Talk:Multiple chemical sensitivity

Possibly Relevant

I have no idea whether this is worth putting in the article, but it looks like there may be some relationship between this and mast cell disorders like Mast Cell Activation Syndrome. https://enveurope.springeropen.com/articles/10.1186/s12302-021-00570-3

Possibly also relevant, not that it's worth citing: https://www.hsph.harvard.edu/hoffman-program/resources/chemicals-in-your-life/what-is-mcstilt/ 173.66.202.193 (talk) 03:12, 30 July 2023 (UTC)

The list of differential diagnoses is long. That's one of the challenges with having (or trying to diagnose a patient who has) non-specific symptoms. WhatamIdoing (talk) 03:45, 30 July 2023 (UTC)

It's Not just another differential diagnosis, though. Scientists are actively arguing that MCAS and MCS are one and the same Sicklesbian (talk) 00:30, 23 June 2024 (UTC)

Chemical used loosely

@Morgan Leigh, you've removed this statement:

"The word chemical in the name is used loosely and includes natural substances"

saying that "erroneous material not supported by source". The cited source says, in part, "The term “chemical” is used to refer broadly to many natural and man-made substances, some of which have several chemical constituents".

Please let me know exactly which word(s) you think are not supported by that source. WhatamIdoing (talk) 22:53, 25 May 2024 (UTC)

Firstly, I was unable to find a 2016 source of that name. A search of the publisher's site reveals 0 results see [1]

Presuming that maybe the year was a typo I thought it must be referring to this work [2] which does not contain anything about MCS.

If there is indeed a 2016 work as cited I would be most obliged if you could point me to it.

Secondly there is a difference between "The word chemical in the name is used loosely and includes natural substances" and "The term “chemical” is used to refer broadly to many natural and man-made substances, some of which have several chemical constituents". The former is erroneous in that all natural substances are chemical substances. The second is making a point that chemical substances and chemical mixtures or compounds are not the same thing. Which, while a valid point, doesn't seem to be a substantive addition to the article. For example such a distinction is not made on other pages that use the word 'chemical' e.g. Chemical Burn.

However if you can provide a link to this source for verification I would support something that makes the source's point unambiguous like "The word chemical in the name refers to single chemicals, chemical mixtures and chemical compounds". Morgan Leigh | Talk 00:13, 26 May 2024 (UTC)

You can find the source in Wikipedia:The Wikipedia Library under De Gruyter. In the future, I suggest that if you can't find the source, you should ask for help instead of asserting that material is not in the cited source, even though you've never read that source and don't actually know what's in it.

I think there are two points to be made here, and that both of them are fully supported by the cited source:

• The word chemical (in MCS) does not have the meaning that a chemist ascribes to that word. It is not "a molecule"; it is "some stuff".
• The problems are not limited to "synthetic" chemicals.

These points are related, and they have to do with two common misunderstandings. The first is the lay person, who probably never took a chemistry class. MCS is widely misunderstood as applying strictly to "synthetic" or "man-made" chemicals, or even as being a type of Chemophobia. When they read "attributed to chemicals", then they think synthetic chemicals, and then think that natural substances are safe. This leads to them thinking that "natural" scented products are safe gifts. However, many actual MCS patients struggle with pine trees – the 100% natural, organic chemicals in pine trees.

On the other end, we have chemical specialists who are told "The chemicals in pine trees make me sick", and they think "Okay, pine trees, that's mostly terpinols, so let's test specifically for α-terpineol", and then they "prove" that the patient isn't affected by pine trees. They overlook the fact that the problem is the whole thing, and not just a single isolated chemical.

The goal, in other words, is to educate well-meaning friends that "chemical" includes "natural" and to educate chemists (because the source does) that "chemical" doesn't mean "single purified molecule". WhatamIdoing (talk) 01:48, 26 May 2024 (UTC)

I did make an error in the summary. I meant to say erroneous and unable to locate source and I didn't notice it until I had already committed the edit. Maybe next time presume good intent instead of giving someone a hard time.

I understand the point you are making about trying to tell the reader that 'chemicals' doesn't just mean natural substances. The eponymous chemicals in MCS are all either elements, or molecules and I am not sure what the "Some stuff" you refer to is composed of other than chemicals. I agree that it is important to prevent promulgating the common misapprehension that natural substances are somehow not composed of chemicals, and to this end I suggest it would be most accurate to go with exactly what the source says i.e. "The term “chemical” is used to refer broadly to ‬many natural and man-made substances, some of which have several chemical constituents". It is hard to paraphrase that without loosing meaning so a direct quote seems most appropriate. Morgan Leigh | Talk 04:42, 27 May 2024 (UTC)

Wikipedia's rules prefer that we Wikipedia:Use our own words. I didn't think it was difficult to paraphrase. The word is used loosely rather than with a chemist's precision. It includes natural substances, rather than exclusively synthetic ones. Ergo, "The word chemical in the name is used loosely and includes natural substances". WhatamIdoing (talk) 04:51, 27 May 2024 (UTC)

Morgan Leigh, you said:

A search of the publisher's site reveals 0 results see [2]

... it must be referring to this work [3] which does not contain anything about MCS.

Please see:

• https://en.wiki.x.io/w/index.php?title=Multiple_chemical_sensitivity&diff=prev&oldid=1225792249

Thanks. --Dustfreeworld (talk) 19:26, 26 May 2024 (UTC)

Thank you for that link. Morgan Leigh | Talk 04:21, 27 May 2024 (UTC)

Claim that a source is not a reliable source

@Valjean Re your removal of the info from Genius, "Chemical sensitivity: pathophysiology or pathopsychology?, can you please explain how a source that is already used in two other places in this article is not a source that can be used a third time? Moreover the material you replaced says the exact opposite of that which the source says. Morgan Leigh | Talk 04:18, 27 May 2024 (UTC) Addenda: Your claim that "The conclusion recognizes the controversial nature of the described "conditions"" has nothing to do with the material you removed, which is about the claim that detoxification is not scientifically validated, which is completely at odds with the source that says "The preferred medical management of CS, designed to restore persistent health and freedom from SRI, involves elimination of the initiating body burden of primary toxicants. The purging of the underlying toxicant burden through innate mechanisms of toxicant elimination or through clinical detoxification interventions for persistent pollutants seems to consistently diminish the immune dysregulation associated with CS and to gradually ameliorate the clinical manifestations of CS." Morgan Leigh | Talk 05:09, 27 May 2024 (UTC)

I have my doubts that this 11-year-old source is strong enough to support the claims that it makes, and it doesn't match with what I see in other, more recent sources, which makes me suspect that this particular sentence about detoxification is WP:UNDUE.

Also (but less importantly), I happened to notice that every paper Genuis cited in support of his detox claims was written by himself. This makes it look like he's the only person who makes such claims. Not my job to do peer review for them, but it does make me wonder a little if that was because he actually couldn't find a single source that agrees with him. WhatamIdoing (talk) 04:59, 27 May 2024 (UTC)

In a field that has so few people studying it it is not uncommon for authors to be citing their own work, and this alone is not reason to suspect the quality of the work. Our opinions about the strength of sources is not a basis for their addition to or removal from Wikipedia because, as you so rightly state, it is not our job to do peer review.

Can you please provide the more modern sources whom you mention so that we can update the article with the information they contain? But until such sources are provided I see no reason for us to second guess a source that meets the criterion for being reliable. I am not particularly wedded to this source at all, I made the change I did solely because it said the exact opposite of that which the source itself said. If you can demonstrate that the source doesn't meet the criterion required for reliability then let's remove it and the info that is being cited by it if no other sources for it can be found. Morgan Leigh | Talk 05:27, 27 May 2024 (UTC)

Sure, I'd suggest CURRENT Diagnosis & Treatment Occupational & Environmental Medicine, which has a whole chapter on MCS. We cite the 2014 edition in the article, but a newer one came out in 2021. It's a Doody's Core Title, which means it's recommended by experts for smaller medical libraries – exactly the kind of place that needs to have reliable mainstream medical school textbooks. WhatamIdoing (talk) 06:22, 27 May 2024 (UTC)

Thanks for that. I will get a hold of it. But if you have access now to it can you see if it says anything about detoxification as a treatment please? Morgan Leigh | Talk 04:08, 29 May 2024 (UTC)

I don't have that one on hand at the moment, but https://onlinelibrary.wiley.com/doi/10.1111/ddg.14027 says that detoxification attempts make things worse (NB: not just useless, but actually harmful overall). WhatamIdoing (talk) 07:17, 1 June 2024 (UTC)

Thanks for finding that interesting paper.

I don't think it says detoxification is useless though. It says "not evidenced based" and "it is difficult to evaluate the benefits of individual substances", which doesn't say anything about detoxification's actual efficacy or harmfulness, rather it speaks to a lack of research demonstrating it one way or another.

Where it says "Treatment with a multitude of pills and infusions may lead to “catastrophizing”, thus making patients perceive their disorder particularly negatively", they are making a really good point about the psychological effects of continual and intensive medical treatment, which can cause harm to patients. This applies just as much to that which all doctors do to treat any condition e.g. they try one treatment, then another, then another, until they find one that works, or they give up. If it is going to be used as the basis for a claim that detoxification is harmful then it would need to clearly state that this is the basis for that claim being made in this paper.

Overall I think because (a) the current text about detoxification says the opposite of that which the source it cites says and (b) both of the sources under discussion here are are peer reviewed and published, we should include what they both say, e.g. Genius recommends detoxification while Harter et al describe it as not supported by evidence and possibly psychologically harmful. Morgan Leigh | Talk 04:19, 3 June 2024 (UTC)

The source says "Some authors recommend...“detoxifying” measures. However, these measures are not evidence based....may lead to “catastrophizing”...this phenomenon is known to have a negative impact on the subsequent disease course".

In other words, detox leads (sometimes) to catastrophizing leads (usually) to bad outcomes. WhatamIdoing (talk) 20:58, 7 June 2024 (UTC)

Then we are in agreement as to what Harter et al. says but for some reason the information from Genius has been removed. Why is it so? Morgan Leigh | Talk 09:15, 22 June 2024 (UTC)

I don't think we should include any material in support of detox, because:

• Genuis appears to be the only researcher in the world who researches or promotes detox, and
• No other high-quality source appears to agree with him or endorse his work, and
• At least one other high-quality source appears to disagree with him.

If you think that detox should be included (favorably), then it would help to find high-quality sources that weren't written by Genuis. At the moment, if I run across another high-quality source that says detox is a bad idea, then I'd be inclined to include a warning against detox. WhatamIdoing (talk) 19:40, 29 June 2024 (UTC)

@Morgan Leigh; I agree with you that there are only few researchers (and thus few sources) in the field. It’s understandable. With MCS being labelled as altmed, and it’s patients being labelled as ‘“may have a tendency to "catastrophically misinterpret benign physical symptoms"’ by our article, I don’t think the field can attract much talented researchers ;-) Just like editors are people, scholars are people too. People need bread. Few people would be interested in a field / condition that is said to be kind of imaginary and “alternative” and hence lacking research fundings. It’s like a loop, and it seems that it’s going to be “altmed” forever. --Dustfreeworld (talk) 21:26, 2 June 2024 (UTC)

Organizing the lead

The lead for a medical article is usually organized into about four paragraphs, in approximately this order:

• Definition and symptoms
• Cause and diagnosis
• Management and prognosis
• Epidemiology, history, society/culture

So: Depression is a mental disorder with low mood; we don't really know "the" cause, but it's diagnosed by a psychiatrist based on self-reported symptoms; it's treated with drugs and behavioral self-care, and usually clears up; lots of people get it and it sucks.

Or: Autism is a neurodevelopmental disorder affecting social communication; it's partly genetic, and diagnosed based on self-reports and behavior; it's managed by accommodating the person's needs, and prognosis depends on things like whether the person has low IQ; prevalence might be increasing, and there's a long history.

(I'm just making these up; different choices may have been made for those specific articles.)

In the case of MCS, following this pattern would look vaguely like this: MCS is a controversial condition involving real symptoms and a belief that the symptoms are caused by chemicals; the cause is unknown and diagnosis is based on self-report and excluding other conditions; management focuses on symptoms, and about half of people get better over time; the prevalence is probably declining (per doi:10.1002/9781119887638.ch18) and wow, did we mention this is controversial?

Until we re-write the entire body of the article, there's not much point in speculating on exactly what wording should be used, but I'd like to get people's ideas about what should go in each paragraph. For example, do you think that prognosis and epidemiology should be in the same paragraph? That the management should come before the diagnosis? Something else? WhatamIdoing (talk) 01:21, 9 June 2024 (UTC)

I think following the pattern makes sense. And diagnosis should come before management. Morgan Leigh | Talk 09:14, 22 June 2024 (UTC)

Redirects here

Idiopathic environmental intolerances redirects here. I'm looking at doi:10.1177/2167702617693327 (2017, but it looks useful) and wondering whether we should turn the IEI page into a Wikipedia:Set index articles. The contents would be roughly a short paragraph like this:

"Idiopathic environmental intolerances are conditions with no proven cause, but which people attribute to various environmental situations. The most common forms are multiple chemical sensitivity, electromagnetic hypersensitivity, and wind turbine syndrome."

followed by a Wikipedia:Summary style entry for each of those three.

MCS, EHS, and WTS aren't all the same, but they do share some similarities, and not every source that talks about IEI is talking about MCS specifically. The name in the lead of this article could become "idiopathic environmental intolerance attributed to chemicals (IEI)", to parallel Idiopathic environmental intolerance attributed to electromagnetic fields.

What do you think? WhatamIdoing (talk) 06:11, 10 June 2024 (UTC)

That makes sense. -- Valjean (talk) (PING me) 00:18, 11 June 2024 (UTC)

Agreed, I think that could be a stand-alone article. WeirdNAnnoyed (talk) 15:02, 13 June 2024 (UTC)

Okay. I've started it at Idiopathic environmental intolerance. WhatamIdoing (talk) 17:51, 13 June 2024 (UTC)