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A reference would be nice to some of these 300 surveys; also: is ginkgo supposed to be a vasodilator? That's what the description sounds like. If so, the list of claimed benefits could perhaps be listed as claimed benefits of taking vasodilators every day. Also, have the effects of long-term use been studied? I know long term us of vasoconstrictors and coagulants such as nicotine can be very harmful. --Andrew 17:42, May 2, 2004 (UTC)

if it "increases blood flow" but may cause headaches, is this simply a way of saying that it is a vasodialator? — Preceding unsigned comment added by Tim Starling (talk • contribs) 29 July 2004 (UTC)

I have never edited medical info on English Wikipedia so am not confident changing this myself.

But the mention of aspirin seems to be contradicted by a randomized controlled trial if I understood right https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5966631/ Chidgk1 (talk) 17:35, 2 July 2021 (UTC)[reply]

@Zefr: I reverted your recent edit for two reasons. First, it removed cited information that is pertinent to the article. Ginkgo biloba's use as a traditional medicine has a history spanning 10 centuries. This history is notable and should be discussed in the article (without making any unfounded medical claims, per Wikipedia:MEDRS). Second, the wording you replaced it with is not accurate. "There is no scientific evidence that ginkgo is helpful for treating any disease" isn't true. There is weak or inconclusive evidence that ginkgo is helpful for treating several diseases as discussed in the medical research section. That's why it originally said "There is no conclusive evidence", which is more accurate. If you have concerns with the wording, perhaps it could be adjusted. Let me know if you have some suggestions. Nosferattus (talk) 15:33, 12 August 2021 (UTC)[reply]

Use "spanning 10 centuries" is as much a myth as the traditional medicine uses are for treating diseases. No records exist to verify, so this statement is misleading and fails WP:V. "Weak" or "inconclusive" evidence is no evidence at all for an encyclopedia, WP:MEDREV. Please don't edit war, WP:WAR, but gain consensus first here on the talk page, WP:CON. Zefr (talk) 15:57, 12 August 2021 (UTC)[reply]

@Zefr: First, I should mention that I do appreciate your work keeping non-scientific medical claims out of Wikipedia articles. For those of us who are interested in the history of traditional medicine and its limited intersection with modern medicine, however, it can be frustrating seeing this sort of information repeatedly removed from Wikipedia even when it is well cited in secondary sources and presented with proper context. Hopefully there can be a middle ground where the information is presented with adequate context to eliminate the possibility of misleading readers while still providing historical information for those who are interested in it. Now on to the matter at hand. Stating that weak or inconclusive evidence is no evidence at all is an obviously false statement. WP:MEDREV does not exclude the use of weak or inconclusive evidence when discussed in secondary sources and given in proper context. And regardless, the section in question is not making any medical claims, only claims about historical use, although I agree it is important to clarify that these uses do not have a sound medical basis. Is there any way that we could achieve that aim without removing all the historical information or making false statements? Nosferattus (talk) 16:13, 12 August 2021 (UTC)[reply]

@Zefr: Also your statements that "No records exist to verify" the use of ginkgo over the past 10 centuries is false. According to the cited source (published by Yale University Press in 2013), the "first undisputed written records of ginkgo" appear in copies of the Shen Nung pharmacopeia around the eleventh and twelfth centuries. What is your basis for claiming that there are no such records? Nosferattus (talk) 17:00, 12 August 2021 (UTC)[reply]

There is a small difference between documenting a very old use and suggesting continuous use for 10 centuries. Does the source mention "10 centuries" or at least document various usages over that time period. It could have been, for example, an ancient use that was forgotten about then revived. There is a tendency, when some editors see "traditional Chinese medicine", to assume it is all completely made up by a 20th century Chinese government to cover up the lack of effective Western medicine. That should make us sceptical about such claims, but there are surely some herbal treatments that have long been used traditionally in China -- it would be quite bizarre if they had no such history. Let's just make sure our sources are good and appear to have researched this matter thoroughly, rather than parrot some contemporary literature.

I don't agree with the "no need to specify the quackery". We have seen this wrt Covid where editors think that completely hiding something they don't agree with will make Wikipedia a better encyclopaedia. No, it makes us a poorer encyclopaedia that fails to answer readers questions. I don't have the book sources. The NIH source mentions historical uses, recent promotional uses, which conditions have had scientific studies, and what the research tells us. If sources generally do this, then per WP:WEIGHT, so should we.

Wrt the '"Weak" or "inconclusive" evidence is no evidence at all for an encyclopedia', this was discussed recently at WT:MED wrt the Creat herbal remedy. This sort of statement is why we require editors to cite the secondary literature, not to interpret the primary literature for themselves. Doing the latter either leads to some editors promoting something that isn't called for, or other editors deleting something that isn't called for. Neither are abiding by policy. If one had to summarise the evidence in one sentence then indeed the "There’s no conclusive evidence that ginkgo is helpful for any health condition." statement from NIH would do. But if one has a paragraph, like I'm sure we do here, then one could take the same approach as NIH and mention what has weak evidence and what clearly has none. Zefr, there is a reason the NIH do this: it is recognised in public health that it is much better to be open and honest about what little or much we know or don't know and what we've looked at and what we haven't, rather than take the "Doctor knows best" approach and simply suppress mention of anything one doesn't fully endorse. The latter approach would just mean that NIH (and Wikipedia) fail to turn up on a Google search for Ginkgo & bladder disorders, say, or fail to satisfy any reader of the page looking for such. That reader then just clicks on the other links Google returned, that do mention those things. And those links could be the very sort of unreliable website we don't want them reading.

We just need to keep asking ourselves per WP:WEIGHT: how are other reliable secondary sources covering this topic? No original research of primary studies (for inclusion or exclusion purposes). -- Colin°^Talk 07:56, 13 August 2021 (UTC)[reply]

@Cerebral726: You removed the sentence...
Ginkgo biloba has been shown to affect vascular permeability and neuronal metabolism.
... with the explanation "cited source is about tinnitus and does not seem to show the stated evidence." Yet the article cited says...
Changes in vascular perfusion and neuronal metabolism are well‐documented effects of Ginkgo biloba in animal and human studies... Ginkgo has been shown to affect vascular permeability and neuronal metabolism.
(Tinnitus is directly related to vascular disease.) Can you please explain why you don't believe the cited source reflects the sentence that I added? Or perhaps you just overlooked the relevant material? Nosferattus (talk) 14:09, 3 September 2021 (UTC)[reply]

My apologies, I did overlook that part, a bad mistake to be sure. I have self reverted, thanks for calling me out! --Cerebral726 (talk) 14:17, 3 September 2021 (UTC)[reply]

And now Zefr has re-removed the sentence despite the consensus here on the talk page. Perhaps they would like to discuss their opinion. Nosferattus (talk) 14:38, 3 September 2021 (UTC)[reply]

The statement of gingko affecting "vascular permeability" and "neuronal metabolism" is bizarre. There are no MEDRS sources in the article cited or in the general medical literature to support such concepts, although there are reports of lab research where large experimental doses of gingko extract may produce such effects. This is misleading information for the encyclopedia, as it cannot be proven in vivo or in clinical research. Further, tinnitus is not "directly related to vascular disease" (read the numerous non-vascular causes in the tinnitus article) - again, there are no MEDRS sources supporting such a claim, which has no place in the gingko article anyway. Zefr (talk) 14:42, 3 September 2021 (UTC)[reply]

I'll add I have no strong opinion on the subject and self reverted because the addition seemed in line with the article. However, I could easily be wrong and don't add to any consensus about it's inclusion. --Cerebral726 (talk) 14:56, 3 September 2021 (UTC)[reply]

@Zefr: And how exactly would you demonstrate vascular permeability or neuronal metabolism in vivo? Regardless, there are plenty of MEDRS sources to support the sentence (including the one already cited), which is not about a medical therapy, but a physiological effect that is well-documented and medically significant, especially in the case of Ginkgo's effect on vascular permeability, which has been documented in the medical literature since at least the 1980s. (See Clostre, F (25 September 1986). "From the body to the cell membrane: the different levels of pharmacological action of Ginkgo biloba extract". Presse medicale (Paris, France : 1983). 15 (31): 1529–38. PMID 2947094.) It's funny that you object to this information here, but not in the Adverse reactions section (increased risk of bleeding, effect on drug interactions). Finally, I didn't say that tinnitus is always related to vascular disease. I just said that it is related which is why Ginkgo was being investigated as a treatment for various forms of tinnitus. It's not a relevant point of contention anyway, as I haven't suggested adding any information to the article about tinnitus. I was just explaining to Cerebral726 why the information was appearing in a study about tinnitus. Nosferattus (talk) 15:35, 3 September 2021 (UTC)[reply]

In vivo vascular (capillary) permeability in the brain is measured in lab animals using blood-injected radiotracers and post-mortem autoradiography (example), while in humans, MRI is typically used (example). Neuronal metabolism is measured in vivo using radiolabeled-glucose and imaging both in the lab and in humans (such as by PET, example). None of these methods has been used to study gingko extract. There are no MEDRS sources to support a statement that gingko affects vascular permeability or neuronal metabolism. There are no MEDRS sources to support use of gingko as a therapeutic agent. Zefr (talk) 15:48, 3 September 2021 (UTC)[reply]

@Zefr: All three of your last sentences are false:

• "None of these methods has been used to study gingko extract." Here is one example of a study showing Ginkgo's effect on neuronal metabolism in vivo using glucose markers: Loffler T, Lee SK, Noldner M, Chatterjee SS, Hoyer S, Schliebs R. (2001). "Effect of Ginkgo biloba extract (EGb 761) on glucose metabolism-related markers in streptozotocin-damaged rat brain." J Neural Transm 108: 1457–1474.
• "There are no MEDRS sources to support a statement that gingko affects vascular permeability or neuronal metabolism." The cited source (a Cochrane Review) is a reliable secondary source which meets MEDRS criteria.
• "There are no MEDRS sources to support use of gingko as a therapeutic agent." Also false. There is weak evidence that gingko can be used as a therapeutic agent for dementia, also according to a medical review article.

Please stop pushing the fringe POV that plants cannot have medical effects or uses. Your editing is disruptive and not based on Wikipedia guidelines. Nosferattus (talk) 20:36, 3 September 2021 (UTC)[reply]

1. This is not an in vivo study of brain glucose metabolism, but rather a study using metabolic markers in brain slices; this is the in vivo method for assessing brain glucose metabolism in vivo; 2) not studied, no reference for the statement, off-topic for the review; suggest Nosferattus observe WP:DEADHORSE; 3) "weak evidence" does not lead to an approved therapy - it is preliminary, unconvincing research not worth mentioning. Nosferattus seems to have difficulty understanding MEDRS: a) there is no WP:WEIGHT in the medical literature for using gingko for any disease, WP:MEDREV; b) there is no scientific consensus, clinical organization, or regulatory agency approving gingko as a prescription drug, WP:MEDSCI; c) there is no high-quality evidence that gingko has any health effect, WP:MEDASSESS, left pyramid. Please take the time to familiarize yourself with these guidelines on choosing sources for medical content in Wikipedia. The user challenging the existing content has the burden of providing a reliable source to support a change, WP:BURDEN. Zefr (talk) 21:13, 3 September 2021 (UTC)[reply]

Arguing that it isn't worth mentioning is purely your POV. When a medical review article says that there is evidence that a substance may be an effective treatment for dementia, that seems pretty notable. And there are certainly enough medical sources discussing Ginkgo and dementia to pass WP:WEIGHT. Also, your statement that "there is no regulatory agency approving gingko as a prescription drug" isn't accurate. Ginkgo extracts are prescribed in Europe under the regulation of the European Medicines Agency Committee on Herbal Medicinal Products, as discussed in the article. Finally, I never claimed that there was high-quality evidence that gingko has any health effect. That is a straw man. Nosferattus (talk) 21:33, 3 September 2021 (UTC)[reply]

It's worth pointing out that the source cited is from Cochrane Library: "Wikipedia and Cochrane collaborate to increase the incorporation of Cochrane research into Wikipedia articles and provide Wikipedia editors with resources for interpreting medical data." Pyrrho the Skeptic (talk) 20:14, 3 September 2021 (UTC)[reply]

One could also point out that the statement from the Cochrane source, "Ginkgo has been shown to affect vascular permeability and neuronal metabolism", has no context in the article, no reference, and is off-topic for the purpose of the review. Although a high standard, a Cochrane review does not necessarily answer the main question intended: use of Ginkgo biloba for tinnitus. Its purpose was to review the tinnitus literature for possible gingko effects, whether the research quality was acceptable or poor (the case across the board). The authors stated in several parts of the review that 1) "there was no evidence that Gingko biloba was effective in patients with a primary complaint of tinnitus", 2) "the methodology of most trials was questionable. The trials of cerebral insufficiency excluded from the review were generally of inadequate methodological quality." 3) "The quality of trials reported was generally poor", and 4) "the evidence that Ginkgo biloba has a predictable and clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unreliable." Zefr (talk) 20:40, 3 September 2021 (UTC)[reply]

@Zefr: Nothing in WP:MEDRS says that the review article has to be focused specifically or exclusively on the claim that it is cited for. It simply needs to be an up-to-date, independent, reliable secondary source. Nosferattus (talk) 20:50, 3 September 2021 (UTC)[reply]

If the sentence is included, it should not be the first in the section, which gives it undue importance and creates a false impression of the medical value of gingko. Peter coxhead (talk) 07:13, 4 September 2021 (UTC)[reply]

Agree, this is at most an incidental detail. Alexbrn (talk) 07:48, 4 September 2021 (UTC)[reply]

Full disclosure - Zefr left a message on my talk page asking that I take a look at this dispute. I'll start by observing that Nosferattus is unnecessarily personalising this content dispute, and ask that they stop doing that. I don't know if there's a background here I'm unaware of, but accusing Zefr of editing disruptively seems extraordinary and unsupportable from the discussion above. I also think it's a bit rich accusing Zefr of setting up a straw man, have previously accused them of pushing the fringe POV that plants cannot have medical effects or uses, which they have not one anywhere in the above discussion. Please rein that stuff in, and keep this discussion focussed on content.

On the question of the sourcing, I tend to agree that this Cochrane review is not MEDRS-compliant for the assertion that Ginkgo has been shown to affect vascular permeability and neuronal metabolism. The whole point of the MEDRS guidelines is that they are there to help us to identify the best possible sources to support biomedical assertions in our articles. If we follow those guidelines, we can safely conclude that this review would be an excellent source to use to support assertions that fall within the remit of the review - ie, "the effect of Ginkgo biloba in patients who are troubled by tinnitus". The assertion about vascular permeability and neuronal metabolism, however, doesn't fall within the remit of the review - it's not something they were investigating. They presumably feel that the assertion is true, or they wouldn't have written it, but since they themselves provide no evidence to support or, or cite any references about it, we can't really go through any of the steps at WP:MEDASSESS because we simply don't know where it is coming from. It's therefore not a good source to support that assertion - a good source would be actual research into this particular question, which we would be able to assess as described in the guidance, and which would also tell us a lot more about what the effects actually are (as a statement, it is very vague. Does it increase permeability, or decrease it? In what context?).

I would advise against including this statement in our article based on this source. Girth Summit _(blether) 12:00, 4 September 2021 (UTC)[reply]