Talk:Kombucha

Section entitled "Kombucha Drops - Kombucha Extract - Information"

Kombucha drops has been merged and redirected to this article, however, the information appears to be copied and pasted verbatim from this webpage: [[1]]. Per Wikipedia:Copyrights, I am removing that information. Edwardian

Mention of possibly unrelated deaths do not belong in Lede

In this edit, I added an update to the claim of linked deaths. However, I am not convinced this deserves mention in the Lede. It would be different if the deaths were found to be caused by Kombucha drinking. That side effects have been noted seems fitting for the Lede, but 2 deaths with no causal link found after 10 years seems more like a fringe claim, and creates a Lede/article that violates WP:NPOV. petrarchan47คุก 22:27, 6 June 2015 (UTC)

Removing the otherwise well supported dead link seemed premature, per WP:LINKROT, as it still supplied enough information to find the article offline. I'm restoring the link, and moving the dead link template inside the ref tags, per Template:Dead link. Grayfell (talk) 04:41, 8 June 2015 (UTC)

Any mention of the history, especially in such cryptic terms as "remedy for immortality" should be clearly explained with solid sources in the body before it is introduced to the lead of the article, otherwise it is undue and non-neutral. (Isn't poison a remedy for immortality?) Grayfell (talk) 04:48, 8 June 2015 (UTC)

Hi GreyFall, I'm not tremendously interested in working on this article, but it does seem strange to leave all mention of history out of the Lede. Would you go ahead and add something you find appropriate? It doesn't read well to have a one line description, and then to jump right into the dire warnings. The unsubstantiated health claims are unsubstantiated because no trials have been conducted, however the current wording suggests that perhaps they have actually looked for evidence and found none. So this is misleading, and what you reverted was my attempt to fix it. Further, I did not remove the dead link from the article, only the Lede, since the claims sourced to it in the Lede were also covered in the NBC reference. Best, petrarchan47คุก 05:04, 8 June 2015 (UTC)

Yeah, I have no problem with the removal of the linked-deaths thing (although I suspect that may prompt further discussion as well). I agree it's odd to leave out the history from the article, but I'm also not all that interested in digging deep on this article, and I don't have any sources handy. I don't understand why you didn't include your source? It was a direct quote from something, no? What you added was reasonable, but without a source it was still scuttlebutt and this article already gets a lot of opinion editing and pseudoscientific blogspam and such, so the last thing it needs is more scuttlebutt. "The claims are not supported by scientific evidence" seems like a perfectly accurate way to phrase it. A lack of studies or trials is the same as a lack of support by scientific evidence. This is veering into WP:MEDRS territory, but when we have multiple sources saying that no benefits have been found, it seems reasonable to me. Grayfell (talk) 05:16, 8 June 2015 (UTC)

Never mind, I see that it's in the NBC puff piece. I'll look it over and expand the history section a little. It's very weak as a source, though. Grayfell (talk) 05:19, 8 June 2015 (UTC)

Usually if I am citing multiple claims to one source, I will link to it only at the end of all claims, rather than at the end of each one. I'm open to suggestions, though, as this has confused people before. petrarchan47คุก 06:19, 8 June 2015 (UTC)

Grayfell Thanks for expanding the history section in the article, however it was the Lede that seemed to be missing mention of the origins of the drink. It is half definition and half warnings, which doesn't reflect the article contents as it should per WP:LEDE. petrarchan47คุก 06:58, 8 June 2015 (UTC)

The NBC source was just too weak to be much use in this case, and I don't think the added content reached the threshold for inclusion in the lead. The bit about etymology (Dr. Kombu) is directly contradicted by other, more academic sources earlier in the article, and the info about its ancient origins is two sentences which are very broad, and are not supported by any other sources. Mentioning when the drink first appeared is a good idea, but there are too many ambiguities and contradictions, and I don't think a date-range should be mentioned in the lead based on this one flawed source. Otherwise saying unambiguously that its 2,000 years old seems like an appeal to tradition. These things should be properly addressed in the body first. Grayfell (talk) 19:50, 8 June 2015 (UTC)

Thank you kindly, Grayfell. This Swedish source has a good bit about the history. If I find some time, I will help with this. petrarchan47คุก 19:55, 8 June 2015 (UTC)

We should summarize the best sources. The ACS mentions death by kombucha. So we do too. Alexbrn (talk) 05:43, 8 June 2015 (UTC)

According to the CDC, Kombucha's "beneficial and/or adverse effects have not been determined scientifically". This is a much more neutral account than the WP article gives. Are there any objections to rephrasing the Lede/article in accordance with the CDC?

I don't know what ACS source you are referencing, perhaps you could leave a link, Alex? Do you consider it stronger than the CDC? petrarchan47คุก 06:19, 8 June 2015 (UTC)

Have you read this article or are you just lede bombing? We quote the ACS in the body: "Available scientific evidence does not support claims that Kombucha tea promotes good health, prevents any ailments, or works to treat cancer or any other disease. Serious side effects and occasional deaths have been linked with drinking Kombucha tea". ACS is a strong MEDRS source and does not contradict the CDC statement. Do not edit war and be aware this page is subject to discretionary sanctions. Alexbrn (talk) 06:38, 8 June 2015 (UTC)

Chill out, no one is edit warring, Alex. petrarchan47คุก 06:49, 8 June 2015 (UTC)

[edit conflict]

Here is the American Cancer Society piece, it references the CDC/FDA article I linked above. An excerpt from ACS:

"No studies have been done on humans to support any of the claims made for Kombucha tea. There have, however, been reports of some serious complications associated with the tea. In April 1995, two women who had been consuming the tea daily for two months were hospitalized with severe acidosis--an abnormal increase of the acid levels in body fluids. Both had high levels of lactic acid upon hospitalization. One woman died of cardiac arrest two days after admission. The second woman’s heart also stopped, but she was stabilized and recovered. The mushrooms used by both women came from the same "parent" mushroom. While no direct link to Kombucha tea was proven in this case, the FDA has warned consumers to use caution when making and drinking the tea."

Details on the case from the CDC:

"The mushrooms used by both women were derived from the same parent mushroom. At least 115 additional persons in the town had used or were using mushrooms from the same source as for the two ill women, but no other cases of unexplained acute illness were reported among these persons. A review of hospital emergency department records for March 1-April 10 did not detect other cases of unexplained lactic acidosis or other likely cases of tea-associated acute illness.

Samples of the mushrooms and samples of the tea consumed by both case-patients were sent to FDA for analysis. Microbiologic analysis of the tea and mushrooms identified several species of yeast and bacteria, including Saccharomyces cerevisiae and Candida valida. No known human pathogens or toxin-producing organisms were identified. The alcohol content of the tea ranged from 0.7% to 1.3%; no methanol was detected."

Having seen the ACS document, do editors feel Alexbrn's preferred version:

"Drinking kombucha has been linked, in rare cases, to serious side effects and deaths, and improper preparation can lead to contamination."

is preferable to this?

"Drinking kombucha has been linked in rare cases to serious side effects and several deaths, although no causal link to these deaths has been established. Improper preparation can lead to contamination."

Saying Kombucha is linked to death, when no causal or direct link has been established in the 10 years since this case, as opposed to noting "no direct link" is non-neutral and misleading. I'm unclear whether the ACS source meets MEDRS requirements, but Alexbrn would know more about this. The 10 year old source does not seem to adhere to MEDRS. petrarchan47คุก 06:51, 8 June 2015 (UTC)

We say what the sources say, and do not engage in editorializing and OR. Trying to discredit a good MEDRS source with a 20-year-old CDC case report (which even warns in red text at its head it may be outdated) is highly problematic. Alexbrn (talk) 06:53, 8 June 2015 (UTC)

OK. The source you prefer says:

"No studies have been done on humans to support any of the claims made for Kombucha tea. There have, however, been reports of some serious complications associated with the tea. In April 1995, two women who had been consuming the tea daily for two months were hospitalized with severe acidosis--an abnormal increase of the acid levels in body fluids. Both had high levels of lactic acid upon hospitalization. One woman died of cardiac arrest two days after admission. The second woman’s heart also stopped, but she was stabilized and recovered. The mushrooms used by both women came from the same "parent" mushroom. While no direct link to Kombucha tea was proven in this case, the FDA has warned consumers to use caution when making and drinking the tea."

And you want to summarize this as:

"Drinking kombucha has been linked, in rare cases, to serious side effects and deaths".

Your source specifically says "no direct link", and you want to quote them as saying "has been linked". I see this as highly problematic and misleading. petrarchan47คุก 07:02, 8 June 2015 (UTC)

Your comprehension is poor. The "no direct link" phrase applies to one case. As the ACS say in general (in their "Overview"): "Available scientific evidence does not support claims that Kombucha tea promotes good health, prevents any ailments, or works to treat cancer or any other disease. Serious side effects and occasional deaths have been linked with drinking Kombucha tea." We reflect that, which is NPOV. Alexbrn (talk) 07:12, 8 June 2015 (UTC)

Alex, could we discuss this sans personal attacks? IMO, this is a fringe claim and although you have one good source, does it not strike you as odd that Kombucha death is mentioned literally nowhere else? It is a strong claim to make, and it is possible that the ACS got it wrong given that they are the only source with such a claim. I would prefer to see at least one MEDRS backing this claim. petrarchan47คุก 07:26, 8 June 2015 (UTC)

The suggestion that the ACS is a source of 'fringe claims' is nonsensical. And we don't second-guess a source because a contributor thinks they might have 'got it wrong'. AndyTheGrump (talk) 07:30, 8 June 2015 (UTC)

I have made no personal attacks, merely pointed out your error. The ACS are not essaying a fringe claim and I suggest if you want to clarify that you raise it at WP:FT/N. We have a good source and will not be swapping it out for outdated primaries or your personal suppositions such as "it is possible that the ACS got it wrong". For further background see also PMID 12808367. Alexbrn (talk) 07:33, 8 June 2015 (UTC)

You pointed out their error, but in an unnecessarily harsh way. A little tact goes a long way and encourages civil discourse. TylerDurden8823 (talk) 07:50, 8 June 2015 (UTC)

I agree with petrarchan47 in regards to the text, I have answered also at original post (since there was already a response there) furthermore I will look for additional sources that dispel any link. thank you--Ozzie10aaaa (talk) 10:52, 8 June 2015 (UTC)

Ozzie, it would be better to find and summarize the best WP:MEDRS sources, we shouldn't go questing for sources to support some pre-decided POV. If there are stronger sources than the ACS (or earlier, Ernst's 2003 systematic review) then bring them forth! Alexbrn (talk) 11:18, 8 June 2015 (UTC)

actually a review 2014 is posted on the other discussion on wikiproject med. will look for more--Ozzie10aaaa (talk) 12:00, 8 June 2015 (UTC)

We already cite that - does it bear on the "death" question? I can't (currently) get access to a full text. Alexbrn (talk) 12:54, 8 June 2015 (UTC)

Sources related the the death, health, safety issue

Alexbrn has introduced this source to support this statement in the Lede (emphasis mine):

Drinking kombucha can cause liver damage and, in rare cases, death.

This is in conflict with even the originally cited ACS' wording, "linked". "Cause" is a big leap forward, and the source used does not support such a claim.

Sources that do not support death claims:

• Mayo Clinic

"There have, however, been reports of adverse effects, such as stomach upset, infections and allergic reactions in kombucha tea drinkers. Kombucha tea is often brewed in homes under nonsterile conditions, making contamination likely. If ceramic pots are used for brewing, lead poisoning might be a concern — the acids in the tea may leach lead from the ceramic glaze.

In short, there isn't good evidence that kombucha tea delivers on its health claims. At the same time, several cases of harm have been reported."

• Science Based Medicine

"The best that can be said about kombucha is that it probably won’t kill you."

• Swedish Medical Center creds

"...there are case reports, which suggest that Kombucha preparations can cause such problems as nausea, jaundice, shortness of breath, throat tightness, headache, dizziness, liver inflammation, and even unconsciousness. 4,5,6 It isn't clear whether the cause of these symptoms is an unusual reaction to a generally nontoxic substance, or a response to unusual toxins that developed in a particular batch of Kombucha.

"In addition, there is one case report of severe lead poisoning caused by regular use of Kombucha brewed in a ceramic pot. 7 When brewed or stored in some ceramics, the risk of lead poisoning results because Kombucha tea is acidic. Many ceramic glazes contain a low level of lead that would not make the pottery dangerous for ordinary use; but if an acidic solution like Kombucha is steeped in them for a long time, a dangerous amount of lead may leech into the solution.

"There is also one report of Kombucha becoming infected with anthrax and passing along the infection to an individual who rubbed it on his skin to alleviate pain. 8 Apparently, anthrax from nearby cows got into the Kombucha mixture and grew."

• NYT reports where the link began, confirming there was no real evidence of a link:

"In 1995, the Centers for Disease Control and Prevention issued a report linking kombucha to the death of an Iowa woman and the illness of another woman. Both experienced severe metabolic acidosis, excessive acid buildup in the body that health officials thought may have been related to their daily use of kombucha. Though the federal center did not definitively cite the tea as the problem, the incident put a damper on kombucha consumption."

The death claim we have in the Lede seems fringe at best. petrarchan47คุก 19:52, 8 June 2015 (UTC)

Petrarchan47 has written of the text "Drinking kombucha can cause liver damage and, in rare cases, death", “the source used does not support such a claim.” I am very surprised by this accusation since the source has "kombucha tea can cause serious hepatic damage and even fatality." In what way is our text not supported by the source? Alexbrn (talk) 08:45, 9 June 2015 (UTC)

— Additionally that same reference is referred to several times as a different reference (eg 2 and 21 are the same reference basically. It looks like there is just the one death "caused"?? by the drink, which is the AIDS guy. I haven't got access to the full paper so I am unclear if the link is actually causal, it just said he had the tea 15 hours before dying. 92.19.86.173 (talk) 10:38, 9 June 2015 (UTC)

Interesting. I was researching matcha tea and came across this discussion. Regarding the RS that alleges kombucha can cause liver damage, etc. I researched the cited source in the footnote of the source cited in the article for verifiability in accordance with WP:V. Btw, Wikipedia:Verifiable but not false is a great essay. The source that caused the misapprehension in the cited book is here: [2] I found no such determination specifically stated in that journal entry. It appears the author of the source cited in this article made an assumption. It is a classic example of what can happen when we ass-u-me. I'm of the mind that the cause statement and RS used to support the assumption is inaccurate. The passage should be modified for factual accuracy and properly cited. Perhaps we should exercise as much care and concern when citing RS in these types of articles as we do in all medical and science related articles such as those involving GMF and GMOs, for example. It would certainly save time and megabytes of space on TP. --Atsme^📞📧 12:10, 9 June 2015 (UTC)

“... I researched the cited source ... ” / “... I am of the mind ... ” ← yes, that's called original research and it's what we must not do. We follow reputably-published secondary sources instead of editors' non-expert views. Alexbrn (talk) 12:17, 9 June 2015 (UTC)

No, that is not considered OR.  It is considered researching for verifiability which editors are actually obligated to do because V is one of the 5 pillars.  OR, for example, is when an editor includes a passage about laboratory research or experimental results that cannot be cited by published sources.  I suggest you read WP:V and familiarize yourself with the policy.  The book that was cited to support the claim that it causes death is incorrectly stated and not supported by the book's own cited source. That is factual inaccuracy - verifiable but false.  The information has been removed, and now the onus is on those who want it included to validate why it should be.  Please keep in mind that It may be considered a violation of WP:V to revert its removal. --Atsme^📞📧 16:07, 9 June 2015 (UTC)

It is the very epitome of OR. You are reintepreting the primary sourced drawn on by a secondary source to reach a different conclusion (and of course this is explicitly called out as a no-no in MEDRS). You've also been deleting secondary-sourced content and using primary sources (a case report). Also bad. Alexbrn (talk) 16:11, 9 June 2015 (UTC)

(ADD) Well, you're now edit-warring your poor content in. I have issued a warning ... Alexbrn (talk) 16:27, 9 June 2015 (UTC)

Please stop your edit warring and battleground behavior and stop the false accusations. I reverted your notice on my TP as it was an abuse of the template. It was also posted to my TP after I posted a friendly warning to you about edit warring which is exactly what you are doing. Policy clearly states that the onus is on the editor who wants to add back the disputed material, and you have not provided one ounce of evidence that supports the extraordinary claim you made in lead. I provided intext attribution from the conclusion of the report in a published, peer reviewed journal, and did not reinterpret anything. The source you are using cited that journal report with an inaccurate statement that was not supported by their cited source, therefore it failed verifiability. Per policy: extraordinary claims require extraordinary sources and that is exactly what I provided with inline text attribution. The onus is now on you to find a RS that is compliant with V and also passes the scrutiny of MEDRS. Furthermore, the simple fact that your source is a RS per MEDRS does not guarantee inclusion of the material cited. I strongly advise you to stop your battleground behavior and edit warring. Atsme^📞📧 16:52, 9 June 2015 (UTC)

You are mis-stating policy, and have replaced a secondary source with a primary because you personally disagree with the secondary (which has nothing to do with WP:V, this source directly supported the cited content). You have twice inserted your preferred text. Alexbrn (talk) 17:10, 9 June 2015 (UTC)

I think perhaps the reason you believe I misstated policy may actually result from your misinterpretation of it. Exceptional claims require exceptional sources - the claim that kambucha tea causes death is an exceptional claim.  Any exceptional claim requires multiple high-quality sources.  Sorry, but the death claim was cited to a single source that was disputed for factual inaccuracy.  The source is verifiable but not true.  Red Flag.  Per policy Red flags that should prompt extra caution include: surprising or apparently important claims not covered by multiple mainstream sources;  The following also applies: claims that are contradicted by the prevailing view within the relevant community, or that would significantly alter mainstream assumptions, especially in science, medicine, history, politics, and biographies of living people. Atsme^📞📧 19:02, 9 June 2015 (UTC)

Certain plants and fungi can cause illness and death; that is a commonplace and not "exceptional". Since we have high quality MEDRS sources saying so here we should use them, rather than privileging your inexpert personal opinions. Alexbrn (talk) 21:07, 9 June 2015 (UTC)

Of course plants and fungi can cause illness and death, but you need to present a source that establishes causality specifically between kombucha consumption and death. Can you do this? Has causality been firmly established? The source in the article that cites the 2009 case report does indeed say "cause", but the original case report does stop short of that: "While Kombucha tea is considered a healthy elixir, the limited evidence currently available raises considerable concern that it may pose serious health risks. Consumption of this tea should be discouraged, as it may be associated with life-threatening lactic acidosis." and says it may be associated with life-threatening lactic acidosis. One case report saying may be associated sounds like a relatively weak case for establishing causality. More evidence is warranted to state that it can cause fatal reactions (associated with fatal reactions...sure). TylerDurden8823 (talk) 22:16, 9 June 2015 (UTC)

What Tyler said. petrarchan47คุก 23:55, 9 June 2015 (UTC)

I'd not object to "has been suspected of causing" as that is still in line with the source. Alexbrn (talk) 05:22, 10 June 2015 (UTC)

It's a fringe claim unsupported by the blurb in your book. Why would the Mayo Clinic fail to mention death if this were an established fact? We should summarize what the best sources say. No good sources are making this claim, and even the ACS was referring to an old case that was so weak the FDA merely gave a warning about the drink. The sources give a much more nuanced picture of how negative health effects arise, such as contamination during the fermentation process, and we should do the same. I think statements about death should be removed until this has been settled. Right now it's an embarrassment to host this 'information'. We should err on the safe side as Wikipedia has a bad reputation for misinformation regarding health content as it is. petrarchan47คุก 07:40, 10 June 2015 (UTC)

Regardless of what is included, please do not try and tie this in with Wikipedia's supposed reputation. What some groups may or may not think of some aspects of Wikipedia is extremely vague and is a terrible precedent to set for why content should be altered. If anyone is embarrassed by content someone else has put into Wikipedia, that's their problem. Grayfell (talk) 07:55, 10 June 2015 (UTC)

On the contrary, why would editors place questionable claims in an article that end up giving skewed information and so give fodder to such groups? The goal should be to have a reputable source of information. If an editor is embarrassed by skewed claims they need to be edited, thats the nature is WP, to improve what others have done. AlbinoFerret 11:37, 10 June 2015 (UTC)

The only people finding this "questionable" are those indulging their own prejudices. Some folks here are in effect arguing for Wikipedia to depart from the established pharmacological literature on this subject:

• Jean M. Wible (2005). Potentially dangerous herbal medicines. Lippincott Williams & Wilkins. p. 266. ISBN 978-0-7817-4798-1. Kombucha tea; a general cure-all; can cause acidosis and death {{cite book}}: |work= ignored (help)
• Bronwen Jean Bryant; Kathleen Mary Knights (2011). Pharmacology for Health Professionals. Elsevier Australia. p. 78. ISBN 978-0-7295-3929-6. Kombucha has been associated with illnesses and death. A tea made from Kombucha is said to be a tonic, but several people have been hospitalised and at least one woman died after taking this product.

Alexbrn (talk) 13:16, 10 June 2015 (UTC)

Alexbrn Do not to comment on other editors, its against a few policies that you should be aware of. AlbinoFerret 14:08, 10 June 2015 (UTC)

I'm trying to find what this comment is referring to, but there is nothing here. This is yet another aspersion cast against fellow editors here, insinuating that there is off-wiki communication. The Komucha cabal? It's almost as bad as this one. petrarchan47คุก

CAM (alt-med) haters systematically use exaggerated claims of side effects and death to discredit natural remedies, most of which are not scientifically supported as in this case. Maybe the benefits of kombucha are also exaggerated and scientifically unsupported but it's not our job to promote or debunk it. Our job is to write about the topic in an encyclopedic manner; i.e. neutral, informative, and sourced to RS that are Wikipedia:Verifiable but not false. I'm sure that's what we're all trying to accomplish, right? The kombucha review basically confirmed that for centuries there have been no reported issues linked to the consumption of kombucha tea prior to reports from the 90s forward but feel free to correct me if I misstated the dates. So what changed? It appears the fermenting process and the utensils used have had a significant influence. Lead seeping into the mix is a concern but it's not an inherent property of kombucha - it's an inherent property of the ceramic utensils. All it takes is a little common sense, a pinch of IAR, and the MEDRS approved review that was conducted last year confirming the safety of kombucha products for consumers. There are lots of books out there and most reference the same reports and articles covered in the review. The review also includes a relatively brief section on toxicity citing a small number of reports involving a small number of cases that MAY be linked to consumption of the product. We cannot state it as the cause in Wiki voice regardless of the misstatements and erroneous conclusion made by a chemist at a Texas university who cited a report that doesn't support his statement. False statements do not belong in the lead of this article. --Atsme^📞📧 22:59, 10 June 2015 (UTC)

There are ownership issues, coupled with hostility, and no real, NPOV concern for the article itself. The concern here seems only to make sure the worst claims possible are front and center, and this is evidenced by the recent edit history. The Lede is in violation of WP:LEDE but I've absolutely no faith that my edits to fix this will not be immediately reverted. History of the drink does not require MEDRS sourcing. There is no reason not to mention the story of the article subject in the Lede as any other WP article would do. Editors are required to edit in a neutral manner, and those with a bias against or for the article subject should recuse themselves if that bias is drowning out the most basic WP guidelines. Because of the hostility and ownership issues, this will be my last comment here. petrarchan47คุก 20:18, 10 June 2015 (UTC)

And Atsme, who just did such an excellent job of covering the issue, might just walk away as well. Anything to do with natural healing methods has been taken over by a few biased editors and it is a waste of time to attempt to change the campaign that's been going on for some time now. Too bad for our encyclopedia, but at least for now I have no idea on how to go about changing it... Gandydancer (talk) 01:57, 11 June 2015 (UTC)

A passer-by's view: couldn't agree more with Gandydancer. This sort of bias and ownership is immensely damaging to Wikipedia's reputation. Although (apologies, off-topic) having read the entirety of this talk page, from a dispassionate point of view the carnage is rather entertaining. — Preceding unsigned comment added by 87.115.171.174 (talk) 11:46, 11 June 2015 (UTC)

Health benefits

• A Review on Kombucha Tea—Microbiology Composition, Fermentation, Beneficial Effects, Toxicity, and Tea Fungus Rasu Jayabalan, Radomir V. Malbaˇsa, Eva S. Lonˇcar, Jasmina S. Vitas, and Muthuswamy Sathishkumar

pg. 10

Although kombucha tea cannot be granted official health claims at this time, it can be recognized as an important part of a sound diet. Not exactly a traditional beverage, kombucha tea is now regarded as a “health” drink, a source of pharmacologically active molecules, an important member of the antioxidant food group, and a functional food with potential beneficial health properties. Research on kombucha demonstrating its beneficial effects and their mechanisms will most likely continue to increase substantially in the next few years. It is apparent that kombucha tea is a source of a wide range of bioactive components that are digested, absorbed, and metabolized by the body, and exert their effects at the cellular level.

• LWT - Food Science and Technology creds

Kombucha a fermented tea has prophylactic and therapeutic properties.

Antimicrobial activities of kombucha were studied against human pathogens.

Five new Kombucha-like drinks were investigated by fermenting herbal extracts.

New fermented beverages exhibited strong antimicrobial potentials (against Candida).

Fermented Lippia citriodora and Foeniculum vulgare may be very healthful.

Just adding newer reports that have found benefits. Our article cites older references stating that none had been found. I won't add anything as I know I will be reverted, so will just leave it here for you. petrarchan47คุก 07:49, 10 June 2015 (UTC)

The first is already cited here. I don't believe either paper has "found benefits" (in people) but rather suppose beneficial mechanisms may exist based on lab work. Have you actually read Jayabalan et.al.? (I'm finding it hard to get a full copy right now.) Alexbrn (talk) 09:35, 10 June 2015 (UTC)

A supposition that benefits may exist based on promising laboratory studies from several sources certainly warrants inclusion under phrasing such as "preliminary studies suggest ... though these benefits have not been conclusively demonstrated in human trials" or similar. Human trials are always valuable, but the laboratory indications are also important, suitably caveated. This has been repeatedly pointed out above. — Preceding unsigned comment added by 87.115.171.174 (talk) 18:55, 10 June 2015 (UTC)

@87.115.171.174: Yes, and we already say this: "Although laboratory experiments are suggestive of possible health effects, there is no evidence that kombucha consumption benefits human health." Alexbrn (talk) 05:31, 11 June 2015 (UTC)

Not the same thing. Laboratory studies constitute _preliminary_ evidence, not a lack of evidence. — Preceding unsigned comment added by 87.115.171.174 (talk) 11:49, 11 June 2015 (UTC)

The second study doesn't seem to meet WP:MEDRS standards. LWT may be reputable, but the study is a primary source. Wikipedia articles generally do not include WP:PRIMARY studies, especially not for medical content, and should never use such material to make generalized health claims, even obliquely. Grayfell (talk) 20:04, 10 June 2015 (UTC)

Greyfell, please explain why you think the second study "doesn't seem to meet" MEDRS standards, and then explain why you think the "death" claims do. Are you saying what was stated in a book written by a chemist at a Texas university is more reliable than a report by 4 MDs, a PharmaD plus a Journal Review which cites that same report? Perhaps I've overlooked something. --Atsme^📞📧 20:57, 10 June 2015 (UTC)

Secondary sources are sources which analyze or summarize primary sources. They are, in almost all cases, preferable for use on Wikipedia. WP:MEDPRI spells it out pretty clearly. Because this is medical content, those secondary sources are also held to higher standards. If the study is important, it should be possible to find it explained in a reliable secondary source. The study itself is perfectly fine as a study. This isn't a comment on the credentials of any scientists, it's about neutrality and due weight, and avoiding WP:SYNTH. I have no idea why Texas would be relevant. Grayfell (talk) 21:19, 10 June 2015 (UTC)

NPOV, V and MEDRS

Agree with your comment from last year, Grayfell That reference needs to be deleted all together and the statements cited to it need to be modified to reflect current sources.  Also, per WP: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.  The only evidence related to illness and death regarding consumption of the tea are case reports published in a peer reviewed medical journal, all of which lack scientific evidence to confirm causality. The book that is cited to the lead statement that links consumption of the tea to death is not cited to a RS and is noncompliant with MEDRS for the following reasons: (1) the claim in the book is misstated, factually incorrect and not supported by the source cited in the book, (2) the cited source is a case report (3) the claim is only one author's opinion and it conflicts with the 2014 Journal review which cites that same case report. Policy dictates extraordinary claims require (multiple) extraordinary sources and all I've seen that link the tea to death cite the same case report which MEDRS considers to be anecdotal and below the minimum requirements. Furthermore, the inclusion of such material in this article demonstrates noncompliance with two core policies, NPOV and V.  I am asking for GF collaboration without the WP:OWN and WP:Battleground behavior we've seen demonstrated by the reverting of GF edits that correct policy noncompliance regarding the unreliable case reports and links to death.  The DS notice is now visible on this TP for all to see.  We all must abide by PAGs and MEDRS when editing this article. Atsme^📞📧 13:31, 11 June 2015 (UTC) 

I'd forgotten I wrote that. The problem as I see it is that there are two angles this article needs to cover. Kombucha is a beverage which is, at least in places I've been recently, widely available in supermarkets, convenience stores, coffee-shops, etc.. From this perspective, mentioning the rare illnesses and deaths in the lead seems a bit undue, because death and illness can be found associated with virtually every consumable product, and sources are are mostly about outlying cases (right?). However, and this is a huge issue, kombucha is also a characterized by some as a health product. It may have some health benefits, but it's also been misrepresented as a treatment for a number of illnesses without any reliable sources at all. If we're talking about a commercially bottled beverage, then the health risks and benefits should be mostly ignored, because the benefits don't have any sources, and the health risks are effectively minimal (one source facetiously said something like "it probably won't kill you"). When talking about how kombucha is made, and if we're describing this as a health tonic, I don't think it's at all undue to mention the risks and to underscore the lack of scientifically studied benefits. Mentioning the death in the body seems like it may be appropriate to the extent that this is about a fringe medical practice. I would like the lead to say something like "risk of potentially fatal illness". That seems like a concise way to explain that it's a serious issue without overselling it. As I understand it, explaining potential risks and being very cautious about medical claims is the underlying rational for MEDRS. Grayfell (talk) 20:10, 11 June 2015 (UTC)

Thank you, Grayfell - I agree with you. Let's work at getting WP:UNDUE and WP:Balance fixed and the rest will self-correct. I suggest using the Journal review since it is the most reliable source we have at this point in time. There are plenty of mainstream media articles on the subject that pass the RS acid test. Mayo is another good source. I am looking forward to collaborating with you. --Atsme^📞📧 20:20, 11 June 2015 (UTC)

Claim tied to primary source (case report)

This claim "Other reports of adverse reactions may be related to unsanitary fermentation conditions, leaching of compounds from the fermentation vessels, or "sickly" kombucha cultures that cannot acidify the brew.[25]" is tied to a primary source. It is unsuitable for a MEDRS claim. AlbinoFerret 19:54, 14 June 2015 (UTC)

I think part of the statement (about the leaching of compounds) is adequately referenced since it's referring to individual case reports, which is covered by the primary reference. However, the rest of the sentence is unreferenced; I'll see if I can find something that references each part. (updated) Ca2james (talk) 02:54, 15 June 2015 (UTC)

Sure, you will need to find reviews, secondary sources for all of it, including the initial claim. Case reports are the most primary form of sources and should not be used for medical claims. Per WP:MEDRS "in general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom." AlbinoFerret 12:47, 15 June 2015 (UTC)

A lot of poorly-sourced stuff there; I've trimmed (and reversed some NNPOV interim edits). Alexbrn (talk) 12:58, 15 June 2015 (UTC)

Yes, and you keep replacing it. I fixed the problem in the lead and in the body of the article using the updated journal review which is compliant with MEDRS. It replaces the old review that is 13 years old. The extraordinary claims of death and toxicity have been removed as they are antecdotal case reports which are considered below minimum requirements for inclusion per MEDRS, not to mention grossly UNDUE. I highly recommend that you stop the unwarranted reverts and your disruptive behavior. Atsme^📞📧 13:08, 15 June 2015 (UTC)

What is it you think is "MEDRS" ? Please focus on content. Alexbrn (talk) 13:15, 15 June 2015 (UTC)

Please focus on the type of source used for medical claims. That is the topic of this section. Replace the primary sources or the claims need to be removed. AlbinoFerret 13:19, 15 June 2015 (UTC)

They've gone. Alexbrn (talk) 13:22, 15 June 2015 (UTC)

AlbinoFerret, WP:MEDRS doesn't say that primary sources must not be used; it says that they should not be used. In circumstances where data is limited, primary sources might be the best-available evidence. Therefore, using them isn't problematic according to the spirit of MEDRS, which is to use the highest-quality sources available. That said, the case study in question is quite old and hasn't been cited or its conclusions repeated anywhere so including it is UNDUE. Ca2james (talk) 15:01, 15 June 2015 (UTC)

Yes, and in practice the circumstances where primary sources are acceptable for health information are extremely limited. Alexbrn (talk) 15:05, 15 June 2015 (UTC)

This isnt just a primary source, but one of the lowest quality primary sources, a case report. MEDRS putts it on par with "anecdotes or conventional wisdom" and neither of those is possible to be used for medical claims. That makes the extremely rare use even harder to justify. If a high quality primary source can be found it can be discussed and possibly brought in through consensus. Any primary source should not be added without consensus. AlbinoFerret 15:43, 15 June 2015 (UTC)

Another Primary sourced claim

"Some adverse health effects may be due to the acidity of the tea; brewers have been cautioned to avoid over-fermentation.[21]" is sourced to a primary source. It needs to be a secondary source for medical claims, of which "adverse effects" is a medical claim. AlbinoFerret 13:17, 15 June 2015 (UTC)

Isn't the "Food and Drug Administration model" primary? The source is secondary to that. Alexbrn (talk) 13:20, 15 June 2015 (UTC)

No the Food and Drug Administration model is just that, it is a model, that is applied to different foods. The source is primary as it is applying the model to Kombucha and discussing that. The source is avilable at the Freelibary for those who dont have access to the print link AlbinoFerret 13:25, 15 June 2015 (UTC)

Might just want to say "To avoid excessive acidity ..." then (and move it out if the Health section)? Alexbrn (talk) 14:21, 15 June 2015 (UTC)

That sounds like a reasonable course of action. AlbinoFerret 15:46, 15 June 2015 (UTC)

CRD Summary of unsupported claims in Ernst review

I have repeatedly asked editors to stop including the poorly sourced, noncompliant extraordinary claims of toxicity and death linked to kombucha products because they are scientifically unsupported claims, and the sources used do not even meet the minimum requirements of MEDRS.  I have added DS alerts to the TPs of those editors who have not been alerted previously. I added the DS alert notice at the top of this article's TP. I have posted friendly notices on TP of those editors who have been edit warring and asked them to please stop the disruption. I have provided below the information that clearly demonstrates why the Ernst systematic review does not meet even the minimum requirements of MEDRS for inclusion of the scientifically unsupported claims of death and toxicity in this article. Reverting in order to include such claims is disruptive and noncompliant with PAGs including WP:MEDRS, UNDUE, NPOV, V but not false, and simply do not belong in this article.

See Results of 2003 Ernst review and CRD commentary. I have included them below for your convenience.

Results of the review

Three case series and two case reports of adverse events were included in the review. These included 28 patients in total.

No studies were found relating to the efficacy of Kombucha.

The reporting of the individual cases was poor, making it difficult to ascertain if Kombucha was the cause of the adverse events reported. The adverse events included suspected liver damage and metabolic acidosis from Kombucha drunk as a tea. One case series described cutaneous anthrax infection through topical application of the tea, although the Kombucha could have been contaminated due to storage in extremely unhygienic conditions.

CRD commentary

The inclusion criteria for this review were necessarily broad to allow for a full analysis of the efficacy and safety of this remedy. A wide range of information sources were searched, making it less likely that studies were missed. It was not possible to assess the validity of the evidence, nor was pooling possible due to a lack of efficacy data. 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.

Please respect our PAGs. Atsme^📞📧 00:51, 16 June 2015 (UTC)

This article is a review, meaning it is secondary, correct? Edzard Ernst is certainly a notable authority on CAM, so I'm not seeing how it fails to meet MEDRS. Is the journal not reliable? Systematic reviews are ideal for medical content. I could easily be missing something, but this source doesn't look fundamentally unusable. The wording is debatable, and it would certainly be nice to have something a bit more recent, but that's typical. Grayfell (talk) 01:44, 16 June 2015 (UTC)

When the review of the review itself states: The reporting of the individual cases was poor it is a clear and unambiguous indication that is represents a poorly sourced' review to make claims that Kombucha was the cause of the adverse events reported. Read the review and the commentary. Just because it is a secondary source doesn't mean it's ok to use it. Read the essay, WP:Verifiable but not false. MEDRS also clearly states the case reports are anecdotal and do not meet minimum requirements so the latter coupled with a review that assesses portions of the systematic review as "poor" tells us we cannot use it as a RS. Atsme^📞📧 02:04, 16 June 2015 (UTC)

Yes, I'm listening, okay? I hope you wouldn't feel the need to yell at me to my face, so maybe cool it with the unnecessary emphasis, because that's the appearance it gives.

Earnst does acknowledge that the reporting was poor. That doesn't automatically make the source poor. The distinction is important. Since the source is reliable, but the content is preliminary, the article content could still be included in a way that reflects that. The author's conclusion seems like a very useful point to bring up, and the article can reflect that. (Again, it would be really nice to have something more recent and comprehensive here):

The author concluded that the claimed benefits of Kombucha were not supported by clinical evidence and, in view of the adverse events profile, its therapeutic use could not be recommended. However, he also noted that the adverse events were described in isolated reports, which cannot allow firm conclusions about causality and allow for generalisation.

Isn't that exactly the point you're trying to clarify in the article? Grayfell (talk) 02:48, 16 June 2015 (UTC)

• Note that AlbinoFerret removed this source[3] on the grounds that it is old when we have newer ones, which is reasonable enough. Alexbrn (talk) 04:54, 16 June 2015 (UTC)

It appears that references to this 12 year old source are growing. There are plenty of newer sources available. This source should be removed per WP:MEDDATE AlbinoFerret 06:13, 20 June 2015 (UTC)

I have not seen "plenty of newer sources". QuackGuru (talk) 06:20, 20 June 2015 (UTC)

There are 28 sources. 2 of the claims are already backed up by other citations, 1 of the remaining can be sourced to whats there. The remaining is an opinion. This is way to much usage for a 12 year old source, and from a journal (though renamed) that has an impact factor of 1.079 and has not made it above 2. Thats extremely low. AlbinoFerret 19:46, 20 June 2015 (UTC)

Edit warring; please respect WP:MEDRS

Atsme is repeatedly deleting MEDRS-compliant material (e.g. that sourced to a 2011 Pharmacology textbook) and creating a section entitled "Health benefits" to which is then added material sourced to this article, which so far as I can see is not even PUBMED indexed - a WP:REDFLAG. These changes are not in line with how we source medical content here, and this edit warring of poor content has got to stop. Alexbrn (talk) 04:01, 16 June 2015 (UTC)

Alexbrn is repeatedly reverting to add back unsupported claims cited to sources that are non-compliant with NPOV, UNDUE, MEDRS, and V. The sources he is citing are referencing case reports which MEDRS considers anecdotal and below the minimum requirement for RS. The claims of toxicity and death are extraordinary claims because they are rare, and random case reports involving unsupported evidence from a very small group of people. The 2003 systematic review and other RS he keeps citing all refer back to the unsupported case reports because there are so few. The recorded case reports have been assessed in the Ernst 2003 systematic review as poor and scientifically unsupported (see my comment below). The material Alex keeps adding back is written in such a way to purposely effect public opinion regarding kombucha which is noncompliant with NPOV. I am concerned that this issue is high enough on the scale of importance that an admin needs to review it and impose DS as needed because of the unsupported medical claims subject of this dispute. Atsme^📞📧 13:01, 16 June 2015 (UTC)

Right so you're talking - good! The claims that kombucha tea drinking is associated with (N.B. that does not mean "causes") fatalities is sourced to two well-published medical textbooks, which as WP:MEDRS tells us are good sources; is has also been mentioned in many earlier works. On what grounds do you say the sources we use are "below the minimum requirement for RS"? (Disagreeing with them does not count).

(Add:) BTW, here's another recent textbook which might be useful:

• Dasgupta A, Sepulveda JL (2013). Other Supplements that Cause Liver Damage. Elsevier. pp. 78–79. ISBN 978-0-12-415858-0. the limited evidence currently available raises safety concerns, especally regarding potential hepatotoxicty and the possibility of life-threatening lactic acidosis {{cite book}}: |work= ignored (help)

Alexbrn (talk) 13:40, 16 June 2015 (UTC)

Alex, implying that I haven't been talking is unwarranted as are your attempts to make me appear to be the one who is edit warring and being disruptive. You are reverting my GF edits which correct the noncompliant material you keep adding back. You are also abusing rollback privileges with your use of TW.  I have long since advised you on your TP to stop edit warring. Your repeated warnings on my TP are also abusive because I am not edit warring, you are. Keep in mind, you warned me to stay off your TP. [4]  It is unacceptable for you to repeatedly add contentious, scientifically unsupported material and reverting my edits which cites the most recent review of kombucha, and meets all the requirements of MEDRS as a verifiably accurate, high quality RS. PAGs tell us that a RS may not be considered reliable for inclusion of contentious material that is scientifically unsupported and/or that is noncompliant with our 3 core content policies, not to mention UNDUE and FRINGE. For the umpteenth time, the sources you keep citing do not meet even the minimum requirements for adding extraordinary claims of death and toxicity because they are based on case reports which are considered anecdotal. As I demonstrated below via Doc James' post at Proj Med, it doesn't matter how many sources you cite if they are all making the same scientifically unsupported claims.  Perhaps you should read more closely the review of the 2003 Ernst systematic review and pay closer attention to the CRD summary because it rates the review's mention of case reports as poor.  My post includes the full summary.  [5] Atsme^📞📧 14:06, 16 June 2015 (UTC)

That doesn't really answer my very specific question, about why the sourcing we use is in your view "below the minimum standard for RS". Sure they are based on case reports etc. but the expert, reliably-published assessment in the sources we use is that those case reports give rise to concerns about possibly of life-threatening adverse effects from kombucha tea. So we relay that expert, reliably-published view as we should. As another editor has explained to you above that the case reports are "poor" does not make secondary sources evaluating those case reports poor. You need to understand that. (Add: I do not think you're right in saying WP:FRINGE applies to these claims either: I shall ask at WP:FT/N for clarification.) Alexbrn (talk) 14:16, 16 June 2015 (UTC)

Comment

I note that there seems to be a good deal of reversion and edit warring in this article. Please remember to Assume good faith, and don't revert edits simply because you don't like another editor's referenced version, which seems to be happening all the time here. Reversion is for combating vandalism not for establishing your version of reality.

This talk page is for discussion, and I suggest that it's used before making edits that revert another editor's GF edits. If you really can't reach an agreed text through adult discussion here, then ask an uninvolved editor to arbitrate, bang heads or whatever.

I'm not going to work back through the edit history to apportion blame, because that is unconstructive, I'm just asking that you play nicely and talk rather than revert. This isn't an FA or GA candidate, so there are no requirement for perfect prose. If an edit is GF and referenced to an RS source it should not e removed without discussion with the other editor

Jimfbleak - talk to me? 09:06, 16 June 2015 (UTC)

Note this had already been raised at WT:MED. I don't know what you mean by saying reversion is happening because "simply because you don't like another editor's referenced version"? In my case "simply not liking" doesn't come into in: I am reverting for the reasons I have given on this talk page, which centre on our need for WP:MEDRS for health information. That's right, no?
Perhaps if there are still questions to decide, an RfC might be the way forward? Alexbrn (talk) 10:32, 16 June 2015 (UTC)

I was trying hard to avoid pointing fingers, but since you ask here are a couple of examples where you have used Twinkle, an anti-vandalism tool, to revert what appear to be GF edits with summaries that do not identify the nature of the vandalism Not an improvement Rv. whitewashing deletions & insertion of comparatively weakly-sourced material. Your edit for these summaries suggest that you are reverting on opinion rather than vandalism. Anti-vandalism tools, such as Twinkle, Huggle, and rollback, should not be used to undo good-faith changes unless an appropriate edit summary is used. The same user was reverted in each case. I can't see how his/her edits were vandalism, and it seems to be that discussion would be better than unilateral bashing with Twinkle. I have no personal interest in this article, and I know that positions can become entrenched. I would just like to see unnecessarily confrontational actions avoided with an aim to reach some consensus.

I think we are a long way from this sort of thing, but there seems to be a need for a more measured approach Jimfbleak - talk to me? 12:35, 16 June 2015 (UTC)

Twinkle's just a tool. I don't see any difference between using it and doing a manual content edit if the result is the same. In both cases I followed up here to the Talk page but have had no response[6][7] which makes it difficult for a measured approach to flourish. And of course the issue at hand has been discussed ad nauseam above. I have no doubt the edits were GF but they are adding medical claims sourced in once case to a primary source and in another to a questionable source, while at the same time deleting material which is not dubiously sourced. We have a responsibility to ensure the health information carried in articles is accurate. I am happy to discuss the particulars of that further if that would help here. Alexbrn (talk) 12:54, 16 June 2015 (UTC)

The onus to restore material that was challenged for noncompliance is on the editor who wants to restore it which in this case is you, Alex. I think an RfC would be a good plan if you think it will support your position but keep in mind that an RfC cannot override policy. The discussion you wikilinked above WT:MED did not include any diffs to support your position. Following are diffs from that discussion that support mine. For convenience, I also included below the comments made by Doc James.

• "we must use the best available sources"
• "Sources / evidence are like school children. 5 first graders do not equal one 5 grade in ability."
• "extreme ideas require extreme sources"

Following is Doc James' post in its entirety:

Reading through a couple of comments: I would disagree that 5 major newspapers are reliable sources when it comes to medical content. Sources / evidence are like school children. 5 first graders do not equal one 5 grade in ability. I like the "true to presentation" bit. I also like that extreme ideas require extreme sources. One would need amazing sources to support the idea that TMers can actually fly Doc James (talk · contribs · email) 6:10 pm, 11 June 2015, last Thursday (5 days ago) (UTC−4)

Perhaps you should read more closely the summaries and conclusions of the 2003 Ernst systematic review and pay closer attention to the CRD summary because it rates the Ernst review's mention of case reports as poor.  My post above provides the full summary - [8]

Bottomline - having multiple RS that make the same scientifically unsupported claims based on the same case reports (extraordinary ones, at that, considering they include claims of death and toxicity based only on a small number of anecdotal reports with no scientific evidence to confirm causality) are still considered unreliable for citing those specific claims. It is noncompliant with MEDRS, not to mention noncompliant with UNDUE, NPOV, V, and FRINGE. The 2014 Review, and the review of the 2003 Ernst review represent high quality sources and they also don't support the material you want included rather they contradict it. Claims of health benefits based on anecdotal evidence is not allowed when writing about health benefits or negative reactions. Refer to the articles on GMO, GMF, Atrazine, Bull Red and the like. Alex, you are well aware of MEDRS and what is and isn't compliant, and you should know the material you want in this article is noncompliant because the claims of death and toxicity are based on anecdotal case reports. I strongly advise you to drop the stick. Atsme^📞📧 17:19, 16 June 2015 (UTC)

I agree with Doc James; I disagree with you. Yet you've gone ahead and re-asserted your edit yet again (I have reverted). You are using a 2014 article which does not seem to appear on PUBMED yet alone in MEDLINE's index. That is a WP:REDFLAG so far as WP:MEDRS is concerned. As I said above, you are simply wrong in dismissing secondary sources because you personally disagree with their use of primary sources. We have a longstanding consensus version of the text (and lede) for this article you are seeking to overturn. You can't just blank well-sourced material because you value your personal assessment more than that of the well-published sources we use. You spout a lot of wiki-acronyms but show very little sign of understanding what they betoken. Alexbrn (talk) 17:44, 16 June 2015 (UTC)

(Add:) Oh, and you've just re-reverted again[9]. I'm backing off and will await the input of other admins/editors as the discussion route with you just seems to be going nowhere. Alexbrn (talk) 17:47, 16 June 2015 (UTC)

:Really? If PUBMED is what you want, I'm happy to cite a 2014 review in PUBMED as well. The abstract is below and I imagine some of our GF collaborators will be adding health information published in that review as well. There are numerous others - it's only a matter of citing them.

J Med Food. 2014 Feb;17(2):179-88. doi: 10.1089/jmf.2013.0031. Epub 2013 Nov 5. Current evidence on physiological activity and expected health effects of kombucha fermented beverage. Vīna I1, Semjonovs P, Linde R, Deniņa I. Abstract Consumption of kombucha fermented tea (KT) has always been associated with different health benefits. Many personal experiences and testimonials of KT drinkers are available throughout the world on the ability of KT to protect against a vast number of metabolic and infectious diseases, but very little scientific evidence is available that validates the beneficial effects of KT. The aim of this review is to give an overview of the recent studies in search of experimental confirmation of the numerous KT health-promoting aspects cited previously. Analysis of the literature data is carried out in correspondence to the recent concepts of health protection's requirements. Attention is given to the active compounds in KT, responsible for the particular effect, and to the mechanisms of their actions. 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. PMID: 24192111 [PubMed - indexed for

Happy reading! Atsme^📞📧 18:35, 16 June 2015 (UTC)

That article has long been cited by us (until YOU removed it in fact calling it "noncompliant, scientifically unsupported"). I sometimes wonder whether some editors aggressively editing are actually in control of the content they're using: the article is getting damaged as a result of such carelessness. Alexbrn (talk) 04:08, 17 June 2015 (UTC)

(edit conflict) Atsme the phrasing you're adding is problematic for several reasons: health is in scarequotes, the quote is undue because there's only one source that says that it's an important member of any group, the sentence "There have not been any human trials conducted to confirm any curative claims associated with the consumption of kombucha tea." is awkward, the phrase "small number of random anecdotal reports" is POV, and you've added the exact same text to the lead and to the health effects section.

Alexbrn, it's not unreasonable to think that a food sciences journal wouldn't be indexed in PUBMED, and not being in PUBMED doesn't necessarily mean that it's a bad source, especially considering that there isn't a whole lot of research out there on this. The journal apparently has an impact factor of 3.54, which seems pretty good.

Both of you are edit-warring and both sets of sources are MEDRS-compliant for this article. The text you're both looking to add is also quite similar. I can't see why both sets of sources couldn't be used to support something like this in Health Effects:

Kombucha has been promoted as an antioxidant health drink that can treat a variety of human illnesses including AIDS, cancer, and diabetes, and that it can stimulate the immune system. Although laboratory experiments are suggestive of possible health effects, human clinical trial evidence that kombucha consumption benefits human health is lacking. The consumption of Kombucha has been associated with some adverse effects including muscle inflammation, poisoning, infection, and the death of at least one person.

And for the lead:

Kombucha is considered to be a health drink with antioxidant properties and has been promoted as treating a number of illnesses, although there have been no human clinical trials verifying kombucha's beneficial effects. Some adverse effects related to the consumption and production of kombucha have been reported in anecdotal case reports. Anecdotal reports have raised concerns over the potential for contamination during home preparation, as well as toxicity concerns due in part to the leaching of lead in ceramic containers during fermentation.

Ca2james (talk) 18:41, 16 June 2015 (UTC)

References

That seems good. That a source isn't in PUBMED does't make it bad in itself, but it makes it iffy for any kind of non-obvious health claim. In general such sources are best avoided for that purpose. Alexbrn (talk) 19:12, 16 June 2015 (UTC)

Can we please stop the WP:DONTGETIT behavior? You can bring the whole Guerrilla Skeptic team in here to support your POV but it isn't going to change the fact that the sources being cited for the extraordinary claims of death and toxicity all reference the same case reports and are not reliable for that purpose. The case reports are anecdotal, so it doesn't matter what book they're in. The reviews are what matter. I've already provided the necessary reviews, and a review of a review, all of which are high quality RS. I am not the only one who has tried to explain the reasons we cannot include the scientifically unsupported claims of toxicity and death in this article - for the umpteenth time, they all reference the same small group of case reports, all of which do not support causality and are considered anecdotal and noncompliant per MEDRS. And please stop accusing me of edit warring. The editors who keep reverting my edits to restore noncompliant material are edit warring. I am quite confident in my understanding of MEDRS - I've had the best teachers in Doc James and MastCell. Other editors have explained the same thing here and/or at Proj Med, including Petrarchan47, AlbinoFerret, Ozzie10aaaa, Special:Contributions/87.115.171.174. I already commended Grayfell for the suggestion to treat it as a beverage. Atsme^📞📧 20:26, 16 June 2015 (UTC)

PS - with regards to the suggestion made by Ca2james, it is not too unlike what I had written that keeps being reverted. It all boils down to whether my prose is accepted or yours. I like mine better because there is no need to mention toxic in the lead. If you can get the negatives of Red Bull added to the lead in that article, then we can do it here, too. The main difference is kombucha is a natural product. Red Bull is not. Atsme^📞📧 20:33, 16 June 2015 (UTC)

Atsme, edit warring requires at least two editors and by repeatedly inserting your text while reverting, you are in fact edit-warring along with the other editors.

Atsme is at least at 3RR.[10][11][12] Alexbrn (talk) 03:53, 17 June 2015 (UTC)

You've said that extraordinary claims require extraordinary evidence. I take it that you mean that saying someone died because of ingesting kombucha is an extraordinary claim and that somehow the reference that supports that people died isn't extraordinary enough. Death due to the ingestion of a substance isn't an extraordinary circumstance at all; it would be much more remarkable if no one died after ingesting a particular something.

To comply with MEDRS means to use the best available sources - that's what the guideline boils down to. When something like kombucha isn't well-researched, we have to use the best sources out there. These sources may not appear on PUBMED; they may be older than five years; they may even be case studies. The fact that these case reports are themselves reported in review references means that those review references do adhere to MEDRS. That's the way reviews work - they review the available literature and that can include case reports.

I agree that detailed mention of the adverse effects (including death) doesnt belong in the lead, which is why my lead proposal just says adverse effects have been reported anecdotally.

Since you both appear to be fine with my proposed text I'm going to add it within the next couple of hours, after dinner. Ca2james (talk) 21:50, 16 June 2015 (UTC)

No, I am not fine with your proposed text. I am fine with the text I wrote that is already in the lead. Your text does not improve what is already there. Atsme^📞📧 22:09, 16 June 2015 (UTC)

There's a lot going on here, but Ca2james' proposal seems like an improvement in terms of readability and weight. While I agree that the article should treat kombucha as a beverage, I did not mean it should only be treated as a beverage, as sources clearly support that it's more complicated than that. The comparison with Red Bull seems flawed, and a more apt one would be energy drinks as a category. I'm not sure what being natural has to do with anything. Grayfell (talk) 22:29, 16 June 2015 (UTC)

Thanks, Greyfell. Atsme, are you fine with the text I'm proposing for the health effects section? If you're fine with that, then I'll add it. As for the lead, I've already pointed out the problems with your proposed wording, as has Doc James, and so we need to figure out a different wording that will work for us all. What, specifically, do you object to in my proposed wording? Ca2james (talk) 00:12, 17 June 2015 (UTC) (ping Grayfell - apologies for the typo - Ca2james (talk) 00:24, 17 June 2015 (UTC))

No, I am not fine with it. The same way you believe my wording is wrong, I believe your wording is wrong. The difference being, my words are backed up by science and what you want to include is anecdotal and not supported by science. The review issue has not yet been resolved and until that is done, unsupported claims will be removed from the article. There is no deadline so please stop trying to rush things. It is not helpful. Atsme^📞📧 01:41, 17 June 2015 (UTC)

It wasn't clear that you weren't fine with the health effects section because you only mentioned the lead. I'm not trying to rush anything; I was trying to negotiate a compromise so that the edit-warring would stop. I specifically pointed out the issues I had with your wording, and I'd appreciate it if you'd do me the same courtesy instead of making general comments. I thought the review issue had been resolved although I'm grateful for the additional references that have been provided in the next section. Ca2james (talk) 02:15, 17 June 2015 (UTC)

Extraordinary claims

I support this version [13] for the following reasons:

Food group

What is with "Kombucha tea is considered a health drink and "an important member of the antioxidant food group."

There is no such thing as an "antioxidant food group". Nothing comes up on pubmed for the quoted phrase [14] Doc James (talk · contribs · email) 23:51, 16 June 2015 (UTC)

It's a quote cited to the review. Why does it have to show up in PUBMED if its quoted from a RS Journal review? Atsme^📞📧 00:07, 17 June 2015 (UTC)

Because, as Alexbrn has pointed out, MEDRS sources are typically indexed on PUBMED. This reference you're using is an exception. Aside from the fact that the quote isn't actually referenced, the quote is UNDUE for the lead as there's only this one RS that says that it's "an important member of the antioxidant food group". If this were a characterization expressed in many RS, then it would be part of the lead. As it is, this needs to stay out. Ca2james (talk) 00:22, 17 June 2015 (UTC)

Being in a review is not enough. There are many poor quality reviews out there. The review generally also needs to be pubmed indexed. The journal needs to have a impact factor more than zero and for extra ordinary statements such as one introducing a new "food group" many high quality sources would be needed.

This is also not something we would put in Wikipedia's voice. Major statements should be supportable by dozens if not hundreds of independent high quality sources. I found zero / O sources discussing this new food group in pubmed. Doc James (talk · contribs · email) 00:26, 17 June 2015 (UTC)

What you're asking us to do is OR, Doc. It's a violation of policy. You are also contradicting MEDRS, so if we are not supposed to trust reviews, MEDRS needs to be rewritten. What you are saying in essence is to perform OR, review all the research and determine which ones are the high quality articles, and formulate our own review. Uhm, that is highly unlikely. You need to rethink your statement. Atsme^📞📧 13:00, 24 June 2015 (UTC)

WP:OR: "This policy of no original research does not apply to talk pages". Contributors are expected to assess the reliability of sources, rather than blindly following guidelines. Though WP:MEDRS specifically mentions indexing as being an indicator of quality anyway. AndyTheGrump (talk) 13:15, 24 June 2015 (UTC)

Perhaps you should start a new section because your OR comment has no relevance to anything I said and neither does the remainder of your comment. I addressed Doc James. Atsme^📞📧 14:17, 24 June 2015 (UTC)

This talk page is open to all contributors - and when you accuse contributors of "violating policy", based on a misunderstanding of guideline you cite, I shall comment on the fact if I so choose. AndyTheGrump (talk) 14:26, 24 June 2015 (UTC)

Let's be clear - you are making unsupported allegations against me. I did not accuse contributors of "violating policy". I said OR is a violation of policy which is not an accusation, it is a factual statement. If I was accusing contributors, I would have said "you", "he" or "she" is violating policy. Perhaps you think I don't understand policy because you don't. You can comment away as long as you are not casting aspersions against me as you just did, but you can also try to be polite by not making rude comments, and allow other editors a chance to speak for themselves. I am not the least bit interested in any comments that demonstrate ill-will toward me, and so far that's all I've been seeing from you. Atsme^📞📧 16:14, 24 June 2015 (UTC)

You said What you're asking us to do is OR, Doc. It's a violation of policy which does accuse contributors of being asked to violate policy. Editors have to find the best, most high-quality sources to support statements. MEDRS codifies how to do that - and it's easy to follow when a subject has been well-researched. Kombucha has received very little research so the best-quality sources all fall short of MEDRS for one reason or another. This doesn't mean that we can't use those sources, however. Ca2james (talk) 16:37, 24 June 2015 (UTC)

I know what I stated - it's there for all to see. It appears a couple of editors have encountered some difficulty grasping the context of what I wrote. It brings [[WP:CIR] to mind, but even more relevant is the fact that my statement was not directed to anyone but Doc James. In the future I will use private email to avoid the disruption. To reiterate - What you're asking us to do is OR, Doc. I further clarified OR, "It's a violation of policy." I wasn't accusing Doc James of violating policy but if you misconstrued it as such, I'm not the one with a problem. I did not accuse anyone of violating OR which is what has been alleged. The allegation that I, "accuse contributors of being asked to violate policy" is really a head scratcher. Wow. Accuse editors of being asked? Mull that around in your heads for a while. Perhaps we've found the root of the problem for the unwarranted reverts. Atsme^📞📧 19:16, 24 June 2015 (UTC)

Busterism

This is spammy wording "recent scientific research indicates the presence of active compounds in kombucha tea that are "responsible for a particular effect and to the mechanisms of their actions" which further indicate that kombucha tea "can efficiently act in health prophylaxis and recovery due to four main properties: detoxification, antioxidation, energizing potencies, and promotion of depressed immunity."

Extraordinary claims require extraordinary evidence. A couple of low / very low quality reviews does not support "detoxification" / "energizing potencies" / "promotion of depressed immunity". This are pseudoscientific terms with no real meaning in the context give. Doc James (talk · contribs · email) 23:54, 16 June 2015 (UTC)

The prose can probably be polished, but it includes quotes from a recent review that did come up in PUBMED so if you are calling one low quality because it didn't show up in PUBMED, and another low quality because it did, then that's pretty wishy-washy. Your reasons for agreeing with the reverts lack teeth, Doc. I realize you are an avid supporter of science based medicine, but we're talking about a natural product that has been around for ages. How did you determine the quality of the two reviews, and where in MEDRS does it say we can do that? Is it based on your POV, expertise, what? Where is the quality gage so I can use it in the future? You might also look at the credentials of the authors involved and if you haven't already, take a look at the papers/research that was reviewed and where it originated. I am not convinced by your argument that your conclusion represents a totally unbiased, objective analysis of two reviews. Please provide some supporting documentation, links, diffs, whatever. Thank you. Atsme^📞📧 00:28, 17 June 2015 (UTC)

Sure 1) should be pubmed indexed (if it is not that is a worrisome sign) 2) should be in a high impact journal (think IF of greater than 10, or 5 at least) An IF of 1 or 2 is low. IF is 1.7 [15] Doc James (talk

What one can pull out of the paper [16] is "very little scientific evidence is available that validates the beneficial effects of KT" Doc James (talk · contribs · email) 00:41, 17 June 2015 (UTC)

If that is the case, and you consider those reviews unacceptable to source any of the benefits the science indicates per their conclusion, then the anecdotal claims that are unsupported by science including claims of toxicity and death absolutely positively do not belong in this article at all. Atsme^📞📧 00:51, 17 June 2015 (UTC)

How is someone dying an 'anecdote'? AndyTheGrump (talk) 00:57, 17 June 2015 (UTC)

Reports of death lead back to a case in 1975, where a mother and daughter became ill, and had been drinking Kombucha for a few months daily. However, so had 130 other people in the town. At the time it was considered to be linked to the Kombucha, but after viewing the evidence the FDA could not conclude that the illnesses (and one death) were caused by the drink, and simply issued a warning. There has never been a conclusive link to any death. Originally this article linked to a blurb on the American Cancer Society website that cited this 1975 case and claimed Kombucha was linked to a death, but that webpage has been removed and the ACS does not make any mention of Kombucha now. (There remain other sources that link to this same case which should also be removed, but this is how it is with science - a good portion of study results end up being redacted, but there are many papers referring to those studies that don't update accordingly.)

The Mayo Clinic is on par with the ACS, and their blurb on Kombucha does not mention any link with death. Editors at this page have not seemed interested in quoting from the Mayo Clinic link as with the ACS. Sourcing was never the issue, the goal is to claim Kombucha is deadly. This is the main problem here. petrarchan47คุก 01:47, 17 June 2015 (UTC)

Nobody is claiming that it is 'deadly'. We are however citing reliable sources which state that it has been linked with deaths. Demanding 'conclusive evidence' regarding the possible toxicity of something people concoct themselves under uncontrolled conditions is probably beyond the skills of contemporary science - but that is no reason not to cite the sources. And no, we can't cite the Mayo Clinic for not saying something... AndyTheGrump (talk) 02:03, 17 June 2015 (UTC)

Petrarchan, are you sure you have the details right? I think you're referring to an incident from 1995, not 1975, in which the two patients were not mother and daughter (and were not reported to be relatives). The case study was published [17]. It has not been retracted, and it noted that no causal link had been established. --Amble (talk) 21:03, 17 June 2015 (UTC)

Well that will be the last time I try to depend on my memory. petrarchan47คุก 01:04, 18 June 2015 (UTC)

Sorry to nitpick, I just wasn't sure whether there was a separate incident that I had missed. --Amble (talk) 05:11, 18 June 2015 (UTC)

Nitpick? I completely mangled the story ;) No, there was just this one incident in '95 as far as I know. petrarchan47คุก 06:59, 18 June 2015 (UTC)

It is a frustrating item, since there's no evidence that the acidosis had anything to do with kombucha. But since it's brought up in reasonably reliable sources with language like "linked to" or "possibly linked to", I don't see how we can get away from some mention. --Amble (talk) 15:19, 18 June 2015 (UTC)

I agree - it's mentioned in the vast majority of sources, but shouldn't be in the Lede, and really should have a bit more explanation. When I first saw this article, the Lede had 4 sentences. The last one read: "Drinking kombucha has been linked, in rare cases, to serious side effects and deaths, and improper preparation can lead to contamination."

There is still no mention of the history of the subject, all attention seems directed toward medical aspects, which is strange. But the Lede reads much better now: "A small number of adverse effects related to drinking kombucha have been reported, and reports have raised concern over the potential for contamination during home preparation." petrarchan47คุก 00:54, 19 June 2015 (UTC)

The question is what is the review acceptable for. If a review in an obscure journal claimed that medication can make you fly (which some do claim) that is not enough evidence to add it to Wikipedia. Extraordinary claims require extraordinary evidence. If the review states little evidence exists that is not hard to believe and thus does not need excellent evidence.

If you state that substance X "detoxifies" that is an extra ordinary claim. First question is what does it detoxify? Are we speaking about lead, mercury, iron? There is evidence that antioxidants cause harm (think vit E in smokers and lung cancer) so are we stating that this stuff causes lung cancer. Does this "promotion of depressed immunity" mean it makes autoimmune diseases worse? Does this "energizing potencies" mean it causes mania? Sounds like dangerous stuff. This paper is speaking in pseudoscience speak. The Mayo site is better [18] Doc James (talk · contribs · email) 03:27, 17 June 2015 (UTC)

Another review

As this is a poorly research area using slightly older reviews is reasonable. For example we have "On the basis of these data it was concluded that the largely undetermined benefits do not outweigh the documented risks of kombucha. It can therefore not be recommended for therapeutic use." [19] Doc James (talk · contribs · email) 00:46, 17 June 2015 (UTC)

Another is http://www.ncbi.nlm.nih.gov/pubmed/10914673 Doc James (talk · contribs · email) 00:47, 17 June 2015 (UTC)

Doc, surely you can't be serious, can you?  Your talking about reviews that are 12 to 15 years old - researchers weren't even conducting the same experiments back then because they sure as heck didn't have the technology they have today. Your arguments are not substantive and if I can see that as a layperson, I doubt it will hold up under the scrutiny of the community, much less our more advanced readers. Jiminy Cricket.  Atsme^📞📧 01:21, 17 June 2015 (UTC)

If you really want to draw the attention of the community to your pro-Kombucha/anti-science advocacy, feel free to do so... AndyTheGrump (talk) 01:44, 17 June 2015 (UTC)

Andy, I strongly advise you to stop the PAs. Making unwarranted claims that I am anti-science anything is harassment and could very well get you blocked if it keeps up. Atsme^📞📧 01:56, 17 June 2015 (UTC)

Feel free to bring alleged PAs up too: you can start with this "Guerrilla Skeptic team" post. [20] Oh, hang on a minute, that's one of yours, isn't it... AndyTheGrump (talk) 02:16, 17 June 2015 (UTC)

Because Kombucha isn't well-researched, the best available sources might in fact be a review that's 15-20 years old. When we're talking about benefits and effects, technology isn't a factor. If we were talking about something that depends on new technology, it would make sense to favour newer reviews if they're available. In this case, the older reviews are still valid because the technology upon which they were based hasn't been superseded by other technology. Please note that these arguments are definitely substantive. Ca2james (talk) 02:36, 17 June 2015 (UTC)

WRT "Doc, surely you can't be serious, can you?" Yes I am. This is an exceedingly poorly researched area. This is not the article on diabetes or cancer. A 15 year old review is fine. Especially because no large RCTs have been done. In fact no RCT of any size has been done. Doc James (talk · contribs · email) 03:30, 17 June 2015 (UTC)

Well, sir, I disagree and for good reason. I took the time to dig into the sources you suggested above.  I also went back and re-read your responses thinking maybe I missed something the first time around.  Following is what I've surmised from your suggestions and recommended sources:

• The Journal for Food Protection, re: the 15 yr. old review you recommended has an IF of 1.7 which you claim is low quality.
• The Forsch Komplementarmed Klass Naturheilkd, re: the 13 yr. old Ernst review you recommended has an IF of 1.6  - I also included the DARE Abstract (previoiusly included it above on this TP) which includes the CRD Summary of the Ernst review and can be seen in its entirety here: [21]

The journals I cited are:

• The Journal of Medicinal Food, re: the 2014 review I cited has an IF of 1.699.  Its editorial review board is here: [22] It is a much better source than either of the two you recommended.
• The Journal of Comprehensive Reviews in Food Science and Food Safety, re: the 2014 review I cited has an IF of 3.54.  Its editorial board can be reviewed here [23] It is the highest quality review based on its IF.

The comparisons between your suggested sources and the sources I cited to support the material included in the article indicate the sources I used are higher quality for more reasons than just the IF (which is a controversial means of measuring the quality of journals anyway). The age of the reviews I chose reflects updated research methods that weren't even available or thought of in the reviews you consider acceptable. The journal review board credentials are better by far as well. I am somewhat disappointed in the position you've taken regarding this article. I also found your mention of pseudoscience a bit disturbing because it makes it appear that you are biased toward natural products despite the reviews that are compliant with MEDRS. If that is the case, please explain how you can possibly be a neutral collaborator. Atsme^📞📧 05:20, 17 June 2015 (UTC)

Yes all the reviews are of low quality. I have not claimed that any are of high quality. So the question than becomes how should we summarize these low quality sources?

The 2014 review states in it's conclusions "There is still a dispute over the beneficial effects of kombucha drink. There has been no evidence published to date on the biological activities of kombucha in human trials. All the biological activities have been investigated using animal experimental models. Toxicity reports on kombucha drink are very rare and scattered." "Although kombucha tea cannot be granted official health claims at this time, it can be recognized as an important part of a sound diet." [24] Doc James (talk · contribs · email) 05:35, 17 June 2015 (UTC)

With respect to pseudoscience I do not see any acceptance of this "antioxidant food group" by medicine or public health [25]. Doc James (talk · contribs · email) 05:40, 17 June 2015 (UTC)

Doc James, it appears to me that you're making judgement calls based on ??? (your expertise?) because for some reason, you don't like the conclusions stated in the two 2014 Reviews I cited. They represent more recent research than the 12 to 15 year old reviews you cited. I find it rather odd. The toxicity reports are anecdotal case reports - and what does MEDRS say about case reports? You're disputing the Reviews - so it's one medical professional vs an entire team of credentialed medical professionals who conducted the review, so please explain to me how the average editor is going to get away with that same practice. I'd really like to know because I seem to be having trouble getting the article updated per MEDRS. It is regressing instead of progressing as a result of the new research. Can you please explain what you just did? Atsme^📞📧 07:20, 17 June 2015 (UTC)

Where are the new human RCTs? Please provide links to them here. One needs human RCTs to state health benefits. Thus why the papers use vague non medical language.

Anyway you need consensus. And there is no consensus to add "Kombucha tea is considered a health drink and "an important member of the antioxidant food group." or "can efficiently act in health prophylaxis and recovery due to four main properties: detoxification, antioxidation, energizing potencies, and promotion of depressed immunity."

We are allowed to use common sense when editing Wikipedia. Rules are applied using human judgement. Doc James (talk · contribs · email) 07:25, 17 June 2015 (UTC)

Then please, use common sense which applies to all of us. You are asking editors to conduct OR by challenging summaries and conclusions in peer reviewed, scientific journal reviews with editorial boards comprising several qualified researchers and medical experts, and for what reason? To simply report the information from those summaries and conclusions per MEDRS and RS? My edits include inline text attribution and quotes with statements that properly identify the sources, and they are not claims made in Wiki voice. Show me in the GMF article where RCTs verify that the consumption of genetically modified food is harmless. Show me the RCTs that verify Red Bull is a harmless "energy" drink. I did not conduct OR, make-up any specific claims and did not state any review claims in Wiki voice rather I clearly identified the research, used "referred to as" for the ubiquitous terms, and properly included relevant statements per the conclusions and summaries of those reviews. I followed WP:V, WP:NOR, WP:NPOV, and WP:MEDRS yet my edits were reverted and challenged based on arguments that are not substantive - such as "not an improvement". The 13 yr old Ernst review you and other medical editors are supporting for inclusion in this article is outdated, and there's no need to read any further than the CRD summary of that review which confirms that it doesn't meet the lowest standards for inclusion per MEDRS regarding the anecdotal case reports. Furthermore, you referred to consensus but it appears you may have overlooked the fact that consensus does not trump policies. I am thoroughly confused over your stance regarding this beverage, Doc James. Atsme^📞📧 13:47, 24 June 2015 (UTC)

Changes to the Lede - removal of death claims, addition of Mayo Clinic source

The second paragraph of the Lede now reads:

Kombucha tea is considered a health drink with antioxidant properties, however no human trials have been conducted to confirm any curative claims.[1] A small number of random anecdotal reports have raised concern over the potential for contamination during home preparation, as well as toxicity concerns due in part to the leaching of lead in ceramic containers during fermentation.

Sourced to the Mayo Clinic:

Proponents claim kombucha tea can stimulate the immune system, prevent cancer, and improve digestion and liver function. However, there's no scientific evidence to support these health claims.

There have, however, been reports of adverse effects, such as stomach upset, infections and allergic reactions in kombucha tea drinkers. Kombucha tea is often brewed in homes under nonsterile conditions, making contamination likely. If ceramic pots are used for brewing, lead poisoning might be a concern — the acids in the tea may leach lead from the ceramic glaze.

As has been argued on this page previously, the best idea is to find a good, solid MEDRS source and stick closely to it. petrarchan47คุก 02:00, 17 June 2015 (UTC)

Thank you for demonstrating that the lede violates WP:NPOV. I shall accordingly revert it. AndyTheGrump (talk) 02:05, 17 June 2015 (UTC)

The death claims do not appear to be significant enough to the subject to be in the lede. Many products including peanut butter, salami, hamburgers, all have issues with potential contamination during preparation and have a history of contamination-associated deaths. These articles do not carry a similar statement in the lede. Commercial sales currently exceed 25 million bottles a year and no deaths have been linked to the commercial product. Dialectric (talk) 06:42, 18 June 2015 (UTC)

'Claims'? If a reliable medical source links kombucha with deaths, we take their word for it - we don't describe them as 'claims'. As for the safety of commercial products, please provide a source making such a statement. AndyTheGrump (talk) 17:01, 18 June 2015 (UTC)

The lede no longer includes the fact that deaths have been reported. I agree with Andy that describing the deaths as "claims" when they've been reported in RS is a POV characterization and wouldn't be acceptable anywhere in the article, let alone the lede. Ca2james (talk) 19:26, 18 June 2015 (UTC)

History section

Doesn't the history section usually appear first? See Green tea for instance. I'm going to move it and expand it a little bit. Thanks, petrarchan47คุก 01:11, 18 June 2015 (UTC)

I was going to ask that Etymology be put first but then I saw it was a subsection of history. I'm fine with the change. Thanks! Ca2james (talk) 02:58, 18 June 2015 (UTC)

Thanks, Ca2. MOS states that there is no firm guideline for the ordering of sections except to refer to similar articles (not that you asked). petrarchan47คุก 03:42, 18 June 2015 (UTC)

I've updated the history from this review. The text from which I quoted is as follows:

Another beverage known as Kombucha, is produced by the fermentation of tea and sugar by a symbiotic association of bacteria and yeasts forming a "tea fun-gus". It also originated in China where the "Divine Che" was prized 220 BC during the Tsin Dynasty for its detoxifying and energizing properties (Roche, 1998). In 414, Doctor Kombu brought the tea fungus to Japan from Korea to cure the digestive troubles of the Emperor. "Tea Kvass" was introduced into Russia by oriental merchants and then into Eastern Europe and Europe around the turn of this century.

Tweak my wording if needed, or add what I've missed. If my reprinting the above is in violation of something, I give you my deepest apologies. (But no more templates to my talk page, please.) petrarchan47คุก 07:08, 20 June 2015 (UTC)

Here is another source that could be used to further expand the history and etymology coverage. I can get to this soon if no one else does. petrarchan47คุก 08:29, 20 June 2015 (UTC)

"energizing and detoxifying agent" ?

Petrarchan47 has now twice inserted text[26][27] 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[28][29], 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. [30]. 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)

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.[31] 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."[32] 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.[33] You claimed "The impact rating is one of those ways"[34] 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.[35] 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, [36]:

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)