Talk:Red yeast rice

Kidneys

In reference to: "ConsumerLab.com found large variation in the active compounds between red yeast rice supplements, and also found that some of them were contaminated with citrinin, a nephrotoxic mycotoxin.[2][3] Evidence about the side effects of red yeast rice is limited, but it may have similar side effects to the drug lovastatin, which include kidney problems and other side effects.[4] Regular medical monitoring is needed to detect such effects." The site linked to in [4] makes no reference to risk of kidney problems induced by lovastatin, nor does the lovastatin page, and indeed multiple clinical trials seem to show lovastatin producing moderate improvements in patients with kidney problems. So why does this say lovastatin causes kidney problems? Was it perhaps a mistake in wording and in reference to the citrinin contaminated batches which were toxic to the kidneys? —Preceding unsigned comment added by Auxin (talk • contribs) 05:01, 31 December 2009 (UTC)

I agree that citrinin is the culprit for kidney problems, and will clear that up as part of my major rewrite.David notMD (talk) 20:21, 9 January 2010 (UTC)

Possible confusion

(Originally posted by Jlo131 in the article's body) To Authors: maybe some confusions between Ang-chau (i.e. in singapore for dessert) and Angkak (i.e. fungkiuk). See http://www.lioncity.net/buddhism/blog/daimond/index.php?cmd=showentry&eid=7841 Hope to get more correct information. Also the color is a bit dark for Red Yeast Rice (as shown in the webpage) Flowerysong (talk) 21:49, 23 February 2008 (UTC)

Mevastatin vs. Lovastatin

Changed mevastatin to lovastatin. Several sources said that Red yeast rice contained mevastatin, but the authorative ones said it was lovastatin. (including the citations already in place.) David.Throop 20:53, 14 February 2006 (UTC)

- It's unbelievable to me that this natural herbal supplement that actually worked has now been forever ruined by the FDA's slavish allegience to the profit goals of the patent drug companies. Instead of worrying about such things as RYR, the FDA should be focused on insisting on better testing and monitoring of the patent drugs they approve. If they discovered a naturally occuring statin in oranges, would they also remove oranges from the market? Unbelievable. Thus, all currently sold RYR supplements are now required, BY LAW, to be entirely ineffective. Your tax dollars at work. Economy1 (talk) 12:53, 12 May 2008 (UTC)

Meanwhile, people die who cannot afford the prescription version of what would have otherwise been available to them through nature. DavidPesta (talk) 15:56, 3 February 2013 (UTC)

Wikipedia used to say

"In 2006 Liu et al published a meta-analysis of clinical trials (Chinese Med 2006;1:4-17). The article cited 93 published, controlled clinical trials (91 published in Chinese). Total cholesterol decreased by 35 mg/dl, LDL-cholesterol by 28 mg/dl, triglycerides by 35 mg/dl, and HDL-cholesterol increased by 6 mg/dl. Zhao et al reported on a four-year trial in people with diabetes (J Cardio Pharmacol 2007;49:81-84). There was a 40-50% reduction in cardio events and cardio deaths in the treated group. Ye et al reported on a four-year trial in elderly Chinese patients with heart disease (J Am Geriatr Soc 2007;55:1015-22). Deaths were down 32%. There is at least one report in the literature of a statin-like myopathy caused by red yeast rice (Mueller PS. Ann Intern Med 2006;145:474-5). An article in the June 15, 2008, issue of the American Journal of Cardiology found that red yeast rice may provide benefits beyond those provided by statins. The researchers reported that the benefits seemed to exceed those reported with lovastatin alone.[1]"

The fact of the matter is that there are numerous studies showing that Red yeast rice is safer and more effective than pharmaceutical drugs and there is practically nothing showing any harm from it (other than the possibility of a contaminated batch, such a possibility exists with any food or anything you buy though).

Jan 2010 and I am in the process of rewriting this section and adding citations. In addition to new trial reports from China there are clinical trials in the lit by DJ Becker, Univ Penn.David notMD (talk) 02:59, 9 January 2010 (UTC)

Liu 2006 replaced with a more recent meta-analysis. The results from the large and long duration trial conducted in China are presented and referenced. RYR safety also presented in more detail and adequately referenced. On the latter, there is clear evidence that RYR can have same adverse effects as lovastatin. Lastly, patents have expired on some of the statin drugs (including lovastatin), so generics are available and costs are low, even if not covered by medical insurance.David notMD (talk) 13:00, 15 June 2017 (UTC)

Merge

Proposal: Merge Red yeast rice into Monascus purpureus. Badagnani 22:53, 27 April 2006 (UTC)

Make M. purpureus a species page and move the rest of the info into RYR. Sjschen 22:56, 27 April 2006 (UTC)

I'm with Sjschen. MP and RYR are as different (and as similar) as oats and oatmeal. – David.Throop 03:26, 28 April 2006 (UTC)

Character

Why does the middle character of the traditional name mean "yeast," but the middle character of the simplified name is an entirely different character (with the same pronunciation) meaning "crooked" or "sheet music"? Badagnani 19:04, 29 April 2006 (UTC)

This has much to do with the way chinese characters were simplified. The most commonly used words have a one-to-one trad->simp mapping. Less commonly used words (such as 麴) are either left the way it is or is are all mapped to one simple character. Thus a character like 曲 is used to write 麴 and thus in turn gains the additional definition of "yeast". As you can see herein lies one of the problems with SCCs.

On another note, the better translation of 麴 is more " fermenting stuff that grows on grain" rather than just "yeast", which in turn is usually called 酵母 (lit. mother of ferment). Interestingly 曲/麴 is also called 酒母 (lit. mother of wine/liquor) in chinese. Sjschen 01:26, 30 April 2006 (UTC)

Wow, heavy. This important stuff should be added to the Wiktionary articles for these characters. Not sure if you work there. Badagnani 03:21, 30 April 2006 (UTC)

Nope, feel free to C&P. Sjschen 03:45, 30 April 2006 (UTC)

XueZhiKang

Please consider adding something similar to the following either in the opening paragraph or in the "Chinese medicine" section:

In China it is widely available as XueZhiKang 血脂康, and in Singapore it is available as Hypocol™.

--Ming

Both Xuezhikang and Hypercol now mentioned in the section on medical uses but not in the intro.David notMD (talk) 20:29, 13 January 2010 (UTC)

Characters

I can't see a ton of characters in the first paragraph because they are in a different language. I just see squares. I think we should get rid of those because the vast majority of people will not have a chinese language pack on their computers. [[TheAngriestPharmacist]] 07:57, 25 April 2007 (UTC)

Red Rice Yeast vs. Red Yeast Rice

It is my understanding (and I am no expert) that it is the yeast that holds the lovastatin properties. Although a google search yields more hits for RYR, isn't RRY a more accurate name for the product? I feel if there is some need clarification, WP would be the place. It seems that when the product is produced and grown, the yeast and rice become inseparable. Is it true that the product used as a HMG-CoA reductase inhibitor is a blended mix of the rice and yeast? Or is there a way to deliver the yeast on its own. Thanks! --travisthurston+ 18:43, 9 July 2008 (UTC)

The product that is traditionally sold is rice that contains red yeast: "Red yeast rice" I suppose the yeast itself could reasonably be called "red rice yeast" but it's a less popular term: Google stats give "rry" ~ 51,900; "ryr" ~ 729,000. I also am not an expert on this product, and I don't know whether the distinction I made is commonly done. --Slashme (talk) 05:08, 10 July 2008 (UTC)

Red yeast rice and statin drugs

This section in the article attempts to capture the complex link between red yeast rice as a dietary supplement and 'statin' drugs such as lovastatin and simvstatin. The marketing of RYR infers that it contains cholesterol lowering activity, which was true for Cholestin when it was introduced to the U.S. market around 1997. In the U.S., the Food and Drug Administration semi-successfully stops sales of RYR products that contain monacolin K, as it is identical to the drug, lovastatin. RYR products that do not claim to contain monacolins and do not explicitly claim to lower cholesterol do not trespass on the FDA's turf.David notMD (talk) 17:44, 26 March 2010 (UTC)

It's sad that the bought govt and the FDA has turned into a turf war between corporate profits and my freedoms. If the government manages my health as well as they manage everything else I'm in huge trouble. I want to manage my own health and I want the government to get out of my way. and if you want to give me this nonsense about 'doctors know best, so I need a prescription for everything and I need to pay for their potential approval' or 'government knows best', it's funny how the government lets people smoke cigarettes and drink alcohol (though the tobacco companies have a monopoly on that) but they don't let people choose their own medicine. The health freedom argument only applies when it facilitates corporate profits and, more specifically, the profits of government established monopolists. I don't care if you think you know better than me what's best for me, if I want to take unadulterated RYR for my health problems it is none of your business. and if I want to wear a magnetic bracelet around my wrist because I think it will somehow magically prevent cancer who are you to force me not to wear it against my will. Mind your own business, no one is telling you what to do with your life. The FDA should be limited to ensuring that labels are complete and accurate (ie: that all ingredients are labeled and that nothing is labeled that isn't present) and perhaps to ensuring that certain possible contraindications are listed (though the seller of a product could optionally note that this is the FDA's opinion and not the opinion of the seller, the FDA shouldn't be allowed to put words in your mouth against your will).

The key point is that it is illegal in the U.S. to sell a prescription drug as an over-the-counter dietary supplement. Hence, no selling RYR that works. Ditto stuff that clams to be an herbal treatment for erectile dysfunction but is really just Viagra. It is immoral but not illegal to sell RYR that does not work, but if a label or website claim is made that it lowers cholesterol, then the Federal Trade Commission may step in.David notMD (talk) 22:02, 5 November 2013 (UTC)

As of 2017, many supplement companies offer red yeast rice products. Majority make no mention of monacolin content nor cholesterol lowering (or any other health benefit). A guess here is that the yeast strains used and methods of fermentation do not yield monacolins.David notMD (talk) 13:09, 15 June 2017 (UTC)

It appears that the ruling was overturned in 1999 but I don't know if there were later developments. The fact that the supplement is so widely available makes me think that that might have been the end of it... -- Phyzome (talk) 17:07, 11 November 2023 (UTC)

Good Article candidate?

With updating and adding refs, question is whether this article is a plausible candidate for Good Article. Any opinions? David notMD (talk) 22:17, 19 December 2018 (UTC)

Cleaned up dead refs and have nominated. Vis-a-vis my User page COI: As of 12/31/18 I am no longer an industry consultant = retired. David notMD (talk) 01:34, 12 January 2019 (UTC).

Clarification on culinary use

It is unclear from the article, and from Google searching (because of all the results for supplements rather than food uses) whether Red Yeast Rice is ever eaten as rice. I.e. is it only used as a spice/colouring or is it sometimes eaten as cooked rice? The section on preparation suggests not, but it is unclear if this is simply an omission or if it would never be eaten as a rice dish in China/Asia. When I say eaten as a rice dish I basically mean: does anyone cook red yeast rice and then eat that as you would normal rice? Someone with knowledge of east Asian cuisine (or better Google-fu than me) should clarify this. — Preceding unsigned comment added by 120.17.209.130 (talk) 02:43, 5 February 2019 (UTC)

Takes time and trouble to ferment the rice with red yeast, so typical uses are dried, ground to powder, and used as a coloring or flavoring agent. Try search on "cooking with red yeast rice" for food and drink uses (example, turns rice wine pink). David notMD (talk) 04:16, 5 February 2019 (UTC)

GA Review

This review is transcluded from Talk:Red yeast rice/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: RecycledPixels (talk · contribs) 22:51, 13 June 2019 (UTC)

I will be taking a look at this article. RecycledPixels (talk) 22:51, 13 June 2019 (UTC)

This review is based upon this version of the article as it appeared on 13 June 2019

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.	There are definitely portions of the article where it flows better than others. The prose quality in certain sections needs improvement. Try reading the first paragraph of "clinical evidence" out loud, for example. It feels like certain words were dropped from each sentence that make me have to re-read it to figure out what it is saying, or whether it was cut-and-pasted from a different source, or translated from a different source. I am unable to tell that, however, since much of that paragraph is uncited. The third and fourth sentence of that paragraph appear to be sourced from Gerards, et al, and they appear closely paraphrased from that paper. Unreferenced sentence removed from first paragraph, as was original research; rest is referenced to Gerards and Peng. There is some questionable capitalization in the article, i.e. "Warning Letter", and some questionable use of [...], like "the quantity of monacolin K varied from none to prescription strength [...]"[17] as though some additional text from that quote had previously been included, but later removed. FDA capitalizes Warning Letter. The ellipses removed. Here's another example of awkward prose and punctuation, from the second paragraph of the clinical evidence section: "Within the first review,[20] the largest and longest duration trial was conducted in China: the China Coronary Secondary Prevention Study (CCSPS)." Colons shouldn't be used like that, and there were a couple of more places where I noticed that. Second and third paragraphs of Clinical evidence merged and the colon and name of the China study deleted. Generally, try to break up and re-word some of the really long sentences that appear, especially late in the article, to make them easier to read and understand. Safety section split into two paragraphs. Run-on sentences split. Removed description of evidence from an individual clinical trial (primary research). The production section reads like a how-to guide rather than an encyclopedia article. Shortened, so less how-to detail.
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.	Lead section of the article contains uncited information that is not mentioned elsewhere in the article, or is contradicted in parts of the article. For example, the fist paragraph of the second paragraph mentions that the food preparation tradition goes back to 300 BC, but no mention of that date is given in the "culinary" subsection of the "uses" section. Culinary text now incorporates and references early documentation from Japan and China, resolving the date conflict. The lead section also does not effectively summarize the article. It doesn't even mention the medical benefits ascribed to the product, yet 1,250 of the article's 1,550 non-lead-section words are about the medical uses. Medicinal use paragraph added to Lead. A 1-sentence paragraph appears at the end of the article and looks out of place. One sentence paragraph merged to preceding paragraph (other option is to delete).
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.	In the traditional Chinese medicine section, there is a date of 800 AD for medicinal use. There is no citation given for that fact. The 800 AD mention deleted. The next sentence in this article refers to the Erdoğrul (misspelled in this article as Erdogrull) and Azirak paper from the Turkish Electronic Journal of Biotechnology paper, so I looked at that. It gives a date of the first century A.D. in the "Historical and traditional use of Monascus purpureus" section (p.37). That paper (p. 38) contains the sentence "Interestingly, red yeast rice is also mentioned in an ancient Chinese pharmacopoeia of medicinal foods and herbs, the Ben Cao Gang Mu of Li Shi-zhen, where it is described as a medication useful for improving digestion and revitalizing the blood (Heber et al. 1999)" but it is used as a citation in this article for the sentence "It is taken internally to invigorate the body, aid in digestion, and revitalize the blood." Although that paper lists a number of wildly optimistic health benefits of red yeast rice that I won't try to list here, "invogorate the body" isn't one of them. "Invigorate the body" deleted. Generally, after the reference spot-checking I performed, and I stopped after a few, I'm not convinced that all of the claims in the article are adequately referenced. Refs added or text removed.
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).	Reference #1 (Shurtleff) is a 660-page book. If you are using it as a reference, you'll need to include a page number where you found that fact. Reference #2 (Starling) is a company press release. Reference 5 (Hu) needs a page number. Working on Shurtleff. Starling is an article in NUTRA Ingredients, a reputable trade magazine. The text it references is about non-Chinese companies entering the RYR market. The ref supports that. For Hu, have sent a query to the author through ResearchGate to get the page numbers. No rely at ResearchGate; unlikely to get page number by any other means. Take your time. If you don't get a response about the Hu reference, is there another reference that can act as an equivalent substitute? Replaced Hu with Song 2019.
	2c. it contains no original research.	There are uncited sections but nothing that jumps out as original research.
	2d. it contains no copyright violations or plagiarism.	Most significant instances plagiarism are actually other sites copying the Wikipedia article, as far as I have found.
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.	Although multiple uses of red yeast rice are mentioned in the article, it is heavily weighted toward the medical supplement side, with only passing mention of other uses. Culinary and TCM sections being revised. There will not be much added. RYR as food color has been to large degree replaced by synthetic color chemicals. One ref removed because it described TCM documents, but the text of the ref had no specific mention of RYR.
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).	The article is unbalanced, but I don't mind the in-depth coverage of the medical uses of the product as long as the other uses are covered to as full an extent.
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.	A lot of the medical uses of the product is covered, but it doesn't cross the line too far into the "OMG you need to try this!" arena.
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.	Article is stable and there are no apparent content disputes.
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.	One image, tagged with CC BY-SA, located on Wikimedia Commons.
	6b. media are relevant to the topic, and have suitable captions.	Image is appropriate and effectively illustrates the subject matter of the article. Caption on the photo is poor. Caption revised The revised caption is a major improvement.
	7. Overall assessment.	The article does not meet all of the GA criteria at this point, as noted above.

Other notes: in the "safety" section, the article has "Ingredient suppliers have also been suspected of "spiking" red yeast rice preparations with purified lovastatin. As evidence, one published analysis reported several commercial products as being almost entirely monacolin K - which would occur if the drug lovastatin was added - rather than the expected composition of many monacolin compounds.". Why would they do that? Would be it cheaper to include synthesized pharmaceuticals rather than natural red yeast rice? I was left confused by that, but there's no approprate GA criteria category to put that question under. Yes, cheaper to add synthetic monacolin K to a red yeast rice product made with a yeast M purpureus strain that has no natural monacolins content (proper use as a food coloring agent) than to use the bioactive strain. "Spiking" of dietary supplements with drugs is a common problem with supplement ingredients sourced from China. Following up on this (doesn't affect the GA status, and you don't even need to answer). Why? Is the M purpureus strain that produces natural monacolins harder to obtain, harder to propagate, more time consuming to actually produce the monacolins than it is to produce the coloration that simulates the real deal? Might be a good point to include in the article, if you know (I don't know is a perfectly acceptable answer). RecycledPixels (talk) 07:04, 21 June 2019 (UTC)

I will leave this open for now in case you want to dive into improving the article starting with what I've listed, but if you don't have the time, I can close it and you can re-nominate it later. I'm aware of how long the GA backlog is, however, so I don't mind putting it on hold. RecycledPixels (talk) 00:34, 14 June 2019 (UTC)

Please do not close it. This GA nomination has been waiting for a reviewer for a very long time. I will tackle all the review comments as fast as I can. David notMD (talk) 02:13, 14 June 2019 (UTC)

It can stay open as long as you need, please leave me a note when you want me to do a re-reading. The examples I listed in the areas to be improved were intended to be illustrative, not exhaustive, so if you tell me you are ready for me to re-read the article, I hope you will not assume that once you clear up the items I have specifically identified, that I would think the article is ready. I am watching this page as well as the article page and I can see the improvements you are making to the article, but am not adding or revising any of my comments until you tell me you are ready for me to come back and take another look. I'm willing to work on this article in my role as long as you are in your role- it's a good subject matter that I find interesting. RecycledPixels (talk) 06:55, 21 June 2019 (UTC)

Second review

This second review is based upon this version of the article as it appears on 15 August 2019. RecycledPixels (talk) 21:36, 15 August 2019 (UTC)

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.	The article has improved a lot during your recent rewriting efforts. There were a few sections that I thought needed cleanup and clarification, but after going through everything, I decided that the changes were minor and nit-picky enough that it would be ok if I just made some changes myself without making myself ineligible as a reviewer. The GA criteria for prose merely calls for clear and concise, with correct spelling and grammar. The article meets that standard, but can still be improved in places in order to meet the "engaging and professional standard" prose called for under featured article standards.
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.	The third paragraph of the lead paragraph reads a bit choppy, but is is understandable. Rewriting the passive voice into active voice may improve readability. Cleaned up one WP:ENGVAR inconsistency. No longer any issues with items being mentioned in the lead but not the body of the article. If I was going to nitpick a bit more, I'd suggest revising the first couple of sentences of the lead so that the very most important aspects of the article are included, so those facts can show up in the quick summary that a reader receives when they hover over a wikilink.
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.	Referencing is improved and facts can easily be traced to their sources.
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).	I still have a bit of concern about the page numbers in Shurtleff, but the facts that it is supporting are so unlikely to be challenged that I'm not going to hold this up over that.
	2c. it contains no original research.	As before, nothing jumps out as original research and the article is still well-referenced.
	2d. it contains no copyright violations or plagiarism.	Still does not have copyright violations or plagiarism.
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.	Broad in scope.
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).	Article stays focused.
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.	Revisions still have not crossed into the realm of advocating the benefits of the product, and contain a balance between the claimed benefits and the claimed risks by each party.
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.	It has not changed while you were patiently waiting for me to come back.
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.	One image, tagged with CC BY-SA, located on Wikimedia Commons.
	6b. media are relevant to the topic, and have suitable captions.	Caption is improved
	7. Overall assessment.	Looks good. Thank you for your patience and all of your hard work.

Note: I have ended up needing to deal with several real-life issues that I had not anticipated when starting this review, and that looks like it will continue for at least the next several weeks and it has meant that the amount of time I have available to contribute here is severely limited. I have requested a second opinion in case someone else is free and can take over for me, but my current situation means it is unlikely I can give this article the attention it deserves at the moment. If nobody else has been able to pick it up in the time between now and when I come back, I will of course resume the review. I apologize for the unanticipated delay. RecycledPixels (talk) 19:16, 24 July 2019 (UTC)

I am back from the real world and am ready to undertake this review. RecycledPixels (talk) 21:36, 15 August 2019 (UTC)

The following is an archived discussion of the DYK nomination of the article below. Please do not modify this page. Subsequent comments should be made on the appropriate discussion page (such as this nomination's talk page, the article's talk page or Wikipedia talk:Did you know), unless there is consensus to re-open the discussion at this page. No further edits should be made to this page.

The result was: promoted by Cwmhiraeth (talk) 05:46, 6 September 2019 (UTC)

(

• Comment or view
• Article history

)

Rice fermented with Monascus purpureus turns red.

• ... that rice fermented with the mold species Monascus purpureus turns dark red – hence red yeast rice (pictured) – and is used in both traditional Chinese medicine and as a modern-day dietary supplement? Source: Refs 3 (Erdogrul) and 4 (Song) support the use as TCM, and refs 21 (Gerards) and 22 (Peng) support dietary supplement
  • ALT1:... that red yeast rice (pictured) is used in both traditional Chinese medicine and as a modern-day dietary supplement?
  • ALT2:... that red yeast rice (pictured) is used as a food coloring agent, in traditional Chinese medicine, and as a modern-day dietary supplement?

• Reviewed: Per lists on my Talk page, to date I have reviewed seven DYKs and this is my seventh nomination, so ahead of the requirement. Last one reviewed was Oriental Basin pocket gopher

Improved to Good Article status by David notMD (talk). Self-nominated at 12:25, 17 August 2019 (UTC).

• Review: The article got the GA tag on 15th August, and was nominated on 17th August, within the stipulated time period. The article as per its GA status and a look over is well referenced and edited. The QPQ requirement is met. The image is clear and is licensed aptly.
• However I would just like to suggest phrasing a hook that is simpler to read. Also the caption and the hook convey the same information so a certain amount of duplicity is happening. Maybe a shorter more concise hook? This is just a suggestion to have an ALT hook and by no means a striking off of the first hook. DiplomatTesterMan (talk) 02:33, 23 August 2019 (UTC)
• ALT1 and ALT2 now provided (above). The initial hook was written before the decision to add the picture. David notMD (talk) 19:16, 23 August 2019 (UTC)

• Overall: Done from my side DiplomatTesterMan (talk) 08:01, 26 August 2019 (UTC)