Talk:Wilson's temperature syndrome

Comments

Looks like average, basic, well-intentioned nonsense to me. Since the median oral body temperature (among healthy adults) is actually less than the 98.6 he demands (and which old textbooks taught), it's clear that more than half the adults in the U.S. will qualify for this so-called 'diagnosis.' Is this really WP:Notable? WhatamIdoing (talk) 21:42, 19 November 2007 (UTC)

Oh, better than that: its symptoms are whatever you've got. Do you have fatigue? If you don't, you're probably sick. If you do, you're normal: we're all fatigued. Do you gain weight "easily?" I'll bet you do, unless you're hyperthyroid. It's not merely well intentioned nonsense, because it combines with the Western patient's desire to lose weight and feel happier. Depression is pandemic, and obesity is epidemic. Further, some psychiatrists are using T3 as an adjunct to their therapies for depression. If T3 has a (slight) effect on mood stability or elevation, and we know absolutely that patients can throw themselves into biochemical hyperthyroidism to lose weight, then Wilson's Syndrome is tailor made for popularity. It's a license to print money.

Is it dangerous? Probably not very dangerous to induce hyperthyroidism sporadically in patients, but it's not nice, and it's not health, and it's not ethical. Geogre (talk) 16:37, 4 January 2009 (UTC)

Perhaps you haven't read this fine article: PMID 16883675. Who needs a placebo arm or validated metrics to study subjective changes, anyway? And don't you see, according to the authors, giving T3 to people with normal thyroid function is just like using estrogen and progesterone to regulate menstrual cycles in women with normal ovarian function. Of course, a stickler (or someone who's taken college-level biology) might point out that estrogen and progesterone are secreted cyclically, while T3 is not. But to return to approved talk-page usage: I think this is probably notable; it has been debunked by the American Thyroid Association, thus satisfying WP:FRINGE. MastCell ^Talk 07:18, 6 January 2009 (UTC)

A high school level introduction to logic suffices to allow reasonably intelligent people to conclude that while double-blind placebo-controlled are the most scientifically rigorous form of experimentation that other less rigorous experiments allow preliminary inferences to be drawn. For your information, non-double blind not placebo-controlled studies are conducted to this day at top tier North American medical schools when funding or a desire for preliminary results suggest.--Alterrabe (talk) 12:08, 6 January 2009 (UTC)

Oh, sure. Hell, for all we know, I may have designed and led a few uncontrolled clinical trials myself, and I only work for top-tier institutions. :) But such studies generally assess toxicities of treatment without reference to efficacy (e.g. Phase I studies). If they make claims about efficacy, they at least make reference to historical control cohorts with similar diseases and emphasize the limitations of such comparisons. Any study measuring a subjective endpoint needs to use a validated, reproducible metric to be meaningful. In this case, we're talking about a poorly defined set of subjective symptoms; we're told that "all patients improved", but according to what metric? How many would have improved with no treatment at all? How can you attribute this "improvement" to the intervention (rather than natural history or the placebo effect) in the absence of a control arm? The problem isn't lack of controls per se; it's the way in which these uncontrolled and unvalidated data are used to present T3 as a "valuable therapy". MastCell ^Talk 00:45, 8 January 2009 (UTC)

Dr. Wilson,

I have only been on the WT3 (Wilson T3) protocol for 39 days and I can report a great improvement following over 60 years of debilitation. What a thrill (on about day 30) when I put my pj's up on the hook behind my bathroom door as I marveled to myself, "That wasn't hard to do at all!"; as it seemed effortless in contrast to my usual routine. That small event was startling in its simplicity. It made me clearly aware of what a painful struggle life has been all these years.

I still have a long way to go, but even the first day of taking T3, I could see that this was the first thing that addressed the extreme fatigue and pain that has plagued me since I was a child.

So often medical interventions only made my symptoms worse even though many doctors initially thought I had "a thyroid problem" until a blood test showed normal T4 levels. I will spare you the details of the many disasterous "treatments" that I have endured which have so negatively effected every aspect of my life.

I look forward to increasingly sound health as I stay with the program. A million thanks go out to Dr. Wilson and all of you who help promote this miracle.

BETTER LATE THAN NEVER from Michigan

For me, this sort of stuff is strongly suggestive!--Alterrabe (talk) 11:51, 13 January 2009 (UTC)

I suppose that's where we differ. I don't find testimonials particularly convincing as an advertising technique, much less to support the scientific pretensions of this topic. Would you like me to produce a testimonial from someone who developed atrial fibrillation because they were inappropriately prescribed T3? Would that prove anything? MastCell ^Talk 19:45, 13 January 2009 (UTC)

Be my guest. I'll raise you and your horror stories with reports of thousands and even tens of thousands of people who died because they drank too much water!--Alterrabe (talk) 12:53, 17 January 2009 (UTC)

Either you are intentionally proving my point, or you have deeply misunderstood it. MastCell ^Talk 04:36, 10 March 2009 (UTC)

Removing Pseudoscience Category

Dear Friends,

I do not feel that Wilson's Syndrome fits in the Pseudoscience Category and suggest that we remove it.

Pseudoscience cat page says: A system of theories or assertions about the natural world that claim or appear to be scientific but that, in fact, are not. ...generally considered pseudoscientific by the scientific community (such as astrology)...have very few followers and are obviously pseudoscientific (such as the modern belief in a flat Earth)...

I agree that Wilson's Syndrome and the article on it published in the PRHSJ do not meet the best and most rigorous standards of scientific evaluation, but I don't feel that particular shortcoming constitutes pseudoscience.

There are many things in everyday medical practice that are considered standard of care that do not meet the highest rigorous standards of scientific evaluation either.

Just above pseudoscience is standard of care. That's where a condition and its treatment stops having few followers and stops being considered by nearly every open-minded practitioner to be false, and starts having many reasonable practitioners with experience with the condition and treatment to agree and form a consensus that there is benefit. Standard of care extends all the way from there all the way through the highest rigors of scientific validation.

The U.S. medicine is regulated based on standard of care. The standard of care is based on "specifies appropriate treatment based on scientific evidence and collaboration between medical and/or psychological professionals involved in the treatment of a given condition." Medicolegally, standard of care is not determined just by "scientific evidence." Treatments can become A standard of care when there is a significant minority of like-minded professionals involved in the treatment of a given condition.

I feel that Wilson's Syndrome (WS) does not fit in the Pseudoscience category because:

An uncontrolled study was published in a medline medical journal. The editors of the journal found it sufficiently scientifically reasonable to publish it. These medical publishing professional didn't find it absurd enough for them to consider it pseudoscience and unworthy of publication.

WS has been taught at CME approved (scientific) medical conventions for over 15 years.

It is taught in the endocrinology (scientific) departments of all 4 accredited Naturopathic Schools in the US.

Well over 150 trained and experienced good faith physicians have signed a consensus statement to document their professional like-mindedness on the scientific validity of this condition and its treatment. The insurance, legal, and medical regulatory areas of our society recognize this as being sufficiently scientific to be a standard of care.

Therefore I don't feel that the category of Pseudoscience is appropriate for Wilson's Syndrome. I believe that the ATA statement adequately makes the point that Wilson's Syndrome does not meet the highest rigors of medical scientific validation. How can that point be made any more strongly? I don't feel the category of pseudoscience makes that point any more strongly because that is actually a different point, a point that is not accurate, and that, I feel, violates the Neutral Point of View principle of Wikipedia. I suggest we remove the Pseudoscience category. Best, MedBoard (talk) 03:04, 10 March 2009 (UTC)

I'll take the incentive and remove it from Category:Pseudoscience for now, until it can be more diligently assessed and (hopefully) categorized accordingly. The current standard for characterizing something as "pseudoscience" can be found at Wikipedia:NPOV#Pseudoscience_and_related_fringe_theories. Thanks for weighing in, and welcome to Wikipedia. ... Kenosis (talk) 03:40, 10 March 2009 (UTC)

I was thinking there had been a discussion somewhere about this, probably on the Fringe noticeboard, but I cannot find it and cannot be sure. I may be conflating different articles in my mind. My apologies, and if I find or remember the discussion I will certainly link it here.

My view: this is certainly fringe. It appears to me that anything which has the support of 150 physicians and one uncontrolled study of 11 patients can hardly be anything else. I see no science, yet this is presented as a medical condition. IMO, Pseudoscience applies. KillerChihuahua^?!? 04:34, 10 March 2009 (UTC)

Well, things come and go in Category:Pseudoscience. I wouldn't make too much of it for the moment. It can always be reinstated into that category. Better to research the available sources on it, try to determine what sources are reliable and what ones might not be, and proceed from there-- after which there'll be a record of the research associated with this page. If somebody feels very strongly about it, by all means revert. I might hazard a guess that many, perhaps even most, people today who rely on naturopathic approaches are fairly well accustomed to occasionally seeing their preferred therapeutic approaches referred as pseudoscience. So it's perhaps not of pressing importance from moment to moment-- though of course it'd be best to get it "right", i.e., consistent with WP:WEIGHT, WP:V#Reliable_sources and WP:RS, and any other pertinent policies. If the research methods involved are asserted by reliable sources to be unscientific while presenting themselves as scientific, then eventually it'll fall into the pseudoscience category; if not, then it won't; if it's in between then WP users will, I imagine, argue ad-nauseum and ad infinitum about it as we've seen in other instances. ... Kenosis (talk) 05:03, 10 March 2009 (UTC)

I tend to agree with Kenosis. My feeling is that Category:Pseudoscience should probably be reserved for things described unequivocally as such by reliable sources. Certainly this "syndrome" fits my personal definition of pseudoscience. On the other hand, I don't see Wilson's Syndrome described as pseudoscience per se by a reliable source. The dubious, implausible, and fringe status of Wilson's Syndrome can be conveyed amply with reference to reliable sources, and readers will draw their own conclusions - it seems a waste of time to argue about the categories.

Just FYI, though - in medicine, the standard of care is not defined by someone's claims making it into print in an obscure journal. It's defined by what expert physicians feel is appropriate in a given situation. Administering thyroid hormone to patients with demonstrably normal thyroid function, to treat vague collections of symptoms, while betraying a basic ignorance of temperature homeostasis, is likely outside most definitions of the standard of care. If a patient suffers adverse effects from thyroid hormone prescribed for dubious indications, then the prescribing physician could certainly face some uncomfortable questions about his/her judgment from a lawyer or from the state medical board. I'm OK with removing Category:Pseudoscience, on grounds of Wikipedia policy. I'm not really OK with passing this off as part of standard of care. MastCell ^Talk 05:08, 10 March 2009 (UTC)

Wow, I really am impressed with the civility, speed, care, wisdom, and professionalism you all are demonstrating here. It is clear you have your own strong opinions on the validity of WS and yet you consider the perspectives of and potential benefits to other visitors to the article, and uphold the policies of the Wikipedia project. I know it's business as usual for you, but still, it makes for a neat place.

150 physicians is a statistically insignificant number, but it is not a legally insignificant number. WS isn't part of the standard of care, as in the majority, it is a standard of care, as in a significant minority. The number that constitutes a significant minority is a matter of judgment but can be surprisingly small. There is a verifiable legal opinion on the WS website that holds that this number has been met. 150 physicians is just the verifiable number. There are many thousands of physicians that use T3 in the treatment of WS every day, and have for many years (unsourced, and not verifiable). As MastCell points out, the standard of care is defined by the opinions of experts. There are experts both for and against, with a judgment made by someone(s) in authority. Standard of care judgments can vary widely from state to state, and from board to board (for example, allopathic board vs. naturopathic board, or holistic medical board). Just as MastCell points out that there are experts that would feel that the treatment of WS is not indicated and inappropriate in every case, and that there are lawyers and boards that would ask physicians difficult questions; there are also experts that would say that thyroid blood tests are not conclusive and that a therapeutic trial of thyroid medicine for thyroid symptoms (which are a collection of numerous vague symptoms) based on body temperature is quite reasonable.

To be sure people have reported adverse reactions to T3 therapy as some have to many other treatments. It sounds as though you that have weighed in here have not seen or spoken with (verification) a person who has responded well to T3 therapy, which is totally understandable. That's what published articles are for, and that's also what verifiable consensuses are for. There are physicians who have actually treated patients with T3 and seen good results. An expert is someone that has special skill, knowledge (or authority), frequently gained by experience or practice. Treating WS is not easy and it is not wildly lucrative (because it is so time intensive). There is a group of physicians that treat WS because of the results they believe they are seeing. This year will be the 7th annual Restorative Medicine Conference for proponents of, among other things, WS. These are CME approved conferences and you might be amazed at the quality of the science presented there. Some attendees say that they are the highest quality meetings they have ever attended. The Restorative medicine conference is usually well-attended with over 100 attendees, and has become one of the largest annual alternative medicine conferences. We are concerned here with opinions, opinions of experts, contributors, editors, administrators, and visitors. It doesn't sound as if you weighing in here have attended a Restorative Medicine Conference but I do believe that if you could see and hear for yourselves the quality and tone of the presentations you would be pleasantly surprised and that your feelings and opinions might be influenced thereby.

By saying this, I'm not suggesting that WS be considered an "Alternative theoretical formulation," because I recognize that the WS point of view is currently in the vast minority. But I do feel that it qualifies as "Questionable science" according to the December of 2006 Arbitration Committee ruling on guidelines on the presentation of topics as pseudoscience in Wikipedia:Requests for arbitration/Pseudoscience. I don't feel the Pseudoscience category is accurate for WS. I do feel this article should be written to show the majority opinion as the majority opinion and the minority opinion as the minority opinion but with a Neutral Point of View. The minority opinion should be fairly and adequately represented, particularly since this is an article about the minority opinion WP:Weight.

Dr. Wilson is speaking this year on WS at the University of Bridgeport College of Naturopathic Medicine, the American Academy of Anit-Aging Medicine, and the Restorative Medicine Conference. As you know Continuing Medical Education (CME) approval has standards (such as approved presentations must not have commercial content and must disclose financial interests). No, none of this means that WS is meeting the highest scientific scrutiny but it is not being done in a corner.

Best regards, MedBoard2 (talk) 16:30, 10 March 2009 (UTC)

By the way, something unusual just happened. I went to log in and the login page wouldn't recognize my password, and when I clicked "email a new password" it said it didn't have an email on file for my username, maybe I didn't enter one. So I had to create a new account. — Preceding unsigned comment added by MedBoard2 (talk • contribs) 18:37, 10 March 2009

Free speech

Some people believe that they have the right to restrict freedom of speech, and this is interfering with other people's health. It would be considerate and professional if people would keep their opinion to themselves unless they are adding something positive to a discussion in an area where they can provide references that indicate your opinion is based on unbiased research, personal experience, or a diploma from an accredited institution that qualifies you to render an opinion on a topic. — Preceding unsigned comment added by Nanoatzin (talk • contribs) 00:09, 28 January 2011 (UTC)

You may wish to read WP:NOTFREESPEECH and WP:RIGHTGREATWRONGS. If you are unhappy about the status of naturopathic medicine in the State of Florida, contacting politicians in Florida will be more appropriate than complaining about it here. WhatamIdoing (talk) 02:25, 28 January 2011 (UTC)

Blessings and thank you for the considerate reply. Doctor Wilson raises an interesting point that low body temperature means something entirely different than facts accepted as common medical knowledge. Sustained low body temperature in the absence of thyroid disease is interpreted by MDs as indicating people have a short time to live (i.e.: time to call the priest for last rights). While it is rare, sustained low body temperature without thyroid disease is not a death sentence. My first concern is that the Medical Board of Florida has made research, diagnosis, and treatment of Wilson's Syndrome illegal in Florida, which is where Doctor Wilson lives, and that outcome is based on one fatality that would not otherwise be considered all that unusual given the accepted medical facts regarding low body temperature. The Medical Board of Florida lacks a physician with a degree from an institution that would make that organization competent to render an opinion on this topic. The scope of a regulatory organization is law and not medicine. My other concern is that discussions about almost every rare disease disappears down a censorship rabbit hole that starts with a reference from Quackwatch, and Quackwatch has indicated that lack of research information on a topic is a valid reason to stop everybody else from discussing that topic. Attempts by an organization to limit the growth of knowledge by hindering free speech on any topic would render that organization not suitable as a reference for an encyclopedia if that activity is related to a conflict of interest. The only way Quackwatch would be free from a conflict of interest on this topic would be if the organization includes a naturopath, which it does not. 207.233.106.102 (talk) 04:33, 28 January 2011 (UTC)

Action against Wilson

per Stephen Barrett, M.D. on website Quackwatch.org: "In 1992, the Florida Board of Medicine fined Wilson $10,000, suspended his license for six months, and ordered him to undergo psychological testing [2]. Although he does not appear to have resumed practice, his ideas are still promoted by the Wilson's Syndrome Foundation."

This strikes me as information that should be included in the article; it is highly significant and should be easily confirmed with other source material.

The language describing the debunking by the American Thyroid Association may also be unnecessarily weak for NPOV. wcf Facts are stubborn. Comments? 17:21, 2 April 2009 (UTC)

I've taken a shot at incorporating some of this material, which is relevant, while regarding the sources. I'm open to rephrasing the ATA bit if you have a suggestion. MastCell ^Talk 21:17, 2 April 2009 (UTC)

I agree with wcf and MastCell that information about the discipline is relevant. I also agree with wcf that the accuracy of the information is easily evaluated using other sources, such as the original consent agreement between the state of Florida and Dr. Wilson which is available to the public.

There are different forms of discipline that a board may take to resolve disputes with a practitioner’s practice of medicine. Some may be decisions or judgments made by the board before or after a trial, another can be an agreement that both sides consent to in order to, among other things, avoid a trial.

In this case, the discipline was a consent agreement. It was agreed to and signed by both Dr. Wilson and the State of Florida, not just the State of Florida. The agreement provided that the State would not seek further redress for the matters at hand and that Dr. Wilson would not pursue any further procedural steps, seek judicial review, or contest the validity of the agreement. Both sides agreed to pay their own legal fees.

The agreement shows that other doctors complained to the board that Dr. Wilson was not practicing in accordance with mainstream medical thinking. Another concern was Dr. Wilson’s use of advertising. The patient who suffered the M.I. while not taking the medicine as prescribed was not the major thrust of the agreement as Quackwatch and the current revision imply. The consent agreement states that an autopsy revealed that the “cause of death was acute myocardial infarction due to arteriosclerotic cardiovascular disease” with no mention of thyroid hormone. It was not determined that the cause of death was or was not related to the hormone Wilson prescribed. For one, it did not go to trial and so judgments and determinations based on opinions were not made. For two, there would be no way to prove such opinions in any case, either way.

In the consent agreement it was agreed that in order to resume practice after a 6 month suspension Dr. Wilson would need to attend 100 hours of CME, submit to psychological testing, pay a $10,000 fine, and not prescribe any thyroid medicine to anyone unless and until the Board of Medicine determines that the medical community has accepted “Wilson’s Syndrome” and Dr. Wilson’s methods and modalities of treatment. A legal opinion on the WTS website suggests that with the WTS Consensus Statement, sufficient acceptance by the medical community has been reached to make WTS treatment at least one standard of care.

Considering that the original document, the Consent Agreement itself is available to the public, it seems best to avoid unnecessarily linking to a third party like Quackwatch (especially when doing so might be considered linking to external harassment … WP:LINKLOVE). Also, the bulk of the reference in the Handbook of Nutrition and Food is the same material from the Quackwatch site word for word. This might be a little like WP:CS / Over-referencing and impedes readability. It might also be analogous to sock-puppeting (WP:SOCK), having two references to essentially the same material.

WP:RS might be an issue also. Googling “stephen barrett m.d.” brings up sites that make accusations about his background and credibility (which may or may not be true). In any case, the references are just not necessary.

The ATA has about 1,000 members. Ostensibly, they are a group of physicians that represent the mainstream medical interpretation of the medical literature. They represent a well-established and influential body of opinion but they are not a regulatory body (except membership to their own association, of course). I feel the opinion of the ATA is relevant and credible representation of mainstream thinking. Though they do not support the existence of WTS, their statement is quite clear both in what it does say and in what it does not say. They did not use the word “implausible” and I feel that the word “unwarranted” better reflects the spirit and tone of the ATA statement.

Making the same point more than once, analogous to over-referencing, impedes readability and also might start to sound a little like bias. For example, in this article, the point is made twice that Dr. Wilson named the syndrome after himself. Now, it makes the point that WTS is outside mainstream medicine (first, by saying it’s alternative, second by saying it’s not mainstream). We could decide which of those versions make the point more clearly and go with that. It’s either alternative, or it’s not mainstream, but to say both might be a little repetitive. I’m not going to change that though.MedBoard2 (talk) 02:31, 4 April 2009 (UTC)

Saying that a "Patient death lead to suspension of Wilson's medical license" is an unverifiable opinion that does not accurately and fairly represent the actions of the board, in context, with a neutral point of view WP:POV. The statement above implies that the Florida Board of Medicine suspended Dr. Wilson's license, when actually, it would be more accurate to say that the Florida Board of Medicine and Dr. Wilson suspended Dr. Wilson's license because it was accomplished by way of a consent agreement. This action was an agreement entered into between the Board and Dr. Wilson that would adequately satisfy the interests of both sides while limiting further costs on both sides. That's what consent agreements are for.

One of the key benefits that the consent agreement affords both sides is freedom from the kind of adjudication implied in the statement above. There is no adjudication because this matter never went to trial. It wasn't determined, or judged, that the death was caused by Dr. Wilson's treatment because it didn't go to trial. What the consent agreement does show is that the Board and Dr. Wilson agreed that by virtue of his license being from the state of Florida that he was subject to the state's regulation of the practice of medicine and that the way he was practicing was outside the state's current standard of care. No where in the consent agreement did the Board allege that Dr. Wilson's treatment of the patient caused her death. And the autopsy showed her myocardial infarction was due to atherosclerosis, without mention of thyroid hormone. Her case was listed as one example of several of how Dr. Wilson's treatment was outside the standard of care, and no more prominence was given to her case than was given to any other. Yes, the consent agreement did mention the death so it is reasonable to retain mention of it in the present article as it has been. To say that it was the patient death that lead to the suspension is misleading and unbalanced. Practicing outside the standard of care he was licensed to practice is why Dr. Wilson and the Board agreed to the suspension. And the Board also specifically agreed that Dr. Wilson could not continue the use of his methods "unless and until the Board of Medicine determines that the medical community has accepted "Wilson's Syndrome" and the methods and modalities of [Dr. Wilson's] treatment." So we see, it wasn't primarily about the death, it was about the current standard of care. MedBoard2 (talk) 04:21, 22 February 2011 (UTC)

I don't think so. "X lead to Y" does not imply the entire path.

Here's what one reliable source says:

In 1991, a 50-year-old woman died after T3 prescribed by Wilson had caused rapid heartbeat that led to a heart attack. The patient's daughter filed a malpractice suit, which was settled out of court for $250,000. In 1992, partly because of this case, the Florida Board of Medicine fined Wilson $10,000, suspended his license for six months, and ordered him to undergo psychological testing.

So the sources are saying that the board suspended his license. Your assertion is rather like saying 'I plea-bargained down to three years, so I'm not a convicted criminal: I volunteered to go to prison.' WhatamIdoing (talk) 06:35, 22 February 2011 (UTC)

Recent issues

I have a few issues with these edits by 67.8.163.26 (talk). First of all, I continue to feel that the American Thyroid Association and Quackwatch are reasonable external links. They are the among the only remotely appropriate independent, secondary sources on the topic and it is reasonable to link them.

One problem is that none of these sources are peer reviewed. They are merely the statements of well-credentialed, medical journalists. In particular, the guy at Mayo was too damned lazy to search pubmed.gov-and was writing after a peer reviewed article came out-which in my book excludes him as a "reliable source" in this matter. It places him the came of partisan folks that are actively ignoring the peer reviewed literature. None of them directly address the 2006 peer reviewed study by Friedman. The ATA has a reason-they were writing before that study came out(and it is clearly marked on their web page that their article hasn't been revised since that time). Quackwatch and the guy at Mayo don't have that excuse. They were simply being sloppy(both of those supposedly reliable sources have been edited since the 2006 peer reviewed study). The chronology of the present article is misleading on that point. Furthermore, none of these sources are reliable as representations of the range of opinion among the alternative medical community(which is important when we are discussing an item which is essentially a claim common within the alternative medical community). The AMA has strong influence over all these sources-and the AMA has lost court cases with respect to how the AMA directs its members to relate to chiropractors for example-which means that although the AMA may have credibility in the area of depicting scientific fact, it may not have credibility in reliably depicting rival organizations. Wilson was received well by some important members of the alternative medical community(i.e ACAM)-and criticized strongly by others. Folks like Ron Kennedy and John Lowe might not be considered as authoritative sources for determination of scientific fact. However, if the topic is what is the range of opinion within the alternative medical community, that needs to cite sources from within the alternative medical community(Lowe for example is recipient of numerous awards from Chiropractic organizations).

More to the point, I would like a bit more information about the "confession" by the deceased patient cited by the state medical board. Could the IP editor provide a link to an online version of the disciplinary report, so that we can independently verify the material in question? Failing that, could s/he please provide more detail - for example, what is the exact "direct quote" mentioned in the edit summary here? Who is being quoted, and in what context and to whom are they speaking? Since none of the secondary sources on the topic mention this item, I feel it's worth verifying per Wikipedia policy before inclusion, and so would welcome this sort of additional information. It's not my intention to exclude information, but I want to make sure we're accurately reporting it, and a more detailed context for the quoted "confession" would help. MastCell ^Talk 03:36, 8 April 2010 (UTC)

MastCell, I admire that it’s not your intention to exclude information, as well as your regard for Wikipedia policy, and your desire for accuracy.

The DPR’s findings with regard to Dr. Wilson are not online but they are verifiable by the public.

This is what the public DPR records have to say regarding your questions about the “direct quote”.

The context of the direct quote is that…”Comes now the …Department of Professional Regulation…and files this Administrative Complaint before the Board of Medicine….and alleges:” The complaint then goes on to allege the facts of the case from the DPR’s point of view that they felt demonstrated that Dr. Wilson was practicing outside the standard of care. In a section titled “Facts pertaining to Patient…”, they reviewed what they accepted as the facts of the patient’s care. The exact direct quote of one of the facts they listed was: “She confessed that she had not been taking the Cytomel as regularly as prescribed.” It is the DPR that is being quoted in the direct quote and they are speaking to the Board of Medicine. However, this fact did not prevent the DPR from filing this complaint that Dr. Wilson was practicing outside the standard of care.

As discussed on this talk page previously, the DPR did not find that the T3 prescribed by Dr. Wilson did or did not result in the patient’s death because it did not go to trial and, in any case, it could not have been proven either way. They did find that the treatment he prescribed was outside the current standard of care and that the patient was not complying with the treatment he prescribed for her. If it is relevant that a woman died while taking medicine that Dr. Wilson prescribed for her and that the treatment he prescribed for her was outside the current standard of care, and I think that is relevant, then it is also relevant that she was not following the treatment plan he prescribed for her. The DPR felt it was relevant to include it as a fact in the case so it would not be representative of the facts of the case to exclude it here.

When you say you continue to feel that the ATA and Quackwatch are reasonable external links, I get the feeling that you have not been fully satisfied these past months that this article has had sufficient weight on the majority point of view. It appears that someone also felt there was not sufficient weight on the minority point of view. I note in history that this article has remained largely unchanged for about 8 months, demonstrating a lot of patience on your part. Then, an editor added a link to the free online Doctor’s Manual that explains the details of the WTS protocol. I can see how you might have felt that was in violation of WP:Weight/Undo Weight, upsetting the balance of weight, giving too much weight to the minority view at the expense of the majority view. Your edit summary on that undo listed WP:ELNO and I’m guessing you meant item #2 (on WP:ELNO page) since there is already a link to the WTS website, and the Doctor’s Manual can be navigated to from there. Undoing the link restored the balance that’s existed but you also added a “Disciplinary Action” subheading; removed the reference to the patient confessing to not taking the medicine as regularly prescribed; and added External links to the ATA statement, and Quackwatch.

It appears to me that you want it to be clear that the minority opinion is represented as the minority opinion and Wikipedia policy certainly supports you in that, as do I. WP:Weight explains that neutrality requires that the article should fairly represent all significant viewpoints that have been published by reliable sources. In this case, the significant viewpoints are that of the DPR (Department of Professional Regulation of Florida, the ATA (American Thyroid Association), and WTS (Wilson’s Syndrome proponents).

For years, there has been a link to the ATA website in the References. It has been occupying the first reference link cited, in keeping with it representing the majority point of view. WP:Weight states “In articles specifically about a minority viewpoint, it is appropriate to give the viewpoint more attention and space. However, such pages should make appropriate reference to the majority viewpoint wherever relevant.” The ATA reference is already cited twice in relevant and prominent areas of the copy making it clear that Wilson’s Syndrome is in fact a minority view.

Since this article is specifically about a minority viewpoint, and more attention and space is appropriate, what resource best represents the minority viewpoint? What resource most clearly elucidates the minority viewpoint? It is the Doctor’s Manual, which details the treatment protocol. This might be why a recent editor sought to link to the Doctor’s Manual. Maybe it would be good to change the current link to the WTS website from the home page to the free online Doctor’s Manual. That wouldn’t take any more space. And if more attention and space is appropriate since the article is about the minority viewpoint, I’m sure WTS proponents would like to squeeze in a link to the opinion of a FDA and medical licensing attorney that assesses the use of T3 for WTS to now be within standard of care treatment, and perhaps, a link to Dr. Wilson’s rebuttal of the ATA statement. The attorney’s verifiable opinion of the consensus of a legally significant minority of like-minded physicians shows that the Pseudoscience category does not apply. Also, this article is written with the bulk of the WTS viewpoint expressed as "He says", as if the WTS viewpoint is held by only one person. That does not correctly represent the prevalence of this viewpoint in society. It is relevant that there is a legally significant constituency of like-minded physicians, verifiable through a licensed FDA attorney, and that Dr. Wilson verifiably speaks on WTS at medical conventions every year and that WTS is taught in endocrinology classes in naturopathic medical schools. By the way, Dr. Wilson is speaking at two naturopathic medical schools on the topic this coming June.

However, WP:External links cautions to “avoid undue weight on particular points of view.” “On articles with multiple points of view, avoid providing links too great in number or weight to one point of view…. Add comments to these links informing the reader of their point of view. If one point of view dominates informed opinion, that should be represented first.” Thus, if you really feel it is necessary to add an external link to the ATA then it could be listed first as the majority view and an external link to the Doctor’s Manual could be listed next as the minority view. This would satisfy WP:weight and WP:NPOV.

For example,

External links

• American Thyroid Association statement on Wilson’s syndrome. This is the majority viewpoint.

• Doctor’s Manual on Wilson’s Temperature Syndrome. This is the minority viewpoint.

What is the encyclopedic value of the Quackwatch link? The significant viewpoints are those of the DPR, ATA, and WTS (Wilson’s Temperature Syndrome proponents), which are clearly presented in their own verifiable sources. The DPR record is verifiable by the public, that’s why Quackwatch (QW) was able to quote from it. The QW link essentially just quotes the viewpoints of the DPR and WTS, found in the public DPR record and in Dr. Wilson’s book (which is available free online, not only that, but in some cases inaccurately. QW misquotes the DPR record on the year of the patient’s death. It also is inaccurate with regard to a 900 line it says is operated by Dr. Wilson. The WTS website describes free customer service and free consultations for physicians. There is no verification available that such a 900 support line as operated in the last 10 years. QW also uses “words to avoid” (“claims”, “bogus”) WP:Words to avoid. The QW link represents two significant viewpoints that better and more accurately speak for themselves.

In WP: Citation overkill it recommends “Where a fact can be established clearly by a single footnote, best practice is to stop there.” The DPR viewpoint is clearly established by the verifiable public record. There is no need for the QW link. And, if there is no need for the QW link, then there is also no need for reference 6 (The Handbook of Nutrition and Food), the bulk of which is the same material from the QW site, word for word. Thus, reference 6 is a quote of QW, which quotes the public record of the DPR. It’s circular.

Let's consider the sections and subsections in the article structure. WP:NPOV explains, “Unbiased writing is the disinterested description of all significant sides of a debate as published by those sources.” The proportion given to each POV should be in proportion to the prevalence of those POV’s in society (but more room might be afforded a minority viewpoint in articles primarily about the minority POV). In WP:NPOV>Achieving neutrality>Article Structure, it says “Segregation of text or other content into different regions or subsections, based solely on the apparent POV of the content itself, may result in an unencylopedic structure…. Be alert for arrangements of formatting, headers, footnotes, or other elements that may unduly favor one particular point of view.”

If you don’t want to split, Origins, claims, and disciplinary action into separate sections (since you undid that) like this:

1 Origins

2 Claims

3 Disciplinary action

4 Evaluations

5 References

And, if you don’t want to give each area its own subsection, like this:

1 Origins, claims, and disciplinary action

1.1 Origins

1.2 Claims

1.3 Disciplinary action

2 Evaluations

3 References

… then it would be more neutral to not add an extra subsection for Disciplinary Action alone, like this:

1 Origins, claims, and disciplinary action

1.1 Disciplinary action

2 Evaluations

3 References

because that creates an unencyclopedic structure, decreases readability, and adds undo weight because the redundancy of it “makes it difficult for a neutral reader to fairly and equally assess the credibility of all relevant and related viewpoints.” WP:NPOV says a more neutral approach is to leave the debate in the narrative, not the structure. If you don’t feel that Disciplinary Action belongs with Origins and Claims then it could be split out as a separate section, like this:

1 Origins and claims

2 Disciplinary action

3 Evaluations

4 References

But if you want “Disciplinary action” “above the fold” (on the screen when a user first arrives) then leaving it where it’s been might be preferable.

MastCell, it appears you have not been satisfied with the article as it has been for the last 8 months. I can appreciate that because I can also see how a WTS proponent would have reason not to have been satisfied with it as it has been either. Another example is that the word “claim” is the first example of words to avoid that is listed on WP:Words to avoid The word “claims” should be avoided in the article and certainly in a section heading. In this case, the word “claims” could be replaced with “assertions,” or “statements”. Thus, “Origins, assertions, and disciplinary action.”

I know that care must be taken to ensure that the minority view is represented as the minority view and that attributions do not give a false impression of parity, but neither should they endorse any particular point of view (WP:NPOV): “It should explain who believes what, and why, and which points of view are most common.” I believe the iteration that’s existed for 8 months accomplishes that, even though it does not satisfy all the proponents of either point of view, and that it is a little hard to live with for both sides.

Therefore, I am not proposing that the word “claims” be removed, or the reference to “Handbook of Nutrition and Food,” or the removal of the Pseudoscience category, or adding a link to the FDA attorney's opinion on the consensus statement, or adding a link to Dr. Wilson's rebuttal of the ATA Statement, or to edit the article to reflect that WTS has more verifiable proponents than one. Rather, I propose that we return to the balance we've accepted for the last 8 months or so.

Best regards )) MedBoard2 (talk) 20:08, 9 April 2010 (UTC)

From Wikipedia:Arbitration/Requests/Case/Transcendental Meditation movement/Proposed decision#Neutrality, verifiability and appropriate weight:

• "In deciding the appropriate weight to place upon a claim or viewpoint, it is its prevalence within reliable published sources that is important, not the prominence given to it by Wikipedians or the general public."

The St. Petersburg Times is a reliable published source and their article is relevant to this topic. It seems to me that it claims that members of the Board made particular statements, and that is reflected in the text of our article. If another reliable published source refuted that claim, then let's see it. It is not our job to discard sources because we don't believe that they are correct; we only report what reliable sources say. Since the mainstream view is that "Wilson's syndrome" has not been shown to exist, the article's scope quite properly includes information about Wilson, as that will be of interest for many readers. --RexxS (talk) 02:17, 27 May 2010 (UTC)

I appreciate your insight. You offered that I could present another reliable published source that refutes the claim that members of the Board made particular claims, and mentioned that is what is reflected in the text of our article. To me, the way the article is written now, the comments by members of the board are being attributed as statements of the board itself; and I feel that the Final Order of the Board refutes that claim. Whenever people possess authority given to them by government, associations, or other organizations, there is always a distinction between what those people do by way of that authority that they possess, and what they do as people outside that capacity. It's true that the title of the St. Pete Times attributes the comments of some of the members of the board to the board itself, but the Final Order doesn't contain those words or remarks. Would you feel that to be satisfactory evidence that "the board", in its official capacity, didn't describe WTS as a "sham", didn't accuse him of "fleecing" patients with a "phony diagnosis", and didn't say [Wilson's] syndrome doesn't exist outside the imagination of Dr. E. Denis Wilson?" Do you think it would be reasonable to change the wording of the article to reflect that these comments were made by "members of the board" (as opposed to by the board itself as an official body?) Or, do you mean one might need to find another reliable published source that says "in its official capacity, the Board of Medicine didn't say WS was a sham, phony diagnosis, or that Dr. Wilson was fleecing patients"? To me, leaving it as it is implies that the board conducted or evaluated scientific research done on the merits of the condition and found the syndrome and its treatment to be false. That would be misleading. The board found, rather, that no so such scientific work had yet been done to show that they were true (the same position of the ATA) and therefore that Dr. Wilson was practicing outside the standard of care, and specifically left the door open to future possible acceptance of the principles of the syndrome by the scientific community. Unproven is not the same thing as proven wrong. Best regards. MedBoard2 (talk) 15:20, 27 May 2010 (UTC)

Thank you for the clarification and I understand your concerns. I read a number of other Final Orders online while trying to establish whether the date of Wilson's Final Order was December 2 or February 12; and I must say they all seem to be very brief, and couched in rather formal (perhaps even legalistic) language. For that reason, I believe that the absence of anything other than a bare record of the decision in Wilson's case could not be used to draw any conclusions about the process used in reaching the decision. For what it's worth, I think you could look for a consensus to change the wording to something like "some members of the Board stated ...", since that, as a minimum, is demonstrably sourceable from the St Petersburg Times article. We actually don't know what source the reporter used – was it an interview with some members, or an official press release, etc. – so it is probably best not to speculate on that, but to try to reach a consensus with other editors on what most accurately represents the sources we have, in the absence of any others. Hope that helps. --RexxS (talk) 17:01, 27 May 2010 (UTC)

Yes, thanks RexxS that helps. The bare record of the decision in Wilson's case is available to the public but is not available online. My understanding is that a source doesn't need to be online to be verifiable. If the St. Pete article is going to be used, it would be great for it to have a little more context. "Some members of the Board stated..." would be more accurate, I feel. --MedBoard2 (talk) 18:52, 27 May 2010 (UTC)

Indeed, sources do not need to be online, but actually on Wikipedia, primary sources, such as the decision can only be used with caution because of the danger of misuse. Our priority is secondary sources. Based on the comments it appears that editors here may not have access to the full St Peterburg Times article. In case you don't here are the relevant parts of the article regarding the Board's comments. "The only trouble, say members of the Florida Board of Medicine, is that there is no evidence such a syndrome exists outside the imagination of Dr. E. Denis Wilson of Orlando. They say Wilson, a 1985 graduate of the University of South Florida College of Medicine in Tampa, is fleecing patients and insurers with treatments for a phony syndrome. "The reality is, he's scamming the public," Dr. Zachariah P. Zachariah, board chairman, said Friday. Even worse, board members said, is that Wilson's treatments are dangerous. .... Board members said their sympathy had to go to the people who paid Wilson $1,200 for a sham weight-loss program that could have killed them. "It looks as though you were exploiting the vulnerable," said Pamela Campbell, a St. Petersburg lawyer who serves as a consumer member on the board."

It's clear that at least some of these comments were addressed to Wilson as part of the decision making and giving process. I note however, that the opinions are ascribed to "members of the board" (or variations thereof) and that the "sham" part refers to the weight loss aspects specifically. It would be good to correct this, and perhaps expand the specific critiques given by the Florida Board of Medicine. PS I can send a copy of the St. P article to anybody who wishes. --Slp1 (talk) 22:55, 27 May 2010 (UTC)

Slp1, I agree with your recent edits in this regard. I can see that the passive voice of "by members of the Florida State Medical Board" is better replaced with the active voice of "Florida State Medical Board members". To me, "Florida State Medical Board members" sounds a little like "all Florida State Medical Board members," along the lines of "the Florida State Medical Board". So I propose, "Some Florida State Medical Board members described...". I don't think it weakens the value of the point at all, but I do feel it is more accurate and better supported by the reference. I suggest that we avoid the risk of being misleading especially when there's no need to take that risk. If, for some reason, anyone has a strong objection to "Some Florida State Board members" then I would propose "Members of the Florida State Medical Board described..." because I feel that would at least place a little more emphasis on the members who said it rather than the board that didn't. We do already have the official actions of the board as a whole prominently listed. --MedBoard2 (talk) 11:54, 28 May 2010 (UTC)

I'm glad you like the edits. As far as stating adding "some", this is not possible. We go with what our sources say and the two sources lump the views together as being those of board members as a whole (with a couple of persons named for the purposes of quotation) rather than attributed to "some" subsection of the board. As far as ""Members of the Florida State Medical Board" vs "Florida State Medical Board members", I'm ambivalent. The former is the formulation principally used by the sources, so maybe we should be using it, but I'm uncomfortable by the argument used here, which seems to be part of ongoing attempt to marginalize the remarks of board members which our secondary sources evidently saw as representing part of the official decision and determination. --Slp1 (talk) 12:19, 28 May 2010 (UTC)

I see your point. I support changing it to the former for the reason you give. --MedBoard2 (talk) 12:56, 28 May 2010 (UTC)

Third opinion

Bradv (talk · contribs) wants to offer a third opinion. To assist with the process, editors are requested to summarize the dispute in a short sentence below.

Viewpoint by (MedBoard2)

Please see discussion page edits and diffs since April 27. Do you feel the St. Pete Times reference usage is appropriate? Also, are we improving the neutrality of this article?

Viewpoint by (uninvolved) Rexxs

The article itself does not have to be neutral, only the way sources are presented has to be; and editors seem to be in dispute over the weight to be given to different reliable sources and the precise way in which they are presented.

Viewpoint by (name here)

....

Third opinion by Bradv

....

Sustained-release T3

I haven't been able to find patients treated with Sustained-release triiodothyronine (T3) in the literature prior to Dr. Wilson using it and describing its use in the 1991 Doctor's Manual. Since then, The New England Journal of Medicine mentioned "The ideal replacement regimen when thyroid-gland function is absent or nearly absent might consist of 10 µg of triiodothyronine daily in sustained-release form (because the hormone is rapidly absorbed and metabolized), along with enough thyroxine to ensure euthyroidism." And, the ATA is mentioning a study reported in the journal "Thyroid" in 2004 concluded that a sustained-release preparation of T3 results in less variation in Serum T3 concentrations than ingestion of standard T3. The NEJM and the ATA do not agree with it being used in patients with normal thyroid gland function but report advantages in using SR T3 over standard T3 in certain circumstances. MedBoard2 (talk) 21:23, 10 April 2010 (UTC)

That's the problem with cherry-picking the medical literature. You cite one trial from 11 years ago which suggested a potential benefit to partial T3 replacement. In fact, there have been at least 6 subsequent randomized trials attempting to reproduce the NEJM findings - all of which were unsuccessful (cf. PMID 14557419, PMID 14557420, PMID 14665656, PMID 15163340, PMID 15767619, PMID 15585551). There have also been at least 2 meta-analyses addressing the question, both of which found no benefit to T3 (PMID 16670166, PMID 15928247). The current medical understanding is that there is no advantage to T3 therapy in the general population, although there is some interest in studying a small subgroup of hypothyroid patients with a specific genetic polymorphism who might hypothetically respond well.

As to "sustained-release" T3, I'm not entirely clear what you're talking about. The only form of T3 that is approved as safe and effective, at least in the US, is liothyronine, which has a half-life of approximately 2.5 days. I'm aware that some compounding pharmacies will jerry-rig formulations of T3 which they describe as "sustained-release", but I'm not aware of any medical literature supporting such a concept, or even supporting the idea that such formulations are released any differently than liothyronine. If know of such data, please point me in the right direction. MastCell ^Talk 07:08, 11 April 2010 (UTC)

Yes, I cited that reference to show that some see a potential advantage of sustained-release T3 over standard T3. In 1991 Dr. Wilson described (in the Doctor's Manual) using T3 compounded, by a pharmacist, with Hydroxypropyl methylcellulose (HPMC) into a hydrophilic matrix system. As I'm sure you know, drug manufacturing is regulated by the FDA, and compounding is regulated by state boards of pharmacy. It is within the legal scope of a pharmacist's profession to make (compound) a medicine according to a doctor's prescription. Of course, that doesn't mean that pharmacists always do a good job of making medicines but it is within their regulated scope of practice. The article quoted by the ATA above is "Thyroxine Plus Low-Dose, Slow-Release Triiodothyronine Replacement in Hypothyroidism: Proof of Principle" Thyroid 2004;14:271-5. They note in the introduction that studies comparing the effects of giving T4 alone versus a fixed T4/T3 combination have showed different results, as you point out. They quote 2 editorials calling for studies to solve the discrepant findings (with one recommendation being the use of T3 in a sustained release manner). In the present study, they used an "in-house slow-release preparation and using Cytomel® as T3 compound." I believe this article supports the concept that compounded T3 preparations can release T3 differently than standard liothyronine. Also, an article "Bioavailability of ibuprofen from hard gelatin capsules containing different viscosity grades of hydroxypropylmethylcellulose and sodium carboxymethylcellulose" (European Journal of Pharmaceutical Sciences Volume 1, Issue 2, June 1993, Pages 109-114) showed that the ibuprofen in capsule with one of the grades of HPMC showed marked sustained drug absorption. Here, Hypromellose (HPMC), it says that HPMC (depending on the grade) has been used in oral tablet and capsule formulations as a "controlled release agent to delay the release of a medicinal compound into the digestive tract." The Dow Chemical company says that "Hypromellose has familiar, well-understood properties. Of the available range of cullulosic controlled-release agents, hypromellose is the most widely used."--MedBoard2 (talk) 22:07, 12 April 2010 (UTC)

I think you missed MastCell's point, which the pharmacologically savvy will understand, that there is absolutely no point in making a "sustained release" preparation for a drug or hormone which already has a biological half-life of more than two days, and a very large volume of distribution. Whether you absorb T3 in 2 hours or 8 hours (you aren't going to get more from simple HPMC), it all goes onto your body's reservoir of albumen and transthyretin, and is stored there. There's no reason to think that the duration of release would make any difference in a substance with those kinetics. SBHarris 01:05, 27 May 2010 (UTC)

Cause of the Symptoms

The lead of this article is quoting what Dr. Wilson and WTS advocates attribute the cause of the symptoms. Notice how low body temperature is not listed as a symptom on the symptom checklist. Advocates do not think of low body temperatures as a symptom but as part of the pathophysiological mechanism (it's Wilson's Temperature Syndrome). On page 26 of the Doctor's Manual it states that the symptoms are attributed to low body temperatures due to impaired peripheral conversion of T4 to T3. The bottom of that page states: "Wilson's Temperature Syndrome can be thought of as a persistent, maladaptive, stress-related, reversible impairment in the conversion of T4 to T3." On page 41 is states, "More than just a reflection of metabolic rate, I feel the body temperature, through enzyme conformation, actually mediates the symptoms of Wilson's Temperature Syndrome." —Preceding unsigned comment added by MedBoard2MedBoard2 (talk) 22:49, 10 April 2010 (UTC)

in response to those who doubt wilsons syndrome as a real disorder i would like to offer my experience. i was diagnosed by my physician after complaints of being cold, lethargic etc. after monitoring my temp for 3 weeks i began a regiman of the thyroid hormone used. i have to say after 3 rounds of taking it that i finally achieved a stable temp and the other symptoms disappeared. that was 5 years ago. i have not had any return of any signs and symptoms since. im also currently a nursing student going for my nurse practioners license just to add a slight bit of credibility to naysayers.....its is a real disease and the treatment worked wonders for my body and my life. i am living testimony that IT IS real and TREATABLE. —Preceding unsigned comment added by 98.117.185.79 (talk) 02:01, 21 April 2010 (UTC)

Representing majority and significant-minority views fairly

NPOV (WP:Neutral Point of View) involves presenting each POV accurately and in context, and not presenting any point of view as “the truth” or “the best view”. The nutshell of the NPOV page states that articles must represent all majority and significant-minority views fairly, proportionately, and in a disinterested tone.

I don’t feel the current version of the article is representing the majority view or the significant-minority view accurately, fairly, in context, and with a disinterested tone.

Mast Cell, I believe you were making a point of the importance of keeping things in context when you pointed out the problem with cherry-picking the medical literature. You pointed out how I cited a trial from 11 years ago when there have been a lot of studies since then which I did not mention. I think you made a good point that it’s problematic to point to a past viewpoint and represent it as if it is a current viewpoint.

Let’s take a look at past and current viewpoints.

The final order of the Board of Medicine with regard to Dr. Wilson was in Feb of 1992, over 18 years ago. There was no mention of Dr. Wilson’s book in the proceedings. The thorough version of the Doctor’s Manual didn’t exist until 1995. There was no web site then, the internet was barely getting started. There were no other doctors using Dr. Wilson’s methods so there was no significant-minority of like-minded practitioners to call upon. It’s not accurate to imply that the Board of Medicine did a thorough review of Dr. Wilson’s ideas and rationale and evaluated and tested their merit and rendered a judgment on the matter; first, because that is not their job, second, the matter did not go to a trial therefore the process ended before the point Dr. Wilson would have given the board a thorough review of his ideas and rationale. The Board of Medicine did review the treatment Dr. Wilson documented on his patients and they found that he was practicing outside the standard of care. They further found that Dr. Wilson could not produce substantiation (by way of scientific studies or medical experts) that he was practicing within the standard of care. That being the case, both sides entered into a consent agreement with neither side admitting any wrong doing (it says that in the document) and avoided a costly trial. In the consent agreement, both sides agreed that Dr. Wilson would not prescribe any thyroid medicine to anyone unless and until the Board of Medicine determined that the medical community has accepted “Wilson’s Syndrome” and Wilson’s methods and modalities of treatment. The official position of the Board specifically left open the possibility that at some later date that Dr. Wilson’s methods and modalities might gain some acceptance in the medical community. The Board did not find that such a development would not be possible because they had not made an evaluation or judgment on that point.

It’s understandable why a member of the board might make an off the record comment to a reporter about it being a “sham,” and that these things only existed in the imagination of Dr. Wilson, because they did. The Board referenced no books, no website, no studies, no experts; the key here being no studies and no experts. Nevertheless, an off-the-record comment to a reporter does not represent the carefully crafted official position of the majority view. The official proceedings speak for themselves. That’s what on-the-record official positions are for. The discipline from the board speaks for itself. Note that his license was not revoked but suspended for 6 months, and that the discipline was imposed only after Dr. Wilson agreed to it. It was an agreement, not a trial.

The current version of this article states that “The Board of Medicine accused Dr. Wilson of fleecing patients with a phony diagnosis. Members of the Board might have made off-the-record comments to a reporter after a meeting, but the Board of Medicine makes no accusations. They hear allegations presented by the Department of Professional Regulation and in this case negotiated a settlement with Dr. Wilson on the matter. The Final Order on the matter does not mention the words “sham”, “fleecing”, and “phony diagnosis”. The “Board of Medicine” should not be quoted as saying something they did not say as an official body. That would be out of context. “Sham,” “fleecing,” and “phony” are words that could be used to mean “unproven,” but probably more people would take those words to mean “proven false” which was not the case. That could be why those words were not used in the official statement. WP:Words to Watch warns against using words like “claim” that can carry non-neutral implications. And WP:NPOV involves presenting each POV accurately and in context, and not presenting any point of view as “the truth” or “the best view”.

18 years ago, the official majority opinion was that there was no scientific evidence in the medical literature to support Dr. Wilson’s methods and modalities of treatment. That made sense because Dr. Wilson was the only one using those methods and he alone constituted the minority viewpoint. Since then, the majority viewpoint and the minority viewpoint have changed. The ATA statement on Wilson’s Syndrome mentions “advocates of Wilson’s syndrome,” acknowledging that these views are no longer held by Dr. Wilson alone. Though the ATA statement on Wilson’s Syndrome attributes the origin of “Wilson’s Syndrome” to Dr. Wilson, their arguments against the validity of the ideas do not involve references to disciplinary actions or events surrounding Dr. Wilson as a practitioner. I imagine it’s because they do not consider ad hominem reasoning (Person 1 makes claim X; There is something objectionable about Person 1; Therefore claim X is false) to be particularly scientific. The Mayo Clinic also refers to “Proponents of Wilson’s Syndrome”, and also makes no reference to Dr. Wilson as a practitioner. The current majority viewpoint is that “Wilson’s Syndrome” is about a number of proponents using unproven therapies for a medically unrecognized diagnostic label that is not substantiated by rigorous testing through properly designed clinical trials. Also, WP:Policies and Guidelines explain that articles should stay within their scope. This article is about Wilson’s Syndrome, not Dr. Wilson.

After the Consent Agreement with the Board of Medicine, Dr. Wilson began speaking about Wilson’s Syndrome at CME-approved medical conventions. He also documented the T3 protocol in full detail in the Doctor’s Manual so that other doctors would be able to use it to treat their patients. There are many doctors on the list of physicians on the website and many more that have signed a consensus statement agreeing with the principles of the T3 protocol. An attorney that specializes in FDA matters is of the opinion that the use of the T3 protocol has reached a critical mass of supporters sufficient to constitute a significant minority of like-minded practitioners and make the T3 protocol a standard of care. One way to establish standard of care is through published studies in medical journals, and another way is through a significant minority of like-minded practitioners. The current version of this article presents the minority view with an inaccurate proportion upon Dr. Wilson and not enough mention of other proponents.

Thus, it is inaccurate to take out of context depictions of the majority view of the past and to take the minority view of the past and portray them by way of proportion and emphasis as if they are the current majority and minority views.

NPOV, one of the five pillars of WP, states “We strive for articles that advocate no single point of view. Sometimes this requires representing multiple points of view, presenting each point of view accurately and in context, and not presenting any point of view as “the truth” or “the best view”. We can state the majority view as the majority view and the significant-minority view as the significant-minority view. MedBoard2 (talk) 23:14, 27 April 2010 (UTC)

That is a bit much to tackle all at once, so I'll start with the basics. Your edits removed a reliable source dealing directly with the topic (namely, the article from the St. Petersburg Times). Your edit also added material from a source which I believe is unencyclopedic and fails this site's sourcing policies. Both aspects make the article poorer. I will go into more detail once I have time to fully digest your argument, but for now, the Times article is entitled "Doctor's syndrome a sham, board says". Our article reflects the content of that reliable source. I don't see any similarly reliable independent, fact-checked, third-party sources that have appeared in the intervening years to contradict that assessment - certainly the Board left the door open for medical science to corroborate Wilson's claims, but I see no reliably sourced evidence that such corroboration has occurred. Let's start with the best available sources on the topic, and follow where they lead - that's the gist of this site's policies and expectations. MastCell ^Talk 03:09, 28 April 2010 (UTC)

Hi MastCell, "sham" could be used to mean "unproven". And some might use the word "fleecing" to describe anyone that sees a potential benefit in using an unproven treatment. However, before any treatment was proven, it was unproven, and it was no less effective when it was unproven than it was when it was proven. Sometimes words like sham and fleecing can have non-neutral implications. In this article I feel those words are being used to mean "evaluated/ considered/tested and proven wrong". That's what WP:W2W is all about, words with ambiguous meanings that can have non-neutral connotations. Unproven is unproven, "sham" or "fleecing" are non-neutral. In no way were Dr. Wilson's ideas, as we have them today, evaluated, considered, or tested because they weren't even presented...the process never got that far and that really wasn't what the process was about. The DPR alleged Dr. Wilson was practicing outside the standard of care, he had no proof he wasn't, consent agreement, case closed. It wasn't about evaluating and testing his theories, it was about whether he knew any experts that agreed with him, and he didn't. Notice that the ATA and Mayo clinic don't use the word sham or fleece, they use appropriately neutral phrases like "found no scientific support for," perfect. Your use of this reference seems a little like using a "Get out of jail free card". It's like breaking the WP policies without breaking WP policies because you didn't say it. It still seems like bad form and not best for the value of the article and Wikipedia.

The majority view (as voiced by the ATA and Mayo Clinic) or significant minority view on Wilson's syndrome do not focus on, rely on for strength, or even make reference to events surrounding Dr. Wilson as an individual practitioner over 18 years ago when he did not have the means (writings) to communicate his ideas on Wilson's Syndrome in much detail and when he was the only one doing it (no experts). Therefore, this source is not necessary or relevant. The way you are using this St. Pete Times reference (juxtaposition, weight) suggests that the Board of Medicine's point of view from 18 years ago in dealing with a doctor who presented no defense, no detail, no book, no manual, no website, no invitations to speak on the topic at CME medical conventions, no constituency of like-minded practitioners, and no experts is somehow part of the majority point of view of today. It is not, even by your own sources. To imply that it is is to take it 18 years out of context.

I noticed your comment in the thread How can Quackwatch be considered a reliable source?. You mentioned that you and other Wikipedians try to be fairly careful and circumspect about Quackwatch as a source. The consensus on that thread is that there is no RS that's allowable in every situation, so context is important. There is no source that's automatically reliable but must be considered on a case by case basis. Why do you feel that Quackwatch is a reliable source in this case when I have already pointed out to you two verifiable inaccuracies on the page your are linking to? Quackwatch might have some reputation for fact checking in general, but in this case, the year of the woman's death is inaccurate (the correct date is in the Final order) and it is not verifiably correct that Dr. Wilson operates a 900 number. If he operates a 900 number why is it that no one at the company knows about it? What is the 900 number? What was it? When was it? Over 10 years ago? Is it that you feel comfortable with QW as a source because you're not quoting anything about the year or the 900 number but just quoting the word "bogus"? Do you feel it improves the quality of this article and Wikipedia to send people to a source on the subject that has at least 2 inaccuracies in one of the only two paragraphs there? Make that 3: there is no "Wilson's Syndrome Foundation." MedBoard2 (talk) 21:51, 28 April 2010 (UTC)

This article could use more impartial eyes so I will initiate dispute resolution since no Third Opinion has been given. MedBoard2 (talk) 15:28, 25 May 2010 (UTC)

I'm sorry, but I see no policy-based rationale for removing one of the few independent, reliable secondary sources dealing directly with Wilson's syndrome. I am not comfortable with excluding this source - which according to Wikipedia's content policies should be valuable in providing an honest overview of the topic. If there are other independent, reliable secondary sources which you feel would add to the article's quality, then please present them for discussion.

Quackwatch is marginal as a source, and we do not rely on it heavily in this article. Nonetheless, despite its weaknesses, it is reasonable to at least mention its viewpoint, with in-line attribution, given the principle of parity of sources. We cite poor-quality sources in the article (wilsonssyndrome.com, for example) where they are promotional or favorable toward Wilson's syndrome; it seems improper to set a much higher bar for sourcing material which fails to promote Wilson's syndrome. MastCell ^Talk 21:50, 25 May 2010 (UTC)

Hi MastCell, it's nice for us to have a little more company here, isn't it? :) Somehow, it's increased my appreciation for the time we've spent working together on this article. I do assume good faith in you and I can easily picture you as an intelligent and honorable person wanting to do what's best for WP, and other people. I like to picture myself as trying to help WP and others too. I think it might be our backgrounds and experiences and points of view that give us different opinions about what is most helpful to WP and other people. That's what policies are for, I suppose. I know that you are sensitive to the significance of time and sequence and context. You once pointed out to me how problematic "cherry picking" is when I referenced a journal article without mentioning a number of articles that had been published since, for example. That's why I was wondering why you removed the year the uncontrolled study was done (2006) seeing it as an "attempt to undermine" (apparently the ATA ref)? I've never seen you take such a stance before. It seems you normally feel that facts are facts and if they undermine they undermine and if they don't they don't. Earlier in this section, you seemed to see significance in time and sequence saying "I don't see any similarly reliable independent, fact-checked, third-party sources that have appeared in the intervening years to contradict that assessment - certainly the Board left the door open for medical science to corroborate Wilson's claims, but I see no reliably sourced evidence that such corroboration has occurred." As much as I believe you to be a proponent of time and sequence, I was wondering why you don't see any encyclopedic value to a neutral reader of the fact that the ATA statement that found no scientific evidence supporting WTS was last updated in 2005 and that the peer reviewed uncontrolled study was published in 2006? I presume it's because you are sure that if the ATA reviewed the 2006 article they'd still find no scientific evidence supporting WTS. In the "Recent Issues" section of this page, you seemed understandably disappointed that the Mayo clinic writer didn't address the 2006 peer reviewed article that came out after the 2005 ATA update, when he could have. If he had, you would have been able to cite him as representing the majority view that, in spite of the 2006 peer reviewed article, there is still no scientific support for WTS. But he didn't. So can you now gain the same benefit you would have had and deal with the "lazy" Mayo writer's "sloppy" oversight by simply reverting "2006 uncontrolled study" to "uncontrolled study" and keeping "2006" off the page? I've gathered from you (paraphrasing) "if you have an independent, secondary, reliable source that says so then post so, but before that we'll wait and see." Why then would you not be content to wait until the ATA updates their statement to 2010 before seeming to decide for WP and all of us (by removing the 2006 date that the ISP editor obviously felt should be included) that their conclusion will be the same?

Also, why did you feel to revert the two words, "peer reviewed" that informed a neutral reader that the uncontrolled study was in fact peer reviewed? Is it because it goes without saying because if it wasn't peer reviewed it wouldn't be allowed at all? You know it's been peer reviewed and I know it's been peer reviewed but many neutral readers will not. You've made it very clear to neutral readers, in several areas of the text of this article, which groups of people in the last 18 years have said that there were no scientific peers that found any value or possibilities in the treatment of WTS. Why do you not wish to allow two words in an entire article to let them know that in 2006 there were a few scientific peers that found some possibilities in it? I don't think "uncontrolled study" conveys "peer reviewed" to a typical reader. Neutral point of view "requires that all majority views and significant minority views published by reliable sources be presented fairly, in a disinterested tone, and in rough proportion to their prevalence within the source material."

Also, why do you object to the link to the WTS website linking directly to the online Doctor's Manual instead of (not in addition to) the home page, inasmuch as it best communicates the minority point of view?

It really is a pleasure working with you, MastCell, and all of you. --MedBoard2 (talk) 21:18, 27 May 2010 (UTC)

I'll leave it MastCell to explain his own views, but as far as the 2006 Friedman study goes, I think it is a very weak source when judged by WP:MEDRS. It is a primary study with a small sample size, lacking a control group, and with no conclusions on the statistical significance of the results (that I can see from the abstract). I won't denigrate the Puerto Rico health sciences journal, but it is very poorly cited in other literature – one of the benchmarks for the highest quality sources. That's not to say it isn't a reliable source, but as with all primary studies, it needs to be treated with care. You are right to assume that the words "peer-reviewed" would not be appropriate because that's the standard for sources compliant with MEDRS. Inserting those words would look (to anybody used to reading medical articles on Wikipedia) like an attempt to inflate the significance of a weak source, so I can understand the resistance to their inclusion. On the other hand, I don't see the same problem with giving the date, and I'd personally prefer to see 2006 given for the study, as it helps someone like me (who knew nothing about WTS) to construct a timeline of the events in the narrative. I'll boldly suggest that you should make a new section at the end of this talk page and give, point-by-point, proposed new wording for each of the issues that concern you. I suspect that this is not intractable, and that there exists some form of words that everyone can live with. --RexxS (talk) 22:31, 27 May 2010 (UTC)

According to Google Scholar, the 2006 paper has been cited exactly 1 time. In other words, it deeply obscure and has had no discernible impact on medical knowledge. Out of curiosity, I chased down the one citation. Here it is - an article about thyrotoxicosis, which describes among its causes the ingestion of T3 to treat "Wilson's syndrome". The authors describe treating a 71-year-old man with congestive heart failure and atrial fibrillation caused by ingestion of excess thyroid hormone. They write:

He weighed 47.25 kg and was very frail... Because the history of Wilson's syndrome and ingestion of liothyronine was not volunteered, serum T3 was not measured. The medical team was not aware of this "syndrome." One of us first met with the patient several days after his admission. The patient was armed with a volume of the Wilson textbook and instructions on how to take liothyronine based on his body temperature. Over several weeks, we had several conversations about thyroid physiology, pathophysiology, and thyroid testing; as a result, he agreed to stop liothyronine and to monitor thyroid function for several months to determine whether he did need thyroid hormone.

The authors go on to note:

The danger of excess liothyronine is demonstrated by the development of uncontrolled atrial fibrillation in patient 13, who carries the non-diagnosis of Wilson's syndrome... There are reports of sustained released tri-iodothyronine being used in this syndrome, a recent one in the Puerto Rico health science journal... There is no evidence-based data for prescribing this therapy for "low temperature" and it can be dangerous, as demonstrated earlier.

So the 2006 paper has been cited only once, and that citation was specifically for the purposes of debunking the article and pointing out the dangers of treating the "non-diagnosis" of Wilson's syndrome with excess T3. Food for thought. MastCell ^Talk 22:44, 27 May 2010 (UTC)

Reading the comments here and at the noticeboard, it seems that MedBoard2 is wanting to argue that older assessment of the syndrome (e.g. the Florida Medical Board etc) have been superseded by newer information and views. This doesn't seem to be the case. This 2006 medical text] says that the temperature measuring and treatment "is not recommended". MastCell quotes a 2008 scholarly article above that calls it a a "non-diagnosis". This] 2009 called the "Cleveland Clinic Guide to Thyroid Disorders" calls it a "dangerous treatment" and explicitly accepts the ATA conclusions that there is no scientific evidence for the therapy. There doesn't seem to be any evidence from scholarly sources that the opinions of the Florida Medical Board or ATA are somehow old hat.--Slp1 (talk) 01:04, 28 May 2010 (UTC)

I'm with MastCell on the sources you removed. For example, I can't imagine why we would want to remove links to the authoritative source about the status of Wilson's medical license (which says "null and void", BTW, not "suspended for six months"). WhatamIdoing (talk) 21:11, 26 May 2010 (UTC)

Thanks, I'm sure you realize that Quackwatch is quoting the authoritative source about the status of Wilson's medical license, which is the Board of Medicine and the Final order. 18 years ago his license was suspended for six months and now he is not practicing, or keeping his license current, but the Board of Medicine never revoked his license. --MedBoard2 (talk) 21:18, 27 May 2010 (UTC)

I too am with MastCell. The mainstream perspective on the validity of this disorder deserves prominent mention. Quackwatch even though not the best source is more mainstream than much of what it covers.Doc James (talk · contribs · email) 21:42, 26 May 2010 (UTC)

Additional sources

(Courtesy of Slp1 (talk · contribs))...

• The Wilson Syndrome, Orlando Sentinel
• Lakeland Ledger
• Longwood Doctor is Censured, Orlando Sentinel
• Cleveland Clinic Guide to Thyroid Disorders, p. 191

Presumably some or all of these would be useful sources for our article. MastCell ^Talk 16:44, 26 May 2010 (UTC)

Context

One thing that I think would help this article is adding some context about the normal human body temperature. Wilson's main diagnostic standard actually means that more than 50% of working-age adults have this "condition". WhatamIdoing (talk) 22:15, 26 May 2010 (UTC)

I agree this could be a valid criticism of the diagnosis of this disease, but I am not sure such a criticism has been published. Such a section might run afoul of original research. --TeaDrinker (talk) 23:15, 26 May 2010 (UTC)

Read the American Thyroid Association statement referenced, which gives a cite for this very point. SBHarris 00:56, 27 May 2010 (UTC)

Helping the lay reader to understand the background to this article would benefit from some context on normal human body temperature. There's no need to present any uncited criticism, merely to present what good quality sources say about body temperature. That would allow a reader to gain a clearer view of the significance or otherwise of Dr Wilson's claims, without any editorialising on our part. --RexxS (talk) 01:54, 27 May 2010 (UTC)

Now don't tell me you're suggesting that we present data and have the reader draw their own conclusion from it?! There's too much data in the world to do that. In order to present data in such a way that the reader is led to the correct conclusion, you'd have to present it with heavy selectively, as though arguing toward a point. Fortunately for me, the American Thyroid Association already did that for me. If they hadn't, you'd technically be out of luck.

The problem wtih Wikipedia is that it's based partly upon a false premise, which is Jimbo Wales' completely ad hoc and unreferenced assertion that if a thing is true, you should easily be able to find some published source in which somebody argues or points out that it is true. Unfortunately, every professional in any field knows that's not the case. Let's see you find me a cite for the fact that Charles Dickins originally wrote David Copperfield in English, for example. The fact that it is obvious-by-inspection means you can't find anybody who actually says it in print (since it's not worth printing). So technically, you can't write it on Wikipedia, either. Examples abound. Another class is the logical problem we have here, where you can get a reference that says all B's are a subset of A's, and another than says all C's are a subset of B's, but unless somebody specifically says that C's are a subset of A's, you can't state that either. Nor can you put down the two other facts side-by-side, if by doing so you wish to advance the position that C's are A. SBHarris 02:12, 27 May 2010 (UTC)

I'm not sure any of us disagree. I stand corrected, there is a reliable source which makes this point, and I think it is a notable one. One of the key points of criticism is the vagueness of the diagnostic criteria, and this makes that point very concrete. We generally do not "present the data;" that's neither possible nor desirable in an encyclopedia. Notable, reliably sourced interpretations of data (which is exactly what the ATA statement is), should be included. --TeaDrinker (talk) 03:04, 27 May 2010 (UTC)

Sorry if I gave that impression, Steve. I was rather trying to say that it would only be necessary to give readers an idea of much normal body temperature can vary, for them to be able to see what the article says in context. It's a piece of missing information that is required for a proper consideration of the second paragraph in Origins, claims, and disciplinary action and we don't need to perform any OR to do that. On the other hand, a quote from the ATA statement works as well. --RexxS (talk) 04:32, 27 May 2010 (UTC)

Citing literature on major depression and bipolar disorder

I think that this is pretty clearly an inappropriate edit. It cites studies of T3 in major depressive disorder (PMID 19108898) and bipolar disorder (PMID 19215985). Neither of these papers has anything to do with "Wilson's syndrome", which is clearly distinct from recognized psychiatric diagnoses such as MDD and bipolar disorder.

It is original synthesis to cite papers on unrelated diagnoses here, particularly as they seem to be used to imply a biological basis for Wilson's claims. If a reliable source has linked Wilson's syndrome to these findings, then we should cite that source. We should not be cherry-picking the psychiatric literature for positive results with T3 and then citing them here. Aside from the obvious violations of content policy, such an approach misuses the cited papers to editorially confer legitimacy to "Wilson's syndrome" - certainly not the intent of the papers. MastCell ^Talk 20:51, 2 December 2010 (UTC)

Wilson's syndrome patient

What I have to say is subjective. I am a Wilson's Syndrome patient. I fit the profile of a classic Wilson's Syndrome patient. I have an Irish-Native American ancestry. There is a pattern of low body temperature in my family that we have always accepted as being in the normal range. I have had low body temperature all my life.

I have a history of depression starting in childhood. Over the years it consistently got worse. Now that I am on the Wilson's Syndrome protocol, I tend not to be as depressed and generally feel that I have more power over my emotional state. What is more, other problems that I never associated with my depression have improved.

The biggest drawback is that there are a number of lifestyle hassles that go with being a Wilson's Syndrome patient. The medicine has to be taken on time, on an empty stomach. It can go bad if it gets too warm. If the medicine goes bad, or if I fail to take it on time I feel extremely tired. But, I would trade feeling tired for feeling depressed any day. I have had to change the way I live, but I feel that I have been given a second chance in life.

I feel that this article is biased against the discovery and treatment of a legitimate disease. Is there nothing that can be said in its defense? If I did not have this treatment, I would be in very big trouble. — Preceding unsigned comment added by Ssechres (talk • contribs) 00:49, 21 June 2011 (UTC)

There really isn't anything good to be said about it.

That you subjectively feel better is not surprising. Most people who undertake an alternative medicine treatment feel empowered by it and feel more hopeful. If they don't, they simply stop taking the alt med treatment. The same effect is seen in people who are enrolled in a randomized, placebo-controlled clinical trial: even people who do not receive the treatment report feeling better. It's called the placebo effect. Basically, taking the decision to address your health issues automatically makes people feel better.

Interestingly, the more difficult the treatment, the stronger the effect, even if the "treatment" is nothing more than sugar pills. Two pills works better than one, an injection works better than a pill, and treatments that have to be carefully timed—say, a substance that must be taken at exact times on an empty stomach—works better than one that can be taken any time of day. WhatamIdoing (talk) 01:41, 21 June 2011 (UTC)

Well, that is a really nicely worded putdown. Thank you. I know what the plecebo effect is and if sugar pills would help, I would take them.

Assuming that you are a doctor, it is interesting to me that while mainstream medicine was unable to help me for over 40 years, as soon as I do find a way to manage my health problems they have nothing good to say about my solution. I can say that I am happier with my current course of treatment than I was with my antidepressants when I had them. And they were more expensive. By the way, I was on the protocol for several months before I realized that my T3s have to be taken on an empty stomach. I was still better off than I had been before. — Preceding unsigned comment added by 141.218.36.94 (talk) 20:35, 21 June 2011 (UTC)

This article relies on reliable sources, not anecdotal claims from individuals. I suggest you stop personalizing this discussion and provide specific examples of how to improve this article, referencing appropriate sources for medical claims. Please also review WP:NOTFORUM; this talk page is for discussion about specific recommendations to improve the article, not a forum to discuss personal feelings about the article or relate personal anecdotes. Further postings that fail WP:NOTFORUM should be removed. Yobol (talk) 20:42, 21 June 2011 (UTC)

I'm not a physician. I also don't intend my comments on the remarkable mind–body relationship to constitute an insult.

That you actually felt better after you started taking this treatment does not actually prove that the treatment is the direct cause of your improved sense of well-being. WhatamIdoing (talk) 20:52, 21 June 2011 (UTC)