Talk:Gulf War syndrome

Dubious

What is the original source cited in the VA report for these boldfaced claims?

"Three large studies have shown a significant but modest increase in birth defects in children born to Gulf War veterans, however information on specific types of birth defects have been inconsistent and the rates fall within the normal range found in the general population."

Multiple sources later in the article indicate that the rates have been two to three times normal for male and female combat veterans, respectively. 71.212.237.94 (talk) 21:34, 18 April 2012 (UTC)

Search for "but modest" in the article, and you'll see the full quote further down. --sciencewatcher (talk) 22:30, 18 April 2012 (UTC)

That reference [6] doesn't link anywhere. 71.212.237.94 (talk) 00:26, 19 April 2012 (UTC)

Well I would suggest fixing the reference. It is definitely not "dubious"...we use that reference in multiple places through the article, and I'm pretty sure I remember reading it myself. --sciencewatcher (talk) 00:46, 19 April 2012 (UTC)

What definition of the word "modest" do you think applies in this context? In what sense is double and triple normal values "within the normal range" of birth defects? 71.212.237.94 (talk) 01:14, 19 April 2012 (UTC)

I've fixed the link. I'd suggest you read the report and you'll find the answer to your question. It is just single studies that have "double and triple" values, but when you put the studies together (i.e. do a meta-analysis) you find that the values are within the normal range (i.e. NOT double and triple). At least, that is what the VA is saying and they are a reliable source. --sciencewatcher (talk) 01:52, 19 April 2012 (UTC)

Are you looking at page 50 or somewhere else? I can find no meta-analysis pertaining to birth defects in the VA report. Please correct me if I am mistaken, but the VA report was not peer reviewed. It states, "The three studies most representative of Gulf War era veterans in the U.S. and U.K. have all indicated significant, but modest, excess rates of birth defects in children of Gulf War veterans. Information on specific types of birth defects has been inconsistent, however,[362] and overall rates are still within the normal range found in the general population.... [362] Doyle P, Maconochie N, Ryan M. Reproductive health of Gulf War veterans. Philos Trans R Soc Lond B Biol Sci. 2006;361:571-584." That study, in turn, states, "Two surveys stand out as being particularly large: one from the USA (Kang et al. 2001) and the other from the UK (Doyle et al. 2004). Both reported some evidence of a modest increase in risk of birth defect for male veterans' offspring born after the war...." but without any mention of whether they were "within normal range." Kang et al. 2001 is PMID 11557183, which states, "These excess rates also extended to the subset of 'moderate to severe' birth defects [males: OR= 1.78 (CI = 1.19-2.66); females: OR = 2.80 (CI = 1.26-6.25)]."

Do you consider an odds ratio of 1.78 for males and 2.8 for females to be "modest"? Kang's follow up study (p.10) found "found that male Gulf War veterans reported having infants with likely birth defects at twice the rate of non-veterans. Furthermore, female Gulf War veterans were almost three times more likely to report children with birth defects than their non-Gulf counterparts ... [W]ith medical records verification, [h]owever, Dr. Kang and his colleagues concluded that the risk of birth defects in children of deployed male veterans still was about 2.2 times that of non-deployed veterans." So as you can see, the odds ratio increased after medical records verification.

I propose removing the "modest ... within normal range" quote from the non-peer reviewed VA report from the introduction, and replacing it with the excerpted numerical figures from the peer reviewed and verified Kang et al. (2001) "population-based survey of 30,000 veterans" in the signs and symptoms section. 71.212.237.94 (talk) 02:51, 19 April 2012 (UTC)

Sorry, I meant review rather than meta-analysis. We should be using the Doyle review as our primary source of info, and using its conclusions rather than those of any individual study. We should perhaps replace the VA quote with a quote from the review instead. Also note that the review says (in relation to the Kang study): "The authors of all three reports have suggested that these findings be treated with caution because they are based on self-reported miscarriage and the role of biased reporting must be considered. The fact that in two of these studies (Kang et al. 2001; Doyle et al. 2004) the miscarriage rates in comparison (NGWV) pregnancies appear unusually low, rather than the rates being particularly high in the veterans' (GWV) pregnancies, provides some evidence that this might indeed be the case." --sciencewatcher (talk) 13:51, 19 April 2012 (UTC)

That's fair, as long as we don't use the word "modest" which is an inherently subjective and non-scientific term. And review or not, "modest" is simply beyond the realm of even vague plausibility in this case. Also, the Doyle et al (2006) review says nothing about whether or not the aggregate is "within the normal range found in the general population". How would you feel about removing the words "but modest" and "and the rates fall within the normal range found in the general population"? Note that Kang did examine the reporting bias, and when he used medical records instead of surveys, he found the number of combat veterans' children with birth defects increased 10%. 71.212.237.94 (talk) 20:37, 19 April 2012 (UTC)

"Modest" is used in the review. Really, the whole section needs to be rewritten based on the review. There is a lot of POV in the article at the moment...it shouldn't be quoting Kang at all for a start because it gives the impression that the science shows there are birth defects, when in reality that is unproven. The birth defects section needs to be entirely rewritten to be more in line with the Doyle review. --sciencewatcher (talk) 22:13, 19 April 2012 (UTC)

Kang surveyed 30,000 vets, found odds ratios of 1.78 for males and 2.8 for females, published that in a peer reviewed journal, and then went back with another survey in 2005, found odds ratios of 2 and 3, then checked medical records and found a 10% increase. Kang is the Chief Epidemiologist for the US Veterans Administration. What exactly are you saying is unproven? And what do you believe is the meaning of the word "modest" in this context? 71.212.237.94 (talk) 23:35, 19 April 2012 (UTC)

Read the review and you'll see that the miscarriage rates aren't abnormally high in vets - it's just that they are abnormally LOW in non-vets. Also, all these are self-reported so need to be treated with caution. That is why we mostly use secondary sources and reviews in wikipedia rather than primary sources - see WP:MEDRS. --sciencewatcher (talk) 15:23, 20 April 2012 (UTC)

I don't think anyone has mentioned miscarriage rates, which are undetectable in the first weeks anyway. Again, Dr. Kang, the Chief Epidemiologist for the Dept. of Veterans Affairs, avoided self-reported surveys of birth defects by analysis of medical records, and in doing so found more of them. Is Doyle even an "independent" secondary source, since her review includes her primary sources? In any case, if you can't state what you think is the meaning of "modest" in the context it is used, then I don't see how you can claim the review using it is superior to Kang's sources. The review includes surveys from countries which were not using teratogenic weaponry, so of course the international aggregate incidence rate will be less. 71.212.237.20 (talk) 19:14, 20 April 2012 (UTC)

My definition of "modest" is completely irrelevant, and I don't particularly care if that word is used or not. This argument is pointless. According to WP:MEDRS and WP:SCHOLARSHIP we should be mainly using well-cited reviews and staying clear of primary sources. --sciencewatcher (talk) 22:00, 20 April 2012 (UTC)

I don't think this is pointless, and I appreciate your sharing your views very much. Per Wikipedia:MEDRS#Use independent sources, "Whenever writing about medical claims not supported by mainstream research, it is vital that third-party, independent sources be used." Since Doyle's review reports on her own primary sources, I believe we should not depend on it. I prefer to remove the word "modest" and the statement about the normal range of the general population which does not appear in any other work. 71.212.237.20 (talk) 00:33, 21 April 2012 (UTC)

It is quite common for reviews to include the authors' own studies. In fact that is a good thing - generally the people who write reviews are experts in their field, so you would expect them to have done some research themselves. Also bear in mind that high quality reviews will have been thoroughly peer-reviewed, so it is not just a case of someone reviewing their own work. Also, I don't think Wikipedia:MEDRS#Use independent sources applies here because this isn't "marginal ideas" or "not supported by mainstream research" - VA, Kang and Doyle are all the "mainstream" here. --sciencewatcher (talk) 02:21, 21 April 2012 (UTC)

Also, right now the article is POV because with your changes you're not mentioning that Kang's study is based on self-reports and is susceptible to recall bias. This is mentioned in all the reviews, which also say that it should be treated with caution. I think you should either put back in the "modest" and "within normal range", or rewrite the section using the reviews (you can use google scholar to find other reviews). POV is the most important policy, so you really need to fix this one way or the other - right now the article is unacceptable because it's pushing the unproven POV that gulf-war vets have more birth defects. I'm concerned you might have a WP:COI here because you seem to be pushing a POV that isn't supported by the reviews. What is your interest in gulf war syndrome? FYI I have no personal/professional experience with gulf war syndrome. --sciencewatcher (talk) 02:46, 21 April 2012 (UTC)

I agree that Kang and Doyle's primary sources are mainstream. The article describes how Kang, presumably in response to the warnings about recall bias, reviewed medical records and found more birth defects. If we include "modest" from the Doyle (2006) review, we need to make it clear that she reviewed the reports from all the countries participating, including those countries which did not use teratogenic weaponry in the Gulf War and which accordingly did not indicate any increased birth defects in their combat veterans at all. I would not object if that is made perfectly clear. I have been unable to find any other peer reviewed reviews in Google Scholar or Pubmed; if you know of any please cite them. As for the "within normal range," that phrase only appears in the VA report which was not peer reviewed, and it certainly doesn't match the fact that all the reports finding increased birth defects state that the lower bound of their odds ratio confidence intervals are very much higher than 1. I can't see why we should include that non-peer reviewed statement which conflicts with the peer reviewed sources. The only thing I did to the statements in question is remove the terms boldfaced at the top of this section. Why do you say that is introducing bias? I have no personal or professional interest in gulf war syndrome, either, but I'm interested in making sure poor summarization choices do not introduce inaccuracies. 71.212.237.20 (talk) 03:27, 21 April 2012 (UTC)

Search for the Kang paper on google scholar, then click on the citations and you'll find at least one other review. In the discussion section of the Doyle review it says "None of the studies discussed here have been able to examine risk according to particular exposures and so we cannot exclude the possibility of undetected adverse effects for small groups of veterans with high exposures to specific agents. A recent review of all literature, including the studies examined here, has looked at teratogenicity in relation to potential exposure to DU (Hindin et al. 2005). The authors concluded that the evidence ‘is consistent with increased risk of birth defects in the offspring of persons exposed to Depleted Uranium’. We believe there is no evidence from published literature on armed service Gulf veterans to support this statement. That, of course, is not the same as saying that such effects do not exist." We really need to look at all the reviews, see what they are saying, and include all the main conclusions in the article. I haven't looked into this in great detail, but it seems that the scientific consensus is that birth defects are unproven, and that is what we should present, giving appropriate WP:WEIGHT to any significant minor viewpoints as per wikipedia policies. With your edits the article slants too far towards the minority POV that birth defects are proven. Although the VA review isn't ideal as it is not peer reviewed - and I'm happy if you or someone else wants to go through the article and replace it with peer-reviewed reviews - at the moment the article is unacceptable, and it would be better to go back to the previous version with "modest" and "within normal range". I think if you read the full-text of the papers in question you'll see where these come from - the VA hasn't just pulled them out of its ass :) --sciencewatcher (talk) 15:34, 21 April 2012 (UTC)

If you mean this review, it isn't limited to Gulf War veterans, so it's not appropriate for this article. Where do you think "within normal range" came from? It's not in the Doyle (2006) review or her 2004 UK survey ("Male Gulf war veterans reported a higher proportion of offspring with any type of malformation than the comparison cohort (OR = 1.5, 95% CI: 1.3, 1.7)" -- again, that lower bound is >1), and it's not in anything by Kang. I'd like to know where the VA got it. I see studies from Australia and France, countries which did not use uranium bullets and accordingly have had no increase in birth defects. I don't see how you can say the effect is unproven, when the VA's Chief Epidemiologist reports odds ratios of greater than 2 and 3, and earlier studies agree. And we haven't even touched on the epidemiology from Iraq yet. 71.212.237.20 (talk) 19:50, 21 April 2012 (UTC)

I can't find the review I was thinking of, so Doyle seems to be the best we have. The "Gulf War Review" you're talking about is just a newsletter - hardly something we can rely on for this article. Also, it says "His research is currently undergoing peer review". The 2008 reference which says "within normal range" is a proper report, so it carries a lot more weight. Regarding the odds ratio: if you read the Doyle review you'll see that it says that rates of miscarriage were higher in non-vets than in vets, so this was "in the normal range" yet still had a high odds ratio. I'm guessing either it is the same for birth defects, or the VA confused the two (unlikely though). If you read the full-text of Kang I'm sure you'll figure it out. Bottom line is that we should be using the Doyle review, and the overall message is that birth defects are unproven. If you can't see that from reading Doyle, further discussion is pointless. --sciencewatcher (talk) 22:39, 21 April 2012 (UTC)

Rather than going round in circles with more discussion, I've just gone ahead and rewritten the section using the Doyle review. --sciencewatcher (talk) 23:17, 21 April 2012 (UTC)

I've flagged your revisions as disputed and I'll add the details of the US and UK studies along with a description of the Doyle review as including the international results from troops who weren't using uranium weapons. 71.212.237.20 (talk) 00:12, 22 April 2012 (UTC)

Please read thoroughly WP:WEIGHT, WP:MEDRS and WP:NPOV before making any edits. --sciencewatcher (talk) 15:25, 22 April 2012 (UTC)

Do you have any sources for your contention that reviews by an author reviewing their own work are considered independent? 71.212.237.20 (talk) 18:41, 22 April 2012 (UTC)

Bring it up on the reliable sources noticeboard if you want. --sciencewatcher (talk) 21:34, 22 April 2012 (UTC)

It might be a better idea to disclose the fact. It certainly would be wise to disclose the odds ratios which she has characterized in the excerpts you selected. Do you have any objections to reporting the odds ratios? If so, why are you more comfortable with the terms like "modest" and "no strong or consistent"? 71.212.237.20 (talk) 22:58, 22 April 2012 (UTC)

I used the word "significant", not "modest". I don't have a problem adding the odds ratio - I just didn't think it added anything. I don't think it would be a good idea to say that she included her own studies and/or is not independent. As I said, that is perfectly normal, so it would be highly POV to do that...you are essentially inferring that the review is not to be trusted because of that fact, which is definitely not the case. --sciencewatcher (talk) 23:46, 22 April 2012 (UTC)

It's perfectly normal, but stating that she reviewed her own study would be highly POV? Can you find any other peer reviewed reviews where the author(s) reviewed their own research? I'm sure they exist, but don't such reviews usually have orders of magnitude more primary sources they are summarizing? I don't have a problem with stating it in neutral terms (e.g. "Doyle et al (2006) reviewed Kang et al (2001) and Doyle et al (2004).....") and I'm glad you are okay with including the odds ratios from the primary sources. It's just that I'm very busy for a few days. 71.212.237.20 (talk) 21:18, 23 April 2012 (UTC)

Well let's see...the very first review I look at ("Chronic Fatigue Syndrome by Judith B Prins, Jos W M van der Meer, Gijs Bleijenberg, Lancet 2006") if you look in the refs you see a whole bunch of Prins refs. Also checked "The HPA axis and the genesis of chronic fatigue syndrome" by Cleare, 2004 - again, lots of Cleare refs (as he is the expert in this area, so he has done lots of research himself). As I said, this is perfectly normal, and shouldn't really need to be mentioned. PS these 2 reviews are used in the Chronic Fatigue Syndrome article as far as I'm aware. sciencewatcher (talk) 21:58, 23 April 2012 (UTC)

I added the odds ratios and removed the dispute tags. 71.215.84.127 (talk) 05:51, 7 May 2012 (UTC)

Why wouldn't an official VA publication describing the results of the review of medical records of US troops' children meet WP:MEDRS? It's an official government source from the Chief Epidemiologist of the VA, a recognized authority, and it was done in response to the survey bias concerns you've included. 71.215.84.127 (talk) 21:49, 7 May 2012 (UTC)

The reason is because it is just a newsletter. In order to satisfy WP:SCHOLARSHIP and WP:MEDRS it would ideally need to be published in a peer-reviewed journal, be a review, and be well-cited. There are exceptions, but you certainly can't use primary sources to debunk a more reliable review (especially when the review itself includes the primary studies you are quoting!) Please revert your changes and read WP:MEDRS and other policies before making any further changes. --sciencewatcher (talk) 22:16, 7 May 2012 (UTC)

Just a newsletter? The Gulf War Review is an official government publication, which are considered on par with works of scholarship per WP:MEDRS#Choosing sources, reporting on the work of the preeminent authority in this case. I have asked for others' opinions at WP:NPOVN. 71.215.84.127 (talk) 23:17, 7 May 2012 (UTC)

Yes, it is just a newsletter. We can't automatically use any source just because it's published on a government website. It even says in the newsletter that the results haven't had peer review yet! Also, you rejected the VA report (which was also a government source, although higher in the MEDRS ranking than this newsletter), so it seems you are picking and choosing sources to suit your POV. --sciencewatcher (talk) 14:16, 8 May 2012 (UTC)

The VA report said "the rates fall within the normal range found in the general population". At one point you said that came from a peer reviewed source. As far as I can tell, it does not. Do you know of one? 71.215.84.127 (talk) 20:36, 8 May 2012 (UTC)

Is the newsletter peer-reviewed? --sciencewatcher (talk) 21:17, 8 May 2012 (UTC)

Government research is not usually peer reviewed. Neither the newsletter nor the VA (committee) report are peer reviewed. The newsletter describes the results of the head of the organization publishing it. The committee report has no source for, and no source exists for, "the rates fall within the normal range found in the general population;" moreover, the peer reviewed sources contradict that statement. 71.215.84.127 (talk) 22:37, 8 May 2012 (UTC)

The point is that the ref you are trying to insert into the article fails WP:MEDRS because it is a newsletter and not peer-reviewed. Also, the major reviews (including the VA) is saying that birth defects are not proven, as as per WP:WEIGHT that is what we should be saying in the lede. You can't cherry pick low-quality sources just so you can put the opposite viewpoint into the article. --sciencewatcher (talk) 23:52, 8 May 2012 (UTC)

Where do they say not proven? They say "modest" which is absurd, but in no sense do they say that the increases with lower confidence intervals above unity are not proven, unless you include troops from countries who were not ordered to hold positions and equipment immediately after teratogenic weaponry had been fired at them. 71.215.84.127 (talk) 01:17, 9 May 2012 (UTC)

I have included the preferred phrasing of "preliminary examination of medical records" suggested by a third party at Wikipedia:Neutral point of view/Noticeboard#Medical records of birth defects in children of Gulf War combat personnel. Please do not remove dispute tags until the dispute is resolved. 71.215.84.127 (talk) 21:48, 9 May 2012 (UTC)

You can't seriously think that a study from a 2003 newsletter that hadn't been peer reviewed passes WP:MEDRS? Also you are misrepresenting the primary studies by not discussing the flaws (as described by Doyle). Really we should only be including Doyle's conclusions and not the primary studies as per WP:MEDRS and WP:WEIGHT. --sciencewatcher (talk) 22:41, 9 May 2012 (UTC)

Yes, I do, and the third party responding at WP:NPOVN seems serious to me, too. I have not removed your excerpt from Doyle's review. I would not consider it forum shopping if you were to seek additional opinions at Wikiproject Medicine. 71.215.84.127 (talk) 23:23, 9 May 2012 (UTC)

Both of Doyle's articles post-date 2003, and therefore take precedence over earlier research. Further, independence is guaranteed by publisher, not author. A study is independent if it is published in a venue the author themselves controls (i.e. blog, journal they are the sole editor of, self-published book, etc). The fact that Doyle's reviews draw upon Doyle's earlier works does not impair independence. If the review you are talking about is this one, the results are negative ("Overall, the results indicated no statistically significant association between parental military service since 1990 and increased risk of birth defects."). As for primary studies, wikipedia is substantially based on secondary sources, which for medical articles means review articles, not primary research. My comments may be off as I'm not sure what studies are being referred to, this is just my initial impression based on what I've been able to glean so far. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:32, 10 May 2012 (UTC)

The largest problem is that the review covers all of the coalition forces, including those countries that had no birth defects. I think it's important to keep the specific studies mentioned, and we had reached consensus on at least including the odds ratios above. And the excerpt you quote measures, "parental military service since 1990," not combat service during the Gulf War. In any case, even the 2008 VA committee report states, "three large studies have shown a significant but modest increase in birth defects in children born to Gulf War veterans," whatever "modest" is supposed to mean. But why would any non-peer reviewed VA source be any more accurate than another from the same publisher, especially one reporting on the medical records review in response to the survey bias complaints? In addition, you deleted the disupute tags when you say you weren't even certain that you were representing the sources correctly. 71.215.84.127 (talk) 05:39, 10 May 2012 (UTC)

Regarding "the review covers all of the coalition forces, including those countries that had no birth defects": that is just your WP:OR, which is irrelevant here (unless it appears in a well-cited review). As for discussions of the VA sources: let's just stick to the Doyle review (and other other well-cited, high quality reviews we find), as those are the best sources to use as per WP:MEDRS. --sciencewatcher (talk) 13:27, 10 May 2012 (UTC)

That is evident from the text of the review and its citations. 71.215.84.127 (talk) 20:13, 10 May 2012 (UTC)

Odds ratios are not good ideas, requiring special expertise to interpret. Prose summaries are better, and secondary sources provide said summaries with less risk of cherry-picking.

I've replaced the POV tag, but so far I don't think it's warranted (and it's not a badge of shame, it should be taken down as soon as possible).

Some quotes from the 2008 report:

Large population-based studies in the U.S. and the U.K. have provided some evidence of excess rates of several types of birth defects among children born to Gulf War veterans, in comparison to nondeployed era veterans. The specific types of birth defects identified have differed in different studies, however, and rates, overall, have been in the normal range expected in the general population. Phase III of VA’s large U.S. National Survey of Gulf War Era Veterans and their Families included clinical evaluations of veterans’ spouses and children. On clinical evaluation, no notable differences were identified between spouses of Gulf War and nondeployed veterans. Findings from clinical evaluations of veterans’ children have not been reported from this study, however. Further, no studies have provided comprehensive information on the health of Gulf War veterans’ children, including rates of diagnosed conditions, symptomatic illness, and learning and behavioral disorders.

It is difficult to draw firm conclusions related to birth defects and pregnancy outcomes in Gulf War veterans, due to the diversity and limitations of study results reported to date. The three studies most representative of Gulf War era veterans in the U.S. and U.K. have all indicated significant, but modest, excess rates of birth defects in children of Gulf War veterans. Information on specific types of birth defects has been inconsistent, however,³⁶² and overall rates are still within the normal range found in the general population.

The 2008 report isn't conclusive, it's suggestive. I've put in a mention. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:36, 10 May 2012 (UTC)

The 2008 report isn't even peer reviewed, as repeatedly mentioned above. It also doesn't have a source which agrees with your boldfaced excerpts. I'll address each of the points you raise here and below when I get more time. Are you inclined to agree to mediation? 71.215.84.127 (talk) 20:13, 10 May 2012 (UTC)

The point isn't if we agree with the source in question, or if we think it has adequate referencing. The point is that it is considered an authoritative source, and if it is accurately summarized. Saying you don't think the report adequately supports its statements is fine - but it carries no real weight on the actual page. Personal opinions matter less than the sources, and I would suggest this is a more than adequate source that is accurately summarized. What sources support the idea that birth defects are more prominent? And keep in mind, if it's a primary source from before 2006, it's pretty much a non-starter. Newer secondary sources take precedence over older, primary. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:12, 10 May 2012 (UTC)

Copied from NPOV noticeboard:

Medical records of birth defects in children of Gulf War combat personnel

In Gulf War syndrome, this edit removed mention of US Department of Veterans Affairs Chief Epidemiologist Han Kang's examination of the medical records of children born to Gulf War combat veterans after surveys found evidence of two times as many birth defects in the children of male troops, and about three times as many in the children of deployed female soldiers. The study of medical records was done in response to the concerns raised about the reliability of surveys in an earlier review and in the survey reports themselves, and it found that there were actually more birth defects than had been described in the survey reports. The editor deleting the medical records check source had earlier included a description of concerns about bias in the surveys, and deleted mention of the surveys in favor of the general conclusions of a review of all troops including those from countries such as Australia and France whose soldiers' children do not have any excess birth defects. At Talk:Gulf War syndrome#Dubious, the editor calls the government publication describing the medical records check "just a newsletter" and therefore says it fails WP:MEDRS. I disagree because it is a government publication held as reliable as scholarship per WP:MEDRS#Choosing sources, describing the work of the preeminent authority on the topic, and as such it presents an opposing view which would be obscured to the point of inaccuracy if it were omitted. I am interested in others' opinions. 71.215.84.127 (talk) 23:10, 7 May 2012 (UTC)

Are you referring to the discussion on page 10 of the Gulf War Review, published by the Department of Veterans Affairs? I have looked at that discussion but I am not convinced that it stands for the statement in question: "A subsequent check against medical records by the Department of Veterans Affairs' Chief Epidemiologist found more birth defects." For one, the footnote mentions ongoing research so the results are not final and there is no opportunity to review the work in progress. I agree with you that this publication might in some cases be considered a reliable source under this section of WP:MEDRS:

Medical and scientific organizations Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the Institute of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization. The reliability of these sources range from formal scientific reports, which can be the equal of the best reviews published in medical journals, through public guides and service announcements, which have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature.

But the statement in question is quite strong and affirmative as compared with the language of the footnote, which speaks of preliminary results. A statement to the effect that preliminary research that involves cross checking the survey results against medical records seems to support the findings would appear more appropriate, in my opinion.Coaster92 (talk) 20:44, 8 May 2012 (UTC)

Yes: "Dr. Kang found that male Gulf War veterans reported having infants with likely birth defects at twice the rate of non-veterans. [see [1]] Furthermore, female Gulf War veterans were almost three times more likely to report children with birth defects than their non-Gulf counterparts. The numbers changed somewhat with medical records verification. However, Dr. Kang and his colleagues concluded that the risk of birth defects in children of deployed male veterans still was about 2.2 times that of non-deployed veterans." (p. 10, emphasis added.)

I agree describing it as a "preliminary examination of medical records" would be superior. 71.215.84.127 (talk) 23:26, 8 May 2012 (UTC)

After editing the article to reflect the suggestion from Coaster92 here, the editor who I was concerned about asked another editor for help, and they have reverted the disputed statements and much more of the article in ways which I believe make the NPOV issues much worse. I'm going to try to address their points when I get more time. 71.215.84.127 (talk) 20:11, 10 May 2012 (UTC)

I'll repeat it again, a 2006 review article takes precedence over a 2001 primary source. The 2006 article concludes its section on birth defects with the following:

The conclusion from these published works is that at present there is no consistent evidence of a strong association between Gulf War deployment of servicemen and the appearance of major, clearly defined, birth defects among infants conceived after the war. For service-women, low numbers in most of the studies make conclusions difficult, but overall there is little evidence of a major effect. The portfolio of studies addressing the risk of birth defects is reasonably sound, and includes a range of methodologies and data sources. But notable limitations include low statistical power to detect rare defects or defects in the offspring of female veterans, the strong likelihood of bias in studies relying on self-report with no validation and the inability to relate outcomes to specific exposures of concern.

You are cherry-picking a newsletter ([2]) from 2003 that is contradicted by a 2006 literature review. That's flat-out wrong. If it were the official reports on investigations into Gulf War Syndrome and related issues - you might have a point. But it's not, it's a newsletter three years older than a peer reviewed secondary source coming to completely different conclusions. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:43, 23 May 2012 (UTC)

Specific diffs

I've just done a blanket revert, here's why:

• This diff

1. The 2001 Kang survey is from 2001, it's now an 11 years old primary study and there have since been two secondary review articles. Emphasizing primary studies over secondary is bad practice, and emphasizing a primary study that is five years older than a secondary study is terrible practice. Ditto a now-archived 2003 report.
2. Doyle's 2003 again primary study is quite equivocal - though it did find an increased risk of stillbirth and subtle malformation, this is thought to be due to recall bias - particularly since again, subsequent studies found little support for an actual increase. This is cherry-picking, not just specific studies, but within a single study. Noting veterans were reporting malformations without noting the reporting might be inaccurate is another issue, and taken together this is quite an example of undue weight on the idea that GWS causes birth defects or stillbirth.
3. The above comments apply to the lead, but the body repeats these issues. The 2006 review takes precedence. I also removed the quote because it was rather easily summarized. Also, reporting odds ratios is generally not done as it requires special knowledge that our general audience is not expected to have.
4. The image taken from Al-Sadoon seems out of place, and the citation to a 2004 book seems dubious - the citation information for the book doesn't seem to be correct. The linked url doesn't work, so I can't check the online source and without a specific link it's a POV-pushing synthesis.
5. Further down, Hodge et al 2001 is a primary study attempting to develop an assay for the presence of depleted uranium. There needs to be a secondary source linking this to Gulf War Syndrome. Ditto for Gwiazda 2004 - primary (and form the abstract, looks like it was unable to differentiate the groups). Schroder 2003 is also primary. Wan 2003 is a primary study in mice. See next bullet
6. The section on uranium exposure is a how-to guide to treat uranium exposure. Unless there are specific sources saying "treating uranium exposure helps with GWS" the section is a lengthy coatrack. See subsequent point.

Sections 5 and 6 are efforts to throw as much at the wall and make it all stick. The reason we don't use primary studies is because they are easy to abuse to provide partisan summaries of issues. Secondary sources synthesize primary (something we can't do) and venture a conclusion. Without such a synthesis (which again, we can't do - either by directly drawing conclusions or by summarizing a bunch of primary studies and letting readers draw their own conclusions) the articles should not be on the page. To have a substantive discussion about the treatment of GWS via uranium chelation we need a source that says exactly that - using uranium chelation, veterans with GWS have been successfully treated. Otherwise the entire section assumes that uranium chelation (or whatever treatment you want to throw out there) is effective and should be used.

• Next diff, same as points 5 and 6 above. Uranium is toxic. GW veterans were exposed to uranium. THEREFORE, GWS is due to uranium toxicity. If this is demonstrated and proven, it should be easy to substantiate this fact through reference to reliable, secondary sources. If this is not proven, it can be noted as a potential concern, but slapping up a bunch of studies that don't make the point for you is original research and undue weight on an idea that's not actually embraced by the mainstream. Wikipedia solidly reports the plodding, boring mainstream - not the cutting edge and not extreme hypotheticals. We report in proportion to the coverage in mainstream sources, demonstrated by citing those sources.
• Next are the external links [3]. External links should have a direct and reciprocal relationship to the page. VMW is a general website not specifically focussed on GWS. If it's got a specific page completely dedicated to GWS, it could possibly be linked - but not just the front page. 91 Outcomes.com appears to be a blog or otherwise personal website, and is unsuitable. National Gulf War Resource Center is similar to the VMW page - it's got stuff on GWS, but it's not dedicated solely to the topic - if it has a dedicated, extensive set of pages on GWS, we could link to that, but not just generally to the front page. Desert Storm Battle Registry appears to be another personal webpage, and one chose to have a URL very close to the Office of the Special Assistant for Gulf War Illnesses, which is potentially misleading to readers and I would say bad practice. A popular documentary from 2007 on GWS doesn't seem like a good idea either, particularly given copyright concerns (see WP:YOUTUBE, many youtube links don't adhere to acceptable copyright).

I've replaced the RAC link. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:22, 10 May 2012 (UTC)

The linked URL from the book citation you could not find in #4 above is easily available from the Internet Archive. 71.212.246.55 (talk) 16:53, 23 May 2012 (UTC)

Again, please do not remove dispute tags before the dispute is resolved. I asked whether you are inclined to agree to mediation above, and you still have not replied. It is a serious mistake to confuse studies of all coalition troops from the Gulf War era with repeated studies of smaller subsets of troops where very substantial increases in birth defects were documented in sources considered essential to eliminate bias per neutral third parties on the NPOV noticeboard. Stating that the children of all troops in the coalition or all US troops from the decade in question have no statistically significant incidence of birth defects is an absurd insult to the most basic standards of neutrality and accuracy when there are repeated reports from the UK and the US Veterans Administration Chief Epidemiologist that the children of the combat troops from those two countries in particular, which just happen to be the countries using uranium weaponry, had multiple times the expected incidence of birth defects. I intend to seek dispute resolution. Again, are you inclined to mediate these questions? 71.212.246.55 (talk) 12:34, 23 May 2012 (UTC)

My last comment was nearly 2 weeks ago, and you provided no reply. Please see {{POV}}, particularly the part where it says POV tags are not badges of shame.

What are the reliable, secondary sources substantiating your points? Rather than tagging the page - why not actually edit? I can't give a comment about a general issue, I need to see specific edits and the accompanying sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:03, 23 May 2012 (UTC)

Gulf War Review is a government secondary source in this case. As I asked on the 10th of May, and today just above, are you or are you not inclined to mediate these questions? 71.212.246.55 (talk) 14:14, 23 May 2012 (UTC)

You haven't addressed any of my points above. Kang's work is from 2001 and 2003, and two secondary sources have since been published which contradict these earlier conclusions. The same with Doyle's 2003 primary study - you are cherry picking early, primary sources to support your claims, while ignoring secondary sources published several years later that contradict your claims. You haven't addressed any of my points above, you've just reverted. Can you provide me a policy or guideline based reason why we should cite primary research from 2001, 2003 and 2004 and ignore secondary sources published more recently? Can you justify your replacement of several external links despite my objections based on WP:EL? WLU (t) (c) Wikipedia's rules:^simple/_complex 14:24, 23 May 2012 (UTC)

I most certainly have addressed your points, repeatedly. Your "secondary sources" have nothing to do with Gulf War illness, because they summarize both symptomatic and asymptomatic populations as the same group -- the entirety of the coalition combat and non-combat forces in one instance, and the entirety of US soldiers from the decade of the war, most of whom got nowhere near Iraq and Kuwait. What basis do you have to even include such sources in the article?

It has been 13 days since I asked you, several times now, if you are willing to mediate. Are you?

The external links meet WP:EL because the Pentagon didn't even recognize Gulf War syndrome as a legitimate illness until 2006, and they have continually been behind the soldiers' support network. We need to mediate that question too, if you are willing. Are you? 71.212.246.55 (talk) 16:15, 23 May 2012 (UTC)

Hello - Are you familiar with the methodological principles of epidemiologic research aimed at defining a disease and establishing possible causes? You objection that the secondary sources "summarize both symptomatic and asymptomatic populations as the same group" suggest that you might not be. I'm genuinely sorry if this sounds elitist, but it is difficult to discuss methodological correctness in the absence without the relevant technical background. Regards, —MistyMorn (talk) 16:34, 23 May 2012 (UTC)

Yes, I most certainly am. If you are studying the results of combat in Iraq and Kuwait in 1991, you do not include soldiers which both did and did not serve in combat in your summary measurements. You compare the two groups to each other. Nor do you include troops which served on the other side of the globe starting in 1999 in your summary measurement. The Doyle (2006) review, which does the former, has no business being in the article. The other source proposed for inclusion above has not actually been included as far as I can tell. 71.212.246.55 (talk) 16:42, 23 May 2012 (UTC)

(edit conflict)From the Doyle article: the Gulf cohort consisted of all UK armed services personnel who served in the Gulf area at some time between August 1990 and June 1991. The randomly selected comparison cohort comprised a similar number of armed services personnel who were in service on 1 January 1991 and were appropriately fit but were not deployed to the Gulf... —MistyMorn (talk) 16:45, 23 May 2012 (UTC)

That is the description of the Doyle (2003) study, not the multinational summary prose (without figures!) in Doyle (2006). 71.212.246.55 (talk) 16:49, 23 May 2012 (UTC)

(edit conflict)(I'm sorry I can't really look into this in detail right now.) —MistyMorn (talk) 16:53, 23 May 2012 (UTC)

It's not up to us to review the research - that is what peer review is for. You are breaking WP:OR by questioning this review (which meets WP:MEDRS according to wikipedia criteria). Occasionally scientists can publish crap in peer-reviewed journals I agree, but in this case I think it is you who doesn't understand the science. Either way it doesn't really matter - in wikipedia we simply include what the reviews state, crap or not. I think you just have to live with that. If you disagree with the reviews you will need to do your own research and get it published in a peer-reviewed journal. --sciencewatcher (talk) 17:39, 23 May 2012 (UTC)

While fully supporting WP:MEDRS, I trust we don't "simply include what the reviews state, crap or not" (there are reviews and reviews...). btw, perhaps I should apologise for my mistimed attempt above to be helpful. —MistyMorn (talk) 18:08, 23 May 2012 (UTC)

Perhaps I was being overdramatic. I've seen "crap" published in both BMJ and Lancet, including one which was a "review". However in general if we follow the wikipedia WP:SCHOLARSHIP and WP:MEDRS guidelines we tend to avoid the bad stuff. My point is that it isn't up to us to decide what is good and what is bad. --sciencewatcher (talk) 18:33, 23 May 2012 (UTC)

I think including "crap" wouldn't square with WP:WEIGHT policy, which would rightly trump the guidelines. Best, —MistyMorn (talk) 18:39, 23 May 2012 (UTC)

External links meet WP:EL by meeting one or more of the criteria in WP:ELYES or WP:ELMAYBE. "Whether the Pentagon recognizes GWS as an illness" is not one of those criteria, nor is "...two groups [being at odds and the soldiers' have been proven correct time and again]". What citation is Gulf War Review? Please provide a hyperlink.

Why does Doyle, 2006, a review article on the reproductive health of Gulf War veterans, have no business being on the page? Because you personally do not like the methodology? WLU (t) (c) Wikipedia's rules:^simple/_complex 20:51, 23 May 2012 (UTC)

I assume this is the "Gulf War Review" in question. It's just a newsletter and it says the results haven't been peer reviewed yet. I'm slightly incredulous as to why 71.212.246.55 thinks its better than the Doyle review. I really can't see how this is anything other than POV pushing. I just had to revert this yet again today. --sciencewatcher (talk) 21:25, 23 May 2012 (UTC)

Please see Coaster92's uninvolved opinion above, from the NPOV noticeboard. The excerpts in question are the official government report of the Chief Epidemiologist of the Department of Veterans Affairs, and as such they represent a review of medical records to confirm the veracity of a medical survey, which is therefore a secondary government source on par with scholarship per WP:MEDRS#Choosing_sources. 71.212.246.55 (talk) 22:13, 23 May 2012 (UTC)

Did Coaster's opinion include a statement saying a 2003 primary article takes precedence over a 2006 secondary article?

The source available through the internet archive - was it published in a peer reviewed journal?

I disagree with your opinion about a 2003 newsletter being equivalent to a secondary MEDRS. Particularly when it's framed as a single-page Q&A session with a footnote, and several notes in the body, qualifying the results as preliminary. Also, this continues your habit of claiming older sources take precedence over newer, peer-reviewed secondary sources. A 2003, informal, non-peer reviewed newsletter aimed at providing lay commentary to a general audience is not comparable to a 2006, secondary, peer reviewed journal article aimed at scholars. Even if we accepted Kang's results, assuming they were identical to the commentary in the newsletter - we would still cite the scientific article, not the newsletter. When you've got a news source reporting on a recent publication, you use the news source to track down the actual article.

This is again cherry picking sources you appear to agree with, while ignoring the sources that come to conclusions you dislike. That's a pretty egregious violation of WP:NPOV. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:09, 24 May 2012 (UTC)

Mediation request

I have been trying to assume good faith. However, the evidence to the contrary seems overwhelming:

1. Sciencewatcher and WLU have repeatedly purported that the international summary prose in Doyle (2006) is representative of combat soldiers compared to noncombat soldiers, when it is not. In fact it is a non-quantitative combined summary of both combat and noncombat troops from all countries, including those which are known to have had no increase in troops' children with birth defects, mixed in with those countries which have had substantial increases in birth defects. Not only is this inaccurate, but it is biased, misleading, and contrary to established secondary sources.

This seems like WP:OR to me. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 23 May 2012 (UTC)

It is not. It is based on the references cited in Doyle (2006). Please have a look at them. 71.212.246.55 (talk) 02:12, 25 May 2012 (UTC)

Discounting a source based on disliking their analysis is an inappropriate application of OR in my opinion. Are there any sources that make this point for you? WLU (t) (c) Wikipedia's rules:^simple/_complex 15:14, 25 May 2012 (UTC)

2. When asked to seek additional opinions from WikiProject Medicine, Sciencewatcher instead contacted WLU, who has no specific medical experience, but could be expected to be sympathetic to Sciencewatcher's side because of their previous interactions. That looks to me like an example of forum shopping and tag-teaming.

This is now raised at WT:MED, where I've often contributed. Perhaps you are seeing WP:CONSENSUS. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 23 May 2012 (UTC)

3. Both Sciencewatcher and WLU have repeatedly ignored the third party decision from the NPOV noticeboard that Kang's odds ratios and medical records examination from the secondary government publication Gulf War Review, which may very well be characterized as a newsletter, but is also a far more appropriate secondary source on par with scholarship for this article than the Doyle (2006) source, should be included along with the Doyle (2003) survey of UK combat troops compared to their noncombat cohort. This appears to me to be further evidence of tag-teaming and disregard for the NPOV policy and accepted dispute resolution procedures.

The "third party decision" is one opinion, and wasn't given the choice between a 2003 primary source versus a 2006 review article. It doesn't seem to have much weight regarding the issues I'm seeing. You're welcome to re-request an opinion with full discussion of the sources and issues. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 23 May 2012 (UTC)

4. WLU has repeatedly refused to indicate, after almost two weeks and several questions, whether or not mediation would be agreeable. This appears to be an attempt to obtain a preferred disputed version by stonewalling dispute resolution procedures.

You attempt to address things on the talk page first generally. Mediation is informal, and I see little use when you don't appear to grasp the policy and guideline issues. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 23 May 2012 (UTC)

5. Both Sciencewatcher and WLU have repeatedly removed dispute tags from the article, sections, and inline text when they knew the dispute was ongoing. This appears to be an attempt to cover up the controversy.

Or, we think they're unwarranted and, as it says on the documentation page (see {{POV}}) the tags are not badges of shame. At least between SW and I, there appears to be agreement (consensus) that the tags are unwarranted. Consensus doesn't mean everyone is happy. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 23 May 2012 (UTC)

6. Sciencewatcher has removed the graph of birth defects reported by the faculty of Basrah University, even after the corroborating archive link which WLU was unable to find had been replaced in the source citation. That just seems like carelessness to me.

Because of these serious issues, I intend to ask for informal mediation, and I will ask that Doc James, who has been active on the page above, or any other mediator he designates from WikiProject Medicine, serve as the mediator to discuss each of the edits in this revert in turn until we have all had the opportunity to discuss each of them. If the other parties agree to abide by the mediator's resulting decisions, I will also agree to them, but I reserve the right to request article, section, and inline dispute tags unless the designated mediator explicitly forbids them, in which case I will agree with the mediator's decision. In no circumstances will I object to dispute tags if any other party requests them.

Are there any objections? If not, do the other parties agree to these terms? 71.212.246.55 (talk) 22:02, 23 May 2012 (UTC)

Fine with me. I would welcome Doc James or anyone else to come in from WikiProject Medicine to take a look at this article. --sciencewatcher (talk) 22:39, 23 May 2012 (UTC)

Doc James is awesome, his presence would be very welcome. Since dispute tags are used to attract attention and start discussion - they seem quite unnecessary. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 23 May 2012 (UTC)

Thank you both. I've asked on Doc James' talk page for his help mediating or finding a mediator from WikiProject Medicine. I'd like to replace the dispute tag at the top of the article while mediation is ongoing. I don't know what "badge of shame" means, but why not indicate that a dispute exists? 71.212.246.55 (talk) 15:35, 24 May 2012 (UTC)

Badge of shame means "someone thinks this page is awful and nasty and shouldn't be trusted". Since the purpose of the tag is to attract independent attention (which it never does, tags are mostly worthless) and we've already asked for that attention, I think the tag serves no purpose except to indicate that someone doesn't like what it says. Having reviewed your reasoning, I don't think there is any merit to your complaint. Collectively, I don't think there's a need for the tag. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:27, 24 May 2012 (UTC)

So you are saying that you are so certain of your interpretation of Doyle's non-quantitative review summary, that Coaster92 and my opinion that the odds ratios and Chief Epidemiologist's medical records review result should also be included does not even rise to the level of a legitimate dispute? On what grounds do you base such certainty? 71.212.246.55 (talk) 02:12, 25 May 2012 (UTC)

Doyle's review article is an acceptable MEDRS, the 2003 newsletter is not. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:14, 25 May 2012 (UTC)

Comments

Will try to provide some feedback regarding this discussion.

• Kang 2001 PMID:11557183 is not a secondary source and thus should not be used per WP:MEDRS. On controversial topics such as this recent secondary sources are a must (i.e. review articles or major medical textbooks from the last 3-5 years or at most 10 years). What about Doyle, P (2006 Apr 29). "Reproductive health of Gulf War veterans". Philosophical transactions of the Royal Society of London. Series B, Biological sciences. 361 (1468): 571–84. PMID 16687262. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)?
• With respect to the external links at the end. My position is we should just have one link to DMOZ and then let the editors over a DMOZ create a list of ELs. I do not see this as a function of an encyclopedia.

The problem is that the VA is not listed in the DMOZ page, and yet it is the official US government page about the illness. For other illnesses such as CFS we have the CDC page, so I don't see a problem in including the VA page as an external link. The anonip just has an issue in that he disagrees with the VA, but that is not a good reason for removing the link. --sciencewatcher (talk) 14:38, 26 May 2012 (UTC)

• There is currently one "disputed tag" on the article. Hopefully we can address issues here.

This should address many of the concerns. Are there other specific issues people wish me to address? Doc James (talk · contribs · email) 22:48, 25 May 2012 (UTC)

Doyle is already used three times on the page (reference 9 in the version I'm looking at now). This addresses the issues as far as I'm concerned. A party we all agreed would be acceptable has essentially agreed with my and Sciencewatcher's assessments of the information, making further efforts without new sources to be WP:POVPUSH and WP:PARENT violations. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:23, 26 May 2012 (UTC)

If the IP comes forwards with new recent review article though... Doc James (talk · contribs · email) 02:27, 26 May 2012 (UTC)

Hinden (2005) is one such review which Sciencwatcher and WLU have removed from the introduction, the section on birth defects, and the section on depleted uranium. Should it be replaced? Are there any reasons to believe that the prose conclusions currently included in the article from the Doyle (2006) review aren't summarizing the birth defect incidence from the children of both combat and noncombat troops from all coalition nations, and thus aren't applicable to this article because non-combat deployed troops have not had any other GWI symptoms? Are there any reasons that the report of Kang's review of medical records isn't a secondary source? Should Table 1 from Doyle (2006) be summarized to address the NPOV issue corroborated by Cruiser92 on the NPOV noticeboard? 71.212.246.55 (talk) 06:52, 26 May 2012 (UTC)

Do not have concerns with the use of http://www.ncbi.nlm.nih.gov/pubmed/16124873 just as long as it is given appropriate weight as mentioned. To what do you refer when you state "report of Kang's review of medical records"? A summary of paper that have been done as presented here http://rstb.royalsocietypublishing.org/content/361/1468/571/T1.expansion.html is not the same as a review of the evidence on a topic at hand. Doc James (talk · contribs · email) 23:14, 26 May 2012 (UTC)

I didn't specifically remove the Hinden review - I think it was just caught up with other changes. The Hinden review seems fine. Regarding your other questions: you just need to give appropriate WP:WEIGHT to anything you add. The problem with your edits is that you seem intent on making the article say that birth defects are proven no matter what the evidence. That isn't how wikipedia works - we just present the evidence from the reviews giving appropriate weight to it all. If the reviews disagree - as they seem to with Hinden - then it's fine to present both viewpoints. However what you can't do is cherrypick bits and pieces from each review just because they support a particular POV, which is what you appear to be doing. As for the comment on the NPOV noticeboard: that user was just commenting on NPOV. However the fact that the Gulf War Review newsletter is not a reliable source for medical information means the point is moot. --sciencewatcher (talk) 14:33, 26 May 2012 (UTC)

Those questions were addressed to Doc James. Gulf War Review is a newsletter. It is also a government publication reporting the results of the VA Chief Epidemiologist performing a medical records review in response to the concerns about survey recall bias discussed at length in Doyle's review. As such, it is also a secondary source on par with scholarship per WP:MEDRS#Choosing sources. If there are any reasons to the contrary, I'm sure they would have been stated by now. Simply repeating "it's a newsletter" over and over doesn't change its government, secondary, authoritative, reliable nature. And the NPOV issues involved in its omission remain to be addressed. 71.212.251.217 (talk) 15:15, 26 May 2012 (UTC)

It's a newsletter sent out to veterans, and it even says that the Kang study hasn't been peer-reviewed yet. Did it even pass peer review (has it been published)? You really are trying my patience here with your tendentiousness. It's clearly and obviously not a MEDRS reliable source. --sciencewatcher (talk) 15:18, 26 May 2012 (UTC)

I asked years ago and was told they were seeking an appropriate venue for publication, but that doesn't change the fact that the report of the medical records review in Gulf War Review is a reliable authoritative secondary government source. Perhaps Doc James can ask? han dot kang at va dot gov, or (202) 443-5600, or perhaps his colleagues such as VA Chief of Public Health Dr. Victoria Davey or Epidemiology Program Director Aaron Schneiderman at the same phone number. This is a difficult issue with enormous vested interests on both sides. I hope you can find the patience to work it through without resorting to further personal attacks. 71.212.251.217 (talk) 16:28, 26 May 2012 (UTC)

Can someone provide me a link to the Gulf War Review article in question? Doc James (talk · contribs · email) 23:22, 26 May 2012 (UTC)

From page 10 here: "Dr. Kang found that male Gulf War veterans reported having infants with likely birth defects at twice the rate of non-veterans. [see [4]] Furthermore, female Gulf War veterans were almost three times more likely to report children with birth defects than their non-Gulf counterparts. The numbers changed somewhat with medical records verification. However, Dr. Kang and his colleagues concluded that the risk of birth defects in children of deployed male veterans still was about 2.2 times that of non-deployed veterans." (emphasis added.)

The uninvolved third party at the NPOV noticeboard recommended referring to that as a preliminary medical records review, and I did, but it was deleted as such. There are no subsequent publications from the Veterans Administration on the subject. 71.212.251.217 (talk) 03:09, 27 May 2012 (UTC)

This http://www.ncbi.nlm.nih.gov/pubmed/11557183 however is a primary source rather than a secondary one. It is typically best to stick with secondary sources which are indexed by pubmed. Is Gulf War Review pubmed indexed? Many over at the NPOV notice board unfortunately do not understand the preference for secondary sources within the scientific subject area. I know this may not be the support you wish. When I write for Wikipedia I typically pull up all the best quality sources and begin writing based on their conclusions. --Doc James (talk · contribs · email) 03:16, 27 May 2012 (UTC)

It is not PubMed Indexed, but is it a government secondary source per the criteria in WP:MEDRS#Choosing sources? In terms of reliability, what would you say the chances are that it misrepresents the actual birth defect outcomes of US Gulf War combat troops? Also, is there any evidence that the Doyle (2006) excerpt currently in the introduction and birth defects section isn't summarizing both combat and non-combat troop outcomes, and if not, is it applicable to Gulf War syndrome, since non-combat troops are asymptomatic? 71.212.251.217 (talk) 05:18, 27 May 2012 (UTC)

A review article is "an attempt to summarize the current state of understanding on a topic". Typically there is a section within "methods" that describe how the authors search the literature to make sure they found all the studies on the topic at hand. I do not see this here and thus am not convinced that this ref is a formal review article in the realm of research methodology. Doc James (talk · contribs · email) 05:48, 27 May 2012 (UTC)

BTW its states that Dr. Kang research is still undergoing peer review in 2001. Has it be published? And has his results been incorporated into a secondary source? The above ref appears to be a side comment on an unpublished primary source. Doc James (talk · contribs · email) 05:53, 27 May 2012 (UTC)

November, 2003. Certainly it's not a review article, but is a review of medical records in order to measure the recall bias of a survey primary or secondary relative to the report of the odds ratio? And what are the chances that it doesn't represent those odds ratios correctly? Are you willing to phone Dr. Kang to see whether this ever made it to a medline indexed publication, and if not what its status is? 71.212.251.217 (talk) 19:27, 27 May 2012 (UTC)

With respect to Doyle I do not understand your concern. Can you clarify?Doc James (talk · contribs · email) 05:56, 27 May 2012 (UTC)

Doyle (2006) summarizes the birth defects of children of "deployed" Gulf War veterans, not combat veterans. Hundreds of thousands of coalition troops were deployed to Saudi Arabia and Kuwait without ever participating in combat. Those non-combat troops have always been entirely asymptomatic of any GWI complaints, so the Doyle review isn't even appropriate for this article. Doyle also includes in her summary the studies of troops from all of the countries which were not using pyrophoric uranium weapons, none of which have ever had increased incidence of birth defects in the children of their combat troops, even when they have had other GWI symptoms. 71.212.251.217 (talk) 19:27, 27 May 2012 (UTC)

Are their secondary sources that just deal with those who where deployed? Doc James (talk · contribs · email) 00:33, 28 May 2012 (UTC)

You mean combat-deployed or just deployed to the region without participating in combat? The Kang sources compare the combat troops' kids to the non-combat cohort, but the Doyle (2006) review summarizes the much smaller rate for both combat and non-combat soldiers from all coalition nations. Also the Doyle (2003) primary source compares combat to non-combat troops, and finds excess birth defects with the lower bound of the odds ratio's confidence interval greater than one. 71.212.251.217 (talk) 03:29, 28 May 2012 (UTC)

Where is the Kang source published?--Doc James (talk · contribs · email) 04:06, 28 May 2012 (UTC)

The primary Kang et al (2001) source is PMID 11557183. I hope you didn't miss my question about whether the Gulf War Review report of Kang's medical records review discussed above is secondary for the purposes of correcting that survey's odds ratios. That was done specifically in response to concerns about the survey's recall bias. 71.212.251.217 (talk) 19:14, 28 May 2012 (UTC)

As a primary source published 11 years ago, I am extremely reluctant to give this a lot of text. In fact, since Doyle, 2006 is both secondary and published five years after Kang (and in particular, cites and discusses Kang, 2001) I would argue we should ignore Kang in favour of Doyle, 2006. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:36, 28 May 2012 (UTC)

My question to the mediator about whether Doyle's conflation of combat and non-combat troops (not to mention conflation of soldiers from countries which did and did not use teratogenic weaponry) renders her review inapplicable to this article stands; as does my question about whether Kang's medical records review is secondary for the purposes of correcting the US combat troops survey odds ratios. 71.212.251.217 (talk) 21:07, 28 May 2012 (UTC)

The Gulf War Review does not appear to be a secondary source / review article. And it does not appear to be pubmed indexed. Thus I would say it is not appropriate. Kang is a primary source and thus is not appropriate. I typically do not analysis the methods of review articles and take there conclusions as stated. I expect the peer reviews to take care of this aspect. I thus do not have a position on if conflation of combat and non - combat troops was appropriate.Doc James (talk · contribs · email) 23:44, 28 May 2012 (UTC)

Hindin (2005)

Just briefly, if I was the one to remove Hindin, 2005 completely then that was an error on my part, it looks acceptable - though old. I would much rather see how the work has developed in the 7 years since 2005 than rely on this study. I'll try to find the time to read and integrate it more when appropriate. Just skimming the first sentences of the discussion suggests it's equivocal, and our readers would be well-served by a discussion of that equivocation, positive and negative. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:02, 28 May 2012 (UTC)

Thank you! PMID 20717542 (full text) and PMID 18926898 (which has everything I would want to include in its abstract) are more recent. PMID 18644222 is a more recent review which is very pertinent in passages of its full text, which I no longer have, but not really its abstract. I requested it at WP:RX. 71.212.251.217 (talk) 19:14, 28 May 2012 (UTC)

Busby, 2010 (PMID 20717542) is out, it is a primary source. Feugier, 2008 (PMID 18926898) is out, it is primary research on rodents. Abu-Musa, 2008 could be used but only those portions related to the actual Gulf War and conclusions that affect all samples (notably "Most of the studies examined had major limitations including recall bias and small number of cases included.").

In any case, caution must be taken not to expand the definition of GWS unduly. If the article does not specifically use the term "Gulf War syndrome" we are problably better off using it with great caution or instead relying on secondary sources that make the link explicitly. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:32, 28 May 2012 (UTC)

As it is Memorial Day, there is something I just have to get off my chest. Suggesting that combat soldiers who have risked their lives in service to their countries might report on a survey that their children have birth defects when they did not is not only absurd, but it is frankly morally repugnant. Nothing will change the fact that when Kang reviewed the medical records, he found 20% more birth defects than had been reported on the survey, not less. Fighting to hide that from readers is shameful. 71.212.251.217 (talk) 21:05, 28 May 2012 (UTC)

Perhaps I'm a good person to illustrate the recall bias concern with a practical illustration. I myself had a tiny birth defect requiring a small surgical intervention, no big deal... In the long term, parents may not take much notice of a minor incident of this sort. The methodological concern here is that, when interviewed, parents who have been thinking a lot about what they know to be a potentially dangerous exposure (risk factor) may also be more focused on possible effects and therefore more likely to recall that small passing incident or think it worthy of mention. And if that happens often enough, the statistical results of the study will artificially "exaggerate" the risks associated with the exposure. That's the concern -- nothing to do with dishonesty on anyone's part. Hope that helps, —MistyMorn (talk) 19:02, 29 May 2012 (UTC)

I understand how it might happen, but we have a government publication from the chief epidemiologist of the VA that the birth defects were under-reported. 71.212.251.217 (talk) 02:26, 3 June 2012 (UTC)

Under-reporting by clinicians is one concern. The possibility of differential "under-reporting" or "over-reporting" by participants within a particular study is a separate concern. In general, researchers have to take into account the possibility that subjects who, for personal reasons, have thought considerably about an issue particularly close to them may be more likely to mention ("report") matters they feel could be related to that issue. As is typical of methodological biases like this, one can have an informed guess at the direction of the bias, but it is difficult to estimate the magnitude of any distortion. So it generally remains an imponderable. I hope this explanation helps provide a small illustration of one of the myriad issues that can make it difficult to reach a clear-cut interpretation of epidemiological evidence of etiology (beyond the expert opinions of individuals or official bodies). —MistyMorn (talk) 09:50, 3 June 2012 (UTC)

The government publication in question states the magnitude of the under-reporting as well. 71.212.251.217 (talk) 18:59, 4 June 2012 (UTC)

A copy of the review you request is here http://www.marciainhorn.com/olwp/wp-content/uploads/Effect-of-war-on-fertility-a-review-of-the-literature.pdf

Cheers--Doc James (talk · contribs · email) 23:48, 28 May 2012 (UTC)

Thanks very much! Is anyone opposed to summarizing each paragraph of the Gulf War section on pages 47 and 48 instead of the earlier Doyle review? 71.212.251.217 (talk) 07:06, 29 May 2012 (UTC)

You misunderstand science. The scientific method is not good at detecting deliberate deception - it is meant to control for inherent and unconscious baises that can run anywhere from simply forgetting a minor but important detail to sophisticated counter-reasoning that prevents someone from changing their mind in the face of contrary evidence. I dislike your attempt to use patriotism and guilt to shame other editors into ignoring the policies and guidelines.

Including a summary of individual studies, even if that summary is sourced to a secondary article, is still bad practice. Particularly when that secondary article lists the many flaws of each individual study. Though Abu-Musa can be included, it must be fairly summarized - and it is very equivocal. The summary should not be "GWV have fertility problems", the review is not a slam-dunk by any means. It is at best suggestive, but with significant limitations - and those limitations should be documented if we are going to list the findings. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:57, 29 May 2012 (UTC)

I dislike wikilawering the policies and guidelines to degrade the accuracy of the encyclopedia. I don't like personal attacks, either. I will start a new section below to workshop the statements in the more recent literature review. 71.212.251.217 (talk) 17:35, 29 May 2012 (UTC)

External Links

My comment above seems to have gotten lost in the hubbub, so I've created a new section.

The problem with removing the va.gov link is that the VA is not listed in the DMOZ page, and yet it is the official US government page about the illness. For other illnesses such as CFS we have the CDC page, so I don't see a problem in including the VA page as an external link. The anonip just has an issue in that he disagrees with the VA, but that is not a good reason for removing the link. --sciencewatcher (talk) 14:38, 26 May 2012 (UTC)

The VA's Gulf War Illness Research Advisory Committee (which is almost entirely not composed of VA officials) didn't even recognize GWI as a legitimate complaint until 2006, long after veterans' support groups (which WLU removed from the external links) had been clamoring for its recognition, and it has remained behind them on correctly recognizing several other issues of fact, so they do not have a track record of fact-checking necessary to be considered a reliable source. Do you want to withdraw your agreement to respect the mediator's decisions? 71.212.251.217 (talk) 19:32, 27 May 2012 (UTC)

Additional external links can be proposed to DMOZ. They are also looking for editors who are interested in building collections of ELs.Doc James (talk · contribs · email) 00:01, 28 May 2012 (UTC)

The DMOZ entry for Gulf War Illness has a lot of very poor quality sites...I would be inclined not to include it at all and curate our own short list of external links. The problem with DMOZ is that even if you suggest a site, it may never appear. DMOZ is like wikipedia, but with one random person controlling each page. --sciencewatcher (talk) 01:32, 28 May 2012 (UTC)

I agree that they need more people curating external links. But I do not think we should consider taking up this task. I strongly support that "Wikipedia is not a collection of external links". I do recognize that I may take a harder position on this then many but if a site is good enough to be an EL it is good enough to be a reference within the article (and thus the content should be within the article and no longer needs to be an external link).--Doc James (talk · contribs · email) 01:35, 28 May 2012 (UTC)

We're talking about the RAC page (http://www1.va.gov/rac-gwvi/)? As the official government page on the illness, this is a good inclusion in my opinion. I would argue it meets WP:ELYES point 3. Support groups aren't good links in my mind, per WP:ELNO #10 as well as Wikipedia:MEDMOS#External_links point 2. Though I agree the DMOZ does have a lot of what I would consider poor quality links, the debate over the existence and form of GWS does include a lot of grass-roots and former veterans pushing the issue forward. Those types of links are included in the DMOZ, along with some critical ones. I think the DMOZ link should be kept. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:49, 28 May 2012 (UTC)

That Committee is the same one which wrote in their 2008 report that birth defect "rates fall within the normal range found in the general population" which is not supported by any of the sources they cite, or any other source on US combat troops. 71.212.251.217 (talk) 18:59, 28 May 2012 (UTC)

That's not a criteria per WP:EL. We cite what is verifiable, not what is true. It usually works quite well. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:25, 28 May 2012 (UTC)

WP:EL states "any site that misleads the reader by use of factually inaccurate material or unverifiable research" should be avoided. WP:ELPOV suggests that if we include the Research Advisory Committee then we should also include the veterans' support groups with whom they have been at odds. 71.212.251.217 (talk) 21:12, 28 May 2012 (UTC)

You, and veterans groups, may think that the material is factually inaccurate - are there any reliable sources that agree with them? All perspectives are not equal, quite deliberately so. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:44, 29 May 2012 (UTC)

Again, none of the sources the RAC-GWI cites agree with their statement that birth defect "rates fall within the normal range found in the general population" for US combat troops. If you want them to be seen as an accurate or verifiable site, then it is your responsibility to show that the statements they publish are accurate or verifiable. That one is not. 71.212.251.217 (talk) 17:33, 29 May 2012 (UTC)

I don't understand. You say one statement on the site is inaccurate, so the entire site is not appropriate as an EL? I don't think that's how it works. A US government site would seem to be a good EL, I would need to see more than "one statement somewhere in the site is wrong" to change that. Yobol (talk) 03:43, 4 June 2012 (UTC)

As I wrote above, it's not the only time the Committee has been inaccurate. They've been at odds with veterans' support groups for more than a decade, and always on the wrong side. It's a consistent pattern and practice. 71.212.251.217 (talk) 19:01, 4 June 2012 (UTC)

Archiving

I've archived everything except the most recent (April, 2012 and on) discussions. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:39, 28 May 2012 (UTC)

Abu-Musa (2008) literature review

Continuing from #Hinden (2005) above, Abu-Musa (2008) "Effect of war on fertility: a review of the literature" Ethics, Bioscience, and Life 3(2):43-53 includes a section on the Gulf War on pages 47 and 48 comprised of five paragraphs. There is also a lengthy discussion of the Gulf War and the various novel toxic exposures it involved in the Discussion section on page 51.

I have an unexpected interruption at the moment, so when I get more time I will summarize those portions here. I invite anyone else to go ahead and do so. 71.212.251.217 (talk) 18:01, 29 May 2012 (UTC)

Are there any objections to including statements from this review along with quantitative statements from Doyle's review (e.g., which do not use the term "modest" or similar nonquantitative characterizations) for balance? 75.166.206.120 (talk) 05:04, 21 June 2012 (UTC)

I note with some concern that WLU has blanket-reverted Abu-Musa from the lead, after having asked for a 3-5 year old literature review above. Furthermore, the revert was done without discussion. 71.212.226.91 (talk) 05:04, 23 June 2012 (UTC)

Shelleh (2012) literature review from last month

"Battlefield reports documented a steady rise of malignancies and newborn malformations after war" -- Shelleh, H.H. (2012) "Depleted Uranium: Is it potentially involved in the recent upsurge of malignancies in populations exposed to war dust?" Saudi Medical Journal 33(5):483-8 PMID 22588807. 71.215.95.182 (talk) 05:15, 15 June 2012 (UTC)

I ask for the mediator's opinion on this reversion without discussion. Both reliance on a more recent secondary PubMed-indexed medical journal literature review and the replacement of the Hindin (2005) literature review were explicitly agreed to above. 75.166.206.120 (talk) 22:36, 20 June 2012 (UTC)

According to MEDRS we should be summarizing the scientific consensus, which you are not doing. Also, Shellah is a new study and has zero citations, so we shouldn't really be using it (see WP:SCHOLARSHIP). You just seem intent on putting in the POV that the gulf war causes birth defects, which according to the scientific evidence is unproven. --sciencewatcher (talk) 23:57, 20 June 2012 (UTC)

So you're saying that Shellah is too new for a literature review? There can be no proof contrary to the fact that breathing uranium fumes causes birth defects. Why would that be a bias or a perspective? It is an absolute fact, first published by Maynard in 1949 and confirmed in every literature review considering the fact thereafter. If there were any such proof, you would have shown evidence for it. Do you believe you have such evidence? 75.166.206.120 (talk) 01:06, 21 June 2012 (UTC)

Yes, Shellah is too new. I was saying there is no overwhelming evidence that gulf war vets' children have birth defects. --sciencewatcher (talk) 02:30, 21 June 2012 (UTC)

This article is about civilians, too, per the first sentence. What do you think the likelihood is that the included statement from Shelleh will be retracted? Can you give an example of any other peer reviewed WP:SECONDARY medical source which was not included in any other article because it was too new? The standard for inclusion is verifiability, which is in abundance, not the existence of overwhelming evidence. Unless you believe the Chief Epidemiologist of the Veterans Administration is incompetent, then there is also overwhelming evidence. 75.166.206.120 (talk) 04:58, 21 June 2012 (UTC)

The main rule we have to follow is NPOV, which you are breaking by cherry-picking sources that fit your POV and removing everything else. --sciencewatcher (talk) 16:07, 21 June 2012 (UTC)

As for sources: verifibility just tells us what we CAN include - it doesn't tell us what we SHOULD include. We use WP:SCHOLARSHIP, WP:WEIGHT and other policies to decide what should be included in the article. It's pretty standard in wikipedia to not include brand new medical studies, unless they are important or there is some other reason to include them. --sciencewatcher (talk) 16:19, 21 June 2012 (UTC)

We have four secondary medical journal articles talking about birth defects: Hindin 2005, Doyle 2006, Abu-Musa 2008, and Shelleh 2012. Three of those reviews say the same thing about birth defects, which I've included. One of those four contrasts very sharply with the other reviews and its primary sources, using non-quantitative terms like "modest". I've been taking that one out. Which one of us is trying to introduce our bias? 71.212.226.91 (talk) 18:39, 21 June 2012 (UTC)

I've rewritten some of the text, as you had misrepresented some of the studies. I've also removed Shelleh from the lede per WP:WEIGHT, as it is a lower quality source than the others. Doyle seems to be the best quality (most citations), so let's just leave that in the lede. Also, Shelleh only discusses leukemia in adults living in Iraq, so it's talking about something completely different to the other reviews. Doyle pretty much agrees with Abu-Musa as far as I can see. It's maybe ok to put a sentence from Shelleh in the main text (which I've done), although I'm pretty sure it fails MEDRS due to having zero citations, so I would be inclined to just delete it. We already include Hindin in the text. Hindin contradicts some of the other parts of the article (like the VA saying that DU has been 'ruled out'). However that is fine - there isn't always agreement in science, so we just present the evidence from the high quality sources. I think we're fairly close to being NPOV now, if not already there. I still think it would be better to include the va.gov link in the links section. --sciencewatcher (talk) 02:44, 22 June 2012 (UTC)

Are you seriously suggesting that the number of citations is more important than recency and consensus in evaluating secondary sources? You have removed the suggestion that there was any increase in birth defects, which is supported by all four of the reviews. As you know, the VA report to which you refer was not peer reviewed and is demonstrably inaccurate. I am reverting the abject whitewash and asking mediator opinion. Shelleh makes weaker statements on this matter than Abu-Musa. Are you suggesting that Doyle and Abu-Musa reach the same conclusions? Or by, "as far as [you] can see," do you mean that you have not yet read Abu-Musa? 71.212.226.91 (talk) 06:45, 22 June 2012 (UTC)

The reviews do agree. Some studies showed an increase in birth defects, but the studies suffered from recall bias and the results need to be treated with caution. All the reviews pretty much state that. If you believe that birth defects are 'proven', you either don't understand the science or your bias is clouding your judgement. As you have openly stated that you have personally written to the VA, it seems that you might perhaps be too close to the subject to edit objectively. Perhaps you should just post on the talk page, and leave the editing to neutral, uninvolved editors who have no personal interest in the subject and can edit objectively based on NPOV and the other wikipedia policies. --sciencewatcher (talk) 14:26, 22 June 2012 (UTC)

All four of the reviews agree with me. I await the mediator's opinion. 71.212.226.91 (talk) 22:24, 22 June 2012 (UTC)

External links

I am still in support of these external links because of the record of inaccuracy of government authorities. The suggested set balances. 71.212.226.91 (talk) 18:05, 23 June 2012 (UTC)

Unwise deletions

I propose replacing the following portions which were deleted by WLU:

Because uranium is a heavy metal and chemical toxicant with nephrotoxic (kidney-damaging), teratogenic (birth defect-causing), immunotoxic, and potentially carcinogenic properties, uranium exposure is associated with a variety of illnesses. The chemical toxicological hazard posed by uranium dwarfs its radiological hazard because it is only weakly radioactive, and depleted uranium even less so. DU has recently been recognized as a neurotoxin. In 2005, depleted uranium was shown to be a neurotoxin in rats.

In 2001, a study was published in Military Medicine that found DU in the urine of Gulf War veterans. Another study, published by Health Physics in 2004, also showed DU in the urine of Gulf War veterans. A study of UK veterans who thought they might have been exposed to DU showed aberrations in their white blood cell chromosomes. Mice immune cells exposed to uranium exhibit abnormalities.

Genotoxic mutagens such as uranium should be treated with chelation therapy or other means shortly after exposure. Incorporated uranium becomes uranyl ions, which accumulate in bone, liver, kidney, and reproductive tissues. Uranium can be decontaminated from steel surfaces and aquifers.

71.212.226.91 (talk) 06:06, 25 June 2012 (UTC)