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Remission after adolescence

In a few cases, complete remission occurs after adolescence, and in many cases total remission occurs after the age of 40.

I got a bit confused by this sentence: is there some technical difference between "complete remission" and "total remission" ? Perhaps the sentence should use only one of the terms. --Ejrh 14:56, 21 Nov 2003 (UTC)

Aphasia and Tourette syndrome

Is there any relation between aphasia and Tourette syndrome? EmRick 15:37, 24 Jun 2004 (UTC)

Both are treated very accessibly in The man who mistook his wife for a hat. I recommend this book, especially if you're interested in either of those conditions. I don't think Dr. Sacks mentioned any connection, but I may have missed it.--Polyparadigm 22:35, 12 Mar 2005 (UTC)

Brain injury (such as caused by stroke or trauma) is a known cause of non-genetic tics, which is referred to as tourettism, to distinguish it from inherited Tourette syndrome. PMID 15867978 Sandy 18:01, 8 February 2006 (UTC)

Descriptions of premonitory urge

Being someone who has Tourette's syndrome, I think that the comparison of an urge to do a tic to an itch is not nearly as accurate as a comparison to the urge to yawn. I will make that modification, and if anyone disagrees with it, feel free to revert it. Cessen 19:58, 28 Nov 2004 (UTC)

Thank you! This is the sort of contribution that makes Wikipedia invaluable. Welcome to Wikipedia. -- Karada 21:50, 28 Nov 2004 (UTC)

Well, it seems that people with TS have different descriptions for their Tics. As someone from the trenchs :) (having TS too) I would rather describe it as an urge to blinking the eyes, you can do with a yawn, but you can't do with a blink, I remember when being a shild, my first tic has been excessive blinking.

I respectfully disagree with the yawn analogy. If you suppress or stifle a yawn, the urge to yawn usually goes away. If you suppress a tic, the urge usually grows, and an explosion of tics afterwards can result. Yawning doesn't behave that way -- if you suppress a yawn, you don't then later have an explosion of yawns. So, it's more like an itch -- you've got to scatch it, or it gets worse. Sandy 00:06, 6 February 2006 (UTC)

Tourette syndrome does exist, but...

I am suspicious of the sentence that begins "TS affects up to 1.13% of children with a wide range of severity..." There was a time when Tourette syndrome was only diagnosed when the symptoms were extreme and plainly unwanted by the patient. Lately it is a suspiciously convenient diagnosis for children, usually boys, who might sometimes enjoy swearing or self-conscious nervous habits. I am not a "spare the rod, spoil the child" type; I certainly think that adults should be patient with hyperactive children. But is Tourette syndrome really the right explanation for most of these cases? And how can it make sense to give the incidence to two decimal places; how can you know that it's up to 1.13%, and not up to 1.14% or up to 1.12%? It looks like some people are replacing parental common sense with bad science. --Greg Kuperberg 13:46, 2 Dec 2004 (UTC)

I can't say I care for your point of view on the matter - whether or not you agree with doctors' diagnoses, or people's parenting methods, has really no bearing on this article or its merits whatsoever. However, you do raise a legitimate point - the figure of 1.13% does sound suspiciously precise to be altogether correct. I'm no statistician, but I don't think I've ever heard of a medical condition being pinpointed down to two decimal places in diagnosis. Can anybody verify/correct this figure based on recent evidence please? - Vaelor 14:37, 3 Dec 2004 (UTC)

My real concern is a drifting definition of Tourette syndrome that would weaken both Wikipedia and general public understanding. Without verifiable etiology, there can't be any consensus on how to define TS. It doesn't look like the etiology is ever confirmed, only the symptoms. In that case, just by changing the threshold of how bad the tics have to be, claiming a prevalence of 10% is as fair as claiming a prevalence of .1%. Any statement about prevalence should warn that it depends on the threshold used to define the disease.

On that note let me try to restate my previous objection. The paragraph in question goes on at length about popular misconceptions about Tourette syndrome. It has a "blame the media" tone which misses an important point: If there are popular misconceptions, they will also interfere with diagnosis. If bystanders believe that Tourette syndrome is defined as excessive swearing, then certainly there are parents who want this diagnosis in their children, and probably there are doctors who accede to these parents. The way that a condition is diagnosed does ultimately affect its definition. It is fair to say that bad movies have been irresponsible about TS. But the article should not imply that these movies stray from objective expertise, when the latter does not exist. --Greg Kuperberg 15:26, 3 Dec 2004 (UTC)

Greg, I can't even begin to relate to this opinion, so forgive me if I don't address it directly for fear I'd just end up saying something ignorant and offensive and possibly starting a flame war. In short though, granted, the only way at this time to diagnose Tourette's is per assessment of the symptoms, and as a result, this can lead to incorrect diagnoses, to both ends of the scale.

The phrase "incorrect diagnosis" implies that there is some way to decide, in principle, whether or not a diagnosis is correct. There isn't. People are no closer to deciding what is or is not Tourette syndrome than they are to deciding what is or is not art, what is or is not pornography, or what is or is not justice. Maybe one day people will give "Tourette syndrome" a relatively precise meaning; or maybe not. --Greg Kuperberg 17:15, 4 Dec 2004 (UTC)

It sounds to me like you're not so much concerned about the information in this article about Tourette's Syndrome being accurate, but more that apparently, because a scientific method of officially diagnosing TS - something concrete, like a CAT scan or x-ray, some kind of hard evidence - hasn't been discovered yet, that must mean Tourette's doesn't exist. I'm no doctor or scientist, but as far as I'm concerned, they know what causes TS, they know what the symptoms of TS are, they know how to medicate it, and as of February, it looks like they now know how to cure it. So frankly, though a more concrete method of proving a diagnosis might make for more reliable information on the syndrome being available to the public and help counteract the unusually high levels of ignorance surrounding the syndrome compared to say, Down Syndrome or Parkinson's Disease, I don't see from where I stand that coming up with a more scientific way of diagnosing the syndrome on paper is anywhere as important as coming up with effective means to combat the symptoms.

Personally, from where I'm standing, if I had to choose between research dollars going towards scientifically proving that I have Tourette's Syndrome on paper, or not almost biting off my own tongue in the morning when my tics go into overdrive after having been dormant for the few hours sleep I managed to get in, I'd choose the latter. Because whether one would require a certain "level of symptoms" to be present in order to be "officially diagnosed" with TS, or whether one doctor calls it Tourette's when another would call it something else, or whether there really is no such thing as TS and the symptoms are just the result of a combination of other problems, whatever the case may be, the symptoms are real, and they can be very disruptive. Believe me, I don't approve of overzealous parents claiming their kid has Tourette's just because he actually has ADHD and won't stop yelling swear words, but in my humble opinion, better that than have the syndrome discredited entirely, and have thousands of people who need treatment be told that they're just schizophrenic, or attention seekers, or need "the Devil driven out of them". Remember, there was a time when we didn't know how to scientifically identify cancer, or Multiple Sclerosis, or Alzheimer's Disease, or prove that the world actually isn't flat, and the sun doesn't revolve around it, but these things were studied and proven with time. Just because mankind hasn't discovered something yet, doesn't mean it's undiscoverable. - Vaelor 14:31, 5 Dec 2004 (UTC)

In my extensive experience though, I've found that more doctors are inclined to misdiagnose that somebody does not have Tourette's Syndrome when in fact they do, than vice versa. However, this could of course be different in other parts of the world. As for the article, it states that some movies imply that the only symptom of TS is coprolalia, which is not the case, hence I see nothing incorrect about the statement. If you have contrasting factual information to provide, then please feel free to edit the article - that's what Wikipedia is all about, after all. - Vaelor 16:06, 4 Dec 2004 (UTC)

I understand completely that Tourette syndrome exists. I have never doubted it. I believe in scientific explanations of the world and I have seen obvious cases of people with uncontrollable tics. It is only reasonable to call this Tourette syndrome. I also believe in basic human sympathy and I would be very glad if the medical community found an effective treatment for involuntary tics in general, or for specific classes of them. If you have Tourette syndrome, then really, you have my sympathy.

However, that does not mean that Tourette syndrome has a fixed, objective definition. Art, pornography, justice, and democracy also exist, but they have no fixed definition either. What would your reaction be if someone said that 1.13% of television programs are pornographic? I would hope that you would be skeptical. I would hope that you would be equally skeptical of claims that TV pornography is "underdiagnosed" or "overdiagnosed". Would that mean that you excuse pornography?

You say that, while you don't approve of overzealous parents who bend the definition of Tourette syndrome, you would prefer that to discrediting the disease entirely. How would you like both together? It is very unfortunate for sufferers of Tourette syndrome that its definition is malleable. People who try to bend the definition, often people who also deny that it can be bent, have unwittingly done the most to discredit diagnosis. Skeptics are not the problem, because there is no organized campaign against diagnosis.

For these reasons I would want the definition in Wikipedia to reflect common sense and limitations of knowledge, rather than to be officious or defensive.

--Greg Kuperberg 15:20, 5 Dec 2004 (UTC)

Oh, on that point, I couldn't agree with you more. I said from the first moment you brought the point of the statistic up here that I agreed it seemed suspicious, and if you or anybody else can find a more accurate way to word that sentence, I for one would appreciate it. I didn't think much of it when I first came across it, but 1.13% does sound to me like a number somebody just made up.

I agree with you on the definitions issue also, but as I said, these things take time. Art, pornography, justice, democracy - these are subjective concepts, and will doubtless always remain open to opinion and interpretation. Though I see the connection you're trying to draw, I think that putting Tourette's Syndrome in the same category is a little inaccurate. One might phrase the question, "What is art?" and get a dozen highly contrasting answers from as many people, as diverse as if you asked the question "How do you measure/define art?". However, the question "What is Tourette's Syndrome?" is a simple black and white question with a straight answer available - although there will still be the grey area when you come to "How do you measure/define Tourette's Syndrome?". What Tourette's Syndrome is, is no more a matter of opinion than what cancer is, or what diabetes is. However, a definitive scientific way of measuring and solidly identifying the syndrome in the human body has not been discovered yet. Neither has a cure for cancer, but that doesn't mean the medical community is going to give up and concede that there's no such thing. Unlike art, pornography, justice, democracy, and other such subjective concepts, a scientific method of definitively identifying Tourette's Syndrome in the human brain will be discovered eventually, I'm sure. However, until that has been done, you're right, information on Tourette's Syndrome such as this Wikipedia article probably shouldn't make claims as to statistics of diagnoses without some form of proof or explanation as to what method of measurement produced that figure. - Vaelor 14:05, 6 Dec 2004 (UTC)

I did some hunting and some Googling, and I can't seem to find that 1.13% figure anywhere.

The fact sheet from NIH has a much more realistic estimate of the number affected, and I'm going to update it in a bit to reflect that figure instead.

Carrie 16:40, 5 Feb 2005 (UTC)

I know this is an old discussion, but I just wanted to add these comments for new readers. Greg, there is one problem with your argument, which is that coprolalia is such a rare symptom, that it's not really the norm to find moms seeking diagnoses of children for swearing. (Although I also agree with you that there are far too many moms willing to attribute bad behavior to tics.) What is likely is to encounter families who have been to endless doctors, trying to understand if their child has asthma or allergies (due to coughing and sniffing), eye or vision problems (due to blinking), or epilepsy (blocking tics), as just a few examples. But, you do raise a concern shared by many about the diagnostic boundaries of the condition. Roger Freeman's blog, referenced in the article, contains a very good discussion of how "arbitrary" the definition of Tourette's is. [1] A person can have two motor tics, plus coprolalia, and be considered to have "severe" TS, because of the coprolalia. But, a person with twenty minor, less noticeable motor tics (abdominal tensing, leg tensing, slight eye blinking, small shoulder shrugs, etc.) -- but no vocal tic -- doesn't meet the diagnostic criteria. Makes no sense !! Sandy 23:08, 8 February 2006 (UTC)

Motor tics and Chronic Tic Disorders?

In looking over this article, I did notice an emphasis on vocal tics when they're only half of the disorder; motor tics are also symptoms. They can be muscle spasms, involuntary hand gestures, or other things. I only know about this because I have Chronic Tic Disorder, which is very similar to TS, except I don't get vocal tics at all; I have involuntary muscle spasms in my upper body. I'm hesitant to make edits myself, but perhaps some information on the chronic tic disorders (which are, as my neurologist explained to me, TS, only missing one of the two types of tics, motor or vocal) and motor tics could be included.

-- a brand-new, harried and slightly confused Ealusaid

I agree that we could stand to expand on the motor tics involved. The article's getting a bit top-heavy, though -- perhaps a new section explaining the types of tics and dividing it into vocal, motor, and complex?

Carrie 7 July 2005 23:01 (UTC)

Done - revised tic and tic disorders entry, some content about tics moved to there, only basic and items specifically relevant to Tourette syndrome left here.. Sandy 20:32, 8 February 2006 (UTC)

I have not been diagnosed with Tourette's Syndrome, although reading that I have done seems to indicate that I may have it. I definitely have motor tics and have in the past (and very occasionally the present) experienced motor tics -- mostly grunting, no obscenities. I was just noticing the urge-to-tic discussions, and I thought I would contribute. When I'm explaining what the tics and supression are like, I usually compare it to blinking of the eyes. You do it, but you don't know you're doing it most of the time. When you do notice it, you still do it, unless you make a conscious effort not to. In these cases, you generally follow that limited conscious-effort period with a rapid making-up-for-lost-time effect, when you blink that much more. Tics work much the same way, certainly in the motor case, and in my limited experience, the vocal as well. The yawning comparison used above is also valid, to an extent, except that one always knows when one is yawning. Oftentimes I am not aware that I am tic-cing, so I think the eye blinking comparison is the most valid that most people can relate to.

Rob

Yes as someone with TS, I would qualify the urge to Tic exactly the same way. It can be compared to blinking, although I would say that Ticing is oftem more conscious that blinking. Oddly and at least for me, Ticing IS voluntary, I can supress it (for a limited amount of time), although this require a lot of mental effort from me.

Howard Hughes

Shouldn't Howard Hughes be added to the 'famous people' list?

I thought he had OCD, not TS. The wiki for Howard Hughes makes no mention of TS. If you have proof he had it, sure it can be added in.

Carrie 7 July 2005 23:01 (UTC)

No, Howard Hughes had OCD Obsessive compulsive disorder it's closely related (they both share the obsessive aspect), but they are not the same syndrom.

chromosome 13, SLITRK1 gene the cause?

Some scientist think this is the genetic target that leads to the problem. [2]

The relevance of this finding is not yet clear, and there may have been some media hype surrounding the importance of the finding. [3]

tourettes guy

[4]

Can something be decided about this site repeatedly being added to the Tourette Syndrome page? There are legions of sites using Tourette's as a joke on the internet. Should they all be added?

"Tourette's Syndrome Plus"

Hello, I just closed the AfD for "Tourette's Syndrome Plus" as a Delete, and removed links to it from this article. However, I note that it is mentioned several times in this article. Most voters in the AfD seemed to think the term was dubious and not widely accepted...if so, will someone with knowledge in this area please examine whether the references to "Tourette's Syndrome Plus" in this article are appropriate, and if not, please remove them? Thanks. Babajobu 06:45, 13 January 2006 (UTC) ---

Tourette's Syndrome Plus is an informative website on Tourette's Syndrome plus its' many comorbid conditions. I am going to put a link to it in the external links section.

Please use the colon to separate your comments from the previous comments of others. Also, please stop deleting previous talk entries. The talk page is used to reach consensus and to discuss entries, and by deleting previous talk entries, consensus becomes more difficult. The TS plus website is an informative website, but its addition seems to open the door to Wiki becoming a DMOZ category. Should every personal website about TS be added? The "TS Plus" site is one of very few personal websites which is actually written by a practicing professional. In the same vein, should every "famous person" who ever claimed that an outburst was Tourettic be added?

I did not delete any previous talk entries on this topic. However, you are not my master.

It appears that you may have, indadvertently or otherwise, overwritten previous talk comments, which have now been restored. 152.163.100.13 15:51, 3 February 2006 (UTC)

There should be links to other organizations, not just the Tourette's Syndrome Association. The TSA does not own this article or this website! They are also not the only charity for TS!

The TS Plus website is mostly written by one individual, but the information is basically accurate. It is not an advertisement of her services, it just has good information! It is absurd to limit links only to websites maintained by organizations! It is better to link to websites which have accurate information.

There should not be links to personal websites written by laypersons who do not maintain updated websites, which include POV and which use dubious credentials. For example, a link to a site signed by a "PhD" which is not a legitimate accredited PhD could mislead readers. Wiki is an encyclopedia, not a search engine. I believe that adding links to sites written by actual practicing professionals could be a reasonable compromise. So, if you agree, we can delete the Tourette's Disorder website, and leave the TS Plus website.

No they should both be posted. The TSA does not control this website, and the TSA has had a dubious past. It is a well known fact that the TSA denied the fact that ADHD and OCD were comorbid conditions for as long as they possibly could. They tried to unsuccessfully discredit Dr. Comings. The TSA does not ike people who disagree with them. The TSA is NOT an OBJECTIVE resource on TS!

Faults aside, the TSA (and its Medical Advisory Board) is the prevailing authority on Tourette's syndrome. The TSA did not deny that ADHD and/or OCD were comorbid conditions. Comorbid does not equal genetic linkage. Valid research by Tourette Syndrome researchers shows that the hypothesized genetic linkage between ADHD and TS is controversial and unclear, while the linkage to OCD is more widely recognized. Many researchers disputed Comings' claims about linkage to other disorders, symptoms, and conditions. I concur that the TSA was wrong to have involved itself in that scientific controversy. 152.163.100.13 15:51, 3 February 2006 (UTC)

These are all arbitrary statements that you have not backed up with any references at all! If you really want to get into the debate over ADHD and/or the debate about the use of stimulants in treating Tourette's, that's another can of worms! That debate itself could warrent another section in the article!

It would not be hard to state the facts as known. There is some evidence that some forms of TS may be associated with ADHD, and there is some evidence that TS is not genetically linked to ADHD at all. There is no clear consensus in either direction, and controversy remains. Easy. While there remains some concern about using stimulants in the treatment of tic disorders, there is abundant, replicated medical evidence supporting the use of stimulants in the presence of tic disorders, and showing that stimulants do not increase tics any more than placebo does. However, the issue with Comings was quite different, as he extended the boundaries of Tourette's beyond the common co-occurring conditions of ADHD and OCD, to include such items as sexual deviation. Sandy 22:26, 3 February 2006 (UTC)

Sandy, you make a lot of assumptions. First of all, why do you assume my name is Toluca? Second, why do you assume I agree with Dr. Comings? I beleive Dr. Comings was a pioneer is proving that OCD and ADHD are typical comorbid conditions, and that it is okay to use stimulants for people who have TS and ADHD. I also agree that Dr. Comings stretched the comorbid thing too far. I especially agree with you on the stimulants issue. Unfortunately, some TS experts, like Dr. Thomas Lowe, on the TSA MAB, still think you should never perscribe stimulates to people with Tourette's. But it looks like we have found something that we agree on!

No assumptions here. I don't know your name, but need to call your something, since you don't sign your entries, and that's what your IP address gives me. I made no statements about your agreement or not with Comings. You made statements about the TSA which are easily checked and refuted by reading Comings' second book, where he describes the conflict in his own words and includes all of the referenced literature. But I got copies of the literature myself, just to be sure. I don't believe that Lowe has served on the MAB for several years, and I urge you not to make this about personalities, rather stick to the actual research. (I may agree with you on Lowe ... but personalities should have no place in this discussion :-) Please try to account for the strength in numbers on the MAB and SAB: even though some individuals, policies, and politics can certainly be problematic, it's a large advisory board, which increases the chance they'll get some things right. Occasionally. Sandy 02:24, 4 February 2006 (UTC)

I don't want to make this about personalities. Still, I don't think we should be scared to mention the name of an expert like Dr. Comings or Dr. Lowe just because you and I may disagree with them. Don't you think the article should say that there are some experts who still think you should not perscribe stimulants? For the sake of being neutral?

I think this article is getting too long, and if we want to talk about personalities or beliefs, perhaps you will feel free to make entries to my talk page instead of here? Maybe that will help us come to consensus sooner? When we get to fixing the treatment section, absolutely, the controversy about stimulants will be mentioned, in the context of the research, not the personalities. I would never do otherwise. Sandy 02:42, 4 February 2006 (UTC)

I don't think we should mention Dr. Lowe's name either or make it a personal thing. But I think that my statement about how Dr. Comings reported higher success rates with clonadine patches is not that controversial. Comings may be controversial, but I don't think that means his name should be excluded in the Clonidine example.

I disagree. This is an encyclopedia. It describes the way thing are. What success rates Comings may or may not have reported, before controlled research was done on any given medication, has no place in an encyclopedia, and much less in a medical entry, where current contolled research is more reflective of the usefulness of the medication. Sandy 03:42, 4 February 2006 (UTC)

I added a link to the Tourette's Syndrome Spectrum Disorder Association. I don't think anybody will object to this, since it is an organization.

Being a valid organization is not a reason to add a link. Does it contribute new information to the topic? Wikipedia is not a suppository of website links. 152.163.100.13 15:51, 3 February 2006 (UTC)

I appreciate that you are using the talk page now. It would be helpful if you would refrain from making further major edits until consensus can be reached, as the entire article is now in dispute and out of compliance with NPOV and verifiablility. With respect to what websites should be referenced as sources, the Wikipedia offical verifiability policy may be helpful. On that basis, the TSDA website seems to comply. Although Babajobu accurately pointed out that the term "Tourette Syndrome Plus" is not widely accepted or recognized, the website itself is written by a reputable and practicing professional, and it does contain verifiably accurate medical information. The objection (with respect to Wikipedia verifiablility) is to websites not written by professionals or maintained by verifiable professional organizations or containing verifiably accurate medical information. With respect to your statements about persons and organizations (such as the TSA or individuals within the TSA), I urge you to review the Wikipedia policy on NPOV- Neutral Point of View, and the five pillars of Wikipedia. We can make better progress towards correcting this article with those policies in mind. 64.12.116.13 04:10, 3 February 2006 (UTC)

"tics"

The Wikipedia entry for tics needs work, and has some information which is confusing and misleading relative to Tourette's and tic disorders. Perhaps this article can unlink from it until it improves?

This suggestion has been out here for many days now. I unlinked from the Wiki entry for tics, because it contains information that is just not descriptive of Tourette's tics, and I don't want to undertake repairing that article. I hope someone bolder than I will fix the tic article and link us back in. I included definitions and descriptions of tics as they apply to Tourette's in this article. Sandy 20:11, 4 February 2006 (UTC)

I've done all I can. But the tic entry really needs a complete rewrite. Most of what I wrote at the top of the Symptom section really belongs in the tic entry, and even more, the tic entry should probably be redefined and redirected to tic disorders in general, so that transient and chronic tics could be discussed there. I hesitate to operate on the tic entry, because I just don't understand why most of what is there is even there, or what conditions most of it applies to, but it sure doesn't reflect an accurate description of Tourette's. Sandy 00:41, 5 February 2006 (UTC)

No one else commented, so I did this work. I rewrote the tic entry, moved a lot of the content from Tourette's to there, and linked back in to the tic entry. Sandy 18:04, 8 February 2006 (UTC)

Marinol

It looks like a discussion is warranted. I cleaned up a lot of what was originally presented by 206.59.60.129 . I left the point the original author was making (some studies have shown some good results with Marijuana), but referenced the research, and corrected the terminology, misspellings, and grammar, while removing POV (e.g.; it is inaccurate to say the TSA did not participate in studies). But the POV is back, research links have been deleted, and the new article has numerous spelling and grammar problems along with the POV. I'm not sure if it will be helpful to try to clean it up again, or if I should revert to 17:53, 26 January 2006 .

It seems that the POV is confusing Marijuana for Marinol, and even misquoted Dr. Kompoliti. Therefore two subsections on Marijuana and Marinol are needed.

And I disagree with the person who claims this topic only warrents two or three sentences -- the same person who tried to delete the entire section on THC and Tourette's!

Thankfully, a sysop RoyBoy, reposted that section!

I think someone is intentionally spreading misinformation. I just deleted a reference that claimed a study showed that marijuana increased tension in TS patients; when the study cited was actually a study on treating TS with Methadone! Methadone is not the same thing as Marijuana or Marinol.

Please do not delete previous talk entries, as that defeats the purpose of the talk page. Also, please include colons to delineate your comments from others' comments. I am hoping the original author of the first marijuana entry will read the Wiki guidelines about writing an NPOV article and using the talk page for reaching consensus. Several edits were made to preserve the point being made about marijuana while doing some necessary editing to the information presented, which as presented, was very hard to follow. If there is any confusion or misinformation, it may be because the original information presented was difficult to follow. This entry has grown beyond an encyclopedic entry. When multiple attempts at editing and requests to use the talk page are met with no response, a revert is the expected outcome. It would be very helpful if the original author would use the talk page to reach consensus. The article now has so much POV that the page could be disputed.

Reading the simplified Wiki ruleset may be helpful. In particular, assume good faith (rather than assuming someone is intentionally spreading misinformation.)

I do not think anybody objects to the current edits to the Marinol information. It seems fine to just put the marijuana studies in the treatment section.

I can't concur with the above statement. The entire section needs a rewrite, to bring it back into compliance with NPOV, verifiability, importance, encyclopedic content, relevance, and it needs copy editing. As stands, the recent edits to the Tourette's entry have taken the page out of compliance with Wikipedia pillars. However, I have temporarily given up on trying to edit the article, but am encouraged that the talk page is now being used, so that hopefully consensus can be reached before any more major edits are made. 64.12.116.13 04:16, 3 February 2006 (UTC)

Rxlist states about Marinol -- "This medication may cause dependence, especially if it has been used regularly for an extended period of time, or if it has been used in high doses. In such cases, if you suddenly stop this drug, withdrawal reactions may occur," and "Although it is very unlikely to occur, this medication can also result in abnormal drug-seeking behavior (addiction/habit-forming). Do not increase your dose, take it more frequently or use it for a longer period of time than prescribed. Properly stop the medication when so directed. This will lessen the chances of becoming addicted." This is but one example of information that needs to be corrected in a complete rewrite.

There is a difference between addiction and dependance. Here is the link to rxlist, I will let people read it themselves, once again![5]

Kate Kompoliti is misquoted entirely. She was speaking of marijuana. The attack on her in particular is ad hominem.

The attack on the TSA is also ad hominem, baseless and unwarranted, as they did fund research and don't have the kind of control over all research funds the author implies. For example, much drug research is funded by the drug companies, and other research is often funded by the NIH. The TSA doesn't report research in its newsletters: it reports it in medical letters, and it did and does report on the marijuana research in the medical summaries.

Further, the information presented about marijuana and Marinol references the same studies. Can someone clarify what was being studied in each case? The controlled study was on cognition, not efficacy, and made no mention of efficacy. Some of the studies rely on self reports. All of the studies suffer from either small sample size, unblindedness, lack of controls, or lack of validated measurements (ie, anecdote). There are no large, controlled, blinded studies on efficacy.

The article is not written in encyclopedic tone, and the content is not proportionate. Tourette's is largely a disorder of childhood (multiple studies show that tics tend to remit as one passes through adolescence), and severe Tourette's in adulthood is an extreme rarity. While it is appreciated that an adult with severe Tourette's may claim benefit from marijuana or Marinol, it is not a useful treatment for the vast majority of persons (children) with Tourette's, and yet this information occupies a large part of the entire article. It needs to be put in proportion and encyclopedic perspective.

The article is not written in NPOV, and extends beyond relevance, as it seems to reflect more of a soapbox about marijuana than research usefulness. There is very little accurate, NPOV information in this article. Copy editing is needed. If the author is not willing to allow editing without reverts, and if these items can't be corrected without a war of reverts, then the article should be disputed.

Similar problems have been introduced by these recent edits into other sections of the Tourette Syndrome entry, so that other sections also have content which needs to be repaired or disputed.

No, Kate Kompoliti was NOT speaking about marijuana, she was speaking about Marinol! Just follow the link to the newsletter and read it for yourself!

Here is the exact quote: "Anecdotal reports, a retrospective survey and a pilot study have suggested a beneficial influence of smoking marijuana on tics and associated behavioral disorders in TS. Most of the reported findings are very preliminary, and need to be confirmed in a much larger and more rigorously designed study. Additionally, this substance is addictive and we suspect that its chronic use causes cognitive impairment, and may be harmful to executive functions and cause selective short-term memory deficits." I urge you to refrain from further editing of the article until a neutral party and copy editor can review and contribute. 205.188.112.22 17:23, 3 February 2006 (UTC)

You are quoting her out of context. Here is the link.[6] Let people read it for themselves!

Quite a few adults have Tourette's Syndrome. It does not go into remission for everyone. TS itself is a rarity. How do you know that Marinol is not effective for children? Do you have any evidence of that?

When you contribute an entry to Wikipedia, the burden is on you to provide the research to back it up. Do you have evidence that Marinol is effective for children, or even for adults? No, because there is none, yet. 205.188.112.22 17:23, 3 February 2006 (UTC)

I believe the article does link to several preliminary studies on the effectiveness of Marinol. Let people read the links themselves!

You made the claim that Marinol is "not effective in children" so the burden of proof is on you. The article does not claim Marinol is useful for TS.

I see no statement made above that "Marinol is not effective in children." There are no large, long-term, well-controlled studies showing efficacy in children or adults. If the claim is not being made that Marinol is useful for Tourette's, than exactly what is the controversy and conversation about ? Sandy 22:19, 3 February 2006 (UTC)

TS itself is not rare. It is a fairly common disorder occurring in childhood, and current prevalence estimates do not show it to be rare. It was once thought to be rare. That is no longer the case. Yes, quite a few adults do have severe TS, and the point you are attempting to make about marijuana and past mistakes by the TSA is appreciated. However, you are not going about making your point in the correct way. Attacking the TSA and individuals within the TSA, and editing without consensus, is not the Wiki way to make your point. 205.188.112.22 17:36, 3 February 2006 (UTC)

Neither the TSA nor any individual in the TSA being attacked! One person on the TSA Medical Advisory Board is being quoted. Here's the link again! [7] Let people read it for themselves!

In the article's current form, this is correct. Your previous entries about the TSA and individuals in the TSA were deleted on prior edits by others. I'm glad to see you are talking about the entry, and I'm sure we can come to consensus. There is appreciation of the point you want to make about marijuana and the TSA, but the information needs to conform with Wikipedia and encyclopedic standards and pillars. 152.163.100.13 19:30, 3 February 2006 (UTC)

Why do you assume others made the edits? Again, this is not about the TSA or about marijuana, it is about Marinol!

I know that I personally edited a number of ad hominem entries about the TSA and individuals in the TSA, trying to bring the article into compliance with Wikipedia pillars. I'm an "other". There were several soapbox entries about marijuana and the TSA, which I edited along with major copy editing. But that's water under the bridge. Can we get a simple summary of what you want to accomplish with this entry, so we can try to move forward? Do we agree that there are no good studies upon which to base statements about the efficacy of either marijuana or Marinol? Do we agree that larger, controlled studies are needed all round? Can we agree that, based on the RxList information about Marinol, the safe use of it as treatment for TS has been overstated here? Can we start by trying to understand what you want to say, and finding points of agreement, and then try to clean up the confusing research entries in order to substantiate your statements, without ad hominem references to people or organizations? 205.188.117.73 21:17, 3 February 2006 (UTC)

Here are the ad hominem entries. 28 Jan Sandy 13:19, 12 February 2006 (UTC)

And, the initial entry: 26 Jan Sandy 00:40, 16 February 2006 (UTC)

You are right, somebody does keep confusing the Marinol studies with the marijuana studies. I just deleted a reference to "controlled research on marijuana" that linked to two studies that were really about Marinol. There is not any controlled research on marijuana that I know of. I get the feeling the same people who claim Dr. Kompoliti was talking about marijuana (she was really talking about Marinol, just read!) are the same people getting the studies confused.

I know that virtually all of the deletions made to the Marinol section after it was disputed, around 12 hours ago, were deleted by myself!

Edits to clean up adhominem attacks have been occurring since Jan 26, not just in the last 12 hours. And the only IP addresses making these additions about marijuana/marinol are all in Oakwood Toluca. That is neither here nor there. The entry is improving. Let's get the article fixed, so the dispute can be removed. Sandy 04:06, 4 February 2006 (UTC)

I do agree with you that the research on marijuana is just anecdotal, and doesn't prove anything. I believe the article makes that clear, however. I do believe that preliminary investigations into Marinol treatment, frankly, showed a lot of promise for Marinol. And of course, I am not claiming that Marinol is an effective treatment. The preliminary findings with Marinol were quite positive, and as scientists usually do, when a smaller study like these shows promise, larger research should be done! Unfortunately, no research is being done. All I want is to point out that so far, all the controlled research on Marinol has shown Marinol to be very safe and effective. I don't mind saying that since the research is only preliminary, Marinol's value as a treatment for TS cannot be completely assessed without doing larger and longer studies. And I think it should be noted that no studies are being done. (I don't have to mention anything about the TSA stopping the funding.)

So, can you summarize what the point is you want to make, so that it can be made concisely? It seems that it boils down to you saying more research is warranted based on the preliminary research? There has been no good controlled research on marinol -- you need to stop insisting there has, and just come to the point, without all the extraneous info. Do you see why it has been stated that this topic warrants one or two sentences? Can you get it down to a manageable, concise, accurate argument, which doesn't overextend the results of the studies, or the claims about safety, and without ad hominem issues involving people or the TSA? I'm sure, if you focus on what you want to say, it can be said concisely. Sandy 04:06, 4 February 2006 (UTC)

Yes, I probably can say it more concisely. But not in two or three sentences. Right now, I am going to rest for a while.

One last thing, however is that yes, most of the studies, like the 6-week study on Marinol were ] well controlled studies. Look up the article on randomized controlled trials, I'm not sure you understand what it is!

I took a crack at it. I hope we're almost there, now that I think I know what you wanted to say. OK, two or three sentences was an exaggeration, but I got it down to a manageable paragraph, which I hope is concise and I hope says what you wanted to convey. I am still concerned that the issue of dependence, as raised by RxList, is completely missing. This is not an entirely safe medication. BTW, you really should check your tone, when you question whether people know what blinded or controlled studies are :-)) Sandy 04:40, 4 February 2006 (UTC)

What I want to avoid is some misleading disclaimer that makes it look like all the research on Marinol is crap. The preliminary research is incouraging. That cannot be denied.

The research is what it is, and it is not up to us to characterize it. It is largely uncontrolled, unblinded, on small samples, and not using validated measurements. That doesn't mean it's worthless. It just means it is what it is, and more controlled, long-term research is needed. That can be said, really, it can, without the emotion, in encyclopedic format. You can't characterize the preliminary research as encouraging: you can characterize it as preliminary. Remember how the inversine stuff didn't pan out once controlled studies were done. An encyclopedia reports as it is, not as we would like it to be. Sandy 04:06, 4 February 2006 (UTC)

Assume good faith. The information you have presented has been so confusing, that attempts to edit and clarify have been difficult at best. Now that you are using the talk page, perhaps consensus can be reached. But since you presented the information, it is up to you to substantiate it. 205.188.112.22 17:23, 3 February 2006 (UTC)

You also need to assume good faith.

I have not seen evidence of bad faith in the editing of your entries. There were attempts to bring the content into encyclopedic and Wikipedia compliance. There was one delete and revert after several requests that you bring your edits to the talk page. If you have a bone to pick with the TSA about marijuana, a personal website is a more appropriate place for that content.

This is not about the TSA or about marijuana! It is about Marinol!

The entries are yours. The distinction has not been made clear. In either case, there are no good controlled studies on adquate sample sizes. And, the safety of Marinol has been somewhat misrepresented. Please don't assume that people are undercutting your work. It just needs to be presented in accordance with Wikipedia standards, and with clarity. 152.163.100.13 19:30, 3 February 2006 (UTC)

I did not say that others are undercutting my work! I made those edits that you keep thinking others made!

The studies in the Marinol section are about Marinol only. That is made very clear and anybody can follow the links to those studies and read them for themselves.

It may be clear to you. An unitiated reader needs to know which chemical is which. To some readers, it's all marijuana, until/unless you define each better. The studies refer to names you haven't defined. Sandy 04:06, 4 February 2006 (UTC)

The paragraph on Marinol starts out by explaining that Marinol is synthetic THC in pill for in the first sentence of the paragraph! It is referred to as Marinol in the rest of the paragraph. If someone is still confused about the concept of THC in a pill, they can click on the Marinol article and read more about it, and even look at a picture of Marinol pills in the Marinol article! The only way to make it more clear in this article is to post the picture of Marinol in this article, but I don't think the picture is necessary in this article.

I just cut out the paragraph mentioning Dr. Komopoliti, because I agree this should not be about personality. I also change the last couple of lines to make it clear that the findings, while incouragings, are preliminary, etc. ...read it for yourself.

I think the section is quite NPOV now.

That's a good start !! It still needs more work to be encyclopedic. Now that I think I know what you wanted to accomplish, I took a crack at editing it. If you concur with my changes, I think the dispute could now be removed. There are no longer any claims about the TSA, about the safety of Marinol, ad hominem attacks, and I think it now says what you want to say -- which is that more study is warranted. I hope we're almost there now. Sandy 04:34, 4 February 2006 (UTC)

Move Pot Elsewhere

The Marinol/marijuana sections are a wild tangent of alternative medicine and the politics of illegal drugs. The material should be moved to the Marinol page and a medical marijuana page. The section should be reduced to a short statement that this is a proposed treatment of Tourette's syndrome, with links to the other pages.

I suppose that the whole treatment section simply dwells too much on on-going research and speculation. It would be a better article if the discussion started with the proven treatments, and then separately and briefly listed the unproven treatments.

Greg Kuperberg 18:34, 4 February 2006 (UTC)

I fully concur. MOST of what has added to treatment seems to have started as vanity entries, by people perhaps wanting to publicize certain controversial or unproven treatments. There is far too much focus on the controversial and unproven. I have been attempting to clean it up, and am still working on beefing upu accepted treatment sections, but if there is more concurrence, I agree with bolder editing and deleting of large portions of the treatment section. ON THE OTHER HAND, some of the more controversial topics do generate a lot of media hype, so maybe it is good to include realistic appraisals of these modalities ??? Sandy 18:52, 4 February 2006 (UTC)

You know, you should not assume that my motive is to publicize certain controversial or unproven treatments. I have contriputed to this article in other ways as well. You are NOT ASSUMING GOOD FAITH!

The experimental treatment section now includes Deep Brain Stimulation and Nicotine. My comments were not directed at you. With respect to marijuana and Marinol, my comments have been with respect to the research, not you. Sandy 01:55, 8 February 2006 (UTC)

Just look a couple of paragraphs up. You said that what has been added to treatment on Marinol was started by "people perhaps wanting to publicize certain controversial or unproven treatments." I was the person who started the posting on Marinol, so you are obviously referring to me! It is an insult to my intelligence when you claim your comments were not directed at me! And even if you comments are not directed at me, they were directed at other people who posted to this article, and you therefore are NOT ASSUMING GOOD FAITH! (For myself or for others!)

I shortened all of the entires for modalities which are experimental or for which there is not good empirical evidence, and combined them into one section, so that these items are now more brief. I don't want to move the discussions elsewhere without the concurrence of others. Sandy 20:02, 4 February 2006 (UTC)

Consensus

Okay, I think a consensus has been reached. But for now, I won't delete the stuff on the talk page on Marinol.

It is noted that you have changed your original statements here after you received responses. To preserve context, I include your original statement, and note that you have made several other changes. You originally wrote "Okay, I think a consensus has been reached, so would Sandy or anyone else object if I delete all this stuff on Marinol? " Sandy 19:23, 8 February 2006 (UTC)

I changed my original statement because I wanted to say that I was not going to delete the stuff on Marinol on the talk pages, and I didn't want people to panic.

But the statement I'm referring to now is: "The paragraph on Marinol should stay roughly as it is and where it is in this article, and not be moved to the Marinol article now or in the future because it belongs in this article." Do you have a good reason to disagree?206.59.60.140 19:27, 8 February 2006 (UTC)

The essence of Wikipedia is that any editor could come along tomorrow and decide to change the entire entry. Leaving the talk page here helps people understand the history and what consensus exists, and what the issues are. But no one can assure that anything you write on Wikipedia will stand. I really suggest you relax on this for a few days, as I've tried to reassure you I have no plans to operate on the Experimental Section. Sandy 19:30, 8 February 2006 (UTC)

If some editor just removed the entire paragraph on Marinol or changed it for no good reason, it would be vandalism. That's not the essence of wikipedia!206.59.60.140 19:45, 8 February 2006 (UTC)

This is my final response on this topic. You misunderstand the essence of Wikipedia, which is editors working together to achieve a better article. If we follow the example you give above, then I vandalized myself when I re-wrote the entire tic article, using the words I had originally included in the Tourette syndrome article, then deleted some of the repetition from the Tourette syndrome article, and linked instead to the tic article. Now it's a more efficient and concise encyclopedia entry. I won't be responding anymore on this topic. Sandy 20:03, 8 February 2006 (UTC)

I understand the concept of people working together to achieve a better article! That is why I think right now the paragraph on Marinol is nearly perfect as it is, where it is and that it should not be moved to the Marinol article in part because that is not precidented on this page or in wikipedia. However, I know I could be wrong! I am always looking for a way to improve this paragraph! That is why I want to see if somebody had a good reason to disagree with me about that statement! If they do, it would be a way to improve the article even more! But I realize now I have asked the wrong question, and I will clairify it.206.59.60.140 20:15, 8 February 2006 (UTC)

Also, are you saying that you had no good reason to rewrite the article on tics? I am saying that deleting the entire paragraph on Marinol or drastically changing it FOR NO GOOD REASON is vandalism!206.59.60.140 20:29, 8 February 2006 (UTC)

I want to clarify something. Yes, I know that the paragraph on Marinol may change, that is why I used the word "ROUGHLY" in that statement. But drastic changes to the paragraph or deleting it altoghether for no good reason would be vandalism.206.59.60.140 19:54, 8 February 2006 (UTC)

So since you still have not provided a good reason to disagree with the statement: "The paragraph on Marinol should stay roughly as it is and where it is in this article, and not be moved to the Marinol article now or in the future because it belongs in this article," after reading the four points I made in support of that statement, I think you do not have a good reason to disagree with it! And if I'm wrong, please post the reason!206.59.60.140 19:49, 8 February 2006 (UTC)

Consensus again

Does anybody have a good reason to drastically change the paragraph on Marinol or move the paragraph to the Marinol article in the future?

(Please read my four points against drastic change and against moving the paragraph to the Marinol article before you answer the question!)

I changed the question to make it more clear. 206.59.60.140 20:19, 8 February 2006 (UTC)

I don't think drastic changes are needed, here's why?:

1. There is just one paragraph on Marinol in this article. It is in the "experimental treatsments" section. It is made clear that the research is only preliminary.

2. In spite of the fact that Greg accused me (or at least somebody who posted to this article) of getting into the "politics of illegal drugs" and being pro "medical-marijuana" when it comes to Marinol (legal by Rx in all 50 states) Greg is wrong! In fact, this could actually be an arguement AGAINST medical marijuana, because it appears that the legal alternative (Marinol) is supperor to marijuana for treating TS! Greg should assume good faith, and learn that marijuana and Marinol are not the same thing.

The information does not belong in the Marinol article because:

3. The Marinol article just has information on what Marinol is and what it has been approved for. It has been used experimentally in treating all sorts of things, and therefore there is no laundry list of all Marinol research for all conditions in the Marinol article. That sort of information belongs in the articles about specific conditions.

4. Many medications' names have been posted to this article, and many of these medications have their own articles in wikipedia that don't mention Tourette's Syndrome at all! So the standard precident, in this very article and on wikipedia, is: Information about off the label research on a drug for treating a specific condition belongs in the article about the specific condition, not the article about the drug!

Well, nobody has disagreed with me so far... so I decided to highlight a this subsection before I delete the stuff on Marinol. But I do think we have a consensus!

As I explained when you raised this earlier, it's not clear that there is consensus, and the discussion should stand, in case some future editor wants to review the issue. Deleting a discussion after only a week or ten days seems premature, and is rarely if ever done on discussion pages. I'm not sure, but deleting talk discussions may be considered vandalism on Wikipedia.

If you are concerned that I may edit the items and move them to the appropriate sections as discussed, I won't do that until/unless there is more concurrence, so I respectfully suggest that relaxing about this issue for now may help.

It would also help if you would start attaching a signature to your entries, so we can follow the conversation easier. All you have to do is put four tildes in a row (~) after each entry, and the date will be included, along with your IP address, which is already included on your entries anyway. Sandy 18:26, 8 February 2006 (UTC)

Okay, if you don't believe there is a concensus that the paragraph on Marinol should remain as it is, where it is, can you at least provide a reason why you disagree? If you do not disagree personally, then I will wait for someone else to come up with a reason to disagree with keeping the Marinol paragraph as it is where it is and let them post their reason!206.59.60.140 18:43, 8 February 2006 (UTC)

But you can't just say "I disagree" without providing a good reason to disagree. If nobody provides a reason to actually disagree, then removing the stuff on Marinol is the right thing to do. Why? Because if nobody has a reason to disagree then a concensous has been reached! Some people may not like the fact that a concensous has been reached, but if they can't come up with a reason to disagree, then there is a concensus!206.59.60.140 18:43, 8 February 2006 (UTC)

Thanks for signing the entry -- that will really help make the conversation easier to follow. As I see you are also concerned about the length of some of these discussions, maybe you will feel encouraged to take some of the more personal discussions to personal talk pages? You can do that by clicking on the person's user name, and from there, click on "Discussion" to go to their talk page. Even better, you can register and set up your own talk page :-)) I hope that's an idea that may help. I've already addressed the issue of consensus, both Greg and I have explained our reasons, and I've mentioned that I have no plans to change the entries for now. How about we just relax? :-)) Sandy 18:46, 8 February 2006 (UTC)

It is usually wiki policy (or at leat it is a precident in other articles) to remove long discussion on the talk page after a concensous has been reached.

I want an agreement not to move the Marinol paragraph because that is where it belongs. I certainly have compromised and worked with you guys, but you are not at all justified in moving the paragraph to the Marinol article now or in the future! Here's my reasoning again:

The Marinol article just has information on what Marinol is and what it has been approved for. It has been used experimentally in treating all sorts of things, and therefore there is no laundry list of all Marinol research for all conditions in the Marinol article. That sort of information belongs in the articles about specific conditions.

Many medications' names have been posted to this article, and many of these medications have their own articles in wikipedia that don't mention Tourette's Syndrome at all! So the standard precident, in this very article and on wikipedia, is: Information about off the label research on a drug for treating a specific condition belongs in the article about the specific condition, not the article about the drug!

So do you have any reason to disagree that the Marinol paragraph should stay in the article, now and in the future?

I am not following your logic -- it's possible I'm not understanding what you're asking? I think you want to delete large sections of this talk page? Please check the Wikipedia guidelines for vandalism. I'm fairly certain that deleting talk page entries is considered vandalism. Further, it's not my call or your call to decide that Greg's comments, for example, can be deleted. Also, the discussion is recent, other editors may come along and need to read the discussion. That is the purpose of talk pages. Sandy 18:49, 8 February 2006 (UTC)

I'm asking if you have a reason to disagree with the two points I made above about the why the paragraph belongs in this article and not in the Marinol article.206.59.60.140 18:55, 8 February 2006 (UTC)

Also it is fine with me to keep these talk pages here, unless we get a concensus otherwise. But I mainly want to see if anybody can come up with a good reason to disagree with the statement at the beginning of this section. 206.59.60.140 19:08, 8 February 2006 (UTC)

Please do not continue altering the talk page. These changes significantly alter a conversation in which others have engaged, and changes the context. Sandy 20:56, 8 February 2006 (UTC)

Suggested wording to incorporate consensus

The current entry, which started on 26 Jan, and became an ad hominem issue about the TSA on 28 Jan, is now in better shape, consolidated under Experimental treatments. I continue to concur with Greg, however, with respect to the Marinol entry. Neither marijuana nor Marinol are currently useful in the treatment of Tourette's, nor are they likely to become useful treatments in the near future. Reference, What Wikipedia is not -- a soapbox. The considerable contributions of Unsigned User can be moved to Marinol and marijuana. Here is my suggested wording to incorporate both Greg's and my concerns over the length and relevance of the Experimental treatments section.
Suggested wording
Nicotine showed preliminary promise in case reports, but these effects were not reproduced in well-controlled trials several years later. ^[1] Studies of nicotine derivatives (mecamylamine, inversine) also showed that they were not effective as monotherapy for the symptoms of Tourette's.^[2] Deep brain stimulation has been used in treating a few patients with severe Tourette's, but is regarded as an experimental and dangerous procedure that is unlikely to become widespread.^[3] Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and neurofeedback, have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome.^[1]^[4] Case reports found that marijuana helped reduce tics, but validation of these results requires longer, controlled studies on larger samples.^[5]^[6] Preliminary research on Dronabinol, synthetic THC in pill form (brand name Marinol®) as a treatment for Tourette's syndrome was promising, but there are concerns about the safety of Marinol, and longer, controlled studies on larger samples are needed.^[7]^[8]^[9] Sandy 01:10, 16 February 2006 (UTC)

"There are concerns about the safety of Marinol" is far to POV. Just because somebody is "concerned" that Marinol causes cognitative impairment, for example, is meaningless. The research shows that Marinol is quite safe and no concerns were raised by the actual trials. You have to have a REASON to be concerned.

Andre Malraux

Malraux certainly had TS. Many books on Malraux say so... I put the link in to cite a biography that mentions his TS, but if the link is somehow offensive, feel free to delete it. But Malraux did have TS.

I found a reputable source. TS Foundation of Canada mentions Malraux.

Another source is the book "Malraux: A life."

Beta blocker subsection

Perhaps what is wrong with this page is that the treatment section should be more in depth. I think a subsection on beta-blockers, and perhaps stimulants, are warrented.

If other people have something to add to the beta-blockers section, please do! The citation I used is an article from the Tourette's Foundation of Canada, so I don't think anybody will have a problem with that source.

Can we please prioritize treatment as to the most common? I appreciate your contribution, but I still think the entire section needs to be reworked, revamped, and beefed up. Can clonidine -- which is the most common, first line treatment -- be moved to the top of the treatment section rather than the bottom? I also feel that the article would be more NPOV if you refrained from referring to specific doctors, and reported on the research instead. I don't see a need to introduce such a controversial figure as David Comings into the article. 205.188.117.73 22:54, 3 February 2006 (UTC)

Major Cleanup and ReWrite Needed

Updating the list of what I have worked on so far. Sandy 17:01, 4 February 2006 (UTC)

Wow. Last time I checked in on this entry, it was not great, but it was passable. Now it’s a trainwreck. Since there seem to have been some editing wars, I will include a discussion of things that need to be addressed before making editing changes myself. The entire article is alarming, and I hesitate to edit in the presence of editing controversy.

As mentioned above, the link to the article on tics isn’t particularly helpful for the context of Tourette’s.

The phrase “that occur repeatedly in the same way” is confusing and needs repair. Movements that "occur repeatedly in the same way" are suggestive of stereotypies or stims. The hallmark of tics is that they constantly change in number, severity, frequency, and anatomical location. The basic definition of Tourette’s needs to be reworked.

I rewrote the basic front-end definition for the article. Sandy 17:01, 4 February 2006 (UTC)

SYMPTOMS

Does not even include a good, basic definition of tics. This should include a working description of motor and phonic tics, descriptions and definitions of each, simple vs. complex tics, and examples. Suppressability and premonitory urge are not adequately explained, especially as they relate to other movement disorders. There is more emphasis on sensory phenomena (coprolalia, echolalia, etc.) than more common tics; yet, even these subjects are not well examined. There is no discussion of simple versus complex tics. A discussion of the spectrum of tic disorders (transient tics, chronic tics, and Tourette's) should also be included and expanded. In summary, the essential information defining Tourette’s is not well addressed.

I got as far as I could on this. The description of tics is top-heavy, and should be included on the "tic" entry, which could be linked to the Tourette's entry, but the "tic" entry is so far off from anything related to Tourette's, that I don't know how to fix it. Sandy 22:17, 4 February 2006 (UTC)

Moved basic definitions to the tic entry, deleted some from Tourette syndrome entry, and linked to the tic entry. Sandy 03:04, 8 February 2006 (UTC)

Rage attacks are mentioned as a symptom. There is no such diagnostic entity as a rage attack, and it is a term that has been used colloquially by many different people with many different diagnoses to mean many different things. Different people may be describing different issues when they use the term. The only thing that has been shown and replicated by many multiple research sources is that “rage attacks” are not part of Tourette’s, rather related to co-occurring conditions which may be present in some persons who also have tics or Tourette's. References to rage attacks should be deleted, as they are not a symptom of Tourette’s. This terminology brings the article into dispute.

Does it bring the article into dispute, or can you just delete the references to rage attacks? Don't assume that only one person has written what you are objecting to.

OK, since no one objected, I deleted it and removed the dispute. Sandy 17:01, 4 February 2006 (UTC)

The tone of some statements is not appropriate for Wikipedia or for an entry about a medical condition. Examples are “a person with Tourette's can feel as if their Tourette's Syndrome has totally taken control of their body, and they almost feel as if they are standing outside of themselves” and “doing so is like putting a lid on a boiling pot of water.”

I did as much as I could on this. Sandy 22:17, 4 February 2006 (UTC)

There is a lot of overlap between the sections of the entry. For example, the sentence about tic severity and adolescence does not belong in symptoms.

I agree, why don't you move or delete the sentence?

I created a whole new prognosis section, and moved things out of other sections into there. The entire section still needs to be expanded and beefed up. Sandy 17:01, 4 February 2006 (UTC)

DIAGNOSIS

Has no treatment at all of differential diagnosis, or how the diagnosis is made, typical presentation and age of onset, etc. “Highly functioning” is a term more often found in autism discussions. Tourette’s does not typically impact upon functioning, so this term is confusing.

Why don't you add something about differential diagnosis, age of onset, etc.? I believe Tourette's can affect functioning, that is all that is claimed by the article.

I did more work on this section. I think that's about all I can add.Sandy 18:28, 4 February 2006 (UTC)

TREATMENT

The most commonly used medications in Tourette’s are never even mentioned (clonidine, tenex). Much more of the article is dedicated to controversial topics and alarming information, while commonplace treatment modalities are overlooked or never mentioned. A dramatic tone is employed in the description of some other medications. Example: “have caused severe permanent brain damage to some people taking them, sometimes as severe as Tardive dyskinesia.” These medications are typically safe when used at correct dosages. The mention of Parkinson’s is spurious.

Perhaps this means the treatment section should be expanded. Why don't you write something about clonodine or other beta-blockers that you say are overlooked?

Done - did all I could. Sandy 00:27, 5 February 2006 (UTC)

The discussion of atypicals includes quotes which aren’t referenced, and discusses only potential negatives, out of context.

The reference to the quote on atypicals is in the wikipedia article on atypicals

I removed the links to Wiki sources, and typed in information from TS sources. The problem with global sources is that they often refer to populations (such as schizophrenics) which take much higher doses of neuroleptics than are prescribed for Tourette's. Sandy 17:01, 4 February 2006 (UTC)

The two paragraphs on tic severity and living with TS do not belong in the treatment section. A prognosis or outcome section is needed. Why are drummers in particular even mentioned? That seems like a vanity entry.

I don't know who mentioned drummers. However, the person was probably referring to Witty Ticcy Ray, decribed by Oliver Sacks.

The issues with the marijuana and marinol entries have already been discussed here (see above). Expert input is needed to bring the treatment section up to the quality needed for a medical entry, along with copy editing.

If there is consensus, the article is now to a state that the dispute could be removed. Waiting to hear from the original author. Sandy 17:01, 4 February 2006 (UTC)

GENETICS

Includes outdated information and does not present the entire story. It was once accepted that the mode of transmission was autosomal dominant, but this has been called into question, and is now held to be an overly simplistic view of the genetics involved in Tourette's. This section also needs a major overhaul by a qualified expert. There are too many vague statements like “it is known that.”

You could be right. I personally do not know enough about genetics and I have never edited the genetics section at all. Do not assume that I wrote everything you object to.

New epidemilogy section created. Info updated. Sandy 22:18, 4 February 2006 (UTC)

FAMOUS PEOPLE

Is one section that looks improved over the past. Relevance needs to be taken into account when adding “famous” people. In the past, this section included vanity entries about people who were not known outside of Tourette’s, or people who had conditions which may co-occur with tics, rather than actual Tourette’s. The idea that Mozart had TS is discredited by experts and it is unfortunate to see that entry here, but that rumor needs to be addressed.

I also did not add the entry of Mozart under famous people. However, the person who did cited both experts who believe that Mozart had TS and experts who do not. But it is more that just a "rumor." I did add the link to the documentry on Mozart and Tourette's.

Toluca, James McConel is a musician and composer, not an expert on Tourette's. I do not concur with the edit you just made to the Mozart entry. Experts who have opined concur that there is no basis for speculating that Mozart had Tourette's. A musician/composer is not an expert on Tourette's. You are making changes without consensus, even as these items have been brought to your attention on the talk page. Sandy 01:03, 4 February 2006 (UTC)

Toluca, you earlier argued vehemently that Leslie Packer's TS Plus website should be included as an authoritative link. Now you are deleting her professional opinion that there is no evidence that Mozart had Tourette's. You can't have it both ways. Is she an authority on TS or not? Either leave in the link to her opinion about Mozart, or take her link out of the External Links section. I'm fine with either option that you choose. I will accept your entry about Simkin, although I don't think anyone would qualify him as a "TS expert." Even you have acknowledged that he is an endocrinologist. Not a psychiatrist or a neurologist? But I will accept that compromise. Sandy 01:45, 4 February 2006 (UTC)

Leslie Packer did not claim that Mozart did not have Tourette's Syndrome. She said however that there is not enough evidence that he did have it either. She was taking a neurtal point of view.

The entry as worded covers that: "they do not believe there is enough evidence to conclude that Mozart had Tourette's" does not say anyone claims that he did not have TS, just that there is not enough evidence to conclude that he did or didn't. If you have better wording, please suggest it. Sandy 17:58, 8 February 2006 (UTC)

Yes Sandy, I know that James McConel is not an expert on TS. But Dr. Benjamin Simkin is a medical expert who wrote a book argueing that Mozart had Tourette's! You belief that there is a consensus amongst experts is flat out wrong!

ENTERTAINMENT INDUSTRY

Why is every possible mention of Tourette’s in the industry worthy of mention here? Why should every show which uses Tourette’s as a cheap plot twist be included as an entry? And why are realistic, important and/or controversial productions, such as 7th Heaven, Ally McBeal, or The Practice overlooked in favor of cheap plot twist mentions of Tourette’s? Some criteria for what should be included here might be helpful. Why is mention of a possible upcoming film, not even in production, warranted? There are too many vanity entries. Again, the entire tone and content of this entry is just not Wikipedic or encyclopedic.

Would like to hear from others on this. I hesitate to tackle the section. At minimum, it could be alphabeticized. And, what verification is there that some of these entries are actually about Tourette's? What is their relevance? Are they vanity entries? Sandy 18:31, 5 February 2006 (UTC)

Touched by an Angel and Ally McBeal. [8]

7th Heaven and The Practice [9][10] [11]

I would say "What about Bob?" because I believe that movie was the first to confuse coprolalia with Tourette's Syndrome. However, i don't have a reference.

I also know there was an LA Law episode on Tourette's Syndrome. Again, I don't have a reference.

Thanks for the tip on LA Law -- I found a reference, and added it. Nice find! What About Bob is already on the list. Sandy 23:15, 8 February 2006 (UTC)

Maybe (if it can be proven) that What about Bob? was the first movie to confuse Tourette's Syndrome with coprolalia we should note that. Also, shouldn't "What About Bob?" be in the first section that includes films that accurately portray TS or have a main character that has TS? Since Bob has TS in the movie, it would fit the second criteria. Unfortuanely, "What About Bob?" might have had more of an influence on the publics misconceptions about TS than any other film. But that makes it significant in a historical sense.

Do you know of any movies made before "What About Bob?" that confused TS for coprolalia?

I didn't see What About Bob. I think it would be difficult to say conclusively that it was the first to stereotype TS and coprolalia. I'll poke around and see if I can find out more about it. Sandy 12:06, 9 February 2006 (UTC)

EXTERNAL LINKS

What do all of these add? Multiple sources of the same or similar information. At least this is better than in the past, when this section included many vanity entries or outdated sites, some of which included copyright issues.

Using this logic, why do we need four different links to the TSA around the world? Why not just one link to the TSA, since have similar information. Have a link to organizations that are not the TSA makes this article more neutral!

I changed the wording that someone attached to the TSA (New-York based group?) back to USA advocacy group, as they do, after all, have chapters in every state, and are the only organization with national reach representing people with Tourette's. Someone may not like that, but Wikipedia reflects the way it is, not the way we may want it to be. As of now, and for many years, the TSDA, on the other hand, only has contacts in Southern California. Sandy 22:27, 4 February 2006 (UTC)

I hope this list is a starting place for improving this entry. Sandy 19:16, 3 February 2006 (UTC)

Thanks for the suggestions. Those are all sections I could work on, but I hesitate to make edits given the current contention that exists, and would prefer to see more consensus before tackling major rewrites. For example, I don't really know how the external links should be handled, and I agree that multiple links to advocacy organizations may not be necessary, but I'm not sure what kind of consensus could be reached about which to include. Certainly, the TSA should not be the only side of the story told. I also don't understand why Witty Ticcy Ray deserves special mention in the symptoms and diagnosis of the condition, but don't want to offend by deleting that. I could clean up the genetics, but this is a recognized area of controversy, so will have to be written carefully, presenting all views, and with consensus. The environment right now seems a bit touchy to tackle that. I could also rewrite treatment, symptoms, etcetera, but again, I hesitate to do so without consensus. I also don't want to just delete rage attacks, as I know that could develop into an issue. Sandy 20:16, 3 February 2006 (UTC)

If others agree, perhaps we could at least create a Prognosis or Outcome section of the entry, and move some of the statements about tic severity and adolescence and others out of the symptoms and diagnosis sections and into that section, which could later be expanded ? What should that section be named? Sandy 22:33, 3 February 2006 (UTC)

No one disagreed, so I did it. Still needs work. Sandy 17:01, 4 February 2006 (UTC)

No Original Research, vanity entries, collection

I've added all the content I can for now, tried to reference it (although some of it is just common knowledge), and am now trying to review the entry with respect to the five pillars of Wikipedia. With respect to No Original Research: It is also not the place to insert your own opinions, experiences, or arguments — all editors must follow our no original research policy.

I happen to personally agree with the following statement, and have seen it used by many of my friends. But, I'm not sure it doesn't qualify as original research, as there is no verifiable, reliable primary source document for this statement. Does it qualify as opinion or experience, and just because some of us associate with people who feel this way, how do we know it accurately reflects how most people with TS feel ???

Some people with Tourette's Syndrome say that even if there was a "magic pill" that would cure them of TS with no side effects, they would not take the pill, as they think the benefits of having TS outweigh the benefits of not having TS.

I just located a primary source reference (final chapter, Tourette's syndrome: Tics, obessions, compulsions, by Leckman and Cohen) which covers the same point in slightly different words. I'll add them in so the point is covered without being original research. Sandy 21:17, 7 February 2006 (UTC)

Well I just wrote that "some" not "most" people with TS would deny a magic cure. I know that I personally have had TS ever since I was a few months old (my case was a very early onset) and I know I would not take this magic pill. But the book "Twitch and Shout" by Adam Seigelman talks about this in the last couple of chapters.

Understood and agreed. But whether it's phrased as some or most, it still may qualify as original research, without a primary source for that statement. You and I both know people in real life who say that, but it needs to be in print from a reputable, verifiable source. So, I added a comment from a book that hopefully covers the same point you wanted to make. Adam Seligman did not write Twitch and Shout, by the way, and Leckman/Cohen provide a more reputable source than Lowell Handler, as it is a medical text rather than fiction. Sandy 18:31, 8 February 2006 (UTC)

Sorry about the author slip up. If you want to remove the bit about the magic pill I do not object.

Also, in the five pillars: Wikipedia is not a dictionary, a collection of primary source documents, a soapbox, a newspaper, a free host, a webspace provider, a series of vanity articles, a memorial collection, an experiment in anarchy or democracy, or a grouping of links (whether internal or external).

I'm still confused about the lengthy list of irrelevant references to Tourette's in the media. Unless someone disagrees, I suggest we delete all spurious references to Tourette's, and focus only on important shows actually about Tourette's, not just referring to Tourette's. Those include, at least, Qunicy, The Tic Code, Touched by an Angel and Ally McBeal [12], 7th Heaven and The Practice [13][14] [15] Opinions ?? What is the usefulness of including a list of every time Tourette's is mentioned on TV or in a movie? Sandy 23:55, 5 February 2006 (UTC)

Dr. Comings FAQ in external links

I added a link to a FAQ written by Dr. Commings. This FAQ contains information on clonidine patches and comorbid conditions, amongst other things, not found on the other websites in external links.

I'm not trying to endorse Dr. Comings. I think ADHD is part of the TS spectrum, but in some of Dr. Comings stuff I think he is forgetting that statical correlation does not mean cause and effect; "The Gene Bomb" in particular, is a very flawed book.

But if we are going to have 3 or 4 links to TSA website around the world which all say basically the same thing, other opinions can be at least be put in external links to make it more balances and neutral.

Also, since the marijuana/marinol stuff has been resolved, would anybody object to delecting the particallarly long dicussion about it on the talk page?

Yes, I would object (we need to leave it because someone else may want to cover these same topics in the future). As to whether it's resolved, I believe we should eventually effect the recommendation of Greg Kuperberg, Move pot elsewhere. I haven't had time. As he indicated, we should move all four experimental treatments out of the Tourette syndrome article and in to their own appropriate articles within Wikipedia {e.g.; Marinol), and make only a one-sentence mention of the experimental treatments here, referencing the appropriate links. I'd like to eventually do the same thing with the long description of tics, by moving a lot of it to the tics entry.

The Marinol page primarly tells you what it is, and what it has been approved for. There have been all sorts of experiments done with Marinol on other off the label conditions, not just Tourette's Syndrome. There is no laundry list of every condition that Marinol has even been researched in the Marinol article. This is the kind of thing you would find in an article about the specific conditions.

The person what said "move marijuana elsewhere" is too stupid to understand the difference between Marinol and marijuana. I say this person is stupid, because I am assuming good faith. There are only two possible ways to confuse Marinol and marijuana at this point (the article is very clear) a) he/she is intentionally trying to confuse people b) he/she is stupid. So assuming good faith, means b.

This person is also a fool for suggesting that I am motivated by a political medical marijuana cause. Marinol is legal by Rx in all 50 states and under federal law. I have also said that the research so far on marijuana and TS has been anecdotal and therefore doesn't really prove anything. But the Marinol research was controlled. This is not an arguement for medical marijuana! In fact, you could say it is an arguement against medical marijuana! At least in this circumstance, it appears the legal alternative is better! The medical marijuana article also does not talk abou the conditions marijuana is supposed to treat. That information belongs in the articles on the specific conditions.

See note below regarding personal attacks.

Whether a particular study is controlled is not enough to qualify it as worthy research. There is good research design, and bad research design, and blinding and placebo controls are only a few of the factors that contribute to good research design. That particular study (in fact, all of them) was a small sample size, the results have not been validated, and the measurement instruments could be questioned in most of the studies referenced. Marinol is not yet close to becoming standard treatment for Tourette's.

Separately, I have brought several things to the Talk page that you don't comment on. Please try to work with others in good faith to improve this article. Sandy 23:07, 7 February 2006 (UTC)

I do not have the time to go though all your comments and comment on them as quickly as you would like me too. So I am focusing on resolving this issue. (One thing at a time.) All drugs are researched in the preliminary stages using smaller sample sizes before they go on to bigger sample sizes. That only makes sense! I did not say Marinol is a standard treatment for Tourette's. That's why it is in the experimental section. But the Marinol page is not a page that tells you everything that Marinol has ever been researched for. It would be somewhat out of place to put this research on the Marinol article.

I have not yet looked at your Comings link, but I can't agree with your reason for including it here. The TSDA link has been added, and that offers the counterbalance you seek. There are good reasons Comings' outdated work (twenty years old in many cases) is not included in most other sources, and is often referenced in the published literature as a counterexample, or as an example of ascertainment bias, or as an example of research which has subsequently been disproven. The article is already top-heavy, stills needs a major red marker, and your suggestion will add controversy without improving current content. I do agree with you that all the other TS advocacy group links aren't needed, under the "What Wikipedia is not" guidelines. It is not a collection of website links.

I deleted the entry for what you called an FAQ from Comings. It was a link to Hope Press, which is a bookseller. Hope Press was a self-founded vanity press, which Comings founded when he encountered problems getting his views published in peer-reviewed journals (he describes this in his second book). Since Hope Press sells his and other books (many of which are approaching irrelevance at 20 years old), it's not just an FAQ, and could be construed here as an advertisement. Sandy 14:06, 8 February 2006 (UTC)

Did you see my question that the statement about the "magic pill" appears to violate the Wikipedia, No Original Research policy ?

I see that you added the marijuana references to the References. I had left them (and some others, referred to only once) as inline references is so that it would be easier to move those sections in the future. I tried to put in the actual References section only things that were referred to in numerous places throughout the article, or that would be more enduring than the pot research. I will move some of those back inline. Sandy 21:12, 7 February 2006 (UTC)

No Personal Attacks

Referencing Greg Kuperberg, unsigned user 206.59.60.140 said, "The person what said 'move marijuana elsewhere' is too stupid to understand the difference between Marinol and marijuana," and "This person is also a fool for suggesting that I am motivated by a political medical marijuana cause."

This person attacked me first, accusing me of having a political agenda, when that is obviously not true.

I'm losing patience with this. Everyone has evidenced good faith in trying to bring this page up to Wikipedia quality, bringing items that need attention to the talk page, which you apparently don't read. Please read the Wiki policies on personal attacks. Sandy 23:00, 7 February 2006 (UTC)

Your points have been made and acknowledged, but Wikipedia is an encyclopedia, not a soapbox. It does not need to include lengthy discussions of every experimental, marginally useful treatment. Sandy 23:00, 7 February 2006 (UTC)

And there isn't a "lengthy discussion" of any experimental treatment. There is a paragraph.

Whatever happened to assuming good faith?

Sandy, the person who accused me of simply writing this stuff on Marinol because of some sort of political agenda was not only saying something that was FALSE, but he failed to ASSUME GOOD FAITH!

When you agree with him, that my motive was politically motivated, you are not assuming good faith. You too need to not violate wikipedia policy!

Greg's entry doesn't mention you. He talks about Wikipedia policies and encyclopedic content and quality with respect to the entry. Each entry in Wikipedia is written by many editors: comments apply globally, not to a given individual. My suggestion would be that if this is going to become a personal struggle, unrelated to Wiki policies, it would be better to take it to personal talk pages. Or just not go there, because it is not consistent with Wikipedia culture or policies. Focus on the content and the policies, to achieve a well-written entry. I won't be responding to any more personal comments. Sandy 02:06, 8 February 2006 (UTC)

He was referring to the person who initially posted the information on Marinol, myself. That is quite clear. There would be no dicussion of Marinol in this article if it weren't for me and therefore he must be reffering to me! And if he was not referring to me, he was referring to somebody who edited this article and therefore he was NOT ASSUMING GOOD FAITH!

This is why I think you are a hypocrite when you lecture me on wiki rules but you don't point out that Greg is assuming bad faith for somebody, and when you too assume SOMEBODY posted in bad faith to the treatments section to publicize a controversial treatment! The rules should be applied to everyone, even you Sandy.

I certainly did assume some good faith in my previous entry. Anyone can veer onto a political tangent out of human frailty. I am having more trouble assuming good faith now, now that there are these ridiculous defensive responses. Greg Kuperberg 08:36, 8 February 2006 (UTC)

It does not matter if you were assuming good faith or not, you were mistaken that anybody was getting into the "politics of illegal drugs" and was supporting medical marijuana because this could actually be used as an arguement AGAINST MEDICAL MARIJUANA! It appears that the legal alternative (Marinol) works better than marijuana in the treatment of TS!

Toward a reasonable consensus

Does anybody have a good reason to drastically change the paragraph on Marinol or move the paragraph to the Marinol article in the future?

(Please read my four points against drastic change and against moving the paragraph to the Marinol article before you answer the question!)

I don't think drastic changes are needed, here's why?:

1. There is just one paragraph on Marinol in this article. It is in the "experimental treatsments" section. It is made clear that the research is only preliminary.

2. In spite of the fact that Greg accused me (or at least somebody who posted to this article) of getting into the "politics of illegal drugs" and being pro "medical-marijuana" when it comes to Marinol (legal by Rx in all 50 states) Greg is wrong! In fact, this could actually be an arguement AGAINST medical marijuana, because it appears that the legal alternative (Marinol) is supperor to marijuana for treating TS! Greg should assume good faith, and learn that marijuana and Marinol are not the same thing.

The information does not belong in the Marinol article because:

3. The Marinol article just has information on what Marinol is and what it has been approved for. It has been used experimentally in treating all sorts of things, and therefore there is no laundry list of all Marinol research for all conditions in the Marinol article. That sort of information belongs in the articles about specific conditions.

4. Many medications' names have been posted to this article, and many of these medications have their own articles in wikipedia that don't mention Tourette's Syndrome at all! So the standard precident, in this very article and on wikipedia, is: Information about off the label research on a drug for treating a specific condition belongs in the article about the specific condition, not the article about the drug!

This is from wikipedia's policy on consensus:

"Note that consensus can only work among reasonable editors who make a good faith effort to work together to accurately and appropriately describe the different views on the subject. (e.g. insisting on insertion of an insignificant factoid into an article in opposition to many other editors has been judged a violation of consensus; see Wikipedia:Requests for arbitration/Charles Darwin-Lincoln dispute.)

It is difficult to specify exactly what constitutes a reasonable or rational position. Nearly every editor believes that their position is reasonable; good editors acknowledge that positions opposed to their own may also be reasonable.ut Wikipedia's consensus practice does not justify stubborn insistence on an eccentric pos Bition combined with refusal to consider other viewpoints in good faith. With respect to good faith, no amount of emphasized assertions that you are editing according to Wikipedia:Neutral point of view while engaging in biased editing will serve to paper over the nature of your activities."

We can argue all we want about semantics or if something is in context or not, but it is now time for people who are simply being stubborn to answer this question!

By the way the defintion of factoid is

"A piece of unverified or inaccurate information that is presented in the press as factual, often as part of a publicity effort, and that is then accepted as true because of frequent repetition: “What one misses finally is what might have emerged beyond both facts and factoids—a profound definition of the Marilyn Monroe phenomenon” (Christopher Lehmann-Haupt)." (answers.com)

None of the information in the Marinol paragraph is unverified or inaccurate, so it contains no factoids!

User 206.59.60.140, Please do not continue altering the talk page. Your disruption of the talk page may lead other editors to conclude that your efforts here are not in good faith. Adding a subheading for clarify is helpful: moving entire sections of the talk page to make a point is disruptive. Sandy 21:29, 8 February 2006 (UTC)

Sandy, stop being stubborn and answer the question "Do you have have a good reason to drastically change the paragraph on Marinol or move the paragraph to the Marinol article in the future?" please! We can talk about headings, and semantics and context etc., but I'd rather talk about SUBSTANCE!

To quote from wiki policy above about good faith, "Wikipedia's consensus practice does not justify stubborn insistence on an eccentric pos Bition combined with refusal to consider other viewpoints in good faith. No amount of emphasized assertions that you are editing according to Wikipedia:Neutral point of view while engaging in biased editing will serve to paper over the nature of your activities." You claim that you are doing your edits in the name of being NPOV, but you don't answer the question at the top of the section directly! This is not good faith! The question is the substance of this discussion. Wiki policy is to not worry so much about whether the edits are NPOV or not, and instead answer the question at the top of this section.206.59.60.140 01:17, 9 February 2006 (UTC)

So far, nobody has given me answer to the question at the top of this section (after reading my 4 points of course.) I believe that is because nobody can think of a good reason to drastically change the Marinol paragraph, or to move the paragraph to the Marinol article in the future. Therefore, if somebody's answer to the question is "No," please say so, in spite of your bias!

To quote from wikipedia policy above, "Wikipedia's consensus practice does not justify stubborn insistence on an eccentric position combined with refusal to consider other viewpoints in good faith." It is not enough to just say "I don't agree" without providing a reason!

I think that some people may need to at least consider, in good faith, the possibility that I am right when I say there is currently no good reason to change the Marinol paragraph drastically, and that there is no good reason to move the paragraph to the Marinol article in the future! 206.59.60.140 01:12, 9 February 2006 (UTC)

I see this is still troubling you. I don't how else to answer the question, as I have already answered it at least three times in the different sections where this topic is discussed, and it is not helpful to continue to restate the same thing. I wish I knew how to make this better, as it's obviously important to you. I don't know where we're getting crossed up, but I do encourage you to bring it to a user talk page, rather than continuing to add volume here on this topic. Sandy 01:43, 9 February 2006 (UTC)

No you have not answered this specific question at all. If you have, PLEASE repeat your answer! Or show me exactly where you posted your answer!

At the very least you can provide me with a link that goes to right to where you claim you posted the answer! It is not hard to provide a link! I must say, if you can't even do that, then you are not acting in good faith! According to wiki policies "Consensus can only work among reasonable editors who make a good faith effort to work together to accurately and appropriately describe the different views on the subject." Please try to accurately describe your answer to the question, or at least provide a link to where you claim to have already posted this answer! I want to read your answer, but I can't find it! So please, as wiki policy says "work together" with me so that I can at least KNOW WHAT YOUR ANSWER IS! 206.59.60.140 02:17, 9 February 2006 (UTC)

Can you at least answer this part of the question: "After looking at points 3 and 4, above, do you have any good reason why the paragraph on Marinol and TS should be moved to the Marinol article in the future?" 206.59.60.140 01:48, 9 February 2006 (UTC)

Twitch and Shout, HBO Documentary awards

Source please for the statement that T&S has a Golden Globe? I found that it has a CINE Golden Eagle, not a Golden Globe. [16]

Here's my reference. [17] 206.59.60.140 00:06, 9 February 2006 (UTC)

There's no mention of a Golden Globe there ?? Sandy 00:09, 9 February 2006 (UTC)

My mistake, it was a golden gate award. I'll take it out of the article.206.59.60.140 00:12, 9 February 2006 (UTC)

Also, of note - the first award nomination for the HBO documentary, as we go into the season: [18]

Okay, I just edited out the statement that it was a "highly acclaimed" documentary, because I felt that was too POV. But mentioning an award that it won is fine with me.

That sounds reasonable, and is fine with me. I also edited the POV out of Twitch and Shout. Sandy 00:11, 9 February 2006 (UTC)

Also, would you mind starting to use edit summaries? That will make it much easier for other editors to understand the reasons for your edits. Thanks! Sandy 00:18, 9 February 2006 (UTC)

"Twitch and Shout" was nominated for and won many awards. This link has all the awards this documentary was nominated for and won.[19]

I only listed the emmy nomination because that was the only award big enough worth mentioning. Likewise, I think we should delete the stuff about the director of the HBO documentary being nominated by the directors guild, that is not that big of an award! Either that, or we should list all the awards Twitch and Shout won!206.59.60.140 23:18, 10 February 2006 (UTC)

Generally speaking, if the awards are not televised, they are not big awards! And we definately should delete the dead link around the director's name since there is no article on this guy! He isn't that important! I will do that now!206.59.60.140 23:22, 10 February 2006 (UTC)

Also, I find it interesting that we would want to publicize a director producer of that HBO documentary who did not have TS! Now, maybe I'm biased because I have TS, but I do think it is very hard for someone who doesn't have it to understand it. I'm sure the TSA could have found somebody with TS to do that documentary! Was anybody who had TS actually hired to work on that documentary (even if only as a grip?)206.59.60.140 23:41, 10 February 2006 (UTC)

In the News

I deleted two links that were simply reviews of documentaries about TS. I don't think that is newsworthy. Articles about the recent genetic discovery would be more newsworthy.

It's helpful to bring items to the talk page before deciding to delete them. The recent genetic discovery is mentioned, and as indicated by TS researchers, the relevance of that finding is questioned, and it may not even apply to genetic Tourette's. I can't agree that the first documentary dealing with Tourette's in children is not noteworthy, and those articles in particular offer information about and, more notably, videos clips of children with TS who are doing quite well, which is a topic that is always of interest. We were all children once :-)) Sandy 00:26, 9 February 2006 (UTC)

I agree that the first documentary on children with TS is noteworthy but I think it should be noted in the part of the article in the documentary section. Perhaps you can link the reviews and the video clips of the documentary in the documentary section? I think an entire new section for reviews about documentaries may not be necessary.

Very good idea ... I'll do that. That is, put the links as part of the documentary item, rather than as news item. Thanks for the suggestion. Sandy 01:29, 9 February 2006 (UTC)

"John's not mad" was an unbiased documentary about a 16-year old with TS, assuming it is really possible to be "unbiased."206.59.60.140 00:58, 9 February 2006 (UTC)

I noticed that you have again deleted the links. Can you recommend any other (unbiased) news links which contain live video clips of children with Tourette's, talking about living with tics, and doing well? I am not aware of any other online source that would allow Wikipedia readers to see a professionally-produced clip of "regular kids" with tics. Sandy 00:34, 9 February 2006 (UTC)

Insider TV dropped the link to the video clip, so I added back in only the News10 report. Sandy 00:40, 9 February 2006 (UTC)

Toward a reasonable half-way consensus

After reading points 3 & 4 below, can anyone give me a good reason why the paragraph on Marinol in this Article should be moved to the Marinol article in the future?

The paragraph does not belong in the Marinol article because:

3. The Marinol article just has information on what Marinol is and what it has been approved for. It has been used experimentally in treating all sorts of things, and therefore there is no laundry list of all Marinol research for all conditions in the Marinol article. That sort of information belongs in the articles about specific conditions.

4. Many medications' names have been posted to this article, and many of these medications have their own articles in wikipedia that don't mention Tourette's Syndrome at all! So the standard precident, in this very article and on wikipedia, is: Information about off the label research on a drug for treating a specific condition belongs in the article about the specific condition, not the article about the drug!

I realize that I am only asking half of what I was asking before in the "Toward a reasonable consensus" section, but since no one can answer that question, I'd like to know what people's answers are to the question at the top of this section. Maybe we can reach a partial concensus.

Any answers to the question at the top of this section are welcome, even if the answer to the question at the top of this section is "No."

Mort Doran, primary source document

I have heard Mort Doran speak at several TSA conferences. Conference bios and write-ups include the info that he was the person upon whom Oliver Sacks based the character using the pseudonym, Jim Bennett, in the book. In his speeches, Mort Doran discusses same (piloting and surgery, and how his tics remit while he is doing either). However, I am unable to locate a primary source document to reference this statement. I no longer have the conference bios. Can anyone help locate a reputable, primary source reference for this statement? Another option is to drop Mort's name, but because some medical experts differ with Oliver Sacks' depictions and portrayals of TS, it is important to establish that "Jim Bennett," and the descriptions of his tics, was not a fictionalized representation.

"Neurologist and writer Oliver Sacks has described a physician with severe TS, (Canadian Mort Doran, M.D., a pilot and surgeon in real life, although a pseudonym was used in the book), whose tics remit almost completely while he is performing surgery." TIA Sandy 13:40, 9 February 2006 (UTC)

From WP:RS, "Wikipedians often report as facts things they remember hearing about or reading somewhere, but they don't remember where, and they don't have any other corroborating information. It's important to seek credible sources to verify these types of reports, and if they cannot be verified, any editor may delete them." Sandy 14:12, 9 February 2006 (UTC)

I finally found my paperwork, a brochure from a TSA conference which includes the bio for Morton L. Doran, MD, the "surgeon written about in The Man Who Mistook His Wife for a Hat by Oliver Sacks, MD" So, I went online looking for a source. Found nothing on Google, but find multiple Google Groups posts, such as CT TSA Conference And the fictional character was Carl Bennett, not Jim Bennett. Sandy 00:07, 15 February 2006 (UTC)

Super-Tourette? Is Oliver Sacks always credible?

Since there are a few references to the "Man Who Mistook His Wife for A Hat" by Sacks in this article, on thing about that book that seemed totally off the wall was when he describes the case of an old lady who has super-Tourette's, 50 times as bad as Witty Ticcy Ray. Even though Sacks describes "Witty Ticcy Ray" as a mild case of Tourette's, Ray had coprolalia, and I'd say anyone with coprolalia does nto have mild Tourette's.

But I don't think super-Tourette's exists and I only have heard about it from that book. Does anybody know anything else about it?

Well, I happen to know of a TSA MAB MD who has expressed publicly his disagreement with Sacks' fictional views, but Usenet entries aren't valid primary sources for Wikipedia. He wrote those books so long ago, that whatever was labeled as "mild" then would not likely be labeled "mild" today. Super-Tourette's sounds like another way of saying what is called "Tourette plus" today. And, you're right -- studies have shown a linear correlation between the number of comorbid conditions and the presence of coprolalia -- suggesting that one needs to have co-occurring conditions beyond tics to have coprolalia. I have problems in general with Sacks fictional literature, and would prefer to delete all references to it, since not all agree with everything he writes. His journal-published info is different, as it is subject to peer review, but his fiction is self-published, and often sensationalized. Unless we can find a reference for substantiating that the fictional "Jim Bennett" was the real person, Dr. Mort Doran, I'd rather delete references to Sacks' fictional literature. Sandy 20:20, 9 February 2006 (UTC)

Well, in the book Sacks said that after meeting Ray he realized that TS was common and all around him. He cited this example of this old lady in a New York Park bench. She didn't have corprolalia, she just mirrored peoples facial expressions in a very exaggerated way. Now usually doctors don't make a diagnosis in a park anyway, but he was not only diagnosing her, he diagnosed her with a whole new condition!

Hence my concern about his fictional writing and sensationalism. Without a thorough examination, ruling out other conditions, he can't diagnose her from a park bench. Sandy 21:45, 9 February 2006 (UTC)

Standard neurological exam normal

I'm trying to reference the entire article. I added this statement to the diagnosis section, but now I can't locate my reference. Will add it back in if found. "Standard neurological examination is usually normal in Tourette's syndrome patients." Sandy 20:45, 9 February 2006 (UTC)

Update - I found my source, but it's not yet published. Maybe someone else can find the same statement somewhere. Sandy 21:07, 9 February 2006 (UTC)

Documentary - Source please, Discovery Health Channel

Still trying to source and reference everything in the article.

Diseases & Conditions: Tourette syndrome" - A documentary on Tourette's Syndrome that was part of the Discovery Health Channel's "Diseases & Conditions" series. This documentary includes numerous Tourette's Syndrome experts.

I haven't been able to locate any primary source document about this documentary, or that it was part of the Diseases and Conditions series, or what "TS experts" may have been included. I recall some sort of controversial documentary that couldn't necessarily be described as having "experts," so we need to locate a source on this. Sandy 22:26, 9 February 2006 (UTC)

Hmmm. Well I think I was wrong -- it was part of the "Medical Mysteries" series, and I think it may have been coproduced by the BBC. I have never heard controvery about it, but many I just am not aware of it.206.59.60.140 04:37, 10 February 2006 (UTC)

Yes, I too remember co-production of a documentary with the BBC, and that it wasn't well received. I'll dig around some more under Medical Mysteries and see if I can come up with any references or descriptions. Sandy 14:11, 10 February 2006 (UTC)

That documentary was made 5 years ago (or more) when some people still thought that nicotine was a good idea. But it did point out that all nicotine does, at best, is double the potency of the neuroleptic drugs. This documentary went though many theories and treatments, but did not endorese any of them. It contained numerous TS experts, including Olive Sacks and David Comings and others whose names I don't recall right now. But since I had heard of Comings and Sacks, of course I remember them. There was also a lady in Brition who had a TS clinic, I can't recall her name... But Sacks and Comings are both TS experts.

If Sacks is not a TS expert, should we be referring to his book in the references section? A lot of books in the references section don't seem to meet your criteria for experts.206.59.60.140 23:07, 10 February 2006 (UTC)

I'm trying to work from Wikipedia criteria, not mine. I've mentioned a couple of times that we need to put Sacks' fictionalized writing into context for a medical article. Sandy 04:14, 11 February 2006 (UTC)

Okay, the name of that expert from Harvard was HI Kushner, I remember now because it said he was the author of "A cursing brain." So I think you would agree that he qualifies as an expert. He is on the TSA MAB is he not? Well he was also in the Discovery Health Channel's Documentary.206.59.61.72 19:22, 15 February 2006 (UTC)

Wiki standards and all fictional stuff

I'm thinking in terms of Wikipedia standards: WP:RS "Try to use sources who have degrees in the field they are discussing. The more reputable ones are affiliated with academic institutions. The most reputable have written textbooks in their field for the undergraduate level or higher: these authors can be expected to have a broad, authoritative grasp of their subject." That puts the TSA and their MAB, and a number of other sources, in another league relative to Comings or Sacks. Comings is a geneticist (not a psychiatrist, not a neurologist) who has never written a TS textbook subject to peer and editorial review (he's self-published by his own vanity press), and as far as I know, Sacks' writings and work with respect to TS (besides being very old) are mostly fictionalized accounts, and neither of them (to my knowledge) are affiliated with academic institutions where, as in the case of most of the TSA MAB, and the likes of Leckman, Cohen, Jankovic, Walkup, etc., they are also heads of their departments. And neither of them are contemporary, practicing "experts" (if we even accept the premise that either of them ever were that, which is debateable): most of what Comings published is now approaching the 20-year mark. I go back to the question of why a medical entry should list every time TS was mentioned in the media or film, and the reminder of what Wikipedia is not: it is not a collection of lists or links. Sandy 22:11, 10 February 2006 (UTC)

Using this logic, should we also remove the link to the "Motherless Brooklyn" book? The author of that book is not a doctor, has never published any textbooks, and at the time he wrote the book, he never even met anybody with TS!

And using this logic, we should get rid of the link to an LA Law episode about a lawyer who sues on behalf of someone with TS. No TS expert of anykind wrote, directed, or producded the episode! They did not publish textbooks on TS! And the LA Law episode really is not very useful at all for a medical standpoint! A doctor won't learn how to treat TS by watching LA Law!

It seem to me that using your logic, all of these fictional entries should be deleted, because they were not made by experts and don't have any medical instructional value! I'm not going to delete them, but I will list them here:

The UK movie, Dirty Filthy Love, tells the story of Mark Furness (Michael Sheen) with Obsessive Compulsive Disorder (OCD) and Tourette's negotiating his way through divorce, his best friend's matchmaking efforts, and a woman who introduces him to therapy, filth and unconditional love.
In a 1990 episode of LA Law, the character, Rollins, represents a man with Tourette's Syndrome who is suing for wrongful termination after he is fired because of his TS.
The main character, and narrator, of the novel Motherless Brooklyn by Jonathan Lethem has Tourette syndrome.
In a January, 1998, episode of The Practice, characters Ellenor and Rebecca fight to keep a 12-year old girl with Tourette's Syndrome in school, raising awareness about issues of educational advocacy for students with Tourette's.
An episode of the television show Quincy, M.E. has Quincy arguing with the drug companies, lawyers and the Food and Drug Administration to promote research into the syndrome. This was a seminal moment in the history of Tourette's, as it led to many people who didn't know what they had was Tourette's getting a name for their symptoms.
A movie released on video, The Tic Code, stars Gregory Hines as a saxophone player with TS who befriends a 10 year old boy who wants to be a jazz pianist (and also has TS). Written by Polly Draper, and produced with her husband, jazz musician Michael Wolff, who has Tourette's in real life.
In the February 7, 2000, episode of 7th Heaven, Simon befriends a boy with Tourette's syndrome.

Should all this stuff go?206.59.60.140 23:02, 10 February 2006 (UTC)

Also, the Discovery Health Channel documentary had many many experts, not just those two! In fact, it had one expert on there just to debate Comings. (The documentary was trying to be neutral.) The guy debating comings had a PhD in Neurology -- forgot his name.) Besides, how many textbooks have been written on TS anyway? I think that people like Comings, who had their own clinic and published a lot of papers on TS in scientific journals are the people who come the closest to being TS experts. I don't know of anybody who has published textbooks on TS for undergrads.206.59.60.140 22:37, 10 February 2006 (UTC)

There are many textbooks and books on TS, several written by people fulfilling Wiki criteria for most reliable sources. These two are very accessible to laypersons, although they have a few chapters on brain circuitry that are more advanced. Cohen, DJ, Jankovic J, Goetz CG, (eds). Advances in Neurology, Vol. 85, Tourette Syndrome. Lippincott, Williams & Wilkins, Philadelphia, PA, 2001. [20] Leckman JF, Cohen DJ. Tourette's Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. John Wiley & Sons, Inc., New York, 1999. [21] I have read both of these cover to cover, and highly recommend them. However, there is a new textbook due out in April, 06, by Walkup, which should provide an update. These authors "have their own clinics", most are/were (Cohen died a few years ago) teaching professionals at institutions of note (e.g.; Yale), their books were subject to editorial and peer review (unlike Comings' self-published work), they are far more and widely journal-published than Comings (in reputable journals), they serve/served on the TSA Medical and Scientific Advisory Boards, and the ones who are alive are still practicing professionals, recognized as the tops in their fields. I don't believe David Comings meets most of those criteria. For a review of some of the problems with his work, see PMID 3165247 . Sandy 12:54, 11 February 2006 (UTC)

Okay, one expert that was on that documentary that I think is on the TSA MAB was this guy from Harvard ... but I forget his name. I don't know the TSA MMAB as well as you do. The guy from Harvard was talking about examining the brains of people with TS who donated their brains to the Harvard brain bank.

I might pass on the textbook thing. I have been driving myself a little nuts "thinking about the monkees" with the article! But at least now I can think about Tourette's a lot more than I could, but I still have limits. For example, books like Motherless Brooklyn and Twitch and Shout I could never finish because they always made me cry.206.59.61.168 18:31, 13 February 2006 (UTC)

OK, I finally located my own notes on this documentary, and now understand why I assigned it to obscurity (as apparently, so did Google). Yes, it was Medical Mysteries, not Diseases & Conditions, yes, it was co-produced in the UK, and there was some confusion in the USA as it eventually aired on the Discovery Health Channel, not the Discovery channel. I submit that it's not a relevant entry here because of 1) its obscurity (only one mention on Google that I can find, by someone with TS who was in the documentary), and 2) the outdated information contained in it. It didn't have any true "TS experts" (reference Wikipedia criteria on reliable sources), but it did have Dr. Sandberg (Sanberg?) from Fl discussing the nicotine research. Several members of the South Florida group had a financial interest (patent holders) in either mecamylamine or inversine (verified in their disclosures in their journal-published research), and the usefulness of those agents in the treatment of TS has since been disproven. I suggest we delete this entry, based on Wiki criteria that Wiki is not a collection or list, and as TS is a medical entry, relevance and reliable sources should be established. For example, Handler's documentary won numerous awards, so may be worthy of mention (I haven't seen it -- I would also suggest removing it if it is found to contain outdated or inaccurate medical information). We also need to come up with a reason for keeping the entry for "John is Not Mad." Sandy 16:02, 10 February 2006 (UTC)

"John's not Mad."

John is not Mad is one of the most famous documentaries ever made about TS, and is one of the most famous BBC documentaries ever made. It was the first documentary to make TS more familar to many people, especially in the UK.

I'd never heard of it until it was listed here a few days ago, but who am I, besides someone who has followed everything you can follow about TS for a decade <grin>? Google turns up 12 hits on "John is not mad" and tourette. Sandy 22:11, 10 February 2006 (UTC)

Now that you've provided the correct name, "John's not Mad," I was able to find it on Google. (Produced in 1989, released by TSA Scotland in 2/04.) Noting that the correct title was added on here after I did the Google search. Although it was released to DVD two years ago, I never heard of it. Perhaps we could discuss items here and nail down the correct details before they get added to the article?Sandy 04:10, 11 February 2006 (UTC)

Look I realize that my spelling is not always perfect, but considering that I have a very bad case of ADHD and TS, and that I used to be terrible at spelling I have come a long way. I'm not asking you to pity me, but can you cut me just a little slack with the spelling and grammer? I'm doing the best that I can.

Hi there. I hope you'll reread my entry and see that I wasn't attacking your spelling, rather explaining why I hadn't come up with the documentary on Google. Spelling attacks are lame -- I wouldn't do that :-) My suggestion was only that if we brought new items here before adding them to the page, we might be better able to nail things down here, which would result in less editing to the main entry. Sandy 22:32, 13 February 2006 (UTC)

Here is a link that I added to the documentary part of the article on John's not made. It should answer your questions.[22] As you can see, it is one of the most famous documentaries on TS. The DVD is being put out by the TS Foundation of Scotland to raise funds, and the DVD was endorsed by Tim Howard.

And here is another link I added to Tourette Scotland's page on John's Not Mad.[23]206.59.60.140 22:29, 10 February 2006 (UTC)

Upon closer examination of the Tourette Scotland website, it appears the TSA chapter of New Jersey is also recieving a donation for the DVDs sold. So there is an endorsement form a TSA chapter as well!

Also if John is not Mad is not justified, they why is the HBO documentary justified? The HBO documentary was NOT the first documentary on children with TS, John's not Mad was!

First is not the only measure of relevance, and that's without mentioning accuracy and durability -- the HBO Documentary's usefulness in representing TS will outlive this entry. Google turns up 20,300 hits on HBO tourette, and 334 on the name of the documentary alone. Since the TSA was involved in the documentary, it doesn't put out any inaccurate medical statements about Tourette's. Reliability of sources, and relevance. Sandy 22:11, 10 February 2006 (UTC)

Well, you consider Tourette Scotland to be a reliable source, right? Why would they endorse a documentary that they thought had inaccurate information?

On Handler's documentary: I agree with you on Handler's medical information, he is partially biased against marijuana treatment, and doesn't bother taling about Marinol. He said that couldn't sit though a movie without smoking pot before he starting taking Orap. He felt incredibly guilty that he smoked marijuana (??) and felt it lead one of his mariages to break up! He completely failed to reconize that he was self-medicing (and it was working) with marijuana (he might have done even better with Marinol!) He acts like Orap was a godsend, because it didn't have the side effects of Haldol. Of course, as you know, that was proven false and Orap may be just as bad as Haldol when it comes to side effects. It certainly is more dangerous than Marinol and even (gasp!) more dangerous than pot! But I like the part where he goes to that town where so many people have TS. I like the fact that he points out that in Zulu culture TS is one of two "diseases" that are considered holy, and anyone with Tourette's Syndrome would be a triabal cheiftan, and a shaman of some sort. I think it is okay to link to things that address some cultural aspects of TS even if they endore Orap way too much.

And the search for the "safe" antipsychotic (what Orap was supposed to be) has always ended up the same way. It is always discovered that the drug is really dangerous, right before the patent expires, but now they've got this NEW antipsychotic that is supposed to be safe! Xyprexa, of all the new antipsychotics, is proven to be the lest likely to cause brain damage or tardive disconesia! But it is the MOST likely to cause weight gain and diabetes! I know people who gained 100 lbs. after taking Xyprexia!

The relevance of the Mozart documentary should also be examined, as there were no Tourette's experts involved; and it makes a claim that no TS experts have endorsed, that we know of, and which authoritative sources have failed to endorse. We need to determine Wikipedia criteria for the inclusion of these entries on a page dealing with a medical condition. Sandy 16:13, 10 February 2006 (UTC)

When it comes to Mozart, I don't really know if he had TS or not. I think that there may not be much evidence that he had TS, but it does not mean it is impossible. I think it is interesting that a doctor wrote a book that somebody published putting forth that theory. Now maybe you're right. and that it is a bad theory. But should we cover up the theory? Wouldn't it actually be better to present both sides?

I agree, it's maybe a matter of in what light it is presented. Sandy 22:11, 10 February 2006 (UTC)

A Brand New Concensus Has Been Reached

I believe we can agree with the following consensus statement:

"Considering points 1, 2, 3 & 4 below, there is no good reason to move the paragraph on Marinol to the Marinol article."

The information does not belong in the Marinol article because:

1. There is just one paragraph on Marinol in this article. It is in the "experimental treatsments" section. It is made clear that the research is only preliminary.

2. In spite of the fact that Greg accused me (or at least somebody who posted to this article) of getting into the "politics of illegal drugs" and being pro "medical-marijuana" when it comes to Marinol (legal by Rx in all 50 states) Greg is wrong! In fact, this could actually be an arguement AGAINST medical marijuana, because it appears that the legal alternative (Marinol) is supperor to marijuana for treating TS! Greg should assume good faith, and learn that marijuana and Marinol are not the same thing.

3. The Marinol article just has information on what Marinol is and what it has been approved for. It has been used experimentally in treating all sorts of things, and therefore there is no laundry list of all Marinol research for all conditions in the Marinol article. That sort of information belongs in the articles about specific conditions.

4. Many medications' names have been posted to this article, and many of these medications have their own articles in wikipedia that don't mention Tourette's Syndrome at all! So the standard precident, in this very article and on wikipedia, is: Information about off the label research on a drug for treating a specific condition belongs in the article about the specific condition, not the article about the drug!

Please note that this is not the same concensus I declared a few days ago, since there was disagreement with the clause on how the paragraph should “roughly stay the same,” so I dropped that part. This is instead a compromise that I was working on in the Towards a Reasonable Half-Way concensus section!

This is from wikipedia's policy on consensus: "Note that consensus can only work among reasonable editors who make a good faith effort to work together to accurately and appropriately describe the different views on the subject. “

Given Wiki policy, I will declare that the “concensus statement” is something everyone agrees with, unless someone disagrees and PROVIDES A GOOD REASON TO DISAGREE! If someone writes and says “I already gave you my reasons” but won’t even provide a link to those reasons, this is acting in bad faith because wiki policy requires editors to work toget in good faith to describe their different views on the subject. If someone can’t easily find your reasons against the concensus statement, we still have a concensus! If you gave reasons to disagree with the last concensus, they do not apply to this one! Please give us your reasons here!

More of Wiki’s concensus policy: “Wikipedia's consensus practice does not justify stubborn insistence on an eccentric pos Bition combined with refusal to consider other viewpoints in good faith.”

For this reason, if someone just says they’re disagreing with the concensus statement without providing a good reason, it shall be assummed that we STILL HAVE A CONCENSUS!

I won't delete this or any other section of the talk page.

If somebody can think of a good reason to disagree with the consensus statement at the top of this section in six months, they can post it!

But until then, we have a consensus ladies and gentleman! Finally!

Talk page?

User 206.59.60.140, it would be nice if you could give us a name to call you - doesn't have to be your real name, but it would be nice to be able to address comments to you instead of your IP address. This talk page is becoming prohibitively long for anyone wanting to work on this article in the future, and some of the discussions digress from the task at hand. I was thinking you might be interested in looking at the article for a condition which has some similarities to Tourette syndrome, and which achieved featured article status on Wikipedia, Asperger syndrome. It gives an example of a well written Wikipedia article, and the encyclopedic tone and quality this article should seek to attain. This is your user talk page. Maybe we can talk about how to move towards that level of article on your talk page? Sandy 00:16, 11 February 2006 (UTC)

That article addresses many things that I thought you said do not belong in this article. I thought you didn't want information about possible social impairments. TS can be one of the most socially impairing disorders, especially in children. (I realize not everyone with TS has this problem. But a lot do! I'd bet it is more socially impairing that Asperger's Syndrome. I'm sure not everyone with Asperger's is socially impaired either.)

TS is like autism in the sense that an autistic person does not innately understand the facial expressions of others (such as a smile) but can learn them intellectually and someone with TS does not understand the concept of what is socially acceptable, but we can learn intellectually. The fact is TS ALWAYS involves irrestable urges to do things that are not socially acceptable. If tics were socially acceptable, nobody would label it as a abberation.

Also, I liked the part in the Asperger's article that talked about how it was a blessing and a curse. This is sort of what I was trying to get at with the "magic pill" thing, because TS can be a blessing and a curse too.206.59.61.72 07:15, 14 February 2006 (UTC)

Hi 206.59.61.72 -- it would be so helpful if you would give us a name to call you :-) I'm not sure where I said we shouldn't have information about social impairments? The reason I referred you to the AS article is that it is the only DSM condition I've located on Wikipedia that was a featured article, meaning that it meets certain standards on Wikipedia and was reviewed by numerous editors and had medical collaboration. Wikipedia principles call for verifiable information from reliable sources. In the majority of cases, TS is not impairing, and in fact, is less impairing than AS (just look at the diagnostic criterion for the two conditions). Impairment in social functioning is not part of TS, so I'm not sure why you say people with TS don't understand that concept of what is socially acceptable? That doesn't apply to any of the people I know with TS, unless they also have co-occurring conditions, such as anxiety disorders, etc. I don't know of a medical source that would agree that TS *always* involves urges to do things that are not socially acceptable. I don't think people label eye blinking, for example, as socially unacceptable -- it's just irritating. Yes, as I mentioned, I personally agreed with the "magic pill" statement, so I found a chapter in a published textbook that dealt with that. When the next textbook about TS comes out in two months, perhaps we can expand on that concept, using information from a verifiable source, and without reflecting our own experiences (which Wikipedia disallows as "original research.") I, too, thought of creating and labeling a section "Blessing and curse," but maybe we can come up with something on our own rather than lifting the AS terminology :-)) Anyway, I just hoped you'd enjoy the AS article, as it gives an example of the encyclopedic tone that Wikipedia aims for. Sandy 12:47, 14 February 2006 (UTC)

Well until the most recent version of the DSM came out (DSM IV TR) all previous version included impairment as a criteria for diagnosis, including the first DSM IV. A lot of people opposed this, saying not everyone with TS has impaired funtioning, etc. AS's has been discovered more recently, and has less lobbing groups behind it than TS does as of now. But I'll bet you that someday, they will remove that requirement for AS that it causes social impairment from the DSM. Anyway, forget the phrase "socially acceptable." TS always involves the irrestable urge to do things that can annoy or irk other people.206.59.61.72 01:39, 15 February 2006 (UTC)

I wouldn't put money on that bet, if I were you <grin>. The "core" deficit in AS is social impairment. Without the impairment, there's no disorder. The core deficit in TS is something physically measurable and viewable: involuntary motor and vocal tics. You can have those without being socially or functionally impaired. TS can exist without impairment: AS can't, because it is defined as a disorder of social impairment. Sandy 02:03, 15 February 2006 (UTC)

Yes TS can exist without impairment. But ask ANYBODY who has TS and they will tell you that they suppress their tics, at least some of the time. Why do they do so? Because around other people and in public tics can make people react in negative ways to the person with TS. A person with TS is never supressing his/her tics because he/she does not like them; usually a person with TS does not understand why other people are making such a big deal about his/her tics. This is what I was getting at with the comment about people with TS not always understanding WHY something is not socially acceptable. We understand that our tics are not socially acceptable, because even when we aren't even aware that we are doing them in public someone will point them out to us. Children are a lot less polite than adults, so this affects children with TS even more. All people with TS supress their tics around others and in public because they know that ticing in public will VERY likely generate negative remarks from others. You can become functional, find creative ways to vent your energy, and effectively supress you tics enough that it does not impair you at all, and your Tourettic energy can even be used to your own advantage. Still, someone with TS is always walking on a tight rope, balancing their need to tic with their need to suppress tics in public because of the negative social consequences of ticing in public view. That is why I say that supressing tics is like putting a lid on a boiling pot of water. (I believe I am unusually gifted at explaining the existential experience of TS to people who do not have it.)206.59.61.72 03:16, 15 February 2006 (UTC)

My tight rope walker analogy is a good one. A tight rope walker HAS to keep moving or else he/she will fall.

And yes, I was also referring to Nietzsche's image of the "tight rope walker" between man and overman. But I'm waxing philosophical.206.59.61.72 18:02, 15 February 2006 (UTC)

tics wikified many times

Does tics really need to be wikified every time? --Chapukwuk 04:28, 11 February 2006 (UTC)

I've been trying to do it once a paragraph, more or less. Can you/someone give us some guidelines? Sandy 05:07, 11 February 2006 (UTC)

generally we link a word or phrase only the first time it appears in an article. Though I think that a second link can be provided the first time it appears in a section that it is key to (such as treatment of tics). I'll go delink a bunch that I think are redundant. Matt 13:40, 12 February 2006 (UTC)

Thank you so much, Matt. I hadn't discovered (yet) a guideline! Sandy 14:55, 12 February 2006 (UTC)

Adding footnotes and other reference notes

I am just beginning to add footnotes, and will merge it into References section when finished. It is important to preserve the order of the footnotes, so please call my attention to any references that need to be added to the article while I am doing the work. Adding references while I'm doing the work may change the order of footnotes. TIA! Sandy 16:06, 11 February 2006 (UTC)

Done adding the ones I know how to do: waiting for guidance on how to best do others. Sandy 19:20, 11 February 2006 (UTC)

I'm not sure the references for the documentaries, "famous" people, etc. are needed in the article, but I'm going to save them here, pending guidance from an experienced editor.

References for "famous" people [24][25][26][27] [28] [29][30][31]

References for documentaries [32] [33] [34]

Update: I converted the referencing to this style - m:Cite/Cite.php - which uses automatic numbering, allowing others to edit without concern for numbering. Sandy 17:11, 12 February 2006 (UTC)

P.A.N.D.A.S.

Hi Sandy. I'd just like to thank you for all your work in this article and this field. Chapukwuk 23:59, 12 February 2006 (UTC)

Anyways, do you have any plans to put some information on or make a reference to P.A.N.D.A.S. in the article?

Thanks! PANDAS is on my To Do list, unless someone else gets to it first <grin> ... I've got a very long To Do list! P.S. - the reason I'm putting it off is that it's a very controversial topic, and I'd like to have other editors involved to help develop consensus on phrasing. Sandy 01:40, 13 February 2006 (UTC)

I began to gather the research info in a Sandbox page of my User page. User:SandyGeorgia/PANDAS I hope we can aim towards a "Causes and origins" section, which will include PANDAS, after the P.A.N.D.A.S. article is improved. Sandy 14:02, 14 February 2006 (UTC)

I think a photograph would enhance this article

One thing I noticed about the AS article is that it did have a photograph included. I have a feeling that articles that are seleted by Wikipedia to be "model articles" or whatever they call it are much more likely to have at least one photograph. This is means the article is at least more than just text and uses more multimedia.

Now I think perhaps a drawing of Giles de la Tourette would be good. Any other ideas?

— Preceding unsigned comment added by 206.59.61.72 (talk • contribs) 18:09, 15 February 2006 (UTC)

Thanks for the picture - yes, that was a much needed addition. (BTW, did you verify that the image you used was not copyrighted? I hadn't gotten to it yet, as I was tracking down the copyright issues.) I configured your picture to be right justified and porportionately-sized. I would like to ask you to please remember 3 things that will make things easier on other editors: please add edit summaries to all your edits, please add new talk sections to the bottom of the talk page, and please sign your entries. TIA! Sandy 20:19, 15 February 2006 (UTC)

Well I found the photo by searching google for images of Gilles de la Tourette (no quotes) and the first one I found was the one I'm using. It just so happens that Google linked it to the TS Disorder's page -- I am not trying to endore that site or sneak a link in to it. But how does on go about finding out the copywrite status on a drawing made in France more than 100 years ago?206.59.61.72 22:40, 15 February 2006 (UTC)

I actually don't know how one goes about finding out if a picture is in the public domain, which is why I had adding a picture on my To Do list, and hadn't yet done it. I needed to research the copyright issue. I think it important to note, however, that the website/webmaster from where you found the picture is not honoring copyright, so you might want to investigate further. Sandy 23:10, 15 February 2006 (UTC)

^ ^a ^b Swerdlow, NR. Tourette Syndrome: Current Controversies and the Battlefield Landscape. Curr Neurol Neurosci Rep. 2005, 5:329-331. PMID 16131414
^ Silver AA, Shytle RD, Sheehan KH, et al. Multicenter, double-blind, placebo-controlled study of mecamylamine monotherapy for Tourette's disorder. J Am Acad Child Adolesc Psychiatry. 2001 Sep;40(9):1103-10. PMID 11556635
^ Tourette Syndrome Association. Statement: Deep Brain Stimulation and Tourette Syndrome Accessed 26 Feb 2005.
^ Zinner SH. Tourette syndrome—much more than tics. Contemporary Pediatrics. Aug 2004;21(8):22-49. Part 1 Part 2
^ Sandyk R, Awerbuch G. Marijuana and Tourette's syndrome. J Clin Psychopharmacol. 1988 Dec;8(6):444-5. PMID 3235704
^ Muller-Vahl KR, Kolbe H, Dengler R. [Gilles de la Tourette syndrome. Effect of nicotine, alcohol and marihuana on clinical symptoms] Nervenarzt. 1997 Dec;68(12):985-9. German. PMID 9465342
^ Muller-Vahl KR, Schneider U, Koblenz A, et al. Treatment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry. 2002 Mar;35(2):57-61. PMID 11951146
^ Muller-Vahl KR, Schneider U, Prevedel H, et al. Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. J Clin Psychiatry. 2003 Apr;64(4):459-65. PMID 12716250
^ Muller-Vahl KR, Prevedel H, Theloe K, et al. Treatment of Tourette syndrome with delta-9-tetrahydrocannabinol (delta 9-THC): no influence on neuropsychological performance. Neuropsychopharmacology. 2003 Feb;28(2):384-8. PMID 12589392

[Swerdlow2005-1] Swerdlow, NR. Tourette Syndrome: Current Controversies and the Battlefield Landscape. Curr Neurol Neurosci Rep. 2005, 5:329-331. PMID 16131414

[2] Silver AA, Shytle RD, Sheehan KH, et al. Multicenter, double-blind, placebo-controlled study of mecamylamine monotherapy for Tourette's disorder. J Am Acad Child Adolesc Psychiatry. 2001 Sep;40(9):1103-10. PMID 11556635

[3] Tourette Syndrome Association. Statement: Deep Brain Stimulation and Tourette Syndrome Accessed 26 Feb 2005.

[Zinner2004-4] Zinner SH. Tourette syndrome—much more than tics. Contemporary Pediatrics. Aug 2004;21(8):22-49. Part 1 Part 2

[5] Sandyk R, Awerbuch G. Marijuana and Tourette's syndrome. J Clin Psychopharmacol. 1988 Dec;8(6):444-5. PMID 3235704

[6] Muller-Vahl KR, Kolbe H, Dengler R. [Gilles de la Tourette syndrome. Effect of nicotine, alcohol and marihuana on clinical symptoms] Nervenarzt. 1997 Dec;68(12):985-9. German. PMID 9465342

[7] Muller-Vahl KR, Schneider U, Koblenz A, et al. Treatment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry. 2002 Mar;35(2):57-61. PMID 11951146

[8] Muller-Vahl KR, Schneider U, Prevedel H, et al. Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. J Clin Psychiatry. 2003 Apr;64(4):459-65. PMID 12716250

[9] Muller-Vahl KR, Prevedel H, Theloe K, et al. Treatment of Tourette syndrome with delta-9-tetrahydrocannabinol (delta 9-THC): no influence on neuropsychological performance. Neuropsychopharmacology. 2003 Feb;28(2):384-8. PMID 12589392

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 The current entry, which started [http://en.wikipedia.org/w/index.php?title=Tourette_syndrome&oldid=36749893#Treatment on 26 Jan], and became an ad hominem issue about the TSA [http://en.wikipedia.org/w/index.php?title=Tourette_syndrome&oldid=37101665 on 28 Jan,] is now in better shape, consolidated under Experimental treatments.  I continue to concur with Greg, however, with respect to the Marinol entry.  Neither marijuana nor Marinol are currently useful in the treatment of Tourette's, nor are they likely to become useful treatments in the near future.  Reference, What Wikipedia is not -- a soapbox.  The considerable contributions of Unsigned User can be moved to Marinol and marijuana.  Here is my suggested wording to incorporate both Greg's and my concerns over the length and relevance of the Experimental treatments section. <br>'''Suggested wording'''</br>[[Nicotine]] showed preliminary promise in case reports, but these effects were not reproduced in well-controlled trials several years later.    <ref name=Swerdlow2005>Swerdlow, NR.  Tourette Syndrome: Current Controversies and the Battlefield Landscape. ''Curr Neurol Neurosci Rep''. 2005, 5:329-331. PMID 16131414</ref>  Studies of nicotine derivatives ([[mecamylamine]], [[inversine]]) also showed that they were not effective as monotherapy for the symptoms of Tourette's.<ref>Silver AA, Shytle RD, Sheehan KH, et al. Multicenter, double-blind, placebo-controlled study of mecamylamine monotherapy for Tourette's disorder.  ''J Am Acad Child Adolesc Psychiatry''. 2001 Sep;40(9):1103-10.  PMID 11556635</ref> [[Deep brain stimulation]] has been used in treating a few patients with severe Tourette's, but is regarded as an experimental and dangerous procedure that is unlikely to become widespread.<ref>Tourette Syndrome Association.  [http://web.archive.org/web/20050226093006/http://www.tsa-usa.org/news/DBS-Statement.htm Statement: Deep Brain Stimulation and Tourette Syndrome]  Accessed 26 Feb 2005.</ref>  [[Complementary and alternative medicine]] approaches, such as dietary modification, allergy testing and allergen control,  and [[neurofeedback]], have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome.<ref name=Swerdlow2005/><ref name=Zinner2004>Zinner SH. Tourette syndrome—much more than tics. ''Contemporary Pediatrics''. Aug 2004;21(8):22-49. [http://tsa-usa.org/research/images/cntped0804_022-036%20T1R2.pdf Part 1][http://tsa-usa.org/research/images/cntped0804_038-049%20T2R1.pdf Part 2]</ref> Case reports found that [[marijuana]] helped reduce tics, but validation of these results requires longer, controlled studies on larger samples.<ref>Sandyk R, Awerbuch G. Marijuana and Tourette's syndrome.  ''J Clin Psychopharmacol''. 1988 Dec;8(6):444-5. PMID 3235704</ref><ref>Muller-Vahl KR, Kolbe H, Dengler R.  [Gilles de la Tourette syndrome. Effect of nicotine, alcohol and marihuana on clinical symptoms]  ''Nervenarzt''. 1997 Dec;68(12):985-9. German. PMID 9465342</ref>  Preliminary research on [[Dronabinol]], synthetic THC in pill form (brand name [[Marinol]]®) as a treatment for Tourette's syndrome was promising, but there are concerns about the safety of Marinol, and longer, controlled studies on larger samples are needed.<ref>Muller-Vahl KR, Schneider U, Koblenz A, et al. Treatment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. ''Pharmacopsychiatry''. 2002 Mar;35(2):57-61. PMID 11951146</ref><ref>Muller-Vahl KR, Schneider U, Prevedel H, et al. Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial.  ''J Clin Psychiatry''. 2003 Apr;64(4):459-65. PMID 12716250</ref><ref>Muller-Vahl KR, Prevedel H, Theloe K, et al. Treatment of Tourette syndrome with delta-9-tetrahydrocannabinol (delta 9-THC): no influence on neuropsychological performance.  ''Neuropsychopharmacology''. 2003 Feb;28(2):384-8. PMID 12589392</ref>  [[User:SandyGeorgia|Sandy]] 01:10, 16 February 2006 (UTC)
+::"There are concerns about the safety of Marinol" is far to POV.  Just because somebody is "concerned" that Marinol causes cognitative impairment, for example, is meaningless.  The research shows that Marinol is quite safe and no concerns were raised by the actual trials.  You have to have a REASON to be concerned.
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