Wikipedia talk:Identifying reliable sources (medicine)
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![]() | Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Identifying reliable sources (medicine).
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![]() | To discuss reliability of specific sources, please go to Wikipedia:Reliable sources/Noticeboard or to the talk pages of WikiProject Medicine or WikiProject Pharmacology. |
These are some Frequently Asked Questions about Wikipedia's guidelines on sourcing for medical content, manual of style for medicine-related articles, and how the guidelines and policies apply to biomedical content.
Primary sources aren't completely banned, but they should only be used in rare situations. An individual primary source may be flawed, such as being a clinical trial that uses too few volunteers. There have been cases where primary sources have been outright fraudulent. Furthermore, a single primary source may produce a different result to what multiple other primary sources suggest, even if it is a high-quality clinical trial. Secondary sources serve two purposes: they combine the results of all relevant primary sources and they filter out primary sources that are unreliable. Secondary sources are not infallible, but they have less room for error than a primary source. This follows a principle that guides the whole of Wikipedia. If a company announces a notable new product, Wikipedia would not cite a press release on the company's website (a primary source) but instead would cite a newspaper article that covers it (a secondary source). The difference with medical information is that the popular press are not suitable sources. Whenever possible, you should cite a secondary source such as:
Primary sources might be useful in these common situations:
The popular press includes many media outlets which are acceptable sources for factual information about current events, sometimes with significant caveats. It also includes media outlets which are discouraged in all cases because the quality of their journalism is inadequate. However, even high-quality media outlets have disadvantages in the context of medicine. Firstly, news articles on medicine will frequently be reporting a new medical primary source, such as the results of a new study. This means that they are effectively acting as a primary source, which as explained above makes those articles generally unsuitable for medical information. These articles also tend to omit important information about the study. If a medical primary source is to be cited at all, the academic paper should be cited directly. Secondly, media coverage of medical topics is often sensationalist. They tend to favor new, dramatic or interesting stories over predictable ones, even though studies that reflect the current scientific consensus tend to be predictable results. They tend to overemphasize the certainty of any result, such as reporting a study result as a conclusive "discovery" before it has been peer-reviewed or tested by other scientists. They may also exaggerate its significance; for instance, presenting a new and experimental treatment as "the cure" for a disease or an every-day substance as "the cause" of a disease. The sensationalism affects both which stories they choose to cover and the content of their coverage. High-quality media outlets can be good sources of non-medical information in an article about a medical topic. Another acceptable use is using a popular press article to give a plain English summary of an academic paper (use the Not necessarily. PubMed is merely a search engine and the majority of content it indexes is not WP:MEDRS. Searches on PUBMED may be narrowed to secondary sources (reviews, systematic reviews, meta-analyses, etc.) so it is a useful tool for source hunting. It is a common misconception that because a source appears in PubMed it is published by, or has the approval of, the National Institutes of Health (NIH), National Center for Biotechnology Information (NCBI), or the US government. These organisations support the search engine but lend no particular weight to the content it indexes.
When fringe claims have been widely reported in the press, have a large popular following, and/or have a long history, it may be appropriate to describe them in terms of that reporting, popularity, or history. However, weight should be determined by MEDRS-compliant sources, and the context (or lack thereof) should not make implications about medical statements that are not supported by such sources. Guidance on the additional considerations relevant to fringe subjects can be found at WP:FRINGE, as well as at other places such as WP:WEIGHT and WP:EXCEPTIONAL. In the case of alternative medicine, medical statements are often derived from an underlying belief system, which will include many propositions that are not subject to MEDRS. These propositions are subject to the usual sourcing requirements and the usual requirements for determining fringe status. There are three possible situations:
In the first case, we cannot say that it does not work, but we can say that there is no evidence to determine whether it works. After multiple, high-quality independent studies have been published, the understanding may transition from "no evidence" to "some evidence" of either an effect or no effect. You should follow the lead of review articles and other secondary sources for determining when this threshold has been crossed. Reports may conflict with each other. For example, a clinical trial may produce no evidence of an effect, but the treatment's manufacturer might produce testimonials claiming a positive effect. You should follow the lead of review articles and other secondary sources for determining how to balance these claims. In other words, is it necessary to say in the article's text the source which supports a medical statement (with attribution)? Or can it simply be stated as an unchallenged fact, with the source only mentioned in the citation (without attribution)? A statement without attribution will come across as being a stronger claim than one with attribution. A result or statement from a reliable secondary source should be included without attribution if it is not disputed by any other recent secondary sources. You should do a search to check that the secondary source you are citing is the most up-to-date assessment of the topic. If there have been two recent secondary sources that contradict each other, then you should attribute the disputed findings. On the other hand, if the findings of one or more recent secondary sources are disputed by one or more secondary sources from many years ago, but not by any recent ones, the recent findings can be stated without attribution. You should also take into account the relative weight secondary sources have. For example, Cochrane Collaboration reviews provide stronger evidence than a regular secondary source. In the rare cases where primary sources can be used, they should be attributed.
Full, searchable list of all tutorials - training materials in HTML, PDF and Video formats YouTube channel for the National Library of Medicine: Tutorial videos from the National Center for Biotechnology Information (NCBI), part of the U.S. National Library of Medicine. Includes presentations and tutorials about NCBI biomolecular and biomedical literature databases and tools. NLM Catalog Help - This book contains information on the NLM Catalog, a database which provides access to NLM bibliographic data for journals, books, audiovisuals, computer software, electronic resources, and other materials via the National Center for Biotechnology Information (NCBI) Entrez retrieval system. The NLM Catalog includes links to full text materials and the library's holdings in LocatorPlus, NLM's online public access catalog. NLM Catalog (rev. December 19, 2019). For full comprehensive instructions, go to: Searching for Journals in NLM Catalog If you know the full or abbreviated name for a journal, and you want to see if it is indexed in MEDLINE, see the instructions at searching by journal title, which I will also reproduce here:
Via a search of the NLM Catalog: List of Abridged Index Medicus journals, also known as "Core clinical journals". Stand alone list: List of current Abridged Index Medicus (AIM) journals (118 journals as of 5 May 2020) Search the NLM Catalog using ====Create a list of all journals indexed in MEDLINE}}
Search the NLM Catalog using MEDLINE, PubMed, and PMC (PubMed Central): How are they different? Most scholarly journals are behind paywalls. Some options to access these articles include visiting a local university library, visiting The Wikipedia Library, and WikiProject Resource Requests. Note that paywalled articles are frequently pirated and made available on the open web. When linking to a journal article, care must be taken not to link to such a pirate copy, as such a link would be a copyright violating link in contravention of Wikipedia's policy. In general if you find such a copy and it is not accompanied by text explicitly stating that it is made available with the permission of the copyright holder, assume that it is potentially infringing, and do not link to it. This holds for all edits in Wikipedia, not just in article space. Search for the title of the article on Google Scholar. On the results page, click on "All n versions" (where n = the number of available versions of that article) at the bottom of a listing. The resulting page might contain PDF or HTML versions of the article. Consult Unpaywall.org for journal articles available without a subscription. Install the UnPaywall extension for Chrome or Firefox to immediately identify articles with a free version. After you install the extension, look to the right side of the page (when you are on the website for an article) for either a grey locked symbol (no free version) or a green unlocked symbol (click on that symbol to access the full text version of the article). An article by librarian John Mark Ockerbloom, titled, "Why Pay for What’s Free? Finding Open Access and Public Domain Articles" offers helpful suggestions.[9] Almost all medical articles are indexed by the PubMed search engine and have a Digital object identifier (DOI) assigned to them. All articles included in PubMed are assigned an eight-digit PubMed identifier (PMID). These identifiers can be used to refer to articles, which is preferred to URLs as it makes a reliable link which is resilient to changes beyond our control – i.e. the publisher being acquired by another publisher and it's "normal" web URLs changing as a consequence. Once you have the PMID, there are a number of tools such as this one which you can use to generate a full citation automatically. In article references, the "doi" and "pmid" parameters are preferred to the "url" parameter for such reasons. On Talk pages, when referring to journal articles, is it good practice to make any link using these types of identifier also:
References
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Simply bad[edit]
Bendegúz Ács asked a little while ago for more information about the sentence that "A source can also simply be bad, where biases in criteria make it less than ideal." Here's a short explanation, in case anyone's interested:
We have criteria that help editors identify sources that are generally better (e.g., peer-reviewed sources, secondary sources, recent sources). However, no single criterion definitely makes a source be good (WP:NOTGOODSOURCE). In addition to all the criteria, you have to use common sense and have a good understanding of the subject. Sometimes a source seems superficially good, but when you read it, you discover that it's just bad. In such cases, you should use your WP:Editorial discretion to avoid relying on a bad source.
Here are some simple examples of how real-world bias could lead an editor to decide that a source is just bad:
- The subject is a disease that's very common in poor countries, but your source tells you about the disease in a wealthy country.
- You need to write something about pregnancy, and the clinical trial involves only males. (That's how the world ended up with the Thalidomide scandal, by the way.)
- The subject is pediatrics, and the data is all from elderly people.
The main reason that we don't explain is because the potential sources of bias are enormous. Editors who are uncertain about whether their source can support the claims they are making should be discussing the specifics on the article's talk page or at Wikipedia talk:WikiProject Medicine. WhatamIdoing (talk) 02:41, 23 February 2024 (UTC)
- Thank you for the clarification and the examples, they definitely make this particular issue much easier for me to understand. However, I would still like to suggest some improvements to the sentence. I think here there are two separate potential issues that may make a source bad, and both are worth mentioning separately.
- One is what your examples are about, and I would call this something along the lines of "subjects/subgroup analysis with low relevancy" or "irrelevant/overly restrictive subjects/subgroup analysis", since the main issue I can identify in your examples is that the source fails to take into account most of the people affected by the topic. I think this particular issue would be worth mentioning in a separate sentence because it does seem important.
- The other one is about problems that are so particular about a study that it is not possible to easily fit into any well-defined criterion. I would not limit these problems to "biases", however, since not every problem possible to make a study bad is considered a bias. So maybe mentioning it in this way would be an improvement: "A source can also simply be bad, due to a bias, or other problem, too particular to be covered by a common editorial criterion. In cases like this, WP:Editorial discretion may be used."
- What do you think? Bendegúz Ács (talk) 23:30, 23 February 2024 (UTC)
- It might be better to re-write the whole sub-section from scratch. I think it is meant to cover things like pesticide manufacturers claiming that their products are utterly harmless. WhatamIdoing (talk) 22:55, 24 February 2024 (UTC)
- I would support a rewrite, but I am not competent enough to come up with a suggestion for a complete new text for the sub-section. I would be happy to review it, though. Bendegúz Ács (talk) 15:01, 25 February 2024 (UTC)
- I've considered just blanking it. Do we truly need WP:MEDBIAS, or is it WP:CREEPY and redundant with other pages? It's only been linked in discussions about a handful of articles.
- @Bon courage, what do you think? Could we live without it? WhatamIdoing (talk) 07:11, 7 March 2024 (UTC)
- Hah! Have never paid any attention to this. It arrived[1] in 2016. WP:DONTSHOUTBIAS eh!? Bon courage (talk) 07:26, 7 March 2024 (UTC)
- Oh, that would have been around the time that we tried (and failed) to put a medicine-specific version of WP:DUE in this guideline. WhatamIdoing (talk) 22:58, 7 March 2024 (UTC)
- I don't see anything there that needs to be (medicine) specific and the "Personal conflicts of interest" isn't about "reliable sources" either. I'd vote for blanking both. The concerns there about biased sources or biased editors belong in general guidelines. -- Colin°Talk 08:55, 7 March 2024 (UTC)
- Since nobody's thought this would be useful during the last ~two months, I've removed it. Removal doesn't mean that it's bad advice. It just seems unnecessary in this particular guideline, and redundant with others (e.g., the Wikipedia:Neutral point of view policy). WhatamIdoing (talk) 03:41, 6 June 2024 (UTC)
- Hah! Have never paid any attention to this. It arrived[1] in 2016. WP:DONTSHOUTBIAS eh!? Bon courage (talk) 07:26, 7 March 2024 (UTC)
- I would support a rewrite, but I am not competent enough to come up with a suggestion for a complete new text for the sub-section. I would be happy to review it, though. Bendegúz Ács (talk) 15:01, 25 February 2024 (UTC)
- It might be better to re-write the whole sub-section from scratch. I think it is meant to cover things like pesticide manufacturers claiming that their products are utterly harmless. WhatamIdoing (talk) 22:55, 24 February 2024 (UTC)
Meta-analyses need careful scrutiny, peer-reviewed or not.[edit]
This
- Glenza, Jessica (28 April 2024). "Junk science is cited in abortion ban cases. Researchers are fighting the 'fatally flawed' work". The Guardian.
Of the 22 studies cited by the meta-analysis, 11 were by the lone author of the paper itself. The meta-analysis "failed to meet any published methodological criteria for systematic reviews" and failed to follow recommendations to avoid statistical dependencies, according to a criticism published in the British Medical Journal (BMJ).
is a cautionary tale. 𝕁𝕄𝔽 (talk) 19:15, 28 April 2024 (UTC)
- Thanks, that's interesting.
- I have been wondering recently why peer review doesn't involve putting each article through an evidence-based checklist (e.g., the Newcastle–Ottawa scale for non-randomized studies; the most relevant checklist for the subject matter could be agreed upon by the reviewers and the editor) and the results published alongside the article. It might make it easier to discover junk science before publication. WhatamIdoing (talk) 21:47, 28 April 2024 (UTC)
- A number of journals now require (or at least strongly encourage) articles to follow appropriate guidelines including completed checklists (usually as part of Supplemental Material). EQUATOR has guidelines/checklists that cover many types of articles. For example, here is part of my boilerplate for rejecting bad MR papers:
- "As you prepare your manuscript for submission to another specialty journal, you may be able to improve it by following one or more of the EQUATOR Guidelines's checklists (https://www.equator-network.org). Mendelian randomization studies must adhere to the best practice as described in the following guideline https://wellcomeopenresearch.org/articles/4-186/v3 and be accompanied to MR-STROBE checklist (https://www.equator-network.org/reporting-guidelines/strobe-mr-statement/)." Jaredroach (talk) 21:27, 12 July 2024 (UTC)
Thalassophobia[edit]
I have an impression that the huge section Diagnosis and Spmothoms is written as an advertisement by snake oil peddlers, such as CBT desensitization, etc. One can find plenty of such phobia-curing webpages in the internets. In its entirety it can be cut and pasted into each and every phobia article only replacing the name of phobia. I suspect this is actually done by various headshrinkers. Can someone write a common page, like, Symptoms and treatment of specific phobias, with proper MEDRS oversight, and then simply refer to it everywhere 99.73.36.110 (talk) 23:39, 7 June 2024 (UTC)
- I suspect that such a page would look a lot like Thalassophobia#Treatment. It already looks similar to Specific phobia#Treatment. WhatamIdoing (talk) 00:41, 8 June 2024 (UTC)
Reconsidering a blanket-ban of primary sources[edit]
The express reason given is essentially a re-hash of the "reproducibility crisis," but I have to say, should we even be trusting these "fact-checking"-like organizations for whom we essentially defer the power of keeping out bad knowledge?
Did you know, for example, the American Psychological Association, known for such works as the DSM-V and numerous textbooks likely to pass as verified work through here without a second thought, is actually a trade organization with the express intent of lobbying on behalf of practicing psychologists, in exchange extracting registration dues, and licensing fees?
Or that the American Pain Society, this time a non-profit society that nominally advocated on behalf of patients by publishing clinical practice guidelines, actually instead acted on behalf of pharmaceutical companies to propagate a treatment mandate to prescribe more products, in essence acting as a marketing channel where physicians were not primed to regard it critically?
I think it might be beneficial to re-investigate the ultimate authority of the organizations/publication guidelines we choose to let pass uncritically with more ability afforded to well-informed individuals to make their case that enough primary research exists to effectively include a consensus on matters of pathology and lines of inquiry related to potential treatment paradigms. We do ourselves a disservice when we shut out promising potential, and similarly to our readers too when academic literature acts more like a thicket than it does pathway. Additivefreesb (talk) 17:52, 12 July 2024 (UTC)
- Which blanket-ban on primary sources are you referring to? Firefangledfeathers (talk / contribs) 17:56, 12 July 2024 (UTC)
- Wikipedia:Identifying reliable sources (medicine)#Avoid primary sources isn't a blanket ban. Wikipedia:Identifying reliable sources (medicine)#Avoid over-emphasizing single studies, particularly in vitro or animal studies is just common sense.
- We have had multiple problems with primary sources, including:
- editors cherry picking the one source that says something completely different from all the others (e.g., cigarettes don't cause lung cancer)
- editors using obviously bad primary sources (e.g., the patent claiming that colloidal silver cures HIV, but it didn't test whether people had HIV in the first place)
- editors believing the media hype (can result in bad content [because newspapers don't always get technical details right] and unbalanced articles [because it's all about what's in today's news, and next week it'll be some other vegetable that everyone's supposed to eat to prevent cancer])
- authors spamming their own publications into as many articles as possible (this happens much less often with review articles)
- plus, of course, all the problems with the reproducibility crisis and the general difficulty of figuring out which primary source to 'believe in', if the data is conflicting.
- Primary sources are more likely to be tolerated in veterinary content or for very rare conditions. WhatamIdoing (talk) 18:38, 12 July 2024 (UTC)
I think something needs to be said of primary sources often also overwhelming both the average reader or editor, owing to both their sheer number, and the fact that even many well-intentioned editors are not deeply knowledgeable about all issues they write about.
Further, there is simply no blanket ban on primary sources. For instance, there is actually not even a recommendation to refrain from using secondary summaries from within primary sources (i.e. background sections or well chosen parts of discussion sections). One of the problems to allay is keeping Wikipedia from reading: xx et al. found 80% mortality, while xy found 79%, and zy found 81% - with WP:OR prohibiting us from summarizing these (which would be a problem due to evidence grading). This becomes less of a problem upon listing authoritative secondary sources, as they already do summation for us, and readers are likely to want to know what, for instance, both the CDC and WHO think about a specific issue.
This guideline already discusses pitfalls of relying on industry and industry-funded sources, and I would not object to a well-thought out extension on issues of industry influence on practice guidelines or biases in professional associations. WP:MEDORG (part of this guideline, which I worked extensively on) points to industry guidelines or guidelines from patient advocacy groups being considered below the threshold of MEDRS.
Perhaps, in the spirit of giving background to a well-though-out question, Colin has input on considerations when MEDRS was originally drafted. CFCF (talk) 17:54, 13 July 2024 (UTC)
- Wikipedia essays about reliable sources
- Project-Class medicine articles
- NA-importance medicine articles
- All WikiProject Medicine pages
- Project-Class pharmacology articles
- NA-importance pharmacology articles
- WikiProject Pharmacology articles
- Project-Class Alternative medicine articles
- Wikipedia pages referenced by the press