Hi. Some people here on Wiki seem to dislike what I wrote about low body iron stores and bloodletting as a strategy against pathogens. Here is the text:
In medical research, iron has been shown to be a very important bacterial growth factor in common pathogens and high iron availability is a major negativ factor in some infections. [1] [2] Therefore, reducing the availability of iron during infection through the production of hepcidin and acute phase proteins like ferritine is a key measure of defence in the body against bacterial pathogens[3] as well as parasitic protozoa.[4].
As bloodletting is the most efficient method to reduce iron availability in the human body, bloodletting may be an effective way to reduce the prevalence and severity of some communicable diseases.[5] Also, the relatively excessive menstruation in humans as well as the very wide prevalence of iron deficiency in women today may be an evolutionary adaptation to pathogens. Iron overload in inflammatory environments in macrophages, which accumulate iron in reaction to hepcidin, is being abused bei intracellular bacteria like Chlamydia, Coxiella, Francisella, Legionella, Mycobacterium, Salmonella and Yersinia Enterocolitica.[6] The supplementation of iron and folic acid has led to increasing prevalence and severity of malaria infections in some health trials in Africa.[7] In addition, there may be links of high iron stores to diabetes[8],[9] atheroscleris[10] and some types of cancer. [11] [12]
Also, as the human body cannot excrete iron other than by menstruation in women, it has to limit its uptake by producing hepcidin, which leads to the accumulation of iron from food in enterocytes, which, over time, die and enter the intestinal lumen and are then excreted with the iron contained. [13] As iron is an important bacterial growth factor also for the intestinal pathogens mentioned above and as immune reactions to common bacteria are a leading factor for morbus crohn, oral supplementation of iron is especially problematic in inflammatory bowel diseases such as Morbus Crohn.[14] Contrary, low body iron stores may be a supportive therapy for Morbus Crohn patients as they do reduce hepcidin production and therefore reduce accumulation of iron in enterocytes, depriving the intestinal pathogens of a growth booster as they penetrate into the intestinal wall.
These and many more findings clearly question the view that bloodletting is purely a pseudoscience and could quite contrary give rise to further research on the subject of moderate iron deficiency as a survival strategy against many widely prevalent pathogens and inflammatory diseases.
NOW: Anyone having a scientifically based challenge to what I wrote should spead up NOW!
And yes, I will try to include the publication names in the sources not just the links to NCBI. Any help is welcome! 2A02:21B0:644D:C3F3:8C97:769E:8846:852C (talk) 12:06, 13 July 2020 (UTC)
- OK, to start with, you are implying a link between bloodletting (as a means of reducing iron) and the role of iron levels in various diseases which are simply not supported by the sources. You cannot take a source that says 'bloodletting reduces iron', and another source that says 'high iron levels are associated with type-2 diabetes', and imply that bloodletting may have any effect on diabetes - that is what is meant by WP:SYNTH. What you would need is a WP:MEDRS-compliant source that says 'bloodletting has been shown to be effective in the treatment of type-2 diabetes'. The same goes for all of these assertions, especially the final paragraph, which isn't sourced at all and appears to be your own analysis. GirthSummit (blether) 12:29, 13 July 2020 (UTC)
- That's some interesting research. I'd support inclusion of some of this in the bloodletting article. Some of it belongs in Human iron metabolism. The last paragraph doesn't belong in an encyclopedia; I'd just let the facts speak for themselves. See WP:SYNTHESIS. Ideally, find a peer-reviewed article that connects bloodletting to iron reduction, then use that to link to Human iron metabolism, which can cite your randomized trials showing the drawbacks of iron supplementation. Obviously bloodletting is not pseudoscience, but we have to endorse statements like that because it's a mainstream encyclopedia and that's what the "mainstream" thinks in 2020. Thanks for contributing. A5 (talk) 12:36, 13 July 2020 (UTC)
- A5, no - linking bloodletting to iron reduction does not then allow you to link it further to studies that are about the drawbacks of iron supplementation. What is needed are sources linking bloodletting directly to any particular ailment that we want to discuss here - otherwise this is all synthesis. GirthSummit (blether) 13:06, 13 July 2020 (UTC)
- I agree with Girth Summit's points. Synthesis is the primary concern, but I would also like to add that most (all?) of the sources are primary source studies, not the review articles called for by WP:MEDRS - MrOllie (talk) 13:30, 13 July 2020 (UTC)
@ Girth Summit and others: If your primary concern is synthesis, you should really read this paper I am linking: https://pubmed.ncbi.nlm.nih.gov/17583479/
It clearly states that "The literature on the potential value of blood-letting is large and the current consensus is that phlebotomy is harmful. However, because
phlebotomy clearly leads to iron deficiency and there is evidence that iron deficiency protects against some infections, its effectiveness against infections should perhaps be re-examined before it is qualified as the remedy that has deluded physicians longer than any other sham therapy." ....
"There are experimental, clinical, anthropologic, and historic evidence that indicate that iron deficiency is protective against infectious bacterial diseases. Thus the iron deficiency, which was almost universal, decreased the odds of death from infectious diseases."
So in this regard, there is no synthesis, there is a single source. Agreed?
Unfortunately, I cannot just ignore the copyright on the study and just send it in full to you. But it was published by Elsevier, a globally leading science publisher.
Also: Let my cite what you wrote: "Obviously bloodletting is not pseudoscience, but we have to endorse statements like that because it's a mainstream encyclopedia and that's what the "mainstream" thinks in 2020." REALLY? I am held to the highest standards of scientific proof and others can just say it is pseudoscience without any proof?? Just ask yourself: Do you want to keep Wikipedia to scientific findings to inform people or do you want to reinforce wrong thinking?
Also, if you state that obviously, bloodletting is not pseudoscience, why are you not correcting the statement and write that it is claimed? Just as I did the change over and over again?
2A02:21B0:644D:C3F3:3924:94CA:B16E:BF7B (talk) 15:05, 13 July 2020 (UTC)
- Elsevier publishes some trash, infamously the journal Homeopathy. This is 13 year old review in a nutrition journal, which is an odd field for statements about blood. A WP:REDFLAG thus flies. It's true that the authors back then queried whether the practice might be looked at again, but as they say "the current consensus is that phlebotomy is harmful". So any attempted use of it would, by their definition, be quackery. Alexbrn (talk) 15:15, 13 July 2020 (UTC)
@Alexbrn: it is not at all odd to have a paper on this in nutrition. Read the paper! It clearly shows, how diet changed and what impact it had on iron levels. And why it seems to have been an evolutionary advantage to be low iron in last few milleniums. And we have all the other papers showing, that high iron levels are harmful in some infections and in some cancers. This can also be stated independantly and certainly belongs much more on the website than saying that bloodletting is pseudoscience without any link to that!
- I have read the paper. I would not be averse to using a review in a nutrition journal for statements about nutrition, but for speculative musings about bloodletting - no. There's nothing reliable to assert and nothing due to report. Does that leave anything to be done? Any proposals based on decent sources? Alexbrn (talk) 15:28, 13 July 2020 (UTC)
So if you consider the study in the Lancet mentioned above as rubbish, that links iron supplementation with more and more intense malaria infections, than I can only conclude that you are against science. If you are really serious about this, I will escalate this to Wikimedia. I have always donated hundreds of dollars per annum to Wiki, because I thought it was a neutral plattform. But I am really starting to have doubts... 2A02:21B0:644D:C3F3:D965:BB96:9E8A:4B85 (talk) 16:16, 13 July 2020 (UTC)
- Don't be daft: you can't "buy" your articles here. If there is a proposal please state it, with source. I see nothing from the Lancet "mentioned above". Alexbrn (talk) 16:21, 13 July 2020 (UTC)
- We can't use an article in the Lancet about links between iron supplementation and malaria to add content about bloodletting. We've been through this already - if there is an article in the Lancet about links between bloodletting and malaria, then by all means tell us. Without that, this is not OK for the reasons already given. GirthSummit (blether) 17:48, 13 July 2020 (UTC)
- (Interesting point that The Lancet, a medical journal named for a bloodletting tool, is being (vaguely and improperly) cited as a component of Original Research on the merits of actual bloodletting. The world has obviously turned full circle! GPinkerton (talk) 19:25, 13 July 2020 (UTC))
- I also found out recently that "leech" means "doctor" in Old English. @2A02:21B0:644D:C3F3:3924:94CA:B16E:BF7B: Take a minute (or a day) to learn how Wikipedia works. WP:AGF means don't say stuff like "I can only conclude that you are against science". Create an account, it makes it easier for us to communicate. You did good to bring this up on the article's talk page, but don't get too ambitious. You said "I thought it was a neutral plattform. But I am really starting to have doubts" - that's honestly the cutest thing I've read all week. Good luck on your adventure - anyway, this article seems like a good place to start - the traffic is low, it's political but not acrimonious. Thank you for PMID 17583479 - I would support the inclusion of this review article, but you have to make the other editors happy as well. A5 (talk) 20:33, 13 July 2020 (UTC)
@Alexbrn: That you have not seen the Lancet source is quite obviously proof, that you did not read my contribution in earnest. To make it even easier for you, I will explicitly copy the link. It is HERE: https://pubmed.ncbi.nlm.nih.gov/16413877/
I will write it in another way, without any synthesis. Readers will be able to use their brain independantly to get it, that 1+1=2. — Preceding unsigned comment added by 2A02:21B0:644F:F4A9:E115:9E8D:4734:F206 (talk) 08:27, 14 July 2020 (UTC)
- An old primary source, so of no use to us here. Alexbrn (talk) 08:48, 14 July 2020 (UTC)
Ok so not to have double standards: Show me a scientific paper that proves, that old sources are unreliable. So please proof that mathematical proofs that 1+1=2 done by Greeks 3000 years ago are wrong. Does any of the other see the double standards now? Someone like AlexBrn should be banned from censoring on this plattform. I will complain to Wikimedia about this and not contribute anymore to a plattform, where people can behave like this. 2A02:21B0:644F:F4A9:E115:9E8D:4734:F206 (talk) 08:54, 14 July 2020 (UTC)
- Please see WP:MEDRS, and for background maybe WP:WHYMEDRS. It's following the WP:PAGs which has given Wikipedia the quality it has. Dodgy material from poor sources will be resisted by the community. Alexbrn (talk) 09:01, 14 July 2020 (UTC)
@AlexBrn: How can you claim The Lancet is dodgy material?! You should stop to just claim arbitrary things and start to have a real discussion and prove your points! 2A02:21B0:644F:F4A9:E115:9E8D:4734:F206 (talk) 09:05, 14 July 2020 (UTC)
- You need to read the links I provided. We generally do not use primary sources for biomedical content. It would also be courteous to others if you WP:INDENTed your posts. Alexbrn (talk) 09:08, 14 July 2020 (UTC)
@all: If it is really consensus here, that it is ok to state on Wiki that "Though bloodletting as a general health measure has been shown to be pseudoscience..." WITHOUT ANY (!) SOURCE, but that is NOT ok to cite a study in the Lancet, that reports negative effects of iron supplementation on infections, than that is it for me with the Wiki platform. No need to waste anymore time here.2A02:21B0:644F:F4A9:E115:9E8D:4734:F206 (talk) 09:32, 14 July 2020 (UTC)
- The assertion that bloodletting is pseudoscience is referenced within the article to a reliable source that directly supports the assertion. Your suggestion that we allow the reader to
use their brain independantly (sic) to get it
is not supported by policy - we keep asking you to read WP:SYNTH, but you seem to be refusing to do so. You cannot draw a novel conclusion that is not directly supported by the sources - your 1+1=2 analogy is frankly ridiculous - medicine is somewhat more complex that elementary arithmetic. But please, yes, do not waste any more of your time on this. GirthSummit (blether) 10:05, 14 July 2020 (UTC)
- The proposed text reverted here was obvious WP:SYNTHESIS to support views that were not even those of the sources cited. —PaleoNeonate – 09:28, 15 July 2020 (UTC)
- @Girth Summit: I'm just confused by your statement:
Your suggestion that we allow the reader to "use their brain independently to get it" is not supported by policy
, according to my interpretation exactly the opposite is true. The "no synthesis" policy means that readers have to use their brain/mind/intelligence rather than being fed conclusions by the article. Can you point to a policy that discourages readers from thinking and reaching independent conclusions, or that discourages us from writing articles that allow this? A5 (talk) 16:27, 15 July 2020 (UTC)
- Per WP:SYNTHESIS, we can't even 'imply' a conclusion. So we couldn't use three unconnected sources over three sentences to write something like 'Bread contains gluten. Gluten aids in elasticity. More elastic muscles make Yoga easier.' Even though we do not explicitly say 'Eating bread makes Yoga easier' we have (incorrectly) implied it. - MrOllie (talk) 17:03, 15 July 2020 (UTC)
- (edit conflict) Maybe WP:GEVAL, WP:YESPOV and WP:V. The type of synthesis above may be appropriate as WP:OR for a paper, but not for the encyclopedia. My reason for being back however is that I remembered of hematochromatosis that is a rare condition where extracting blood is a possible treatment today. It could serve as a counter-example: it'd be easy to find a medically-reliable source (WP:MEDRS) mentioning this fact directly. —PaleoNeonate – 17:12, 15 July 2020 (UTC)
- A5 I got your ping while I was out with the dog, so sat down now at my screen to reply, but find that me learnéd colleagues have already done so. I won't add any more links to what they have provided, but I'll say this: if policy dictates that we shouldn't say something explicitly, it follows that we shouldn't attempt to imply it. Leaving a trail of breadcrumbs in the form of unconnected facts, and hoping that the reader will pick up the inference, is not how we write articles. GirthSummit (blether) 17:21, 15 July 2020 (UTC)
@Girth Summit: You have misunderstood me. I was suggesting I am writing something WITHOUT synthesis, because I can get you a study that proves that 1+1=2 and that bloodletting reduces iron store levels in the body. And I can seperately do a bullet list with studies that link high iron stores to several infections and diseases. Whether the reader does a link in his head is up to him. This is what I meant. I would not do the link, but obviously, a reader with a bit of cognitive capability would do it. It would not violate the policy.
And yes: medicine is awfully complex, but that bloodletting is reducing iron stores is as easy as 1+1=2. But obviously, moderaters leaving a comment like...
"Therapeutic phlebotomy refers to the drawing of a unit of blood in specific cases like hemochromatosis, ...., to reduce the number of red blood cells." is just so silly that anyone with medical understanding will laugh out loud, so funny! :-]]] You would really need help, but given your quite ignorant colleques, it is just a waste of time. This is it for me in trying to improve the website and certainly, I will not donate a single penny in my life again to Wiki. 2A02:21B0:644F:D592:95BE:92A3:11AA:7D20 (talk) 18:13, 15 July 2020 (UTC)
- And in this case, it's not to prevent infections or to promote evolutionary adaptations, but because of the damage to organs that can result from long term iron accumulation when the body does not naturally eliminate the excess. Anemia would be a likely result of the same treatment on someone who doesn't suffer from the condition. —PaleoNeonate – 20:18, 15 July 2020 (UTC)
- @IP editor: What you are proposing would still be prohibited by policy. Let's say we accept that an old article from a journal on nutrition would be acceptable to use as a source on blood letting - that isn't accepted by other editors on this thread, but let's pretend for a moment that it is. So, we then state that as a fact - blood letting reduces iron levels in the body. What possible reason would we then have to list a bunch of conditions that are associated with elevated levels of iron, or with supplementation of iron in the diet? The only possible reason for doing that would be to imply a link between the two - and that would be synth, pure and simple.
- Why is this an issue? Because by trying to make that connection, you are implying something that we cannot get from these sources - that blood letting might potentially be of benefit to these conditions. Blood letting may reduce iron levels in the body, but presumably it has other effects. Is there any evidence that the overall effect of blood letting would be beneficial to people with these complaints? We would need WP:MEDRS-level sources to tell us that, which we don't seem to have. We don't leave trails of breadcrumbs for the reader and hope they will follow them to a conclusion that the sources themselves don't support, most especially not with biomedical information.
- As an aside, I do wish you'd stop going on about your donations to the foundation. I have no way of knowing whether you are telling the truth about having donated in the past, but I don't imagine that the foundation will collapse without your financial support, and donating money yields precisely zero in terms of editorial authority. What you do with your money is entirely your own business, it's not relevant to this discussion. GirthSummit (blether) 10:33, 16 July 2020 (UTC)
- Just to weigh in again, I think that Girth Summit is basically correct that 2A02:21B0:644F:D592:95BE:92A3:11AA:7D20's proposed way of getting around SYNTH is not going to be acceptable here. Basically we'd need to find a peer-reviewed review article that connects bloodletting with iron deficiency. I wouldn't be surprised if such an article existed, but it needs to be found (and possibly discussed).
- Although I'm not an expert, I would imagine that a "history of bloodletting" article or section would have less stringent requirements for references. For example, it should be possible to point out that "leech" means "doctor" in Old English, and that the journal "The Lancet" refers to a bloodletting instrument. These are both of historical interest. Further, if (for example) a 19th-century publication could be found connecting bloodletting with iron deficiency, then that would be acceptable to mention in a historical context, although citing a recent historical review would be preferable. Linking the words "iron deficiency" to Human iron metabolism would also be acceptable. Furthermore, I believe that referencing a randomized trial about the relation between, say, iron supplementation and malaria could be acceptable on the latter article. Taken together, these proposed changes would allow the curious reader to make his/her own connections. So it's not that "trails of breadcrumbs" are disallowed per se, which is what I was trying to argue.
- Finally, Girth Summit has a point about your amusing rhetoric - I think we're all wondering how old you are 2A02:21B0:644F:D592:95BE:92A3:11AA:7D20 - and welcome to Wikipedia, but what about creating an account? Then you can sign up for email notifications when this page changes... BTW I'll be gone for at least a week, but I hope everyone continues to have productive fun without me. Oh yeah, feel free to try editing some easier (i.e. non-medical) articles first; I said before that this is a "good place to start", but I meant compared to other articles on medicine. For editing practice I would not start with a medical article. A5 (talk) 11:16, 16 July 2020 (UTC)
- A5, briefly: WP:MEDRS refers biomedical assertions, not biomedical articles - it applies to all articles. Using primary research (like randomized trials) is discouraged by MEDRS, which calls for secondary sources like systematic reviews. A nineteenth century source would be an acceptable primary source for what people thought in the nineteenth century; it wouldn't be acceptable as a source to make assertions of fact about medicine. Since you seem to be talking above about 'getting around SYNTH', I'm now going to drop a notification on your talk page that has some important information. GirthSummit (blether) 11:39, 16 July 2020 (UTC)
- @Girth Summit: I don't think that's a fair characterization. I was talking about how to make Wikipedia a useful source of information without violating the guidelines. That means "getting around" or "following" all the rules on this site. But when you say "getting around", it sounds like you're accusing me of having an evil purpose in following the rules, which is not correct. However, thank you for the additional guidelines (which you may as well post here as well) and for your thoughts on reliable sources, which I generally agree with. A5 (talk) 14:53, 16 July 2020 (UTC)
- A5, if I've misunderstood your intention, then I apologise; I thought you were saying that you thought it would be a good idea to try to 'get around' our policy on original research, in the sense described here - if that wasn't what you meant, then we're good. Our articles are most useful when they do not try to lead the reader to draw conclusions that are not supported by reliable sources. GirthSummit (blether) 15:01, 16 July 2020 (UTC)