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Alternative Medicine Section Order Disparity

Hi everyone, I have a question I would like to open to the community here about something I've noticed on alternative medicine pages. I have noticed several pages such as herbalism, ayurvedic, homeopathy, naturopathy, and applied kinesiology have a certain order but others such as acupuncture and chiropractic (more the former than the latter article) serve as examples of contrast and do not put the history section in the beginning (though the chiropractic article does have conceptual basis in the beginning and it could be argued that is at least somewhat related to the history section). So, is there a page that guides us on this or a policy about how to order sections in alternative medicine (system) articles? If so, can someone direct me to this page please?. If not, perhaps we should discuss this issue since there seems to be a lack of uniformity in the articles. TylerDurden8823 (talk) 06:45, 10 August 2014 (UTC)

Not sure if there would be an advantage to uniformity. The altmed space is diverse enough that different topics may require different ordering. Generally, a chronological basis for ordering gives a natural reading order - so if there is a "History" section having it first would be reasonable. One thing to be alert to is a propensity from some POV-pushers to try and gather the "negative" material in one section and then push it down the article. Alexbrn talk|contribs|COI 07:41, 10 August 2014 (UTC)

WP:MEDMOS, we can discuss it further. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:43, 10 August 2014 (UTC)

The above is copied from the initial discussion on Wikiproject talk Medicine. In response to Alex's comments, a few points. First, both the medicine and alternative medicine spaces are quite diverse yet for the medicine articles we do have a clear section heading standard even though articles sometimes deviate to this to a certain extent. However, good and featured articles (aka our well-written medical articles) tend to have a significant degree of uniformity when it comes to how we order our sections, so I don't see why this should not extend to the alternative medicine space too. The diverse argument doesn't seem to hold up. Second, I agree that it makes sense to have the history section earlier in the article due to the majority of articles having it that way and because, as you mentioned, it holds a certain chronologic appeal. Lastly, I'm not sure how POV pushers would "gather the negative material in one section and then push it down the article" successfully. Unless we're talking about an enormous article like acupuncture, then I suppose such an action could partially succeed in an article like that. However, most alternative medicine articles I see are nowhere near that size. On top of that, the menu of sections early in the article would still show the existence of a critical/criticism section in the article for readers and the lead of any halfway decently written article with a criticism section should allude to the fact that there is criticism (and this would render a POV pusher's attempts to shove negative material out of sight at the bottom of the article meaningless). So, overall, I don't think that's really something we need to be alert for as you say. It seems like a non-issue to me. I'm not saying POV-pushing is a non-issue, but I think they would be largely unsuccessful hiding criticism from readers with a simple reordering of sections. That just sounds paranoid to me. We should focus on the main issue here though which is whether a guide similar to MEDMOS should be written or if MEDMOS should be edited to be more inclusive and have a set of guidelines for alternative medicine articles. On the main WP:MEDMOS page here for example I really didn't see anything talking about standard efficacy/effectiveness or criticism sections, yet I see such sections in many medical and alternative medicine articles. I think that merits further discussion. TylerDurden8823 (talk) 16:03, 10 August 2014 (UTC)

If you are going to have unifirmity as the goal, then altmed pages like, Chiropractic, should be organized the same way that conventional med pages, like Orthopedics, are.

Overall, though, I think that the conformity seen in FAs is a symptom of a problem rather than a feature to be emulated. WhatamIdoing (talk) 01:35, 22 August 2014 (UTC)

The flow of articles regarding diseases

I suggest the flow of such articles to be like this : cause & transmission --> symptoms & signs --> pathophysiology --> diagnosis --> treatment/management --> prognosis --> prevention --> epidemiology --> history. This is supposed to be also the "flow" of getting and tackling a disease, isn't it? Biomedicinal (talk) 04:28, 13 August 2014

We have many thousands of articles that follow the current style. There are arguments for many orders. Do not really see this as the flow of tackling a disease. Many medical sources put epidemiology first. Would need clear consensus for a change. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:43, 14 August 2014 (UTC)

Starting with ==Cause== makes sense for many infectious diseases. However, if the cause is unknown, then it isn't such a good section to lead with. WhatamIdoing (talk) 01:37, 22 August 2014 (UTC)

A change to some of our headings

We had a meeting at Cancer Research UK at which we discussed simplifying some of our terms. We should discuss them one by one and then I guess have a support oppose to determine if we should move in this direction. The plan is to have a bot make the changes that have consensus.Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:36, 20 August 2014 (UTC)

Mechanism instead of Pathophysiology

Mechanism IMO is a similar term. Both are currently acceptable. I propose we use mechanism consistently. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:36, 20 August 2014 (UTC)

Agree Thanks JMH for starting this section off! I was waiting until I thought more people were back from vacation, but this page doesn't self-archive as quickly as project talk. Wiki CRUK John/Johnbod (talk) 22:15, 20 August 2014 (UTC)

Support "Mechanism" for clarity. Seppi333 (Insert 2¢ | Maintained) 22:42, 20 August 2014 (UTC)

Support "Mechanism" as a shorter, simpler word. (I'd rather not see mass changes made for any of these.) WhatamIdoing (talk) 01:38, 22 August 2014 (UTC)

• Not sure For many other articles covered by MEDMOS, there are similar terms being used. Drugs have a Mechanism of action section, surgeries have "technique", and medical tests have "mechanism". For all of these, the concept is "How it works", but it sounds informal to have a "How it works" section even though I think that might be more understandable than mechanism plus it applies more consistently. Aside from the informality, is the concept of "How it works" what we are trying to express? How does that compare with "mechanism"? I checked a grammar board but got no good insight. I think a lot of people say "how it works" but it seems like something people would say, but not write. Blue Rasberry (talk) 15:34, 22 August 2014 (UTC)
• Support mechanism. --Anthonyhcole (talk · contribs · email) 17:54, 23 August 2014 (UTC)
• Support -- CFCF 🍌 (email) 07:07, 1 September 2014 (UTC)
• Support this is an important accessibility issue. --101.116.66.140 (talk) 22:51, 9 September 2014 (UTC)
• Support I absolutely agree that this will be a more accessible term for Misplaced Pages readers. TylerDurden8823 (talk) 02:00, 10 September 2014 (UTC)

Outcomes instead of Prognosis

Outcomes is simpler and more understandable. They are similar enough that I would support the change. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:36, 20 August 2014 (UTC)

An alternative could be Outlook. But I do rather like the plurality of Outcomes. That's a relevant aspect, imo (as briefly discussed at CRUK). 86.157.144.73 (talk) 20:43, 20 August 2014 (UTC)

Either outlook or outcomes. Wiki CRUK John/Johnbod (talk) 22:15, 20 August 2014 (UTC)

Support "Outcomes" for clarity. Seppi333 (Insert 2¢ | Maintained) 22:42, 20 August 2014 (UTC)

No opinion. What matters to me more is that the section exists. It's missing in far too many of our articles. WhatamIdoing (talk) 01:39, 22 August 2014 (UTC)

• Support "Outcomes" Blue Rasberry (talk) 15:22, 22 August 2014 (UTC)

Oppose. "Outcome(s)" sounds too definite, too guaranteed. "Possible outcomes" might do, but IMO prognosis is a well-known word. --Hordaland (talk) 20:42, 22 August 2014 (UTC)

I like possible outcomes. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:15, 22 August 2014 (UTC)

Also fine with that. Wiki CRUK John (talk) 14:37, 23 August 2014 (UTC)

I like "possible outcomes". Blue Rasberry (talk) 14:07, 25 August 2014 (UTC)

Either is an improvement but I prefer "outlook". --Anthonyhcole (talk · contribs · email) 17:52, 23 August 2014 (UTC)

Support either. I more strongly favor outlook, but it isn't very important to me, as said previously both are an improvment.-- CFCF 🍌 (email) 07:07, 1 September 2014 (UTC)

Support Outlook aswell Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:39, 1 September 2014 (UTC)

Support the idea of outlook. I agree with WAID that the bigger issue is the absence of this section in many articles rather than what we name it. TylerDurden8823 (talk) 14:46, 1 September 2014 (UTC)

Epidemiology?

Not sure if there is a simpler term we can use. Statistics maybe but it is not that similar. Can others think of suggestion? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:36, 20 August 2014 (UTC)

Don't know what the answer is, but this title has always stood out for me as the classic example of how WP medical articles are not lay-reader friendly. Alexbrn 20:02, 20 August 2014 (UTC)

Why not "population distribution" (i.e., what segments of a population are most affected by the disease or condition)? Per WP:HEAD, it is not necessary to repeat the title of the article in section headings and therefore it is understood that "population distribution" refers to the disease. Boghog (talk) 20:28, 20 August 2014 (UTC)

Suggest Frequency. Certainly not perfect, but good enough, imo. More specific than "Statistics" and simpler than "Population distribution", which would still sound forbiddingly technical to many lay readers, imo. Clearly a worldwide perspective is important, though many articles currently lack this even under the current "Epidemiology" heading. 86.157.144.73 (talk) 20:40, 20 August 2014 (UTC)

Certainly a change would be good. I also note that typically we have "causes", including eg % of cases attributable to smoking, in its own section, so that "Epidemiology" is just frequency/statistics, whereas an epidemiologist would I think typically feel that "Epidemiology is the study of how often diseases occur in different groups of people and why" (my bolding), and that our approach therefore only covers half his/her subject in the section named after it. Another reason to change. Really we just cover the demographics side in these sections, but that's another "ology". "Frequency" might puzzle some in this context, whereas "statistics" is pretty clear and straightforward, unless anyone has a better idea. Not sure about "population distribution", but it's possible. Or just "distribution"? If we used questions as headings it would be easier, but we don't. Wiki CRUK John/Johnbod (talk) 22:08, 20 August 2014 (UTC)

Yes agree that we usually split out half of epidemiology into causes and thus our epidemiology sections do not contain all the epidemiology. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:30, 20 August 2014 (UTC)

(edit conflict)Just "Distribution" would do nicely, I think. Implicitly includes demographics, prevalence, and avoids the lay reader's conception that it pertains to infectious disease only. LeadSongDog come howl! 22:34, 20 August 2014 (UTC)

Yes distribution may work. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:39, 20 August 2014 (UTC)

+1 for "Distribution". Fwiw, a classic definition of epidemiology is: "The study of the distribution and determinants of health-related events or states in specified populations..." In this section we summarize the distribution, while the determinants go under "Causes". All while trying to achieve or maintain a global perspective for the various populations. 86.134.200.29 (talk) 08:31, 21 August 2014 (UTC)

My inclination is to try out an alternative like ==Distribution==, and to see where it works and where it doesn't. I'm not sure that Pregnancy#Epidemiology would be improved by changing it to "Distribution", which has a very geographical feel. ("Q: What is the distribution for pregnancy?" "A: Well, pretty much the entire inhabited world.") WhatamIdoing (talk) 01:42, 22 August 2014 (UTC)

That's not even correct in the geographical sense of distribution, but clearly we intend a statistical meaning, as we're still discussing epidemiology by another name. Some countries have far higher rates than others, or compare rural to urban. Certainly there are significant distributions against age, sex (d'oh!), religion, marital status, economic status, time since previous pregnancy, perhaps political orientation? And then there's the question of exposure to the, erm, "infectious" agent. Any of these could be subsections of interest to the reader. LeadSongDog come howl! 21:52, 22 August 2014 (UTC)

• Support "distribution" The WHO uses this word too. Blue Rasberry (talk) 15:20, 22 August 2014 (UTC)

Populations affected? --Anthonyhcole (talk · contribs · email) 17:56, 23 August 2014 (UTC)

Maybe? Or maybe "People affected"? That might sound weird when you're writing about one of those rare diseases that kills babies in infancy, since "people" usually refers to adults. WhatamIdoing (talk) 05:58, 1 September 2014 (UTC)

Rather than having an across the board change as their might not be one term that works for all articles, we could simply add to the number of possible headings that can be used for this section and use which everyone is simplest and appropriate. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:20, 23 August 2014 (UTC)

I'm fine with that, but I think we are agreed that "Epidemiology" is generally a problem because a) lots of general readers don't understand it and b) we typically cover only the statistics/distribution part of it in this section. If we recommend a variety of terms we should probably come up with thinking as to when the different ones might be the best choice. For example, taking from above, I don't see that "Populations affected" works well with "Pregnancy". It might with "Dengue fever", but then so does "Distribution". Both do perhaps have a "very geographical feel", but I think "distribution" works better where things like age, gender and occupation are big factors. Most people will take "Populations affected" to mean "the populations of which countries". If we are getting a bot to make the changes I imagine we need to make a default choice, which people can then change manually where they think that best. Wiki CRUK John/Johnbod (talk) 22:59, 23 August 2014 (UTC)

How many other options can we come up with? I'd be happy to hear more ideas, even if they might only work for some types of articles. I'll add another to the list: What about something like "Characteristics of patients" (although we usually avoid the term 'patients')? WhatamIdoing (talk) 05:58, 1 September 2014 (UTC)

My immediate thought would be to use Those affected. -- CFCF 🍌 (email) 07:07, 1 September 2014 (UTC)

• Support "distribution" I think this feels the most generally applicable - I agree that there may be situations where it doesn't quite fit but I think they're more likely to me minority cases. Distribution is also not necessarily geographic - it can also be socioeconomic, ethnic, etc. So, yeah, 'distribution' gets my vote HenryScow (talk) 16:51, 18 September 2014 (UTC)

Contraindications

Earlier this year the heading "indications" was changed to uses. This followed a discussion in 2011. A "use" may not be indicated; it could just be optional, so the meaning was changed a bit here.

Should "contraindications" likewise be changed to be the opposite of "uses"? A contraindication is a strong deterrent, but sometimes there is discouragement which is not a contraindication. For example, sometimes doctors and mothers somehow decide to have caesarean section surgery when it is not medically indicated, and various authorities say that this ought not happen and people should not be choosing to have surgeries without a medical indication. Similarly, there are other treatments which are discouraged but not contraindicated. Misplaced Pages was criticized for not giving information about FDA drug safety alerts, which again frequently are not contraindications but may be reasons to avoid using something. Is it the intent of this heading to usage warnings which are not contraindications?

Does this heading need to exist at all, or should it just be part of uses? There is always a uses section in articles. The contraindications section may or may not appear.

Other names could be "When to not use", "Uses to avoid", "Reasons to avoid", "Usage warnings", or just "Warnings". Note that for drugs we already have an "adverse effects" section and for procedures a "risks and complications" section in addition to the contraindications section of each of those.

I like "Warnings". Does that fit here? Blue Rasberry (talk) 21:51, 16 September 2014 (UTC)

I don't like ==Warnings==. I think that we'll end up with fights about whether only official warnings should be included, or whether adverse effects should be included, or whether this is the right section for "call your doctor if you experience..." medical advice. (The "right section" for that last one is "on some other website".)

"Reasons to avoid" is my current favorite out of your list, but I'm flexible. WhatamIdoing (talk) 23:24, 16 September 2014 (UTC)

Indications is a legal term as is contraindications. The preferred term IMO is side effects. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:47, 17 September 2014 (UTC)

Actually, indication is not (just) a legal term. A suspected broken bone is a very good indication for getting an X-ray of said bone, for example. WhatamIdoing (talk) 23:54, 9 October 2014 (UTC)

Contraindication says (unrefed) "Relative contraindications may also be referred to as cautions, such as in the British National Formulary.", but suggests no alternative term for absolute contraindications. As I said last time, I'm softer on "contraindications" than "indications", partly because the former is really only found as a medical term. I like "reasons to avoid" best of the suggestions so far. I think (as we discussed last time) both these terms are even less familiar to UK readers than US, and a search of the huge NHS Choices website shows no use of "contraindication" at all, while the 20 uses of "indication" all seem mainly directed at prefoessionals rather than patients . So an alternative is very desirable. If we do use it as a header we should begin the section with something like "Reasons not to use this drug/treatment include ....", instead of eg "Simvastatin is contraindicated with pregnancy, breast feeding and liver disease.", as we typically now have. The article Contraindications to thrombolysis currently manages to avoid completely either explaining or linking the term at all! This seems to be our only "Contraindications only" article, and should surely be merged back - I've tagged it for the project. Wiki CRUK John (talk) 10:53, 17 September 2014 (UTC)

Support "reasons to avoid". "Side effects" doesn't cut it, as total avoidance in some cases is necessary. --Hordaland (talk) 13:29, 18 September 2014 (UTC)

And side effects is a whole different concept. Pregnancy is a contraindication for all sorts of things, but not a side effect of them. Wiki CRUK John (talk) 15:04, 18 September 2014 (UTC)

References in the lead

Currently there is confusion around if references are needed in the lead or not. My position is that we should have references in the lead and this is for a couple of reasons:

1. Our readers expect them. I used to not add refs to the lead and people would come along and add "citation needed". Used to get into small edit wars to remove them. A huge drain on time.
2. Am working to improve and translate the leads of key medical articles into as many other languages as possible. So far have 51 articles ready Misplaced Pages:WikiProject_Medicine/Translation_task_force/RTT(Simplified)L. Other languages of course need references to. Thus everyone referencing the lead helps support this effort.

Will add something along this line to our MOS unless people oppose. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:46, 4 September 2014 (UTC)

• I completely agree that referencing the lead of medical articles is important. Ideally, the lead of Misplaced Pages health articles will be a well referenced plain language overview of the topic that can be re-used separately for a brief standalone article for either translation or as simple introduction to a topic. Sydney Poore/FloNight♥♥♥♥ 13:49, 4 September 2014 (UTC)
• Support It seems like a good idea but this is a change at odds with many years of precedent as presented at Misplaced Pages:Manual_of_Style/Lead_section#Citations. I would like to see a lot of support from health editors before this is put into MEDMOS. This might also be a good time to confirm WikiProject Medicine's stance on the necessity of citations. In much of Misplaced Pages, citations are optional. In medicine it is my understanding that information is deleted without discussion when it is not backed with citations. Perhaps the broader idea here is that all health content on Misplaced Pages must be followed with citations after every sentence, with the complementary idea that it is desirable for as many statements on Misplaced Pages as possible to be backed with citations. Blue Rasberry (talk) 13:59, 4 September 2014 (UTC)

The style I use if a ref supports an entire paragraph is have the ref at the end and hidden refs after each sentence. It makes it a lot easier to figure stuff out if text is rearranged or someone adds a citation needed tag Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:47, 4 September 2014 (UTC)

The proposal above is not so much at odds with Misplaced Pages:Manual of Style/Lead section#Citations; that guideline is clear that it's a good idea to add citations to the lead for controversial or otherwise likely to be contested matters. Well, medical text (not all of it, but a lot of it) is likely to be contested. I prefer citations in the lead for any Misplaced Pages article, since so many Misplaced Pages editors (even experienced Misplaced Pages editors) don't consider that what is in the lead might be cited lower in the article. It's the same type of thing that leads to WP:Citation overkill; for example, a Misplaced Pages editor not considering that an entire paragraph is likely sourced to the one reference at the end of the paragraph (it's often the case that the editor simply was too lazy to read the source).

Blue Rasberry has started a discussion on this matter at Misplaced Pages talk:Manual of Style/Lead section. Flyer22 (talk) 16:22, 4 September 2014 (UTC)

• Support. I tried to do this on the dextroamphetamine page, but they were removed by User:Seppi333, and then he told me that in order to make them in line with other amfetamine-related articles I had to place the references in some footnotes, which takes up some unnecessary time, especially seeing how I was only going to place just one pertinent reference for each point, hence there'd be no issue of clutter (If you would like to see this discussion see here). Brenton (contribs · email · talk · uploads) 17:25, 4 September 2014 (UTC)
• support any claim made about health is highly likely to be contentious and since there is a high likelihood of people assuming that "Its in Wiki, it must be true" we should be extra cautious about putting people's health in jeopardy. -- TRPoD aka The Red Pen of Doom 21:56, 6 September 2014 (UTC)
• Oppose. The general WP manual of style is stringent enough by saying refs can be added for controversial claims. I do not agree with above commenters that most health claims are controversial, only a small minority are and they are the exception rather than the rule. Furthermore I fully support the translation project, but I don't think that is reason enough to change guidelines for article content on this Misplaced Pages. --WS (talk) 22:07, 6 September 2014 (UTC)
• Support. Will save my sanity at subsequent FA noms. Seppi333 (Insert 2¢ | Maintained) 22:34, 6 September 2014 (UTC)
• Support. I agree with the statement above that readers expect references in the lead. I think the absence of references in the lead can cause a lot of confusion for readers since some of them may not be willing to scroll lower and see that the content in the lead is just the brief summary and that the references come later. I don't see any particular harm in having the references in the lead and again in the body of the article. Is it a bit redundant? Yeah, but as an encyclopedia it is always best to remember that these articles are meant to be read and it's important to appreciate the readers' perspective. Even if this is at odds with years of precedent from Misplaced Pages guidelines, I think this can be a positive change. TylerDurden8823 (talk) 23:01, 6 September 2014 (UTC)
• Oppose. Wow, this thread sure shows a lot of confusions piled on top of confusions.

  WP:Verifiability policy trumps WP:Manual of Style and other guidelines; any facts added to a WP article's lead have to have citations somewhere in the article. If the facts are not in the main body of the article and cited there, then they have to be cited in the lead. That also means rewriting is in order, because something in the lead should also be mentioned in the main body of the article, as the lead is just a summary.

  WikiProject Medicine does not maintain its own manual of style, but a Misplaced Pages Manual of Style sub-page, and it is subordinate to the main one and to the general rules in the not-field-specific sub-pages like MOS:LEAD; it is not "our MOS" in distinction to WP's MOS. This is a matter of policy, at WP:LOCALCONSENSUS. If some participants in WP:MED want to do something notably divergent from the mainstream MOS, they should seek consensus outside their topical camp, to change the broader guidelines (either to apply more generally what these wikiproject participants want to do specifically, because it's a better approach, or to account for what these wikiproject participants want to do as an explicit topical exception to general practice, and why). Note WP:ADVOCACY, WP:SOAPBOX and WP:FACTION and the failure of WP:Esperanza; no wikiproject is an entity unto itself, a club, an organization, in a position to engage in collective wikipolitical activism positions; there is no "WikiProject Medicine's stance on" anything, except on the off-chance that something actually gains unanimous wikiproject participant support, and even then that's simply what some editors with a similar interest agree on, and does not represent any kind of supervote on Misplaced Pages.

  The notion that facts in medical article leads are unusually likely to be challenged is false; rather, facts in leads that are not sourced in the main body are likely to be challenged, regardless of topic, and facts anywhere within medical articles are more likely to be challenged than facts in more trivial topics like fiction fandom. That it's happened more than average with regard to medical articles' leads is side-effect of this wikiproject's habit of translating the leads (only) of foreign-language Wikipedias' medical articles to create stubs here, and has nothing to do with the general reliability of medical info on WP or its likelihood of being challenged, vs. political, botanical, or other information people care about the accuracy of. Putting citations where they belong has nothing imaginable to do with "putting people's health in jeopardy" (see hyperbole and argument to emotion).

  Further, this idea would be a massive change to Misplaced Pages policy, site-wide, and is not a decision some wikiproject can make in a vacuum: "the lead ... will be a well referenced plain language overview of the topic that can be re-used separately for a brief standalone article for either translation or as simple introduction to a topic." That is absolutely not what lead sections are or intended to be. This wikiproject's habit of creating en.wikipedia stubs by perhaps uncritically translating just the lead of articles at other-language Wikipedias is something that needs to be questioned, not something we need to intentionally encourage more of.

  Another example of nonsense is "In much of Misplaced Pages, citations are optional." That's not true at all. But neither is the opposite claim, "information is deleted without discussion when it is not backed with citations"; that's generally untrue except in cases where there's good reason, e.g. because it seems to violate WP:Biographies of living people policy, seems to be fringe theory or pseudoscience, or is patently POV-pushing. (What usually happens is questionable material gets challenged with {{citation needed}}.) When something actually factual is deleted, restore it with a citation. If it was already cited elsewhere in the article, reinstate it without a new citation and note that it's already cited. If someone still deletes it, seek WP:Dispute resolution, as the other editor is the one in error. If they want to insist on a citation at that spot, even in the lead, you can go ahead and put one there to mollify them, but no one has the magical right to re-re-re-remove information from the article simply because it's not cited the exact way they want it to be cited. It's usually not worth arguing with these people, and the redundant citation in the lead will eventually be removed by someone else as redundant.

  Re: WP:Citation overkill (an essay) and this wikiprojects' penchant for engaging in it, and the suggestion to cite after every sentence: There is no WP rule that citations should be used after every sentence. Universally, they should be used after every fact or string of facts that come from a single source. There's no problem adding more citations to the same source (unless it rises to the level of citation overkill), if several discrete but contiguous sentences came from the same source, especially if they're discrete enough that someone might insert other material between them. But some sentences require multiple internal citations when facts in them come from separate sources. I.e., there is no relationship of any kind between "a sentence has ended" and "facts need citations".

  PS: Some of the concerns here are invalid, and are coming from some kind of "this is WikiProject Health" position, where the purpose of our articles on medical topics is imagined to be providing health advice. But this is forbidden by the WP:What Misplaced Pages is not policy (and could raise legal issues in many jurisdictions, too).  — SMcCandlish ☺ ☏ ¢ ≽ⱷ҅_ᴥⱷ≼  23:27, 6 September 2014 (UTC)

• 2¢: I'm just going to point out that this proposal is not actually at odds with the MOS (specifically, MOS:LEADCITE). That policy section doesn't indicate a particular way to deal with citations in the lead. The case-by-case basis clause ("The necessity for citations in a lead should be determined on a case-by-case basis by editorial consensus" - note that this language does not mean an article-by-article basis) isn't at odds with this proposal since, in this context, all WP:MED-tagged articles are the current "case" under consideration. Seppi333 (Insert 2¢ | Maintained) 23:50, 6 September 2014 (UTC)

Indeed, there is much wrong with SMcCandlish's initial post in this section. On a side note: SMcCandlish told WP:Manual of Style editors that they perhaps need to keep an eye on MOS:MED, as if MOS:MED can't offer advice on formatting medical articles and generally follow that advice. Flyer22 (talk) 23:56, 6 September 2014 (UTC)

And specifically regarding "information is deleted without discussion when it is not backed with citations," that is often true. Happens all the time on Misplaced Pages, even in common sense matters, as many experienced Wikipedians know. In other words, it's not always a "violate WP:Biographies of living people policy, seems to be fringe theory or pseudoscience, or is patently POV-pushing" matter that causes the deletion. The WP:Verifiability talk page has had recent discussions about that type of thing. Many Misplaced Pages editors don't know of or rather ignore the WP:Preserve policy. Flyer22 (talk) 00:09, 7 September 2014 (UTC)

• Oppose All articles should follow the general English Misplaced Pages guidelines. If the lead section is properly constructed and summarizes the rest of the article, then it doesn't need any citations. Of course, while an article is being built up, the "lead section" may contain new information, and citations are needed. But in a properly constructed article, there should be no new information in the lead and hence no need for citations. Misplaced Pages is not an academic journal. Peter coxhead (talk) 07:59, 7 September 2014 (UTC)
• Infoboxes first The lead, by its nature, is a general summary in ordinary text. As it is summarising the body of the article, there ought to be some sort of cross-reference between the lead and the body to make sure it all hangs together. Appropriate structures for doing this seem to be lacking. In the meantime, please consider infoboxes, such as the one for dextroamphetamine, which is the example given above. Infoboxes are intended to contain discrete, hard facts, rather than general statements and so would be a better place to start requiring detailed citations of these hard facts. In the case of dextroamphetamine, you currently have to go quite a long way down the infobox before you find any citations. But note that some content there may be implicitly citing a reference. For example, we are told that the IUPAC name is "(2S)-1-phenylpropan-2-amine". Is this implicitly citing IUPAC as an authority or do they just provide general rules rather than definitive names for every compound? I look around and find the NCBI page. This seems to be a good reference and agrees about the IUPAC name. But I notice that the 2D and 3D representations of the structure seem to be different. This seems quite a big deal. Perhaps the infobox templates should have their parameters in pairs - one parameter for the fact and one for the the supporting citation. If there's no citation then the fact is not displayed. With a tight, formal structure like that, we might get somewhere. Andrew (talk) 08:08, 7 September 2014 (UTC)

It's not just medicine-related articles where sourcing in infoboxes is an issue. Editors seem to believe, wrongly, that briefly presented information in an infobox doesn't need sourcing, whereas it is subject to the same considerations as any other part of the article. It certainly helps if infoboxes have explicit parameters for references (e.g. taxoboxes for organisms have |synonyms= and |synonyms_ref=). Peter coxhead (talk) 08:26, 7 September 2014 (UTC)

• Oppose a special guideline per SMcCandlish. Note that I am only opposing the proposal that there be a different standard for medical articles, not an increase of citations in the lead either by changing the main guideline or in the course of your editing per WP:IAR if nothing else. There is just too much bureaucracy already without having it where the first paragraph is or isn't referenced inline based on what the topic of the article is. Wnt (talk) 09:38, 7 September 2014 (UTC)

User:Wnt as you will noteDoc James (talk · contribs · email) (if I write on your page reply on mine) 00:45, 17 September 2014 (UTC)

• Support The opposition is severely miss-guided to what issue this tackles. Most cases are trivial to correct, and there is no reason to go through "dispute resolution" for any of them. The case is rather one of work-load. By having such a policy we make the job of policing articles much much simpler. -- CFCF 🍌 (email) 11:48, 7 September 2014 (UTC)

  Nay, I think that when we define what a "lede paragraph" is, we're creating an expectation in the reader. Maybe the reader should be expected to trust that the lede is a general summary of the article and not expect to see claims verified there. Maybe that doesn't work well so we should verify claims there. But either way, the reader is going to have to develop a mental image that "this is how a Misplaced Pages article works". If we have different standards on it for different types of content, then there will be less clarity as to whether a lede of any given article is questionable or not. Wnt (talk) 12:48, 7 September 2014 (UTC)

  This isn't a reader focused change, and anything summarized in the lede must still be present in the full article–this is not changed. The only difference is us actually giving the citation used for statements in the lede. Having this type of policy simplifies the writing of good ledes and allows for more time spent working on improving content, and less on discussing why poor edits are removed. -- CFCF 🍌 (email) 14:14, 7 September 2014 (UTC)

  Well, the OP said "our readers expect them" - and it may be true. Bear in mind that I don't think that we can even accurately categorize articles as medical vs. non-medical, because I think there is a smooth continuum between these, and even an arbitrary distinction would rely on a very specific philosophy of what is medical on which people will disagree. Wnt (talk) 15:25, 7 September 2014 (UTC)

• It depends on exactly what you add. I don't mind having citations in the lead, especially for well-developed articles that are being translated. However, I don't want to see people saying that they're "required by MEDMOS". For the specific case of articles for translation, it might be better to recommend this on the advice to translators page, on how to prepare a page for translation. WhatamIdoing (talk) 16:41, 7 September 2014 (UTC)
• Support In order for our health articles to be useful for reuse, they need to have a plain language comprehensive summary that is supported by references. We know that Misplaced Pages English article leads are regularly being reused for translation. We know that the lead of our articles are being reused by other organizations to explain health concepts in plain language. And we know that Misplaced Pages medical articles are regularly read by people with pretty different potential levels of comprehension of the topic. We need to keep this in mind and structure the articles so that we are useful for these different audiences. For example, we know that medical students and clinicians use Misplaced Pages articles and benefit from a greater level of detail than the average reader. So, it is appropriate for the body of the article to cover the topic with more complex language and concepts. But the general reader should not have to read to the bottom of the article and try to comprehend the more complex vocabulary and concepts in order to find the references. So there are valid reasons to add references to the lead of articles and mentioning this in the manual of style will help everyone understand why it is needed. Sydney Poore/FloNight♥♥♥♥ 20:52, 7 September 2014 (UTC)

Very well put, agree completely. -- CFCF 🍌 (email) 05:54, 8 September 2014 (UTC)

Misplaced Pages is not a medical encyclopedia. Articles on all sorts of topics are used by all sorts of readers. There's no reason to treat medical articles differently in this respect, even supposing a clear-cut separation were possible. Peter coxhead (talk) 21:42, 8 September 2014 (UTC)

Thanks for sharing your thinking. Actually there are loads of good reasons for treating medical articles differently. :-) And many regular editors to Misplaced Pages health articles are up to the challenge of creating high quality content that is CC BY-SA licensed and can be read by a broad range of readers on Misplaced Pages English, or reused off Misplaced Pages English. I hope you will reconsider your objection because I think that it is short sighted to have a one size fit all approach for all types of articles when there a sensible reasons to use different approaches. Sydney Poore/FloNight♥♥♥♥ 23:03, 8 September 2014 (UTC)

Many WikiProjects could claim that there are "loads of good reasons" for treating their articles differently (and indeed some of them have done so). I always distrust 'slippery slope' arguments, so an exception could be made for medical articles without necessarily setting a precedent, but the reasons would have to be more convincing to those outside the project than I've seen so far. Also, a discussion here cannot over-ride the existing MOS; if the project wants to change the MOS there needs to be a discussion there. Peter coxhead (talk) 13:06, 9 September 2014 (UTC)

• Support References in the lede are a convenience to our readers who may not go on to examine the rest of the article. For a FA quality article you could be sure that the lede content is expanded in the body. But most articles are not at the standard, so to remove doubt there should be references up front. Referencing should apply to important facts,not just controversial statements. Verifiability trumps style, so that is why we need references. Graeme Bartlett (talk) 22:11, 8 September 2014 (UTC)
• Support Especially per the last two (FloNight and Graeme Bartlett. Wiki CRUK John (talk) 09:39, 9 September 2014 (UTC)
• Oppose The lead is a summary of an encyclopedic article. Refs in the lead are therefore redundant, except under certain circumstances. See Manual of Style for those. Medical articles are largely based on current science, and should therefore not be any more controversial than any other "type" of article also based on current knowledge. There is nothing special about medical articles here. GenQuest 17:29, 10 September 2014 (UTC)

Your response shows a striking lack of understanding of the subject matter. Medicine is highly controversial, and there are constantly those who push new unproved treatments onto Misplaced Pages. Medical articles are uniquely controversial and any statement at all is open to controversy, and it would be fully legitimate to accept references in the lede of medical articles purely on that basis. (Without needing to change the main MOS). -- CFCF 🍌 (email) 06:55, 11 September 2014 (UTC)

There is nothing uniquely controversial about medical articles. POV-pushers abound in articles about history, religion and politics, to name but three. Peter coxhead (talk) 10:52, 11 September 2014 (UTC)

It is not the likelihood of controversy but the potential risks of incorrect information that is special about medical articles. Armenia–Azerbaijan relations is highly controversial but mistakes or bias in the English Misplaced Pages article are unlikely to kill anyone. That's not so with Alternative cancer treatments. Wiki CRUK John (talk) 11:34, 11 September 2014 (UTC)

Your response shows a striking lack of understanding of Misplaced Pages. It is NOT, and does not purport to be, anywhere near a primary reference work, especially in the field of medicine. If non-sourced info is added to the article or the lede, it should be removed. The structure of the WMoS is what governs that. Medical articles may be near and dear to you, but they carry the same weight as any other article in this little encyclopedia. Besides, if someone is using Misplaced Pages as their main source of medical knowledge, they have other issues in their life, lack of common sense being the most prominent diagnosis. GenQuest 15:19, 11 September 2014 (UTC)

GenQuest, I'm pretty familiar with WP:CITELEAD. It says (direct quotation), "The presence of citations in the introduction is neither required in every article nor prohibited in any article." I'm not sure how people get from what CITELEAD says to claiming that citations in the lead are redundant and shouldn't be used except for specific, explicitly authorized exceptions. WhatamIdoing (talk) 15:39, 11 September 2014 (UTC)

• Support We want to make our articles more easily verifiable by our readers. I agree that this is especially key as people life may be in the balance. BLPs receive `special` acknowledgement. But precedent is not an issue. This is an issue of common sense. The proposal is not a requirement for refs in the lead just an explicit allowance of references in the lead. They are already allowed implicitly. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:01, 11 September 2014 (UTC)
  • What special allowance is being proposed? I see "My position is that we should have references in the lead and this is for a couple of reasons..." That looks like a soft requirement (Should rather than shall). What is the actual proposal.? Protonk (talk) 19:56, 11 September 2014 (UTC)
    • ”Ａｄｄｉｎg references to the lead is reasonable but not required as long as the text in question is supported in the body of the article"Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:19, 12 September 2014 (UTC)
      • Seems fine to me. I can support that. Protonk (talk) 11:53, 12 September 2014 (UTC)
      • As I understand it, direct quotations must be sourced at every instance, including the lead. In practice, contentious negative matter (especially if not widely known) about living people is also commonly "required" to be cited in the lead. It might be preferable to write only, "Adding references to the lead is reasonable but not normally required". WhatamIdoing (talk) 00:50, 26 October 2014 (UTC)
• Oppose. All facts in the introduction should be in the main body of the article . Introductions are easier to write without in-line references. Snowman (talk) 18:19, 9 October 2014 (UTC)

Section ordering for addictive drugs

Can we specify the section ordering in addictive drug articles for sections on substance dependence and/or addiction (this would also affect the current placement of withdrawal) in our MOS for standardization? I'm bringing this up since the section ordering came up in my FA nomination for amphetamine, which has withdrawal placed under overdose.

We currently indicate placing withdrawal under adverse effects; this concept, in a clinical context (per the DSM), is closely related to substance dependence (i.e., more or less, "drug addiction") since it is always paired with physical dependence and/or psychological dependence. Ideally, I think these topics should either be together in a new level 2 section titled "Addiction" or "Substance dependence" (these two terms are apt/appropriate section headers for any subsections on tolerance, withdrawal, sensitization, physical dependence, and psychological dependence) or be placed as a subsection of either "Overdose" or "Adverse effects" – the prevailing position in current medical reviews would then be used to determine which of the two headers is more appropriate for addiction-related subsections in a given drug article. I think overdose would be a more apt section heading than adverse effects for these, primarily because I'm not aware of any addictive pharmaceuticals which have the capacity to induce a true addiction (i.e., ruinously compulsive drug use) when taken as indicated (i.e., at therapeutic doses), except in rare cases/unusual circumstances.

This isn't a particularly urgent proposal, but I think it is necessary to develop the layout for these sections in our articles on addictive drugs. I'd also like to have amphetamine's layout agree with the MOS. Seppi333 (Insert 2¢ | Maintained) 22:59, 6 October 2014 (UTC)

I am happy with the section under either side effects or overdose. A side effect of using opioids can be addiction. If used for end of life care this is typically not a big issue. drugs.com puts it under a heading called precautions along with other side effects Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:10, 7 October 2014 (UTC)

Touché. Come to think of it, benzos are another example of a drug class that have a high addiction risk from chronic therapeutic use... I've modified my proposal to reflect this; I think it may be best to use the prevailing opinion/position in medical reviews to determine which level 2 section (Adverse effects vs Overdose) is more appropriate for subsections covering addiction/dependence/withdrawal. I think this approach would be flexible enough to appropriately and logically organize sections on those topics in any addictive drug article. Seppi333 (Insert 2¢ | Maintained) 10:17, 7 October 2014 (UTC)

While recognizing the context, it bothers me to see people say that dependence and addiction are even roughly the same thing. People with type 1 diabetes are dependent on insulin, but they are definitely not addicted to it. Whatever you write with opioids and benzos in mind should not screw up articles about insulin therapy (or any of the dozens of other take-this-or-die drugs on the market). WhatamIdoing (talk) 00:02, 10 October 2014 (UTC)

I agree; I've edited the proposal to limit the scope to addictive drug articles. They're obviously not the same thing, but they're used interchangeably in large part because of the DSM. Seppi333 (Insert 2¢ | Maintained) 21:13, 10 October 2014 (UTC)

People, women, and females

About once a year or so, someone changes some sex-specific articles to refer to "people" rather than "males" or "men". This has happened, for example, at Pregnancy, which is a condition that only affects biological females (among humans). It also happens (perhaps more often) at articles that are more complicated on the sex and gender front, such as articles about conditions that disproportionately affect intersex people.

In broad overview, the relevant cases are:

1. The article (or specific point) is sex-specific, and not related to intersex or transgender issues.
2. The article is not sex-specific, and not related to intersex or transgender issues.
3. The article is about an issue that is associated with intersex or transgender conditions.

The last two are the easy ones: You should avoid talking about "males" or "men" when the information applies to everyone equally. You should be especially careful about gendered language when writing about intersex and transgender issues.

The first is the complicated case, and the one that I'd like to get people's opinions on.

If you write, "X% of women and Y% of men died of heart attacks last year", then people who don't identify with the gender binary will feel excluded, and people whose biological sex does not match their gender identity may not know which statistic applies to themselves. This will include some intersexed people, but not all of them.

If you write "X% of females and Y% of males died of heart attacks last year", then people may complain that the text is harder (in readability terms, the less-familiar word males is a slightly 'harder' word than men). Lay- and patient-oriented websites tend to use words like women more often than females. It may also seem less warm and human(e), similar to calling people "patients" or "cases" rather than "people". Because "male" applies from (before) birth, writing about males will sometimes be interpreted as meaning both men and boys, even if the context is only relevant to adult (or even aged) males. This will include transgendered people, but it will still exclude intersexed people.

If you write "Z% of people died of heart attacks last year", then you lose the sex-specific information. In other cases, you may not be able to convert: If the source says that "Y% of women became pregnant last year", you cannot convert that into "Z% of people" (which includes the entire population of the world) or re-phrase it as "Y% of females" (which implies all ages of females, including infants), because your answer will be wrong and you will violate WP:NOR.

I think we can take it as read that NOR-violating transformations are unacceptable. However, that leaves us a lot of room. Here are some questions that I'd like you to think about:

• If something could be phrased as either males or men (or as females or women), when would you choose the one, and when the other? Which word(s( do you think you use the most when writing Misplaced Pages articles?
• If a condition could apply to an intersexed or transgendered person, when would you choose inclusive language or when would you choose non-inclusive language?
• If you were writing a brief note in this guideline to reduce disputes about this type of phrasing (perhaps something similar to the guidance we provide about the word patient), what would you say? Would you say anything? What advice would you give a new editor who was contemplating a change in this type of language (either to or away from whichever you think is "normal")?

I'm interested in hearing opinions. As far as I'm concerned, the more opinions, the better. WP:There is no deadline for figuring out what ideas we have on this question. WhatamIdoing (talk) 00:43, 26 October 2014 (UTC)

• Project-Class medicine pages
• NA-importance medicine pages
• All WikiProject Medicine pages
• Project-Class pharmacology pages
• NA-importance pharmacology pages
• WikiProject Pharmacology articles
• Project-Class Anatomy pages
• NA-importance Anatomy pages
• Anatomy articles about an unassessed area
• WikiProject Anatomy articles
• Project-Class Disability pages
• WikiProject Disability articles