sources are the Telegraph, thestraightdope.com, TransGriot, sports-reference.com. Nothing here remotely resembles a "proper diagnosis", which in the case of the Press sisters was never made. At best, we should write something like "The Press sisters retired in 1966, coinciding with the introduction of required gender verification in track & field. This led to widespread, yet never proven, rumors regarding the Presses' genders" (from the last cited source). Gitz (talk) (contribs) 19:20, 1 September 2024 (UTC)- I'm not sure that there is a problem with this (other than the last sentence probably needing to say sex instead of genders). "She was accused of..." is not the same as "She had..." We don't need a medical journal to say that some athletes get accused of having the "wrong" type of body, or that the accusations, even if completely unfounded, can lead to real-world consequences for the accused athlete. In such cases, the article content should focus on the fact that the accusations historically happened, without implying that the accusations are medically true. WhatamIdoing (talk) 20:13, 1 September 2024 (UTC)
- Agree, that example does not seem to be about 'diagnosis' or 'serious medical conditions'. Bon courage (talk) 20:20, 1 September 2024 (UTC)
- I'm not sure that there is a problem with this (other than the last sentence probably needing to say sex instead of genders). "She was accused of..." is not the same as "She had..." We don't need a medical journal to say that some athletes get accused of having the "wrong" type of body, or that the accusations, even if completely unfounded, can lead to real-world consequences for the accused athlete. In such cases, the article content should focus on the fact that the accusations historically happened, without implying that the accusations are medically true. WhatamIdoing (talk) 20:13, 1 September 2024 (UTC)
- I think that if there is a consensus on this approach, then we should write it down somewhere in unambiguous terms, because I keep coming across BLPs that do not follow it. From the article about a recently deceased woman, Tamara Press:
- I think there's a danger of over-thinking this. For Wikipedia to say any living person has a serious medical condition there would need to be a proper diagnosis and (in reality) that private information would need to be made public in a decent, reputable WP:RS. Speculation about a condition, or armchair diagnosis – if ever due – would need to come from a MEDRS source of some sort. Bon courage (talk) 12:02, 29 August 2024 (UTC)
- Yes, I understand. Let me expand on what you've said. In a talk page discussion, when an editor says "we need WP:MEDRS sources for this statement", this might mean either: 1) "WP:MEDRS applies here". Based on our discussion, this is wrong if the statement is about an individual's diagnosis as opposed to general biomedical knowledge. To include content about a diagnosis in a BLP, we need sufficient coverage from generally reliable sources to ensure due weight, but MEDRS-level sources aren't strictly necessary; 2) Or, "Given the contentious and complex nature of this topic, we should require MEDRS-level sources - the usual NEWSORGs are not sufficient". This would be a suggestion, not a policy requirement; it may gain consensus on the talk page, but doesn't reflect the standard use of MEDRS. Gitz (talk) (contribs) 09:46, 29 August 2024 (UTC)
- Seems like the answer to the question in the title to this section (Does WP:MEDRS apply to medical information about individuals?) is already covered by Wikipedia:Biomedical_information#What_is_not_biomedical_information?. A relevant excerpt of examples of what is not covered by MEDRS:
- Notable cases
- If the patient is still alive or is recently deceased, the Wikipedia:Biographies of living people rules apply.
- Popular culture
- Examples of people with the disease in literature, video, or songs
- I don't see a need to further clarify the issue. Mr. Swordfish (talk) 14:47, 3 September 2024 (UTC)
- I had noticed this page, which is indeed quite relevant to this discussion. However, it is only an explanatory essay (
This page is not one of Wikipedia's policies or guidelines
). So, if I'm not mistaken, there's nothing to stop a local consensus being reached that diagnoses in a particular BLP (because it's particularly controversial, because the diagnosis is difficult, because news organisations don't seem reliable enough...) require MEDRS-level sources. But in general there seems to be no doubt that MEDRS does not apply to individual diagnoses: the medical conditions of a living person can be covered with the usual WP:RS and the usual policies and guidelines, including WP:WIKIVOICE and WP:INTEXT (if the diagnosis is controversial or just "rumours" or "accusations"). Gitz (talk) (contribs) 15:14, 3 September 2024 (UTC)- There's nothing in MEDRS that says BLPs are "biomedical information", either.
- If you run into problems that you can't resolve on your own (POV pushing comes in many guises), then I suggest asking for help at Wikipedia talk:WikiProject Medicine. WhatamIdoing (talk) 16:38, 3 September 2024 (UTC)
- You might also be interested in WP:Bring me a rock. WhatamIdoing (talk) 16:39, 3 September 2024 (UTC)
- I'm not familiar with the backstory here but isn't the problem from the other direction – that is with editors wanting to say that Dave the Doctor has said Paul Politician obviously has dementia or that Alice the Athlete is a man, actually? Bon courage (talk) 16:58, 3 September 2024 (UTC)
- Yes, I think that the point is whether WP:MEDRS prevents these editors from making this case, or whether it's just a normal dispute about WP:RS and WP:WEIGHT. Do they need Dave the Doctor to have published his theories in a reputable medical journal, or is it enough that Dave's views have been covered by many news organisations? Gitz (talk) (contribs) 17:12, 3 September 2024 (UTC)
- You mean articles like Age and health concerns about Donald Trump#Allegations of mental illness by medical professionals? I don't expect editors to restrict themselves to MEDRS' ideal in such articles. WhatamIdoing (talk) 01:41, 4 September 2024 (UTC)
- O God that exists eh? An "ideal" MEDRS source is never going to exist for such material but I do think a MEDRS source of some sort is needed for diagnosis of a medical condition in a BLP, a source sufficient to support the weight of the claim made. I suspect the real issue here is AP2/GENSEX and editors wanting to advocate positions, which is something this WikiProject cannot fix. I see we also have Age and health concerns about Joe Biden which delightfully has "No signs of cognitive decline or dementia were noted.[citation needed]". It seems to be attempting to source stuff to the Whitehouse's published presidential physical exam, which would be some sort of MEDRS, FWIW? Bon courage (talk) 03:55, 4 September 2024 (UTC)
- Of course it exists. These armchair diagnoses got so much attention in the press during the previous elections that I heard the APA put out a warning to its members about it being unethical to claim you've diagnosed someone who isn't your patient (and illegal to disclose your diagnoses if he is). It would be WP:UNDUE to exclude it, but impossible to source statements like "He's scientifically proven to have _____". Therefore the contents end up being some variation on "Alice claims he has _____", and editors
fight overnegotiate about which claims are necessary to include and how to phrase them. - A published presidential exam would be a primary source, which is not the MEDRS ideal. Based on the media kerfuffle around one of Trump's published reports allegedly having been written by his (political) staff, we should probably insist upon WP:INTEXT attribution for such sources. WhatamIdoing (talk) 04:00, 4 September 2024 (UTC)
- For sure. Bon courage (talk) 04:02, 4 September 2024 (UTC)
- Of course it exists. These armchair diagnoses got so much attention in the press during the previous elections that I heard the APA put out a warning to its members about it being unethical to claim you've diagnosed someone who isn't your patient (and illegal to disclose your diagnoses if he is). It would be WP:UNDUE to exclude it, but impossible to source statements like "He's scientifically proven to have _____". Therefore the contents end up being some variation on "Alice claims he has _____", and editors
- O God that exists eh? An "ideal" MEDRS source is never going to exist for such material but I do think a MEDRS source of some sort is needed for diagnosis of a medical condition in a BLP, a source sufficient to support the weight of the claim made. I suspect the real issue here is AP2/GENSEX and editors wanting to advocate positions, which is something this WikiProject cannot fix. I see we also have Age and health concerns about Joe Biden which delightfully has "No signs of cognitive decline or dementia were noted.[citation needed]". It seems to be attempting to source stuff to the Whitehouse's published presidential physical exam, which would be some sort of MEDRS, FWIW? Bon courage (talk) 03:55, 4 September 2024 (UTC)
- You mean articles like Age and health concerns about Donald Trump#Allegations of mental illness by medical professionals? I don't expect editors to restrict themselves to MEDRS' ideal in such articles. WhatamIdoing (talk) 01:41, 4 September 2024 (UTC)
- What has prompted this discussoin is editors, Gitz included, wanting to include material in an article that includes speculation about a medical diagnosis in the absense of reliable evidence. TarnishedPathtalk 00:12, 4 September 2024 (UTC)
- You need a MEDRS-quality source to say, e.g., that human sexual differentiation exists on a spectrum rather than a binary, and therefore at some level we are all intersex. You do not need a MEDRS-quality source to say that Imane Khelif has been accused of having a medical condition that could render her ineligible for competing in women's sports. WhatamIdoing (talk) 01:34, 4 September 2024 (UTC)
- But what about that she has all the signs of having that condition, so the diagnosis surely follows? Bon courage (talk) 03:45, 4 September 2024 (UTC)
- I haven't followed this, but I saw a headline about 5α-Reductase 2 deficiency, which doesn't necessarily come with visible signs. WhatamIdoing (talk) 04:14, 4 September 2024 (UTC)
- I am not clear what you mean, Bon courage, but doesn't WP:OR apply there? We shouldn't be drawing conclusions. If RS have drawn conclusions, we report what RS said, subject to normal BLP rules. Bondegezou (talk) 11:55, 4 September 2024 (UTC)
- My assumption was it would be sourced. I have no interest in this particular case (and have not followed it) but, hypothetically, if Doctor Dave says something about biomedical about Athlete Alice (or Paul Politician, or Celebrity Caleb) along the lines of "I can see from observation X that they have condition Y" I don't think that's okay to relay that if it just comes from a lay source, as much for reasons of BLP/NPOV as for weakness of the sourcing. Bon courage (talk) 12:02, 4 September 2024 (UTC)
- Exactly, and in the content dispute that has brought about this discussion (Imane Khelif) we have some pundits, some of whom happen to have degrees in adjacent areas and one or two that are subject matter experts, either engaging in commentary (in sources) which are presumptive or speculative about the subjects medical conditions when it would be unethical for them to discuss a patient diagnosis when they are not the treating doctor or illegal if they are. Editors, such as the one who started this discussion, have tried to push the comments of those pundits as evidence that there is reasonable discussion about the subject's diagnosis and not a whole bunch of misinformation. TarnishedPathtalk 12:37, 4 September 2024 (UTC)
- I don't want to go into the specifics of the case as this is a general discussion, but some background information might be helpful. In 2023 Imane Khelif was disqualified by the International Boxing Federation (a Russian-led, much-criticised sport organisation) because (they claimed) she has XY chromosomes. She waived her appeal against that decision and never released a medical test showing that she has XX chromosomes. In 2024 the International Olympic Committee took the athletes' passports at face value and did not carry out gender testing. So some sports journalists and commentators took it for granted that Khelif has XY chromosomes. Some sources have reported either that she is intersex (Italian press) or that she may be intersex (BBC, New York Times - all major English-speaking NEWSORGs). Even if that were the case, it doesn't mean that she went through male puberty and had a competitive advantage at the Olympics: certain forms of DSDs don't provide any advantage. However, some (more or less WP:BIASED) "experts" ventured a speculative diagnosis of 5-ARD (which would give her a competitive advantage) based on observations such as visual evidence of high levels of testosterone and the like. On the Imane Khelif talk page, there was a broad consensus (myself included) that she should not be described as intersex, not even hypothetically or with attribution ("some have argued that ... she may be"). The point of contention in this RfC is whether to include in the lead that she's been the subject of public debate about her eligibility to compete with women (and also about the soundness of the IOC policy of "stick to the passport, no testing"). In the context of that discussion, I was partially blocked for making this comment. Gitz (talk) (contribs) 13:20, 4 September 2024 (UTC)
- Well there you have it. On such multiple-WP:CTOPs, sourcing and behaviour needs to be impeccable or sanctions will likely follow. Personally speculating on a Talk page about somebody's medical condition(s) is really irrelevant to this discussion and not anything WP:MED or MEDRS can influence. FAFO. Bon courage (talk) 13:34, 4 September 2024 (UTC)
- Fair enough. This thread, however, is significant if the issue comes up again in talk page discussions, as it's likely to happen. In my view, there is a clear consensus that WP:MEDRS does not apply to individual diagnoses (as per WP:NOTBMI), unless they based on or express controversial biomedical theories. If I were not involved, I would venture to close it with this statement. Gitz (talk) (contribs) 13:43, 4 September 2024 (UTC)
- Well yeah, where that is a proper 'diagnosis' and not pundit speculation and/or in a weak source. Bon courage (talk) 13:47, 4 September 2024 (UTC)
- Fair enough. This thread, however, is significant if the issue comes up again in talk page discussions, as it's likely to happen. In my view, there is a clear consensus that WP:MEDRS does not apply to individual diagnoses (as per WP:NOTBMI), unless they based on or express controversial biomedical theories. If I were not involved, I would venture to close it with this statement. Gitz (talk) (contribs) 13:43, 4 September 2024 (UTC)
- a) A reliable sources don't say she waived her appeal. A reliable sources say she couldn't continue due to not having the funds.
- b) The onus isn't on her to disprove the IBA which is unreliable and discredited.
- c) Italian sources posting that she is intersex are obviously engaging in disinformation on the basis of nationalism.
- d) any expert who isn't her doctor speculating about medical diagnosis is engaging in unethical behaviour. They can't claim high levels of testosterone when they are not her doctor and there are is no reliable evidence.
- e) the point of the RFC is to insert language into the article which paints the picture that there has been legitimate concerns, when there has not. Legitimate concerns are based of reliable evidence/facts and there is an abundant lack of those. TarnishedPathtalk 01:17, 5 September 2024 (UTC)
A reliable sources don't say she waived her appeal
. Times of Israel, "Khelif initially appealed but then withdrew her motion"; Forbes, "Khelif later withdrew her appeal"; BBC, "Khelif did take her case to the Court of Arbitration for Sport (Cas), but then withdrew the appeal"; 3 Wire Sports, "Both athletes were afforded the chance to appeal the DQs to the Swiss-based Court of Appeal. Lin did not. Khelif did but then opted last July not to pursue the matter"; France 24: "Khelif did take her case to the Court of Arbitration for Sport (CAS) but then withdrew the appeal". And so on...- As for your other comments: the athlete's body has always been a subject of public debate. Ideals of beauty and physique, performance enhancement and doping, gender and sexuality, body image and eating disorders... you name it. It's part and parcel of being a professional athlete, it's not a matter of
The onus isn't on her to disprove ... any expert who isn't her doctor speculating about medical diagnosis is engaging in unethical behaviour ... Legitimate concerns are based of reliable evidence/facts
. Your questionable reading of BLP+MEDRS+GENSEX denies and trivialises a significant public debate in sport, preventing its coverage based on RS. Gitz (talk) (contribs) 02:01, 5 September 2024 (UTC)- You were banned from the article for a reason. Why are you discussing it here? M.Bitton (talk) 02:26, 5 September 2024 (UTC)
- I am partially blocked, not topic banned. Anyway, you're right - there's no point in continuing to discuss Khelif here. The issue raised by my original post also seems to have been sufficiently clarified. Gitz (talk) (contribs) 09:33, 5 September 2024 (UTC)
- From the Sydney Morning Herald "
Three months later, CAS issued a termination order because Khelif could not fund the costs of the matter
". - As per the rest of what you wrote, M.Bitton summed it up. TarnishedPathtalk 03:28, 5 September 2024 (UTC)
- You were banned from the article for a reason. Why are you discussing it here? M.Bitton (talk) 02:26, 5 September 2024 (UTC)
- Well there you have it. On such multiple-WP:CTOPs, sourcing and behaviour needs to be impeccable or sanctions will likely follow. Personally speculating on a Talk page about somebody's medical condition(s) is really irrelevant to this discussion and not anything WP:MED or MEDRS can influence. FAFO. Bon courage (talk) 13:34, 4 September 2024 (UTC)
- I don't want to go into the specifics of the case as this is a general discussion, but some background information might be helpful. In 2023 Imane Khelif was disqualified by the International Boxing Federation (a Russian-led, much-criticised sport organisation) because (they claimed) she has XY chromosomes. She waived her appeal against that decision and never released a medical test showing that she has XX chromosomes. In 2024 the International Olympic Committee took the athletes' passports at face value and did not carry out gender testing. So some sports journalists and commentators took it for granted that Khelif has XY chromosomes. Some sources have reported either that she is intersex (Italian press) or that she may be intersex (BBC, New York Times - all major English-speaking NEWSORGs). Even if that were the case, it doesn't mean that she went through male puberty and had a competitive advantage at the Olympics: certain forms of DSDs don't provide any advantage. However, some (more or less WP:BIASED) "experts" ventured a speculative diagnosis of 5-ARD (which would give her a competitive advantage) based on observations such as visual evidence of high levels of testosterone and the like. On the Imane Khelif talk page, there was a broad consensus (myself included) that she should not be described as intersex, not even hypothetically or with attribution ("some have argued that ... she may be"). The point of contention in this RfC is whether to include in the lead that she's been the subject of public debate about her eligibility to compete with women (and also about the soundness of the IOC policy of "stick to the passport, no testing"). In the context of that discussion, I was partially blocked for making this comment. Gitz (talk) (contribs) 13:20, 4 September 2024 (UTC)
- @Bon courage, I think I disagree with you about hypothetically, if Doctor Dave says something about biomedical about Athlete Alice (or Paul Politician, or Celebrity Caleb) along the lines of "I can see from observation X that they have condition Y" I don't think that's okay to relay that if it just comes from a lay source. To illustrate why, I'm going to give you my own totally non-RS diagnosis about a BLP: Bryce Dallas Howard has a significantly elevated risk of skin cancer due to her genetics.
- How can I, a lay person, make such a strong medical claim about a person I've never met, much less examined, and actually don't know anything about except that her name turns up in lists of actresses with naturally red hair and green eyes? It's very simple: Every single human with naturally red hair and green eyes has a significantly elevated risk of skin cancer.
- We wouldn't want to put this in an article about her (unless, e.g., she announced that she had skin cancer, or got involved in skin cancer prevention advertisements), but that's because it'd be UNDUE, not because it's untrue. But this is such a lightweight claim that any barely passable source should be considered sufficient.
- (Why did I pick that as an example? Because a few years back, the California legislature has decided that students should not be exposed to their own genetic information as part of a class, and a professor gave that as an example of an unintended consequence.)
- I don't think that all medical claims need the same level of sourcing. Sometimes a person's appearance alone is sufficient; often it's not. And some conditions are more stigmatized, which, as you indicated, has BLP and DUE implications. WhatamIdoing (talk) 06:56, 9 September 2024 (UTC)
- Okay, so would you agree if the prohibition applied only to "non-obvious" statements? Bon courage (talk) 07:50, 9 September 2024 (UTC)
- I think the decision needs to be multi-factorial. "Obviousness" is one factor (e.g., "He has a bad sunburn"). Part of the difficulty here is that what's obvious to "me" isn't obvious to everyone.
- Self-disclosure should be another. People do sometimes lie about their health, and misdiagnoses happen, so a press release saying that Chris Celebrity can't eat gluten should never be taken as the final word, but generally you assume that a qualified healthcare professional was involved.
- Did you ever work on the Terry Schiavo article? I remember a physician-turned-politician saying that he was convinced she was conscious on the basis of a very brief video clip. It turned out that the video clip was carefully chosen because if you saw those few seconds alone, she looked like she was watching a balloon move. (The autopsy report said she was totally blind as a result of brain damage.) So I think you also want some judgement call about credibility. Someone looking to score political points is less credible than someone who isn't. Someone with relevant expertise is more credible than ordinary people. Someone with more information is more credible than someone less information. Someone whose voice was elevated by a high-quality publisher/source is more credible than someone whose claim only got published because a junky source thought it'd drive traffic.
- And then sometimes we have to throw this all away and say: So much has been written about speculations on Donald Trump's mental and physical health that the speculation should be covered one way or the other. The question there is not whether the speculation is true (e.g., "Is he really a narcissist?"), but whether the speculation is impactful (e.g., "Did the claim that he's supposedly a narcissist have any effect on whether people are likely to vote for him?"). WhatamIdoing (talk) 22:03, 9 September 2024 (UTC)
- Yes, there are people who have been 'cured' of cancer but where the diagnosis was questionable in the first place. I don't know about Terry Schiavo. I agree sources should always be credible. Bon courage (talk) 05:34, 10 September 2024 (UTC)
- Okay, so would you agree if the prohibition applied only to "non-obvious" statements? Bon courage (talk) 07:50, 9 September 2024 (UTC)
- Exactly, and in the content dispute that has brought about this discussion (Imane Khelif) we have some pundits, some of whom happen to have degrees in adjacent areas and one or two that are subject matter experts, either engaging in commentary (in sources) which are presumptive or speculative about the subjects medical conditions when it would be unethical for them to discuss a patient diagnosis when they are not the treating doctor or illegal if they are. Editors, such as the one who started this discussion, have tried to push the comments of those pundits as evidence that there is reasonable discussion about the subject's diagnosis and not a whole bunch of misinformation. TarnishedPathtalk 12:37, 4 September 2024 (UTC)
- My assumption was it would be sourced. I have no interest in this particular case (and have not followed it) but, hypothetically, if Doctor Dave says something about biomedical about Athlete Alice (or Paul Politician, or Celebrity Caleb) along the lines of "I can see from observation X that they have condition Y" I don't think that's okay to relay that if it just comes from a lay source, as much for reasons of BLP/NPOV as for weakness of the sourcing. Bon courage (talk) 12:02, 4 September 2024 (UTC)
- But what about that she has all the signs of having that condition, so the diagnosis surely follows? Bon courage (talk) 03:45, 4 September 2024 (UTC)
- You need a MEDRS-quality source to say, e.g., that human sexual differentiation exists on a spectrum rather than a binary, and therefore at some level we are all intersex. You do not need a MEDRS-quality source to say that Imane Khelif has been accused of having a medical condition that could render her ineligible for competing in women's sports. WhatamIdoing (talk) 01:34, 4 September 2024 (UTC)
- Yes, I think that the point is whether WP:MEDRS prevents these editors from making this case, or whether it's just a normal dispute about WP:RS and WP:WEIGHT. Do they need Dave the Doctor to have published his theories in a reputable medical journal, or is it enough that Dave's views have been covered by many news organisations? Gitz (talk) (contribs) 17:12, 3 September 2024 (UTC)
- I had noticed this page, which is indeed quite relevant to this discussion. However, it is only an explanatory essay (
I agree with what others are saying. I'm not sure that whoever said a MEDRS is required for saying an individual has a medical condition has really thought it through. We have other guidelines that deal with speculative, negative information about individuals. We likely have countless biographical articles that note people got cancer or had epilepsy or died of a stroke that are sourced to newspapers, and those aren't MEDRS. Contentious extraordinary claims require high quality sources. Wrt historical figures, even medical journals can be prone to armchair diagnoses of dubious quality. -- Colin°Talk 18:30, 3 September 2024 (UTC)
- We have a lot of articles that cite newspapers or obits to say "Alice died at the age of 67 from cancer", which are entirely acceptable and not MEDRS' ideal. See Angelina Jolie#Cancer prevention treatment for an WP:FA that discusses one individual's personal medical information without citing a single medical journal, reference book, or anything similar. Instead, it relies almost entirely on news stories (or worse). WhatamIdoing (talk) 01:38, 4 September 2024 (UTC)
- I don't think anybody's arguing (are they?) that MEDRS is needed to relay the knowledge that somebody has a medical condition. What's at stake is the sourcing required to make the determination that somebody has (or might have) such a condition. Right so; to repeat: For Wikipedia to say any living person has a serious medical condition there would need to be a proper diagnosis and (in reality) that private information would need to be made public in a decent, reputable WP:RS. Speculation about a condition, or armchair diagnosis – if ever due – would need to come from a MEDRS source of some sort. I don't think any change of WP:PAG is necessary. Bon courage (talk) 01:31, 5 September 2024 (UTC)
- If I've understood the distinction you're drawing, then we need:
- Pretty much any reliable source to say that Chris Celebrity has been diagnosed (e.g., by their own doctor) with scaryitis. See, e.g., Charles III#Health.
- MEDRS-level article to say that, according to people who have never examined them, Chris Celebrity appears to have scaryitis. See, e.g., Retrospective diagnosis#Examples.
- And (perhaps? are we agreed?) multiple decent sources (e.g., news and magazines) to say that Chris Celebrity has been the subject of speculation about health conditions, but these should not say that the speculations are either true or definitely false. See, e.g., basically all of Age and health concerns about Donald Trump.
- WhatamIdoing (talk) 07:22, 9 September 2024 (UTC)
- Yeah something like that. In the second case obviously a strong MEDRS isn't needed to say (e.g.) somebody 'sounded hoarse' while singing; but to say their gait was characteristic of a neurological condition would need something with some MEDRS chops. Bon courage (talk) 07:33, 9 September 2024 (UTC)
- For that second category, I'd expect "some MEDRS chops" to be generally on the lower side (perhaps a peer-reviewed primary source), and I think we need to use sensible judgment, so that things that are more common and obvious don't require much, but wild speculation requires stronger sources. WhatamIdoing (talk) 07:41, 9 September 2024 (UTC)
- I think Chris's surname is unhelpful. None of the people at Retrospective diagnosis#Examples are "celebrities" and I would hope medical journals would have better things to do than speculate on the Kardashians or the latest Love Island contestants. The Marfan's syndrome source is sadly typical of superficially "MEDRS" sources, where a famous name is dropped in the introduction to a more serious article that isn't about them at all. Presumably journal editors/reviewers permit this kind of speculation as "harmless" and don't stop to think "but some Wikipedian might cite this".
- I'm not sure there is good evidence that for historical figures, supposedly MEDRS sources are any better than a serious history book. Possibly a serious historian has dug up detailed descriptions of their illness and described them to a medical expert like any scholar might about any fact outside of their expertise. So some Oxford University Press history book could well diagnose an illness or cause of death and I actually think historians would be more professionally motivated to get their history right vs some random consultant neurologist attempting an entertaining introduction to their latest review. -- Colin°Talk 14:29, 10 September 2024 (UTC)
- Health of Abraham Lincoln lists several possible diagnoses. We would presumably accept a med school textbook saying that he might have had Marfan's (or, perhaps more likely, depression), and perhaps a similarly serious work of history would also be appropriate. I think it's worth thinking over, but right now, I'm having trouble explaining why a scholarly history book feels okay, but the "peer-reviewed literary analysis" mentioned at Talk:Cass Review concerns me. Perhaps the latter is closer to the concept of using a primary source to debunk a secondary one. I'm still thinking about it. WhatamIdoing (talk) 03:21, 15 September 2024 (UTC)
- Maybe the thing to think about is what would the peer reviewers (and editors and publishers) be concerning themselves with? A neurological paper, outlining the state of understanding of a condition and its treatment, is concerned with whether that is an accurate and comprehensive medical review, not whether the introduction correctly identifies some long dead historical figure. Whereas presumably a university press history book is concerned with getting history right.
- A literary analysis would seem to be utterly unconcerned with truth, facts, or indeed the real world, but seeks to view a piece of writing under various conceptual frameworks and thought processes. It seems that two literary analysis papers could produce entirely contradictory conclusions about a work, and that would be just fine as long as the analysis is self consistent. It seems to me that using it to say something about the real world is as much a conceptual error as using an academic theology paper about some Hindu script's story about a god, is evidence that this god does or does not exist. -- Colin°Talk 18:34, 15 September 2024 (UTC)
- Health of Abraham Lincoln lists several possible diagnoses. We would presumably accept a med school textbook saying that he might have had Marfan's (or, perhaps more likely, depression), and perhaps a similarly serious work of history would also be appropriate. I think it's worth thinking over, but right now, I'm having trouble explaining why a scholarly history book feels okay, but the "peer-reviewed literary analysis" mentioned at Talk:Cass Review concerns me. Perhaps the latter is closer to the concept of using a primary source to debunk a secondary one. I'm still thinking about it. WhatamIdoing (talk) 03:21, 15 September 2024 (UTC)
- Yeah something like that. In the second case obviously a strong MEDRS isn't needed to say (e.g.) somebody 'sounded hoarse' while singing; but to say their gait was characteristic of a neurological condition would need something with some MEDRS chops. Bon courage (talk) 07:33, 9 September 2024 (UTC)
- If I've understood the distinction you're drawing, then we need:
- I don't think anybody's arguing (are they?) that MEDRS is needed to relay the knowledge that somebody has a medical condition. What's at stake is the sourcing required to make the determination that somebody has (or might have) such a condition. Right so; to repeat: For Wikipedia to say any living person has a serious medical condition there would need to be a proper diagnosis and (in reality) that private information would need to be made public in a decent, reputable WP:RS. Speculation about a condition, or armchair diagnosis – if ever due – would need to come from a MEDRS source of some sort. I don't think any change of WP:PAG is necessary. Bon courage (talk) 01:31, 5 September 2024 (UTC)
Another area where this sort of question comes up is around Lucy Letby, the nurse who was twice found guilty of murder/attempted murder. There has been considerable media discussion about the safety of those convictions, often revolving around expert issues of medicine and statistics. How do we ensure good sourcing? There's an ongoing discussion at Talk:Lucy_Letby#Determination_of_WP:UNDUE_should_be_per_RS and input would be welcome. I feel parts of the article spend too much time on discussing individual commentaries by experts that are getting close to WP:PRIMARY, for example. Bondegezou (talk) 11:27, 8 September 2024 (UTC)
- Well I'm not going there, but I'd have thought Wikipedia should stick to a summary: i.e. that's she's been convicted but doubts have been raised about the safety of that conviction, without going into the weeds about breathing tubes, statistical analysis and so on. Bon courage (talk) 12:27, 8 September 2024 (UTC)
- I'd agree with that. That is certainly not the current approach being taken! It is 100% in the weeds, lots of "this expert said this", a huge Lucy_Letby#Doubts_about_the_convictions section. 7667 word article with 28% on the Doubts section. Bondegezou (talk) 13:20, 8 September 2024 (UTC)
- I'm supposing that is one of those articles where WP:NOTNEWS goes out the window while the media is pumping out volumes of stuff. Bon courage (talk) 13:30, 8 September 2024 (UTC)
- NOTNEWS is opposed to Wikipedia creating original news reports. It's got nothing against citing the news or keeping articles up to date. I think this is more of a WP:VNOT situation: Just because you can find a source that quotes someone who says ____ is/isn't evidence of guilt/innocence doesn't mean that an encyclopedia article needs to include it. We need more bottom-line summaries ("She was convicted, though some experts have doubts") and less blow-by-blow detail ("Well, Dr. Expert says that discoloration alone isn't proof of air embolism, but Dr. Authority said that discoloration wasn't considered alone"). WhatamIdoing (talk) 07:33, 9 September 2024 (UTC)
- I'm thinking of WP:NOTNEW's "not all verifiable events are suitable for inclusion in Wikipedia", but sure this overlaps with a long of other NOTs. Bon courage (talk) 07:36, 9 September 2024 (UTC)
- If either of you, or anyone else, would like to input those, or other, thoughts at Talk:Lucy_Letby#Determination_of_WP:UNDUE_should_be_per_RS, that would be appreciated. Bondegezou (talk) 12:34, 9 September 2024 (UTC)
- Per Bon courage, yes it has got something against citing the news or keeping the articles up to date. It has multiple statements to the effect of "Wikipedia doesn't want everything you read about in the news" in it. But as Bon courage notes, editor enthusiasm is hard to contain while it is an ongoing story. And for an encyclopaedic POV, it is awful because the deluge of stories is based around editorial policy/position rather than what the current best sources say. We are at the mercy of whether some newspaper editor wants to run with the Evil Nurse angle or the Miscarriage of Justice / Cover Up angle. Which angle sells more papers or suits our political agenda? -- 14:03, 10 September 2024 (UTC) Colin°Talk 14:03, 10 September 2024 (UTC)
- I'm thinking of WP:NOTNEW's "not all verifiable events are suitable for inclusion in Wikipedia", but sure this overlaps with a long of other NOTs. Bon courage (talk) 07:36, 9 September 2024 (UTC)
- NOTNEWS is opposed to Wikipedia creating original news reports. It's got nothing against citing the news or keeping articles up to date. I think this is more of a WP:VNOT situation: Just because you can find a source that quotes someone who says ____ is/isn't evidence of guilt/innocence doesn't mean that an encyclopedia article needs to include it. We need more bottom-line summaries ("She was convicted, though some experts have doubts") and less blow-by-blow detail ("Well, Dr. Expert says that discoloration alone isn't proof of air embolism, but Dr. Authority said that discoloration wasn't considered alone"). WhatamIdoing (talk) 07:33, 9 September 2024 (UTC)
- I'm supposing that is one of those articles where WP:NOTNEWS goes out the window while the media is pumping out volumes of stuff. Bon courage (talk) 13:30, 8 September 2024 (UTC)
- I'd agree with that. That is certainly not the current approach being taken! It is 100% in the weeds, lots of "this expert said this", a huge Lucy_Letby#Doubts_about_the_convictions section. 7667 word article with 28% on the Doubts section. Bondegezou (talk) 13:20, 8 September 2024 (UTC)
MEDRS and WP:PARITY
This has come up a few times in the past. Sometimes there are plainly WP:FRINGE medical treatments that are so out-there or obscure that no peer-reviewed coverage of them exists; editors will occasionally then argue that we cannot say that there is no proof of their effectiveness (or that we cannot otherwise describe them as fringe in ways that might touch on biomedical information), citing WP:MEDRS. This is, I think, the sort of situation WP:PARITY exists for - if no high-quality academic sources touch on a fringe topic at all, then, provided it is plainly WP:FRINGE, we don't need highest-quality sources to broadly dismiss it. I propose adding a note about PARITY to MEDRS somewhere, along with perhaps a bit of loose guidance for how such coverage should be handled. --Aquillion (talk) 19:12, 29 August 2024 (UTC)
- I agree that many such cases call for application of PARITY. If it's possible, it's almost always preferable not to mention a fringe medical claim, rather than mention it and draw from non-MEDRS sources to counter it. It's not always possible, since non-medical sources have an attraction to fringe claims. In principal, I'd support some PARITY guidance here, perhaps with a recommendation to start a discussion at this talk page or FTN if unsure about best practices. Firefangledfeathers (talk / contribs) 19:22, 29 August 2024 (UTC)
- I wonder if we need to address things in different ways. For example, consider these use cases:
- Are all herbal/traditional/self-care remedies truly FRINGE? Valerian (herb) is a traditional herbal anxiolytic. Our section on its uses is self-contradictory (there's no proof that it works; also, it's a central nervous system depressant ...which means that it works). We cite an 18-year-old Cochrane report that declined to draw any conclusions, and we use that to present the conclusion that "Valerian has not been shown to be helpful" for anxiety. Is valerian's traditional use as an anxiolytic truly FRINGE? I don't know. PMID 36144755, PMID 33922184, and PMID 33463459 say it works, PMID 35378276 says they can't tell if it works, PMID 34116572 and PMID 33480339 say it's "promising", and PMID 33086877 says it depends on the quality of the product. I'm not sure what we should be saying, but I don't think that declaring "FRINGE, so I can use weak sources as long as they say it doesn't work".
- Are we talking about whole articles or brief mentions? In a lot of cases, the correct answer is just not to mention it. But if the fringe-y subject is also a notable subject, then we've got to say something. My inclination is to do the best we can, just like we have to do the best we can with experimental "scientific" drugs. We may declare a hyped drug from Big Pharma to be notable on the grounds that it's in the business news, but we still have to describe what it is, and that's (a) often going to be based on primary sources and (b) always going to be based on sources connected to the drug developer/manufacturer. Independent researchers can't get their hands on experimental drugs to run totally independent tests. We manage with the whole of Category:Experimental drugs, so I suspect we can manage equally well with the latest multi-level marketing product.
- WhatamIdoing (talk) 20:31, 29 August 2024 (UTC)
- I wonder if we need to address things in different ways. For example, consider these use cases: