Wikipedia talk:WikiProject Medicine/Archive 114

Hi, I am having a dispute with User:Sbelknap about reading levels in articles about drugs. See the version of Clonidine here, compared with this one. There is some discussion at my talk page here.

There has been a discussion about reading level at WT:MEDMOS (the only thing there now). Am also placing a note of this at WT:PHARM since this was pharmacology content.

What are folks' thoughts? Jytdog (talk) 13:25, 9 July 2018 (UTC)

Yes simplification is important. Doc James (talk · contribs · email) 14:10, 9 July 2018 (UTC)

"Everything Should Be Made as Simple as Possible, But Not Simpler" - Albert Einstein

I think their version of the lead would be great in a section on mechanism. The lead is for random people who just want to know a simple summary of the drug and google it. The rest of the article can dive into more depth. Natureium (talk) 14:16, 9 July 2018 (UTC)

Many ledes for pharmacology articles are wrong, trivial or both. I strongly agree with Doc James that simplicity is important. However, the root of simplicity for drugs should be in the conceptual articles, not the drug articles. The drug articles should use technical terms that are defined in simple terms in the conceptual articles. For example, This is the first sentence I proposed for the lede for the clonidine article: Clonidine (trade names Catapres, Kapvay, Nexiclon, Clophelin, and others) is a centrally-acting sympatholytic α₂ adrenergic agonist^[1] My intent was to provide hyperlinks to articles that would explain "centrally-acting" "sympatholytic", "alpha-2 adrenergic receptor", and "agonist." Alternatively, this could be expressed using multiple sentences. Either way, these concepts are the essence of what clonidine is in a pharmacology context. Thus, these should be in the lede. Here is the lede for adrenergic drug from Encyclopedia Britannica: "Adrenergic drug, any of various drugs that mimic or interfere with the functioning of the sympathetic nervous system by affecting the release or action of norepinephrine and epinephrine. These hormones, which are also known as noradrenaline and adrenaline, are secreted by the adrenal gland, hence their association with the term adrenergic. The primary actions of norepinephrine and epinephrine are to mediate the “fight-or-flight response.” Thus, they constrict blood vessels (vasoconstriction), which increases blood pressure, and accelerate the rate and force of contractions of the heart. Adrenergic drugs that produce or inhibit these effects are known as sympathomimetic agents and sympatholytic agents, respectively."— Preceding unsigned comment added by Sbelknap (talk • contribs)

I disagree strongly with the assertion that "the root of simplicity for drugs should be in the conceptual articles, not the drug articles". I think it is the other way round.
An average reader coming across an article about a drug is less likely to understand pharmacological and physiological concepts than those finding their way to articles on drug classes. A patient is not necessarily aware that his drug is of a certain type, and that simvastatin is a statin isn't even immediately obvious, if you do not know that statins exist. That said, we have ample room for detailed description in the body of articles, and Jytdog's lede summary is better for this reason.

Also, arguing that Encyclopedia Brittanica does things one way is not an especially strong argument around here. Carl Fredrik ^talk 23:15, 9 July 2018 (UTC)

Like Doc James, I am of the mind that articles about drugs should be as simple as possible (without eroding the validity of the content). Generally, we should strive to simplify or define jargon (or provide both) when applicable (e.g. using the term "dry mouth" in place of "xerostomia"). The purpose of these efforts is to improve the accessibility of medical content for a lay audience. I believe that this should be true even for more "complex" sections, such as the "Mechanism of Action" subsection under "Pharmacology."

In reference to the clonidine article specifically, I think it would be a good idea to break up the MoA § by indication/effect. I may put some work into that to display my meaning. I concur with Carl Fredrik that drug articles should be the focus of simplification, since I imagine that these receive greater lay-person traffic than technical, "conceptual" topics in pharmacology. ―Biochemistry🙴❤ 03:07, 10 July 2018 (UTC)

This "centrally-acting sympatholytic α2 adrenergic agonist" should never occur within the first sentence of any article. You only learn this stuff near the end of medical school or into residency.

One should not need a professional degree in the subject matter in question to find a Wikipedia article useful. Doc James (talk · contribs · email) 10:18, 10 July 2018 (UTC)

I am more familiar with science education in the US and to a lesser extent, in the UK and the EU, and so can't speak to the situation in Canada. In the US concepts of "adrenergic" "cholinergic" and "dopaminergic" are introduced to elementary school students age 11 - 13, are covered again in Freshman Biology in High school (age 14), are covered in more detail in AP Biology during the Junior or Senior year (age 16 - 18), in college during Introductory Biology (age 18 - 19), and for biology majors during Neurobiology (age 19 - 21), then in medical school physiology, again in medical school pharmacology, and during clinical rotations in pediatrics, medicine, Emergency medicine. The concept agonist and antagonist are introduced in Freshman High School Biology. The concept of alpha 1 and alpha 2 adrenergic receptors, beta 1 and beta 2 adrenergic receptors, dopamine receptors, and acetylcholine receptors are first introduced in AP Biology in High School. The concept of centrally-acting vs. peripherally-acting are covered in AP Biology. I served as a Science Olympiad coach for elementary school students aged 11 - 13 for several years. I do have some idea what an intelligent laymen knows and what they can learn. Our team finished second in the nation. I have also taught pharmacology and clinical pharmacology to medical students for 34 years. For 10 years, I was on the National Board of Medical Examiners Pharmacology Committee that created the exams for the USMLE Step 1 Exams. Perhaps Doc James misremembers his own educational experience. Regardless, his comments about education on neuroscience do not accurately desccribe the experience of American students.Sbelknap (talk) 19:00, 10 July 2018 (UTC)

That's surprising. It hasn't been that many years since I was in school, but I didn't learn about the concepts of "adrenergic", "cholinergic", and "dopaminergic" until I was an undergrad. I probably learned about antagonists/agonists in high school, but I took a lot more science classes in high school than were required. I think the rest of the concepts you talk about I learned during undergrad. Natureium (talk) 19:04, 10 July 2018 (UTC)

Perhaps not so surprising. There is a tendency to have amnesia for initial experience with material that is also covered later. Both you and Doc James appear to be victims of this phenomenon. It might be best to move to some more objective source of evidence than our own idiosyncratic experience. Here is the Khan Academy lesson for High School AP Biology on neurotransmitters: https://www.khanacademy.org/science/biology/ap-biology/ap-human-biology/modal/a/neurotransmitters-their-receptors

I am beginning to understand the reasons why the wikipedia pharmacology articles are so terribly bad. The community of editors interested in these pages is completely wrong-headed as to what an intelligent laymen knows (or knew in high school). You all simply do not know your audience.Sbelknap (talk) 19:43, 10 July 2018 (UTC)

Or... you could be wrong. Jytdog (talk) 21:47, 10 July 2018 (UTC)

"In the US concepts of "adrenergic" "cholinergic" and "dopaminergic" are introduced to elementary school students age 11 - 13". I got no dog in this fight, but I can tell you that this isn't part of the Canadian curriculum at any point. I'm a 33 year old man with a Master's degree in physics who took all sciences possible in K-12, and 2 biology classes for my undergrad, and I couldn't tell you what those things are without looking them up. This is the first I hear of them. Headbomb {t · c · p · b} 22:18, 10 July 2018 (UTC)

Which is another matter entirely. Your assertion that you don't remember these things does not mean that you never learned these things. Sbelknap

I can't remember what I never learned in the first place. Those are specialist terms. I know what dopamine and adrenaline is, but this not K-12 material, and the word "adrenergic" does not evoke adrenaline to the non-expert. And absolutely no one would have any clue what acetylcholine. I recognize 'acetyl' because I have some background in chemistry, but hell if I know what choline is, or that "cholinergic" would refer to it. Headbomb {t · c · p · b} 01:49, 11 July 2018 (UTC)

Well, I tried to find evidence to back up your claim, and I've failed. Here are two searchable links to 7th-grade biology textbooks, and I have been unable to find anything in them that suggests that these concepts are even named at this level. Not even simpler concepts, like "serotonin" and "dopamine", are turning up for me. The focus seems to be on anatomy ("optic nerve" and "dura") rather than function. Perhaps someone else wants to have a go at seeing whether they can find these concepts in a seventh-grade biology textbook? I don't doubt that a dedicated child with special extra coaching could understand this; I'm just unable to find any evidence that it's presented to in the regular biology curriculum at this age. Only 5% of American kids are going to be taking AP Biology. Unless we're writing Wikipedia articles for the educationally privileged 5%, then "let's put it in the first sentence, because they cover this in AP biology" doesn't seem like an appropriate plan. WhatamIdoing (talk) 01:15, 11 July 2018 (UTC)

For whatever it's worth, I got through a major in biochemistry and taught various biology courses to first- and second-year science and medicine students in Australia for several years before I ever learned "adrenergic" or "cholinergic". Neither term appears in the >1300 pages of our general biology textbook for first-years. Adrian J. Hunter^{(talk•contribs)} 03:06, 12 July 2018 (UTC)

Lets take the lede for clonidine as an example:

"Clonidine is a medication that is used to treat high blood pressure, attention deficit hyperactivity disorder, anxiety disorders, tic disorders, withdrawal (from either alcohol, opioids, or smoking), migraine, menopausal flushing, diarrhea, and certain pain conditions."

A definition ought to first say what a thing is, then (maybe) say what it is used for; e.g., Hammer n. A hand tool consisting of a handle with a head of metal or other heavy rigid material that is attached at a right angle, used for striking or pounding.

The key facts about clonidine are that it is 1. sympatholytic 2. alpha 2 adrenergic agonist 3 centrally-acting

It is marketed under many brand names.

False. It is hardly "marketed" at all. Instead, it is sold as a generic drug. Even the patch has a generic version.

The adverse effects include sedation, dry mouth, and low blood pressure.[1]

The Adverse drug effects paragraph in the lead ought to have a sentence for "most frequent" and a clause for "most serious." The essential information is that most adverse effects are mild and tend to diminish with continued therapy. The most frequent (which appear to be dose-related) are dry mouth, occurring in about 40 of 100 patients; drowsiness, about 33 in 100; dizziness, about 16 in 100; constipation and sedation, each about 10 in 100. The most serious adverse effects are low blood pressure, depression, and slow heart rate.

Clonidine treats high blood pressure by stimulating α2 receptors in the brain stem, which decreases peripheral vascular resistance, lowering blood pressure.

No. The blood pressure lowering effects of clonidine are caused, at least in part, by activating alpha 2 receptors in the lower brainstem.

Clonidine also may cause bradycardia, probably due to a temporary increase in vascular resistance caused by clonidine stimulating α2 receptors in smooth muscles in blood vessels.

No. Clonidine increases parasympathetic outflow, which may slow the heart rate.

This blood pressure raising effect is seen when the drug is given intravenously, and is not usual when clonidine is given by mouth or by the transdermal route.[5]:201-203

To what antecedent is "This" referring?

This sort of awfulness occurs throughout the pharmacology article ledes. When one looks through the revision history, one finds attempts to correct the errors, but these are shouted down by wikilawyers. Pharmacology is a science. If an editor does not respect that, then that editor is more of a vandal than an editor. Sbelknap (talk) 22:58, 10 July 2018 (UTC)

I don't think I agree with this analysis. From my POV, the "key fact" sounds a lot more like "your grandfather is probably taking the stuff in that bottle to treat high blood pressure" than "biochemists classify it in these ways".

On a tangent, a few years back, we collected comments from readers about Wikipedia articles. The comments on rare-disease articles have stuck with me. They didn't ask for more information about how to classify it or what the etiology was, or anything like that. They asked whether their friend's baby was going to die. I learned from this that the stuff that interests our intellectual, ivory-tower contributor base is very different from what our readers are actually looking for. IMO, if your target is the rare person who is going to look up all of those classification terms, then you can count on that person to read past the first sentence. You can, in fact, count on them reading the entire article, which is something that almost nobody actually does. But the one who just needs to learn "Scary Disease doesn't kill kids" or "Those are Grandpa's high blood pressure pills"? They don't need that. WhatamIdoing (talk) 01:39, 11 July 2018 (UTC)

The wikipedia editors for rare diseases don't seem to agree with your perspective. Here is the beginning of the lede for Maple syrup urine disease (MSUD), also called branched-chain ketoaciduria, is an autosomal recessive[1] metabolic disorder affecting branched-chain amino acids. It is one type of organic acidemia.[2] The condition gets its name from the distinctive sweet odor of affected infants' urine, particularly prior to diagnosis, and during times of acute illness.[3] — Preceding unsigned comment added by Sbelknap (talk • contribs) 03:17, 11 July 2018 (UTC)

That kind of introductory sentence is exactly why we got those complaints about the articles' contents.  :-/ WhatamIdoing (talk) 23:30, 11 July 2018 (UTC)

Here is a good example from the first paragraph of a technical wikipedia article:

Esterel is a synchronous programming language for the development of complex reactive systems. The imperative programming style of Esterel allows the simple expression of parallelism and preemption. As a consequence, it is well suited for control-dominated model designs.

Notice that the terms "synchronous programming language", "complex reactive systems", "imperative programming style", "parallelism", "preemption", and "control-dominated model designs" are used in this first paragraph of the lede. If one doesn't understand these terms, then most of them have hyperlinks to decent articles that explain them. That is the model that the pharmacology articles ought to use.

Each technical discipline has its own core vocabulary. There are about 400 core technical words in pharmacology. About 100 or so of these words cover 90% of the need for technical vocabulary. This attempt to eschew technical words in a technical article is sheer folly. It is not what technical articles for other disciplines do. Here is another example:

Staggered tuning is a technique used in the design of multi-stage tuned amplifiers whereby each stage is tuned to a slightly different frequency. In comparison to synchronous tuning (where each stage is tuned identically) it produces a wider bandwidth at the expense of reduced gain. It also produces a sharper transition from the passband to the stopband. Both staggered tuning and synchronous tuning circuits are easier to tune and manufacture than many other filter types.

The function of stagger-tuned circuits can be expressed as a rational function and hence they can be designed to any of the major filter responses such as Butterworth and Chebyshev. The poles of the circuit are easy to manipulate to achieve the desired response because of the amplifier buffering between stages.

Applications include television IF amplifiers (mostly 20th century receivers) and wireless LAN. Sbelknap (talk) 23:52, 10 July 2018 (UTC)

Basically, say it twice in the lead - first simply, then with the technical terms. What about the unintelligent layman, which using your standards would seem to include most of us? Johnbod (talk) 01:24, 11 July 2018 (UTC)

On the Esterel example: I happen to have the advantage of knowing what those "vocabulary words" are, but that text didn't really tell me anything about that programming language. So if you know as little about Esterel as I did, here's the answer: it's an old programming language that would be useful for programming things like stoplights, banks of elevators, vending machines, and (in the realm of biology) tools to measure reflexes. It looks like the main commercial use might be audio processing equipment. That class of programming languages is better at handling simultaneous input (e.g., two vehicles arriving at an intersection at exactly the same time) than normal async programming languages. If I were working on that article, I'd probably start with a sentence such as "Esterel is an uncommon programming language that is often used to control machines and computers that react to real-time events. It may be used to process audio or to control hardware, such as elevators and traffic lights". I'd bet that the typical person will get a lot more out of my description than out of the list of classifications. WhatamIdoing (talk) 01:55, 11 July 2018 (UTC)

A technical article in wikipedia ought to use the core technical vocabulary of the relevant discipline. Otherwise, the article is shorn from its intellectual base. Instead of redefining the core technical words across hundreds of articles, use hyperlinks. That is their purpose. There is actual research on hyperlinks: they help the average reader more than the highly-motivated reader.^[2]

I read the Esterel lede differently. The first paragraph of the lede for the Esterel article accurately and precisely specifies what the language is. The lede is accessible to the non-expert, providing the hyperlinks so as to understand the descriptors in the lede.

Esterel 5.0 is not an "old" language. It is in active use in industry and in academia. In fact, I use Esterel in my research. The Esterel family of languages includes Lustre, which was used to build SCADE, the system that runs the Airbus 380. I expect that your characterization of Esterel as a stoplight language would make Gerard Berry laugh. Sbelknap (talk) 02:59, 11 July 2018 (UTC)

Berry's first publication about Esterel was in 1983. That's the same year that the Apple Lisa (selling for "just" the equivalent of $32309), MS-DOS version 2, Microsoft Word version 1, and Lotus 1-2-3 v1 were released. 3.5" floppies were brand-new, and available in single-sided only, and most consumers were still swapping 5.25" ones. Almost nobody had hard drives at home, and when they did, they often held barely 5 or 10 MB. Consumers were coveting Intel's 286 chip, and larger businesses were looking at fancy "minicomputers" that were "only" as big as a washing machine, rather than the size of a truck, not counting the tape drive or expensive, washing-machine-sized hard drives you needed for your data. The fastest computer in the world was the Cray, and despite being big enough to double as furniture, it had less computing power and less memory than the iPhones being sold today. In 1983, "the internet" had 1,000 hosts, "the backbone" was critical infrastructure (DNS was brand-new), and it would have zero websites for another two decades. Borland's C++ and MS Windows were still dreams, and PostScript was still in John Warnock's garage. So, yeah: by most people's standards, 1983 really is "old" for computing, even if some of us are old enough to personally remember it.

Oh, and if Berry's amused that Esterel can be used for traffic control, then he's been amused at least since he published that idea himself in 1999 (e.g., page 10, section 1.2). WhatamIdoing (talk) 23:28, 11 July 2018 (UTC)

If this approach you all are using to writing pharmacology articles is so great, then why are the articles so terrible? Have you all considered that using folksy language instead of technical terms renders these articles uneditable? Isn't this the real reason why a 14 year old article with hundreds of edits is still filled with errors? For example, here is one edit:

(Changed Sympathoolytic to the correct Sympathomimetic in line 1. Clonidine is an alpha 2 agonist, therefore a sympathomimetic. (medical student)) (undo)

Let us imagine that this well-meaning medical student saw this first sentence in the lede instead of the pile of rubble that was present at the time: clonidine is a centrally-acting, sympatholytic alpha-2 adrenergic agonist. This student would then stop and think and realize that his own understanding was close to being correct, but not quite. He would not have then introduced yet another error into the article. You all are thinking about some lowest common denominator reader that will read the article. But editors are also readers, and they will unintentionally vandalize complex descriptions written in folksy language. They are more likely to respect technical language, reviewing it for accuracy, and perhaps improving it. I suggest that the wikipedia pharmacology articles are uneditable in their current form. A new approach is needed. Lets use the approach that other technical articles use. Sbelknap (talk) 03:43, 11 July 2018 (UTC)

See WP:OTHERCRAP and WP:NOTFINISHED. Headbomb {t · c · p · b} 03:33, 11 July 2018 (UTC)

On the contrary, Sbelknap, I believe that the use of jargon is what easily contributes to mistakes—both in interpretation of sources, and in a reader's understanding. Wikipedia is meant for the lay public, so let us write it in such a way that it is accessible to them. However, let us do so in a way that is stimulating and useful to those with more advanced knowledge. I am not convinced that it is somehow impossible to write both clearly and informatively. I do not pretend myself to be an expert in such writing, but it is something I strive for. What say you re: the ADHD sub§ under the MoA§? ―Biochemistry🙴❤ 03:56, 11 July 2018 (UTC)

There is some poor-quality evidence that clonidine may have a modest effect in ADHD in adolescents. I notice that the sub for this article does not cite Hirota's meta-analysis ^[3], which perhaps it should. AFAIK, there is no evidence that clonidine acts via the central alpha-2 adrenergic mechanism in ADHD (and no cite is provided in the sub you point to), nor is there evidence that alpha-2 adrenergic receptors are of some central importance in ADHD. There were some studies in an animal model of ADHD, but my understanding is that this model is not considered relevant to the human ADHD phenomenon. Perhaps if there were studies cited on this, we could see. Sbelknap (talk) 11:04, 11 July 2018 (UTC)

Steve, above you wrote that you work with kids in science olympiads who are in grade school and AP biology classes. When you write "intelligent layperson" you appear to be talking about people way, way over on the flat part of the bell curve. Super-smart people who are actually studying this stuff. That is horribly skewed and absolutely not who we write for.

No one here will argue that our articles do not need improvement. They do.

But as long as you keep generating content aimed at people who are a) super smart and b) educated in biology/pharmacology (these are not the same sets of people, necessarily) you are going to keep wasting your own time and the time of experienced editors. That is not building the encyclopedia but rather squandering the most valuable resource we all have -- time. Jytdog (talk) 20:05, 11 July 2018 (UTC)

@Sbelknap: I think you missed the point of my writing entirely, and are trying to argue for the incorporation of primary research here. The cited article is a review that describes the connection between alpha-2A ARs in ADHD. My point was to get your feedback on whether you thought the section, in terms of its readability (which is the topic we are discussing at present, yes?) was acceptably comprehensive while also accessible to a lay person. My intention was to demonstrate to you that it is indeed possible to accomplish both; we don't need to overwhelm our readers with jargon. Could I have summed the section up with a one-liner like, "Clonidine's alpha-2A AR agnoism induces a sympatholytic effect on downstream prefrontal cortex neurons."? Probably, but that would be practically useless to a layperson.―Biochemistry🙴❤ 03:01, 12 July 2018 (UTC)

Jytdog, (and other interested editors) I challenge you to provide one example of a wikipedia article on a medical drug that meets the wikipedia criteria for a wikipedia featured article. Those criteria are here: [] One article.

The content I have attempted to create is for intelligent laypersons, which is a large fraction of any human population, anywhere. I am suggesting that as long as editors of wikipedia pharmacology articles are prohibited from using the core technical vocabulary of the discipline, the quality of those articles will remain poor. In my opinion, the *cause* of the poor quality is, in part, the policies and culture that are unique to medical editing on wikipedia. Many of these pharmacology articles have existed for more than a decade, yet remain rife with error. If you review the revision history for the pharmacology articles you will notice that many attempts at correction of errors are thwarted. The pharmacology articles lag behind other technical articles in wikipedia, which have steadily improved. I am suggesting that the prohibition on the use of the core technical vocabulary of pharmacology in these articles is the *cause* of the poor quality of the pharmacology articles relative to those for other STEM disciplines. Editors in other areas of wikipedia apparently accept/encourage the use of core technical vocabularies.

Doc James stated, "One should not need a professional degree in the subject matter in question to find a Wikipedia article useful." I provided evidence that contradicted this idea that a professional degree was required to understand the core vocabulary of pharmacology. Here is that video Khan Academy lesson for High School AP Biology on neurotransmitters: https://www.khanacademy.org/science/biology/ap-biology/ap-human-biology/modal/a/neurotransmitters-their-receptors

Perhaps this is progress, as you now concede that some high school students achieve mastery of some of the technical vocabulary of pharmacology. Many less accomplished high school students also are familiar with the meaning of "adrenergic", "cholinergic", "dopaminergic", "serotonergic", "agonist", "antagonist", etc. I note that my use of the word "agonist" has been removed from wikipedia articles that contain the word "antagonist" a few sentences away.

The wikipedia guidelines and culture do not respect pharmacology as a science. There are good reasons for using technical words, as they facilitate clear communication. Technical words are widely used in wikipedia, with hyperlinks to articles that explain them, often very well. Pharmacology is an outlier in wikipedia on this issue.

Jytdog, you are certainly wise to not waste the time of experienced editors. However, under the current wikipedia culture, the efforts of editors of pharmacology articles *is* being wasted. The product of these efforts is quite poor. The pharmacology articles are condescending to their audience. I frankly don't see utility of most of these articles for any audience. The quality problems could quickly be addressed by using the same approach to technical vocabulary that is used in other STEM articles.

I propose that we compile a core vocabulary of pharmacology terms (agonist, half-life, alpha adrenergic, etc), with broad input from interested wikipedia editors. I envision eventually using about 100 terms. We would first change wikipedia pharm policies to permit use of these core technical terms in wikipedia drug articles. We would then want to expend some effort to improve the pharmacology vocabulary articles. Many articles for these core terms exist, though some improvements would be advisable if we are going to use them to build the articles for specific drugs. Is there a mechanism on wikipedia for doing modified Delphi trials to build such a list? Or is there some other suitable mechanism we could use? Perhaps just a wikipedia page for core terms of pharmacology? What do you suggest? Sbelknap (talk) 21:44, 11 July 2018 (UTC)

You complain fiercely about the poor quality of articles but you make edits like this, where you persist in writing crappy citations that other people need to work over to make them usable in an online encyclopedia, even as you put tons of weight on clickable wikilinks. Doc James and I have both showed you the tool that allows you to create an elegant citation with links in seconds. You blow that off.

You also quote something without saying who or what you are quoting (I learned not to do that in junior high school).

You do not understand our mission and are so busy being contrarian that you are screwing up very basic editing details and wasting everyone's time.

This place survives in the tension between individual boldness and minding the community (what you dismiss as "wikilawyering" is actually the "constitution" that holds this place together). You are all the way over on the "bold" side. It is not a sustainable approach to editing. Jytdog (talk) 23:30, 11 July 2018 (UTC)

Strongly against any proposal that would create a mandated list of vocabulary terms to use whilst writing WP:PHARM articles. I'll be frank Sbelknap: even if such a list existed, I would not use it. It would be an overwhelming task to create, let alone memorize, such a list, and any attempt to apply it would present an insurmountable, bureaucratic burden—especially for new editors.―Biochemistry🙴❤ 02:49, 12 July 2018 (UTC)

I accept Jytdog's criticism that I did not use the correct tool to edit in this case. I apologize for this, but did not know (still do not understand) that I was doing anything incorrectly. I will stand by the *content* of what I wrote, which was a big improvement over what was there. The net effect is that this article is worse than it could have been. Perhaps rather than fierce attacks on process errors, gentle reminders and requests to repair an editing error could be used? Or is that not part of the etiquette of the wikipedia community?

I note that Jytdog does not address my above proposal, which was exactly the attempt to engage the community that Jytdog seems to be asking for. Perhaps Jytdog could share his opinion on my proposal? I openly solicited Jytdog's opinion in my comments directly above. Jytdog invited me to this page to engage in this discussion and I agreed to participate. I concede that process matters. Will Jytdog concede that content matters? Perhaps Jytdog can provide us with a *single* pharmacology article that meets the criteria for a wikipedia featured article? Sbelknap (talk) 00:02, 12 July 2018 (UTC)

You are asking the wrong person about FAs; I find that whole structure to have gone wrong and to have become an engine of drama-mongering, and I stay far, far away from it.

I already said that much of WP, including our health content, needs work.

That is why this new crusade of yours is such a tragedy. Please just try to learn the basics. Formatting citations is explained in WP:MEDHOW. Please actually read WP:MEDMOS and try to follow it. Learn what we actually do here and how we do it and why before you try to reform everything. I try to explain these very basic things in User:Jytdog/How. I want our articles to be high quality and accessible to every day people. That takes work. Letting your academic scientist flag fly when you write here is not OK. You need to condescend (one of my favorite theological terms -- to come down to be with) and write for our target audience without giving up rigor. This is hard.

I have said that you could be immensely valuable here. Instead you keep wasting our time and yours with these crusades. Please just learn what we do and how and why and try to follow it, and work. Once you show that you "get it" -- that you are what we call clueful -- you will be able to persuade people here. Jytdog (talk) 01:42, 12 July 2018 (UTC)

The tragedy is that thousands of editors have contributed to wikipedia drug articles and nearly all of them are flawed. I have spent many months learning what you all do and why. I have pored through revision histories for dozens of drug articles. There appears to be a serious problem, I intend to fix this problem. If the current approach works, then please point me towards one medical drug article that meets the criteria for a wikipedia featured article. One article. I will use it as a learning device for my edits. Sbelknap (talk) 03:33, 12 July 2018 (UTC)

I spend a lot of time looking at pages and how they got to their present state as well. This place is truly insane. Anybody can come here and write anything.... and you know, bell curves being what they are, most edits are bad or mediocre, some are good and a few are very good. But even the very good ones fall out of date unless somebody new who is competent comes along and updates what that person did. It just lifts my heart when I see somebody make a good edit and I whoop when I see a great one.

There are a lot of ways that people make bad edits. Some of them are vandalism or spam, some are just wrong, some remove good, well sourced content, some are "news" that are not "accepted knowledge"... some put UNDUE weight on some aspect, some are hyper-technical. There are many ways to go wrong. There is content i would love to build but I spend most of my time fixing bad content. Just doing maintenance.

And it kills me when I see somebody who could be making great, mission-oriented edits making bad ones. You really could do great things here Steve. But when I see edits like this, I will fix them. They are not good edits here. Here. You could do so much better.

Again, I do not care about FA. You are asking the wrong person. If you want to ask me to point you to an article with pharmacology content that I think is really good and on-mission, I will try to find some. Jytdog (talk) 04:03, 12 July 2018 (UTC)

Sbelknap, if you want to see an FA – a process that was basically "tuned" to fit history and the other humanities, and which IMO does not fit technical subjects perfectly – then see Bupropion or any of the other articles listed at Wikipedia:WikiProject Pharmacology#Featured content. You should be able to find the exact revision that was approved by looking in the boxes at the top of the talk page. WhatamIdoing (talk) 17:34, 12 July 2018 (UTC)

The current version of the bupropion article is quite similar to the FA version. The lede (current version) begins:

Bupropion, sold under the brand names Wellbutrin and Zyban among others, is a medication primarily used as an antidepressant and smoking cessation aid.[7][8][9] It is an effective antidepressant on its own, but is also used as an add-on medication in cases of incomplete response to first-line SSRI antidepressants.[10]

There are only a few published reports describing clinical trials of bupropion. Based on what little evidence is available, bupropion is a weak antidepressant, having almost no effect on depression. There is a high-quality meta-analysis published in 2018 in a good journal that synthesizes the available evidence on bupropion as an antidepressant.^[1]

On the single most important issue, antidepressant efficacy, the wikipedia bupropion article gets it spectacularly wrong. There are many other errors in the bupropion article. I counted 10 serious errors after reading carefully through the entire article once (~45 minutes of reading). I would rate the quality of the wikipedia bupropion article as very poor. I would agree that the wikipedia bupropion article is better than nearly all the other wikipedia drug articles I've read. I expect that many readers of the wikipedia bupropion article will want to know whether or not bupropion is effective, and the article misinforms them on this point.

So what are we to do? Sbelknap (talk) 21:37, 12 July 2018 (UTC)

Well, that claim is supported by a source from 2005, so I'd start by wondering whether recent review articles held a different view. A quick search of reviews in core clinical journals didn't turn up anything recent, but perhaps a more thorough search will turn up a couple of useful sources. WhatamIdoing (talk) 06:42, 13 July 2018 (UTC)

For what it's worth, I don't think the bupropion article has been compliant with the WP:FA criteria since I first read through it 3–4 years ago. As for the clonidine article, it's fine to be as detailed/technical as one wishes when describing a drug's pharmacodynamics in the body of the article, but article leads are supposed to be pretty dumbed down. Normally, I'd dedicate 1 of 4 lead paragraphs to a drug's pharmacology for a fairly lengthy drug article, using really basic/simplistic language – while still maintaining accuracy – to describe its pharmacodynamics.

In any event, bupropion probably needs to undergo a WP:featured article review. Seppi333 (Insert 2¢) 09:49, 13 July 2018 (UTC)

Lets be very clear here. There has never been evidence that bupropion was particularly effective for depression. The serious flaws in this article were present at the time it was first recognized as an FA. The article has been of very poor quality since it was a stub. It has gained length but never improved. I've gone through the revision history, which is fascinating. I note that Jytdog, Doc James, and others who are high-frequency editors have made many contributions to the bupropion article. Somehow they all missed the fact that there is very little evidence available about bupropion and what is available shows that thre the drug is ineffective. Numerous other errors remain uncorrected.

Something is very wrong here. If one were to deliberately create drug articles that obscure the truth, one could hardly have done worse. There are many high quality articles in other technical areas of wikipedia but none of them are about drugs. Those who are knowledgeable about drugs are greeted with hectoring wikilawyers who attack them until they stop editing. Look at the revision histories and then look at the editing history of knowledgeable drug article editors who are attacked. Please explain how I am wrong here. I am struggling mightily to assume good intentions by those who police the wikipedia drug articles. The evidence speaks for itself.

I again ask knowledgeable wikipedia editors to kindly provide links to wikipedia drug articles that they consider to be of high quality. I have not found any. If I am to achieve the "clueful" state that Jytdog mentions, I will need at least one example of how this community and these processes (which are unique to this subculture of wikipedia) have produced at least one wikipedia drug article that is high quality. Please advise. Sbelknap (talk) 11:54, 13 July 2018 (UTC)

Even if every single fact is completely backwards, those articles are still good models for writing style. The FAC regulars are better at "brilliant prose" (a requirement for FA status) than at evaluating scientific evidence (which isn't even mentioned in the FA criteria). WhatamIdoing (talk) 15:55, 13 July 2018 (UTC)

@Sbelknap: There are only a few entries at category:FA-Class pharmacology articles, and most of those could use a review. That said, Linezolid does seem to have a lede that we could afford to emulate elsewhere. Serpin's lede is rather more technical than necessary, but is still encouraging. LeadSongDog come howl! 16:21, 13 July 2018 (UTC)

The linezolid article is of poor quality. Lets through selected statements in the lede.

"Linezolid is an antibiotic used for the treatment of infections caused by Gram-positive bacteria that are resistant to other antibiotics."

This definition fails to distinguish linezolid from the other drugs used to treat MRSA, such as trimethoprim/sulfamethoxazole, vancomycin, daptomycin, tigecycline, or quinupristin/dalfopristin. The purpose of a definition is to *define*. The defining characteristics are that linezolid has and oral formulation and that it binds to the 50S subunit of the bacterial ribosome, blocking formation of the initiation complex for protein synthesis. Here is a better intro:

Linezolid is an oxazolidinone antibiotic that blocks initiation of protein synthesis by binding to the 50S subunit of the bacterial ribosome. Linezolid has antibacterial activity against many strains of methicillin-resistant staphylococcus aureus and other firmicutes (gram-positive bacteria). Linezolid is effective when given by mouth, which is an important advantage compared to vancomycin, daptomycin, tigecycline, or quinupristin/dalfopristin, all of which are available only in parenteral formulations.

Serious side effects may include serotonin syndrome…

No. This ought not be in the lede, as this is rarely, if ever, a clinically relevant issue. A nuanced discussion is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805572/

"Linezolid was discovered in the mid 1990s and was approved for commercial use in 2000."

No. This does not do justice to the facts. A group of scientists at duPont spent a good chunk of their lives working on this, and wikipedia consigns them to oblivion. This reminds me of how Pfizer "discovered" penicillin. (Pfizer "discovered" penicillin by noticing that Fleming and Florey had already discovered penicillin. Pfizer did discover how to make a lot of money manufacturing penicillin, though.) The oxazolidinones are synthetic drugs that were first discovered in the 1980s by scientists at duPont. Scientists at Pfizer later did further research exploring the structure:activity relationship of oxazolidines, and identified linezolid as a drug with good antibacterial activity and good oral bioavailability. ^[2][3]

These drug article ledes contrast with other articles in wikipedia which have both a lay audience and a technical audience. Consider the wikipedia entry for moose:

"The moose (North America) or elk (Eurasia), Alces alces, is the largest extant species in the deer family. Moose are distinguished by the broad, flat (or palmate) antlers of the males; other members of the family have antlers with a dendritic ("twig-like") configuration. Moose typically inhabit boreal forests and temperate broadleaf and mixed forests of the Northern Hemisphere in temperate to subarctic climates."

Notice all the technical words used in the moose article. Here is a version of the moose lede written in the style of a wikipedia drug article:

"The moose is a type of deer with a big thing on its head that lives in the woods and drinks water."

--— Preceding unsigned comment added by Sbelknap (talk • contribs) 20:41, 13 July 2018 (UTC)

This

Linezolid is an oxazolidinone antibiotic that blocks initiation of protein synthesis by binding to the 50S subunit of the bacterial ribosome. Linezolid has antibacterial activity against many strains of methicillin-resistant staphylococcus aureus and other firmicutes (gram-positive bacteria). Linezolid is effective when given by mouth, which is an important advantage compared to vancomycin, daptomycin, tigecycline, or quinupristin/dalfopristin, all of which are available only in parenteral formulations.

is unacceptably too technical. You are writing for the wrong audience. You are getting no traction here at WT:MED for your advocacy to write at the level of a biomedical journal article. You could try taking this to the wider community but you will get even less as most people will find that incomprehensible. Jytdog (talk) 00:33, 14 July 2018 (UTC)

Jytdog, if you could provide examples of wikipedia drug articles that you consider to be of high quality, I would be grateful. Thanks. Sbelknap (talk) 02:15, 14 July 2018 (UTC)

By this time it is a pointless exercise, as you will simply say "it is not written at the level of a biomedical journal" and write something boring and clueless like we would find in any standard pharmacology book. We all know already what that kind of writing looks like; we read it every day and many of us write that way outside of WP. This is by now just tiresome. It is hard to write in this genre. You don't want to do that work, so be it. Your edits will not stick. Jytdog (talk) 02:38, 14 July 2018 (UTC)

I have given very specific examples of major flaws in articles that are claimed to be good. These errors had nothing to do with the use of technical vocabulary. Jytdog continues to mischaracterize my points. My critiques are available above for anybody to read. There are many technical articles in wikipedia that are of high quality. Jytdog promised to tell us one drug article that is high quality. I would be grateful to Jytdog if he would do so. Sbelknap (talk) 19:49, 14 July 2018 (UTC)

@Sbelknap: I think what you wrote is fine for the body of the article, but leads are supposed to use very simplistic language. As an example of how you might revise what you wrote to be more suitable for a lead, compare the following two paragraphs:

(1) Linezolid is an oxazolidinone antibiotic that blocks initiation of protein synthesis by binding to the 50S subunit of the bacterial ribosome. Linezolid has antibacterial activity against many strains of methicillin-resistant staphylococcus aureus and other firmicutes (gram-positive bacteria). Linezolid is effective when given by mouth, which is an important advantage compared to vancomycin, daptomycin, tigecycline, or quinupristin/dalfopristin, all of which are available only in parenteral formulations.

(2) Linezolid is an oxazolidinone antibiotic that inhibits bacterial protein production. Linezolid has antibacterial activity against many strains of methicillin-resistant staphylococcus aureus and other gram-positive bacteria. Linezolid is effective when given by mouth, which is an important advantage compared to vancomycin, daptomycin, tigecycline, and quinupristin/dalfopristin, all of which are poorly absorbed following ingestion. (NB: I'm assuming these drugs all have poor oral bioavailability)

This type of simplistic summary of its pharmacology isn't really any different than the pharmacology content in the lead of Beta-Hydroxy beta-methylbutyric acid being a stupidly simplistic summary of Beta-Hydroxy beta-methylbutyric acid#Pharmacology. Seppi333 (Insert 2¢) 02:49, 14 July 2018 (UTC)

I like your edits. This is an improvement over what I wrote. However, if one were to put this in the linezolid lede, I expect that it would be reverted almost immediately by Jytdog, Doc James, or one of the other well-meaning drug article police. Sbelknap (talk) 19:55, 14 July 2018 (UTC)

After going through the pharmacology section, the linezolid article didn't seem that bad. It was a little out of date, but not terribly so. Most of the information was accurate w.r.t. a 2018 pharmacology review. The main issue with linezolid is that its references are inconsistently formatted and it has a lot of older refs due to it being largely written back in 2009 and the article lacking a maintainer. I expect some of the article content is still dated, so it likely needs further attention in other sections of the article. As for the lead, I made a few minor changes but it seemed fine (i.e., compliant with MOS:LEAD) overall. Seppi333 (Insert 2¢) 07:42, 14 July 2018 (UTC)

I pointed out what I consider to be serious flaws in the lede of the linezolid article, which I described above. I read carefully through the main article, and found many errors. Its not just out-of-date, some of this content was wrong when it was first introduced. Sbelknap (talk) 19:49, 14 July 2018 (UTC)

Sbelknap, you are quite right that there does not exist a single drug/med article that meets FA (declining) standards. FA is a broken process; it is, though, the best Wikipedia has to offer in an overall broken model. Many of your criticisms of drug articles are spot on, but your approach is not likely to yield the productive results you wish. The problem with our drug articles is not reading level (alone), not the broken FA process, and not the need for lists of acceptable words. It is, quite simply, that there are almost no competent editors on Wikipedia who work on drug articles. Fvasconcellos was one of the best, and he is hardly active any more. The problem with our drug articles is that Wikipedia was, for a long time, populated by pharm editors who a) could not write, but b) had chips on their shoulders. As you have many valid criticisms, perhaps you will alter your approach and find a group of editors willing to collaborate on article improvement. (Good luck with that-- I have found it harder and harder as Wikipedia loses once good editors. ) SandyGeorgia (Talk) 14:59, 14 July 2018 (UTC)

I agree with you that there is a shortage of pharmacology editors on wikipedia. The question is, why? If one works through the revision history for the drug articles, one finds competent, knowledgeable editors who make useful edits. Often, these competent pharmacology editors are attacked by wikilawyers who are long on process knowledge and short on content knowledge. If one then looks through the contributions logs for these competent pharmacology editors, one finds that after attacks by wikilawyers, their contributions precipitously decline or cease. Interested editors can go and look for themselves. This looks like a death spiral to me. Sbelknap (talk) 19:49, 14 July 2018 (UTC)

Some claim that those with expertise in pharmacology are wiki-defective in some way. Perhaps there is something to that. However, I believe the major problem lies elsewhere. Pharmacology is a science. It seems to me that the current culture does not understand or respect that pharmacology as a science. I've read many, many non-pharmacology articles and made a few edits in technical areas other than pharmacology, and the culture there seems much more in keeping with what I understand the mission of wikipedia to be. The drug article community seems to resent experts and chases them away.

I'm looking for a drug article that is of good quality. Perhaps such an article would be helpful as a template for the community. I haven't found one so far. Do you know of any, User:SandyGeorgia? Sbelknap (talk) 19:49, 14 July 2018 (UTC)

User:SandyGeorgia I have thought of you a few times throughout this discussion. The goal of this thread was get wider input on reading level. SBelknap has been continually raising other issues, which has made it hard to focus on this. I realize you have your own set of things you are unhappy about and that some of these other issues align with them, but part of the work we need to do to bring Sbelknap into the community is help him learn what we do in Wikipedia, and how and why. In your view, is the level of reading of the content that he has generated and that he has proposed here, appropriate for Wikipedia or not? Jytdog (talk) 14:12, 15 July 2018 (UTC)

I don't understand why so many claim that FA is a broken process. I find it works quite well, with solid comments the vast, vast majority of the time. It's certainly fine for science topics, we brought Quark to FA-level, it took three times to get, specifically because it was hard to make the CKM matrix section in (Quark#Weak interaction) accessible to layfolk, but once you do through it, you really do end up with something polished. Headbomb {t · c · p · b} 15:27, 14 July 2018 (UTC)

I agree that there are many technical articles in wikipedia that are of high quality. There are no high-quality drug articles that I've seen. If you know of one, please tell us. The question is, why are the wikipedia drug articles so much worse than other technical articles? Sbelknap (talk) 19:49, 14 July 2018 (UTC)

Headbomb, Quark was promoted almost a decade ago, after I archived it twice. The FA process today has little to do with what it was a decade ago. Since then, intense scrutiny on articles has become very rare, articles are allowed to languish at FAC for months on end, many FAs are passing on minimal support, many more get no review at all, a small core of regulars review and support only each others' work (which is rarely to standard), and you can find basic grammatical issues in just about any FA passed.

Sbelknap, there are few good technical FAs these days-- the problem is not only pharm. The problem with pharm articles is similar to the problem with math articles; the editors who focus in those areas refuse to understand that the technical issues are not the problem with the articles-- the attitude and lack of writing skill and collaboration is. We see the same thing happening today in medicine articles; non-med editors who come in to polish writing are treated rudely and leave. As I told you, the problem in pharm articles is almost entirely related to the chips on shoulders. If a core group of editors with drug knowledge would realize that the problem is in the writing, and work with good writers to bring their technical expertise to the article, a good drug article would be possible. It would also help if med editors would make room for the real writers to work alongside them. SandyGeorgia (Talk) 13:01, 15 July 2018 (UTC)

After going through parts of both linezolid and bupropion, it occurred to me that most of our older pharmacology/medical FAs likely need updates in certain sections. A lot of the sources in linezolid/bupropion are outdated (i.e., >10 years since publication), even in the medical uses sections; that's particularly problematic for statements about absolute or comparative efficacy which are cited to these sources. In relation to disease-related FAs, this is also problematic for treatment sections that still cite outdated sources. If we don't make an effort to maintain our FAs, they eventually won't be FAs anymore. Seppi333 (Insert 2¢) 08:14, 15 July 2018 (UTC)

The gene database HgenetInfoDB does not have its own article (and apparently never has) but it is still linked from over a dozen articles. However the database itself appears to be offline , suggesting that all wikilinks to it and links to urls in the database should be removed (typically they are included in infoboxes like the one on 5-HTTLPR). IntoThinAir (formerly Everymorning) talk 16:33, 12 July 2018 (UTC)

All the infobox ones can be removed by altering the Template:Infobox single nucleotide polymorphism. Would be good to mention their. Doc James (talk · contribs · email) 17:17, 12 July 2018 (UTC)

It looks like it was added in 2008 by a logged-out editor from Denmark. I don't know who to ask/who might know about this. Maybe a question for Wikipedia:WikiProject Molecular and Cell Biology? WhatamIdoing (talk) 20:59, 12 July 2018 (UTC)

This seems to be resolved, as I have removed it myself from the infobox Doc James refers to above. IntoThinAir (formerly Everymorning) talk 03:39, 18 July 2018 (UTC)

Almost all the articles in Category:Rare syndromes are genetic. Do we really need a separate category? Natureium (talk) 19:06, 18 July 2018 (UTC)

nope! but it would be best to consolidate in the less specific one for the inevitable strays. Jytdog (talk) 20:04, 18 July 2018 (UTC)

This publishers is listed as possibly predatory. Wondering peoples thoughts? Doc James (talk · contribs · email) 15:19, 14 July 2018 (UTC)

seems so --Ozzie10aaaa (talk) 17:47, 14 July 2018 (UTC)

I think that article is talking about something else – a fee to send the original draft to the publisher, with no idea of whether it will be accepted, rather than a fee to have the article made free-as-in-beer after it has cleared peer review and been accepted by the editor. Even quite respectable publications such as PNAS charge authors hundreds or thousands of dollars to make the paywall go away. The BMJ charges an article publication fee of £3000 (US $4800). WhatamIdoing (talk) 22:24, 16 July 2018 (UTC)

• 443 uses on Wikipedia. Guess we start removing them: insource:"intechopen.com" Carl Fredrik ^talk 07:29, 15 July 2018 (UTC)

Interestingly, 5 InTech journals appear to have been published by Sage Publications for about 2 years now. More criticism of InTech can be read here. This seems to paint a mixed picture when it comes to whether their journals are predatory: the publisher has been criticized as predatory, but why would Sage pay to acquire 5 of their journals if it didn't think they were legit? IntoThinAir (formerly Everymorning) talk 01:10, 17 July 2018 (UTC)

In the case of Sage set the fee to a one-time $1200 per article after peer review and acceptance. Was that the same when InTech published it? LeadSongDog come howl! 22:44, 18 July 2018 (UTC)

should be placed in an article or made standalone article...IMO--Ozzie10aaaa (talk) 20:43, 12 July 2018 (UTC)

It's a press release -- not even a primary source. Without better sourcing, there is no justification for doing anything with it. Looie496 (talk) 00:17, 13 July 2018 (UTC)

We already have an article on medipix, the underlying CERN technology. If/when RS become available for the "color" x-ray device, they could be added to the medical imaging subsection there. --{{u|Mark viking}} {Talk} 00:29, 13 July 2018 (UTC)

Picture looks like a CT image not a plain X ray. Agree will need better sources. Can go here Medipix#X-ray_imaging Doc James (talk · contribs · email) 13:42, 13 July 2018 (UTC)

University of Canterbury--Ozzie10aaaa (talk) 13:56, 13 July 2018 (UTC)

As far as I can make out, what they are doing is CT scanning using a mixture of X-ray energies, and using differential attenuation of different frequencies to assign colors to voxels. Looie496 (talk) 16:23, 13 July 2018 (UTC)

Normally the use of human-visible colors to represent an invisible-energy spectrum is referred to as "false color". Accordingly, this should be called a "false-color x-ray" or "false-color CT image". The more that the image looks realistic, the more important it becomes to name it correctly to avoid misleading the viewer. LeadSongDog come howl! 22:53, 18 July 2018 (UTC)

Are not mentioned in MEDMOS for diseases. Where do you all think they should go? Am looking at this edit to Diabetes... Jytdog (talk) 02:42, 6 July 2018 (UTC)

Hmm. The ideal approach might depend upon the details. Here's some ideas off the top of my head: ==Epidemiology== if they co-exist but don't really interact. ==Pathophysiology== if the causes are related. ==Symptoms== if the obvious presence of one means you should investigate the existence of the other. ==Treatment== if it affects treatment (e.g., "Many people with Disease also have Scary, in which case they can't take this Scary-exacerbating drug").

Other people may have other/better ideas. WhatamIdoing (talk) 16:30, 6 July 2018 (UTC)

One alternative is to introduce the following division into MEDMOS:

==Related diseases==
===Differential diagnosis===
===Comorbidities===
Just thinking about it now makes sense to me, and it's odd that it hasn't been raised before. It would of course require splitting out Differential diagnosis from the ==Diagnosis== sections, but this isn't a formal issue and will be resolved over time.
Another alternative is to place it as follows:
==Diagnosis==
===Differential diagnosis===
===Comorbidities===
Though this feels less natural for me. Carl Fredrik ^talk 16:40, 6 July 2018 (UTC)

Use of the actual word may be a bridge too far for a general audience. Most people will cope with the word "diagnosis", or even "differential" thanks to medical shows... I doubt "comorbidity" will slide down quite so easily. Basie (talk) 07:29, 7 July 2018 (UTC)

It would require some short clarification of what a comorbidity is on each article; to which an alternative is ===Associated diseases=== (To further make myself clear I am in favor of splitting comborbities from other sections, because a treatment section would be overly detailed with such information, and it is more likely to be read if it is under an independent header. We know that most people only read the sections they believe are relevant to them.) Carl Fredrik ^talk 10:23, 7 July 2018 (UTC)

If we want people to read it, then we should use a plain-language title.

I think that the separate vs same section question depends upon how many there are. In other conditions, there might only be one sentence to write.

Are you thinking about a strict definition of comorbidities (technically unrelated diseases that happen to occur at the same time (e.g., common cold + broken arm = comorbidity) or a broader one (diabetes causes kidney failure)? If the latter is more important, then a ===Complications=== section (or something like that; for all the things that are commonly present together because they have related causes/processes) might be more appropriate. WhatamIdoing (talk) 17:25, 7 July 2018 (UTC)

When is it appropriate to include very technical information, well beyond the comprehension of 95% of visitors, e.g., drugs (medications) and the chemical information in the sidebar? Only in sidebars? What about the fact that many medical & other health professionals use Wikipedia to learn about all sorts of topics related to their studies/profession? Are they not an important part of our audience? (I understand that Wikipedia is not a medical textbook.) I don't mean to come across as harshly challenging or the like. These are simply questions I've had for a while that this discussion brought to mind.   - Mark D Worthen PsyD (talk) 23:17, 7 July 2018 (UTC)

Markworthen, I took the liberty of moving your comment out of the middle of WAID's. I agree, it's a tricky needle to thread but I don't think the fact that health professionals use Wikipedia means we should allow the content to drift further away from something a general audience will understand. Cheers, Basie (talk) 23:26, 7 July 2018 (UTC)\

yes, the general audiance is our main target for articles...IMO--Ozzie10aaaa (talk) 10:44, 19 July 2018 (UTC)

• Comment I typically put them under "signs and symptoms" Doc James (talk · contribs · email) 10:59, 8 July 2018 (UTC)

• I should have noted in the OP that I looked for past discussions of this; they are brief and not resolved.
  • 2006 Wikipedia_talk:WikiProject_Medicine/Medical_genetics_task_force/Archive_1#Tourette_syndrome
  • 2007 Wikipedia_talk:Manual_of_Style/Medicine-related_articles/Archive_2#Screening_and_Diagnosis
  • 2012 Wikipedia_talk:WikiProject_Medicine/Archive_27#Random_trivia -- Jytdog (talk) 15:50, 9 July 2018 (UTC)