Talk:Multiple chemical sensitivity/Archive 3

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There may be several causes

The #Causes section says (again), "There may be several causes."

This sentence actually means what it says: "There may be several causes." It does not mean, "several hypotheses have been put forward, and we don't know which one (if any) of these will turn out to be right." It means "There may be several causes," as in, "The cause of Patient #1's symptoms may be completely different from the cause of Patient #2's symptoms."

This is not unusual: many forms of cancer, for example, have multiple causes. "There are several causes of leukemia" means "Patient #1's leukemia was caused by ionizing radiation, but Patient #2's leukemia was caused by pesticides." WhatamIdoing (talk) 05:56, 2 July 2010 (UTC)

"Major peer-reviewed article" by ML Pall

The following text was added to the article today:

However, in a major peer-reviewed paper on multiple chemical sensitivity by Professor Martin L. Pall, published in October 2009, five important facts about the disease came to light; briefly that it is very common - even more so than diabetes; that it is caused by toxic chemical exposure; that genes that determine the rate of metabolism of chemicals influence susceptibility to becoming ill with MCS; that there is a detailed and generally well supported mechanism for MCS based on the NO/ONOO cycle; and that rather than being a psychogenic disease, the evidence points to the clear conclusion that MCS is a physiological disease initiated by toxic chemical exposure.

Even if it was verifiable, I'd object the style of this addition - you can't call the views of a single researcher "important facts" unless they've been called so by other reliable sources; that said, I doubt this paragraph is verifiable via a reliable source: Prof. Pall's homepage is self-published, and the only article of his that was published in October 2009 is this one. It was published in Medical Hypotheses, a journal that doesn't have peer-review (or at least didn't, as this may be about to change). I'll therefore revert this latest addition. --Six words (talk) 14:15, 23 July 2010 (UTC)

I agree: This is a WP:PRIMARY source, and the hype is simply unacceptable. WhatamIdoing (talk) 18:12, 23 July 2010 (UTC)

I agree, that was written poorly, however, an article by him in General and Applied Toxicology published by Wiley, does appear to be peer-reviewed. I'll add a section with the hyperbole taken out. I'm new to editing Wikipedia, please let me know if I have done this in an NPOV manner. DzOregon (talk) 03:20, 30 December 2010 (UTC)

Being peer-reviewed does not automatically mean we can/should include it. You also need to consider the fact that his articles are just hypotheses, and they appear to be WP:FRINGE. Also check out WP:MEDRS and WP:WEIGHT. --sciencewatcher (talk) 04:06, 30 December 2010 (UTC)

I addressed the understandable criticisms of lack of peer-review and self-promotion for the post above. Can you please clarify how his hypotheses "appear to be WP:FRINGE". His academic standing and publishing record on this and other bio-chemistry topics would seem to indicate otherwise. DzOregon (talk) 04:52, 30 December 2010 (UTC)

Here's the quick and easy test for FRINGEy: Name all the "certified experts" who support Pall's idea. Now name all the equally qualified people who oppose it. Which list is longer, and by how much?

When I run down this list on the 'pro' side, I get Pall himself, and, um... um...

When I run down the list on the 'anti' side, I get half a dozen major medical bodies, the noisy Ronald Gots (of course), and a variety of researchers who think that MCS-claiming patients almost always have depression or anxiety (although the identification of an incorrect self-diagnosis doesn't actually rule out the possibility of MCS in a small number of MCS-claiming patients).

What's your version of the list look like? Can you name a handful of prominent medical supporters of Pall's theories? Or does his side of the academic table look pretty empty to you, too? WhatamIdoing (talk) 06:29, 30 December 2010 (UTC)

Can you direct us to some links of the "half a dozen major medical bodies" and "variety of researchers" who specifically respond to Pall's theory and oppose it (not just have their own competing theory)? I'm genuinely interested in reading that.

Also, Pall addresses the NMDA receptors and how they are made more sensitive by the exposure, which results in increased anxiety and depression. I don't know whether Pall is correct or not, but his biochemical explanation is interesting enough and logically sound enough that it was published by credible, peer-reviewed journals. DzOregon (talk) 05:10, 4 January 2011 (UTC)

Several of them are already named in this article. I notice that you provide zero names of credible supporters, and I assume this is because you aren't aware of any.

What you and I find interesting and logical is really irrelevant. If all the 'experts' in the field except Pall are saying "left", and Pall is saying "right", then even if Pall is later proven to be absolutely, 100% right, he's still WP:FRINGEy for Wikipedia's purposes (for now). WhatamIdoing (talk) 06:16, 4 January 2011 (UTC)

I'm being sincere. I really would like to read anything published by the "half a dozen major medical bodies" that directly refutes Pall's work. Can you please post some links here or shall we assume they don't exist? Your assumption works both ways.DzOregon (talk) 10:10, 6 January 2011 (UTC)

I would also like to see who is on this list other than Ronald Gots and Stephen Barrett.--69.141.124.198 (talk) 05:08, 19 February 2011 (UTC)

Question for 2over0: I'm confused as to why you removed the elevated nitric oxide levels section "per talk". I'm new to contributing to Wikipedia, but I really am trying to learn and follow the ways that entries are made and how the talk side of things works. I saw two objections above, but neither one provided any credible source for their objections. Does snarkiness and quoting WP: references really carry weight here?

On the other hand, I would welcome the chance to read multiple credible sources who have addressed and discredited Pall's theory. So far I haven't seen any, just other people with their own competing theories.

Admittedly this is not evidence of correctness, but if you google search for Multiple Chemical Sensitivity Theory the 3rd and 6th items returned are about Dr Pall. It's hardly an obscure item that noone is paying any attention to, so I assume your objection is about it's accuracy. I ask again, could someone please post links to direct refutations of Dr Pall's theory?DzOregon (talk) 09:18, 14 January 2011 (UTC)

One of the tools you can use is to search for the paper on google scholar and see how many citations it gets. Pall's papers get about 55 citations each, which would normally be sufficient for a mention in the article. However his papers are all hypotheses, which ranks pretty far down the MEDRS scale - we should normally only use information that is published in reviews. I think it is fine to mention it as a hypothesis, as long as we don't give to much weight to it. I see we already mention Pall's theory in a sentence in the article, so that is probably sufficient. --sciencewatcher (talk) 15:35, 18 January 2011 (UTC)

New NPOV notice

I'm slightly baffled by this - I don't see where people have tried to add other countries' recognition to the lede and been reverted. If you want to add something, go ahead and add it (or discuss it here). As long as it conforms to the wikipedia policies there won't be a problem. --sciencewatcher (talk) 16:58, 19 February 2011 (UTC)

I agree, I see no dispute here so thus have removed template.StevieNic (talk) 09:13, 20 February 2011 (UTC)

This discussion is full of disputes. This is why I am placing the notice on the page. This notice is not to be removed until all the editors of the article agree to remove it as per NPOV. I will consider the removal of this notice vandalism.

Xrin (talk) 04:26, 26 February 2011 (UTC)

I've removed it again..Once again there is no dispute here..The undue weight section of NPOV states, "Neutrality assigns weight to viewpoints in proportion to their prominence." To make the article give a lot of attention to, or even take the side of, a small minority of researchers is to give that minority and clearly goes against Wikipedia policy. Therefore you are only representing a minority viewpoint..StevieNic (talk) 08:41, 26 February 2011 (UTC)

I agree. When an editor places a NPOV template, he has to give a detailed explanation on the talk page. Talk pages usually are full of disputes, so that alone isn't a valid reason for templating an article, and reading through the discussions one more time I think that all the questions raised were answered. --Six words (talk) 09:12, 26 February 2011 (UTC)

The article appears to be within the usual standards and fixable by normal editing. Xrin, please make specific proposals regarding what content you consider to be in violation of the Neutral point of view policy so we can start to talk about how to fix it. - 2/0 (cont.) 13:30, 26 February 2011 (UTC)

Xrin, Wikipedia defines vandalism as "a deliberate attempt to compromise the integrity of Wikipedia." The people who have removed the NPOV tag have done so in a good faith attempt to improve Wikipedia, so the tag removal cannot be considered vandalism, even if you oppose it. -- JTSchreiber (talk) 16:46, 26 February 2011 (UTC)

Picking apart studies

This was added:

However, the methodology of the blinded study depended on olfactory maskers, which may themselves have caused reactions in MCS patients, in effect making “clean air” chemically contaminated. In addition, it is unclear how long patients were given to recover from any given chemical challenge before being given a new challenge. Patients may have been still reacting to a past chemical when exposed to a new one, or to “clean air.” Research has shown that chemically sensitive individuals take longer than controls to regain their baseline state after exposure to chemicals. The researchers concluded that the adaptation time after chemical exposure needs to be considered in future research.

and I thought that I'd explain the problems. The main problem is that encyclopedia articles don't pick apart studies. We normally say what happened, and skip the whole "he said, she said" debate between the various factions.

Additionally, I thought the following points might interest you, if you have an interest in the subject:

• The "clean air" did not contain any olfactory masking agent. That's what makes it "clean air" rather than "masking agent control".
• In at least most of these studies, the patient chose the olfactory masker on the basis that previous experience proved to the patient's satisfaction that it would not produce symptoms in that patient.
• If it's "unclear" much time passed between prompts, the time-honored response from scientists is to demand a fuller account of the research from the authors of the paper, not to assume that obviously it wasn't enough because you didn't get the results you expected. WhatamIdoing (talk) 18:42, 4 July 2011 (UTC)

SPECT and psychometric scale changes after a chemical challenge suggest neurogenic origin of MCS - PMID 19801154

Orriols R, Costa R, Cuberas G, Jacas C, Castell J, Sunyer J.

Brain dysfunction in multiple chemical sensitivity.

J Neurol Sci. 2009 Dec 15;287(1-2):72-8. Epub 2009 Oct 3.

Abstract

Multiple Chemical Sensitivity (MCS) is a chronic acquired disorder of unknown pathogenesis. The aim of this study was to ascertain whether MCS patients present brain single photon emission computed tomography (SPECT) and psychometric scale changes after a chemical challenge. This procedure was performed with chemical products at non-toxic concentrations in 8 patients diagnosed with MCS and in their healthy controls. In comparison to controls, cases presented basal brain SPECT hypoperfusion in small cortical areas of the right parietal and both temporal and fronto-orbital lobes. After chemical challenge, cases showed hypoperfusion in the olfactory, right and left hippocampus, right parahippocampus, right amygdala, right thalamus, right and left Rolandic and right temporal cortex regions(p<or=0.01). By contrast, controls showed hyperperfusion in the cingulus, right parahippocampus, left thalamus and some cortex regions (p<or=0.01). The clustered deactivation pattern in cases was stronger than in controls (p=0.012) and the clustered activation pattern in controls was higher than in cases (p=0.012). In comparison to controls, cases presented poorer quality of life and neurocognitive function at baseline, and neurocognitive worsening after chemical exposure. Chemical exposure caused neurocognitive impairment, and SPECT brain dysfunction particularly in odor-processing areas, thereby suggesting a neurogenic origin of MCS.

PMID 19801154 — Preceding unsigned comment added by 99.190.133.143 (talk) 23:32, 8 November 2011 (UTC)

Alleged

Every now and again, we get someone who wants to change the article to say something like "MCS is the alleged condition..."

The thing is, it's not true. MCS is a real chronic medical condition. What's "alleged" is that "chemicals" have anything to do with the condition. The fact that these people don't feel well for months at a time (=the definition of a chronic medical condition) is widely acknowledged by all sides.

So I wonder whether it might help to say something directly about that fact, like "Experts on all sides of the debate agree that people with MCS experience genuine suffering. What is disputed is the cause of that suffering." What do you think? WhatamIdoing (talk) 20:20, 9 February 2012 (UTC)

The problem is that it's not agreed that MCS is a valid illness diagnosis. Have a look at the electromagnetic hypersensitivity article - it starts with "Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) is a set of claims of adverse medical symptoms purportedly caused by exposure to electromagnetic fields". We should maybe use similar language here. --sciencewatcher (talk) 15:48, 10 February 2012 (UTC)

I agree that the wording should make it clear that some medical experts do not agree that the condition exists. Instead, they believe that the patients with these symptoms should always receive other diagnoses. Also, I think that we should try to avoid the words "alleged" and "claims" per WP:WORDS. -- JTSchreiber (talk) 06:18, 11 February 2012 (UTC)

Perfume allergy

I somehow completely missed this, but last week a bit of content was added arguing that perfume allergy is a “more widely accepted” “alternative explanation” for MCS, sourced with this: PMID 17877753. I haven't read the whole article yet (I will, but not tonight) but the abstract doesn't indicate that there's any discussion of MCS in this study. It's also a primary source, so I will remove this (at least for now). --Six words (talk) 22:42, 16 February 2012 (UTC)

The vanilloid receptor as a putative target of diverse chemicals in multiple chemical sensitivity. -- PMID 16241041

Pall ML, Anderson JH.

The vanilloid receptor as a putative target of diverse chemicals in multiple chemical sensitivity.

Arch Environ Health. 2004 Jul;59(7):363-75.

Abstract

PMID 16241041 Ocdnctx (talk) 16:56, 30 January 2013 (UTC)

"Multiple chemical sensitivity (MCS) is a common condition ... " Study found "... Reduced 5-HT(1A) Receptor Binding Potential ... " in brain. PMID 23349968

Hillert L, Jovanovic H, Ahs F, Savic I.

Women with Multiple Chemical Sensitivity Have Increased Harm Avoidance and Reduced 5-HT(1A) Receptor Binding Potential in the Anterior Cingulate and Amygdala.

PLoS One. 2013;8(1):e54781. doi: 10.1371/journal.pone.0054781. Epub 2013 Jan 22.

PMID 23349968

http://www.ncbi.nlm.nih.gov/pubmed/23349968

Abstract

PMID 23349968

Ocdnctx (talk) 16:56, 30 January 2013 (UTC)

Please do not violate Wikipedia's WP:Copyright policy by cutting and pasting whole abstracts from papers. The abstracts are copyrighted. Anyone who wants to read them can click through the link. WhatamIdoing (talk) 05:24, 27 February 2013 (UTC)

There are so many old ideas here, that I wonder if you have not taken the opinions of someone in litigation against this condition.

First off, the updates on the current opinions of WHO and of the AMA are totally incorrect.

Don't take someone's agenda to quote some old article where someone said that once.

Go to the source, a publication by t he AMA and the EPA and the American Lung Association and the consumer safety Comm. Citation - where the updated stand is:

Indoor Air Pollution: An Introduction for Health Professionals (1994)

“The current consensus is that in cases of claimed or suspected MCS, complaints should not be dismissed as psychogenic, and a thorough workup is essential. Primary care givers should determine that the individual does not have an underlying physiological problem and should consider the value of consultation with allergists and other specialists.” (page 20)

U.S. Department of Housing and Urban Development (HUD)

MCS Disorder and Environmental Illness as Handicaps (1992)

"The General Counsel has accepted the attached memorandums the Department's position on the issue of when Multiple Chemical Sensitivity Disorder (MCS) and Environmental Illness (EI) are "handicaps" within the meaning of subsection 802 (h) of the Fair Housing Act (the "Act"), 42 U.S. C. 3602(h), and the Department's implementing regulation, 24 C.F.R. 100.201 (1991). In sum, MCS and EI can be associated with physical impairments which substantially impair one or more of a person's major life activities. Thus, individuals disabled by MCS and EI can be handicapped within the meaning of the Act. However, while MCS or EI can be handicaps under the Act, ordinary allergies generally would not be."

U.S. Department of Education

Multiple Chemical Sensitivity Policy and Resources (2001)

"MCS Is Now Recognized as a Disability. Both the US Department of Housing and Urban Development (HUD) and the Social Security Administration (SSA) have recognized MCS as a disabling condition. People with MCS have won several Workers Compensation cases. A recent human rights lawsuit in Pennsylvania established the right of an affected person to safe living space in subsidized housing. Both the Maryland State Legislature and New Jersey State Department of Health have commissioned studies of MCS. The NJ study provides an excellent overview of medical and legal issues related to MCS."

Social Security

DI 24515.064 Evaluation Of Specific Issues — Environmental Illness (1996)

“In claims alleging disability due to environmental illness, it is often difficult to identify abnormal signs and laboratory findings which can be associated with the alleged symptoms. Therefore, in evaluating claims based on environmental illness, all of the claimant's symptoms, signs, and laboratory findings must be considered to determine if there is a medically determinable impairment and the impact of any impairment on the claimant's ability to work. This evaluation should be made on an individual case-by-case basis to determine if the impairment prevents substantial gainful activity.”

U.S. Department of Health and Human Services, Centers For Disease Control and Prevention

Indoor Environmental Quality Policy (2010)

“Fragrance is not appropriate for a professional work environment, and the use of some products with fragrance may be detrimental to the health of workers with chemical sensitivities, allergies, asthma, and chronic headaches/migraines.” (page 9)

— Preceding unsigned comment added by 98.15.241.174 (talk) 11:26, 8 April 2013 (UTC)

Do you understand the difference between "these people are disabled" and "this disability is caused by chemicals"? Nobody really believes that all of these people are healthy. The dispute is over whether the illness is actually caused by chemicals, or if it's caused by something else (e.g., neurological problems). WhatamIdoing (talk) 03:26, 11 April 2013 (UTC)

Multiple chemical sensitivity (MCS) is a relatively common clinical diagnosis

Alessandrini M1, Micarelli A1, Bruno E1, Ottaviani F1, Conetta M2, Cormano A2, Genovesi G2.

Intranasal administration of hyaluronan as a further resource in olfactory performance in multiple chemical sensitivity syndrome.

Int J Immunopathol Pharmacol. 2013 Oct-Dec;26(4):1019-25.

Abstract

Multiple chemical sensitivity (MCS) is a relatively common clinical diagnosis in western populations

http://www.ncbi.nlm.nih.gov/pubmed/?term=Intranasal administration of hyaluronan as a further resource in olfactory performance in multiple chemical sensitivity syndrome

[PubMed indexing in process; expected to be assigned PMID: 24355241]

That's an interesting WP:PRIMARY source; thanks for posting it. I've always wondered whether reducing the ability to smell things would improve MCS-attributed symptoms, and it appears that it works. However, it's not exactly a great source for claiming that MCS is "common", or even "relatively common". WhatamIdoing (talk) 22:43, 22 December 2013 (UTC)

Other names

This was removed:

MCS has been given many different names by proponents, including toxic injury (TI), chemical sensitivity (CS), chemical injury syndrome (CI), 20th century syndrome, environmental illness (EI), sick building syndrome, idiopathic environmental intolerance (IEI), and toxicant-induced loss of tolerance (TILT). These names generally are intended to name the cause favored by the proponent or to emphasize the severity of symptoms.

I think it's important to list the alternative names, so that people following a redirect to this page know that they are in the correct place. WhatamIdoing (talk) 22:33, 21 January 2014 (UTC)

Reference 59

Reference 59 seems to be broken:

People who have stronger emotional states will react more strongly to a smell.[59] — Preceding unsigned comment added by 193.174.1.214 (talk) 07:04, 6 June 2014 (UTC)

Multiple Chemical Sensitivities definition on Wikipedia does not have up-to-date information

Please update your files on Multiple Chemical Sensitivities with the following information and pdf file. http://www.womenshealthmatters.ca/assets/legacy/wch/pdfs/ESMCSStatusReportJune22011.pdf This is a report from the Women's College Hospital, Toronto, on Environmental Sensitivities-Multiple Chemical Sensitivities Report, Environmental Health Clinic, 2010 & 2011 AnnieMeg(AnnieMeg (talk) 01:55, 10 December 2014 (UTC))

neutrality concern with "lack of widespread recognition" section, paragraph 3

Disclosure: I have MCS and am therefore an advocate of a viewpoint a bit different from the historic consensus in mainstream medicine.

The third paragraph in the "lack of widespread recognition" section cites Dr. Gots as a defense expert, without disclosing that he was the paid head of the nonprofit ESRI, an advocacy organization funded by undisclosed sources (but with a disclosed board of directors primarily from the chemical industry), which existed and was quite successful as an advocacy organization to discredit MCS.

I think this could be better balanced by a (separate paragraph) mention of the late Cindy Duehring, a mention of Bonye Mathews (need to check spelling), a discussion of advocacy over the years, a mention of the Chemical Sensitivity Foundation and its role, or inserting a sentence at the end of the Dr. Gots paragraph crediting him with his employment by and role in ESRI, and describing ESRI as non-neutral in some objective way. (The CSPI makes a suitably professional statement on ESRI.)

Fstevenchalmers (talk) 08:36, 16 August 2013 (UTC)

On Gots, we do say he is a "frequent defense consultant in toxic tort litigation", which indicates his perspective and position. The Toxicology article has passed peer-review, so we need to be careful to avoid implying that we (Wikipedia editors) have a better idea than the reviewers of what constitutes reliable academic research. Alexbrn ^{talk|contribs|COI} 09:07, 16 August 2013 (UTC)

It might be interesting to have a history of MCS advocacy, but I don't think that this particular paragraph is the right place for it. WhatamIdoing (talk) 02:54, 17 August 2013 (UTC)

While I support the Wikipedia ground rules, in this particular case I would like to point out that ESRI successfully distorted the available peer reviewed literature in the field of MCS. The ten or so years of paid advocacy there, which ended around a decade ago, attempted to create the perception of an emerging consensus in peer reviewed papers that MCS is entirely psychological in nature, not physical. This was done both by promoting/funding/encouraging psych research and publication, and by creating confusion and debate around the case definition of MCS, then using that confusion to label any research into MCS as a physical phenomenon as flawed because the definition was unclear, and then going to the funding sources of such research (and presumably to any journal intending to publish it) to discourage the waste of their resources on such flawed work. See Dr. McCampbell's 2001 article at http://www.tldp.com/issue/210/mcsundersi.htm (and no, in science exposes like that aren't peer reviewed). An official study in the UK a few years ago, intended to influence policy, took a position on MCS based on a review of the literature from that period: ESRI was successful. My point is not to disagree with Wikipedia's rules, it's to point out that in this particular case the rules cause Wikipedia to repeat the position a special interest has successfully injected into the peer reviewed literature, rather than a balanced view.

The idea of a section on the history of MCS advocacy is a good one. It would be very easy to distract from the section by discussing the way allergy got raised from quackery to a recognized specialty around 50-60 years ago by carefully distinguishing itself from Theron Randolph's work, which evolved to "clinical ecology", was essentially exiled from mainstream medicine at the time Allergy was recognized, and is now known as Environmental Medicine. (Not Occupational and Environmental Medicine, that's another specialty.) (Is it now much less surprising that the Allergy specialty, both reciting the positions which got Allergy recognized and in competition for patients with Environmental Medicine, would take the position that MCS does not exist?) To have the style and objectivity expected of a Wikipedia article, I would think this would need to be three sentences at most, yet I think there's a lot which could be covered: (1) history going back 100 years, just cite some source around patients experiencing something doctors couldn't explain, my guess is Albert Donnay at MCS Referral and Resources would probably be able to find something; (2) Theron Randolph's work in the 1950s; (3) rise of the chemical industry post world war II, and finding itself under fire after Silent Spring published in early 1960s -- need to legitimize chemical industry responding to chemophobes; (4) rise of the clinical ecology field of medicine (I don't know the history well here and it's probably been rewritten by the victors anyhow); (5) observation of increasing number of patients meeting a loose definition of MCS in 1960s and 1970s (very few objective sources here, special interests do not want these studies done), and emergence of many small MCS organizations each of whom sees MCS from a slightly different perspective; (6) publication of book "Chemical Exposures: High Stakes" by Ashford and Miller; (7) The debate over the MCS case definition (8) The anti alternative medicine drive, which through NCAHF in the late 1990s through mid 2000s pushed the various state medical boards to crack down on physicians practicing alternative medicine, one target of which (at least here in California) was taking away the license of physicians who diagnose MCS. Fstevenchalmers (talk) 20:23, 17 August 2013 (UTC)

As far as Wikipedia is concerned, what's published in mainstream sources is correct. If ERSI's "distortion" is widely accepted, then Wikipedia will put forward that viewpoint as being the mainstream, widely accepted position, even if the less popular viewpoint says that the widely held one is the result of maliciousness or marketing or anything else.

I disagree with your division of diseases into "psychological" and "physical". The dichotomy is not helpful, and in the case of MCS, it's also wrong to say that the mainstream view is that MCS is "psychological". If any condition can be successfully treated with drugs, then that condition is very likely "physical" at some level. A large fraction of MCS people (perhaps we should call this group the "self-mis-diagnosed" group) see their symptoms resolve when they are treated for common "physical" (psychiatric/neurological) conditions like anxiety. WhatamIdoing (talk) 23:58, 23 August 2013 (UTC)

I personally concur: the distinction between physical and psychological has its roots in politics and not science. Mainstream medicine's support of that distinction is part of what has prevented progress on understanding MCS over the last 50 years. However, if we are to write such a paragraph or section we have to do so within Wikipedia's conservative rules. I am a bit concerned that we don't have a critical mass of editors in this discussion to get this right (balanced and suitably conservative) the first time. Think we ought to try anyhow? Fstevenchalmers (talk) 21:37, 24 August 2013 (UTC)

I think the first step would be identifying a high-quality WP:Independent source (which in this situation means not a pro-MCS source like an MCS support website, but also not a definitively anti-MCS person like Gots) that covers the history or development of the MCS concept. Do you know of any? WhatamIdoing (talk) 05:43, 25 August 2013 (UTC)

I just added some material from http://ijt.sagepub.com/content/18/6/383.abstract
I don't have Sage access, so I haven't read past the abstract. It would be good for someone to pursue that further. The literature review might be rich enough to support the proposed section.
I'm a bit bothered by the tendentious naming of these subsections. A "Controversy" section might be a good way to reorganize things.
Bn (talk) 12:57, 29 June 2014 (UTC)

This might be useful, if the online journal is accepted as RS:
http://www.tldp.com/issue/210/mcsundersi.htm
Bn (talk) 13:00, 29 June 2014 (UTC)

As a relative of someone who has MCS, I get quite annoyed when what I feel are The Evil Chemical Corporations™ are removing bits here and there, when of course it is probably just being tidied up. However, this article is still too U.S. centric, and around the world edits I've made ages ago have been removed, as well as links to helpful documentation. I'm not going into edit wars, but well done ideological warriors, may you retire to conservapedia. When I get journal access, I will reference some stuff from this review (cited on the page) 124.168.159.142 (talk) 08:31, 2 December 2014 (UTC)

It was me who reverted your last change. I'm not a 'chemical company' (LOL). I just reverted because you made an error. I have no interest whatsoever in being 'conservative' or anything else. All I care about is accuracy. Feel free to discuss changes here. --sciencewatcher (talk) 00:35, 3 December 2014 (UTC)

Reliable Sources

An annotated bibliography is available by email from the author of "The Medical Perspective on Environmental Sensitivities.". In response to my request for a link to this bibliography, she explained that Canadian federal law requires documents to be translated into French before they can be posted on a website, and there was no funding for translation. Her email: Margaret Sears <[email protected]>

She referred me to some more recent sources at http://thechemicaledge.com/downloadable-reports/, for example

• http://thechemicaledge.files.wordpress.com/2013/12/rie_quantitative-data-report.pdf

• http://thechemicaledge.files.wordpress.com/2013/12/rie_academic-and-clinical-perspectives.pdf

Contributions to MCS article by a Medical Librarian undone.. please explain ... all sources are either MEDLINE, Government sites, or NGOs

from: 20:11, 17 February 2015 (diff | hist) . . ( 852)‎ . . Multiple chemical sensitivity ‎

MCS is not recognized as an organic, chemical-caused illness by the World Health Organization, American Medical Association, and other organizations.[2][3] However, since 1994 the American Lung Association, American Medical Association, U.S. Consumer Product Safety Commission, and the U.S. Environmental Protection Agency have obliquely supported the diagnosis of MCS. Indoor Air Pollution: An Introduction for Health Professionals Also, the US Social Security Administration will accept MCS as a cause of long-term disability on a case-by-case basis. See Environmental Illness at the SSA . Additionally, MCS has an ICD Medical Code now in 10 countries MCS Fact Sheet There are currently about 300 papers indexed in MEDLINE about MCS Chemical Sensitivity, so there is a good amount of science that backs up this poorly understood medical issue. Blinded clinical trials have shown MCS patients react as often and as strongly to placebos as they do to chemical stimuli; existence and severity of symptoms is related to perception that a chemical stimulus is present.[4][5] Depression, anxiety, somatoform disorder, and similar mental health conditions are commonly associated with reports of MCS.[6][7] Regardless of the etiology, some people with severe symptoms are disabled as a result.

Thank you. — Preceding unsigned comment added by Kd3qc (talk • contribs) 01:47, 9 April 2015 (UTC) Kd3qc (talk) 17:55, 10 April 2015 (UTC)

The Medical Librarian who contributed the above paragraph has asked for an explanation re: why some of the paragraph was eliminated; "all sources are either MEDLINE, Government sites, or NGOs." Interestingly, the parts not eliminated are those sure to make the Chemical Industry very, very happy. And the parts that were eliminated (WITHOUT EXPLANATION EVEN WHEN THAT WAS REQUESTED) would have made Big Chem very, very unhappy.... Athana (talk) 23:26, 12 May 2015 (UTC)

Comments

Added "See also" wikilink Spacetoast (talk) 06:22, 7 September 2015 (UTC)

The tinfoil in this particular hat is particularly awful, even for Wikipedia. — Preceding unsigned comment added by JohnDoeMD (talk • contribs) 04:28, 8 September 2015 (UTC)

This article is simply unbalanced.

Taking into account that Wikipedia does not pretend that its articles are scientific, I can only say that I do not agree with the opinion of the writer of this article. I've had several symptoms usually attributed to MCS and/or CFS for about thirteen years and have learnt more about these illnesses than I ever wanted to know, including all the various viewpoints as to its existence or not. I've managed to remain functional and have therefore never needed to have my symptoms verified with a view to e.g. disability payments, so I have no financial stake in its existence or otherwise. To someone like me, with long-standing knowledge and experience of MCS, this writer's opinion is therefore obviously biased. He/she seems to be of the opinion that MCS is not an illness and has gone to considerable effort to "prove" this with selected references. (I cannot help but wonder whether the writer has a financial interest in proving the non-existence of MCS, as Dr Ronald Gots and ESRI are/were known to have, because anyone who goes to such trouble to write an article on a subject as this writer obviously has, would have given a more balanced view, as there are many references to both sides of the question. The choice of only the negative references makes one wonder why it was so important to NOT give both sides.) One can only hope that anyone wishing to know more about MCS will also look at other websites, such as that by MCS AMERICA, to see the other side of the picture. I've just had a quick look at PubMed, and found thirty recent abstracts (i.e. peer-reviewed scientific research) treating MCS as an accepted disease within a very short time. MCS has also been recognised as a disease in several countries, although not in the UK, and in several states of the USA. This article certainly does not inspire confidence in Wikipedia as a source of balanced information.Illacon (talk) 18:46, 11 September 2015 (UTC)<MCS America><PubMed>

By which you mean it doesn't support the business model of quacks. This is by design. Guy (Help!) 22:11, 11 September 2015 (UTC)

Wikipedia doesn't automatically include all research. See WP:MEDRS. The weight of evidence points to MCS being a real illness, but not caused by chemicals, and that is what the article reflects. --sciencewatcher (talk) 06:47, 12 September 2015 (UTC)

Sciencewatcher... I would like to engage in more dialog about the Multiple Chemical Sensitivity Page

[moved from my talk page]

In an effort to get information to those who would benefit most from it, I would like to engage in more dialog about MCS with you. I hope we can reach an understanding that will benefit the entire Wikipedia community, including those suffering from Environmental Illnesses such as MCS.

I'll start. I never heard of MCS until developing it. This is why I want to include the emerging science from outside of America as well as the MEDLINE articles that keep being published on the illness. I don't understand how the modern American medical community doesn't understand that this is not some kind of mass delusion. What is more likely: a) This is a psychosomatic problem that "disturbed" people experience with no real harm caused so they should not really be helped or b) MCS is a real problem that is caused and exacerbated by chemicals in a way we don't yet understand that completely destroys lives? I am of the opinion that the answer is b.

There are more than 1,000 documented cases of MCS around the world at this point. See: https://www.facebook.com/groups/MCSMap/ The link will take you to a map of self-added people who suffer from MCS. There are many who would look at the Wikipedia page as it is and conclude that MCS doesn't exist. That is what happened to me, initially. (I have a high opinion of Wikipedia in general). So, the situation was that I had MCS and thought that it was not MCS because of the tone and content of the Wikipedia page. Ironic. It wasn't until I put on my medical librarian hat and searched MEDLINE that I realized that Multiple Chemical Sensitivity is a emerging problem worldwide that is not going away.

I'd love to hear from you your thoughts on what I've shared. I'd also like to apologize for my previous show of anger over your reverts. Holding on to anger is like holding a hot coal in your hand with the intention of throwing it at someone else. You are the one who gets burned.

First of all, you should understand how wikipedia works. We basically just repeat what the reliable sources say. You can't simply find 300 medline studies and add them to the article, you need to follow WP:MEDRS. That basically says that we use high quality reviews. Also WP:NPOV, which says that the article has to reflect the evidence, not giving excessive weight to minority points of view.

In terms of research, I think we do already include all of the relevant research. There has been quite a lot of research into MCS, and it seems to mostly point towards MCS being primarily a psychological illness which nevertheless does cause great harm. Although the chemicals don't appear to directly cause MCS, there may be a hypersensitivity to smells which makes it appear that the illness is caused by chemicals. Having said that, if there is any good evidence (e.g. double blind studies) showing a different result, then we should also include those studies. That's the way wikipedia works -- we don't decide which studies to include based on some decision by me or any other editor. Instead we simply present all the high quality sources with appropriate weight, and let the evidence speak for itself.--sciencewatcher (talk) 21:38, 16 April 2015 (UTC)

You'll never find "relevant research" about MCS -- the chemical industry is squelching it. Just the way Big Tobacco squelched all the "relevant research" about nicotine and the other deadly chemicals in tobacco. Athana (talk) 13:11, 7 September 2015 (UTC)

Wikipedia, you might as well face the truth: the chemical industry owns you just as it does the rest of us. You'll never be able to print accurate information about this subject -- or any other the big corporations don't want you to. Your own rules and regulations have given them the perfect loop hole through which to make you irrelevant. Athana (talk) 13:27, 7 September 2015 (UTC)

^^^^ See above. This article needs to be completely rewritten from a neutral, scientific standpoint. There's no controversy here. None. The article lists 2 prominent physicians' groups that say this isn't a real thing. The more complete list would be "all of them, as well as all high-powered studies." The vast, vast majority of people who claim to have this actually have clinical psych disorder. Scientifically, study after study proves that. Studies again also show that, when they can't smell it, sufferers can't tell their "irritant" from placebo. Again, the high-powered studies from reputable institutions only go one way here. Long, meandering, largely-incoherent paragraphs about how chemical companies are hiding research and assassinating opposition that are on this talk page and occasionally appear on this article are beyond silly. As a man of science who's studied in this area, I only note that this article is "teaching the controversy" akin to a page saying the earth if 5000 years old (with the article written in a slant that implies it really is 5000 years old). Let's not "teach the controversy" here. There isn't one. Isn't there a tag we can add to the page about "science skepticism" articles? It would be great to warn the public that the views expressed in this article go against the vast weight of science, studies, physicians' professional consensus, physicians' organizations and general educated belief. I remember we had one when I was last active on Wikipedia. — Preceding unsigned comment added by ScientificMethodGuy (talk • contribs) 04:47, 8 September 2015 (UTC)

Do not confuse major medical organizations not yet accepting MCS as organic as them accepting it as psychosomatic.

It's actually more complicated than many realize to prove or disprove MCS in general, or in specific cases.

We can not conclude MCS in general is psychosomatic from a few small provocation studies. The reviews disqualified all but a few small studies from weighing their conclusion.

The provocation trials have been disputed for various flaws, but even if they were perfect, at most they could only ever show that the study participants don't have MCS; it cannot show nobody has it.

We can not extrapolate from a small number of cases to all unstudied cases.

With most MCS cases being self-diagnosed and quack-diagnosed, it should be expected that there could be many false cases obscuring true cases.

It's possible that false MCS cases predominate in some studies due to true cases being more rare and/or selection biases for false cases.

For example, many studies have recruited from quack clinics which may be a selection bias for false cases. Bruce A Hart (talk) 09:52, 23 September 2015 (UTC)

Idiopathic environmental intolerances attributed to smells vs. electromagnetic fields

Recently, the page "multiple chemical sensitivity" was moved to "idiopathic environmental intolerances". I do not contest this move. However, it should be mentioned somewhere in the article that this article only deals with idiopathic environmental intolerances attributed to smells [1] and not with idiopathic environmental intolerances attributed to electromagnetic fields (IEI-EMF, electromagnetic hypersensitivity). — Preceding unsigned comment added by 94.220.8.181 (talk) 08:57, 6 September 2015 (UTC)

I'm not sure that it's such a good idea to combine the two concepts. I'll have to spend more time looking at the sources before I make up my mind about whether this move was such a good idea. User:JzG, can you provide any sources that show this name has actually changed? AFAICT, you didn't add any sources to the article that address that question at all. WhatamIdoing (talk) 13:00, 23 September 2015 (UTC)

Symptoms

I restored two general summary statements (obviously supported) because I thought that the points were important and because, from a perspective of good encyclopedic writing, having topic sentences and summaries is important. These two points are basically incontestable on factual grounds:

• A person who claims MCS can actually be disabled. The "true cause" might be depression or anxiety (the most common causes found in studies) or something else, but claiming to have MCS does not mean that the person is actually healthy. It's not usual to cite sources in the lead, but this is supported by all the sources that talk about disability payments, in addition to several others. Also, it ought to be obvious that if your problem is depression or anxiety, that it can be disabling, especially if you're refusing to treat it on the grounds that you don't believe that you have a psychiatric issue.
• The symptoms of MCS are whatever the person says they are. This is such a strange situation that it should headline the symptoms section and be stated in plain, simple (but non-derogatory) language. (Just imagine someone saying, "I have influenza, and it doesn't cause coughing or fevers; instead, it caused this rash on my foot", and having all of the other people with the flu take that self-diagnosis seriously. But that actually does happen with MCS.) WhatamIdoing (talk) 13:16, 23 September 2015 (UTC)

It is fair to say that some people are disabled as a result of the symptoms. The second para you introduced was unsourced and largely redundant to text we already have. Guy (Help!) 16:37, 23 September 2015 (UTC)

Guy, if by "redundant" you mean "a proper, plain-English introductory summary to the main points of the section", then I am willing to agree. I'm not sure why that is grounds for removal, however. WhatamIdoing (talk) 19:25, 17 October 2015 (UTC)

Guy, also, I'm confused about where the POV is that you claimed in the edit summary. The text said, "Symptoms of MCS include anything that is disruptive to mental or physical wellness and that the affected individual attributes to exposure to a chemical or scent. The nature of the symptoms may be physical, such as a skin rash, or psychological, such as a feeling anxious about the substance." Does that not accurately reflect the balance of mainstream sources? WhatamIdoing (talk) 19:53, 17 October 2015 (UTC)

Red flag word: wellness. If the affected individual attributes it to a chemical, that does not mean the chemical causes it. Like "electromagnetic hypersensitivity", in which provocation tests show that the self-proclaimed sensitives are not actually able to discern whether the signal is there or not. They are not disabled by the disorder, they are disabled by anxiety symptoms brought on by quacks and charlatans who tell them they are sensitive tio things they are not. Guy (Help!) 21:45, 18 October 2015 (UTC)

I understand that fact, and I understand that you think this fact is stupid. I don't mind if you think that reality is stupid, but this reliance on attribution is the actual reality here.

The fact that this is all about attribution is precisely why I think it is important to put this at the top of the section, in the plainest possible language. If it were possible to comply with WP:TONE and write "You don't have MCS because some chemical actually makes you feel bad. You have MCS because you say that some chemical makes you feel bad, regardless of whether that's true or not", then that would work for me.

What we've got right now is a section that says, effectively, "Here is the list of the True™ Symptoms of MCS:". IMO what we need is a section that says (with suitable encyclopedic tone), "Look, this is all based on nothing more than some people saying that 'chemicals' cause these symptoms in them. So, just to give you a fair description of the condition, here's the list of symptoms that these people say they experience:".

I am seriously surprised that you can't support explaining that these symptoms are merely allegations rather than actually proven. WhatamIdoing (talk) 16:45, 19 October 2015 (UTC)

ICD code choices.

Per WP:NPOV I've added ICD-9-CM and ICD-10 codes for the psychological and physiological points of view. My ordering is based entirely on the order in which you'd come across them within those books. Little pob (talk) 20:27, 18 October 2015 (UTC)

Thanks. We know that a lot of medical coders use Wikipedia as a reference when they're stuck, so this will be really helpful to some of our readers. WhatamIdoing (talk) 16:55, 19 October 2015 (UTC)

Also, sarcasm always helps. Guy (Help!) 11:25, 22 October 2015 (UTC)

Requested move 17 October 2015

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section.

The result of the move request was: Moved as requested Mike Cline (talk) 17:47, 5 November 2015 (UTC)

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Idiopathic environmental intolerances → Multiple chemical sensitivity – Moved without discussion to a name that does not reflect the subject of the page. WhatamIdoing (talk) 19:44, 17 October 2015 (UTC) Relisted. Jenks24 (talk) 10:41, 25 October 2015 (UTC)

This requires a little explanation, and it took me a while to check sources and make sure I had things straight.

There are a lot of names for this condition. Some of that's political, some of that's what happens when scientists are sorting out "new" problems, some of that's personal preferences of splitters and lumpers. However, the one thing that is fairly clear is that idiopathic environmental intolerances come in different flavors, and not all of them are blamed on "chemicals". The two most important sub-types are the one that's blamed on "chemicals" ("Multiple chemical sensitivity"), and the one that's blamed on "electromagnetic fields" ("Electromagnetic hypersensitivity").

Idiopathic environmental intolerances (IEIs) could be an article (just like Cancer can be an article, even though there are different types of cancer), but what we really can't do is pick one of the IEIs, and rename that sub-type as IEI. That's too much like renaming Lung cancer to Cancer and omitting the rest.

Consequently, I'm requesting that this page be moved back to Multiple chemical sensitivity, which is the most common name for IEI-attributed-to-chemicals. There's no evidence of a consensus for the move and no good sources to support it. I don't really care about the fate of the IEI page itself; it could redirect here (as the much more common of the two types), get turned into a dab page, or get turned into an article that discusses all the IEIs. My goal here is solely getting this page, whose subject is exclusively the blamed-on-chemicals type, to be at the WP:COMMONNAME for the blamed-on-chemicals type. WhatamIdoing (talk) 19:44, 17 October 2015 (UTC)

• support per the reasons given above WP:COMMONNAME--Ozzie10aaaa (talk) 20:32, 17 October 2015 (UTC)
• Support for reasons given above, including WP:COMMONNAME. As another note, the disambiguation page for MCS has been mangled to remove any Wikilink to this article. In addition, the inbox appears to be misleading in its claim that MCS is "Not recognised" in ICD coding. There seems to be no single worldwide ICD standard code, but there exist many nationally recognized ICD codes, as can be seen by web searching on "multiple chemical sensitivity icd". Reify-tech (talk) 21:34, 17 October 2015 (UTC)
• Oppose since this is questionable at best. We have redirects so that people looking for "multiple chemical sensitivity" can find this article. The major problem with an article on "multiple chemical sensitivity" is the old bait-and-switch: start with a valid but rare condition, and use it to crowbar in the fake disorder "diagnosed" and "treated" by quacks and charlatans as if it is the same thing. Guy (Help!) 21:42, 18 October 2015 (UTC)
  • WhatamIdoing (comments above) was asking about good sources to base the current article name ?--Ozzie10aaaa (talk) 13:29, 19 October 2015 (UTC)
• Oppose, at least for now. It looks like what would make more sense would be a merge and redirect of electromagnetic hypersensitivity into this article, so that all the various flavors of IEI are under one roof. Correct me if I'm mistaken, but the only real difference between multiple chemical sensitivity and electromagnetic hypersensitivity is the nature of the stimulus that the sufferers believe is causing their symptoms; there isn't any underlying organic distinction between the two—right? Treatment, in both cases, involves providing emotional support, minimizing the harmful impact of the patient's lifestyle choices, and providing appropriate treatment for any underlying mental illness. TenOfAllTrades(talk) 16:05, 19 October 2015 (UTC)
  • The experience of triggers is different. A lot of MCS people have very specific moments with problems: ("I walk past the stinky laundry detergent at the store, and I feel like I can't breathe"). This doesn't usually happen so obviously with EH folks (although they may be triggered by sounds rather than smells, e.g., a buzz in a fluorescent light fixture).
    But fundamentally, that's a WP:MERGE proposal, which is not achieved with a unilateral page WP:MOVE. In fact, if you wanted to merge the pages, then the sensible thing to do would be to move this article's history back where it was for years, and create the merge, with proper attribution, de novo. WhatamIdoing (talk) 16:53, 19 October 2015 (UTC)

If they're only distinguished by triggers, I would again suggest that there's no reason to maintain two separate articles. There really isn't a lot to say about these two conditions if we confine ourselves to reliable sources (rather than incorporating a lot of advocacy).

While I don't think it's useful to get bogged down in a 'process' argument, there's not a problem with proper attribution if a merge from electromagnetic hypersensitivity into this article – with appropriate attribution of any content brought over – were carried out. (Doing so certainly wouldn't be any less "sensible".) TenOfAllTrades(talk) 19:44, 19 October 2015 (UTC)

• Support, as it now stands. I agree that an eventual merge with electromagnetic hypersensitivity is better, for the good reasons above, but since that hasn't been formally proposed nor has anyone volunteered to do the work, the move would at least be better than the current state; I can't oppose it just because a merge might happen someday. Is there a WP mechanism to suspend this discussion while a Merge discussion is carried out? I'm not aware of one. Grothmag (talk) 19:14, 21 October 2015 (UTC)

• Support per above. Alex2006 (talk) 10:53, 25 October 2015 (UTC)

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The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Placebo controlled trial

Just a note to try to clear up some confusion by the anon IP (91.159.150.31) who keeps trying to remove a couple of placebo controlled studies from the lede. When s/he removed the text most recently, it was with the edit summary

Don't mix up sensitivity for smells (tuoksuyliherkkyys) and MCS (react also on smelles chemicals, not only the ones that smell). If you use placebos in a test, and they contain chemicals, a person with MCS, will have a reaction. And the reaction is real.

If I understand correctly, the IP editor is arguing that since MCS sufferers nominally react to odorless ("smelles"?) chemicals then placebo-controlled studies aren't valid, as the placebo may also contain "chemicals".

Fundamentally, this misunderstands the trial conditions actually used by Bornschein et al. (PMID 18568800, the fourth footnote). In their test, they exposed self-identified MCS sufferers to a mixture of organic solvents in air (at a concentration below the odor threshold for the mixture) or to clean air (the placebo condition), and looked for a difference in response to the the two different conditions. There was no statistically-significant effect. In other words, the study seems to be exactly on point to address the IP's objection—under conditions where an MCS sufferer can't smell the chemicals, exposure had no effect. TenOfAllTrades(talk) 15:52, 9 December 2015 (UTC)

It's possible that the logged-out editor actually meant odorless chemicals, i.e., the types of poisons favored by authors of murder mysteries. Some of them are quite deadly even to the least sensitive person.

The problem with this wish for "chemical-free" controls, of course, is that putting a person in a place with no chemicals whatsoever would result in murder charges. Every single molecule of life-sustaining oxygen is 100% "chemical gas". WhatamIdoing (talk) 02:43, 14 March 2016 (UTC)

Prevalence of Multiple Chemical Sensitivity, of Fragrance Sensitivity, Symptomatology and Etiology, Asthma and Chemical Hypersensitivity,

Caress, S.M., Steinemann, A.C. "Prevalence of Fragrance Sensitivity in the American Population." Journal of Environmental Health 71(7): 46-50, 2009.

Provided with permission from the Journal of Environmental Health, a publication of the National Environmental Health Association http://www.neha.org.

Caress, S.M., Steinemann, A.C. "Asthma and Chemical Hypersensitivity: Prevalence, Etiology, and Age of Onset." Toxicology and Industrial Health 25(1): 71-78, 2009.

Provided with permission from Sage Publications, Toxicology and Industrial Health, http://tih.sagepub.com

Caress, S., Steinemann, A. "A Review of a Two-Phase Population Study of Multiple Chemical Sensitivities." Environmental Health Perspectives 111(12): 1490-1497, 2003.

Provided with permission from Environmental Health Perspectives, http://ehp.niehs.nih.gov

Caress, S., Steinemann, A. "A National Population Study of the Prevalence of Multiple Chemical Sensitivity." Archives of Environmental Health: An International Journal 58(6): 300-305, 2003.

Provided with permission from the Taylor & Francis Group, Archives of Environmental Health: An International Journal, http://www.tandfonline.com/toc/vzeh20/current

Caress, S., Steinemann, A., Waddick, C. "Symptomatology and Etiology of Multiple Chemical Sensitivities in the Southeastern United States." Archives of Environmental Health: An International Journal 57(5): 429-436, 2002.

Provided with permission from the Taylor & Francis Group, Archives of Environmental Health: An International Journal, http://www.tandfonline.com/toc/vzeh20/current — Preceding unsigned comment added by Ocdcntx (talk • contribs) 21:26, 22 June 2016 (UTC)

Testing - physical vs learned response and the eventual solution

Closed discussion which did not propose changes to article or offer any supporting sources. TenOfAllTrades(talk) 15:18, 12 August 2016 (UTC)

As explained in "Thoughts on multiple chemical sensitivity" below - as the evidence suggests the plastic off-gas products act similar to tobacco smoke - the chemicals boil in room temperature from glues, PVC cable sleeves (rate & boil temp depends on mfg.process, some don't smell at all) etc, then deposit/bind to surfaces or permeate skin/get inhaled. It should be assumed that the compounds involved have different half-lives and some bind more strongly than others - exactly like smell residue from additives added to food or drinks to give them certain taste. I found that some such volatile artificial flavour additives permeate the plastic containers they came in and then the smell turns into a residue that most detergents don't clean. In my own *personal* experience I can say that the time it takes for the toxic effects to show up is very variable and this makes perfect sense. If we assume a model where exercising and perhaps "sauna" and even alcohol all combine to boil the VOC residue from the body and further exposure is eliminated or reduced, after the residue levels are very low it will more time for the symptoms causing residues and metabolites to build to level where effects show up. The symptoms may strongly be function of accumulation threshold (tip of the iceberg effect). If the "iceberg" of accumulation is not yet visible, you might not get effect. However psychological stress response to belief of being effected could trigged same response even when not effected in reality. A key distinction is: Does a learned response match actual non-learned physical response. If so, most typical "tests" would be invalid in effect as it doesn't really matter if the presumed toxic chemical is present or not in the test situation - because even if the MCS affected person could unlearn their negative response, if the response is triggered by say a common plasticizer, it does not practically matter what happens in the test situation. A completely fool-proof testing would involve the test subject being 3-4 weeks in exposed and unexposed control environments. eg. You could have two identical living spaces, one with air conditioning that is "placebo" ie. a simple fan and another that filters VOC's from the air. It could also be important to control for dust, so you'd need a low dust and above average dust situations as well. This may sound "perfect" but because the plastics also transmit the compounds through touch, you'd have to actually still also control for the materials, so we get back to the point where the only solution to MCS is to ban made in CheapCountry plastic. (The cheap country is cheap because they don't take the time to process the plastic products such that they would not off-gas at the end user or transit) — Preceding unsigned comment added by 91.155.26.87 (talk) 12:35, 7 August 2016 (UTC) Thoughts on multiple chemical sensitivity I base this on reading the article as of now and how it insinuates that MCS is largely psychological. A more accurate interpretation is that it "gets psychological" but the reason it does that is due to continued low exposure (I propose that VOCs turn into solids, based on how "new car smell" turns into solids also, part of which accumulate into body - possibly after metabolism change). If the exposure sources were eliminated, I posit that the possibly learned/somatic responses would not develop in the first place. - People in chemical & drug industry are biased in two ways : the usual way (being in the industry affected by possible regulations) and most likely also a selection bias where people who are predisposed to become sensitive are likely to not seek jobs in or switch careers. The sensitive people may/could be test subjects but as the article explains there are difficulties in separating neurological/physical and learned responses. - To say if there is a harmful effect to some % of population you'd have to find those likely to be effected before they are effected and even if you could do this there is the problem that the initial responses are very weak and not measurable externally. eg. before I even knew that such sensitivity or problem existed, the only observable symptoms were such that they could be attributed to some other thing. - The way I noticed there were symptoms related to VOC from plastics was by alternating environments from plastic heavy to none. eg. room full of computers vs being a lot outdoors while still having the same diet and exercise routine. - What complicates this is that since the synthetic VOC emissions boil at various very low temperatures, there is significant difference whether your daily activities have your extremities warm up or not. This is to say that if you exercise regularly, you probably won't get the MCS symptoms because the VOC's that cause most symptoms boil off somewhere between 25-37c range. However the fact still is that the chemicals have effects, the exercising and other things can be considered to simply mask the issue. If you are disabled or old, you should still have available products that don't outgas, including all cables, building materials, electronics, keyboards, mouses. The industry's issue is that if it could be shown clearly the outgas products are toxic then businesses that prioritize profit over value could quickly go bust as discounts would not keep them in business - quality/value metrics get thrown out if you are in a race to do things quick. In the meantime the market is open for anyone with some marketing budget and money for independent testing to show their products are safer than the competition. There isn't really even any argument about "what to test". There are tests that measure simply "anything" that ends up transmitted from touch or outgassing (these tests are used by NASA when selecting materials for space missions). So the marketing simply needs to show that widely used cheap products have different properties. Following theory has not been studied but I suspect that alcohol may interact with the VOC metabolism such that alcohol users may not develop similar sensitivity. I base this on by tests on how alcohol interacts with PVC off-gas solids residues (soak foul smelling cables in isopropyl alhocol water mix and let it dry, smell appears to change). (it appears to "boil" the solids off, similar thing could happen when you consume alcohol - just a theory so far as I don't drink alcohol at all and it could be hard to separate the alcohol side effects from the VOC residue interaction) - The strategy of finding "less toxic alternative" is only good if the focus is not solely on "after disposal" but also on whether the synthetic chemical get into working/living area air or interact with skin on touch. - "Hard, Cheap, Synthetic" likely in conflict with biodegradability/low landfill toxicity. Landfill toxicity is however likely to become less of an issue with landfill mining and advances in waste disposal where residual gasses from waste can be turned into small amounts of glass-like solids or re-used. (this mining plasma gasification does not entirely eliminate the toxic waste but allows storing it safely compared to the current methods because the 'toxic glass' won't leach like the plastics in the landfill) - Long term sustainable solution is to design products to order with high quality materials. Factories/producers need ability to rapidly & cheaply change configuration (factory setup automation?) to lower cost of ordering materially different products. (eg. referring to computer keyboards here, most seem to be made by couple different factories cheaply and are the largest source of chemical exposure) - You can test how crappy your plastic product/keyboard is by pointing a hair dryer at it - if it starts almost immediately smelling foul you know the plastic is crap quality that turns volatile at low temps. Ideally the electronics don't off-gas at all under 75 degrees celsius because then they can be heat treated at anytime, which is important because shipping containers may go through heat treatment and plastic chemicals should not transition or interact with things after leaving factory. — Preceding unsigned comment added by 91.155.26.87 (talk) 11:37, 7 August 2016 (UTC) Jut so you're aware, article talk pages (like this one) are for discussions about how to improve Wikipedia articles. I'm afraid that they aren't intended to be used as a general discussion forum about the topic, or a place to post your personal experiences, opinions, theories, or testing protocols. Do you have suggestions for specific changes to the article, based on high-quality reliable sources? TenOfAllTrades(talk) 18:08, 7 August 2016 (UTC)

AshMash (talk) 17:46, 24 February 2017 (UTC)AshMash

Heading

Hello, I am a physician familiar with MCS and new to wiki editing. I'm seeing various issues with the main article that I'm hoping will be addressed. There is a heavy bias in the article that favors a dismissive and anti intellectual narrative concerning these peoples experience. I feel like I'm watching witches getting burned in the dark ages. Lack of evidence is not evidence to the contrary. Ignoring evidence does not constitute lack of evidence. Calling people crazy does not help them seek needed medical attention. any thoughts? Dr.Neil (talk) 11:53, 2 May 2017 (UTC)

TILT

SoBeMeland wished to introduce an article about TILT from Discover magazine in support of the addition:

I've moved it here for discussion. One problem is how close this phrasing is to the subtitle of the article referenced.

I see from the archives that TILT has been discussed before for this page. Beyond referring them to WP:MEDRS, is there anything else we can do to help them get started?  —jmcgnh^{(talk) (contribs)} 04:17, 2 July 2016 (UTC)

Not really, no. Discover is never going to meet RS. Guy (Help!) 05:55, 3 September 2016 (UTC)

There are multiple publications on TILT outside of discover magazine. Is there some logical reason it is being excluded as a theory? Dr.Neil (talk) 12:21, 2 May 2017 (UTC)

Improved links with new paragraph

I am concerned that at least one reference link on the MCS page directs to a subscription only website. It does not appear proper to quote from such a source in the reference, even for clarification, if the context and overall content of the website containing the quote are generally inaccessible, and there is a better alternative. This reference, 3 Gots RE (1995). "Multiple chemical sensitivities--public policy". J. Toxicol. Clin. Toxicol. 33 (2): 111–3. doi:10.3109/15563659509500459. PMID 7897748

quotes from a very old (1995) source, and redirects to 'Taylor Francis online'- http://www.tandfonline.com/action/cookieAbsent

I suggest replacing this reference with the generic source - https://www.ncbi.nlm.nih.gov/pubmed/7897748

which puts the article in its correct context of workers' compensation claims, along with with other relevant and more recent sources available, and therefore removing the included quote (from the article's abstract) or preferably removing reference 3 altogether. This is especially desirable since public policy, particularly that of the Environmental Protection Agency, has now moved on considerably, see -

https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality

It would also be in the interest of balance to include the link above in the main page.

There are a considerable number of relevant peer-reviewed articles listed on this web page -

http://www.chemicalsensitivityfoundation.org/chemical-sensitivity-research_bibliography.html

some of which I do not have immediate access to, lacking academic subscription access at present, so I have not yet had a chance to select the most relevant articles to propose links to. However since the main page begins,

'Multiple Chemical Sensitivity ... is a disputed ... condition'

it seems more than reasonable in the meantime to include a link to the Multiple Chemical Sensitivity Foundation bibliography page somewhere near the top of the wikipedia page, as without such a reference the nature of the issues in dispute is unclear, and a largely a matter of loose speculation.

I also propose removing the word (and unecessary link) 'vague' as it precedes a list of specific (ie defined) reported symptoms.

I will leave these matters here for discussion for the time being, and hope to return to them for feedback in the near future.

The sentence,

"British Gulf War syndrome sufferers who used personal organophosphate pesticides may be more likely to report the symptoms of MCS.[28]"

was included in the main paragraph heading 'Genetic differences in metabolism', which is clearly a mistake, so for the time being I have edited the page with a paragraph break, as though I am not an expert on Gulf War veterans' experiences or organophosphate poisoning, Gulf War Syndrome is a subject in itself, and it is inaccurate as well as disrespectful for these veterans to have their health issues directly joined to a mis-labelled note. — Preceding unsigned comment added by AshMash (talk • contribs) 17:22, 24 February 2017 (UTC)

I agree with the proposed changes, and attempted to make some of them, however the edits were quickly erased. What I find amazing about this place is that I am a medical doctor who treats MCS patients, and I can be shouted down by any quack with their degree from google U Dr.Neil (talk) 12:25, 2 May 2017 (UTC)

That's what's so great about wikipedia! It doesn't matter what qualifications anyone claims to have. Anyone's contributions are valued when they provide reliable sources for their additions. Natureium (talk) 14:01, 2 May 2017 (UTC)

Ideas to spread awareness through Wikipedia

Hi! I'm returning to Wikipedia after a long absence due to medical issues and now with a new diagnosis of Ehlers Danlos Syndrome and possible Mast Cell Activation Syndrome, after being diagnosed previously with fibromyalgia and suggested MCS, all these things possibly being related for many of us. I noticed that the Fibromyalgia page on Wikipedia doesn't mention Ehlers Danlos Syndrome, even though a large number of us with FMS are now being diagnosed with EDS as awareness increases. I think it would be very helpful to many people to steer them this way if they show other EDS symptoms. I also noticed there's no mention on this EDS page of Mast Cell Activation Disorders, Including Mast Cell Activation Syndrome, despite it being a common comorbid disorder https://en.wikipedia.org/wiki/Mast_cell_activation_syndrome And there's no mention of that at https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity even though MCS and MCAS strongly appear to be overlapping syndromes by different names. I would like to find supporting studies and link all these things together for people learning about these conditions. I think we could connect A LOT of dots for people suffering from these syndromes, like myself, or people they know with these problems. I keep meaning to do it myself, but I'm in them middle of a lot of medical stuff myself, of course, and I'm relearning how to edit here, too, after many years away, so I'm asking that if anyone would love to make these really significant contributions for the greater good to please feel free to jump on it. Thanks! — Preceding unsigned comment added by AliaZebra (talk • contribs) 01:16, 3 November 2016 (UTC)

I am noticing a lot of biased posts that are dismissive of MCS, and of general scientific inquiry- which frankly is shocking as I thought that's why most of us were here. I feel like the lack of scientific consensus is being viewed as lack of knowledge and evidence, of which there are a plethora of both. Dr.Neil (talk) 12:20, 2 May 2017 (UTC)

The article cites reliable, science-based sources, that clearly establish a consensus that, with all available evidence, MCS is largely if not entirely psychosomatic. If you have equally reliable sources (i.e. medical journals and peer reviewed studies, not Natural News or InfoWars), you are welcome to add such content. But Wikipedia is for documentation of existing sources, not 'activism' to promote a fringe hypothesis. Trilobright (talk) 13:05, 15 June 2017 (UTC)

Video links on Chemical Sensitivity, History of Environmental Medicine and treatment techniques, Mold exposure, Legislation on Wi-fi

1 a. NEW: https://www.youtube.com/watch?v=Xd9wcWqO3Ww&index=25&list=PLMAz9ZRXjYmoXSabQE54w0DhZ28y11mEO

Mass State House: L Testimony on EMF - no Wi-fi in schools.

1. b https://www.youtube.com/watch?v=yfJfxBDSm9g Massachusetts State House Testimony on EMF education 3 minutes

2. https://vimeo.com/228667494 White House Chronicle

3. https://www.youtube.com/watch?v=9qWLM7pMR2E NIEHS 2016 Landmark Government Lecture

4. https://www.youtube.com/watch?v=XOdO5bpSJaY Young Man Testimonial after 5 days

5. https://www.youtube.com/watch?v=kz6tTObAv_0 Cleveland Clinic Data Lecture

6. https://www.youtube.com/watch?v=yhy4DNuvyTk Penn Med Part 2 A

7. https://www.youtube.com/watch?v=QBHZiOCF1QA Penn Med Part 2 B

8. https://www.youtube.com/watch?v=8NlSw-XisIo&t=257s Doris Rapp Env sick schools

9. https://www.youtube.com/watch?v=Bq90WKHlaVM&t=36s Vineyard View Opiate addiction

10. https://www.youtube.com/watch?v=16Vx5-pZBNw Opiate Addiction MV School/ Hospital CEO

Posted by Lisa Nagy MD FAAEM, Boarded in Emergency Medicine and Environmental Medicine Lisanagy (talk) 06:50, 2 February 2018 (UTC)

Okay and? Doc James (talk · contribs · email) 07:02, 2 February 2018 (UTC)

Some very dated statements given undue weight

defunct NIEHS webpage

At the top of the Causes section, we have

There is no clear consensus for the cause or causes of the symptoms of MCS. A 2007 National Institute of Environmental Health Sciences paper defined MCS as a "chronic, recurring disease caused by a person's inability to tolerate an environmental chemical or class of foreign chemicals".[11]

The citation ([11]) is to an Archive.org mirror (https://web.archive.org/web/20070516181511/http://www.niehs.nih.gov/external/faq/mcss.htm) because the original webpage no longer exists. I can't find the text anywhere on the current NIEHS website (though someone with more capable search-fu is welcome to take a shot at it). Googling just finds lots of Wikipedia mirrors and advocacy sites that quote the same text (and who probably pulled it from our article).

Our use and description of this source are both problematic. The date is just wrong—2007 is the date on the particular Wayback Machine entry quoted, but the same page existed in Wayback archives at least as early as 2003. The page doesn't cite any published sources more recent than 2001. As well, it's incorrect to describe the publication as a "paper"; it seems to be some sort of contributed post to some kind of FAQ-type collection. It would have been very questionable for us to represent the page as speaking in the NIEHS' voice even when it was still posted on their website; it's entirely inappropriate for us to continue to use it now. TenOfAllTrades (talk) 20:14, 5 February 2018 (UTC)

Re the Epidemiology subsection

Apologies to TenOfAllTrades (talk) if I am hijacking the section.

The two references used in the Epidemiology subsection — Lax and Henneberger (1995, PMID 8572720) and Donnay (1999; doi:10.1080/109158199225099) seem to be outdated and/or not up to WP:MEDRS. The former is 23 years old, and details a study of just 35 patients; the latter is 19 years old, is not listed in Pubmed, and (as per the abstract) makes statements that are now outdated. Is there any more recent and/or better evidence that could be substituted? --papageno (talk) 04:32, 17 August 2018 (UTC)

Studies to include

Would someone please update the article with info from these 2 studies?

This recent one (2015) found reliable biomarkers out of a sample of 200 patients with MCS including histaminemia, Nitrotyrosin, autoantibodies, and hypoperfusion in the limbic system. Reliable disease biomarkers characterizing and identifying electrohypersensitivity and multiple chemical sensitivity as two etiopathogenic aspects of a unique pathological disorder.

This one discusses how the TRP channels in the chemosensory trigeminal nerves in the nose may play a role in chemical sensitivity. Breathtaking TRP Channels: TRPA1 and TRPV1 in Airway Chemosensation and Reflex Control

--2605:E000:8A50:6900:31FE:493E:812F:6E0B (talk) 21:07, 5 November 2018 (UTC)

I haven't looked at the second article, but I'd be leery of using the first. They have no control group for comparison, and the conclusions are not supported by the content: nowhere do the authors show that these markers separate EHS/MCS from each other nor from any other population. Perhaps this is unsurprising when they come from the unusual position that these are "widely accepted diagnoses". Grothmag (talk) 20:11, 21 November 2018 (UTC)

New additions

Please read the policies and guidelines regarding content on wikipedia. Especially relevant in this case is WP:MEDRS and WP:FRINGE. The additions made to this page are not appropriate. If you post a wall of text trying to argue this, I'm not going to read it. If you think that this actually does not apply, please clearly state what exactly doesn't apply. Natureium (talk) 21:36, 15 December 2018 (UTC)

Suggestions for improving the Intro

Thanks for the welcome and for asking of my overall impression of the article. I had a think and put down some thoughts on the intro. MKarlsssson (talk) 13:07, 20 December 2018 (UTC)MKarlssssonMKarlsssson (talk) 13:07, 20 December 2018 (UTC)

Bias up top

The intro is now a bit more up to date and a few notches less biased than it was (thank you to the editors who helped with that). In my view, it didn't, and still doesn't, adhere to a neutral point of view WP:NPOV. It gives the psychogenic theory of MCS undue weight, well above the toxicological theory and all other theories. This is bias. Recent reviews we cite say the etiology and causes of MCS aren’t understood. Therefore one postulated cause shouldn’t be elevated above another.

I’d like to see the intro edited so that it reflects a neutral point of view. This is how I think that could be done. MKarlssssonMKarlsssson (talk) 13:07, 20 December 2018 (UTC)

Just because a source says there may be or are abnormalities in the limbic system and increased sensory sensitivity does not mean it is not a psychiatric or psychogenic disorder since the limbic system could just explain the anxiety part of the disorder. It is biologically implausible that scents of say perfume could wreak havoc on someone’s mental of physical wellbeing.--Literaturegeek | T@1k? 20:11, 20 December 2018 (UTC)

I agree that the lines between "psychological", "psychiatric", and "neurological" are very blurry. But I think it's important to write the body of the article first. WhatamIdoing (talk) 21:53, 20 December 2018 (UTC)

Recommended edits

1. Ditch “pseudomedical diagnosis” and “nocebo” from the box on the top right.

2. Move the provocation/nocebo studies sentence into causes or into its own section under causes

3. Move the “depression, somatoform, anxiety” sentence into “causes”

4. Change “peculiar” to “particular”MKarlssssonMKarlsssson (talk) 13:07, 20 December 2018 (UTC)

Top-right box playing favourites

“Nocebo” here suggests MCS is all nocebo and that’s absolutely not the consensus, nor was it the finding of the review of the provocation studies cited (it’s also not the most important thing about MCS). And “pseudomedical diagnosis” isn't consistent with the current scientific consensus, nor is it mentioned in the academic reviews we’ve included from 2018. This is biased and misleading. The psychogenic camp is clearly the teacher's pet. MKarlssssonMKarlsssson (talk) 13:07, 20 December 2018 (UTC)

Until such time that multiple chemical sensitivity is accepted by the world health organisation and similar it will be a pseudodiagnosis.--Literaturegeek | T@1k? 20:11, 20 December 2018 (UTC)

Position of provocation studies and nocebo

Provocation/nocebo studies are not generic information about what MCS is. That’s why several editors tried to move the sentence about provocation studies in the intro to “causes”/“psychological” (and each time it was moved back). This reference is clearly there to support the psychogenic theory. It’s giving it undue weight having it in the intro. Does it have a place on the page? Sure it does. But if you put it in the intro, you’re giving it elevated importance above other research. Also, it’s from 2006. Hardly current. You could just as easily mention limbic system abnormalities. But, no, doing that in the intro would be biased too. So, please, put research about possible causes under “causes”.

And on nocebo, asthma sufferers have repeatedly been shown in clinical studies to have asthma attacks in response to nocebo provocations. Here’s one https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814540/. Does this prove asthma is a psychogenic condition or a pseudomedical diagnosis? Nup. Does asthma have reference to nocebo trials in its WK intro? Nup. Because it’s not the most important thing you need to know about asthma. Same goes here.

If you’re interested in nocebo, you might like this 2018 study: https://www.ncbi.nlm.nih.gov/pubmed/30146057 of nocebo in neurological diseases. It concludes that “nocebo responses have been found to be very prevalent in various neurological conditions, in particular, in many brain disorders including headache, Parkinson's disease, Alzheimer's disease, depression, epilepsy, multiple sclerosis and motor neuron disease.”

On the basis of recent research like this, I’d argue that the subject of nocebo responses should have its own section, below causes. It is interesting and it is important, but when researchers don’t understand the relationship between nocebo and causes of a condition, it’s misleading to elevate it as key to our understanding of MCS. It isn’t. MKarlssssonMKarlsssson (talk) 13:07, 20 December 2018 (UTC)

Yea, but asthma has an enormous amount of scientific evidence determining it to be a real physical disorder whereas MCS works on biologically unlikely theories, and nocebo is necessary to explain why some people think they react to microscopic amounts of perfume or solvent in the air etc. I accept newer sources should be sought.--Literaturegeek | T@1k? 20:11, 20 December 2018 (UTC)

I don't think that's true. Tiny amounts of some smells can have truly surprising results. The situation with average MCS seems to be less Hyperosmia (which can have neurological causes, and which some MCS people do report) and more like Parosmia – you can smell something, but you can't quite place it, so the brain decides that it's probably dangerous. Add a little natural tendency towards anxiety, and you can easily imagine how that could quickly spiral downwards. Anyway, my point isn't that I've got it figured out, but that it's not necessary to reach for a nocebo effect to explain anything here. That's one option, but it's not the only option. WhatamIdoing (talk) 22:03, 20 December 2018 (UTC)

One mistake throughout this page (and it's an important one) is that people with MCS don't only react to odours, as MKarlssson has raised above.

This is well documented in the literature, including in the recent review from Milan University.--Leobenite | T@1k? —Preceding undated comment added 05:05, 16 October 2019 (UTC)

Position of line on mental illness being the cause of MCS

This sentence also has no place being in the intro: “Some experts attribute the symptoms to depression, somatoform disorders, or anxiety disorders”. Why is this up top when other, I'd argue, more current and accepted theories aren't? You could equally put: “Many experts think MCS is caused by chemical injury or limbic system impairment”. Also, this reference is from 2001. Outdated studies don’t belong in the intro. This line goes under “causes”, “psychological’, where it was moved to several times in recent edits, only to be moved back.

The broad context here that's worth considering, too, is that historically a lot of diseases, where the aetiology of symptoms wasn’t understood and the subjective experience of sufferers wasn’t considered important, were labelled psychogenic. A good example is multiple sclerosis, formerly known as “hysterical paralysis”[2] prior to MRIs -- ouch!!

Automatically giving conditions that aren’t understood yet a psychogenic explanation is a questionable habit that still enjoys unjustified currency, and this habit is a recurring theme in this article.

Is MCS an anxiety disorder? Nup. Is it correlated with them? Yep. And on this, please consider that social isolation is stressful for humans and it’s one of the biggest risk factors for mental illness (MCS can be profoundly socially isolating). Being chronically ill also isn’t fun (understatement). Barriers to accessing public spaces, employment and social participation are a hard gig for MCS sufferers (perfumed personal-care products being the main barrier there). I would argue that being psychologically stressed out would be an understandable response to the psychosocial and physical stresses that people with MCS tend to live with. And several studies (eg. this one[3]) have found that mental health symptoms tended to arrive post onset of MCS.

Why am I going down this road? Because the intro doesn't even mention that MCS can be associated with high levels of disability. I mention above that nocebo studies aren't the most important thing you need to know about MCS. I'd argue that the way sufferers are disabled by MCS is (regardless of the cause/s of the condition). I think this subject not getting proper coverage is a major weakness of the article. And I'll come back to this later.MKarlssssonMKarlsssson (talk) 13:07, 20 December 2018 (UTC)

There is little doubt that many people claiming to have MCS are sick with symptoms. The question is their eitiology, which could be mental illness (depression, anxiety, somatoform etc), chronic fatigue syndrome, IBS, side effect of a medication, celiac disease, thyroid disorders etc - really a laundry list of a thousand and one different possible reasons for feeling terrible. But then for MCS sufferers to say their health and wellbeing is horrific and are house bound because they’re sensitive to perfume smells, solvent smells, is really just biologically implausible self-misdiagnosis of real symtoms with a different cause. You need sources to say they are housebound because of MCS. Do you have any? Just because a hundred or so years ago some doctor misdiagnosed MS as a hysterical disorder does not prove the biologically unlikely disorder of MCS is real.--Literaturegeek | T@1k? 20:11, 20 December 2018 (UTC)

“Peculiar personality traits” ableist

Re the Viziano reference and the line about “peculiar” personality traits being associated with MCS, this is a subjective judgment (after all, one person’s peculiar, could be another’s charming), it’s certainly negative and it’s moderately denigrating of sufferers. Yes, it is the language used in the translation of the review, but that doesn’t mean we should republish ableist[4] language.

The days of labelling people with lesser-understood disabilities or atypical behaviours or appearances “peculiar” are gone. It’s offensive. I suggest changing it to “particular personality traits”. This would give readers the concept minus the negative subjective judgment.

If you got this far, thanks for reading. I’d be interested to hear your thoughts on any of this.

MKarlsssson (talk) 13:07, 20 December 2018 (UTC)MKarlssssonMKarlsssson (talk) 13:07, 20 December 2018 (UTC)

Your signature seems to get duplicated. Just type four tildes, one time, and nothing else. It should add your user name, a link to your talk page, and the date automatically. (If you're already doing that, and not typing four tildes, then your name, and then four more tildes, then let me know, and we'll go de-bug your account.)

I think that the "psychogenic" thing is built into the definition of MCS, which says that you have MCS if you say you do. What's to stop a person with depression or anxiety from saying "No, doc, really, I don't have anxiety. Anxiety is for weak people. I have physical problems with those nasty chemicals"? Well – nothing. Unlike a true allergy (which is also over-reported in self-diagnoses), there's no requirement that the problems be proven in an objective fashion. So from the POV of the general-practice clinician, a third of patients have an anxiety disorder, and a tiny fraction have problems with multiple chemicals, so statistically, if someone shows up in a doctor's office claiming that dryer sheets (which I hate without reservation) causes panic attacks, the doc is realistically going to think anxiety first, and "chemicals" only much later.

Overall, I see a self-contradiction in the current first paragraph (it is the "result of low-level exposures" to chemicals, but the etiology is not agreed upon – either we know that it's the result of these chemicals, or the etiology is still being debated, but it's not possible for both of these claims to be true), but I don't think we should try to fix the lead first. The best process is usually to find a couple of good sources, and to build the body of the article first, and then to summarize the body into a lead.

So let's pretend this was a game. The first step in the game is to find the last two or three review articles on this subject. The most recent three that I see are:

• Rossi, Sabrina; Pitidis, Alessio (February 2018). "Multiple Chemical Sensitivity". Journal of Occupational and Environmental Medicine. 60 (2): 138–146. doi:10.1097/JOM.0000000000001215. ISSN 1076-2752. PMC 5794238. PMID 29111991.{{cite journal}}: CS1 maint: PMC format (link)
• Alessandrini, Marco; Della-Morte, David; Pasquantonio, Guido; Micarelli, Alessandro; Viziano, Andrea (2018-11-01). "Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review". International Archives of Occupational and Environmental Health. 91 (8): 923–935. doi:10.1007/s00420-018-1346-z. ISSN 1432-1246.
• Dantoft, Thomas M.; Andersson, Linus; Nordin, Steven; Skovbjerg, Sine (2015). "Chemical intolerance". Current Rheumatology Reviews. 11 (2): 167–184. ISSN 1875-6360. PMID 26088215.

They seem to describe a range of viewpoints on the question of "chemicals", from skeptical to supportive, which is exactly what we need for that part of the article. Do those look like decent journals to you? Are there any more recent reviews that you think would be better? WhatamIdoing (talk) 17:29, 20 December 2018 (UTC)

On Gots

I've been really It appears from this review [5] that the dismissive quotations from writings of Ronald Gots should not be cited as authoritative. The abstract of his tendentious 1995 editorial is quoted in its entirety, with three references to that footnote in this

Turning back time with the intro

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.

---

@TylerDurden8823: I see that you've taken the introduction back to some version of what it was before, without consultation, when it had been carefully updated, over several months, by several people, in line with 2017-2019 reviews.

I feel disappointed that the good work that was done has been undone. I'm also confused about why this has happened without any discussion or consultation here.

I propose that the old introduction be put back–for now—and that any contentious issues about it be discussed here, and that changes be made in line with the consensus reached and in line with WP policies.

Previously, we had two verbatim definitions of MCS, both from the two most recent large scale reviews. Now, instead we have Tyler's own creative definition, which is transparently biased in favour of the psychogenic cause arguments.

This is not an improvement, it's a step back to the nineties. Can we please bring this page forward to 2019.

I'd like to invite other editors to give their opinions on this, and for that, here's the old intro for you to compare with what is there now. Leobenite (talk) 04:58, 14 December 2019 (UTC)Leobenite

Multiple Chemical Sensitivity (MCS), also known as Idiopathic Environmental Intolerances (IEI) and Environmental Sensitivities/Multiple Chemical Sensitivities (ES/MCS), was defined in a 2017 scientific review as "a complex syndrome that manifests as a result of exposure to a low level of various common contaminants."[1]

A 2019 review described the condition as an "acquired disorder characterized by recurrent symptoms, affecting multiple organs and systems, which arise in response to a demonstrable exposure to chemicals, even at low doses, much lower than those that would cause a reaction in the general population."[2]

Chemicals that are common triggers for MCS symptoms include pesticides, petrochemicals, formaldehyde, and perfumed products.[3] Natural irritants like mold and woodfire smoke are also common incitants.[4]

The etiology, diagnosis, and treatment of MCS are still debated among researchers.[1] MCS is not recognized as a separate, discrete disease by the World Health Organization (WHO), but a 2017 scientific review said that it can be codified as a clinical condition using disease codes in WHO's 2010 International Classification of Diseases (ICD10).[5] It also said that the condition is recognized as a discrete pathology in some countries' disease codes and by some governmental agencies.[6][7][8]

I totally agree with Leobenite. Tyler's edits have just brought back tired old narratives, which have been discredited. Martin Kempf (talk) 05:29, 14 December 2019 (UTC)Martin Kempf

Not quite. Your edits were rather bold and fall under WP:BRD. The onus is on the individual(s) introducing new material to justify its inclusion, not the other way around. There is no "consultation" required. There are several problems with the material added. Much of the material falls short of Wikipedia's high standards for sourcing when it comes to sources of medical information (see WP:MEDRS). Furthermore, it is written in a style that seems to indicate that multiple chemical sensitivity is a real disorder, when in fact, it's not a recognized condition in the medical community (as properly stated in the article). I will open this discussion to the community so we have their opinions as well. On a side note, please remember to focus on content and not editors. We write what is in the highest quality sources; this is not just about "my opinion". Also, the references that were added are not properly formatted. For example, I see no accessible links to many of these documents (e.g., the Italian Working Group article). This leads to a concerning lack of transparency for other editors. At a minimum, please add links to your sources. TylerDurden8823 (talk) 06:32, 14 December 2019 (UTC)

On recognition @TylerDurden8823: I'm an Aussie, and here, it's recognised by two colleges of physicians: the Royal Australasian College of Physicians and ACNEM. It's also recognised by at least four Australian state health departments, who each have their own hospital policies for patients with MCS. Now, I understand that it's also recognised by health departments in Canada, Italy, Spain and Japan. Just saying "it's not recognised" will not make it so. If it didn't have some level of recognition, we wouldn't have this many studies and reviews being written about it. QueerWordGirl (talk) 07:31, 14 December 2019 (UTC)QueerWordGirl

May I please have some links showing where you found these recognitions? I suspect that this mak be another case like electromagnetic hypersensitivity; The Swedish National Board of Health and Welfare found EHS not to exist while at the same time recognizing is that people claiming to suffer from EHS are in fact experiencing symptoms that, regardless of their actual cause, can be considered functionally impairing. They concluded that these people are indeed impaired, but made it clear that there is no reason to believe it has anything to do with electromagnetic fields. --Guy Macon (talk) 09:20, 14 December 2019 (UTC)

Still waiting for that evidence. I see that you have answered other questions while ignoring this one... ---Guy Macon (talk) 13:47, 14 December 2019 (UTC)

@Leobenite: I totally support your suggestion to put back the old intro and the old hacked away pieces of the toxicological causes section. Deleting that would appear to be not a very subtle way of bumping down toxic causes in favour of bumping up psychogenic causes. And that box! What is that? It's ridiculous and BIAASSSED! QueerWordGirl (talk) 07:31, 14 December 2019 (UTC)QueerWordGirl

Can you provide high-quality reliable sources (e.g., from the RACP) so we can verify that, please? TylerDurden8823 (talk) 08:25, 14 December 2019 (UTC)

@TylerDurden8823: Ah, that's your concern with the Italian Consensus. OK, for transparency, it's available in Italian here https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf. I can put that in the references. I have a PDF of a translation, but I don't know if it's available online yet. I was waiting to see if that got put up somewhere. If you can't find it (I couldn't last I looked), I'd be happy to share my copy with you (and with any other editors on here who would like to read it). I'm also concerned that you're discrediting a source without having read it.  

Anyhow, the conclusions of the Italian Consensus are not that different to the Canada Taskforce report or to the Rossi & Pitidis review—although each have a different focus. The Canada Taskforce was an entire government agency set up to look at this disease (with CFS & Fibro) over three years. This was a pretty extensive research project, with a very large number of people (including doctors and health department staff) involved. Likewise, Rossi & Pitidis looked at 17 years of MCS studies, and they paint MCS as a very serious health condition, and they talk about the problems codifying it, which I tried to incorporate in my update of the recognition sentence.  

I honestly can't see how any of these three sources don't comply with the Biomedical sources policy. From my perspective, they are solid. So, if, after looking them over, you still think they don't comply, please outline exactly how, so that we (the editors who have been using these sources) understand. And please also consider that the Rossi & Pitidis references had been in the intro for a long time. They got removed today when the sensitive subject of recognition got touched.

But back to the new intro. It breaches NPOV. It puts undue weight on one point of view (psychogenic causes) that the last several large scale academic reviews have not given much oxygen too (well, the Canadians gave it no Oxygen at all). The new intro's sources are old, when newer solid sources are available. I don't know how that can be justified. As well, the box is biased. It breaches NPOV. (And it's a pretty offensive graphic for sufferers, I would imagine.)

@QueerWordGirl: @Martin Kempf: thanks for letting us know what you think. And @QueerWordGirl: you're right that the picture of recognition isn't black and white—it's complex, varied and changing. Just as the causes of this condition would appear to be complex, as Graeme Edwards of RACP explained clearly. @Guy Macon: I'm not aware of all the sources QueerWordGirl is talking about, but the comments of Dr Edwards, the representative of RACP at the Australian parliarmentary inquiry into mould illness, certainly show that he thinks MCS is a thing, and a thing which is associated with changes in the brain. Some of his comments are, or were, on the page, if you want to read. As for state health department hospital guidelines from Australia, here is Victoria's https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Multiple-Chemical-Sensitivity-A-guide-for-Victorian-hospitals Canberra, South Australia and Tasmania also have similiar policies. Individual hospitals also have them (eg. The Mercy hospital in NYC and California http://www.lassentech.com/eimcspro.html)

In summary, if concrete problems with the last three reviews can't be clearly explained (and, no, cries of "fringe" aren't concrete), I note that several active editors on here support my suggestion to put back what was deleted today.Leobenite (talk) 09:36, 14 December 2019 (UTC)Leobenite 

Again, I will reiterate that the onus is on the person introducing material to show that it's meritorious/worthy of inclusion, not the other way around. Please try to internalize that message. It's crucial. Transparency was a concern I have, not the only concern. I want to make sure I'm perfectly clear about that. I certainly would appreciate seeing an English copy (as I imagine most readers for English Wikipedia would to assess a source's veracity. That response sounded a little too laissez-faire in my view for a verifiability issue (see WP:V). If I can't verify a source's quality, how can I (or any other editor) assess it fully? We can't-and that's a major problem. Also, one significant way I am screening its quality is that it doesn't appear to have been published in a reputable high-impact peer-reviewed journal that I can see. That's a major red flag. So yes, I am already able to start assessing the likelihood of poor quality even before seeing it. In general, I would strongly encourage you to always make sure whenever you attempt to add information to Wikipedia to include a high quality reference to support it and to ensure it's available to other editors. That's a major check and balance on this collaborative site.

I am also quite concerned about the content due to what ScienceFlyer said about the Italian Consensus group and the group in Canada higher up on this page. That raises major concerns for me. The intro does not breach NPOV (this is a common argument I see made when someone doesn't like what is said there). It reflects what the highest quality sources say and that does not constitute an NPOV breach. Please see WP:GEVAL and User:Guy_Macon/Yes._We_are_biased.. Please take note that other editors also agree with me that the sources I removed do not appear to satisfy the MEDRS criteria-that should tell you something. Just because Rossi & Pititidis paint MCS as a serious condition doesn't make it so and it doesn't mean there is acceptance on a consensus level in the medical community. Whether material has been present in the article for a long time is irrelevant. I have seen lots of material that was wrong, flawed, etc. in different articles that was unchallenged, but that doesn't mean the information is correct or deserves to stay. So far, I wouldn't characterize the newer sources as "solid" and I would disagree with your suggestion that they should supplant those references. The box also does not breach NPOV-it is consistent with what the medical community as a whole and high-quality sources state. Again, I realize this may not be in line with your own POV, but that doesn't make it an NPOV violation. There are lots of pages on subjects that can be touchy for people (e.g., Morgellons, Chronic Lyme, etc) where many people lobby for the information to say what they want since they don't like what's written, but that's not how Wikipedia works. We don't rewrite articles just because it may be offensive to someone who believes they have MCS/IEI if the sources agree that it's not a diagnosable condition based in reality. If high-quality medical science were to change and provide an explanation and show that it is based in reality, then we would reflect that, but I am highly skeptical that will occur. Exceptional claims require exceptional evidence for support. That's the bottom line. I have yet to see that produced but I (and hopefully other editors) will assess the merits (or lack thereof) of the sources you have proposed. Also, "cries" of fringe are actually a very legitimate objection whether you accept that or not, so be prepared for that. So far, the quality of the sources cited in support of MCS/IEI being more "accepted" are less than compelling (a single medical center with a statement from 20 years ago without a clear statement about the etiology/legitimacy of the condition, which is also true for the Australian document provided). TylerDurden8823 (talk) 10:31, 14 December 2019 (UTC)

@TylerDurden8823: Here is an English translation for download of the Italian Consensus infoamica.it/wp-content/uploads/2019/07/Italian-MCS-Consensus.pdf Verify away. It is a breach of NPOV because the new edits are not in line with the last four reviews that have have been published on this subject. Two of these were in peer-reviewed journals, one was published by a government department, and one was published by a large group of doctors and researchers. The psych studies you have there in the psych section are mostly from the 80s and 90s and they are primary sources and opinion pieces. And yet, despite them not being reviews and despite them being out of date, and despite their viewpoint not being the viewpoint expressed in any of the last four reviews, their viewpoint has have been elevated to the intro. How is that demonstrating a NPOV? Rossi & Pitidis is in a reliable peer-reviewed journal. Do you really think that you and your hoardes, who clearly haven't read the reviews, have greater expertise than these writers who have combed through 17 years of studies? Leobenite (talk) 16:09, 14 December 2019 (UTC)Leobenite

The problem with Rossi & Pitidis is (a) it appears to stray into novel synthesis and (b) it does not account for the provocation studies that show a clear inability to distinguish between real and fake exposure. It's the latter that lump this in with electromagnetic hypersensitivity and the rest of the fake diseases. And the existence of recent studies that try to demosntrate MCS is a thing is hardly a surprise: diagnosing and treating fake diseases is hugely profitable for quacks. Neither Rossi nor Pitidis has a PhD, both are MSc, and their prior research is either not cited (likely) or, if the name matches are them, appears to be in unrelated fields. I'm pretty confident that fails WP:MEDRS. Guy (help!) 20:52, 14 December 2019 (UTC)

Let me make one thing perfectly clear.

Wikipedia does not allow claims that a disorder or disease exists unless it has been shown to exist through a double-blind clinical trail with the results published in a peer-reviewed journal that meets the requirements of WP:MEDRS.

To see how Wikipedia handles articles about alleged disorders that don't actually exist, see Electromagnetic hypersensitivity, Wind turbine syndrome, Aerotoxic syndrome and Wilson's temperature syndrome. --Guy Macon (talk) 13:45, 14 December 2019 (UTC)

@Guy Macon: Being recognized and existing are two very different things (and the history of the recognition of a variety of diseases will demonstrate that). None of the recent academic work says MCS doesn't exist. Leobenite (talk) 16:09, 14 December 2019 (UTC)Leobenite

Mainstream sources generally say that the symptoms exist and are real but attribute them to other medical or psychiatric illnesses. In other words MCS does not exist but instead this group of people are misdiagnosing symptoms as being caused by chemicals when the symptoms exist for other reasons, e.g., anxiety, depression, somatisation disorder, CFS, etc.--Literaturegeek | T@1k? 16:22, 14 December 2019 (UTC)

No need to ping me. I am following the thread. My problem is that the articles says "There is a lack of agreement among MCS researchers on the cause or causes of the condition." in the Causes section. There is no cause of the condition. There may be a cause for why people think they have a condition that does not exist.

If it made it clear that it was talking about possible causes for people reporting certain symptoms that would be fine. Also, the article should not list "Genetic", "Immunological", "Neurological" or "Toxicological" as causes. Every one of those so-called "causes" is precluded by the fact that those who claim that they are sensitive to chemicals cannot tell chemicals from pure fresh air in a double blind test. Only the psychological cause is consistent with that result. --Guy Macon (talk) 16:42, 14 December 2019 (UTC)

I would just add that the abnormal immunological, neurological and toxicological findings are just possible evidence of an underlying disorder, i.e. abnormal neurological and immunological findings are present in a wide range of psychiatric, medical and neurological disorders, e.g., CFS, IBS, depression, anxiety, certain personality disorders, schizophrenia, fibromyalgia, tobacco use disorder, alcohol use disorder, adverse drug reactions or drug withdrawal reactions — literally tens of thousands of potential real illnesses. It is just evidence that people with MCS have a genuine illness, but it is not evidence that MCS exists. There is no biologically plausible mechanism that brief exposure to perfume, solvent smells in low levels could cause such immunological and neurological abnormalities. Basically, MCS is a self-misdiagnosis of symptoms caused by something else. MCS does not exist because double blind clinical trials have demonstrated that.--Literaturegeek | T@1k? 19:26, 14 December 2019 (UTC)

Re: "Mainstream sources generally say that the symptoms exist and are real but attribute them to other medical or psychiatric illnesses." is this not also true of people who self-report being victims of mind control by government satellites, alien abductions, demonic possession, and "The Squirrel Made Me Do It"? --Guy Macon (talk) 14:03, 15 December 2019 (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.