Talk:Morgellons/Archive4

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Archive This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Contents

My notes on changes

  1. Removed In the news section. Wikipedia is not google news. Important news stories are already in the references.
  2. Edited the CDC investigation. The only point of quoting exensively from the RFQ is as a backdoor to say that Morgellons is real.
  3. I've rewritten the history section to emphasize the role of the MRF in raising public awareness.

Symptoms and diagnosis

  1. While there is agreement on the symptoms suggested by the MRF, the data behind it (such as limited cognitive function provable by standard testing) is unpublished and unverifiable by our standards, so I'm going to report the symptoms without the suggestive commentary.
  2. Removed the description quoted from the American Journal of Psychiatry article--that was about a homeless man and drug abuser who had formication and visual hallucination of bugs, also a drug user.
    To clarify, the AJP article is still cited in the intro and the causes section (#3), but I'm not sure an extensive quotation is appropriate style choice. I will also cite it in the treatment section.
  3. Rearranged the symptom stuff to make it easier to categorize.
  4. Removed the stuff about fiber analysis by the Tulsa PD. For one thing, it is totally unbelievable that the fibers were heated to 1400C and showed no change; for another, it totally contradicts the views by the MRF researchers that the fibers are cellulose producded by Agrobacterium or hyphae of an unusual fungus.
  5. Nearly done with symptoms and causes. Comments invited. Still a little light, I think.



Proposal to edit main article

I would like to renew my proposal to replace the intro and history sections of the article with the sandbox version. I have tried to be responsive to issues and concerns that were brought up. I have tried to edit for a better style (it read like a collection of newspaper articles), and more focused content (on the role of the MRF in promoting the disease). Please respond on the article talk page talk:Morgellons. Thanks. Thatcher131 04:22, 10 August 2007 (UTC)


Treatment

I mentioned this on the Morgellons page -- I think that a treatment section isn't a good idea since the cause of this disease is unknown. Many sufferers have resorted to medicating themselves and we don't want wiki to be responsible for people's treatment decisions. Does that make sense? I am concerned about people getting harmed/liability issues. Pez1103 17:59, 9 August 2007 (UTC)

I think you'll find most disease articles have treatment sections. Thatcher131 18:05, 9 August 2007 (UTC)
Yes but these diseases probably have some idea of what they are treating, and clinical tests to support the treatment, and standard treatment plans that have been generally accepted by physicians. Since no one knows at this point if it is pyschological, parasitic, viral, fungal, bacterial, anyone treating it is just guessing. It's not a big deal to me -- I just saw this as a potential problem that I wanted to mention. It's up to you. Pez1103 18:24, 9 August 2007 (UTC)
Editing is collaborative. Let's see where it goes. Thatcher131 18:25, 9 August 2007 (UTC)
The cause of Chronic Fatigue Syndrome is just as unknown, and there is an huge, extensive, section on treatment there, including esoteric treatments such as the removal of teeth and Lyme-style antibiotics. Herd of Swine 19:18, 9 August 2007 (UTC)
I just hope it isn't an effort to try to bring in the three letters to the editor that say Morgellons is DOP and should be treated with anti psychotics since it was already decided by Flysee that these letters did not belong in the article Pez1103 22:04, 9 August 2007 (UTC)
Pez, those letters and commentaries are not off limits. They are written by professionals in peer-reviewed journals, they have extensive references, are listed in PubMed, and have been cited by peer-reviewed articles. There is nothing wrong with those letters. They are very useful references. I'm assuming you mean these: [18], [19] and [20] (and maybe [21]. Herd of Swine 01:28, 10 August 2007 (UTC)


Fyslee specifically removed all references to these letters to the editor within the past two weeks. He said that they did not belong to the article. There are two letters to the editor which suggest antibiotics as effective treatment also. These letters were also banned from the article. He said that letters to the editor were just people's opinions and should not be included as cites. It doesn't make sense to keep going back and forth on this. If so Maybe Thatcher has some insight about this issue. Pez1103 02:47, 10 August 2007 (UTC)

Sigh. It sounds like Fyslee is operating from the strictest possible interpretation of the reliable source policy. That is, the letters do not count because they are the opinions of MRF-associated doctors and the claims have not been reported in peer-reviewed journals or reproduced by independent researchers. This is a valid point. However, I believe that a looser interpretation is possible. The opinions of scientists who are experts in their fields are routinely quoted in science articles all over the place. If the objection here is that the opinions are not supported by objective research, or that the scientists have potential conflicts of interest, that can be dealt with in a disclosure sentence, as I have tried to do. Thatcher131 03:18, 10 August 2007 (UTC)
I support inclusion of references written by qualified people (ie, doctors, scientists) when peer-reviewed references are not available, according to WP:V. WP:RS does not even mention the term "peer-reviewed". --Parsifal Hello 03:31, 10 August 2007 (UTC)
I tried to find the edits -- Revision as of 15:00, 29 July 2007 (edit) (undo) Fyslee (Talk | contribs) (rmv unreliable sources)Revision as of 14:38, 29 July 2007 (edit) (undo) Fyslee (Talk | contribs) (a letter to the editor is not a WP:RS) -- At the time I was trying to include a letter from Bransfield and was told that it didn't apply and all the cites were taken out. Bransfield wrote a letter that distinguished DOP and Morgellons and stated that his patients improved with antibiotics. Dr Harvey in his letter to the editor stated that his patients also improved on antibiotics. Pez1103 03:45, 10 August 2007 (UTC)
I haven't read the letters yet but I will eventually; its also important to distinguish between letters that are commentary or opinion and letters that report results. The letter format is used in many medical journals for short reports of a case or a clinical experience that is worth sharing but not worth (or able to be) writing up as a full research study. (Full research studies often take years and cost hundreds of thousands of dollars to complete.) The letter format may be used to describe an interesting case, or to note a doctor's clinical experience using a particular drug ("In our clinic we find that although drug A costs twice as much as drug B, it is more effective so patients can stop using it sooner, with a net savings" for example.) I have never heard, on Wikipedia or in the scientific community where I work, that such letters are unreliable. While a full double-blind trial of an antibiotic for Morgellons is the gold standard, if a doctor reports in a letter to a journal that he treated 5 Morgellons patients with a certain drug and they improved, that is certainly quotable according to our usual policies. Thatcher131 04:10, 10 August 2007 (UTC)
I think this all refers to one particular point of contention back then during a heated edit war between Pez1103 and Fyslee (see: [22] and subsequent edits (over about 20 minutes, with no discussion) , and does not apply to broader issues within the article. What two editors momentarily agreed upon between themselves about one particular point of order does not establish any kind of authority. Pez, please stop mentioning this as if you achieved some consensus - you did not. Letters in reputable journals are obviously acceptable sources if there are no better sources. I have no problem with Bransfield and Harvey being referenced if it is relevant, so long as it is noted they are MRF Board members. Large quotes though are not the way to go. They should be used as references, for example, in that some doctors treat Morgellons with Pimozide and Olanzapine, and some (MRF board members) treat it with antibiotics. These letters (at least the non-MRF letters) have been cited in other journal articles, such as the Dunn article in the American Journal of Psychiatry [23] Herd of Swine 04:27, 10 August 2007 (UTC)
Actually that's a good point, I can also check on citations to see if other medical journal articles cite these letters. Thanks for reminding me. Defnitely the way to cite the letters is to say, "Dr. Smith, a member of the MRF advisory board, reported some success with antibiotic treatment.Citation" rather than extensive quotations. I write in this style all the time for my real job. Thatcher131 04:43, 10 August 2007 (UTC)
My concern at the time (and always in this type of case) is that we were on a slippery slope that would allow anyone's letter to the editor (I have written letters to the editor of the BMJ several times) to become part of Wikipedia. That's not just a backdoor means of getting one's own POV included using what is claimed as a RS, but it's moving the backdoor to the front of the house! I could point to numerous examples of a banned user who constantly references her ancient and newer letters to the editor as proof that she is a published author and that the medical journal adopts her position because they "published" her.
I can understand how in some cases such letters from recognized authorities in their field would carry much more weight and be allowable, but that would be a matter of opinion, and such decisions can be twisted by the editors active at that moment in time. We just need to be careful. It depends on the point being made and the purpose of the citation: Is it being used as "scientific proof"; an example of current opinion of the person being quoted (which would make it very allowable); or some other purpose? -- Fyslee/talk 06:20, 10 August 2007 (UTC)
Each reference needs to stand on its own merits according to its use. Who wrote the letter, what are their qualifications? Who published it, what are their standards? We're not making a general decision about whether or not "letters to the editor" are OK as sources. There's no slippery slope. --Parsifal Hello 06:32, 10 August 2007 (UTC)
I agree that we need to take each case on its own, but it is a slippery slope that has even been used by Pez1103 to deal with an actual opinion article. Pez tried to elevate the status of the opinion article and I revised the edit here. Such attempts to boost the authority of the MRF position by inflating the status of what was an opinion article is just one of many POV editorial tactics we've seen from this user. -- Fyslee/talk 06:51, 10 August 2007 (UTC)
Please stay on topic. We are not discussing Pez1103, we are discussing references. It doesn't matter what "editorial tactics" have been used in the past. It only matters what we do next. There's no slippery slope, because one bad reference that gets by under the radar does not set a "precedent". If someone inserts a questionable reference, you (or anyone else) are welcome to question it. If it does not meet WP:V and WP:RS, it can be removed. I don't see any of that as a problem. --Parsifal Hello 07:08, 10 August 2007 (UTC)
I will try to refrain from unnecessary mention of that user. I was just explaining my concerns, which happens to be the context of this discussion as brought up by Pez1103. If my edits and concerns had not been mentioned by her, I wouldn't have tried to explain. I will drop this now since no further explanation is necessary. -- Fyslee/talk 08:31, 10 August 2007 (UTC)
Thanks, that seems like a good choice. No worries. --Parsifal Hello 08:47, 10 August 2007 (UTC)

<--(outdent) What interests me is that the Am J. Clin Derm article by Savely, Leitao and Stricker is labeled in PubMed as a "review" and while it is a review of various conditions that have some relationship to Morgellons, all the claims about Morgellons itself are based on their otherwise unpublished clinical experience. For example, in talking about perforating dermatosis (in which fiber-like structures appear under the skin) they say "These dermatoses are distinct from Morgellons disease because the protruding fibers are made up of elastic or collagenous tissue that is easily identifiable by histopathology." They cite a study of fibers in perforating dermatosis but there is no citation or data showing that Morgellons fibers are different. It makes me wonder how stringently the review was itself peer-reviewed (compared, say, to an original research article). Fyslee's diff was an appropriate toning-down of the description. What I have tried to do in the draft sandbox sections is to say, for example, "Dr. William T. Harvey, a member of the MRF Medical Advisory Board, has reported that Morgellons patients also exhibit laboratory findings including increased levels of inflammatory cytokines, increased insulin, and antibodies to three bacterial pathogens.[18] However, these findings have not been reported in the peer-reviewed medical literature." (If instead of making generalities, Harvey had reported specific data showing that Morgellons patients has elevated blood levels of IL-6 and TNF-alpha compared to patients with non-Morgellons dermatitis, with appropriate controls and statistical analysis, that would be another matter, of course.) That should hopefully allow the opinions of these scientists to be fairly described while also providing the reader with the necessary caveats. Thatcher131 11:04, 10 August 2007 (UTC)

I'm afraid I didn't notice the heat of this issue, so I'll try also to shed a little light. Knowing the editorial policies for letters in a couple of scientific publications in my field, I would say that a letter, even to a reputable journal, is only a WP:RS if it would be so if self-published. Most journals, in my experience, select letters for interest to the targetted readership, and edit only for grammar and potential lawsuits, not for possible accuracy. (If a letter states that a paper previously published in the journal is inaccurate, the author(s) of that paper are often given the right to reply.)
Need I remind editors of a letter in Physical Review Letters B, which purported to be a letter dated 15 years in the future and thanking some researchers for their work in tachyon research? There may have been other indications that it was a hoax, but it was published....
If an actual reviewed paper used the data implied by the letters, that might be different. — Arthur Rubin | (talk) 15:22, 10 August 2007 (UTC)
Unfortunately there is NO "data" anywhere, in any letter or paper. All we have is anecdotes. The letters are really no different from the commentary articles - if you read them, you'll see the same discussion style tone, speculation, and lack of quantifiable evidence in both. So, given the lack of better sources, they seem like reasonable references for things like "some doctors report success with ..." . Herd of Swine 15:40, 10 August 2007 (UTC)
Or better, "Doctors affiliated with the MRF have reported success with..." at least until some non-MRF reports come out. Thatcher131 17:09, 10 August 2007 (UTC)
This all bears on the relevancy for considering letters to the editor (LTTE) as RS. I don't exclude the possibility, but, as I mentioned above, I have written letters to the editor of the BMJ several times and gotten them published. I even got editorial help from them (with several back-and-forth emails before final publishing), just to make sure that my entry in the discussions would be interesting and make the point. I definitely wouldn't consider those LTTE as RS in any sense. If I was notable enough to have a biographical article here (which I am not!), then those LTTE could be referenced as examples of my opinions, which is another matter entirely. We just need to be careful. That's all. -- Fyslee/talk 21:09, 10 August 2007 (UTC)


Symptoms and Causes section ready to go live?

I would like to propose moving the Symptoms and Proposed Causes sections into the live article. Please comment on Talk:Morgellons. Thanks. Thatcher131 02:39, 15 August 2007 (UTC)


Treatment

Does anyone else want to work on the treatment section? I will try to get to it tomorrow night. Thatcher131 02:39, 15 August 2007 (UTC)

If you agree with my comment about WP:LIVING[43] I really would like to see it removed promply per WP:LIVING. There has been a lot of subtle and overt MRF disinformation that should stop. ThanksWard20 20:28, 16 August 2007 (UTC)
It's not disinformation - it's a fact. She said Rife had been used. The argument that facts should not be included because they make someone look bad is weak. I agree the Rife reference should be removed because it is was not widely reported in secondary sources, just the primary source: Savely herself (one quote from Savely in an online chat), but NOT because of anything in Wikipedia:Biographies of living persons. Several people consider the Rife machine to be a valid form of treatment for many diseases, it seems Savely herself does, based on that one comment. Herd of Swine 20:52, 16 August 2007 (UTC)
I believe the text I would like to see removed is disinformation, and contentious. The structure of the text in the article, "One of the authors of the two original papers on Morgellons has said the rife machine helps in 30% of cases." makes it seem like something important is being revealed, and does make it seem Savely might consider rife a valid form of treatment as you yourself have stated. Her actual answer was,"Yes, Rife machines are sometimes used and in approximately 30 percent of cases it helps." Savely never said she used rife or approved of it, and the answer indicated the response was no better than the Placebo effect. Her answer is non-committal.
Rife machines are not FDA approved devices, and many if not most medical professionals consider Rife treatment a form of quackery. I believe one quote from Savely in an online chat is a poor source, and implying she might consider a Non-FDA treatment valid from her actual answer is questionable. WP:LIVING policy Unsourced or poorly sourced material — whether negative, positive, or just questionable — about living persons should be removed immediately and without discussion from Wikipedia articles.
If the actual Savely question and answer had been quoted with the 30% explained in context, I would consider that non-contentious and factual.Ward20 04:21, 17 August 2007 (UTC)
Well, obviously long term antibiotics is not FDA approved for Morgellons, and she uses that. It's not even IDSA approved for Lyme (for which she also uses it). Many medical professionals consider long term antibiotics for Lyme (and hence Morgellons) a form of quackery. I'm not arguing for this quote, I just don't want you to claim precedent on some false grounds. It's not being removed for defamation, it's being removed because it was a comment she made in an web chat. Herd of Swine 04:28, 17 August 2007 (UTC)
Information that is questionable and depicts a living person badly is disinformation (my opinion) and against WP:LIVING policy. For examples:
"An unapproved device may be used in human subjects only if it is approved for clinical testing under an IDE"[44] (investigational device exemption).
"It is entirely legal in the United States and in many other countries to use drugs off-label. Exceptions to this are certain controlled substances, such as opiates, which cannot be legally prescribed except for approved purposes (at least in the U.S.)",[45]Off-label use. "Both ILADS and ISDA guidelines are meant to guide the physician and neither are the final word on treatment for Lyme disease. Ultimately physicians should make their choices based upon the available science and best interest of their patients taking into account benefits and risks of any treatment."[46] Lyme disease controversy.
"On one side are those who believe that Lyme disease is relatively rare, easily diagnosed with available blood tests, and easily treated with two to four weeks of antibiotics.[2] On the other side are those who believe that Lyme disease is under-diagnosed, that available blood tests are unreliable, and that extended antibiotic treatment is often necessary.[3][4][5][6]
The majority of public health agencies such as the U.S. Centers for Disease Control maintain the former position. While this narrower position is sometimes described as the "mainstream" view of Lyme disease, published studies involving non-randomized surveys of physicians in endemic areas found physicians evenly split in their views, with the majority recognizing seronegative Lyme disease, and roughly half prescribing extended courses of antibiotics for chronic Lyme disease.[7][8]" [47]Lyme disease controversy.
The statement, "Many medical professionals consider long term antibiotics for Lyme (and hence Morgellons) a form of quackery.", is most likely true, but as can be seen above, it does not mean that it is quackery, but it may be inflammatory.
I ask that more caution be used in order that reputations of living persons and WP:LIVING policy be protected.Ward20 20:54, 18 August 2007 (UTC)

Lead

I have a couple of questions about the following text in the lead.

"A majority of health professionals, including most dermatologists, regard Morgellons as a manifestation of other known medical conditions, including delusional parasitosis[3][4] and believe any fibers found are from textiles such as clothing.[5]"

I can not find where the second word "majority" is coming from as I do not find that in cite [3] or (5), I do not have access to (4).

The text, "and believe any fibers found are from textiles such as clothing.[5]" needs to be reworded, tagged [citation needed], or deleted because as it is written it is not verifiable to the cite. The cite quotes one dermatologist Dr. Levine, "He says he has studied the fibers his patients bring in by the bag-load and they are textile in nature." Although there does seem to be a few dermatologists that say similar things in various cites, it seems a stretch to use this cite to say a majority of health professionals, including most dermatologists, believe this.Ward20 21:35, 20 August 2007 (UTC)

I found the "majority of health professionals" talk.[48] Unless reference (4)[49] says the same thing I think this source[50] should also be cited for the text above because it is the most recent.

I also found, "dermatologists say they are simply fibers from clothing, embedded in self-imposed sores."[51] which seems to be closest to the present article text.Ward20 23:06, 20 August 2007 (UTC)

The word "majority" is a summary of several sources, and has been discussed before, and, I thought, agreed upon.
See: [52], "Most doctors do not recognize Morgellons as a disease", [53] "Most doctors don't even believe it exists because the symptoms don’t fit anything listed in medical textbooks", [54] "most doctors don't acknowledge it as a real disease", [55],"most doctors believe the painful illness, called Morgellons Disease, is psychological", [56] "Most doctors interviewed dismiss alleged evidence that medical science has overlooked what patients are calling “Morgellons’ disease” and insist that the patients are delusional", [57] "most doctors believe Morgellons is not in the skin, but in the head."
It could be changed to "most doctors", if you think that's better.
The text of fibers being clothing is also a synthesis of MANY sources, with just one reference being given for clarity.
I think perhaps you misunderstand the way articles are constructed. The intent is not to quote something, and then cite it. Where facts are not in dispute (i.e., there are many sources that say one thing, and no sources that say otherwise), then it's fine to simply describe what the situation is in your own words. Not the article is not saying that is IS delusions, or that it IS clothing fiber, it is simply saying what most medical professionals say about the subject. Herd of Swine 04:01, 21 August 2007 (UTC)
You're right, it was discussed before. I missed it. That was in the second post which I neglected to indent, sorry. The words "most doctors" are more accurate to the news articles you cited. The wording here is in dispute. This text is quite different than text produced by the Mayo Clinic,[58] "Some health professionals believe that signs and symptoms of Morgellons disease are caused by another condition, often mental illness." The text used should be cited to show what source or sources are being relied upon. Readers and future editors will will then be able to easier judge the text quality.
As to fibers, I can find sources that say dermatologists, or individual dermatologists say the fibers are textile or clothing. Others hypothesize the fibers are not textile or clothing.[Stricker RB, Savely VR, Zaltsman A, Citovsky V (2007) Contribution of Agrobacterium to morgellons disease] [59][60][61] I can not find a source that says most doctors say the fibers are textile or clothing which is how I interpret the present text in the article.
How about this, Most doctors, and dermatologists, regard Morgellons as a manifestation of other known medical conditions, including delusional parasitosis.[3][4][62]
Dermatologists say any fibers found are from textiles such as clothing,[63] but preliminary studies by MRF associates lead them to hypothesize fibers from Morgellons patients are not from textiles or clothing.[Stricker RB, Savely VR, Zaltsman A, Citovsky V (2007) Contribution of Agrobacterium to morgellons disease] [64][65][66]"
Or:
Dermatologists say any fibers found are from textiles such as clothing,[67] but preliminary studies by MRF associates lead them to hypothesize the dermatologists are not correct.[Stricker RB, Savely VR, Zaltsman A, Citovsky V (2007) Contribution of Agrobacterium to morgellons disease] [68][69][70]"
Or:
The fibers found from Morgellons patients are in dispute as to their origin.[71][Stricker RB, Savely VR, Zaltsman A, Citovsky V (2007) Contribution of Agrobacterium to morgellons disease] [72][73][74]
The more I work with the fibers issue, the more I think it may be too complex to put in the lead and should be left to the body to explain. Ward20 08:29, 21 August 2007 (UTC)