User talk:Buster23/PANDAS Discusion 1

Buster23 (talk) 00:26, 14 September 2009 (UTC)[reply]

Hey there

Sorry if Wiki is seeming a little hostile. This topic is surprisingly controversial, so is perhaps a difficult place to start editing! However, at least we agree on the overall framework and what type of sources we need. If you need access to journals that are pay-per-view I've got quite good library subscriptions at my institution, so e-mail me if you think I might be able to get something. Tim Vickers (talk) 20:29, 9 September 2009 (UTC)[reply]

Thank you Tim. I appreciate the offer on papers and will take you up on it if I get stuck. I realize you were an editor on the PANDAS article. It is taking me a couple days to wrap my head around how reporting three viewpoints is synthesis rather than representing the key points of view. Perhaps a bit of coaching here would help me rather than in the talk:PANDAS page. What would help me the most is to look at the ReferencesUsed section of Talk:PANDAS and help me understand how those primary citations are okay versus others. I appreciate that others feel there is no other viewpoint but the position that PANDAS is not a distinct subgroup of OCD and tic disorders and the hypothesis is wrong, but I'm struggling whether suppressing the contrary evidence and dropping all references to the proported positive results creates the desired WP:NPOV. Buster23 (talk) 23:30, 9 September 2009 (UTC)[reply]

PANDAS

Your recent edits are introducing synthesis, original research, plagiarism, linking and other manual of style errors, including typographical and footnote errors (... and/or compulsions,[1]. Some ...) Please read Talk:PANDAS and work towards consensus and a better understanding of Wiki policies and guidelines; it is a more effective way of editing than spending time on text that will likely be removed or reverted. I don't have time to contribute, as I am preparing to travel, but if I come home to a damaged article, without consensus on talk, reversion to the previously accurate (if incomplete) version of the article will be a possibility. I hope you will gain consensus for your edits, lest your work be lost. SandyGeorgia (Talk) 05:12, 9 September 2009 (UTC)[reply]

My goodness, you do swing hard (especially on a newbee to Wikipedia). You might not like my contributions, you might argue with them, but I'd really appreciate a discussion on the accuracy of the text, balance of positions, or the rules by which we're selecting references rather than the lashing out on accidental grammatical/posting errors. To call quoted and cited work plagiarism seems out of character especially for a very seasoned editor such as yourself.

I'll make typos -- sorry, I don't know all the WP keywords and policies yet, but I'll learn. For example, I started by asking about how references were determined and was surprised by the assertion that some surveys are better than others and some primary references are better than other primary references.

I get that you think there is no merit to the PANDAS subgroup. I even get how you reached that conclusion. I'm even okay with the conclusion of the article that states that at this time there isn't sufficient research to say that auto-antibodies cause OCD or tics and IVIG and PEX are dangerous and efficacy is unproven for the PANDAS subgroup. However, we can't ignore the research that says there is contradictory evidence here (especially papers published in Nature unless we have refutation papers in the same level of journal). It would be hard to claim that papers published in high quality journals like JNI and Nature represent minority positions.

I am very grateful for each of the pages you've pointed me to, and actually have read each page. However, it does take time to follow all the policies and guidelines of wikipedia. I'll learn how to keep my post clean, just bear with me. You'll find I am quite knowledgable on the PANDAS topic (though we might disagree as to what certain primary papers say or whether they are significant). Please try to keep your posts civil. I will.Buster23 (talk) 23:07, 9 September 2009 (UTC)[reply]

I linked elsewhere to a Dispatch on plagiarism; even when it's in the public domain, we shouldn't lift text directly from other sources unless we quote and attribute them. The paraphrase that was there before was actually a better method of developing text than lifting directly from other writers.

There was attribution to the source specifically with a citation after the referenced material. I've moved the citation foward 1 line, but all of that was intended as a direct quote. If there is a better way to indicate a definition, I'm all for it. The clinical identification is repeated in almost all papers on PANDAS (reviews or otherwise) and significant debate occurred between Kurlan and Swedo on each word. Reintepreting such a definition would be itself synthesis and original work particularly if it change in anyway the definition (which it did). Since the core of the debate is about the existance of the subgroup. Reinterpreting the definition is original work. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

Our personal opinions about PANDAS are irrelevant; Wiki articles reflect reliable sources, in this case, the best medical sources, which are typically the best and most recent reviews (of which there are many for PANDAS, so we should have no need to use other sources), but may occassionally (depending on the article and the text cited) be other sources ... see WP:V. Since I believe I've read every review written through mid-2008, it's easy to spot when the artile gets off track, although several of us have put off the much-needed completion of the article. Frankly, that has partly been because PANDAS is a fringe area that attracts tendentious editors with incomplete knowledge of PANDAS, who have several times in the past made work on that article very difficult, typically ending in a mass revert to the previous at least accurate, if incomplete and poorly cited text.

On the occasional typographical and WP:MOS errors, I typically have no problem correcting those myself while new editors are learning the ropes, but when edits also include synthesis, after you've been asked multiple times to develop text and consensus on talk, it's discouraging to have to also correct minor errors in text that never should have been added, particularly to the lead, which should be addressed once the full article is developed.

Hopefully you noticed that I started the discussion in the articles talk page before even touching the article by asking about the references, how they were chosen, and had read all the prior debate in the talk. From the log it appears that the editors at the time were not Wikipedia:Assume_good_faith. In my own case, the Wikipedia:BeBold recommends editing the article and discussing in talk. This was the policy I was following. The page recommends using talk pages first for community pages (which this isn't). I'm fine with trying this current method, but it will be cumbersome and slow. I, for example, would have liked to discuss how to represent the three viewpoints without synthesis rather than just pulling the text, but I also agree with one of the other editors that addressing the lead is something reserved for the end. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

I apologize that I haven't been more helpful in my specific commentary, as I'm preparing to travel for three weeks and just haven't had time to dig through my dozens of PANDAS review articles to address specifics, and am more than a bit concerned that, if you don't read more of the recent reviews (particularly the strong consensus rejecting or questioning every part of the hypothesis as proposed), editing is less likely to be productive, and more likely to need rewrite. It is not *I* that thinks there is no merit to the PANDAS hypothesis; we must reflect what recent reviews say, and if you read the literature, you'll find that the hypothesis has little support as formulated, every piece of the definition has been questioned by reliable reviews, although many researchers do agree that something autoimmune may be involved. Please try not to focus on your beliefs, rather reading reliable reviews.

I haven't expressed my beliefs one way or the other and do apologize for characterizing yours. If you find a paper you really don't think I've read, please send me a link. I am extremely familiar with most (all) of the primary work. I actually don't believe there is one "consensus" position on PANDAS. I suppose we could say that the only consensus is that it is controversial, but even then, the "what is controversial" is moving. As such, to match WP:NPOV we have to present the balance of the views. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

I don't know why you raised WP:CIVIL; perhaps you haven't read it? I've not been uncivil to you, although it did seem to take a lot of typing to get your attention and to get you to work with other editors before introducing text to a difficult and controversial topic.

I'm not sure what to say to that except Wikipedia:Assume_good_faith. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

I do apologize for my scattered and hurried posts, that most certainly may have appeared harsh and incomplete, as I haven't had time to dig in to my research drawer to answer your specific questions. The article as it stands now is so incomplete that it will need a complete rewrite from reliable sources anyway, and going at it piecemeal might not yield the best results.

I agree, but I think we have to get to some basics -- what consitutes the sources we're using, do we agree what they say, are they properly representing points of view, have they been refuted.... 06:15, 10 September 2009 (UTC)

A fresh read of all reliable reviews might be a better starting place;

which is why I started on what do we mean by "reliable reviews" as I think we started there and could not agree on when one review is "better" than other. I'm willing to use forward citations, type of journal, whether authors come from different camps, international representations, .... I really think this is the critical step and this is why I was soliciting which core sources we'd use. The current article that cites websites and press dispatches is just not in keeping with reliable sources. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

I believe I have all of them except the most recent, and I do hope you've read most of them since you want to tackle a complex topic.

I have I think all primary research and almost all secondary research. If there is one that you have that you think I haven't read I'm very willing to read it and add it to my collection. I'm a very seasoned research scientist and am very happy to read and integrate any paper particularly on this topic. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

Getting it right the first time will involved much less back and forth and discussion on talk. But that rewrite is going to also have to include mention of how each piece of the PANDAS hypothesis has been refuted, disproven, or is unhelpful or muddled .. this is territory covered by numerous reliable sources.

Well, I'm really interested in which single paper you think has refuted all of the last decade's controversy. There's a confusion going on between clinical findings and scientific findings and your reference will help me know what you are arguing. I'm not diagreeing, just curious what recent paper has driven consensus on anything except that more research is needed and there's controversy :-) I'm actually serious and will read anything you reference. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

Getting balance to the article will be a challenge, but for now, it reflects an accurate state of affairs, although the article needs to be completed and better sourced.

In general I agree, but many of the statements were not correct representations of the actual findings in the citations. This is why I'm focused on cleaning first on things I think we can agree on before proposing additions. Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

I will bear with you, and I hope you will also bear with the fact that I didn't have time this week to deal with the incorrect additions to this article and would have appreciated consensus on talk before incorrect additions to the article. You will have the pleasure here of working with several of Wiki's very finest editors (Eubulides, Colin and Tim Vickers) which is typically a very good experience, but I must again ask that you recognize that you've chosen a very complex topic, moved forward before you understood Wiki policies or acknowledged the full body of research on PANDAS, and don't appear to have yet read all of the recent reviews of PANDAS; trying to develop an incomplete article on a controversial topic without a solid grounding in the last ten years of PANDAS research may prove to be difficult,

I think you'll find I have quite a good grounding. Assume I do rather than the opposite - it'll work out better.Buster23 (talk) 06:15, 10 September 2009 (UTC)[reply]

and waiting to gain consensus on talk, allowing for others to respond, before charging in to the article will likely be less frustrating for all involved.

I hope you find the project enjoyable; the article is a difficult undertaking, but you're in good hands with Eubulides, Colin and Tim Vickers (although I'm not sure if any of them has read every single review for at least ten years on PANDAS as I have ... if they haven't, though, I bet they will now !) SandyGeorgia (Talk) 02:44, 10 September 2009 (UTC)[reply]

I'm sorry I've not found time to retun to this sooner, although from your recent posts at Talk:PANDAS I'm once again getting a frustrating sense that you're not reading anything I type or any links I give you anyway. So, I'll try again.

You've mentioned the BOLD cycle above; that works for many articles, but is less likely to yield the best results on a controversial and complex topic like PANDAS. You've mentioned WP:AGF above. It doesn't matter who got us off on the wrong foot as much as who gets things back on track, but let me point out that the first failure of AGF occurred right here, when you accused me of POV, while you (still) have an incomplete understanding of sourcing policies on Wiki. You haven't yet understood how primary sources are sometimes acceptable, or how consensus is part of determining which reliable sources are best for particular applications. Your recent statements on talk seem to suggest we can just pick a favorite review and write an article around that, while you seem to overlook the fact that writing a complete article about a topic as complex as PANDAS will be a less frustrating process if everyone has full knowledge of all of the literature. Your accusation of POV wasn't a good start.

Having a personal POV isn't a bad thing. I was saying that you had one point of view from the quote "I would suggest more recent and better quality reviews than those; for example, Pavone (2006) calls PANDAS a "well-defined" syndrome, something that is clearly challenged by almost all reliable reviews. Every part of the definition has been challenged !! It is not clear that those are the best reviews for this article." You stated that it being a well-defined syndrome is challenged by almost all reliable reviews. I cannot find recent reviews post the interchange between Singer and Swedo in 2005 that made any claim that it wasn't well defined. Whether it is useful and distinct is certainly in argument. My comment was that you were excluding Pavone solely because of claiming it was well-defined which if we are to place any value on the reports by Singer, Kurlan, Morris it has to be. Otherwise, we should draw into question their methodology on applying the criteria to children (i.e., that their findings are not valid because they failed to select PANDAS kids correctly).Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

But, past mistakes are neither here nor there at this point; more significantly, I still haven't managed to impress upon you that I am on vacation-- a much-needed first vacation in a very long time-- I don't have access to all of my literature here, and I didn't plan to spend my vacation writing a controversial article with someone who hasn't yet acknowledged or demonstrated having read all of the recent literature.

I appreciate that you are on vacation. I hope you enjoy it and recommend you see if other editors are able to come to concensus. I have tried to honor your request while you are on vacation of not doing anything to the article till you return. I have acknowledged (7 times) that I have read all the recent literature (except 2 which I can't get). What I haven't demonstrated is that I'm convinced by the literature that PANDAS has been refuted or that there isn't a supported and well published alternate point of view. If you want this to be productive, please stop saying asking me to "read the articles" and instead say "please see Singer 2008 second paragraph where he states 'blah blah'" to do otherwise is really not helpful. Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

I am trying to impress upon you that learning Wiki policies and guidelines, and spending time getting up to speed on all of the literature, will ultimately be the fastest and most stable way forward on this article, and asking me for quotes and citations when I have several times explained that I am on vacation and don't have all of my literature isn't helpful.

You can come back to the citation when you get back or perhaps another editor will help. Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

I'm sorry I can't change those facts for you, but the current facts are that there are almost no other editors on Wiki knowledgeable in PANDAS, the capable editors who could be working on this article (Colin, Eubulides, Tim Vickers) are some of Wik's finest and most busy editors and it will be easier on all of them if you read everything and learn policy before filling the talk page with a lot of reading.

Sandy, I'm not even sure how to respond to the above. I have been trying to get to a common ground. You are out, I get that, but I'm hoping you aren't the only other editor out there. I'm happy to continue conversations with Tim and Eubulides. Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

It is your choise if you want to wait for me to be available or not, be patient or not, wait for some of Wiki's busiest editors to have time to work on the article, but this is not an article that will be quickly or easily written, so patience, while you immerse yourself in all of the literature and Wiki policies, might be helpful.

sigh, the best way to come up to speed on policies is to practice them. Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

Perhaps you could be interested in working on some less controversial and complex topics while you wait for everyone to read and access all of the literature, as that would be one route to learning how Wiki works?

Thanks for the suggestion however, I seriously doubt I'll get the "coaching" that this article will provide. Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

Back to the sourcing issues. First, you're removing primary sources, which doesn't help us or our readers, rather than replacing them. Primary sources shouldn't be used to dispute secondary reviews, but some source is better than no source ... at least they give us a pointer as we work towards replacing them with better sources.

We reached agreement that the citation did not support the statement and therefore should be removed. I removed it. We then had a discussion in talk about what primary and secondary citations would support the position. The paper I recommended was not supported and thus I asked for which of the various article you (or other editors) wanted to use. The ones I proposed (including Moretti 2008) were fine. I don't agree that leaving a known inacurrate citation is the correct action.Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

Second, you still seem to be under the impression that we can pick one or two reviews, and write the article from them.

No I'm not under that impression.Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

That may be the case for other, less complex or controversial articles, but in this case, a thorough knowledge of all of the reviews will be much more helpful.

I'm aware of that and have read them.Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

As an example, Lombroso and Scahill-- an excellent source-- reference Mell, which is a poor primary study because it's drawn from a computer registry, which in the case of TS and tics, can easily be shot full of holes. So, we don't just pick one or two reviews and stick with them to the exclusion of everything else; we weigh and discuss, once everyone has read all of the sources. As another example to help you understand it's not black-and-white territory, the New England Journal of Medicine (a reputable journal) once printed a TS review with a faulty definition of the condition !! So, even though the NEJM would seem to be a recent reputable review source for TS, the fact that the peer reviewers let an incorrect definition of the condition get by means that we can come to consensus not to use that review, even though it technically meets MEDRS. Consensus applies in choosing the best sources, that depends on what is being sourced, and we can't really do that until everyone has read everything useful.

I've read Lombroso and Scahill, I've read Mell, I've read Dell, ... You seem to want to assert I haven't read the articles, I have. Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

I've also yet to understand your concern about definitions. TS and OCD are well-defined in the DSM; it's not up to us to redefine them, and we can't put out original research images.

I realize that you haven't understood my point, I actually thought you would object to the image, but still wanted to use it to improve the discussion. We certainly have tons of original research and opinions in the Talk page :-). The image was intended as a working image so that you and I could agree on what the classification of PANDAS is and that the current article representing something about PANDAS/Tourette syndrom should become a subsection of the article as quickly as possible so that we aren't misrepresenting that PANDAS is a subset of Tourette syndrome (an impression left by the current article). My initial joining to the forum was to add the balance to the article of the PANDAS/OCD research and also to bring in the immunlogic elements around anti-lysogangliosides and CaM Kinase II activation. If you are okay with my adding content in a section on those two topics that can be edited by you and the other authors, I'm very happy to do so. However, since there seems to be true push back on changing anything or adding content, I'm left with needing to correct inaccuracies in the current article.Buster23 (talk) 16:38, 12 September 2009 (UTC)[reply]

For example, your recent statement about OCD without tics comes out of nowhere for me and I have no idea what you're referencing or how it relates to any of the other discussion-- of course OCD can occur without tics.

My post was that PANDAS can occur without tics. Please see the new 1 by 1 section.

Your post said "It seems we haven't been (i.e., that a DSM IV diagnosis of OCD can occur without tics, ... " I don't know where that statement comes from or what it relates to or what definitional problems you think exist: of course OCD can occur without tics. I've asked for you to clarify several times where you think we're having definitional issues. OCD and TS are well-defined by the DSM. We can go round and round on semantics, or we can simply start rewriting the article, section by section, from the recent reviews. The problem I'm having now is that everythig you've proposed so far hasn't been completely accurate, so I continue to be concerned that you haven't given me a direct answer about which reviews you have full-text access to. SandyGeorgia (Talk) 17:04, 12 September 2009 (UTC)[reply]

Although I've posted similar several places at Talk:PANDAS, I've yet to see ackowledgement there that you have several crucial sources. So, I'll ask here. Do you have all of these, in addition to the newer list posted by Eubulides ?

PMID 15721825 Singer recent review
PMID 17667475 Swain recent review
PMID 16970870 Gilbert recent review
PMID 15060240 Kurlan (free full text available)
PMID 12842229 Singer
PMID 15173540 The Yale Group (free full text available)

And, from Volume 99 of Advances in Neurology (if you don't have these, you can request the book on an interlibrary loan):

PMID 16536364
PMID 16536363
PMID 16536362
PMID 16536361

A read of all of these may help you understand that, while many researchers agree that something autoimmunological is likely happening in a subset of tic/OCD children, the PANDAS hypothesis as currently formulated is still questioned, ill-defined, and unproven. There is likely some autoimmune process happening, but PANDAS as formulated isn't it, and it's too ill-defined to prove. I hope this reading will help, and we can get back on track on talk. But I cannot respond to a lot of specifics when I'm on vacation, and it is quite frustrating to have had this "urgent" need to fix this article, after it's languished under tendentious editing for many years, come up just as I finally get a much-needed vacation. And now, I must get back to my hosts, who have been waiting an hour for me to join them for breakfast ... that is all I can do for now. Best regards, SandyGeorgia (Talk) 15:33, 12 September 2009 (UTC)[reply]

Just to let you know, you should not split up another editors' posts, rather respond below them-- you shouldn't separate another editors' sig from their posts (see WP:TALK) ... just saying, I won't worry about it on your talk page, but just for you to know for article talk pages. Once again, in the absence of a direct answer, do you have the full text of the reviews I listed above? I fear we aren't going to progress unless we're all working from the full body of literature. SandyGeorgia (Talk) 16:58, 12 September 2009 (UTC)[reply]

Hi Sandy, the problem with the approach you mention is that I'm likely to miss one of your questions or comments if I don't respond in line, but thank. I was going to respond to your comment from an hour ago, but then thought I should respond to each individual item since you were kind enough to cite the actual articles that you wanted to know if I had read. It took me that long to go through my filing cabinet to pull and re-review the paper, the forward citation indexes and to verify which I had and which I didn't.

So in answer to your question, "Do you have all of these, in addition to the newer list posted by Eubulides ?"

PMID 15721825 Singer recent review -- Yes. This work provided some response to Dale, did not address Kirvan, cited studies on TS patients where only one patient had probably OCD-only in the PANDAS subset.
PMID 17667475 Swain recent review -- Yes. Cites Kirvan, makes good comments on methodological issues; however, restricts comments to TS and not the OCD clinical findings.
PMID 16970870 Gilbert recent review -- Yes. Good paper. Makes statement on methodological issue on antibiotic use, but doesn't cite actual issue in Snider 2005.
PMID 15060240 Kurlan (free full text available) -- Yes. Great paper. Well formed and responded to. So if citing, should also cite response. Swedo PMID 15060242
PMID 12842229 Singer -- Yes. Lots in this paper. Most has been addressed in followup studies. The survey is now out of date. By the way, I encourage you to read Yaddanapudi et al 2009 (PMID 19668249) if you haven't seen it.
PMID 15173540 The Yale Group (free full text available) -- Yes. Actually this is the one I have lots of red marks on and would be delighted to discuss as it was looking at much older kids. For example, the OCD probable exacerbation was 17 years old.

With respect to Volume 99 of Advances in Neurology

PMID 16536364
PMID 16536363
PMID 16536362
PMID 16536361

Unfortunately, I don't have that book. The individual papers are familiar and I'm surprised that I don't seem to have the articles. I'm wondering if they were individually published outside the volume. In any case, I'll ask my research library for a copy -- it isn't on the shelves.

With respect to your question regarding the other papers in Talk, I have read every paper except Pichichero 2009 (PMID 19280860).

Is there a remaining question you have here?

I'm pretty sure the A/N papers should be available individually (others are), but if you can't get your hands on them, you may be able to get the entire book through entire library loan. I haven't yet read them thoroughly, only skimmed them. As far as I know, the PANDAS article has never been updated to reflect the A/N papers, although Yale researchers had been saying for a long time that they agreed that *something* autoimmune-related was going on in a subset of kids, although PANDAS as formulated might not be it. I can't write new content about autoimmunology unless Tim Vickers comes on board to help; that's why I'd rather we work on globally generating new text, rather than potentially wearing down Tim (a very busy editor) with current changes that are less significant in relation to the overall rewrite needed. I'm glad you have all the other papers ! SandyGeorgia (Talk) 22:08, 12 September 2009 (UTC)[reply]

As to your vacation, there isn't an urgency here, but this is wikipedia where the world edits. You don't have to do the argument yourself if you trust any other editor. You've referred to some good editors that I'm hoping they'll respond so we get more of a group discussion than a debate. You can always argue for a revert if when we're done in discussion you really take issue. Buster23 (talk) 18:51, 12 September 2009 (UTC)[reply]

I'm confident they will, but they are all very busy editors, and I'm guessing they're not going to spin their wheels until they're read all the new research. I still have some to get through, but had the pleasure of the worst screaming baby I've ever heard on the plane, so have as yet done no catching up. SandyGeorgia (Talk) 22:10, 12 September 2009 (UTC)[reply]

New starting point

To hopefully offer a starting point again, take it that I'm fine with Singer's long held statement that "until other clinical or laboratory markers are available to distinguish tic disorders from PANDAS, the presence of tics before any infection-related exacerbation should exclude the diagnosis of a primary post-infectious etiology, i.e., PANDAS." I think that could be the concensus opinion of neurologists or those studying Tourette syndrome. Now, as to OCD exacerbations, I think the evidence is going the other way -- whether PANDAS is just a subset of SC with the carditis of ARF being undiagnosed, who knows. But the evidence is showing that children who meet the published critieria of PANDAS and SC are separable from controls. So, I wonder if we can agree on this last paragragh -- any chance? Buster23 (talk) 18:51, 12 September 2009 (UTC)[reply]

I can't agree or disagree there, because I haven't yet read any of the latest reviews posted by Eubulides, and I'm more familiar with TS research, far less knowledgeable on SC. Patience while everyone reads all the new material :) SandyGeorgia (Talk) 22:13, 12 September 2009 (UTC)[reply]

Friendly request

Buster, as detailed at Talk:PANDAS, File:Pandas ts tics ocd.jpg is original research and contains errors. Unfortunately, Google is likely to pick up the image and the errors will be propogated. For other editors to submit the image for deletion will be time-consuming and somewhat unpleasant; could I ask that, as the creator, you request that it be deleted? That will be the least painful way of removing the image. Best regards, SandyGeorgia (Talk) 18:35, 12 September 2009 (UTC)[reply]

Sandy, there's lots of original drawings and photographs in wikipedia -- that's one of the criteria of uploading it :-). I'm happy to correct the image if you really think that the CTD should be separated from TS. However, I find papers about clinical presentation that indicate the two overlap (as the vocal tic is sometimes not very apparent). The image is on the Talk page (not in the article). My goal here is that we reach agreement on what's in the image. Once we get there, my purpose for the image is removed and I can replace it.

At this point, I'd like to wait till we close our conversation before removing the image. I'd be happy to correct it to match your perspective -- because in doing so, I'd be sure I really knew that we agreed on the classification. We won't use it for the article, but I would like to align on what is supported and what isn't in Talk. Buster23 (talk) 19:10, 12 September 2009 (UTC)[reply]

well, diagnostically, one has either chronic tic disorder or TS, but not both. The distinction may only be clear in retrospect, but nonetheless, the diagnostic criterion do not overlap. That is only one of the errors pointed out. I don't get involved with images, so I don't know how to tag one as being inaccurate, but it troubles me that an incorrect image will be picked up by Google images. SandyGeorgia (Talk) 22:00, 12 September 2009 (UTC)[reply]

Even if the image is only on the talk page, it will still be picked up and propogated by Google, and it's inaccurate. It shows Chronic Tic Disorder overlapping with TS, when those two diagoses are mutually exclusive, according to the DSM. It shows PANDAS as possibly occuring in TS or tics, but not with chronic tic disorder, which isn't correct (PANDAS is proposed to occur with tic disorders, and chronic tic disorder is a tic disorder). It shows Syndenham Chorea as a very large subset of OCD; do you have a source for that? The easiest thing for all involved is for you to correct the graph, or ask that it be deleted. Otherwise, it has to be submitted to IFD (Images for Deletion) at Commons, which will not be a productive use of editor time. Regards, SandyGeorgia (Talk) 23:17, 12 September 2009 (UTC)[reply]

I'm perfectly happy to make it more accurate and will do so and correct it. I'll remove the overlap. Do you know how images are updated? I'll start looking but if you happen to know where to go, that'd be great.

I'll also remove the black circles if you wish. This was more to point out to you where Kurlan disclosed the samples in the longitudinal study work that underlies the individual 2008/2009 papers by Singer, Morris, Leckman and others. I was trying to underscore that the samples were drawn from children diagnosed with a pre-established tic disorder (Tourette syndrome or CTD) and they were only studying (on purpose) one part of the diagram.

In terms of size of bubbles, venn diagrams are generally used for readability and to show unions and intersections rather than size of bubbles indicating frequency. For example, from what I've read it sounds like true TS is a small subset of childhood tic disorders, SC is rare too and only some of SC gets OCD.

So, maybe we have our agreement. Do you feel that the article is talking about the PANDAS bubble in the diagram (the whole thing) or only about the intersection of TS with YGTSS exacerbation and the PANDAS bubble? Would you support separating the evidence questioning the relationship between PANDAS/TS from PANDAS/tics from PANDAS/OCD. We have great papers on the PANDAS/TS and what I've been trying to get to since the beginning is to add text about PANDAS/OCD. Someone else can work on addressing PANDAS/tics if needed. Buster23 (talk) 23:57, 12 September 2009 (UTC)[reply]

I'm sorry, I don't speak images at all -- I avoid them because they're a nightmare. I know the two tic issues are wrong, but I don't know the SC/OCD research, so I'll feel more comfortable if you provide a citation on SC as a substantial subset of OCD. I thought it was a separate condition, with comorbid OCD as a possibility, but I'm ignorant on SC. If that's the case, the overlap shown on the chart misleads the reader (I was a math undergrad, so you don't have to explain Venn diagrams to me -- fact is, readers will interpret that MOST SC involves OCD from that diagram. If you can fix the diagram, it will be in the best interests of our readers, before it propogates to other sites. Fvasconcellos (talk · contribs) may know how to do it. It doesn't really matter what the article is talking about; the article is grossly incomplete, and we've never been able to finish it because 1) the very few editors who are capable are busy, and 2) we constantly deal with tendentious, typically TS, editors. If I were so inclined, I'd stick an unbalanced tag on the article because it contains no mention at all of the significant problems with the hypothesis, as detailed by Singer, Kurlan and many others, but as long as it wasn't grossly inaccurate, I was inclined to let it be until we had time to deal with it. Yes, we are certainly missing a fuller discussion of OCD, SC, and a whole lot more ... I don't think we disagree, the article is grossly incomplete in all realms, which is why I'm uninterested in pouring over every word currently there, until I've read all the new reviews, and I suspect is why Eubulides is encouraging that we simply begin drafting entire new sections. I think it's important to work in a way that doesn't force Tim Vickers to pick through insignificant issues, and to just get to the heart of the needed rewrite. I've got to stop for the day ... BBQ in my honor with people I haven't seen for 20 years. Regards, SandyGeorgia (Talk) 00:21, 13 September 2009 (UTC)[reply]

Sandy, adding new sections will likely work better than what has felt like blocking behavior (you may not have intended it that way, but it sure seemed that you didn't want any changes to current text). I am uncomfortable with the current text because the narrowness of scope (to mostly comparing to Tourette syndrome) creates a bias because the reader is left with the impression that studies regarding PANDAS/TS are the same as making conclusions about PANDAS/OCD. It is the omission that is the biggest issue for me.

I think you are well read on PANDAS/TS, I am well read on PANDAS/OCD and on pathogenesis for PANDAS/OCD. Between us we can likely have two great sections and perhaps an interesting section on the combined pathogenesis.

Perhaps the way through is to split the article along these lines. I can now see that this is likely what was being proposed by Eubulides.Buster23 (talk) 01:31, 13 September 2009 (UTC)[reply]

I missed this before, but before dividing the article this way, we should see several reliable reviews supporting that kind of division; this would be new news to me, as the hypothesis involves tics or OCs, and TS in clinical populations also typically involves both. Before I can comment on that, I have to get my hands on some of the newer reviews that focus more on OCD. SandyGeorgia (Talk) 06:15, 14 September 2009 (UTC)[reply]