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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
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)
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)
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)
[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.
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)
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)
as the diet and sport take a toll on the wrestler's bodyis 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]
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)
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)
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)
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)
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...
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)
Three months later, CAS issued a termination order because Khelif could not fund the costs of the matter".
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)
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)