User talk:Buster23/PANDAS Discusion 1

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

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)


 * 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)

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. Sandy Georgia (Talk) 05:12, 9 September 2009 (UTC)
 * 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)

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)

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 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)

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)

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 Assume_good_faith. Buster23 (talk) 06:15, 10 September 2009 (UTC)

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)

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)

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)

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)

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)

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 !) Sandy Georgia  (Talk) 02:44, 10 September 2009 (UTC)


 * 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)


 * 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)


 * 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)


 * 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)
 * 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)
 * 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)


 * 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)


 * 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)


 * 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)
 * 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)


 * 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)


 * 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.  Sandy Georgia  (Talk) 17:04, 12 September 2009 (UTC)


 * 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, Sandy Georgia (Talk) 15:33, 12 September 2009 (UTC)


 * 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.  Sandy Georgia  (Talk) 16:58, 12 September 2009 (UTC)
 * 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 !  Sandy Georgia  (Talk) 22:08, 12 September 2009 (UTC)

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)


 * 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.  Sandy Georgia  (Talk) 22:10, 12 September 2009 (UTC)

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)


 * 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 :)  Sandy Georgia  (Talk) 22:13, 12 September 2009 (UTC)

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, Sandy Georgia (Talk) 18:35, 12 September 2009 (UTC)
 * 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)


 * 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.  Sandy Georgia  (Talk) 22:00, 12 September 2009 (UTC)

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, Sandy Georgia (Talk) 23:17, 12 September 2009 (UTC)


 * 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)


 * 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.   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,  Sandy Georgia  (Talk) 00:21, 13 September 2009 (UTC)


 * 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)


 * 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.  Sandy Georgia  (Talk) 06:15, 14 September 2009 (UTC)

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, Sandy Georgia (Talk) 18:35, 12 September 2009 (UTC)
 * 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)


 * 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.  Sandy Georgia  (Talk) 22:00, 12 September 2009 (UTC)

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, Sandy Georgia (Talk) 23:17, 12 September 2009 (UTC)


 * 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)


 * 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.   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,  Sandy Georgia  (Talk) 00:21, 13 September 2009 (UTC)


 * 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)


 * 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.  Sandy Georgia  (Talk) 06:15, 14 September 2009 (UTC)

Queries and comments
I'm curious about why you're adding primary sources to the article and the talk page? Also, please try to avoid using inline citations on the talk page, as these are lost when the page is archived, and are very confusing-- the ref mechanism is intended to be used in articles. When discussing text on talk we typically just use PMID followed by the number, which links to the abstract. Also, the tool you're using for generating citations isn't following the same format used throughout this (and most) medical articles, the Diberri format. We should also stick to a standardized ref naming, which is now Authoryear, for consistency. It's going to be very hard to get Eubulides or Tim Vickers to spend time in the article if the page is constantly filled up with nipicks and lists; I lost the entire day today just trying to clean things up and make sense of where we are, what reviews I need to get, etc., so I'm curious why you're adding primary sources ? I won't be able to retackle Classification until about Thursday now; I didn't expect to take so much time to try to sort through the talk page. Also, it would help if you would note that footnotes follow punctuation with no space, see WP:FN. Have you learned to follow the article history and diffs? I asked because just after I defined NIMH, you redefined it again; perhaps you missed my earlier edit. On Wiki, terms and acronyms are typically linked and defined on the first occurrence (see WP:OVERLINKing). Sandy Georgia (Talk) 05:26, 14 September 2009 (UTC)


 * Just trying to close the current article before we move onto even stuff like the Classification page. I see it as lets get stable so you and I aren't fighting and can leave the past.


 * If the Diberri tool worked for me, I'd use it. The one on Wikipedia doesn't. Can we agree on a tool that we all can use otherwise rewriting them will kill me.


 * I only went to inline, because the reference section was added by another editor who then moved the references inline. Otherwise, I wouldn't have done that.


 * Thank for the comment bout footnotes. I do know that but didn't see my cut/paste was infront of the period.


 * Yes, I saw the edits and was tracking in diffs, I saw it get expanded (me), linked (you), renamed back to NIMH (you). But did not see that it was defined above. Thanks.  I'll read WP:OVERLINK to see if two references in different sections is overlinking.

Buster23 (talk) 05:42, 14 September 2009 (UTC)


 * Have read WP:OVERLINK and the split of the reference over a section seems to qualify for the exception. Thus the second use should be linked so as to provide context.

Buster23 (talk) 05:47, 14 September 2009 (UTC)


 * Because the Diberri tool is broken, I put all the citations at the top of the talk page where we could get to them, and spent a lot of time repairing them. But now you're adding new primary sources :)  All medical articles use the Diberri format because it's the correct one; if you use another tool, you need to make small adjustments, like et al on author lists of more than five (reduce to three), WP:ENDASH on page ranges, and no punc at end of article title-- small adjustments-- usually, I can do those, but with my travel, all of this keeping up is killing me.  Yes, the ref thing inline on talk got started somehow, and is a bad practice. Made a mess of the talk page, so we should stop it now.  Just add PMID and the number ... when we add the text to the article, we add the complete citation.  There is a LOT to learn about Wiki editing, which is why it can be so hard to start on a complex article !!  I lost most of today-- tomorrow I drive to the mountains, Tuesday on a horse, Wednesday drive back, may get to what I really wanted to do today (some Classification excerpts) on Thursday.  I do hope you'll find some time to read and review some bio/health and medicine featured articles, as they are instructive in Wiki writing. I gather from your IP edits that you are in my grad school neck of the woods, with the folks for whom the building in which I studied was named.  Best regards,  Sandy Georgia  (Talk) 05:50, 14 September 2009 (UTC)

Interesting, but nope. I too got my graduate degree from there. Ah, though, I get your subtlety/indirection. Seemed a good site to route from. Buster23 (talk) 06:25, 14 September 2009 (UTC)
 * I've got to quit for the day; sorry I didn't make more progress on text of substance, but I hope we're in better shape to start moving forward! I still hope you'll read autism, Asperger syndrome (mostly Eubulides, some me), Tourette syndrome (mostly me, a lot of Eubulides and Colin), and a whole lot of Tim Vickers work in bio, to get a good idea of Wiki writing (you can find Tim's list at WP:WBFAN). Best, Sandy Georgia  (Talk) 06:34, 14 September 2009 (UTC)

Joke and quick comment

I saw a comic that has a picture of a guy at computer swearing and his wife in the background saying "are you ever going to bed" and he replies "Not now, someone is on the internet and they're wrong." Made me laugh and pause.

I'm only going at this because I care what is being said about PANDAS and it is clear you do to. My actual personal point of view is that PANDAS is probably not a separate condition, but rather a minor form of Sydenham chorea where the rheumatic fever/carditis is either going undetected or that the antibody causing SC is just slightly different from the antibody causing ARF. What's interesting there is that SC follows 4-6 months after ARF. 4-6 months. Wow. It makes one wonder if there aren't two things going on. SC is separated cleanly from Tourette syndrome because chorea isn't tics, but mild chorea might look a lot like a tic. I find Kirvan's work really intriguing and it stands unrefuted.

I'm really not that bad a person and not out to mess up your article, but just like you, I don't want folks picking up old material and thinking that PANDAS is Tourette syndrome when it is likely not -- or thinking that PANDAS is disproven, when there is still a lot unknown. Let's make the current article a little more balanced (I know you think it isn't unbalanced but I sure do). I'm not going for completeness yet, just a bit more balance. Then let's write a great article together.

Frankly if we get a couple more edits in the current stuff, we'll both feel more calm and get more sleep because I won't be worried that we're propogating something 'wrong' and you won't feel like I haven't read something that shows it's right. I really and truly am not in a rush here. Regards, Buster23 (talk) 06:57, 14 September 2009 (UTC)


 * We've lost some very good Wiki editors lately because they *didn't* listen to the wife swearing in the background when they should have: that's sad. Then they storm off of Wiki in a huff, targeting Wiki or other editors, when Wiki was interfering with real life, causing their frustration.  Something to keep in mind and avoid :)  A relationship is more important than an article.
 * Yes, I care deeply about PANDAS (because of the potential effect of misinfo on children's health), but it is not an article I can write by myself, so it has languished and suffered with frequent uninformed tendentious editors showing up. They typically have read no research, aren't scientifically oriented, and conclude with "I know PANDAS is real because I have it!"  I'm always left pondering how one can "have" an unproven hypothesis :)
 * Some of the wording nuances you have picked up may have been written by Tim Vickers, who as a very busy editor has done his best to help out on this article and at least keep it clean, but they are subtle and finer wording points that anyone not thoroughly immersed in these conditions will miss; your recent improvements are good, and I don't think the back and forth was wasted time ... you've picked a hard article to wade through as a new editor, and you've probably learned a lot from the back and forth. But, to keep Tim and Eubulides involved, talk page posts should be brief and concise ... if you're unsure, perhaps set up a sandbox, work there, and just link it in to the talk page.
 * I know you're not a bad editor, and you never came across as that sort of tendentious editor, but your first edits did have me pretty nervous ... the timing (with my pending travel) didn't help :) I no longer have a personal opinion ... still need to read the latest reviews ... but I've just heard the Yale guys saying for years that they thought it was something autoimmune, but not necessarily as currently formulated in the PANDAS hypothesis.  Singer's latest paper seems to say he disagrees now with even that, so I need to catch up.  BUT.  What does disturb me is that the very researchers who have set about critically examining the hypothesis depend greatly on the NIH for funding, so I suspect they moderate their opposition to the hypothesis out of self-interest.  Some years back, the NIH gave the TSA something like $18 million.  The conflict of interest is concerning, and I suspect that the PANDAS hypothesis has gotten as far as it has only because of 1) parental guilt (parents would rather say their child tics because of strep than genes), 2) parents desperate for a cure, who hope a genetic condition can be "cured" by antibiotics et al, and 3) researchers who won't outright say the hypothesis is bullroar because they don't want to alienate the NIH.  These three factors are troubling, and children's health is endangered-- worse, their mental health is endangered by unaccepting "cure"-obsessed parents.  The parental lack of acceptance of children with tics and OCD can be as or more damaging to the child as the condition itself (lots of good wording on that in the Leckman/Cohen TS book).  The article is unbalanced in both directions:  it's just incomplete.  The real serious problems with the hypothesis haven't yet even been touched upon, which is why we should try to develop new text in sandbox ... it will be a hard article to complete, but if we can develop a more brief talk page style :) that will help keep other editors interested.  Off for the mountains later, will be out of action several days ... Regards,  Sandy Georgia  (Talk) 15:18, 14 September 2009 (UTC)
 * Hi Sandy, normally I would have kept the notes in Talk brief, but the approach of moving the discussion into notes caused the quick explosion -- as I'm sure it does when this approach is used on Policy pages or other contentious items.
 * On the cure obsessed parents... I'm sure most parents would want their child cured if possible. There is a very high placebo effect that needs to be factored in and it really is ridiculous that no one has repeated the Perlmutter 1999 study to get a second check -- since I think it is that study that forms the basic elements of the controversy.
 * One of the more interesting items to me is that kids with tics tend to see a neurologist. Kids with OCD tend to see a psychiatrist.  I'm pretty convinced that classic tic disorders without OCD have different pathogenesis than sydenham chorea.  I'm also pretty convinced that long-standing tic disorders that have no remission are also not similar to sydenham chorea.  It is the remission (not the waxing and waning) that is so curious in the clinical presentation of these kids.  They actually seem to get better. Whether this is placebo effect or something else, who knows, but 19+ points on CYBOCS is a huge shift of presenting features.
 * What's a bit disquieting is if (just if) this turns out to literally be a sequelea to strep, then there's a bunch of kids getting treated with some really dangerous anti-psychotics (including off-label SSRI's like Lexapro which isn't approved or studied for children). So is it worse to treat these kids with life-long anti-psychotics or to try 2 weeks of antibiotics at time of sudden onset. It's an interesting group versus individual risk question....
 * In all the studies by Singer, Kurlan, Morris -- they're always looking at much older kids who were diagnosed correctly (presumably) with Tourette syndrome 3 years prior and have had (presumably) no remission lasting longer than 3 months. This in and of itself should exclude them from the PANDAS subgroup because they did not have "a relapsing-remitting" course. Buster23 (talk) 15:36, 14 September 2009 (UTC)


 * I still have a lot of catching up to (I'm at least a year behind on TS, since I took on the FAC delegate "job"), but I was under the impression that some of the prospective studies had now been completed and that we have better answers to your queries?? Besides what you mention, there's the whole business of whether "TS only" is a different condition that TS with comorbids (for example, is TS+ADHD separate from TS-only).  All of this makes sorting out PANDAS very tricky.  One thing that really frustrates me is to see Mell cited as a source, when using a computer registry for conditions with so many vagaries of diagnosis is just not ideal ....  Sandy Georgia  (Talk) 15:43, 14 September 2009 (UTC)

I went ahead and archived so the talk page will be clean; remember that archived only means off the page, but you can still access those sections if needed. Sandy Georgia (Talk) 15:51, 14 September 2009 (UTC)


 * Are you saying you archived material even when I specifically asked you to wait a few days?


 * See talk there ... after you asked me to wait, you made a later post that we had closed out those topics, so I guess I misunderstood. THe problem is that the talk page is a mess, and I couldn't find any remaining issues or workable content there, so thought clearing out to start over would be best for all.  I apologize for misreading your last message.  Put a list here of sections you want brought back, and I'll resurrect them before I leave in a few hours.  It may be better to learn to work in a sandbox, though, where you can use inline refs, etc., while you learn more about how talk pages are typically used ... that talk page got quickly out of control. You can propose new text, for example, with a relist in User:Buster23/PANDAS, where we can all read it without clutter on PANDAS talk, and your page will have it's own talk page.  Sandy Georgia  (Talk) 17:38, 14 September 2009 (UTC)


 * I'm heading out soon, and haven't heard back from you which sections you want resurrected. If you pop a list at, I'm sure he will pull back anything you think still needs review.  Again, I'm sorry for the misunderstanding.  I thought a perusal of the last half of the AS talk archives, starting here, would give you an idea of typical talk page usage.  It's often easier to construct new text in a sandbox.  Regards, Sandy Georgia  (Talk) 18:54, 14 September 2009 (UTC)


 * Wow, does everyone stay on all the time... I think I've got to turn this around to an expectation that I'll checkin once a day -- got to get some sleep. Hope that rate is okay on new article. I agree about the sandboxes.  Perhaps a joint one or is it better as an individual one? Buster23 (talk) 18:58, 14 September 2009 (UTC)

3RR
Please give serious consideration to WP:3RR and WP:BRD. Your faulty editing has been pointed out and well documented on talk, but you reinstated it without consensus. If you continue, you could be blocked. Sandy Georgia (Talk) 18:02, 25 February 2012 (UTC)
 * Thank you SandyGeorgia for the reminders. Your edits were also without consensus and thus I needed to revert since you had simultaneously marked the document for deletion and started editing content by removal. 18:06, 25 February 2012 (UTC)
 * It doesn't appear that you have read WP:BRD or WP:3RR. Please do so. Also, please see WP:IDIDNTHEARTHAT; it doesn't work.  As explained at BRD, you added text, it was contested as non-policy compliand and removed, that was documented and explained-- the next step is that it is up to you to gain consensus before re-adding the text.  By doing so without consensus, you are WP:EDITWARRING.  Sandy Georgia  (Talk) 18:11, 25 February 2012 (UTC)
 * I did review WP:BRD and followed the following logic:
 * 1) BE BOLD, and make what you currently believe to be the optimal change. (what you did)
 * 2) Wait until someone reverts your edit. (which I just did)
 * 3) You have now discovered a Most Interested Person. (which you have)
 * 4) Discuss the changes you would like to make with this Most Interested Person, perhaps using other forms of Wikipedia dispute resolution as needed, and reach a compromise. (which we are doing)
 * Was there a different policy you were considering? Buster23 (talk) 18:37, 25 February 2012 (UTC)
 * Buster, have you reviewed WP:IDIDNTHEARTHAT? 1, you, who created the content fork; 2, me, who reverted it; 3, me, who knows the research and Wikipedia policies; 4- you should discuss before reverting.  Edit warring never ends well; good articles can be built based on an discussion, collabortion, and editing according to policy.  Along the way, you can even learn something about PANDAS, and your edit experience will be more enjoyable.  If you will start reading policies and guidelines, and basing your edits and discussions upon them, our work will be much easier and less time consuming.  Sandy Georgia  (Talk) 23:00, 25 February 2012 (UTC)
 * Yes, Sandy, I did read WP:IDIDNTHEARTHAT. I don't agree that I created a content fork. I don't see deleting it as addressing the topic.  I grant you know the research (as do I) but you have a different perspective/interpretation on the outcome.  I grant you know wikipedia policies better than any (although at some point I wonder if the practicing of the welcoming bit is there).  Together I'm sure we'll learn more things about PANDAS.  I will continue reviewing any policy you send my way, but in general, it is likely more effective if you cited a particular part of the policy (such as WP:MEDRS now requires secondary sources) rather than throwing the whole policy as it isn't always clear what your objection is. Buster23 (talk) 23:27, 25 February 2012 (UTC)


 * Welcoming?  We've been going round this block since 2009-- you knew then about MEDRS, but you still created an article based on primary sources.  I don't believe MEDRS has changed since we last went through it, so I'm not sure what else I can point out to you, and I'm sorry it wasn't clear, but I thought you understood it from the last time we discussed your edits to PANDAS.  If you've now read it, that will help.  WP:NN (our policies on notability) and WP:RECENTISM will explain why we don't create an article based on one new source; a much better article might be written if and when more info becomes available, but for now, we have only one source.   There are a number of reviews listed on the PANDAS talk page-- those are only the most recent, there are many more.  We don't interpret: we report what high quality sources say.  The more concerning point of your editing is things like adding the diagnostic codes for OCD in the infobox; a hypothesized condition, PANS, is not OCD, and it would show good faith if you would remove the obviously false information from the infobox.  The issue of exact cut-and-paste text also needs to be addressed: it would help if you would remove all of that, or attribute it and add quotes.  Sandy Georgia  (Talk) 05:36, 26 February 2012 (UTC)
 * IN fact, I have just now reviewed our old talk discussions, and we most certainly discussed MEDRS, including specific high-quality secondary reviews, and lists of same. So, your posts here are most confusing, since you knew this info and yet still created an article based on primary sources, ignoring better secondary review sources, and now you're inquiring about same?  Confused ... Sandy Georgia  (Talk) 05:45, 26 February 2012 (UTC)

3RR
Please give serious consideration to WP:3RR and WP:BRD. Your faulty editing has been pointed out and well documented on talk, but you reinstated it without consensus. If you continue, you could be blocked. Sandy Georgia (Talk) 18:02, 25 February 2012 (UTC)
 * Thank you SandyGeorgia for the reminders. Your edits were also without consensus and thus I needed to revert since you had simultaneously marked the document for deletion and started editing content by removal. 18:06, 25 February 2012 (UTC)
 * It doesn't appear that you have read WP:BRD or WP:3RR. Please do so. Also, please see WP:IDIDNTHEARTHAT; it doesn't work.  As explained at BRD, you added text, it was contested as non-policy compliand and removed, that was documented and explained-- the next step is that it is up to you to gain consensus before re-adding the text.  By doing so without consensus, you are WP:EDITWARRING.  Sandy Georgia  (Talk) 18:11, 25 February 2012 (UTC)
 * I did review WP:BRD and followed the following logic:
 * 1) BE BOLD, and make what you currently believe to be the optimal change. (what you did)
 * 2) Wait until someone reverts your edit. (which I just did)
 * 3) You have now discovered a Most Interested Person. (which you have)
 * 4) Discuss the changes you would like to make with this Most Interested Person, perhaps using other forms of Wikipedia dispute resolution as needed, and reach a compromise. (which we are doing)
 * Was there a different policy you were considering? Buster23 (talk) 18:37, 25 February 2012 (UTC)
 * Buster, have you reviewed WP:IDIDNTHEARTHAT? 1, you, who created the content fork; 2, me, who reverted it; 3, me, who knows the research and Wikipedia policies; 4- you should discuss before reverting.  Edit warring never ends well; good articles can be built based on an discussion, collabortion, and editing according to policy.  Along the way, you can even learn something about PANDAS, and your edit experience will be more enjoyable.  If you will start reading policies and guidelines, and basing your edits and discussions upon them, our work will be much easier and less time consuming.  Sandy Georgia  (Talk) 23:00, 25 February 2012 (UTC)
 * Yes, Sandy, I did read WP:IDIDNTHEARTHAT. I don't agree that I created a content fork. I don't see deleting it as addressing the topic.  I grant you know the research (as do I) but you have a different perspective/interpretation on the outcome.  I grant you know wikipedia policies better than any (although at some point I wonder if the practicing of the welcoming bit is there).  Together I'm sure we'll learn more things about PANDAS.  I will continue reviewing any policy you send my way, but in general, it is likely more effective if you cited a particular part of the policy (such as WP:MEDRS now requires secondary sources) rather than throwing the whole policy as it isn't always clear what your objection is. Buster23 (talk) 23:27, 25 February 2012 (UTC)


 * Welcoming?  We've been going round this block since 2009-- you knew then about MEDRS, but you still created an article based on primary sources.  I don't believe MEDRS has changed since we last went through it, so I'm not sure what else I can point out to you, and I'm sorry it wasn't clear, but I thought you understood it from the last time we discussed your edits to PANDAS.  If you've now read it, that will help.  WP:NN (our policies on notability) and WP:RECENTISM will explain why we don't create an article based on one new source; a much better article might be written if and when more info becomes available, but for now, we have only one source.   There are a number of reviews listed on the PANDAS talk page-- those are only the most recent, there are many more.  We don't interpret: we report what high quality sources say.  The more concerning point of your editing is things like adding the diagnostic codes for OCD in the infobox; a hypothesized condition, PANS, is not OCD, and it would show good faith if you would remove the obviously false information from the infobox.  The issue of exact cut-and-paste text also needs to be addressed: it would help if you would remove all of that, or attribute it and add quotes.  Sandy Georgia  (Talk) 05:36, 26 February 2012 (UTC)
 * IN fact, I have just now reviewed our old talk discussions, and we most certainly discussed MEDRS, including specific high-quality secondary reviews, and lists of same. So, your posts here are most confusing, since you knew this info and yet still created an article based on primary sources, ignoring better secondary review sources, and now you're inquiring about same?  Confused ... Sandy Georgia  (Talk) 05:45, 26 February 2012 (UTC)
 * Yes, what was good about 2010 was that we spent time agreeing on the secondary papers we would use in the PANDAS article. We had some disagreement about reviews where you tended to prefer ones from neurologists and I tended to prefer ones from psychiatrists, but this settled out.  It's probably time to redo the list.   We discussed during that time that a secondary review did not mean that it was merely a review article in PUBMED, but rather that the author was removed from and commenting on the primary research.  We would use review articles as possible, but on the PANDAS page you had stated "Some uses of primary sources and other websites are appropriate; please read Wp:V and WP:MEDRS. When they can be replaced by reviews, they should be, but the issue is correct use of primary sources."  The restriction to just review articles in PUBMED would be a change to WP:MEDRS and I'll have to check how many articles satisfy this condition.  In the case of PANS, I think we need to reference the PANS paper (with links to the commentaries by the National Institute of Mental Health  and the International OCD Foundation ) until more reviews appear. I'll work with you on the selected reviews section and see if we can realign on the review papers. Buster23 (talk) 17:24, 26 February 2012 (UTC)
 * There is no requirement that secondary reviews be PubMed indexed (although typically when they aren't, that raises legitimate questions about the source). General sourcing guidelines on Wikipedia (not only medical) speak to sources being third party (independent from the subject), which the NIH isn't in this case (nor is the OC foundation, and neither are peer reviewed).  For example, what if another group of researchers were to oppose the PANS proposal and put forward something entirely different?  We would have wasted our time on the wrong article; by consolidating it all at PANDAS until clear support in the literature emerges, our job is easier.  The only reason I'm accepting that (Swedo/Leckman) source at all is because Leckman is on board-- clearly he's making an attempt to find a way forward with the NIH, which makes that paper worthwhile.  But it can only be used in a limited fashion-- it's not been vetted outside, it's not PubMed-indexed, etc-- so we take all of that into account with respect to how we use it.  Werelived hasn't been using it correctly, and has spammed faulty text across mutliple articles (not your problem, sample), and I have no idea where he came up with that Harvard business (perhaps he's referring to Jenike ???), when the non-govermental researchers who have had to do most of the work of dealing with the faulty PANDAS hypothesis have been the Yale Group (Leckman et al), the Rochester folks (Kurlan et al), and Johns Hopkins (Singer et al).  I don't know where Werelived came up with his conspiracy theory, where he pretty much came right out and said I most be either Harvard or insurance.   Everyone working on the PANDAS issue has been trying to determine what is going on with autoimmunity and sudden onset of symptoms; that they disagree that the PANDAS hypothesis was well formulated does not mean they weren't trying to figure out what was going on and how to move forward.  The conspiracy theory is outrageous, so I'll be watching Werelived's edits closely, particularly after he proposed a text addition to Tourette syndrome that was out-and-out wrong,  so I'm unsure of his knowledge wrt PANDAS on any level. The problem with the misinterpretation of this ongoing research and attempt to sort out what is happening with autoimmunity and sudden onset of symptoms is that, in the meantime, lots of parents have made lots of very bad decisions for their children, based on research that they misinterpreted as fact, that is something these papers repeatedly discuss, and that is why these articles need to very carefully reflect good sources, secondary reviews, and accurate medical statements.  Sandy Georgia  (Talk) 16:26, 27 February 2012 (UTC)

Ping
I want to get moving while I have free time, so want to be sure you've seen so we won't get crosswise on the next steps. I'm ready to get moving, the text at PANS should first be fixed so it can be merged, and there are licensing requirements involved in how to do a merge. Regards, Sandy Georgia (Talk) 16:10, 27 February 2012 (UTC)
 * this, and
 * this,
 * Hi just back from work. I'll respond to your posts after dinner.  Sorry, during the week it will take me generally a day to reply to you. Buster23 (talk) 03:42, 28 February 2012 (UTC)
 * Sandy, just a reminder that I cannot engage at the rate you are posting content. If you want my review on content, please give me 24-48 hours. I try to work on Wikipedia at night. Buster23 (talk) 06:11, 1 March 2012 (UTC)
 * I don't mind slowing down as long as we're working collaboratively, and it does help to know your schedule (I'm the opposite-- get busy first thing in the morning usually, although tomorrow I have app'ts all day). What happened before is that when I didn't hear back from you-- or sometimes when I did your answers were inconclusive-- after waiting several days I went ahead and did the work (so I don't lose track of what I'm doing :)  I think you should have more faith: I do believe we can do this if we'll just discuss more on talk before adding text.  The sources say what they say and we can get this done-- the problem to date has been no one to work on the article, whenever I requested outside input other editors really didn't understand the topic so may not have helped (the Pichichero example you gave), all complicated by my relocation and having zero free time for three years.  Regards, Sandy Georgia  (Talk) 06:19, 1 March 2012 (UTC)

End of Archive
Buster23 (talk) 05:31, 4 March 2012 (UTC)