User talk:Dr.michael.benjamin

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Archive 1: February 2007

Contents

[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)

[edit] User:Regulations - curious development

So it turns out our good friend User:Regulations is a sock puppet (illegitimate second account) of a user named Billy Ego. Billy Ego is apparently a proud self-proclaimed admirer of extreme (read fascist) politics, and has just been banned by Wikipedia's Arbitration Committee, along with Regulations. Therefore, with that problem resolved, I'd propose revisiting the FDA page and making some rational changes - deleting the separate Criticism of the FDA article, reinstating a "criticism" section in the main FDA article, and trimming the criticism down to what a rational person would think is appropriate. Are you interested? It should be a piece of cake compared to dealing with User:Regulations. MastCell Talk 01:23, 15 April 2007 (UTC)

Fascinating. What would stop Mr. Ego from doing the same thing all over again? Sometimes I think Wikipedia is like trying to explain calculus to a horse. Have you ever gone over to citizendium? Having said this, I will help. I got pretty busy in my professional life, but things are calming down a little so far.--Dr.michael.benjamin 06:09, 15 April 2007 (UTC)
I haven't checked out Citizendium, although I'm familiar with its principles. I actually prefer the "anyone can edit" model, in that it makes me think a little harder. You'd probably agree that as a physician, people sometimes let you get away with a certain amount of hand-waving at times because they trust that, when it comes down to it, you know what you're talking about. Here, if anything, it's the opposite. I actually took the "physician" box off my userpage after I got tired of people saying things like, "Obviously you can't really be a doctor", just because I don't believe that garlic or Vitamin C can cure cancer or agree with their pet theory (despite the fact that it was published in Medical Hypotheses!)
Anyhow, our friend from the FDA page was a fairly extreme example of the sort of problems Wikipedia engenders. Most disputes can be settled more reasonably, so I'd encourage you to stick around. The medical articles can always use more help. Medical controversies tend to be a little tougher going, as many ideas that are discredited in the real world have staunch advocates here, but such is life. It will all get worked out by the deadline. MastCell Talk 00:00, 1 May 2007 (UTC)

[edit] Food and Drug Administration

Hi Dr. B. With respect to your recent edits, I was wondering if we could complete the discussion about the appropriate location for criticism in this article. I continue to strongly believe it should be limited to very clearly defined sections, and should not be scattered throughout the article, particularly in the initial sections. I've made comments on the talk page but no changes as of yet. -RustavoTalk/Contribs 23:25, 30 April 2007 (UTC)

I just wanted to let you know that I've asked for the Criticism of the FDA page to be (temporarily?) restored so that we can finish the discussion/vote on the fate of that content. There is a pending vote that had been started, and I've suggested we try to reach a consensus, or at least majority decision, in the next five days. -RustavoTalk/Contribs 00:28, 3 May 2007 (UTC)

I thought we already voted. I would vote to redact the criticisms into the main body of the page. In a constructive way.--Dr.michael.benjamin 03:33, 3 May 2007 (UTC)

[edit] Edit summaries

Hi there, doc! It's always good to see doctors such as yourself devote some time to Wikipedia articles, too bad there aren't more.

I just took care of a few things that I saw needed fixing on the Linus Pauling article, and then decided to take a quick look back through the recent edit history to get a sense of what sorts of things people have been working on. Your series of edits back on March 12 caught my eye — what with seeing your full name repeated 5 times in a row, and the edit summary on your first edit: "Call a spade a spade" ! :)

I figured that was worth having a look at, and then proceeded through the next 4 edits. What struck me was that all but that first edit were marked as "minor" edits, but only one of them could (possibly) be considered minor. So I thought I would leave you a note to bring this to your attention for future edits. You might want to take a look at the page on Minor edits, which explains what the term really means in WP usage.

I would imagine that, as a doctor, you are pressed for time, so I don't want to discourage you from editing — but it really helps your fellow editors when you take a moment to give some indication of what you've done in your edits. (I'm appending an "edit summary" template below which lays this out pretty well.)

PS - I noticed on your user page that you've done a lot of editing on blood disorders, etc. Hope you don't mind my asking, is that your specialty?

Regards, Cgingold 10:46, 19 May 2007 (UTC)

You've got to be kidding me. Those edits are buried under so many layers of wikicruft and pseudoscience that I'll bet there's not more than one or two words left on the page now from my original edits. I think you singling me out for criticism about the magnitude of the edits is laughable, considering the impact they've had on the structure of the page. No offense, but your time is probably better spent actually editing the article than educating me on the finer points of wikidom. You seem to have spent quite a bit of time editing the article, so I'm assuming there's something constructive there. The article is a haven and repository for outrageous claims, and seems to be guarded by "orthomolecular" devotees. I gave up on it a long time ago. It wouldn't matter if I wrote a thousand word edit summary if people just come later and revert to the original text.
I am a hematologist and oncologist, and I am also board certified in internal medicine. You can look me up on the California and Georgia state medical board websites.
Thanks for caring.--Dr.michael.benjamin 06:45, 21 May 2007 (UTC)
Good grief... I'm not sure how, but somehow you've completely missed -- and misconstrued -- the reason for my note, doc. I suppose you're not real used to having folks point things out and suggest that you might give them your attention. But "...singling me out for criticism about the magnitude of the edits..."?? <sigh>... I really didn't do anything of the sort. I wasn't even taking issue with your edits -- the whole point of the note was to encourage you to leave better edit summaries, rather than marking nearly all of your edits as "minor edits". That's something that is stressed as fundamentally important -- hardly to be dismissed as "the finer points of wikidom". (In fact, knowingly marking significant edits as "minor" is very frowned upon -- in some circumstances, it might even be construed as deliberately misleading other editors.)
You know, I really do appreciate your taking the time to contribute to Wikipedia. As I said, I presume that, as a doctor, your time is at a premium, so I can well understand that leaving useful edit summaries might seem burdensome -- but I assure you, it isn't pointless. It's sort of like leaving clear, useful notes in your patients' charts, so the other health care personnel have a good idea of what's going on. Hope that helps.
Regards, Cgingold 11:30, 24 May 2007 (UTC)
PS - I nearly missed spotting that little comment you left on my user page. It's a lot better to leave notes on the talk page, since that automatically notifies you that somebody has left a note.
Right-sorry about that...My main gripe is that you can leave detailed notes on the edit summary, you can spend an hour redacting an article, and they'll still delete your stuff. Sure, if we can all assume we are working towards the same goal, every little bit helps. Does the edit get reported on a different "new edit" page depending on if it's major or minor? Is that how people detect what's happening on Wikipedia?--Dr.michael.benjamin 18:45, 24 May 2007 (UTC)
Believe me, you're not alone -- I dare say every conscientious editor feels similar types of frustrations to a greater or lesser degree. As to your question, if you follow the link to Minor edit there's a good explanation on that page that covers the subject pretty well. And Edit summary is also well worth reading, if you haven't seen it yet. Sorry for my delays in responding to your replies, I've been suffering/recovering from a pretty severe case of shingles, so I haven't been able to stay on top of things here on Wiki the way I normally would. Cgingold 23:47, 26 May 2007 (UTC)

When editing an article on Wikipedia there is a small field labeled "Edit summary" under the main edit-box. It looks like this:

Edit summary text box

The text written here will appear on the Recent changes page, in the page revision history, on the diff page, and in the watchlists of users who are watching that article. See m:Help:Edit summary for full information on this feature.

Filling in the edit summary field greatly helps your fellow contributors in understanding what you changed, so please always fill in the edit summary field, especially for big edits or when you are making subtle but important changes, like changing dates or numbers. Thank you.

[edit] Breast Cancer article

Thanks for your edits on the breast cancer article. As a lay editor who has this page on my watchlist, I'm thrilled to see an oncologist working on it. A question--is the order of topics in the Epidemiologic risk factors and etiology section logical? I can't discern a pattern to the order. I'm afraid it may have developed over time, with topics added at the bottom as various editors came in to make additions. The topics should be in some kind of logical order-- from those considered the strongest risk factors to the weakest, or alphabetical, or most studied to newest, or something. Your thoughts? I will watch this page, so please feel free to reply here. Thanks, -- Sfmammamia 20:21, 23 May 2007 (UTC)

Happy to help. I think alphabetical should be fine. I'll redact it.--Dr.michael.benjamin 03:18, 24 May 2007 (UTC)

(EC) Kudos on your recent contributions to Breast cancer - nice work! And thanks for taking the time to throughly cite refs throughout the additions (much appreciated). -- MarcoTolo 20:23, 23 May 2007 (UTC)

Happy to help. Hope it stays up longer than my other contributions. Also, it's not done--I only got halfway through epidemiology.--Dr.michael.benjamin 03:18, 24 May 2007 (UTC)

[edit] Breast cancer FYI

I removed the NSABP link for two reasons: when an article on the same topic exists, an internal link to that article is preferable and the editor who originally inserted the link only edited in a manner that was promotional of NSABP, which is consistent with an insider and conflict of interest. Recently an administrator deleted the NSABP article as a blatant copyright infringement. So until a proper article is recreated, I have absolutely no problem with a neutral editor reinserting a link to the NSABP site. Burlywood 13:14, 31 May 2007 (UTC)

[edit] Cancer

Hey Dr. B, I noticed you took a crack at improving cancer. The intro definitely needed work, though I agree with you that it is a tough balancing act with the amount of stuff that could go in there. I think we need to keep a broad audience in mind and avoid too much biological detail in describing carcinogenesis in the intro - that said, your changes are a big improvement over what was there before. One question - I noticed that you used the term "malignant" several times in the first paragraph to define cancer. I recently converted the page malignant to a disambiguation page, since I view its use in reference to neoplastic diseases to be flat out synonymous with the word cancer, and the page as it existed was sort of a poor-man's cancer page. So I think it is perhaps better just to define cancer as a clone of cells that divides without limit, invades, and/or metastasizes, rather that say "cancer is a clone of cells that behave in a malignant manner", which to me reads "cancer is a clone of cells that behave in a cancer-like manner." Just my two cents - let me know if you think I'm missing something here. -RustavoTalk/Contribs 07:43, 6 June 2007 (UTC)

I think using the word malignant is important when it comes to defining cancer, since not all neoplasms behave in a malignant fashion. What sets cancer apart from benign neoplasms like hamartomas or carcinoma in situ isn't so much the underlying biology, or cell of origin, but the clinical behavior. I do define malignant as uncontrolled growth but also the potential for metastasis. People affected by cancer, such as patients or family or friends, as well as students writing reports, need to understand that basic concept about cancer before learning other things.
The definition is a little loosey-goosey because, if you think about it, what really is cancer? To me, it's malignant behavior, and if that's a little tautological, so be it.
The biological components I put in the intro are basic concepts, and reflect the current state of knowledge about how cancer gets started. What was there before was a discussion about "mutations," that read like it was written by a college freshman (no offense if you wrote it). There are a lot of other things going on to cause cancer besides "mutations," and I'm sorry if the concepts are complex, but they are crossreferenced elsewhere in Wikipedia. This boils down to the same old debate over how technical an article should be. I think we should try to define concepts using the actual words the scientists use, then make the concepts accessible through analogies and examples.
The summary was actually a lot more technical and detailed before, with an in-depth discussion of the implications of "mutations". It's a lot more broad now, and I think that's a good thing. If you like, one can take out all the biological stuff there and just say, "There are a number of important environmental, genetic, and immunologic abberations underlying the etiology of cancer, many of which are summarized below."--Dr.michael.benjamin 15:40, 6 June 2007 (UTC)
No, the only sections I had worked on were classification, and treatment, and those just in passing. I may sit down some time in the next week or so and try to iron the article out as a whole (I just graduated, and still have a few weeks before my path residency starts - hence all the time on my hands.) Obviously it would be great to get this article up to top quality. By the way, I just created a new oncology article - hormonal therapy (oncology) out of whole cloth. I'd love it if you could give it a quick review.-RustavoTalk/Contribs 17:01, 6 June 2007 (UTC)
Congratulations, doc! May you make many excellent contributions both to Wikipedia and medicine. This is probably your highest point right now--you just had a nice graduation and residency hasn't started. Enjoy it!--Dr.michael.benjamin 19:41, 6 June 2007 (UTC)

[edit] The cancer article

I think much of your recent work tries to repeat stuff that perhaps ought to be in carcinogenesis. Cancer should really only contain facts that are completely established. I wonder whether "microRNA" should be mentioned in the article introduction.

There is evidence to support the statement, but as Jimmy Wales says, it's not critical to have it in there now. There could be a "new concepts in carcinogenesis" sentence that includes microRNAs, mutations, translocations, etc.--Dr.michael.benjamin 20:57, 10 June 2007 (UTC)
I think the biology of cancer is tied closely with carcinogenesis. Certainly there could be crossreferences. I think it's hard enough for me to edit one article without having to take on editing another article that probably differs quite a bit from the cancer article.--Dr.michael.benjamin 20:57, 10 June 2007 (UTC)

There is a marked paucity of sources for this crucial article. Given that it is one of the most heavily-viewed health articles, perhaps we should spend a few days finding solid sources for the most important material. I have used the 2005 cancer statistics source to give some basis for the otherwise so loosely cited epidemiology of cancer. There must be much better historical sources than Ralph Moss PhD, who is not without controversy (this is his website).

I agree that there need to be more and better sources, but some of the material was really weak, and it doesn't make sense to spend a lot of time referencing garbage material.

I'd be quite happy to collaborate here. MastCell, Rustavo and several other edits could (and probably would) help. JFW | T@lk 09:57, 10 June 2007 (UTC)

Sounds like herding cats, but anything that improves the article would be great. I know my patients are reading Wikipedia.--Dr.michael.benjamin 20:57, 10 June 2007 (UTC)
I thought about it some more, and I think the basic issue between us is a philosophical one. I'll bet you think that the cancer article is "done," so all it really needs are references. I will further venture to guess that you feel this way because you wrote a good part of the article. I, on the other hand, do not feel that it is anywhere near "done," though I do think it is "good." It doesn't have the depth that a truly great article will have, in that it does not yet reflect the state of knowledge about a topic. There are thin, weak areas that need more text, and I think we are a ways away from touching the bottom here, so this is the real reason why I think references are not quite enough. So, nothing against all the hard work you've no doubt put in to this point; there's just a long ways to go.--Dr.michael.benjamin 06:50, 13 June 2007 (UTC)

I don't think the article is "done" (no Wikipedia article is ever "done"), but I'm not sure if runaway expansion is the way forward. I've actually only written small parts of the article (which have subsequently been edited heavily). My concern is more that as more detail is added, the bigger picture gets lost. With a massive subject like cancer, some things are indeed better split off into subarticles (as has done in mammoth subjects like The Holocaust). In my experience, the appearance of level 5 headings is usually an indication that this is necessary. I wouldn't mind discussing this is somewhat more detail on Talk:Cancer, to see if we can come to an agreement with the other editors. JFW | T@lk 22:43, 13 June 2007 (UTC)

Sorry about being somewhat grumpy before. You've certainly made useful improvements to the article; I do still feel we need more references that truly represent the literature. Perhaps ASCO position statements etc may be useful here. We need to describe the way cancer is being diagnosed and treated. JFW | T@lk 21:38, 5 July 2007 (UTC)
Your huge contributions to Wikipedia, and therefore to erasing human ignorance, are more important to me than any mood you had. I agree that more references are needed. It takes a long time to add a reference, I would estimate at least ten minutes per reference. I agree the diagnosis and treatment sections could be better. There is a lot of overlap between screening and diagnosis (also prevention and treatment), so it'll be key to avoid redundancy.--Dr.michael.benjamin 00:35, 6 July 2007 (UTC)

[edit] Barnstar

Dr Benjamin, you deserve a barnstar. [By the way, are you an oncologist?] Axl 11:05, 25 June 2007 (UTC)

The E=mc² Barnstar
Dr.michael.benjamin, for contributions to medical articles. Axl 11:05, 25 June 2007 (UTC)

Wow, thanks! Yes, I'm an oncologist. I had given myself a novice editor star, but this one's much cooler.--Dr.michael.benjamin 04:47, 26 June 2007 (UTC)

[edit] Proposal for WP:ONCOLOGY

I am trying to gauge what the interest would be for a WP:ONCOLOGY category. This would be under the broader auspices of WP:MED, along the lines of WP:RENAL and WP:Rads. It would address standards of care and best practices in surgical, medical, and radiation oncology, along with maintaining and editing cancer related articles.

If this is something you are interested in, please sign underneath the relevant section at Wikipedia:WikiProject_Council/Proposals#Oncology

Regards, Djma12 (talk) 01:12, 2 September 2007 (UTC)

[edit] VA/CDC incident

Hello Dr Benjamin, could I have your opinion on the recent additions of Chaveso (talk · contribs) on cancer and his responses on Talk:Cancer? I think we cannot afford to mention incidents if we cannot provide the context to those incidents. JFW | T@lk 07:16, 2 November 2007 (UTC)

Chaveso seems semi-responsible. I think his point was not in the proper context, so I rewrote the paragraph to give it proper context. His paragraph works as a few words with some references. The section wasn't too well written, and, as usual, the topic page would be a lot better if people devoted as much time to editing it, instead of the discussion page.--Dr.michael.benjamin 07:11, 3 November 2007 (UTC)

[edit] Terri Schiavo

I was wondering if you could take a look at the Terri Schiavo#Five years of family conflict? I think that the section is too long because, in effect, Terri's diagnosis and her legal status at the end of the 5 year period is the same as at the beginning. All the back-and-forth of the family legal conflict seems to me to be a lot of detail that does not advance the story. Do you think that the section could simply be condensed to simply a complete diagnosis and a factoring out of the family conflict onto a separate page? We can retain citations that support the diagnosis, but the rest of the legal details are, in terms of the story, inconclusive.

I don't feel like there's anything to add or subtract from that section. Part of the absurdity and sadness of the case stems from the protracted legal maneuvers. This section was obviously written by people with detailed knowledge of the cases, and lends a lot of good context to the fiasco that followed. I hope it doesn't get deleted ever.--Dr.michael.benjamin 04:52, 6 November 2007 (UTC)
Also, the legal details are not inconclusive. They show that the courts consistently supported Michael Schiavo's claim to guardianship, and that the Schindlers were not able to achieve control over her care, despite five court cases. This lays the groundwork for understanding why they appealed to other bodies of government, such as the legislature, and finally the executive department.--Dr.michael.benjamin 04:52, 6 November 2007 (UTC)
You are correct in your conclusion that Terry Schiavo is "about" medical ethics, but there are other concepts that map to that one, including a narrative about court cases, medical information, social and political considerations. She was also a person, wife, daughter, etc. Medical ethics, in many cases, is in the eye of the beholder, and the most informative cases are sometimes the least clear.--Dr.michael.benjamin 04:52, 6 November 2007 (UTC)

Also: if you could take a look at Henrietta Lacks, I would like your opinion on how that article is currently balanced. In particular, as a biography, we do not learn a lot about Lacks while she was alive compared to the amount of space spent on her legacy. In particular, the "medical science" content belongs on the HeLa article. I feel that both the Lacks and the Schiavo biographies are not about medical science; they are about medical ethics. I think that you can help to separate out the two issues so that the stories are properly balanced to emphasize the legal and ethical aspects.--Straightpress 15:25, 5 November 2007 (UTC)

You are very kind to seek me out for comments on these articles. I thought the Henrietta Lacks article was interesting. Certainly, her legacy to people outside her family for her contribution to science and the alleviation of human suffering has to be more noteworthy than her life history. I think if you wanted to add more information about Lacks' life in the biography section, that would be terrific--it would add more context and depth to the legacy portion. I would hate to punish the legacy section though, just because the biography section is a little light. The legacy section is fully of meaty details, relevant things like the fact that these cells made it onto an unmanned satellite, and that Jonas Salk used them to create the polio vaccine. I had never thought about these things, though, of course, I had heard about the HeLa cell line. It helps me as a doctor understand something about that moment in history. We don't really think too much about polio these days, except about the vaccine, but people really worried about it years ago, and breakthroughs like the discovery of the HeLa cell line made it possible for humanity to move on to bigger and better things. To me, the Lacks article is not about medical ethics as much as it is about an important historical moment and the aftermath we are still feeling from that moment today.--Dr.michael.benjamin 04:52, 6 November 2007 (UTC)

I think that the issues with both articles are a matter of organization and focus. A biography, typically, is about how a person used their mind to effect the lives of future generations. Neither of these two subjects used their mind, but the existence of theirs lives is significant to our current generation because of the resulting impact on science and law. For instance, one might try to separate TS from the "TS controversy" as two distinct articles, but that would make the biography rather brief. An important "perspective" issue is that Terri's medical data is viewed as personal and "hers", but its historical significance is not intrinsic to her person and her mind but rather, creates a profile that could be applied then to any patient with brain damage and end-of-life issues. Specifically, does all that medical data belong in her "biography" because it is "hers" or does not belong in a "Terri Schiavo controversy" article instead? There is a third article that you might consider: EM. This is a more difficult subject because clearly we are concerned with the person's mind and with the large legal impact it has. Plus, this person is, like yourself, a physician and active surgeon in the USA and still alive and that adds additional complications. These articles are useful examples that I think can help to drive the process of creating better guidelines about how these articles and this information should be organized.--Laughitup2 (talk) 10:01, 5 December 2007 (UTC)

Thanks for your comment, though I think you are a sockpuppet of Straightpress. If I didn't know anything about Schiavo, for example, I would be very fortunate to find the TS article in its current condition. It gives us Terry Schiavo, not the person, not the biography, but the concept. The article is the very answer to the question, "What was all that ruckus about Terry Schiavo back a few years ago?" It gives a newcomer a sketch of the contentious events of (the end) of her life. It shines the light of truth upon what actually happened, and it's a valuable contribution to Wikipedia. Sure, you could be nominalist and say, "But it's not a biography of the person," and you would be right technically. But I think that when someone visits Wikipedia with a query of "Terry Schiavo," they probably encountered her name in a newspaper or conversation and want the basic reason why someone would have made reference to her story. "What's relevant about the TS story?" Bam, it's all there in the article. Biographies make nice books, but not necessarily good Wikipedia entries.--Dr.michael.benjamin (talk) 07:17, 6 December 2007 (UTC)

Well, if you look at the state of the article back in January 1, 2006, you will find it to now be an improvement. For instance, the first sentence was clearly one crafted by a committee:

Theresa Marie "Terri" Schiavo (December 3, 1963 – March 31, 2005) was a woman from St. Petersburg, Florida whose unusual medical and family circumstances and attendant legal battles fueled intense media attention and led to several high-profile court decisions and involvement by prominent politicians and interest groups.

Note the vague "unusual medical and family circumstances" rather than saying that she was profoundly brain damaged. This compromise was due to the influence of right-to-lifers (really, what they are is anti-euthanasia, but I do not might using that term because they are also anti-abortion-rights). I supposed the stable result of Wikipedia is supposed to be "a compromise", but most people trying to read this were put off right from the start. See [Wikipedia:Peer review/Terri Schiavo]] for some of the feedback. I still say that the complex intermingling of non-notable (1998-2002) legal/medical discovery and wrangling could be quickly summarized and the reader would lose little of the crux of the matter so long as a decent prognosis was presented. If you think about it, when the reader asks "how does this apply to my family?", the "new information" is almost all legal. By that I mean, the reader is going to learn little about how to avoid this sort of cardiac arrest in a family member by reading this story. If a family member does suffer profound brain damage, then the typical American hospital team will be able to reliably inform the relatives when there is little hope of recovery. Where this article comes into play is after the medical damage is done and the family is faced with the legal issue of life-support termination. Then it becomes a legal, social and perhaps religious issue. Well, at least the introduction now is easier to understand and covers only the high-priority issues. If you look back though the talk pages, you will see that a lot of wrangling between the right-to-lifers and others was over minute wording. Note how the wording is still that she had "a diagnosis of persistent vegetative state" rather than bold stating simply that she was in "a persistent vegetative state". The difference is that the former focuses on the physician and that latter focus on the patient. The reason to do that is to insert doubt in the mind of the reader about the diagnosis. The same goes for the focus on Michael Schiavo. If you read "Silent Witness", you will see that the author, Mark Fuhrman is persistently trying to suggest that Michael Schiavo violently caused his wife's cardiac arrest. You will find that same level of logic in the EM story: focus on the male in insinuate that he is to blame. In both cases, we will never know for sure, but we do ask the courts to resolve the matter. In Schiavo's case, there was a seven year delay in carrying out his will. In Foretich's (EM's husband) case, he also went through many years of trying to clear his name. Both succeeded in the end, but the U.S. Congress changed the law in both cases when the existing law would have resolved the matter adequately. Well, Morgan case is different because she fled the jurisdiction, but I think that the lesson to take away from both cases is that the legislature should be discouraged from attempting to resolve ongoing court cases via new legislation. I am bolding assuming that you have no religious agenda on these matters and can separate the medical and legal aspects well. So in the end, here at Wikipedia, the TS story was, in some ways, held hostage by the right-to-lifers and the EM story croaked because of a lack of popularity. But both are notable and deserve to be done with balance (NPOV, if you will) and with clear, well-written prose. But first, you have to figure out priorities. Both are complicated enough were they can be written NPOV but still be unbalanced in terms of what facts and factual details are included. If they are written by committee (as that former first sentence was), then you will just end up with a bunch of clauses rather than a coherent narrative.--Laughitup2 (talk) 09:42, 9 December 2007 (UTC)

Thanks for that thoughtful response. I personally believe in euthanasia, but I think it's good that an article is edited in a way that is sensitive to the "other side." I think the introduction strikes a decent tone, and I agree that there were certainly unusual family and medical circumstances that ignited a storm of media and society interest. I think the episode is a good way to get people talking about end-of-life, but it's not necessarily a resource for people searching for the right answer for their particular end-of-life issue, as you propose. Also, "persistent vegetative state" is not a really solid diagnosis for anything in my mind, because it deals with a syndrome, not an etiology. Anytime we describe a medical condition by its manifestations only (arthritis) rather than the etiologic agent (pneumococcal pneumonia, for example), we are dealing with an uncertain entity. You are entitled to think that the TS article is better without the legalistic details; I think that's part of what makes the whole story so fascinating. As a doctor, I feel validated that the system worked to uphold the sanctity of my professional assessment. Let no legal body regulate my practice. The details of the story then are confirmation that the courts will generally uphold my medical judgement, though the legislature or executive bodies may try to modify that. HTH.--Dr.michael.benjamin (talk) 02:43, 13 December 2007 (UTC)
The etiology is fine to aim for if you are looking to cure the patient, but in this case, recurrent cardiac arrest never seemed to be a danger once she was under hospital care. With the brain damage already fact, much of the politics then devolves into a blame game. Some point to Schiavo's bulimia and potassium deficit, suggesting that the cardiac arrest episode was primarily due to the her own dieting and erratic water intake and therefor her own fault. Others, such as Furhman, insinuate that some unsubstantiated notion of an action on Michael's part in the form of domestic violence caused the cardiac arrest. Much of the political drama is derived from this blame game, especially since successfully pinning the blame on the husband would not only represent a form of justice that would be satisfying to some observers in its own right, but because it would almost certainly strip him of his authority, which would then devolve to the parents, thus dramatically "saving the victim". It is ironic that the malpractice settlement, while seeming to support the bulimia etiology, did not properly resolve any matters of fact; it only resolved matters of the money.--75.37.14.196 (talk) 09:45, 21 January 2008 (UTC)

[edit] TTP

Could you support your edit on TTP, mentioning the Furlan-Tsai hypothesis, with a reference? JFW | T@lk 11:40, 4 December 2007 (UTC)

Funny you should ask. I think I read that term in NEJM, but I couldn't find it last night. I'll keep looking.--Dr.michael.benjamin (talk) 07:28, 5 December 2007 (UTC)
Looks like that Furlan-Tsai hypothesis got picked up by several wiki-crawlers, as my entry is the only hit on google!--Dr.michael.benjamin (talk) 07:38, 5 December 2007 (UTC)

[edit] More content online

I have seen a rise in publicly available surgical videos this year. Some links:

--Laughitup2 (talk) 11:35, 9 December 2007 (UTC)