Talk:Medical uses of silver/Archive 6

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New year

i'll be addressing all raised matters soon. However in this time i would like to wish everyone a happy new year. Its my sincere hope that the new year will be different and the cycle of what was going on this page for years will be broken. I hope that there is no need for two groups of editors opposing each other. I think all personal remarks shall stop. Instead of taking this article too personal i wish that the two groups will unite into one and work in a constructive way. Ryanspir (talk) 14:42, 31 December 2012 (UTC)ryanspir

It's not about groups of editors. It's about what reliable sources say and how we summarise them to make an article. Itsmejudith (talk) 16:44, 2 January 2013 (UTC)

That's what I'm trying to do. I see different references to agrya. In all of them it's being said that the person who became blue was 1) consuming silver for a very long time. 2) The condition of becoming blue doesn't affect the health. Its an absolutely cosmetic condition. So I'm trying to summarize it.Ryanspir (talk) 14:44, 11 January 2013 (UTC)

side-effect or adverse effect

The subject means that it can happen with recommended way of using and recommended dosage. However, even the study which says rapid onset of becoming blue speaking about several months. And its understandable, because normal published cases are talking about years of constant use. Generally, i have seen three factors: 1. Long-term use. 2. Use of high ppm cs. 3. Constant overdosing. Most important are factors one and two. Therefore i'm proposing to rename this section to overdosing. I have also asked geni and now asking all editors, if someone could please provide a case whereby a person became blue following use of cs of ten to thirty ppm, the way most cs are currently being sold around the world.16:12, 3 January 2013 (UTC)ryanspir — Preceding unsigned comment added by Ryanspir (talk • contribs)

Since all of the reputable, reliable sources available discuss argyria as an adverse effect of colloidal silver, that's how we should discuss it. I don't think we should resort to hair-splitting or special pleading here. There is no scientifically valid "recommended dose" of colliodal silver, because it hasn't been shown to actually do anything. You seem to be suggesting that we advise readers that there's a "safe" dose of colloidal silver below which they don't have to worry about adverse effects. That suggestion isn't borne out by reliable sources and is, frankly, a dangerous misservice to our readers. MastCell ^Talk 17:50, 3 January 2013 (UTC)

Just ran across this discussion and agree that argyria is described in reliable sources as an adverse effect of colloidal silver, for which there is no recognized "safe and effective" dose. -- Scray (talk) 20:10, 4 January 2013 (UTC)

I also oppose the renaming the "Adverse health effects" section to anything like "Side effects" or "Overdosing" or anything else that implies there is a safe or "correct" dosing. As pointed out, reliable sources do not support the idea that there is any such thing as a safe or correct dose. Zad68 20:16, 4 January 2013 (UTC)

Correct dosing is established by manufacturer. Safe dosage in case of silver ingestion has been established by EPA and they performed the research based on 70 cases of argrya.Ryanspir (talk) 14:38, 11 January 2013 (UTC)

As has been pointed out several times now, there is no indication that the EPA's statement can be considered endorsement of a "safe dose". The EPA does not establish "safe dosage" standards in the first place. All the EPA does is make recommendations about exposure limits. Zad68 14:59, 11 January 2013 (UTC)

A quote: "However, the advisory informs consumers that the Environmental Protection Agency (EPA) has established a chronic oral Reference Dose (RfD) of 5 micrograms (µg) of silver per kilogram (kg) of body weight per day (5 µg/kg/day) based on a review of 70 cases of argyria that were associated with oral, intranasal, or pharyngeal use of organic and colloidal silver compounds.

I see the direct meaning as: if one keeps under this dosage, he won't get argyria.Ryanspir (talk) 17:02, 11 January 2013 (UTC)

Dosage

Do not discuss other editors here. Article talk pages are for discussing content only.
The following discussion has been closed. Please do not modify it.
Judith, you see? Thats what i was talking about. Mastcell is attacking and at the same time accusing. He picks up the words to make it personal. And his message looks as of one who is trying to prove his point, regardless of available studies. Why would fda clear something for specific indications if its not effective? Now, his message looks more of someone who wants to engage into heated personal debate, rather than constructive neutral discussion based on good faith. The topic is actually is not even about it being effective or not. Now, to the context.

We are not advising readers anything. We provide information as it is. The dose i was refering to is the one prescribed by the companies which produce it. In medical articles what is written under side or adverse effect means for usage of a correct doseage. Furthermore, i'm asking fellow editors to provide any publication of a men turning blue following use of not home made cs, with ten to thirty ppm, so that we could include it here. 04:58, 4 January 2013 (UTC)ryanspir — Preceding unsigned comment added by Ryanspir (talk • contribs)

You've repeated several times that the FDA has "cleared" or "approved" colloidal silver. Could you provide a source to support that assertion? To my knowledge, the FDA has not approved oral colloidal silver products for any indication. As of today, the relevant FDA website contains two items on colloidal silver.

The first is an alert aimed at healthcare providers, stating in part: "... based on current scientific research, it is not possible for FDA to define a 'safe' level of silver in dietary supplements or an exposure that will not result in argyria." ([1]).

The second relevant FDA document is a Consumer Advisory warning that colloidal silver has no known medical benefits and carries the risk of serious side effects (e.g. argyria): "Silver is a nonessential mineral that has no known physiological functions or benefits when taken orally. Silver has some appropriate medical uses, such as medicines, bandages, and dressings used to treat burns, skin wounds, or skin infections, and as medicines used to prevent the eye condition called conjunctivitis in newborn infants. However, there are no legally marketed prescription or over-the-counter (OTC) drugs containing silver that are taken by mouth." ([2], emphasis mine).

In light of those sources, could you clarify your assertion that the FDA has "cleared" colloidal silver "for specific indications"? Separately, since the FDA is unable to identify a "safe" dose of colloidal silver, why should we imply that doses of <30 ppm are safe? MastCell ^Talk 21:12, 4 January 2013 (UTC)

Ryan asked me to look just at the "congressional evidence", and I have done that. It is a document with annexes that a Utah company submitted to a congressional committee. I don't see anything in it that could be used in this article; it is a one-sided document and not independent of the manufacturer. I note a annexe that is a facsimile of a document from the government of Ghana, apparently approving a brand of colloidal silver. Crucially, it describes the product as "homeopathic". This seems to get to the heart of what we are being asked to consider. Ryan will correct me if I'm mistaken, but the amount of silver actually contained in this product is so low that it is to all practical purposes just water. Therefore it is entirely safe for both external and internal application. By the same token it has no medical effects. Itsmejudith (talk) 23:24, 4 January 2013 (UTC)

Ryan drew my attention to this with a note on my Talk page. The statement was, there is a safe dosage of silver ingestion which is shown in the continuation of the reference 5 provided by mastcell ... since fda cleared cs for external application and because other forms of silver are routinely being used in traditional medicine can we add this article to medicine Wikiproject. The reference appears to be this letter from the FDA. So it appears we have two pieces of information:

• The FDA states it is not possible for them to define any "safe" level of ingestion
• The EPA recommends not to 5 exceed micrograms (µg) of silver per kilogram (kg) of body weight per day. I do not see any kind of characterization of this level as "safe" or "effective" any other such thing. Probably the EPA also has recommendations not to exceed exposure to a certain level of gasoline fumes per day for service station workers, for example. We'd need the EPA document for full context.

Ryan, what exact article content are you proposing to include in the article, sourced to this letter? Zad68 19:05, 7 January 2013 (UTC)

In reference 5 its written that epa established safe dosage. Epa is a reliable source and that dosage is based on their research. We should find a way to convey the message that there wasn't any published case of turning blue at this concentration, and that most, if not all cases of turning blue were following long term, at least several months of duration, and mostly if not all cases were due to a combination of high concentrations of silver used and prolonged use. We could also show some mathematic following a normal adult of eighty or so kg of weight because it will be hard for people correlate ppm and the epa info.Ryanspir (talk) 14:28, 11 January 2013 (UTC)

The claim In reference 5 its written that epa established safe dosage. is simply untrue as I pointed out in my previous note. Zad68 14:33, 11 January 2013 (UTC)

As you have rightly said, this discussion duplicates the one on "side-effect or adverse effect" section. So lets stop it here to avoid repetitions and continue on that section.Ryanspir (talk) 17:14, 11 January 2013 (UTC)

serious adverse health effect

i think that becoming blue is not a serious and is not a health adverse effect. All reliable publications consider it as a laser-reversible, cosmetic adverse effect, which appears following prolong overdosing in some individuals. The main point is that becoming blue doesn't compromise the health. Of course there is a psychological issue, yet it should be discussed on the relevant page. I'm sure i'm going to be corrected by the editors here who i hope will be neutral and respective.Ryanspir (talk) 15:46, 10 January 2013 (UTC)

It's fine for you to think that. However, we do not put the personal opinions of Wikipedia editors into our articles. If reliable sources describe it as an "adverse health effect" then that is what we put into the article. The NIH clearly describes argyria as an "adverse effect". Zad68 16:16, 10 January 2013 (UTC)

Agree, we do not go by individual editor opinion, but by what our sources say. Yobol (talk) 19:55, 10 January 2013 (UTC)

Ok Zad. So do you agree meanwhile to replace all references to argyria as "serious health adverse effect" to "adverse effect" as mentioned in NIH? And how can we say 'irreversible' condition if on this very article we say there is a laser treatment?Ryanspir (talk) 14:06, 11 January 2013 (UTC)

Pubmed id

hello, could you please tell me why have you selectively asked me to provide pubmed id? Does it mean that all references without pubmed id shall be removed from this article? I hope you didn't ask it because you feel angry that there are peer reviewed studies supporting cs? I'm calling you to assume good faith, be emotionally detached and be neutral.Ryanspir (talk) 16:17, 10 January 2013 (UTC)

See WP:MEDRS for Wikipedia's sourcing standards for biomedical information, and especially the mentions of PubMed. Wikipedia editors experienced with sourcing for medical claims generally start by asking for the PMID of a proposed source. If it doesn't have one, it's a red flag that the proposed source is very likely not a reliable source for biomedical information.

So, are you saying that the source does not have a PMID? Zad68 17:44, 10 January 2013 (UTC)

The journal,"Anti-Aging Therapeutics" is not listed as part of the NLM: http://www.ncbi.nlm.nih.gov/nlmcatalog/journals

I think this means that the article cannot have a PMID.Desoto10 (talk) 23:35, 10 January 2013 (UTC)

In addition, the author of the article is Dr. Gordon Pedersen, who is the Chief Scientific Officer at American Biotech Labs, who make the product.Desoto10 (talk) 23:47, 10 January 2013 (UTC)

I think the peer reviewed references I have provided do not have PMID and yet they are reliable sources. In 2008 when this article was published, no FDA clearance existed for cs, including external use. Therefore both internal and external uses of cs were under the segment of the alternative medicine. Thus, it's rather obvious that article in the field of the alternative medicine was published in a journal of the alternative medicine which contains other alternative information topics, such as telepathy. We are currently engaged in editing of an article of medicine uses of silver, some of which were cleared by US FDA for external applications and some (like internal ingestion by mouth) are in the segment of alternative medicine. The current category of this article states "alternative medicine".Ryanspir (talk) 13:57, 11 January 2013 (UTC)

About American Labs - there is no problem about that. Any drug company initiates studies to prove effectiveness of their medicines. Viagra or antibiotics manufacturer don't necessarily wait until someone will do that for them.Ryanspir (talk) 14:00, 11 January 2013 (UTC)

safe dosage

this is my reply to mastcell which i have posted on his talk page, and it also addresses a question of zad about what i'm proposing:

sounds good to me. Lets clear some issues. In your first message you said 'hasn't been shown to do anything' meaning anything at all, internal or external. However currently there is cs which have been cleared by fda for external use. Now, if you will continue to read reference 5 its written that epa established safe dosage. Epa is a reliable source and that dosage is based on their research. I do not propose to imply that under 30ppm is safe. But we should find a way to convey the message that there wasn't any published case of turning blue at this concentration, and that most, if not all cases of turning blue were following long term, at least several months of duration, and mostly if not all cases were due to a combination of high concentrations of silver used and prolonged use. We could also show some mathematic following a normal adult of eighty or so kg of weight because it will be hard for people correlate ppm and the epa info. Ryanspir (talk) 14:47, 5 January 2013 (UTC)

Yes, I see Mastcell is back, displaying his bias against colloidal silver. Theres no attempt at balance here. Replacing already negative (but informative) quotes from the NCCAM with other quotes from the NCCAM that are even MORE negative but LESS informative shows he is not interested in helping to build a useful article here. Its all just 'Warning, warning warning!Side effects' and 'lack of effectiveness' are each mentioned 3 times in opening section alone. — Preceding unsigned comment added by 182.239.234.56 (talk) 06:11, 11 January 2013 (UTC)

I agree, however it's not necessary about Mastcell, but the majority of the editors act currently this way on this page. I personally didn't even know what is NCCAM before two weeks ago. I'm not a US citizen and I do know about US FDA, EPA, etc. I think quoting the latest 2012 US FDA advisory regarding colloidal silver is much more informative than to read old FDA advisory reflected and opinionated by NCCAM. Why should we quote what FDA said using NCCAM website and not just refer to the reference #5 which constitutes the current position of FDA which is much more reasonable.Ryanspir (talk) 13:49, 11 January 2013 (UTC)

FDA 'Prohibition'.

Mikenorton. Before reverting my post again please explain which part of my revision is misleading. Its virtually a word for word quote from the NCCAM. (reference '18'). Are you suggesting the NACCM site is misleading? On the contrary I would suggest your revision is in fact the misleading one. Your revision, as it stood, created the impression that all colloidal silver products from all stores are universally prohibited from sale. Of course thats not true. Although its a direct quote from the NCCAM site I do not believe that the average reader will understand that the words 'drugs' has a very specific meaning that does not include alternative medicines. Also the term 'over the counter' is not universally understood - especially outside the USA. Many readers would not know that 'over the counter' specifically refers to drugstores, chemists, or pharmacies. It seems to me that you cherry picked only half the paragraph from the NACCM to create the impression that colloidal silver was now an illegal product, which is patently untrue. — Preceding unsigned comment added by 182.239.234.56 (talk) 09:59, 24 December 2012 (UTC)

Here is the exact NCCAM quote. "In 1999, the FDA prohibited the sale of over-the-counter drugs containing colloidal silver or silver salts because they had not been shown to be safe and effective. However, colloidal silver products are still being sold as dietary supplements or homeopathic remedies." In my edit I added an explanation of 'over the counter' and included the word 'legally' (which is obviously true). — Preceding unsigned comment added by 182.239.234.56 (talk) 10:08, 24 December 2012 (UTC)

I've added some more from the same source lest anyone should get the impression that the FDA and NACCM are somehow endorsing uses as a 'dietary supplement' or as a 'homeopathic remedy'. The lack of qualifications was I felt misleading. Mikenorton (talk) 15:48, 24 December 2012 (UTC)

After all the warnings and statements that it's not effective I doubt someone will get such an impression.Ryanspir (talk) 12:18, 12 January 2013 (UTC)

Silversol peer reviewed study

The Journal of the Science of Healing Outcomes, Volume 1 No.1, August 2008 Silver Sol and The Successful Treatment of Hospital Acquired MRSA in Human Subjects With Ongoing Infection Anti-Aging Therapeutics, Vol. 11, Chapter 35, pgs. 295 - 300, Copyright 2009. Here is a link to the Table of Contents/abstracts of that volume http://www.a4minfo.net/Thera11.pdf Ryanspir (talk) 11:59, 8 January 2013 (UTC)

What is the PubMed ID of the journal article? Zad68 14:08, 8 January 2013 (UTC)

Why are you presenting this? The paragraph appears to be an abstract from a presentation. What is the evidence that this paragraph was "peer-reviewed"? Does anybody consider this notable?Desoto10 (talk) 18:58, 8 January 2013 (UTC)

That's a good question. I think I'm presenting it because I would like to improve the article by including all views.Btw: you don't need to put a link to your archives, it's enough that you said that you are quoting me.Ryanspir (talk) 15:05, 11 January 2013 (UTC)

I am copying this response from Ryanspir from my talk page to here where it belongs:

peer reviewed why are you again taking a negative position? Why do i need to prove that a peer reviewed article is indeed peer reviewed? Most links to peer reviewed studies are referenced to their abstracts, thats how it done, just check it in different articles. I think i might have the full study, if you like i might send it to your email. I'm asking you again, assume good faith, be neutral. Ryanspir (talk) 17:31, 9 January 2013 (UTC)

Here is the "article" which seems to be either a chapter in a book or from a presentation. There is virtually no way to interpret the results because the methods section is so lacking.

http://www.worldhealth.net/pdf/Pedersen-SilverSol.pdf Desoto10 (talk) 18:05, 9 January 2013 (UTC)

"Peer review policy":

The journal uses the super-peer review system in that the journal relies on the fact that an author of many dozens of papers—as established via a bibliography—is a good candidate for continuing to publish significant, reliable work. The Managing Editor will review the paper himself and, as needed, assign it to one of the members of the editorial board having expertise in the area of research reported in the paper and in the unlikely event of one such being unavailable on the board, one outside specialist may be invited to review the paper.

I don't think that this qualifies as "Peer Review".Desoto10 (talk) 20:52, 9 January 2013 (UTC)

The editorial board contains some interesting characters, such as Konstantin Korotkov, who has published a book called "Light after Life: A Scientific Journey into the Spiritual World", Joie Jones, who has published "An Extensive Laboratory Study of Pranic Healing Using Cells in Culture Subjected to Gamma Radiation", William A. Tiller who published "Science and Human Transformation: Subtle Energies, Intentionality and Consciousness", Brian David Josephson who accepts that telepathy exists and Marc Newkirk who is president of the "Lightfield Foundation", responsible for "the technology recently introduced which utilizes information fields as a basis for facilitating the restoration of innate human capacities". Mikenorton (talk) 21:55, 9 January 2013 (UTC)

Agree with what appears to be a forming consensus that this does not appear to be a reliable source for use here. Yobol (talk) 19:56, 10 January 2013 (UTC)

I see no evidence that this journal is a reliable source. That said, I also don't think comments on beliefs of editorial board members are germane. -- Scray (talk) 01:04, 11 January 2013 (UTC)

The source clearly does not meet even the bare minimum requirements of WP:MEDRS and so is not a reliable source for biomedical claims. There appears to be a strong consensus on this now. Zad68 01:35, 11 January 2013 (UTC)

And how about this one: http://www.researchgate.net/publication/228968107_Effect_of_Prophylactic_Treatment_with_ASAP-AGX-32_and_ASAP_Solutions_on_an_Avian_Influenza_A_(H5N1)_Virus_Infection_in_Mice ? Also please see continuation of the discussion about this article in the section below which in which I say that articles about alternative medicine are being printed in alternative medicine journals.

If we will follow the way of thinking of desoto, yobol, scray and zad how article about telepathy would look like? Just an empty space? Because there is no any published material on PMID which either approves or disapproves telepathy. If you will see the article however, almost all if not all the references there are from alternative sources. Of course wp:rs is governing telepathy and medrs is governing medicine, but it's the same spirit. Articles related to alternative health are published in the journals of alternative. That's why they are not mainstream.Ryanspir (talk) 14:15, 11 January 2013 (UTC)

Why haven't you read WP:MEDRS yet? If you would like to be contributing biomedical information to Wikipedia articles, WP:MEDRS is required reading. The source provided is not WP:MEDRS-compliant, as it is a 1) primary study, 2) conducted in non-human subjects, 3) not published in a MEDLINE-indexed journal. Zad68 14:27, 11 January 2013 (UTC)

Could you please provide quotes from medrs?Ryanspir (talk) 15:08, 11 January 2013 (UTC)

Yes, I will, but here is the deal: I will provide the requested quotes from WP:MEDRS if and only if you commit to reading and applying WP:MEDRS in your editing. Do you agree? Zad68 15:13, 11 January 2013 (UTC)

Yes,I do. In fact, I'm the one who advocated to use medrs even though Vsmith (admin) was against using medrs for this article. And, here is my deal for you: do not open new discussions about what is obvious. Why should we go into uncertainties of using NCCAM which quotes FDA if we have got the most updated FDA advisory with EPA findings which is official and based on research? That's a really long shot that someone will agree that NCCAM statements can be more important than FDA's especially dealing with what is since 2009 is a conventional medicine. Do you agree? Ryanspir (talk) 16:55, 11 January 2013 (UTC)

If you are already familiar with and advocate WP:MEDRS, as you state, there is no reason for me to go through the patronizing exercise of copying and pasting its contents here. The outstanding question then becomes--why don't your edits exhibit understanding and application of WP:MEDRS? And as I already stated, if you still have concerns about whether NCCAM is a reliable source, start a WP:RSN discussion. There is already consensus on this page that NCCAM is a reliable source so there is no use discussing that further here. Zad68 19:17, 11 January 2013 (UTC)

Allow me to respectfully disagree. There is no such consensus in my opinion. And I don't mean that NCCAM is not a reliable source, I mean that specific NCCAM statement to which I was referring is not a reliable one, because it contradicts FDA and because it issues advisory out of their mandate.Ryanspir (talk) 12:02, 12 January 2013 (UTC)

CDC and arygria

The reference 55 should be updated to http://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=538&tid=97. And, I would like to quote from CDC which supports the way I want to summarize some aspects of this condition: "Exposure to high levels of silver for a long period of time may result in a condition called arygria, a blue-gray discoloration of the skin and other body tissues. Lower-level exposures to silver may also cause silver to be deposited in the skin and other parts of the body; however, this is not known to be harmful. Argyria is a permanent effect, but it appears to be a cosmetic problem that may not be otherwise harmful to health." Emphasis mine. So key words: "long period", "high levels", "not harmful to health" and "cosmetic problem". Ryanspir (talk) 15:24, 11 January 2013 (UTC)

The ATSDR position is already in the article. At this point, repeating yourself over and over will not get you what you want. Yobol (talk) 16:46, 11 January 2013 (UTC)

I'm not repeating myself. And I want nothing but improvement of the article. ATSDR position is indeed already in the article, but there is a contradiction to other sections of the article which do not see argyria as a cosmetic problem.Ryanspir (talk) 11:29, 12 January 2013 (UTC)

Moved wdfords addition to the right section.Ryanspir (talk) 11:29, 12 January 2013 (UTC)

Good article?

At first glance this article looks well referenced. I wonder if we happen to already have a good article on our hands. Biosthmors (talk) 19:46, 11 January 2013 (UTC)

I've just started doing GA reviews and wouldn't pass this as-is. Some of the sourcing is extremely out-of-date per WP:MEDRS and the prose needs a lot of cleanup, and it needs a few images. But it should be doable without a complete rewrite... hmmm... Zad68 19:51, 11 January 2013 (UTC)

Absolutely agree with Zad.Ryanspir (talk) 11:31, 12 January 2013 (UTC)

History section - minor fixes

"With the development of modern antibiotics in the 1940s, the use of silver as an antimicrobial agent diminished.[6]" I think it should be said "has diminished".

In section Wound and burn dressings "In World War I, before the advent of antibiotics, silver compounds were used to prevent and treat infections." Should be moved into History section in my opinion.Ryanspir (talk) 12:09, 12 January 2013 (UTC)ryanspir

Agryria - Adverse effects section

"Argyria is generally believed to be irreversible, with the only practical method of minimizing its cosmetic disfigurement being to avoid the sun,[50] but laser therapy has been used to treat it with satisfactory cosmetic results.[51][52][53]". In my opinion this statement contradicts itself. It's either irreversible, partly reversible or reversible. It cannot be "generally believed to be irreversible" and "laser therapy has been used to treat it with satisfactory cosmetic results. Emphasize mine.Ryanspir (talk) 12:13, 12 January 2013 (UTC)

NCCAM is not reliable and its statements contradicts reality

1) I would like NCCAM statements not to be used because they contradict reality. 2) And replace all old FDA advisories about cs to the current one of 2012 in where it addressing specifically ingesting by mouth. (Like: ^ "Colloidal Silver Not Approved". U.S. Food and Drug Administration. 2007-02-12. Retrieved 2008-09-22.)

Instead of obsolete NCCAM statements in where they quote old FDA advisories we should use current FDA advisory and current EPA information. Ryanspir (talk) 15:18, 11 January 2013 (UTC)

The NCCAM online fact sheet was last updated February 2012. The consensus here is that it is a reliable source. If you'd like some outside opinions, ask at WP:RSN. Zad68 15:21, 11 January 2013 (UTC)

And what is your opinion that NCCAM can only deal with alternative medicines? That is it's designed segment, right? They cannot overrule FDA clearances, right? FDA says that this cs has been cleared for external applications for following conditions. And NCCAM says its not effective as an alternative medicine for all conditions. But once FDA cleared it, it's no longer an alternative medicine. So how NCCAM can still have power over it?Ryanspir (talk) 15:32, 11 January 2013 (UTC)

Please open a discussion at WP:RSN and provide a link to it. Zad68 15:34, 11 January 2013 (UTC)

Lets try to form a consensus about it here. I think it's a direct logic. And, to add: NCCAM uses the information provided by FDA, that's why they quote them. FDA do not quote NCCAM. It seems that NCCAM though updated the date on their page still referring to the old FDA advisory (because we do have read the new advisory which clearly separates internal use by mouth and other uses). NCCAM's mandate is to deal only with alternative medicines. They cannot issue any statements about a conventional medicine cleared by FDA because it's not covered by their mandate.Ryanspir (talk) 16:45, 11 January 2013 (UTC)

NCCAM is absolutely a reliable source for alt med products such as colloidal silver. Objecting to it because it does not conform to your version of The Truth(TM) will get you nowhere. Yobol (talk) 16:49, 11 January 2013 (UTC)

Since 2009 colloidal silver made by American Biotech Labs is no longer an alternative medicine for as long as it is used for external applications for the given conditions specified in the FDA clearance. It can be prescribed by doctors and have health claims, something which alternative medicines do not.Ryanspir (talk) 17:11, 11 January 2013 (UTC)

The FDA oversees drugs and devices and it has specified which can and which cannot be legally marketed in the US. The FDA has cleared medical devices containing silver for wound dressings and some internal uses as an anti-bacterial coating, not the silver itself. That is the nature of the 510(k) process. Clearance of a silver-containing device is not even remotely similar to approval of silver as a drug. The FDA has approved several silver preparations for topical application for second and third degree burns. These are drugs that contain silver. Note I have not mentioned alternative medicine yet, just FDA-approved drugs and FDA-cleared devices. OK. Now, the FDA has also essentially banned any other medical uses of silver, including ingestion and OTC topical application. These "other uses" are the alternative medicine uses. This all happened in 1999 or so and the FDA has not changed its viewpoint since then. This is not outdated in the slightest. This is the law. Now we come to NCCAM. This is one of the institutes of the National Institutes of Health, run by the PHS. There are a variety of these institutes, for things like eyes, cancer, diabetes, mental illness, AIDS, etc. These institutes provide research and information. NCCAM was formed to try to apply scientific research to the broad field of alternative medicine. NCCAM announcements carry no legal authority, but are considered by most reasonable people to be among the most reliable sources of information available. And so, yes, NCCAM's opinion about alternative medicine applications for silver, which includes all uses except those listed above as FDA-cleared or approved, is highly relevant and is, arguably, the most reliable source on this matter. In a nutshell, NIH and its institutes such as NCCAM are advisory, while the FDA has the force of law. The EPA is primarily concerned with toxins, such as silver, in the environment and the CDC is concerned with, well, the control of diseases.Desoto10 (talk) 22:17, 11 January 2013 (UTC)

I agree with most of your definitions here. But some things I disagree. I wouldn't object NCCAM to be considered a reliable source if it would separate internal and external application as FDA does and thus any advisory which comes from NCCAM would not be contradicting FDA. If NCCAM would separate and issue advisory only regarding internal ingestion which is in the segment of alternative medicine I guess I wouldn't object on the grounds that it contradicts established reality and FDA. You have tried to add original research which would say that NCCAM is primarily concerned with internal application, but it was unreferenced. As such, we should not include references to NCCAM until the time they will update their advisory. Ryanspir (talk) 11:57, 12 January 2013 (UTC)

"but are considered by most reasonable people to be among the most reliable sources of information available." - Any reference for this please? As I have said, two weeks ago I even didn't know what NCCAM is. In my opinion people who are living outside of the US do not know this US authority as it plays an advisory role and only in the field of the alternative medicines.Ryanspir (talk) 11:57, 12 January 2013 (UTC)

Even if silver was suddenly considered an accepted mainstream medicine for ingestion/topical application, it wouldn't make the research conducted by NCCAM instantly irrelevant. - Floydian ^τ _¢ 02:22, 12 January 2013 (UTC)

Could you please tell me why it wouldn't? If it would be accepted in the mainstream medicine, that would mean that it's effective. So, how could we write in the wikipedia that it is not effective? And, was there any research performed by NCCAM? Please let me know the link to this research.Ryanspir (talk) 11:29, 12 January 2013 (UTC)

Sources don't always agree, that's the nature of science. I'm not sure if there was any research, I'm just saying that statements or opinions given by NCCAM don't suddenly become irrelevant because of a new study, they have to be weighted and the wording of the article updated to reflect the disparity between sources. This is why tertiary sources are the most desirable; they summarize the secondary sources. In the absence of tertiary sources, its up to editors to discuss and determine the weight of various sources. - Floydian ^τ _¢ 15:20, 14 January 2013 (UTC)

As a general principle on science articles, I am inclined to agree that older sources do get overtaken by more recent research, and we need to keep up to date. We should certainly specify the NCCAM warning "of the few prescription drugs containing silver, all are for topical use; there are no FDA-approved prescription or over-the-counter drugs containing silver that are taken orally", at [3]. NCCAM cannot be ignored, unless FDA or CDC has specifically stated that the NCCAM warnings are out of date - or words to that effect. I do not see any contradiction between FDA clearance for external use, vs this NCCAM statement. I think Ryanspir should also read [4] before we continue in this direction.Wdford (talk) 16:52, 11 January 2013 (UTC)

Sorry, we cannot specify this. It would be an original research. That's why I'm proposing not to consider NCCAM till their statement will be updated. How you do not see that it contradicts? FDA separates internal and external uses and clears American Biotech Labs cs for external use. NCCAM on the other hand don't make such a distinction. So a person who has been prescribed a conventionally FDA cleared gel for his wound, by a conventional doctor would be utterly intrigued to find that this article says its not effective based on NCCAM statement which supposes to advice only regarding alternative medicines. As Desoto said FDA establishes the rules and NCCAM is advisory. Ryanspir (talk) 11:57, 12 January 2013 (UTC)

edit conflict conversation moved from user to talk--argyria

Hi. I hope that I didn't walk all over your addition to History in Med Uses of Silver as I was rearranging the sections into what I consider a more logical progression at the same time, I think. If I screwed up your stuff, I am sorry.Desoto10 (talk) 00:29, 12 January 2013 (UTC)

I went back and checked and it looks as though your new stuff is intact, but please do check. Thanks, Desoto10 (talk) 00:32, 12 January 2013 (UTC)

Thanks, everything looks fine. Separate question - do we really need to have a detailed explanation here of argyria - it is linked to the main Argyria article already? We really seem to mention it a lot of times, considering its such a small part of the topic. Maybe we could rationalise the adverse effects and regulations material to remove duplications? Wdford (talk) 00:41, 12 January 2013 (UTC)

I agree.Ryanspir (talk) 14:48, 13 January 2013 (UTC)

We should probably move this conversation over to the article talk page, but yes, I was wondering the same thing. To the best of my understanding, the medical consensus is that the exact amount of silver and the timeframe over which someone is exposed to silver that causes argyria is unclear. The EPA and other "toxic exposure" regulatory bodies seem to use the old 1935 data where people were injected with silver in pretty large doses to get their minimum "safe" amounts. Since there are currently no legitimate drugs for ingestion that contain silver we cannot use these high doses to rationalize the validity of the nutritional supplements that contain smaller amounts of silver. One problem with editing this article is that there seems to be a lack of knowledge about the differences between drugs, devices, and supplements and how the FDA, NIH, EPA, CDC are involved. I'll move this conversation now.Desoto10 (talk) 21:56, 12 January 2013 (UTC)

"The EPA and other "toxic exposure" regulatory bodies seem to use the old 1935 data where" - why do you think that EPA uses this data? In the EPA recommendation its stated that it comes from a study of 70 argyria cases, but I didn't see that it's from 1935. What I was curios, is to find if there are any cases of argyria nowdays, even with prolonged use and even if drinking huge amounts everyday. But neither I nor other editors could find any registered cases for concentrations of 10ppm to 30ppm. Why did I choose these concentrations? It's because most of the colloidal silver sold currently on the market is in this range. Also, homemade silver is also mostly producing concentration in this range. "lack of knowledge" - I do understand everything you have mentioned, if you would like to know, please ask.Ryanspir (talk) 14:48, 13 January 2013 (UTC)

Our responsibility

As it is understood that if cs would easily make people blue and it would be our article which would be too positive for cs use, we would be partly responsible for that situation. Especially considering that cs for internal ingestion is in the segment of the alternative medicine, so it is not normally being prescribed by conventional doctors. Therefore it's at the discretion of any potential user whether to use or not to use it. Since googling and yahooing "colloidal silver" produces this wiki article as the hit #1, the people who have heard about it will be forming their opinion by reading this article. If we on the other hand will deliver an article which is too negative, that would deter people from using cs and thus result in people dying, people being not cured from a condition for which cs is effective, people being cured less efficiently, people absent from work for longer periods due to being sick. Cs is covering a segment of cures for colds whereby a conventional medicine has no cure for them. [this use is still anecdotal but perhaps there are studies about effectiveness for colds as well, i'll just have to look].

It is the position of the wikipedia that it must not provide a medical advice. Currently anyone who will read this article gets impression of DON'T USE IT written in red letters. According to http://www.ncbi.nlm.nih.gov/pubmed/18854209 "Metallic silver in the form of silver nanoparticles has made a remarkable comeback as a potential antimicrobial agent." According to http://www.ncbi.nlm.nih.gov/pubmed/21839058 Its antimicrobial activity against MRSA was not only comparable to silver sulfadiazine, but the formulation was also effective against different yeast and dermatophyte species. "Silver nanoparticles" is the alternative name for a broad definition of "colloidal silver" we are using in the article.

The conclusion is that we need to strike a fine balance in summarizing available reliable information.Ryanspir (talk) 15:22, 14 January 2013 (UTC)

Revenge by Yobol

The editor has removed part of the article in an apparent 'revenge' due to my edit. This action constitutes revenge because the editor did so with comment 'let's go all the way' and neither engaged on the talk page. Someone kindly revert it. Also, at that link at pubmed there are at least two more studies about nanosilver, one of which found it to be synergetic with conventional antibiotics. They are listed under 'related citations'.Ryanspir (talk) 08:44, 14 January 2013 (UTC)

Ryanspir, Yobol's edits were not "vandalism" as defined by Wikipedia, see WP:NOTVAND. Falsely accusing your fellow editors of vandalism is rather serious and I suggest you retract the accusation. The edit was perfectly appropriate for the reasons given in the edit summary. Zad68 14:41, 14 January 2013 (UTC)

Agree, revenge isn't listed as "vandalism" therefore I'm retracting. Thanks for pointing it out. Ryanspir (talk) 15:22, 15 January 2013 (UTC)ryanspir

"Quote from medrs: For that reason, edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. In particular, this description should follow closely to the interpretation of the data given by the authors or by other reliable secondary sources. Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources, as defined above." So if Yobol felt that this study wasn't represented correctly on the article he could have proposed a better wording. He however removed it immediately after I have removed the botswana study.

Speaking about this, what you did yesterday is not ok either. I have added 1 secondary approved by yourself study with two adjunct primary researches. You have removed the secondary study which is fully complaint with medrs because you didn't have the time to read the study yourself. That would mean that you are holding for yourself some special power of approval of what should be written in the article. However, I let it pass due to respect for your contributions. Yet, please, don't capitalize on it. I expect you to revert your revert till the time you will read the study and will put it into better wording. 14:51, 15 January 2013 (UTC)

Rather urgently, you need to read WP:NOTVAND and also WP:AGF. Zad68 14:53, 15 January 2013 (UTC)

Thanks, just did so. You are right regarding Yobol and yourself. Retracting. However, how should I call your action of removing a secondary source? Ryanspir (talk) 15:22, 15 January 2013 (UTC)

Thanks... The removal of the secondary source is WP:BRD. I didn't say it's unsuitable (it might be, I'm not sure), I am just saying it needs more careful summarizing. Zad68 16:14, 15 January 2013 (UTC)

CS effectiveness

http://www.ncbi.nlm.nih.gov/pubmed/18069039 http://www.ncbi.nlm.nih.gov/pubmed/17468052 http://www.ncbi.nlm.nih.gov/pubmed/18854209 http://www.ncbi.nlm.nih.gov/pubmed/19141039 http://www.ncbi.nlm.nih.gov/pubmed/19523420 http://www.ncbi.nlm.nih.gov/pubmed/22286985 — Preceding unsigned comment added by Ryanspir (talk • contribs) 15:07, 14 January 2013 (UTC)

"Silver nanoparticles as a new generation of antimicrobials." CS is considered as a new vector in the medicine.Ryanspir (talk) 14:29, 14 January 2013 (UTC)

The first two articles are primary research and so are not suitable per WP:MEDRS. However the third article PMID 18854209 is a recent review article in a MEDLINE-indexed peer-reviewed journal with a high impact factor. In my opinion, that article is worth looking into and possibly using in this article. Zad68 14:44, 14 January 2013 (UTC)

Well, in my opinion primary studies are not necessary unacceptable per MEDRS and I'm glad that we fully agree on the third article. I would also like to thank Yobol who inspired me to initiate this research. Also this http://www.ncbi.nlm.nih.gov/pubmed/21839058. Ryanspir (talk) 15:25, 14 January 2013 (UTC)

When good-quality, up-to-date secondary sources are available, we use them in strong preference to primary studies. Zad68 14:56, 15 January 2013 (UTC)

Agree. However primary sources which are adjunct to the secondary sources aren't failing MEDRS. Ryanspir (talk) 15:12, 15 January 2013 (UTC)

Removal of Botswana study

For sure there must be some reliable effectiveness of fda cleared medicine. If it would be easy to get such clearances, other cs companies would get them as well. Now, epa would approve since 2003, reapprove in 2006 and in 2009 a basically water to be used in hospitals, thus putting lives of patients at risk? And seeing the approval letters, one will see that every new approval adds more bacteria to the list of being killed due to new emerging studies. Kindly review the references on the talk page to the fda and epa which i have posted. Therefore Botswana study which say that cs is not effective in vitro, contradicts ALL other studies, and FDA position and clearances and EPA approvals. It effectively means that EPA allowed for a non-effective water to be used in hospital emergency rooms for years thus putting lives of patients at a direct list. Such extraordinary statement should come from extraordinary source in order to be compliant with wp policy.Ryanspir (talk) 14:37, 14 January 2013 (UTC)ryanspir

Which one is the "Botswana study"?Desoto10 (talk) 04:29, 15 January 2013 (UTC)

Disinfectants, antiseptics

I broke the "Other Medicinal Uses" paragraph into two sections, since disinfectants and antiseptics are different classes of bacteriostatic compounds. I deleted the WWI sentence since it did not seem important, given that we cover "early 20th century" in the history section. It also did not have a source although one would be easy to find. I could not find reference to AgNO3 caustic luna sticks on the NCCAM site, but I swear I saw it somewhere.Desoto10 (talk) 04:20, 15 January 2013 (UTC)

nicely done! Zad68 04:25, 15 January 2013 (UTC)

A study on Silver Sol

This study about silver sol was performed independent from the American Biotech Labs and was published by Penn State University:

Ultradilute Ag-aquasols with Extraordinary Bactericidal Properties: Role of the System Ag-O-H2O Dr. Rustum Roy Materials Research Innovations 2007, volume 11, issue 1. I was able to locate it at: http://www.docstoc.com/docs/97232286/Ultradilute-Ag-aquasols-with-extraordinary-bactericidal-properties. However perhaps there is a direct link to the "Materials Research Innovations 2007, volume 11, issue 1." in which the university has published the research. Ryanspir (talk) 14:15, 15 January 2013 (UTC)

Although interesting, 1) the article is primary research, 2) the journal Materials Research Innovations that the article is published in is not PUBMED-cataloged much less MEDLINE-indexed, and perhaps most relevantly, 3) the article studied no health effects and the article conclusions do not comment on the medical uses of silver, so I can't see how the article might be useful here in this article. Zad68 14:25, 15 January 2013 (UTC)

You might be right. However, it was published by a independant university, because when I posted other articles about Silver Sol technology, some editors pointed that it was performed and published by the company which produces it. That's why I wanted to provide an independant source. Although a primary study, it doesn't fails MEDRS as its adjunct to the secondary literature PMID 18854209. Ryanspir (talk) 14:55, 15 January 2013 (UTC)

As always you can propose content changes based on the source and we'll discuss them. Zad68 14:59, 15 January 2013 (UTC)

Sure. At this time I would like to know opinion of other editors as well. If there is any content change they may propose based on this study we should certainly review it. Ryanspir (talk) 15:09, 15 January 2013 (UTC)

The article was funded in part by American Biotech Labs, the makers of the tested product and the authors used data provided by ABL. The big table in the article refers back to another article by some of the same authors which refers back to ABL for the "remarkable antibiotic propertis" of the product. The table is simply data provided by the comapany. The paper in question is purely an analysis of the physical properties of the product and has no bearing on medicine. This same journal has published (by the same authors) a paper citing the regrowth of a human finger using Ag as evidence for the value of Ag as medicine. This paper might go in the silver article, but even the authors admit that their results are "far from conclusive on

several scientific questions which need to be answered". This paper is in no way "independent from ABL".Desoto10 (talk) 20:01, 15 January 2013 (UTC)

Cochrane on burns

The recent edit about the Cochrane report is misleading. The Cochrane Collaboration doesn't actually test substances, they merely quality-review the tests and studies conducted by other people. The Cochrane conclusion here was merely that the "studies" that they reviewed were of inappropriate randomness, size and duration to meet their standard of a detailed medical "study". This does not overturn the mountains of evidence published by medics who have used the substances in practice over many years and have found them to be highly effective - it merely says that saving thousands of lives in hospitals around the world is not the same thing as a Randomized controlled trial, which nobody is actually arguing with. I think the article is appropriately worded as is, but we can certainly expand the Cochrane paragraph for detail if the blue-link is not enough.

Silver-impregnated products remain the gold standard for burn wound treatment until a reliable source proclaims a new and better gold standard - which Cochrane has not attempted to do (and which Cochrane in fact never attempts to do).

The fact that some silver combinations slow healing is well known, but they are still commonly used on the basis that "slow healing is better than no healing" - rather a slower-healing wound than gangrene. Wdford (talk) 08:35, 15 January 2013 (UTC)

No. You do not understand. If a review finds that none of the studies meet minimum standards then you cannot claim anything about the treatment. It means that you cannot say that "thousands of people were healed" because there is no evidence for that statement, nor can you say "slow healing is better than no healing" because there is no evidence for that statement based on this review. In any case, why dwell on this particular reivew when there are several which do find reasonable studies and make conclusions (mostly mixed) about silver-containing dressings. You also seem to misunderstand the role of Cochrane Reviews and evidence-based medicine. The authors of these reviews first search for studies, then evaluate the methods used in the studies for validity, and then they collate the conclusions. It is called a meta-analysis and is one of the primary factors used to determine treatment efficacy.Desoto10 (talk) 21:48, 15 January 2013 (UTC)

I guess we could change it to "There is no evidence that silver sol improves outcomes and some that it might slow healing. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:02, 15 January 2013 (UTC)

Please refrain from using the term Silver Sol as this refers to a specific product marketed by American Biotech Labs. Unless, of course we are actually talking about Silver Sol.Desoto10 (talk) 21:48, 15 January 2013 (UTC)

Right. The Gel which contains Silver Sol, the one which has been cleared by FDA is actually provides faster healing than normal. This study "Silver Sol Improves Wound Healing" by Gordon Pedersen, Keith Moeller, The Journal of the Science of Healing Outcomes, Volume 1 No.4, January 2009 shows that. Though its a primary research, it doesn't fail medrs because it provides that when used as adjunct to the secondary research and the fda clearance.

Medrs: "Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources." - This study doesn't. "Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature", this study is adjunct to the secondary research "http://www.ncbi.nlm.nih.gov/pubmed/18854209?dopt=Abstract" which says: "Nanotechnology is gaining tremendous impetus in the present century due to its capability of modulating metals into their nanosize, which drastically changes the chemical, physical and optical properties of metals. Metallic silver in the form of silver nanoparticles has made a remarkable comeback as a potential antimicrobial agent. The use of silver nanoparticles is also important, as several pathogenic bacteria have developed resistance against various antibiotics. Hence, silver nanoparticles have emerged up with diverse medical applications ranging from silver based dressings, silver coated medicinal devices, such as nanogels, nanolotions, etc." Ryanspir (talk) 14:31, 15 January 2013 (UTC)

The Pedersen article is not peer reviewed in a non-indexed journal. That it contains the lowest level of research, individual case studies with no controls, no blinding and no quantitative measures of outcome is more important than that fact that it is a primary source. Please refrain from brining up this journal again.Desoto10 (talk) 23:09, 15 January 2013 (UTC)

Just a note that CDRH website lists over 200 cleared silver-containing devices, with many of them wound dressings.Desoto10 (talk) 04:09, 16 January 2013 (UTC)

Removed primary research

"One death has been reported in the medical literature due to silver toxicity, in which a 71-year-old man developed status epilepticus after repeated oral ingestion of colloidal silver.[40]" There is no secondary review of such cases, so it fails medrs right away. It also fails logically, because there were at least 70 cases in 1935 and more since that time with people becoming blue due to excessive long term consumption of high doses of silver. However, neither of them died. It's virtually impossible to overdose more than they did and they didn't die from cs use. Ryanspir (talk) 14:39, 15 January 2013 (UTC)

Agree with the removal of the content for the WP:MEDRS reason given (not commenting on your "It also fails logically..." statement). Generally in an overview article like this one we do not mention individual case reports. Zad68 14:42, 15 January 2013 (UTC)

I'm glad we agreed on this one. I personally wouldn't remove it if it would be a straight forward case, if it would elucidate how cs killed this man and if there would be at least a few similar cases. But cs wasn't clearly implicated in this case, no similar cases provided. And from encyclopia perspective you are right as well, we shouldn't mention individual case reports. Ryanspir (talk) 15:05, 15 January 2013 (UTC)

Of course. Little reason for primary research. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:05, 15 January 2013 (UTC)

I put this back in after rewording a bit. This death is specifically mentioned in an already included tertiary source (Sloan-Kettering) which we use many times throughout the article. They also provide a commentary.Desoto10 (talk) 21:42, 16 January 2013 (UTC)

I am still not happy with the source

One death has been reported in the medical literature due to silver toxicity, in which a 71-year-old man died of status epilepticus and neurologic toxicity due to repeated ingestion of colloidal silver.

It is supported by a case report and this agragator of primary sources[5] which simply repeats this primary studies conclusions.

This is simply not a sufficient source per WP:MEDRS. And should probably be removed completely from the article. Doc James (talk · contribs ·email) (if I write on your page reply on mine) 23:11, 16 January 2013 (UTC)

I don't feel too strongly about this, so leave it out.Desoto10 (talk) 00:28, 17 January 2013 (UTC)

Chopra

We give Chopra a lot of weight in our article [6]. He states "This has been largely due to the spread of methicillin-resistantStaphylococcus aureus and the resultant reduction in first-line antibiotic prescribing." But this is not a statement of effectiveness but rather one of popularity. MRSA is only mentioned in the abstract. To papers in the ref refer to MRSA but one does not mention silver at all [7] and the other is an invitro study. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:02, 16 January 2013 (UTC)

I found the same thing about that article. Again, this is why we should concentrate on the conclusion section of articles, not the introduction.Desoto10 (talk) 22:18, 16 January 2013 (UTC)

Silver sol

This "The gold standard in topical burn treatment is silver sulfadiazine" was presented out of context. It is no longer the "gold standard" by the way. We have a more recent Cochrane review that raises concerns. Right after that statement in this paper it states "Moreover, results of the extensive literature review we conducted failed to reveal any clinical studies regarding the risks and probabilities of wounds in general to become infected, about the effect of silver dressings on already infected wounds, nor about studies comparing the effect of silver or other antiseptic dressings on prevention of wound infection. Irrespective of the source of silver, whether released from solutions, creams and ointments or nanocrystalline silver released from commercially available new dressings, silver is highly toxic to both keratinocytes and fibroblasts" Thus we were in fact misrepresenting the conclusions of this paper as well Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:08, 15 January 2013 (UTC)

This is always a problem. The source does say that Ag sulfadiazine is the gold standard, but concludes that there is little evidence of efficacy. What do you propose?Desoto10 (talk) 18:37, 15 January 2013 (UTC)

We mention that it used to be the gold standard. And that the evidence does not show superiority. I think that is a fair balance. Thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:44, 15 January 2013 (UTC)

Better. This problem often appears when someone takes bits and pieces from the Introduction section of an article rather than from the Conclusions. An example is: "Wound dressings containing silver are increasing in importance due to the increase of antibiotic-resistant bacteria" from a paper by Ian Chopra which we put in the article. This statement is not a conclusion of the article, but something that the author says at the beginning as a reason for writing the paper. In the Conclusions section he concludes something about the mechanism of action of Ag and how Ag-containing dressings that release large amounts of silver are better than those that release low amounts. To me, that is the conclusion of the paper and what we should cite it for, not something that is in the Introduction. This particular reference (Chopra) is suspect because Chopra was funded by Smith and Nephew who, surprise, surprise, make a silver-containing wound dressing that release slarge amounts of silver which Chopra finds to be the most effective.Desoto10 (talk) 21:30, 15 January 2013 (UTC)

Cochrane is a much better source and should be given greater prominence especially since their reviews are more recent than this one. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:34, 15 January 2013 (UTC)

I agree.Desoto10 (talk) 21:53, 15 January 2013 (UTC)

I strongly disagree, as that is not a fair reflection of the many reliable sources on the topic.

Firstly, the conclusion of both Cochrane reviews was that the “evidence is insufficient”. This must be balanced against the many papers from different hospitals and research teams that report good results from using silver-based dressings. For example the first Cochrane review concludes that: “There is insufficient evidence to establish whether silver-containing dressings or topical agents promote wound healing or prevent wound infection; some poor quality evidence for SSD suggests the opposite.” [8] The second review concludes: “There is a paucity of high quality RCTs on dressings for superficial and partial thickness burn injury…. Despite some potentially positive findings, the evidence, which largely derives from trials with methodological shortcomings, is of limited usefulness in aiding clinicians in choosing suitable treatments.” [9] The article needs to be a bit more clear about the actual conclusions.

On the other hand, a very recent conference of an expert working group under the auspices of Wounds International concluded that the studies analysed by the Cochrane reviews were not representative for various reasons, and that the evidence shows that silver-based dressings are actually effective if used as directed. See [10] and [11] .

Second, the two Cochrane reviews quoted here are both out of date already – they only reviewed trials up to 2009. The state of the art changes rapidly in medical research. A quick google search brought up a number of much more recent papers which evidence the effectiveness of silver-based wound treatments. In addition to the FDA/CDRH, see for example [12] and [13] and [14] and [15] and [16]. The article should give greater weight to more recent studies than to older studies, and should not disguise the fact that much evidence supports silver-based treatments even if Cochrane wasn’t happy with the size and duration etc of the particular studies they reviewed. I was always happy to note the Cochrane reservations, but the current wording is unbalanced and unrepresentative.

The more recent evidence does indicate that SSD gels are being overtaken by silver-impregnated gauze's, but not that SSD has been ruled ineffectual. I am obviously happy to give greater prominence to the newer techniques, but giving prime prominence to the Cochrane reviews does not seem appropriate. Wdford (talk) 14:11, 16 January 2013 (UTC)

The refs that you point to are primary except for the last one. They are mostly in vitro studies of bacteriostatic and -cidal effects. Your expert panel, organized by a journal publisher, provides little new information except that the use of silver-containing dressings should be used only for short periods of time and only for infected wounds, not as a preventative dressing. They also confirm that the silver dressings may slow the rate of healing, but they say that increasing the rate of healing is not what the dressings are for. To better manke your point you will need to find recent reviews from reliable sources, not bits and pieces of the primary literature.Desoto10 (talk) 17:54, 16 January 2013 (UTC)

With respect to silver containing dressing, these are very expensive and a lot of people wish to promote them beyond the evidence. It is the general consensus here at Wikipedia and within the medical community at large that Cochrane reviews are some of the highest quality of evidence. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:43, 16 January 2013 (UTC)

Its true that the expert panel provides "little that is new" - however what they did do was confirm that various silver-based products are effective if used properly. They are a secondary source in that they review the primary sources, and they are more up to date than the studies reviewed by Cochrane. What is your objection to this source please? Wdford (talk) 10:39, 17 January 2013 (UTC)

The reason why we value Cochrane more highly is due to issues of conflict of interest. This guideline was paid for by "unrestricted educational grants from B Braun, ConvaTec and Systagenix". These are manufacturers of silver products [17] [18] Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:41, 17 January 2013 (UTC)

I'm sure Cochrane is a reliable source when it says "the evidence strongly suggests that ..". However here we have two Cochrane conclusions which both state that the sources they reviewed were of poor-quality and were unreliable. Against that we have an international panel of experts in the field, who are much more up to date, backed by many papers from researchers, the practical experience of many hospitals, and the FDA. There is no evidence of bias in their conclusions - on the contrary, there is much evidence to support them. I'm not suggesting we leave out Cochrane, but the article currently is unbalanced and incomplete. Wdford (talk) 12:19, 17 January 2013 (UTC)

Secondary sources have looked at the primary studies and found them wanting. That means that they find no evidence for Ag efficacy. That is what we say. Why not try to find some independent secondary sources that say otherwise and add those?Desoto10 (talk) 05:40, 18 January 2013 (UTC)

Wikipedia, like other tertiary science sources, lags behind bleeding edge research because we use secondary or other tertiary sources. We have to wait until the primary literature has been evaluated and the results of the evaluation are published. I provided such recent reviews concerning wound dressings for diabetic foot ulcers earlier. As with most of the reviews, they find no significant differences between dressings. The problem with the Wounds International expert panel is, as Doc James mentions, the paper was funded by three companies that have a vested interest in a positive outcome for silver use. Regardless of whether or not the paper is actually unbiased or not, I think most people would agree that there is the perception of conflict of interest which lowers its quality and usefulness.Desoto10 (talk) 23:12, 17 January 2013 (UTC)