Talk:Linaclotide

inconsistent structure

The structure shown has a methyl on the main chain amide of the asparagine residue that is not in the chemical name. 69.72.27.190 (talk) 23:38, 14 February 2013 (UTC)

Removed methyl group. Thanks for catching this error! --ἀνυπόδητος (talk) 15:43, 16 February 2013 (UTC)

US bias

Linaclotide was licensed for use in the EU in November 2012, and is subject to special monitoring measures. This is not reflected in the article, which concentrates solely on the USA. I will try to expand this point in the main article, with relevant references, shortly. Englishbriar (talk) 01:46, 1 October 2014 (UTC)

Good point, touched on in [[1]] and at EMA sites. Also plan to reference the two brand names, but I will get to this when consensus about other aspects, as below, is attained; I will resume work after that situation resolves. FeatherPluma (talk) 01:36, 29 April 2016 (UTC)

mechanism of action listed is incorrect

primary mechanism of action listed seems to be incorrect, e.g. " It acts by increasing fluid secretion, thereby accelerating gastrointestinal (GI) transit, and has GC-C-mediated analgesic effects." . The effect on gut neurons might help decrease discomfort, but this is not the primary mechanism. Pollira (talk) 15:02, 14 July 2015 (UTC)

That's essentially correct. Although it can also be said that GC-C effects do seem to go on downstream to secondary mechanism neuronal effects - see package insert, and also [2] and [3]. I see that the concern has been left ignored for a about a year. I agree that this should be included as it is eminently capable of being sourced. However, this doesn't imply that drinking more water is the equivalent of having a secretory surface effect at the luminal edge from the medication. FeatherPluma (talk) 19:09, 28 April 2016 (UTC)

Phase I and selected phase III data

Although the mechanism of action was not corrected for almost a year (see above section), the same day as it was modified and material that fails WP:MEDRS was removed in favor of a proper overview, a cherry-plucked subset of the studies in the PI was added back to the article. I contest this 1) on wikipedia policy grounds (see WP:MEDRS) and 2) on a scientific basis (this is not "just a policy" - problems with phase I data and with cherry plucked subsets of phase III information are the reason we have WP:MEDRS and 3) I do not feel that the edit summary adequately explains the editing action. Unless a cogent reason for this material is provided, it will be eligible for permanent deletion with prejudice after a review period. FeatherPluma (talk) 19:15, 28 April 2016 (UTC)

Blind reverts are never appropriate methods to remove sourced content; you've done this twice already to advance your edit war. Per WP:BRD, the artilce has been restored to the status quo ante and shouldn't be changed until clear consensus is established for your position to remove this content. You will be blocked -- with prejudice -- if you persist in this edit war.

Above and beyond the failure to understand that we pick cherries -- we don't pluck them -- is the fact that the sourced material in question has been present for 4 1/2 years, since the day the article was written. That you "do not feel that the edit summary adequately explains the editing action" is an extremely poor rationale for undoing an edit.

I support this content 1) on wikipedia policy grounds and 2) on a scientific basis and 3) I do not feel that one editor's arbitrary concerns that the edit summary adequately explains the editing action are a valid justification for removal. If you believe that the sources have been cherry picked -- and they haven't -- add some additional reliable sources, as the inappropriate removal deprives the reader of important context about specific findings. Alansohn (talk) 19:36, 28 April 2016 (UTC)

You have added back verifiably wrong text. I contend, as stated in my initial edit summary, that the material you are adding back is an erroneous representation of the BACKGROUND and METHODS sections, mixing them up. The 40 odd patients are grossly inadequate reflection of the literature of 4 very large studies, with many hundreds of trial participants. I am not edit warring. Being verbally firm with me in the face of this problem, explained in edit summaries, and threatening a block is highly inappropriate. FeatherPluma (talk) 19:45, 28 April 2016 (UTC

Removing sourced content through repeated blind reverts and edit warring is simply disruptive. If there are other studies not listed, add them. If you see an issue, fix it. Cherry-picking through the article to remove content you don't like only makes the article worse. If you're willing to work to improve the article, I'm more than happy to work with you. Alansohn (talk) 20:25, 28 April 2016 (UTC)

@Alansohn:

Short answer:

1. This article is tagged at the top of this page as a medical article. That tag specifies that, if possible, sourcing should meet WP:MEDRS. This threshold is more stringent than sourcing for general articles. The essence here is that some "generally sourced" content fails WP:MEDRS.
2. I am a little hesitant to ask this, as I really don't mean to be critical in any way and I had assumed you are very familiar with it, but are you actually factoring in WP:MEDRS or are you using a standard sourcing approach?
3. Of course, if there's a legitimate reason for retaining the content that is in queston, please lay it out for discussion.
4. In practice, I comply with the notions of WP:MEDRS less rigidly than most medical editors. In practice, you can almost always talk me into any reasonable course of action if you explain your preference.
5. I did not arbitrarily remove content just because I did not like it. It was removed for cause, and I cited policy to explain what I did. I did this in both the edit summary and again here when I brought the concern here to discuss and review. I made no blind reverts (as I understand that term). Nor did I revert twice. Nor did I edit war, at all. I am very upset with the accusatory onslaught. I did not fail to add updated references and I improved the text in the article. I really, really, really dislike feeling that I am being bullied with behaviorally disproportionate threats of seeking a permanent block. WP:AGF, were you unfamiliar with WP:MEDRS, and did you miss it both in the edit summary and here?

Long answer: The text in question may have been appropriate as the best information available when it was added some years ago. However, it had not been updated, and there are better sources now. The content in question is not the result of consensus collaboration. When I assessed it, I found several sourcing problems. I replaced what I removed with appropriate text and sources.

1. The first part of the text in question is from a source which itself expressly states that it's a small pilot study. And which emphasizes that. Over and over. In its abstract. And in its discussion section. It fails WP:MEDRS.
2. It is a primary source. It fails WP:MEDRS this way too. (Although emphasized in the guideline, I am flexible about this, if there are no other options and if the text is written very carefully.)
3. The wikipedia text doesn't properly distinguish the OBJECTIVES and METHODS sections of the primary source. The source verifiably does not support the wikipedia claim that the source "describes" (sic) the phase I patients. I have access to the entire paper behind the paywall. The source merely mentions phase I data in passing: the point the source is making is that this pilot study (phase III) was the next step. This is standard fare, and it's not meaningful encyclopedic content.
4. I improved the article by replacing the WP:MEDRS non-compliant pilot study reference and associated wikipedia text. I suggest that since a broader array of better sources now exist, that one small non-pivotal pilot phase III trial should not receive undue attention.
5. The references I added reflect both labeled indications. I added both approved doses.
6. In contrast, the pilot data is restricted to one indication.
7. In contrast, the pilot data used 3 different doses, not one of which is the relevant approved dose, or even something that can be deployed by manipulating pill numbers etc.
8. The sources I added have full text available to everyone. In contrast, the main text of the pilot paper is restricted behind a paywall, and only the abstract can be accessed.
9. Moving on to the second part. This uses NYT as its source. This is a good source for general articles, but this type of "source" is specifically discouraged in WP:MEDRS for explaining study results. Notice though that I didn't discard the NYT reference entirely: it remained attached as support for the background section.
10. Although there may have only been one trial result available when that was added some years ago, there are now four pivotal trials, collated nicely by the FDA-approved package insert (PI), which I referenced. In principle, it is improper now to over-emphasize one endpoint from one trial. This is also discussed in WP:MEDRS.
11. I also removed the unrepresentative (I explain "unrepresentative" more fully in a moment at point #13) subset of IBS-C Trial 1 data given by NYT. Please see WP:MEDPOP, a subsection of WP:MEDRS, for why we do this: the explanation there is exactly what is happening in this NYT source. The WP:MEDRS citations I added point to the totality of information in the four large pivotal trials collectively. It represents a large increase in patient numbers and it reflects the various study phase III data, including CRFs etc., that was reviewed by the FDA.
12. I added a referenced explanation that gave the correct doses for each approved indication. The dose is dissimilar for the two labeled indications. This wasn't there before.
13. There are two different indications, each indication with its own dose(s), and each with its own pair of mutually confirmatory studies. The Wikipedia text you added back does not explain whether it’s for IBS-C (it is) or both (it’s not) or CIC (it’s not). While indicated for CIC, the population data was perhaps more modest – see the PI. The position Wikipedia rightly takes in medical articles is more disengaged and more circumspect than in general articles. There is a professionally written package insert for a reason. The data you added back, taken from NYT, guess what -- just happens to be the most favorable of the various endpoints, and thus unrepresentative collectively. (The best is not the average.)
14. The text you added back takes the numerically-defined composite endpoint of a 30% reduction in pain along with a time element and a CSBM frequency element (a complex composite clinical endpoint laid out in the PI source I added) and replaces that complex composite with the word “significant”. There are technical reasons this seemingly reasonable summarization is disallowed, among which is that “significant” has different meaning in clinical trial group statistics from how we know it is understood as a word by potential medication users. If this is unclear, I will explain further.
15. Quoting one endpoint from one study from one indication with one dose is not information (that informs and instructs), it's data churning (citing numbers without proper context and balance).
16. It is not good practice to imply that the pharma company is principally responsible for obtaining the results of the trial. Other editors will criticize this type of wording for several reasons.
17. Your second revert edit summary claims it replaces removed sourced content. But it does not do that at all. Your second revert only takes away new material I had added.

I agree that, until consensus is attained, the text that I feel is problematic will remain. When your concerns have been resolved, or alternatively if other input generates a wider consensus, I will resume improving the article in the direction I was taking it. I intend to briefly summarize the four sourced pivotal studies, already in the references I added, and by also using the sources I have earmarked in the section below.

What do you think, are you now OK with this more thorough explanation? Can we / I get on with working on the article? (updated) FeatherPluma (talk) 08:24, 30 April 2016 (UTC)

There is no rush on this. However, I have resumed editing. I will proceed with microedits in a gradual way, maybe 1 or 2 edits every few days. This will provide ample opportunity to discuss the changes step by step if there is disagreement about the editorial decisions. FeatherPluma (talk) 01:03, 5 May 2016 (UTC)

When I created this article from scratch almost six years ago, I created it as part of an encyclopedia that anyone can edit. I had seen mentions of the drug in the "popular press", was fascinated by the mechanism in which it works and realized that there was no existing Wikipedia article; there was a hole to be filled and I did my best to fill it. Every source was reliable and verifiable. The material added has stood the test of time of the 300-400 people reading the article each day over the past several years, with a significant portion of the original content still in the article. As I read WP:MEDRS, the sources that would be necessary to properly write and update this article are simply inaccessible to me or any other non-professional. The material removed deprives the reader of useful information regarding the medication; as originally added it was an accurate summary of the sources then available, however it does not meet the letter of of the law of WP:MEDRS. In the long run, I believe that this makes the article far less useful for the reader. Sadly, this is yet one more article that will be lost to the general editing public, with little likely benefit to the general reading public. Feel free to edit as you see fit as I'm not sure that I can edit the article further in any meaningful manner without access to the necessary sources. Alansohn (talk) 03:40, 5 May 2016 (UTC)

@Alansohn: Thank you for your efforts, then and now, which I appreciate, and that I do believe has been helpful to many people, as you imply. Thank you for clearing the way for future careful updates. I will nonetheless continue to microedit in a very gradual way so that the reasoning is transparent and so that there is ample opportunity to interact on the proposed changes.

You started this article and it sees ongoing traffic. Even with proposed updates, a very substantial proportion of the initial underlying structure and of the initial durable content will remain. All of this is good.

Fortunately, WP:MEDRS-compliant sources are readily available to the public for this article. These sources are readily available to everyone. They are completely within the ability of most general readers to use, either reading or working with the article. Interestingly, in stark contrast, the source you were adamant about retaining, and that you twice reverted to, and continue to defend to some extent, is available to the public only as an abstract. Its body text is behind a paywall. It may well be possible that that is why the wording in question has withstood the winds of time, as Joe Public can't access the main text. Many people would be unable to uncover for themselves that the wording was based on a quick (but understandable) misread, presumably of the abstract only, as it is inconsistent with the article text itself. This was explained in the edit summary.

WP:MEDRS is neither draconian nor legalistic. Its purpose is not to make things highly technical or inaccessible. In its essence, it merely recommends that editors exert appropriate precautions. The material which is proposed for removal most certainly does not provide a reader any useful information regarding the medication, as has been carefully explained. Contrary to your edit summaries, the material was replaced with publically available information regarding the 4 large pivotal phase III trials.

It should not be necessary for other people to do your apologizing for you. It does seem that you were not fully aware of WP:MEDRS and so your behavioral reaction was a vigorous defense of text that you feel was sourced. I can readily understand that. The matrix of considerations in different parts of this encyclopedia is enormous, so we all do tend to need to discuss things collaboratively when issues arise. One possible aspect to maybe consider is to WP:AGF, which did not seem to happen here. Most discussions are facilitated by making the assumption, unless there is unequivocal evidence to the contrary, that editors who have worked here for a few years are here to improve content, are here to collaborate in a friendly way with you, are probably trying to get things done but willing to digress and discuss, and are not here to undermine you in some personal way or be bullied. I see from your block record that there is a track record of recurrent problems in the far distant past in this way.

I appreciate your input and I agree that it's good to give me a reminder that any possible modifications need to be easy to understand for the general readership that we target. For example, your input reminds me that "pivotal trial" is jargon, and an alternative will need to be deployed. Of course, you are most welcome to edit this article whenever you want. I am comparatively unemphatic about WP:MEDRS, and always very willing to consider well-considered exceptions. Despite WP:MEDRS, I did not remove nor do I plan to remove the NYT source completely. I merely propose that the one endpoint (out of several per trial) from one of 4 trials that NYT selectively and exclusively reports be contextualized in the totality of considerations about the medication. If at this time you have philosophical animus to the guideline, you may be right to disengage on your own initiative, but if further thought lessens that hostility, as I believe it should, I encourage you to please consider contributing to this particular article and to this class of articles, which I am confident would very much benefit from your ongoing input. I look forward to interacting more easily next time. Best wishes to you for future happy editing. FeatherPluma (talk) 19:26, 5 May 2016 (UTC)

Other WP:MEDRS-compliant sources

These reviews can be considered for incorporation:

References

FeatherPluma (talk) 01:46, 29 April 2016 (UTC) updated FeatherPluma (talk) 03:45, 6 May 2016 (UTC)

And possibly consider:
http://onlinelibrary.wiley.com/doi/10.1111/apt.12604/full
http://onlinelibrary.wiley.com/doi/10.1111/nmo.12264/full
http://onlinelibrary.wiley.com/doi/10.1111/nmo.12151/full
https://www.ncbi.nlm.nih.gov/pubmed/23116208
FeatherPluma (talk) 22:25, 22 August 2016 (UTC)