Wikipedia:Dispute resolution noticeboard/Morgellons

Morgellons


4 July 2013

Have you discussed this on a talk page?

Yes, I have discussed this issue on a talk page already.

Location of dispute Users involved Dispute overview

Current scientific consensus from large, influential organizations like the CDC is that individuals with Morgellons have a delusional belief that they are infested with parasites. There is general agreement across all parties that this is indeed the scientific consensus. There is a proposal to add new content to the article; the policy cited in support of the addition is WP:NPOV. The new proposed content discusses a new theory for the origin of Morgellons, stating that there is an actual infectious parasite. This issue basically is that many editors do not agree that the sources cited meet WP:MEDRS, the medical sourcing guideline. There is general agreement that if there were WP:MEDRS-compliant reliable secondary sources supporting the new theory that such content could be included. But many editors state that as the sources are not reliable, and because WP:NPOV only applies to views presented in reliable sources, the WP:NPOV policy cannot be used in support of including the actual parasite theory.

Have you tried to resolve this previously?

LOTS and LOTS of discussion on the Talk page

How do you think we can help?

Determine consensus as to whether the sources proposed are indeed authoritative WP:MEDRS-compliant secondary sources such that per WP:NPOV the mention of the parasite theory is warranted.

Opening comments by Erythema
Please limit to 2000 characters - longer statements may be deleted in their entirety or asked to be shortened. This is so a volunteer can review the dispute in a timely manner. Thanks. In a nut shell. The actual dispute is more complicated than described by the others involved with this dispute indicate. Morgellons is a controversial illness. There are 2 POVs represented in medical literature. This is evident with a PubMed search. 1 POV is that the illness is delusional in etiology. The other is that it is not and there are publications indicating that it is caused by a bacterial infection. This bacterium, Borrelia, is related to syphilis and thus explains the psychiatric manifestations experience by some patients. The predominant POV is that it is delusional, however the POV that it is infectious in etiology represents a significant minority POV and thus it deserves proportional representation. The problems are 2 fold: One, content from the infectious POV has been blocked, even for one paragraph to be included, even while leaving the existing text untouched: Two, there is a great deal of bias in the current article. It has been carefully edited to maximize the opinion that it is delusional in etiology. The references are largely cherry-picked and do not follow WP:MEDRS policy. Over half of the references come from Popular Press, i.e. newspaper articles, TV interviews and the like. One of these is even an interview with an "anonymous dermatologist" in Popular Mechanics magazine and lacks verifiability, as do the rest. These are clearly not appropriate secondary sources. Those that are from peer-reviewed medical journals are predominantly opinion pieces -- again they are not appropriate secondary sources. The remaining few are original research. This is an area of medicine undergoing active research and as such there are not many (if any) suitable secondary sources. I have proposed to add ONE small paragraph from the infectious POV on the grounds that a significant minority view needs to be represented for NPOV. They are original research, but WP:MEDRS allows original research when secondary sources are lacking. The current article has used a few original research papers. WP:MEDRS encourages the use of on-line medical journals as they can be accessed by readers, but I have been told that they are unreliable (and numerous other things). There have been false statements made that are damaging to the reputations of the medical journals publishing papers representing the infectious POV that I find offensive and objectionable. NPOV cannot be achieved as long as double standards of policy application are applied to the two viewpoints. I have repeatedly asked for reasonable and objective justification, but have yet to receive an answer that makes sense. Mostly when I bring up a valid point there is no response at all. I am a new user and WP indicates I should be welcomed and treated with patience. Instead I have been bullied and treated with hostility. If fair and proportionate representation of both POVs cannot be achieved then the current article should be deleted on the grounds that the references used to not meet WP policy.Erythema (talk) 14:49, 6 July 2013 (UTC)Erythema

Opening comments by Drgao
This dispute relates to the article on Morgellons disease, a disease involving skin symptoms and mental symptoms.

A severe non-neutrality exists in this article, as I now describe.

Amongst researchers, there are two competing views on the nature of Morgellons disease: viewpoint (1) says that Morgellons is a real skin disease manifesting body-wide skin lesions and other skin symptoms, likely caused by an infection, and also involving some concomitant mental symptoms; viewpoint (2) says that Morgellons is not a real physical disease at all, but purely a psychiatric condition called delusional parasitosis, in which sufferers self-inflict their skin wounds.

This dispute relates to the fact that viewpoint (1) gets almost no mention at all in the article, and viewpoint (2) not only dominates the vast majority of the article, but furthermore, viewpoint (2) is presented as if it is an established fact.

WP:WEIGHT requires that articles represent all significant viewpoints published by reliable sources, in proportion to the prominence of each viewpoint in those sources. So in order to determine the precise prominence of each of the two viewpoints, I have performed a full scientific literature survey of reliable sources, and by enumerating all relevant studies, I counted that there is 1 secondary study, and 9 primary studies supporting viewpoint (1), and 3 secondary studies, and 15 primary studies supporting viewpoint (2).

You can the full details of all the studies I counted up HERE.

Thus from these figures which quantify the prominence of each viewpoint, it is clear that viewpoint (1) should be given around ⅓ of the article text space, and viewpoint (2) around ⅔ of the article text space. But at present, viewpoint (1) occupies only a few percent of the text space.

Myself (Drgao) and editor Erythema say this severe imbalance in the article completely flouts the NPOV requirements of Wikipedia, but all the other editors disagree with us, and they prevent us from adding new material to the article. Drgao (talk) 02:16, 5 July 2013 (UTC)

MInor updates made on July 7th. Drgao (talk) 21:56, 7 July 2013 (UTC)

Opening comments by TechBear
I had gotten involved with the article in late May, in response to one editor trying to bring in sources from journals known to be "pay to publish." Soon after, a new editor stepped in with a different set of references, asserting that they showed the established scientific consensus to be wrong and demanding that the article be rewritten accordingly. I and others pointed out the problems in new editor's sources; rather than seek out better sources, this person fell to ad hominem attacks and accusations that Wikipedia was trying to "suppress important information" (actual quote.)

I am willing to concede that the current consensus may be wrong; it certainly would not be the first time that long-standing conclusions fell to new research. However, it is my view that any evidence attempting to overturn an established position must meet a high standard of quality, and that this is especially important with regards to medical science, where the well being and even lives of people may hang in the balance. The evidence must come from reputable research sponsors, be reviewed by research experts in the field who have the skill and expertise to evaluate the methodology and conclusions, and be published in a well respected journal. It is my opinion that the sources this editor wishes to use simply do not meet this minimum standard of quality, and therefore should not be used as the basis for rewriting established consensus.

TechBear &#124; Talk &#124; Contributions 04:03, 5 July 2013 (UTC)

Opening comments by Arthur Rubin
I agree with the opening comments by Scray; however I have an objection to the formulation of the dispute. It's not "new proposed content" or a "new theory". The theory was first proposed by Mary, and it's not even new to the article. It was removed from the article when no WP:MEDRS sources could be found. They still haven't been found. — Arthur Rubin (talk) 05:20, 4 July 2013 (UTC)

Opening comments by Dbrodbeck
There are simply no good WP:MEDRS secondary sources that say that any of these WP:FRINGE views have any use. If we include this material we would be giving WP:UNDUE weight to these fringe ideas. Many of us have tried, in vain, to explain these policies to the couple of WP:SPAs who want this material included. The ad hominem attacks and personal attacks in general, while they have toned down some, did not help matters. This material does not belong in the article, that is the bottom line. Dbrodbeck (talk) 12:33, 4 July 2013 (UTC)

Opening comments by Dawn Bard
I think the article is appropriately neutral and well sourced, and I think any objective review of the page and the talk page with WP:MEDRS, WP:NPOV, WP:UNDUE and WP:FRINGE in mind will support this. Sailsbystars below has presented some excellent points. This odd press release, which essentially alleges a Wikipedia conspiracy to keep the truth about Morgellons hidden, predated some of the contentious editing and discussions that have led up to this dipute resolution. I think what we really have here is a broad, policy-based consensus that the article should stand as it is for now. A couple of very passionate, largely single-purpose editors disagree with this consensus, but their efforts on the talk page have failed thus far to change the larger consensus. Cheers, Dawn Bard (talk) 17:06, 4 July 2013 (UTC)

Opening comments by Zad68
My view is that the sources offered to support the "genuine infestation/infection" view are insufficient to rise above WP:FRINGE and it would give undue prominence or legitimacy to a non-accepted fringe view to include in the article. There have been two groups of sources offered. The first included three sources, listed in the discussion here. The comments regarding the unworthiness of f1000research and the Dove Press journals there are accurate: the reliability of the journal articles doesn't meet WP:MEDRS and are not MEDLINE indexed, or even PubMed indexed at all. The list of sources given here is an excellent and comprehensive list of PubMed-indexed articles regarding the subject, and the editor who put it together is to be thanked, but the analysis offered is not in line with consensus interpretation of WP:MEDRS. Per policy, primary sources are not to be used to support a WP:DUEWEIGHT (part of WP:NPOV) argument. So, looking only at secondary sources, we have three up-to-date MEDLINE-indexed secondary sources stating Morgellons is delusional; we have a single MEDLINE indexed secondary source from 2006 that does not meet WP:MEDRS per WP:MEDDATE. This leaves three secondary sources supporting delusional, zero supporting infection. (This list also does not include other sources like the CDC, which also does not support infection.) As there are no WP:MEDRS-compliant secondary sources supporting infection, per policy the article should not cover it. (Note I will be away most of the weekend, back maybe Saturday or Sunday night.)  19:34, 5 July 2013 (UTC)

Opening comments by Scray
I hope that this process will help us move past the current cycle, which consumes energy (and has often included ad hominem attacks) but does not seem to be progressing. The article currently addresses the minority viewpoint that Morgellon disease has an infectious etiology, with due weight considering the strong consensus in high-quality sources that this is a delusional parasitosis (rather than infection) syndrome. Primary reports in low-quality journals should not be used to refute the strong consensus in high-quality secondary sources. -- Scray (talk) 04:01, 4 July 2013 (UTC)

Opening comments by Garrondo
Please limit to 2000 characters - longer statements may be deleted in their entirety or asked to be shortened. This is so a volunteer can review the dispute in a timely manner. Thanks.

Opening comments by Judgeking
Please limit to 2000 characters - longer statements may be deleted in their entirety or asked to be shortened. This is so a volunteer can review the dispute in a timely manner. Thanks.

Opening comments by Sailsbystars
Please limit to 2000 characters - longer statements may be deleted in their entirety or asked to be shortened. This is so a volunteer can review the dispute in a timely manner. Thanks. So I've never been to one of these before, but I think the most relevant thing I can do is quote my comparison of the proposed sources and existing sources for the article, and why the former should not have undue weight in the article. Sailsbystars (talk) 07:17, 4 July 2013 (UTC)

... there are some commonalities in all science fields. Dubious research gets published all the time (hence the phrase "publishing in a peer reviewed journal is a necessary, but not sufficient condition for acceptance") in every field. There are several common threads of fringe research that cross all disciplines of research:
 * 1) Fringe research is often published in less well-known journals.  The disease associations for Morgellons are published in Clin Cosmet Investig Dermatol.  and f1000research which may or may not have rigorous peer review.  The CDC study was published in PLoS One, arguable one of if not the most prestigious medical journal.  Multiple other studies have appeared in the American Journal of Psychiatry, the official journal of the psychiatric society supporting a psychological diagnosis.
 * 2) If research is accepted, it will be cited by other people.  Hinkle 2011 has 9 citations by other groups.  Pearson 2012 (CDC study) has 13 citations by other groups.  Middelveen and Stricker 2011("Filament formation associated with spirochetal....") has 7 citations, but of those only two of those aren't self-citations, and those two both disagreed with the conclusion of the study.  Lack of favorable external citations is bad.
 * 3) Conversely, excessive self-citation is usually not a sign of a healthy research programme
 * 4) Lastly, when the researchers have to make a press release railing against wikipedia's biases in a desperate attempt to get included in the article, that's usually not a good sign (and that's actually how I came to  be interested this article)
 * So that's how I can evaluate, using objective criteria, how accepted an idea is within a scientific field, even one I don't know much about. So how could you convince me this infectious etiology material should be included?  Showing me some citations to their studies from outside their research group by other research groups that support their findings would be a good start, and I think would be fairly persuasive to other editors on this page as well.  Sailsbystars (talk) 21:40, 27 June 2013 (UTC)

Opening comments by BullRangifer
An important aspect of this dispute is whether advocates of a fringe idea (that Morgellons is a real dermatologic condition, rather than a form of delusional parasitosis) can use Wikipedia to promote that POV as a mainstream POV, or of at least equal worth to the mainstream scientific POV on the subject (which is that it's a form of delusional parasitosis). They believe that NPOV is violated when they are not given equal due weight. Sorry, but that's not true. They fail to understand NPOV.

They constantly use primary studies to make their point, in violation of MEDRS. This is not the place to make cutting edge pronouncements. For one thing, being on the cutting edge means you're on the wrong side of the knife. Yes, that's a joke, but for Wikipedia, it's the way we apply our sourcing policies. We are always supposed to be "behind the curve," never on the leading edge of publishing new facts. IF (that's a big IF) this ever turns out to be proven to be a new dermatologic condition, the major dermatology organizations will state that fact in unequivocal terms.

When that happens, and not before then, the POV pushed by these believers will have to remain the fringe position, in opposition to the mainstream one, which happens to be that these editors are pushing a delusional belief. Until then, their POV will be documented, but not given equal weight with the current scientific consensus. The article content and due weight balance will indeed change when large literature reviews that are not affiliated with those who make a living from pushing this fringe POV start to clearly document it as a new disease. Independent replication of research results must happen again and again. Then we'll definitely document that fact, and Morgellons will be presented here at Wikipedia as a new disease. It will happen, but a short time AFTER it happens in the real world. These editors must be patient and stop disrupting Wikipedia. They are a huge time sink and need to be blocked, or, at the least, immediately topic banned.

That several of them are delusional happens to be a fact, since several of them have admitted to being sufferers, and even admitted to having mental health issues. Too bad about that, but this is not the place to push a POV based on primary sources, often from "paid to publish" sources, or fringe scientists affiliated with the modern creator of the term "Morgellons". -- Brangifer (talk) 06:23, 6 July 2013 (UTC)

Opening comments by 137.111.13.200
The research group that released the content that is being discussed in this section was funded through a foundation that solicits donations ostensibly from Morgellons sufferers. There is therefore a financial interest in the dissemination of this particular group's content. The articles themselves are primary sources, which significantly contradict other primary and secondary sources. This is most likely due to methodological differences which are best judged through secondary sources, and thus we should wait until these become available. The author of the study discussed authored a press release targeting editors on the Morgellons wikipedia page. I am lead to believe it likely that this author is pressuring editors on the talk page to include their work on the main page, under the username "Erythema". The anonymity of wikipedia users is an important dimension, however if someone is trying to insert their own work into an article, especially when that work is challenged as a reliable source, then the potential conflict of interests should be addressed. I don't think avoiding the question serves anyone's purposes in this case.137.111.13.200 (talk) 04:51, 4 July 2013 (UTC)

Opening comments by 198.199.134.100
At this point, I no longer find it reasonable to assume good faith on the part of the editors favoring the inclusion of fringe research. One of them has now created a sockpuppet account to try and "mediate" the dispute. Erythema shows strong signs of actually being one of the fringe researchers who recently issued a press release decrying Wikipedia's policies (and did not deny it when directly asked). Drgao is operating under the idea that because the concensus of the medical community now supports the existence of some other condition that Drgao suffers from, we should include fringe research about Morgellons; Drgao also repeatedly misrepresents studies or quotes from studies that do not support his views as doing so and even claimed that an opinion piece published well before any modern primary sources about Morgellons (the other two predate the current scientific method, one predates Pasteur) was a "secondary source". Neither has contributed to any other Wikipedia article. There are one or two other editors in favor of fringe research, but they don't appear to be meaningfully contributing to the discussion. I realize the named editors sincerely believe Morgellons is a non-delusional condition, but deliberate dishonesty is not a valid method of seeking editor concensus. 198.199.134.100 (talk) 00:38, 6 July 2013 (UTC)


 * Correction: Drgao does get involved in editing other pages on similar/related topics. 198.199.134.100 (talk) 02:45, 6 July 2013 (UTC)

Discussion
Please do not use this for discussing the dispute prior to a volunteer opening the thread for comments - continue discussing the issues on the article talk page if necessary.
 * Hitherto uninvolved editor who stummbled across this DRN. I've taken the time to read the extensive discussion on the article talk page and examone the sources, and I have to agree that all of the sources proposed for the fringe view fall far short of WP:MEDRS. In short, there is not mention of the fringe "research" in reliable medical sources. Most of it has been published in non-peer reveiwed publication that would never be read by mainstream medical researchers in the first place. The material that Drgao and Erythema would like to add to this article is thus unreliably sourced, and violates WP:NPOV, especially WP:WEIGHT and WP:GEVAL. It clearly falls under WP:FRINGE. I just see a lot of deadhorse argumentation and WP:IDHT on the article talk page, and I'm really having a hard time assuming good faith. I don't see much point in further discussion unless WP:MEDRS sources are produced. Consensus on the talk page is already pretty clear that the sources produced so far are unreliable, and I agree. Dominus Vobisdu (talk) 21:33, 5 July 2013 (UTC)

Please note the following ANI discussion regarding this DRN: Administrators'_noticeboard/Incidents. 15:27, 5 July 2013 (UTC)


 * Please wait until the problem with mediation is sorted out, and for the process to be formally restarted. We cannot continue this discussion while the disruption continues. 15:54, 5 July 2013 (UTC)

Invoking mediation controls: For the present time, in light of the controversy pending here, I am assuming the role of mediator here and invoking the rules set out at MEDIATION to exercise the right to edit this discussion as if it were my own user talk page, which includes the right to refactor, strike, or remove any edits which I feel are inappropriate. Regards, TransporterMan  ( TALK ) 15:58, 5 July 2013 (UTC)

Opening statements: Editors who have not yet made opening statements should feel free to go ahead and make them in their respective sections, above, and are advised to do so as promptly as possible. Regards, TransporterMan  ( TALK ) 16:43, 5 July 2013 (UTC)

Update: It would appear that InLoveNoi has indeed withdrawn as a DRN volunteer (actually, has ceased editing since being told by a sysop to withdraw or be blocked). I have de-collapsed, but left closed, the foregoing discussion and will await further opening statements. I have, further, redacted via strikeout all procedural discussions above so as to leave only discussions about the substance of the dispute. While the remaining discussions are premature and I will not allow them to continue at this time, they are what they are and they should not be removed from the record. If discussion does proceed, then we can give them as much or as little weight as they may deserve. Regards, TransporterMan  ( TALK ) 19:21, 5 July 2013 (UTC) Further update: InLoveNoi is now indefinitely blocked as a sockpuppet. — TransporterMan  ( TALK ) 21:46, 5 July 2013 (UTC)


 * I have just deleted a comment by Drgao, a party to this dispute, added to the discussion here before this case was opened for discussion. I — reluctantly — retained the one by Dominus Vobisdu, though I moved it into the closed section, because s/he was not a party to the dispute. All further comments of a nonprocedural nature in this "Talk:Morgellons discussion" will be summarily deleted if made before this case is opened for discussion. — TransporterMan  ( TALK ) 00:37, 6 July 2013 (UTC)


 * I have now deleted all the preliminary edits by and  as both accounts have been indefinitely blocked as sockpuppets of blocked user . In the process, I have also deleted some response edits by legitimate participants here, but all that were deleted were merely responsive to the attempts by Ryanspir to manipulate this process and did not make any substantive comments on the substance of this case. If anyone objects, please drop a note on my user talk page and we'll discuss working your comments back in. Regards,  TransporterMan  ( TALK ) 16:39, 9 July 2013 (UTC)

Inquiry to all parties
We're waiting for the last two listed editors to give opening statements, but while we're waiting I need to raise this issue: The DRN guidelines say:"Volunteers who have had past dealings with the article, subject matter, or with the editors involved in a dispute which would bias their response must not act as a volunteer on that dispute. If any editor objects to a volunteer's participation in a dispute, the volunteer must either withdraw or take the objection to the DRN talk page to let the community comment upon whether or not the volunteer should continue in that dispute."As long as I've been doing dispute resolution, I have no doubt that I have at least crossed paths with some of the editors in this case. I will represent to you that to the extent that I have done so I have not formed any opinions or impressions which would cause me to be biased either against them or in their favor. Indeed, I don't have any particular memories of any of you except that some of your usernames seem familiar to me. That does not mean that I have not had strong interactions and even confrontations or commiserations with some of you. It only means that I don't remember them if I did. If any come back to mind, I will immediately disclose them here. (If anyone wants to check my prior interactions with everyone here, more power to you: You can use the tool here to do so. Let me know if you find anything.} But my point is this: If you want to lodge an objection to my further participation, do it now, not later, unless I subsequently discuss a connection. Also, if any of you have had interactions with me, good or bad, which might bias me please say so now and I'll specifically check those out. Regards, TransporterMan  ( TALK ) 21:58, 6 July 2013 (UTC) PS: Feel free to answer or address this inquiry, below, but do not begin discussing the dispute yet. — TM


 * I have no issue with you moderating. Can we get started?  We're only missing statements from Garrondo and Judgeking, and their involvement in this discussion at the article Talk page was minimal.  I count only 3 comments from Garrondo, all over 1 month old, and Garrondo has been editing since the DRN notice so it does not look like Garrondo is interested.  I count only 2 comments from Judgeking, most recent was 10 days ago, Judgeking hasn't edited since 27 June.  And based on their involvement at the article, their viewpoints are already being represented here by many other editors already.    16:55, 7 July 2013 (UTC)


 * I'm inclined to feel the same way. I'm going to give them until tomorrow to weigh in or for anyone else to lodge an objection to my mediation and if neither occurs, we'll probably forge ahead. Regards, TransporterMan  ( TALK ) 19:53, 7 July 2013 (UTC)

Initial ground rules
The following are adopted pursuant to MEDIATION, and are subject to supplementation, revision, or revocation at any time.


 * You must check this page every day you edit Wikipedia (and at least once every 48 hours if you don't have an edit during that time) and respond to any inquiries which I make. If you're going to be unavailable for awhile and unable to check this and/or respond, say so and I'll decide whether to put this on hold or move forward without you.
 * At least for the present time, this will move forward in a question and answer manner in which I ask questions or make comments and request you to respond. Some inquiries may be to individuals, others may be to groups or factions. Do not respond to or comment upon responses or answers made by others unless I request it. If you do, I reserve the right to delete those responses. Only answer the question that I ask, do not jump ahead or say anything else. Again, I reserve the right to delete any answers which go beyond the questions that I ask.
 * Be civil. Do not comment about one another. If you wish to comment or complain about another user's conduct, motivations, identity, or anything else, take it to an administrator (I'm not one, by the way), to WP:RFC/U, or to WP:ANI, but don't raise it here (do drop a note on my user talk page that you're doing that, however, as I may want to put a hold on the proceedings here until that conduct matter is resolved.) Listen up: This rule will be strictly enforced. Don't say, "I didn't mean it that way" or "I was just angry", just don't do it. Comments made in violation of this rule will be deleted the first time; the second time, either you or me will be leaving this discusion.
 * Except for Judgeking and Garrondo (who can still make opening statements), the opening statements are now closed. Do not change or supplement them further.
 * I tend to be courteous and say "please" before requests, instructions, or rules. Do not take my use of "please" to mean that what follows it is optional. Indeed, none of my requests, instructions, or rules are optional; if I mean something to be optional, I'll make that unmistakeably clear with a qualifier such as, "You don't have to answer this if you don't want to" or "This isn't required, but" or something like that.
 * The IP editors must keep up with the IP's they're editing from and let us know here if they change. This isn't required, but I would strongly prefer that they create accounts, identify them with their IP, and sign in to participate here.

Regards, TransporterMan  ( TALK ) 15:37, 8 July 2013 (UTC)

Beginning the mediation
'Read the "Initial ground rules" section, above. Your continued participation in this mediation constitutes complete acceptance of the foregoing rules.'

As I understand it, this is a NPOV dispute with certain editors wishing to include material in the article saying that Morgellons is an actual, as opposed to mental, disease or condition. Other editors oppose that inclusion because they claim that the sources are insufficiently reliable to include it. Although one editor, Erythema, also claims that the existing material about Morgellons being a mental condition is also inadequately sourced, I do not see that as the primary matter in dispute in this case except perhaps as a question of what balance to give the competing views if the real-disease theory proves to be includable. From my point of view, to try to decide how much space and/or weight to give the real-disease theory before deciding whether or not it can be included at all is putting the horse before the cart and I do not intend to discuss or allow discussion of that issue until the other issue is resolved, at which time we may go on to the proper-weight issue.


 * Inquiry #1 @Everyone: As I analyze it, Erythema and Drgao support the inclusion of the material in question. All other participants here oppose it due to lack of adequate sources. Please let me know, below, if I've got that wrong. Don't answer at all if I have it right.
 * Inquiry #2 @Everyone: If there any sources whose reliability is in question other than the following, please list them below:
 * The mystery of Morgellons disease: infection or delusion? (2006) MEDLINE Full paper
 * Morgellons: a novel dermatological perspective as the multisystem infective disease borreliosis (2013).
 * Association of spirochetal infection with Morgellons disease (2013).
 * Characterization and evolution of dermal filaments from patients with Morgellons disease (2013)
 * [ Morgellons Disease: A Chemical and Light Microscopic Study (2012)].
 * Filament formation associated with spirochetal infection: a comparative approach to Morgellons disease (2011)
 * Delusions may not always be delusions (2010, Editorial) MEDLINE Full paper
 * Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology (2010)
 * Morgellons disease, illuminating an undefined illness: a case series (2009)
 * Myiasis, fillan, and the morgellons (1946) MEDLINE Full paper


 * Inquiry #3 @Everyone: There are three ways we can approach this mediation:
 * Method A (default) — Classic Mediation: A traditional mediation where I try to get everyone to come to agreement.
 * Method B — Opinion: I can read all the arguments and merely provide a third-party neutral opinion, which everyone is free to accept or reject, but which closes the mediation on the point on which I opine.
 * Method C — Arbitration by agreement: Same as #2, but everyone involved here agrees that they will abide by my opinion and quit discussing the issue in dispute until something changes in the real world (for example, new studies or sources being done and becoming available) which renders it inapplicable.
 * We'll use Method A unless everyone prefers B or C, though I reserve the right to use B on my on volition if and when I think it becomes appropriate. Method C would require an affirmative agreement from everyone. So in the space below, just indicate which one you would prefer. Just put in something like ":A — ~" or ":B then A then C, in that order — ~"

Regards, TransporterMan  ( TALK ) 15:37, 8 July 2013 (UTC)


 * Responses to Inquiry #1:
 * The material dramatically deviates from previous studies, and it is questionable whether it would have passed the orthodox peer-review stages of mainstream journals (due to the combination of methodology and conclusions). However, it is incorrect to suggest that this automatically renders the conclusions false. It requires the adjudication of further research and impartial literature review from secondary sources. I believe the material would be suitable for the page if and when that happens. This essentially fleshes out the first inquiry, as I see it.137.111.13.200 (talk) 23:30, 8 July 2013 (UTC)
 * Your understanding is correct. However, my concerns are, as you mentioned, 2 fold. If the references used to support the inclusion of new material do not meet WP standards for medical references then, few of the references used in the current article do either.Erythema (talk) 20:59, 9 July 2013 (UTC)

I think an additional problem is that some editors are claiming that some studies or portions thereof support the "actual disease" hypothesis when they clearly do not. Where the studies have a "conclusions" section, I'd like to seek agreement that we judge the study as supporting that conclusion instead of quote mining the study. 198.199.134.100 (talk) 23:57, 8 July 2013 (UTC)
 * Responses to Inquiry #2:
 * I realize the WP policy does not favor using original research, but that it does allow for the inclusion of primary studies when secondary studies are lacking. I want to be clear that I do not expect the inclusion of new material to be used in a way that is not compatible with WP policy. I honestly want the article to be a fair and unbiased representation of the medical literature available on this topic, but if primary sources are used to reference 1 POV then they should be allowed to reference the other (or any other POVs). I would like to mention there is a reliable secondary resource citing material supporting the infectious hypothesis. Other editors seem to agree that the F1000 itself is a prestigious group of scientists and doctors, although they dispute F1000 Research. The F1000 (not part of F1000 Research) have cited the paper, Morgellons Disease: A Chemical and Light Microscopic Study (2012), in F1000 Prime as a recommended article, f1000.com/prime/716597867, and as a must read or very good article. This citation is not the same as the paper itself (it was published by OMICS) and is therefore a secondary source. I would like to see this included as an additional reference.Erythema (talk) 21:30, 9 July 2013 (UTC)


 * Responses to Inquiry #3:
 * I prefer Method C most, Method B next, and Method A least, but will still agree to move forward with any of them.  15:46, 8 July 2013 (UTC)


 * I echo Zad68 in preferring C, B, and A last, but agreeing to abide by whichever approach will resolve the dispute. TechBear  &#124; Talk &#124; Contributions 16:18, 8 July 2013 (UTC)


 * A (based on TM's suggestion), but C and B are fine, too -- Scray (talk) 21:22, 8 July 2013 (UTC)


 * C and B, then A, in the interest of reaching consensus (and after considering why so many favor this, I agree). -- Scray (talk) 16:11, 9 July 2013 (UTC)


 * C is my preference, followed by A, then lastly B. Drgao (talk) 23:11, 8 July 2013 (UTC)


 * C is my preference, then A then B.137.111.13.200 (talk) 23:21, 8 July 2013 (UTC)


 * Definitely C. A & B wouldn't be a definitive decision on the process and I'd prefer to resolve this ASAP. 198.199.134.100 (talk) 23:57, 8 July 2013 (UTC)


 * Prefer C. Unsure as to preference between remaining options. Sailsbystars (talk) 04:04, 9 July 2013 (UTC)


 * C,B then A. Dbrodbeck (talk) 12:30, 9 July 2013 (UTC)


 * C, then B then A. I'll participate whichever is ultimately chosen. Cheers, Dawn Bard (talk) 21:08, 9 July 2013 (UTC)


 * I prefer A if it is possible. But if not either B or C.Erythema (talk) 21:33, 9 July 2013 (UTC)


 * Interim evaluation of the foregoing: Since option C is the first preference of most participants and at least an alternative choice of everyone else, I would use C except that two editors, Brangifer and Arthur Rubin, have not agreed to it (or any other choice) and C must be unanimous to be available. I would ordinarily just move ahead with one of the other options but when the responses already given are evaluated it's very close to a dead heat between A and B. I'm going to poke them on their talk pages and ask them to weigh in here. If they've not done so in the next 24 hours or so, then we'll move ahead. Regards, TransporterMan  ( TALK ) 15:54, 11 July 2013 (UTC)


 * I prefer C. -- Brangifer (talk) 03:15, 12 July 2013 (UTC)
 * My apologies for the delay. I prefer C, as well.  — Arthur Rubin  (talk) 21:46, 12 July 2013 (UTC)

Moving forward with C
Though we've not heard from Arthur Rubin, I've taken a long look at his user page, user status, and history and believe that we can expect that he will respect any result we reach here even if he has not specifically agreed to option C, so that's what we are going to go with.
 * In that context, everyone needs to understand that with option C that what we have is, essentially, an agreement that you will not dispute this matter further with one another.
 * It does not mean that any third parties are bound by that agreement, so it is entirely possible for a new editor — not a sockpuppet or new account of one of you, but an entirely new participant — to come along and start advocating for one side or the other and this decision will not be binding in any way on them.
 * Because of that, your agreement to this method also implies that not only will you agree to abide by it, but that you will not solicit third parties to come along and reopen it.
 * If a third party does come along and their position is opposite to that decided here, it further means that those on the prevailing side here must be able to oppose that third party without interference or negative input from those on the other side here.


 * It also means that if new sources pro or con are developed, by which I mean that they are published for the first time after the decision here, then they can be raised and discussed by either side.
 * As part of the concept here, the idea is to end this dispute. You have my promise that I will not decide the matter frivolously, arbitrarily, or lightly or with any bias other than a bias in favor of doing what's best for the encyclopedia in keeping with its policies, guidelines, and customary practices, but what I decide will not be subject to further discussion or appeal.
 * Finally, this agreement is a handshake and obligation of honor, not an enforceable agreement. I'm not an administrator and even if I was there's no provision in policy for enforcing an agreement such as this.

So stop and engage in a bit of self-examination for a moment. Let's say I come back with a decision that is to the absolute opposite of what you think is right and with either no explanation of it (I reserve the right to just decide without explanation, though it's not likely that's what I'll do) or with an explanation that you think is dead wrong. What I'm asking of you is whether on your honor you can commit right now to gritting your teeth and living with that result without rejecting it, arguing against it, carping about it, or finagling a way around it. There's no dishonor in saying no, but only if you do it now.

Here we go: I've carefully avoided studying the issue until now, just so I could be neutral in setting all this up and in giving the question a fair reading when the time came. From now through next Monday, I'm going to start studying the issue. If anyone either wants to back out on the agreement after the introspection I've just asked for, or if anyone wants to make any comments about any of the specific sources listed above, feel free to do so below, but do it before 11:59 UTC on Monday, July 15, 2013. Regards, TransporterMan  ( TALK ) 17:55, 12 July 2013 (UTC)


 * Sounds great. I'm sure everyone who supported Option C was aware that this was what they were choosing, the description going into it was pretty clear.  Are you stating that you will be STARTING your review on Monday?  I just want to be sure that the three recent discussions at Talk:Morgellons entitled Talk:Morgellons, Talk:Morgellons, and Talk:Morgellons are read and considered carefully as part of the review process.  Thanks...   18:20, 12 July 2013 (UTC)


 * I'll be sure to consider them; if anyone else has specific discussions to which they wish to point me, please feel free to do so here. I'll be doing my review starting immediately with a view towards issuing a decision on Tuesday, though if I have questions I need to pose here, or unexpected real world issues (which are always possible for me on weekends), it might be delayed. Regards, TransporterMan  ( TALK ) 18:41, 12 July 2013 (UTC)

@Erythema: At the article talk page you have asserted several times that, "There are provisions for relaxation of the No original research policy when secondary sources are lacking." While I don't think that assertion is going to affect the answer of what I'm considering at this point in time, I'd like to make sure. Please identify the provisions that you're talking about. Regards, TransporterMan  ( TALK ) 19:26, 12 July 2013 (UTC)


 * (Responses copied from my user talk page. — TransporterMan  ( TALK ) 13:58, 16 July 2013 (UTC))


 * Sorry to take so long to get back to your request for information on relaxing policy. I am out of town at a conference and have not had much time for wikipedia. First thanks for volunteering to mediate this heated topic. Whatever way you decide I very much appreciate the attention you are giving this and your neutrality. I honestly do not want to do anything that opposes WP policy and if the addition of new material conflicts with policy I completely understand. My concern is the bias that I feel the current article has, especially because it does involve health of people. The main article is written as though there is no other POV other than a delusional etiology and I feel the patients with this disorder and the public need to know there are other POVs. A Pub Med search on Morgellons does not provide many, if any, appropriate secondary sources. There aren't any good systematic review articles. There is quite a lot on WP:MEDRS on the use of primary sources and how to use them. This was the section where it says that policy can be relaxed when an area is undergoing active research. I believe there is another mention somewhere else and I will look more thoroughly for it. Again, thanks for volunteering.


 * WP:MEDDATE


 * Here are some rules of thumb for keeping an article up-to-date, while maintaining the more-important goal of reliability. These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published. Erythema (talk) 03:35, 16 July 2013 (UTC)


 * Hi Transporterman, I cannot find anything in WP:MEDRS that indicates that primary resources should not be used when secondary sources are lacking. In the current article on Morgellons very few references are from peer-reviewed medical journals. Of those that are almost all are opinion peices, and of those that are not there are 2 original research. Here's some more on primary resources that seems to indicate that they can be used providing they are used correctly. WP:MEDRS: Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse. For that reason, edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. In particular, this description should follow closely the interpretation of the data given by the authors, or by other reliable secondary sources. Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources. Regards Erythema (talk) 04:36, 16 July 2013 (UTC)

Opinion and call for additional arguments
I have reviewed the sources in question, i.e. those listed above in my posting of 15:37, 8 July 2013, and those subsequently mentioned by others. WP:MEDRS says:"Wikipedia's articles, while not intended to provide medical advice, are nonetheless an important and widely used source of health information. Therefore, it is vital that the biomedical information in all types of articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge. Ideal sources for such content includes literature reviews or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies."It also says:"After enough time has passed for a review in the area to be published, the review should be cited in preference to the primary study. ... If no review on the subject is published in a reasonable amount of time, then the text associated with the primary source should be removed."And says:"Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources."While other portions of MEDRS are also applicable, it is my belief that except for two or perhaps three of the sources that none of the listed sources are sufficiently reliable to be cited in the article due to substantial doubt about their publishers having the "reputation for fact-checking and accuracy" required by WP:SOURCES. Note that I said WP:SOURCES, not WP:MEDRS. By that I mean to say that I do not believe that they meet even the standard needed for ordinary sources at Wikipedia. When one filters that through the higher standard required by WP:MEDRS, I believe that there is no possibility that they could serve as reliable sources for medical articles. The articles which I have reference to here are those published by F1000, Dove Press, and OMICS. That leaves the three articles published by Springer, BioMed, and British Medical Journal. The publishers of the first and third are clearly reliable and I am uncertain about BioMed. I believe the BMJ article, which is merely a 1946 letter to the journal is, however, both too old and too anecdotal to be of any use in the article except perhaps to provide some historical information if and when the disease theory can positively appear in the article in depth. That leaves the Springer ("The mystery of Morgellons disease", Savely, Leitao, and Stricker) and BioMed ("Morgellons disease, illuminating", Harvey, Bransfield, Mercer, Leitao, et al) articles. '''I would like to hear arguments about why or why not those two particular articles do or do not qualify as MEDRS-reliable sources and should or should not be used in the article. In that regard, I would also welcome comments about why the CDC study is appropriate for the article, but those two articles are or are not.''' Any participant may respond below and I'll receive arguments through 23:59 UST on Thursday, July 18. ''Please do not respond to one another's arguments, simply make your own case. This opinion is final as to the other sources, please refrain from commenting on them; any comments on the F1000, Dove Press, OMICS, and BMJ sources will be disregarded and deleted.'' Regards,  TransporterMan  ( TALK ) 21:44, 16 July 2013 (UTC) PS: If you assert that something is determined by a policy or guideline, please provide a link to the specific section of the policy or guideline you are asserting. — TransporterMan  ( TALK ) 21:50, 16 July 2013 (UTC) 
 * The following discussion is closed pending the issuance of a final decision.  — TransporterMan  ( TALK ) 14:22, 19 July 2013 (UTC)


 * I'd say the CDC study is relevant simply for the history of the condition, which is how it's used in the article. The 2006 article could be included in that fashion (and already is). However, if you check the link to the full article, it simply doesn't count as a secondary study. It was published at least two years before any modern primary sources; the only "Morgellons is non-delusional" article it cites is the 1946 letter. It therefore does not make the "non-delusional" argument more than a fringe view. Stricker is also credited in the paper and has a very poor reputation from being found guilty of scientific misconduct. I can't comment on the 2009 article at the moment, other than to say that Leitao is credited in the article and is also considered an unreliable researcher by mainstream medical consensus; I'll try to look into it later. 198.199.134.100 (talk) 01:16, 17 July 2013 (UTC)
 * The Savely et al (2006) paper is an opinion piece, at the top of the article it actually says 'current opinion' so really it is a long letter to the editor. Harvey et al, (2009) is a primary source with Mary Leitao as an author.  These two papers are really good refs for the WP:FRINGE view that this is a distinct disease, but nothing beyond that.  If they are to be used, they must be used with great care.  The CDC study was conducted by the CDC whose reputation is pretty decent.  Dbrodbeck (talk) 12:38, 17 July 2013 (UTC)
 * I'd add that the CDC study is notable in that it's cited fairly authoritatively both in the media and in other subsequent publications in reliable sources. On the BioMed article.... I find it more than a little dubious that the lead author's contact is an aol email (click author info) and the only people not using home emails are a veterinary clinic and the MRF.  Legitimate researchers usually have emails from research institutions.  Sailsbystars (talk) 06:17, 18 July 2013 (UTC)


 * The CDC study is relevant as the medical/governmental reaction to lobbying from people associated with the Morgellons condition, I believe the study itself was mentioned on the page long before the conclusions of the study came out. That a study was being conducted by the CDC at all was apparently important at that time. The conclusions of the study, even though they are essentially from a primary source (regardless of the profile of the CDC), are relevant purely in an historical sense, if not a medical one. However, the CDC study has been reviewed in secondary sources (http://onlinelibrary.wiley.com/doi/10.1111/ijd.12067/full- Medline; http://www.ncbi.nlm.nih.gov/pubmed/22583072- Medline), and the conclusions are in accord with the consensus that is somewhat apparent on the issue.
 * The Savely 2006 article is an opinion piece, which would have made sense as something to include in lieu of reliable studies about the condition, although now after numerous studies on the subject have been published, the space where that paper would go has been filled with actual information.
 * The Harvey 2009 article has two citations from reliable secondary sources (that I can see)- (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690364/- Medline) cited it thus- "The current consensus is that this disease is a new manifestation and variant of delusional infestation with ‘infection’ by an inanimate material"
 * The only other citation in a Medline article was the CDC study, which mentioned an elevated level of cytokines as in Harvey. Not much support for the infestation suggestion.137.111.13.200 (talk) 09:43, 18 July 2013 (UTC)


 * I should point out that the CDC study accepted the possibility that Morgellons might be a real physical disease, as the following statement from the study demonstrates: the authors of the CDC study stated that "we were not able to conclude based on this study whether this unexplained dermopathy represents a new condition, as has been proposed by those who use the term Morgellons, or [whether it represents] wider recognition of an existing condition such as delusional infestation." If the CDC study is to be included in the article, the fact that the CDC accept that Morgellons could be a real physical disease should be mentioned.


 * At present the CDC study is only used to support the delusional infestation view of Morgellons in the article. The article needs to represent the CDC study neutrally. Drgao (talk) 13:40, 18 July 2013 (UTC)
 * Please clarify, where in is there support for that "real physical disease"? All I can see is "a new condition", such as a different variation of the delusion. LeadSongDog  come howl!  17:21, 18 July 2013 (UTC)


 * How come you stopped reading at the comma? The CDC study says: "a new condition, as has been proposed by those who use the term Morgellons". People who use the term Morgellons say that the condition is a real physical skin disease. Drgao (talk) 17:38, 18 July 2013 (UTC)


 * Numerous papers indeed suggest that the condition is a real physical skin disease, caused by delusional infestation. Whether or not the condition is characterised by anything that sets it apart from DI is not clear. Do you believe the abstract of their study contradicts with their conclusions? "No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation."137.111.13.200 (talk) 04:33, 19 July 2013 (UTC)


 * Delusional infestation is not a real physical skin disease in this context, in the sense in that the researchers who propose Morgellons is a DI believe that the skin lesions are merely cause by excessive scratching of the skin (ie, the lesions are self-inflicted), rather than caused by some metabolic or physiological pathology of the skin. I think the researchers of the CDC study are playing games with words a little: by your above quote, they seem to be siding to an extent with the delusional infestation idea of Morgellons; but in the conclusion of the article, the CDC cover themselves by no matter what Morgellons turns out to be, by saying that they could not determine whether Morgellons was a real physical skin disease or a delusional infestation. Drgao (talk) 10:43, 19 July 2013 (UTC)


 * The above discussion is preserved as an archive. Please do not modify it. 

Final opinion and closing comments
Based on the opening and foregoing arguments and on my own personal investigation into the matter, I find that:
 * The Savely 2006 article is reliable as, and only as, an opinion piece, and generally only reliable as support for what statements attributed to its authors say, if — and only if — the opinions of its authors can be shown to be be both relevant to the article and needed to support, without giving undue weight to, some point which is otherwise supported by relevant sources. I further believe, without holding in a binding way, that such a use, with that limitation, is probably unneeded.
 * The Harvey 2009 article is, on its own, a reliable but very weak source under WP:MEDRS due to the nature of the study and the lack of subsequent positive citations in clearly-reliable sources. The two times it has been cited, once in the CDC study and a second one here have not been to support the theory that there is a non-psychological cause for Morgellons. Similar to the Savely 2006 article, I cannot see what it would add to the sources already present in the article (but I do not hold what I say in this sentence out to be binding). I also note that in the How do you think we can help? section, above, the listing editor says that this request is to, "Determine consensus as to whether the sources proposed are indeed authoritative WP:MEDRS-compliant secondary sources such that per WP:NPOV the mention of the parasite theory is warranted." I see no support in Harvey 2009 for the theory that Morgellons may actually be caused by parasites, and I do not believe that it is reliable to support that theory.
 * I only mentioned the CDC study above as a foil for examination of Savely 2006 and Harvey 2009, so let me note that I neither express nor imply any opinion about the reliability of that study, pro or con.

Though some participants have indicated that they would like this opinion to extend beyond the mere question of source reliability into the issue of what weight and balance to give any sources which proved to be reliable and to the question of whether the existing sources in the article are reliable to support the psychological theory. I believe that would be beyond the scope of this request and that those matters need to be more fully discussed at the article talk page in light of this opinion and so must decline that request.

Thanks to all the participants for their cooperation and patience in this matter. Best regards, TransporterMan  ( TALK ) 20:21, 19 July 2013 (UTC)