Wikipedia talk:Identifying reliable sources (medicine)
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![]() | Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Identifying reliable sources (medicine).
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These are some Frequently Asked Questions about Wikipedia's guidelines on sourcing for medical content, manual of style for medicine-related articles, and how the guidelines and policies apply to biomedical content. General
Does Wikipedia have special rules for medical information?
Yes, but the guidelines for medical information follow the same broad principles as the rest of Wikipedia. Examples of this include the requirement for reliable sources and the preference for secondary sources over primary sources. These apply to both medical and non-medical information. However, there are differences in the details of the guidelines, such as which sources are considered reliable. Why do you have special rules for medical information?
Different types of sources have different strengths and weaknesses. A type of source that is good for scientific information is not usually as reliable for political information, and vice versa. Since Wikipedia's readers may make medical decisions based on information found in our articles,[1] we want to use high-quality sources when writing about biomedical information. Many sources that are acceptable for other types of information under Wikipedia's general sourcing guideline, such as the popular press, are not suitable sources for reliable medical information.[2][3][4] (See also: WP:MEDPOP and WP:WHYMEDRS) When do I need to follow MEDRS?
MEDRS-compliant sources are required for all biomedical information. Like the policy on the biographies of living people ("BLP"), MEDRS applies to statements and not to articles: biomedical statements in non-medical articles need to comply with MEDRS, while non-medical statements in medical articles do not need to follow MEDRS. Also like BLP, the spirit of MEDRS is to err on the side of caution when making biomedical statements. Content about human biochemistry or about medical research in animals is also subject to MEDRS if it is relevant to human health. Sourcing
I used a peer-reviewed source, but it was reverted, and the editor said I needed to use a review. I did, didn't I?
Probably not. Most peer-reviewed articles are not review articles. The very similar names are easily confused. For most (not all) purposes, the ideal source is a peer-reviewed review article. Why can't I use primary sources?
Primary sources aren't completely banned, but they should only be used in rare situations. An individual primary source may be flawed, such as being a clinical trial that uses too few volunteers. There have been cases where primary sources have been outright fraudulent. Furthermore, a single primary source may produce a different result to what multiple other primary sources suggest, even if it is a high-quality clinical trial. Secondary sources serve two purposes: they combine the results of all relevant primary sources and they filter out primary sources that are unreliable. Secondary sources are not infallible, but they have less room for error than a primary source. This follows a principle that guides the whole of Wikipedia. If a company announces a notable new product, Wikipedia would not cite a press release on the company's website (a primary source) but instead would cite a newspaper article that covers it (a secondary source). The difference with medical information is that the popular press are not suitable sources. Whenever possible, you should cite a secondary source such as:
So if primary sources can be used in rare cases, what are those rare cases?
Primary sources might be useful in these common situations:
Why can't I use articles from the popular press?
The popular press includes many media outlets which are acceptable sources for factual information about current events, sometimes with significant caveats. It also includes media outlets which are discouraged in all cases because the quality of their journalism is inadequate. However, even high-quality media outlets have disadvantages in the context of medicine. Firstly, news articles on medicine will frequently be reporting a new medical primary source, such as the results of a new study. This means that they are effectively acting as a primary source, which as explained above makes those articles generally unsuitable for medical information. These articles also tend to omit important information about the study. If a medical primary source is to be cited at all, the academic paper should be cited directly. Secondly, media coverage of medical topics is often sensationalist. They tend to favor new, dramatic or interesting stories over predictable ones, even though studies that reflect the current scientific consensus tend to be predictable results. They tend to overemphasize the certainty of any result, such as reporting a study result as a conclusive "discovery" before it has been peer-reviewed or tested by other scientists. They may also exaggerate its significance; for instance, presenting a new and experimental treatment as "the cure" for a disease or an every-day substance as "the cause" of a disease. The sensationalism affects both which stories they choose to cover and the content of their coverage. High-quality media outlets can be good sources of non-medical information in an article about a medical topic. Another acceptable use is using a popular press article to give a plain English summary of an academic paper (use the I have a source from PubMed, so that's reliable right?
Not necessarily. PubMed is merely a search engine and the majority of content it indexes is not WP:MEDRS. Searches on PUBMED may be narrowed to secondary sources (reviews, systematic reviews, meta-analyses, etc.) so it is a useful tool for source hunting. It is a common misconception that because a source appears in PubMed it is published by, or has the approval of, the National Institutes of Health (NIH), National Center for Biotechnology Information (NCBI), or the US government. These organisations support the search engine but lend no particular weight to the content it indexes. Can I use websites like Quackwatch?
Quackwatch is a self-published website by an author who is an expert in problems with complementary and alternative medicine. Whenever possible, you should use a scholarly source instead of Quackwatch. However, if no scholarly sources are available, and the subject is still notable, then it might be reasonable to cite Quackwatch with WP:INTEXT attribution to the POV. Can I cite Chinese studies about Traditional Chinese Medicine?
As of 2014, there are concerns regarding positive bias in publications from China on Traditional Chinese Medicine.[5][6] Such sources should be used with caution. The problem also includes issues with the academic system in China.[7] Can I cite NCCAM (now NCCIH)?
Yes, but again only with WP:DUE weight. Unlike other branches of the National Institutes of Health, which are generally accepted as authoritative in their fields, NCCAM has been the focus of significant criticism from within the scientific community.[8] Whenever possible, you should cite the established literature directly. What if I can’t find any MEDRS-compliant sources on a subject?
MEDRS contains a section about finding sources which may be helpful. Alternatively, a more experienced editor may be able to help you find them (or to confirm that they do not exist). Neutrality
What is a fringe medical claim?
A fringe medical claim is one that differs significantly from the prevailing views or mainstream views in the scientific medical community. This is similar to Wikipedia's general definition of a fringe claim. A claim can still be a fringe medical claim even if it has a large following in other areas of public life (such as politics and the popular press). How should fringe medical claims be described?
When fringe claims have been widely reported in the press, have a large popular following, and/or have a long history, it may be appropriate to describe them in terms of that reporting, popularity, or history. However, weight should be determined by MEDRS-compliant sources, and the context (or lack thereof) should not make implications about medical statements that are not supported by such sources. Guidance on the additional considerations relevant to fringe subjects can be found at WP:FRINGE, as well as at other places such as WP:WEIGHT and WP:EXCEPTIONAL. In the case of alternative medicine, medical statements are often derived from an underlying belief system, which will include many propositions that are not subject to MEDRS. These propositions are subject to the usual sourcing requirements and the usual requirements for determining fringe status. If a treatment hasn't been shown to work, can we say it doesn't work?
There are three possible situations:
In the first case, we cannot say that it does not work, but we can say that there is no evidence to determine whether it works. After multiple, high-quality independent studies have been published, the understanding may transition from "no evidence" to "some evidence" of either an effect or no effect. You should follow the lead of review articles and other secondary sources for determining when this threshold has been crossed. Reports may conflict with each other. For example, a clinical trial may produce no evidence of an effect, but the treatment's manufacturer might produce testimonials claiming a positive effect. You should follow the lead of review articles and other secondary sources for determining how to balance these claims. Should medical content be attributed?
In other words, is it necessary to say in the article's text the source which supports a medical statement (with attribution)? Or can it simply be stated as an unchallenged fact, with the source only mentioned in the citation (without attribution)? A statement without attribution will come across as being a stronger claim than one with attribution. A result or statement from a reliable secondary source should be included without attribution if it is not disputed by any other recent secondary sources. You should do a search to check that the secondary source you are citing is the most up-to-date assessment of the topic. If there have been two recent secondary sources that contradict each other, then you should attribute the disputed findings. On the other hand, if the findings of one or more recent secondary sources are disputed by one or more secondary sources from many years ago, but not by any recent ones, the recent findings can be stated without attribution. You should also take into account the relative weight secondary sources have. For example, Cochrane Collaboration reviews provide stronger evidence than a regular secondary source. In the rare cases where primary sources can be used, they should be attributed. Why not say there is a call for more research?
It is common for scientific publications to say something like this, either directly or indirectly. There are several reasons for this. It could be argued that more research is always a bonus, even if the topic has already been thoroughly researched. Sometimes, these statements may be made partly because authors need to convince readers that the topic is important in order to secure future funding sources. As such, saying this does not communicate much information, and it may also mislead readers into thinking that the existing information on a topic is less reliable than it really is. How can Quackwatch be considered a reliable source?
As noted above, Quackwatch does not meet the usual standard as a reliable source, but it can be used (with attribution) for information on a topic of alternative and complementary medicine if there are no scholarly sources available for the same purpose. The guidelines on fringe theories includes the concept of parity: if a notable fringe theory is primarily described by self-published sources, then verifiable and reliable criticism of the fringe theory does not need to be published in a peer-reviewed journal. It only needs to come from a better source. Finding and using sources
How can I find good sources using PubMed?
National Library of Medicine (NLM), PubMed, NCBI, & MEDLINE help, tutorials, documentation, & support
Full, searchable list of all tutorials - training materials in HTML, PDF and Video formats YouTube channel for the National Library of Medicine: Tutorial videos from the National Center for Biotechnology Information (NCBI), part of the U.S. National Library of Medicine. Includes presentations and tutorials about NCBI biomolecular and biomedical literature databases and tools. PubMed FAQs
National Library of Medicine (NLM) Catalog
NLM Catalog Help - This book contains information on the NLM Catalog, a database which provides access to NLM bibliographic data for journals, books, audiovisuals, computer software, electronic resources, and other materials via the National Center for Biotechnology Information (NCBI) Entrez retrieval system. The NLM Catalog includes links to full text materials and the library's holdings in LocatorPlus, NLM's online public access catalog. NLM Catalog (rev. December 19, 2019). Finding journals that comply with WP:MEDRS standards
For full comprehensive instructions, go to: Searching for Journals in NLM Catalog Determine if a specific journal is indexed in MEDLINE
If you know the full or abbreviated name for a journal, and you want to see if it is indexed in MEDLINE, see the instructions at searching by journal title, which I will also reproduce here:
Review the list of Abridged Index Medicus journals
Via a search of the NLM Catalog: List of Abridged Index Medicus journals, also known as "Core clinical journals". Stand alone list: List of current Abridged Index Medicus (AIM) journals (118 journals as of 5 May 2020) Create a list of all Index Medicus journals
Search the NLM Catalog using ====Create a list of all journals indexed in MEDLINE}}
Search the NLM Catalog using MEDLINE, PubMed, and PMC (PubMed Central): How are they different?
MEDLINE, PubMed, and PMC (PubMed Central): How are they different? Are there ways to find good sources other than PubMed?
Besides being a secondary source, what else indicates a source is of high quality?
I found what looks like a good source, but can't access the full text – what next?
Most scholarly journals are behind paywalls. Some options to access these articles include visiting a local university library, visiting The Wikipedia Library, and WikiProject Resource Requests. Note that paywalled articles are frequently pirated and made available on the open web. When linking to a journal article, care must be taken not to link to such a pirate copy, as such a link would be a copyright violating link in contravention of Wikipedia's policy. In general if you find such a copy and it is not accompanied by text explicitly stating that it is made available with the permission of the copyright holder, assume that it is potentially infringing, and do not link to it. This holds for all edits in Wikipedia, not just in article space. Google Scholar
Search for the title of the article on Google Scholar. On the results page, click on "All n versions" (where n = the number of available versions of that article) at the bottom of a listing. The resulting page might contain PDF or HTML versions of the article. Unpaywall
Consult Unpaywall.org for journal articles available without a subscription. Install the UnPaywall extension for Chrome or Firefox to immediately identify articles with a free version. After you install the extension, look to the right side of the page (when you are on the website for an article) for either a grey locked symbol (no free version) or a green unlocked symbol (click on that symbol to access the full text version of the article). Librarian's advice
An article by librarian John Mark Ockerbloom, titled, "Why Pay for What’s Free? Finding Open Access and Public Domain Articles" offers helpful suggestions.[9] How do I reference a medical article?
Almost all medical articles are indexed by the PubMed search engine and have a Digital object identifier (DOI) assigned to them. All articles included in PubMed are assigned an eight-digit PubMed identifier (PMID). These identifiers can be used to refer to articles, which is preferred to URLs as it makes a reliable link which is resilient to changes beyond our control – i.e. the publisher being acquired by another publisher and it's "normal" web URLs changing as a consequence. Once you have the PMID, there are a number of tools such as this one which you can use to generate a full citation automatically. In article references, the "doi" and "pmid" parameters are preferred to the "url" parameter for such reasons. On Talk pages, when referring to journal articles, is it good practice to make any link using these types of identifier also:
Conflict of interest
Are there special considerations for conflicts of interest for health content?
See WP:MEDCOI. What if I am being paid to edit medical content?
See WP:PAID. References
References
Other helpful resources
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Meta-analyses need careful scrutiny, peer-reviewed or not.
[edit]This
- Glenza, Jessica (28 April 2024). "Junk science is cited in abortion ban cases. Researchers are fighting the 'fatally flawed' work". The Guardian.
Of the 22 studies cited by the meta-analysis, 11 were by the lone author of the paper itself. The meta-analysis "failed to meet any published methodological criteria for systematic reviews" and failed to follow recommendations to avoid statistical dependencies, according to a criticism published in the British Medical Journal (BMJ).
is a cautionary tale. 𝕁𝕄𝔽 (talk) 19:15, 28 April 2024 (UTC)
- Thanks, that's interesting.
- I have been wondering recently why peer review doesn't involve putting each article through an evidence-based checklist (e.g., the Newcastle–Ottawa scale for non-randomized studies; the most relevant checklist for the subject matter could be agreed upon by the reviewers and the editor) and the results published alongside the article. It might make it easier to discover junk science before publication. WhatamIdoing (talk) 21:47, 28 April 2024 (UTC)
- A number of journals now require (or at least strongly encourage) articles to follow appropriate guidelines including completed checklists (usually as part of Supplemental Material). EQUATOR has guidelines/checklists that cover many types of articles. For example, here is part of my boilerplate for rejecting bad MR papers:
- "As you prepare your manuscript for submission to another specialty journal, you may be able to improve it by following one or more of the EQUATOR Guidelines's checklists (https://www.equator-network.org). Mendelian randomization studies must adhere to the best practice as described in the following guideline https://wellcomeopenresearch.org/articles/4-186/v3 and be accompanied to MR-STROBE checklist (https://www.equator-network.org/reporting-guidelines/strobe-mr-statement/)." Jaredroach (talk) 21:27, 12 July 2024 (UTC)
Reconsidering a blanket-ban of primary sources
[edit]The express reason given is essentially a re-hash of the "reproducibility crisis," but I have to say, should we even be trusting these "fact-checking"-like organizations for whom we essentially defer the power of keeping out bad knowledge?
Did you know, for example, the American Psychological Association, known for such works as the DSM-V and numerous textbooks likely to pass as verified work through here without a second thought, is actually a trade organization with the express intent of lobbying on behalf of practicing psychologists, in exchange extracting registration dues, and licensing fees?
Or that the American Pain Society, this time a non-profit society that nominally advocated on behalf of patients by publishing clinical practice guidelines, actually instead acted on behalf of pharmaceutical companies to propagate a treatment mandate to prescribe more products, in essence acting as a marketing channel where physicians were not primed to regard it critically?
I think it might be beneficial to re-investigate the ultimate authority of the organizations/publication guidelines we choose to let pass uncritically with more ability afforded to well-informed individuals to make their case that enough primary research exists to effectively include a consensus on matters of pathology and lines of inquiry related to potential treatment paradigms. We do ourselves a disservice when we shut out promising potential, and similarly to our readers too when academic literature acts more like a thicket than it does pathway. Additivefreesb (talk) 17:52, 12 July 2024 (UTC)
- Which blanket-ban on primary sources are you referring to? Firefangledfeathers (talk / contribs) 17:56, 12 July 2024 (UTC)
- Wikipedia:Identifying reliable sources (medicine)#Avoid primary sources isn't a blanket ban. Wikipedia:Identifying reliable sources (medicine)#Avoid over-emphasizing single studies, particularly in vitro or animal studies is just common sense.
- We have had multiple problems with primary sources, including:
- editors cherry picking the one source that says something completely different from all the others (e.g., cigarettes don't cause lung cancer)
- editors using obviously bad primary sources (e.g., the patent claiming that colloidal silver cures HIV, but it didn't test whether people had HIV in the first place)
- editors believing the media hype (can result in bad content [because newspapers don't always get technical details right] and unbalanced articles [because it's all about what's in today's news, and next week it'll be some other vegetable that everyone's supposed to eat to prevent cancer])
- authors spamming their own publications into as many articles as possible (this happens much less often with review articles)
- plus, of course, all the problems with the reproducibility crisis and the general difficulty of figuring out which primary source to 'believe in', if the data is conflicting.
- Primary sources are more likely to be tolerated in veterinary content or for very rare conditions. WhatamIdoing (talk) 18:38, 12 July 2024 (UTC)
I think something needs to be said of primary sources often also overwhelming both the average reader or editor, owing to both their sheer number, and the fact that even many well-intentioned editors are not deeply knowledgeable about all issues they write about.
Further, there is simply no blanket ban on primary sources. For instance, there is actually not even a recommendation to refrain from using secondary summaries from within primary sources (i.e. background sections or well chosen parts of discussion sections). One of the problems to allay is keeping Wikipedia from reading: xx et al. found 80% mortality, while xy found 79%, and zy found 81% - with WP:OR prohibiting us from summarizing these (which would be a problem due to evidence grading). This becomes less of a problem upon listing authoritative secondary sources, as they already do summation for us, and readers are likely to want to know what, for instance, both the CDC and WHO think about a specific issue.
This guideline already discusses pitfalls of relying on industry and industry-funded sources, and I would not object to a well-thought out extension on issues of industry influence on practice guidelines or biases in professional associations. WP:MEDORG (part of this guideline, which I worked extensively on) points to industry guidelines or guidelines from patient advocacy groups being considered below the threshold of MEDRS.
Perhaps, in the spirit of giving background to a well-though-out question, Colin has input on considerations when MEDRS was originally drafted. CFCF (talk) 17:54, 13 July 2024 (UTC)
- Lots of people worked on the early drafts of MEDRS. My significant part was realising the medical project's guideline, which was becoming MEDMOS, needed the RS stuff pulled out of it into a new page. But the key battles we had then were editors who thought they knew better than these secondary sources or who thought journalists on their favourite paper did better. Citing the secondary literature was something academics are taught to avoid so it didn't come naturally.
- Coming back to the original question about our favoured MEDORG guidelines having a malign influence behind them. Consider then if we let editors build our medical articles much like someone might write their own review from the primary research studies. That same malign influence would appear on Wikipedia as editors cherry picking primary sources. There isn't a mechanism whereby Wikipedia might be expected to do better, and a fair amount of evidence that it would do worse.
- Wikipedia has a unique editing model where anyone can edit but the consequence of this is we agreed to make the selection and summarising of primary research studies into "somebody else's problem". We found alignment with Wikipedia's preference for "secondary sources" with readily available reviews, guidelines and textbooks. Our model, of relying on existing publications and a crude grading system for those publications, isn't perfect. It is too easy to find oneself reading a journal by a bad publisher. As you point out, it is possible that some apparent authorities are merely fronts for vested interests. But this surely also malignly affects medicine as a whole, so is something the real world needs to fix for itself, rather than us hope we can work around the problem. -- Colin°Talk 09:47, 14 July 2024 (UTC)
- I think that there is sound reason for Wikipedia:Identifying reliable sources (medicine)#Avoid primary sources. For example, consider the following:
- Piper, Kelsey (2024-08-23). "The staggering death toll of scientific lies". Vox. Retrieved 2024-08-23.
- The article highlights cardiologist Don Poldermans's use of apparently fake data in studies that then led to a faulty conclusion that beta blockers were beneficial before heart surgery.
- The article then goes on to state:
[E]xperts who study scientific misconduct believe that thousands of people may be dead because of him.
After the revelations,
[of the falsified data]a new meta-analysis was published in 2014, evaluating whether to use beta blockers before cardiac surgery. It found that a course of beta blockers made it 27 percent more likely that someone would die within 30 days of their heart surgery.
Tens of millions of heart surgeries were conducted across the US and Europe during the years from 2009 to 2013 when those misguided guidelines were in place. One provocative analysis from cardiologists Graham Cole and Darrel Francis estimated that there were 800,000 deaths compared to if the best practices had been established five years sooner. While that exact number is hotly contested, a 27 percent increase in mortality for a common procedure for years on end can add up to an extraordinary death toll.
- Note the clarifying & corrective effects of secondary sources in this situation. Peaceray (talk) 18:02, 23 August 2024 (UTC)
Editorials and op-eds
[edit]This guideline lacks the equivalent of what WP:RSOPINION is to WP:RS. Having a section on how to use opinion pieces would enhance the accuracy and reliability of medical articles. It is not uncommon for editors of scientific journals to provide their own commentary on various issues; however, these editorials are distinct from the peer-reviewed articles that form the core content of the journals. 124.104.164.12 (talk) 21:13, 24 July 2024 (UTC)
- Can you give me a couple of examples of opinion pieces that you'd like to cite in a Wikipedia article? WhatamIdoing (talk) 00:36, 25 July 2024 (UTC)
Hi all, looking for some guidance on what, if any content in Rikishi#Health effects requires MEDRS? This is for a Good Article nomination that is currently ongoing. Rollinginhisgrave (talk) 14:59, 14 August 2024 (UTC)
- @Rollinginhisgrave, the most important thing to do is to use the best sources that you can. Most of MEDRS is directed towards questions about whether a particular medication is safe and effective for a particular condition, and is not relevant to content about whether people in a small profession have shorter lifespans. There is relatively little formal research available.[1]
- You might consider whether some of the sources used in that section are out of date. For example, the sentence about body fat percentage is cited to a 30-year-old book, so it might not have up-to-date statistics. (20% body fat is probably an appropriate obesity cutoff for East Asian people.) WhatamIdoing (talk) 00:50, 15 August 2024 (UTC)
- As always, thankyou WhatamIdoing for your help. Rollinginhisgrave (talk) 00:55, 15 August 2024 (UTC)
- Statements about life expectancy are getting into the realm of MEDRS, but the following phrase about
as the diet and sport take a toll on the wrestler's body
is where it is making medical claims (although vague). The source used there[2] is a primary source and looks to be a short communication rather than a full research article. I checked Web of Science, and it only has 5 citations, but one of them is a review that may be worth using where it mentions sumo, especially in the context of the previous source.[3] - The second paragraph is where I'd be looking for more medical related sources though. Really anything that says that X results in higher incidence of Y for health issues is something pretty squarely needing medical sourcing. That said, this can be a gray area where you might range from commentary from coaches to those trained in sports medicine. At a glance I can't really assess the sources used there, but it's probably worth searching for more up to date sourcing while looking for medical sources there. KoA (talk) 01:45, 15 August 2024 (UTC)
There are currently two RFCs at Talk:Imane Khelif. Interested editors are invited to participate at Talk:Imane Khelif#RfC lead and Talk:Imane Khelif#RfC on weight of "misinformation" in lead. TarnishedPathtalk 10:45, 23 August 2024 (UTC)
- You might get more responses if you post it at Wikipedia talk:WikiProject Medicine. WhatamIdoing (talk) 17:14, 23 August 2024 (UTC)
- Wikipedia essays about reliable sources
- Project-Class medicine articles
- NA-importance medicine articles
- All WikiProject Medicine pages
- Project-Class pharmacology articles
- NA-importance pharmacology articles
- WikiProject Pharmacology articles
- Project-Class Alternative medicine articles
- Wikipedia pages referenced by the press