User talk:Dr.michael.benjamin

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Archive 1: February 2007

Contents 1 Medicare Part B 2 Welcome 3 FDA 4 FDA article / Abagail alliance case 5 Cholangiocarcinoma 6 FDA

[edit] Medicare Part B

In order to continue to provide a summary level of detail within the Part B section of Medicare (United States), I have removed and reworded some (but not all) of your recent contributions to that article. I did this not because I thought this material is bad, but instead because it was far too in-depth for an article about the whole Medicare program. As you have demonstrated knowledge regarding Part B, perhaps you could include this material in an article specifically about Part B. For naming consistency and clarity, I would suggest that Medicare Part B might be an appropriate name. If you would like some ideas about what that article might look like, you might use the Medicare Part D article as a reference. Thank you for helping to improve the Medicare article, and adding to related articles here on Wikipedia! -- 12.106.111.10 22:43, 15 February 2007 (UTC)

I like the changes you made to the reimbursement section of the article. I do think the rules are sophisticated, not complex, and I think sophisticated is a more neutral word than complex, which has a negative connotation if you think about it. By the way, there hadn't been many edits recently on the Medicare USA article until I came to town, so I'm at least happy to drum up interest in an otherwise dull subject!--Dr.michael.benjamin 06:34, 16 February 2007 (UTC)

Thank you for the complement, and I hope you at least consider creating/working on a Part B article. I personally feel that complex is the better description, and that it doesn't necessarily have have negative connotations in this context, but that sophisticated instead seems to have an overly positive connotation instead. In reality either word would probably work fine, or perhaps a third alternative could be found that would work better than either of these.

If you look over the history of Medicare (United States), and other articles found in Category:Medicare and Medicaid (United States) you will see that people editing from 12.106.111.10 have made a consistent and sustained effort over some time now to improve these articles, as well as other unrelated articles. If you go to User talk:12.106.111.10 you will find out why those using 12.106.111.10 edit anonymously from that IP, instead of login in to an account. You can also see the edit history of that IP address here, and you are welcome to review edits made from that IP address. I hope you understand that editing from an IP address is perfectly acceptable here at Wikipedia, as long as one behaves themselves, as should all contributers.

Discussing the usefulness & appropriateness of an edit on a talk page (as was done with comments here) is common here - I explained my reasoning, you explained yours, and you also provided the citation that was requested. There was no need to recreate any efforts to create and update the table (which you will note I assisted with), as it is very easy to copy/paste the material back in from a previous version of the article. Please don't take any edits from this IP personally, even if you disagree with changes made to your contributions, as WP:OWN applies equally to everyone. I look forward to working with you on other articles, as it seems we have some overlapping interest in article topics. Cheers! -- 12.106.111.10 16:47, 16 February 2007 (UTC)

You seem nice, and I understand that everyone at 12.106.111.10 works in a cubicle at a big corp, but I'm sorry, I'm just not going to have as satisfying a relationship with you knowing only your IP address. Would it make any sense to say, "Darn it, 12.106.111.10, there you go again!" Or, "12.106.111.11 would never say that!"--Dr.michael.benjamin 07:00, 17 February 2007 (UTC)

[edit] Welcome

... and thanks for your attention to MGUS and CLL, among others. I've been meaning to work on those for awhile, particularly MGUS. If you have a moment, take a look at acute myeloid leukemia - I put a lot of work into it awhile back, and got it into featured article shape, but I'd appreciate any comments you have on how it could be edited or improved. I started working on CML but didn't get too far. Also, the article on polycythemia was a little jumbled and I've tried to straighten it out, particularly distinguishig P. vera from secondary polycythemia, but it's also very much a work in progress. Anyhoo, sorry to ramble on - welcome and please let me know if I can help. You may also want to check out Wikiproject Clinical Medicine. MastCell 18:12, 19 February 2007 (UTC)

I'll have a look. Right off the bat, the AML article could use a table of the prognostic significance of cytogenetic alterations, which I'll create now. Thanks for the welcome...I don't think Wikipedia should recapitulate UpToDate, but it provides a great resource to patients and doctors in other countries. You've done a super job so far.--Dr.michael.benjamin 20:21, 19 February 2007 (UTC)

Yes, I think the difficulty is always to define the target audience, since professionals, patients, and interested laypeople alike read Wikipedia. For instance, it'd be interesting, as a physician, to talk about FLT3 inhibitors, more basic pathobiology of AML, more info on transplant vs. consolidation chemo in various risk groups, trials of gemtuzumab with induction chemo, etc... but sometimes I think too much detail makes the article sound too technical and unreadable, like a textbook, when the average reader may want to know about symptoms, treatment, and chances of cure. Anyhoo, thanks for your input and good to have you here. MastCell 22:16, 19 February 2007 (UTC)

Well, see what you think about the genetic component. I tried to be pretty general. One of the peer review comments was that there wasn't enough "cutting edge" type information in the article, and really the genetic research is where the field (actually all medicine!) is headed. Also, sometimes I find patients have latched on to random bits of information they read in the newspaper or on the internet, so it's nice to at least have everything in one place, even if the details are elsewhere. For example, there could be a whole article on FLT3 alone.--Dr.michael.benjamin 22:24, 19 February 2007 (UTC)

See what you think about my B-cell clonality article. It could use a little work, but I think it serves a purpose.--Dr.michael.benjamin 22:24, 19 February 2007 (UTC)

Speaking of the popular press, don't know how much general oncology you do, but you might want to look at the dichloroacetic acid page... it's been hyped quite a bit recently. MastCell 22:43, 19 February 2007 (UTC)

Fixed a little. The press really went crazy with this...--Dr.michael.benjamin 03:18, 20 February 2007 (UTC)

[edit] FDA

I see you came across the Food and Drug Administration article. What a frickin mess. I started to wade through the "Criticism" section (which is 80% of the article), because it read like a stream-of-consciousness, nearly totally unsourced thoughts of an employee of the Life Extension Foundation or something. I worked on it a few weeks back, removed a bunch of original research, and settled for tagging a lot of the other unattributed stuff. It needs a major improvement - after all, there is lots of valid criticism of the FDA, it's just not presented well in the article. If you're interested in working on it, let me know and perhaps we can improve the article. MastCell 19:53, 6 March 2007 (UTC)

I agree--it's a ton of garbage, basically unsubstantiated urban myths. People have this strong visceral response to the FDA for some reason, like there's some huge conspiracy or something. It looked like someone had gone through the criticism section--I'm glad it was you, but it's also kind of sad that you and I and probably a very small number of people are the main ones out there trying to make the medical section more scientific. I worry that if these crackpots really wanted to make it difficult with revert wars and vandalism, there wouldn't be much anyone could do about it. But still I must try. Good to see someone's looking at what I do.--Dr.michael.benjamin 05:08, 7 March 2007 (UTC)

So I did the section on food criticism. The points about the food coloring are bogus, and the antibiotics in livestock is something they're working on, and the bovine growth hormones are just not that well-studied. I think maybe that entire section should go bye-bye, or maybe be condensed down to one paragraph.--Dr.michael.benjamin 05:08, 7 March 2007 (UTC)

It could probably be condensed. I think it should be mentioned, since there really is public concern over it, but ideally there would be better sourcing. One option is to remove the unsourced material aggressively and then ask for sources before it's reinstituted - often that's the quickest way to clean the Augean stables when an article is truly a mishmash of unsourced opinion. I think the FDA could do a much better job, and there's no question it's susceptible to political pressure (witness the Plan B debacle), but the criticism section seems to be, as you said, a visceral response. As far as edit wars and reverting, I wouldn't worry too much about that. The best defense is good sources - if you have have decent sources regarding antibiotics in livestock, food coloring, etc then it will work itself out, and I haven't come across any edit-warriors since I've been working on the article (admittedly, only a very short time). MastCell 17:43, 7 March 2007 (UTC)

Look at the page on (Roman) Catholicism. No criticism there! How do other pages deal with criticism?--Dr.michael.benjamin 08:25, 10 March 2007 (UTC)

[edit] FDA article / Abagail alliance case

Hey Dr. B., I liked the Abagail alliance section. I do think the concern about patients avoiding randomized or placebo-controlled trials is central to this issue though - the ASCO amicus brief discussed this at length. According to the initial appeals court ruling, the 'right' the plaintiffs are claiming would kick in after phase I trials have been completed for the drug, so the "unfettered access" to the drug would compete against accrual to randomized phase II and phase III trials. Rustavo 04:48, 11 March 2007 (UTC)

I still think unfettered access for terminal patients would retard accrual to most phase I and phase II studies, but not because people want an alternative to a potential placebo. To understand why requires an understanding of how cancer clinical trials operate (N.B. I'm a private practice doc, but here's my take on how clinical trials are conducted in oncology)...Terminal cancer patients are not usually offered placebos in early phase clinical studies. Phase I and II trials are mostly conducted without a control arm--the scientific question they ask is not, "How does the drug compare to a different treatment?" Almost by definition, the questions asked by Phase I and II clinical trials are, "Is the drug safe? Is there any sign of efficacy?" If the answer to these questions is "yes," then the drug proceeds to controlled trials with a comparison arm (i.e., Phase III studies). Most of the time, randomized phase III trials in terminally ill patients compare standard of care treatment (not placebo) versus standard of care plus the new agent. That's because investigators find it difficult to accrue patients to trials where there's a good chance the patient will just get a sugar pill--if there's already a treatment that might work. Also, the informed consent process ensures that patients in placebo controlled trials understand that there is a chance they will get a placebo. So you see, unfettered access isn't a way for terminal patients to avoid the sugar pill--for them there usually isn't a sugar pill--that is too fraught with ethical problems, and wouldn't really address the question in 90% of cancer clinical trials. Unfettered access is a way for people to have any pill they dream necessary, any time. Some people really believe this would be a Good Thing, which is why there's so much criticism about the FDA on the page. People want drugs, and they don't want the government or anyone else telling them what they can and can't have. Fortunately, scientists are still able to have a chance to study drugs under controlled circumstances. If the Abigail case has its expected consequences, drug development will break down completely, and we may never learn which drugs are safe and effective. Notice how few well-designed clinical trials there are in herbal medicine. It's not that there's no money in it--it's a multibillion dollar industry. The problem is that there's no regulation, so there's no incentive to perform expensive, time-consuming trials. That's why this case is so dangerous, and why we shouldn't dilute the impact of it. The complaint [1] against the FDA does not specify at which phase of clinical testing the drugs should be made available.--Dr.michael.benjamin 07:48, 11 March 2007 (UTC)

Sounds good, sorry about the nitpicking. I'm not going to pretend my one month of elective experience in med onc compares to your training and experience. Rustavo 16:01, 11 March 2007 (UTC)

To pick up on one of those threads, the problem (from my perspective, anyway) is that Phase III trials often don't get done, or are done with an inappropriate comparator. If the Phase II data looks promising enough, it seems drugs often enter widespread use before the completion of Phase III trials - and the Phase III's that are done sometimes use an odd choice of "placebo (conventional therapy)" arm (i.e. the cetuximab in head/neck cancer study). I do think your points about the importance of the case, the need for structured clinical trials, and the distinction with herbal medicine. MastCell 16:21, 11 March 2007 (UTC)

[edit] Cholangiocarcinoma

Hello - I just finished a fairly major expansion of the cholangiocarcinoma article, and I was wondering if you'd take a look and let me know what you think. I was surprised by how much literature there is on cholangiocarcinoma, but a lot of it is in the surgical literature, which I'm a little less used to perusing. Anyhoo, I'm trying to beef it up into a solid article, so any feedback you have would be welcome. Thanks. MastCell 16:49, 15 March 2007 (UTC)

Funny you should mention it--I reviewed the cholangiocarcinoma literature for a patient I had only last month, and I, too was amazed by how many trials there were. Medical oncology as well. I can say, for example, that combining chemotherapy with radiation is a standard treatment, supported by the literature. I'll have a look.--24.24.177.129 04:54, 16 March 2007 (UTC)

[edit] FDA

I responded to your post on my talk page. MastCell ^Talk 17:43, 25 March 2007 (UTC)

Honestly, our libertarian friend is on a tear. Wikipedia's policies are not slowing him down. It's probably best to try to rein in the more egregious excesses, but hold off on major revisions until the pace slows down a little. It'll work itself out by the deadline. MastCell ^Talk 03:50, 29 March 2007 (UTC)

My suggestion is to give him a week with the page, then suggest that we discuss the results with a mediator. We've ignored him before, and he comes back - he doesn't seem to have many other pages on his agenda. He's now gotten into the habit of quick-reverting nearly all of my attempts to make his claims concise, readable and accurate, and I'm not willing to try to keep up anymore. -Rustavo 03:37, 31 March 2007 (UTC)

He seems to have cut back on his edits, considering we've allowed him to properly source most of his controversial or weasely statements. The remaining issue now stands to make everything as concise as possible (or, preferably, fork the Criticisms section). // 3R1C 02:55, 3 April 2007 (UTC)

You know, the article has improved significantly. R has inflamed all us rational thinkers, but he also has provided an incentive to improve the article. Thanks 3R1C for your key edits.--Dr.michael.benjamin 05:31, 3 April 2007 (UTC)

Glad to have been what I feel is the third perspective you guys needed. Hopefully I helped you all reach a compromise on these issues. Everyone's statements are nearly cited completely, so ithink we have superceded any POV or Weasel Wording issues, thankfully. Additionally, wanted to let you know Regulations went on ahead and forked the article into [{Critcisms of the FDA]]. After all the work and stress spent on that section, we need to make sure it doesn't get deleted . // 3R1C 06:08, 4 April 2007 (UTC)