Wikipedia talk:Requests for mediation/Vaccine controversy

This Request for Mediation has been closed. This case was closed by: Sunray (talk) 08:41, 18 January 2010 (UTC). The reason given for closure was: reason for closure. Parties: If you wish to resume this mediation, please file a new request.

Beginning mediation

Welcome to the mediation for Vaccine controversy. I am willing to mediate this case. My view of mediation is that it can be a valuable process for learning providing that participants agree on certain basic groundrules. Feel free to contact me on my talk page if you have any questions. Sunray (talk) 22:09, 8 November 2009 (UTC)

Here are some groundrules that have worked in other cases:

1. Stick to content, not the contributor - This should be uncontroversial, since it is policy. Personal attacks will be removed by the mediator, substituting the following template: (Personal attack removed) If there is a need to give feedback to another participant, consider using these basic guidelines.
2. Keep posts short. - Long tendentious posts are hard to follow. If folks wish to discuss or comment on something at length, editors may create a subpage for it with a short section here linking to it.
3. Listen to fellow editors, assuming good faith.
4. Seek consensus rather than continually repeating the same point.

Acceptance of groundrules

Please signify your agreement to the above groundrules by typing * '''Agree''' ~~~~ below.

• Agree. Eubulides (talk) 01:19, 9 November 2009 (UTC)
• Agree. Yobol (talk) 01:57, 9 November 2009 (UTC)
• Agree. Sebastian Garth (talk) 20:50, 9 November 2009 (UTC)

Opening statements

Please make an opening statement of 250 words or less, stating the problem and any possible solutions that you foresee.

• This is a disagreement over whether Vaccine controversy can say that a notion "is flawed". Reliable sources on the topic agree that there are serious objections to the notion of vaccine overload, and one of these sources (Gerber & Offit 2009, PMID 19128068) specifically says that the notion "is flawed for several reasons". I have no trouble with proposals to paraphrase the wording. The article could, for example, say that the notion "has flaws" or "is faulty" or "has faults" or "has problems" etc. More fundamentally, I have no trouble with changing what the article says about this medical topic so long as its claims faithfully reflect what reliable medical sources say, giving proper weight to what these sources directly say about the topic. Eubulides (talk) 01:19, 9 November 2009 (UTC)

• The sentence in question, "The idea is flawed, for several reasons" is a paraphrase of the cited reference (Gerber & Offit). Objections were raised regarding pointedly saying that the notion "is flawed" is a violation of various policies, and that instead, a watered down, less definitive version should be used such as adding qualifying phrases such as "evidence has shown", "studies have shown" etc. It is my reading of various policies that we should not water down statements when there is no controversy in the mainstream scientific literature. As no one has presented any evidence of such controversy, and the reference cited says that it "is flawed," I do not believe any watering down of the sentence is appropriate. Yobol (talk) 01:57, 9 November 2009 (UTC)

• My contention is that the current wording lacks an appropriate sense of neutrality. Fundamentally, the issue of vaccine overload arises naturally from questions of pharmacokinetic interaction, which in and of itself cannot be unequivocally ruled out as a flawed assumption, per se. That is, even as studies may refute the proposition for a given combination of substances, they nonetheless do not invalidate the principles of pharmacokinetics, in general. To that end, statements on the subject should not attempt to convey a sense of "absolute fact", but rather present the matter in a clear, unbiased manner, in accordance with Wikipedia standards. The easiest way to do this without removing any of the existing content, I think, would simply be to attribute the statement to the source, either directly or indirectly. I suggest wording such as "studies have shown", "research has found", "some have pointed out", etc, which would adequately support the cited reference while maintaining a neutral tone overall. Sebastian Garth (talk) 15:12, 9 November 2009 (UTC)
  • Thank you all for such comprehensive statements! I will respond to them within the next hour. In the meantime, Sebastian, would you be willing to signify your agreement with the groundrules by signing, above? Sunray (talk) 18:52, 9 November 2009 (UTC)
  • Yes. Sorry, I missed that. Sebastian Garth (talk) 20:54, 9 November 2009 (UTC)

I understand from reading your statements that the debate has to do with both faithfulness to sources and the need for neutrality of wording. Eubuildes introduces the concern that since sources describe the notion of "vaccine overload" as flawed, the wording of our article must reflect that faithfully. Yobol says that a paraphrase of that statement must not water down the meaning. He adds that the article should reflect the mainstream scientific literature. Sebastian speaks to the question of neutrality. He is concerned that statements not imply absolute truth and suggests employing wording such as: "studies have shown." In your three comments, I believe I detect a common interest in accurately reflecting the views of the scientific community on this subject. It also seems clear that you are all trying to respect WP policies, and particularly WP:NPOV. Have I understood correctly? Sunray (talk) 21:09, 9 November 2009 (UTC)

• Yes. Eubulides (talk) 21:25, 9 November 2009 (UTC)
• Yes. Yobol (talk) 00:16, 10 November 2009 (UTC)
• Yes. Sebastian Garth (talk) 01:09, 10 November 2009 (UTC)

Ways of addressing concerns

Good. Now comes the difficult part. If we focus on the common interests, what are possible ways of resolving this dilemma? In responding, please try to avoid restating the point(s) you have already expressed. Instead, think of the other guy's position and see if you can somehow address their concern(s). Sunray (talk) 06:06, 10 November 2009 (UTC)

• My suggestion would be to come up with wording that carries an appropriate connotation of neutrality, without using wording that casts editorial doubts on what the sources say. Clearly the sources do not establish an absolute fact that the vaccine overload theory is incorrect, or is wrong, or is false, or anything like that, and the article should not give that impression. On the other hand, the sources are quite clear that the vaccine overload theory has no scientific support and has significant problems, and the article should not soft-pedal this either. I suggest coming up with wording that faithfully reflects the conclusions of reliable sources, without making these conclusions seem disparaging or dismissive, and without drawing undue attention to the sources in such a way that casts doubt in the reader's mind as to whether the sources are reliable. Eubulides (talk) 06:43, 10 November 2009 (UTC)
  • Would an actual quote or two from sources be useful here? Sunray (talk) 07:05, 10 November 2009 (UTC)
    • Perhaps. From Gregson & Edelman 2003 (PMID 14753385): "There is no evidence that currently recommended vaccines overload or weaken the infant immune system." And from Gerber & Offit 2009 (PMID 19128068): "The notion that children might be receiving too many vaccines too soon and that these vaccines either overwhelm an immature immune system or generate a pathologic, autism‐inducing autoimmune response is flawed for several reasons: 1. Vaccines do not overwhelm the immune system.... 2. Multiple vaccinations do not weaken the immune system.... 3. Autism is not an immune‐mediated disease.... 4. No studies have compared the incidence of autism in vaccinated, unvaccinated, or alternatively vaccinated children ..." Eubulides (talk) 07:57, 10 November 2009 (UTC)

So we could say that there is no evidence that vaccines currently in use can overload or weaken infant immune systems, and cite these authors? Sunray (talk) 18:26, 10 November 2009 (UTC)

The article already does that, by saying "no scientific evidence supports this idea", where "this idea" refers to "the assertion that giving many vaccines at once may overwhelm or weaken a child's immune system, and lead to adverse effects". This part of the article is supported by Hilton et al. 2006 (PMID 16581162). As far as I know, there's no dispute among participants over this part of the article. Eubulides (talk) 00:45, 11 November 2009 (UTC)

• From my standpoint, moving forward would be best facilitated by understanding the objections better. From my read of the literature, "vaccine overload" has always been framed from an immunologic standpoint (i.e. can the antigens in the vaccines overwhelm the human immune system); however, the objection above notes that it is at its core instead a "pharmacokinetic" problem, a framing I do not recall seeing. If sources addressing vaccine overload with regard to pharmacokinetics could be presented (it has been previously asked for, but none provided), it may make my understanding of the dispute better. Yobol (talk) 13:28, 10 November 2009 (UTC)

I agree that to go into the issue of pharmachokenetics, we should look at some sources that address this. Would one of you be able to provide some citations on this? Sunray (talk) 18:26, 10 November 2009 (UTC)

• • Consider the case of the thiomersal controversy. This is nothing less (though perhaps more) than a vaccine overload issue itself (and hence a pharmacokinetic matter). That is, a small amount of murcurial compounds in the system may pose a small risk, but the administration of several vaccines containing the substance within short periods of time may in fact introduce enough mercury to cause harm. So, pharmacokinetics is necessarily the underlying science being applied to the problem. You may not see the words "vaccine overload" and "pharmacokinetics" in the same article, but then again, neither do you see "basketball" and "physics" together, although the former is obviously governed by the principles of the latter. The relationship here is identical. Sebastian Garth (talk) 15:02, 10 November 2009 (UTC)
    • The thiomersal controversy spoke specifically about the pharmacology/toxicology of thiomersal, and has been expressed in those terms by the WP:MEDRS. As I stated above, the "vaccine overload" issue has been, to my knowledge, exclusively looked at from an immunologic standpoint, not a "pharmacokinetic" one. I do not doubt that there are pharmacology issues with vaccines in general. I, however, do not see how it is related to "vaccine overload" in particular, nor do I see any evidence that "vaccine overload" has been primarily a "pharmacokinetic" issue as you described above. Yobol (talk) 18:09, 10 November 2009 (UTC)
    • One certainly does see "basketball" and "physics" together; see, for example, the highly cited paper "The physics of basketball" doi:10.1119/1.12511. Conversely, because we don't see "vaccine overload" and "pharmacokinetics" discussed together by reliable sources, we can't base this article's contents on our own hypotheses of how the latter might influence the former. Eubulides (talk) 00:45, 11 November 2009 (UTC)

• I also agree that the citation should faithfully represent the the source, and that we should not choose wording that would cast doubt upon the validity of the referenced statement(s). On the other hand, we should recognize that the conclusions being drawn are largely based on heuristic interpretations, which can only address a limited subset of the problem, and as such some sort of qualification (attribution, direct quote, etc) would allow it's inclusion without creating a false sense of finality. Anecdotal observations simply do not achieve the same level of certainty as with thorough scientific analysis, and so a more balanced representation of the findings would be most appropriate. Sebastian Garth (talk) 15:02, 10 November 2009 (UTC)

Balance is an important aspect of achieving a neutral point of view. The key here, will be ensuring appropriate weight. How could we achieve this? Sunray (talk) 18:26, 10 November 2009 (UTC)

I guess I would suggest something along these lines:

• "Vaccine overload has been examined in numerous studies, and yet none have found any evidence to support claims that it poses any significant risks. Instead, researchers have noted several flaws in the underlying assumption."

• "Research has found no substantial risk of vaccine overload, and studies have even pointed out why the very idea itself is flawed."

• "Studies that have been conducted on the subject have concluded that there are no trends to indicate that vaccine overload is a significant issue, and some have pointed out that the assumption itself is flawed, for several reasons."

Any of those would communicate the original message clearly, I think, while conforming with a strictly neutral editorial style. Sebastian Garth (talk) 19:56, 10 November 2009 (UTC)

These statements all seem to stray fairly far from the wording of the sources. Given the disagreement, would you be willing to agree that we should come closer to the actual wording? Sunray (talk) 07:07, 11 November 2009 (UTC)

To be quite honest, it really doesn't matter to me how exactly the statement is worded, as long as it adheres to a neutral point of view. So yes, I would be fine with a formulation that matches the source more closely. Sebastian Garth (talk) 21:32, 11 November 2009 (UTC)

It seems to me before suggesting how to make a change, it is important to decide whether a change needs to be made. A good place to start is to provide references for the notion that "vaccine overload" is at its core a "pharmacokinetic" issue, as suggested by the mediator above. Yobol (talk) 21:15, 10 November 2009 (UTC)

Given that the wording in the article is not a direct quote, and thus up to interpretation, I think it fair to conclude that a change does need to be made. How could we do that to meet the concerns raised? Sunray (talk) 07:07, 11 November 2009 (UTC)

Let me reprhase to be clear. I do not oppose all changes to the wording; I am in no way wedded to the exact phrasing in the current sentence. However, presenting examples of watered down wording, which seems to at the crux of the dispute seems to me to be another form of repeating the points already raised. It seems to me that elaborating on the basis of the dispute would be a more productive way forward, such as describing how the current wording fits (or does not fit) with our guidelines. For example, since WP:NPOV appears to be the guideline at the heart of the dispute, WP:ASF states we should state facts as facts if there is "no serious dispute"; there is no serious dispute in the scientific community about the concept of "vaccine overload", and therefore it would seem that rather than attribution as if it is an opinion, it would be better to state it clearly as a fact without the need for watered down attribution.Yobol (talk) 12:23, 11 November 2009 (UTC)

OK, I get that. You are not opposed to re-wording, but want the wording to accurately reflect what is said in the literature. It seems to me that health policy makers have a problem when it comes to immune overload. There is a perception out there (not sure how widespread it is) that immune overload is a possibility. The problem for health authorities, then, is with clarifying the realities of the situation. Is that right? Sunray (talk) 19:03, 11 November 2009 (UTC)

That sounds about right. The studies that describe the topic are done in response to the lay public's concerns about it, not driven by any particular concerns from within the medical community, and, to my knowledge, have all laid to rest the even biological plausibility of "vaccine overload." There has been no evidence presented that there is any significant concern about this in the mainstream scientific community except to assuage the publics fears. Yobol (talk) 20:31, 11 November 2009 (UTC)

That is not entirely accurate. There will always be pharmacokinetic concerns with respect to vaccines (as shown here [[1]], for example), and this necessarily includes "vaccine overload" and other related issues. At any rate, to make a statement of fact (as does the current wording) we should be able to verify that the sources have indeed established such a thing. Yet the sources in question only raise points based on generalizations, such as that children are exposed to more pathogens on a daily basis, that children's immune systems are amazingly well adept at "generating a vast array of protective responses", and so forth. These interpretations certainly support the opinion that vaccine overload is not a serious issue, but they nonetheless are not sufficient enough to allow the statement in question to be admitted as fact. Sebastian Garth (talk) 21:32, 11 November 2009 (UTC)

The trial you cite does not in any way relate to the specific concept of "vaccine overload" as understood by the medical literature except by the tangential relation about being about vaccines. Throughout this process from the talk page to this mediation you have yet to provide one reference supporting your assertions about "vaccine overload" specifically and "pharmacokinetics". Your assertions would be much more convincing were you to provide actual references or citations backing up your core contentions. You are, in essence, substituting your own judgement for those of the cited sources, something which would seem to violate WP:NOR. Yobol (talk) 21:44, 11 November 2009 (UTC)

You continue to deny the relationship between pharmacokinetics and vaccine overload on the basis that there is no literature explicitly connecting the two, but this is nothing more than a minor technicality. The reality is that pharmacokinetics are used to study the safety and effectiveness of vaccines, and thus this must naturally extend to the question of vaccine overload. That isn't "original research"; The connection is rather obvious. Concerning the other matter, the trial that I cited is, in fact, the origin of the statement in question. Specifically, it says: "The notion that children might be receiving too many vaccines too soon and that these vaccines either overwhelm an immature immune system or generate a pathologic, autism‐inducing autoimmune response is flawed for several reasons". It then goes on to list the generalizations that I pointed out earlier. The bottom line is that if the source does not establish a fact in it's assertion that the idea of vaccine overload "is flawed, for several reasons" then the statement should not be represented as such. Sebastian Garth (talk) 14:53, 12 November 2009 (UTC)

If there is an "obvious" connection you should have no problem finding a single reference that connects the two. Connecting two ideas that no known reliable, verifiable source and coming to an independent conclusion that no other source comes to is the very definition of original research. I am quite honestly baffled by your characterization of the trial you cite as the "origin" of the quote in Gerber and Offit as it does not appear to be cited by Gerber and Offit, and as far as I can tell, has never even been published. Yobol (talk) 15:36, 12 November 2009 (UTC)

Your claim that the connection is original research is specious, at best. If you can clearly demonstrate that the two are not related, either by logic or citation, I will gladly retract my argument. Otherwise, I must maintain that the connection is intrinsic, as it is a simple matter of course. With respect to the Gerber and Offit quote, it can be found in their article "Vaccines and Autism: A Tale of Shifting Hypotheses" under the section titled "Too Many Vaccines". Here is a link to the article [[2]]. Sebastian Garth (talk) 16:57, 12 November 2009 (UTC)

Sebastian, statements such as: "your claim... is specious, at best" do not assume good faith. Would you be able to stick to the content, not the contributor, please? Sunray (talk) 17:48, 12 November 2009 (UTC)

Sorry, I meant to imply that his position, although technically correct, was a bit unrealistic. But, yes, in the future I will avoid such ambiguous statements. Sebastian Garth (talk) 18:43, 12 November 2009 (UTC)

(Undent)Firstly, the burden of proof is on those who wish to make the connection. I did not propose it, you did. Until you provide a citation linking the two, it is original research. Secondly, I know where the quote from Gerber and Offit came from. However the trial you cite in this diff [3] about tetanus immunization is not about "vaccine overload" and does not appear in Gerber and Offit, so I fail to see the relevance it has. Yobol (talk) 17:09, 12 November 2009 (UTC)

I think that I have sufficiently proven a connection. The onus is now on you to illustrate why the association is incorrect. As to the tetanus reference, I was simply giving an example of the pharmacokinetic implications in the study of vaccines, in general. It only stands to reason that these principles must be applied to the issue of vaccine overload, as well. At any rate, my original point was that the Gerber/Offit article does not give factual basis to the statement that "the idea is flawed for several reasons", and so it should not be admitted as a fact. Oh, and if it helps to make this section more readable, I will just reply at this indentation level. Sebastian Garth (talk) 17:41, 12 November 2009 (UTC)

What, exactly, is the connection? "Proof" would be in the form of quotes from a reliable source. Would you be able to provide some sources that clarify your claim?

The connection is simply that pharmacokinetic analysis is used in the study of the effects of vaccines (eg: the tetanus reference that I provided earlier), and that the issue of vaccine overload is one such (possible) effect. Unfortunately, though, I couldn't find any references using the two phrases together. Sebastian Garth (talk) 18:43, 12 November 2009 (UTC)

If there is no reference tying the concepts of pharmacokinetics and "vaccine overload" together, therefore, any objections you raise on those grounds are original research. I am confused as to why we are proceeding with discussing changes when the original objection does not appear to have merit.Yobol (talk) 20:36, 12 November 2009 (UTC)

Very well. I will agree not to raise any more objections based on those grounds, as a concession that there is no technical linkage. Sebastian Garth (talk) 22:22, 12 November 2009 (UTC)

As to the Gerber/Offit article. I've suggested that we could quote directly from that. What are your views on that? Sunray (talk) 17:54, 12 November 2009 (UTC)

A direct quote would be fine, yes. Even a simple attribution such as "research has shown", or something to that effect would be sufficient, I think. Sebastian Garth (talk) 18:43, 12 November 2009 (UTC)

In light of the discussion in the next section, would you be able to suggest an acceptable wording? Sunray (talk) 19:29, 12 November 2009 (UTC)

Sure. As a direct quote, perhaps:

• In an article published in the Clinical Infectious Diseases journal, Jeffrey S. Gerber and Paul A. Offit state that "the notion that children might be receiving too many vaccines too soon and that these vaccines either overwhelm an immature immune system or generate a pathologic, autism-inducing autoimmune response is flawed for several reasons".

Or as an indirect quote (and somewhat paraphrased), maybe:

• Research has shown, however, that the notion of vaccine overload is flawed for several reasons.

Sebastian Garth (talk) 20:14, 12 November 2009 (UTC)

What do other participants think of these alternatives proposed by Sebastian? Sunray (talk) 20:21, 12 November 2009 (UTC)

These "alternatives" were among the very first suggested and reverted. Again, the question from my standpoint is that there is no need to water down a fact-based statement that it is flawed with clauses like "research has shown", etc. as documented in my opening statement. In fact, watering down would probably be more a violation of WP:NPOV given the lack of any contention in the scientific community on the subject. The lack of any references to support his contentions has certainly not changed my mind. Yobol (talk) 20:40, 12 November 2009 (UTC)

We are here because the wording was objected to. Bearing in mind that consensus is WP's fundamental model for editorial decision-making, we need to agree on the best alternative wording. I gather from what you have said, that you think that a direct quote would be preferable to stating something like "research has shown." Sunray (talk) 21:05, 12 November 2009 (UTC)

It would seem to me that mere objection is not sufficient to obligate a change wording. For instance, if I were to "object" to the article on AIDS to not directly describe HIV as the cause of AIDS, but to water down that statement, would they be obligated to for the mere reason I objected to it? Or would they come to a community consensus based on available arguments and what the reliable, verifiable resources have said? In fact I think both the direct quote and the additional watering down phrases such as "research has shown" are far inferior to the current wording. Yobol (talk) 21:17, 12 November 2009 (UTC)

I will be the first to agree with you that objection alone does not warrant a change in wording. But the contention here was raised for a valid reason, to wit, that the article supporting the statement did not establish fact. The theory of vaccine overload is not supported by any evidence. This is a fact. The theory of vaccine overload is flawed. That is an opinion. The distinction is important. Sebastian Garth (talk) 22:22, 12 November 2009 (UTC)

The cited sources say one thing. You say they are wrong. You have not provided any references to back up your claim. Maybe I'm missing something here, but if all the provided references support one position and no references support another, it seems to me that it is fairly obvious which position is the correct one to be expressed here on Wikipedia. Yobol (talk) 22:26, 12 November 2009 (UTC)

I never said that it was wrong, but that it was an opinion. From the reasons that Gerber and Offit gave to explain why the theory of vaccine overload is flawed, specifically what facts were presented to support their claim? Sebastian Garth (talk) 22:37, 12 November 2009 (UTC)

Per WP:ASF we should treat any assertion as a fact and report it as such if there is "no serious dispute". As you have provided no reference that shows a serious dispute with what Gerber and Offit have said in the scientific community, we should treat it as a fact, per WP:NPOV, a Wikipedia policy. Yobol (talk) 22:45, 12 November 2009 (UTC)

Or rather, "Assert facts, including facts about opinions—but do not assert the opinions themselves", and "By value or opinion [...] we mean 'a matter which is subject to dispute'". Moreover, it becomes fact (indisputable) only after it has been proven. Sebastian Garth (talk) 23:20, 12 November 2009 (UTC)

There is no dispute in the medical literature. You have provided no evidence of a dispute. Therefore we should assert it as a fact, as the guideline says. There is no indication in the policy about asserting a fact only after it is "proven". Please stop making up your own rules and terminology.Yobol (talk) 02:43, 13 November 2009 (UTC)

My understanding of the objection

My understanding of the objection is that it is one team of researchers who have used the wording: "The idea is flawed, for several reasons..." The questions this raises, IMO are: While the statement may reflect the literature on the subject, how can we (WP) say so unless we are quoting a source? How can we be clear that it is not Wikipedia, but rather Gerber and Offit who are making this statement? Sunray (talk) 22:40, 12 November 2009 (UTC)

We can say so because there is no evidence to the contrary. Wikipedia reports what sources say. That is why we have inline citations. Yobol (talk) 22:45, 12 November 2009 (UTC)

How do we know there is no evidence to the contrary? Sunray (talk) 22:51, 12 November 2009 (UTC)

Unless I've missed something, none has been presented. Yobol (talk) 22:54, 12 November 2009 (UTC)

On the other hand, is there general agreement in the literature that the notion is flawed? I haven't seen that, yet either. Sunray (talk) 23:18, 12 November 2009 (UTC)

You mean besides the review article by Gerber and Offit that has been quoted several times now? Every citation in the Vaccine controversy article in that section supports Gerber and Offit in that there is no evidence for the concept of "vaccine overload". Yobol (talk) 02:43, 13 November 2009 (UTC)

There is general agreement among reliable sources that the notion is flawed, or unfounded, or has serious problems, or however one wants to put it. This was discussed, in some detail, in Talk:Vaccine controversy #RFC: NPOV wording. Example sources mentioned there include Gregson & Edelman 2003 (PMID 14753385), Bonhoeffer & Heininger 2007 (PMID 17471032), and Schneeweiss et al. 2008 (PMID 19471677). Other sources that say or assume that vaccine overload has serious problems include Tickner et al. 2006 (PMID 16890330), Leask et al. 2008 (PMID 18578819), Heininger 2006 (PMID 16784799), Hilton et al. 2006 (PMID 16581162), and Bedford & Lansley 2007 (PMID 17920170). These sources all agree that there's no evidence for the "vaccine overload" notion: they use phrases like "unfounded concerns" and "misperceptions" to describe the vaccine-overload and similar notions. There is strong consensus among reliable sources that the vaccine-overload notion is flawed. No reliable sources to the contrary have been presented, and it's exceedingly unlikely that any such sources exist. Eubulides (talk) 03:01, 13 November 2009 (UTC)

We seem to be talking about different things. Even a cursory review of the literature indicates that there is no evidence to support the vaccine overload theory. I hadn't thought that was in contention here. Am I wrong about that?

What I was speaking about was the line in the article that says: "The idea is flawed, for several reasons." So far I've only seen one source that says this. If there are others, would you be able to list them and quote the wording they use, please? Sunray (talk) 03:55, 13 November 2009 (UTC)

Are you asking if another source uses the exact phrase "is flawed"? How much more flawed can a scientific concept be then one that has no evidence supporting it?Yobol (talk) 04:16, 13 November 2009 (UTC)

Perhaps, then, we should use wording such as "is not supported by evidence", or similar? It doesn't match the source as precisely, but at least it could be stated as fact. Sebastian Garth (talk) 04:30, 13 November 2009 (UTC)

• The article already says "no scientific evidence supports this idea". Suggesting that we reword "is flawed" to "is not supported" is tantamount to suggesting that we remove "is flawed".
• The sources I gave do not merely say that there's no evidence. They say that the idea is a "misperception" (Heininger 2006, PMID 16784799), that it's an "unfounded concern" (Leask et al. 2008, PMID 18578819), and that it "is flawed" (Gerber & Offit 2009, PMID 19128068). The depth of the mainstream scientific and medical objection to the vaccine-overload notion would not be accurately summarized merely by stating there's no evidence.
• Here's another source: Smith MJ (2009). "Vaccines and vaccine safety". In Shah S (ed.). Infectious Diseases. New York: McGraw-Hill Medical. pp. 36–42. ISBN 007148924X. This lists vaccine overload as a myth (specifically, it says on page 37 "We then review the biologic and epidemiologic data surrounding popular myths about vaccines.") and goes on to say why, in a section called "Too many shots" on page 40. This section's contents are too long to reproduce here, for copyright reasons, but it lists several problems with the vaccine overload theory: Most childhood infections are not prevented by vaccines, and vaccines therefore present only a small part of the antigenic burden. The total exposure to antigens in vaccines is significantly less now than it was for most of the 20th century. Not only is there no evidence that vaccinations weaken the immune system, there is some evidence that they actually strengthen it. Several studies have investigated whether giving multiple vaccinations alters vaccine immunogenicity, and they've found that it does not.
• Any fair summary of the body of mainstream sources cannot say merely that there's no evidence for vaccine overload. To be fair, the summary has to reflect the consensus conclusion that the notion is flawed, or that it's a misperception, or that it's unfounded, or that it's a myth (these are all words taken from the above sources), or something like that.

Eubulides (talk) 07:47, 13 November 2009 (UTC)

Can you propose a formulation using the word "unfounded" that would fit well within the context of that section? Sebastian Garth (talk) 08:46, 13 November 2009 (UTC)

No, wait! Here's another quote from a reliable source: "'The idea of vaccine overload damaging our immune defences is rubbish,' said Professor David Goldblatt, director of clinical research and development at Great Ormond Street Children's Hospital, London. 'It is a myth, and those who spread it are doing immense harm.'"[4] But anyway, "unfounded" is a bit too mild (it's just "scientifically unsupported" rephrased) but it would work when combined with some other word. "Unfounded myth", perhaps? ("Unfounded rubbish" may go a bit too far...). So, we could replace "The idea is flawed, for several reasons." with "There are several objections to this popular but unfounded myth." Eubulides (talk) 09:05, 13 November 2009 (UTC)

Although I think "is flawed" is a simpler and therefore from a prose perspective a better phrasing, I think "unfounded myth" conveys the necessary established consensus on the subject and would not object to its use.Yobol (talk) 19:53, 13 November 2009 (UTC)

Thanks Eubulides for thoroughly documenting the views of the medical community. Our task is to determine how best to treat this. The controversy is not an insignificant matter. A google search for "vaccine overload" nets about 5,800 hits. Here's an article on the subject: [5] Note that Goldblatt's comments are placed in quotes and he is named in the text. I'm not saying that we should reference Golbblatt (agree with Yobol that "is flawed" seems fine), only noting that comments of this nature are probably best dealt with as actual quotes to be encyclopedic. As has been observed, this is not solely a medical dispute. It is also a health policy matter. We should probably reflect that as well. Sunray (talk) 20:28, 13 November 2009 (UTC)

If I may, why would using "actual quotes" be superior in this situation? In the course of being encyclopedic, we make statements of facts in articles all the time with a minimum of direct quotes; instead, we reference information and facts with inline citations. Why would quotations be superior in this situation over a simple statement with inline citation? Yobol (talk) 04:04, 14 November 2009 (UTC)

I think we should be careful, though, not to state medical opinions, however ubiquitous, as fact. If we can find some references to substantiate the claim that vaccine overload is a myth, flawed, or problematic, then I really wouldn't have any problem with stating it as such, but as of yet none of the arguments that I've seen have been able to dismantle the theory in a scientific way. This is the inherent problem with "positive" refutation: it forces one to disprove the specific points of a theory. On the other hand, "negative" refutation (eg: "this theory is baseless") places the burden of proof on the proponents of the theory in question. The latter is much easier state in response to "what if" scenarios (such as vaccine overload), and is vastly more difficult to attack than the former. So, using that form, we could say that the vaccine overload theory is "completely unfounded", "without a single merit", "totally baseless", "lacking any evidence whatsoever", etc, which would be well supported by the facts, obviously. Sebastian Garth (talk) 07:15, 14 November 2009 (UTC)

Please see #Medical opinions below. Eubulides (talk) 09:15, 14 November 2009 (UTC)

Medical opinions

• "I think we should be careful, though, not to state medical opinions, however ubiquitous, as fact." The problem with this argument is, where does it end? Does it mean that we need to reword AIDS so that it no longer says that sex with a virgin does not cure AIDS? Instead, we must reword the article to say merely that there's no scientific evidence that having sex with a virgin cures AIDS, or to say that Professor So-and-So says that having sex with a virgin does not cure AIDS? Surely not. And if not, then what's the difference between how Wikipedia should treat the popular myth that having sex with a virgin cures AIDS vs. the popular myth of vaccine overload?

Well, that specific example could be easily refuted, actually. But in any case, yes, I would say that all material stated as fact on Wikipedia should be verifiable. I realize that this is difficult to do in the face of all the theories out there that do so much disservice to public health, but nonetheless this is an encyclopedia, not a medical journal. As per WP:ASF we should stick to the facts (and state opinions as opinions). That said, I just want to reiterate that a statement such as "Research has shown that the notion of vaccine overload is flawed for several reasons" does just that, by attribution, without introducing a single iota of doubt. In one fell swoop we have clearly stated the general consensus, emphasized that the matter has been seriously considered, and even communicated an important health service message - all while adhering to the highest standard of NPOV. Sebastian Garth (talk) 11:29, 14 November 2009 (UTC)

Stating something as a fact is just that. Saying "research has shown" is attributing an opinion, and implies doubt or dispute that is not there. Adhering to WP:NPOV to the best degree would require us to state it as a fact. Yobol (talk) 17:01, 14 November 2009 (UTC)

• "that specific example could be easily refuted, actually" No, actually, it can't be refuted so easily, and AIDS does not cite any source that refutes it. The claim is not that sex with a virgin always cures AIDS; it's that it sometimes helps cure it, or prevent it. There is no scientific study directly on the topic. Does this mean that AIDS needs to be rewritten? And if not, what's the difference between how Wikipedia should cover that AIDS myth and this vaccine myth?

Sure it can. Blood transfusions, mosquito bites, and other forms of fluid exchange, to begin with. That's certainly verifiable, isn't it? Sebastian Garth (talk) 22:55, 14 November 2009 (UTC)

Sorry, but the previous comment seems to have nothing to do with the earlier ones. Whether AIDS can be caused by blood transfusions has nothing to do with the popular myth that having sex with virgins can sometimes cure AIDS. It appears that we cannot find any substantial difference between how Wikipedia articles should treat these two popular myths (vaccine overload, and sex-with-virgins-helps-cure-AIDS). Eubulides (talk) 06:51, 15 November 2009 (UTC)

• "we should stick to the facts (and state opinions as opinions)" Medical articles can and should state the consensus conclusions of mainstream medical sources without in-text attribution. There is no need for the AIDS article to provide in-text attribution for the claim that having sex with virgins does not cure AIDS; there is no dispute among reliable sources about this claim. The same thing holds for countless other consensus medical conclusions in Wikipedia.

And if the general consensus is that "the virgin AIDS cure theory is rubbish", should we then state this as a fact, too? According to WP:ASF, an opinion is a matter that is subject to dispute. Consider that in the past twenty years over thirteen thousand claims have been filed alleging vaccine injury, and almost two billion dollars have been paid out in restitution. That's possible grounds for dispute, don't you think? So until we can produce reliable sources that actually provide evidence that the theory is flawed, we should treat it as an opinion. That said, stating it as such does not necessarily diminish it's impact. Many facts are stated with direct/indirect attribution, as quotes, etc, and yet they are generally accepted without question. I don't see why this would be an exception. The purpose, of course, is simply to ensure that it can't be construed as a POV opinion. I think we've lost sight of that here. Sebastian Garth (talk) 22:55, 14 November 2009 (UTC)

By this logic, every sentence in the article on Evolution needs to be attributed as there is "dispute" by creationists as to the validity of the article. Likewise, we aren't able to say definitively HIV causes AIDS in our AIDS article because there is a "dispute" by HIV denialists about this fact as well. No, there is no dispute in the medical community about this subject. If we allow every controversy article lead to mass attributions and watering down, we would never be encyclopedic in our content. Yobol (talk) 01:08, 15 November 2009 (UTC)

There are real vaccine injuries, and there is restitution for them. But those large sums in restitution have not been paid because of vaccine overload; they have been paid for other reasons. That restitution provides zero basis for disputing what reliable sources say about vaccine overload. Eubulides (talk) 06:51, 15 November 2009 (UTC)

I think this point bears repeating; just because something is related to vaccines in general (in this case vaccine injury cases), it does not necessarily mean that it relates to vaccine overload in particular (and often will not). Please avoid conflating unrelated vaccine topics (such as vaccine injury and "pharmacokinetics") with this issue of vaccine overload as you have done twice now. Yobol (talk) 16:45, 15 November 2009 (UTC)

• I agree with Yobol that "research has shown" is inappropriate here. It's the sort of wording one would find in a promotional website, and is inappropriate for an encyclopedia. Also, it's not supported by a reliable source.

Eubulides (talk) 21:33, 14 November 2009 (UTC)

I really don't see how it isn't "supported by a reliable source". Isn't it verifiable? And isn't that what the source that we are referencing is doing - researching? Maybe I'm missing something, though. Can you elaborate on that a bit more, please? Sebastian Garth (talk) 22:55, 14 November 2009 (UTC)

As far as I know we have no reliable source saying "research has shown". We do have a reliable source saying that the notion is flawed, and yes, that source did some research; but reliable sources are allowed to do original research, so that's OK. Eubulides (talk) 06:51, 15 November 2009 (UTC)

• "none of the arguments that I've seen have been able to dismantle the theory in a scientific way" The text does not say that the theory has been dismantled in a scientific way. It says only that the theory has flaws, and that there's no scientific evidence for it.

But by saying "has flaws" necessarily means that there is a body of evidence that directly disproves the theory, in a point-wise fashion. The problem with the Gerber and Offit examples is that they only support the anti-overload position, rather than destabilize the opposition. Sebastian Garth (talk) 11:29, 14 November 2009 (UTC)

I have no idea what "destabilizing" a position means. The Gerber and Offit article pointed out flaws in the concept. That you do not want to recognize it and want to justify using your own opinion over those of the recognized experts and WP:RS on the topic seems to be supporting WP:OR. Yobol (talk) 17:01, 14 November 2009 (UTC)

• "without a single merit", "totally baseless", "lacking any evidence whatsoever" These terms sound far more agitated and go much farther in advancing a position than does the the relatively calm and neutral "has flaws". Before using terms like those, surely we'd need a reliable source that uses similar wording.

Eubulides (talk) 09:15, 14 November 2009 (UTC)

Okay, well those may not have been the best examples, but I was really just demonstrating different formulations that would qualify as "negative" refutations. Point is, they are fact-based statements that could stand alone, and at least meet the required level of neutrality. Perhaps: "The notion that the immune system is susceptible to vaccine overload has never been substantiated and research has even shown that multiple vaccinations may actually strengthen the immune system.". We could still associate it with the Gerber-Offit reference (though it would need an additional citation, obviously), but of course the next sentence would need to be reworded (ie: "For example [...]" -> ???). Sebastian Garth (talk) 11:29, 14 November 2009 (UTC)

"...is flawed" is simple, straight-forward. Adding extra wording when it can be simply stated seems un-encyclopedic and unnecessary, nevermind the fact that adding "has never been substantiated" does not accurately describe what the sources say. The sources go further to describe it as "flawed" or a "myth". Any wording must take that into account to be WP:NPOV. Yobol (talk) 17:01, 14 November 2009 (UTC)

Section Break

Unfortunately none of the suggested wordings are directly supported by reliable sources. No reliable source says, for example, that "researchers have noted several flaws", or "some have pointed out that", or "studies have even pointed out why". These are our editorial interpretations of the sources, and Wikipedia articles aren't supposed to do that. Unfortunately the suggested wordings also cast mild doubts on what the reliable sources are saying, by attributing them in text, something that is not normally done for mainstream-consensus conclusions. Is there some other way to address the perceived problem of neutrality in the current article, without requiring in-text attribution? Eubulides (talk) 00:45, 11 November 2009 (UTC)

Yes, anything that deviates from the actual text of the studies could be open to interpretation. Would someone be able to suggest a way forward? Sunray (talk) 07:07, 11 November 2009 (UTC)

Alternatives

So far participants have not come to agreement on the appropriate wording for the disputed phrase. It seems to me that the various concerns expressed above have merit. Thus, I would like to consider alternatives that meet the concerns. One way to way to approach this that has often been useful in past mediations is to have participants work together on finding a solution. Would each of you be willing to do that? If so, would someone be willing to get us started? Sunray (talk) 20:31, 13 November 2009 (UTC)

I thought that's what we are already doing in the previous sections, that is, trying to come up with mutually acceptable wording. What would be the difference between what we're already trying to do, and what's being proposed for this section? Eubulides (talk) 09:18, 14 November 2009 (UTC)

OK, I will let you folks work that out then. I do find, however, that participants seem stuck in their own positional views. I think we will probably need to find a way to break out of that. Let me know when you are ready to work on that. Sunray (talk) 21:12, 14 November 2009 (UTC)

We can't even agree what it means to be a fact according to WP:ASF or what "in dispute" means. This is going in circles (the same circles that it was going in the talk page). When people are quoting guidelines and then coming up with their own original definition of what a "fact" is [6], it isn't hard to see why no progress is being made. Yobol (talk) 01:05, 15 November 2009 (UTC)

So far, you have continued your talk page discussions. That is not to be confused with mediation. I was hopeful, in the beginning, that you three were willing to mediate. I retain that hope. However, things have veered back to more of the same. To succeed at mediation we will need to start afresh. Let me know if/when you are willing to do that. Sunray (talk) 20:16, 15 November 2009 (UTC)

I'm a little confused by this statement. If you do not think the above is where we should be, I would think you would tell us what and where you think this is going to go. What does the fresh start mean? Where did we go wrong above? Without more guidance, how are we to know where you, as the mediator, want us to go? Yobol (talk) 20:33, 15 November 2009 (UTC)

You said: "This is going in circles (the same circles that it was going in the talk page)." I am agreeing with that statement. But it does not work for me to "tell you" anything, unless all three of you want my opinion. (I've experimented with venturing an opinion already, which was roundly dismissed). I don't think you are going wrong. It's just that so far there is no mediation happening. My suggestion at the top of this section is that we begin working together - the three of you, with me as facilitator. I cannot predict where that will lead us, only that it has worked in the past. If I get the positive signal that you are all ready to do that, I will give you my summary of where I think it's at and what we might begin to do. Sunray (talk) 20:58, 15 November 2009 (UTC)

"My suggestion at the top of this section is that we begin working together - the three of you, with me as facilitator." I guess I was under the mistaken impression that was what we were doing. Yobol (talk) 00:48, 16 November 2009 (UTC)

To be clear: My view is that what has happened is that the talk page discussions have simply continued here. Yobol has said that participants seem to be going in circles. I'm saying that I believe that this is the case because participants are not yet mediating in good faith. I've suggested that we change gears. That would involve a facilitated conversation between the three of you. My offer stands. I would like to hear a response from each of the participants. Sunray (talk) 19:27, 16 November 2009 (UTC)

I haven't yet given up on mediation, and I'm willing to try a facilitated conversation. Perhaps I'm naive, but I see no evidence of bad faith here. Eubulides (talk) 20:01, 16 November 2009 (UTC)

You are quite right. I did not mean to imply that there was any bad faith. My point is that what has been happening is not to be confused with mediation. Sunray (talk) 03:54, 17 November 2009 (UTC)

I'm willing to try to get this resolved. Yobol (talk) 20:48, 16 November 2009 (UTC)

We haven't heard from Sebastian yet, but here's where I think we are at: Two editors like the statement "the vaccine controversy is flawed." The third has expressed concerns about it. I've said that I think that the concerns should be addressed, rather than simply maintaining that the statement cannot be changed. So I suggest that we now examine the concerns and see what we can agree on. I can go through what has been said and pull out comments that I think should be addressed. Then we could examine them one by one. Would this be acceptable? Sunray (talk) 02:16, 18 November 2009 (UTC)

I think getting to the heart of the objections would be a great idea. Yobol (talk) 02:28, 18 November 2009 (UTC)

Sounds good. Eubulides (talk) 05:53, 18 November 2009 (UTC)

Sebastian hasn't been around for a couple of days. I've left him a message on his talk page. Hopefully he will check in soon. Sunray (talk) 07:28, 19 November 2009 (UTC)

I apologize for the absence. I've been taking a wait-and-see attitude to see if some suggestions develop on the other side, which might be helpful at this point. As far as my own position, I want to stress that I'm willing to work with everyone to reach an agreement on this. There are numerous ways to phrase that section, and I'm not preferential to any one particular formulation. Whatever communicates the idea best without adopting a POV tone would be acceptable to me. I realize that some feel that the current wording is fine, but then again it may well be that this is a borderline case. If so, it would behoove us, I think, to approach the issue with a bit more objectivity. The guiding question should be "What would be in the best interest of Wikipedia?", above all else. Sebastian Garth (talk) 20:31, 19 November 2009 (UTC)

Good, let's resume. Sunray (talk) 23:05, 19 November 2009 (UTC)

New approach

This time, I would like to begin by asking participants to address me in their responses. In turn, I will try to respond to each comment made. That way, hopefully we can break the cycle of argumentation and defence of a particular position. I did not intend to be critical when I introduced this section, only to say that mediation is not easy. There is no "magic bullet" and it is hard to make progress unless participants are willing to be flexible and to learn. It usually involves hard work. The more we can collaborate, the easier it usually is.

My review of the discussions suggests that the summary I gave at the top of the page is still valid. However, we can perhaps put a finer point on it. It seems that the statement: "the notion of vaccine controversy is flawed" is very much the issue we are concerned with at present. So the question then becomes, how does that statement meet, or fail to meet, the requirements of maintaining a neutral point of view? Rather than try to answer that right away, let's break this down into some sub-components:

• We have identified a large number of sources. How many actually say that the notion is flawed?
• What other descriptors appear more than once?
• How could we categorize the various statements?

If someone wanted to actually categorize the various statements in a table, that could be helpful. However, it's fine to just respond in paragraph form as well. Let's take it slow at first. Sunray (talk) 23:05, 19 November 2009 (UTC)

Well, after a search of PubMed, google, and others, I could only find the "flawed" characterization in the Gerber-Offit article. The most prevalant wording was "not supported by evidence" or similar. A report by the Institute of Medicine states specifically:

• "The committee found that evidence favors rejection of a causal relationship between multiple immunizations and increased risk for infections and for type I diabetes. They also found that epidemiological evidence regarding risk for allergic disease, particularly asthma, was inadequate to accept or reject a causal relationship."

Note that the findings were not conclusive. Another study, titled "Immunisation attitudes, knowledge and practices of health professionals in regional NSW" by J. Leask, et al, actually finds:

• "Out of 926 surveys sent, 434 were returned (47%). The great majority of the health professionals (97%) believed that vaccines were safe, effective and necessary. However, in approximately one-third of respondents, there were specific concerns about additives, immune system overload and the number of vaccines. Significantly more health professionals in the North Coast area believed that additives in vaccines may be harmful and that adding more vaccines to the schedule would make immunisation too complex. Among GPs, over half felt uncomfortable about giving more than two injections at the one visit."

So, there is even uncertainty among the practitioners (who are doing the actual administration of the vaccines 'in the field' and thus are able to directly observe the effects). Overall, then, it seems that although there is no direct evidence to support the vaccine overload theory, neither would it be correct to state that the consensus is that it is "flawed", per se. Sebastian Garth (talk) 00:12, 20 November 2009 (UTC)

I'm not sure one can generalize from one or two studies. Also, I had thought that none of us were questioning the premise that the preponderance of evidence pointed to problems with the vaccine overload concept. Was I mistaken about this? Sunray (talk) 08:45, 20 November 2009 (UTC)

No, I do agree that the overwhelming opinion seems to be that it has problems, but just that there is still enough doubt/inconclusiveness to prevent it from being stated as an indisputable fact. On the other hand, there isn't much evidence to support claim that vaccine overload does exist, either, and to lend any credence to it in the article would really constitute WP:UNDUE. In other words, stating that "research has shown", or any other formulation employing some sort of attribution would be fine; Wikipedia doesn't state it as fact, experts do. That was my whole point, really. Sebastian Garth (talk) 11:31, 20 November 2009 (UTC)

Thanks for that clarification. Now I would like to hear responses to the three questions from Eubulides and Yobol. Also, if there are any other matters participants would like to discuss, please list them. Sunray (talk) 15:44, 20 November 2009 (UTC)

Sebastian Garth lists two sources.

• The first, the Institute of Medicine 2002 report, concluded "evidence favors rejection of a causal relationship" for vaccine overload causing infections (which is the usual hypothesis for vaccine overload: it is said to overwhelm and weaken the immune system). The phrase "evidence favors rejection of a causal relationship" is a polite way of saying that the notion is wrong and we have good evidence to prove it. The IoM concluded something less strong about allergies, but allergies are not part of the vaccine overload hypothesis; if anything, the hypotheses about allergies are the opposite of the vaccine overload hypothesis, as they hypothesize that vaccines cause the immune system to become too strong.

Studies don't generally aim to be polite - concise language prevents ambiguity, after all. So no, I really can't agree with that interpretation. Sebastian Garth (talk) 17:40, 23 November 2009 (UTC)

• The second, Leask et al. 2008 (PMID 18578819), makes the fundamental point that vaccine overload is an unfounded concern, and that many health care professionals express concern about it anyway. This does not undercut the conclusion that the concern is unfounded: many misperceptions are common even among health care professionals.

Nonetheless, it proves that the rejection of "vaccine overload" can be seriously/plausibly disputed, so many of those formulations really wouldn't be in accordance with WP:ASF. Sebastian Garth (talk) 17:40, 23 November 2009 (UTC)

To go back to Sunray's questions, here's a brief summary, in table form, of what reliable sources say about the notion of vaccine overload. To save space (and save me work) this table mentions only the sources quoted so far on this page:

"The notion ... is flawed for several reasons"	Gerber & Offit 2009 (PMID 19128068)
"There is no evidence that currently recommended vaccines overload or weaken the infant immune system."	Gregson & Edelman 2003 (PMID 14753385)
"misperception"	Heininger 2006 (PMID 16784799)
"unfounded concern"	Leask et al. 2008 (PMID 18578819)
"It is a myth, and those who spread it are doing immense harm."	David Goldblatt 2006
"evidence favors rejection of a causal relationship"	Institute of Medicine 2002

Eubulides (talk) 09:00, 23 November 2009 (UTC)

Thanks for doing the table. So far, I have difficulty characterizing the various findings, although Gregson and Edelman's statement seems close to summarizing what has been presented thus far. Perhaps other studies could be added to see whether patterns of findings emerge beyond saying "no evidence." Sunray (talk) 13:55, 23 November 2009 (UTC)

I wouldn't have a problem with using the Gregson & Edelman citation without attribution, personally. It seems to be the most prevalent formulation, anyway, so it may well be the best representation of the general consensus. How does everyone else feel about that? Sebastian Garth (talk) 17:40, 23 November 2009 (UTC)

Excuse me for jumping in. I'm not sure if this is allowed. I've been following this discussion for some time and would like to add something. You guys can chuck it out, ignore it or ask me to sign the above groundrules if you want. I think Eubulides admirable tendency to only quote the most reliable sources is limiting our ability to gauge the language used by experts. Here's a list compiled from the first few Google pages I got

Myth 7. Giving a child more than one vaccine at a time can increase the risk of harmful side-effects, which can overload the child’s immune system. Fact. A child’s immune system handles several hundred foreign bodies every day, and can easily handle multiple vaccines administered at the same time. Antibodies are proteins designed to recognize harmful invasions. The antigens/antibodies a child is exposed to through vaccine regimens are a drop in the ocean compared to those a child is exposed to every day or while having a simple cold or sore throat.	WHO/Europe[7]
Won't all these jabs overload my baby's immune system? No. ‘Vaccine overload' is a myth. ‘From birth, a baby comes into contact with thousands of viruses, which the immune system copes with every day. It's estimated that a baby's immune system could tolerate 1,000 vaccines at one time,'	Dr Hicks (Prima Baby expert GP)[8]
Although some people have suggested that giving the three vaccines together might overload a child's immune system, there is no evidence to support this claim.	The Medical Team, NetDoctor.co.uk.[9]
Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean.	Dr Paul Offit, reported by BabyTalk magazine.[10]
Myth: Vaccines can weaken and overload the immune system.	Peel Public Health[11]
Myth: Vaccines are bad for my body and too many vaccines may harm my immune system. Fact: Vaccines are not strong enough to overload the immune systems memory.	Simcoe Muskoka District Health Unit[12]
Following are six misconceptions that appear in literature about vaccination... 6. Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system. Children are exposed to many foreign antigens every day. ... In the face of these normal events, it seems unlikely that the number of separate antigens contained in childhood vaccines . . . would represent an appreciable added burden on the immune system that would be immunosuppressive. ... studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects.	CDC.[13]
Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or "use up" the immune system.	Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S. PMID 11773551
Myth: Giving a child more than one vaccine at a time increases the risk of harmful side effects and can overload the immune system.	Singapore Government Health Promotion Board[14]
some parent "advocacy" groups have expressed concern that this combined vaccine could overload the immune system. This is based on two misconceptions....	Helen Bedford, David Elliman, BMJ Editorial[15]

I could easily go on, for the medical service in every country in the world has vaccine programmes and will have a web page dedicated to countering concerns. From baby magazines and newspapers, through BMJ and Pediatrics editorials, through to CDC and WHO statements we have a clear message from anyone who knows how the immune system works and what vaccines do: that "vaccine overload" is a misconception (a false or mistaken idea or belief: OED), and a myth (a widely held but false belief: OED). This isn't a topic where one must weight the balance of evidence to choose one option over another. Like whether one drug is better than another, or whether to treat something for one month or two. This is an example where one of the options is actually conceptually flawed (a misconception). And the view that is is flawed is widely held to be fact by the medical community worldwide. Colin°^Talk 17:15, 23 November 2009 (UTC)

First of all, you're more than welcome to participate in the discussion, as far as I'm concerned (I can't think of any guidelines that would prohibit it, anyway, but I guess it's up to the mediator, ultimately). I haven't had time to review your entire post, but I'll do that now and respond shortly. Cheers. Sebastian Garth (talk) 17:46, 23 November 2009 (UTC)

Okay, well good references overall, Colin. I think the real question here, though, is whether or not the matter is subject to dispute (see WP:ASF). Consider the results of this study by A.W. Taylor-Robinson at the University of Leeds, for example:

• "This highlights a possible serious drawback of combined pertussis vaccine use and is of considerable concern since pertussis vaccination is known to be an etiologic factor in the development of childhood asthma (3). The incidence of asthma is on the increase and so is the use of multiple vaccination procedures. When pertussis is combined with diphtheria and tetanus (the DTP vaccination given in the UK to 8-week-old babies along with Hib and, in some cases, tuberculosis), the same immune deviation develops, a bias towards Th2 responsiveness. The pertussis vaccine may not be the culprit in the case of asthma, but may be a marker for the effects of multiple vaccination, as it is not usually given in isolation."

Neuorsurgeon Russel L Blaylock, M.D., even goes as far as to assert that, quote:

• "There is considerable scientific evidence indicating that giving this many vaccines at one time poses a substantial risk of neurological injury that may impair these children’s intellectual capacity and behavior on a permanent bases."

So, we really haven't established that the argument against vaccine overload is indisputable, or confirmed that it is a myth, beyond all doubt. That isn't even taking into account the substantial number of reports from parents who contend that their child has suffered adverse reactions to multiple vaccine exposure; while notable, it simply isn't admissable as encyclopedic material, unfortunately. Sebastian Garth (talk) 18:49, 23 November 2009 (UTC)

Thanks to Colin for his contributions. If he thinks that we could benefit from having certain facts, that is fine. However, he is not part of the mediation, and therefore has no status in the discussion. That means that he should not be offering an opinion. So, I would ask him to refrain from doing that, please.

The examples that Colin has given show that the vaccine overload concept has frequently been referred to as a "myth" and also as a "misconception. The statement "no evidence," once more, comes up. Again, our task is to find the best way of categorizing this without resorting to original research. We need to bear in mind that we are not an academic publication with an author, but rather, an encyclopedia. Sunray (talk) 18:19, 23 November 2009 (UTC)

OK. WP:ASF says "By "fact" we mean "a piece of information about which there is no serious dispute." (my emphasis). I think that once Russell Blaylock is held up as an example of a serious challenge to CDC/WHO/NHS/BMJ, it is time for me to unwatch. Colin°^Talk 19:52, 23 November 2009 (UTC)

Colin is now entering the discussion. If that continues, I will have to exclude it. Participants have given the example of WP:ASF before. I believe this has been clarified, but briefly: There is no debate about the facts. The point we are working on right now is how best to characterize those facts. Sunray (talk) 22:05, 23 November 2009 (UTC)

• Colin is correct that Russell Blaylock is not a reliable source; it would be more accurate to call him a WP:FRINGE source. Also, Taylor-Robinson 1999 (PMID 10371102) is not about vaccine overload: it is a primary source about allergy, which as I've already explained is a different topic. So, neither of those sources seriously dispute the mainstream consensus that Colin accurately summarized. It is not our job as Wikipedia editors to establish that a theory is true (or is false) "beyond all doubt"; otherwise, even articles like Evolution would have to be rewritten to include in-text attribution even for routine facts about evolution, because an editor might (accurately) object that such facts have not been established "beyond all doubt". There is no dispute among reliable sources that the vaccine overload theory is flawed/a myth/a misconception/whatever; all that's in dispute here, as I understand it, is how to word this.

I don't see how the Taylor-Robinson study doesn't relate to vaccine overload; It specifically states that multiple vaccinations may induce atopic reactions, even using wording such as "This large antigen loading [...]", "Multiple vaccinations shift this delicate balance [...]", and "An increase in the incidence of childhood atopic diseases may be expected as a result of concurrent vaccination strategies [...]". Sebastian Garth (talk) 18:55, 24 November 2009 (UTC)

The vaccine overload notion says that multiple vaccinations at once "overwhelm or weaken a child's immune system" (quoting the article). The Taylor-Robinson study is about multiple vaccinations, but it is not about vaccine overload, because it doesn't hypothesizes that the multiple vaccinations overwhelm or weaken the immune system. On the contrary, that source hypothesizes that the vaccinations cause an atopic reaction, in which the immune system becomes too strong. (Just as an aside, that source provides weak evidence to support their assertion, but we're starting to stray from the subject of vaccine overload.) Eubulides (talk) 20:27, 24 November 2009 (UTC)

However you wish to put it, the bottom line is that the study found that excessive antigen loads resulting from multiple vaccinations may cause adverse reactions. Sebastian Garth (talk) 21:48, 24 November 2009 (UTC)

Changes to the wording of the article

• Since this discussion began, this section of the article has been expanded by Locke9k, and flaws of the vaccine overload notion are now discussed in considerably more detail. The paragraph now has the following form:

"The idea is flawed, for several reasons. First, .... Second, .... Finally, ...."

with the disputed "is flawed" sentence serving as the topic sentence that binds together the remaining sentences. We cannot simply remove the "is flawed" sentence, as some topic sentence is needed for that paragraph. Would some other topic sentence do? It should accurately summarize the paragraph; and there's no need to use in-text attribution here, since there's no dispute among reliable sources about what's in the paragraph.

Eubulides (talk) 00:14, 24 November 2009 (UTC)

Certainly, if we were writing an academic paper we might well say "the idea is flawed for several reasons..." It would be an opinion based on the facts. How, though, can we state such an opinion in an encyclopedia? Consider the following statement from WP:ASF:

"When we discuss an opinion, we attribute the opinion to someone and discuss the fact that they have this opinion. For instance, rather than asserting that "The Beatles were the greatest band ever", locate a source such as Rolling Stone magazine and say: "Rolling Stone said that the Beatles were the greatest band ever", and include a reference to the issue in which that statement was made."

Many people hold the opinion that the Beatles were the greatest band ever. Yet, because it is not an opinion held by everyone, we cannot make such a statement. In our case, we have shown that the literature gives a variety of descriptions of the vaccine overload concept including that it is "flawed," "a myth," "a misconception," and "rubbish." Do any one of these descriptors sum up the body of opinion on the subject? Moreover, if we were to pick one, would it not be original research? How could we address this? Sunray (talk) 09:00, 24 November 2009 (UTC)

The previous comment would seem to imply that every statement in Wikipedia requires in-text attribution. One reliable source might say "the earth is round"; another "the earth is a ball"; another "the earth is spherical": if we were to pick one of these wordings, would that be original research? Surely not. When there is general agreement among reliable sources, as is the case here, we can summarize that agreement without having to quote one source and its wording. Eubulides (talk) 17:54, 24 November 2009 (UTC)

Somehow, I don't seem to be getting my point across. "Round" and "spherical" are close synonyms. "Flawed" and "myth" are not. The vast majority of people believe that the earth is round. "Flawed" is one of several views of the problem with the vaccine overload concept. Based on the above tables, if we were to pick one word, "myth" would probably be the best, because it is seemingly the most common descriptor and gets at the health policy angle. However, the view that vaccine overload is a myth is not universal (like the earth being round). That is why, I think, we have to pay attention to the policy statement I've quoted above. Would you be able to comment on how we can meet that element of policy so as to ensure a neutral point of view? Sunray (talk) 18:13, 24 November 2009 (UTC)

• Choosing "myth" would be fine. "Myth", "flawed", "misperception", and "rubbish" all convey basically the same idea, which is that the vaccine-overload notion is not only unsupported by the evidence, it is contradicted by the evidence. For example, if you were to call up Gerber & Offit (the authors of the source saying "flawed"), I'm sure they would agree with the word "myth" as well; they'd also agree with the other words. I'm not basing this purely on my guesswork: Offit himself has called the theory a "myth", in the following source Offit PA, Bell LM (2003). Vaccines: What You Should Know (3rd ed.). Wiley. ISBN 0471420042. It says (p. 92) "Below we have listed the most commonly aired stories about vaccines and have tried to separate fact from myth" with vaccine overload being one of the myths.
• Because there's no disagreement among reliable sources, we should not use wording (such as in-text attribution) that implies any such disagreement. Going back to the hypothetical example, "round" and "spherical" are not exact synonyms (for example "round" is less precise, and also applies to two dimensions as well as three), and a contrarian editor of the Earth article could seize on the fact that the words are not exact synonyms, and therefore insist on in-text attribution for the claim that the earth is round, using the same argument that's being used here to insist on in-text attribution for the claim that the vaccine overload notion has flaws.

Eubulides (talk) 20:27, 24 November 2009 (UTC)

[outdent] Eubulides said: "vaccine-overload notion is not only unsupported by the evidence, it is contradicted by the evidence." That sounds to me like a pretty good statement for the article. And then we could add some specific quotes including the "flawed" quote and others. This seems like progress. What do others think? Sunray (talk) 23:18, 24 November 2009 (UTC)

I don't know, "contradicted" almost seems too strongly worded. I don't particularly favor that formulation, personally, but I guess it would be okay. Sebastian Garth (talk) 23:44, 24 November 2009 (UTC)

Fair comment. I don't didn't mean to imply that it is necessarily ideal wording, but rather, that it is going in the right direction, IMO. It seems to better meet the intent of policy. So if others agree, we could tune it up and come up with something that participants agree on that is also an improvement to the article. Sunray (talk) 23:39, 25 November 2009 (UTC)

I proposed this new wording in Talk:Vaccine controversy #Proposed replacement for the sentence about "flawed". There is currently a near-edit-war going on in Vaccine controversy #Vaccine overload, over the same topic, discussed in Talk:Vaccine controversy #No serious dispute, so it's not clear how well this will turn out. Eubulides (talk) 00:41, 29 November 2009 (UTC)

Thanks, I've asked a question on the talk page. Sunray (talk) 05:22, 29 November 2009 (UTC)

Another study

I just wanted to present another study, published by Christopher P. Howson, PhD, et al, that would support the argument that the possibility of vaccine overload has yet to be ruled out as a myth:

• "In August 1991, the Institute of Medicine released a report entitled Adverse Effects of Pertussis and Rubella Vaccines, which examined 18 adverse events in relation to diphtheria-tetanus-pertussis (DTP) vaccine and four adverse events in relation to the currently used rubella vaccine strain, RA 27/3. The committee spent 20 months reviewing a wide range of information sources, including case series and individual case reports, both published and unpublished, epidemiologic studies, studies in animals, and other laboratory studies. The committee found that the evidence indicates a causal relation between DTP vaccine and anaphylaxis and between the pertussis component of DTP vaccine and extended periods of inconsolable crying or screaming. The committee also reported that the evidence indicates a causal relation between the rubella vaccine and acute arthritis in adult women. The committee found the available evidence weaker but still consistent with a causal relation between DTP vaccine and two conditions—acute encephalopathy and hypotonic, hyporesponsive episodes—and between rubella vaccine and chronic arthritis in adult women. Estimated incidence rates of these adverse events following vaccination are provided, where possible. The committee found that the evidence does not indicate a causal relation between the DTP vaccine and infantile spasms, hypsarrhythmia, Reye's syndrome, and sudden infant death syndrome. The committee found insufficient evidence to indicate either the presence or absence of a causal relation between DTP vaccine and chronic neurologic damage, aseptic meningitis, erythema multiforme or other rash, Guillain-Barré syndrome, hemolytic anemia, juvenile diabetes, learning disabilities and attention-deficit disorder, peripheral mononeuropathy, or thrombocytopenia, and between rubella vaccine and radiculoneuritis and other neuropathies or thrombocytopenic purpura. The committee's evaluative methods are briefly described and a summary of research needs is provided."

Obviously, the connection is yet not completely conclusive, and so it seems that something similar to the current wording being used, with attribution, would still be most appropriate, rather than present the matter with a measure of doubt (which would probably qualify as WP:OR, anyway). Sebastian Garth (talk) 17:52, 24 November 2009 (UTC)

The previous comment does not seem to have anything to do with vaccine overload. It is about other adverse reactions to vaccines, such as anaphylaxis, which are well-known. Let's stick to the subject of vaccine overload, please. Eubulides (talk) 17:54, 24 November 2009 (UTC)

Yes, that is how I read it as well. Sunray (talk) 18:18, 24 November 2009 (UTC)

Closing mediation

I propose to close this mediation as unsuccessful. While participants have been willing to discuss the matters at issue, I do not see any willingness to collaborate or compromise on the article talk page. If any of the participants have questions about what I am saying, or wish to try once more, by all means, let me know. Otherwise, I will close the mediation in one week. Sunray (talk) 08:17, 1 December 2009 (UTC)

I agree with closing this mediation. However, the previous comment does not summarize the mediation well. SebastianGarth and I agreed on the wording "vaccine-overload notion is not only unsupported by the evidence, it is contradicted by the evidence", and Yobol did not comment on or disagree with this wording. This reflects a willingness to compromise. It is true that other editors, who are not participants in this mediation, disagree strongly with this compromise wording, which makes it unlikely that the compromise wording will replace the disputed wording in the article. But that does not in any way suggest an unwillingness to collaborate or compromise among the participants here. Eubulides (talk) 08:28, 1 December 2009 (UTC)

You are correct that your proposed change does show a willingness to collaborate on your part. I have modified that in my closing statement. However, it would have been preferable for us to collectively agree on a proposed wording and then decide on a strategy. The way in which it was presented did not contribute to that outcome. I did misread the mood on the talk page. I had considered it as being one in which my own comments and questions might be taken seriously, and that didn't happen. So I share in the responsibility for the outcome there.

It would still be possible to achieve a successful mediation if we were able to agree on a strategy for proposing changes to the article. We would need consensus here first. Then we would take the discussion to the talk page. If there was no agreement there, we could initiate an RfC. As long as all parties would agree to be bound by the result, the mediation would be categorized as successful, IMO. Sunray (talk) 16:52, 1 December 2009 (UTC)