Misplaced Pages

Talk:Scrambler therapy

Article snapshot taken from Wikipedia with creative commons attribution-sharealike license. Give it a read and then ask your questions in the chat. We can research this topic together.

This is an old revision of this page, as edited by Bon courage (talk | contribs) at 05:28, 18 April 2015 (→Any medical expert comments on this article as a source?: cmt). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Revision as of 05:28, 18 April 2015 by Bon courage (talk | contribs) (→Any medical expert comments on this article as a source?: cmt)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)
Articles for deletionThis article was nominated for deletion on 7 April 2015. The result of the discussion was no consensus.
WikiProject iconMedicine Start‑class Mid‑importance
WikiProject iconThis article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Misplaced Pages talk:WikiProject Medicine.MedicineWikipedia:WikiProject MedicineTemplate:WikiProject Medicinemedicine
StartThis article has been rated as Start-class on Misplaced Pages's content assessment scale.
MidThis article has been rated as Mid-importance on the project's importance scale.
Ideal sources for Misplaced Pages's health content are defined in the guideline Misplaced Pages:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Scrambler therapy.
Individuals with a conflict of interest, particularly those representing the subject of the article, are strongly advised not to directly edit the article. See Misplaced Pages:Conflict of interest. You may request corrections or suggest content here on the Talk page for independent editors to review, or contact us if the issue is urgent.

previously deleted

see Misplaced Pages:Articles for deletion/Scrambler therapy. MastCell you had nominated this before, and Sandstein you had closed it. I have put up for speedy per G4. Jytdog (talk) 18:19, 7 April 2015 (UTC)

Speedy deletion declined, the article is significantly different from last time around, with more sources. But it does read vaguely quackish and promotional, and needs cleanup at the least.  Sandstein  18:25, 7 April 2015 (UTC)
thanks - could not see old version. will re-nom, 2nd time, i guess. thanks. Jytdog (talk) 18:29, 7 April 2015 (UTC)
Give me a flippin chance. There are a lot of research papers on this subject including some I have not listed, most later than 2008. Two are from 2015 so the device is currently actively studied. I have only just launched this article. You hardly expect it to be the final word. The research papers are diverse. I cant see anything promotional or quackish in the text written so far - just basic information - for example i say there are no known side effects, i have found nothing from anything i have read to suggest otherwise.--Penbat (talk) 18:39, 7 April 2015 (UTC)
Hi Penbat. What MEDRS compliant sources do you find for the treatment? I looked and found none. Jytdog (talk) 18:41, 7 April 2015 (UTC)
You replied here, but not at the message I left on your talk page. please reply there. Here is a link: User_talk:Penbat#SPA_.2F_COI. Thanks. Jytdog (talk) 18:42, 7 April 2015 (UTC)
Hi Penbat - i have no more concerns about COI on your part. Thanks for replyingJytdog (talk) 22:09, 7 April 2015 (UTC)
@Jytdog Please could you explain why Sparadeo F, Kaufman C, D'Amato S (2012) is not MEDRS compliant?__DrChrissy (talk) 20:25, 7 April 2015 (UTC)
@Jytdog Now that you have removed the completely inappropriate COI template you imposed to try and bully another editor, perhaps you would turn your mind to answering my question about why Sparadeo F, Kaufman C, D'Amato S (2012) is not MEDRS compliant?__DrChrissy (talk) 22:13, 7 April 2015 (UTC)
Instead of deleting my edits, why do you continue to refuse to answer the question?__DrChrissy (talk) 23:14, 7 April 2015 (UTC)

Misapplication of WP:MEDRS

If you want a case study in misapplication of WP:MEDRS, look at the recent edits to this article. Alexbrn has tagged-bombed two clearly reliable secondary sources because they are a "practice guideline" and an "opinion piece." Meanwhile, WP:MEDRS describes "medical guidelines or institutional position papers" as "ideal sources for clinical evidence." Alexbrn also replaced my neutral summary of what the sources actually said with his own conclusion that "there is no good evidence." 24.215.92.54 (talk) 11:23, 8 April 2015 (UTC)

Another misapplication in this article? Alexbrn removed a reference here with the edit summary "journal does not appear to be in PUBMED/MEDLINE". I am unable to find anywhere in WP:MEDRS a statement that only journals in PUBMED/MEDLINE can be used. If I am wrong, please direct me to the relevant passage of text.__DrChrissy (talk) 11:42, 8 April 2015 (UTC)
There may be exceptional circumstances in which such lesser sources could be used, but MEDRS warns against non-MEDLINE indexed articles, and WP:REDFLAG applies. If you disagree, cd always check as WT:MED ... Alexbrn (talk) 11:47, 8 April 2015 (UTC)
Did you forget to login? And did you forget to quote MEDRS with some integrity? What it actually says is "medical guidelines and position statements from nationally or internationally recognised expert bodies" (my emphasis) – which one of your sources ain't. Alexbrn (talk) 11:45, 8 April 2015 (UTC); amended 11:58, 8 April 2015 (UTC)
The clinical guideline is by the American Society of Clinical Oncology, which is, in fact, a nationally recognized expert body. Even if it were not, the issue is what WP:MEDRS forbids or discourages. It certainly does not discourage guidelines. 24.215.92.54 (talk) 11:50, 8 April 2015 (UTC)
Apologies, I missed that and shall de-tag. Alexbrn (talk) 11:58, 8 April 2015 (UTC)
@Alexbrn Please quote the section of WP:MEDRS that "warns against" non-MEDLINE index publications. The only relevant piece I can see is "Other indications that a biomedical journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE"....hardly a warning against! As for PUBMED, I can find nothing that relates to this being a criterion for including/excluding a source. This makes your edit summary rather misleading to say the least.__DrChrissy (talk) 12:03, 8 April 2015 (UTC)
That something may be unreliable is indeed a warning—it is vital that the biomedical information in all types of articles be based on reliable, third-party, published secondary sources and accurately reflect current medical knowledge; so if something seems iffy (by not being MEDLINE-indexed or not included in PUBMED) then its reliability is in question. Better to use strong sources. My edit summary—"rmv. journal does not appear to be in PUBMED/MEDLINE; also likely copyvio link"—is perfect. Alexbrn (talk) 13:03, 8 April 2015 (UTC)
So is the sentence I quoted the one you would use to support your actions - or is there another relevant piece somewhere in WP:MEDRS?__DrChrissy (talk) 13:12, 8 April 2015 (UTC)
I edit according to all of our WP:PAGs, not wikilawyered single sentences (though it is important; read my response again). But as I said, if in doubt, check consensus at WT:MED. Alexbrn (talk) 13:22, 8 April 2015 (UTC)
OK: I take that as a refusal to quote the section of the guidelines which you say support your behaviour.__DrChrissy (talk) 13:37, 8 April 2015 (UTC)

New sources

yep the Hershman source (PMID 24733808) that was added here is MEDRS. a good one. scrambler is mentioned in it, in a "special commentary" section that starts out saying "A number of nonpharmacologic interventions have been investigated for their role in preventing or treating peripheral neuropathy. However, the paucity of RCT evidence prohibited inclusion of those studies in this systematic review." They briefly talk about acu, then briefly talk about scrambler and make it clear that there is insufficient evidence to say much about it, and use some scare quotes when they do. Thanks for pointing it out, Alexbrn.

Rivera (PMID 25596818) was added here. Also a good MEDRS source; also a passing mention and saying only "we don't know yet".

These were added after i nominated the article. I'll add mention of them there. Passing mention is not enough for NOTABILITY in my view. Jytdog (talk) 12:24, 8 April 2015 (UTC)

efficacy

Particularly in such a brief article as this is at present, "no good evidence that it is effective in treating neuropathic pain" jumped out at me as pretty definitive and damning (a a non-technical reader on medical topics), and I attempted to verify this at the cited source ("Overview of neuropathy associated with taxanes for the treatment of metastatic breast cancer"), but was unable to. The paper cited doesn't seem to be primarily about so-called scrambler therapy, and the one mention of it I could find was:

"In uncontrolled studies, treatment with a noninvasive electro-analgesia device, referred to as “Scrambler” therapy, demonstrated benefit for painful chemotherapy-induced peripheral neuropathy ; however, the results of other studies have been mixed. In a randomized controlled study of patients with neuropathic pain, Scrambler therapy appeared to be more beneficial than guideline-based drug management at relieving chronic neuropathic pain as assessed with a visual analog scale (P < .0001) . However, Scrambler therapy failed to show any significant difference from sham therapy in pain scores in a recent randomized double-blind study of patients with neuropathic pain . Further studies of Scrambler therapy in various solid tumors are ongoing."

I'm am not a medical expert, so perhaps I am missing some subtler indications in this excerpt or overlooked relevant material elsewhere in this study; otherwise, a fair summary of the source in plain English would seem to be: "There is some evidence of efficacy; research into it is ongoing." To say instead that this indicates "no good evidence that it is effective" seems to be a stretch, more like an original conclusion than a balanced summary of the information I could find (and "good" is vague to me as a general reader).

Also:

  • Scrambler therapy in the cited paper seems to be somewhat of a peripheral, due diligence mention, appearing appears in a round-up paragraph (lead sentence: "Nonpharmaceutical methods of neuropathy management are also being studied."), along with manual therapy (i.e., massage) and acupuncture, which reinforces my impression that this source is not exactly high-grade for effectively dismissing scrambler therapy, as it is not very much about it in the first place.

FYI, I came across this article via AfD notice, and have never even heard of this before. My participation here is based on wanting to help maintain open, balanced, free coverage on Misplaced Pages, regardless of topic! --Tsavage (talk) 15:22, 8 April 2015 (UTC)

Hi Tsavage, yes primary sources about health were removed per MEDRS. the 2 MEDRS sources are clear that there is insufficient data to say if it works. this is not ambiguous. Jytdog (talk) 15:37, 8 April 2015 (UTC)

@Tsavage I agree with you totally. I have looked at the references as objectively as I possibly can and in no way could I summarise their content as ""no good evidence that it is effective"". I would actually edit this out of the article citing it as Original Research, however, I get the feeling I am being pushed into an edit-warring scenario here, so I won't just at the moment.__DrChrissy (talk) 16:59, 8 April 2015 (UTC)

Agree with Jytdog - this is a good paraphrase (and it's not "damning" - there's just no good evidence for this use). There is the added nuance that the strongest evidence in the review—the blinded trial—found that the therapy was positively ineffective for this use, but rather than get into the weeds just saying "no good evidence" (or "no strong evidence") is what we want. Alexbrn (talk) 17:04, 8 April 2015 (UTC)

neither of you edit much in health related content. Things don't work in that field as you may think. something either has enough evidence that we can say "it works", or it does not. There is a high bar and if something doesn't cross it, we say "there is no good evidence it is effective." This is really important for health content. And there are a lot of pushers of woo in WP who will take something like a primary source describing an unblinded, small N study where some effect was shown and want to blow that up into "evidence it is effective." that is upside down. Jytdog (talk) 17:04, 8 April 2015 (UTC)
neither of you edit much in health related content - We should be wary of creating walled gardens with regard to categorizing and attempting to regulate particular areas of content. A fundamental Misplaced Pages policy is, "There is no need to read any policy or guideline pages to start editing" - this is the second sentence of the procedural policy concerning the creation of policies and guidelines. The intent (per the rest of that policy), is not to say, "You can edit as you like, but be prepared for other editors to jump on your work brandishing guidelines that at times seem to defy common sense and include matters of arbitrary preference" - ultimately, everything in Misplaced Pages has to be understandable by a general audience.
In this case, is "good evidence" a formal technical term in scientific medical research? If so, it should be clearly defined as such so I can make sense of it. Otherwise, when you say, "no good evidence" (as opposed to "no evidence"), I expect only "bad evidence," which I interpret as (1) no positive evidence whatsoever, and (2) incompetent and/or deliberately misleading attempts at producing evidence. In other words, common sense plain English understanding leaves an extremely negative and critical - "damning" - impressiong. Yet when I read the cited source, it doesn't seem to say that. If this is all specialized medical language, it should be translated into plain English suitable for a general encyclopedia reader. --Tsavage (talk) 17:41, 8 April 2015 (UTC)
of course there are no walled garden. but there is WP:CIR as well and WikiProject Medicine has been effective at making our health articles solid; this is what wikiprojects are for. Jytdog (talk) 17:51, 8 April 2015 (UTC)
Please don't muddy the waters and evade the question by throwing up a link to an ESSAY. Misplaced Pages:Competence is required is an essay that focuses mainly on language and behavioral basics, as in being familiar with WP editing basics: don't be rude, don't hold grudges or push strongly held personal opinions, be mindful of any limitations you may have in writing in English, and so forth. Regarding technical expertise, it says: "Insufficient technical knowledge is not usually a problem, unless when adding, deleting, or changing technical content." Which brings us back to the unanswered question:
is "good evidence" a formal technical term in scientific medical research? If so, it should be clearly defined as such so I can make sense of it.
Thanks! --Tsavage (talk) 18:07, 8 April 2015 (UTC)
yep commonly used. read any cochrane review. Jytdog (talk) 18:12, 8 April 2015 (UTC)
So your answer is, "good evidence" is a formal technical term in scientific medical research? What is a "Cochrane review," do you have a link, does one of those contain a definition of "good evidence"? If it is not, there is not way for me to verify it's use in an article, then it is obviously subject to my interpretation as a general reader, which I have given above. --Tsavage (talk) 18:22, 8 April 2015 (UTC)
Additionally, don't you need a reliable secondary source to explicitly summarize that cited material as "no good evidence" or "no strong evidence"? That seems to be original synthesis requiring particular medical research expertise in order to evaluate the various claims made in the cited source and form a conclusion. As anonymous editors, by definition we have no verifiable credentials, and so cannot directly summarize technical language. My summary above, relying on a basic understanding of English, was "Some evidence; research ongoing." --Tsavage (talk) 18:40, 8 April 2015 (UTC)

in these situations I generally resort to quoting the source. hopefully that will satisfy you. Jytdog (talk) 18:51, 8 April 2015 (UTC)

What you have done with your latest edit is switch sources to another study where Scrambler therapy is far from the primary topic, and then proceed to selectively quote a negative fragment (your quote MAY BE the most relevant part of what was presented, but that is not verifiable as it stands). The entire passage from Prevention and Management of Chemotherapy-InducedPeripheral Neuropathy in Survivors of Adult Cancers:American Society of Clinical Oncology ClinicalPractice Guideline," with your selected sole quote highlighted by me:
Evidence of efficacy of electrocutaneous nerve stimulation in relieving refractory chronic pain led investigators to test its potential in patients with CIPN. A small pilot study specifically tested the MC5-A Calmare device on 16 patients with refractory CIPN. The device, which is hypothesized to provide ‘‘nonpain” information to the cutaneous nerves to block the effect of pain, showed an improvement in pain scores (59% reduction at 10 days, P .001) with no reported adverse effects. However, a placebo-controlled, randomized, small (14 total patients) trial, published only as an abstract, was unable to demonstrate a benefit for scrambler therapy. Randomized controlled evaluation of the efficacy of electrocutaneous nerve stimulation in CIPN is ongoing.
My plain English summary of that is, "Mixed results; research ongoing." And does "published only as an abstract" mean the full-text study is not available for review? If so, it doesn't make sense to select just that item to represent a collection of results. What it seems you need here is a reliable review of the scientific literature on "Scrambler therapy," of which PUBMED lists 13 items. --Tsavage (talk) 19:07, 8 April 2015 (UTC)
Tsavage, what you are proposing is not OK. are you interested in hearing an explanation in how we handle health related claims? i will try to explain more, if you like. there really is sense to it, and we do it consistently. if you are not interested, i won't run through it. (and you don't seem to be making any distinction between primary and secondary sources...) Jytdog (talk) 19:11, 8 April 2015 (UTC)
I am not "proposing" anything, I am discussing and trying to understand the rationale behind edits, and reconciling that with my understanding of the final product, the article, as an interested, non-technical reader. It's pretty simple, I am being the "uninvolved editor" that everyone solicits when the launching RfCs and AfDs and whatnot.
Of course I'm interested in learning more. "How we handle health related claims" is kind of an interesting premise, I thought "I" was already an equal in "we" along with all other editors everywhere in Misplaced Pages.
That said, please do elaborate (or if it is your interpretation of something I can read directly, please instead point me there).
(Regarding primary and secondary sources, I adjusted part of an earlier comment in this thread (original struck) if that what you were referring to. The two studies cited here are reviews of findings on management of neuropathy, of which Scrambler theory is one proposed method. Otherwise, not sure what you mean.) --Tsavage (talk) 19:33, 8 April 2015 (UTC)

ok, three examples:

  • i am Dr. Woo. I have invented the WooThing, which I believe Cures Cancer. I am able to test my WooThing on five people who have cancer, and I follow them for 2 months, and all of them don't die. I find some journal that publishes my study. I start WooThing company and start cranking out press releases that get picked up by phys.org and other sites that snap up every press release out there. OK, is there "some evidence" that WooThing cures cancer? The way Project Medicine works, heck no. There are not even any secondary sources on it, so we wouldn't discuss efficacy at all, as there are no reliable sources discussing efficacy. Should WooThing have a WP article? Probably not.
  • This article. Happily there are two review articles that at least give it passing mention. The "pilot study" you quote is not an RCT; RCTs are the only kind of clinical trial that can even count as good evidence in medicine. The only RCT there was, had a tiny N and has not even published yet. There is no good evidence that it works.
  • look at say Bupropion. This is a drug that has been tested in huge RCTs and gone through regulatory approval in many countries. There are tons of review articles, including cochrane reviews, on this drug, that provide reliable sources we can summarize and use. We can say with confidence "the available evidence indicates that it is effective in clinical depression" and statements like that.

do you see how it goes? this is all described in MEDRS and MEDMOS, and is how Project Medicine generally works across all articles for drugs, devices, vaccines, dietary supplements, etc etc. any kind of health claim. there are places where it gets dicey (e.g. tox) but generally it works very well and WP talks consistently about these kinds of claims, to the extent that project medicine is able to get there (WP is of course amazingly lumpy despite our best efforts) Jytdog (talk) 20:05, 8 April 2015 (UTC)

Thanks for the effort. Still, this feels like more smoke, by restating the obvious: "Don't base articles on press releases." Kinda universal. Check. The foolproofing value of RCTs - randomly assign different treatments or no treatment/placebo to subjects, see what happens - is also not hard to grasp, so that a review of multiple RCTs is considered high-quality, is easily understood. Check. Favor studies published in well-recognized, peer-reviewed journals. Check...
This still doesn't take me to where "experienced health topic editors" are allowed to synthesize summaries with statements like "no good evidence," or selectively highlight certain results because they are from types of studies that are considered higher quality, without explicit explanation. The general reader can't be expected to know that a randomized control trial is so high-grade, that anything considered inferior in the source can be simply left out here, that needs to come from a reliable published review. We remain anonymous editors, and verifiability has to take that into account, we have no special expertise when it comes to summarizing. I totally get what you're saying, but this is a general encyclopedia, not a medical text - everything should be CLEAR AND TRANSPARENT for all readers.
Something like: "Studies are few, and high-quality evidence of effectiveness is not available. In two reviews of neuropathy management options, blah blah... " Since this is no Bupropion as far a sources, help the readers out, don't abandon them! --Tsavage (talk) 22:21, 8 April 2015 (UTC)
with "sounds like smoke", I'm done. (and while the double blinded RCT design is indeed "high grade", an RCT of 14 people is worthless. for pete's sake) Jytdog (talk)
Hershman source: "However, a placebo-controlled, randomized, small (14 total patients) trial, published only as an abstract, was unable to demonstrate a benefit for scrambler therapy."
Rivera source: "Scrambler therapy failed to show any significant difference from sham therapy in pain scores in a recent randomized double-blind study of patients with neuropathic pain"
both discussing the only double-blinded RCT that has been published. Jytdog (talk) 22:42, 8 April 2015 (UTC)
Jytdog, you seem happy to engage in discussion, yet you consistently avoid direct questions. You've never answered whether "good evidence" is a formal technical term in scientific research, which sounds kinda, yes or no. Now, I'm asking directly:
How is it that "experienced health topic editors" are allowed to synthesize summaries with statements like "no good evidence," or selectively highlight certain results because they are from types of studies that are considered higher quality, without explicit explanation? We remain anonymous editors, and verifiability has to take that into account, we have no special expertise when it comes to summarizing.
We've discussed before, and one of what I characterize as your tactics is to claim the other person didn't respond to you (or perhaps doesn't understand the topic at hand), so I politely reconstituted your lesson in my own words, to indicate my understanding of "how we handle health related claims", yet you choose to attach to three other words, "sounds like smoke." This acting as an "uninvolved editor" sure is tiring and time-consuming, hahaha. Fun, fun, fun!!! --Tsavage (talk) 22:57, 8 April 2015 (UTC)
ok, i am getting too frustrated. first, you called me a liar. so, more friction between us. second, you asked me to tell you what guides us. I cited MEDRS to you. It is pretty clear that you didn't read it. And if you did, not with care. And not the part called "Assess evidence quality". And you have no idea how we carry and interpret that guideline in day-to-day editing. and you are acting like the worst kind of guy editors in WP who make this place suck. aggressive and mansplaining stuff you know nothing about. so really, i am done interacting with you. i will let other editors respond to you. Jytdog (talk) 23:07, 8 April 2015 (UTC) (striking, was rewriting when ec happened Jytdog (talk) 23:25, 8 April 2015 (UTC))
Perfect: 0/2 in actually responding directly. Instead, off to the emo (Why are you saying I called you a liar? And then proceeding to call me names?). Mansplaining (wow, there IS a page!), it's all kinda rude, but instead, hahahahaha... (If you post one more time, I'll leave it for you to have the last word!!) --Tsavage (talk) 23:21, 8 April 2015 (UTC)
yep as usual you insult me and expect me just to ignore it ("feels like more smoke" = "you are a liar") i will try to ignore it. the direct answer is: please read the part of MEDRS about "Assess evidence quality". as with many policies and guidelines, all the ways we work with it are not written down but are just part of the editing culture. Jytdog (talk) 23:07, 8 April 2015 (UTC)

drchrissy i am fine with the actual edit you made here but not with the edit note. in any case, thanks. Looks like we have the consensus of alexbrn, me, and drchrissy for that version. Jytdog (talk) 14:02, 9 April 2015 (UTC)

And why are you unhappy with the edit note?__DrChrissy (talk) 14:21, 9 April 2015 (UTC)

wording: "no good evidence" vs "no strong evidence"

I have changed "no good evidence" to "no strong evidence" - reasoning as above. "No good evidence" may be a commonly used phrase in medical research circles, but here in a general encyclopedia, and most specifically, in this sparsely worded stub article context, as I have pointed out in detail above, I find it ambiguous. This wording was in fact also proposed as an alternative by Alexbrn earlier in this thread, so if there is a pressing reason to use "good" specifically, please discuss first if there is a desire to revert. Thanks! --Tsavage (talk) 15:32, 9 April 2015 (UTC)

I did propose that, but when saying so it's probably good to add that the strongest evidence we have is in fact that this treatment is ineffective ... which is all getting a bit over-complicated. So maybe plain old "no good evidence" is best after all ... ?
Both of these in my opinion are OR. We are sitting here as editors with our own skills and lack of skills stating whether scientific evidence is "good" or "strong" when neither of the cited sources use these words. I think a much better way of stating it would be "There is evidence that the Scrambler system benefited patients (insert source), although another study found no beneficial effects (insert source). It is not our position as editors to judge whether the scientific evidence is "good" or "strong" or whatever. (If it is, we need to consider careflly, potential pseudoreplication and Type I errors which appear to have been ignored by the sources we are giving and the reviewers of the original papers.)__DrChrissy (talk) 16:08, 9 April 2015 (UTC)
We must paraphrase well, dipping into discussion of the underlying literature is not good style and simply having a "on the one had; on the other" type of statement would ignore the relative strength of the evidence - which we wouldn't want to discuss in the article anyway. I think a plain old "no good evidence" is about as good as we can do here, but am always open to views from the experts at WT:MED if it's really necessary to continue this. Alexbrn (talk) 16:21, 9 April 2015 (UTC)
This is not paraphrasing. The sources make no statement whatsoever about the relative strengths of the evidence - this is being made up by you and you are inserting it into the article! If you wish, we can start a discussion on the relative strengths of the evidence - I am more than happy to get involved in that.__DrChrissy (talk) 16:42, 9 April 2015 (UTC)
Well, we fundamentally disagree so don't I see any point in continuing. To repeat, if you want to widen the consensus by all means post to the WT:MED noticeboard for expert input on this matter. Alexbrn (talk) 17:23, 9 April 2015 (UTC)
I believe this is a much wider issue than just WT:MED. This is original research and therefore involves ALL in the WP community. We fundamentally disagree because you have made a mistake by making this edit. I invite you to delete or edit it as appropriate.__DrChrissy (talk) 17:32, 9 April 2015 (UTC)
I won't bother to change this again, it seems okay to me as is. The WT:MED folk can tell best if something's a fair paraphrase of a medical text; the wider community would defer to them in any case. Alexbrn (talk) 17:36, 9 April 2015 (UTC)
Though we do need something here. I've restored the consensus text you removed as it's good enough. Alexbrn (talk) 17:45, 9 April 2015 (UTC)
OR is not good enough. I should not have to tell you that. Please explain why you think this OR statement is a piece of consensus text.__DrChrissy (talk) 17:48, 9 April 2015 (UTC)

Facepalm Facepalm see above. Alexbrn (talk) 18:04, 9 April 2015 (UTC)

@Alexbrn: At the risk of having you faceplam yourself again, this is where things get hazy for me. Do we recognize "experts" at Misplaced Pages who can essentially override core policy and guidelines? I guess in practice this may happen and seem necessary and expedient, it also seems dangerous, a classic slippery slope, as WP has no mechanism for verifying credentials, and the checks and balances of random editors weighing in can in practice be all but eliminated. It seems what is being suggested is that, as a general encyclopedia reader (and editor), in cases where special technical knowledge is required that I don't possess, I should trust self-confirmed experts in that area to synthesize conclusions for me (at least, in cases where no secondary review source is there to do that)? Is that not what "no good evidence" is, a Misplaced Pages editor's "expert" summary of specialized medical data?
Seems to me the core Misplaced Pages approach suggests instead writing it out rather than shorthanding it, for example, to convey "no good evidence" clearly, explain the evidence: "One qualitative study indicated X, while a more rigorous random control trial blah blah..." (just a rough example, not a proposed wording), rather than simply synthesize conclusions. It doesn't seem such a hardship, it's only be necessary in cases like this where there is not a huge choice of reference material.
This is not mountain out of molehill around a single phrase, it addresses the somewhat pointed editing I've encountered in recent weeks all over the place, people getting worn down by referencing rules and guidelines (like WT:MED), but really only trying to promote their own view of things as the one and true course (and I'm still assuming good faith, combined with wrongheadedness). (FYI: My input on Misplaced Pages, here and elsewhere, is strictly, independently, 100% my own! :) --Tsavage (talk) 21:42, 9 April 2015 (UTC)
I can appreciate it's hard at first, but you might want to look at the AN/I thread I linked below where some other medical editors are weighing in. There is "no good evidence" - that is a safe, faithful & plain reading of what is in the text. It doesn't require huge expertise to arrive at that, more familiarity with WP:MEDRS. There may be room for discussion about how that is then presented (as we've had). Why not look at some featured medical articles to get a feel for how medical content is paraphrased here and what WP's idea of best practice is? What we must be very careful of doing is giving credence to research results that have not been accepted by good secondary sources. Alexbrn (talk) 21:50, 9 April 2015 (UTC)
@Alexbrn: Thanks for the thoughtful (although kinda creepy indoctrination-to-the-cult-sounding) words. My concern, I think already clearly stated, is with editors staking out subject territories and gradually eclipsing core Misplaced Pages policy with increasingly prescriptive specialized "guidelines" that are aggressively enforced by regular, frequent, "full-time" editors and self-confirmed expert editors, resulting when met with opposition in editing approaches as displayed on this page, and steadily replacing collaborative, constructive, unhurried editing that is accessible to anyone who can display a measure of basic critical thinking and English literacy. This ownership behavior makes editing practically a combat sport, and certainly scares off, or at least annoys off, casual and first-time editors, which is likely very bad for the encyclopedia as a whole, as any significant loss of diversity tends to be. And the joy of it all gets sapped right out.
It's great that dedicated editors, including no doubt extremely intelligent and highly educated ones, have devoted themselves via Projects to specific areas like medicine and military history and film and video games and so forth. But imagine if each of those Projects got so full of rules and "experts" that a simple, unaffiliated generalist editor has to face a wall of special guidance in order to contribute.
A bedrock core policy, from right at the top of the procedural policy guiding the creation of Misplaced Pages policies and guidelines is: "There is no need to read any policy or guideline pages to start editing." I don't take that as a trick statement, which actually means, "but if you're not quite intimately familiar with WP:MEDRS first, good luck editing this medical stuff over here."
Even at this point in the discussion, you seem to still be defending the idea that an "experienced" health/medical article editor has special dispensation to synthesize conclusions from specialized technical source material and present them without normal attribution in article content, like summarizing the results of several medical trials as, "no good evidence." Whether it is a health article or a cooking article where many Misplaced Pages editors who are also top chefs and food engineering scientists concur that that is definitely "too much salt," it is not verifiable content until there is a proper citable source. Am I wrong? --Tsavage (talk) 04:36, 10 April 2015 (UTC)
Spot on Tsavage! I, however, do feel I am in a position to challenge the "paraphrasing". I have X degrees, I have published X papers cited in MEDLINE, I have X books published, I have been an editor on X journals for X years....and on, and on and on. So, why should my "paraphrasing" (which is really OR) be deleted in favour of another editor's made up comments?__DrChrissy (talk) 21:51, 9 April 2015 (UTC)
@Tsavage: it's not expertise which decides things on WP, it's consensus. However competence is required and that includes appropriate familiarity with the WP:PAGs that govern topics, as well as competence in reading comprehension and writing. On the topics at issue (the summarizing of a source, and whether the earliest date of published research can be mentioned) I've given multiple policy-backed responses saying what I think. I think you're wrong in arguing against my wise position. Fine: people can disagree. The mechanism to resolve such disagreements is through WP:DR so I invite you to pursue something that way if you're not satisfied. Note this has already been elevated to WP:AN/I and the responses there are instructive. What I'm not prepared to do is enter into lengthy discussion on a talk page not only justifying edits, but justifying the entire WP culture behind what we do. I don't write the rules, I follow them (with some small exceptions). If you want somebody to do that kind of explaining, maybe WP:MENTORSHIP may be a good option? Alexbrn (talk) 06:09, 10 April 2015 (UTC)
@Alexbrn:That's fine, you've made your position quite clear, there is no need to carry on endlessly, once "consensus" gets tossed in whole hog, I find that fairly good evidence of an end of road. I have read and participated in the AN/I thing, and that hasn't added anything really: two sides, little middle ground. Your suggestion of mentorship as an alternative to you simply answering what was ultimately a yes or no question betrays some frustration...well, that's mutual! Cheers!! --Tsavage (talk) 06:42, 10 April 2015 (UTC)


Relevant discussion at→ Misplaced Pages:No_original_research/Noticeboard#Is_this_summary_OR.3F

Note: there's a discussion open here regarding this issue. Zad68 19:15, 10 April 2015 (UTC)

published as early as X

in this dif, drchrissy added:

A research paper into its effectiveness was published as early as 2000.

References

  1. Serafini, G., Marineo, G. and Sabato, A.F. (2000). "Scrambler therapy": a new option in neuropathic pain treatment?". The Pain Clinic. 12 (4): 287–298.{{cite journal}}: CS1 maint: multiple names: authors list (link)

This is trivia and WP:OR. It is the editor (acting as an author) commenting on the publication history. We as editors don't do this in WP. You need secondary sources that say this, and say why it is has some significance. There are endless factoids we could point about things in this way. Like "Anna Olsson is the corresponding author for the "Ethical Treatment of Animals in Applied Animal Behaviour Research" published by the International Society for Applied Ethology. (ref)." It is both WP:OR and trivia. Jytdog (talk) 16:02, 8 April 2015 (UTC)

with regard to this edit note while reverting, which says "It is not trivia to know that research has been conducted for 15 years. In fact this is essential to the article" -- it is trivia. All proposed medical treatments have long, long development timelines. This is no different. it is trivia. Jytdog (talk) 16:06, 8 April 2015 (UTC)
Other than this reference, the other three journal references are dated 2014 or 2015 (the website (which no doubt will be removed from the article soon) indicates research has been going since 2002). Without this reference, the article mistakenly gives the impression that there is no history of research. Oh, I happen to know Anna Olsson professionally (I wonder if you are fishing to out me)- I don't think she would really like being described as Trivia.__DrChrissy (talk) 16:24, 8 April 2015 (UTC)
(total aside with regard to the example i used; i have been reading about the ethics of animal testing for work and just happened to have that up. How strange that you know her!) to the point: the secondary sources describe the clinical testing of the device and cite publications of that research. there is no doubt it has been under development. What you have added is OR and trivia. We'll see what others have to say about that. Jytdog (talk) 16:34, 8 April 2015 (UTC)

Agree with Jytdog this is trivial - and original research (against which we have a policy): editors must not take it upon themselves to perform research on what the early/earliest papers were on this topic and then insert their findings sourced to a reference which does not even verify the thought that is expressed. Ugh. Alexbrn (talk) 17:00, 8 April 2015 (UTC)

Whether it is trivia is simply a matter of opinion and we shall see what others say. With respect to OR, it is a neutral statement that there is a paper out there which exists and I am letting the reader know where I can find it. If this is OR, then for every reference we use, there would have to be a reference to that reference! Absolutely ridiculous!__DrChrissy (talk) 17:09, 8 April 2015 (UTC)
no you are making a meta-statement about the reference, not summarizing content from the reference itself. it is different. It like saying Anna Ollson is the corresponding author - pulling some random factoid from information about the publication. in your case, its date. Jytdog (talk) 17:14, 8 April 2015 (UTC)
There in nothing in the source that supports your text "A research paper into its effectiveness was published as early as 2000" - obviously, since nobody writing in 2000 would have such a "as early as" thought. WP:V is a core policy too you know; you're misrepresenting the source to support your WP:OR. Alexbrn (talk) 17:17, 8 April 2015 (UTC)
I've had a bit of a dig around and I can't find any WP: pages on what meta-statements are. Presumablt there is a polict or guideline which says these should not be made, otherwise you would not have made such a statement. Please can you provide which policy/guideline says I should not be using meta-statements.__DrChrissy (talk) 17:43, 8 April 2015 (UTC)
There are many kinds of WP:OR and many kinds of trivia and you will not find everything legislated. Jytdog (talk) 17:53, 8 April 2015 (UTC)
OK - that is twice in one day I have encountered editors unable to give the supporting material for their actions.__DrChrissy (talk) 18:02, 8 April 2015 (UTC)
I am very comfortable with the grounding in OR and trivia. anyway, positions here are clear and so far there is no consensus for the text you added today. i won't edit war with you but will wait for further input.Jytdog (talk) 18:13, 8 April 2015 (UTC)

I don't follow the editorial reasoning here, why is it that a paper titled "Scrambler therapy," which is also the title of this article, can't be mentioned in this article (using whatever neutral language)? For example:

The US government's PUBMED citation database for biomedical literature lists "Scrambler therapy" by...etc...

Also, mentioned but unanswered in my comment in the previous section: why no mention here when this paper is cited in another paper that is currently cited in this article (and specifically, supporting the material in the cited paper that is referenced here). --Tsavage (talk) 18:25, 8 April 2015 (UTC)

Also, isn't a research paper considered a proper secondary source about itself as a topic or about its originators, depending on context, as in "Scrambler therapy timeline: A paper entitled 'Scrambler therapy' was published in 2005," or whatever? In that case, it's simply a historical reference to the existence of the paper, not a reference to content. I believe this was mentioned above, where Jytdog countered with: "pulling some random factoid from information about the publication. in your case, its date" - isn't the date of a study pretty integral to the study, are there many studies published undated? --Tsavage (talk) 22:41, 8 April 2015 (UTC)

pulling a random primary source into the article and stating its date is random; trivia. why don't we pick the paper before that, or after that? it is pure WP:OR to do this. why do just one? why not 20? it can stay in the article, tagged. am not going to fuss over this. Jytdog (talk) 22:50, 8 April 2015 (UTC)
Is it a random paper? It seemed like the original paper by the people who originated this. In any case, if the effort wasn't to strip the article to nothing for AfD, instead, to develop it, including this paper would be the the start of some sort of history or timeline coverage. So you're "giving up" on it? Sounds like making a mess, disassembling the car against other advice, then throwing up your hands and saying, "you don't like it, you fix it." Maybe it wasn't broken in the first place...is the point. (FYI: I am being as diligent as possible in pursuing my points, because I've lately run into the pattern of people being bullied and worn down by a handful of regular editors, intentionally or not. This isn't good for keeping the encyclopedia fresh and high-grade... People leave and don't come back.) --Tsavage (talk) 23:08, 8 April 2015 (UTC)
your question "is it a random paper" points up the OR problem perfectly. we generally use content from a source (that is determined to be reliable or not based on its meta-data) to build WP content from. here, the WP content is a comment on the source's meta-data. it is without context and random. Jytdog (talk) 23:36, 8 April 2015 (UTC)
I disagree that it is random. I have searched for earlier papers and I can not find them. This is of course OR, so with strict interpretation of OR, I can not say it is the "first paper". In my own opinion, I feel it is destructive to delete such a non-influential atatement but extremely important contribution to add context. If I read "first paper" and was worried about it, I would research it and not simply delete it. If I was REALLY worried about it, I would tag it rather than delete it. Is the WP project really that fragile that it will be brought to its knees by potentially getting the date wrong of the first publication of a research program? I considered writing "A paper investigating the Scrambler system was published in 2000"; this is not OR, but it is rather bland to say the least. I actually think common-sense should prevail here, rather than strict adherance to a wiki-lawyered interpretation of a policy.__DrChrissy (talk) 12:45, 9 April 2015 (UTC)
@Jytdog & Alexbrn You have stated that this statement is trivia. Please could you direct me to the policy/guidelines/essay on which you base this argument for deletion.__DrChrissy (talk) 13:26, 9 April 2015 (UTC)
@Jytdog: Please note that in my contribution to this thread, the original "as early as" was not what I am discussing, I questioned the apparent intent to remove from the article, for whatever reason, a reliably indexed paper called "Scrambler therapy" from an article called...Scrambler therapy. I proposed a non-OR wording - "The US government's PUBMED citation database for biomedical literature lists "Scrambler therapy" by...etc..." - but you have not addressed that.
I also pointed out that, to my understanding, a primary source study of a topic becomes a secondary source about, for example, research into that topic. So if we are discussing medical merits of Scrambler therapy, then "Scrambler therapy" is a primary source. But if we are setting out, in say a History or Background section, the nature and chronology of research efforts into Scrambler therapy, then "Scrambler therapy" the single-study paper would be considered a secondary source, for information about general scope and methodology, date, participants, and so forth. Am I incorrect here? Pleae let me know, I will learn from that and stand corrected! :) --Tsavage (talk) 15:51, 9 April 2015 (UTC)

Tsavage you are really proposing to describe what pubmed says, in the content? if so, what would be the source for that? Jytdog (talk) 16:10, 9 April 2015 (UTC)

I was having thoughts along similar lines to the first point made by Tsavage. If I run a search for articles on woo, I should be able to say, "the first article published on woo was in 2000" with a reference to the search engine and relevant parameters. If anyone has a search with an earlier date, so be it. We simply edit it, rather than delete the first statement.__DrChrissy (talk) 16:25, 9 April 2015 (UTC)

Yeah, do your own inexpert research then put it on Misplaced Pages. Just what you mustn't do. Alexbrn (talk) 16:28, 9 April 2015 (UTC)
Do you mean like the totally unsourceable OR here? I suggest you look at this edit very carefully.__DrChrissy (talk) 16:37, 9 April 2015 (UTC)
@Jytdog: (1) "what would be the source for that?" To restate my question with an example: For Scrambler therapy, I want to create a History section. I look for reliable sources that review the origins, milestones and general nature of research on the topic. As part of my source material, I reference individual scrambler studies for details such as when they were published, type of testing performed (description, like, "RCT," not results), participants, where published. In this usage, I am asking, is not each individual published study in this context a secondary source for providing information on the state of research into that topic at that time, therefore, its own source?
(2) As far as citable sources, isn't PUBMED, or I guess, technically, MEDLINE, as an abstracts database, a reliable secondary source in itself? A search result listing abstracts of found literature is a document on its own, so can I not cite it for various editorial purposes, regarding all or subsets of the literature in that listing (provided, of course, there is no synthesis of conclusions)?
(3) Apart from (1), isn't it acceptable to use primary sources published by the subject, for non-controversial information about the subject: for example, describing a movie plot using the movie as the source, or using a company web site for basic information about that company? Does this not apply in non-medical effect coverage (such as in a History section) of medical topics, like here, referring to a study like "Scrambler therapy" for information on when it was published?
I'm trying to avoid getting too caught up in the nuances of academic or medical research conventions, and keep to the plain English, general encyclopedia Misplaced Pages spirit, so clarification would be extremely helpful in developing further as an editor. Thanks! --Tsavage (talk) 17:25, 9 April 2015 (UTC)
unless you can find a secondary source that recounts the history, your recounting it from primary sources is WP:OR. that is what historians do in their books - gather the primary sources and tell the story. we as editors cannot do that. we edit, not author. if there is a secondary source telling the history of scrambler, sure that can be summarized in the article. pubmed is not a secondary source and has nothing but data - you are right that you would have to synthesize stuff to use it for anything. Jytdog (talk) 17:47, 9 April 2015 (UTC)
I see this as being akin to Misplaced Pages:These are not original research#simple calculations. If a url is given for a search, and this includes the parameters used (or the search results shows these), this is verifiable. If the search result shows a list of publications, then it is showing which is the first publication.__DrChrissy (talk) 18:09, 9 April 2015 (UTC)
This is so wrong-headed it's hard to know where to start. First, the search engine's corpus may not be accurate; secondly, the result is dynamic and so not guaranteed to return a stable result; thirdly, search engines can tailor their result depending on the user agent information. And on top of all this it's original research! A search engine result is not a "simple calculation" - saying they're equivalent is disruptive wikilawyering. Alexbrn (talk) 18:30, 9 April 2015 (UTC)
Why all this effort to exclude material without being able to clearly explain why and on what basis? I'm just trying to get a straight answer on how one might include THIS PAPER, "Scrambler therapy" in THIS ARTICLE, Scrambler therapy, for the simple editorial reason that it seems relevant to the topic. WP policy: "A primary source may only be used on Misplaced Pages to make straightforward, descriptive statements of facts that can be verified by any educated person with access to the primary source but without further, specialized knowledge." Do the title, the publication date, the authors, the publisher, and the general nature of the study as described in the abstract, with no reference to results, medical claims or effects, not constitute such straightforward, easily verified use of the source? And if I include two sources or three or more that way, with no conclusions drawn by aggregating material from them, how is that original research? It seems you're saying that every item must have a secondary source that at least says, "This item exists," and every list of items must have a secondary source that lists those items? --Tsavage (talk) 21:23, 9 April 2015 (UTC)
Tsavage i completely understand that your common sense is telling you that you ~should~ be able to include a scientific paper called 'scrambler therapy' in a WP article on 'scrambler therapy'. Clear as day, that this is what you want. This is a primary source. every WP content policy (WP:OR, WP:NPOV, WP:VERIFY) and both sourcing guidelines (RS and MEDRS) urge us to use secondary sources to build articles. The reasons for this are many and are deep in the guts of WP (I recently added a mini-essay on this, on my userpage). so, we steer clear of primary sources. that is how WP works. sure we can sometimes use primary sources, but gingerly, and with little-to-no WEIGHT on them, and with some good reason. So what is the need to use that primary source in particular? Jytdog (talk) 23:50, 9 April 2015 (UTC)
Jytdog, I truly apprecite that, unlike many other editors in discussion, you do hang in there and actually discuss! Kudos!! Now, if only you could be more EFFICIENT, by trying to actually address full questions in one shot! Yes, I get that you get that my common sense says scrambler paper in scrambler article. That wasn't my main point. It's about interpretation of Misplaced Pages policies and guidelines. You didn't answer the central question, which is: Why can I not list that (and other) papers in, say, a simple "Published papers" section, just like I would any other relevant list in any other article, citing the items as reliable sources for the basic info about themselves like title, author, etc, per WP policy: "A primary source may only be used on Misplaced Pages to make straightforward, descriptive statements of facts that can be verified by any educated person with access to the primary source but without further, specialized knowledge." A list is a list. It's relevance is usually obvious. A simple descriptive heading makes it even more obvious. I don't need a source to say a list of studies is...a list of studies. --Tsavage (talk) 00:05, 10 April 2015 (UTC)
"just like you would in any other article"... do you really include lots of lists when you edit? the instinct to do that is just so strange to me, Tsavage. can you show me any article on a product in WP where there is just a list of articles about the product? we don't do that in any health related articles (see WP:MEDMOS for the standard sections of a health-related article) For a lot of health products things, the idea of just copy/pasting all the references out of pubmed would be crazy - there can be dozens. in this case there happens to be ~10 so it doesn't seem too crazy. but i really don't get why you would want to Jytdog (talk) 00:25, 10 April 2015 (UTC)
It's not complicated, it's a simple possible approach that I would perhaps apply to improve this article: in a case like this, without a lot of secondary review material, and as you say, a relatively small number of reliably searchable papers, a dozen or so, a simple listing with brief description might be one way to neutrally and verifiably document some background. It wouldn't be crazy listy, instead, an annotated chronological list, more a series of tasty, bite-sized paragraphs (accessible, inviting, readable), something like (rough example only):
  • "Study title" (year) Author, Author. Publisher. Brief description from abstract, like, randomized controlled trial, or 37 patients treated for up to 10 days.
That's what I'm talking about, editorial solutions that follow core guidance and make more content available, not less. And no, I don't create lots of lists when I edit. And this list would probably eventually be edited out if much more material became available. And my point here is to suggest practical constructive approaches to editing (what I usually do in non-contentious situations), rather than strip down, AfD, purge type editing. Are we in a rush? --Tsavage (talk) 05:07, 10 April 2015 (UTC)

FYI - AN/I posting

A section relevant to this article is at WP:AN/I#Alexbrn and Jtydog inserting OR material despite being warned. Alexbrn (talk) 21:26, 9 April 2015 (UTC)

Misapplication of WP:MEDRS.

An editor recently reverted an edit here indicating this "contravened Edit Warring in Violation of BRD and MEDRS...". I am assuming MEDRS is WP:MEDRS. I have looked at this guideline and it makes no mention whatsoever about edit warring.__DrChrissy (talk) 10:02, 13 April 2015 (UTC)

while the rationale was compressed it is clear that the words "restored sources that were removed per" MEDRS were elided. so that the second half should read "and restored sources that were removed per MEDRS". Jytdog (talk) 12:04, 13 April 2015 (UTC)
Sorry, but I can't see the point you are trying to make - this is about an editor incorrectly using WP:MEDRS to substantiate an accusation of edit warring. Where does "Restoring sources..." come into it?__DrChrissy (talk) 13:18, 13 April 2015 (UTC)
no you are misinterpreting the edit note. edit notes are compressed. while it is reasonable to ask for clarification, you have asked and been answered. what the editor meant was clear as day per my note above. if you want to make drama over this it will go nowhere as the meaning was clear, as i just explained to you. Jytdog (talk) 13:49, 13 April 2015 (UTC)
@Jytdog Here, you edited my edit without entering into discussion. Misplaced Pages:Talk page guidelines states "Never edit or move someone's comment to change its meaning, even on your own talk page." (Bold is used in the statement). It also says "To avoid disputes, it is best to discuss a heading change with the editor who started the thread, if possible, when a change is likely to be controversial." Do not ever edit my edits again, here or elsewhere, without discussing this first. If you do, I will deem this to be WP:Incivility.__DrChrissy (talk) 17:51, 13 April 2015 (UTC)
actually section headers are open game, and are meant to be neutral. didn't touch your comments. Jytdog (talk) 18:08, 13 April 2015 (UTC)

(e/c) DrChrissy, you know, also at WP:TPG, it says:

Section headings: Because threads are shared by multiple editors (regardless how many have posted so far), no one, including the original poster, "owns" a talk page discussion or its heading. It is generally acceptable to change headings when a better header is appropriate, e.g., one more descriptive of the content of the discussion or the issue discussed, less one-sided, more appropriate for accessibility reasons, etc.
and the diff you provided shows that Jytdog didn't edit a comment text of yours but rather made the heading more appropriate by removing a "...again", which looks like a one-sided pot shot. Yes the same guideline goes on to say,
To avoid disputes, it is best to discuss a heading change with the editor who started the thread, if possible, when a change is likely to be controversial.
Was removing the pot-shot really "controversial"? And is this really how we want to collaborate with each other on an article Talk page? Zad68 18:13, 13 April 2015 (UTC)
I did not talk about "comments"; I talked about "edits" - a heading is part of an edit. The guidance stands that Jtydog should have discussed a heading change with me before editing this. Of course I agree this type of discussion should not be the use of the Talk page, but Jtydog simply refuses to engage in a collegiate way and flagrantly ignores guideline advice. Anyway, I have been forced into making the warning of WP:Incivility and noted the misuse of WP:MEDRS. Shall we all just drop this stick? __DrChrissy (talk) 18:41, 13 April 2015 (UTC)
OK DrChrissy, I hear you that you feel the edit was a MEDRS issue, and that you didn't like Jytdog touching what you typed. I agree with you that this section isn't productive. Would you agree to having this section {{hat}}ted? Zad68 18:59, 13 April 2015 (UTC)
Not just yet please. There may be other editors who wish to comment and this has only been live in the European time zones I think.__DrChrissy (talk) 19:03, 13 April 2015 (UTC)
OK I can't say I totally understand keeping a section open that you've already said isn't a great use of an article Talk page, but, as you wish... Zad68 19:08, 13 April 2015 (UTC)

Potential sources

I found 2 review articles that may contribute to the notability of this therapy. However I don't have access to the full text of either of them and scrambler therapy is not mentioned in either of their abstracts (they just came up in a Google Scholar search). The reviews are here and here if someone with access wants to look at them. Everymorning talk 01:00, 14 April 2015 (UTC)

thanks everymorning. the first link is PMID 24500635 , the second link is PMID 23008320; the third link is PMID 24718395.
  • PMID 24500635 a review in a great journal from 2014. it has one sentence on scrambler per se. "However, new percutaneous methods appear to be effective for treatment of intractable pain syndromes, where the implanted systems did not show dramatic benefit. As an example, Scrambler therapy showed significant improvement of chronic neuropathic pain"
  • PMID 23008320 is by Pachman from 2012 and scramber gets a passing mention "A pilot trial supported that Scrambler therapy, a novel treatment that provides electrocutaneous nerve stimulation simulating endogenous nerve action potentials, was helpful in the treatment of CIPN" and later "However, Scrambler therapy may have benefit in the treatment of visceral or postsurgical cancer pain." citing a paper from 2003, and it is listed in a table in a column called "Interventions With Potential Benefit Needing Further Study' That group updated their review in PMID 25119581, which is an "opinion" piece. They cite some more trials that have been done since 2012 and their conclusion is again that more research is needed.
  • PMID 24718395 is from 2014, and is a pretty low quality journal - the text is available for free so everybody can read it, they also say "The results of these preliminary studies need to be confirmed via clinical trials to be used in cancer subjects including breast cancer survivors' Jytdog (talk) 01:39, 14 April 2015 (UTC)
  • can't figure out where this one came from:
  • PMID 24780851 is from 2014 and is about treating pain in kids. These guys are pretty enthusiastic about it.:
"Scrambler Therapy (ST) is a new noninvasive neuro- modulation approach to the treatment of chronic neuro- pathic pain . The underlying theoretical perspective does not rely on the Gate Control theory but instead on the theory that the nervous system is a cybernetic system that responds to coded information . In chronic pain, nociceptors have theoretically been damaged and produce erroneous pain codes that can be produced independent of a sensory source (eg, phantom limb pain) . Neuromatrix theory postu- lates that the pain signals must be reinterpreted by the brain to return to homeostasis and thereby no longer produce chronic pain . ST is thought to interfere with the pain neuromatrix by providing nonpain codes . Initially de- veloped as a treatment for oncological neuropathic pain and chemotherapy-induced peripheral neuropathy, ST has been used successfully on a variety of chronic pain symptoms, but there has not been a focused large-scale study of this method in the pediatric population . Recent investigations of the efficacy of ST have all demonstrated excellent results with various forms of adult neuropathic pain (eg, neuropathy, neuralgia, CRPS, failed back syndrome) . The results of ST with 173 consecutive adult admissions demonstrated significant improvement across multiple diagnostic groups, including CRPS, with improvement maintained for 6 months in 75% of the patients treated . Studies on ST in pediatric CRPS appear to be indicated." So, they say that for kids, more study is needed. Jytdog (talk) 01:44, 14 April 2015 (UTC)

Any medical expert comments on this article as a source?

This article, Researcher Says Calmare ‘Scrambler’ Provides Pain Relief, from Sep 2013, is a fairly in-depth journalistic report, which talks to an MD (Dr. Thomas Smith) at Johns Hopkins University School of Medicine who is actively investigating and publishing on Scrambler, and interviews the company marketing the Scrambler device in the US. It contains several items that, as a Misplaced Pages editor, I would find interesting to pursue for any type of article, to flesh out the coverage and present a complete and balanced encyclopedic summary of the subject.

Considering that this is a MEDICINE-related article, it would be great to get general and/or specific feedback on using the article as a source. Some specific points (direct quotes from the source article in italics):

  • The publication the article appears in, a webzine called National Pain Report seems to be reasonably reliable, in that it is generally well-written, current, and the authors seem to be credible for their topics. That Beth Darnall, PhD, Clinical Associate Professor, Pain Medicine at Stanford School of Medicine, is a regular columnist, with the publication listed in her mini-bio on the Stanford site gave it an extra point. I haven't vetted it further than a quick look. So far, any problems with it as a reliable source?
  • ...about three dozen Scrambler devices are now in use at pain clinics in the United States, mostly on the east coast. They are licensed to Competitive Technologies, Inc. (OTC: CTTC) a small technology company in Fairfield, Connecticut that distributes and leases the Scrambler under the name Calmare pain therapy. - This is interesting background on the device in the US: where it comes from, how many there are. Is there a problem with this info from this source?
  • “If this were a very rich company, it would invest $3 million and do a 60 patient sham controlled trial in a heartbeat. But the company doesn’t have that money,” says Smith. - This seemed to me to be noteworthy background on why the device has appeared in the legitimate medical literature over at least a decade, yet does not have a body of significant trials. Is this a significant problem, selective funding of RCTs, or is this a common excuse for marginal devices being hawked by small, opportunistic, bottom-feeding companies, or somewhere in between?
  • Perhaps the biggest barrier to making the Calmare Scrambler more widely used is that the therapy is not usually covered by Medicare or private insurance companies. As a result, many patients pay in cash, usually about $150 to $200 per treatment. That can add up to thousands of dollars after a standard course of ten treatments. and "We are not what is called a ‘standard of care’ yet. And believe me, if we were, the number of people that could be treated with this would escalate dramatically," said Johnnie Johnson, Competitive Technologies’ chief financial officer. - Again, how much of this is an issue for treatments, and should it be mentioned as a consideration (or a simple fact) here? Is there a relevant story behind how treatments and devices do or don't get insurance-approved (for example, I recall lots of fictional plots and actual news stories based around medical insurers apparently holding out on various newer treatments just because they are newer, apparently for monetary self-serving reasons).
  • Direct comparison is made to spinal cord stimulators, an apparently established device-based treatment: ...the Scrambler, which is similar to a spinal cord stimulator, but far less invasive. Spinal cord stimulators, which also use electricity to block pain, are surgically implanted next to the spine. ... “It’s almost as if we’re getting the same ultimate end result as spinal cord stimulator, but without having to unroof the spinal cord, sew an electrode on and then have it permanently connect to an implantable pump that costs $50,000.” - Is there any medical validity to this comparison, i.e. the impression I get is that this is somewhat like another delivery method for an already-proven type of approach using electrical stimulation.
  • Dr. Smith says more studies are needed to fully understand how the Calmare Scrambler works – and why it doesn’t for some patients. “There are probably 20 percent of people who don’t respond to anything, but it seems like the other 80 percent get at least minimal, if not substantial relief. We’ve had people where you can actually see the redness and pain and inflammation diminish over a couple of days as the pain gets re-set,” Smith says. “It could be that some of this is placebo. And I’m more than willing to accept that,” he adds. - In general across various subject areas, using this material with an expert quote from Smith would seem fine; is it not suitable to summarize this excerpt in this article, for example with something like: "According to Scrambler therapy researcher Smith, more studies are needed to understand how and on whom the it works: 'xxxx quote xxxx'" If not, why not?

As a non-technical, non-medical editor, I'm truly interested to see how some editors propose to apply the special standards of WikiProject Medicine to editorial creation. I could "test" all of this by editing the article and seeing what happens - oh, joy! - but this seems to be a potentially more collaborative and efficient approach. Thanks in advance! --Tsavage (talk) 18:59, 17 April 2015 (UTC)

Zad68's comments

Here are my comments as a Misplaced Pages editor.

  • The nationalpainreport.com website isn't the kind of website we use for unattributed statements of fact, and in fact isn't the kind of website I'd expect a quality reference work to use at all. This website appears to be part of a group of self-cross-referencing websites that include americannewsreport.com, painnewsnetwork.org and thenationalpainfoundation.org. These websites are operated by a small group of people, including Pat Anson, the writer of the article. You can do your own web searches on the author's name and add in a few filter keywords like "pain" to find out more about the individuals, and they do not appear to have any significant medical training and they are not associated with any recognized academic or research institution. What they do appear to be is a group of amateur enthusiasts who have set up a marketing network. As such this article and the other ones like it within this network of websites would not meet WP:RS much less WP:MEDRS as normally applied.
  • What does seem legit is Dr. Thomas Smith. He holds a named chair position at Johns Hopkins, which has a very well-respected medical school, and per WP:NACADEMICS the named chair position would make him assumed to be notable enough for his own Misplaced Pages article. He is the Director of Palliative Medicine, so his notability is directly related to this article topic. So something he has to say about Scrambler I would expect to be noteworthy enough to include, although attributed.
  • Smith is apparently doing his own research into the effectiveness of the device. He was listed as an author on this study from 2013. Here he has registered a clinical trial, a randomized double-blind sham-controlled trial, which should indeed produce determinative evidence. Study scheduled to conclude July 2017.
  • I also saw somewhere (can't find it now) that Smith declares no competing interests re Scrambler. I would take such a declaration seriously (unlikely that he's lying or hiding something) given his high profile position and how much more he would stand to lose in his reputation if it came to light it wasn't true.

Overall I find the marketing website quotes not useable due to the high likelihood that they'd be taking the quotes out of context or not providing all relevant information, but I'd look into summarizing something by Smith, with attribution, and making sure to reflect any important qualifiers and context.

Interested to hear from others. Zad68 22:13, 17 April 2015 (UTC)

Waiting for the secondary literature sounds like a good plan. It's not as if we're in any hurry, and we don't want to get ahead of the science. Alexbrn (talk) 05:28, 18 April 2015 (UTC)
Categories:
Talk:Scrambler therapy Add topic