Talk:Kombucha/Archive 2

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Edit-warring, source removal, WP:V issues

AlbinoFerret is edit-warring text into the article that the claims for Komucha only come from those that drink it.[1][2] The second edit removes a good (MSKCC) source from the arivle as it impeded this view, which is bad. But as far as I can see the new source fails WP:V too. Not good. Alexbrn (talk) 22:42, 24 June 2015 (UTC)

Two reverts, while adding a source to back up the edit is hardly "edit warring". You on the other hand removed an edit tied to a review instead of removing a lower quality source. AlbinoFerret 22:44, 24 June 2015 (UTC)

The article text is no longer properly supported by the cited reference, which is kind of fundamental. Reverting a revert to get there compounds things. Alexbrn (talk) 22:47, 24 June 2015 (UTC)

Yes it is, and if you would have left it alone it would have been also fine. AlbinoFerret 22:49, 24 June 2015 (UTC)

Please provide a quotation from the source that supports our article text. Alexbrn (talk) 22:52, 24 June 2015 (UTC)

Page 543 the section is "Beneficial effects of kombucha tea".AlbinoFerret 22:54, 24 June 2015 (UTC)

I'm looking for a quotation (text please), one that says only drinkers of the tea claim it cures AIDS, etc. You're aware WP:V is core policy? Alexbrn (talk) 22:56, 24 June 2015 (UTC)

Its called a summery, you know what that is? Its what we are supposed to be doing with sources. The other source was also summarised. AlbinoFerret 22:59, 24 June 2015 (UTC)

Alexbrn, the only edit warring was your removal of a substantive edit that was supported by the source. Please stop edit warring. Atsme^📞📧 23:01, 24 June 2015 (UTC)

That's a pathetic response. The source you cited doesn't even mention AIDS? So how can we "summarize" it by mentioning AIDS? that's getting more specific, not more general. It's a WP:V failure. Alexbrn (talk) 23:05, 24 June 2015 (UTC)

Pathetic response? And that is how you justify a revert, Alexbrn? Hopefully Callanecc is still overseeing this article, particularly your comments because your actions have been challenged by more than a few editors. Atsme^📞📧 23:11, 24 June 2015 (UTC)

Reverts are fine (see WP:BRD for an example of how), reverts to right policy wrongs especially so. Repeated reverts (especially of reverts) ... not so good. Since it's likely this article is about to hit Arbcom I hope editors are being extra scrupulous about upholding policies (like WP:V), because there is likely to be some intense scrutiny soon. Alexbrn (talk) 23:18, 24 June 2015 (UTC)

Good, perhaps you or they can explain what section of MEDRS allows using the Memorial Sloan Kettering Cancer Center in a medical section. AlbinoFerret 23:33, 24 June 2015 (UTC)

For detailing the promotional claims made for Kombucha. No problem. Alexbrn (talk) 23:37, 24 June 2015 (UTC)

The diffs I have accumulated regarding the use of MSKCC as a RS for health claims are quite different from your take on it, Alexbrn. You might want to review the discussion at G. Edward Griffin to see how readily MSKCC was accepted as a RS. Atsme^📞📧 23:46, 24 June 2015 (UTC)

Don't use it for health claims, but for details on how a product is marketed it's not problematic. Alexbrn (talk) 23:56, 24 June 2015 (UTC)

But it is a health claim. It says and did say some people promote that it can have an effect on medical conditions. AlbinoFerret 23:59, 24 June 2015 (UTC)

That's not biomedical information that falls under WP:MEDRS, it's only a description of what the scammers claim. Any reasonable RS is okay for describing such claims. I note the WP:V violation remains. Alexbrn (talk) 00:03, 25 June 2015 (UTC)

Why include any specific illnesses rather than make a general statement about belief in its curative powers? On what basis are the listed illnesses selected, or do we want to list all of them - the Jayabalan paper lists over a dozen, and AIDS is not on that list.Dialectric (talk) 00:10, 25 June 2015 (UTC)

Perhaps that one isnt in the list, but "Enhance the immune system and stimulate interferon production" is. Perhaps we can change it to what the review says if specific things are needed. AlbinoFerret 00:25, 25 June 2015 (UTC)

@Alexbrn Even if we take that its meant to be scammers, even though that isnt stated, yes it is a negative medical claim stating it doesnt but is claimed to. AlbinoFerret 00:30, 25 June 2015 (UTC)

I'd think we'd want to include the claims that are most often mentioned in the most sources per WEIGHT. There must be a few sources that mention those apparent benefits, and they'd be considered RS for that information only. One reason to include the major illnesses is because those are the ones that attract the most scam treatments. If someone claims that kombucha cures these illnesses, that might be worth mentioning in the article. Note that kombucha appears in Alternative cancer treatments; if it's significant enough to mention there, it makes sense that it would be mentioned here. I don't think there's a corresponding AIDS article. Ca2james (talk) 00:45, 25 June 2015 (UTC)

Alternative cancer treatments uses the same MSKCC source discussed above. I think there are a number of sources out there for the cancer cure claim, but I would like to see additional sourcing for the AIDS claim.Dialectric (talk) 00:53, 25 June 2015 (UTC)

Why was this removed [3] as a supporting ref? It did indeed support the content. Our goal is to accurately reflex mainstream opinion on alt med stuff. This source is useful for that position. It is at least as good as a couple of low quality journals. We would not use it to refute JAMA, the Lancet or BMJ but the J Med Food is not those. Doc James (talk · contribs · email) 12:57, 25 June 2015 (UTC)

Non pubmed indexed source

This source is NOT pubmed indexed [4]. Thus it does not support "The U.S. Food and Drug Administration has stated that Kombucha is safe to drink."

This is supposedly based on "Food and Drug Administration. FDA cautions consumers on "Kombucha Mushroom Tea" {News release}. Washington, DC: US Department of Health and Human Services, Public Health Service, Food and Drug Administration, March 23, 1995." which is summarized by the CDC as "FDA has evaluated the practices of the commercial producers of the Kombucha mushroom and has found no pathogenic organisms or hygiene violations" [5]

Which is not the same as saying it is safe to drink. Doc James (talk · contribs · email) 13:55, 25 June 2015 (UTC)

Please point out on any PAG, including WP:MEDRS that says a peer reviewed journal must be pubmed indexed. The claim is verifiable,

"The U.S. Food and Drug Administration and Kappa Laboratories, Miami, Florida, U.S.A. (1995), have carried out microbiological and biochemical tests and reported that kombucha tea is safe for human consumption.

in A Review on Kombucha Tea—Microbiology, Composition, Fermentation, Beneficial Effects, Toxicity, and Tea Fungus AlbinoFerret 14:10, 25 June 2015 (UTC)

Sure "Other indications that a biomedical journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE" in WP:MEDRS Doc James (talk · contribs · email) 14:15, 25 June 2015 (UTC)

The word is "may" what proof do you have that it isnt? AlbinoFerret 14:17, 25 June 2015 (UTC)

While it misquotes sources and is not pubmed indexed. So common sense indicates that it is inappropriate for medical claims.

Incredible claims require incredible sources. Doc James (talk · contribs · email) 14:19, 25 June 2015 (UTC)

Please provide examples of the misquotes.Dialectric (talk) 14:24, 25 June 2015 (UTC)

The FDA example. For there is no evidence that the FDA stated that "kombucha tea is safe for human consumption." We should be using the FDA directly not some questionable interpretation of it. Doc James (talk · contribs · email) 14:26, 25 June 2015 (UTC)

(edit conflict) This source is an investigation into adverse effects and is essentially a primary source. It probably could be used to support statements regarding promoted benefits of kombucha but nowhere does this source say that drinking kombucha is safe. What it does say is Drinking this tea in quantities typically consumed (approximately 4 oz daily) may not cause adverse effects in healthy persons which is not equivalent to saying it's safe. Ca2james (talk) 14:30, 25 June 2015 (UTC)

What has been done here is WP:OR the source does not place references at claims. The CDC report is specifically mentioned in another section "Two cases of unexplained severe illness have also been reported following kombucha consumption (Centers for Disease Control and Prevention 1995)". The OR is taking a refrence that we have no idea pertains to the claim and saying it does. AlbinoFerret 15:30, 25 June 2015 (UTC)

I appear to be talkiong about a different source. My apologies for adding to the confusion. The review article [6] does say "The U.S. Food and Drug Administration and Kappa Laboratories, Miami, Florida, U.S.A. (1995), have carried out microbiological and biochemical tests and reported that kombucha tea is safe for human consumption. Whether that's what the FDA actually said is another story. Ca2james (talk) 15:40, 25 June 2015 (UTC)

Yes there is no evidence that the FDA stated that. We must not misrepresent the position of the FDA. Doc James (talk · contribs · email) 15:46, 25 June 2015 (UTC)

Per WP:TRUTH we shouldnt be doing research into sources like this. In any event to completly remove all sourced claims from this source is just wrong. Perhaps the thinking has changed since 1995, in that case perhaps the statement should be changed to reflect when it was made. AlbinoFerret 15:50, 25 June 2015 (UTC)

We do not use low quality, non pubmed indexed sources to make false clames. We use common sense. Doc James (talk · contribs · email) 15:55, 25 June 2015 (UTC)

Prove it is false. AlbinoFerret 15:58, 25 June 2015 (UTC)

Lets look at what the FDA actually says

Search for Kombucha on FDA.gov [7]

• Warning to company making health claims for Kombucha [8] which than states "Furthermore, FDA has no information that your products are generally recognized as safe and effective for the above referenced conditions" from 2004 Doc James (talk · contribs · email) 14:35, 25 June 2015 (UTC)

we cannot use non pubmed indexed reviews to support medical content, therefore I support DocJames--Ozzie10aaaa (talk) 14:59, 25 June 2015 (UTC)

The claim was from 1995, you cant discount it by using a 2004 source, thats OR. There is also a difference between saying it treats illness and it is safe to drink, more OR AlbinoFerret 15:31, 25 June 2015 (UTC)

No you need to provide evidence that that is the FDA's position. That source is poor quality and there is no evidence that that is the FDA's position. Can you link to FDA.gov and provide a source that states it is? Doc James (talk · contribs · email) 15:47, 25 June 2015 (UTC)

From 1995? We have all seen things fall off the web. You have engaged in OR to remove a source.15:55, 25 June 2015 (UTC)

I have removed a low quality source that is not pubmed indexed and is highly questionable. Doc James (talk · contribs · email) 15:57, 25 June 2015 (UTC)

You engaged in OR to remove a source by applying a reference in it to another claim you have no idea pertains to it. AlbinoFerret 15:59, 25 June 2015 (UTC)

that is not OR.--Ozzie10aaaa (talk) 17:16, 25 June 2015 (UTC)

(edit conflict) In this case we have a conflict between what this paper says the FDA has said and what the CDC says the FDA said. Since both interpretations can't be true, one of them is misstating the FDA's position. In this case, it would be better to quote the FDA's position instead of relying on these sources. That's not OR. FTR, I found one copy of the FDA press release but I don't know if it's a true copy. Ca2james (talk) 16:14, 25 June 2015 (UTC)

That may be, and perhaps removing the FDA claim is a good idea until its straitened out. We dont know if that source is referring to the one the journal article is using. But to remove all the claims tied to this source is wrong. AlbinoFerret 16:18, 25 June 2015 (UTC)

Thanks User:Ca2james for proving that paper false. So we have a non pubmed indexed source that contains false information. Defininately not a reliable source. Doc James (talk · contribs · email) 16:23, 25 June 2015 (UTC)

This whole discussion is a waste of time. It is clearly evident that the review is bunk. We need to get rid of it and move on. -- CFCF 🍌 (email) 17:02, 25 June 2015 (UTC)

The criteria for determining whether a review is 'bunk', acceptable, or 'high quality' are poorly defined, so this discussion is necessary. What if a Pubmed-indexed source misquotes a source or sources? How many misquotes are necessary for a source to be dismissed?Dialectric (talk) 17:50, 25 June 2015 (UTC)

Yes there is clearly good, a grey area, and clearly bad. A non pubmed indexed source that makes false statements is in the clearly bad area. Other clearly bad articles would be ones that plagarise from Wikipedia such as this review did [9]. Doc James (talk · contribs · email) 18:08, 25 June 2015 (UTC)

The issue is how large the gray area is. In the above discussions, it seems that every source mentioned in this article falls into it and has to be argued out. The e-cigarette review reads as bad from the start with only 1 author who holds no apparent qualifications in the field. The Jayabalan paper's lead author is an assistant prof. with a Ph.D. in Biotechnology.Dialectric (talk) 18:29, 25 June 2015 (UTC)

True this paper is not as bad as the e-cig publication. Doc James (talk · contribs · email) 18:40, 25 June 2015 (UTC)

Dialectric, take a peek at Red Bull, the energy drink. You'll have a hay day over there. For some reason, none of the editors who are here chipping away at kombucha (a 2000+ year old drink) appear to be interested in the absence of toxicity claims over there. It's pretty amazing considering the deaths associated to that drink - little to no mention of it in the article - big promo piece. Anyway, with regards to Doc's request for us to provide RCTs to support the claim kombucha is a healthy drink, I was wondering if someone could direct me to the RCTs that confirm an apple's health benefits, or perhaps apple juice, or apple cider? I figured it would help get me on the right track considering the high toxicity of apple seeds can be deadly. So many more people eat apples than drink kombucha, so I don't quite understand why mention of the seeds wasn't included in the lede of that article like what's being done here. [10], [11]. Just trying to wrap my head around the reasons kombucha has drawn so much attention by some of our top medical editors, especially considering the lack of attention paid to the deadly toxins present in the foods we eat everyday - like an apple - and the energy drinks millions are consuming. I realize it's unethical to stage RCTs to determine toxicity so we can save time not having to search for those. Atsme^📞📧 00:08, 26 June 2015 (UTC)

It would be more helpful if you stopped making WP:POINTY statements about how WP:OTHERSTUFFEXISTS. Additional eyes on this article were requested at WT:MED which explains why so many editors are here. Ca2james (talk) 00:52, 26 June 2015 (UTC)

Astme, I hope you are not encouraging people to eat apples now. Where does this quackery end? As wikipedia helpfully shows, apples are poison. As a safety precaution, I recommend sticking to this chemical apple-free pie filled with nutritious, FDA approved ingredients: http://www.theawl.com/2011/09/chemical-apple-pie-apple-pie-without-the-apples.Dialectric (talk) 01:54, 26 June 2015 (UTC)

Speaking of 'other stuff' - have ya'll ever heard that beer never killed anyone? According to the Lede, it's safer than Kombucha! petrarchan47คุก 04:04, 26 June 2015 (UTC)

We need to take into consideration the way kombucha is being promoted as a cure-all. I personally like it and like the taste of it, but I'm not going to say that my preference is based upon any scientific evidence, as little as I would present my preference of beer as being based on science. It is possible that kombucha may have health benefits, but as far as the evidence goes it is lacking and we need to show that here. It's also possible that the article on beer lacks proper health information, but for one beer isn't generally seen as healthy, and neither does the article present it as such. If you consider the FDA to be fear-mongering in their publications that isn't on Wikipedia to consider.

When it comes to the ridiculous example of apples that is a straw-man argument that has no bearing on this case. If you were to write "apples are healthy, they cure cancer" we would be on the same page, and the strike-down would be similarly strong. -- CFCF 🍌 (email) 07:25, 26 June 2015 (UTC)

Then we are on the same page, CFCF. There is an age-old health claim associated with apples; i.e., An apple a day keeps the doctor away. See [12], [13], and [14]. I'm sure we can hand pick articles/reviews from PUBMED to show the toxicity concerns of apple seeds in the same manner that it has been applied to kombucha and make apples look toxic under certain circumstances - like people who make apple juice at home and throw in a cup full of apple seeds in hopes of it curing cancer. I also found what is ubiquitously termed as antioxidant food groups which seemed to stump some of our editors who may not have considered how it's used around the world, [15]. In vitro and in vivo research indicates the claims are valid, and that includes the 2000 Review by Elsevier, and the 2014 Reviews which include one that has an IF rating >3.5. I'm still looking for RCTs to back up all the health claims of the antioxidant and probiotic properties but for some reason, I seriously doubt they exist because as long as the science supports it, as it does with apples, black & green tea which are high in antioxidants, there is no need. Atsme^📞📧 14:15, 26 June 2015 (UTC)

Removal?

All sources for this topic are from low impact sources

Thus not sure why this was removed "A 2003 Edzard Ernst systematic review found that the mostly unclear benefits do not outweigh the known risks.<ref name=Ernst2003/>"

We are trying to write about this topic with only poor sources. Doc James (talk · contribs · email) 07:50, 21 June 2015 (UTC)

Its a 12 year old source that has an impact factor of 1.07. Thats about as low as you can get. The source is still in the article for the one claim that hasn't been sourced to a newer review. The place is was removed from, 2 claims that are sourced to other sources, it was not needed. The remaining removed claim is an opinion which was recently added. From such a low scoring journal, and its age, it should only come in with consensus. AlbinoFerret 08:09, 21 June 2015 (UTC)

I also don't think the statement is necessary. If the source was great, maybe adding that this particular person found this particular result might be valuable but the source isn't that great. I see no issue with using the source in the article since none of the sources are that good; I just don't see that it should be called out this way. Ca2james (talk) 08:17, 21 June 2015 (UTC)

The source is very good for the mundane claim because it was written by Edzard Ernst. QuackGuru (talk) 08:23, 21 June 2015 (UTC)

Agree that the Ernst systematic review appears to a be a as good a quality source as we have. It is a bit old, but this is an area where little actual research is done so I don't think it runs afoul of WP:MEDDATE. I think it would be adequate for this type of statement. Yobol (talk) 14:37, 21 June 2015 (UTC)

Exactly how is one of the lowest quality sources in the article the best quality? Why are 3 sources so necessary that we need to use a 12 year old low quality source? AlbinoFerret 14:55, 21 June 2015 (UTC)

You are making the assumption it is the "lowest quality source". I see no indication that it is any lower in quality than any of the other sources. As I stated, its age is not an issue to me because this is not an area of much research, meaning it is unlikely to be out of date. Yobol (talk) 15:06, 21 June 2015 (UTC)

There are enough newer sources where it is not needed. An imact factor of 1.07 speaks of its quality, I didnt give it that. AlbinoFerret 16:06, 21 June 2015 (UTC)

If my memory serves, the Elsevier Review has a 3.59 IF (5 yr rating) and easily qualifies as a higher quality source than the Ernst review which doesn't pass the bias test, much less efficacy or toxicity claims which are based on anecdotal case reports that don't even meet the lowest standards of MEDRS. Elsevier plus the other 2 recent Reviews and the 3rd party NBCNews Health section article authored by a RD that includes an interview with an internist from Mayo are significantly higher quality sources than what is being promoted on this TP now and is sadly being used in the lede. As for the url I included in the Elsevier citation, idelete it and it's a non-issue, then add back the material from that review because it is compliant with NPOV and sourced to higher quality material. The other 2 reviews are 2014 so it's not really fair to compare their rankings with reviews that have been around for 12 to 15 years. I've not seen one valid argument to keep the noncompliant material in the lede or in the body of the text - preventing me from editing the article isn't going to make the current lede compliant with NPOV or MEDRS. I also don't see any justification for suppressing important information from this article that was summarized in conclusions supported by scientific evidence in peer reviewed Journal reviews with higher IF ratings and more current research than what is being cited in the article now. Atsme^📞📧 00:15, 22 June 2015 (UTC)

You don't have consensus for your edits or support for your interpretation of MEDRS and NPOV. You keep saying you're right but that doesn't mean that you actually are right. This issue has been extensively discussed here, on Doc James' Talk page, and FTN; maybe instead of reasserting your view, you could try addressing the arguments that other editors have made? I mean this in the best possible faith and with the best possible goodwill. Ca2james (talk) 01:10, 22 June 2015 (UTC)

Let's address the MEDRS issue specifically. It is a fact that there are newer reviews than the Ernst, by several years, in journals with similar or better impact rating. In other articles, I have seen WP:MEDDATE used as sole justification for removing studies older than 5 years, sometimes in an edit summary with no prior talk discussion, by editors active in wikiproject medicine. It is unclear why this guideline should be so malleable as to allow for the inclusion of a study that is more than 10 years old given the newer reviews.Dialectric (talk) 08:12, 22 June 2015 (UTC)

This guidelines is malleable to accommodate poorly studied areas such as this one. Doc James (talk · contribs · email) 13:24, 22 June 2015 (UTC)

Allowances for older sources are reasonable if no recent sources exist, or if very few exist and an older source is of high(er) quality, but neither of those conditions apply here.Dialectric (talk) 05:58, 23 June 2015 (UTC)

There are 3 (THREE) reviews of this stuff as it pertains to health on pubmed.[16] One from 2014, one from 2003 and one from 2000. So yes very few exist. Doc James (talk · contribs · email) 07:44, 23 June 2015 (UTC)

The source still is in the article, just not the opinion. AlbinoFerret 14:31, 23 June 2015 (UTC)

You claimed "There are plenty of newer sources available."[17] Apparently there is very few sources available. The statement is not seriously disputed in high-quality reviews. QuackGuru (talk) 18:17, 23 June 2015 (UTC)

You have taken my comments out of context. My comments on the number of sources specifically refers to the number of them in the WP article. Then as it applies to two Ernst references that were removed that had other references backing up the claims made. The reason the opinion was removed is that it comes from a very low rated source and its age. Ernst is still in the article to a claim that has not been sourced to a newer and or better quality source. But should one come available in the future it also should be replaced on the remaining claim. WP:MEDRS tells us to judge sources by quality, while pubmed is a good rule of thumb to assess quality, it can be done by other means, impact rating is one of those ways. AlbinoFerret 18:32, 23 June 2015 (UTC)

According to WP:ASSERT the statement is an undisputed fact.[18] You claimed "The impact rating is one of those ways"[19] However, it was pointed out that the other sources are poor sources. Edzard Ernst on the other hand is a notable expert. QuackGuru (talk) 19:07, 23 June 2015 (UTC)

Its an opinion, there is a dispute on including it because of its quality and age. Because there are other sources that may be low quality in the article, as long as they are not opinions, and of the similar low quality, they have stayed in the article until a better source becomes available. The source was not completely removed, one fact from it still remains until a better quality and or newer source becomes available. At this point WP:SILENCE does not apply as an indication of consensus. AlbinoFerret 19:15, 23 June 2015 (UTC)

It is not a disputed opinion according to WP:ASSERT.[20] Your argument for deleting it is not correct because the other sources are poor sources. You did not disagreed that Edzard Ernst is an expert. QuackGuru (talk) 19:21, 23 June 2015 (UTC)

Arguing to keep a single 12 year old review is ludicrous in light of the more recent reviews of equal or higher quality. Scan the discussions above if you're uncertain what sources and reviews have been mentioned. Per the CRD (Center for Reviews and Dissimenation) summary, [21]:

1. "The author commented that no formal assessment of the validity of the evidence was possible."
2. "The author appropriately cautioned against the therapeutic use of an unproven remedy and highlighted potential side-effects which may or may not be attributable to the remedy itself.
3. "Three case series and two case reports of adverse events were included in the review. These included 28 patients in total." <----28 patients total out of how many people over how many years? Read MEDRS regarding case studies. Also keep in mind that no one is suggesting that kombucha tea is a therapeutic or curative remedy.
4. "The reporting of the individual cases was poor, making it difficult to ascertain if Kombucha was the cause of the adverse events reported."
5. "However, he also noted that the adverse events were described in isolated reports, which cannot allow firm conclusions about causality and allow for generalisation." Refer to #2 above.
6. CRD commentary - It was not possible to assess the validity of the evidence, nor was pooling possible due to a lack of efficacy data.
7. CRD commentary - Reports of adverse events were described and comments were made on the likely cause-effect relationship. It was unclear whether the review involved more than one reviewer in the study selection and data extraction processes, which could serve to minimise bias. Although the author appropriately cautions the use of an unproven remedy with potential side-effects, it is important to note that not all of the adverse events may be attributable to the remedy itself.

It can't get any more clear than that - it's not just old, it's a low quality review to boot. There are a few older reviews with higher IF ratings but they still don't include any of the recent research. Following is a list of reviews in addition to what we've already included (there may be some redundancy)....

Journal Reviews

Happy reading! Atsme^📞📧 23:40, 23 June 2015 (UTC)

None of that makes the Ermst review a "low quality review" - they are all comments on the quality of the evidence it was studying, not the review itself. In fact, it seems to be the only systematic review of the effects of kombucha that is available. I don't have access to the full text of the 2014 paper, but its abstract doesn't indicate that it is a systematic review as far as I can see. Can someone with access to the full text check and confirm whether or not it is a systematic review?

Reports of adverse events are almost inevitably going to be to some extent anecdotal (i.e. case studies etc.). Can you imagine anyone getting ethics approval for a RCT aiming to study harmful effects in human subjects? Brunton (talk) 08:10, 24 June 2015 (UTC)

Quite so. As has been pointed-out repeatedly during these discussions, editors cannot write-off good secondary sources because they judge themselves better placed to evaluate the primary evidence. That is completely wrong-headed and contrary to our policies and guidelines. Alexbrn (talk) 08:44, 24 June 2015 (UTC)

Quite not. Doc James even referred to it as low quality based on the IF rating. Scan the discussions above. Read the CDR summary of the Ernst review which summarizes the reasons why it is safe for us to surmise that the anecdotal case reports and lack of scientific evidence fails even the lowest requirements per MEDRS. I've included the pertinent information above. There are other reviews in more recent peer reviewed scientific journals with editorial boards comprising quality researchers, academics and medical experts that have higher IF ratings than Ernst, and include new and improved research studies. As Doc James stated above, apply common sense. Atsme^📞📧 13:56, 24 June 2015 (UTC)

@Alexbrn the source hasnt been written off, it still exists in the article. But I would hardly call a source with a 1.07 Impact rating a "good" source, then its age comes into play.

@Brunton the source is in the article for an adverse effects claim, its reference 18. What has been removed is its use where other newer sources were cited and the opinion. AlbinoFerret 15:14, 24 June 2015 (UTC)

I wouldn't expect research on kombucha to feature in a high-impact journal. Still, I don't see a pressing need to use the Ernst source as we have other sources making the same points, it's behind a hard-to-penetrate paywall (I can't get it electronically via library access) and also (I believe) written in German. So nobody here presumably has any familiarity with it anyway. Conversely, since the content it's supporting is not really contested (since other sources agree) there's no great harm in using it either. Alexbrn (talk) 15:24, 24 June 2015 (UTC)

A simple solution, if other newer and or higher quality sources agree with the opinion, use the claim from them. AlbinoFerret 15:28, 24 June 2015 (UTC)

An even simpler solution, per MEDRS: Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources. It says it all. Atsme^📞📧 15:58, 24 June 2015 (UTC)

And if the case reports are included in a review article, it can be included in the article. That's how this review article thing works. Ca2james (talk) 16:30, 24 June 2015 (UTC)

Excuse me, but what part of the MEDRS statement (my bold for emphasis), whether in the popular press or a peer reviewed medical journal supports your comment of it being acceptable in a review article in a peer reviewed medical journal? Atsme^📞📧 16:35, 24 June 2015 (UTC)

I don't understand your question or how it relates to my statement. Case reports are primary sources, and in general we can't cite them in our articles. If case reports are included in an review article (which I'm using as shorthand for peer-reviewed journal article), then we can cite the review article because it's a secondary source and has analyzed the primary sources. Ca2james (talk) 16:46, 24 June 2015 (UTC)

A simpler solution, since no higher quality sources strongly disagrees with the claim, we should use it. QuackGuru (talk) 19:22, 24 June 2015 (UTC)

• Ca2james, I don't understand your question or how your statement relates to MEDRS. I will reiterate and use bold underline for emphasis....Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources. We all know what a peer reviewed medical journal is, and we understand that a peer reviewed medical journal may contain reviews, and we also understand that reviews in a peer reviewed medical journal may have case reports, right? There is a sequence of events but all point to the main event which happens to be peer reviewed medical journals.
• QG - what claim? Atsme^📞📧 19:31, 24 June 2015 (UTC)

• "A 2003 Edzard Ernst systematic review found that the mostly unclear benefits do not outweigh the known risks.<ref name=Ernst2003/>"[22] QuackGuru (talk) 19:32, 24 June 2015 (UTC)

Which is why it is unacceptable. Subsequent reviews include updated research which contradicts the Ernst review and have different conclusions which is why MEDRS supports the 5 year time frame. I also provided the CRD summary for the Ernst review which further supports my position. Atsme^📞📧 19:47, 24 June 2015 (UTC)

Since the research is very limited we can also include this statement. QuackGuru (talk) 19:50, 24 June 2015 (UTC)

As well as this one [23], and the updated reviews which includes this one [24]. I truly believe you would be an asset to Red Bull with regards to correcting the misinformation that is running rampant in that article. Atsme^📞📧 20:00, 24 June 2015 (UTC)

Quackguru's 'since no higher quality sources strongly disagrees(sic) with the claim,' argument invites all kinds of flawed research into articles. A lot of this discussion and similar disagreements on poorly researched medical subjects could be resolved if MEDRS set out a clear line on what is and is not usable, specifically for poorly researched areas. The guideline's vagueness may empower some editors with an extensive background in assessing medical research, but to others, it feels like Moving the goalposts. If editors want to limit RS to pubmed indexed sources, there should be a coherent explanation/justification on WP:MEDRS, and the limitation should apply to all MEDRS areas. If editors want to limit valid sources to a certain impact factor threshold, that should be made clear on MEDRS. Arguing it out piecemeal on every article is a waste of editors' time and results in needless confrontational edits. Dialectric (talk) 20:02, 24 June 2015 (UTC)

User:Atsme, you have confirmed there is very little research and high-quality reviews on the topic. QuackGuru (talk) 20:25, 24 June 2015 (UTC)

User:Dialectric, since no higher quality sources strongly disagree with the claim, there is no issue with using the systematic review to verify the claim. WP:MEDDATE is very clear: "These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published." Since there has been "little progress" we can relax MEDRS to include older reviews. QuackGuru (talk) 20:25, 24 June 2015 (UTC)

I will respond with the utmost politeness regarding your reference to our guidelines being "relaxed in areas where little progress is being made", and simply say that I like the sound you make when you're not typing. Your response is pure hogwash and you know it. The wishy-washy changes back and forth to make the guidelines suit your POV is unacceptable. There actually are higher quality sources that strongly disagree with the claims you want included but it appears you have failed to review them. I have already provided the IF ratings. Please read the discussions. Atsme^📞📧 22:50, 24 June 2015 (UTC)

Quackguru, the 'may need to be relaxed' language in the MEDRS section you cite is fundamentally unclear because it is vague. When should they be relaxed? When shouldn't they be? How relaxed? As I suggest above, this is the sort of vagueness MEDRS could prevent if it included a concrete framework for what is and isn't acceptable. But this discussion is getting beyond the subject at hand. I may raise it MEDRS talk eventually. Dialectric (talk) 00:48, 25 June 2015 (UTC)

They should be relaxed when we don't have several reviews for the adverse effects. That's what we are currently doing with the other poor sources in the section. Of course, a review written by Ersnt is a high-quality review. QuackGuru (talk) 05:08, 25 June 2015 (UTC)

We will never be able to create a guideline that catches every possible case and if we go over the top to specify every exception we are bound to face the opposite error, when the guidelines are too strict. I think it's fully reasonable that when we have very few recent reviews that we accept citations from older high-quality reviews. -- CFCF 🍌 (email) 05:48, 25 June 2015 (UTC)

I agree that a clearer guideline wouldn't catch everything, but the current guideline could certainly be made more specific without handicapping editors. See the new section below about PUBMED indexed sources. If these are needed, or held above other sources, the guideline should specify that. The definition of 'high quality' is still nebulous. Quackguru may be repeating it based on Ernst's reputation, but the low impact factor, age, and admitted poor quality of the data (again see (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0020339/) all point away from its being 'high quality'.Dialectric (talk) 14:18, 25 June 2015 (UTC)

We are not using several other sources that have a high impact factor, or is a recent high-quality review. Wikipedia's WP:MEDDATE is very clear on this. Therefore, we can use other sources like the Ernst review when the evidence is so limited. QuackGuru (talk) 01:02, 26 June 2015 (UTC)

We are using it, just not for opinions. AlbinoFerret 01:04, 26 June 2015 (UTC)

"We are using it, just not for opinions." is not a valid reason to delete the conclusion from the review. Since you think it is an opinion I have kept the attribution without WP:ASSERTing it as fact.

I clearly made a valid argument for including the statement you deleted based on MEDDATE. Since you could not provide a reasonable rebuttal based on WP:MEDDATE I have restored the statement. QuackGuru (talk) 01:18, 26 June 2015 (UTC)

There is clear evidence in this thread that its impact factor of 1.07 makes this a low quality source. There is no consensus for inclusion for the opinion. AlbinoFerret 01:47, 26 June 2015 (UTC)

Removal break

If this was a well-researched area then we could exclude sources because of their impact factor. However, there aren't many sources out there, and they're all low-quality for one reason or another, so impact factor as a measure of quality isn't useful here.

The new sentence is better than the original and I can support its inclusion. I'm not convinced that the sentence belongs where it was put but that whole section needs work. If other reviews have made the same conclusion, we can add them as references to this statement. If they've made different conclusions, then we can say that this 2003 study said x while that later one concluded y. Would that work for you? Ca2james (talk) 04:56, 26 June 2015 (UTC)

Its the same thing, from a 12 year old low quality source. It seems MEDRS is strongly supported, until someone wants to bend it a little, its just sad. AlbinoFerret 11:43, 26 June 2015 (UTC)

Hey AlbinoFerret - this has been written a bunch of times here, but WP:MEDDATE says "These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published.". A key thing here is that in a topic where there is lots of ongoing clinical work (see for example Statin#Primary_prevention) that can be incorporated into new reviews, new reviews are essential. The issue with Kombucha is that there have not been any serious clinical studies - if you look at the evidence base being discussed in the Dufresne review (from 2000 btw, and as far as I can see nobody(!) has objected to it on the basis of its age), in Ernst from 2003, and in the Vına review from 2014, you will see that all Vina does is include a few additional animal and in vitro studies - basically the same clinical evidence base that Ernst and Dufresne looked at. There is no more human evidence - nothing additional to say over those 14 years. MEDRS is all about ensuring that we base WP content about health on the best evidence we have from reviews, which generally aligns with consensus statements from major medical/scientific bodies. There has just been nothing to update here and all three of the sources are of equal value in that regard - you would have an argument if you could say something like "Vina includes data from a major clinical trial that Ernst and Defresne didn't have access to - we need to rely on Vina and get rid of the other two." But nobody can say that. Nobody is abusing anything here. Jytdog (talk) 12:32, 26 June 2015 (UTC)

This isnt all about the date. Ernst is one of the lowest impact ratings on the page. Age and quality should make opinions, not reviewed claims, unusable. AlbinoFerret 12:52, 26 June 2015 (UTC)

great, i hope that discussion here can move past the MEDDATE issue. On the impact issue, all these sources are pretty crappy - none of them are NEJM, Science, Nature, etc.

This is a "fad food" with marketing hype and very little evidence...and very little money and effort spent on studying it clinically (companies in the space don't need to spend money to show safety/efficacy, so they don't!). On top of that, to the extent people are doing home-made kombucha... everybody who does home canning knows the dangers of botulism in that context, and fermenting things at home on purpose also requires a lot of care. discussing those risks doesn't seem at all crazy to me. I'm having a hard time understanding why there is all this drama. Jytdog (talk) 14:14, 26 June 2015 (UTC)

Noncompliance with WP:NPOV, WP:UNDUE, WP:MEDRS. Atsme^📞📧14:34, 26 June 2015 (UTC)

Case reports and reviews

Bringing this here so as not to clutter up the discussion above. Atsme, It seems to me that you're talking about case reports, which I know shouldn't be used in articles. I'm talking about review articles that include case reports; we're allowed to use those because review articles are generally considered secondary sources. The fact that there are few case reports is a red herring. Ca2james (talk) 22:31, 24 June 2015 (UTC)

No, I'm talking about MEDRS and what that guideline clearly states about case reports regardless of where they are mentioned, including peer reviewed scientific Journals. Please try a little harder to understand the guidelines. A case report is a case report is a case report, it doesn't matter where it shows up. It doesn't matter who evaluates it - it is a case report which means it is anecdotal. Seriously - medical editors need to understand why case reports are anecdotal. I'm a 30+ year journalist/writer/publisher and a layperson regarding medical topics and can understand the simple mechanics of MEDRS guidelines. WP:CIR. Atsme^📞📧 23:08, 24 June 2015 (UTC)

WP:CIR indeed. Have you wondered why every experienced med editor here is telling you you are mistaken? By your logic a systematic review that considered just RCTs (also unreliable sources per WP:MEDRS) would be unreliable because it inherits the unreliability of the material it considers: or in other words, everything would be unreliable. Having a good secondary source "launders" primary sources such as case reports and trials and gives us secondary expert judgement that is ideal for encyclopedic use; that is just fundamental to our sourcing policies. Alexbrn (talk) 23:14, 24 June 2015 (UTC)

A summary of the Ernst abstract says "no formal assessment of the validity of the evidence was possible." (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0020339/) The Jayabalan 2014 paper mentions the anthrax report in passing without comment. Anthrax is only mentioned in that one sentence, and not in the conclusion. How is pulling the mention of anthrax from both papers not WP:UNDUE and Wikipedia:Cherrypicking? Is mention alone sufficient to meet your standard of "secondary expert judgement"? Dialectric (talk) 23:31, 24 June 2015 (UTC)

How is that relevant to the question at hand?

Apparently when some editors don't agree with peer reviewed Journals they resort to primary sources they can personally review - er, uhm...is that allowed? So if we don't like a review, we can resort to primary? If that's the case, there are a whole bunch of primary sources that dispute the ones Alex has cited. Perhaps we should use their reasoning to do so if it is truly valid. Considering the Ernst review is old and unsupported by scientific evidence, it appears we can resort to creating our own reviews by cherry picking primary sources that say what we want them say, right? That is exactly what is happening here. A handful of medical editors don't like what the new research concludes so they decided to create their own reviews by picking and choosing primary research articles. Will someone please explain to me how this is not abuse of MEDRS? Where is Doc James and why hasn't he responded to any of this? Atsme^📞📧 23:41, 24 June 2015 (UTC)

That seems "not even wrong" as a response. We don't use primary sources; we use secondary sources per WP:MEDRS. Peer-reviewing is orthogonal to whether something is primary or secondary. Ernst is a secondary source, a Review. The fact that (as you keep saying) you think it "unsupported by scientific evidence" has no bearing on that fact. Alexbrn (talk) 23:52, 24 June 2015 (UTC)

Atsme, there's no need for condescension. Medical editors do understand how case reports are anecdotal and how case reports are "laundered" (I like that wording!) via a secondary review. Laypeople are often unable to understand that anecdotal reports are no substitute for scientific trials. Not that you appear to think this, of course. You seem to think that if a peer-edited journal paper includes anecdotal case reports, that paper is inadmissable as a source per MEDRS (possibly to mention those case reports? That part of your argument isn't clear). You also seem to think that I and all the other medical editors have to prove to you how this kind of secondary source doesn't meet MEDRS. However, you're the one that wants to exclude the study, so you're the one that has to show that it doesn't meet MEDRS. You have so far failed to do that. If you have other arguments, please briefly present them so that we can talk about this issue and get it sorted. Otherwise, please drop the stick. Thanks. Ca2james (talk) 00:34, 25 June 2015 (UTC)

I agree that there is no need for condescension so why do you keep resorting to it as you just did...in a polite but disruptive manner? What I've experienced reading your comments to me ill-will and a gross misapprehension of policy and intent. The onus is on those editors who want to restore noncompliant material, and so far each time that burden has been placed where it belongs, noncompliant claims are being removed, like the death claim in the lede. Certainly you don't think I'm going to stop holding editors accountable for the material they want to add. I can't think of anything worse than trying to put forward an argument that lacks validity. My arguments haven't failed. Yours have because of your misapprehension of anecdotal case reports when MEDRS is black & white clear on the subject. Trying to discredit me as providing an unclear argument falls back to you - the onus is on you to prove that a stated guideline is wrong. Show me where it states in MEDRS that anecdotal reports are acceptable as long as they are in peer-edited journal paper which is in direct conflict with MEDRS. I am growing weary of arguments that are not substantive and blatant contradictions of PAGs. Atsme^📞📧 13:41, 26 June 2015 (UTC)

You keep saying that I bear you ill will but I don't. I - and the experienced medical editors - disagree with your interpretation of policies and guidelines. However, disagreement does not automatically imply ill will; similarly, just because you disagree with criticism does not mean it's unwarranted or not substantive. I and other editors have repeatedly explained how and why your interpretations and guidelines are incorrect. I think it's safe to say that we're all weary of this argument. Ca2james (talk) 20:37, 26 June 2015 (UTC)

Adding: not all of the articles you posted above in the Journal Reviews list are useful. 2 and 5, in particular, don't focus on kombucha and kombucha isn't even mentioned in the abstracts. 4 might be useful for the microbiology section as it appears to discuss that aspect; however, it cannot be used to support health claims because microbiological effects do not necessarily yield health benefits. Both 1 and 3 discuss the adverse effects and neither contradicts the Ernst review. Why do you say they do?

With respect to the claims you had previously edit-warred over:

• much of the text you added was about black tea, which is WP:COATRACK. Kombucha can be made with many liquids and focusing on black tea is UNDUE.
• you added: Kombucha tea is often referred to as a beneficial health drink because of its combined antioxidant activity, and its probiotic properties produced by live bacteria or metabolites of bacteria during fermentation is OR because although research has shown that kombucha contains probiotics and antioxidants, there's no research showing that they actually have a beneficial effect.
• you added: There have also been a small number of random anecdotal case reports that have raised some concern over lactic acidosis and other potentially harmful effects linked to unsafe practices during home preparation, such as lead contamination from leaching ceramic containers during fermentation. This statement replaced the discussion on adverse effects. Not actually saying "adverse effects" plus using "random anecdotal case reports" is both poor wording and POV-pushing because it minimizes their existence. Adverse effects were reviewed in the three best reviews we have on health effects (1 and 3 in the above list, plus Ernst) and they need to be included in the article along with some kind of a caveat that evidence is poor. We cannot just dismiss them. Ca2james (talk) 06:39, 25 June 2015 (UTC)

The primary ingredient of kombucha is black tea or green tea and both are made from leaves of the shrub Camellia sinensis. Black tea is simply stronger in flavor than the less oxidized teas from the same shrub. It also appears that you don't understand WP:COATRACK because a coatrack is what this article is now because of its censorship of scientific information. A coatrack article fails to give a truthful impression of the subject. The use of the outdated, low quality Ernst review adds to the problem. Perhaps you should read some of the reviews you've been rejecting. Atsme^📞📧 13:41, 26 June 2015 (UTC)

I don't think my statement was clear, and I'd appreciate it if you would ask me for clarification instead of telling me that I don't know what I'm talking about. Your post comes across as condescending, demeaning, and uncivil and all that isn't needed here.

Even if, say, kombucha were primarily brewed in beer, that would not be a reason to include the benefits or drawbacks of beer consumption in this article because this is an article on kombucha, not beer (and my understanding of COATRACK says that including beer benefits and drawbacks would be an example of coatracked content). The same reasoning holds true for black tea in this article.

if RS discuss how black tea contributes to properties of kombucha, then it might make sense to include a summary of this in the article. In the review papers I've read, I haven't seen this connection made. Which RS support it? Do you have quotes? Without RS to make that connection, such text is OR/SYNTH.

Even if RS support such a summary, we're still left with the problem that kombucha is made primarily with either black or green tea, and so focusing on the benefits of black tea is UNDUE. I hope all this is clearer. Ca2james (talk) 20:37, 26 June 2015 (UTC)

BC CDC assessment?

Is a food safety assessment presented by the British Columbia Centre for Disease Control considered a reliable source per MEDRS? Ca2james (talk) 17:20, 25 June 2015 (UTC)

Yes it is a position statement from a governement organization. Doc James (talk · contribs · email) 18:05, 25 June 2015 (UTC)

Thank you. It has a good review section with information on how kombucha is made and includes an overview of the hazards. I particularly like that this paper differentiates biological hazards associated mainly with molds and other contamination from chemical hazards associated mainly with over-fermentation, acetic acid, and pH. I'll see if I can figure out a way to add it to the article. Ca2james (talk) 01:03, 26 June 2015 (UTC)

It's not our job to teach people how to make the stuff, only that improper home preparation is associated with potential toxicity. Why don't you cherrypick more positive aspects of the drink instead of consistently focusing on the potential negatives? What you're doing is UNDUE and certainly not NPOV. Atsme^📞📧 14:18, 26 June 2015 (UTC)

Agree we mustn't be a tutorial, but Ca2james's edits don't constitute one and properly reflect a good source - so, improvement! Alexbrn (talk) 14:28, 26 June 2015 (UTC)

The issue is WP:UNDUE and WP:NPOV, and the repeated references to the same 28 anecdotal case reports that fail compliance with WP:MEDRS. Jiminy Cricket, why is that so hard to grasp? To keep bringing up the same unsupported anecdotal information that doesn't go beyond maybe is clearly UNDUE and FRINGE. Again, the claims are scientifically unsupported regardless of what Review it's published in or what government states so. They are anecdotal claims, not to mention old anecdotal claims based on a small group of people, most of which dates back to 1995 with a few more recent but rare cases that are over 5 years old involving people who had underlying health issues, like AIDS. There is no justification for anything more than a paragraph about the potential toxicity associated with the fermentation process during home preparation. There has not been one, not one case that proves causality. Treat it like the GMF safety issues are being treated - no scientific evidence to support the claims. Atsme^📞📧 14:48, 26 June 2015 (UTC)

If multiple reliable sources report something as fact, it is not FRINGE, regardless of how many times you make that ridiculous claim. AndyTheGrump (talk) 15:35, 26 June 2015 (UTC)

To begin, there are no "facts" because what is being challenged here is scientifically unsupported material based on assumptions and unadulterated potential, not fact, so it is FRINGE according to WP:FRINGE Furthermore, WP:MEDRS clearly states (my bold underline for emphasis) Roughly in descending order of quality, lower-quality evidence in medical research comes from individual RCTs; other controlled studies; quasi-experimental studies; non-experimental, prospective, observational studies, such as cohort studies and case control studies; cross-sectional studies (surveys), and other correlation studies such as ecological studies; retrospective analyses; and non-evidence-based expert opinion or clinical experience. Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources. I'm weary of making this same argument over and over again, so please drop the stick. Atsme^📞📧 15:56, 26 June 2015 (UTC)

You're wrong & nobody with any familiarity with MEDRS agrees with you. MEDRS says "Ideal sources for biomedical material include general or systematic reviews" and these reviews of course collate, sift, and analyze lower-quality evidence. That does not disqualify them, it is essentially what they are. This repeated wrong-headedness is now getting disruptive. Alexbrn (talk) 16:11, 26 June 2015 (UTC)

Wait - Atsme, are you saying that a review paper that has reviewed case reports is the same thing as case reports published in a peer reviewed medical journal? They're not the same thing although I can see how this could be confusing because the language used is similar. A single case report published anywhere wouldn't be a suitable source. However, once it's included in a review article then it's part of a larger paper: the review. We can cite the review paper (assuming it's OK for other MEDRS reasons). If think the article as it stands does a good job of summarising the different papers with respect to adverse effects; certainly it's much improved. Ca2james (talk) 19:21, 26 June 2015 (UTC)

I quoted exactly what it states in MEDRS. The green text is quoted directly from the guideline. I don't see anywhere in the guideline that states a review published in a peer reviewed medical journal is the exception or that it's exempted. A medical journal is a medical journal and in it are reviews. The guideline is pretty specific about it - Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources. Just because a single reviewer does a systematic review in peer reviewed medical journal and single-handedly decides unsupported science is now considered to be causality is hogwash. It refers back to non-evidence-based expert opinion. You can't add evidence where there is none, and being in a review doesn't make anecdotal case reports suddenly have validity as scientifically based causality. Show me that statement in MEDRS. Atsme^📞📧 19:42, 26 June 2015 (UTC)

Peer reviewed does NOT equal review article. Doc James (talk · contribs · email) 20:23, 26 June 2015 (UTC)

Yes, I hope that the difference is understood. Though published review articles are themselves peer reviewed. Part of the issue with case reports for me is that as Alexbrn writes above, a review is expected to "collate, sift, and analyze lower-quality evidence." including case reports, but in this case the reviews simply list the reports without any analysis, or, apparently, any sifting - looking at the Ernst summary, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0020339/, we see that there is no clear selection critera and that apparently any study or report having something to do with kombucha and health was included.Dialectric (talk) 21:21, 26 June 2015 (UTC)

Right. The distinction is that a case report published in a peer-reviewed medical journal or on the news is not the same thing as a review paper that reviews the case report that is published in a peer-reviewed medical journal. The former is a case report and the latter is a review. I see how the MEDRS language is a bit unclear in this regard and clarifying it might be a good idea. The kombucha review articles list the case reports and basically advise caution because the benefits are unproven and there have been isolated issues that may have had nothing to do with kombucha consumption. The link to the Ernst review says However, he also noted that the adverse events were described in isolated reports, which cannot allow firm conclusions about causality and allow for generalisation. About data selection, I'm not sure that it's practical to define narrow case report selection criteria or to do much in the way of sifting of that case report data since there are so few data points. Kombucha isn't like, say, omega 3, which has been very well studied and case reports are selected and sifted much more carefully. If there was more information on kombucha, the same narrowing of scope and data sifting would happen. Does that make sense? Ca2james (talk) 03:06, 27 June 2015 (UTC)

Yes. Incidentally, the general reasons why a review takes these case reports into consideration is well explained in the Ernst review (which I now have a text of)

The relative paucity of documented adverse events might indicate that problems occur rarely; it could, on the other hand, also be due to a high level of under-reporting of adverse events. Consumers are considerably less likely to report adverse effects from unconventional therapies than from conventional OTC medications [14]. Even though the case reports and case series mentioned above are in themselves not compelling, they have to be taken seriously and should be followed up with more rigorous investigations.

Alexbrn (talk) 05:00, 27 June 2015 (UTC)

"energizing and detoxifying agent" ?

Petrarchan47 has now twice inserted text[25][26] saying that kombucha was "valued as an energizing and detoxifying agent". As well as being pseudoscientific babble (what is an "energizing agent", and what does "detoxifying" mean?) this implies these are objective properties of the drink, rather than misapprehensions of the age, and is sourced to a non-MEDRS source ... so, iffy health claims by the back door. The source itself makes a proper qualification by saying "When we study the development of civilization and the role of food and folk medicine, we often discover that many foods and beverages were used for their assumed beneficial effects on health" (my bold). I propose a more neutral wording, that kombucha was "thought to have medicinal properties". Alexbrn (talk) 20:39, 20 June 2015 (UTC)

Alex, I cannot for the life of me believe you don't understand the basics. I have added neither of those claims. The first time you reverted 2 hours worth of my work for no reason whatsoever, you did not remove the claim about antioxidants, and I never added it. I simply moved it from the bottom of the "chemical and biological properties" section, and in your revert you simply moved it back.

It goes without saying that quoting RS regarding the history of the drink is in no way comparable to inserting "pseudoscientific babble". I'm inserting history. People thought the earth was flat once too, is the editor who added that information to WP guilty of inserting pseudoscientific babble?

You are not helping this article and the editing process. I am not of sure the goal of your actions, but I don't recognize it as guideline based. petrarchan47คุก 20:53, 20 June 2015 (UTC)

I gave diffs for your addition and reversion[27][28], so saying "I have added neither of those claims" would seem to be incorrect. Alexbrn (talk) 20:57, 20 June 2015 (UTC)

Again, I do not believe that you aren't understanding the difference between adding history and adding a claim. You seem to believe that I want to make this article bend in favor of the subject. Remember that I was only attracted to work on this because of the mention of death in the Lede - something only you thought was a good idea. Now, I am trying to add some history since no one squatting on this article has been able to gather enough to make a mention of it in the Lede, which is in violation of WP:LEDE. As for my personal opinion, I assure you I am not here to promote Kombucha. I was simply embarrassed by the state of the Lede when I first saw it. It looked to be biased, as do your arguments against my work. petrarchan47คุก 21:07, 20 June 2015 (UTC)

None of which addresses the point at hand. You've added a claim in a non-neutral way. It's like saying (to use your parallel) "the flatness of the Earth was established in the 12th century by many philosophers" - i.e. it presents pseudoscience as though it was a fact, recognized at the time (in contrast to what even the source you use does). My simple re-word sidestepped this issue and you reverted to re-assert your preferred text. Alexbrn (talk) 21:17, 20 June 2015 (UTC)

It does appear that the claim is sourced

"It also originated in China where the ``Divine Che was prized 220 BC during the Tsin Dynasty for its detoxifying and energizing properties"

AlbinoFerret 21:21, 20 June 2015 (UTC)

In that case the article can mention that Divine Che was thought to have detoxifying and energizing properties, but saying that it does have those properties (which aren't well-defined or supported by any other refs) doesn't belong in the article. Ca2james (talk) 00:36, 21 June 2015 (UTC)

The claim is purely historical. I thought Alexbrn's edit solved the issue nicely. [29]. AlbinoFerret 01:27, 21 June 2015 (UTC)

I hadn't seen the edit or closely read Alexbrn's proposal when I made my reply, but as it happened we came up with very similar wording. I also thought the edit solved the issue nicely. Ca2james (talk) 04:32, 21 June 2015 (UTC)

Alex's new text is almost exactly what I wrote, although my version was called POV, and changed to "the tea was thought to have medicinal properties". My question is whether the claim of POV and his original change represents a correct read of the guidelines. I got an edit warring notice for reverting his text only once.

That the "Tsing Dynasty valued the drink as ..." is the exact same thing as saying it was "thought to be ..." except that we are loosing some context. Both sources say it was "prized" - that indicates a certain value placed on the drink that is missing in the toned down "thought to be". Why not stick to the source?

Alex also claims the source is not MEDRS for health claims. This is not a health claim; it is a claim about history. Is it true that historical claims need MEDRS sources? I think the MEDRS guideline is being misused, yet I am the one being reverted and called POV, and getting nasty templates added to my talk page. I am growing very tired of people not calling out this bs, and covering for their buddies, or looking the other way. petrarchan47คุก 06:07, 21 June 2015 (UTC)

So, focusing on content as we should: it's not the same to say something was "valued for property x" and "valued because it was thought to have property x", since the first form implies property x is real. Any biomedical information here is subject to MEDRS, even historical stuff. Alexbrn (talk) 06:18, 21 June 2015 (UTC)

This is what RS states: "was prized 220 BC during the Tsin Dynasty for its detoxifying and energizing properties". Obviously, people during the time believed the tea had these properties. You seem to be going out of your way to censor history in order to promote a clear POV against the subject, as evidenced by your addition of "caused at least one death" to the Lede (until you were reverted). "Prized 220 BC during the Tsin Dynasty for its detoxifying and energizing properties" is in no way "biomedical information". We aren't "implying" anything except what an ancient people believed. You can't call my edit POV when it so closely mimics the RS, unless the RS is itself non neutral. petrarchan47คุก 06:42, 21 June 2015 (UTC)

“people during the time believed the tea had these properties” ← and now the fact that was a "belief" is clear from our article. I'd say job done. Thanks for expanding the history section. Alexbrn (talk) 07:07, 21 June 2015 (UTC)

I think "believed" works as well as "thought to be". Either modifier makes it clear that back in the day, they thought the tea provided these benefits. If the statement omitted this modifier, then the implication would be that the tea provided these benefits at that time and continues to provide them today. Since no RCTs have shown that the tea does provide these benefits, the article can't imply that it does. Ca2james (talk) 08:11, 21 June 2015 (UTC)

Yes, either term would do. Note this issue has now been raised at two(!) noticeboards (WP:NPOV/N and WT:MED), and from the responses there the consensus on how our WP:PAGs apply in such cases as these, seems clear. Alexbrn (talk) 08:21, 21 June 2015 (UTC)

The source uses "During the Tsing Dynasty it was prized as" to signal "back in the day" - I don't see why Wikipedia would assume our readers can't figure out we are speaking of the beliefs of the distant past. I still fail to understand why I'm getting edit warring notices for one single revert, nor why my quoting the source could possibly be called POV. petrarchan47คุก 15:39, 21 June 2015 (UTC)

The issues went to two noticeboards because there are two issues being raised - the claim the my edit was POV, and the claim that MEDRS is required to talk about what they believed in 220 BC. I can't bring up the MEDRS problem at NPOV, or I would have stuck to just one. It's certainly a more rational approach to edit warring that templating a user page after one fricking revert. petrarchan47คุก 15:44, 21 June 2015 (UTC)

The source does use language that indicates that the belief was held back in the day but your proposed wording does not use that language. The advice received in all three discussions (two noticeboards plus here) is the same: the statement has to be qualified to show it was believed by this group back then. Ca2james (talk) 15:53, 21 June 2015 (UTC)

I support the "group X believed Y" wording for a historical example. 'prized' is an unnecessary value judgement.Dialectric (talk) 15:55, 21 June 2015 (UTC)

My point is that the wording sticks to RS, which placed the value judgement in the sentence to convey a historical fact - it was prized, highly valued, at the time, for certain properties that, one assumes from the wording, they believed it had. I quoted almost directly from the source, I didn't change the meaning at all, so how can that be considered POV? I'm frustrated because there seems to be a level of censorship of history that is in keeping with a general POV here at this article; this POV is evidenced by the fight against removing the one death from the Lede. Normally when I edit, I stick as close to possible to the source and that has always kept me very safe. In this case, I couldn't have worded it any closer without copying it directly, yet it's being claimed that "my wording" is not neutral, and that the authors of the review used the term "prized" unnessesarily. I frankly don't understand how to edit alongside the Project Medicine group. I don't recognize the arguments, templating tactics, and buddy system as any way to build an encyclopedia. I go to the proper noticeboard, as well as PM talk with specific questions, and I am given a hard time for doing so. I added to the history section because there is no mention of history in the Lede (?!), and because I was told by the OWNers of this article that the history section needs expansion first. When I try to add history, my work is reverted and called POV. I found two good sources for the history; they both say very little, and they say the same thing. So that is what I added. I am baffled as to why are there so many editors here, and yet no one helping build the history section, and building a proper lede? Why is this left up to a few who then become targets of aggression? Why would anyone want to help edit in this environment and why am I the only person asking these questions? petrarchan47คุก 17:18, 21 June 2015 (UTC)

Thank you for building out the History section. I think one reason there are so many editors here is because help was requested at WT:MED (where history isn't exactly a focus). As for this one sentence, I want to try to make it clear why your preferred version doesn't work but I'm having trouble figuring out which part doesn't make sense to you. I hope it's ok if I pick apart the reasoning as I see it.

• Looking at the original text, it says the Divine Che was prized 220 BC during the Tsin Dynasty for its detoxifying and energizing properties. I was wrong above where I said that the sourxe indicated that this group believed that the tea had those properties, because the source doesn't explicitly say that. So yes, when you write In 220 BC, during the Tsing Dynasty, the tea was prized as an energizing and detoxifying agent, you are sticking close to the original source.
• Your proposed wording does a better job than the source of indicating that the group thought the tea had these properties.
• However, it is possible to read the sentence as indicating not only that the group thought the tea had those benefits back in the day, but that it actually does provide those benefits today. This is because to say that a group prized a thing for a property (in this case energizing and detoxifying) implies that the property still exists.

• There is an issue with the word "prized" because that's a value judgement and could be considered a WP:PEACOCK word, and PEACOCK words are not considered neutral. I realize that the word is being used because it's close to the original source, but in that case, it's better to quote the original source - provided that there are no oteher objections to the statement (which there are in this case).

• Detoxification and energization are considered health benefits, albeit vaguely-stated and poorly-defined ones.
• To say or imply that a product actually provides a health benefit is a health claim, no matter where the text occurs.
• All health claims must be supported by sources conforming to MEDRS.
• Since there are no such sources, the article can't even imply indirectly that the product provides those benefits.
• Therefore, to avoid making implied health claims, it's better to explicitly say that group believed that the tea had those benefits.

Does that make more sense? If not, please let me know where it's unclear so that we can settle this issue. Thanks. Ca2james (talk) 19:22, 21 June 2015 (UTC)

If we're talking about ideas of over 2000 years ago, are the terms "energizing" and "detoxifying" even appropriate? Wouldn't the concepts current then have been more concerned with terms analagous to "chi" and "humours"? Brunton (talk) 08:15, 28 June 2015 (UTC)

History

Kombucha originated 5,000 years ago in China, where it was known as "Divine Che" (Divine Tea).[citation needed] Which source verifies the claim? See Kombucha#History. QuackGuru (talk) 20:53, 28 June 2015 (UTC)

The fossil record? . What I found was in a review that states: Kombucha originated in northeast China (Manchuria) where it was prized during the Tsin Dynasty (“Ling Chi”), about 220 B.C., for its detoxifying and energizing properties. In 414 A.D., the physician Kombu brought the tea fungus to Japan and he used it to cure the digestive problems of the Emperor Inkyo. See [30]. Atsme^📞📧 21:06, 28 June 2015 (UTC)

Right, but that source doesn't support the statement that QuackGuru mentioned. Does someone have a source for that statement? Ca2james (talk) 23:18, 28 June 2015 (UTC)

I provided a source for kombucha's origin as stated in a scientific journal review. If you have a problem with that source, then look it up yourself and stop expecting other editors to do it for you. Atsme^📞📧 23:33, 28 June 2015 (UTC)

I don't have a problem with the source you provided, except that it didn't support the whole sentence. Since I didn't add the stuff in the first place I thought someone else working on this might know which paper supported the other half. As it happens, I did look for support for the sentence and I found it: the Dufresne paper "Tea, Kombucha, and health: a review" supports the statement with It was taken in China 5000 years ago for its stimulating and detoxifying properties in the elimination of alcohol and toxins, to improve blood and urine flow, to relieve joint pains, and to improve resistance to diseases. The Divine Che statement should be linked to 220BC per your source, so linking it with the 5000 years ago in China part of the sentence is wrong. I'll fix this now - thanks for pointing out it wasn't sourced and for helping find sources. Ca2james (talk) 23:43, 28 June 2015 (UTC)

I've just finished the change. The Dufresne paper does support the Divine Che stuff (I hadn't looked for that part before) so I just used that for that statement since the Jaybalan review that Atsme gave was pulled from the article because it misstated the FDA's conclusions, per the section above. Ca2james (talk) 23:48, 28 June 2015 (UTC)

Simpler language

This "There is however no good evidence that kombucha consumption benefits human health."

is simpler than

"There is however no unequivocal, preponderant evidence that kombucha consumption benefits human health."

Thus I say we go with the first one. Doc James (talk · contribs · email) 21:11, 1 July 2015 (UTC)

Well the first one seems to be written to confuse the reader, so I think it's an obvious choice. -- CFCF 🍌 (email) 07:34, 4 July 2015 (UTC)

You mean the second? Alexbrn (talk) 10:01, 4 July 2015 (UTC)

Ordering of sections

Health claims are of greater interest to readers and thus IMO should come sooner. Biochemical properties may be of interest to researchers but have little real world meaning. Doc James (talk · contribs · email) 17:54, 28 June 2015 (UTC)

The health claims and adverse effects are related to the biochemical properties. From an explanatory perspective, it seems odd to talk about the adverse effects related to acid production or contamination before talking about how it's made. Similarly, health benefits are thought to be related to the biochemical properties, so talking about health benefits first doesn't make sense to me. That said, I'm not wedded to any particular ordering; I just want the article to flow logically. If someone can write the health benefits and adverse effects to make the logical dependencies work when these sections come before biochemistry, I'd be as happy with that. Ca2james (talk) 18:29, 28 June 2015 (UTC)

The health effects are a general picture. The biochemical properties are tentative research ideas. We should present the main summary before we delve into details. This is why we put research sections last in medical and pharmaceutical articles. Doc James (talk · contribs · email) 18:34, 28 June 2015 (UTC)

After I wrote my reply I went and looked at WP:MEDMOS and saw that you're right. Thanks for explaining this and for your patience. Ca2james (talk) 18:59, 28 June 2015 (UTC)

I have also read MEDMOS, and I'm thinking perhaps a very important section has been overlooked: Writing for the wrong audience. I'm not going to elaborate on each and every paragraph and section in the article, but as a quick example I'll refer to the most obvious statement in the 3rd paragraph of the lead: A systematic review found the mostly unclear benefits of kombucha drinking did not outweigh the known risks.. Aside from the poorly written prose, what are the known risks? Are you referring to the anecdotal case reports that were summarized in the systematic review as poor reporting, scientifically unsupported and/or anecdotal and unconfirmed? You're citing an outdated 2003 low quality systematic review by a single author but nothing is mentioned about the quality of the source. There is also a double whammy because (1) not only does the conclusion in the review confirm the information is scientifically unsupported, (2) our general readers don't have a clue as to the significance of a systematic review, especially an old one that is lacking in current research and was summarized in the CRD summary as lacking in multiple areas. What's right is right and if you're going to generalize the "health effects", then get it right. The FDA pulled its warning. A journal review dated June 2014 that has a 4.182 IF states: Chemical analysis of kombucha showed the presence of various organic acids, such as acetic, gluconic, glucuronic, citric, L-lactic, malic, tartaric, malonic, oxalic, succinic, pyruvic, usnic; also sugars, such as sucrose, glucose, and fructose; the vitamins B1, B2, B6, B12, and C; 14 amino acids, biogenic amines, purines, pigments, lipids, proteins, some hydrolytic enzymes, ethanol, antibiotically active matter, carbon dioxide, phenol, as well as some tea polyphenols, minerals, anions, DSL, as well as insufficiently known products of yeast and bacterial metabolites. [31]. Where is that mentioned in the article? I'm sorry, but I find the censorship of important updated information rather troubling, and the lack of NPOV evidenced in this article concerns me. I've never touched the drink - have no desire to even try it. I'm simply a writer who expects to see the correct information in an encyclopedic entry per MEDMOS. Atsme^📞📧 19:43, 28 June 2015 (UTC)

Isn't that sentence you quoted mentioned in the Chemical and biological properties section Along with multiple species of yeast and bacteria, Kombucha contains organic acids, enzymes, amino acids, and polyphenols they produce. The exact quantities of these items vary between samples, but may contain: acetic acid, ethanol, gluconic acid, glucuronic acid, glycerol, lactic acid, usnic acid and B-vitamins.[27][28][29] Kombucha has also been found to contain about 1.51 mg/mL of vitamin C.[30]? Ca2james (talk) 00:00, 29 June 2015 (UTC)

One issue Atsme raises is how review articles are described in the article text. Saying the Ernst review is low quality in the article would be OR, but if there is no mention of any indicator of quality, a poorly done review that just squeaks by the bar for inclusion will appear on equal footing with a well-written review in a top journal. Lay-readers will likely not distinguish between the good journal and the mediocre. How can we assign weight to review conclusions? Or should we just accept that mediocre science or science based on limited evidence be on equal footing with excellent science once the bar for inclusion is met?Dialectric (talk) 17:47, 30 June 2015 (UTC)

Dialectric on what basis are you saying the Ernst review itself is of lower quality than others? have you the 2014 review, and the Ernst review? They are remarkably different. If you need either, i can email them to you. Jytdog (talk) 19:19, 30 June 2015 (UTC)

As for ordering of sections, we spoke about this here already - WP guidelines suggest following other similar articles when determining section placement. Green tea puts history first, as do so many encyclopedia articles. I think we can't assume the reader wants to read primarily about health claims when they come here. They might, but how do we know this? It's also a short enough article that section ordering may not be as important as it is in more sprawling pages. petrarchan47คุก 07:07, 4 July 2015 (UTC)

Agreed. The section ordering mentioned at the start of this section was in reference to my changes to put microbiological content (now called composition and properties) ahead of the health stuff. Both were still after the history section. Ca2james (talk) 18:30, 4 July 2015 (UTC)

Verification issue

In the article we find this claim. "While rigorous study of the toxicity and its molecular agents is yet lacking, an association has been made between symptoms observed in a number of Kombucha toxicity cases, and the presence of the hepatotoxin, usnic acid,[18]"

The only mention of Kombucha in the reference is.

"Rare instances of hepatotoxicity have also been reported with use of lichen based teas known as Kombucha tea, but whether these were due to usnic acid or another contaminant of the tea was not shown."

The claim is unsupported as it is "not shown" not an association. AlbinoFerret 04:41, 7 July 2015 (UTC)

Sorry, Albino, I didn't see this until now. Please see section below. We have conflicting sources, and need more scrutiny. petrarchan47คุก 05:10, 8 July 2015 (UTC)

Hepatotoxic Botanicals

This review does not mention Kombucha at all, yet is included in the article and was used to support this revert, followed closely by this one. Editors are using unrelated reviews to counter the Dfresne review which is specifically about Kombucha, and states specially (as I noted in my edit) that these claims are unfounded: The presence of usnic acid in Kombucha reported once has not been confirmed in recent studies (Blanc, 1996). . Has any recent study proved otherwise?

Can someone explain how reviews that don't mention Kombucha can be justifiably used to override those that do? petrarchan47คุก 21:38, 7 July 2015 (UTC)

You need to read the review again, specifically page 384 and 385 where Kombucha is specifically discussed. Yobol (talk) 21:41, 7 July 2015 (UTC)

Would you be so kind as to detail the information here? I don't have access to 300 pages of text. What does it say? What study is referenced, and what was the year? Thanks, petrarchan47คุก 21:42, 7 July 2015 (UTC)

Why are you removing information, stating a source does not discuss Kombucha, if don't have access to the text? Yobol (talk) 21:45, 7 July 2015 (UTC)

I mistakenly thought I was viewing the full text. I have since found it, so your generous help is no longer needed. petrarchan47คุก 22:13, 7 July 2015 (UTC)

The full text pdf is downloadable at the ejournals.library.ualberta.ca link you posted, Petrarchan47.Dialectric (talk) 22:09, 7 July 2015 (UTC)

Yes, I see that just prior to the usnic acid discussion, the review reads:

• This healthy beverage has been used as therapy for several conditions like treating cancer, increasing T cell count, lowering blood pressure, curing arthritis, treating gastrointestinal disorders and alleviating constipation. Kombusha tea is also known as “fountain of youth” tonic as it restores the gray hair, reduces wrinkles and treats acne.

Should I assume that the very neutral and science loving editors in control of this page have added this content as well? I'm going to assume no, and I'll further wager that there would be significant problems with anyone attempting to do so. petrarchan47คุก 22:13, 7 July 2015 (UTC)

Perhaps you should realize there is a difference between what something is used for, and whether or not it actually does what it is used for. Yobol (talk) 22:15, 7 July 2015 (UTC)

A straight reading of the text is that according to the authors, kombucha 'restores the gray hair(sic), reduces wrinkles and treats acne.' The paper is full of poor grammar, but guessing that the author's intended meaning differs from the text is OR. This paper should probably be dismissed as a source entirely.Dialectric (talk) 22:32, 7 July 2015 (UTC)

This is a systematic review of hepatotoxicity of herbs, which it is clearly reliable for discussion of the hepatotoxicity of kombucha, and the reason why we are using it to discuss usnic acid in our text. Since any other health effects not related to hepatotoxicity is outside the actual scope of the review article, I would agree that we should not use it for that purpose, but on the discussion of the hepatoxicity, it appears to be reliable for that information. Yobol (talk) 22:41, 7 July 2015 (UTC)

A systematic review can be a sufficiently unreliable source to be excluded from the article, as DocJames made clear in a recent discussion on this page. This one is certainly not 'clearly reliable' - bad grammar and a low impact rating are both red flags. It may be reliable, but that is an open question - a close reading is needed to determine how deep the problems with this paper extend.Dialectric (talk) 01:45, 8 July 2015 (UTC)

I agree that it says it restores grey hair, reduces wrinkles and treats acne. It is full of bad grammar, and we should not engage in OR. Its got all the red flags of a poor source that someone could use to say it "restores grey hair, reduces wrinkles and treats acne" in the article. Time for this one to be removed. AlbinoFerret 14:14, 8 July 2015 (UTC)

AlbinoFerret Do you have access to the ratings of this and Dufresne? petrarchan47คุก 03:57, 11 July 2015 (UTC)

The impact of the Journal Of Pharmacy And Pharmaceutical Sciences is 1.856 and Food Research International, the second one, is 2.818. AlbinoFerret 12:00, 11 July 2015 (UTC)

Calling Doc James (or anyone proficient in the nuances of MEDRS) - we have conflicting reviews here, do we go with the higher rating? petrarchan47คุก 17:05, 11 July 2015 (UTC)

The difference between 1.8 and 2.8 is small. Neither is particularly high. Doc James (talk · contribs · email) 17:43, 11 July 2015 (UTC)

The attitude towards fixing this discrepancy is incredibly laid back compared with what we've witnessed surrounding positive (or even neutral) additions. In the same way, we didn't see much fuss over the claim in the lede that Kombucha was linked to, or even caused deaths. This is a POV that enjoys much support in WP, but not in RS.

I suggest adding the Dufresne source, as I did here (reverted twice by Alex/Jdog). petrarchan47คุก 18:22, 13 July 2015 (UTC)

Does anyone disagree with this move, or do I have to wait and find out by having my work reverted by the team again? petrarchan47คุก 18:06, 15 July 2015 (UTC)

I removed the poor quality source, as there is general dislike for it here, and it is redundant here. The 2000 source saying there is no usnic acid is still not useful in light of sources 13 and 15 years saying that there is a risk of liver damage possibly from usinic acid. Jytdog (talk) 18:34, 15 July 2015 (UTC)

Petrarchan47 it appears that you are attempting to use the 2000 Dufresne source to say that results of the 2013 study were subsequently contradicted. Something from 2000 cannot subsequently contradict a later study so adding Dufresne there makes no sense. Ca2james (talk) 21:13, 16 July 2015 (UTC)

On its face, it makes little sense. However the 2013 source is of such poor quality, there is good reason to check into whether these two conflicting sources are actually referring to the same data, with the lower quality, newer review having missed the study invalidating previous findings, resulting in misinformation. I mean, they claim too that This healthy beverage has been used as therapy for several conditions like treating cancer, increasing T cell count, lowering blood pressure, curing arthritis, treating gastrointestinal disorders and alleviating constipation. Kombusha tea is also known as “fountain of youth” tonic as it restores the gray hair, reduces wrinkles and treats acne. Do you see why some are questioning its results and suggesting any claims made to it be removed from the article? petrarchan47คุก 22:39, 16 July 2015 (UTC)

Not only does saying that a paper published in 2000 subsequently contradicts a paper published in 2013 make little sense on its face, further investigation indicates that it makes no sense at its root. The 2000 Dufresne paper refers to a 1996 paper when it says "The presence of usnic acid in Kombucha reported once has not been confirmed in recent studies." The 2013 paper refers to later papers - from 2009 and 2000 - when it says "The exact toxic agent of Kombusha mushroom is unknown but it showed to have usnic acid that is derived from lichen." The 2000 paper and the 2013 paper are not referring to the same data and it is clear that it is the 2013 paper that contradicts the 2000 paper. To say otherwise is ... I don't even know what to call it; SYNTH, maybe? Certainly it's a mischaracterization of conclusions of the available sources.

Trying to exclude one or another study from this article because it's poor quality ignores the fact that every other study used in the article is also poor quality per MEDRS: all of them are either old or the journal has a low impact factor.

What I see are several editors who are attempting to exclude adverse effects from this article in what appears to be an attempt at whitewashing. Some might call that POV-pushing. The fact is that adverse effects have been included in the available literature, and to not include them in the article is a violation of NPOV. Ca2james (talk) 16:39, 17 July 2015 (UTC)

We all agree that the sourcing is of low quality overall. That does not preclude evaluation of any one source on its merits (and inaccuracies). Calling for one study to be excluded is exactly what Doc James did earlier in this discussion.Dialectric (talk) 18:08, 17 July 2015 (UTC)

The rest of that discussion indicates clearly why that source was called to be dropped: that particular source misrepresented the FDA conclusions it was citing, which is a serious breach of scholarship. Once that kind of breach has been found, the entire paper's reliability is called into question. That is not the situation in this case. The editors arguing for exclusion of various papers aren't doing so because there's a clear scholarship problem (well, aside from the patently ridiculous arguments saying that reviews of case studies should be excluded). No, editors here are trying to exclude studies because they're low quality. Again, every single study used in this article is low quality for one reason or another. Saying that a study should be excluded just because it's low quality is focusing on a low-quality tree in a forest of them. Ca2james (talk) 23:09, 17 July 2015 (UTC)

Death in the article

make this a subsection as it's not a part of the discussion on usnic acid. Ca2james (talk) 16:15, 17 July 2015 (UTC)

We've already been over the death claims in detail, and unless there has been a dramatic change in the sources cited and new claims have surfaced other than the same poorly documented outdated case studies that are lacking causality, the insistence to keep those claims in the article is questionable at best. It's time for an RfC. Atsme^📞📧 02:06, 16 July 2015 (UTC)

The death is no longer in the lede and kombucha is mentioned as only a possible cause. Atsme, you've been trying to get the death excluded from this article for some time based on your misunderstanding of MEDRS with respect to case reports and review articles. This issue has been discussed at length on this Talk page and at FTN and your interpretation of MEDRS with respect to case reports and reviews is unsupported. An RfC isn't needed on this issue; what's needed is for you to let this go. Ca2james (talk) 21:13, 16 July 2015 (UTC)

Yes, I do understand that it's gone from the lede as it should be. I hardly think it's appropriate to scare readers about a popular refreshing tea beverage believed to have health benefits, especially when the claims are scientifically unsupported, and all point back to the same 23 poorly documented case reports that are 20+ years old and are as random as they are rare. The fact those same cases have been mirrored in journal reviews and books doesn't suddenly make them scientifically "supported". While my understanding of MEDRS may not be at the same level as my understanding of copyvio, I fully understand NPOV and UNDUE. My concerns are over the following poorly written, nonspecific, scientifically unsupported, sensationalized claims that create UNDUE and are noncompliant with NPOV in the Adverse effects section as follows:

1. The consumption of Kombucha has been associated with adverse effects including severe hepatic and renal toxicity, and metabolic acidosis.[12][13][14]
2. There are numerous cases of severe adverse reactions to ingesting the drink, and at least one woman died after consuming it, though the death was only discussed in relation to and not unequivocally linked to the drink.[16],
3. Topical use of the tea has been associated with anthrax infection on the skin, but in this case, Kombucha contamination may have occurred during storage.[1]
4. Kombucha has been rarely associated with damage to the liver (hepatotoxicity), and samples of the tea have been shown to contain the hepatotoxin usnic acid. Whether the cases of damage to the liver is due to the usnic acid, contamination or other toxin is not known.[14][18]

We've already gone over this in depth. Sensationalism has no place in the encyclopedia and we don't give fringe theories undue weight, in this case I refer to fringe because the claims have little or no scientific support. The anthrax bit really needs to go away. If it isn't scientifically supported, it doesn't belong. It's embarrassing to even suggest kombucha caused an anthrax infection. How do we know that person didn't own sheep or cattle? Rare associations don't belong either. Seriously, stop and think about how many rare occurrences of death and illness are associated with vaccines and various drugs. If it's not scientifically supported, it doesn't belong in the article. The two books cited are by the same author, Amitave Dasgupta, and they focus on herbal supplements and remedies; one of which had only a few paragraphs about kombucha scattered throughout the book while the other included a page or two with graphs - mirroring of the same 23 case reports. The same applies to the Journal of Pharmacy & Pharmaceutical Sciences systematic review which also references the same poorly documented case reports regarding toxicity where there is absolutely no confirmed causality. Numerous cases? Nope. In fact, the J of Pharm actually mentioned potential causality that made sense and should have been included but for some reason it was omitted. I also noticed the omission of the health benefits of kombucha as stated in that same systematic review which raises issues with NPOV and UNDUE in the Health claims section where the Ernst review needs to be deleted all together considering it is the lowest quality of all the sources cited and is contradicted by newer systematic reviews in higher quality journals.

Another quality source is Comprehensive Reviews in Food Science and Food Safety Journal published by the Institute of Food Technologists [32] which has an IF of 4.182, [33]. The article states: Toxicity reports on kombucha drink are very rare and scattered. Toxicity must be evaluated thoroughly using modern procedures. The J Pharm supports the same conclusion as Comp Rev regarding health benefits. Atsme^📞📧 03:21, 17 July 2015 (UTC)

Why do you insist yet again on misrepresenting WP:FRINGE policy? There is no fringe theory being presented in relation to deaths stated to have been possibly caused by Kombucha. In fact, there is no theory to speak of at all - merely the reporting of what appears to be a rare event, in reliable sources. No, of course the sources aren't reporting this as 'MEDRS' - because that would be entirely impossible, short of conducting wildly-unethical experiments that nobody would ever consider sanctioning. The sources merely report the facts, because they feel - correctly - that those using Kombucha should be fully aware of such facts before consuming the substance. At least one death has occurred in circumstances where the consumption of Kombucha may reasonably be inferred to have been a possible cause. Not definite, but possible. That such reliable sources have chosen, over a period of many years since the initial incident, to report the matter is an indication that they consider the matter worthy of bringing to the attention of the public - and it would accordingly both be negligent of Wikipedia not to do the same, and a violation of WP:NPOV policy not to do so. And much the same comments apply to other reliably-sourced reports of possible risks. We aren't in the business of hiding well-sourced reports of possible harmful effects from our readers just because some contributors demand impossible sourcing for inconvenient facts. AndyTheGrump (talk) 04:05, 17 July 2015 (UTC)

Sorry, but possibly is not scientifically supported especially a "possibly" resulting from poorly documented case reports. The way those sections are written imply something entirely different. Evidence indicates the potential for harmful effects may result from contamination during preparation, but that applies to a number of beverages that undergo fermentation where conditions may not be optimal, [34], [35], [36]. Atsme^📞📧 04:42, 17 July 2015 (UTC)

Forgot to add this [37] --Atsme^📞📧 04:46, 17 July 2015 (UTC)

What exactly is "possibly is not scientifically supported" supposed to mean? Are you under the misapprehension that science only deals in absolute certainties? AndyTheGrump (talk) 05:10, 17 July 2015 (UTC)

AndyTheGrump's invoking of 'wildly-unethical experiments' is a distraction. There are numerous ways the toxicology could be tested more rigorously without endangering human subjects.Dialectric (talk) 04:48, 17 July 2015 (UTC)

Certainly there are experiments that might reduce some of the uncertainties, though given the fact that Kombucha is frequently brewed in less-than-ideal conditions not all of them. Have any such experiments been conducted? AndyTheGrump (talk) 05:13, 17 July 2015 (UTC)

On first pass, at least this one animal trial: http://www.ncbi.nlm.nih.gov/pubmed/11351863 Dialectric (talk) 05:23, 17 July 2015 (UTC)

As I'm sure you are aware, such a trial is almost certain not to reveal the sort of possible low-frequency negative effects we are discussing here. Nor can it reasonably be expected to reveal the true risks of fermentation in uncontrolled conditions. And I'm also sure you are well aware that toxicology tests on one species may not always be representative when used to draw conclusions about another. As a test, it is mildly reassuring, possibly, but certainly not legitimate grounds to discount the existing evidence which raises doubts - and as I have already noted, later sources, which are presumably aware of this data have still chosen to report on the possible risks. Why should Wikipedia not permit our readers to learn this? What is it exactly that makes Wikipedia contributors uniquely suited to decide which information our readers should get to see on the subject? Why should we be appointing ourselves as gatekeepers here? We have no mandate to exclude warnings justbecause we don't like them, which is what is being proposed here ... AndyTheGrump (talk) 05:48, 17 July 2015 (UTC)

Arguing in favor of poorly written passages is futile. The misapprehension is that 23 poorly documented case reports most of which are 20+ years old, random and rare should not be given UNDUE in this article regardless of what book or journal those same case reports were published. Fact - there is no confirmed causality. The reviews in peer reviewed journals confirm that causality is scientifically unsupported. It has a very low significance factor. There are so many other factors that likely caused the death of those people, the most obvious of which were omitted from the section but why go into such detail. There is more scientific evidence that supports kombucha's association with health benefits which have noticeably been omitted. There is no way of knowing for certain what particular brew was associated, if it was commercial or home brewed, were the conditions sanitary (see FDA link I provided), what ingredients were added or what utensils were used. What you're suggesting we do here regarding the death and toxicity claims is far more relevant to Beer, a GA that is PP, especially in light of the following: [38], [39], [40]. There are far greater risks home brewing beer than there ever has been with kombucha but there is no mention of death or toxicity in those articles except for the alcohol content. The same applies to Red Bull. Atsme^📞📧 12:47, 17 July 2015 (UTC)

Adverse effects have been included in journal reviews on kombucha and to not include them in this article is UNDUE. The article correctly reflects what those reviews say, which is that adverse effects have been reported but it's uncertain whether kombucha caused the effects. Excluding adverse effects because of that uncertainty means that the article would no longer reflect the research, and that would definitely be an NPOV violation.

There is no evidence that the health effects kombucha is claimed to have are actually present. Studies have shown chemical effects but that doesn't mean that those chemical effects can be considered health effects. It's like when, say, scientists discover a chemical that acts on a mechanism by which a particular cancer metastasizes. Does that mean that this chemical can be said to prevent metastasis (or cure cancer)? No. Something seen in a lab does not automatically translate to real-world effects: the two are not equivalent. I realize that news articles incorrectly say that they are equivalent all the time, which is one reason why news articles aren't RS for health claims according to MEDRS.

Finally, bringing in other stuff - which don't have associated health claims the way kombucha does, so the presence or absence of adverse effects cannot be compared to kombucha - doesn't mean that this article should be whitewashed. Ca2james (talk) 16:57, 17 July 2015 (UTC)

• Ca2james, I am wondering where you got the idea that only negative health effects have been shown for Kombucha. For an evidence-based approach to the subject, see PUBMED 24192111 It is shown that KT can efficiently act in health prophylaxis and recovery due to four main properties: detoxification, antioxidation, energizing potencies, and promotion of depressed immunity. The recent experimental studies on the consumption of KT suggest that it is suitable for prevention against broad-spectrum metabolic and infective disorders. This makes KT attractive as a fermented functional beverage for health prophylaxis. - Linde et al, 2014. petrarchan47คุก 01:38, 18 July 2015 (UTC)

Petrarchan47, I got the idea that adverse effects have been written in every review I've read because they've been in every review I read. The review you're referring to is new to me. Do you or does anyone have a copy of it that I could read as it's behind a paywall? We don't just use the abstract as a ref; we have to read the whole paper. Thanks. Ca2james (talk) 07:50, 18 July 2015 (UTC)

Adding: I didn't mean to imply that I personally have to approve the inclusion of this review in the article; I just wanted to read the paper. Since you're referring to it I figured that you probably had a copy. Ca2james (talk) 16:32, 18 July 2015 (UTC)

AndyTheGrump, your comment that 'We have no mandate to exclude warnings justbecause(sic) we don't like them,' is again a distraction. This section started with a very specific focus and unresolved issue, that is, whether kombucha contains usnic acid. The sources differ on this subject. Some sources that link kombucha and usnic acid describe kombucha as a 'lichen tea', which it is not. Clarifying this point would be a concrete improvement to the article. Repeatedly overgeneralising the argument in response to specific issues with specific warnings and sources is unconstructive.Dialectric (talk) 14:53, 17 July 2015 (UTC)

The section may well have started with 'a very specific focus' - it wasn't however me that decided once again to spam this page with facile comments misapplying WP:FRINGE to well-sourced content regarding possible fatalities. I suggest you direct your comments towards the person responsible in future. AndyTheGrump (talk) 15:09, 17 July 2015 (UTC)

ATG, please confine your comments to article content, not editors. Atsme^📞📧 18:35, 17 July 2015 (UTC)

And how about you please stop spamming this page with repetitive nonsense about WP:FRINGE. If you really think you are interpreting policy properly, do what you said you were going to do, and start an RfC. Otherwise drop it - because raising it time and time again when nobody is giving the argument any credence is getting tendentious. AndyTheGrump (talk) 20:07, 17 July 2015 (UTC)

Again, I ask that you please comment on the content and stop the incivility. TP of articles are for carrying on discussions about the article, not your opinions of other editors. Atsme^📞📧 01:08, 18 July 2015 (UTC)

Adverse effects section

I disagree with Atsme about many things, but she was right about one thing: the Adverse effects section was poorly-written. That's not a reason to remove it, of course, but it is a reason to try to improve it. To that end, I've made some changes to it that I think both reads better and makes things clearer. In particular, I've added a couple of sentences about how reports of adverse effects are rare and I've moved things around to remove duplication and keep similar things together. There's still much room for improvement but I think it's better now. Ca2james (talk) 17:05, 18 July 2015 (UTC)

A definite improvement. Well done. AndyTheGrump (talk) 17:21, 18 July 2015 (UTC)

J Med Food paper

I was able to read the J Med Food paper that Petrarchan47 found. That paper doesn't mention adverse effects because its focus is to determine which beneficial effects kombucha has or is likely to have, and which chemical or microbioal properties contribute to those effects. In this, it explicitly excludes the examination of adverse effects. Note that this is also a low-quality paper, being published in a pay to play journal that has an impact factor of 1.626, so it fits right in with the forest of low-quality papers used in this article. I've tweaked the health claims section to better reflect that paper's contents. I hope this is ok. Ca2james (talk) 22:15, 18 July 2015 (UTC)

Back to usnic

Per Dialectic, let's not get off-track before we've dealt with this issue. I dug around last night and discovered that the sources claiming usnic acid was present in Kombucha cite, from what I could ascertain, 3 incidents in 1995. The Dufresne source cites a 1996 study that said further studies have failed to find it. Either we add the Dufresne source ("The presence of usnic acid in Kombucha reported once has not been confirmed in recent studies (Blanc, 1996).") to give a NPOV picture., or we remove mention of it altogether. As Grump says above, just because you don't like the study results, doesn't mean we don't add it. petrarchan47คุก 01:38, 18 July 2015 (UTC)

Did you read my previous comment where I showed that the 2013 study was referring to two later studies than the 1996 Blanc study? The relevant sentence in this article says, in part, samples of the tea have been shown to contain the hepatotoxin usnic acid. We can add "in some studies" to that sentence which would show that it isn't a unanimous conclusion in all reviews. We can't say that a 2000 study contradicts a 2013 study, however. Ca2james (talk) 02:55, 18 July 2015 (UTC)

Petrarchan47, I've modified the sentence to read Some studies have found the hepatotoxin usnic acid in kombucha, although it is not known whether the cases of damage to the liver are due to the usnic acid contamination or to some other toxin. Does that work for you? Ca2james (talk) 16:25, 18 July 2015 (UTC)

This language is an improvement. Do the studies that mention usnic acid describe it as a contaminant, or a natural byproduct of the production? The usnic acid article currently says that the only confirmed source of usnic acid is lichens, so there is an open question if the studies found usnic acid are correct: how did it get there? was the kombucha somehow contaminated by lichen? If, alternatively, a colony of bacteria and yeast can produce a chemical thought to be produced only by lichens, that would be extraordinary, and extraordinary claims require extraordinary sources.Dialectric (talk) 17:08, 18 July 2015 (UTC)

Agree with Dialectric here, but thanks very much Ca2 for your efforts and kindness. Why don't we use the rest of this TP section to spell out everything we've got on usnic/Kombucha, along with the dates of studies referenced, and go from there - an easy-to-read, bullet-point list would be really helpful? If indeed Dufresne's refutation isn't considered reason enough to delete the section altogether, I prefer as always to use language close to that used in the sources. petrarchan47คุก 00:07, 19 July 2015 (UTC)