Misplaced Pages

Revision as of 03:49, 26 April 2009

Temazepam

Please take a look, some guy is inserting non-notable spam for some non-notable Mylan Inc, showing bottle with non-notable generic pills, linking to Mylan Inc. I am blocked for reverting him 2 times. This industry sock has connections... 70.137.146.36 (talk) 01:25, 24 February 2009 (UTC)

I see that you have resolved this issue by the looks of things.--Literaturegeek | T@1k? 03:51, 25 February 2009 (UTC)

161.150.2.55 sock account mwalla 70.137.184.193 (talk) 01:46, 26 February 2009 (UTC)

both have blanked a long series of warnings off their talk page. They do tricks like inserting unsigned comments (without autosign even! that must be some trick, but visible in edit history) into OTHER editors edits in conversations, to make them look stupid and obscene. 70.137.184.193 (talk) 02:09, 26 February 2009 (UTC)

Very well spotted 70.137, I think that you are right. Their edit history looks similar.--Literaturegeek | T@1k? 11:14, 26 February 2009 (UTC)

Indeed wasn't difficult, as 161.xx has several times signed with 161.xx mwalla! 70.137.184.193 (talk) 05:13, 27 February 2009 (UTC)

Take a look at Temazepam discussion. Do you like British humor? 70.137.184.193 (talk) 05:13, 27 February 2009 (UTC)

Also look at 67.133.55.18 with the same habits and commonly discussing with the other ones. Help, I am a 'noid. But that doesn't mean they are not out to get me... ;) 70.137.184.193 (talk) 23:31, 26 February 2009 (UTC)

I looked at the temazepam page. I saw that you said that you were leaving or something. Have you left wikipedia?--Literaturegeek | T@1k? 22:33, 5 March 2009 (UTC)

After my recent communications did give me the impression that WP is not an academic community any more, I think I need a vacation. The temazepam discussion likely showed, that commercial interests are involved. But such a level of discussion is not to my taste. See also User_talk:Fvasconcellos and User_talk:St3vo for my impression of the admin-bots or admin-idiots. I had fun discussing articles on a scientific level, in a field that is foreign to me, but I can't see how I can profit from the general kind of discussions about the dumbing down of WP and inclusion of spam - in particular if the argument appears as if run by feeble minded persons. If you like, take a look at estazolam and talk, as I have done a bit proofreading. You have to do that on your own, I will not participate much in the future. The kind of overly eager admins have been my nemesis in professional life, and actually have been the nemesis of every scientific worker. But look, they are running whole departments today and degrade scientific workers to mere foot soldiers. 70.137.170.213 (talk) 22:59, 8 March 2009 (UTC)

FQ

Looks like you are making some progress on FQ. Thanks for putting all this work in. Looks like there is a strong active lobby against FQ. I am unsure about Misplaced Pages and medicine. There are such strong lobby on both sides of medical issues that these pages just seem to tern into struggles between two oposing groups. I am starting to come to the conclusion that medicine is just to controversial to be dealt with by an open source. www.wikidoc.org might have a better format. I will of course stick with www.uptodate.com and journal reviews. Those who care to see physicians will come to us. Those who beleive in homeopathy will head in that direction. Cheers --Doc James (talk · contribs · email) 18:07, 26 February 2009 (UTC)

You are welcome and thank you for all of the work that you have done as well. I think there is still some work to do but I feel less of an "urgent need" to address the remaining issues of the quinolone articles as I feel that the major concerns of the articles, original research, undue weight etc etc have largely been resolved. Thank God for that because I was burning myself out on these talk pages and articles as probably were you. I wouldn't lose faith in wikipedia. Just because a small number of drugs are controversial and there are two opposing views on those drugs or even conditions doesn't mean that open source is a bad idea. If it wasn't for wikipedia, you would either have a drug company website in the top 10 pages or an activist website in the top 10 pages with the rest of the pages doing an amateurish job. At least on wiki as a community effort there are ways to challenge out and out bias from one side or the other. Being critical of a handful of drugs or critical of one aspect of medicine is not a denunciation of medicine in itself. Infact without disagreement, or challenge, medicine would become a dogmatic religion and scientific progress would be very slow and much more flawed. Don't throw the baby out with the bath water as the saying goes, when it comes to open source. :) There are pros and cons to everything. As for alternative healthcare it is very exploitive, most alternative healthcare people throw supplements at a person. If they were truely a health orientated field, they would look more for causes of ill health, eg alcohol consumption, sedative hypnotic use, overuse of overcounter drugs, smoking, poor diet, lack of sunshine and exercise and maybe would promote healthier life style but alas they just want for the most part to exploit their customer by selling supplements and herbs. I see that you work in preventative healthcare so you are in a good field of medicine in my opinion as you are inteerested more in diagnosing the cause before tackling the symptoms and also preventing disease states from happening in the first place eg lifestyle changes such as overeating, drinking too much smoking tobacco etc, so you are already ahead of most doctors in my book. If I am interpreting preventative medicine properly. :)--Literaturegeek | T@1k? 05:48, 27 February 2009 (UTC)

The name of the article is exceedingly important and why I got involved in the first place. Adverse effect is NPOV toxicity is not.--Doc James (talk · contribs · email) 14:51, 27 February 2009 (UTC)

I am very interested in preventative medicine but am not a public health physician. I do recommend the cessation of smoking, exercise and weight loss, and vacinnation to dozens of people a day. However most of my colleges do not.--Doc James (talk · contribs · email) 16:36, 27 February 2009 (UTC)

Here is an article in which DNA damage is mentioned specifically:

Cell Biol Toxicol. 2000;16(5):303-12. Related Articles, Links

UVA-induced oxidative damage in retinal pigment epithelial cells after H2O2 or sparfloxacin exposure. Verna LK, Holman SA, Lee VC, Hoh J. Division of Biomedical Sciences, University of California Riverside, 92521, USA. Retinal impairment is one of the leading causes of visual loss in an aging human population. To explore a possible cause for retinal damage in the human population, we have monitored DNA oxidation in human retinal pigment epithelial (RPE) cells after exposure to hydrogen peroxide (H2O2) or the quinolone antibacterial sparfloxacin. When H2O2- or sparfloxacin-exposed cells were further exposed to ultraviolet A (UVA) irradiation, oxidative damage to the DNA of these cells was greatly increased over baseline values. This RPE+pharmaceutical-UVA cell system was developed to mimic in vivo retinal degeneration, seen in mouse studies using quinolone and UVA exposure. DNA damage produced by sparfloxacin and UVA in RPE cells could be remedied by the use of antioxidants, indicating a possible in vivo method for prevention or minimization of retinal damage in humans PMID: 11201054 Davidtfull (talk) 00:13, 8 March 2009 (UTC)

Thanks David, I used the reference.--Literaturegeek | T@1k? 15:39, 12 March 2009 (UTC)

Alprazolam

Article needs proofreading against sources. In particular death statistics, temazepam etc. Remark: I wouldn't call suicide exactly recreational use. (Of course, everybody his.) 70.137.142.217 (talk) 23:15, 10 March 2009 (UTC)

I fixed it, thanks.--Literaturegeek | T@1k? 00:02, 11 March 2009 (UTC)

The article contains inappropriate refs for the connection to the "rave epidemic", etc. Some links to the Ohio State assembly turn out to be opinions of a police detective about the rave epidemic, others are dead links, one (removed) is a story about a dead junkie in the "St Augustins" local newspaper., one is an animal experiment with rats. 70.137.142.217 (talk) 18:20, 11 March 2009 (UTC)

The article doesn't mention the rave epidemic. All the refs are used for was to say that when alprazolam is used illicitly that it is often used in combination with other illicit drugs or to help the come down from use of illicit drugs. Is that really disputed? That section someone else wrote but ended up with lots of citations needed so I dug out the citations. I recall you once stating that benzos are usually used in combination with other drugs. I fixed the broken reference, they changed the URL. The animal study is backed up with other refs about alprazolam being misused with heroin in humans. It is NOT a scientific section. Not every aspect of a drug article can be peer reviewed nor needs to be. It is only a section on recreational misuse at the bottom of the article. It is not pharmacokinetics or therapeutic indications etc. I did try and find medical references for use of alprazolam with specific illicit drug classes but couldn't find any. There were quite a few saying about it being misused and being a drug of abuse but the peer reviewed sources did not go into specific details, like for example that alprazolam is used to help people "come down" or intensify the effects of heroin or alcohol etc. I don't see the problem, but anyway I did not write that section but I did add the citations because they were flagged a long time ago as "citation needed".--Literaturegeek | T@1k? 19:15, 11 March 2009 (UTC)

Alprazolam is the most commonly abused pharmaceuticals in the USA, are you really saying that you think that alprazolam is always used in isolation and never mixed with heroin, alcohol or cannabis? What exactly is your complaint?--Literaturegeek | T@1k? 19:22, 11 March 2009 (UTC)

Nothing, just that one is a dead link (not linking a document but some Ohio office), one is the "Cheesetown News" or "Cheeseville Herald", whatever, one is a detective testimony (thats the one with the rave epidemic), one is an animal experiment, proving that rats get a better high of too little alprazolam with too little heroin, than of either alone. Well, it shows that rats would in theory mix what they can get their hands on, if they were junkies. (It also shows that scientists use whatever they can get their hands on to write articles for their career.) I have no complaints, except I noticed that you want A-grade status for the article, and wanted to do a favor by a hint where the article could need a little better refs. I do not dispute the fact of mixed poly drug abuse with benzos incl. alprazolam at all, just wanted to help beef up your work. 70.137.142.217 (talk) 22:21, 11 March 2009 (UTC)

Thanks for the help. I did fix the dead link which you pointed out as being broken. Read the rat study again and you will see that the first 2 or 3 sentences describe humans mixing benzos with heroin to enhance its effects. They were trying to replicate the reports of humans mixing heroin with benzos in animals is all. I will just leave things as they are for now, the good article reviewer hasn't raised any problems with that part of the article. It wasn't me who submitted the article for good article evaluation but was someone else.--Literaturegeek | T@1k? 15:50, 12 March 2009 (UTC)

Of course, humans mixing benzos with heroin were the MOTIVATION for the study, to see if this can be replicated with one of the std studies for addictive drugs, namely PLACE PREFERENCE. The outcome was positive. However, with this setup the study is slightly tangential for the section. As such it can be left in, just have been telling you my concerns. But the "Cheeseville Herald" (whatever) really looks cheesy, and I would delete it just for looking cheesy and being anecdotal. 70.137.142.217 (talk) 20:23, 12 March 2009 (UTC)

Yes but like I say I didn't quote the animal findings and used it for its mention of humans mixing heroin and benzos. The article passed Good Article status. Maybe when it goes up for featured article status I can work on improving quality of refs. :-)--Literaturegeek | T@1k? 10:46, 14 March 2009 (UTC)

GA review of Alprazolam

I've read over the changes and I've passed it's GA review, congratulations. MPJ-DK (talk) 09:08, 14 March 2009 (UTC)

Great news! :) Thank you very much for taking the time to do a review on the article.--Literaturegeek | T@1k? 10:40, 14 March 2009 (UTC)

Good work on Long-term effects of alcohol

I've not had time to look at all your changes but they seem like a vast improvement on what preceded them. Keep it up! Nunquam Dormio (talk) 09:18, 14 March 2009 (UTC)

I appreciate the message. The long term effects of alcohol article was a health hazard. It is more neutral and accurate now but still a lot of information missing like effects on liver and pancreas. The two most important adverse effects on the body from alcohol!--Literaturegeek | T@1k? 10:42, 14 March 2009 (UTC)

I second the thanks. The links and attributions are gone and I can help make sure they won't come back, but detecting and undoing the bias that still remains require both expertise and a lot of work. Flowanda | Talk 00:17, 15 March 2009 (UTC)

That would be great if you could keep the page on your watch list and try to keep out major bias from the article. The main problem now is what is lacking, rather than what is remaining I feel. Liver disorders and pancreatic damage are the most glaring adverse effects of alcohol that are not covered in the article.--Literaturegeek | T@1k? 02:12, 15 March 2009 (UTC)

Welcome to Misplaced Pages. Although everyone is welcome to make constructive contributions to Misplaced Pages, at least one of your recent edits, such as the one you made to Diazepam, did not appear to be constructive and has been reverted. Please use the sandbox for any test edits you would like to make, and read the welcome page to learn more about contributing constructively to this encyclopedia. Thank you. Armadude (talk) 13:32, 17 March 2009 (UTC)Armadude

Please see this WP:DTTR. I explained why I reverted your text in edit summary. If you didn't like my revert take it to the article talk page. You are using a laboratory study in mice to say that diazepam is used in vetenary medicine. You are misrepresenting references.--Literaturegeek | T@1k? 13:45, 17 March 2009 (UTC)

Diazepam

Hello Litgeraturegeek. I happened to see this article pop up on my watch list due to a bit of controversy, and found this reference about veterinary use. (The Merck Manual should be a reliable source). So the claim appears legit, though it may or may not be a significant enough use to deserve space in the article. I don't have an opinion on that. EdJohnston (talk) 13:57, 17 March 2009 (UTC)

Hi, that reference looks good. I reverted the user because the reference that they were using wasn't about use in veterenary medicine but was just a lab study on mice.--Literaturegeek | T@1k? 14:24, 17 March 2009 (UTC)

major depression

I had fixed a couple of verbs (is --> are) and a comma and copied my fixes back in after edit conflict. I've not looked at refs at all, 'twas just meant to improve sentences. - Hordaland (talk) 20:13, 19 March 2009 (UTC)

I replied on your talk page.--Literaturegeek | T@1k? 20:38, 19 March 2009 (UTC)

Note

Regarding the discussion at Sockpuppet investigations/Mwalla: Making unsubstantiated accusations goes against assuming good faith, and may constitute a personal attack. I'm in no way saying the user is completely innocent, but you're a well established user and therefore you should be more mindful of policy and try not to make things worse. Proper sanctions have already been put in place and investigations are underway; there's no reason for you to make detrimental claims. Nja 09:39, 21 March 2009 (UTC)

I read the links you suggested and I am not sure if I broke them. Since the block you gave mwalla has created at least two new sock puppets which an independent wiki BOT has added to the possible sockpuppet list. One of those sock puppets after attacking an article to change it to say drug abuse when refs were talking about prescribed users, has now changed it to say long term use, trying to make it look like it is ME who is using the sockpuppets. This person is malicious, all that I did was revert one of their repeated vandal edits to user comments and report them to the admin board. I reported them because I had seen enough users complain about them altering their comments to say the opposite. Considering what they are doing I am finding it very difficult to retain my temper. I would request that you block all of their suspected sock puppets that are following myself and sceptical chymist about on and harrassing us. I do admit that my message on their talk page did constitute losing my temper and for that I have to acknowledge that I lost my cool. I still think that I am correct in raising the issue that they may have shares or stocks in the product they are editing. This behaviour and levels they are going to to win their battle of getting fake data into an article is just simplynot normal and thus speculating with some evidence based on where their ip address comes from (a financial institution) is most definitely warrented and I have seen such speculation raised before on wiki even by admins in such cases. I am sorry I don't want to fall out with you, I understand how difficult your job is and that you do this voluntarily.--Literaturegeek | T@1k? 10:19, 21 March 2009 (UTC)

Do update the current investigative report with new suspected socks. Nja 10:55, 21 March 2009 (UTC)

I have done an update to the page, thank you. No admin seems to be following that investigation up anymore which is frustrating.--Literaturegeek | T@1k? 11:28, 21 March 2009 (UTC)

Anon 70.137.xxx.xxx

Are you still about on wikipedia?--Literaturegeek | T@1k? 15:49, 21 March 2009 (UTC)

paroxetine

Thank you for your tremendously diligent work on the paroxetine article and talk page, and dealing with Mwalla! I took a break from that and was sad to see Mwalla then went on to attack you (and others) instead. Two articles elsewhere on paroxetine shed more light on the history of the drug. One I mentioned in the discussion page, noting that financial analysts expected it to sell poorly because of its inferiority to already established competitors, until GSK marketing made it into a blockbuster; alas I have not been able to find that article again. The other article, which I highly recommend, is still online: . Regarding word choice (withdrawal vs. discontinuation, dependence vs. addiction vs. habit forming), WP is an encyclopedia for a general audience so generally understood terminology seems best. The widely reported symptoms look like withdrawal to me - especially since they may be fatal. Also, because pharmacists sometimes put the wrong pills in the bottle, some customers may go through withdrawal without even knowing why. Patients would then experience withdrawal symptoms that their doctors might not recognize, because GSK told the doctors the drug was "not habit forming." I believe in WP:NPOV and presenting balanced information, but GSK clearly misled the public on paroxetine, and Mwalla and others seem determined to continue that.TVC 15 (talk) 23:44, 22 March 2009 (UTC)

You are very welcome. I didn't think that I had done all that much work on the paroxetine article. Most of it was just reverting vandalism of Mwalla and challenging their fake data. You had a lot more trouble with Mwalla than what I did, so you deserve credit for putting up with them for so long. I am a little disappointed that the ban has not been extended on the Mwalla account after all the hastle they caused everyone. I have never heard of SSRI withdrawals being fatal unless you mean indirectly, eg suicide from severe rebound/withdrawal related depression? Only sedative hypnotic withdrawal has any realistic chance of killing you directly. I read the article you suggested. I have heard much of that before. I know that it can be very confusing for the general public and even doctors when a drug is advertised as non-habit forming, non-addictive, because the general public and even many doctors will jump to the conclusion that that means that you can stop the drug with little difficulty. In the British National Formulary, CSM advice describes withdrawal syndrome for abrupt withdrawal of antipsychotics and recommends gradual reduction. It is guidance that has been around for at least a couple of decades so it shows how the terminology is fairly new. To be quite honest though, I try to avoid getting in major arguments over discontinuation versus withdrawal syndrome wording because to the reader it will mean the same thing. I usually edit it as withdrawal syndrome and then if someone changes it to discontinuation I just let it be, not worth battling over. Many psychotropic drugs can cause quite unpleasant withdrawal effects if stopped too quickly. The antipsychotic articles could actually do with a short section on abrupt withdrawal and withdrawal effects actually.--Literaturegeek | T@1k? 10:35, 23 March 2009 (UTC)

Good catch about whether SSRI discontinuation can be fatal. I had been thinking partly about the indirect risk (withdrawal-induced suicidality leading to suicide). I had also been thinking of a stated risk in the prescribing information, but on re-reading I see it is listed as part of a separate risk, hyponatremia: "Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including PAXIL... Signs and symptoms associated with more severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death." Presumably that risk would be dose-related, so probably higher during full-dose treatment than during discontinuation. Another thing about SSRI withdrawal, the advice to taper seems unsupported by (and in the case of paroxetine contradicted by) empirical data. Tapering sounds plausible based on experience with other drug classes, but paroxetine studies reportedly find no benefit. Nevertheless, GSK urges tapering, so they can sell a few more pills to patients who have decided to quit. (That might sound cynical, but it's actually justified in this instance. I was previously very supportive of pharma and biotech companies. Then widespread reports about oxycodone, paroxetine, and Vioxx forced me to recognize that some marketing departments really do twist data and put profits ahead of patient safety. Obviously, GSK did that with paroxetine.) GSK could have prevented many (probably most) patients' discontinuation syndromes by suggesting an SSRI with a longer half-life, such as fluoxetine as noted in the WP article. But, GSK just had to sell a few more pills, rather than suggest a competitor's product. In drug companies as in financial services, large organizations can unfortunately drift towards short-sighted decisions, as each person in the chain of command looks for opportunities for quick promotion, avoids criticism ("not a team player"), and rationalizes the results. Eventually, the company gets sued and the facts emerge, but by that time the executives have banked their gains and moved on.TVC 15 (talk) 18:38, 23 March 2009 (UTC)

P.S. Mwalla has now been blocked for three months.TVC 15 (talk) 22:26, 23 March 2009 (UTC)

Why would it be contraindicated to taper paroxetine? Tapering does work, trust me I know, well works in making symptoms less intense but still nasty to get off of even with a taper. Most of those clinical studies do a 2 - 4 week detox and call it a "slow taper" anyway so I would ignor such studies in drawing such conclusions. Switching to a drug with the same pharmacodynamics which has a longer half life and which is available in low potency doses and/or liquid form is usually the best option. Yup I saw that Mwalla has been blocked for 3 months so hopefully we can have some piece and quiet now.--Literaturegeek | T@1k? 22:32, 23 March 2009 (UTC)

Thanks for the additional information. To clarify, I didn't say tapering was contraindicated, just that randomized studies found no significant difference between people who taper and people who don't. Individual experience within groups can vary, and a difference that isn't 'statistically significant' can be important to some individuals even if they are too few to affect the statistics, but I am not aware of any controlled studies showing a statistically significant benefit to tapering. On the paroxetine talk page, Skinwalker described his difficult experience quitting venlafexine, which has an even shorter half-life than paroxetine. I first read about the inverse correlation between half-life and withdrawal risk years ago, can't remember where now, but it applies across SSRIs: the shorter the half-life, the more likely the drug will cause withdrawal symptoms, even if the patient tapers. The Minnesota article was especially sad because if the 12-year-old girl's doctor had known about it, he might have switched her to fluoxetine or citalopram instead of repeatedly trying to taper paroxetine. (It's even sadder because studies have since shown children don't even benefit from paroxetine anyway.) What frustrates me is all these discoveries and possibilities get buried when a big advertiser decides the drug will sell more if it is called "not habit forming."TVC 15 (talk) 01:45, 24 March 2009 (UTC)

What speed was the tapering? Yea I have heard venlafaxine can be quite difficult to come off of. I was just speaking to a lady today who was on paroxetine for several years who quit it cold turkey with no withdrawal at all but was ill for several years and still has some lingering symptoms 7 years later after quitting a lowish dose of diazepam, although she took benzos for almost 30 years so maybe not a good comparison.--Literaturegeek | T@1k? 21:16, 24 March 2009 (UTC)

Good question about the tapering speed, and I did see your comment about timing above, but finding a useful answer may be difficult. GSK belatedly acknowledged that discontinuation symptoms can affect anyone and said that "it is therefore advised that when paroxetine treatment is no longer required, gradual discontinuation by dose tapering be carried out." However, GSK does not cite any studies showing any benefit to tapering. They also provide no comparisons of timing, and say "There have been no comparisons of different down-titration regimens within studies." Apparently someone at GSK assumed tapering might help (patients or at least sales), but without any controlled data to support that assumption. So, even if the studies showing _no_ benefit may have used the wrong speed, that still leaves no controlled studies supporting the manufacturer's self-serving advice. Maybe there are such studies somewhere and I just haven't seen them. Individual experience can vary widely, and may be directly or indirectly causal or coincidental. If GSK had been candid about paroxetine from the start, there might be good data by now, but alas that was not the case.TVC 15 (talk) 07:14, 25 March 2009 (UTC)

P.S. your note about "low potency doses" and "liquid form" is very interesting. If there are reliable sources, they would make a great addition to the article. For example, crushing paroxetine pills and mixing them with water might get around the half-life issue, by allowing smaller but more frequent doses. This is why I get frustrated with GSK's mishandling of paroxetine: if GSK had simply acknowledged the issue, solutions would have been suggested and could have been studied, and the issue might have been resolved easily. Instead, GSK chose to deny there was an issue, and spent a fortune distributing misinformation via misleading TV ads.TVC 15 (talk) 08:04, 25 March 2009 (UTC)

There shouldn't be any need to do a "Do It Yourself" job like crushing the pill as it is available in liquid form which if necessary can be administered in devided doses 2 or 3 times per day and also allows for smaller dose reductions in people who find coming off paroxetine particularly difficult. Here is a reliable source which mentions using liquid paroxetine for withdrawal of paroxetine.--Literaturegeek | T@1k? 13:17, 25 March 2009 (UTC)

Thanks very much for the link :) I've added it and a quote from it to the article. I agree DIY _shouldn't_ be necessary but it can be, particularly in countries where prescriptions are both required and expensive. For example, in the USA, a patient trying to quit paroxetine would not be allowed to purchase it in liquid form without first paying for another visit to the prescriber ($200), persuading the prescriber that the "not habit forming" drug is causing withdrawal, and buying permission/prescription to buy the liquid form ($200 for 250ml on Drugstore.com). Those prices assume everything is being done on a non-emergency basis when appointments are available; an emergency room visit can easily cost $10,000. (Yes, ten thousand USD for a single visit.) You mentioned a friend's experience on paroxetine, I can only hope that friend had insurance that actually paid. See Michael Moore's movie _Sicko_, or U.S. bankruptcy statistics showing more than a million bankruptcies annually, mostly due to medical costs. Alas the need for DIY is ubiquitous, and slivering pills or crushing them into water might be the most practical slow-taper solution.TVC 15 (talk) 06:52, 27 March 2009 (UTC)

YVW. I see your point regarding people living in America. I have watched Michael Moore's film Sicko before, there sure are some major issues regarding healthcare expenses in the USA.--Literaturegeek | T@1k? 10:51, 27 March 2009 (UTC)

about WikiProject Medicine Design

Thank you for you replay, I think I can redesign the page, but at this time I am very busy with my exam, please if you have any suggestions for colors, designs, or any other thing, comment on my talk page :-) Maen. K. A. (talk) 18:12, 25 March 2009 (UTC)

Thank you and I ll work on that Maen. K. A. (talk) 18:39, 25 March 2009 (UTC)

Guidance request

Literaturegeek, it would help if you kept your query to the point rather than cloud it. Your hyperbolic description of "authors were employed by literally over 20 pharmaceutical companies" shows what bias you think that introduces. Is everyone employed by the pharma industry incapable of decent research? Perhaps a lifetime of professional employment gives one experience rather than corrupting? You gave your personal analysis (from reading the primary sources cited as well as--presumably--the wider literature they didn't cite) that those authors had "cherry picked 2 or 3 primary sources" which they then distorted. Do you see where I'm getting the "I can review primary sources better than the experts" subtext from? You may well be right, or you could be completely wrong. On WP, our opinions on the facts don't have much weight. Colin° 19:51, 2 April 2009 (UTC)

It wasn't hyperbolic, because it was true. I found their number of conflicts on a quick search of pubmed and locating papers where they declared their COI. Your comment is a strawman argument because I was discussing an individual source where they had misrepresented their sources not in general. Of course people in the pay of drug companies often provide sound data. I cite articles by people working for the drug companies as I am sure you do if it makes a good source. Also your statement is a strawman argument because I also gave examples of inaccurate factoids I have seen in books but you have cherry picked my example of in the pay of "20 drug companies" a problem I raised on the reliable sources page. I am not in dispute with anyone over inaccurate factoids so I have no agenda by raising these issues as the person who sourced the book did not cite the inaccurate data. I just noticed it and have noticed several examples in books not being accurate eg benzos are GABA reuptake inhibitors and thought that it was notible enough to raise on the reliable sources talk page. I regret doing so for all the drama it seems to have caused although I got the answers that I wanted and I am more clearer on the subject matter and what to do in such scenarios.--Literaturegeek | T@1k? 20:17, 2 April 2009 (UTC)

I'm not trying to build an "argument", "strawman" or otherwise. I didn't cherry-pick your examples; I commented on both of them. You clearly stated that the authors being in employment of a pharma company was evidence that a "seemingly high quality book" was actually otherwise. Then you claimed (on your own interpretation of the evidence, apparently, rather than based on another secondary source) that those authors were not only wrong but had deliberately misrepresented the truth. Why did a question "What do I do when I think there are errors in my sources" have to include your uncovering of the dastardly deeds of those employed by big pharma? Colin° 20:33, 2 April 2009 (UTC)

No, my issue was not they were employed by the pharm companies as stated above I use such refs sometimes by drug company people. You are chopping my sentences up and misrepresenting them again, the whole sentence said both they are employed by the drug companies and that they distorted their sources. The issue was isolated incidents of inaccuracies of books including accidental inaccurate factoids. Why they did it was a side note. If they are distorting their refs and inserting nonsense into their book then yes I dispute it. I have plenty of secondary sources to dispute the book. Also I explained in my second post that I had misread the project recommendations of only reliable books as initially I thought any book written by any doctor is "excellent" source. As you have focused on one isolated example I raised on the reliable source talk page, you do realise that you have no clue to what part of the book I am referring to and thus you have no clue what you are talking about and are just basically arguing with me because you are one of these internet characters who want to go about picking fights for no logical reason on earth and then hounding people to death until you win the argument going round and round in circles distorting what they (me) are saying? I am getting pretty tired of it now because you came out of nowhere rewriting what I said, synthesising what I said and then arguing about something you don't even know what you are arguing about going on and going on. It is getting pretty annoying now. I just had Mwalla following me about on sockpuppets all over wiki, long term effects of alcohol, major depression articles causing mayhem and had to engage in a lengthy sock investigation to get them blocked for 3 months for harrassing me and other editors and in the process I got into disputes with other editors on articles who fell for their nonsense. Now I feel I have attracted another Mwalla type for no apparent reason wants to cause me grief. I hope my instincts are wrong.

On a side note I do admit though if we are dealing with a controversial aspect of medicine or a drug I prefer independent publications and I actually think doctors and pharmacologists prefer to read independent reviews themselves and would regard independent literature as more reliable than literatue by people with a COI. I am sure if there was a poll of doctors and pharmacology with a question, Do you view publications and reviews by independent authors as more reliable than those by authors with a potential conflict of interest? Yes, No or no difference, you would be up in the high 80 or 90's percent of healthcare professionals voting similar to my views. Although sometimes if there is disagreement for neutrality both viewpoints require to be cited. Anyway this paragraph is off topic and not the issue I was raising on the reliable source page.--Literaturegeek | T@1k? 21:10, 2 April 2009 (UTC)

To show you are yet again distorting what I was saying, show me where I suggested that the policy should be to not use sources if there is a COI regardless of accuracy? Clearly my problem was one of distorted info in a small number of books, including inaccuracies of such as benzos are reuptake inhibitors and the like. The speculative motive is an explaination of possibly why it is so. But no doubt you will continue to argue based on nothing that I was saying that I wanted all refs with a COI to be declared null and void or dubious or relegated to weak evidence regardless of scientific rigor of their data which is false.--Literaturegeek | T@1k? 21:27, 2 April 2009 (UTC)

We seem to be having a real communication difficulty here because you are accusing me of all sorts of things I didn't say and claiming that I'm accusing you of things you didn't say. BTW, I didn't "come out of nowhere". I helped write that guideline and I've had to defend it against editors who think they are cleverer and more neutral than the experts that WP would rather they cite. Colin° 22:31, 2 April 2009 (UTC)

As explained on the talk page I unfortunately misread the text on the project and assumed any medical book written by any doctor was "excellent" source. I corrected my error and striked out my text when I realised my error when I saw that there were reliability guidelines for which books are considered reliable. I now know that the scenarios that I raised are best resolved through discussion on a article talk page, other secondary sources, consensus or if all else fails the RS noticeboard. So I was not trying to change the policy to allow for synthesis using primary sources. Largely it was myself half asleep at the time misreading the guideline on citing books. Sorry for assuming you came out of nowhere, I did not realise that you wrote a lot of that policy article. I know that there are people who want guidelines changed just so that it can fit their POV or weak source so they can insert their "truth" into an article. I support you in defending the project page against such actions. I think you thought that I was one of those people but as explained intially I thought it said almost any book was reliable if it was medical but striked out text once realising I misread. Believe it or not I do prefer to avoid arguments and fall outs on wiki and I don't mind being challenged as in most cases it often results in improvements to articles or wiki in general. I from time to time get my sources challenged and if they are weak sources I try and find better sources or enter into discussion. Earlier today I for example added 5 review articles to the lead of an article to replace a weaker source that was challenged and inappropriate for a lead citation. I think we misinterpreted each other and feelings got a bit heated so hopefully we can resolve this without turning into each other's enemy so to speak.--Literaturegeek | T@1k? 23:01, 2 April 2009 (UTC)

If you recall when I added a link on poly-pharmacology worsening epilepsy in some cases you deleted it, explained that it was primary source and also outdated. I read your comments and agreed with you fully especially as epilepsy is a serious disorder and agreed with your decision that the source was outdated and not a review article. So I do in general like my edits if they are weak, wrong or dubious to be challenged. I did not want guidelines changed over such a scenario. I understand how wiki works and understand the guideline policy and agree with it.--Literaturegeek | T@1k? 23:09, 2 April 2009 (UTC)

Sorry for misinterpreting your comments. Colin° 09:08, 3 April 2009 (UTC)

Thank you Colin and I am sorry for losing my cool.--Literaturegeek | T@1k? 10:55, 3 April 2009 (UTC)

Benzos, Alcohol wd

Indeed oxazepam is one of the weaker benzos, but it doesn't need hepatic metabolism for elimination, something that may be of importance in alcoholics with a damaged liver.(?) It is available in elephant tablets for such purposes, e.g "Praxiten 50" and "Adumbran forte" both with 50mg oxazepam. A few of those are not too weak to do the job. Then you can use Distraneurin, which is heavy duty. Maybe this is all a bit dated. Cough, dust... Maybe I can change the lightbulbs in the substance abuse department. Red is blue, and plus is minus. But I guess I am largely right with my reply to Rose bartram. Maybe forgot to mention that kindling and excitotoxicity may lead to a self-propagating avalanche mode of destruction, where the already damaged/exhausted cells lead to a further attenuation of inhibitory feedback on the yet unaffected or less damaged cells, so that it runs through the brain like a bush fire, maybe there is a ref for that. Once in that mode it is hard to stop. Btw I guess that Distraneurin has more overlap with alcohol in its effects than benzos, not limited to enhanced GABA effect, so in difficult cases it may be a more appropriate substitution, maybe read up on that for alcoholism. (distra vs. benzos) Another hint is scopolamine. This is also heavy duty historical stuff, potentially to be used together(!) with other sedatives.(chloral hydrate, distraneurin) Nobody at the clinic complains then, that it is too weak. ;-) 70.137.165.53 (talk) 13:54, 4 April 2009 (UTC)

Yea I know. I think you are referring to my edit summary? I have left in that it is effective and sometimes recommended for those with severe liver disorders and the elderly due to lack of drug accumulation. LOL, I think your reply to Rose was thorough and indepth enough. Chlormethiazole, we call it heminevrin here, isn't used very often now adays because of its high risk of overdose and also it has a fairly common side effect of causing eye irritation or pain for some reason. We have to be careful not to kill the patient 70.137 with your cocktails of chloral, scopolamine and goodness knows what else, haha.  ;-)--Literaturegeek | T@1k? 19:37, 4 April 2009 (UTC)

It is hard to kill somebody with sedatives, if he is used to a bottle of vodka. Such mixtures are historical and effective. The benzos have replaced these largely. An anecdote from 1st hand is the old guy who came out of anesthesia for hip replacement after they had to give him a horse dose, because the normal dose for anesthesia would just make him cheerful. So they look for him if he has bad aftereffects, and find that he has sent another patient outside to buy him fried chicken and a bottle, and he is in his bed with a plate full of bones and drinking brandy. 70.137.165.53 (talk) 20:13, 4 April 2009 (UTC)

Of course "cocktails" of sedatives are mostly of historical interest, but I believe they are still used a lot by anesthesists. In the old days lots of these were around under brand names by the big pharmaceutical companies. e.g. scopolamine+phenobarbital, methaqualone+diphenhydramine (Mandrax), barbiturate mixtures, also with diphenhydramine as sleeping pills or sedatives, mixtures of meprobamate and/or barbiturates with a psychoanaleptic as "non-drowsy" day tranquilizers. This stuff would make drug dealers pale in envy today. In fact the risk of overdose in barbiturates, clomethiazol, chloral, methaqualone and all the other old sedatives is high compared to the very benign benzos, but still very low in normal use for the intended purpose. The problem was that people could and would use them for suicide and then they would do the trick, because they had no ceiling on effect on the brain stem function. You could kill yourself with a pack of those. (Uhh, well, just like with paracetamol) With benzos this is at least difficult. But this doesn't mean the old meds were unsafe in intended use, so I think you are overrating the risk of killing the patient. I don't seriously propose to go back to the 50's and 60's medications, but barbiturates may do a better job in alcohol detox than benzos, but only in difficult cases, same for clomethiazol. Of course you cannot give them to take home if the patient is suicidal or has a mean mother in law. ;-) 70.137.165.53 (talk) 07:48, 5 April 2009 (UTC)

I said about being careful not to kill the patient with your chemical concoctions more of a joke, hence the "haha". ;-) I know benzos are much safer in overdose than the older sedative hypnotics.--Literaturegeek | T@1k? 20:56, 5 April 2009 (UTC)

1. insomnia technique - Actually, I was describing a traditional technique - please read this - http://healinglightseries.com/sleep.html and feel confirmed that the technique is a valid technique. And please discuss with me on my talk page. Gkrishn2.iitk (talk) 21:52, 7 April 2009 (UTC)

Category:Suspected Misplaced Pages sockpuppets of Mwalla

For every category you create, you should specify parent categories to which it belongs. In the case of a category like this one, parent categories are provided automatically when you include a {{Sockpuppet category}} template. I've added the template.

I am a human being, not a bot, so you can contact me if you have questions about this. Best regards, --Stepheng3 (talk) 02:38, 8 April 2009 (UTC)

Thank you for bringing this to my attention. :)--Literaturegeek | T@1k? 07:58, 9 April 2009 (UTC)

You're welcome. And thank you for your many valuable contributions to Misplaced Pages. --Stepheng3 (talk) 16:47, 9 April 2009 (UTC)

Mortality

Greetings! Thanks for your contributions to Insomnia. One of your recent edits included a link to Mortality, a disambiguation page. The use of these links is discouraged on Misplaced Pages as they are unhelpful to readers. In the future, please check your links to make sure they point to articles. Thank you! twirligig_T to 17:32, 8 April 2009 (UTC)

Ah, ok sorry about that. Sometimes I forget about checking the wiki links. I will try and be more careful in future.--Literaturegeek | T@1k? 14:58, 9 April 2009 (UTC)

Benzodiazepines in TORDIA study

You may be interested in this result from a study on depressed adolescents PMID 19223438:

There was no association between either adjunctive use of sleep medications or stimulants and suicidal events. Treatment with benzodiazepines was associated with suicidal adverse events (6 of 10 versus 42 of 324 (13.0%), Fisher’s exact test, p0.001). The majority of benzodiazepine use took place at one site (8 of 10), but the relationship between benzodiazepine use and suicidal events persisted when the analyses were restricted to that site (4 of 8 versus 9 of 84 , Fisher’s exact test, p=0.01). The use of a benzodiazepine was associated with a faster time to a suicidal event (z=3.27, p=0.001), even after control was added for baseline differences in self-rated ideation (z=2.18, p=0.03), family conflict (z=3.02, p=0.003), and drug or alcohol use (z=2.13, p=0.03).

There was no association between the use of stimulants and nonsuicidal self-injury events. There was a much higher rate of nonsuicidal self-injury events in those treated with benzodiazepines (4 of 10 versus 27 of 324 , Fisher’s exact test, p=0.009) and in those who received treatment for sleep problems (10 of 58 versus 21/276 , x2=5.28, df=1, p=0.02). After controlling for a history of nonsuicidal self-injury, the use of benzodiazepine was still associated with a faster time to a suicidal event (z=2.96, p=0.003), whereas use of sleep medication was not (z=0.83, p=0.41).

The relationship between the use of benzodiazepines and the occurrence of self-harm events must be interpreted cautiously because of the small number involved, the heavy representation of just one site, and nonrandom assignment. Meta-analyses do not find such an association, although some clinical studies do (36–38). Possible explanations could include cognitive effects of benzodiazepines resulting in increased risk-taking and disinhibition (39).

The Sceptical Chymist (talk) 11:27, 9 April 2009 (UTC)

It is interesting, thanks for sending me it. From what I have read the drugs which are most associated with suicide are the sedative hypnotics, particularly alcoholism and benzodiazepine dependence much moreso than antidepressants. The suicide rate is about 10% in benzo misusers and a similar figure in alcoholics. Similar to the suicide rate that you see in schizophrenia and major depression. It seems to be more common in long term dependence or chronic misuse and less often due to acute paradoxical effects.--Literaturegeek | T@1k? 15:19, 9 April 2009 (UTC)

Moxiflocacin interactions: What about NSAIDs and corticosteroids?

I'm getting there. Just haven't got there yet. There is still a lot of work to be done here, just doing a little at a time is all. But yes those same interactions apply to all the drugs in this class. I intend to rearrange the article to match the same layout used by levaquin and cipro, as well as the same information for things that are a class component, issue, or effect.Davidtfull (talk) 04:42, 10 April 2009 (UTC)

Ok, great David. :) I do the same a little at a time when I am building up an article.--Literaturegeek | T@1k? 09:03, 13 April 2009 (UTC)

See talk benzodiazepine

I have tried to do the poor ratties and the oppressed minorities justice and put the self-administration studies and discriminative-stimulus studies together with the patch-clamp neuron studies into perspective as what they likely are: artifacts of model studies of the hell-hole society as seen by the underdog office clerk and the assembly line worker, working against the clock. Not: model studies of the free and enlightened citizen, who was abstractly envisioned by the founding fathers, in his pursuit of happiness in the new world, after they achieved independence from the stinking and rotten monarchy of the perverted and degenerate old world parasites. 70.137.153.83 (talk) 13:52, 11 April 2009 (UTC)

early psychosis

would welcome your rewrite and attention to my addition of treatment outcome articles. If you have any thoughts about how to show that a topic has recieved an increased in the number of published articles over time, i would appreciate your thoughts Earlypsychosis (talk) 11:12, 12 April 2009 (UTC)

I think that your rewrites have been very productive on the early psychosis article. The only thing that I was left wondering was, why earlier intervention in psychosis is believed to produce more favourable outcomes? From my knowledge on the subject the paranoia, delusions if left untreated for prolonged periods of time, i.e. years then the delusions become "hardwired" or more engrained. Perhaps there are other theories? Are there any refs which speculate or give evidence as to why earlier intervention produces in general more favourable outcomes?--Literaturegeek | T@1k? 12:03, 13 April 2009 (UTC)

your views might reflect the more conventional assumptions held about these symptoms, that is not supported by the literature. There is now a challenge to the view that schizophrenia is hardwired, engrained, purely biological - and good evidence against the original Kraepelin idea that the condition has a declining course (a post Kraepelin perspective). Some of the more recovery conceptualisations of mental illness are now based on good research and robust models - rather than some of the previous antipsychiatry bias. Unfortunately many of the articles on wikipedia are yet to reflect this changing view. Richard Bentalls text book is a good read. The British Psychological society publication is still a good read five years later . Daniel Freeman has written a good text on paranoid (recently review in the guardian newspaper (www.guardian.co.uk)). Poor outcome and disability is clearly linked with delays to treatment. The early psychosis approach finds these clients earlier, provides optimal treatments and prevents the normal decline seen in those not treated early enough. Earlypsychosis (talk) 10:07, 15 April 2009 (UTC)

• book review
• article on paranoid thinking

Earlypsychosis (talk) 18:59, 15 April 2009 (UTC)

Thank you for the links. I am aware that psychosis often "burns itself out", maybe not entirely but the symptoms tend to reduce as a person ages. The pdf link had a lot of good detail in it but it was too long for me to read all of it. I am aware that psychiatry is changing quite rapidly with regards to more of a push towards community based treatment, more use of CBT strategies, increased use of atypical neuroleptics etc. I am sure the treatment of psychosis will continue to improve an adapt and previous theories will be challenged or even debunked in time. If there has been a shift in views amongst psychiatrist it shouldn't be too difficult to track down a good review article on the change in thinking in psychiatry. As far as Daniel Freeman goes, I disagree that a quarter of the population is paranoid to the point of it being a mental health disorder for having some illogical thoughts. That kind of thinking would make 99% of the population having some sort of a mental disorder. Having some distrust of authority or illogical worries is not a mental disorder but simply due to factors such as the media, intelligence level or environment they live in and so forth but not due to an "illness" or "disorder". Perhaps I misinterpreted the review article on his book.--Literaturegeek | T@1k? 19:36, 15 April 2009 (UTC)

His questionaire for paranoia is definitely not mainstream and the way it is designed it would get a huge number of false positives.--Literaturegeek | T@1k? 19:54, 15 April 2009 (UTC)

Sportsman

This user name is very similar to one of the current ones User talk:Sportsmandda Cheers --Doc James (talk · contribs · email) 17:25, 22 April 2009 (UTC)

Yea, probably same person, both created within a day o2 of each other but I think that they have been around wikipedia longer than that. Their very first edit was to their userpage, adding a lot of userboxes, Sportsmand seems to have quite a knowledge on the various wikipedia policies, like disputing an article, tagging an article, neutrality and then adding userboxes on their first edit. They are too knowledgable about wikipedia for a brand new member. They have been around for a long time so I think they are a sock of another user or another member. You might have some ideas of who they might be as you have been around the ADHD articles longer than I have.--Literaturegeek | T@1k? 19:01, 22 April 2009 (UTC)

I agree it does look like Mwalla. These are definitely someone with a great deal of experience on wikipedia. Scuro has been the only one I have really had problems with but this is not his writing or argument style. Thanks for helping out.--Doc James (talk · contribs · email) 23:11, 22 April 2009 (UTC)

You are welcome. Mwalla is meant to be blocked for 3 months. They were on a different username a week or 2 ago as judycal or something like that. Might have to start another sock investigation and try and persuade an admin to start banning based on behavioural evidence if they are ip evading. They will cause more hastle for themselves than they will for me so I don't mind. Maybe we should just start reverting all of their edits to the talk page as vandalism by a stalking sockpuppet of Mwalla evading 3 month ban in edit summary? I might do that.--Literaturegeek | T@1k? 23:23, 22 April 2009 (UTC)

All of their future edits, I meant.--Literaturegeek | T@1k? 00:15, 23 April 2009 (UTC)

Benzo article review

Sorry, I see now that the remark was both non-specific and negative, therefore pointless, and you were right to erase it. However, I am certainly not following you around. There are just so very many articles that you manage, they are impossible to avoid. And no, I did not in the end have any effect on the alprazolam article because you changed the wording to reverse the sense of what little I contributed, then dismissed the sources as biased and worthless. I regret having given the impression of a personal vendetta.Rose bartram (talk) 01:11, 26 April 2009 (UTC)

Oh right ok, I just wondered how you knew the benzo article was up for good article review. I guess you found it via the talk page or something. Sorry for wrongly assuming and accusing. I think that you may be referring to this edit. I changed that because after reading the source that you used, I saw that the way that you had interpreted it misinterpreted the ref, I merely expanded on the citation that you used. Please don't feel bad, I have flown off the handle on wikipedia myself, mainly in my early days on here. I don't mind people who have opposing views. You know believe it or not I do believe that you have helped improve the benzo artcles or stimulated me to improve the references, eg the 3 review articles now on the lead of the benzo withdrawal article. :) The alprazolam article as well led to some improvements.--Literaturegeek | T@1k? 02:12, 26 April 2009 (UTC)

The article was on alprazolam but you left out the results on alprazolam which showed it to be worse than the longer acting benzodiazepines. That was why I added in the statement of alprazolam and it causing 35% of people withdrawal after only 8 weeks. It would be senseless to quote the results of long acting benzodiazepines but not alprazolam. It may have not been your intention to show alprazolam caused a higher and quicker incidence of withdrawal but that was what the data in the source that you chose said, although the authors tried to play this down which made me look into their bias and conflict of interest etc. I was not unfair to include the stats from the ref on alprazolam for the article alprazolam. I didn't distort but clarified misleading paragraph by expanding using the source you chose to use. I don't mind debates like this by the way just didn't like the personal attack type post on review article. I am happy to debate mine and your edits. :)--Literaturegeek | T@1k? 02:16, 26 April 2009 (UTC)

ADHD controversies page

Do not remove a POV tag without discussion in talk. Read the tag itself, it states as much. Procedurally you can not remove the tag and ask questions later. One has to assume good faith, and allow that the other editor is attempting to improve the article.--scuro (talk) 03:48, 26 April 2009 (UTC)

Your recent editing history shows that you are currently engaged in an edit war; that means that you are repeatedly changing content back to how you think it should be, when you have seen that other editors disagree. To resolve the content dispute, please do not revert or change the edits of others when you are reverted. Instead of reverting, please use the talk page to work toward making a version that represents consensus among editors. The best practice at this stage is to discuss, not edit-war; read about how this is done. If discussions reach an impasse, you can then post a request for help at a relevant noticeboard or seek dispute resolution. In some cases, you may wish to request temporary page protection.

Being involved in an edit war can result in you being blocked from editing—especially if you violate the three-revert rule, which states that an editor must not perform more than three reverts on a single page within a 24-hour period. Undoing another editor's work—whether in whole or in part, whether involving the same or different material each time—counts as a revert. Also keep in mind that while violating the three-revert rule often leads to a block, you can still be blocked for edit warring—even if you do not violate the three-revert rule—should your behavior indicate that you intend to continue reverting repeatedly.