Talk:Chronic cerebrospinal venous insufficiency controversy/Archive 1

Archive 1

Archive 2

Unreliable assumptions

The assumptions in this article seemes very very unreliable to me!
"100% reliability to diagnosize MS in a blind experiment"
This statement alone is not only hard to believe. This number is absurd for everyone who has experience in neuroscience. It makes no sense to show all weak parts of this assumptions. This article seemes to me part of an advertising campain of a small group of scientist to promote things which have been discussed with negative results more than 20 year ago. The thesis is in fundamental contrast to mainstream scientific results. So take care and don't trust this text easily. Kiu77 (talk) 16:36, 18 October 2009 (UTC)

The referred article was published on December 2008 on "Journal of Neurology, Neurosurgery, and Psychiatry" [1], nearly one year ago, and has been therefore peer-reviewed. Anybody that finds an inconsistency could post there his comments. As far as I know, nobody has complained about the accuracy of the article. I think that if you consider it untrustworthy is your duty to give a reference justifying that. Therefore I think your "Unreliable sources" post should be removed.

By the way, a 100% reliability is perfectly normal when the number of cases studied is small and the population is pre-selected, as this is the case. Have you really read the article?--Juansempere (talk) 08:47, 19 October 2009 (UTC)

Thank you for your reply. As you said, the numbers, their meaning, creation and importance are questionable and not reliable. Therefore some warnings and additional informations should be included in the article to prevent people in believing that the assumptions made in this article are scientific common sense (what they are definitely not) or that the whole concept is more than an outsider thingy, which it is.

I have to grant you that. The published number is 100% but in such a small trial it is not so reliable. Would you agree to replace that sentence with something like "it has shown a high sensitivity and specifity"?

You did not mention, that the whole story is an old story which never got acceptance of the scientific community. This is important information. Whithout this the article gives the impression that totally accepted facts are reported, what is a very wrong impression.

The venous theory of MS was resurrected before the given article. Anyway, the given text only shows a high frecuency of vascular problems in people with MS, saying that it can be used as an aditional criteria for diagnosis. It does not state that MS is the consequence of them, and I have been very careful saying "A connection with Multiple Sclerosis has been proposed but the possible relationship is still under study". Besides I have clearly called the section "hypothesis". We can add aditional information if you want.

What you perhaps don't know that since late summer 2009 there is a massive and aggressively promoted campaign looking like viral marketing to promote CCVS as the one and only reason of MS symptoms. And the promoters state in an absolutely dogmatic matter that implantation of stents in the jugular veins is the healing of every ms. This is a dangerous development.

No proof exist that to cure CCSVI will cure MS and that should be stated clearly in the article. But a relationship with vascular malfunction has been shown and that is a problem itself. It is natural that MS patients want to get their vascular system tested just in case. Of course they should follow the advice of a vascular doctor if problems are found. Nevertheless I see no danger. I really cannot imagine a vascular surgeon stenting anybody that request it, just because the patient ask him, without an angiography showing a stenosis.

And the promoters link to this wikipedia article to "prove" their absurd assertions.

Well, I don't think that this article proves anyhing, and we cannot prevent people from linking here. We can add an aditional note stating that no link has been demonstrated between CCSVI and MS but there is already one.

Therefore one has to be very careful and the pure info about the assumptions behind the concept of CCVS is not enough. Thats one of the reasons for I think this article is not really neutral or supported by enough scientific evidence. --Kiu77 (talk) 09:39, 19 October 2009 (UTC)

I have already made the changes previously said. Would you agree to remove the warning? Would you correct anything else?--Juansempere (talk) 11:12, 19 October 2009 (UTC)

After a week waiting for a reply, no more comments have been posted. Besides, the previous comments referred more to the redaction than to the quality of the referemces. And redaction has been fixed. I will remove the "sources quality" box. --Juansempere (talk) 04:34, 26 October 2009 (UTC)

Anyway: The first polish persons say that they have implantet stents in their veins - is this dangerous or not? Despite I believe nothing and think of them as complete lyers trying to make some money in obscure polish hospitals I don't think this is a easy case. And not every stupid idea should have a site in wikipedia in my eyes. -- Kiu77 (talk) 00:20, 9 November 2009 (UTC)

OK, but this is a stupid idea with support from journals such as "Journal of Neurology, Neurosurgery, and Psychiatry", "Neuropathology applied and Neurobiology", or "Archives of neurology". If like you suspect there is people trying to make money out of it cheating others, we can do nothing about it. Should we write in the "Eiffel tower" article that it is not for sale, just in case somebody tries to sell it to the tourists?

perhaps more history will put this "discovery" in proper context

1. Rindfleisch E. Histologisches detail zu der grauen degeneration von gehirn und ruckenmark. Archives of Pathological Anatomy and Physiology. 1863;26:474–483.

as you can see the possibility that vascular pathogenesis is linked to autoimmune myelin destruction by autoreactive T lymphocytes, was suggested long ago and you are doing nobody any favours by omitting this reference which is cited in your reference [2]. (note: "linked to", not yet "caused by")

secondly, there is a spectrum of neurodegenerative illnesses that are caused by iron in the brain, some genetic and some not. i think it is as absurd to say "all MS is caused by excessive iron in the brain" as it is to say "all excessive iron in the brain results in MS".

thirdly i am disturbed by the aggressive marketing - and it is that - of the venous stent procedure as some sort of panacaea. even if there should turn out to be a definitive correlation between venous malformations and MS, the intermediate step has yet to be nailed down, namely the precise mechanism by which the iron stores in the brain cause destruction of myelin. —Preceding unsigned comment added by 76.71.93.151 (talk) 20:44, 21 November 2009 (UTC)

OR tag

This condition was described in 2008. No attempt is made to clearly state the typical symptoms of CCSVI, nor is there a plausible explanation why this process should lead to focal lesions as opposed to intracranial hypertension. There is also no clear explanation why immune-based treatments should be effective in reducing relapses of MS. A cautious rewrite with much less reliance on a single paper (Zamboni) should be performed. JFW | T@lk 21:04, 22 November 2009 (UTC)

Hi JFW. First of all this article is not intended to be about "venous MS", which is the thing that you critizise, but about the vascular disease called CCSVI. CCSVI existence has been confirmed by secondary sources via MRV and therefore is not an hypothesis anymore. The article at is ending refers to the hypothesis of "venous MS" calling it explicitly hypothesis. Maybe it is a new hypothesis, but secondary research has been performed and is therefore as valid as any other. I have moved by now your OR tag to the appropiate MS section, but I still do not agree with it.

Second, I think the tag you have choosen is wrong. Original research is intended for writers that refer to unpublished information. In this case there are peer-reviewed publications that cannot be considered unreliable.

About the alleged "reliance on a single paper" I really do not understand why you wrote that. There are several references in this section to different articles and the one that you claim to be the only one is not even mentioned.

Therefore I consider that your tag is inappropiate even in the header of the section.--Juansempere (talk) 13:51, 23 November 2009 (UTC)

The articles in question should explicitly refer to CCVI, by name, in order to be used, otherwise the page and section is engaging in original research and probably being used as a soapbox to promote a novel and as-yet unaccepted condition. Zamboni is the primary author of this hypothesis, until it has been replicated and becomes accepted by at least a minority of other researchers it should, per WP:RECENTISM, be treated with kid gloves. Extra caution should be used to ensure we aren't replicating the research Zamboni has done to create a background for his hypothesis. WP:NPOV is also a concern, particularly giving undue weight on a minority opinion (Zamboni's). Don't mix "giving people hope" with "giving false hope based on an unproven theory". WLU (t) (c) Wikipedia's rules:^simple/_complex 20:47, 25 November 2009 (UTC)

Are you speaking about CCSVI or about the possible relationship with MS? If you speak about the MS relationship, as it seems is the case, none of the given articles are primary research. The relationship was first proposed in the 80's and all the given papers are therefore secondary research. Of course they do not have to speak about CCSVI or refer to it by name. Most of them predate the article of Zamboni.--Juansempere (talk) 14:27, 26 November 2009 (UTC)

If it's going to be cited on this page, it really should refer to CCSVI by name. Otherwise, we should cite the source that says "these articles are actually talking about CCSVI" and leave the primary sources out of it. If CCSVI exists as a recognized and accepted clinical entity, it should be discussed here. If it's a novel hypothesis (as suggested in the text), it should remain a relatively short article until acceptance is reached and substantive research occurs. If its a shoehorn for a new diagnosis of MS, that would seem to be a fringe hypothesis that should be briefly mentioned, then left alone until the idea gains major acceptance and replication. That Zamboni is the primary, if not only author to research and promote the idea, that is another indication we should be cautious. Note that I'm referring to WP:FRINGE in a fairly cautious manner - it's not a "creationism" fringe theory, think of it as Helicobacter pylori circa late 1983 versus cold fusion circa mid-1989; both generated controversy and minimal acceptance at the time of announcement. One went on to win a Nobel prize, the other turned out to be experimental artifact. Right now, we don't know which way Zamboni's hypothesis will go; if it gains acceptance, great! If it fizzles out, then it should be removed from the page. Only time will tell. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:54, 26 November 2009 (UTC)

Then I understand that your point is that we should not refer to a general theory in this article (venous problems as cause of MS) because the article is strongly related to a particular theory (CCSVI as the cause) and it can be misleading. Well, I have to admit that your point makes sense, but you have to admit that the venous theory existed even before the Zamboni article and that it should be documented somewhere. How would you propose to do it?--Juansempere (talk) 15:06, 26 November 2009 (UTC)

CCSVI itself is a very novel diagnosis. Before a lengthy article can be written, it should be established that it is well-accepted, or at least has significant minority acceptance (per WP:UNDUE). Essentially, until that can be demonstrated, the article should remain quite short and be clearly indicated as prospective and novel. The problem with novel hypotheses is of course, the dearth of reliable sources. No matter what, the page should be made up of the best sources available. That means recent review articles. I would use only those articles that are explicitly meant to summarize the whole field (not those discussing individual experiments), that are published in reliable sources (journals, not conference abstracts or schedules) and I would continue to be brief - it's not like there is a demonstrated treatment based on this theory yet. If there are no such review articles, only primary sources, I would simply mention it, with a reference, and not expand in great detail. None of this is easy, UNDUE issues require considerable editor agreement and an interpretation of the literature that is difficult to justify. The best way is to use caution and be sure to only use secondary sources that are explicit in referring to CCSVI. If you can find more articles not authored by Zamboni, published in a variety of journals, and minimal criticisms, that all suggests the theory is gaining acceptance. However, if they're still at the stage of doing 60-patient test runs, I don't think we can expect a lengthy featured article just yet. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:07, 26 November 2009 (UTC)

I've removed the OR tag; at this point it's irrelevant, especially considering recent events in Canada re: MS Society providing funds for the research. Like it or not, it's a viable hypothesis and must be written as such. Whether or not there's a connection is to be determined, but the possibility is there and content here must be treated accordingly. When we get results, we'll update as we go.--Cpt ricard (talk) 22:55, 28 November 2009 (UTC)

Comment

WLU: "way too much promotion of Zamboni for my taste" Way too much intervention by WLU, for my taste. Why did you remove all the background information, and all the references? From: deletionism , 'Rather than deleting it, why not simply add to it?' —Preceding unsigned comment added by Alphons1968 (talk • contribs) 18:35, November 27, 2009

The background information is original research for an unproven, unaccepted hypothesis, that gives undue weight to a newly-proposed concept. The page should be expanded as more peer-reviewed sources come in which indicate the idea is gaining traction outside of Zamboni's lab. If it's a real finding, it'll happen. Wikipedia is not the place to promote a novel theory. We present the plodding mainstream. CCSVI is a theory at this point, and one that only really has one 60-person trial behind it, done by a single lab. Deletionism is a philosophy, while the policies and guidelines I've cited are, well, policies and guidelines. I'm not saying the page can never detail the background of CCSVI and MS, just that it's too soon right now. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:34, 29 November 2009 (UTC)

I agree with WLU - I was a little too strident also over at multiple sclerosis and thankfully was reminded of what our duties were by Garrondo. Until more reliable sources appear (and I think we all hope they do), we need to stay on the known aspects. WP:crystal ball heavily applies here. I'm like most people who heard about this and went "Oooh! That makes sense!" but we have higher standards to maintain here. And we'll keep adding info as it becomes available!--Cpt ricard (talk) 00:13, 30 November 2009 (UTC)

I disagree, the information is to important to delete. The page has been up here for month now. Because it attracts media, people such as WLU deletes half of it. Those are the people who do "Oooh! That makes sense!" and start to edit. So it got out of sync in relation to other pages as well. Facts are, the study of Zamboni clearly showed in MS patients, 180 positive criteria and 145 negative criteria, in contrast, merging all control groups, positive criteria were 33 and negative criteria 1142. Consequently, the risk of MS was dramatically increased by 43-fold. This means 4300%! (Fisher exact test) Now the University of Buffalo did a pilot, showing all of the MS patients (100%) had CCSVI, none of the control group. This proved Zamboni was right, now they are started testing 1700 people. Please leave the information alone, or come up with articles which proves Zamboni is wrong, and add them to the CCSVI page. Alphons1968 (talk) 02:22, 30 November 2009 (UTC)

WLU, your patronizing user-talk you gave me, makes you not a very nice person, to my opinion. Alphons1968 (talk) 02:21, 30 November 2009 (UTC)

Wikipedia's pages are based on it's policies and guidelines, not the preferences of individual editors. Please read the policies and guidelines I've referred to and edit accordingly. There now appears to be consensus from three other editors (Cpt ricard, myself and Juansempere) that the page should be relatively brief and expand as the medical establishment and scientific community comes to accept it (if it does, the page should remain short if no-one can replicate Zamboni's findings and they never gain acceptance in the mainstream). Also, it's considered rude to make personal comments or attribute motivations on other editors. It can get you blocked if continued. Make arguments based on sources and wikipedia's rules not personality contests. I did come to this page because of the publicity over the theory, and given its problems, I edited accordingly. I am not opposed to the page expanding, I just think that wikipedia's policies clearly support doing so slowly as more information comes in. There's not even enough publications to do a review article yet! Per WP:MEDRS, reporting on individual studies is not ideal, in fact it is discouraged. Please become familiar with wikipedia's policies before reverting again based on personal preference rather than the rules. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:16, 30 November 2009 (UTC)

First "it's considered rude to make personal comments or attribute motivations on other editors", okay you just sended me the intro for fun? Second "if no-one can replicate Zamboni's findings", we don't have to agree on the findings, we only describe them. Did you read about the University of Buffalo? They proved it already in their pilot-study! Third "Cpt ricard, myself and Juansempere", I did not hear from Juansempere, you just deleted half of his information put on Wikipedia, just of a sudden. This happened first at 25th of November. There was no consensus. You just did. Then a second time at 29th of November, after 'Cpt ricard' edited some content of it already. There was no consensus, you just did. And now, the third time in a row. You reverted the page again on 30th of November. There was no consensus, you just did. This makes you a violator of the three-revert rule (3RR). I saw on you user page this not your first time. So please leave the page alone, you are not helping anyone. Alphons1968 (talk) 19:12, 30 November 2009 (UTC)

Some info about Zamboni: Reasons why some consider CCSVI to be unscientific--Kiu77 (talk) 23:56, 22 February 2010 (UTC)

Undent. Please read the rest of the talk page, particularly the section titled #OR tag. Also see WP:BOLD and what the actual three revert rule is. Please review our policies and guidelines as they determine content, not what individual editors think is important. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:35, 30 November 2009 (UTC)

More info wouldn't hurt Wikipedia

As an extern, I get the impression editors who are the most cautious or conservative about the MS hyotheses are also the most purely (coincidentally?) fierce against the expansion of the entry. This is a little bit puzzling. Some have rightly pointed out that cold fusion was both "coldly" received, and later demonstrated to be flawed. Right. Does that mean that had Wikipedia existed at the time of the first publication, the article "Cold Fusion" would have been a couple of lines long? No. The potential impact of a scientific hypothesis (if properly published in peer-reviewed literature) justifies the length of the text, it is then the content of the article that should explain the consensus and completeness. As a counter example, I could cite some thousands of rock-solid much-reproduced scientific findings that don't even have an entry, not one single line, in Wikipedia (not because they are wrong, just because there's no clear impact). So, I don't think the length of any WP article has all to do with the established consensus (more text may actually better clarify the lack thereof). If one wants to assert the article should be really very short, other reasons should be given (like, the publishers are not so reliable, MS-related conditions have no public impact, the researcher is not a professional, the hypothesis is blatantly absurd for any expert or even for a non-expert, whatever). To summarize, I'm in favor of a slight extension of the article if some think more info are needed, certainly not a reduction of it, given the potential importance of it and given the mentioned fact that MS Canada society is now putting funds on it. --Gibbzmann (talk) 18:08, 30 November 2009 (UTC)

I agree with you, but the problem for expansion is the lack of secondary sources to extend the article. Maybe we could use warnings about the experimental status, but in my first version I was very careful explicitly calling hypothesis to this subject and for some editors it was not enough. Therefore now I think is better to keep it small in the lack of consensus.--Juansempere (talk) 11:20, 1 December 2009 (UTC)

Per WP:RECENTISM and WP:MEDRS, we shouldn't expand or dramatically alter articles just because a new hypothesis has been proposed or a pilot study has been promising. Per WP:UNDUE, we should report what most scholars believe, as demonstrated in peer-reviewed journals, review articles and scholarly books. Given the novelty of the hypothesis, it is appropriate to report on it, but it's not appropriate to praise it, or proclaim it a cure. Bar one small section, I think the page as is does a reasonable job (though I'm keenly interested in any criticisms that have been ventured to date). WLU (t) (c) Wikipedia's rules:^simple/_complex 14:04, 3 December 2009 (UTC)

Problems with references

I agree with some previous editors that the syndrome is being presented too much as a agreed fact, while at the moment it has no acceptance between the scientific community, although this can be discussed depending on the strengh and number of different primary and secondary (preferibly the latters), but of course no self-publised data or OR. I have taken a look at some of the references and I find important problems with them, which should be clarified and fixed. For the moment my biggest problems are with the following sources:

• Lee BB, Bergan JB, Gloviczki P, et al. Guidelines For Diagnosis And Treatment Of Venous Malformations. A Consensus Document Of The International Union Of Phlebology. International Angiology, 2009, in press: The Pdf is only the programm to a conference. I have looked inside for the word "guideline" and nothing matches the proposed title. The closest thing I have found is " Session of the European Venous Forum (BO5.6). Workshop on updating International guidelines on the prevention of venous thromboembolism". I have also looked for Lee and only appears as part of the scientific advisory board. As it says in press I have looked for any published articles of Lee in pubmed. I have only found a similar article with the title "Arterio-venous malformation: how much do we know?" PMID 19767485. Unless it is clarified which is the exact title of the source and how does it cover the sentence for which it is used as reference this is not a valid reference.
• Dr. Marian Simka, The many sonographic faces of CCSVI: This is only a pdf with no author in it, no source where it has been found, no date... There is no indication that it has been peer reviewed (we can not know even if it has been truly been written by Simka). At best it qualifies by a self-published source and as such is clearly not a reliable source per WP:MEDRS
• Rationale and preliminary results of endovascular treatment of Multiple Sclerosis: This has been published from a symposium (and with very bad printing quality, I have to add): Do we have any indication that it has been peer-reviewed in any way? I am prone to think that the answer is no and this qualifies as a self-publised non reliable source.

As a side note I would add that if editors properly annotated sources (preferibly using Diberri's tool) it would be much more easier to check if the use of references if factually correct.

Best regards: --Garrondo (talk) 20:20, 30 November 2009 (UTC)

I have removed the two first references (as 85.54.135.71, not logged in). I am not sure that the third one should be removed. A symposium is a peer-rewieval itself. --Juansempere (talk) 10:44, 1 December 2009 (UTC)

Not really: a symposium is not exactly a congress. Most times in a symposium speakers are invited to do a speech in a given theme, but the content of the speech is not pre-reviewed by the organization, as opposed to a congress, where speeches are always peer-reviewed. However it is true that being a symposium qualifies as something written by an expert in the field (from my point of view); but nevertheless it should be treated with even more care than a primary article in a peer-reviewed journal. Bests.--Garrondo (talk) 11:06, 1 December 2009 (UTC)

This is the abstract of the pilot study of Buffalo maybe it is of use. thanks Alphons1968 (talk) 01:32, 2 December 2009 (UTC)

Irrespective, the results aren't peer reviewed until published in a peer reviewed journal or other accepted venue. Conference abstracts and the like (as well as prospective studies) are of very, very limted use since they're not really reliable, they've not been vetted (participants can really say just about anything - conferences are mostly about seeding ideas rather than testing or validating them) and they're essentially prospective. These could be used to say something like "there is interest... research has begun..." or to point to a study that is being started, but certainly not to say "it has been demonstrated" or claim anything factual beyond mere existence. Even a citation to a study that's going to be done is somewhat problematic - it could end at any point, and it is again a lot of weight on something prospective (WP:RECENTISM again). At this point that's my common sense and somewhat informed opinion but I'm asking for clarification over at WT:MEDRS. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:40, 3 December 2009 (UTC)

Possible copyright violation

In the following sentence: Blocks in the azygous vein can be indirectly and non-invasively detected only by the means of Doppler sonography, and, invasively by selective venography it felt strange that there was a small number after it. I looked for a exact match in google for the sentence and I obtained a result. This sentence and the next one seem to have been copied verbatim from ca.groups.yahoo.com/group/CanadaMS/message/3550 altough I have problems to access the site. I do not now how to continue in these cases, but this has to be fixed right now. Bests.--Garrondo (talk) 20:29, 30 November 2009 (UTC)

Hi Garrondo. I have not checked that source, but, are you sure that they have not taken the paragraph from wikipedia? Just in case I will try to rewrite it as soon as I can.

I can not know it... it is always a possibility, and as say I can not access the site.--Garrondo (talk) 08:16, 1 December 2009 (UTC)

Sorry for not posting. I couldn't

I suppose I should have posted something before, having creted the article and being one of the supporters for addition of information. Sorry. I was abroad for job. Anyway I have not much too post. I really think that at this moment is better to be careful and to keep the article small. I really think that this makes sense, but wikipedia policy is that truth does not matter. Only sources do.

On the other hand, is important to define what a secondary source is, because the articles of Zamboni are secondary sources respect the venous theories of the 80's, but at the same time they are primary sources in a lot of senses. Maybe we should have a discussion about what is a primary and a secondary source before going on.

Appart of that, thanks Alphons1968 for your support, but when WLU removed information from the article most of it was not mine and in fact, we had a discussion and at the end I agreed with the removal. I still think that there is no technical problem with wikipedia policies, but it is true that the way it was written can be misleading.

Just for ending the post, I think we should try to find a consensus. Nobody will get a benefit from an edition war. -- Juansempere (talk) 23:15, 30 November 2009 (UTC)

Secondary sources have a specific meaning in medical articles - see here and here. For articles like this one, secondary sources are review articles though per the second link we can judiciously use primary sources (experimental results published in peer-reviewed journals). This meaning of a secondary source is substantially different from the rest of wikipedia - a journal article would be considered a secondary source for most non-medical articles. I'm not averse to including this in the page, but I'm concerned over synthesis of primary sources to support a specific hypothesis, particularly one that is so new. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:34, 3 December 2009 (UTC)

There is already a review article. I think it fully qualifies as secondary source. Unfortunately is not available under a free license and I cannot copy it here. It is writen by Susan Jeffrey, news editor for Medscape Neurology & Neurosurgery. It is fully available here [2] (free of charge, but registration required)--Juansempere (talk) 13:38, 7 December 2009 (UTC)

So long as it verifies the sentences it is attached to, it's no biggie. Editors are expected to assume good faith that we're doing our best to be accurate and fair. If challenged, you may want to share it with the person doing the challenging (you'd have to e-mail it to them, which involves replying to an e-mail sent from wikipedia; no way to attach directly). Don't put your e-mail address on the page though, spambots can steal it. WLU (t) (c) Wikipedia's rules:^simple/_complex 21:02, 10 December 2009 (UTC)

I am not very sure on wether it can be considered a review: it is more a news article for physicians than a peer-reviewed article evaluating scientific data up to date. It do not think it qualifies as a secondary source according to WP:MEDRS.--Garrondo (talk) 21:13, 10 December 2009 (UTC)

Could be used for factual claims made, but not regarding efficacy - i.e. developed by Zamboni, some studies, but I wouldn't use it for results, "cured X people", etc. MEDRS governs medical claims only, not information and context. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:37, 10 December 2009 (UTC)

Sounds reasonable.--Garrondo (talk) 08:16, 11 December 2009 (UTC)

Confusing refs

The following sentence: "In cases of stenosis, it can also be diagnosed via MRV (magnetic resonance venography) and SWI (Susceptibility weighted imaging) , but the operator has to know what to look for. Computed tomography is less precise but the results are more operator-independent" uses two references. However these references are unneeded and lead to confusion. I explain myself: Both references are general articles on the procedures, and therefore unneeded since the SWI and MRV are well stablished. They are confusing because they give the appearance that they support the use of the 2 procedures for the diagnosis of CCVI, which they do not. I am going to remove them.

Additionally there is no reference to support that CCSVI can be diagnosed via MRV and SWI. Do we have a reference?

Bests.--Garrondo (talk) 09:09, 1 December 2009 (UTC)

Original research

From the treatment section:

• It is unknown if chemical vasodilation can improve this condition, but seems unlikely in cases of stenosis due to mechanical pressure.
• When it is due to defective venous valves, a possibility of repair them called valvuloplasty exist, but has never been performed for CCSVI. It is currently unknown whether blood thinners or artificial blood can help in this condition.
• Being a physical flow problem, the possibility of practising good posture and working ergonomically could reduce the consequences of reflux. In the case of blocked jugulars, the condition could be improved by standing as much as possible, sleeping inclined or sitting up, in order to avoid using the jugulars, but again no studies exist to date.
• Also part of the damage caused by CCSVI (iron accumulation) could be reduced. There are some substances called iron chelators able to remove the iron in the tissues. They are present in natural substances as green tea. Also antioxidants could help to reduce the damage.

All these sentences are completely unsourced, and frankly from my point of view they sound to me as if a wikipedia editor had proposed them in good faith after reasoning that they made sense from what he had read on CCSVI. Unless we can find a reliable source specifically saying that they could be of use to CCSVI they are OR no matter how much sense they seem to make. Does that reference exist?

Bests.--Garrondo (talk) 15:24, 1 December 2009 (UTC)

I have added several specific tags and a general box on the need of additional references. If they are not provided most of the section will probably be eliminated per original research.--Garrondo (talk) 15:31, 1 December 2009 (UTC)

There might be some issues there. However, look at this sentence for example: "When it is due to defective venous valves, a possibility of repair them called valvuloplasty exist, but has never been performed for CCSVI. It is currently unknown whether blood thinners or artificial blood can help in this condition". Well, apart from reasoning about whether it is essential information or not, is it correct to argue that it should be sourced? It starts with a common-sense observation and concludes such information is not available yet (so, no source could be there, of course). Maybe the word "theoretical" before "possibility" would certainly be better. I have no definitive opinion about this paragraph, but in some instances the issue I see is more about that information being essential (or relevant) or not, rather than one of sourcing (one would assume both the editor and the common reader are equipped with a minimal amount of common sense). --Gibbzmann (talk) 16:04, 2 December 2009 (UTC)

Merely to include in the treatment section means that it needs to have been discussed as a possible treatment. If it has not we are the ones deciding that it is a plausible treatment and that is OR. I agree with you that the issue is about the info being relevant and/or essential... but the thing of asking about a source is that sources are the ones that are going to provide the info on wether the info is relevant or not similarly to what it occurs with notability procedures: if there are no sources connecting the proposed treatments and CCSVI then they are not relevant and should be removed; however if they exist, even only saying that they seem plausible although not yet tested I would be happy to leave them. Bests.--Garrondo (talk) 23:01, 2 December 2009 (UTC)

I'm a big WP:PROVEIT fan, particularly given the recommendations of chelation, the "natural green tea" cure suggested (which also looks like a synthesis - iron chelators bind to iron; green tea contains iron chelators; therefore green tea can treat CCSVI), antioxidants, and the idea that standing all the time is a treatment. I'd favour simply removing the section. If the diagnosis isn't clear, then the treatment must be speculative - if it's speculation based on a source, great. If there's no source, I'm concerned. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:20, 3 December 2009 (UTC)

Truth to say, green tea has long been suggested as benefecial for MS sufferers. On the other hand, I don't know whether making the connection here would be OR. Not necessairily though. If we write that (just as one example) "antioxidants have already been suggested to alleviate some of the symtoms of MS and this would also be consistent with the hypothesis", we would be stating the obvious (not in that it does work, nor that it does explain why green tea is beneficial, but only in that is not inconsistent). Yet, I'm open to the opposite view. --Gibbzmann (talk) 02:37, 5 December 2009 (UTC)

I agree with WLU that it is clearly a sinthesis. Saying that this is consistent with the hipotheis is the OR: I mean, it is not so obvious, very specific knowledge of pathophisiology is needed to say that it is consistent with the hypothesis, and we are no experts. Unless somebody has said that it is consistent we are not the ones to do it. Additionally it is not really true that antioxidants have proved benefitial.--Garrondo (talk) 20:39, 5 December 2009 (UTC)

Blind?

I have been reading the Zamboni article PMID 19060024 and unless I have missed something the evaluation of CCSVI was not blind: In page 394 states "Venography was performed, being aware of patients’ diagnoses.". I am going to change it in the article. Bests.--Garrondo (talk) 08:38, 3 December 2009 (UTC)

The abstract says that the evaluation was blinded. Read in the METHODS paragraph: It says "Sixty-five patients affected by CDMS, and [ ... ] BLINDLY underwent a combined transcranial and extracranial colour-Doppler high-resolution examination [...]". If you don't have objections I will revert your change.--Juansempere (talk) 18:26, 3 December 2009 (UTC)

It's pretty rare that we include specific methodological details of individual studies on pages, even medical ones. The results either stand on their own and we can trust them, or they don't. We shouldn't be "guiding" readers to come to the "right" conclusions. Does it improve the page substantially, considering wikipedia is an encyclopedia, and this intended to be a general reference book for a general audience? I don't think so. Even the specificity comment is dubious, the only reason I'm really even a bit OK with it is that the page is pretty short and a 100% success rate is dramatic. However, a lack of blinding could also be the reason for such a high success rate... WLU (t) (c) Wikipedia's rules:^simple/_complex 23:40, 3 December 2009 (UTC)

Maybe is not important to reference in the article what was blinded and what was not. The cause of doubts is that there were several trials before the surgery procedures. I will try to summarize everything here to take it into account when doing editions.

The team of Ferrara published 5 papers prior to the surgeries. The first one in 2006 was describing similarities between iron deposition in MS patients and varicose veins . After this finding, they started a research about possible intracranial venous flood.

In their second paper("Intracranial Venous Haemodynamics in MS"), they took 89 MS patients and 60 controls looking for flood problems in a battery of 5 dopplers. They found that though sometimes non-MSers were failing tests, only MSers failed two or more failures.

Later, looking for the origin of the problems, they moved to investigate the combination with extracranial flood. Their third article is called "Doppler haemodynamics of venous return" . It was not blinded, and it basically describes the procedure and the condition of blood return.

As a consequence, they did their fourth paper, called "The Value of Cerebral Doppler Haemodynamics in the assessment of MS" . This paper basically describes the same procedure, but it is blinded to the doppler operator and to the person that performed the diagnosis. It involved 109 patients and 177 controls, some of them with other diseases. After dopplers were done they were send to diagnosis numbered. When it was unblinded, they repeated consistently the former result. All MS patients had 2 failures in the battery of doppler tests and only them had this amount of failures.

The fifth paper was trying to relate the doppler findings to venous stenosis . This is the paper in which they speak about CCSVI for the first time. This time they took 65 MSrs and 235 controls. The blinded part was like before, and then they made venograms to the patients. Only doppler-positive people was shown to have stenosis.

Only after these five publications they began with angioplasty trials. The part of the surgery is better known by its popularity, but anyway I think is the less important piece in the search of the causes of MS. Is quite surprising that patients report inmediate benefit, and it suggest that the mechanism proposed by the Ferrara team is wrong, but is completely irrelevant. The relationship of blood flow and MS is quite well stablished regardless of the underlying mechanism.--Juansempere (talk) 11:30, 5 December 2009 (UTC)

Reordering

Since CCSVI has only been discussed in relation to MS and it has not been found in patients it has no sense to describe it as a complex that can occur outside MS. I have reorderered the article to show this moving the MS hipothesis inside the symptoms section with its own subsection. Additional benefits are that some redundant info is eliminated and that this way we also comply with the WP:MEDMOS recommendations on sections. Bests.--Garrondo (talk) 09:01, 3 December 2009 (UTC)

Venous Multiple Sclerosis hypothesis

Regarding this section, I'm pretty much OK with the current version bar the final paragraph. If an editor is the one posing the link between CCSVI in references 9-15, then this is original research and should not be done. If it has been done by someone else then it is OK, but we must cite the "someone else. For instance, if these statements are based on a paper published by Zamboni that says "previous work shows evidence supporting this theory^{[9][10][11][12][13][14][15]}" then we should be citing Zamboni saying this rather than the original sources. That's totally legitemate, but the current version looks like someone thinks the connections make sense, and therefore included them on the page. If CCSVI was only proposed in 2008, then the linearity of time excludes Minagar 2006, Ge 2008, Goodkin 1998 and Filippi 2004, while the delays in publishing and research pretty much takes care of the rest.

I don't object to the information, only the current sourcing. If it's based on say, this paper, or this one, we should cite them as a secondary summary as a discussion and prospective theory rather than using the primary sources to prove it. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:31, 3 December 2009 (UTC)

MS Canada did not fund it "due to" public response

There has been some free intepretation of what MS Canada head has said. The Section VMS hypothesis reported the sentence: "Due to public response, the Multiple Sclerosis Society of Canada has committed to funding further experimental trials on the hypothesis". The President of MS Canada actually said, at various stages: “This merits serious and robust studies so we're going to issue a request for proposals,” Yves Savoie, president of the MS Society of Canada, said in an interview. Before that, the words “exciting” and “potentially paradigm shifting” are understaood to belong to the same person. Indeed, further down: Mr. Savoie insisted the group's position has not changed [skeptical about CCSVI-MS], but, because of the overwhelming public response to the media stories, he wanted to stress the group's support for research that would either prove or disprove the theory. This doesn't indicate public support as the main reason for funding the research, at the very least only one of the motives. I think he rather stresses that public response prompted them to act coherently with their mission statement. In fact, further down: “We're conscious of the potential paradigm shift this represents and we believe every avenue merits being probed,” he said. “But our policy is to not put all our eggs in one basket.” To say that all of the above is well reppresented by the sentence "Due to public response, the Multiple Sclerosis Society of Canada has committed to funding further experimental trials on the hypothesis" is a little bit of some arbitrary cut-off of what the article reports. --Gibbzmann (talk) 13:46, 8 December 2009 (UTC)

Eliminated per lacking sources

Since no references have been provided for the following text and it really sounds as original research I have eliminated it from the diagnosis section. I move it here so if sources are found it can be readded.

In cases of stenosis, it can also be diagnosed via magnetic resonance angiography and susceptibility weighted imaging, but the operator has to know what to look for. Computed tomography is less precise but the results are more operator-independent.

Venograms are the gold standard proof of abnormalities but they are X-ray based and are performed only after previous tests have shown something wrong. Azygous obstruction occurs approximately in 90% patients affected by CCSVI associated to MS, and in the totality of patients affected by the primary progressive course.

Impedance phlebography is currently under study for diagnosis.

Bests.--Garrondo (talk) 18:26, 21 December 2009 (UTC)

A Warning from the German MS Organisation

The german NGO "DMSG" (the greatest independent MS patient organisation in Germany) published a general warning and a scientific evaluation of the CCSVI hypothesis. Their scientific peers think that the CCSVI concept is unscientific, useless and ethically questionable. Here a google translation from the original german text: [3]
Not only therefore I wonder where there is a prominent part of critique missing in this article...
--Kiu77 (talk) 21:56, 4 January 2010 (UTC)

Wedge-shaped medullary lesions in multiple sclerosis

Researcher of Austalia and China report in this paper the possible relationship between MS and CCSVI: Multiple sclerosis (MS) is a heterogeneous disease with variable clinical features and magnetic resonance imaging (MRI) findings. We report four MS cases with unusual wedge-shaped lesions in the paramedian ventral medulla oblongata demonstrated on MRI. The clinical features and MRI characteristics of the medullary lesions suggest an impairment of venous drainage. We propose that the formation of these wedge-shaped lesions may be related to the pattern of venous drainage in the ventral medulla and raised venous pressure due to chronic cerebrospinal venous insufficiency (CCSVI) which has recently been described in MS. Alphons1968 (talk) 22:48, 12 January 2010 (UTC)

Congenital truncular malformations

Leaving the hot topic (the relationship with MS) aside, there are news about CCSVI. The International Union of Phlebology has agreed to accept CCSVI as a syndrome of its own [4]. Therefore is worthy of study even if at the end is unrelated with MS

The paper says that the IUP (International Union of Phlebology) has had a Conference on Venous Malformations. They produced a "Consensus document and Guidelines", where they classified the stenoses found in CCSVI as "truncular congenital vascular malformations".

This means that this kind of stenoses are recognized now as a problem themselves, and that they are congenital (ie. product of the embrion development). Therefore they cannot be produced by MS. If the relationship with MS gets confirmed, they should be regarded as a possible cause, never a consequence.

The document has no abstract in PubMed [5] and is not freely available, but I can quote a paragraph under fair use policy:

"Truncular VM (Venous malformations) lesions may also occur in veins with the same embryologic origin or draining the same territory (e.g., stenosing lesions of the extracranial jugular veins, superior vena cava, and azygos vein system along the main outflow pathways of the cerebro-spinal venous system as suspected cause of multiple sclerosis)" --Juansempere (talk) 19:33, 26 January 2010 (UTC)

New/ongoing clinical trials

Don't have time to add info from this until later; in the meantime if someone would like to do the honours. . ..

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20091215/ccsvi_091215/20091215?hub=Health —Preceding unsigned comment added by Cpt ricard (talk • contribs) 05:00, 21 January 2010 (UTC)

Blinded??

2 journalistic articles have been recently added for the second trial (buffalo trial). These kind of articles are not considered reliable sources and they should be taken with great care. Until a peer reviewed article is published I would not enter to say any specific numbers or I would say something like "in a press release on the preliminary results of the trial...". I will also eliminate it from the lead until further confirmation.

Additionally one of the two is most probably incorrect (and it is an indication on why press releases are not considered reliable): how can the investigation described be double-blinded? Double blinded is normally used in clinical trials and means that nor the patient nor the physician knows if the patient is having medication or placebo. In this case where they are searching for differences between patients and healthy controls double-blindness is impossible and single-blindness is almost impossible. A diagnosed patient will always know that he has MS. In most cases the phsysician even if not told about the diagnosis will also know if he is dealing with a patient (unless he is completely asymptomatic) or a healthy control.

I know that this investigation has raised great interest in patient circles, but we cannot jump to grab the first piece of news that appears in the horizon. Wikipedia is not a news blog or anything similar. Bests.--Garrondo (talk) 13:41, 11 February 2010 (UTC)

I think in this case double blinded means that the radiologist and the person that performs the diagnosis are different and both are unaware of the condition of the patient. Anyway, let's wait for the publication. --Juansempere (talk) 12:11, 12 February 2010 (UTC)

In that case it would simply be "single-blinded" or "blinded", but never "double blinded"... but as you say there will not be any doubts when it is really published--Garrondo (talk) 20:07, 12 February 2010 (UTC)

Garrondo says. "In this case where they are searching for differences between patients and healthy controls double-blindness is impossible and single-blindness is almost impossible." Now I'm buffled. This article on WP reports the words of Lily Jung: "We would welcome some randomized, controlled, double-blinded studies to look at the issue." This basically means that we are reporting criticism that asks for an admittedly impossible task. Should we determine that - in this instance - Lily Jung is an unreliable source? Or should we determine that one of the press releases is not unreliable in claiming that it has been achieved? You cannot have it both ways. It is the same claim. Decide, it is impossible, or it is possible. We either eliminate both or we keep both, at least based on this ground [that double-blinded tests are (im)possible]. Additionally, to my knowledge the investigation conducted by Zamboni and Salvi in connection with MS was single-blinded, i.e. when looking for his/her veins Zamboni didn't know about the situation of the patient. In fact this is precisely why in the aftermath Salvi decided to put his career on the line, because Zamboni kept up guessing it right 100% of the time (either way). Of course you can argue that in some cases the situation of the patient could surface, somehow, by Zamboni looking at some symptoms. First of all, this hypothesis is a potential systematic error in any similar situation, that should be regarded as such, as a bias that isn't enough to completely disregard one's finding. Secondly, I'm not sure about this but I'm quite confident Salvi wasn't sending MS-free patients who didn't have symptoms of other pathologies, i.e. I doubt the controls were asymptomatic (I rather think they were also Salvi's patients, but without MS). --Gibbzmann (talk) 11:30, 16 February 2010 (UTC)

First of all: be calm. Second of all you are mixing to 2 different articles. We have 2 Zamboni articles: in one of them they look for differences between patients and controls in venous flow and therefore it is not a trial since no treatment is investigated. This one is the one that is being replicated at Canada. A press note of the Canada investigation said that it was double blinded, while only clinical trials can be double blinded. Most problably this study is (or at least should be) single blinded, i.e. the investigator is not told the condition of the subject (either patient or control) when doing his evaluation on venous flow. We have a second article: an study of the effect of a treatment. When Jung asks for double-blinded studies she is talking about the treatment study. She is asking for an investigation where the patient does not know if he is treated or simply receives a placebo operation and where the evaluator who later studies the effects of treatment does not know it either. Nevertheless a press release is not considered a reliable source, so we should wait for at least to the published results; while on the other hand the Jung reference is the closest thing we have to a secondary source since it reviews all the primary sources we have at the moment.Bests.--Garrondo (talk) 11:56, 16 February 2010 (UTC)

I'm very calm, I'm very sorry if I appeared not to be so. I'm firm and dry when I write, but no attack is intended. Thanks for the explanation. I'm residually dubious about the placebo operation. Maybe it is my ignorance in this field of research, so I excluded Jung could have been referring to such a work hypothesis, but I trust your interpretation. Is it standard practice to sedate (albeit locally) and enter into a vein in control patients? The stent pocedure also involves pain in the aftermath. Is it likely no patient would notice he is perfectly fine after the placebo operation? But I'm digressing. By the way, still on the "Critics" Section, I think the phrase "the greatest independent MS patient organisation in Germany" should go away, both because it is unsourced and because WP doesn't endorse absolutes of primacy or ... ultimacy. E.g., on Michael Jordan: His biography on the National Basketball Association (NBA) website states, "By acclamation, Michael Jordan is the greatest basketball player of all time." and not altogether Michael Jordan is the greatest basketball player of all time. --Gibbzmann (talk) 13:04, 16 February 2010 (UTC)

Regarding the "greatest" most probably refers to the biggest and it is a translation problem. I am not really sure about how to change it. Regarding the other discusssion: I am neither sure on what was Jung referring with double blinded since as you say it is not so clear in a surgical procedure (it would be completely unethical to perform a surgical procedure and then use placebo), however I am quite sure that she is referring to the treatment article since she later says but before then would not be encouraging our patients to jump in with both feet to do this procedure and the term double-blinded refers "per se" to a treatment study.--Garrondo (talk) 14:54, 16 February 2010 (UTC)

If somehow sourced, I would substitute "greatest" with "largest", or simply "prominent", or otherwise "an independent MS patient organisation" would fit. Regarding Jung, it is probably too generic to guess. It could alternatively mean (roughly) "before doing the surgery routinely, let's be sure patients actually do need one", and this would be consistent with double-blindedness being referred to damage assessment (as you cannot know if surgery works before actually doing surgery, but at least you may know if it makes sense to even attempt). It is not a critique of CCSVI per se, however, but we'll leave it there - as it is - for the time being. --Gibbzmann (talk) 16:10, 16 February 2010 (UTC)

Let's eliminate it as "an independent MS patient organisation": We do not have a source on how big it is (nor is it really relevant).--Garrondo (talk) 16:44, 16 February 2010 (UTC)

Blinding refers to treatment; in this case the treatment of the shunting, etc. would be blinded, so the patient would be told they would be receiving this shunting, go through the anaesthesia, perhaps even the incisions required, but then not go through the anti-stenosing treatment. But they ALL have MS, of course. Thus, randomizing who actually gets it and who doesn't, and with neither the doctors nor the patients knowing who has what, you can double blind a trial (though the doctors will be tougher to blind, but I'm sure people smarter than I are working on it).--Cpt ricard (talk) 22:29, 25 May 2010 (UTC)

Meatpuppeting

[6] WLU (t) (c) Wikipedia's rules:^simple/_complex 21:17, 1 March 2010 (UTC)

DMSG again

The reference to the DMSG, Deutsche Multiple Sklrose Gesselschaft, is problematic. It's a primary source. Is it independent? From what? Organizations form as patient organizations, often, but as they develop, they find sources of funding, often from drug companies, and can end up advocating the interests of drug companies instead of their original constituency. This is not any kind of charge against DMSG directly (maybe someone who can search German sources can tell us more), but such a source does not necessarily stack up well against standard secondary sources, and the Medline article is pretty good and balanced. The headline there is telling: "Endovascular Treatment of Cerebrospinal Venous Insufficiency Safe, May Provide Benefit in MS." Obviously, Dr. Jung was correct, such a claim is overstated, if taken as proven, the study was inadequate for that.

There are two parts to this article: the alleged syndrome and a proposed treatment which proceeds from the hypothesis regarding the syndrome. They are separate, and, to some extent, the article confuses them.

I can say this about DMSG and CCVI: if I had MS, or someone I loved had MS, I'd be very excited about CVVI and the implications. That is far from saying that I'd jump for invasive surgery, and caution is exactly appropriate. But having MS is no fun, either, and one would think that information about CCVI and the research going on with respect to it would be prominent on the DMSG home page. The link from the article does not go to a specific page about CCVI, it seems that it might be pointing to a video, but I can't see a translation of that. I was unable to find a page on the DMSG site that justifies the claim in the article. Accordingly, I'll be removing it.

However, I did find on the site a forum post that led me to this: Stanford University Halts CCSVI Treatments After Two Serious Incidents. Cause for concern, of course. There is CCSVI, Stanford University, University of Buffalo and University of British Columbia ( http://www.examiner.com/x-32750-Lima-Multiple-Sclerosis-Examiner~y2010m1d6-CCSVI-Stanford-University-and-the-University-of-Buffalo ), as well, about that Stanford report and more.

The examiner.com site is not considered reliable source, because of allegedly inadequate editorial review, if there is any at all, and it has been, for that reason, blacklisted, so use of this as a source for the article would be problematic and require special consideration. --Abd (talk) 23:45, 10 March 2010 (UTC)

It's very important to distinguish between the syndrome hypothesis and any attempted treatment. The problem at Stanford has to do with treatment only.

There is a very clear report from the National Multiple Sclerosis Society, dated Feb. 9, 2010. This is also a primary source, but should give a more complete view of a patient advocacy group on CCVI. --Abd (talk) 23:13, 10 March 2010 (UTC)

It does not add any new information to what is already in the article, and as you say is a primary article. I would not add it. The first review on CCSVI has just been publised and it has already been added to the MS article. As soon as I can I will summarize it here; although it is quite negative.--Garrondo (talk) 08:46, 11 March 2010 (UTC)

The important point here is that CCVI as an alleged syndrome is quite distinct from treatment. The proposed treatments (there is more than one) could be dangerous, useless, etc., and that would not indicate that the syndrome does not exist. Criticism of the treatment is not criticism of the syndrome, and it's also possible that a treatment would work, but the theoretical basis for the treatment (the syndrome) is in error. --Abd (talk) 15:53, 11 March 2010 (UTC)

Agreed in theory but not in practice: The article we have includes both the syndrome and its treatments since it would not make much sense to have a separate article on the treatment of an already too specific syndrome, therefore critiques to the treatment should be left here. Bests.--Garrondo (talk) 16:10, 11 March 2010 (UTC)

• I don't see a "quite negative" report cited at the MS article. Are you talking about the press release from the Buffalo study? That's not "quite negative." It merely shows what has been suspected: CCSVI may be a contributing factor to MS (or exacerbates MS symptoms) but is not necessarily the only factor. The association between CCSVI and MS is shown to be significant by that study, but much will depend on details which may not have been disclosed. I do agree that the NMSS's notice of this press release is a kind of secondary source, it's notable. It should be used with caution.

• Here is a press release dated yesterday, found from the NMSS news page. It's hardly "negative" in fact it looks highly positive! First Blinded Study of Venous Insufficiency Prevalence in MS Shows Promising Results is the headline. This is about the syndrome. It has nothing directly to do with treatment, though it might imply treatment possibilities if the venous insufficiency is a contributing cause of MS. --Abd (talk) 17:06, 11 March 2010 (UTC)

• I would not propose a separate article, but the way that criticism in placed in the article is mixed-up. Criticism of a treatment is not criticism of the syndrome, so the former should be covered in the section on treatment. There is apparently criticism of the syndrome, but it's mixed up with the treatment. (Obviously, dangerous surgical treatment of a non-existent symdrome would be a bad idea! -- and some sources may thus be critical of both.) --Abd (talk) 16:15, 11 March 2010 (UTC)

I have already added to source I was talking of, and I have reprhased the critiques. Since per WP:MEDRS is the most reliable source we have up to the moment I think we should add quite more from it to the article. Most probably instead of having a critique section we should integrate content from this article to each of the sections treated in it such as diagnosis, sensitivity of the method, treatment...--Garrondo (talk) 16:39, 11 March 2010 (UTC)

• I'll look. Thanks. --Abd (talk) 17:06, 11 March 2010 (UTC)

(unindent)The problem with the critique, which I moved to the section on treatment at this point, is that the Jeffrey article really cites only some statements urging caution and avoiding "premature" conclusions, and I don't read it as a criticism of "methodology." Obviously, preliminary studies are not mature ones! What I see, overall, in the Jeffrey article is strong support, not criticism, but there is the usual caution and balance we'd expect from medical experts. The Khan "Point of view" in the Annals of Neurology is probably important, but from the abstract it seems to be mostly urging standard caution, and is not reporting specific criticism of the diagnosis itself, though it mentions "technological and conceptual shortcomings." The full article probably contains review material of interest. From the abstract alone, it's thin. The Buffalo study may make this report largely obsolete, a technical response making perhaps cogent objections that turn out not to apply. Until we have better secondary sources, we should be parsimonious, without neglecting what's verifiable from reliable source. --Abd (talk) 17:30, 11 March 2010 (UTC)

I have the full article and the Khan article does have methodological critiques. Please do not remove again the section since it is a good summary of Khans article.--Garrondo (talk) 19:07, 11 March 2010 (UTC)

It actually criticizes CCSVI entity itself, diagnosis, relationship with MS, and methodology of Zamboni's all articles. What we should do is add specific critiques to each section, but for the moment this is better than saying that problems are limited to only treatment.--Garrondo (talk) 19:12, 11 March 2010 (UTC)

But, of course, we don't say that, see the lede. It's just that criticism based on the allegedly improper identification of the syndrome itself and criticism based on alleged hazards or ineffectiveness of treatment are quite distinct, even though they may be mixed in a single critique. It seems that the evidence for a syndrome is now strong, but, obviously, the jury is still out as to consensus in the field. The significance as a cause of MS is as yet not established, it's simply been associated with a blinded study with significant numbers of participants, making earlier criticism ("caution," really) somewhat obsolete. I'll know more when I see the full article. Is it available on-line? I can't afford to pay for it. The criticism in the Jeffrey article is only the standard "preliminary result" criticism, but from what you've said, the Khan article goes deeper? I'd have added criticism to the syndrome section, but without the detail of that article, it would be way too thin. Are there other sources? General criticism, by the way, should not be implied from a single source. Are there other reliable sources with methodological criticism as to identification of the syndrome? --Abd (talk) 19:47, 11 March 2010 (UTC)

Multiple Sclerosis Resource Center (UK) has a page with news on this, with citations of articles published in sources meeting RS for news. (News reports should not be assumed to represent scientific fact, but rather notable events and information.) I found this there. It's a kind of reliable source (a medical expert column for a major media outlet) on the controversy. And it is quite cautious, underscoring the reasons for caution at the same time as it points out the positive aspects. Nothing will be conclusive on the science until there are more studies and peer-reviewed secondary sources covering them. --Abd (talk) 20:19, 11 March 2010 (UTC)

By the way, Garrondo, the move to a separate Criticism section was just fine. It can sit there for now. Thanks. --Abd (talk) 20:21, 11 March 2010 (UTC)

Both sources seem interesting. We could integrate the news of adverse effects, since as you say it is only a piece of news. Regarding the other source I believe that the khan article might be a better source. Right now I do not have much time, but if interested I could try to send you the pdf article, so you can read it.--Garrondo (talk) 08:19, 12 March 2010 (UTC)

POV

I have concerns regarding POV. A hypothesis / association is presented as fact. The first two sentences need to be rephrased in a less optimistic manner. The references are mainly to primary research rather than reviews so we need to keep this tentative. Doc James (talk · contribs · email) 17:51, 11 March 2010 (UTC)

• Thanks for looking, Doc. I agree; I'm going to edit that first paragraph to make it more neutral according to the issue you point out, and remove the POV tag. Before replacing it, I'd urge you to review the edit, and if it could be done better, please fix it instead of just tagging the article again. To be clear, at this point CCVSI is a hypothesis, on which work is actively being done. I see no sign that the diagnosis is broadly accepted, but it's certainly raising wide notice, with the National Multiple Sclerosis Society pushing strongly and promising funding for studies.

• However, if you believe that the lead is still not neutral, and you don't have time to fix it yourself, feel free to replace the tag, I'm only removing it for anticipated efficiency. --Abd (talk) 18:13, 11 March 2010 (UTC)

Yes usually I would just fix these things. But I realize that this is a controversial topic so wanted to post here first to get a consensus before making changes. If you could make the above changes would appreciate it.Doc James (talk · contribs · email) 18:16, 11 March 2010 (UTC)

Done. I hope it satisfies your concerns. Thanks. --Abd (talk) 18:22, 11 March 2010 (UTC)

Integration of MS section into the article

Almost all sources talk about CCSVI AND multiple sclerosis. In fact as far as I know there is no source talking about CCSVI on its own (With the possible exception of PMID 20087280, which I can not access. This has its counterpart in our article, with only a few lines on CCSVI on its own and a huge subsection on MS and CCSVI which covers diagnosis, treatment, further research... In accordance to the sources we have I think a reorganization of the article integrating different aspects of the relationship between MS and CCSVI in its specifics subsections, instead of having a subsection of its own bigger than all the other sections of the article, would be a really good idea. Additionally we know have a reliable secondary source integration all info on the different aspects of this relationship together with some possible problems on the CCSVI theory. This source could be used to back up both this integration of content with possible flaws that have been pointed out in each subsection. Comments?--Garrondo (talk) 21:26, 17 March 2010 (UTC)

Since nobody commented I was bold and went ahead. I left most info but reorganized it to be more in accordance with both sources and WP:MEDMOS. As exceptions to MEDMOS layout I moved history to the beginning of the article and left a "reception" section at the end of the article. I believe that in the history section a brief summary of the articles from Zamboni would be of use to the reader to understand how have we ended here (in a similar way to what is done in the secondary source we have or the medscape article). Bests.--Garrondo (talk) 18:03, 18 March 2010 (UTC)

I just have one remark. I just can't quite follow the logic of a paragraph saying that the theory has been found not credible by those who have found it not credible. I'll try to make a small change. --Gibbzmann (talk) 01:50, 19 March 2010 (UTC)

It probably was an integration mistake. It sounds fine right now. Thanks.--Garrondo (talk) 17:09, 19 March 2010 (UTC)

Critics to the methodology

I have added the "citation requested" tag to the paragraph that says that the neurological community has critizised Zamboni methodology. I have read a lot of critics, but I have found no article that critizises the methodology of Zamboni while stablish the existance of CCSVI (special kind of venous reflux in veins)

This article is supposed to be about CCSVI, not about surgical treatment of MS.

Maybe is not such a good idea to mix the existence of CCSVI, whith its relevance to MS and with the possible utility of surgery. This kind of sentences can be misread outside their appropiate context.

If we keep all the information together, at least we should specify the precise meaning of sentences of this kind.--Juansempere (talk) 18:40, 23 March 2010 (UTC)

I'm also not that comfortable with statements such as "the neurology community" (as a whole), unless you can show that most relevant associations of experts issued collective and agreed-upon statements to that effect. --Gibbzmann (talk) 14:24, 23 March 2010 (UTC)

Diagnostic criteria

We have a new publication on diagnostic criteria. I can not acces the full text but they talk about 4 diagnostic criteria and two needed for diagnosis in the abstract, while we have in the article that 2 out of 5 are needed. Where does this discrepancy come from? Have the criteria changed? Can anybody access de full article? Bests.--Garrondo (talk) 19:10, 3 May 2010 (UTC)

I have not access either. I don't know if that is the issue, but I might try to hypothesize the following. If you need 2 positive responses out of 5 criteria, and you have access only to 4 of those criteria, then 2 out of 4 certainly implies 2 out of 5 (in a sense, you don't need the 5th criterion if you already found 2 out of 4). In other words, with the 5th criteria they could only find more evidence of correlation, in theory, certainly not less. But I don't know why they used 4 criteria in the first place. --Gibbzmann (talk) 11:24, 11 May 2010 (UTC)

Indirect confirmation of what I was saying in their sentence: "Additional transcranial investigations may increase the rate of patients found positive in our survey." --Gibbzmann (talk) 11:26, 11 May 2010 (UTC)

Treatment section

Present text, "Some US hospital has banned the surgical procedure outside of clinical trials until more evidence to support its use is available", seems odd given that the cited ref specifically says "halted at Stanford" in its title. Can someone with full text access to that ref please verify that was the intent? Thanks, LeadSongDog come howl 20:29, 4 May 2010 (UTC)

It discusses Standford and than mentions other hospital that have pulled it."But in the U.S., hospitals are beginning to ban the procedures for MS patients until more research is done," from the Globe and Mail Doc James (talk · contribs · email) 15:33, 19 May 2010 (UTC)

Blinding

I am an idiot: I decided to edit an archive instead of writing on here. Long day. Anyways, here's the addition: Blinding refers to treatment; in this case the treatment of the shunting, etc. would be blinded, so the patient would be told they would be receiving this shunting, go through the anaesthesia, perhaps even the incisions required, but then not go through the anti-stenosing treatment. But they ALL have MS, of course. Thus, randomizing who actually gets it and who doesn't, and with neither the doctors nor the patients knowing who has what, you can double blind a trial (though the doctors will be tougher to blind, but I'm sure people smarter than I are working on it).--Cpt ricard (talk) 22:32, 25 May 2010 (UTC)

With arthroscopy surgery for osteoarthritis they even made incisions in the skin but did not insert any instruments into the joint. The conclusion was that the nearly half million of these procedures we do a year does not improve outcomes.Doc James (talk · contribs · email) 22:36, 25 May 2010 (UTC)

That would make a lot of sense, if it's implemented worldwide tomorrow for all non-emergency standard surgical procedures. --Gibbzmann (talk) 13:47, 26 May 2010 (UTC)

Theory

This ref refers to CCSVI as a theory "There is no doubt that their work though preliminary, have raised many questions regarding the cause of MS, and how it may be treated based on the theory of CCSVI." [7] Doc James (talk · contribs · email) 14:22, 26 May 2010 (UTC)

I read the archeive and it mention that "The International Union of Phlebology has agreed to accept CCSVI as a syndrome of its own". If one looks at the names on this publication one will find Zamboni listed. The majority of the scientific community consider this a theory as per the ref above.Doc James (talk · contribs · email) 14:48, 26 May 2010 (UTC)

I think here we have an issue of ambiguity of language. CCSVI is a syndrome. It may be everywhere in us, but it is still deemed a syndrome, also formally recognized as such (by at least one medical organization). On the other hand, since it's been introduced at the same time as being proposed to be linked to MS, one may refer to CCSVI as a theory, implictly linking it to the MS-CCSVI hypothesis. This is not uncommon. Gravity is an observed fact. Gravity is also a theory. But if in the literatue one refers to "the theory of gravity", it doesn't mean that if the theory (arguably that of Einstein) is proved false, then we must agree that gravity does not exist and that massive obejects do not fall to the ground (or that planets do not exert attraction on each other). That one writes about "the theory of gravity" does not even mean that "gravity" is not observed. Rather, in the case of CCSVI as linked to MS, I would not oppose that we refer to it as a hypothesis and not as a theory. --Gibbzmann (talk) 14:50, 26 May 2010 (UTC)

Is it recognized by any major organization without Zamboni such as the ICD 10? It does not common up in the ICD10 [8] I agree with the issues surround gravity, but they do not use the term syndrome in physics. I have no problems refering to the link as a hypothesis as you suggest. Doc James (talk · contribs · email) 14:54, 26 May 2010 (UTC)

"The majority of the scientific community consider this a theory". In this particular case, you should find a majority position in the literature arguing that malfunctions in the CS veins of the type described are absent in the human species. What is partly agreed upon is that the hypothesis of a link with MS is not yet established, not that the syndrome is altogether non-existent (although some think so). You should provide refs for the latter. --Gibbzmann (talk) 14:58, 26 May 2010 (UTC)

"I agree with the issues surround gravity, but they do not use the term syndrome in physics." But they do refer to observed facts. I'm merely opinting out the ambiguity. If I refer to something as "the theory of X" it doesn't mean that if my theory is false, then X does not exist and collapses with the theory. If "the theory of gravity" is not there anymore, gravity is there regardless. It only means that what most refer to as "the theory of X" is false. The same goes for your citation. "There is no doubt that their work though preliminary, have raised many questions regarding the cause of MS, and how it may be treated based on the theory of CCSVI." This sentence, in my opinion, though ambiguous, does not in any way mean that CCSVI is not a syndrome, but it means that it is the link with MS that is only theretical. --Gibbzmann (talk) 15:07, 26 May 2010 (UTC)

It is not up to those who do not believe a syndrome exists to prove its none existence. This is like the god issue were those who do not believe are requested to prove gods none existence. Until the WHO's ICD 10 or disease database or another major organization classifies it as a syndrome we should not. I agree theories are not necessarily false but to be classified as a syndrome it has to be recognized as such. Disease database dose not mention it here [9]. Zamboni introduced the idea of CCSVI for the first time during his MS study were he claims to have found it only in people with MS and not in anyone else. It is not used outside the context of MS. Has only been measured using equipment partly developed by Zamboni himself.Doc James (talk · contribs · email) 15:09, 26 May 2010 (UTC)

Similarly to what it occurs in this talk page there are some that consider it a syndrome while others only a hypothesis (or theory). Unless we find some statement saying that any such posture is majoritarian both positions should be shown in the article. We surely are capable of finding a compromise to show that even its state as syndrome is still under debate.--Garrondo (talk) 15:25, 26 May 2010 (UTC)

Yes I would be fine with that. We could say that it is not recognized currently by the ICD 10, disease database etc as a syndrome. But is recognized by a organization in which Zamboni is a member.Doc James (talk · contribs · email) 15:28, 26 May 2010 (UTC)

I'll come back to the discussion. I must first and foremost strongly object to the outline of the entry. I've just modified it. Even the primary sources involved, which arguably justify the very existence of this page, never described CCSVI as anything near: "a theory which postulates that the flow of blood in the veins draining the central nervous system (CNS) is compromised thus promoting the development of brain dysfunction, especially multiple sclerosis." It is stated clearly there that CCSVI is proposed as a syndrome, not merely, solely and exclusively as a theory of a MS factor. Its very name cannot be more eloquent about this. If you're unhappy about the "promotion" to syndrome, please just accept a softer definition as mine, "hypothesized" or "postulated" syndrome (although I myself think these adjectives shouldn't even be used). A creative definition of CCSVI, in complete opposition to the primary sources, is in my opinion unacceptable. I must add that this very issue was discussed months ago and there was much agreement on the fact that the distinction between the alleged syndrme and its link with MS should be made as clear as possible. Please see archived discussion and editing history. The ending of the article, where we "used" to have people disagreeing on this on that, wouldn't even make sense anymore. People who think that CCSVI exist but the link is unproven? It would be a meaningless sentence to a WP reader, if the page where to stay as it is now. --Gibbzmann (talk) 15:37, 26 May 2010 (UTC)

Yes, Garrondo, you always prove a sensible person. I've already tried to achieve what you also just said, although my wording could be improved. I don't deem it necessary to explictly state that it's not in ICD 10. We can do better than being bureaucrats. --Gibbzmann (talk) 15:42, 26 May 2010 (UTC)

We do have a review on the topic [10]. My concern is the presenting as fact "CCVSI is a syndrome" when we do not have evidence that this is widely accepted by clinicians. We should use reviews as per WP:MEDRS whenever possible. I am unsure how best to present the fact that this is not in the ICD 10 with out a ref saying so.Doc James (talk · contribs · email) 16:52, 26 May 2010 (UTC)

I would say that the use of words such as postulated, hypotethized, or any similar others is for the moment a good idea, since it is far from mainstream or accepted. Proof is precisely the lack of reviews on the subject or the fact than almost all the articles on the subject have Zamboni as an author. Maybe we could integrate all this discussion with a few lines under reception using Khan and phebology union articles. Maybe something like "while some accept the existing evidence for the existance of CCSVI as an independent syndrome (Phebology) others still think of such consideration as premature (Khan).--Garrondo (talk) 17:25, 26 May 2010 (UTC)

Regarding ICD-10: I am not used to using it since I am no physician, but we have a tangential link in the infobox to I87.2 Venous insufficiency (chronic)(peripheral). We should decide if such link is suitable, and eliminate it if not.--Garrondo (talk) 17:25, 26 May 2010 (UTC)

That is for peripheral venous insufficiency. It turns ones legs purple. Medline has a page on it [11]. BTW there are no valves in the veins above the heart thus blood flows backwards every time you stand on your head.Doc James (talk · contribs · email) 17:31, 26 May 2010 (UTC)

Then, why do we link it? It leads to think that it is included in ICD-10. Should be eliminated... If we can not have an infobox becouse there is no info for it there is no problem with that.--Garrondo (talk) 17:38, 26 May 2010 (UTC)

Yes i agree none of the items in the infobox pertain to this topic but to peripheral venous insufficiency. I would not have a problem with it being removed.Doc James (talk · contribs · email) 17:52, 26 May 2010 (UTC)

Since it seems we are all wikiholic today lets wait to hear Gibbzmann's opinion.--Garrondo (talk) 17:56, 26 May 2010 (UTC)

I don't know. I would start by deleting ICD-9 and DiseasesDB. I would pause for the others. Can "I87. Other specified disorders of veins" or "I87.9 Disorder of vein, unspecified" of ICD-10 apply? Also, what about MeSH? - "general or unspecified but usually of the legs". It is a generic classification, true, but one might argue that it does not ... not apply. I suspend my judgment, but as ICD-10 goes I don't see it as so problematic. I would be in favor of keeping any useful information that is not explicitly false, misleading or not applicable. Going back to the issue. Doctor, is it your opinion that also the azygos vein definitely lacks valve in everybody? Also, my (poor) understanding of veins is that they are immensely variable from one person to another. Do you think that it is nevertheless impossible that someone has a valve where there should be none? I think that this is also the issue. Uh, and of course valves make less sense (just because they are less useful) wherever the natural flow is already from top to bottom. Unless it's the muscles that they need to oppose. BTW, as a side comment I've had a personal experience, whence some preofessionals argued that they already new of similar problems of patients in the same veins. Apparently, some people are saying there's nothing new with this purported syndrome, others that it doesn't exist. :-) --Gibbzmann (talk) 23:20, 26 May 2010 (UTC)

(undent) Yes I guess we can keep the ones that are sufficiently vague. If it says general problem of the veins then if this is confirmed it would be a general problem of the veins. Nothing is technically impossible wrt valves above the heart I have just never heard of them and have been unable to find any evidence to support there existence. I was reading the other week though of a man who had endometriosis.Doc James (talk · contribs · email) 01:21, 27 May 2010 (UTC)

There are valves in the coronary veins [12] but greys says there are non in the cerebral vein [13] But this ref says there are valves above the clavicle some of which are non functional.[14] Doc James (talk · contribs · email) 01:24, 27 May 2010 (UTC)

Revert of first description

I have reverted the inclusion of an 1977 article as first description. They do not coin it CCSVI so we can not decide that it was the first description of the syndrome. At most we could add it to the history section as an antecedent to the theory of Zamboni, and this could only be done if we found a reference stating that it actually was an antecedent. Otherwise is simply original research: we deciding that both descriptions are the same. Bests.--Garrondo (talk) 13:43, 4 June 2010 (UTC)

This is the first reference I have found about "flow of blood in the veins draining the central nervous system" (the definition of CCSVI in this article). To be self-consistent the article has to admit it as the first report of CCSVI, or else the definition should be changed.

Besides, not to mention previous reports in this sense gives the impression that blood reflux had never been reported to be a potential problem before, which is not true.--Juansempere (talk) 15:59, 4 June 2010 (UTC)

We would need a secondary source that mades this statement.Doc James (talk · contribs · email) 15:57, 4 June 2010 (UTC)

No secondary source is needed in this case. The sentence does not say if the report was true or wrong. Only says that it had been reported previously and the report is enough to confirm this.--Juansempere (talk) 15:59, 4 June 2010 (UTC)

Did it refer to it as CCSVI? Doc James (talk · contribs · email) 16:00, 4 June 2010 (UTC)

My point is that the article has to be consistent with itself. If CCSVI is defined as "flow of blood in the veins draining the central nervous system" (the definition of CCSVI in this article) then anyone reporting this problem should be mentioned. At least in the history section. Of course other possibility would be to change the definition to restrict the meaning.--Juansempere (talk) 16:16, 4 June 2010 (UTC)

I disagree completely: The article is on the CCSVI syndrome. CCSVI was described recently and has a specific set of diagnostic criteria which have to be met, and which are measured using an specific 2010 technology. Anything which does use the term CCSVI, and/or which does not meet criteria, and/or which is not related by reliable sources directly to CCSVI as a diagnosis precceeding the description of the syndrome can not be related to CCSVI. We are not the ones to decide that that 1972 description is related to the CCSVI syndrome. Can be similar, or completely different, but that is for others to decide.Bests.--Garrondo (talk) 17:15, 4 June 2010 (UTC)

You don't disagree with your sentence. You are stating that CCSVI is described as "a specific set of diagnostic criteria which have to be met". Then you should change the definition of the article by this definition you consider correct, and state that vein reflux is not enough to diagnosize CCSVI. As it is written now it seems the opposite.--Juansempere (talk) 23:16, 4 June 2010 (UTC)

Nope: we have a whole section on diagnosis that gives 5 criteria for something to be considered CCSVI. The lead simply gives the main characteristic but does not define the disease. Nevertheless is is quite simple: do we have any reference linking the proposed study and CCSVI? A-No: Then we can not say they are related; otherwise it is OR. B-Yes: include it.--Garrondo (talk) 00:34, 5 June 2010 (UTC)

I agree with G above. Unless they in the paper call it CCSVI we cannot make the assumption that it was.Doc James (talk · contribs · email) 03:58, 5 June 2010 (UTC)

Bad reference

Somebody claims that the equipment used by Zamboni has been developed by himself, and gives as reference:

Murray, Terry (5 May 2010). "Zamboni's MS theory on thin ice". The Medical Post

I have been unable to find it with google, and as far as I know, Zamboni was using equipments from the brand "Esaote". I think the assertion is wrong. Please check it.--Juansempere (talk) 13:42, 4 June 2010 (UTC)

Agreed. It sounds very strange... Most probably an error in reference, although I do not have knowledge enough to judge.--Garrondo (talk) 13:51, 4 June 2010 (UTC)

No that is in fact what the reference says. I was the one who added it. This is partly why his theory is being questioned. Unfortunately the Medical Post requires payment. If people wish a copy let me know.--Doc James (talk · contribs · email) 14:02, 4 June 2010 (UTC)

I really would like to see it. Not that I doubt of you, but sometimes reporters get their information wrong, and this report contradicts other information I have. How would you sent me the article?--Juansempere (talk) 20:10, 6 June 2010 (UTC)

Sure if you could email me your email address. You have reports that the technique used by Zamboni was used by others and is well validated? This would be a good reference.--Doc James (talk · contribs · email) 16:04, 4 June 2010 (UTC)

Here there is a statement of the hilarescere foundation saying that Esaote provided the equipments: [15]Here is the esaote web page claiming to be developing diagnosis equipment since the 80's [16]This doesn't prove that Zamboni is not affiliated in some way with them, but I suppose that he would be required to do a disclaimer if he were a shareholder or employee of ESAOTE.--Juansempere (talk) 16:26, 4 June 2010 (UTC)

Wow these press releases are a little over the top. The medical post does in depend medical journalism. Well I would not use it for confirming or refuting a disease it does deal with controversies in medicine which do not go in the clinical literature. We do not follow WP:MEDRS for social / cultural stuff. I agree we should attribute it to Dr. Zivadinov though.Doc James (talk · contribs · email) 16:37, 4 June 2010 (UTC)

I am not claiming that I can prove beyond doubt that this man was not involved in developing Doppler equipment. I only show you what I said. That the information you gave contradicts the one I have.

Is it really relevant for the article wether Zamboni developed its own equipment? It does not give more or less credibility to his theory. If we are not capable of finding something definitive that states if it used or not its own equipment we have two possibilities: 1-Eliminate the line on him developing the machines 2-Showing that ones say he developed his equipment and others the opposite. I would rather eliminate the whole sentence since it does not really add much.--Garrondo (talk) 17:14, 4 June 2010 (UTC)

(undent) I think this is an important point. The press releases tries to make it appear that the medical community agrees with CCSVI. This is in fact not true. The fact that it is diagnosed using equipment partly developed by this gentleman is of further concern and thus relevant here.Doc James (talk · contribs · email) 21:50, 4 June 2010 (UTC)

I agree. Is an important point, and therefore it shouldn't be supported by a document that is a press release. At least it should be double checked. I have just sent you my email. Please forward me the document and I will take a look. Thanks--Juansempere (talk) 19:49, 6 June 2010 (UTC)

Please correct me if I am wrong, but this is an article from a newspaper, not from a peer reviewed medical journal. The author of the article says "Diagnostics [...] MAY require a proprietary machine in which Dr. Zamboni WAS SAID to have a commercial interest" (Was said? By whom? No reference is given nor the author assumes responsibility). The only sentence that could have relevance comes from Zivanidov that says "“The deep cerebral structures are very difficult to determine if not (performed) with some specific technology that Dr. Zamboni actually developed and is now commercializing". Is is not clear what technology he refers to, but for sure, he doesn't refer to extracranial doppler. If you don't mind, I will remove your assertion --Juansempere (talk) 09:57, 7 June 2010 (UTC).

Your final conclusion above is however what we say in the article.Doc James (talk · contribs · email) 12:36, 7 June 2010 (UTC)

My final conclusion is not what you say in the article. It is not said anywhere that they used the equipment developed by Zamboni during the tests. In fact they didn't. Anyway even if I liked your sentence, the reference is not good enough. Have you changed your quality criteria now? If that is valid, I have a lot of press releases that I can post.--Juansempere (talk) 21:12, 10 June 2010 (UTC)

CCSVI as consequence of truncular malformations

Here is a review by a team independent from Zamboni, that says that truncular venous malformations can produce CCSVI. [17]. It has been published in International Angiology, 95 Vol. 29, No. 2. If nobody disagrees, I will include the reference to the truncular venous malformations.--Juansempere (talk) 21:10, 10 June 2010 (UTC)

No problem with me. I could only take a fast look at the document, but it is a review in a peer-review journal so I believe it is a good reference. Bests.--Garrondo (talk) 08:06, 13 June 2010 (UTC)

Addition sourced to dutch press release

There has been an addition, elimination, and re-installation of some lines sourced to a document in dutch. Content is sourced although to a press primary source similarly to the press release from the Buffalo trial. An additional complication is that it is in dutch. I have asked the author for a better source if there is one and to another wikipedian who speaks dutch to confirm claims made with the source. Nevertheless none of these reasons are enough to eliminate content right now (As already said there is a precedent in the article with the Buffalo press release, and the fact that it is in dutch is not enough to eliminate a source per se). It certanly does not look as OR if the content follows the source (which I can not say right now since I do not know dutch). Lets wait some time to see if somebody answers. Bests.--Garrondo (talk) 22:55, 18 June 2010 (UTC)

I have been bold, assumed to texts follows source, clarified that it has been a press release and combined it with the buffalo press release since both are press releases not yet publised on a scientific journal on replications of Zamboni's first article. Bests.--Garrondo (talk) 23:04, 18 June 2010 (UTC)

Using google translation I have eliminated some OR from the text. Right now I think it closely follows the source as required when using primary sources.--Garrondo (talk) 23:15, 18 June 2010 (UTC)

New York Times

Here is an article in the NYTs [18] Doc James (talk · contribs · email) 17:48, 29 June 2010 (UTC)

Hi Doc James. As it can be seen from your posts you don't really trust in the MS/CCSVI theory. Maybe this is not the place to ask questions, but I have been trying to find arguments to refute it, and I have found none. Could you tell me why you consider impossible that MS lesions are caused by blood reflux? Is there any feature of the lessions that contradicts this explanation? I have a decision to make about a relative and I would like to know any point of view. --Juansempere (talk) 16:59, 22 July 2010 (UTC)

By policy, WP does not give medical advice. Even if we did, there simply has not been sufficient high-quality research yet done to test Zamboni's theory. We have small studies that are not even double blind, let alone blinded randomized controlled trials. The genetic studies, if they hold up under review, suggest but don't prove a genetic connection between MS and CCSVI. This may mean they both arise independently from the same genes or that MS causes CCSVI or that CCSVI causes MS. We simply don't yet know. Evidence based medicine avoids untested logical leaps wherever possible. LeadSongDog come howl! 16:33, 23 July 2010 (UTC)

The burden of proof is on those who have put forth this theory not on those who are at this point unconvinced. I do not consider it impossible but we do not yet have proper studies looking at hard endpoints, the few studies there are have contradictory results, there has been insufficient verification by third party investigators, the pathophysiology / mechanism of function is not convincing. Finally this idea has been put forth via TV more than in the medical press. The references are in the article to support these statements.Doc James (talk · contribs · email) 17:53, 23 July 2010 (UTC)

Thanks for your response- I agree that the burden of proof is on the proposers side, but as you can see in my question I was not complaining about anything. My question was just if you can give me your personal reason to doubt the MS-CCSVI connection. The reason is just because I want to know any other point of view and I cannot find supporters of the "other side" to speak with in forums. Could you tell me more about why "pathophysiology / mechanism of function" is not convincing?. Thanks again.--Juansempere (talk) 19:20, 25 July 2010 (UTC)

Minor update "Reception" - how many experts

This issue was discussed extensively in a previous thread and the agreement took a lot of time, before editing what had been for a while the final version. The agreement was that many experts doubt the efficacy of the cure, some doubt that CCSVI it has to do with MS, a few even question the very existence of the malfomrations. It was decided to put it into a form more or less like: most experts disagree on at least one (if not more) of the claims made by the ccsvi and ccsvi-ms proponenets. In time, the pharse became something sounding like "most experts concurrently disagreee on all three claims". This is not supported, moreover it flattens the response (which is not) as a uniform response on all three issues; so I changed "most" to "some" as the most economic change to the new phrasing. --Gibbzmann (talk) 10:26, 30 June 2010 (UTC)

PMID 20398855 says in the first lines: "Recent reports of a possible link between venous abnormalities and multiple sclerosis have been associated with high levels of media hype. Many experts caution against premature promotion of the hypothesis and call for objectivity and scepticism in follow-up studies". I have reviewed the other sources in the article and none of them say that "some" doubt. Do we have a source saying what you propose? I'll wait for your answer until reverting since it is not crucial, but sources for the moment say "many". Bests.--Garrondo (talk) 11:43, 30 June 2010 (UTC)

Are we really to go over and over N times on the same issues? We've been through this before. The "many" (which is sintactically closer to "some" than to "most") this one refers to is for those who "caution against premature promotion of the hypothesis" of "a possible link between venous abnormalities and multiple sclerosis". The "many", which is not "most" as it said before anyway, thus refers to those questioning the solidity of the CCSVI-MS link. Then there are those who even question the very existence of CCSVI, which you should prove are "most" (or "many") experts. In fact on a logical scale, we could infer the following rough size of groups: (1) the largest group, those arguing operating is premature; (2) those arguing CCSVI, even if it really existed, is unlikely to be related to MS; (3) arguably the smaller group of the three, those who consider it unquastionable that there's no such a thing as CCSVI malformations, and everybody who manages to be alive must have proper veins in the upper body. We had solved this issue in style, by just saying that "most" experts question the solidity of either "some" or "all" of the three statements (a-b-c). I just don't get why from time to time we must modify good, clear and neutral statements with ones that are either more extreme or less well supported, if not both. What's the urge? As the sentence was now, it implied that "most" experts "at the same time" question the tenability of ALL three counts (that CCSVI exists, that it's realted to MS, that it's OK to do the surgery). Do you at least agree that we are talking of three different issues? You cannot just take the "most" referring to one of the three and freely apply it to all three. --Gibbzmann (talk) 13:51, 30 June 2010 (UTC)

There are far more shadings of this than Gibbzmann lists above. Some will simply doubt that the science is sufficiently mature to legally or ethically justify off-label clinical action given the well known risks that accompany venous stents. Virtually all will doubt if it is sufficiently mature to persuade insurers to pay for the procedure. Some will believe that it exists and causes some but not all cases of MS. Some will believe the malformations exist and that they cause MS, but suspect that the intervention has only placebo effect in reversing MS. I could go on, but what's the point? The reason for doing the studies is to reduce the scope of our collective ignorance. We just have to wait until they are done, published, and reviewed.LeadSongDog come howl! 16:36, 30 June 2010 (UTC)

I do not agree on anything since it is not relevant that I agree or disagree: Do we have a source that says that experts differ on they degree of doubts on those 3 issues?: I do not think so. Do we have proof that the mere existence of CCSVI is more agreed than its relation with CCSVI? I also do not think so since right now the CCSVI theory mainly exists in relationship with MS (We still have only one source which does not mention MS in its title or abstrac). What we have is a source that states that CCSVI in relationship with MS (Anything else would be difficult since almost nobody talks about CCSVI independently of MS) is disagreed by MANY experts. We cannot talk on anything different at this point (whether if experts agree or disagree on the existence of CCSVI) since we have no sources for it. Bests.--Garrondo (talk) 20:52, 30 June 2010 (UTC)

"We cannot talk on anything different at this point". Then why just don't you cut it all out, any reference to people having any idea on the issues of freely going to the operating room and to to people doubting the very existence of CCSVI? Why do we have to have statements that you yourself are claiming are unsupported? Just stick to CCSVI-MS, and throw out all the rest. We don't need point a, b, c and all stuff. Next, I still want to see the source for "most" experts. --Gibbzmann (talk) —Preceding undated comment added 01:54, 1 July 2010 (UTC).

I am sorry, but probably due to me not being English, and maybe also to you writing in a rush due to tension I have not understood what you propose in your last post. On the other hand I am going to try to breath and everybody else should do the same: I believe that the article is quite balanced now and I have already said at the begining of this post that I was not going to change anything until consensus was formed since it is probably a minor issue, so there is no need for us to stress :-).--Garrondo (talk) 07:26, 1 July 2010 (UTC)

Ha! Sorry mate, I'm just passionate in general, whether I'm calm or not, but I assure you there's no stress involved on my part, nor intention to cause any. I made another change which I wish also clarifies what I was talking about. I just get toned down when I feel we are wasting some of our efforts talking it over again, in spite of it having been already discussed at length before. I guess that's common here, anyway.

LeadSongDog I think is somewhat right in that if you also hear what people are saying, his portrait of the situation and of its complexity is quite correct. This has not do to with what is sourced or written on solid paper, of course, but it does have to do with us wikipedians understanding that there are several matters involved, and thus we should not extrapolate the contingent to the general. In this sense LeadSongDog was giving advice, I guess, not claiming his statements should be written down. For example, the inistence on the complete identification of CCSVI alone with the CCSVI-MS paradigm, that you also make, is a reflection of one point of view, which could be true or logical to some extent, but which is an arbitrary extrapolation of what has been written. The articles that talk about it, despite the fact that they go on to propose the link, do explitly say that CCSVI, to them, might be a condition of its own right. Again, you might even encounter an angiologist claiming he always knew some people had similar problems to those veins so "what's the issue". It is not so self-evident then, what is being described here. --Gibbzmann (talk) 11:35, 1 July 2010 (UTC)

I still think that some references would be needed, but I do not think the matter is worth this discussion, and additionally the "number of experts" although a bit "weasel" satisfies me. Let's leave for the moment as it is.--Garrondo (talk) 13:42, 1 July 2010 (UTC)

References are not substitutes for the functioning mind. --Gibbzmann (talk) 19:47, 1 July 2010 (UTC)

Unbalanced article

I just came across this article today...this is very big news in Canada due to the SK premier funding this treatment, and a lot of people will be coming here for more information. Right now the article appears to be very unbalanced - it gives the strong impression that this is a plausible theory, when the opposite is in fact the case. I find it slightly strange that you guys are arguing over such a minor point (in the section above) when the entire article has such a unbalanced POV!

The lede is the worst - it doesn't mention any of the problems with the theory or the criticism by scientists. Also, there doesn't appear to be any mention of the death(s) and serious consequences suffered by some patients who have had this treatment.

The best reference we have at the moment appears to be the lancet article. Looking through google scholar and pubmed I found practically nothing that wasn't written by Zamboni - the Lancet article seems to be the only reference that comes anywhere close to an independent review (yes, it's only a commentary, and not normally considered WP:MEDRS, but it seems to be the best we've got). I think we should be taking more info from this Lancet commentary to balance out the article. --sciencewatcher (talk) 01:45, 5 August 2010 (UTC)

I agree completely. Editors keep removing the balance and it takes continuous work to re add it. If one looks back at the edit history it was a couple of WP:SPA who made the changes. Doc James (talk · contribs · email) 03:57, 5 August 2010 (UTC)

Note apparently two failed replications [19] and a blog posting by Steve Novella [20]. Looks like both studies are in the article, but the page very much seems to be suggesting potential treatments and benefits before the results have been meaningfully replicated. WLU (t) (c) Wikipedia's rules:^simple/_complex 07:55, 5 August 2010 (UTC)

Yes, the German study was already there, but the Swedish one wasn't - I added it. I've also made quite a few changes to the article and I think it is more balanced now - it doesn't read like a Zamboni fan page any more. --sciencewatcher (talk) 15:55, 5 August 2010 (UTC)

Definitely a great improvement.Doc James (talk · contribs · email) 16:39, 5 August 2010 (UTC)

I have removed some of the changes: in summary I have eliminated all mention on the number of subjects in the different studies and their nationality (meaningless to mean reader and discouraged in MEDMOS), I have eliminated the title of the subsection "dangers" (sounds too much as medical advice, is PoV, and stillistically is unneded for a single paragraph section and single paragraph subsection), and I have moved the comments on the replications from the history to the diagnosis section, since all of them are specifically on the MS and CCSVI, leaving a single line with the references in the history section. Bests.--Garrondo (talk) 18:34, 8 August 2010 (UTC)

I added the 'dangers' title specifically to draw attention to it. I'm not aware of any problems with having a single paragraph in a section, and if anything it could be expanded. I don't think it is POV to draw attention to the fact that two people have had serious consequences (and one died) from an unproven, dubious treatment. In fact if you read the Lancet commentary they have quite a long section right at the start of the article about the dangers. I think it is correct WP:Weight to mention this, and not POV. --sciencewatcher (talk) 19:47, 8 August 2010 (UTC)

How about using side effects? Doc James (talk · contribs · email) 19:49, 8 August 2010 (UTC)

While I still disagree that a subsection is needed for a single paragraph I would say that the correct terminology is "adverse events". Nevertheless we do not have to draw attention to anything since we do not give medical advise. Readers are capable enough of reading two consecutive paragraphs and still recognise that the seconds explains that there are potential adverse events in surgery without using a subsection heading.--Garrondo (talk) 11:03, 9 August 2010 (UTC)

Reference to broken DOI

A reference was recently added to this article using the Cite DOI template. The citation bot tried to expand the citation, but could not access the specified DOI. Please check that the DOI doi:10.1002/ana.22132 has been correctly entered. If the DOI is correct, it is possible that it has not yet been entered into the CrossRef database. Please complete the reference by hand here. The script that left this message was unable to track down the user who added the citation; it may be prudent to alert them to this message. Thanks, Citation bot 2 (talk) 15:44, 5 August 2010 (UTC)

fixed - I had to edit it manually. --sciencewatcher (talk) 15:53, 5 August 2010 (UTC)

Are press releases valid as references?

This article contains several press releases supporting assertions. If they are not removed in a reasonable time, and no reason is given for a special consideration, I will assume that press releases are good enough for this article and I will add the Buffalo data to the article. --Juansempere (talk) 21:59, 19 August 2010 (UTC)

No, press releases are not valid references for medical information - see WP:MEDRS. They are only valid for non-medical info (e.g. people's opinions, whether Canada is going to fund research, etc.) If there is any medical info being supported by a press release, it probably needs to be changed to a proper journal reference or removed. --sciencewatcher (talk) 22:15, 19 August 2010 (UTC)

Perfect. Therefore if nobody else objects I will remove all the assertions based on press releases in a couple of days. Some of them even contradict real publications.--Juansempere (talk) 07:09, 20 August 2010 (UTC)

I completely disagree: Press releases are only used in the research directions section to say that a giving university or center are conducting research which has not been finished yet (e.g: Buffalo or Amsterdam), and state their preliminary results: however it has been taken great care to state that those results have been communicated as press releases, therefore are ongoing research and not yet validated (In accordance with MEDRS). They are also used to say that a region is funding or not research (not a medical claim). Regarding the buffalo study: it is already commented in the article with a more reliable source since two months after that press release the results were presented in the American Academy of Neurology meeting and commented in a "neurology today" article. Nevertheless since results are not yet definitive it was decided to maintain them in the research directions section.--Garrondo (talk) 07:17, 20 August 2010 (UTC)

Garrondo is right. The correct response is to ensure the statements in the article are couched in such a way that it is clear to the reader that they are based on press releases, not to eliminate them entirely. A press release from a credible organization is expected to be factually informative, but not usually expected to be fair or balanced in its portrayal of that organization. They should be used, but with caution. LeadSongDog come howl! 15:27, 20 August 2010 (UTC)

Additionally I do not know what do you specifically mean with "contradict real publications". Which press releases and real publications are your referring to?--Garrondo (talk) 15:36, 20 August 2010 (UTC)

Warfarin

I do not think that the fact that the article on secondary effects says that the patient was on warfarin permits us to say that hemorrage could have been do to it: it should be the source specifically stating it.--Garrondo (talk) 20:52, 2 September 2010 (UTC)

The source states "shortly after her return", which means several days after the procedure, "while on coumadin" (which is warfarin). If you read the warfarin article, you will see that haemorrage is the main side effect of warfarin. Any manipulations with the vessels are likely to cause either immediate haemorrhage or, in the post-procedural period, trombosis. This is exactly why anticoagulants (including warfarin) are administered preventively. In this case, the death was caused not by the procedure itself but by the post-procedural treatment (possibly inappropriate dose) for this particular patient with the family history of haemorrhagic stroke. Not to mention this would be a distortion of the facts described in the source. Sergei Gutnikov (talk) 00:54, 3 September 2010 (UTC)

Fine with me. I have only eliminated the word "fatal" from hemorraghic stroke: if she died it is clear that it was fatal.--Garrondo (talk) 06:22, 3 September 2010 (UTC)

Translation:French

Has anyone begun a French translation? --Lilymaielang 06:54, 3 September 2010 (UTC) —Preceding unsigned comment added by Lilymaielang (talk • contribs)

Canada

Is it really needed to have a full, long paragraph on research in Canada with info on specific regions just talking about what politicians have said that they intend to do? From my point of view it is clearly excessive and should be summarized or simply eliminated... It could clearly have a non-worldwide perspective tag...Opinions? --Garrondo (talk) 06:16, 1 September 2010 (UTC)

I have added the template on exccesive regional coverage.--Garrondo (talk) 06:30, 1 September 2010 (UTC)

This is really quite big news here in Canada, and has been for a few months (or at least since when Sask announced they were going to fund clinical trials). We have the leaders of various provinces talking about this treatment, and also the Canadian federal government's research arm making comments about the lack of evidence - that would seem to be quite WP:WEIGHTy. --sciencewatcher (talk) 15:03, 1 September 2010 (UTC)

I agree with Garrondo that lenght should be minimised but without loss of information. Which is: Canada seems to be the most interested in this topic, here I agree with Sciencewatcher. This is also indirectly confirmed by the fact that a big proportion of patients in the Polish clinic that treats CCSVI are from Canada. So, it is not a biased view, it's reality. If I am wrong, let the non-Canadian parties add information about their contribution into treatment/trials/research of CCSVI. Sergei Gutnikov (talk) 15:18, 1 September 2010 (UTC)

MS is more common in Canada than nearly any other region / country in the world. Thus we take this condition more seriously than those farther south. The amount of coverage should reflect the sources.Doc James (talk · contribs · email) 16:29, 1 September 2010 (UTC)

I feel that the fact that two of the editors are canadian (Doc James and ScienceWatcher, not sure about Sergei) might be covertly biasing the weight of the article... On the other hand even if it is "big news" in Canada, is that relevant for the article at a world-level perspective? In other words: is it important for a person in China who wants to understand CCSVI to know what each of the provinces of Canada plan to do? I feel it could be summarized in some way... The tag should remain until A-We have a outside secondary source indicating that CCSVI debate is stronger in Canada (I do not think Canadian newspapers can give a reliabe perspective on this) B-Debate on other places (which I am sure it exists) is explained.--Garrondo (talk) 06:48, 2 September 2010 (UTC)

If I am correct the first mention of this condition was made on CBC News. I am sure the people of China have more pressing diseases to worry about locally. No problems with letting the tag stay though.Doc James (talk · contribs · email) 06:56, 2 September 2010 (UTC)

Ok... Change China with Spain... :-) --Garrondo (talk) 07:33, 2 September 2010 (UTC)

Garrondo asks: Is it important for a person in China who wants to understand CCSVI to know what each of the provinces of Canada plan to do? -- Yes, it is important for any person to understand that research into CCSVI is supported by more than one authority (even if they are in the same country). This can be mentioned shorter in fewer sentences, though. Sergei Gutnikov (talk) 13:08, 2 September 2010 (UTC) (Department of Clinical Neurology, Oxford University, United Kingdom)

If I do a google news search for "liberation therapy ms" (without the quotes) every single story in the first 2 pages of results is from Canada. It should be noted however that it says 'google news Canada' at the top and that could be influencing results (even if I do the search on news.google.co.uk it still says 'google news Canada' presumably based on my ip address). I'd suggest trying this search from another country and see what you get. Google news does generally pick up stories from around the world, so if every single news story that comes up is from Canada that is pretty telling. --sciencewatcher (talk) 14:01, 2 September 2010 (UTC)

I have done a similar test with similar results, and I have also tried in spanish with few results. It seems that you were right and it is sounding more in Canada. Even so I do think that since the article has a worldwide perspective we could try to summarize it. On a side note I will be away of wikipedia for two weeks so do not get angry if I do not answer these days.--Garrondo (talk) 21:16, 2 September 2010 (UTC)

Summary proposal

I have tried today to summarize the paragraph. I post my proposal here. I have tried to eliminate country specific data such as politician names or names of provinces, which are not relevant for people outside the country and the topic, while maintaining the message (or even enhancing it with the introductory sentence) that debate is heated regarding funding in Canada. Since I go away tomorrow editors can work on it for some days and if there is agreement feel free to add it to the article.--Garrondo (talk) 07:05, 3 September 2010 (UTC)

Debate has been heated regarding funding of CCSVI research in Canada. The Multiple Sclerosis Society has committed to funding experimental trials. At a political level there have been contradictory positions, with provinces funding trials, others stating that since therapy is unproven they should wait, and others urging for a pan-Canadian trial. Canadian Institutes of Health Research, the federal agency responsible for funding health research, has recommended that Canada Health not fund a pan-Canadian trial of liberation therapy yet because "There is an overwhelming lack of scientific evidence on the safety and efficacy of the procedure, or even that there is any link between blocked veins and MS." It has suggested a scientific expert working group made up of the principal investigators for the seven MS Society-sponsored studies.

I support this wording. Sergei Gutnikov (talk) 13:32, 3 September 2010 (UTC)

Yes, this is good, thanks. I just added a sentence about the health minister accept the CIHR recommendation. --sciencewatcher (talk) 14:38, 3 September 2010 (UTC)

Review on controversy over funding in Canada

I just found this PMID 20584927 (free access). No time to take a look, but it seems interesting.--Garrondo (talk) 07:19, 3 September 2010 (UTC)

When I followed the link on Sept 5 2010, it goes only to an editorial citation and the comment, "Access to treatment for multiple sclerosis must be based on science, not hope." which appears to be a reply to the question, "Why can't I get my veins unblocked in Canada?"

The controversy in Canada is not about the availability or unavailability of the treatment in Canada. Initially people started asking about the treatment. However, the doctors, politicians, medical societies, MS Society, etc., through the media and directly with patients, all did a very good job of informing people of the importance of clinical trials, the placebo effect and the idea behind a blind trial. A few people are still desperate, understandably, but there's little or no controversy over access to the treatment itself.

The controversy is over support, or lack of support, for clinical trials to determine the effectiveness (or ineffectiveness) of CCSVI liberation therapy.

What adds to the controversy is that people are getting the treatment done anyways. Some people may feel it's appropriate to expedite the trials for this reason. This would not be an issue for a treatment that wasn't already being offered somewhere. (If this is put in the article, I can come up with the reference if it's phrased appropriately.)

This clarification is necessary because if the article shifts focuses on the availability of treatment in Canada as the controversy, it will be misleading. There's little controversy over that. —Preceding unsigned comment added by 142.163.130.130 (talk) 12:20, 5 September 2010 (UTC)

I added a reference to Bernhard Juurlink's 1998 proposal because I think it's relevant to the topic, but I'm not happy with where I placed it and the wording. I'll fix it if I think of something better. In the meantime, if somebody else can improve it, please do. —Preceding unsigned comment added by 142.163.130.130 (talk) 15:30, 5 September 2010 (UTC)

Full quotes

I have eliminated the quote on interventional radiologists in USA and Canada supporting intervention with caution, has been reverted and I have eliminated it again. So it is time to discuss it here. My point is that we have different statements by different organizations on different things, and we do not quote anything from any of them. They are all similarly important (unless there is some reason to say the opposite) and quoting a full paragraph from only one of them is to give undue weight a a non NPOV. In addition it is redundant, since it gives no further info to simply summarizing its content (specially since anybody interested can go to the source).--Garrondo (talk) 11:34, 20 September 2010 (UTC)

No, it should be reinstated and then discussed here. Please do not delete information from the article, add. Sergei Gutnikov (talk) 11:58, 20 September 2010 (UTC)

I believe I usually discuss issues here... After your second reversion I have left the info in the article. Nevertheless I have stated my reasons for eliminating it, while you have not stated any reasons for its maintainance...--Garrondo (talk) 12:11, 20 September 2010 (UTC)

Comments from anybody else???? --Garrondo (talk) 06:22, 21 September 2010 (UTC)

We should generally summarize information rather than use full quotes IMO. This is an encyclopedia not a newspaper.Doc James (talk · contribs · email) 17:51, 21 September 2010 (UTC)

Side question

The MS Society of Canada has since announced CAD1 million towards such a clinical trial "when a therapeutic trial is warranted and approved"

I do not understand the meaning of CAD1 million: what does it mean? Can an internal link be added or meaning explained?--Garrondo (talk) 06:54, 21 September 2010 (UTC)

CAnadian Dollars. 10:03, 21 September 2010 (UTC) —Preceding unsigned comment added by Sergei Gutnikov (talk • contribs)

Thanks, now it is clearer.--Garrondo (talk) 10:26, 21 September 2010 (UTC)

Research

This page should only us review articles. Does anyone have a copy of this?

• Beal E (2010). "Vascular angioplasty for ms?". Nat Rev Neurol. 6 (4): 184. doi:10.1038/nrneurol.2010.23. PMID 20383884. {{cite journal}}: Unknown parameter |month= ignored (help)

Doc James (talk · contribs · email) 01:52, 21 September 2010 (UTC)

I have a copy. I'll email it to you. NW (Talk) 05:12, 21 September 2010 (UTC)

Thanks Doc James (talk · contribs · email) 17:49, 21 September 2010 (UTC)

About the "conflict" of results

The article says:

In 2010 there were conflicting results when evaluating the relationship between MS and CCSVI.

Speaking about blinded trials if one yields a positive result is enough to consider the hypothesis valid. If some groups are not able to reproduce the positive result it does not matter. Probably they are just doing something wrong. That's why trials are blinded. To show that a method works even if other groups cannot reproduce it.

Since the Buffalo clinical trial have already been published I think the results that are against it become irrelevant.

Specially those that found CCSVI cases below 25.9 percent (prevalence of CCSVI in healthy controls) are unsustainable at this moment. They should be removed from the article because they had clearly a failure during the procedure and they contradict better founded results. --Juansempere (talk) 21:59, 19 August 2010 (UTC)

This just seems to be preliminary results. It says the full results will be published in "April" (but it is already August). What happened? --sciencewatcher (talk) 22:21, 19 August 2010 (UTC)

They have not yet been published in a peer review journal, only presented in the april's american academy of neurology meeting.--Garrondo (talk) 15:41, 20 August 2010 (UTC)

On the other hand a blind study only means that one of the multiple possible existing bias that exist when researching (evaluator bias) is controlled: while it is the highest quality kind of research by no means it implies that a positive result overrides any other results on other investigations. All results have to be balanced taking into account many different factors such as size, blindness, number of positive results, number of negative results...and that is what systematic reviews deal with... Balancing all data on an issue.--Garrondo (talk) 15:51, 20 August 2010 (UTC)

A trial can be blind or double-blind but otherwise have a poor methodology. Science is supposed to be reproducible. If something can't be reproduced, it doesn't mean the attempt at reproducing the results is flawed. It could be the original study was flawed. It could be both were flawed. And so on. A result that is not reproducible raises questions that need to be answered. Those answers may or may not be what we want, but they are necessary and we're better off with them than to just be happy with the first positive results and move head with our eyes closed.

If there are conflicting but otherwise reputable results, the article should reflect this. —Preceding unsigned comment added by 142.163.130.130 (talk) 16:19, 6 September 2010 (UTC)

Could a table be useful here?

Given that there are really conflicting results maybe we could do a table showing them. I suppose it is enough to give five fields to any of them. Four for the outcome (true positives, true negatives, false positives, false negatives) and one boolean saying whether the trial was blinded.

As far as I know we have five studies: The Zamboni original, the two germans that gave negative result, Jordania and the first part of Zivadinov. With a table like this well maintained people can see how the evidence grows to one side or the other.

Anybody agrees to insert such a table?

--Juansempere (talk) 08:42, 21 September 2010 (UTC)

I am not fully convinced, but we could give it a try here and include it later in the article. Which data will it include? Additionally I am not sure on how could we present Zivadinovs data since it has only been presented at a conference.--Garrondo (talk) 10:40, 22 September 2010 (UTC)

Maybe we should wait until Zivadinov presents formally his results. --Juansempere (talk) 08:42, 21 September 2010 (UTC) —Preceding unsigned comment added by 94.126.240.2 (talk)

Perfect. Lets wait then... When we have the results we can decide about the table.--Garrondo (talk) 11:23, 24 September 2010 (UTC)

POV

The treatment section is exactly why we do not use primary research but review articles per WP:MEDRS. There is no currently accepted procedure for this condition. Evidence of its existence is still questionable. Doc James (talk · contribs · email) 01:27, 21 September 2010 (UTC)

WP:MEDRS: If an important scientific result is so new that no reliable reviews have been published on it, it may be helpful to cite the primary source that reported the result. Sergei Gutnikov (talk) 23:41, 21 September 2010 (UTC)

Hi Doc James. At this moment there are reviews speaking about CCSVI. Evidence of CCSVI existence could be questionable for you, but not in the article (The threshold for inclusion in Wikipedia is verifiability, not truthWikipedia:Verifiability). By the way, is there any review speaking about the supposed dangers of angioplasty that you often refer? (and I don't mean general problems, but a relationship between angioplasty and two deaths that are ofter reported)--Juansempere (talk) 09:51, 23 September 2010 (UTC)

Well done, Juansempere! This is a secondary source that should be mentioned first in the article as suggests WP:MEDRS Sergei Gutnikov (talk) 17:02, 23 September 2010 (UTC)

I have added two 2010 reviews of CCSVI that discuss CCSVI in tentative language.Doc James (talk · contribs · email) 17:11, 23 September 2010 (UTC)

BTW the ref link above agree saying "may cause CCSVI and may be involved in MS"Doc James (talk · contribs · email) 17:19, 23 September 2010 (UTC)

We can add a sentence in the beginning that the very existence of the syndrome itself is questioned (not just of its link with MS) with references to reviews. And then we can remove the "unbalanced artice" tag, can't we? Sergei Gutnikov (talk) 18:08, 23 September 2010 (UTC)

(CCSVI) is a term for poor blood flow in the veins of the head and neckas per "A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS)" We need to reflect this.Doc James (talk · contribs · email) 18:17, 23 September 2010 (UTC)

That is not exact. It is claimed that CCSVI precedes the development of Multiple Sclerosis. Therefore it is claimed that it can appear without having MS fully developed. --Juansempere (talk) 21:09, 26 September 2010 (UTC)

Besides, we should agree now in the definition of MS. If somebody with a negative in McDonald criteria shows MS lesions in his brain after autopsy, Would you agree he had MS?. And the reversal. If somebody with a positive in McDonald's show no lesions after autopsy, Would you agree that he had no MS? Do we agree that MS definition is based in the presence of lesions?--Juansempere (talk) 21:09, 26 September 2010 (UTC)

Review

It is stated that this [21] is a review. Published in what journal? Doc James (talk · contribs · email) 04:25, 9 September 2010 (UTC)

It is a compilation of quotations from primary sources published online by a charity. The matter is not clinical, therefore it is a subject to WP:PRIMARY "A primary source may only be used on Wikipedia to make straightforward, descriptive statements that any educated person, with access to the source but without specialist knowledge, will be able to verify are supported by the source." These primary sources should be checked. Sergei Gutnikov (talk) 18:48, 10 September 2010 (UTC)

claiming that this problem was known since 1863 by the medical community is a medical claim thus removed until the issues of sources are addressed.

Retrospectively, venous abnormalities in MS were noticed and reported as long ago as 1863. Eduard von Rindfleisch noticed that, consistently in all the autopsy specimens of MS brains he viewed with his microscope, a vein engorged with blood was present at the centre of each lesion. He wrote:

If one looks carefully at freshly altered parts of the white matter ... one perceives already with the naked eye a red point or line in the middle of each individual focus,.. the lumen of a small vessel engorged with blood ... All this leads us to search for the primary cause of the disease in an alteration of individual vessels and their ramifications; All vessels running inside the foci, but also those which traverse the immediately surrounding but still intact parenchyma are in a state characteristic of chronic inflammation. Rindfleisch E. - "Histologisches detail zu der grauen degeneration von gehirn und ruckenmark". Archives of Pathological Anatomy and Physiology. 1863;26:474–483, cited in.

Doc James (talk · contribs · email) 20:56, 16 September 2010 (UTC)

It is not a medical claim - it says nothing about treatment. It is only about pathology (pathological anatomy). And it is cited in a proper journal, so it will be a secondary source - I will add the ref to the article. Please do not delete meaningful and interesting information. Sergei Gutnikov (talk) 14:03, 17 September 2010 (UTC)

Pathology is a discipline of medicine. Were is this proper journal in which the review was cited? All I see is a charities home page which is not a suitable source.Doc James (talk · contribs · email) 16:16, 17 September 2010 (UTC)

Okay see you have added a new reference to this content. It is now properly sourced. Doc James (talk · contribs · email) 16:22, 17 September 2010 (UTC)

I disagree to the whole inclusion of this paragraph: the fact that there have been previous reports on associations between MS and vascular pathology is irrelevant to this article unless a reliable source links such studies and CCSVI: it is OR since we are deciding that such studies talk about something similar to CCSVI which is not necessarily true. We are not vascular experts so we can not relate any description of vascular pathology in MS to CCSVI and we are implicitely doing so by including it in the history section. With the references provided we can only validate that some researchers have found vascular pathology in MS but that is not relevant for the CCSVI article unless a (preferably secondary) source states so. Does any of our references on CCSVI name previous studies (this or other) on MS and vascular pathology? If not I believe the whole par should be eliminated per WP:OR.--Garrondo (talk) 08:48, 20 September 2010 (UTC)

First reference of the two links it with CCSVI, hence not WP:OR. Sergei Gutnikov (talk) 11:15, 20 September 2010 (UTC)

But is this first reference a reliable one? Not according to MEDRS I believe... Do we have a reliable source linking them?--Garrondo (talk) 11:25, 20 September 2010 (UTC)

It is reliable secondary source - anyone can check the primary sources it refers to (and I did). Sergei Gutnikov (talk) 11:54, 20 September 2010 (UTC)

I agree that the article linking MS and vascular pathology is a reliable source but not the one linking vascular pathology in MS and CCSVI since it is a website of a CCSVI group. My critique stands: we are not the ones to decide if the 1890 article is relevant to the CCSVI article: if a reliable source names it in relationship to CCSVI we can add it, if not (as now) if we name it we are perferming original research and specially a synthesis. Would be great to hear others opinions.--Garrondo (talk) 12:08, 20 September 2010 (UTC)

It is clear from their own website that Proventus is a pressure group, and hence is not a WP:MEDRS in any sense. It is in no way a sufficient source to establish a connection between Rindfleisch and CCSVI. Keep looking.LeadSongDog come howl! 19:39, 20 September 2010 (UTC)

I agree with the comments above by Garrondo and LeadSongDog. When the review quote was first put into the article, I was scratching my head trying to figure out whether or not it was related to CCSVI. As Garrondo correctly points out above, it's not up to us as editors to figure this out - if a reliable source doesn't link them then it is WP:OR or WP:SYNTH to do so in the article. The website www.proventus.org.uk isn't a reliable source. --sciencewatcher (talk) 20:31, 20 September 2010 (UTC)

Yes the first ref is still no good. The second is okay. The second links vascular stuff to MS and not CCSVI than it should not be on this page. Doc James (talk · contribs · email) 21:01, 20 September 2010 (UTC)

Added MS Resource Centre which is not a pressure group. It also states the link between CCSVI and the vascular pathology. WP:SOURCES: "Academic and peer-reviewed publications are usually the most reliable sources where available, such as in history, medicine, and science, but they are not the only reliable sources in such areas. Material from reliable non-academic sources may also be used." Sergei Gutnikov (talk) 22:21, 20 September 2010 (UTC)

I assume you mean the "A Brief History of the Early Venous Vascular Observations in Multiple Sclerosis (MS)" section? It says at the bottom "Disclaimer: Dr. E. Mark Haacke, PhD is a Physicist, not a Medical Doctor" and it just seems to be a website set up by some guy. How reliable is a physicist's homepage for info about vascular disease? Generally WP:MEDRS applies for medical information except in special circumstances. I don't think this would even pass WP:RS never mind WP:MEDRS. --sciencewatcher (talk) 22:47, 20 September 2010 (UTC)

Your assumption is wrong. I mean what I clearly cited - a webpage by MSRC that reviewed several sources, including that page by Haacke. Haacke is the primary source (if your remark about physicist being unable to say something reliable about medicine is not merely medical snobism, what is it?), MSRC is a secondary source in this case. Sergei Gutnikov (talk) 23:13, 20 September 2010 (UTC)

Not snobism, just academic reality (and I'm not any more qualified than him myself FYI). But it's mostly the medium (i.e. webpage versus a peer reviewed journal) that makes it unreliable. --sciencewatcher (talk) 23:52, 20 September 2010 (UTC)

On controversial topics such as this we should only use peer reviewed review articles. I support the removal of this statement attempting to link vascular problems with CCSVI in the 1800s.Doc James (talk · contribs · email) 23:20, 20 September 2010 (UTC)

4 different editors (including me) think that the reference is not sufficient, while one one does the opposite. I believe it is as close to consensus as we will get. I am going to eliminate the lines on the history section until a better source is found.--Garrondo (talk) 06:21, 21 September 2010 (UTC)

The fact that there is vascular pathology in MS lesions is not a controversial topic. Consensus is not voting. Garrondo, although you do a lot of work on the MS articles, which is greatly appreciated, please do not treat them as your own. And do not delete information - add! Shortening without loss of information is always welcome. Sergei Gutnikov (talk) 10:00, 21 September 2010 (UTC)

Stop saying that I own this article, since I believe that I have clearly shown that I do not feel I do... Of course it is not voting but 4 people saying a thing and you saying the opposite surely has some importance... Nobody doubts that vascular pathology in MS lesions is not controversial but that is not the point. The point is that unless this kind of vascular pathology in MS is related to CCSVI in a reliable source it has no place in the article since it is OR (By including it we are implicitly saying that it is connected to CCSVI).--Garrondo (talk) 10:18, 21 September 2010 (UTC)

It is not we, who linked CCSVI with the 19-th century publications. Doepp et al published said it explicitly at a conference: "Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins1,2. Recent sonographic and angiographic studies suggested this topographic pattern may be caused by venous congestion, a condition termed ‘chronic cerebro-spinal venous insufficiency’ (‘CCSVI’) (Fig. 1) (1)." and elaborated in a peer-reviewed journal (quote below). Sergei Gutnikov (talk) 10:46, 21 September 2010 (UTC)

For nearly 150 years, a topographic relationship has been noted between focal MS lesions in the WM and cerebral veins,7, 8 although as many MS lesions become confluent over time, their venocentric nature may become less apparent. Evidence suggests the topographic association between focal demyelination and cerebral veins in MS arises from a disruption of the blood-brain barrier in the course of an immune response. Whether this response reflects an early event in the pathogenesis of lesion formation,9 or rather a secondary phenomenon, for example initiated through unmasking of (auto-)antigens following oligodendrocyte apoptosis,10 has yet to be clarified. Based on findings using venous ultrasound and selective venography studies of cerebrospinal veins, an alternative hypothesis has recently emerged claiming to explain the association between cerebral veins and the distribution of demyelinating MS lesions as a result of chronically impaired venous drainage from the CNS.11, 12 A subsequent study by the same group assessed the effect of endovascular angioplasty in patients with MS and what they coined chronic cerebrospinal venous insufficiency (CCSVI).

Well, that is a reference all right, albeit only to a "rapid communication", but not for what that selected quote might imply. Note the glaringly obvious finding in title of the paper: Doepp F, Paul F, Valdueza JM, Schmierer K, Schreiber SJ (August 2010). "No cerebrocervical venous congestion in patients with multiple sclerosis". Annals of Neurology. 68 (2): 173–83. doi:10.1002/ana.22085.{{cite journal}}: CS1 maint: multiple names: authors list (link)

LeadSongDog come howl! 16:26, 21 September 2010 (UTC)

Exactly! As the primary source they say "No cerebrocervical venous congestion..." - that's their own results (and some people here say that the primary sources should be discarded). But in the literature review, which is a secondary source, Doepp et al acknowledge the link. Sergei Gutnikov (talk) 17:10, 21 September 2010 (UTC)

CCSVI is a vascular phenomena but not all vascular phenomena are CCSVI. While this might be appropriate in an article about the causes of MS unless this 1800s paper was about CCSVI a large block of text regarding it is not appropriate here. Doc James (talk · contribs · email) 17:54, 21 September 2010 (UTC)

(edit conflict)

What literature review? The Doepp paper that you linked to and I cited is just a "rapid communication" on original research, not even properly peer reviewed, let alone constituting a literature review. It is a weak primary source that says the opposite of what you infer: It acknowledges only that other authors had hypothesized a CCSVI-MS link, certainly not that such a link exists. LeadSongDog come howl! 17:58, 21 September 2010 (UTC)

Is this a review? - Murray, Terry (5 May 2010). "Zamboni's MS theory on thin ice". The Medical Post 46 (8): 1, 6–7. - The whole first paragragh in the "Reception" section is based on it. Should we delete it? Sergei Gutnikov (talk) 01:25, 22 September 2010 (UTC)

I think it is, but not for medical claims, but no medical claims are made in the reception section. I would not be a reliable source for a medical claim, but it probably is for a "social" section.--Garrondo (talk) 13:01, 22 September 2010 (UTC)

These claims: "(a) that the syndrome actually exists; (b) that it could be causative of (or a co-factor in) multiple sclerosis; (c) that vascular treatments for the syndrome would prevent or reduce the incidence of multiple sclerosis" are medical. Please delete them until you find a review. If you don't agree - please reinstate reference to the 1863 publication by Rindfleisch, that has been rejected on the ground of absence of a review. Otherwise it will be double-standards here. Sergei Gutnikov (talk) 13:42, 22 September 2010 (UTC)

It says that it has been received with skepticism because some experts think that: it is not referencing a medical claim but a belief by some experts, without judging if it is a valid belief or not, similarly to saying that patients have received it with hope, without judging if this hope is justified or not by data. So no, the fact that it is not a peer reviewed article does not mean that it is an invalid reference in this case.--Garrondo (talk) 15:09, 22

September 2010 (UTC)

In that case, let's write "von Rindfleisch thinks that...". Otherwise - double standards. Sergei Gutnikov (talk) 20:36, 22 September 2010 (UTC)

I suspect you've misunderstood the objection to using von Rindfleisch. His early findings have a place in the history of MS, and in the MS article, but we have no review to connect them to CCSVI, hence no justification to put them in the CCSVI article. To do so would violate wp:SYNTH. Can we move on to something more productive now, please? LeadSongDog come howl! 21:24, 22 September 2010 (UTC)

We have exactly the same type of "review" published by an organisation Multiple Sclerosis Resource Centre as the "review" by the Canadian Health and Care Network that is accepted by Garrondo. Definitely double standards here. Sergei Gutnikov (talk) 02:06, 23 September 2010 (UTC)

Could you please identify (cite) the papers you refer to? I can't figure it out from the above, all I see is a link to website homepages. Further, please take a closer look at wp:MEDRS and wp:PSTS. We look for content in the review, not in the primary sources that it reviewed. LeadSongDog come howl! 03:53, 23 September 2010 (UTC)

Added references above as requested. We do look for content in the review, not in the primary sources that it reviewed. Sergei Gutnikov (talk) 04:09, 23 September 2010 (UTC)

So what part of this are you thinking is a review? All I see is a list of low quality primary sources, not a review that adds critical analysis. I haven't seen the The Medical Post article, but it doesn't look particularly like a useful publication either. LeadSongDog come howl! 05:10, 23 September 2010 (UTC)

A list, approved by the editor is a review as it implies the editor's approval of the primary sources. It is a secondary source in Wikipedia's definition because it relates or discusses information originally presented elsewhere. Discussion is not mandatory for a source to be reliable. Sergei Gutnikov (talk) 15:58, 23 September 2010 (UTC)

Full stop and trying to move forward

I feel this discussion in running in circles and nothing positive is going to come out at this rate. Right now I am quite lost on what and why is Sergei trying to introduce in the article. I would like to ask him to re-state: 1-The content that he thinks that merits inclusion. 2-The reason why he thinks it is important for the article. 3-The references he believes that support the addition. Number two is probably the most important since re-reading the discussion I have not found anything similar to it. Hopefully with this break and the summary asked we can re-initiate the discussion and move forward.--Garrondo (talk) 16:22, 23 September 2010 (UTC)

1. CCSVI is a venous pathology associated with MS. Many dispute this association. Although the term CCSVI was coined in 2008, the history of association between venous pathology and MS goes more than a century back to 1863.

2. It is important to show this long history. Zamboni discovered the problew with the large veins. The abnormalities of venulae in MS loci have been known long time ago.

3. Secondary references to Rindfleisch observation of abnormal venulae in MS and the best available source that supports suggestion that this may be linked with CCSVI . Editorial publication on a website of a reputable organisation is a type of scientific publication as it is stated in Wikipedia (scientific publications on the World Wide Web) Sergei Gutnikov (talk) 17:59, 23 September 2010 (UTC)

As I see it, we have the following statements with different levels of sourcing

• MS has been associated to vascular pathology for a long time: There are many references for this, uncontested.
• In 2008 Zamboni described an specific picture of vascular problems in MS. Logical conclusion from this: CCSVI is a (proposed) vascular problem in MS but not every vascular problem in MS has to be related to CCSVI. I would agree to have in the history section two lines similar to the ones above. We would be stating two facts that are known but only relating them as CCSVI being a subset of the possible vascular problems in MS

• We have an specific citation on vascular problems in MS (Rindfleisch): A doubt I have is if it is notable due to being the first to relate vascular problems to MS, due to the similarity of its description to CCSVI, or both: If it is notable only due to the first reason it is not really notable for the history section of CCSVI (At least not the full quote that was initially given. Maye we could include something similar to what you say IF we know for sure that it is the first association between the two) . For the second and third I do not believe that we have really reliable sources: a copied text in a charity web site does it is red flag alarm for not reliability. (Similarly, and as an example of its non-reliability, this website also gives info on the usefulness of the Best Bet Diet, when all major health organizations have stated that there are no indications of diets having any effect on the management of MS).

Summarizing: My proposal to begin the history section is: Venous pathology has been associated with MS for more than a century (Secondary reference saying specifically this sentence, citing any author, not necessarily Rindfleisch). In 2008 Zamboni described an specific picture of vascular problems that he defends to be related to MS... Rest of the section

Would this be a sufficient compromise?

--Garrondo (talk) 18:35, 23 September 2010 (UTC)

I would support Garrondo's wording.Doc James (talk · contribs · email) 18:50, 23 September 2010 (UTC)

I agree with that. Although I have no personal attachment to Rindfleisch, I think we should mention his work as pioneering, with the date 1863, unless somebody finds an earlier reliable publication. Sergei Gutnikov (talk) 19:38, 23 September 2010 (UTC)

Yesterday I added a secondary cited line re Rindfleisch's pioneering microscopic pathology work to Multiple sclerosis#History, where I would contend that it belongs. I don't see that it would contribute anything here, though the historical review which I cited there may also be useful for the statement Garrondo proposes. If others are agreed to include it in this article, I would not further object. LeadSongDog come howl! 20:00, 23 September 2010 (UTC)

Again

In addition to the text agreed above there has been another addition that I do not feel meets the qualification for inclusion: "In 1976 stenosis of the internal jugular vein and azygos vein was shown in myelopathies": This is a primary study (and additionally in french). Similarly to discussed above unless we have a source that links it to CCSVI history it is irrelevant to the article since mielopathies are a different disease to MS and we are not the ones to decide which articles in the history of science are relevant for CCSVI history. Comments? --Garrondo (talk) 06:55, 28 September 2010 (UTC)

Yes should definitely be removed. Doc James (talk · contribs · email) 07:00, 28 September 2010 (UTC)

Should definitely be kept. This is an important part of history, it shows that Zamboni was not the first to look at this. It is only a short sentence - for whom and what trouble does it's presence make? Sergei Gutnikov (talk) 20:44, 29 September 2010 (UTC)

This has been here for two days with no further comments so today I eliminated the sentence. Now it has been reverted by Sergei without discussing it here. Discussion is same as above. There is no secondary ref connecting this studies with CCSVI and MS. Us implying that it is conneceted is OR. Find a reliable medical ref and text will be readded.--Garrondo (talk) 20:47, 29 September 2010 (UTC)

More specifically Sergei's edit summary was: "it shows that Zamboni was not the first to look at this". I say: find a source that states the he was not. We are not the ones to show.--Garrondo (talk) 20:49, 29 September 2010 (UTC)

Garrondo, I do not suggest to say in the article "Zamboni was not the first to look at this". Therefore I will not look for a source that is saying that. I suggest to say in the article "In 1976 this issue of veins blockage was looked at in context of myelin diseases". And for that I've found a source. Now, please add information to Wikipedia and do not delete verifiable information. Sergei Gutnikov (talk) 21:16, 29 September 2010 (UTC)

Then it is irrelevant for this article: you can add it to the "myelinopathies" article, or to vein blockage article, but not to the CCSVI article, since there is no indication in reliable sources that it is notable for the article. This article is titled CCSVI if I remember correctly and it is about a very specific syndrome.--Garrondo (talk) 21:25, 29 September 2010 (UTC)

Well I think I should agree with you here. The 1976 paper is relevant but quite aside and how far aside we draw the border is arbitrary. You prefer to narrow the borders and I accept it. Sergei Gutnikov (talk) 21:33, 29 September 2010 (UTC)

Consensus then. Bests.--Garrondo (talk) 22:02, 29 September 2010 (UTC)

Side note: I believe that with 4 million articles deleting is as important in WP as including new info (if not more important). Copyright or OR can normally only be dealed by deleting, and I prefer quality to quantity.--Garrondo (talk) 21:29, 29 September 2010 (UTC)

Treatment section

The treatment section is for discussing currently accepted and performed treatments. There are none for this condition. Pilot studies are just that research studies looking into if a larger study should be done.Doc James (talk · contribs · email) 17:49, 21 September 2010 (UTC)

I would usually agree with you, but I do feel that this time we could make an exception since while there are no proved treatments there have been some proposed ones: I believe we should leave them under the treament sections while stating very clear that they are not proved and still only under research (similarly as it already does). The treatments are hypothetical but that is in line with the full article, which talks about an hipothesis syndrome.--Garrondo (talk) 10:45, 22 September 2010 (UTC)

Somebody had to change the "Proposed consequences of these theories include" because it is bad style. As for sections order, Diagnosis and Treatment should go after History and Research - please change. Sergei Gutnikov (talk) 10:53, 22 September 2010 (UTC)

Actually WP:MEDMOS states the preferred order for medical articles and places diagnosis and treatment before history and research. We were following it until your last changes. Your changes do not go in accordance with the manual of style for medical articles so at the very least they should be discussed in the talk page first.--Garrondo (talk) 12:57, 22 September 2010 (UTC)

The set of sections in the current version does not comply with WP:MEDMOS for syndromes - should be changed. You are right, History is recommended to be placed towards the end - so be it. And please change the stupid phrase "consequences of these theories include: intracranial hypoxia..." - a theory cannot lead to hypoxia and so on. Sergei Gutnikov (talk) 13:33, 22 September 2010 (UTC)

I agree with you on this one: a theory can not cause anything :-) i'll try to change it today, or feel free to do it. --Garrondo (talk) 14:54, 22 September 2010 (UTC)

Done.--Garrondo (talk) 14:59, 22 September 2010 (UTC)

Give the details about research in a treatment section for stuff that is not treatments is miss leading. Doc James (talk · contribs · email) 06:43, 23 September 2010 (UTC)

What do you mean with "for stuff that is not treatments"?--Garrondo (talk) 07:15, 23 September 2010 (UTC)

(Undent) Pilot studies do not support the use of a procedure or medication for treatment they only support the need for further treatment thus it is undue weight to include pilots in a treatment section.Doc James (talk · contribs · email) 17:09, 23 September 2010 (UTC)

• WP:MEDMOS: Treatment or Management: This might include any type of currently used treatment, such as diet, exercise, medication, palliative care, physical therapy, psychotherapy, self care, surgery, watchful waiting, and many other possibilities.

Research directions: Include only if addressed by significant sources. Honorable Doc James, as you can see, anything related to treatment should be given in the Treatment section, and the Research section should include only specific research matters. Please do not revert. Sergei Gutnikov (talk) 23:38, 28 September 2010 (UTC)

These are NOT "currently used treatments". We need to use exclusively review articles in the treatments section per WP:DUE and WP:MEDRS. The current info is using primary sources to contradict a review article. Thus it does not belong in the treatment section Please get consensus. Doc James (talk · contribs · email) 23:46, 28 September 2010 (UTC)

Are you a Doctor? If a patient has a condition (whatever) and a medical professional does some intervention (again, whatever) in order to alleviate this condition and improve the patients state or quality of life, this is treatment isn't it? It doest not matter whether it is established or experimental, whether a drug is given or a placebo - all these are treatments. And WP:MEDMOS clearly states that it should be in the Treatment section (quotation above). Sergei Gutnikov (talk) 00:07, 29 September 2010 (UTC)

I still think we should leave it in research until the evidence is more than just in the research stage. Pilot studies do not direct treatment but direct further study thus "pilots". Placebos are not deemed treatment. And these techniques are not being legally used in MS patients in Canada currently outside of research studies.Doc James (talk · contribs · email) 00:23, 29 September 2010 (UTC)

1) We are talking about treatment of CCSVI, not MS. 2) We are discussing medical issue of treatment, not legal 3) Jurisdiction of Canada is a specific issue that we don't need to discuss in the general section of treatment - we should describe treatment in a worldwide aspect. Sergei Gutnikov (talk) 00:36, 29 September 2010 (UTC)

I guess there are a few non western countries that are using this "treatment" in the absence of evidence (India and Poland I think). Are there reasons to treat CCSVI other than MS? Doc James (talk · contribs · email) 01:00, 29 September 2010 (UTC)

Non-Western countries are also countries, you know. And you don't need to express your thoughts in Wikipedia (that's original research), you need to cite sources. For example, treatment of CCSVI in MS patients is supported by the government in Kuwait. Sergei Gutnikov (talk) 01:09, 29 September 2010 (UTC)

(undent) please provide review articles, I have asked for outside input, have tagged this article as POV. Doc James (talk · contribs · email) 01:34, 29 September 2010 (UTC) We are now using Kuwait newpapers to contradict per reviewed published review articles. [22] Readded POV tag.Doc James (talk · contribs · email) 01:30, 29 September 2010 (UTC)

Please remove POV and don't be ridiculous - what review articles for political decisions? Two newspaper articles, one from the country of interest and another from a different country (coincidentlally - yours) are more than enough. You say that talking about conspiracy is funny - I thought so too, but now I have doubts. You add POV every time any evidence in favour of treatment is added. Sergei Gutnikov (talk) 01:38, 29 September 2010 (UTC)

Lets wait for others to comment. Tags is too stay until issues are dealt with. Doc James (talk · contribs · email) 01:43, 29 September 2010 (UTC)

This time I am neutral: I do not really care whether current treatments are described in treatments (as far as they are described as still non proven and under research) or in research directions (and it is said that while still under research they are used by patients). This time we are in a middle ground: while the treatment is non proved and non approved it is used by some (many?) doctors and patients. Both descriptions I believe that match sources and reality and are neutral (I believe we have reviews that state both things: 1-that it not proven; 2-that it is used. From my point of view we should choose one, shake hands and stop edit warring.--Garrondo (talk) 07:05, 29 September 2010 (UTC)

"As a form of treatment, outside the trial setting, these procedures are not currently recommended." Now we have to say, where. Sergei Gutnikov (talk) 13:00, 29 September 2010 (UTC)

Angioplasty and stenting are investigational (there is not evidence yet at this point that they treat ie improve MS/CCSVI) thus they are not treatments IMO. They are potential treatments or treatments undergoing active research.Doc James (talk · contribs · email) 13:35, 29 September 2010 (UTC)

As I said I do not really care much where it is said; but on the one hand we have to reflect scientific evidence (none), and as ans encyclopedia we also have to reflect reality (in spite of evidence they are being used by medical doctors and patients. These "treatments" are as notable for being used than for being investigated and such notability has to be noted somehow.--Garrondo (talk) 13:42, 29 September 2010 (UTC)

As long as we discuss the scientific conclusions before we discuss the culture / social / legal ones I am okay with it. The last change you made I find exceptable[23]. Doc James (talk · contribs · email) 13:53, 29 September 2010 (UTC)

Image

A new image has been added (own work by Sergei): I have a problem with the caption since I do not understand its point: "While pressure in the balloon is relatively low, stenosis prevents the balloon to inflate in the middle".. What does this mean? Is this an MS patient with a balloon? Do we have a source for this conclussion? How do we now that the cause for not inflating in the middle is stenosis (This are not critiques: I simply do not know much about radiology). In addition I have some problems over copyright: When Sergei states in WP COMMONS "own work" what does he mean? That he scanned the image? That he was the radiologist? That he was the subject of the image? Who is the subject of the image? Where does it come from? I think I remember some discussions over radiological images in WP:MED over who has the copyright and it was a complex issue... Clarification is needed or it may be deleted in commons. --Garrondo (talk) 07:16, 28 September 2010 (UTC)

It is my own work. Taken with my own digital camera from the angiograph display screen during the treatment procedure. I am not a radiologist but I was present there. And it has a correct description. The patient suffers from primary progressive MS and both jugular veins vere stenosed. Increasing of pressure in the balloon widened the stenotic ring in the right jugular vein. I can also add a picture of collateral venous flow caused by stenosis, and normal flow after stenting. Sergei Gutnikov (talk) 17:57, 28 September 2010 (UTC)

Sergei do you sell this equipment? Or are you involved in these trials? Doc James (talk · contribs · email) 22:05, 28 September 2010 (UTC)

No and no. Why? Sergei Gutnikov (talk) 23:27, 28 September 2010 (UTC)

It is to do with possible WP:COI problems, to see if they exist with you. Doc James I don't think was accusing, just wondering and asking. People with a WP:COI can still edit wikipedia.--Literaturegeek | T@1k? 19:26, 29 September 2010 (UTC)

((MOVING EDIT PLACED IN WRONG SECTION TO CORRECT SECTION))

Please relax

This is getting out of hands: Please everybody try to relax and stop making personal accusations and assuming bad faith. I would also like to ask everybody to try to reach consensus in talk page BEFORE making changes to the article instead of AFTER so no edit wars occur. Thanks to all contributors in advance.--Garrondo (talk) 13:14, 29 September 2010 (UTC)

Kuwait

This is what we had:

Kuwait is the only country in the world where it is recommended by the medical authorities.

This is what the ref says:

the health ministry will allow radiologists to begin treating MS patients who have CCSVI, starting next week, as part of an ongoing study.

Medical authorities are not recommending this therapy just allowing studies to go ahead. Doc James (talk · contribs · email) 10:27, 29 September 2010 (UTC)

Speaking of POV, people who have a personal interest in CCSVI should have a look at WP:COI. Having a conflict of interest doesn't mean you can't edit wikipedia, but they should serious reconsider it if their edits are driven more by a desire for something to be true rather than relying on reliable sources. --sciencewatcher (talk) 12:02, 29 September 2010 (UTC)

Yes, true. It looks like honorable Doc James tries to present the Kuwait case as only research trial contrary to what is clearly written in the source he cites. And there is written, I quote "But after review, and submissions from physicians and patients, the decision was to allow the treatments, which will be covered by the state-financed medical system ... Patients who agree to treatment will be part of an ongoing study that will be done in cooperation with a Kuwait neurologist."</ref name="Kuwait"> That means treatment is first (in Kuwait), research is collateral. Therefore this should be in the treatment section. Sergei Gutnikov (talk) 12:21, 29 September 2010 (UTC)

I do not see the support in the ref for "recommended by the medical authorities" Plus this is a newspaper and not that reliable of a source to begin with. Doc James (talk · contribs · email) 12:22, 29 September 2010 (UTC)

Look again more carefully. "Kuwait's minister of health has given interventional radiologists in the country the go-ahead". Isn't a minister of health a governmental authority? And for political decisions a newspaper is a reliable source accepted by Wikipedia. If another newspaper says the opposite, both views should be presented. Sergei Gutnikov (talk) 12:30, 29 September 2010 (UTC)

That is not the same as recommended the procedure to treat MS.Doc James (talk · contribs · email) 12:33, 29 September 2010 (UTC)

There is no reason to believe this is not a reliable source: it is a newspaper, and therefore it can be used as a source for non-medical statements and news. The fact that Kuwait government is going to pay CCSVI treatment is not a medical claim but an economic one. NOW, on the other hand I fully agree that the fact that they are going to pay for CCSVI treatments is not the same that they recommend them. We should stay closely to the source and say something like "Kuwait is the first country to permit interventional radiologists treatment of CCSVI in multiple sclerosis and cover its costs through the state medical system".I hope we all agree with this wording.--Garrondo (talk) 12:44, 29 September 2010 (UTC)

Changed already. Not it's time to remove POV. Sergei Gutnikov (talk) 12:47, 29 September 2010 (UTC)

(undent) The procedure is being performed without official sanctions in at least 40 other countries.Doc James (talk · contribs · email) 12:55, 29 September 2010 (UTC)

I agree with Doc James - we shouldn't be twisting a news story to say something it does not say. I'm not sure if we can even say it is the 'only country', as I'm pretty sure there are other countries allowing the procedure (where are all these Canadian patients going?) Oh, and my comment about conflict of interest was aimed at Sergei, not Doc James. --sciencewatcher (talk) 13:00, 29 September 2010 (UTC)

Pardon me? What conflict of interest? Why personal accusations? Please apologise. Sergei Gutnikov (talk) 13:06, 29 September 2010 (UTC)

The fact that Kuwait is allowing the procedure as a trial needs to be stipulated. Doc James (talk · contribs · email) 13:21, 29 September 2010 (UTC)

You are trying to misinterpret the source. It says, as I quoted above, that treatment is allowed (on its own). However, since treatment is made anyway, it will be also used as a trial. Of course, we can stipulate that, if it is important. Sergei Gutnikov (talk) 14:13, 29 September 2010 (UTC)

You admitted yourself that you were present at a procedure. That is a conflict of interest. Whether or not it affects your editing is another question. I'm not insulting you or trying to cause trouble, just calmly pointing out some facts - please assume good faith! --sciencewatcher (talk) 15:47, 29 September 2010 (UTC)

Oh, really? If I was present at a conference and saw patients and the procedure in a clinic as a visiting doctor, I have a conflict of interests? Or maybe I just have more of interest in the procedure than many of people who discuss what they have not seen? And this interest makes me to move my a make an effort and actually go and see it? Who of my opponents actually saw the procedure and talked to the patients before and after? Doc James hasn't. You? Garrondo? Sergei Gutnikov (talk) 15:59, 29 September 2010 (UTC)

Talk pages are for improving the article. Stop this unconstructive conversation or take it to one of the user talk pages of editors involved.--Garrondo (talk) 17:18, 29 September 2010 (UTC)

Incorrect. If an editor's behaviour is affecting the article then it is appropriate to discuss it on the talk page. See WP:DUCK. Sergei appears to have a close personal involvement with CCSVI, which is a WP:COI. --sciencewatcher (talk) 17:36, 29 September 2010 (UTC)

I worked with people with MS for two years. I have a COI. Doc James is an emergency doctor and sees people with acute attacks of MS. He has a COI. Now that we all have a COI lets center in how to 1-RELAX and STOP ASSUMMING BAD FAITH 2-IMPROVE THE ARTICLE.--Garrondo (talk) 17:47, 29 September 2010 (UTC)

I am not sure a bias is necessarily a WP:COI, although there is a red line lying somewhere in a grey area.--Literaturegeek | T@1k? 19:48, 29 September 2010 (UTC)

(outdent) I read the source, and my interpretation of it is that people living in Kuwait who have chronic cerebrospinal venous insufficiency can receive an experimental treatment as part of a clinical trial. As it was experimental and also because of financial costs, governmental approval wass required from the national medical department over there.--Literaturegeek | T@1k? 19:48, 29 September 2010 (UTC)

To conclude on what I said above, I do not think that it should be described as a treatment as it is part of a clinical trial. If the results are positive, then we can describe it as a treatment. Lets wait for the outcome of the research in Kuwait.--Literaturegeek | T@1k? 18:20, 2 October 2010 (UTC)

Read the source again. It is treatment first. Trial is collateral. So it is a treatment. Even experimental treatment is treatment but here it is not declared as experimental. Sergei Gutnikov (talk) 19:27, 2 October 2010 (UTC)

Experimental treatment as part of a clinical trial. It is not an approved treatment outside of research settings.--Literaturegeek | T@1k? 21:57, 2 October 2010 (UTC)

Here is a direct quotation from the source: after review, and submissions from physicians and patients, the decision was to allow the treatments, which will be covered by the state-financed medical system.</ref name="Kuwait> Please give a direct quote which states that the treatment is only experimental in Kuwait. Sergei Gutnikov (talk) 07:16, 3 October 2010 (UTC)

At least the point of view of the journalist and the intention of the article (and therefore in the sources we have, independently of reality) is to say that it is admitted as treatment in Kuwait. It only comments on the trial secondarily. It would be great to have other sources in the issue to contrast info: I do not feel completely comfortable to base the statement in a single western source on a piece of news in an eastern country and a highly mediatic and controversial area. However, right now is all we have. I believe we are following the source here.--Garrondo (talk) 06:14, 4 October 2010 (UTC)

Practical petition to editors

After the outburst of editions of last week I am taking a look at the article and I find at least 3 references completely unformatted. Since all major editors of this page are experienced it would be great if we all made the effort of correctly formatting all sources we added. I know that diberris tool makes it really easy for pmid works but if we add a web site we should take the time to hand-complete the cite template. Otherwise there has to come somebody afterwards who does it. While I admit that in the middle of an almost-edit-war is difficult to think about formats another possibility is that editors come back soon after to fix their additions. Anyway I'll try to format existing references today. Thanks in advance to everybody and happy editing.--Garrondo (talk) 06:31, 4 October 2010 (UTC)

There is no sense to bother about meticulous formatting when somebody comes and deletes the input. Waste of time. So, formatting is important but only when there are no deleteists around. Sergei Gutnikov (talk) 09:05, 4 October 2010 (UTC)

Formatting makes easier to check references and therefore increases both reliability and usefulness of the article. Do not take it as a personal attack. You have not been the only one to do it: it seems that I am the only one doing this job.--Garrondo (talk) 09:13, 4 October 2010 (UTC)

Question on English grammar

I am Spanish, so not sure about this. I'll want opinion from those with English as mother language. In the following sentence: In 2010 conflicting results of evaluating the relationship between MS and CCSVI were published the OF sounds really awkward to me. Is it the correct preposition? I believe that earlier versions (maybe wrongly written by me :-) said when evaluating. Which one is more accurate? Is there any other way of saying it? --Garrondo (talk) 08:46, 4 October 2010 (UTC)

"Of" is okay here. Sergei Gutnikov (talk) 08:58, 4 October 2010 (UTC)

The grammar sounds bad to me, but I can't think of a better way right now. Any suggestions? --sciencewatcher (talk) 09:12, 4 October 2010 (UTC)

Observations on CCSVI Disputes

It seems lost on everyone that nearly all disputes of connections between CCSVI and MS arise in the neurology medical community and not the vascular medical community. All you must do to find weakness in the September 2010 Annals of Neurology study is to read the spate of blog responses by MSers posted immediately after the study came out. Most notably, neither the German nor the simultaneous Swiss study followed through with Zamboni's rigorous course of examination. I was left wondering why two supposedly important studies were conducted primary by neurologists and NOT primarily by vascular doctors. Meanwhile, it seemed rather convenient that both the German and the Swiss study broke simultaneously to three MAJOR US papers (WSJ, LA Times, New York Times) and also that many doctors conducting the German study have significant connections to mega-pharma. The current market for interferon is in the billions; and massive cash flows are at stake should MS prove to be primarily of vascular origin as opposed to immunological origin.

The connection between CCSVI and MS will be confirmed very shortly anyway because IRBs are cropping up with FSIRs all over the country; and FSIRs are beggining to conduct studies of their own in all corners, using catheter venograms which are far more efficacious than doppler. Buzz currently is that percentages are anywhere from 94 to 98% (; and the only questions remaining are not IF an MSer has CCSVI but how it has been missed or where it is hiding.

I find it rather curious that this Wikipedia article characterizes the Buffalo study as "partially conflicting with those of Zamboni" even as the Buffalo Neuroimaging Analysis Center itself finds its own discoveries compelling enough to plow rapidly further with deeper examination: http://www.medhelp.org/posts/Multiple-Sclerosis/received-this-newsletter-from-Buffalo-Neuroimaging-Analysis-Center-re-CCSVI/show/1166246

The only other REAL question as of 10/2010 for CCSVI is the efficaciousness angioplasty and stenting. Simply go back to Zamboni's numbers (which should have been published in this Wikipedia esp. if you are going to publish Buffalo's "conflicting" numbers) for current efficaciousness of angioplasty. What needs to be researched is NOT the connection but how, rather, to get jugular stents to work. Additional research as to a possible congenital link with malformations, etc, needs to be performed. We need to understand WHY, not if, the veins are collapsing and malforming.

As for remaining calm, I do not have MS; but try telling that to the millions of patients who have MS and are following this topic closely. I have someone very close who has MS. They don't have time to dilly dally when much is known; and I can say from following CCSVI closely; and digging into all that is public for the past year...This Wikipedia article does not remotely do the topic justice and I am scratching my head and wondering why. MSers already know far more than this article posts...and the article comes across to me as PR to create doubt. The reverting of studies on and off in this Wikipedia article is disturbing. No one with MS comes here for information on this...

They don't have time to dilly dally when much is known - I support this wholeheartedly. If we were discussing removal of a bening wart, we might recommend to wait for years of trials. To force the MS patients with progressive disability to wait is unethical. A medical practicioner should not encourage an unproven though potentially beneficial method, but for those patients who are determined to get it, making deliberate obstacles is not right. As SRI says (blockquote in the article), the decision should be made by the patients, their relatives and family doctors. Sergei Gutnikov (talk) 18:25, 27 September 2010 (UTC)

Here at Wikipedia we quote reliable sources. This is not the feelings of said sources. Doc James (talk · contribs · email) 20:31, 27 September 2010 (UTC)

Here at Wikipedia we also, in accordance with WP:MEDRES, "Use independent sources. Many medical claims lack reliable research about the efficacy and safety of proposed treatments, or about the legitimacy of statements made by proponents. In such cases, reliable sources may be much more difficult to find and unreliable sources can often be more readily available. Whenever writing about medical claims not supported by mainstream research, it is vital that third-party, independent sources be used. Sources written and reviewed by the advocates of such marginal ideas can be used to describe notable personal opinions, but extreme care should be taken." Sergei Gutnikov (talk) 21:40, 27 September 2010 (UTC)

We are not commited to give every piece of unbalanced, unreliable info to MS patients so they can find their closest surgery room to insert themselves a stent. The fact that that kind of info is lacking in wikipedia is a strenght and not a problem: there are thousands of MS blogs for that. We are building and encyclopedia here based in reliable sources, based in what we know and not in what we hope.--Garrondo (talk) 07:07, 28 September 2010 (UTC)

We have reliable sources that say the benefits are not yet determined and thus the procedure is not recommended. We do not get to refute this because we believe differently or can provide primary sources. BTW we have socialized medicine up here in Canada. These claims of conspiracy are funny. Doc James (talk · contribs · email) 07:14, 28 September 2010 (UTC)

For anecdotal evidence: I just visited an fsir clinic in the u.s. run by an ivy league, magna cum doctor who completed his eleventh procedure on a close relative of mine (Last week of 9/10). The point, quite simply: Out of 11 patients to that date he uncovered 11 stenoses using catheter venogram which is the widely acknowledged "gold standard." All studies that do not use catheter venogram are subject to potential false negatives. Debating correlations between MS and Venous malformations is wasting precious time. If you want to approach this topic from a truly knowledgeable angle: read everything you can find on doctors like Sclafani who have rapidly discovered subtle false negatives. Even healthy-looking azygous veins turn out to have hidden stenoses upon close scrutiny. Also, my relative experienced the sudden ability to perform functions with a leg that had shut down over a two year period due to secondary progressive MS. Anecdotal, yes, but any neurologist worth his salt will quickly admit that secondary progressives do not suddenly have remission of serious symptoms.

This wikipedia article would do well to view ANY studies that do not utilize catheter venograms with skepticism. That is the bottom line. Doppler is so vulnerable it is not even funny. MRV's are subject to false negatives as well.

Angioplasty and stent treatments are certainly debatable.

Re: Socialized medicine/funny conspiracy theories - A socialized system in no way prevents commercial interests (big pharma) from seeking any and every possible public, policy, press, or other outlet to fund/spin support of 10-digit+ revenue streams. Big pharma wants to sell medicines worldwide to both capitalist and socialist patients. The more permanently chronic the better. "Conspiracy theories" are always valid when these kinds of dollars are at stake. Indeed "conspiracies" as phrased, are to be expected. E.G. Kansas is not known as a petroleum hot-bed; and yet the Koch brothers, two of the richest people in America, (http://en.wikipedia.org/wiki/Koch_brothers) whose empire was inherited as a result of daddy's dealings with socialist Russia...actively fund research intended to undermine the notion of global warming >> And any political activity to help avoid paying taxes. They pay for the outcome. That is simply how money that big works. Interest in pure profit knows no political boundaries as the generational heritage quickly demonstrates. What is funnier: To assume that scientists are never swayed by funding sources. BP actively sought contracts (with aggressive control over information release) with every marine biologist they could get their hands on from Miami to the Texas/Mexico boarder immediately subsequent to the spill...that was reported all over the media. Why on earth would you suspect big money would behave any differently here? Again, Doepp was funded. Avonex's retail price went up 386% over 11 years (Over 13% annualized). Costs did not grow anywhere close to that rate. That behavior was extremely typical across pricing of ALL Multiple Sclerosis interferons/therapies (Tysabri, etc). The prices are leaning hard on desperate people. For big pharma, the game is simply supply/demand and doing anything possible to encourage the massive revenue streams. The point that seems quite lost in a debate like this: Just how large those streams are. As though people don't have a clue how much money is at stake. The pressures to sustain are enormous. Don't kid yourself.—Preceding unsigned comment added by BillySpilly (talk • contribs) 16:35:35

Is there an edit proposal in there somewhere? LeadSongDog come howl! 16:46, 5 October 2010 (UTC)

Reflections on First or only?

While a reference we have says that Kuwait was the first I believe that it is better to say that it is the only one. Reasons: They say it was the first, but we (editors) have not read of any other country so it is most probably the only one so far. We have another source that says "But while the procedure is conducted in private clinics in more than 40 countries worldwide, and is available through the public health care system in Kuwait, it is currently unavailable in Canada." We do not talk about the other 191 countries in the world. Since we have not found any indication that it is paid we can assume by default that it is not paid. It sounds really ackward for the reader as it is now since he is left with the doubt over all these other countries. What are we suppossed to do? Find a source for each country that does not finance it? Do not say anything on these countries until we have a source for each of them or a general source? Since the second source is a Canadian newspaper can we assume that what the journalist intends to say is that it is the only one? To get rid of the sentence about Canada would be great, but only possible if we generalize to Kuwait being the only.--Garrondo (talk) 16:25, 29 September 2010 :(UTC)

We shoud say "first" because this is what the source says. "Only" would be our original research. We do not have any source, reliable or not, that says "only". As for sentence about Canada, I think it doesn't go well here (precisely because it makes Canada outstanding of 191 other countries). But it will go well to the section about Canadian research, in the very beginning. I propose to move it there. Sergei Gutnikov (talk) 16:44, 29 September 2010 (UTC)

Disagree: from my point of view this is the place to say than Canada does not support it(exactly the same as it is said that it is supported in Kuwait) UNLESS a more general statement is found. I still believe that we can say "the only" based on the second source and common sense. If there is no agreement to say "only" then we will have to continue adding sources to countries that do not support it until a general source is found.--Garrondo (talk) 17:13, 29 September 2010 (UTC)

We cannot say "only". What reliable source are you going to quote? If none - it will be original research that is not permitted. And it changes the flavour: "first" may be taken as "one of many forthcoming", "only" may rather imply "the odd one, out of step". Therefore we have to stick with the source. As for Canada, you can add other countries that do not allow this procedure but this would look quite strange as Canada looks in this paragraph now. Sergei Gutnikov (talk) 20:33, 29 September 2010 (UTC)

I will not pursuit this issue more, while I believe that sources implicetely say a thing explicitely they do other, so if controverted we have to stay at the explicit level.--Garrondo (talk) 22:05, 29 September 2010 (UTC)

The Canada Health Act doesn't dictate which medical procedures a province's health insurance plan will fund, that decision is made at the provincial level. It is extremely unlikely that all provinces will agree on whether or not to fund procedures for CCSVI. They rarely agree on anything controversial. At present it seems Saskatchewan is the most likely to fund them. LeadSongDog come howl! 05:32, 5 October 2010 (UTC)

Misinterpretation of Khan et al source as secondary

"As a form of treatment, outside the trial setting, these procedures are not currently recommended." ). Actually we have a problem with citing this sentence. I've checked the source and it is the opinion expressed by Khan and co-workers, so it is a primary source (for this sentence), not a secondary review. Should be deleted or used with extreme caution. Sergei Gutnikov (talk) 13:20, 29 September 2010 (UTC)

Huh? Doc James (talk · contribs · email) 13:24, 29 September 2010 (UTC)

That is precisely the aim of a review: review and balance sources and produce some form of conclusion from them. That is their conclusion from their review and is a valid one as a secondary source.--Garrondo (talk) 13:27, 29 September 2010 (UTC)

No. The review validates the primary sources (it's not just Dick's opinion, but Tom and Harry have read it and included in their review of the subject, with comments and analysis). But here we have Khan et al who said that and nobody has yet verified that their conclusion is correct. Sergei Gutnikov (talk) 13:46, 29 September 2010 (UTC)

This is not the usual interpretation. You can ask at WP:RS though if you disagree. Doc James (talk · contribs · email) 13:51, 29 September 2010 (UTC)

Why is Khan referenced twice? ref 1 and ref 16 are the same. An article on CCSVI and the first reference to Khan makes the article unbalanced big time! First put up the reference to the Zamboni work, the rest follows Alphons1968 (talk) 14:51, 10 October 2010 (UTC)

Keep it short?

Since the article I have posted is a secondary review which concludes 2 very different things, being both relevant to the article there is no reason to leave one out, much less this reason being simply a "keep it short". To ommit one of such conclussions is to have a NNPOV. There is no policy that says something like "keep it short even if with it you eliminate important info". Is it? We have a reliable source which especifically concludes: "evidence linking it to increased iron in MS is lacking". Conclussion is extremely relevant to the article.--Garrondo (talk) 12:11, 4 October 2010 (UTC)

I have asked for comments in the medicine project talk. Lets hear others opinions. --Garrondo (talk) 12:52, 4 October 2010 (UTC)

Garrondo, please also explain why you fantasised about "CCSVI defendants". I think it shows your biased attidude. Sergei Gutnikov (talk) 13:57, 4 October 2010 (UTC)

I think that he meant "defenders of CCSVI". A simple error of English usage, not a fantasy. This is not his first language, and that is a subtle distinction. For future reference, Garrondo, "defendant" is used in English almost exclusively in the context of the courtroom to describe a person who has been charged with an offence and who is mounting a legal defence. LeadSongDog come howl! 16:22, 4 October 2010 (UTC)

It's not about a syllabus, its about Garrondo's selective criticism of any evidence in favour of CCSVI hypothesis. Criticism of defenders (of whatever), when it is not present in the source, is taking sides and a biased point of view by definition, isn't it? Sergei Gutnikov (talk) 18:20, 4 October 2010 (UTC)

First: As pointed already my choosing of the word defendant has been completely unintentional, it is great to learn the difference between both words. The word "defensores" is used in both cases in Spanish. Secondly, if you took a look at my last edition BEFORE reverting it you would see that I said nothing on defendants or defenders. I simply paraphrased the two conclussions of the article and you still reverted it to leave only one of them (the one favoring your position?). Who is being biased here? Stop doing personal attacks on me (even if disguished with irony) and give a reason for reverting that edition in addition to brevity since you have not done it yet. We want to know why do you oppose the edition, not why you do not like me.--Garrondo (talk) 20:09, 4 October 2010 (UTC)

"Defendants" was unintentional, nobody arques with that, but you added a passage about "defenders" which was not in the source. When suggesting to add two conclusions you ommitted the first one (of three, not two!) which is "CCSVI is an interesting hypothesis". But you don't like anything that says anything positive about CCSVI, do you? By the way, that source is an editorial - can an editorial be considered a peer-reviewed article? But the whole story of iron deposits can be safely limited to two sentences: 1) Zamboni suggested it as a pathophysiological mechanism; 2) there are evidences that it is more complicated than that. For details a separate article can be created if necessary. Sergei Gutnikov (talk) 20:59, 4 October 2010 (UTC)

Once again, you attribute a POV to a fellow editor: "you don't like anything that says anything positive about CCSVI". Please stop this, it is completely unnecessary as well as incivil. We would all love to have reliable sources saying that CCSVI has been shown to cause MS and that a simple surgery can cure it. Right now we don't have such reliable sources. That isn't anyone's fault. Those sources simply don't exist at this time. If/when they do, we will be delighted to use them. LeadSongDog come howl! 05:16, 5 October 2010 (UTC)

To Sergei:

1-No: creating such an article would be simple content forking. There is no need for that since we only have 3 references for it and it is hardly a notable subject. Its place is this article. It has only been discussed in the context of CCSVI and its place is the pathophisiology section.

2-The usefulness of editorials has been discussed several times in the reliable sources noticeboard. Conclussion is usually that they are half way between a primary and secondary source (Experts in the field review an article and they locate it into a broader context; although they are not a complete literature review).

3-It is clearly useful in this case in which experts talk specifically about the pathophisiology mechanism of CCSVI and its level of evidence. Moreover since CCSVI is still a theory under evaluation which has been sparsely reviewed it is one of the few non primary sources we have (and the only one on the mechanism). As soon as there is a higher quality source I will add it (Every week I type CCSVI in pubmed, that is how I added these sources).

4-You continue talking about the defenders issue, which I dropped a long time ago: My last proposal was: It has been concluded that evidence linking CCSVI and iron deposition is lacking, and that dysregulation of iron methabolism in MS is more complex than simply iron accumulation in the brain tissue. It follows exactly the conclussions on pathophisiology of the article. All reason given for elimination was keep it short.

5-Up to this moment you have not given any reasons to opposse my edition. Criticism should be of the edition and not the editor (On the other hand you have done plenty on the last one).

6-Regarding the conclussion on the interestingness of the theory as a conclussion of the editorial: its place is clearly not the pathophisiology section (it is not about pathophisiology of CCSVI but about CCSVI theory in general). We can discuss if there is a place for it in other sections of the article, but that nonetheless is a different discussion to this proposal.

--Garrondo (talk) 06:53, 5 October 2010 (UTC)

We have seen it before, I totally agree on Sergei we have to add more information on the subject in favour of deleting stuff. For example mentioning the latest "research" on not finding a relationship between Iron deposits and CCSVI is great, was extremely fast put in in here, but you also have to add the proof of prof. dr. Haacke and prof dr. Zamboni where they state researchers have to look for Hemosiderin and not for Ferritine.... I hope this makes things clear. We don't have to judge findings, or be smarter than researchers. Try to avoid making the article pre-biased by not mentioning the other information also or making conclusions in absence of or deleting by that useful other information. The Ferritine ref. shows the problem. Alphons1968 (talk) 14:23, 5 October 2010 (UTC)

Do you have any reliable sources on them saying it? I have not found anything similar searching for articles in pubmed. Nevertheless still nobody has given any reasons to leave out the conclusion from the editorial, which is the specific question why I created this subsection. We can discuss any other inclusion or deletion in a different thread.--Garrondo (talk) 14:32, 5 October 2010 (UTC)

Due to lack of time I hoped you all would check them out :-) Some fast google results on this Characterizing iron deposition in multiple sclerosis lesions using susceptibility weighted imaging and Urine hemosiderin: a novel marker to assess the severity of chronic venous disease hope it will contain enough iron else I have to dig around again Alphons1968 (talk) 14:41, 5 October 2010 (UTC)

The reason for User:Garrondo: Haacke et al showed evidence. Then, the editorial that says "lacking evidence" only shows that the authors of that non-peer-reviewed editorial at the time of writing their article lacked the evidence. The evidence is published by Haacke et al and is now duly cited in this Wikipedia article. However, the second conclusion from the editorial, that the iron issue is complicated, is not refuted by any sources. Sergei Gutnikov (talk) 14:44, 5 October 2010 (UTC)

Time frame goes against your reasoning: Haacke's article is from april, and the editorial from 3 days ago. The fact that authors think there is no evidence is even more relevant since it comes AFTER Haackes article. I agree with you that Hacke and the editorial say different things, but disagree with you that only the uncontroverted statement should be in the article: the editorial is a valid reference here (as it is Hackes) and both should be in the article. The fact that two sources oppose is no valid reason to eliminate a conclussion from one of them unless there is a clear supperiority on reliability of one of them (which does not occur here: one is older and a primary source, although peer-reviewed. The other is a secondary source, specifically a review by experts in the field, newer, but only editorially reviewed) --Garrondo (talk) 17:16, 5 October 2010 (UTC)

I believe this study was started 3 years ago. An older (1999) study Ferritin, transferrin and iron concentrations in the cerebrospinal fluid of multiple sclerosis patients concluded Ferritin levels were significantly elevated in the CSF of chronic progressive active MS patients (4.71+/-0.54 ng/ml) compared to levels in normal individuals (3.07+/-0.17 ng/ml). A study of Zamboni on Inflammation in venous disease was about red blood cell extravasation and either dermal hemosiderin deposits or iron laden-phagocytes. Not Ferritin but Hemosiderin! An earlier study of Zamboni titled Urine hemosiderin: a novel marker to assess the severity of chronic venous disease showed it was in the urine, not the spinal fluid. The conclusion of the researcher that normal levels of Ferritin in spinal fluid suggest against an etiologic role of chronic venous insufficiency is therefore improper and incorrect. If you look at the data, there is an increase of Ferritin levels within MS patients, the same increase the researcher at the University of Kansas reported. The problem is this study looked for the wrong bio-marker at the wrong place and they want to use this to target CCSVI?! Maybe for the time being it is better to delete it. Alphons1968 (talk) 01:08, 7 October 2010 (UTC)

The above comment may have missed the point in the LeVine et al. 1999 study conclusions, that ferritin levels in CSF can "distinguish between chronic progressive and relapsing-remitting MS", being elevated in the first group but normal in the second. LeadSongDog come howl! 05:17, 7 October 2010 (UTC)

Moreover the sentence The conclusion of the researcher that normal levels of Ferritin in spinal fluid suggest against an etiologic role of chronic venous insufficiency is therefore improper and incorrect is a clear OR research by an editor, unless we have a secondary source that states specifically that such specific conclussion is wrong.--Garrondo (talk) 06:37, 7 October 2010 (UTC)

I would also like to know what do you mean with "duly" cited. Are we not following the source? What changes do you propose? (I have to add nevertheless that this is a separate issue)--Garrondo (talk) 17:16, 5 October 2010 (UTC)

Nevermind on this one: I hope it has been fixed with my new proposal.--Garrondo (talk) 06:56, 7 October 2010 (UTC)

Trying to move forward on pathophysiology

Trying to move forward I have changed the paragraph to: Relation between venous pressure and iron depositions in the brain in MS patients was found in a neuroimaging study. According to its authors this finding gave credence to Zamboni's theory of CCSVI originating MS.[17] Another work found normal ferritin levels in the cerebrospinal fluid of MS patients stating authors that this would not support CCSVI to have a role at the origin of MS through iron deposition.[18] It was later concluded by others that evidence linking CCSVI and iron deposition is lacking, and that dysregulation of iron methabolism in MS is more complex than simply iron accumulation in the brain tissue. It is not short but gives similar weight to all sources, and makes clear that there is no consensus as it adscribes conclussions to specific authors and not the medical community. I hope it satisfies all involved editors since it closesly follows all sources we have on pathophisiology.--Garrondo (talk) 17:44, 5 October 2010 (UTC)

Can you keep it shorter? We are writing a popular encyclopedia, not a review for a scientific journal. Spelling: pathophysiology. Sergei Gutnikov (talk) 22:02, 5 October 2010 (UTC)

Sorry about spelling: that is one of those words that I know I misspell every time I write it but if I am in a talk page I usually do not bother to check if I did it correctly. Regarding shortiness: We can try, but the shorter it is the easier somebody thinks it is biased. I am open to suggestions on summary style here since I am not sure on know how to do it. Nevertheless the pathophysiology section is not too long right now so I do not feel it is a big problem. Moreover what I think that is too long is the paragraph in the genetic study: I doubt any lay readers understand a single word (I barely do) or are interested in all the names of all the genes that were obtained. Being a primary study we could make it shorter and easier to understand.--Garrondo (talk) 06:41, 6 October 2010 (UTC)

The "normal ferritin levels" is definitely not true, see my earlier statement about it. It is better to skip it, or make a remark on the improper and incorrect conclusion, but the latter is up to other researcher, not to us :-) Alphons1968 (talk) 01:15, 7 October 2010 (UTC)

Completely disagree: The source especifically says "normal ferritinn levels" so it is verifiable, and we can not decide whether it is true or not since they are all primary sources and we have no reviews on the issue we can only state exactly their conclussions.--Garrondo (talk) 06:31, 7 October 2010 (UTC)

I know you are quoting the conclusion. But the research is not related to CCSVI, as I clearly showed (OR), so why are you putting it on WP? Because the researcher said so? You already added a link to the press-release of the same group ?!, "VU Medical Center (17 June 2010)". Do you want some links to facebook where this new research is targeted? Maybe it is better to delete this part and see what other researcher have to say about the conclusions so it gets more balanced. Alphons1968 (talk) 11:10, 7 October 2010 (UTC)

1-Not because the authors say it: the authors say it and the reviewers of the article have not disagreed, exactly as it happens with the Haacke's article (Hacke et al. say that their results give credence to the CCSVI theory, while it is only a study on MS patients, so it could be said that it is not related to CCSVI. Situation between both articles is similar) Do you have any reliable source specifically stating that it is not related to CCSVI? . Since both articles appear in a peer-reviewed journal we can use such sources (with care), until a higher quality source reviews existing literature. 2-What I had not noticed is that this article had been done by the same authors than the press release. The press release was there (research directions) until something more formal appeared (similarly to the Buffalo press release), so I will check it out and eliminate it from the research directions section. Thanks for pointing it out. 3-Facebook is clearly not a reliable source for any kind of medical claims. You should find a reliable source specifically targeting this new research: a reliable source saying specifically that searching ferritin in CSF of MS patients is not relevant for the evaluation of the CCSVI theory. Until we have such source the article is as valid and notable as all the other primary studies of this article. If you still disagree you can go to the reliable source noticeboard and ask there about the reliability of its conclussions.--Garrondo (talk) 13:08, 7 October 2010 (UTC)

Press release and article have nothing in common except they are from Amsterdam: one talks about ferritin in CSF, the other about veins with venography. Any indications that they are talking about the same results?--Garrondo (talk) 13:18, 7 October 2010 (UTC)

The critical article of Kahn et al. was co-authored by Barkhof (VUmc, Amsterdam) and special thanks were added to Polman (VUmc, Amsterdam). The press release was of VUmc, Amsterdam (Yes they are the same people working ar VUmc, Amsterdam). The "ferritin in CSF" research was co-authored by Barkhof (VUmc, Amsterdam) and Polman (VUmc, Amsterdam). A few weeks ago prof. dr. Rohit Bakshi of Harvard University confirmed Iron in CNS in respect to CCSVI. He has done 10 year of research Iron in Chronic Brain Disorders: Imaging and Neurotherapeutic Implications and agreed on Zamboni's CCSVI. This it is verifiable by the Sclérose en plaques : nouvelle confirmation de l'hypothèse Zamboni, and we can not decide whether it is true or not since they are all primary sources and we have no reviews on the issue ;-) Alphons1968 (talk) 13:07, 8 October 2010 (UTC)

I was not asking if they were the same people (they are skeptikal towards CCSVI, but that does not invalidate their articles, as it does not invalidate Zambonis), but if it was the same study, and it does not seem so. Regarding your piece of news: that is not a reliable source for a medical claim since it is a newspaper writting so we cannot integrate it in the article. We should wait until they publish something in a peer-reviewd journal (I mean something specifically talking about CCSVI).--Garrondo

On the "that is not a reliable source" I disagree, mainstream newspapers, electronic media may also be used, subject to the same criteria WP:V. I say it again, we don't have to agree on the work, but because of WP:NPOV it must be balanced. Also we must add Breakthroughs in Imaging Neurovascular Diseases from GoogleTechTalks. The presentation from prof. dr. Haacke had special attention for iron and supports Zamboni's work. It is clearly WP:V. It balances the view of the Ferritin researchers. Alphons1968 (talk) 15:15, 10 October 2010 (UTC)

(talk) 14:51, 8 October 2010 (UTC)

Consensus is that they are not reliable sources for medical claims. If you disagree place for discussion is not this article talk.: From WP:MEDRS: The popular press is generally not a reliable source for science and medicine information in articles. Most medical news articles fail to discuss important issues such as evidence quality, costs, and risks versus benefits,[6] and news articles too often convey wrong or misleading information about health care.--Garrondo (talk) 17:34, 10 October 2010 (UTC)

>A Google talk in you tube is even less reliable: to begin with it has a disclaimer stating that it contains solely the opinion of the author... Stop wasting our time bringing unreliable sources and wait until they are published (they eventually will be if they are really so important). I would also recommend you read all through WP:MEDRS. --Garrondo (talk) 17:41, 10 October 2010 (UTC)

Don't miss the point here! WP:NOR So if we are allowing the Ferritin information on WP, which is clearly WP:OR than we have to balance it out. Else remove the information. The CCSVI article is full of WP:OR. We are getting in trouble of the WP:NPOV So, it is better to allow also other information on the iron subject. Neutral point of view (NPOV) is a fundamental principle of Wikipedia. All Wikipedia articles must be written from a neutral point of view. This means representing fairly, proportionately, and as far as possible without bias, all significant views (!!) that have been published by reliable sources. This is non-negotiable and expected of all articles and all editors. Alphons1968 (talk) 11:31, 11 October 2010 (UTC)

I think the Googletalk Breakthroughs in Imaging Neurovascular Diseases is interesting, relevant and presents plenty of illustrative pictures. A link to it, as a source of that material, will not make harm to the article (and - yes, it complies with WP:MEDRS#Use_independent_sources). Our honorable colleague Garrondo, you are free not to waste your time - nobody is forced to take part in the Wikipedia project. Sergei Gutnikov (talk) 14:41, 11 October 2010 (UTC)

Sergei, please stop using sarcasm and irony to attack other editors. It is not the first time you do it and I am quite tired of it.--Garrondo (talk) 06:48, 13 October 2010 (UTC)

Regarding the link: it is not a reliable source per WP:MEDRS since it is only the opinion of an expert in a non peer reviewed source (it is specifically stated at the begining). Therefore has no place in an enclyclopedia, although it would surely be of use at a CCSVI site (which this is not). Nevertheless Haacke would surely publish his results and or opinions on CCSVI in a journal sooner or later and then we will be able to use them.--Garrondo (talk) 06:48, 13 October 2010 (UTC)

Yes, it is a reliable source. Read the WP:MEDRS#Use_independent_sources, it clearly states Whenever writing about medical claims not supported by mainstream research, it is vital that third-party, independent sources be used. Sources written and reviewed by the advocates of such marginal ideas can be used to describe notable personal opinions. And as using this source add valuable information to the article, there is no harm in adding it. Sergei Gutnikov (talk) 12:43, 13 October 2010 (UTC)

I would say that CCSVI is mainstream research of a non-mainstream theory: Proof is the numbers of works on the issue that have been published since Zamboni's initial report. I do not feel there is really a need to have sources from non-peer reviewed sources, although it is true that Haacke is an expert, and most probably his opinion a notable one. Nevertheless, MEDRS also states the they should be used with extreme caution. How do you suggest it could be used to improve the article?.--Garrondo (talk) 13:06, 13 October 2010 (UTC)

It wasn't me, it was another editor who suggested to add that link to Google Talk. I watched the link and saw many interesting pictures shown in the talk. Other readers may find them useful too. Sergei Gutnikov (talk) 13:19, 13 October 2010 (UTC)

You in this case intended to be a plural. I completely disagree with using it to debunk a valid source in a peer-reviewed journal, but other specific uses can be discussed.--Garrondo (talk) 15:26, 13 October 2010 (UTC)

It has become a very scientific dispute. Wiki is a popular encyclopedia. I've structured this section and had re-written it in a more narrative way with a reader from general public in mind. Also started to popularise genetics - needs to be continued. Sergei Gutnikov (talk) 22:05, 8 October 2010 (UTC)

Sounds great to me: thanks for that, I tried to think of some way to do exactly what you have done but I was not able to summarize it without changing weight or balance. Good work.--Garrondo (talk) 10:04, 9 October 2010 (UTC)

Maybe we could change the focus of the paragraph to center on the discussion of the article and not so much in the results section (saying something similar to the discussion section in the abstract). This way we would not need to name every gene and would probably be easier to understand for non-experts. I'll try to create a proposal.--Garrondo (talk) 06:48, 13 October 2010 (UTC)

Lassmann

I'm not entirely sure we should be relying on a 1999 paper (Lassmann) for etiology when there are other much more current reviews, such as LeadSongDog come howl! 19:26, 5 October 2010 (UTC)

Well: it is actually used to reference that Reindfleisch noted vascular patholgy more than a hundred years ago in the history section so I do not really have much against this source due to its very specific use. On the other hand since we have two Lassman references for the same statement maybe we should stay only with the most recent one since it is equally useful. Nevertheless this is a different debate to my proposal so I will create a subsection so we can discuss each issue on its own time and place.--Garrondo (talk) 19:44, 5 October 2010 (UTC)

I agree with LeadSongDog that the most recent review should be mentioned. And on Lassmann I agree with Garrondo. Sergei Gutnikov (talk) 22:10, 5 October 2010 (UTC)

Eliminated oldest.--Garrondo (talk) 06:48, 7 October 2010 (UTC)