Talk:Multiple chemical sensitivity

Recent changes

I saw the recent changes that got reverted and thought it worth starting a discussion. Discussing changes per section might be easiest. Seems like WP expects sections to be updated before any changes to the lead. I haven't made the time to read up on the details of the reverted edits and their sources. Amousey (they/them pronouns) (talk) 23:20, 23 June 2020 (UTC)

Here are two small changes that could be discussed:

• "MCS is not an allergy" – It isn't, and it has been claimed to be. The direct statement is probably more useful/educational than a technical statement about immune markers.
• 'Some experts attribute the symptoms to depression, somatoform disorders, or anxiety disorders. – This had been incorrectly tagged as needing a non-primary source, but the cited source is a review article. A more recent source would be appropriate.

WhatamIdoing (talk) 22:04, 25 June 2020 (UTC)

AltMed or not

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

In the last year, PubMed shows five review articles, which were published in these five journals: [1][2][3][4][5] None of those journals are categorized as alt med journals.

The citations most frequently used in the article are a med school textbook, a report from a government agency charged with long-term care, and two conventional medical journals.[6][7]

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

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

The German thing

Someone tried, in good faith, for approximately the zillionth time, to add a claim that the German government recognizes MCS as a single, discrete, non-psychiatric disease. The sentence in question was copied straight from a MCS website.

The main problem is that it's not exactly true. AFAICT basis for this claim is that a MCS patient wrote to the Austrian (remember, Austria is not part of Germany) health system to find out what medical billing code should be used for MCS patients whose doctors want to get paid. The reply has been scanned and posted all over the internet. The letter says that Austria uses the same set of billing codes as Germany (large countries create their own custom variations of the ICD, and smaller ones mostly copy their neighbors to save the expense of creating their own), and the Austrians will pay for MCS-related medical services billed under T78.4, which is a catch-all category for all unknown/unspecified apparent reactions to anything – or nothing.

So on the theory that the best defense is a good offense, I've expanded the ICD section to cite a recent journal that discusses the problem of which billing codes to use, and provided basic background information. I hope that will both educate people on the actual situation, and discourage them from repeating misleading claims. WhatamIdoing (talk) 17:23, 14 August 2020 (UTC)

Not idiopathic environmental intolerances

The lede stated that this unrecognized diagnosis is also known as idiopathic environmental intolerances (IEI). This is incorrect. Since the subject has no diagnosis code, as it is not accepted in mainstream medicine, it has been proposed to use the idiopathic environmental intolerances (IEI) diagnosis code in lieu. Ifnord (talk) 20:39, 20 February 2021 (UTC)

It's still a verifiable other name.

MCS is not entirely "rejected" by mainstream medicine. It is accepted that these people are sick, sometimes to the point of being fully disabled. It is accepted that people experience symptoms when they can detect exposure.

It's really only the exact mechanism of pathogenesis that is rejected. Multiple different ones have been proposed over the decades. WhatamIdoing (talk) 05:50, 2 March 2021 (UTC)

ICPS

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