Talk:Multiple chemical sensitivity

Pathomechanism, risk factors and diagnosis

As I have been suggested here and here, you have to discuss in the English Wikipedia whether you are allowed to expand an article or not. Hence the question whether the pathomechanism, some of the risk factors or the diagnosis may be mentioned in the article or not. Opinions? -- Brackenheim (talk) 22:41, 14 August 2021 (UTC)

Note: In Germany we have an ICD-10 classification for MCS as well as a large medical association that is constantly researching the disease. Both the disease and the orthomolecular therapy have also received multiple legal recognition. Therefore, one can say that the pathomechanism relates to the situation in Germany. Perhaps the mechanism is different in other countries - then I would be very interested in the sources ... -- Brackenheim (talk) 09:44, 15 August 2021 (UTC)

At this time, as only sources for Germany have been produced we can only say this is true in Germany.Slatersteven (talk) 12:51, 15 August 2021 (UTC)

What is the name of this "large medical association"? It wouldn't happen to be Deutsche Gesellschaft für Orthomolekular-Medizin (German Society for Orthomolecular Medicine), would it?

Regardless of this, the changes you have made are not acceptable without discussion. You should not have edit warred, but sought a consensus. Currently, the article presents the condition as if it's uncontroversial ("is a chronic acquired illness"), by contrast to the long-standing consensus version ("is an unrecognized and controversial diagnosis"). The article needs to be reverted back to the March 29 version (right before an IP radically changed things, without anyone noticing the change). Some good edits after that might deserve restoration, but the current presentation of a fringe subject as if it's a mainstream subject is not acceptable.

It appears that this article hasn't been monitored, so fringe advocates have run wild here. Bbb23, we need to get this done so we can then discuss the future development of the article, but currently the article is a literal danger to public health (some treatment options for MCS are dangerous). Any mainstream recognition of the condition since that time can then be used to update the article.

BTW, the ICD-11 has no listing for MCS. -- Valjean (talk) 15:44, 15 August 2021 (UTC)

It looks like the March 29th version is the long standing at this point. From what I can tell, as an outside observer that just saw the WP:AN3 posting, it looks like Brackenheim was restoring the status quo. Given that fact, BRD should of been followed by Slatersteven & ScienceFlyer who failed to start any discussion on the topic. PackMecEng (talk) 16:00, 15 August 2021 (UTC)

Errr, that was the version we reverted to. This is Brackenheim's first edit [[1]], it is an addition, not a restoration. Made after the 29th of March.Slatersteven (talk) 16:08, 15 August 2021 (UTC)

Exactly. Brackenheim added huge amounts of content without any discussion. So that's a BOLD series of edits. If they had met no resistance, that would have been okay, but they did meet resistance. Then they edit warred repeatedly and their version is now frozen by the protection. Disputed BOLD edits must be reverted and then discussed. -- Valjean (talk) 16:12, 15 August 2021 (UTC)

So as it is accepted the 29th of march version is the long-standing version, the article should be reset to that point.Slatersteven (talk) 16:30, 15 August 2021 (UTC)

The name of the medical association is "Deutscher Berufsverband Klinischer Umweltmediziner". As you can read in the article (Multiple_chemical_sensitivity#International_Statistical_Classification_of_Diseases), "the public health service in Germany permits healthcare providers to bill for MCS-related medical services under the ICD-10 code T78.4".

I’m sorry I included the section without discussion. I have always found Wikipedia to be a free encyclopedia in which everyone can share their knowledge with others. So it was alien to me so far to ask first and then expand an article. Although I was warned by a number of Wikipedians that the corresponding regulations in the English Wikipedia are totally different, I simply could not imagine this until now. -- Brackenheim (talk) 19:32, 15 August 2021 (UTC)

ICD-11 (WHO): 4A8Z (see: Transition from ICD-10-GM to ICD-11 -- Brackenheim (talk) 22:14, 15 August 2021 (UTC)

There is no problem in principle with including something without discussion. See WP:BRD. --Hob Gadling (talk) 06:37, 16 August 2021 (UTC)

Yes, BRD starts with WP:BOLD, but that stops applying when the edit meets objections (the "R" in BRD). Then the previously existing status quo version should be restored while ongoing "D"iscussion determines what to do. -- Valjean (talk) 15:51, 16 August 2021 (UTC)

I had tried to leave that part as an exercise to Brackenheim, but you are probably right to spell it out. --Hob Gadling (talk) 20:49, 17 August 2021 (UTC)

Apologies for the delay in commenting. I support reverting to the state of the article as it was on March 29. It is premature to discuss the pathogenesis of a condition that hasn't been found to exist. This was extensively discussed in 2019, when a consensus was reached. The presence of an ICD code does not mean that a condition is common or even that it exists. Medical professionals often joke about the absurdity of some ICD codes, and there are some ICD codes for pseudoscientific diagnoses such as "Liver qi stagnation pattern" and "Bladder meridian pattern". Additionally, WHO ICD10 codes (J68.9, T78.4 ) do not seem to mention MCS. ScienceFlyer (talk) 17:09, 17 August 2021 (UTC)

I am following up on this and again propose to revert to the article state as of March 29. ScienceFlyer (talk) 11:43, 26 August 2021 (UTC)

If there is no further objection, I will revert the article to the state as of March 29. ScienceFlyer (talk) 07:46, 30 August 2021 (UTC)

I am still in favor of at least leaving the explanations of the pathomechanism in the article. There are many diseases with unknown cause or with only little known facts (e.g. idiopathic Parkinson's syndrome). Such diseases do not have a simple mechanism as there is with a cold, so Wikipedia should rather reflect the current state of research. -- Brackenheim (talk) 11:48, 30 August 2021 (UTC)

My apologies for lacking mastery of Wikipedia notifications. If I had known this discussion was taking place last month, I would have objected to reverting the article to its March 29 state. It is my belief that that state, and the state of at least a decade preceding, contains a mix of facts (that's what Wikipedia should report) and opinions which both serve special interests and contradict my lived experience of the last 25 years with MCS. That is, the article of that date used classic propaganda techniques to convey a belief not based in fact. Fstevenchalmers (talk) 23:50, 17 September 2021 (UTC)

• Upon reading this article, it became apparent that several facts in the first paragraph are out of date and incorrect. The first is stating that it is unrecognized. While I agree that MCS is controversial, stating it is unrecognized is unequivocally incorrect. For example, it has been officially recognized by the Canadian Human Rights Commission and as such is legally recognized in Canada . . Precedent setting cases have tested this (see https://ecojustice.ca/a-victory-for-victims-of-environmental-sensitivities-or-multiple-chemical-sensitivities/). This alone proves that MCS is not unrecognized, as a G8 country of over 30 million people recognizes it at the Federal level. Other jurisdictions that recognize MCS include Germany, Luxembourg, Austria, Japan, Australia, new Mexico, and the USA department of education (see http://csn-deutschland.de/mcs_disability.pdf?fbclid=IwAR3XkGZ1AAfZqxXtrRoE1LYJ2ECsV6rBUlXvzSXFJA1QoD4rMmsUmMgBseA). Any one of Jurisdictions alone invalidates the statement that MCS is unrecognized. Silliestchris (talk) 21:33, September 17, 2021‎ (UTC)

Upon again reviewing this section, it is obvious that the first paragraph is completely erroneous in saying MCS is unrecognized, as it is recognized legally and medically in several jurisdictions, as pointed out by Brackenheim (Germany) and myself (Canada as well as Germany, Luxembourg, Austria, Japan, Australia, new Mexico, and the USA department of education). If you disagree with me, then please provide contradiction to its recognition at the Federal level in Canada by the Canadian Human Rights Commission. However, as long as a single governing entity in the world (such as the CHRC where I live) officially recognizes it, then it is not unrecognized.

Therefore, in order to repair this mistake, I suggest we replace recognized with one of the following 3 changes:

1) Remove the word unrecognized completely.

2) Replace unrecognized with "formerly unrecognized"

3) Replace unrecognized with "unrecognized by (list bodies that do not recognize MCS, with citations on their official stance) and recognized by (list bodies that recognize MCS, with citations on their official stance)

If there are no opinions within say, 1 week, I can just go ahead and fix this error, likely with option 1.

Silliestchris (talk) 23:26, 17 September 2021 (UTC)

Concur that the word "unrecognized" conveys an opinion, not fact. I believe this word is in the article to color the reader's perception based on an author's opinion and not based on fact. The fact is MCS is recognized by some and recognition is vehemently opposed by others. I think the simplest correction to opinion having crept into this article which is supposed to be fact based is Silliestchris's option 1 above. Fstevenchalmers (talk) 23:50, 17 September 2021 (UTC)

References

I agree with removing the word "unrecognized". In addition to the bodies mentioned earlier, there are also state agencies in the USA that recognize MCS. Janraison (talk) 04:29, 18 September 2021 (UTC)

→Janraison, you would be doing non-partisanism a great service if you listed here the state agencies in the USA that recognize MCS, and for bonus points you could provide links to where this is stated.

Silliestchris (talk) 04:48, 18 September 2021 (UTC)

I concur that the word unrecognized should be removed, as it conveys an opinion! Other editors have pointed out numerous institutions that recognize it. Sciencebuilder (talk) 01:44, 27 September 2021 (UTC)

I believe the word unrecognized should be removed from the first sentence.

I would also appreciate it if people would quit claiming that permission to get paid when someone shows up in your clinic means that it's a recognized disease entity.

Although I'm pretty sure that it won't do any good, let me once again say that to be a recognized disease entity, it has to be a single condition with a predictable pattern. Every single person who has the thing has to have the same thing. Every person who shows up with the predictable pattern has to have that thing. This is probably not true with MCS. The science isn't there yet. We're still at a point when five licensed physicians could look at the same patient, and one could say "must be MCS", one could say "it's obviously Chronic Lyme disease", a third could say "Looks like Chronic fatigue syndrome with anxiety to me", the fourth could say "You're all wrong, because it's Traumatic brain injury", and the fifth could say "Post-traumatic stress disorder, with traumatic coupling to strong scents".

"Recognized" does not mean that sick people get disability benefits. "Recognized" means that we know enough that mainstream medicine has enough information that they can expect doctors to recognize when the patient has it, and when the patient doesn't. WhatamIdoing (talk) 02:23, 30 October 2021 (UTC)

WhatamIdoing is correct here. The condition is unrecognized by the scientific community. Chamaemelum (talk) 22:07, 9 July 2023 (UTC)

Remove pdate template?

Is there reall major, actual, research such as meta-studies on this that warrant the update-template? Looking at the article as well as the Talk page it looks obvious that the crrent article ver ell represent the current state of research. Is it fair to remove the "update" template? Leord Redhammer (talk) 12:25, 4 March 2022 (UTC)

Possibly Relevant

I have no idea whether this is worth putting in the article, but it looks like there may be some relationship between this and mast cell disorders like Mast Cell Activation Syndrome. https://enveurope.springeropen.com/articles/10.1186/s12302-021-00570-3

Possibly also relevant, not that it's worth citing: https://www.hsph.harvard.edu/hoffman-program/resources/chemicals-in-your-life/what-is-mcstilt/ 173.66.202.193 (talk) 03:12, 30 July 2023 (UTC)

The list of differential diagnoses is long. That's one of the challenges with having (or trying to diagnose a patient who has) non-specific symptoms. WhatamIdoing (talk) 03:45, 30 July 2023 (UTC)

New in depth peer reviewed survey paper / not sure journal is credible enough

Just ran across a heavily sourced August 2023 review paper on MCS, from a peer reviewed journal, but pay-to-published on Elsevier. I thought the content was thorough and timely. The authors in their conclusions do, citing the role of TRPV1 and TRPA1 receptors, come down strongly on a physical origin.

This journal is not seen as credible under Wikipedia standards, correct? I'd love to give it a citation in the article, but only if appropriate

https://www.sciencedirect.com/science/article/pii/S0149763423001963 Fstevenchalmers (talk) 09:16, 26 February 2024 (UTC)

What gives the impression that Neuroscience and Biobehavioral Reviews isn't credible? Reconrabbit 16:08, 26 February 2024 (UTC)

Neuroscience & Biobehavioral Reviews is one of the top journals in their field.[2] Whatever one thinks of Elsevier's profitability, it is still considered reputable.

The main challenge with this paper will be determining what is WP:DUE. Is this more of a "one source thinks this" situation, or more of a "most researchers think this"? We can't look into a WP:CRYSTALBALL to figure out what will be accepted in the future.

This reminds me of a debate about Polycystic ovary syndrome about 20 years ago, in which one researcher proposed that women who didn't have a particular indicator (something about insulin resistance, I think) didn't really have PCOS, even if they had the traditional symptoms. This line of research could have a similar effect: if you think you have MCS, but you don't have this biological marker – well, you don't actually have MCS after all. This transition happens a lot in some fields (e.g., various subtypes of cancer get lumped and re-divided all the time), and sometimes it's quite easy to handle in an article (you add some variant on "In 2012, the Medical Authority changed the diagnostic criteria to require a minimum of four French hens and three calling birds"), but I'm not sure that it will be so easy in this case. WhatamIdoing (talk) 23:00, 26 February 2024 (UTC)

If someone wanted to do something useful to help people understand this paper, then an article on a cough challenge study might be useful (just a generic "what is it?" article, not mentioning MCS). Look at Bronchial challenge test for a basic model. Both capsaicin and citric acid have commonly been used in these studies, though I didn't see anything about citric acid in this particular paper. WhatamIdoing (talk) 23:17, 26 February 2024 (UTC)

I have added information from this paper as well as other sources. This is absolutely a top journal in its field and is a review article so it absolutely isn't a case of just one source thinks this. Morgan Leigh | Talk 05:07, 13 May 2024 (UTC)

@Morgan Leigh I reverted your edits due to adding WP:FRINGE material. The journal features opinions by various authors, including long-time MCS advocates John Molot and Margaret Sears. When content by advocates for fringe topics is published in a journal, it does not whitewash it into a reliable medical source. I would suggest considering the paywalled material in the same journal by Karen Binkley. Binkley has also co-authored a response to Molot et al which I haven't read yet because it is paywalled. ScienceFlyer (talk) 00:49, 14 May 2024 (UTC)

Sources from the last five years are best; if it's older than 10 years, we really should avoid citing it.

I don't think we can reject the The Journal of Allergy and Clinical Immunology – it's impact factor (~9) and Scopus ratings indicate that it's an influential journal – even though they did publish a letter to the editor from John Molot (though I don't see Sears anywhere in the search results for that journal, ever?), but we don't normally want to be citing the correspondence section, either.

If the Binkley paper looks useful, then perhaps someone at Wikipedia:WikiProject Resource Exchange/Resource Request could find it. WhatamIdoing (talk) 02:18, 14 May 2024 (UTC)

I have reverted your revert because reverting a lot of changes because you don't support one source used when many other sources were also included is not a reasonable approach. Rather one should deal with each source at a time.

I agree with WhatamIdoing that Journal of Allergy and Clinical Immunology is a reputable journal and I also agree a more recent source would be preferable. Also you seem to be saying that it is not ok to cite a review article from one author from this journal but it is ok to cite a letter to the editor from another author in the same journal. This does not seem to be a cogent approach.

I suggest that when what you call fringe material is published in reputable journals it just might not be as fringe as you are charachterising it to be. Morgan Leigh | Talk 04:30, 15 May 2024 (UTC)

@Zefr Simply reverting a page that has already been unreverted and about which discussion is ongoing without discussing it at all on the talk page is poor practice and I ask that you post here to seek consensus for your view. Unless you are suggesting every one of the several sources that were added are all fringe your reversion seems unwarranted. Reverting on the basis that the reference formatting is not great makes it super difficult to presume good intent on your part as such things are not a valid reason to revert. The normal thing to do would be to fix them. I totally agree that the refs in this page need a lot of work as there are all different styles used. Seeing you feel the refs are so bad that they were worth including as a reason for reversion I invite you to fix them.Morgan Leigh | Talk 05:34, 15 May 2024 (UTC)

Despite insufficient discussion here and no consensus existing, you re-established your prior version which reads like a synthesis of interpretations particularly from the Molot publication, which itself is highly speculative and based on early-stage studies. Your version does not impress as a mainstream view.

Regarding the style and reference formatting issues, I left a message on your talk page. Zefr (talk) 15:09, 15 May 2024 (UTC)

A synthesis of information from reliable academic journals is exactly what every single wikipedia page does. I can't see how this is a serious critique.

I did revert for the very good reason that the reasons given by the person who reverted the work I had done on the article were not consistent with wp policy. i.e. the journal they claimed was not reliable was agreed by two other editors to be reliable and as ScienceFlyer did not identify any other sources that they thought were fringe.

Your claim that I didn't work towards consensus is erroneous. e.g.;

I agreed with editor WhatamIdoing that The Journal of Allergy and Clinical Immunology that ScienceFlyer criticised was a reliable source and as ScienceFlyer did not identify any other sources that they thought were fringe I call that a consensus.

I also agreed with WhatamIdoing that Neuroscience & Biobehavioral Reviews is one of the top journals in its field so I call that a consensus. Your personal opinions about the Molot paper are completely irrelevant. It is published in a top journal so it can be cited.

I agreed with WhatamIdoing that the Sears reference was outdated and the idea of diseases being recognised by countries is a bit silly and so removed that material. I call that a consensus.

Your note on my talk page is just a complaint about referencing format, in itself not a reason for reversion as the references do actually work. It seems to me you could have more profitably spent the time you spent complaining on my talk page on fixing the referencing format if you were so concerned about it.

All in all it looks to me like I spent considerable time good faith editing this page, and admitting it still needs a lot of work, and you just drive by reverted it. So I am not seeing any valid reasons for your reversion here. Unless you can explain exactly what you think is fringe I don't think the reversion should stand. Morgan Leigh | Talk 23:53, 15 May 2024 (UTC)

I am not especially well versed in the way medical topics are written about and the sourcing requirements, but as someone watching this conversation I am willing to go through and correct the unformatted citations to use Citation templates, provided that work isn't reverted in this ongoing discussion. Reconrabbit 23:58, 15 May 2024 (UTC)

Thank you for your kind offer. Perhaps it might be wise to wait until Zefr replies and we work out what we will do about the reversion. While it is possible to revert and keep some content it is a bit fiddly and I would hate for your work to be lost. Morgan Leigh | Talk 00:41, 16 May 2024 (UTC)

Understood, I'll give it some time. Reconrabbit 01:05, 16 May 2024 (UTC)

For reference, this is the complete Molot review from the Wikipedia Library. It is a comprehensive analysis of MCS issues, but the potential mechanisms discussed are unestablished beyond preliminary research to address direct cause-and-effect relationships between chemical stimulants and in vivo receptor hypersensitivities that would explain MCS.

Morgan's prior version mentioned speculation about TRP receptor stimulation, capsaicin challenges, and brain imaging studies which provide only conjecture about how chemical stimulants affect people with this syndrome. The revision added was not an improvement over the prior and existing version.

The Molot review reveals the slow progress of good research on MCS: it is difficult to study precisely, with nothing notable in recent literature as acceptable sources for the article per WP:MEDASSESS. Zefr (talk) 17:00, 16 May 2024 (UTC)

That German myth will apparently never die

@Morgan Leigh:

I noticed that your preferred version included this: "MCS is recognized as an organic, chemical-caused illness by several countries, notably in the United States, Germany and Denmark, and Australia."

Leaving aside the whole question of what it means for a disease to be "recognized by a country", Sears is not only outdated but merely repeats a since debunked claim. Words like "Germany says it's an organic, chemical-caused illness" don't appear in the source.

The real story, which is explained a bit in the section that differentiates between "discrete disease entity" and "how the doctor gets paid", is this:

Years ago, someone wrote to the Austrian health bureaucracy to ask what they thought about MCS. The response, which was in German, that the Austrian health agency uses the same billing system as Germany, and that German healthcare providers bill for MCS-related services under ICD-10 code T78.4 (idiosyncratic reactions, which itself is part of T78, Adverse reactions, not otherwise specified).

A scanned copy of this letter was posted in internet forums with the false claim that Germany (i.e., the country that did not write this letter) officially recognizes MCS (i.e., what the letter did not say)! The letter didn't say that MCS is a discrete disease or that MCS; it said that if the doctor wants to get paid for treating it, then the doctor's office have to bill under something that's not MCS because they don't recognize MCS as a separate disease. Since 99% of the people seeing this couldn't read a word of German, they trusted it – and forwarded it, and repeated it, and believed it. But it's not true.

We've tried to explain this rather obliquely in Multiple chemical sensitivity#International Statistical Classification of Diseases but perhaps we're being too polite. If you think it would help to have something that sounds like "Despite long-standing myths circulating on the internet, Germany doesn't actually recognize MCS as an organic, chemical-caused illness", then we could probably source that.

For the other countries:

• Sears says it's recognized in the US because "Prevalence has been measured, based upon doctor diagnoses, and self-reporting". Not one word about "organic, chemical-caused illness", nor a single syllable about governmental recognition.
• Sears says it's recognized in Denmark because an anti-pollution organization congratulated themselves on reducing indoor air pollution.
• The Australian website carefully specifies that MCS is "attributted to...chemicals", which is the opposite of recognizing it as an organic, chemical-caused illness. The cited source is National Industrial Chemicals Notification and Assessment Scheme, which was replaced by the Australian Industrial Chemicals Introduction Scheme a few years ago. The new website says nothing about MCS.

Bottom line: None of these countries actually recognize MCS as an organic, chemical-caused illness. WhatamIdoing (talk) 02:49, 14 May 2024 (UTC)

I agree with you about that source being questionable, both due to it's age and what it was being used to cite. But seeing it was already there instead of removing it I changed the text to say what it seemed to me to be saying. You seem to have more details from other sources than I was able to get from that source so I have just gone ahead and deleted that passage as I agree that saying a disease is not/is recognised is dumb anyway.Morgan Leigh | Talk 04:03, 15 May 2024 (UTC)