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Thanks!

For your help in reviewing and expanding thyrotoxic periodic paralysis! JFW | T@lk 10:40, 22 November 2010 (UTC)

ArbCom

Thanks for your note and the compliment. However I've discovered that I have an aversion to reading through tens of thousands of words concerning petty disputes that I don't care about. I ran for ArbCom twice (and nearly made it the first time) but I have never regretted my lack of success. OTOH, why don't you run? You've got a good head on your shoulders and you communicate well. You've been around long enough to learn how things are done but not so long that you've made lots of enemies or lost interest. Think about it.   Will Beback  talk  11:18, 22 November 2010 (UTC)

Thanks for the vote of confidence :-) Doc James (talk · contribs · email) 11:31, 22 November 2010 (UTC)

CCD

Nice job on the CCD article! Gandydancer (talk) 16:31, 22 November 2010 (UTC)

Glad to see you feel it is an improvement. Doc James (talk · contribs · email) 23:19, 22 November 2010 (UTC)

Presuming of the intention of an editor

In this comment [1] you presume that my statement "The tags are used to inform the readers of a likey non-NPOV situation." explain my intention in informing the readers. It does not. It was referring to my understanding of Wikipedia:NPOV_dispute, which I believe focus on the viewpoint of the readers. I did not express my personal motivation, which involves many feelings. As far as the guideline are concerned, the most important aspect of my motivation is to have the participation of readers in the talk page. You could not know, but you should not presume that you know and you should not discuss my personal motivation in the article talk page. Cheers. Edith Sirius Lee (talk) 17:03, 22 November 2010 (UTC)

You wrote everything inside the brackets. I did not presume anything just quoting you.Doc James (talk · contribs · email) 22:49, 22 November 2010 (UTC)
This statement was my understanding of a guideline saying that Tags are useful to let readers know about a dispute. You replied that this is not what the tags should be used for. I agreed that the purpose is to bring extra opinions, a point that is also mentioned in the guideline. However, you kept bringing this point again, so I had to conclude that you assumed there was something wrong in my understanding of the purpose of the tags. If you had mentioned it only once, it would have been fine. Edith Sirius Lee (talk) 23:25, 22 November 2010 (UTC)

The Signpost: 22 November 2010

Reliability of sources

I agree that in general the unmoderated nature of Knols allows unreliability. However, the information in this Knol on Clostridium novyi is all peer reviewed research. The rest is admittedly anecdotal and, as with all first observations, phenomenological. Subsequent careful investigation may confirm or refute initial observations. With all sources one is required to use judgement. Rubbishing a Knol just because it is a Knol would seem to be an abdication of judgement. I decided to use a Knol as a means to publication because biomedical researchers are increasingly using this route because of inadequacies and expense in the journal route. One has only to recall the stem cell scandals to realise that journal articles are not always reliable either. It would generate more light than heat if we were to concentrate on content rather than medium. Andybiddulph (talk) 10:18, 25 November 2010 (UTC)

Reliability of sources

I went through over a hundred gigabytes of research papers and articles. There are only two review articles on Clostridium novyi, this Knol and the Wiki entry which I wrote. It would appear that I am the world expert on this -- God help us all ! Andybiddulph (talk) 10:36, 25 November 2010 (UTC)

Pre-Seed in the news

Hi,

I've asked before to have an article about Pre-Seed on Wikipedia, and you responded that it wasn't notable enough. I wanted to pass along a link that I ask you check out. There were recently a couple of new studies done and one independant study was picked up by Reuters News. We have been getting a lot of press play on this. Can you please look at this and reconsider having an article on Pre-Seed, or at least add a Pre-Seed section on the personal lubricant page that discusses its fertility-friendly qualities? "Reuters News" Thank you Darb8033 (talk) 18:44, 22 November 2010 (UTC)

I have redirected the term. Still not really significant but might be enough for a single line. Doc James (talk · contribs · email) 23:21, 22 November 2010 (UTC)
Forgive me since I am still fairly new at this. Since you redirected the term Pre-Seed to the personal lubricant page, can I edit that page to include Pre-Seed? Under the Personal lubricant types section, it lists a lot of different types. Could I add a new type in this section called Fertility-friendly and then write a short section on Pre-Seed? If there are currently types in this section for anal specific lubricants and masterbation specific lubricants, can I add Fertility specific to this and mention Pre-Seed since it is the only lubricant on the market that the FDA allows to claim it is safe for trying to conceive? Thank you Darb8033 (talk) 00:33, 23 November 2010 (UTC)
Yes if it has specific FDA approval feel free. One should also mention that the use of cooking oil is a cheaper alternative and probably as good per the ref. Doc James (talk · contribs · email) 02:49, 23 November 2010 (UTC)
I'm a bit suspicious of a COI here. Ronk01 talk 00:27, 26 November 2010 (UTC)
Yes I am sure there is. Doc James (talk · contribs · email) 00:38, 26 November 2010 (UTC)

Wikipedia:WikiProject Veterinary medicine

I am interested in getting this project going, and there is probably one other user who is very interested, although he/she and I are currently skirting uncommon grounds. I see you're not a real vet, you just play one on en.wiki--me too. --Kleopatra (talk) 00:41, 27 November 2010 (UTC)

The Signpost: 29 November 2010

Med colab of the month

Just a friendly reminder to start a vote on Wikipedia talk:WikiProject Medicine/Collaboration of the Month over this months colab of the month. Thanks! Peter.C • talk 01:03, 2 December 2010 (UTC)

TM structure RfC

Hello Doc James,

Re: the TM structure RfC, do you see a way to cover topics that are repeated across multiple detail pages, within the context of a summary page? If so, you may be able to turn your concerns into a few summary guidelines that all could agree on. –SJ+ 22:57, 5 December 2010 (UTC)

Thanks for your clarification. We will figure out have to make something work I am sure in line with this consensus. Doc James (talk · contribs · email) 23:00, 5 December 2010 (UTC)
This seems like unnecessarily moving away from a simple consensus, which is to simply summarize the detail articles. If the topics are already covered in the detail articles, then summarizing these detail articles will also summarize these topics. It is not complicated. It is even better because they will be in their natural context. Why taking them out of their context? Edith Sirius Lee (talk) 00:17, 6 December 2010 (UTC)

Re-org of DV article

Very nicely done. The article's presentation is vastly improved.--Cybermud (talk) 00:55, 7 December 2010 (UTC)

Thank you. --Doc James (talk · contribs · email) 00:56, 7 December 2010 (UTC)

The Signpost: 6 December 2010

Comment

I want y0u to show me aclear Xrays about heart faliure —Preceding unsigned comment added by 212.0.130.7 (talk) 19:12, 9 December 2010 (UTC)

You mean other than this one? [2] Doc James (talk · contribs · email) 19:35, 9 December 2010 (UTC)

Bell's Palsy

Hi. I'm Robert, or "Snud," from the Bell's Palsy page. I didn't want to waste space there on chit chat. I'm sorry I got too vague, but the point I was making was about internet medical articles being hidden from the public. I think the only reason doctors do that is because they think the hoi-polloi will not understand. I suppose it's true. I know this is especially true of psychoanalysis where the doctors encounter such hostile resistance to unflattering self-discovery.

Anyway, have you taken over the Bell's palsy page or are you just assisting LiteraryGeek because of my complaint? Snud (talk) 07:29, 11 December 2010 (UTC)My watchlist

I write a lot of medical stuff. It is not doctors who "hide" articles. But journal publishers. The publishers need to make money from the journals and thus one needs to pay for access to most of them.Doc James (talk · contribs · email) 08:08, 11 December 2010 (UTC)
I hate to ask you this, but maybe you could contribute some medical stuff to the subject of Bell's palsy...I think all medical libraries buy access to the Psychoanalysis Electronic Publishing website. I have a hunch it's full of cases of Bell's palsy being treated with psychotherapy.http://www.pep-web.org/Snud (talk) 19:21, 11 December 2010 (UTC)
I am unable to find any review articles on this subject using pubmed. Thus not convinced it is notable. Feel free to show me otherwise. See WP:MEDRS for a discussion of referencing for Wikipedia. Doc James (talk · contribs · email) 00:42, 12 December 2010 (UTC)

Page load time

Hi James, I notice that you had a discussion with Anthonyhcole (talk · contribs) on Talk:Pain about the use of citation templates a little while ago. I have challenged him again on this, but given the unusual nature of the argument I've also opened a thread on the village pump about this. Keen to hear your comments.[3] JFW | T@lk 08:59, 12 December 2010 (UTC)

stomach cancer is associated with which blood group ? —Preceding unsigned comment added by 117.197.118.60 (talk) 11:35, 13 December 2010 (UTC)

Thanks

Hi Dr. Heilman, I hope this is the right way/place to respond, and thank you for your welcome message. Indeed I am new here, but will try not to let that be an excuse for any 'inappropriate' edits. Clearly you have noticed my changes to the low back pain and spinal manipulation pages, hopefully I have not broken any of the rules just yet :) Although I still disagree with your placement of a 2004 reference (Cochrane or not) before newer research in the low back pain article, I hope that by not making a big deal out of it that you will believe that I am only interested in making edits that are acurate and NPOV despite my inherent bias as a student of chiropractic. I like to think that my research background guides my interpretation of the literature more so than any 'emotional' ties to my future profession. If you question any of my edits, etc., I am always willing to discuss them. Similarly, if you ever have any advice regarding my approach to editing, I am always happy to take advice from one with more experience than I. Best regards, Aaron Puhlaa (talk) 22:16, 13 December 2010 (UTC)

Thanks for the tips Dr. Heilman! Puhlaa (talk) 00:36, 14 December 2010 (UTC)

The Signpost: 13 December 2010

Newbie question

Hey, perhaps this is the wrong place to put this, but I'm wondering if you can give me some pointers regarding uploading images from medical journals/texts - not too sure where that falls under the copyright act. I generally don't carry a camera in the ER! It's nice to see another CCFP-EM here, btw. Cheers! (Minceymeatypie (talk) 22:03, 14 December 2010 (UTC))

Scanning through my references. If I change the references so that it does not show up in the heading, will that work? (Amazing how I've taken Wikipedia for granted for ages, never realising the work that goes into it!) (Minceymeatypie (talk) 22:43, 14 December 2010 (UTC))
The revision to burns - you reverted it citing that references shouldn't be used in the heading. I am changing that - were there other problems that needed fixing? (Not sure if that was what you meant by the formatting being wrong) (Minceymeatypie (talk) 23:03, 14 December 2010 (UTC))

Assistance with referencing

Dr Heilman, I have had troubles with referencing, and have been unable to determine what I am doing wrong. I dont have any issues with including a reference in general, but when trying to use the "naming" function, so that I dont have to include the entire reference text each time the reference appears, I seem to be useless! I have tried the help resource, but I cant figure out what I am doing wrong. If you have a moment, would you check the "Chiropractic" page and see what is wrong with my attempts. My edits were to the 'Education' section, you will see the long list of my attempted 'fixes' (embarassed). The 'names' of the 2 references I added are 'CMCCMediaRoom' and 'GovOntario'

As a second question, I feel that the "Chiropractic" page as a whole could use some work (it is so long, and there is alot of repitition that could be streamlined), but I have come to find in the discussion for that page that it is a nasty place to work. How would you recommend I approach editing this page to avoid trouble? Regards, Puhlaa (talk) 02:30, 15 December 2010 (UTC)
Dr Heilman, Thanks for fixing those references and for your advice. The efficacy of total chiropractic care can be a complex issue to research, especially when you consider that chiropractic is much more than just manipulation to many practitioners (manipulation, acupuncture, deep-tissue 'massage', posture/ergonomic counseling, exercise, nutrition, etc). However, I can quite easily tell you where I stand on the matter of where and when spinal manipulation alone is best used. For me, and consistent with what we are taught at CMCC, manipulation on its own has been found to be effective, and can be a mainstream approach for LBP, neck pain, and some forms of headache, and may also help other common MSK-related conditions. As for non-MSK conditions like asthma, I think total chiropractic care can be a great form of complementary treatment for some people (especially chronic sufferers), as research has shown that our therapy often improves quality of life scores. However, I do not feel that chiropractic is an appropriate "first line of care" for non-MSK conditions, and should not be used to replace conventional medical care. I will believe otherwise if/when research exists to say otherwise, and I think that if all chiropractors felt the same we would have far more 'cultural authority'. I also think co-management/cooperation between all health care providers is whats best for patients and is the future of healthcare. Just for fun....I also believe in the germ theory and am pro-vaccination :) Best regards, Puhlaa (talk) 12:09, 15 December 2010 (UTC)
As you as your push mainstream scientific opinion to the forefront you will not encounter too many problems. Doc James (talk · contribs · email) 12:19, 15 December 2010 (UTC)

Patient you might have an interest in

Hey, James, any ideas as to what might cause a ICH in a 22 y/o with normal BMI, mild hypertension (pt. records ind. avg. 131/93), and recent severe wt. loss (about 18 ks in a month) (My friend's pt.) I thought Ephedra, cavernous angioma (doesn't really explain the wt. loss), aneurysm (also doesn't really explain the wt. loss), anabolic steroids, or autoimmune. Thoughts? Ronk01 talk 04:08, 15 December 2010 (UTC)

Yes usually intracranial hemorrhage in young people are either due to hypertension ( drug induced ) or aneurysmal bleeding. What type of bleed was it? Doc James (talk · contribs · email) 04:26, 15 December 2010 (UTC)
Well, they did another CT, and it turns out it was a small neoplasm eroding the MCA. Apparently they didn't see it before because of the hemorrhage. I'll send you the scan if I can get consent, and convince my administrator to allow me to send it (we have an annoyingly strict policy regarding pictures taken in the hospital). I would have gone with Ephedra otherwise, especially considering the rapid wt. loss. Ronk01 talk 05:07, 15 December 2010 (UTC)
WRT images if it is non identifiable you should not need permission. We use PACs here and it is hard to get the images off. One has to hit the "print screen" button, paste the image into paint, then crop to remove all ID before uploading it to WikiCommons.Doc James (talk · contribs · email) 07:00, 15 December 2010 (UTC)
I'll see what I can do. Ronk01 talk 21:34, 15 December 2010 (UTC)

I tried (Electrotrichogenesis)

It's still not MEDRS worthy, but it might have notability as a treatment in common use. I have no problem redacting the medical claims as long as people can find information about this technique generally. See if you think it holds up... Ocaasi (talk) 16:13, 15 December 2010 (UTC)

Data wiki; thoughts research articles

Would you mind telling me where you heard about this data wiki?

In regard to the discussion at otitis media: What it comes down to is that I think Wikipedia exists to document scholarly information. As long as information is at the scholarly level and is accurately summarized in Wikipedia, I don't think there is a big problem. For example, if there are two RCTs, they can be described neutrally and the reader is left to draw their own conclusions, which is the type of neutrality that we strive for in Wikipedia.

Although WP:MEDRS does not distinguish between different research articles, in reality there is a big difference between a randomized controlled clinical trial and an in vitro study. In the example at otitis media, there was a promising RCT (n~50) published in 2003. As of when I added it, there were no reviews that I could find. There's a group in Wikipedia who therefore believe that there should be no mention of such a thing, if there are no reviews. In the meantime, they might allow for speculative treatment based on in vitro evidence to be mentioned as long as it was mentioned through a review. Isn't that odd? And then, when I found a review of the 2003 RCT, it basically summarized the RCT in the same way that I would have summarized it in Wikipedia.

Reviews can provide a false sense of security in the reliability of the information, and they also allow people to channel their (non-neutral) opinions through a cherry-picked reviewer. Anyway, I think RCTs and other research articles should only be used when good reviews aren't available, but IMO there's ideally more to good medical editing than searching PubMed, clicking the reviews tab, and copying the conclusions in using slightly different wording – although I'll admit that is probably the best way to start, and most of us volunteers (particularly ones like me) don't have the time or expertise to do a lot more.

The biggest problem with using research articles at the level of an RCT is information overload, improper summaries of the RCTs, and a concern that the reader isn't smart enough to understand things like statistical power. These are legitimate concerns, but it's also a bit of a "dumbing-down" tactic. I just don't agree with the WP:RECENTISM philosophy that Wikipedia should be dumbed down or lag new research by an indefinite amount of time depending upon the whims of medical review article writers. Yes, the new information could be inaccurate - it might get people excited over nothing. But it could also be accurate, and contribute to a proper understanding of the issue sooner. On net, my philosophy is that Wikipedia should make it easier to track new developments and help clarify new areas rather than discourage the documentation and spread of new science.

I'm tempted to bring this discussion back up at WP:MEDRS, but I think most of us have better things to do than fight over bureaucratic legalese. Anyway, sorry for the TL;DR. II | (t - c) 03:02, 16 December 2010 (UTC)

I do agree with much of what you have said. I do think though that it is important to keep what is currently accepted medical practice separate from what is cutting edge controversial research. We do make allowances for research sections at the end of article. I guess the thing is WP:DUE. For example recently moved the "HIV cure" from the treatment section to the research section of both the HIV and the AIDS articles. Yes they may be on to something but I am not going to start recommending it yet...
WRT the data wiki it was discussed on the listserv. Do not think it went anywhere.
Narrowing things down to reviews gives a more general conclusion and keeps the amount of info manageable. If you look at a topic such as Transcendental Meditation. We have a recent 2007 review of something like 1200 studies on the topic. Most of the hundreds of studies are riddles with conflict of interest and they where being used to drown out the independent review. There are attempts to promote the practice beyond mainstream science while claiming it is mainstream science.
BTW I think the balance you have provided to manipulation for otitis is good. Doc James (talk · contribs · email) 03:12, 16 December 2010 (UTC)
I agree that it's important to keep the information manageable, but I think it is still possible to use research articles sparingly. Thank you for your sympathy for my concern about excluding certain information and kind words, and I hope I haven't come off as too abrasive - I do greatly appreciate all the work you do in the fundamentals of medicine, and I hope you continue to work boldly even if I argue against some of your work. As long as we can somehow incorporate emerging research, then I'll be satisfied - but in the future we may have to get third opinions when there's no handy "review" to settle things - and I'm not necessarily talking about third opinions from WP:MED, since I know they will probably always fall on the exclusionary side. There are people outside of WP:MED who also count in determining what gets included in Wikipedia articles, and I think a lot of the people outside of WP:MED would be surprised at what the people in WP:MED consider acceptable sources. II | (t - c) 06:16, 16 December 2010 (UTC)

Plagiarism/copyvio

Hello, in a recent edit here you changed it so that verbatim text from a different website here is written in the wikipedia article without quotation marks. The original text is copyrighted, so it's illegal to copy it verbatim without quotation marks. OK well, I'm not a lawyer so I'm not quite sure what the law is, but anyway wikipedia policy requires quotation marks. Besides the copyright problem, there's also a violation of wikipedia plaigiarism policy to incorporate verbatim text without quotation marks or an "Attribution template" or something equivalent.

Do you agree? Hope that makes sense! Thanks for your good work, :-) --Steve (talk) 04:26, 16 December 2010 (UTC)

This is a NIH website. Quotes or not does not effect copyright (look at google books where google has put quotes around whole books and is having problem). The reference is attribution by the ref and this is enough as far as I am aware. But if you have concerns probably best to find a lawyer. I also changed the text some and it is just a simple list. Not everything can be copyrighted. For example a group of psychologist claimed copyright over two pentagons. Doc James (talk · contribs · email) 05:04, 16 December 2010 (UTC)
Anyway I was only compressing it per WP:DUE ADAM is not a very good source per WP:MEDMOS and IMO should never be used. I have been updating that section using recent review articles that come to the exact opposite conclusion that we had. Triggers are minor and have little concrete evidence to support their actually existence.Doc James (talk · contribs · email) 06:28, 16 December 2010 (UTC)

Actually the WP guideline on plagiarism states that copying Public Domain texts can be done attributing text both with a reference and a template at the end of the article. See: Wikipedia:Plagiarism#Public-domain_sources. Bests. --Garrondo (talk) 07:37, 16 December 2010 (UTC)

Yes thanks as it says here [4] "Where Wikipedia uses large amounts of content from public-domain sources, it is appropriate to use one of these templates to note the source." Doc James (talk · contribs · email) 07:42, 16 December 2010 (UTC)

Verifiability/Use English/Burden conflated with content issues

File:Kanazawa-C-3209.jpg
This public sculpture in bronze is located in Kanazawa, Ishikawa Prefecture, Japan. In the context of this thread, it illustrates a process of running-in-place; and at the same time, it suggests of a kind of circular, tortured logic loop.

Doc James -- On one hand, Mentoring Tenmei was a failure because we didn't develop plausible strategies for averting the problem which has developed here at Talk:List of tributaries of Imperial China#Cite does not verify asserted "facts".

  • In 2009, I foresaw a set of prospective issues recurring ad nauseam; and I sought help here. The counter-intuitive result was ArbCom punishment in order to molify the indignant, extravagant complaints of Caspian blue and Teeninvestor.
  • In 2010, Mentorship did not address the questions with which I began nor did the investment of time encompass averting recidivism. Regrettably, my writing and weekly status reports for mentors remained opaque. I didn't manage to ask for help in a way that made responding easy or possible.

On the other hand, Mentoring Tenmei was a success because both Caspian blue and Teeninvestor appear to have withdrawn from Wikipedia, and I'm still here to address the kinds of questions their edits and strategies inspired. In their absence, WP:Verifiability/WP:Use English/WP:Burden will continue to be conflated with content issues; but my comments and questions are less likely to be misconstrued as personal attacks.

Doc James -- Now that the formal mentorship period has ended, are you willing to help me develop a strategy for dealing with problems I expect to recur. These do not appear to be conventional in your editing experience. This may be unique to East Asian topics and contributors; and if so, your perspective is all the more valuable.

I predict that problems like the one here will persist and increase in the foreseeable future -- not because this is a self-fulfilling prophesy -- but because of developments in East Asia and because of the nature of our collaborative context. This category includes the stale problems I discovered with Caspian blue at Talk:Joseon Tongsinsa/Archive 1 and also similar to what I encountered with Teeninvestor at Talk:Tang Dynasty in Inner Asia/Archive 1.

I do not invite your intervention in any specific dispute thread. Rather, I'm looking for your help in forward-looking analysis and planning. The response I'm looking for is binary: "yes" or "no"?

If you're no longer interested in this kind of open-ended activity, please accept my sincere thanks for the help you've already offered. --Tenmei (talk) 19:50, 20 December 2010 (UTC)

The Signpost: 20 December 2010

Dengue fever

Everybody seems to forget that I am a psychologist... :-), so I am not sure it will be the best review. In addition right now lots of work until Christmas in real life, so I do not think I will have the required time for a GAN in a while. Sorry... Bests.--Garrondo (talk) 12:02, 21 December 2010 (UTC)

Herpes simplex

Thanks for adding the additional content about barriers to the Herpes simplex article, and for removing the questionable statement. --Pnm (talk) 04:04, 23 December 2010 (UTC)

It's my first time editing med content. WP:MEDRS was really helpful, thanks. I feel a bit more confident after reading it. --Pnm (talk) 04:19, 23 December 2010 (UTC)

Tis the season....

Happy holidays.
Best wishes for joy and happiness. Guerillero | My Talk 02:43, 25 December 2010 (UTC)
Many thanks and same too you. Doc James (talk · contribs · email) 17:24, 25 December 2010 (UTC)

RE: Reference

Thanks for your concern on references. For the sake of record, I'm one of the early Wikipedians (13th or so) and English is not my native language. The major problems with Wikipedians are that 1. Majority of them believes in Google and wants references (Tamil and related topics are one of the worst affected in these aspect; as olden Tamil people were so adverse to document their names and many Tamil articles are not yet translated and can't stand for Google Test), 2. Others are always wrong mentality--instead of trying to contribute or improve, 3. Reverting without reading the article--just because it contradicts their belief (Remember Science itself is a changing thing and olden theories are now lies). Sorry for the lengthy lamentation; but, I hope you can understand the problems and solutions. Thanks. --Rrjanbiah (talk) 06:35, 26 December 2010 (UTC)

The desire for references are not "a major problem with Wikipedians" they are essential. They are require to create a reliable source. Doc James (talk · contribs · email) 10:26, 26 December 2010 (UTC)

References

Thanks for encouraging me to use consistent formatting. I've fixed the refs I recently added. The links you posted on my Talk page are quite useful. But I don't understand one thing: should I give the page numbers for the whole article or just the pages I"m citing? The template seems to require the former. Do I maybe give the specific page number once I've closed the cite tag? TimidGuy (talk) 12:20, 27 December 2010 (UTC)

The Signpost: 27 December 2010

Anal Fissure

I edited the anal fissure article based on my own personal experience, and the advice of my new doctor. I have suffered with a fissure for perhaps twelve years, and no-one ever advised me how to avaoid the pain during defecation. It was the Wikipedia article, which stated which "side" of the anus it usually appears on, which led me to ponder whether the doctors could tell me where mine might be, and whether there is a best sitting position. Accordingly, I spoke to my new doctor, who advised me that the squatting position is the most natural, and why didn't I try a stool? Since that advice, I have had no real pain during defecation at all (!!!!!!!) and I wondered to myself whether I could enter this as a hint into the Wikipedia article to help other sufferers. Of course I cannot quote research - unless I write my own paper, but that wouldn't be peer-reviewed. If you let it stand (well, squat), I can promise never to touch another medical article again!!!Southamite (talk) 19:51, 26 December 2010 (UTC)

I am unable to find anything to verify this. Let me know if you can. Doc James (talk · contribs · email) 20:29, 26 December 2010 (UTC)
You might look to some cross-cultural sources. I spent time living in south east Asia where all of the toilets are at ground level. Even 80 year old grandmothers easily go down into a full squat. As anyone who has done yoga can also attest, when the knees are up near the chest and the glutes are lengthened, the relevant portals are also more easily passed through. The experience, once adjusted to, was surprisingly effortless compared to modern, seated methods. Ocaasi (talk) 00:23, 29 December 2010 (UTC)
Here are some sources: A Slate magazine feature, not a MEDRS, but a nice overview. It linked to this study (primary, n=6, 'Conclusion: The results of the present study suggest that the greater the hip flexion achieved by squatting, the straighter the rectoanal canal will be, and accordingly, less strain will be required for defecation'). There's some natural health movement advocacy such as this and this. Suggested medical issues involve better muscular support for the pelvic floor, less stretching of the pudendal nerves, better sealing of the ileocecal valve, alignment of the rectoanal canal, relaxation of the puborectalis and anal sphincter muscles, and increased intra-abdominal pressure to aid in full elimination. Not sure about any of that, but at least it's a proposed mechanism. Ocaasi (talk) 01:01, 29 December 2010 (UTC)
Ok, a few more (pubmed)... On point: [5], [6], [7], [8], [9] [10], [11], [12], [13], [14], [15]; and background [16], [17], [18], [19]. Ocaasi (talk) 01:21, 29 December 2010 (UTC)

RFC/U

I hope it won't come to this, and Basket of Puppies (talk · contribs) will settle down and respect consensus, but considering his recent edits and failure to respond to normal WP:DR processes of engaging editors on talk, I've begun gathering diffs for a potential WP:RFC/U here; please feel free to add any, and I hope it won't be necessary. I do believe that Schizophrenia can be salvaged with a sustained effort, and hope the disruption will cease so work can progress. SandyGeorgia (Talk) 19:05, 27 December 2010 (UTC)

Same continues, and he continues to remove attempts to discuss with him with "LOL" edit summaries. If you're interest in co-certifying an RFC/U (two certifiers are required), I will begin preparing it. User:SandyGeorgia/sandbox#BoP_RFC.2FU. We can't progress on the FAR with this kind of disruption continuing. SandyGeorgia (Talk) 00:11, 29 December 2010 (UTC)

He's exhibiting very strange, intransigent behavior: refusing to answer direct questions, removing talk page posts, perseverating on points already answered. Perhaps he gets overheated when he is challenged and doesn't read critically; maybe a cooling off period will help;. I'll ignore it for a while to see if he comes around, if not, I'll prepare the RFC/U. What a MASSIVE waste of valuable editor time. SandyGeorgia (Talk) 00:40, 29 December 2010 (UTC)

Dengue GAC

I'm going to step away from dengue fever for a bit to give you a chance to deal with some of the points on the talkpage. GrahamColm has made some useful additions in the diagnostic department, and corrected a couple of schoolboy howlers that I introduced. Now I need a space to put the nine reviews that I printed off... JFW | T@lk 21:02, 27 December 2010 (UTC)

Ha, I actually had the nasty little beast once in South America, undiagnosed until I broke out in the hemorraghic rash. I only recall laying in bed and saying, "just leave me alone and let me die in peace". If you get closer to approaching FAC, let me know well in advance so I can have a look. SandyGeorgia (Talk) 21:10, 27 December 2010 (UTC)
Great thank JFD will work further shortly.Doc James (talk · contribs · email) 12:02, 29 December 2010 (UTC)

Frailty

I thought this news blog post might interest you. Do you think that Frailty syndrome is the right place for this information, or another article? WhatamIdoing (talk) 05:34, 29 December 2010 (UTC)

How about in a prognosis section or an "in the elderly" section on the surgery page? At they frailty syn page would also be useful. Doc James (talk · contribs · email) 11:40, 29 December 2010 (UTC)

 Done See Surgery#In elderly patients, Frailty syndrome, and now even Geriatrics. WhatamIdoing (talk) 23:34, 29 December 2010 (UTC)

UpToDate

I've just looked at this for the first time. Do I need to pay something to be able to access more content? My first perusal there leads to a question: this article doesn't tell me where it's published, and it doesn't seem to be a published article. Is it written by Jankovic for Uptodate? If so, that concerns me, as Jankovic is not a mainstream thinker on TS, and some of his peers disagree with him. I don't see anything wrong in the excerpt I can see there, but can I use Uptodate to find other articles, or will I only be finding Jankovic's sometimes idiosyncratic views? NEJM once published completely and undeniably wrong info written by Jankovic, and more widely recognized TS researchers told me they wouldn't take him on, as they didn't want a repeat of an old debacle that played out in the journals (TSA vs. Comings). If the article excerpt I found at UpToDate is in fact this article, it has a blatant error in the definition of TS; better and more recent reviews are available, and NEJM really goofed on that one. SandyGeorgia (Talk) 16:24, 30 December 2010 (UTC)

Have sent you some stuff. Doc James (talk · contribs · email) 17:00, 30 December 2010 (UTC)

Thanks! That article appears to have been written for UpToDate by Jankovic; is that wrong? I have some problems with how he has used Freeman's international registry: Freeman himself attached many disclaimers about how to use his international registry of cases, and how not to use that data; it's concerning that Jankovic writes parts of that article around a registry that is subject to diagnoses based on limited review, clinical ascertainment bias, and has numerous biases and shortcomings acknowledged by its author, with a lot of info about how to use that data correctly, which was intended to suggest areas of further research. Jankovic then tries to substantiate this by referring to one broader based study which also had limitations, while not mentioning other studies. Other than that, it's a fine article-- I'm just wondering if I'm correct in seeing that UpToDate's main article on TS was authored by Jankovic for UpToDate, since he got blatantly wrong info about the diagnosis of TS published in the NEJM, addressed by a Letter to the Editor from another physician, correcting the info, but never retracted by NEJM (and cited in that article).

Perhaps you're familiar with Roger Freeman in British Columbia? He is one of the true gems among TS researchers. I admire him not only because he's a classic "gentleman and a scholar", but also because he has guts: he wasn't reluctant to express his views about 1. Scientology advancing the idea that stimulants increased tics (some US researchers were hesitant on that, apparently fearing lawsuits, and good research now clearly debunks the idea that stimulants can't be used in the presence of tics); 2. David Comings' biased research on TS; or 3. Oliver Sacks idiosyncratic views on TS, focusing on the bizarre. SandyGeorgia (Talk) 17:42, 30 December 2010 (UTC)

Yes Jankovic wrote this for Uptodate. Not familiar with Freeman. Not spend much time reading in this subject area to tell you the truth. Can only take on so many controversial topics :-) Doc James (talk · contribs · email) 18:48, 30 December 2010 (UTC)
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