Talk:SIDS/Archive 3

Archive 1

Archive 2

Archive 3

Cardiac arrhythmias as important in both SIDS and SADS/SUDS

I'm seeing in various places, such as a textbook (in passing) and www.sads.org (in more depth), that cardiac arrhythmias are probably an important subset of cause in both SIDS and SADS/SUDS, with numbers like 10%, 30%, and 40% of cases being thrown around. Channelopathies are being mentioned as transient factors that cause arrhythmias but don't leave any detectable evidence once death occurs, hence the lack of known causality at autopsy. Doc James was right that we need refs to cover it, but I lack time and expertise to do it right now. However, if it is such a big factor, it needs to get covered here eventually. All I have time for right now is to note that here at Talk. Thanks to anyone who can do more with it. Quercus solaris (talk) 00:20, 12 January 2016 (UTC)

We mention "heart problems" in the lead. This would include both structural and functional problems such as channelopathies. Doc James (talk · contribs · email) 00:34, 12 January 2016 (UTC)

Have added a bit [1] Doc James (talk · contribs · email) 00:45, 12 January 2016 (UTC)

Unclear what this has to do with SIDS

"There is a correlation between sleep cycles and the onset of apneas."

Doc James (talk · contribs · email) 15:46, 25 January 2016 (UTC)

Car Seat Safety

Many people are unaware that leaving your precious infant to sleep in their safety-tested car seat could actually be very detrimental to their survival. In most SIDS cases that correspond with strangulation, 52% of them took place in a car seat. Most often times it has to do with the straps on the car seat specifically. In some cases the child was left unsupervised for as little as 3-6 minutes. The reason this typically occurs is because the child is not positioned flat on their back. When the child is placed in a car seat their neck typically goes to one side or the other, causing their airway blockage to be obstructed. Most of the time this has to do with the way that the buckles on the harness are secured on the baby. To help avoid car seat death for your infant it is said that whenever you are not traveling and your child falls asleep in the car seat you should move them to a safe spot immediately. If you are traveling and your child falls asleep in the car it is best to have a mirror angled so you can easily see your child and make sure that they are still breathing. Most hospitals offer car seat safety classes for new parents. This is a great preventative measure to take in order to teach parents how to create safe sleep for their new infant. Often times car seats get used as a replacement crib because the infant falls asleep quickly in them and stays asleep for a longer period of time. This should be avoided at all costs because most SIDS deaths are caused by lack of knowledge by the caregiver by leaving the infant in their car seat for a long period of time while they are not traveling. — Preceding unsigned comment added by MariahBeebe (talk • contribs) 20:12, 29 February 2016 (UTC)

Hello there new studies about breastfeeding Federal University of Pelotas and the edge of the bed, no bedside no substance in bed is better and http://www.jpeds.com/article/S0022-3476(15)01284-6/abstract to sleep in his own bed in the parents' bedroom, I'm from Germany but I think you find it so in english. Kind regards — Preceding unsigned comment added by Funkycameo (talk • contribs) 13:07, 2 March 2016 (UTC)

References

Sources

1. http://www.naeyc.org/files/academy/file/ProgramAdministratorGuideSafeSleep.pdf, I plan to use this source because it is through NAEYC, which stands for National Association of Education for Young Children. Here it lists what SIDS is and how to prevent it according to NAEYC procedures in NAEYC accredited child development centers across the nation.

I guess the question is what do you wish to use it to say? Doc James (talk · contribs · email) 15:06, 17 April 2016 (UTC)

2. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Preventing-SIDS.aspx, this article seems relevant because it is an updated list on what to do to prevent SIDS. I think this is helpful because it is directed at parents and is written in words in which parents can easily understand.

Not a good source. Doc James (talk · contribs · email) 15:06, 17 April 2016 (UTC)

3. http://www.news-medical.net/news/20160215/Babies-should-sleep-in-their-own-beds-during-first-three-months-to-reduce-risk-of-SIDS.aspx. This is a news article published by medical.net that is very recent. Since SIDS causes change annually, it is important to keep up to date on what the newest research says to do with your child in order to promise safe sleep.

Popular press. We tend not to use this. The causes of SIDS does not change annually. Doc James (talk · contribs · email) 15:06, 17 April 2016 (UTC)

4. http://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/basics/definition/con-20020269, I like this source because Mayo is one of the most notable places to look for reliable medical information. This explains that SIDS can be prevented, but not fully, because sometimes babies just "forget to breath". Even after extensive autopsies, the cause of death can remain unknown.

Mayoclinic is not a great source. Doc James (talk · contribs · email) 15:06, 17 April 2016 (UTC)

5. http://www.cdc.gov/sids/. This source is all about SIDS, it gives detailed information like every source I have already listed, but this one also gives sources for parents to help them grieve and cope. I thought that this might be a nice source because it helps the parent to understand what happened and how to move forward.

This last one is good. Doc James (talk · contribs · email)

— Preceding unsigned comment added by MariahBeebe (talk • contribs) 21:03, 22 February 2016 (UTC)

Please read WP:MEDRS regarding sourcing. Doc James (talk · contribs · email) 15:06, 17 April 2016 (UTC)

study on use of fans

I've added this sentence to the section on prevention:

One study found a large beneficial effect from the use of fans[11], but the study as not been replicated, and the AAP has no official recommendation on their use [9].

My previous addition of a citation to this study was reverted. Please discuss here before reverting. This seems to be a complete and fair assessment of the state of knowledge regarding this study. Wpegden (talk) 15:21, 12 April 2016 (UTC)

Per WP:MEDRS we tend to stick with secondary sources and we specifically do not use primary sources to refute secondary ones. Doc James (talk · contribs · email) 17:02, 12 April 2016 (UTC)

Per WP:MEDRS, we should not use primary sources to contradict secondary sources. The sentence I added is a direct and concise summary of the statement from the secondary source [9]. It includes the primary source as an additional pointer. The secondary source contains all the information in that sentence that I added and keeps getting deleted. In particular, we do not need to avoid referring to primary sources at all. (Many primary sources are linked from this article.) Note that the citation [11] could be removed from the sentence, and the sentence would still be completely supported by the secondary source [9]. There is no contradiction between sources 9, 11, or the added sentence. Wpegden (talk) 17:15, 12 April 2016 (UTC)

This is the one study you added Coleman-Phox, K; Odouli, R; Li, DK (October 2008). "Use of a fan during sleep and the risk of sudden infant death syndrome". Archives of pediatric and adolescent medicine. 162 (10): 963-8. doi:10.1001/archpedi.162.10.963. PMID 18838649. Retrieved 4/4/2016. {{cite journal}}: Check date values in: |accessdate= (help)

This is a primary source looking at 185 infants. It is not a secondary source. Doc James (talk · contribs · email) 17:19, 12 April 2016 (UTC)

But you deleted the whole sentence. The whole sentence is supported by the secondary source [9]. I included a link to the primary source [11] which [9] cites also. [9] and [11] are not in contradiction. Wpegden (talk) 17:22, 12 April 2016 (UTC)

So the next question is how should we summarize the review article used in the lead? The text in question is

"One US study found that the use of a fan decreased the risk of SIDS (adjusted OR 0.28; 95% confidence interval, 0.10–0.77). (10) This study, however, was limited by having a small sample of fan users and by questions about the accuracy of parental recall. Furthermore, although one other study has demonstrated a decreased risk of SIDS if the room is well ventilated, no other studies have confirmed these findings. Therefore, there is currently no recommendation for or against fan use as a SIDS risk reduction strategy."

IMO it is better summarized as "Evidence is not sufficient for the use of fans." as their is only one low quality study. Will ask for further input. I consider this to be over positive "One study found a large beneficial effect from the use of fans, but the study as not been replicated, and the AAP has no official recommendation on their use". It does not mention that it was based on parental recall for example. And IMO is overly detailed for the lead. Doc James (talk · contribs · email) 17:26, 12 April 2016 (UTC)

I would favor clarifying it by adding more information rather than less. "Evidence is not sufficient" leaves open many incorrect interpretations (such as that the issue has been considered by multiple studies, and that some studies have found an effect while others have not). Wpegden (talk) 17:30, 12 April 2016 (UTC)

Evidence not sufficient means there is not enough evidence to determine if fans are useful or not. Doc James (talk · contribs · email) 17:32, 12 April 2016 (UTC)

Obviously, you know what I'm about to say: "some evidence" means that there is some evidence of an effect (i.e., in this case, one study, with all its limitations) but there is uncertainty about the finding. Wpegden (talk) 17:34, 12 April 2016 (UTC)

I think as a general principle: when multiple people are disagreeing about the meaning of a short statement, expanding the short statement is a reliable way of producing better agreement. We could make a long list of things for which "Evidence is not sufficient" for preventing SIDS: birthday parties, loud music, angled crib orientations, etc. "Evidence is not sufficient" does not merit mention in an article: this is the state of all things which are not studied at all. When we say something about fan use, it should be that there is some (limited) evidence that they are effective (though not enough for the AAP to have made a recommendation on their use.) Wpegden (talk) 17:38, 12 April 2016 (UTC)

We summarize what high quality sources say. We could summarize it as "there is not enough evidence to recommend the use of fans". Many things have one or a couple of poorly done studies. That does not mean it is accepted as mainstream practice. Anyway have requested further input. Doc James (talk · contribs · email) 17:40, 12 April 2016 (UTC)

You seem intent on preventing the wikipedia article from mentioning the study on fans. Maybe if you explain why I will understand? I think it should be mentioned, since it is discussed in the "high quality secondary sources". It is part of the discussed literature on SIDS prevention. The current view is that the evidence isn't strong enough to merit a recommendation by the AAP, as I noted in my sentence. Wpegden (talk) 17:47, 12 April 2016 (UTC)

I think this "One study found a large beneficial effect from the use of fans" misrepresents the source in question and does not belong in the lead.

A more accurate reflection of the source is "there is not enough evidence to recommend the use of fans". One could maybe discuss how one study tentatively supported it but was not very well done. Doc James (talk · contribs · email) 18:01, 12 April 2016 (UTC)

• There is a good quality secondary source that reviews and summarizes the available evidence from primary sources, we should just use the secondary source, not the primary. Zad68 18:06, 12 April 2016 (UTC)

• Wpegden you nailed it with this comment: because there is insufficient evidence to say if fans work or not, we should say nothing, just like we say about the other things you listed. Jytdog (talk) 18:10, 12 April 2016 (UTC)

At zad68: are you proposing keeping my sentence but removing the ref to the primary source? At Jytdog: unlike the use of fans to prevent SIDS, none of those other examples in my comment are discussed in the secondary literature on SIDS. Wpegden (talk) 18:23, 12 April 2016 (UTC)

Agree we should mention fans. I guess the question is were? Would be happy to see it in just the body of the text aswell as it is not that significant. Doc James (talk · contribs · email) 18:47, 12 April 2016 (UTC)

I am perfectly fine with having it just in the body. How about I remove mention of fans from the intro, and replace the sentence "Evidence regarding fans and swaddling is unclear[9]" in the body (immediately under "prevention" but before the subheadings) with

"One study found a large beneficial effect from the use of fans[11], but the study as not been replicated, and the AAP makes no recommendation on their use [9]. Evidence regarding swaddling is mixed[9]."

Note that unlike the case of fans, swaddling really has some studies "for", and some "against". We could remove the reference to [11], but I think there is a case to be made for including it: here, it is not a source of information (since the wiki article is not asserting that fans are useful); instead, it is referenced because it is the subject of the sentence: it is the one study on fans that was done.Wpegden (talk) 19:55, 12 April 2016 (UTC)

In my view since there is nothing to say, we should say nothing. Since Woegden is committed to saying something, we can say something but it should be only as much as is necessary to say "we don't know because there is hardly any evidence and what evidence there is, has no real value". So one short sentence in the body of the article: "The evidence about whether fans are useful to prevent SIDS is scant and inconclusive." Nothing in the lead. The comment that the journal published on the one study that was done, which received the typical media hype, was scathing (PMID 19414701) - the review is a little kinder but no less dismissive. Jytdog (talk) 00:03, 13 April 2016 (UTC)

"...what evidence there is, has no real value." You are proposing a baseless statement with no support from high quality sources. The comment you cite in that journal is not a high quality secondary source. (And, it should be mentioned, that comment exhibits some fundamental confusions about the nature of case-control studies. That is not a discussion which should be had on Wikipedia, however, which is why we should stick to secondary sources.) Considering the question: "do fans reduce the risk of SIDS?" There is one, relatively small case-control study which attempted to study this question. It found a large effect. No repeat of the study has been attempted. The study has all the weakness of case-control studies. [Let us take a moment to remind ourselves that there are no randomized trials on any methods to reduce SIDS risk. Even the advantages of supine sleeping must be inferred from case-control and other correlation studies.] The findings of the one study are intriguing, but have not been replicated, and could well turn out to be misleading. This is all documented in the secondary literature, and deserves to be covered in a long article on the topic of SIDS. Wpegden (talk) 00:59, 13 April 2016 (UTC)

I am citing the review that you brought which said that the study was badly conducted which means that it tells us nothing. You need to recognize that there is no support from 4 editors with a lot more experience editing topics about health than you and yield. That is what the fundamental policy of Wikipedia WP:CONSENSUS is all about. Jytdog (talk) 08:00, 13 April 2016 (UTC)

agree per WP CONSENSUS--Ozzie10aaaa (talk) 10:29, 13 April 2016 (UTC)

My concern with "there is not enough evidence to recommend the use of fans", despite its popularity with our evidence-focused editors, is that it's (at least) equally true "there is not enough evidence to recommend against the use of fans" – and many non-professional readers are going to misinterpret the statement as "fans might be bad". Wpegden's description (just one study, don't know if it's true) is not liable to this misunderstanding.

I don't think that there's a good MEDRS-based argument here. This is really a question of style and WP:DUE weight. If it's worth mentioning at all (probably, given how often it is mentioned in other – including non-scientific! – reliable sources), then do you mention only the current state of evidence, or do you provide comprehensive content? WhatamIdoing (talk) 03:38, 13 April 2016 (UTC)

This policy statement from the AAP states There is currently insufficient evidence to recommend the use of a fan as a SIDS risk-reduction strategy. and that's the extent of the coverage. At this point, I think:

1. There's consensus that our article should use this secondary source and summarize the brief statement it makes about fans, being careful not to indicate that there's enough evidence to recommend either for or agains them,
2. There's consensus here that the secondary source doesn't give enough emphasis on fans that for there to be a strong desire to mention in the lead
3. There isn't consensus to include the primary source.

Suggested wording to include is: "The effect that fans might have on the risk of SIDS has not been studied well enough to make a recommendation about their use." Zad68 03:58, 13 April 2016 (UTC)

I'm good with that - great to cite that major body and the review, which say the same thing. Jytdog (talk) 08:00, 13 April 2016 (UTC)

This wording doesn't make sense, because Wikipedia is not in the business of making recommendations about anything. We are writing a summary of knowledge, not a policy document. We should not say what we recommend and what we don't. It is part of the secondary knowledge that one, limited, correlation study found an positive effect from fan use. It is reasonable to include this knowledge in the article. Much (most?) of the secondary literature on SIDS risk factors discuss this study and its limitations. There is no wikipedia policy that we cannot mention knowledge which is not the basis of current AAP recommendations, which is what you seem to be aiming for. Wpegden (talk) 17:40, 13 April 2016 (UTC)

Here's an updated proposal, which we perhaps can all agree on: "One study found a reduction in SIDS from fan use, but the issue has not been studied well enough for the AAP to make a recommendation about their use." This is completely supported by the secondary source currently used in the lede. (And is a more complete summary of their content on the issue. Your are proposing selectively censoring their content.) Wpegden (talk) 17:43, 13 April 2016 (UTC)

Yes the AAP statement presented by Zad is excellent. Yes Wikipedia does not "make" recommendations we simply report on recommendations made by others. Doc James (talk · contribs · email) 18:52, 13 April 2016 (UTC)

His statement doesnt say whose recommendation is being witheld. The AAP? The EAP? The editor's personal recommendation? This is the point of the following

suggestion: "One study found a reduction in SIDS from fan use, but the issue has not been studied well enough for the AAP to make a recommendation about their use." This sentence nicely summarizes the content of [9] on fans. Wpegden (talk) 19:03, 13 April 2016 (UTC)

We could go with "The effect that fans might have on the risk of SIDS has not been studied well enough for the AAP to make a recommendation about their use." in the body. Doc James (talk · contribs · email) 19:07, 13 April 2016 (UTC)

I still think that the study deserves mention in the body since it is well-discussed in the secondary literature, but I understand your concern not to oversell one isolated study. As a compromise, how about: Although one study found a reduced SIDS rate in rooms with fans, the effect that fans might have on the risk of SIDS has not been studied well enough for the AAP to make a recommendation about their use. This is quite a conservative statement. The wording emphasizes that only one study has been done and we should expect more to be done to have trustworthy evidence. We can include the link to the primary study or not, at your option; I am okay either way as long as the secondary source which cites the primary source is cited. Wpegden (talk) 20:02, 13 April 2016 (UTC)

I thought the previous suggestion by Zad68 was reasonably balanced. There appears to be sufficient doubt about the conclusions of this study, which relate to the methodology used. One academic responded with correspondence to the journal to raise their concerns that there had been "selection and recall bias, low enrolment numbers and dissimilar study groups”. Drchriswilliams (talk) 20:28, 13 April 2016 (UTC)

As I'm sure you are aware, Dr. Chris, these issues (with the exception of study size) plague any correlation study. In particular, they apply to every study ever conducted on every risk factor for SIDS. The comments made by the respondents about the dissimilar case and control groups are particular jarring, and seem to indicate a fundamental confusion about the nature of case/control studies. (Note that the secondary sources do not repeat this complaint.) I'm happy to continue this discussion further but I'm not sure the Talk page is the place to be having this discussion. Up to you though. I still see no reason to censor the secondary sources, which consider it worth noting that one limited study on fan use has been conducted and found a positive effect, while more evidence is needed before a trustworthy recommendation can be made. Wpegden (talk) 22:05, 13 April 2016 (UTC)

I suppose the point I wish to convey is that there are difficulties that arise if this is included in the prevention section. Organisations making recommendations on prevention, having synthesised evidence, such as NICHD and AAP don't include any recommendations around use of fans. I don't doubt that this is a difficult area to research. I do wonder that the current inadequacies around the evidence base means that coverage on the role of fans might sit better in the section of the article which relates to the media response. Drchriswilliams (talk) 22:32, 13 April 2016 (UTC)

Although I think the meaning of the sentence is clear in any section, for the purpose of compromise I would consider placing it elsewhere. I understand that you think the "prevention" section should only list things for which there is strong evidence of a preventative effect, as opposed to giving information about the state of our knowledge regarding various possible interventions. I don't agree but I consider the viewpoint reasonable. How about placing the sentence I suggested under the "Other" section, under "Risk Factors"? Wpegden (talk) 00:12, 14 April 2016 (UTC)

No one is talking about "censor the secondary sources". In fact I believe I added the source in question. What we are arguing about is what the source in question means. It clearly states fans have not been well enough studied for the AAP to support their use. That is the main position of that paper and what we should say. It appears that this position has majority support. Doc James (talk · contribs · email) 12:55, 14 April 2016 (UTC)

The Moon and Fu paper (a high quality secondary source, I think we all agree) contains two basic facts regarding fans. It says 1) One limited study found a beneficial effect from their use, and 2) The AAP does not consider the evidence strong enough to make a recommendation at this time. You are insisting on including Fact 2 while insisting that Fact 1 not appear in the wiki article. I don't see any justification for this. (Imagine for a minute that I was insisting that we include Fact 1 and omit Fact 2. You would surely find that frustrating, but it would be as supportable from this secondary source as your current position.) At this point, you seem to have dug in on the insistence that we omit Fact 1 without convincing me that there is any justification for it, since Fact 1 appears in high quality secondary sources. I have made multiple attempts at compromise, both with how we word Fact 1 and where it goes in the article. To avoid an indefinite edit war, I propose that we seek mediation, in the hopes that we will reach some consensus. Wpegden (talk) 19:10, 14 April 2016 (UTC)

One very limited study is what we have. It is not just me who considers it most appropriate to just present the fact that the AAP does not consider there to be sufficient evidence to recommend fans.

We work on consensus. You could try a RfC but consensus is already fairly clear. Doc James (talk · contribs · email) 20:04, 14 April 2016 (UTC)

Is the Moon and Fu paper in question the CME article published in 2012 that says it is based on a 2007 review paper here? In Moon's 2016 paper SIDS Risk: It's More Than Just the Sleep Environment there is not one mention of fans. Drchriswilliams (talk) 20:14, 14 April 2016 (UTC)

The Moon and Fu article is available publicly here: https://pedclerk.sites.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/sids.pdf At Doc James: I am not proposing citing one limited study. I am proposing citing a high quality secondary source which considered it worth noting that a single study on fans had been done. Wpegden (talk) 20:24, 14 April 2016 (UTC)

This is the policy statement from 2011 [2] from the AAP which might be best to go with. They mention fans but not the single trail. Doc James (talk · contribs · email) 20:19, 14 April 2016 (UTC)

There is no reason this article can only summarize AAP recommendations. It can cover the broad knowledge base on SIDS of high-quality secondary sources. If we want a separate article or subsection, "AAP recommendations on SIDS", I will not try to insert any mention of this study. Wpegden (talk) 20:24, 14 April 2016 (UTC)

Honestly, the pushback on this issue puzzles me. This would hardly the most obscure fact in this article. The article also mentions a "tentative link with Staphylococcus aureus and Escherichia coli", which doesn't even cite a high quality secondary source. Wpegden (talk) 20:30, 14 April 2016 (UTC)

Generally we summarize the conclusions of the best-quality secondary sources, and we don't detail the blow-by-blow analysis of the primary sources that the secondary source might have used to come to its conclusions.
I've applied the updated wording that received support. At this point there's no consensus to include mention of the individual, poor-quality primary study, so it should be left out. Unless strong new arguments appear it doesn't seem like we need to discuss this any further. Zad68 03:41, 15 April 2016 (UTC)

My 0.02 is that it's very clear that sleeping on the back is the recommended mitigation strategy. I would hate for some parent with a finicky child that prefers to sleep on their stomach or is easier to put to sleep on their stomach think they can use a fan instead of placing the child on their back. I don't really care if they use a fan as it doesn't seem harmful, just that it can be exasperating putting an infant to sleep and bad info or misleading info or poor info that competes with very good info is dangerous. "But I used a fan" is the last thing the ER physician wants to hear or have to explain it to grieving parents. A few weeks of no sleep and any idea seems good. The lead is certainly not a good place if even a place exists. --DHeyward (talk) 21:20, 14 April 2016 (UTC)

Judging by the current recommendations, which reflect the lack of conclusive evidence on fans, fans should not be mentioned in the lead section. Drchriswilliams (talk) 15:10, 15 April 2016 (UTC)

DHeyward: I understand this viewpoint, and I suspect it is behind a lot of the resistance I have encountered here. You are worried that revealing certain true information (that one limited study found a beneficial effect from fans) may adversely impact clinical outcomes overall. It is natural to engage in this kind of psychoanalysis of the general population, and, indeed, these considerations do certainly affect the recommendations of bodies like the AAP. But they can play no role in our decision of what information to include in a Wikipedia article. We should not censor this information based on these concerns, which are analogous (milder, even) than those regarding the detailed discussions of "answers" to inkblot tests on the Rorschach test article. One can make a convincing case that making detailed knowledge the Rorschach test publicly available hinders clinical outcomes (even in life-threatening cases). But that is not a judgement for us to make on Wikipedia. We should be determining what information is true and relevant to the subject matter (or what is in debate, which can also be included). In this case, the fact that one limited study found a beneficial use from fans is true and relevant, based on the fact that high quality secondary sources cover this fact. (They also cover the fact that the evidence from one limited study is too weak to make a recommendation from, which we should also include.) I don't think there is any debate about this fact; no one has cited a paper claiming that the true number of studies is in fact 0 or 2 or 3. Wpegden (talk) 17:23, 15 April 2016 (UTC)

No-one doubts that a study exists that attempts to look at whether fans might affect the risk. It seems there is some agreement around the recognition that this study has limitations. The secondary source cited that picks up on this study is a CME article, not a systematic review. Even the CME article that mentions the fan study follows on by saying: "no other studies have confirmed these findings". So, I’m not suggesting that the Wikipedia article should make no mention of the study, simply that there are sections where it wouldn't seem appropriate to locate any discussion. I think the level of confidence about research into other areas means fans shouldn't feature in either the lead, nor the section about prevention. Drchriswilliams (talk) 18:09, 15 April 2016 (UTC)

I think these are all reasonable points. How about I borrow your quote and suggest One study found a beneficial effect from the use of fans, but no other studies have confirmed these findings, and the AAP makes no recommendation about their use. And we can put the sentence anywhere in the article that you like. (I proposed under Risk factors -- Other, before.) Or I am happy to discuss other possible wordings. Wpegden (talk) 18:26, 15 April 2016 (UTC)

I can't take credit for the quote, which is directly from Moon and Fu article. I would suggest an appropriate title for a section sub-heading to include this under might be "Inconclusive research". As you mentioned previously there are other studies referred to in this Wikipedia article that might sit better in such a section. Drchriswilliams (talk) 19:03, 15 April 2016 (UTC)

===Insufficient research=== would be more accurate. The research came to a conclusion, and no research has come to any other conclusion. The AAP merely wants someone else to do another study, to see whether a second one comes to the same conclusion. WhatamIdoing (talk) 04:51, 16 April 2016 (UTC)

I'm not satisfied with the hardline approach of "evidence über alles" here. PMID 18838649 was big news. Even a letter to the editor that criticized the methods said that it had received "major media attention". And we're trying to reduce the entire topic to – to put it in plainer language – "One professional organization hasn't made up its mind about fans yet".

• Are there no other professional organizations in the world that talk about SIDS? It always feels bad when we cite solely one American organization on an issue of such worldwide concern.
• Can we not just briefly say why the AAP even bothered to make their shoulder-shrugging statement? They did this because there's some research that suggests it's helpful, and that research got a lot of attention, not because their random keyword generator told them to say something about fans. In the same paragraph, they also mentioned another study on the beneficial effects of good ventilation in the bedroom. (In fact, a better description of that section of the AAP paper would be "Limited research into room ventilation, including the use of fans or keeping doors and windows open, has shown a beneficial effect on SIDS, although the AAP does not make a formal recommendation either way", rather than "One study on fans has shown a beneficial effect, although the AAP does not make a formal recommendation either way".)
• Even its critics say that using a fan is "not a harmful intervention"[3] and might be useless at best. The AAP discusses this in a section about the dangers of overheating – a deadly problem that fans are known to prevent and treat. Typical lay-oriented web sources like WebMD also mention overheating as a risk factor. No sources offer any reason not to use a fan.
• WP:MEDMOS says not to censor information in an effort to manipulate people into making the "right" choice. I'm therefore opposed to any proposal to omit information on the grounds that someone might, hypothetically, decide to choose "trade" risk factors. WhatamIdoing (talk) 05:23, 16 April 2016 (UTC)

We do not report the outcome of every single study. I consider the suggestion of giving this single study greater space to be undue weight. Doc James (talk · contribs · email) 13:08, 16 April 2016 (UTC)

Nobody is suggesting reporting every single study. We are only suggesting reporting on studies which were covered in high quality secondary sources. I think a separate section on inconclusive (or insufficient---I don't think it really matters) research is the best idea. This will not give the study undue weight in the wiki article. It will be the same weight given to the study by high-quality secondary sources. Wpegden (talk) 22:31, 16 April 2016 (UTC)

The 2011 policy statement from the AAP, which is a top-tier source per WP:MEDASSESS, doesn't mention the individual primary study at all. We generally summarize the conclusions of the best-quality secondary sources. I don't see why this article should give any space at all to it. Zad68 02:09, 17 April 2016 (UTC)

You are misrepresenting WP:MEDASSESS, which concerns the use of sources to establish "evidence for treatment efficacy." WP:MEDASSESS would prevent someone from adding a statement "Fans have been shown to reduce the incidence of SIDS", citing the primary source. But no one is suggesting doing that. The proposal is to add a verifiable fact to the article which is discussed in multiple high-quality secondary sources: that one study found a beneficial effect from fans, and that the AAP considers the evidence too weak to make a recommendation based on. As noted above, the attempts to prevent this verifiable fact from appearing in the article are a violation of WP:MEDMOS, which cautions against "[emphasizing or de-emphasizing] verifiable facts so that readers will make the 'right' choice in the real world." WP:MEDMOS is also why we cannot restrict this article to covering things from AAP policy statements. As made clear by WP:MEDMOS, the target audience for the wiki article is a general audience (including scientists, lay-people without children, people curious about how science interacts with medicine, etc. etc.) which is not the case for AAP policy statements (which target healthcare professionals and patients, which is explicitly discouraged by WP:MEDMOS), and this difference in target audience should be reflected in a high-quality wiki article on SIDS. A major manifestation of this difference in target audience should be that the wiki article covers topics which are covered in high-quality secondary sources, but do not form the basis of recommendations to patients and practitioners made by professional organizations. As noted previously, the wiki article currently contains other material of this type. Wpegden (talk) 13:10, 17 April 2016 (UTC)

quick note: I have put in a request to change my username as I get back to participating in Wikipedia. I've requested a change to RandomVariable. So assuming the change goes through, note that I, he and him, she and her are all the same person. Wpegden (talk) 17:50, 17 April 2016 (UTC)

Wpegden, literally no one here is agreeing with you and we have all stated the policy and guideline-based reasons. At this point you are being WP:TENDENTIOUS; continuing to push is going to do nothing but give you a bad reputation. I will not be responding further here per WP:SHUN and I reckon others will soon do the same. Jytdog (talk) 01:21, 18 April 2016 (UTC)

Jytdog, I understand this conversation has gotten long and hard to pay close attention to, but both Drchriswilliams and WhatamIdoing have indicated agreement with the general idea of including a mention of the study in some form or another. So that is three people (so far). If you have a policy or guideline-based reason that you feel I haven't refuted, tell me what it is and let's discuss back and forth. Otherwise you are just stonewalling and reverting instead of discussing will be edit-warring. Wpegden (talk) 01:32, 18 April 2016 (UTC)

User:Zad68, doi:10.1542/peds.2011-2285 (the AAP 2011 paper) says:

OVERHEATING, FANS, AND ROOM VENTILATION

Avoid Overheating and Head Covering in Infants

There is clear evidence that the risk of SIDS is associated with the amount of clothing or blankets on an infant and the room temperature.182,218,294,295 Infants who sleep in the prone position have a higher risk of overheating than do supine sleeping infants.182 It is unclear whether the relationship to overheating is an independent factor or merely a reflection of the increased risk of SIDS and suffocation with blankets and other potentially asphyxiating objects in the sleeping environment. Head covering during sleep is of particular concern. In a recent systematic review, the pooled mean prevalence of head covering among SIDS victims was 24.6% compared with 3.2% among control infants.154 It is not known whether the risk associated with head covering is attributable to overheating, hypoxia, or rebreathing.

There has been some suggestion that room ventilation may be important. One study found that bedroom heating, compared with no bedroom heating, increases SIDS risk (OR: 4.5),235 and another study has also demonstrated a decreased risk of SIDS in a well-ventilated bedroom (windows and doors open) (OR: 0.4).296 In 1 study, the use of a fan seemed to reduce the risk of SIDS (adjusted OR: 0.28 [95% CI: 0.10 – 0.77]).297 However, because of the possibility of recall bias, the small sample size of controls using fans (n = 36), a lack of detail about the location and types of fans used, and the weak link to a mechanism, this study's results should be interpreted with caution. On the basis of available data, the task force cannot make a recommendation on the use of a fan as a SIDS risk-reduction strategy.

Getting back to business...

I think that two whole sentences about the "1 study" counts as "mentioning" the study.  ;-)

User:Doc James, if you can look past the original edit for a moment and focus on the main point of this section in the AAP paper ("stuff related to overheating", such as heating and ventilation), then I think there's plenty of attention to the subject – they mention three separate studies on that broader subject of heating and ventilation in the babies' bedrooms – and that this attention is not adequately reflected in the article at the moment. The word overheating appears only twice in the article (once in the lead and once in an example), even though we know, with certainty, that heat stress kills babies. Cute little baby hats aren't mentioned at all, even though the AAP names three different ways that they can kill a sleeping baby. (If you read the prevention section of the article, you could be forgiven for thinking that only blankets on the head mattered.)

We can do better than this. Let's figure out a way to improve the article, rather than trying to play some my-guideline-is-better-than-your-guideline game with the very first proposal. There's information in the AAP paper, based on three related primary sources, that isn't represented adequately. Let's find a way to fix that. WhatamIdoing (talk) 05:31, 18 April 2016 (UTC)

WhatamIdoing, sure, the policy statement doesn't but the AAP's 30-page technical report does. This seems to be normal for them, they release a policy statement and a technical report together (30 pages seems typical), with the technical report providing the evidence guiding the policy. Like I mentioned above, in general I don't think Wikipedia articles should be providing a blow-by-blow with a mention of every primary source a large, detailed source like a technical report does. Our article size guidelines don't guide us to do that, and our articles cover a lot more than just evidence--it's this difference between Wikipedia's goals and a technical report's goals that require we curate what we use from it carefully. The AAP SIDS technical report lists 356 sources. If we were in the practice of re-covering every source they used in their report, our article would be ridiculously large and unwieldy. The best practice for Wikipedia is to summarize the conclusions of secondary sources--we shouldn't mention every primary source the secondary source uses.
Agree that we should get back to the business of working on this article. Zad68 13:31, 18 April 2016 (UTC)

No one is proposing adding a study just because it got a citation. The report devotes an entire section to "OVERHEATING, FANS, AND ROOM VENTILATION". Half of this section is devoted to the fan study and the ventilation study. There is a verifiable fact supported by this and other high quality secondary sources: one study found a beneficial effect from fans. Multiple sources consider this relevant to SIDS enough to mention. They could have ignored it if they considered it irrelevant SIDS. Wpegden (talk) 14:59, 18 April 2016 (UTC)

Well if we're moving past arguing for including mention of individual primary studies, great! The article already says "Elevated or reduced room temperature also increases the risk,[21] as does excessive bedding, clothing, soft sleep surfaces, and stuffed animals.[22]" in addition to "The effect that fans might have on the risk of SIDS has not been studied well enough to make a recommendations.[9]" Don't those two sentences summarize the conclusions of the secondary source adequately? Zad68 15:05, 18 April 2016 (UTC)

You misunderstand me (I hope not intentionally!). The verifiable fact which we believe should be added is: one study found a beneficial effect from the use of fans. The reason it should be added is not that this study has merely been cited by secondary sources (as a source of information for some synthesized view), but because the study itself is discussed by high quality secondary sources. Maybe a helpful question at this point is: Do you believe that the wiki article should only cover material from AAP policy statements? Wpegden (talk) 15:13, 18 April 2016 (UTC)

Ah, ok. Wikipedia is an encyclopedia--a tertiary source. Wikipedia articles should summarize the conclusions of secondary sources. Read what I wrote above to WAID--The AAP usually releases a policy statement with a technical report. The technical report is a very deep dive into the available evidence, and generally has paragraphs that include 1) the primary evidence considered (could be many many studies) and their evaluation of the quality of that evidence, and 2) the conclusion they drew from it. I'm saying that summarization of 2) is what we should include. The technical report is 30 pages long and references hundreds of sources. If we go the path of also including 1) it'll make our articles hopelessly long, confusing and unreadable. If the reader wants to see the review of the evidence underlying the conclusion they can drill through to the cited source. In this case, the 1) is the single, poor-quality study regarding fans, and 2) is their conclusion "On the basis of available data, the task force cannot make a recommendation on the use of a fan as a SIDS risk-reduction strategy." I'm saying we should summarize their conclusion the secondary source drew from the available evidence. Does that make sense? Zad68 15:27, 18 April 2016 (UTC)

We should be summarizing the content of secondary sources, not just their conclusions. The existence of contentious and unsettled viewpoints can be covered with context. I think it is undisputed that the existence of limited research finding beneficial effects from fans and ventilation is a verifiable fact which is part of the content of several secondary sources. The part of your viewpoint that I am very unclear on is whether you are defending the general position of only including material from AAP policy statements. Wpegden (talk) 16:28, 18 April 2016 (UTC)

Alright so now we have localized our disagreement. That's good. Could you please apply the same principle you are applying to fans to the topic of breastfeeding and SIDS, using the AAP technical report? What is the result of doing that, and how does it compare to existing article content? Is it an improvement or no? Now continue doing that for all the other topics covered in the AAP technical report. Looking forward to reviewing your results. Zad68 16:33, 18 April 2016 (UTC)

User:Zad68, I do not agree that "Elevated or reduced room temperature also increases the risk" is an adequate summary of the AAP's belief that:

• Heavy clothing and blankets increases the risk.
• Artificial heating increases the risk.
• Hats and other head coverings increase the risk.
• Poor room ventilation (=air movement, irrespective of air temperature and irrespective of whether that air movement is from fans or open windows) increases the risk.

Do you think that a "elevated room temperature" is an adequate summary of these four items? WhatamIdoing (talk) 22:39, 18 April 2016 (UTC)

Wpegden's application of principle to SIDS and breastfeeding

Wpegden It'd be great if you'd place the results of this exercise here in this section so it's easy to find. Zad68 18:27, 18 April 2016 (UTC)

Zad, I am the first to agree that the wiki article on SIDS has more than one problem. I will be happy to help you work on other sections, but right now we have our work cut out for us!! Wpegden (talk) 18:30, 18 April 2016 (UTC)

If you'd complete this request it'd certainly help us answer our current problem. Won't you please complete it? Or are you realizing that there's a problem with the approach you've taken? (That is the point of this exercise.) Zad68 18:34, 18 April 2016 (UTC)

Continued from above....

Agree with Zad68 – it's a key feature of the encyclopedia that we summarize the best sources and do not try and "look behind the curtain" to see how we might arrive at a different (or different kind of) summary than these best sources. Alexbrn (talk) 16:38, 18 April 2016 (UTC)

Hi Alexbrn. I am not suggesting a different summary as the secondary sources, but the same one as the secondary sources: namely, that one study was done, and that the evidence is considered too weak for the AAP to make a recommendation from. This is exactly the content of several high-quality secondary sources. Wpegden (talk) 18:31, 18 April 2016 (UTC)

Alex, I'm concerned that we aren't managing to summarize the reliable sources fully. We're cherry-picking pieces of one source. WhatamIdoing (talk) 22:39, 18 April 2016 (UTC)

DRN

Since it seems we are often talking past each other (again, I hope unintentionally) I hope dispute resolution may help us reach consensus. I don't know how to make a correct wiki link, but the request is here: https://en.wikipedia.org/wiki/Wikipedia:Dispute_resolution_noticeboard Wpegden (talk) 15:17, 18 April 2016 (UTC)

We disagree on the amount of weight that single not very well done primary source should receive. IMO it should receive little weight. We could have a RfC on the topic but DR is not going to accomplish much. Doc James (talk · contribs · email) 16:39, 18 April 2016 (UTC)

"not very well done" is a judgement call. I think that if you read the original study and the follow-up letter which complained about the study carefully, you will conclude that the authors of the letter are largely confused. Other than study size, their complaints apply to every study ever done on SIDS risk factors. (Something you would expect them to know but which they fail to mention.) They also come across as strangely statistically illiterate. But in any case, although I am happy to discuss these issues further with you, our personal interpretations of the study can obviously not form the basis of what goes in the article. We need to stick to high-quality secondary sources, which do cover the existence of the study, mention its weaknesses, and note that the evidence is considered too weak for the AAP to make a recommendation. Wpegden (talk) 18:08, 18 April 2016 (UTC)

I don't thing a DRN is a good use of time. Zad68 16:41, 18 April 2016 (UTC)

This is not a fan. This is not from "a single not very well done primary source". Why isn't it mentioned in the prevention section?

We even disagree about whether the dispute is over a "single not very well done primary source" (about fans), or about "multiple sources on the much broader concept of room heating and ventilation" (central heating and electric fans and open windows). WhatamIdoing (talk) 22:46, 18 April 2016 (UTC)

Should the wiki article only discuss material from AAP policy proposals on SIDS

This seems to be an essential source of disagreement in the previous section. In particular, it seems Zad68 supports such a restriction since these are the "best sources". I think Doc James has been careful not to take a position on this, but we should hear it from him. To me, it seems clear that such a restriction is not consistent with WP:MEDMOS, since the AAP policy recommendations have a more limited audience (patients and practitioners) than the wiki article is supposed to have. This seems to be a key point, since I think we all agree that the existence of a study finding a beneficial effect of fans is a verifiable fact covered by high quality secondary sources. We seem to disagree about whether its omission from AAP policy proposals means that we should omit it from the wiki article. Wpegden (talk) 18:02, 18 April 2016 (UTC)

No, the technical report is useful, and I never said (or intended to say!) that the policy statement is the only useful one of the two (policy + technical report). Sorry for any contributing to this miscommunication on my part. Zad68 18:08, 18 April 2016 (UTC)

Ok good. It was your reply "Alright so now we have localized our disagreement...." which made me conclude that you thought this. If we agree that we should cover material which is discussed in high-quality secondary sources, can you give me a guiding principle that you are using to not cover the fact that one limited study was done which found a beneficial effect of fan use? This is a verifiable fact which may high-quality secondary sources find noticeable enough to discuss. Wpegden (talk) 18:15, 18 April 2016 (UTC)

Yes, WP:DUE. The best use of a large, very detailed source like the technical report is to summarize the conclusions. I've said that many times now. Zad68 18:25, 18 April 2016 (UTC)

You think only conclusions from research can be covered in Wikipedia in general? Or just in this article? Where is appropriate to cover ongoing inconclusive research on Wikipedia, in your view? Wpegden (talk) 18:39, 18 April 2016 (UTC)

list of statements currently in article which are nonconforming with the proposed standard.

It is being proposed by many editors that material can only appear in the article on SIDS if it forms the basis of conclusive link to SIDS according to a high quality secondary source. In particular, being discussed in a secondary source is not supposed to be sufficient. I am listing here some sentences in the article which I think do not currently conform. Maybe someone can clarify the difference? A few of these (e.g., nicotine level correlations) could probably be resourced to secondary studies. For most in this list, that does not seem to be the case.

SID correlates with levels of nicotine and derivatives in the infant.[19] Nicotine and derivatives cause significant alterations in fetal neurodevelopment.[20]

It is not clear if co-sleeping among mothers who breastfeed without any other risk factors increased SIDS risk.[27]

Anemia has also been linked to SIDS[30]

About 10 to 20% of SIDS cases are believed to be due to channelopathies, which are inherited defects in the ion channels which play an important role in the contraction of the heart.[36]

There is a tentative link with Staphylococcus aureus and Escherichia coli.[37]

The entire section on Differential Diagnosis

Pacifiers do not appear to affect breastfeeding in the first four months, even though this is a common misconception.[56]

A study published in the European Journal of Pediatrics in August 1998[58] has shown the protective effects of a sleep sack as reducing the incidence of turning from back to front during sleep, reinforcing putting a baby to sleep on its back for placement into the sleep sack and preventing bedding from coming up over the face which leads to increased temperature and carbon dioxide rebreathing. They conclude in their study, "The use of a sleeping-sack should be particularly promoted for infants with a low birth weight."

A large investigation into diphtheria-tetanus-pertussis vaccination and potential SIDS association by Berlin School of Public Health, Charité – Universitätsmedizin Berlin concluded: "Increased DTP immunisation coverage is associated with decreased SIDS mortality. Current recommendations on timely DTP immunisation should be emphasised to prevent not only specific infectious diseases but also potentially SIDS."[60]

More than 50% of African American infants were placed in non-recommended sleeping positions according to a study completed in South Carolina.[73]

Should these be removed? Or can someone clarify the justification for their inclusion? Wpegden (talk) 23:35, 18 April 2016 (UTC)

It is the policy of our encyclopedia that biomedical claims have to be supported by high-quality, reliable, secondary sources. If you feel that a claim is unsupported by such a source, then please go ahead and remove it. --RexxS (talk) 23:45, 18 April 2016 (UTC)

You realize that I am not advocating adding a biomedical claim (e.g, "fans reduce the risk of SIDS") to the article. I am proposing adding a historical statement about the state of research on a topic. ("One study exists which found ... and but is limited in that ..."). The high-quality, reliable secondary sources support this statement. Wpegden (talk) 00:01, 19 April 2016 (UTC)

And you realise that I've already told you that it's WP:UNDUE. There's no point in telling our audience about primary research that secondary sources have not deemed sufficient to establish any effectiveness in preventing SIDS.

I've had a look at current references 19 and 20. They are primary studies. The text about correlation isn't a biomedical claim, but I'm not sure what it tells our audience that the first (well-sourced) sentence doesn't: SIDS rates are higher for infants of mothers who smoke during pregnancy. The third sentence about causation can't be supported by the primary study, but we'd be better off using Zhang K; Wang X (2013). "Maternal smoking and increased risk of sudden infant death syndrome: a meta-analysis". Legal Medicine (Tokyo, Japan). 15 (3): 115–21. doi:10.1016/j.legalmed.2012.10.007. PMID 23219585. to talk about the effects of maternal smoking on fetal development and subsequent risk of SIDS. You might want to look for other secondary sources to replace primary ones. --RexxS (talk) 00:36, 19 April 2016 (UTC)

Moving on

I accept that at this time there is not support for explicitly mentioning research on heating, ventilation, and fans in the article on SIDS. I am still interested in feedback on the guideline proposal above, since I think this would help codify the thinking we used to come to this conclusion, but in the meantime, we should probably also get back to the question of what actually should go int he article.

Currently, the two sentences in the article are:

"Evidence is not sufficient for the use of fans.[9] "

and

"The effect that fans might have on the risk of SIDS has not been studied well enough to make any recommendation about them.[9]"

I think both of these sentences currently have a slight syntax problem, since it is not Wikipedia which makes or declines to make medical recommendations. I propose the following wordings:

"Insufficient evidence exists for the AAP to make a recommendation on fans.[9]"

and

"The effect that fans might have on the risk of SIDS has not been studied well enough for the AAP to make a recommendation about their use.[9]"

Both of these are minimal changes to fix a limited problem of voice. Also, there is consensus that these reflect the conclusions of the secondary sources. I believe that the initial opposition to my edits (Doc James) agreed with the need to make this kind of change to the article. In fact, the proposal for the second sentence here is the proposal he made in the discussion above.

Any objections before I make these changes?Wpegden (talk) 19:53, 20 April 2016 (UTC)

It is fine the way it is. Doc James (talk · contribs · email) 19:55, 20 April 2016 (UTC)

Hi Doc James. I am proposing the change that you proposed above. Are you now opposed to the change? It would really be nice at this point to get the sense that we have all been participating in a good-faith discussion. I am trying to reach consensus by agreeing with your earlier proposal. Wpegden (talk) 19:58, 20 April 2016 (UTC)

The AAP is authoritative enough that in-line attribution like you're suggesting isn't necessary. Zad68 20:11, 20 April 2016 (UTC)

I am now saying that I am happy with how it currently is. Doc James (talk · contribs · email) 13:23, 21 April 2016 (UTC)

Not about improving the article, please discuss editor behavior elsewhere...
The following discussion has been closed. Please do not modify it.
Ok, the opposition I'm encountering really seems to be driven by psychology rather than reason. You "win". I will focus wikipedia time in areas where discussions are more grounded in reason and less in reflexive "no"'s. Wpegden (talk) 20:04, 20 April 2016 (UTC) Sorry you feel that way.... Zad68 20:11, 20 April 2016 (UTC) Not just about 'feeling' at Wpegden's side, Zad, they have lots of reasons to be disappointed. The word they choose, 'disappointed', may be an understatement. Wpegden clearly pointed out that Doc James changed opinion [4] without clarifying here or elsewhere. Wpegden is right to complain about that. Then Jytdog enters this and this, twice invoking Admin's Authority on content. Not just blocking, but indefinitely from the bat. I find this astonishing, clearly crossing the line of admin rights into unprovoked threatening. Jytdog is literally telling an editor to shut up or be blocked. Really, Wpegden arguing on a talkpage is no reason to block. I see no wrong of forceful language by Wpegden (and of course, if that were a reason to use the word "blocking", it should have been be pointed out at first opportunity). Instead, Wpegden is applying GF, patience and arguments, as one can read. Then Jytdog pointing to WP:IDHT is irony (I hope per AGF). I suggest that Jytdog strikes those offensive and threatening remarks. Also, if Jytdog has the admin rights, they should reconsider this behaviour wrt that bit. And look at this: in the process Jytdog and DocJames confirm the point Wpegden made: reflexive response. In short: no single point of bad faith or misbehaviour by Wpegden in sight. Bad faith from start by Jytdog, and then entering serious admin threats (out of place, mixing up content discussion with blocking reasons). -DePiep (talk) 07:05, 21 April 2016 (UTC) Those two diffs are absolutely not threats. I invoked no Admin authority. I did not "enter" at Doc James page. I suggest you review the whole discussion - all of it - before weighing in. Jytdog (talk) 07:15, 21 April 2016 (UTC) Yes they are; yes you did; yes you did; no I don't have to. It is you who is supposed to add trespassing diffs, unsollicited, before threatening with indef(!) block, and with that how WP:IDHT is a blocking reason at all. And if I were to find more bad behaviour in the 'review' you demand, why should I expect you to digest them at all? You reply is a qed for my point. -DePiep (talk) 07:25, 21 April 2016 (UTC) sure, you can just write whatever floats into your mind. this is not a serious discussion. Jytdog (talk) 08:53, 21 April 2016 (UTC) We all can (the point is: but why would you block indef for that?). And you may be right: this is not a discussion -- any more. Since one of us added a PA there and pedantic paternalism here. But back to the point: why didn't you add diffs that support your threat of indef blocking? -DePiep (talk) 10:41, 21 April 2016 (UTC) I cannot answer your question as it is based on a false premise. Jytdog (talk) 10:58, 21 April 2016 (UTC)

Oh dear. It is, by improving talkpage discussion and opposing admin threats & shutdowns. And once again an involved editor shuts down by claiming superior judgement. -DePiep (talk) 13:29, 21 April 2016 (UTC)

Should the wiki article cover the fact that one limited study found a beneficial effect from fan use?

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Should the wiki article include a mention of the study on fans? To be clear, I don't think anyone is advocating including a statement that fans reduce the risk of SIDS in the wiki article, as high-quality secondary sources do not make that claim. Instead, the question is whether it is appropriate, in some form, to include a mention of the fact that this study was done (including its limitations), or whether the existence of the study cannot be mentioned at all. High quality secondary sources discuss the findings of the study, so they would be the basis of its inclusion. Wpegden (talk) 18:18, 18 April 2016 (UTC)

Responses

No. It is hard to know from the wording what this "mention ... in some form" would be, but this looks like part of an ongoing push to try and get some angle on this topic, as the title of this RfC suggests ("beneficial effect"!). We have a good secondary source, we should stick at most to summarising its conclusion, specifically that there is no established beneficial effect. There is no need to fish for significance in the underlying data in a way which makes Wikipedia's view differ from the source in the conclusions to be drawn. Alexbrn (talk) 18:31, 18 April 2016 (UTC)

To know what is meant by "mention ... in some form", there are several concrete suggestions that were made above. One was: Although one study found a reduced SIDS rate in rooms with fans, the effect that fans might have on the risk of SIDS has not been studied well enough for the AAP to make a recommendation about their use. Wpegden (talk) 18:35, 18 April 2016 (UTC)

Respondees to a RfC respond to its request and probably won't go dredging through previous Talk page discussions. Alexbrn (talk) 18:38, 18 April 2016 (UTC)

No, just summarize the conclusion of the secondary source, per WP:DUE and all the above. Wikipedia articles shouldn't be loaded down with a blow-by-blow of every mention of every primary source in a large, detailed source like a technical report. Our article size guidelines don't guide us to do that, and our articles cover a lot more than just evidence--it's this difference between Wikipedia's goals and a technical report's goals that require we curate what we use from it carefully. The AAP SIDS technical report lists 356 sources. If we were in the practice of re-covering every source they used in their report, our article would be ridiculously large and unwieldy. The best practice for Wikipedia is to summarize the conclusions of secondary sources--we shouldn't mention every primary source the secondary source uses. Zad68 18:32, 18 April 2016 (UTC)

Multiple secondary sources discussed above devote entire sections (with headings with the word "fan" in them!) to the issue of fan use and room ventilation. We are not talking about including an obscure citation. Wpegden (talk) 18:37, 18 April 2016 (UTC)

Let's say we follow this principle, with the section where there is only one source cited, because that's all there is. Now from the same source check out Breastfeeding, where there's 27 source citations. How about Pacifier use where there's 47 source citations? What will the article look like if we follow this approach? It's a principle that will lead to bad article results. Zad68 18:41, 18 April 2016 (UTC)

I am not proposing including any citation from the article. The fan study itself is discussed in the text of the article, under a major subject heading bearings its topic. Half of the section is spent just on this study and one other study. Wpegden (talk) 18:53, 18 April 2016 (UTC)

So what? You're not qualified to take the text of a secondary source and draw your own conclusions from it, which is what you're proposing to do. --RexxS (talk) 23:20, 18 April 2016 (UTC)

This makes me think you don't understand what I am proposing to add to the article. Can you tell me what you think I am proposing to add? Wpegden (talk) 00:18, 19 April 2016 (UTC)

I'm pretty sure you're proposing to add UNDUE coverage of one minor primary study. --RexxS (talk) 00:47, 19 April 2016 (UTC)

It bothers me that you are pretty sure of this without even knowing what, concretely, I am proposing. Wpegden (talk) 00:50, 19 April 2016 (UTC)

It bothers me that you're still proposing to discuss one minor primary study when half-a-dozen other editors have told you "no". --RexxS (talk) 01:01, 19 April 2016 (UTC)

Yes. The existence of one study on the use of fans is covered by multiple high-quality secondary sources. This article and this one both discuss the study, and each devote an entire section to the issue of fan use and room ventilation. The fact that the state of knowledge on this issue is preliminary may make it inappropriate as the source of recommendations to patients or clinicians, but the wiki article should target a general audience (scientists, people interested in the interaction of science and medicine, laypeople without babies, etc.). The fact that high-quality secondary sources consider this noteworthy should justify a mention of the study (without making recommendations based on it). Wpegden (talk) 18:46, 18 April 2016 (UTC)

Nobody's saying the conclusions the secondaries draw (can't say anything because there's next to no evidence) shouldn't be included. There's just no reason to include mention of that particular study. Let the secondaries do their job, which is to evaluate the primaries and draw conclusions from them. Zad68 18:48, 18 April 2016 (UTC)

Your approach would prohibit all coverage on wikipedia of ongoing or inconclusive research, even when noteworthy enough to be discussed in high-quality secondary sources. Wpegden (talk) 18:54, 18 April 2016 (UTC)

If they're used in a high-quality secondary to draw a conclusion, as is exactly the case here, the result of the study as well as its quality and power are incorporated into that conclusion--it's exactly what we depend on secondaries to do for us. Zad68 18:58, 18 April 2016 (UTC)

Relevant here is my question to you from above, which I think you missed: "Do you think only conclusions from research can be covered in Wikipedia in general? Or just in this article? Where, if ever, is it appropriate to cover ongoing inconclusive research on Wikipedia, in your view?" Wpegden (talk) 20:11, 18 April 2016 (UTC)

Ongoing or inconclusive research on biomedical issues requires the conclusions of a secondary review. We don't report the research, just the results that secondary reviews find significant enough to reach a conclusion on. You're confusing an encyclopedia with a medical journal that does publish ongoing and inconclusive research. --RexxS (talk) 23:31, 18 April 2016 (UTC)

You think that inconclusive research is not covered in medical articles on Wikipedia? How would that work??? For many topics inconclusive research is all we have!! Visit the page on Mad Cow disease, for example. Should the entire "Cause" section there be deleted?? Wpegden (talk) 00:17, 19 April 2016 (UTC)

Don't put words into my mouth. Read what I wrote, and read WP:MEDRS, particularly "Many treatments or proposed treatments lack good research into their efficacy and safety. ... If independent sources discussing a medical subject are of low quality, then it is likely that the subject itself is not notable enough to have its own article or relevant for mention in other articles." (my emphasis) --RexxS (talk) 00:54, 19 April 2016 (UTC)

The medical subject I proposed including in the article is "research on fans and SIDS". This subject is discussed by high quality secondary sources. Or do you disagree with that now? Wpegden (talk) 18:58, 19 April 2016 (UTC)

• No Consider it best to stick with the overall conclusions of the American Academy of Pediatrics which is that "the effect that fans might have on the risk of SIDS has not been studied well enough to make any recommendation about them" as we currently have. Doc James (talk · contribs · email) 19:06, 18 April 2016 (UTC)

It seems like sticking to AAP recommendations is in disagreement with WP:MEDMOS. The audience of recommendations is patients and clinicians, for whom relevant but inconclusive research---even presented in context---may be inappropriate. The wiki article is a general audience. Wpegden (talk) 19:21, 18 April 2016 (UTC)

And "relevant but inconclusive research" is equally unsuitable for the audience of a general encyclopedia like ours. --RexxS (talk) 23:33, 18 April 2016 (UTC)

Then I propose you visit Bovine spongiform encephalopathy and delete the section on "Cause" there. Wpegden (talk) 00:30, 19 April 2016 (UTC)

I propose you read WP:OTHERSTUFFEXISTS and get back to discussing this article when you have. And you might want to find out the difference between primary and secondary sources, because "Bovine Spongiform Encephalopaphy: An Overview" (PDF). Animal and Plant Health Inspection Service, United States Department of Agriculture. December 2006. Retrieved 8 April 2008. certainly isn't a primary source. --RexxS (talk) 00:59, 19 April 2016 (UTC)

• No. There's no evidence that fans have any effect on risk, and it is WP:UNDUE to make a meal of a primary study when a secondary dismisses the idea. I also object to the way that our text in Sudden infant death syndrome #Prevention is phrased: "The effect that fans might have on the risk of SIDS has not been studied well enough to make any recommendation about them." What secondary source justifies our article - in Wikipedia's voice - talking about the effect of fans simply as something that has not been studied well enough yet? This is classic POV-pushing. The text ought to be "There is no evidence of any beneficial effect of fans on the risk of SIDS" and I'll be implementing that change in the absence of any secondary source stating anything different. --RexxS (talk) 22:01, 18 April 2016 (UTC)

"no evidence"? There is a primary study published in a reputable journal providing some evidence of an effect. What is your source going to be for the statement that there is no evidence of an effect? The secondary sources in question do not say that there is no evidence. They reference the study and say that the evidence is not strong enough to make a recommendation. Have you read the secondary sources in question? I want to emphasize that I am not proposing "making meal" of the primary study. I am proposing giving it exactly the same coverage the secondary sources give it. Namely: the study exists, but it does not provide strong enough evidence to form the basis of a clinical recommendation. Wpegden (talk) 22:53, 18 April 2016 (UTC)

Yes no evidence. For any biomedical claim in Wikipedia, we require secondary sources. The secondary source says there's no evidence of any effect of fans on the risk of SIDS. The primary study is insufficient to support any claim relating to that. Have you read WP:MEDRS? And I want to emphasise that you are proposing elevating a single primary study far beyond its value. It matters not one job that a secondary source references the study. That's the job of a review. It's not the job of this encyclopedia. I can see you're proposing giving it exactly the same coverage the secondary sources give it, and I'm telling you that an encyclopedia doesn't give the same coverage to primary sources as secondary sources give to primary sources. Our job is to summarise secondary sources, not replicate them. And another thing: you need to stop badgering everybody who disagrees with you. The point of an RfC is to get opinions from other editors and not to provide you with a platform to regurgitate your mistaken ideas ad nauseum. --RexxS (talk) 23:18, 18 April 2016 (UTC)

The secondary source says there's no evidence of any effect of fans on the risk of SIDS. Please provide a quote to this effect. One says "this study’s results should be interpreted with caution," while the other says "Furthermore, although one other study has demonstrated a decreased risk of SIDS if the room is well ventilated, no other studies have confirmed these findings... Therefore, there is currently no recommendation..." Which of these do you read as claiming there is no evidence? You are correct that we should not be giving exactly the same coverage. I misspoke. I meant we would be giving a summary with the same balance; i.e., not giving the study undue weight. If after asserting multiple times that sources say there is no evidence, I really am expecting you to be able to back that up if you are engaging in a good-faith discussion. Wpegden (talk) 23:23, 18 April 2016 (UTC)

The secondary source says there's no evidence of any effect of fans on the risk of SIDS. there's your quote. It's what I just wrote. Which bit of it don't you understand? Provide a quote for me that says "There is evidence of an effect of fans on the risk of SIDS". Neither of your two unattributed suggestions says that. The text in our article is sourced to PMID 22753789 which states "The evidence for fan use or swaddling as strategies to reduce the risk of SIDS is inconclusive." That's pretty clear that no conclusions can be drawn. There's no evidence of any effect of fans on the risk of SIDS and that's all we're interested in here. --RexxS (talk) 23:41, 18 April 2016 (UTC)

I'm asking for a quote from the sources, not from you. You also misunderstand my proposal. I am not proposing saying that there is evidence for fan use. I am proposing saying that one study was done which found a beneficial effect. Do you want me to provide quotes from the secondary sources supporting this claim? (They already appear in the discussion above.) Wpegden (talk) 5:03 pm, Today (UTC−7)

I've already read the quote from the secondary source dismissing the claim: However, because of the possibility of recall bias, the small sample size of controls using fans (n = 36), a lack of detail about the location and types of fans used, and the weak link to a mechanism, this study's results should be interpreted with caution. On the basis of available data, the task force cannot make a recommendation on the use of a fan as a SIDS risk-reduction strategy. As far as the secondary source is concerned there's no evidence that fans have any effect on risk of SIDS, so there's absolutely no chance of you being able to sneak in doubt about that by juxtaposing a load of tangential discussion about a primary study that was deemed inadequate. --RexxS (talk) 01:12, 19 April 2016 (UTC)

You interpret "this study's results should be interpreted with caution" as meaning "there is no evidence"? Then, if those mean the same thing to you, how about we use the wording of the article? We can quote the article directly to make sure we are all happy, sahying '"In 1 study, the use of a fan seemed to reduce the risk of SIDS," but because of weaknesses with the study, "this study's results should be interpreted with caution"'. Or do you object to the wording of the secondary source itself? Wpegden (talk) 01:18, 19 April 2016 (UTC)

How about we call a spade a spade? There's no evidence of effectiveness and we should say just that. I don't see why we need to quote what a secondary source says about a primary source. We just need to summarise its conclusions, and leave the reader to read the source if they want to know what the source's authors thought about the evidence that they examined. --RexxS (talk) 01:32, 19 April 2016 (UTC)

• No no evidence that fans have effect on risk of SIDS in any way...IMO(where is there any evidence?)--Ozzie10aaaa (talk) 22:21, 18 April 2016 (UTC)

There is one limited piece of evidence. That is what this whole discussion is about. One primary study published in a reputable journal by researchers in the field found a (large, in fact!!) positive effect from fan use. The study is not without its flaws. Like all other studies on all risk factors for SIDS, the study is a correlation study, which makes inferring causation problematic. But it does provide one limited piece of evidence. More importantly, the fact that this study was done is noteworthy enough to appear in multiple high quality secondary sources. The fact that it is well-covered in the secondary literature is what should justify its inclusion. Wpegden (talk) 22:56, 18 April 2016 (UTC)

The study is not sufficient to support a claim of a "positive effect from fan use", and no matter how many times reviews examine it, that does not justify its inclusion in Wikipedia. This encyclopedia does not include content about individual pieces of research per se. That's the job of reviews in journals. Our job is to report what the best quality sources tell us about SIDS, not about what researchers might be looking at. Wikipedia is not a crystal ball. In this case we report what the best sources tell us about ways of preventing SIDS, and that's sleeping position, breastfeeding, limiting soft bedding, immunizing the infant and using pacifiers. The rest is tangential stuff that doesn't have any evidence of effectiveness. --RexxS (talk) 23:58, 18 April 2016 (UTC)

Maybe we actually agree. I am not proposing claiming a positive effect from fan use. I am proposing covering the fact, which the secondary sources feel is worth covering, that one study was done about fans. Reporting "what the best sources tell us about ways of preventing SIDS" is a violation of WP:MEDMOS, since it is directing its coverage specifically at practitioners and patients. A wikipedia article should be directed at a general audience. For example, someone (without babies, perhaps!) reading the SIDS article may be curious what possible links have been explored (even inconclusively). For such a reader, the fact that the role of temperature, ventilation, and fan use has received some attention may be interesting. Wpegden (talk) 00:07, 19 April 2016 (UTC)

No we don't agree. Your assertion that Reporting "what the best sources tell us about ways of preventing SIDS" is a violation of WP:MEDMOS is complete and utter rubbish. WP:MEDMOS #Diseases or disorders or syndromes gives the sections we should include, one of which is Prevention, and every developed medical article contains such a section. What do you expect to find in the "Prevention" section if it's not what the best sources tell us about ways of preventing the syndrome? --RexxS (talk) 00:44, 19 April 2016 (UTC)

I understand this is a long discussion but a lot of our problems are coming from misunderstandings. I am not proposing adding anything to the prevention section. Specifically, above, we considered creating a separate section titled Inconclusive research in which to include the proposal. Wpegden (talk) 00:49, 19 April 2016 (UTC)

Of course you are. You can't get the primary study included in the section to which it should relate, "Prevention", so you want to make a new section just to include it. What on earth makes you think that an encyclopedia article would be improved by having a section on "Inconclusive research"? What's next, a WP:POV-fork to a new article called Inconclusive research on prevention of sudden infant death syndrome? --RexxS (talk) 01:18, 19 April 2016 (UTC)

You are trying to psychoanalyze me now. Your are incorrectly assuming that I want people to use fans for prevention of SIDS. You are wrong about that. I think the study is interesting for some of wikipedia's audience and worth knowing about. As I've noted before, for many medical topics, inconclusive research forms the bulk of the content, because the topic is poorly understood (as is SIDS). This is why I proposed visiting the article on Mad Cow disease. Wpegden (talk) 01:22, 19 April 2016 (UTC)

Don't put words in my mouth again. I've made no assertion about you wanting people to use fans for anything. I have pointed out that you want to include discussion about a primary study that has no WP:WEIGHT, and that's not going to happen. There are plenty of secondary sources to use to write content about SIDS; we don't need an analysis of a primary source to write the Prevention section. --RexxS (talk) 01:38, 19 April 2016 (UTC)

I am not proposing any specific content for the Prevention section in particular. See above. Wpegden (talk) 18:57, 19 April 2016 (UTC)

• Weak oppose to inclusion of the finding of the particular study. I understand where Wpegden is coming from, but this comes down a WP:WEIGHT issue in my impression. There are many occasions when crafting our encyclopaedic content, especially in the area of biomedical research, that we omit particular claims because they do not reflect consensus science or even a significant vein of research and thus are not appropriate to an encyclopaedic summary of the topic. Such should be the case here. Establishing that a fact is covered in reliable, independent and secondary sources is just the first hurdle to inclusion; it is a necessary but not (in itself) sufficient standard for testing the appropriateness of the content.

Now, we should not be tempted to go down the rabbit hole of assessing the quality of the research itself (as some might be tempted to do here, because the study is incredibly weak to criticism on all manner of conflation of factors and poor empirical rigor), but what we can do is look at how much traction this notion has generated and whether it would be WP:UNDUE to mention it, even if the mention was brief and detailed the uncertainty of the findings. In my opinion, it would be undue, and the amount of influence the suggested claim would be given, not withstanding every good faith effort to contextualize it, is not justified by the profile of the research. Believe me, I'm usually one who errs on the side of inclusion and argues for attempts to appropriately attribute and provide context for a claim, rather than omit it altogether. But in this instance, I just don't think the balancing test works out in favour of adding the primary source or the direct claim in question. Snow ^{let's rap} 00:16, 19 April 2016 (UTC)

Let me emphasize an area of agreement. The study is indeed in many ways terrible and weak to all manners of criticism. The trouble with SIDS is that all studies on risk factors for SIDS have this property (although this study has more weaknesses than many). They all are correlation studies with the potential for large confounding effects. The fan study, in particular, is probably not nearly as bad as the studies on immunizations. Can you imagine a better predictor of parental noncompliance with clinical recommendations for SIDS prevention than the forgoing of immunizations? Fan-use is at least least largely orthogonal to whether or not patients listen to their doctors. Wpegden (talk) 01:08, 19 April 2016 (UTC)

I appreciate your comments. Can you help me understand why the major billing this receives in the two high-quality sources (entire sections devoted to the topic) do not merit inclusion in the article? If you look at the major section headings in those secondary sources (This article and this one), essentially all others concern topics covered in this wiki article. To me that is a simple test that it is noteworthy. Sometimes even a discredited study would even be noteworthy, and should be presented as such. Why is there no context in which this study should be presented? I am concerned that we are motivated by trying to steer patients in the right direction by de-emphasizing this study, even though the fact that it was conducted is notable (regardless of whether it provides convincing evidence of a link between fan use and SIDS). Wpegden (talk) 00:22, 19 April 2016 (UTC)

Maybe let me push the Bovine spongiform encephalopathy analogy a little bit more. Is the discussion in secondary sources on the possible relevance of ventilation and fans to SIDS less mainstream than research suggesting that the agent causing Mad Cow disease is a "a Virus,[14] Virino,[15] Spiroplasma,[16] or Acinetobacter[17]"? The possible connection between ventilation, fans, and SIDS is too tentative to be the basis of recommendations, but still of interest to some members of a general audience (e.g., those interested in what possible mechanisms or risk factors have been explored in research). Wpegden (talk) 00:43, 19 April 2016 (UTC)

Those who are interested in what possible mechanisms or risk factors have been explored in research can read the references. It's our job to summarise them, not reproduce them in minute detail. --RexxS (talk) 01:22, 19 April 2016 (UTC)

Summarizing is exactly what I propose. Here are the top-level headings from the secondary source: SUDDEN INFANT DEATH SYNDROME AND SUDDEN UNEXPECTED INFANT DEATH: DEFINITIONS AND DIAGNOSTIC ISSUES; PATHOPHYSIOLOGY AND GENETICS OF SIDS; ISSUES RELATED TO SLEEP POSITION; SLEEP SURFACES; BED-SHARING; BEDDING; PRENATAL AND POSTNATAL EXPOSURES (INCLUDING SMOKING AND ALCOHOL); BREASTFEEDING; PACIFIER USE; OVERHEATING, FANS, AND ROOM VENTILATION; SWADDLING; IMMUNIZATIONS AND SIDS. Studies done on all of these topics are discussed in the wiki article, except for the section on OVERHEATING, FANS, AND ROOM VENTILATION. We are second-guessing the secondary sources by deciding that the studies covered by this section are non-notable. Wpegden (talk) 01:31, 19 April 2016 (UTC)

Then start an RfC to take the discussions about the primary sources out of the article. You'll get my support. Notability is the criterion for deciding whether an article should exist, not on whether particular content should be included in an article. You want WP:Verifiability and WP:WEIGHT for that. --RexxS (talk) 01:45, 19 April 2016 (UTC)

• No, interpret any finding from research that has known limitations with caution. Drchriswilliams (talk) 06:13, 19 April 2016 (UTC)

Are you opposing any mention of the study, or just saying we shouldn't interpret it's results carelessly? I would be open to any suggestions of wordings for inclusion, listing limitations of the study, etc. I am not proposing saying that fans reduce the risk of SIDS.Wpegden (talk) 14:49, 19 April 2016 (UTC)

• No. Just went through and read this very-lengthy discussion. In my opinion, mentioning the fans would be to mention a primary source, and to give it undue weight. I did not read the AAP report, but I assume they comment on many primary sources throughout. If we were to include this info, we may as well mention each primary sources AAP reviews and then give AAP's conclusion on that source. Instead, we should give the conclusions the AAP arrived at (which, it appears to me, would be that increased body temperature is associated with SIDS; though again I didn't read the AAP report). Best of luck in reaching some kind of peaceful, happy agreement. Ajpolino (talk) 00:47, 20 April 2016 (UTC)

Is there any chances you could be bothered to glance at (This article and this one)? If I hadn't looked at these I would agree with you. In particular, in each one, "Fans, ventilation, and heating" are a major topic to which an entire section is devoted. The essential question is: shouldn't it be mentioned then that research on this topic has been done? Wpegden (talk) 12:45, 20 April 2016 (UTC)

I could indeed be bothered to glance at those papers (disclaimer: I only read the sections on fans that you pointed to). Each of these sections mention the study in question and seem to conclude that it is unclear whether or not fans are associated with decreased risk of SIDS. So, just to clarify my opinion here, I'm ok (in theory) with mentioning here that there is insufficient evidence to evaluate an association between fans and SIDS (since this is a conclusion of the secondary sources). However, I'm opposed to stating here that one study found a benefit of fans, but others think the study is weak (since this would be summarizing the conclusion of a primary source, then giving the secondary source's opinion on it). I don't think the primary source that found an association between fans and SIDS merits specific mention. So my opinion on the thread's question ("the question is whether it is appropriate, in some form, to include a mention of the fact that this study was done (including its limitations)") is that no, it is not appropriate to mention the fact that this study was done. Thanks for the follow-up question. I hope that helps clarify my thinking. If you think I'm missing something, I'm happy to be pointed to more reading. Ajpolino (talk) 18:14, 20 April 2016 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

proposal for new medical article guideline

The message I am getting from editors over and over again is that it is inappropriate for wikipedia to present inconclusive research, even when it is well-covered by high-quality secondary sources. (For anyone new to this discussion, I encourage a text search of the talk page for the terms "inconclusive research" and "summarize the conclusions" of the discussions above.)

Can we formalize this as a potential guideline for inclusion on WP:MEDMOS? It would be helpful to know that we are being consistent.

Here is a proposal: please propose modifications / improvements:

Generally, Wikipedia articles on medicine should refrain from discussing inconclusive research on a topic.

I.e., we can say "It is inconclusive whether there is a link between X and Y" when a secondary source says this,

but we cannot say "a link has been proposed between X and Y, but evidence is weak...", by citing a secondary study, which is referring to an inconclusive link proposed by a primary study. Wpegden (talk) 16:41, 19 April 2016 (UTC)

I have restricted the proposal to medicine, rather than science in general, since I am confident that a more general proposal would have no chance of inclusion in Wikipedia guidelines for science articles. Based on the discussions above, on the other hand, the community of Wikipedia medical editors seem like they may welcome such a proposal.

I believe such a proposal would be very helpful to new editors on medical articles, for whom this proposal may be non-obvious. Hopefully, if we can agree on this proposal here, we can move it up to a discussion at the appropriate levels. Wpegden (talk) 14:50, 19 April 2016 (UTC)

This is just apples and oranges. I really don't see how you're getting from wanting to include specific mention of a singular, poor-quality study, to excluding content that summarizes high quality secondary sources' assessments of the state of the evidence when that assessment is "inconclusive", as is the case very, very often. Regardless, this should be at WT:MEDRS and not here. Zad68 15:53, 19 April 2016 (UTC)

Zad68, I have structured this proposal to mirror your viewpoint as closely as possible. Please help me steer it if I have misaimed. In particular, I am saying that medical articles should avoid discussing research done on a topic, when the research is not considered to be sufficient evidence to draw a conclusion from. I believe that is what you have said over and over again (we should just "summarize the conclusions" of secondary sources, so research they discuss which hasn't been used to draw conclusions shouldn't be mentioned). It is possible that the wording above isn't capturing this fully? Would you like to help me try to improve it to more accurately reflect your view? Do you feel like I am misunderstanding or misinterpreting your viewpoint? I have honestly tried to capture it exactly as presented in the discussion above. Wpegden (talk) 16:02, 19 April 2016 (UTC)

To clarify, I do not intend this proposal to prohibit articles from summarizing a secondary source's view that research is inconclusive. We can say: "It is inconclusive whether there is a link between X and Y". The point of the proposal is to prohibit the discussion of the research which is discussed by the secondary, but from which they don't draw conclusions. We cannot say things like "a link has been proposed between X and Y" (citing a secondary study, which is referring to an inconclusive link proposed by a primary study). I really think this proposal is tracking the arguments above quite precisely. Wpegden (talk) 16:36, 19 April 2016 (UTC)

OK Wpegden I now have theory about the root cause of the issue here. Here is the entirety of the AAP technical's report treatment regarding fans, all three sentences:

1. In 1 study, the use of a fan seemed to reduce the risk of SIDS (adjusted OR: 0.28 [95% CI: 0.10 – 0.77]).297
2. However, because of the possibility of recall bias, the small sample size of controls using fans (n = 36), a lack of detail about the location and types of fans used, and the weak link to a mechanism, this study's results should be interpreted with caution.
3. On the basis of available data, the task force cannot make a recommendation on the use of a fan as a SIDS risk-reduction strategy.

Can you please distinguish between the sentences where the AAP is presenting that primary source evidence they considered, and where the AAP is drawing a conclusion regarding the state of the evidence? You can format your response like "sentence 1: ....; sentence 2: ..." etc. Thanks... Zad68 16:40, 19 April 2016 (UTC)

sentence 1: primary source evidence supporting link between fan use and SIDS risk.

sentence 2: limitations of evidence. (i.e., why evidence is not conclusive).

sentence 3: Ergo, no recommendation is made. (Sorry for frequent re-editing) Wpegden (talk) 16:45, 19 April 2016 (UTC)

Thus the proposal above will prohibit discussing part 1 in a wiki article on medicine, since it was not the basis of a conclusion drawn by the secondary source. Wpegden (talk) 16:47, 19 April 2016 (UTC)

That's the thing, 1) was EXACTLY what the AAP used to draw the conclusion. The conclusion is "The state of the evidence is such that no recommendation can be made." What I and others (see the RFC above) are saying is that we use 3), not 1) and 2). Zad68 16:50, 19 April 2016 (UTC)

Wait, are you arguing that the primary source does not constitute inconclusive research? You are suggesting that it is instead conclusive research, whose finding is that the AAP makes no recommendation about fan use? Are you sure that's what you are suggesting? To emphasize the point: presumably, if this study had not been done, the AAP would still have no recommedation about fans. The study is not the "basis" of a "lack of recommendations". There is no recommendation because the study is considered inconclusive. Wpegden (talk) 16:57, 19 April 2016 (UTC)

The AAP's conclusion regarding the state of the evidence is that there is insufficient evidence to make a recommendation. I (and others) just can't make it any plainer than that. You can argue that the one study was "conclusive"--it sure concluded that fans are helpful. But when the AAP assess the quality of the study they judged that it wasn't good enough to use to make a recommendation. Sorry I and others can't seem to get this across. Zad68 17:20, 19 April 2016 (UTC)

I don't disagree with any of that. The current proposal is to codify the principle you are using, that studies discussed by secondary sources but too weak for secondary sources to make decisions based on should not be included in medical articles. Wpegden (talk) 18:55, 19 April 2016 (UTC)

As far as using 3), not 1) and 2), my reply is, let's codify this into a concrete proposal, to avoid these kind of misunderstandings in the future, and ensure consistency across medical articles in wikipedia. Is your proposal to only dicuss AAP recommendations? To not discuss inconclusive links? Something else? Wpegden (talk) 16:57, 19 April 2016 (UTC)

To be frank, this discussion based about a proposal seems to be an attempt to continue a previous argument. I don't think that extrapolating from a specific situation in this way is helpful. Drchriswilliams (talk) 17:03, 19 April 2016 (UTC)

Why is a guideline not helpful? Wikipedia has guidelines for a reason. They help produce consensus. Having this proposal could have avoided this whole mess. Wpegden (talk) 17:05, 19 April 2016 (UTC)

WP:CGTW#8 applies. It's pretty clear by now that Wpegden is a nothing but a problem here. I foresee administrative action being necessary shortly. Alexbrn (talk) 17:45, 19 April 2016 (UTC)

WP:CGTW#8 states: Anyone who edits policy pages to favor their position in a specific dispute has no business editing policy pages. I have not edited any policy pages. Moreover, the change I am proposing is against my position in the dispute. I am making the proposal because it would be helpful to have a clear standard on inclusion, regardless of whether it is the one I agree with. Did you deliberately ignore the fact that my proposal is against my position, or did you miss it? Wpegden (talk) 19:02, 19 April 2016 (UTC)

Positions on proposal

Amazingly, despite paragraphs of text in this section, no actual positions seem to be taken on the actual proposal made above. Can we collect answers in this section? I propose answers of the form:

A) Agree with proposed statement, and am open to some version of it being part of the guidelines

B) Agree with proposed statement, but am not open to some version of it being part of the guidelines

C) Disagree with proposed statement, and do not want it to become a guideline

D) Disagree with proposed statement, but am open to some version of it being part of the guidelines.

My position is

D. Although I disagree with the statement, if it reflects the medical wikipedia community standard, then it is best to codify this to help reach consensus in the future. Wpegden (talk) 19:14, 19 April 2016 (UTC)

• No it is clear above. People support the current wording in the article and not the new wording you propose. You already have a RfC open. And what does this discussion have to do with SIDS? Doc James (talk · contribs · email) 20:02, 19 April 2016 (UTC)

I am trying to take what we have learned about the communities view on inclusion standards from the SIDS discussion, and propose a guideline which would help reach consensus in similar situations in the future. You are A,B,C,D or you decline to say? Is there a better place to discuss this proposal? Wpegden (talk) 20:27, 19 April 2016 (UTC)

Yes; changes to the wording of policy should be discussed on the talk page for the guideline which you'd like to propose a change too (they should also be advertised in a central community discussion space, such as WP:VPP or WP:CD). But I wouldn't count on this particular proposal garnering much support, and I can't recommend the attempt; I'll tell you honestly that it looks as if you are using this "well, let's at least make the policy reflect what I'm being forced to accept here (or at least my interpretation of it)" proposal as a kind of platform to continue a passive-aggressive critique of the outcome of the discussion above, after you were unanimously out-!voted in an RfC you yourself opened.

That may very well not be your intention, but I feel fairly confident in saying that I'm not the only one getting the sense that your continued fixation doesn't feel helpful. Even if you genuinely just want clarity here, I suggest you WP:DROPTHESTICK and let the matter go for a time--in a few weeks, if you come back to this issue and feel you still want to change policy to reflect the consensus here (for the sake of other editors and the project at large), then, by all means, broach it at the talk page for the policy you want to change and/or a community discussion space. But my honest assessment is that you will not make much headway there with the proposed change. Still, if you're determined to try, I'll advise you in the process myself. Snow ^{let's rap} 07:50, 22 April 2016 (UTC)

Note: My apologies Wpedgen; I did not see the message in a lower thread wherein you already stated your decision to drop the matter and focus your energies elsewhere. Snow ^{let's rap} 16:29, 22 April 2016 (UTC)

Note on using "off topic" tag: "these templates should not be used by involved parties to end a discussion over the objections of other editors." Wpegden (talk) 20:31, 19 April 2016 (UTC)

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Sources

• This source is Frontiers and generally deemed not appropriate.{{cite

journal|last1=Elhaik|first1=E|title=A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome.|journal=frontiers in Neurology|date=October 2016|volume=7|pages=1–12|pmid=27840622|doi=10.3389/fneur.2016.00180}}</ref>

• This source is not pubmed indexed {{cite

journal|last1=Elhaik|first1=E|title=Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS).|journal=Journal of Clinical and Translational Research|date=January 2019|volume=4|issue=2|pages=5|doi=http://dx.doi.org/10.18053/jctres.04.201802.005 }}

Doc James (talk · contribs · email) 12:21, 18 March 2019 (UTC)

Source is now up on pubmed but it has an impact factor of zero.[5] Still not suitable. Doc James (talk · contribs · email) 09:08, 22 March 2019 (UTC)

Professor Peter Fleming from Bristol

Why don't I see an English article about this man? Looks like he saved a lot of lives. 1 2 10 11

And not even worthy of mention in this article? МетаСкептик12 (talk) 16:39, 20 May 2019 (UTC)

UCSF Foundations 2 2019, Group 7a goals

1. Improve article organization

2. Proposals for the Risk Factors section: Infant deaths attributed to SIDS are unlikely to stem from one single cause, but are often linked to multiple risk factors. Michaelfashola (talk) 20:29, 1 August 2019 (UTC)

3. Proposal for the general section: In 2016 the rate of SIDS was reported to be between 0.2 to 0.5 per 1000 births. In numerous countries; the incidence of SIDS seems to have been lowered by the installment of "safe sleep campaigns" Michaelfashola (talk)

4. Proposition for the other section of risk factors.

infants who are born preterm are at four times the risk of SIDS, research suggests that this is related to an underdeveloped ability to control the cardiovascular system. 

Colette's Review of UCSF Foundations 2 2019, Group 7a Goals

Goal 1. No edits were made to improve article organization yet. The article was already fairly organized into appropriate sections.
Goal 2. A sentence was added to clarify that SIDS has multiple risk factors.
Goal 3. Safe sleep campaigns are mentioned, but could use further elaboration.
Goal 4. A sentence was added to highlight the increased risk of premature infants due to CV effects, but could use further elaboration.
Overall, most group goals were addressed and provided clarification to the article.
Additional details and explanations would offer further improvement to the article. All added points were verifiable by cited secondary sources.

Cpktruong (talk) 21:08, 5 August 2019 (UTC)

Matt's Review

Part 1: The article was not substantially improved. Group 7a's goals are addressed as the following:
1. The article organization has yet to be improved.
2. SIDS was identified to have multiple risk factors and cited.
3. Edits to the general section have yet to be made.
4. The risk factor was added. However, the sentence could be improved grammatically.
Part 2: The article edits maintained its neutral point of view.
Maludino (talk) 21:16, 5 August 2019 (UTC)

Emily's Review to UCSF Foundations II 2019, Group 7A

The groups edits do not substantially improve the article. It seems as though they only added one sentence into the "other" header, and rewrote an already existing sentence.
The goals are not very clear. Most are proposals and it doesn't seem as though any of them have been met.
No evidence of plagiarism or copyright violation was found.
Emilyplasencia (talk) 21:52, 5 August 2019 (UTC)

Jacklyn Ang's Review for Foundations II 7a, group edits

•Do the group’s edits substantially improve the article as described in the Wikipedia peer review “Guiding framework”?

No, the group's edits only consisted of an additional sentence under the "other" header. However, this can be compromised because the overall article contains substantial amount of statistics, facts, and different risk factors that contribute to Sudden Infant Death Syndrome.

•Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…

Yes, the article was already organized into sections and the added edit was placed in the appropriate section.

• Has the group achieved its overall goals for improvement? The goals of the group are:

1. Improve article organization---> Article is already organized appropriately

2. Proposals for the Risk Factors section: Infant deaths attributed to SIDS are unlikely to stem from one single cause, but are often linked to multiple risk factors. Michaelfashola (talk) 20:29, 1 August 2019 (UTC) [1]---> The proposal along with the reference was implemented onto the article.

3. Proposal for the general section: In 2016 the rate of SIDS was reported to be between 0.2 to 0.5 per 1000 births. In numerous countries; the incidence of SIDS seems to have been lowered by the installment of "safe sleep campaigns" Michaelfashola (talk) [2]---> Safe sleep campaigns should be elaborated more instead of adding these statistics. In the general section, safe sleep campaigns were mentioned with statistical rates.

4. Proposition for the other section of risk factors.---> This was added under the "other" header. I recommend breaking up the sentence into two sentences with the second sentence starting "research suggests..."

Jacklyn.Ang (talk) 22:51, 5 August 2019 (UTC)

Proposal to lock edits

The page has been under attack by anti-vaccine advocates in the last several says. I recommend we lock this page. — Preceding unsigned comment added by 2600:1008:B14B:8ED7:44BF:3AF0:B451:97C9 (talk) 21:27, 27 October 2019 (UTC)

Agreed —Licks-rocks (talk) 22:44, 29 October 2019 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 July 2019 and 23 August 2019. Further details are available on the course page. Student editor(s): Sara.F.Shaikh, Michaelfashola, Ashleyher, ManuelSeraydarian.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 10:23, 17 January 2022 (UTC)

Research result on biochemical SIDS marker

https://www.biospace.com/article/researchers-answer-how-and-why-infants-die-from-sids/

Excerpt:

“The theory was that if the infant stopped breathing during sleep, the defect would keep them from startling or waking up.

“The Sydney researchers were able to confirm this theory by analyzing dried blood samples taken from newborns who died from SIDS and other unknown causes. Each SIDS sample was then compared with blood taken from healthy babies. They found the activity of the enzyme butyrylcholinesterase (BChE) was significantly lower in babies who died of SIDS compared to living infants and other non-SIDS infant deaths. BChE plays a major role in the brain’s arousal pathway, explaining why SIDS typically occurs during sleep.

“Previously, parents were told SIDS could be prevented if they only took proper precautions: laying babies on their backs, not letting them overheat and keeping all toys and blankets out of the crib are a few of the most important preventative steps. Importantly, they still are, as there is still no test for this biomarker.”

Jo3sampl (talk) 21:33, 16 May 2022 (UTC)