User:MCDB40Student81/sandbox

Article Evaluation

VAMP regimen (evaluated 2/11/18)

Although everything in this article was on topic and neutrally reporting facts, I found several problems with it, and it is easy to see why it is currently listed as a snub article. First of all, there is no formal introduction section, nor are there any subsections. Instead, there is a one sentence definition, followed by four bulleted examples of what the regimens include. The viewpoints that are included need to be expanded more fully and more completely, and there are sections that are obviously missing from the article; a subsection about the history and development of the VAMP regimen would be a good addition to the article, and the article does not discuss or discuss the successes and drawbacks of VAMP as a means of treating cancer. In terms of sources, the ones used are neutral and reliable, and each fact in the article is supported with references. However, it seems like too many of the sources are too specific to give enough general information about the topic (and this fact is reflected in the articles' lack of broad information about VAMP). Scientific studies are great sources, but an article like this could use some more background that it is entirely missing at this point. The talk page is completely empty, which is also a sign that probably only one person was working on this article.

Content Gaps

According to Wikipedia's education dashboard, content gaps are pieces of information that are currently missing from Wikipedia. This could refer to articles that do not completely cover their topics, or it could also refer to entire articles and topics that have yet to be written about. There are several possible ways to identify these gaps. Gaps can be identified within articles by peer evaluations of articles by fellow Wikipedia editors, as my exercise above showed; when I was reading the VAMP article, I asked myself what information I knew about VAMP and what information I would want to know more about VAMP and checked if the article included it. Content gaps could also be found by searching on the internet for information about a topic and finding that there is no Wikipedia article about that topic.

Content gaps emerge for a couple of different reasons. Sometimes, gaps are due to a fault of the article writers, if they fail to cover a major aspect of their topic that there is ample information about. Sometimes, however, there are subjects about which it is currently not possible to have a perfect article, either because the topic is too heavily contested to talk about objectively, or because there is not enough reliable information to write about a topic (e.g. a new medical treatment that needs to go through clinical trials or that is in the early stages of development). If content gaps are a result of poorly written articles, these can be fixed and more thoroughly researched by Wikipedia editors.

Excellent job on these answers grade A RJBazell (talk) 18:17, 12 February 2018 (UTC)

It does matter who writes on Wikipedia because biases need to be controlled for. Someone who is involved directly with a topic should not write about that topic, because it is not possible to write completely objectively on something that you yourself are working on. In fact, even sources from people directly involved with a topic should not be used because Wikipedia articles are meant to present unbiased facts, so they should be supported by unbiased evidence.

To be unbiased on Wikipedia means to be presenting a completely neutral, unpersuasive presentation of facts about a subject. To write an unbiased Wikipedia article, one has to carefully and rigorously evaluate their sources for bias, and only work from sources that themselves are neutral. Unlike in many other forms of academic writing, no interpretive work should be done on the part of the article writer. In this way, Wikipedia has a more strict interpretation of bias than the way I usually think about it. In the past research papers I have written, the prompts have asked me to come up with an 'impartial' answer to a contested issue by looking carefully at both sides and then arguing for my own stance on the issue; but, of course, this task is not impartial at all! By looking at biased sources, I formed my own subjective view on the topic, and then my final papers made persuasive arguments biased by my personal view on the subject. The task of Wikipedia writers is entirely different. Wikipedia aims to eliminate all opinions and biased viewpoints from their presentation of a subject, and to distill each subject into pure facts conveying what we currently know about the topic.

Discussion: Thinking about Sources and Plagiarism

• Blog posts and press releases are poor sources of information because they are both subjective and usually unsupported by rigorous evidence. As a rule, it is much better to look at general reviews, books, and encyclopedia articles. With both of these types of sources, there is no good way to verify where the authors got their information from, and that is problematic when presenting information that the general public will read and trust.

• Using a company's website as a source for an article about that company has obvious bias problems; the way that a company presents itself is never going to be unbiased and will always be trying to display impressiveness and an (often exaggeratedly) optimistic view of itself. One should instead find neutral sources that can look at a company from an unbiased lens.
• Copyright infringement and plagiarism are both words given to stealing property that isn't yours and passing it off as if it were. However, copyright infringement usually refers to physical or tangible objects; for the purposes of wikipedia this usually means pictures. Plagiarism refers to the stealing of intellectual property, pretending ideas that you got from somewhere are your own; even if sources are cited, one can plagiarize by paraphrasing too closely.
• Both plagiarism and copyright infringement are obviously wrong, and they are also easily avoidable. Don't use pictures that are not found in Wikimedia Commons, and cite all sources carefully and without paraphrasing. Generally it is a good idea to not have the exact wording of your sources in front of you so that you are not plagiarizing or paraphrasing too closely; instead, jot shorthand notes on the big ideas of the article and, when necessary, statistics and data, and work off of those notes.

Discussion: Thinking about Wikipedia

• I think that Wikipedia's strict definition of bias is very important given the kind of resource that it is: an online, accessible encyclopedia. As Wikipedia is a resource that is meant to inform a general audience about objectively true facts on a topic, people trust information on Wikipedia as if it were fact; thus, it is critical that Wikipedia article's are free from all forms of persuasion. In the context of medical articles, this is even more clear. Students without medical expertise writing on drug topics, like me, must be very careful not to make statements that persuade and dissuade people from taking courses of action, and all action to that effect should be left to healthcare professionals.
• The impacts of wikipedia are huge. Whenever I need to google something in an everyday situation, I visit Wikipedia as a first resource a majority of the time. It makes information that used to take trips to the local library retrievable in seconds at the touch of a button. However, it is not without its limitations. Wikipedia is limited by its content gaps, as has been previously discussed in discussion responses in this sandbox. It is also limited by the bounds of solid human knowledge; subject and issues which are still areas of research or are still hotly contested will not be able to be covered well in Wikipedia articles until professionals reach a more uniform decision about things.
• Wikipedia excludes biased or unreliable sources of information, including blog posts, press releases, and information released from the subject itself (to avoid conflicts of interest and self-bias). As stated in the first question, I think it is good and proper that Wikipedia has such stringent requirements. However, it does have a few drawbacks, and sometimes the rules must be tweaked. In the case of news articles, sometimes these are the only good source of information about a topic if that topic is a current event, and I do not think it is a bad thing for someone to write an article about a current event, even if they can only source from newspapers, as long as their information is pooled from multiple sources and does not plagiarize those news sources. This sure beats the alternative of waiting years and years for that information to be written about in History textbooks, and then writing an article. In the case of not using information from the source itself, this also can come with its fair share of drawbacks. For example, a science researcher is not allowed to write on information that he is researching, even though he may be an expert in the field. This means that it will take time for his or her research to be analyzed and written about in a larger review article, and only then can a proper wikipedia article be written about the topic. The Wikipedia-approved sources are definitely better and more reliable than a single study, but it means that Wikipedians must wait for information to be confirmed before making it accessible.
• Wikipedia strives to contain the bounds of confident human knowledge, so if it were written 100 years ago, it would include many less articles and much less information on it. My article on VAMP, for example, would not exist, because VAMP would not have happened yet. If Wikipedia were written 100 years from now, it would contain (hopefully) much more information than it currently does, reflecting the (hopefully) great breakthroughs that humans will make in the next 100 years. I think there would also be many more contributors to Wikipedia, as Wikipedia continues to grow into one of the most important information resources on the internet.

Chosen Article: VAMP Regimen

I have chosen to work on the VAMP regimen article for the remainder of this semester. The article is listed under medium importance of medical articles and as a stub, so I think I will produce something that will be seen by a decent amount of people, which is exciting. It is very lacking in information and organization, and there is much room for general improvement. More specific comments about this article are above, because this was the article that I evaluated in previous part of my Wikipedia Training. I will reference these comments as I begin to work on and improve the article.

Bibliography for VAMP Regimen

Mukherjee, Siddhartha (2010). The Emperor of all Maladies. Scribbler.

DeVita, Vincent (November 2008). [ http://cancerres.aacrjournals.org/content/68/21/8643 "A History of Cancer Chemotherapy"] Check |url= value (help). American Association for Cancer Research. 68: 8643–8653.

Pritchard, Justin R.; Lauffenburger, Douglas A.; Hemann, Michael T. (2012-10). "Understanding Resistance to Combination Chemotherapy". Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy. 15 (0): 249–257. doi:10.1016/j.drup.2012.10.003. ISSN 1368-7646. PMC 3975170 . PMID 23164555. Check date values in: |date= (help)

Forgeson, G. V.; Selby, P.; Lakhani, S.; Zulian, G.; Viner, C.; Maitland, J.; McElwain, T. J. (October 1988). "Infused vincristine and adriamycin with high dose methylprednisolone (VAMP) in advanced previously treated multiple myeloma patients". British Journal of Cancer. 58 (4): 469–473. ISSN 0007-0920. PMC 2246797 . PMID 3207601.

Stuart, N. S.; Blackledge, G. R.; Child, J. A.; Fletcher, J.; Perren, T. J.; O'Brien, C. J.; Jones, E. L.; Ellis, I. O.; Kavanagh, J. A. (1988). "A new approach to the treatment of advanced high-grade non-Hodgkin's lymphoma--intensive two-phase chemotherapy". Cancer Chemotherapy and Pharmacology. 22 (2): 141–146. ISSN 0344-5704. PMID 3409445.

Lead Section and Outline for Body Edits

Outline for my edits to the article:

In addition to fixing up the lead section, I plan to add a few other sections to this article to make it more complete. I will add a section about the development of VAMP, elaborating on the history of the drug, and discussion in a neutral manner the controversy over these trials. I will also add a mechanism of action section, where I will discuss the mechanisms behind each of the four drugs in the original VAMP combination more thoroughly; I will also use this section to discuss the synergistic effects of combination chemotherapy as opposed to single chemotherapy drugs.

Original article copied from VAMP regimen:

VAMP regimen or VAMP chemotherapy is a combination chemotherapy regimen including Vincristine. It was developed by Frei and Freireich at the National Cancer Institute, with its first trial in 1961.

VAMP chemotherapy can refer to any of :

• Vincristine for 4 days, doxorubicin (Adriamycin) for 4 days and methylprednisolone for 5 days per cycle. e.g. for kidney disease. - With the addition of cyclophosphamide this becomes C-VAMP.
• Vincristine, doxorubicin (Adriamycin), methotrexate and prednisone used in combination with radiation therapy for the treatment of low-risk childhood Hodgkin lymphoma.
• Vincristine, amethopterin, 6-mercaptopurine, and prednisone for leukemia.

The VAMP regimen is used in the treatment of cancer. It serves as a type of treatment for Hodgkin lymphoma.

My Edits - Final Draft:

VAMP regimen or VAMP chemotherapy is a four-drug combination chemotherapy regimen, used today in the treatment of Hodgkin lymphoma. It was one of the earliest combination chemotherapy regimens, originally developed as a treatment for childhood leukemia by a group of researchers at the National Cancer Institute led by Emil Frei and Emil Freireich. The first clinical trial of VAMP began in 1961. Because it was the first time that four chemotherapeutic agents were used at once, the trial was highly controversial at its time. Although new combination chemotherapy regimens have replaced the use of VAMP in the treatment of childhood leukemia, VAMP is considered an important precursor to modern treatments, confirming the effectiveness of combination chemotherapy and leading to the use of combination chemotherapy regimens to treat other types of cancer.

The VAMP regimen developed by Freireich and Frei was a combination of vincristine, amethopterin, mercaptopurine, and prednisone. Now, other combinations and doses that are referred to as VAMP, including C-VAMP and a VAMP regimen that replaces the mercaptopurine of the original combination with doxorubicin. All these regimens take advantage of the synergistic effects of combining multiple chemotherapy agents.

History

By 1960, several chemotherapeutic agents had emerged, among these nitrogen mustards, folic acid inhibitors, and purine analogs, each with their own individual history and development. Furthermore, the work of Howard Skipper, who argued that every remaining cancer cell in the body must be eradicated in order to ensure the survival of the patient, shifted clinical practice towards more aggressive chemotherapy regimens. Importantly, Skipper also established that the use of multiple chemotherapy drugs at once provided synergistic benefits over single agents. However, the idea of combination chemotherapy was initially met with resistance by researchers concerned about the toxicity of multiple harmful drugs being used simultaneously.

VAMP emerged amid a period of cautious and methodical testing of various combinations of chemotherapeutic agents. Due to the immense possibilities of combinations and the potential dangers of these aggressive regimens, this trial process was slow and, in the view of some, inefficient.

Emil Frei and Emil Friereich, researchers at the National Cancer Institute (NCI) took bold and decisive action, proposing a regimen of four chemotherapeutic agents, more drugs than had ever been previously attempted. The aggressiveness and potential lethal toxicity of this proposal was alarming to many fellow members of the NCI, who felt that Frei and Freireich were making a dangerous break with the systematic trial processes that characterized the leukemia group of the NCI. However, Frei and Freireich felt that the current pace of the NCI was too slow to make progress.

Initially, the leukemia group rejected the VAMP proposal, denying funding until many of their current trials had been completed. However, an arrangement was reached that involved the VAMP trial being run separately from the rest of the leukemia group at the NCI. The trial began in 1961 on children with leukemia.

In the initial weeks, the children were pushed to the brink of death by VAMP's four chemotherapy agents, each cytotoxic on its own. After a few weeks, however, the children's marrow healed, remissions came, and leukemia was undetectable in many of the patients. These remissions astounded Frei and Freirdrich's peers, and gained supporters even from those who formerly resisted the trial. The remission rate ultimately increased to 60%, and around half of those remissions lasted for several years.

However, the remissions were not permanent for most. Because none of the components of VAMP could cross the blood–brain barrier, there was nothing stopping the leukemia from reemerging in the nervous system and invading the brain. These relapses proved deadly for all but a few.

Molecular structure of Vincristine

Mechanisms of Action

VAMP includes four drugs, vincristine, amethopterine, methotrexate, and prednisone, operating under independent pathways, which work in concert with one another as an anti-tumor therapy. Combining multiple chemotherapeutic drugs into one treatment helps overcome the problem of drug resistance. Furthermore, combination chemotherapy allows multiple independently-acting drugs to be administered at their maximum dose, which increases the treatments toxicity to cancer cells without being deadly to the patient.

Vincristine is a drug isolated from the Madagascar periwinkle, first discovered by the Eli Lilly company in 1958 in a search process that involved testing thousands of plant extracts. It was initially planned to be an antidiabetic drug. However, it was soon found to be an effective anti-leukemia agent even at small doses. Vincristine functions by binding to and inhibiting microtubule production in the mitotic spindle necessary for the cellular replication, halting cell division in metaphase. With their chromosomes unable to separate, the cells ultimately die.

Molecular structure of Methotrexate

Methotrexate, or amethopterin, is a drug developed by Sidney Farber. It operates by inhibiting the production of folic acid, a precursor to cellular DNA that is necessary for DNA synthesis. By interfering with several major enzymes involved in folic acid production, including dihydrofolate reductase, methotrexate disrupts cellular replication.

Molecular structure of Mercaptopurine

Mercaptopurine, or 6-MP is an analog of guanine, and inhibits cellular replication through multiple mechanisms. 6-MP halts purine synthesis, and also products of the metabolism of 6-MP become incorporated during DNA replication, leading to a mismatching of nucleotides that triggers apoptosis through the cell's DNA repair mechanisms.

Molecular structure of Prednisone

Prednisone is a corticosteroid that is used as an anti-inflammatory agent it the treatment of a variety of medical conditions. Generally, it reduces redness and swelling, but its use in cancer involves inducing apoptosis in lymphocytes. More research remains to be done to determine the exact mechanism of prednisone-induced apoptosis.

Peer Review

Hey! Your article is in really great shape in my opinion! You turned a very subpar article into one filled with helpful information. I really liked that you added different sections because this made it a lot more organized which was helpful. You used a lot of sources which is great. There are only a few things I would look out for and make sure you're thinking about. The first is just making sure that your wording is as precise as possible. Some of the sentences are a bit confusing and could be reworded just to make it sound more clear and more like a Wikipedia article. I think you should also shy away from talking about how important this regimen was. I think we're supposed to leave that up to the readers and not tell them that kind of stuff, but I'm not sure. Also, maybe changing the style a little bit to make it sound more information instead of like a story. It reads better the way you've worded it, but it doesn't sound like just information. Fleshing out who Fri and Friedrich were would be helpful along with making sure you talk about who actually thought the regimen was ineffective instead of just using the word some. You also sound as if you're leaning toward a particular side which was pro this regimen which makes sense but maybe try to make it sound a little more neutral. Overall, this is a really great start! Great job!

Peer Review Response

Thanks for your helpful advice! I think I do need to be a bit more cautious about neutrality, especially in my history section. I think as I add more sources to that section it will help me achieve a more balanced and neutral reflection, and I can probably also figure out how to include the more negative aspects of VAMP from Mukherjee as well. I could also definitely fix the tone and polish up my sentences as I move towards a final draft. Thanks for your comments, and I will definitely strive to incorporate them in the final version of the paper!