Talk:Graves' disease/Archive 1

This is an archive of past discussions about Graves' disease. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 1

Archive 2

Just for reference, Graves' disease is also called Basedow's disease in Japan. Cyborg Ninja 03:42, 3 June 2007 (UTC)

Has any work been done on immune therapy treatments for graves disease? --74.99.4.177 21:49, 3 April 2007 (UTC)

I haven't heard of any immune therapy treatments being used for Graves' disease. Are you talking about like using a drug to suppress the immune system? I think that the risks from those drugs make them a bad choice when there are two better options available, and that's why it's rarely if ever used. Cyborg Ninja 03:42, 3 June 2007 (UTC)

I have Graves' and my doctor said that suppressing the immune system would cause more problems. L3lackEyedAngels (talk) 22:39, 25 March 2009 (UTC)

The reference to Heino needs checking. As far as I know he wears glasses because he is an albino. If he suffers from GB disease as well so be it, but it's news to me...

I've tidied up some grammar, although mine isn't great, and added a little on alternative names for the eye problem, and headache as a symptom, as it is a common presenting symptom (patients who are thyrotoxic exhibit symptoms of poisoning, as the name suggests, which include headache, nausea and bloodshot eyes , very similar to waking up each morning with a bad hangover but without the need for alcohol).

I don't have a reference to hand, but I'm fairy sure the 4:1 female to male ratio is too low. At least one reference claims 20 in a 1000 women, and 1 in a thousand men as occurence, but also notes that the disease appears to be becoming more common (with no clear evidence whether this is due to better diagnosis, or an increase in frequency).

Not sure on the policy of linking to other sites, but members of the Chicago thyroid center, and other researchers extensively published in the peer reviewed medical literature maintain an encyclopedic reference on thyroid disorders at http://www.thyroidmanager.org/ which might be of use to those researching the topic.

There is some controversy on the use of Iodine 131 in treating the disorder, as it is linked to an increase in the occurence of eye problems. However since no reference to treament is in the original page I'm not sure if a discussion of such is appropriate there. The hyperthyroidism is usually adequately treated with antithyroid drugs or a partial thyroidectomy. The eye problems may be treated with steroids, eye drops, and ultimately surgery or orbital radiation treatments, although recent studies suggest the orbital radiation treatment may not be as effective as once thought.

The references had been shamelessly copy&pasted from Whonamedit.com. I've reformatted them. We need some discussion on whether all those old references need to be mentioned, while there are no references to clinical or pathological reviews! Your opinions please. JFW | T@lk 11:41, 2 Jan 2005 (UTC)

Thank you anonymous editor, but please work on your style. Bulletted lists and lots of capitals do not make it prettier.... JFW | T@lk 09:58, 6 Feb 2005 (UTC)

Q. Is cardiac failure rare? if so, can you say so, so as not to alarm suffers using this page to find out what they've got. thanks

A. Yes, cardiac failure is rare, usually occurring in post-thyroidectomy patients due to a temporary increase in thyroid hormones (Thyroid Storm) brought on by surgery. Thyroid Storm is a rare but serious complication of Graves' Disease, heart failure is a complication of thyroid storm (otherwise known as thyrotoxicosis). The likelihood of developing thyrotoxicosis is low because, most patients undergo Thyroid Hormone Suppressant therapies prior to surgery.

Please, understand that Graves' Disease is a very serious condition. The information provided is intended to inform, not to scare. It is estimated that 13 million people in the United States alone have undiagnosed Hyperthyroidism. Articles like this help to increase public awareness of serious autoimmune diseases like Graves', Hashimos Thyroiditis, Hypothyroidism, and etc...

The following is an excerpt from my paper, Graves' Disease, A cause for concern which was inspired by my mother whom, I almost lost to Graves' Disease 3 years ago.

"It should be noted, Thyroid Storm is deadly if left untreated. Its symptoms include, Tachycardia (abnormally rapid heart rate), Diaphoresis (profuse sweating), and Dehydration secondary to GI losses (commonly referred to as diarrhea). Patients experiencing Thyroid Storm may also exhibit: Warm, moist skin, Widened pulse pressure, Congestive heart failure (may be a high output failure), Thyromegaly (meaning goiter or abnormally enlarged thyroid gland), Exophthalmos {protrusion of the eyeball from the socket), Shock, Atrial fibrillation. There are no clinical tests to determine Thyroid Storm as a cause so, “In the emergency department, thyroid storm often must be recognized and treated on clinical grounds, because laboratory confirmation of the disease cannot be obtained in a timely manner.” Those who experience these symptoms should seek immediate medical care."

From: Graves' Disease, A cause for concern By: Brandie A. Plunkett Contact: brandieann@clearwire.net

Reference: http://www.emedicine.com/emerg/topic269.htm

Suggestions for "noted suffers" for a more varied selection.

• Yolanda Gail Devers -- US Olympic Athlete -- ref Wikipedia and gaildevers.com biography
• Janica Kostelic -- Croatian Olympic, and World class, skier -- ref http://www.janica.hr (note reference says only thyroid problem).
• Marty Feldman -- British Actor and Comedian -- ref Wikipedia (note reference says only thyroid problem).

This section still needs some work. Wwallacee 21:22, 21 February 2007 (UTC)

Is the bugleweed recommendation suitable encyclopedia material?-Wetman 05:29, 11 October 2007 (UTC)

I'd have thought Bugleweed and Lemon balm would qualify for a mention as they are recognized herbal treatments. I'm not aware of any evidence that they work, and they certainly present the risk people might try them instead of therapies which are proven to be effective, but their (mis-?)use in this condition is a matter of fact not opinion.

There is no reason that it should be a recommendation, without evidence they work as well or better than the current best drug (Methimazole/Carbimazole), which given my experience of people who tried the herbal route is unlikely to be forthcoming without significant advances in the herbal treatments. —Preceding unsigned comment added by 84.45.158.52 (talk) 12:07, 15 December 2007 (UTC)

• Discussion at Wikipedia talk:MED#Eponymous disease possessive naming. Anthony Appleyard (talk) 10:47, 11 February 2008 (UTC)
  • Currently archived at Wikipedia talk:WikiProject Medicine/Archive 6#Eponymous disease possessive naming.
    Bistromaths (talk) 16:24, 2 January 2009 (UTC)

If you're going to use an apostrophe, Graves is a proper name, so the article should be titled Graves's disease. Being incorrect for classical reasons is poor form. (One wouldn't write Jesus', would they?)

I agree with the note made in (Circulation. 1999;99:164-167.) (American Heart Association) where Dr. Tsung Cheng recommends dropping the possessive altogether.

134.84.0.109 (talk) 16:51, 20 September 2009 (UTC)

Should the section titled "No treatment" be "Natural history" instead? 192.234.106.2 (talk) 19:16, 30 April 2008 (UTC)

Is a thyroid condition that produces bulging eyes necessarily Graves disease? I came across a source in which actress Countess Vaughn says she has a thyroid condition that made her eyes bulge while a teenager, and that she has to take medication for it, but she never names the disease. I'd like to add it to the article under "Noted sufferers". Is this okay? Or are there other thyroid conditions that might be the one she has? Nightscream (talk) 01:42, 9 March 2009 (UTC)

The division of the disorders is difficult till we fully understand the causes. The bulging eyes are "Thyroid Eye Disease" (TED), it is predominantly seen in association with autoimmune hyperthyroid disease (Graves' disease). TED is sometimes seen in patients who are hypothyroid, and rarely in people who are euthyroid (normal thyroid levels) and remain normal (i.e. some people have eyes that bulge shortly before their thyroid levels go wrong). It is an open question as to whether these patients have Graves' disease proper (and have gone hypothyroid - it can happen). As such no one is likely to tell you that you are wrong for calling the bulging eyes "Graves' disease", especially if there is any imbalance in thyroid hormone levels. I'm not aware of other thyroid diseases leading to bulging eyes, and certainly no common ones do.SimonWaters (talk) 20:20, 12 April 2009 (UTC)

This is the second time in a week that I've had to remove baseless claims concerning CAM treatments from this article. Both times, the claims were completely unsubstantiated and without citations. If you want to claim that a certain CAM treatment or herb or other non-evidence-based method treats this disease in some way, then provide a citation so that we can check your references. Otherwise it's nothing but anecdotal nonsense.

Here are the reasons the latest section was removed in its entirety:

Some forms of complementary and alternative medicine (CAM) have been used traditionally to treat Graves disease.

Yes, and some people use magic spells to treat allergies. What makes this claim any different (or any more valid)?

These treatments still lack supporting evidenced-based literature.

In fact, they lack all evidence, not just literature. Disagree? Provide a citation so we can check the evidence that you have.

Treatments involve herbal remedies used to suppress and/or correct the over active immune response. CAM treatments include: the immune-suppressing herbs Hemidesimus and Tylophera, the immune-regulating herb Echinacea and the dietary removal of goitrogenic foods; vegetables in the genus Brassica.

Please provide citations that show that these herbs do what you claim they do. If you can't, then this is misleading and potentially harmful.

Considering the immune interaction with the endocrine system in triggering Graves disease, these treatments warrant further study.

Who says? You? Again, if you have no citations, then this is incorrect and potentially harmful information. --Transity (talk) 17:53, 16 March 2009 (UTC)

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No forms of complementary and alternative medicine have been shown to provide any benefit for those suffering from Graves' disease.

This statement may be true, but there's no citation. One might argue that the lack of evidence constitutes proof, but that doesn't make the statement helpful or informative. Because there's no evidence and nothing useful to write down, I'll delete the entire section presently. L3lackEyedAngels (talk) 01:32, 26 March 2009 (UTC)

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Actually, this statement doesn't need (and, I'd argue, can't have) a citation. The fact that CAM treatments are not supported by any evidence at all is enough to allow this statement to stand on its own. Someone who wants to claim the opposite - that a specific CAM treatment does work for Graves' disease - is the person who has to cite their sources as their claim flies in the face of current scientific knowledge. For my part, I cannot link to every failed study of CAM, which is the citation we would need if we truly wanted to reference this claim. Asking for a citation for the removed statement is, I would say, like asking for a citation for the statement that Santa Claus is a mythical figure and not a real person (check the entry - no citation for that statement). So yes, lack of evidence is enough to make this a valid statement.

Is the statement you removed helpful or informative? I guess if someone comes to this article to find out which CAM treatments are effective for Graves' disease, and they see that none have been shown to have any benefit, they have an answer. If they find no mention of CAM at all, they do not have an answer and must look elsewhere as Wikipedia is silent on the issue. So yes, I believe there is a value to the statement that you removed (which I wrote to replace a list of nonsense).

That said, I'm happy to leave the section out for now pending further discussion, or until someone promoting CAM drops in a bunch of unsupported claims without any citations, at which time I'll likely drop my version right back in over it, with the exception that I'll link to the Alternative Medicine article which, I think, covers the "non-evidence-based" aspect of CAM adequately. --Transity (talk) 18:04, 27 March 2009 (UTC)

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So, are you planning on putting the same statement in every other article on a disease doesn't have effective CAM treatments? The way I see it, if CAM isn't mentioned, then I assume that it doesn't apply. If CAM treatments were typically effective, then I suppose that signaling where CAM doesn't work would be useful. However, that were the case, and CAM was known to usually work, would it really be CAM? Furthermore, I always look elsewhere after reading an article from Wikipedia, or any encyclopedia. I would hope my behavior is typical.

Now, a list of CAM supplements that might be harmful to a Graves' patient, like kelp, would be useful. L3lackEyedAngels (talk) 18:18, 2 April 2009 (UTC)

Then again, I bet there are a bunch of CAM related supplements that would be bad. What I really want is a statement that anything that has iodine should be avoided.L3lackEyedAngels (talk) 18:51, 2 April 2009 (UTC)

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Yes, if you come here and see no mention of CAM, you assume it doesn't apply. Yes, the fact that CAM is, by definition, unproven, should make it unnecessary to say that it doesn't work for each disease (if it were proven, it would be medicine, plain and simple). And yes, you (and I) always check other sources besides just Wikipedia. But sadly, none of these are universal statements.

A lot of people start from the basic assumption that some forms of CAM work and are proven to be effective (a false premise, but a popular one). If they come here trying to find out which CAM treatments work for Graves' disease, and they see no mention of CAM, we will be sending them elsewhere for their answer, potentially to a pro-CAM site that could woefully misinform them. If they start from a pro-CAM position, then silence isn't going to tell them that CAM doesn't work for Graves' disease. Do I think we should have to add a statement like mine to every disease? No, I don't. Do I think that we do have to? Maybe. Sad, but that may be where we are. In fact, I watch a number of articles on other conditions and perform the same functions on those.

So I understand your argument. In a perfect world, I think your approach would be the right one. And even in this world, I'm not 100% certain that it's wrong. But right now, I still lean more toward providing an answer than toward remaining silent. --Transity (talk) 15:50, 3 April 2009 (UTC)

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I understand that you want to prevent misinformation, but the statement won't correct misconceptions regarding CAM. If readers want CAM, or don't want the treatments listed here, they'll keep looking elsewhere. For that, the article deserves no fault, with or without the statement. Therefore, it doesn't have a useful function. Hence, I removed it. I only detect babysitting as its function. I hate being babysat and we shouldn't treat other readers that way. We're not editing the Simple English Wikipedia after all.

Furthermore, the statement gives CAM more legitimacy than it deserves, no? L3lackEyedAngels (talk) 18:40, 3 April 2009 (UTC)

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I agree that it won't stop a CAM believer from looking elsewhere for CAM treatments for Graves' disease. But I do think it makes sense to state that there is no scientific evidence for CAM for Graves' disease as a point of fact. Don't forget, not everyone who buys into CAM is beyond logic and reason. There are fence-sitters who need to see the facts. That's the reason for my hesitation here. Personally, I'd love it if this section didn't appear in any article - it's all unsupported nonsense, and it doesn't belong in any medical article (to say the least).

One note: deleting an entire section sometimes generates more problems than rewriting it. In the past when I've done that, I've had my deletion reverted, and I've ended up having to rewrite the section anyway. So if people keep adding an Alt Med section, deletion may not always fly. But let's see what happens without the section here. If it stays away, I'll gladly leave it out. --Transity (talk) 18:53, 3 April 2009 (UTC)

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As regards CAM I hold by my suggestion under Bugle weed. The widespread use of this herb (Lycopis Virginicus) for treating Graves' historically is factual. Indeed when there was no other effective treatment it may even have been the medication of choice. There is even research spun of from its use - Endocrinology. 1985 May;116(5):1687-93. Similar references will be found for Lemon Balm. Yes, anyone trying these is taking substantive risk with their life - but that merely means it is important to present it precisely. Is it not wiser to present the information as objectively as possible, so someone finding it here will see "there is some research, but we now have more effective drugs". Rather than finding a biased site which cites the research making WP look incomplete.SimonWaters (talk) 20:51, 12 April 2009 (UTC)

I don't think you're seeing bias, Simon, I think you're seeing unreferenced statements being questioned and, in this case, deleted.

That study (here) isn't very easy to understand. Here's what WP:MEDRS has to say about using a primary source like this one:

...edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. In particular, this description should follow closely to the interpretation of the data given by the authors, or by other reliable secondary sources. Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources...

The conclusion of the abstract says: "Our findings provide a possible rationale for the empirical, though poorly documented, use of [freeze-dried extracts of various herbs] in the treatment of Graves' disease and some support for the suggestion that Graves'-specific IgG may have structural similarities to TSH itself." What does that mean? I'm honestly not sure what layperson statement this review would drive. I don't think that simply repeating the conclusion above makes sense, and I don't know how to properly paraphrase it. Is there a better reference out there? Maybe a review of this and/or further studies? Maybe something more recent? Something that makes clear what the takeaway is for this research? Or, if you have a statement that you think could be included based on this study (sticking to WP:MEDRS), please post it here, and we can discuss with the larger community.

Alternately, if you want to put in something about how these herbs used to be used, then that's a horse of a different color. All you need in that case is a historical source that states that fact (that such-and-such herb was used by such-and-such group at one time to treat Graves' disease), and you can add it as a historical fact. By that I mean that you can add it, say, in a section called Folk Medicine (or something similar), and state that it was used at one time, though there is no solid scientific evidence of it's effectiveness (unless you have relevant studies, then see above). Make sense? --Transity ^{(talk • contribs)} 15:58, 13 April 2009 (UTC)

The following was added to the CAM section recently (replacing the old version in its entirety):

Similarly to Glaucoma, patients who smoke marijuana notice a decrease in swelling of ocular muscles. Marijuana also reduces the irritability associated with Graves' disease.

While the glaucoma article is properly referenced to support similar claims, this one is not. The study referenced in the glaucoma article was specific to glaucoma. Further, the underlying causes of the "eye pressure" seems to differ significantly between glaucoma and Graves' disease, so we can't simply assume that something that relieves "eye pressure" in glaucoma will also work for Graves' disease. In addition, the way the statement (above) is phrased suggests anecdotal evidence as opposed to any clinical trials. As such, even though I support the legalization of medical (and other) marijuana use, I have reverted to the previous version of this section.

If someone wants to add this back, please provide citations showing that this works for Graves' disease. Also, I would suggest a new section as this isn't really an Alternative Treatment in the CAM sense (e.g. homeopathy, reiki, and other pseudo-scientific practices). Cannabis has medically recognized benefits, unlike true CAM treatments, and if there is any evidence that it can impact Graves' disease, then let's call it out in another section. --Transity (talk) 13:58, 24 March 2009 (UTC)

I'd like to suggest that the Graves' disease#Famous sufferers section should only list people who are to some extent famous for being Graves' disease sufferers (as opposed to anyone notable enough to warrant an article who has also suffered Graves' disease). What do others think? 58.8.3.66 (talk) 19:38, 3 April 2009 (UTC)

If a Graves' patient is already famous enough to have an article in the Wikipedia, I think we should list that person here. I mean, it would have to be an extreme, or at lease weird, case of Graves' to meet the criteria that you propose. I have Graves' and can tell you that it's not very interesting.

Patients who read this article will enjoy learning about notable people who also have the same condition. L3lackEyedAngels (talk) 19:02, 6 April 2009 (UTC)

...it would have to be an extreme, or at lease weird, case of Graves' to meet the criteria that you propose - not really. There are three listed now; Marty Feldman and Diane Finley clearly do meet the criteria; Ayaka appears not to. - 58.8.2.151 (talk) 22:16, 6 April 2009 (UTC)

Of those three, I can only construe Feldman as having an interesting case of Graves' because he used one of his symptoms in his acting career. How does Finley meet the criteria with her sunglasses? L3lackEyedAngels (talk) 13:30, 8 April 2009 (UTC)

She's well known for, and recognised by, the sunglasses ([1]/[2]) - which is what I meant when I suggested to some extent famous. - 58.8.211.127 (talk) 14:11, 8 April 2009 (UTC)

I don't see any reason to exclude someone who is famous for other reasons. Citing a famous actor (for example) as having this condition even though it isn't widely known is a perfectly valid use of this section, in my opinion. It isn't like we'd be outing anyone - in order to appear here, the information would have to be verifiable and in the public domain already. I say list both. --Transity ^{(talk • contribs)} 14:17, 8 April 2009 (UTC)

Some of the cases are illustrative of a possible external triggering cause-- for example both president GHW Bush, the first lady Barbara, and the white house dog all developed Graves disease at about the same time. The secret service for a time went around testing the water supply. Barbara Bush's eyes are still affected. SBHarris 02:31, 11 May 2009 (UTC)

This claim that John Adams suffered from Graves' Disease comes from Encyclopaedia Brittanica. There, it says "Recent scholarly studies suggest that he might have suffered from a hyperthyroid condition subsequently known as Graves’ disease." To me, this reference isn't a very good one. Shouldn't we cite the scholarly studies instead? Too bad the EB doesn't cite them. Also, is it really kosher for one encyclopaedia to cite another? Does anyone know which scholarly studies the EB refers to? L3lackEyedAngels (talk) 15:26, 17 July 2009 (UTC)

Well, until we have a better reference, I'm going to remove Mr. Adams from the list. KLP (talk) 00:24, 18 January 2010 (UTC)

As you can see, I've added a bunch of external links about Graves' disease. I've had Graves' disease for many years, and have been roaming the internet for information the past three years. There's a lot of info on the web, not all of it of great quality. I've taken good care to add only high quality links: there is realy good information in them. I structured the links into subtitles, so it's quite overviewable. As for the forums: there are many on the web, so I've added the most active. I believe they are relevant, because they provide the possibility to see "inside". Same with the personal stories. I've seen a LOT of Graves info on the web, and this selection contains really the best websites I've encountered. There's always room for improvement, of course, but for a large part I think it's a valuable add to the article. Correct me if I'm wrong. Sevák Tzevánerig (talk) 03:02, 27 May 2009 (UTC)

I actually just tagged the External Links as getting too long, and containing links to be avoided. My advice would be to look at WP:External Links. That page provides guidelines (not policies) about what should and (generally) should not be included in the External Links section of a WP article. For example:

Links in the "External links" section should be kept to a minimum.

And:

Each link should be considered on its merits, using the following guidelines. As the number of external links in an article grows longer, assessment should become stricter.

Check out other medical articles to get a sense of how large the External Links sections are for other similar articles. I think you'll see that this one stands out as being much longer.

You may also want to check the list of links generally to be avoided at WP:ELNO. Both open wikis (like graves.medshelf.org) and discussion forums (you have added several) are on that list. There are also multiple links to the same site (several instances), which is also to be avoided.

You may want to read through the links I provided above, and take another pass at the External Links list, thinning it down somewhat and removing some of the "to be avoided" links. --Transity ^{(talk • contribs)} 03:24, 27 May 2009 (UTC)

Hey Transity. First of, thanks for the advice, feedback, and corrections lately. I've read the wikipedia guidelines on external links, but I'm basicly sticking to my point. Even more so, actually. I'll try to make clear why.

Is the whole purpose of wikipedia not to combine all 'our' knowledge, to make an elaborate 'product' about a certain topic? And is the integration of the web not a very usefull extension of the very idea on which wikipedia is based? Not all the links in this section are of "scientifc sources", but would it not be unscientific to just include "scientific" knowledge? I'm not saying pseudoscience and wrong information. I'm saying, e.g., that the reports of the conscious minds of humans who are experiencing the "object of our affection" (in this case, Graves disease) first hand, are an essential piece of the puzzle in providing a nuanced picture of the subject (The patient experience...). It's not scientific knowledge per se, but it sure makes for a better understanding. There's a lot of people out there, who are creating a lot of knowledge on the web, and certainly not all contribute to wikipedia. Above that, there are limits to an article. Besides all the scientific knowledge, which we try to add as completely as possible into an article, there's also knowledge that doesn't fall into the category "scientific knowledge".

A lot of people who are, directly or indirectly, confronted with Graves disease, will turn to the web for information. Wikipedia is most likely their first step. Is it not tremendously usefull when, besides the article itself, all the webs resources concerning the disease, have been assessed by someone who's seen it all, and has added the links he deemed most qualitative? By adding links to forums, you are providing good places for patients to turn to. It also provides "scientists" with the places where they can see Graves disease in action, so to speak. You do not provide all forums, you provide the best ones. That implies that you have seen a lot of them, and assessed them. So yes, there's some sort of original "reaserch" in this, but being "scientifically correct" isn't scientific. Just be scientific.

Honestly, I think it is one of the things that is lacking in many articles on wikipedia. When you provide no external links, it's as if you close yourself of from the world, so to speak. And that is not 'wikipedian', or scientific, if you will.

Take the futured article Autism. One link? That's actually a bit pathetic. Come on, there's a whole world out there. People who are knowledgable about the topic can and should add the internet's best 'resources'. It's the same as a scientific book: a lot of its merrit comes from the bibliography/further reading section it provides at the end (that is not exhaustive, but qualitative: in researching the subject, the author has seen and assessed a lot of resources; why waste all that work and let your knowledge about the zillion resources out there evaporate into thin air?). You cannot stand on your own. Wikipedia has a tremendous potential of being a quality guide to the web's resources. This idea should be developed more, and find it's way in a more elaborate manner into the external links guidelines.

Above that, the external links should be more structured. Take the futured article influenza. There's no overview, no structure. What about the futured article Tooth enamel? Links are provided, but without a guide. You should just figure it all out by yourself. That way, some knowledge has been left untapped. The person who has added the link, has done that for a purpose: because he thought it a usefull link. But why not add the reason? What is the link about, what does it contain? Just links without context... Be bold, I say.

If there are a lot of usefull links, you should not limit the number of links just for the purpose of some guideline. Yes, you should make your assessment more stricter. That has been the case in the collection of links I have presented. Rather, I believe it usefull to create a structure, so the higher number of links don't become a cluttered heap. If you compare the Graves disease external links section to the external links section of the futured article influenza, what looks best? What gives the best overview? Or look at tuberculosis. Yes, some structure is provided, but it's still lacking, still gives a cluttered impression. By the way, this futured article has about the same number of links as Graves disease, if you leave the video's out.

So, basicly I'm saying that the following applies here: "Wikipedia has many rules. Instead of following every rule, it is acceptable to use common sense as you go about editing. Being too wrapped up in rules can cause you to lose perspective, so there are times when it is better to ignore a rule." Be bold...

Actually, following this bolder idea of the external links, I'll add another section in the external link chapter. Look at it, and think about it. From a humanistic, pure knowledgeable point of view. It may be onorthodox, but it is more "scientific" than a conservative approach to the external links section... And yes, it contains some sort of "original research", but it's an assessment of the sources 'out there'.

So my conclusion: I love wikipedia, but I believe the external links section is embryional in many articles, and there should be a more "scientific", broader, visionary idea as the the how and why of internet links. It's an untapped opportunity. We are the internet. There is not one place for knowledge. There are many. And they should use each other. They should be assessed and gathered. The value of an article is so much higher with a qualitative, extensive, structurised links section.

Just some thoughts I had... What do you think? Sevák Tzevánerig (talk) 21:24, 27 May 2009 (UTC)

Oh, and the two cases where I added multiple links to the same website, is justified, I believe. The wrong-diagnosis site has a structural problem, which I tried to solve through the multiple links. Te thyroid surgery site contains three good articles, which I tried to make clear by the multiple links. Sevák Tzevánerig (talk) 21:57, 27 May 2009 (UTC)

• I have removed all of the external links from the article, as I don't see how any of them can be justified under the guidelines for external links. This is an encyclopedia, not a web directory. Phil Bridger (talk) 22:16, 27 May 2009 (UTC)

The following comment from Transity was copy/pasted from User talk:Sevák Tzevánerig by Sevák Tzevánerig.

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It looks like the External Links were removed entirely while we were talking, with the intent that any additions are to be discussed first on the Talk page. I was in the middle of making notes on which ones I'd support keeping and which ones I would support removing. I'll share those notes with you here. If you want to suggest adds, this is where my head is at the moment.

As a note, my objections to the links had nothing to do with "unscientific" approaches. I have no problem including patient accounts (etc.) that are not accounts from peer-reviewed journals. My objection was the length (which was, in my opinion, overwhelming the article itself), and the inclusion of some links that seemed contrary to the guidelines on External Links (WP:EL). And yes, ignore all rules is sometimes the way to go, but I'm not convinced that's the case with this lengthy list of links.

Don't forget that none of us made the rules here. WP set up guidelines for how they'd like External Links to be approached. I may or may not agree with their guidelines, but unless there's a good reason for ignoring them, I tend to favor listening to them. Should this be a one-stop-shop for all things Graves' disease (and thyroid dysfunction)? That's not how the site is setup, no. Would such a site be useful? Sure, but WP seems to be saying that it isn't what they want here.

Finally, in my notes, I didn't address the last section you added as they weren't up when I made this list. In general, while I may agree personally with the need to call out quackery for what it is, I don't think the WP External Links is the best place to do so.

Anyway, here are my notes, for what they are worth. Anything listed as "keep" is a provisional keep since I haven't looked extensively at all of these sites yet, and there could be something there to change my mind. Of course, it's possible that I could be talked into others as well. Feel free to delete my notes if they clutter your page too much.

--Transity ^{(talk • contribs)} 02:16, 28 May 2009 (UTC)

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Thanks for your elaborate reply. I added your input on the article discussion page, as you can see, hope you don't mind, but that's what it's for. As for my previous input, I didn't want to fence with the word scientific, but it was just a means to explore an idea, one of which I still support. However, I agree that the assessment should be very strict when adding many links, so I took a more sceptic look and indeed, some links can be striked. The five graves disease stories I had already deleted, before someone deleted everything.

I made a new stub-article about the thyroid disease health scams, as e-book health scams are a wide phenomenom on the internet, and there's not yet a wikipedia article about it. So I've added thyroid Disease Health Scam in the See Also Section. As for the forums, I would keep one, namely the one from the National Graves Disease Foundation, as it's the most active Graves disease forum around. And if you're gonna have a "patient experience" section, you should have at least one forum.

As for the repeat links: I think it's a merrit to single some sections of the website out ("repeat") as many website are so large, that excellent information doesn't come to the surfice so easily as it should. So I'm in favour of keeping them: they would stand on their own, and would be added if they were not part of an already stated website. It's not there fault that they're snowed in...

Partly touching the same problem, are the videos. Yes, they are also repeats, but videos provide an easy information acces, and should be put on the foreground. And they are all good videos.

I striked the link to the 30 articles compilation, as it's too small a compilation.

The thyroid Australia I suggest keeping. Acces does not require membership, only full access does. Even without membership, you are provided with quality, very trustworthy information. Above that, in my 9 years of Graves disease experience, I've found it one of the best places for information... Very high quality.

As for the Wrong-Diagnosis repeat links... It's a tricky one, and I definitely see your objection. But the site is good, except for one thing: it has a very confusing structure. As a Graves patient, I experienced all the symptoms that are involved with this illness, and many of them are mental: confusion, lack of concentration, lack of overview are 'prevalent'. Which makes sites like this very frustrating. Hence I made a selection of all the usable sections of the website. I sugest you try to naviagte and understand the website. Then check out http://www.wrongdiagnosis.com/g/graves_disease/intro.htm#contents, to see what I mean, and tell me what you think. Maybe it's just me, but...

As for the h2g2 article, it's actually quite good, and contains some footnotes. If you want to really assess it, also check out this talk page of some patients http://www.bbc.co.uk/dna/h2g2/F83234?thread=169927. It's a complicated disease... So I'm in favor of keeping this website.

I'll make the adjustments, so anybody willing to join in this discussion, please do, but don't just delete it all. Use some tact, will ya, you're not the only one who's putting a lot of their time in it, trying to honestly make a better article... —Preceding unsigned comment added by Sevák Tzevánerig (talk • contribs) 15:09, 29 May 2009 (UTC)

I honestly don't think that this is the place to step people through the various sections of other sites via individual links to specific articles, entries or videos. We should provide one link to sites like thyroid.about.com and wrongdiagnosis, and let people navigate those sites themselves.

The list is still significantly too long (IMO). I understand your arguments, but I'm still in the same place I was when I took my notes (above) with a few exceptions (removing more links than I suggested above, in fact). Here's my version of the list, down to six entries, all of which link to main pages of solid sources (as opposed to individual articles, videos, or entries on each site):

• Medline Plus Medical Encyclopedia entry for Graves' Disease: Information on causes, symptoms, treatments and complications
• Wrong Diagnosis entry for Graves' Disease: Extensive array of information on Graves' disease
• Columbia University's New York Thyroid Center: Wide array of information on Thyroid dysfunction
• Endocrineweb entry about the Thyroid Gland
• Thyroid Disease Manager: Analysis of all aspects of human thyroid disease and thyroid physiology
• Thyroid portal at About.com: Managed by health activist and patient advocate Mary Shomon

I know you want to include more, but I really don't think this is the place to create a "one stop shop" for all of the information you gathered.

I removed the link to thyroid-info.com as it is also maintained by Mary Shomon (like thyroid.about.com) and because it reads at times like a page of adverts for books, seminars, and supplements. In addition, a lot of these are links to general information about the Thyroid and Thyroid disorders, and not to information specifically about Graves' disease. But with the possible exception of the last link, I think these are acceptable, and I think this list is of the proper length. --Transity ^{(talk • contribs)} 19:57, 29 May 2009 (UTC)

I've added several links to their appropriate section: the links about thyroid surgery in the article about thyroid surgery, links about thyroid disease more general, in the article thyroid disease, etc. The endocrine web article adds very little, and is actually quite limited, so I striked it. The article about osteoporisis should stay, untill somebody implements the content into the article. The h2g2 article is a full sized article that adds a lot of colour to the issue, has footnotes, and so in my opinion, should stay. it addresses issues that are not adressed in the WP article, so untill that happens... As for the video's, I moved Gail dever's story to the patient experience section; the rest of the videos adress the automimmune condition directly, and future highly educated people, so I'm not striking them. As for the patient experience: the merrit of adding such a section, is, in my opinion, quite obvious. Why would you delete them? I do not understand. They are the people who are in the center of the subject, they are the robots that are on Mars, have direct access. Yes, it is subjective, but I don't think that should be a problem. And yes, it is generally not done in WP articles about diseases, but that doens't mean it shouldn't be done. The external links section are mostly underdeveloped, with no structure or general approach, and doesn't get the attention it deserves, in my opinion. It's an innovative apporach to a fully nuanced article, so I won't budge on this. We obviously won't agree on the issues that are left, so I think we can use some other objective opinions. If more are against the idea than for it, so be it, but I still think it would be a loss. Sevák Tzevánerig (talk) 13:56, 31 May 2009 (UTC)

Personally I hate to lose information, and there's nothing wrong with creating a stand-alone list article (see WP:LIST called List of links for information relating to Graves' disease. You can then put in in the best half dozen or so as a summmary of this, and expand to include all the good links you have in the list-of-links article, which can serve as the summary article for the links subsection, as per WP:SS. I'm going to go ahead and create the list of links article, and see what you can do with it. It needs a header and cat tags. SBHarris 22:55, 2 June 2009 (UTC)

I moved List of links for information relating to Graves' disease to User:Sbharris/sandbox in accordance with my shoot-first-ask-questions-later policy. I now see that it is stuff hived off the parent article and that it had been discussed. But even so, I suggest you seek support at talk:Graves' disease before moving it back. Why not put it on your website? Or downgrade it to a sub-page of talk:Graves' disease? — RHaworth (Talk | contribs) 23:27, 2 June 2009 (UTC)

Excuse me? What makes you think you get to use "shoot first, ask questions later," and not I? Since I did indeed act first. The article I created was an exquistitely sourced and verifiable list of links which works fine as a stand alone list, and an expansion of the subsection of external links in the main article. It solves several problems. What you've done now is speedily delete an article out of process, for reasons which you cannot defend. Take a look at List of Chinese people. Not to be impolite, but why don't you insert that one into YOUR sandbox? You are not helping to solve problems, here. SBHarris 23:37, 2 June 2009 (UTC)

List of Chinese people is a list of internal Wikipedia links. Major difference between that and a list of external links. Ridernyc (talk) 02:23, 3 June 2009 (UTC)

While there is indeed a difference bewteen a list of internal links and a list of external links, I think it's quite a good idea to make a seperate article containing links, if the list is too long; just like when a sub-part of an article is too long, only a summary is included, with a link to the larger article.

By the way, what is the difference with the external link section of the featured article Tuberculosis? It has 18 links... And not all very qualitative, might I add. On top of that, I agree with Sbharris that the length is not an appropriate criteria for just striking links.

For now, I've created a good selection of links in the external link section, and worked out the new article List of links for information relating to Graves' disease.

As for the embryonic state of the idea of the external link section, I think a few good points have been made in this discussion. E.g. if you add a link to a foundation about a disease, why this particular foundation? Why not every foundation, for that matter? What are your criteria for excluding the others? It's just totally random. There is no disclaimer. The guidelines appear to be: add random good links, in random order, don't add structure to the section... I find it quite chaotic. 84.195.7.42 (talk) 13:23, 3 June 2009 (UTC)

Tuberculosis has 18 links, and at a glance they don't seem to be contrary to the guidelines on external links. This article had upwards of 60 links, and most of them were contrary to those guidelines (expand my notes above to see what I mean). So while the length of the list of external links is relevant (as stated in the guidelines), the content of the links was also in question. Personally, I think the list is probably too short now (some good links have been cut, and I doubt the separate list article will survive a request for deletion given the guidelines at what Wikipedia is not). --Transity ^{(talk • contribs)} 14:23, 3 June 2009 (UTC)

60 links ain't a fair number to fence with: that was due to the duplicate links issue, which is already a thing of the past (for most part). I had reduced the number of links further down to less than 20, and defended every one that was left. The use of a stand-alone article for links on Graves' disease would give more freedom in adding links, hence e.g. instead of one thyroid forum, I inserted the three most valuable on the net: the forum of the NGDF is part of the foundation, and monitored quite sharply by qualified medical personel. The forum of Mary Shomon is monitored by this woman, who wrote several books on thyroid diseases, and has a reputation of being very "scientific" in her assessments. The other forum I added for it's very good overview and indication of the central issues with thyroid disease, and the activity of its members.

The whole idea of a more elaborate external links section, seems to be new and progressive, and thus it must not be strictly assessed by the guidelines that exist, but by the merrit that arises by adding these extra links to this particular article (i.e. common sense). Ask yourself this: why do some feautured articles contain like a dozen links, and some contain absolutely none? Seems to me a clear indication the guidelines concerning external links are lacking, and should be explored further. Sevák Tzevánerig (talk) 16:24, 3 June 2009 (UTC)

(undent) I certainly didn't mean to misrepresent you - I merely counted the links on the newly-created List page.

Either way, though, I have concerns with the items in the list (both the 60+ link list and the 20ish link list). I understand that the guidelines are just that - guidelines - but take it as my opinion that, by and large, I agree with those guidelines. I agree that, as a list of external links grows longer, the criteria for adding links should become more stringent. I agree that multiple links to the same site should be avoided. I think that open wikis and forums should be carefully assessed and only included if they are truly worthy of note. I do, however, like the idea of External Links, and if good links exist, I feel they should be included.

Of course on all these points, YMMV, which is why we're having this discussion. In my opinion (which is all I can speak for), a list of 6-10 of the best links from the original list are appropriate (based on number and content). Any more, and I feel that the sources become less useful, and the list threatens to overwhelm the article. Any less and I feel that we are cutting out some good links. Others have expressed other opinions above. Somewhere amongst all this text is a good answer. My suggestions are pretty well documented, so I don't think I have much more to say at this time. --Transity ^{(talk • contribs)} 17:03, 3 June 2009 (UTC)

So far, Sevák Tzevánerig, no one here has agreed with the expanded list, and several editors have pointedly disagreed with it. You are adding it back against the current consensus. I, for one, have pretty clearly spelled out my issues with the overwhelming majority of these links, and I will remove the ones that I disagree with. This list, as you've re-added it, is still way too long, and still contains many links that fly in the face of WP:ELNO. I'm sorry, but please don't add them back against consensus. Build a consensus first, then add them. --Transity ^{(talk • contribs)} 16:39, 10 June 2009 (UTC)

Done. Please note that for any edit summary referencing WP:ELNO #4, I actually meant WP:ELPOINTS #4 - my mistake. The sentiment still holds, though. There are still links on this list that I favor deleting, but for now I've only removed the ones that I see as truly problematic. The ones listed below are still in the article, though I consider them sub par (IMO):

• Thyroid Australia - borderline since some info is only for paid members
• h2g2 entry on Graves' disease (see h2g2) - borderline as an open wiki, though I know WP uses h2g2 elsewhere
• Graves' Disease Explained Through Symbolism: An artistic take on a patient's experiences with Graves' disease - borderline as it doesn't seem all that useful
• Tim Bennie: A patient's description of his personal experience with hyperthyroidism - borderline as self-published anecdotes
• Twenty personal stories: With pictures of Graves' eye disease, and contact information - borderline as a series of anecdotes

Please don't just add the removed links back without some kind of consensus. --Transity ^{(talk • contribs)} 17:30, 10 June 2009 (UTC)

I would like to add my support to Transity's comments. Wikipedia is an encyclopedia, not a web directory. Phil Bridger (talk) 19:19, 10 June 2009 (UTC)

As for now, there's only two people who have actually made it clear they are against my approach. Two are in favor. As for the discussion, Transity has made his view clear, and provided some arguments. I believe I've adressed every one of them, and so this discussion has not ended. You cannot just repeat your argument, and say, that's that, case settled. 'Cause that's what's basicly been going on here. Take Phil Bridger argument: "Wikipedia is an encyclopedia, not a web directory". And that's it. Quite an empty argument, if I may say so. I think I made some valuable points against that idea, but haven't gotten a meaningfull response to them. I try to honestly explore this idea of a more elaborate external link section, with what I believe are very reasonable arguments. As for now, I've moved my selection with a minor exploration to my talk page, for the time being.

As for the selection that exists on the Graves' disease article at this point, I got some remarks.

THYROID FOUNDATIONS. The link to the American Thyroid Association was added, and also the link to the National Graves' Disease Foundation. Why these foundation particularly? Why not also The Australian Thyroid Foundation, Thyroid Foundation of Canada, Thyroid Patient Advocacy UK, Thyroid UK, British Thyroid Association, British Thyroid Foundation, European Euthyroid Project, European Thyroid Association, Latin American Thyroid Association, Trifoundation, Thyroid Federation International? (and there are more) What merrits the selection of these two thyroid foundations, and why not one of the others? My thought: totally random! The reason I added the thyroid foundation of Australia link, was that it has VERY good information, compared to many other ones. The National Graves Disease Information link that was added, has VERY little information, and actually adds nothing to the article. The only reason that would merrit the add, would be that the link would be part of a section called Thyroid Foundations. This, however, has, IMO, no merrit, as the only people who would benefit from thyroid foundations websites, are patients, and they usually get to the thyroid foundation of their country pretty naturaly. Adding a link to a thyroid foundation would thus only be valuable in two occations: a) they have a generally very good site, or b) they have a good section on a particular subject of Graves' disease. In this case, the link to that particular section should be added, NOT to the homepage of the website. Hence the particlar links two two (of the many) PDF document from the American Thyroid Association, instead of to the homepage; what's the use of linking to the homepage? In the reasoning used, this link would only be valuable if you add all the thyroid foundations to the external links section.

The links exist (and should be added/assessed) in relation to the other links and the article, not as links on there own. It's ONE article, that USES other links to expand it's horizon. The link section is an integral part of the article.

Endocrineweb entry about the Thyroid Gland Poor link; adds nothing to the article. Only section of this website that grants inclusion, is the article about thyroid surgery. The rest is futile. By not cutting into websites (like this) you are creating a flood of information, in which it is easy to drown. The removal of some of the 'small introductions' that were provided, has the same effect. It explains why this or that link is included in the selection, and it tells the reader what to expect, gives a small introduction that lubricates the persons entry to the website he knows nothing about. This introduction should be kept as short, but informative as possible. Overview and clarity is an important issue. Thyroid Disease, Osteoporosis, and Calcium: Article about thyroid disease and the risk of osteoporosis from MedicineNet. The article title can be omitted. The main information is "Article about thyroid disease and the risk of osteoporosis". I would indeed add the MedicineNet internal link, plus the fact that it's been written by an MD. That's all the info you need.

"h2g2 entry on Graves' disease (see h2g2)" Someone who comes for the graves' disease article, doesn't come to learn a lot about the website h2g2. The context information should be provided quickly and shortly, without having to lead them to the Wikipedia article about h2g2, to see in what light they should read that particluar article. So, I believe it's better so say "From the peer-reviewed online encyclopedia h2g2". Date fo the article is important, as medicine developes. "Quite a good article" was my small introduction. What else to put? Article? It's quite good. That's information. That's lubricant. That's context, as well.

"Drug Therapy: Antithyroid drugs: Newsletter article from Medicina Interna" Newsletter article? Medicina Interna? By providing the link that way, you are assuming anybody will know what you are talking about. 99.9 % of the people do not know what "newsletter article" or "medicina interna" means. "Elaborate article about the use of thyroid drugs Written by an MD" is all the information that is relevant here.

"Patient information: Antithyroid drugs at UpToDate" Same story here. "Up to date article about antithyroid drugs From the evidence based, peer-reviewed medical information resource UpToDate" Core information: up to date, peer-reviewed... Unnecessary sidesteps should be avoided.

The two links to the free Clinical Thyroidology magazines, are absolute jems, and should be kept.

I do not agree with the deletion of the other websites, for which I have provided arguments before.

What's with the deletion of the three links to info about thyroid surgery? Together, they are brilliant in the information they give of thyroid surgery. I thought about adding them to the Thyroidectomy article, but for now, that's an article you just want to run away from. Very uninviting, if I may say so.

The radioactive iodine link? There is no article about it, so why remove the link? It's a good one.

As for Thyroid Australia I added it because the quality of information it provides jumps out. Yes, not all is free, and payed links are indeed a no-no. But some good things come at a price, that's just the way it sometimes is. IMO, the quality of this link, merrits the exception.

I've added some other arguments for a new approach to the external links section on my user page User:Sevák Tzevánerig Sevák Tzevánerig (talk) 00:33, 11 June 2009 (UTC)

If you're struggling with my position, here it is: you haven't provided any compelling reasons to ignore the guidelines in WP:ELNO and WP:ELPOINTS that I cited in my initial arguments. Yes, we can ignore the rules, but only when there's a compelling reason to do so. I haven't seen one yet. That's my opinion. You've certainly argued your points (in short that it would be useful to sufferers of Graves' disease to use WP as a one-stop shop for such links), but I do not agree that WP is the place to house such a list. That doesn't mean that I'm ignoring your arguments, it means that I don't agree with them.

Regarding the titles of the links, I changed them because it seemed like you were editorializing instead of presenting external links. Saying that something is "quite good" and "written by an MD" seems, in my opinion, to be the wrong tone for external links. Using the actual title of an article, or pointing out that it is the Thyroid section of a certain site is, in my opinion, the way to go. To me, that seems much more encyclopedic.

If you want to strike some of the links still in the article, then by all means, go ahead. I thought they had all been added by you. But if you don't like one or more, then delete them. I can't think of another reason why you would criticize these links, but since no one has defended them as sacrosanct, I feel like I must be missing something. As for my deletions, I did them one-by-one with specific edit summaries so that you could see my reason for deleting each one. So if you have a question about why I deleted something, check the edit summaries in the history first. If I missed a summary for one, then please go ahead and ask me, but I think I got them all.

Also, if you feel that other links (such as some the foundations you listed) are better links, then by all means, say so. That doesn't sound like the case, though. It sounds more like you already think that the better ones are on your list, and that these others are inferior. I can only assume, then, that you're trying to make a point. I question the point you are making, though, since the selection of which foundations to include is a function of your original list. In short, we trusted you to an extent because you said you already had the "best of the best," and we didn't go check out other foundations to test you out. So the answer to why we included these and not those is: we used what you suggested. So it was only random if your initial selection was random. Again, I have to wonder if I am missing something.

Finally, I haven't seen anyone here support the inclusion of any version of your longer lists in the article. I've seen people who supported creating a new article for these links, but no one (thus far) who has agreed that the longer list should be in the article. I would go back to what RHaworth said above: "Why not put it on your website? Or downgrade it to a sub-page of talk:Graves' disease?" That way the information is intact, but it doesn't overwhelm the article, or fly in the face of WP:EL. --Transity ^{(talk • contribs)} 01:28, 11 June 2009 (UTC)

I'm against the inclusion of this list of links here for the same reasons I was against it being spun off into the now deleted article. I have explained my position on this numerous times and been totally ignored and have had to repeat myself several times to the same editor. Edit this list to a manageable amount of links, make it not a directory. In fact remove links that are not providing sourcing for the article that's my stance. Ridernyc (talk) 02:23, 11 June 2009 (UTC)

@ Ridernyc: as far as I can tell, only thing you brought to this discussion was: "List of Chinese people is a list of internal Wikipedia links. Major difference between that and a list of external links." Which is indeed a valid point, there is a difference between internal and external links. But that's no argument against external links; it's an argument against the argument that there are lists of internal links, and that this in itself merrits an external links list. I'm sorry if I missed the repeats of your viewpoints, but they haven't reached me. By structurising the links, they are very maneagable, and instant overview is provided. The grouping in sections has the effect that there aren't as much links as there are.

@ Transity: your arguments are the same as your initial ones, and I have adressed every one of them already. All you do is repeat them.

"deleting four links to videos since we already provide links to the sites that host them". "consolidating four deep links to thyroid.org to one link to the main site". I've adressed this 'doubling' of links. Only counterargument you provide is WP:ELNO and WP:ELPOINTS. Yes, these are the guidelines, I am aware of them. I have, however, provided many arguments to be flexible with the guidelines in this article, and to underscore my BE BOLD approach. The following articles exist for a reason Gaming the system, Don't revert due to no consensus, Wikipedia is not a bureaucracy, Be bold, Ignore all rules, Use common sense and I have tried to make clear why these ideas are apt here. To me, all you are doing seems like "arguing the word of policy to defeat the principles of policy". I've addressed the higher principles several times (better article, more knowledge, more nuances, more real scientific approach to a disease), all you are doing are quoting guidelines, and saying that you agree with the guidelines. Without adressing my arguments that are in line of the higher principles, only debunking them by quoting the guidelines, and that I haven't provided compelling reasons. Do you mind being more specific?

You say that I haven't provided any compelling arguments to flex the guidelines. I actually believe I did succeed in this, and you have so far ignored these ideas. Nevertheless, I've got the feeling I'm utterly failing in explaining the merrits of the selection I presented, and the value of the different onorthodox linking styles. Let me thus again try to adress some of the counterarguments you provide.

First, let me point to the idea that an elaborate external link section is not warranted or possible for every article. However, some articles DO warrant an elaborate external link section, like diseases. Thus, an external link section is not appropriate for every article, but that should not mean some subjects can not use an external link section. There is an enormous variety in the nature of subjects that appear in an encyclopedia: by arguing for "a small number of links" for every article, you are assuming that the nature of everything in the universe is of that same particular nature that only maximum a dozen external links should be added in the external link section of an online encyclopedia, and preferably, much less than a dozen. More external links do not add value to the knowledge of anything. I believe you are mistaken. If you are 'afraid' that the external link section should grow infinitely, then let me assure you: though enormous amounts of websites exist about a single subject, it is a general reality that the number of "golden" links, the really valuable ones, is usually quite modest, not endless, and thus "collectible".

Secondly, some argue: strike links that are 'double'. Meaning: they are part of a website that you already cite. But think about it: if there is a BIG website, with lots of pages, like 1, and somewhere in that mountain, there are two very good videos. Those videos woúld be added if they weren't part of the big website, as they are valuable. Does it not have merrit to pick them out? They stand on there own; it's not they're fault they are snowed in, and are likely to be missed. If someone's research needs aren't extreme, (s)he will most likely not spit out every website in it's entirety. But all reserach levels can use a video: they are very 'easy', accessible, give an easy introduction and add colour, are concrete... They speak to all. If you would not pick them out, only the people who want every detail, will encounter them as they delve extensively through the huge website. For an example of a professional encyclopedia that uses 'double' links: [3]. By not deep linking, you are flooding the reader with unnecessary information. In that case, yes, it's easy to have too many links. But deep linking is a specific, sniper approach, which allows you to provide a lot of good, specific information, without overwhelming the reader. Only linking to main sites is a bad approach, IMO.

Thirdly, you say "You've certainly argued your points (in short that it would be useful to sufferers of Graves' disease to use WP as a one-stop shop for such links". I believe that's quite an unfair summary of my points, actually. Yes, most people that will come to this article are patients (+family & friends), but the higher principle, the main reason, I'm behind the approach I'm taking is not for "a one-stop shop for such links" (not all forums, not all foundations, etc), but for the amelioration of the picture that is created of Graves' disease through the article.

"Regarding the titles of the links, I changed them because it seemed like you were editorializing instead of presenting external links. Saying that something is "quite good" and "written by an MD" seems, in my opinion, to be the wrong tone for external links." I agree that "quite good" is open for amelioration, but this particular example is not representative of the "editorializing " I provided for the other links, which seems to me quite encylopedic, and moreover, a better, more friendly approach to providing external links. I have elaborated this above; by pointing out the one weak point ("quite good") does not invalidate the approach I proposed. By cutting short the information that was added to the external links (the "lubrication"), you are assuming people a) know what (e.g.) h2g2 is (which is not the case for a lot of people), or b) are willing, and have the time to, go to the internal link you are proving for h2g2. This is mostly not the case. Why not add "From the online wiki-encyclopedia h2g2"? You are assuming knowledge that is simply not present in the reader. "See h2g2"? People don't come here to see h2g2, they come for the external link, the relevant core information about h2g2 should be provided before they go to the link, and without them having to deduct it from the article itself.

"removing link to Gail Devers video (per WP:ELNO #4, and because we already use this source as a reference in the main article, under notable sufferers" None of the other notable sufferers have any elaboration about their illness. So Gail Devers video link seems to be appropriate here, under the patient experience. You are assuming everybody will check out the article for every single notable sufferer.

" replacing deep link to ngdf.org forum with link to main site (per WP:ELPOINTS #4, and WP:ELNO #10". I've already addressed the deep link issue before. NGDF main site adds nothing whatsover to the article. It's just quite irrelevant information (in relation to what links already are available). Above that, the deep link to the forum is almost invisible. Merrits to pick it out, as an example of a forum in the patient experience section.

"moved h2g2 entry up, and changed wording (not a peer-reviewed encylopedia, but rather an open-wiki, which are usually not preferred per WP:ELNO #12)" Yes, indeed, rather open-wiki. And yes, usually not preferred, but it is the article that is at the center here, not the website. I've defended this article before.

"replacing deep link to NY Thyroid Center with link to main site". Only relevant info is the thyroid surgery info -> deep link merrited

"striking link to thyroid-info.com as it seems to have a lot of ads for the author's products and books (WP:ELNO #5))" The link is NOT about the website, it is about the article, which gives a good overview/answer to the whole controversy about the thyroid drugs. Mary Shomon is a well respected and the most well-known thyroid advocate, who has written numerous books, and takes a very scientific and reasonable approach to thyroid issues, always trying to give people the best information, debunking pseudo-science, quoting scientif reearch, etc.

About the thyroid foundation websites. I see that you added them because I added them. I only added them for their particular deep link, not their main website. If you link to the main website of only two thyroid foundations websites, you give the idea a selection is made, which has not happened, and thus, the links should be considered random and biased. If you give the link to a deep link of a thyroid foundation, you also give the idea a selection is made, and this is correct: the best is selected and provided.

As a sidenote, check out the approach Wikidoc [4] takes on external links: on the right side, you have a ton of internet resources. There is some merrit in what they do, like guiding the reader to the internet resources, but they mostly do not single out the good stuff. Which is my approach here. Sevák Tzevánerig (talk) 14:20, 11 June 2009 (UTC)

The reason that my arguments sound a lot like my original arguments is because, in my opinion, you've said nothing to sway me from that initial stance. I'm not ignoring your arguments, they just aren't convincing me of anything. And repeating your arguments stands very little chance of doing so. So yes, you have failed in explaining the merits of your position, but not because I'm "ignoring" you. I just don't agree with your points.

And lest you continue to think that I'm just quoting policy for policy's sake, let me be blunt. I think the longer lists that you've provided overwhelm the article (as I've said before), and I think that the inclusion of many links to the same site smacks of nannying and hand-holding, and I am against it. I do not feel that it is necessary or even beneficial to point people to every part of a given website that you happen to feel is worthwhile. I feel that pointing them to the site and letting them do their own research so that they can find what is important to them is the superior approach. The guidelines seem to agree with me on these points, which is why I'm quoting them - not just to be anal.

Regarding the Gail Devers video, all I can say is that it's pretty widely accepted that External Links are for links that don't already exist in the article itself. Since this link is already used in the Notable Sufferers section, it shouldn't be included in the External Links. Once again, your assumption that people won't check the references in an article smacks of hand-holding.

Regarding forums, I agree with the guidelines that forums are generally to be avoided. While there is some value in forum discussions, there is also invariably a lot of incorrect and sometimes dangerous information. So instead of linking to the forums, I've changed the links to go directly to a main site that also includes that forum (in some cases). This lets people use the site, and decide if they want to use the forum. I would think that would be a good compromise.

Most disturbingly you say:

I've adressed this 'doubling' of links. Only counterargument you provide is WP:ELNO and WP:ELPOINTS. Yes, these are the guidelines, I am aware of them. I have, however, provided many arguments to be flexible with the guidelines in this article, and to underscore my BE BOLD approach. The following articles exist for a reason Gaming the system, Don't revert due to no consensus, Wikipedia is not a bureaucracy, Be bold, Ignore all rules, Use common sense and I have tried to make clear why these ideas are apt here. To me, all you are doing seems like "arguing the word of policy to defeat the principles of policy". I've addressed the higher principles several times (better article, more knowledge, more nuances, more real scientific approach to a disease), all you are doing are quoting guidelines, and saying that you agree with the guidelines. Without adressing my arguments that are in line of the higher principles, only debunking them by quoting the guidelines, and that I haven't provided compelling reasons. Do you mind being more specific?

I've been as specific as I can be at this point. I don't agree with the hand-holding approach that you are arguing for. I think that people should be pointed to a larger site so that they can find their own "nuggets of gold," rather than being shoved into yours. Maybe that's too blunt, but I honestly don't know how else to say it at this point. And yes, we should ignore all rules, but not every time. And as I've said many, many times, you haven't shown me a compelling reason to do so in this case. That's as direct as I can be.

I'd also caution you at this point to assume good faith as the quote above seems highly accusatory (and off-base). It seems that your frustration is starting to show through. Please don't assume my motives, or that I've ignored your arguments. Please don't accuse me of gaming the system, or of making reverts without consensus as I most certainly haven't done those things.

At this point, I'd suggest one of two approaches since the consensus is against you here. First, you can try to argue for the insertion of one link at a time. That would eliminate these huge walls of text that you keep creating, and perhaps you could win over some people on a point-by-point basis. Second, if you don't want to do that, and if you want to keep arguing this holistically, then I suggest you take this to RfC. --Transity ^{(talk • contribs)} 16:23, 11 June 2009 (UTC)

"the longer lists that you've provided overwhelm the article" I don't think that quantity should be an issue, only the quality of the links. The article is generaly OK, but there's room for improvement. The external link section provides an opportunity to fill the gaps untill somebody expands those sections of the article, e.g. thyroid drugs, thyroid surgery. Your line of thought would mean that if an article is a stub, then please don't add any external links, because they will overwhelm the article. I think adding links can, on the contrary, give an incentive to improve the article in the places that are still lacking. Articles are always a work in progress on Wikipedia, and thus the length of the article should have no impact on the length of the links. Quality is the criterion, quantity has little to do with it. If the number of quality links becomes cluttering, and the overview is lost, one should group the links, not strike perfectly good links.

• Please don't assign me a position, or try to extend my position to apply it elsewhere. I consider each edit on its merits, and your characterization here is inaccurate. It is also off topic. My point is that a list the size of the ones you've suggested would overwhelm this article, and I stand by that statement. Other lists on other articles would be judged separately.-Inline response by Transity
  • The use of reasonable extrapolation of an idea is an often used and acknowledged method in debate. I don't believe I raped your thought, I only wanted to explore your line of thought, in order to show that it is, IMO, flawed, in this article, and in the view of the arguments I have provided. You have, again, stayed on the surface and used a very general counterargument that doesn't say anything. WHY does this overwhelm this article, and why is that a bad thing? How does your one argument neutralize my arguments about the length of the list? Why is this off topic? I have so far written down several specific reasons that go against your idea. You claim to be very specific, but I cannot fail to judge that you haven't elaborated anything, and have not adressed my specific counterarguments and broader ideas that support a longer external list link. -Inline response by User:Sevák Tzevánerig

"I think that the inclusion of many links to the same site smacks of nannying and hand-holding". How does that possibly merrit the label "nannying and hand-holding"? By giving links in an external links section, you have already decided which of the thousands of links are good and which are not. Why suddenly stop that approach on the level of the websites themselves? There is little distinction in assessing which websites are worthwile, and which parts of a website are worthwile. If you really want to avoid being a nanny, you should follow the approach of Wikidoc, e.g, for the most cited articles about Graves' disease, they link to [5]. So, if one would push your argument a bit further, the only external link that should be added in our article, is this one: [6]. Above that, I've provided an example of deep-linking by a professional encyclopedia (scholars), are they hand-holding the reader? What about the link to the article about thyroid drugs on UpToDate [7]: following your line of thinking, we should instead provide the more general link [8], because there are also articles about hyperthyroidism, hypothyroidism, and antibodies, all issues a person with Graves' disease will be confronted with. Although I admit the analogy isn't completely correct, as it is not a website specifically about Graves' disease, one could assume that the search results would stand for the "homepage" about Graves' disease on the UpToDate website. The articles about hyper-, hypothyroidism, antibodies, don't add anything to what is already stated in the WP article and what is already included in other links, neither do the members-only articles (as they are not accessible). Why not cut away with all that irrelevant information? That's the basic thinking behind the deep-linking approad. "I do not feel that it is necessary or even beneficial to point people to every part of a given website that you happen to feel is worthwhile". You are overstating my use of this approach, there are only a few instances.

• You wanted the specific reason that I agree with the guidelines on deep linking, and I gave it to you. I get that you don't agree with me. Once again you've assigned me a position that is inaccurate. Please don't extend my position to such an extreme that it is no longer representative of my position. In addition, a link to a Google search (or an UpToDate search) result is against WP:EL. (Yes, that last sentence is at least half presented tongue-in-cheek.) -Inline response by Transity
  • Again, reasonable exploration by extrapolation. On top of that, I have specifically said that the analogy and extrapolation is not 100%, and has been pushed a bit; but, despite these small flaws (inherent in an extrapolation), I don't see how it is not a good one. And yes, you have given me an argument. I have provided numerous arguments against your argument and in favor of the deep-linking issue. Yet, instead of adressing my counterarguments, you just repeat your initial argument, which, by the rules of debate, has been 'neutralised/discredited' by my counterarguments, untill you 'save' it by adressing my counterarguments. Don't want to be a dick by this kind of talk, but seriously, you say you're specific, I still think you're general, and are not adressing my counterarguments against your argument, instead only repeating your initial argument and assuming that that'll do.-Inline response by User:Sevák Tzevánerig

"your assumption that people won't check the references in an article smacks of hand-holding" It is actually quite a realistic assumption... Most people aren't diggers. What is wrong with guiding the way? You are doing it aleardy on the level of an external links section, why not be consistent, and do it all the way? That way, the selection you provide makes more sense, and will not overwhelm with double information. The quality of a link is not only assessed on its own, but also in relation to the other links that are added in the external links section.

• My opinion is that we should point people to good resources, and let them do their own research on those sites. If a site is useless other than one article, then yes we can link to that article instead of the main site. If that's what you're saying for one or more of the links, then please specifically call it out. But if you feel the need to link to 2+ parts of a given site, then perhaps other areas also have merit. And perhaps what you find useful doesn't match with what others would find useful. That's why I don't agree with this argument. -Inline response by Transity
  • YES, that is what I have been saying all along, are you kidding me? Mostly deep-linking is used when indeed the website is useless other than one article (useless in the light of the information that is already provided once or more in the WP article and the other links in the list - this is not a personal assessment in se: everybody who reads the article and has explored all the links in depth, can see what information is double, and when linking to the main site is to be avoided, as only the specific sub-page is of use in the selection of links that is added to this specific WP-article). That's one issue with the deep-linking that we agree upon, and is actually a fairly general use in Wikipedia articles. The other deep-linking that is the subject of this debate is when 2+ links of the same website are reffered to. This is, in the link I am proposing, the case for the "voluminous" websites wrongdiagnosis and about.com. I have given numerous specific arguments why these four videos deserve to be picked out, and put in the list, under the heading VIDEOS. I have given arguments why I think it is merritable to "guide" readers who want to know more about Graves' disease, to this videos. Yet, you have not adressed my specific arguments and counterarguments against your arguments, and again, basicly are repeating your initial arguments, which I have already adressed in dept. Have you even seen the entire videos? They provide core information of Graves' disease. The two from about.com explore the automimmune cause of Graves disease (and thyroid disease), the root cause of the disease. They give a visualisation of the cause, and it's effect in the body. The videos picked out from the voluminous website wrongdiagnosis, also go the core issues about the disease, explained by qualified medical personel. Together, the videos enrich the external links section (and the article) by enlarging the variety of the nature of information. If Wikipedia owned the copyright, them videos would have been implemented into the article itself, or referred to in Wikipedia Commons. Instead of buying the bloody copyright, we can cheaply link to it... -Inline response by User:Sevák Tzevánerig

"Regarding forums, I agree with the guidelines that forums are generally to be avoided. While there is some value in forum discussions, there is also invariably a lot of incorrect and sometimes dangerous information. So instead of linking to the forums, I've changed the links to go directly to a main site that also includes that forum (in some cases). This lets people use the site, and decide if they want to use the forum. I would think that would be a good compromise." The point of a patient experience section, is to disclose the source of the science, the disease itself. The point is not to provide facts, but an inside look into the human experience of Graves' disease. Seems pretty clear that one shouldn't look for scientific facts in the patient experience section. So your deletion of the forum and instead adding a link to the main website of NGDF (which holds little information and only an obscure link to the forum), does that not smack of nannying and hand-holding? Above that, I've only added one single forum, clearly saying it is just an example, and the most active Graves' disease forum in existence, so it's a good example (besides, this one is under the supervision -albeit loose- of experienced people, people who've written books on the topic -albeit not scientific ones- but who have a lot of experience in Graves' disease information, and are related to the foundation)

• I don't see how my change constitutes hand-holding, no. I see how it sends someone to a site that happens to contain a forum (and other information), and it lets them decide what information to look at. I'd say that's the opposite of hand-holding. -Inline response by Transity
  • Do you think the main website NGDF should be added to the links? I don't think you are actually proposing this, but nevertheless, if you actually check out the information that is on the site, you can easily see that there isn't much information about the disease, and certainly nothing that is not already addressed by the article/links, better and in more depth. If this link should be included in the list, the only reason would be that it is an example of a Graves disease foundation. Which might or might not be usefull in the external link section. I am neutral on this website. If you want to add it, you should reserach the other Graves' foundations, and decide which one is/are the "best" to add. To me, the only reasonable "article" of this website, is the forum, as part of the section Patient Experience. To adress you hand-holding argument: if one doesn't want to see an example (the best example, might I add) of a Graves disease online bulletin board, or a (good, might I add) collection of links around the patient experience, then what holds them from not going to them? It's all properly and clearly marked what websites the links go to, so shouldn't be a problem to filter what people want or don't want to go to.-Inline response by User:Sevák Tzevánerig

By providing those links to the Wikipedia guidelines on the BE BOLD topic (and co), my intend was not to be accusatory, but merely pointing out that there is a good reason why there are so many articles around the general guideline of being bold, in Wikipedia. As they are the base of my arguments, I don't think I was being off-based. I didn't mean to offend you, nor accuse you of anything. That said, long discussions like ours inherently have the tendency to get a little heated sometimes; nothing wrong with that, as long as one stays a bit civil, and keeps the real goal of the discussion in mind.

• I'm fine with a good, passionate debate. I just took exception at the appearance of being told that I was gaming the system. I don't ever quote guidelines that I disagree with (policies are a different animal, but guidelines aren't as strict) for the sake of quoting them. If you see me quote one, take it to mean that I agree with that guideline. But understand that, sometimes, my agreement is based on something "fluffy" like style or layout (or how the length of an External Links section can overwhelm an article), and that such concerns are not, to me, trivial ones. -Inline response by Transity
  • Very well, but how can one defend making sacrifices to content for the sake of style or layout? Good content is priority, style and layout are of a lesser importance, but mostly I don't think it is even necessary to make adjustments to content for the sake of style or layout; one needn't sacrifice one to have the other, both can usually be kept in good state, with some creative editing.-Inline response by User:Sevák Tzevánerig

"I think that people should be pointed to a larger site so that they can find their own "nuggets of gold," rather than being shoved into yours" The merrit of a website is usually not a one-man assessment. The quality or disquality of a website is something that is usually fairly quickly agreed upon, usualy has a quick consensus. And again, by having an external link section, one is already shuving the reader into "our" nuggets of gold. So, again, the only link that is merrited in this line of thought should be this one [9].

• In my opinion, if there's a good website with good information (in general), we should send people there to look around. We aren't telling them what the good stuff is - we're letting them decide. And understand that your good stuff may not be the same as theirs. Maybe they already have the answers that you found so critical, and are instead looking for something that you've known for a long time. Let them be the judge. Our goal should be to provide links to good sites that provide good information about a range of topics associated with the article. Directing people to such a list of sites is, to me, not at all the same as directing people to specific pages on these sites. As an example, maybe a given reader has no desire to see the videos you've linked to. Maybe they prefer to read about these conditions, and frankly don't want to be bothered with the videos. That person would be disappointed to see links to videos without links to the sites housing them. Conversely, a person who did want to see these videos could still find them if we provide links to the larger sites (like wrongdiagnosis.com). -Inline response by Transity
  • I agree that there's a difference between guiding people to good websites, and guiding people to good parts of websites, but definitely not as big a difference as you claim it to be. Above that, it seems to me that you aren't being consistent in your convictions. Here, you propagate the idea that "if there's a good website with good information (in general), we should send people there to look around. We aren't telling them what the good stuff is - we're letting them decide ... Directing people to such a list of sites is, to me, not at all the same as directing people to specific pages on these sites.". In the same text, you say "If a site is useless other than one article, then yes we can link to that article instead of the main site". To be fair, it's not completely contradictory, but I still think you're walking a thin line here. In one instance, you say: "yes, we can decide what is good about a site" -and yes, it's true, we CAN- and in another you say, no, we can't we should let them decide". To be clear, I am not directing readers to "my" stuff, all websites are pretty straight forward: there's six reputable websites with general information, then quality articles and patient brochures about specific topics that have received only limited "airplay" in the article. The patient section is a case that should be adressed seperately, which I shall do below. About the videos: the same argument that you make against the videos, can be used in favor of the videos. I've already given numerous reasons why it has merrit picking out those four videos, both today, and before (arguments which you have mostly ignored). About the ignoring of my arguments, you said "The reason that my arguments sound a lot like my original arguments is because, in my opinion, you've said nothing to sway me from that initial stance. I'm not ignoring your arguments, they just aren't convincing me of anything. And repeating your arguments stands very little chance of doing so." It's quite easy, to state that I've said nothing to "sway me from my initial stand (*PERIOD*)". Despite your denial, you ARE ignoring many of my principal arguments, sweeping them off the table by a simple "I'm not convinced". Discussion means explaining the WHY, adress arguments specifically, not declaring that thou art not convinced, or give a general cliché (sorry, but really, you're asking for it:).-Inline response by User:Sevák Tzevánerig

The points of discussion here seem to be not so much about the quality of the websites that are linked to, but more about: deep-linking, linking to the part of a website or the entire website instead, small contextualization of the links that are provided, the merrit of a "patient experience" section, and the grouping of links to create a better overview. I think that's all?

• Some of the sites are being discussed based on their quality, and some on other factors. I think I've clearly laid out where I didn't like websites and why (thyroid-info.com had too many ads, some of the patient sites didn't seem like high-quality sites, etc.). So no, that's not "all" we've discussed. But yes, some are being discussed on other factors (like the Gail Devers video whose content is beside the point since it already appears in the main article as a reference). -Inline response by Transity
  • I admit you have changed my mind about some of the sites I initially included. They have been removed since then. I have also come to the conclusion that the article on the thyroid-info website, should not be included. It's actually a fairly good take on the whole issue of dessicated thyroid extract, but this whole issue is a very hot controversy in the thyroid world, so it's better to be very carefull about any info on this topic. Numerous studies have appeared on the issue, but the medical community itself stays divided, so... As for the quality of the websites, please check out the link selection that I am backing at this time, it's quite different from the beginning of this whole discussion, and a lot better, thanks to this discussion. I have also deleted the h2g2 article, as I discovered some outdated information in it (relating to the borderline in TSH testing, which is quite important) and because it's seven years old, and we've got other links to compensate for this loss. I believe then that the main points of discussion left are the video-links, and the patient experience links. On that issue, I do want to point out that the criteria in this section is not one of high-quality sites. One has to keep in mind: you're not going to find raw patient experiences on "reputable" websites. But honestly, do you think their is reason to doubt the good faith of people writing down their experiences? The only doubt of quality of these links is this link [10]. The others are YouTube, a story in the Observer, a forum (highest quality of its kind, a point which I have elaborated upon before), and a long text. So it's not the quality of the website that is discussed here, but the relevance of the content (I shall go into this below). I agree that [11] is quite debatable, even if a patient experience section is agreed upon, but the merrits of it is that it brings together almost twenty different stories from twenty different people, with pictures and contact information. I thought that by adding more stories, the result would give a more general, varied picture of patient experiences, as they vary, and just three stories will provide a lesser representation of the wide variety in personal experiences, whilst more than 20 (and a forum) can be considered more representative, a better sample. I will defend the individual links of the patient experience section below, where you can state your reservations. If you have objections to some of the of the other links not yet adressed, please make a new heading, so as to distance it from this endless text.-Inline response by User:Sevák Tzevánerig

I have in many instances given arguments for specific websites, but that didn't seem to help much. The quality of most websites is not what's being discussed, it's rather the points I've given above. So, the discussion that is to be held here, is indeed "hollistic", as it is about the broader ideas behind the links.

• I suggested (and still suggest) that you take these one by one. When someone sees a wall of text (as we've now both created), they tend to shy away. My advice is to start a new section to discuss one change or addition that you'd like to make, and argue the merits of that change/addition alone. If, though, you'd prefer to keep things holistic, then I don't know what to tell you. Even going to RfC may not help as the same wall of text will greet everyone who stops by, and in my experience, that tends to send potential RfC editors running for the foothills (I know I've had that reaction). -Inline response by Transity
  • Indeed, no one will bother to read it. I suggest we bring it to a close, and go at it more specifically -Inline response by User:Sevák Tzevánerig

Yes, I agree that you do not agree and are direct and blunt, but you are, IMO, not quite specific. Instead, you use general arguments that have become little short of clichés. I think I've provided many details in my viewpoints, that either warrant specific agreeing or disagreeing, not a general "no, don't agree, because I'm not convinced your arguments are compelling".

• I'm sorry, but I don't know how to be any more specific. I'm sorry you think my arguments are clichés - I obviously do not agree. I've attempted again to address your issues point-by-point here. Maybe that will help. -Inline response by Transity

As the number of people who have given their point of view, is quite meager, I suggest asking some other people to give their view of the issue. I think the merrit of you and me discussing this amongst ourselves, has mostly dissipated. Sevák Tzevánerig (talk) 19:17, 11 June 2009 (UTC)

• I agree. You can wait to see if others have more input, but failing that, I suggest either addressing a single issue at a time, or trying RfC. -Inline response by Transity

I've addressed your concerns inline above. Please find my responses as bullets under your paragraphs. --Transity ^{(talk • contribs)} 19:52, 11 June 2009 (UTC)

• strong delete - That list, as currently now at User:Sbharris/sandbox, indeed mostly for the chop as external links go. Personal stories on blog-like site or self-published sites are not helpful in providing a greater degree of information than should be in the article were it at featured article status - i.e. per WP:EL. A few of the sites do give good and useful extra info, but the list overall is so poor as to warrent deletion, and then an individual case made for a few selective items. Wikipedia is not a link farm, nor patient experience magazine. If the items were to be kept as an overall list, then WP:Cite requires that an external source be found to indicate that they are "the best on the web" or an accepted "collective body of work" that should be read by doctors or patients - but this list is purely a subjective personal selection of its wikipedian editor, and so is not verified from medical reliable sources as notable or anything other than original research. David Ruben ^Talk 22:10, 11 June 2009 (UTC)

• • The list that you viewed at User:Sbharris/sandbox, was an old (and very messy) version of what I am proposing. I have just updated that page, so please, if you want to see what is being discussed here and want a say in this debate, check it out. As for the criticism on the list that I propose, I would like to point out that many feautured WP-articles on diseases, contain a link to the Open Directory project, which is, in fact, a link farm, nothing more, nothing less. What is the difference by linking to a link farm, or including the links in the external section? To me, it seems there is none, there's an apparent distinction, but it's an empty one, and you are kidding yourself if you think there's a real difference, it's a hypocritic thought (no offence or malice intended, I'm talking about the idea). So actually, all the feautured articles contain disguised link farms, and in those link farms there are links to blogs, and personal stories. Why not acknowledge that? Plus, by linking to the Open Directory link farm, the editors of the article are not taking into account the relation between the specific article and the links, and are providing a selection of links that is not edited or adjusted to the content of the article (actually, that is the difference between linking to a general link farm, and having a selection of your own, atuned to the specific article and audience). Above that, is it not a noble goal to try to collect the best websites about the subject, and have a well thought through selection of the thousands of websites that exist, instead of a rather random, embryonic list, with no general approach or goal? That this selection is purely a subjective selection, yes, well, might I inform you that this is the case for every selection of external links, in every WP article? Sevák Tzevánerig (talk) 04:15, 13 June 2009 (UTC)

• • • Ok, per updated list - Strong delete for reasons stated - patient experience forum sites are not medical reliable source, the Thyroid Disease Manager site is aimed at the physician and so not primarily a site for patients let alone the gernal wikipedian reader. Nothing in that list gives a citation to a secondary source confirming the selection of items is useful as a whole body of work, and specific items therefore need to be argued on a case by case basis and most are inappropriate (per WP:EL, and general convention of what is felt useful in medical topics - go look at other medical articles) David Ruben ^Talk 16:57, 13 June 2009 (UTC)

A Patient Experience Section This section has been matter of debate. I have given numerous arguments for the inclusion of such a section in the external links. This might by onorthodox, but I have explained above why I think it has merrit: if you want to join in this specific debate, please use your browser and search "patient experience" to see what arguments have already been presented, as to not repeat and adress things unnecessary. The section that is up for proposal, can be found at User:Sbharris/sandbox. Please discuss this issue here. Note that is has already been pointed out several times that the guidelines generally favor not including some of the proposed links. So, I repeat, you do not have to repeat that again. Because that is exactly what is to be debated here, namely if the guidelines BE BOLD and COMMON SENSE (Be bold, Ignore all rules, Use common sense) warrant an exception here. I have elaborated why I believe exceptions are warranted here, in the long discussion which you can find above. Please adress those reasons, and don't quote guidelines, because it has already been made VERY clear to me that the guidelines favor a different approach (and I have made it clear that there is a reason why so many guidelines exist that state to be flexible with the guidelines and to use common sense and keep the higher principle above "the word of policy"). Your opinions are very much appreciated...Sevák Tzevánerig (talk) 04:29, 13 June 2009 (UTC)

---

As a whole, I think it's quite an OK selection of links: there's one video of a prominent Graves' patient (Gail Devers), one forum with thousands of "stories", one artistic take that seems to be very much appreciated and on the mark, a personal story sided with an elaborate exploration of the medical literature, a collection of twenty raw stories, and a press article:

FORUM - National Graves' Disease Foundation Example of a Graves' disease online bulletin board (1000 members, most active one in existence)

If you are going to have a patient experience section, you cannot exclude a forum. The more "stories" are included, the wider your base for representation is for a general patient experience. This particular online bulletin board, is part of the National Graves Disease Foundation, and is monitored by five people, among who Nancy H. Patterson (PhD., Chairman of the Board of NGDF), Jake George (co-author of Graves Disease in our Own words). It has 1100 members, and is the most active forum that exists. It has quite a long history, and has an enormous archive, separated from the active posting.Sevák Tzevánerig (talk) 04:29, 13 June 2009 (UTC)

VIDEO - A Champion Battles Thyroid Disease Gail Devers' battle with Graves' disease

I have defended this link, as it shows an actual person discussing her experience. She is famous not only for her sports career, but also for being an official spokeswoman for thyroid disease. Also, the nature of the medium through which this story is presented, merrits the add.Sevák Tzevánerig (talk) 04:29, 13 June 2009 (UTC)

VIDEO - Graves' Disease Explained Through Symbolism An artistic take on a patient's experiences

A nice link, it's a recent video, so not that much reactions yet, but they do signify it would be a good add to this section: A truly wonderful video that brought me to tears! Awesome symbolism for such a crippling disease in so many ways. I have watched it many times over and each time I remember and feel something different about Graves disease thanks so much Em i lov these videos theres hope. T2S thank you so much for this video....It was very enlightening. I go to the endo tomorrow....thanks again! Hike thanks! been dealing with gd since i was 15, now 35,...its nice to see a representation of my own feelings on it!!..thanks so much. its not easy. Venus Wow! Thanks for sharing. It gave me chills and some tears. How very true to our lives it is. I forwarded the link to my family so maybe they can understand more of what goes on with our minds and bodies. Hugs, Pat Thank you for putting together such a helpful collage of symbols and music that so clearly conveys the subtle and frightening realities of Graves thyroid disease. I am glad to learn that you are on the mend and making such a large quantity of information available to those patients who are still working through this problem. Best regards. THANK YOU, this is great for sharing with my friends and family so they too can understand about graves disease and how I felt too Em Thank you! I wish I could show your vids to my Drs and make them understand. But now that they have taken my thyroid out....hey Im cured even though I feel so bad most days I want to crawl into a cave go to sleep and die.Sevák Tzevánerig (talk) 04:29, 13 June 2009 (UTC)

Tim Bennie A patient's description of his personal experience with hyperthyroidism, along with many informative excerpts from medical journals, and an extensive bibliography

The main content of these documents are an overwhelming amount of informative quotes from scientific articles, all of which are referred to. There is also an extensive bibliography. Biographical information about Tim Bennie can be found at http://gravesdiseasetimbennie.com/home. On his curriculum vitae, it reads: Personal Research and Writing, Indiana University Medical Library, Indianapolis, IN. Compiled a 130 page booklet describing Graves’ thyroid illness. Analyzed the information from more than 240 medical journal articles as a basis for this effort (www.gravesdiseasetimbennie.com). “Tim has impressed me with his passion to learn as much as possible about his medical issue and the treatise which he wrote about Hyperthyroidism was remarkable. His research and insight was something I would expect from a postgraduate medical resident.” Excerpted from a physician’s letter of reference.Sevák Tzevánerig (talk) 04:29, 13 June 2009 (UTC)

Twenty personal stories With pictures of Graves' eye disease, and contact information

I agree that this link is quite debatable, but the merrits of it is that it brings together almost twenty different stories from twenty different people, with pictures and contact information. I thought that by adding more stories, the result would give a more general, varied picture of patient experiences, as they vary, and just three stories will provide a lesser representation of the wide variety in personal experiences, whilst more than 20 (and a forum) can be considered more representative, a better sample.Sevák Tzevánerig (talk) 04:29, 13 June 2009 (UTC)

Story that appeared in The Observer, Sunday 18 March 2001

Graves' disease in the press...Sevák Tzevánerig (talk) 04:29, 13 June 2009 (UTC)

• Can you please try to make concise points instead of posting giant list of unreadable text. Ridernyc (talk) 04:52, 13 June 2009 (UTC)

• Sorry, but you don't get to set the ground rules of the discussion. If this article is to be an exception to the guidelines then you have to explain what is so exceptional about Graves' Disease as a topic to mean that it should be treated differently from any other topic. All you have done is describe why these links may be suitable for a web directory, not why they are suitable for an encyclopedia. Phil Bridger (talk) 10:21, 13 June 2009 (UTC)

• I'm sorry, but just because you've offered arguments to my points doesn't mean that I (or we) are now required to counter those arguments. I find your arguments unconvincing for the reasons I've laid out, and I do not feel at all obligated to counter what I see as weak arguments. As Phil Bridger stated, you're the one who wants to ignore the guidelines (which is fine), but the burden of "proof" then is on your shoulders to convince others why you are right. I'll suggest this one more time: maybe if you focus on one link that you think really should be added (not one section), and try to explain why that one link is exceptional enough to be included despite the guidelines, that might work. Right now, you're still using a shotgun approach, and I doubt that will have much effect at this point. And here's a hint: don't make the link you choose the Gail Devers video as links that already appear in the article as references stand pretty much no chance of being included in the External Links section. --Transity ^{(talk • contribs)} 14:38, 13 June 2009 (UTC)

• Concur, indeed this section of the links is most in need of editorial chop. "Patient Experience Section" generally has no place in medical articles - wikipedia is not written for patients (per Wikipedia:General disclaimer#Not professional advice and Wikipedia:Medical disclaimer). It might relate to part of a symptoms section, but using instead medically reliable sources to verify, and possibly if a notable controversy over patients pressing for better recognition or wider funding of treatment, but magazine type background personal stories is not what an encyclopaedia is for. David Ruben ^Talk 17:07, 13 June 2009 (UTC)

• I have deleted the link to the h2g2 article as Sevák Tzevánerig no longer supports its inclusion (see above). I have also deleted the entire Patient Experience section as there seems to be a general consensus that the links do not warrant inclusion at this time. If someone believes I've overstepped, please let me know as that was not my intent. --Transity ^{(talk • contribs)} 19:18, 13 June 2009 (UTC)

Next main issue is that many of the sections are not specifically about Graves' Disease, and so are tangential to this one topic. Some might be better in the more general hyperthyroidism or antithyroid agent articles. Hence we don't have a list of external sites for say Atrial Fibrillation with section on Electrocardiography tracings and machines, only to duplicate this at supraventricular tachycardia, bradycardia and myocardial infarction. The list needs be about Graves alone, else we might as well include here external links for thyroid function tests leading to phlebotomy and then to hypodermic needles, not forgetting needle gauge comparison chart details which so affects the patient experience of discomfort on having their Graves' disease monitored ! (PS please don't now dump the sections I'm highlighting into the other thyroid articles without first discussing in relevant talk pages to consider individual merits) David Ruben ^Talk 00:13, 14 June 2009 (UTC)

True. At a glance, I'd say that the following fall into the "about the thyroid in general" category:

• Columbia University's New York Thyroid Center: Wide array of information on Thyroid dysfunction
• Endocrineweb entry about the Thyroid Gland
• Thyroid Disease Manager: Analysis of all aspects of human thyroid disease and thyroid physiology
• Thyroid portal at About.com: Managed by health activist and patient advocate Mary Shomon
• American Thyroid Association
• Thyroid Australia
• Thyroid Disease, Osteoporosis, and Calcium: Article about thyroid disease and the risk of osteoporosis from MedicineNet
• Drug Therapy: Antithyroid drugs: Newsletter article from Medicina Interna
• Patient information: Antithyroid drugs at UpToDate

Of those, the about.com page has a subsection about Graves' disease (see here). So I'd propose we remove the links above (they can be debated for addition on other articles on those talk pages), and add the link to the Graves'-specific section of the about.com page. --Transity ^{(talk • contribs)} 02:32, 14 June 2009 (UTC)

About the "tangential" nature of hyperthyroidism: it is actually THE main effect Graves' disease has. This is why it is so prominently featured in the article, and why the three possible treatments for Graves' disease are directed at treating the hyperthyroidism. So I wouldn't say it is tangential to Graves' disease, it's intrinsic to it. That's why I added Thyroid Disease, Osteoporosis, and Calcium, which is specifically about hyperthyroidism and osteoporosis (despite the title -> read the article). Are the treatments to Graves' disease tangential to Graves' disease? If so, then the links about thyroid drugs, thyroid surgery, and radioactive iodine treatment maybe should be moved to those pages Antithyroid agent, Iodine-131, Thyroidectomy. And should those internal links be made in the corresponding chapter titles? I don't think there's an article about thyroid drugs, yet, which are always administered together with anithyroid drugs, so I though it would be appropriate to put those links here. As for Thyroid Disease Manager, I think it's actually the best link: it gives very reliable, detailed, uptodate information about a whole range of topics that are closely associated with Graves' disease: the disease itself, hyperthyroidism, autoimmunity, thyroid surgery, radioactive iodine, thyroid drugs, antithyroid drugs, ... As for the links Columbia University's New York Thyroid Center, Endocrineweb entry about the Thyroid Gland, American Thyroid Association, I suggested a deep-link to a sub-page of those websites (as you can find on my userpage), as good, reliable sources about thyroid surgery and radioactive iodine. I think the main websites contain little that hasn't already been touched by the article or other links.Sevák Tzevánerig (talk) 19:22, 16 June 2009 (UTC)

You misunderstand, antithyroid drugs obviously mainstay of treating Graves, but a link to a website about antithyroid drugs is best placed on page about them, ie antithyroid agent, and not duplicated in hyperthyroidism, Graves, thyroid storm, Thyroid adenoma, Toxic multinodular goitre, Postpartum thyroiditis etc - in this regards the link is tangential to Graves as not specific or exclusively about Graves Management - please reread my analogies. As for thyroidmanager.org - No - as it states itself "offers an up-to-date analysis of thyrotoxicosis, hypothyroidism, thyroid nodules and cancer, thyroiditis, and all aspects of human thyroid disease and thyroid physiology" and so clerarly not specifically about Graves - homepage perhaps suitable for consideration for the top-level article thyroid but is quite inappropriate for this single disease... but a sub-page on Graves would be on topic. If other links "good reliable sources about thyroid surgery and radioactive iodine", then they belong for consideration to thyroidectomy and Iodine-131 (to which "radioactive iodine" redirects) articles. David Ruben ^Talk 23:30, 16 June 2009 (UTC)

Ok, I agree with the thyroid surgery en co links. However, the thyroidmanager link: there's three sections of Graves' disease, which provide a very elaborate, complete and up-to-date analysis of Graves' disease. It gives more depth to all the little things Graves' consist of: all the treatments, everything about the influence of thyroid hormones and thyroid drugs, effect of thyroid abnormalities, etc. What more can you ask from an external link to this article? I honestly think you should give this one a second thought.Sevák Tzevánerig (talk) 20:50, 18 June 2009 (UTC)

Can anyone give a better explanation of the before and after image under Graves' disease#Incidence and epidemiology? I am guessing that it is a radiograph picking up the betas or gammas from the I-131 preferentially uptaken to the thyroid, but I do not know enough to write an explanation. - 2/0 (cont.) 16:55, 1 September 2009 (UTC)