Talk:Multiple chemical sensitivity/Archive 5

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New Quebec report

The McGill Office for Science and Society has an English review of an exhaustive French-language review on MCS. The McGill OSS's take away is: "An 840-page report by Quebec’s public health agency summarizes the state of our knowledge on MCS and comes to the conclusion that trace amounts of chemicals are not to blame and that MCS is a type of anxiety disorder in which anticipation of a danger causes very real and debilitating physical symptoms" ScienceFlyer (talk) 02:59, 27 September 2021 (UTC)

I do not read French so cannot study the review itself. A concern has been raised that the review, or its introduction, I am not clear, raises the point that people with {some word translated as MCS} consume an excess number of doctor's office visits in Canada's national health system. One can infer that a motivation for this report is reducing those visits. If so, that clouds the objectivity of the review. I await facts. Fstevenchalmers (talk) 08:55, 27 September 2021 (UTC)

That sounds like another advocates' conspiracy theory, which would need to be well-sourced in a reliable publication to have any bearing. As the report of a governmental health body, this is a gold standard MEDRS and Wikipedia needs to reflect it. Alexbrn (talk) 08:58, 27 September 2021 (UTC)

Yeah, I realized later my comment would sound that way. Sorry. The only person I know in Canada who has a copy of the full paper, is an academic, and is studying it has told me he is very confused. It is unthinkable in academia for someone to rewrite the summary section of a large survey project like this to support a specific political agenda. It is not uncommon in government at all, because policy people read only the summary and not the full text. I genuinely hope the press releases which feature the paper but focus on policy outcomes are not an indication of such policy hijacking of academic work in this case. Whether the paper supports, or does not support, my "interested party" interests is far less important than that its academic integrity is intact. Fstevenchalmers (talk) 09:58, 27 September 2021 (UTC)

If your Canadian mate is confused, tell him to look at the conclusion, it's quite clear. -Roxy the sceptical dog. wooF 10:54, 27 September 2021 (UTC)

The English language press release (linked above) is quite clear: the ministry in Canada with the single payer Canada health program had a cost problem with people with MCS consuming too many doctor visits, so they commissioned a report to find out why. They then put out a press release saying (surprise) the report found that MCS is always anxiety, which was the political goal of the ministry commissioning the report. The press release incorrectly says MCS was first reported in 1956, probably referencing a Theron Randolph paper, when in fact what we now call MCS has been reported at least since the 1880s (the start of using natural gas lighting in cities).

Just for reference, conspiracy theories are how the weak minded explain things they do not understand, or worse, how the unethical manipulate the weak minded. When my father moved to Washington DC as his company's Director Government Relations many presidential administrations ago, one of the things his mentors taught him was "when you see something happen in Washington DC, figure out who benefits. That's who's behind it, no matter how much it appears otherwise." That's always stuck with me. Nothing is a conspiracy. No one has time for conspiracies. It's all just business.

I hope the paper's integrity is intact, whether or not it supports my (clearly disclosed) interest in this topic.

Fstevenchalmers (talk) 11:49, 27 September 2021 (UTC)

So when you say "They then put out a press release saying (surprise) the report found that MCS is always anxiety, which was the political goal of the ministry commissioning the report" what in effect you're saying is that the science is being covered-up or distorted for some reason. This is a conspiracy theory. I strongly suggest leaving such lines of argument alone, as they do nothing to help this Project and are instead disruptive. Alexbrn (talk) 11:54, 27 September 2021 (UTC)

Oh, for heaven's sakes. If this paper came from SRI or MITRE as contract research for a client, would you give it equal weight? US law required the contract research work done universities such as Stanford and MIT be spun off as separate companies generations ago (SRI was Stanford's and MITRE was MIT's). Both could be quality academic research, but in the absence of journal editors and peer review we simply don't know. Characterizing my basic concern about the objectivity of contract research paid for by an interested party as "conspiracy theory" is an emotional appeal, not reason. Fstevenchalmers (talk) 01:06, 28 September 2021 (UTC)

In Wikipedia terms, this is an excellent source, and editors are prohibited from rejecting sources because of personal objection to funding sources. The internal and external peer reviewers are listed on page 2. See WP:MEDRS for guidance on selecting medical sources. INSPQ is only an "interested party" in the sense that they have an interest in promoting public health. If you are implying they have some kind of malign conflict of interest then again, that is conspiracist. Alexbrn (talk) 04:56, 28 September 2021 (UTC)

I found the 4 page INSPQ Key Messages and Summary document more relevant here than the journalist press release cited above. Fstevenchalmers (talk) 00:40, 28 September 2021 (UTC)

As this page is in English, and the report is only available in French, I do not believe this report would be valuable. Perhaps put it forward on frenchepedia? A brief 4 page summary with no references is not good enough for transparency. Additionally, I see previous attempts to incorporate Canadian contributions to this page have been resisted, including my own suggestion of molot et al., 2021. Sciencebuilder (talk) 14:37, 27 September 2021 (UTC)

Additionally, the McGill article in question claims that the Quebec document reviews 4000 documents, when in reality there are ~1500 documents in its references. With this 2500 reference discrepancy, I would stay away from that source. Sciencebuilder (talk) 14:48, 27 September 2021 (UTC)

A source does not have to be in English to be reliable (obviously). I suggest focussing more on the 58 page Synthèse[1]. We will need to use the WP:BESTSOURCES like this to update the article. Silly guesswork about a "discrepancy" can be safely discounted. Alexbrn (talk) 14:51, 27 September 2021 (UTC)

A quote from the results of the 4 page summary: "Studies have found the following changes in all the syndromes and pathologies studied: a disruption of the hypothalamic-pituitary-adrenal axis, an increase in inflammatory cytokines, a disruption in oxidative homeostasis, a chronic decrease in neuromodulator levels (serotonin, dopamine, norepinephrine). In addition, using brain imaging, alterations in brain function and structure were observed that affect the limbic system circuits (emotions, memory, learning) and the prefrontal cortex (attention, reasoning, strategic thinking, judgment)." Sciencebuilder (talk) 14:56, 27 September 2021 (UTC)

Yes, further confirming the point this is a "real" condition with real symptoms and real consequences. Such knowledge is great for our purposes. Alexbrn (talk) 14:59, 27 September 2021 (UTC)

Alexbrn (talk · contribs), I looked at the 58 page summary, it is also in French. We need to get French speakers in here to review the document before it can be fairly evaluated for a neutral point of view.

Also, I am wondering what this means for the wikipedia article's claim that MCS is unrecognized?

And finally, aren't you a little bit concerned that the conclusion states "a disruption in oxidative homeostasis" and then goes on to say "there is no evidence to support the hypothesis of a relationship between MCS and the toxicity of chemicals at their usual concentrations in the environment". These two statements are contradictory. Sciencebuilder (talk) 15:07, 27 September 2021 (UTC)

My French is adequate and there are plenty of other Wikipedians who can help expand the article with this source. I'm still only a little way into it but what I'm seeing so far is that it says all these physical phenomena observed in people with MCS overlap with the physical phenomena observed for other similar conditions like depression or PTSD, and are consistent with the overall classification of MCS as a kind of anxiety. Alexbrn (talk) 15:13, 27 September 2021 (UTC)

Alexbrn (talk · contribs) I would be particularly interested to know where the observed symptom of "disruption in oxidative homeostasis" overlaps with symptoms anxiety in this report. Additionally, I do not believe overlapping of symptoms is adequate to say they are the same symptom. For example, brain cancer and head trauma have many overlapping symptoms yet they are distinctly separate. More research in the cause of MCS is required before one can say so simply it is caused by anxiety.

Reading the results and conclusion of the summary critically shows many leaps of logic or faulty logic that make me question the neutrality of the summary's author. More on this later. Sciencebuilder (talk) 16:17, 27 September 2021 (UTC)

Sounds like you have your own ideas and beliefs but they're not relevant to our purpose, which is merely to digest and summarize good sources. See WP:NOR. Also, please be sure to WP:INDENT your Talk page posts. Alexbrn (talk) 16:21, 27 September 2021 (UTC)

Alexbrn (talk · contribs) Yes, our goal is to summarize good sources. I am trying to undertstand if this is a good source. I would be very interested to know what you learn about the overlap of "disruption in oxidative homeostasis" and symptoms of anxiety, as the main conclusion of this report is that mcs and anxiety have overlapping symptoms. Sciencebuilder (talk) 16:44, 27 September 2021 (UTC)

Alexbrn (talk · contribs) I see you added the Canadian Quebec article with a neutrally toned sentence. Although I do not recall getting consensus on this in the talk page, I would be ok with it if the 2021 molot et al. article I introduced yesterday were added as an additional citation on this same sentence, as this is the same type of work and from the same country. Sciencebuilder (talk) 19:46, 27 September 2021 (UTC)

The Quebec report is particularly valuable because it offers a comprehensive detailed overview of the entire topic space, including a historical overview. pmid:34529912 is a niche review with a particular, specific focus (i.e. "how host defense mechanisms against adverse airborne exposures relate to the probable interacting and overlapping pathophysiological features of neurodegeneration and multiple chemical sensitivity"), so is irrelevant in the context of describing hypotheses in history. If you think pmid:34529912 is useful for some other purpose, that is another matter. Alexbrn (talk) 01:51, 28 September 2021 (UTC)

Alexbrn (talk · contribs) I do think pmid:34529912 is useful for another purpose, specifically in possible causes. As you are clearly an experienced editor (48000 edits) , perhaps you can aid me in this regard? The authors, after review of 351 articles, do have a very brief and focused conclusion which is only 2 paragraphs. What are your thoughts? Sciencebuilder (talk) 20:36, 28 September 2021 (UTC)

@Sciencebuilder: As I stated above, pmid:34529912 can't be used. Authors Molot, Marshall, and Bray are associated with the a dubious "Environmental Health Clinic" and are WP:FRINGE. Marshall is associated with the fringe group American_Academy_of_Environmental_Medicine. ScienceFlyer (talk) 21:29, 28 September 2021 (UTC)

pmid:34529912 is a review article in a reputable journal, so there would need to be some published evidence showing its dubious nature before Wikipedia could reject it. On first reading, however, I think the issue is more that it has a very narrow focus and even within that, its conclusion is a kind of shrug (it "feels" like it has been toned down during peer review). So far as I can see, all the article is really saying is that it's possible a specific combination of receptors may be sensitized by pollution and this could lead to MCS, and maybe this should be researched in future. Such a tentative conclusion is not WP:FRINGE, but it's also a big nothingburger. Alexbrn (talk) 05:36, 29 September 2021 (UTC)

ScienceFlyer (talk · contribs), I agree with above, that the article has been peer reviewed in a high impact journal, I urge you to provide evidence when making such serious accusations about credibility of scholarly work. Sciencebuilder (talk) 17:34, 29 September 2021 (UTC)

Ontario task force report

Next door to Quebec is Ontario, similar in size and population. It looks like Ontario government commissioned a report on mcs, as well, available here:

https://www.health.gov.on.ca/en/common/ministry/publications/reports/environmental_health_2018/default.aspx

I thought we could all take a look at this and see how it can be incorporated into the wiki page. Sciencebuilder (talk) 21:54, 29 September 2021 (UTC)

It's a different type of document to the Quebec one, being focused more on policy rather than the underlying biomedicine. But useful if it's felt some coverage of Ontario policy is due. Do we know if these Task Force recommendations were accepted? Alexbrn (talk) 00:19, 30 September 2021 (UTC)

I took a look at MEDRS, and I'm not sure if it applies to task force reports: "Biomedical information requires MEDRS sourcing that complies with this guideline, whereas general information in the same article may not." is the Ontario report biomedical information? IDK Sciencebuilder (talk) 01:48, 30 September 2021 (UTC)

State of this article

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Based on the edits there seems to be a number of users that have a vested interest in keeping MCS as marginalized as possible. What is the motivation here? Citation for use in litigation? — Preceding unsigned comment added by 222.155.235.238 (talk) 04:10, 9 October 2021 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

AltMed or not

One of the ongoing disputes seems to be over whether MCS should be considered "alt med".

In the last year, PubMed shows five review articles, which were published in these five journals: [2][3][4][5][6] None of those journals are categorized as alt med journals.

The citations most frequently used in the article are a med school textbook, a report from a government agency charged with long-term care, and two conventional medical journals.[7][8]

I therefore don't think that we should include the altmed sidebar at the top of this article. It doesn't really fit with the sources that we're using or the sources that we should be using. What do you think? WhatamIdoing (talk) 22:20, 25 June 2020 (UTC)

• Support As above, plus not a type of medicine. Rest of alt medicine is treatments. Amousey (they/them pronouns) (talk) 01:09, 26 June 2020 (UTC)
• Oppose This belongs in Alt-Med with all the other Alt-Med diagnoses, viz, Adrenal fatigue, Aerotoxic syndrome, Autistic enterocolitis, Candida hypersensitivity, Chronic Lyme disease, Electromagnetic hypersensitivity, Heavy legs, Leaky gut syndrome, Wilson's temperature syndrome and Wind turbine syndrome -Roxy the elfin dog . wooF 04:33, 26 June 2020 (UTC)
  • Can you provide some high-quality MEDRS sources that support your opinion that this is altmed? If the scientific community agrees with you, then it ought to be pretty easy to find a few journal articles or a med school textbook or two that says this. WhatamIdoing (talk) 00:37, 27 June 2020 (UTC)
    • Can you provide some high-quality MEDRS sources that support your opinion that this is med? If the scientific community agrees with you, then it ought to be pretty easy to find a few journal articles or a med school textbook or two that says this. -Roxy the elfin dog . wooF 11:43, 27 June 2020 (UTC)
      • I did. Did you read the medical school textbook on MCS? WhatamIdoing (talk) 20:38, 29 June 2020 (UTC)
• Oppose — similar thinking to that given by Roxy the elfin dog .. --papageno (talk) 19:57, 26 June 2020 (UTC)
• Oppose as above. I also felt that the sources listed above are unimpressive, why no Lancet, NEJM, Science, Nature? Or even a step below those giants?--Smokefoot (talk) 21:15, 26 June 2020 (UTC)
  • Because they haven't published anything on it recently? (They have published a few small things in the past, but WP:MEDDATE excludes them.) Also, have you somehow been misled into believing that nothing published in those journals is altmed? (Science is really news, not research anyway.) WhatamIdoing (talk) 00:36, 27 June 2020 (UTC)
    • Re "Science is really news". If you buy that, you basically invalidate your opinion here. It is true that Science also publishes news, but getting a research paper published in Science is extremely competitive.--Smokefoot (talk) 12:31, 27 June 2020 (UTC)
    • Because scientisits, being sensible people, tend to do science on real things, that will give results that will increase our knowledge, common good etc. They recognise that investigating "nonsense" is fruitless, and wont get you an attractive life partner, and lots of lucre. -Roxy the elfin dog . wooF 11:54, 27 June 2020 (UTC)
      • Do you have any recent high-quality sources say that people feeling sick when they smell strange chemicals is all nonsense and not real? I've got a med school textbook that disagrees with you, so I'd be happy to consider any source that is equivalent or better – not just a website.
        And even if some or all of it is "wrong" (several different mechanisms have been proposed over the decades, and AFAICT they're all wrong so far), that wouldn't make the idea that some people feel sick when they're around smelly things be "alternative". Only half of conventional medicine is evidence-based. WhatamIdoing (talk) 20:40, 29 June 2020 (UTC)
• Oppose. Fake diagnoses are an integral part of fake medicine. Guy (help!) 21:24, 29 June 2020 (UTC)
  • JzG, could you please do what none of the other voters have done, and find a couple of high-qualty sources that says it's altmed? If we're going to label it as altmed, then I need a source that plausibly passes MEDRS that just says that.
    • Here's The Merck Manual, which is happy to label many things as altmed, and it doesn't. They're happy to say that it "cannot be explained by nonpsychologic factors", but they don't mention altmed.
    • Here's Johns Hopkins, which says "under debate in the medical community" and indicates that anxiety may be the primary mechanism – but they don't mention altmed.
    • Here's WebMD: "Those feelings are real. But they can happen for many reasons. The question is whether MCS is an illness. Health experts don’t agree on that." They don't mention altmed.
    • Here's Science-Based Medicine: Guess what? They don't say that it's an altmed diagnosis, either. They have a big, bold heading that says "Conclusion: The symptoms are real, the cause is unknown". They warn that people who believe that they have MCS are at risk for exploitation by altmed practitioners, but that's not the same as saying that MCS itself is an altmed idea. They are willing to go so far as to say that it's not a single, distinct clinical entity, and on other pages they call it "disputed diagnosis" and "controversial", but that is not synonymous with altmed. ("Not a single, distinct clinical entity" is a common situation in conventional medicine. Fever isn't a single, distinct clinical entity, either.)
    • Here's Gots and Barrett at Quackwatch, promoting their 1998 book, which discusses MCS (among other things). Altmed isn't mentioned. Their book (which is much too old to be cited in the article) has about 60 pages on MCS. They pronounce many strongly held opinions about it, including that they believe it is a social phenomenon rather than a single, distinct clinical entity, but altmed isn't mentioned. Here's Barrett at Quackwatch, in a blog post he updated in 2016. He's got nothing positive to say about it, with questionable perhaps being his favorite word, but I find no words that directly support a claim that it's altmed appear in it.
  • The medical textbook that is cited in the article doesn't say that it's altmed. I can't find any source that actually, directly says that MCS is altmed and that you'd normally accept as plausibly passing MEDRS. I get it: a couple of decades ago, everyone decided the proposed mechanism was nonsense, and 99% of us have never looked back. (Why should we?) But I can't make a statement, even an implicit one, that anything is altmed on Wikipedia without a source that actually says that. It's not good enough for editors to Just Know that something is altmed. We need sources. Where are those sources? WhatamIdoing (talk) 03:16, 30 June 2020 (UTC)
• Better diagnosed as a functional disorder Functional disorders have become the more accepted terminology for this kind of presentation. It's considered unlikely to be a distinct disorder. A legitimate practitioner probably should not give a patient this diagnosis, rather a functional disorder seems more appropriate, the symptoms are not explained by an obvious particular pathology and may occur with other functional disorders. In functional disorders the symptoms are most certainly real to the patient and debilitating, often with our current state of knowledge the most effective treatments may be psychological or placebo based in the absence of a better alternative (does have the unfortunate implication that Quack medicine might be just as effective in these cases). For all of these disorders, the relative role of biological factors and psychological factors is not well known, nor is the way they interact. PainProf (talk) 04:33, 8 July 2020 (UTC)
• Support The entire article essentially reads as "class of symptoms medically observed and verified, but without a well-understood mechanism, likely neurological", and similar framing is presented on other legitimate medical-oriented sites. Are we just supposed to slap derogatory sidebars on anything we don't like, without providing sources? If so, then why doesn't non-celiac gluten sensitivity get a big 'fake' banner slapped on it too? How is THIS poorly-understood but observed sensitivity different from THAT one? GeneralKJones (talk) 14:39, 28 September 2020 (UTC)

• Support This article is linked to from the "Fragrance Intolerance" article, which appears to support the idea that this is a real condition, or at least some parts of it are real. It is recognized as a protected disability. This article states that the organization who invented the term (ESRI) did so with the intention of confusing valid syndromes (MCS) with "alternative medicine" (electrical sensitivity) and with the intention of painting it as psychological in origin. At least some of the references appear to be valid, and the ESRI no longer exists. Even though it isn't recognized by the AMA as a physiological condition, it is nevertheless a real condition and has been known for over 60 years. ADHD isn't alt-medicine. Depression isn't alt-medicine. PTSD isn't alt-medicine. The debate is not whether this is alternative medicine, the debate is whether this is pscyhological or physiological in origin. To label this "Alt-Medicine" is a political statement on the order of calling "vaccines" alt-medicine: i.e., there is real harm to real people with this disability. Jenkstom (talk) 21:49, June 7, 2021‎ (UTC)

• Support

Here are a few high quality sources from prestigious medical journals that support MCS as med:

https://doi.org/10.3390/ijms21061915 (International Journal of Molecular Sciences)

https://doi.org/10.1515/reveh-2015-8888 (Reviews on Environmental Health)

10.1097/JOM.0000000000001215 (Journal of occupational and Environmental Medicine)

https://doi-org.login.ezproxy.library.ualberta.ca/10.1007/s00420-015-1053-y (International Archives of Occupational and Environmental Health)

https://doi.org/10.4168/aair.2014.6.5.409 (Allergy, asthma & immunology research)

https://doi-org.login.ezproxy.library.ualberta.ca/10.1007/s00259-014-2969-2 (European Journal of Nuclear Medicine and Molecular Imaging)

https://doi.org/10.1016/j.ijheh.2018.08.001 (International Journal of Hygiene and Environmental Health)

https://doi-org.login.ezproxy.library.ualberta.ca/10.1007/s00405-014-3015-5 (European Archives of Oto-Rhino-Laryngology)

https://doi.org/10.1515/reveh-2020-0058 (Reviews on Environmental Health)

https://doi.org/10.1371/journal.pone.0215144 (PLoS ONE) Ok to be fair I’ve never heard of PLoS ONE

https://doi.org/10.1016/j.clysa.2014.06.006 (Clínica y Salud)

https://doi.org/10.3390/ijerph17186551 (International Journal of Environmental Research and Public Health)

This list barely scratches the surface, there has been an explosion of high quality aetiological research on MCS since De Luca et al., 2011. https://doi.org/10.3390/ijerph8072770

So Roxy the Dog, what say you? Do you want more? I can =easily double or triple this list.

Silliestchris (talk) 22:53, 17 September 2021 (UTC)

• Support MCS is a highly politically charged topic with a number of special interests influencing medicine over the past 50 years wanting MCS marginalized. The article should report facts. The article should not be a vehicle for those who want MCS marginalized to apply a label or tag which does so.

Fstevenchalmers (talk) 23:29, 17 September 2021 (UTC)

• Support As a person suffering from a debilitating condition that matches the description of MCS, I find the suggestion of it being "fake" as reckless, arrogant and cruel, but mostly as being irresponsible. If you'll forgive the dramatic comparision, our lack of adequate understanding of a health problem is no an more of an excuse to relegate it to fiction than a slave's inability to to escape their master was an excuse to claim that they like being enslaved. My "testimony" here is certainly anecdotal and should be considered an original source, but I am a man of science -- a software/firmware & electrical engineer of 35 years (and a general polymath geek) -- and I have complete faith that science will figure it out. I have many hypothesis as do my various doctors (which I'll spare you). What is verifiable and repeatable is that exposure to certain chemicals results in specific pathological symptoms and avoiding the chemicals mostly avoids the symptoms. For the remainder, I presume there are unidentified substances, conditions or other triggers that are simply not yet identified.

I know that it is not olfactory-related in my case, because I have experienced sudden and severe symptoms when suddenly exposed to air I was previously not (when a car door was opened) where I had perceived no odor. So I kindly request from my fellow Wikipedians, more dry facts and less bullsh*t please. Let's treat this as a condition that is not currently medically recognized, fully understood, or properly described, continue to try to identify bad actors and weed out their work (i.e., the Andrew Wakefields), and keep the UFOs / lizard men out of it. Daniel Santos (talk) 06:41, 29 October 2021 (UTC)

ICPS

In 1996, WHO/ICPS had a conference. Is ICPS the International Programme on Chemical Safety or International Programme on Chemical Sensitivity or International Classification for Patient Safety? All three of these were in the article until a moment ago. WhatamIdoing (talk) 06:35, 2 March 2021 (UTC)

Here is a contemporary reference in which it is "International Programme on Chemical Safety" https://apps.who.int/iris/handle/10665/63109 Note that contemporary accounts were that this was a planned very small workshop on an obscure topic which a handful of people attended and hijacked into a discussion of MCS in order to create the name Idiopathic Environmental Intolerance in a seemingly WHO context. I cannot provide any objective reference for the contemporary account, which proceeds to say that the original attendees walked out when they realized their session had been hijacked. Thus, this journal article report on the session (which I do not have access to) was written by the victors, who I have characterized as purveying disinformation in support of a litigation defense effort. https://journals.sagepub.com/doi/abs/10.1177/096032719701600414

Fstevenchalmers (talk) 07:33, 15 June 2021 (UTC)

Thanks for following up on this. WhatamIdoing (talk) 02:12, 30 October 2021 (UTC)

Symptoms are not "vague"

I propose removing the word "vague" in reference to symptoms (In the intro paragraph and in the symptoms section) The symptoms listed are not specific to a single illness, true; however, they are not vague. Examples of vague would be: "I just don't feel well" ... "I feel worn out" ... I feel sick" Janraison (talk) 04:37, 18 September 2021 (UTC)

No, the vagueness is sourced in the body text. -Roxy the sceptical dog. wooF 16:04, 18 September 2021 (UTC)

I very much have MCS and can (anecdotally) affirm that "vague" symptoms is a good description. In point of fact, my symptoms vary with the chemical and I've begun to be able to connect some specific symptoms with specific chemicals or classes of chemicals. Daniel Santos (talk) 05:20, 29 October 2021 (UTC)

@Daniel Santos: Concur with your statement of fact. The problem is Wikipedia is an encyclopedia and the standard of fact for any medical related article is a statement in a recent peer reviewed secondary source. The concept is that an encyclopedia article summarizes the consensus of the relevant science, at the trailing edge. I'm too new as an editor to link the policy but that is what I'm supposed to do here giving you this feedback. Fstevenchalmers (talk) 08:23, 29 October 2021 (UTC)

WP:MEDRS. You are welcome. -Roxy the sceptical dog. wooF 13:55, 29 October 2021 (UTC)

@Daniel Santos: the essay Wikipedia:Why MEDRS? is what helped me understand Wikipedia's role and why the sourcing of medical fact is what it is on Wikipedia. That is non binding explanation. The policy is WP:MEDRS Fstevenchalmers (talk) 23:09, 29 October 2021 (UTC)

@Fstevenchalmers: thank you; I am aware. I haven't been a very active editor for a decade or so, but I guess I just felt like throwing my original source / opinion in the talk page anyway. The first time I saw this article I was shocked to see the alternative medicine sidebar where MCS was grouped with conspiracy theories. I certainly hope to see that improve, but between my work and the MCS symptoms, it's unlikely I'll have the time and energy required to gather and read enough sources to do anything meaningful. Best, Daniel Santos (talk) 00:46, 30 October 2021 (UTC)

@Daniel Santos: Understandable. Reality is that we have to give Ron Gots credit that the anti MCS recognition advocacy he caused to be injected in the peer reviewed literature 25 to 30 years ago still tip the scale of secondary sources to what we see in this article today. See the Quebec study (which I still can't find in English, and whose summaries in the popular press are not objective), which came down anti MCS recognition. The work out of Italy in my opinion is balanced but has a strong pro physical MCS recognition component. I don't have my head around Italian Expert Consensus on Clinical and Therapeutic Management of Multiple Chemical Sensitivity (MCS) which was published two days ago; any thoughts on how much weight that brand new secondary source should be given in the discussion of this page? Fstevenchalmers (talk) 01:49, 30 October 2021 (UTC)

Describing symptoms as being "vague" is sourced and accurate. Many diseases have vague symptoms such as feeling slightly off, feeling more tired than you think is reasonable for your activity/sleep levels, feeling uncomfortable but not being able to pinpoint a body part that hurts, not wanting to eat like you normally do, etc. Having vague symptoms is typical of Ovarian cancer and other serious diseases. WhatamIdoing (talk) 02:35, 30 October 2021 (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)

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 [[9]], 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)

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 is caused by chemicals; it said that if the doctor wants to get paid for treating a symptomatic person, 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)

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.[10] 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)

Firstly, your comments are not in accord with your reason given for reverting i.e. that the material was fringe. Please specify how it is that research published in journals that a consensus of authors here have agreed are reliable sources is fringe.

Your claim that my edit "was not an improvement over the prior and existing version." is not substantiated by the rest of your reply which is comprised of your unsourced opinions about the state of research into MCS while my additions to the article were supported by reliable sources or were direct quotes from research published in top journals.

It is difficult to see how can you sustain your claim that there is "nothing notable in recent literature as acceptable sources" regarding MCS while at the same time arguing to remove material published in an in depth review of the most recent research that is published in sources that a consensus of editors agree are reliable. Morgan Leigh | Talk 22:39, 17 May 2024 (UTC)

Zefr has had a week to reply to justify their position with sources but has failed to do so. However WhatamIdoing has done some good work in the article in the mean time so instead of reverting I suggest we go forward and add the info that we have consensus on. So if @Reconrabbit you want to go ahead and fix the referencing that would be a great start. I will get onto citing some stuff from journals once you have done that. Morgan Leigh | Talk 00:51, 24 May 2024 (UTC)

I have started working on it. I am using a tool that segregates all citations from the text and reinserts them so apologies if there are errors in the process. Reconrabbit 01:35, 24 May 2024 (UTC)

Should be standardized now. Please let me know if there is anything strange that resulted from my changes - I am not intimately familiar with the content of the article, only this particular discussion. Reconrabbit 01:57, 24 May 2024 (UTC)

Thanks for doing that work @Reconrabbit. It is an important and oft overlooked thing. Morgan Leigh | Talk 22:02, 25 May 2024 (UTC)